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July—October 3. A rim of osteophyte around the head of the humerus and around the attachment of the labrum to the glenoid is an almost invariable accompaniment of gleno-humeral OA. There is an uncommon form of OA of the shoulder which is atrophic and rapidly destructive;39 the destruction may involve not only the glenohumeral joint, but the ACJ, and the head and neck of the humerus. Insights from paleopathology, Joint Bone Spine, , 71, — Hand: The thumb base is an extremely common site for OA in the hand, and so are the distal and proximal interphalangeal joints dips and pips.
The disease may be secondary to trauma. Prior to the disease was most likely to affect only a single joint, or set of joints, whereas there was an increasing tendency for more than one joint to be affected after that date. The patellofemoral joint is most com- monly affected, followed by the lateral and medial tibiofemoral joints in that order.
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Females are more likely to be affected than males51 and OA of the knee is very strongly correlated with obesity. Are there differences in the aetiology? Clinical Rheumatology, , 22, — Clinical Rheumatology, , 14, — Annals of the Rheumatic Diseases, , 66, 86— Osteoarthritis of the ankle is approximately nine times less frequent than OA of the hip or knee. New bone around the fovea is by no means only found with OA of the hip.
It may be found in an otherwise apparently normal hip and presumably reflects either repeated micro-trauma to, or inflammation of the ligamentum teres. There is plenty of evidence to suggest that osteoarthritis may be a complication of PDB68 and that it may actually accelerate its progress. There are a number of reasons that PDB might induce OA, including bone enlargement, softening of the subchondral bone or alteration of normal joint dynamics. Osteoporosis: Clinical studies have shown that there is a direct relationship between OA and bone density; that is, patients with OA tend to have a higher bone density than those without.
What are the consequences? British Journal of Rheumatology, , 35, — Arthritis and Rheumatism, , 46, 1—4. Rotator cuff disease RCD : The shoulder joint is an extremely complex joint which allows for a very great range of movement,75 but on this account, it sacrifices stability.
The gleno-humeral joint is very shallow but its depth is increased somewhat by the presence of a fibrous labrum that attaches to the rim of the glenoid. It is also stabilised to some extent by the tendons of four muscles that arise from the scapula and insert into the lesser and greater tuberosities of the humerus, forming part of the joint capsule. These muscles are from anterior to posterior in the order in which they insert into the humerus subscapularis, supraspinatus, infraspinatus and teres minor. The long head of biceps takes its origin from the labrum and runs through the joint and in the bicipital groove76 on the front of the humerus, filling the gap between the subscapularis and the supraspinatus tendons.
The four muscles act as rotators of the humerus and the combined tendinous structure around the shoulder joint is referred to as the rotator cuff. Rotator cuff disease RCD is extremely common and is a frequent cause of shoulder pain,77 especially in the elderly. RCD seems to be a true degenerative disease,78 the 74 M Brickley and T Waldron, Relationship between bone density and osteoarthritis in a skeletal population from London, Bone, , 22, — Causes of rotator cuff disease Extrinsic factors Intrinsic factors Traumatic tear in tendons from a fall Poor blood supply or other accident Normal attrition and degeneration with ageing Over-use injuries from repetitive Calcification of tendons lifting, pushing, pulling or throwing Note that RCD is often due to a combination of extrinsic and intrinsic factors.
RCD is associated with over-use, such as occurs in some occupational groups,79 and it may be a complication of os acromiale qv. Tears in subscapularis have been associated with variations in the morphology of the acromion. The changes are seen in the insertions of the rotator cuff muscles. These changes include pitting, alteration in normal contour and the presence of enthesophytes. Moreover it is easy to tell which of the 79 M Hagberg and DH Wegman, Prevalence rates and odds ratios of shoulder-neck disease in different occupational groups, British Journal of Industrial Medicine, , 44, —; P Frost and JH Anderson, Shoulder impingement syndrome in relation to shoulder intensive work, Occupational and Environmental Medicine, , 56, — A radiologic and histologic post- mortem investigation of the coracoacromial arch, Clinical Othopedics, , , 39— New bone may also be found on the coracoid, and on the acromion, and the ACJ is frequently involved.