Osteoarthritis and Rheumatoid Arthritis

Question	Answer
Osteoarthritis primary effects weight bearing joints and the most commonly effected sites include?	Cervical spine (C5-C6), lumbar spine, hips, knees
Osteoarthritis is a degeneration of what type of cartilage?1)hyaline cartilage (articular cartilage) 2) elastic cartilage 3) fibrocartilage	articular cartilage
After the articular cartilage is degenerated is osteoarthritis, what type of bone is thickened? 1)trabecular bone 2) spongy bone 3)subchondral bone	subchondral bone
Osteoarthritis is diagnosed at what age in what population	After age 40, men more than women
What are the risk factors of osteoarthritis?	Trauma, repetitive micro trauma, obesity
What is the step by step pathogenesis of osteoarthritis?	1)cartilage becomes soft and damaged 2)osteophytes form 3)subchondral bone thickens 4) synovitis is mild to moderate
What types of things would increase the pain in osteoarthritis?	Increased pain after exercise, increased pain with weather changes
How long would joint stiffness last in osteoarthritis?	Less than 15 minutes
What clinical findings with the joints would you find with osteoarthritis?	Pain present at the affected joint, localized to a few joints, joints enlarged,joint motion limited, joint crepitus, joint stiffness < 15 minutes, Bouchard’s nodes, Heberden’s nodes
What type of onset is found in osteoarthritis?	Gradual onset
What types of modalities can you use with patients with osteoarthritis?	Cold,heat,US, hydrotherapy,paraffin,TENS,NSAIDs
How can you reduce the wb on the effected joints effected by OA?	Patient education on energy conservation, body mechanics, joint protection techniques, Rest, splinting, assistive devices, weight loss
What types of exercises would you do for patients with osteoarthritis?	Isometric followed by gradual progression to isotonic exercise
Where do you find Heberden’s nodes and Bouchard’s nodes; in RA or OA?	OA
What is a hard or bony swelling that can develop in the DIP?	Herberden’s nodes
What is a hard or bony swelling that can develop in the PIP?	Bouchard’s nodes
Will orthopedic surgical intervention be effective in OA or RA?	OA because RA is more of a systemic disease
In what joints does RA start?	Onset may occur first at any joint but it is common to find it in the small joints of the hand,foot,wrist and ankle
What is rheumatoid arthritis and how common is it?	Systemic autoimmune disorder of unknown etiology that involves periods of exacerbation and remission; 1-2% of the American population
Which of the following structures in RA has a chronic inflammatory reaction?A) Articular cartilage B) synovial tissues C) capsule D)subchondral	B) synovial tissues
Who is more affected by RA and at what age does it start?	Women affected 3 times more than men, most common age of onset is between 30-50 years of age
What is the pathogenesis of RA?	1)thickening of synovial membrane in affected joints 2) colonization of lymphocytes which synthesize the rheumatoid factor 3) subsequent erosion of cartilage and supporting structures
How long does morning stiffness last in joints effected by RA?	Greater than one hour
What clinical presentation will you find with joints effected by RA?	Symmetrical polyarthritis, Pain and tenderness of affected joints, morning stiffness > 1 hour, warm joints, redness at joints
What type of onset typically presents with RA?	Onset may be gradual or immediate
What particular deformity of the joints occurs in joints affected by RA?	Boutonniere deformity-DIP extension, PIP flexion, Swan neck deformity-DIF flexion, PIP hyperextension
What is a Boutonniere deformity?	DIP extension, PIP flexion
What is a Swan neck deformity?	DIP flexion, PIP hyperextension
What are the systemic characteristics associated with RA?	Decrease in appetite, malaise and increased fatigue
What types of modalities can be used on joints with RA?	Hydrotherapy, hot pack, paraffin, cold; AVOID deep heat
What type of therapy should be used with the acute stage of RA?A) Active ROM B) isometrics C) passive ROM D) joint mobilizations	passive ROM
What type of therapy should be used in the subacute stage of RA?A)Active ROM B) isometrics C) passive ROM D) joint mobilizations	Active ROM
In OA or RA is complete bed rest or regular rest periods indicated?	RA
In OA or RA should splinting and use of assistive devices be used?	Both OA and RA
What should the patient education be focused on in OA and RA patients?	Patient education on disease process, energy conservation,body mechanics, joint protection techniques
What is rheumatism?	Non specific term for medical problems effecting the joints and connective tissues
What are some conditions that present with rheumatism?	OA, RA,JRA, gout, systemic lupus erythematosus, ankylosisng spondylitis
What is rheumatism characterized by?	Inflammation, degeneration or metabolic derangement of the connective tissue, soreness, joint pain, stiffness of muscles
What does the PT exam consist of for a patient who has rheumatism?	Measurement of independence with functional activities, measurement of joint inflammation, measurement of joint ROM, determination of limiting factors including pain, weakness, and fatigue
What should you measure in the joints in a person with rheumatism?	Joint ROM and joint inflammation
What are the short term goals in a patient with rheumatism in the acute stage?	Alleviate pain,Decrease inflammation maintain strength and endurance to activity
What can you provide to help the patient with rheumatism in the acute stage to be safe with motion?	Provide splinting and/or assistive devices to increase safety
What would you want the patient with rheumatism be independent with as a long term goal?	Proper body mechanics, reduction of biomechanical stressors, exercise program
What things do you want your patient with rheumatism to maximize as part of their long term goal?	Functional mobility, endurance to tolerate ADL

