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
Treatment for SCFE?
- surgery
Etiology of thrombophlebitis (DVT)?
- inflammation of a vein ass. w/ blood clot formation
- usually in the legs or pelvis
- occurs in patients reovering from child birth, surgery or prolonged bed rest
- oral contraceptives predisposes females to this
- clot in the leg can dislodge and cause blockage in the lung = pulmonary embolism
SS of thrombophlebitis?
- pain and swelling in the posterior calf
- prolonged period of bedrest or position where stasis of blood may occur
Test for Thrombophlebitis?
- homans test
- diagnostic ultrasound
Treatment for Thrombophlebitis?
- anticoagulant therapy (warfarin, herparin)
SS of ALS?
- progressive muscle weakness and atrophy
- signs of anterior horn dysfunction seen inhand first
- site of onset is random, progression is asymettrical
- fasiculation and UML signs
SS of Aneurysmal Bone cyst?
- benign usualy before 30
- metaphsysi of long bone
- xray
+ well circumsribed, eccentric, periosteal bulging
Treatment of ABC?
- surgical removal of lesion
- get xray and refer
SS of angina?
- precipitated by exertion and relieved by rest or sublingual nitroglycerine
- lasts usually less than 30 mins
SS of Bicipital tendonitis?
- tenderness over the proximal bicipital groove of the humerus,
- resisted supination and flexion is painful
- yergasons, resisted supination and flexion
- speeds, 90 deg shoulder flexion + elbow extension, resist extension force applied to forearm
SS of lateral epicondylitis?
- lateral elbow pain (tennis elbow)
- repetitive tearing of extensor carpi radialis brevis tendon and extensor carpi radialis longs
- repetitive wrist extension, radial deviation and supination
- cozen’s: arm pronated wrist radially deviated and extended, resist flexion
- mills: pronation, extension of arm and flexion of the wrist, while palp epicondyle,
Etiology of ITB sprain/strain?
- ITB rubs against the lateral epicondyle of the femur
- worse with running (downhill bad b/c heel strike)
- hyper pronation is bad for it as well
SS of ITB sprain/Strain?
- insidious onset of lateral knee pain
- agg w/ downhill running
- pain with leg extension
Tests for ITB sprain/strain?
- lateral epicondyle palpation*
- nobels test, applying pressure ar various degress of flexion and extension
SS of popliteal tendonitis?
- insidious onset lateral knee pain
- agg by
+ downhill running
+ walking - popliteal muscle allow internal rotation of the leg and pull the posterior lateral meniscus back during knee flexion
Tests for popliteal tendonitis?
- Tenderness at insertion point of distal femur, just anterior to the LCL*
- tenderness can also be found behind the LCL
- pain w/ resisted internall rotation mostly when combined with 30 deg of knee flexion
- foot may be hyperpronated
Treatment for popliteal tendonitis?
- adjust areas around to improve function
- PRICE
- pain free ROM
Etiology of fibular head fixation?
- sudden onset of lateral knee pain
- usually after sudden dorsiflexion or plantarflexion injury at the ankle
- hamstring curls the biceps femoris draws the fibular head posteriorly leading to fixation
SS of fibular head fixation?
- tender over proximal fibular head
- peroneal nerve impingment potential
- ankle involvement*
- agg by
+ leg curls (hamstring) - forced dorsiflexion = pain
- hurts with running, tennis, squash
Etiology of lateral collateral ligament tear?
- severe varus stress*
- accompanied by a lateral meniscus injury
Etiology of patellar #?
- anterior knee pain after trauma
- knee hitting dashboard in a car accident
- usually comminuted
Test for Patellar #?
- xray
- pain localized over the patella
Etiology for patellofemoral syndrome (runner’s knee(?
- anterior knee pain
- b/c running
- b/c going up and down steps and sitting for long periods of time
- tracking disorder of the patella b/c weak VMO
SS of patellofemoral pain syndrome?
- insidious onset
- crepitus when squat
- pain going up stairs or running
- iritation tot he infrapatellar fat pad
Test for patellofemoral pain syndrome?
- palpation and auscultation of the patella as it undergoes ROM
- if pain only at the bottom of ROM most probably meniscus not PFPS
- chronic overpronation
Etiology of Chondromalacia Patella?
- not a tracking disorder (VMO is normal)
- decrease in patellar cartillage
- history of patellar injury
SS of chondromalacia patella?
- insidious
- crepitus when squat
- pain with running prolonged sitting, going up stairs
Tests for chondromalacia patella?
- xray if management for PFPS is not working
Etiology of Patellar tendonitis (jumper’s knee)?
- anterior knee pain w/ jumping or sprinting
- occurs b/c of repetitive stress
SS of patellar tendionitis?
- anterior knee pain with jumping or running
Tests for patellar tendonitis?
- pain at patellar tendon or tibial tuberosity
- resisted extension beyong 90 deg is painful*
SS of Osgood-Schlatter’s disease?
- young athlete
- pain and swelling at tibial tuberosity
- resisted extension painful
Etiology of Osteochondritis Disicans?
- anterior knee pain and crepitus
- usually occurs at the lateral femoral condyle
- caused by squating, running and rising from a seated position
- condyle fragement in the joint space
SS of osteochondritis dissecans?
- locking of the knee with a feeling of instability
- agg by
+ squating
+ running
+ rising from a seated position - anterior knee pain
Treatment of osteochondritis dissecans?
- refer for surgery
Etiology of pes anserine bursitis?
- near the proximal medial tibia
- conjoined tendons of sartorius, gracilis and semitendinosus, lies superficial to the MCL
- diabetic, older, overweight
SS of pes anserine bursitis?
- insidious onset of pain anterior medially in the knee
- pain on knee flexion*
- painful resisted external rotation and internal rotation
- exaccerbated by walking up and down stairs
Etiology of Plica syndrome?
- chronic overuse of the knee from embryonic dividers in the knee
- mediopatellar plica most commonly involved
similar to pes anserine pain
SS of plica syndrome?
- clicking
- snapping
- occasionaly giving way
- anterior medial pain
- ## aggrevated by prolonged standing, squatinng, sitting or stair climbing
Tests for plica syndrome?
- taut band on the medial peripatellar region reproducing pain *
osgood schlatter vs patellar tendonosis?
• Is there tenderness directly anterior and posterior to the patella. Is there pain on extension? If this is an adolescent athlete, select O-S, otherwise, patellar tendinosis.
Etiology of baker’s cyst?
- popliteal cyst
- fluid distension of gastrocnemio-semimebranosus bursa
- joint effsion displaced into this cyst as a prtective mechanism
SS of backer’s cyst?
- popliteal swelling
- bowstrings test
- posterior knee pain
Treatment of backer’s cyst?
- refer for drainage
Etiology of MCL tear?
- valgus stress injury
Test for MCL injury?
- valgus stress tests at different degrees of flexion
Etiology of an ACL tear?
- pop during an injury
- anterior force causing anterior slippage of the tibia on the femur
- twisting motions w/ deceleration
+ skiers
+ football
+ basketball
+ soccer - flexed knee gets a valgus load with internal rotation of the tibia
Tests for ACL tear?
- lachman test: knee 30 deg of flexion and pulled forward to see if anterior displacement
- anterior draer test: knee at 90 and anterior draw
- slocum test
- MRI
Etiology of compartment syndrome?
- exertional compartment syndome seen mostly in athletes b/c increased exercise
- blunt trauma to the leg can also cause an increase in the pressure
SS of compartment syndrome?
- ache in the leg 10 - 30 mins post exercise
- redness
Treatment for compartment syndrome?
- PRICE
- if trauma, care doesn’t work, or professionaol athlete refer
Etiology of dislocated patella?
- a young athlete with weak VMO, undergos trauma where the patella will displace laterally
- high school football
Etiology of meniscal tear?
- due to rotational injury, usually accompanies ACL and MCL injury
SS of meniscal tear?
- swelling
- knee locking untill patient reaches full extension
- knee giving way
Tests for meniscal tear?
- medial joint line tenderness
- McMurray’s
- apleys
- basically compression + rotation to mimic the injury
- use MRI
Treatment for meniscal tear?
- PRICE, painfree ROM, strenghten, ADL, proprioception, Return to sport
Etiology of PCL tear?
- resists posterior translation of the tibia on the femur
- blow to the anterior tibia when the knee is flexed
SS of PCL tear?
