wrist and hand joint hypomob

Question 1

usual cause for hypomob of wrist and hand

Answer 1

RA
OA
acute jt trauma
immob

Question 2

compare RA and OA in terms of age of onset

Answer 2

RA - 15 to 50 yo

OA - after 40 yo

Question 3

compare RA and OA in terms of progression

Answer 3

RA - sudden, weeks to months

OA - gradual; yrs

Question 4

compare RA and OA in terms of manifestations

Answer 4

RA - inflammatory synovitis; damage to cartilage and bone

OA - cartilage degeneration, altered jt structure and osteophyte formations

Question 5

compare RA and OA in terms of joint involvement

Answer 5

RA - bilat; PIP, MCP, wrist, elbow and shoulder

OA - unilateral; DIP, PIP, 1st CMC

Question 6

compare RA and OA in terms of systemic signs

Answer 6

RA - present

OA - none

Question 7

compare RA and OA in terms of ssx in acute stage

Answer 7

RA - ssx of inflammation, morning stiffness at least 1 hr, inc pain c activity

OA - morning stiffness < 30 mins, inc pain c WB, crepitus, LOM

Question 8

compare RA and OA in terms of ssx in advanced stage

Answer 8

RA - jt capsule weakening, cartilage destruction, tendon rupture, muscle imbalance, subluxation and deformity

OA - capsular laxity, hypermob or instab, contractures, general weakness and poor endurance

Question 9

goals during protection phase

Answer 9

control pain and protect joints

maintain joint and tendon mobility and muscle integrity

Question 10

interventions to control pain and protect joints

Answer 10

pt educ - advice to rest, etiology, ssx

pain management - meds given by MD, modalities, gr 1-2 oscillations

splinting/orthosis - help to maintain grip and protect involved jts

activity mod - breakdown large tasks, AD or adaptations

Question 11

interventions to maintain joint and tendon mobility and muscle integrity

Answer 11

ROM exercise - PROM, AAROM, AROM

multiple angle sets - pwede din isoms

tendon gliding - perform full motion in the uninvolved joints and as much motion as possible in the involved

Question 12

intervention scenario during protection phase

Answer 12

restore as primary - dec pain to function

compensate as secondary - use other hand if unilateral

Question 13

discuss goals during controlled motion and return to function phases

Answer 13

inc joint play and accessory motions

improve joint tracking and pain-free motion

improve mob, strength and function

Question 14

give interventions to inc joint play and accessory motions

Answer 14

joint mob - grade 3-4

Question 15

give interventions to improve joint tracking and pain-free motion

Answer 15

MWM for wrist and digits - lateral glide while during wrist ext

Question 16

give interventions to improve mob, strength and function

Answer 16

neuromuscular control and strength

functional activities

conditioning exercises

joint protection

proper form and specificity training

Question 17

intervention scenario for controlled motion and return to function phase

Answer 17

restore

Question 18

what are the joint protection principles

Answer 18

respect pain

maintain functional ROM, strength and endurance

balance activity level and rest

use stronger, larger muscles

avoid deforming postures

use appropriate AD