What can you say from this picture?

Learning objective for today

 Describe osteoarthritis.  Causes of arthritis  Compare the causes of osteoarthritis in people under 40 and over 40.

Our learning outcome

 At the end of the lesson you must know what is osteoarthritis and how it is occuring in people under 40 and above 40.

Osteoarthritis
 Osteoarthritis (OA) is the most common joint disorder, which is due to aging and wear and tear on a joint.  In osteoarthritis, the cartilage that normally reduces friction and cushions the joints becomes roughened and erodes.

Causes of osteoarthritis
Osteoarthritis is a normal result of aging. It is

also caused by 'wear and tear' on a joint. Cartilage is the firm, rubbery tissue that cushions your bones at the joints, and allows bones to glide over one another. If the cartilage breaks down and wears away, the bones rub together. This causes pain, swelling, and stiffness. Bony spurs or extra bone may form around the joint. The ligaments and muscles around the joint become weaker and stiffer.

 OA tends to run in families. Being overweight increases the risk of OA in the hip,

knee, ankle, and foot joints because extra weight causes more wear and tear. Fractures or other joint injuries can lead to OA later in life. This includes injuries to the cartilage and ligaments in your joints. Jobs that involve kneeling or squatting for more than an hour a day put you at the highest risk. Jobs that involve lifting, climbing stairs, or walking also put you at risk. Playing sports that involve direct impact on the joint (such as football), twisting (such as basketball or soccer), or throwing also increase the risk of arthritis. Bursae, the fluid filled sacs swell with extra fluid if a joint is used a lot.

Bursae

the fluid sacs

 The bursae the fluid sacs

which cushion the joints, may swell with extra fluid if a joint is used a lot.  These swollen sacs can press against other tissues, causing inflammation and pain.

Symptoms of osteoarthritis
Pain and stiffness in the joints are the most common

symptoms. The pain is often worse after exercise and when you put weight or pressure on the joint. If you have osteoarthritis, your joints probably become stiffer and harder to move over time. You may notice a rubbing, grating, or crackling sound when you move the joint. The phrase "morning stiffness" refers to the pain and stiffness you may feel when you first wake up in the morning. Stiffness usually lasts for 30 minutes or less. It is improved by mild activity that "warms up" the joint. During the day, the pain may get worse when you're active and feel better when you are resting. After a while, the pain may be present when you are resting. It may even wake you up at night. Some people might not have symptoms, even though x-rays show the changes of OA.

Signs and tests

A physical exam can show: Joint movement may cause a cracking (grating)

sound, called crepitation Joint swelling (bones around the joints may feel larger than normal) Limited range of motion Tenderness when the joint is pressed Normal movement is often painful No blood tests are helpful in diagnosing OA. An x-ray of affected joints will show a loss of the joint space. In advanced cases, there will be a wearing down of the ends of the bone and bone spurs.

SURGERY
With the use of modern imaging techniques and technological

advances in surgery, many athletes recover the full use of their joints and continue to excel in sports. Severe cases of OA might need surgery to replace or repair damaged joints. Surgical options include: Arthroscopic surgery to trim torn and damaged cartilage Changing the alignment of a bone to relieve stress on the bone or joint (osteotomy) Surgical fusion of bones, usually in the spine (arthrodesis) Total or partial replacement of the damaged joint with an artificial joint (knee replacement, hip replacement, shoulder replacement, ankle replacement, elbow replacement)

Arthroscopic surgery

Arthrodesis replacement

& ankle

Osteotomy

A footballer experienced a very sharp pain outside the ankle with swelling but no pain inside
 What happened to him?  Do you think there is a fracture ? Give reason for your answer.

Initial diagnosis & treatment

Footballer was diagnosed with one or more sprained ligaments and no fractured bones. Conventional treatment was given for soft tissue injury for 24 48 hrs. RICE rest, ice, compression and elevation. MRI scan ( magnetic resonance imaging) revealed one of his lateral ankle was completely ruptured and remaining lateral ligaments were partially torn. An MRI machine uses a powerful magnetic field to align the magnetization of some atoms in the body, and radio frequency fields to systematically alter the alignment of this magnetization.

