Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Osteoarthritis


Related Terms

  • Arthrosis
  • Articular Disease
  • Atrophic Arthritis
  • Degenerative Joint Disease
  • Hypertrophic Arthritis
  • Noninflammatory Arthritis
  • Osteoarthrosis
  • Secondary Osteoarthritis

Differential Diagnosis

Specialists

  • Occupational Therapist
  • Orthopedic (Orthopaedic) Surgeon
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Physical Therapist
  • Rheumatologist

Comorbid Conditions

  • Conditions that precipitate secondary osteoarthritis (e.g., hemochromatosis, gout, chondrocalcinosis, intra-articular fracture)
  • Obesity

Factors Influencing Duration

Rest and exercise must be balanced. Too much rest will weaken muscles surrounding the affected joint. This places further stress on the joint and causes additional pain and instability. Repetitive activities at home or on the job that place stress on the affected joint or cause overuse of the affected joint may lengthen disability. The presence of comorbid illness, especially metabolic, autoimmune, or neuromuscular disorders, may increase duration. Depression or other emotional reactions possibly triggered by pain and limitation of movement and function can make it more difficult to cope or overcome symptoms of osteoarthritis.

Medical Codes

ICD-9-CM:
715.00 - Osteoarthrosis, Generalized; Degenerative Joint Disease, involving Multiple Joints, Site Unspecified
715.04 - Osteoarthrosis, Generalized; Degenerative Joint Disease, involving Multiple Joints, Hand; Carpus; Metacarpus; Phalanges [Fingers]
715.09 - Osteoarthrosis, Generalized; Degenerative Joint Disease, involving Multiple Joints, Multiple Sites
715.10 - Osteoarthrosis, Localized, Primary, Site Unspecified
715.11 - Osteoarthrosis, Localized, Primary, Shoulder Region; Acromioclavicular Joint(s); Glenohumeral Joint(s); Sternoclavicular Joint(s); Clavicle; Scapula
715.12 - Osteoarthrosis, Localized, Primary, Upper Arm; Elbow Joint; Humerus
715.13 - Osteoarthrosis, Localized, Primary, Forearm; Radius; Ulna; Wrist Joint
715.14 - Osteoarthrosis, Localized, Primary, Hand; Carpus; Metacarpus; Phalanges [Fingers]
715.15 - Osteoarthrosis, Localized, Primary, Pelvic Region and Thigh; Buttock, Femur, Hip (Joint)
715.16 - Osteoarthrosis, Localized, Primary, Lower Leg; Fibula; Knee Joint; Patella; Tibia
715.17 - Osteoarthrosis, Localized, Primary, Ankle and Foot; Ankle Joint; Digits [Toes]; Metatarsus; Phalanges, Foot; Tarsus; Other Joints in Foot
715.18 - Osteoarthrosis, Localized, Primary, Other Specific Sites; Head; Neck; Ribs; Skull; Trunk; Vertebral Column
715.20 - Osteoarthrosis, Localized, Secondary, Site Unspecified
715.21 - Osteoarthrosis, Localized, Secondary, Shoulder Region; Acromioclavicular Joint(s); Glenohumeral Joint(s); Sternoclavicular Joint(s); Clavicle; Scapula
715.22 - Osteoarthrosis, Localized, Secondary, Upper Arm; Elbow Joint; Humerus
715.23 - Osteoarthrosis, Localized, Secondary, Forearm; Radius; Ulna; Wrist Joint
715.24 - Osteoarthrosis, Localized, Secondary, Hand; Carpus; Metacarpus; Phalanges [Fingers]
715.25 - Osteoarthrosis, Localized, Secondary, Pelvic Region and Thigh; Buttock, Femur, Hip (Joint)
715.26 - Osteoarthrosis, Localized, Secondary, Lower Leg; Fibula; Knee Joint; Patella; Tibia
715.27 - Osteoarthrosis, Localized, Secondary, Ankle and Foot; Ankle Joint; Digits [Toes]; Metatarsus; Phalanges, Foot; Tarsus; Other Joints in Foot
715.28 - Osteoarthrosis, Localized, Secondary, Other Specific Sites; Head; Neck; Ribs; Skull; Trunk; Vertebral Column
715.30 - Osteoarthrosis, Localized, Not Specified whether Primary or Secondary, Site Unspecified
715.31 - Osteoarthrosis, Localized, Not Specified whether Primary or Secondary, Shoulder Region; Acromioclavicular Joint(s); Glenohumeral Joint(s); Sternoclavicular Joint(s); Clavicle; Scapula
715.32 - Osteoarthrosis, Localized, Not Specified whether Primary or Secondary, Upper Arm; Elbow Joint; Humerus
715.33 - Osteoarthrosis, Localized, Not Specified whether Primary or Secondary, Forearm; Radius; Ulna; Wrist Joint
715.34 - Osteoarthrosis, Localized, Not Specified whether Primary or Secondary, Hand; Carpus; Metacarpus; Phalanges [Fingers]
715.35 - Osteoarthrosis, Localized, Not Specified Whether Primary or Secondary, Pelvic Region and Thigh; Buttock, Femur, Hip (Joint)
715.36 - Osteoarthrosis, Localized, Not Specified whether Primary or Secondary, Lower Leg; Fibula; Knee Joint; Patella; Tibia
715.37 - Osteoarthrosis, Localized, Not Specified whether Primary or Secondary, Ankle and Foot; Ankle Joint; Digits [Toes]; Metatarsus; Phalanges, Foot; Tarsus; Other Joints in Foot
715.38 - Osteoarthrosis, Localized, Not Specified whether Primary or Secondary, Other Specific Sites; Head; Neck; Ribs; Skull; Trunk; Vertebral Column
715.80 - Osteoarthrosis Involving, or with Mention of More than One Site, but Not Specified as Generalized, Site Unspecified
715.89 - Osteoarthrosis Involving, or With Mention of More than One Site, but Not Specified as Generalized, Multiple Sites
715.90 - Osteoarthrosis, Unspecified whether Generalized or Localized, Site Unspecified
715.91 - Osteoarthrosis, Unspecified whether Generalized or Localized, Shoulder Region; Acromioclavicular Joint(s); Glenohumeral Joint(s); Sternoclavicular Joint(s); Clavicle; Scapula
715.92 - Osteoarthrosis, Unspecified whether Generalized or Localized, Upper Arm; Elbow Joint; Humerus
715.93 - Osteoarthrosis, Unspecified whether Generalized or Localized, Forearm; Radius; Ulna; Wrist Joint
715.94 - Osteoarthrosis, Unspecified whether Generalized or Localized, Hand; Carpus; Metacarpus; Phalanges [Fingers]
715.95 - Osteoarthrosis, Unspecified whether Generalized or Localized, Pelvic Region and Thigh; Buttock, Femur, Hip (Joint)
715.96 - Osteoarthrosis, Unspecified whether Generalized or Localized, Lower Leg; Fibula; Knee Joint; Patella; Tibia
715.97 - Osteoarthrosis, Unspecified whether Generalized or Localized, Ankle and Foot; Ankle Joint; Digits [Toes]; Metatarsus; Phalanges, Foot; Tarsus; Other Joints in Foot
715.98 - Osteoarthrosis, Unspecified whether Generalized or Localized, Other Specific Sites; Head; Neck; Ribs; Skull; Trunk; Vertebral Column

