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RA
chronic and progressive inflammatory systemic disease affecting connective tissue
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what 4 criteria has to be present for 6 wks?
- 1.morning sitffness > 1hr
- 2. arthritis of 3 or more joints (at the same time) soft tissue swelling
- 3. Arthritis of the hands in at least 1 area
- 4. symmetric arthritis
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3 other criteria for RA
- Rheumatod nodules over boney prominences
- serum rheumatoid factor
- radiological changes
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4 different prognostic groupings of RA
- 1/3 pts have 1 acute attack, then get better in a few wks
- 2-3 bad yrs, develop residual joint changes, then into remission
- most common cripples-onset of months or years with progressive deterioration of articular cartilage
- manifested primarily by extra-articular symptoms. Typically a shorter life span d/t systemic failure
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Possible causes of RA
- infection
- auto immune disorder
- hereditary component
- endocrine disorder
- psychological factors
- dietary considerations
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Pathology of RA
- chronic inflammation of synovial membrane-abnormal cellular products
- fluid pressure phenomena
- tendon sheaths show inflammatory changes
- slender projections into joint causing pain
- develop adhesions
- instability
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RA treatment during acute
- rest
- resting splints to help prevent deformity
- medication to control pain and decrease synovial irritation
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RA Tx Active Inflam
- Pt ed
- minimize joint stiffness & maintain ROM
- -gentle P/AROM
- minimize muscle atrophy
- -gentle pain free isometrics
- prevent joint deformity
- -biomechanical rest
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Tx Contras and Pres for Active Inflam of RA
- Do not stretch swollen joints or apply heavy resistance exercise that causes joint stress
- Precaustions-respect fatigue and increased pain, do not overstress osteoporotic bone or lax ligament
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Tx sub acute-chronic RA
- Maintance of ROM
- pool therapy
- heat (moist)
- isometrics
- corrective splinting
- joint protection
- AD
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Acute Hematogeneous Osteomyelitis
- rapid developing blood-borne bacterial infection of bone and marrow in children
- one of the most serious inflammatory disorders of the musculoskeletal systme
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Acute Hematogeneous Osteomyelitis
Incidence
- Bone disease of growing bones
- boys 3x more likely
- LE more commonly affected
- occurs frequently of metaphyseal regions of long bones
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Acute Hematogeneous Osteomyelitis
Etiology
- staphylococcus aureus most common
- portal of entry is through skin
- 2nd to infected wounds
- (celllulitis)
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OA
- progressive destruction of articular cartilage
- Non inflammatory
- non systemic
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Types of OA
- primary-cause unknown
- secondary-trauma, congential, or other musculoskeletal disease
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OA Etiology
- obesity
- smoking
- deviated arthorkinematics
- immoblization
- trauma
- microtrauma
- excessive work outs
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Chondromalacia
- disease process where articular cartilage becomes yellow, opaque and softens
- typically wiht the patella
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OA vs. RA
- OA is articular cartilage, RA is synovium
- OA not inflammatory
- RA systemic
- OA initially proteoglycan and collagen synthesis-RA later
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OA Signs & Symptoms
- Pain w activity (no/decreased pain at rest)
- some joint swelling
- loss of ROM-painful,dont use, weak, adaptive shortening
- bone deformity
- joint popping
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OA pain caused by
- incongruent joint surfaces
- abnormal pressure
- trabecular micro fx
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arthrodesis
surgical procedure too fuse a joint
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Rehab managment OA
- pt education
- -deforming forces and prevention HEP
- decrease effects of stiffness-AROM
- decrease pain
- -splinting, ADs
- improve conditioning
- improve balance
- increase ROM-stretching
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Precautions w OA
- Increased pain w resistive exercises
- -too much WB or load on joint
- wrong ROM
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Cardiac Output
- stroke volume -amount of blood ejected each contrtaction
- X HR
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Hip Fx Classified by
- Location
- extra capsular or intertrochanteric
- femoral neck or subcapital
- proximal femoral shaft or subtrochanteric
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Complications with Fx
- AVN
- DVT 40-90%
- 3 main complications
- -malunion, delayed union, non union
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