Osteoarthritis Recap PDF

- Osteoarthritis is a degenerative joint disease characterized by the breakdown of the joint's cartilage - The cartilage is a tough elastic material that covers and protects the ends of bones from friction - Bits of cartilage may break off and cause pain and swelling in the joint between bones up to...

- Osteoarthritis is a degenerative joint disease characterized by the breakdown of the joint's cartilage - The cartilage is a tough elastic material that covers and protects the ends of bones from friction - Bits of cartilage may break off and cause pain and swelling in the joint between bones up to locking and limited range of motion in late stages - It is one of the most important degenerative joint diseases (DJD) - It is the most common form of arthritis - Most common affected joint is the knee **MCQ** - Followed by weight-bearing joints (Hip - Spine - Feet and Ankle) - Finger OA is less common Q: How does the cartilage protect against friction? 1- Cartilage acts as a shock absorber when you put weight on the joint 2- Slippery surface of the cartilage allows the bones to move smoothly 3- Also the presence of synovial fluid facilitates the motion of the joint However in a diseased Joint: 1- Cartilage gradually becomes rough & thin, and bone underneath thicken 2- Over time cartilage may wear entirely and bones will rub together 3- Synovial fluid becomes less viscous - Unknown (Idiopathic) - Heredity - Excess weight (obesity) puts extra stress on the weight-bearing joints, especially the knees and hips - Joint injury or trauma as in: a) Sport (wear and tear in joint “repeated trauma”) b) Accident - Other diseases (as Rheumatoid Arthritis) - High heel shoes abnormal position adds pressure on relatively weaker joints which causes osteoarthritis overtime - Clinically by history of manifestations (Signs & Symptoms) *IMP to mention* - Clinically by history of complications - Physical examination - Blood tests to exclude autoimmune diseases as rheumatoid and lupus - Nil / Minimal changes Stage I Minimal Subchondral Bone Sclerosis dense white lines Decreased joint space Stage II Mild Decreased joint space + Osteophyte formation and geodeslytic lesions Stage III Moderate Decreased joint space + Osteophyte formation + Malalignmenet Stage IV Severe (Deformity) Joined ends - Pain especially when moving a joint - Swelling or bumps - Stiff fingers and foot - Hear grating sound ‫ بيزيق‬when the roughened cartilage on the surface of the bones rubs together - Hard movement (walking and climbing stairs) - Cartilage ulcer due to erosion of the cartilaginous end of the bone - Muscle weakening that hold the joint in place because they are not being used - Loss of joint shape and function - Deformities as genuvarum and genuvalgum Remember var ≈ far so Genuvarum = ‫الركبتين بعاد عن بعض‬ - Regular Exercise - Weight control - Prevention of trauma Degenerative changes in joints Muscle weakening and loss Pain of function (Especially when moving) Decreased Physical Activity - Only way to break the cycle is by controlling the pain or improve function 1) Analgesics drugs oral or systemic - Non-selective NSAIDs - Selective NSAIDs (Cox-2 inhibitor) are as effective as non-selective NSAIDs and have less chances of gastrointestinal injury and side effects 2) Cream and gels to temporary pain relive 3) Intra-articular injection - Corticosteroid in severe inflammation - Hyaluronic acid ‫ حقنة الزيت‬provides lubrication, decrease inflammation and improve pain Improve flexibility and strengthen muscles surrounding joints #Arthritis have less pain and better function in active people Goals of physiotherapy - Reduce pain - Improve movement and posture - Strengthen muscles - Improve independent function - Assess and treat biomechanical problems that may exacerbate the pain and loss of function Arthroscopy - To remove damage or osteophytes (debridement) - To flush the joint to remove any loose part (lavage or irrigation) Advantage - Delay the need fore more serious surgery as joint replacement - The incision is small size (less invasive) - The pain that result of surgery is minimal - Restore function and decrease pain - One day surgery (patient can be discharged in the same day) Disadvantages - Risk of Anesthesia - Infection - DVT - Nerve/Vessel injury - Improvement lasts only for 3 - 4 years #Arthroscopy can also be used in investigation of joint Corrective Osteotomy Is a procedure in which we change the position or alignment of knee so your weight shift away from the damaged area #As in Genuvarum and Genuvalgum ‫بيخلي تقل الجسم بدل ما هو متوزع علي المفصل كله يكون متركز علي الجزء المقوس و بالتالي يتأكل‬ Genuvarum and Genuvalgum can be both a complication and a cause of Osteoarthritis (Explain) Advantage Decrease pain and restore function Disadvantages May need knee replacement surgery in future (Arthroplasty) Arthroplasty Procedure done by replacing the joint with an artifcial one made of metal or plastic usually done for old age or desperate young cases and can be: - Hemiarthroplasty (Unicompartmental knee arthroplasty) only one part of joint (As knee) is replaced - Total Replacement More common Advantage The result of the joint replacement are generally excellent (there are signifcant pain relief and improved function) Disadvantages - Rehabilitation may take 3 to 6 months - Artifcial joint may loosen or wear out so that a second surgery is needed - Patients undergoing arthroplasty are in a high risk of thrombosis as DVT so prophylactic anticoagulant should be given #Osteoarthritis usually occurs in older people after the age of 45 years but occur at any age #It is usually located in only one or a few joints #The joints are less inflamed than in other arthritic conditions #Progression of pain is almost always gradual #It affects men and women in equal numbers but after the 50 age the women are more #The life span or artifcial is about 10 years in 9% of people #Walking without pain is a blessing worth showing gratitude to God