Endo- Arthropathies- Dr. Dougherty

Front 1

number one cause of chroncc diability in US

Back 1

arthritis

Front 2

habilis

Back 2

ability

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classic signs and sympotoms of arthritis

Back 3

rubor
tumor
calor
dolor
functio laesa (loss of function)

Front 4

bottom line with patients who have arthritis

Back 4

what are you going to do to help the patients

Front 5

3 basic forms of arthritis

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inflammatory
osteoarthritis
traumatic

Front 6

traunatic injury
1. who gets
2. definition
3. why it causes pain

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1. people with injury or fracture
2. leads to avascular necrosis, blood supply to bone is cut off
3. lack of blood supply, surrounding cartilage deteriorates and bones grind or rub together

Front 7

OA
1. who gets it?
2. definition?
3. why it causes pain

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1. middle-aged and older
2. joint disease gets worse over time, not inflammatory
3. cartilage erodes, allows bones of joint to grind or rub together

Front 8

fibrillation

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-early degenerative change due to loss of proteoglycans
-ground-glass appearance-- yellowish discoloration
-equal to superficial erosion of cartilage
-unmasks collagen fivers and increases water content in chondrocytes

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eburnation

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-complete loss of artcular cartilage
-thickening of subchondral boen- osteosclerosis
-ivory-like appearance (hard and polished)
-permanent lesion

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OA radiograph findings

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subchondral cysts
osteophytes
subchondral sclerosis (narrowing)
complete loss of chondral surfaces

Front 11

joint mice

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-osteochondromatosis
-fragments of cartilage and/ or bone floating free in synovial fluid
-seen in degenerative joint
-in "osteochondrosis dissecans"

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RA

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-most common INFLAMMATORY arthritis
-woman and younger people
-immune system and joint swelling
-attacks synovium "egg-white"
-body tries to get rid of synovial lining

Front 13

RA radiographic finding

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joint effusion
erosions at the intracapsular articular margins
marginal erosions for hypertrophied synovium and granulation tussue
uniform joint spaces narrowing

Front 14

tips for arthritis

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-OA and RA can coexist
-OA can be unilateral and bilateral
-RA usually bilateral
-RA immunologically related

Front 15

tissue deformations occurs when

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-during applied physiologically relevant stress levels and loading rates

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distinct process contributes to joint destruction

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synovitis
formation of pannus tissue
activation of osteoclasts

Front 17

tissue remodeling

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-new cartilage and bone formation eventually leading to ankylosis

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villous hyperplasia (hypertrophy)

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-common, non-specific rxn of synovial membrane
-velvety appearance- due to tongue-like synovial villi covered with hyperplastic synoviocytes
-think RA

Front 19

capular fibrosis

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thickening of capsule due to proliferation of connective tiissue and deposition of exudate

Front 20

pannus

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-piece of cloth- rough tissue
-grannulation of synovial membrane
-eroded articular cartilage

Front 21

osteophytes

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-boney outgrowths
-derived from chondrification of fibrous tissue
-where- junction of cartilage with periosteum and insertions of synovial capsules to bone

Front 22

-process of osteophyte formation is known as what

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osteophytosis

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fixation

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-abnormal immobility and consolidation of joint
-tissue remodeling
-ankylosis
-affected joint tends to assume least painful position and may become more or less permanently fixed

Front 24

end-stage joint

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-several chronic articular changes in same joint
-need to joint replacement
-permanent and cannot fix

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3 portions of body

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pelvic girdle
spine
shoulder girdle

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lwer extremity kinetic chain

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ankle angle
knee angle
pelvic tilt

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scapular dyskinesia

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carry angle of arms

Front 28

how do you want to look at patients

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at all planes

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geriatric standing

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-most of body weight shifted to heels
-shift to ground (knees)
-carrying angle changes

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posture and obesity

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-as belly gets bigger, weight distribution move down
-geriatric and obesity= BAD

Front 31

what is gait

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controlled falling with propulsion

Front 32

normal gait
1. pelvis
2. hip
3. knee
4. ankle/ foot

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1. rotates and tilts
2. extension to flexion; balance over hip
3. flexes than extends
4. plantar flexion to dorsiflexion

Front 33

normal geriatric gait

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-slowed gait
-decreased, symmetrical stride= normal
-assymetrical gait- more OA b/c unilateral
-less pronounced heel strike
-walking down hill with very heavy backpack

Front 34

most common cause of injury in patients over 65 yo? why?

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falls
- due to tripping (poor foot clearance, altered knee motion key factor)
-slow reaction time and transfers
-gait speed
-activity-specific balance confidence
-static and dynamic balance

Front 35

what can modify weight distribution during gait changing stability of lower kinetic chain

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-posterior tilt of pelvis
-reduced knee angle
-reduced ankle angle
-altered force vectors on foot placement

Front 36

posterior pelvic tilt

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-hip extension- elongates iliofemoral ligament-- develop force and undergo deformation much like stiff rubber band
-ligament's vectors passively resist further hip extension
-remodeling- results in flexion contractures

Front 37

resultant post. pelvic tilt tightness tethers pelvis

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hamstring
iliopsoas
erector spinae

Front 38

progressive atroph and resultant weakness affects

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abdominal core
gluteus maximus
disrupted gluteus medius and/ or minus

Front 39

cervical hyperkyphosis

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-every inch head moves forward, heads gains 10 lbs in weight
-weight redistributed to upper back and beck
-chin drops forward onto chest
-extension muscles of neck- constant contraction
-pressure on suboccipital nerves
-leads to development of upper thoracic kyphosis-- Dowager Hump

Front 40

Dowager Hump

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anterior vertebra compression fractior
-anterior wedging
-upper thoracic kyphosis

Front 41

thoracic kyphosis

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-50% of elderly
-postural kyphosis- posturally correctable
-structural kyphosis- deformity in vertebrae, more angular
-possible cardiac and respiratory system

Front 42

gibbus deformity

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-particularly sharo, angular curve
-with thoracic kyphosis

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structural kyphosis
1. primary
2. secondary

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1. congenital, associated with heart and kidney conditions
2. caused by another condition (osteoporosis, compression fractures, degenerative disc disease)
-includes height loss

Front 44

lumbar lordosis

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-3 main points of movement (intevertebral disc and 2 facet joints)
-disc thins with aging
-causes facet joints to press together
-hyper lordosis will affect weight distribution

Front 45

lumbar lordosis can be contributed to by what?

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-disk disease (herniated nuleus pulposa, broad based bulging)
-osseous pathology- (spondylosis, spondylolithesis, interbody fusion)
-spinal cord (compression, stenosis)

Front 46

scoliosis- adult degenerative

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-redistribution of weight
-affects both superior and inferior to deformity

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thoracic girdle- scapular dyskinesia

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-posterior medial scapula stabilizer weakness- (rounded shoulder)
-affects glenohumeral articulation
-acromial clavicular and sternoclavicular angle articulations altered
-affects carrying angle of arm

Front 48

carry angle of arms

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-swinging of opposing arm assists in compensating balance and rotation moments through the trunk
-forward tilt of torso and anterior inferior rotation of glenohumeral joint alters hanging and swing adding weight on forward propulsion
-utilization of assistive devices can alter