Tag Archives: splints

Juvenile Rheumatoid Arthritis

July 19, 2016 Teresa Stockton - Blog, Pediatrics

Definition

Juvenile rheumatoid arthritis (JRA), also known as juvenile idiopathic arthritis, is a disease of the joints in children. It can affect a child over a long period of time. JRA often starts before the child is 16 years old.

In Juvenile rheumatoid arthritis, the joint becomes swollen. It will make the joint painful and difficult to move. JRA can also lead to long term damage to the joint. For some, JRA can interfere with the child’s growth and development.

There are 5 major types of juvenile rheumatoid arthritis:
• Pauciarticular JRA—4 or less joints are affected in the first 6 months of illness
• Polyarticular JRA—5 or more joints are affected in the first 6 months of illness
• Enthesitis associated arthritis—swelling of the tendon at the bone
• Psoriatic arthritis—associated with a skin disease called psoriasis
• Systemic onset JRA (also called Stills disease)—affects the entire body, least common type of JRA

Causes

Juvenile rheumatoid arthritis is caused by a problem of the immune system. The normal job of the immune system is to find and destroy items that should not be in the body, like viruses. With JRA, the immune system attacks the healthy tissue in the joint. It is not clear why this happens. The immune system problems may be caused by genetics and/or factors in the environment.

People of Hispanic American, Asian American, Pacific Islander, Native American, or African American descent are at higher risk.
Having prediabetes means that you are at high risk for developing diabetes and may already be experiencing adverse effects of elevated blood sugar levels.

Risk Factors

Girls are more likely to get JRA than boys.

There are no clear risk factors for JRA. Factors that may be associated with some types of JRA include:
• Family history of:
• Anterior uveitis with eye pain
• Inflammatory back arthritis (ankylosing spondylitis)
• Inflammatory bowel disease

Symptoms

• Symptoms may include:
• Joint stiffness, especially in the morning or after periods of rest
• Pain, swelling, tenderness, or weakness in the joints
• Fever
• Weight loss
• Fatigue or irritability
• Swelling in the eye—especially associated with eye pain, redness, or sensitivity to light
• Swollen lymph nodes
• Growth problems, such as:
• Growth that is too fast or too slow in one joint (may cause one leg or arm to be longer than the other)
• Joints grow unevenly, off to one side
• Overall growth may be slowed

Some symptoms are specific to each type of juvenile rheumatoid arthritis . For example:
• Symptoms common with pauciarticular JRA include:
• Problems most often found in large joints. These joints include knees, ankles, wrists, and elbows.
• If the left-side joint is affected, then the right-side similar joint will not be affected. For example, if the right knee is affected, then the left knee will be healthy.
• May also have swelling and pain at on the tendons and ligaments attached to the bone

• Symptoms common with polyarticular JRA include:
• Problems found most often in small joints of the fingers and hands. May also affect weight-bearing joints like the knees, hips, ankles, and feet.
• Joints on both sides of the body are affected. For example, if the left hand is affected, then the right hand will also be affected.
• May also have a blood disorder called anemia. This is an abnormally low number of red blood cells.
• One type of polyarticular JRA may occur with:
• A low-grade fever
• Nodules—bumps on parts of body that receive a lot of pressure such as elbows

• Symptoms common with systemic onset JRA include:
• Some of the first signs may be a high fever, chills, and a rash on the thighs and chest. May appear on and off for weeks or months
• May have swelling in the heart, lungs, and surrounding tissues
• The lymph nodes, liver and/or spleen may become enlarged
• Children with enthesitis arthritis often have tenderness over the joint where the pelvis and spine meet.
• Children with psoriatic arthritis often have finger or toe swelling. There may also be damage on fingernails.

Often, there are remissions and flare-ups. Remission is a time when the symptoms improve or disappear. Flare-ups are times when symptoms become worse.

Diagnosis

You will be asked about your child’s symptoms. You will also be asked about your family medical history. A physical exam will be done. An eye examination may also be done to check for swelling in the eye. Your child may be referred to a specialist if JRA is suspected. The specialist is a doctor that focuses on diseases of the joints.

Images may be taken of your child’s bodily structures. This can be done with x-rays.

