Musculoskeletal Conditions Flashcards
1
Q
_____________ limb amputations occur 3 times more often than ___________ limb amputations.
A
Lower
Upper
2
Q
Amputation can be congenital or caused by traumatic or surgical removal of whole or part of a limb such as leg, foot, arm, or hand.
The most common cause of upper limb amputation is __________.
The most common causes of lower limb amputation are _________ and ___________.
A
Upper Limb: Trauma
Lower limb: peripheral vascular disease, diabetes
3
Q
An above the elbow amputation is called…
A
transhumeral
4
Q
A below the elbow amputation is called…
A
transradial
5
Q
A below the wrist amputation is called…
A
transmetacarpal
6
Q
An above the knee amputation is called…
A
transfemoral
7
Q
A below the knee amputation is called…
A
transtibial
8
Q
A _______________ is an amputation across a joint such as hip, wrist, elbow, or shoulder.
A
Disarticulation
9
Q
A below the ankle amputation is called…
A
transmetatarsal
10
Q
An ankle disarticulation is called…
A
Syme’s amputation
11
Q
Preprosthetic training occurs from postsurgery until client receives permanent prosthesis.
One of the main goals of this period is to assist the client in coping with psychological aspects of limb loss, including changed body scheme, reduced self-esteem and self-efficacy, shock, disbelief, anger, grief, guilt, denial, hopelessness, and depression.
What are at least 2 other goals?
A
Optimize wound healing.
Maximize residual limb shrinkage and shaping to achieve tapered distal end, the optimal shape for a prosthetic socket.
Desensitize residual limb.
Maintain or increase range of motion (ROM) and strength.
Facilitate independence in ADLs.
Explore prosthetic options (if desired)
12
Q
Prosthetic training occurs after the client receives permanent prosthesis.
One goal is to teach the client to independently don and doff prosthesis.
What are at least 2 other goals?
A
Train the client in care of the prosthesis.
Increase the client’s wearing time to full day.
Provide prosthetic control and functional use training.
Encourage the client in independent use of the prosthesis.
13
Q
What are 3 factors (including client factors) limiting performance that should be evaluated during the Post-operative and preprosthetic phase?
A
Pain
Skin complications, including delayed healing, necrosis, and skin graft adherence to bone
Edema of residual limb
Bone spurs
Neuroma on distal end of residual limb
Phantom limb pain, a sensation that appears to occur in the missing limb such as stabbing, cramping, burning, or throbbing
Phantom sensation, the sensation of the limb that is no longer there
14
Q
What are 3 factors (including client factors) limiting performance that should be evaluated during the prosthetic phase?
A
Any changes in sensation in the residual limb, including hypersensitivity and sensation loss
Presence and severity of phantom sensations
Pain
Body image and self-image
Strength, flexibility, and endurance of the residual limb in preparation for prosthesis wearing; full body strength, flexibility, and endurance
Skin integrity
Performance patterns including habits, routines, and roles, that may have been affected by amputation
Pressure injury as a result of ill-fitting prosthesis socket or wrinkles in prosthetic sock
Sebaceous cysts resulting from torque of prosthetic socket
Edema resulting from ill-fitting socket or too-tight prosthetic sock
Sensory changes such as loss of sensory information as a result of missing limb, residual limb hyperesthesia (oversensitivity), areas of absent or impaired sensation, phantom limb or phantom sensations.
15
Q
Name at least 2 interventions during the preprosthetic phase.
A
Limb hygiene
Wound care and healing
Limb shrinkage and shaping: The client is trained to wrap the residual limb in an elastic bandage to reduce and control edema and develop a tapered shape. An elastic shrinker or compression garment may be introduced with physician clearance once drainage stops.
Desensitization of the residual limb through tapping, vibration, constant pressure, and rubbing with varying textures
Joint mobility and stretching
Exercise program for ROM and strengthening muscle groups proximal to amputation and core strength
Wheelchairs: Clients with lower limb amputations require residual limb support; the large rear wheels should be placed further back to counterbalance missing limbs, and the wheelchair should have antitippers.
