Full Course Description

Therapeutic Strategies for Degenerative Joint Disease: Overcoming Pain and Improving Function


Diagnostic Criteria for Degenerative Joint Disease (DJD)

  • American Medical Association (AMA) Guidelines
  • Arthritis foundation’s guidelines

Patient Presentation

  • Medical history
  • DJD v. Rheumatoid Arthritis v. Gout
  • Other Arthritic conditions

The Pathophysiology of DJD in:

  • Weight-bearing joints
  • Non-weight bearing joints
  • The spine

Joint Conservation

  • Silver Sneakers
  • Ergonomic work and home environments
  • Biomechanics
  • Positional awareness

Techniques to Maintain Mobility

  • Motion is lotion
  • Muscle balance
  • Joint stability
  • Diet and supplements
    • Super foods
    • Over the counter supplements

Medical Management

  • Medication
    • Benefits
    • Risks


  • Arthroscopy
  • Total joint arthroplasty
    • Total hip
    • Total knee
    • Total shoulder
      • Conventional
      • Reverse
  • Ankle
  • MCP replacement

Physical Therapy Management

  • Pre-Hab
    • Introduction of assistive devices
    • Pre-op exercise program
    • Smoking cessation
    • Weight reduction
    • Motivational interviewing techniques

Total Joint Regimens

  • Acute care post-op
    • Post-op teaching
    • Gait instruction specific to intervention
    • Exercise programs
    • Critical pathways
  • Precautions

Outpatient Rehab

  • Program Goals
  • Design of exercise regimen
  • Scar care management
  • Outcome measure
  • Gait Progression
    • Household v. community ambulation
    • Addressing the “What can I do?”
    • Mature adult
    • Middle-aged adult


  • 1+ year to complete recovery
  • Activity guideline
  • Quality of life
  • Cost benefits of activities


  1. Summarize the commonly-experienced condition of degenerative joint disease.
  2. Explain focused history taking techniques and examination methods to create diagnostic skills for evaluation of upper and lower extremity degenerative joints.
  3. Evaluate the decision-making processes regarding conservative and surgical treatment options for patients with degenerative joints.
  4. Obtain methods to effectively educate patients regarding: the arthritic process, treatment options, recovery steps, and long-term expectations.
  5. Describe recovery and rehabilitation stages to counsel and consult patients.
  6. Determine the strategies to share with patients to optimally prevent or delay arthritic changes.
Copyright : 10/19/2016

An Intensive Training Lab on Total Joint Replacements


Determinants for Joint Replacement

  • Muscle imbalance
  • Acute injuries
  • Chronic conditions
  • Systemic conditions

Pre-operative Selection Determinants

  • Postural deformity
  • Diagnostic imaging
  • Function and pain level
  • Conservative therapies
  • Physical co-morbidities
  • Relative bone density
  • Post-op considerations: Acute rehab? Skilled nursing? Home? Which is the right choice in terms of accessibility, assistance, activity restrictions, and length of time?

Surgical Procedures with Video Presentations

  • Total shoulder arthroplasty (TSA)
  • Reverse TSA
  • Total elbow arthroplasty
  • Total hip arthroplasty (THA), conventional posterior and lateral approaches
  • Anterior THA and THA revision
  • Total knee replacement (TKA), conventional and subvastus
  • Total ankle replacement
  • The future of joint replacement:
    • Video radio graph assisted total elbow arthroplasty
    • Computerized and robotic assisted hip, knee and ankle replacement

Acute Post-op Recovery Interventions

  • Pain management, opioid tolerance and opioid induced constipation (OIC)
  • Wound care/Infection prevention demonstration of PICO dressing
  • VTE prophylaxis
    • Hands on demonstration
      • Point-of-care PT/INR
      • The latest recommendations on TED hose
      • Cold recirculator units and cold compression devices

Treatment Sessions for the Acute through the Subacute Recovery Phase

  • Physical/Occupational therapy
  • Movement restrictions
  • Demonstration of proper positioning
  • Hands on practice
    • UE: Donning and doffing of UE immobilizers
      • Shoulder, distal UE exercises, and active proximal scapular exercise, cervical stretching techniques
    • Hip: Immediate post-op exercises and progressions for the conventional/anterior approach hips, including transfer considerations
    • Knee: Immediate post-op exercises and progressions for the conventional/subvastus approach, forms of stretching

Out-patient and Beyond: Strategies for Optimal Function and Joint Longevity

  • Hands on activities
    • Shoulder: Manual techniques to build proximal scapular stabilization, progression to rotator cuff strengthening
    • Hip: Progression of core pelvic strengthening, proximal trunk stability, proprioceptive, balance, coordination activities, return of normal gait mechanics
    • Knee: Progression of flexibility exercises, patellar mobilization, importance of proper footwear, proprioceptive, balance, coordination activities, return of normal gait mechanics


  1. Participate in hands-on application of acute and sub-acute intervention strategies for the total shoulder, hip, and knee patient.
  2. Evaluate the key indications for timing of joint replacement surgery, including post-op recovery considerations.
  3. Practice application of cold therapies, UE immobilizers, and point-of-care PT/INR.
  4. Evaluate post-operative pain, wound care, and anticoagulant options.
  5. Compare surgical approaches and procedures through video presentations to determine appropriate post-op restrictions.
  6. Explain the indications to reverse a TSA.
  7. Distinguish between the various surgical approaches currently available for THA.
  8. Differentiate between traditional surgical approaches and the subvastus approach for TKA.
  9. Analyze the advantages of computerized and robotic assisted replacement surgeries.
  10. Practice hands-on application of advanced out-patient intervention strategies for the total shoulder, hip, and knee patient.
Copyright : 10/27/2016