Overview

© Reed Group
Osteoarthritis is the most common joint disorder. Loss of cartilage and overgrowth of bone within the affected joint can lead to pain and joint deformity. The disease may affect one or more joints and is a primary cause of disability among adults.

Osteoarthritis usually begins with painless changes in components of the joint cartilage such as collagen and the substances that provide the cartilage's resilience (proteoglycans). As the cartilage starts to erode, particles irritate the joint lining (synovium) causing stiffness, inflammation, and swelling. Although osteoarthritis is classified as noninflammatory arthritis, inflammation occurs as immune activity (i.e., release of cytokines and metalloproteinases into the joints) begins in the affected joints. Tiny fluid-filled cavities form in the bone marrow beneath the cartilage (subchondral cysts), weakening the bone. Bone overgrowth at joint edges can produce bumps or bone spurs (osteophytes) causing pain and interfering with normal joint function. Instead of being smooth and slippery, the cartilage eventually becomes so rough and pitted that the joint no longer moves smoothly. The bone, joint capsule, tissue lining the joint (synovial tissue), tendons, and cartilage are all eventually affected. The degree of pain has been shown to correlate poorly with the extent of cartilage damage.

Primary osteoarthritis affects joints without any known cause (idiopathic), most often the joints of the finger, hip, knee, big toe, and the cervical and lumbar spine. Bony lumps (Bouchard's nodes and Heberden's nodes) appear and worsen over time at the middle and end joints of the fingers, respectively. The hip and knee are particularly vulnerable to osteoarthritis because of their weight-bearing function; other weight-bearing joints also affected, including the feet and vertebral joints of the cervical and lumbosacral spine.

