MODUL

ARTHRITIS

1
 PENDAHULUAN

Penyakit Rematik penyakit yang menyerang

sendi dan menyebabkan peradangan sendi

Artritis mencakup satu atau beberapa sendi

dalam proses peradangan (inflammatory) dan
destruktif ataupun proses degeneratif mekanik
tanpa peradangan (non inflammatory)

Gejala gejala (nyeri, keterbatasan LGS,

deformitas sendi) DISABILITAS
2
MODUL IKFR
 Keterbatasan
Nyeri Atrofi Otot
LGS

Ggg
Instabilitas
Deformitas Pembebanan
Sendi
Sendi

Ggg Densitas Penurunan

Tulang Fungsi

MODUL IKFR3
 Pencegahan

Menghilangkan masalah agar tidak

terjadi kecacatan

Mengurangi masalah agar kecacatan

yg terjadi dapat diminimalkan

Memaksimalkan fungsi yang ada

Memberi kualitas hidup yang lebih baik

MODUL IKFR4
 ANAMNESIS

PEMERIKSAAN FISIK

1. ISTIRAHAT
2. TERAPI LATIHAN
TATALAKSANA KFR 3. MODALITAS
4. ORTOSIS
MODUL IKFR5
DE LISA 6
[Link] connective-tissue disease
RA, SLE, psoriatic arthritis [PSA]
[Link] crystal-induced disease
gout, pseudogout
[Link] induced by infectious agents
bacterial, viral, spirochete, tuberculous, and
fungal arthritis
[Link] spondyloarthropathies
ankylosing spondylitis [AS])

DE LISA 7
[Link], posttraumatic, or overuse
osteoarthritis [OA], posttraumatic aseptic
necrosis [AN]
[Link]
lipid storage disease, hemoglobinopathies

DE LISA 8
 CLINICAL FEATURES inflammatory disease:
- acute painful onset
- fever
- erythema of the skin over the joint involved
- warmth of the joint
- tenderness
LABORATORY (inflammatory process):
- peripheral white blood cell count
- erythrocyte sedimentation rate (ESR)
X-RAY
soft-tissue swelling, bony erosions, or
uniform cartilage loss

9
Common Rheumatic Diseases :
Osteoarthritis
Rheumatoid Arthritis
Less Common Rheumatic Diseases :
Ankylosing Spondylitis
Gout
Lupus Arthritis
Psoriatic Arthritis

BRADDOM 10
 RA OA AS Gout
Definisi Penyakit inflamasi Noninflammatory Chronic Penyakit akibat
autoimun yang menyerang progressive disorder of inflammatory deposisi Kristal
terutama lapisan sinovial joint leading to disorder of the monosodium urat di
sendi diarthrodial akibat deterioration of the axial skeleton jaringan
aktivitas sistem imunitas articular cartilage & affecting the
tubuh yang berlebihan new bone formation at sacroiliac joint &
the joint surfaces & the spine.
Etiologi tidak diketahui margins.

Bersifat kronik, sistemik,

erosif destruksi
prevalensi 1% dari populasi Most common form More common in
of arthritis white
Increases with age, Genetic marker
repetitive trauma, (+) HLA-B27~
obesity, genetics, 90%
stress on the joint

Insiden : (2 : 1) 1:1 (45-55 thn), > > >

(>55 thn)
11
Usia 20-60 (puncak 40-50) 50-60 20-30 30-50
12
 RA OA AS Gout
Sendi yang - PIP, MCP, MTP joint - Primer : knee, - Sacroiliac joint >> MTP I, ankle,
paling sering - Hand & wrist MTP,DIP,CMC,hip, - Lumbar vertebra > knee, wrist,
terlibat - Cervical spine (C1-C2) spine - Thoracic vertebra elbow, jari tangan
- Ankle,hip & knee - Sekunder : elbow, - Certvical vertebra (asimetris)
- Shoulder shoulder
(keterlibatan bilateral,simetris & (keterlibatan unilateral,
poliartikular) asimetris &
monoartikular, sendi
weight bearing)

