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Understanding Knee Osteoarthritis Causes

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46 views38 pages

Understanding Knee Osteoarthritis Causes

Uploaded by

hajarapk758
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd

OA KNEE

Primary OA
Secondary OA
Age. The ability of cartilage to heal decreases
as a person gets older.
Heredity
Gender. Women who are 55 and older are more
likely than men to develop osteoarthritis of the
knee.
Repetitive stress injuries. These are usually a
result of the type of job a person has. People
with certain occupations that include a lot of
activity that can stress the joint, such as
kneeling, squatting, or lifting heavy weights
 Athletics. Athletes involved in soccer,
tennis, or long-distance running may be
at higher risk for developing
osteoarthritis of the knee
 obesity
SIGNS AND SYMPTOMS

 pain that increases when you are active,


but gets a little better with rest
 swelling
 feeling of warmth in the joint
 stiffness in the knee, especially in the
morning or when you have been sitting
for a while
 decrease in mobility of the knee, making
it difficult to get in and out of chairs or
cars, use the stairs, or walk
 creaking, crackly sound that is heard
when the knee moves
RADIOLOGICAL FEATURES
 Narrowing of joint space
 Osteophytes at the margin of he joints
 Sclerosis at the margin of the joints
 Cystic changes in the bony ends
PHYSICAL CHANGES
 Early
 Joints
may appear normal
 Gait may be antalgic
 Later
 Joints may be warm to palpation
 Palpable osteophytes frequently are noted
 Joint effusion
 Range-of-motion limitations, because of
bony restrictions and/or soft tissue
contractures, are characteristic
 Crepitus with range of motion
 Deformity
 Flexion with Varus deformity

 Crepitus
 Loss of function
 Step up and step down activities difficult
 Not able to squat
A patient with
typical OA of the
knees. In the normal
standing posture
there is a mild varus
angulation of the
knee joints due to
symmetrical OA of
the medial
tibiofemoral
ASSESSMENT

 Assessment of pain
 Site , nature and duration of pain
 Factors which precipitate pain (weight
bearing, movement, posture)
 Assessment of function

The influence of the disease on the


functional performance of the patient
are examined
 Assessment of joint stiffness
 Passive ROM and end feel
 Type of joint restriction noted
 Firm and leathery end feel without
effusion indicates capsular fibrosis
 Locking end feel =bony ankylosis
 Assessment of power, endurance,tone
and volume of muscle
 Quadriceps, hamstring, and glutie
 Assessment of tenderness
 Degree and area of tenderness, effusion
and crepitus
 Assessment of deformity
 Check any deformity
 Stability
 In supine and with weight bearing
 Knee rating scale for pain and function (50 points)

 Pain free standing and long walk 50

 Mild pain, painless walking up to 1 km 40

Considerable pain on long standing/


Walking pain free up to less than ½ km 20

Considerable pain walking confined to


Indoor only 10

 Severe pain on standing / walking or


Even at rest 5
 Unable to walk 0
 Radio graphic classification
 Stage I- bony spur only (osteophytes)
 Stage II- narrowing of joint spaces ,less
than half of the normal joint space
 Stage III – narrowing of the joint space ,
more than half the normal joint space
 Stage IV- obliteration of joint space or
bone attrition under 1 cm
 Stage V- major bone attrition , more
than 1 cm , sublaxaton or secondary
lateral arthrosis
 OA seen in usually 3 areas
 Patello- femoral compartment
 Medial tibio femoral compartment
 Lateral tibio femoral compartment

 Med. Tibio fem compartment is the


commonest site.
TREATMENT PRINCIPLES
 Education
 Physiotherapy
 Exercise program
 Pain relief modalities
 Aids and appliances
 Medical Treatment
 Surgical Treatment
EDUCATION
 Prevent overloading of joint. Obesity!!
 Appropriate use of treatment modalities
 Importance of exercise program
 Teach to avoid frequent standing and sitting
 Gait training
 Do not step up or step-down affected limb
using full weight
 Use arm support while rising from the chair
 Aids, appliances, braces
 Medial treatments
 Surgical treatments
PHYSIOTHERAPY
 Pain releaving modalities
 Maitland mobilization technique 1 and
2grade
 Relaxed passive movement with hip
flexion
 Relax knee flexion up to possible range
 Accessory movements – give ant glide ,
post glide
TO INCREASE ROM

