musculo-skeletal disorders - osteoarthritis

7/30/2019 Musculo-Skeletal Disorders - Osteoarthritis

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Musculo-Skeletal Disorders - Osteoarthritis

By Kyle J. Norton

Musculoskeletal disorders (MSDs) is medical condition mostly caused by

work related occupations and working environment, affecting patients'

muscles, joints, tendons, ligaments and nerves and developing over time. A

community sample of 73 females and 32 males aged 85 and over underwent

a standardised examination at home. Musculoskeletal pain was reported by

57% of those interviewed. A major restriction ofjoint movement range was

frequent in the shoulder but uncommon in other joints. A shoulder

disorder was found in 27% of subjects, rheumatoid arthritis in 1% and

osteoarthritis (OA) of the hand, hip, and knee in five, seven, and 18% ofsubjects, respectively. Disability was frequent: a walking distance of < 500

m was found in 60% and ADL dependency in 40% of the group. Factors

related to one or both of these disability measures included female gender,

hip and knee OA, impaired vision, cognitive impairment and

neurological disease(1).

Osteoarthritis

I. Osteoarthritis (OA), a form of arthritis, is defined as a condition of

as a result of aging causes of wear and tear on a joint, affecting over 25million people in the United States in alone.

II. Symptoms

Symptoms of osteoarthritis is aching pain, stiffness, or difficulty moving the

joint may develop in one or more joints. The pain usually gets worse in

change of weather at night and in the advanced of the diseases the pain can

occur even at rest.

1. Pain in joints of the hand

Most commonly affected joints of the hand in osteoarthritis include the

carpometacarpal joint of the thumb (CMC 1) and the distal (DIP) andproximal (PIP) interphalangeal joints. Ageing, female gender, genotype,

heavy work causing pressure on the hands, and injuries predispose to

osteoarthritis in the hand. The pain is likely to be due to secondary synovitis

caused by molecules released from the joint cartilage(3).

2. Knee and Hip


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Osteoarthritis (OA) of the knee and hip is among the most frequent and

debilitating arthritic conditionsosteoarthritis. Key features of the

pathological joint changes in OA include: cartilage destruction by pro-

inflammatory cytokines, matrix metalloproteinases and prostaglandins,

which promote a catabolic environment; subchondral bone remodelling and

resorption; hypertrophic differentiation of chondrocytes; neovascularisation

of synovial tissue; and focal calcification of joint cartilage(4).

3. Spine

Vertebral deformity, in particular wedging, of the thoracic spine is not

exclusively characteristic for osteoporosis and that certain vertebral

deformities develop by mechanisms other than fracture. Osteoporotic

fracture of the thoracic spine is characterized by an exaggerated reduction of

the midheight to posterior height in addition to reduction of the anterior to

posterior height. Osteoarthritis affecting the low back can lead to chroniclow back pain (lumbago) and degenerative disc disease (spondylosis).

Other researchers indicated that Postmenopausal women with lumbar spine

disc degeneration are characterized by increased CII degradation. The

contribution of lumbar spine disc space narrowing (DSN) to type II collagen

(CII) degradation was similar to, and independent of, the contribution of

radiologic knee OA or clinical hand OA. Lumbar spine disc degeneration in

elderly patients should be assessed when analyzing levels of C-terminal

crosslinking telopeptide of CII (CTX-II) in studies of knee, hip, and hand

OA(5).

III. Causes of Risk Factors

A. Causes

1. Process of wear and repair

Osteoarthritis (OA) is a widespread degenerative disease of skeletal joints

and is often associated with senescence in vertebrates. OA commonly results

from excessive or abnormal mechanical loading of weight-bearing joints

('wear-and-tear'), arising from heavy long-term use or specific injuries; yet,in the absence of injury, the aetiology of OA remains obscure(6)

Improper repair process of injure of joints can result of symptoms of

Osteoarthritis (OA) in old age, according to TCM.

2. Nutrient deficiency

Poor nutritional conditions experienced by moose (Alces alces) early in life


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are linked to greater prevalence of OA during senescence as well as reduced

life expectancy(7).

3. Cartilage

Cartilage is a flexible connective tissue which cushions the ends of bones in

your joints and allows the joints to move smoothly. If the cartilage becomes

rough or wears down due to aging or damage, it can causes pain as a result

of bone in the joint rubbing against another bone.

The above causes of Osteoarthritis (OA) are the result of injure, overuse,

Rheumatoid Arthritis, etc.

4. Etc.

B. Risk factors

Aging changes in the musculoskeletal system contribute to the developmentof OA by making the joint more susceptible to the effects of other OA risk

factors that include abnormal biomechanics, joint injury, genetics, and

obesity. Age-related sarcopenia and increased bone turnover may also

contribute to the development of OA(8). Other suggested that Osteoarthritis

development in the injured joints is caused by intra-articular pathogenic

processes initiated at the time of injury, combined with long-term changes in

dynamic joint loading. Variation in outcome is reinforced by additional

variables associated with the individual such as age, sex, genetics, obesity,

muscle strength, activity, and reinjury(8a).

1. Age and age related sarcopenis

Older adult are at increased risk of developing osteoarthritis as a result of

muscular atrophy that occurs due aging. Normal aging in humans is

associated with declines in skeletal muscle mass and strength and increased

muscle fatigability (sarcopenia). These changes, together with the age-

associated decline in whole-body exercise tolerance (VO2max), can

substantially reduce the amount and intensity of physical activities

performed by elderly (>60 y) men and women (Evans 1995)(9).

2. Gender and raceWomen and Male Asian are at higher risk to develop osteoarthritis than men

and male Caucasians, accordingly. The total prevalence of knee ROA was

24.3 % (CI 23.4-25.2 %). The whole prevalence in male patients was 24.3 %

(CI 23.4-25.2 %); I2 = 59.4 (p = 0.002) and in female patients 32.6 % (CI

31.8-33.4 %); I2 = 49,1 (p < 0.001). Younger male patients (age 50-) had a

prevalence of 5.6 (CI 4.5-6.8). In older patients (80+) the male prevalence


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was 44.5 % (CI 39.6-49.5 %). In this age group female patients had a

prevalence of 71.6 % (CI 67.6-75.3 %). The higher prevalence of knee ROA

in female patients was significant (OR = 1.8 [1.7-1.9]; I2 = 46.0 [p

musculo-skeletal disorders - osteoarthritis

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