- lack of pain
- posterior drawer test
- revere lachman test
- hughston’s test
- sag sign
- bounce home test
Etiology of osteosarcome?
- 3rd most common primary bone tumour
- b/w 10 -25
- > M
SS of osteosarcoma?
- pain with activity
- limp
- site of tumour has swelling, redness and heat
Etiology of suppurative osteomyelitis?
- due to staph aureus
- invades bone via hematogenous spread, post operative or puncture wounds
- age 2 - 12, >M
SS of suppurative osteomyelitis?
- fever
- chills
- pain
- swelling
- prior infection
Etiology of osteomyelitis?
- infection of the joint
SS of osteomyelitis?
- tenderness and pain in the joint
Etiology of Leukemia?
- malignant disease of the bone marrow and blood b/c proliferating WBCs
- most common = acute form in kids
- b/w 2 - 5 yrs
SS of Leukemia?
- generalized joint pain
- weakness
- lethargy
- xray
+ osteopenia of long bone
+ raindrop skull
SS of growing pains?
- diagnosis of exclusion
- ages 2 - 5 and 10 - 12
- intermittent pain
- more muscular pain
Etiology of Juvenile RA?
- from 2 - 12
- seronegative
- autoimmune
SS of Juvenile RA?
- high fever
- rash
- uveitis
- pericarditis
- flare up = stills disease
- must rule out lyme disease
- symmettrical distribution, potential atlantoaxial instability
Etiology of OA?
- older patient
- trauma or surgery to knee
SS of OA?
- stiffness
- knee pain, worse w/ prolonged sitting or walking
- mild swelling
- progressive bowlegged
Etiology of acromioclavicular joint sprain?
- direct trauma from a fall on the superior aspect of shoulder with arm adducted
- indirect force from FOOSH injury, usually affects the AC ligaments and spares the coracoclavicular ligaments
- car accident
- sports injury
- heavy lifting or pulling
Tests for AC joint sprain?
- O’Brien test
- pain w/ >90 deg abduction
- pain with passive horizontal adduction
Type 1 AC joint sprain?
- AC ligaments sprained,
- minimal tenderness
- swelling
- no displacment
Type 2 AC joint sprain?
- AC sprain and slight coracoclavicular sprain
- slight elevation of the lateral clavicle (step off)
Tpe 3 AC joint sprain?
- complete AC and coracoclavicular ligament sprain
- elevated clavicle
- AC tenderness
Management of AC sprain?
- Acute: PRICE
- if grade 3 refer to ortho
Etiology of Adhesive capsulitis?
- unknown cause
- ages 40 - 65
- > W
- diabetes
- prolonged imobilization of arm
- tendonitis
- non dominant arm
SS of adhesive capsulitis?
- decreased ROM, abduction and external rotation = capsular pattern
- pain with abduction and external rotation
Stage 1 adhesive capsulitis?
- peradhesive
- gradual onset of painful abduction and external rotation
- no limited ROM
Stage 2 adhesive capsulitis?
- acute adhesive synovitis
- painful arc
- decreased ROM
- constant pain
- pain decreased with motion
- muscle atrophy
Stage 2 adhesive capsulitis?
- extreme decrease in ROM
- gradual improvement of ROM
Etiology of Bicipital Tendonitis?
- inflammation of the tendon sheath surrounding the long head of the biceps
- b/c repeated overhead throwing activity of lifting
SS of Bicipital Tendonitis?
- speeds
- yergasons: pain and click
- pain w/ pressure on the bicipital groove and in the biceps muscle belly
- pop with flexion, abduction and external rotation
- pain is more anterior
Etiology of Breast Cancer?
- carcinoma within the breast duct
- lobular cancer
- fam history
- BRACA gene
- early menarche late menopause
- oral contraceptives
SS of Breast Cancer?
- non movable lump
- exaggeration of unusual skin
- peau d’oragne
Etiology of cholecystitis?
- acute inflammation of the gallbladder wall
- response to cystic duct obstuction by cholelithiasis (gallstones)
SS of cholecystitis?
- colicky pain
- sever right upper quadrant
- radiates to the lower scapular/ shoulder
- nausea
- involuntary guarding of the right side
- gallbladder becomes palpable
- pain with deep inspiration and right upper quadrant palpation (murphy’s sign)
- takes 2 - 3 days to resolve
Etiology of glenohumeral dislocation?
- direct or indirect injury
- anterior most common, b/c external rotation and extension of humerus
SS of glenohumeral dislocation?
- pain
- can’t use arm
Etiology of gout?
- peripheral joint arthritis b/c crystal deposition
- usually in the olecranon and in the big toe of foot
SS of acute gout?
- no warning
- minor trauma, purine rich food, alcohol, fatigue, stress
- monoarticular
- pain gets woese and more severe
- swelling, warmth, redness and tenderness
- big toe is most common
SS of chronic gout?
- permanent erosive joint deformity
- decreased ROM of hand and feet
- urate deposits in bursae and tendons
- enlarging tophi
Etiology of Myocardial Infarction?
- abrupt redcution of blood flow to part of the myocardium
- thrombus
- plaque rupture
SS of myocardial infarction?
shortness of breathe or fatigue
- deep substernal pain
- pressure on the chest ( elephant sitting on chest)
- radiation to the back, jaw, or left arm
- similar pain to angina pectoris, but long, not reliefed with rest
- severe pain
- restless
- aprehensive with pale, cool, diaphoretic skin
- peripheral/central cyanosis
Etiology of myofascial trigger point of the subscapularis muscle?
- b/c heavy push motion
- swimmers often get this injury, leads to instability of the rotator cuff and impingement syndrome
- bench press
- push motions
- popping shoulder
- throwing
SS of myofascial trigger point of the subsacpularis muscle?
limited abduction and external rotation
- local pain
- pain with pushing
Etiology of Pneumonia?
- acute infection of the lung parenchyma, involving alveolar spaces and interstitial tissue
- caused by bacteria such as S. Pneumoniae = most common
and H. Influenzae
SS of pneumonia?
- previous upper respiratory tract infection
- sudden shaking chill, if persistent chills = other diagnosis
- fever
- pain with breathing on the affect side
- cough -> purulent and blood streaked
- dyspnea
- increased temp 38 - 40 deg
- increased pulse and respirations to
Etiology of Polymyalgia Rheumatica?
- pain and stiffness in the proximal muscle groups w/out weakness of atrophy
- elevated ESR
- underlying temporal arthesis (swelli gof blood vessels)
SS of polymyalgia rheumatica?
- severe pain the proimal muscle groups
- pain and stiffness of the neck, pectoral and pelvic girdles
- morning stiffness
- systemic complaints: fever, depression, weight loss
DDx polymyalgia rheumatic and RA?
- Polymyalgia does not have hjoint synovitis, RH factor or rheumatoid nodules
DDX polymyalgia rheumatica and multiple myeloma?
- no monoclonal (plasma) overproduction
DDx polymyalgia rheumatica and fibromyalgia?
- systemic features and elevated ESR
Etiology of Pulmonary (bronchiogenic) Carcinoma?
- 90% of the primary lung tumours
- most common in 45 - 70 yrs olds that smoke cigarettes
SS of pulmonary (bronchiogenic) carcinoma?
- cough with hemoptysis
- blood streaked sputum
- horners syndrome: exothalamos, miosis, pitosis, ipsilateral facial anhidrosis
- pancoast syndrome: pain, numbness, weakness in the affected arm
Etiology of rotator cuff strain and tear?
- trauma or activity that injured the supraspinatus (abduction), infaspinatus (abduction and internal rotation), teres minor (external rotation) subscapularis (internal rotation)
- prolonged or repetitive use of muscle tendon: over head throwing, lifting activites, baseball, football, swimming
- trauma to shoulder, usually b/c abduction and external rotation
Grade 1 rotator cuff strain?
- takes 7 days to 4 weeks to hea;
- min fibre tearing
- slight decrease in the strenght
- min pain
Grade 2 rotator cuff strain?
- takes 2 weeks to 3 months to heal
- partial tearing of the fibres
- mod pain
- strength loss
Grade 3 rotator cuff strain?
- takes 2 months to 1 yr to heal
- full muscle tear
SS of Rotator cuff strain?
- immediate pain
- popping or tearing sensation at th etime of injury
- increased shoulder pain with movement, specifically active and resisted ROM
- decreased strength
Etiology of SC joint sprain (dislocation)?
