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spine), Generalized osteoarthritis or Kellgren’s syndrome. Marked by two localized, pathological features, the progressive destruction of articular cartilage and the formation of bone at the margins of the joint (Sullivan) Most common type of arthritis is an asymmetrical non-inflammatory disease that has no systemic component. (De Lisa) In OA, there are differences in the water content ratio of certain cartilage constituent. And an increase in degradative enzyme activity compared with in non – osteoarthritis joint. (Braddom) Most common form of arthritis, is a primarily a disease of cartilage, not of the synovium. In the upper limb, it most commonly involves the CMC joint of the thumb. A thumb spica hand – based or forearm – based splint can be prescribed for CMC joint OA by limiting motion at the base of the thumb, the splint decrease pain, especially with pinching – type activity. (Braddom) Characterized by degenerative changes in articular cartilage and bony overgrowth at the joint margin (Shunts)
It is a group of diseases and mechanical abnormalities entailing degradation of
joints, including articular cartilage and the subchondral bone next to it.
Osteoarthritis is a type of arthritis that is caused by the breakdown and eventual
loss of the cartilage of one or more joints. Classification of Osteoarthritis OA is often graded on radiographs according to the criteria of Kellgren and Lawrence using an ordinal scale of five levels: Grade 0 – normal radiograph Grade 1 – doubtful narrowing of the joint space and possible osteophytes Grade 2 – definite osteophytes and absent or questionable narrowing of the joint space Grade 3 – moderate osteophytes and joint space narrowing, some sclerosis and possible deformity
Grade 4 – large osteophytes, marked narrowing of joint space, severe sclerosis and definite deformity.
General Criteria of OA 1. Pain on motion relieve by rest. 2. Aching pain and stiffness in joint after prolonged rest especially in early morning hour relieve in less than 30 minutes with mild exercise. 3. Restraining of cartilage or loss of joint space seen X- ray examination. 4. Increase density of subchondral bone. 5. There is reactive bone overgrowth at margin of joint. Clinical classification criteria for knee and hip osteoarthritis Knee osteoarthritis 1. Knee pain 2. Joint stiffness < 30 minutes 3. Crepitus 4. Bony enlargement 5. Bony tenderness 6. No palpable warmth Hip osteoarthritis
1. Hip internal rotation > 15 degrees with pain, morning stiffness < 60 minutes, and
age > 50 years old, or 2. Hip internal rotation < 15 degrees and hip flexion < 155 degrees Two main types of arthritis I. Inflammatory arthritis fall into four groups: 1. Inflammatory connective tissue disease (RA, JRA, SLE, DM-PM, mixed connective tissue disease) 2. Inflammatory crystal induced disease (Gout , pseudogout)
3. Inflammation induced by infectious agent (Bacterial, viral, tuberculosis & fungal arthritis) 4. Seronegative spondyloarthropathies (AS, Psoriatic Arthritis[PSA],Reiter’s disease, Inflammatory bowel disease[BD]) II. Non – inflammatory arthritis
1. Degenerative (OA, Postraumatizing aseptic necrosis[AN])
2. Metabolic (Lipid storage disease, Hemochromatosis, Hypogammaglobulinemia, Hemoglobinopathies) RELATED ANATOMY:
JOINT Also called an articulation or arthrosis, is a point of contact between two bones, between the bone and cartilage. The structural classification of joints is based on two criteria. 1. Presence or absence of a space between the articulating bones, called synovial cavity. 2. Type of connective tissue that binds the bones together. Structurally
Fibrous joints- bones re held together by fibrous connective tissue that is rich in
collagen fibers; they lack a synovial cavity.
Cartilaginous joints- bones are held together by cartilage; they lack a synovial
cavity. The articulating bones are tightly connected by either Hyaline Cartilage (reduce friction, shock absorber).
Synovial joints- bones forming the joint have a synovial cavity and are united by
the dense irregular connective tissue of an articular capsule, and often by accessory ligaments. Functionally
Synarthrosis- immovable joint Amphiarthrosis- slightly movable joint Diarthrosis- a freely movable joint
Synovial Cavity - this allows a joint to be freely movable.
Synovial fluid -reduce friction by lubricating the joint and supplying nutrients to and removing metabolic wastes from the chondrocytes within the articular cartilage. Joint capsule - a tough membrane sac that encloses all the bones and other joint parts. Synovium - a thin membrane inside the joint capsule that secretes synovial fluid. Cartilage- covers the articulating surface of the bones with a smooth, slippery surface but does not bind them together. Subchondral bone - layer of bone in which is just below the cartilage. Osteophytes-typically develop as a reparative response by the remaining cartilage.
Back Anatomy The Spinal Column: The spinal column (also called the vertebral column) contains and protects the spinal cord and supports the body and head. The spinal column is flexible to allow movement of the body. The spinal column is comprised of a column of small bones called vertebrae. Shock absorbing discs separate the vertebrae. Vertebrae: The 24 vertebrae are named according to their location along the spine. We start out with 33 vertebrae but the lowest nine fuses together to form single bones- 5 fused vertebrae form the sacrum and 4 tiny fused vertebrae form the coccyx (tailbone).
projecting from either side of the vertebral arch and serve as attachments for the muscles and ligaments. Each vertebra arch has four (two superior and two inferior) articular processes.connects with the pelvis Coccyx: (the tailbone) with 4 very small fused vertebrae.The 24 True or Movable Vertebrae: Cervical spine (neck area) with 7 vertebrae (labeled C1 .C7) Thoracic spine (chest area) with 12 vertebrae (labeled T1 .projecting from the center of the vertebral arch. . Articular processes meet and interlock at the facet joints to link one vertebra with the next. basically cylindrical in shape. the vertebral arch has several processes (bony projections).L5) Fused Vertebrae (Below the lumbar spine): Sacrum: a triangular shaped solid base with 5 fused vertebrae . Transverse processes . Vertebral Arch: The posterior part of a vertebra. Vertebral Body: The anterior segment and largest part of a vertebra. Main Parts of a Vertebra: The two main parts of the vertebra are the vertebral body and the vertebral arch. Processes (bony projections) of the Vertebral Arch: Spinous process . and serve as attachments for the muscles and ligaments.T12) Lumbar spine (lower back) with 5 vertebrae (labeled L1 .