ADL retraining and consideration of modifications of environment and activity, as well as adaptive strategies. Change in hand dominance, if pertinent, is introduced.
Psychosocial adjustment
Exploration of optimal prosthesis to meet patient’s goals (if desired).
16
Q
A _____________ attaches the prosthesis to the residual limb.
A
Socket
17
Q
A terminal device is…
A
Lower limb amputation: foot
Upper limb amputation: hand
18
Q
In upper limb prostheses, a _____________- is combined with the harness to transmit body forces to control the cable that operates the TD.
A
control system
19
Q
In lower limb prostheses, a __________ is used to connect the TD to the socket.
A
pylon
20
Q
A __________________ protects the residual limb and improves the fit of the socket
A
prosthetic sock or gel liner
21
Q
Which prosthetic system is described below?
active prosthesis, cable driven and uses gross proximal body movements
A
Body-powered prosthesis
22
Q
Which prosthetic system is described below?
uses muscle surface electricity to control TD, increased grip force and more natural appearance. Must have two muscle sites that fit within the prosthesis to provide signal.
A
Electrically powered prosthesis (myoelectric prosthesis)
23
Q
Which prosthetic system is described below?
combines body-powered and electrically powered, most commonly used with transhumeral amputation.
A
Hybrid prosthesis
24
Q
Which prosthetic system is described below?
cosmetic, static and does not have grasp.
A
Passive prosthesis
25
Which prosthetic system is described below?
*designed for particular activity or task*
Activity-specific prosthesis
26
The Initial wearing time of a prosthetic should be _______________ minutes.
**15 to 30 (minutes)**
The prosthesis should then be removed, and the stump examined for reddened areas.
If no reddened areas are apparent after 20 minutes, the wearing time is increased in 15- to 30-minute increments until the client wears the prosthesis for a full day.
*Any reddened areas that do not disappear after approximately 20 minutes should be reported to the prosthetist so the prosthesis can be adjusted.*
27
How often should the interior of a prosthesis be cleaned?
Clean the interior **daily** with mild soap and water.
Allow prosthesis to *dry completely* prior to donning.
28
__________________ is the operation of each component of the upper limb prosthesis.
Prosthesis **control** training
29
______________ is the integration of prosthesis components for efficient assist during functional use.
Prosthesis **use** training
30
___________ is the identification of the optimal position of each positioning unit (e.g., wrist, elbow) to perform an activity or grasp an object.
Prepositioning training
31
________________ is terminal device control during grasp activities.
Prehension training
32
_________________ is the control and use of the prosthesis during functional activities including incorporation of the TD as a functional assist, and focusing on a problem-solving approach
Functional training
33
A __________________ is the shortening of skin, ligaments, joint capsule, tendons, and muscles resulting from conditions such as burns, wound healing, muscle imbalance from peripheral nerve injury, spinal cord injury, increased muscle tone from a stroke, head injury, and cerebral palsy.
**Contracture**
Contractures impede normal range of motion and affect movement.
*Soft tissue*: responds to therapy.
*Boney block*: requires surgery to release.
34
What are the five steps (in order) to treat contractures?
1. Superficial and deep heat to increase tissue extensibility
2. Slow stretch
3. Static splinting
4. Serial, or progressive, static splinting
5. Dynamic splinting.
35
This type of splint is used to reduce MCP hyperextension and interphalangeal (IP) flexion contractures; MCPs are splinted to block hyperextension.
Lumbrical bar splint
36
This typing of splinting uses fiberglass or plaster of Paris materials to position clients with increased tone and over time to stretch soft-tissue contractures.
Serial casting
37
This type of splint is used to maintain the wrist in neutral position or extension, the MPs in flexion, the IPs in extension, and the thumb in abduction with opposition.
