arthritis, osteogenesis imperfecta (OI), & AMC

arthritis

inflammation of joint(s)

rheumatoid arthritis (RA)

• systemic, symmetrical, affects small joints

• remissions and exacerbations

• pain, symptoms, limited ROM, fatigue, weight loss, limited ADL, inflammation, social isolation, deformities

types of deformities with RA

• ulnar drift and subluxation of MCP joints

• boutonniere deformity

• swan neck deformity

• zig zag deformity

boutonniere deformity

flexion of POP joint and hyperextension of DIP joint

swan neck deformity

hyperextension of the PIP joint and flexion of the DIP joint

osteoarthritis

• degenerative joint disease

  • not systemic, wear and tear

• pain, stiffness, limited ROM, bone spurs

evaluations for arthritis

• profile

• ROM

• muscle strength

  • avoid muscle testing unless requested by the physician

  • document strength in relation to function

• grip strength: use sphygmomanometer or bulb dynamometer

• ADL and role activities

• pain

• edema: volumeter or tape measure

orthotics for arthritis

• resting hand orthosis in the acute stage

• wrist orthosis if arthritis specific to the wrist

• ulnar drift orthosis to prevent ulnar drifts of the MCP joints

• dynamic MCP extension orthosis with radial pull for post op MCP arthroplasties

swan neck orthosis

• silver rings

• 3-point oval 8

• digital dorsal orthosis in slight PIP flexion

boutonniere orthosis

• silver rings

• 3-point oval 8

• PIP extension orthosis

intervention for arthritis

• joint protection

• energy conservation

• pain management

• ROM

• PAMs

• strengthening

  • avoid during inflammatory stage

PAMs for arthritis

• fluidotherapy & hot packs can be used before exercise

  • avoid during inflammatory stage

• paraffin recommended for hands

• cold packs can be used during inflammatory

  • effective for decreasing pain and swelling

osteogenesis imperfecta (OI)

dysfunction of one of several genes responsible for producing collagen for the development of bone structure and strength

• malformed bones, brittle bones that fracture easily

• developmental growth problems

• loose joints

• whites of eyes (sclera) look blue, purple, gray

• brittle, misshapen, or discolored teeth

• hearing loss

OI type I

mild symptoms

OI types IV, V, and VI

moderate symptoms

OI types II, III, VII, and VIII

severe symptoms (type II most severe)

eval for OI

• developmental eval of childhood occupations and occupational performance

• environmental risk factors

• strength & endurance

• joint flexibility & ROM

intervention for ROM

• family, caregiver, teacher education on proper handling, positioning, activity adaptations, environmental mods, need to observe all safety precautions

• preventative positioning/splinting

• weight-bearing activities to facilitate bone growth

• health education

arthrogryposis multiple congenita (AMC)

• congenital joint contractures

• signs and symptoms can vary

  • weakness, limited/no ROM in affected joints

  • congenital heart defects, spinal defects, torticollis, diaphragm involvement

• typical cog development

AMS typical resting position for UEs

shoulder internally rotated, elbows extended, wrists flexed

AMS typical resting position for LEs

internally rotated, flexed hips, clubfeet

eval for AMC

• ROM and functional muscle strength

• mobility, positioning, movement

• ability to participate in occupations at home and in school, work, community settings

• comprehensive developmental assessment

intervention for AMC

• gentle ROM and weight bearing exercise to maintain joint integrity and build muscle strength

• environmental mods

• mobility device training

• caregiver education