Facet Joints: Facet joints (commonly called spinal joints) join adjacent vertebrae. arachnoid. The dura mater is the outermost and toughest of the three meninges. Discs: The vertebral bodies are separated by shock absorbing intervertebral discs. Three meninges (membranes) cover the spinal cord.Intervertebral Foramen (plural: intervertebral foramina): The opening formed between adjacent vertebrae from which the spinal nerves exit. and dura mater. Spinal Cord: A part of the central nervous system. There is an opening on each side. Meninges: The three membranes enclosing the spinal cord and brain . ligaments and discs support the joints of the spine. the spinal cord transmits messages from the brain to other parts of the body and vice versa. Theses discs have a tough outer coating with and contain a jelly-like substance. .the pia mater. The surfaces of the bones that make up the facet joints are coated with smooth cartilage that allows the bones to glide smoothly against each other. Facet joints are hinge-like and allow adjacent vertebrae to move on one another to allow bending and twisting and also keep the spine within a normal range of motion. Spinal nerves branch out form the spinal cord. Muscles.The spinal cord begins at the brain and runs down to the level of the second lumbar vertebrae.
forming the wrist joint. Ligaments: Ligaments are tough bands of connective tissue that connect the vertebrae. Further into the palm. . Hand Anatomy Bones and Joints There are 27 bones within the wrist and hand. called carpals. Facet joints and ligaments help protect the spine by limiting how far the spine can bend or twist. Muscles: Muscles support the spine and allow movement. abdomen and buttocks stabilize the spine and maintain proper posture. the carpals connect to the metacarpals. the radius and ulna. Muscles of the back. Small bone shafts called phalanges line up to form each finger and thumb. Muscles protect the spine by absorbing shock before it reaches the discs and facet joints. The wrist itself contains eight small bones.Spinal Canal: Spinal Canal (also called vertebral canal) is the large canal in the center of the spinal column that contains the spinal cord and its membranes. There are five metacarpals forming the palm of the hand. One metacarpal connects to each finger and thumb. The carpals join with the two forearm bones.
called interphalangeal joints (IP joints). The three phalanges in each finger are separated by two joints. the strongest ligament is the volar plate. This white. Ligaments and Tendons Ligaments are tough bands of tissue that connect bones together. called collateral ligaments. The function of the collateral ligaments is to prevent abnormal sideways bending of each joint. The joint near the end of the finger is called the distal IP joint (DIP joint). are found on either side of each finger and thumb joint. The one closest to the MCP joint (knuckle) is called the proximal IP joint (PIP joint). and thumb are covered on the ends with articular cartilage. fingers. These joints are called the metacarpophalangeal joints (MCP joints). The IP joints of the digits also work like hinges when you bend and straighten your fingers and thumb. The thumb only has one IP joint between the two thumb phalanges. or articulate. There is articular cartilage essentially everywhere that two bony surfaces move against one another. The function of articular cartilage is to absorb shock and provide an extremely smooth surface to facilitate motion. The MCP joints work like a hinge when you bend and straighten your fingers and thumb. In the PIP joint (the middle joint between the main knuckle and the DIP joint). Two important structures. shiny material has a rubbery consistency. The ligament tightens as the joint is . This ligament connects the proximal phalanx to the middle phalanx on the palm side of the joint. The joints of the hand.The main knuckle joints are formed by the connections of the phalanges to the metacarpals.
while the femoral neck is directed superiorly. laterally and anteriorly.5 cm. The cuplike acetabulum forms at the union of three pelvic bones — the ilium. where they eventually connect to the extensor tendons before crossing over the back of the wrist joint. The extensor hood flattens out to cover the top of the finger and sends out branches on each side that connect to the bones in the middle and end of the finger. It forms the primary connection between the bones of the lower limb and the axial skeleton of the trunk and pelvis. they tug on the extensor tendon and straighten the finger. and anteriorly. pubis. and the ischial tuberosity ("sitting bone") Proximally the femur is largely covered by muscles and. The place where the extensor tendon attaches to the middle phalanx is called the central slip. The acetabulum grasps almost half the femoral ball. the posterior inferior iliac spine (PIIS). The hip joint is a synovial joint formed by the articulation of the rounded head of the femur and the cup-like acetabulum of the pelvis. Prominent palpable bony structures of the hip bone include the iliac crest. . the greater trochanter is often the only palpable bony structure. as can happen with a tear. the anterior superior (ASIS) and posterior superior iliac spines (PSIS). The tendons that allow each finger joint to straighten are called the extensor tendons.straightened and keeps the PIP joint from bending back too far (hyperextending).] The head of the femur is attached to the shaft by a thin neck region The acetabulum is oriented inferiorly. Problems occur when the central slip is damaged. the acetabular labrum. the five or so tubercles and the lower lateral borders of the sacrum. The extensor tendons of the fingers begin as muscles that arise from the backside of the forearm bones. and ischium. It is a special type of spheroidal or ball and socket joint where the roughly spherical femoral head is largely contained within the acetabulum and has an average radius of curvature of 2. Hip Anatomy The bones of the hip region are the hip bone and the femur (or thigh bone). Finger deformities can occur when the volar plate loosens from disease or injury. the extensor tendons become the extensor hood. When the extensor muscles contract. a grip augmented by a ring-shaped fibrocartilaginous lip. which extends the joint beyond the equator. These muscles travel towards the hand. medially. as a consequence. Both joint surfaces are covered with a strong but lubricated layer called articular hyaline cartilage. As they travel into the fingers.
The extracapsular ligaments are the iliofemoral. There is also a slight rotational component in this motion. the ligamentum teres. This limits hyperextension of the knee and prevents the anterior sliding of the tibia in the femur. and the ligaments stabilize the joint. rides on the knee joint as the knee bends. and pubofemoral ligaments attached to the bones of the pelvis (the ilium. or. and ischium respectively). attaches by ligaments and a capsule to your tibia. which runs parallel to the tibia. ischiofemoral. The knee muscles which go across the knee joint are the quadriceps and the hamstrings. the muscles move the joint. The bones support the knee and provide the rigid structure of the joint. The patella or what we call the knee cap. When the knee moves. as it is medically termed. which is the large bone in your thigh. is attached to a depression in the acetabulum (the acetabular notch) and a depression on the femoral head (the fovea of the head) Knee Anatomy The knee is essentially made up of four bones. The intracapsular ligament. flex and extend. All three strengthen the capsule and prevent an excessive range of movement in the joint. Anterior Cruciate Ligament. Posterior Cruciate Ligament-Extends anteriorly and medially from a depression from the posterior intercondylar area of the tibia and lateral meniscus to the anterior part of the . The femur. Just below and next to the tibia is the fibula. pubis.Extends posteriorly and laterally from a point anterior to the intercondylar area of the tibia to the posterior part of the medial surface of the lateral condyle of the femur. The ligaments are equally important in the knee joint because they hold the joint together. it does not just bend and straighten.
