Clinical examination and X-rays

Diagnosis is made with reasonable certainty based on history and clinical examination. X-rays may confirm the diagnosis.

Patients report good months and bad months or symptom changes with weather changes. Comparing the symptoms of arthrosis of hip on one particular day may not accurately represent the overall progression of the condition.

The typical changes seen on X-ray include: joint space narrowing, subchondral sclerosis (increased bony formation around the joint), subchondral cyst formation, and osteophytes. Plain films may not correlate with the findings on physical examination or with the degree of pain. Usually other imaging techniques are not necessary to clinically diagnose arthrosis.

In 1990, the American College of Rheumatology, using data from a multi-center study, developed a set of criteria for the diagnosis of hand arthrosis based on hard tissue enlargement and swelling of certain joints. These criteria were found to be 92% sensitive and 98% specific for hand arthrosis versus other entities such as rheumatoid arthritis and spondyloarthropathies.

Related pathologies whose names may be confused with arthrosis include pseudo-arthrosis. This is derived from the Greek words pseudo, meaning “false”, and arthrosis, meaning “joint.” Radiographic diagnosis results in diagnosis of a fracture within a joint, which is not to be confused with arthrosis which is a degenerative pathology affecting a high incidence of distal phalangeal joints of female patients.

Signs and symptoms

The main symptom is pain, causing loss of ability and often stiffness. “Pain” is generally described as a sharp ache, or a burning sensation in the associate muscles and tendons. Arthrosis can cause a crackling noise (called “crepitus”) when the affected joint is moved or touched, and patients may experience muscle spasm and contractions in the tendons. Occasionally, the joints may also be filled with fluid. Humid and cold weather increases the pain in many patients.

Arthrosis commonly affects the hands, feet, spine, and the large weight bearing joints, such as the hips and knees, although in theory, any joint in the body can be affected. As arthrosis progresses, the affected joints appear larger, are stiff and painful, and usually feel worse, the more they are used throughout the day, thus distinguishing it from rheumatoid arthritis.

In smaller joints, such as at the fingers, hard bony enlargements, called Heberden’s nodes (on the distal interphalangeal joints) and/or Bouchard’s nodes (on the proximal interphalangeal joints), may form, and though they are not necessarily painful, they do limit the movement of the fingers significantly. Arthrosis at the toes leads to the formation of bunions, rendering them red or swollen. Some people notice these physical changes before they experience any pain.
