Osteoarthritis in Young People
Original Editor - Anna Jansma
Top Contributors - Lucinda hampton, Oyemi Sillo, Claudia Karina, Kim Jackson, Lauren Lopez, Nupur Smit Shah, Anna Jansma, Evan Thomas, Lauren Heydenrych and Reem Ramadan
Definition[edit | edit source]
Osteoarthritis (OA) is one of the most devastating chronic conditions that affect people around the world. Although the usual population associated with the condition is the elderly (who are mostly inactive), athletes and younger individuals are also susceptible.
- Depending on the population, the etiology may differ; injuries, occupational activities, and obesity appear to be the most common causes of OA in young and athletic populations.
- Diagnosing OA in athletes and young individuals is sometimes challenging because of their increased pain tolerance.
- However, the treatment of OA in these populations does not differ from its management in the general population[1].
Potential Causes[edit | edit source]
There are a whole range of potential causes of osteoarthritis in young adults (14-40). These include –
- Leading a sedentary (non-active) lifestyle
- Poor posture when sitting for long periods
- Heavy lifting (potentially with poor technique, but not necessarily)
- Doing an office job with large amounts of sitting at a desk/ computer
- Being overweight or clinically obese
- Being very active (running lots of marathons for example)
- Playing impact sports such as rugby or football
- Joint injuries
- Birth defects such as hip dysplasia or different length legs
- Hormone disorders that affect growth
- Diabetes
- Osteoarthritis in the family[2][3]
Assessment[edit | edit source]
Assessment of OA in younger people should focus on a:
- Patient-centred history,
- Comprehensive physical examination,
- Performance-based measures
- Patient-reported outcome measures to enable monitoring of symptoms and function over time.
Referral for imaging should be reserved for people presenting with atypical signs or symptoms that may indicate diagnoses other than OA.
Treatment Approach[edit | edit source]
The treatment of OA in these populations does not differ from its management in the general population.[1] See osteoarthritis
Nonpharmacological approaches are core strategies for the management of OA in younger people, and these include appropriate disease-related education, activity modification (including for work-related tasks), physical therapist- prescribed exercise programs to address identified physical impairments, and weight control or weight loss.
- High-quality evidence has shown no benefit of arthroscopy for knee OA, and there are no published clinical trials to support the use of hip arthroscopy for OA.
- Referral for joint-conserving or joint replacement surgery should be considered when nonpharmacological and pharmacological management strategies are no longer effective.[2]
Clinical Presentation[edit | edit source]
Nonspecific symptoms, mainly local:
- Pain
- Loss in ROM
- Crepitation
- Stiffness / total blocking
- Morphological deformities
Pain is more likely caused by congenital hip dysplasia, athletic injuries, trauma, spondyloarthropathy, and by conditions that first appear during this stage of life, such as rheumatoid arthritis, osteoarthritis, intravenous drug use, alcoholism, or corticosteroid use.[4]
Furthermore the more common characteristics of generalized osteoarthritis can be found in the young adult, mainly in the Hip and Knee.
Examination[edit | edit source]
The examination should evaluate the patient’s functional performance.[5] The examiner should:
- Inspect posture and movement in daily activities, with special attention for the back, pelvis, ankles and feet. If walking aids are used, the upper extremity must also be inspected.
- Palpate for presence of swelling or raised temperature and muscle tone.
- Do active/passive functional testing
- Assess muscle strength
- Assess mobility
- Assess balance and stability
- Assess coordination
Prevention[edit | edit source]
The prevention of development of osteoarthritis in the adolescent can be achieved by reducing risk factors. Physiotherapists can promote the maintenance of a healthy weight, low-impact activities, giving exercises to improve joint stability to prevent joint injuries.[6] They can have influence by preventing further progression or complications of a disorder and improving the patient’s self-efficacy.[5]
In case of malalignments (leg-length discrepancy, varus/valgus, etc.) young patients should be referred to a podiatrist for insoles to prevent the development of OA (in the hip or knee) at an older age.
References[edit | edit source]
- ↑ 1.0 1.1 Amoako AO, Pujalte GG. Osteoarthritis in young, active, and athletic individuals. Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders. 2014 Jan;7:CMAMD-S14386.Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4039183/(accessed 17.10.20210
- ↑ 2.0 2.1 Ackerman IN, Kemp JL, Crossley KM, Culvenor AG, Hinman RS. Hip and knee osteoarthritis affects younger people, too. journal of orthopaedic & sports physical therapy. 2017 Feb;47(2):67-79.Available: https://www.jospt.org/doi/full/10.2519/jospt.2017.7286(accessed 17.10.2021)
- ↑ Oddis CV. New perspectives on osteoarthritis. The American journal of medicine. 1996 Feb 26;100(2):10S-5S.Available: https://www.sciencedirect.com/science/article/abs/pii/S0002934397895411(accessed 17.10.2021)
- ↑ Troum OM., Crues JV. The Young Adult With Hip Pain: Diagnosis and Medical Treatment (2004) Division of Rheumatology, University of Southern California, 9-17 (C)
- ↑ 5.0 5.1 Royal Dutch Society for Physical Therapy (2010). KNGF Guideline for Physical Therapy in patients with osteoarthritis of the hip and knee. De Fysiotherapeut, V120, 1 (D)
- ↑ Nicholson S. et al. Reducing Premature Osteoarthritis in the Adolescent Through Appropriate Screening. (2009) Journal of Pediatric Nursing, 24, 69-74 (B)
