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Multisystem, Medical: NSAID, corticosteroids, NMARDS, biologics, PT Rx …

- - - - S&S of RA
        
        1hr morning stiffness
        
        fatigue (constant immune response)
        
        weight loss
        
        Fever/malaise
        
        Quad & hand atrophy
        
        Tenosynovitis = tendon damage = rupture
        
        C1-2 instability (Radiculopathy = refer immediately)
        
        Sh & elbow instability
        
        Olecranon bursitis (bilateral)
        
        Ulnar nerve entrapment
        
        Elbow F contractures
        
        Carpal tunnel
        
        Knee laxity = bakers cyst & knee F contracture
        Ankle: hindfoot pronation, forefoot planus, flattened medial arch, subtalar instability = tarsal tunnel (medial)
        Feet: metatarsalgia, spurs, Morton's neuroma, toe deformities
        CV
        
        Vasculitis (discolouration & ischemic ulcers)
        
        Secondary peripheral artery disease
        
        Accelerated atherosclerosis --> ischemic heart disease
        
        Pleuritis/ pulmonary nodes = decreased gas exchange
        
        Eyes: episcleritis or scleritis
        
        Hand deformities
        
        Ant/volar subluxation of wrist & hand on radius (piano key sign) may cause extensor tendon rupture
        
        :arrow_down: UD & compensatory MCP ulnar drift due to:
        
        Proximal row subluxing ulnarly
        
        Distal row subluxing radially
        
        Zig zag effect trying to correct ulnar drift
        
        Trigger finger 3-4th digit
        
        Swan neck deformity
        (MCP F, PIP hyperextension, DIP F)
        Cause:
        
        Muscle spasm of intrinsic
        
        Ant capsule stretched, lateral bands move dorsally (up) = FDP dominance
        
        Rupture of extensor digitorum communis (at DIP)
        
        Boutonnieres deformity
        (MCP E, PIP F, DIP E)
        Chronic synovitis = Central slip lengthens causing volar (down) slip of lateral bands
        
        Thumb deformities
        Type 1: IP hyperextension & MCP F
        Type 2: IP hyperextension, CMC sublux
        Type 3: CMC sublux & MCP hyperextension
        
        Common location for rheumatoid nodules: Olecranon, forearms, achilles
      - Remission: 3mnths no pain or swelling with no more than 15mins of morning stiffness
      - SAJI
        Active jt
        
        Swelling
        
        Tenderness
        
        OP
        
        Jt damage
        
        Crepitus
        
        Deformity
        
        Loss of more than 20% ROM
        
        Ligament instability
- - - - Complications related to breast ca
        
        Post Op pain (incisional & posterior cervical & shoulder girdle)
        
        Post op vascular complications ( DVT, Pneumonia)
        
        Decreased chest wall expansion
        
        :arrow_down: sh mobility
        
        Weakness (surgical incision/ removal of pec)
        
        Postural malignment (pain)
        
        Fatigue
      - Rx post breast ca:
        
        Postural education
        
        AROM
        
        complex decongestive therapy
        
        avoid excessive tension on incision or blanching of scar
        
        Do gravity assisted positions when exercising (avoid dependent position)
        
        Scar massage
        
        Aerobic exercises
- - - - Special considerations:
        
        Report motor changes (may indicate neurotoxicity)
        
        Avoid resistance ex's & manual therapy if bone metastasis due to # risk.
        
        Minimize rotation if bone metastasis in vertebrae
        
        Avoid modalities in local area (Check sensation prior due to neuropathies)
        
        Adapt if blood count too low (fatigue)
        
        No mobilisation if low platelets = excessive bleeding
- - - - CV: CVA,CVD,MI,PVD
        :arrow_up: atherosclerotic plague ->ischemic to tissues = Intermittent cloudification & neuropathy
      - Peripheral neuropathy:
        Affecting sensory & motor nerves
        "glove & stocking"
        poor balance (proprioception)
        Charcot foot (multiple unknown #) = high risk of ulcer & amputation
      - Autonomic:
        
        :arrow_up: resting HR
        
        :arrow_down: BP & HR response to exercise
        
        Poor thermoregulation (overheating)
        
        Orthostatic hypotension
        
        :arrow_up: risk of post-exercise hypotension (longer cool downs)
      - Retina damage = blindness
        Avoid activities which :arrow_up: BP suddenly:
        
        Valsaver
        
        Head down
        
        Heavy lifting
        
        Strenuous UL
      - Kidney damage - protein loss in urine, kidney failure (dialysis)