Added Info for Final Flashcards
What mm are affected in lateral epicondylitis?
Ext carpi radialis longus
Ext carpi radialis brevis
Ext digitorum
Ext digiti minimi
What causes lateral epicondylitis?
Repetitive overuse
What is the proper term instead of lateral epicondylitis?
Lateral epicondylagia
What are the sx of lateral epicondylitis?
Pain with palpation
What is the tx for acute lateral epicondylitis?
Resolving pain and swelling
What are the tx options for acute lateral epicondylitis?
Ice, phonophoresis, ionto Analgesics and NSAIDs Rest Protection from stress Activity modification Steroid injections Wrist cock-up splint
What are the interventions of the initial healing stage?
Avoid repetitive motions
Short-term ADL modification, sports, and job-related activities
If this all fails inject steroids to reduce inflammation
What mm are involved in medial epicondylitis?
Pronator teres
Flexor carpi radialis
Flexor carpi ulnaris
Flexor digitorum superficialis
What is the cause of medial epicondylitis?
Overuse
What is the dominant feature of medial epicondylitis?
Pain over medial epicondyle
What interventions are included in medial epicondylitis?
NSAIDs, ice Phonophoresis, ionto Relative active rest, protection Gentle active motion Static low-load, long duration stretching Avoid repetitive flexing and pronation Resistance training
What is another name for medial valgus stress overload?
Valgus extension overload
Who is the most common population at risk for medial valgus stress overload?
Athletes with repetitive throwing and racquet sports
What is the physiologic cause of medial valgus stress overload?
Tensile, compressive, and torsional forces during max force of throwing
What structure is involved in medial valgus stress overload?
Capsuololigamentous structure
What is the common tx for medial valgus stress overload?
NSAIDs and analgesics Ice massage Phonophoresis Rest and protection Omit stressing activities Short-term rest - running, cycling, and strength training Flexibility exercises
How to manage medial valgus stress overload?
Gentle low-load static stretch
Low load, long duration stretch
How do you treat an acute grade III Medial Collateral Ligament?
Managed conservatively by ice, NSAIDs, analgesics, and rest and protection
Avoid ER
What is an elbow lateral collateral ligament injury?
Second most commonly dislocated large joint
Caused by hyperext and posterolateral rotation
How long does it take for ligaments to heal?
6-8 weeks
What is the function of the elbow LCL?
Prevents rotary instability
What age group is at most risk for elbow LCL injury?
Under 10 years old
How do you manage LCL ligament injury?
Control pain and swelling
Hinged elbow brace
Strengthening activities
- Isos 1-10 days
- PRE 10-14 days
What is the goal of managing elbow LCL injury?
Restore ROM while slowly applying stresses to heal
Control pain and swelling
What operative management is included with elbow LCL injury?
Reconstruction = recreate ulnar aspect of LCL complex
Allograft or autograft
Initiate rehab immediately
What muscles/tendons are involved with either allograft or autograft reconstruction for elbow LCL?
Palmaris longus
Lateral triceps
Semitendinosus
What muscles/tendons are involved with an allograft reconstruction for elbow LCL?
Plantaris
What occurs during the post-op phase of elbow LCL reconstruction?
Week 0-3
Fixed at 90-degrees flex and full pronation
What occurs during the intermediate phase of elbow LCL reconstruction?
Elbow PROM 30-100 degrees with progressive strength - 10-degrees per week
What occurs during the advanced phase of elbow LCL reconstruction?
Week 8
Plyometrics at week 10
What occurs during the interval sports program for elbow LCL reconstruction?
> /= 16 weeks
Full AROM and strength within 15% of contralateral side
Thrower’s 10
What is a supracondylar fractures?
Distal humerus fracture
Usually occurs in children
What is Type I supracondylar fracture?
Most common
Results from FOOSH
What is Type II supracondylar fracture?
Direct trauma to the posterior elbow
Flexion injury
How do you treat supracondylar fractures?
Closed reduction and immobilization for 4-6 weeks
Initially
- Focus on motion and strength
- General body conditioning
- AROM of hand, wrist, and shoulder
Then gentle active motion
Progressive active motion of elbow and RPEs
- When evidence of healing
- Min 6 weeks post-op
- Demo improved motion without pain
What are the complications of supracondylar fractures?
