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48 Cards in this Set
- Front
- Back
number one cause of chroncc diability in US
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arthritis
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habilis
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ability
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classic signs and sympotoms of arthritis
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rubor
tumor calor dolor functio laesa (loss of function) |
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bottom line with patients who have arthritis
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what are you going to do to help the patients
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3 basic forms of arthritis
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inflammatory
osteoarthritis traumatic |
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traunatic injury
1. who gets 2. definition 3. why it causes pain |
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 |
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OA
1. who gets it? 2. definition? 3. why it causes pain |
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 |
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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 |
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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 |
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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 |
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tips for arthritis
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-OA and RA can coexist
-OA can be unilateral and bilateral -RA usually bilateral -RA immunologically related |
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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 |
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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 |
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capular fibrosis
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thickening of capsule due to proliferation of connective tiissue and deposition of exudate
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pannus
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-piece of cloth- rough tissue
-grannulation of synovial membrane -eroded articular cartilage |
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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 |
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-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 |
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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
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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 |
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what is gait
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controlled falling with propulsion
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normal gait
1. pelvis 2. hip 3. knee 4. ankle/ foot |
1. rotates and tilts
2. extension to flexion; balance over hip 3. flexes than extends 4. plantar flexion to dorsiflexion |
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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 |
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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 |
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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 |
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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 |
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resultant post. pelvic tilt tightness tethers pelvis
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hamstring
iliopsoas erector spinae |
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progressive atroph and resultant weakness affects
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abdominal core
gluteus maximus disrupted gluteus medius and/ or minus |
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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 |
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Dowager Hump
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anterior vertebra compression fractior
-anterior wedging -upper thoracic kyphosis |
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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 |
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gibbus deformity
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-particularly sharo, angular curve
-with thoracic kyphosis |
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structural kyphosis
1. primary 2. secondary |
1. congenital, associated with heart and kidney conditions
2. caused by another condition (osteoporosis, compression fractures, degenerative disc disease) -includes height loss |
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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 |
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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) |
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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 |
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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 |