Rheumatoid Arthritis and Joint Health Quiz

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the most common form of inflammatory arthritis?

Post-traumatic arthritis

Osteoarthritis

Rheumatoid arthritis (correct)

Degenerative joint disease

Which of the following is NOT typically a result of joint degeneration?

Increased synovial fluid production (correct)

Softening of cartilage

Formation of osteophytes

Subchondral bone sclerosis

What type of bone growth occurs in most bones of the body?

Intramembranous

Membranous

Endochondral (correct)

Cartilaginous

What percentage of individuals over 75 years old are likely to experience symptoms of joint degeneration?

80% Signup and view all the answers

What is the primary function of synovial fluid?

Nourishes cartilage and lubricates joint surfaces Signup and view all the answers

Which symptom is characteristic of rheumatoid arthritis but not typically associated with osteoarthritis?

Morning stiffness Signup and view all the answers

What is the key characteristic of tendons compared to ligaments?

Transmit loads to bones Signup and view all the answers

What role do disease modifying drugs play in the treatment of rheumatoid arthritis?

Prevent activation of the inflammatory process Signup and view all the answers

Which degree of sprain indicates a partial rupture with significant pain?

2nd degree Signup and view all the answers

What defines optimal loading in the context of physical tissue stress?

Load that maximizes physiological adaptation Signup and view all the answers

What is a common cause of joint degeneration?

Overuse Signup and view all the answers

What is the annual failure rate for joint replacements according to the given data?

1% Signup and view all the answers

What is the impact of aging on the mechanical properties of collagen in tendons and ligaments?

Reduces elasticity and strength Signup and view all the answers

Which condition is characterized by polyarticular and symmetrical joint involvement?

Rheumatoid arthritis Signup and view all the answers

What is a characteristic feature of cartilage?

Aneural and avascular Signup and view all the answers

Which type of muscle fiber is slow twitch and suited for low load, high repetition activities?

Type I Signup and view all the answers

What is the primary focus for progressing individuals with low functional reactivity?

Enhancing motion correction and strength conditioning Signup and view all the answers

What are the two types of physical stress identified?

Macrotrauma and microtrauma Signup and view all the answers

What distinguishes a traumatic event in the context of physical stress?

It is a one-time occurrence unlikely to recur Signup and view all the answers

What is primarily aimed at when addressing microtraumas?

Facilitating tissue recovery Signup and view all the answers

Which of the following statements is true regarding low levels of physical stress?

They may progress to more severe injuries if not addressed Signup and view all the answers

Which assessment question is most relevant when determining if a painful area is affecting range of motion?

What is the quantity of pain on a scale from 0-10? Signup and view all the answers

In the evaluation of function related to range of motion, which factor is considered more critical?

Functional range of motion for the individual Signup and view all the answers

When a patient reports limited movement, what is an essential joint to assess?

The joint itself along with joints above and below Signup and view all the answers

How is side-to-side symmetry related to assessing normal ranges of motion?

It provides a baseline for establishing normal ROM for that individual. Signup and view all the answers

Which of the following examples illustrates a critical loss of range of motion impacting function significantly?

Loss of 5 degrees of ankle dorsiflexion for walking Signup and view all the answers

Why is it important to check all joints of the lower extremity when any joint is involved?

Because of the closed-kinetic chain function of the lower extremity Signup and view all the answers

What characteristic of pain should be assessed if it is present during movement?

Quality of the pain (e.g., dull, sharp) Signup and view all the answers

For effective range of motion assessment, which motion should be prioritized when examining an elbow injury?

Elbow flexion along with wrist and shoulder motions Signup and view all the answers

What is the primary purpose of special tests in clinical evaluations?

To rule in or out specific diagnoses Signup and view all the answers

Why should palpation be performed at the end of an examination?

To avoid increasing pain during examination Signup and view all the answers

What should be combined with special tests to improve the accuracy of a diagnosis?

Other examination findings Signup and view all the answers

What type of information can 'red flags' provide during an evaluation?

Signs that suggest the need for referral Signup and view all the answers

What does it mean if a special test has high sensitivity?

It correctly identifies most true positives Signup and view all the answers

How should the evaluation process be approached after gathering patient information?

By categorizing information and making initial assessments Signup and view all the answers

What limitation is noted regarding the use of special tests?

They rarely yield conclusive results on their own Signup and view all the answers

What sort of tone and irritability can palpation help identify?

