Oeteoarthritis and HA

Oeteoarthritis and HA

Do you suffer from these symptoms

- Knee pain during movement
- Creaking or grinding sensation during movement
- Knee stiffness after rest
- Knee joint swelling
- Loss of range of movement / loss of mobility

Understanding HA

Hyaluronic acid (HA) is a naturally occurring molecules that are contained in many tissues, not just the joints. HA is one of the components that give our tissues flexibility.

HA is essential for healthy cartilage. It’s the chemical backbone that olds together the molecules, such as chondroitin sulfate, that make up the cartilage and give joint cartilage its special properties. HA is what makes joint cartilage the smoothest and most friction-free substance in nature. Nothing man-made can approach the performance of this remarkable tissues.

Oeteoarthritis and HA

HA is what makes synovial fluid thick and viscous - and it’s these properties that are vital to normal knee joint junction.

But when osteoarthritis strikes, the amount of HA in the knee joint drops. In severe osteoarthritis, the level of HA in the joint fluid may decrease by 75% or more. When HA levels in the knee drop, for instance, the result is a creaking and grinding sensation, knee pain and, often, a condition called “movie-goers knee”.

It may sound funny, but movie-goers knee is no joke. it’s a real medical condition that occurs after someone with knee osteoarthritis sits with the knee bent at a sharp angle for a prolonged period of time - such as sitting through a feature movie or driving a car for a couple of hours.

Upon arising, a sudden, sharp, stabbing knee pain occurs. The knee pain usually goes away after walking a few steps, as the remaining fluid in the knee coats the surfaces of the cartilage ad cuts down on the friction.

Choosing the Best HA supplement

As researchers learn more about the HA pathways in the knee joints, they continue to discover new ways in which HA helps to relieve pain and improve function in patients with osteoarthritis.

One of things they've learned is that oral HA supplements can be very effective - but only if they’re a high quality product that closely mimics the body’s own HA.

Today, the oral forms of HA sold as dietary supplements come from three general categories:
1. Low-purity animal extractions with collagen
2. Fermentation from bacteria; or
3. Concentrated extractions from avian sources

The original pharmaceutical forms of injected HA were all derived from the avian sources, so it makes sense that this is also the optimal form for dietary supplements.

Low-purity animal extractions mixed with collagen are undesirable because of two reasons. To get an adequate quantity of HA from these supplements, you’d have to take them in very large amounts. Also it’s questionable whether the biological activity of this source of HA is comparable with the others. HA derived from bacterial fermentation may also be less functional and it doesn't have some of the natural active components found in the concentrated extractions from avian sources.

Anaesthesia

Anaesthesia

What is Anaesthesia

Anaesthesia is the absence of pain sensation in either all or part of the body. In general anaesthesia consciousness is lost and you go “sleep”. In local anaesthesia only a part of the body is made numb, example like your arm or leg or abdomen. This is call regional anaesthesia.

Epidural anaesthesia is a special form of regional anaesthesia which can be used to numb the area of your chest, abdomen, pelvis and legs.

What is an epidural

Epidural anaesthesia is used to temporary numb the nerves carrying pain sensation. A special epidural needle is inserted into the lower part of back; a small amount of local anaesthesia may be first injected into the skin of the area. This causes a little sting but it is often the only part that hurts. The tip of the epidural needle is advanced into the space which contains the nerves before they enter the spinal cord. With the epidural needle in place, a fine plastic tubing can then be passed through the needle. The needle is withdrawn and the plastics tube taped in place so drug doses can be made through it with no further injections.

Epidural anaesthetic - What happens first

Before performing an epidural anaesthetic, first your anaesthetist will ask you about your previous anaesthetic history and will assess your medical condition. You will be asked questions about any allergies you may have, and about any medications you may be taking. An intravenous drip will be started, usually through an injection on the back of your hand. Extra fluid is given through this drip. It is also used t give drugs rapidly when necessary. If you are in extreme pain when requesting your epidural, then your pre-anaesthesia consultation may be brief. You can rest assured that your anaesthetist will commence your epidural as soon as it is considered safe to do so. Any questions you wish to ask will be readily answered.

