DDx Flashcards
Etiology of an intracranial Aneurysm?
- ballooning/dilation of blood vessel wall
- traumatic or congenital rupture of the middle or anterior cerebral arteries or communicating branches of the circle of willis
SS of intracranial aneurysm?
- asym till rupture
- new or change in HA
- can compress other structures causing
+ ocular palsies
+ diplopia
+ squint
+ facial pain - bitemporal deficet indicate pressure on the optic chiasm
- homo hemiopia b/c pressure on optic chaiasm
- neuro deficits
- once intracranial pressure increases vommiting, dizziness and alterations in pulse and respiratory rates
- seizures
- kernigs sign
- B/L babinski
Tests for intracranial aneurysm?
- CT scan
Treatment for intracranial aneurysm?
- surgery
- lumbar puncture
Etiology of BPPB?
- b/c degen otoconia floating in the post semicircular canal
- debris gets stuck to the cupula making it heavier = cupulolithiasis
debris can float int he long arm of the canal as well causing inappropriate endolymph movement = canalolithiasis - most commong cause of vertigo
SS of BPPV?
- vertgio with certain head positions
- severe vertigo for seconds to mins
- horizontal nystagmus
- diminishes over month or 2
NO hearing loss
Tests for BPPV?
- Dix Hallpike maneuver
- take sitting patient w/ 45 deg head rotation into supine while maintian head turn
- once supint the vertigo and nystagmus will begin
Treatment for BPPV?
- Eply’s
- Semonts
- meds and surgery
Etiology for cervicogenic HA?
- referal from soft tissue
- trigeminalcervical nucleus allows referal of the pain from the neck to the head
SS of cervicogenic HA?`
- daily HA w/ neuro signs
- decreased ROM w/ pain
- restriction in the C spine especially occiput
- xray show arthrosis
Treatment of cervicogenic HA?
- SMT and soft tissue
Etiology of Classic Migraine (migraine w/ aura)?
- neurogenic, thought to be vascular
SS of classical migrane?
- female
- unilateral throbbing (pulsating) HA
- photophobia
- phonophobia
- prodrome: bild spot w/ lights, numbness, sensory loss, weakness
- nausea
- vommiting
Treatment of classic Migraine?
- SMT for chronic
- meds
Etiology of clsuter HA?
- unknown
SS of Cluster HA?
- middle aged male occurs over days or weeks and appear again weeks or months later - last 30 mins - triggered by alcohol or certain foods - Horner's syndrome \+ Pitosis \+ miosis \+ anhydrosis - severe - unilateral - periorbital - lacrimation stuff nose - facial swelling
Treatment of Cluster HA?
- meds
- chronic cluster low grade mob
- episodic cluster just exercise
Etiology of common migrane?
- neuro cause
- hypothetical causes
SS of common migraine?
- female
- unilateral
- pulsitile
- severe HA
- no neuro
- nausea and vomitting
Treatment of common Migraine?
- SMT
- meds
SS of concussion?
- post trauma
- loss of awareness or memory
- papilary sign and brainstem function intact
Treatment of concussion?
- ABC first aid and send to hospital
Eitology of Crainial nerve 1 (olfactory) lesion?
- ethmoid #
SS of CN 1 lesion?
- ansomia
SS of CN2 (optic nerve) lesion?
- transection = ispsilateral blidness, loss of direct light reflex
- w/ constriction = optic atrophy
- compresion at the optic chaism = hemiopia
Etiology of Occulomotor nerve (CN 3) lesion?
- transtentorial herniation, b/c supdural or epidural hematoma
- aneurysm of carotid and posterior commnuicating artery
- diabetese melitus
SS of transtentorial herniation on CN 3?
- diplopia
- ptosis
- eye down and out
SS of aneurysm of carotid and posterior communicating artery?
- dilated and fixed pupil
SS of Diabetes Mellitus on CN3?
- pupil contrictor fibres fine
- central fibres damaged
SS of CN 4 (Trochlear) lesion?
- cannot look down and out
SS of Trigeminal Nerve lesion?
- general facial sensation
- loss of corneal reflex
- flaccid muscles of mastication
- jaw deviates to side of lesion
- tensor tympani paralysis (low pitch deafness)
SS of CN 6 (Abducens) lesion?
- lateral rectus muscle weak
- cannot look out
SS of Facial nerve (CN 6) lesion?
- muscles of facial expression don’t work
- loss of corneal reflex
- loss of ant 2/3 taste
- hyperacusis b/c stapedius paralysis
- bell’s palsy (half of face loss function)
What is central facial palsy?
- corticobulbar fibres in the interal capsule transect causing contralateral weakness sparring the forehead (UMN lesion of the facial nerve)
What is crocodile tear syndrome?
- lesion prox to the geniculate ganglison
- lacrimation during eating
What is Mobeius syndrome?
- congenital facial diplegia and convergent strabismus
SS of CN 8 (vesibularcochlear) lesion?
- vertigo
- nystagmus
SS of CN 9 (Glossopharengheal) lesion?
- loss of gag (pharyngeal) reflex)
- loss of carotid sinus reflex
- loss of post 1/3 tongue taste
- glossophanyngeal neuralgia
SS of CN 10 (vagus) lesion?
- ipsilateral soft palate, lpharynx and larynx paralysis \+ dysphonia \+ dyspnea \+ dysarthia \+ dysphagia - uvula goes to the contralateral side - loss of gag (palatal) reflex - anesthesia of pharynx and larynx \+ unilateral loss of cough reflex
Etiology of vagus nerve compression?
