Osteoarthritis Genu

Short Case
Wahyu Sita Wardani

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Anatomi

Sendi lutut dibentuk oleh :

• Bagian distal Femur
• Bagian proximal Tibia
• Patella
• Sendi : Femurotibial &
Patellofemoral
• Meniskus : Medialis
dan lateralis
• Ligamentum kolateral :
Medial dan lateral
• Ligamentum krusiatum:
Anterior dan posterior
• Otot – otot sekitar lutut
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 ANATOMI
• Sendi lutut  artikulasi distal femur & bagian
proximal tibia & meniscus.
• 2 permukaan di distal femur  permukaan
ant. Patella & permukaan inf.tibia.
• Permukaan Patella  sadel & asimetris. Fx
mekaniknya: me(+) rotatory movement
extensor.
• Tibial plateau  2 permukaan artikuler,
medial (oval, >dalam &> konkaf serta >
bundar)dari lateral.
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OT 4 0 Kinesiology- Lower extremity kne locking mechanism.mp4

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CASE REPORT

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 Patient Identity
Name Mr. M
Age 73 years old
Sex Male
Address Krakah Selatan Surabaya

Religion Islam
Ethnic Javanese
Occupation Pensioner from

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 History Taking
• Referred from Orthopedic Department
Outpatient Clinic with OA Genu Dextra

• Chief Complaint: Nyeri lutut kanan

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 History of Present Illness

• He felt pain at both knee since 3 weeks ago, with VAS

5. Pain is described as such a dull pain. It didn`t
radiate.
• The pain increase especially when he bent his knee for
praying activity, when he do the tahiyat sitting
position.
• The Pain decrease when he take a rest.
• He also felt stiffness on his both knee when he wake
up in the morning and it last about five minutes. It was
relieved when he started to walk.
• No radiating pain, no tingling sensation, no numbness
 History of Past Illness
• About 10 years ago, the patient had an accident, he
got hit by a car from backside, when he’s riding a
motorcycle.
Patient said by the orthopedic doctor he should be
given casting, but the patient take the casting out by
himself,
After that he felt stifness at his right ankle until now
• History of HT (+), routinely controlled in Cardiology
Outpatient Clinic
treated by Micardis 80mg 1x1
• History of DM (-)
 Physical Examination
• General State
Consciousness: CM Ambulation: Independent Gait: Antalgic

Right Handed W: 78 kg H: 179 cm BMI: 24,3

Vital Signs: BP: 130/80 mmHg RR: 18x/min
HR: 88 x/min
Head and Neck Anemic/Jaundice/Cyanosis/ -
Dyspneu
Thorax Heart/Lung N
Abdomen N
Extremities Warm at all extremities
Barthel Index 100
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 • Neurological State

Cranial Nerves I-XII N

Muscle Tone N
Deep Tendon BPR +2 | +2 KPR +2 | +2
Reflexes
TPR +2 | +2 APR +2 | +2
Pathological Hofmann - | - Babinski - | -
Reflexes
Tromner - | -
Sensory Deficits No sensory deficits

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 • Musculoskeletal State
Region Movement ROM MMT
Neck Flex. Full (0-45°) 5
Ext. Full (0-45°) 5
Lat. Flex. Full (0-45°)/Full (0-45°) 5/5
Rot. Full (0-60°)/Full (0-60°) 5/5
Trunk Flex. Full 5
Ext. Full (0-30°) 5
Lat. Flex. Full (0-35°)/Full (0-35°) 5/5
Rot. Full (0-45°)/Full (0-45°) 5/5 28
Region Movement ROM MMT
Shoulder Flex. Full (0-180°) Full (0-180°) 5 5
Ext. Full (0-80°) Full (0-80°) 5 5
Abd. Full (0-180°) Full (0-180°) 5 5
Add. Full (0-45°) Full (0-45°) 5 5
Int. Rot. Full (0-55°) Full (0-55°) 5 5
Ext. Rot Full (0-45°) Full (0-45°) 5 5
Elbow Flex. Full (0-150°) Full (0-150°) 5 5
Ext. Full (150-0°) Full (150-0°) 5 5
Pro. Full (0-80°) Full (0-80°) 5 5
Sup. Full (0-80°) Full (0-80°) 5 5
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Region Movement ROM MMT
Wrist Flex. Full (0-80°) Full (0-80°) 5 5
Ext. Full (0-70°) Full (0-70°) 5 5
Rad. Dev. Full (0-20°) Full (0-20°) 5 5
Ulnar Dev. Full (0-30°) Full (0-30°) 5 5
Finger Flex. Full (0-90°) Full (0-90°) 5 5
MCP Ext. Full (0-15°) Full (0-15°) 5 5
Abd. Full (0-20°) Full (0-20°) 5 5
Add. Full (20-0°) Full (20-0°) 5 5
PIP Flex. Full (0-100°) Full (0-100°) 5 5
Ext. Full (100-0°) Full (100-0°) 5 5
DIP Flex. Full (0-90°) Full (0-90°) 5 5
Ext. Full (90-0°) Full (0-180°) 5 5 30
Region Movement ROM MMT
Thumb Flex/Ext Full (0-50°) Full (0-50°) 5 5
MCP Abd/Add Full (0-50°) Full (0-50°) 5 5
Opposition 5 5
IP Flex/Ext Full (0-90°) Full (0-90°) 5 5
Hip Flex. Full (0-125°) Full (0-125°) 5 5
Ext. Full (0-30°) Full (0-30°) 5 5
Abd. Full (0-45°) Full (0-45°) 5 5
Add. Full (0-20°) Full (0-20°) 5 5
Int. Rot Full (0-80°) Full (0-80°) 5 5
Ext. Rot Full (0-80°) Full (0-80°) 5 5
Knee Flex. Full (0-135°) Full (0-90°) 5 5
Ext. Full (135-0°) Full (135-0°) 5 5 31
Region Movement ROM MMT
Ankle Inver. Full (0-35°) Full (0-35°) 5 5
Ever. Full (0-25°) Full (0-25°) 5 5
Dorsal Flex. 0-10° Full (0-30°) 5 5
Plantar Flex. Full (0-45°) Full (0-45°) 5 5
Toes Flex. Full (0-30°) Full (0-30°) 5 5
MTP Ext. Full (0-80°) Full (0-80°) 5 5
IP Flex. Full (0-50°) Full (0-50°) 5 5
Ext. Full (0-80°) Full (0-80°) 5 5
Big Toe Flex. Full (0-25°) Full (0-25°) 5 5
MTP Ext. Full (0-80°) Full (0-80°) 5 5
IP Flex Full (0-25°) Full (0-25°) 5 5
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 • Local State, Knee region

