Kisner Ch 11 & 12- Joint, Connective tissue, and bone disorders Flashcards
What are the clinical signs and symptoms of Arthritis and Arthrosis?
Impaired mobility
Impaired muscle performance
Impaired balance
Functional limitations
At what age does RA typically begin?
b/t 15 and 50
What is the progression rate of RA?
May develop suddenly, with in weeks or months
How does RA manifest?
Inflammatory synovitis and irreversible structural damage to cartilage and bone
What joints are involved with RA?
Affects many joints, usually bilaterally
MCP & PIP of hands, wrists, elbows, shoulders
Cervical spine
MTP, talonavicular & ankles
What are the JOINT signs and symptoms of RA?
Redness Warmth Swelling Prolonged morning stiffness Increase joint pain w/ activity
What are the SYSTEMIC signs and symptoms of RA?
General feeling of sickness & fatigue
Weight loss & fever
Development of rheumatoid nodules
May have ocular, respiratory, hematological, and cardiac symptoms
At what age does OA typically begin?
After age of 40
How does OA progress?
Develops slowly over many years in response to mechanical stress
How does OA manifest?
Cartilage degradations
altered joint formation
osteophyte formation
Which joints are typically affected by OA?
Affects a few joints asymmetrically
DIP, PIP, 1st CMC of hands
Cervical and lumbar spine
Hips, knees, 1st MTP of feet
What are the JOINT signs & symptoms of OA?
Morning stiffness, increased joint pain w/ weight bearing and strenuous activity
Crepitus and loss of ROM
Describe a POC for a pt. w/ RA during the active inflammatory period
Patient education Joint protection and energy conservation Joint mobility Exercise Functional training
Describe a POC for a pt. w/ RA during the subacute and chronic inflammatory period
Treatment approach
Joint protection and activity modification
Flexibility and strength
Cardiopulmonary endurance
What are the principles for joint protections and energy conservation for RA?
Monitor activities & stop when pt. feels discomfort or fatigue
Use frequent but short episodes of exercise
Alternate activities to avoid fatigue
Decrease level of activities or omit activities that provoke joint pain
Maintain a functional level of joint ROM & muscular strength and endurance
Balance work & rest to avoid muscular & total body fatigue
Increase rest during flare ups
Avoid deforming postures
Avoid prolonged static positioning/ change positions every 20-30 minutes
Use stronger and larger muscles and joints during activities
Use appropriate adaptive equipment
POC for OA
Patient instruction Pain management: early stages Pain management: late stages Assistive and supportive devices and activity Resistance exercise Stretching and joint mobilization Balance activities Aerobic conditioning
What similarities to fibromyalgia and myofascial pain syndrome share?
Pain in muscles
Decreased ROM
Postural stresses
Fibromyalgia vs Myofascial pain syndrome
FM: Tender points at specific cites, No referred patterns of pain, No tight band of muscle, & Fatigue and waking unrefreshed
MFPS: Trigger points in muscle, referred patterns of pain, tight band muscle, no fatigue related complaints
What factor contribute to Fibromyalgia flares ups?
Emotional stresses
Physical stresses
Environmental stresses
Interventions to assist w/ Fibromyalgia?
Exercise Prescription meds, OTC meds Avoidance of stress factors Cognitive behavior therapy Pacing activities to avoid flare ups Diet modification Decreasing alcohol & caffeine consumption
What are the possible causes of trigger points for Myofascial pain syndrome?
Chronic & acute overload of muscle
Poorly conditioned muscles
Postural stresses
Poor body mechanics
Management of Myofascial pain syndrome?
Correct contributing factors to chronic overload of the muscle
Eliminate the trigger point
Strengthen the muscle
What are primary risk factors for osteoporosis?
Post menopausal Caucasian or Asian decent Family history Low body weight Little or no physical activity diet low in calcium & vitamin D Smoking
What are secondary risk factors for osteoporosis?
Gastrointestinal disorder Hyperthyroidism Chronic renal failure Excessive alcohol consumption Glucocorticoids
How prevent osteoporosis?
Diet rich in calcium & vitamin D
Weight bearing exercise
Testing for bone density & medication if needed
Moderate alcohol consumption & no smoking
What type of force causes a tranverse or oblique fracture, Greenstick in children?