- aortic aneurysm
- tumours of neck
SS of CN 11 (accessory nerve) lesion?
- SCM paralysis
+ cannot rotate to opposite side - traepzius paralysis
+ shoulder drop
SS of CN 12 (Hypoglossal) lesion?
- tongue hemiparalysis
- ipsilateral deviation
Etiology of facet syndrome?
- minor trauma (sudden head turning)
- facet or capsule is the source of the pain
- emniscoids can become trapped or pinched
degen can cause facet pain
SS of facet syndrome?
- neck and upper back pain/stiffness
- sharp pain w/ motion
- local pain w/
+ kemps
+ Spurling’s
+ Jackson’s - scleratomal refferal
- tender and motion restriction on palpation
limited C spine A and PROM - NO nerve root tension signs
- Muscle HT
Tests for Facet syndrome?
- clinical
- facet arthrosis on xray
Treatment for facet syndrome?
- SMT
- ice
- ultrasound, tens
- meds, facet denervation/injections
Etiology of Glaucoma?
- progressive damage to the eye b/c increased intraoccular pressure
- most common cause of blindness
SS of Glaucoma?
- no early symptoms
- visual field loss
- blindness
+ first there is peripheral vision loss
+ then central
Tests for Glaucoma?
- asymmetric Intraocular pressure
- elevated intraocular pressure in eye w/ most damage to optic nerve
- intraocular pressure can be high or normal
Treatment of Glaucoma?
- meds
- laser therapy
- refer to optometrist
Types of Hematoma?
- subarachnoid
- subdural
- epidural
- intracerebral
Etiology of subarachnoid hematoma?
- berry aneurysm
- AV malformation
- trauma
- hemorrhagic diathesis
Etiology of subdural hematoma?
- venous bleeding between the dura and the arachnoid
SS of subdural hematoma?
- gradual signs of cerebral compression
- takes hrs, days or weeks post injury to surface
Etiology of epidural hematoma?
- arterial hemorrhage associated with skull # and laceration of the middle meningeal artery
- # of temporal bone usually
- # of occipital bone can also cause
SS of epidural hematoma?
- short lucid period of consciousness followed by rapid cerebral compression signs
Etiology of a intracerebral hematoma?
- hypertension
- ass w/ Charcot-Bouchard aneurysms
- often in the basal ganglia, thalamus, pons, cerebellum and frontal lobe
Etiology of Herpes Zoster of the facial nerve?
- invasion of the 8th cranial nerve ganglia and geniculate ganglia of the facial enrve by the herpes zoster virus
SS of Herpes Zoster of the facial nerve?
- pain before vessicle eruptionin 2 -3 days
- severe ear pain
- hearing loss
- vertigo
- paralysis of facial nerve
- vessicles on pinna and inner ear canal
Tests for herpes zoster of the facial nerve?
- elevated lymphocytes and protein in CSF
Treatment for herpes zoster of the facial nerve?
- antivirals
coricosteroids
Etiology of hyper tension HA?
- intracranial hypertension w/out evidence of SOL, obstruction, or infection
SS of hypertension HA?
- papilledema (swelling of the optic nerve)
- partial or complete monocular vision loss
Tests for hypertension HA?
- CT, MRI, EEG normal
- CSF presure increased but normal fluid
Etiology of intracranial mass?
- expanding intracranial lesion
- granuloma
- paracytic cyst
- hemorrhage
- anurysm
- abcess
- neoplasm
SS of Intracranial mass?
- b/c increased intracranial pressure
- HA
- vomitting
- mental status changes
- drowsiness
- lethargy
- obtuseness
- personality changes
- disordered conduct
- impaired mental status
- papilledema
changes in
+ temp
+BP
+ pulse
+ respiratoy rate suually before death
Treatment of intracranial mass?
- depends on the type of mass
Etiology of medication reaction?
- daily use of over the counter meds at reccomended dose or higher
SS of Medication reaction HA?
- chronic overuse of analgesics
- HA
Treatment of medication reaction HA?
- get patient to stop taking meds
Etiology of pneumoccocal meningitis?
- acute bacterial infection of either: \+ Neisseris meningitides \+ strep pneumonia - meningicoccal meningitis usually occurs within the first year of life - pneumococcal meningitis common in adults w/ history of: \+ chronic otitis \+ sinusitis \+ mastoiditis \+ closed head injury w/ CSF leaks
SS of pneumococcal meningitis?
- respiratory illness
- fever
- HA
- stiff neckl
- vommiting
- adults ill w/in 24 hrs
- change in conciousness
- seizures and cranial neuopahties
- waterhouse friderichsen syndrom w/ vascular collapse
Tests for Pneumococcal meningitis?
- brudzinski’s
- kernigns
- Uni or bi lateral babinski’s
- lumbar puncture should bne done after a CT to exclude a mass lesion
- culture CSF to find: + for bacteria
Treatment for Pneumococcal meningitis?
- multiple antibiotics
Etiology of aseptic meningitis?
- meningitis inflammation w/out bacteria on exam
- can be due to a viral infection
Etiology of Myofascial trigger points of suboccipital muscles?
- trigger pint = hypersensitive area of muscle that refers pain to another part of the body
- usually b/c of repetitive trauma
SS of Myofascial trigger points of suboccipital muscles?
