rectly impacted by knee OA but may have subsequent damage and may contribute to the degeneration of the knee joint. The knee joint is stabilized by musculature surrounding the joint. The surrounding musculature is the quadriceps muscle, the ham- strings muscles, and muscles of the calf. The quadriceps muscle acts to extend the leg at the knee and flex the thigh at the hip. The hamstring muscle group works together to flex the leg at the knee. The calf muscles act as a flexor of the knee and a plantar flexor of the foot. Weakness of the muscles that surround the knee joint can lead to further degeneration and increase the rate of the progression of knee OA. ● Limitations of daily activities. ● Need for assistive devices/aids. Other symptoms ● Joint crepitation. ● Elevated sensitivity to damp/cold. ● Stepwise progression (Adapted from Michael et. al, 2010). Physical examination The physical examination includes inspection, palpation, testing of the range of motion, and special testing as needed. Special function tests may include ligament stability, meniscus tests, and gait analysis. Ligamentous testing may include testing of the lat- eral ligaments with valgus or varus stress and testing the anterior and posterior cruciate ligaments with drawer tests (Michael et al., 2010). The menisci should be tested manually. The femoropatellar joint and patellar mobility should be evaluated to look for signs of irritation as a result of any damage or dysfunction of these struc- tures (Michael et al.). Imaging studies X-ray imaging studies are used for primary diagnosis of knee OA and to assess the progression of the disease (Michael et al., 2010). An X ray that shows the narrowing of the joint space is a good indicator of knee OA as well as bone spurs (Bhatia et al., 2012). In some cases, to gain further clarity, an MRI scan may be needed (Bhatia et al.). An MRI will allow the physician to see if there is any damage to the soft tissue structures in the knee joint (Bhatia et al.). Laboratory testing may also be included in the diagnostics, which can help rule in or out other conditions that may be con- tributing to knee pain. ● Stage 2 : Moderate joint space narrowing; moderate subchon- dral sclerosis. ● Stage 3 : > 50% joint space narrowing; rounded femoral con- dyle; extensive subchondral sclerosis; extensive osteophyte formation. ● Stage 4 : Joint destruction; obliterated joint space; subchon- dral cysts in the tibial head and femoral condyle; subluxed position. A study was performed to describe trajectories of functional de- cline among initially well-functioning people with or at risk of developing knee OA and to examine the association of demo- graphic, disease severity, and modifiable risk factors with trajec- tories (Cross et al., 2014). This study found that the severity of radiographic knee OA and knee pain and the presence of obesity and depressive symptoms at baseline were associated with de- cline (Cross et al.). There was no apparent association observed for age, sex, or race with the trajectory groups (Cross et al.). These findings can help to identify those patients at greater risk of knee OA and those at risk for developing functional limitations. The findings of this study are consistent with the risk factor of obesity for developing OA or for experiencing a steady progression of the disease. Obesity puts a person at greater risk of developing OA and can enhance the progression of the disease, which is why
lateral ligament, the lateral collateral ligament, the anterior cruci- ate ligament, and the posterior cruciate ligament. The medial and lateral collateral ligaments act to stabilize the knee in a medial to lateral direction or sideways movement of the knee; the anterior and posterior cruciate ligaments help to control the forward and backward translation motion of the knee joint. The tendons associated with the knee joint are the quadriceps tendon and the patellar tendon. The quadriceps tendon connects the quadriceps muscle to the patella; the patellar tendon attaches the patella to the tibia. These structures of the knee are not di- Diagnostic process of knee OA The main purpose of the diagnostic process is to rule in or rule out a diagnosis of knee OA. The correct diagnosis is important in determining the appropriate treatment. The components of diag- nosing a patient with knee OA include the patient history, physical examination, imaging studies, and in some cases laboratory test- ing (Michael et al., 2010). Patient history Patients with knee OA often complain of pain with movement, which typically occurs when movement begins or when the pa- tient begins to walk (Michael et al., 2010). The pain is often de- scribed a dull ache. As the disease progresses, the patient will report that the pain is more continuous than intermittent. Pain begins at rest or at night, which is a sign of advanced OA. It is im- portant to ask patients what their functional activity status is and how the knee pain affects their daily life. Often patients with knee OA will progress to some type of disability because of difficulty with walking, managing stairs, and standing. Patients may see a functional decline as the disease progresses. It may also be useful to get a job history or recreational history to help get a complete picture of the patient’s history. Specific historical features of OA: Pain: ● Pain at the beginning of movement. ● Pain during movement. ● Progression of pain to permanent pain or night pain. ● Need for pain medication. Loss of function ● Stiffness. ● Limitations in range of motion. Staging The clinical signs and symptoms of OA and the radiographic find- ings follow a typical course with progression of the disease and can be incorporated into a clinical staging system. A number of scoring systems have been developed. One scoring system is after Kellgren and Lawrence, 1957, that still stands today: ● Stage 0 : No abnormality. ● Stage 1 : Incipient osteoarthritis; beginning of osteophyte for- mation on eminences. Functional decline among those with knee OA According to Cross and colleagues (2014), OA ranks as the 11th highest contributor to global disability and is the leading cause of functional limitation in older adults. Functional limitations among individuals with knee OA include difficulty with walking and man- aging stairs. Arthritis-related conditions have been found to be the second most common reason for medical visits related to chronic conditions and are only second to hypertension (Cherry et al., 2008). Interventions provided to individuals with knee OA are performed to restore function for patients who are nonsurgical and those patients who present postoperative following a total knee replacement. It is important for the physical therapist to recognize and under- stand patterns of functional decline to effectively treat functional limitations in patients with knee OA.
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