Secondary osteoarthritis occurs as the result of trauma to a joint. It can also be caused by a congenital joint disease, infection, or a neurologic, metabolic, or endocrine disease. Secondary osteoarthritis may affect any joint.

Osteoarthritis should not be confused with rheumatoid arthritis, which is an autoimmune inflammatory arthritis. Rheumatoid arthritis and other rheumatoid diseases are systemic diseases with constitutional symptoms that can affect the entire body, not just the joints. In contrast, osteoarthritis affects only the joints.

Although it is the most common joint disease worldwide, little is known about what actually causes osteoarthritis. Often thought of as an inevitable part of aging, osteoarthritis is, in fact, not caused by the simple wear and tear that occurs during aging. However, age-related changes in cartilage are known to stem from a decreased ability to control the normal breakdown of cartilage components and inefficient cartilage repair mechanisms. Normal aging influences metabolic changes that trigger imbalances between cartilage synthesis and degradation. Oxidative stress associated with aging, disease, poor nutrition, and immune-mediated inflammation, all contribute to this imbalance. Joint injury or excessive weight bearing may also contribute, causing post-traumatic joint deterioration and eventually osteoarthritis. Research also has established that a genetic component may predispose individuals to develop osteoarthritis. Bone density plays a role in the development of osteoarthritis.

Incidence and Prevalence: Osteoarthritis affects over 20 million individuals in the US and is the most common articular disease worldwide (Lozada); about half of adults over age 65 are affected (Lozada). Degenerative joint disease of the knee is the leading cause of chronic disability in the US (Brandt) and is more common among black women than in other groups (Lozada). Prevalence varies worldwide and differs among ethnic groups.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Increased risk for developing osteoarthritis is associated with increasing age, obesity, female sex, history of trauma or repetitive occupational trauma such as activities that require frequent bending or carrying heavy loads. Risk factors for developing secondary osteoarthritis include participation in high impact sports such as football, history of inflammatory arthritis (i.e., rheumatoid arthritis), and presence of neuromuscular or metabolic disorders. Recreational running does not contribute to degenerative joint disease. Symptoms of the disease increase with age (Hellmann). The single greatest risk factor for osteoarthritis is age; radiographic evidence of the disease is found in 30% of individuals 45 to 65 years of age and in 80% of those age 80 or older, usually without symptoms (Lozada). Between the ages of 40 and 70, women are more troubled with osteoarthritis than men; after age 70, the rates are the same (Brandt; Porter), indicating earlier onset for women believed to be due in part to hormonal changes associated with menopause.

Source: Medical Disability Advisor



Diagnosis

History: Pain is the most common presenting symptom among individuals seeking medical attention. Symptoms of osteoarthritis develop gradually. In the early stages, the only complaint may be morning stiffness that resolves within 30 minutes after starting activity. As the disease progresses, joints become swollen and painful. The pain worsens with increased activity and weight bearing throughout the day, and is relieved with rest. Range of motion may be limited. Stiffness becomes more intense. Certain movements produce a grating, grinding sound (crepitus) or a catching sensation. Some joints such as the knee may become unstable due to stretching of the ligaments that surround and support the joint, and loss of cartilage within the joint. The hip may lose its range of motion and becomes stiff and painful. Symptoms of osteoarthritis in the hip may sometimes be felt in the groin or the knee. Back pain is the most common symptom of osteoarthritis of the spine. When osteoarthritis occurs in the neck or lower back, bone overgrowth can press on the spinal nerves causing pain, numbness, and weakness in an arm or leg. The individual may report a history of specific injury years before developing symptoms.

Physical exam: In the early stages, few or no signs may be seen on physical examination. If the disease has progressed, deformity and contractures may be observed. Joints may be slightly warm to the touch and swollen from increased synovial fluid or bone overgrowth. Nodular swellings (Heberden's or Bouchard's nodes) may be felt or seen on the fingers. Knees may bend either inward (knock knees, genu valgum) or outward (bow-legs or genu varum) or may seem flexed in a fixed state (flexion contracture). Affected joints may be tender to the touch. Active and passive range of motion may cause pain. Crepitus may be present in affected joints during motion.

