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Ortho PTA > Added Info for Final > Flashcards

Added Info for Final Flashcards

1
Q

What mm are affected in lateral epicondylitis?

A

Ext carpi radialis longus
Ext carpi radialis brevis
Ext digitorum
Ext digiti minimi

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2
Q

What causes lateral epicondylitis?

A

Repetitive overuse

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3
Q

What is the proper term instead of lateral epicondylitis?

A

Lateral epicondylagia

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4
Q

What are the sx of lateral epicondylitis?

A

Pain with palpation

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5
Q

What is the tx for acute lateral epicondylitis?

A

Resolving pain and swelling

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6
Q

What are the tx options for acute lateral epicondylitis?

A 
Ice, phonophoresis, ionto
Analgesics and NSAIDs
Rest
Protection from stress
Activity modification
Steroid injections
Wrist cock-up splint
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7
Q

What are the interventions of the initial healing stage?

A

Avoid repetitive motions

Short-term ADL modification, sports, and job-related activities

If this all fails inject steroids to reduce inflammation

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8
Q

What mm are involved in medial epicondylitis?

A

Pronator teres
Flexor carpi radialis
Flexor carpi ulnaris
Flexor digitorum superficialis

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9
Q

What is the cause of medial epicondylitis?

A

Overuse

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10
Q

What is the dominant feature of medial epicondylitis?

A

Pain over medial epicondyle

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11
Q

What interventions are included in medial epicondylitis?

A 
NSAIDs, ice
Phonophoresis, ionto
Relative active rest, protection
Gentle active motion
Static low-load, long duration stretching
Avoid repetitive flexing and pronation
Resistance training
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12
Q

What is another name for medial valgus stress overload?

A

Valgus extension overload

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13
Q

Who is the most common population at risk for medial valgus stress overload?

A

Athletes with repetitive throwing and racquet sports

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14
Q

What is the physiologic cause of medial valgus stress overload?

A

Tensile, compressive, and torsional forces during max force of throwing

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15
Q

What structure is involved in medial valgus stress overload?

A

Capsuololigamentous structure

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16
Q

What is the common tx for medial valgus stress overload?

A 
NSAIDs and analgesics
Ice massage
Phonophoresis
Rest and protection
Omit stressing activities
Short-term rest - running, cycling, and strength training
Flexibility exercises
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17
Q

How to manage medial valgus stress overload?

A

Gentle low-load static stretch

Low load, long duration stretch

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18
Q

How do you treat an acute grade III Medial Collateral Ligament?

A

Managed conservatively by ice, NSAIDs, analgesics, and rest and protection

Avoid ER

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19
Q

What is an elbow lateral collateral ligament injury?

A

Second most commonly dislocated large joint

Caused by hyperext and posterolateral rotation

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20
Q

How long does it take for ligaments to heal?

A

6-8 weeks

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21
Q

What is the function of the elbow LCL?

A

Prevents rotary instability

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22
Q

What age group is at most risk for elbow LCL injury?

A

Under 10 years old

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23
Q

How do you manage LCL ligament injury?

A

Control pain and swelling

Hinged elbow brace

Strengthening activities

  • Isos 1-10 days
  • PRE 10-14 days
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24
Q

What is the goal of managing elbow LCL injury?

A

Restore ROM while slowly applying stresses to heal

Control pain and swelling

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25
Q

What operative management is included with elbow LCL injury?

A

Reconstruction = recreate ulnar aspect of LCL complex

Allograft or autograft

Initiate rehab immediately

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26
Q

What muscles/tendons are involved with either allograft or autograft reconstruction for elbow LCL?

A

Palmaris longus
Lateral triceps
Semitendinosus

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27
Q

What muscles/tendons are involved with an allograft reconstruction for elbow LCL?

A

Plantaris

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28
Q

What occurs during the post-op phase of elbow LCL reconstruction?

A

Week 0-3

Fixed at 90-degrees flex and full pronation

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29
Q

What occurs during the intermediate phase of elbow LCL reconstruction?

A

Elbow PROM 30-100 degrees with progressive strength - 10-degrees per week

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30
Q

What occurs during the advanced phase of elbow LCL reconstruction?

A

Week 8

Plyometrics at week 10

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31
Q

What occurs during the interval sports program for elbow LCL reconstruction?

