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MSK differential Dx Flashcards

1
Q

Signs and symptoms

  • pain
  • swelling
  • decreased ROM
  • bony deformity
  • asymmetrical
A

OA

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2
Q

What is Ankylosing spondylitis?

A

Progressive inflammatory disorder that initially affects the axial skeleton

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3
Q

Where in the body does ankylosing spondylitis initially affect?

A

axial skeleton

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4
Q

When is the initial onset of ankylosing spondylitis?

A

before 40 y/o

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5
Q

What are commonly the first symptoms of ankylosing spondylitis?

A
  • mid/low back pain
  • morning stiffness
  • sacroiliitis
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6
Q

What is rheumatoid arthritis?

A

Chronic systemic autoimmune disorder

–> Individuals produce antibodies to their own immunogloulins, such as rheumatoid factor and ACPA.

thought to have genetic etiology

Commonly characterized by periods of exacerbation and remission

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7
Q

When is the avg onset of RA?

A

40-60 y/o

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8
Q

Signs and symptoms

  • bilateral and symmetrical synovial joint involvement
  • inflammation
  • weight loss
  • fever
  • extreme fatigue
A

RA

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9
Q

When is the onset of juvenile RA (JRA)?

A

before 16 y/o

remission in 75% of cases

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10
Q

What diagnostic tests are used to diagnose RA?

A
  • radiographs
  • increased WBCs
  • increased ESR
  • anemia
  • increased Rheumatoid factor
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11
Q

What diagnosis is characterized by decalcification of bones due to vitamin D deficiency?

A

Osteomalacia

s/s
- severe pain
- Fx
- weakness
- deformities

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12
Q

What diagnosis is characterized by trigger points?

A

myofascial pain syndrome

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13
Q

What are the histological characteristics of tendinosis/tendinopathy?

A
  • hypercellularity
  • hypervascularity
  • no indication of inflammatory infiltrates
  • loose collagen fibers
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14
Q

When is surgery warranted to treat myositis ossificans?

A
  • Only in patients with hereditary myositis ossificans
  • after maturation of the lesion (6-24 months)
  • when lesions mechanically interfere with joint movement or cause nerve impingement
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15
Q

What diagnosis is commonly referred to as reflex sympathetic dystrophy (RSD)?

A

CRPS

Thought to be related to trauma or precipitating event

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16
Q

What triggers CRPS I?

A

Tissue injury

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17
Q

Diagnosis

Dysfunction of sympathetic nervous system including pain, circulation, and vasomotor disturbances WITHOUT nerve injury

A

CRPS I

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18
Q

What is the difference between CRPS I and II?

A

CRPS II involves a nerve injury

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19
Q

What medications can be used to treat CRPS?

A
  • antiseizure drugs
  • antidepressants
  • corticosteroids
  • opioids
  • topical drugs
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20
Q

What are the long term results of CRPS?

A
  • atrophy and weakness in close proximity to affected area(s)
  • skin changes
  • osteoporosis
  • decreased proprioception
  • contractures
  • pain
  • ## edema
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21
Q

What clinical diagnostic tests are used to diagnose CRPS?

A

None

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22
Q

What is the common name for Osteitis Deformans?

A

Paget’s disease

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23
Q

What is Paget’s disease?

A

Metaobolic bone disease involving abnormal osteoblastic and osteoclastic activity - characterized by initial phase of excessive bone reabsorption followed by a reactive phase of excessive abnormal bone formation

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24
Q

What does Paget’s disease commonly result in?

A
  • spinal stenosis
  • facet arthropathy
  • possible spinal Fx

New bone structure is fragile and weak. Causes painful deformities of external and internal structures

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25
Q

What is the presentation of torticollis?

A

SB toward the affected side
+
ROT away from the affected side

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26
Q

Most traumatic GH instability occurs in what direction of dislocation?

A

anteroinferior

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27
Q

(true/false) Posterior dislocations of the GH joint are common

A

FALSE

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28
Q

What is a hill-sachs lesion?

