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Musculoskeletal 1 > Hand examination/arthritis and deformities > Flashcards

Hand examination/arthritis and deformities Flashcards

1
Q

What is articular cartilage made of

A
  • articular chondrocytes which provide
  • extracellular matrix
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2
Q

what is the extracellular matrix composed of

A
  • collagen (type 2 forms fibrils that provide shear strength to matrix)
  • proteoglycans, carry GAGs-chondroitin sulfate (bind with water molecules)
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3
Q

Articular cartilage properties/function

A
  • absorb compressive loads and deforms without damage (80% water- GAGs)
  • withstand tensile shear stress (extracellular matrix) - collagen fibrils
  • lubricates joint
  • avascular = not good healing properties
  • aneural = dont feel damage until its bone on bone
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4
Q

Osteoarthritis DJD etiology

A
  • Wear/tear - degradation of articular cartilage: natural occurrence of aging >40 y/o
  • abuse, overuse
  • joint injury
  • hypermobility
  • hypomobility
  • post surgery
  • heredity
  • obesity especially in LE
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5
Q

Explain how these can cause OA
1. joint injury
2. hypermobility
3. hypomobility

A
  1. intra-articular fx, dislocation, ligament tear can cause damage to articular cartilage as well
  2. hypermobility: excessive motion can cause wear and tear
  3. hypomobility: tight and doesn’t move = no nutrition getting to the joint
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6
Q

How does OA cycle occur

A
  1. depletion of ground substance GAGS, chondroitin sulfate decreases, decreases in water content
  2. chondrocytes turn off and matrix therefore does not replace and collagen fibers fibrillate
  3. chondrocyte death occurs; release of proteolytic enzymes
  4. inflammation and activaiton of pain receptors
  5. capsillar fibrosis = decrease ROM, nutrition, lubrication
  6. progressive cartilage degradation, decrease shock/load absorption
  7. increase force to subchondral bone causing osteophytes
  8. altered joint mechanics
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7
Q

Signs and symptoms of OA

A
  • joint pain
  • effusion
  • stiffness
  • crepitus
  • muscule inhibition: decrease strength
  • joint mobility: hypomobile (OA)
  • abnormal movement patterns and compensations
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8
Q

signs and symptoms in RA that differ from OA slightly

A
  • hypermobile/instable
  • deformities and altered joint mechanics
    *can happen with OA but more common in RA
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9
Q

POC for OA patients

A
  • educate patient: activity modification, joint protection
  • decrease joint stiffness: PROM, AAROM, AROM, joint mobilization(- increase ROM)
  • Decrease mechanical stress and prevent deforming forces: prevent faulty mechanics, splinting, bracing positioning, strengthening muscules, rest when needed
  • Improve neuromuscular control, strength, endurance: low intensity and low impact
  • improve balance:
  • improve physical conditioning: low impact aerobic exercise
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10
Q

Osteoarthritis deformities in the hand and what would you expect an X-ray to show

A
  • heberden’s nodes = DIP
  • bouchard’s nodes = PIP
  • X-ray = loss of joint space, osteophytes
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11
Q

etiology for RA

A
  • Chronic systemic inflammation autoimmune disease
  • affects joints, ligaments, capsulesm synovium, CT, tendon sheaths, fascia, muscules, nerves, eyes, organs, skin
  • multiple joints, symmetrica/Bilateral
  • affects wrist, hands, MCP, PIP joints
  • both genders any age
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12
Q

What are the types of RA

A
  • intermittent
  • low grade
  • progressive
  • rapid progressive

least involved to most involved

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13
Q

Types of RA

Intermittent

A
  • exacerbations and remissions
  • flare ups that come and go
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14
Q

Tyeps of RA

Low grade

A
  • mild no deformities
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15
Q

Types of RA

Progressive

A
  • worsening
  • deformities
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16
Q

Types of RA

Rapid progressive

A
  • rapid wrosening with deformities
17
Q

RA

  • destructive of joint tissue due to
A
  • synovitis: inflammation of synovium
  • erosion of joint articular cartilage and bone: thickened synvoial fluid, proteolytic enzymes, and pannus formation that smothers joint and imparis nutrition
  • altered mechanics: altered support of the joint, laxity: bony and ligament destruction, muscule inhibtion and deformities
18
Q

