week 6

Question 1

Primary OA

Answer 1

No know caused may be localized or generalized  DIP and first CMC joints most often involved  Incidence increases with age

Question 2

Secondary OA

Answer 2

Has identifiable cause such as trauma  Any age

Question 3

Defined as a gradual loss of articular cartilage due to degenerative joint disease and chemical factors

Answer 3

Osteoarthritis

Question 4

Clinical Manifestations of OA

Answer 4

Joint pain  Boney enlargement  Stiffness  Tenderness  Limited motion  Crepitus  Malalignment  Joint deformity  Inflammation (edema, soft-tissue can be observed in acute exacerbations)

Question 5

OA joint deformities

Answer 5

CMC jt commonly effected  Characterized by thumb adduction and subluxation from the trapezium, MP hyperextension, IP joint flexion  Pinch is painful  Heberden’s nodes (DIP jts)  Bouchard’s nodes (PIP jts

Question 6

OT Treatment for OA

Answer 6

Patient Education  Weight management  Joint protection techniques  Adaptive equipment  Environmental modifications  Energy conservation

Question 7

Joint protection techniques

Answer 7

Respect pain  Minimize force and load on joints  Balance rest and activity  Use larger, stronger joints  Good body mechanics  Avoid positions of deformity  Decrease effort and resistance  Maintain ROM

Question 8

OT interventions

Answer 8

Modalities (PAMs)- depending on your state and facility  Pain-free ROM  AROM exercises  Isometric strengthening  General conditioning  Avoid pinch strengthening  Splinting  Thumb – Short opponens splint  Custom, prefab, neoprene

Question 9

Chronic autoimmune disorder affecting 1.3 million Americans synovial membrane of a joint becomes inflamed and wears away at the bone, cartilage and soft tissues which contributes to joint deformities

Answer 9

RA

Question 10

Clinical Manifestations of RA

Answer 10

Symmetric polyarticular pain  Swelling  Morning stiffness (1-2 hours)  Joint deformities  Rheumatoid nodules  Fatigue  Depression

Question 11

Joint swelling and inflammation, no destructive changes, possible presence of osteoporosis on X-ray “flare” 

Answer 11

Stage 1, Early phase Acute phase of RA

Question 12

synovium begins to invade the soft tissues producing tenosynovitis and limiting joint movement (no joint deformities yet), adjacent muscle atrophy

Answer 12

Stage 2, Moderate Phase (Proliferative) of RA

Question 13

synovial erosion causes irreversible changes including joint deformities, loosening of ligamentous insertions, impairment of tendon function, muscle atrophy and joint disorganization. X-ray evidence of cartilage and bone destruction and osteoporosis 

Answer 13

Stage 3, Severe Phase (Destructive):

Question 14

synovial activity “burnt out” fibrosis or bony ankylosis

Answer 14

Stage 4, Terminal phase (Chronic)

Question 15

Extensor tendons slip to the ulnar aspect of the metacarpal head

Answer 15

Ulnar deviation of digits at MP joints (Ulnar drift)

Question 16

PIP hyperextension with DIP extension lag, due to erosion of the PIP volar plate, rupture of lateral band or FDS rupture 

Answer 16

swan neck deformity

Question 17

PIP flexion contracture with DIP hyperextension (caused by rupture or lengthening of the central slip of the EDC)

Answer 17

Boutonniere deformity

Question 18

OT treatment for RA

Answer 18

Education  Prevent joint deformities  Sleep and Rest  Modalities (PAMs)  Therapeutic exercise  Adaptive equipment  Splinting  For rest, deformity, function  Joint Protection  Fatigue management  Energy Conservation

Question 19

aidsthe immune system inremoving and destroying waste, debris, dead blood cells, pathogens,toxins, and cancer cells. The lymphatic system removes excess fluid, and waste products from the interstitial spaces between the cells.

Answer 19

lymphatic system

Question 20

This is the fluid that is in the tissues between cells. So fluid that is not in cells but between them.

Answer 20

is interstitial fluid

Question 21

Lymph is made up of

Answer 21

protein, water, cellular components and particles, and fat. White blood cells, called lymphocytes, are one type of cellular particle in lymph. These play a roll in the immune response of the body.

Question 22

Lymphatic system development

Answer 22

The lymphatic system begins to develop during the fifth week of gestation. It develops from the mesoderm. Connective tissue, muscle, bone, urogenital and circulatory systems all develop from the mesoderm which is the middle layer of the 3 primary germ cell layers. (Embryonic development and gestation)

Question 23

difference between the lymphatic system and circulatory system

Answer 23

The lymphatic system lays parallel to the circulatory system. The lymphatic system is an open system where the circulatory system is a closed system. The circulatory system also differs from the lymphatic as it has an electric pump THE HEART! The lymphatic system relies on muscle contractions to help facilitate lymph movement, minimal muscle contractions within some lymphatic vessels and a small vacuum from lymph nodes.

