Osteo arthritis of knee/osteo arthrosis/Degenerative joint disease(kneepain)

While age is a major risk factor for osteoarthritis of the knee, young people can get it too. For some individuals, it may be hereditary. For others, osteoarthritis of the knee can result from injury or infection or even from being overweight.

Osteoarthritis, commonly known as wear and tear arthritis, is a condition in which the natural cushioning between joints -- cartilage -- wears away. When this happens, the bones of the joints rub more closely against one another with less of the shock-absorbing benefits of cartilage. The rubbing results in pain, swelling, stiffness, decreased ability to move and, sometimes, the formation of bone spurs.

Pathogenesis of Osteoarthritis

Signs:

Pain on movement

Swelling of the joint

Articular gelling - stiffness lasting short periods and dissipates after initial ROM.

Spasm of periarticular muscles

Bony enlargement of the joint

Limitation of range of movement - End ROM mostly affected

Crepitus when moved - loud cracks & crunches if the arthritis is severe.

Tenderness to pressure
- Around the joint margins
- Very sore if knocked or injured in any way

Joint Deformity or poor alignment
- Genu Varum (Bow Legs)
- Genu Valgum (Knock Knee)

Symptoms:

Pain:

The types of pain are aching: fleeting and constant, refered: passing down the limb, Sharp stabbing: loose bodies, throbbing: mainly at night. Or bursitis.

Early Disease Condition - Gradual onset, mild in intensity, brought on by joint usage, and relieved with rest.

May be vague around joint

Self-limited or intermittent

Severe Disease Condition - pain at rest & during night

Severity of pain does not reflect the severity of the disease

Joint stiffness < 30 minutes in the morning and becomes worse as the day goes on.

Loss of normal function of the joint and the person as a whole.

Advanced Condition - Sense of grinding or locking of a joint, and buckling or instability of joints during demanding tasks.

Modifiable risk factors

Obesity, Occupation, Trauma, Sports

Non-modifiable risk factors

Age; gender (female); ethnicity; family history.

CONSERVATIVE TREATMENTS & PHYSICAL THERAPY ADVICE

The primary goals of treating osteoarthritis of the knee are to relieve the pain and return mobility. The treatment plan will typically include a combination of the following:

Pharmological therapy:

Pain relievers and anti-inflammatory drugs. This includes over-the-counter choices such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen sodium (Aleve). Don't take over-the-counter medications for more than 10 days without checking with your doctor.

Taking them for longer increases the chance of side effects. If over-the-counter medications don't provide relief, your doctor may give you a prescription anti-inflammatory drug or other medication to help ease the pain.

Glucosamine and Chondroitin Sulfate may prove beneficial in alleviating the symptoms and complaints of symptomatic osteoarthritis of the knee.

. Chronic use of glucosamine chondroitin sulfate may elevate serum cholesterol and we encourage you to discuss its use with your Primary Care Provider.

Injections of corticosteroids or hyaluronic acid into the knee

Steroids are powerful anti-inflammatory drugs. Hyaluronic acid is normally present in joints as a type of lubricating fluid. Alternative therapies. Some alternative therapies that may be effective include topical creams with capsaicin

Non-pharmological therapy:

Using devices such as braces, There are two types of braces: "unloader" braces, which take the weight away from the side of the knee affected by arthritis; and "support" braces, which provide support for the entire knee.

Occupational therapy Occupational therapists teach you ways to perform regular, daily activities, such as housework, with less pain.

Physical therapy:

Physiotherapy is a non-pharmacological conservative treatment approach that is recommended in clinical guidelines for the management of knee osteoarthritis.

Physiotherapy should be considered prior to pharmacological interventions for patients with osteoarthritis, given its low risk of adverse effects and the widespread benefits it can offer most patients with osteoarthritis.

Physiotherapy treatment of knee osteoarthritis may encompass any or all of the following: advice, information & education, exercise programs, joint mobilization, muscle re-education, assistance with use of aids [eg walking sticks, braces, orthotics) or electrotherapy modalities. For optimal benefits, physiotherapy management should be based on an individual clinical assessment and tailored to the patient's individual presentation and problems

AIMS:

To control pain.

To decrease the swelling.

To increase the blood supply.

To prevent further strain or damage to affected joint.

To improve movement.

To correct the deformity and contracture.

To improve muscle power.

To maintain or improve functional independence

EXERCISE THERAPY

1)Exercise program should be simple.

2)It should be developed on the basis of the normal kinematics to regain the correct mechanism of knee joint.

3)Exercise program includes.

Isometric exercises:

This is exercise in which muscles are tensed for a period without actually moving them. It can be performed without actually bending a painful joint. As muscles are exercised against resistance, their size and power will increase

QUADS ISOMETRIC EXERCISES

SHORT ARC EXTENSIONS

Lie or sit with a rolled towel underneath the knees. Relax the head.

Straighten the knees, bringing the heels up off the floor. Keep them up for a count to five

Relax. Repeat routine 10 times

SIMPLE ACTIVE KNEE EXTENSION EXERCISE

1 Quad sets

Place a pillow lengthwise under your knee. Pull your toes back and push your leg down to squash the pillow. Hold for 10 seconds and repeat up to 20 times. You should feel your thigh and gluteus muscles during this exercise. Begin with moderate effort and then increase your effort gradually. This exercise can be done lying flat as shown, sitting in a recliner, or leaning against a wall.

2 Hamstring sets

Lie on your back with knees bent and toes up. Dig your heels into the ground and pull back without sliding your heels. Hold for 10 seconds and repeat up to 20 times. You should feel the back of your thigh, the hamstrings, during this exercise. As with quad sets, start with a moderate effort and increase your effort gradually.