Anaesthetic - What are the risk

No anaesthetic is without risk, but most patients do not suffer any serious complications. When they do occur, complications vary from mild and inconvenient (headache, backache, nausea, vomiting, shivering, drip side bruising) to the severe but very rare, such as damage to the spinal cord or nervous system, or death. The risk of developing a serious complication is very remote when the epidural is performed by someone who is inexperienced, and when ongoing care is provided by staff who are experienced in epidural management.

Epidural anaesthetic - What are the side effects

Once your pain has been relieved, your  blood pressure can fall somewhat an this might make you feel a little light-headed or nauseated. A fall in blood pressure is usually not serious and can easily treated. Sometimes the fall is helpful, if your blood pressure is already high. It is important not to lie flat on your back because this position can affect your circulation and blood pressure and make you feel faint. You should always lie on your side, or arrange a pillow to tilt your body to one side.

Epidural anaesthetic - What more should I know

Occasionally the epidural needle is inserted a little further than intended, causing a “lumbar puncture” or mall leak of the fluid surrounding the spinal cord. This is not serious in itself but can cause a severe headache, which can be treated effectively. Infection following an epidural is extremely rare and if treated early with antibiotics usually recovered completely without complications. Epidural are very safe when performed and managed properly. Serious complications are extremely rare. Minor complications such as lumbar puncture headache, are uncommon and are easily treated.

Epidural anaesthetic - What drugs are used

Modern epidural in usually combine a low concentration local anaesthetic with a morphine-related pain relieving drug such as fentanyl. This takes away the pain but allows enough sensation for you to still feel your movements.

Knee Osteoarthritis OA

Knee Osteoarthritis OA

Osteoarthritis or OA is a wear and tear disease that develops gradually over the years due to repetitive damages in the knee joint because of certain activities or events. Besides ageing, there are other reasons that may cause you to be at higher risk of developing OA, such as being overweight, family history of Osteoarthritis, and certain occupations.

OA usually develops slowly, and gradually worsens over time. The knee pain symptoms may range from mild to very very severe. In general, there are four stages of OA based on medical X-ray findings

Stage 1 - Narrowing of knee joint space is unlikely.
Stage 2 - Minimal change in knee joint space; identified small osteophytes (bone spurs formed around the joint)
Stage 3 - Moderate knee joint space narrowing; presence of multiple osteophytes
Stage 4 - Severe knee joint space narrowing with bone-on-bone contact; presence of multiple large osteophytes.

Healthy Knee VS Knee with OA

In a healthy knee there is a small amount of lubricating fluid, known as synovial fluid, in the knee joint. A substance known as hyaluronic acid is found predominately in synovial fluid. The primary function of hyaluronic acid is to provide lubrication and reduce fiction when the knee joint moves or bends. It also has shock absorbing ability to protect your knee joint when, for example, you jump.

When you have OA of the knee the cartilage that protects the ends of the bones gradually deteriorates. OA of the knee also causes the synovial fluid inside the knee joint to become damaged and lose its shock absorbing abilities. Therefore, t can no longer protect your knee joint effectively. Joint mat begin to scrub against each other, causing pain, stiffness and loss of movement in the knee joint. This is why you experience pain, swelling and loss of mobility.

Common symptoms of Osteoarthritis OA

1. Knee pain during movement and even at rest
2. A grating sensation in the joint during movement
3. Stiffness after periods of rest
4. Knee Joint swelling
5. Loss of range of movement
6. Loss of mobility
7. Weakened posture due to knee pain and stiffness

The symptoms of Osteoarthritis OA are treatable, especially in the early stages of disease. If OA is not treated appropriately, these knee pain symptoms can get worsen over time. Constant knee pain and limited movement probably make even simple tasks and pleasures increasingly difficult for you. If you have pain or stiffness in one or both knees, contact your doctor for knee pain diagnosis to find out if you have Osteoarthritis OA.

Treatments option for Osteoarthritis OA

1.  Lifestyle changes, including moderate exercise, weight control and reducing stress on your knee joint.

2. Oral pain relievers such as paracetamol or NSAID is for temporary knee pain relief.

3. Dietary supplements, such as glucosamines, and also used to help manage knee pain However, taking these supplements does not stop your  Osteoarthritis from getting worse.