Criteria for diagnosis of RA

Criteria for diagnosis of RA

A
  1. morning stiffness in and around joints lasting at least 1 hour
  2. at least 3 joints simultaneously have soft tissue swelling or fluid observed by physician
  3. swelling in the wrist, MCP or PIP joints
  4. symmetrical arthritis (B/L)
  5. Rheumatoid nodules
  6. serum rheumatoid factor
  7. radiographic changes inculding erosions or periarticular osteopenia in hand or wrist

diagnosis made if 4/7 criteria
1-4 must be present for 6 weeks

19
Q

RA active diesase periods Signs and symptoms

A
  • synovitis: B/L in hands and wrist
  • warm, swollen, painful, stiffness
  • muscule weakness
  • tenosynovitis (inflammation of tendon sheaths)
  • joint erosion/joint instability
  • may be assoicated with: anorexia, weight loss, fever, fatgue, sleep loss
20
Q

DX of RA

besides the classifications

A
  • blood test for rheumatoid factor
  • RF antibodies
  • found in 80% of patients
21
Q

Describe these two in realtion to RA

  • tenosynovitis
  • joint erosion/instability
A
  1. Tenosynvitis:
  • inflammation of tendon sheaths
  • finger flexors, extensor tendonds
  • can lead to tendon ruptures
  • Carpal tunnel syndrome from the swollen tendons
  1. joint erosion leads to instability:
  • subluxations
  • deformities over time
  • muscule imbalances
  • dominant flexor tendon pull
  • radiography - erosion, opsteopenia/osetoporosis
22
Q

synovial pseudocysts

A
  • synvoial fluid going into “vaccum” in bone
23
Q

RA deformities

A
  • MCP volar plate palmar dislocation
  • wrist radial driff = sublux carpals ulnarly
  • MCP ulnar drift = RCL weakening, ulnar pull of flexor tendons
24
Q

Swan neck deformity

A
  • dorsal sublux of lateral bands
  • hyperextension PIP
  • flexed DIP
25
Q

Boutonniere

A
  • ruptured central band with lateral band drifts volarly
  • PIP flexion
  • DIP extension
26
Q

MCP palmar dislocation

A
  • MCP ruptured collateral ligament and volar plate
  • stretched collateral ligament
  • finger flexor pull, bowstringing forceof the flexor tendon and pulleys
27
Q

Mallet Finger

A

flexed DIP

  • extensor mechanism
  • lateral bands rupture at DIP
  • inability to actively extend DIP

RA deformity

28
Q

RA management during active periods

A
  1. educate: rest, joint protection, orthosis, splint
  2. decrease pain: modalities, massage, grades 1,2
  3. minimize stiffness: PROM, AAROM, AROM with care (no active stretching)
  4. minimize athrophy: place/hold isometrics to AAROM to AROM
  5. prevent deformity: supportive and assistive equipment (dont do anything agressive and provide support)
29
Q

Precuations with RA management during active periods

A
  • fatigue
  • increase pain
  • dont over stress/stretch tissues
30
Q

Contraindications with treatments for RA active periods

A
  • overstretching of lax joints
  • heavy resistance exercise
31
Q

RA principles: joint protection, energy conservation sumarized

A
  1. avoid deforming positions
  2. short, frequent bouts of exercise: stop if discomfort, fatigue
  3. alternate activites, rest to avoid fatigue
  4. decrease activities if joint pain develops and exisits > 1 hour
  5. maintain functional ROM, Strength, endurance
  6. increase rest during flare-ups
  7. avoid deforming positions, change positions every 20-30 minutes
  8. use stronger, larger muscules and joints
  9. use appropriate adaptive equipment
32
Q

Guidelines for RA patients for exercise

A
  • low intensity therapeutic exercise with rest
  • reduce pain
  • improving functional status
  • high intensoity is not recommended due to exacerbating symptoms
33
Q

Gouty arthritis

A
  • hyperuricemia/excessive uric acid in blood
  • deposits of sodium urate crystal in joint
  • acute attack/onset
34
Q

Gouty arthritis signs and symptoms

A
  • seen in hands and feet
  • joints are swollen, hot, inflammed
  • held in open pack position
  • severe pain with limited ROM
  • comon in great toe MTP, gait deviation ER hip
35
Q

Interventions for gouty arthritis

A
  • medications: NSAIDs, colchicine, steriods
  • joint protection - rest from function, splinting
  • diet - avoid foods that trigger gout
  • condition usually calms in weeks time
36
Q

Differential diagnosis with UE presentation similar to arthritis

A
  • cardiac,CHF: B/L swelling, clubbing for fingers
  • diabetes, peripheral neuropathy
  • sensory loss - UE glove pattern, peripheral nerve pattern
  • tropic/vascular changes: shiny dry onion skin, hair loss, thick nails

Musculoskeletal 1 (42 decks)

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