A

> /= 16 weeks

Full AROM and strength within 15% of contralateral side

Thrower’s 10

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32
Q

What is a supracondylar fractures?

A

Distal humerus fracture

Usually occurs in children

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33
Q

What is Type I supracondylar fracture?

A

Most common

Results from FOOSH

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34
Q

What is Type II supracondylar fracture?

A

Direct trauma to the posterior elbow

Flexion injury

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35
Q

How do you treat supracondylar fractures?

A

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
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36
Q

What are the complications of supracondylar fractures?

A

Nonunion, malunion, and jt contracture

Volkmann ischemic contracture when fx is displaced

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37
Q

What are the 6 sx that indicate vascular obstruction?

A
  • 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
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38
Q

What are intercondylar “T” or “Y” fractures?

A

Injuries extend between the condyles of the distal humerus and involved articular surfaces

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39
Q

What is a Type I Intercondylar fracture?

A

Nondisplaced (not coming apart)

Extend between two condyles

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40
Q

What is Type II Intercondylar fracture?

A

Displaced without rotation of fracture fragments

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41
Q

What is Type III Intercondylar fracture?

A

Displaced with rotational deformity

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42
Q

What is Type IV Intercondylar fracture?

A

Severely comminuted (burst) fx with signifcant separation b/t two condyles

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43
Q

What is the treatment for intercondylar fractures?

A

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
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44
Q

What is involved in intercondylar fracture rehab?

A

Early post-immobilization period, no passive manipulation or passive stretching

After wound closure

  • Whirlpool bath
  • Elbow flex/ext and pronate/supinate
  • Specific jt mobs
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45
Q

What indicates bone has healed?

A

Bony callus

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46
Q

What is a radial head fracture?

A

Result of FOOSH

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47
Q

What is a Type I radial head fracture?

A

Nondisplaced

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48
Q

What is a Type II radial head fracture?

A

Marginal fracture with displacement

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49
Q

What is a Type III radial head fracture?

A

Comminuted fx of entire radial head

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50
Q

What is a Type IV radial head fracture?

A

Any radial head fx with elbow dislocation

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51
Q

What does tx look like for Type I radial head fracture?

A

Immobilization ranging from 5-7 days up to 3-4 weeks

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52
Q

What does tx look like for Type II radial head fracture?

A

Radial head can be excised or stabilized with ORIF

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53
Q

What is an olecranon fracture?

A

Fx after falling on olecranon process or indirect forceful contraction of the triceps

Can be displaced or nondisplaced

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54
Q

What are the 4 subclasses of displaced olecranon fractures?

A

Avulsion fx, displaced
Oblique or transverse fx
Comminuted fx
Fx-dislocation

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55
Q

What is tx for a nondisplaced fx?

A

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

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56
Q

What is part of the initial phase of PT for a displaced olecranon fx?

A

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

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57
Q

What are elbow fracture-dislocations?

A

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

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58
Q

What are the complications involved with elbow fracture-dislocations?

A

Loss of ext

10 wk after dislocation, 30-degrees flex contracture, and with 10-degree flex contracture typically observed 2 years later

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59
Q

What does therapy look like after an elbow fracture-dislocation?

A

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

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60
Q

What are the special tests for the elbow?

A

Cozen’s test
Maudsly’s test
Tinel at cubital tunnel
Valgus stress test

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61
Q

What is the dart throwing motion of the wrist?

A

Combo of all motions

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62
Q

Which CMC joints are most mobile?

A

1st, 4th, and 5th

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63
Q

What motion occurs at the MP jt?

A

Flex, ext, ABD, and ADD

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64
Q

What motion occurs at the IP jt?

A

Flex and ext

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65
Q

What physical characteristics should you look for with a wrist/hand injury?

A 
Skin color
Wrinkling
Bruising
Hair growth
Resting posture
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66
Q

How do you measure edema of wrist/hand?

A

Volumetrics

Circumferential at various levels

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67
Q

What is the inflammatory phase of healing?

A

4-5 days post-injury or surgery

Avoid aggressive handling

Support structures

Edema and wound management

Motion of adjacent and uninvolved jt

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68
Q

What is the fibroplastic phase of healing?

