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from flashcardlet > -O09 Emily: Station 3. > Flashcards

-O09 Emily: Station 3. Flashcards

0
Q

Symptoms of Rheumatoid arthritis

A 
Stiff/painful joints
Inflammation
Warm to touch
Fatigue
Joint deviation
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1
Q

Rheumatoid arthritis

A 
Auto-immune systemic diseases 
Commonly presents bilateral in 
-hands
-feet
-wrists
-neck/spine
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2
Q

Disease process of RA

A
  • Synovium lines the joint and synovial fluid fills the joint space
  • the body releases antibodies which attack the synovial lining instead of the body fighting bacteria
  • Damage to the synovial lining causes an inflammatory response and release of chemicals
  • synovial lining begins to swell due to new formation of blood vessels forming (angiogenesis)
  • Joint stiffens due to pain
  • tendon sheaths/ligaments become inflammed which can lead to joint deviation
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3
Q

Early presentation of ra in the foot

A 
Degeneration of joint and soft tissue
Fatty pad migration
-prominent met heads
Muscle imbalance
Loss of 1st ray motion
Hallux limitus/rigidus
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4
Q

Late presentation of ra in the foot

A

Pes planus due to loss of arch structure
Toe deformities from muscle imbalance-claw/hammer/mallet
Hallux valgus
Hindfoot valgus

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5
Q

Medication for RA

A

Painkillers-paracetamol, codine
NSAIDS- ibuprofen, diclofebac
Corticosteroids-reduce pain/stiffness/swelling
DMARDs-methotrexate (blocks side effects of chemicals produced when antibodies attack synovial lining therefore reduces disease progression)

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6
Q

Diagnosis of ra

A 
Rheumatoid factor and symptoms
Seronegative RA(20%) - RF not present
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7
Q

Osteoarthritis

A 
'Wear and tear' arthritis
Most common (~8 million in UK)
Mainly presents unilateral in load bearing joints
-hips
-knees
-1st MTPJ
-lower back
-neck
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8
Q

Risk factors oa

A 
Family history
Overweight
Previous joint injury/abnormality
Age > 40
Women
Other joint diseases
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9
Q

OA

A

Disease of synovial joints characterised by cartilage loss and per-articular bone response
Ranges from:
Atrophic disease
-cartilage destruction with no bone response
Hypertrophic disease
-new bone formation in joint margins

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10
Q

Disease process for oa

A
  • cartilage is a smooth surfaced material used for shock absorption
  • certain joints begin to degenerate due to increased strain/load
  • cartilage begins to wear down (erosion) causing the joint space to narrow
  • osteophytes form in an attempt to repair damage-swelling and joint stiffness
  • decreased rom and bony deformities
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11
Q

Surgery for oa

A

Total joint replacement
Unicompartmental replacement
Realignment osteotomy
Arthrodesis

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12
Q

Oa knee bracing

A

Pain relief
Increase activity level

Valgus control
3 point forces
Applied via straps
Even pressure distribution
Unload joint

Split middle force into 2
Dynamic unloading
Rotation control
Balanced load distribution

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13
Q

Valgus knee

A

Lateral compartment oa

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14
Q

Varus knee

A

Medial compartment oa

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15
Q

Juvenille idiopathic arthritis

A

Occurs in children <16 (1 in 1000 in uk)
Does not normally mean arthritis will continue into adulthood
Can be genetic

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16
Q

Types of juvenille idiopathic arthritis

A 
Oligoarthritis
Polyarthritis 
Systemic arthritis
Psoriatic arthritis
Enthrsitis-related arthritis
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17
Q

Oligoarthritis

A 
Affects 1-4 joints 
60% of jia suffer this type
If throughout childhood therefore persistant oligoarthritis
Spreads to more joints after 6 months 
-extended oligoarthritis
Most common in girls  
-20% risk
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18
Q

