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OCS prep > Osteoarthritis > Flashcards

Osteoarthritis Flashcards

1
Q

With the goal to improve knee extension in OA:

  • what types of manual mobs (~3)
  • what type of STM (1)
  • what types of exercises; 2-3 examples
A
  • AP, AP w/ add/abd, extension w/ tibial ER
  • posterior knee STM
  • quad sets, TKE, calf/hamstring stretches (repeated extension challenge)
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2
Q

With the goal to improve knee flx in OA:

  • what types of manual mobs (~4)
  • what type of STM
  • what types of exercises; 2-3 examples
A
  • knee flx, knee flx w/ add/abd, flexion w/ tibial IR, patellar mobs
  • anterior knee STM
  • mini-squats, bike, quad stretch prone (repeated flx challenge)
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3
Q

With the goal of improving patellar mobility, what types of exercise challenge is recommended; flexion or extension?

A
  • flexion
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4
Q

Strengthening exercise has effects for:

  • Grade A (5)
  • Grade C (2)
A 
Grade A
•	Pain (rest and w/ functional activities)
•	Function
•	ROM
•	Grip force
•	Level of energy

Grade C
• Quad peak torque
• Specific and timed functional activities

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5
Q

General physical activity has positive effects for:

  • Grade A (6)
  • Grade C (1)
A 
Grade A
•	Pain (functional activities)
•	Stride length
•	Functional status
•	Energy level
•	Aerobic capacity
•	Medication use

Grade C
• Disability in ADL

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6
Q

Manual therapy combined with exercise has positive effects for:
- Grade A (1)

*arguably other effects depending on other studies

A

Grade A

- pain

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7
Q

T or F

Manual therapy plus exercise is no better than exercise or strength training alone.

A

F;

Manual therapy w/ exercise has greater effects on pain, although exercise/strength training does still have positive effects on pain and function.

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8
Q

How long can the effects of manual therapy last for pain/function?

A

Studies have shown lasting effects out to a year

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9
Q

Is there a benefit for manual therapy over HEP after a year?

A
  • A year out, the benefits of manual therapy plus HEP were equivalent to just HEP, but in the shorter term (4 and 8 weeks), there was an increased positive effect for manual therapy
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10
Q

T or F

Manual therapy for knee OA can follow a protocol.

A
  • Eh, F; more effective if tailored to the individual
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11
Q

Arguably, what is the greatest measurable effect that manual therapy can have for pts with knee OA?

A
  • pain reduction; hypoalgesic effects
  • could also say improving joint tissue quality, however that’s less measureable
  • also likely, ROM, but that wasn’t cited in the medbridge presentation in this section at least
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12
Q

T or F;

Accessory mobilization to an osteoarthritic knee only produces local hypoalgesic effects

A
  • F; both local and widespread effects
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13
Q

What are recommended interventions for PF OA? (5)

A
  • patellar mobs
  • taping
  • exercise
  • stretching
  • daily HEP
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14
Q

What are 3 examples of appropriate exercise for PF OA?

A
  • quad strengthening
  • seated hip ER
  • standing hip abd
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15
Q

With conservative management, __% of pts can see __% improvement of their symptoms, while __% can see at least __% improvement.

A

~60% of pts can see an improvement of 50% in their symptoms; 80% see an improvement of at least 12%

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16
Q

T or F:

Knee OA causes the most disability of any involved joint or body region

A

T

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17
Q

TKA earlier than __ years of age is associated with increased risk of mortality

A

55 yo

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18
Q

What are the strongest predictors of knee OA? (4) Other predictors? (3)

A 
Strongest predictors of OA
o	Female gender
o	Increased body mass index
o	Knee injury that changes biomechanics
o	Early degenerative changes (chondromalacia)

Other predictors of OA
o Occupations requiring frequent kneeling/squatting
o High impact sports
o Altered joint mechanics

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19
Q

T or F;

ACL reconstruction reduces the risk of OA development

A

F

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20
Q

A high percentage of pts w/ ACL reconstruction can develop OA within ___ years

A

10-15 years

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21
Q

Is the prognosis better after ACL reconstruction for younger or older patients?

