Degenerative Joint Disorders Flashcards
Etiology of DJD
Combination of factors
-biomedical
-Biomechanical
-genetic factors
Pathogenesis of DJD
narrowing of joint capsule
wear and tear on bones
hyaline cartilage decreases
Shock absorber decreases and muscles begin absorbing shock
localized to joints
Primary vs secondary DJD
primary- spontaneous
Secondary- due to fx, injury or disease, process can be halted if this is the cause
medical treatment for DJD
pain meds, weight reduction, arthroplasties, arthrodesis, osteotomy, osteoplasty
Clinical presentation of DJD
joint tenderness/ pain
impaired ROM
pain increased with activity and decreased with rest
Crepitus
morning and night stiffness
Pain progresses
Bone changes
Proliferation of bones- bone spurs
Osteophyte formation- at site of capsular and ligament attachment
capped by layers of cartilage
Heberden’s Nodes
distal phalanx slide along middle phalanx on the forces applied to pinch and grasp
Results in great shearing stress
Bouchard nodes
PIP joints
Conservative tx for arthritis
reduce pain
modalities
maintain and increase strength as long as pain does not increase
increase independence
educate the client on ways to protect the joints that have the smallest muscles around them
Pre-operative tx
Patient education
objective assessment (look at how their life is now vs how it will be after surgery)
functional assessment
pre-op splinting if needed
Post-op therapy of OA
static splint
Dynamic splint if indicated
Edema and Scar control
AROM/PROM
Monitor pain
Functional use/retraining
Arthroplasty def and goals
replacement of joints
Goals: relive pain, improve function, increase ROM
Total arthroplasty vs hemiarthroplasty
Total- 2 surfaces are replaced (ex. acetabulum and femoral head)
Hemi- only 1 joint surface replaced (ex. only femoral head)
Restrictions following an Arthroplasty
Related to severity of fx if indicated
Ability of device to withstand stress
Weight of patient
cognitive status
Most common place for musculoskeletal disorder of spine
Degeneration first noted in lumbar and cervical spine regions
Causes of MSK disorder of spine
mechanical factors
chemical factors
injuries
Spondylolisthesis (forward slip of vertebral body)
infection
Disc degeneration causing MSK disorder of spine
nucleus degenerates due to lack of hydration
Decreased resilience, thickness and height
loses elasticity
Causes segmental instability, hyper extension, narrowing, stenosis
Segmental instability causing MSK disorder of spine
smooth motion lost due to disk degeneration
uneven and excessive motion
joints form traction spurs
more susceptible to injury
chronic backache
pain may be referred to buttocks
Segmental hyperextension of spine
Degenerative changes in annulus fibrosus
caused by obesity or decreased abdominal tone
Presents with chronic low back pain
Segmental narrowing
Progressive narrowing of disc space with age
decreased joint motion, stiff, decreased pain
late stage of Degenerative disc disease
loss of mobility in lumbar spine
Herniation of intervertebral disc
effects young males most
Stretching of the annulus fibrosis causes pain
herniation compresses/stretches nerve root- sciatica
loss of lumbar lordosis, trunk shifts to one side
mobility of spine lost
Spinal stenosis
most common in lumbar spine
ache in buttocks, thigh, calf when walking or standing
common over age of 50
narrowing of spinal canal compresses nerve roots
pain relieved by sitting or reclining
Aim of tx for MSK disorders of spine
Decrease pain
increase function
back education programs
treatment methods for MSK disorders of spine
psychological considerations- reassurance
pharmacology- decrease inflammation
Bed rest with early mobility- rest of short period on firm mattress
Spinal braces
OT adresses IADL, ADL and donning and doffing braces
Spinal fusion
most common
will not be able to increase ROM
Fuse higher and lower than injury
Laminectomy
decompression
Removed part of bone, spurs and ligaments and then fuse
Foraminotomy
Widens spaces for nerve roots
Discectomy
Surgical removal of herniated disc lateral removes the central portion of the intervertebral disc and the nucleus
Disc replacement
new vertebrae
for pts whose back pain has not be reduced by non-operative methods
Intervention after spinal surgery
Bracing
Gradual return to activity
Teach adaptive care techniques to avoid trunk rotation
Log rolling in bed
no pushing/pulling
use AE
