C A S E P R E S E N TAT I O N

ON
O.A KNEE AND RIGHT FROZEN SHOULDER

D . R U C H I T H A R E D D Y
1 9 Z 5 1 T 0 0 0 4
PH A R M. D 5 T H Y E A R
GE E T H A N JA L I C O L L E G E O F PH A R MA C Y
A case study of 70 yrs male patient was admitted in the hospital with chief complaints of
pain in both knees since 1 year.
Pain in Rt shoulder joint and diagnosed with O.A KNEE AND RIGHT FROZEN
SHOULDER
 INTRODUCTION :
OSTEOARTHRITIS:
• Osteoarthritis is the most common form of arthritis in the knee. It is a degenerative,"wear-and-tear"
type of arthritis that occurs most often in people 50 years of age and older, but may occur in
younger people, too.
• Osteoarthritis (OA) of the knee affects the bones, the cartilage, and the synovium in the knee joint.
• In osteoarthritis, the cartilage in the knee 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 develops slowly and the pain it causes worsens over time.
FROZEN SHOULDER:
• Frozen shoulder is a common condition in which the shoulder stiffens, reducing its mobility.It is
also known as adhesive capsulitis.
• The term "frozen shoulder" is often used incorrectly for arthritis, but these two conditions are
unrelated.
• Frozen shoulder refers specifically to the shoulder joint, while arthritis may refer to other or
multiple joints
• It can affect one or both shoulders.
SYMPTOMS:
• A knee joint affected by arthritis may be painful and inflamed. Generally, the pain develops gradually over time,
although sudden onset is also possible. There are other symptoms, as well:
• The joint may become stiff and swollen, making it difficult to bend and straighten the knee.
• Pain and swelling may be worse in the morning, or after sitting or resting.
• Vigorous activity may cause pain to flare up.
• Loose fragments of cartilage and other tissue can interfere with the smooth motion of joints. The knee may "lock"
or "stick" during movement. It may creak, click, snap or make a grinding noise (crepitus).
• Pain may cause a feeling of weakness or buckling in the knee.
• Many people with arthritis note increased joint pain with rainy weather.
• A person with a frozen shoulder will have a persistently painful and stiff shoulder joint.
• Signs and symptoms develop gradually, and usually resolve on their own.
DIAGNOSIS:
 During the physical exam, your doctor will check your affected joint for tenderness, swelling, redness and
flexibility.
 Imaging tests
To get pictures of the affected joint, your doctor might recommend:
•X-rays. Cartilage doesn't show up on X-ray images, but cartilage loss is revealed by a narrowing of the space
between the bones in your joint. An X-ray can also show bone spurs around a joint.
•Magnetic resonance imaging (MRI). An MRI uses radio waves and a strong magnetic field to produce
detailed images of bone and soft tissues, including cartilage. An MRI isn't commonly needed to diagnose
osteoarthritis but can help provide more information in complex cases.
 Analyzing your blood or joint fluid can help confirm the diagnosis.
MANAGEMENT AND TREATMENT:

Osteoarthritis can't be reversed, but treatments can reduce pain and help you move better.
 Medications
Medications that can help relieve osteoarthritis symptoms, primarily pain, include:
•Acetaminophen. Acetaminophen (Tylenol, others) has been shown to help some people with osteoarthritis who have mild to
moderate pain. Taking more than the recommended dose of acetaminophen can cause liver damage.
•Nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter NSAIDs, such as ibuprofen (Advil, Motrin IB, others) and
naproxen sodium (Aleve, others), taken at the recommended doses, typically relieve osteoarthritis pain. Stronger NSAIDs are
available by prescription.
NSAIDs can cause stomach upset, cardiovascular problems, bleeding problems, and liver and kidney damage. NSAIDs as gels,
applied to the skin over the affected joint, have fewer side effects and may relieve pain just as well.
•Duloxetine (Cymbalta). Normally used as an antidepressant, this medication is also approved to treat chronic pain, including
osteoarthritis pain.
 Therapy
Physical therapy. A physical therapist can show you exercises to strengthen the muscles around your joint, increase your
flexibility and reduce pain. Regular gentle exercise that you do on your own, such as swimming or walking, can be equally
effective.
Occupational therapy. An occupational therapist can help you discover ways to do everyday tasks without putting extra stress on
your already painful joint. For instance, a toothbrush with a large grip could make brushing your teeth easier if you have
osteoarthritis in your hands.
 SURGICAL AND OTHER PROCEDURES:
If conservative treatments don't help, you may want to consider procedures such as:
Cortisone injections. Injections of corticosteroid medications may relieve pain in your joint. During this
procedure your doctor numbs the area around your joint, then places a needle into the space within your joint and
injects medication. The number of cortisone injections you can receive each year is generally limited to three or
four injections, because the medication can worsen joint damage over time.
Lubrication injections. Injections of hyaluronic acid may offer pain relief by providing some cushioning in your
knee, though some research suggests these injections offer no more relief than a placebo. Hyaluronic acid is similar
to a component normally found in your joint fluid
Realigning bones. If osteoarthritis has damaged one side of your knee more than the other, an osteotomy might be
helpful. In a knee osteotomy, a surgeon cuts across the bone either above or below the knee, and then removes or
adds a wedge of bone. This shifts your body weight away from the worn-out part of your knee.
Joint replacement. In joint replacement surgery (arthroplasty), your surgeon removes your damaged joint surfaces
and replaces them with plastic and metal parts. Surgical risks include infections and blood clots. Artificial joints
can wear out or come loose and may need to eventually be replaced.
CASE :
NAME : XYZ
AGE70 YRS
SEX : MNALE
DOA : 2/10/23
DOD : 5/10/23
IP NO : 231002110
C/O : c/o pain in both knees since 1 year.
Pain in Rt shoulder joint.
DEPT :ORTHOPEDIOCS

PRESENT MEDICAL HISTORY: Nill

PAST MEDICAL HISTORY:
Underwent surgery for hydrocele and cataract Rt eye 6 months back.
PERSONAL HISTORY:
Appetite - Normal Bowel -regular
Micturition - Normal Allergies -NS
Habits - ex Alcoholic, ex Smoker
REVIEW OF SYSTEM :
Blood pressure(mmHg) :130/80
Pulse Rate(bpm) :74/min
Respiratory Rate(bpm) :16/min

SYSTEMIC EXAMINATION:
CVS : S1 S2++
RS : BAE+
Abd : Soft
CNS : Normal
 COMPLETE BLOOD PICTURE :
PARAMETERS TEST VALUES
Haemoglobin:12.0-18.0g/dl 13.8g/dl
RBC Count:4.5-6.5ml/m3 4.56ml/m3
WBC Count:4000-11000cells/m3 8300cells/m3
Neutrophils:30-70% 60%
Lymphocytes:20-50% 36%
Eosinophils:1-6% 2%
Monocyte:2-8% 2%
Platelet:1.5-4.5lakhs/m3 2.74lakh/m3

BIOCHEMISTRY:

PARAMETER TEST VALUES

RPG:60-160mg/dl 120mg/dl
COMPLETE URINE EXAMINATION

PARAMETER TEST VALUE

Volume 20ml
Specific gravity 0.015
Appearence Clear
Colour Pale yellow
Reaction Acidic
DIAGNOSIS:

Based upon the chief complaints it is finally diagnosed as O.A KNEE AND
RIGHT FROZEN SHOULDER
PROGRESS NOTE :

DATE DAY COMPLAINTS TREATMENT

3/10/23 1 c/o:-Pain over right shoulder T . Ultracet BD
↓ knee jaw T . Rantac 150mg BD
O/E :- Temp - Normal T . Limcee 500mg OD
4/10/23 2 O/E:- Temp – Normal continue same therapy

5/10/23 3 O/E :- ↓ Knee pain T . Ultracet BD

T . Rantac 150mg BD
T . Neurokind LC OD
 SOAP ANALYSIS

SUBJECTIVE: A 70year male patient was admitted in the hospital with chief complaints of pain in both knees
since 1year
Pain in Rt shoulder joint and diagnosed with O.A KNEE AND RIGHT FROZEN SHOULDER

OBJECTIVE:

ASSESSMENT: Based on subjective and objective data, the patient was assessed as O.A KNEE AND RIGHT
FROZEN SHOULDER
 PLAN :
DRUG GENERIC DOSE RO FRE THERAPEUTIC USE DURATIO
NAME A Q N
T.Ultracet Paracetamol(325 1 Tab P/O BD Treats pain 3 DAYS
mg)
+Tramadol(37.5
mg)
T.Rantac Ranitidine 150mg P/O BD PPI 3 DAYS

T.Limcee Vitamin C 1 Tab P/O BD It is an antioxidant that can 3 DAYS

strengthen bodys natural
defences and boost the
immune system. Also
protects from infections.
T.Nurokind Levocarnitine(50 1 Tab P/O OD It is used to treat Nutritional 5/8
LC 0mg) deficiencies.
+Methylcobalam
ine(1500mg)
+Folic
acid(1.5mg)
 DISCHARGE
MEDICATION:
BRAND GENERIC NAME DOSE RO FRE INDICATION DURATIO
NAME A Q N
T. Rantac Ranitidine 150mg P/O BD PPI 1 Week

T.Diclo diclofenac 50mg p/o Tid Reduces pain 1 week

T. Calinta max Calcitriol(0.25mcg)+ Calcium 1 Tab P/O BD It is used for growth 1 week
carbonate(20mg)+ZnSO4 and development of
(1250mg) bones.
T.Nurokind Levocarnitine(500mg) 1 Tab P/O OD It is used to treat 1 week
LC +Methylcobalamine(1500mg) Nutritional
+Folic acid(1.5mg) deficiencies.
PHARMACIST CARE INTERVENTION :
- DRUG-DRUG INTERACTIONS :

MINOR DRUG INTERACTION :

- RANITIDINE WITH ACETAMINOPHEN
The metabolism of Acetaminophen can be decreased when combined with
Ranitidine.
ADR’S : No ADR’S noted

- Cortiocosteroids can be added if the inflammation is high

SUMMARY :

A 70 yr old male Presented with c/o pain in both knees since 1 year.
Pain in Rt shoulder joint , diagnosed with O.A KNEEE AND RIGHT FROZEN
SHOULDER , Provided with medications of NSAIDS , multi vitamin , ppi were given
PATIENT COUNSELLING:
DISEASE COUNSELLING :
• Osteoarthritis is the most common form of arthritis in the knee. It is a
degenerative,"wear-and-tear" type of arthritis that occurs most often
in people 50 years of age and older, but may occur in younger people,
too.
• Osteoarthritis (OA) of the knee affects the bones, the cartilage, and
the synovium in the knee joint.
FROZEN SHOULDER:
• Frozen shoulder is a common condition in which the shoulder
stiffens, reducing its mobility.It is also known as adhesive capsulitis.
• The term "frozen shoulder" is often used incorrectly for arthritis, but
these two conditions are unrelated.
• Frozen shoulder refers specifically to the shoulder joint, while
arthritis may refer to other or multiple joints
• It can affect one or both shoulders.
MEDICATION COUSELLING
• T.Ultracet is used to relieve severe acute pain.It is advised to take for not more than 5 days.
• It is better to take with food to avoid an upset stomach.
• T.Nurokind-LC helps replenish important nutrients in your body.
• Avoid taking Ranitidine(antacid) within 2 hrs of taking nurokind-LC
• T.Ultracet and Rantac should be taken at morning and bed time.
• T. Nurokind-LC should be taken after lunch.
LIFE STYLE MODIFICATION :
• After the recovery it is suggested to loose weight. Being overweight puts undue strain on weight bearing
joints such as youe knees.
• Sleep well . A good nights sleep will help you cope with pain.
• Use hot packs by ↑ blood flow, hot compresses can ease pain.
• Frozen shoulder exercises are usually the cornerstone of treating frozen shoulder.
• Similarly physical exercises can help in reducing pain in case of osteoarthritis.
• Massage the affected joint to ↑ the blood flow to that particular area.
• It is suggested to place pillow on your affected area/side.

FOOD AND NUTRITION

• Increase intake of anti-inflammatory foods such as fruits, vegetables, oily fish, nuts,seeds.
• Foods to be avoided are simple carbohydrates and fats.
REFERENCE :
https://www.naturesintentionsnaturopathy.com/arthritis/lifestyle-c
hanges-to-manage-osteoarthritis.html

www.medscape.com
www.drungbank.com
www.healthtoday