OSTEOARTHRITIS

Presented by:
V.ELAMATHI
Mpt, 2ndyr.
•

INTRODUCTION :
OSTEOARTHRITIS (OA) IS PRIMARILY CONFINED TO ONE OR MORE SYNOVIAL
JOINTS AND ITS SURROUNDING SOFT TISSUES.
• OSTEOARTHRITIS IS A PAINFUL, CHRONIC JOINT DISORDER THAT PRIMARILY
AFFECTS THE JOINTS OF THE KNEES, HANDS, HIPS AND SPINE. THE INTENSITY
OF THE SYMPTOMS VARY FOR EACH INDIVIDUAL AND USUALLY PROGRESS
SLOWLY.
• CHARACTERIZED BY GRADUAL DETERIORATION AND LOSS OF CARTILAGINOUS
WEIGHT BEARING SURFACE OF THE JOINTS, SCLEROTIC CHANGES IN
SUBCHONDRAL BONE.
• IT MAINLY AFFECTS PEOPLE OVER THE AGE OF 40 YEARS.
• IN OSTEOARTHRITIS, THE CARTILAGE IN BETWEEN THE JOINT GRADUALLY
WEARS AWAY. AS THE CARTILAGE WEARS AWAY, IT BECOMES FRAYED AND
ROUGH, AND THE PROTECTIVE SPACE BETWEEN THE BONES DECREASES. THIS
CAN RESULT IN BONE RUBBING ON BONE, AND PRODUCE PAINFUL BONE SPURS.
OSTEOARTHRITIS USUALLY DEVELOPS SLOWLY AND THE PAIN IT CAUSES
WORSENS OVER TIME.
 PATHOLOGY OF OSTEOARTHRITIS : • WEIGHT-BEARING JOINTS OF
THE LOWER LIMBS AND SPINE ARE MOST COMMONLY INVOLVED IN
OSTEOARTHRITIS.
• THE ARTICULAR SURFACE BECOMES ROUGH AND THE CARTILAGE IN THE
AFFECTED AREA DEGENERATES, PARTICULARLY AT THE POINTS OF GREATEST
PRESSURE. WHILE AT THE MARGINS OF THE JOINT OSTEOPHYTES ARE FORMED.
• THE LUBRICATION MECHANISM OF THE JOINT IS AFFECTED AND IT MAY BECOME
DRY AND CREAKY, EVEN TO THE EXTENT OF THE INDIVIDUALS BEING ABLE TO
HEAR THE JOINT CREPITUS.
• THE MUSCLES CLOSE TO AN AFFECTED JOINT MAY SPASM AS A PROTECTION
MECHANISM TO PREVENT PAINFUL MOVEMENT, ALSO MUSCLES MAY BE
ATROPHIED.
CLASSIFICATION 1- PRIMARY OSTEOARTHRITIS: IT DEVELOPS SPONTANEOUSLY
IN MIDDLE AGE, AND APPEARS TO BE IDIOPATHIC. IT CAN BE LOCALISED OR
GENERALISED.
2- SECONDARY OSTEOARTHRITIS HAS AN UNDERLYING CAUSE. IT MAY DEVELOP
IN RESPONSE TO A NUMBER OF DIFFERENT FACTORS SUCH AS:
• 1- TRAUMA AFTER SEVERE INJURY, RESULTING IN FRACTURES OF THE JOINT
SURFACES, LIGAMENTS INJURIES AND MENISCAL DAMAGE.
• 2- DISLOCATION. 3- INFECTION. 4- INFLAMMATORY ARTHRITIS 5- LOSS OF FULL
RANGE OF MOTION, POOR MUSCULAR POWER AND STRENGTH 6- LOSS OF
ADEQUATE JOINT ALIGNMENT AND DEFORMITY. 7- OBESITY. 8- HEMOPHILIA.
9- HYPERTHYROIDISM.
 RADIOGRAPHY:

The Kellgren and Lawrence 5-point classification system remains the most widely used criteria
for grading radiographic changes. • Grade 0: normal radiograph • Grade 1: doubtful narrowing
of the joint space and possible osteophytes • Grade 2: definite osteophytes and absent or
question- able 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.
CAUSES OF OSTEOARTHRITIS THE CAUSE IS UNKNOWN BUT A NUMBER OF
PREDISPOSING FACTORS MAY BE CONSIDERED: 1- CONDITIONS IN SECONDARY
OSTEOARTHRITIS.
2- HERIDITARY. 3- POOR POSTURE AND ALTERED BIOMECHANICS OF THE JOINT. 4-
THE AGEING PROCESS IN JOINT CARTILAGE. 5- DEFECTIVE LUBRICATING
MECHANISM AND UNEVEN NUTRITION OF THE ARTICULAR CARTILAGE,
RECURRENT SYNOVIAL EFFUSION.
SYMPTOMS 1. PAIN WITH OR AFTER MOVEMENT: USUALLY PAIN IS EXACERBATED
WITH ACTIVITY AND IS WORST AT THE END OF THE DAY AND IN BED AT NIGHT. 2.
JOINT PAIN DECREASED OR RELIEVED WITH REST, MUSCLE SPASM. 3. SWELLING
MAY BE DUE TO BONY DEFORMITY SUCH AS OSTEOPHYTES FORMATION, OR DUE
TO AN EFFUSION CAUSED BY SYNOVIAL FLUID ACCUMULATION AFTER
PROLONGED ACTIVITY. 4. FEELING OF STIFFNESS IN THE AFFECTED JOINTS. E.G.
EARLY MORNING STIFFNESS OF LESS THAN 30 MINUTES. 5. REDUCED PHYSICAL
FUNCTIONING.
JOINTS
• HANDS AND FINGERS OSTEOARTHRITIS MAY PRESENT DIFFERENTLY AND
RESULT IN VARIED LEVELS OF IMPAIRMENT DEPENDING ON THE JOINTS
INVOLVED. IN THE HAND, DIP AND PIP INVOLVEMENT MAY RESULT IN REDUCED
ROM, POOR GRIP STRENGTH, BONY NODES .
DEFORMITY:
BOUCHARD’S NODES AT THE PIP JOINTS AND HEBERDEN’S NODES AT THE DIP
JOINTS ARE OFTEN TENDER IN THE EARLY STAGES AND CAN LEAD TO MARKED
RESTRICTIONS IN FINGER ROM AND FINE MOTOR SKILLS.
•
• HIP OA : DECREASED ROM WITH A TENDENCY FOR THE HIP TO BE
HELD IN A SOMEWHAT FLEXED, ABDUCTED, AND EXTERNALLY
ROTATED POSITION. INTERNAL ROTATION IS USUALLY
RESTRICTED AND PAINFUL.
KNEES EARLY PRESENTATION OF KNEE OA INCLUDES PAIN WITH WEIGHT-BEARING
ACTIVITIES SUCH AS CLIMBING STAIRS AND SQUATTING. IN LATER STAGES, BOTH
PAIN AND STIFFNESS ARE RE-PORTED AFTER PROLONGED SITTING.
DEFORMITY:
• VARUS DEFORMITY (BOW LEG): IT IS AN EXCESSIVE INWARD ANGULATION , THAT IS
ANGLED MEDIALLY TOWARDS THE BODY’S MIDLINE.
• VALGUS DEFORMITY (KNOCK KNEE): IT IS AN EXCESSIVE OUTWARD ANGULATION, THAT
IS, ANGLED LATERALLY, AWAY FROM BODY’S MIDLINE.
• FEET AND TOES : FIRST MTP JOINT IS THE MOST COMMON SITE OF OA
AFFECTING THE FOOT AND MAY RESULT IN HALLUX RIGIDUS OR HALLUX
VALGUS DEFORMITIY.
• TOES AS A RESULT OF OA AND RESULTANT SHORTENING OF THE LONG
EXTENSORS CAN LEAD TO HAMMER TOES.
• FOREFOOT : IN THE TERMINAL STANCE PHASE OF GAIT AND BALANCE ISSUES.
SPINE
• THE LOWER CERVICAL AND MID TO LOWER LUMBAR REGIONS OF THE SPINE
ARE MOST SUSCEPTIBLE TO OA. ALL SPINAL ARTICULATIONS CAN
EXPERIENCE DEGENERATIVE CHANGES;
• FACET JOINT OSTEOPHYTES CAN CONTRIBUTE TO LATERAL AND CENTRAL
LUMBAR STENOSIS AND SUBSEQUENT NERVE ROOT IMPINGEMENT AND
CAUSE RADICULAR PAIN.
•
DIAGNOSTIC INVESTIGATIONS
1. LABORATORY TESTS ARE NORMAL, AND BLOOD TESTS ARE NORMAL UNLESS THE
OSTEOARTHRITIS IS DUE TO A BIOCHEMICAL CONDITION SUCH AS GOUT,
RHEUMATOID ARTHRITIS.
2. X-RAY : A BASIC X-RAY IS USED TO RESEARCH BREAKDOWN OF CARTILAGE,
NARROWING OF JOINT SPACE, FORMING OF BONE SPURS AND TO EXCLUDE OTHER
CAUSES OF PAIN IN THE AFFECTED JOINT. 3. ULTRASOUND: USES SOUND WAVES TO
PICTURES THE STRUCTURES OR SMALL CHANGES IN TISSUES OF THE JOINT SUCH AS
CYSTS, FLUID BUILDUP, CARTILAGE THINNING AND THICKENING OF SYNOVIUM OR
BONE SPURS 4. ARTHROSCOPY: IS A SURGICAL TECHNIQUE WHERE A CAMERA IS
INSERTED IN THE AFFECTED JOINT TO OBTAIN VISUAL INFORMATION ABOUT THE
DAMAGE CAUSED TO THE JOINT BY THE OA. 5. MRI: MAGNETIC RESONANCE IMAGING
(MRI). PROVIDES A VIEW THAT OFFERS BETTER IMAGES OF CARTILAGE AND OTHER
STRUCTURES TO DETECT EARLY ABNORMALITIES TYPICAL OF OSTEOARTHRITIS.
• OUTCOME MEASURES

