Osteoarthritis is the most common type of joint disease and involves degenerative changes at synovial joints in the body. It's a challenging condition to treat and is becoming an economic burden to the health care systems in many countries. In the U.S., for example, the number of adults with arthritis is projected to increase from 42.7 million in 2002 to around 65 million in 2030, due to the aging population.¹

Synovial joints are the ones affected in osteoarthritis. Within the synovial joint are the articulating bones, articular cartilage, a fibrous joint capsule and synovial membrane, synovial fluid, and joint cavity. These structures work together to create smooth gliding movement where adjacent bones contact each other. Maintaining this surface is especially important in the weight-bearing joints, such as the hip or knee, as excessive compressive stress can lead to bone degeneration.

Osteoarthritis is divided into two categories: primary and secondary. Primary osteoarthritis develops gradually from excessive wear on the joints, but the specific factors that lead to the condition are not well understood. Repetitive stress to the joints of the hips, knees and hands in certain occupations could play a role in creating the problem for some clients.

Secondary osteoarthritis develops as the result of some other disease or pathological condition. Traumatic injury to the joint can initiate joint damage that leads to cartilage degeneration. In other cases, surgery, obesity or various activities are directly related to the condition's onset. The condition is prevalent in soccer players due to impact trauma, and in weight lifters because of their increased body weight.^2,3 Greater weight and joint degeneration also can increase the likelihood of lower extremity postural distortions, such as genu varum (bow leg) and genu valgum (knock-knee). Both of these distortions lead to more joint wear and increased chance of developing osteoarthritis.

In some cases, inflammation from osteoarthritis stimulates bone spurs to form around the joints, causing further pain and dysfunction. The spurs are common in the interphalangeal joints of the fingers. They are called Heberden's nodes when they develop at the distal interphalangeal joints and Bouchard's nodes at the proximal interphalangeal joint.⁴ Spurs that develop from spinal osteoarthritis (also called spondylitis) can press on adjacent nerve roots and mimic intervertebral disc herniation.⁴

Osteoarthritis produces pain in the joints that is aggravated with movement. Due to continual use, pain usually is worse later in the day. Joint swelling might increase with activity. Pain sometimes arises from long periods of immobility or even from changes in weather, although the association between weather and arthritis symptoms still is not clear.⁵ Unlike systemic forms of arthritis, such as rheumatoid arthritis, there are no effects to organs or other remote tissues. The tissue damage is confined to the surfaces of the affected joints, although pain can be referred to other locations.

Osteoarthritis typically affects the fingers, spine, hips and knees. While it periodically occurs in other joints, it is not common in the shoulder, elbow, wrist or ankle. It does appear to have a hereditary pattern, but a direct congenital cause of osteoarthritis has not been established. There is a greater incidence in younger males and females over 45 years of age.⁶ Pain usually is worse in the later part of the day, and the client also might complain of swelling, heat, and crepitus in the joint. Reports of aggravated pain with changes in the weather are common. The client also might report an increase in symptoms as a result of long periods of immobility, especially if the condition is more advanced. Joint swelling is evident in many cases, but absence of visible swelling does not indicate absence of the condition.

Characteristics in Physical Examination

The affected joints might be tender to palpation due to increased swelling in the area. Tenderness is more common if the condition is advanced or if palpation presses the affected joint surfaces together. Bone spurs, if present, can sometimes be felt around the affected joint, especially in the fingers.

Active and passive motions can cause pain in any direction the joint is moved. However, pain can fluctuate with the time of day or the degree of aggravation of the joint. If the affected joint is a weight-bearing joint, pain is worse when active movement is performed while bearing weight. Edema, muscle spasm or bone spurs could all prematurely limit the available range of movement. The end feel for joint motions tends to be a bit leathery and a capsular pattern of restriction typically is evident. In some cases, pain and weakness is evident during resisted motions.

A Role for Massage

While cartilage degeneration cannot be reversed, massage and stretching can be used to reduce muscle spasm and decrease compressive forces associated with the joint disorder. These approaches also are helpful in reducing edema resulting from inflammation. Avoiding activities that increase joint irritation, compression or inflammation is important. Weight reduction, rest, supportive braces and some exercise can be helpful, especially for osteoarthritis in the weight-bearing joints. If osteoarthritis is suspected, it's advisable to have it confirmed by a physician through X-ray. It also would be helpful to consult further with the physician for the most appropriate role for massage in the treatment process.

References

1. Bolen J, Sniezek J, Theis K, et al. Racial/ethnic differences in the prevalence and impact of doctor-diagnosed arthritis - United States, 2002. MMWR 2005;54(05):119-123.
2. Kujala UM, Kettunen J, Paananen H, et al. Knee osteoarthritis in former runners, soccer players, weight lifters, and shooters. Arthritis Rheum, Apr 1995;38(4):539-546.
3. Drawer S, Fuller CW. Propensity for osteoarthritis and lower limb joint pain in retired professional soccer players. Br J Sports Med, Dec 2001;35(6):402-408.
4. Stacy G, Basu AP. "Osteoarthritis, Primary." eMedicine, Nov. 4, 2005. Available at: www.emedicine.com. Accessed March 31, 2006.
5. Aikman H. The association between arthritis and the weather. Int J Biometeorol, Jun 1997;40(4):192-199.
6. Stitik TP, Foye P. "Osteoarthritis." eMedicine, April 8, 2005. Available at: www.emedicine.com. Accessed March 30, 2006.