Module 3: Lesson 1: Arthritis Flashcards
How many types of arthritic conditions are there?
Over 100
How many components does a normal joint include?
5
Name the components of a normal joint
- Joint space
- Smooth surface
- Cartilage on the articular surfaces
- Synovial lining and fluid
- Joint capsule
Bouchards nodes are located where?
PIP joints
Heberdens nodes are located where?
DIP joints
What are some symptoms of osteoarthritis?
- Pain, stiffness, swelling, loss of motion, crepitus and secondary inflammation
Describe some common features of OA
- Non inflammatory
- Degenerative joint disease
- Cartilage changes
- Bone spurs develop
True or false:
OA is a degenerative joint disease
True
True or false:
OA is an inflammatory diease
False - non inflammatory
What are some common comorbidities of OA?
- Trigger finger
- CTS
- DeQuervains
- Ganglion cysts
The following are comorbidities of what:
- Trigger finger
- CTS
- DeQ!uervains
- Ganglion Cysts
OA
What are some common medications for OA?
- Analgesics and topical analgesics
- NSAIDS for inflammation, swelling and pain
- COX-2 inhibitors for pain and inflammation
- Corticosteroids
- Viscosupplements
Describe common features of RA
- Autoimmune, inflammatory disorder
- Systemic
- Leads to joint deformity
- Bilateral and symmetrical
- Nodules commonly seen at elbow and or proximal ulna on dorsal aspect
True or false:
RA is an inflammatory disorder
True
How does RA begin?
Synovitis - synovial lining and fluid is attacked which causes inflammation that leads to destruction of other joint structures
What are some comorbidities of RA?
- At onset:
- Hypertension
- COPD
- Diabetes
- Hypothyroidism
- Malignancy
- After 5 years
- Hypertension
- Malignancy
- Stroke
- MI
- Osteoporosis
The following comorbidities are found with what?
- At onset:
- Hypertension
- COPD
- Diabetes
- Hypothyroidism
- Malignancy
- After 5 years
- Hypertension
- Malignancy
- Stroke
- MI
- Osteoporosis
RA
Name the most common symptoms of RA
- Pain
- Fatigue
- Inflammation/swelling
- Stiffness/loss of ROM in the mornings
- Socially isolated
- Deformities
- Crepitus
- Nodes
- Symmetrical
How many stages does RA typically go through?
4
Describe the 4 states of RA
- Acute: active inflammation which presents with painful, red, hot, and swollen joints.
- Subacute: Less inflammation, but stiffness remains. No joint deformities, but joint destruction continues.
- Chronic active: Less pain, but joint deformities present
- Chronic inactive: Joint deformities and skeletal collapse
Describe the medications for RA
- NSAIDS for inflammation, swelling and pain
- Corticosteroids
- Disease modifying antirheumatic drucs
How is OA diagnosed?
Look for radiographic changes
How is RA diagnosed?
- Individuals need a score of greater than or equal to 6/10 based on 4 different criteria
- Joint involvement
- Serology (protein)
- Duration of symptoms
What are some deformities found in RA?
- Ulnar drift (subluxation)
- Boutonniere deformity
- Swan neck deformity
- Radial drift of wrist
- Zigzag deformity
Below are some examples of deformities that can be seen with what?
- Ulnar drift (subluxation)
- Boutonniere deformity
- Swan neck deformity
- Radial drift of wrist
- Zigzag deformity
RA
When completing arthritis assessments it is important to look at swelling and inflammation. Describe it.
- Effusion: Fluid in capsule surrounding joint
- Boggy: acute phase; soft and spongy
- Chronic synovitis: Firm to touch
Read fact
For arthritis testing of strength:
- It is best to assess through function
- Grip testing Jamar (1 trial) at handle position 2, blood pressure cuff dynamometer and vigorimeter
True or false:
During a acute arthritis flare up, heat is recommended.
False it is contraindicated
Name some PAM that are used for arthritis to help with pain and ROM stiffness.
- Pain: Hotpacks, continuous ultrasound, paraffin and heating pads. Cryotherapy can be helpful for pain.
- ROM: Hotpacks, fluidotherapy and paraffin.
Below are interventions for what phase of arthritis:
- AROM: pain free, gentle with involved joints
- AAROM/PROM is performed when someone is too weak to exercise
***Resistance exercises are contraindicated in this phase
Acute & subacute phase
Describe arthritis management for the acute and subacute phase.
- AROM: pain free, gentle with involved joints
- AAROM/PROM is performed when someone is too weak to exercise
***Resistance exercises are contraindicated in the acute phase
What interventions listed below describe treatment for this phase of arthritis treatment.
- AROM, pain free, gentle ROM to involved joints
- AAROM/PROM is performed when someone is too weak to exercise
- Passive stretching can be done, but complete with extreme caution
- Gentle resistive exercise can begin: Start with isometrics and proceed to light isotonic exercise
Chronic active & chronic inactive
Describe treatment for the chronic active and chronic inactive arthritis phases.
- AROM, pain free, gentle ROM to involved joints
- AAROM/PROM is performed when someone is too weak to exercise
- Passive stretching can be done, but complete with extreme caution
- Gentle resistive exercise can begin: Start with isometrics and proceed to light isotonic exercise
True or false:
A HEP that focuses on resistive exercises was found to be more effective for individuals with RA than stretching to improve funciton.
