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Musckuloskeletal > Arthritis > Flashcards

Arthritis Flashcards

1
Q

Arthritis

A
  • number 1 cause of disability in the country

- Arthritis or arthropathy is not a single disease; it is an informal way of referring to joint pain or joint disease.

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2
Q

two common forms of Arthritis

A

Osteoarthritis/Degenerative Arthritis-

  • the most common joint disorder in the world
  • OA is associated with a defective integrity of the articular cartilage and changes in the underlying bone.

Rheumatoid Arthritis

  • is a chronic, systemic, inflammatory auto-immune disorder.
  • affects more than just the joints. Joints affected as a secondary effect of RA (affects the eyes, tissue) it is an autoimmune response where it attacks the body.

*Can get earing away or bone formation in areas it should not be, Bone spurs develop because of inflammation on surface, creating uneven surface.

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3
Q

Other forms of Arthritis

A
  • Systemic Lupus Erythematosus
  • Gout
  • Bursitis
  • Fibromyalgia
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4
Q

Systemic Lupus Erythematosus

A

Autoimmune disease causing inflammation and blood vessel abnormalities

*falls under the arthritis arthopathy conditions

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5
Q

Gout

A

A disorder cause by uric acid or urate crystal deposition that usually affects one to a few joints at a time.

*caused by too much uric acid in the body. Can just affect the big toe, gets really inflamed and really painful. Usually these folks have to really watch their diet. Don’t want to get the uric acid build up. Have to have injections into site or diet change.

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6
Q

Bursitis

A

Inflammation of the bursa

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7
Q

Fibromyalgia

A

Diffuse widespread pain with specific tender points

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8
Q

OA/degenerative arthritis

A
  • most common type of arthritis
  • the wear and tear disease
  • cartilage wears away
  • bone against bone causes pain and inflammation
  • inflammation can lead to osteophyte formation (small bone spurs that can cause stiffness and problems with the normal mechanics of movement)
  • First sign- the cartilage starts to thin (the joint shock absorbers start to wear away) then we start to get bone on bone contact and pain occurs.
  • Take x-ray to look at the joint surfaces to see how much space is between bones. If no space they know the cartilage has worn away or even worse (more advanced) erosion on the surfaces.
  • Swelling, redness, due to inflammation
  • Inflammation can cause the formation of bone spurs that can take away and limit motion and lead to stiffness.
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9
Q

Osteophytes

A

Osteophyte formation at the MP level can cause trigger finger as it can hinder tendon excursion through the A1 pulley system

*When treating trigger finger we need to look if they have rheumatoid or degenerative arthritis.

If an osteophyte they have to burn it off- drill it down.

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10
Q

Heberden’s Nodes:

A

Distal Phalanx Osteophytes

Boney spurs (abnormal bumps) at the DIP joint they are called Heberden’s Nodes

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11
Q

Bouchard’s Nodes

A

Proximal Phalanx Osteophytes

When bone spurs at the PIP level are known as Bouchard’s Nodes

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12
Q

Crepitus

A

Grating, popping, crackling of tissues and joint surfaces. Crepitus is a sign of inflammation and in the case of a joint could indicate uneven joint surfaces and deterioration of cartilage

  • Crepitus can be at joints when we move them. If it pops and there is not pain it isn’t something we have to worry about. Can be caused by gas.
  • can indicate uneven surfaces
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13
Q

Risk factors

A
  • excessive weight- more weight on joints=more wear and tear.
  • Family History
  • Age and previous injury (ACL tear example)
  • Work history involving repetitive movement and lifting resistance

*Loosy goosy joint ligaments may be good when we are young but are bad when we get older. More wear and tear.

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14
Q

Treatment and healing

A
  • Currently there is no cure for OA- only joint replacement- can repair the surfaces (take away the pain but no substitute for what they anatomically had before) will be precautions and things they have to be careful with.
  • client specific treatment based on occupational goals
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15
Q

Medications for osteoarthritis

A

-NSAIDS (aleve and advil)
-Cox 2 inhibitors
-Chondroitin and Glucosamine sulfate (help to prevent progression)
-Topical creams (insurance covers)
Compounded creams (this really helps with inflammation, work much better not covered by insurance

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16
Q

1st CMC basal joint arthritis

A

super common. more so in females

arthritis of the thumb- base of the thumb and the trapezium

17
Q

Interesting facts

A

-pinch at tip transmits forces 7-12 times down to the CMCJ of the thumb

  • Females develop arthritis in this joint more than males
  • hormones
  • size of bone
  • occupational tasks
18
Q

Pt. chief complaint

A
  • pain when pinching or gripping
  • difficulty performing ADLs, opening jars, clothing fasteners
  • Difficulty tearing packages
  • therapist who perform a lot of manual therapy at high risk.

*palpation and vision are important

19
Q

Evaluation

A

CMC grind test

  • Visual Observations: Nodules, zig zag deformity of the thumb, flexion or hyperextension of the IP, Joint laxity or hyper extension at the MP
  • Look for tight webspace (adductor pollicis tightness)
  • Measure ROM of the thumb, especially palmar and radial abduction
  • Grip and pinch strength if pain is low.
  • Assess thumb posture when pinching.
  • Assess dorsal capsule stability using lateral key pinch
20
Q

OT role in conservative management

A
  • educate in web space stretch
  • splinting to support CMC
  • selective strengthening of stabilizing muscles
21
Q

Metagrip:Handlab.com

A

can get laxity in the beak ligament

-Stabilizes the joint posteriorly and volarly and helps keep it into flexion. It helps to stabilize the joint. Measure girth of the metacarpal. Put on client and then pinch it to where it stabilizes their joint. (covered by insurance, has its own L code).