- blow to the acromion of the scapula
- force transmitted through the pectoral girdle with a FOOSH
- clavicle can also break
Etiology of subacromial bursitis?
- subacromial bursa bound superiorly by coracoacromial ligament and acromion, inferiorly bound by rotator cuff and capsule
- previous tendonitis, tenosynovitis or inflammatory process in the bone or joint
SS of acute subacromial bursitis?
- excrutiating pain w/out relief on repositioning
- AROM painful
- pain and limitation on passive abduction and external rotation
- empty end feel b/c cannot go into full ROM without pain
- heat
- swelling
SS of chronic subacromial bursitis?
- vague
- pain after excessive overhead use
- night pain
Etiology of Supraclavicular nerve entrapemnt?
- inn. C3, c4 arising, supplying the supraspinatus and infraspinatus compression in the posterior triangle
SS of supraclavicular nerve entrapment?
- numbness and tingling along top and anterior shoulder
- decreased shoulder abduction strength
Etiology of SUpraspinatus tendonitis?
- eccentric overload of the supraspinatus
SS of Supraspinatus tendonitis?
- pain and weakness on full passive abduction
- painful arc
Tests for subacromial impingement?
- neers
- empty can
- hawkins kennedy
Etiology of syringomyelia?
- fluid filled neuro cavity (thecal sac) in the spinal cord (syringomyelia) or brain (syringobulbia)
- related to congenital annomilies
- usually in the cervical area
SS of syringomyelia?
- spinothalamic fibres interupted thus decreased pain and temp sensation
- deficits begin in the fingers then spread
- cape like sensory deficit over shoulders and bacl
- corticospinal tract compression = motor involvement, spasticity of the legs
SS pf syringobulbia?
- vertigo
- nystagmus
- unilateral or bilateral facial sensation im,apirment
- dysarthia
- dysphagia
- horseness
Etiology of TOS?
- women b/w 35 - 55
- compression of the subclavian vessies, lower or medial trunks of thebrachial plexus against a cervical rib, Pec minor HT or HT scalene muscles
SS of TOS?
- pain and paresthesia medially in the arms
- mild or moderate sensonary imapirment in the c8 - T1 dermatomal distribution
- aching in the supper arm, shoulder and neck
- waking up in the middle of the night, shake hand to normalize
- discoloration of the hands
Test for TOS?
- adson’s
- wrights
- edens
- east (ROO’s)
Etiology of abdominal aortic Aneurysm?
- in L2 - L4 region
- AAA
- caused by arthrosclerosis
- hypertension
- smoking
- trauma
- arteritis
SS of AAA?
- deep boring pain when ruture
- visceral pain in the lumbosacral region
- abdominal pulsation
- asymptomatic until rupture
Tests for AAA?
- palpation
- auscultation
- lateral or ap lumbar films
Etiology for Angina Pectoris?
- myocardial ischemia b/c coronary atherosclerosis
SS of Angina Pectoris?
- vague ache that becomes sever with exertion
- felt beneath sternum
- radiates to the left shoulder and inside of arm
- agg by exertion, emotional stress
- relieved by rest, vasodilation of coronary arteries by sublingual nitoglycerin
Tests for Angina Pectoris?
- ECG testing
- stress ECG
- coronary angiography
SS of Asthma?
- recurrent:
- dyspnea
- wheezing on inspiration and expiration b/c constriction of the bronchi
- coughing
- viscous exercise
- emotional stress
- hypertinic accessory musckles of breathing
- tripod stance
Tests for Asthma?
- pulmonary function test
- lung volumes and capacity
Treatment for asthma?
- elimination of causitive agent
- bronchodilators
- beta-adrenergic drugs
Etiology of Bronchitis?
- inflammation of the mucous membranes of the tracheobronchial tree
SS of acute bronchitis?
- rpoductive cough
- fever
- H/T of mucous secreting structures
- back pain
- b/c spread of the URTI
SS of Chronic bronchitis?
- excessive mucous production w/ productive cough at least 3 months in at least 2 years
- frequent chest infections
- cyanosis
- hypoxemia
- hypercapnia
- cor pulmonale (RSHF)
- respiratory failure
Test for bronchitis?
- clinically
- pulmonary function test
- chest xray
SS of cervical facet joint syndrome?
- neck and upper back stiffness
- sharp pain with neck movements
- absence of arm numbness and weakness
- sudden onset
- refered pain
- decreased ROM
+ kemps for local pain
SS of costovertebral dysfunction?
- localised over non- articular rib tubercle posteriorly
- sharp sudden pain
- pain on deep inspiration or coughing
- pain with direct prssure of the T spine
Etiology of Cholelithiasis?
- formation of presence of calculi in the gallbladder
- female, fat >40
SS of cholelithiasis?
- asymptomatic for long periods of time
- pain occurs in the right upper quadrant, radiating to the right lower scapula
- colic is constant
- nausea
Tests for Cholelithiasis?
- ultrasound
Etiology of GERD?
- incompetence of the lower esophageal sphincter
SS of GERD?
- heart burn w or w/out regurgitation
- epigastric pain after large meal or when lay down
- esophagitis, esophageal strictyure
- esophageal ulcer
- barret’s metaplasia
Treatment for GERD?
- elevated head of bed
- avoid acid: coffee. alcohol, fat, chocolate
- avoid antricholeinergic drugs and smoking
Etiology of Gastric/Peptic/duodenal ulcer?
- NSAIDs
- H pylori
- these disrupt the normal mucosal lining and make it more susceptible to acid
SS of gastric/ peptic ulcer?
- eating exacerbates the pain
- burning pain
SS duopdenal ulcer?
- epigastric burning pain
- relieved by food, reoccurs 2 -3 hrs after meal
Tests for GERD?
- contrast medium endoscopy to rule out stomach cancer
Etiology of Hiatal Hernia?
- protrusion of the stomach above the diaphragm
SS of Hiatal Hernia?
- chest pain
- GERD
SS of intercostal Neuritis?
- unilateral pain, extending in a band like pattern around the chest
Etiology of intercostal neuritis?
- idiopathic
- diabetes
- herpes zoster
- osteophytic encroachment
- rib sublux
SS of Kidney Stones?
- sudden severe pain felt over the posterior lower ribs
- radiates anteriorly into the groin
- nausea
Test for Kidney Stones?
- location of pain
- urinanalysis w/ hematuria
- xray showing opacity
Etiology of Pancreatitis?
- biliary tract disease
- predisposed by alcoholism and excess fat
SS of Pancreatitis?
- fever
- elevated WBC
- severe abdominal pain radiates to the back
- abdominal pain that radiates to the back
- sitting up and leaning forward reduce the pain
- coughing, movement and deep breathing accentuate pain
- nausea
Tests for pancreatitis?
- serum amylase and lipase
Etiology of Pnemothorax?
- spontaneous in tall people
- trauma
- free area in the visceral and the parietal pleura
SS of Pneumothorax?
- sudden sharp chest pain
- dysponea
- occasionally a dry hackin cough
- pain refered to the same side shoulder, across the chest of the abdomin
Tests for Pneumothorax?
- decreased chest wall motion on the affected side
- increased resonnacnce on percussion, absent tactile femitis
Etiology of Pulmonary Embolism?
- blood clot or nitrogen buble blocvking a pulmonary artery, restricting blood flow to lung parenchyma
SS of Pulmonary Embolism?
- dysponea
- sudden chest pain
- shock
- cyanosis
SS of pulmonary infarction?
- 6 to 24 hrs after formation of embolus
- pleural effesion
- hemoptysis
- leukocytosis
- fever
- tachycardia
- arrhythmia
- striking distension of the neck veins
Etiology of Scheuermann’s disease?
- males
- 13 -17
- thoracic spine
SS of scheurmann’s disease?
- pain
- fatigue
- increased kyphosis
Etiology of shingles?
- herpes zoster
- invaded the posterior root ganglion of the thoracic and trigeminal nerves
SS of shingles?
- intermittent or constant pain that is superficial or deep
- fever
- HA
- vessicles form leaving that area of skin hypersensitive
- unilateral
SS of Thoracic compression #?
- sudden Thoracic pain
- hyperflexion, axial compression
- pathological # if patient is above 50
- long term corticosteroid use and over 70 suggests compression #
- pain with percussion and deep pressure
Etiology of URTI?
- common cold
- picornaviruses
- rhinovirus
- echovirus
- coxdakievirus
SS of URTI?
