Kisner Chap 11

bone stuff

This is the limitation of a joint without inflammation

Arthrosis

Age of onset for RA

between age 15 and 50

Age of onset for OA

Usually after age of 40

This disease usually develops slowly over many years in response to mechanical stress

OA

This disease may develop suddenly, within weeks or months

RA

The manifestations of RA are?

Inflammatory synovitis and irreversible structural damage to cartilage and bone

The manifestations of OA are?

Cartilage degradation, altered joint architecture, osteophyte formation

True or False:

OA usually affects a many joints and is usually symmetrical

False:

Few joints, Asymmetrical

True or False:

RA affects many joints and is usually bilateral

True

Which joints does OA usually affect?

• DIP, PIP, 1st CMC

• Cervical and lumbar spine

• Hips, Knees, 1st MTP

Which joints does RA usually affect?

• MCP and PIP of hands, wrists, elbows, shoulders

• Cervical spine

• MTP, talonavicular and ankle

How long does morning stiffness last for OA according to Kisner (7th edition)

<30 mins

True or False:
OA and RA can have systemic s/sx

False:

Only RA has systemic s/sx

Review Criteria for classification of RA

Review Criteria for classification of RA (PPT)

RA is characterized by symmetric, erosive synovitis with periods of ________ and _________

exacerbation (flare) and remission

True or False:

In RA, joints are characteristically involved with early inflammatory changes in the synovial membrane, central portions of the articular cartilage, and subchondral marrow spaces.

False:

peripheral portions of the articular cartilage

True or False:

With progression of the RA, cancellous bone becomes exposed. Fibrosis, ossific ankylosis, or subluxation may eventually cause deformity and disability

True

When using joint mob for treating RA, which grades are used to inhibit pain and minimize fluid stasis?

Grades 1 and 2

Management Guidelines for RA (Active disease period)

Principles of joint protection and energy conservation

True or False:

With degeneration dt OA, there may be capsular tightness as a result of bone remodeling and capsule distention, leading to hypermobility or instability in some ranges of joint motion.

False

capsular laxity

These nodes are common OA, develops in the DIP joints

Herberden’s Nodes

Which nodes develop in the PIP jts. during OA

Bouchard’s Nodes

True or False:

In the late stages of OA pain usually occurs because of excessive activity and stress on the involved joint and is relieved with rest.

False:

Early stages

Management Guidelines for OA:

In OA, pain that cannot be managed with activity modification and analgesics is usually an indication for _____________

surgical intervention

True or False:

Nontraditional forms of exercise, such as tai chi, have been found to be effective for improving balance in patients with OA.1

True

True or False:
When prescribing aerobic conditioning to an OA patient, jogging is a good exercise to prescribe.

False:

Avoid activities that cause repetitive intensive loading of the joints, such as jogging and jumping.

Individuals with ____ process nociceptive signals differently while individuals with _____ have localized changes in the muscle

Individuals with Fibromyalgia process nociceptive signals differently while individuals with Myofascial pain syndrome have localized changes in the muscle

True or False

Fibromyalgia is a chronic condition characterized by widespread pain that affects multiple body regions plus the axial skeleton and that has lasted for more than 5 months.

False:

More than 3 months.

How many tender points at specific sites throughout the body does patients with FM have?

11 of 18 tender points

True or False:

Some symptoms that FM has in common with MPS are nonrestorative sleep, morning stiffness and fatigue with subsequent diminished exercise tolerance.

False:

These symptoms are only found in patients with FM

Similarities and differences of FM and MPS

Prevalence of FM:

• Which gender (biological) is more affected?

• Which gender (biological) reports longer durations of symptoms?

• At what age can you get FM?

• Does the prevalence increase or decrease with age?

• Which gender (biological) reports more pain intensity?

Prevalence of FM:

• Female

• Male

• Any age but usually appear during early to middle adulthood. (usually 18)

• Yes

• Female

True or False:
For many of those diagnosed with FM, the symptoms develop after physical trauma such as a motor vehicle accident or a viral infection.

True

In FM, Pain is usually described as ________ in origin

Muscular

In, FM, predominantly reported in which areas?

scapula, head, neck, chest, and low back

True or False:

In FM, there is a significant fluctuation in symptoms. Some days an individual may be pain free, whereas other days the pain is markedly increased.

True

Individuals with FM have a higher incidence of:

• tendonitis

• headaches

• irritable bowel

• temporal mandibular joint dysfunction,

• restless leg syndrome

• mitral valve prolapse

• anxiety

• depression

• memory problems.