- tenderness and hyper tonicity of suboccipital muscles
- trigger points in the suboccipitals
Tests for suboccipital myofascial trigger points?
- palpation of the suboccipitals
Treatment of suboccipital myofascial trigger points?
- soft tissue
- stretches
- MRT
- postural education
Etiology of otitis media?
- bacterial/viral infection of the middle ear
- microrganisms from the nasopharynx migrate to the middle ear via the eustachian tube
- newborns:
+ enteric bacteria
+ e coli
+ staph aureus - post neonatal
+ ecoli rarley cause - older kids
+ strep pneumonia
+ haemophilus infulenzae
+ s aureus
SS of otitis media?
- persistent, sever earache initially
- hearing loss
- fever
- nausea
- vommiting
- dirrhea
- red bulging tympanic membrane
- bloody purulent otorrhea
Tests for otitis media?
- clinically found
- myringotomy can be performed to culture the exudate
Treatment of otitis media?
- antibiotics
- refer
Etiology of nerve root irritation or segmental radiculopathy?
- herniated disc
- bony changes in RA or OA can compress single roots
SS of nerve root impingement?
- radicular pain w/ sensory deficits
- ventral root involvment = motor weakness in dermatomal distribution
- corresponding DTRs dimminished as well
- pain agg by
+ moving spine
+ coughing
+ sneezing
+ valsava - ortho tests reproduce neck and arm pain
- brokody’s releives the pain
Tests for nerve root impingment?
- MRI is the best for disc herniation
- oblique xray can be used to observe the IVF of cervicals
Treatment for nerve root impingment?
- muscle relaxants
- surgical decompression
- chiro mob or adjustment
- traction
Etiology of Sinusitis?
- inflammation of the paranasal sinuses due to viral bacterial or fungal infection
- acute sinusitis usually caused by acute viral respiratory infection
SS of sinusitis?
- area over affected sinus tender
- different sinuses blocked cause pain in that area:
+ maxillary: toothache, maxillary area HA
+ frontal: frontal area, HA
+ ethmoid: behind eyes and frontal (splitting HA)
+ spenoid: not localised - malaise
- fever
- chills
- red translucent mucous membrane
Treatment of sinusitis?
- steam inhalation
Etiology of Temporal arteritis?
- chronic inflam of the large blood vessels
- usually occurs alongside polymyalgia rheumatica
SS of temporal arteritis?
- severe HA –> tempral and occipital
- scalp tenderness, visual disturbance
- pain on chewing
- blindness
- arthritis, carpal tunnel
- fatigue
- swollen and tender nodules in tempral arteries
Tests for Temporal arteritis?
- increased ESR when active
- normochronmic, normocytic anemia
- increased alp
- biopsy required
Treatment for Temporal arteritis?
- Prednisone
Etiology of TMJ dysfunction?
- stress
- bruxism
- head trauma
SS of TMJ dysfunction?
- pain in the jaw and face around TMJ
- clicking and popping sound with opening and chewing
- pain when chewing hard foods
Treatment for TMJ dysfunction?
- mild analgesics
- mouth guard
Etiology of Tension HA?
- inhanced painproprioception
- co-mobuid migraine, mood disorder, sleep dysfunction, anxiety
SS of tension HA?
- HA lasts form 30 min - 7 days
- wraps around head (tight band around head)
- bilateral
- no nausea vomitting, photophobia
- increased hypertonicity
Treatment of Tension HA?
- analgesics
- tricyclic antidepressants
Etiology of Trigeminal Neuralgia?
- disorder of the trigeminal nerve
- compression of the trigeminal root
SS of Trigeminal Neuralgia?
- trigger point pain
- eating = pain
- brushing teeth = pain
- last from seconds to mins most often maxillary
Treatment for Trigeminal neuralgia?
- carbamazepine meds
- peripheral nerve blocks provide temporary releif
Etiology of Vertebrobasilar artery dissection?
- can occur most commonly at C6 or C2 b/c of spinal manipulation or common daily actyivites like driving
- intimal tearing occurs which causes decreased blood supply in itself of creates an embolis which further blocks the artery
- Wallemberg’s syndrome or Locked in (cerebromedullospinal disconnection) syndrome can occur
Etiology of Wallenberg’s syndrome?
- Vertebral artery dissection
- occlusion of the PICA
SS of wallenberg’s syndrome?
- vertigo
- diplopia
- dysarthria
Etiology of Locked in Syndrome?
- vertebral artery disection
SS of locked in syndrome?
- more serious than wallenberg’s
- = leaves the patient paralyzed
SS of vertebrobasilar artery dissection?
- neurologic dysfunction w/ sudden onset
- less than 24 hrs
- 5 D’s and 3 Ns
Etiology of Abdominal Aortic Aneurysm?
- athersclerotic aneurysms
- usually below the renal arteries
- > M
SS of AAA?
- asym until rupture
- severe middle abdominal or LBP
- leg pain w/ exertion (claudication)
Tests for AAA?
- pusatile mid or upper abdominal mass
- palation sensitive for masses greater than 3 cm
- radio graph show calcification around L2 and L4, if greater than 3.8cm aneurysm
Treatment for AAA?
- refer
- if 4 - 6 cm surgery
- contraindication to Lumbar SMT
Etiology for Cauda Equina Syndrome?
