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Class project for PhysDys

Peggy Bates

on 12 February 2013

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Transcript of Osteoarthritis

Osteoarthritis About the Disorder Case Study OT Treatment Plan What is it? Osteoarthritis is a degenerative joint disorder caused by aging and wear and tear that affects 27 million Americans Why does it happen? As people age, cartilage breaks down, wears away and bones begin to rub together Long term goals Client will be independent in bathing and dressing.

Client will increase wrist ROM by 10-15 degrees in order to prepare a light meal with setup or supervision. How do you know if you have it? Joints crackling
Limited range of motion
X-rays Symptoms of OA Pain


Stiffness of Joints Diagnosis Right Forearm/Wrist Osteoarthritis with a Triangular Fibrocartilage Complex tear How do we do it? Why we do it Short term goals Client will demonstrate a good working knowledge of compensatory techniques in order to be modified independent in bathing, and dressing.
Client will reduce pain and edema in order to be modified independent in bathing and dressing.
Client will increase wrist ROM by 5-10 degrees in order to prepare light meal with moderate assistance.
Client will demonstrate good working knowledge and use of joint protection techniques in order to reduce pain from 7/10 to 5/10 during ADLs. Treatment session
Edema management for 10 minutes using cold packs
Pain management for 10 minutes using retrograde massage
Increasing ROM for 10 minutes using AAROM and 10 minutes using AROM
I would begin session with client in seated position at table on an elevated, cushioned foam wedge, hand in elevated position. Place ice pack on covered, affected area for 10 minutes. After icing, I would provide retrograde massage for 10 minutes, placing the fingers higher than the elbow. Massaging each fingertip toward the forearm in one continuous motion will move the fluid back toward the heart and stimulate the superficial lymphatic system. After massage, I would place a compression glove on the hand with Velcro straps on the tips and ask the client to pull the digits down as far as they could, while flexing the wrist, no more than 5-10 degrees, prior to feeling pain. Remove glove and continue client’s position, eliciting wrist and finger AROM from the client by demonstration.

Education for 10 minutes on wound care
Education for 10 minutes on Joint protection
During this time I would provide client with information that would help them to understand and practice healthy wound care, including pros and cons, infection control, healing process, normal expectations, products to use and avoid and how to protect area. I would request that the client repeat instructions and information so that I was confident that they were leaving with the correct information. I would also provide information in the form of handouts, including websites addresses. For joint protection I would provide information about what joint protection is, the importance of protecting all joints, and when to protect them. Due to the additional diagnosis of osteoarthritis, I would provide supplemental information about preventing further injuries as well as an overview of the disorder itself. Strengths -Independent in all ADLs before surgery

-Motivated for treatment

-Good rehab potential

-Currently using non-dominant hand for some ADLs Bea is a retired, right-hand dominant female with a right hand triangular fibrocartilage complex sprain/tear, specifically the extensor carpi ulnaris, on the dorsum side of the hand. She obtained this injury while washing her hands. She has also been diagnosed with right forearm/wrist osteoarthritis and hand/wrist tenosynovitis, otherwise states good health. Bea Hurton Middle aged men and women are affected equally, however as they age, it is more common in women.

Everyone has some symptoms of osteoarthritis by age 70. Risk Factors Some genetic contribution
Being overweight
Preforming repetitive jobs
Constant direct impact to the joint
Squatting, lifting or kneeling for more than an hour a day No blood test for osteoarthritis Triangular Fibrocartilage Complex One specific tear common in osteoarthritis patients occurs within the Triangular Fibrocartilage Complex or TFCC. The TFCC is a structure found between the distal ulna and the ulnar carpals. It is composed of the articular disc, the meniscus homologue, the ulnar collateral ligament, the volar and dorsal radioulnar ligaments, and the sheath of the extensor carpi ulnaris. What do we do? Training clients how to engage in meaningful activities using adaptive equipment helps them become more independent Maintain or increase ROM, endurance and strength Education about lifestyle changes, protecting joints, energy conservation, healthy diet, and the importance of incorporating rest into schedules. The goal for the osteoarthritis client is to be as independent as they can be without pain.
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