Factors that affect the severity of FM symptoms:

• Environmental stresses

• Physical stresses

• Emotional stresses

When managing FM, which type of exercises can reduce the common symptoms of FM

Aerobic exercise

Additional interventions for FM include:

• Prescription medication

• Over-the-counter medication

• Instruction in pacing activities, in an attempt to avoid fluctuations in symptoms

• Cognitive behaviour therapy

• Avoidance of stress factors

• Decreasing alcohol and caffeine consumption

• Diet modification

• Manual therapy

a hyperirritable area in a tight band of muscle.

trigger point

The pain from trigger points is described as?

dull, aching, and deep.

The trigger points may be ______ (producing a classic pain pattern) or _____ (asymptomatic unless palpated)

The trigger points may be active (producing a classic pain pattern) or latent (asymptomatic unless palpated)

This is defined as a chronic, regional pain syndrome with the hallmark classification being trigger points in a muscle that have a specific referred pattern of pain, along with sensory, motor, and autonomic symptoms.

Myofascial Pain Syndrome

Additional impairments of MPS:

• Decreased ROM (when muscle is stretched)

• Decreased muscle strength

• Increased pain when stretching muscles

Treatment of MPS consists of 3 components

• Correct chronic overload

• Eliminate the trigger point

  • Contract-relax-passive & Contract-relax-active stretching

  • Trigger point release

  • Spray and stretch

  • Dry needling or injection

  • Modalities

• Strengthen muscle

Disease of bone that leads to decreased mineral content and weakening of the bone. This weakening may lead to fractures.

Osteoporosis

Women more affected than men

The diagnosis of osteoporosis is determined by the T-score of a bone mineral density (BMD) scan.

• Normal: __________

• Osteopenia: __________

• Osteoporosis: __________

The diagnosis of osteoporosis is determined by the T-score of a bone mineral density (BMD) scan.

• Normal: –1.0 or higher

• Osteopenia: –1.0 to –2.4

• Osteoporosis: –2.5 or less

Cells in bone called _______ resorb bone, especially if calcium is needed for particular body functions and not enough is obtained in the diet

osteoclasts

The cycle of osteoclastic and osteoblastic activity are balanced until when?

Third decade of life

With increasing age, there is a shift to greater resorption

For women, resorption is accelerated during _______ owing to the decrease in estrogen.

menopause

Recommendations for Exercise for osteoporosis:

Aerobic

• Frequency?

• Intensity?

• 5 or more days per week

• 30 mins mod intensity or 20 mins vigorous intensity

  • 3 short bouts of 10 mins per day is acceptable

Recommendations for Exercise for osteoporosis:

Resistance

• Frequency?

• Intensity?

• 2-3 days per week with rest days in between

• 8-12 RM

True or False:

When prescribing exercise to osteoporotic patients, flexion activities and exercise, such as supine curl-ups and sit-ups, as well as the use of sitting abdominal machines, should be avoided.

True

Stress into spinal flexion increases the risk of a vertebral compression fracture.

types of fractures:

A Twisting (torsional) causes what type of fracture

Spiral

Pathological fracture are caused by whatt forces

Normal force on abnormal bone

A Crushing (compression) force causes what fracture

Compression fracture; Torus (buckle) fracture in children

A Transverse or oblique fracture; Greenstick fracture in children is caused by what type of force

Bending (angulatory)

An avulsion fracture is caused by what type of force

Straight pulling (traction)

A fatigue fracture or stress fracture is caused by?

Repetitive microtrauma

How to name a fracture:

3 stages of bone healing:

• Phase where there is hematoma formation and cellular proliferation

• phase in which there is callous formation uniting the breach and ossification

• phase in which there is consolidation and __________ of the bone

• Inflammatory Phase

• Reparative phase

• Remodeling Phase

When the fracture site is firm enough that it no longer moves, it is _______ united

Clinically

True or False:

During the stage of clinical union on radiographic examination, the fracture line is no longer apparent

False:

the fracture line is still apparent, but there is evidence of bone in the callus

The bone is considered _________ healed, or consolidated, when the temporary callus has been replaced by mature lamellar bone

radiographically healed

children heal within?

adolescents within?

and adults within?

children heal within 4 to 6 weeks

adolescents within 6 to 8 weeks,

and adults within 10 to 18 weeks.

Which type of bone is more susceptible to compression forces, resulting in crush or compression fractures?

Cancellous bone

Complications of Fractures:

• Swelling contained within a compartment

• Fat embolism

• Skin ulceration, nerve injury, or vascular compromise

• Problems with fixation devices

• Infection

• Refracture

• Delayed union

Management Guidelines for Postfracture / Period of immobilization

When applying joint mob exercises post immobilization, which grades are used initially?

grades 1 and 2

What type of stretching is used for postfracture postimmobilization patients

PNF stretching

For how many weeks following immobilization are light isometrics used for treating the weak muscles?

2 to 3 weeks

Management Guidelines for Postfracture / Postimmobilization