WRIST AND FINGERS : FUNCTIONAL INDEX OF HAND OSTEOARTHRITIS (FIHOA)- TARGETED AT

THE FUNCTIONAL CAPACITY OF HANDS AFFECTED BY OA WITH 10 ITEM QUESTIONNAIRE.
HIP : HIP DISABILITY AND OSTEOARTHRITIS OUTCOME SCORE (HOOS)-TO ASSESS THE
OUTCOMES IN FIVE (PAIN, SYMPTOMS, ACTIVITY OF DAILY LIVING, SPORTS, RECREATION
FUNCTIONAL, HIP REALTED QUALITY OF LIFE).
KNEE: KNEE INJURY AND OESTEOARTHRITIS OUTCOME SCORE (KOOS) SCORES FROM 0-10, THE
WESTERN ONTARIO AND MCMASTER UNIVERSITIES ARTHRITIS INDEX (WOMAC) IS WIDELY USED
IN THE EVALUATION OF HIP AND KNEE OSTEOARTHRITIS.
FEET AND TOES: THE AMERICAN ORTHOPAEDIC FOOT AND ANKLE SOCIETY ANKLE-HINDFOOT
SCALE.
TREATMENT OF OSTEOARTHRITIS OSTEOARTHRITIS CANNOT BE CURED BUT
MAY BE CONTROLLED WITH APPROPRIATE TREATMENT. THE GOALS OF
TREATMENT ARE TO RELIEVE THE SYMPTOMS AND TO MANAGE THE EFFECTS OF
PROGRESSION OF THE PATHOLOGIC PROCESS. TREATMENT IS USUALLY EITHER
CONSERVATIVE OR SURGICAL IN NATURE: I. CONSERVATIVE TREATMENT A. REST
MAY REDUCE COMPRESSION AND SHEARING ON THE JOINT AND TO ALLOW
INFLAMMATION TO SUBSIDE. B. DRUG THERAPY FOR RELIEVING PAIN, INCLUDING
NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS) OR A LOCAL INJECTION
OF STEROIDS WHERE NECESSARY. C. DIET: MOST PATIENTS NEED ADVICE IN
WEIGHT REDUCTION