There is also a bursa around the knee joint. It helps to protect the joint and allows the bones to slide freely on each other. The talus is connected to the calcaneus at the subtalar joint. the large tibia and the smaller fibula. The meniscus is a C-shaped piece of tissue which fits into the joint between the tibia and the femur.lateral surface of the medial condyle of femur. Just down the foot from the ankle is a set of five bones called tarsal bones that work together as a group. The ankle joint allows the foot to bend up and down. The knee joint also has a structure made of cartilage. or ankle bone. come together at the ankle joint to form a very stable structure known as a mortise and tenon joint. which is called the meniscus or meniscal cartilage. These bones are unique in the way they fit together. When the foot is twisted in one direction by . The two bones that make up the back part of the foot (sometimes referred to as the hindfoot) are the talus and the calcaneus. The mortise and tenon structure is well known to carpenters and craftsmen who use this joint in the construction of everything from furniture to large buildings. The arrangement is very stable. There are multiple joints between the tarsal bones. Feet Anatomy Bones and Joints The skeleton of the foot begins with the talus. The subtalar joint allows the foot to rock from side to side. that forms part of the ankle joint. or heelbone.Prevents posteriorsliding of the tibia when the knee is flexed. The two bones of the lower leg. A bursa is a little fluid sac that helps the muscles and tendons slide freely as the knee moves.
and jumping. Ligaments and tendons come in many different sizes. and movement in these joints is very important for a normal walking pattern. Ligaments are very similar to tendons. It attaches the calf muscles to the heel bone to allow us to raise up on our toes. The posterior tibial tendon attaches one of the smaller muscles of the calf to the underside of the foot.the muscles of the foot and leg. Finally. The anterior tibial tendon allows . This tendon helps support the arch and allows us to turn the foot inward. these bones lock together and form a very rigid structure. without much movement at the joints. the phalanges. Both of these structures are made up of small fibers of a material called collagen. there are the bones of the toes. The tarsal bones are connected to the five long bones of the foot called the metatarsals. The thicker the ligament (or tendon) the stronger the ligament (or tendon) is. Not much motion occurs at the joints between the bones of the toes. is the most important toe for walking. and like rope. The toes have tendons attached that bend the toes down (on the bottom of the toes) and straighten the toes (on the top of the toes). The joint between the metatarsals and the first phalanx is called the metatarsophalangeal joint (MTP). they become unlocked and allow the foot to conform to whatever surface the foot is contacting. are made up of many smaller fibers. The two groups of bones are fairly rigidly connected. and the first MTP joint is a common area for problems in the foot. running. Ligaments and Tendons Ligaments are the soft tissues that attach bones to bones. When they are twisted in the opposite direction. or hallux. These joints form the ball of the foot. The big toe. The large Achilles tendon is the most important tendon for walking. The collagen fibers are bundled together to form a rope-like structure. The difference is that tendons attach muscles to bones.
CMC and MTP. It is made up of the ligaments around the joint and the soft tissues between the ligaments that fill in the gaps and form the sac. 65 -74 years of age men more often have hip involvement than women. The fact that osteoarthritic changes are . joint swelling and night pain. Knee involvement is seen in two genders from 55-64 years of age. in the weight bearing joints and in joints that have become incongruent or have been used abnormally. Women more commonly have OA of the DIP. The cause of the degeneration is unknown. and defects in synovial fluid and chondrocyte function. Its prevalence increase with age 7% of men and 8% of women 18 – 24 years of age showed evidence of OA. By 75 to 79 years of age all had evidence of OA. The pervasiveness of osteoarthritis. Most of these ligaments form part of the joint capsule around each of the joints of the foot. PIP. EPIDEMIOLOGY: Most common form of arthritis Extremely common condition after 40 years of age It is estimated that 80% of the population will have radiographic evidence of OA by age 65 Widespread in adults older than 65 years old Men > women before the age of 45 but reverses after age 45. A joint capsule is a watertight sac that forms around all joints. Two tendons run behind the outer bump of the ankle (called the lateral malleolus) and help turn the foot outward.us to raise the foot. makes arthritis the leading cause of disability. but the possibilities include collagen framework damage secondary to fatigue or abrasion. changes in the synthesis of proteoglycan or its degradation. Degenerative changes in articular cartilage are more common and more severe with advancing age. impairment and job loss among adults and limits everyday activities ETIOLOGY: Cartilage degeneration is the hallmark of the disease. Women experience greater severity of symptoms and report more problems with morning stiffness. as well as its conditions. Many small ligaments hold the bones of the foot together.
Additionally there are changes in the composition of newly synthesized proteoglycan. there is also evidence that reduced compliance in bone and periarticular structure may initiate the degenerative process. may result from any condition that disturbs normal joint function. and the . although there is a shift from type II collagen fibers to a larger proportion of type I collagen. malalignment as a result of fractures. As the articular cartilage is destroyed the joint space narrows. It is frequently seen in the younger age range. This increase suggests that the proteoglycan have been allowed to swell with water far beyond normal. articular cartilage loses its compressive stiffness and elasticity.often localized to only part of a single joint suggests that there are causative factors other than age and attrition. Primary osteoarthritis – used to designate cases in which no underlying cause for the joint disease is clearly apparent. congenital subluxation of the hips and a host of others. w/c has been confirmed in humans is an increase in water content. Mechanical injury. decrease shock absorption and greater impact loading of the joint. Subchondral bone in turn can then become sclerotic and stiffer than normal bone. Secondary osteoarthritis – in which an antecedent disease or injury is believed to be related to the arthritis. which in turn result in the transformation of compressive forces to underlying bone. The traditional view of OA is that the disease process starts with an unpaired injury to articular cartilage. Changes in cartilage proteoglycans will also negatively affect the ability of the cartilage to form a squeeze film over its surface during joint loading. proteoglycans are lost. The process of osteophyte formation in OA is not well unerdstood. Thus there may be genetically determined chemical differences in the cartilage of some individuals that predispose it to early degeneration. there is a greater succeptibility than in those who have no family history of arthritis. One of the first noticeable changes in cartilage is the mild “fraying” or “flaking” of superficial collagen fibers. Collagen synthesis is increased initially. PATHOPHYSIOLOGY: The first osteoarthritic change in articular cartilage. may cause intra-articular changes that act as a predisposing or aggravating cause. the kind found in skin and fibrous tissues. In later stages of disease progression. Deeper fraying or fibrillation of the upper third of the cartilage follows and occurs in areas of greater weight bearing. repeated trauma. It may be localized (confined to one or two joints) or generalized (present in three or more joints). however. current hypothesis have implicated increase vascularity in degenerated cartilage venous congestion from subchondral cyst and thickened subchondral trabeculae. including burnt-out rheumatoid arthritis. The cartilage may degenerate to the point that subcondral bone is expose. These changes in cartilage and bone result in increase friction. although the mechanism by w/c this occurs is unknown. which may consist of a single major trauma or repeated minor traumas. In people over 45 years of age whose parents have suffered from arthritis late in life.
