Arthritis Flashcards
osteoarthritis
“wear and tear disease”breakdown in the articular cartilage due to both mechanical and chemical factors
osteophytes
“bone spurs”new bone formations that can occur in addition to cartilage breakdown in OA, resulting in pain and limitations of joint movement
“triggering”
limited digital ROM caused by dragging of the tendon as it passes through a pulleyoften caused by osteophytes
“locking”
the digit locks into flexion as the tendon fails to pass through a pulleyoften caused by osteophytes
Bouchard’s nodes
nodules occurring with OA at the PIP joint
Heberden’s nodes
nodules occurring with OA at the DIP joint
crepitus
grating or popping in joints
common areas of OA involvement (6)
DIPsPIPsCMC of thumbkneeshipsspine
early stage OA
joint space narrowedswelling around joints
moderate stage OA
development of osteophytes, cysts, and/or subcondral sclerosis
late stage OA
bone erosionsubluxationfibrotic ankylosis
subcondral sclerosis
increase in bone density
fibrotic ankylosis
stiffening of a joint due to fibrous growth of tissues in joint
evaluation assessments of OA (6)
painAROMjoint stabilityinflammationpalpationability to perform ADLs
PROM and OA
typically not evaluated due to joint instability
assessing ligament stability of thumb in OA
evaluate pinch patterns
grind test
for DJD at the CMC jointinvolves compressing the joint while gently rotating the head of the metacarpal on the trapezium+ with pain and crepitus
general joint protection principles (6)
- respect pain2. balance rest and activity3. exercise in a pain-free range4. avoid positions of deformity5. reduce the effort and force6. use larger/stronger joints
Is “no pain, no gain” a good rule of thumb for the OA patient?
NO
OA modalities
warm shower/bathsuperficial heat (hot packs/fluido)non-thermal USlow level laserelectrotherapycryotherapy
exercise and OA (4)
- avoid painful ROM by staying within comfort level2. combine exercise with joint protection3. thumb web space stretching4. strengthening 1st dorsal interossi is helpful
OA of the thumb
characterized at CMC joint by MC adduction and subluxation from the trapezium, MP hyperextension, and IP flexion*deformity more pronounced during heavy pinch activities
Eaton Classification
radiographic classification for staging basal joint arthritis of the thumbwidely used to define severity as well as guide treatment
Eaton Stage I
normal appearance of articular surface and slight joint space widening
Eaton Stage II
minimal sclerotic changes of subchondral bone with osteophytes and loose bodies less than 2 mm
Eaton Stage III
trapeziometacarpal joint space markedly narrowed and cystic changes present; subluxation of the MC may have occured; osteophytes and loose bodies greater than 2 mm
Eaton Stage IV
presence of scaphotrapezial joint disease with narrowing
CMC orthoses
prefabricated, custom fabricated, PUSH MetaGrip
advantages of PUSH MetaGrip
long term durability, resisting abrasioncovers minimal surface of palmheat resistantcan be worn under glove
CMC interposition arthroplasty
resection of CMC joint that then allows the MC to return to ABducted positiondonor tendon is rolled up and interpositioned in the joint spaceligaments are reconstructed
CMC interpostion arthroplasty post-op
cast 4-6 weeks then orthosis for 6-12 weeks
CMC interposition arthroplasty precautions
most surgeons recommend waiting at least 3 months before any heavy pinching activities are allowed
OA of DIP joint
often have Heberden’s nodespainful initially, but pain usually decreases over timeorthoses can help support joint/decrease painsurgical fusion is option
rheumatoid arthritis
an inflammatory, systemic, autoimmune disordermanifests primarily in synovial tissueoften symmetrical and bilateralconsists of remissions and exacerbations
common areas of RA involvement in the hand (4)
MPsPIPsthumbwrist
Stage I RA
joint swelling and inflammationwarm when palpatedmost painful phase
Stage II RA
decrease in symptomsnodules may develop in bursa
Stage III RA
destructiveless pain reportedirreversible joint deformities
Stage IV RA
chronic inactive or skeletal collapse and deformitymay include instability, dislocation, spontaneous fusion
RA deformities of hand (7)
- swan neck deformity2. boutonniere deformity3. MCP joint ulnar deviation4. volar subluxation of the carpus on the radius5. distal ulnar dorsal subluxation6. thumb deformities7. crepitus
swan neck deformity
DIP flexion and PIP hyperextension
boutonniere deformity
PIP flexion and DIP hyperextension weakened central tendon, lateral bands slip volar to PIP joint
intrinsic plus position
MP flexion with IP extension
In RA, what position do the MP joints want to go?
ulnar deviation
Oval-8 splint
high temperature plastic splint option for swan neck deformity
Non-Op treatment RA (5)
- joint protection2. modalities3. exercise4. strengthening5. remedies
RA joint protection
along with principles for OA should also address specific deformity or potential deformity
RA precautions (2)
- heat is contraindicated during the acute inflammatory phase2. exercises should never create deforming forces
wrist and MP joint deformities
ulnar displacement of the proximal carpal row due to ligament instability can cause radial deviation of the handMPs may secondarily go into ulnar deviation