A

5 days to 3 weeks

Gentle motion if not contrainidicated

Maintain AROM to adjacent jt

Reduce edema and pain

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69
Q

What is the maturation phase of healing?

A

3 weeks to a year

Therapy can progress to stretching, strengthening, and scar management

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70
Q

What does tx/rehab look like for a bony injury of forearm, wrist, and digits?

A

of fragments in fx

Fragment orientation (displaced or not)

Closed/open reduction

Surgery

Involvement of articular surfaces

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71
Q

What is a Colles Fx?

A

Radial fx within 2.5 cm of wrist

Can lead to displacement in a dorsal direction

Caused by fall on palm

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72
Q

What is a Smith’s fracture?

A

Fall on dorsum of hand

Distal radial fragment displacement in a palmar direction

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73
Q

What does rehab look like for someone in a cast/splint with Colles or Smith’s fractures?

A

Start ASAP once immobilization period is complete

Light gripping, pinching, and use of fingers with no pain

Active forearm rotation within limit of cast

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74
Q

What are the goals of rehab for a Colles or Smith’s fracture?

A

Reduce edema

Maintain digit ROM thru exercise

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75
Q

What kind of cast is used for a Colles or Smith’s fracture?

A

Up to elbow to prevent rotation of distal radius and ulna

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76
Q

How often should the “six pack” exercises be performed?

A

Hourly

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77
Q

What does rehab look like once cast is removed on a radial fracture?

A

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

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78
Q

What is a distal ulnar fx?

A

Usually combo with distal radial fx

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79
Q

What sx/sx are common in distal ulnar fx?

A

Rotation or WB with persistent pain

Should do further examination to rule out tears of the triangular fibrocartilage complex

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80
Q

What is the most common cause of carpal fractures?

A

FOOSH

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81
Q

What is the most common carpal to fracture?

A

Scaphoid

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82
Q

What is a complication of a scaphoid fracture?

A

Volkmann’s ischemia

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83
Q

What is the least common carpal to fracture?

A

Trapezoid

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84
Q

What are scaphoid fractures?

A

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

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85
Q

What does rehab look like during immobilization for a scaphoid fracture?

A

Edema reduction

ROM at uninvolved jt

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86
Q

What does rehab look like after the cast is removed?

A

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

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87
Q

Where can metacarpal fractures occur?

A

Base
Shaft
Neck
Head

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88
Q

How can metacarpals become fractured?

A

Fall
Jammed fingers
Direct blows

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89
Q

What is a metacarpal fracture?

A

Nondisplaced/minimally displaced

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90
Q

How is a nondisplaced metacarpal fracture treated initially?

A

Put in cast or splint for 3-4 weeks

MCP jt placed at 45-60 degrees of flex to prevent shortening

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91
Q

How is a displaced metacarpal fracture treated initially?

A

Surgery and fixation

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92
Q

What is a Boxer’s fracture?

A

Neck of 4th or 5th MC

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93
Q

What causes a Boxer’s fracture?

A

Striking a hard object with a clenched fist

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94
Q

What are common treatments for a Boxer’s fracture?

A

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

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95
Q

Why is edema in the hand a big deal?

A

Can cause adhesions to the tendon pully system causing dysfunction

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96
Q

What is a Bennett fracture?

A

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

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97
Q

What is the treatment for a Bennett fracture?

A

Closed reduction and rigid cast immobilization ~6 weeks

ORIF - 4-6 week of immobilization

98
Q

What is the tendon is involved with a Bennett fracture?

A

Abductor pollucis longus tendon

99
Q

How are stable, closed, nondisplaced phalanx fractures treated?

A

Buddy taping
Simple splints
Immediate AROM

100
Q

How are more complex, closed, proximal and middle phalanx fractures treated?

A

Placed in hand-based splint for 3-4 weeks

101
Q

What is the most common complication of a phalanx fracture?

A

Loss of PIP extension

102
Q

What are blocking exercises and why are they used?

A

Help prevent tendons from adhering to fracture site

Get specific jt motion

Hold last IP jt and work on flex/ext

103
Q

What is a common cause of ligamentous wrist injuries?

A

Sprains with various degrees of carpal instability

Usually caused by FOOSH

104
Q

How are minor wrist sprains usually treated?