- burning in the nose or throat
- sneezing
- rhinorrhea
- no fever
- pharyngitis
- mild cough
Etiology of anterior interossesous nerve syndrome?
- entrapment of the motor branch of the median nerve
- innervates the FPL, FDP and pronator quadratus
- compressed at the flexor digitorum superficialis or the deep head of the prionator teres
SS of anterior interossesou nerve syndrome?
- local proximal anterior forearm pain
- due to repetitive activity or single vilent forearm muscle contraction
- weakness of pinching thimb and index finger
Tests for anterior interosseous nerve syndrome?
- froment sign (instead of an ok with the dip of the thumb flexed it is extended so that the thumb and the index grip flat
- resisted elbow pronation w/ full elbow flexion
- numbness of the pronator quadratus
Treatment for anterior interosseous nerve syndrome?
- NSAIDS
- splinting
- rest
Etiology of Avascular nercrosis of the scaphoid?
- # of scaphoid b/c of FOOSH
SS of scaphoid AVN?
- pain at the anatomical snuff box after a foosh
- extension, flexion and radial deviation are all decreased
- hematoma
- tenderness to pressure over the scaphoid
Test for Scaphoid AVN?
- xray in 2 weeks post injury to show the non- union
Etiology of carpal tunnel syndrome?
- compression in the tunnel from prolonged/repetitive extension
- fluid retention with pregnancy, RA, diabetes, connective tissue disorders, vitamin B deficiency
SS of carpal tunnel syndrome?
- pain, numbness and tingling in the palmar surface of the thumb and radial two and one half fingers
- worse at night, burning and aching
Tests for carpal tunnel?
- tinels tap
- phalen’s
- reverse phalen’s
Treatment for carpal tunnel?
- splinting
- ergonomic change
- vitamin B suplemments
Etiology of Colle’s #?
- silver fork #
- # withing the epiphysis of the radius
- FOOSH
SS of Colle’s #?
- hand is displaced dorsally and laterally
- used xray to confirm
Etiology of cubital tunnel syndrome?
- compression of the ulnar nerve at the elbow
- compression between the 2 heads of the Flexor carpi ulnaris
- seen in baseball pitchers
SS of cubital tunnel syndrome?
- elbow pain
- medial forearm pain
- paresthesia into the ring and the little finger
Tests for cubital tunnel syndrome?
- pain reproduced with passive or resisted elbow flexion, while elbow is maximally flexed
Treatment for cubital tunnel syndrome?
-PRICE
Etiology of de quervian’s syndrome?
- stenosing tenosynovitis of the abductor pollicis longus and extensor pollicis brevis as a result of chronic microtrauma
- activity with forceful gripping, ulnar deviation and repetitive use of the thumb
SS of de quervain’s syndrome?
- local pain over the anatomical snuffbox
- pain radiates up distal forearm
- swelling in the tendons
Tests for de quervain’s syndrome?
- Finklestein’s
Treatment for de quervain’s syndrome?
- activity modification
- NSAIDS
SS of diabetes mellitus?
- peripheral neuropathy
- sensory deficits, beginning with a glove and stocking distribution
- numbness, tingling and paresthesia B?L in all extremities
Tests for Diabetes mellitus?
- oral glucose test
- fasting glucose test
Etiology of Guyon’s cannal compression?
- compression of the ulnar nerve in the tunnel of guyon
- constant compression from handlebars (cyclists)
- vascular abnormalities
- # of the hook of hamate
SS of guyon canal compression?
- numbness/tingling or pain in the fourth and fifth digits
Tests for guyons canal compression?
- tinels at the wrist for ulnar nerve
- froment’s sign`
Treatment for guyon’s canal compression?
- change activites
Etiology of Median nerve palsy?
- originated fomr the C5 - T1 spinal nerves (lateral and medial cords)
- compression points:
+ axilla
+ bicipital aponeuosis
+ sublimis bridge
+ next to humerus
+ pronator teres
+ carpal tunnel
SS of median nerve palsy?
- decreased sensation over the thumb, 2, 3 and half of the 4th digit
Etiology for a metacarpal #?
- direct blow or axial force ex. punching a wall
- alsoe called bar room #
SS of metacarpal #?
- pain over the metacarpal joint
- usually 4th metacarpal
- rotational deformity at the metatcarpal with flexion
Tests for metacarpal #?
- xray
- percussion of the finger will increase pain
Etiology of Myasthenia Gravis?
- neuromuscular transmission is blocked by autoantibodies that bind acetylcholine rexeptors at the post-synaptic NMJ
- idipathic or ass. with RA. SLE
SS of Myasthenia Gravis?
- young women
- double vision
- difficulty swallowing
- weakness of more used arm
- weakness of the jaw muscles when chewing
- single sided miosis
Tests for myasthenia gravis?
- drug testing w/ anticholinesterase, causes temporary increase in strength
SS of palmaris longus muscle strain?
- pain at the medial epicondyle of the humerus or distal flexor retinaculum
- potential compressio nof the median nerve due to inflammation
- pain with active or resisted wrist flexion
Etiology of Radial tunnel syndrome (Posterior Interosseous nerve syndrome)?
- compression of the superficial branch of the radial nerve in the proximal forearm or back of the arm, radiating pain into the dorsum of forearma nd hand
- lesions at the elbow include
+ trauma
+ ganglia
+ lipoma
+ bone tumour
+ radial bursitis
SS of radial tunnel syndrome?
- posterior wrist or forearm pain
- weakness of wrist extension or thumb and index finger extension
- no sensory loss*
- pain is reproduced w/ forceful wrist extension
Tests for Radial Tunel syndrome?
- localized tinel’s sign
- tenderness along the course of the radial nerve
- ddx from lateral epicondylitis
- palpation and muscle testing
Etiology of Pronator Teres Syndrome?
- compression at \+ bicipital aponeuosis, \+ between the 2 heads of the pronator teres \+ FDS \+ ligament of struthers \+ median artery \+ bicipital tuberosity bursa
SS of pronator teres syndrome?
- anterior forearm pain
- rrepetitive pronation and wrist flexion
- carpanter
- weight lifter
- no trauma
Tests for Pronator teres syndrome?
- pressure over the pronator teres
- resisted elbow flexion and supination w/ max elbow flexion, implies bicipital aponeurosis or ligament of struthers
- resisted pronation, keeping elbow extended and wrist flexed, suggests pronator teres compression
- resisted middle finger flexion suggests compresion b/c FDS
Etiology of radial nerve palsy?
- branch of posterior cord C5 - T1
- compression at
+ axilla
+ spinal groove
+ humerus #
+ saturday night palsy
+ arcade of frohse
+ wrist
SS of radial nerve palsy?
- decreased posterior arm forearm and back of hand sensation
Test for radial nerve palsy above elbow?
- triceps
- brachioradialis
- ECRL
- ECRB
Tests for radial nerve palsy below the elbow?
- supinator
- ECU
- ED
- extensor digiti minimi
- Abductor pollicis longus
- extensor indicis
- extensor pollicis brevis
- extensor policis longus*
Test for median nerve palsy?
- pronator teres
- flexor carpi radialis
- palmaris longus
- flexor digitrum superficialis
- flexor digitorum profundus
- flexor policis longus
- pronator quadratus
- abductor pollicis brevis
- flexor pollicis brevis
- opponens pollicis
- 1st and 2nd lumbrical
Etiology of Raynaud’s phenomenon?
- spasm of arterioles in the digits and sometimes the nose and tongue - cold and cyanosis
- common in young women
- seondary to other conditions
+ scleroderma
+ RA
+ SLE
+ obstructive arterial disease
+ neurogenic lesion
+ drug intoxications
SS of Raynaud’s Penomenon?
- intermittent blanching or cyanosis of the digits is precipitated by exposure to the cold or emotional upset
- do not occur above the MCP and spares the thumb
- pain is uncommon but paresthesias are frequency
- lasts minutes to hrs
- phenomenon is due to an underlying condition, the raynauds disease is idiopathic
Etiology of a Smith’s # (reverse colle’s #)
- hyperflexion
SS of smith’s #?
- anterior displacment of the distal radial bone fragment
SS of RA?
any of 4
- morning stiffness > 1 hr
- arthritis of 3 or more joints
- arthritis of the hadn
- symmetrical arthritis
- rheumatoid nodules
- Rh factor
- synovial thickening
Etiology of a Ulnar nerve palsy?
compression at: - axilla - upper arm (above elbow) = \+ weak FCU and FDP - cubital tunnel = most common - guyon's canal
SS of ulnar nerve palsy?