Polyarthritis

A

More than 4 joints affected in first 6 months

Affects around 20%

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19
Q

Types of polyarthritis

A

Polyarthritis rheumatoid factor negative

Polyarthritis rheumatoid factor positive

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20
Q

Polyarthritis rheumatoid factor negative

A

Most children are rf negative
Often effects hands and feet and leads to knees elbows neck and hips
One quarter of children go into remission

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21
Q

Polyarthritis rheumatoid factor positive

A

10% affected
Tend to be girls <10
Disease can be quite severe

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22
Q

Systemic arthritis

A 
10% of jia
Affects whole body
Tends to start under 5
Most difficult type
Can be confused with measels menigitis or leukaemia
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23
Q

Psoriatic arthritis

A

Scaly skin rash on finger or toe nails

<1 in 10 affected

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24
Q

Enthesitis related arthritis

A

Normally boys > 8
Swelling at enthesis (where tendon attaches to bone)
Mainly affects lower limb

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25
Q

Chondromalacia patellae

A

Affects 1 in 3 teens/adults
Softening of cartilage lining on posterior aspect of knee cap
Symptoms of pain and crepitus

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26
Q

Sjogrens syndrome

A

Autoimmune disorder where the body attacks own tissues
Common symptoms=dry eyes/mouth aching and lethargy
Secondary sjorens associated with rheumatic disease eg ra
Primary sjorens not associated with rheumatic disease
Mainly women age 40-60

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27
Q

Complex regional pain syndrome

A

Also called reflex sympathetic dystrophy
Continuous pain
Can occur after trauma
Extreme sensitivity of affected area

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28
Q

Raynaulds phenomenon

A 
Response to extreme temperature change
Colour of hands/feet changes in the cold
White=blood supply decreased
Blue=blood oxygen decreased
Red=blood rushing back as hands begin to warm
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29
Q

Bahcets syndrome

A

Inflammed tissue
Small blood vessels become inflammed
Main symptoms
-inflamed eyes, mouth ulcers, joint pain, skin problems

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30
Q

Polymyostitus

A

Muscle inflammation
Mainly affects large muscles
-eg shoulders hips and thighs
Muscles feel weak and tired

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31
Q

Osteoporosis

A

Mainly affects postmenopausal women
Classified into
-senile osteoporosis
-idiopathic osteoporosis
-post menopausal
Bone becomes more fragile and bone matrix decreases
Porous bone
Affects whole skeleton with spinal changes most obvious - reduction of total bone mass
Compression fractures if vertebrae and upper end of femur and lower end of radius are prone to fracture easily
Xrays show reduced density of vertebral bodies and rounded kyphosis of thoracic spine with prominent processes in thoracic/thoracolumbar region
-trunk is shortened

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32
Q

Gout

A

Rheumatic disease
Buildup of urate crystals which cause inflammation
-red hot swollen painful joint
Tends to be seen in 1st mtpj
May form white crystals called tophi on ear or hands

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33
Q

Osteochondritis

A

Vascular abnormalities
-caused by transient vascular disturbances
-partial venous occlusion (different from aseptic necrosis)
-Kohlers disease affects navicular bone in the foot and presents with pain on dorsum of foot
Damage to the apophyses
-when muscles attached to apophyses can lift/pull away apophysis during growth spurt

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34
Q

Severs disease

A

Occurs at the heel
Pain and tenderness at proximal edge of calcaneal apophysis due to traction by achilles tendon
Apophysis=where tendon attaches to epiphyseal plate

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35
Q

Osteomalacia

A

Found in adults due to lack of calcium and poor mineralisation of ostoid (uncalcified matrix of bone)
Known as rickets in children
Caused by lack of vitamin d
1 in 1000 people are affected

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36
Q

Systems of osteomalacia

A 
Pain in hips
Muscle weakness
Numbness around mouth
Numbness of extremities
Spasms of hands or feet
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37
Q

Radiographic features of osteomalacia

A 
Long bones may be curved
Mutliple spontaneus fractures
Not seen in osteoporosis
-ribs
-pelvis ramus
-elsewhere
Thinking of cortex and tuberculae of bone
38
Q

