Professional Documents
Culture Documents
Treatment Options
1.
NonPharmacological
2.
Pharmacological
3.
Surgical
Patient Education
2.
Weight Reduction
3.
Physiotherapy/Exercise
4.
Appliances
Patient Education
Education is most important intervention for
all people with OA.
Education of the patient with OA can
increase the
practice of healthy behavior,
improve health status and
decrease health care utilization.
Weight Loss
Over weight is the single most important
potentially modifiable risk factor for the
development of lower limb OA.
Felson et al revealed that a weight loss of 11.2
pounds over a 10-year period decreased the
likelihood of developing knee OA by 50%.
A decrease in body
mass is associated
with a significant
reduction
in
compressive and
resultant knee
forces.
The
accumulated
Physical Therapy
American College of Rheumatology recommend
that patients with symptomatic lower limb OA
m u s t b e e n r o l l e d i n a Ph y s i o t h e r a p y
Programme.
1.
Specific Modalities
2.
ROM Exercise
3.
Stretching Exercise
4.
5.
Mobility Training
6.
Aerobic Conditioning
7.
Specific Modalities
(Thermotherapy/Cryotherapy/Electrical
Stimulation)
Cold:
is more likely than heat to benefit in acute
arthritic flares characterized by pain and
swelling.
Principle:
cold induced vasoconstriction which helps to
limit tissue edema and has anti-inflammatory
effect by lowering joint temperature,
collagenase activity and WBC count with in
Heat:
is used in OA patients in order to enhance
stretching exercises by increasing tissue elasticity
and in order to provide analgesia.
Principle:
Heat induced analgesia occurs as a result of direct
suppression of free nerve endings via vasodilation.
It also suppress
skeletal muscle hyperactivity
through activation of descending pain inhibitory
system.
Therapeutic ultrasound
Therapeutic ultrasound is the most commonly
used deep heating modality.
In this the high frequency sound wave produce
heat at deep tissue
TENS
TENS has been found superior to placebo and
useful as an effective adjunct to therapeutic
exercise or NSAIDs with respect to pain relief by
many studies.
TENS Techniques
TENS is a technique to stimulate different
categories of nerve fibers.
1.
Conventional TENS:
2.
3.
Intense TENS
ROM Exercise
ROM exercise are generally given to prevent
motion loss with in the osteoarthritic joint.
Physiotherapy programme should be tailored
according to a patients ability to independently
perform range of motion.
Stretching Exercise
To prevent abnormal force generation to
develop across a joint
because of muscle
tightness.
Stretching is most
effective if performed
on a daily basis
particularly after tissue
has been heated as
heating enables collagen
to be maximally
stretched.
Mobility Training
(Ambulation, elevation,stairs, assistive devices)
Assistive devices are capable of partially
unloading painful weight bearing joints.( 15% of
body weight)
Use of assistive cane on contralateral side is
most effective.
Unfortunately compliance with assistive devices
for ambulation is less
Aerobic Conditioning
Aerobic conditioning programme counteracts the
decreased aerobic capacity that may have an
adverse impact on overall morbidity and
mortality.
It also provides analgesic effect by releasing
endogenous opioids.
It also counteracts depression and anxiety.
Orthotic Management
Orthotic intervention is recommended for some
patients with knee and hip OA.
Lateral wedge foot orthoses have been shown in
some biomechanical and clinical studies to reduce
load on the medial compartment of the knee.
Pharmacological Management
1.
treatment is unsuccessful.
Codine one to two 30mg tablets every 4 to 6 hrly
to a maximum of 240mg (60mg codine =6mg
morphine)
2.
pain.
Intra-articular injections with corticosteroids can
be given when patient have moderate to severe
pain and when there are local signs of
inflammation and joint effusion.
Surgical Management
Surgery is deployed both early in the course of
disease as well as later, when joint destruction
occurs.
Surgery may also have a preventive role prior to
the onset of OA.
Hip resurfacing.
2.
3.
Comorbities included
diabetes,
hypertension,
cardiovascular disease,
renal failure,
GI bleeding,
depression, or
a physical impairment limiting activity,
including obesity.