Osteoarthrosis: Causes, Features, & PT Management.

Osteoarthrosis, also known as osteoarthritis, is a non-inflammatory degenerative disease of articular cartilage. It is characterized by:

• Thinning and destruction of articular cartilage
• Formation of osteophytes
• Capsular fibrosis

Etiology:

The exact etiology of osteoarthritis is not fully understood. Several factors have been identified as contributing to its development and progression.

Age is one of the major risk factors for osteoarthritis. As people age, the cartilage undergoes normal wear and tear, which can lead to the breakdown of cartilage. This can cause the bones to rub against each other, leading to pain, stiffness, and decreased mobility.

Genetics also plays a role in the development of osteoarthritis. Studies have shown that certain genes are associated with an increased risk of developing the condition. Additionally, abnormalities in the structure and composition of cartilage and other joint tissues may be inherited and contribute to the development of osteoarthritis.

Obesity is another major risk factor for osteoarthritis. Excess weight places additional stress on the joints, particularly the knees and hips. It can accelerate the breakdown of cartilage and lead to the development of osteoarthritis. In addition, adipose tissue releases pro-inflammatory cytokines that can contribute to joint inflammation and damage.

Injuries and trauma to the joint can also lead to the development of osteoarthritis. This can include injuries from sports or accidents, as well as repetitive stress injuries from occupations that involve repetitive motions. These injuries can damage the cartilage and other joint tissues, leading to the development of osteoarthritis over time.

Other factors include joint misalignment, hormonal imbalances, and certain medical conditions such as diabetes and gout. While the exact cause of osteoarthritis is not fully understood, it is clear that a combination of factors, including age, genetics, obesity, injury, and other medical conditions, contribute to its development and progression.

Pathology of Osteoarthrosis:

In osteoarthrosis, the cartilage becomes thinner and less elastic, losing its ability to absorb shock and provide a smooth surface for joint movement. The cells within the cartilage, called chondrocytes, become less active and produce fewer of the proteins needed to maintain healthy cartilage.

In response to the loss of cartilage, the body attempts to repair the damage by producing new bone in the joint, which can lead to the formation of bone spurs or osteophytes. The subchondral bone, which lies just below the cartilage, also thickens and becomes dense, as a result of increased stress and pressure on the joint.

Inflammation within the joint also plays a role in the pathology of osteoarthritis. The synovial membrane, which lines the joint and produces synovial fluid, can become thickened and inflamed, leading to further damage to the cartilage and bone.

Overall, the pathology of osteoarthritis is characterized by a complex interplay of factors, including the breakdown of cartilage, the formation of bone spurs, changes in the subchondral bone, and joint inflammation. These changes can lead to significant pain and disability, particularly in weight-bearing joints such as the knees, hips, and spine.

Clinical Features of Osteoarthrosis:

The following are the clinical features of osteoarthritis:

1. Joint Pain: Osteoarthritis causes pain in the affected joint, which can be described as a dull ache or burning sensation. Pain may be worse after periods of inactivity, such as waking up in the morning, and may improve with movement.
2. Stiffness: Stiffness is a common symptom of osteoarthritis, especially in the morning or after a period of inactivity. The stiffness may be more pronounced after prolonged periods of sitting or standing.
3. Reduced range of motion: Osteoarthritis can cause a reduction in the range of motion of the affected joint. This can make it difficult to perform certain activities, such as bending or reaching.
4. Swelling: Swelling or inflammation of the joint is a common symptom of osteoarthritis. It can make the joint appear red and feel warm to the touch.
5. Crepitus: Crepitus is a cracking or popping sound that can occur when the affected joint is moved. This is caused by the roughening of the joint surfaces due to the loss of cartilage.
6. Muscle weakness: Osteoarthritis can cause muscle weakness in the affected limb due to reduced use of the joint.
7. Deformities: In advanced cases of osteoarthritis, joint deformities may occur, such as the development of bony growths (osteophytes) or misalignment of the joint.