A

Immobilized in short arm cast or splint for 3-4 weeks

105
Q

How is a severe wrist sprain treated?

A

Rigid immobilization for 6-12 weeks

ORIF

Closed reduction with pinning

106
Q

What is the overall treatment for wrist sprains/other ligamentous injuries?

A

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

107
Q

What causes a triangular fibrocartilage complex injury?

A

Injury from axial force to ulnar side during WB and gripping, or a FOOSH

108
Q

What is the common sx for triangular fibrocartilage complex injury?

A

Pain in the ulnar side of wrist

109
Q

What is the initial treatment for Triangular Fibrocartilage Complex injury?

A

Rest and splint of wrist and elbow to prevent forearm rotation for 4-6 weeks

110
Q

What is part of a gradual program to Triangular Fibrocartilage Complex injury?

A

Gradual ROM and progressive strengthening

111
Q

What is Skier’s thumb?

A

Acute sprain of UCL of thumb

Valgus stress and thumb hyperextension

112
Q

What are common treatments for Skier’s thumb?

A

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

113
Q

What are tendinopathies of the wrist?

A

Extrinsic mm tendon response to stress under the pulley system

114
Q

What is tendinitis?

A

Inflammation of the tendon

115
Q

What is tenosynovitis?

A

Inflammation of synovial sheath of tendon

116
Q

What is tendinosis?

A

Degeneration of tendon

117
Q

What is De Quervain’s Disease?

A

Condition affecting ABD pollucis longus and ext pollucis brevis tendons and sheaths

118
Q

How does De Quervain’s present?

A

Pain on radial side of wrist

119
Q

What is a special test for De Quervain’s?

A

Finklestein

120
Q

What are treatment options for De Quervains?

A

Activity modification

Immobilization

Pain and edema reduction

Once pain free ROM = strengthen eccentric and concentric motions

121
Q

What are examples of wrist tendon injuries?

A

Ext tendon lacerations, ruptures, and repairs

122
Q

What is important to remember when working with a pt who has an extensor tendon injury?

A

Ext mm are weaker than flexors

Follow PT instructions precisely during an ext repair

123
Q

What is a mallet finger?

A

Interruption of ext tendon mechanism over DIP jt

May also involve distal phalanx fx

May take up to 6 months for full motion

124
Q

What is a Boutonniere deformity?

A

Interruption of central tendon and triangular ligament of PIP jt
- PIP jt flex with DIP jt hyperext

125
Q

What is the goal of rehab for a Boutonniere deformity?

A

Approximate ends of tendon so they can heal together

126
Q

What does rehab look like for someone with a Boutonniere deformity?

A

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

127
Q

What type of surgeries should always be managed by CHT?

A

Flexor tendon repairs

128
Q

What are the 3 approaches to flexor tendon injury rehab?

A

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

129
Q

What is Dupuytren’s disease?

A

Formation of pits and firm nodules that lie just below skin of the palm by forming adhesions

130
Q

What causes nodules in Dupuytren’s disease?

A

Overactive fibroblasts that can be bunching the skin

131
Q

What are the surgical interventions for Dupuytrens?

A

Fasciotomy
Regional fasciectomy
Dermofasciectomy

132
Q

What is an extensive fasciectomy?

A

Removal of diseased tissue and any tissue that has the potential of becoming diseased

133
Q

What is a dermofasciectomy?

A

Removal of skin that overlies the diseased tissue as well as diseased tissue

134
Q

What does post-op care look like for someone with Dupuytren’s disease?

A

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

135
Q

What does conservative management for Dupuytren’s look like?

A

Steroid injection

Collagenase injection to rupture the contracted fascia

136
Q

What is compression neuropathy?

A

Occurs when adjacent structures constrict peripheral nerve and limit blood supply = impaired nerve conduction

137
Q

What is entrapment neuropathy?

A

Occurs when gliding the nerve is restricted by CT leading to stretching of the nerve with normal jt motion

138
Q

What motor loss is involved with CTS?

A

Thenar intrinsic mm

ABD pollicis brevis and opponens pollicis

Loss of first two lumbrical mm

139
Q

What is Complex Regional pain Syndrome?

