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OSTEOARTHRITIS (OA) Rogelio A Balagat MD ASMPH
Assignment: Age Weight & height (BMI) Joint pain (VAS) Joint deformity
Definition of OA Joint failure failure of protective mechanisms cartilage loss subchondral bone changes osteophytes capsule stretching mild synovitis periarticular muscle weakness
-OA +OA WEIGHT-BEARING FAILURE OF PROTECTIVE MECHANISMS JOINT INJURYJOINT REPAIR -OA +OA
Cartilage Avascular Aneural Load-bearing Low frictionMain joint protector Cartilage Avascular Aneural Load-bearing Low friction
Joint protectors Joint fluid lubrication Muscle-skin sensory afferentnerve mechanoreceptors Muscle-tendon co-contraction Subchondral bone shock-absorption
CATABOLISM SYNTHESIS CHONDROCYTE
↑AGE ↑WEIGHT PREVIOUS DAMAGE
accumulated microtrauma lower limb malalignment genetic factorsPRIMARY OA aging bone & cartilage mechanical factors accumulated microtrauma lower limb malalignment genetic factors
congenital, genetic, developmental disorders SECONDARY OA mechanical joint incongruity congenital, genetic, developmental disorders prior joint trauma/surgery prior inflammatory joint disease bleeding dyscrasia neuropathic joint disease excessive intra-articular steroid injections endocrinopathies & metabolic disorders acromegaly Cushing’s disease gout/pseudogout
Chronic >40, F>M, ↑weight Non-inflammatory DIP, CMC1, Knee, Hip Use-related pain onset of movement after activity improved with rest
KNEE OA HAND OA Bouchard’s nodes (PIP) Heberden’s nodes (DIP)“squared-off” base of thumb malalignment swelling crepitus
HIP OA pain in groin or inner thighantalgic gait, limited/loss of flexion, extension, rotation predisposing conditions congenital hip dysplasia, avascular necrosis
SPINE OA disc/vertebral bodies (spondylosis) paraspinal pain, spasmapophyseal joints, disc/vertebral bodies (spondylosis) paraspinal pain, spasm radicular symptoms cervical neck pain, radiates to shoulder, upper back, distal arm weakness, paresthesias of hand, arm
SPINE OA lumbar low back pain, radiates to buttocks, legs, feetcauda equina syndrome neurogenic claudication cord compression- leg weakness; gait, balance problems mechanical compression of vital structures- dysphagia, cough, headache, vertigo
Radiography Bone formation (-) bone erosion
DIFFERENTIAL DIAGNOSISRheumatoid Arthritis Monoarticular Polyarticular Spondyloarthropathies Psoriatic arthritis Reactive arthritis Inflammatory bowel disease Ankylosing spondylitis
DIFFERENTIAL DIAGNOSISCrystal-induced arthritis Gout Other disorders infectious arthritis periarticular tendenitis or bursitis Rare neoplastic synovitis pigmented villonodular synovitis neoplastic metastasis to juxta-articular bone
Management PHARMACOLOGIC NON PHARMACOLOGIC ADJUNCTS toConsidered as ADJUNCTS to Non-pharmacologic Management Considered as the CORNERSTONE in the Management of OA SURGICAL INTERVENTION
PHARMACOLOGIC NON PHARMACOLOGIC Psychosocial InterventionsTopical Agents Patient Education Intra-articular Agents Psychosocial Measures Oral (Systemic) Agents Physical Modalities Symptom Modifiers Thermal Modalities Potential Disease Modifiers Exercise Supportive Devices Modifications in ADL
Lower Limb Problems Orthopaedic Medicine.
Upper Limb Orthopaedic Medicine.
In the name of GOD.
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