Joint Disorders

  1. General Arthritis Info
    • 101 different kinds, akll involve joint inflammation as dominant problem
    • affects 37 million americans
    • most are chronic need to be managed oer the pt lifetime
    • includes rheumatoid, juvenile RA,
  2. Joint Changes With Arthritis
    • Joint capsule: stretches out due to inflammtion allows movement between bones
    • Synovium: produces too muc fluid, lining becomes thick
    • Joint Space: enlarges due to excess fluid
    • Cartilage: eaten away by inflammatory process, rough, brokes pieces: decrease ROM, increase pain
    • Bones: inflammation stretches supporting ligaments, bones shift resulting in poor alignment absent cartilage in bone on bone grinding osteophytes form
  3. Osteoarthritis
    • decrease cartilage: erroded from excess mechanical stress
    • Eventullay expossi subchondral bone
    • Cysts and osteophytes for, break off into synovial cavity and cuase further irritation
    • Synovial & casular thickening, joint effusion
  4. OA / DJD Pathology & Etiology
    • Patho: part of normal aging process but influenced by lifestyle work demands
    • Wear and tear over time
    • Most common type affects 7% of population
    • Etiology: unknow related to cumulative trauma over time
    • Congenital deformity or injury predisposis pt to DJD
    • Genetic
  5. DJD Onset and S&S
    • Onset: after 50
    • S&S: pain localized to few WB joints ( hips, knees, spine)
    • Pain wiht exercise - decreases with rest
    • Stiffness with inactivity
    • Joint enlargement, heberdens nodes
    • As disease progresses symptoms increase
  6. DJD Treatment
    • Medical: medication - aspirin, analgesics for pain Corticosteroid injections into joint
    • Surgery: debridement of bony spurs, fusion, arthroplasty
  7. DJD Therapeutic Exercise
    • Rest of involved joints
    • Wt Reduction if obese
    • Isometrics, limited isotonic
    • need to watch joint mechanic very carefully
  8. RA general info
    • Ch;ronic progressive nonspecific inflammation of peripheral joints
    • In response granulation tissue, forms results in destruction of articular surfaces adhesion form and decreased ROM results
    • A systemic disease also affect lungs heart blood vessesl eyes and skin
    • Characterized by EXACERBATIONS and REMISSIONS
  9. RA Etiology
    • Autoimmure
    • Infection
    • Genetic
    • Stress
  10. Onset of RA
    • Ages 25-50
    • 75% insidious 25% acute
    • Diagnosed when pt has joint pain for 6 months
    • 3:1 female to male ratio
    • Approximately 1% of population
  11. RA Symptoms
    • Swollen, painful joints, Bilateral distal involement
    • Order of involvement of joints: hands, wrists, knees, elbows, shoulder, hips
    • Stiffness in Am or after prolonged position
    • Early afternoon fatigues and malaise
    • decreased ROM of joints
    • Anemci undernourished chronically ill
  12. RA deformaties
    • After Inflammation recedes, stretche out damaged join settels into wrong positon
    • Ulnar Deviation
    • Swan Neck Deformity: PIP hyperextension DIP flexion
    • Boutonier Deformity: PIP flextion DIP hyperextention
    • Frozen shoulder
    • Hypermobility
  13. RA treatment
    • Early Treatment/ management - better outcome
    • Need team approach: MD, RN, PT/OT, SW
    • Consdierations: 75% improce wtih conervative mgmt, 10% eventually fully disable
    • Functional problems due to joint damge
    • Limited eneryg will need to learn about energy conservations
    • Side effects of medications
  14. RA medications
    • Asprin NSAID
    • Steroids
    • Gold compounds
    • Tetracycline (antibiotic)
    • Immunosuppressive meds
    • No one drug helps all
  15. RA Medical Managment
    • Lifestyle Changes: rest for acute phase, balance of rest and exercise for rest of life
    • Therapy: pain control, supportice and assistive devices, joint protection, energy conservation, ROM (gentle, within limits of pain)
  16. RA Therapy Goals druing Exacerbation
    • Decrease inflammation and pain
    • Minimize joint stiffness, maintain ROM
    • Minimize muscle atrophy
    • Joint protection
    • Prevent Deformities - protect joint structures
  17. RA therapy goals during Remission
    • Maintain ROM, strenth
    • Non-impact low impact conditioning exercise
    • Pt education, family training, provide resources such as Arthritis foundation
  18. Juvenile RA
    • Systemic like RA
    • Females more than males
    • Early onset, more acute
    • Symptoms: affects large joints, systemic effect more severe, can interfere with growth and development
    • not as severe and slower progressing
  19. Juvenile RA Treatment
    • Medicine: aspirin, NSAID
    • Avoid steroids unless severe
    • More meds needed during growth spurts
    • Therapy PROM, AROMS aquatic therapy
    • Splintin
    • need to monitor, educate parents
  20. Ankylosing Spondylitis
    • Inflammatory disease of the spine
    • Bony growth into tissue space - vertebral fusion - no pain
    • deformity if poor positioning while ankylosing process proceeds
    • Onset 1% of population 3:1 male to female
    • late teens early 20's
    • Course: exacerbations and remissions
  21. Ankylosing Spondylitis Symptoms
    • unknown cause
    • Symptoms: fever, fatigue, wt loss, anorexia, anemia, X-ray shows si joint fusion, pain in low back prios to fusion, neck 75% LS spine 50%, Si joint 100%, hips30%, shoulders 30%
  22. Ankylosing Spondylitis Treatment
    Meds, proper posture during fusin process, exercise to help strenthen extensors
  23. Septic Arthritis
    • Patho: hx of minor trauma, blood borne bacteria
    • Etiology: staphyloccus aureus
    • Symptoms: Edema, purulent exudate, pain, redness
    • Treatment: aggressive antibiotics
  24. Gout
    • Patho: Deposits of uric acit crystals in jt. trigger inflammtion
    • Etiology: decreased renal excertion or uic acid or metabolic prob.
    • S&S: red swollen big toe MP joint
    • Pain during gait
  25. Gout Treatment
    • Decrease serum uric acid levels
    • Meds and diet
    • NSAIDs
    • therapy: teach gain with assistive divice
  26. Bursitis/Tendinitis
    • Def: inflammtion of tendon/ bursa, tennis elbow, dequervain syndrome
    • Etiology: trauma, overuse/ disuse, aging
    • S&S: pain, tenderness, decrease strength, decrease ROM
  27. Bursitis/ Tendinitis Treatment
    • Pain management
    • Gradual ROM, strengthening
    • Joing portection
    • Work site assmt
    • posure and body mech.
    • Prevention
Card Set
Joint Disorders