Osteoarthritis of the knee is a common chronic degenerative osteoarthropathy, also known as proliferative knee osteoarthritis and age-related knee osteoarthritis. The clinical onset is most common in middle-aged and elderly people, with more women than men.
The etiology of this disease is not well understood, but is closely related to age, gender, occupation, metabolism, and injury. The pathological change is a joint lesion caused by degenerative changes in articular cartilage, mainly osteophytes, and the inflammation of synovial membrane is a secondary lesion.
Chinese medicine believes that this disease is caused by chronic strain, cold or minor trauma; secondly, it is caused by old age and weakness, liver and kidney deficiency, and lack of qi and blood.
Clinical manifestations
1. Slow onset, mostly seen in middle-aged and elderly obese women, often with a history of exertion.
2. The pain is aggravated by knee joint activities, characterized by paroxysmal pain at first, then persistent pain, more so at night with exertion, and obvious pain when going up and down stairs.
3. The knee joint activity is limited, or even limping. Very few patients may develop interlocking phenomenon or knee joint effusion.
4. There may be popping and grinding sounds when the joint moves, and some patients have swollen joints.
Signs and examinations
1. There is obvious pressure pain at the knee patella, and atrophy of the quadriceps muscle is visible.
2.X-ray film shows hyperplasia of the inner and outer condyles of the tibia and femur, intercondylar spine and calcification of the patellar ligament.
3.Patellar grinding test was positive.
4. Laboratory tests: normal blood and urine, normal blood sedimentation, negative anti-O and rheumatoid factor, non-inflammatory joint fluid.
Classification of symptoms
1.Qi deficiency and blood stasis: swelling and pain in the affected area, aggravated by movement, restricted function, fatigue and weakness, less energy, spontaneous sweating. Dark tongue with petechiae, weak pulse.
2, deficiency of qi and blood: deformity of the joint, heavy hidden pain, pale face, dizziness, weakness, spontaneous sweating, pale tongue, deficient pulse.
3, Yang deficiency and cold stagnation: old age and kidney deficiency, long illness and kidney injury, pale face, cold form and limbs, severe pain in the joints, increased pain when cold, inability to flex and extend, soreness and coldness in the waist and knees, pale tongue with white fur, sunken and weak pulse.
Diagnosis basis
1. History of repeated strain or trauma.
2, mostly in the middle-aged and elderly, symptoms are mostly gradually aggravated, can be suddenly aggravated by exertion, trauma. Exclude rheumatism, rheumatoid arthritis, severe trauma to the knee joint (such as fracture, meniscus injury, etc.), lower limb deformity and joint infection.
3. There are typical symptoms of knee pain with limited joint movement. Pain in going up and down stairs and pain in the knee in a semi-squatting position are aggravated.
4.There are the following typical signs: swelling of the knee joint, sometimes there is pressure pain or percussion pain in the medial and lateral joint space; joint activity popping and grinding sounds; joint contracture or quadriceps atrophy.
5, X-ray, can be seen bone joint edge hyperplasia, joint gap narrowing, ligament calcification, tibial intercondylar spine become sharp, sometimes visible osteoporosis.
Differential diagnosis
1, chondromalacia patellae: the greater the knee activity, the more obvious the pain, and there is hyperextension pain, walking weakness. There is pressure pain on the anterior, inferior, medial, lateral and N fossa of the knee. When the knee is extended with pressure on the patella, friction and pain can be palpated. Patellar grinding test is positive.
2. Lateral collateral ligament injury of the knee: there is fixed pressure pain at the site of ligament injury, often at the upper and lower attachment points of the ligament or in the middle. The knee joint is in a semi-flexed position, with limited movement of the joint. Positive lateral squeeze test.
3, knee meniscal injury: history of trauma, post-injury joint pain, swelling, popping and interlocking phenomenon, pressure pain in the internal and external space of the knee. In the chronic phase, the quadriceps muscle atrophy is especially obvious in the medial quadriceps. The McDonald’s sign and grinding test are positive.
4. Subpatellar fat pad injury: history of trauma, strain or cold in the knee. The pain of the knee joint, especially in stairs, is aggravated by knee hyperextension, the pressure pain of the infrapatellar fat pad is obvious, the knee hyperextension test is positive, the patellar tendon relaxation pressure pain test is positive. x-ray lateral knee film, the texture of the fat pad scaffold is thickened, and a few fat pad calcification shadows are visible.
Treatment
I. Tuina treatment (taking the right knee joint as an example)
(I) Basic techniques
1. The patient is placed in a supine position. The practitioner stands next to him and uses the palm roots of both hands to rub along the spleen and stomach meridians of the lower limb from top to bottom to the lower edge of the patella, repeatedly for 2 minutes. Afterwards, press the Liangqiu and Blood Sea with both thumbs at the same time, so that there is a local soreness and swelling.
