Knee Osteoarthritis Quiz
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Questions and Answers

What is the most common joint affected by osteoarthritis?

  • Hip joint
  • Knee joint (correct)
  • Shoulder joint
  • Elbow joint

Which demographic is most likely to experience symptomatic knee osteoarthritis?

  • Men under 50 years old
  • Women aged 60 and older (correct)
  • Males aged 30 to 45 years
  • Children under 18 years

Which statement accurately describes the nature of knee osteoarthritis?

  • It involves degeneration of various joint structures. (correct)
  • It is primarily an inflammatory joint disease.
  • It is a rare form of joint disorder.
  • It is reversible with appropriate treatment.

How prevalent is osteoarthritis in adults over the age of 70?

<p>As high as 40% (B)</p> Signup and view all the answers

What is the primary cause of knee osteoarthritis?

<p>Wear and tear of articular cartilage (D)</p> Signup and view all the answers

Which change characterizes the cartilage in knee osteoarthritis?

<p>Decreased thickness and quality. (C)</p> Signup and view all the answers

What distinguishes osteoarthritis from inflammatory joint diseases?

<p>Osteoarthritis is not classified as an inflammatory condition. (B)</p> Signup and view all the answers

Which of the following structures is NOT involved in the degeneration associated with knee osteoarthritis?

<p>Tendon sheaths (B)</p> Signup and view all the answers

What is the primary source of pain in cases of early osteoarthritis?

<p>Changes to the joint capsule and surrounding structures (C)</p> Signup and view all the answers

Which joint compartment is most commonly affected in knee osteoarthritis?

<p>Medial tibiofemoral joint (B)</p> Signup and view all the answers

What characterizes primary osteoarthritis?

<p>It is primarily related to the aging process. (A)</p> Signup and view all the answers

How does a varus deformity manifest in osteoarthritis of the knee?

<p>Increased bowing of the legs (D)</p> Signup and view all the answers

What type of osteoarthritis is most likely to occur due to previous trauma?

<p>Secondary osteoarthritis (B)</p> Signup and view all the answers

Which of the following conditions is NOT a typical risk factor for osteoarthritis?

<p>Increased water content in cartilage (C)</p> Signup and view all the answers

What may contribute to osteoarthritis stemming from metabolic disorders?

<p>Conditions like rickets (B)</p> Signup and view all the answers

Which joint structures typically undergo changes due to osteoarthritis?

<p>Joint capsule, ligaments, and surrounding muscles (A)</p> Signup and view all the answers

What factor contributes to increased weight on the knees with weight gain?

<p>Every pound of weight gain adds 3 to 4 pounds on the knees. (A)</p> Signup and view all the answers

Which of the following is NOT a consequence of muscle atrophy in joint conditions?

<p>Increased joint stabilization. (A)</p> Signup and view all the answers

Which cytokine is notably increased due to obesity and can impact cartilage health?

<p>Leptin. (D)</p> Signup and view all the answers

What phenomenon is described as stiffness that resolves after a short period of activity?

<p>Gelling phenomenon. (C)</p> Signup and view all the answers

Which of the following is a common clinical presentation in patients with osteoarthritis?

<p>Joint pain that starts strong and decreases with rest. (D)</p> Signup and view all the answers

Which type of injuries usually relate to repetitive stress in certain occupations or sports?

<p>Repetitive stress injuries. (D)</p> Signup and view all the answers

How does obesity affect chemical substances that contribute to joint degradation?

<p>It increases levels of leptin and C-reactive protein. (B)</p> Signup and view all the answers

What is the most likely result of poor knee stability and weak muscles?

<p>Increased risk of injury. (C)</p> Signup and view all the answers

What is the primary purpose of using a knee brace for patients with moderate or severe knee osteoarthritis (OA)?

<p>To alleviate pain and improve proprioception. (C)</p> Signup and view all the answers

Which statement regarding corrective braces for knee osteoarthritis is accurate?

