Osteoarthritis Overview and Pathophysiology

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Questions and Answers

What is a primary characteristic of Patellofemoral Pain Syndrome (PFPS)?

Chronic pain that only occurs after long periods of rest.

It is typically associated with acute injuries.

Insidious onset of poorly defined anterior knee pain. (correct)

Immediate onset of well-defined lateral knee pain.

Which muscle imbalance is a contributing factor to PFPS?

Muscle imbalance between the vastus lateralis (VL) and vastus medialis oblique (VMO). (correct)

Weakness in the soleus and gastrocnemius muscles.

Strength imbalance between hip flexors and extensors.

Tightness in the iliopsoas and rectus femoris.

Which activity is most likely to aggravate symptoms of PFPS?

Stairs and prolonged sitting. (correct)

Exercise that includes sudden stops.

Swimming.

Light jogging on flat surfaces.

How does the patella move during knee flexion?

It moves inferiorly and medially. Signup and view all the answers

What mechanical issue is associated with PFPS?

Abnormal patella movement and mal-tracking. Signup and view all the answers

What symptom is associated with knee osteoarthritis?

Joint pain that improves with rest Signup and view all the answers

Which of the following observations would indicate knee swelling?

Reduced knee range of motion Signup and view all the answers

Which tendon injury is associated with the patellar region of the knee?

Patella tendon Signup and view all the answers

What type of gait may indicate knee joint issues?

Antalgic gait Signup and view all the answers

Which activity is most likely to lead to hamstring tendon injuries?

Running or sprinting Signup and view all the answers

What is a common characteristic associated with plantar fasciitis?

Reduced ankle dorsiflexion and first MTP extension ROM Signup and view all the answers

Which ligament is primarily involved in an inversion ankle sprain?

Anterior talofibular ligament Signup and view all the answers

What type of ankle sprain is less common but has a longer healing time?

Eversion sprain Signup and view all the answers

Which test can be used to assess for plantar fasciitis during examination?

Windlass test Signup and view all the answers

What symptom is typically assessed to diagnose an ankle sprain?

Presence of audible snap at injury Signup and view all the answers

What is a primary characteristic of osteoarthritis (OA)?

Degradation and loss of articular cartilage Signup and view all the answers

Which of the following is NOT a typical symptom of knee osteoarthritis?

Swelling of the ankle Signup and view all the answers

Which risk factor is associated with the development of osteoarthritis (OA)?

Obesity Signup and view all the answers

How many percent of women over 60 years have symptomatic knee osteoarthritis?

13% Signup and view all the answers

Which of the following statements about knee OA is true?

Stiffness is worse in the morning or after prolonged static positions Signup and view all the answers

What does secondary osteoarthritis result from?

Previous joint abnormalities such as trauma Signup and view all the answers

Which of the following mechanisms contributes to the symptoms of osteoarthritis?

Hypertrophic bone changes and osteophyte formation Signup and view all the answers

What is a common misdiagnosis for knee osteoarthritis based on symptoms?

Meniscal injury Signup and view all the answers

What is the classic injury mechanism associated with Anterior Cruciate Ligament (ACL) injuries?

Twisting mechanism with pivoting movement Signup and view all the answers

Which of the following is a common sign of ACL injury in the immediate aftermath?

Sudden pain with an audible pop Signup and view all the answers

What type of imaging is primarily used to diagnose a Posterior Cruciate Ligament (PCL) injury?

MRI Signup and view all the answers

Which condition implies that the patella disarticulates laterally from the patellofemoral joint?

Patellar instability Signup and view all the answers

What is the primary stabilizer implicated in patellar instability?

Medial patellofemoral ligament (MPFL) Signup and view all the answers

Which type of knee injury is most commonly associated with meniscal tears?

Twisting movement with the knee flexed Signup and view all the answers

What role do menisci serve within the knee joint?

Transmit loads and absorb shock Signup and view all the answers

What is the typical clinical presentation of a traumatic meniscal injury?

