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Arthritis > overview > Flashcards

overview Flashcards

1
Q

Osteoarthritis (OA)

  • define
  • characteristics
  • onset
A
  • degenerative joint disease, attacks hyaline cartilage of synovial-lined joints
  • characterized by breakdown of articular cartilage and reactive new bone formation
  • cartilage softens–>large sections wear away–>dec. joint space–>new bone formation–>bone on bone contact
  • non-inflammatory (secondary inflammation may occur)
  • onset: slowly over period of years
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2
Q

OA: joints affected

A
  • individual joints

- neck, spine, hips, knees, MTPs, DIPs, PIPs, thumb CMCs, weight bearing joints

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3
Q

OA: symptoms/clinical features

A
  • joint pain
  • stiffness
  • tenderness
  • limited movement
  • variable degrees of local inflammation
  • crepitus
  • morning stiffness <30 mins
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4
Q

Rheumatoid arthritis (RA)

  • define
  • characteristics
  • onset
A
  • chronic, systemic inflammatory condition. possibly autoimmune inflammatory response in joint lining
  • synovitis: inflammation of synovial membrane that lines joint capsules
  • joint swelling from excess synovial fluid, thickening joint capsule-weakens capsule, distends ligaments
  • synovial membrane activity destroys cartilage, bone, tendons, ligaments, scar tissue forms causing rigidity
  • may have exacerbations and flare-ups & remissions
  • onset: often suddenly, within weeks or months
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5
Q

Two categories of RA

A
  1. reversible signs and symptoms due to acute inflammatory synovitis
  2. irreversible cumulative structural damage (from recurrent synovitis)
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6
Q

RA: joints affected

A
  • polyarticular, symmetric

- neck, jaw, hips, knees, ankles, MTPs, shoulders, elbows, wrists, PIPs, MCPs, thumb joints

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7
Q

RA: symptoms/clinical features

A
  • low-grade fever
  • fatigue
  • malaise
  • extra-articular manifestations
  • symmetric polyarticular pain and swelling
  • morning stiffness >/1 hr, often >2 hrs
  • synovial inflammation: warm, spongy, erythematous joints
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8
Q

Four stages of RA inflammatory process

A
  1. acute
  2. subacute
  3. chronic active
  4. chronic inactive

*stages may overlap

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9
Q

symptoms of acute RA

A
  • limited mvmt
  • pain and tenderness at rest that increase with movement
  • overall stiffness
  • weakness
  • tingling
  • numbness
  • hot/red joints
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10
Q

symptoms of subacute RA

A
  • limited mvmt
  • tingling
  • decrease in pain and tenderness
  • stiffness limited to AM
  • joints appear pink and warm
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11
Q

symptoms of chronic active RA

A
  • less tingling, pain, and tenderness
  • increased tolerance of activity
  • endurance remains low
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12
Q

symptoms of chronic inactive RA

A
  • no signs of inflammation

- low endurance, pain, and stiffness due to disuse

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13
Q

Most common joint changes usually seen in RA

A
  • wrist radial deviation
  • MP ulnar deviation
  • swan neck
  • boutonniere
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14
Q

OT eval for arthritis

A
  • ct hx
  • occupational profile
  • occupational performance status
  • cognitive, psychologic, social status
  • clinical status
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15
Q

Clinical status: eval components

A
  • inflammation
  • ROM
  • strength
  • hand function
  • stiffness
  • pain
  • sensation
  • joint instability and deformity (instability can lead to deformity)
  • physical endurance
  • functional mobility
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16
Q

Signs of inflammation and synovitis indicate________

A

active disease process

17
Q

Types of swelling: effusion

A
  • excess fluid in the joint capsule

- seen as fusiform swelling that is spindle shaped and conforms to the shape of the joint

18
Q

Types of swelling: boggy

A
  • thin and full of fluid
  • puffy, spongy, soft to the touch
  • seen in early active stages of synovitis
19
Q

What is it called when a ct.’s AROM is significantly less than their PROM? What causes this?