A

compression Fx of posterior humeral head

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29
Q

What is a bankart lesion?

A

avulsion of anteroinferior capsule and glenoid labrum

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30
Q

(true or false) Immobilization for a greater tuberosity fracture is not needed

A

True

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31
Q

With what diagnoses is adhesive capsulitis most common?

A

DM and thyroid disease

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32
Q

What is de-quervain’s synovitis?

A

inflammation/degeneration of extensor pollicis brevis and abductor pollicis longus tendons

located in first dorsal compartment

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33
Q

What causes de-quervains synovitis?

A

Repetitive microtrauma or complication of swelling during pregnancy

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34
Q

What action can relieve symptoms of carpal tunnel?

A

Shaking hands

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35
Q

What interventions are allowed to treat de-quervain’s synovitis?

A
  • heat
  • microwave diathermy
  • IFC
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36
Q

What is the most common wrist fracture?

A

Colle’s

Dorsal dislocation fx of radius (Dinner Fork deformity)

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37
Q

How long are colle’s fractures immobilized for?

A

5-8 weeks

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38
Q

What are complications of a colle’s fracture?

A

Median nerve impingement caused by excessive edema

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39
Q

What is the most common carpal to be fractured?

A

Scaphoid

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40
Q

What wrist pathology has a “garden spade” deformity?

A

smith’s Fx

Anterior dislocation fx of the radius

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41
Q

How long are carpals immobilized after a scaphoid fx?

A

4-8 wks

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42
Q

What special tests can be positive in the presence of ITB tightness/syndrome?

A
  • Noble compression test
  • Ober’s test
  • Palpation over ITB insertion
  • excessive hip IR in stance phase
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43
Q

Most people with trochanteric bursitis also have what?

A

RA

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44
Q

What is the common cause for coxa vara and coxa valga?

A

Necrosis of femoral head occurring from septic arthritis

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45
Q

What degree of hip ER is indicative of possible piriformis syndrome?

A

< 60 degrees

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46
Q

When does the piriformis become an interal rotator and abductor of the hip?

A

90 degrees of hip FLX

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47
Q

Signs and symptoms

  • acute or gradual onset of pain in the groin
  • pathology with 1+ of the following: adductors, iliopsoas, inguinal, pubic
A

sports hernia

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48
Q

What are the 6 P’s of acute compartment syndrome?

A
  • pain
  • pallor
  • paresis
  • parasthesia
  • palpable tenderness
  • pulselessness
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49
Q

(true/false) Acute compartment syndrome is a medical emergency requiring an emergent fasciotomy

A

true

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50
Q

What is the cause of acute compartment syndrome?

A

direct trauma and/or fracture

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51
Q

What is the most common LE compartment to experience chronic exertional compartment syndrome?

A

anterior

results in anterolateral pain and possible paresthesia

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52
Q

(true/false) Medial ankle ligaments are commonly sprained

A

FALSE

lateral is more common

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53
Q

What is medial tibial stress syndrome?

A

Overuse injury of the posterior tibialis and/or medial soleus resulting in periosteal inflammation at muscle attachment sites

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54
Q

What are the criteria for diagnosis of carpal tunnel syndrome?

A
  • age > 45 y/o
  • shaking hands relieves symptoms
  • sensory loss in thumb
  • wrist ratio index > .67
  • CTQ-SSS score is > 1/9
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55
Q

What digits are commonly affected by dupuytren’s contracture in those with diabetes?

A

3rd and 4th digits

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56
Q

What digits are commonly affected by dupuytren’s contracture in those without diabetes?

A

4th and 5th digits

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57
Q

Describe boutionniere deformity.

A

Rupture of central tendinous slip of the extensor hood – MCP EXT, PIP FLX, DIP EXT

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58
Q

What commonly causes boutionniere deformity?

A
  1. trauma
  2. RA w/ central extensor tendon degeneration
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59
Q

Describe swan neck deformity.