Muscle tone and tissue irritability Signup and view all the answers

What is the primary purpose of using a complete body chart in the examination process?

To screen for red flags and develop clinical hypotheses Signup and view all the answers

Why should diagnostic tests not be reviewed until the end of the examination?

To avoid biasing the examination process Signup and view all the answers

What are the two primary tasks during the initial observation phase of a patient examination?

Establishing rapport and observing the patient's movement Signup and view all the answers

What does the abbreviation SINSS stand for in the context of understanding a patient's complaint?

Severity, Irritability, Nature, Stage, and Site Signup and view all the answers

Which of the following should be included in patient-reported materials prior to the examination?

Intake forms and functional outcome measures Signup and view all the answers

What is an important characteristic that distinguishes exceptional therapists from adequate therapists?

The level of rapport established with patients Signup and view all the answers

In initial patient observations, which aspect is NOT typically observed?

Presence of insurance documents Signup and view all the answers

What is the primary goal of gathering a patient's history during the examination process?

To identify red flags and understand the complaint Signup and view all the answers

Study Notes

Musculoskeletal I: Introduction to the Patient Management Model and Upper Extremity

This course introduces the patient management model and upper extremity anatomy.
The course is for the Doctor of Physical Therapy program, Summer 2024.

Bones

Dynamic tissues that remodel, capable of withstanding compressive and tensile forces.
Anatomical structures with a rigid framework, withstand mechanical loads.
Levers for the locomotor function of muscles.
Protect important organs.
Hemopoietic tissue.
Storage or reservoir for calcium, magnesium, and sodium.
Osteoblasts - calcitonin
Osteoclasts - parathyroid hormone (PTH).
Woven bone: low mineral content, initial phase of fracture healing, random collagen arrangement; mechanically weaker.
Lamellar bone: mature, organized collagen arrangement; mechanically stronger.
Tensile force: elongation, easy fracture
Compressive force: shortening, osteoporotic fracture
Shear force: angulation, fracture more frequent in areas with more cancellous bone
Fracture: single load or repetitive low load exceeds repair rate.
Wolff's law: bone remodeling in response to stress.

Bone Growth

Endochondral ossification: most bones.
Membranous ossification: sutures of skull and a few other bones.

Cartilage

Viscoelastic tissue
Withstands shear and compressive forces.
Aneural (no nerves) and avascular (no blood vessels).
Chondrocytes and intracellular substance.
Sponge-like behavior.

Synovial Membrane

Large functional surface
Synovial fluid: viscous, pale, yellow, clear fluid that nourishes the cartilage
Nourishes the cartilage (cushioning and lubrication role).

Tendons and Ligaments

Tendons transmit loads to bones.
Ligaments prevent excessive motion and guide joint motion; give passive stability.
Closed packed position is maximum bony congruency.
Fibroblasts + matrix
Aging causes collagen, changing mechanical properties.
Sprains: 1st degree = microfailure of fibers, minimal pain, no instability; 2nd degree = partial rupture, ~50% strength, pain, some instability; 3rd degree = almost complete rupture, intense pain initially less after, severe instability.

Physical Tissue Stress Model

Adaptation to stress: too little stress or too much stress.
Stress on tissues necessary for health (for tissues to remain healthy).

Skeletal Muscles

600 muscles, 50% of body weight.
3 types of contraction: I – slow twitch, low load, high repetition; II – fast twitch, high load, low/high repetition types.
Muscle fiber structure (thick and thin filaments of sarcomeres).
Relationship of tension to muscle length.
Optimal muscle length results in maximum tension.

Optimal Loading

The load applied to structures maximizes physiological adaptation.
Variables influencing optimal loading: tissue type, pathological presentation.
Loading goals include: increased tensile strength, collagen reorganization, increased muscle-tendon unit stiffness, and neural reorganization.

Diagnostic Work-Up

History and physical exam are the most important aspects of patient interaction.
Establishes rapport with the patient.
History provides important clues for guiding the clinical exam.
Imaging studies (e.g., X-rays, CT, MRI, ultrasound) and educating patients about findings and treatment options are essential parts of the work-up.