A
  • older

- younger patients have higher risk of revision and a worse prognosis

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22
Q

What are the recommendations for orthotics with knee OA?

A
  • mixed evidence. Might be helpful, but not conclusive.
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23
Q

Are there benefits for corticosteroid injection for knee OA before starting exercise therapy?

A
  • no; measured at 2, 14, 26 weeks
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24
Q

Is surgery w/ post-op PT better than just PT for knee OA?

A
  • no; not sure how long out this was measured
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25
Q

Describe the differences between Grade I through IV mobilizations.

A
  • I and IV are small amplitude
  • I and II are prior to tissue resistance
  • III and IV are into tissue resistance
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26
Q

What is the difference between:

  • sign
  • symptom
  • comparable sign
A

Sign: anything within a joint/structure or regarding its movement that is abnormal

 - Hypomobility, palpable soft tissue change, quad weakness
 - An objective physical exam finding

Symptom: something the patient complains of
- Pain, dizziness, weakness, N/T

Comparable sign: sign found on exam that reproduces the pt’s pain/symptoms, or demonstrates an abnormality at an appropriate level for the pain/symptom
- Does not necessarily have to reproduce the exact symptoms

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27
Q

Hip OA is most common in pts over the age of ____

A

60

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28
Q

___% of pts over the age of ___ will have hip OA

A
  • 28% of pts with OA over the age of 45 will have hip OA
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29
Q

Hip OA is more common in males or females?

A
  • females
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30
Q

The risk factors for hip OA include: (4)

A
  • Age
  • Previous hx of
     Developmental disorders
    • Developmental dysplasia
    • Congenital dislocation
    • Legg-calve-perthes
    • SCFE
     Trauma (e.g., fx)
     High impact athletics
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31
Q

What is the relationship between obesity and hip OA risk?

A
  • conflicting evidence for whether obesity increases risk of developing hip OA, but it may be associated with the progression of OA
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32
Q

What are the anatomical structural changes that occur with hip OA? (5)

A 
	Synovial inflammation
	Articular cartilage degradation
	Development of osteophytes
	Sclerotic changes to subchondral bone
	Bony cysts in later stages
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33
Q

What is the standard for imaging classification for severity of OA in the hip? What is it based on?

A
  • joint space narrowing

 Normal: 3-5 mm
 Significant change: greater than 0.5 mm change
 Moderate: less than 2.5 mm (osteophytes likely present)
 Severe: less than 1.5 mm (sclerotic hardening)

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34
Q

If a pt is complaining of morning stiffness that lasts for hours, is this indicative of OA?

A
  • no; typically OA morning stiffness resolves in 30-60 minutes.
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35
Q

What are Altman’s criteria for hip OA diagnosis? (5)

A

 Hip pain
 Internal rotation ROM difference of 15* or >
 Pain with IR
 AM stiffness (typically less than 60 minutes)
 ESR

*this is the clinical + lab decision tree…which has more clinical than the clinical alone…unsure why

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36
Q

What are the standard complaints for hip OA on initial hx? (6)

A

o Difficulties with walking on level, uneven surfaces, and stairs (no directional preference)
o Problems with sustained positioning like driving, sitting
o Difficulties getting dressed or lifting the leg
o Groin pain that may refer to the medial knee
o AM pain and stiffness that decreases after one hour
o Pain at end range of motion (IR most painful)

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37
Q

Do people with hip OA usually have a greater problem going up or down the stairs?

A
  • not usually; maybe one will hurt more than the other, but no clear trend
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38
Q

What is the typical pain pattern associated with hip OA?

Where might it refer to?

A
  • groin pain

- medial knee

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39
Q

An arthritic hip typically hurts most with which movement?

A
  • internal rotation
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40
Q

What is the capsular pattern of restriction for the hip?

A
  • IR > ABD > flx
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41
Q

How much difference in internal rotation between hips is considered pathological?

A

> 15*

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42
Q

What muscles are most often found to be weak with hip OA? (2; movements)

A
  • abduction

- extension

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43
Q

What is the CPR for hip OA diagnosis? (5)

A 
o	Painful squatting
o	Painful flexion
o	Scour test that produces groin pain
o	Painful extension
o	IR <25*
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44
Q

What is the effect of education for hip OA?