- decreased medial forearm and palmar 4th and 5th digit sensation
Tests for ulnar nerve palsy?
- flexor carpi ulnaris
- flexor digitorum profundus
- interossei
- lumbricals 3 and 4
- adductor pollicis
- abductor digiti minimi
- flexor digiti minimi brevis
- opponens digiti minimi
Treatment for cervical disc?
- SMT adjacent to the level of herniation after trial of mobilisation, improvement should be seen in 6- 8weeks
Treatment for cervical rib induced TOS?
adjust
- gradual improvement in 3 months
Etiology of Chronic Fatigue Syndrome?
- chronic and persistent fatigue and cognitive difficulties of 6 months duration
- females > males
- epstein-barr infection prior
SS of chronic fatigue?
4 of following
- fatigue
- short term memory impairment
- sore throat
- tender lymph nodes
- myalgia
- chest pain
- palpitation
- HA
- photophobia
- depression
- mood swings
Treatment for chronic fatigue?
- chiro care and comange w/ other modalities of care
Etiology of DISH?
- general spinal and extraspinal articul;ar disorder
- ligamentous calcification and ossifiation specifically the ALL
SS of DISH?
- Males > Females
- diabetes
- dysphagia
- decreased rotation (<45 deg)
Tests for DISH?
xray
- ossification of atleast 4 flowing segments
- disc height normal
- sometimes also ossification of the PLL
Etiology for TVP #?
- avulsion of the paraspinal muscle with severe hyperextension and lateral flexion injury to the lumbar spine
Etiology for Pars #?
- hyperextension of the lumbar spine
- # at L4 or L5
- oblique xray can see the scotty dog collar brokern
SS of pars and TVP #?
- flank pain
- hematuria if renal damage
SS of spinal stenosis?
pain in back or legs with
- walking
- urnning
- climbing stairs
- pain relieved with flexion, uphill walking therefore less painful then downhill walking)
Etiology of Toticolis?
- involuntary tonic contraction or intermittent spasm of the neck muscles, especially the SCM
Etiology of congenital torticolis?
- b/c birth trauma causing SCM to become fibrous
Etiology of Adult torticolis?
- CNS infection
- tumour
- basal ganglion disease
- spontaneous recovery
SS of congenital torticolis?
- fixed asymetry of the head
- bruising of the SCM can be seen days after the delivery
SS of adult onset torticolis?
- painful SCM spasm
Treatment for torticolis?
- SMT
- SCM massage and lengething
Names for acoustic neuromas?
- acoustic schwannomas
- acoustic neurinomas
Etiology of Acoustic neuroma?
- from schwan cells arising from the vestibular division of the vestibulocochlear nerve
- the 5th and 7th cranial nerves can also be affectd
SS of acoustic neuroma?
- hearing loss*
- tinnitus*
- gradual onset
- dizziness and unsteadiness (not true BPPV b/c not position related)
Treatment of acoustic neuroma?
- refer for surgery
Etiology of acute vestibular neuritis?
- sudden onset of severe vertigo that is at first persistent then becomes paroxysmal
- neuron inflamation of the vestibulocochlear nerve because viral infection
SS of acute vestibular neuritis?
- first attack of vertigo is sever and persists
- accompanies by nausea and vomitting
- lasts 7 to 10 days
- nystagmus toward affected side
- no hearing loss or tinnitus*
- sometimes dysarthia, ataxia and disdiadochokinesis
Tests for acute vestibular neuritis?
- audiologic assessment
- MRI of head
- electronystagmography w/ caloric testing
Treatment of acute vestibular neuritis?
- refer to MD meds same as meniere’s disease
- vestibular training and balance exercises
Etiology of Benign Paroxysmal Positional Vertigo (BPPV)?
- vertigo less than 30 sec brought on by certain head positions
- cupulolithiasis: deposits of debris in the cupular of the posterior semicircular canal
- occurs when patient lies on one side or tips their head backward to look up
SS of BPPV?
- vertigo when head in certain position usually lying on ear or tipping head backward
- Nystagmus
- non hearing loss or tinnitus*
- gets better in few weeks to months
Tests for BPPV?
- positional nystagmus
- dix hall pike
- CNS lesion is vertical nystagmus, continues for as long as the position is held
- audiologic assessment
- electronystagmography with caloric testing
- head MRI
Treatment for BPPV?
- avoid the provocative position
- otoconia repositing maneuvers
- epleys
- semont
- habituation exercises
- if last >1 consider surgery
Etiology of a concussion?
- transient post traumatic loss of awareness or memory
- lasts from seconds to minutes
- pupilary and other brain stem functions are still intact
SS of postconcussion syndrome?
- HA
- dizziness
- difficulty concentrating
- variable amnesia
- depression
- apathy
- anxiety
Test for concussion?
- state of conciousness
- breathing pattern
- pupil size
- reaction to light
- occulomotor activity
- motor activity in the limbs
- CT
- MRI
- glasgow coma scale
Treatment for concussion?
- observe for 24 hrs
- if no fracture or hematoma seen in xray or CT no need to be hospitalised
What is diplopia?
- double vision
Myopia?
- nearsighted
Hyperopia?
- farsighted
Etiology of primary Encephalitis?
- aacute inflammation of the brain b/c viral invasion or hypersensitivity
- usually b/c viral infection
+ arbovirus
+ poliovirus
+ echovirus
+ coxsackievirus
Etiology of secondary encephalitis?
complication of infection:
- measles
- chickenpox
- rubella
- smallpox
SS of encephalitis?
- fever
- HA
- nausea
- stiff neck
- altered conciousness
- personality changes
- seizures
- paresis
Tests for encephalitis?
- normal glucose
- no bacteria
- virus isolated from the CSF
- MRI detect the brain inflammation the earliest
Treatment for encephalitis?
- refer for meds to control virus
Etiology of Facet Syndrome?
- well localised LBP w/ some hip or butt pain above the knee
- sudden onset after misjudged movement
- facet and the capsule are the source of the pain, mediated by the medial branch of the posterior primary rami
- meniscoids become entraped or pinched and cause pain
- substance )
- degeneration in older individuals
Tests of Facet syndrome?
- local pain
- absence of neuro symptoms
- absence of nerve root tension signs/tests
- local pain w/ kemps, if repro w/ SLR does not extend past the knee
- xray, general degeneration and hyperlordosis
Etiology of Herpes Zoster Oticus (Pamsy hunt, viral neuonitis, ganglionitis)?
- invasion of the vestibulocochlear and the geniculate ganglion of the facial nerve by the herpes zoster virus
SS of Herpes Zoster Oticus?
- severe ear pain
- hearing loss
- vertigo
- paralysis of the facial nerve
- vesicles in the ear canal
- vertigo lasts from days to weeks
- facial sensory loss can resolve or become permenant
Treatment for Herpes Zoster Oticus?
- refer to MD, corticosteroids, antiivirals, decompression
Etiology of primary hypertension?
- elevated systolic or diastolic BP
- unknown cause
Etiology of secondary hypertension?
- renal parenchymal disease \+ glomerulonephritis \+ pyelonephritis \+ polycystic renal disease \+ collagen disease of the kindey - pheochromocytoma (adrenals) - cushings - Addisons - hyperthyroidism - myexedema - excessive alcohol - oral contraceptives
SS of hypertension?
- dizziness
- flushed face
- ha
- fatigue
- epitaxis
- Left ventricular HT
- renal changes
+ hemorrhage
+ excudate
Tests for hypertension?
- higher systolic and diastolic BP
Treatment of hypertension?
- lifestyle change:
+ weight reduction
+ salt decrease
Etiology of Orthostatic hypotension?
- fall in BP > 20/10 mm Hg when stand up
- b/c hypovolemia
SS of orthostatic hypotension?
- faint
- light headed
- dizzy
- confused
- visual blurring
- all b/c decreased blood flow to the brain
Etiology of Labyrinthine Tumor?
similar to acoustic neuroma
Etiology of Labyrthitis?
- inner ear bacterial infection
- seondary to otitis media or purulent meningitis
- usually get meningitis after
SS of Labyrinthitis?
- severe vertigo and nystagmus
- complete hearing loss
- sometimes facial paralysis
Treatment of Labyrinthitis?