22
Q

Isometric Strengthening of the 1st interossei

A

Pretend resting hand over ball. Abduct finger and then apply resistance.
1st dorsal interossei abducts.

23
Q

Isometric strengthening of the flexors and extensors

A
  • Air ball squeeze for 10 repetitions/10 second holds (flexion)
  • Rubber band extension for 10 repetitions/10 second holds (extension) around digits just distal to MP joint.
  • Goal to maintain the natural arc of the thumb which reduces forces at the CMCJ
24
Q

Surgical intervention: CMC suspension arthroplasty

A

go in and make a dorsal incision and break it into small fragments an then pull out the pieces (get rid of the trapezium)

  • Metacarpal will fall into the thumb and shortens the thumb and impacts function.
  • Suspension arthroplasty- suspend for metacarpal with muscle (sometimes used the palmaris longus tendon)
  • LRT- ligament reconstruction trapeziotomy- works much better- still anchovy procedure but also has the ligament repair.
  • Last one- drill a hole and run it from second metacarpal to the 1st metacarpal and keeps it from dropping down into that space and in the mean time scar tissue can fall into that space (temporary suspension with suture wire.
25
Q

Post op rehab

A
  • cast for 4 to 6 weeks (6 if ligament reconstruction)
  • AROM
  • Scar massage
  • Edema control
26
Q

RA

A
  • autoimmune disorder
  • Immune system attacks the body
  • Destroys soft tissues and ligaments
  • Results in pain and deformity
  • Can coincide with other forms of arthritis

*can get both RA and OA

27
Q

RA cont’d

A

-RA is a chronic disease that causes pain, stiffness, swelling and loss of function in the joints. It occurs when your immune system mistakenly starts attacking the healthy soft tissue surrounding the joints.

can also affect other systems including the skin, pulmonary , and cardiovascular systems

28
Q

Signs and Symptoms of RA

A

Affects soft tissues first then bone

Joint pain, swelling and stiffness

Fatigue and muscle pain

Flu-like symptoms, including low-grade fever

Worse joint stiffness after sleeping or prolonged sitting

Rheumatoid nodules, or lumps of tissue under the skin. Usually soft (synovitis)

Loss of appetite and/or weight loss

29
Q

what is involved in RA

A

Synovium- is a tissue that lines the entire inner surface of the joint, except where the joint is lined with cartilage

  • when synovium becomes inflamed it is known as synovitis
  • In RA the synovium thickens from 2 cell layers to 12 layers and turns into a deconstructive tissue known as pannus
30
Q

RA- Stage 1

A
  • most painful
  • characterized by swelling and inflammation that is warm to the touch. No changes visible on x-ray
  • early diagnosis and treatment focusing on decreasing inflammation in stage 1 will result in less damage in the later stages of RA
  • With OA we can do a little bit more with modalities (not as much with RA- splinting not as effective and not as effective with modalities)
31
Q

other stages of RA

A
  • symptoms start to decrease in STAGE 2
  • the inflammatory synovium forms a pannus that extends beyond the cartilage and invades the ligament attachments and tendons. Joint ROM is less painful
  • there are no obvious deformities (with x-rays)
32
Q

Stage 2

A

pannus formation

  • swelling starts to subside
  • the synovium thickens and develops an inflammatory tissue called pannus. This tissue is destructive and destroys cartilage, ligaments, joint capsule, tendon and eventually leads to bone erosion.
33
Q

stage 3

A
  • Destructive, chronic active phase. Pain is less but irreversible joint damage has occurred
  • Radiographic changes of bone and cartilage destruction, joint deformity and possible tendon rupture. Super vulnerable to tendon rupture (commonly a digital tendon due to sharpness and sheering from the metacarpal heads)
  • EDC jumps off the track with these folks (because of loose sagittal band). Drop to the side and affects the pull through.

Get Ulnar drift because of the zigzag deformation with a flexed posture.

34
Q

Stage 4

A

skeletal collapse and severe joint deformities

-supporting soft tissues are totally deteriorated and the joints become unstable

35
Q

Zig Zag deformity

A

Carpal=ulnar drift
Metacarpal= radial drift
Digital drift= ulnar drift

Can see swan neck deformity or boutonnieres deformity depending on what tendons are injured

36
Q

treatment

A

-control inflammation through medication

splinting to prevent deformity

  • Ulnar drift
  • resting hand splint
  • wrist support

*Don’t want to block wrist motion during the day. Just use a hand splint to support hand structure to prevent resting in ulnar drift. Help keep in proper alignment to prevent developing proper deformity.

Doc does two procedures

  • Can go in and tighten up the ulnar collateral ligament and place joint back into a neutral position (we make splint to help support proper alignment and add outrigger to help extend joints as well)
  • if surfaces are too far gone they have to go in and replace the joint surfaces. Place little spacers in made of either silicone or titanium just cannot do power grip with this but it helps with pain reduction. Can do ADLs but no heavy lifting or chores.

Elbow replacement- 5 pound limit on it. Functional but no heavy lifting or activity. (no more than 10 pounds) purely for pain reduction.
-wrist and elbow are least effective in terms of returning to function.

37
Q

Surgery in RA

A
  • extensor tendon ruptures/repair
  • Joint replacements and realignment
  • Wrist fusion- fuse bonds together in a functional posture to oppose and flex without pain. Goal is to control pain
  • Total wrist replacement

Carpectomy- take out the proximal row all together besides the pisiform

38
Q

Treatment of Arthritis

A
  • patient education regarding the disease process and importance of controlling the inflammation
  • support groups

*Helps when the patient understands the disease process. The pathology and why (they appreciate it). Explain to them in layman terms and if they understand it then maybe progress to the medical terms so they really understand everything. More compliance with the treatment process and gives them confidence that you know what you are doing.

Musckuloskeletal (14 decks)

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