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S2 PTA 104 disease > MSK > Flashcards

MSK Flashcards

1
Q

X-ray

A

Photons produced by electromagnetic energy are absorbed by large calcium atoms but not absorbed by smaller atoms in soft tissue
- useful in the detection of pathology of the skeletal system
A: alignment (scoliosis)
B: bone (intact, fractured, fucked?)
C: cartilage (joint spaces)
D: density (osteoporosis cannot be diagnosed, needs further tests)

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2
Q

CT Scan

A

Computerized tomography scan

  • combines a series of x-ray views taken from many different angles and computer programming to produce cross-sectional images of the bones and soft tissues
  • indications: when X-ray results are normal but physical exam findings suggest pathology is present; determining pathology in transverse plane; small lesions
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3
Q

MRI

A

Magnetic resonance imaging

  • uses a magnetic field and radio waves to create detailed images of the organs and tissues within 3D images
  • CANT BE USED WITH METAL
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4
Q

DEXA

A

Dual Energy X-ray Absorptiometry

  • preferred technique for measuring bone mineral density
  • non-invasive use of two energy waves
  • 10-20 minutes
  • mostly hip and spine
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5
Q

OA vs RA

A
  • OA: a type of arthritis marked by progressive cartilage deterioration in synovial joints, particularly hands, spine, knees, and hips
  • RA: an autoimmune disorder causing chronic systemic inflammatory disease
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6
Q

OA types and pathophysiology

A

1 . Idiopathic
2. Previous injury/infection to joint; repetitive stresses; hyperthyroidism

  • patho: repeated abnormal stresses to articular cartilage cause alteration in cartilage matrix. Decreased water content, collagen, proteoglycans makes shit brittle.. Hyaline breakdown and limited repair ability. Osteophytes
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7
Q

OA onset / patterns

A

Insidious with steady progression at variable rates

  • asymmetrical or unilateral
  • joint space narrowing
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8
Q

OA S&S

A
  • Signs: localized stiffness and tenderness, morning stiffness that eases < 1 hr, instability, pain with/after activity
  • symptoms: enlarged/deformed joints, crepitus, joint swolling
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9
Q

Classification of OA

A

Grade 1: no narrowing of the joint space, possible osteophytes (bone spurs)

2: definite osteophytes and absent or questionable narrowing of joint space
3. Moderate osteophytes and joint space narrowing, some sclerosis and possible deformity
4: large osteophytes, marked narrowing of joint space, severe sclerosis and definite deformity

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10
Q

Peripheral pain

A

Local

  • cartilage
  • bone
  • swelling
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11
Q

Central pain

A
  • diffuse hyperalgesia
  • multifocal
  • fatigue
  • insomnia
  • memory impairment
  • mood disorders
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12
Q

Central sensitization

A

An alteration in pain processing

  • loss of descending anti-nocioceptive mechanisms
  • “Wind up”
  • sensitivity of central neurons to peripheral inputs
  • increased response of CNS neurons which inform of pain when faced with inputs from low threshold mechanoreceptors
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13
Q

Wind up

A

Perceived increase in pain intensity over time when given painful stimulus is delivered repeatedly above a critical rate. It is caused by repeated stimulation of group C peripheral nerve fibers, leading to progressively increasing electrical response in the corresponding spinal cord (posterior horn) neurons

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14
Q

Allodynia

A

Perceived pain from non-painful input

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15
Q

Hyperalgesia

A

Increased sensitivity to pain or “painful” stimulus. May not actually be painful
- may be due to damaged nocioceptors or peripheral nerves

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16
Q

Joint replacement

A
  • greater risk of continued pain post replacement if OA, high pain levels, or low pain threshold
  • modifiable risk factors include: excess body mass, joint injury, occupation stresses, mal-alignment
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17
Q

RA types

A

Systemic autoimmune inflammatory idiopathic disease with the presence of rheumatoid factor. Heterogeneous group of disorders where inflammation in joints in the main problem

  • monocyclic: 1 episode, no recurrence
  • polycyclic: fluctuating levels of disease
  • progressive: unremitting
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18
Q

Arthritis disorders

A
  • RA - scleroderma - lupus - gout - psoriatic arthritis - ankylosis spondylitis
19
Q

RA pathology

A

Articular (in the joint)

  • synovial membrane inflammation
  • pan us formation (mass of inflammatory tissue - erodes cartilage surface)
20
Q

Pathophysiology of

  • scleritis
  • vasculitis
  • raynaud’s
  • pericarditis
  • anemia
A

Pathophysiology of

  • scleritis: inflammation of sclera in eye
  • vasculitis: inflammation of blood vessels
  • raynaud’s: vasospasm in superficial blood vessels of hands and feet
  • pericarditis: inflammation of pericardium of heart
  • anemia: decreased RBC formation from bone
21
Q

Juvenile RA

A

Most common type of JA: juvenile idiopathic arthritis

  • younger than 16
  • 1+ joints for 6+ weeks
  • other causes ruled out
  • blood tests and imaging
22
Q