- rare central compression of the spinal cord below L1
SS for Cauda Equina Syndrome?
- urinary retention (bowelk and bladder issues)
- saddle paresthesia
- numbness aroudnt eh groin or genital area
- sexual incontience
Tests for Cauda equina syndrome?
- valsava
- pain radiating B/L legs
- sensory or motor loss in both legs
- babinski response
Etiology of congenital hip dysplasia (dislocation()?
- acetabular deformities
- inversion of the limbs and capsular tightness causes dislocation
- breach delievers
- adduction and extension of the neonats legs
- hormonal laxity
Tests for congential hip dysplasia?
- ortolani’s sign:
+ abduction/ external rotation causes a clunk sound - Barlows Test
+ flexion and abduction w/ long axis traction or posterior rpessure of the femoral head creates clunk - Galeazzi’s test
+ comparing knee height with infant supine and hips and knees flexed - ultrasound
- radiographic findings show a distruption of shelton’s line: concave curve under femoral neck going into the obturaor foramen, increased skinner angle
Treatment of congenital hip dysplasia?
- depends on the age
- usually harness if found early
- if found later on surgery
SS of Osteoarthritis (degenerative arthrosis)?
- non- inflammatory
- gradual pain worse by exercise
- pain worse in the morning* get better with activity
- decreased ROM
- tenderness
- crepitus
Tests for OA?
- clinical
- xray ( incidental finding)
Treatment for OA?
- rehab
- patient education
- stretches, strenghtening exercises
Etiology of Degenerative disc disease (DDD)?
- initial traumatic event
- involves forced forward flexion and/or rotational mocemtn
SS of DDD?
- LBP
- sometimes pain refers
- exacerbated by activity
+ sitting
+ getting up from seated position
+ waking up in the morning
+ lumbar flexion
lifting
+ vibration
+ coughing
+ sneezing
+ valsava
Tests for DDD?
- patient prefer to stand or sit in extension position
- palpation of lumbar paraspinals and spine stabilizers = tender
- L spine ROM limited and painful, mostly flexion, extension can also be painful though
- MRI for disc herniation
- xray helpful for DDD but usually in older patients >35
Treatment for DDD?
- adjustment (open space)
Etiology of Dysmenorrhea?
- combination of vasoconstriction and myometrioal contraction
- increased discomfort caused by fluid retention and estrogen increases salt retention
SS of dysmenorrhea?
- increased pain w/ menses
- pain in lower abdomin and pelvis radiating to the back or inner thighs
Tests for Dysmenorrhea?
pelvis exam/ GIT exam
Management for dysmenorrhea?
- NSAIDs, decrease prostoglandins
- SMT sometimes helps, omega 3, vitamin B12
Etiology of facet syndrome?
- facet and capsule are the source of the pain
- predis[posed by degeneration of the facet usually in > middle aged people
SS of Facet Syndrome?
- well localised LBP
- sometimes have some buttock or leg pain above the knee
- sudden onset after misjudged movement or getting up from a flexed position
Tests for Facet syndrome?
- no neuro signs
- no nerve roots tests positive
- pain is local with kemps
- if repro w/ slr doesn’t go past the knee
Treatment for Facet SYndrome?
- SMT
Etiology of Intervertebral disc derangment?
- protrusion of the nucleus through the annulus fibrosis, usually posteriolaterally
- the herniated disc material releases substances that cause an autoimmune inflammatory reaction
- this protrusion can sometimes sompress on nerve roots causing radicular symptoms
SS of Intervertebral disc derangement?
- LBP and leg pain below the knee
- agg by sudden bending or twisting
- past history of LBP that has been resolved
Tests for L5/S1 Intervertebral disc derangement causing L5 radiculopathy?
- usually L5 or S1 disc bulge
L5 - weakness of dorsiflexion of the big toe
- numbness on lateral aspect of lower leg
Tests for L5/S1 Intervertebral disc derangement causing S1 radiculopathy?
- absent achilles reflex
- weakness of plantar flexion
- numbness on the back of the calf, lateral or sole of the foot
Tests for general intervertebral disc derangement?
- SLR
- well leg raise
- braggards
- MRI
Treatment for intervertebral disc derrangement?
- avoid rotation
- open up joint space ( lateral flexion)
flexion distraction - pelvic blocking
- activator
Etiology for compression #?
- combination of flexion and axial compression
- usually at T/L junction
- risk factors:
+ early menopause
+ osteopenia
+ corticosteroids
+ hyperthyroidism
+ malignancy
SS of compression #?
- acute pain doesnot radiate
- agg by weight bearing
- local tenderness
- subsides in few days or weeks
Tests for compression $?
- xray \+ step defect \+ wedge deformity \+ linear zone of condensation \+ endplate distruption \+ paraspinal swelling
Etiology of lateral canal stenosis?
- disc nucleus protrudes posterolaterally into the extradural space
- compresses on the nerve root
SS of lateral canal stenosis?
- pain in dermatomal distribution of the cord being compressed
- worse on movement
- agg by:
+ valsava - numbness or parasthesia in dermatomal distribution
Tests for lateral canal stenosis?
- hypo reflexia when test DTR
- weak flaccid muscles
- SLR
- CT
- MRI
Treatment for lateral canal stenosis?
SMT, with little to no rotation
Etiology of Lumbosacral spine sprain/strain?
