Diseases of Bone Flashcards
Osteoporosis (OP)
Disease in which the bone loses density and strength.
Women after age 30 lose approx 0.5% of bone mass/year. After menopause 1-3%/year.
Osteomalacia
Pathological, metabolic condition of bones caused by the lack of vit D, Ca, or phosphate absorption in adulthood.
Causes softening and weakening of the bones. Fx are common.
Si and Sy: general body aches and pains, muscle weakness, bone pain, postural changes, bowing of long bones of LL, stress Fx, and weight loss.
PT intervention: not indicated.
Legg-Calvé-Perthes Disease
Pediatric disease caused by avascular necrosis of the proximal femoral epiphysis.
Si and Sy: flattening of the head of the femur or collapse of the head of the femur. Can lead to arthritis in later life. Limp, pain and stiffness in the hip, groin pain, ant thigh and knee pain, atrophy of leg muscles, TOP hip, and ↓ ROM in hip abd and IR.
PT intervention: gait training, ex’s for strengthening the hip and ↑ hip ROM, parental advice for suitable activities for children with a brace.
Slipped Capital Femoral Epiphysis
Condition similar to Legg-Calvé-Perthes, except that the femoral head slides on the femur at the epiphysis during growth of the bone and the femur becomes laterally rotated.
Si and Sy: pain and restriction of movement at hip and knee pain as a result of altered ambulation patterns.
PT intervention: strengthening ex’s, gait reeducation with crutches for NWB or PWB. Avoid add beyond midline.
Paget’s Disease (Osteitis Deformans)
Healthy structure of the bone is replaced by a more solid structure and ↓ strength on the bone.
Si and Sy: many pt experience minimal si and sy. Other pt with severe or longstanding disease have fatigue, general joint stiffness, bone pain, ↑ Tx kyphosis, gait disorders, frequent Fx, and occasionally heart disease. Also bone tumors (sarcomas).
PT intervention: directed toward prevention of falls, ambulation education, and general strengthening and endurance ex’s.
Osteomyelitis
Inflammation of bone caused by infection.
Si and Sy: fever, TOP over the area, fatigue, and symptoms associated with inflammation.
PT intervention: not indicated in the infectious stage. After resolution of infection: ex’s programs, gait reeducation and whirlpool debridement (after surgical debridement).
Tuberculosis in the Bone
Tuberculosis (lung disease) can attack the synovial membrane and spread to bones. Most commonly affected areas are spine, and long bones (knee and hip especially).
PT intervention: program to strengthen muscles, improve endurance to activity, and restore fx independence. In acute phase of TB joint disease, positioning and bed mobility ex’s.
Bone Tumors (Osteosarcoma, Osteoma, Osteoid Osteoma, Osteoblastoma, OSteochondroma, Giant cell tumor of bone, Ewing’s sarcoma, Fibrous Dysplasia, Multiple Myeloma, and Bone Metastases)
PT intervention normally focuses on return to fx activities and ex’s for strength, endurance, and mobility.
► Osteosarcoma: malignant; <30yo; especially close to knee.
► Osteoma: benign; older; head and neck.
► Osteoid Osteoma: benign; 20-30 yo; long bones of LL.
► Osteoblastoma: rare; 20-30 yo; spine.
► Osteochondroma (aka Exostoses): benign; children; close to knee and prox humerus.
► Giant cell tumor of bone (aka Osteoclastomas): usually benign; 20-40 yo; close to knee, distal radius, and prox humerus.
► Ewing’s sarcoma (aka PNET): malignant; 5-20 yo; long bones, pelvis, and chest.
► Fibrous Dysplasia: not a tumor, trabecular bone replaced by fibrous tissue.
► Multiple Myeloma: malignant; >65 yo.
► Bone Metastases: flat bones, as well as vertebrae.
Cartilage Tumors
> Chondroma: mostly no symptoms. PT intervention not indicated.
> Chondrosarcoma: incidence 8 in 1M people. PT intervention not indicated.
Joint Abnormalities
> Genu valgum (knock-knee): can lead to pes planus.
> Genu varum (bow legs)
Genetic Bone Abnormalities
> Talipes Equinovarus (clubfoot): foot in plantar flexion + abd + inversion at subtalar joint and abd + inversion at midtarsal joint. PT intervention involves positioning and stretching, and casting and weight-bearing activities.
> Developmental Dysplasia of the Hip (DDH): PT intervention: in children → teach parents how to use the brace at home / in adults who develop arthritis → treatment similar to OA.
> Torticollis (aka wryneck or cervical dystonia): condition in children where head and neck are held in a side-flexed and rotated position. PT intervention: soft tissue stretching of SCM muscle.