A

MCP FLX, PIP EXT, DIP FLX

Results from contracture of intrinsic mm with dorsal subluxation of lateral extensor tendons

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60
Q

When does swan neck deformity commonly occur?

A
  1. Trauma
  2. RA w/ degeneration of lateral extensor tendons
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60
Q

Describe Ape hand deformity.

A

Muscle wasting of thenar eminence - parallel to 2nd digit

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61
Q

Describe mallet finger.

A

DIP FLX due to avulsion of extensor tendon

Caused by trauma forcing the digit into FLX

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62
Q

What is another name for Flexor digitorum profundus tendon rupture?

A

Jersey finger

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62
Q

Describe jersey finger.

A

DIP hyperEXT

Caused by excessive hyperEXT w/ maximal finger FLX contraction

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63
Q

What digit commonly experiences jersey finger?

A

Ring finger

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63
Q

Describe gamekeeper’s thumb

A

Sprain/rupture of UCL in the 1st digit MCP joint – medial instability of the thumb

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64
Q

Describe boxer’s Fx?

A

5th metacarpal Fx (at the neck)

casted for 2-4 wks

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65
Q

Femoroacetabular impingement (FAI) is frequently associated with what other pathology?

A

Labral tear

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66
Q

What combined movements cause the unhappy triad?

ACL, MCL, medial meniscus injury

A
  1. Valgus
  2. FLX
  3. ER

When foot is planted

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67
Q

What combination of movements can cause Meniscal injury?

A
  1. ROT
  2. FLX
  3. compression
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68
Q

When can NMES be used for ACL sprains?

A

6-8 weeks after ACL reconstruction

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69
Q

When can concentric and eccentric exercises start after ACL reconstruction?

A

4-6 wks for up to 10 months

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70
Q

What are the criteria used for diagnosis of meniscal tear?

A
  • twisting injury
  • tearing sensation
    - delayed effusion
  • Hx of catching/locking
  • pain with HyperEXT
  • pain with max. FLX
  • (+) McMurrays
  • (+) Thessaly’s
  • joint line tenderness
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71
Q

What is PFPS a result of?

A

Elevated patellofemoral joint loading caused by one or more of the following:
1. trauma
2. biomechanics
3. muscle tightness
4. muscle weakness

Can also be assoc. with patellar tendinopathy and/or chondromalacia patellae

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72
Q

What is another name for “Fat pad syndrome of the knee”?

A

Hoffa’s syndrome

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73
Q

What is jumper’s knee?

A

Patellar tendinosis/tendinopathy

degenerative condition of patellar tendon; commonly deep aspect

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74
Q

What commonly causes pes anserine bursitis?

A
  1. Overuse
  2. contusion
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75
Q

What criteria should be used for diagnosis of PFPS?

A
  • retropatellar or peripatellar pain
  • reproduction of pain with squatting, stairs, prolonged sitting, or other loading activities
  • exclusion of other possible dx
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76
Q

What femoral condyle is commonly fractured?

A

Medial

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77
Q

What are the Ottawa Knee rules?

A
  • age > 55 y/o
  • isolated patellar tenderness
  • TTP of fibular head
  • Unable to perform Knee FLX > 90 degrees
  • Unable to WB immediately after injury and in ED
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78
Q

What are the Ottawa knee and ankle rules used for?

A

To rule-in the need for XR series

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79
Q

What is the common MOI for tibial plateau Fx?

A

combination of valgus and compression during knee FLX

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80
Q

What is the common MOI for epiphyseal plate Fx?

A

WB torsional stress

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81
Q

Most stress Fx occur in what LE bone?

A

Tibia

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82
Q

What is a grade I lateral ankle sprain?

A
  • no loss of function
  • minimal tearing of ATFL
  • minimal tearing of calcaneofiular ligaments
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83
Q

What is a grade II lateral ankle sprain?

A
  • some loss of function
  • partial disruption of ATFL and CF ligaments
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84
Q

What is a grade III lateral ankle sprain?