RA onset and patterns

A 
Onset: any age, peak between 35-55 yo
Patterns
- bilateral/symmetrical involvement 
- hands (PIP, MCP, RC)
- feet (MTP, IT, subtalar)
- less common: knees, bows, shoulder, TMJ
23
Q

Swan neck vs boutonnière deformity

A

Pic

24
Q

RA S&S

A
  • Symptoms: resting and night pain; morning stiffness lasting >1 hr; muscle weakness; lethargy
  • Signs: swelling; inflammatory signs; joint deformities; muscle wasting
25
Q

Total hip precautions (ant vs post)

A
  • Ant: ER, extension, abduction

- Post: IR, flexion, adduction

26
Q

PT treatment

A

Exercise - strengthen weak mm - improve flexibility - decrease pain - decrease psychosocial effects of disease (depression) - weight loss - improved circulation to cartilage (open change ex) - aquatic therapy

  • 3-5x/wk at 60-80% max HR, warmup/cooldown 5-15 min, aerobic ex 5-40 min
27
Q

Special considerations PT exercise

A
  • avoid strenuous during flare ups
  • minimize high impact loading
  • reduce biomechanical stresses on joints
  • control stretching activities
  • avoid high reps
  • dont forget warm up / cool down
  • good shoes and time of day when least painful
  • functional exercise
28
Q

Modalities

A
  • heat: hot packs, paraffin, ultrasound (increase circulation, CT extensibility, and decrease pain)
  • cold: ice ( decrease pain and inflammation)
  • e-stim: TENS, IFC (decrease pain and inflammation)
29
Q

PT education

A
  • flare ups: ?
  • joint protection and posturing: decrease prolonged static postures. Activity avoidance
  • exercise expectations: muscle soreness expected in beginning. Exercise best typically in afternoon or specific to patients pain patterns and medication schedule
30
Q

Gout

A

Deposits of Uriel acid crystals in tissue and fluid

  • episodic not chronic
  • purines: red meat, alcohol, seafood
31
Q

Ankylosis spondylitis

A

Fibrosis - calcification - fusion of joints = pain

- forward head, kyphosis and decreased lordosis

32
Q

Heterotopic ossificiation

A

Bone formation in soft tissue (esp in hip, knee, shoulder, elbow)

  • unknown causes but tends to come with trauma
  • intense painful treatments
33
Q

Bursitis

A

Inflammation of bursa, very painful. No where for fluid to go but out
- treatment: PRICE, AROM, steroid injection, or aspiration

34
Q

Tendinitis

A

Inflammation of a tendon usually due to repetitive motion. Often tender to touch

35
Q

Tenosynovitis

A

Inflammation of the lining of the synovial sheath that surrounds a tendon. Usually in wrist (de quervain’s)

36
Q

Treatment of tendon injuries

A

PRICE (acute)

  • joint protection
  • biomechanincal evalutaiton to change cause of tendon irritation
  • possible splinting
  • iontophoresis
  • progressive exercise, eccentric
37
Q

Osteoporosis

A

Decreased bone mass and micro damage

  • fragility or spontaneous fractures
  • early demineralization is osteopenia
  • back pain, weakness, forward head
  • **avoid trunk flexion activities
  • posture edu, braces, resistance exercises, vibration
38
Q

Osteomalacia

A

Softening of bones; metabolic disorder involving mineral loss in bone

  • results from deficiency of vitamin D and phosphates required for bone mineralization
  • legs bowing, pathological fractures, weakness, short
  • Vit d deficiency, no sunlight, celiac disease, kidney or liver disorders
39
Q

Osteomyelitis

A

Bone infection usually caused by bacteria or fungi

  • swelling, abscesses, tender, fever, pain
  • bones infected by bloodstream, direct invasion, or infections in adjacent bone or soft tissues
  • usually staph
40
Q

Paget’s disease

A

Progressive bone disease that occurs in adults older than 40 yo; metabolic disorder affecting how bone breakdown and new bone formed is distorted (thick and brittle)

  • idiopathic, viral infection or genes
  • normal spongy bone replaced by abnormal bone
41
Q

Bone tumors

A

Abnormal growth of cells within the bone that may be benign or malignant (majority)

  • often in areas of rapid growth
  • genetic, radiation, trauma, metastasis
  • pain at night, swelling, mass
42
Q

Polymyalgia rheumatica

A

Pain and stiffness in multiple proximal muscles due to joint inflammation

  • gradual onset
  • giant cell arteritis
43
Q

Myofascial pain syndrome

A

Overuse/muscle stress syndrome with trigger points.

  • active: pain at rest/activity
  • latent: no pain but weak
  • satellite: mm within referral pain pattern
  • overload, trauma, posture
44
Q

MF

  • etiology
  • S&S
  • management
A
  • etiology: overload, trauma, postural faults, stress
  • S&S: taut, myofascial band, exquisitely tender spots, pain referral pattern, decreased ROM
  • management: injections, ice, US, pressure to trigger point, restore strength and proprioceptors, positioning

S2 PTA 104 disease (15 decks)

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