Ekstra - (+) (-) - (+) - (+)

artikuler - skin (subcutaneous nodules, vasculitis - Iritis >> - ginjal : nefropati
lesion) - Cardiac gout
- ocular (keratoconjunctivitis, - Apical pulmonary - saluran kemih :
episcleritis, scleritis) fibrosis batu asam urat
- pulmo (pleurisy, pulmonary fibrosis ) - Amyloidosis di sal. kemih
- cardiac ( pericarditis, valvular heart - Neurologic (cauda
disease) equine synd, C1-
- gastrointestinal (gastritis, peptic ulcer) C2 subluksasi
- renal
- neurologic (entrapment neuropathies)
- hematologic (hypochromic-microcytic
anemia, feltys synd)
13
OSTEOARTHRITIS

14
 RA OA AS Gout
Saat Paling terasa di pagi Nyeri bertambah saat Nyeri daerah sendi Nyeri yang sangat
terjadinya hari, berkurang dengan beraktivitas (weight SacroIliac biasanya pada dini
nyeri & kegiatan selama siang bearing), Nyeri hari
kekakuan hari berkurang dengan Nyeri & kekakuan
istirahat punggung
Articular Gelling [Link] lebih
kekakuan stlh istirahat terasa di pagi hari
lama/inaktifitas, & berkurang selama
kekakuan hilang dlm siang hari,
bbrp menit stlh aktifitas

Sifat rasa - Ringan - Ringan sedang - Persistent - Sangat nyeri smp

sakit - Hilang dengan Nyeri bertambah saat symptom min 3 bbrp hari
istirahat beraktivitas (weight bulan - Diikuti nyeri
- Berlangsung selama bearing), Nyeri yang berkurang
berbulan2 berkurang dengan secara
- Tanpa berkurang rasa istirahat menyeluruh
sakit berarti 15
 RA OA AS Gout
Morning >1-2 jam <30 menit 3 jam (-)
stiffness

Gejala - Low grade fever - fever (-) - Low grade fever - Acute :
konstitusional without chills - Fatique Fever, chills,
- Fatique - Weight loss malaise
- malaise

Atrofi otot Di sekitar sendi Di sekitar sendi Di sekitar sendi (-)

yang terkena yang terkena yang terkena

Bentuk sendi - Pembengkakan - Pembengkakan - Pembengkakan - Pembengkakan

periartikuler (+) periartikuler (-) periartikuler (-) periartikuler (+)
- Efusi sendi (+) - Efusi sendi (-) - Efusi sendi (-) - Efusi sendi (+)
- Kemerahan pada
sendi MTP I
joint (podagra)
16
MORNING STIFFNESS

17
CUCURULLO
 RA OA AS Gout
Hasil Rheumatoid Factor Tidak ada HLA-B27 (+) Kristal MSUM di dalam
pemeriksaan LED kelainan ESR & CRP cairan sendi : keruh,
laboratorium CRP + Anemia lekosit 20rb-100rb/ml
CBC : normochromic/ Hiperuricemia
trombocytosis, normocytic (peningkatan kadar
hypochromic RF & ANA (-) asam urat sampai 2x SD
microcytic anemia, diatas nilai normal)
eosinophilia - : > 7 mg/dl
Synovial fluid - : > 6 mg/dl
analysis : viskositas Kadar as urat urin 24
rendah, WBC (1- jam : > 750-1000 mg/24
75rb mm3), >70% jam
PMNs, transparent Cek juga KGD, ureum,
cloudy kreatinin, profil lipid
CCP (Cyclic C darah
Peptide):
sensitifitas 53-68%

