Symptoms and signs of osteoarthritis

Symptoms of osteoarthritis AO 
  • Pain of osteoarthritis: is characterized by dull aching  pain poorly localized up till severe pain may awake patient during sleep the pain  increase with activity as with joint movement and using and the pain relieved by rest the pain increase at the end of the day  the pain may occur with minimal motion and even at rest the pain may become sharp due to muscle spasm around the joint the pain worse by exercise
  • Joint stiffness: limited stiffness on awakening in the morning and after a periods of inactivity during the day is common as the joint is limbered up the patient feel better
  • If the patient sits down for any length of time pain may develop after the commencement of activity
  • patients may complains from locking episodes and joint loosen as in loose bodies or meniscal tear
  • Limitation of motion or movement :often involving loss of extension and flexion 
  • In the hip joint :patient usually maintain 90 degree of flexion but lose most abduction and internal and external rotation
  • In the knee joint: most patient develop a flexion contracture usually mild 
  • Loss of dorsiflexion :in the ankle may occur
  • Flexion contractures :in the proximal and distal interphalangeal joints
  • Pain at the base of the thumb :with loss of the gripe strength and range of motion due to affection of the first carpometacarpal joint of the thumb occurs in women more then 50 years
  • Crepitation may be feel or audible
  • Bunion formation :which it is a combination of degenerative joint disease at the first metatarsal phalangeal joint and angulation or varus at the same joint  symptoms include progression of swelling and pain difficulty with shoe wear and walking and inflammation of the brusa of the medial aspect of the joint
Signs of osteoarthritis
Minimal joint effusion may be present
  • Localized tenderness along the area of significant degenerative changes
  • Swelling as palpable osteophytes
  • Crepitation may occur with attempts at range of motion
  • Range of motion is diminished compared with the normal extremity
  • Increased joint effusion is common after slight twisting or giving way episodes
  • Local warmth or erythema are absent or very rare
  • General or systemic signs as fever are absent
  • Muscle wasting and the limb is held in a position of comfort in long standing cases
  • In the hands marginal joint osteophyte give the appearance of nodes around distal intrephalangeal joints (Heberden,s nodes) and proximal interphalangeal joints( Bouchard,s nodes) and carpometacarpal joint of the thumb which appears squared
  • In the knee varus or valgus deformity are common
  • In the hip fixed flexion are common
  • Shortening of the leg in advanced osteoarthritis
  • In the elbow joint there is loss of extension and with stiffness 
Symptoms and signs of secondary osteoarthritis according to the underlying disease
Investigations of osteoarthritis
Complete blood count Erythrocyte sedimentation rate rheumatoid factor serum calcium alkaline phosphatase
and electrophoresis are usually within normal limits
Secondary osteoarthritis
 Laboratory abnormalities may be present as high levels of uric acid in gout or high levels of alkaline phosphatase in paget,s diseae
Synovial fluid analysis in osteoarthritis AO
Non inflammatory the white blood cells are normal or minimal increase viscosity is good uric acid or CPPD crystals are not found glucose is generally normal no bacteria are seen on gram stain
 these differentiated it from septic arthritis or other types
Plain X rays
 Showing these criteria
  • Narrowing or loss of joint space
  • Osteophytes formation
  • Subchondral sclerosis
  • Subarticular bone cysts
  • Heberden,s nodes
  • Bouchard,s nodes
  • Sublaxation of one vertebral on another may occur especially in the lumbar spine and narrowing of foraminal space due to osteophyres formation
  • In the knee any compartment of the knee medial lateral or patellofemoral may be involved as complete collapse of the lateral joint causes the patient to be  knock kneed or in a valgus position  medial compartment causes the patient to be bow legged or in varus position
CT scanning and MRI scanning
  Very good for proper diagnosis and detection any joint abnormalities or soft tissue also  detection any ligaments injury meniscal tears loose bodies osteophytes formation also showing are of degenerative changes subchondral cysts
Isotopes bone scanning
 Using technetium 99 shows increased uptake around osteoarthritic joint
Differential diagnosis
  • Rheumatoid arthritis
  • Gouty arthritis
  • Calcium pyrophosphate arthropathy
  • Osteonecrosis
  • Neuropathic joint related to endocrine disease
  • Loss of joint space and angulation deformity
  • Complete collapse on the inner or outer side of the joint such as knee deformity also occur
  • Subluxation  as in carpometacarpal joint of the thumb and vertebral body
  • Ankylosis or complete bony fusion of a jointsuch as greater toe metatarsophalangeal joint
  • Interarticular loose bodies or joint mice related to subchondral fractures
Treatment of osteoarthritis
Medical and conservative treatment
  • Pain relieved by simple analgesics and non steroid anti inflammatory drugs
  • Loss or reduction of weight  can be effective in reducing the pain
  • Reduction of activity
  • Heat fomentation on the affected joint
  • Reducing of the load from affected joint by using stick or crutches in the hand opposite to joint 
  • Valgus support insoles for footwear thick grips on household utensils , raised lavatory seats and high chairs rails and handles for specific activities such as getting in and out of the bath
  • Encourage the patient to maintain their joint motion and muscular strength if they can not do this on their own they should be transfer to physical therapist
  • Joint splintage to relieve the pain
  • Intra-articular steroid injection especially in acute painful joint but this give temporary relieve of the pain also good for associated soft tissue problems  such as chronic medial collateral ligament pain in the knee joint or trochanteric brusitis in hip joint  but steroid injection should be do not given more than three times per year
  • Intra-articular injection of synthetic hyaluronate acts as nutritional supplementation to acts like synovial fluid may be used
Surgical treatment of osteoarthritis
To realign to excise to fuse or to replace the joint  and to relive the pain and restore normal joint function and this depend on the age of the patient either young or old age and the occupation and general condition of the patient by
  • Joint orthrodesis means joint is fused usually indicated for severe pain not respond to medical treatment and usually used in young patient
  • Joint arthroplasty or to remove of the diseased joint which can be excised eg Keller,s procedure of the big teo Girdlestone,s procedure of the hip joint or excision and replacement  eg total hip replacement or total knee replacement joint
  • Osteotomy to realignment to alter joint biomechancis
  • Arthroscopic decompression  such as in shoulder joint osteoarthritis particularly associated with rotator cuff dysfunction causing impingement syndrome
New and experimental treatment
  • Soft tissue grafts: periosteal or perichondral grafts are sewn over the defect eg a small piece of rib perichondrium is transported into a metacarpophalangeal joint
  • Chondrocyte transportation: which articular cartilage is harvested from the knee by arthroscopy the chondrocytes are cultured and the placed in the defect a periosteal flap is then sutured over the defect with the cells present medial femoral condyle defects are being treated  by this way
  • Mosaic grafts :is an autograft osteochondral plugs are taken from the peripheral area of the anteromedial or anterolateral femoral condyle , corresponding holes are drilled to match the size and depth of the plug on the chondral defect  which are then inserted into the defect differing plug size create a mosaic look
  • Artificial matrix: such as carbon fiber collagen bone matrix and polyacetic acid are used to try to achieve a matrix upon which cartilage can grow
  • Fresh osteochondral grafts
 For more details about definition causes and pathology of osteoarthritis see here

0 comment:

Post a Comment