Osteogenesis imperfecta

A

Genetic disorder of connective tissue
Bones break easy of little or no apparent cause
4 recognised forms of disorder
1 in 10000-15000

39
Q

Types of osteogenesis imperfecta

A

Type 1
Type 2
Type 3
Type 4

40
Q

Type 1 osteogenesis imperfecta

A 
Most common and mildest type of OI
Bones predisposed to fracture
-most fractures occur before puberty
Loose joints and low muscle tone
Whites of eyes usually have blue/purple/grey tint
Triangular face
Tendency towards scoliosis
Bone deformity absent/minimal
Brittle teeth 
Hearing loss beginning early 20s-30s
Collagen structure is normal but amount is less than normal
41
Q

Osteogenesis imperfecta type 2

A

Most severe form
Frequently lethal at/shortly after birth (due to respiratory problems)
Numerous fractures and severe bone deformity
Small stature with underdeveloped lungs
Collagen is improperly formed

42
Q

Osteogenesis imperfecta type 3

A 
Bones fracture easily 
-often present at birth and x-rays may reveal healed fractures that occurred before birth 
Short stature
Whites of eyes have blue/purple/grey tint
Loose joints and poor musculature development in the arms and legs
Barrel shaped rib cage
Triangular face
Scoliosis
Respiratory problems possible
Bone deformity often severe
Brittle teeth
Hearing loss problems
Collagen is improperly formed
43
Q

Type 4 osteogenesis imperfecta

A 
Between type 1 and 3 in severity
Bones fracture easily, most before puberty
Shorter than average stature
Eye whites normal in colour
Mild to moderate bone deformity 
Tendency towards scoliosis 
Barrel-shaped rib cage
Triangular face
Brittle teeth
Hearing loss problems
Collagen is improperly formed
44
Q

Genetics of osteogenesis imperfecta

A

Most cases inherited by dominant gene

-defect either chromosome

45
Q

Fibromyalgia

A

Longterm condition causing pain all over body as well as fatigue
-aching, burning pain
Mainly severe in parts of body that are used most
Pain in muscles, but not joints
Tendons and ligaments affected by pain

46
Q

Spinal cord injury classification

A

Tetraplegia

Paraplegia

47
Q

Tetraplegia

A

C1-c7

Involves arms and legs

48
Q

Paraplegia

A

T1-s5

Involves trunk and legs

49
Q

Spinal cord syndromes

A 
Central cord syndrome
Brown sequard syndrome
Cauda equina syndrome
Anterior cord sydrome
Posterior cord syndrome
50
Q

Central cord syndrome

A

Mainly effects arms
Associated with hyperextension in an osteoarthritic spine
Loss of motor function
Can regain walking, bowel and bladder function

51
Q

Brown sequard syndrome

A

Motor weakness on one side and sensation deficits on the other
Caused by penetrating trauma fracture or dislocation

52
Q

Cauda equina syndrome

A

Bowel and bladder problems with mild leg weakness

Causes by central disc prolapse at l4-l5 or l5-s1

53
Q

Anterior cord syndrome

A

Distal to injury loss of motor function, pain sensation and temperature sensation
Touch proprioception and vibration sensations are normal
Patients generally worsen

54
Q

Posterior cord syndrome

A

Very rare

Damage to posterior spinal artery

55
Q

Effects of spinal cord injury

A

Myotomes-cervical
Myotomes-thoracic
Myotomes-lumbar
Myotomes-sacral

56
Q

Effects of spinal cord injury:myotomes-cervical

A

C3-5 supplies diaphragm
C6 supplies wrist extensors
C7 supplies elbow extensors
C8 supplies finger flexors

57
Q

Effects of spinal cord injury -myotomes: thoracic

A

T1 spreads fingers and normal hand function
T1-12 chest wall and abdominal muscles
T2-5 partial trunk movement
T6-12 partial abdominal muscle strength

