Degenerative Joint Diseases and Bone Pathologies

Question 1

Osteoarthritis (OA) (Def)

Answer 1

Degenerative joint disease.

Pt with OA undergo periods during which the joint may become inflammatory in nature, but it’s not specifically an inflammatory disease.

Question 2

Osteoarthritis (Si and Sy)

Answer 2

> Damage of the hyaline cartilage.
Fibrillation: cracks in the surface of the cartilage (because of water absorption).
Eburnation: smooth and shiny appearance of bone ends.
Osteophytes: bony spurs that develop at the margins of the arthritic joint. May interfere with joint motion and break off.

Question 3

Osteoarthritis (Clinical Picture)

Answer 3

> Pain on weight-bearing (night pain may occur after extensive activity, as well as pain after exercise).
Stiffness after inactivity that improves with movement.
↓ ROM caused by muscle spasm, contractures, or bony blockage.
Muscle atrophy, weakness, and spasm as a result of disuse and overstretching of the muscles.
Joint deformity and enlargement.
Joint crepitus: grating noise within the joint.
↓ fx, or loss of fx, as a result of pain and muscles weakness.

Question 4

OA of the Hip

Answer 4

> Pain often referred into the groin and along the ant aspect of upper leg as far as the knee.
Muscles involved: hip flex, add, and ext rot.
Muscle atrophy most apparent in hip ext and abd.
Standing balance is also affected.
Trendelenburg gait may be developed.

Question 5

OA of the Knee

Answer 5

> Muscle spasms frequent in HS, causing a flex deformity/contracture of the knee.
Quads become atrophied and genu valgus occurs.
Pain felt ant, toward thigh and ankle.
Pt often limp and complain from knee “giving way”.

Question 6

OA of the Hands

Answer 6

> Develops slowly over many years.
Heberden’s nodes: found on the Distal Interphalangeal joints (DIPs).
Bouchard’s nodes: found on the Proximal Interphalangeal joints (PIPs).
Hands become quite deformed.

Question 7

OA of the Feet

Answer 7

> Mainly involves the 1st MetaTarsoPhalangeal joint (MTP), resulting in hallux valgus deformity.

Question 8

OA (PT intervention)

Answer 8

> Focus on strengthening weak muscles, endurance activities, and HEP.
Relief of pain: heat, ice, US, electrical stimulation, and massage. (Parafin wax baths for hands, patella mobs for knee).

Question 9

OA (Recommendations)

Answer 9

1. Use a cane (less stress on other joints).
2. Avoid same position for long periods.
3. Avoid prolonged standing in one position.
4. Exercise every day.
5. Control weight.
6. Do NOT place a pillow beneath knee (will encourage knee and hip flex deformities).
7. Do NOT lift heavy weights.
8. Keep joints warm (cold can aggr).
9. Use a moist heating pad for pain control.
10. If knees swell, elevate for 15’ x3/day.
11. Walk as much as possible to maintain aerobic capacity.
12. Pace activity to little and often, rather than too much at once.
13. Avoid sitting for prolonged periods.
14. Avoid crossing the legs (impairs circulation).
15. Follow the physician’s prescription for medications.

Question 10

Spondylosis (Def)

Answer 10

Degenerative disease affecting the intervertebral discs of the spine.

Question 11

Spondylosis (Si and Sy)

Answer 11

> “Lipping” of the bodies of the vertebrae.
Crush or compression Fx.
Ligamentous thickening.
Dura mater becomes inflamed → sharp and intense pain.
Osteophytes → reduced lumen → nerve root impingement.

Question 12

Spondylosis (PT intervention)

Answer 12

Goals: restore fx through postural reeducation, muscle strengthening ex’s, flexibility ex’s, mobilisation of spinal joints, and relief of pain.

Pt normally respond well to hydrotherapy and mobilisations.

Question 13

Spondylosis (Clinical Picture)

Answer 13

1. Onset after a period of stress.
2. HAs, neck ache, sh and arm pain in pt with Cx spondylosis.
3. Neck musculature weakness.
4. Lipping of vertebral bodies, ↓ space between Vx bodies and osteophytes.
5. Referred pain into arm along a dermatome (nerve root pressure).
6. Pain in LB, especially SIJ region, with pain in buttocks and hips.
7. Muscle spasms in LB ext muscles.
8. Altered sensation and paresthesias along dermatome of the nerve root affected.
9. Limitation of ROM in the spinal joints.

Question 14

Spondylosis (General considerations)

Answer 14

► If you sleep supine → use only one pillow (prevents forward neck posture).
► If you sleep on your side → use 2 pillows under head and 1 between knees (head and LB aligned).
► Perform regular stretches (prevents stiffness).
► Practice good ergonomics.
► Move around regularly and do not remain in the same position for long periods.

Question 15

Spondylolysis (Def)

Answer 15

Disease process involving a defect in the pars interarticularis of the Vx of the lumbar spine.

Usually occurs at level L4/5 or L5/S1.

If Vx slips anteriorly = spondylolisthesis.

Question 16

Spondylolysis (PT intervention)

Answer 16

> Abd and ext muscle strengthening ex’s.
Postural reeducation.
Lifestyle adaptations.

Question 17

Infective (Septic) Arthritis

Answer 17

Normally only one joint affected.

Most cases are treated with antibiotics and resolve, leaving no lasting damage.

PT: after infection has been fully treated.

Question 18

Hemophilic Arthritis

Answer 18

Specific type of arthritis present in pt with hemophilia that occurs when hemarthrosis is present.

Si and Sy: sudden onset pain after an injury of any kind or prolonged unusual activity.

PT intervention: similar to other types of arthritis. Caution to avoid additional bleeding. Low-impact ex’s recommended.

Question 19

Gout

Answer 19

Several types of arthritis-like conditions caused by crystals within the joints. Pt with gout have a ↓ ability to excrete uric acid, that collects in the joints as a crystal.

Most cases start in the MTP joint of the great toe, but can affect any joint, especially knee, ankle, and elbow.

PT intervention: PT do not play a major role. Activity during an acute episode is contraindicated.