Arthritis Flashcards
1
Q
What are the goals of therapy for arthritis?
A
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.
2
Q
What is Osteoarthritis?
A
- 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
3
Q
What are OA symptoms?
A
- Use related pain
- Stiffness after inactivity
- Loss of cartilage – bone enlargement
- Commonly seen in the DIPs/PIPs
4
Q
What are Herbenden’s nodes?
A
- Bony enlargements that indicate cartilage damage
- found at DIP joints
5
Q
What are Bouchard’s nodes?
A
- bony enlargements found at PIP joints
6
Q
What is RA?
A
- 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
7
Q
What are the stages of RA?
A
8
Q
What are the common arthritic hand deformities?
A
- 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)
9
Q
What is swan neck?
A
- 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
10
Q
What is the Bunnel test?
A
- 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
11
Q
What are the OT interventions for OA?
A
- 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
12
Q
What are some swan neck splints?
A
- Extension Block
- Murphy Ring
- Oval Eight
- Silver Ring
13
Q
What is boutonniere deformity?
A
- 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
14
Q
Describe boutonniere?
A
- 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
15
Q
OT intervention for boutonniere’s?
A
- 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
16
Q
MCP Deformities
Ulnar drift/volar subluxation
A
MP Arthroplasty: Severe Arthritis
- Ulnar drift and volar subluxation and/or intrinsic tightness
- Appropriate amount of bone stock required
- If not: salvage procedure: fusion
17
Q
Rheumatoid Thumb
A
- Synovial inflammation
- Destroy articular cartilage
- Stretch collateral ligaments
- Decrease in joint support/stability
- CMC Inflammation
18
Q
What are the thumb deformities?
A
19
Q
What is the OT intervention for the thumb?
A
- Initially when joint are supple/correctable
- Maintain ROM
- Joint protection
- Splinting
When CMC becomes involved
- Long Opponens CMC splint
- Prevent adduction of 1st metacarpal
- Maintain Functional ROM
20
Q
Splinting
A
- CMC involvement- protect CMC, Prevent 1st Metacarpal subluxation
- Long Opponens splint – night wear and as much as possible during the day
- Remove for gentle ROM exersises 3x’s /day
- Short opponens to wear during daily functional activies
21
Q
What are some OT arthritis interventions?
A
- ADL/Functional training
- Patient Education
- Energy Conservation/Joint Protection
- Pain/edema management
- General conditioning
- Strengthening / ROM
- Contracture prevention/management
- Hand function and dexterity
- Pinch (5-7 lbs required for most ADLs)
- Grip (at least 20 lbs required for ADLs)
¢NOTE: Do not test Grip/Pinch if patient is having an Active Flare
22
Q
What are some other treatments?
A
- Medications
- Nonsteroidal Anti-inflammatory (NSAIDs)
- Advil, Aleve, Naprosyn, Celebrex, Bayer, Bufferin
- Side effects: gastrointestinal/liver complications, Celebrex: stroke / heart attack
- Cortiocosteroids
- Cortisone, prednisone
- Side effects: weight gain, hypertension, insomnia, mood changes
- Disease Modifying Antirheumatic Drugs (DMARDs)
- Gold Salts, Methotrexate, Penicillamine
- Side effects: Liver, kidney,blood effects, immunosuppression
- Surgery
- Synovectomy
- Arthorodesis
- Tendon repair
23
Q
What are some energy conservation techniques?
A
- Use the strongest, largest joint possible
- Use two hands
- Push instead of lift or pull
- Reduce effort & force
- Lightweight tools and utensils
- Add levers
- Smaller size containers
- Use good posture
- Use good body mechanics
- Adequate rest and nutrition
Delegate or eliminate tasks
24
Q
Describe joint protection and techniques?
A
- Provide Adaptive equipment to protect thumb
- Car door opening
- Key turner
- Built up pen/felt tip pens
- Built up/light weight eating utensils
- Built up knitting needles/crochet hooks
- Shorten time engaging in these activities
- No wringing rags
25
What are positions to AVOID?
* Arthritic joints are inflammed, may be damaged, and are not as strong as normal joints
* Excessive stresses further damage structures leading to deformities
* Deformities follow “normal” pull of the joints
* Resistive movement should be done opposite positions of deformities
* Avoid bent elbows, knees, hips, and back while sleeping.
* Practice good posture during the day.
* Use workstation evaluation for proper posture.
See text for specific hand deformities.
Avoid Tight grip:
* Overstresses all finger joints
* Ulnar drift of finger
* Inflammation of MP
* Avoid sustained holding
* Causes fatigue and stretching of soft tissue
* Use adaptive equipment
* Frequent rest breaks
* Stretch opposite of holding patterns
26
Techniques to use of strongest joint?
* Usually the most proximal joint
* Bilateral use best if possible
* Adaptive technique or equipment to avoid use altogether
* Slide heavy objects on kitchen counters.
* Use palms, rather than fingers, to lift or push.
* Carry a backpack, instead of a handheld purse.
* Keep packages close to the body—use two hands.
* Push swinging doors open with side of body instead of the hands.
27
Pain
* Decrease activities that lead to fatigue the next day
* Stop activities before the point of discomfort.
* Decrease activities that cause pain that lasts more than 2 hours.
* Avoid activities that put strain on painful or stiff joints.
28
OT intervention
* ADL/Functional training
* Adaptive Equipment
* Self Management
* Patient Education
* Energy Conservation/Joint Protection
* Pain/edema management
* Strengthening / ROM
* Contracture prevention/management
* Hand function and dexterity
* Pinch (5-7 lbs required for most ADLs)
* Grip (at least 20 lbs required for ADLs)
* NOTE: Do not test Grip/Pinch if patient is having an Active Flare
* Splinting
