Rheumatology

Question 1

Describe how to do a PT evaluation

Answer 1

Hx:

–current and pass illnesses

–previous surgeries

–previous rehab services

–Medication

–last/next appt with rheumatologist

–social hx etc…

Disease activity & damage

1) Inflammation

• Duration of morning stiffness
• Grip strength
• Active joint count
• VAS for pain and fatigue
• Tests:

–Erythrocyte Sedimentation Rate (N = <15 mm/hr ♂, <20 mm/hr ♀)

–RF+

–x-rays, etc.

2) Damage (deformities)

– Damaged joint count

3) Extra-articular features

• Raynaud’s
• Eye and mouth dryness, etc,…

Physical and Functional status

–ROM & MMT

–Neurological exam

–Posture

–Balance

–Endurance

–Transfers

–Gait

–Stairs, etc…

Subjective assessment

• “How do you feel in the morning?”
• Patients with an active disease usually experience morning stiffness > than 30 min (but variable

Question 2

how to do grip strength

Answer 2

• Usually we don’t use a dynamometer
• Take reading where it stabilizes for 3 seconds
• Don’t forget to subtract the starting point: answer is 8

Question 3

what defines the active joint count?

Answer 3

• Measures inflammatory activity
• Active joint = Inflamed joint
• A single active joint is an indication of disease activity

Question 4

what are the 3 criteria to assess disease activity?

Answer 4

• Joint Effusion
• Joint Tenderness
• Stress Pain

*In order to be categorized as active, a joint must present at least one of the three criteria

*If first test if positive, don’t do the next test

*only need one of these criteria to consider it active!!

Question 5

how to test for joint effusion, joint tenderness, and stress pain?

Answer 5

1) Joint effusion
- 4 finger and 2 finger technique
- knee (brush test)
- elbow test (radial head, flex/ext of elbow): A bulge of synovium is detected over or just above the radial head in full elb extension as you passively ext the elb from a 45 degrees flexed position.
2) Joint tenderness

–Tested over joint line

–Applied pressure should be just enough to cause blanching of your fingernail when testing

3) stress pain

–Gentle overpressure (O.P.) at end of ROM during passive movement

Question 6

what are common rheumatology deformities?

Answer 6

Question 7

TMJ (Temporomandibular joint)

Answer 7

Question 8

Sternoclavicular joint

Answer 8

Question 9

Acromioclavicular joint

Answer 9

Question 10

Glenohumeral joint

Answer 10

Question 11

Elbow

Answer 11

Question 12

Wrist

Answer 12

Question 13

CMC thumb

Answer 13

Stabilize trapezium – push towards trapezium or do full circle (circumduction)

Question 14

MCP joints

Answer 14

Question 15

PIP and DIP joints of the hand

Answer 15

Question 16

Hip (not included in the joint count)

Answer 16

Question 17

knee

Answer 17

Question 18

Ankle joint

Answer 18

Question 19

MTP joints

Answer 19

Question 20

PIP and DIP joints of foot

Answer 20