What is Joint protection?
the process of reducing STRESS and PAIN in joints to minimize joint INFLAMMATION and maintain good joint structure
What are the 10 basic principles of joint protection:
- Maintain muscle strength and ROM in joints
- Avoid external pressures or internal stresses in the POSITION OF DEFORMITY
- Use STRONGEST joints available (ex.using knees)
- Use joint in its most stable plane
- Ensure correct PATTERNS of movement
- Maintain good posture
- Take rest periods
- Don’t hold joints or muscles in one position for any length of time
- Dont attempt activity tjat cant be stopped immediately (ex. carrying hot object)
- Respect pain
What is Energy Conservation?
What are 7 ENERGY CONSERVATION TECHNIQUES?
the efficient and appropriate use of energy throughout the day… can enable a person to continue to be independent
- Plan ahead
- Organize storage
- Eliminate a job if not always necessarily (ex. don’t dust everyday)
- Sit when working if possible
- Avoid carrying heavy objects
- Avoid holding; use stabilizers (ex. non-sliding mats)
- Select proper equipment for working (ex. electrical can opener)
2 common types of arthritis
- Rheumatoid arthritis
- Osteoarthritis
What is OA?
What does it affect the most?
Do men and women have it equally?
- “wearing away” of cartilage= irritation of bone
- limited joint involvement
- knee
- yes
What 2 joints are mainly affected in OA in the hand ?
CMC during pinch and DIP
Is there inflammation in OA?
a little bit of swelling, but not lots of inflammation- mainly in RA
What are some symptoms of OA in hands?
- JOINT CREPITUS: grinding feeling/crunchy when joints move
- joint stiffness
- less ROM
- instability of CMC (thumb)
- non-systemic
What are the 2 nodes in OA?
- Heberden’s nodes: at DIP joint
2. Bouchard’s nodes: PIP joint
What are 4 mechanical stress on hand to avoid?
- Pinch
- Pinch with torqu (turning key)
- Pushing/pulling (peeling veggie
- Rep. movements
What are 4 basic treatments for OA?
- Splint
- Heat (paraffin wax)
- AROM
- Strengthening
What is RA?
- systemic disease
- the synovitis (inflammation of synovium) destroys joint structues
Does RA affect women or men more?
75% more women
What are some symptoms of RA?
-specifically of the hand?
- inflammation of MCP and DIP joints
- ULNAR DEVIATION !!
- immobility
- affects joints symmetrically (both knees/ both elbows etc.)
What are the 4 stages of RA?
after acute inflammatory..
1) Inflammatory: synovitis
2) Proliferation stage: synovium invades surrounding soft tissues; -Day SPLINT needed!
- nodules (commonly in elbow)
- trigger finger “snapping” when extending: TENDONS become thickened
3) Destructive Phase: joint deformity progressed
- ULNAR DRIFT!
4) Final/Chronic Stage: boney fusion of joints
- permanent loss of ROM
- “burned out”- no pain or swelling present anymore
What are some medication for RA?
- NSAIDS : against inflammation
- Steroids: faster acting that NSAIDS, but more side effects
- DMARDS: disease modifying drugs
- Analgesics: pain killers, but no inflammatory effect
In what stage are TENDONS affected in RA ?
What happens to the Tendons?
-how can it be fixed if severe?
Stage 2:
tendons become thickened, have trouble traveling through the flexor sheath
-results in “snapping”
-can only be fixed with surgery
What are some surgical treatment for RA? (3)
- Synovectomy
- Tenosynovectomy: removal of diseased tendon sheath
- Arthroplasty: joint replacement
What is a mallet finger?
“droop” of DIP
> damage to insertin of extensor tendon
What is Boutonniere deformity ?
-flexion of PIP
-hyperextension of DIP
> damage to central extensors and volar slipping of lateral bands
What is Swan neck deformity?
-hyperextension of PIP
-flexion in DIP
> caused by overstretching of volar plate of PIP
WHat are 6 types of hand splints ?
- Wrist
- Wrist and thumb
- Thumb
- Finger/Digital (ex. for Boutonniere)
- Anti-ulnar drift
- Resting hand: worn during night and flare-ups
What are some adaptive devices for the kitchen for Arthritic patients?
- dycem= non-slip mat
- adapted cutting board
- rubazote closed cell tubing: (to put in knife to cut)
- Zim jar opener
What are some adaptive devices for writing for Arthritic patients?
-Why important?
- study write
- writing bird
- you can use shoulder
- decrease ulnar drift
- avoids fine motor
- good for muscle weakness