A

Clinical condition in which pain resulting from an injury is abnormally severe and/or prolonged compared to that of normal post injury

140
Q

What is Type I CRPS?

A

Without nn injury

141
Q

What is Type II CRPS?

A

With nn injury

142
Q

What are sx/sx of CRPS?

A

Pain - light touch or air

Trophic changes

Autonomic disturbances - hot, cold, red, pale, goosebumps

Edema

Functional impairment

143
Q

What are the best predictors of CRPS?

A

Clinical criteria for early recognition and tx

Bone scans
Radiographs
Cold stress tests
Microvascular perfusion test

144
Q

What are treatment options for CRPS?

A

Multidisciplinary approach

145
Q

What is the role of the PTA in tx of CRPS?

A

Observe and report pt response to tx

Avoid increasing sx

Pain control

Desensitization programs and sensory re-ed

146
Q

What non-aggressive tx is involved with CRPS?

A 
Mirror box
Contrast bath
Moist heat
Gentle massage
TENS
Compression stocking
Exercises to tolerance
147
Q

What is the goal of non-aggressive tx for CRPS?

A

Prevent condition from progressing to chronic pain, disability, and deformity

148
Q

What are examples of wrist orthoses?

A 
WHFO
Single jt splint
Thomas suspension for finger
Tenodesis 
Cock up
Prefabricated
Platform/resting
149
Q

What is a tenodesis splint used for?

A

Keep wrist in ext and use finger flexors

150
Q

What is a cock-up splint used for?

A

CTS and epicondylitis

151
Q

What is the benefit of a WHFO?

A

Applies tension

152
Q

What type of pt uses a platform/resting orthoses?

A

Stroke pt

153
Q

What are examples of elbow orthoses?

A

Lateral epicondylitis splint
Flex POP elbow orthosis
Dynamic elbow
Static splint

154
Q

What are examples of shoulder orthoses?

A

Sling and swath or shoulder immobilizer

If need ABD = airplane splint

155
Q

What are the special tests of the wrist?

A 
Finklestein's
Phalens
Reverse Phalen's 
Tinel's
Hand elevation
156
Q

What is Phalen’s test used for?

A

CTS

157
Q

What is Finklestein’s test used for?

A

DeQuarvins disease

158
Q

What is Reverse Phalen’s used for?

A

CTS - extreme ext

159
Q

What is Tinel’s test used for?

A

CTS

160
Q

What is the hand elevation test used for?

A

Vasculature and CTS

161
Q

What are the symptoms of arthritis?

A

Pain
jt stiffness
Swelling
Overall decrease in function

162
Q

What is the cause of arthritis?

A

Not fully understood

Predispositions - obesity, inactivity, increased age, and gender

163
Q

What is osteoarthritis?

A

Most common

Most painful and disabling jt disorder

Affects articular cartilage

Decreased synthesis of cartilage

164
Q

What are the causes of OA?

A

Combo of biomechanical, metabolic, and genetic

165
Q

What are associated risk factors to OA?

A

Obesity
Trauma
Infection
Repeated jt overuse

166
Q

What population is at most risk for OA?

A

More common in women over 45 y/o

167
Q

How to manage OA?

A

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

168
Q

What population experiences RA more?

A

Women between 20-40 years old

169
Q

What is the cause of RA?

A

Unknown, but linked to viral/bacterial infection that triggers autoimmune response

Genetic and environmental factors

170
Q

What is RA?

A

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

171
Q

What are the early signs of RA?

A

Fatigue, wt loss, fever, and MS pain

172
Q

What are the later sx/sx of RA?

A

Pain, tenderness, swelling, redness, and stiffness

173
Q

What are some extraarticular manifestations of RA?

A

Can affect lungs, heart, BV, eyes, skin, and other organs

174
Q

What are common physical changes in the fingers and toes from RA?

A 
Swelling of jt
Hyperflex and ext
Volar subluxation
Ulnar deviation
Hallux valgus
Hammer toes
175
Q

What are common physical changes in the hand from RA?

A

Swan neck deformity - hyperext PIP and flex DIP

Boutonniere deforimty - flex PIP and hyperext DIP

Ulnar deviation of fingers

176
Q

How do we manage RA?

A

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

177
Q

What is reactive arthritis?