<p>Their efficacy varies, and they are not recommended as a standard treatment. (B)</p> Signup and view all the answers

What is a potential negative consequence of prolonged usage of gait retraining methods for knee loading reduction?

<p>Muscle tightness and abnormal walking patterns. (A)</p> Signup and view all the answers

How should lateral wedge insoles be designed for patients with medial compartment OA?

<p>They should have different heights to create a net wedge angle for knee unloading. (C)</p> Signup and view all the answers

What biomechanical strategy can be used to decrease knee joint loading during acute pain episodes?

<p>Decreasing walking velocity. (C)</p> Signup and view all the answers

Which of the following is a characteristic of 'rest' braces for the knee?

<p>They may lead to quadriceps muscle weakening. (B)</p> Signup and view all the answers

When using foot orthoses, what should be considered to achieve effective unloading of the knee?

<p>The simultaneous use of lateral foot insert and medial foot arch. (B)</p> Signup and view all the answers

What effect does out-toeing have on the knee joint during walking?

<p>It reduces the ground reaction force moment arm to the knee joint center. (B)</p> Signup and view all the answers

Which treatment is supported by evidence for pain reduction?

<p>TENS (A)</p> Signup and view all the answers

What is the primary purpose of using cryotherapy during acute flare-ups?

<p>To provide pain relief (D)</p> Signup and view all the answers

Which statement about joint mobilization is correct?

<p>Hip mobilization is pursued if specific pain criteria are met. (C)</p> Signup and view all the answers

What should be avoided as a treatment for knee pain according to the content?

<p>Heat Therapy (C)</p> Signup and view all the answers

What is the recommended approach for improving mobility and range of motion?

<p>Active free range of motion exercises within painless limits (A)</p> Signup and view all the answers

Which therapeutic option has no clinical benefit?

<p>Electromagnetic Field Therapy (C)</p> Signup and view all the answers

What is a potential effect of massage therapy?

<p>Reducing tension and improving circulation temporarily (C)</p> Signup and view all the answers

What type of muscles should be targeted for stretching exercises?

<p>Hip adductors, flexors, and quadriceps (B)</p> Signup and view all the answers

What is a significant benefit of quadriceps strengthening in the treatment of knee osteoarthritis?

<p>It can delay the necessity for surgery. (B)</p> Signup and view all the answers

Why is hip abductor muscle strengthening important in conjunction with quadriceps strengthening?

<p>It stabilizes medial joint loading on the knee. (C)</p> Signup and view all the answers

What is a primary reason for recommending aquatic exercise for patients with knee osteoarthritis?

<p>It provides lower weight bearing on the joints. (B)</p> Signup and view all the answers

Which neuromuscular mechanism is suggested as a cause of quadriceps activation failure in knee osteoarthritis?

<p>Inability to contract efficiently. (C)</p> Signup and view all the answers

What impact can aerobic exercises have on patients with knee osteoarthritis?

<p>Increase in muscle strength and overall function. (B)</p> Signup and view all the answers

What differentiates closed kinetic chain exercises from open kinetic chain exercises?

<p>Open chain exercises limit joint compression. (A)</p> Signup and view all the answers

What role does proprioceptive exercise play in the treatment of knee degeneration?

<p>It addresses deficits in balance and stabilization. (C)</p> Signup and view all the answers

What is a potential drawback of low-impact aerobic exercises for knee osteoarthritis treatment?

<p>They can be cost-ineffective compared to other methods. (C)</p> Signup and view all the answers

Flashcards

Weight and Knee Stress

Excess body weight puts extra stress on knee joints, adding 3-4 pounds of pressure for every pound gained.

Obesity and Cartilage Damage

Chemicals like leptin and C-reactive protein, released during obesity, can damage knee cartilage.

Muscle Weakness & Knee Problems

Weak muscles, poor knee stability, and abnormal movement can all contribute to knee problems.

Gender and Knee Health

Women are more likely to experience knee problems than men.

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Repetitive Stress and Knee Injuries

Repetitive movements, especially in sports or certain jobs, can lead to knee injuries.

