Osteoarthritis of the Lumbar Spine PowerPoint

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Presented by Debbie Jarnagin-Stearns, Jennifer Lavin & Melody Hicks

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Osteoarthritis of the Lumbar Spine:

Osteoarthritis of the Lumbar Spine October 12, 2011 Presented By: Debbie Jarnigan -Stearns, Jennifer Lavin & Melody Hicks

General Description of Osteoarthritis:

General Description of Osteoarthritis Osteoarthritis (OA) is also synonymous to Degenerative Joint Disease (DJD) Common Disorder to one or more joints Localized Disorder No Systemic Effects Initiated by local deterioration of articular cartilage Characterized by progressive breakdown of cartilage Hypertrophy remodeling of subchondral bone secondary inflammation of synovial membranes Mainly affects weight-bearing joints 2 1. Salter RB. Degenerative Disorders of Joints and Related Tissues . Textbook of Disorders and Injuries of the Musculoskeletal System. 3 rd Ed. Lippincott Williams & Wilkins, PA. 1999. Chapter 11.

General Description of Lumbar Spine OA:

General Description of Lumbar Spine OA More common in Spinal Column due to the amount of stresses and strains applied to the spine throughout one’s lifetime 1 . Intervertebral discs usually the first structure affected by normal aging degenerative changes 1 Must be aware of differences of Degenerative Disc Disease (DDD) as well as Degenerative Joint Disease (DJD) of the lumbar spine. 3 1. Salter RB. Degenerative Disorders of Joints and Related Tissues . Textbook of Disorders and Injuries of the Musculoskeletal System. 3 rd Ed. Lippincott Williams & Wilkins, PA. 1999. Chapter 11.

General Description of Lumbar Spine:

General Description of Lumbar Spine Intervertebral Disc Joints Symphysis Joint Couplet unit between two vertebral bodies 3 parts Nucleus pulposus Annulus fibrosis Hyaline cartilage end plates on opposing vertebral body surfaces Image URL: http://www.popovic.com.au/surgery_spinal.html Image URL: http://ittcs.wordpress.com/2010/06/01/anatomy-and-physiology-the-intervertebral-discs/ 4 1. Salter RB. Degenerative Disorders of Joints and Related Tissues . Textbook of Disorders and Injuries of the Musculoskeletal System. 3 rd Ed. Lippincott Williams & Wilkins, PA. 1999. Chapter 11.

General Description of Lumbar Spine:

General Description of Lumbar Spine Posterior Facet Joints Diarthrodial /Synovial Joint Guide, Steady & Limit movement of vertebral bodies on each other 1 Composed of Fibrous capsule Synovial membrane Articular cartilage surfaces Image URL: http://med1022notes.blogspot.com/ Image URL: http://jama.ama-assn.org/content/304/1/114.full 5 1. Salter RB. Degenerative Disorders of Joints and Related Tissues . Textbook of Disorders and Injuries of the Musculoskeletal System. 3 rd Ed. Lippincott Williams & Wilkins, PA. 1999. Chapter 11.

Lumbar Spine OA Signs & Symptoms :

Lumbar Spine OA Signs & Symptoms Affects a single joint or multiple joints Pain & Swelling Pain likely to only occur/worsen with motion Except in later stages of the disease Loss of ROM Bony deformity Specific stiffness of an area of the body Upon awaking/after longer periods of inactivity Crepitis is common No bilateral symmetry as with RA Patient’s can be asymptomatic even with imaging confirmation 2. Sullivan SB, Schmitz TJ. Arthritis . Physical Rehabilitation. 5 th Ed. F.A. Davis Company, PA. 2007. Chapter 26. 6

Lumbar Spine OA Signs & Symptoms :

Lumbar Spine OA Signs & Symptoms Since cartilage is aneural , the damage to the cartilage is not was causes the patient’s pain 2 OA Pain is attributed to: Incongruent articulations of joint surfaces Periosteal elevation 2° to bone proliferation at the joint margin Abnormal pressure on subchondral bone Trabecular microfractures Joint capsule distension 7 2. Sullivan SB, Schmitz TJ. Arthritis . Physical Rehabilitation. 5 th Ed. F.A. Davis Company, PA. 2007. Chapter 26.

Lumbar Spine OA Incidence:

Lumbar Spine OA Incidence OA is the most common type of arthritis 1 Type of OA Primary (idiopathic) 1 Exaggeration of the aging process of the joint Secondary 1 Injury/Deformity/Disease that affects articular cartilage Can occur at any age Not common in younger individuals but extremely common after 40 years. 2 >60 years; 25% of women & 15% of men will have symptoms related to OA 1 >75 years; >80% of women & men will have symptoms related to OA 1 8 Salter RB. Degenerative Disorders of Joints and Related Tissues . Textbook of Disorders and Injuries of the Musculoskeletal System. 3 rd Ed. Lippincott Williams & Wilkins, PA. 1999. Chapter 11 . Sullivan SB, Schmitz TJ. Arthritis . Physical Rehabilitation. 5 th Ed. F.A. Davis Company, PA. 2007. Chapter 26 .

