Osteoarthritis is a degenerative joint disease caused by wear and tear that results in loss of articular cartilage. It commonly affects weight-bearing joints like the knee, hip, and spine. Risk factors include age, genetics, obesity, injury, malalignment, occupation, posture, and footwear. Symptoms include joint pain, stiffness, swelling, loss of range of motion, and crepitus. Diagnosis is based on symptoms and x-ray findings of joint space narrowing, osteophytes, and subchondral cysts. Treatment focuses on non-operative options like activity modification, exercises, weight loss, bracing, and medications. For advanced arthritis, surgical options include arthroscopic debridement
Osteoarthritis, also known as degenerative arthritis degenerative joint disease, OA, or osteoarthrosis, is a form of arthritis caused by inflammation, breakdown, and the eventual loss of cartilage in the joints - the cartilage wears down over time.
Learn the causes, symptoms and treatment for osteoarthritis of the knee in this presentation by Jeffrey Rosenberg MD, Summit Medical Group. http://www.summitmedicalgroup.com/doctor/jrosenberg/ Dr. Rosenberg is a member of the American Medical Society for Sports Medicine, American Academy of Family Practice, and Society of Teachers in Family Medicine. He is the author of book chapters that are published in the most recent edition of 5-minute Sports Medicine Consult.
Osteoarthritis is a chronic degenerative disorder of synovial joints in which there is progressive softening and erosion/disintegration of the articular cartilage. In the presentation, I will deal in detail about the condition in every dimension with the most recent evidence.
Homeopathic medicines are very highly effective in management of piles and the symptoms associated with it such as pain, bleeding, itching, etc. The point to be emphasized is that the relief of symptoms is obtained with absolute gentleness and without invasion or surgery of any kind. Besides, the condition has high backslide rate taking after surgical treatment, since surgery does not focus on the main drivers such as hereditary inclinations, periodic clogging, and so forth. Homeopathic drugs work at the root level and can change these hereditary inclinations accordingly decreasing odds of backslide and repeat of the condition essentially. Homeopathy treatment reduces the intra abdominal pressure. There are good medicines that relieve constipation which plays major role in developing piles.
6 most common important homeopathy medicines for piles:
Aesculus :
Nux Vomica:
Graphites
Hamamelis
collinsonia,
aesculus
Osteoarthritis, also known as degenerative arthritis degenerative joint disease, OA, or osteoarthrosis, is a form of arthritis caused by inflammation, breakdown, and the eventual loss of cartilage in the joints - the cartilage wears down over time.
Learn the causes, symptoms and treatment for osteoarthritis of the knee in this presentation by Jeffrey Rosenberg MD, Summit Medical Group. http://www.summitmedicalgroup.com/doctor/jrosenberg/ Dr. Rosenberg is a member of the American Medical Society for Sports Medicine, American Academy of Family Practice, and Society of Teachers in Family Medicine. He is the author of book chapters that are published in the most recent edition of 5-minute Sports Medicine Consult.
Osteoarthritis is a chronic degenerative disorder of synovial joints in which there is progressive softening and erosion/disintegration of the articular cartilage. In the presentation, I will deal in detail about the condition in every dimension with the most recent evidence.
Homeopathic medicines are very highly effective in management of piles and the symptoms associated with it such as pain, bleeding, itching, etc. The point to be emphasized is that the relief of symptoms is obtained with absolute gentleness and without invasion or surgery of any kind. Besides, the condition has high backslide rate taking after surgical treatment, since surgery does not focus on the main drivers such as hereditary inclinations, periodic clogging, and so forth. Homeopathic drugs work at the root level and can change these hereditary inclinations accordingly decreasing odds of backslide and repeat of the condition essentially. Homeopathy treatment reduces the intra abdominal pressure. There are good medicines that relieve constipation which plays major role in developing piles.
6 most common important homeopathy medicines for piles:
Aesculus :
Nux Vomica:
Graphites
Hamamelis
collinsonia,
aesculus
Osteoarthritis is the most common form of arthritis. It is caused by the breakdown of cartilage, Ayurveda has the best treatment for all type of arthritis.
Complete Presentation Piece about Osteoarthritis
Osteoarthritis is a joint disease that mostly affects cartilage. Cartilage is the slippery tissue that covers the ends of bones in a joint. Healthy cartilage allows bones to glide over each other. It also helps absorb shock of movement. In osteoarthritis, the top layer of cartilage breaks down and wears away. This allows bones under the cartilage to rub together. The rubbing causes pain, swelling, and loss of motion of the joint. Over time, the joint may lose its normal shape. Also, bone spurs may grow on the edges of the joint. Bits of bone or cartilage can break off and float inside the joint space, which causes more pain and damage.