- muscle contraction during a forcedull muscular stretch
- uisually occurs with lateral bending and flexion or lateral bending and rotation
SS of lumbosacral sprain/strain?
- pain in the L/S area that is local
- ROM mostly flexion is painful and reduced (AROM and RROM painful, PROM pain free)
- pain worse w/ movement
- muscle spasm w/ palpation
Management of lumbosacral sprain/strain?
- reduced inflam
- PRICE
- Painfree ROM
Etiology of metastaic tumours to the brain or spine?
- cancer cells migrate through lymph, blood or CSF
- grow outside of the dural matter
- mets from breast, prostate lungs and kidney are common
SS of metastatic tumours to the brain and spine?
- persistent pain
- worse at night
- no mechanical aggrevation or relief
- unplanned weight loss
- excessive fatigue
- worse w/ standing, lifting heavy objects
- bed rest sometimes alleviates pain but gradually worsens
Tests for mets?
- xray
- CT
- MRI
Etiology of myofascial trigger point of the Piriformis?
- sciatic nerve can be compressed by the piriformis muscle ( piriformis syndrome)
SS of myofascial trigger point of the piriformis?
- pain w/ resisted external rotation of hip
- palpation over the piriformis causes referal down back of the leg
Etiology of myofascial trigger point of the psoas?
- shortening of the psoas which is a hip flexor, causing an increase in the lumbosacral angle and increasing the lumbar lordosis
SS of Myofascial trigger point of the psoas?
- pain at the T/L
- sometimes reffered to the knee
- pain releived by sitting
- patient present as being flexed forward
Tests for myofascial trigger point of the psoas?
- Thomas Test
Etiology of Myofascial pain of the QL?
- QL originates on the TVP of the lumbar vertebrae and inserts onto the ilac crest
- serves to raise hip
- QL trigger points refer into the low back, hips, butt and groin, common cause of LBP
- weak abdonminal muscles causing overcomrensation by the QL
Etiology of primary low back tumours?
- originate in the lumbar spine
SS of primary low back tumours?
- radiating pain
- loss of muscle function
- unexplained weight loss
- pain unrelated to activity
- fatigue
- chronic productive cough
- night pain
- smoker
- unremitting pain
Types of Prostatitis?
- Acute bacterial
- chronic bacterial
- chronic nonbacterial
SS of acute bacterial protatitis?
- chills
- fever
- increased urinary frequency and urgency
- peroneal and low back pain
- dysuria
- nocturia
- hematuria
SS of chronic bacterial prostatiTIS?
- relapsing UTI*
- low back and peroneal pain
- increased urinary urgency and frequency
- painful urination
SS of chronic nonbacterial prostatitis?
- more common than bacterial
- same as chronic but no history of UTI and no culture found on test
SS of Reiters (reactive arthritis)?
- young male
- LBP after
+ urethritis (burning on urination)
+ conjuntivitis - can’t see cant pee cant dance
Etiology of reiters syndrome (reactive arthritis)?
- seronegative arthopathy following an infection
- chlamydia
- salmonella
Tests for Reiters syndrome?
- conjuntivitis
- mucocutaneous lesion on the tongue, palate, penis or foot
- urethritis that is unresponsive to antibiotics
- arthritis affecting SI, knee and ankles asymetrically
- increase in ESR
- increase in HLA- B27
- on xray
+ unilateral narrowing and erosion of SI joint
+ sausage finger or toes because of the swelling
Treatment for Reiters?
- refer
- SMT contra
Etiology of Sacroiliac joint dysfunction?
- in younger patients
- pregnancy
- DDD
- prolonged or sudden lifting or bending
SS of sacroiliac joint dysfunction?
- pain over lower back
- pain over unilateral SI joint after straightening from a stooped position
- pain radiates down the back of the leg
- pain relieved by sitting or lying
Tests for sacroliiac joint dysfunction?
- compression of the SI
- Ganslen’s
- Gillets
- conisder reiters if can’t see pee dance
- consider AS if significant decrease in forward flexion
Treatment of Sacroiliac joint dysfunction?
- SMT
- exercise
What are the seronegative spondyloarthopathies?
- reiters
- psoriatic
- enteric
- AS
SS of psoriatic arthritis?
- psoriatic lesion on the extensor surfaces
- pitting of nails
- dry red silvery scaly rash
- distal interphalangheal joint affected*
- asymettrical involvement of joint
- xray
+ sausage digits
+ mouse ears –> reabsorption of the terminal phalanges
SS of seronegative spondyloarthropathies?
- young male
- 20 - 40
- intermittent inflmmation
- back pain
- worse at night
- radiation of pain into the buttocks, anterior or posterior thigh
- early mornming stiffness
- stooped posture
- anemia
- loss of apetite
Tests for seronegative spondyloarthopathy?
- chronic back pain
- stiffness
- global decrease in ROM
- schober test
- xray
+ SI changes (pseudowidening, erosions, sclerosis)
+ trolley track appearcne w/ AS
Treatment for seronegative spondyloarthropathy?
- SMT- only in remssion periods
- stretching
- exercise
Etiology of lateral spinal stenosis?
- bony or tissue encroachment
- congenital or aquired
- conmgenital predisposition is short pedicles
- calcified ligamentum lavum
SS of spinal stenosis?
- over 50
- leg and back pain
- unilateral opr bilater based off lateral or cental stenosis
- onset of leg pain w/ walking that reduces after rest or maintaing a stooped posture
Tests for Spinal stenosis?
