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- Welcome back to The Art of Medicine.
The diagnosis of osteoarthritis
depends on careful analysis of your condition.
Let's take a look at the common symptoms
and how we evaluate your pain.
- Symptoms for osteoarthritis are three.
Pain, swelling and stiffness.
They can all either be present at the same time
or you can see each one individually
in different degrees.
The pain can either be because of particles
flaking off and irritating the lining of the joint
or increased pressure within the bone.
Similarly, the stiffness can be because
of fluid inside the joint or it can just be
because of increased pressure in the bone
because of not having as much cushion there.
Osteoarthritis is nothing more than wearing away
that gristle on the end of the bone
and instead of having seven to 10 millimeters
of tread, you may have three to four millimeters of tread.
And the swelling can either be because of fluid,
which is an irritation to the lining of the joint,
or it can be just because of thickening
of the lining of the joint, both of which
will cause limited motion.
The common symptoms with osteoarthritis
are more functional.
They're difficulty with walking,
ascending or descending stairs,
particularly descending stairs where you put
more force across the kneecap area,
kneeling, bending, squatting, where again you're
loading and compressing the joint at its extreme,
and driving often times where you have to
hold that knee in one particular spot.
The symptoms of osteoarthritis often times
are made worse any time the knee is held
in one position or compressed in one position
for an extended period of time.
All of these decrease the amount of motion
across the knee and decrease the amount of lubrication.
On physical exam for osteoarthritis we're really trying
to evaluate the nature of the pain, swelling and stiffness.
We are looking for several specific findings.
We're looking to see where you're pain is located,
if your knee is swollen,
we test to see if your knee is stiff
and if you have weakness or atrophy.
The exam consists of trying to localize this discomfort,
identify any laxity, and identify any mechanical
symptoms, any palpable catching, clicking or locking
that may be present.
- [Voiceover] An x-ray is the most common study
that we use in helping us diagnose
osteoarthritis of the knee.
This is a normal x-ray of a patient.
The thigh bone, the leg bone,
this is the front view.
And between the two bones, a normal space.
It's when this normal space is reduced
that we have osteoarthritis and we'll show that
in this next x-ray.
Here we have a patient that has osteoarthritis of the knee.
This is the front view of the knee.
An x-ray that shows the thigh bone,
the leg bone, any normal-appearing space
between the bones on the outer side of the knee,
as opposed to the inner side of the knee
where we now see the bones touching.
This touching of the bones
indicates advanced osteoarthritis of the knee.
The other study other than an x-ray
that we can use in helping us diagnose
arthritis of the knee is an MRI.
This is an MRI showing the front of the knee.
Again, on top is the thigh bone,
below here is the leg bone.
Now we're able to see between these bones
what we call the miniscus.
Some people call them the cartilages.
On the outer side of the knee here
we see this black triangle
that indicates a normal miniscus or cartilage.
On the inner side of the knee
we have, once again, a triangle
that is partially black but has white streaks in it
that indicate a tear of the miniscus.
So this is an arthritic knee and part of
the arthritic pattern is what we call
a degenerative tear of the miniscus.
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