A

AKA Reiter syndrome

Abrupt onset in young men with triad conjunctivitis, urethritis, and oligoarticular arthritis

178
Q

What is urethritis?

A

Inflammation of urethra

Painful urination

179
Q

What is oligoarthritis?

A

Arthritis with inflammation of 2-4 joints

180
Q

When does Reiter syndrome present?

A

Within days or weeks after dysenteric or sexually transmitted infection

181
Q

What is Psoriatic arthritis?

A

Seronegative inflammatory jt disease in people with psoriasis

Resembles RA

182
Q

What is Psoriasis?

A

Inherited chronic inflammatory skin disease characterized by silvery scales on a bright red plaque

183
Q

What makes psoriatic arthritis different from RA?

A 
Difference in DIP involvement
Psoriasis
Fam hx
Nail pitting
Sausage like digits
184
Q

What are the demographics and characteristics of psoriatic arthritis?

A

Between 30-50 y/o

Asymmetric involvement and involves small jt of hands and feet

185
Q

How to manage psoriatic arthritis?

A

Similar to RA - no cure

NSAIDS
Most of the time disease is mild and non-destructive
Tx of sx management

186
Q

What is Juvenile RA?

A

Chronic inflammatory disease in childhood

187
Q

What are the three types of JRA?

A

Pauciarticular
Polyarticular
Systemic

188
Q

What is the cause of JRA?

A

Unknown

Thought to be triggered by environmental factors or infection

189
Q

What age is commonly affected by JRA?

A

~16 y/o

Girls more than boys

190
Q

What are other sx of JRA?

A 
Fever
Rash
Fatigue
Anemia
Loss of appetite
Stiffness
Irritability
Altered mobility
Change in ADLs
191
Q

What do we do for management of JRA?

A

Combo of meds, PT, and OT

192
Q

What kind of meds are used for JRA?

A 
NSAIDs
Corticosteroids
DMARDs
Infliximab
Immunosuppressives
193
Q

What kind of PT is done for someone with JRA?

A 
Stretches
Heat
Splints
Serial casting
RPE
Aquatics
Education - jt protection and energy conservation
194
Q

What is septic arthritis?

A

Invasion of jt by an infectious agent that results in arthritis

195
Q

What causes septic arthritis?

A

Bacterial infection, but can be viral, mycobacterial, or fungal

196
Q

What are the two types of septic arthritis?

A

Gonococcal

Nongonococcal

197
Q

What is gonococcal arthritis?

A

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

198
Q

What is nongonococcal arthritis?

A

Primarily monoarticular and in large WB jt and wrists

Previous jt damage from disease like RA

IV drug users are at increased risk

199
Q

What is the most common nongonococcal arthritis?

A

Staph aureus

200
Q

What are the sx of nongonococcal arthritis?

A

Sudden onset of acute arthritis with pain, swelling, and heat to one jt

Chills and fever can be possible

201
Q

What are the common jts affected by nongonococcal arthritis?

A

Hip
Wrist
Shoulder
Ankle

Knee is most common

202
Q

How to manage nongonococcal arthritis?

A

Quickly give systemic antibiotics

Aspiration of infected jt

Early intervention important

Immobilization and heat can help decrease pain

203
Q

What management should be done during the acute phase?

A

Rest, elevation, and immobilization

204
Q

What are risk factors to keep in mind with nongonococcal arthritis?

A 
Infection elsewhere in body
Presence of systemic disease
Recent jt aspiration or surgery
Prosthetic jt
Immunosuppressants
IV drug abuse
205
Q

What is spondyloarthropathies?

A

LBP that increases with rest and improves with activity

206
Q

What population is most at risk to develop spondyloarthropathies?

A

Run in families
More common in M
Onset before 40 y/o
Have inflammatory arthriis of the spine or peripheral jt

207
Q

What is the cause of spondyloarthropathies?

A

Absence of autoantibodies in serum

Associated with human leukocyte antigen-B27

208
Q

What is ankylosing Spondylitis?

A

Inflammation of synovium of spinal arthrodial jt and all jt ligaments of spine at their insertion points to bone

209
Q

What are the characteristics of ankylosing spondylitis?

A

Lost of lumbar curvature
Reduced chest expansion
Increased thoracic kyphosis

Squaring of vertebra and destruction of SI jt

210
Q

What population is most at risk for ankylosing spondylitis?

