Conditions in OT Exam #1 - Arthritis, Ortho, & Pain

Rheumatoid Arthritis

A chronic, systemic, inflammatory autoimmune disorder created through a complex interplay of contextual factors, genes, and abnormal immune response

• redness, warmth, and swelling of joints

• fatigue, feeling of sickness, weight loss, fever

• usually affects same joint on both sides of body

• may develop suddenly, within weeks, or months

• most often begins between ages 25-50

Osteoarthritis

Degenerative joint disease; inflammation of the bone and joints

• most common type of arthritis

• primarily affects cartilage

• may initially affect joints asymmetrically

• affects hands and weight bearing joints

• can cause joint pain and stiffness

• usually develops slowly over many years

Swan Neck Deformity

Swan Neck Deformity Splint

Boutonniere Deformity

Boutonniere Deformity Splint

Ulnar Drift

Gout & Hyperuricemia

Gout: a crystalline form of inflammatory arthritis that is marked by significant pain that first presents in the metatarsophalangeal joint of the big toe; crystallization of uric acid within affected joints

Hyperuricemia: a high serum uric acid level that exceeds 6.8 mg/dL and is associated with an imbalance of production and excretion through the urine

Systemic Lupus Erythematosus

Chronic disease with no cure that causes pain and inflammation in any part of the body; body attacks otherwise healthy tissue

Butterfly Rash: symptom of SLE - rash across bridge of nose and cheeks

Juvenile Idiopathic Arthritis

Most common type of arthritis in children under 16 years of age

• not a childhood version of RA

• not one disease process with one cause but considered a heterogeneous group of diseases each with distinguishing features

Crepitus

The crunching feeling or sound coming from the articular surface

Arthroplasty

Joint replacement

Factors that Determine a Fracture

1) The amount of force applied to the bone

2) The strength or toughness of the bone

Pathological Fracture

Fracture caused by insufficiency of the bone due to low density; can’t sustain normal force

Osteopenia

Reversible weakening of the bone that increases risks of developing osteoporosis

Heterotopic Ossification

Abnormal bone formation in extra skeletal soft tissues; cause & pathophysiology unknown

Ecchymosis

Discoloration of the skin caused by bleeding/bruising

Open vs. Closed Fracture

Open: breaks through the skin’s surface

Closed: not broken through the skin’s surface

Types of Fractures

Comminuted Fracture

Has 2 or more bone fragments

Greenstick Fracture

Bone breaks on one side and bends on the other rather than snapping in two

Often seen in children whose bones are soft and growing

ORIF - Open Reduction & Internal Fixation

Secures fractures with hardware (plates, screws)

External Fixation

Total Hip Replacement

Posterior: enter from back; move, cut, repair muscles and capsule with artificial material

Anterior: enter from front; work between the muscles - better recovery and less pain

Hip Precautions

Posterior:

Don’t bend past 90 degrees

No internal rotation

Don’t cross legs

Anterior:

No external rotation

Don’t extend hip (leg behind you)

IM - Intramedullary Nailing

Metal rod into femur

No hip precautions (because did not replace the joint)

• typically, patients are WBAT – weight bearing as tolerated

Adaptive Equipment for Hip Replacement

Sock aid

Reacher

Dressing Stick

Commode

Long sponge / shower head

Weight Bearing Status

NWB – Non-weight bearing – Operated leg should not touch floor

TTWB – Toe-touch weight bearing – 10-15% - Foot of operated leg may rest on the floor

PWB – Partial weight bearing – 30-50% of weight through operated leg; typically specify %

WBAT – Weight bearing as tolerated – As much weight as patient can tolerate

FWB – Full weight bearing

Total Knee Replacement

No precautions

Normal ADLs within 3-6 weeks

Walking to prevent clots

Spinal Precautions

No BLT!

Bending

Lifting

Twisting

Lumbar Fusion vs. Lumbar Disc Replacement

Lumbar disc replacement preserves spinal motion and may allow faster recovery, while spinal fusion stabilizes the spine but eliminates movement at the treated segment

Total Shoulder Replacement Precautions

NWB

No lifting more than a coffee cup

Limited shoulder movements

• At discretion of surgeon, based on procedure

Myofascial Pain vs. Fibromyalgia

Myofascial Pain: chronic pain disorder in which pressure on sensitized muscles causes pain that presents in other muscular regions

• localized

• intense, deep muscular pain

• 
  

Fibromyalgia: diffuse pain that’s widely spread throughout the musculoskeletal system

• widespread and diffuse

• often several co-existing conditions

Common Trigger Points of Myofascial Syndrome

Types of trigger points:

Active – Pressure produces pain at site

Latent – Dormant; no pain on palpation

Secondary – Become active when a different muscle is palpated

Satellite – Elicit pain because of close proximity to another trigger point

Low Back Pain & 6 Common Conditions

1) Lumbar Radiculopathy: sciatica - nerves are compressed by bones and cartilage

2) Herniated Disc: outer layer of disc ruptures from vertebral pressure

3) Spondylolisthesis: one vertebra slides or displaces over another one

4) Spondylosis: form of OA characterized by age-related degenerative spinal column changes

5) Facet Joint Syndrome: as discs lose water and compress, disc height changes causing misalignment

6) Spinal Stenosis: degenerative, when 1 or more spinal openings begin to narrow causing pressure on the spinal cord or nerves

Rotator Cuff Injury

Immediate pain

Dull pain

Pain while laying down

Weakness and restricted ROM

Elbow Conditions

Medial Epicondylitis: golfer’s elbow; pain occurs on the inside of elbow

Lateral Epicondylitis: tennis elbow; pain occurs on the outside of elbow - repetitive use of the forearm muscles

Carpal Tunnel

Compression of medial nerve at the wrist

Olecranon Bursitis

Bursa between skin and olecranon process of the ulna becomes inflamed

Osteochondritis Dissecans

Disrupted blood flow to joint results in necrosis and loosening of bone & cartilage

De Quervain Tenosynovitis

Pain and inflammation of the tendons located on the radial side of the wrist at the base of the thumb