OSTEOARTHRITIS

deterioration of the articular cartilage.

• When this happens it leads to bone break down because the
bones within the joint start to rub upon one another.  
• This will cause changes inside and outside of the bone.
• The inside of the bone will start to experience abnormal
hardening (sclerosis)
• The outside of the bone will experience osteophytes
formation (bone spurs).
• It occurs in the synovial joints
• A result of a combination of genetic factors, overuse and
injury.
 WHAT IS A BONE CARTILAGE?

• Bone cartilage is a rubbery, smooth tissue found

within the joint that covers the end of each bone.
• It acts as a protective mechanism for movement by
providing this slick surface for the bones to slide
and glide during movement.
• In addition, it absorbs shock from movement.
 WHAT HAPPENS?

• The top layer of cartilage begins to

breakdown and wear away 🡪 loss of joint
space 🡪 bones grate on each other 🡪 no
easy gliding of bones during movement
without friction 🡪 erodes the bone 🡪
osteophyte formation
FOUR KEY XRAY CHANGES
 CAUSES

• Occurs in older age 40+

• Increased risk if patient has had repeated joint
injuries
• Jobs that are strenuous
• Overweight
• Genetics
 SIGNS/SYMPTOMS: PRESENTATION

• Outgrowths that are bony, especially on the hands

due to bone spur formation
• Heberden’s Node (most common): found on the
distal interphalangeal joint (joint closest to the
finger nail)
• Bouchard’s Node: found on the proximal
interphalangeal joint (middle finger joint)
 SIGNS/SYMPTOMS: PRESENTATION

• Sunrise Stiffness - LESS than 30 minutes  - pain

will be the worst at the end of day from overuse
than compared to morning time
• Tenderness when touching the joint site with bony
overgrowths
• Experience grating (crepitus) of the bones when
moving/flexing joint from bones rubbing together
and joint pain with activity which goes away with
rest
• Only the joints: Asymmetrical/Uneven , limited to
joints along with limited mobility
COMMONLY AFFECTED JOINTS
• Heberden’s nodes (in the DIP
joints)
• Bouchard’s nodes (in the PIP
joints)
• Squaring at the base of the
thumb at the carpo-metacarpal
joint
• Weak grip
• Reduced range of motion
• carpo-metacarpal joint at the
base of the thumb is a saddle joint
with the metacarpal bone of the
thumb sat on the trapezius bone
like a saddle.
• It gets a lot of use from everyday
activities.
• This makes it very prone to wear
when used for complex
movements.
 MANAGEMENT

• Patient Education about the condition

• Advise on lifestyle changes such as weight loss if
overweight to reduce the load on the joint
• Physiotherapy to improve strength to support the joint 
• Occupational therapy and orthotics to support activities
and function
• Stepwise use of analgesia to control symptoms:
• Oral paracetamol and topical NSAIDs or topical capsaicin 
• Add oral NSAIDs and consider also prescribing a proton
pump inhibitor (PPI)
• Consider opiates such as codeine and morphine.
• Intra-articular steroid injections provide a temporary
reduction in inflammation and improve symptoms.
• Joint replacement can be used in severe cases. The hip
and knee are the most commonly replaced joints.