MSK Conditions Flashcards
Arthrogryposis
Non-progressive congenital disorder resulting in rigid joints, weak or non-functioning muscles due to inability to move in the womb muscles and joints could not develop properly
Hip dislocations, contractures, and club feet
Rx: surgery, splinting, positioning, ROM, ADL training and assistive aids
CRPS
Complex Regional Pain Syndrome
Abnormal sympathetic reflex resulting from from a persistent painful lesion
S&S: pain, edema, decreased circulation, OP, dry skin, decreased proprio and muscle atrophy
DfDx: trophic changes in skine, bones and joints
Rx: pain modalities, joint mobs, WB/closed chain ex, massage, manual lymphatic drainage, splinting
Colles’ Fracture
Most common wrist # from outstretched hand
Distal fragment of the radius has a dorsal displacement resulting in a radial shift of the wrist and hand
DfDx: Xray shows # and displacement & obs of radial shift/deformity
RX: casting, early A/PROM, progressive resisitance, mobs, closed chain stabilization ex’s
Osteoarthritis (OA)
A rheumatoid, non-systemic disease (often effects articular cartilage in WB joints first)
Morning stiffness, improved with ex
gradual onset, 1+ joints
S&S: decreased joint range, flex contractures, tenderness, crepitus or grating sensations
Rx: Nsaid’s, functional training and ed, ROM, isometric/tonic/kinetic and postural ex
ADL training, Surgery/joint replacement prn
Fibromyalgia
Immune System disorder or unknown origin that causes tenderness, pain and stiffness in the muscles.
Related to stress, anxiety, fatigue and sleeplessness
women > men
Characterized by aching or burning muscles, diffuse pain and tender point through the body
Rx: ADL edu training, stress management, meds (analgesic and anti-depressant), local modalities and techniques for pain relief, aerobic conditioning and Improving sleeping patters
Gout
Gouty Arthritis
Metabolic disease marked by elevated level of serum uric acid and deposition or urate crystals in the joints, soft tissues, kidneys.
Most often affects, big toe, ankle and mid-foot.
Sever joint pain at night with warmth, erythema and extreme hypersensitivity.
RX: rest, elevate and joint protection in acute stage, anti-inflammatories, daily use of Colchicine
Diet , weight loss and moderating alcohol intake to decrease serum levels
Allopurinol to reduce hyperuricemia
Hemophilia
Hereditary hemorrhagic disorder that results from the deficiency of specific clotting factors
PT considerations: hemiarthrosis, muscle bleeds (can lead to deformity, neuropathy, ischemia)
Rx: splinting, Ice, rest, elevation at the acutestage
with chronic focus on joint protection, maintaining fxn, ROM, endurance/strength, ADLS and use of asisstive devices
ITB Friction Syndrome
AN irritation caused by the rubbing of the ITB over the lateral femoral epicondyle
Often an overuse injury in runners
DfDx: +ve Obers, excessive hip IR in standing, TOP over ITB insertion, +ve Noble compression test
Rx: stretching, pain and inflamm mods, soft tissue mobs, shoe orthosis
Myositis Ossificans
Trauma to a muscle resulting in the calcified or ossified hematoma
Frequent location are quads, brachialis and biceps
X ray will confirm calcium deposts
Rx: conservative/gentle active and AAROM
Passive stretching NOT indicated, NO manual overpressure at EOR
Osteochondritis dissecans
Osteochondral # where there is separation of the articular cartilage from the underlying bone.
Usually involving medial femoral condyle and less often at the femoral head an talar dome.
Dx x-ray
Rx: if # is displaced then surgery is indicated
Post-op Rx: gait training, fxn strengthening, conditioning
Osteomalacia
Decalcification of bones
Results from Vitamin D deficiency which may cause deformities 3”s and severe pain
Rx: pain control and fxn mobility training
Osteomyelitis
Acute or chronic bone infection
Commonly results from combo of traumatic injury and an acute infection
in Children: distal femur and prox tibia, humerus and radius
in Adults: localizes in the pelvis, vertebrae and usually results from contamination related to surgery or trauma
Rx: high does IV antibiotics, cast, traction or bed rest, may require surgical to drain the infection and chronic infection may lead to amputation.
Osteoporosis (OP)
The most common metabolic bone disease
Affects white women most commonly
Depletes bone density increasing risk of #
Common # sites: thoracic and lumbar, femoral neck, prox humerus, prox tibia, pelvis, distal radius
Postmenopausal OP is directly related to the decrease in estrogen production
Rx: pain Mx, postural re-ed, breathing ex’s, general conditioning, pectoral stretching, abdominal strengthening (without excessive/repetitive flexion of spine due to increased risk of a wedge #), WB ex’s
Paget’s Disease
Osteitis Deformans - a slowly progressive metabolic bone disease (cause unknown)
Characterized by initial phase ( excessive bone resorption) followed by reactive phase (excessive abnormal bone formation). The new bone structure is fragile, weak and causes painful deformities of the external contour and internal structure.
Fatal when associated with CHF, bone sarcoma or giant cell tumors
Involved sites # easily and heal slowly (usually incompletely)
Vertebral collapse or vascular changes can lead to paraplegia
Rx: none is asymptomatic, drug therapy when symptomatic
Patellofemoral Dysfunction
The patella fails to track properly in the trochlear groove of the femur
Instability or pain occurs in first 30 deg of knee flex
Aggravated by: stairs, prolonged sitting, squatting, jumping
DfDx: Q angle >18 deg, +ve chondromalacia test, abnormal tracking of patella during flex/ext
Rx: McConnell’s taping, strenghtening of vastus medialis, stretching ITB and TFL
Corerection for knee/foot deformtities with inserts, friction massage over lateral retinaculum, patellar mobs
DO NOT USE generic quad sets and Single leg raiseflexion
What is “moviegoers sign” and in what condition is it seen?