Tests: X-rays of the affected joints show a characteristic pattern of joint space narrowing, bony growths (spurs or osteophytes), bone cysts, and lipping at the joint surfaces. The signs visible on x-ray may not however, correlate with the individual's symptoms of pain, swelling, and stiffness. For example, an individual's knee x-rays may show large spurs, narrow joint space, and loose bodies floating in the joint. While this would indicate a longstanding problem, the individual may have had only mild symptoms or no symptoms at all. The individual may have sought medical care only after a seemingly insignificant injury or when prolonged activity aggravated the symptoms. X-rays do not reveal changes in cartilage. For this, an MRI is required, but it is not normally used for this diagnostic purpose.

Laboratory tests are done only to rule out another diagnosis and to evaluate individual’s general health status. Erythrocyte sedimentation rate, complete blood count (CBC), C-reactive protein (CRP), and antinuclear antibody test are performed if an inflammatory process is suspected. These tests usually are normal or negative in osteoarthritis. Examination of joint fluid (arthrocentesis) may be performed to rule out infection, gout, or rheumatoid arthritis. A test for rheumatoid factor (RF) also may be done to rule out rheumatoid arthritis.

Source: Medical Disability Advisor



Treatment

Treatment is aimed at controlling pain and inflammation while maintaining mobility. Primary treatment options include exercise and medication. The treatment plan is based on several factors including the extent of joint involvement, the number and sites of involved joints, the nature of the individual's pain symptoms, presence of other health problems, the individual's age, and lifestyle issues such as occupation and typical activities of daily living.

Nonpharmacologic intervention is the mainstay of therapy for osteoarthritis. The goal of exercise in treating and managing osteoarthritis is to keep the cartilage healthy, maintain range of motion, and strengthen tendons and muscles to enable them to absorb stress placed on the joints. Exercises may include range of motion, strengthening (isotonic, isokinetic, and isometric), postural, and stretching exercises.

Physical therapy may also include heat treatments (warm baths, dipping the hand into hot paraffin mixed with mineral oil), massage, and traction. When the neck is affected, deep heat treatment using high-frequency current (diathermy) or ultrasound may be helpful.

Because they provide only short-term relief, drugs are the least important aspect of the total treatment plan. Pain relievers (analgesics) may be taken to reduce pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to reduce inflammation. In addition, local corticosteroid injection occasionally may be given to reduce inflammation, but may provide only temporary relief of symptoms (Bellamy). Injections of sodium hyaluronate (viscosupplementation), a natural ingredient of joint fluid, may be given to lubricate the joint. This may help reduce pain and improve function, particularly of the knee joint; however, studies examining treatment efficacy are conflicting (Bellamy; Lo). Topical analgesic creams may also be used. Muscle relaxants may be given if muscles are strained or show evidence of spasm while compensating for the affected joint. While these treatments help to control the symptoms, they do not affect the progression of the disease.

With progression to severe disease, supportive devices such as canes, braces, or shoe inserts may be needed to lessen stress on the joint and assist mobility. Exercise should be continued but may need to be modified during periods when supportive devices are required.

Surgical options should be considered in cases of advanced osteoarthritis or when all other treatments have failed to bring relief. Arthroscopic débridement with or without surgical lavage is not recommended for individuals with knee osteoarthritis without accompanying meniscal or cruciate ligament pathology (Kirkley; Laupattarakasem; Moseley). Surgical cutting and realignment of bone (osteotomy) increases movement and helps redistribute weight evenly on the joint. This may be done at the knee or hip and is most often used to treat younger individuals with osteoarthritis. Arthrodesis (fusion) surgically fixes the joint in a permanent position. The hip or knee joint often is replaced with an artificial joint (arthroplasty). Joint replacement is usually very successful in improving motion and function and dramatically decreasing the pain.

Source: Medical Disability Advisor



ACOEM

ACOEM's Practice Guidelines, the gold standard in effective medical treatment of occupational injuries and illnesses, are provided in this section to complement the disability duration guidelines.*
 
Chronic Pain
Hand/Finger Osteoarthritis
 
* The relationship between the MDGuidelines (MDA) content and ACOEM's guidelines is approximate and does not always link identical diagnoses. The user should consult the diagnostic codes in both guidelines, as well as the clinical descriptions, before assuming an equivalence.

Source: ACOEM Practice Guidelines



Prognosis

The outcome of osteoarthritis is unpredictable and depends on which joints are involved and rate of disease progression. Individuals with osteoarthritis often experience periods when symptoms are mild and periods when they are more severe. Although the disease typically progresses, it can stabilize, or even rarely, reverse. The disease may cause long-term pain and significantly limit activity, especially when knees, hips, or cervical spine is involved.

Source: Medical Disability Advisor



Rehabilitation

The focus of rehabilitation for osteoarthritis is to maintain an individual's function by controlling pain, as well as by promoting joint integrity and muscle strength.