Inspection Deformities Genu Varus

Inflammation Signs -/-
Redness, Rash -/-
Palpation Tenderness + medial MTP/-
Crepitus +/+
Warmth -/-

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• Special Tests
Right Left
Patellar Grinding + +
Anterior Drawer Test - -
Posterior Drawer Test - -
Valgus Stress Test - -
Varus Stress Test - -
Compression Test - -
Distraction Test - -
Mc Murray Test - -
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 Right Left
Q Angle
- Non WB 16° 25°
- WB 18° 28°
Leg Length
- Apparent 86 cm 86 cm
- True 79 cm 79 cm

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Supporting Examinations

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 Assessment
Clinical Diagnosis OA Genu Dextra + Genu Varus
Deformity + Hypertension

Functional Impairment -OA Genu Dextra

Diagnosis -Genu varus deformity
-Edema ankle D

Disability Difficulty to do tahiyat sitting

position during Sholat

Handicap
Problem List
– Surgical:
– -Medical: OA Genu Dextra + Genu Varus Deformity + Hypertension
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R1 (Mobilization)
Rehabilitation
Antalgic gait
R2 (ADL)

R3 (Communication) No problem
R4 (Psychology) Worry about her disease

R5 (Social Economy) -
R6 (Vocational) Couldn’t do Sholat properly
R7 (Other) Pain on right knee VAS 5
Genu Varus Deformity
Hypertension

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Therapeutic Modality: Therapeutic Exercise:
-SWD contraplanar -Isotonic stregthening exercise : Quadriceps and
27,12 MHz Hamstring D/S as tolerate
Continues, -Endurance Exercise : Static Cycle , intensity THR
intensity : 94,2-102x/minute,or Borg Scale 11-13, duration
Comfortable 15—20 minute, 3-5x/week
warmth, duration :
15-20 minutes Orthesa :
-TENS at Knee Brace
tenderpoints right
knee ( frequency
100 Hz, intensity
as patient
tolerance, duration
20 minutes,
3x/week)

Monitoring Clinical, VAS

Education Health Education/Home Exercise Programs
-Explain about patient condition
-Explain about knee joint conservation
-Continue Exercise at Home
-Icing at the tender area for 15-20 min 3-4x/day
-Elevasi, Ankle Pumping, Gentle Stroke Massage Ankle D
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 SUMMARY
• Male, 73 yo, referred from orthopedic outpatient clinic with
CC pain at right knee especially when sitting in Tahiyat
position for 3 weeks. Felt like dull pain, eased with resting .
Stiffness in the morning <30 minutes. No radiating pain, no
tingling sensation, no numbness, no fever. She worked as
housewife, had difficulty go to the second floor of her house
by stairs. Had accident 4 months ago and had done pinning on
her left ankle.
• Physical exam finding were: genu varus deformity, crepitus,

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• Plan for this patient were:
– SWD Contra Planar at right knee, TENS at tender
point, isotonic strengthening exercise: quadriceps and
Hamstring D/S, Endurance exercise with static cycle,
ankle pumping
– Monitor px complain, VAS, circumference, edema,
– Educate the px about her condition, about knee
conservation, to continue exercise at home, icing at
the tender area. Ankle pumping and gentle stroke
massage

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Thank You

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