Conditions - Gold Flashcards
Ankylosing Spondylitis
Inflammation of the spine and larger peripheral joints that can lead to destruction of ligament-osseous junction followed by fibrosis and ossification.
Possible genetic and environmental factors.
Men are 2-3x more likely to acquire than women. Onset usually between 20-40 yo.
Low back pain, morning stiffness, impaired spinal extension, limited ROM for over 3 month period of time. Also fixed flexion at hips, kyphosis, fatigue, weight loss.
Postural exercises emphasizing extension, ROM, pain management, energy conservation techniques. Low impact and aerobic exercise with emphasis on extension and rotation. Swimming highly recommended.
High impact and flexion exercises contraindicated. Avoid excessive exercise, as it can cause inflammation.
Arterial Insufficiency Ulcer
Usually related to peripheral artery disease (PAD). Risk factors include smoking, obesity, diabetes, hypertension, atherosclerosis.
Usually located in lower 1/3 of LE (dorsum of foot, lateral malleolus, toes).
Wound edges may initially be irregular but progress to smooth/defined edges.
Light pink in color if clean.
Minimal bleeding and exudate.
Discoloration of nails (yellow) or skin (pale).
Skin may be shiny, thin, hairless, and cool to touch.
Distal pulses absent or diminished.
Pain with dependent position or activity (intermittent claudication).
Breast Cancer
Painless mass with or without generalized discomfort in area of mass. May progress to painful, change shape, bleed from nipple, dimple over area of mass. Metastasis indicated by bone pain, UE edema, and weight loss.
Related to estrogen, gender, age, young menarche, late menopause, family hx, high alcohol intake, high fat diet, radiation exposure.
Makes up 30% of female cancers and 2nd leading cause of death in female cancers.
PT indicated for lymphedema management, post surgical breathing exercises, positioning, pain management, strengthening, and endurance, ROM, intermittent compression.
Full thickness burn
Complete destruction of epidermis, dermis (hair follicle and nerve endings), and subcutaneous fat layer and underlying muscles.
Variable appearance: deep red, black, or white. Eschar, edema, no pain/sensation. During initial stages, patient will experience thermoregulation impairment, SOB, electrolyte disturbances, poor urine output, and variation in level of consciousness.
Autograft usually required. PT begins immediately following skin graft procedure. Includes wound care, pulmonary exercises, positioning, splinting, contracture prevention, and immobilization for 3-5 days. Will also include edema control, monitoring elastic garments, stretching, massage, hydrotherapy, ROM, debridement, relaxation techniques, and functional mobility.
Partial thickness burns
Superficial partial-thickness involves epidermis and papillary dermis. Free nerve endings are exposed, making burn extremely painful. Red color that will blanch. Blisters and superficial moisture. Will typically re-epithelialize with little to no scarring in 5-21 days.
Deep partial-thickness involves epidermis and majority of dermis (reticular dermis), as well as hair follicles, sebaceous glands, and sweat glands. Less pain due to damage of nerve endings. Can result in hypertrophic or keloid scarring. Red color that will not blanch, edema, cellular necrosis. Healing occurs with grafting or scar tissue formation. Healing takes 21-35 days if uncomplicated.
Complex regional pain syndrome
Usually found in extremity that has experienced trauma. Results from increase in sympathetic nervous system activity that releases nonepinephrine and causes vasoconstriction. Results in pain and sensitivity to peripheral stimulation.
Predisposing factors are trauma, surgery, CVA, TBI, repetitive motion disorders, and LMN and peripheral nerve injuries. Most common in 35-60 yo and females 3x more likely than males.
Intense burning, chronic pain that can spread proximally. May have tremors, spasms, and atrophy. Stage I (acute): Edema, thermal changes, discoloration, stiffness, and dryness. Stage II (dystrophic): Worsening/constant pain, edema, trophic skin changes. Bone loss, osteoporosis, and subchondral bone erosion. Stage III (atrophic): Pain that spreads, hardened edema, decreased limb temperature, atrophic changes to fingers or toes.
PT includes pain control, skin care, joint mobs, desensitization, functional activities, modalities/TENS, pool therapy, relaxation training, stretching, ROM, light weight bearing, edema management.
Can resolve spontaneously, be chronic, or be recurring/remission. Prognosis depends on when treatment was initiated (first 6 months is best).
Diabetes Mellitus Type I
Diminished or absent production of insulin due to destruction of beta cells or islet of Lagerhans in pancreas. It is an autoimmune disease.
Usually starts in children ages 4 and up with highest incidence of onset from 11-13 yo.
Polyuria, polydipsia (excessive thirst), polyphagia (excessive eating/hunger), nausea, weight loss, fatigue, blurred vision, and dehydration.
Should exercise at 50-60% of max HR.
Diabetes Mellitus Type II
Inappropriate cellular response to insulin, prevent adequate absorption of blood glucose. Due to inadequate supply or cellular resistance to insulin.
Common symptoms are polydipsia, polyuria, blurred vision, delayed healing, and frequent infections.
