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osteoarthritis of the spine

Pathology: - most common in facet joints of C6-C7 & L3-S1 Clinical manifestations: 1) lumbosacral osteoarthritis - pain localizes poorly - pain aggravated by movement, relieved by rest - may radiate to paraspinal areas or buttocks - osteophyte encroachment on a nerve root may produce radicular symptoms, L4-L5 & L5-S1 most commonly involved - acute symptoms may be superimposed on chronic mechanical low back pain 2) cervical spine osteoarthritis - stiffness & decreased range of motion - lateral flexion & extension generally more limited than forward flexion 3) osteoarthritis of the hands would be supporting evidence Laboratory: - laboratory testing in the absence of clinical evidence of a systemic disorder is not indicated [2] Radiology: - X-ray of spine - MRI of spine if diagnosis is uncertain Differential diagnosis: 1) spinal stenosis 2) muscle spasm 3) nerve root compression a) C6 & C7 most commonly involved b) weakness in wrist extensors & biceps, decreased biceps DTR, decreased sensation in thumb & index finger suggest C6 involvement c) weakness of the triceps, decreased triceps DTR, decreased sensation in index & middle fingers suggest C7 involvement 4) diffuse idiopathic skeletal hyperostosis (DISH) Management: 1) identify & eliminate provocative activities [2] 2) weight reduction, back posture, abdominal muscle strenthening 3) acetaminophen or a short course of NSAIDs 4) gabapentin or tricyclic antidepressant for neurogenic pain 5) glucocorticoid injections may be useful 6) consider opiates & other pain management stategies for refractory pain [2] 7) see osteoarthritis

Related

diffuse idiopathic skeletal hyperostosis (DISH, Forestier disease, ankylosing hyperostosis of the spine, spondylosis hyperostotica) facet/zygapophysial/interarticular joints low back pain (LBP) spinal stenosis vertebra

General

osteoarthritis (OA)

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 17. American College of Physicians, Philadelphia 1998, 2015
  2. Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society