- IV antibiotics
Etiology of Meniere’s disease?
idiopathic
SS of meniere’s disease?
- recurrent prostrating vertigo
- sensory hearing loss
- tinnitus
- feeling of fullness in the ear
- sudden onset
- nausea and vommiting
- feeling of fullness*
Treatment of Meniere’s disease?
- vestibular neurectomy relieves th vertigo and preserves the hearing
- meds
- SMT
Etiology of Motion sickness?
- repetitive angular and linear acceleration and decelleration causing nausea and vommiting
- basically the excessive stimulation of the vestibular apparatus
SS of motion sickness?
- cyclic nausea and vomiting
Etiology of Multiple sclerosis?
- progressive CNS disorder, characterized by patches of demylination in the brain and the spinal cord
- idiopathic
- > W
- 20 - 40
- mostley affect the lateral and the posterior columns
SS of MS?
- paresthesias in extremities, trunk or side of the face
- weakness or clumsiness of a leg or a hand
- visual disturbances: partial blindness
Tests for MS?
- diagnosis of exclusion
- brain MRI
- lumbar puncture
Treatment for MS?
- corticosteroids
- symptomatic treatments
- regular exercise
Etiology of Myringitis?
- Inflammation of the tympanic membrane secondary to viral or bacterial infection
SS of Myringitis?
- inflammation of the tympanic membrane
- vesicles develop on the tympanic membrane
- pain is sudden onset and lasts from 24 - 48 hrs
- if hearing loss and fever = ostits media
Treatment for myringitis?
- differential cause if bacterial or mycoplasmal
- rupture the vesicles and give antibiotics
Etiology of Otitis media?
- bacterial or viral infection in the middle ear, usually after an URTI
- common in young children
- escherichia coli
- staph aureus
- stepth pneumonia
- h influenzae
SS of otitis media?
- persistent severe earache
- hearing loss
- fever
- nausea
- dirreha
SS of chronic otitis media?
- conductive hearing loss b/c perforation in the tympanic membrane
Etiology of Temporal Bone fracture?
- bleeding from ear after a skull injury
- facial paralysis
- permanent hearing loss
- assessed w/ Weber’s and Rinne’s tests
Treatment of temporal bone fracture?
- penicillin to prevent meningitis
- tympanic repair if patientexperiences hearing loss
Etiology of temporal lob seizures?
- comples partial seizure
- originate in the temporal lobe
SS of temporal lobe seizures?
- losses contact w/ surroundings for 1 - 2 mins
- stare
- purposeless movements
- unintelligible sounds
- mental confusion
Etiology of TIA?
- sudden focal neural abnormalities of breif duration
- due to cerebral emboli in the internal carotis, middle cerebral or the vertebrobasilar system
SS of TIA?
- last from 2 - 30 min
- resolve without any persisting neurological function compromise
- 5 ds and 3 NS
Etiology of Atelectasis?
- airless states of the lung
- caused by intraluminar bronchial obstruction which result from:
+ bronchial excudate
+ endobronchial tumours
+ granuloma
SS of Atelectasis?
- pain oni the affected side
- sudden onset of dyspnea and cyanosis
- drop in BP
- tachycardia
- elevated temperature
- shock
- dullness on percussion
- no breath sounds with auscultation
- mediastinum deviates towards the side of lung collapse
Etiology of Bronchiectasis?
- irreversible focal bronchial dilation
- chronic infection
- diverse conditions
- congenital or hereditary
- inhalation of noxious chemicals
- preceding atelectasis
SS of bronchiectasis?
- chronic cough with sputum prodcution
Etiology of costochondritis?
- inflammation of the costochondral or costosternal joints that causes local pain and tenderness
- b/c repetitive micro trauma
SS of costochondritis?
- insidious onset
- chest wall pain usually w/ repetiive motion or unaccustomed activity ex. painting
- worse when move trunk, deep inspiration or exertion
- pain decreased with decreased breathing or changing position
- sharp pain
- wax and waning
- mostly bilateral
- if unilateal and edema = tietze
Treatment of costcoshondirits?
- NSAIDS
- stretching and local heat
- avoid repetive use of the musculature in the area
- modify ergonomics
Treatment of myofascial trigger point of the pectoralis muscle?
- pec is stretched w/ horizontal abduction
- prees down on coracoid process
Etiology of scalene trigger point?
- ipsilateral lateral flexion and contralateral rotation overuse
Treatment of the myofascial trigger point of the serratus anterior muscle?
- stretched with arm abducted and lateral flex to the opposite side
Etiology of COPD?
- airflow obstruction due to chronic bronchitis or emphysema
- progressively worsens
- chronic productive cough for 3 months for atleast 2 years
SS of COPD?
- productive cough
- worse in morning and produces a small amount of colorless sputum
- dyspnoea
- cyanosis
- cor pulmonae
- elevated and distension of julglar veins
- peripheral edema
- crackles w/ inspiration
Etiology of Pancoast Tumor?
- in the apex of the pleura
- direct spread from a sulcus bronchiogenic carcinoma
- pain in the shoulder and ulnar distribution of the arm
- also cause horner syndrome
SS of Pancoast tumor?
- pain in the shoulder an ulnar distribution of the arm
- horner syndrome
- unremmiting pain
- xray:
+ apical cap on the lung
Etiology of Pleurisy?
- direct entry of infectious or irritating substance into the plueral space
- trauma, asbestos
SS of pleuristy?
inflam of the pleura
- stabbing chest pain
- worse by cough, respiration, trunk bending
- pain occurs with deep breathe or cough
- local spot of pain
- motion and breathe sounds of the affected side is diminished
Tests for plueisy?
- recent infection
- no nausea vomiting or disturbed bowel function
- pain agg by breathing or coughing
- intercostal neurtitis if no pain on respiration
Etiology of Subacute endocardidits?
- previous infection
- congestive heart failure
- IV drug users
SS og Subacute endocarditis?
- fever and chills
- anorexia
- weight loss
- malaise
- HA
- night sweats
- shortness of breath
- cough
- dyspnea
- petichiae
- splinter hemorrhages
- osler nodes: tender nodes on distal digits
- janeway lesion: non tender macuale on palms and soles
- roth spots: retinal hemorrhages w/ small clear centers
Etiology of achilles tendonitis?
- formed from the gastrocs and the soleus, inserting into the superior aspect of the calcaneus
- overuse in running or jumping
- direct trauma from forced dorsiflexion
SS of achilles tendonitis?
- pain with palpation
- pain with passive dorsiflexion
- palpable scarring in the tendon
Treatment of achilles tendonitis?
- rest ice and NSAIDs
- do not exercise through the pain or will form a rigid scar
Etiology if Anterior talo-fibular ligament sprain?
- excessive inversion
Tests for anterior talo-fibular ligament sprain?
- talar tilt test
- anterior drawer test
Treatment of grade 1 anterior talo fibular ligament sprain
PRICE
Treatment of grade 2 anterior talo fibular ligament sprain
- PRICE
- crutches
- rehab w/ ROM and ankle strenghtening
Treatment of grade 3 anterior talo fibular ligament sprain
- refer
Etiology of calcaneal spur?
ossification b/c of plantar fascia traction on the periosteum of the calcaneus
- stress at the plantar aspect of the calcaneus at the acttachment of the plantar aponeurosis
- excessive running, standing or walking
- can occurs by itself or with diseases like reiters, AS, DISH
SS of calcaneal spur?
- constant pain on the undersurface of the heel, radiates from the anterior portion into the rest of the plantar aspect of the foot
- pain with walking or standing
- pain relieved by rest
- local tenderness is found over the medial portion of the spur
- swlling
- passive dorsiflexion of the toes may accentuate the pain
Test for calcaneal spur?
- see on an xray
Treatment for calcaneal spur?
- PRICE
- heel lifts
- donut shaped show inserts which take pressure off of the heel spurs
- surgery
- shock wave therapy
Etiology for Charcot’s joints?
- rapid destructive arthropathy of various causes from impaired pain perception and position sense
- no sensation of pain or proprioception compromised the protective reflexes of the joint = trauma to occurs, mostly in the knee
SS for charcots joints?
- confused with OA
- mild pain, but usually not present
- hemorrhagic effusion
- subluxation and instability
- acute joint dislocation
- neurogenic arthropathy progresses more rapidly than OA
- neurological disorder that results in painless but destructive arthropathy
Tests for charcots joint?
