A COMMON JOINT DISEASE

OSTEOARTHRITIS
-Osteoarthritis is one of the most common degenerative joint disease causing pain in certain large joints of the body, like shoulder, elbow, wrist, hip, knee, ankle.
it is a condition of synovial joint (the joint containing synovial fluid), however" INFLAMMATION is NOT a PROMINENT FEATURE" of the condition.
-The condition of osteoarthritis results in symptomatic joint failure. 

 EPIDEMIOLOGY:

-The condition rises in prevalence from the age of 30. 
-Most commonly occurring in the age of 30 and above.
-The joints which are more prone to the disease are the hip and the knee joints.
-Women are affected more as compared to men. (Hip joint equally affected in men and women).
-occupational risk factors also play an important role in the occurrence, such as farmers are more prone to hip OA, football players are more prone to knee OA.

ETIOLOGY:

-Mechanical factors
-Metabolic factors
-Trauma
-Obesity
-Smoking
-Gender
-Genetics
-Usage
-Occupation

CLASSIFICATION:


PRIMARY OA:
Occurs in old age, largely affecting the weight bearing joints (hip and knee), the condition is more common.
SECONDARY OA:
Occurs as a result of an underlying primary condition of the joint leading to degenerative changes in the joint, it may occur at any age after adolescence, hip joint is more affected.

PATHOLOGY:

  • ·  The degenerative changes affects the articular cartilage. 
·     -   There is an enzymatic degradation of the major structural components.
·       - There is an increase in the water content and depletion of the proteoglycans from the cartilage matrix.
·   -     The chondrocytes increases their production of matrix components and divide to produce metabolically active clones of chondrocytes.
 -With an increase in the turnover of the aggrecan, the concentration decreases, decreased size of aggrecan molecules causes increased water concentration which is the first change occurring at the joint.
-Repeated weight bearing on such joint causes fibrillation. 
-The degeneration of the articular cartilage begins and there is:
-Fibrillation of the cartilage,
-Focal loss of the cartilage,
- Thinning of the cartilage,
-Damage to the cartilage abraded by the grinding mechanism at the points of contact between the articular surfaces until the underlying bone is exposed.
-The bone at the margins of the joint hypertrophies and forms a rim of projecting spurs known as osteophytes
-Formation of subchondral cysts occurs along with sclerosis.
- At joint capsule, there is thickening leading to joint stiffness.

CLINICAL FEATURES:

  • PAIN (VARIABLE AND INTERMITTENT)
  • FUNCTIONAL DISABILITY
  • RESTRICTED ROM (TERMINAL MILITATION)
  • SWELLING
  • TENDERNESS
  • STIFFNESS
  • MUSCLE WEAKNESS
  • MUSCLE WASTING (QUADRICEPS FEMORIS)
  • CREPITUS ON MOVEMENT
  • DEFORMITY: VARUS OF KNEE, FLEXION- ADDUCTION-EXTERNAL ROTATION OF HIP.
  • IRREGULAR AND ENLARGED JOINTS

TYPES:

  • NODAL OA:

- Polyarticular Finger Interphallangeal Joint OA, 
- Fingers are affected
-Heberden's node formation
-Marked female predisposition
-Peak onset in middle age
-Pre disposition to other joints
Sstrong genetic pre disposition
-Lateral deviation of fingers
-Involvement of first carpometacarpal joint
-Thumb base OA occurs

  • KNEE OA:

-Targets patello-femoral joint and medial tibio-femoral joint of knee.
-Etiology: trauma, gender, obesity, smoking, occupation.
-In men the condition is unilateral
-In women the conditon is bilateral and symetrical
-Pain in anterior and medial aspect
-Pain worsens on climbing stairs
-Posteriorly pain occurs in the popliteal fossa due to formation of popliteal cyst.
-Symptoms:
-Difficulty in walking, climbing stairs, rising from chair, bending.
·         on local examination
-Jerky, Asymmetrical 'Antalgic Gait'.
-Fixed Flexion deformity.
-Swelling
-Tenderness.
-Restricted Rom (flexion/extension)
-Crepitus

  • HIP OA:

Targets superior aspect of the hip joint.
-Pain in anterior groin, radiating to buttock, anterior thigh, knee, shin.
-Pain increases on lying.
 On local examination:
-Antalgic Gait.
-Tenderness over Greater tronchanter.
-Anterior groin tenderness.
-Ipsilateral leg shortening.
-weakness of muscle. (Quadriceps and gluteal)

INVESTIGATION:

Radiological examination
The image has been taken from a real case study

  • Narrowing of joint spaces.
  • Subchondral Sclerosis: dense bone under the articular surfaces
  • subchondral  cysts
  • osteophyte formation
  • deformity of joint

MANAGEMENT:

·         PATIENT EDUCATION:

-Full explanation to the patient about the nature of the disease. Explaining the patient about the treatment protocol and awareness of  the risk factors, aggravating factors.

