RA/OA/osteoporosis/osteopenia

Question 1

Characteristic sign of RA

Answer 1

Ulnar drift (affects MCPs in hands)

Question 2

When turning a knob, what movements should be encouraged with RA?

Answer 2

Movements that place MCPs in radial deviation (want to avoid UD due to it being a deformity of RA)

Question 3

Joint protection principles

Answer 3

• Respect pain
• distribute load on more than 1 joint
• reduce strength/effort to perform activity/change the way to perform it using AD or reduce weight of utensils
• use each joint in its most stable/functional anatomical plane
• avoid positions/forces in directions that favor deformity
• use stronger/larger joint to work
• avoid staying in same position for a long time
• don’t hold objects with excessive force
• avoid awkward postures/inappropriate ways to pick up & handle objects
• maintain muscle strength/ROM

Question 4

Rheumatoid arthritis

Answer 4

Systemic, symmetrical, affects MANY joints: pain, stiffness, limited ROM, fatigue, weight loss, limited ADL status, diminished roles
- attacks small joints of hand
- remissions & exacerbations
- acute phase: inflammatory process of synovial lining
- due to infection/autoimmune

Question 5

Common joint deformities with RA

Answer 5

1. Ulnar deviation & subluxation of wrists, MCPs
2. Boutonnière deformity
3. Swan neck deformity

Question 6

Heberden’s nodes

Answer 6

At DIP joints

Question 7

Bouchards nodes

Answer 7

At PIP joints

Question 8

Osteoarthritis (OA)

Answer 8

Degenerative joint disease (pain, stiffness, limited ROM, bone spurs)
- due to wear & tear (not systemic)
- affects large weight bearing joints
- attacks hyaline cartilage
- causes: genetic, trauma, inflammation, cumulative trauma, endocrine/metabolic diseases

Question 9

Heat modalities for arthritis (RA & OA)

Answer 9

• Hot packs before exercise, avoid during inflammation stage
• paraffin for the hands recommended