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Phys Dys > Arthritis > Flashcards

Arthritis Flashcards

1
Q

What is osteoarthritis (OA)?

A

AKA degenerative joint disease

Causes the cartilage in joints to break down, which results in joint pain and stuffness

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2
Q

What are common joints affected in OA? (8)

A

Neck, spine, hips, knees, MTPs, DIPs, PIPs, thumb CMCs

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3
Q

What is the disease process of OA?

A

Not inflammatory - Primary OA has no known cause & is typically associated with aging & overuse of joints. Secondary OA is related to an identifiable cause such as trauma, anatomic abnormalities, infection, or aseptic necrosis.

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4
Q

How long does morning stiffness typically last in OA?

A

<30min

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5
Q

Signs & symptoms of OA (7)

A
  1. Pain
  2. Stiffness
  3. Tenderness
  4. Limited mvmt
  5. Variable degrees of inflammation
  6. Crepitus
  7. “Gelling” after inactivity (stiffness)
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6
Q

What is crepitus?

A

An audible or palpable crunching or popping in the joint caused the the irregularity of opposing cartilage surfaces

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7
Q

What is rheumatoid arthritis (RA)?

A

Chronic, autoimmune inflammatory condition, which develops suddenly over a period of weeks-months

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8
Q

What are common joints affected in RA? (11)

A
  1. Neck
  2. Jaw
  3. Hips
  4. Knees
  5. Ankles
  6. MTPs
  7. Shoulders
  8. Elbows
  9. Wrists
  10. PIPs
  11. MCPs
  12. Thumb CMCs
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9
Q

What is the disease process of RA?

A

Inflammatory, characterized by synovitis & a polyarticular & symmetrical presentation. Characterized by flare-ups and periods of remission.

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10
Q

How long does morning stiffness typically last in RA?

A

1-2+ hours

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11
Q

Systemic features of RA?

A

Fever, malaise, fatigue

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12
Q

Mechanism of RA disease process

A

Synovitis (inflammation of synovial membrane) - degrading enzymes, swelling due to too much synovial fluid, enlargement of the synovium, & thickening of joint capsule

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13
Q

What are common deformities due to RA? (4)

A
  1. Wrist radial deviation
  2. MP ulnar deviation
  3. Swan neck deformity
  4. Boutonniere deformity
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14
Q

OT Eval Process for Arthritis: (5)

A
  1. Client hx (dx, onset, meds, etc.)
  2. Occupational profile (roles, activity, typical occ’s)
  3. Occupational performance status (ability to participate in meaningful roles & occupations)
  4. Cognitive, psychologic, & social status
  5. Clinical status (inflammation, ROM, strength, hand function, stiffness, pain, sensation, joint instability & deformity, physical endurance & functional mobility)
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15
Q

Procedures for MTT with arthritis (4)

A
  1. Resistance is applied in the pain-free range (not the hard/soft end-feel)
  2. Use joint protection principles
  3. Discontinue resistance if there is pain
  4. Use functional motions when use of resistance is contraindicated (in acute or active phase of arthritis)
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16
Q

What are Bouchard’s nodes?

A

Osteophyte formation (enlarged bony nodule) of the PIP

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17
Q

What are Heberden’s nodes?

A

Osteophyte formation (enlarged bony nodule) of the DIP

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18
Q

What is anklyosis?

A

Fusion of the bones of a joint, characterized by lack of joint mobility.

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19
Q

What is multilans deformity?

A

Characterized by floppy joints with redundant skin - bones shorted & renders the joint completely unusable.

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20
Q

Overarching goal of OT intervention with arthritis

A
  1. Decrease pain
  2. Protect joints
  3. Increase function
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21
Q

General OT objectives include (6)

A
  1. Maintain or increase ability to engage in meaningful occupations
  2. Maintain or increase joint mobility & strength
  3. Maximize physical endurance
  4. Protect against or minimize deformity
  5. Increase understanding of disease & how to deal with it
  6. Assist with adjustment to disability
22
Q 
Stage of Disease: Acute.
Name Symptoms (6), Objectives (2), & Tx considerations (9)
A

Symptoms: Pain, inflammation, hot red joints, tenderness, overall stiffness, limited motion
Objectives: Decr. pain & inflammation, & maintain ROM, strength & endurance
Tx Considerations: Splinting for localized rest day & night, incr. bedrest, joint protection, AD, PAMs, gentle AROM or PROM to point of pain (no stretch), proper positioning, functional activities to tolerance, isometric exercise