Localized swelling with history of direct trauma Signup and view all the answers

Study Notes

Osteoarthritis (OA)

A condition causing joint pain accompanied by functional limitation and reduced quality of life.
Can be primary, without a predisposing trauma or disease, usually associated with aging or secondary caused by previous joint abnormality, e.g., previous trauma, rheumatoid arthritis, Inflammatory arthritis, infectious arthritis.
Most commonly seen at the hip and knee in the lower limb (LL), and IP joints and 1st MCP joint in the upper limb (UL).
Risk factors for developing OA include age, female gender, obesity, anatomical factors, muscle weakness, and joint injury.
OA is diagnosed clinically.
Symptoms commonly include:
- Pain worse with activity and better with rest
- Age > 45 years
- Morning stiffness lasting less than 30 minutes
- Bony joint enlargement
- Limitation in range of motion.

OA - Pathophysiology

Characterized by a degeneration and loss of articular cartilage.
Bone changes (hypertrophic) and osteophyte formation.
Subchondral bone remodelling.
Chronic inflammation of the synovium membrane.

Knee OA

Approx. 13% of women, 10% of men >60 years have symptomatic knee OA.
Prevalence is higher in females than males.
Radiographs show that only ~15% of patients with radiographic findings of knee OA are symptomatic.

Symptoms of Knee OA

Gradual onset of symptoms, pain, and stiffness in the knee joint.
Stiffness worse in the morning or after prolonged static positions, improves within 30 minutes.
Pain gets worse with prolonged activities, bending, stairs and worse with inactivity.
Pain improves with rest.
Knee stiffness, swelling, decreased ambulatory capacity
Could have clicking, giving way and crepitus.

Signs of Knee OA

Knee swelling, deformity
Reduced knee Range of motion (ROM) both actively and passively in most directions.
Restricted patella movement.
Gait - antalgic gait, asymmetrical.

Tendon Injuries

Tendon injuries are common and can be caused by acute injury or overuse.
Tendon injuries can occur in the lower limb (LL) in a variety of locations including:
- Hamstrings - distal and proximal (taught with hip and thigh)
- Rectus Femoris - distal and proximal (taught with hip and thigh)
- Patella Tendon (AKA Patellar Ligament)
- Achilles Tendon
- Tibialis Posterior
- Flexor Hallucis Longus
- Peroneals

LL Tendon Injuries - Clinical Presentation

Subjective History / Causes:
- Hamstring: Gradual onset or acute injury - running, sprinting, soccer, rugby
- Rectus Femoris: Gradual onset or acute injury - running, sprinting, weights.
Symptoms:
- Distal Hamstring: Gastroc length
- Distal Rectus Femoris: Knee to wall
Palpation:
- Hamstring: Tender over injured muscle - depends on which part of the muscle (belly, MTJs) Depending on grade - palpable gap/dip in muscle
- Rectus Femoris: Tender over injured muscle - depends on which part of muscle (belly, MTJs) Depending on grade - palpable gap/dip in muscle

Patellofemoral Pain Syndrome (PFPS)

An umbrella term for peri-patellar or retro-patellar pain.
A common musculoskeletal condition characterized by insidious onset of poorly defined anterior knee pain.
Onset of symptoms can be slow or develop acutely.
Pain worsens with lower limb loading activities like stairs, squatting, running, prolonged sitting.
Pain can be aggravated by stairs, squatting, running, prolonged sitting

Contributing Factors of PFPS

Overuse, Gradual Onset Injury: Increase in PFJ loading activities, stairs, running, squats, lunges.
Causative and contributing factors - multifactorial:
- Training factors / errors
- Malalignment of the leg - static and dynamic
- Patella maltracking
- Pronated foot type
- Inadequate flexibility
- Muscle imbalance - between VL and VMO
- Reduced hip abductor and external rotation strength

PFPS - Pathophysiology

Pathophysiology unclear. May be due to:
- Inflamed synovial lining and fat pad tissues
- Irritation of the retinacula
- Cartilage changes
- Increased osseous metabolic activity of the patella.

Signs of PFPS

Abnormal patella movement / mal-tracking observed.
Altered LL alignment and biomechanics:
- Knee valgus, excessive foot pronation
- Poor pelvic and LL control under load, e.g.PCL = posterolateral instability

Anterior Cruciate Ligament (ALC) Injury

Classic injury involves a twisting mechanism - pivoting movement and often non-contact.
Occurs in sports like soccer, basketball, netball, downhill skiing, rugby, gymnastics.
There is usually immediate effusion (swelling) occurring 5 minutes to one hour post injury with large haemoarthrosis (blood in the joint).
Pain will usually occur +/- an audible ‘pop’ or ‘feeling of something going’.
Often associated with meniscal tears, articular cartilage injuries, MCL injuries.

