THEMANAGEMENT OSTEOARTHRITISIN PHYSICAL MEDICINEAND
REHABILITATIONDr. MOCH. RIDWAN,Sp.KFRDEPARTEMENT OF PHYSICAL
MEDICINE AND REHABILITATIONSCHOOL OF MEDICINEBRAWIJAYA
UNIVERSITYDr. SAIFUL ANWAR GENERAL HOSPITAL PROBLEMS PATIENT WITH
OSTEOARTHRITIS PAIN REDUCED RANGE OF MOTION MUSCLEWEAKNESS
JOINTSWELLING JOINTDEFORMITY JOINT CAPSULE CONTRACTURE
FUNCTIONALLIMITATIONG eneticsA gingMetabolism (cartilage)E xessive
movementsLocal biomechanical factorsSite and severity of OA3 R!
"ER!OSR# $A#M $%L# &'(&3 R! "ER!OSR# $A#M $%L#
&'(&Abnormal stressNormal joint physiologyNormal
stressAbnormal joint physiologyMs!le "ea#nessPAIN$OINT
%ESTR&'TION%ISABILIT(AgingSepsisIn)lammation*eneti!
mtationBiomaterial )atigeObesityTrama+o!al ,e)e!tBone
Remo,elingAltere, joint loa,ing'ell-Matri. InjryAberrant repair
responseEn/ymati! ,egra,ation'ollagen ,isrption an, proteogly!an
lossMe!hani!al )ailre01 History21 Physi!al e.am31
45ray6Labe.am01History is important 7 gra,al onset o) symptoms8
la!# o) in)lammation8 sometimes history o) 9prior injury, overuse,
or other secondary triggerDDiagnosisiagnosisOA(1) OA(1)) R!
"ER!OSR# $A#M $%L# &'(&DDiagnosisiagnosisOA(2)
OA(2)SymptomsPa!St"!#ssG#$$!% *la!# o)erythema8 or
"armthP&ys'a$ #(am!ato!C)#pt*s+o!y
#!$a)%#m#!t,&yp#)t)op&' '&a!%#sD#')#as#-ROMMa$a$%!m#!t
, -#.o)mtyT#!-#)!#ss to pa$pato! / +s+ally not m+ch :, R! "ER!OSR#
$A#M $%L# &'(& T mo)# .#at*)#s0 t mo)# $1#$y t -a%!oss, R!
"ER!OSR# $A#M $%L# &'(&Radiographic Features-$oint s.ace
narro/ing-S+bchondral sclerosis-Marginal osteo.hytes-S+bchondral
cyst0 R! "ER!OSR# $A#M $%L# &'(&0 R! "ER!OSR# $A#M $%L#
&'(&1'elah sen,i menyempitosteofit1 R! "ER!OSR# $A#M $%L#
&'(&1 R! "ER!OSR# $A#M $%L# &'(&ASSESSMENT-2%M3ER
O4 5E A44E6E! $O#2-LO6A#O2-SE7ER#8THE GOALS OF MANAGEMENT :TO
MAINTAIN COMFORTPRESERVE FUNCTIONPREVENT DEFORMITYTherapeti!
e.er!iseTherapeti! Physi!al agentsEle!trotherapyOrthoti!Assisti;e
,e;i!e )or amblationO!!pational therapyAerobi!
