Osteoarthritis

Present by: Sahar Abdualaziz, Moneerah Al Otibai, Noha Al

Basha.

Outline

DefinitionPathologyCausesSign and symptomsJoint affectedFeaturesDiagnosisComplication

Treatment:

A- medicalB- surgicalc- physical therapy

Definition:

Osteoarthritis (OA): is a degenerative joint disease characterized by the breakdown of the joint's cartilage. It called degenerative joint disease.

the most common form of arthritis.

Pathology:

It is caused by the breakdown of cartilage.

Cartilage is the tough elastic material that covers and protects the ends of bones. Bits of cartilage may break off and cause pain and swelling in the joint between bones.

 This pain and swelling is called inflammation.

pathology

In healthy joints cartilage acts as a shock absorber when you put weight on the joint. The slippery surface of the cartilage allows the bones to move smoothly .

joint osteoarthritis the cartilage gradually becomes rough and thin, and the bone underneath thickens. Over time the cartilage may wear away entirely, and the bones will rub

together .

Causes

1-unknown.2-heredity.

3-excess weight (obesity) :puts extra stress on the weight-bearing joints, especially the knees and hips.

4-joint injury: a- sport (wear and tear in joint).

b- occupation (squat position over many years.

5-other disease RA.6-high heel shoes .

Sign and symptoms:

1-pain, especially when moving a joint.

2-swelling or bumps.

3-sore and stiff (fingers and foot).

4-hear grating sound when the roughened cartilage on the surface of the bones rubs together.

5 -hard movement (walk and up stair) .

Joint affected:

OA commonly affects weight-bearing joints such as hips, knees, feet and spine. However, non-weight bearing joints such as finger joints.

Knee OA is more common in Saudi Arabia

Factor to distinguish OA and other disease.

1-Osteoarthritis usually occurs in older people after the age 45 years, but occur at any age.

2-It is usually located in only one or a few joints.3-The joints are less inflamed than in other

arthritic conditions.4-Progression of pain is almost always gradual.

5-It affects men and women in equal numbers but after the 50 age the women is more.

Diagnosis

1-history of symptoms2-physical exam..

3-blood test to detect( OA or RA.)

4 -x-ray

Complication of OA

1-The muscles that hold the joint in place weaken

because they are not being used.

2-Over time, the joint looses its shape and does

not work at all.

Decreased Physical Activity

Changes in Joint

PainMuscle Weakness

Loss of Normal Function

Treatment

Medical:

1-Analgesics drugs:

A) Acetaminophen :to relieve mild to moderate arthritis pain.

Side effect:liver damage.B) Codeine preparation: to relive severe arthritis pain. Side effect: may cause constipation

2-Cream and gels: to temporary pain relive.

3-Nonsteroidal anti-inflammatory drugs (NSAIDs):

To reduce pain and swelling of the joint and decrease stiffness.

a) Non-selective NSAIDs: e.g. aspirin-Low dose use to relive pain.- Higher dose and regular use to suppress inflammationSide effect:Stomach upset, diarrhea and abdominal pain

B) Selective NSAIDs (Cox-2 inhibitor): are as effective as non-selective NSAIDs and less cause gastrointestinal injury and side effect.

Joint irrigation:the joint space is flushed with fluid to remove cartilage debris, irritating crystals and other substance.

*use to reduce pain, stiffness and tenderness and allow for increased physical activity.

Corticosteroid:May be injected into the joint to relive severe inflammation.Cortisone as asteroid that reduce inflammation and swelling.

Surgical1-Arthroscopy: use to1-invistigation of joint.2-treatment:a) To remove damage (debridement)b) To flush the joint to remove anyloose part (lavage or irrigation)

*Advantage:1-delay the need fore more serious surgery e.g. joint replacement.2-the incision is small size.3-the pain that result of surgery is minimal 4-restore function and decrease pain.

*Disadvantage:1-Risk of anesthesia.2-infection3-damage to nerve or blood vessels 4-DVT

2-osteotomy:Is procedure change the position or alignment of knee so yourweight shift away from the damage area.This procedure only be done when only one area or side of kneedamage.

*Advantage:Decrease pain and restore function.

*Disadvantage:May need knee replacement surgery in future.

3-arthroplasty:(joint replacement)Procedure done by artificial joint replace all joint (total

replacement) or part of knee damage (Unicompartmental knee arthroplasty).Artificial joint made from metal and plastic.

Advantage:1- the result of the joint replacement are generally excellent (there

are significant pain relief and improve function).

Disadvantages:1-rehabilitation may take 3to6 month.2-the artificial joint may loosen or wear out so that second surgery

is needed.* The life span or artificial is about 10 years in 9%of the people.

Physical Therapy

Physical therapy and exercise improve flexibility and strengthen the muscles surrounding the joints.

People who exercise regularly their arthritis will typically have less pain and better function than those who are inactive.

physiotherapy treatment program will help:• Reduce pain• Improve movement and posture• Strengthen muscles• Improve independent function• Assess and treat biomechanical problems that may exacerbate

the pain and loss of function

Exercises Exercise can help:

prevent the disability that result from inactivity. It promotes the health and normal function of muscles and bones.

