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					      Osteoarthritis

Present by: Sahar Abdualaziz,
 Moneerah Al Otibai, Noha Al
            Basha.
Outline
Definition          Treatment:
Pathology           A- medical
Causes              B- surgical
Sign and symptoms   c- physical therapy
Joint affected
Features
Diagnosis
Complication
    Definition:

Osteoarthritis (OA): is a degenerative joint
disease characterized by the breakdown of the
joint's cartilage. It called degenerative joint
disease.

the most common form of arthritis.
   Pathology:

It is caused by the breakdown of cartilage.

Cartilage is the tough elastic material that
covers and protects the ends of bones. Bits of
cartilage may break off and cause pain and
swelling in the joint between bones.
This pain and swelling is called inflammation.
pathology
In healthy joints      joint osteoarthritis the
cartilage acts as a    cartilage gradually
shock absorber         becomes rough and
when you put           thin, and the bone
weight on the joint.   underneath thickens.
The slippery           Over time the
surface of the         cartilage may wear
cartilage allows the   away entirely, and the
bones to move          bones will rub
smoothly.              together .
   Causes

1-unknown.
2-heredity.
3-excess weight (obesity) :puts extra stress on
the weight-bearing joints, especially the knees
and hips.
4-joint injury:
   a- sport (wear and tear in joint).
   b- occupation (squat position over many years.
5-other disease RA.
6-high heel shoes.
    Sign and symptoms:

1-pain, especially when moving a joint.
2-swelling or bumps.
3-sore and stiff (fingers and foot).
4-hear grating sound when the roughened
cartilage on the surface of the bones rubs
together.
5- hard movement (walk and up stair).
   Joint affected:

OA commonly affects weight-bearing joints
such as hips, knees, feet and spine.
However, non-weight bearing joints such as
finger joints.

Knee OA is more common in Saudi Arabia
    Factor to distinguish OA and
            other disease.

1-Osteoarthritis usually occurs in older people
after the age 45 years, but occur at any age.
2-It is usually located in only one or a few
joints.
3-The joints are less inflamed than in other
arthritic conditions.
4-Progression of pain is almost always gradual.
5-It affects men and women in equal numbers
but after the 50 age the women is more.
                   Diagnosis

1-history of symptoms
2-physical exam..
3-blood test to detect
     (OA or RA).
4- x-ray
           Complication of OA

1-The muscles that hold the joint in place weaken
  because they are not being used.

2-Over time, the joint looses its shape and does
  not work at all.
                           Changes in Joint




   Muscle Weakness
                                               Pain
Loss of Normal Function




                          Decreased Physical
                               Activity
                        Treatment
  Medical:
1-Analgesics drugs:

A) Acetaminophen :to relieve mild to moderate arthritis pain.
Side effect:
liver damage.
B) Codeine preparation: to relive severe arthritis pain.
 Side effect: may cause constipation

2-Cream and gels: to temporary pain relive.
3-Nonsteroidal anti-inflammatory drugs (NSAIDs):

To reduce pain and swelling of the joint and decrease stiffness.

a) Non-selective NSAIDs: e.g. aspirin
-Low dose use to relive pain.
- Higher dose and regular use to suppress inflammation
Side effect:
Stomach upset, diarrhea and abdominal pain

B) Selective NSAIDs (Cox-2 inhibitor): are as effective as non-
   selective NSAIDs and less cause gastrointestinal injury and side
   effect.
Joint irrigation:
the joint space is flushed with fluid to remove cartilage debris,
irritating crystals and other substance.

*use to reduce pain, stiffness and tenderness and allow
 for increased physical activity.


Corticosteroid:
May be injected into the joint to relive severe inflammation.
Cortisone as asteroid that reduce inflammation and swelling.
   Surgical
1-Arthroscopy: use to
1-invistigation of joint.
2-treatment:
a) To remove damage (debridement)
b) To flush the joint to remove any
loose part (lavage or irrigation)
*Advantage:                                    *Disadvantage:
1-delay the need fore more serious surgery     1-Risk of anesthesia.
  e.g. joint replacement.                      2-infection
2-the incision is small size.                  3-damage to nerve or
3-the pain that result of surgery is minimal   blood vessels
4-restore function and decrease pain.          4-DVT
2-osteotomy:
Is procedure change the position or alignment of knee so your
weight shift away from the damage area.
This procedure only be done when only one area or side of knee
damage.
*Advantage:
Decrease pain and restore function.
*Disadvantage:
May need knee replacement surgery in future.
3-arthroplasty:(joint replacement)
Procedure done by artificial joint replace all joint (total replacement)
or part of knee damage (Unicompartmental knee arthroplasty).
Artificial joint made from metal and plastic.

 Advantage:
1- the result of the joint replacement are generally excellent (there are
   significant pain relief and improve function).
Disadvantages:
1-rehabilitation may take 3to6 month.
2-the artificial joint may loosen or wear out so that second surgery is
   needed.
* The life span or artificial is about 10 years in 9%of the people.
                        Physical Therapy

   Physical therapy and exercise improve flexibility and strengthen
    the muscles surrounding the joints.

   People who exercise regularly their arthritis will typically have less
    pain and better function than those who are inactive.

    physiotherapy treatment program will help:
• 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
                           Exercises
   Exercise can help:

   prevent the disability that result from inactivity.

   It promotes the health and normal function of muscles and bones.

   Exercise keeps the muscles toned and increases bone mineral density,
    which reduces the risk of osteoporosis and fractures. It also promotes
    cardiovascular health, which decreases the risk of heart disease.

