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26th January 2024
Signs
- Bony swelling and joint deformity (due to osteophytes)
- Joint effusion (can occur in the knee)
- Reduced range of movement in the joint
- Pain at extremes of joint movement
- Tenderness/warmth around the joint
- Joint instability
- Muscle weakness or wasting around affected joint
- Crepitus – grating/crunching sound, commonly felt on passive or active movement of joint, caused by friction between bone and cartilage
- Absence of systemic features, e.g. rash, fever
The specific presentation of OA depends on the affected joint, and a detailed history and examination can reveal the following features:
| Hand OA | |
|---|---|
| History | Examination |
| Pain can radiate towards the thumb or wrist and distal forearm. Often exacerbated by strong grip | Typically affects the first carpometacarpal (CMC) joint at the base of the thumb, the DIP joints and the PIP joints |
| Reduced grip or pinch strength, which can cause difficulties with tasks such as opening jars, turning keys, fastening buttons, writing, etc | Fixed flexion deformity of CMC joint, with hyperextension of the distal joints |
| Wasting of thenar muscles | |
| Heberden’s nodes: bony nodules on the DIP joints
Bouchard’s nodes: bony nodules on the PIP joints |
|
| Pain/warmth/redness/swelling of affected joints | |
| Ulnar or radial deviation at affected joints | |
| Painful mucous-filled cysts on the dorsum of the finger | |
| “Squaring” at the base of the thumb caused by partial dislocation of CMC joint | |
Table 1: Possible clinical features of hand osteoarthritis
Adapted from: National Institute for Health and Care Excellence (NICE) Clinical Knowledge Summaries: Osteoarthritis [Internet]. Cks.nice.org.uk. 2021 [cited 12 August 2022]. Available from: https://cks.nice.org.uk/topics/osteoarthritis/diagnosis/diagnosis/
Image Source: Wikimedia Commons (2006). Heberden-Arthrose, Licensed under a creative commons licence. Available for free at: https://commons.wikimedia.org/wiki/File:Heberden-Arthrose.JPG#globalusage (Accessed: 24 June 2021).
| Hip OA | |
|---|---|
| History | Examination |
| Pain felt in the groin and anterior/lateral thigh. Can also be referred to the knee or the testicle on the affected side in males | Painful restriction of internal rotation with hip flexed |
| Difficulty walking, climbing stairs, driving, painful sexual intercourse | Antalgic gait
Trendelenburg gait in advanced disease – towards affected hip with reduced time weight-bearing on that side; pelvis tilting down on unaffected side due to wasting and weakness of gluteal and anterior thigh muscles |
| Shortening of the lower limb | |
Table 2: Possible clinical features of hip osteoarthritis
Adapted from: National Institute for Health and Care Excellence (NICE) Clinical Knowledge Summaries: Osteoarthritis [Internet]. Cks.nice.org.uk. 2021 [cited 12 August 2022]. Available from: https://cks.nice.org.uk/topics/osteoarthritis/diagnosis/diagnosis/
| Knee OA | |
|---|---|
| History | Examination |
| Usually, bilateral pain, felt in and around the knee. Unilateral symptoms usually secondary to pre-existing trauma or disease | Varus (bow-legged) or valgus (knock-knee) deformities |
| Difficulty walking, particularly when going down the stairs if patellofemoral involvement | Locking (inability to straighten knee due to loose meniscal cartilage in the joint |
| Progressive pain on sitting, relieved by standing | Crepitus or joint line tenderness |
| Sensation of knee ‘giving way’ due to weak quadriceps and altered load-bearing | Small to moderate effusions |
| Bony swelling around knee in advanced disease | |
| Antalgic gait – towards affected hip with reduced time weight-bearing on that side; pelvis is in neutral position | |
Table 3: Possible clinical features of knee osteoarthritis
Adapted from: National Institute for Health and Care Excellence (NICE) Clinical Knowledge Summaries: Osteoarthritis [Internet]. Cks.nice.org.uk. 2021 [cited 12 August 2022]. Available from: https://cks.nice.org.uk/topics/osteoarthritis/diagnosis/diagnosis/
Image Source: Wikimedia Commons (2007). Valgus, Licensed under a creative commons licence. Available for free at: https://commons.wikimedia.org/wiki/File:Valgus.jpg (Accessed: 24 June 2021).
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