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BCPR > Module 3: Lesson 1: Arthritis > Flashcards

Module 3: Lesson 1: Arthritis Flashcards

1
Q

How many types of arthritic conditions are there?

A

Over 100

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2
Q

How many components does a normal joint include?

A

5

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3
Q

Name the components of a normal joint

A
  • Joint space
  • Smooth surface
  • Cartilage on the articular surfaces
  • Synovial lining and fluid
  • Joint capsule
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4
Q

Bouchards nodes are located where?

A

PIP joints

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5
Q

Heberdens nodes are located where?

A

DIP joints

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6
Q

What are some symptoms of osteoarthritis?

A
  • Pain, stiffness, swelling, loss of motion, crepitus and secondary inflammation
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7
Q

Describe some common features of OA

A
  • Non inflammatory
  • Degenerative joint disease
  • Cartilage changes
  • Bone spurs develop
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8
Q

True or false:

OA is a degenerative joint disease

A

True

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9
Q

True or false:

OA is an inflammatory diease

A

False - non inflammatory

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10
Q

What are some common comorbidities of OA?

A
  • Trigger finger
  • CTS
  • DeQuervains
  • Ganglion cysts
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11
Q

The following are comorbidities of what:

  • Trigger finger
  • CTS
  • DeQ!uervains
  • Ganglion Cysts
A

OA

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12
Q

What are some common medications for OA?

A
  • Analgesics and topical analgesics
  • NSAIDS for inflammation, swelling and pain
  • COX-2 inhibitors for pain and inflammation
  • Corticosteroids
  • Viscosupplements
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13
Q

Describe common features of RA

A
  • Autoimmune, inflammatory disorder
  • Systemic
  • Leads to joint deformity
  • Bilateral and symmetrical
  • Nodules commonly seen at elbow and or proximal ulna on dorsal aspect
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14
Q

True or false:

RA is an inflammatory disorder

A

True

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15
Q

How does RA begin?

A

Synovitis - synovial lining and fluid is attacked which causes inflammation that leads to destruction of other joint structures

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16
Q

What are some comorbidities of RA?

A
  • At onset:
    • Hypertension
    • COPD
    • Diabetes
    • Hypothyroidism
    • Malignancy
  • After 5 years
    • Hypertension
    • Malignancy
    • Stroke
    • MI
    • Osteoporosis
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17
Q

The following comorbidities are found with what?

  • At onset:
    • Hypertension
    • COPD
    • Diabetes
    • Hypothyroidism
    • Malignancy
  • After 5 years
    • Hypertension
    • Malignancy
    • Stroke
    • MI
    • Osteoporosis
A

RA

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18
Q

Name the most common symptoms of RA

A
  • Pain
  • Fatigue
  • Inflammation/swelling
  • Stiffness/loss of ROM in the mornings
  • Socially isolated
  • Deformities
  • Crepitus
  • Nodes
  • Symmetrical
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19
Q

How many stages does RA typically go through?

A

4

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20
Q

Describe the 4 states of RA

A
  • 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
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21
Q

Describe the medications for RA

A
  • NSAIDS for inflammation, swelling and pain
  • Corticosteroids
  • Disease modifying antirheumatic drucs
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22
Q

How is OA diagnosed?

A

Look for radiographic changes

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23
Q

How is RA diagnosed?

A
  • Individuals need a score of greater than or equal to 6/10 based on 4 different criteria
  • Joint involvement
  • Serology (protein)
  • Duration of symptoms
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24
Q

What are some deformities found in RA?

A
  • Ulnar drift (subluxation)
  • Boutonniere deformity
  • Swan neck deformity
  • Radial drift of wrist
  • Zigzag deformity
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25
Q

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
A

RA

26
Q

When completing arthritis assessments it is important to look at swelling and inflammation. Describe it.

A
  • Effusion: Fluid in capsule surrounding joint
  • Boggy: acute phase; soft and spongy
  • Chronic synovitis: Firm to touch
27
Q

Read fact

A

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
28
Q

True or false:

During a acute arthritis flare up, heat is recommended.