A

 Exercise therapy may postpone THR surgery in patinets with hip OA
 Education seems to have an effect on joint survival rates
 Exercise and education (5.4 years) are better than education alone (3.5 years)

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45
Q

How long can pain relief be expected to last following a land-based exercise program for hip/knee OA?

A

2-6 months

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46
Q

Is there a relationship between the number of face-to-face visits with a PT and the magnitude of a treatment effect for exercise with knee or hip OA?

A
  • yes; a higher number of visits will typically increase the effect
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47
Q

Are there certain types of exercise programs that are more beneficial for hip OA than others?

A
  • sort of. Any supervised regularly performed exercise program is likely to be beneficial
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48
Q

Exercise programs conducted regularly have impacts on which factors in patients with hip OA? (3)

Are these short, or long-term effects?

A
  • pain
  • function
  • QoL
  • Short term
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49
Q

Is manual therapy beneficial for hip OA? Is it better than exercise?

A
  • it does seem to be beneficial. It does not seem to be more beneficial than exercise, when looking at the whole body of research.

There is one study that showed greater improvements with manual therapy compared to exercise therapy in pain, stiffness, ROM, and function when measured out to 29 weeks. Other evidence is mixed.

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50
Q

Is heat or ice better for hip OA?

A
  • doesn’t matter. Whatever feels better.
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51
Q

Is TENS recommended for hip OA management?

A
  • eh. It’s not, not recommended. It can be used for short-term symptom management, but there’s not super strong support for it.
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52
Q

Are modalities appropriate to use to treat hip OA?

A
  • yes, in support of other interventions (exercise, manual, education)
  • not super effective on their own
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53
Q

Are walking aids recommended for use with hip or knee OA?

A
  • sort of. They can be used. A crutch or cane in the contralateral hand is recommended. Otherwise a walker or frame for B disease.
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54
Q

Should patients with hip or knee OA who are overweight be encouraged to lose weight?

A
  • yes, per OARSI recommendations. Doesn’t seem associated with risk of development of hip OA, but likely associated with progression
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55
Q

With GH OA, do the humeral head and glenoid typically need to both be replaced at the same time, if the pt is getting a replacement?

A
  • nope. Usually one surface is more worn out than the other.
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56
Q

What are the standard PT interventions for GH OA?

  • per medbridge
A

 Modalities (short term help)
 Joint mobilization (usually global stiffness)
 Range of motion
 Strengthening

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57
Q

What is the current level of evidence in the literature for recommendations for total shoulder arthroplasty rehabilitation?

A
  • expert opinion. There’s not much research into best practices for protocols
58
Q

Is pre-habilitation effective for shoulder OA prior to replacement?

A
  • not usually. Typically restricted by pain
59
Q

After a TSA, how long can a pt expect to be in a sling?

A
  • 1-2 weeks, 24/7

- out to 4-6 weeks at night

60
Q

When is strengthening usually introduced into TSA protocols?

A
  • 4-6 weeks
61
Q

What are usually the general restrictions for Phase I of a TSA protocol?

A
  • no forced motion (passive or active); avoid significant tissue resistance or muscle contraction
  • no IR past the frontal plane
62
Q

What are usually the general restrictions for Phase II of a TSA protocol?

A
  • no lifting over 2-3 lbs

- but can push ROM a bit more

63
Q

When can an individual expect to return to sports /recreational activities following a TSA?

A
  • 4-5 months
64
Q

How long does phase I of a TSA protocol typically last?

A

~4 weeks

65
Q

When is phase II typically for a TSA protocol?

A
  • 4-6 weeks
66
Q

What types of exercise are appropriate for initiating strengthening exercises for a TSA? What phase can this happen in?

A
  • submaximal isometrics in neutral positioning

- phase II

67
Q

In Phase II, AROM can be initiated (in the later stage) for which movements initially? Is pain ok?