- bicycle or walk test: to diff b/w vascular or neurogenic claudication
- when stooped the pain remitis b/c IVF opens up in this posture
- MRI
- CT
Treatment for spinal stenosis?
- improve or remain stable w/out treatment
- if severe neuro deficit do surgery
- flexion distraction is good
Etiology of Spondylolisthesis?
- Isthmic b/c stress fracture of pars usually at L5
- in gymnists that do repetivitive hyper extensioin
SS of spondylolisthesis?
- young = isthmic
- older = degenerative
- LBP worse w/ extension
Tests for spondylolisthesis?
- xray lateral
- increased back or leg pain with one leg test
- increased pain w/ hyperextension
- palaption find step defect, or more prominent sp at the level of the spondy
Treatment of spondylolisthesis?
- grade 1 can SMT
- grade 2 or 3 refer
Etiology of UTI?
- dependent on age and gender
- most commonly caused by gram-negative aerobic bacteria
SS of UTI?
- increased urinary frequency and urgency
- painful urination =dysuria
Tests for UTI?
- urinanalysis
Treatment for UTI?
- cranberry juice
- antibiotic treatment
Etiology of avlusion fracture of the anterior superior iliac spine?
- adolescent athletes
- occurs at apophysis
- caused by the sartoris muscle
SS of avulsion fracture of the anterior superior iliac spine?
- sudden acute pain near the ASIS during athletic activity
- local swelling
- increased pain w/ hip and trunk movement
Tests for avulsion fracture of the ASIS?
- pain w/ ROM, especially abduction and flexion
- Thomas Test
- gaenslens buit pain at hip not SI
- xray
+ see callous formation during healing phase
Treatment of avulsion fracture of ASIS?
- Acute: PRICE, NSAIDs
- After 48 hrs: ice, massage, tens, ifc, us
Etiology of bursitis?
- bursae protects the points of friction b/w muscle and tendons and tendon and bone
- can be injured by trauma
- deep bursa injury b/c repetitive motions
What are the different shoulder bursa?
- subacromial
- subdeltoid
What are the different hip bursa?
- subtroachanteric
- iliopectineal
- ischial
What are the different knee bursa?
- pre patella
- infrapatella
- sub patellar
What are the elbow bursa?
- olecronon
SS of Bursitis?
- pain in all AROM
- swollen and hot
- RROM painfull
- patient is acute
Test for bursitis?
- All ROM in different motion
Etiology of Degenerative joint disease?
- progressive degeneration
- loss of articular cartilage
- joint margin changes
- weight bearing joint, pips, dips, and shoulder or elbow joint are commonly affected
- women get OA of hand
- men get OA of Hip
SS of Degenerative joint disease?
- HX of trauma or repetitive minor trauma
- stiffness and joint pain
- decreased ROM
- gradual onset
- short period of morning stiffness
- heberden’s nodes at the DIPs
Tests for DJD?
- crepitus and pain during passive ROM
- xray
+ non uniform joint space loss
+ osteophytes
+ subchondral sclerosis
+ joint mice
+ facet arthrosis
+ loss of disc neight
+ subchondral sclerosis
Treatment for DJD?
- SMT if tolerated
- pain management:
+ rest
+ hot packs
+ meds
+ traction - weight loss, exercise
- surgery if severe
Etiology for hip dislocation?
- in MVA or contact sport
- Anterior or posterior
Etiology for anterior hip dislocation
- hip flexed, leg abducted and externally rotated
- common in sport where running and high speed and have to land with flexed knee
- femoral head comes out of the head anteriorly causing fracture and tearing potential illiofemoral and pubofemoral ligaments
Etiology for psoterior hip dislocation?
- 80% of hip dislocations are posterior
- forces strikes flexed knee while hip is flexed adducted and interally rotated
- running player tackled and falls onto a flexed knee
SS of posterior hip dislocation?
- severe hip pain inn hip region and upper leg
- inability to walk or do hip ROM
- sometimes numbness and tiungling in the legs
- affected limb of posterior hip dislocation appears shortened, internally rotated and adducted
- superior dislocation: hip extended and externally rotated
- inferior: hip flexed, abducted and externally rotated
Tests for hip dislocation?
- xray
- CT
Treatment for hip dislocation?
- refer
- PRICE
- post 7 days rehab
- if neuro complications, surgery
Etiology of femoral neck fracture?
- severe fall or MVA
- osteoporosis = most common cause
SS of femoral neck fracture?
- pain in hip, buttock or pubic area
- affected leg shortens
- hip brusing
- toe in on affected leg
Etiology of Fibromyalgia?
- > Femals
- b/w 20 - 25
SS of Fibromyalgia?
- chronmic diffuse pain
- poor sleep
- multiple somatic complaints
- minimum 3 months duration
- fatigue and poor sleep
- morning stiffness
Tests for fibnromyalgia?
- everything normal
- multiple tender points: atleast 11/18
Treatment for fibromyalgia?
- SMT
- Heat
- massage
- meds
- excercise*
Etiology of iliotibialband contracture (ITB syndrome)?
- gradual lateral knee pain that starts over ina few day to weeks
- associated w/ running, downhill aggrevating b/c heel strike
- ITB rubs against lateral femoral condyle
SS of ITB syndrome?
- tender lateral femoral condyle
Tests for ITB syndrome?
