ASHT - arthritis Flashcards
(21 cards)
What is the pathophysiology of RA?
Inflammation > histological changes in synovium > interaction with other soft tissues in joint > Joint destruction.
What is the invasion of Panus in RA?
Proteins from thickened synovium damage cartilage, bone, tendons, and ligaments, leading to instability.
Which joints are most commonly affected by RA? (4)
Wrist/DRUJ, MP Joint, PIP, DIP.
Often multiple joints; some deformities occur secondary to changes at adjacent joints.
What are the RA changes at the wrist?
Radial deviation, diseased synovium affects RSC and SL, flexion of scaphoid, carpus pulled radially.
What causes the zigzag deformity in RA?
Wrist RD, MP ulnar deviation, and carpal shift.
What is Vaughn-Jackson syndrome?
Extensor tendon ruptures over ulna (RA).
What is a Mannerfelt Lesion?
FPL rupture over scaphoid (RA).
What are the RA changes at MP joints?
Ulnar deviation and volar subluxation.
What are contributing factors to ulnar deviation at MP joints? (7)
RD at wrist,
instability at collateral ligaments,
EDC decentralization,
dorsal apparatus stretched out,
radial sagittal fibers and collateral ligaments become stretched,
imbalances in intrinsics,
forces of ADL use/radial pinch.
What are contributing factors to volar subluxation at MP joints? (3)
Synovitis weakens ligament and tendon insertions about the MCP joint capsule,
EDC decentralizes and becomes an ulnar deviator at MP,
long flexors unopposed by EDC enhance volar migration of P1.
What is the cause of RA Swan neck deformity?
PIP hyperextension with DIP extension lag due to synovial destruction to extensor mechanism and volar plate combined with intrinsic muscle tightness.
What is the treatment for RA Swan neck deformity?
Early treatment: rebalance with intrinsic stretches in early stages, protect PIP from hyperextension with ring.
What is the RA Boutonniere deformity?
PIP flexion with DIP hyperextension due to synovial destruction to extensor mechanism.
What are the types of RA thumb deformities?
Type 1: Boutonniere (MP flexion, IP hyperextension).
Type 2: CMC flexion/adduction with MP flexion and IP hyperextension.
Type 3: Swan neck (CMC subluxation/flexion/adduction with MP hyperextension and IP flexion).
What are types IV, V, and VI RA thumb deformities?
Type IV: MP radial deviation (UCL laxity) with CMC flexion/adduction.
Type V: MP hyperextension (lax volar plate) without CMC involvement.
Type VI: ‘Arthritis mutilans’ – bone loss at any level.
What is psoriatic arthritis?
Auto-immune inflammation of skin and joints, sausage-like digits, thick red and scaly skin (psoriasis), reduced motion, spontaneous ankylosis of PIP and DIP joints, pencil-in-cup deformity, nails may be pitted, ages 30-50.
What are Bouchard nodes?
Nodes at the PIP.
What are Heberden nodes?
Nodes at the DIP.
What is the dynamic stability approach to CMC OA?
Open up web space for muscle rebalancing, use joint mobilization for pain control, teach muscle stabilization and strengthening, consider orthotic fabrication.
What is synovectomy in RA?
Surgical procedure to relieve pain, decrease inflammation, return ROM, improve function through elimination of pain; will not prevent progression.
What is the rehab protocol after surgery for Swan neck?
Block extension, start flexion immediately, can use template.