18
 RA OA AS Gout
Radiografi Marginal bone Osteophyte Sacroiliac joint Acute gouty
erosions formation narrowing o Soft tissue swelling
Juxta articular Asimetris fusion, symmetric around the affected joint
osteopenia narrowing of Pseudo-widening o Asimetris
Simetris the joint space of the joint space o Predileksi : MTP dig 1,
Predileksi swelling of Subchondral o Subchondral fingers,wrist, elbow
joint di wrist, bony sclerosis bone resorption- Chronic tophaceous
MCP,PIP,MTP bukan Osseous cysts blurring o Tophi : as nodules in
DIP, talonavicular (subcondral o Erosion sclerosis lobulated soft tissue
joint cysts) o Calcification masses
Erosi ulnar styloid, Erosi (-) ankylosis o Bone erosions develop
metatarsal head dari Bamboo spine near tophi just slightly
MTP joint Syndesmophyte removed from the
Early : Soft tissue formation periarticular surface,
swelling, joint Osteopenia/bone develop overhanging
space, osteophenia wash out (+) margins (punched out
Late : uniform joint Straightening of lesion)
space narrowing, the C-spine
malalignment, fusi Hip & shoulder Joint space is preserved
sendi, erosi involved to a lesser Osteopenia (-)
extent 19
X-Ray Findings in Osteoarthritis

20
BRADDOM
X-Ray Findings in Osteoarthritis

21
BRADDOM
 Kellgren-Lawrence
Radiographic Grading Scale

22
BRADDOM
 RA OA AS Gout
Joint Hand & wrist Hand & wrist - Lumbar lordosis
deformity o Boutonniere (fleksi PIP, hiperekstensi DIP & MCP): o Heberdens - Thoracic kyphosis thopous
tripoint finger splint node : spur - Cervical ankylosis
oSwan neck (kontraktur fleksi MCP, hiperekstensi PIP, formation - Lumbar spine or
fleksi DIP) : swan neck ring splint at the DIP lower cervical :
oDeviasi ulnar jari : ulnar deviation splint joint sering fraktur
oTenosynovitis flexor tendon sheath (De Quervains synd) o Bouchards - Hip & shoulder :
Atlantoaxial joint subluxation nodes : PIP onset juvenile (<16
Foot & ankle thn)
oHammer toe deformities Menyebabkan
oClaw toe deformities ekspansi ddg dada
oHallux valgus restrictive lung
oDeviasi lateral jari disease
oTarsal tunnel synd
Hip
oProtrusion acetabulum
Shoulder
oGlenohumeral arthritis
oFrozen shoulder
Elbow
oOlecranon bursitis
oUlnar neurophaties
Knee
oPopliteal (Bakers) cyst
23
oFlexion contracture
Typical deformities and x-ray findings in RA

