Joint Derangements/Dysfunction Flashcards
A loose body is often the result of…
OA or chip fracture
Loose body S&S
Locking/catching
Loose body Ax
ROM end feel as a bony block or may be springy
Hypermobility Rx
- Mobilize stiff or hypomobile tissue/joint/segment
- Strengthen to stabilize the hypermobile segment/tissue
- Movement retraining - maintenance
- Supportive devices (brace/tape)
What is spondylosis
What can it lead to
OA of spine -> degeneration of joints
Can lead to disc herniation &/or stenosis
What is spondylolysis
Pars interarticularis (fibrous tissue) defect
- Degeneration of spine joints
- Seen in younger patients w/ hyper extension & rotation sports
Is spondylolysis mostly symptomatic or asymmptomatic
asymmptomatic
What may bilateral spondylolysis lead to
spondylolisthesis
What is the most common segment for spondylolisthesis
L5/S1
spondylolisthesis MOI
Hyper extension
spondylolisthesis types:
Spondyloytic spondylolisthesis - Progressive period of rapid growth - Rarely progresses to adult life - Younger population Degenerative spondylolisthesis - 2° to DJD + Z-joint subluxation -> OA of joints in spine, foramina narrowing - Older population
Grading of spondylolisthesis
1-4 25% of each grade of slippage
spondylolisthesis S&S
- Central LBP +/- referred pain, associated with weak abs +/- tight hamstrings
- Aggravating factor: EXT
- Easing factor: FLEX
Spondylolisthesis Rx
Stability
- Flexion exercises (open IVF to decrease pressure on nerve roots)
- Inner unit strengthening: TA/multifidus/PF
- Brace if needed
- Work into painful range with proper stability - avoid hyperextension
- Surgery?
When is surgery needed for spondylolisthesis
- Increased slippage or instability even with brace
- hard neurological signs
- evidence of spinal cord involvement
- intractable pain despite treatment
Hypomobility MOI
Adaptive shortening or soft tissue (tightness or contracture) or joint
- Muscle: atrophy & weakness
- Tendon: Decreased tensile strength
- Ligament: Decreased tensile strength, Increased stiffness/adhesions
- Cartilage: decreased synovial fluid, H2O content
- Bone: Increased resorption, decreased bone mass/mineral content
Study capsular pattern, resting position, closed packed position table
Pg 9
Dislocation S&S
Increase ROM
Soft end feel
+/- pain
Complications of GH dislocation
Rotator cuff tears
Axillary nerve damage
Dislocation types
TUBS: Traumatic onset, unidirectional anterior, bankart lesion, surgery
AMBRI - Atraumatic, multidirectional, bilateral shoulder findings, rehab appropriate, INF capsule shift
TUBS dislocation MOI
Abduction + ER
Bankart lesion
Definition + S&S
- Avulsion + of ant/inf capsule & ligaments
S&S: Clicking, apprehension, deep vague pain
Slap Lesion
- Def
- MOI
- Major cause of pain in _)___
Superior labrum lesion ant-> post
Elevated position w/ sudden concentric + eccentric biceps contraction
- Major cause of pain in throwers
Hill sachs lesion
- Compression Fracture post/lateral humeral head
Fracture dislocation usually occurs where?
S&S ?
Usually acromion, humeral head
S&S -> deformity, constant pain, systemic signs (nausea)
Which ligaments stabilize the AC joint
Trapezoid and conoid ligaments
S&S of an AC joint subluxation
- Step deformity
- Osteolysis (bone resorption d/t repetitive microtrauma or post trauma
Is an AC joint subluxation surgical
no
Growth plate closure - proximal and distal femur
Prox: 18yrs
Dist: 20yrs
Growth plate closure - proximal and distal tibia
Prox: 16-18yrs
Dist: 15-17 yrs
Growth plate closure - proximal and distal Humerus
Prox: 20yrs
Dist: 16yrs
Growth plate closure - proximal and distal radius
Prox: 18yrs
Dist: 20 years
Fracture types and causes
- Spiral: twisting injury
o Transverse/oblique direct blow - Compression/crush: longitudinal force
- Comminuted: fragments of bone
- Greenstick: young kids - malleable bones, # on only 1 side
- Avulsion: piece of bone pulled off - de-attachment of soft tissue (ligaments)
- Impact: compression force (usually more stable)
Colles fracture
Distal radius + subluxation of distal ulna
Bennetts Fracture
Fractura dislocation of CMC thumb joint
Scaphoid fracture MOI
FOOSH
Complications of fractures
- Avascular necrosis
- Muscle weakness, contractures, re-#, infection, delayed union, malunion, CRPS
Where is there a high rate of avascular necrosis
- proximal femur
- 5th MT