A
  • complete loss of function
  • complete rupture of ATFL and CF ligaments
  • partial tear of PTFL
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85
Q

What are the ottawa foot rules?

A
  1. TTP base of 5th metatarsal
  2. TTP at navicular
  3. Inability to take 4 steps immediately after and in ED
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86
Q

What causes tarsal tunnel syndrome?

A
  1. excessive pronation
  2. overuse resulting in tendonitis of long flexor and posterior tibialis tendon
  3. trauma

Entrapment of the posterior tibial nerve within the tarsal tunnel

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87
Q

Signs and symptoms

Experiencing the following along the medial ankle to the plantar surface of the foot:
- parasthesia
- pain
- numbness

A

Tarsal tunnel syndrome

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88
Q

What test can be used to rule-in tarsal tunnel syndrome?

A

Tinel’s sign

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89
Q

What tendinopathy is commonly seen in ballet dancers?

A

Flexor hallucis tendinopathy

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90
Q

What is the deformity observation for pes cavus (hollow foot)?

A
  • Increase longitudinal arch
  • drop of anterior arch
  • metatarsal heads lower than hindfoot
  • PF and splaying of forefoot
  • claw toes
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91
Q

What is the deformity observation for equinus?

A

foot PF

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92
Q

what is the cause of equinus?

A
  • congenital bone deformity
  • neuro disorders (Ex: CP)
  • triceps surae contracture
  • trauma
  • inflammatory disease
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93
Q

What is observed with hallux valgus?

A
  • medial deviation of 1st metatarsal
  • 1st metatarsal head and base move medially
  • 1st distal phalanx moves laterally
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94
Q

What is metatarsalgia?

A

Inflammation of the plantar aspect of the 1st and 2nd metatarsal heads

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95
Q

What is charcot-marie tooth disease?

A

peroneal muscular atrophy affecting the sensory and motor nerves

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96
Q

(true/false) In progressive stages of charcot-marie tooth disease can affect the muscles of the hands and forearms

A

true

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97
Q

Signs and symptoms

  • bilateral paresthesia and pain in back, buttocks, thighs, calves, and feet
A

stenosis

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98
Q

What movement increases pain when stenosis is present?

A
  • EXT
  • ipsilateral SB
  • ipsilateral ROT
  • walking
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99
Q

What movement decreases pain when stenosis is present?

A
  • FLX
  • prolonged rest
  • activity modification
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100
Q

What medications are used for stenosis and disc conditions?

A
  • NSAIDS
  • acetominophen
  • corticosteroids
  • muscle relaxants
  • trigger point injections
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101
Q

What degree of FLX should the cervical spine be placed in to provide optimum IV foraminal opening?

A

15 degrees

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102
Q

What are contraindications for Traction when treating stenosis?

A
  • pregnancy
  • hypermobility
  • RA
  • down syndrome
  • systemic diseases affecting ligament integrity
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103
Q

Signs and symptoms

  • constant, deep, aching pain in back
  • increased pain with movement in back
  • referred LE pain
  • no neuro findings
A

IV disc disruption

annulus is disrupted but external structures are not

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104
Q

Why is herniation in the posterolateral aspect most common?

A
  • posterior disc is narrow in height
  • PLL is not as strong as ALL
  • posterior lamellae of annulus is thinner
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105
Q

Where in the spine is central posterior herniation commonly observed?

A

cervical spine

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106
Q

(true/false) Those with central posterior herniation experience CNS symptoms

A

True

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107
Q

What movement is most comfortable in patients with facet entrapment?

A

FLX

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108
Q

What are the early signs and symptoms of whiplash injury?

A
  • HA
  • neck pain
  • limited movement
  • reversal of lower cervical spine lordosis
  • decreased upper cervical kyphosis
  • vision and hearing changes
  • noise and light irritability
  • nausea
  • swallowing difficulty
  • emotional lability
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109
Q

What are the later symptoms of whiplash injury?

