Osteoarthritis

Question 1

Chronic non-inflammatory, degenerative disorder primarily affecting articular cartilage of synovial joints

Answer 1

Osteoarthritis (OA)

Question 2

• Commonly after age 40

- 85% of population over age 70 have some degree

Answer 2

Risk Factors of OA

Question 3

• Idiopathic, genetic
• Altered biomechanics
• Immobilization
• Mechanical injury to joint, repeated stress
• Obesity
• May be 2ndary to Gout, RA, Paget’s or Septic Arthritis.

Answer 3

Causes of OA

Question 4

• Achiness, tenderness with extensive use
• Can be unilateral or bilateral
• AM: stiff, ↓ ROM relieved by 30 min of activity
• Crepitus
• ↓ ROM
• ↑ pain w/ WB & strenuous activity
• Hypertonic mm crossing joint, sometimes spasm

Answer 4

Early Clinical Manifestations of OA

Question 5

• Pain w/ minimal active motion, PROM
• Pain is not relieved by rest
• Night pain
• Local tenderness
• Disuse atrophy, ↓ strength
• ↓ ROM w/ bony end feel/palpable crepitation
• Joint deformity-Bouchard’s/Heberden’s nodes
• Osteophyte formation
• Gait abnormalities due to antalgia
• Instability
• Periods of acute inflammation, spasm, edema

Answer 5

Later Clinical Manifestations of OA

Question 6

• Passive: bony end-feel, leathery end-feel
• Resisted: weakness, pain
• Special testing to rule out tendonitis, bursitis
• Palpation – adhesions, osteophytes, tone
• Gait
• Posture

Answer 6

Assessments for OA

Question 7

• ↓ pain/stiffness in affected joint(s)
• ↑ circulation into mm crossing joints
• ↑/Maintain ROM
• ↑ proprioception/balance

Answer 7

Short-term Aims for OA

Question 8

• Correct biomechanical error
• ↑ strength and endurance of mm
• Maintain joint health
• Improve physical conditioning

Answer 8

Long-term Aims for OA

Question 9

• TP release
• PROM, stretch techniques
• Joint play
• If post-Sx: scar/fascial work

Answer 9

Massage Treatment for OA

Question 10

• No hot hydro over joint replacements
• Aggressive joint play if osteophytes present
• Precautions appropriate for prescribed medications

Answer 10

OA Contraindications

Question 11

• Active ROM
• Isometric strengthening
• Low impact aerobic activity
• Balance/proprioceptive training

Answer 11

Remex for OA

Question 12

• Deep moist heat and contrast baths
• Whirlpool
• Epsom-salt bath
• Wax treatments prior to joint play

Answer 12

Hydrotherapy for OA

Question 13

• Self-massage if possible
• Splints, braces
• Support groups
• Devices to enhance ADL’s
• KEEP ACTIVE!

Answer 13

Home Care for OA

Question 14

• NSAIDs (ibuprofen, ASA) including Celebrex, Aleve
• Tylenol (acetaminophen)
• Topical analgesics: Voltaren (diclofenac), capsaicin (derived from red peppers), Arnica w MSM
• Glucosamine chondroitin
• Synovial fluid replacement: Hyalgan (hyaluronic acid) injected into the joint.
• Cortisone injection
• Surgery
• Physio, occupational therapies

Answer 14

Medications for OA