3 Straight leg raise

Tighten your thigh and pull your toes back just as you do for the quad set, then maintain the muscle tightness as you slowly raise your leg 18 inches. Lower slowly, relax your muscles briefly, then tighten your thigh, pull your toes back and repeat 20 times.Note: These first 3 knee exercises are the least stressful on the knee joint as they require little to no movement of the knee itself.

4 Bridging

Knees bent and feet flat on the floor as above with your heels spaced comfortably from your bottom. Fold a bed pillow in half, and place it between your knees. Squeeze the pillow and hold on to it tightly. Raise your bottom upward slowly lifting one vertebra at a time from your exercise mat. Continue lifting your bottom upward until there is a straight line from your shoulders to your knees. Hold this position 5-10 seconds. Repeat 6-8 times. Think of reaching your knees forward over your ankles.

Note: If this exercise is uncomfortable, just squeeze the pillow and hold it 10 seconds. This is called an adductor set, as it works the inner thigh muscles. Once you can do this (and knee exercises #1 and 2) 20 times with a strong effort, try bridging again.

5 Knee extension

Sit upright in a chair, straighten your leg, tighten your thigh and pull your toes back. Hold for 10 seconds and repeat up to 20 times. The more you tighten your muscles, the better results you’ll get from this exercise. You may feel a stretch behind your knee during the exercise. For a greater challenge, straighten both legs at the same time, or do this exercise with an adjustable ankle weight up to 5 pounds.

If you feel a strong stretch behind your knee during the exercise, pump your ankle (point your toes and flex your foot back) several times instead of just holding your toes back--this will help improve your flexibility.

Note: Knee exercises #6 and 7 are balance exercises.

6 Heel raises

Hold onto a chair or countertop only as much as you need to for safety. Go up on your toes as high as possible without leaning your body weight forward. Stay up and maintain your balance for 2-3 seconds. Repeat up to 25 times. Keep your weight over your big toes as you go up and down .Once you can easily do 25 repetitions, try lowering back down on one foot. Then progress to single leg heel raises.

7 Butt kicks

Keep your knees in line and lift your heel as high as possible. Stand upright when you lift your heel. You will feel your hamstrings during this exercise, and you may feel a stretch in the front of your thigh. Repeat up to 20 times on each side. Add an ankle weight to increase the challenge.

GAIT RE-EDUCATION:

The gait should be analyzed and corrected as required. Gait re-education includes management of stairs, slopes, standing to sitting and bed to chair transfers. Postural awareness needs to be stimulated and the patient encouraged to assume a more efficient posture.

SELF MANAGEMENT:

This includes:

1)Weight control

2)Stress control.

3)Joint protection.

4)Assistive devices.

WEIGHT CONTROL:

Weight control is important to successful osteoarthritis management. Being over weight is a risk factor for osteoarthritis. Controlling weight can lessen pain by reducing stress on individual. Weight loss should be occupied with regimen of more Physical Activity. 30 minutes of daily exercise is enough.
- Stress control techniques are helpful to regain a sense of control while relieving their osteo arthritic pain.
- Techniques of stress management.
- Muscle relaxation.
- Controlled breathing.
- Biofeedback.
- Self hypnosis.
- Time management.

STRESS CONTROL:

JOINT PROTECTION

Joint protection begins with learning new ways to use the osteoarthirtis of knee joint.

Joint stress and strain on the knee joint is limited by following ways.

Bend at the knees and straighten the legs.

Get up from a chair by sliding forward to the chair’s edge, keeping the feet flat on the floor, and using the palms of the hands to push against the chair’s arms or seat. Stand up by straightening the hips and knee. Use higher seats rather than deep, soft sofas.

Never squat or kneel, as these positions strain the hips and knees.

Maintain good posture to avoid putting stress on the joints.

Wear well-cushioned athletic shoes with good arch support whenever possible. If dress shoes must be worn, women should choose styles with heels that are no higher than one inch.

ASSISTIVE DEVICES

Walking aids like canes, sticks are used.

If one knee is effected a single stick is used in the opposite hand.

If both the knees are effected tow sticks will be needed.

In severe cases orthotics may be needed.

Surgery: When other treatments don't work, surgery is a good option.

If your doctor wants to treat the osteoarthritis in the knee with surgery, the options are arthroscopy, osteotomy, and arthroplasty.

Arthroscopy uses a small telescope (arthroscope) and other small instruments. The surgery is performed through small incisions. The surgeon uses the arthroscope to see into the joint space. Once there, the surgeon can remove damaged cartilage or loose particles, clean the bone surface, and repair other types of tissue if those damages are discovered. The procedure is often used on younger patients (55 years old and younger) in order to delay more serious surgery.

An osteotomy is a procedure that aims to make the knee alignment better by changing the shape of the bones. This type of surgery may be recommended if you have damage primarily in one area of the knee. It might also be recommended if you have broken your knee and it has not healed well. An osteotomy is not permanent, and further surgery may be necessary later on.

Joint replacement surgery, or arthroplasty, is a surgical procedure in which joints are replaced with artificial parts made from metals or plastic. The replacement could involve one side of the knee or the entire knee. Joint replacement surgery is usually reserved for people over age 50 with severe osteoarthritis.

The surgery may need to be repeated later if the joint wears out again after several years, but with today's modern advancements most new joints will last over 20 years. The surgery has risks, but the results are generally very good.

Disclaimer: This information might have been copied from different sources to give the best accessible

Tuesday, January 28, 2014