Upload
samuel-powell
View
214
Download
0
Tags:
Embed Size (px)
Citation preview
DEGENERATIVE DISEASE IN ORTHOPAEDICGede Chandra P. Yudha
DEGENERATIVE DISEASE• a disease in which the function or structure of the affected
tissues or organs will increasingly deteriorate over time• Aging related• Degeneratif orthopedi degenerasi pada sistem
muskuloskeletal• Hard tissue joint, bone• Soft tisue
DEGENERATIVE JOINT DISEASE• Osteoarthritis (OA)• Local deterioration of articular
cartilage• Characterized by :• Progressive deterioration of articular
cartilage• Secondary inflammation of synovium• Capsular fibrosis• Subchondral remodelling
(subchondral sclerosis)• Cyst formation• Osteophyte formation
• Most common type of arthritis• 2 type :• Primary develop spontaneously• Secondary secondary due to other
cause (injury, deformity, disease)
Patophysiology• Articular cartilage function as “shock absorber”• In order to do so, it has several physical and biomechanical
properties :• Resilience• Low friction and smooth surface
• Resiliency due to water content decreasing over time due to loss of proteoglycans
• Decrease proteoglycans decrease water content cartilage softening fibrillation fissuring cartilage erosion eburnation
Normal Knee vs OS Knee
Derajat Kerusakan Sendi – Arthroscopic View
CLINICAL FEATURES
• SYMPTOMS• Pain• Stiffness• Alteration in shape• Functional impairment• anxiety,depression
SIGNS• Crepitus• Restricted movement• Tenderness• Bony swelling• Deformity• Muscle wasting/weakness• Effusion, increased warmth
• Instability
Radiographic Changes• 4 GAMBARAN UTAMA RADIOLOGIS• Penyempitan celah sendi• Sklerosis subchondral• Pembentukan kista subchondral• Osteofit
• Klasifikasi : Kellgren - Lawrence
X-ray Appearance
Management – Non Surgical• Pharmacological• Analgesics• NSAIDs• DMOADs• Glucosamines• Viscosupplements• PRP
• Non pharmacological• Physical theraphy• Occupational theraphy• Braces• Lifestyle modification• Weight reduction
Management – Surgical • Arthroscopy + debridement• Osteotomy• Joint replacement
DEGENERATIVE BONE DISEASE
• OSTEOPOROSIS• Definition (WHO) : a condition characterized by reduced
bone mass and disruption of bone architecture, resulting in increased bone fragility and increased fracture risk• 2 types :• Primary
• Post menopausal osteoporosis• Senile osteoporosis
• Secondary (due to other disease)• Drug induce• Chronic disease• Neoplasm • Endocrine abnormality• Disuse
Osteoporosis• Epidemiology• An estimated 8 million women and 2 million men in the United
States have bone density levels in the diagnostic range of osteoporosis.
• The percentage of patients with osteoporosis increases progressively with age -- of US women, 13% in their 50s, 27% in their 60s, 47% in their 70s, and 67% in their 80s meet the diagnostic criteria for osteoporosis.
• For every 10% decline in bone mass, there is an approximate doubling of fracture risk in the population.
Osteoporosis Risk Factors
Non modifiable
• Sex• Race• Age• Frame size
Modifiable
• Alcohol• Smoking• Low BMI• Poor nutrition• Vitamin D deficiency• Estrogen deficiency• Eating disorders• Insufficient exercise• Steroids and other
medication
Osteoporosis – Clinical Findings
• Mostly no symptoms – silent disease
• Other symptoms :• Back pain• Pathologic fracture• Decrease body height
• Osteoporosis tests :• Bone Mineral Density
• DEXA, CT, X-ray, Ultrasound• Bone scan• Laboratory test
• CTx, PTH, Vitamin D, Blood calcium
Osteoporosis - Workup• Laboratory• Blood/ serum
• Ca, P• Vitamin D level• Serum PTH• CTx, Osteocalcin (Bone markers)
• Urine• Hydroxyproline
• Bone Mineral Density• Ultrasound• DEXA• QCT
Dual Energy X-ray Absorptiometry (DEXA)
Osteoporosis - Management • Prevention• Treatment• Osteoporosis• Osteoporosis complications
Osteoporosis – Prevention • Calcium rich diet• Vitamin D• Maintain active lifestyle• Avoid smoking, alcohol• Sunlight exposure
Osteoporosis – Treatment • Osteoporosis treatment :• Calcium• Vitamin D• Hormone Replacement teraphy• Anti resorbtion drugs• Treatment of primary disease (in secondary osteoporosis)
• Osteoporosis complication treatment :• Non surgical
• Supportive treatment• Bed rest
• Surgical• Vertebroplasty• Joint replacement• Osteosynthesis
DEGENERATIVE DISEASE OF THE SOFT TISSUE• Supraspinatus tendinitis• Tennis elbow• Golfer’s elbow• De Quervain’s Tenosynovitis• Trigger finger• Bursitis
SUPRASPINATUS TENDINITIS• Inflammation of the Supraspinatus tendon• Due to wearing and tearing• If severe can cause torn • Clinical signs & symptoms :• Painful arc• Tenderness• Decreasing ROM
• Treatment• Rest• Physiotheraphy• Arthroscopic debridement• Repair
TENNIS ELBOW & GOLFER’S ELBOW
• Tennis elbow• Inflammation of LATERAL
epicondyle• Golfers elbow• Inflammation of MEDIAL epicondyle
• Due to repetitive chronic injury• Clinical findings :• Pain• Swelling
• Treatment :• Non surgical : NSAIDs, injection,
physiotheraphy• Surgical : release
DE QUERVAIN’S TENOSYNOVITIS
• Inflammation of tendon sheath of APL & EPB tendon (dorsal extensor tendon 1st compartment)
• Clinical findings :• Pain - Finklestein test • Swelling, nodule
• Treatment :• Non Surgical
• Rest• Brace • NSAIDs• Physiotheraphy
• Surgical • Release
TRIGGER FINGER• Inflammation of flexor tendon underneath
the pulley fibrosis nodule unable to pass smoothly under the pulley
• Clinical findings :• Pain• Nodule• Triggering
• Treatment :• Non surgical : rest, NSAIDs, physiotheraphy• Surgical : release
BURSITIS• Inflammation of bursae• Bursae :• a small fluid-filled sac where friction would
otherwise occur. Bursae function to facilitate the gliding of muscles or tendons over bony or ligamentous surfaces.
• Clinical findings :• Pain • Swelling (over bony prominences)
• Treatment• Non surgical
• Ice• Eliminate the cause (friction, pressure)• Padding • NSAIDs
• Surgical• Excision
RS ORTHOPEDI & TRAUMATOLOGI SURABAYAJl. Emerald Mansion TX 10 Citraland - Surabaya