Thinning of the intervertebral disk and spur formation at the anterolateral margin of the of the vertebral bodies result from disk degeneration and reactive bone formation. Each of these hypotheses may explain how this bony growth contributes to the pain and loss of motion that accompany by OA. In later stages the vertebral bodies becomes flattened and much new bone develops about their margin.continued sloughing of articular cartilage. changes often termed spondylosis or spondylophytosis. person over 40y/o Observed in lumbar and cervical levels Constant use of back are probably an important causative factor Pathology Pathological changes are take place in the spinal diarthrodial (apophyseal) and in the intervertebral joints. Spur formation may occur about the articular facets. OSTEOARTHRITIS OF THE SPINE Extremely common Seen often in stocky and obese Male > female. they may be represent a related but distinct degenerative process. Roentgenograms are present to some degree in a high percentage of old people who have never had significant backpain. Clinical features Morning stiffness Radiating pain around toward the chest or abdomen or down the legs or arm. this true of heavy individuals. Ultimately there are frequently develops so much disk space narrowing and osteophyte formation that is stiffened but very stable and relatively painless articulation result. . producing so called bridging and leaf formation. usually accompany OA of the facet joints.
Salicylates for relieving discomfort. OSTEOARTHRITIS OF THE HANDS OSTEORTHRITIS OF THE KNEE Of the major joints the knee is the most frequently affected by OA. Treatment Rest and restriction of activity. Attacks tend to occur less frequently when the spine becomes more stable. Thomas collar may be very effective in the management of neck pain Surgical treatment when there are sign of nerve root or spinal cord compression by osteophytes.Radiating pain is particularly common in the lumboscaral joints and of the intervertebral foramina of the cervical spine Deformity of the lumbar spine (lateral curvature and decrease normal lordosis may develop). Knee problems may be unilateral. Hot packs and the use of massage. bilateral or tricompartmental. Pain in the knee with OA may be due to: Loss of cartilage Mechanical compression of the medial knee compartment .
Acute pain and swelling. though for less duration than occurs with rheumatoid arthritis. weight reduction in obese patients. active person with severe degenerative changes limited to one knee. Pain and swelling o the knee lead to restricted ROM and contractures of the joint capsule and hamstrings. Crutches may be needed until acute symptoms subside. are treated by hot compress. but the durabiity of total knee arthroplasty in an active patient is yet to be established. The treatment of early osteoarthritis of the knee consists of strengthening exercises for the quadriceps and hamstring muscles. Microfractures and subchondral fractures Capsular distention by effusion Physical findings include slight limitation of the joint motion. Arthroplasty. by total joint replacement may result in a painless joint with satisfactory motion. and mild to moderate joint effusion. there is . OSTEOARTHRITIS OF THE HIP Hip osteoarthritis is caused by deterioration of articular cartilage and wear-andtear of the hip joint. Total joint replacement the treatment of choice in severe bilateral osteoarthritis of the knee. A varus or valgus deformity may be associated with some mediolateral instability. Most significantly. Morning stiffness. usually restriction of the last few degrees of flexion and extension. often following a twisting injury or stressful use of the joint. There are several reasons this can develop: previous hip injury previous fracture. Osteotomy can correct the deformity and shift the weight bearing load to the less involved side of the jt. rest. which changes hip alignment genetics congenital and developmental hip disease subchondral bone that is too soft or too hard avascular necrosis Patients who have hip osteoarthritis have pain localized to the groin area and the front or side of the thigh. Arthrodesis for a younger. and an elastic knee support. is also characteristic of hip osteoarthritis.
realigns angles of the hip joint total hip replacement . For mild cases. The symptoms can worsen to the point that pain is constantly present.an arthroscope checks the condition of the articular cartilage osteotomy . Symptoms of Foot Osteoarthritis . and pain which occurs with movement. CT scans. Surgery is appropriate for patients with hip osteoarthritis who have failed other more conservative treatment options. Foot will be examined for swelling. joint protection) patient education Surgery is considered a last resort treatment option. Surgical procedures include: arthroscopy . or MRI may be used to help diagnose foot osteoarthritis. There are also non-drug treatments that can help: weight loss (normal weight people have a 20% risk of hip OA. Imaging studies of the bone structure of the affected foot will likely be performed. limited range of motion.limited range of motion of the hip and pain during motion. Medications are one way to treat hip osteoarthritis. Evidence from X-rays. overweight have 25% risk. bone spurs or other deformities.new acetabular and femoral components are implanted OSTEOARTHRITIS OF THE FEET Diagnosis of Foot Osteoarthritis Doctors will perform a physical examination. acetaminophen is usually tried first. and obese have 39% risk) water exercise programs physical therapy (range of motion and strengthening exercises) occupational therapy (assistive devices. NSAIDs (non-steroidal anti-inflammatory) and opioid analgesics are used for moderate to severe hip osteoarthritis. A gait analysis may be performed to evaluate stride while walking and the strength of the feet.
calcaneocuboid joint) the midfoot (metatarsounieform joint) the great toe (first metatarsophalangeal joint) Treatment of Foot Osteoarthritis Treatment options for foot osteoarthritis are aimed at relieving symptoms. The foot joints that are most commonly affected by osteoarthritis include: • • • • the ankle (tibioltalar joint) the 3 joints of the hindfoot (talocalcaneal joint. your doctor may suggest surgery. Your doctor will likely recommend one or more nonsurgical options first. The goal of foot surgery is to relieve pain and restore function. talonavicular joint. Depending on the joint involved. or arthroplasty (joint replacement) may be considered. There are non-surgical and surgical options.The usual symptoms associated with foot osteoarthritis include: • • • • pain and stiffness of the affected foot swelling near the affected joint limited range of motion and difficulty walking bony protrusions (spurs) There are 28 bones and more than 30 joints in the human foot. Non-surgical options include: Non steroidal anti-inflammatory drugs or analgesics (to relieve pain and swelling) Shoe inserts (to add support or provide extra cushioning) Orthotics (custom-made shoes or suppports) Braces (to restrict motion or prevent more deformity) Physical therapy or exercise (to improve range of motion and stability) Steroid injections (to deliver anti-inflammatory medication to the joint directly) Dietary supplements If non-surgical options are ineffective. CLINICAL MANIFESTATIONS: . arthrodesis (fusion). arthroscopy.
associated with an aching pain in or about the affected joint The involvement is more often monoarticular than polyarticular Continued use of the joint increases discomfort which may be relieved by rest. . Less frequent is similar enlargement of the PIP joints (Bouchard’s nodes) Late Stage of Osteoarthritis There is limitation of joint motion and disability. support and heat. bony enlargement of the DIP joints (Heberden’s nodes) is one of the commonest sign. The patient tires easily on exertion The symptoms are worse in cold. especially in the larger weightbearing joints Pain may then be present even when the joint is at rest. wet weather There is slight enlargement of the affected joints which may be slightly tender about margins (such changes are usually most noticeable in the fingers and knees) In the hands.Common Areas of Affection of Osteoarthritis Early Stage of Osteoarthritis Usual complains of stiffness of one or more joints.