Nonunion, malunion, and jt contracture
Volkmann ischemic contracture when fx is displaced
What are the 6 sx that indicate vascular obstruction?
- Severe forearm mm pain
- Limit painful finger movement
- Purple discoloration of hand
- Initial paresthesia followed by loss of sensation
- Loss of radial pulse and lateral loss of capillary return
- Pallor, anesthesia, and paralysis
What are intercondylar “T” or “Y” fractures?
Injuries extend between the condyles of the distal humerus and involved articular surfaces
What is a Type I Intercondylar fracture?
Nondisplaced (not coming apart)
Extend between two condyles
What is Type II Intercondylar fracture?
Displaced without rotation of fracture fragments
What is Type III Intercondylar fracture?
Displaced with rotational deformity
What is Type IV Intercondylar fracture?
Severely comminuted (burst) fx with signifcant separation b/t two condyles
What is the treatment for intercondylar fractures?
Type I - immobilization for ~3 weeks. Followed by progressive and gentle AROM
Resistance exercise until bony union
ORIF
Type IV - tx differently to those with osteoporosis
Elderly
- Bag of Bones technique
- Collar and cuff sling
- Flexion and sling help prevent reduction of fracture fragments
What is involved in intercondylar fracture rehab?
Early post-immobilization period, no passive manipulation or passive stretching
After wound closure
- Whirlpool bath
- Elbow flex/ext and pronate/supinate
- Specific jt mobs
What indicates bone has healed?
Bony callus
What is a radial head fracture?
Result of FOOSH
What is a Type I radial head fracture?
Nondisplaced
What is a Type II radial head fracture?
Marginal fracture with displacement
What is a Type III radial head fracture?
Comminuted fx of entire radial head
What is a Type IV radial head fracture?
Any radial head fx with elbow dislocation
What does tx look like for Type I radial head fracture?
Immobilization ranging from 5-7 days up to 3-4 weeks
What does tx look like for Type II radial head fracture?
Radial head can be excised or stabilized with ORIF
What is an olecranon fracture?
Fx after falling on olecranon process or indirect forceful contraction of the triceps
Can be displaced or nondisplaced
What are the 4 subclasses of displaced olecranon fractures?
Avulsion fx, displaced
Oblique or transverse fx
Comminuted fx
Fx-dislocation
What is tx for a nondisplaced fx?
Immobilization for 6-8 weeks
Gentle AROM after 3 weeks of immobilizations
Flex should not exceed 90-degrees for the first 6-8 weeks after injury
What is part of the initial phase of PT for a displaced olecranon fx?
AROM of hand, wrist, and shoulder
General physical conditioning program
Active elbow flex should not exceed 90-degrees for first 2 months
Secure bone healing at 6-8 weeks
Progress to concentric and eccentric loading
What are elbow fracture-dislocations?
Caused by FOOSH
Combo fx and dislocation
Occurs more often in men
Isolated posterior elbow dislocation - placed in 90-degree flex splint for 3-6 weeks of immobilization
Myositis ossificans - AROM when appropriate
What are the complications involved with elbow fracture-dislocations?
Loss of ext
10 wk after dislocation, 30-degrees flex contracture, and with 10-degree flex contracture typically observed 2 years later
What does therapy look like after an elbow fracture-dislocation?
Early protected AROM
Passive stretch is strict during early healing phase
Radial head excision = loss of 25-30 degrees of pro/sup if post-op immobilization lasts longer than 4 weeks
Isolated dislocation = loss of full elbow ext is not uncommon
What are the special tests for the elbow?
Cozen’s test
Maudsly’s test
Tinel at cubital tunnel
Valgus stress test
What is the dart throwing motion of the wrist?
Combo of all motions
Which CMC joints are most mobile?
1st, 4th, and 5th
What motion occurs at the MP jt?
Flex, ext, ABD, and ADD
What motion occurs at the IP jt?
Flex and ext
What physical characteristics should you look for with a wrist/hand injury?
Skin color Wrinkling Bruising Hair growth Resting posture
How do you measure edema of wrist/hand?
Volumetrics
Circumferential at various levels
What is the inflammatory phase of healing?
4-5 days post-injury or surgery
Avoid aggressive handling
Support structures
Edema and wound management
Motion of adjacent and uninvolved jt
What is the fibroplastic phase of healing?
