This document provides an overview of osteoarthritis of the knee, including its definition, classification, epidemiology, anatomy, pathology, risk factors, diagnosis, grading, and management. Some key points are:
- Osteoarthritis is a degenerative joint condition characterized by cartilage breakdown and new bone growth. It commonly affects the knee joint.
- Risk factors include age, obesity, previous injury, activities like squatting that increase pressure on the knee.
- Diagnosis involves clinical exams, x-rays showing bone changes and loss of joint space, and ruling out other causes through tests.
- Treatment focuses on lifestyle changes like weight loss and exercise, medications, injections, and sometimes surgery like knee replacement
ANKLE FRACTURES
Pott’s fracture
A Pott’s fracture is a type of ankle fracture that is characterized by a break in one or more bony prominences on the sides of the ankle known as the malleoli.
Also known as Broken Ankle, Ankle Fracture and malleolar fracture.
Pott’s fracture often occurs in combination with other injuries such as a sprained ankle or other fractures of the foot, ankle or lower leg.
Knee Osteoarthritis, a common cause of knee pain and treatment ranges from exercises,tablets,arthroscopy,deformity correction to total knee replacement (TKR).
Complications after surgery can even be corrected if occurs by proper evaluation,planning and execution of the Revision Surgery.
Knee osteoarthritis basics to reconstruction to replacement dr.sandeep c agrawal agraesn hospital gondia india
ANKLE FRACTURES
Pott’s fracture
A Pott’s fracture is a type of ankle fracture that is characterized by a break in one or more bony prominences on the sides of the ankle known as the malleoli.
Also known as Broken Ankle, Ankle Fracture and malleolar fracture.
Pott’s fracture often occurs in combination with other injuries such as a sprained ankle or other fractures of the foot, ankle or lower leg.
Knee Osteoarthritis, a common cause of knee pain and treatment ranges from exercises,tablets,arthroscopy,deformity correction to total knee replacement (TKR).
Complications after surgery can even be corrected if occurs by proper evaluation,planning and execution of the Revision Surgery.
Knee osteoarthritis basics to reconstruction to replacement dr.sandeep c agrawal agraesn hospital gondia india
Thailand Guideline for Hepatocellular Carcinoma
source of info:
http://www.gastrothai.net/files/178.Thailand%20Guideline%20for%20Hepatocellular%20Carcinoma.pdf
Understanding Osteoarthritis and Chronic Knee PainKneesForLife
http://www.kneesforlifepodcast.com
This presentation explains what osteoarthritis is and how it relates to chronic knee pain. Presented by Dr. Timothy Payne, M.D. For more on knee pain relief including a free book excerpt and audio on common misconceptions, visit http://www.kneesforlifepodcast.com
Fracture regarding information and also useful in nursing in that types of fracture included and also include treatment regarding fracture , nursing care plan...commonly fracture is more so its very useful for study.....
Students, digital devices and success - Andreas Schleicher - 27 May 2024..pptxEduSkills OECD
Andreas Schleicher presents at the OECD webinar ‘Digital devices in schools: detrimental distraction or secret to success?’ on 27 May 2024. The presentation was based on findings from PISA 2022 results and the webinar helped launch the PISA in Focus ‘Managing screen time: How to protect and equip students against distraction’ https://www.oecd-ilibrary.org/education/managing-screen-time_7c225af4-en and the OECD Education Policy Perspective ‘Students, digital devices and success’ can be found here - https://oe.cd/il/5yV
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
We all have good and bad thoughts from time to time and situation to situation. We are bombarded daily with spiraling thoughts(both negative and positive) creating all-consuming feel , making us difficult to manage with associated suffering. Good thoughts are like our Mob Signal (Positive thought) amidst noise(negative thought) in the atmosphere. Negative thoughts like noise outweigh positive thoughts. These thoughts often create unwanted confusion, trouble, stress and frustration in our mind as well as chaos in our physical world. Negative thoughts are also known as “distorted thinking”.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
The Art Pastor's Guide to Sabbath | Steve ThomasonSteve Thomason
What is the purpose of the Sabbath Law in the Torah. It is interesting to compare how the context of the law shifts from Exodus to Deuteronomy. Who gets to rest, and why?