Ice massage and cold packs are effective in pain control (Brosseau). Transcutaneous electrical nerve stimulation (TENS) and acupuncture-like TENS appear to decrease pain and stiffness in the knee. Electrical stimulation therapy may also have some benefit for knee osteoarthritis (Hulme).

The therapist will develop an exercise program to address the loss of motion and strength in the affected joint. Supervised exercises, including stretching, strengthening, and aerobic exercises are effective in both reducing pain and improving physical function among individuals with knee and hip osteoarthritis (Brosseau; Fransen, 2008, 2009). Knee and hip osteoarthritis respond equally to supervised group or individual exercise sessions (Suomi). Aerobics and strengthening exercise is recommended, and acupuncture can be used in combination with other active therapy. When available, aquatic exercise is effective for management of knee and hip osteoarthritis (Bartels). Initiating a self-guided program, including regular exercise and weight loss, is helpful in improving functional limitations and pain (Scott).

Braces, orthotic insoles, and taping are useful to support affected joints (Scott; Brouwer) and may improve function and decrease pain in individuals with osteoarthritis. Orthotics may accordingly help to maintain the individual's independence and minimize energy expenditure. However, orthotics must be used in conjunction with an active exercise program for the involved body parts. Occupational therapy and / or ergonomic assessments may be beneficial for determining modifications and assistive devices that will allow for return to work and full function in daily tasks.

If surgery is required, the treating physician will dictate the rehabilitation protocol. Refer to Lane for a complete discussion.

FREQUENCY OF REHABILITATION VISITS
Nonsurgical
SpecialistOsteoarthritis
Occupational or Physical TherapistUp to 24 visits within 10 weeks (Mei-Hwa)
The table above represents a range of the usual acceptable number of visits for uncomplicated cases. It provides a framework based on the duration of tissue healing time and standard clinical practice.

Source: Medical Disability Advisor



Complications

A bone overgrowth (osteophyte) pressing on nerves in the cervical or lumbar vertebrae (spondylosis) can cause spinal nerve compression (radiculopathy) and dysfunction of the spinal cord (myelopathy). Osteoarthritis in the cervical spine can result in progressive disc degeneration, disc herniation, and spinal nerve compression with symptoms such as tingling or numbness (paresthesia) in the extremities. Compression of blood vessels (vertebral artery) supplying the back of the brain can result in vision problems, vertigo, nausea, and vomiting. Osteophytes pressing on the esophagus can make swallowing difficult. Osteoarthritis of the knee can result in atrophy of the quadriceps muscles because of disuse. Infection or increased inflammation of an affected joint can complicate the course and treatment plan.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Modifications may be necessary during weight-bearing activities or where a joint is overused or repetitively stressed. When hips or lower extremities are involved, limited stair climbing, squatting, and kneeling are advised. Additional rest periods may be needed. Accommodations must be made for supportive devices such as canes, braces, stools, or wheelchairs. Company policy on medication usage should be reviewed to determine if pain medication use is compatible with job safety and function. Reassignment to a job with lighter exertion may be helpful in returning the individual to work.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Has individual experienced progressive joint stiffness, pain, and loss of motion?
  • Did the physical exam reveal one or more inflamed, stiff, deformed joints?
  • Was the diagnosis confirmed with diagnostic x-rays?
  • Were other conditions with similar symptoms ruled out (e.g., bursitis, tendinitis, radicular spine pain, pigmented villonodular synovitis, osteochondritis dissecans, osteochondromatosis, osteonecrosis, Paget's disease, osteoporotic fractures, rheumatoid arthritis)?
  • Is osteoarthritis primary or secondary? If secondary, are underlying conditions being treated?

Regarding treatment:

  • Have pain and inflammation been effectively controlled with analgesics and anti-inflammatory medications? If side effects are present, is there an alternative medication that could be prescribed?
  • Has individual been instructed about maintaining an appropriate body weight and getting regular physical exercise?
  • Is individual following a prescribed exercise plan that includes range of motion, strengthening, and stretching exercises?
  • Would individual benefit from consultation with a physical and / or occupational therapist?
  • If the conservative treatments have been ineffective, is surgical intervention warranted?
  • If overweight, has individual been referred to a weight loss program?