- 6 D’s: increased density, debris, destruction, distension, dislocation and disorganization
- parrots beak deformity
Distribution of charcots joint based off of the underlying neurological condition. What is the distibution of tabes doralis charcots joint?
- knee and hip
What is the distibution of diabetes melitis charcots joint?
- foot
What is the distibution of Syringomyelia charcots joint?
- upper limb, especialy the elbow and shoulder
Treatment of charcots joint?
- treatment of underlying neurlogical condition
- surgery and prevention
Etiology of Diabetes Melitus Type 1?
- impairment in insluin secretion (type 1)
- hyperglycemia
- diabetic ketoacidosis
- any age mostly develops in childhood or teen years
SS of Diabetes mellitus?
- polyuria
- polydipsia
- weight loss
- hyperglycemia =
+ blurred vision
+ fatigue
+ nausea
Tests for diabetes mellitus?
- fasting glucose: > 140 mg/dL or > 7.77 mmol/L
- almost 0 blood insulin
Etiology of type 2 Diabetes Melitus?
- non insulin dependent
- hyperglycemia and insulin resistence
- diabetic ketoacidosis is rare
- ass. w/ obesity
- vaginal candidiasis (yeast infection)
SS of type 2 diabetes mellitus?
- atherosclerosis leads to symptomatic coronary artery disease
- claudication
- skin breakdown
- infection
- retinopathy, macular edema -> blindness
- diabetic neuropathy, glove stocking sensory deficits
- foot ulcers and joint problems
Tests for diabetes mellitus?
- overnight fasting blood glucose:
+ > 140 mg/dL or >7.77 mmol/L
Treatment for diabetes mellitus?
- diet to reduce weight
- patient education
- oral drug to control hyperglycemia
Etiology of gout?
- monosodium urate crysta deposition in avascular tissues
- Tophi are deposited in the jonit and are large enough to be seen on xray
- b/c decreased renal clearance of urate
SS of gout?
- starts w/out warning
- precipitated by minor trauma
- overindulgence in purine rich food, alcohol
- fatigue
- emotional stress
- medical stress
- acute monarticular pain
- nocturnal
- progressively more severe
- acute infection
- warm shiny or purplish skin
- big toe, ankle, knee and elbow = common sites
Tests for gout?
- elevated blood urate
+ > 7mg/dL - needle shaped urate crystals are free in the fluid or engulfed by phagocytes
- xray
+ punched out lesions in the subchondral bone
Treatment of gout?
- nsaids
- colchicine, allopurinol
- diet prevention
Etiology of hallux limitus?
- limited ROM in the big toe
- biomech abnormalities
- pressure from shoe can cause the pain or neuritis
SS of hallux limitus?
- pain w/ swelling
- bony proliferation around the dorsal aspect and lateral aspect of the metatarsal head
- alignment of the joint is altered in hallux valgus
- limited dorsiflexion of the big toe
- xray:
+ djd of 1st metatarsal head
+ lateral osteophytes
+ naroowing of JS - Lab no rheumatoid factor or HLA - B27 = this
Treatment of hallux limitus?
- pad area
- local anesthetic
- antiinflamatory
- show modification
- analgesics
Etiology of Hallux Valgus?
- lateral deviation of the hallux
- excessive pronation of the ankles
SS of hallux valgus?
- bunion at 1st met head
- pain at 1st met head
- lateral deviation of 1st met head
Tests for hallux valgus?
- enlarged 1st MTP joint w/ lim motion
- pain on palp of joint
- increased dorsiflexion of the the 1st big toe
- xray
+ JS narrowing
+ bony spurs extending from the metatarsal heads
Treatment for hallux valgus?
- passive exercises and toe traction
- local anesthetic
- orthotics
Etiology of mortons neuroma (interdigital nerve pain?
- neuroma usually b/w 3rd and 4th digit
- loss of fat pad protecting the interdigital nerves of the foot
- repetitive trauma
- improper foot wear
- gradual persistent benign thickening and enlargement of the perineurium of one or more of the interdigital nerves of the foot
SS of Mortons neuroma?
- pain along one or more nerves of the foot radiating to the ball or the toes
- patients with neuroma complain of a mild ache or discomfort in the foot near the 4th metatarsla head
- burning or tingling near 4th metatarsal head
- feels like a marble or a pebble is inside your foot
Tests for mortons neuroma?
- plantar palpation of ther interdigital space
- thumb pressure applied b/w 3rd and 4th metatarsal heads = pain w/ morton neuroma
Treatment for morton’s neuroma/
- resloves quick with insoles
- lidocaine helps w/ neuralgia
- corticosteroids
- surgical excession of the neuroma
Etiology of Osteochondritis Dissecans?
- loss of blood supply to an ares of bone underneath the joint surface = pain
- AVN of bone
- cartilage eventually seperates from the diseased bone
- fragments break loose into the knee joint causing locking of the joint
SS of osteochondritis dissecans?
- weakness
- sharp pain
- joint locking
Tests for osteochondritis dissecans?
- xray
- MRI
- arthroscopy
- positive wilsons test
Treatment for osteochondritis dissecans?
- if not fragmented the bone can be fixed in place with pins or screws
- if fragements bone graft
Etiology of Osteoid Osteoma?
- benign bone tumor of the long bones
- small lucent nidus surrounded by sclerotid region
- 10 - 25 yrs olds
SS of osteoid osteoma?
- painful, worse at night
- releieved w/ aspirin
Tests for osteoid osteoma?
- xray
+ small lucent zone surrounded by a larger sclerotic zone
+ similar appearance to a brodie’s abcess
Treatment for osteoid osteoma?
- small radiolucent zone is located and surgically removed
Etiology of Raynaud’s Disase?
- spasm of arterioles in the digits and occasionally nose and tongue with intermittent pallor or cyanosis
- disease = idiopathic
- phenomenon= b/c underlying conditions
Etiology of Raynaud’s Phenomenon?
- secondary to other conditions: \+ scleroderma \+ SLE \+ RA - neurolesions - drug intoxication - dysproteinemia - myxedema - primary pulmonary hypertension - trauma
SS of Raynaud’s phenomenon?
- intermittent blanching or cyanosis of the digits precipitated by exposure to cold or by emotional stressor
- color change
- does not affect the thumb
- no pain, often paresthesia
- vasospasm of the digital arteries
- warm hands restores the color and sensation
Test for Raynauds?
- in disease the tropic skin changes are not present whereas in phenomenon there will be changes in the skin according to the underlying disease
Etiology for Reiter’s syndrome?
- seronegative arthropathy
- can’t see cant pee cant dance
- infectious
+chlamydia
+shingella
+salmonella
+yersina
+campylobacter - men 20 - 40
- increased incidence in people with HLA-B27
SS of Reiter’s syndrome (reactive arthritis?
- urethritis
- fever
- conjunctivitis
- arthritis
- asymetrical
- back pain
Tests for Reactive arthrits?
- peripheral arthritis w/ urethritis or cervicitis
- ddx in several months
- positive gonococcal culture, rapid response to penicillin
- arthritis or skin lesion similar to psoriatc
Treatment for reactive arthrits?
- tetracycline for up to 3 months reccomended
Etiology of RA?
- idiopahtic
- > W
- b/w 25 - 50
SS of RA?
- insidious
- progressive joint involvement
- tenderness in inflamed joints
- synovial thickening
- siffness for > 30min
- early afternoon fatigue and malaise also occur
Tests for RA?
- lab findings
- increased ESR
- RF
- no crystals
- xray
+ soft tissue sweeling
+ periarticular arthritis
+ JS narrowing
+ marginal erosion
Treatment for RA?
- improve w/ conservative treatment
- contra for cervical manipulation b/c atlanto axial instability
- NSAIDs
Etiology of infectious (septic arthrits)?
- mos commonly caused by neisseria gonorrheoae
- spreads from infects surfaces, cervix, rectum or pharynx to small joints fo the hands, wrists elbows, knees and ankles
- nongonococcal arthritis is caused by Staph Aureus
SS of infectioous (septic) arthritis?
- acute onset of joint pain and swelling
- rapid onset
- mod to severe joint pain
- warmth
- tenderness
- restricted motion
Tests for infectious arthrtis?
- increased WBC
- increased ESR
- increased c reactive protein
- viscosity and glucose conentrations usually decreased
Treatment for infectious arthritis?