58
Q

Effects of spinal cord injury- myotomes-lumbar

A

L2 all movement of trunk and hips
L3 knee extension
L4 ankle dorsiflexion
L5 extensor hallucis longus

59
Q

Effects of spinal cord injury- myotomes - sacral

A

S1-2 gastrocnemius/soleus

S3-5 bladder, bowel, sex organs, anal and other pelvic muscles

60
Q

Frankel scale

A

Based in motor and sensory deficits
A complete paralysis
B sensory function only below injury level
C incomplete motor function below injury level
D fair - good motor function below injury level
E normal function

61
Q

The international standards classification for sci

A 
Most accepted classification
Examination of 
-dermatomes for sensory impairment
-myotomes for motor impairment
Identifies the lowest level of normal function from c1-c5
A-motor and sensory complete
B-motor complete
C-motor complete
D-motor incomplete but functional
E-recovery of function
62
Q

Benefits of standing/walking

A 
Prevention of contracture
Reduced risk of osteoporosis
Fewer utis 
Improved cardiopulmonary function
Psychological
63
Q

Swivel walker

A 
Allows hands-free walking
Gives some mobility to severely disabled
Swivel footplates
1. User shifts weight to one side
2. Other side lifts off ground
3. Device pivots around stance foot
64
Q

Orthoses for paraplegic walking

A 
Bilateral kafo
Bilateral hkafo
Reciprocating gait orthosis
Hip guidance orthosis
Lsu-rgo (louisiana state uni rgo) 
Advance rgo 
I-rgo
Rgos with conventional hip joint 
Nocral design rgos
65
Q

Bilateral kafo

A

A) flexion control from upper limbs
B) no internal/external rotation control
C) no abduction/adduction control
Hip flexion prevented by an extension moment from upper limbs (crutches)
Upper limbs requires to stabilise hip
Some patients overextend torso so grf passes posterior to hips
Subperineal joints for bilateral kafos
-placed proximal medial
-prevent adduction of hips (allows better ground clearance)
-limit internal/external hip rotation

66
Q

Bilateral HKAFO

A

A) swing through gait
B) hip joints improve standing balance
C) hip joints increase energy consumption
D) strain on lumbar and upper spines
E) unreliable hip joints
locked hips in swing and stance cause a swing through gait
Increased lumbar motion caused by locking the hips
Upper limbs needed to raise body off the ground during swing
-strain on wrist elbows and shoulders
Locked hip joints
-high force at mechanical joints
-high shear force at rivets

67
Q

Reciprocating gait orthosis (rgo)

A 
Each leg passes the other
Important features
-reliability of components
-low friction in hip joints
-ground clearance
-cosmesis
Low friction hip joints needed to make reciprocation easier 
Ground clearance prevents hip adduction
68
Q

Describe ground clearance in a rgo

A

Achieved by elevation of the pelvis
-orthosis should prevent hip adduction during swing
-orthosis should prevent hip adduction in the stance hip
Hips adduct therefore clearance reduced
-elevating com
Prevent dorsiflexion at end of stance phase

69
Q

Rgo advantages

A

Hip joints are connected
As one flexes the other extends - impossible for bilateral hip flexion (unless seated)
Extension aid limits stride length

70
Q

Rgo contraindications

A 
Significant contracture 
Significant spasticity 
Obesity
Poor ul strength 
poor motivation
71
Q

Hip guidance orthosis (hgo)

A

Parawalker designed at orlav
-conventional design
-worn over clothing
-feet inside rigid footplates to prevent dorsiflexion
-hip joints resist adduction
Improves ground clearance
-allows free flexion and extension
Fitted with stride limiters
Flexion can still occur bilaterally
-rely on upper limbs (similar to bilateral kafos)
Parawalker can be used with hip flexion contractures (common in paraplegia)

72
Q

What are 3 design features of an hgo

A

Rigid frame (tubular design at pelvis) prevents hip adduction
Reliance on upper limbs for stability
Enhances ability to clear contralateral limb in swing

