OSTEOARTHRITIS GENU

Gutama Arya Pringga, dr.

 DATABASE (8th November 2016)
Identity
Name : Mrs. NF
 Sex : Female
 Age : 57 years old
 Address : Surabaya
 Occupation : Coffee seller
 Religion : Moslem
 Marital status : Married
Ethnic : Javanese

Referred by Orthopedic Outpatient Clinic with OA

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Genu Dextra
Chief Complaint : Nyeri pada lutut kanan

History of Present Illness :

 She felt pain at right knee since one and half month ago after walked in
long distance. Pain was felt like ‘kemeng’’and didn’t radiated. VAS was
3-4 . Pain occurred especially when changed position at rest and from
sitting to standing and sometimes when walked up and walk down the
stairs.
 She also felt stiffness for about 30 minutes at the morning.
 She had difficulty in toilet use and sholat in flexed knee position.
 Knee swelling, numbness, and tingling sensation were denied.

History of Activity
 She was coffee seller for about 2 years. Her coffee shop opened for 12
hours/day and she stood up for about half of time the coffee shop
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opened.
 History of Past Illness
 Hypertension (-)
 Cardiac disease (-)
 Diabetic Mellitus (-)
 Trauma (-)

History of Medication
 Paracetemol 3x 500 mg (prn pain), Calcium lactate, vit B complex
2x1 (orthopedic outpatient clinic)

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 Physical Examination
General Status
Compos mentis, independent ambulation, normal gait, right handed
domination.

Weight: 75 kg; Height : 152 cm; BMI : 32,46 kg/cm2

RR : 18 x/minute BP : 110/70 HR : 84 x/minute

Head and neck : anemi -, jaundice -, cyanosis -, oedema –

Chest : heart : S1S2 single, murmur -, gallop -
lung : rh-/-, wh-/-
Abdomen : soefl, hepar and lien unpalpable
Extremities : warm -/-
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 Musculoskeletal Status

NECK ROM MMT

Flexion F (0-450) 5
Extension F (0-450) 5
Lateral bending F/F (0-450) 5/5
Rotation F/F (0-600) 5/5

TRUNK ROM MMT

Flexion F (0-800) 5
Extension F (0-300) 5
Lateral bending F/F (0-350) 5/5
Rotation F/F (0-450) 5/5

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 SHOULDER ROM MMT
Flexion F/F (0-1800) 5/5
Extension F/F (0-600) 5/5
Abduction F/F (0-1800) 5/5
Adduction F/F (0-450) 5/5
Internal rotation F/F (0-700) 5/5
External rotation F/F (0-900) 5/5

ELBOW ROM MMT

Flexion F/F (0-1500) 5/5

Extension F/F (1500-0) 5/5

Supination F/F (0-900) 5/5

Pronation F/F (0-900) 5/5

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WRIST ROM MMT

Flexion F/F (0-800) 5/5

Extension F/F (0-700) 5/5

Ulnar deviation F/F (0-300) 5/5

Radial deviation F/F (0-200) 5/5

THUMB ROM MMT

Flexion
MCP F/F (0-900) 5/5
IP F/F (0-800) 5/5
Extension F/F (0-300) 5/5
Abduction F/F (0-700) 5/5
Adduction F/F (700-0) 5/5
Opposition F/F 5/5

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 FINGERS ROM MMT
Flexion
MCP F/F (0-900) 5/5
PIP F/F (0-1000) 5/5
DIP F/F (0-900) 5/5
Extension F/F (0-300) 5/5
Abduction F/F (0-200) 5/5
Adduction F/F (200-0) 5/5
Opposition F/F 5/5

HIP ROM MMT

Flexion F/F (0-1200) 5/5
Extension F/F (0-300) 5/5
Abduction F/F (0-450) 5/5
Adduction F/F (0-300) 5/5
Internal rotation F/F (0-450) 5/5
External rotation F/F (0-350) 5/5
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 KNEE ROM MMT

