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ICD-9-CM Codes

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  • 715 Osteoarthrosis and allied disorders

  • 715.14 Osteoarthrosis localized primary involving hand

  • 715.24 Osteoarthrosis localized secondary involving hand

  • 715.9 Osteoarthrosis unspecified whether generalized or localized

  • 715.94 Osteoarthrosis unspecified whether generalized or localized involving hand

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ICD-10-CM Codes

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  • M19.049 Primary osteoarthritis, unspecified hand

  • M19.249 Secondary osteoarthritis, unspecified hand

  • M18.9 Osteoarthritis of first carpometacarpal joint, unspecified

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Preferred Practice Patterns1

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  • 4D: Impaired joint mobility, motor function, muscle performance, and range of motion associated with connective tissue dysfunction

  • 4F: Impaired Joint Mobility, Motor Function, Muscle Performance, Range of Motion, and Reflex Integrity Associated With Spinal Disorders

  • 4H: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated With Joint Arthroplasty

  • 4I: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated With Bony or Soft Tissue Surgery

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Key Features

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Description

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  • Most common form of Osteoarthritis (OA)

  • Degenerative

  • Commonly affects hand and weight-bearing joints

  • Can also affect interphalangeal joints and first metatarsophalangeal joint

  • Associated with increasing age, obesity, sex and race/ethnicity

  • Associated with abnormal loading of the joints

  • Characterized by joint pain

  • Arthrosis

  • Osteoarthrosis

  • Polyarthrosis

  • Degenerative joint disease

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Essentials of Diagnosis

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  • Radiography is a standard method for diagnosis

  • Kellgren and Lawrence (KL) grade ≥ 2 (definite radiographic OA)2

  • Osteophytes, joint-space narrowing, sclerosis

  • Also cartilage lesions, bone marrow lesions, synovitis, effusion, and subchondral bone attrition/sclerosis

  • Erosion of articular cartilage

  • Synovial hyperplasia

  • Fibrosis

  • Inflammatory cell infiltration

  • Conventional radiograph is the most commonly used tool in OA.

  • Diagnosis is made based on a careful history taking, physical examination, imaging studies, laboratory examination, and exclusion of other possible diseases.

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General Considerations

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  • Low bone mineral density (BMD)

  • Repetitive joint use or loading

  • Joint alignment

  • Bone or joint morphology

  • Calcification (e.g., of the knee meniscus)

  • Bone formation, cyst formation

  • Thickening of subchondral bone plate, osteosclerosis

  • Overall joint dysfunction

  • Joint swelling and inflammation (in certain cases, severe cases)

  • Joint pain

  • Morning stiffness

  • Long-term disease

    • Secondary problems

      • Muscle atrophy and weakness

      • Bony protrusion/prominence

      • Joint deformity

      • Grasping difficulty

      • Difficulty with ADLs

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Demographics

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  • Increase in age (middle to older age)

  • Women are more affected than men

  • African American and Caucasian

  • May affect about 12% of the population (US and other developed countries)3

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Clinical Findings

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Signs and Symptoms

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  • Joint pain

  • Aching joint

  • Joint stiffness

  • Muscle weakness

  • Muscle atrophy

  • Crepitus

  • Bony enlargement

  • Limited joint ROM

  • Joint line tenderness

  • Joint deformity in severe cases

  • Activity limitation

  • Heberden's nodes

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Functional Implications

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  • Limited mobility

  • Household- and work-related activity limitation/restriction

  • Decreased overall activity and participation

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Possible Contributing Causes

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  • Chronic factors affecting the joint such as obesity, BMD, and leg length discrepancy (LLD)

  • Aging

  • Chronic and vigorous ...

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