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Osteoarthritis
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Osteoarthritis is a chronic, degenerative disorder ofmultiple etiology, characterized by loss of articularcartilage and periarticular bone remodeling.
Causes
` Previous knee injury` Repetitive strain on the knee` Fractures, ligament tear, and meniscal injury -affect
alignment; promote wear and tear.
` Genetics` Obesity
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` Pain: worsen following activity,` Stiffness at rest- quickly goes away with activity
` Limited range of motion in the knee
` Localized swelling
` X-rays: joint space narrowing, bony enlargements andosteophyte formation.
` Joint tenderness
` Crepitus- (crackling, grinding noise with movement)
` Local inflammation` OA progresses- Pain continuous even when not weight-
bearing
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` Oral medications: Acetaminophen, Opioid
analgesics , NSAIDS ( ibuprofen, naproxen,
dicofenac, meloxicam)
` Corticosteroid injections` Topical creams and gels
Conservative
` Education
` Physical therapy ROM exercise, musclestrengthening, aerobic conditioning.
` Weight loss
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` The program should be individualised after considering:` Severity of pain` Joint stability
` The program should include:` Warm-up 5 minutes. Range-of-movement exercises.
` Flexibility exercises daily stretching and range-of-movementexercises.` Strengthening exercises (a) Isometric exercises (static muscle
contraction that does not move a joint or alter muscle length) up totwice daily during acute inflammatory periods; and (b) Isotonicexercises (resistance training exercises, often with weights), maximumtwo days per week.
` Endurance/fitness exercises such as walking, swimming, dancing,aquarobics, cycling, 34 times per week.
` The intensity, duration, and frequency of exercise should be specifiedand graded to allow for progression.
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A 64 year old Indian female presents to the Physio
outpatients complaining of left knee pain
Cues
64 year oldIndian female
Left knee-weight bearing joint
Pain
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` Fracture
` OA
` Rheumatoid arthritis
` Ligament injury ( ACL, PCL, LCL, MCL)` Meniscal injury
` Referred pain
` Tendinitis
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Name: Mrs. X Age: 64yrs Race: I Gender: F
MP: Throbbing pain on the medial and lateral sideof the left knee joint.
HPC: Pain started in September last year with noclear onset. She was been seen by a privatedoctor for her knee and was taking antinflammatory drugs. Upon her diabetes checkup atCWM the doctor referred her to Physio
outpatients.PrMHx: Diabetes Mellitis, HTN, Chronic Renal
Failure stage II since past 2 years.
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` PMHX: Eye surgery last year Nov for cataracts
` Aggravating factors- walking, sitting for long withlegs hanging.
` Easing factors- Rest
` 24 hr behavior: Pain doesnt change with time
` Severity: 8/10 pain
` SHX: Retired nurse, living with her husband.
`
FHX:` SQ: Poor eyesight, no previous injuries to her left
knee. Hobbies: Sewing and gardening
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` Investigations: X-ray showed narrow joint space.
` Medications:
T Gleprgide 5mg
T ASA 150 mgT Enalpril 5mg
T Simrotatin
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` Surface heat to the superficial regions of the body.