Fisioterapia y osteoartritis: una revisión histórica de las técnicas utilizadas en el pasado y su relevancia actual / Physiotherapy and osteoarthritis: a historical review of techniques used in the past and their current relevance

Objetivo principal: El propósito de esta revisión ha sido proveer una visión histórica de las técnicas de fisioterapia empleadas en el pasado y su relevancia actual en el tratamiento de la Osteoartritis (OA). Metodología: Se realizó una búsqueda exhaustiva en bases de datos y análisis de la literatura. Se incluyeron artículos que abordaran el tratamiento de la OA en fisioterapia desde la Historia Antigua hasta la actualidad. Resultados principales: Se seleccionaron 34 publicaciones que abordaron el tratamiento de la OA en diferentes períodos históricos. Las técnicas identificadas fueron desde tratamientos a base de ungüentos hasta enfoques actuales como la hidroterapia y la electroterapia. Conclusión principal: El abordaje fisioterapéutico de la OA ha evolucionado a lo largo de la historia con el empleo de diversas técnicas y agentes físicos. Desde el siglo XIX las técnicas empleadas lograron un avance científico y terapéutico valioso para esta afección (AU)

Objective: The purpose of this review has been to provide a historical perspective on the physiotherapy techniques used in the past and their current relevance in the treatment of Osteoarthritis (OA). Methods: A comprehensive search of databases and literature analysis was conducted. Articles addressing the treatment of OA in physiotherapy from Ancient History to the present were included. Results: 34 publications addressing the treatment of OA in different historical periods were selected. The identified techniques ranged from ointment-based treatments to current approaches such as hydrotherapy and electrotherapy. Conclusions: The physiotherapeutic approach to OA has evolved throughout history, utilizing various techniques and physical agents. Since the 19th century, the employed techniques have achieved valuable scientific and therapeutic advancements for this condition (AU)

Osteoarthritis in past human populations from Radom (14th-17th and 18th-19th century).

Osteoarthritis (OA) is a widespread skeletal condition in the historical population, but it still raises many methodological and interpretative problems. The present study aimed to examine the osteoarthritic changes (osteophytes, porosity, eburnation) in the skeletal material from Radom (14th-19th century) (Poland), enriching knowledge about osteoarthritis and its prevalence in the past. Additionally, a comparison of OA changes prevalence in two chronological periods (the population from Radom during the 14th-17th century versus the 18th-19th century) was done. In the Late Medieval (14th-17th century) population from Radom, osteoarthritic changes were observed in 22% of individuals (males, 18%; females, 29%) and in the Modern Period Radom (18th-19th century) in 25% individuals (males, 25.7%; females, 26.5%). In both skeletal samples, the greatest number of OA changes was recorded in the hip and elbow. Knee and ankle were the least affected joints. Osteophytes were the most frequently observed type of lesions, while eburnation was the least frequent. Although the higher prevalence of osteoarthritis in the Modern Period in Radom is noted, the differences are not statistically significant. Taking the multifactorial etiology of osteoarthritic changes, and the fact that osteoarthritis, as a single indicator of health, could not tell much about the overall lifestyle of past human populations, one must be caution when drawing unambiguous conclusions according to the simple, linear effect of environmental changes on osteoarthritic changes formation.

Arthritis in the hands of saints shown in 15th century Venetian altarpieces by Bartolomeo Vivarini.

Bartolomeo Vivarini (1432-1499) was the most prolific member of a prominent 15th-century Venetian family of artists who specialised in religious art, particularly altarpieces. Unlike their Florentine counterparts, Venetian artists of this period were typically more concerned with decorative effects than with accuracy of description, so their paintings often lacked detailed anatomical information. Bartolomeo, however, began the move toward anatomical realism in the Vivarini family. Two pictures of saints from his altarpieces are presented here to illustrate his depiction of arthritic hand deformities. The hands of Saint Louis of Toulouse (painted c. 1465-7), a young man who died in his 20s, show signs of inflammatory arthritis, while the effects of degenerative osteoarthritis can be seen in the hands of Saint Mark (painted c. 1470), who is portrayed as a man in late middle age. These observations extend the findings of previous studies of Florentine altarpieces from the same period, as well as more general studies of deformed extremities in Italian, Flemish and French Renaissance paintings. They also support the broader proposition that when 15th-century Venetian painters began to embrace anatomical realism they were capable of providing sufficient detail to enable pathological deformities in their figures to be identified.