After the acute phase of rheumatic fever the joints recover completely. especially in the absence of an increase of the non-protein or urea nitrogen. Joint Tuberculosis In its early stages. ankylosis and invalidism in its late stage. it may be confused with rheumatoid arthritis. may produce transient locking Examination at this stage reveals moderate swelling and puffiness with loss of the normal joint contour A tendency to early fatigue is more pronounced DIFFERENTIAL DIAGNOSIS: Rheumatic Fever Acute inflammatory stage that may initially appear as migratory polyarthritis simulating early rheumatoid arthritis. Serologic tests may aid in the differentiation. High fever and leukocytosis may distinguish the early case from rheumatoid arthritis and destructive changes in the roentgenograms may distinguish the late case. Malalignment of the joint is a frequent result of the irregular degeneration and loss of articular cartilage Crepitation may be noticed frequently. Aspiration of the joint may yield pus and a positive culture confirms the diagnosis. however tuberculosis is more often monoarticular. Culture of the joint exudates or biopsy of the synovial membrane may be necessary to establish the diagnosis. more insidious its onset and is likely to show more bone destruction roentgenographically. Gout Its high blood uric acid level is characteristic. Pyogenic Arthritis A single large joint is involved. The patient with acute rheumatic fever is more likely to have had a streptococcic throat infection and to have electrocardiographic changes and a high fever. Rheumatoid Arthritis It is a connective tissue disease characterized by chronic inflammatory changes in the synovial membranes and other structures by migratory swelling and stiffness of the joints in its early stage and by a variable degree of deformity. unlike their usual course in rheumatoid arthritis. especially in the knee. It may be possible to demonstrate urate crystals in the joint aspirate by means of polarized light microscopy. In gout .
subcutaneous nodules and high titers of rheumatoid factor in the serum.the joint quickly loses its tenderness between attacks and the great toe is often the first part of the body to be affected. Systemic Lupus Erythematous The patient usually shows minimal joint changes. splenomegaly. Reiter’s Syndrome It is an ill-defined disease occurring chiefly in adult males and characterized by the triad of polyarthritis. Ankylosis Spondylitis A chronic arthritis usually beginning in the sacroiliac joint and lumbar spine and extending proximally. There is also a postdysenteric form of the disease that may follow Shigella infections. This may be an atypical or prodromal form of rheumatoid arthritis or other connective tissue disease. Psoriatic Arthritis A polyarthritis resembling but probably distinct which is associated with psoriasis. severe systemic symptoms and the characteristic lupus erythematosus cell phenomenon. nongonorrheal urethritis and conjunctivitis. Felty’s Syndrome A severe arthritis associated with leucopenia. Distinguishing features include frequent involvement of the distal interphalangeal joints. Intermittent Hydrarthrosis A recurring joint effusion characterized by an absence of acute inflammatory signs and by a relatively constant periodicity. Palindromic Rheumatism Characterized by repeated brief episodes of acute arthritis with signs of local inflammation but without residual joint damage. Juvenile Rheumatoid Arthritis (Still’s Disease) This is an uncommon crippling disease of childhood. Enteropathic Arthritis . sometimes associated with marked destruction of bone (arthritis mutilans) and the absence of subcutaneous nodules and of rheumatoid factor in the serum. the systemic form of which is associated with fever and enlargement of lymph nodes and spleen. Children s affected may develop morbilliform rash and severe systemic manifestations. The knee is most frequently affected.
Many times. salivary and other glands. heart. although it stabilizes in some patients. then stabilization for a period). and more severe joint pain can predict subsequent worsening in function in patients with OA of the knee. The course of those with progressive disease is usually one of intermittent worsening (worsening. It is most common in the hip. Sjorgren’s Syndrome An immunologic disease characterized by deficient moisture production of the lacrimal. better mental health. Eventually. and shoulder. An unstable joint. the healthy part of the bone may collapse. which can increase the risk of joint instability). This is called "idiopathic aseptic necrosis" -. . A peripheral polyarthritis associated with chronic bowel disease such as ulcerative colitis or Crohn’s disease. and those who are better able to perform aerobic exercise experience less disability than those with lesser amounts of these factors. intestines. or a severe trauma. obesity.. Aseptic necrosis can be caused by disease. After a while part of the bone breaks off. lungs. synovium.g. Progressive Systemic Sclerosis (Scleroderma) Generalized disorder of connective tissue characterized by fibrosis and degenerative changes in the skin. In contrast.aseptic necrosis without any known cause. If this condition is not treated. no trauma or disease is present. such as a break or dislocation. The course of the peripheral arthritis generally follows that of the bowel disorder. Patients with OA may be able to function normally despite pain or may have varying degrees of physical disability. digital arteries or certain internal organs notably the esophagus. impaired sensation. bone damage gets worse. that affects the blood supply to the bone. patients with better muscle strength. rather than a slow decrease in function. Exercise may help to prevent loss of strength and decrease disability. those who avoid activity due to pain may develop muscle weakness. PROGNOSIS: Osteoarthritis generally worsens slowly over time. stronger social supports. Worsening disability may be correlated with coping styles (e. Aseptic necrosis Bone death caused by poor blood supply to the area. knee. kidney and thyroid. Aseptic necrosis occurs when part of the bone does not get blood and dies.
Luke’s/Roosevelt Hospital and associate professor of medicine at Columbia University. scleroderma. MD. lupus. Determining which joints is involved and how their function is impaired helps the physician to distinguish OA from other forms of arthritis.MEDICAL MANAGEMENT: Diagnostic Procedure Physical Examination A primary care physician or rheumatologist (specialist in rheumatic disorders of the joints and related structures) will ask about: Joint symptoms Previous or current illnesses Traumatic injuries Operations you may have had Allergies Other medical conditions The physician will inspect the affected joint(s). Tests to detect specific subsets of these antibodies can be used to confirm the diagnosis of a particular disease or form of arthritis. skin rashes. If your symptoms and physical examination suggest rheumatoid arthritis. underused joints may show signs of weakness. chief of rheumatology at St. The muscles that surround painful. . Sjogren’s syndrome. they are very important to verify and confirm the presence of some diseases. and other bodily signs. The pattern of arthritis in the hands may be especially helpful in the diagnosis. checking for swelling. tender points. the following tests can often confirm your doctor’s suspicions: Antinuclear antibody (ANA) – Commonly found in the blood of people who have lupus. ANAs (abnormal antibodies directed against the cells’ nuclei) can also suggest the presence of polymyositis. redness and heat. Sjogren’s syndrome. Laboratory Tests While lab tests aren’t needed for every form of arthritis. Lyme disease or one of a few other inflammatory forms of arthritis. mixed connective tissue disease or rheumatoid arthritis. OA tends to involve the base of the thumb and the middle and end joints of the digits. according to Robert Lahita.