•
 PHYSIOTHERAPY MANAGEMENT: 1.PAIN CONTROL: A. THERMAL AGENTS:
PARAFFIN WAX, US, IR, HEAT PADS, HOT PACKS. B. HYDROTHERAPY: HOT OR COLD
PACKS BECAUSE ICE PACKS OVER THE JOINT REDUCE PAIN AND INFLAMMATION
ESPECIALLY IN ACUTE CASES.
C. ELECTRICAL STIMULATION: (TENS, INTERFERENTIAL). 2. EXTERNAL FORCE
CONTROL IS ACCOMPLISHED BY: A. REDUCTION OF THE PATIENT’S WEIGHT
THROUGH DIET AND EXERCISE REGIMES.
B. USING ASSISTIVE DEVICES SUCH AS ORTHOTICS OR AMBULATORY DEVICES (A
CANE, CRUTCHES, OR A WALKER) MAY BE NEEDED TO REDUCE THE WEIGHT-
BEARING LOAD ON THE JOINT.
3. THE EXERCISES RECOMMENDED FOR OA ARE A. FREE ACTIVE EXERCISES AND
MOBILIZATION. B. MUSCLE STRENGTHENING PROGRAM: AT A HIGH REPETITION RATE AND
AGAINST LOW RESISTANCE. THE MAIN MUSCLES REQUIRING STRENGTHENING ARE:
QUADRICEPS, HIP ABDUCTORS AND HIP EXTENSORS. KNEE EXTENSOR MUSCLES TO
PREVENT MUSCLE ATROPHY AND TO AVOID EXCESSIVE JOINT MOTION. SHORT-ARC
TERMINAL EXTENSION EXERCISES CAN BE USED TO STRENGTHEN THE QUADRICEPS .
C. STRENGTHENING EXERCISES ALSO INCLUDE ISOTONIC, ISOKINETIC EXERCISES,
RESISTED EXERCISES.
D. MOBILITY OF JOINTS: PHYSIOLOGICAL MOVEMENTS IS INVALUABLE AT THE EARLIER
STAGES OF THE CONDITION.
E. STRETCHING THE CAPSULE AND APPLYING RHYTHMICAL MOVEMENT HELP TO
DIMINISH THE DEGENERATION BY IMPROVING NUTRITION.
F. MOBILIZATIONS MAY BE APPLIED IN THE HYDROTHERAPY POOL (PAIN RELIEF AND
INCREASED FUNCTION) ESPECIALLY FOR THE HIP AND LUMBAR SPINE.
INSTRUCTIONS AND ADVICE TO PATIENTS: • WALKING IS GOOD FOR
LUBRICATION AND NUTRITION OF THE JOINT. WALK A LITTLE EVERY DAY WITHIN
LIMITS OF PAIN.
• USE WALKING AIDS TO RELIEVE PAIN AND STRESS TO HELP BALANCE. REST 5-10
MINUTES EVERY HOUR BUT AVOID BEING IN ONE POSITION FOR LONGER THAN
HALF AN HOUR. IF THIS IS NOT POSSIBLE, E.G. IN A TRAIN OR CAR, THEN
PRACTISE ISOMETRIC MUSCLE CONTRACTIONS EVERY SO OFTEN. EXERCISE
DAILY. IF BED REST IS NECESSARY, AS WITH ‘FLU’ WHEN FEVER STAGE IS
PASSED AND THE JOINTS HAVE STOPPED ACHING TRY TO MOVE EACH JOINT IN
EVERY DIRECTION EVERY HALF HOUR OR SO. ALSO, PRACTISE ISOMETRIC
CONTRACTIONS.
• WEIGH REGULARLY, AT LEAST ONCE A WEEK. TRY TO KEEP WEIGHT UNDER
CONTROL. AVOID SITTING WITH THE KNEES CROSSED TO PREVENT DEFORMITY.
• DO NOT SIT OR LIE WITH A PILLOW UNDER THE KNEES.
• AVOID PUTTING SUDDEN STRAIN ON THE JOINTS, E.G. LIFTING HEAVY LOADS. DO
A LITTLE HOUSEWORK EVERY DAY. IN COLD WEATHER, WRAP UP WELL; COLD
PREDISPOSES TO MUSCLE SPASM. DO NOT EXERCISES FROM COLD, USE A
RUBBER HOT WATER-BOTTLE OR ELECTRIC HEAT PAD TO WARM THE MUSCLES
PRIOR TO EXERCISE.
• USE OF A HOT WATER-BOTTLE IS LESS DANGEROUS.
• ALTHOUGH THERE IS NO CURE, THE EFFECTS OF OA CAN BE MINIMIZED SO THAT
FUNCTIONAL CAPACITY CAN BE MAINTAINED.
SURGICAL TREATMENT MAIN SURGICAL TECHNIQUES ARE: 1. JOINT
ARTHROPLASTY : SURGICAL PROCEDURE TO RESTORE THE FUNCTION OF A JOINT
BY REPLACING THE STRUCTURE. 2. OSTEOTOMY : OSTEOTOMY INVOLVES CUTTING
AND RESHAPING ONE OF THE BONES.
3. ARTHRODESIS OR PERMANENT FUSION OF THE JOINT.
 Step up
and step
down
Wall squat
Hamstring and quadriceps stretching
Calf muscle stretch
Quadriceps stretch
Adductor stretch
Hamstring stretch
 REFRENCE : ESSENTIAL OF ORTHOPAEDICS AND APPLIED PHYSIOTHERAPY
BY JAYANTJOSHI

PHYSICAL REHABILITATION BY SUSAN O SULLIVAN

THANK YOU……