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Overuse & Underuse of Knees

Both overuse and underuse of knee joints can lead to cartilage problems.

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Knee Pain and Stiffness

Knee pain that worsens with activity and decreases with rest, often accompanied by stiffness, is a common sign.

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Knee Swelling

Swelling in the knee joint can be caused by inflammation, fluid buildup, and other factors.

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Osteoarthritis (OA)

A condition where the cartilage in a joint breaks down over time, leading to pain, stiffness, and decreased mobility.

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Anserine Bursitis

Inflammation of the bursa, a fluid-filled sac that helps reduce friction between bones, tendons, and muscles, especially in the knee.

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Iliotibial Band Syndrome

A condition caused by tightness and inflammation of the iliotibial band, a thick band of tissue running along the outside of the thigh.

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Secondary OA

A type of osteoarthritis affecting the knee joint caused by factors other than aging.

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Primary OA

A type of osteoarthritis affecting the knee joint without a clear cause.

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Varus Deformity

A condition where the knee joint becomes bowlegged due to cartilage loss on the inner side.

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Valgus Deformity

A condition where the knee joint becomes knock-kneed due to cartilage loss on the outer side.

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Tibiofemoral Joint

The area of the knee joint where the thighbone (femur) meets the shinbone (tibia).

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What is Osteoarthritis (OA)?

Osteoarthritis (OA) is a chronic joint disorder causing pain and stiffness, primarily affecting weight-bearing joints like knees, hips, and spine. It involves progressive loss of cartilage, leading to bone-on-bone friction.

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Who is most affected by knee OA?

The knee joint is most commonly affected by OA, which primarily affects older individuals, with prevalence increasing after age 45. Women are more likely to be affected than men.

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Is Osteoarthritis Inflammatory?

Osteoarthritis is not an inflammatory condition, but rather a degenerative joint disease involving cartilage breakdown, subchondral bone changes, and degeneration of ligaments, capsules, and synovial membranes. It is a progressive disease that cannot be reversed.

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What is the main cause of Osteoarthritis?

The primary cause of OA is attributed to wear and tear on the joint cartilage over time. This leads to thinning, softening, and eventual breakdown of the cartilage, which is unable to repair itself.

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What are the common symptoms of knee OA?

Individuals with OA experience pain, stiffness primarily in the morning or after periods of inactivity, reduced range of motion in the affected joint, and often a feeling of crepitus - a crackling or grating sensation during movement.

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How is knee OA diagnosed?

Diagnosis of knee OA usually involves physical examination, reviewing medical history, and performing X-rays. Blood tests are typically not used in diagnosing OA.

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How is knee OA managed?

Management of knee OA involves a multi-faceted approach to alleviate pain and improve function. This includes medications like pain relievers and anti-inflammatory drugs, physical therapy to strengthen muscles and maintain mobility, weight management, and assistive devices like braces or walking sticks.

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Does everyone with OA experience symptoms?

While OA can lead to significant pain and limitation of movement, it is important to remember that not everyone with radiographic signs of OA will experience symptoms. OA is a common condition, affecting a significant portion of the population, particularly older individuals.

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Knee Brace

A type of knee brace that helps to reduce pain and inflammation in the knee joint by providing support and limiting movement.

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Corrective Braces

These braces are designed to correct misalignments in the knee joint, such as valgus deformity (knock-knee).

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Foot Orthosis

Insoles that are used to help alleviate knee pain by distributing weight more evenly and reducing stress on the knee joint.

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Lateral and Medial Wedge Insoles

Lateral wedge insoles are used for patients with medial compartment osteoarthritis, while medial wedge insoles are used for lateral compartment osteoarthritis.

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Increase Toe Out

A type of gait retraining strategy that involves increasing the angle between the feet during walking. This helps reduce the load on the knee joint.

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Reducing Walking Velocity

A type of gait retraining strategy that involves slowing down your walking pace. This helps decrease the impact on the knee joint.