Antideformity resting hand splints (burn intrinsic plus)
38
____________________ is a syndrome consisting of widespread pain with tenderness and stiffness that is independent of a specific injury or lesion.
**Fibromyalgia**
Symptoms include widespread soft tissue pain, nonrestorative sleep, fatigue, inability to think clearly, paresthesias and joint swelling, depression, and anxiety.
39
Name at least 3 interventions for fibromyalgia.
Client education to **avoid pain triggers and manage stress**
Gentle regular **aerobic exercise, gentle daily stretching, strengthening** activities
**Cognitive–behavioral therapy**
**Sleep hygiene** techniques
**Myofascial release** and trigger point treatment, massage, **relaxation** exercises, biofeedback
Progressive strength training
**Fatigue, stress, and pain management; pacing activities; work simplification and energy conservation** techniques
**Memory aids**
**Modification of activity or environment** or adaptive equipment
40
______________ are one of the most commonly occurring conditions in adults. Older adults are particularly vulnerable.
Osteoporosis is a significant risk factor, as is reduced mobility; both factors can be present in aging populations, particularly women.
**Hip fractures**
*Trauma is the primary cause* of fractures, often with falling as the mechanism of injury.
Osteoporosis is particularly problematic because decreased bone density occurs in the neck of the femur.
41
This type of hip fracture can be caused by slight trauma or rotational force; they occur most commonly in women older than age 60 with osteoporosis.
Femoral neck fractures
42
This type of hip fracture results from a direct trauma or force between the greater and lesser trochanter.
Intertrochanteric fractures
43
This type of hip fracture results from a direct trauma to the lesser trochanter; they are most often the result of a car accident or fall and occur mostly in people younger than age 60.
Subtrochanteric fractures
44
Explain the 5 levels of weight bearing restrictions:
- Non–weight bearing
- Toe-touch weight bearing
- Partial weight bearing
- Weight bearing at tolerance
- Full weight bearing
**Non–weight bearing**: No weight can be placed on the affected extremity.
**Toe-touch weight bearing**: The toe of the affected extremity can touch the ground for balance only; 90% of body weight is placed on unaffected leg.
**Partial weight bearing**: The affected extremity may bear only 50% of client’s body weight.
**Weight bearing at tolerance**: The client judges how much weight they can tolerate on the basis of pain response.
**Full weight bearing**: The client may put 100% of their weight on the affected extremity without causing damage.
45
Hip replacements (arthroplasty) are most often used to _______________ or _______________.
restore joint motion
address joint pain
46
________________, ________________, and ___________________ often precede joint replacements.
Osteoarthritis
Rheumatoid arthritis
Degenerative joint diseases
47
This hip replacement approach has the following precautions:
- no hip flexion greater than 90°
- no internal rotation
- no adduction of affected hip joint
**Posterolateral approach**
Hip precautions are dependent on the type of surgery, and failure to follow them may result in hip dislocation and further injury.
Out-of-bed activity should occur early with both approaches, traditionally 1 to 3 days post-operation.
48
This hip replacement approach has the following precautions:
- no external rotation
- no extension
- no adduction of affected hip joint
**Anterolateral approach**
Hip precautions are dependent on the type of surgery, and failure to follow them may result in hip dislocation and further injury.
Out-of-bed activity should occur early with both approaches, traditionally 1 to 3 days post-operation.
49
For hip replacements, what kind of education/reeducation is important?
hip precautions
bed mobility
proper transfer techniques
home modification recommendations
ROM restrictions
positioning to perform ADLs
50
What are some things to consider regarding ADLs/IADLs for a person who has had hip replacement?
Teach prescribed precautions
Teach safety techniques
Teach compensatory strategies for ADLs such as lower-body dressing, bathing, sexual activity
Alternative options for bathing (e.g., dry shampoo, rinse-free shampoo cap, washing hair in the sink) may be considered for clients unable to shower in a tub or walk-in shower.