People with osteoarthritis often have joint pain and reduced motion. Unlike some other forms of arthritis, osteoarthritis affects only joints and not internal organs. Rheumatoid arthritis - the second most common form of arthritis - affects other parts of the body besides the joints. Osteoarthritis is the most common type of arthritis.
Who Gets Osteoarthritis?
What Causes Osteoarthritis?
How Is Osteoarthritis Diagnosed?
How Is Osteoarthritis Treated?
How Can Self-Care and a "Good-Health Attitude" Help?
What Research Is Being Done on Osteoarthritis?
Who Gets Osteoarthritis?
Osteoarthritis occurs most often in older people. Younger people sometimes get osteoarthritis primarily from joint injuries.
What Causes Osteoarthritis?
Osteoarthritis usually happens gradually over time. Some risk factors that might lead to it include:
Being overweight
Getting older
Joint injury
Joints that are not properly formed
A genetic defect in joint cartilage
Stresses on the joints from certain jobs and playing sports.
How Is Osteoarthritis Diagnosed?
Osteoarthritis can occur in any joint. It occurs most often in the hands, knees, hips, and spine.
Warning signs of osteoarthritis are:
Stiffness in a joint after getting out of bed or sitting for a long time
Swelling or tenderness in one or more joints
A crunching feeling or the sound of bone rubbing on bone.
http://www.niams.nih.gov/health_info/Osteoarthritis/osteoarthritis_ff.asp
Osteoarthritis of the Knee Joint is a quite common condition found in Indian Population. This presentation is made to understand how this condition affects patients and what are the different Physiotherapy measures to make the patient functionally independent.
a presentation on Osteoarthritis that covers the basic knowledge regarding OA and help junior doctors especially the house officers and medical officers to get the concept in a simple way.
Foot Health 101 - Ali El-Saheli DPM,FACFAS - April 23, 2019Summit Health
We’ll discuss simple steps to keep your feet strong and mobile. With proper detection, intervention and care most foot and ankle problems can be lessened or prevented. Learn from our expert about preventative care and the latest treatments for common and athletic foot injuries, diabetic foot complications, arthritis and skin and nail disorders.
Osteoarthritis is the most common form of arthritis. It is caused by the breakdown of cartilage, Ayurveda has the best treatment for all type of arthritis.
Complete Presentation Piece about Osteoarthritis
Osteoarthritis is a joint disease that mostly affects cartilage. Cartilage is the slippery tissue that covers the ends of bones in a joint. Healthy cartilage allows bones to glide over each other. It also helps absorb shock of movement. In osteoarthritis, the top layer of cartilage breaks down and wears away. This allows bones under the cartilage to rub together. The rubbing causes pain, swelling, and loss of motion of the joint. Over time, the joint may lose its normal shape. Also, bone spurs may grow on the edges of the joint. Bits of bone or cartilage can break off and float inside the joint space, which causes more pain and damage.
People with osteoarthritis often have joint pain and reduced motion. Unlike some other forms of arthritis, osteoarthritis affects only joints and not internal organs. Rheumatoid arthritis - the second most common form of arthritis - affects other parts of the body besides the joints. Osteoarthritis is the most common type of arthritis.
Who Gets Osteoarthritis?
What Causes Osteoarthritis?
How Is Osteoarthritis Diagnosed?
How Is Osteoarthritis Treated?
How Can Self-Care and a "Good-Health Attitude" Help?
What Research Is Being Done on Osteoarthritis?
Who Gets Osteoarthritis?
Osteoarthritis occurs most often in older people. Younger people sometimes get osteoarthritis primarily from joint injuries.
What Causes Osteoarthritis?
Osteoarthritis usually happens gradually over time. Some risk factors that might lead to it include:
Being overweight
Getting older
Joint injury
Joints that are not properly formed
A genetic defect in joint cartilage
Stresses on the joints from certain jobs and playing sports.
How Is Osteoarthritis Diagnosed?
Osteoarthritis can occur in any joint. It occurs most often in the hands, knees, hips, and spine.
Warning signs of osteoarthritis are:
Stiffness in a joint after getting out of bed or sitting for a long time
Swelling or tenderness in one or more joints
A crunching feeling or the sound of bone rubbing on bone.
http://www.niams.nih.gov/health_info/Osteoarthritis/osteoarthritis_ff.asp
Osteoarthritis of the Knee Joint is a quite common condition found in Indian Population. This presentation is made to understand how this condition affects patients and what are the different Physiotherapy measures to make the patient functionally independent.
a presentation on Osteoarthritis that covers the basic knowledge regarding OA and help junior doctors especially the house officers and medical officers to get the concept in a simple way.