24
BRADDOM
Boutonnire Deformity Swan Neck Deformity

25
CUCURULLO
Typical deformities and x-ray findings in RA

26
BRADDOM
Monoarticular gout tophi deposits

27
BRADDOM
The American College of Rheumatology
Knee OA

28
BRADDOM
The American College of Rheumatology
Hand OA

29
BRADDOM
The American College of Rheumatology
Hip OA

30
BRADDOM
 American Rheumatology Association (ARA)
1988 Rheumatoid Arthritis

Harus memenuhi 4 dari 7 kriteria 31

Kriteria 1 - 4 harus ada minimal 6 mgg BRADDOM
 AS Gout
Kriteria New York (1984): ARA :
Kriteria klinis : Terdapat kristal monosodium urat didlm cairan
o Nyeri pinggang min 3 bln, tdk sendi atau
berkurang dengan istirahat, Terdapat kristal monosodium urat didlm tofi
membaik dengan gerak atau
o Pembatasan gerak vertebra lumbal Didapatkan 6 dr 12 :
pada bidang sagital & frontal oInflamasi maks pd hr I
o Pengembangan dada menurun oSerangan arthritis akut > 1x
Kriteria radiologis oArthritis monoartikuler
oBilateral sacroilitis grade 2-4 oSendi yg terkena berwarna kemerahan
Atau oPembengkakan & nyeri pada sendi MTP I
oUnilateral sacroilitis grade 3-4 oSerangan pada sendi tarsal unilateral
oAdanya tofus
Disebut SA definitif apabila oHiperurisemia
didapatkan 1 kriteria klinis + oRadiologi : pembengkakan sendi asimetris
radiologis oRadiologi : kista subkortikal tanpa erosi
oKultur bakteri cairan sendi (-) 32
 RA OA
Treatment Education Education
o Joint protection o Weight loss
o Home exercise program PT/OT :
Relative rest : acute inflamed o ROM, strengthening, aerobic exerc
Exercise : o Assistive device
o Acute, severe inflamed joint : splinting utk o Modalitas Cryotherapy, TENS
immobilisasi + twice daily full & slow PROM o Joint protection & energy conservation
o Mild disease : isometric exercise Medication
o Isotonic, Isokinetic must be avoided o Acetaminophen : Pct 4 x 1gr
Modalitas : o NSAIDs
o Superficial heating : paraffin o COX-2 inhibitor
o Cryotherapy : acute inflamed o Analgesic narcotics : tramadol
Orthotic joint rest, prevent deformities o Intra-articular steroid or hialuronan or NSAID : max
Medication 3x/thn
o NSAID o Topical : krem NSAID, salisilat atau capsaicin
o DMARD (Disease Modifying Antirheumatic Drugs) Suplemen : glucosamine, condroitin sulfat
: metotreksat, sulfazalasin, hidroksikloroquin, Surgery :
garam emas, minosiklin, azatioprin siklosporin, D- o Arthroscopic debridement
penisilamin o Osteotomi tibial tinggi
o Kortikosteroid o Arthroplasti
o Agen biologi : anti TNF, anti IL-1, anti sel bodi Terapi terbaru : Stem cell mesenkim (asalnya tlg rawan)
Surgery Memperbaiki jaringan tlg rawan yg rusak dgn
o Synovectomy berdifferensiasi.
o Arthroplasty Tlg rawan sendi hialin: saraf, pemb darah, jar limfe (-)
33
o Arthrodesis
o Tendon repairs
Tripoint finger splint

Swan neck ring splint

34
 AS Gout
Education Penatalaksanaan :
o Good posture Akut : kolkisin, NSAID, steroid
o Firm mattress, sleep straight-supine or Jangka pjg utk mengatasi hiperurisemia &
prone mencegah komplikasi : allopurinol or probenesid
o Prevent flexion contractures Pencegahan serangan akut gout :
PT o kolkisin 1-2x0,5 mg/hr walaupun hiperurisemia (-
o Spine mobility-extension exercise ), diberi 12 bln stlh serangan akut terakhir
o Swimming o hindari diuretic tiazid, asetosal dosis rendah,
o Joint protection fenilbutazon, pirazinamid
Pulmonary- maintain chest expansion o vol urin hrs 1 ml/menit
o Deep breathing exercise o koreksi obesitas dgn diet
o Cessation of smoking o hindari alcohol ( ekskresi as urat), bir
Medications : mengandung purin
o NSAID indocin o hindari makanan yg mengandung tinggi purin
o Corticosteroid
o Sulfasalazine
o Methotreksat
o Topical corticosteroid drops uveitis
35
 Arthritis is one of the most common
manifestations of systemic lupus erythematosus
(SLE)
Less inflammatory than in RA
Deformities in the joints
The hand and knee are most typically involved.
Avascular necrosis (AVN) typically occurs in
larger joints such as the hip and knee.
Periarticular structures can be inflamed, leading
to tendonitis, tenosynovitis, and tendon
rupture.
Management : NSAIDs, antimalarial drugs, and
low-dose corticosteroids

