Osteoarthritis Cont

Cure Arthritis Naturally

Cure Arthritis Naturally

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progressive disease affecting both the soft tissues and the cartilage of the knee joint. According to the Outerbridge scale, which is arthroscopic, osteoarthritis is graded from I (chondromalacia) to IV (bare bone) and correspondingly in a radiological score (as seen by X-ray) from 0-4. CLINICAL FINDINGS Depends on the severity. There is effusion in around 70 per cent of cases. Deformation of the knee and protruding osteophytes can be found. A systematic and thorough approach in the clinical examination is crucial to a successful outcome. Tests of core stability, proprioception, muscle strength and balance and the flexibility of the entire kinetic chain must be thoroughly evaluated to assist in rehabilitation.

INVESTIGATIONS Weight-bearing x-ray can help to grade the severity but there could be major localised cartilage damage before X-ray will show a decreased joint space. Since this is a gradual disorder, many patients only seek medical advice in situations where the knee is particularly bad. Often meniscal tears suddenly occur, locking the knee or causing symptoms in an already sore knee. Arthroscopy is an excellent diagnostic tool to verify the extent and location of osteoarthritis as well as sorting out the meniscal problem. Shifting the load from a medial osteoarthritis to an unaffected lateral compartment may relieve symptoms over a long period of time. TREATMENT There is no definite cure for this condition. However, there is a range of symptomatic treatments available: physiotherapy and exercise modification, NSAID, injections of synovial fluid derivates, cortisone, arthroscopic debridement, excision of loose bodies and trimming of blocking osteophytes, various forms of osteotomies for unilateral compartment osteoarthritis and, as an end range measure, knee replacement. A modern knee replacement will last for 10 to 20 years. REFERRALS These patients are very much helped by being evaluated clinically by their physician, surgeon and physiotherapist in close collaboration. EXERCISE PRESCRIPTION Cycling, walking, freestyle swimming and low-impact sports like golf are good alternatives to keep up general fitness. EVALUATION OF TREATMENT OUTCOMES Monitoring of clinical symptoms and signs. DIFFERENTIAL DIAGNOSES Meniscal tears, OCD, loose bodies, chondral injuries, reactive arthritis. PROGNOSIS Fair-Poor. Due to the progressive development of symptoms, this condition often ends a sporting career.

Fig. 127 OCD could present as loose fragments locking the joint

SYMPTOMS There is gradual onset of diffuse or localised exercise-induced pain and soreness, often also at rest, usually in a young athlete without preceding trauma.

AETIOLOGY The aetiology is unknown but is often thought to be due to repetitive minor trauma. The sub-chondral bone goes into avascular necrosis and the overlying cartilage cracks. This condition often presents as a result of sudden changes in training habits, such as an increase in intensity or amount of impact. It is therefore often misunderstood as an over-use condition. It is graded I (softening of cartilage), II (cracks and fibrillation), III (partial loosening) or IV (loose fragment in the joint). CLINICAL FINDINGS Symptoms depend on the grade and location of the OCD, from occasional soreness and minor effusion to a locked knee with major effusion.

INVESTIGATIONS X-ray taken in 20 degrees of flexion on weight bearing is valuable if the OCD is on the femur condyle. MRI will show subchondral oedema and is valuable to outline the extent of the injury. Arthroscopy should be performed to investigate the extent of the injury and treat it.

TREATMENT Depends on severity and location but usually involves arthroscopic surgery. Loose bodies are excised, frail edges are trimmed or vaporised and the bare bone area is micro-fractured or drilled

Fig. 129 The same OCD, as seen by MRI, with marked subchondral oedema

Fig. 128 OCD, as seen on X-ray

Fig. 129 The same OCD, as seen by MRI, with marked subchondral oedema

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Treating Rheumatoid Arthritis With Herbs Spices Roots

Treating Rheumatoid Arthritis With Herbs Spices Roots

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