5 days to 3 weeks
Gentle motion if not contrainidicated
Maintain AROM to adjacent jt
Reduce edema and pain
What is the maturation phase of healing?
3 weeks to a year
Therapy can progress to stretching, strengthening, and scar management
What does tx/rehab look like for a bony injury of forearm, wrist, and digits?
of fragments in fx
Fragment orientation (displaced or not)
Closed/open reduction
Surgery
Involvement of articular surfaces
What is a Colles Fx?
Radial fx within 2.5 cm of wrist
Can lead to displacement in a dorsal direction
Caused by fall on palm
What is a Smith’s fracture?
Fall on dorsum of hand
Distal radial fragment displacement in a palmar direction
What does rehab look like for someone in a cast/splint with Colles or Smith’s fractures?
Start ASAP once immobilization period is complete
Light gripping, pinching, and use of fingers with no pain
Active forearm rotation within limit of cast
What are the goals of rehab for a Colles or Smith’s fracture?
Reduce edema
Maintain digit ROM thru exercise
What kind of cast is used for a Colles or Smith’s fracture?
Up to elbow to prevent rotation of distal radius and ulna
How often should the “six pack” exercises be performed?
Hourly
What does rehab look like once cast is removed on a radial fracture?
AROM and AAROM of wrist
Pt education
Submax iso
Strengthen at 4-5 weeks
Progress to CKC WB
Return to work without restrictions ~10 weeks
What is a distal ulnar fx?
Usually combo with distal radial fx
What sx/sx are common in distal ulnar fx?
Rotation or WB with persistent pain
Should do further examination to rule out tears of the triangular fibrocartilage complex
What is the most common cause of carpal fractures?
FOOSH
What is the most common carpal to fracture?
Scaphoid
What is a complication of a scaphoid fracture?
Volkmann’s ischemia
What is the least common carpal to fracture?
Trapezoid
What are scaphoid fractures?
Result of fall on palm with wrist hyperextended and radially deviated
Often dismissed as sprain = delayed tx
1/3 of bone have high incidence of nonunion leading to poor vasculature
What does rehab look like during immobilization for a scaphoid fracture?
Edema reduction
ROM at uninvolved jt
What does rehab look like after the cast is removed?
Use thumb spica
Wrist exercise to focus on gliding of wrist and finger muscles
Putty, sustained gripping, and gradual CKC exercise to progress tolerance
Return to full activity ~12 weeks post cast removal
Where can metacarpal fractures occur?
Base
Shaft
Neck
Head
How can metacarpals become fractured?
Fall
Jammed fingers
Direct blows
What is a metacarpal fracture?
Nondisplaced/minimally displaced
How is a nondisplaced metacarpal fracture treated initially?
Put in cast or splint for 3-4 weeks
MCP jt placed at 45-60 degrees of flex to prevent shortening
How is a displaced metacarpal fracture treated initially?
Surgery and fixation
What is a Boxer’s fracture?
Neck of 4th or 5th MC
What causes a Boxer’s fracture?
Striking a hard object with a clenched fist
What are common treatments for a Boxer’s fracture?
Wrist immobilized into slight ext and MP flex for 3-4 weeks
PIP jt are free to move
Isotoner glove may be given to help manage edema. Otherwise massage and elevation
Why is edema in the hand a big deal?
Can cause adhesions to the tendon pully system causing dysfunction
What is a Bennett fracture?
Fracture of palmar base of the 1st MC bone
Fragment held in place by ligaments, but remainder of base is pulled radially and dorsally = fracture dislocation
What is the treatment for a Bennett fracture?
Closed reduction and rigid cast immobilization ~6 weeks
ORIF - 4-6 week of immobilization
What is the tendon is involved with a Bennett fracture?
Abductor pollucis longus tendon
How are stable, closed, nondisplaced phalanx fractures treated?
Buddy taping
Simple splints
Immediate AROM
How are more complex, closed, proximal and middle phalanx fractures treated?
Placed in hand-based splint for 3-4 weeks
What is the most common complication of a phalanx fracture?
Loss of PIP extension
What are blocking exercises and why are they used?
Help prevent tendons from adhering to fracture site
Get specific jt motion
Hold last IP jt and work on flex/ext
What is a common cause of ligamentous wrist injuries?