BRADDOM 36
BRADDOM 37
 Pemeriksaan KFR pada arthritis

ANAMNESIS
Riwayat penyakit sekarang :
- Keluhan nyeri & deskripsi, lokalisasi & penyebaran
- Kaku sendi
- Kelemahan otot & nyeri otot
Faktor resiko
Riwayat penyakit dahulu
Riwayat pekerjaan
Riwayat kegiatan/olahraga
Kemampuan fungsional sebelum sakit
Riwayat psikoekonomi
Harapan pasien 38
 PEMERIKSAAN UMUM
Tanda vital
Status gizi : BB
Pemeriksaan sistem kardiorespirasi
Pemeriksaan sistem muskuloskeletal lain
PEMERIKSAAN DASAR KFR
Inspeksi : alignment, deformitas, pembengkakan, tinggi
bahu, tinggi cristailiaka, kista Baker, lordosis cervikal, lumbal
& kifosis thorakal
Lingkup gerak sendi
Atrofi otot
Tonus, ketahanan dan kekuatan otot
Refleks
Balans & kontrol trunk
Pola jalan/gait
ADL
Psikologis 39
 PEMERIKSAAN KHUSUS
Muskuloskeletal : sendi, otot, tulang
Neuromuskuler
PEMERIKSAAN PENUNJANG & PENCITRAAN :
X foto
Sampel darah, urin, cairan sendi,
USG
PEMERIKSAAN FUNGSIONAL
FIM

40
 Diagnosis fungsional & beratnya penyakit/ tahapan
arthritis spesifik
Prognosis fungsional & tujuan tatalaksana KFR
Metode intervensi KFR sesuai perjalanan
penyakit/tahapan arthritis serta orthosa &/ alat
bantu
Evaluasi hasil terapi KFR & tindak lanjut
tatalaksana
Mengenali masalah dan penyulit, melakukan
antisipasi untuk mencegahnya & penanganan
&/rujukan bila diperlukan
41
KNEE ANATOMY

42
KNEE DEFORMITIES

43
TROPHY [Link]

44
ROM KNEE

45
 Q angle (Quadricep angle)
Sudut yang dibentuk diantara tarikan m
quadricep & tibial shaft pada posisi supine
: 8-14
: 18
Diukur diantara garis dari SIAS ke patellar
midpoint & garis dari tibial tubercle melalui
patellar mid point

Genu valgum (knock knee) : pusat knee joint

jatuh pada medial dari axis yg menghubungkan
pusat hip & ankle joint
> 3 cm jarak antara malleolus medial posisi
berdiri
Genu varum (bow leg) : pusat knee joint jatuh
pada lateral dari axis yg menghubungkan pusat
hip & ankle joint
> 3 cm jarak antara condillus femoralis medial
46
posisi berdiri
MMT [Link] & M. HAMSTRING

47
VALGUS & VARUS STRESS TEST

48
ANTERIOR & POSTERIOR DRAWER TEST

49
MC MURRAY TEST

50
51
APLEYS COMPRESSION & DISTRACTION

52
PELVIC ROCK TEST
Patient lie supine
Thumb SIAS
Palm Illiac tubercle
Compress the pelvis
toward the midline of the
body
Pain Sacro Iliac Joint
(+)
- Infection
- Secondary to trauma

53
 GAENSLENS SIGN

Drop unsupported leg

Draws both legs to his chest pain in the SI Joint (+)

54
PATRICK / FABERE TEST
Patient lie supine
Hip Joint Flexi, Abduction,
Exorotation
Inguinal Pain (+)
- Pathology in the hip joint
- Or surrounding muscle
One hand in the SIAS opposite
site
Another hand in the affected
knee joint
Press down these 2 points
Pain (+)
- Sacro Iliac pathology
55
SCHOBER TEST

Detecting limitation of forward

flexion and hyperextension of
the lumbar spine.
Standing erect place a
landmark midline at a point 5
cm below the iliac crest line
and 10 cm above on the
spinous processes
On forward flexion the line
should increase 5 cm
< 5 cm restriction

