Arthritis Flashcards

1
Q

osteoarthritis

A

“wear and tear disease”breakdown in the articular cartilage due to both mechanical and chemical factors

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2
Q

osteophytes

A

“bone spurs”new bone formations that can occur in addition to cartilage breakdown in OA, resulting in pain and limitations of joint movement

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3
Q

“triggering”

A

limited digital ROM caused by dragging of the tendon as it passes through a pulleyoften caused by osteophytes

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4
Q

“locking”

A

the digit locks into flexion as the tendon fails to pass through a pulleyoften caused by osteophytes

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5
Q

Bouchard’s nodes

A

nodules occurring with OA at the PIP joint

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6
Q

Heberden’s nodes

A

nodules occurring with OA at the DIP joint

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7
Q

crepitus

A

grating or popping in joints

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8
Q

common areas of OA involvement (6)

A

DIPsPIPsCMC of thumbkneeshipsspine

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9
Q

early stage OA

A

joint space narrowedswelling around joints

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10
Q

moderate stage OA

A

development of osteophytes, cysts, and/or subcondral sclerosis

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11
Q

late stage OA

A

bone erosionsubluxationfibrotic ankylosis

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12
Q

subcondral sclerosis

A

increase in bone density

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13
Q

fibrotic ankylosis

A

stiffening of a joint due to fibrous growth of tissues in joint

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14
Q

evaluation assessments of OA (6)

A

painAROMjoint stabilityinflammationpalpationability to perform ADLs

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15
Q

PROM and OA

A

typically not evaluated due to joint instability

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16
Q

assessing ligament stability of thumb in OA

A

evaluate pinch patterns

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17
Q

grind test

A

for DJD at the CMC jointinvolves compressing the joint while gently rotating the head of the metacarpal on the trapezium+ with pain and crepitus

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18
Q

general joint protection principles (6)

A
  1. respect pain2. balance rest and activity3. exercise in a pain-free range4. avoid positions of deformity5. reduce the effort and force6. use larger/stronger joints
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19
Q

Is “no pain, no gain” a good rule of thumb for the OA patient?

A

NO

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20
Q

OA modalities

A

warm shower/bathsuperficial heat (hot packs/fluido)non-thermal USlow level laserelectrotherapycryotherapy

21
Q

exercise and OA (4)

A
  1. avoid painful ROM by staying within comfort level2. combine exercise with joint protection3. thumb web space stretching4. strengthening 1st dorsal interossi is helpful
22
Q

OA of the thumb

A

characterized at CMC joint by MC adduction and subluxation from the trapezium, MP hyperextension, and IP flexion*deformity more pronounced during heavy pinch activities

23
Q

Eaton Classification

A

radiographic classification for staging basal joint arthritis of the thumbwidely used to define severity as well as guide treatment

24
Q

Eaton Stage I

A

normal appearance of articular surface and slight joint space widening

25
Q

Eaton Stage II

A

minimal sclerotic changes of subchondral bone with osteophytes and loose bodies less than 2 mm

26
Q

Eaton Stage III

A

trapeziometacarpal joint space markedly narrowed and cystic changes present; subluxation of the MC may have occured; osteophytes and loose bodies greater than 2 mm

27
Q

Eaton Stage IV

A

presence of scaphotrapezial joint disease with narrowing

28
Q

CMC orthoses

A

prefabricated, custom fabricated, PUSH MetaGrip

29
Q

advantages of PUSH MetaGrip

A

long term durability, resisting abrasioncovers minimal surface of palmheat resistantcan be worn under glove

30
Q

CMC interposition arthroplasty

A

resection of CMC joint that then allows the MC to return to ABducted positiondonor tendon is rolled up and interpositioned in the joint spaceligaments are reconstructed

31
Q

CMC interpostion arthroplasty post-op

A

cast 4-6 weeks then orthosis for 6-12 weeks

32
Q

CMC interposition arthroplasty precautions

A

most surgeons recommend waiting at least 3 months before any heavy pinching activities are allowed

33
Q

OA of DIP joint

A

often have Heberden’s nodespainful initially, but pain usually decreases over timeorthoses can help support joint/decrease painsurgical fusion is option

34
Q

rheumatoid arthritis

A

an inflammatory, systemic, autoimmune disordermanifests primarily in synovial tissueoften symmetrical and bilateralconsists of remissions and exacerbations

35
Q

common areas of RA involvement in the hand (4)

A

MPsPIPsthumbwrist

36
Q

Stage I RA

A

joint swelling and inflammationwarm when palpatedmost painful phase

37
Q

Stage II RA

A

decrease in symptomsnodules may develop in bursa

38
Q

Stage III RA

A

destructiveless pain reportedirreversible joint deformities

39
Q

Stage IV RA

A

chronic inactive or skeletal collapse and deformitymay include instability, dislocation, spontaneous fusion

40
Q

RA deformities of hand (7)

A
  1. swan neck deformity2. boutonniere deformity3. MCP joint ulnar deviation4. volar subluxation of the carpus on the radius5. distal ulnar dorsal subluxation6. thumb deformities7. crepitus
41
Q

swan neck deformity

A

DIP flexion and PIP hyperextension

42
Q

boutonniere deformity

A

PIP flexion and DIP hyperextension weakened central tendon, lateral bands slip volar to PIP joint

43
Q

intrinsic plus position

A

MP flexion with IP extension

44
Q

In RA, what position do the MP joints want to go?

A

ulnar deviation

45
Q

Oval-8 splint

A

high temperature plastic splint option for swan neck deformity

46
Q

Non-Op treatment RA (5)

A
  1. joint protection2. modalities3. exercise4. strengthening5. remedies
47
Q

RA joint protection

A

along with principles for OA should also address specific deformity or potential deformity

48
Q

RA precautions (2)

A
  1. heat is contraindicated during the acute inflammatory phase2. exercises should never create deforming forces
49
Q

wrist and MP joint deformities

A

ulnar displacement of the proximal carpal row due to ligament instability can cause radial deviation of the handMPs may secondarily go into ulnar deviation