Fibromyalgia
Classified as rheumatology syndrome or a nonarticular rheumatic condition.
Exact etiology unknown but may be due to dysfunction with stress system, ANS, immune, and/or reproductive and hormone system. May be associated with diet, sleep disorders, viral infections, psychological distress, occupational/environmental factors, hypothyroidism, trauma, and potential hereditary links.
Most common msk disorder in US. Greater incidence in females. Can affect any age but most common in 14-68 yo.
Pain is primary symptom caused by tender points within muscles, tendons, and ligaments. Widespread hx of pain that exists in all 4 quadrants of the body. May complain of fatigue, memory in visual impairments, sleep disturbances, IBS, headaches, and anxiety/depression.
PT includes relaxation techniques, energy conservation, gentle stretching, moist heat, ultrasound, posture and body mechanics, biofeedback, aquatic therapy, and exercise to tolerance. Should not work through pain. Require short exercise sessions initially (3-5 min).
Majority of people exhibit moderate symptoms usually for years or entire lifetime.
Human Immunodeficiency Virus
Invades and destroys cells within the immune system.
Transmitting through contact with blood, semen, vaginal secretions, and breast milk.
3 stages: Acute HIV infection, Clinical Latency/Asymptomatic HIV/Chronic HIV infection, and AIDS.
PT may include fitness, flexibility, energy conservation, stress management, ADL equipment, relaxation, aquatic therapy, modalities, positioning, pain management, breathing, and neurological rehab.
Juvenile Rheumatoid Arthritis
Autoimmune disease found in children less than 16 yo.
Symptoms are primarily inflammation and stiffness to multiple joints for a period of greater than 6 weeks.
Some pts outgrow symptoms and are not affected as adults and others have long-term symptoms.
3 Classifications:
1) Pauciarticular JRA: Four or less joints involved, asymmetric, usually mild. Most common, 50% of JRA cases.
2) Polyarticular JRA: More than 4 joints involved, usually symmetrical, involves joints of hands and feet and larger joints, potential for severe destruction, 30-40% of cases.
3) Systemic JRA: Known as Still’s disease. Onset includes fever, chills, rash followed by myalgia and polyarthritis. Includes anemia, hepatosplenomegaly, lymphadenopathy, pericarditis, and myocarditis. 10-20% of cases.
PT: ROM, pain control, strengthening, functional mobility, endurance, modalities, splint/orthotics, swimming.
Lymphedema Post-Mastectomy
Excess accumulation of lymph fluid when damage or removal of axillary lymph nodes occur during mastectomy.
Usually no pain but tight or heavy sensation in legs.
Stage 1: Pitting edema that reduces with elevation overnight. No fibrotic changes.
Stage 2: Increase in non-pitting edema that does not reduce with elevation and fibrotic changes .
Stage 3: Skin changes, frequent infections, severe non-pitting edema. Lymphostatic elephantiasis.
PT: Complete decongestive therapy, short stretch bandages, retrograde massage, and exercise.
Neuropathic Ulcer
Due to combination of peripheral neuropathy, atherosclerotic changes, and pressure.
Most common in diabetic population.
Common sites: heel, tips of prominent or hammer toes, dorsal aspect of hammer toes, plantar surface of metatarsal heads, and bunions.
Typically has oval or round well-defined edges with a calloused rim. Usually granulation tissue with little necrosis. Exudate minimal. Surrounding skin is shiny, dry, and inelastic. Pain minimal. Distal pulses may be diminished/absent but ABI not always accurate due to development of vessel rigidity.
Osteoporosis
Primary osteoporosis: idiopathic, involutional (senile), post-menopausal. Risk factors include inadequate dietary calcium, smoking, excessive caffeine, high intake of alcohol or salt, small stature, Caucasian, inactive lifestyle, family hx or chronic disease.
Secondary occurs due to primary disease (endocrine disorders, malnutrition, other diseases) or prolonged use of drug therapies (including heparin or corticosteroid).
PT: Encourage weight bearing activities as tolerated. Avoid heavy resistance exercise, excessive flexion during exercise or household activities, and use of ballistic movements. Light resistance such as small dumbbells or bands can be used with caution after physician consultation.
Pressure Ulcer
Unrelieved pressure is >32 mmHg to an area for more than 2 hours.
Stage 1: Nonblanchable erythema of intact skin. May be increase in warmth or altered coloration.
Stage 2: Partial thickness involving epidermis, dermis, or both. Does not extend through entire dermis.
Stage 3: Extends into subcutaneous tissue but not through fascia.
Stage 4: Extends through fascia and deeper. Full thickness wound that may damage muscles, bones, ligaments, or tendons.
Can be staged using Braden scale, Gosnell scale, or Norton scale.
PT: Use seat cushions, multipodus boots, or specialized mattress. Can use non-occlusive or occlusive dressings. Avoid use of hot water and massage surrounding site. Position bed at less that 45 deg to avoid shear/friction.
