Stages of Osteoarthritis. Flashcards
What is the sequence of histological changes in the early stages of OA?
Chondrocytes are destroyed (trauma or malnutrition)-> decreased proteoglycan synthesis-> decreased water retention-> “thinning” of cartilage and decreased joint space.
True or False: Both traumatic and non- traumatic will have a capsular pattern of restriction.
True; traumatic has immediate onset, but both will show the capsular pattern .
Traumatic onset of OA will show what S/S?
Pain on motion and spasm end feel
Non traumatic onset of OA looks like?
Thinning of cartilage that leads to instability
What does treatment for early stage OA consist of?
Acute: RICE
Non-Acute: Emphasis on NWB ROM exercises through full ROM. Make sure they go into closed pack position!!
At this stage in OA is it possible to fix this patient with physical therapy?
No; at this point you are just buying them time
In the intermediate stage of OA what does excessive joint play play cause?
Microtrauma to both the capsule and ligaments. If non-traumatic can also lead to instability.
With traumatic and non traumatic causes what is the end result of OA in the intermediate stage?
Fibrotic changes in periarticular tissue.
If a patient in the middle stage loses ROM what is the result?
Further malnutrition of the hyaline cartilage which leads to further destruction of chondrocytes.
If you instigate constant motion with the patient above what will the necrosis in the joint be replaced with?
Fibrocartilaginous scar tissue
If the patient refuses to move and stops going through ROM what will the necrotic cartilage turn in to?
Calcific plaques, this greatly reduces the diffusion of nutrients.
Later in this stage the patient will get “loose bodies”. What are these?
Loose pieces of cartilage and/or bone “floating” within the joint. (basically crepitus)
Fibrotic changes in the intermediate stage cause what S/S?
Capsular pattern with a capsular end feel. (You may find excessive jt play with testing which will have a firm end feel.)
In later stages when the loose bodies have developed how will the S/S change?
Pts will complain of loss of control of the joint; c/o it giving way or twinges of pain with WB.
True/False: The intermediate stage of OA is where PT is MOST helpful.
True (according to the book)
Are there specific joint mobs that work best in this stage?
Not necessarily, the mob should match the irritability the patient is feeling.
Passive stretching should include stretching of what?
Stretch the periarticular structures (muscles included). Work against the capsular pattern!
Exercises should encourage habituation. What does that mean in this situation?
Means that exercises should make sure pt goes in and out of the closed pack position.
By the late stage of OA the joint destruction has reached to what point?
Reached the sub-chondral bone region and joint mice are common complication.
What is considered the most significant change in the late stage of OA?
The presence of osteophytes.
Destruction of the hyaline will be seen on an X-ray. What should you see?
Diminished joint space.
Do the osteophytes merge or ankylose in the joint?
No; the joint may progress to ankylosing, but the osteophytes themselves never merge.
True or False: You can reverse some of the changes that happen in the late stages of OA.
False. By this stage the destruction is complete and irreversible.
What are the S/S of late OA?
1) Joint capsule swelling
2) Bony osteophytosis
3) Gross ROM restriction in capsular pattern.
4) Possible bony end feel
