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2010 5 Feb

Understanding The Risk Factors And Management Of Osteoarthritis

Osteoarthritis being the most common type of arthritis, occurs in about 10% of adults , with up to 50% of the elderly suffering from it. It is basically a degenerative form of arthritis, in which the cartilage, whose function is to cushion the joints, gets worn out with age.

This “wear-and-tear” of the cartilage over time, results in the bone surfaces becoming exposed to increased friction during movement. Pain, swelling and loss of mobility eventually develop. In more advance stages, the joint loses it normal shape and bony spurs may grow on the edges of the joint. Bits of bone or cartilage may break off and float inside the joint space, further causing pain and loss of mobility.

WHAT CAUSES OSTEOARTHRITIS?
The following would increase your risk:
Being overweight
Aging
Previous injury to the joint
Mechanical stresses on the joint from high impact sports, certain jobs, pathological or congenital mal-alignment of bones

SYMPTOMS OF OSTEOARTHRITIS
Symptoms in the initial stages may include pain, tenderness, stiffness, creaking and locking of the affected joint. As the condition progresses, there may be swelling of the joint due to fluid collection within the joint. In the more advanced stages, there is bony deformity (caused by bony spurs) and mal-alignment of the limb (eg. “varus” deformity of the knee). Patients experience increasing pain upon weight bearing, thus limiting walking, and finally, even standing.

Osteoarthritis commonly affects the hands, feet, spine and weight-bearing joints, such as the hips and knees . In the smaller joints, such as in the fingers, hard bony swellings called Heberden’s nodes and Bouchard’s nodes may form. These are typically not painful , but they sometimes limit joint movement.

DIAGNOSIS
Diagnosis can usually be made by your sugeon with reasonable certainty by a thorough physical examination. X-rays are used to confirm the diagnosis as well as to document progressive X-ray changes (thinning of cartilage, bony spurs, loose bodies, mal-alignment of joint etc) as the condition progresses.

HOW IS OSTEOARTHRITIS TREATED?

Non-Pharmacological:
Weight loss – Excess body weight puts more strain on the knee joints. A typical vicious cycle exists: (1) Overweight person develops knee osteoarthritis (2) painful knees reduce mobility (3) with reduced mobility, more weight is gained (4) more weight worsens the arthritis.
Exercise regularly – regular aerobic, strengthening and range of motion exercises help strengthen muscles that stabilize the joints.
Adequate dietary intake of Calcium and Vitamin D for bone strength.
Warm soaks and heat packs to help relief pain.
Refrain from excessive walking during periods of acute pain.
Orthoses and walking aids – splints and braces help with joint alignment and weight redistribution. Walking frames and crutches help take load away from the arthritic knee.
Physiotherapy
Acupuncture

Pharmacological Measures:
Pain-killers – paracetamol-based medication,
Non-steroidal anti-inflammatory drugs (NSAIDS) etc.
Glucosamine and/or chondroitin sulfate.
Topical rubs with NSAIDS or capsaicin.
Joint injections by a surgeon

Surgical Treatment:
Joint lavage (wash out) and arthroscopic debridement (clearing)
Osteotomy – a wedge of bone located near the damaged joint is removed to realign the knee. This causes a shift of weight from the area of damaged cartilage to the area where there is more healthy cartilage.
Total Joint Replacement – considered to be the last resort option in which the severely arthritic joint, having failed more conservative methods of therapy, is replaced with a prosthetic joint.

Treatment decisions must be individualized to the needs of the patient.
For example , a young athlete with knee arthritis from a previous injury, will require treatment because his arthritis impairs his activities. For him, conservative treatment with possible arthroscopic lavage and debridement would be more appropriate than total joint replacement, in view of his young age.
In contrast, severe osteoarthritis of the knee in an elderly gentleman , which when examined in isolation, would lead one to consider total knee replacement. However, if this knee belonged to a bed-bound gentleman, then perhaps simple pain-killers would be all that is required.

Dr Ang C.D
SingaporeDoc

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2009 16 Nov

Easy And Effective Techniques For Leg Pain Relief

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Pain is the body’s reaction to an injury or threat such as burning heat or a wound. The cause may be a physical injury, a disease, or it could simply be an emotional upset. Considered as a common complaint, leg pain is also a common symptom for a lot of different causes such as muscle spasms or cramps, injuries, dehydration, or the depletion of minerals like potassium, sodium, calcium, or magnesium. It can also be classified as inflammatory, orthopedic, neurological, and vascular.

Sometimes, we feel this terribly intense pain at the back of our leg while asleep. This is called a Charley horse or muscle spasm which is characterized by a tightening of leg muscles that seems like forming into a hard knot, making your leg difficult and painful to move. When a muscle is in spasm, it contracts involuntarily and does not relax.

When working out, always take a lot of liquids to avoid dehydration. Low levels of minerals and electrolytes in the body can also predispose a person to muscle spasms. Some spasms occur because the nerve that connects to a muscle is irritated. While tired, over-used or injured muscle is prone to spasms. Activities like swimming, running, and jumping can also trigger the condition.

When muscle spasms strike, stop your activity or whatever you are doing at once. Stretch and massage the affected muscle area. Both heat and ice are natural leg pain relief which can help relax the muscle and soothe the pain. Pain medications such as non-steroidal anti inflammatory drugs can reduce discomfort when muscles continue to be sore. In severe cases, consult your health care provider for anti-spasm medications.

Some helpful tips to prevent muscle spasms:
· Stretching and massage improves flexibility;
· Workouts and exercise programs should be within your capabilities;
· Take lots of fluids during exercise; and
· Eat fruits rich in potassium like bananas and oranges.
Another type of leg pain is Restless Legs Syndrome (RLS) which is a neurological disorder that brings about a compulsory desire to move the limbs accompanied by a burning or tingling sensation as if there are insects crawling in the lower legs. Such sensations may vary depending on its severity, from uncomfortable to irritating to painful. Unfortunately, trying to relax would only activate the symptoms resulting to difficulty getting and maintaining sleep. This condition causes exhaustion and daytime fatigue when ignored.

Since research considers this condition as “idiopathic” which means that the cause is unknown, leg pain relief depends on identifying the associated or underlying medical conditions.

Osteoarthritis, rheumatoid arthritis, and fibromyalgia are sometimes associated with restless legs syndrome. Those who experience sleep disturbance will have to manage and modify their lifestyle such as minimizing if not totally avoiding alcohol or caffeine intake. Medications such as arthritis pain relief or skeletal muscle relaxant drugs may be administered to those with associated medical conditions like arthritis.
Tiredness or burning pain in the legs is caused by poor circulation and blockage of blood in the leg arteries. This pain is brought on by exercise, so getting enough rest is the best leg pain relief. Sometimes, limping occurs due to leg cramps. This is called claudication.

Narrowed or blocked arteries can occur anywhere in the body. Oftentimes, after a period of walking, the blockage occurs in the legs, most commonly in the calf or the foot. This is called intermittent claudication and is relieved by enough leg rest.
A healthy diet is as important as a daily program of walking for short periods, and stopping when there’s pain or cramps. Avoid wearing tight shoes to improve your condition. However, make sure to let your doctor check any non-healing wounds on the lower legs and feet. When leg pain does not go away, remains hot, red and swollen, seek medical help immediately.

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