Presentation on theme: "Www.pspbc.ca Bilateral Knee Osteoarthritis Case 6 : Ruth-Ann."— Presentation transcript:
www.pspbc.ca Bilateral Knee Osteoarthritis Case 6 : Ruth-Ann
2 Faculty/Presenter Disclosure with Faculty’s Name:Faculty’s Name:
3 Disclosure of Commercial Support. Mitigating potential bias N/A.
4 Objectives When working with CPP, you will be able to: Identify key elements of osteoarthritis history List 3 assessment tools that may be useful Identity appropriate investigations Appropriate management
5 Bilateral Knee Pain Ruth Ann is a 62 yr old retired elementary school teacher She was touring through Europe 3 weeks ago when she tripped on some cobblestone roads and landed straight on her knee caps. She noticed some initial mild swelling the next day but had significant swelling and pain after flying home. She is gradually improving but still complains of anterior and medial pain bilaterally especially with descending stairs, prolonged standing greater than 15 minutes and with using the elliptical machine at the gym.
6 What are your Key Questions? How do you determine if this is osteoarthritis or a structural trauma?
8 History Prior to her fall 3 weeks ago, she complained of intermittent knee pain with long walks and gardening. She had never sought medical care for this complaint but often used a menthol rub for relief of aching. She currently describes intermittent deep aching, like a bruise, that is combined with occasional sharp pain under her knee cap especially with going down stairs. She get relief with heat and rest.
13 Knee Symptoms indicating Structural Instability Swelling Locking Giving Way Clicking Sudden, large effusion versus small delayed swelling Knee is stuck in position, indicative of meniscal tear Knee buckles, unexpected fall, instability from ligament tear, large meniscal tear Common and often non- painful, often patellar related
19 Physical Exam What physical examination techniques would you use? We found: Right Knee active flexion 110 degrees - pain end range, Passive flexion is 125 degrees - pain end range. Left Knee active and passive flexion is full. Patellar compression causes pain on right knee Mild Joint effusion on right knee Ligaments and mensici are intact Gait demonstrates mild limp on right for first 5 steps then normalizes.
23 Management Tools How would you determine if investigations were appropriate ? We used: Is there poor or no response to appropriate treatment? Are pain levels unmanaged with best medications? Are there prolonged rheumatological symptoms greater than 6 weeks ?
25 What is best Management Ruth-Ann has mild to moderate osteoarthritis likely in the patellar and medial compartments Her pain is improving but she is hesitant to continue with activity for fear of flaring her symptoms Best Practice would focus on: Medications Rehabilitation and Exercise Patient Education and Self- Management
36 Goal Setting Ruth-Ann is improving on her follow-up visit 3 weeks later. She is using occasional pain medication after prolonged activity She is back to her daily activities She would like to discuss “safe exercise” as she has decided to join a seniors gym program and lose some weight.
41 Clinical Impression Bilateral Knee Osteoarthritis Right worse than left Patellar and Medial compartments Mild to Moderate Pre-existing mild with moderate exacerbation after trauma Managed with pain medications, rehabilitation exercise, education and promotion of self management Investigations if concerned about inflammatory symptoms Xrays if suspected fracture or for OA prognosis
42 Key Clinical Information What are the key criteria for Osteoarthritis? Morning Stiffness less than 30 min. Intermittent Pain associated with activity Recurrent episodes May lead to bony deformity and decreasing function
43 Summary When working with Osteoarthritis, it is important to: -Identify the differences between inflammatory and non-inflammatory joint disease -Focus on Pain and Function in assessment and management -Focus on patient self management for lifestyle factors