True
Name an exercise to address ulnar drift
Radial walks
- Palm down on table move each digit over toward thumb laterally one at a time
Name an exercise to address a boutonniere deformity
- DIP active and passive flexion exercise
- They help stretchy the oblique retinacular ligament and position the lateral bands so that they are dorsal to the PIP
**Hold the PIP joint
What type of orthosis is recommended for ulnar drift?
- Hand based ulnar drift orthosis
- Resting hand orthosis
What type of orthosis is recommended for a boutonniere issue?
- Oval 8 splints
- Silver ring splints
- 3 point orthosis if there is swelling
What type of orthosis is recommended for a swan neck deformity>
- Oval 8 splints
- Silver Ring splints
- 3 point orthosis if there is swelling
What type of orthosis is recommended for a zigzag deformity?
- Antideformity resting hand orthosis-wrist extension 10-15 degrees, MCPs 0 degrees to slight flexion and IP joints in slight flexion. thumb in partial opposition. Note the wrist and MCPs should be in neutral deviation
Name some common joint protection techniques used with those with arthritis.
- Respect pain
- Use larger/stronger joints and muscles
- Distribute load over several joints
- Avoid tight or prolonged grasp
- Avoid positions of deformity
- Avoid remaining in 1 position for long periods
- EC
- Alternate heavy and light tasks
- Use work simplification techniques
What is a CMC arthroplasty?
- CMC interposition arthroplasty
- Includes removal of the arthritic trapezium, donor tendon interpositioned in the pace and ligaments are replaced.
Describe the process of a CMC arthroplasty
- Surgery is followed by 4-6 weeks of casting
- After case is removed: Hand is placed in forearm based thumb spica orthosis
- Pt is told to remove the orthosis several times a day to perform AROM to wrist, thumb and digits
- May progress to gentle strengthening when cleared by MD (avoid heavy pinching exercises)
- Return to work after 12 weeks
Describe general progress after shoulder arthroplasty.
- Day 0 - week 1: AROM of uninvolved joints, pendulum exercises, 1 handed ADLs, therapist performs PROM when instructed by MD (supine)
- Week 2-4: Teach patient to perform IR/ER by using power of univolved arm (i.e. using dowel or cane)
- Week 4-6: Increase PROM per MD, gentle isometerics
- Week 6-8: Begin AROM (first in supine), can begin active shoulder elevation with dowel in supine, progress to against gravity AROM at 8 wks
- Week 8: Strengthening with therapy band and light weight
- Week 12: Begin light work and leisure skills
Below are precautions for what type of shoulder surgery?
- Avoid IR, Adduction and extension
- Avoid movements such as washing your opposite underarm, tucking in your shirt and wiping
Reverse total shoulder arthroplasty
Describe the precautions for a reverse TSA
- Avoid IR, Adduction and extension
- Avoid movements such as washing your opposite underarm, tucking in your shirt and wiping
The precautions listed below are for what type of shoulder surgery?
-No WB through extremity
- No extension beyond neutral
- No ER past 30 degrees or IR past 60 degrees
- No lifting more then 1-2 lbs
TSA
Describe the precautions for a TSA
-No WB through extremity
- No extension beyond neutral
- No ER past 30 degrees or IR past 60 degrees
- No lifting more then 1-2 lbs
Describe recover after a reverse TSA
- Week 1-2: Begin PROM following ROM restrictions of surgeon, by week 2 can progress to AAROM and gentle isometerics
- Week 2: Can begin pain free AROM
- Week 6: Light strengthening exercises and ADL activities
**No IR, adduction and extension to small of back
Describe precautions for a posterior hip replacement
- No hip flexion beyond 90 degrees
- No hip adduction past neutral
- No hip internal rotation
Describe hip precautions for anterior replacement
- No hip extension
- No hip ER
Describe precautions for global hip replacement (posterior and anterior)
- No hip flexion beyond 90 degrees
- No hip adduciton past neutral
- No hip IR or ER
- No hip prone lying
- No bridging
Describe hip precautions for a trochanteric replacement
No active hip abduction
The following describes what hip replacement type:
- No hip extension
- No hip ER
Anterior
The following describes what hip replacement type:
- No hip flexion beyond 90 degrees
- No hip adduction past neutral
- No hip IR
Posterior
The following describes what hip replacement type:
- No active hip abduction
Trochanteric
The following describes what hip replacement type:
- No hip flexion beyond 90 degrees
- No hip adduciton past neutral
- No hip IR or ER
- No hip prone lying
- No bridging
Global
Describe sexual activity following a knee replacement.
- Refrain from kneeling
- Consider side lying position
Describe sexual activity following hip preplacement
- Refrain for few weeks
- OT can suggest sexual expression as an alternative until cleared by surgeon
- Once sex can resume:
- Side lying on non operative side, hip abduction maintained by placing multiple pillow between knees
- Supine position: Place pillows under knees to prevent excessive ER
What 4 things should OTs observe when looking at arthritis patients?
Observe the following:
- Swelling/inflammation (effusion, boggy, etc)
- Nodes (Bouchards or Heberdens)
- Fixed deformities
- Hand deformities for R (i.e. ulnar drift, zigzag deformity, etc.)
Name the 6 components when assessing a patient with arthritis
- Pain
- ROM
- Strength
- Sensation
- Stability (stabilize proximal joint, glide distal lateral/medial)
- Fatigue