73
Q

Lsu-rgo (louisiana state uni rgo)

A

Contemporary design
Hip joints joined by 2 bowden cables
-one hip flexes, other extends

74
Q

Disadvantages of lsu-rgo

A

Cable friction/failure

Poor adduction control

75
Q

Advanced rgo (argo)

A

Introduced by rsl steeper

1) single push pull cable
- lies in lumbar lordosis (more cosmetic)
2) better quality hip joints
- lower friction
3) pneumatic struts
- aid knee extension when rising from seated
- control knee flexion when sitting to standing

76
Q

Irgo

A 
Uses pivoting bar instead of cables 
Ensures very low friction
Custom made torso section
Optional extras
-abduction hinge hip joint (ease for cathaterisation, transfering and donning) 
-preselected quick disconnect hip joint
    Allows sitting
    Removal in 3 planes
    Allows complete hip motion for easy transfers
    Crossing over of lower legs
77
Q

Rgos with conventional hip joint

A

-fear of unlocking joint
-fear of loosing balance
-instability
-anterior lean
Use posterior walking frame for more upright posture

78
Q

Nocral design rgos

A 
Poplawski 1989
Dual pivot mechanism
-reduces bulk
-decreases weight
-reduces torque on pivot points
Torso section can accommodate spinal deformities
79
Q

Perthes disease

A

Aka legg calve perthes, calve perthes, avasucular necrosis
Childhood disease effecting epiphysis of the head of femur causing necrosis
Form of osteochondritis at the hip
Blood vessels regrow in an attempt to return blood supply to dead bone/tissue
New bone tissue grows at the femoral head, which remodels over several years

80
Q

Symptoms of perthes disease

A 
Hip/groin pain
Limb
Muscle wasting at hip
Lld
Loss of rom
81
Q

Diagnosis of perthes disease

A

Xray tends to show flattened femoral head
Bone scan
Mri

82
Q

Treatment of perthes disease

A 
Plaster cast/brace
-slightly abducted
Surgery
Bed rest/crutches
Avoid high impact sports
83
Q

Sufe

A

Slipped upper femoral epiphysis
2-10 per 100,000 affected
2.4 male:1 female
Boys 10-16, girls 10-14 outside these ages tend to be endocrine or systemic
Femoral neck displaces anterior causing a fracture through epiphysis

84
Q

Types of supe

A

Pre slip
-wide epiphyseal line without slippage
Acute form
-slippage occurs suddenly, normally sponaneously
Acute-on-chronic
-slippage occurs acutely where there is already chronic slip
Chronic
-steadily progressive slippage (most common form)

85
Q

Mechanical factors of sufe

A

Obesity
Local trauma
Decrease in normal femoral anteversion
Weakened perichondrial ring

86
Q

Symptoms of sufe

A

Pain at hip/knee/thigh
Knee pain referred from hip
Pain during walking which increases when running, jumping, pivoting

87
Q

Pre-slip sufe

A

Slight discomfort

88
Q

Acute sufe

A

Severe pain unable to walk/stand
Limp, external rotation of leg and trunk shift
Limited hip rom, espint rot and abd

89
Q

Acute on chronic sufe

A

Pain, limp and altered gait over several months which becomes very painful

90
Q

Chronic sufe

A 
Able to walk with altered gait
Reports of knee pain
A/a 
Hip externally rotates during flexion
Mild to moderate leg shortening and atrophy
91
Q

Arthrogryposis multiplex congenita

A

Rare congenital disorder and nonprogressive
Multiple joint contractures occur as well as muscle weakness and fibrosis
Most common type
-affects hands, wrists, elbows, shoulders, hips, knees, feet. Jaw and back can be affected in severe cases

92
Q

Paget’s disease

A

Normal cycle of bone renewal and repair disrupted
Results in large mishapen bones
2nd most common type of bone disease following osteoporosis
Tends to affect white british adults age over 55
-combination of genetic and environmental factors
Bone weakness
Tends to be localised to one/a few bones

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