- depends on the results of culture, wheterh antibacterial or antiviral
Etiology of Epiphysitis of the calcaneus (sever’s disease)?
- develops from 2 centers of ossification
- one begins at birth and other doesn’t begin before the 8th yr
- in ages 8 - 16
- excessive strain w/ vigorous activities
SS of Sever’s disease?
- heel pain
- history of trauma
Tests for sever’s disease?
- location of pain along the margins of the heel
- patients age
- history of athletic involvement
- warmth and swelling
- xray no relpful
Treatment for severs disease?
- heel pads: reduce the pull of the achilles on the heel
- immobilization of the foot in a cast is usually effective
Etiology of posteriolateral talar tubercle fracture?
- sudden jump on the ball of the foot or toes or from steeping backward off a chair with force
- tow walkers more prone to this injury
SS of posteriolateral tala tubercle #?
- pain and swellin behind the ankle
- difficulty walking downhill or descending stairs
- persistent swelling with no obvious history of injury
- heat may be present but is mild
Tests for posteriolateral talar tubercle #?
- plantar flexion = pain
- lateral flexion xray = see #
Treatment of posteriolateral talar tubercle #?
- refer
- immobilize for 4 - 6 weeks
- if pain still there corticosteroids and an anestetic may be effective
Etiology of tibial nerve neuralgia (tarsal tunnel syndrome)?
- compression of the tibial nerve at the medial part of the ankle under the tarsal tunnel
- synovitis of the flexor tnedons
- inflam arthritis
- venous stasis edema
SS of Tarsal tunnel syndome?
- pain in and around ankle that extends into the toes
- pain worse w/ walking
- releieved with rest
- can occur while standing or while wearing various types of foot wear
Tests for tarsal tunnel syndrome?
- tapping the posterior nerve below the medial malleolus, when the site of compression is struck it will generate distal tingling
- electrodiagnostic testing
- when swelling in the area of the nerve try to determine why?
Treatment for tarsal tunnel?
- strap foot into neutral or more inverted position
- orthotic
- corticosteroids w/ local anesthetic
Etiology of varicose veins?
- valvular dysfuinction
- weakness in the vein wall
- hormonal changes ( preggo)
- abdominal tumor
- prolonged standing aggrevates but does not cause varicose veins
- deep thrombphlebitis
SS of varicose veins?
- aching
- fatigue
- heat
- relieved by elevating leg or wearing compression socks
- symptoms do not relate to the size of degree of varicosities
- worsen with menstration
- tense and palpable
Tests for varivose veins?
- seen by patient
- pain relief when the leg is elevated
- sometimes trendelembergu = retrograde flow of blood = incompetent saphenous valve
Treatment for varicose veins?
- incurable
- symptom relief is primary goal
- compression socks
- cosmetic surgery
Etiology of Venous Thrombosis?
- can occur in superfical or deep veins
- Superficial thrombophlebitis
- deep vein thrombosis
- chronic venous insufficiency
- anticoagulant drugs can prevent these from forming
SS of venous thrombosis?
- acute thrombophlebitis arise over hours to 1 or 2 days
- superficial thrombophlebitis
- pain
- tenderness
- erythema
- warmth
- palpation of a superficial cord in the leg reflects occlusion of a superficial vein
- ## DVT can be asym
Where can DVT occur?
- popliteal, femopral and inliac segments = hard cord in the femoral triangle, medial thigh or popliteal space
- with an iliofemoral DVT we can see dilated superficial veins over the leg, thigh , hip and lower abdome
Treatment for Venous throbosis?
- no therapy
- warm compress
- NSAIDs
- acute DVT hospitslb/c risk of pulmonary embolism
Etiology of acute bronchitis?
- bacterial or viral infection of the bronchial tress
SS of acute bronchitis?
- prior URTI
- distressing cough
- initially non-productive cough but becomes prulent
- if fever = pneumonia
- dyspnea
- crackling
- wheezing
Treatment for acute bronchitis?
- rest
- antibiotics
Etiology of Asthma?
- airway obstruction and inflammation\
- due to brachospasm trigger by a hypersensitivity reaction
SS of Asthma?
- varies
- wheezing, cough and shortness of breath
- itching voer anterior neck
- dry cough
- dyspnea
- tightness or pressure in the chest
- tachycardia
- high pitched wheeze
- hyperinflated chest
- cyanosis
Treatment of Ashtma?
- control allergne exposure
- anticholinergics to relax smooth muscle
long term: corticosteroids
Etiology of Bronchiectasis?
- infection
- mechanical alteration b/c atelectasis or loss of parenchymal volume
- unilateral or bilateral
- chronic inflammation and loss of cila
SS of Bronchiectasis?
- begins in early childhood
- chronic cough
- worsen gradually
- wheezing
- dyspnea
- crackles
- airflow obstruction
Treatment of bronchiectasis?
- refer for anti biotics
Etiology of Chronic obstructive pulmonary disease?
- chronic bronchitis or emphysema and progressive obstruction
- smokers, dilation of submucosal glands and dilated ducts
- panacinar emphysema: affects whol acinus
- centrilobular emphysema: begins in the respiratory bronchiole and spreads peripherally
SS of COPD?
- smokers develop productive cough
- as gets worse intervals between syumptoms shorten
- hyperinflation of the lungs
- breath sounds decreased
Treatment of COPD?
- reduce environmental exposure i.e smoking
- oxygen therapy
- reduce symptoms using anti inflamatories
Etiology of congestive heart failure?
- plasma volume increases and increased fluid in the lungs, abdomin and peripheral tissue
- b/c L ventricular failure: coronary heart disease and hypertension
and b/c R ventricular failure: L ventricle failure and tricuspid regurg
SS of CHF?
- right sided, left sided or both
- gradual or sudden onset
- cyanosis
- edema
- LVF: pink frothy sputum
- RVF: peripheral edema
Etiology of scleroderma?
- degenerative adn vascular abnormalities in the skin (Scleroderma), articular structures and internal organs (esopahgus, GI, lung, heart, kidney)
- unknown cause
- degen changes
- > W
- cicumscribed patches or linear sclerosis
SS pf scleroderma?
- CREST: \+ calcinosis \+ Raynauds \+ esophageal dysfucntion \+ sclerodactyly: taught shiny and pigmented skin, mask like face \+ telangiectasia - musculoskeletal pain: friction rubs on the jonits - renal insufficiency - cardiac arythmia, lung fibrosis - dysphagia
Etiology of sinus infection?
- inflammation of the paranasal sinuses
- acute by:
+ streptococci
+ pneumococci
+ Haemophilus influenzae
+ staphylococci - chronic sinusitis by:
+ gram nergative
SS of sinus infection?
- area over the sinus tender adn swollen
- maxillary, ethmoid and frontal sinusitis cause local pain and frontal HA
- malaise
- fevers
- chills
- nasal mucosa
SS of myofascial trigger point of the intercostal muscles?
- pain local to trigger point extends anteriorly when severe
- restricted rotation of T spine
- chest pain with deep respiration
SS of myofascial trigger point of the pectorals?
- refered pain, localizes substernally, anterior chest and breast, extends down the ulnar aspect of the arm to the 4th and 5th digits
- can be mistaken for ischemic pain if on the left side
SS of myofascial trigger point of the scalene muscle?
- refered pain radiates anterior, lateral or posterior
- anterior pain: pectoral
- lateral pain: down front and back of the arm (skipping elbow)
- posteriorly: upper vertebral border of the scapula and the area medial to it
SS of myofascial trigger point of the serratus anterior muscle?
- refered pain to the side and back of the chest and down ulnar side of the arm
SS of hypocalcemia?
- muscle cramps
- tetany
- convulsion
- caused by decreased magnesium
SS of hypercalcemia?
- excessive bone reabs
- constipation
- anorexia
- nausea
- abdominal pain
SS of chromium toxicity?
- skin irritation
- potential perforation of the nasal spteum
- carcinoma of the lung
SS of folic acid deficiency?
- in prego women = spina bifida, neural tube defects
Niacin (B3) deficiency?
- pellegra \+ dermatitis \+ dirreaha \+ dementia \+ death
SS of cerebral beri-beri?
- also called wenicke koraskoff syndrome
- mental confusion
- aphonia
- confabulation -> nystagmus
SS of peripheral beri beri?
- paresthesia of toes
- burning of feet
- peripheral neuropathy
SS of vitamin D deficiency?
- rickets
- osteomalacia