A
  • flexion, abduction, ER, IR

- should be pain-free

68
Q

What are the AROM goals in phase III of TSA for:

  • flexion
  • abduction
  • ER
  • IR
  • elevation
A

o 140* flexion
- 120* abduction in supine
o 60* ER in scapular plane supine
o 70* IR in scapular plane supine in 30* abd
o 120* active elevation with no substitution

69
Q

What is currently more common; reverse TSA, or traditional TSA?

A
  • reverse TSA has become more common
70
Q

A rTSA places the demand for shoulder elevaiton on what muscle?

A
  • deltoid
71
Q

What is a significant concern for rTSA that is less a concern in TSA?

A
  • dislocation
72
Q

What movements are more concerning for dislocation of rTSA?

A
  • IR/add with extension
73
Q

How long to ROM precautions usually last for rTSA to minimize risk of dislocation?

A
  • 12 weeks
74
Q

What ROM can be expected for functional elevation ROM following rTSA?

A
  • ~105*
75
Q

External rotation following rTSA is dependent on which muscle?

A
  • teres minor
76
Q

When is PROM usually initiated with rTSA?

A
  • around 4 weeks. generally in the 3-6 week timeframe, but delayed to allow for deltoid tissue to heal
77
Q

Can you do distal AROM in phase I of rTSA rehab?

A
  • yes, that’s allowed
78
Q

What are the Phase I PROM limitations for rTSA? How long are they in place?

A
  • flexion elevation <90*
  • ER: 20-30* ( may be different if subscap repair)
  • no IR
  • 6 weeks
79
Q

In the second portion of Phase I (how long?) rTSA, what are the new ROM restrictions?

A
  • 6 weeks
  • elevation in scapular plane 120-140*
  • ER 35-40*
  • IR passively with shoulder in 60* abd
80
Q

In late phase II rTSA, what kind of strengthening exercises? Low weight, high rep; or high weight, low rep?

A
  • low weight, high rep
81
Q

What is often the weight limits associated with rTSA for functional activity? Is it bimanual or unilateral? How long should this be followed?

A
  • lift no > 10-15lbs; bimanual; indefinitely
82
Q

What are the standard tests for symptoms of GH OA?

A
  • compression (scour)

- distraction for alleviation

83
Q

What location of pain is characteristic for shoulder OA?

A
  • pain deep in the shoulder
84
Q

What are standard PT interventions for elbow OA? (4)

A

 Modalities
 Joint mobilization
 ROM
 Strengthening

85
Q

What are the standard PT interventions for wrist OA? (6-ish)

A 
	Modalities
     •	     Parrafin wax/dipping
	Joint mobilization
	ROM
	Strengthening
	Splinting
86
Q

Wrist fusion is more typical for those with degeneration at which bones?

A
  • carpals
87
Q

What are the standard PT interventions for hand OA? (6-ish)

A 
	Modalities
     •	     Parrafin wax/dipping
	Joint mobilization
	ROM
	Strengthening
	Splinting
88
Q

What 3 modalities are often used to manage hand OA?

A
  • parrafin wax
  • heat
  • ultrasound
89
Q

What is the most common site of OA joint pain?

A
  • hand
90
Q

Aside from the hand, what are the next three most common sites of chronic joint pain?

A
  • knee
  • shoulder
  • hip
91
Q

1 in __ women and 1 in __ men over the age of ___ will have an osteoporosis related fx with ___% mortality rate within ___ months

A
  • 1 in 2 women, and 1 in 4 men over 50yo will have an osteoporosis related fx w/ 20% mortality rate within 12 months of hip fx
92
Q

___% of people over the age of ____ have chronic joint pain

A

40% of people over the age of 65 have chronic joint pain

93
Q

The rate of OA is > __% in people over the age of ___

A

> 50% in people over the age of 65

94
Q

OA is more common in ______ (men/women)

A
  • more common in women
95
Q

The risk for knee OA increase __x w/ a hx of non-specific injury.

A

3x

96
Q

The risk for knee OA increase __x w/ a hx of meniscal injury, ACL injury, or femur fx.

A

6x

97
Q

Prevalence of hip OA is __% in people over the age of ___

A

Prevalence of hip OA is ~28% in people over the age of 45

98
Q

Articular cartilage is more specifically referred to as ______ cartilage

A
  • hyalin
99
Q

Hyalin cartilage is present in all ________ joints.