Flexion F/F (0-1350) 5/5

Extension F/F (1350-0) 5/5

ANKLE ROM MMT

Dorsoflexion F/F (0-200) 5/5

Plantarflexion F/F (0-500) 5/5

Inversion F/F (0-350) 5/5

Eversion F/F (0-150) 5/5

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 BIG TOE ROM MMT

Flexion

MTP F/F (0-300) 5/5

IP F/F (0-500) 5/5

Extension F/F (0-800) 5/5

TOES ROM MMT

Flexion

MTP F/F (0-250) 5/5

IP F/F (0-250) 5/5

Extension F/F (0-800) 5/5

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 Neurological Examination
N. Cranialis I –XII : Normal
Physiological Reflex :
BPR +2/+2 KPR +2/+2
TPR +2/+2 APR+2/+2
Pathological Reflex : Babinski -/-, HT -/-
Sensory deficit : -/-

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 Locally Status Region of Knee
Inspection :
 Redness -/-
 Swelling -/-
 Deformity -/-

Palpation :
Tender point + (area MTP) /-
Warmth -/-
Crepitation +/+
Atrofi VMO +/-

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 Barthel Index : 100 (Independent)
WOMAC Score : 17,7 %

Circumference
MTP : 36/36 cm
Below 10 cm : 42/42 cm
Above 10 cm : 48/49 cm

Q angle
Weightbearing : 15°/15° valgus
Non weightbearing : 10°/10° valgus

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 Special Test
 Patellar Griding Test : +/+
 Anterior Drawer Test : -/-
 Posterior Drawer Test : -/-
 Lachman : -/-
 Valgus Stress Test : -/-
 Varus Stress Test : -/-
 Compression Test : -/-
 Distraction Test : -/-
 Mc. Murray : -/-

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 Additional Examination

X-ray Genu D AP/Lat (2/11/2016)

16 Osteoarthritis Femorotibial Joint Kanan Grade 1-2
Osteoarthritis Femoropatellar Joint Kanan Grade 1
 PROBLEM LIST
Medical : Osteoarthritis Genu Dextra Grade I +
Obesity
Surgical : -
Rehabilitation :
R1 (Mobilisation) : difficulty in walked up/down the stair
R2(ADL) : difficulty in toilet use and sholat in flexed
knee position because of pain
R3 (Communication) : -
R4 ( Psychologis) : Worried about her disease
R5 ( Social Economi): -
R6 ( Vocasional) :-
R7 (others) : - Pain at right knee (VAS 3-4)
- Tender point at right knee (MTP)
- Crepitation both of knee
- Atrophy right VMO
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- Obesity
 DIAGNOSIS
Medical : Osteoarthritis Genu Dextra Grade I + Obesity
Rehabilitation :
Impairment : - Pain at right knee (VAS 3-4)
- Tender point at right knee (MTP)
- Crepitation both of knee
- Atrophy right VMO
- Obesity
Disability : difficulty in toilet use, sholat in flexed knee
position,and walked up and down the stairs because
of pain
Handicap :-
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 PLANNING
Surgical :-
Medical :-
Rehabilitation Medicine :
P. Dx : Consult to nutritionist
P. Tx : Physioteraphy
Modality : - SWD 27,12 MHz contraplanar, intensity
suitable with patient’s tolerance, 20-30
minutes
- Isotonic quadriceps strengthening with Q bench
P. Mx : clinically, VAS
P. Ex : Health Education, Home Exercise Programe 
tell patient about her condition, icing if pain, quadriceps
strengthening exercise at home, genu joint conservation, and
body weight reduction.
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 SUMMARY
A female 57 yo referred from Orthopedic Outpatient Clinic with OA
Genu Dextra
She felt pain at right knee since one and half month ago. Pain was felt
like ‘kemeng’’and didn’t radiated. VAS was 3-4. Pain occurred especially
when changed position at rest and from sitting to standing and sometimes
when walked up and walk down the stairs. She had difficulty in toilet use
and sholat in flexed knee position. She also felt stiffness for about 30
minutes at the morning. Physical examination revealed tender point at right
MTP, knee crepitation, atrofi right VMO, and positive patelar grinding test.
From X ray examination, we found osteoarthritis femurotibial and
femuropatellar joint dextra grade 1.
We diagnosed the patient with OA Genu Dextra Grade I + Obesity.
Our planning therapy were SWD and isotonic quadriceps strengthening. We
planned to monitor clinical sign and symptomps and VAS. We educated the
patient about her condition, icing if pain, quadriceps strengthening exercise
at home, genu joint conservation, and body weight reduction.

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 TERIMA KASIH

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