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Osteoarthritis: disorder of synovial joints, which occurs when damage…
Osteoarthritis: disorder of synovial joints, which occurs when damage triggers repair processes leading to structural changes within a joint.
Diagnosis
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activity related joint pain, developing over months/years
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Risk Factors
Genetic- FHx hip, hand and knee
Biological -increasing age, female sex with hip OA, obesity, high bone density, low bone density
Biomechanical- joint injury or damage, joint laxity and reduced muscle strength, exercise stresses, occupational stresses
Complications
Joint deformity — due to bony nodules on the dorsum of the finger next to the DIP and PIP joints (Heberden's and Bouchard's nodes, respectively). As disease progresses, there may be ulnar or radial deviation at affected joints.
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Hand involvement may affect grip and pinch strength, causing difficulty with activities such as opening jars, turning keys or door handles, lifting saucepans, fastening buttons, and writing.
Knee and hip involvement may cause difficulty walking, climbing stairs, dressing, driving, or make sex painful.
Psychosocial impact — may affect self-confidence, self-esteem, sleep quality, relationships and ability to self-care and care for others; may cause anxiety and depression.
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Chronic pain syndrome — may worsen existing chronic pain or trigger chronic pain due to persistent activation of neural pain pathways.
Differentials
General:Inflammatory arthropathy, Septic joint, Fracture of the bone adjacent to the joint, Malignancy including bony metastases
Hand OA- OA of the wrist, Scapholunate ligament injury, Ganglion, De Quervain's tenosynovitis,Trigger thumb
Knee OA-Patellofemoral pain, Anserine bursitis, Greater trochanteric pain syndrome Iliotibial band syndrome, meniscal tear, anterior cruciate ligament tear
Hip OA- Greater trochanteric pain syndrome, Meralgia paraesthetica, Sciatica, Spinal stenosis, Osteonecrosis of the hip, Iliotibial band syndrome
Assessment
Hx of symptoms, affect on QOL, FHx, risk factors, assess anxiety/depression
Physical examination- joint tenderness, crepitus, bony swelling, excess fluid, restricted movement, joint instability, weakness or thinning of muscles supporting bone
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Management
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alternative therapies- acupuncture, aromatherapy
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