Deck 42: Arthritis

Question 1

An occupational therapy (OT)practitioner is evaluating a 60-year-old female with rheumatoid arthritis.The OT practitioner observes that the patient is unable to extend her fourth and fifth digits.The patient has full passive range of motion (ROM)and no pain.She has good active flexion.The patient reports that she has difficulty opening her hand around an object such as a can or jar.The therapist should suspect that the patient has which of the following conditions?

A) Two trigger fingers
B) Weakness of the digit extensors
C) Rupture of the digit extensors
D) Finger joint subluxations

Answer 1

C
Rupture of the extensor tendons to the fourth and fifth digits can occur when the extensors rub on a rough,bony surface,often at the wrist because of synovial invasion.

Question 2

A 54-year-old client with rheumatoid arthritis is demonstrating a swan neck deformity at the third and fourth digits of her dominant (right)hand.She has full active flexion of the digits but reports some difficulty in initiating digit flexion after extending her digits fully.This causes her to have difficulty with keyboarding and grasping larger objects.The patient is in a sales position,and cosmesis is important to her on the job.What splint should the therapist recommend?

A) A Silver Ring custom metal splint or polypropylene (Oval-8) splint providing slight proximal interphalangeal (PIP) flexion
B) A custom fabricated thermoplastic finger based splint in slight PIP flexion
C) A resting pan splint at night only in PIP flexion
D) A wrist extension splint that will then encourage PIP flexion

Answer 2

A
A and B will allow activities of daily living while preventing PIP joint hyperextension that is seen in the swan neck deformity.Because cosmesis is important and long-term use of the splint will be necessary,the Silver Ring or Oval-8 splint will be the most durable and the most cosmetically appealing.

Question 3

A patient with osteoarthritis demonstrates a type III thumb deformity and reports pain with pinching activities.The therapist notices that there appears to be subluxation of the metacarpal during pinching,as noted by a bony enlargement at the base of the thumb.The splint should gently position the thumb opposite of the passively corrected deformity.With a type III deformity,the splint should gently place the thumb in which of the following?

A) CMC abduction, metacarpophalangeal (MP) joint slight flexion, and provide CMC stability to prevent subluxation
B) CMC joint adduction, MP extension, and provide CMC stability to prevent metacarpal subluxation
C) CMC abduction, interphalangeal (IP) flexion, and provide CMC stability to prevent metacarpal subluxation.
D) CMC flexion, IP extension, and provide CMC stability to prevent metacarpal subluxation

Answer 3

A
A type III deformity involves CMC joint subluxation,adduction,and flexion; MP joint hyperextension; and IP joint flexion.Only (A)provides a statement that positions the joints opposite of that deformity.

Question 4

A clinician is evaluating a client with rheumatoid arthritis.In addition to the client-centered interview,occupational profile,and occupational performance evaluation,the therapist wishes to document the clinical status.The clinician notices severe hand deformities and joint enlargements that may make goniometric measurements difficult.How should the therapist go about documenting digit flexion?

A) The therapist will be unable to measure the joint flexion because of the deformities.
B) The therapist should measure the distance from the fingertips to the distal palmar crease with a ruler.
C) The therapist should measure over the joint enlargements at each joint.
D) The therapist should account and subtract for the enlarged joint in determining the joint flexion.

Question 5

An OT practitioner is working with a 55-year-old client with osteoarthritis.She has pain at the base of her thumb at the carpometacarpal (CMC)joint and nodes at several of the distal interphalangeal (DIP)joints.She reports attending a yoga class the previous evening that required weight bearing on her hands.Her pain increased after the class and still persists during her OT appointment.What should the OT practitioner tell the patient?

A) Continue the yoga class to increase strength.
B) Avoid any activity that causes pain for more than 1 to 2 hours after completion.
C) Review joint protection principles.
D) B and C.