Foot Health 101 - Ali El-Saheli DPM,FACFAS - April 23, 2019Summit Health
We’ll discuss simple steps to keep your feet strong and mobile. With proper detection, intervention and care most foot and ankle problems can be lessened or prevented. Learn from our expert about preventative care and the latest treatments for common and athletic foot injuries, diabetic foot complications, arthritis and skin and nail disorders.
My Feet Ache, Now What? - Dr. Ucciiferri - 12.9.19 - Bernardsville Library Summit Health
Foot, heel and arch pain can occur for a variety of reasons. The pain can be more severe with certain types of footwear, especially dress shoes. Don’t let foot pain stop you from dancing into the holiday season. Learn about some common foot pain conditions, such as plantar fasciitis (heel pain), Morton’s neuroma (feeling of a pebble or folding sock in foot) and other foot pain conditions, and the many treatment methods used to alleviate pain.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
2. Disclosure
• no financial relationship with
any of the company implants or
products mentioned in this talk
• Exparel (liposomal bupivacaine)
– received compensation in the
past for being one of the
consultants
3. Articular cartilage and joint anatomy
• Joint is made up of two or more bones
• Articular cartilage at the end of bones.
Up to 4 mm thick in larger joints
• Joint fluid – contains hyaluronic acid
• Smooth surfaces with viscous joint
fluid in between makes it smooth
movements comparable to ice-on-ice
• Changes in articular cartilage with
osteoarthritis
- Increase in water content
- Decrease stiffness
- Chondrocytes (cartilage cells) clumps up
in cluster
- Decrease GAG (joint vitamins like keratan
sulfate and glucosamine)
- Collagen fibers gets disorganized
5. Osteoarthritis
•Osteoarthritis - wear & tear type
- loss of articular cartilage
•It is non inflammatory disease
but inflammation can set up in
later stage of the disease
•most common type of arthritis
after the age of 50
•used to be known as “crippling
disease” - not anymore
6. Risk factors for osteoarthritis
• Age: increasing age with
wear and tear
• Genetics: hereditary
• Obesity: increase stress to
weight bearing joints like
knee and hip
• Injury: previous injury with
damage to cartilage or
change in alignment
7. Risk factors for osteoarthritis
• Leg mal-alignment or
deformity
(congenital/trauma): wear
in one side of joint
- bow legs or knock knee
• Occupation: increase stress
on certain joints
- mechanics, sports
professionals, surgeons
• Persistent wrong posture or
wrong foot ware
8. Symptoms of osteoarthritis
• Pain
- Dull aching
- Good days and bad days
- Cold weather
• Stiffness – in the morning, after period of
inactivity
• Loss of range of motion
- Prevents full extension, loss of flexion
10. Commonly involved joints and associated symptoms
• Knee
• hip
• Spine
- Lower back (lumbar)
- Neck (cervical spine)
• basal joint of the
thumb
• shoulder
• big toe MTP joint
• joints of fingers
11. Commonly involved joints: Knee-symptoms
- Hinge joint
- Three bones…
- most common joint to develop OA
- Diffuse or localized pain
- Worse after prolonged inactivity or
overactivity
- Stairs, getting in & out of chair
- Giving out of knee (instability)
- Popping
- Deformity (knock knee/bow legs)
12. Commonly involved joints: Hip-symptoms
- Ball and socket joint
- Pain in groin and front of the thigh
- Knee pain (sometimes only knee
pain)
- Difficulty in raising from toilet,
getting in and out of car
- Difficulty in wearing sox & shoe
- Shortening of the leg in extreme
arthritis is bone destruction.
13. Commonly involved joints: lumbar spine - symptoms
- Degeneration of disc
- Facet joint degeneration
- Spondylolisthesis
• Lower Back pain
• Spasm kind of pain
• Radiating pain in legs –
pinch nerve in lumbar
spine - Sciatica
• tingling and/or
numbness
• Muscle weakness in
extreme cases
14. Commonly involved joints: cervical spine - symptoms
- Degeneration of disc
- Facet joint degeneration
- Spondylolisthesis
• Neck pain
• Spasm kind of pain
• Crepitus with neck
movement
• Radiating pain in arms to
fingers
• tingling and/or numbness
• Muscle weakness in
extreme cases
15. Commonly involved joints: basal joint of thumb-symptoms
- Trapezium (carpal) metacarpal joint
- Pain at the base of the thumb
- Difficulty in turning the door knob
- Difficulty in opening the jar
- Deformity in severe cases
16. Commonly involved joints – symptoms
• Shoulder
- Ball and socket joint
- Pain around shoulder
- Radiating to arm
- Difficulty in overhead work or
reaching the back
- Crepitus
• Great toe MTP joint
- pain at the base of the toe
- Pain with walking
- Pain in certain shoe
- Bunion deformity in severe
cases
17. Commonly involved joints: finger joints - symptoms
• Interphalangeal joints
• Metacarpo-phalangeal
joint
- Nodules (spur)