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Gait Retraining

Techniques used to improve walking patterns and reduce stress on the knee joint.

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Ground Reaction Force

This refers to the force that is exerted on the knee joint during walking.

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Open Kinetic Chain Exercises

Exercises where the moving body part is not fixed, allowing for greater range of motion and less stress on joints.

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Closed Kinetic Chain Exercises

Exercises where the moving body part is fixed, increasing stability and joint compression.

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Antigravity Muscles

Muscles that resist gravity to maintain posture, like those in the hips and legs.

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Aerobic Exercises

Exercises that increase heart rate and improve cardiovascular health. Examples include walking, cycling, or swimming.

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Aquatic Exercises

Exercises performed in water, reducing joint stress due to buoyancy.

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Proprioception

The ability to sense your body's position and movement in space.

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Quadriceps Strengthening

A treatment approach focusing on strengthening muscles around the knee joint to improve stability and reduce pain.

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Functional Exercises

Exercises designed to target specific muscle groups to improve function and balance.

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TENS for knee pain

A type of therapy where electrodes are placed on the skin to deliver electrical impulses, potentially reducing pain by stimulating nerves. This can be used to treat knee pain, but evidence of its effectiveness is limited.

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Ultrasound for knee OA

A non-invasive treatment using sound waves to generate heat in tissues, potentially reducing inflammation and improving joint mobility. However, its effectiveness for knee osteoarthritis is not conclusively proven.

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Joint mobilization for knee OA

A technique involving gentle manipulation of the knee joint. Focuses on improving range of motion, reducing stiffness, and easing pain. May be most effective during acute knee flares.

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Tapping techniques for knee pain

A technique involving the use of tape to modify the mechanics of the knee joint, potentially stabilizing it, reducing stress, and altering patella alignment. However, the effectiveness can vary widely, and it tends to have a short-term effect.

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Stretching exercises for knee OA

A form of physical therapy targeting specific muscles, like the hip flexors, hamstrings, and quadriceps. Helps improve flexibility, reduce tightness, and improve overall knee joint mechanics.

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Active ROM exercises for knee OA

Incorporating controlled movement within the limits of pain. This helps maintain joint lubrication, remove pain metabolites, and enhance blood circulation to the joint.

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Grade III, IV Joint Mobilization

A specialized type of mobilization involving forceful, controlled movements that aim to restore joint mobility and flexibility. This needs to be performed by a qualified professional and cautiously.

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Knee distraction mobilization

A type of mobilization focusing on carefully separating the joint surfaces while gently moving the knee. Can help improve overall joint mechanics, reduce pain and stiffness.

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Study Notes

Knee Osteoarthritis (OA) Overview

  • OA is a chronic, painful joint disorder affecting knees, hands, hips, and spine.
  • Symptoms typically progress slowly.
  • Knee is the most common affected joint.
  • Primarily affects individuals over 45 years old.
  • Not all individuals with radiographic findings experience symptoms.
  • Women are affected more than men.
  • Prevalence increases with age (13% in 60+ years old and up to 40% in 70+ years old).

Synovial Joints

  • Synovial joints are freely movable (diarthrotic).
  • Key structures include articular cartilage, synovial membrane, joint cavity, and joint capsule.
  • Articular cartilage is a specialized connective tissue covering the ends of bones in joints.
  • This cartilage contains collagen fibers, chondrocytes, and a proteoglycan matrix, including chondroitin sulfate.
  • Synovial membrane secretes synovial fluid.
  • Joint cavity is filled with synovial fluid, acting as a lubricant cushioning the bones.
  • Joint capsule is made of dense connective tissue to stabilize and protect the joint.

Osteoarthritis Pathogenesis

  • OA is characterized by degenerative changes in the joint, including articular cartilage, subchondral bone, ligaments, joint capsule, and synovial membrane.
  • This degeneration arises from changes in cartilage quality and thickness, leading to cracks, and even complete loss of the cartilage.