Lumbar Spine OA Diagnosis:

Lumbar Spine OA Diagnosis Detailed Patient & Medical History Physical Examination & Assessment of Spinal Movement X-Ray Other Test May be done to rule out OA such as MRI CT Scan Bone scans Blood Tests Joint Aspiration 3. WebMD . Spinal Osteoarthritis (degenerative arthritis of the spine). Osteoarthritis Health Centre. http://www.webmd.boots.com/osteoarthritis/spinal-osteoarthritis-degenerative-arthritis-of-the-spine. Accessed October 11, 2011. Last updated September 23, 2011. 9

Lumbar Spine OA Prognosis:

Lumbar Spine OA Prognosis OA is a chronic disease Often progressive No cure for OA Using a degenerating joint progresses it’s deterioration Increasing pain Increasing loss of ROM Low Back Pain associated with OA may be more painful for middle aged vs. elderly individuals 1 In elderly, joint may become relatively stiff & stable Decreasing pain as well as decreasing demands made on the joint Therefore, pain may improve with increasing age 1. Salter RB. Degenerative Disorders of Joints and Related Tissues . Textbook of Disorders and Injuries of the Musculoskeletal System. 3 rd Ed. Lippincott Williams & Wilkins, PA. 1999. Chapter 11. 10

Lumbar Spine OA Impact on Function:

Lumbar Spine OA Impact on Function Depends on Structural severity Symptom Presentation Rate of Progression Treatments attempted i.e. Surgical procedures could limit function OA of the Lumbar spine has the potential to be very debilitating but each case impacts patient function differently Potential Areas for Functional Limitations Gait Posture Pain Management Endurance Strength Range of motion 11

Role of Imaging In OA Diagnosis & Management:

Role of Imaging In OA Diagnosis & Management Diagnosis Role Detecting joint space narrowing, osteophytes , subchodral sclerosis, subchodral cyst formation and subluxations resulting from osteoarthritis. Imaging is necessary to help confirm OA by the degenerative changes present at the bone. Imaging is helpful in distinguishing between OA and other types of arthritis. Management Role Imaging can tell the physician what stage of disease the patient has and this will indicate the degree of medical intervention needed. Imaging is helpful in the management of OA by determining the degree of damage done to the bone. Determining the degree of damage is necessary in determining the most appropriate treatment (PT, injections, or surgery) 12 4. Osteoarthritis. (2010). Retrieved October 12, 2010, from http://www.niams.nih.gov/Health_Info/Osteoarthritis/#6 5. MR vs CT Facet Joint OA. Retrieved October 12, 2010 from http://www.pfirrmann.ch/pdf/Weishaupt_MR_vs_CT_FacetJointOA_SkeletalRadiol_28_1999.pdf

Best Imaging OA in the Lumbar Spine:

Best Imaging OA in the Lumbar Spine Radiograph Detect changes in bone easily and clearly including spondylolysthesis , narrowing of the joint spaces. Shows best picture of the bone and any changes in the bone. Most common & cost-effective form of imaging in confirming the diagnosis of osteoarthritis. MRI More sensitive to changes in soft tissue. Gives clinician information on deterioration of articular cartilage in facet joints, disc herniation , narrowing of the spinal canal and compression of the spinal cord. Used in ruling in osteoarthritis as well as ruling out other diagnosis. Helps determine the state of the articular cartilage. Since the posterior facet joint is the articulating joint of the spine it is important to assess this portion of the lumbar spine & determine the integrity of the articular cartilage and joint capsule. 13 4. Osteoarthritis. (2010). Retrieved October 12, 2010, from http://www.niams.nih.gov/Health_Info/Osteoarthritis/#6 5. MR vs CT Facet Joint OA. Retrieved October 12, 2010 from http://www.pfirrmann.ch/pdf/Weishaupt_MR_vs_CT_FacetJointOA_SkeletalRadiol_28_1999.pdf

Lumbar Spine OA Radiograph:

Lumbar Spine OA Radiograph Findings, Biomechanical & Physical Impairments In this image of a lumbar vertebra, we see the facet joint space narrowed. This narrowing of synovial joint space causes lack of rotation leading to stiffness and pain after long periods of sitting, antalgic gait, difficulty with ADLs and balance impairments. 14 Image URL: http://www.e-radiography.net/radiology/degenerative_joint_disease.htm

Lumbar Spine OA MRI:

Lumbar Spine OA MRI Findings, Biomechanical & Physical Impairments We see in this case the OA is so severe it has caused the disc at L4/L5 to bulge into the spinal cord. 15 Image URL: http://images.rheumatology.org/viewphoto.php?albumId=75691&imageId=5231122

2 Questions for Classmates:

2 Questions for Classmates Why is it important to determine the integrity of the articular cartilage of the facet joints? What complications can arise from the deterioration of this cartilage? 16

References:

References Salter RB. Degenerative Disorders of Joints and Related Tissues. In: Textbook of Disorders and Injuries of the Musculoskeletal System . 3 rd Ed. Lippincott Williams & Wilkins, PA; 1999:257-302. Sullivan SB, Schmitz TJ. Arthritis. In: Physical Rehabilitation . 5 th Ed. F.A. Davis Company, PA; 2007:1057-1089. WebMD. Spinal Osteoarthritis (degenerative arthritis of the spine). Osteoarthritis Health Centre. Available at http://www.webmd.boots.com/osteoarthritis/spinal-osteoarthritis-degenerative-arthritis-of-the-spine. Accessed October 11, 2011. Last updated September 23, 2011. Osteoarthritis. (2010). Retrieved October 12, 2010, from http://www.niams.nih.gov/Health_Info/Osteoarthritis/#6 MR vs CT Facet Joint OA. Retrieved October 12, 2010 from http://www.pfirrmann.ch/pdf/Weishaupt_MR_vs_CT_FacetJointOA_SkeletalRadiol_28_1999.pdf 17

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