2. The practitioner stands on the patient’s left side and uses multiple fingers to rub along the patella, repeatedly for 1 minute. Afterwards, push the patella to the right side with the left thumb, while the right thumb does a little pressing on the left edge of the patella, using the pain point as the main stimulation area, and repeatedly apply the surgery for 1 minute. And vice versa.
3. The physician holds the posterior side of the knee joint with both hands while pressing the inner and outer knee eyes with both thumbs, flexing and extending the knee joint while doing so, repeatedly for 1 minute.
4. The patient is placed in a prone position, and the doctor uses both hands to do multi-finger kneading along the posterior side of the lower extremity from the transverse gluteal crease to the gastrocnemius muscle, focusing on the knee N fossa, repeatedly for about 2 minutes.
5. Standing on the right side of the patient, the doctor uses the right thumb to knead the central or yingu, while holding the patient’s ankle joint with the left hand to do the grinding method, repeatedly for 1 minute. Subsequently, the right thumb and index finger knead the semimembranosus and semitendinosus muscles, and repeat the operation for about 1 minute.
6.The doctor presses Kunlun and Taixi with the left thumb and index finger, while rubbing the knee N fossa and gastrocnemius muscle with the palm of the right hand, repeatedly applying the operation to flush.
7. The patient is placed in the healthy side position. The practitioner stands and then uses both hands to rub along the bile and stomach meridians (equivalent to the quadriceps region) from top to bottom, repeatedly for 1 minute.
8. The practitioner uses the left thumb to press the ring jump and the right thumb to press the Yanglingquan, while doing knee flexion and extension exercises, repeatedly for 1 minute.
(II) Addition and reduction
1.Qi deficiency and blood stasis
Point and press Heteng and Qi Chong, each point for about 1 minute.
2, deficiency of qi and blood
Tap and press the points of Fu Hare, Yin Ling Quan, Foot San Li and San Yin Jiao, each for about 1 minute.
3, Yang deficiency and cold condensation
Tap and rub Yongquan and Qi Chong, each point for about 1 minute.
Physical therapy
Chinese medicine ion introduction. It has the effect of relieving muscle spasm, improving blood circulation, reducing swelling, anti-inflammation and analgesia.
C. Fumigation
Take the herb of Stretching the tendons, the herb of Bones, the bark of Haitong, the bark of Wujia, and Sichuan pepper, and fumigate the knee with water for 30 minutes each time, twice a day, for 10 days as a course of treatment.
IV. Acupuncture
Acupuncture points are taken from the inner and outer knee eyes, Yanglingquan, Yinlingquan, Heting, Liangqiu, Blood Sea, and Foot Sanli. Take acupuncture points according to the symptoms, flatly tonic and flatly diarrheal.
V. Closure
If the pain is severe, inject 0.5-1 ml of prednisolone acetate plus 1-2 ml of 2% lidocaine into the knee joint cavity once every 1-2 weeks, 2-3 times in total.
VI. Drug treatment
(A) Topical medication
Topical rubs and adhesive pain relief creams, such as Furtalin emulsion, Qizheng pain relief paste, etc.; if the pain is more severe, local closure can be done.
If the swelling of the knee joint is obvious, apply external Chinese medicine, Jianbuhu Qianwan or Douduwan, etc., and fix it with bandages under pressure.
(B) Internal medicine
Take Danggui Chicken Blood Vine Soup, Sifu Pain Relief Soup with addition or subtraction, or use Xiaohuoluo Pill, Bone Spur Tablet, Bone Growth Pill, Jianbu Hu Qian Wan, etc. to activate blood and warm the menstruation to relieve pain.
If the pain is obvious, you can take drugs such as fenbid, quick pain, futalin tablets and anti-inflammatory pain. It is not advisable to take hormonal drugs.
Prevention and care
1. Rest should be given for severe knee swelling and pain.
2. Take the initiative to strengthen the quadriceps exercise to improve quadriceps muscle strength.
3. Avoid overload activities and labor to reduce the burden on the knee joint.
4. Obese patients should moderate their appetite, which is an effective measure to reduce the involvement of the knee joint.
Indications for hospital admission
1. Swelling of the joint, pain and difficulty in taking care of oneself.
2, long-term joint lesions, conventional manipulation is not effective, adapted to physical therapy or other treatment.
Efficacy criteria
Cured: Knee pain and swelling disappeared, knee joint function freely.
Improvement: most of the knee pain and signs disappeared, and the knee function improved.
Ineffective: No improvement of symptoms.
Discharge criteria
1.Knee pain and swelling are significantly reduced.
2. Basic recovery of functional activities and self-care.
Clinical evaluation index】 Cure rate>62% Improvement rate>35% Failure rate<3% Death rate0