PHTH1012 012 Osteomyelitis & Arthritis - Rodriguez.pdf

Dr. Sacha V. Oliver (ASc., BSc., M.T., MBBS, BBMed Sci. MSc.) March 25, 2024 R. Willis (Primary Author) & C. Thoms- Rodriquez Physical therapy is needed to facilitate/maintain: Active range of motion flexibility and strength relieves the musculoskeletal pain ( associated with muscular weakness, para...

Dr. Sacha V. Oliver (ASc., BSc., M.T., MBBS, BBMed Sci. MSc.) March 25, 2024 R. Willis (Primary Author) & C. Thoms- Rodriquez Physical therapy is needed to facilitate/maintain: Active range of motion flexibility and strength relieves the musculoskeletal pain ( associated with muscular weakness, paralysis, and immobility) passive range of motion exercises are preferred to avoid overexertion /muscle damage. Occupational therapy is needed to help the patient avoid further injury. ARTHRITIS Clinical Features Pain, stiffness(esp. early am), loss of function, inflammation, Diff Dx Monoarthritis SEPTIC ARTHRITIS, TB ARTHRITIS, trauma, gout, spondyloarthritidis, OSTEOARTHRITIS, haemarthrosis Polyarthritis RHEUMATOID ARTHRITIS, rheumatic fever, VIRAL ILLNESS, SLE, crystal induced arthritis ASSESS extent of joint involvement, symmetry, change in anatomy, limited movement, associated features IVESTIGATE X-RAY; Joint aspiration(microscopy for cells or crytsals, culture); Blood-CBC ,ESR, collagen vascular screen etc; other invx as is appropriate TREAT AS APPROPRIATE Physiotherapy helps to improve mobility flexibility and strength Commonest joint condition Clinical features: Pain on movement, worse at end of day, stiffness, joint instability; joint tenderness, bony swelling, poor ROM, Most commonly affected joints: DIP; 1st MCP; 1st MTP, spine, hip then knee. Radiology Loss of joint space, subchondral sclerosis and cysts, marginal osteophytes. Other invx normal Rx Analgaesics; ?corticosteroid injection; joint replacement; weight reduction; PHYSICAL THERAPY Persistent symmetrical, polyarthritis F>M Pathology: Immunogenesis is thought to be via presentation of culprit antigen to T-helper cells with subsequent cytokine mediated synovial neutrophil exudate, which releases cartilage degrading enzymes; eventually pannus formation (granulation tissue) Clinical features Swollen, painful, stiff hands and feet esp in the am. At 1st PIP, MCP, and wrist joint and swelling. Then if erosive, ulnar deviation and volar subluxation at MCP joints; Boutonniere and swan neck deformoties of the fingers, Z deformities of the thumbs. Wrist subluxation, tendon rupture, wasting of adjacent muscle, Atlanto-axial subluxation may threaten the spinal cord; Extra articular features such as anaemia etc. Invx- Xray, Rheumatoid factor Management-exercise; physical therapy,aids(orthoses eg. splints); Sx; Intra-lesional steroids; NSAIDS; DMD’s eg methotrexate THE END