23
Q 
Stage of Disease: Subacute.
Name Symptoms (4), Objectives (2), & Tx considerations (10)
A

Symptoms: inflammation subsiding, warm pink joints, decr. tenderness & pain, stiffness limited to morning
Objectives: Decr. pain & inflammation, & maintain ROM, strength & endurance
Tx Considerations: Less restrictive splinting during day, splinting con’t at night, joint protection, AD, PAMs, AROM or PROM w/ gentle stretch, proper positioning, incr. functional activities to tolerance, isometric exercise

24
Q 
Stage of Disease: Chronic Active. 
Name Symptoms (4), Objectives (2), & Tx considerations (8)
A

Symptoms: minimal inflammation, less tenderness & pain, incr. activity tolerance, low endurance
Objectives: Decr. pain & inflammation, & INCREASE ROM, strength & endurance
Tx Considerations: splinting as needed, joint protection, AD as needed, PAMs as needed, AROM or PROM w/ stretch, incr. functional activities, cardiovascular exercise, resistive exercise (but don’t over stretch joint)

25
Q 
Stage of Disease: Chronic Inactive. 
Name Symptoms (3), Objectives (3), & Tx considerations (10)
A

Symptoms: No inflammation, pain & stiffness from disuse, low endurance
Objectives: Decr. pain, & increase or maintain ROM, increase strength & endurance
Tx Considerations: splinting as needed, joint protection, AD as needed, PAMs as needed, AROM or PROM w/ stretch, incr. functional activities, cardiovascular exercise, resistive exercise (but don’t over stretch joint)

26
Q

General treatment precautions related to arthritis (6)

A
  1. Respect pain
  2. Avoid fatigue
  3. Avoid placing stress on inflamed or unstable joints
  4. Use resistive exercise or activity w/ caution
  5. Be aware of sensory impairments
  6. Be cautious with fragile skin resulting from system disease or pharmacologic side effects.
27
Q

Primary categories of OT Tx for Arthritis

A
  1. Rest & Sleep
  2. PAMs
  3. Therapeutic Exercise
  4. Therapeutic Activity
  5. Splinting
  6. Assistive Devices
  7. Client & family education
28
Q

OT Tx for Arthritis: SLEEP & REST

A

Rest & relaxation can effectively break the cycle of pain, stress & depression by allowing the body time to heal itself.
Recommendation: 8-10hrs sleep per night, 1/2-1hr rest breaks in morning & afternoon
OUTCOMES: less joint swelling, pain, & fatigue

29
Q

OT Tx for Arthritis: PAMs

A

Helpful in relieving pain or increasing/maintaining ROM
Modalities: superficial heat & cold agents
*Note heat has risk of incr. inflammation - not recommended for acutely inflamed joints. In subacute or chronic phases, heat & cold may be equally effective

30
Q

Contraindication of Raynaud’s phenomenon?

A

COLD is contraindicated for this vasospastic disorder of the digits

31
Q

OT Tx for Arthritis: THERAPEUTIC EXERCISE

A

Purpose is to keep muscles joints functioning as normally as possible by maintaining muscle strength, preventing disuse atrophy, & maintaining/improving ROM

32
Q

What’s a sign modification of exercise program is needed?

A

Pain lasting more than 1-2hrs

33
Q

General guidelines for exercise for a ct with Arthritis

A
  1. Avoid undue stress on joints
  2. Avoid pain & swelling
  3. Work within ct’s comfortable ROM
34
Q

Contraindication in exercise program for Active Phase arthritis

A

If in active phase, never STRETCH the joint. PROM & AROM may be used, but only within pain limits/comfy ROM

35
Q

When can resistive exercised be used?

A

NEVER IN ACUTE PHASE

May be appropriate at later phases

36
Q

OT Tx for Arthritis: THERAPEUTIC ACTIVITY

A

Both physical & physiological benefits - Discussing past & present hobbies will help determine a beneficial activity, graded appropriately for safe engagement

37
Q

What activities do you have to be careful with RA?

