DISEASE TREATED IN PHYSICAL THERAPY: RHEUMATOID ARTHRITIS - page 2

Rheumatoid arthritis is a disease often seen and treated in the physical therapy setting. This article, written from the point of view of a physical therapist, provides an overview of the disease, the prognosis for those afflicted, and common treatments.

Rheumatoid Arthritis - page 2

What Joints are typically involved?

Joint deformities in RA are a result of the synovitis involved with the disease as well as pannus (granular tissue) formation within the joint. Cartilage and bone damage result from this chronic inflammation. The patient's attempt to avoid painful positions leads to posturing the joint in the least painful position.

Resulting joint deformities include:

  1. Joint immobilizations
  2. Muscle spasm and shortening
  3. Bone and Cartilage destruction
  4. Ligament laxity
  5. Altered tendon function

Commonly affected joints:

  1. Cervical Spine
    • frequently involved.
    • neck stiffness
    • general motion loss
    • C1-C2 instability due to tenosynovitis of Transverse ligament
  2. Shoulder
    • presence of swelling often not detected.
    • motion loss is observed - Frozen Shoulder Syndrome
    • symptoms worse at night
  3. Elbow
    • easiest to detect.
    • flexion deformity common
    • Ulnar nerve neuropathies may develop
  4. Hand /Wrist/Fingers
    • almost all patients with RA have hand, wrist, MCP (metacarpalphalangeal) and PIP (proximal phalangeal) involvement.
    • ulnar deviation of MCP
    • radial deviation at wrists
    • Swan-neck deformities
    • Boutonniere deformities
    • "Z" deformity of thumb
    • rheumatoid Nodules along tendon sheaths
    • nodular thickening along flexor tendons of the palms
    • tendon Ruptures - most common Extensor Pollicus Longus
  1. Knee
    • effusion and synovial thickening
    • Baker's cyst
    • Flexion with valgus and external rotation tibia, posterior subluxation of tibia
  2. Hip
    • initial dysfunction usually difficulty putting on one's shoes and socks
  3. Foot & Ankle
    • lower extremity involvement leads to greater dysfunction and pain due to weight bearing role
    • widening of forefoot (Metatarsophalangeal) joints
    • dropping of metatarsal(MT) heads
    • distal displacement of MT fat pads
    • lateral deviation of 1st toe
    • claw or hammer toes
    • pronation and eversion of foot
    • tarsal tunnel involvement resulting in burning paresthesia


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