- Scaphoid
- Proximal humerus
- talus neck
- Navicular
Locations of a hip fracture
Femoral neck
Intertrochanteric
Subtrochanteric
Hip fracture conservative vs. surgical management
Conservative: less complications, increased bed rest, decreased healing time, slower rehab
Surgical: Decreased length of stay, improved rehab, risks
Hemiarthroplasty vs total arthroplasty
Hemi : just femoral head
Total: femoral head + acetabulum
Types of hip fracture surgery
- Cemented: Increased stability, better for sedentary elderly w/ poor bone quality
- Uncemented: components coated w/ beads - where new bone can grow, better for younger Pts, revision in 10yrs
- Hybrid - Femoral component = cemented, acetabular component = uncemented
Precautions following total arthroplasty - post-lateral approach
- NO hip flexion past 90
- NO IR
- NO ER
- NO hip add past midline for 1st 3months
Precautions following total arthroplasty - lateral approach
- No hip flex past 90
- NO IR
- No hip add past midline for 1st 3 months
Precautions following total arthroplasty - Anterior approach
- No hip ext
- NO hip ER
- NO Hip adduction past midline for 1st 3 months
Precautions following hemiarthroplasty -
No restrictions with movement & WBAT
Check MD Orders
Indication for hemi, total, and reverse shoulder arthroplasty
Hemi: Arthritic conditions (w/out glenoid involvement, severe fractures of proximal humerus
Total: OA, inflammatory arthritis, osteonecrosis involving the glenoid, post-traumatic degenerative joint disease
Reverse: OA or compound fractures of the humerus w/ deficiency of the rotator cuff.
Patients must have _____ in order to receive a total shoulder arthroplasty
rotator cuff
Post op precautions for a total shoulder arthroplasty
Immobilization daily for 1 week nightly for 1 month, sling 4 weeks
Post op precautions for a reverse shoulder arthroplasty
flexion/elevation in scapular plane passively up to 0- degrees, pure abduction
Post op contraindication for a reverse shoulder arthroplasty
Avoid IR for 6weeks
Types of bone
- Cortical - outside long bones
- Cancellous - inside, more affected by OP
OP Categories
- Normal: 0-1.0 SD of young adult mean
- Low bone mass: 1-2.5 SD below young adult mean (Osteopenia)
- Osteoporosis - 2.5+ SD below young adult mean
OP Types
Primary type 1 - Post menopausal women
Primary type 2 - 70+ years risk women=men
Secondary OP - Due to another med condition or treatment, any age
OP risk factors
Family history, lifestyle Gender Age Lifetime exposure to estrogen, breast cancer Fragility fracture under 40yrs
OP Dx
Bone scan
Fracture assessment tools - FRAX, CAROC 2010
OP Ax
Vertebroplasty -> fusing of 3+ segments- Risk of subsequent fracture
OP Rx
- Pharmacological - anti-absorption agents, anabolic bone formation (hormone treatment). Side effects = vertigo, nausea, dizziness, muscle/back/ue/le pain
- Nutrition: Ca+, Vit D
- PT: posture, aerobic (WB), resistance exercises, core, balance, extension exercises, no spinal flex or flex + rot
S&S of tumor fractures
Asymptomatic but can show cancer signs
Primary malignant tumors of soft tissues/bone are common or rare?
Most likely population?
RARE
May occur in youth
Types of soft tissue/bone tumors
Osteosarcoma
Synovial sarcoma
Malignant tumors
Osteoid osteoma
Where do Osteosarcomas occur? S&S? Rx?
At ends of long bones
Pain - at joint, worse with activity
Imaging- xray moth eaten appearance
Rx: surgery
Where do Synovial sarcomas occur? S&S? Rx?
In larger joints - knee/ankle
Pain - at night, w/ activity
Swelling/instability
Rx: Surgery, chemo/radiation
Rx for malignant bone tumors
Metastasize from elsewhere
Rx: Thorough PMx & FHx
Are osteoid osteoma malignant or benign? S&S? Key sign? Rx?
Benign Pain in bone, At night, w/ exercise Key sign: no pain w/ aspirin Imaging: CT scan shows a central focus point Rx: ablation, ethanol, laser
Degenerative joint disease:
- Cause
- Population
- Result
Due to mechanical change, joint disease, joint trauma
Seen in Pts >40 yrs
Result: ++ Loading on surfaces that are weight bearing
Types of vertebral degenerative joint disease
- Spinal (lateral) stenosis
- Central stenosis (canal)
- Spondylosis - spine OA
- Spondylolysis - Pars interarticularis defect, may start as stress #
- Spondylolisthesis
Degenerative joint disease Rx
- Joint protection
- Increase joint mechanics
- aquatics = Decrease WB
