Module 2 ch 11 arthritis/fibro/etc

Question 1

Age of onset of this joint pathology is usually after the age of 40

Answer 1

osteoarthritis

Question 2

age of onset of this joint pathology usually begins between 15 and 50

Answer 2

RA

Question 3

progression of this joint pathology develops slowly over many years in response to mechanical stress

Answer 3

OA

Question 4

this joint pathology develops suddenly within weeks or months

Answer 4

RA

Question 5

this joint pathology meneifests with cartilage degradation, altered joint architecture, and osteophyte formation

Answer 5

OA

Question 6

this joint pathology manifests with inflammatory synovitis and irreversible structural damage to cartilage and bone

Answer 6

RA

Question 7

this joint pathology involves a few joints (usually ASYMMETRICAL) and typically involves DIP, PIP, 1st CMC of hands, cervical and lumbar spine, hips/knees/1st MTP of feet

Answer 7

OA

Question 8

this joint pathology usually affects many joints, usually BILATERAL, typically the MCP and PIP of hands, wrists, elbows, shoulders
Cervical spine
MTP, talonavicular joint and ankle

Answer 8

RA

Question 9

This joint pathology usually has morning stiffness (usually less than 30 min), increased joint pain with weight bearing and strenuous activity, crepitus and loss of ROM

Answer 9

OA

Question 10

This joint pathology usually has redness, warmth, swelling, and prolonged morning stiffness, increased joint pain with activity

Answer 10

RA

Question 11

this joint pathology has no systemic signs and symptoms

Answer 11

OA

Question 12

this joint pathology has systemic signs such as general feeling of sickness and fatigue, weight loss, and fever. May develop rheumatoid nodules, may have ocular, respiratory, hematological and cardiac symptoms

Answer 12

RA

Question 13

Arthritis

Answer 13

inflammation of the joint, most common types are RA and OA

Question 14

arthrosis

Answer 14

limitation of a joint without inflammation

Question 15

Capsular pattern

Answer 15

pattern of limitation in a capsule that is usually firm end feel unless acute then the end feel may be guarded, decreased and possibly painful joint play and joint swelling (effusion)

Question 16

when might arthrosis be present in someone

Answer 16

pt is recovering from a fracture or other problem needing immobilization. There is limited joint play along with other connective tissue and mm contractures limiting range of motion

Question 17

joint swelling may cause weakness from disuse or reflex inhibition of stabilizing muscles, T or F

Answer 17

T
Mm weakness or inhibition leads to imbalances in strength and flexibility and poor support for the involved joints

Question 18

would patients with joint issues develop balance and awareness issues? Why ?

Answer 18

yes. Because of altered or decreased sensory input from joint MECHANORECEPTORS and mm spindle particularly an issue with arthritic weight bearing joints

Question 19

will a patient with arthritis have activity limitations and participation restrictions ?

Answer 19

probably yeah :)

Question 20

is RA and OA both autoimmune disorders ?

Answer 20

No
RA autoimmune
OA chronic degenerative disorder

Question 21

Rheumatoid Arthritis

Answer 21

autoimmune, chronic, inflammatory, systemic disease primarily of unknown etiology affecting the synovial lining of joints as well as other connective tissue

Question 22

RA has periods of exacerbation (flare up) and periods of ______

Answer 22

remission

Question 23

A way to look at RA progression

Answer 23

big time synovitis > changes synovial membrane, peripheral parts of articular cartilage , and subchondral marrow spaces > granulation tissue forms covers and erodes the articular cartilage, bone and ligaments in joint capsule > adhesions may form restricting joint mobility. As it continues to progress, cancellous bone exposed and ultimately fibrosis, ossification ankylosis, or subluxation may cause deformity and disability

Question 24

RA may have synovitis and tenosynovitis

Answer 24

true

Question 25

ankylosis

Answer 25

fusing of a joint

Question 26

Therapeutic exercises cannot positively alter the pathological process of RA, but if administered carefully, they can help prevent, retard, or correct the mechanical limitations and deforming forces that occur and, therefore, help maintain function.

