Physical Ax in RA Flashcards
Active joint count is a measure of _____ ______
inflammatory activity
Three criteria for an active joint?
- effusion
- joint tenderness
- stress pain
Active joint count criteria are always _______ assessed, as they progressively increase the level of stress imposed on the ____ _____
sequentially; joint capsule
Joint count ax for children?
- presence of joint swelling
OR - Limitation of motion with heat, plus overpressure pain, OR
- joint line tenderness
4 steps in the exam set up?
- ensure client is relaxed and seated in a comfortable position
- provide pillow to support UE
- all jewelry must be removed
- explain what you are doing and inform the client of the realist
STOP method?
S - swelling
T - tenderness
OP - overpressure
When in doubt, record joint at ______
inactive
________ = fluid that is confined by the joint capsule but freely mobile within that space
effusion
Fluctuation of fluid is detectable along the _____ ______
joint margins
3 methods to measure effusion?
- 2 thumb
- 4 finger
- bulge sign
_____ tissue deposited about the joint may mimic an effusion
fatty
What is the difference between fatty tissue and true joint effusion?
fat = soft but fixed in location and is OUTSIDE joint capsule effusion = fluctuation in all planes
Bony enlargement and joint deformities (do/do not) constitute joint swelling.
do NOT
In the 2 thumb technique, the pressure thumb should be directed slightly _____ from the sensor thumb to prevent a shift in ______ structure
away; periarticular
In the 4 finger technique, the sensor fingers must be just above the ______ _______
collateral ligaments
There may be a _____ sign over the _____ head when elbow is moved from 45 degrees of flexion to full extension
bulge; radial
When testing joint tenderness, apply firm pressure with enough force to blanch the examiners nail beds (T/F).
TRUE
How to test joint tenderness in clients with pain syndromes ?
compare pain from pressure on the joint line to an equal amount of pressure on an adjacent bone or soft tissue; for joint to be classified as active, the pain on joint palpation must be greater
Stress pain = stretching the _______ joint capsule
inflamed
In stress pain, apply gentle overpressure when the joint is at the limit of its _____ range
passive
The # of damaged joints is related to the duration of _____ and its ______
disease ; aggressiveness
3 strategies in treating TMJ?
- posture
- soft tissue
- regain rotation
TMJ is often involved (later/earlier) in disease
later
TMJ involvement in disease = bony erosion of mandibular ______ and joint space narrowing
condyle
End stage TMJ disease may result in ____ in open bite
fusion
ROM in TMJ: normal opening / closing ?
35-50 mm
ROM in TMJ: normal lateral deviation?
10-15 mm
ROM in TMJ: normal protrusion ?
3-6 mm
What 3 things are you looking for when you palpate the TMJ?
- crepitus
- clicking
- locking
______ is common in the shoulder
synovitis
Thinning of the RC may lead to ______
rupture
Synovitis in the shoulder can cause the humeral head to migrate _______; leads to impingement of _____ and _____; and ___ joint damage
superiorly; bursae; tendons; AC
Synovitis will bulge out of the ___-___ fossa in the elbow
para-olecranon
Loss of ______ is common in elbow, leading to _____ contracture
extension; flexion
______ _______ joint commonly involved, leading to erosion of radial head
superior radioulnar
Rheumatoid nodules do not occur in the elbow (T/F).
FALSE
3 special tests for wrist and hand pathologies in RA?
- piano key sign at DRUJ
- radial collateral ligament test at MCP
- Bunnel-Littler (hand intrinsics)
What structures does the piano key test test ?
- TFCC
- disc
- volar and dorsal RU ligaments
- ulnocarpal ligaments
- ECU sheath
- LT interosseous ligament
C__-__ most often involved in RA; why?
1-2; has most ligaments, joint capsules, and synovial linings due to mobility at this joint
Progression of instability at AA joint is associated with what 3 things?
- steroid use
- seropositive disease
- RA nodules
Synovitis causes stretching / erosion of the ______ ligament at the AA joint
transverse
Erosion of ____ and _____ facets of atlas with RA
dens; superior
Subluxation of AA joint occurs with relative ______ translation of dens with _____ flexion of C spine
posterior; forward
In AA subluxation, the _____ _____ and _____ _____ are compromised
SC; vertebral artery
AA subluxation is prevalent is ___-___ % of RA pt’s
10-55
AA subluxation is more likely in _____
males
6 s/s of AA subluxation?
- pain, suboccipital headache
- “heavy head” sensation
- clunking
- bilateral paraesthesia
- dizziness, blurred vision
- dysphagia
Many pt’s with AA subluxation are asymptomatic (T/F)?
TRUE
From the _______ ax we determine risk and what ______ tests to do or not to do
subjective; objective
MUST ask pt’s the __ __’s and ___ __’s in regards to C-Spine subjective
5 D’s; 3 N’s
______ nerve testing in c-spine ax w/ pt’s w/ RA
cranial
If there is any report of paresthesia, 3N’s or 5D’s, abnormal cranial nerve findings or less than 40 degrees ROM do not test _______
stability
What 2 tests can be used to rule out anterior instability at AA joint?
- sharp pursor
2. anterior shear stability test
6 possible changes in hip due to RA?
- synovitis
- cartilage erosion
- capsular pattern
- groin pain
- flexion deformity
- trochanteric bursitis
______ cyst common in knee of pts with RA
bakers
______ deformity at knee may occur
flexion
4 changes in ankle due to RA?
- TC synovitis
- visible swelling
- capsular pattern
- shortened achilles tendon
______ may occur at subtalar joint
synovitis
Ligamentous laxity + bony erosion = ____ drops medially and plantarly; _____ drops; _____ deformity
talus; navicular; valgus
______ _____ tendinopathy, becomes lengthened, potential rupture
tib post
Loss of _______ arch = pronation and increased ______ of mid foot and toes; calcaneus _____
longitudinal; abduction; everts
_______ phalanx at 1st MTP drafts _______ (hallux valgus)
proximal; laterally
MTP subluxation = displacement of ______
flexors
Unopposed ______ pull the proximal phalanx into hyper-______
extensors; extension
Important to check _____ _____ in cases of MTP subluxation
skin integrity
____ ____ = long and short flexor and extensor altered biomechanics
claw toe
Claw toe is associated of weakness of _______
intrinsics
Claw toe = MTP _____, PIP and DIP ______
extension; flexion
Claw toes affects all the toes (T/F)
FALSE (not big toe)
Hammer toe = usually at ___ toe
2nd
Hammer toe = ____ of pip; _______ of DIP
flexion; hyperextension
Mallet toe = usually ____ toe
2nd
Mallet toe = ______ of DIP
flexion
