Copyright 2011
By: Gregory R. Waryasz, MD
Osteoarthritis is a condition of degeneration of the joints in the body. Osteoarthritis affects approximately 40 million people in the United States. It typically is a disease of older individuals, but can be present in younger individuals.
It is characterized by pain, stiffness, focal swelling, and decreased range of motion of affected joints. There can be significant deformity to an affected extremity or the digits. Heberden nodes and Bouchard nodes are deformities of the fingers associated with osteoarthritis. Heberden nodes are located at the distal interphalangeal joint, while Bouchard nodes are located at the proximal interphalangeal joints.
The cause is a failure of chondrocytes to repair damaged cartilage. Osteoarthritis can be a primary intrinsic defect or a secondary defect. Secondary causes of osteoarthritis include trauma, infection, acquired, or a congenital condition. Conditions such as Legg-Calve-Perthes and developmental dysplasia of the hip (DDH) can lead to development of early onset hip osteoarthritis for example.
It results in four major findings; subchondral sclerosis, subchondral cysts, osteophytes, and joint space narrowing.
It is sometimes complicated by inability to respond to nonoperative and operative measures. It can created severe disability due to inability to perform activities of daily living. Subchondral fractures can occur acutely as well.
Diagnosis is made by physical exam and x-rays.
Imaging includes the use of x-rays, CT scans, and MRI
Treatment is usually with observation, rest, NSAIDs, steroid injections and physical therapy initially. With disease progression, each joint is treated differently. Hip, knee, shoulder, and elbow osteoarthritis can be treated with a joint replacement procedure. Vertebral osteoarthritis can be treated with a fusion procedure to limit the range of motion of the spine.
References
Davis MF, Davis PF, Ross DS. Expert Guide to Sports Medicine. ACP Series, 2005.
Lieberman J (ed), AAOS Comprehensive Orthopaedic Review, American Academy of Orthopaedic Surgeons, 2008.
Moore K, Dalley A (eds), Clinically Oriented Anatomy (5th edition), Lippincott Williams & Wilkins, Philadelphia, PA, 2006.