Regarding prognosis:

  • To what extent is function impaired?
  • Have work and home activities been modified in order to reduce weight-bearing action and repetitive movement stress on affected joint?
  • Has individual experienced any complications, such as spondylosis or infection that may affect recovery?
  • Are complications or comorbid illness affecting individual’s response to osteoarthritis treatment?
  • Does individual feel helpless or depressed about coping with the pain?
  • Would individual benefit from attending a chronic pain management program?
  • Would individual benefit from counseling or enrollment in a support group?

Source: Medical Disability Advisor



References

Cited

Bartels, E. "Aquatic Exercise for the Treatment of Knee and Hip Osteoarthritis." Cochrane Database of Systematic Reviews. Ed. E. Bartels. Issue 4 ed. John. Wiley & Sons, 2007. NA.

Bellamy, N., et al. "Viscosupplementation for the treatment of osteoarthritis of the knee." Cochrane Database of Systematic Reviews. John. Wiley & Sons, 2006.

Brandt, Kenneth D. "Osteoarthritis." Internal Medicine. Ed. Jay H. Stein. 5th ed. St. Louis: Mosby, Inc., 1998. 1264-1268.

Brosseau, L., et al. "Intensity of Exercise for the Treatment of Osteoarthritis." Cochrane Database of Systematic Reviews 2 (2003): CD004259. National Center for Biotechnology Information. National Library of Medicine. 21 Nov. 2008 <PMID: 12804510>.

Brouwer, R W, et al. "Braces and Orthoses for Treating Osteoarthritis of the Knee." Cochrane Database of Systematic Reviews. Eds. R W Brouwer, et al. John. Wiley & Sons, 2009.

Fransen, M., and S. McConnell. "Exercise for Osteoarthritis of the Knee." Cochrane Database of Systematic Reviews. Eds. R W Brouwer, et al. John. Wiley & Sons, 2009.

Fransen, M., G. Hernandez-Molina, and S. Reichenbach. "Exercise for Osteoarthritis of the Hip." Cochrane Database of Systematic Reviews. Eds. W. Laupattarakasem, et al. John. Wiley & Sons, 2008.

Hellmann, David. "Arthritis & Musculoskeletal Disorders." Current Medical Diagnosis and Treatment 2004. Eds. Lawrence M. Tierney, S. J. Mcphee, and M. A. Papadakis. 43rd ed. New York: McGraw-Hill, 2003. 778-832.

Hulme, JM, et al., eds. "Electromagnetic fields for the treatment of osteoarthritis." Cochrane Database of Systematic Reviews. John. Wiley & Sons, 2002.

Kirkley, A., et al., eds. "A randomized trial of arthroscopic surgery for osteoarthritis of the knee." New England Journal of Medicine 359 11 (2009): 1097-1107.

Laupattarakasem, W., et al. "Arthroscopic debridement for knee osteoarthritis." Cochrane Database of Systematic Reviews. Eds. W. Laupattarakasem, et al. John. Wiley & Sons, 2008.

Lo, G., et al. "Intra-articular hyaluronic acid in treatment of knee osteoarthritis: A Meta-analysis." JAMA 290 23 3115-3121.

Lozada, Carlos J., and Eli Steigelfest. "Osteoarthritis." eMedicine. 5 May. 2010. Medscape. 14 Dec. 2011 <http://emedicine.medscape.com/article/330487-overview>.

Mei-Hwa, Jan, et al., eds. "Investigation of Clinical Effects of High- and Low-Resistence Training for Patients with Knee Osteoarthritis:A randomized Controlled Trial." Physical Therapy 88 Number 4 (2008): 427-436.

Moseley, G. L., A. Gallace, and C. Spence, eds. "Is mirror therapy all it is cracked up to be? Current Evidence and future directions." Pain 138 1 (2008): 7-10. PubMed. <PMID: 18621484>.

Porter, Robert S., et al. "Osteoarthritis." The Merck Manual of Diagnosis and Therapy. Ed. Robert S. Porter. 19th ed. Whitehouse Station, NJ: Merck Laboratories, 2011.

Scott, David, and Anna Kowalczyk. "Osteoarthritis of the knee." BMJ Clinical Evidence Handbook: Musculoskeletal disorders. Eds. N. Collins, et al. BMJ Publishing Group, 2007. 1121.

Suomi, R., and D. Collier. "Effects of Arthritis Exercise Programs on Functional Fitness and Perceived Activities of Daily Living Measures in Older Adults with Arthritis." Archives of Physical and Medical Rehabilitation 84 11 (2003): 1589-1594. National Center for Biotechnology Information. National Library of Medicine. 21 Nov. 2008 <PMID: 14639556>.

Source: Medical Disability Advisor






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