 Passive movements
 Stretching ( passive &active) quadriceps,
hamstring
 Active assisted
 Re education board
 Self assisted knee flexion in high sitting
 Using thera band
 Active knee flexion and extension
 Cycling
 Hydrotherapy
 Suspension
 Mini squat
 Maitland 3 & 4(prone lying)
IMPROVE MUSCLE STRENGTH

 Isometric
 Static quadriceps
 Manual resistance and weight cuffs ex
 PRE
 Thera band resisted ex
 Quadriceps table
 SLR in different planes
 Squatting
 Hydrotherapy
 wobble board ( to improve coordination)
 Improve functional activities
MEDICAL TREATMENT
 Simple analgesics: paracetamol, low
dose ibuprofen
 NSAID’s
 Intra-articular corticosteroids
 Topical treatment eg NSAID creams
SURGICAL METHOD
 Arthroscopic washout joint debriment
 Osteotomy
 Arthroplasty
PT MANAGEMENT
 ACUTE
 Aim
 Prevention
 To relieve pain and spasm
 Maintain joint ROM
 Prevent deformity
 Prevent muscle weakness
 Measures of prevention
 Early identification of people with
trauma ,obese etc.
 X-ray findings
 Examination of joint kinematics,end feel
 Depending upon the findings –strngthenong is
needed,improving flexibility,endurance
 Guidance to avoid various posture
 Nutrition to obese
 Inhibition of degenerative changes during
immobilization by CPM,traction
 Early management of congenital abnormalities
BASIC APPROACH TO
TREATMENT
 Pain control
 Acute-superficial heat/cold therapy
 Wax,hotpacks,IRR
 Chronic-SWD
 Phonophoresis with ibrufen
 IFT,cryotherapy (10 to
15min),TENS,hydrotherapy,
 Rest-splint,brace
 Traction
 Increase ROM
 Free exercise
 Hydrotherapy +PNF (hold relax, slow
reversal)
 When mechanical dysfunction-
manipulation and mobilization
 Hamstring stretch
 Improve muscle power,endurance and
tone
 PRE-glutei,quads,hams
 Isotonic ex
 Isometric
 SLR,SLR with wt
 Vastus medialis strengthening
 Quads setting
 Posture, gait assistive devices
 Correct posture
 Adequate assistance like cane
 Home advice
 Reduce body wt
 Avoid uneven surface
 Frequent standing and sitting aviod
 Avoid squatting,jogging
 Avoid long walk
 Avoid cross leg sitting-sustained knee flexion
 Avoid walk with heavy wt
 Avoid unsupported limbing
 Avoid kneeling
 Avoid unarmed chair
 Orthosis
 Telescopic varus valgus support (TVS)
 Foot wear modification
 Wedge insole with lateral height of 7-12
mm, so that posterior part of calcaneum
is tilted laterally at an angle of 5degree
from floor. This decrease the
compressive force on the medial
compartment bearing wt.
 Clinically effective till upto 3rd stage of
OA
 CHRONIC
 Aim
 Decrease pain
 Prevent ?progression of deformity
 Maintain muscle function
 Pain
 SWD, IFT,WAX, Hot
water ,hydrotherapy ,TENS

 Exercise
 ROM ex
 Hams stretching
 Isometrics
 SLR
 Ex. For vastus medialis
 Patellar ex.
 Orthosis-to prevent varus deformity
 Foot wear modification
 Home advice
 Osteotomy
 During immobilization
 3 to 6 weeks
 Isometrics-quads,hams
 Active ex to all joint
 Non wt bearing crutch-3 point
 During mobilization
 AROM –affected joint
 Pain relief modality –wax,hot pack
 Mobilization to affected joint
 Non wt bearing-partial-wt bearing (8
weeks)

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