56
TRENDELENBURG TEST

57
TRUE LEG LENGTH

58
TRUE LEG LENGTH

59
60
APPARENT LEG LENGTH

61
OBER TEST

62
63
64
GOAL Maintenance and restoration of function
as well as prevention of dysfunction.
INTERVENTION Individualized treatment plans
to maximize patient function by :
Education
Physical modalities

Exercise
Assistive and adaptive devices
Energy conservation

Joint protection
Vocational planning

DE LISA 65
 Istirahat lokal (Local Rest) FASE AKUT / SUB
AKUT
TUJUAN :
- Mengurangi nyeri
- Mengurangi peradangan pd sendi
INTERVENSI :
At night nonfunctional resting splints
During the day functional splints
Short rest periode during the day of 20 to
30 minutes splints
ADD :
One ROM exercise daily for joints during rest of 2
weeks duration
MODUL IKFR DE LISA 66
 TUJUAN :
- Pemeliharaan dan peningkatan LGS
- Penguatan otot
- Peningkatan ketahanan
- Peningkatan fungsi secara menyeluruh

INTERVENSI :
- Passive Exercise
- Active Exercise

MODUL IKFR DE LISA 67

 INDIKASI FASE AKUT / SUB AKUT
passively or actively move the acute joint
(PROM / AROM Exercise) through the
tolerable range once or twice a day to
prevent motion loss.
CAUTION
PROM should be : gently
IF NOT Increase intra-articular pressure
in the presence of joint effusion rupture of
the joint capsule

68
Isometric (static contraction)
INDICATION patients with significantly
biomechanically compromised joints
ADVANTAGE muscle tension can be generated with
minimal joint stress
CAUTION isometric exercise in an inflamed joint is
not recommended
PRESCRIPTION 3 X daily 2/3 maximal contractions
held for 6 seconds, with 20 seconds of rest between
each
With isometric exercise, muscle strength is only
achieved at the angle at which the muscle is trained.
69
Isotonic (dynamic contraction)
INDICATION for patients without acutely
inflamed or mechanically deranged joints
(Because it stresses the joint throughout its
ROM)
PRESCRIPTION A lowload resistive muscle
training program light weights (1 to 3 lb)
and 10 repetitions.
Strength is achieved throughout the range

Isokinetic dynamic contraction

Isokinetic exercise should not be used in
arthritic patients (with joint effusion, Baker
cyst, ligamentous laxity, acute joints, or joint
replacements)

70
 Patients with systemic RD limited
endurance and their ability to perform static
or dynamic tasks is impaired
PRESCRIPTION :
an exercise program of at least 60%
maximal heart rate 20 minutes at least
two times a week for 6 weeks

71
 INDICATION
to prevent contractures and maintain or
restore ROM by breaking capsular adhesions.
CONTRA INDICATION
acute inflammation

72
 Swimming is an excellent form of isotonic
exercise for arthritis patients because gravity
is eliminated and ROM of the joints is less
painful.
Dancing have shown increased strength,
flexibility, and aerobic capacity, decreased
joint pain and depression

73
HEAT
Mainardi et al. found no increase and no
decrease in joint destruction and inflammatory
activity in the hand in RA with the use of
superficial heat.
When joint temperature is increased from 30.5C
to 36C, as it is in active RA, collagenase found in
rheumatoid synovium is four times as active,
resulting in lysis of cartilage
HEAT EFFECT :
- Heat can raise the threshold for pain
- Heat affects the viscoelastic properties of
collagen
DE LISA 74
COLD
Some clinical studies have shown greater and
more prolonged relief of pain with ice than
deep or superficial heat in patients with RA.
COLD EFFECT :
- decrease the pain threshold
- can relax surrounding spastic muscles by
direct action on the muscle spindle activity
- decrease joint temperature
- inhibit collagenase activity in the synovium

DE LISA 75
 FUNCTION :
- unweight joints
- stabilize joints
- decrease joint motion
- support joints in a position of maximal function
- increase joint motion (dynamic splint)
UPPER EXTREMITIES Hand and Wrist
- Resting splints
- Functional wrist splints
- Thumb post splints
- Ring splints
- Dynamic splints.
DE LISA 76
Resting splints
Immobilize the hand and
wrist
Are used at night for
patients with :
- active RA
- CTS
- extensor tendinitis
Functional wrist splints
Extend to the mid-palmar
crease permit finger
function, block wrist
flexion
Are used for activities
during periods of 77
inflammation.
 A functional thumb Thumb spica
postsplint De Quervain
to relieve CMC and IP
pain associated with
OA.

