Osteoarthritis (OA)

A chronic, degenerative disorder primarily affecting the articular cartilage of synovial joints, with eventual bony remodeling and overgrowth at the margins of the joint.

Background and Characteristics

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  • Refers to degeneration and inflammation of bone and cartilage in articulating (moving) areas
  • Pain with weight bearing and joint motion can progress into partial to full loss of motion and pathological fusion (ankylosis)
  • Osteophytes (bone spurring) may be identified on x-ray or diagnostic imaging. They can form in response to abnormal joint stresses
  • osteoarthritis2.jpg
    • http://www.medical-look.com/Joint_pain/Osteoarthritis.html
  • Pathological bone remodeling can lead to ligamentous laxity and joint hypermobility/instability
  • Can result in secondary nerve or postural dysfunction due to loss of joint height/space
  • Symptoms are exacerbated with overuse, weather changes, or prolonged immobilization
  • Associated with advancing age and family history (primary OA), lifestyle habits (sedentary, obesity, high-impact sports, repetitive loading/lifting), prior fracture or injury, and loss of bone density (secondary OA)

Signs and Symptoms

  • pain - localized and referred
  • impaired joint mobility (typically a capsular pattern)
    • firm end-feel indicates chronic presentation
    • guarded end-feel indicates acute presentation
    • includes effusion and/or crepitus
    • loss of accessory joint motion
  • impaired muscle performance
    • muscle length-tension relationships
    • inadequate activation or guarding of postural stabilizers
  • impaired balance
    • joint degeneration limits feedback from proprioceptors
  • functional limitations
    • may need adaptive equipment to complete a functional activity or to protect joint(s) from further injury

     

 

Principles of Management of Osteoarthritis

  • Patient instruction
  • Pain management—early stages
    • emphasis is on reducing joint stiffness, balancing activity and rest, and reinforcing the role of movement in joint health
  • Pain management—late stages
    • consider modalities for home use, pacing and prioritizing, modifying activities
  • Assistive and supportive devices and activity
    • bracing, aquatics, assistive devices for ADLs, home and environmental modifications
  • Resistance exercise
    • emphasis is on strengthening within non-painful ranges, isometrics to minimize disuse atrophy
    • open chain activities with resistance across long lever arms can increase joint loads and exacerbate arthritis symptoms
  • Stretching and joint mobilization
    • assisted and patient instruction in safe and effective technique
    • involved joints typically have a firm end-feel due to bony changes in the articulating areas
  • Balance activities
  • Aerobic conditioning
    • patient education on exercise parameters, including low impact-low joint stress activities