Answer 26

Therapeutic exercises cannot positively alter the pathological process of RA, but if administered carefully, they can help prevent, retard, or correct the mechanical limitations and deforming forces that occur and, therefore, help maintain function.

Question 27

With RA, pain and stiffness _______ after strenuous activity

Answer 27

worsen

Question 28

Precautions of pts with RA

Answer 28

Secondary effects of steroidal medications may include osteoporosis and ligamentous laxity, so use exercises that do not cause excessive stress to bones or joints. Respect fatigue and increased pain; do not overstress osteoporotic bone or lax ligaments.

Question 29

Contraindications of pts with RA

Answer 29

Do not perform stretching techniques across swollen joints. When there is effusion, limited motion is the result of excessive fluid in the joint space. Forcing motion on the distended capsule overstretches it, leading to subsequent hypermobility (or subluxation) when the swelling abates. It may also increase the irritability of the joint and prolong the joint reaction.

Question 30

Principles of Management: Active Inflammatory Period of RA

Answer 30

Patient education. Because periods of active disease may last several months to more than a year, begin education in the overall treatment plan, safe activity, and joint protection (Box 11.3) as soon as possible.100 It is imperative to involve the patient in the management, so he or she learns how to conserve energy and avoid potential deforming stresses during activities and when exercising.

Joint protection and energy conservation. It is important that the patient learns to respect fatigue and, when tired, rests to minimize undue stress to all the body systems. Because inflamed joints are easily damaged and rest is encouraged to protect the joints, teach the patient how to rest the joints in nondeforming positions and to intersperse rest with ROM.

Joint mobility. Use gentle grade I and II distraction and oscillation techniques to inhibit pain and minimize fluid stasis. Stretching techniques are not performed when joints are swollen.

Exercise. The type and intensity of exercise vary depending on the symptoms. Encourage the patient to do active exercises through as much ROM as possible (not stretching). If active exercises are not tolerated owing to pain and swelling, passive ROM is used. Once symptoms of pain and signs of swelling are controlled with medication, progress exercises as if subacute.

Functional training. Modify any activities of daily living (ADL) needed in order to protect the joints. If necessary, use orthoses and assistive devices to provide protection.

Question 31

Principles of Joint Protection and Energy Conservation

Answer 31

Monitor activities and stop when discomfort or fatigue begins to develop.
Use frequent but short episodes of exercise (three to five sessions per day) rather than one long session.
Alternate activities to avoid fatigue.
Decrease level of activities or omit provoking activities if joint pain develops and persists for more than 1 hour after activity.
Maintain a functional level of joint ROM and muscular strength and endurance.
Balance work and rest to avoid muscular and total body fatigue.
Increase rest during flares of the disease.
Avoid deforming positions.
Avoid prolonged static positioning; change positions during the day every 20 to 30 minutes.
Use stronger and larger muscles and joints during activities whenever possible.
Use appropriate adaptive equipment.

Question 32

Principles of Management: Subacute and Chronic Stages of RA

Answer 32

Treatment approach. The treatment approach is the same as with any subacute and chronic musculoskeletal disorder, except appropriate precautions must be taken because the pathological changes from the disease process make the tissues more susceptible to damage.

Joint protection and activity modification. Continue to emphasize the importance of protecting the joints by adapting the environment, and by modifying activity, using orthoses, and assistive devices.

Flexibility and strength. To improve function, exercises should be aimed at improving flexibility, muscle strength, and muscle endurance within the tolerance of the joints.35

Cardiopulmonary endurance. Nonimpact or low-impact conditioning exercises—such as aquatic exercise, cycling, aerobic dancing, and walking/running—performed within the tolerance of the individual improve aerobic capacity and physical activity and decrease depression and anxiety.10,105,132,159 Group activities, such as water aerobics, also provide social support in conjunction with the activity. One randomized review suggested that aerobic training also has a positive impact on the cardiovascular status of patients with RA

PRECAUTIONS: The joint capsule, ligaments, and tendons may be structurally weakened by the rheumatic process (also as a result of using steroids), so the dosage of stretching and joint mobilization techniques used to counter any contractures or adhesions must be carefully graded.

CONTRAINDICATIONS: Vigorous stretching or high-velocity thrust manipulative techniques.