Orthopedics

Unit Overview

  • This unit covers various orthopedic conditions and their impact on occupation and rehabilitation.

  • Key topics include:

    • Pathophysiology and etiology of arthritis and other conditions

    • Medical, pharmacological, and brief therapeutic interventions

    • Safety indications, precautions, and contraindications

    • Occupational impact of orthopedic conditions including:

    • Arthritis

      • Osteoarthritis (OA)

      • Rheumatoid Arthritis (RA)

    • Joint Replacements

      • Total Hip Arthroplasty (THA)

      • Total Knee Arthroplasty (TKA)

      • Total Shoulder Arthroplasty (TSA)

    • Other Conditions

      • Degenerative Disc Disease

      • Osteoporosis and Osteopenia

Guiding Questions

  • Which joints are commonly affected by OA and RA?

  • What is the Occupational Therapist's (OT) role in working with people who have OA?

  • What can OTs do to address the needs of people who have RA?

Pathophysiology and Etiology

  • Arthritis encompasses various arthritic conditions, primarily OA and RA.

  • OA and RA can occur at any age, but OTs predominantly work with older adults.

  • Arthritis causes significant disability, affecting over 58 million Americans.

  • Understanding these conditions is crucial for managing symptoms and promoting engagement in occupations.

Osteoarthritis (OA)

  • Most prevalent type of arthritis in the US, affecting approximately 30 million adults.

  • Affects cartilage between bones, resulting in:

    • Pain

    • Stiffness

    • Swelling

  • Commonly affected weightbearing joints include:

    • Hands

    • Hips

    • Knees

  • Increasing prevalence of OA in the spine.

  • Risk factors:

    • Joint injury/overuse

    • Being a woman

    • Overweight

    • Family history of OA

    • Aging (considered a strong risk factor)

  • Symptoms of OA:

    • Pain

    • Aching

    • Stiffness

    • Decreased joint motion

    • Swelling

Rheumatoid Arthritis (RA)

  • Most common rheumatic arthritis, affecting about 1% of the population (~1 million people in the US).

  • A systemic autoimmune disease impacting not just the joints but also:

    • Eyes

    • Skin

    • Lungs

    • Heart

    • Gastrointestinal system

    • Kidneys

    • Nervous system

  • Risk factors:

    • Older age

    • Female gender

    • Genetic predispositions

    • Smoking history

    • Obesity

  • RA typically presents symmetrically and involves:

    • Inflammation of the synovial joint

    • Ulnar drifting due to MCP subluxation

  • Symptoms include:

    • Redness and pain in multiple joints

    • Stiffness and tenderness

    • Symptoms may develop suddenly or gradually, with exacerbations and remissions.

    • Most common onset occurs between ages 25-50.

Differences Between OA and RA

  • OA:

    • Asymmetric presentation

    • Wear and tear of involved joints

    • Underlying pathology involves joint cartilage thinning and degradation.

    • Formation of bony nodules (Bouchard nodes at PIP and Heberden nodes at DIP joints).

  • RA:

    • Symmetric presentation

    • Involves multiple joints bilaterally.

    • Associated with more systemic symptoms like weight loss, fever, fatigue, and weakness.

Other Joint Conditions

  • Gout:

    • Caused by high uric acid levels, leading to crystal deposits causing inflammation.

  • Lupus:

    • Chronic autoimmune disease causing systemic inflammation.

  • Psoriatic Arthritis:

    • Linked to psoriasis; characterized by joint pain and skin rashes.

  • Juvenile Idiopathic Arthritis (JIA):

    • Most common form of arthritis in children under 16.

    • Not simply a childhood version of RA; has distinct features.

Osteoarthritis Details

  • Develops slowly, typically asymmetrically at first.

  • Symptoms worsen with inactivity (gel phenomenon).

  • Diagnosis via x-rays following a clinical exam focusing on:

    • Pain

    • Stiffness

    • Swelling

  • Interventions include:

    • Total Joint Arthroplasty (hip, knee, shoulder) for severe cases.

    • Medical focus on relieving pain, reducing edema, and preserving joint functions.

Rheumatoid Arthritis Stages

  • Acute Stage:

    • Most inflamed; limited range of motion (ROM).

  • Subacute Stage:

    • Decreased ROM, less tenderness, and inflammation.

  • Chronic-active Stage:

    • Minimal pain at rest, improved function with activity adaptations.

  • Chronic-inactive Stage:

    • Slightly limited ROM, can participate in functional tasks.

Medical Interventions for RA

  • Focus on:

    • Relief of joint stiffness and pain

    • Reduction of edema

    • Normal joint function preservation

    • Use of Disease Modifying Antirheumatic Drugs (DMARDs) like methotrexate.

  • Safety precautions include avoiding activities that exacerbate joint issues.

Total Hip Arthroplasty (THA)

  • Procedure involves:

    • Removal of damaged bone/cartilage.

    • Replacement with prosthetic components, cemented or press fit.

    • Involves metal or ceramic ball and socket replacements.

  • Precautions post-THA:

    • Avoid hip flexion beyond 90 degrees.

    • Avoid hip adduction and rotation of the operated leg.

    • Follow physician recommendations for activity.

Role of OT After THA

  • Assist with:

    • Return to meaningful roles post-surgery.

    • Equipment recommendations.

    • Educational training on functional tasks.

Total Knee Arthroplasty (TKA)

  • Focus on relieving knee joint pain.

  • Clients often allowed weight bearing as tolerated post-surgery.

  • OT's role similar to THA, emphasizing functional role return and adaptations.

Total Shoulder Arthroplasty (TSA)

  • Aims include:

    • Pain relief

    • Restoring motion and function.

  • Post-surgery implications on daily activities addressed during OT sessions.

Degenerative Disc Disease

  • Often causes radiating pain due to disc deterioration in the neck or lower back.

  • Treated conservatively or through surgical interventions such as spinal fusion.

Typical Precautions Post-Spinal Surgery

  • No bending

  • No twisting

  • No lifting over 5-10 lbs.

Case Study Example

  • Case: Miguel DeSantos, 65, diagnosed with OA affecting his knees and shoulders.

  • Miguel experienced severe pain affecting his daily tasks and was prescribed OT after an injection for pain relief.

Osteoporosis and Osteopenia

  • Osteoporosis: Condition where bone formation lags behind bone breakdown, common in older adults.

  • Osteopenia: Reversible stage preceding osteoporosis; significant in adults over 50.

  • Sarcopenia: Age-related loss of muscle mass.