A
  • diarthrodial joints
100
Q

Cartilage nutrition occurs through ________, which requires __________

A

diffusion, which requires compression

101
Q

Reduced loading of cartilage can result in: (2)

A
  • reduced nutrition; potential degenerative changes

- reduced lubrication

102
Q

Impact loading can be detrimental to cartilage if frequency is too high, because:

A
  • cartilage may not be able to deform and redistribute pressure quickly enough, resulting in smaller areas being exposed to stress/loading
103
Q

What occurs to cartilage when joints are immobilized in the short term, and how long do the changes take to occur?

A
  • atrophy/thinning of articular cartilage
  • increased water content
  • can occur within a few weeks
104
Q

Is AROM enough to maintain cartilage health if a joint is NWB?

A
  • not likely; can still see cartilage atrophy/thinning even with joint ROM
  • compressive forces are really important.
105
Q

What occurs to cartilage with prolonged immobilization? (3)

A
  • fibrofatty build up in the joint spaces/tissues
  • adhesion formation
  • arthrofibrosis (joint scarring)
106
Q

What are three physiological changes that occur with aging that are thought to contribute to development of OA?

A
  • loss of proteoglycans
  • loss of water content
  • reduction in the integrity of collagen fibers
107
Q

What are 4 primary influences for the development of OA?

A
  • aging
  • genetics
  • abnormal joint mechanics/loading
  • obesity
108
Q

What is the general physiological progression of OA? (4 stages)

A
  • increased water content, with decreased proteoglycans
  • fibrillation, fissuring, and erosion of the articular cartilage surface (roughening)
  • calcification of the subchondral bone
  • chondrocyte proliferation, hypertrophy of osseous tissue, apoptosis of articular cartilage
109
Q

Grade I OA is characterized by

A
  • Mild fibrillation or cracks in the superficial zone; mild roughness
  • Proteoglycan degradation has begun
110
Q

Grade II OA is characterized by

A
  • Discontinuity of the cartilage in the superficial zone

- Chondrocytes in the mid-zone now start to show changes

111
Q

Grade III OA is characterized by

A
  • Extensions of the cracks in the superficial zone into the mid-zone
  • Cell disruption/death in mid-zone
  • Progression of chondrocyte changes
112
Q

Grade IV OA is characterized by

A
  • Significant cartilage erosion; delamination/loss of superficial zone
  • Much larger cracks in the superficial zone
113
Q

Grade V OA is characterized by

A
  • Total loss of the hyaline cartilage
  • Often microfractures along the surface of the bone
  • Bone on bone
114
Q

Grade VI OA is characterized by

A
  • Changes in the bony structure
  • Bone remodeling; subchondral bone formation, cyst formation
  • Palpable changes around the bone
115
Q

What changes occur with the synovium in OA? (4)

A
  • synovial hyperplasia; increased proliferation of synovial tissue
  • inflammatory cell infiltration
  • thickening/fibrosis of synovium
  • cartilage/bone fragments lodged in the synovium can perpetuate these changes
116
Q

What are the two main changes that occur in subchondral bone in OA?

A
  • Sclerosis (hardening)

- cyst formation

117
Q

What are the nutrition recommendations for OA management?

A
  • none that have solid support/evidence. Most supplements won’t hurt
118
Q

Which structures in the joint that are affected by OA are innervated?

A
  • bone and synovium

- cartilage is not innervated

119
Q

Bone marrow lesions are found in ___% of people with knee pain.

A

-77%

120
Q

Are pain and OA severity related?

A
  • kind of, but not as cleanly as we’d like it to be.

- pain severity can seems to be related to OA severity. There is a relationship between pain and radiographic severity.

121
Q

People with OA and medial regional pain are most at risk for what structural defect?

A
  • bone marrow lesion, followed by meniscal extrusion, and then meniscal damage
122
Q

People with OA and medial joint line pain are at risk for what structure defect?

A
  • bone marrow lesion
123
Q

What characterizes radiographic stage I OA?

A

o Stage I: minute osteophytes with normal joint space

124
Q

What characterizes radiographic stage II OA?

