MS Conditions

Question 1

Your patient comes to you with a diagnosis of DJD, and they don’t know what that is. How would you explain it to them?

Answer 1

degenerative joint disease, also known as osteoarthritis, is a degeneration of the cartilage in weight-bearing joints
- also known for hypertrophy of subchondral bone and joint capsule

Can be due to mechanical changes over time, joint trauma, or disease

Question 2

You’re chart reviewing for a patient with ankylosing spondylitis. What is this condition, and what can you expect to see?

Answer 2

rheumatoid disease; progressive inflammatory condition that affects axial skeleton

• kyphotic deformity of the c and t-spines, with loss of lordosis in lumbar spine
• might have mid/low back pain, morning stiffness, sacroilitis

Question 3

What meds can be taken for ankylosing spondylitis?

Answer 3

NSAIDs (since inflammatory), corticosteroid therapy or meds to suppress immune system

Question 4

What’s the first line of medication treatment for OA?

Answer 4

NSAIDs; glucocorticoids can be shot into joints that don’t respond

Question 5

ER at the femur causes what motion at the tibia?

Answer 5

ER - think coupling patterns

Question 6

T/F: Morning stiffness is pretty typical with DJD.

Answer 6

false, usually not too bad but if so does go away within 4-5 hours (?! conflicting statements in book)

Question 7

T/F: People with OA tend to feel better with exercise.

Answer 7

true - TELL THEM THIS

Question 8

What kinds of meds are people on for OA?

Answer 8

NSAIDS

Question 9

T/F: Fibromyalgia is considered an immune disorder.

Answer 9

true - immune involvement with issues of mood, sleep

Question 10

How might patients with fibro describe their pain?

Answer 10

aching, burning

diffuse pain all over

Question 11

What are PT’s goals with DJD patients?

Answer 11

1) provide joint protection strategies (think of lifting, getting in/out of car, etc)
2) maintain/improve joint mechanics and strength
3) aerobic exercise conditioning to limit sedentary life that results in further joint limitations

Question 12

What should be a big component of fibro treatment?

Answer 12

aerobic exercise training
improve sleeping patterns
stress management (journaling, tai-chi/yoga)

Question 13

What does gout most often affect?

Answer 13

feet

- esp. great toe, ankle, and mid-foot

Question 14

T/F: People with gout get intense joint pain in the mornings.

Answer 14

false, at night: warmth, redness, extreme tenderness

Question 15

How is gout managed?

Answer 15

with anti inflammatory meds, and colchicine

- need to lower urate concentration in body fluids with diet, weight loss, and moderation fo alcohol intake

Question 16

What can PT do for gout?

Answer 16

• educate on lifestyle: need to have a healthy diet, lose weight, and drink alcohol sparingly to decrease this pain
• rest, elevate, and protect joint of injury during acute phase

Question 17

How would PT intervene for an acute injury for a patient with hemophilia? What are the concerns?

Answer 17

initial concerns: bleeding into joint/muscle, causing deformity and/or decreased mobility
- bleeding near peripheral nerves or arteries can cause neuropathies, ischemia, etc

SO for treatment:
- ice, rest, elevation in acute stage; splint

Question 18

For a chronic injury with a hemophiliac, what does PT do?

Answer 18

enforce daily ROM exercise
ADL training
maintaining joint function/protection
splints/ADs if needed

Question 19

What interventions wouldn’t be appropriate for patients with hemophilia?

Answer 19

stretching (d/t risk for myositis ossificans)

Question 20

T/F: An excessively externally rotated hip during stance is indicative of a IT band syndrome.

Answer 20

false, excessively internally rotated

Question 21

Where are frequent locations for myositis ossificans to occur?

Answer 21

quads
biceps brachii
brachialis

Question 22

What is osteochondritis dissecans?

Answer 22

separation of articular cartilage from underlying bone (osteochondral fracture)

Question 23

What is the difference between osteoporosis and osteomalacia?

Answer 23

osteomalacia = decalcification of bones d/t lack of vitamin D

osteoporosis = metabolic disease that depletes bone mineral density/mass

Question 24

What location is most common for osteochondritis dissecans?

Answer 24

medial femoral condyle

- occasionally at femoral head and talar dome

Question 25

After surgery for osteochondritis dissecans, what are PT’s main goals?

Answer 25

improve aerobic conditioning post surgery
gait training
functional training/strengthening

Question 26

What is Paget’s disease?

Answer 26

slowly progressive metabolic bone disease

• sites of excessive bone reabsorption followed by excessive abnormal bone formation
• these sites are unstable, prone to fx (often in spine, pelvis, femur, skull)

Question 27

What is the expected Q-angle for a patient with patellofemoral dysfunction?

Answer 27

> 18deg

Question 28

McConnel’s taping technique is useful for what diagnosis?

Answer 28

PFP

Question 29

Raynaud’s phenomenon often accompanies what disorder?

Answer 29

scleroderma

Question 30

What are the first signs of scleroderma?

Answer 30

heart burn, dyspnea, polyarthralgia