51
_______ and ____________ are primary reasons people elect to have knee joint replacements.
**Pain
Loss of function**
Often due to osteoarthritis, degenerative joint disease, trauma or injury to the knee, or other rheumatic conditions.
May be compounded by obesity or aging.
52
What are precautions
Client should **avoid excessive knee rotation for up to 12 weeks after surgery**.
Usually **no restriction on flexion and extension of knee**.
Clients will usually start out-of-bed activity on the first day after surgery
53
This knee replacement procedure is often performed with minimally invasive technique when the client has medial or lateral compartmental damage between femur and tibia.
Partial or unicompartmental knee arthroplasty (UKA)
54
This type of knee replacement is done when the client has damage to two or more compartments of the knee.
Total knee replacement or total knee arthroplasty (TKA)
55
_____________ is the leading cause of disability in Americans younger than 45 years.
Lower back pain
56
Name the lower back condition described below.
*stress tearing of the fibers of a disc, causing an outward bulge pressing on spinal nerves*
A. Sciatic pain
B. Spinal stenosis
C. Facet joint pain
D. Spondylolysis
E. Spondylolisthesis
F. Herniated nucleus pulposus
G. Compression fracture
F. Herniated nucleus pulposus
57
Name the lower back condition described below.
*vertebral osteoporosis*
A. Sciatic pain
B. Spinal stenosis
C. Facet joint pain
D. Spondylolysis
E. Spondylolisthesis
F. Herniated nucleus pulposus
G. Compression fracture
G. Compression fracture
58
Name the lower back condition described below.
*trapping of the nerve by a herniated disc*
A. Sciatic pain
B. Spinal stenosis
C. Facet joint pain
D. Spondylolysis
E. Spondylolisthesis
F. Herniated nucleus pulposus
G. Compression fracture
A. Sciatic pain
59
Name the lower back condition described below.
*inflammation or changes of the spinal joints*
A. Sciatic pain
B. Spinal stenosis
C. Facet joint pain
D. Spondylolysis
E. Spondylolisthesis
F. Herniated nucleus pulposus
G. Compression fracture
C. Facet joint pain
60
Name the lower back condition described below.
*narrowing of the intervertebral foramen*
A. Sciatic pain
B. Spinal stenosis
C. Facet joint pain
D. Spondylolysis
E. Spondylolisthesis
F. Herniated nucleus pulposus
G. Compression fracture
B. Spinal stenosis
61
Name the lower back condition described below.
*stress fracture of the dorsal to transverse process*
A. Sciatic pain
B. Spinal stenosis
C. Facet joint pain
D. Spondylolysis
E. Spondylolisthesis
F. Herniated nucleus pulposus
G. Compression fracture
D. Spondylolysis
62
Name the lower back condition described below.
*slippage of a vertebra out of position*
A. Sciatic pain
B. Spinal stenosis
C. Facet joint pain
D. Spondylolysis
E. Spondylolisthesis
F. Herniated nucleus pulposus
G. Compression fracture
E. Spondylolisthesis
63
Name at least 3 interventions for lower back pain.
**Education regarding back anatomy** and movements related to the client’s occupational performance
Use of **neutral spine back stabilization techniques** to promote decreased pain
**Body mechanics**
Training in **adaptive equipment and modified tasks**
**Task analysis** and introduction of ergonomic design
Training in **energy conservation**
**Use of occupation to increase strength and endurance**
Education for **pain management, stress reduction, and coping**
**Lifestyle modifications**
**Medication management**
ADL and IADL training
64
Name at least 3 standards of body mechanics for lower back pain.
Maintain a straight back; minimize lumbar lordosis.
Bend from the hip.
Avoid twisting.
Maintain good posture.
Carry loads close to body.
Lift with the legs.
Lift with a wide base of support.
Lift in the sagittal plane.
Lift slowly.
65
Describe 1 lift considerations.
