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PHYSIOTHERAPY
MANAGEMENT
FOR ARTHRITIC
CONDITIONS
BY
Dr: Osama Ragaa
Assistant prof. of Physical Therapy
Batterjee College for medical sciences& technology
Degenerative joint disease (DJD)
or degenerative osteoarthritis (OA):
• Is a degenerative articular condition characterized
by deterioration of the cartilaginous weight bearing
surfaces of joints, presence of sclerotic changes in
subchondral bone, and proliferation (formation) of
new bone appear as osteophytes add spurs in x-ray.
• Due to excessive external forces.
• Weight bearing joints: hips, knees, and spine are at
risk.
Symptoms:
• Pain with or after movement( stair climbing).
• Stiffness of the affected joint.
• Physical signs:
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•
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Tenderness.
Crepitus.
Swelling.
Limited ROM.
Apparent shortening of the leg.
Bony deformation , muscle weakness in advanced cases.
Diagnostic Investigations:
• Radiological examination( x-ray) show loss
of joint space ,irregularity ,and
osteophytes.
Physical therapy
management:
Goals:
-Protect the affected joint.
-Decrease of pain.
-Improve the muscular function.
-Increase endurance& aerobic capacity.
Treatment:
• For goal(1):
• reduce patient’s weight.
• Using assistive walking devices.
• Joint supporting devices.
•For goal(2):
-Thermal agents( paraffin, IR, US).
-Electrical currents( TENS, interferential, or
didynamic current).
•For goal(3):
-Strengthening exercises especially for quadriceps
muscle: e.g.: short arc terminal extension, and straight
leg raising exercises.
-Stretching exercises for hip flexors, adductors,
hamstrings, and iliotibial band.
•For goal(4):
-Hydrotherapy.
-Stationary bicycle with high seat.
-Gradual walking programs.
Rheumatoid Arthritis:
• Is a systemic( affects multiple joint
systems) connective tissue disorder
characterized by inflammation in the
synovial lining of the joint that result in
articular cartilage and bone destruction.
• Women have two to three times greater
incidence than men.
• Hand joints are usually affected then feet,
knees, and elbows.
Clinical features:
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•
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Joint stiffness.
Pain.
Joint swelling.
Muscle wasting.
Joint deformity.
Diagnostic tests:
• Laboratory testing show increased white
blood cells and erythrocyte sedimentation
rate( ESR).
• Hemoglobin test will show anemia.
• Rheumatic factor will be elevated
(positive).
Physical therapy management:
• Aims:
Education on the disease, its treatment, and
self management techniques.
Relief of symptoms( pain& stiffness).
Modify the patient’s environment.
Improve patient’s psychological status.
Treatment:
• Pain modalities.
• Exercises:
• In the acute stage, mobility exercises
through the pain free range in addition to
isometric exercises.
• In the chronic stage, total body aerobic
activity as walking, swimming, and cycling.
Gout(Gouty arthritis):
• Disorder of purine metabolism
characterized by elevated serum uric acid
(hyperuricemia).
• Uric acid changes into crystals and
deposits into peripheral joints and other
tissues
( kidneys).
• Most frequently observed at great toe of
foot and the knee joint.
Diagnostic tests:
-------------Laboratory testing shows elevation of
serum uric acid level.
• Early identification of condition with fast
implementation of intervention is very
important.
Septic arthritis:
• is the purulent invasion of a joint by an
infectious agent which produces arthritis.
• Usually only one joint is affected
(monoarthritis).
• Affected joint is red, hot, and swollen.
• Diagnosis by aspiration & cultural
sensitivity.
• If NOT properly treated will lead to joint
fusion.
Chondromalacia Patella
(Patellofemoral Syndrome):
• Chondromalacia patella is abnormal softening of the
cartilage of the under the kneecap (patella).
Chondromalacia patella results from degeneration of
cartilage due to poor alignment of the kneecap as it
slides over the lower end of the thigh bone (femur).
