Kisner Ch 11 & 12- Joint, Connective tissue, and bone disorders

Question 1

What are the clinical signs and symptoms of Arthritis and Arthrosis?

Answer 1

Impaired mobility
Impaired muscle performance
Impaired balance
Functional limitations

Question 2

At what age does RA typically begin?

Answer 2

b/t 15 and 50

Question 3

What is the progression rate of RA?

Answer 3

May develop suddenly, with in weeks or months

Question 4

How does RA manifest?

Answer 4

Inflammatory synovitis and irreversible structural damage to cartilage and bone

Question 5

What joints are involved with RA?

Answer 5

Affects many joints, usually bilaterally
MCP & PIP of hands, wrists, elbows, shoulders
Cervical spine
MTP, talonavicular & ankles

Question 6

What are the JOINT signs and symptoms of RA?

Answer 6

Redness
Warmth
Swelling
Prolonged morning stiffness
Increase joint pain w/ activity

Question 7

What are the SYSTEMIC signs and symptoms of RA?

Answer 7

General feeling of sickness & fatigue
Weight loss & fever
Development of rheumatoid nodules
May have ocular, respiratory, hematological, and cardiac symptoms

Question 8

At what age does OA typically begin?

Answer 8

After age of 40

Question 9

How does OA progress?

Answer 9

Develops slowly over many years in response to mechanical stress

Question 10

How does OA manifest?

Answer 10

Cartilage degradations
altered joint formation
osteophyte formation

Question 11

Which joints are typically affected by OA?

Answer 11

Affects a few joints asymmetrically
DIP, PIP, 1st CMC of hands
Cervical and lumbar spine
Hips, knees, 1st MTP of feet

Question 12

What are the JOINT signs & symptoms of OA?

Answer 12

Morning stiffness, increased joint pain w/ weight bearing and strenuous activity
Crepitus and loss of ROM

Question 13

Describe a POC for a pt. w/ RA during the active inflammatory period

Answer 13

Patient education
Joint protection and energy conservation
Joint mobility
Exercise
Functional training

Question 14

Describe a POC for a pt. w/ RA during the subacute and chronic inflammatory period

Answer 14

Treatment approach
Joint protection and activity modification
Flexibility and strength
Cardiopulmonary endurance

Question 15

What are the principles for joint protections and energy conservation for RA?

Answer 15

Monitor activities & stop when pt. feels discomfort or fatigue
Use frequent but short episodes of exercise
Alternate activities to avoid fatigue
Decrease level of activities or omit activities that provoke joint pain
Maintain a functional level of joint ROM & muscular strength and endurance
Balance work & rest to avoid muscular & total body fatigue
Increase rest during flare ups
Avoid deforming postures
Avoid prolonged static positioning/ change positions every 20-30 minutes
Use stronger and larger muscles and joints during activities
Use appropriate adaptive equipment

Question 16

POC for OA

Answer 16

Patient instruction
Pain management: early stages
Pain management: late stages
Assistive and supportive devices and activity
Resistance exercise
Stretching and joint mobilization
Balance activities
Aerobic conditioning

Question 17

What similarities to fibromyalgia and myofascial pain syndrome share?

Answer 17

Pain in muscles
Decreased ROM
Postural stresses

Question 18

Fibromyalgia vs Myofascial pain syndrome

Answer 18

FM: Tender points at specific cites, No referred patterns of pain, No tight band of muscle, & Fatigue and waking unrefreshed
MFPS: Trigger points in muscle, referred patterns of pain, tight band muscle, no fatigue related complaints

Question 19

What factor contribute to Fibromyalgia flares ups?

Answer 19

Emotional stresses
Physical stresses
Environmental stresses

Question 20

Interventions to assist w/ Fibromyalgia?

Answer 20

Exercise
Prescription meds, OTC meds
Avoidance of stress factors
Cognitive behavior therapy
Pacing activities to avoid flare ups
Diet modification
Decreasing alcohol & caffeine consumption

Question 21

What are the possible causes of trigger points for Myofascial pain syndrome?

Answer 21

Chronic & acute overload of muscle
Poorly conditioned muscles
Postural stresses
Poor body mechanics

Question 22

Management of Myofascial pain syndrome?

Answer 22

Correct contributing factors to chronic overload of the muscle
Eliminate the trigger point
Strengthen the muscle

Question 23

What are primary risk factors for osteoporosis?

Answer 23

Post menopausal
Caucasian or Asian decent
Family history
Low body weight
Little or no physical activity
diet low in calcium & vitamin D
Smoking

Question 24

What are secondary risk factors for osteoporosis?

Answer 24

Gastrointestinal disorder
Hyperthyroidism
Chronic renal failure
Excessive alcohol consumption
Glucocorticoids

Question 25

How prevent osteoporosis?

Answer 25

Diet rich in calcium & vitamin D Weight bearing exercise Testing for bone density & medication if needed Moderate alcohol consumption & no smoking

Question 26

What type of force causes a tranverse or oblique fracture, Greenstick in children?