Your child’s bodily fluids may be tested. This can be done with:
• Blood tests
• Urine tests
• Tests of joint fluid

Treatment

Talk with your doctor about the best plan for your child. The plan will work to control swelling, relieve pain, and control joint damage. The goal is to keep a high level of physical and social function. This will help keep a good quality of life. Treatment options include the following:

Medication

There are several types of medication that may be used:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)—to help swelling and pain
• Disease-modifying antirheumatic drugs (DMARDs)—to slow the progression of the disease
• Tumor necrosis factor (TNF) blockers—to decrease swelling, pain, and joint stiffness
• Interleukin inhibitors—to reduces disease activity
• Corticosteroids through IV or by mouth—for swelling
• Steroid injections into the joint—may help relieve swelling and pain in some children

Polyarticular JRA may become inactive in children who begin medications within 2 years of onset.

Physical Therapy

Exercise is done to strengthen muscles and to help manage pain. Strong nearby muscles will support the joint. It also helps to recover the range of motion of the joints. Normal daily activities are encouraged. Non-contact sports and recreational activities may be good options. Physical activities can also help boost a child’s confidence in their physical abilities.

Physical therapy may be needed. This will help to make the muscles strong and keep the joints moving well.

Maintenance Devices

Splints and other devices may be recommended. They may be worn to keep bone and joint growth normal. Some joints may get stuck in a bent position. These devices can help prevent this.

Prevention

There is no known way to prevent JRA.

by Jacquelyn Rudis

RESOURCES:
American College of Rheumatology
http://www.rheumatology.org

Arthritis Foundation
http://www.arthritis.org

CANADIAN RESOURCES:
The Arthritis Society
http://www.arthritis.ca

Health Canada
http://www.hc-sc.gc.ca

REFERENCES:

Hofer MF, Mouy R, et al. Juvenile idiopathic arthritides evaluated prospectively in a single center according to the Durban criteria. J Rheumatol. 2001. 28:1083.

Juvenile idiopathic arthritis (JIA) enthesitis related. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 16, 2015. Accessed December 21, 2015.

Juvenile idiopathic arthritis (JIA) oligoarticular. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 16, 2015. Accessed December 21, 2015.

Juvenile idiopathic arthritis (JIA) polyarticular. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 16, 2015. Accessed December 21, 2015.

Juvenile idiopathic arthritis (JIA) systemic-onset. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 16, 2015. Accessed December 21, 2015.

JAMA Patient Page. Juvenile idiopathic arthritis. JAMA. 2005;294:1722.

Petty RE, Southwood TR, et al. Revision of the proposed classification criteria for juvenile idiopathic arthritis: Durban, 1997. J Rheumatol.1998; 25:1991.

2/5/2013 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed: De Benedetti F, Brunner HI, Ruperto N, et al. Randomized trial of tocilizumab in systemic juvenile idiopathic arthritis. N Eng J Med. 2012;367(25):2385-95.

2/24/2014 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Limenis E, Grosbein HA, et al. The relationship between physical activity levels and pain in children with juvenile idiopathic arthritis. J Rheumatol. 2014 Feb;41(2):345-351.

9/2/2014 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Guzman J, Oen K, et al. The outcomes of juvenile idiopathic arthritis in children managed with contemporary treatments: results from the ReACCh-Out cohort. Ann Rheum Dis. 2014 May 19.

Last reviewed December 2015 by Kari Kassir, MD Last Updated: 12/20/2014

EBSCO Information Services is fully accredited by URAC. URAC is an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification and commendation.

Taping: A Pain Reliever When All Others Fail

August 13, 2015 Kevin - Blog, Sports and Fitness

“It’s gone” and “I can’t believe a little piece of tape can help that much”. These are typical comments made by patients after they have been shown how to tape their joints. Hand therapists have expanded the tricks in their bag of treatment options for pain reduction methods. Kinesio taping is now used as an effective pain reliever for hands. Patients who have not found traditional splints comfortable or effective now have an alternative. They report significant improvements in hand function with the use of simple taping techniques due to reduced pain.