Bending
What type of force causes a spiral fracture?
twisting
How is an avulsion fracture caused?
Straight pulling force
What type of force causes stress fractures?
Repetitive microtrauma
What type of fracture is created by a crushing force?
Compression fracture
Torus (buckle) fracture in children
What type of force causes a pathological fracture?
Normal force on bone
What are the types of abnormal healing of fractures?
Malunion
Delayed union
Non union
What is a malunion?
fracture heals in an unsatisfactory position resulting in bone deformity
What is a delayed union?
The fracture takes longer than normal to heal
What is a non union?
fracture fails to unite w/ boney union
Stages of bone healing
Inflammatory
Reparative
Remodeling
What is a rigid internal fixation?
Surgical application of a rod or plate w/ screws to keep a bone stable while healing
Healing time from fractures?
Children 4-6 weeks
Adolescents 6-8 weeks
Adults 10-18 weeks
Cancellous bone is more susceptible to which type of forces?
Compressive
What may be affected if a fracture occurs at an epiphyseal plate?
growth
In what stage of bone healing does a callus form? Where do osteogenic cells proliferate from?
reparative
periosteum & endosteum
Name the complications of fractures?
swelling fat embolism problems w/ fixation devices Infection Refracture Delayed or nonunion
Post-fracture POC
Teach functional adaptions, safe ambulations, bed mobility
Ice & elevation
Intermittent muscle setting, active ROM to joints above & below immobilized region
Resistive exercises to major muscle groups not immobilized
Post immobilization POC
Joint mobilization PNF stretching Functional activities Muscle performance Scar tissue mobilization
What are indications for surgical intervention?
Incapacitating pain at rest or with activity
Marked limitation of motion
Gross instability of a joint or bony segment
Joint deformity or abnormal alignment
Significant structural degeneration
Chronic joint swelling
Failed nonsurgical or previous surgical management
Significant loss of function leading to disability as the result of any of the preceding factors
What examinations and evaluations are performed preoperation?
Pain Range of motion and joint integrity Integrity of the skin Muscle performance (strength and endurance) Posture Gait analysis Functional status
What are postoperative guidelines?
Instruction in safe positioning, safe limb movements & precautions/ contraindications
Relaxation exercises
Use of estim, ice, or heat
Proper wound care
Elevation of operated limb, active muscle pumping at distal joints, compression garments, gentle distal to proximal massage
What are potential post operative complications?
Pulmonary Complications
Deep Vein Thrombosis
Subluxation or Dislocation after Joint Surgery
Restricted Motion From Adhesions and Scar Tissue Formation
Failure, Displacement, or Loosening of Internal Fixation
What is Arthrodesis?
a surgical fusion of the surfaces of a joint
Indicated for joint pain associated w/ late-stage arthritis & joint instability
Where is Arthodesis used most frequently?
Cervical, lumbar spine
Wrist, thumb, and ankle
What is Arthroplasty?
Any reconstructive joint procedure, with or without joint implant, designed to relieve pain & improve function
Arthroscopic debridement & lavage
Arthroscopic removal of fibrillated cartilage, unstable chondral flaps, and loose bodies in a joint
What is arthroscopic debridement & lavage indicated for?
Relive joint pain and biomechanical catching during joint movements
What is a synovectomy?
Removal of synovium (lining of a joint) in the presence of chronic inflammation
What patient population typically undergoes this procedure?
RA patients
It is indicated if medical management has failed to alleviate joint inflammation for 4 to 6 months
Post operative management for muscle repair
Immediately after surgery perform muscle setting exercise
After immobilization is removed begin AROM in protected range
Partial weight bearing until pt. achieves functional level of strength & flexibility
Low load, high rep resistance exercise
Vigorous stretching and full level activity are contraindicated until soft tissue healing is complete (typical 6 to 8 weeks)
Post operative management for tendon repair
Muscle setting
Begin controlled antigravity motions after tendon has had several weeks to heal
Weight bearing may be restricted
Heavy lighting activities are contraindicated for 6 to 8 weeks
What are procedures for Release, Lengthening, or Decompression of Soft Tissue?
Myotomy
Tenotomy
Fasiotomy