- Swelling of finger joints
- Difficulty in fine activities
- Deformity - lesser amount
compared to rheumatoid
arthritis
18. Diagnosis
• Medical history - symptoms
- slowly worsening pain
- pain with certain movements
- stiffness after inactivity
• Physical exam - joint specific
• x-rays - most important
• other diagnosis - usually don't
require advanced imaging like CT
scan or MRI except for spine
23. How to prevent or slow down osteoarthritis?
• Activity modification
- Prevent activities which make joint hurt
more (avoid stress on joint)
- Knee: avoid squatting, pounding of joint
(running, jumping), prolonged sitting.
- Hip: use elevated toilet seat, use cane,
install grab bar in bathroom
- Hand/fingers: avoid repeated activities.
Use door knob extension and key
turners. Use of electric can openers or
jar openers
- Spine: avoid weight lifting, avoid bad
posture
25. How to prevent or slow down osteoarthritis?
• Weight reduction
- Each pound of weight loss decreases 4 pound of stress
from knee joint
• Muscle strengthening exercises
- Strong muscles and ligaments around the joint will take
some load/stress off of the joint – decreases the pain
and slows wearing of the cartilage
• Joint vitamins
- Vit D and Calcium: soft subchondral bone (bone
underneath the cartilage) leads to early arthritis.
- Glucosamine and chondroitin sulfate (?): questionable
role. Studies suggested no added benefits in treatment
or prevention of osteoarthritis
27. Treatment - activity modification
Limit activities which causes/aggravate the pain
- Knee: avoid squatting, limit stair, avaoid prolonged sitting with flexed
knees.
- Hip: use elevated toilet seat, use cane, install grab bar in bathroom
- Hand/fingers: avoid repeated activities. Use door knob extension and
key turners. Use of electric can openers or jar openers
- Spine: avoid weight lifting, avoid bad posture
28. Treatment - exercise or physical therapy
- Helps strengthening of muscles around
joint
- decrease stress on joint
- keeps joint mobile, avoid stiffness
• knee - quad sets, balance
• hip - hip girdle muscles
- water therapy can help with joint
arthritis pain
• spine - back and core strengthening
- Physical therapy - key for long term
pain relief of back pain due to arthritis
29. spine - exercise or physical therapy
• back and core strengthening exercises
• have to do it regularly
30. Treatment – weight reduction
• Each pound of weight loss decreases 4 pound
of stress from knee joint
• Peri-operative risks for complications increases
in obese patients (infection, wound healing
problems, blood clot, loosening of implants)
• VA hospitals denied knee or hip replacement
surgery to patients with BMI above 35
• Medicare and Medicaid also asks for
explanation if joint replacement planned in
patient above BMI 40
• Diet, joint protective exercises , bariatric
surgery for morbid obesity
31. Treatment - cane, heel wedges
• Walking aid and support help
reducing stress on joint
• Cane should be used in opposite
hand
• shoe insert or wedges - for knock
knees (valgus) and bow legs (varus)
32. Treatment - Brace
• Unloader brace for bow legs or
knock knee
• Thumb brace
• Lumbar support brace
• Soft cervical collar
• Ankle brace
- shouldn’t use regularly, weakens
muscles.
33. Treatment - topical cream
- relieves pain with less side effects
- Work as counter-irritants, local anti-
inflammatory or local anesthetic
• Capsaicin – derived from cayenne peppers
• Bengay – Methyl salicylate or menthol
• Voltaren gel – Diclofenac (need Rx –
insurance)
• Lidocaine patch
• Aspercreme (Trolamine)
• Icy hot
• Biofreeze
34. Treatment - oral pain meds
• Acetaminophen (Tylenol)
• NSAID (Aleve, Ibuprofen - Motrin, Advil) -
stomach burn, kidney problem
• Combining Tylenol with Aleve/ibuprofen –
synergistic effect (less side effects than
taking one type of medicine in excess)
• COX-2 inhibitor (Celebrex)- less stomach
burn
• Cymbalta (Duloxetine) – off label use
• opioid medications - should be avoided for
arthritis pain
35. Treatment – Intra-articular injections
Cortisone (steroid) Injection
- Mixture of depo-medrol (steroid) and numbing
medicine
- Acts within hours, lasts 6 weeks to 3 months
depending on severity of arthritis
- Commonly used for knee, shoulder and thumb
arthritis – can be done in office/clinic
- Hip and back/neck injections needs
fluoroscopic/x-ray guidance
- Can be repeated every 3 – 4 months but decrease
efficacy with subsequent injections
- Multiple injections can damage remaining cartilage
- Tolerable (does it hurt?)
