THE MANAGEMENT

OSTEOARTHRITIS IN PHYSICAL
MEDICINE AND REHABILITATION
Dr. MOCH. RIDWAN,Sp.KFR
DEPARTEMENT OF PHYSICAL MEDICINE AND
REHABILITATION
SCHOOL OF MEDICINE
BRAWIJAYA UNIVERSITY
Dr. SAIFUL ANWAR GENERAL HOSPITAL

PROBLEMS PATIENT WITH

OSTEOARTHRITIS
PAIN
REDUCED RANGE OF
MOTION
MUSCLE WEAKNESS
JOINT SWELLING
JOINT DEFORMITY
JOINT CAPSULE
CONTRACTURE
FUNCTIONAL LIMITATION

Local
biomechanical
factors

enetics

ging

etabolism (cartilage)

xessive movements
RTD PERDOSRI JATIM JULI
2012
RTD PERDOSRI JATIM JULI 2012

Site and
severity of
OA
3
3

Abnormal stress
Normal joint physiology

Obesity
Trauma
Focal defect
Bone Remodeling
Altered joint loading

Normal stress
Abnormal joint physiology

Muscle weakness

PAIN
JOINT DESTRUCTION
DISABILITY

Cell/Matrix Injury
Aberrant repair response
Enzymatic degradation
Collagen disruption and
proteoglycan loss
Mechanical failure

Aging
Sepsis
Inflammation
Genetic mutation
Biomaterial fatigue

Diagnosis OA (1)
1. History
2. Physical exam
3. X-ray & Lab exam
1. History is important
gradual onset of symptoms,
lack of inflammation,
sometimes history of : prior injury,
overuse, or other secondary trigger
RTD PERDOSRI JATIM JULI
2012

Diagnosis OA (2)
Symptoms
Pain
Stiffness
Gelling
lack of
erythema,
or warmth

Physical examination
Crepitus
Bony enlargement /
hypertrophic changes
Decreased ROM
Malalignment / deformity
Tenderness to palpation (
usually not much )

The more features,

the more likely
the diagnosis
RTD PERDOSRI JATIM JULI
2012

RTD PERDOSRI JATIM JULI 2012

7
7

Radiographic
Features
Joint space
narrowing
Subchondral
sclerosis
Marginal
osteophytes
Subchondral cyst
RTD PERDOSRI JATIM JULI
2012
RTD PERDOSRI JATIM JULI 2012

8
8

osteofit

Celah sendi
menyempit

RTD PERDOSRI JATIM JULI

2012
RTD PERDOSRI JATIM JULI 2012

ASSESSMENT
NUMBER OF THE AFFECTED JOINT
LOCATION
SEVERITY

THE GOALS OF MANAGEMENT :

TO MAINTAIN COMFORT
PRESERVE FUNCTION
PREVENT DEFORMITY

Management patient with Osteoarthritis in Physical Medicine &

Rehabilitation

Therapeutic Physical
agents

Orthotic

Occupational therapy

Patient education

Therapeutic
exercise

Electrotherapy

Assistive device for

ambulation

Aerobic program

Weight loss

THERAPEUTIC EXERCISE

RANGE OF MOTION
STRENGTHENING EXERCISE
STRETCHING EXERCJSE
HOME EXERCISE PROGRAM
AEROBIC (ESP. AQUATIC) PROGRAM

RANGE OF MOTION
ACTIVE ROM
ACTIVE ASSISTIVE ROM
TO PREVENT MOTION LOSS
TO IMPROVE FLEXIBILITY

MUSCLE STRENGTHENING
EXERCISE
ISOMETRIC EXERCISE
ISOTONIC EXERCISE
ISOKINETIC EXERCISE

QUADRICEP WEAKNESS
A PRIMARY RISK FACTOR :
KNEE PAIN
DISABILITY
PROGRESSION OF JOINT DAMAGE

 Quadriceps contraction may

decelerate impulse loading during
gait and therefore protect the knee
from damage

THERAPEUTIC PHYSICAL
AGENTS

HEAT / COLD
DIATHERMY ( MWD, SWD, USD )
LASER
HYDROTHERAPY

DIATHERMY
MWD / SWD / USD

REDUCE PAIN
ANTI INFLAMMATORY
MUSCLE RELAXATION
INCREASE BLOOD FLOW

ELECTROTHERAPY
TENS :
Presynaptic inhibition of the spinal cord
Direct inhibition of on excited
Restoration of afferent input

ORTHOTIC
KNEE BRACE
LATERAL WEDGE

LATERAL WEDGE ( FOOT ORTHOSES)

LATERAL WEDGE ( FOOT ORTHOSES)

ORTHOTIC
BENEFITS OF ORTHOTIC :
Reducing ambulation associated

pain
Promoting function
Energy conservation
Joint protection

 To help achieve and maintain

patellar tracking
To prevent abnormal compression
forces
To prevent degenerative changes

ORTHOTIC
KNEE BRACE

ASSISTIVE DEVICE FOR

AMBULATION
CANE
WALKER
CRUTCH

WALKING AIDS
TO REDUCE THE STRESS APPLIED TO
WEIGHT BEARING JOINT
TO IMPROVE PATIENT STABILITY
DURING AMBULATION
TO IMPROVE ENERGY EFFICIENT
GAIT PATTERN

 REDISTRIBUTE AND EXTEND THE

WEIGHT BEARING AREA
REDUCE LOWER LIMB PAIN
PROVIDE SMALL PROPULSIVE FORCE
PROVIDE SENSORY FEEDBACK

OCCUPATIONAL THERAPY
JOINT PROTECTION
ENERGY CONSERVATION
ACTIVITIES OF DAILY LIVING
TRAINING

OCCUPATIONAL THERAPY
ASSESMENT OF AND TRAINING :
ADL
INSTRUMENTAL ADL
PROVISION OF ASSISTIVE DEVICE :
INCREASE FUNCTION
PAIN REDUCTION
INSTRUCTION IN JOINT PROTECTION
TECHNIQUES
ENERGY COSERVATION TECHNIQUES

PATIENT EDUCATION
SELF MANAGEMENT PROGRAMS
EDUCATIONS OF THE PATIENT
FAMILY, FRIENDS OR OTHER
CAREGIVER

BODY WEIGHT
Increased Risk Factor knee OA
Fatique of Quadricep Muscle

WEIGHT LOSS ( IF OVERWEIGHT )

EXERCISE
DIETARY CHANGES

The Most Effective Weight

Intervention

Fat and Caloric Restriction

Increased Physical Activity
Behavioral Reinforcement
An Extended Weight Maintenance
Program

HYDROTHERAPY

AEROBIC CONDITIONING
EXERCISE
RELEASE OF ENDOGENOUS OPOID
IMPROVEMENT IN SYMPTOMS OF
DEPRESSION AND ANXIETY

AEROBIC EXERCISE
WALKING PROGRAM
AQUATIC THERAPY

PREVENTIVE PROTECTION OF
JOINTS
FLEXIBILITY
STRENGHT
PROPIOCEPTION

REDUCING JOINT STRESSER

DECREASING SHOCK IMPACTS TO THE JOINT
MAXIMAZING JOINT MOVEMENT
ALIGNMENT

THANK YOU