It caracteizează by damaging cartilage accompanied by increased activity of subchondral bone. The disease belongs to a group of degenerative rheumatism.
Osteoarthritis is not a known cause. The etiology is multifactorial: age, genetic predisposition, stress, mechanical, biochemical changes of cartilage, joint inflammation
It initially produces a “lint” superficial and fine cracking of the cartilage. Along the crack is widening and cartilage volume decreases. It’s possible to break the cartilage in the joint cavity detachment of small fragments called “articular mice.”
You can highlight areas highlighting the lack of cartilage subchondral bone microfracture showing. Osteofitici spurs can form at the edge of the articular surface, subchondral bone thickening and sclerosis and the occurrence of bone cysts juxtaarticulare.
All changes lead to joint space narrowing, deformities and subluxations.
Joint pain occurs after exercise and rest can alleviate the joint. With the progression of the disease may occur at rest. Cold and wet weather can worsen the pain. The emergence of the inflammation causes pain synovitis.
Joint stiffness occurs after prolonged rest and usually disappears after 10-15 minutes of joint mobilization.
Active and passive movements may be limited due to stiffness or soft tissue fibrosis.
Physical examination may find a joint enlarged due to synovitis or proliferative changes in bone and cartilage. Palpation of the joint during movement highlights crackles. The moments can be seen evolving advanced deformities and subluxations.
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– Joint space narrowing due to cartilage damage
– Subchondral osteosclerosis
– Subchondral bone cysts
– Marginal osteophytosis
– Osteoporosis epiphyseal
If secondary arthrosis require specific explorations (endocrine,
Degenerative changes are summarized under the generic name of spondylosis or spondilartroză. Can I interest disco-vertebral joints and / or joints. The most common locations are in the C5, T8, L3.
Disco-vertebral arthrosis begins by initial damage inter-vertebral disc, more precisely by damaging its nucleus pulposus and then ring or fibrocartilaginos. There may be bone spurs that develop especially on the front of the vertebral body. Their appearance in the posterolateral position can damage nerve roots, causing a painful symptomatology root.
Sometimes the nucleus pulposus of intervertebral disc break fibrocartilaginos ring damaged by abnormal pressures exerted on him and herniates. When the process is to produce lateral holes conjugation affected nerve roots, and when rupture occurs posteriorly to install median cord compression syndrome.
Effect facet joints result in slight previous vertebral slip (spondylolisthesis).
Clinical symptoms may be absent long. When there is dominated by pain. Radicular pain can be caused by compression of the nerve root or the side bulging intervertebral disc nucleus pulposus or through holes formed in the conjugation spurs. Impairment of any roots nerve can express through pain, paraesthesia, anesthesia in area dermatomatomului properly by altering tendon reflexes or motor disorders.
If are interested in locating more frequent cervical vertebrae C5-C6. Facet joint osteoarthritis affects interlining C2-C3 and C3-C4. The common clinical signs can sometimes add occipital headache, dizziness, vertigo, visual disturbances rarely.
Dorsal spine impairment may be caused by senescence or may be secondary to changes of vertebral statics and Scheuermann’s disease in young people suffering the growing area suffering vertebral plateaus small osteochondral necrosis that can induce changes in vertebral body height or intraspongioase disc herniation (Schmorl nodes). Appears in adolescents (14-18 years) and especially in males. It translates clinically by the occurrence of back pain and dorsal kyphosis which has a tendency to progression. While the edge of vertebral body bone spurs may occur.
When osteophytes in osteoarthritis develops exaggerated and join together to form true bone bridges, thick vertical hyperostosis is called spondylosis. Radiologic features:
– Attach at least four vertebrae
– The integrity of intervertebral disc space height keeping
– No osteosclerosis edges of the vertebral body
– Lack of sacroiliac joint erosions and sclerosis
– A transparent space between the vertebral body and ligament calcification previous
In spondilartroza local lumbar pain occurs frequently. It can beaccompanied by radicular-type pain. Affected root is identified by assessing patellar reflex, Achilles and calf muscles appreciation in force. When there are more spinous process and hyperlordosis conditions or due to intervertebral discs turtirii contact may occur between the two apophyses of some neighboring vertebrae. It produces an interspinous neoarticulaţie can become the painful inflammation. Occur particularly in the lumbar region, especially in women.