Multiple occurrence of premature polyarticular osteoarthritis in an early medieval Bohemian cemetery (Prague, Czech Republic).

OBJECTIVES: To highlight conditions that may cause early-onset degenerative joint disease, and to assess the possible impact of such diseases upon everyday life. MATERIAL: Four adults aged under 50 years from a medieval skeletal collection of Prague (Czechia). METHODS: Visual, osteometric, X-ray, and histological examinations, stable isotope analysis of bone collagen. RESULTS: All four individuals showed multiple symmetrical degenerative changes, affecting the majority of joints of the postcranial skeleton. Associated dysplastic deformities were observed in all individuals, including bilateral hip dysplasia (n = 1), flattening of the femoral condyles (n = 3), and substantial deformation of the elbows (n = 3). The diet of the affected individuals differed from the contemporary population sample. CONCLUSIONS: We propose the diagnosis of a mild form of skeletal dysplasia in these four individuals, with multiple epiphyseal dysplasia or type-II collagenopathy linked to premature osteoarthritis as the most probable causes. SIGNIFICANCE: Combining the skeletal findings with information from the medical literature, this paper defines several characteristic traits which may assist with the diagnosis of skeletal dysplasia in the archaeological record. LIMITATIONS: As no genetic analysis was performed to confirm the possible kinship of the individuals, it is not possible to definitively assess whether the individuals suffered from the same hereditary condition or from different forms of skeletal dysplasia. SUGGESTIONS FOR FURTHER RESEARCH: Further studies on premature osteoarthritis in archaeological skeletal series are needed to correct the underrepresentation of these mild forms of dysplasia in past populations.

Relationships between osteoarthritic changes (osteophytes, porosity, eburnation) based on historical skeletal material.

Background: Three main diagnostic types of osteoarthritic changes are distinguished in clinical and anthropological literature: osteophytes, porosity, and eburnation. The nature of the relationship between these changes and how lesions progress over time is still unclear.Aim: The aim of the present study is the analysis of the relationships between osteophytes, porosity, and eburnation based on skeletal material.Subjects and methods: The analysis employed the skeletal collection from Cedynia (199 individuals) from tenth to fourteenth-century Poland. Marginal osteophytes (OP), porosity (POR), and eburnation (EB) were examined on a shoulder, elbow, wrist, hip, knee, and ankle.Results: Osteophytes and porosity occurred independently of each other. Combinations of osteophytes and porosity (OP + POR) and osteophytes, porosity, and eburnation (OP + POR + EB) were rarely observed. Combinations of osteophytes and eburnation (OP + EB) or porosity and eburnation (POR + EB) were not found. There was a significant correlation between osteophytes and porosity in the scapula, proximal end of the ulna and proximal end of the femur. Osteophytes and eburnation were correlated at the distal end of the ulna. Porosity and eburnation were correlated at the distal end of the radius and distal end of the ulna. When all joints were considered together, all the types of osteoarthritic changes were correlated. However, the relationship between osteophytes and eburnation and between porosity and eburnation was only slightly significant. Osteophytes preceded porosity, but there were a few cases where more developed porosity accompanied less developed osteophytes.Conclusions: The findings indicate that correlations between osteoarthritic changes are weak, albeit statistically significant and further studies of the relationship between changes are necessary.

Osteoarthritis, entheses, and long bone cross-sectional geometry in the Andes: Usage, history, and future directions.

Akin to approaches encouraged by Verano (1997) in the Andes, and Ortner (2011, 2012) for general paleopathological studies, this article focuses on accurate descriptions and definitions of osteoarthritis, entheses, and long bone cross-sectional geometry. By evaluating these conditions as part of biological responses to abnormal skeletal changes and biomechanical stress, this research discusses each condition's pathogenesis. Further, this article emphasizes a "small data" approach to evaluating these conditions in ancient culturally and biologically related human populations, where the study samples must have good skeletal preservation, where estimates of age and sex need to be included as major factors, and where abnormalities need to be described and evaluated. This article also discusses global clinical and osteological research on ways scholars are currently trying to establish industry-wide methods to evaluate osteoarthritis, entheses, and long bone cross-sectional geometry. Recent studies have focused on rigorous evaluation of methodological techniques, recording protocols, and inter- and intra-observer error problems. Additionally, scholars have focused on physical intensity of movement using biomechanics, evaluated burials of known occupation, and used complex statistical methods to help interpret skeletal changes associated with these conditions. This article also narrows to focus on these conditions within thematic "small data" areas throughout the Andes. This research concludes with describing future directions to understand skeletal changes, such as more multidisciplinary studies between osteologists and pathologists, collaborations with living people to collect CT, x-rays, or computer-aided motion capture, and a stronger focus on how these conditions correlate with intense biomechanical changes in younger individuals.