Sprains with various degrees of carpal instability
Usually caused by FOOSH
How are minor wrist sprains usually treated?
Immobilized in short arm cast or splint for 3-4 weeks
How is a severe wrist sprain treated?
Rigid immobilization for 6-12 weeks
ORIF
Closed reduction with pinning
What is the overall treatment for wrist sprains/other ligamentous injuries?
Control pain and inflammation
After immobilization - gentle active pain-free motion in all planes
Forearm rotation and tendon glides between wrist and fingers
Submax isos with gradual progression to CKC
Gradual increase of speed
Sustained grip
What causes a triangular fibrocartilage complex injury?
Injury from axial force to ulnar side during WB and gripping, or a FOOSH
What is the common sx for triangular fibrocartilage complex injury?
Pain in the ulnar side of wrist
What is the initial treatment for Triangular Fibrocartilage Complex injury?
Rest and splint of wrist and elbow to prevent forearm rotation for 4-6 weeks
What is part of a gradual program to Triangular Fibrocartilage Complex injury?
Gradual ROM and progressive strengthening
What is Skier’s thumb?
Acute sprain of UCL of thumb
Valgus stress and thumb hyperextension
What are common treatments for Skier’s thumb?
Nonsurgical with thumb spica or rigid immobilization for 3-4 week
Reduce edema
Active thumb MCP and composite CMC, MCP, and IP jt motion after splint is removed
Progressive strengthening at 5-6 weeks
What are tendinopathies of the wrist?
Extrinsic mm tendon response to stress under the pulley system
What is tendinitis?
Inflammation of the tendon
What is tenosynovitis?
Inflammation of synovial sheath of tendon
What is tendinosis?
Degeneration of tendon
What is De Quervain’s Disease?
Condition affecting ABD pollucis longus and ext pollucis brevis tendons and sheaths
How does De Quervain’s present?
Pain on radial side of wrist
What is a special test for De Quervain’s?
Finklestein
What are treatment options for De Quervains?
Activity modification
Immobilization
Pain and edema reduction
Once pain free ROM = strengthen eccentric and concentric motions
What are examples of wrist tendon injuries?
Ext tendon lacerations, ruptures, and repairs
What is important to remember when working with a pt who has an extensor tendon injury?
Ext mm are weaker than flexors
Follow PT instructions precisely during an ext repair
What is a mallet finger?
Interruption of ext tendon mechanism over DIP jt
May also involve distal phalanx fx
May take up to 6 months for full motion
What is a Boutonniere deformity?
Interruption of central tendon and triangular ligament of PIP jt
- PIP jt flex with DIP jt hyperext
What is the goal of rehab for a Boutonniere deformity?
Approximate ends of tendon so they can heal together
What does rehab look like for someone with a Boutonniere deformity?
Active and passive DIP flex
After 6 weeks, AROM of PIP jt, but it is still splinted between sessions for 2-4 week
May take up to 6-9 months
What type of surgeries should always be managed by CHT?
Flexor tendon repairs
What are the 3 approaches to flexor tendon injury rehab?
Immobilization - ~3-4 weeks
Early passive mobilization - passive flex and active ext within limits of splint
Early active mobilization - moved actively within 48 hours of repair and carefully outlined by limits set by surgeon
What is Dupuytren’s disease?
Formation of pits and firm nodules that lie just below skin of the palm by forming adhesions
What causes nodules in Dupuytren’s disease?
Overactive fibroblasts that can be bunching the skin
What are the surgical interventions for Dupuytrens?
Fasciotomy
Regional fasciectomy
Dermofasciectomy
What is an extensive fasciectomy?
Removal of diseased tissue and any tissue that has the potential of becoming diseased
What is a dermofasciectomy?
Removal of skin that overlies the diseased tissue as well as diseased tissue
What does post-op care look like for someone with Dupuytren’s disease?
Dorsal splint - allow full flex but limit ext
Watch for early signs of SRPS
Volar splint at 3 weeks with gradual increased composite ext
ROM, strengthening, and scar management
What does conservative management for Dupuytren’s look like?
Steroid injection
Collagenase injection to rupture the contracted fascia
What is compression neuropathy?
Occurs when adjacent structures constrict peripheral nerve and limit blood supply = impaired nerve conduction
What is entrapment neuropathy?