Median herniation in the lumbar spine occurs syndrome “ponytail” that dominates semsibilitate sphincter disorders and perineal area.
Laboratory diagnosis is radiographic
At radiography aims to:
– Straightness spine
– Shape and size of the vertebral body and intervertebral spaces
– Assessment of bone density
– Existence of osteocondensări of vertebral plateaus
– The presence of marginal osteophytes
Radiography may reveal:
– A process of kyphosis
– Change the shape and size of the vertebral body
The existence of hernias intraspongioase
– Presence osteoartrozelor interpinoase
– Previous osteophytes
– Any movement of the vertebral body
One can practice CT, MRI
¾ oblique radiograph is used to detect bone spurs developed
conjugation holes. When they are found to explain radiculopathies brachial plexus cervical spine.
Osteoarthritis of the hand
Between wrists most commonly affected are the distal interphalangeal where marginal osteophytes made so-called Heberden’s nodes. Women are more often affected than men. Simultaneously later and initially less likely to be affected in the same way proximal interphalangeal joints, in which lymph nodes are called Bouchard. They are located more frequently in the index and medius.
Another common location in hand is the first carpo-metacarpal joint.
Rarely occurs, especially posttraumatic or workers using pneumatic hammers
Suffering metarsofalangiene first joint is the most common. Medial protruding bone spurs is characteristic commonly called mont. Occurs after wearing tight shoes.
Knees are frequently affected. Osteoarthritis of the knee is accompanied by an average synovitis. If an intangible longer periarticular muscles atrophy quickly. When degenerative changes occur unevenly between the medial and lateral tibial plateau, the deformed knee (genu varus or genu valgus) and becomes unstable
Coxaartroza is more common in men as opposed to osteoarthritis occurs more frequently in women. The pain of osteoarthritis occurs when walking and especially the ascent and descent. It can be reflected in local and neighboring regions in the iliac crest, in the buttock, or even to the knees. Passive movements of the joints are limited by pain. Associated with limb shortening. This vicious induce static postures and difficulty walking, with subsequent changes in the lumbar spine. Radiographic examination shows: interlining joint narrowing, osteophytes, osteoporosis, deformed femoral head and acetabular.
Obese patients are recommended to correct weight.
Patients who practice trades that require joints in non-physiological, they suggest changing jobs or interruptions intermitante the reuperatorie physiotherapy practice. Isometric exercises are preferred.
Physical procedures include use of heat: warm baths, paraffin, diathermy, infrared, ultrasound. Rarely heat can aggravate pain and then recommend ice pack applications.
Corrections orthopedic surgery involving resection of large osteophytes, arthroplasty, arthrodesis.
As drug use NSAIDs or topical general about local intraarticular corticosteroid medication.
Some of steroidal substances are incorporated into ointment for local use.
Corticoid substances are prescribed intra-or periarticular. Intraarticular injection is indicated especially in times the inflammation of synovial fluid profusely. Repeated administration may cause damage to the articular cartilage. Periarticular injections are not accompanied by adverse effects on cartilage. In order to restore cartilage cartilage extract is administered.
Particular treatment of various locations
At hand are obtained significant benefits by intra-articular administration of corticosteroids. In advanced cases, surgical correction is recommended. Heberden nodules, the inflammation can be alleviated by physiotherapy hot local procedures.
Osteoratrita falangiană metatarsal surgical correction of hallux uncertain when large marginal osteophytes.
Gonarthrosis benefit from exercise, especially those performed in water. It prohibits placing below the knee painful periods purposes painkiller. It can also turn to local cortcoterapie.
Osteoarthritis of the hip is often disabling and can lead to spondylitis. In these cases the initial stages the focus is on passive and active exercise to prevent capsular fibrosis. Total hip arthroplasty is successful in cases of total ankylosis.
If cervical spine damage – analgesics local heat
Lower-back pain from lumbar spondylosis respond to local heat, rest, analgesics medication and / or antiinflamtoare. Nevrlgia sciatica – local infiltration paravertebral, epidural or spinal anesthesia infiltration. In severe cases with neurological deficits required surgery.