Sensory testing

Question	Answer
Light touch	cotton ball; light pressure with finger
Deep pain	squeeze forearm or calf
Superficial pain	pen cap, paper clip end, pin
Vibration	tuning fork
Proprioception	i.d. static position of an extremity/part
Kinesthesia	i.d. direction & extent of movement of joint or body part
Temperature	hot & cold test tubes
Stereognosis	i.d. object without sight
Graphesthesia	draw number or letter on the skin with your finger, then i.e. without sight
2-point discrimination	2-point caliper on skin; i.d. 1 or 2 points without sight

Differential diagnosis- Hematological and Endocrine disorders

Question	Answer
Define Hemochromatosis	An autosomal recessive hereditary disorder characterized by excessive iron absorption by small intestine
Define Anemia	An abnormality of quality or quantity of blood
Define Sickle-cell Disease	Refers to a group of inherited, autosomal recessive disorders in which RBCs are crescent/sickle shaped instead of biconcave
Define Hemophilia	A bleeding disorder inherited as sex-linked autosomal recessive trait, abnormality of plasma clotting proteins
Define Thrombocytopenia	An increase in number of circulating platelets, caused by inadequate platelet production from bone marrow & spleen
An increase in INTRAvascular fluid will lead to...	CHF, increased pulse, & increased respiration
A decrease in INTRAvascular fluid will lead to...	Decreased BP, increased pulse & increased respiration
An increase in EXTRAvascular fluid will lead to...	Edema, Ascites, Pleural Effusion
A decrease in EXTRAvascular fluid will lead to...	Decreased skin turgor & fatigue
Define Upper Urinary Tract Infection	An infection of the urinary tract located at kidney & ureters
Define Lower Urinary Tract	An infection of urinary tract located at bladder & urethra
Define Functional Incontinence	Person has normal urine control but is unwilling or has difficulty reaching toilet in time bc of muscle/joint dysfuntion or environmental barriers
Define Stress Incontinence	Loss of urine due to activities that increase intraabdominal pressure such as coughing, lifting, or laughing
Define Urge Incontinence	The sudden unexpected urge to urinate & the uncontrolled loss of urine; often related to reduced bladder capacity, detrusor instability, or hypersensitive bladder
Define Overflow Incontinence	The constant leaking of urine from a bladder that is full but unable to empty
List Reasons for Overflow Incontinence	Anatomic obstruction (ie-prostate enlargement) Neurogenic bladder (ie-SCI)
Define Interstitial Cystitis	Complex, chronic disorder characterized by inflamed or irritated bladder wall
Define Pyelonephritis	an infectious, inflammatory disease involving the kidney parenchyma and renal pelvis
Define Dialysis Dysequilibrium	Result of drastic changes at beginning of dialysis; S&S include nausea, vomiting, drowsiness, HA, & seizures
Define Dialysis Dementia	Result of chronic tx; S&S include cerebral dysfunction, speech difficulties, mental confusion, seizures & occasionally death
PT Role in Management of pt receiving Dialysis...	Record vitals while pt exercising Do NOT take BP at shunt site Avoid trauma to peritoneal catheters
Define Type I Diabetes	Decrease in size & number of Islet cells of pancreas resulting in inadequate production of insulin
