Clinical patterns Flashcards
Paget’s disease epidemiological features
European descent, over 55 yo.
Paget’s disease aetiology
unknown
Paget’s disease proposed pathophysiology/pain mechanism
excessive osteoclastic bone resorption / increased osteoblastic bone formation - dull or aching pain or no pain
Paget’s disease differential diagnoses
osteomalacia
Paget’s disease symptoms
pain + aching of bones / pain worse after lying or sitting
hearing loss
paraethesia
Paget’s disease mechanism of injury
can have OA in surrounding joints
Paget’s disease contributing factors
suspected environmental + genetic factors
Paget’s disease physical exam findings
misshapen bones, affected bones warmer
Paget’s disease tests for condition
X ray or bone scan
Paget’s disease diagnostic interventions
alkaline phosphatase (enzyme for bone growth) present
Paget’s disease precautions/contraindications
high impact PA
Paget’s disease prognosis
excellent if diagnosed + treated early before hearing loss etc. occurs
Paget’s disease physiotherapy management options
can help maintain muscle strength, flexibility + joint ROM
Paget’s disease other management
PA
healthy diet
heat + cold packs
Paget’s disease medical management options
bisphosphonates - slow progression by controlling bone building process
pain killers
surgery
Osteoporosis epidemiological features
post menopausal women
older men
Osteoporosis aetiology
low BMD / micro-architectural deterioration of bone tissue
Osteoporosis pathophysiology + pain mechanisms
low bone mineral density
no pain unless spinal compression fracture
Osteoporosis differential diagnoses
osteomalacia
infection
osteonecrosis
Osteoporosis symtpoms
silent disease
Osteoporosis contributing factors
smoking/alcohol abuse
decreased PA
decreased calcium, vitamin D, protein intake
some drugs
Osteoporosis screening questions
early menopause?
history of smoking?
Osteoporosis tests for condition
scanning axial skeleton w/ dual energy x-ray absorptiometry (DXA)
Osteoporosis diagnostic investigatiosn
T score of 2.5 or less on DXA
Osteoporosis precautions/contraindications
some medications
Osteoporosis prognosis
15+ years after diagnosis if take medication + make lifestyle changes
Osteoporosis physio management options
measures to prevent falls, improving vision, aids for daily living, promoting exercise
Osteoporosis other management
limit alcohol/stop smoking
take vit. d + calcium
increase weight bearing + maintain optimal body weight
Osteoporosis other medical management
boniva, reclast
Rheumatoid arthritis epidemiological features
female - onset 40s + 50s
male onset 80s
Rheumatoid arthritis aetiology
genetic contribution
exposure to certain antigen
Rheumatoid arthritis pathophysiology + pain mechansim
- synovitis + synovial hyperplasia
- various cytokines, effector cells + signalling pathways
- proliferation of synovial tissue, infiltration of inflammatory factors
Rheumatoid arthritis prognosis
significant disability + early mortality if left untreated
Rheumatoid arthritis main problem
inflammation of joints / polyarticular pain + swelling
Rheumatoid arthritis area of symptoms
PIP joints (fingers), MCP joints, wrists, knees, ankles, MTP joints
Rheumatoid arthritis characteristics of symptoms
ache + stiffness
Rheumatoid arthritis behaviour of symptoms
- stiffness worse after inactivity or vigorous exercise
- morning stiffness over 30 mins
Rheumatoid arthritis typical activity restriction
cessation of work
Rheumatoid arthritis typical history/mechanism of injury
insidious without incident
multiple joints affected
Rheumatoid arthritis contributing factors
genetic
Rheumatoid arthritis screening questions
personal/family history of autoimmune diseases
Rheumatoid arthritis physical examination features
- swelling/redness around joint
- atrophy
- active/passive movements limited
- reduced strength in hands
- muscle length X reducing ROM
Rheumatoid arthritis tests for condition
x rays, arthocentesis
Rheumatoid arthritis diagnostic investigations
IgM antibodies present in blood tests
Rheumatoid arthritis precautions + contraindications
quit smoking
avoid certain food eg. red meat
Rheumatoid arthritis physio management options
suggest exercise program
Rheumatoid arthritis other management options
assistive devices, home mods
Rheumatoid arthritis medical management
surgery, medications eg. analgesics, NSAIDs, corticosteroids, DMARDs
Osteoarthritis epidemiological features
female
1 in 3 over 65
Osteoarthritis aetiology
obesity, inactivity, past joint injury, muscle weakness
Osteoarthritis pathophysiology + pain mechanisms
- degradation of articular cartilage
- thickening of subchondral bone
- inflammation of synovium
pain = tenderness when pressed
Osteoarthritis prognosis
joint damage X be undone - increased mortality if untreated
Osteoarthritis differential diagnoses
fibromyalgia, rheumatoid arthritis, psoriatic arthritis
Osteoarthritis main problem
joint pain
Osteoarthritis characteristics of symptoms
stiffness, aching, tenderness
Osteoarthritis behaviour of symptoms
better in warmer weather
Osteoarthritis contributing factors
past injury, sedentary, overweight, history of trauma
Osteoarthritis physical examination findings
functional movement issues
limited active/passive movement
muscle strength + length decrease in muscles around joint