ORTHOPEDIC PT 2

ARTHRITIC AND CONNECTIVE TISSUE DISEASES

JESSIE ANNE MANLUTAC
SEPTEMBER 29, 2021
_________________________________________________________________________________________________

d. Bilateral symptoms
OUTLINE
e. Muscles
I. Arthritic Conditions f. (+) systemic sx
A. Rheumatoid Arthritis g. deformities
B. Osteoarthritis
C. Fibromyalgia PRINCIPLES OF MANAGEMENT IN ACUTE PHASE
D. Myofascial Pain Syndrome h. Patient education
i. Relieve pain and mm guarding and promote
I. ARTHRITIC CONDITIONS relaxation
j. Minimize joint stiffness and maintain
A. RHEUMATOID ARTHRITIS available motion
● Term k. Minimize mm atrophy
○ is an autoimmune, chronic, inflammatory, l. Prevent deformity and protect the joint
systemic disease primarily affecting the structures *contraindications
synovial lining of the joints as well as other
connective tissues JOINT PROTECTION
○ Has fluctuating course ● Monitor activities and stop when discomfort or
fatigue begins to develop
CHARACTERISTICS OF RA ● Use frequent but short episodes of exercise (three to
● Intermittent in nature five sessions per day) rather than one long session.
● Early inflammatory changes in the joint structures ● Alternate activities to avoid fatigue
leading to joint space narrowing and pannus ● Decrease level of activities or omit provoking
formation activities if joint pain develops and persists for more
● Exposed cancellous bone with dse. Progression than 1 hour after activity
● Fibrosis, ankylosis, and subluxation may eventually ● Maintain a functional level of joint ROM and
cause deformity and disability muscular strength and endurance
● Inflammatory changes can also occur in tendon ● Balance work and rest to avoid muscular and total
sheaths and eventually rupture if subjected to friction body fatigue
● Extra-articular manifestation can occur ● Increase rest during flares of the disease
● Avoid deforming positions
CRITERIA FOR DIAGNOSIS FOR RA ● Avoid prolonged static positioning change positions
during the day every 20 to 30 minutes
Criterion Definition ● Use stronger and larger muscles and joints during
Morning stiffness Stiffness in joints lasting at least 1 activities whenever possible
hour ● Use appropriate adaptive equipment
Arthritis in 3 or more Pain and swelling in at least 3
joints joints PRINCIPLES OF MX IN SUBACUTE AND CHRONIC
STAGES
Arthritis in hand joints
Swelling in at least 1 of the
● When is it subacute?
following area: wrist, MCP or PIP
● Tx approach : same as with any other
joint
musculoskeletal disorder but appropriate
Symmetric arthritis Involvement of the same joint precautions are observed
area on both sides of the body ● Improve flexibility, mm performance,
Rheumatoid nodules Subcutaneous nodules over bony cardiopulmonary endurance
prominences or extensor ● Non to low impact conditioning exercises
surfaces or around joint ● contraindications
Serum rheumatoid factor Positive rheumatoid factor
Radiologic changes Periarticular osteopenia or
erosions in joints visible on Notes from professor’s PPT
radiographs of hands or feet

PERIODS OF ACTIVE DSE B. OSTEOARTHRITIS

● SIGNS AND SX ● Degenerative joint disease
a. Joint effusion ● Primarily affects articular cartilage of synovial joints
b. Morning joint stiffness with eventual bony remodelling and overgrowth of
c. Pain spurs
LABASTIDA, MAGALLANES, SULAYAO 1
 C. FIBROMYALGIA
CHARACTERISTIC OF OSTEOARTHRITIS ● Chronic condition characterized by widespread pain
● (+) capsular laxity leading to hypermobility and that covers half of the body (right or left/ up or down)
instability and has lasted for more than 3 months
● Contractures ● 1/18 tender points
● Destruction of articular cartilage ● Non restorative sleep
● Genetic but can be also associated with obesity,
sports with repetitive impact and twisting and Characteristics:
occupations and activities that require kneeling and ● Early to middle adulthood
squatting while lifting weight ● Sx develop after physical trauma
● (+) crepitation and loose bodies ● Pain is described as muscular in origin
● Wearing out of articular cartilage and eventual ● Significant fluctuation of sx
exposure of subchondral bone ● Has higher incidents of tendonitis, h/a, irritable
● Increased bone density along the joint line with bowel, TMJ dysfxn, restless leg syndrome, mitral
osteoporosis in the adjacent metaphysis valve prolapse, anxiety, depression, and memory
● Enlargement of affected joints (nodules)\ problems
● MC affected joints
Contributing Factors to Flare:
PRINCIPLES OF MANAGEMENT ● Environmental stress, changes in barometric
1. Educate patient pressure, cold dampness, fog, and rain and
2. Decrease effects of joint stiffness sometime fluorescent lights
3. Decrease pain from mechanical stress and prevent ● Physical stress: repetitive activities such as typing,
deforming forces playing piano, vacuuming, prolonged periods of
4. Increase ROM sitting
5. Improve neuromuscular control, strength, and ● Emotional stress
muscle endurance
6. Improve balance Management
7. Improve physical conditioning ● Meds
● Energy conservation
RA VS. OA ● Activity pacing
● Stress avoidance
● Decrease alcohol and caffeine intake
● Diet mod.
● Symptomatic treatment

D. MYOFASCIAL PAIN SYNDROME

● Chronic, regional pain syndrome
● Hallmark: (+) trigger points
● Trigger point
○ Hyperirritable area in a tight band of muscle
○ Pain described as dull, aching and deep
FIBROMYALGIA AND MPS ○ May be active or latent
● Chronic pain syndromes ○ Decreased ROM in mm
○ Weakness

Possible Causes:
● Chronic muscular overload secondary to repetitive
activities or that maintain muscle in shortened
position
● Acute overload of mm such as slipping and catching
oneself
● Poorly conditioned muscles
● Postural stress
● Poor body mechanics

Management
● CR-passive stretch technique
● CR-AC
● Trigger point release
● Spray and stretch
● Dry needling