UE Orthopedics Flashcards
Overarching goal of OT for arthritis
1) decrease pain
2) protect joints
3) increase function
General objectives of OT for arthritis are:
1) maintain or increase ability to engage in meaningful occupations
2) maintain or increase joint mobility and strength
3) maximize physical endurance
4) protect against or minimize effect of deformities
5) Increase understanding of disease and best methods of dealing with its physical, functional, and psychological effects
6) assist with adjustment to disability
Treatment Objectives by Stage of Arthritis
ACUTE: decrease pain and inflammation; maintain ROM, strength and endurance (splinting, AE, PAMs, A/PROM, activity tolerance)
SUBACUTE: decrease pain/inflam, maintain ROM, strength, endurance (less restrictive splinting during day, AE, PAMs, A/PROM with gentle stretch, positioning, activity tolerance)
CHRONIC ACTIVE: decr pain/inflam, increase ROM, strength, endurance (joint protection, splint as needed, AE, PAMs, A/PROM with end-range stretch, resistive exercise, cardio, incr functional activities)
CHRONIC INACTIVE: decr pain, incr/maintain ROM, incr strength/endurance (joint protect, splint as needed, AE, PAMs, A/PROM with end-range stretch, resistive exercise, cardio, incr functional activities)
Tx Precautions for Arthritis
- Respect pain
- Avoid fatigue
- Avoid stressing inflamed/unstable joints
- Use resistive exercise/activity with caution
- Be aware of sensory impairments
- Be cautious with fragile skin from systemic disease or pharmacologic side effects
Recommended rest and sleep during periods of active systemic inflammatory disease (RA)
- At least 8-10 hours of sleep at night
- 30 min to 1 hr morning and afternoon rest periods
- Localized rest of joints may include splint, avoiding/modifying activity, or positioning to avoid joint stress
Exercise guidelines for Arthritis
- Can be dynamic (isotonic) or static (isometric), and aimed toward recovery of function
- Do not create deforming forces with exercise (be cautious with hand strength/grip exercises)
- Resistive exercise should be avoided during acute flares or inflammation, but may be used in other stages
- Isometric are least painful for RA; eliminates joint motion
- Hold Isometric contractions for 6-12 seconds
- Gradual progression of reps or resistance is recommended
- Sedentary people may need daily program; active only once/week
Resting Hand Splint
- For tx of acute synovitis of wrist/hand
- Provides localized rest to involved joints
- Relieves pain, decreases muscle spasm, and protects joints vulnerable to contracture/deformity
- Worn continually during flare-ups with daily break for skin hygiene/ROM
- May wear at night in later stages to increase comfort/prevent deformity
Wrist Splint
- Provides wrist stability
- Decreases pain, improves function
- May be custom or prefabricated
- Provide support while allowing functional use of hand
- May also support the MCP joints
MCP Ulnar Deviation Splint
- Pain relief, stability, alignment and reduced stress on painful, subluxed or deviated joints
- May slow deformity but not prevent/correct it
- Soft to rigid, custom or prefabricated
- Infrequently prescribed
- Impedes functional use of hand and may increase pain/stress on adjacent PIP joints
Swan Neck Splint (PIP Hyperextension Block)
- Restricts hyperextension of PIP
- Allows easy flexion of PIP, improving function
- Can be fabricated from thermo-plastics for short term use
- Commercial products for more durable, long-term wear
- Can also provide lateral stability to unstable IP joints of fingers/thumb
Boutonniere Splint (PIP Extension Block)
- Leaves DIP joint free to flex
- Same fabrication options as Swan Neck Splint
- Monitor skin for pressure on dorsum of PIP
- May prefer only wearing at night for functionality
Thumb Splint
- Positioning opposite of developing deformity in early stages
- Provides stability and pain-free pinch in later stages
- Hand-based short thumb spica/opponens splints leave wrist and IP joints free; can be used for MCP/CMC problems
- Long thumb spica for CMC joint without including wrist or MCPs
Dynamic Splints and Serial Static Splints
- To regain ROM lost by shortening of structures, or to maximize motion after surgery
- Must monitor for adverse pain/swelling
- Static more well-tolerated bc they apply less force on joint
Silicone-Lined Digital Sleeves and Pads
• Helpful in protecting painful nodes or nodules from external trauma
Joint Protection and Fatigue Management Principles
- Respect pain
- Maintain muscle strength and joint ROM
- Use each joint in its most stable anatomic and functional plane
- Avoid positions of deformity
- Use the strongest joints available
- Ensure correct patterns of movement
- 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
