131 Osteoarthrosis
Salient features
History
• Stiffness after a period of inactivity
• Impairment of gait as a result of joint pain
• Knees: pain on activities such as climbing stairs, getting out of a chair, and walking long distances. Morning stiffness usually lasts <30 min. Ask the patient whether their knees ‘give way’, a so-called instability symptom
• Hip: morning stiffness and pain (lasting <30 min) and pain at rest or at night are common. However, nocturnal hip pain may reflect inflammatory arthritis, infection, tumours or crystal diseases.
Examination
• Heberden’s nodes (bony swellings) at the terminal interphalangeal joints
• Squaring of the hands as a result of subluxation of the first metacarpophalangeal joint.
• Tell the examiner that you would like to examine the hips and knees as these joints are usually involved.
• Knee: feel for crepitus: it may be red, warm and tender, and have an effusion.
• Hip: the strongest clinical indicator of osteoarthritis of the hip is pain, exacerbated by internal or external rotation of the hip while the knee is in full extension. An assessment of the range of motion of the knee joint and lower lumbar spine may help to determine whether hip pain is referred from these other joint rather than the hip.