A

Activities that require use of hand in prolonged static positions (e.g. knitting & crocheting)
*NOTE: Only truly contraindicated if there is active MCP synovitis, a developing swan neck deformity, or thumb CMC involvement

38
Q

OT Tx for Arthritis: SPLINTING (6 indications)

A 
Fundamental goal = maximize function
Indications: 
1. reduce inflammation
2. decr. pain
3. support unstable joints
4. proper positioning
5. limit undesired motion
6. incr. ROM. 
*Primarily beneficial during acute phase
39
Q

Common splints for arthritis (7)

A
  1. Resting hand splint
  2. Wrist splint
  3. MCP ulnar deviation splint
  4. Swan neck splint
  5. Boutonniere splints
  6. Hand-based short thumb spica splint
  7. Opponens splint
40
Q

When is a resting hand splint used? Functions?

A

During acute phase (acute synovitis of the wrist & hand).
Primary function: provide localized rest to involved joints
Other functions: Decr. pain, decr. muscle spasm, & protect joints vulnerable to contracture

41
Q

Recommended position for resting splint

A

Slight wrist extension (0-20 degrees)
Slight wrist ulnar deviation (10-20 degrees)
MCP flexion (20-30 degrees)
Slight PIP & DIP flexion (10-30 degrees)
Thumb - slight ext., abduct. @ CMC, & flex. @ DIP/PIP

42
Q

What an ideal wearing schedule for a resting splint?

A

Worn continually for the duration of the flare-up. Removed at least once a day for skin hygiene & gentle ROM exercises. Con’t full-time wearing schedule for at least 2 weeks after flare-up, with a gradual decrease in wearing time to allow joints to recover. Eventually only wear at night.

43
Q

What are the benefits/function of a wrist splint?

A

Provide wrist stability, decrease pain, & improve function

44
Q

What are the benefits/function of a MCP ulnar deviation splint?

A

Pain relief, stability, alignment, & reduced stress on painful, subluxed, or deviated joints. May slow progression of deformity, but will not prevent it.

45
Q

What are the benefits/function of a swan neck splint?

A

AKA PIP hyperextension block. Used to restrict unwanted PIP hyperextension. Allows the ct to flex the PIP joint more efficiently

46
Q

What are the benefits/function of a boutonniere splint?

A

Block PIP in extension & leave the DIP free to flex

Splinting at night in maximal extension can attempt to maintain ROM

47
Q

What are the benefits/function of thumb splints?

A

Hand-based short thumb spica splint & Opponens splint - used for probs at the MCP or CMC & leave the IPs free
Improve pain & function & reduce subluxation

48
Q

Are dynamic splints ever used? Indications? Cons?

A

Dynamic or serial splints may be used to increase ROM or maximize motion after surgery (e.g. joint arthroplasty). May be indicated if: there is soft-end feel, web space is preserved, & there is minimal inflammation.
Static splinting is generally more tolerated due to stress dynamic splinting puts on a joint.

49
Q

Common Assistive Devices for Arthritis (8)

A
  1. Long-handled devices (e.g. dressing stick, sponge, etc.)
  2. Devices with built-up handles (e.g. pens, button hooks)
  3. Grab Bars
  4. Shower chair/bath bench
  5. Raised toilet seat
  6. Reacher
  7. Knob turner
  8. Electric can & jar openers
50
Q

What’s the purpose of joint protection?

A

Avoid/reduce internal & external joint stress, pain, & inflammation

51
Q

Principles of Joint Protection (10)

A
  1. Respect pain - it’s a signal from the body telling you something’s wrong & working through pain can cause joint damage. Stop before it’s painful.
  2. Maintain muscle strength & joint ROM
  3. Use each joint in its most stable anatomic & functional plane
  4. Avoid positions of deformity
  5. Use the strongest joints available.
  6. Ensure correct patterns of mvmt
  7. Avoid staying in one position for long periods - change body positions, gripping postures, take frequent breaks & integrate active motion into activities
  8. Avoid starting an activity that cannot be stopped immediately if it becomes too stressful
  9. Balance rest & activity - the key to increasing functional endurance is to rest before fatigue sets in
  10. Reduce force & effort
52
Q

Principles of Fatigue Mgmt (6)

A
  1. Attitudes & emotions - remove yourself from stressful situations, use relaxation techniques
  2. Body mechanics - Use your legs when lifting, keep back straight. Avoid reaching. Sit when working.
  3. Work pace - get 10-12hrs of rest daily (night + naps), alternate easy & difficult tasks, spread work throughout the week
  4. Leisure time - Devote a portion of your day to something to enjoy
  5. Work methods - keep items within reach, good light, joint protection, work surfaces @ correct height
  6. Organization - plan ahead, don’t rush, prioritize, delegate

Phys Dys (6 decks)

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