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Hand/UE 3 > Arthritis > Flashcards

Arthritis Flashcards

1
Q

osteoarthritis

A

“wear and tear disease”

breakdown in the articular cartilage due to both mechanical and chemical factors

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2
Q

osteophytes

A

“bone spurs”

new bone formations that can occur in addition to cartilage breakdown in OA, resulting in pain and limitations of joint movement

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3
Q

“triggering”

A

limited digital ROM caused by dragging of the tendon as it passes through a pulley
often caused by osteophytes

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4
Q

“locking”

A

the digit locks into flexion as the tendon fails to pass through a pulley
often caused by osteophytes

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5
Q

Bouchard’s nodes

A

nodules occurring with OA at the PIP joint

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6
Q

Heberden’s nodes

A

nodules occurring with OA at the DIP joint

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7
Q

crepitus

A

grating or popping in joints

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8
Q

common areas of OA involvement (6)

A 
DIPs
PIPs
CMC of thumb
knees
hips
spine
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9
Q

early stage OA

A

joint space narrowed

swelling around joints

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10
Q

moderate stage OA

A

development of osteophytes, cysts, and/or subcondral sclerosis

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11
Q

late stage OA

A

bone erosion
subluxation
fibrotic ankylosis

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12
Q

subcondral sclerosis

A

increase in bone density

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13
Q

fibrotic ankylosis

A

stiffening of a joint due to fibrous growth of tissues in joint

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14
Q

evaluation assessments of OA (6)

A 
pain
AROM
joint stability
inflammation
palpation
ability to perform ADLs
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15
Q

PROM and OA

A

typically not evaluated due to joint instability

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16
Q

assessing ligament stability of thumb in OA

A

evaluate pinch patterns

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17
Q

grind test

A

for DJD at the CMC joint
involves compressing the joint while gently rotating the head of the metacarpal on the trapezium
+ with pain and crepitus

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18
Q

general joint protection principles (6)

A
  1. respect pain
  2. balance rest and activity
  3. exercise in a pain-free range
  4. avoid positions of deformity
  5. reduce the effort and force
  6. use larger/stronger joints
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19
Q

Is “no pain, no gain” a good rule of thumb for the OA patient?

A

NO

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20
Q

OA modalities

A 
warm shower/bath
superficial heat (hot packs/fluido)
non-thermal US
low level laser
electrotherapy
cryotherapy
21
Q

exercise and OA (4)

A
  1. avoid painful ROM by staying within comfort level
  2. combine exercise with joint protection
  3. thumb web space stretching
  4. strengthening 1st dorsal interossi is helpful
22
Q

OA of the thumb

A

characterized at CMC joint by MC adduction and subluxation from the trapezium, MP hyperextension, and IP flexion
*deformity more pronounced during heavy pinch activities

23
Q

Eaton Classification

A

radiographic classification for staging basal joint arthritis of the thumb
widely used to define severity as well as guide treatment

24
Q

Eaton Stage I

A

normal appearance of articular surface and slight joint space widening

25
Q

Eaton Stage II

A

minimal sclerotic changes of subchondral bone with osteophytes and loose bodies less than 2 mm

26
Q

Eaton Stage III

A

trapeziometacarpal joint space markedly narrowed and cystic changes present; subluxation of the MC may have occured; osteophytes and loose bodies greater than 2 mm

27
Q

Eaton Stage IV

A

presence of scaphotrapezial joint disease with narrowing

28
Q

CMC orthoses

A

prefabricated, custom fabricated, PUSH MetaGrip

29
Q

advantages of PUSH MetaGrip

A

long term durability, resisting abrasion
covers minimal surface of palm
heat resistant
can be worn under glove

30
Q

CMC interposition arthroplasty

A

resection of CMC joint that then allows the MC to return to ABducted position
donor tendon is rolled up and interpositioned in the joint space
ligaments are reconstructed

31
Q

CMC interpostion arthroplasty post-op

A

cast 4-6 weeks then orthosis for 6-12 weeks

32
Q

CMC interposition arthroplasty precautions

A

most surgeons recommend waiting at least 3 months before any heavy pinching activities are allowed

33
Q

OA of DIP joint

A

often have Heberden’s nodes
painful initially, but pain usually decreases over time
orthoses can help support joint/decrease pain
surgical fusion is option

34
Q

rheumatoid arthritis

A

an inflammatory, systemic, autoimmune disorder
manifests primarily in synovial tissue
often symmetrical and bilateral
consists of remissions and exacerbations

35
Q

common areas of RA involvement in the hand (4)

A

MPs
PIPs
thumb
wrist

36
Q

Stage I RA

A

joint swelling and inflammation
warm when palpated
most painful phase

37
Q

Stage II RA

A

decrease in symptoms

nodules may develop in bursa

38
Q

Stage III RA

A

destructive
less pain reported
irreversible joint deformities

39
Q

Stage IV RA

A

chronic inactive or skeletal collapse and deformity

may include instability, dislocation, spontaneous fusion

40
Q

RA deformities of hand (7)

A
  1. swan neck deformity
  2. boutonniere deformity
  3. MCP joint ulnar deviation
  4. volar subluxation of the carpus on the radius
  5. distal ulnar dorsal subluxation
  6. thumb deformities
  7. crepitus
41
Q

swan neck deformity

A

DIP flexion and PIP hyperextension

42
Q

boutonniere deformity

A

PIP flexion and DIP hyperextension

weakened central tendon, lateral bands slip volar to PIP joint

43
Q

intrinsic plus position

A

MP flexion with IP extension

44
Q

In RA, what position do the MP joints want to go?

A

ulnar deviation

45
Q

Oval-8 splint

A

high temperature plastic splint option for swan neck deformity

46
Q

Non-Op treatment RA (5)

A
  1. joint protection
  2. modalities
  3. exercise
  4. strengthening
  5. remedies
47
Q

RA joint protection

A

along with principles for OA should also address specific deformity or potential deformity

48
Q

RA precautions (2)

A
  1. heat is contraindicated during the acute inflammatory phase
  2. exercises should never create deforming forces
49
Q

wrist and MP joint deformities

A

ulnar displacement of the proximal carpal row due to ligament instability can cause radial deviation of the hand
MPs may secondarily go into ulnar deviation

Hand/UE 3 (7 decks)

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