Answer 26

Bending

Question 27

What type of force causes a spiral fracture?

Answer 27

twisting

Question 28

How is an avulsion fracture caused?

Answer 28

Straight pulling force

Question 29

What type of force causes stress fractures?

Answer 29

Repetitive microtrauma

Question 30

What type of fracture is created by a crushing force?

Answer 30

Compression fracture | Torus (buckle) fracture in children

Question 31

What type of force causes a pathological fracture?

Answer 31

Normal force on bone

Question 32

What are the types of abnormal healing of fractures?

Answer 32

Malunion Delayed union Non union

Question 33

What is a malunion?

Answer 33

fracture heals in an unsatisfactory position resulting in bone deformity

Question 34

What is a delayed union?

Answer 34

The fracture takes longer than normal to heal

Question 35

What is a non union?

Answer 35

fracture fails to unite w/ boney union

Question 36

Stages of bone healing

Answer 36

Inflammatory Reparative Remodeling

Question 37

What is a rigid internal fixation?

Answer 37

Surgical application of a rod or plate w/ screws to keep a bone stable while healing

Question 38

Healing time from fractures?

Answer 38

Children 4-6 weeks Adolescents 6-8 weeks Adults 10-18 weeks

Question 39

Cancellous bone is more susceptible to which type of forces?

Answer 39

Compressive

Question 40

What may be affected if a fracture occurs at an epiphyseal plate?

Answer 40

growth

Question 41

In what stage of bone healing does a callus form? Where do osteogenic cells proliferate from?

Answer 41

reparative | periosteum & endosteum

Question 42

Name the complications of fractures?

Answer 42

``` swelling fat embolism problems w/ fixation devices Infection Refracture Delayed or nonunion ```

Question 43

Post-fracture POC

Answer 43

Teach functional adaptions, safe ambulations, bed mobility Ice & elevation Intermittent muscle setting, active ROM to joints above & below immobilized region Resistive exercises to major muscle groups not immobilized

Question 44

Post immobilization POC

Answer 44

``` Joint mobilization PNF stretching Functional activities Muscle performance Scar tissue mobilization ```

Question 45

What are indications for surgical intervention?

Answer 45

Incapacitating pain at rest or with activity Marked limitation of motion Gross instability of a joint or bony segment Joint deformity or abnormal alignment Significant structural degeneration Chronic joint swelling Failed nonsurgical or previous surgical management Significant loss of function leading to disability as the result of any of the preceding factors

Question 46

What examinations and evaluations are performed preoperation?

Answer 46

``` Pain Range of motion and joint integrity Integrity of the skin Muscle performance (strength and endurance) Posture Gait analysis Functional status ```

Question 47

What are postoperative guidelines?

Answer 47

Instruction in safe positioning, safe limb movements & precautions/ contraindications Relaxation exercises Use of estim, ice, or heat Proper wound care Elevation of operated limb, active muscle pumping at distal joints, compression garments, gentle distal to proximal massage

Question 48

What are potential post operative complications?

Answer 48

Pulmonary Complications Deep Vein Thrombosis Subluxation or Dislocation after Joint Surgery Restricted Motion From Adhesions and Scar Tissue Formation Failure, Displacement, or Loosening of Internal Fixation

Question 49

What is Arthrodesis?

Answer 49

a surgical fusion of the surfaces of a joint | Indicated for joint pain associated w/ late-stage arthritis & joint instability

Question 50

Where is Arthodesis used most frequently?

Answer 50

Cervical, lumbar spine | Wrist, thumb, and ankle

Question 51

What is Arthroplasty?

Answer 51

Any reconstructive joint procedure, with or without joint implant, designed to relieve pain & improve function

Question 52

Arthroscopic debridement & lavage

Answer 52

Arthroscopic removal of fibrillated cartilage, unstable chondral flaps, and loose bodies in a joint

Question 53

What is arthroscopic debridement & lavage indicated for?

Answer 53

Relive joint pain and biomechanical catching during joint movements

Question 54

What is a synovectomy?

Answer 54

Removal of synovium (lining of a joint) in the presence of chronic inflammation

Question 55

What patient population typically undergoes this procedure?

Answer 55

RA patients | It is indicated if medical management has failed to alleviate joint inflammation for 4 to 6 months

Question 56

Post operative management for muscle repair

Answer 56

Immediately after surgery perform muscle setting exercise After immobilization is removed begin AROM in protected range Partial weight bearing until pt. achieves functional level of strength & flexibility Low load, high rep resistance exercise Vigorous stretching and full level activity are contraindicated until soft tissue healing is complete (typical 6 to 8 weeks)

Question 57

Post operative management for tendon repair

Answer 57

Muscle setting Begin controlled antigravity motions after tendon has had several weeks to heal Weight bearing may be restricted Heavy lighting activities are contraindicated for 6 to 8 weeks

Question 58

What are procedures for Release, Lengthening, or Decompression of Soft Tissue?

Answer 58

Myotomy Tenotomy Fasiotomy