HOW IT WORKS: Traditional splints have a history of mixed results. Hard or soft neoprene devices were used but patients often complained they were bulky, uncomfortable, and caused additional pain. Today’s therapists have borrowed taping techniques used by athletic trainers. These methods often decrease pain, provide external support for healing tissues, help reduce edema, and are less cumbersome than splints.
TAPE TYPES: Various types of tape may be used depending on the type of support needed and the patient’s tolerance of adhesives. Examples include McConnell and Kinesio tapes. Proper tape and adhesive, as well as wrapping styles, will maximize results.
EFFECTIVE TREATMENT AREAS: Typical pain-reducing taping areas include many of the typical painful hot spots in the hand such as the CMC joint, thumb, ulnar-sided wrist pain as well as joint ligament pain.
KINESIO TAPING ADVANTAGES: Taping is a low-profile alternative to traditional splinting. It provides custom relief to the area needing support. It is cost-effective in that a splint need not be purchased. It is easier for the patient and may result in better treatment compliance.

If you are a patient with hand or wrist pain talk to your physical or occupational therapist about taping as a low-cost practical method of pain relief. Information provided by our friends at Plymouth Physical Therapy Specialists

More PTandMe articles about Kinesio Taping can be found here:

How to Treat Tennis Elbow

June 30, 2015 Kevin - Arm, Blog

What Causes Tennis Elbow?

Tennis Elbow, also known as lateral epicondylitis is an inflammation of the tendon fibers that attach the forearm extensor muscles to the outside of the elbow. More recently it is believed that this condition is due to the degeneration of the wrist extensor tendons. Either way, this affects the muscles that lift the wrist and hand. Pain may be felt where these fibers attach to the bone on the outside of the elbow or along the muscles in the forearm. Overuse of the muscles and tendons of the forearm and elbow are the most common reasons people develop the injury. Repeating some types of activities over and over again can put too much strain on the elbow tendons. These activities are not necessarily high-level sports competitions. Hammering nails, picking up heavy buckets, or pruning shrubs can all cause the pain. Some patients, however, develop tennis elbow without any specific recognizable activity leading to symptoms.

How to Treat Tennis Elbow

Splints: Your physician or therapist may fit you with a strap to provide support to the involved muscles. Remember not to fasten the strap too tight as this can cause more problems. You may also be given a wrist splint to wear to provide rest to the muscles and tendons that bend and straighten the wrist. If your elbow is extremely tender, you will be provided with a heelbo or cushion to prevent the elbow from being hit. Wear these devices as directed. You can’t get better unless you wear the splints properly.

Ice and/or Heat Applications: Discuss with your physical therapist how to correctly apply ice or heat to the parts of your elbow and forearm that are involved. Icing can help reduce swelling/inflammation in the muscles and tendons that cause epicondylitis. Your therapist may also recommend heat to increase circulation in the area and decrease symptoms, especially if your condition is more chronic. Do not apply either for longer than 10 to 15 minutes at a time.

Stretching and Strengthening: Your physical therapist will instruct on how to treat tennis elbow by showing proper stretching and strengthening techniques as prescribed by your physician. Stretching improves the range of motion, increases circulation, and decreases muscle fatigue and swelling. Stretching the extensor muscle mass also provides tissue elongation to relieve muscle contractions. Strengthening helps build and tone the small muscles affected in epicondylitis, while hopefully decreasing pain and preventing a return of symptoms. Your therapist and physician will instruct you on what exercises to perform, when to begin them, and how often to complete the exercises.

Exercise Example from The Jackson Clinics

Sports: You may want to stop playing any racquet sports for now to allow adequate healing and reduction of pain. Also avoid sports such as baseball, bowling, or golf until you are pain-free. Weightlifting and bike riding can also pose problems. For tennis players, your serve, racquet, and ball all play important parts in your recovery, so be sure to speak about this with your physical therapist before resuming play.

Rest: Now that you have sought medical attention, you only get one opportunity to rest the arm and decrease your symptoms. This doesn’t mean you should stop using your arm and put it in a sling. It does mean you need to stop doing the activities and movements that cause inflammation and pain Follow the advice of your physician and therapist and discontinue activities that provoke pain.

Look at what you do and how you do it, not only in your work setting but at home, too. Remember, while tendonitis occasionally occurs from a one-time incorrect movement, it usually occurs from the overuse of a small muscle group. In other words, the continual repetition of incorrect movements will eventually stress the body, setting the stage for pain and inflammation.

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