Musculoskeletal Conditions

Question 1

Arthritic Conditions

2 Categories

Answer 1

1. Degenerative Joint Disease, degenerative OA, OA

2. Rheumatoid conditions (Ankylosing Spondylitis, Gout, Psoriatic Arthritis, RA

Question 2

DJD

OA

Answer 2

a degenerative process of varied etiology with mechanical changes, diseases, and/or joint trauma

degeneration of articular cartilage with hypertrophy of subchondral bone and joint capsule of WB bones

Question 3

DJD/OA

Answer 3

Degenerative with mechanical changes/disease/joint trauma

Degeneration articular cartilage + hypertrophy of subchondral bone/joint capsule of WB joints

Meds: NSAIDs, glucocorticoid injections to reduce inflammation

Tests: X-ray (decr joint space/articular cartilage height/osteophyte) + lab test rule out RA

PT; joint protection, joint mechanics and connective tissue function, aerobic capacity/endurance i.e. Aquatic

Question 4

Ankylosing spondylitis

Answer 4

Rheumatoid condition:
Progressive inflammatory (unknown etiology) initially axial skeleton (initial LBP, sacriolitis, morning stiffness)
–>incr kyphosis cervical/thoracic and decreased lumbar lordosis
–>3xmen > women

Meds: NSAIDs, corticosteroid (to suppress immune system), cytotoxic drugs, TNF factor

Tests: HLA-B27 antigen

PT: flexibility trunk especially for extension, endurance, relaxation for respiratory function (incr vital capacity)

Question 5

Gout

Answer 5

Genetic purine metabolism elevated uric acid (hyperdrive is)–crystal deposits into peripheral joints/kidneys
**mostly knee and great toe

Meds: NSAIDs, cox-2 inhibitors (cardiac side effect), colchicine, corticosteroids, ACTH, allopurinol

Test: labs monosodium urate crystals in synovial fluid/connective tissue samples

PT: Pt education prevent injury/reduce involved joints, important to identify condition early

Question 6

Psoriatic Arthritis

Answer 6

Chronic erosive inflammatory disorder associated with psoriasis –erosive degeneration in joints of digits and axial skeleton

(Male = female)

Meds: NSAIDs, acetaminophen, corticosteroids, DMARDs slow progression, BRMs (enebrel = etanercept)

Tests: to rule our RA

PT; joint protection, improve joint mechanics and connective tissue function, endurance

Question 7

RA

Answer 7

Chronic, symmetrical pattern in synovial tissues and articular cartilage of joints/hands/wrist/elbows/shoulders/knees/ankles/feet

**MCP and PIP: pannus, ulnar drift, collar subluxation MCP joints
(Usually not DIP)
**swan neck deformity and boutonnière deformity, Bouchard’s nodes

Women 2-3x> men
Peds (JRA) before 16yrs, remission in 75%

Meds: gold compounds, DMARDs (methotrexate, hydroxycholoroquine), NSAIDs, immunosuppressive agents (cyclosporine, apathy orpine, mycophenlate), corticosteroids

Tests: X-ray symmetrical involvement in joints
:ab incr WBC count, erythrocytes sedimentation rate, anemia (Hbg, HCT), Rheumatoid factor elevated.

PT: joint protection, maintain joint mechanics/connective tissue function, endurance