OA Flashcards
Main affected joint by OA
- hip
- knee
- ankle (talocrural and subtalar)
- 1st MPT
- midfoot joint (lisfranc)
Type of OA and causes
1- Primary: unknown cause
2- secondary : known causes
First- hereditary, mechanical, stress, aging
Second- Congenital, RA, obesity, acute trauma, diabetes, inflammation, infection, surgery
OA mechanism
Failure of chondrocyte to control degeneration and repair of cartilage
Chondropathy: softening and thinning of the cartilage, loss and attempts for regeneration
Hip OA (all)
- morning stiffness
- increase with activity
- loss of ROm and muscle strength
Testing
- SCOUR
- reducePROM especially in hip IR extension decreased
- lat pain in active hip flexion
- pain in active hip extension
Knee OA (all)
- deformity, pain, swelling, muscle atrophy, scar
- gait impairment
- muscle weakness
Test :
- reduce PROM
- squat aggravate
- general observation
Conséquences of cartilage loss in OA
OA > muscle weakness> joint instability> reduce ADL
OA > pain > reduce ADL
Loss of proprioception and compensation contribute to joint instability
Potential predictor of fall and fracture
Hip OA/ knee OA
Personal factor: age, women, depression, living alone
Importance of load distribution in the foot during gait in OA
Altered gait > abnormal joint loading
Compensation stress on other joint.
Poor shock absorption increase OA progression in overloaded joint
Overview ankle and foot OA
- tibiotalar : DF/PF : high limitation gait + high pain wb
- subtalar : ev/inv : poor balance on uneven ground
- 1 MTP : toe off : poor push off during gait and painful stiff toe
- talonavicular: mobility and adaptability med foot : loss adaptability med foot
-calcaneocuboid : stability lat foot : pain in twisting and walking
- lisfranc : forefoot stability and transfer force from triceps surae to forefoot : pain in midfoot, instability
Ankle OA aetiology
Post trauma OA represent 80%
16% due CAI
Takakura classification of ankle OA
Stage 1- No narrowing of joint but early sclerosis
Stage 2- Narrowing medial joint space
Stage 3a- obliteration of medial joint space
Stage 3b- obliteration continue to roof dome of talus
Stage 4- obliteration of the whole joint with complete bone contact
OA management
- strength (weight. BW. resistance band)
- Balance and Flexibility( stretching and ROM exercise)
- Aerobic ( at least 150min per week)
Pain should always be under 2 (if not increase inflammation and damage cartilage
Surgical management of foot OA
- Midfoot fusion ( treat joint pain cause by midfoot arthritis, instability arch)
- subtalar fusion ( severe arthritis that cannot be control by non surgical treatment)
- total ankle replacement and lat lig repair( advance arthritis and lat instability)
Rehab phase fusion vs TAR
Voir tableau
Hallux rigidis
Disabling arthritis of the 1 MTP joint
- degeneration cartilage
- large osteophyte
- joint stiffness and pain
Conservative treatment ( activity modif, supportive footwear/orthosis, NSAID)
Surgical treatment (hemi arthroplasty or arthrodesis)
Management 1st MTP joint OA
Intrinsic and extrinsic foot strengthening
Proprioception/ balance
Flexibility Rom
MT
Lisfranc injury
Displacement of metatarsal bone from tarsal
Axial load + PF
- swelling, bruising, pain mid foot, bump midfoot, widening midfoot area, not able WB, bruise blood midfoot
Management lisfranc injury
If less than 2 mm displacement can heal with casting for 6 weeks
If not surgery
Special test lisfranc
- lisfranc joint Squeeze test
- pronation abduction test
- piano key test
Management lisfranc
- restore midfoot stability
Reduce long term disabilit- essential to prevent post op OA
Difference OA / RA
OA > 50, morning stiffness less 30min, no systemic syndrome; decrease AROM PROM, crepitus, tenderness, joint malalignment body enlargement
RA 25-50y, morning stiffness for few hour, unexplained pain for more than 4 weeks, systemic symptoms; sign of inflammation, extra articular manifestation
