Week 6 - Osteoarthritis Flashcards
a disorder of joints characterized by deterioration of the articular cartilage and secondary bone formation. onset is non-inflammatory but secondary inflammation is common
OA
describe the gender prevalence of OA.
2/3 female
name 4 etiologies of OA.
- genetic
- metabolic
- systemic
- traumatic
___ ___ is a risk factor for OA.
excess weight
what is the main cause of OA?
injury (to joints, fractures, ligament tears) and overuse (long periods of standing, heavy lifting, typing)
OA has the highest ___ of ALL illnesses.
morbidity
name 3 general symptoms of OA.
- joint stiffness (limited ROM or stiffness, clicking/cracking when joint moves)
- swelling
- pain
name 2 situations when OA pain improves.
- after gentle exercise and/or light activity
- after rest
when does OA pain worsen?
after forceful gripping or pinching
ppl with OA can have increased pain in what type of weather?
cold weather
ppl with OA experience stiffness after how many mins of static position?
15-30 mins
ppl with OA experience limited joint ROM and deformity due to what 2 things?
osteophyte formation or cartilage loss
ppl with OA can have ___ ___ from disuse.
muscle weakness/atrophy
name 6 most commonly involved joints.
- knees
- hips
- PIP and DIP joints of hand
- CMC joint of thumb
- spine
name 6 most commonly involved joints.
- knees
- hips
- PIP and DIP joints of hand
- CMC joint of thumb
- spine
what is the key to self management?
patient education
what is the general purpose of OT in OA?
evaluate functional performance and teach pt. how to self-manage OA
name 5 aspects of OA self management.
- eliminate aggravating factors
- reducing stiffness, pain and inflammation
- maintain ROM and muscle strength
- reducing joint stress
- increase functional independence
name a symptom of OA of the hand.
pain with functional activities - exacerbated with activities requiring sustained or repetitive grip and pinch
how is OA of the hand managed?
- pain management
- rest via joint immobilization (orthotics) - to stabilize CMC joint
- activity modification - adaptive equipment
- joint protection techniques
which joint of the hand is very commonly involved?
CMC joint
osteophytes at DIP joints
Heberdon’s nodes
osteophytes at PIP joints
Bouchard’s nodes
what is STT arthritis?
CMC joint (scaphoid, trapezium, trapezoid)
name 3 symptoms of CMC joint OA.
- pain
- stiffness
- tenderness
name 3 signs of CMC joint OA.
- bony enlargement
- limited ROM
- deformity
describe a CMC orthosis for OA.
- hand based with C bar
- allows IP movement
- wrist free
name 3 PAMs for acute inflammation OA.
- cold
- electrical stimulation
- superficial heat
name 1 PAM for chronic inflammation for OA.
conversion heat (ultrasound)
pts. with OA of CMC joint may need to learn what during activities?
lighter touch
name 3 orthoses to reduce OA stiffness.
- soft splints
- tubigrip
- isotoner gloves
- coban wrap
what is 1 way to reduce OA stiffness?
exercise in warm water in morning
name 2 ways to increase OA joint ROM.
- heat and GENTLE stretch
- home exercise program (HEP)
name 2 ways to increase strength in pts. with OA.
- strengthening around specific joints
- moderate load for strengthening
- walking to improve cardio and general fitness
describe an orthosis for STT arthritis.
- splint wrist AND CMC joints
- forearm based splint
name 2 treatments for STT arthritis.
- splinting
- corticosteroid injections
in which type of arthritis do you see a lot of swelling and which do you see bony nodes?
RA - swelling
OA - bony nodes
describe ROM interventions for OA.
starts with AROM
should you use the dynamometer or pinch gauge for pts. with OA who are acutely inflamed?
no
determines whether or not there is pain at CMC joint (compressing MC at trapezium)
grind test*
have pt. grab the tip of their thumb and go into ulnar deviation; if tendons on that side (APL and EPB) are inflamed they’ll scream in pain; used in CMC joint arthritis
finkelstein test*
short thumb spica
splint that supports CMC joint
supports CMC joint right at the base
Metagrip splint
thin fragile, weaker, prevents palmar subluxation - key role in pronation/opposition
anterior oblique “beak” ligament (AOL)
strongest toughest ligament - key ligament in stabilizing CMC joint during powerful subluxing forces in power pinch/grip
dorsal ligament complex
essential in stabilizing thumb MC to index in absence of other ligaments or excision of trapezium
intermetacarpal ligament
name 3 dynamic stability exercises for OA.
- restoration of thumb web space
- joint mobilization for pain control
- orthotic fabrication to stabilize the CMC joint - as appropriate
pressure to adductor by pinching with opposite thumb or clip, contract-release with stretch, or manual release
adductor muscle release
grasp thumb with opposite hand behind back - let weight of arms distract joint
mobilization: distraction
rest involved CMC joint atop skull, insert opposite thumb in webspace or gently on thumb column - hold hand gently rock forward and back 1-3 or more minutes
mobilization: reduce dorsal subluxing
reach across dorsum of involved hand, wrap fingers around the length of the 1st MC, press hand to chest and gently loosen CMC joint by rolling the involved thumb away from chest, hold for 1-3 or more mins.
mobilization: retro-position
-move through full abduction/adduction, then progress: first AROM - light resistance (rubberband), 10-15x 3x a day to max. resistance 10-12x/once per day
strengthening: first dorsal interosseous
strengthen in a C position for which 3 muscles?
- extensor pollicis brevis
- abductor pollicis brevis
- opponens pollicis
place thumb in opposition to fingertips: begin to pinch, if MP starts to collapse STOP
place and hold