A
  • lag

- caused by pain, weakness, mechanical inefficiencies due to joint damage

20
Q

How is strength testing in clients with arthritis different from normal testing procedures?

A

Resistance is applied at the end range of pain-free motion rather than at the true end of the ROM.

21
Q

Muscle atrophy indicates_________ and __________

A
  • severe weakness

- possible nerve compression

22
Q

Signs of intrinsic hand atrophy

A
  • flattening of thenar and hypothenar eminences

- hallowing between metacarpals on dorsal aspect of hand

23
Q

standardized & non-standardized tests of hand function

A
  • Jebson-Taylor Hand Function Test (use for ct.s over 5yrs old; ok for ct’s with disabilities that impact hand function)
  • observation of ct performing common functional tasks requiring various grasp and prehensile patterns.
24
Q

Intervention: overarching goals

A
  1. decrease pain
  2. protect joints
  3. increase function
25
Q

intervention: general objectives of OT

A
  • maintain/increase ability to engage in occupations
  • maintain/increase joint mobility and strength
  • maximize physical endurance
  • protect against or minimize effects of deformities
  • increase understanding of the disease and methods for dealing with physical, functional, psychosocial effects
  • assist with adjustment to disability
26
Q

OT intervention: tx methods

A
  • sleep and rest
  • PAMs
  • therapeutic exercise
  • therapeutic activities
  • splinting
  • assistive devices
  • ct and family education (disease process, symptom mgmt, joint protection and fatigue mgmt)
27
Q

Assisted devices for arthritis: dressing

A
  • dressing stick
  • shoe horn
  • sock aid
  • button hook
  • zipper pull
  • elastic shoelaces
28
Q

Assisted devices for arthritis: bathing

A
  • hand-held shower hose
  • bath bench
  • grab bars
  • long-handles sponge
29
Q

Assisted devices for arthritis: toileting

A
  • raised toilet seat
  • grab bars
  • extended perineal hygiene aid
30
Q

Assisted devices for arthritis: feeding

A
  • built-up or extended-handle utensils

- lightweight T-handled mug

31
Q

Assisted devices for arthritis: meal prep

A
  • electric can and jar openers
  • adapted cutting board
  • utensils with built-up handles
  • ergonomic right-angled knives
  • rolling utility cart
  • knob turner for stove
  • reacher
32
Q

Assisted devices for arthritis: miscellaneous

A
  • doorknob levers
  • built-up or extended key holder
  • extended-handle dust pan
  • built-up pens
  • loop or spring-loaded scissors
  • speaker phone
33
Q

Components of Ct and family education

A
  • disease process
  • symptom mgmt (monitoring signs for inflammation, when to modify/cease activity, rationale/integration of PAMS into daily routine)
  • joint protection and fatigue mgmt
34
Q

Tx precautions related to arthritis

A
  • respect pain
  • avoid fatigue
  • avoid placing stress on inflamed or unstable joints
  • use resistive exercise or activity w/caution
  • be aware of sensory impairments
  • be cautious with fragile skin
35
Q

What is a sign that therapeutic exercise or activity should be modified or decreased?

A

Pain lasting 1 or 2 hours after completion of exercise/activity

36
Q

Which kind of exercise is usually lease painful for cts with RA? Why?

A
  • isometric exercises

- they eliminate joint motion and can be effective in improving muscle strength and endurance

37
Q

Contraindications for exercise with arthritis

A
  • NEVER stretch during acute phase
  • NEVER use resistive exercise during acute phase
  • grip-strengthening exercise, even using light putty, can put large forces on unstable hand joints (should be avoided in rheumatoid hand involvement)
38
Q

general principles of fatigue mgmt/joint protection

A
  • respect pain
  • maintain muscle strength and joint ROM
  • use each joint in its most stable anatomic and functional plane
  • avoid positions of deformity
  • use strongest joints available
  • ensure correct patterns of mvmt
  • 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

Arthritis (3 decks)

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