WEEK 12 - KNEE OSTEOARTHRITIS

Question 1

What factors influence OA?

Answer 1

• pain and disability are poorly explained by degree of structural damage on scan
• pain experience influenced by multiple factors that can create inflammation, that make the joint sensitive, swollen, stiff and sore
  
  • biological - muscle weakness, findings on the scan, inflammation
  • psychological - low confidence, unhelpful beliefs, stress, depressed mood
  • social - work and sport demands
  • lifestyle - poor sleep, low or excessive physical activity, excess belly fat, poor diet

Question 2

Knee OA physical examination findings

Answer 2

Observation

In standing
- Any obvious differences in swelling, amount of flexion/offloading, muscle tone, muscle atrophy, evidence of guarding
- Varus knee position

Functional assessment
- Walking
- Maybe a squat
- Looking at quads strength
- Any crepitus, joint restriction with pain
- STS
- Stairs

Observe:
- Offloading, weakness
- Symptom modification procedures
- Medial Patella glide
- Altering Varus/Valgus position of the knee
- Increased hip flexion/reduced quads load
- Ankle posture change
- Foot posture change

Palpate
- No palpable warmth around the knee
- Any bony irregularities
- Tenderness around joint lines

AROM/PROM
- Crepitus
- Restricted or painful ROM testing
- Joint tenderness

Muscle capacity/strength
- STS
- Hand-held dynamometry
- Quads, hamstrings, adductors

Muscle length
- Thomas/modified Thomas test

Question 3

Differential diagnosis - knee OA vs PFP

Answer 3

Onset
knee OA - gradual onset due to degenerative joint changes and increases in sensitisation
PFP - multifactorial causes with no consistent structural damage - acute increase in knee loading or poor neuromuscular control (hip and knee instability or muscle weakness)

Diagnosis
Knee OA: Clinical diagnosis using EULAR criteria: - Age ≥40, activity-related pain, stiffness <30 mins - + crepitus, restricted ROM or bony enlargement - Physical signs: joint tenderness, ROM loss, muscle guarding - No imaging needed
PFP - Diagnosis of exclusion: - Pain with stairs, squats, sitting long periods - Pain often in terminal extension range - Clinical tests:  * Patellar compression test  * Movement pattern analysis  * Dynamic valgus - Exclude: patellar tendinopathy (pain with resisted deep knee flexion), meniscal/ligament injury

Question 4

Knee OA - ongoing management

Answer 4

Exercise
- strength - mostly quads
e.g - STS, step ups, leg extensions
- motor control
- some pain during exercise is normal / safe
- cardiovascular / aerobic
- increasing walking, stairs
- balance

education
- about the condition
- trigger
- dispel commonly held beliefs
- empower patient
- psychosocial strategies - beliefs, stress, sleep

weight loss
- = pain reduction
- complex and tricky to navigate with patients

PROMs
- pateint specific functional scale
- knee injury with OA outcome score

FOMs
- 30s chair STS
- stair climb test
- TUG
- 6 MWT

referral
- GP
- pharmacist
- dietician
-clin psych

Question 5

PFJ ongoing management

Answer 5

dependent on pt presentation
exercise
- resistance - 12 week program, hip targeted due to knee irritability
- gait retraining
- patella taping
- ankle ortheses

subject matter
- load Mx
- how to effectively manage pain
- address fear of moveemnt/pain/damage
- address psychosocial factors, sleep, stress, diet

quads
- wall sit
- SL STS
- goblet squat - heel elevated
- avoid open chain exercies

ankle mobs