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Osteoarthritis - Coggle Diagram
Osteoarthritis
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Hand
Pain can radiate distally towards the thumb or proximally to the wrist and distal forearm, and is often exacerbated by pinching actions or strong grip.
Pain can radiate distally towards the thumb or proximally to the wrist and distal forearm, and is often exacerbated by pinching actions or strong grip.
Typically affects the first carpometacarpal (CMC) joint at the base of the thumb, the distal interphalangeal (DIP) joint and the proximal interphalangeal (PIP) joint
The CMC joint may develop a fixed flexion deformity, with hyperextension of the distal joints
In advanced disease, there may be 'squaring' at the joint caused by subluxation (partial dislocation), formation of osteophytes, and remodelling of the bones.
Initially, there may be features of inflammation such as pain, warmth, redness, and swelling of affected DIP and PIP joints.
As disease progresses, there may be ulnar or radial deviation at affected joints.
Associated features may include: Mucoid cysts, Heberden's and Bouchard's nodes.
Knee
Medial tibiofemoral involvement causes anteromedial pain, mainly on walking.
Lateral tibiofemoral involvement causes anterolateral pain, mainly on walking
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Patellofemoral involvement causes anterior knee pain worsened on inclines or stairs, particularly when going down; and progressive aching on prolonged sitting that is relieved by standing.
Typically is bilateral and symmetrical, affecting the medial tibiofemoral, lateral tibiofemoral, or patellofemoral compartments, with pain localized to the affected compartment.
Associated features: giving way, locking (inability to straighten knee), crepitus and tenderness, restricted flexion and extension, small-to-moderate effusions.
Advanced disease: Bony swelling of the femoral condyles and lateral tibial plateau, varus (bow-legged) or valgus (knock-knee) deformity, antalgic gait.
Hip
An antalgic gait — a lurch towards the affected hip with less time spent weight-bearing on that side; the pelvis is held normally.
Advanced disease - A Trendelenburg gait — a lurch towards the affected hip with less time spent weight-bearing on that side and the pelvis tilting down on the unaffected side, caused by wasting and weakness of the gluteal and anterior thigh muscles
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Advanced disease: A fixed flexion external rotation deformity, with compensatory increased lumbar lordosis and pelvic tilt. The lower limb can be significantly shortened.
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Deep pain in the anterior groin on walking or climbing stairs, with possible referred pain to the lateral thigh and buttock, anterior thigh, knee, and ankle.
Management
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Advice on self-management for symptoms relief such as weight loss, exercise, footwear, heat/cold packs, TENS.
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If first line treatment ineffective consider: oral NSAIDs, opioids such as codeine and topical capsaican.
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Assessment
Ask about
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Psychosocial impact: quality of life, effect on mood and relationships, housing and any dependents affected
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Location, onset, duration, progression, pattern and severity of symptoms
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Routine x-ray is usually not required to confirm diagnosis unless there is uncertainty, to exclude alternative condition or sudden deterioration in symptoms
Diagnosis
Clinical features
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No morning joint-related stiffness, or morning stiffness lasting no longer than 30 minutes
Activity related joint pain - typically one/a few joints are affected at any one time, pain develops over months/years
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Osteoarthritis is defined as a disorder of synovial joints which occurs when damage triggers repair processes leading to structural changes within a joint. These repair processes alter the structure of the joint over time, causing typical features of: localised loss of cartilage, remodelling of adjacent bone and the formation of osteophytes and mild synovitis.