Stages of Osteoarthritis.

Question 1

What is the sequence of histological changes in the early stages of OA?

Answer 1

Chondrocytes are destroyed (trauma or malnutrition)-> decreased proteoglycan synthesis-> decreased water retention-> “thinning” of cartilage and decreased joint space.

Question 2

True or False: Both traumatic and non- traumatic will have a capsular pattern of restriction.

Answer 2

True; traumatic has immediate onset, but both will show the capsular pattern .

Question 3

Traumatic onset of OA will show what S/S?

Answer 3

Pain on motion and spasm end feel

Question 4

Non traumatic onset of OA looks like?

Answer 4

Thinning of cartilage that leads to instability

Question 5

What does treatment for early stage OA consist of?

Answer 5

Acute: RICE

Non-Acute: Emphasis on NWB ROM exercises through full ROM. Make sure they go into closed pack position!!

Question 6

At this stage in OA is it possible to fix this patient with physical therapy?

Answer 6

No; at this point you are just buying them time

Question 7

In the intermediate stage of OA what does excessive joint play play cause?

Answer 7

Microtrauma to both the capsule and ligaments. If non-traumatic can also lead to instability.

Question 8

With traumatic and non traumatic causes what is the end result of OA in the intermediate stage?

Answer 8

Fibrotic changes in periarticular tissue.

Question 9

If a patient in the middle stage loses ROM what is the result?

Answer 9

Further malnutrition of the hyaline cartilage which leads to further destruction of chondrocytes.

Question 10

If you instigate constant motion with the patient above what will the necrosis in the joint be replaced with?

Answer 10

Fibrocartilaginous scar tissue

Question 11

If the patient refuses to move and stops going through ROM what will the necrotic cartilage turn in to?

Answer 11

Calcific plaques, this greatly reduces the diffusion of nutrients.

Question 12

Later in this stage the patient will get “loose bodies”. What are these?

Answer 12

Loose pieces of cartilage and/or bone “floating” within the joint. (basically crepitus)

Question 13

Fibrotic changes in the intermediate stage cause what S/S?

Answer 13

Capsular pattern with a capsular end feel. (You may find excessive jt play with testing which will have a firm end feel.)

Question 14

In later stages when the loose bodies have developed how will the S/S change?

Answer 14

Pts will complain of loss of control of the joint; c/o it giving way or twinges of pain with WB.

Question 15

True/False: The intermediate stage of OA is where PT is MOST helpful.

Answer 15

True (according to the book)

Question 16

Are there specific joint mobs that work best in this stage?

Answer 16

Not necessarily, the mob should match the irritability the patient is feeling.

Question 17

Passive stretching should include stretching of what?

Answer 17

Stretch the periarticular structures (muscles included). Work against the capsular pattern!

Question 18

Exercises should encourage habituation. What does that mean in this situation?

Answer 18

Means that exercises should make sure pt goes in and out of the closed pack position.

Question 19

By the late stage of OA the joint destruction has reached to what point?

Answer 19

Reached the sub-chondral bone region and joint mice are common complication.

Question 20

What is considered the most significant change in the late stage of OA?

Answer 20

The presence of osteophytes.

Question 21

Destruction of the hyaline will be seen on an X-ray. What should you see?

Answer 21

Diminished joint space.

Question 22

Do the osteophytes merge or ankylose in the joint?

Answer 22

No; the joint may progress to ankylosing, but the osteophytes themselves never merge.

Question 23

True or False: You can reverse some of the changes that happen in the late stages of OA.

Answer 23

False. By this stage the destruction is complete and irreversible.

Question 24

What are the S/S of late OA?

Answer 24

1) Joint capsule swelling
2) Bony osteophytosis
3) Gross ROM restriction in capsular pattern.
4) Possible bony end feel

Question 25

What is the only real treatment for late stage OA?

Answer 25

Try to regain joint motion and strength at the joints in the same kinetic chain. Mobs and heat modalities are helpful.