**Semi-squat**: face the object and lower both knees toward the floor, maintain a straight back and posterior pelvic tilt
**Large or heavy objects**: lower one knee to the floor to add more central support. Keep the mass close to the body’s center of gravity. Use the knee on the floor to help push up.
**Light, well-balanced loads**: carry close to the body with straight spinal alignment
66
What are some considerations for bathing and dressing with lower back pain?
**Bathing**
- All items should be kept *within reach* (shower caddy, shower ledge or rack, or alternative device).
- A *handheld shower and long-handled scrub brush* reduce unnecessary movements and twisting.
**Dressing**
- Emphasis is placed on *minimizing bending*.
- The client should *sit while dressing.*
- The *client should lie flat on the bed when pulling clothing up*.
- Socks are applied and removed by *bringing the foot to the knee*.
- *Slip-on shoes* are encouraged if possible.
- *Belts are threaded through the loops before donning pants* to decrease twisting.
67
In regard to functional mobility, what are some things to consider for individuals with lower back pain?
**Logrolling**, a technique for rolling the body as a whole unit without twisting, is recommended for bed mobility.
To sit up, the client **bends the knees and pushes up with the arms**.
To lie down, the client **brings the legs up and uses the arms to lower the body to the bedside**.
For toilet mobility, the **client lowers the body while maintaining a straight back** and neutral spine.
**Firm-armed chairs** are encouraged to ensure that the client is not too low, which increases vulnerability to back stress.
The client is **advised not to sit for longer than 15 to 20 minutes**.
68
In regard to sexual activity, what are some things to consider for individuals with lower back pain?
The lower back should be in the **neutral position**; a **rolled towel or pillow** under the lower back can assist.
**Stretching and warming up** muscles can prevent further injury.
A **warm shower** can relax muscles and reduce pain.
69
In regard to rest and sleep, what are some things to consider for individuals with lower back pain?
A **firm, supportive mattress is important.
The pillow should support the neck and head without causing flexion; foam pillows are helpful.
For sleeping on the back, a pillow under the knees** reduces strain on the lower back.
For lying on the side, a **pillow between the knees** helps the top leg maintain alignment and reduces the possibility of twisting.
Lying on the stomach may be permissible for some people, with a **pillow under the feet** to take stress off the lower back.
70
True or false: After age 50, osteoarthritis is more common in women than in men.
True
71
__________________ is a noninflammatory condition that causes a breakdown in articular cartilage as a result of mechanical and chemical factors, resulting in reduced joint space and eventually painful bone-on-bone contact.
**Osteoarthritis**
OA can affect all joints; however, the most common are the base of the thumb, proximal and distal joints of the fingers, hips, and knees.
*OA can be classified as follows:
1. Primary*: localized or generalized joint involvement and no known cause
2. *Secondary*: related to trauma, congenital abnormalities, infection, or necrosis.
72
True or false: There is a cure for osteoarthritis.
False
73
____________ are a complication of osteoarthritis that occurs on the DIP joints.
Heberden’s nodes
74
____________ are a complication of osteoarthritis that occurs on the PIP joints.
Bouchard’s nodes
75
Is surgery recommended for osteoarthritis?
Only if conservative treatment is unsuccessful
76
What are some factors affecting participation in someone with osteoarthritis?
Pain
Joint changes such as instability, loss of motion, weakness, and fatigue.
77
What are some things to assess for in an individual with osteoarthritis?
Posture
Presence of location of inflammation
active and passive ROM
gross strength
hand function
stiffness
pain
sensation
deformity
physical endurance
78
Name at least 3 PAMs to reduce pain and increase ROM in someone with osteoarthritis.
Paraffin
Fluidotherapy
Hot packs, microwave packs
Hydrotherapy
Electric stimulation
79
What are some exercise and physical activity interventions for osteoarthritis?
