Physical and Occupational Therapy Quiz

Rheumatoid Arthritis

• Persistent symmetrical polyarthritis, more common in females
• Pathology: Immunogenesis via presentation of antigen to T-helper cells, leading to cytokine-mediated synovial neutrophil exudate, cartilage degrading enzymes, and pannus formation
• Clinical features: Swollen, painful, stiff hands and feet, especially in the am, at 1st PIP, MCP, and wrist joints
• Swelling leads to ulnar deviation and volar subluxation at MCP joints, Boutonniere and swan neck deformities of the fingers, and Z deformities of the thumbs
• Wrist subluxation, tendon rupture, wasting of adjacent muscle, and Atlanto-axial subluxation may threaten the spinal cord
• Extra-articular features include anaemia, etc.

Physical Therapy

• Necessary to facilitate and maintain active range of motion, flexibility, and strength
• Relieves musculoskeletal pain associated with muscular weakness, paralysis, and immobility
• Passive range of motion exercises are preferred to avoid overexertion and muscle damage
• Occupational therapy helps patients avoid further injury

Arthritis

• Clinical features: Pain, stiffness (especially in the early morning), loss of function, inflammation
• Differential diagnosis: Monoarthritis (septic arthritis, TB arthritis, trauma, gout, spondyloarthritidis, osteoarthritis, haemarthrosis), polyarthritis (rheumatoid arthritis, rheumatic fever, viral illness, SLE, crystal-induced arthritis)
• Assessment: Extent of joint involvement, symmetry, change in anatomy, limited movement, associated features
• Investigation: X-ray, joint aspiration, blood tests (CBC, ESR, collagen vascular screen)

Osteoarthritis

• Most common joint condition
• Clinical features: Pain on movement, worse at the end of the day, stiffness, joint instability, joint tenderness, bony swelling, poor ROM
• Most commonly affected joints: DIP, 1st MCP, 1st MTP, spine, hip, and knee
• Radiology: Loss of joint space, subchondral sclerosis and cysts, marginal osteophytes