- Nobel’s Compression test
+ pressure on the distal ITB while extending the knee from flexed position - ober’s test
+ let the side lying patient leg fall behing them, if above table then ITB syndrome
Treatment for ITB syndrome?
- stretching
- myofascial relase
Etiology for inguinal hernia?
- bulging of organ through abnormal opending
- can be forced through the inguinal cannal
What is a direct inguinal hernial?
- weakness in the floor of the inguinal canal lets herniation occur
- in men >40
What is an indirect inguinal hernia?
- most common
- herniation through the internal inguinal ring
SS of inguinal hernia?
- lump in the groin near the thigh
- pain in the groin
- partial or complete blockage of the intestine
Tests for inguinal hernia?
- auscultate scrotum for bowel sounds
- swelling in the inguinal region when the patient cough
- palation
Treatment for inguinal herina?
- can usaully reduce on its own but refer to sdoc
- surgery to repair opening in the muscle or if the hernia is stragulated causing bowel obstruction
Etiology of Juvenile rheumatoid arthritis?
- ages 16 or under
- = autoimmune
SS of Juvenile RA?
- persistent joint swelling
- pain
- stiffness, worse in morning
- systematic onset in 20% of patietns
+ affects one joint and organs
+ high fever
+ rash
+ splenomegaly
+ adenopathy
+ RF and ANA absent - Pauciarticular onset 40%
+ 4 or less joints
+ young girls
+ ANA
+ boys develop other spondyloathopathy - polyartcular
+ 5 or more joint
+ complete remssion
+ no RF
Tests for juvenile RA?
- RF
- increased esr
- ANA
- xray
Treatment of Juvenile RA?
- if + RF then prognosis is poor
- refer to md for testing
Etiology for Leg-Calve-Perthes disease?
- AVN of adolescent femoral head
- most common osteochondroses
- occurs b/w 5 and 10, usually unilateral
- secondary to other condition
- self limiting
SS of Leg-Calve-Perthes disease?
- pain in the hip
- gait disturbance
- gradual onset and slow progression
Test for Leg-Calve-Perthes disease?
- decreased hip abduction and internal rotation**
- trendelemberg
- xray
+ flat femoral head (mushroom cap deformity)
+ fragmentation of the femoral head (snow cap deformity)
+ head contains areas of lucency and sclerosis
Treatment of Leg-Calve Perthes?
- comange with ortho
Etiology of Lumbar disc herniation?
- commonly at L4/L5 and L5/S1
- spontaneously resolve within 6 months
SS of Lumbar disc herniation?
- sudden onset of LBP and potential leg pain past the knee
- dermatomal pattern
- agg by, increase in intradiscal pressure
- weakness in muscle
- decreased sensation in dermatomal pattern
- hyporeflexia when testing DTRs
Tests for lumbar disc herniation?
- decreased ROM
- SLR
- kemps for referal
- MRI
Treatment for lumbar disc herniation?
- SMT, refer if not reponsive in 6 weeks
Etiology of MEralgia Paresthetica?
- L2-3 ventral rami (lateral femoral cutaneous nerve)
- uncommon excpet w/ pregnancy and obesity
- trauma to groin area where nerve passes ASIS near the inguinal ligament
- prolonged rest or standing can cause compression
- prlonged hip extension or flexion can also cause compression
- sometimes iatrogenic from surgery
- sometimes an inguinal hernia can cause the compression
SS of meralgia paresthetica?
- paresthesia over lateral thigh
- no motor loss
- decreased light touch
- increased pin prink
Tests for meralgia paresthetica?
- Tinel’s tap near the ASIS
Treatment of meralgia paresthetica?
- chiro care
- reduced casuing factors = obesity, posture or ergonomics
Etiology of myofascial trigger point of the gluteus medius muscle?
- hypersensitive area or band of muscle that refers pain
- usually because of constant state of contracture (HT)
SS of myofascial trigger point of the gluteus medias muscle?
- tenderness and hypersensitivity of the gluteus medias muscle
- referal-> into low back and the thigh
Treatment for myofascial trigger point of the gluteus medius muscle?
- Stretch
- release trigger point
Etiology of Myofascial trigger point of the psoas muscle?
- HT of muscle
SS of myofascial trigger point of the psoas?
- tenderness of the psoas muscle
- refer to low back, upper gluteal, upper anterior thigh
Treatment for myofascial trigger point of the psoas?
- massage
- stretch
- release trigger point
Etiology of Osteomyelitis?
- infection of the bone and bone marrow
- caused by many microorganisms
+ s aureus
+ streptococci - recent compromise in the skin
SS of osteomyelitis?
- bone pain
- high fever
- formation of an abscess at the site of infection
Tests for osteomyelitis?
- culture
- biopsy
- xray
Treatment for osteomyelitis?
- refer for antibiotic treatment
Etiology for Paget’s disease?
- osteitis deformans
- localised areas of bone become hyperactive and relax the normal matrix with softened enlarged bone
- > 40
- > m
SS of Paget’s?
- asymptomatic
- insidious
- pain
- stiffness
- fatigability
- bone deformity
- HA
- decreased hearing
- increasing skull size
- bone ache very deep, worse at night
Tests for Pagets?
- xray
- elevated alkaline phosphatase*
- increased urinary excretion of pyrinoline cross-links
- serum calcium and phosphorus levels are usually normal
Treatment for Pagets?
- chiro for non serious pain
- MD for emds to control the proliferation of bone
Etiology of piriformis syndroime?