Exercise keeps the muscles toned and increases bone mineral density, which reduces the risk of osteoporosis and fractures. It also promotes cardiovascular health, which decreases the risk of heart disease.

In addition, there are also psychosocial benefits to exercise, including an improved sense of well-being and the relief of depression.

     

Range-of-motion exercises are gentle stretching exercises which move each joint as far as possible in all directions.

These exercises need to be done daily to help keep joints fully mobile and prevent stiffness and deformities.

ROM (range-of-motion) exercises are especially important for arthritis patients, who because of intense inflammatory pain tend not to want to move painful joints.

Range of Motion Exercises

Strengthening Exercises

Strengthening exercises help increase muscle strength. Strong muscles help to support the joints, making the joints more stable, and helping a person move more easily and with less pain.

The two types of strengthening exercises are isometric and isotonic:

Isometric exercises involve tightening the muscles, without moving the joints. These exercises are especially useful when joint motion is impaired.

Isotonic exercises involve strengthening the muscles by moving the joints.

Stretching Exercises

Stretching the muscles that support the knee is important in preventing injury. Flexible muscles are not as easily injured as tight muscles. Tightness of muscles connected to the knee can also pull the knee out of alignment.

When doing stretching knee exercises, be careful to go slowly and not to overstretch.

Aerobic Exercise

Aerobic exercise benefits those with knee problems by toning the muscles of the leg that support the knee joint to absorb shock before it reaches the knee joint.

Aerobic exercises also help in weight reduction. Losing weight reduces stress on the knee joint - the impact placed upon on the knees is three times the body weight while walking.

Aerobics also stimulate your the body to release endorphins - natural painkillers produced by one's own body.

Aerobic exercise is important for the health of the heart, lungs, and overall function of the body.

Warm up before aerobic exercise to slowly increase your heart rate and breathing rate. Five minutes of slow paced walking, and a few minutes of stretching are sufficient. Cooling down in the same manner is also important be sure to stretch your quadriceps and hamstrings.

Walking: Start with about 5 minutes of slower paced walking to warm up. Walk at a medium pace for about another 10 minutes per day and gradually build up to 30 - 60 minutes by adding a few minutes each time you walk. End your walk with 5 minutes of slower paced walking. After you get into better shape you can start walking at a faster pace to increase the intensity of your walks.

Swimming and Water Exercises

swimming is an excellent no-impact exercise. Regular 'land' exercises can also be done underwater.

The buoyancy of the water supports most of the body's weight while the resistance of the water make your muscles work harder to perform movements.

You can use dumbbells and weights strapped to the ankles to intensify the workout without stressing the knees and other weight-bearing joints.

Stationary bikes: Make sure your seat is high enough so that your knees are not bent beyond a 90-degree angle. Your knee should be slightly bent when your pedal is furthest away. An upright stationary bike (looks like a regular bike) gives you a higher intensity work out than a recumbent bike.

Heat and cold therapies

Applying heat and cold to arthritic joints can help to control symptoms such as pain and stiffness.

Heat therapy : Heat relieves pain and stiffness in arthritic joints. Heat can be applied to the joints with hot packs, hot water bottles, heating pads, or electrically heated mittens.

Heating pads should be set on a timer and used for no more than 20 minutes at a time. The heating pad can be reapplied after 20 minutes of no use.

Cold therapy : Cold relieves pain in arthritic joints and reduces muscle spasms. Cold can be applied for short periods using ice packs or topical coolant sprays. People with certain medical conditions, such as the Raynaud phenomenon, should not use cold therapy.

Orthoses & Assistive devices

Orthoses : Orthoses are devices that promote normal alignment and function of the joints. There are many different types of orthoses that can reduce symptoms and help maintain function in people with osteoarthritis.

Well-cushioned shoes and shoe inserts may reduce stress on the joints of the spine and leg.

Splints that immobilize the joints can reduce pain and inflammation, and many splints can be worn throughout the day and night. Braces can help stabilize unstable joints.

Assistive devices : Canes, walkers, electric powered seat lifts, raised toilet seats, and tub and shower bars can reduce the stress on joints and make it easier to perform daily tasks.

TENS Therapy

A TENS unit delivers a mild electrical current to the skin, stimulating nerve fibers in the skin that may interfere with the transmission of pain signals from the arthritic joint.

The use of TENS for people with osteoarthritis is controversial. Some studies have found that those who use TENS for arthritis of the knee have reduced knee pain, a greater ability to bend the knee, and a reduced duration of morning stiffness.

However, one study found that the benefits occurred primarily during active use of the TENS unit, and another study found that TENS was no more effective for relieving pain than the drug naproxen.

Activity limitations

The following positions and activities place excessive pressure on the knee joint and must be limited until knee pain and swelling resolve: Squatting ,Kneeling ,Twisting and pivoting, repetitive bending and Bicycling.

The preferred exercise equipment for the knee should provide smooth motion of the knee, maximal toning of the front and back thigh muscles (quadriceps and hamstring muscles).

THERE IS NO CURE,BUT THERE ARE WAYS OF MANAGING

AND THE PHYSIOTHERAPY IS AN IMPORTANT PART OF THAT MANAGEMENT.