Osteoarthritis

DEFINITION
Osteoarthritis is a joint condition in which degeneration and loss of articular cartilage occur, leading to pain and deformity. Two forms are usually recognized: primary (idiopathic) and secondary. The primary form may be localized or generalized.

PHYSICAL FINDINGS AND CLINICAL PRESENTATION
● Similar symptoms in most forms: stiffness, pain, and crepitus
● Joint tenderness, swelling
● Decreased range of motion, joint contractures
● Crepitus with motion
● Bony hypertrophy
● Pain with range of motion
● Distal interphalangeal (DIP) joint involvement possibly leading to development of nodular swellings called Heberden’s nodes
● Proximal interphalangeal (PIP) joint involvement possibly leading to development of nodular swellings called
Bouchard’s nodes
● Figures 290–3 and 290–4 illustrate common abnormalities of the hands and feet.
CAUSE
Primary osteoarthritis is of unknown cause. Secondary osteoarthritis may result from a number of disorders including trauma, metabolic conditions, and other forms of arthritis.
DIFFERENTIAL DIAGNOSIS
● Bursitis, tendinitis
● Radicular spine pain
● Infl ammatory arthritides
● Infectious arthritis

IMAGING STUDIES
● When the knee is involved with pain, x-rays should always be taken with the patient standing
● X-ray evaluation reveals:
● Joint space narrowing
● Subchondral sclerosis
● New bone formation in the form of osteophytes
TREATMENT
● Rest, restricted use or weight bearing, and moist heat
● Walking aids such as a cane (often helpful for weightbearing joints)
● Suitable footwear
● Gentle range of motion and strengthening exercise
● Local creams and liniments to provide a counterirritant effect
● Education, reassurance
● Mild analgesics for joint pain
● NSAIDs if infl ammation is present
● Occasional local corticosteroid injections
● Viscosupplementation (injection of hyaluronic acid products into the degenerative joint) is of uncertain benefit.
● Nutritional supplements (glucosamine and chondroitin) are unproved.