this test helps doctors diagnose gout. Uric acid – By measuring the level of uric acid in the blood. vasculitis (inflammation of the blood vessels) and psoriatic arthritis. a joint fluid test may show that an infectious agent has been eradicated by . confirming a diagnosis of gout or bacteria. the greater the amount of inflammation. Rheumatoid factor (RF) – Designed to detect and measure the level of an antibody that acts against the blood component gamma globulin. fall and settle (like sediment) in the bottom of a glass tube over the course of an hour. HLA tissue typing – This test. Monitoring Disease Severity and Medication Response To determine the progression of the disease or how it is responding to treatment. suggesting that the joint inflammation is caused by infection. can often confirm a diagnosis of ankylosing spondylitis (a disease involving inflammation of the spine and sacroiliac joint) or Reiter’s syndrome (a disease involving inflammation of the urethra. The higher the rate. eyes and joints). Joint fluid tests – In this procedure. which is similar to drawing blood. Erythrocyte sedimentation rate – Also called ESR or “sed rate. The genetic marker HLA-B27 is almost always present in people with either of these diseases. causing inflammation and severe pain. doctors sometimes use some of the same tests they use to diagnose arthritis. the surgeon can take a sample of muscle to be examined for signs of damage to the muscle fibers. such as lupus. An examination of the fluid may reveal uric acid crystals. Findings can confirm a diagnosis of polymyositis or vasculitis. Muscle biopsy – By going a little deeper into the tissue than with the skin biopsy. this test is often positive in people with rheumatoid arthritis. Lyme serology – This test detects an immune response to the infectious agent that causes Lyme disease and thus can be used to confirm a diagnosis of the disease. Skin biopsy – Taking small samples of skin and examining them under a microscope can help doctors diagnose forms of arthritis that involve the skin. the doctor inserts a needle into a joint space and removes fluid.” this test measures how fast red blood cells cling together. which detects the presence of certain genetic markers in the blood. a condition that occurs when excess uric acid crystallizes and forms deposits in the joints and other tissues. For example.
Low counts may suggest that your medications are causing gastrointestinal bleeding. thus. SGPT. For that reason. or “sticky” cells. Platelet count – This test measures the number of platelets. Muscle Enzyme tests (CPK. which measure levels of liver enzymes in the blood. alkaline phosphatase) – These tests. In other cases. Checking for Drug Side Effects Often a drug side effect is obvious – you become nauseated. Doctors may use this test to monitor kidney function in people with lupus or in those taking medications that could affect the kidneys. White blood cell count – A blood test showing a low number of infection-fighting white blood cells may suggest that your medication is decreasing your supply of white blood cells and. Such tests can measure the amount of muscle damaged as well as how effective medication has been in reducing the inflammation that caused the muscle damage. doctors often use lab tests to check for side effects – before they become major problems. Hematocrit (HCT) and hemoglobin (Hgb) – These tests measure the number and quality of your red blood cells. The following tests are the most common: Liver enzyme tests (SGOT. Or a “sed rate” test may be conducted a number of times to determine if inflammation is subsiding. that help the blood to clot. aldolase) – Muscles that have been damaged by some rheumatic diseases release certain enzymes into the blood. a normal waste product of the muscles. in the blood. Salicylate level – This test measures the amount of salicylate (the main ingredient in aspirin and in some other NSAIDs) in the blood to determine if enough is being absorbed to effectively reduce inflammation. A low number of platelets could suggest that your medication has put you at risk of bleeding heavily. bilirubin. the effects progress unnoticed – until a liver is damaged or a silent ulcer begins to bleed dangerously. develop a rash or experience blurred vision or ringing in your ears. The test can also determine if the level of salicylate is high enough to create dangerous side effects. and these enzymes can be detected through blood tests.antibiotics. your body’s chances of fighting infection. Lab Tests’ Limitations . can help doctors determine if certain medications have caused damage to the liver. A test showing a high level of creatinine means that the kidneys are not working well enough to remove waste products from the body. Creatinine test – This test is used to determine the extent of kidney function by measuring the level of creatinine.
Other tests. others may be positive in people who don’t have – or may never develop – a particular disease. The goals of drug therapy in patients with OA are to relieve pain and decrease inflammation when it is present. determine the cause of chronic back pain or examine internal organs affected by some forms of arthritis. The right tests. may be required to diagnose osteoarthritis. however. and progression of deformity. only one in five people tests positive for rheumatoid factor. Surgical Intervention Surgery represents one of the greatest advances in the management of arthritis in the last 40 years. lab tests have their limitations. release c) Tendon transfers Three procedures for bone and joint: a) Osteotomy b) Arthroplasty c) Arthrodesis Drug Therapy Drug therapy on OA has no effect on disease progression and is ancillary to the more general measures of pain control. although the last two are not always correlated. 15 to 20 percent of people without ankylosing spondylitis have the HLA-B27 genetic marker. lab tests are essential to the diagnostic and treatment process. for every individual with either RA or OA. for instance. along with your doctor’s own observations and your participation in the process. loss of function. In the early stages of rheumatoid arthritis. including X-rays and magnetic resonance imaging. Three procedures for soft tissue: a) Synovectomy b) Soft tse. Surgery is not appropriate. PT Management . Even so. can help you get the safest and most effective treatment for your disease.Despite their many benefits. The primary indications for surgery are pain. and the careful selection of the patients and the timing of the procedure are critical. Some may show negative results even when a person has the disease being tested for. Not all forms of arthritis can be confirmed by lab tests.
Maintain and regain adequate levels of physical activity. light intensity isometric contraction. 2. Prevent position of deformity. Pacing . non-weight bearing quadriceps and hamstring isometric and should be performed 2x daily. hold for 6 sec. 4. stationary bicycles) progressive resistive isotonic exercise For strengthening. x 10 reps. Joint conservation technique: 1. With patellofemoral disorder. quadriceps isometrics with the knee extended are best to avoid patellafemoral compression. isotonic exercise functional exercise ROM proprioceptive training balance training endurance training (walking. Respect the pain. Use larger joint joint than smaller joint. 3. Hot Packs Cold Packs PWB TENS orthoses alleviate pain through biomechanical support Patellofemoral Taping long shifting knee bones Adequate quality and quantity of sleep at night and short rest during the day is advisable. ROM 5.