A

False it is contraindicated

29
Q

Name some PAM that are used for arthritis to help with pain and ROM stiffness.

A
  • Pain: Hotpacks, continuous ultrasound, paraffin and heating pads. Cryotherapy can be helpful for pain.
  • ROM: Hotpacks, fluidotherapy and paraffin.
30
Q

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
A

Acute & subacute phase

31
Q

Describe arthritis management for the acute and subacute phase.

A
  • 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
32
Q

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
A

Chronic active & chronic inactive

33
Q

Describe treatment for the chronic active and chronic inactive arthritis phases.

A
  • 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
34
Q

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.

A

True

35
Q

Name an exercise to address ulnar drift

A

Radial walks

  • Palm down on table move each digit over toward thumb laterally one at a time
36
Q

Name an exercise to address a boutonniere deformity

A
  • 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

37
Q

What type of orthosis is recommended for ulnar drift?

A
  • Hand based ulnar drift orthosis
  • Resting hand orthosis
38
Q

What type of orthosis is recommended for a boutonniere issue?

A
  • Oval 8 splints
  • Silver ring splints
  • 3 point orthosis if there is swelling
39
Q

What type of orthosis is recommended for a swan neck deformity>

A
  • Oval 8 splints
  • Silver Ring splints
  • 3 point orthosis if there is swelling
40
Q

What type of orthosis is recommended for a zigzag deformity?

A
  • 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
41
Q

Name some common joint protection techniques used with those with arthritis.

A
  • 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
42
Q

What is a CMC arthroplasty?

A
  • CMC interposition arthroplasty
  • Includes removal of the arthritic trapezium, donor tendon interpositioned in the pace and ligaments are replaced.
43
Q

Describe the process of a CMC arthroplasty

A
  • 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
44
Q

Describe general progress after shoulder arthroplasty.

A
  • 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
45
Q

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
A

Reverse total shoulder arthroplasty

46
Q

Describe the precautions for a reverse TSA

A
  • Avoid IR, Adduction and extension
  • Avoid movements such as washing your opposite underarm, tucking in your shirt and wiping
47
Q

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

A

TSA

48
Q

Describe the precautions for a TSA

A

-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

49
Q

Describe recover after a reverse TSA

A
  • 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

50
Q

Describe precautions for a posterior hip replacement

A
  • No hip flexion beyond 90 degrees
  • No hip adduction past neutral
  • No hip internal rotation
51
Q

Describe hip precautions for anterior replacement

A
  • No hip extension
  • No hip ER
52
Q

Describe precautions for global hip replacement (posterior and anterior)

A
  • No hip flexion beyond 90 degrees
  • No hip adduciton past neutral
  • No hip IR or ER
  • No hip prone lying
  • No bridging
53
Q

Describe hip precautions for a trochanteric replacement

A

No active hip abduction

54
Q

The following describes what hip replacement type:

  • No hip extension
  • No hip ER
A

Anterior

55
Q

The following describes what hip replacement type:

  • No hip flexion beyond 90 degrees
  • No hip adduction past neutral
  • No hip IR
A

Posterior

56
Q

The following describes what hip replacement type:

  • No active hip abduction
A

Trochanteric

57
Q

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
A

Global

58
Q

Describe sexual activity following a knee replacement.

A
  • Refrain from kneeling
  • Consider side lying position
59
Q

Describe sexual activity following hip preplacement

A
  • 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
60
Q

What 4 things should OTs observe when looking at arthritis patients?

A

Observe the following:

  1. Swelling/inflammation (effusion, boggy, etc)
  2. Nodes (Bouchards or Heberdens)
  3. Fixed deformities
  4. Hand deformities for R (i.e. ulnar drift, zigzag deformity, etc.)
61
Q

Name the 6 components when assessing a patient with arthritis

A
  1. Pain
  2. ROM
  3. Strength
  4. Sensation
  5. Stability (stabilize proximal joint, glide distal lateral/medial)
  6. Fatigue

BCPR (19 decks)

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