Pain with prolonged sitting
Can be seen with patellofemoral pain syndrome
What are the patellar positions and what intervention doe they indicate?
Normal - patella articular surfaces evenly against anterior femur
Patella baja - lower than normal placement
-Inferior patellar glide
Patella alta - high displacement of the patella
- less efficient in exerting forces for knee ext
- Superior patellar glide
What the “camel sign?”
The camel sign results in two “humps” from patella alta. The high patella is one hump and the infrapattelar fad pad creates the second hump.
Scleroderma
Progressive systemic sclerosis is a chronic disorder characterized by fibrosis and changes of the internal organs and skin
Early symptoms are polyarthralgia, heartburn, dyspnea and often accompanied by Rauynaud’s phenomenon
Rx: maintain joint range, meds, strengthening ex’s
Pronator Teres Syndrome
Madian nerve entrapment in the pronator teres muscles
DfDx: +ve pronator teres syndrome test
Rx: manual nerve glides, stretching ex’s, AROM, US, NMES for nerve healing
Rheumatoid Arthritis (RA)
Chronic, systemic inflammatory disseas of unknown etiology. Women ~30-40 yo) > Men
Symmetrical pattern of dysfunction in synovial tissue and articular cartilage of the peripheral skeleton, Cx spine commonly involved
May include cardiovascular, pulmonary or GI conditions
Eye lesion, infection and OP
Juvinille RA - onset before 16 y/o
-complete remission in 75% children
-may affect a number of joints but characterized by fever and rash
RX: reduce pain, mobility, minimize stiffness, edema, orthoses to prevent deformities, pt ed
Scaphoid Fracture
(Navicular)
MOI: FOOSH (usually young person injury)
Increased risk of avascular necrosisdue to poor blood supply to scaphoid
Dx: x-ray
RX: maintain ROM of nearby joints when casted,
functional retraining
Scoliosis
Uknown etiology
Structural - irreversible curvature with rotational component (seen w/fwd flex)
Nonstructural - reversible curve without rotation that straightens with flex
DfDx: x-ray, postural analysis, fwd flex test
Rx: bracing, surgery (Harrington rods), respiratory care of cobb angle >40 degrees
Non-structural managed with stretching shoe lifts and postural reeducation
Sjogren’s Syndrome
A rheumtatoid like disorder charcterized by dryness of the mucus membranes, joint inflamm, and anemia.
More common than lupus less common than RA.
DfDx: dry eyes, mouth and join inflamm
Rx: sip fluids, chew gum, use mouthwash, maintain mobility and fxn through ex program
Smith’s Fracture
Distal # of radius which dislocates ventrally, AKA Reverse Colles’ Fracture
MOI: falling in wrists in flexion (colles’ falling on wrists in extension)
Rx: casting, early A/PROM, progressive resisitance, mobs, closed chain stabilization ex’s
What are the degrees of a sprain?
First degree- come fibers torn, small amount of hemorrhage, joint remains stable
Second degree- portion of the ligament or capsule is torn, moderate amount of hemorrhage, some fxn loss, joint stability intact
Third Degree- complete avulsion of the ligament or joint capsule, loss of fxn, joint instability, pronounced hemorrhaging and swelling
Systemic Lupus Erythematosus
SLE
Chronic, systemic (multi-organ), rheumatoid, inflamm disorder of connective tissue
Etiology unknown
S&S: malaise, fatigue, arthralgia, fever,Skin rash (butterfly across nose and face),
Rx: topical corticosteroids for skin, pt ed (nutrition, skin care, energy conservation), ROM ex’s, erg and postural training
DfDx for TMJ
Synovitis and Capsulitis- pain preauricular (anterior to ear) and unable to fully close back teeth together, opening <40mm due to pain, pain decreases with rest
Hypermobility- “jaw feels like it goes out of place”
May report noises (pops or clicks), short term episode of jaw-catching when fully opened, mandibular depression >40mm and deviates to non-involved side
Disc displacement w/Reduction- noises with opening and closing, palpable opening/closing click (“reciprocal click”)
Disc Displacement w/o Reduction- intermittent locking without noises, opening limited 20-25mm with deflection toward involved side, limited lateral excursion to contralateral side.
What are the types Tibial Fractures and how to do you treat them?
March #’s- inferior third of tibia, resulting from increase in an activity they’re not used to (i.e. long walks)
Spiral #’s- occur at the jxn of the middle and inferior thirds resulting from severe tibial torsion (i.e. ski boot #)
Compound #’s- direct blow to tibia (i.e. car bumper)
Rx: Casting (ORIF), early A/PROM,progressive, resistance, mobs, close chain stabilization ex’s
Torticollis
Wryneck
Occurs when SCM continuously contracts resulting in lateral bend of the head toward the affected side and rotation contralaterally
Usually develops in utero as congenital condition
Rx: mods to reduce spasm, stretching, biofeedback, postural ed and training
THR Precautions
Avoid hip flex and add past neutral
Posterolateral approach- avoid IR past neutral
Anterolateral approach - avoid ER past neutral
WB orders depend on surgeon
