NGR6605 EXAM 2 - Musculoskeletal PPT's: Questions With In-Depth Solutions

NGR6605 EXAM 2 - Musculoskeletal PPT's:
Questions With In-Depth Solutions

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Terms in this set (110)


• Osteoarthritis
• Rheumatoid arthritis
• Juvenile RA
Conditions of Arthritis:
• Gout
• Reactive arthritis
• Ankylosing spondilitis

• Degenerative joint disease with progressive loss of
articular cartilage in moveable joints, degeneration of
cartilage, bone hypertrophy, formation of osteophytes
and subchondral cysts & subchondral sclerosis in
synovial joints and vertebrae.
• Most common form of joint disease - Affects 25% of
adult population
Osteoarthritis (OA): • Degeneration and loss of articular cartilage and
subchondral bone in joint. Smooth cartilage
softens, becomes pitted and frayed while bone ends
thicken and form spurs
• Fluid-filled cysts may form in bone near joint - These
changes create pain whenever the joint
is moved
• Disease is usually slowly progressive

• Advancing Age (usually starts between 55-65 yrs)
• Athletic or repetitive use
• Joint trauma
Risk Factors for OA:
• Metabolic disease
• Obesity
• Hereditary

, • Gradual joint pain, stiffness & enlargement
• Usually affects weight bearing joints
• Limited joint ROM, tenderness along joint line
• AM stiffness or stiffness after prolonged immobility
Presentation OA:
usually lasts less than 30 minutes
• Several joints may be affected, but usually not as many
as are affected in RA
• Course Crepitus

• Distal interphalangeal joints (DIP joints) - Heberden's
nodes
• Proximal interphalangeal joints (PIP joints) - Bouchard's
Osteoarthritis: In Hands
nodes
• Carpometacarpal joints (thumb) - Pain from gripping
and twisting Movements

• Hips:
- Affects greater trochanter
- Reduced internal rotation
- Unequal leg length (> 2 inches)
• Knees
- Pain with weight bearing activity
- Difficulty with stairs
- Difficulty standing
OA Symptoms:
- Possible mild effusion
• Cervical and lumbosacral spine - Disc degeneration
• C6-C7
• L3-S1
- Pain
- Muscle stiffness
- Crepitus
- Limited ROM

• Based on history & physical exam
• No lab tests
• Plain X-ray of weight bearing joints and spine must
indicate all 4 of the following:
OA Diagnosis:
- joint space narrowing
- Osteophytes
- Sclerosis of the subchondral bone
- Bone cysts

, • Ice for acute pain; heat for subacute pain
• Alteration of ADLs
• PT/OT- ROM
• DAILY exercise
• Pain management
OA Treatment: - Tylenol, NSAIDs
- Possible steroids
- Topical preparations
• Weight loss if obese
• Refer to orthopedic surgeon/ orthopedist if functional
Impairment

• Chronic systemic inflammatory disorder - autoimmune
• Extra-articular manifestations: rheumatoid nodules,
vasculitis, neuropathy, scleritis,
pericarditis, splenomegaly
Rheumatoid Arthritis (RA) • Inflammation of synovial membrane within joints
- Joint swelling
- Pain
• Peak onset 4th decade of life but 5% start in childhood
• Female > male (2-3:1) articular manifestations

, • Pt often appears chronically ill
• Fatigue, weakness, and anorexia
• Low-grade fever
• Stiffness in morning for more than 30 minutes, abates
throughout day
• Polyarticular onset---often symmetric
• Warmth over joint, swelling, pain, erythema, tender,
swelling
- May see nodules over bony prominences (elbow, back
of heel)
• Eventually joint deformities


Extraarticullar RA - Ocular
* may see these conditions
RA Presentation: - SICCA symptoms - dryness mucus membraines
- Episcleritis
- Scleritis
- Uveitis


Cancers and Rheumatoid Symptoms:
- Clubbing
- Pulmonary hypertrophic osteoarthrapthy
- Harbinger of deadly disease
- Lung CA and infections
- Acanthosis Palmaris - "woof hands" -
- Palmar Fascitis
- Scleroderma
- CREST Disease - myriad of symptoms
- Grottons Papules

- "woof hands"
- Seen in RA
Acanthosis Palmaris -



• ARA Criteria for Classification of RA
• For optimum outcome, any patient suspected of
RA Diagnosis: having RA should be referred to a
rheumatologist for evaluation and the development of a
collaborative management plan