Define Type II Diabetes	Characterized by a gradual increase in peripheral insulin resistance with an insulin-secretory defect that varies in severity
In which type of Diabetes are pts considered Insulin Dependent?	Type I Diabetes
Which type of Diabetes are pt's at risk for if they are obese adults?	Type II Diabetes
Signs of Hyperglycemia	CNS changes: irritability, HA, blurred vision, slurred speech, difficulty concentrating, confusion, incoordination Sympathetic: diaphoresis, pallor, piloerection, tachycardia, shakiness, hunger
List Classic Signs & Symptoms of DM	Hyperglycemia, Glycosuria, Polyuria, Polydipsia, Polyphagia & wt loss, fatigue
Clinical signs & symptoms of Hyperglycemia	CNS changes; confusion, diminished reflexes, paresthia,Fruity odor to breath, weakness, complaint of thirst, rapid weak pulse, rapid deep inspirations
What is the leading cause of blindness in ages 20-74?	Diabetes
What is the leading cause of non-traumatic LE amputation and End-stage Renal disease?	Diabetes
A pt with DM should NOT exercise when...	Blood glucose levels are high (at or near 250mg/dL) OR Urine test is positive for ketones
What is considered the most common pathological hormone deficiency?	Hypothyroidism
Define Cretinism	Congenital Hypothyroidism
Symptoms of Hyperthyroidism	Nervousness, Hyperreflexia, wt loss, hunger, heat intolerance, palpitations, bounding pulse, tachycardia, diarrhea, increase metabolic processes, possible exercise intolerance
Symptoms of Hypothyroidism	Wt gain, increased appetite, lethargy & fatigue, Low BP, cold intolerance, dry skin & hair, goiter, possible exercise intolerance/exercise induced myalgia, reduced CO
Define Acromegaly	Result of increased & unregulated growth hormone (GH) production, usually cause by GH-secreting pituitary tumor
Signs & Symptoms of Acromegaly	Acral growth;enlargement of facial bone structure, enlarged hands & feet; visceral outgrowth macroglossia, enlarged heart mm, thyroid, liver, kidney; insulin antagonism, nitrogen retention, increased risk colon polyps/tumor
Adrenal Hypofunction is also referred to as...	Addson's Disease
Excessive production of Androgens is also known as...	Adrenal Virilism
Excessive secretion of Glucocorticosteroids is also known as...	Cushing's Syndrome
Excessive Aldosterone production is known as...	Hyperaldosteronism
Define Adrenal Crisis	Medical Emergency: characterized by profound asthenia, severe pains in abdomen, lower back, legs, peripheral vascular compromise & eventual renal shutdown
Signs & Symptoms of Adrenal Virilism	Hirsutism, baldness, acne, deepening of voice, amenorrhea, atrophy of uterus, clitoral hypertrophy, decreased breast size increased muscularity (occurs in men & women)
Signs & Symptoms of Cushing's Syndrome	"moon face" & "buffalo hump", muscle wasting & weakness, truncal obesity, HTN, thin/atrophic skin with poor wound healing, osteoporosis, glucose intolerance, psychiatric disturbances
List common clinical causes for fluid & electrolyte imbalances	Burns, surgery, DM, malignancy, acute alcoholism, socioeconomic status, dehydration, edema, fatigue, BP changes, CHF
PT role in Complex Disorders (CRPS, Fibromyalgia etc.)	Increase function, improve sleep thru relaxation techniques, energy conservation, ergonomic education, decrease pain & fatigue, soft-tissue & joints mobs, carefully controlled, graded exercises, lifestyle modifications esp to reduce stress

