degenerative joint disease

Degenerative joint disease and role of physiotherapy

Degenerative joint disease, osteoarthritis?

Osteoarthritis, shortened as O.A which may simply mean Old-age Arthritis can be defined as “degenerative joint disease associated with ageing and characterized by destruction of articular cartilage following impaired synovium nutrition, formation of osteophyte (bony margins) leading to a variable degree of pain and instability of the affected joint.”

Though Osteoarthritis a degenerative joint disease, can occur in all joints due to ageing, it is commonly seen in weight-bearing joints such as those of the Hip, Knee, Ankle, and Spine as in the case of spondylosis/ spondylitis resulting in radiculopathy which in turn results to pain in the Low back or Neck pain which may or may not extend to the leg or upper arm respectively.

Clinical signs and symptoms:

The symptoms are usually persistent and often associated with Mentalists, physical and social consequences among which may include; sleep disturbances, reduced joint range of motion, physical activity and symptoms of anxiety and depression. Consequently, the health-related-quality of life (HRQOL) of these patients become low with resultant higher morbidity.

Patients with Osteoarthritis generally complain of pain. Depending on the severity of the condition, pain is said to worsen when the affected joint is exposed to strenuous activity.

Patients also experience stiffness in the early morning i.e difficulty in moving the affected joints after a period of rest, this is thought to be associated with gelling of the synovial fluid at the joint. Swelling of joint and abnormal coarse sound/sensation (crepitus) caused by flaked cartilage may also be observed .

Risk factors of osteoarthritis

The following factors may predispose individual to Osteoarthritis:

1-Obesity this imposes unusual stress over the joints especially the hip, knee and ankle.
2-Abnormal posture
3-Occupation, this is due to repetitive overuse of the involved joint with specificity to occupation
4-Gender; Owing to hormonal changes, women are more prone to be affected by Osteoarthritis than men
5-Age: Averagely aged and elderly individual are affected.
Others include previous injury to joints, congenital deformity and so on

Review of joint anatomy and pathophysiology

Understanding the anatomical components of joint will lay a prosperous foundation for easier understanding of the pathogenesis of the condition.

A joint exists where to or more skeletal components whether bone or cartilage come together to meet (make a point of articulation). The absence of of joint between bones will render rigidity and immobility of the whole body.

In order to to facilitate full range of motion of a joint that is free of painful restriction, other anatomical components/ soft tissues ( muscles, ligaments, cartilages and synovium) associate to give structural reinforcement of the movable joints.

Ligament serve as an elastic band that firmly stabilizes the joint. Cartilage together with synovium lining it, helps to lubricate the bony ends thus reducing friction direct rubbing of the bony ends as movement is initiated. The muscular mass making the outer layer of the joint is chiefly responsible for the movement of joint by its ability to lengthen and shorten ( eccentric and concentric concentric contraction.

Pathophysiology of osteoarthritis

Osteoarthritis is traditionally thought of as a ‘wear and tear’ disease which occurs as we age. However, recent research suggests otherwise.

The pathogenesis of OA involves a degradation of cartilage and remodelling of bone due to an active response of chondrocytes in the articular cartilage and the inflammatory cells in the surrounding tissues.

The release of enzymes from these cells break down collagen and proteoglycans, destroying the articular cartilage. The exposure of the underlying subchondral bone results in sclerosis, followed by reactive remodelling changes that lead to the formation of osteophytes and subchondral bone cysts. The joint space is progressively lost overtime.

Management of degenerative joint disease:

The treatment of Osteoarthritis is usually conservative in nature with physiotherapy playing a major role following a meticulous assessment in order to retard progression and improve function.

Physiotherapy all along consist of different modalities such as assistive devices, patient education on condition, postural adjustment, exercises (strengthening exercises to improve muscle power and flexibility exercises to improve joint range of motion) electrotherapy for pain relief and functional training.

Manual therapy may be employed for relief of pain by massage and traction (pulling force) in the case of pain radiating to the upper arm and or lower leg.

Local heat or ice packs when swelling is present and joint support with the use of braces may also be beneficial.

Patients who are overweight should also be advised on weight loss.

Essentials of orthopaedic for physiotherapists John Ebnenzar.

Abba Muhammad Tawfiq

Department of Medical Rehabilitation, Physiotherapy

University of Maiduguri, Nigeria

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