Scenario 3

Question 1

OA left knee, describe typical presentation?

Answer 1

ROM likely to be effected

Pain, swelling, deformity of joint

Question 2

Problems

Answer 2

Pain 2/10  7/10
Stiffness
Swelling
Walking and stairs

S high
I moderate
N- arthrogenic degenerative

Question 3

Treatment aims

Answer 3

Decrease pain on activity to 2/10 in 2/52
Decrease stiffness and swelling in 1/52
Increase functional activity- walking/stairs 2/52

Question 4

Ax plan

Answer 4

Palpation (osteophytic growth- decrease in joint space, crepitus, swelling and tenderness, warmth)
AROM and PROM- quality and end feel
Sweep test- shows if there is intracapsular inflammation in knee

Don’t forget Rotation

Accessory ROM of joint

Question 5

Other information

Answer 5

Exercise tolerance of patient
Social history- job etc
Comorbidities

Question 6

Rx plan?

Answer 6

Joint problem, treat the joint

Accessory ROM or Physiological

Think concave/convex rule AP or PA

Distraction to relieve pressure from compressed joints
Joint mobilisations
-grade 1-2 to decrease pain
-3 x 30s as this should be long enough to see the effect, pain gate theory
-relaxes muscle guarding
-increases circulation

Exercise- because muscles can act as shock absorbers decreasing the pressure on the joint

- Squats to strengthen
- cycling to increase cardiovascular fitness
- Weight loss if overweight

Question 7

Long term plan?

Answer 7

Very severe: surgery may be required TKR
NSAIDs/ painkillers
Education and self-management

Question 8

Pathology of OA

Answer 8

OA is a degenerative joint disease where chrondrocytes release enzymes that break down cartilage. Proteoglycans are also broken down these then duplicates and absorb too much water. This fibrolates and splits cartilage making it rough and causing friction in the joint. The joint tries to repair itself, development of osteophytes. Debris from the cartilage degradation deposits in the joint space causing inflammation. This leads to effusion and can lead to stretching of the capsule.