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OCS > Osteoarthritis > Flashcards

Osteoarthritis Flashcards

1
Q

Diagnosing hip OA

A
  • moderate anterior or lateral hip pain during weight bearing
  • morning stiffness <1 hour in duration after waking
  • hip IR ROM less than 24 degrees or hip IR and hip flexion 15 degrees less than the nonpainful side
  • increased hip pain associated with passive hip IR
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2
Q

Tests to assess activity limitation, participation restrictions, and changes in the patient’s level of function.

A
  • 6 minute walk test
  • 30 second chair stand
  • stair measure
  • TUG
  • self paced walk
  • timed SLS
  • 4 square step test
  • step test
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3
Q

Common sites of OA

A
  • knee (17%)
  • shoulder (8%)
  • hip (6%)
  • hand
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4
Q

What is OA

A
  • Molecular derangement leading to anatomic and/or physiologic derangement characterized by…
  • cartilage degradation
  • bone remodeling
  • osteophyte formation
  • joint inflammation
  • loss of joint function
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5
Q

Likelihood of developing OA with nonspecific knee injury

A

-3 times more likely to develop OA

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6
Q

Likelihood of developing OA with injuries to ACL, meniscus, and femoral fx

A
  • 6 times more likely to develop OA
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7
Q

Articular cartilage

A
  • avascular
  • gets nutrients through diffusion
  • requires intermittent mechanical pressure to encourage diffusion
  • total relief of pressure impedes nutrition and negatively contribute to its health
  • self lubricating
  • load applied=fluid released, load released=fluid absorbed
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8
Q

Articular cartilage response to immobilization

A
  • changes can occur in a few weeks
  • atrophy and thinning of articular cartilage
  • decreased proteoglycan synthesis, decreased amount of matrix, increased water content
  • changes can occur eve if joint can move but weight bearing is not allowed
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9
Q

Effects of prolonged immobilization with regards to articular cartilage

A
  • fibro fatty build up in joint space

- may lead to adhesions formation between fibro fatty mass and articular cartilage

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10
Q

Effects of aging on articular cartilage

A
  • changes in properties of proteoglycans
  • decreased water content
  • decrease in integrity of collagen fibers
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11
Q

Consideration fo re-mobilization of joint with regards to articular cartilage

A
  • assume articular cartilage has altered structural and mechanical function
  • gradual exposure of compressive loading through muscle conractions and progressive weight bearing
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12
Q

Stresses that may induce inflammatory pathways in articular cartilage

A
  • abnormal mechanical loading
  • obesity
  • genetics
  • aging
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13
Q

Changes in cartilage structure with OA

A
  • increased water, decreased proteoglycans
  • fibrullation, fissuring, and erosion
  • calcification/sclerosis of subchondral bone
  • chondrocyte proliferation, hypertrophy, apoptosis (cellular death)
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14
Q

Kellgres lawrence grading of OA

A

0: no radiological findings of OA
I: doubtful joint space narrowing and possible osteophytic lipping
II: Definitie osteophytes and possible narrowing of joint space
III: Moderate multiple osteophytes, definite narrowing of the joint space, small pseudocystic areas with sclerotic walls and possible deformity if bone contour
IV: large osteophytes, marked narrowing of joint space, severe sclerosis and deficit in deformity of bone contour.

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15
Q

Changes in bone with OA

A
  • sclerosis of subchondral bone
  • cyst formation
  • bone marrow lesions
  • osteophyte formation
  • osteonecrosis and bone attrition
  • joint deformity
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16
Q

Sources of pain with OA

A
  • Not cartilage as it is avascular
  • synovium
  • bone
  • nerves
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17
Q

Synovium as pain source

A
  • synovitis from inflammatory cell infiltration, cartilage, and bone debris
  • infrapatellar fat pad irritation may trigger synovitis
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18
Q

Bone as pain source

A
  • subchondral bone: thinning of cartilage and vascular congestion due to intraosseus compression, bone angina, and bone attrition
  • periostitis from osteophyte formation
  • bone marrow lesions (found in 77% of patients with knee pain that is osteoarthritic in nature)
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19
Q

Nerve as a pain source

A
  • may result in alterations of nerve structure in tissues
  • may result in neuropathic pain source
  • nerves become hypersensitive
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20
Q

Consistency of pain in OA

A

-pain may be more inconsistent with early OA and becomes more consistent as disease progresses

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21
Q

Clinical and laboratory diagnosis of OA

A
  1. > 50 years
  2. stiffness >30 minutes
  3. crepitus
  4. bony tenderness
  5. bony enlargement
  6. no palpable warmth
  7. erythrocyte sedimentation rate under 40 mm/hour
  8. Rheumatoid factor under 1:40
  9. SF OA
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22
Q

Clinical recommendations for treatment of OA

A
  • land based exercise can decrease pain for 2-6 months
  • magnitude of recover increases with face to face appointments with PT
  • Hip mobilizations
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23
Q

Hip mobilizations can improve knee pain if five variables identified

A
  1. hip or groin pain and parasthesia
  2. anterior thigh pain
  3. passive knee flexion >122 degrees
  4. passive hip IR <17 degrees
  5. pain with hip distraction
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24
Q

Conservative care for glenohumeral OA

A
  • lifestyle modification
  • PT (heat modalities, joint mobilization, ROM, strengthening)
  • Intra-articular injections
  • medication
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25
Q

Differentiating OA from adhesive capsulitis

A

OA is stiff in all directions, adhesive capsulitis follows capsular pattern.