**AROM exercises** are encouraged; PROM is used only if AROM is precluded.
**Isometric or isotonic strengthening** exercises can be performed to tolerance.
**Low-impact aerobic conditioning** exercises can increase flexibility, strength, endurance, and cardiovascular fitness.
**Pinching exercises** may be contraindicated with CMC joint instability because of stresses on the joint.
**Aquatic exercise**
Land-based exercise (e.g., aerobic exercise, **balance training, resistance training, home-based** programs)
Upper extremity **interval exercise**
**Yoga and Tai Chi**
80
What are at least 2 education topics related to osteoarthritis?
Education topics should include symptom management, disease process, principles of joint protection and fatigue management, stress management, pain management, and available community resources.
81
Name at least 5 principles of joint protection and fatigue management.
**Respect pain.**
Maintain **muscle strength and joint ROM**.
Use each joint in its most **stable anatomical and functional plane**.
**Avoid positions of deformity.**
Use the **strongest joint** available.
Ensure **correct patterns of movement**.
**Avoid staying in one position** for long periods.
**Avoid starting an activity that cannot be stopped immediately if it becomes too stressful.**
**Balance rest** and activity.
**Reduce force and effort**.
82
___________________ is a progressive condition characterized by low bone mass or density and deterioration leading to bone fragility and pathological fractures, particularly of weight-bearing bones.
**Osteoporosis**
*Risk factors* include inadequate calcium intake, estrogen deficiency, cigarette smoking, alcoholism, and a sedentary lifestyle.
Osteoporosis can occur *secondary to certain medications*, such as prolonged exposure to steroids. It can also be related to alcoholism, hyperthyroidism, and malnutrition.
83
_______________ is a reversible weakening of the bone and is a precursor to osteoporosis.
Osteopenia
84
True or false: Clients are often not diagnosed with osteoporosis until they experience a stress fracture of the vertebrae or hip.
True
85
Collapse of vertebrae causing kyphotic posture, reduction of joint ROM, stiffness, impaired movement, pain, and pathological fracture are all symptoms of...
Osteoporosis
86
In additiont o being prescribed antiresorptive medications, usually bisphosphonates, to slow bone loss, taking calcium, and/or hormone-related therapy for osteoporosis, clients should also be advised to... (name 2 interventions/education points)
exercise
reduce smoking
reduce alcohol consumption
reduce caffeine consumption
87
When working with someone with osteoporosis, what is one of the most important factors to assess?
Fall risk
88
Name at least 2 contraindicated exercises for advanced osteoporosis.
1. Vigorous aerobic workouts
2. Exercises that require twisting or bending
3. Abdominal machines
4. Biceps-curl machines
5. Rowing machines
6. Tennis
7. Golf
8. Bowling
*Encourage low-impact weight-bearing activities, such as walking, to increase physical activity.*
89
_________________ is a chronic, systemic, inflammatory condition that affects 1.5 million people in the United States. It occurs primarily in women ages 40–60.
**Rheumatoid arthritis (RA)**
RA is a progressive inflammation of the synovial membrane (synovitis) of the diarthrodial joints
90
The most common deformities in RA are:
1. _____________
2. _____________
3. _____________
4. _____________
**1. wrist radial deviation
2. MP ulnar deviation
3. swan neck deformity
4. boutonniere deformities**
RA can lead to *destruction of ligament, tendon, cartilage, and bone.*
*Joint swelling from excessive synovial fluid*, combined with enlargement of the synovium and thickening of the joint capsule, lead to *weakened joint capsules and distended tendons* and ligaments.
91
What period of rheumatoid arthritis is described below?
*no signs of inflammation, low endurance, pain from stiffness and weakened joints, morning stiffness primarily related to disuse, limited ROM, weakness and muscle atrophy, contractures*
A. acute
B. subacute
C. chronic-active
D. chronic-inactive
D. chronic-inactive
92
What period of rheumatoid arthritis is described below?
*reduced pain and tenderness; morning stiffness; limited movement; tingling or numbness; pink, warm joints; low endurance; weakness; gel phenomenon; weight loss or decreased appetite; mild fever*
A. acute
B. subacute
C. chronic-active
D. chronic-inactive
B. subacute
93
What period of rheumatoid arthritis is described below?