Red Flags

Cancer: night pain, constant pain, weight loss, appetite loss, fatigue, and history of cancer
Cardiovascular: shortness of breath, dizziness, chest pain
Gastrointestinal/Genitourinary: abdominal pain, heartburn, nausea, vomiting
Neurological: problems with hearing, swallowing, speech, severe headache, blurry vision, balance problems
Miscellaneous: fever, night sweats, severe emotional disturbances, joint swelling without injury, pregnancy (consider trimester-dependent contraindications).

Introduction to Imaging

Physical therapists have a history of successful use of imaging in the US military system.
Imaging reduces unnecessary procedures.
Imaging improves client satisfaction and decreases costs.

Radiography

Most cost-effective initial test in orthopedics.
Used to assess bone and joint pathology, fracture, healing, and progression.
Minimum of two views (90 degrees) needed.
Provides patient exposure to radiation.
Structures are shaded in ways for different tissues (metal=white, contrast media=bright white, bone=white, water=grey, fat=gray/black, air=black).
Must look for proper size, shape, cortex thickness, continuity, and relationships with other bones.

Bones of the Elbow

Humerus: capitellum, radial fossa, trochlea, coronoid fossa, olecranon
Radius: head of radius, articular fovea, neck of radius, radial tuberosity
Ulna: trochlear notch, coronoid process, radial notch, ulnar tuberosity
Lateral epicondyle, lateral supracondylar ridge, medial epicondyle, medial supracondylar ridge.

Joints of the Elbow

Humeroulnar: hinge joint (flexion/extension)
Humeroradial: modified hinge (pronation/supination)
Proximal and distal radial-ulnar

Muscles of the Elbow/Forearm

Magnetic Resonance Imaging (MRI)

Primarily used for soft tissue lesions (rotator cuff tears, meniscal tears, ACL tears, osteomyelitis, osteonecrosis, stress fractures).
False positive rates – at times over diagnosis

Computed Tomography (CT)

Provides 3-D info, especially cortical margins of bone.
Extremely useful for certain fractures (e.g., tibial plateaus, scapula fractures, ankle fractures, talus, spine).
Now optimal method for detection of pulmonary emboli.

Bone Scan

Absorptiometry (DEXA)

Best way to measure bone density and bone health.
Upper lumbar spine and femurs are ideal for measurement.

Diagnostic Ultrasound

Revealing as MRI but much less costly
Useful for muscle and tendons

Important Concepts to Musculoskeletal Patient Management

Sackett's Model of Evidence-Based Practice (EBP)
Guide to PT Patient Management Model (rehab cycle).
International Classification of Functioning, Disability, and Health (ICF) Classification

Examination for Musculoskeletal Disorders

Typical sequence of examination for musculoskeletal disorders.
Elements and the sequence may be modified, depending on various environmental or patient factors.

Patient Reported Materials and Initial Observation

Review of intake forms and functional outcome measures (e.g., Oswestry, Neck Disability Index)
Gather history and identify potential red flags. Review of body chart and pain scale.
Establish a rapport (warm, confident, in charge but polite).
Observe movement, affect, posture, and communication.

History

Location, nature, severity, irritability, mechanism of injury/symptoms.
How have symptoms (or complaints) changed?
Review all systems (physical, neurological, psychological aspects associated with the complaint).
Ask about red flags.

Diagnostic Workup

Includes taking the patient's history, examining them physically, and ordering any necessary tests.

Screening Exam

To identify possible issues quickly, especially painful or neurological issues related to the complaint.
A comprehensive exam (e.g neck and spine, symmetry, etc.)

Movement Analysis

Demonstrating patient's selected movement
Watch for: pain, symmetry, efficiency of movement.

Active Range of Motion (AROM)

Quantity of range of motion.
Quality: grimacing, difficulty, lack of control, reports of pain.

Passive Range of Motion (PROM)

Osteokinematic and arthrokinematic motions to consider the quality and quantity of motion, any pain, and the presence/absence of any blocking.

Resistive Tests

Muscle selective tissue-tension testing.
Manual muscle testing (MMT).

Muscle Length

Muscle length testing.

Special Tests

Specific tests for specific joint/muscles/structures. Must consider sensitivity, specificity, likelihood ratio.

Palpation

Soft tissue and bone.

Evaluation

Gather all known information into general categories and make basic initial assessments about the problem.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Test your knowledge on inflammatory arthritis, joint degeneration, and the role of therapies in managing these conditions. This quiz covers essential aspects of bone growth, cartilage health, and the significance of synovial fluid. Ideal for students or professionals interested in rheumatology and orthopedics.