26
Q

Indications for total shoulder replacement

A
  • Degenerative joint disease (OA, RA, proximal humeral fx’s, post traumatic RA)
  • RTC arthropathy
  • Avascular necrosis
  • Past failed replacement or hemiarthroplasty
27
Q

Goals of shoulder arthroplasty

A
  • Typically prehab is inefficient due to level of pain.
  • pain
  • function
  • sleep
28
Q

Total shoulder rehab guidelines

A
  • Sling during the day for 1-2 weeks, at night for 4-6 weeks
  • patient education
  • general ROM for the first 4-6 weeks
  • strength progressions to isometrics
29
Q

Phase I of TSA rehab

A
  • decrease pain and inflammation
  • maintain integrity of orthoses
  • decrease muscle inhibition
  • improve PROM, initiate AAROM in late phase I
  • full distal extremity AROM
  • independence with modified ADL’s/IADL’s
30
Q

Phase II of TSA rehab

A

4-6 weeks

  • control pain and inflammation
  • full PROM
  • increase AROM but do not over stress healing tissue
  • initiate dynamic shoulder stability
31
Q

Phase III of TSA rehab

A
  • restore strength, power, and endurance
  • optimize scapulohumeral rhythm
  • gradually return to functional activities with upper extremities.
32
Q

Phase IV of TSA rehab

A
  • nonpainful AROM
  • functional use of UE
  • maximize strength and endurance
  • gradual return to more advanced activities
33
Q

TSA phase I exercise guidelines

A
  • cryotherapy
  • scapular isometrics
  • PROM as tolerated
  • avoid anterior capsular stretching
  • begin assisted flexion, ABD, IR, and ER in scaption
  • AROM of distal extremities
34
Q

TSA phase II exercise guidelines

A
  • cryotherapy
  • PROM, AAROM
  • manual therapy as indicated
  • initiate AROM of flexion, IR, ER, ABD in pain free ROM
  • begin submax strengthening isometrics in neutral
  • scapular strengthening
  • initiate glenohumeral and scapulothoracic stabilization
  • continue distal extremity strengthening
35
Q

TSA phase III exercise guidelines

A
  • tolerates AROM/AAROM/strengthening
  • AROM: 140 flexion, 120 ABD in supine, 60 ER in scapular plane in supine, 70 AROM in IR in scapular plane
  • 120 active elevation against gravity without substitution
36
Q

TSA phase IV exercise guidelines

A
  • independent with HEP
  • 80% UE AROM is pain free
  • full functional use of UE
  • maximized muscular strength, power, and endurance
  • pt has returned to advanced functional activities
37
Q

When to do a reverse TSA

A
  • GH joint arthritis
  • irreparable rotator cuff tear
  • complex fracture
  • failed TSA with RTC tendons deficient or absent
38
Q

Reverse TSA post op considerations

A
  • limit IR/ADD with extension for about 12 weeks
  • rely more on deltoid and scapular stabilizers
  • ER dependent on condition of teres minor
39
Q

Reverse TSA phase I guidelines

A

Goals: maintain integrity of joint, restore PROM
Precautions: delay PROM for 3-6 weeks, usually begin PROM around week 4 to allow deltoid to heal.

40
Q

Reverse TSA phase I exercise

A
  • cryotherapy
  • all activities can be advanced based on clinical presentation and progression
  • adjust program and expectation if there was a RTC repair
  • flexion and elevation in scapular plane 120-140 by 6 weeks
  • ER 30-45 (more limits if RTC repair)
  • passive IR at week 6 with arm in 60 degrees of ABD
41
Q

Early phase II exercise reverse TSA

A
  • dislocation precautions still in place (no IR/ADD/EXT)
  • progress PROM to AAROM in supine
  • progress to sitting and standing
  • rotational AAROM
42
Q

Late phase II exercise reverse TSA

A
  • AAROM–>AROM
  • gentle strengthening
  • week 8-9 begin submax rotational isometrics
  • progress deltoid and scapular exercises to AROM (low weight high reps)
  • scapular mobs
43
Q

Phase III exercise reverse TSA

A
  • start when PROM/AAROM/AROM is appropriate
  • continue dislocation precautions
  • isotonic activation of deltoid and periscap musculature
  • resistive strengthening of the elbow, wrist, and hand
  • should be at 2-3 pounds for PRE’s
  • continue low weight high rep
44
Q