*low-grade inflammation, decreased ROM, less tingling, pain and tenderness primarily with movement, low endurance*
A. acute
B. subacute
C. chronic-active
D. chronic-inactive
C. chronic-active
94
What period of rheumatoid arthritis is described below?
*pain and tenderness at rest that increases with movement; limited ROM; overall stiffness; gel phenomenon (inability to move joints after rest); weakness; tingling or numbness; hot, red joints; cold, sweaty hands; low endurance; weight loss or decreased appetite; fever*
A. acute
B. subacute
C. chronic-active
D. chronic-inactive
A. acute
95
At this stage of rheumatoid arthritis, there is radiographic evidence of RA; possible slight subchondral bone destruction and possible presence of slight cartilage destruction; no joint deformity (possible limited ROM); adjacent muscle atrophy; possible presence of extra-articular soft-tissue lesions.
Stage II, moderate
96
At this stage of rheumatoid arthritis, there is radiographic evidence of RA; cartilage and bone destruction; joint deformity; extensive muscle atrophy; possible presence of extra-articular soft-tissue lesions.
Stage III, severe
97
At this stage of rheumatoid arthritis, there are no destructive changes on X ray, however, there is a possible presence of RA.
Stage I, early
98
At this stage of rheumatoid arthritis, there is radiographic evidence of RA; fibrous or bony ankylosis in addition to cartilage and bone destruction; joint deformity; extensive muscle atrophy; possible presence of extra-articular soft-tissue lesions.
Stage IV, terminal
99
Common symptoms of rheumatoid arthritis are pain, redness, warmth, tenderness, morning stiffness, ROM limitations, muscle weakness, weight loss, malaise, fatigue, and depression.
Name at least 5 of the most common joints it affects.
proximal interphalangeal (PIP) joints
metacarpophalangeal (MCP) joints
all thumb joints
wrist
elbow
ankle
metatarsophalangeal (MTP) joints
temporomandibular joints
hips
knees
shoulder
cervical spine
100
Flexion of the PIP joint and hyperextension of the DIP joint is called ___________________ and is common in rheumatoid arthritis.
Boutonniere deformity
101
Hyperextension of the PIP joint and flexion of the DIP joint is called ___________________ and is common in rheumatoid arthritis.
Swan neck deformity
102
Flexion of the DIP joint is called ___________________ and is common in rheumatoid arthritis.
Mallet finger
103
Radial deviation of the wrist and ulnar deviation of the MCP joints is called ___________________ and is common in rheumatoid arthritis.
Ulnar drift (sometimes called a zigzag deformity)
104
This kind of deformity seen in rheumatoid arthritis is characterized by very floppy joints with shortened bones and redundant skin; caused by reabsorption of bone ends; most common in the MCP, PIP, radiocarpal, or radioulnar joints.
Mutilans deformity
105
__________ is hyperextension of the MTP and flexion of the PIP and DIP of the tarsals and is commonly seen in rheumatoid arthritis.
Claw toe
106
__________ is hyperextension of the MTP, flexion of the PIP, and hyperextension of DIP of the tarsals and is commonly seen in rheumatoid arthritis.
Hammer toe
107
__________ is subluxation of the metatarsal heads and is commonly seen in rheumatoid arthritis.
Cock-up toe
108
__________ is fibular deviation of the first toe and is commonly seen in rheumatoid arthritis.
Hallux valgus or bunion
109
Which type of rheumatoid arthritis of the thumb (deformity) is described below?
*MCP hyperextension and instability of the MCP ulnar collateral ligament (similar to gamekeeper’s thumb, or injury to the ulnar collateral ligament of the thumb)*
A. Type I
B. Type II
C. Type III
D. Type IV
E. Type V
F. Type VI
D. Type IV
110
Which type of rheumatoid arthritis of the thumb (deformity) is described below?