·         ADVICE AND INSTRUCTIONS:

-patient is advised to avoid the climbing of stairs, prolonged sitting, and prolonged walking.
-the active movements of the joints to maintain ROM
-strengthening of the muscles with the help of resistance,
Resistance can be in the form of weight cuffs, dumbbells, therabands.
-Closed chain exercises: squatting, planks, pushups.
-Quadriceps table
-Cycling (static and dynamic)

·         DRUGS:

-Analgesics used to suppress pain.
-Initial trial of pracetamol.
-NSAIDs
-Steroids

·         REDUCTION OF ADVERSE MECHANICAL FACTORS:

-wearing shock absorbing footwear.
-weight reduction.
-use of walking sticks.
-avoiding stress and strain.

·         SURGERY:

-osteotomy: brings relief in symptoms.
-joint replacement: for cases crippled with advanced damage.
-joint debridement: the affected joint is opened and the cartilage is smoothened, the osteophytes and the hypertrophied synovium is excised.
-arthroscopy: removal of loose bodies, meniscal tears.

·   PHYSIOTHERAPY:

-hot fomentation.
-IFT to reduce pain
-ultrasonic therapy to localized tenderness.
-active/passive movements to maintain full ROM
-STENGTHENING EXERCISES:
·         KNEE: (EACH MOVEMENT WITH 10 REPEATITIONS)
 Knee isometric exercises:
-keep a towel roll or a pillow under the knee and press and hold for 10 seconds and release.
-keep the towel roll or pillow under the heel and press and count 10 and release.
-Keep the pillow or the towel roll between both the knees and press and count 10.
-straight leg raise: raise the leg at an angle of approximately 45 degrees and count 10.
Bend the knee and straighten.
In a high sitting position (on a chair, couch) straighten your leg and count 10 and release.
·         HIP: (EACH MOVEMENT WITH 10 REPEATITIONS)
-straight leg raise: raise the leg at an angle of approximately 45 degrees and count 10.
-in a side lying position, lift the leg and count 10 and release.
-in supine lying position, take the leg out of the couch and count 10 and release.
(The same movements can be done with weights added).
-stretching of the tightened muscles.

References:
Essential Orthopaedics, j. Maheshwari, 3rd edition (revised).
Davidson's Principles and practice of Medicine, 19th Edition, edited b Christopher Haslett, Edwin R. Chilvers, Nicholas Boon, Nicki R. Colledge, International editor John A.A. Hunter.

Comments

Post a Comment

Popular posts from this blog

SUBACROMIAL BURSITIS

Image
WHAT IS SUBACROMIAL BURSAE? Subacromial bursa is a sac like structure filled with fluid found in the shoulder joint. The subacromial bursa separates the rotator cuff muscles, particularly the supraspinatus muscle from the acromion process (a bony structure), the overlying coracoacromial ligament and deltoid muscle. The bursa provides a smooth movement of the shoulder joint and reduce friction. WHAT IS BURSITIS? Bursitis is the inflammation (irritation) of the bursa. The subacromial bursa is the most commonly inflamed bursa in the shoulder joint. Inflammation of the subacromial bursa becomes a cause of pain in performing activities and movements occurring at shoulder joint. It leads to a restricted movement at the joint due to pain while performing the motion. Hence, a restricted range of motion occurs. WHAT CAUSES SUBACROMIAL BURSITIS? ·          Injury to the shoulder ·         ...
Read more

SACROILIAC JOINT DYSFUNCTION

Image
WHAT IS SACROILIAC JOINT ? The Sacroiliac joint is the joint formed between the sacrum and the ilium located in the pelvis on each side of the lower spine. The joint is half synovial and half syndesmosis. Syndesmosis is a type of fibrous joint in which the intervening fibrous connective tissue form an interosseous membrane or ligament. Synovial potion of the joint is C shaped, with the convex iliac surface of the C facing anteriorly and inferiorly. The more acute the C the more stable the joint and the less the likelihood of the lesion to the joint. The sacral surface is slightly concave. The size and shape of the articular surfaces vary greatly among individuals. These surfaces are smooth in children.  They become rough in adults which allows them to fit in one another restricting the movements occurring at the joint and adds strength to the joints and transfer weight from lower limb to spine. The articular surface of the ilium is covered with fibrocartilage, the a...
Read more

TESTS FOR SACROILIAC JOINT DYSFYNCTION

Image
·            PROVOCATION TESTS 1.        GAENSLEN’S TEST: The gaenslen’s test stresses the sacroiliac joint, increased pain on the joint while performing the test is indicative of the sacroiliac joint dysfunction. -           The patient in lying on the couch in a side lying position with the affected leg hyperextended (hanging outside the couch). Patient flexes the other leg and holds knee to chest. The therapist stabilizes the pelvis while the extending the hip by holding it from distal thigh. The pain in the sacroiliac joint may be caused due to a sacroiliac joint pathology, lesion or dysfunction. -           The patient is lying supine (this position limits the amount of hyperextension at the hip) the affected leg is hanging out of the couch, the therapist puts one hand on the hyperextended leg from distal thi...
Read more