78
Tripoint finger splint

Swan neck ring splint

79
Ulnar deviation splint

80
 LOWER EXTREMITIES Foot and Ankle
RA Excess pronation at the subtalar joint,
loss of the medial arch, and subtalar
movement pain tarsal tunnel syndrome

81
 RA ankle a short-leg patellar tendon-
bearing orthosis shifts weight away from
the ankle to the patellar tendon

82
 OA, RA Hallux Valgus deformity Silicone
Soft Insert

83
 OA Laxity OA Varus / Valgus
Ligament Dynamic deformity Knee
Splint Brace with lateral /
medial pad

84
 FUNCTION :
- compensate for limited ROM and pain
- help promote independence and lesser
impairment, and disability
- improve patient function

DE LISA 85
Walker Platform Crutches

Distribute weight on
the forearm
Reducing the need for
wrist extension and
eliminating weight-
bearing forces
through the wrist and
hand

86
DE LISA
Dressing Stick

Zipper hooks Shoehorns Clip & Pull Pants Assist

Button hooks Large-handled Dressing Stick87

Clothing made with Velcro

Long-handled sponges

88
 shower with a seat
elevated toilet seats

89
Principles techniques to reduce force across
joints :
using the largest possible joints to support
activity
avoid overuse by interrupting sustained
activity with rest periods
using adaptive equipment and strategies for
efficient use of joints
using splints when limbs need to be
supported in functional positions

DE LISA 90
Principles techniques to maximize function
with energy-efficient :
orthotics

assistive devices ambulation

adaptive aids and clothing
proper environmental design
rest periods throughout the day
maintenance of ROM and strength
maintenance of proper posture

DE LISA 91
 The Health Assessment Questionnaire (HAQ)
disability index
The Arthritis Impact Measurement Scales 2
(AIMS2)
The Western Ontario and McMaster
Universities Arthritis Index (WOMAC)
Short Form health survey (SF-36)

BRADDOM DE LISA 92
 Indications : the restoration or preservation
of joint mechanics and function, and relief of
pain, improve function
Hip Replacement surgery patients with RA,
SLE (avascular necrosis), and AS
Total Knee Replacement surgery patients
with bi- and unicompartmental joint space
destruction, persistent pain, and functional
loss

DE LISA 93
 Teaching the patient crutch walking with the
appropriate type of crutch
weight reduction for the obese patient
Strengthening of the quadriceps before knee
replacement and the hip abductors before hip
surgery.

DE LISA 94
 The rehabilitation management goals of a
total joint replacement program are :
- to relieve pain
- to redevelop comfortable musculoskeletal
function
- to use joint protection techniques to avoid
overstressing the prosthetic joint

DE LISA 95
 ROM started immediately with ankle pumps
Isometric exercise to the quadriceps
Stand (bedside) with :
- Full Weight Bearing cemented
- Partial Weight Bearing uncemented
Patients are placed in an abduction sling
Told to restrict hip flexion to less than 90
degrees use an elevated toilet seat and an
elevated chair seat
AVOID adduction and internal rotation (IR)
Discharge from the hospital fifth day
Strengthening quadriceps, hip abductor, and
hip flexor DE LISA 96
 Knee ROM started immediately
(w/continuous passive motion machine)
Total weight bearing (to tolerance) with
crutches and ambulation is started on the
first postoperative day using crutches or a
walker
Active assistive flexion is the basic of
management and usually needs to be done
under supervision of the physical therapist

DE LISA 97
98