It is important to note that the severity and frequency of these symptoms can vary depending on the individual and the affected joint. It is also possible for some people with osteoarthritis to have few or no symptoms, despite significant joint damage

Diagnosis:

Diagnosing osteoarthritis typically involves a combination of patient history, physical examination, and imaging studies. A doctor may suspect osteoarthritis if a patient presents with joint pain, stiffness, or swelling. To confirm the diagnosis, the doctor may perform the following steps:

1. Patient history: The doctor will ask about the patient’s symptoms, including the location and duration of joint pain, stiffness, and swelling. They may also inquire about the patient’s medical history, family history, and any previous injuries or surgeries that may have contributed to the development of osteoarthritis.
2. Physical examination: The doctor will perform a physical examination to assess the affected joint’s range of motion, stability, and strength. They may also look for signs of joint deformity or inflammation.
3. Imaging studies: Imaging studies, such as X-rays or MRI scans, can help confirm the diagnosis of osteoarthritis. X-rays can reveal joint damage, such as the loss of cartilage and the development of bony growths (osteophytes), while MRI scans can show more detailed images of joint damage.
4. Laboratory tests: While laboratory tests cannot diagnose osteoarthritis, they can rule out other conditions that may cause similar symptoms. Blood tests, for example, can help rule out rheumatoid arthritis or other autoimmune conditions.

Overall, the diagnosis of osteoarthritis requires a thorough medical evaluation to confirm the presence of joint damage and rule out other possible causes of joint pain and stiffness. With a proper diagnosis, patients can receive appropriate treatment and management to help manage their symptoms and improve their quality of life.

Grading of Osteoarthrosis:

Radiographic findings can be used to grade the severity of osteoarthrosis in a joint. There are several grading systems for osteoarthrosis, but the most commonly used is the Kellgren-Lawrence grading system, which classifies osteoarthrosis into five grades based on X-ray findings.

The Kellgren-Lawrence grading system for osteoarthritis on X-ray is as follows:

Grade 0: The joint appears normal with no evidence of osteoarthritis.

Grade 1: There is minor joint space narrowing and possible osteophyte (bony growth) formation.

Grade 2: There is moderate joint space narrowing and osteophyte formation. The joint is still considered mild to moderate.

Grade 3: There is significant joint space narrowing, osteophyte formation, and some bony remodeling. The joint is considered moderately severe.

Grade 4: There is severe joint space narrowing, extensive osteophyte formation, and significant bony remodeling. The joint is considered severe.

It is important to note that the grading system is not always perfectly correlated with the symptoms or functional limitations of osteoarthritis. Some people with mild osteoarthritis may have significant symptoms, while others with more severe osteoarthritis may have few symptoms. In addition, the grading system is just one tool in the diagnosis and management of osteoarthritis, and doctors typically consider a variety of factors, including patient history and physical exam findings, when determining the best course of treatment.

Differential Diagnosis:

• Rheumatoid arthritis
• Gout
• Fibromyalgia
• Spondyloarthropathy
• Ankylosis spondylitis

Treatment:

Medications:

• NSAIDs
• Acetaminophen
• Opioids
• Glucosamine and chondroitin sulfate
• Glucocorticoids
• Intra-articular injections

Medical procedures:

• Total joint replacement
• Joint lavage
• Debridement

PT Management of Osteoarthrosis:

Physiotherapy can be an effective treatment option for osteoarthrosis, helping to alleviate symptoms and improve mobility.

