7940 South University Blvd Suite 100
Centennial Co 80109
Phone (303) 927-6181 or (720) 515-8002
Email: GenesisSpineCenter@gmail.com
Genesis Chiropractic Spine & Sports Center      













DDD/DJD

General Information

Description:

  • Low back pain syndrome, localized degenerative joint disease (DJD)

Also called:

  • Degenerative arthritis
  • Osteoarthritis
  • Osteoarthrosis

Incidence/Prevalence:

  • Degenerative joint disease is seventh most common diagnosis made during family physician visits; analysis of patient visits to family physicians in United States 1995-1998 in National Ambulatory Medical Care Survey; degenerative joint disease diagnosis coded in 4% of visits (Ann Fam Med 2004 Sep-Oct;2(5):411)

Causes and Risk Factors

Causes:

  • Causes of degenerative joint disease
    • Traumatic (repetitive stress)
    • Prior inflammatory or septic arthritis
    • Congenital abnormalities of joints
    • Endocrine disorders (acromegaly, hyperparathyroidism, diabetes)
    • Metabolic disorders (ochronosis, hemosiderosis, Wilson's disease)
    • Neuropathic disorders (diabetes, syphilis)
    • Avascular necrosis
    • Paget's disease

Pathogenesis:

  • Primarily a disease of cartilage
    • Deterioration of articular cartilage over many years
    • Synovial membrane intact
  • Change in cartilage collagen network with multiple theories regarding pathogenesis
    • Biomechanical - stress and aging derange chondrocytes
    • Biochemical - inflammatory reaction to stress, lytic enzymes, decreased keratan sulfate, increased chondroitin sulfate
    • Aging theories - decreased proteoglycan aggregation, loosening of type II collagen, wear and tear
    • Body reacts to cartilage destruction by bone formation, calcium pyrophosphate deposition, increased collagen turnover, secondary synovitis, damaged chondrocytes release proteases and collagenases (IL-1, TNF-alpha catabolic), TGF-beta and FGF anabolic (also insulin-like growth factor 1)
  • Initial stages of increased production and degradation of proteoglycan and collagen - increased thickness of cartilage, increased water content, decreased glycosaminoglycan content, cellular division and clustering of chondrocytes (transient proliferative response), increased matrix metalloproteinase activity
  • later stage with drop out of chondrocytes - fibrillation leading to deep clefts and ulceration of cartilage surface, shearing forces with thinning of cartilage, bony sclerosis, osteophyte formation
  • Bone-on-bone contact in joint leads to more rapid deterioration in movement and function
  • Bone marrow lesions might cause pain in osteoarthritis; MRI study of 401 adults with knee arthritis on radiography; comparing 351 who reported pain vs. 50 without pain, 78% vs. 30% had discrete areas of increased signal adjacent to subcortical bone in either femur or tibia (consistent with fluid), 36% vs. 2% had large lesions (Ann Intern Med 2001 Apr 3;134(7):541 in J Watch 2001 Jun 1;21(11);88), editorial can be found in Ann Intern Med 2001 Apr 3;134(7);541, commentary can be found in Ann Intern Med 2002 Apr 16;136(8):630

Likely risk factors:

  • Previous low back trauma

Complications and Associated Conditions

Complications:

  • Radiculopathy (pain on straight leg raising, sciatica)
  • Spinal stenosis (very common in elderly, predisposition by "tre foil" canal, neurogenic claudication)
  • Cauda Equina syndrome (surgical emergency, severe massive disk herniation, diffuse lower extremity weakness and numbness, bladder and bowel dysfunction)
  • Spondylosis (degeneration of intervertebral disc)
  • Spondylolysis (defect in pars reticularis of pedicle)
  • Spondylolisthesis (spondylolysis with subluxation, cause of spinal stenosis, leads to forward subluxation of vertebral body)

History and Physical

History:

Chief concern (CC):

  • Low back pain (LBP)

History of present illness (HPI):

  • See Acute low back pain or Chronic low back pain
  • Symptoms aggravated with extension (involvement of facet joints)

Past medical history (PMH):

  • Previous problems (diagnosis, x-rays, treatment), arthritis, gout

Social history (SH):

  • Psychologic status, how condition affects life, loss of income, secondary gain, fear of disability, psychogenic muscle tension, depression
  • Ask about functional impact including limitations in ability to work, meet family responsibilities or enjoy leisure time

Review of systems (ROS):

  • Gynecologic, urinary, gastrointestinal, systemic

Physical:

General physical:

  • See Acute low back pain or Chronic low back pain
  • Symptoms aggravated with extension (involvement of facet joints)