A
  • chronic head and neck pain
  • decreased ROM
  • TMJ dysfunction
  • disequilirium
  • anxiety and depression
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110
Q

What are the primary bone tumors?

A
  • multiple myeloma
  • Ewing’s sarcoma
  • malignant lymphoma
  • chondrosarcoma
  • osteosarcoma
  • chondromas
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111
Q

What are the primary sites of metastatic bone cancer?

A
  • lungs
  • prostate
  • breast
  • kidney
  • thyroid
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112
Q

What are s/s of esophageal cancer?

A
  • referred back pain
  • pain with swallowing
  • dysphagia
  • weight loss
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113
Q

What does pain radiate in the presence of pancreatic cancer?

A

deep, gnawing pain radiating to the chest and back

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114
Q

signs and symptoms

Mid-epigastric pain radiating to the back

A

acute pancreatitis

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115
Q

signs and symptoms

  • abrupt, severe RUQ pain
  • N/V
  • fever
A

Cholecystitis

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116
Q

Definition

Angle made by the foot with respect to a straight line plotted in the direction the child is walking

A

Foot progression angle (gait angle)

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117
Q

Definition

Angle between the axis of the foot and thigh measure with the child prone and knees at 90 degrees

A

Thigh-foot angle

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118
Q

What does the thigh-foot angle describe?

A

angle of tibial torsion

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119
Q

In what position is toe-in/pigeon toe most prominent?

A

W sitting

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120
Q

What are the 3 types of deformity causing pigeon toe?

A
  1. metatarsus adductus
  2. internal tibial torsion
  3. increased femoral anteversion (25-30 degrees FWD)
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121
Q

What is the most common congenital foot deformity?

A

Metatarsus adductus

Greater in females and on the L side

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122
Q

What is talipes equinovarus?

“Clubfoot”

A
  • PF
  • midtarsal ADD
  • subtalar, talocalcaneal, talonavicular, and calcaneofibular INV

Cause: intrauterine malpositioning - abnormal development of head and neck of the talus

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123
Q

What is genu valgum?

A

Excessive lateral tibial torsion and patellar positioning

(“Knock knees”)

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124
Q

What is genu varum?

A

excessive medial tibial torsion

(“Bow-legs”)

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125
Q

What population is genu varum normal in?

A

Infants and toddlers

  • maximum genu varum present at 6-12 months
  • gradually straighten by 18-24 months
126
Q

What infant populations are likely to develop hip dysplasia?

A
  • Females
  • hip dysplasia while in utero
  • low levels of amniotic fluid
  • Swaddled too tightly
126
Q

What is the normal angle of genu valgum in males and females?

A

Males: 7 degrees
Females: 8 degrees

127
Q

What is the gold standard of treatment for hip dysplasia in infants?

A

Pavlik-harness

128
Q

How does the pavlik harness position the LEs?

A

hip FLX and abduction to maintain formal head acetabulum

129
Q

When should a pavlik harness be used?

A

newborns to 6 months

130
Q

When can closed reduction surgery be performed on children for correction of hip dysplasia?

A

6 months to 2 yrs

Spica cast applied for 12 weeks

131
Q

When can open reduction surgery be performed on children for correction of hip dysplasia?

A

> 2 y/o

Spica cast applied for 6-12 weeks

132
Q

signs and symptoms: pediatric population

  • unilateral hip or groin pain
  • crying at night
  • antalgic limp
  • recent history of upper tract infection
A

Transient synovitis

inflammation of synovium in the hip

133
Q

What does treatment consist of for transient synovitis?

A

NSAIDs and rest for 7-10 days

134
Q

What is the cause of Legg-Calve Perthes disease?

A

Decreased blood supply to femoral head

135
Q

What is the age of onset for legg-calve-perthes disease?

A

2-13 y/o

more common in males

imaging will show bony crescent sign

136
Q

How long is casting applied for legg-calve perthes disease?

A

4-6 wks

use of NSAIDs and acetaminophen

137
Q

What is the most common hip disorder in adolescents?