Spine- Anatomy

Question	Answer
What are joints of the vertebral bodies/ discs called?	intervertebral jts
Joints of the vertebral processes are called?	facet jts
Intervertebral discs are found between what levels of the spine?	C2-S1
Fibrocartilage seperated from body of vertebrae by hyaline cartilage describes what structure?	cartilaginous end plate
Secondary cartilage means?	remains cartilagenous in adulthood
No blood supply and no innervation describe what part of the IV disc?	nucleus pulposus
This part of the IV disc attaches to cartilaginous endplates and outer 1/3 has blood supply and innervation.	annulus fibrosis
Facet joints are ____ synovial joints	plane
What are the 3 components of a synovial joint?	joint capsule, synovial membrane, and articular cartilage.
Where is the atlanto-occipital joint located?	between the atlas and occiput
What type of jt is the A-O jt?	synovial condyloid joint
What mvmt does the A-O jt allow for?	head nodding
Where is the atlanto-axial jt located?	between atlas and axis
The A-A has ___ median and ___ lateral joint.	1 median, 2 lateral
What cervicle jt allows for 55-58% of head rotation?	atlanto-axial jt
This atlanto axial jt is a synovial pivot jt.	median jt
This atlanto axial jt is a synovial plane jt.	lateral jts
The medial atlanto-axial jt is made up of what vertebral structures?	anterior arch of atlas C1 and dens of C2
What vertebral structures make up the lateral jt of the A-A jt?	lateral masses of C1 and superior facet of C2
This lig runs from the atlas' ant tubercle to the sacrum	anterior longitudinal ligament (ALL)
The ALL attaches to the ____ surface of the vertebral ___ and ___.	anterior, bodies and discs
What mvmt is the ALL designed to limit	excessive extension
Which is stronger the AlL or the PLL and by how much?	the ALL is 2x stronger
This ligament is continuos superiorly as the anterior atlanto-occipital membrane.	ALL
The A-O membrane attaches to what?	anterior arch of atlas, and anterior margin of foramen magnum
This ligament attaches to the posterior vertebral bodies from C2-S1.	posterior ongitudinal ligament (PLL)
This ligament continues superiorly as the tectorial membrane.	PLL
Which ligament ALL or PLL is designed to resist flexion?	PLL
The tectorial membrane attaches to what?	posterior surface of dens, and anterior edge of foramen magnum
What are the ligaments of the vertebral arches (5)?	ligamentum flavum, supraspinous ligament, ligamentum nuchae, interspinous ligament, and intertransverse ligaments
This ligament connects to lamina from C2-C5, is 80% elastin and 20% collagen.	ligamentum flavum
What gives the ligamentum flavum its yellow color?	the 80% elastin component
The yellow ligament countiues superiorly as what?	the posterior O-A membrane and the posterior A-A membrane.
The posterior A-O membrane attaches to what?	the posterior arch of the atlas and posterior margin of foramen magnum.
This ligament connects to the tips of SPs C7 to approx L3/4 and is well developed in the lumbar spine.	Supraspinous Lig
The supraspinous lig countinues superiorly as the ___ ____.	ligamentum nuchae
This lig offers little resistance fo seperation of SPs, however there is little consensus on this information.	supraspinous ligament
This lig extends from C7 to external occipital protuberance and its exact role is not yet determined. Thought to be involved with A/P stability.	ligamentum nuchae
This ligament connects the vertebral spines and offers litle resistance to fexion.	interspinous ligaments
This ligament connects to the TPs, is well developed in the lumbar spine, seperates ant and post mm of spine, and ability to limit lateral flexion is thought but questionable.	intertransverse ligaments
Where are the jt capsules strongest in the spine?	at the transition regions of the spine
What lig is found at the A-A median jt?	Cruciform (cruciate) ligament, transverse and longitudinal.
The transverse component of the cruciform lig goes around the ____.	dens
The longitudinal bands of the cruciform lig attach to.	foramen magnum and the axis
This component of the cruciform lig prevents anterior displacement of C1 and C2.	transverse lig
What two populations have to be considered when treating area of upper spine?	Downs syndrom and RA.
Loss of integrity of this lig in an absolute referal with not treatment in cervical spine.	transverse lig
Which would be damaged first if there were an injury at C1 C2 juncion, the dens or the trans lig?	the dens
The alar ligaments attach where?	the dens to the medial surface of occipital condyles.
Alar lig limits A-A ____.	rotation
What structures in the vertebral column limit ROM and need to be considered when assessing motion?	IV discs, shape/orientation of jt, capsule, and ligaments.