A case of erosive polyarthropathy from Medieval northern Italy (12th-13th centuries).

OBJECTIVE: To evaluate and differentially diagnose erosive skeletal lesions located on multiple joints of an individual archaeologically recovered in 2017. MATERIALS: Skeletal remains of a well-preserved skeleton dating to the 12th-13th centuries from the medieval church of San Biagio in Cittiglio (Varese, northern Italy). METHODS: Macroscopic and radiographic imaging. RESULTS: Erosive marginal symmetrical lesions are present on the metatarsophalangeal, metacarpophalangeal and interphalangeal joints of an adult male, aged 55-75 years. Osteolytic changes, in the form of pocket erosions, surface resorptions and pseudocyst formations, are also macroscopically observed on some carpal and tarsal bones and on several large peripheral joints. CONCLUSIONS: A careful differential diagnosis of the lesions and their macroscopic and radiological appearance is suggestive of a case of rheumatoid arthritis-like polyarthropathy. SIGNIFICANCE: This case contributes to the debate regarding the antiquity of erosive polyarthropathies, providing additional evidence for the existence of these diseases in the Old World prior to the European discovery of the Americas. LIMITATIONS: Small sample size limits discussion of the scope of the disease in antiquity. SUGGESTIONS FOR FURTHER RESEARCH: This case highlights the need for further macroscopic, radiographic, and biomolecular studies of pre-modern European skeletal samples to investigate the hypothesized pre-existence of these pathological conditions in Europe prior to 1492.

Defining the osteoarthritis patient: back to the future.

The history of osteoarthritis (OA) is important because it can help broaden our perspective on past and present controversies. The naming of OA, beginning with Heberden's nodes, is itself a fascinating story. According to Albert Hoffa, R. Llewellyn Jones and Archibald Edward Garrod, the name OA was introduced in the mid-nineteenth century by surgeon Richard von Volkmann who distinguished it from rheumatoid arthritis and gout. Others preferred the terms 'chronical rheumatism', 'senile arthritis', 'hypertrophic arthritis' or 'arthritis deformans'. A similar narrative applies to the concept of OA affecting the whole joint vs the 'wear-and-tear' hypothesis, inflammation and the role of the central nervous system (CNS). In the late nineteenth and early twentieth centuries, the Garrods (father and son) and Hermann Senator argued that OA was a whole joint disease, and that inflammation played a major role in its progression. Garrod Jnr and John Spender also linked OA to a neurogenic lesion 'outside the joint'. The remaining twentieth century was no less dynamic, with major advances in basic science, diagnostics, treatments, surgical interventions and technologies. Today, OA is characterized as a multi-disease with inflammation, immune and CNS dysfunction playing central roles in whole joint damage, injury progression, pain and disability. In the current 'omics' era (genomics, proteomics and metabolomics), we owe a great debt to past physicians and surgeons who dared to think 'outside-the-box' to explain and treat OA. Over 130 years later, despite these developments, we still don't fully understand the underlying complexities of OA, and we still don't have a cure.

Historical Prevalence of Radiological Appendicular Osteoarthritis in Cats (1972-1973).

Interest in feline osteoarthritis has grown recently; this might be due to increased prevalence or increased awareness. This study records the presence of appendicular osteoarthritis in a subset of the United Kingdom cat population in the 1970s and estimates its prevalence. One hundred cats euthanized in 1972-1973 had a series of skeletal radiographic images taken post mortem. Each joint was put into a set with or without osteoarthritis according to the presence or absence of a specified set of radiographic features. Limited historical data were analyzed. The prevalence of osteoarthritis in these cats was 74%. There is no evidence that feline osteoarthritis is a "novel" disease. The prevalence was similar to recent prospective radiological surveys. Recent interest in the condition may have derived from more attention being paid to feline medicine and welfare.

The relationship of age, activity, and body size on osteoarthritis in weight-bearing skeletal regions.