A

Greater in men

Occurs late teens to early 20s

211
Q

What is involved in ankylosing spondylitis management?

A

PT and drug therapy

212
Q

What kind of management is involved with early rehab?

A

TherEx with anti-inflammatory

Exercise to improve mobility, posture, and function

Pt education

213
Q

What is involved in the pharmacological intervention of ankylosing spondylitis?

A

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
214
Q

What is nonarthritic rheumatic gout?

A

Metabolic disorder - deposit of monosodium urate crystals in the jt, soft tissue, kidneys, and other CT

Crystals cause acute or chronic inflammation stimulating mediators

215
Q

What population tends to have an overproduction of uric acid?

A

Hx of lymphoma, leukemia, or psoriasis

Men over 30 y/o and occasional menopausal women

216
Q

What are the characteristics of gout?

A

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

217
Q

What are the sx/sx of gout?

A

Jts become tender, swollen, warm, red

Fever can occur

Severe gouty attacks suddenly return more frequently and longer lasting

218
Q

What are tx options for gout?

A 
NSAIDs
Corticosteroids
RICE
Protection during acute
Manage diet, avoid hyperuricemic meds, colchicine, and reduce serum uric acid
219
Q

What dietary changes can be made to reduce uric acid?

A

Weight loss

Moderation of alcohol

Avoid high purine foods

220
Q

What foods are considered to be high in purine?

A 
Organ meats
Bacon
Anchovies
Venison
Veal
Goose
Yeast
Mackerel
Codfish
Haddock
Herring
Shrimp
Sardines
Scallops
221
Q

What is fibromyalgia?

A

Chronic, widespread mm pain

Last at least 3 months with 11-18 tender areas

222
Q

What are the common characteristics of fibromyalgia?

A 
Chronic, widespread pain
Aching
Fatigue
Stiffness
HA
Sleep disorders
Mood disorders
IBS
Paresthesias
223
Q

What population is fibromyalgia most common in?

A

Women between 20-50 y/o

224
Q

How do you manage fibromyalgia?

A

Meds

Exercise

225
Q

What do meds do for fibromyalgia?

A

Manage pain and sleep disturbances

Antidepressants
Mm relaxants
Antianxiety
Sleep aids

226
Q

What is SLE?

A

Chronic inflammatory autoimmune disorder that can affect multiple organ systems

227
Q

Who most commonly has SLE?

A

Women in childbearing years

Rarely found in older adults

228
Q

What is the cause of SLE?

A

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

229
Q

What are general sx/sx of SLE?

A 
Fever
Fatigue
Anorexia
Weight loss
Myalgias
Jt involvement in most pt
Symmetric polyarthritis
Severity can range
230
Q

How do you manage SLE?

A

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

231
Q

What is osteoporosis?

A

Loss of bone mass due to decrease osteoblast activity and/or increased osteoclast activity

232
Q

What is the function of osteoblasts?

A

Build bones and maintain

233
Q

What rebuilds bone?

A

Osteoblasts and osteoclasts

~120 days

234
Q

When does bone resorption start to exceed bone formation and density decrease?

A

Mid 30s

235
Q

What are the risk factors of osteoporosis?

A

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

236
Q

What are clinical features associated with osteoporosis?

A

Kyphosis

Vertebral compression fracture

Hip fracture

Distal radius fractures

237
Q

How is one diagnosed with osteoporosis?

A

Measure mineral bone density thru a DEXA

238
Q

What are preventative measures to osteoporosis?

A

Proper diet with adequate Ca and Vit D

WB exercise

Estrogen therapy

Combo meds

Strength training in postmenopausal women

239
Q

What are common rehab managements for rheumatic disorders?

A

Cold

Heat

EStim

Stretching

Strengthening

Aerobics

Aquatics

240
Q

What are common meds used to manage rheumatic disorders?

A

Analgesics

NSAIDs

Corticosteroids

DMARDs

Biologic response modifiers

Supplements

241
Q

What are examples of surgical management for rheumatic disorders?

A

Synovectomy

Osteotomy

Resection

Arthrodesis

Arthroscopy

Arthroplasty

Ortho PTA (4 decks)

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