OT EXAM ARTHRITIC HAND Flashcards
What is osteoarthritis?
-“Wearing away” of the cartilage results in irritation of the bone.
-Seen in joints that bear weight (Knees, hips, spine)
Where in the hand is OA seen?
CMCJ of the thumb, DIPS PIPS
What part of the bone is affected in OA?
Subchondral bone
Symptoms of OA
Crepitus, less ROM, joint pain, joint stiffness and swelling
osteophytes are?
bone growth
Where are Herberdens nodes found?
DIP
Where are Bouchards nodes found?
PIP
Squaring at the wrist?
due to prominence of 1st CMC joint
How does OA appear initially?
asymmetrically
TX for OA:
Medication
Avoiding activities which cause pain
Maintain ADL’s- joint protection and energy conservation principles
Splinting
Moist heat or paraffin
AROM
Mild strengthening exercises
Avoid what movements with OA?
-sustained pinch (knitting, hand tools, garden tools)
-sustained pinch with torque (key turning, can opening)
-Pinch with pushing and pulling (vegetable peeling, hand sawing, ski poles),
-repetitive movements (cutting with scissors, spray bottles)
RA:
- A systemic disease
- 75% affected are women
- Morning stiffness
- Proliferation of the synovium in joints
- Synovitis invades the joint capsule destroying the supporting structures of the joint
- Chronic synovitis is persistent with repeated inflammation of the synovium
Where is RA seen in the hands?
MCPJ and PIPJ
- Pannus
Inflamed synovium, turns into diseased tissue which eats the ends of the bones away
How does RA appear?
Usually symmetrical- attacks the wrists, hands, knees, elbows, shoulders, ankles
Stages of RA
ACUTE-INFLAMMATORY
PROLIFERATIVE STAGE
DESTRUCTIVE PHASE: ADVANCED
FINAL STAGE: CHRONIC
Medications for arthritis
- NSAIDS
- Steroids
- DMARDS
- Analgesics
Surgical TX’s
- Synovectomy- removal of diseased synovium
- Tenosynovectomy- removal of diseased tendon
- Tendon surgeries: repair, release, transfer
- Arthroplasty: joint replacement
- Arthrodesis: joint fusion
Mallet finger
-Droop of DIP
-Damage of insertion of the extensor tendon
Boutonniere
-PIP bends, DIP extends
-destruction of central slip of the extensors and volar slipping of the lateral bands.
Swan neck deformity
- PIPJ in hyperextension and DIPJ in flexion.
- Caused by overstretching of the volar plate of the PIPJ.
TX principles
O ROM- gentle AROM should be done at least once daily
O Gentle stretching of intrinsics (MCPs extended, flex IPs)
O Resistive exercises: often “soft” resistance only
O Heat and cold modalities.
O Joint protection and energy conservation
O Pain management; relaxation, yoga.
O Splinting