4. Topical pain-relieving creams to apply to your skin

5. Physical and occupational therapy to strengthen muscles and improve mobility.

6. Steroid injections to temporary relieve knee pain and reduce swelling. However, repeated use of steroid injections may itself  accelerate cartilage degradation.

7. Viscosupplementation - A knee joint injection, such as Synvisc-One, the replaces damaged joint fluid with a substance similar  to healthy joint fluid, in order to reduce knee pain and often improve function as well.

8. Surgery, often recommended when knee pain is severe and other treatments have not provided relief.

Front Knee Pain - Chondromalacia Patella

Front knee pain is a very common problem faces by many people. The front knee pain usually causes by the tissue around the kneecap including the tendons, bones and cartilage surfaces. These tissues are undertaken high forces during daily activities and sports. Sports activities like running, hiking, jumping, and squatting can impose up to 6 times of body weight to these tissues. Repetitive high usage of these issues will gradually leads to tissue breakdown and subsequently feels the front knee pain. 

PATHOLOGY

Medical survey show that almost everybody encounter cartilage damage on knee cartilage when they perform arthroscopic surgery. At the age of 15 and above, the cartilage surfaces behind the kneecap are usually begin to tear out. The front knee pain from chondromalacia mostly happen with the age of 15 to 60 years old. In addition to it, most of the people diagnose with chondromalacia do not have symptoms.

All the tissues around the kneecap cartilage area are surrounding by nerve except cartilage surfaces. From there the nerve produce pain feeling to us. The most common situation is the tenderness when we touch the kneecap. It can be swelling. Grinding sound can be heard from front kneecap when we perform squatting and bending.

The medical finding for the front knee pain is the damage of the cartilage behind the kneecap or patella. The cartilage that covers the kneecap bone is the thickest cartilage in human body system. It is so thick so that it can support our body weight and pressures from heavy activities while maintain the joint in between connected firmly. 

TREATMENT

The first choice treatment of front knee pain or chondromalacia of the patella is strengthening program of the quadriceps muscle. Strengthening of the quadriceps muscle if done in correct manner can provides approximately 90% recovery rate for the pain of front knee condition chondromalacia. The reason that strengthening of the quadriceps muscle so effective is that it removes the pressure away from the kneecap cartilage and puts it into the muscular tissue. With this strengthening program it let the pressure distribute evenly in the knee cap and thigh bone joint.

EXERCISES




Front knee pain exercises involves strengthening-stretching of the quadriceps muscle. All strengthening of the quadriceps muscle should be done within the range that keeps pressure on the kneecap low. This range is between full extensions where the knee is straight to approximately 45 degrees of bending of the knee. The exercises should be done with high repetition in 3 sets of 20 or 30 which are appropriate. There should be no pain during the exercises. Ice should be applied to the front part of the knee for approximately 10-20 minutes after the exercise program.

Anti-inflammatory medicines are very useful and can be taken on a daily basis. Exercises can be performed on a daily basis, but should be performed at least three times a week. Daily activities that can result to the front knee pain should be avoided or reduce to minimal. If the recommended exercise program done persistently and properly, most people able to recover.

VISCO SUPPLEMENTATION

Lubrication or visco supplementation injection may be required if exercise and strengthening of the quadriceps muscle are not resolve the front knee pain.

Synovial fluid within the knee joint is highly viscous which provides a friction-free environment. Hyaluronic acid (HA) which is present in synovial fluid is also found in most body tissues. In a healthy body system in adult, synovial fluid HA has a molecular weight of 4-5 million. HA also binds to proteoglycans to stabilize the structure of the articulate cartilage.

Lubrication or Hylagan injections provide the joint lubrication and shock absorption, as well as decrease friction or rubbing within the knee joint which may slow the progression of osteoarthritis. However, not all the patients who receive Hylagan injections relief from the front knee pain, only about 50% have symptomatic relief. One injection is given into the knee joint each week for three weeks and may be repeated as soon as 6 months. Studies also show that Hylagan injections might be useful for the first time, but if the front knee pain happen again, the injection of Hylagan will no more effective and useful.

SURGICAL TREATMENT

When exercises fail to improve the front knee pain, surgery may be the last resort and the only solution if the symptoms are significant enough to severely affected our daily activities and mobility.