B.N Feb. 1. Manila Married ® Former teacher Philippine Orthopedic Center (OPD) Hospicio de San Jose Rehab Unit Dr.A 67 y/o ♀ 1928 Malvar St.D: Rehab M.D: Date of Referral: Date of PT Consultation: Date of I. 8. 2010 Feb.6. 2010 Osteoarthritis of the ® knee HPI: . 2010 Feb. Rest. M. INITIAL EVALUATION GEN INFO: Patient’s Initial: Age: Sex: Address: Civil Status: Handedness: Occupation: Referring Unit: Rehabilitation Unit: Referring M. Use of adaptive device. 7. 2. Use devices to protect joint.E: Dx: O. 2. Sta Ana.A Dr.
Pt also experienced ® knee joint stiffness upon awakening especially in the morning and relieve in less than 30 minutes with mild exercise. gardening. M. 1.A Date Feb. going to the park). getting up and down from sitting) and using stairs. M.1. 2010 Feb. 2010 . and was given medication (see present medications).2/10. the intermittent dull nagging pain on ® knee increased from 5/10 7/10 with marked stiffness. was diagnosed to have OA of the ® knee. 2010 Feb.1. A week after was referred to PT for further evaluation and tx. ANCILLARY PROCEDURES: Diagnostic Procedure X-ray Findings Cartilage degeneration M. experienced intermittent dull nagging pain on ® knee with a P/S of 3/10 upon walking from her house going to the park ~25 meters then pt decided to go home. M.A Date Feb. The pt lessened her daily activities (doing household chores.Present condition started 6 months PTC when pt.1. 3months PTC. getting in and out of a car. 1 month PTC.1.A Dr. These had made it difficult for the pt to do sit to stand activities (going to bathroom. M.A Dr. This condition last for about 48 weeks.A Dr. Pt. decided to take medication (Flanax 500 mg PRN) the pain decrease from 5/10 .D Dr. 2010 Feb. This prompted the pt to seek medical assistance and undergone diagnostic procedures (see ancillary procedures). use eficascent oil and took a rest and the pain subsided. Pt. the intermittent dull nagging pain on ® knee increased from 3/10 -5 /10 upon walking from her house going to the sari – sari store ~12 meters. This lasted for about 47 weeks. M. 2010 Laboratory Exams ESR RF ANA Synovial Fluid PRESENT MEDICATIONS: Findings (N) (-) RF (-) ANA Clear M.D Dr.
i. Pt works as a teacher for 5yrs. b. jolly and happy person Sedentary Lifestyle. controlled (Metformin 500 mg) since 1986 (-) hospitalization (-) Cardiopulmonary Problems (-) Trauma. Indication Osteoarthritis. controlled (Metoprolol 50 mg) since 1986 Highest BP: 160/90 mmHg Baseline: 130/80 mmHg Lowest BP: 110/80 mmHg (+) NIDDM. spends most of the time at home watching TV (-) alcohol beverage drinker (-) smoker Diet includes rice.i.d. b. cooking and gardening. (frequent walking) .O.O.i.d. b. 50 mg P.O. 500 mg P. Analgesia Htn DM (+) HTN.d. meat and vegetables Hobbies include cross stitching. (-) fx FMHx: HTN DM Arthritis Cardiac Condition Pulmonary Condition PSEHx: Paternal (+) (+) (-) (-) (-) Maternal (+) (-) (+) (-) (-) Type A personality.Dosage Voltaren Metoprolol Metformin PMHx: 50mg P.
Pt lives in a two-story house c her daughter’s family Financially stable Home set-up: ~ 10 steps from the garden to front door ~ 10 steps from the front door to living room ~ 10 steps from living room to bathroom ~ 15 steps from bathroom to dining room ~ 30 steps from dining room to master’s bedroom ~ 10 step-staircase S: c/o: “Sumasakit ang kanang tuhod ko lalo na kapag naglalakad ako” ~15 meters PT Translation: Pt complains of intermittent dull nagging pain (p/s 5/10-7/100 on ® knee and is aggravated upon walking approximately ~15 meter Pt Goal: To relieve the intermittent dull nagging pain on ® knee and eliminate the difficulty in ADL.P a: p: 130/80 mmHg 130/70 mmHg 140/90 mmHg During: RR: a: p: 16 cpm 16 cpm . O: VS: B.
PR: a: p: 80 bpm 79 bpm T: 37.1˚ C *(axillary) Findings: Normal VS Significance: For baseline purposes OI: ambulatory c moderate difficulty s assistive device endomorph alert. cooperative (+) swelling ® knee (+)® genu varum (+) postural deviation (see postural analysis) (+) gait deviation (see gait analysis) (-) erythema on ® knee (-) skin discoloration PALPATION: Normothermic on all exposed body parts on (B) UE/LE except Hyperthermic ® knee Normotonic on all exposed body parts on (B) UE/LE Senile skin turgor & consistency (+) crepitus on ® knee (+) grade 3 tenderness on ® knee (+) joint effusion on ® knee (+) moderate osteophyte formation SENSORY A: Superficial Somatic Sensation . coherent.
superficial pain and thermal sensation Significance: For baseline purposes DTR: Legend 0 + ++ +++ ++++ Areflexia Hyporeflexia Normoreflexia Hyperreflexia Clonus Findings: Normoreflexia on (B) UE/LE Findings: For baseline purposes ROM .(STD Used) Superfical pain-pinprick Light touch-wisp of cotton Thermal sensation-hot/cold using test tube Findings: (N) sensation of (B) UE/LE as to light touch.
100 0 .135 P 0 .95 DIFFERENCE A 45 P 40 ENDFEEL boggy 135-0 135-0 0 .90 P 0 .All joints of (B) UE and LE are WNL. Action ® Knee flexors ® Knee extensors Grade 3/5 3/5 Findings: muscle weakness on ® knee flexors and extensors Significance: 2˚ to pain . actively and passively done pain free c normal end feel except for the following: MOTION Knee flexion Knee extension (L) A 0 .135 ® A 0 .105 35 30 boggy Findings: LOM on ® knee flexion and extension Significance: 2˚ to joint effusion MMT All ms of (B) UE and LE are grossly graded 5/5 except for: Note: Break Test was used on ® knee flexors at 90˚ and ® knee extensors at 100˚.