programPatiente,!ationWeightlossManagementpatient"ithOsteoarthritisin
Physi!alMe,i!ine 6 RehabilitationTHERAPEUTIC EXERCISE RANGE OF
MOTIONSTRENGTHENING EXERCISESTRETCHING EXERCJSEHOME EXERCISE
PROGRAMAEROBIC (ESP. AUATIC! PROGRAMRANGE OF MOTIONACTIVE ROMACTIVE
ASSISTIVEROM TO PREVENT MOTION LOSS TO IMPROVE
FLEXIBILITYMUSCLESTRENGTHENING EXERCISEISOMETRIC EXERCISEISOTONIC
EXERCISEISOKINETIC EXERCISEUADRICEP WEAKNESSA PRIMARY RISK FACTOR :
KNEE PAINDISABILITYPROGRESSION OF JOINT DAMAGE"#$r%&'p(
&)*+r#&+%)* ,#- $'&'.'r#+' %,p".(' .)#$%*/ $"r%*/ /#%+
#*$ +0'r'1)r' pr)+'&+ +0' 2*'' 1r), $#,#/'THERAPEUTIC PHYSICAL
AGENTSHEAT 3 COLDDIATHERMY ( MWD, SWD, USD
!LASERHYDROTHERAPYDIATHERMYMWD 3 SWD 3 USDREDUCE PAINANTI
INFLAMMATORYMUSCLE RELAXATIONINCREASE BLOOD FLOWELECTROTHERAPYTENS
:Pr'(-*#p+%& %*0%4%+%)* )1 +0' (p%*#. &)r$D%r'&+
%*0%4%+%)* )1 )* '5&%+'$R'(+)r#+%)* )1 #11'r'*+
%*p"+ORTHOTICKNEE BRACELATERAL WEDGELATERAL WEDGE ( FOOT
ORTHOSES!LATERAL WEDGE ( FOOT ORTHOSES!ORTHOTICBENEFITSOFORTHOTIC :
R'$"&%*/ #,4".#+%)* #(()&%#+'$ p#%* Pr),)+%*/ 1"*&+%)*
E*'r/- &)*('r6#+%)* J)%*+ pr)+'&+%)* T) 0'.p #&0%'6'
#*$ ,#%*+#%* p#+'..#r +r#&2%*/ T) pr'6'*+ #4*)r,#.
&),pr'((%)* 1)r&'( T) pr'6'*+ $'/'*'r#+%6'
&0#*/'sORTHOTICKNEE BRACEASSISTIVE DEVICE FOR
AMBULATIONCANEWALKERCRUTCHWALKING AIDSTO REDUCE THE STRESS APPLIED
TO WEIGHT BEARING JOINTTO IMPROVE PATIENTSTABILITY DURING
AMBULATIONTO IMPROVE ENERGY EFFICIENT GAIT PATTERNREDISTRIBUTE AND
EXTEND THE WEIGHT BEARING AREAREDUCE LOWER LIMB PAINPROVIDE SMALL
PROPULSIVE FORCEPROVIDE SENSORY FEEDBACKOCCUPATIONAL THERAPYJOINT
PROTECTION ENERGY CONSERVATIONACTIVITIES OF DAILY LIVING
TRAININGOCCUPATIONAL THERAPYASSESMENT OF AND TRAINING :
ADLINSTRUMENTAL ADLPROVISION OF ASSISTIVE DEVICE :INCREASE
FUNCTIONPAIN REDUCTIONINSTRUCTION IN JOINT PROTECTION
TECHNIQUESENERGY COSERVATION TECHNIQUESPATIENT EDUCATION SELF
MANAGEMENT PROGRAMSEDUCATIONS OF THE PATIENT FAMILY, FRIENDS OR
OTHER CAREGIVERBODY WEIGHTI*&r'#('$ R%(2 F#&+)r 2*''
OAF#+%7"' )1 "#$r%&'p M"(&.'WEIGHT LOSS ( IF OVERWEIGHT
!EXERCISEDIETARY CHANGEST0' M)(+ E11'&+%6' W'%/0+
I*+'r6'*+%)*F#+ #*$ C#.)r%& R'(+r%&+%)*I*&r'#('$ P0-(%.
A&+%6%+-B'0#6%)r#. R'%*1)r&','*+A* E5+'*$'$ W'%/0+
M#%*+'*#*&' Pr)/r#,H(%ROTHERAP(AEROBIC CONDITIONING
EXERCISERELEASE OF ENDOGENOUS OPOIDIMPROVEMENT IN SYMPTOMS OF
DEPRESSION AND ANXIETYAEROBIC EXERCISEWALKING PROGRAMAUATIC
THERAPYPREVENTIVE PROTECTION OF
JOINTSFLEXIBILITYSTRENGHTPROPIOCEPTIONREDUCING JOINT
STRESSERDECREASING SHOCK IMPACTS TO THE JOINTMAXIMA8ING JOINT
MOVEMENTALIGNMENT THANK YOU
