Midterm Theory Flashcards
A chronic, systemic, autoimmune disorder causing symmetrical, erosive synovitis of the joints. Eyes, lungs and the cardiovascular system may be affected
RA
What joints are most often affected in RA?
- Fingers (DIPs)
- Hands
- Wrists
- Knees
- Feet
- Upper cervical (C1/C2)
Viral pathogens, and antibodies launch a full scale attack on these health tissues bilaterally
Who is most commonly affected by RA?
- Women are 2.5/3 times more affected than men (3/1)
- 20-40 most frequently
What are Ci’s to tx and assessment for RA?
- No testing during flare ups
- AF ROM and PR ROM tested in pain free ranges only
- No PF testing in severe R.A
- AR testing in pain free ranges only
- All relevant treatment precautions in the event of neuropathies, pulmonary and cardiovascular involvement
- Do not work directly on or distal to inflamed joint
- Do not traction C-spine or perform joint play techniques if there is C-spine involvement
- Do not friction ligaments capsules or tendons in severe progressive R.A or of the client is taking anti-inflammatories
- Modify hydrotherapy and techniques in the case of joint replacement or flare up
- Avoid vigorous techniques or overly long treatments as they will fatigue the client make them susceptible to a flare up
- Avoid heavy applications during flare ups. Use cool cloths, arm or foot baths
What is the difference between RA and OA?
RA Autoimmune and bilateral Could lead to OA Have Burchard's: PIPs Swan Neck: DIPs
OA
Degenerative and not bilateral
Bones/cartilage. Wear and tear with age
Hands, hips, knees, L4/L5, C4/C7 - upper thoracic
Both affect the joints
What are CI’s to tx and assessment for clients with OA?
1) Do not mobilize hypermobile joints!
2) Do not mobilize joints with osteoformation
What is the recommended remedial exercise program for clients with OA? How does it differ from RA?
ADD MORE
OA
Increased ??
Walking/swimming - weight bearing exercise to decreased impact
RA:
Swimming, pain to stop pain?
Disorder of carbohydrate, protein and fat metabolism. Resulting from imbalance b/t insulin availability and insulin needed
Diabetes
What are different types of Diabetes?
1) Diabetes Mellitus Type 1: Insulin dependent
2) Diabetes Mellitus Type 2: Non insulin dependent
3) Gestational Diabetes: Glucose intolerance during pregnancy
What are the 3 P’s of Diabetes?
Polyuria: Excessive urination
Polydipsia: Excessive Thirst
Polyphagia: Excessive hunger
Prior to treating a client with insulin dependent diabetes, what is important to know?
Injection sites
What are common insulin injection sites?
Tummy, Thigh, Upper Arm
Progressive condition of axial skeleton presenting as pain and stiffness of the spine leading to bony ankylosis of the SI joint
Ankylosing Spondylitis
What are the 2 types of AS?
ADD ANSWER
1) Marie-Stumpell
2) Bechtrew
How can you alter your diet when you suffer from Gout?
No: Red meat, organ meat, anchovies, sardines, seafood, lentils, mushrooms, peads, asparagus, alcohol
hat are the extra-articular symptoms of clients with AS?
1) Pain in the SI & Lumbar
2) Muscle stiffness or pain after prolonged rest, interrupted sleep due to pain, fatigue, fever, weight loss
3) Misdiagnosed with muscles strain or spasm, loss of ROM in spine, lordosis, kyphotic spine, osteoporosis of the spine
What is Scleroderma?
Autoimmune disease of connective tissue characterized by thickening (fibrous) of the skin, fascia, tendon sheaths of the body
What is CREST?
C: Calcinosis
Formation of tiny calcium deposits
R: Raynaud Phenomenon
Spasms of the small articular, supplying the finger, toes, lungs
E: Esophageal Dysmotility
Poor functioning muscles of the lower ⅔ of the esophagus
S: Sclerodactyly
Localized thickening of the skin over the fingers and toes
T: Telangiectasia
Tiny red blotches, caused by dilated capillaries that appear on the face
This hormone produced by the pancreas. It regulates carbohydrate and fat metabolism. It takes up glucose and stores it as glycogen
Insulin
What is the most common complication associated with diabetes?
Blindness is most common Chronic Complication of Diabetes
What are the complications associated with diabetes?