This study examined the simultaneous impact of multiple underlying factors on OA expression in weight-bearing joints of the vertebrae and lower limb of a modern European skeletal sample (Lisbon and Sassari). OA was evaluated using standard ranked categorical scoring; composite OA scores derived through principal component analysis. Body size was calculated from postcranial measurements; torsional strength (J) of the femoral midshaft was calculated from three-dimensional surface models, size standardized and used as a proxy for activity. A standard multiple regression was applied. In all regions, the linear combination of age, body mass, stature, and J was significantly related to differences in OA. Across all joints, age was the strongest predictor; neither body size, nor activity variables demonstrated a statistical relationship with OA at the lumbar or knee; J demonstrated a negative correlation with pelvic OA. Variation in OA can be explained by age, stature, body mass, and structural adaptation related to habitual use. The negative correlation between femoral torsional strength with OA suggests that long-term, repetitive physical work capacity in childhood may be protective against OA development later in life. The multifactorial aetiology of OA requires incorporating multiple lines of evidence to interpret individual or population health from bone samples.

Exploring sex differences in diets and activity patterns through dental and skeletal studies in populations from ancient Corinth, Greece.

Sex and temporal differences are assessed in relation to dietary habits and activity patterns in three ancient populations from Corinth, Greece. The skeletal sample spans time from the Geometric to the Early Byzantine Period (9th c. BCE-5th c. CE). Dental caries and tooth wear have been proven to be reliable dietary indicators. Similarly, spinal osteoarthritis, spinal facet remodeling and Schmorl's nodes, have been used to infer activity patterns.

From art to science: the functional damage due to thumb osteoarthritis finely described by Velazquez 300 years before its clinical description.

Velazquez showed to know the entity of thumb osteoarthritis by finely describing it in one of his paintings. The concepts of anatomical damage, loss of strenght, and functional impairment are transmitted to the observer.

Resource intensification and osteoarthritis patterns: changes in activity in the prehistoric Sacramento-San Joaquin Delta region.

OBJECTIVES: Ethnohistoric accounts and archaeological research from Central California document a shift from the use of lower-cost, high-ranked resources (e.g., large game) toward the greater use of higher-cost, low-ranked resources (e.g., acorns and small seeds) during the Late Holocene (4500-200 BP). The subsistence transition from higher consumption of large game toward an increased reliance on acorns was likely associated with increases in levels of logistical mobility and physical activity. This study predicts that mobility and overall workload patterns changed during this transition to accommodate new food procurement strategies and incorporate new dietary resources during the Late Holocene in Central California. MATERIALS AND METHODS: Osteoarthritis prevalence was scored in the shoulder, elbow, hip, and knee of adult individuals (n = 256) from seven archaeological sites in the Sacramento-San Joaquin Delta region. Comparisons were made between osteoarthritis prevalence, sex, age-at-death, and time period using ANCOVAs. RESULTS: The results of this study indicate significant increases in osteoarthritis prevalence in the hip of adult males and females during the Late Period (1200-200 BP), even after correcting for the cumulative effects of age. No differences were observed between the sexes or between time periods for the shoulder, elbow, and knee joints. DISCUSSION: The temporal increase in hip osteoarthritis supports the hypothesis that there was an increasing need for greater logistical mobility over time to procure key resources away from the village sites. Additionally, the lack of sex differences in osteoarthritis prevalence may suggest that females and males likely performed similar levels of activity during these periods.

Osteoarthritis, labour division, and occupational specialization of the Late Shang China - insights from Yinxu (ca. 1250 - 1046 B.C.).

This research investigates the prevalence of human osteoarthritis at Yinxu, the last capital of the Late Shang dynasty (ca. 1250-1046 B.C.), to gain insights about lifeways of early urban populations in ancient China. A total of 167 skeletal remains from two sites (Xiaomintun and Xin'anzhuang) were analyzed to examine osteoarthritis at eight appendicular joints and through three spinal osseous indicators. High osteoarthritis frequencies were found in the remains with males showing significantly higher osteoarthritis on the upper body (compared to that of the females). This distinctive pattern becomes more obvious for males from Xiaomintun. Furthermore, Xiaomintun people showed significantly higher osteoarthritis in both sexes than those from Xin'anzhuang. Higher upper body osteoarthritis is speculated to be caused by repetitive lifting and carrying heavy-weight objects, disproportionately adding more stress and thus more osseous changes to the upper than the lower body. Such lifting-carrying could be derived from intensified physical activities in general and specialized occupations in particular. Higher osteoarthritis in males may reveal a gendered division of labour, with higher osteoarthritis in Xiaomintun strongly indicating an occupational difference between the two sites. The latter speculation can be supported by the recovery of substantially more bronze-casting artifacts in Xiaomintun. It is also intriguing that relatively higher osteoarthritis was noticed in Xiaomintun females, which seems to suggest that those women might have also participated in bronze-casting activities as a "family business." Such a family-involved occupation, if it existed, may have contributed to establishment of occupation-oriented neighborhoods as proposed by many Shang archaeologists.