Question 24

the movement of particles in a solution from an area of higher concentration to an area of lower concentration.

Answer 24

Diffusion

Question 25

movement of water molecules from a place of higher water concentration to a place of lower concentration through a permeable membrane.

Answer 25

Osmosis

Question 26

outward forces are greater than inward forces.

Answer 26

Filtration

Question 27

inward forces outweigh outward forces.

Answer 27

Reabsorption

Question 28

responsible for draining lymph from the skin and subcutaneous tissue.

Answer 28

superficial layer

Question 29

drains lymph from muscle tissue, tendon sheaths, nervous tissues, the periosteum, and joint structures.

Answer 29

deep layer

Question 30

begin the drainage system. These are located in close proximity to blood capillaries. Through open junctions the lymph capillaries are able to absorb interstitial fluid.

Answer 30

Lymph capillaries

Question 31

connect lymph capillaries and collectors. In some areas they have wall like lymph capillaries and are able to absorb lymph and have valves like lymph collectors.

Answer 31

Precollectors

Question 32

transport lymph to lymph nodes and lymphatic trunks. These vessels have valves that allow lymph to more in one direction, proximal.

Answer 32

lymph collectors

Question 33

act as protector by filtering debris from lymph, immune function with production of antibodies, and thicken lymph trough the reabsorption of water.

Answer 33

lymph nodes

Question 34

generally have a more developed muscle structure and receive lymph from superficial and deep layers. These vessels combine at the cisterna chyli and there become the largest lymph vessel called the thoracic duct.

Answer 34

lymphatic trunks

Question 35

the largest lymph vessel of the body, transports lymph to the venous angle.

Answer 35

thoracic duct

Question 36

the junction between the left internal jugular and left subclavian vein.

Answer 36

The left venous angle

Question 37

Most common insufficiency
Caused by lymphatic load exceeding capacity of the anatomical and functionally intact lymphatic system
May occur as a result of insufficient cardiac or kidney function

Answer 37

Dynamic Insufficiency

Question 38

This is when both dynamic and mechanical insufficiencies are present Both the transport capacity is reduced and the lymphatic load is increased.

Answer 38

Combined Insufficiency

Question 39

Is a reduction in transport capacity due to functional or organic causes
May occur as a result of tissue removal or damage. Tissues may be removed due to medical intervention for cancerous tissues. Damage may occur to tissues during cancer treatment such as radiation, burns to skin, or the presence of toxins such as medicines or parasites.

Answer 39

Mechanical Insufficiency

Question 40

a low-protein swelling, is a symptom rather than a disease. Several conditions may cause edema such as congestive heart failure, chronic venous insufficiency, pregnancy, immobility, constricting garments and/or jewelry.

Answer 40

EDEMA

Question 41

is a disease rather then a symptom and is a high-protein swelling. This high-protein content can result in secondary complications such as hardening of tissues, infections, and an increase in limb size.

Answer 41

lymphedema

Question 42

Edema that begins immediately as a result of trauma or infection. Generally lasts up to 5 days and then begins to subside.

Answer 42

Acute Phase

Question 43

treatment for acute phase of edema

Answer 43

Limited active motion of uninvolved areas

Balance of activity and rest for all structures to prevent inflammation or increase in edema

Elevation (ensure not contraindicated for client situation)
Loose elastic glove or stockinette
Coban
Finger bandage wraps

Observation of visible skin coloring while bulky dressings/orthoses are utilized

Light retrograde massage

Question 44

continues beyond the acute phase and becomes chronic if still present longer then 3 months.

Answer 44

subacute edema

Question 45

is hard, indurated, and resistant to pitting

Answer 45

chronic edema

Question 46

treatment for subacute edema

Answer 46

Start proximally with diaphragmatic breathing, trunk stretches, trunk exercises, easy yoga trunk stretches

Active and passive exercise
Loose elastic glove, loose stockinette, cotton finger wrap bandages and Coban
Elastic taping

Question 47

treatment for lymphedema

Answer 47

Complete decongestive therapy involves manual lymph drainage (MLD) to drain congested tissues
Short stretch compression bandaging
Education on nutrition, self massage and bandaging, skin care
Development and teaching exercise program
Measurement and ordering of compression garments to maintain limb size *requires advanced training

Question 48

precautions for treating edema

Answer 48

In the presence of congestive heart failure (CHF), kidney failure, blood clots (DVT), infection, and undiagnosed cancer DO NOT apply interventions for edema. Medical clearance needs to be secured prior to treatment.