Investigations for ACL Injury

X-ray - to exclude any fractures.
MRI - detects ACL and associated injuries.

Signs of ACL Injury

Examination difficult in the first few days due to swelling.
Altered weightbearing - often on crutches.
Restricted knee ROM.
Knee joint tenderness.
Special tests - Lachman’s and Anterior Drawer tests
Widespread tenderness around the knee.

Posterior Cruciate Ligament Injury

Mechanism – direct blow to anterior tibia with knee in flexed position. Occurs during activities such as a dashboard in a car, contact from an opponent or equipment, or a fall onto a hyper-flexed knee.
Often associated with meniscal and chondral injury.
Up to 60% involve disruption of posterolateral structures (LCL, popliteus complex) = posterolateral instability
Poorly defined pain, mainly posterior.
Minimal swelling.

Posterior Cruciate Ligament Injury - Special Tests

Posterior drawer test

Posterior Cruciate Ligament Injury - Investigations

X-ray - to exclude bony avulsion.
MRI - diagnose PCL and other structures.

Patella Instability

Patellar instability, by definition, is a condition where the patella bone pathologically disarticulates out from the patellofemoral joint, either subluxing or complete dislocation laterally.
It can be traumatic (twisting or jumping) followed by hemarthrosis / severe effusion or atraumatic, due to ligament laxity/hypermobility, and no significant trauma.
Disruption to the medial patellofemoral ligament (MPFL) (primary stabiliser) = passive instability.

Patella Instability - Clinical Presentation

Anterior knee pain and swelling.
Reports of instability or “popping out”.
Patella usually relocates naturally on knee extension.
Tenderness over the medial border of the patella.
Special tests - patella lateral apprehension test.

Patella Instability - Investigations

X-ray - to exclude fracture.

Meniscal Injury

Two types – traumatic or degenerative

Menisci

Lie on the periphery of the tibial plateaus, following the basic outlines of the tibial plateaus.
Important biomechanical function:
- Load transmission – transmit between 50-95% of loads of the knee.
- Shock absorption.
- Joint stability.
- Spreads stress over the joint surface and decreasing cartilage wear.

Traumatic Meniscal Tears

Most common mechanism of injury is a twisting movement on a slightly flexed knee with the foot anchored on the ground - change of direction sports (football, basketball, rugby) or standing, walking, running.
In more severe cases, walking aggravates, and pain increases during the day

Plantar Fasciitis

Associated with:
- High BMI
- Excessive pronation (and supination) - static and dynamic
- Pes planus (low arches) or pes cavus (high arches)
- Prolonged standing occupations, running, excessive walking, dancing
- Inadequate footwear
- Reduced hamstring and calf flexibility

Signs of Plantar Fasciitis

Acute tenderness to palpation along the medial plantar aspect of the foot and insertion into the calcaneus.
Dorsiflexion of the ankle and extension of the toes may cause pain (Windlass test).
Reduced ankle DF and first MTP extension ROM.
Decreased strength plantar flexors and toe flexors.
Reduced ankle and calf flexibility.
Excessive foot pronation or supination (van Leewan et al., 2016)

Ankle Sprains

Lateral Ligament Injuries
- Inversion sprain: anterior talofibular lig – forced inversion and plantarflexion. calcaneofibular ligament – forced inversion. Posterior talofibular - rarely injured. Complete tear of all ligaments – associated with dislocations and fractures.
Medial (Deltoid) Ligament Injury
- Eversion sprain: Less common than lateral injuries, but twice as long to heal.

Ankle Sprains - Diagnosis

History is critical - mechanism? audible snap? Could they immediately weight bear? pain, swelling, tenderness, bruising
Pain on stretching or compressing ligament, e.g. ankle inversion or eversion.
Ligament stress tests - anterior drawer, talar tilts used to determine grade, compare both sides as large inter-individual variability.

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Description

This quiz covers the essential aspects of Osteoarthritis (OA), including its causes, symptoms, and risk factors. It also explores the underlying pathophysiology of OA, highlighting cartilage degeneration and bone changes. Test your knowledge of this common joint condition and understand the impact it has on quality of life.