   In addition, there are also psychosocial benefits to exercise,
    including an improved sense of well-being and the relief of depression.
           Range of Motion Exercises

   Range-of-motion exercises are gentle stretching
    exercises which move each joint as far as possible in all
    directions.

   These exercises need to be done daily to help keep
    joints fully mobile and prevent stiffness and deformities.

    ROM (range-of-motion) exercises are especially
    important for arthritis patients, who because of intense
    inflammatory pain tend not to want to move painful
    joints.
              Strengthening Exercises
   Strengthening exercises help increase muscle strength. Strong
    muscles help to support the joints, making the joints more
    stable, and helping a person move more easily and with less pain.

    The two types of strengthening exercises are
    isometric and isotonic:

   Isometric exercises involve tightening the muscles, without
    moving the joints. These exercises are especially useful when
    joint motion is impaired.

   Isotonic exercises involve strengthening the muscles by moving
    the joints.
               Stretching Exercises
   Stretching the muscles that support the knee is
    important in preventing injury. Flexible muscles are not
    as easily injured as tight muscles. Tightness of muscles
    connected to the knee can also pull the knee out of
    alignment .

   When doing stretching knee exercises, be careful to go
    slowly and not to overstretch.
                  Aerobic Exercise

   Aerobic exercise benefits those with knee problems
    by toning the muscles of the leg that support the
    knee joint to absorb shock before it reaches the
    knee joint .

   Aerobic exercises also help in weight reduction.
    Losing weight reduces stress on the knee joint - the
    impact placed upon on the knees is three times the
    body weight while walking.

   Aerobics also stimulate your the body to release
    endorphins - natural painkillers produced by one's own
    body.
   Aerobic exercise is important for the health of the
    heart, lungs, and overall function of the body.


   Warm up before aerobic exercise to slowly increase
    your heart rate and breathing rate. Five minutes of
    slow paced walking, and a few minutes of stretching
    are sufficient. Cooling down in the same manner is
    also important be sure to stretch your quadriceps and
    hamstrings .
   Walking: Start with about 5 minutes of slower paced walking to
    warm up. Walk at a medium pace for about another 10 minutes per
    day and gradually build up to 30 - 60 minutes by adding a few
    minutes each time you walk. End your walk with 5 minutes of
    slower paced walking. After you get into better shape you can
    start walking at a faster pace to increase the intensity of your
    walks.
   Swimming and Water Exercises

   swimming is an excellent no-impact exercise. Regular 'land'
    exercises can also be done underwater.

   The buoyancy of the water supports most of the body's weight
    while the resistance of the water make your muscles work harder
    to perform movements.

   You can use dumbbells and weights strapped to the ankles to
    intensify the workout without stressing the knees and other
    weight-bearing joints .
   Stationary bikes :Make sure your seat is high enough so
    that your knees are not bent beyond a 90-degree angle. Your
    knee should be slightly bent when your pedal is furthest
    away. An upright stationary bike (looks like a regular bike)
    gives you a higher intensity work out than a recumbent bike.
            Heat and cold therapies

   Applying heat and cold to arthritic joints can help to
    control symptoms such as pain and stiffness.

   Heat therapy : Heat relieves pain and stiffness in
    arthritic joints. Heat can be applied to the joints
    with hot packs, hot water bottles, heating pads, or
    electrically heated mittens.

   Heating pads should be set on a timer and used for
    no more than 20 minutes at a time. The heating pad
    can be reapplied after 20 minutes of no use.
   Cold therapy : Cold relieves pain in arthritic joints and
    reduces muscle spasms. Cold can be applied for short
    periods using ice packs or topical coolant sprays.
    People with certain medical conditions, such as the
    Raynaud phenomenon, should not use cold therapy.
          Orthoses & Assistive devices
   Orthoses : Orthoses are devices that promote normal alignment
    and function of the joints. There are many different types of
    orthoses that can reduce symptoms and help maintain function in
    people with osteoarthritis.

   Well-cushioned shoes and shoe inserts may reduce
    stress on the joints of the spine and leg.



   Splints that immobilize the joints can reduce pain and
    inflammation, and many splints can be worn throughout
    the day and night. Braces can help stabilize unstable
    joints.
   Assistive devices : Canes, walkers, electric powered
    seat lifts, raised toilet seats, and tub and shower
    bars can reduce the stress on joints and make it
    easier to perform daily tasks.
                    TENS Therapy
   A TENS unit delivers a mild electrical current to the skin,
    stimulating nerve fibers in the skin that may interfere with the
    transmission of pain signals from the arthritic joint.

   The use of TENS for people with osteoarthritis is controversial.
    Some studies have found that those who use TENS for arthritis
    of the knee have reduced knee pain, a greater ability to bend the
    knee, and a reduced duration of morning stiffness.

   However, one study found that the benefits occurred primarily
    during active use of the TENS unit, and another study found that
    TENS was no more effective for relieving pain than the drug
    naproxen.
                 Activity limitations

   The following positions and activities place excessive
    pressure on the knee joint and must be limited until
    knee pain and swelling resolve: Squatting ,Kneeling
    ,Twisting and pivoting, repetitive bending and Bicycling.

   The preferred exercise equipment for the knee should
    provide smooth motion of the knee, maximal toning of
    the front and back thigh muscles (quadriceps and
    hamstring muscles).
    THERE IS NO
CURE,BUT THERE ARE
WAYS OF MANAGING
      AND THE
 PHYSIOTHERAPY IS
AN IMPORTANT PART
      OF THAT
   MANAGEMENT.

				
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posted:7/26/2011
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