The oldest case yet reported of osteoarthritis in a dog: an archaeological and radiological evaluation.

A century ago the remains of a dog skeleton were found in an archaeological double human burial, near Bonn-Oberkassel (Germany). Recent re-examination of the dog remains revealed that they were about 14,500 years old. Based on the growth plates, the animal was considered to be approximately 7·5 months old at the time of death. Based on the minimal humeral diameter, it was calculated that it was approximately 0·47 m tall at the shoulder and weighed approximately 15·7 kg. The right proximal ulna of this skeleton showed osteoarthritis, manifested by an osteophyte of 5×3×1·5 mm3 at its cranial edge, with no identified primary developmental causes for osteoarthritis. Osteochondritis dissecans, joint incongruity and trauma are possible aetiologies. The left ulna did not reveal any abnormalities.

Variation of skeletal degenerative joint disease features in an identified Italian modern skeletal collection.

OBJECTIVES: The objective of this study was to investigate the relationship of degenerative joint disease (DJD) features (marginal lipping, porosity, surface osteophytes, eburnation, and loss of joint morphology) with sex, age, and occupation. MATERIALS AND METHODS: We devised a recording method for scoring the single features in the shoulder, elbow, wrist, hip, knee, and ankle of an Italian skeletal sample of 332 individuals (males = 161, females = 171) of known sex, age, and occupation from the Frassetto collection (Sassari, Sardinia, 19th-20th century). RESULTS: Our data revealed that: (1) the frequency of all features increases with age; (2) porosity is the first feature to appear, being in general the most frequent feature in young adults; (3) sex differences are especially found in the upper limbs of mature and elderly adults; (4) marginal lipping and surface osteophytes show a lesser age correlation and, in general, higher frequencies in the left lower limb; (5) no differences were found among different occupations. DISCUSSION: We explain these results in light of different metabolic and adaptive processes in relation to age and sex. Static (weight-bearing) rather than dynamic mechanical stress could play a pivotal role in the distribution of the features observed in the lower limbs. The considerable increase in marginal lipping and surface osteophytes in elderly adults may be an adaptation for sustaining mechanical loading, balancing the loss of bone tissue which is characteristic of ageing processes (osteopenia, osteoporosis). Am J Phys Anthropol, 2016. © 2016 Wiley Periodicals, Inc. Am J Phys Anthropol 160:683-693, 2016. © 2016 Wiley Periodicals, Inc.

Osteoarthritis among the prehispanic population from La Gomera and El Hierro (Canary Islands): a comparative study.

The pathogenesis of osteoarthritis is still unclear, and several factors may play a role in its development, including joint trauma or microtrauma (usually related to lifestyle), local inflammation, loading charge, and genetics. Assessment of osteoarthritis among ancient populations is important, since it may yield information relative to life habits. Therefore, we have performed the present study in order to assess the prevalence of osteoarthritis among the prehispanic populations from La Gomera and El Hierro, two islands of the Canary Archipelago with a similar size and altitude which were colonized by individuals of North African origin about 2000 - 2500 years ago. The economy of these people was based on goat herding, shellfishing, and agriculture together with consumption of some wild vegetal species. However, despite a similar geographic environment and a similar economic pattern, prevalence of osteoarthritis was by far higher among the population from La Gomera (78.57 % vs 15.85 %, p < 0.001), and that of eburnation, 11.65 % and 1.05 %, respectively (p = 0.016); in contrast, the population of El Hierro was markedly more robust than that of La Gomera. Globally, a trend to an inverse relationship was observed between epiphyseal robusticity index and the presence of osteoarthritis, which was statistically significant when only men were analysed. However, after performing a multivariate analysis, the only factor that was independently related to the presence of osteoarthritis was the variable "island" (i.e., population group), suggesting that - possibly - genetic factors played a major role in the differences observed.