CASE THREE A 65-year old obese woman with a diagnosis of osteoarthritis (OAj hás

Question

CASE THREE A 65-year old obese woman with a diagnosis of osteoarthritis (OAj hás been having increased pain in her right knee that worsens with movement and weight bearing Rest relieves the pain. Physical evaluation reveals an enlarged joint with a valus r the joint on passive movement. A. Explain the specific pathogenesis (pathophysiology) behind each of the following: a. The enlarged joint b. Its crepitus (grinding or creaking) c. The valgus (bowed-in/ inward leaning) deformity. Explain the tendency for involvement of the knee in people with this woman's characteristics (sex, age, and morphology). B. Describe the treatments available to help this woman improve her mobility and, therefore, her quality of life. C.

Explanation / Answer

A.a) Osteoarthritis is marked by progressive deterioration of the articular cartilage. it causesbone buildup and the loss of articular cartilage in peripheral and axial joints. It affects the weight- bearing joints and joints that receive the greatest stress, such as the hips,knees, lower vertebral column, and hands. the cause of primary OA is not known. Risk factors include trauma, aging, obesity, genetic changes and smoking. Because of all these causes cartilage injury occurs and leads to chondrocytes proliferate and secrete inflammatory cytokines and proteases and thus resulting in secondary chronic inflammation and chondrocyte drop-out, cartilage loss and subchondral bone injury.

A.b) Crepitus in OA - the reason is arthritis damages cartilage and bone. As the damaged knee joint moves, it may crackle and crunch.( Mechanical stress or biochemical changes slowly break down the cartilage that cushions the joint, causing inflammation and pain. Over the time, the cartilage is destroyed and the bones grind together.)

A.c) Valgus knee deformity- when the knee is not perfectly aligned from side to side, either a valgus or varus malalignment may occur.Valgua knee or ''knock-knee'' is commonly caused by arthritis of the knee and the feet are not touching.Severe valgus deformity place stress on the articular cartilage, bone, and ligaments of the knee joint which causes the progression of knee osteoarthritis.

B.OA is a common disease of aged population and one of the leading causes of disability. Incidence of knee OA is rising by increasing average age. It is the most common articular disease of the developed world and a leading cause of chronic disability,mostly as a consequence of the knee OA and or hip OA.

C. Management includes1. Pain management 2. Nutrition 3. Physical Mobility 4. Surgical Mangement

PAIN MANAGEMENT:- Administer medications as prescribed such as acetaminophen, or topical applications, NSAIDS. Muscle relaxants may also be prescribed for muscle spasm, especially those occuring in the back. Prepare the client for corticosteriod injections inti joints as prescribed. Position joints in function position and avoid flexion of knees and hips. Immobilize the affected part with a splint or brace until inflammation subsides. Avoid large pillows under thehead or knees. Provide a bed or foot cradle to keep linen off to feet and legs until inflammation subsides. Instruct the patient in the importance of moist heat, hot packs or compresses , and paraffin dips as prescribed. Apply cold applications as prescribed when the joint is actuely inflamed. Encourage adequate rest.

NUTRITION:- Encouarge a well- balanced diet. Maintain weight within normal range to decrease stress on the joints.

PHYSICAL MOBILITY:- Instruct the client to balance activity with rest and to participate in an exercise program that limits stressing affected joints. Instruct the client that exercises should be active ratehr than passive and to to stop exercise if pain occurs. Instruct the client to limit exercise when joint inflammation is sever.

SURGICAL MANAGEMENT:- i)Osteotomy:- the bone is resected to correct joint deformity, promote realignment , and reduce joint stress.

ii)Total Joint Replacement or arthroplasty

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