Download osteoarthritis

Osteoarthritis
Present by: Sahar Abdualaziz,
Moneerah Al Otibai, Noha Al
Basha.
Outline
Definition
Pathology
Causes
Sign and symptoms
Joint affected
Features
Diagnosis
Complication
Treatment:
A- medical
B- surgical
c- 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 symptoms
2-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.
Changes in Joint
Muscle Weakness
Pain
Loss of Normal Function
Decreased Physical
Activity
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 inflammation
Side effect:
Stomach upset, diarrhea and abdominal pain
B) Selective NSAIDs (Cox-2 inhibitor): are as effective as nonselective 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.
Surgical
1-Arthroscopy: use to
1-invistigation of joint.
2-treatment:
a) To remove damage (debridement)
b) To flush the joint to remove any
loose 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-infection
3-damage to nerve or
blood vessels
4-DVT
2-osteotomy:
Is procedure change the position or alignment of knee so your
weight shift away from the damage area.
This procedure only be done when only one area or side of knee
damage.
*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
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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:
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prevent the disability that result from inactivity.
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It promotes the health and normal function of muscles and bones.
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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
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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.
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:
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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
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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
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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.
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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 .
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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.
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Swimming and Water Exercises
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swimming is an excellent no-impact exercise. Regular 'land'
exercises can also be done underwater.
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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 .
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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
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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.
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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
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Orthoses : Orthoses are devices that promote normal alignment
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Well-cushioned shoes and shoe inserts may reduce
stress on the joints of the spine and leg.
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and function of the joints. There are many different types of
orthoses that can reduce symptoms and help maintain function in
people with osteoarthritis.
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.
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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
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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
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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.