How to Create Map Views in the Odoo 17 ERPCeline George
The map views are useful for providing a geographical representation of data. They allow users to visualize and analyze the data in a more intuitive manner.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
1. Osteoarthritis Knee
By: Dr Om Prakash Shah
Professor
Department of Orthopaedics
Rohilkhand Medical College
Bareilly(U.P.)
Ex HOD Dr SN Medical
College, Jodhpur(Rajasthan)
2. Definition
Osteoarthritis is a non-inflammatory, degenerative condition of joints Characterized
by degeneration of articular cartilage and formation of new bone i.e.
osteophytes.
It is one of the main joint of the lower limb, and for the routine daily activities of the
person it is a very important joint.
4. Primary OA
• More common than secondary OA
• Cause –Unknown
• Common-in elders where there is no previous pathology.
• Its mainly due to wear and tear changes occuring in old ages
mainly in weight bearing joints.
Secondary OA
Due to a predisposing cause such as:
1.Injury to the joint
2.Previous infection
3.RA
4.CDH
5.Deformity
6.Obesity
7.hyperthyriodism
5. Epidemiology
• Knee OA most common cause of disability in adults
• Decreased work productivity, frequent sick days
• Highest medical expenses of all arthritis conditions
• Due to habit of sitting cross-legged and squatting OA is more prevalent in
India.
• Symptomatic Knee OA
– More than 11% of persons > 64yr
8. Pathology
OA is a degenerative condition primarily affecting the articular
cartilage.
1. Articular cartilage
2. Bone
3. Synovial membrane
4. Capsule
5. Ligament
6. Muscle
9. Articular Cartilage-
The lower end of the femur ( condyle of the femur) is covered by thick articular
cartilage about 0.5-1 cm in thickness. Similarly, upper end of the tibia (condyle
of the tibia) is also covered by 0.5-1 cm thick articular cartilage.
Articular cartilage is a smooth, shiny and elastic structure and it serves the function
of a shock absorber.
Cartilage is the 1st structure to be affected.
Erosion occurs,often central & frequently in wt. bearing areas.
Right: Early OA with area of cartilage loss in
the center.
Left: More advanced changes with extensive
cartilage loss and exposed underlying bone
10. Changes in Bone
• Bone surface become hard & polished as there is loss of protection from
the cartilage.
• Cystic cavities form in the subchondral bone because eburnated bone is
brittle and microfractures occur.
• Venous congestion in the subchondral bone.
• Osteophytes form at the margin of the articular surface,which may get
projected into the jt. Or into capsule & ligament,bone of the wt.-bearing jt.
• Tibial condyles become flatened, medial tibial condyle is more affected and
depressed as the weight bearing line passes medially. Thus, giving rise to
varus deformity.
11. A patient with typical OA of the
knees. In the normal standing
posture there is a mild varus
angulation of the knee joints due to
symmetrical OA of the medial
tibiofemoral compartments
Knee joint Effusion
12. Synovial Membrane-
• Synovial membrane undergo hypertrophy and become oedematous (which can
lead to ‘cold’ effusions).
• Reduction of synovial fluid secretion results in loss of nutrition and lubricating
action of articular cartilage.
Capsule
It undergoes fibrous degeneration and there are low-grade chronic inflammatory
changes.
13. Ligaments-
• Undergoes fibrous degernation
• There is low grade chronic inflammatory changes and acc.to the aspect joint
become contracted or elongated.
Muscles
Undergoes atrophy,as pt. is not able to use the jt. Because of pain which further
limits movts. and function.