1) Peripheral Neuropathies:
such as paresthesia in the legs and feet, muscle weakness, foot drop, carpal tunnel syndrome and impotence in men
2) Vasomotor Reflex Defects:
lead to dizziness and syncope (fainting) when moving from supine to standing
3) Impaired Innervation to the Bladder:
can lead to urinary stasis and the development of bladder infections and renal complications
4) Nephropathies:
diabetics have increased susceptibility to pyelonephritis (kidney inflammation) and papillary or glomerulosclerosis (scarring of tiny vessels in kidney)
5) Retinopathies:
Diabetes is the leading cause of acquired blindness. There is an increased risk of cataracts and glaucoma, microaneurysm formation (spots on retina), hemorrhage, scarring and retinal detachment.
6) Vascular Complications:
Increased risk for coronary artery disease, cerebrovascular disease, peripheral vascular disease
7) Diabetic Foot Ulcers:
Poor circulation and tissue health results in ulceration, infections, gangrene and eventually amputation. Common sites for damage are the back of the heel, plantar metatarsal area or great toe. Feet should be inspected daily for blisters, open sores, fungal infections. Feet should be kept warm, clean and dry. Nails should be trimmed carefully to avoid cuts.
8) Periarthritis and Adhesive Capsulitis:
result in limited joint mobility particularly in the hands (Dupuytren’s Contracture)
9) Reflex Sympathetic Dystrophy (RSD):
a condition characterized by pain, hyperesthesia (sensitivity to stimuli/touch), hyperhidrosis, tenderness and swelling of the hands and feet
What is the cause and contributing factors of Diabetes? (For both types)
1) Absolute insulin deficiency or impaired insulin production from the pancreas
2) Defective insulin receptors on cells
3) Genetic predisposition which causes an auto-immune response to the pancreatic B-cells which produce insulin
4) Environmental factors in a genetically susceptible person (viruses and chemical toxins)
What are the symptoms associated with Diabetes Type 1?
1) Polyuria (increase urine output)
2) Glycosuria/ ketonuria (glucose and ketones in urine)
3) Polydipsia (increase thirst)
4) Polyphagia (increase in hunger)
5) Unusual weight loss with normal eating and activity
6) Extreme fatigue
7) Irritability
8) Sweet smelling breath
9) Nausea and vomiting
10) Blood sugar levels fluctuate often including hyperglycemia and hypoglycemia, either can have potentially serious consequences – ketoacidosis
11) Often difficult to stabilize this type of diabetes mellitus
What are the symptoms associated with Diabetes Type 2?
1) Same as IDDM +
2) Frequent infections (esp. Skin, gums, bladder)
3) Slow wound healing, cuts and bruises
4) Tingling and numbness in hands and feet
5) Blurred vision
6) Fairly stable and easy to control
What are the contraindications for treatment of Diabetes?
1) Keep juice, fruit on hand for sugar
2) No massage on injection sites
3) When in doubt administer sugar only not insulin
4) Monitor cuts, ulcers. Ensure areas is clean - prone to infection
5) Peripheral Neuropathies cause altered sensation - adjust hydro as they may not feel hot or cold
6) Try to arrange appt just after insulin injection
7) No deep on areas where sensation changes
What is gestational diabetes?
Glucose intolerance during pregnancy
-They are also at a higher risk for developing diabetes 5-10 years after delivery
What are the risk factors of gestational diabetes?
1) Women with a family history of diabetes
2) History of stillbirth or spontaneous abortion
3) Presence of fetal anomalies in previous birth
4) Previous history of having large babies
5) Obesity of mother
6) Advanced maternal age
7) Five or more pregnancies
Understand the rationale on treating on or around injection sites?
New injection sites should be avoided during massage as excess insulin may be retained in the tissue and can be released during massage on-site. The tissue may also be tender.
Old injection sites need to be located as repeated scarring and tissue breakdown can occur in these areas. Extra caution is needed in massaging these areas as the tissue may be fragile. Common injection sites are the abdomen, thighs and biceps
Chronic, degenerative progressive deterioration of a joint characterized by a loss of articulate cartilage and reactive changes at the margins of joints and subchondral bone
Wear and tear of cartilage, unilateral
Osteoarthritis
Be able to describe the process of degeneration at the joint?
Inflammation of the joint capsule → fibrosis → capsular restriction → facet irritation → gradual degeneration due to altered biomechanics → OA
Define primary osteoarthritis?
- Idiopathic
- Aging, Wear and Tear, Genetic Factors
Define secondary osteoarthritis?