Phase IV exercise reverse TSA

A
  • usually independent with HEP, D/C criteria include…
  • ->functional pain free AROM flexion: 80-120 ER: 30
  • ->return to light household work with 10-15 lb limit
  • ->weight limit is for bimanual activities and should be followed indefinitely
45
Q

How to help manage OA

A
  • lifestyle modifications
  • modalities
  • joint mobs
  • ROM
  • strengthening
  • intra-articular injections (hyaline more effective that corticosteroids)
  • medications (tylenol is typically most effective)
46
Q

Elbow replacement

A
  • not commonly done, usually for those with severe RA or hx of juvenile rheumatoid conditions
  • no lifting >3-5 lbs for 4 weeks
  • return to activity when incision is healed and prosthesis is stable to return to moderate activity
47
Q

Surgical intervention for wrist OA

A
  • used for worst case scenarios
  • ROM typically restricted to 40-75% of normal
  • fusion is typically done to increase stability and decrease pain
48
Q

Hand OA recommendations (poor evidence to support)

A
  1. Combo of meds and conservative therapy
  2. individualized treatment to address risk factors
  3. joint protection techniques and exercise
  4. heat modalities
  5. splinting
  6. local use of topical NSAIDs and capsacon
  7. paracetemal for long term pain management
  8. oral NSAIDs
  9. SYSDOA
  10. intra-articular injections
  11. surgery as a last resort
49
Q

Risk factors for hip OA

A
  • age
  • developmental disorders
  • ->developmental dysplasia
  • ->congenital dislocations
  • ->legg-calve perthes disease
  • ->slipped capital femoral ephysis
  • trauma (fractures)
  • high impact athletics
50
Q

Altman’s clinical criteria for diagnosis of OA

A
  • hip pain
  • IR ROM<15 degrees
  • erythrocite sedimentation rate <20 mm/hr
  • pain with hip IR
  • AM stiffness
51
Q

Historical complaints for hip OA

A
  • difficulty walking over uneven ground and going up and down stairs
  • pain with sustained positioning like sitting and driving
  • difficulties getting dressed or lifting leg
  • groin pain that radiates to knee
  • AM pain and stiffness that decreases after 1 hour
  • pain at end ROM, especially IR
52
Q

Hip OA ROM

A
  • capsular pattern of limitation: IR greater than ABD, which is greater than flexion
  • > 15 degrees difference is considered pathological
53
Q

Clinical prediction rule for hip OA

A
  • painful squatting
  • painful flexion
  • scour test that produces groin pain
  • painful extension
  • IR <25 degrees
54
Q

Adult Still’s Disease

A
  • Rare inflammatory arthritis similar to RA
  • High fever that spikes once or twice a day
  • Salmon pink rash on the trunk, arms, or legs
  • Sore throat and swollen lymph nodes in the neck
  • Joint and muscle aching lasting at least 2 weeks. The most commonly affected joints are ankles, shoulders, elbows, and fingers.
55
Q

Ankylosing Spondylitis

A
  • Chronic pain and stiffness in the low back, buttocks, and hips that usually develops over weeks or months.
  • Pain and stiffness that worsens during periods of rest or inactivity and improves with movement and exercise
  • Back pain during the night or early morning.
56
Q

Complex Regional Pain Syndrome

A
  • pain, swelling, and stiffness in the affected areas
  • changes in temperature and color of skin, rapid nail and hair growth.
  • burning pain, skin becoming drawn, muscles and other tissues becoming wasted and contracted, or reduced joint movement and limb function
57
Q

Infectious Arthritis

A
  • arthritis caused by an infection in the joint, also called septic arthritis
58
Q

Juvenile Idiopathic Arthritis

A
  • joints are warm to the touch
  • swelling and tenderness at joints
  • fever
  • rash
  • favoring one limb over another or limping
  • pain often worse following sleep or inactivity
  • stiffness, especially in the morning
  • inability to bend or straighten joints completely
  • decreased physical activity
  • fatigue
  • sleep problems
  • swollen lymph nodes
  • reduced appetite and/or weight loss
59
Q

Palindromic Rheumatism Symptoms

A
  • sudden, multiple, and recurring attacks of joint pain and swelling. Usually 2-3 joints are involved and the joint usually returns back to normal without any permanent joint damage.
  • may develop RA later in life
60
Q

Psoriatic Arthritis

A
  • typically affects the ankle, knees, fingers, toes, and lower back. The distal finger joint may swell.
  • may have tenderness or pain where tendons and ligaments attach to the bones
  • skin symptoms include thick, red skin with flaky silver white scaly patches
  • nails may become pitted or infected looking
  • may also develop eye problems
61
Q

Reactive arthritis

A
  • inflammation of the joints, eyes, bladder, and urethra. Sometimes mouth sores and skin rashes.
62
Q

Rheumatoid arthritis

A
  • joint pain, tenderness, swelling or stiffness for 6 weeks or longer
  • morning stiffness for 30 minutes or longer
  • more than one joint affected
  • the same joints on both sides of the body are affected

OCS (11 decks)

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