Arthritis Flashcards
What are the goals of therapy for arthritis?
The goals of therapy are to reduce inflammation, decrease trauma to the joints, decrease pain, facilitate proper joint alignment, and improve function in activities of daily living.
What is Osteoarthritis?
- Incidence: Increases with age (60-65 y.o.)
- Develops over a period of years
- Impacts individual joints
- Joints commonly affected: Neck, spine, hips, knees, MTPs, DIPs, PIPs, CMC
- Morning stiffness: 30 min
What are OA symptoms?
- Use related pain
- Stiffness after inactivity
- Loss of cartilage – bone enlargement
- Commonly seen in the DIPs/PIPs
What are Herbenden’s nodes?
- Bony enlargements that indicate cartilage damage
- found at DIP joints
What are Bouchard’s nodes?
- bony enlargements found at PIP joints
What is RA?
- Systemic inflammatory condition
- Peak incidence: 40-60 y.o.
- 3:1 ratio female-to-male
- Occurs suddenly (within several weeks/months)
- Joint involvement: symmetrical
- Joints commonly affected: Neck, jaw, knees, ankles, MTPs, shoulders, elbows, wrists, PIPs, MCPs and thumb joints
- Morning stiffness: 1-2 hours
What are the stages of RA?
What are the common arthritic hand deformities?
- Swan Neck
- Boutonniere Deformity
- Thumb Deformities
- Ulnar Drift and Volar Subluxation of MPs
- Heberden’s nodes (common with OA)
- Bouchard’s nodes (common with OA)
What is swan neck?
- Dorsal displacement of the lateral bands
- Decrease tension to extend DIP
- PIP: synovitis stretches volar plate, PIP hyper-extends, lateral bands displace dorsally relaxing the pull on the terminal tendon which leads to flexion of DIP
- Tight intrinsic
- Position to AVOID: LATERAL PINCH INTRINSIC PLUS POSITION
What is the Bunnel test?
- Intrinsic Tightness is demonstrated by comparing passive PIP joint flexion w/ MP joint held in extension and then flexion; Intrinsics are put on stretch with MCP extension
- Test: Passively hold pt’s MCP joints in extension & either actively or passively flex PIP
- Intrinsic tightness- IP joints will have limited flexion when MP are passively extended (when MP joint are held in flexion, active extension of IP joint is normal)
- *PIP joint flexion is restricted when MP joint is held in extension but not when MP joint is held in flexion, PIP ROM is WNL
What are the OT interventions for OA?
- A/PROM exercises
- Joint protection/adaptive equipment
- Intrinsic stretch exercises: Passive IP flexion stretch with MP extended
- Tri-point splint
- Dorsal pressure on proximal and middle phalanx
- Volar pressure at the PIP joint
- Allow full flexion
What are some swan neck splints?
- Extension Block
- Murphy Ring
- Oval Eight
- Silver Ring
What is boutonniere deformity?
- Deformity of a digit in which it assumes a posture of conjoint PIP flexion and DIP hyperextension
- Proximal pull of extensor mechanism may also lead to MP extension
Describe boutonniere?
- Loss of the central slip results in unopposed PIP flexion by the FDS tendon
- Volar migration of the lateral bands secondary to transverse retinacular ligament and triangular ligament laxity
- Intrinsic tendon pulls directly on the DIP joint which results in hyperextension
Positions to AVOID: Hyperextension at DIP, flexion at PIP
OT intervention for boutonniere’s?
- Acute
- Modalities to decrease pain/edema
- PIP splinted in 0 degrees extension – DIP/MP free
- Exercises to increase PIP extension and DIP active flexion
- Chronic deformity
- Primary Goals: Increase PIP ROM, decrease pain/edema
- A/PROM and resistive exercises – 3-5x’s/day
- Active DIP exercises (Burton)
- Splinting program to gain ROM
- Static, dynamic, serial
If PIP contracture persists: surgical intervention may be considered
What are the thumb deformities?
