RA/SLE 3.

General state:
ANAMNESIS a. Eye: iridocyclitis, visual acuity, anemia
6. Fall:
1. Identity: age, job b. Head: Micrognathia/ underdeveloped
a. History of fall
2. Chief complaint: mandibular (polyarticular), mallar rash
b. History of near fall
a. Pain/swelling/warm/stiffnesschild irritable (SLE)
c. Instability when walking
b. Ambulation, child stop walking c. Neck: Lymphadenopathy, pain,
d. Fear of fall
c. Fall: instability when walking/fear of fall subluxation (atlanto-axial instability)
e. Mechanism of fall
d. Fatigue/endurance d. Skin: salmon colored rash (systemic
f. Risk factor
3. Joint pain: JRA)  palm
i. Intrinsic: age, sensory, motoric, visual,
a. Site: symmetric 4. UE look: trophy, inflammation (wrist, MCP,
cognitive (elderly)
b. Onset PIP, elbow) ; deformity (boutonnierre, swan
ii. Extrinsic: footwear, medication,
c. Characteristic neck, ulnar deviation, Z-shaped deformity,
environment
d. Radiation rheumatoid nodule)
7. Therapy and progressivity
e. ADL 5. UE feel: tenderness, tone, spasm, warm,
a. Medication
f. Time propioceptive
b. Exercise
g. Exacerbation 6. UE move: ROM, crepitation, MMT
c. Modalities
h. Severity 7. Special test: finkelstein test, piano key sign,
d. Orthosis
4. ACR criterias of RA: pseudobenediction sign
e. Walking aid
a. Morning stiffness> 1 hour 8. Hand prehension
f. Injection
b. Arthritis > 3 joints Standing
g. Surgery
c. Arthritis of hand joints 9. Transfer sit to stand
h. Home program
d. Symmetric arthritis 10. Posture
8. Limitation in activity/ADL
e. Rheumatoid nodule a. Anterior: shoulder, body arm distance, knee
a. Ambulation
f. Serum RF (+) b. Posterior: shoulder, scoliosis, pelvic
b. Hand function
g. Radiographic changes obliquity, ankle valgum/varum
c. ADL
*Arthritis: swelling, warmth, tenderness, pain, c. Lateral: forward head, hiperkyphosis,
d. Restriction in job/school/leisure
stiffness after sleep or rest, limited ROM hiperlordosis, knee flexion,
9. Comorbidity
5. Other complain/extraarticular manifestation: pronated/supinated foot, equinus
10. Family history
a. Fatigue 11. Chest Expansion
11. Environmental factor: family, accessibility at
b. Anemia 12. Gait: no knee locking, decreased stance phase
home, financial, insurance
c. Subcutaneous nodule of affected limb/antalgic gait, equinus
12. Personal factor: work/school, psychological
d. Scleritis, iridocyclitis (pauciarticular JRA) Supine
problem, hope
e. Neuropathy 1. General State
PHYSICAL EXAMINATION (patient dressed)
f. Myositis, vasculitis a. Cor: Pericarditis, myocarditis
Sitting
g. Pericarditis, myocarditis b. Lungs: Interstitial pneumocytis
1. Vital sign
h. Interstisial pneumonitis c. Hepatosplenomegaly
2. Nutrition
i. Sjogren syndrome
 d. Skin: salmon colored rash (systemic a. Ambulation a. Education of high risk of fall
JRA)  trunk, extremity b. ADL b. Walking aid
2. LE look: inflammationankle, talonavicular, c. Restriction in job/school/leisure c. Home modification
MTP; deformity (claw toe/hammer toe, hallux 2. Impairment: Long term
valgus), rheumatoid nodule, a. Knee pain/swelling/stiffness 1. Children optimize growth and development
Trophy if atrophythigh circumference b. Bursitis Adult prevent further deformities
3. LE feel: ballotement, tone, tenderness, warm c. Contraction/contracture a. Education of prognosis and compliance
hip, knee, ankle, foot; d. Muscle spasm to medication
Spasm, sensory, proprioceptive e. Atrophy b. Nutritional management
4. LE move: f. Joint deformities c. Exercise: isometric in acute; isotonic &
a. Pain, crepitation g. Postural imbalance stretching in nonacute
b. ROM hip flexion, abduction, 3. Risk/history/fear of fall d. Proper body mechanis:
internal/external rotation, knee extensor, 4. Associated problems 2. Management of associated problems
ankle dorsi/plantarflexor a. Visual impairment 3. Return to work/school
c. MMT hip flexion, knee extensor b. Low endurance/fatigue
5. Special testif adult and knee pain (+) c. Neuropathy:weakness, hipestesi DIAGNOSTIC CRITERIA
a. Patellar grinding test 5. Psychosocial problems
b. Valgus/varus
c. Mcmurray REHABILITATION GOALS
d. Fair/fabere test Short term
e. Drawer test 1. Confirmed diagnosis: X-ray/USG
f. GaleazziLLD Ro cervical with open mouth AAS
Sidelying 2. Control inflammation symptoms (pain, stiffness,
1. MMT hip abduction swelling) Improve activities
Prone a. Medication!!!
1. Trunk look: deformity, b. RICE
2. Trunk feel: spasm, tenderness, taut band c. Modalities
3. LE look: inflammation d. Injection
4. LE feel: tone of hamstring/gastroc e. Orthosis, splinting
5. LE move: f. Walking aid
a. ROM hip extensor, knee extensor g. Education of joint protection
b. MMT hip extensor, knee flexor, ankle 3. Maintain functional activity Micrognathia due to: the disease directly affects the
plantarflexor a. Assistive device growth center of the condyle, the presence of
6. LE special test: appley, distraction test b. ADL training misplaced and unused teeth in the young affects
c. Hand function training
the mandibular growth
REHABILITATION PROBLEMS d. Energy conservation
1. Activity/participation: 4. Prevent fall
 3. What is the mechanism of ulnar deviation of the
fingers? How is it treated?
Weakening of ECU, ulnar and radial collateral
ligaments, resulting in wrist and finger deviation
in the ulnar direction. Treated with ulnar
deviation splint.
4. What occurs in tenosynovitis of the flexor
tendon sheath?
Diffuse swelling of volar surfaces of the
phalanges between the joints with grating of
flexor tendon sheath.
5. What is a pseudobenediction sign?
6. Extensor tendons rupture due to abrasion from
rubbing on sharp elevated ulnar styloid,
resulting in inability to extend 4th and 5th
digits.

Hand deformities in rheumatoid arthritis

1. What is a Boutonniere's deformity? How is it
treated?
Caused by weakness/rupture of terminal
portion of extensor hood resulting in extensors
of the PIP slipping and becoming flexors. This
causes flexion of the PIP, hyperextension of the
DIP and MCP. (Position of finger as if buttoning
a button.) Treat with tripoint finger splint.
2. What is a swan neck deformity? How is it
treated
Caused by contracture of intrinsic and deep
flexor muscles and tendons of fingers, resulting
in flexion contracture of MCP, hyperextension
of PIP, and flexion of DIP. Treat with swan neck
ring splint