*CMC flexion/adduction, MCP flexion, and interphalangeal joint hyperextension (similar to boutonniere deformity in fingers)*
A. Type I
B. Type II
C. Type III
D. Type IV
E. Type V
F. Type VI
B. Type II
111
Which type of rheumatoid arthritis of the thumb (deformity) is described below?
*CMC subluxation, MCP hyperextension, and interphalangeal joint flexion (similar to swan neck deformity in fingers)*
A. Type I
B. Type II
C. Type III
D. Type IV
E. Type V
F. Type VI
C. Type III
112
Which type of rheumatoid arthritis of the thumb (deformity) is described below?
*MCP flexion and interphalangeal joint hyperextension (similar to boutonniere deformity in fingers)*
A. Type I
B. Type II
C. Type III
D. Type IV
E. Type V
F. Type VI
A. Type I
113
Which type of rheumatoid arthritis of the thumb (deformity) is described below?
*Thumb collapse because of arthritis mutilans*
A. Type I
B. Type II
C. Type III
D. Type IV
E. Type V
F. Type VI
F. Type VI
114
Which type of rheumatoid arthritis of the thumb (deformity) is described below?
*MCP hyperextension because of a lax volar plate*
A. Type I
B. Type II
C. Type III
D. Type IV
E. Type V
F. Type VI
E. Type V
115
Surgical intervention for RA is done to relieve pain and improve function when conservative treatment has failed.
Name 2 surgical interventions.
Synovectomy (excision of diseased synovium)
Tenosynovectomy (removal of diseased tendon sheaths)
Tendon surgery and tendon transfers
Peripheral nerve decompression
Arthroplasty
Arthrodesis
116
Factors affecting participation are pain, joint stiffness, joint deformity, decreased joint mobility and stability, atrophy and decreased muscle power, and fatigue. Considering the nature of rheumatoid arthritis, what factor related to participation should also be assessed?
**Sensation**
Clients may have *peripheral neuropathies* related to RA.
Also assess posture, presence of location of inflammation, active and passive ROM on noninflamed joints, gross strength, hand function, stiffness, pain, sensation, deformity, and physical endurance.
117
During active flare ups of rheumatoid arthritis, what are some interventions that are appropriate for clients?
1. Clients should be instructed to **limit activities during acute flare-ups** to prevent placing stress on unstable joints. Clients should be instructed in how to resume normal activities as the symptoms reduce.
2. **Assistive devices** can be provided to compensate for reduced ROM, strength, and hand function to increase independence and participation.
3. **Physical agent modalities**, superficial heat and cold, can be used to control symptoms in preparation for occupation-based activity.
118
Therapeutic exercise and physical activity interventions can be use to increase strength, improve function, reduce fatigue, address depression, improve walking ability, and decrease pain in client's with rheumatoid arthritis.
Provide some examples of therapeutic exercise and physical activity interventions for this population.
**ROM exercises**: *AROM* can be used through full pain-free range. PROM may be more appropriate during acute flare-ups to prevent stress on inflamed joints.
**Strengthening exercises**: *Isometric exercises within pain-free exertions* are appropriate during acute flare-ups. Isotonic, progressive resistive exercises can be performed as tolerated when the client is in remission. Care should be taken to ensure that the amount of resistance is appropriate and that the client works in a pain-free range.
**Aerobic exercises**: *Low-impact aerobic activities*, such as walking, stationary bicycling, or low-impact dancing can increase flexibility, strength, endurance, and cardiovascular fitness.
**Aquatic exercise**
**Yoga and Tai Chi**
119
Is splinting appropriate for the rheumatoid arthritis population?
**YES!**
Splinting can be used to **reduce inflammation and pain** (e.g., resting hand splint), properly **position and support unstable joints** (e.g., MCP ulnar deviation, swan neck deformity), **limit undesirable motions**, increase **ROM**, **prevent deformity**, and **increase function**.
120