Occurs when gliding the nerve is restricted by CT leading to stretching of the nerve with normal jt motion
What motor loss is involved with CTS?
Thenar intrinsic mm
ABD pollicis brevis and opponens pollicis
Loss of first two lumbrical mm
What is Complex Regional pain Syndrome?
Clinical condition in which pain resulting from an injury is abnormally severe and/or prolonged compared to that of normal post injury
What is Type I CRPS?
Without nn injury
What is Type II CRPS?
With nn injury
What are sx/sx of CRPS?
Pain - light touch or air
Trophic changes
Autonomic disturbances - hot, cold, red, pale, goosebumps
Edema
Functional impairment
What are the best predictors of CRPS?
Clinical criteria for early recognition and tx
Bone scans
Radiographs
Cold stress tests
Microvascular perfusion test
What are treatment options for CRPS?
Multidisciplinary approach
What is the role of the PTA in tx of CRPS?
Observe and report pt response to tx
Avoid increasing sx
Pain control
Desensitization programs and sensory re-ed
What non-aggressive tx is involved with CRPS?
Mirror box Contrast bath Moist heat Gentle massage TENS Compression stocking Exercises to tolerance
What is the goal of non-aggressive tx for CRPS?
Prevent condition from progressing to chronic pain, disability, and deformity
What are examples of wrist orthoses?
WHFO Single jt splint Thomas suspension for finger Tenodesis Cock up Prefabricated Platform/resting
What is a tenodesis splint used for?
Keep wrist in ext and use finger flexors
What is a cock-up splint used for?
CTS and epicondylitis
What is the benefit of a WHFO?
Applies tension
What type of pt uses a platform/resting orthoses?
Stroke pt
What are examples of elbow orthoses?
Lateral epicondylitis splint
Flex POP elbow orthosis
Dynamic elbow
Static splint
What are examples of shoulder orthoses?
Sling and swath or shoulder immobilizer
If need ABD = airplane splint
What are the special tests of the wrist?
Finklestein's Phalens Reverse Phalen's Tinel's Hand elevation
What is Phalen’s test used for?
CTS
What is Finklestein’s test used for?
DeQuarvins disease
What is Reverse Phalen’s used for?
CTS - extreme ext
What is Tinel’s test used for?
CTS
What is the hand elevation test used for?
Vasculature and CTS
What are the symptoms of arthritis?
Pain
jt stiffness
Swelling
Overall decrease in function
What is the cause of arthritis?
Not fully understood
Predispositions - obesity, inactivity, increased age, and gender
What is osteoarthritis?
Most common
Most painful and disabling jt disorder
Affects articular cartilage
Decreased synthesis of cartilage
What are the causes of OA?
Combo of biomechanical, metabolic, and genetic
What are associated risk factors to OA?
Obesity
Trauma
Infection
Repeated jt overuse
What population is at most risk for OA?
More common in women over 45 y/o
How to manage OA?
Preventative measures to slow progression or better manage symptoms
Lose weight
Add vitamin D and calcium
Mm weakness and repetitive motions
Education on jt protection, health behavior changes, and importance of exercise
What population experiences RA more?
Women between 20-40 years old
What is the cause of RA?
Unknown, but linked to viral/bacterial infection that triggers autoimmune response
Genetic and environmental factors
What is RA?
Damage to synovial lining
Autoimmune response activates T-cells, which cause cytokine secretion = expand synovial layer
Cytokines increase activation of fibroblast-like cells and macrophages = breakdown of cartilage and bone
What are the early signs of RA?
Fatigue, wt loss, fever, and MS pain
What are the later sx/sx of RA?
Pain, tenderness, swelling, redness, and stiffness
What are some extraarticular manifestations of RA?
Can affect lungs, heart, BV, eyes, skin, and other organs
What are common physical changes in the fingers and toes from RA?
Swelling of jt Hyperflex and ext Volar subluxation Ulnar deviation Hallux valgus Hammer toes
What are common physical changes in the hand from RA?
Swan neck deformity - hyperext PIP and flex DIP
Boutonniere deforimty - flex PIP and hyperext DIP
Ulnar deviation of fingers
How do we manage RA?