- Caused by trauma, pathology
- Inflammation: Infection in joint
- Bone disease
- Bleeding Disorders
- Neurological Disorders
What are the symptoms that are associated with the Early stages of osteoarthritis?
1) Few visible changes, capsule/ligaments thickening
2) Swelling is low grade not visible
3) Slight decrease ROM
4) End-feel normal/springy
5) Surrounding muscle guarding
6) Pain after normal use, relieved by rest
7) Morning stiffness last 30 mins
What are the symptoms that are associated with the late stages of osteoarthritis?
1) Visible palpable change in joint and shape, Osteophytes
2) Swelling low grade but chronic
3) Progressive loss ROM (PR ROM)
4) End feel premature and bony
5) Surrounding muscle spasm
6) Pain during rest
7) Morning stiffness last longer than 30 mins
What are the common locations of osteoarthritis?
1) Hips, Knees, SI, Facet joint, L5-S1
2) Small joints hands and feet
3) Lumbar, Cervical spine
Know the treatment approaches for clients with the various stages of osteoarthritis.
1) Correct predisposing factors
Correct muscle imbalance through stretch, eliminate TP
2) Educate client on proper body use
Lifting objects, stretching before activity, taking breaks, posture
3) Encourage Activity
Move through pain in EARLY OA
4) Rest and cool hydro
During FLARE UP
5) Massage
GSM, PR ROM, Low grade joint play, tissue health, etc
What is the relationship between osteoarthritis and facet irritation
1) OA, FJI and Herination may all be connected or lead to one another
2) If client has FJI due to faulty posture and the FJI becomes chronic, then degenerative changes occur causing OA of FJ leading to instability of the spine which can lead to DDD due to increase mechanical stress on IVD which may result in Disc Herniation
Define Disc prolapse?
Tearing of both the inner and outer layers of the annulus fibrosis causing the nucleus pulposus to bulge directly into the intervertebral space.
Define Disc Herniation?
- A bulging of the nucleus pulposus against the outer layers of the annulus fibrosis into the intervertebral space. – - Tearing of the inner annulus fibrosis layers leads to a structural weakening, but the outer layers remain intact.
What are the causes of DDD?
1) Postural or occupational deviation leading to excessive rotation
2) Fixation of the spine will lead to degenerative changes especially above and below the sites of fixation. Joints above and below a fixation will make up for the loss of movement and become hypermobile causing excessive wear and tear on the spine.
3) Direct trauma such as a fall or whiplash or lift and twist injuries
What are the CI’s for DDD? (Same with OA)
1) As disease progresses ROM will diminish due to osteophyte formation, and bone rubs against bone
2) Don’t mobilize hypermobile joints (above and below fixations of spine)
3) Don’t mobilize joints with osteophytes, possible to break of and become loose body
4) No hydro during flare up
5) No temp extremes if joint has been placed with pins, plates, etc
6) No Friction around joint that has been treated with Corticosteroid
7) Don’t remove protective muscle guarding around hypermobile joint
8) Modify hydro if client has altered sensation along nerve root
In RA what are all the classes for an RA diagnosis?
- Morning Stiffness- in and around ,lasting at least 1 hour before maximal improvement
- Arthritis of 3 or more joints- Simultaneous soft-tissue swelling or fluid (not bony overgrowth alone) observed in 3 of the following 14 joints: left or right PIP’s, MCP’s, wrists, elbows, knees, ankles, and MTP joints
- Arthritis of hand joints- at least one area swollen in a wrist, MCP, or PIP joint (DIP’s are rarely involved)
- Symmetric Arthiritis- simultaneous involvement of the same joint areas on both sides of the body (bilateral involvement of the PIP’s, MCP’s, or MTP’s is acceptable without absolute symmetry).
- Rheumatoid Nodules- subcutaneous nodules over bony prominences, extensor surfaces, or surrounding joints.
- Serum rheumatoid factor- abnormal amounts of serum rheumatoid factor.
- Radiographic changes- hand and wrist radiographs showing erosion and bony decalcification localized in or adjacent to involved joints. (O.A of a joint alone does not qualify)
In RA what 4 do you need present for an RA diagnosis?
1) Morning Stiffness
2) Arthritis of 3 or more joints
3) Arthritis of Hand joints
4) Symmetric Arthritis
What are the causes and contributors to RA?
1) Idiopathic
2) Autoimmune disease, and occurs bilaterally
3) Most have RF factor in blood
4) 60% found to have genetic marker HLA
5) Emotional trauma/stress exacerbate attacks
6) Ratio 3/1 for women
