1. Osteoarthritis

2. What is osteoarthritis (OA)? Degenerative joint disease Slowly evolving disease Originates in the cartilage Causes inflammation of the joints Characterized by the breakdown of cartilage

3. Causes of primary and secondary OA Primary – Unknown cause – Cascade of joint degeneration – Defect in the articular cartilage Secondary – Trauma – Infection – Hemarthrosis – Osteonecrosis

4. Risk factors Cause is unknown but is mainly related to – Age Prevalence: 60% men & 70% women over 65 years old affected by OA – Gender Men & women equally affected before 55 years old Women at greater risk over 55 years old – Genetics – Overweight or obese – Fractures – Overuse of joints – Biomechanical factors

5. Joints most affected Weight bearing joints – Knee – Hip – Shoulder – Lumbar spine – Cervical spine – First carpometacarpal joint – First metatarsophalangeal joint

6. Signs & Symptoms Pain Stiffness Bony enlargement Limited ROM Crepitus on motion Tenderness on pressure Joint effusion Malalignment Joint deformity Inflammation

7. Stiffness Lasts short durations after periods of inactivity – Usually less that 30 minutes Morning stiffness usually lasts 5-10 minutes Movement and activity decrease stiffness

8. Pain description Deep ache Worse with activity Better after rest Pain is at rest and at night in the advanced stages

9. Examination Audible crepitus Enlarged joint surfaces – Osteophytes may be palpable Joints intermittently warm and tender Axial loading with rotation reproduces symptoms

10. What next? If a patient presents with signs and symptoms that resemble OA and have not yet been diagnosed, refer back to the primary care physician for further tests

11. Medical management Diagnosis is made by a physician based on the correlation of history, physical examination, radiologic findings, laboratory tests – Need to rule out rheumatic disease American College of Rheumatology diagnosis guidelines for knee OA: – Radiograpyic changes – osteophyte formation – One or more of the following Age greater than 50 years old Morning stiffness less that 30 minutes Crepitus with motion

12. Physical Therapy Role PT can educate on disease process, protection of joints, and modifications for exercise – Exercise can lessen the level of disability and pain for a patient with OA Interesting fact: – To reduce the risk of OA by 30%, strengthen the quadriceps and maintain a healthy body weight

13. Physical Therapy Role Goals – Improve physical function – Increase isometric strength – Enhance gait speed and stride length – Improve quality of life Manual therapy and guided exercise is beneficial for patients with OA