Arthritis

Question 1

osteoarthritis

Answer 1

“wear and tear disease”

breakdown in the articular cartilage due to both mechanical and chemical factors

Question 2

osteophytes

Answer 2

“bone spurs”

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

Question 3

“triggering”

Answer 3

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

Question 4

“locking”

Answer 4

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

Question 5

Bouchard’s nodes

Answer 5

nodules occurring with OA at the PIP joint

Question 6

Heberden’s nodes

Answer 6

nodules occurring with OA at the DIP joint

Question 7

crepitus

Answer 7

grating or popping in joints

Question 8

common areas of OA involvement (6)

Answer 8

DIPs
PIPs
CMC of thumb
knees
hips
spine

Question 9

early stage OA

Answer 9

joint space narrowed

swelling around joints

Question 10

moderate stage OA

Answer 10

development of osteophytes, cysts, and/or subcondral sclerosis

Question 11

late stage OA

Answer 11

bone erosion
subluxation
fibrotic ankylosis

Question 12

subcondral sclerosis

Answer 12

increase in bone density

Question 13

fibrotic ankylosis

Answer 13

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

Question 14

evaluation assessments of OA (6)

Answer 14

pain
AROM
joint stability
inflammation
palpation
ability to perform ADLs

Question 15

PROM and OA

Answer 15

typically not evaluated due to joint instability

Question 16

assessing ligament stability of thumb in OA

Answer 16

evaluate pinch patterns

Question 17

grind test

Answer 17

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

Question 18

general joint protection principles (6)

Answer 18

1. respect pain
2. balance rest and activity
3. exercise in a pain-free range
4. avoid positions of deformity
5. reduce the effort and force
6. use larger/stronger joints

Question 19

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

Answer 19

NO

Question 20

OA modalities

Answer 20

warm shower/bath
superficial heat (hot packs/fluido)
non-thermal US
low level laser
electrotherapy
cryotherapy

Question 21

exercise and OA (4)

Answer 21

1. avoid painful ROM by staying within comfort level
2. combine exercise with joint protection
3. thumb web space stretching
4. strengthening 1st dorsal interossi is helpful

Question 22

OA of the thumb

Answer 22

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

Question 23

Eaton Classification

Answer 23

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

Question 24

Eaton Stage I

Answer 24

normal appearance of articular surface and slight joint space widening

Question 25

Eaton Stage II

Answer 25

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

Question 26

Eaton Stage III

Answer 26

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

Question 27

Eaton Stage IV

Answer 27

presence of scaphotrapezial joint disease with narrowing

Question 28

CMC orthoses

Answer 28

prefabricated, custom fabricated, PUSH MetaGrip

Question 29

advantages of PUSH MetaGrip

Answer 29

long term durability, resisting abrasion covers minimal surface of palm heat resistant can be worn under glove

Question 30

CMC interposition arthroplasty

Answer 30

resection of CMC joint that then allows the MC to return to ABducted position donor tendon is rolled up and interpositioned in the joint space ligaments are reconstructed

Question 31

CMC interpostion arthroplasty post-op

Answer 31

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

Question 32

CMC interposition arthroplasty precautions

Answer 32

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

Question 33

OA of DIP joint

Answer 33

often have Heberden's nodes painful initially, but pain usually decreases over time orthoses can help support joint/decrease pain surgical fusion is option

Question 34

rheumatoid arthritis

Answer 34

an inflammatory, systemic, autoimmune disorder manifests primarily in synovial tissue often symmetrical and bilateral consists of remissions and exacerbations

Question 35

common areas of RA involvement in the hand (4)

Answer 35

MPs PIPs thumb wrist

Question 36

Stage I RA

Answer 36

joint swelling and inflammation warm when palpated most painful phase

Question 37

Stage II RA

Answer 37

decrease in symptoms | nodules may develop in bursa

Question 38

Stage III RA

Answer 38

destructive less pain reported irreversible joint deformities

Question 39

Stage IV RA

Answer 39

chronic inactive or skeletal collapse and deformity | may include instability, dislocation, spontaneous fusion

Question 40

RA deformities of hand (7)

Answer 40

1. swan neck deformity 2. boutonniere deformity 3. MCP joint ulnar deviation 4. volar subluxation of the carpus on the radius 5. distal ulnar dorsal subluxation 6. thumb deformities 7. crepitus

Question 41

swan neck deformity

Answer 41

DIP flexion and PIP hyperextension

Question 42

boutonniere deformity

Answer 42

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

Question 43

intrinsic plus position

Answer 43

MP flexion with IP extension

Question 44

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

Answer 44

ulnar deviation

Question 45

Oval-8 splint

Answer 45

high temperature plastic splint option for swan neck deformity

Question 46

Non-Op treatment RA (5)

Answer 46

1. joint protection 2. modalities 3. exercise 4. strengthening 5. remedies

Question 47

RA joint protection

Answer 47

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

Question 48

RA precautions (2)

Answer 48

1. heat is contraindicated during the acute inflammatory phase 2. exercises should never create deforming forces

Question 49

wrist and MP joint deformities

Answer 49

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