Degenerative joint disorders syndrome (DJDS)

The additional information. There are two types of DJDS: “primary” – when the
insult remains unclear and “secondary” – after ether arthritis or trauma.
 History
Complaints

Joint pain
1. Joint pains are mainly related to movement and
weight-bearing, relieved by rest (Usage pain).
This type of the pain due to pressure upon a
subchondral bone.
2. Night or “bone” pain – mostly at night, poorly
related to movement (It due to increased
pressure in subchondral bone).
3. Blockade of joint. It is the sudden sharp pain
depriving the patient with an opportunity to do
any movement in the affected joint. It happens
when the “loose” osteochondral body is
restrained with articulate surfaces of bones.

Bone swelling or deformity of joints;

Deviation of the fingers; changed alignment of knee joints
Limitation of the function of joints;
Audible crepitation.
 Present illness
1. Often the slow but efficient “primary” DJDS process compensates for the
insults, resulting in an anatomically altered bud pain-free functioning joint.
Sometimes, however, because of either overwhelming or chronic insult or an
inherently poor repair response, it fails, resulting in progressive tissue
damage, more frequent association with symptoms.
2. “Secondary” DJDS develops after a trauma or JIS.

Life history

1. A variety of mechanical, metabolic, genetic or constitutional insults may

damage a synovial joint. Although overt trauma is a commonly recognized
local predisposing factor, more subtle repetitive adverse loading of joints
during occupation or competitive sports also appears important. Recognized
occupational risk for DJDS includes farming (hip), mining (knee) and
professional football (knee).
2. The occurrence of DJDS in members of their family

Physical Examination Inspection of gait

«Duck gait» in the patients with DJDS of both hip joints. It is the rocking of a
trunk in the both sides during walking.
The additional information. The typical localization of “primary” DJDS is in the hip
joints, knee joints, and the 1st metocarpophalangeal joints. On arms the distal
interfalangeal joints are often affected. The involvement of the proximal
interphalangeal joints happens less often. The process is symmetrical.
The secondary syndrome is located in the damaged joints. The process is
asymmetrical.
 Inspection of involved joints at rest

1. Bony swelling around joint

margins [marginal osteophytes:
e.g. Heberden’s (distal IPJs) and
Bouchard’s (proximal IPJs)
nodes];
2. Deviations of fingers
3. Changed alignment [bow legs
(genu varum), knock knees (genu
valgum)]
 Palpation of involved joints at rest

1. Bony swelling around joint margins [fixed; bone consistence; painless];

2. “Loose” osteochondral bodies [movable; bone consistence]

Inspection and palpation during movement

1. Functional restriction (Affected most active movements)
2. Pain on usage.
3. Active and passive movement affected equally
4. Palpable, sometimes audible, coarse crepitus (rough articular surfaces).

Investigations
Lab tests
Total blood count and ESR- normal results
 Imaging Studies
Plain radiography. (proliferation of new
bone [marginal osteophytes] with
remodeling of joint contour, focal joint-
space narrowing, subchondral sclerosis,
bone cysts, partial dislocation
(subluxation), osteochondral bodies);

Arthroscopy (focal loss of articular hyaline cartilage, “loose” osteochondral bodies)