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DEGENERATIVE OSTEOARTHRITIS Treatment and Rehabilitation Assoc. Prof. Ece AYDOĞ Physical Medicine and Rehabilitation.

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Presentation on theme: "DEGENERATIVE OSTEOARTHRITIS Treatment and Rehabilitation Assoc. Prof. Ece AYDOĞ Physical Medicine and Rehabilitation."— Presentation transcript:

1 DEGENERATIVE OSTEOARTHRITIS Treatment and Rehabilitation Assoc. Prof. Ece AYDOĞ Physical Medicine and Rehabilitation

2 Cartilage is a protein substance that serves as a "cushion" between the bones of the joints. Osteoarthritis is a type of arthritis that is caused by the breakdown and eventual loss of the cartilage of one or more joints.

3 Constituents of hyaline cartilage Cellular material: Chondrocytes:5% Extracellular material: Matrix:95% ( Water comprises approximately 70%) – Collagen fibres – Proteoglycan molecules

4 Proteoglycan Aggregate Large hygroscopic molecules Long central chain of hyaluronic acid Numerous side chains alongs its length, each with; – Central cores of protein – Chondroitin sulphate and keratan sulphate side chains Pg’s attract water and put collagen under tension

5 Normal Articular Cartilage Softening and swelling of cartilage

6 Loss of cartilage Softening and swelling Fibrillation Full thickness cracks Eburnation Subchondral cysts Subchondral sclerosis Osteophyte formation ‘



9 Individual risk factors for development of OA Obesity: knee > Hip Family history (genetic): polyarticular esp hands Trauma Hypermobility Dysplasia: Hip and knee Occupation and sport: excessive and repeated loading of a joint

10 Clinical features Pain and tenderness Originates in joint /periarticular soft tissue Diffuse/ sharp and stabbing local pain Initially, symptomatic patients incur pain during activity, which can be relieved by rest and may respond to simple analgesics Joints may become unstable as the OA progresses; therefore, the pain may become more prominent (even during rest) and may not respond to medications

11 Movement abnormalities Gelling  stiffness after periods of inactivity  passes over within minutes of using joint again Coarse crepitus  palpate/hear Reduced ROM  capsular thickening and bony changes in joint

12 Deformities Mild synovitis Osteophytes Joint laxity Asymmetrical joint destruction leading to angulation


14 Treatment Principles Education Physiotherapy – Exercise program – Pain relief modalities Aids and appliances Medical Treatment Surgical Treatment

15 Prevent overloading of joint; Obesity!! Appropriate use of treatment modalities Importance of exercise program


17 Exercises Flexibility exercises — daily stretching and range-of-movement exercises. Strengthening exercises — (a) Isometric exercises (static muscle contraction that does not move a joint or alter muscle length) up to twice daily during acute inflammatory periods; and (b) Isotonic exercises (resistance training exercises, often with weights), maximum two days per week. Endurance/fitness exercises — such as walking, swimming, dancing, aquarobics, cycling, 3–4 times per week.  The intensity, duration, and frequency of exercise s hould be specified and graded to allow for progression.


19 Physical Agents  Heat  Cold  Water  Pressure  Sound  Electrical Current

20 Physical Agents Cryotherapy: Ice packs, commercial cold packs, iced towels, ice massage, cold baths (immersion), vapocoalant spray, contrast baths. Radiant heat: Infrared Conductive heat -Hot packs -Paraffin bath Superficial heat Hydrotherapy -Whirlpool -Hubbard tank Shortwave diathermy Deep heat Ultrasound -

21 General Indications Purported Uses  Modulate pain  Reduce or eliminate inflammation  Increase rate of healing  Modify muscle tone  Increase connective tissue extensibility

22 Ice Contraindications  Cold hypersensitivity  Raynaud’s disease  Regenerating peripheral nerves Precautions  Over superficial main branches of nerve Peroneal nerve  Open wounds  Poor sensation

23 Application 10 minutes is sufficient Re-applied regularly, every 2-3 hours Following approximately the first 3-5 days of an acute injury

24 Red/Infra-Red Phototherapy

25 Conductive Heat Hot Packs Moist heat Canvas filled wityh silica gel Immersed in water of about 77 C

26 Paraffin Bath Tank containing a mixture of paraffin and mineral oil C Areas that are diffucult to heat Helps to soften the skin

27 Contraindications (heat) Pregnancy Acute inflammotory conditions Active Cancer Active bleeding Patients with cardiac insufficiency Extremly old adults and children less than 4 years old Patients with peripheral vascular disease Tissues that are devitalized by x-ray theraphy Already existing fever

28 Precautions Already existing edeme Patients with sensory loss Patients who are confused

29 Low Level Laser Therapy Cold Laser Therapy Primary Effects – Similar to effects of Infrared therapy Secondary Effects – Cell proliferation, protein synthesis, growth factor secretion, neurotransmitter modification Tertiary Effects – System effects; Increase immune response, stimulate bone healing

30 Ultrasound Therapeutic Ultrasound sends high frequency sound waves through tissue and has a thermal effect. Therapeutic ultrasound frequency used is 0.7 to 3.3.MHzMHz Maximum energy absorption in soft tissue is 2 to 5 cm. Intensity decreases as the waves penetrate deeper. They are absorbed primarily by connective tissue: ligaments, tendons, and fascia (and also by scar tissue)

31 Ultrasound Typical applications of Ultrasound  Pain control (Munting 1978)  Increase tissue extensibility (Knight 2001)  Accelerate healing wounds (Dyson 1978), bone fractures (Duarte 1983)  et al Pharm Res 1992)

32 Ultrasound Two types of benefit: Thermal effects Non thermal effects Indications: Soft tissue shortening (Joint contractures, scarring) Subacute and chronic inflammation

33 Electrical Stimulation Common uses:  Pain control (TENS, interferential)  Iontophoresis (Direct Current)  Muscle stimulation (NMES)  Tissue healing (wound care)

34 TENS (Transcutaneous Electrical Nerve Stimulation) Pain control 2 theories of how TENS may control pain Gate control theory – high frequency TENS Opiate-mediated control – low frequency TENS (Acupuncture- like TENS)

35 TENS Contraindications  Patients with cardiac pacemakers  Pregnancy  Sites over the carotid sinus, laryngeal or pharyngeal muscles, sensitive eye areas, or mucosal membranes  Do not use while operating hazardous machinery

36 Aids and appliances Braces / splints Special shoes/insoles Mobility aids Aids: dressing, reaching, tap openers, kitchen aids Taping of patella in patello femoral OA


38 Tapping

39 Medical Treatment Simple analgesics: paracetamol Topical treatment; NSAI, capsaicin creams Glucoseamine; oral, topical NSAID’s Tramadol or opioidis Intra-articular corticosteroids Intra-articular viscosupplementation PRP


41 Joint replacement surgery Indications: pain affecting work, sleep, walking and leisure activities Complications – sepsis – loosening – lifespan of materials (mechanical failure)

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