Education and prevention
Prevent pain, deformities, loss of function, loss of social, physical and work capabilities
Start with stretching and ROM exercise in pain free range
Prevent contractures and mm atrophy
Vigorous activity should be avoid during exacerbation of sx
Start early with DMARDS
NSAIDs
Corticosteroids for swelling, pain, and fatigue
Biologic modifiers to block cytokine = decrease cartilage breakdown
What is reactive arthritis?
AKA Reiter syndrome
Abrupt onset in young men with triad conjunctivitis, urethritis, and oligoarticular arthritis
What is urethritis?
Inflammation of urethra
Painful urination
What is oligoarthritis?
Arthritis with inflammation of 2-4 joints
When does Reiter syndrome present?
Within days or weeks after dysenteric or sexually transmitted infection
What is Psoriatic arthritis?
Seronegative inflammatory jt disease in people with psoriasis
Resembles RA
What is Psoriasis?
Inherited chronic inflammatory skin disease characterized by silvery scales on a bright red plaque
What makes psoriatic arthritis different from RA?
Difference in DIP involvement Psoriasis Fam hx Nail pitting Sausage like digits
What are the demographics and characteristics of psoriatic arthritis?
Between 30-50 y/o
Asymmetric involvement and involves small jt of hands and feet
How to manage psoriatic arthritis?
Similar to RA - no cure
NSAIDS
Most of the time disease is mild and non-destructive
Tx of sx management
What is Juvenile RA?
Chronic inflammatory disease in childhood
What are the three types of JRA?
Pauciarticular
Polyarticular
Systemic
What is the cause of JRA?
Unknown
Thought to be triggered by environmental factors or infection
What age is commonly affected by JRA?
~16 y/o
Girls more than boys
What are other sx of JRA?
Fever Rash Fatigue Anemia Loss of appetite Stiffness Irritability Altered mobility Change in ADLs
What do we do for management of JRA?
Combo of meds, PT, and OT
What kind of meds are used for JRA?
NSAIDs Corticosteroids DMARDs Infliximab Immunosuppressives
What kind of PT is done for someone with JRA?
Stretches Heat Splints Serial casting RPE Aquatics Education - jt protection and energy conservation
What is septic arthritis?
Invasion of jt by an infectious agent that results in arthritis
What causes septic arthritis?
Bacterial infection, but can be viral, mycobacterial, or fungal
What are the two types of septic arthritis?
Gonococcal
Nongonococcal
What is gonococcal arthritis?
Occurs in healthier individuals
Starts with 1-4 days of non-inflammatory pain
Chronic arthritis or tendinits are common sx preceding
Tend to have asymptomatic lesions with 2-10 small necrotic pustules over extremities - esp palms and soles
What is nongonococcal arthritis?
Primarily monoarticular and in large WB jt and wrists
Previous jt damage from disease like RA
IV drug users are at increased risk
What is the most common nongonococcal arthritis?
Staph aureus
What are the sx of nongonococcal arthritis?
Sudden onset of acute arthritis with pain, swelling, and heat to one jt
Chills and fever can be possible
What are the common jts affected by nongonococcal arthritis?
Hip
Wrist
Shoulder
Ankle
Knee is most common
How to manage nongonococcal arthritis?
Quickly give systemic antibiotics
Aspiration of infected jt
Early intervention important
Immobilization and heat can help decrease pain
What management should be done during the acute phase?
Rest, elevation, and immobilization
What are risk factors to keep in mind with nongonococcal arthritis?
Infection elsewhere in body Presence of systemic disease Recent jt aspiration or surgery Prosthetic jt Immunosuppressants IV drug abuse
What is spondyloarthropathies?
LBP that increases with rest and improves with activity
What population is most at risk to develop spondyloarthropathies?
Run in families
More common in M
Onset before 40 y/o
Have inflammatory arthriis of the spine or peripheral jt
What is the cause of spondyloarthropathies?
Absence of autoantibodies in serum
Associated with human leukocyte antigen-B27
What is ankylosing Spondylitis?
Inflammation of synovium of spinal arthrodial jt and all jt ligaments of spine at their insertion points to bone
What are the characteristics of ankylosing spondylitis?
Lost of lumbar curvature
Reduced chest expansion
Increased thoracic kyphosis
Squaring of vertebra and destruction of SI jt
What population is most at risk for ankylosing spondylitis?
Greater in men
Occurs late teens to early 20s
What is involved in ankylosing spondylitis management?