•
Chondromalacia commonly occurs in females. Girls
in their teens and young athletes are at elevated
risk because the cartilage of the knee is subjected to
excessive and uneven pressure due to the structural
changes that accompany rapid growth.
Chondromalacia may also occur in adults over age 40
as part of the wear-and-tear process that eventually
leads to osteoarthritis of the knee joint .
What causes chondromalacia patella?
• The patella is normally pulled over the end of the femur
in a straight line by the quadriceps muscle. Patients with
chondromalacia patella frequently have abnormal
patellar "tracking" toward the lateral side of the
femur. This slightly off-track pathway allows the
undersurface of the patella to grate along the femur
causing chronic inflammation and pain .
Factors that may precipitate chondromalacia
include trauma, overuse, or abnormal forces
on the knee joint. It can develop in runners,
cyclists, and soccer players, especially if
someone is knock-kneed or flat-footed.
What are the symptoms of chondromalacia
patella?
• The symptoms of chondromalacia patella are
generally a vague discomfort of the inner knee area,
aggravated by activity (running, jumping, climbing or
descending stairs) or by prolonged sitting with knees
in a moderately bent position (so called "theater sign"
of pain upon arising from theater seat).
• Some patients may also have a vague sense of
"tightness" or "fullness" in the knee area.
• Occasionally, if chronic symptoms are ignored, the
associated loss of quadriceps muscle strength may
cause the leg to "give out.“
• Besides an obvious reduction in quadriceps
muscle mass, mild swelling of the knee area may
occur.
How is chondromalacia patella treated?
• The primary goal for treatment and rehabilitation of
chondromalacia patella is to create a straighter
pathway for the patella to follow during quadriceps
contraction..
• Selective strengthening of the inner portion of the
quadriceps muscle will help normalize the tracking of the
patella. "Quad sets" are the foundation of such a
program.
• Stretching the quadriceps and hamstring muscle groups
is critical for an effective and lasting rehabilitation of
chondromalacia patella.
• Generally, full squat exercises with weights are avoided.
• Occasionally, bracing & taping with patellar centering
devices are required.
Surgical treatment for arthritis:
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Arthroscopy.
Osteotomy.
Arthroplasty.
Arthrodesis.
Syovectomy.
Arthroscopy :
• Is a surgical procedure orthopedic surgeons use to
visualize, diagnose, and treat problems inside a
joint.
• The term literally means "to look within the joint."
• Six joints are most frequently examined with this
instrument. These include the knee, shoulder, elbow,
ankle, hip, and wrist.
• Most patients have their arthroscopic surgery as
outpatients and are home several hours after the
surgery.
It is not unusual for patients to go back to work or resume daily
activities within a few days. Athletes may in some cases return to
athletic activities within a few weeks.
Osteotomy:
• Is a surgical procedure in which a portion
of the bone( usually triangular in shape) is
removed to correct a deformity that causes
an overpressure on a particular joint.
• It is used as an alternative to total joint
replacement( Arthroplasity) in young and
active patients.
• Should be followed by long&
comprehensive rehabilitation program.
Arthroplasty:
• Creation of an artificial joint to correct
advanced degenerative arthritis.
• May be excision arthroplasty, have- joint or
total joint arthroplasty.
Arthrodesis:
• Surgical fusion of the joint to get red of
significant pain, or chronic instability.
• Recommended when loss of function is
acceptable.
• ROM exercises are NOT indicated but
strengthening of the areas around the joint
is recommended.
Synovectomy:
• Synovectomy is done to remove inflamed joint tissue
(synovium) that is causing unacceptable pain.
• It is used to treat joints affected by rheumatoid
arthritis that have minimal bone or cartilage
destruction when medicine has not relieved pain.
The surgeon will enter the joint through a small
incision with an arthroscope.
Physical therapy after Synovectomy consists of
range of motion exercises and strength
building. Physical therapy may be
uncomfortable or even painful at first, but it is
essential to regain strength and range of
motion.
*If ROM restoration is slow, mobilization under general
anesthesia may be recommended.
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