OT EXAM ARTHRITIC HAND

Question 1

What is osteoarthritis?

Answer 1

-“Wearing away” of the cartilage results in irritation of the bone.
-Seen in joints that bear weight (Knees, hips, spine)

Question 2

Where in the hand is OA seen?

Answer 2

CMCJ of the thumb, DIPS PIPS

Question 3

What part of the bone is affected in OA?

Answer 3

Subchondral bone

Question 4

Symptoms of OA

Answer 4

Crepitus, less ROM, joint pain, joint stiffness and swelling

Question 5

osteophytes are?

Answer 5

bone growth

Question 6

Where are Herberdens nodes found?

Answer 6

DIP

Question 7

Where are Bouchards nodes found?

Answer 7

PIP

Question 8

Squaring at the wrist?

Answer 8

due to prominence of 1st CMC joint

Question 9

How does OA appear initially?

Answer 9

asymmetrically

Question 10

TX for OA:

Answer 10

Medication
Avoiding activities which cause pain
Maintain ADL’s- joint protection and energy conservation principles
Splinting
Moist heat or paraffin
AROM
Mild strengthening exercises

Question 11

Avoid what movements with OA?

Answer 11

-sustained pinch (knitting, hand tools, garden tools)
-sustained pinch with torque (key turning, can opening)
-Pinch with pushing and pulling (vegetable peeling, hand sawing, ski poles),
-repetitive movements (cutting with scissors, spray bottles)

Question 12

RA:

Answer 12

• A systemic disease
• 75% affected are women
• Morning stiffness
• Proliferation of the synovium in joints
• Synovitis invades the joint capsule destroying the supporting structures of the joint
• Chronic synovitis is persistent with repeated inflammation of the synovium

Question 13

Where is RA seen in the hands?

Answer 13

MCPJ and PIPJ

Question 14

• Pannus

Answer 14

Inflamed synovium, turns into diseased tissue which eats the ends of the bones away

Question 15

How does RA appear?

Answer 15

Usually symmetrical- attacks the wrists, hands, knees, elbows, shoulders, ankles

Question 16

Stages of RA

Answer 16

ACUTE-INFLAMMATORY
PROLIFERATIVE STAGE
DESTRUCTIVE PHASE: ADVANCED
FINAL STAGE: CHRONIC

Question 17

Medications for arthritis

Answer 17

• NSAIDS
• Steroids
• DMARDS
• Analgesics

Question 18

Surgical TX’s

Answer 18

• Synovectomy- removal of diseased synovium
• Tenosynovectomy- removal of diseased tendon
• Tendon surgeries: repair, release, transfer
• Arthroplasty: joint replacement
• Arthrodesis: joint fusion

Question 19

Mallet finger

Answer 19

-Droop of DIP
-Damage of insertion of the extensor tendon

Question 20

Boutonniere

Answer 20

-PIP bends, DIP extends
-destruction of central slip of the extensors and volar slipping of the lateral bands.

Question 21

Swan neck deformity

Answer 21

• PIPJ in hyperextension and DIPJ in flexion.
• Caused by overstretching of the volar plate of the PIPJ.

Question 22

TX principles

Answer 22

O ROM- gentle AROM should be done at least once daily
O Gentle stretching of intrinsics (MCPs extended, flex IPs)
O Resistive exercises: often “soft” resistance only
O Heat and cold modalities.
O Joint protection and energy conservation
O Pain management; relaxation, yoga.
O Splinting