Non-Cartilaginous Sources of Pain

  • Cartilage itself does not produce pain initially.
  • Pain stems from changes in non-cartilaginous components like the joint capsule (degenerated & inflamed), synovium (effusion), subchondral bone (expansion and spur formation), ligaments (laxity), and peri-articular muscles (atrophy), including anserine bursitis and iliotibial band syndrome.
  • X-ray changes do not always accurately reflect pain severity.

OA Clinical Presentation

  • Joint pain and stiffness: Pain is typically mechanical, linked to activity (e.g., standing, walking). Stiffness often lessens with movement but may be more pronounced at the end of the day.
  • Morning stiffness: Usually lasts no more than 30 minutes.
  • Swelling: Synovial irritation, periarticular structure inflammation, and bursa inflammation can cause edema (swelling).
  • Muscle spasm: A protective mechanism related to inflammation and metabolites, restricting movement.
  • Muscle weakness and atrophy: Result from pain-induced muscle inhibition and lack of use, leading to the possible loss of function.
  • Decreased ROM: Stiffness and limitation of range of motion.
  • Crepitation: A grinding sensation within the joint, caused by broken cartilage flakes.
  • Deformity/Instability: Irregular load distributions and muscle imbalances contribute to joint and bone deformities.
  • Antalgic Gait: A walking pattern adapted to reduce pain by modifying limb loading during gait.

OA Diagnosis

  • Clinical findings (patient history of pain, examination of the joint)
  • Radiological findings (e.g., osteophytes, narrowed joint space).

OA Imaging

  • X-rays are the standard for diagnosis. (Osteophytes, narrowed joint spaces, sclerosis, and eburnation are diagnostic features.)
  • MRI or arthroscopy might supplement X-rays for detailed evaluation before possible surgery.

OA Treatment

  • Medical Management: NSAIDs and topical/injectable drugs to manage pain and inflammation (with considerations about side effects). Intra-articular injections of corticosteroids. Glucosamine and hyaluronic acids can also help.
  • Surgical Management: Osteotomy to adjust bone alignment. Arthroplasty (joint replacement) is for severe cases.

Conservative Treatment Options

  • Exercise Therapy: Patient education and supervised/home exercise programs (combined with diet control and low-impact exercises).
  • Weight Loss: Crucial for decreasing strain on the affected joint.
  • Knee Bracing (offloading braces): Relieving pressure on the affected area of the knee joint.
  • Foot Orthoses (lateral wedge): Realigning the foot placement, affecting the knee's mechanics.

Physical Therapy Management

  • Assessment: ROM testing, muscle strength testing, joint stability checks, proprioception evaluations, gait assessments, posture, function, and psychological well-being.
  • Treatment Goals: Reduce joint load, decrease pain and inflammation, increase joint mobility and ROM, improve muscle strength, improve joint stability and proprioception, prevent/slow joint deformity progression, and improve function and independence with ADLs, improving gait.
  • Methods: Weight reduction, assistive devices (canes, crutches, walkers), gait retraining (toe-out gait, reduced walking velocity), and muscle strengthening exercises.

OA Advice for Patients

  • Weight Loss: To reduce load on knees.
  • Lifestyle/Daily Routine Modification: Avoiding extreme postures and activities that exacerbate the condition.
  • Limit extremes of range of motion (avoid over-extending the knee).
  • Avoid long periods of standing, sitting, or lying in one position.
  • Use appropriate walking aids.
  • Eat healthy (fibers important).
  • Stay hydrated.
  • Avoid extreme temperature exposure.
  • Protect the jointAvoid high-impact sports and activities.

Functional and Gait Training

  • Proprioceptive exercises
  • Balance exercises
  • Water-based activities
  • Closed kinetic chain exercises

Potential Differential Diagnoses

  • Various knee pain possibilities (e.g., meniscus tears, ligament sprains).

Therapies

  • TENS, Interferential Therapy
  • Ultrasound
  • Cryotherapy
  • Massage Therapy
  • Taping Techniques
  • Joint Mobilization (knee, hip)

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