Treatment
 A cast was put to prevent the ankle moving for 2 weeks, then compression and massage to reduce any remaining swelling.  Overtime scar tissue began to repair the ligament and hold it together so no operation was required.  Had the footballer ruptured 2 or more ligaments then the ankle would have needed surgery.

Another footballer twisted his left knee and complained something was catching when he straightened his knee

An MRI scan showed a medial meniscus tear. A meniscus is a piece of cartilage found where two bones meet (joint space). Menisci (plural of meniscus) protect and cushion the joint surface and bone ends. In the knee, the crescent-shaped menisci are positioned between the ends of the upper (femur) and lower (tibia) leg bones. The menisci protect the joint surface and absorb the shock produced by activities such as walking, running, and jumping.

Treatment arthroscopic menisectomy ( keyhole surgery)

The player had an operation

to remove the torn part using arthroscopic menisectomy. This involves using a fibreoptic tube with a small camera and light attached to look inside the knee. Small surgical instruments can be inserted so the surgeon can cut away the torn area and remove it. This is done with very small incisions around the knee.

Anterior cruciate ligament

The anterior cruciate

ligament, also called the ACL, is one of the four major ligaments of the knee. The ACL prevents excessive motion of the knee joint--patients who sustain an injury to their ACL may complain of symptoms of the knee "giving out."

Major ligaments of knee

 Medial collateral

ligaments  Lateral collateral ligaments  Anterior cruciate ligaments  Posterior cruciate ligaments

A 21 year old footballer collapsed suddenly during a game, gripping a right knee which was swollen

 MRI scan showed a complete rupture of the Anterior cruciate ligament.

Treatments
 There are two main treatment options.  The first uses rest and no surgery, while the second involves reconstructive surgery of the ACL.  Research shows surgery is best for people who wish to continue in sport.

Different techniques to repair the ligament

 Some involve using the patient s own patella or hamstring tendons.  Allograft ( donated tissue from someone who has died) can be used.  Keyhole surgery is used is done in both the cases.  Intensive physiotherapy to restore the knee movement and to build up the muscle power.  It takes about 9 months for recovery.

Prosthesis
 In medicine, a prosthesis, prosthetic, or prosthetic limb is an artificial device extension that replaces a missing body part.

Prosthetic limbs
 Warrior Games, May 16th

through may 21st 2011, through a joint effort between the U.S. Department of Defense and U.S. Olympic Committee. These inaugural games are part of an effort to inspire recovery, capitalize on physical fitness, and promote opportunities for growth and achievement among those wounded, ill, or injured warriors

Using prosthesis
 There has been a revolution in the development and design of artificial joints ( particularly hips and knees) and limbs (prostheses).  These help ordinary people from pain due to arthritis and also helps athletes with permanent disabilities to compete more effectively .

Elephant with prosthesis

Development in artificial limb

Knee replacement
 Most commonly the end of the

femur is replaced with a metal prosthesis, while the end of the tibia/ fibula is replaced by a combination of metal and plastic.

Limitations of knee replacement

1. Some sports, such as skiing and horse riding are discouraged because of the chance of falls damaging the joints. 2. They wear out more quickly if you exercise a lot. 3. The metal and plastic may wear loose from the bone to which they are attached. 4. Bits wearing of the joint can cause the real bone to be reabsorbed and weakened.

Prosthetic limbsand carbon fibres, limbs for athletes 1. Using new alloys, plastics
and part limbs have been developed which have revolutionised the way people with disabilities can compete. 2. Prosthetic foot can change shape as the body weight presses down on it, returning back to shape as it lifts off the ground and providing a similar spring in the step to functioning ankle. 3. Jointed prosthetic feet are available. 4. Carbon fibre limbs such as the Cheetah prosthetic does not look like a human leg but give outstanding functional performance.

Cheetah prosthetic limbs

 Oscar Pistorius can run faster than all able bodied runners.  He lost both his legs when he was 11 months old.  He won 100, 200 and 400m events in 2008 Beijing Paralympics and hold world records for disabled runners using carbon fibre blades.

International Amateur Athletics Federation ( IAAF) ban Prostheses Why?

1. In 2007 Oscar Pistorius took part in an International competition against able bodied runners. It was found that using the Cheetah prosthetic he could run at the same speed as an able bodied athlete while using up to 30% less energy. 2. As technology progresses, disabled athletes might regularly outrun able bodied competitors.