36. Treatment – Intra-articular injections
Hyluronic acid (gel) injection
- synthetic joint fluid
- Joint lubrication
- Does not regrow the worn cartilage but
possibly slow down further degenration
- Works in only 50% of patients
- Acts slow, lasts longer if works
- Series of 3 injections
- Insurance denial (AAOS has no positive
recommendation)
Platelet rich plasma (PRP) injection
- Largest study published in 2013 suggests it
decrease pain by 3 to 6 months
- Insurance payment issue due to cost and
questionable long term efficacy
37. Surgical treatment
• Surgical advancement - no longer have
to “live” with arthritis
• Consider surgical treatment once non
operative treatment exhausted
• In my practice, patient makes the
decision when they are ready for the
surgery
• Joint preservative versus joint
replacement surgery
• Sophisticated joint replacement started
in early 70s in USA, it has advanced
significantly now
• No longer crippling disease
1969
38. Surgical options for hip osteoarthritis
• Arthroscopic surgery rarely work for
hip osteoarthritis
• Fusion is almost obsolete
• Hip replacement
- Partial hip replacement is mostly for
fracture only
- Total hip replacement (arthroplasty)
- Surface replacement arthroplasty
(metal-on-metal) – found to have
metal toxicity - failed
39. Total hip replacement (arthroplasty)
• Replace socket and head ball
• Medicare/federal health have
announced it as second most
successful surgery in restoring quality
of life next to the cataract surgery.
• Types or bearing surfaces options
- Metal or ceramic on plastic
(polyethylene) – best option in current
time
- Ceramic on ceramic – less wear but
squeaking and fracture
- Metal on metal – failed due to metal
ions release and causing severe soft
tissue reaction.
40. Total hip replacement (arthroplasty)
• Different approaches
- Posterior (back)
- Direct anterior (front)
- Lateral/antero-lateral (side)
Posterior approach (traditional hip
replacement)
- Time tested, used for years
- More dislocation - precautions
- Have to cut and reattach muscles –
longer recovery
- Implant position may not be
consistently accurate
41. Total hip replacement (arthroplasty)
• Direct anterior approach
- no need to cut muscles –
faster recovery
- Less dislocation
- Done under x-ray, so more
accurate implants placement
and restoration of leg length
- Difficult to do surgery -
Learning curve for surgeon,
more complications during
learning curve
42. Surgical options for knee osteoarthritis
• Knee arthroscopic surgery
- temporary pain relief, helps more in
mild to moderate OA
- AAOS doesn’t have strong
recommendation for it
- Speeds up process of osteoarthritis
• Osteotomy
- High tibial osteotomy for bow legs
- Distal femoral osteotomy for knock
knees
- For one compartment arthritis only
in younger patients
44. Surgical options for knee – total knee replacement
• 500,000 knee replacement per year in
USA
• Scarifies ACL and sometimes PCL
• Good pain relief – 95% happy patients
depending on their expectation
• VCU CMH joint replacement program
45. Surgical treatment of thumb osteoarthritis
• Arthroscopic surgery
• Excisional arthroplasty with
tendon interposition
• Arthrodesis (fusion)
• Joint replacement
46. Surgical treatment of shoulder osteoarthritis
• Arthroscopic surgery – minimum role in osteoarthritis
• Hemiarthroplasty (partial shoulder replacement)
• Total shoulder replacement
• Reverse total shoulder replacement
47. Surgical treatment of toe MTP joint osteoarthritis
• Fusion (arthrodesis)
• Joint replacement
48. Treatment for spine (back and neck) arthritis
• Regular back and core
strengthening exercises
• Heat pad
• Pain meds
• Steroid (prednisone) for acute pain
• Muscle relaxer
• Brace (for short duration)
• Epidural steroid injection
• surgery
49. Treatment for spine (back and neck) arthritis
• Regular back and core strengthening
exercises
• Heat pad
• Pain meds
• Steroid (prednisone) for acute pain
• Muscle relaxer
• Brace (for short duration)
• Epidural steroid injection
• Surgery
- Nerve decompression
(Laminectomy/discectomy) + fusion
- Disc replacement surgery
50. Surgical treatment of hand joints osteoarthritis
• Bone spur removal
• Joint replacement