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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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  • M19.049 Primary osteoarthritis, unspecified hand
  • M19.249 Secondary osteoarthritis, unspecified hand
  • M18.9 Osteoarthritis of first carpometacarpal joint, unspecified

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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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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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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 joint loading
  • Previous chronic joint injury (e.g. accident, trauma), hence secondary Osteoarthritis (OA)

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Differential Diagnosis

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