14. Risk Factors
• Age (>45 yrs)
• Female (more common in post-menopausal women)
• Obesity ( most important modifiable)
• Previous knee injury (specially previous trauma and sports injury)
• Lower extremity malalignment
• Habit of squatting and sitting cross-legged
• High impact activities
• Muscle weakness
• Osteoporosis
15. Diagnosis of Knee OA
Tests
• FBC, ESR, RF
• Arthrocentesis
• X-rays (3 views)
– Weight-bearing AP
– Lateral
– Tangential Patellar (Sunrise)
• MRI
16. • Clinical symptoms
Pain
Joint Stiffness
Swelling
Crepitus
Varus Deformity
Synovial Thickening and effusion
• Synovial fluid
1. WBC<2000/mm3
2. Clear color
3. High Viscosity
• X-rays
1. Osteophytes
2. Loss of joint space
3. Subchondral sclerosis
4. Subchondral cysts
17. Pain and Tenderness
– Usually slow onset of discomfort, with gradual and intermittent increase
– Pain is more on wt. bearing due to stress on the synovial membrane & later
on due to bone surface,which r rich in nerve endings coming in contact.
-Initially relieved by rest but later on disturb sleep.
-Diffuse/ sharp and stabbing local pain
– Types of pain
• Mechanical: increases with use of the joint
• Inflammatory phases
• Rest pain later on in 50%
• Night pain in 30% later on
18. Joint Stiffness-
– ‘Gelling’: stiffness after periods of inactivity, passes over within minutes
(approx 15min.) of using joint again
– Coarse crepitus: palpate/hear (due to flaked cartilage & eburnated bone ends)
– Reduced ROM: capsular thickening and bony changes in joint,ms. Spasm or
soft tissue contracture.
25. The use of shoes and insoles to reduce
impact loading on lower limb joints.
Modern sports shoes (‘trainers’) often
have appropriate insoles. Alternatively,
special heel or shoe insoles of sorbithane
or viscoelastic materials can be used.
They may help relieve pain as well as
reducing the peak impact load on the
joints during walking.
26. Surgical Management
High Tibial Osteotomy
• Indication:
– Unicompartmental arthritis
– Genu varus or valgus
• Realign mechanical axis
• Age < 60yo
• < 15 degrees deformity19
28. Total Knee Arthroplasty
• Indication:
– Pain during rest is the strongest indication
– Diffuse arthritis
– Severe pain
– Functional impairment
• Pain relief > functional gain
• ACL sacrificed
• PCL also may be sacrificed
• Prosthesis 10-yr survival: 90%
29.
30. Normal Knee Physiology
• Cartilage- Sponge like action (deformation and reformation)
Beneficial for the joint function
Facilitates blood supply of the joint
• Synovial Fluid- Lubrication of the joint and the articular cartilage
(secreted by the synovial membrane around the joint)
Smoothens the articular surface
• Healthy cartilage and good lubrication is necessary for smooth functioning
and pain free movement of the joint
• Good mechanical axis is also necessary for smooth knee function
31. • Protein Diet
• Multi-vitamins and multi- minerals
• Green vegetables
• Antioxidants, are necessary for repair of day to day wear and tear of the
cartilage and maintainance of healthy cartilage
32. Effect of Pressure over Knee joint
• Pressure = Force/Area
• With every 1 kg loss of weight pressure over the knee joint will be decreased
by 4 times the normal
• While walking pressure over the knee joint- 4-5 times the normal pressure
• While running pressure over the knee joint- 6-7 times the normal pressure
• While going uphill (climbing stairs) pressure over the knee joint is 7 times the
normal
• Squatting and sitting cross-legged decreases the contact area between the joint
surface so resulting in increase of pressure over the joint.
33. Effect of cane support in OA knee
• The cane will shift the centre of gravity during weight bearing forward to
the body, thus decreasing the pressure over the knee joint by balancing the
pelvis.
• There is about 20% decrease in the pressure over the knee joint.
• The stick should be held in the hand of the same side that of the affected
knee.
• The length of the stick should be upto the greater trochanter of the femur
from the ground and the elbow should be in 15 degree flexion.
• The handle of the cane should be straight and not curved.