Function of ____ is to protect, support, provide mechanical basis for movement, and produce blood cells
bone
-Local tissue reaction to injury
-Heat, Redness, Swelling, Pain, Loss of function
inflammation
-are important in intercellular interactions between WBCs
-are molecules that are secreted from one cell to interact with another cell at receptor sites
Cytokines
Prevalent chronic condition
Leading cause of disability
Encompasses > 100 diseases and conditions
Rheumatic Diseases
“when clinically evident…characterized by joint pain, tenderness, limitation of movement, crepitus, occasional effusion, variable degrees of inflammation without systemic effects.”
Osteoarthritis
Gradual loss of articular cartilage
thickening of subchondral bone
_________at joint margins
mild, chronic, nonspecific synovial inflammation
osteophytes
-Structural and biochemical changes of the matrix occurduring aging.
-Reduced capacity of molecules to retain water.
-Biomechanical properties altered- fissures develop
Aging cartilage
what is phase 1 of OA joints?
edema
what is phase II of OA joints?
fissuring and pitting of cartilage
what is phase III of OA joints?
fragments of cartilage detach and “fall” into the articular cartilage and uncover subchondral bone where osteophytes form.
-osteophytes proximal interphalangeal joints
-boney growth on sides
-Chronic, systemic inflammatorydisease
-Symmetric polyarticular pain, swelling,morning stiffness, malaise, and fatigue
-Etiology unknown
-Progressive joint damage resulting insignificant disability if not treated
Rheumatoid Arthritis
3-1 female to male ratio with primary onset between ages of 35 and 50.
RA
How long for stiffness to improve for RA?
greater than or equal to one hour
Arthritis of PIP, MCP, and wrist joints
Symmetry of presentation
RA
Most commonly joint affected for RA?
Wrists
Swelling, pain, and stiffness
Small joints of hands, wrists, elbows, knees, andfeet
Fatigue
Features of RA
Articular or Periarticular Structures?
synovium, synovialfluid, articular cartilage, joint capsule
Articular
Articular or Periarticular Structures?
tendon, bursa,ligament, muscle, bone, fascia,nerve, skin
Periarticular
5 signs of inflammation
Inflammation leads to increased blood flow that can be felt as HEAT.
Increased blood flow causes the skin to look RED.
The synovium produces extra fluid when inflamed which we see as SWELLING.
PAIN due to Swelling or due to joint cartilagedamage.
STIFFNESS or loss of funtion.
True or false?
Swelling may be in (articular) or around (perarticular) the joint
True
The Joint lining or the Synovial Membrane is the structure that is inflamed.
Synovitis
Increased fluid causes pressure on the surrounding joint structures which is experienced as ______. Damage is causedwhen the inflamedsynovium grows overthe cartilage
Pain
-Swelling stretches the supporting ligaments.
-Joint laxity is the result.
-Joint laxity and instability causes deformity.
Deformity
Too much joint movement
Instability
_____is secondary to joint inflammation and pain.
-happens slowly and is reversible
muscle weakness
make it more difficult to move the joint.
pain and swelling
True or false?
Joints will stiffen up and lose flexibility if they are not moved regularly through range of motion
TRUE
True or false?
It is easier to prevent stiffness than to reverse it.
True
The longer you have Rheumatoid Arthritis and the more aggressive the disease is, the more ______ ______ that will occur!
cartilage damage
If the joint is swollen, tenderness is assessed or not assessed?
NOT assessed
If the joint is swollen or tender, stress pain is assessed or not assessed.
NOT assessed
The amount of pressure applied to the joint is equal to ...
the examiner’s fingernails blanching (4 kg/cm2)
True or false?
Assess most joints in neutral position
True
How can you measure disease activity?
Total number of swollen and tender joints
How many joints are required for the disease to be considered active?
3 joints - active disease
Positions of deformity primarily refer to positions of...
flexion
ulnar deviation
poor biomechanics
Hand deformity:
bump on wrist due to raised, loose ligaments between ulna and radius
Piano key
Hand deformity:
tendons shift off of MCP joint,causing fingers to shift towards the little finger
Ulnar deviation
Managing local inflammation (at rest)
Offering joint stability
Improving function
Hand splints
Will I lose motion and muscle strength if I use a splint?
Yes, if the splint is worn all of the time.
However, functional splints are meant to make you moreactive.