- irritation of the sciatic nerve due to piriformis contracture or spasm
- mechanical or chemical irriation of the nociceptiors
- causing paresthesia
- can be b/c
+ trauma
+ vascular ischemia
+ tight external rotators
+ overuse
SS of piriformis syndrome?
- leg length inequality
- decreased internal rotation of the hip
decreased adduction of the hip - foot external rotation
- SI joint fixation
Tests for pirifomis syndroim?
- palation \+ reproduce referal - +SLR, bonnets - + Hibbs and piriformis test - (-) nafzinger and valsalva test - normal DTR
Treatment for piriformis syndrome?
- stretch
- trigger point release
Etiology of poliomyelitis?
- polio infection
- fecal oral route
- to CNS where it causes lesion of the gray matter
SS of minor polimyelitis?
- recovery within 24 -72 hrs
- fever
- HA
- stiff neck
- sore throat
- vomiting
SS of major poliomyelitis?
- fever
- HA
- stiff neck and back
- deep muscle pan
- decreased DTR and muscle weakness
- hyperesthesia
- paresthesia
Tests for poliomyelitis?
- asymetric flaccis limn paralysis without sensory loss
- spinal tap to check CSF
Treatment of polio?
refer and comange w/ physical therapy to keep the joint moving
Etiology of psoas tendonitis?
- tendonitis = inflamation of a tendon
- tenosynovitis = inflamation of a tendon sheath
- occurs in middle aged or older people
- repeated trauma, strain or excess exercise
- ass w/ RA, systemic sclerosis, gout, diabetes, reiters
SS of Psoas tendonitis?
- painful on hip/trunk flexion
- swollen
Test for psoas tendonitis?
- calcium deposit on xray
- painful AROM
Treatment for psoas tendonitis?
- rest or immobilisation for acute relief (2 - 3 days) + PRICE
- NSAIDs for 7 - 10 days
- corticosteroid injection`
Etiology of Septic (Pyogenic) Arthritis?
- inflamation of joint caused by pyogenic microorganisms = painful and hot
- Acute infection
+ 95 % neisseria gonorrhoeae = most common
+nongonncoccal arthrits usualy staph sureus - Chronic infectious arthritis
+ myobacterium
SS of septic arthritis?
- fever
- painful swollen joints
- decreased ROM
Tests for septic arthritis?
- increased WBC, ESR and C-reactive protein
- refer for joint aspiration for culture
- xray
Treatment of septic arthritis?
- refer antibiotics
Etiology of Rheumatic fever w/ monoarthritis of the hip?
- affects children b/w 4 and 18
after a streptococcal infection
+ tonsilitis
+ pharyngitis
SS of Rheumatic fever with mono arthritis of the hip?
- recent ilness or infection
- systemic illness
- tenderness and inflammation around joints*
- fever
- jerky movements
- nodules under the skin
- skin rash
- sometime heart or valve inflamation can result in scarring of valves = stenosis
Tests for Rheumatic fever?
- increased ESR and C-reactive protein
- abnormal ECG
Treatment for Rheumatic fever?
- penicilin
- salicyates
- steroids
Etiology of RA?
- chronic acute inflammatory disease
- > F
- 20 - 50
SS of RA?
- symmetrical joint pain and swelling
- fever
- fatigue
- polyarthritis
- deformities of hand and wrist
+ swan neck and boutonneire deformity - bouchard nodes at PIP, never affects the DIPs
- ulnar deviation of the wrist
- can affect the cervical region
Test for RA?
- RH factor
- increased ESR
- antinuclear antibodies (ANA)
- xray
+ bilateral symmetry
+ marginal erosion
+ uniform joint space loss - C1 2 subluxation
Treatment for RA?
- contraindication for cervical SMT
- adjust, soft tissue, remmber no cure
Etiology of sacroiliac joint dysfunction?
- pregnancy
- leg length inequality
- trauma
- ligament laxity
SS of sacroiliac dysfunction?
- Low back or SI joint pain
- worse when sitting or weight bearing
- fell stiffness
Tests for sacroiliac dysfunction?
- Si compression
- yeomans
- gaenslens
- gillettes
- faber
- xray negative
Treatment for sacroiliac dysfunction?
- chiro
- massage
Etiology for segmental radiculopathy?
- herniated disc
- muscular entrapment
SS of segmental radiculopathy?
- radicular pain
ventral root = motor weakness and muscle atrophy - dorsal root = sensory changes in dermatomal distribution
- DTR dimminished
- pain aggrevated by moving spine, coughing, sneezing, valsalva
- muscle stretches can agg the pain
Test for segmental radiculopathy?
- xray
- CT
- SLR
- increased thecal pressure
- musc wasting
Treatment for segmental radiculopathy?
- muscle relaxant
- surgical decompression
- chiro treatment, mobilisation, cervical traction
Etiology of Slipped capital femoral epiphysis?
growth plate of the femoral head slipps back and inward
- results b/c deformity of the ball and socket = limitation of moevment
- most common cause for limp in kids
SS of SCFE?
- limited ROM
- limp
- decreased internal rotation*
- > boys
- slippage 12-15
- sometimes bilateral
Tests for SCFE?
- xray frog leg
+ see that the femoral head is below klein’s line: line at the superior part of the fenmoral neck intersects the femoral head, if it doesn’t this indicated SCFE
