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degenerative joint disease explanation free
Our review of the literature did not find any studies on clinical interventions that prevent or treat secondary conditions associated with amputation. Currently, precautionary measures or clinical interventions for reducing the onset or severity of degenerative joint disease or back pain are based on anecdotal clinical judgment. For example, decreasing the reliance on the nonamputated limb during walking, standing, or performing everyday activities would theoretically reduce stresses on the joints of the lower limb and reduce compensatory movement strategies that alter the mechanics of the spine. Convention suggests that a comprehensive program that includes quality prosthetic care and proper physical conditioning would be beneficial.
Most people with amputation have an active and satisfying quality of life [6-7]. However, the concern is that having an amputation for a long period of time is associated with secondary physical conditions, including osteoarthritis, osteoporosis, back pain, and other musculoskeletal problems. These conditions are believed to result from increased forces on the intact limb and altered body mechanics that occur secondary to limb loss and/or prosthesis use. This article reviews the literature on the impact of altered gait in people with lower-limb amputation and degenerative conditions that may occur to the lower limbs and spine.
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Musculoskeletal pathologies often develop as secondary complications in people with amputation, which may affect their mobility and quality of life. An alteration of biomechanics occurs with the use of one or more prostheses. Individuals with amputation tend to favor their intact limb and stress it more during mobility and daily activities. This tendency can cause degenerative changes of the intact limb, such as osteoarthritis of the knee and/or hip joints. Since people with amputation spend less time on their residual limb, osteopenia and subsequent osteoporosis often occur secondary to insufficient loading of the bones. Prosthetic fit and alignment can influence posture and comfort, which may promote greater equal force distribution across the intact and prosthetic sides during gait and tentatively decrease the susceptibility to osteoarthritis. Moreover, back pain that is bothersome and influences activity is a common complaint among individuals with amputation. Back pain has been linked to poor socket fit and alignment, postural changes, leg-length discrepancy, amputation level, and general deconditioning. Knowledge of the possible secondary complications of amputation can help rehabilitation practitioners provide high-quality, prophylactic care for their patients with lower-limb amputation.
Submitting an exhaustive list of research possibilities is beyond the scope of this literature review; however, some areas for future research on secondary conditions related to lower-limb amputation would include the following topics. Research is needed to understand the incidence of degenerative joint disease and how it affects the joints of the lower limbs and spine. While current studies demonstrate that secondary conditions are present after amputation, validation of predictive profiles is needed to predetermine which individuals with amputation are at greatest risk. Studies are needed to define good prosthetic fit and determine the implications of poor prosthetic fit. Likewise, studies are needed to determine the differences between socket designs and prosthetic components with respect to forces placed on the contralateral limb and spine. Similarly, studies that investigate prosthetic socket alignment and prosthetic length and the relationship to the hip, pelvis, and spine in people with transfemoral amputation may have significant clinical value. In addition, the effects of traditional therapies, such as orthotic shoe inserts for medial knee pain, or pharmacological and nonpharmacological therapies for osteoarthritis and osteoporosis should be explored. Studies investigating therapeutic interventions such as balance training, strengthening, gait training, and other movement strategies should be investigated with respect to load sharing with the prosthetic limb and to stress reduction on the contralateral limb. Finally, research exploring the effects of physical conditioning, especially to stabilize the trunk muscles to reduce back pain and maintain an active lifestyle, may guide clinicians and prosthesis users alike.
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Abstract — Musculoskeletal imbalances or pathologies often develop into secondary physical conditions or complications that may affect the mobility and quality of life of people with lower-limb amputation. Using one or more prostheses causes people with amputation to alter the biomechanics of their movement. For example, people with lower-limb amputation often favor and stress their intact lower limb more during everyday activities. This can lead to degenerative changes such as osteoarthritis of the knee and/or hip joints of the intact limb. Since people with amputation spend less time on their residual limb, osteopenia and subsequent osteoporosis often occur secondary to insufficient loading through the long bones of the lower limb. A proper prosthetic fit increases the probability of equal force distribution across the intact and prosthetic limbs during ambulation, thus decreasing the risk of osteoarthritis. People with limb loss commonly complain of back pain, which is linked to poor prosthetic fit and alignment, postural changes, leg-length discrepancy, amputation level, and general deconditioning. We review the literature on secondary complications among people with lower-limb loss who are long-term prosthesis wearers.
Hungerford and Cockin were the first authors to describe, with American and British World War II veterans, that people with amputation have a higher incidence of patellofemoral osteoarthritic degeneration on their intact limb than do people without amputation . They found that 22 percent of the veterans without amputation had significant patellofemoral osteoarthritis; this percentage increased to 41 percent among the veterans with transtibial amputation and 63 percent among the veterans with transfemoral amputation. Burke et al. found similar results and attributed gait asymmetry and an increased load on the intact limb to the higher incidence of osteoarthritis in the joints of long-term prosthesis users; 27 percent of the subjects with amputation had grades 1 through 3 osteoarthritis of their intact side knee; none had grade 4 osteoarthritis .
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Degenerative changes in the spine: Is this ..
Osteoarthrosis (OA) is a common degenerative joint disorder in which the cartilage is more or less destroyed and the structure of the underlying bone is affected. Sometimes it is accompanied by few symptoms, but usually OA causes suffering, changes in ability to work and a decreased quality of life. Changes in the joint can be seen on x ray, and an OA sufferer usually seeks medical care because of pain, which is present even at rest, and a diminished range of motion. In severe cases, the joint may become totally stiff, and even destroyed. Surgery to replace a destroyed joint and replace it with a prosthesis is well developed today.
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