The knee is actively extended with the tibia medially rotated. Findings: Pain is evident all throughout the motion indicating of (-) osteochondritis dissecans Significance: for ruling out purposes FUNCTIONAL ANALYSIS: Legend Tolerance Balance . The patient is then asked to rotate the tibia laterally and the pain disappears.SPECIAL TESTS Test: Bulge Test The examiner commences just below the joint line on the medial side of the patella. This finding indicates a positive test. A wave of fluid passes to the medial side of the joint and bulges out just below medial distal portion or border of the patella. The wave of fluid may take up to 2 seconds to appear. the pain in the knee increases. which is indicative of osteochondritis dissecans of the femoral condyle. stroking proximally toward the patient’s hip as far as the suprapatellar pouch two or three times with the palm and fingers. At approximately 30° of flexion (0° being straight leg). With the opposite hand. and the patient is asked to stop the flexion movement. Findings: (+) bulging of fluid just below the medial distal portion of the patella Significance: 2° to joint effusion Test: Wilson Test The patient sits with the knee flexed over the examining table. the examiner strokes down the lateral side of the patella.
maintain and weight shift can assume and maintain can assume can neither assume nor maintain >45 31- 16-30 mins 1-15 mins 0 min Balance Sitting Standing N F Tolerance N F Findings: Pt has normal balance and tolerance as to sitting.N (normal) mins G (good) 45 mins F (fair) P (poor) O (zero) can assume. (N) balance and fair tolerance as to standing Significance: 2˚ to pain on ® knee POSTURAL ANALYSIS: All bony landmarks are level except: Anterior ASIS are level ® Knee medial angulation Posterior PSIS are level ® Knee medial angulation Findings: (+) postural deviation manifested by genu varum on ® knee Significance: 2˚ to position of comfort . maintain. weight shift and challenged can assume.
2 in. speed Arm swing (N) 15 in. walking 80 m Result 12 in. 60 m (N) Difference 3 in. 2-4 in. 90-120 steps/min. 30 in. 70 steps/min. 0 0 20 steps/min.GAIT ANALYSIS: Hip Stance phase Heel strike Foot Flat Mid Stance Heel Off Toe Off Swing phase Acceleration Mid Swing Deceleration ® Decrease Decrease Decrease Decrease Decrease (L) Increase Increase Increase Increase Increase ® Knee (L) Increase Increase Increase Increase Increase ® Ankle (L) Increase Increase Increase Increase Increase Decrease Decrease Decrease Decrease Decrease Decrease Decrease Decrease Decrease Decrease Increase Increase Increase Decrease Decrease Decrease Increase Increase Increase Decrease Decrease Decrease Increase Increase Increase Decrease Decrease Decrease Other Parameters Step length Stride length Base width Cadence Ave. 30 in. 20 m Findings: (+)antalgic gait Significance: 2˚ to OA of the ® knee ADL: Fully dependent Self-care: Bathing Toileting Eating Partially dependent Independent √ √ c minimal difficulty √ .
3. weakness on ® knee flexors and extensors Grade 3 tenderness on ® knee Joint effusion ® knee Impaired standing balance and tolerance Moderate difficulty as to ambulation.Grooming UE dressing LE dressing Bed mobility: Supine to sidelying Supine to long sitting Rolling Transfers: Bed óchair Ambulation √ √ √ c minimal difficulty √ √ √ √ c minimal difficulty √ c moderate difficulty Findings: Pt can perform all ADL but with moderate difficulty at most as to ambulation. Maintenance of physical therapy is advised to prevent aggravation of pain and deformity. LE dressing and self-care as to . Pt have DM &Htn. transfer lower extremity dressing and self-care as to toileting Significance: 2˚ to pain and deformity A: PT Impression: Pt presents with intermittent dull localized aching pain upon walking 2 0 to OA on ® knee Rehab Potential: Pt has only a fair potential 2˚ to old age. PROBLEM LIST: 1. Intermittent dull nagging pain of 7/10 on ® knee LOM on ® knee flexion and extension ms. Avoid excessive knee motion. 7. Rehab Precaution: monitor BP. 5. 2. transfer. 4. 6.
HMP with TENS x 20 min on ® knee. 7. STG: (6-8 sessions) 1 1 To decrease the intermittent dull nagging pain from 7/10 to 3/10 on ® knee. 8. Gait training using cane. Postural deviation 9. To increase ROM by 5-10 increments on ® knee flexion and extension To increase muscle strength on ® knee flexors and extensors To reduce swelling on ® knee To improve standing balance and tolerance. transfer. 2.5w/cm2 on ® knee. 1 1 1 1 1 1 1 1 1 1 P: Mgt: 1. 4. LE dressing and self-care as to toileting) 1 1 To improve posture. To attain the highest functional level of the pt as to ADL (ambulation. 1 1 To improve gait pattern. Pool Therapy x 1 a week. LE dressing and self-care as to toileting) s pain s/c assistive device. 3.. To prevent the progression of deformity.toileting 8. US x 1. transfer. To maintain the general body condition of the pt. PRE’s on (L) side using ankle weights towards knee flexion and extension x 10 reps x 2 sets. 5. 3. To maintain the normal integrity of unaffected limbs. 2. Bicycle ergometer x 10 minutes 6. Gait deviation LTG: 1. Isometric exercise 4. Patellar mobilization . To improve performance of ADL as to ambulation.
use a cane as an assist. . Always maintain an extended knee position during rest. 5. Quadriceps isometrics x 6 secs hold x 10 reps x 2 sets. Avoid the use of pillow under the knee at night because this encourages knee and hip flexion contracture. Avoid walking far distances and if un-avoided. Step exercises on the staircase as tolerated. 4. 2. a.HI: 1. b. Put a hot towel over the ® knee every time the pain is felt. Perform the instructed exercises at home. 3. plantar flexion at the ankle and venous obstruction in the popliteal area.
MARY ROSE ROJO . ALAN TROY L. UDM PT-INTERN BATCH 2012 SUBMITTED TO: MS.HOSPICIO DE SAN JOSE PHYSICAL THERAPY UNIT AYALA AVENUE. MANILA WRITTEN REPORT IN OSTEOARTHRITIS DE LEON.
It is wonderful to think what music can do in their behavior that might help us understand & in order to treat them well as a whole individuals capable of connecting to the society through music.MUSIC THERAPY JUNE 13. There are no cryings or any unwanted behavior that manifest during that span of time. Some of the children even dance and sing together with us. most of the children reacted positively to the music that is being played. Everything is in its right place. It seems like they are in some form of state wherein everything is serene. It is composed of songs that is weel suited for pediatric patients. This music therapy is such a great opportunity for I witness the undisputed effect of music to those kids. Most of them.DE LEON. acts in such a way that is in synchrony & some form of contact to the music. . Music therapy is purely music being played in a room where the patients are gathered. at first I thought that it would be just like any other treatments combined with background music but then I was mistaken. At first. peaceful & calm. the children's behavior are the usual that they showed to us during treatments but when the music therapy started. ALAN TROY L. UDM PT INTERN BATCH 2012 REACTION PAPER.2011 It was my first time to attend & witness what a music therapy is.
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