PT and drug therapy
What kind of management is involved with early rehab?
TherEx with anti-inflammatory
Exercise to improve mobility, posture, and function
Pt education
What is involved in the pharmacological intervention of ankylosing spondylitis?
NSAIDs = decrease pain and stiffness
- Indomethacin most common to decrease night pain and morning stiffness
- Sulfasalazine = reduce acute-phase reactants. Can act as disease-modifying agen
What is nonarthritic rheumatic gout?
Metabolic disorder - deposit of monosodium urate crystals in the jt, soft tissue, kidneys, and other CT
Crystals cause acute or chronic inflammation stimulating mediators
What population tends to have an overproduction of uric acid?
Hx of lymphoma, leukemia, or psoriasis
Men over 30 y/o and occasional menopausal women
What are the characteristics of gout?
Acute monoarticular onset with worst pain at night
Great toe is most common
Ankle, knee, wrist, elbow and fingers can also be infected
Can be chronic
What are the sx/sx of gout?
Jts become tender, swollen, warm, red
Fever can occur
Severe gouty attacks suddenly return more frequently and longer lasting
What are tx options for gout?
NSAIDs Corticosteroids RICE Protection during acute Manage diet, avoid hyperuricemic meds, colchicine, and reduce serum uric acid
What dietary changes can be made to reduce uric acid?
Weight loss
Moderation of alcohol
Avoid high purine foods
What foods are considered to be high in purine?
Organ meats Bacon Anchovies Venison Veal Goose Yeast Mackerel Codfish Haddock Herring Shrimp Sardines Scallops
What is fibromyalgia?
Chronic, widespread mm pain
Last at least 3 months with 11-18 tender areas
What are the common characteristics of fibromyalgia?
Chronic, widespread pain Aching Fatigue Stiffness HA Sleep disorders Mood disorders IBS Paresthesias
What population is fibromyalgia most common in?
Women between 20-50 y/o
How do you manage fibromyalgia?
Meds
Exercise
What do meds do for fibromyalgia?
Manage pain and sleep disturbances
Antidepressants
Mm relaxants
Antianxiety
Sleep aids
What is SLE?
Chronic inflammatory autoimmune disorder that can affect multiple organ systems
Who most commonly has SLE?
Women in childbearing years
Rarely found in older adults
What is the cause of SLE?
Unknown
Thought to be related to environmental and genetic factors
Hereditary factors, physical and mental stress, exposure to sunlight or UV, strep or viral infections, and abnormal estrogen metabolism
What are general sx/sx of SLE?
Fever Fatigue Anorexia Weight loss Myalgias Jt involvement in most pt Symmetric polyarthritis Severity can range
How do you manage SLE?
Pt education
Relapse are less likely if sx are managed
Jt pain similar to RA with NSAIDs
Caution sun exposure and apply sunscreen
Topical corticosteroids for rash and skin lesions
What is osteoporosis?
Loss of bone mass due to decrease osteoblast activity and/or increased osteoclast activity
What is the function of osteoblasts?
Build bones and maintain
What rebuilds bone?
Osteoblasts and osteoclasts
~120 days
When does bone resorption start to exceed bone formation and density decrease?
Mid 30s
What are the risk factors of osteoporosis?
Sedentary lifestyle
Caucasian/Asian
Thin body frame
Smoking, excessive alcohol
Immobilization
Early menopause
Low calcium and Vit D intake
Corticosteroids
More common in women and directly associated with aging
What are clinical features associated with osteoporosis?
Kyphosis
Vertebral compression fracture
Hip fracture
Distal radius fractures
How is one diagnosed with osteoporosis?
Measure mineral bone density thru a DEXA
What are preventative measures to osteoporosis?
Proper diet with adequate Ca and Vit D
WB exercise
Estrogen therapy
Combo meds
Strength training in postmenopausal women
What are common rehab managements for rheumatic disorders?
Cold
Heat
EStim
Stretching
Strengthening
Aerobics
Aquatics
What are common meds used to manage rheumatic disorders?
Analgesics
NSAIDs
Corticosteroids
DMARDs
Biologic response modifiers
Supplements
What are examples of surgical management for rheumatic disorders?
Synovectomy
Osteotomy
Resection
Arthrodesis
Arthroscopy
Arthroplasty
