Catching up on: Arthritis: OA versus RA Fractures Tendon ...
Arthritis: OA versus RA Fractures
Tendon Injuries RSD/CRPS
Major Issues re Arthritis
Main goal is to prevent loss of ROM and avoid deforming forces and habits. Interventions aimed at this use splints, joint protection education, adaptive equipment, energy conservation education.
Critical to differentiate osteo arthritis or OA (also called degenerative arthritis and deg. Jt. Disease or DJD) from rheumatoid arthritis or RA.
OA=Joint-specific disease
RA=systemic disease
Joint "end feel" is bony Joint "end feel" is soft
Joints limited in ROM but are stiff and may be fused (ankylosed) with spurs and bony bridges across joint space.
May involve only one joint.
Joints have limited ROM but are hypermobile, may be subluxed or even dislocated; sign of RA is instability in joints.
Joints involved may go through flare ups and get worse; more joints can become involved (polyarthritis).
OA
RA
Predisposed to from Occurs in multiple joints - bilateral
previous fractures involvement although not symmetrical.
involving the
This is a systemic disease involving
articular surface autoimmunity - Starts with production of
(fracture is said to auto antibodies against normally
"cross the joint
circulating antibodies in the synovial
line") - interrupted fluid. This results in inflammatory
hyaline cartilage response in which the synovial tissue and
heals with
then other joint structures (ligaments
fibrocartilage, which and bone) responsible for joint integrity
is rough and leads and strength are damaged. Very common
to degenerative for OTs to work with individuals with
changes over time. severe involvement in MCPs, PIPs, wrists;
sometimes shoulders and elbows.
Evaluations
ROM - goniometry - but look for different effects ? RA (1) hypermobile joints early with full ROM and soft end feels and (2) later ROM limitations associated with subluxation and dislocation deformities like ulnar drift of MCPs, volar subluxation and dislocation of MCPs, boutonniere, swan neck, Types I ? IV thumb deformities; also more likely to have multiple joint involvement (polyarthritis) as this is a systemic autoimmune disease OA with ROM limitations and hard or bony end feels; more likely to have isolated joint involvement
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