Here are some physiotherapy management strategies for osteoarthritis:

1. Exercise: Regular exercise can help reduce joint pain and stiffness, improve range of motion, and build strength. Low-impact exercises such as walking, cycling, and swimming are often recommended for people with osteoarthritis. Physiotherapists can design individualized exercise programs that are safe and effective for each patient.
2. Manual therapy: Manual therapy techniques such as joint mobilization, soft tissue mobilization, and muscle energy techniques can help improve joint mobility and reduce pain. These techniques can be especially helpful for people with osteoarthritis of the spine or hip.
3. Heat and cold therapy: Applying heat or cold to the affected joint can help reduce pain and stiffness. Heat can help improve blood flow to the joint, while cold can help reduce inflammation. A physiotherapist can recommend the appropriate temperature and duration of application for each patient.
4. Assistive devices: Using assistive devices such as canes, walkers, and braces can help reduce joint stress and improve stability. A physiotherapist can help assess which assistive devices are appropriate for each patient.
5. Education: Physiotherapists can provide education on joint protection techniques, such as pacing activities, avoiding repetitive movements, and maintaining proper posture. This can help reduce joint stress and prevent further damage to the affected joint.
6. Weight management: Maintaining a healthy weight can help reduce joint stress and improve mobility. A physiotherapist can provide advice on healthy eating habits and safe exercises for weight management.

Overall, physiotherapy can be an effective treatment option for osteoarthrosis. A physiotherapist can design an individualized treatment plan that takes into account each patient’s unique needs and goals, and help them manage their symptoms and improve their quality of life.

Exercises For Osteoarthrosis:

WHY EXERCISES?

• Exercises are basically to improve the strength of the muscles.
• Muscles are dynamic stabilizers of the joint, if they are weak joint will no longer be stable.
• Muscles are the drivers of the joint, if they are weak, the joint will no longer produce the movements required for the activities of daily living.
• Therefore, in order to improve the stability and mobility of the joint, improvement of the strength of the muscles remains a primary goal of the therapy.

PROGRESSION OF EXERCISES:

1. Isometric exercises
2. Close kinetic chain exercises
3. Open kinetic chain exercises
4. Stretching exercises
5. Conditioning exercises

Isometric Exercises:

These exercises are taught to the patient irrespective of the stage (mild/moderate or severe)

Lie on the floor with legs straight. Put a towel roll below the knee and press the towel with your knee joint. Hold the press for 10 seconds and repeat it for 10 times with one leg.

This time, put the towel roll below the ankle and then press the towel with your ankle towards the floor. Hold for 10 seconds and do it for 10 times.

Lie down on the floor. Raise your leg 30-40 degrees from the floor and hold there for 10 seconds. Do it for 10 times.

Lie on your side with the affected leg up. Raise the leg straight off the floor and hold there for about 10 seconds. Do it for 10 times.

Lie on your stomach. Raise your leg straight off the floor about 25-30 degrees and hold there for 10 seconds. Do it for 10 times.

Close Kinetic Chain Exercises:

Stand against a wall and squat down until your thighs are parallel to the ground. Avoid deep squatting.

VMO or vastus medialis oblique is a muscle of anterior thight. Strengthening of this muscle is very essential for managing osteoarthrosis.

For this, press a ball or a towel roll between both of your knees during wall squat. Don’t let the ball drop. Hold the ball or towel roll between the knees for about 10 seconds.

This can also be done by sitting on a high stool. For this, sit on a high stool with knees 90 degrees flexed. Hold the towel roll between both of your knees. While holding the towel, straight out one leg and dorsiflex your ankle. Hold the leg up in the air for 10 seconds.

Isotonic Exercises:

Lie down on the floor with both legs straight. Now, slowly bend and straighten out one leg for about 10 times. Do it with both the legs.

Sit on a chair as shown in the picture below. Raise the leg straight parallel to the floor and hold there for 5-10 seconds.This can also be done using ankle weights. This will add on some resistance.

Stretching Exercise:

Conclusion:

In conclusion, osteoarthritis is a common degenerative joint disease that affects millions of people worldwide. Its exact cause is not yet fully understood, but there are several risk factors that increase the likelihood of developing the disease. Although there is no cure, management strategies can help alleviate symptoms and improve quality of life. If you suspect you may have osteoarthritis, it is important to consult with a healthcare professional for proper diagnosis and treatment.