Dr. Sarah Ehsan (PT)

Topics to be covered in this lecture: Arthritis–arthrosis Fibromyalgia and myofascial pain syndrome Osteoporosis Fractures–post-traumatic immobilization Indications for surgical intervention

ARTHRITIS :inflammation of a joint Rheumatoid arthritis and osteoarthritis Arthrosis : limitation of a joint without inflammation Trauma, recovering from a fracture, immobilization Due to involvement of connective tissues and muscles

Clinical Signs and Symptoms Impaired Mobility capsular pattern (characteristic pattern of limitation) Reduced joint play Firm end-feel (guarded incase of acute condition) Effusion Impaired Muscle Performance Impaired Balance (reduced sensory input from mechanoreceptors and muscle spindles) Activity Limitations/Participation restriction

Comparison of Osteoarthritis and Rheumatoid Arthritis

Rheumatoid Arthritis An autoimmune Chronic inflammatory, systemic disease primarily affecting the synovial lining of joints as well as other connective tissue. Fluctuating course Symptoms vary from mild stiffness requiring minor lifestyle changes and medication OR abrupt swelling, stiffness and progressive deformities requiring major life style modification, surgery and medication

Rheumatoid Arthritis: Characteristics Exacerbation (flare) and remission Inflammatory changes in Synovial membrane articular cartilage Subchondral marrow spaces Tendon sheath Granulation tissue (pannus),Erodes the articular cartilage, bone, and ligaments, Adhesions, Fibrosis, ossific ankylosis, or subluxation,Deformity and disability Tenosynovitis, tendon sheaths may rupture Extra-articular changes Rheumatoid nodules Atrophy and fibrosis of muscles Muscular weakness Fatigue mild cardiac changes

Radiographic hallmarks

Criteria for Diagnosis of Rheumatoid Arthritis

Signs and Symptoms—Periods of Active Disease (may last months to more than a year) Effusion and swelling of the joints Joint stiffness in morning pain on motion Pain and stiffness worsen after strenuous activity smaller joints of the hands and feet, PIP bilateral deformed and may ankylose or subluxate Nonspecific symptoms low-grade fever loss of appetite Weight, malaise, and fatigue

Principles of Joint Protection Do’s Monitor activities frequent but short episodes of exercise Alternate activities to avoid fatigue Decrease level of activities functional level of ROM, strength and endurance Increase rest during flares of the disease. appropriate adaptive equipment Do Not’s Avoid deforming positions. Avoid prolonged static positioning; change positions during the day every 20 to 30 minutes Muscular and total body fatigue

Principles of Management—Subacute and Chronic Stages Joint protection (splints, avoid over use, modify environment) Improving flexibility Muscle performance Cardiopulmonary endurance Low–impact conditioning exercises Swimming and bicycling Improve aerobic capacity Decrease depression and anxiety. Group activities such as water aerobics

Principles of Management—Subacute and Chronic Stages PRECAUTIONS Dosage of stretching and joint mobilization techniques Dosage of stretching and joint mobilization techniques CONTRAINDICATIONS Vigorous stretching or manipulative techniques Vigorous stretching or manipulative techniques

Osteoarthritis—Degenerative Joint Disease Osteoarthritis (OA) is a chronic degenerative disorder primarily affecting the articular cartilage of synovial joints, with eventual boney remodeling and overgrowth at the margins of the joints (spurs and lipping)

Etiology etiology of OA is not known Mechanical injury to the joint due to a major stress repeated minor stresses poor movement of synovial fluid when the joint is immobilized genetically related, especially in the hands and hips and to some degree in the knees.

risk factors Obesity Weakness of the quadriceps muscles Joint impact Sports with repetitive impact and twisting (e.g., soccer, baseball pitching, football) Occupational activities such as jobs that require kneeling and squatting with heavy lifting

Characteristics of OA capsular laxity,hypermobility or instability in some part of range pain and decreased willingness to move lead to contractures eventually. Rapid destruction of articular cartilage occurs with immobilization

Characteristics of OA The cartilage splits and thins out, losing its ability to withstand stress. As a result, crepitation or loose bodies may occur in the joint. Eventually, subchondral bone becomes exposed. There is increased density of the bone along the joint line, with cystic bone loss and osteoporosis in the adjacent metaphysis. During the early stages, asymptomatic because the cartilage is avascular and aneural

Characteristics of OA Enlargement of effected joints: Heberden’s nodes (enlargement of the distal interphalangeal joint of the fingers) Bouchard’s nodes (enlargement of the proximal interphalangeal joints)

Commonly involved joints Weight-bearing joints (hips and knees) Cervical and lumbar spine Distal interphalangeal joints of the fingers Carpometacarpal joint of the thumb 1 st MTP

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