Is Arthritis causing havoc on your golf game?

Overview: 

Osteoarthritis is the most common rheumatic disease, a chronic systemic inflammatory disease characterized by joint destruction.  Up to 80% of patients have some limitation of their activities and 25% are unable to perform their usual daily activities.  By the age of 40, more than 90% of general population have radiographic changes of osteoarthritis in weight-bearing joints.  Although it's often called, "the wear and tear" disease, current understanding depicts it as a combination of mechanical and biochemical processes. 

Mechanical - cartilage injury after impact loading
Biochemical - failure to repair to compensate for the injury

What are the clinical Signs and Symptoms?

  • stiffness with initial use (seldomly longer than 15 min)
  • pain on movement of weight bearing joint and relieved by rest
  • joint margent tenderness
  • enlargement of joint (osteophytes, bone spurs - proliferation of cartilage and bone)
  • fine crepitus
  • deformity (late sequela of osteoarthritis)
  • joint effusion usually mild
  • laboratory result NO elevation ESR or other infammation signs

What is my Severity?

Severity of your condition depends on variable factors: radiographic finding, clinical signs and symptoms, comorbidity.  But one way to objectively categorize current disease progression is through the conventional radiograph grading:

  • grade 0: normal
  • grade 1: possible joint space narrowing and subtle osteophytes
  • grade 2: definite joint space narrowing, defined osteophytes and some sclerosis, especially in acetabular region
  • grade 3: marked joint space narrowing, small osteophytes, some sclerosis and cyst formation and deformity of femoral head and acetabulum
  • grade 4: gross loss of joint space with above features plus large osteophytes and increased deformity of the femoral head and acetabulum

Which joints are mostly affected?

Distal interphalangeal joints, proximal interphalangeal joints (finger), hips, knees, spine.  It's seen as well in the shoulders, elbows, ankles.

What are my initial Treatment options?

The goals are to relieve pain, preserve joint range of motion and function, and prevent further injury.  Analgesics such as acetaminophen are first choice.  Weight loss to decrease unnecessary force on the weight-bearing joints.  Physical therapy (isometric or isotonic exercises) and muscle strengthening to provide support around the joint, because your kinetic chain has changed due to the body's natural modification to avoid the pain.  But the kinetic chain change can create more pain down the road because of small imperfections in biomechanic along the way. 

If there is symptomatic effusion or signs of intra-articular fluid infammation (synovitis), corticosteroids injections can offer temporary relief.  In some patients with knee osteoarthritis, hyaluronic acid (Synvisc) injections may benefit.  

 

Dr. David Carfagno is a Board Certified Internist and Sports Physician, who trained at the Cleveland Clinic Foundation

Tri-Quoc Pham M.A. is ACSM Certified Personal Trainer and a 4th year medical student at Arizona College of Osteopathic Medicine

 

Altman R, Alarcón G, Appelrouth D, et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum 1991; 34:505.

Rosenberg ZS, Shankman S, Steiner GC, et al. Rapid destructive osteoarthritis: clinical, radiographic, and pathologic features. Radiology 1992; 182:213.

Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Arthritis Rheum 2000; 43:1905.