What is Osteoarthritis?

Osteoarthritis has known many other definitions by time until a more recent definition was issued by Kuttner et al, in 1994 and reads as follows: "Osteoarthritis is a group of overlapping distinct diseases, which may have different etiologies but with similar biologic, morphologic, and clinical outcomes. The disease processes not only affect the articular cartilage, but involve the entire joint, including the subchondral bone, ligaments, capsule, synovial membrane, and periarticular muscles. Ultimately, the articular cartilage degenerates with fibrillation, fissures, ulceration, and full thickness loss of the joint surface.

Characteristics/Clinical Presentation
Clinical signs depend mainly to the affected joint but usually, they show some common characteristics. They're mainly local. Symptoms are:

This is a 'mechanical' type of pain which is generated by mobilization, increases with fatigue and decreases with rest. Pain occurs in the morning or after a period of inactivity. Mostly, there's no overnight pain. The intensity of pain is variable. Sometimes it's dull and tolerable, other times it's very heavy with short peaks. It can be stimulated by cold, trauma and fatigue.

This pain occurs at the level of the subchondral bone and in capsuloligamentar and muscular structures.

Limition in movement (loss of ROM):
Limitation in movements expires insidious, progressive and will be noticed after several years. This limitation is mainly related to the blocking of voluntary muscle functioning and the reflexcontracture. It's also the result of changes in the articular spaces, with incongruention of joint surfaces. Some patients complain about stiffness in the morning, which holds on for a longer period but is less severe than the morningstiffness from rheumatoid arthritis or ankylosing spondylitis. In most of the patients the limitation in movement is progressive. The severity increases with time and is accompanied with the joint deformities and wear of the cartilage.

The sounds you can hear are cracking, scraping and sounds from crepitation. They're generated by mobilization of the joint. You can even hear them when you palpate the joint. Irregularities in the articulating joint surfaces and poor quality of the remaining cartilage is very likely to be the cause.

Difficult and painful mobilization:
It's important to differentiate between total blocking and limited mobility, due to immobilization for a longer period. Total blocking is caused by the presence of meniscus, unusual structures, etc.

Morphological deformities:
The affected joint is only in a few cases red and feels warm. Normally, it has a normal color and temperature. The increase in volume is due to changes in ratio between the joint surfaces. There may also be moisture in the arthritic joint, caused by irritation, mechanical and/or biochemical phenomena at the synovial membrane.

Physiotherapy management includes interventions such as manual therapy, therapeutic exercises, modalities, massage, acupuncture and functional training.

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