A

o Stage II: identifieable osteophytes but joint space still maintained (Mild)

125
Q

What characterizes radiographic stage III OA?

A

o Stage III: moderate reduction in joint space (Moderate)

126
Q

What characterizes radiographic stage IV OA?

A

o Stage IV: severe reduction in joint space (Severe)

127
Q

The clinical dx of knee OA requires knee pain with at least ___ of what 6 signs?

A
  • knee pain with at least 3 of the following:
  • Over 50 yo
  • AM Stiffness for < 30 minutes
  • Crepitus
  • Bony tenderness
  • Bony enlargement
  • No palpable warmth
128
Q

The clinical plus radiographic dx for knee OA requires knee pain with at least ___ of what signs?

A
  • knee pain with at least 1 of the following:
  • Over 50 yo
  • AM Stiffness for < 30 minutes
  • Crepitus and osteophytes
129
Q

What is the CPR for pts with knee OA that may benefit from hip mobs? (4)

A
  • Hip or groin pain or paresthesia
  • Anterior thigh pain
  • Passive knee flexion less than 122*
  • Passive hip internal rotation <17*
  • Pain with hip distraction
130
Q

Is there a synergistic effect for manual therapy and exercise?

A
  • not convincingly per the current literature, but as both provide an effect, it’s a good idea to do both.
131
Q

Do booster sessions make a difference with pain or function?

A
  • current research doesn’t show a significant effect at one year, however, there is a potential relationship between reduced pain and booster sessions a year out
132
Q

What are the effects of bracing on knee OA?

A
  • shown to change compartmental loading, however, only marginal benefits for pain or function
  • generally inconclusive effects
133
Q

Are lateral wedges recommended for use in knee OA management?

A
  • used to be prescribed regularly, but currently they are not supported to have any significant effect
134
Q

Is acupuncture effective for OA treatment?

A
  • statistically significant effect on pain, but not to the level of MCID in current research
135
Q

What are 7 risk factors for the development of OA? What are their characteristics?

A
  • Age
    o Increases with age
  • Sex
    o 70:30 female:male
  • Obesity
    o Associated with increased incidence of knee OA
    o Associated with greater progression if you already have OA
  • Genetics
    o 40-65% of OA may be attributed to genetic factors (more so in the hip and hand than the knee)
    o Overall, not well understood
  • Bone Mineral Density (BMD)
    o Higher BMD is associated with 2.3x greater incidence of knee OA
    o Not associated with progression of OA in those who already have OA
  • Occupation
    o Occupations that require lots of squatting, kneeling, combined with heavy lifting
  • Previous knee injuries
    o ACL and/or meniscal injury significantly increases the risk of knee OA
    o Surgical management does not prevent the incidence of OA
136
Q

Genetics is attributed to OA development in what regions the most?

A
  • hip and hand, more than knee
137
Q

Is physical activity associated with development of knee OA?

A
  • mildly. No evidence that a physically active lifestyle increases risk
  • some higher risk with vigorous/sports activity, but may be related to other risk factors as well (obesity, injury)
138
Q

What are the grades and descriptions of the Kellgren-Lawrence scale for OA?

A
  • Grade 0: No radiographic findings of OA
  • Grade 1: minute osteophytes of doubtful clinical significance
  • Grade 2: Definite osteophytes with unimpaired joint space
  • Grade 3: Definite osteophytes with moderate joint space narrowing
  • Grade 4: Definite osteophytes with severe joint space narrowing and subchondral sclerosis
139
Q

What are some limitations of radiographs for knee OA diagnosis?

A
  • may have early cartilage degeneration that doesn’t show up. MRI is a better tool; best tool would be MRI with contrast. Standard MRI may miss this too.
140
Q

What is the age cut-off associated with increased risk of developing knee OA?

A
  • 55; at least in women.
141
Q

Altman’s radiographic diagnostic criteria look for which criteria?

A
  • presence of osteophytes

- does NOT include joint space narrowing

142
Q

What are some potential modifiable pre-treatment factors that influence knee OA outcomes? (5)

A 
o	Obesity
o	Joint mobility
o	Alignment
o	Knee instability
o	Psychosocial factors (self-efficacy)

OCS prep (25 decks)

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