Osteoarthritis

Osteoarthritis is one types of arthritis commonly heard amongst aged population, especially female over age of 55 years old. Osteoarthritis is abbreviated as OA or referred to as degenerative arthritis or degenerative joint disease (DJD). Among the over 100 different types of arthritis conditions, osteoarthritis is the most common happen condition.

Cartilage is a connector between the bones and the joints that serves as a "cushion". Arthritis always caused by tear down and eventual loss of the cartilage of joints. Osteoarthritis commonly affects the hands, feet, spine, and large weight-bearing joints, such as the hips and knees.

Primary osteoarthritis is mostly a result of natural aging of the joint. When we are getting older, the fluid compound of the cartilage will increases, and the protein substance makeup of cartilage will degenerates. Gradually, cartilage begins to degenerate by flaking. In advanced osteoarthritis, cartilage cushion between the bones and the joints will totally loss. Joint pain will gradually appear and become obvious over repetitive use of the worn joints for our daily activities.



Signs and symptoms of osteoarthritis vary from patient to patient. Osteoarthritis of the knees always linked to obesity or excess upper body weight, or has history of injury or joint surgery. Bowlegged is a osteoarthritis condition cause by progressive cartilage degeneration of the knee joints that lead to deformity and outward curvature of the knees.

People with osteoarthritis of the weight-bearing joints such as the knees can develop a limp. The limping condition can go worsen over the time as more cartilage degenerates. Medicine and some common treatments may not curable for some patients regarding to the joint pain and limping. Severe osteoarthritis of the knees is one of the most common reasons for knee replacement surgical.

There is no way to use blood test for the diagnosis of osteoarthritis. However blood test can be performed to exclude diseases that can cause secondary osteoarthritis, as well as to exclude other arthritis conditions that look similar to osteoarthritis.

X-rays of the affected joints can be used to diagnose osteoarthritis. The common X-ray findings of osteoarthritis include loss of joint cartilage, narrowing of the joint space between adjacent bones, and bone spur formation.

Weight reduction cause by obesity that put on excessive weight on joint is important for the treatment. Intense activities that put excessive stress on the joint cartilage should avoid. There are no specific treatments to halt cartilage degeneration or to repair damaged cartilage in osteoarthritis. The goal of treatment in osteoarthritis is to reduce joint pain and inflammation while improving and maintaining joint function. Physical therapy and mechanical support devices such as knee braces can relief the condition.

Pain Inside Knee Joint PCL Injury

Pain inside knee joint, a posterior cruciate ligament injury is causing by tearing or stretching of the posterior cruciate ligament PCL.

Physical examination by doctor needed when there are signs of PCL injury. Doctor will ask you to move your knee joint in different ways. Fluid in the knee joint may also check to see if there is bleeding inside knee joint. For more serious case, knee joint MRI and knee joint x-ray may be required.

The posterior cruciate ligament PCL is the strongest ligament in the knee. It extends from the top-rear surface of the tibia to the bottom-front surface of the femur. The ligament controls the stability of posterior knee joint, avoiding tibia from moving over behind the femur.

Posterior cruciate ligament injury usually happen by over stretching the knee joint (hyperextension). This can easily happen if you land improperly or too hard from jumping. The PCL injury can also caused from a direct blow to the flexed knee, such as smashing your knee in a car accident (called "dashboard injury") or falling hard on a bent knee.

Posterior cruciate ligament injury symptoms are obvious to be seen. When you have below symptoms, you have chances of PCL injury.

• Knee joint pain 

• Knee joint instability 

• Back knee swelling 

In common practice, first aid treatments for PCL injury are

• Applying ice to the area 

• Elevating the knee joint above the level of the heart 

• Taking non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief 

You should not have any intense physical activity until the knee swelling is shrinking down until disappear and the pain inside knee joint is gone. Proper physical therapy can help you to regain knee joint and leg muscle strength. If the PCL injury are more serious and cannot recover from above therapy, you may need surgery. This may be either knee arthroscopy or open surgical reconstruction.

For ages population, pain inside knee joint are more commonly happen. There are weak to their bone, ligaments and knee joint. Daily physical activities are advised not to be intense and be careful.