A

SCFE

unknown etiology

138
Q

What is SCFE?

A

Slipped femoral head posteriorly and inferiorly within the acetabulum

139
Q

What is the avg age range of onset for SCFE in females?

A

8-15 y/o

avg. 11 y/o

140
Q

signs and symptoms: pediatrics

  • AROM restriction of hip ABD, FLX, and IR
  • vague knee, thigh, and hip pain
  • Trendelenurg gait
A

SCFE

141
Q

definition: pediatrics

Mechanical dysfunction resulting in traction aphophysitis of the tibial tubercle at patellar tendon insertion

A

Osgood-schlatter disease

142
Q

What is the most common cause of heel pain in growing children before or during their peak growth spurt?

Bilateral in 60% of cases

A

Sever’s disease (calcaneal apophysitis)

143
Q

What causes sever’s disease?

A

Repetitive microtrauma due to increased traction by the achilles tendon at its insertion site

144
Q

What is sinding-Larsen Johannson’s disease?

A

Traction apophysitis at the patella-patellar tendon junction

Occurs due to repetitive overuse, after sig. growth, or inc. activity

145
Q

definition: pediatrics

a joint disorder in which a segment of bone and cartilage starts to separate from the rest of the bone after repeated stress or trauma

usually involved medial femoral condyle

A

Osteochondritis dissecans

146
Q

When does osteochondritis dissecans commonly occur?

A

12-15 y/o

147
Q

defintion: pediatrics

Localized avascular necrosis of the humeral capitulum leading to loss of subchondral bone with fissuring and softening of articular surfaces at the humeroradial joint.

A

Panner’s disease

148
Q

When can panner’s disease occur

A

< 10 y/o

149
Q

What is structural scoliosis?

A

Irreversible scoliosis with lateral curvature of the spine with a ROT component

curve becomes apparent when flexing the spine

150
Q

What is nonstructural scoliosis?

A

Scoliosis that has reversible lateral curvature of the spine without a ROT component

straightens as the individual performs FLX

Can be managed by stretching, show lifts, and postural reeducation

151
Q

At what degree of scoliosis can conservative treatment be used?

A

< 25 degrees

152
Q

At what degree of scoliosis are braces used?

A

25-45 degrees

153
Q

At what degree of scoliosis is surgery warranted?

Placement of Harrington rod instrumentation

A

> 45 degrees

154
Q

When do infants develop normal arches in the foot?

A

2-3 y/o

155
Q

What are different causes of congenital muscular torticollis?

A
  1. breech position
  2. forceps birth
  3. vacuum birth
  4. restrictive intrauterine environment
  5. genetics
  6. cervical abnormalities
156
Q

What is spasmic torticollis?

A

Torticollis with CNS pathology

157
Q

What is arthrogryposis multiplex congenita?

A

Congenital deformity of the skeleton and soft tissues (contractures, weakness, etc)

158
Q

(true/false) Intelligence is affected by arthrogryposis multiplex congenita

A

false

159
Q

What is osteogenesis imperfecta?

A

Inherited autosomal dominant gene disorder that is characterized by abnormal collagen synthesis leading to an imbalance between bone deposition and reabsorption

Cortical and cancellous bones become thin, leading to FX and deformity of WB bones

160
Q

What medications are used to treat osteogenesis imperfecta?

A
  1. vitamin D
  2. estrogen
  3. bisphosphanates
  4. calcitonin
161
Q

What is spondylolysis?

A

Fx of the pars interarticularis

“scotty dog fx”

162
Q

What is spondylolithesis?

A

anterior or posterior slippage of a vertebrae on another due to bilateral pars interarticularis fracture

163
Q

Describe the grades of spondylolithesis.

A

Grade 1: 25% slippage
grade 2: 50% slippage
grade 3: 75% slippage
grade 4: 100% slippage

164
Q

How long is a pt immobilized after PCL reconstruction? How are they positioned?

A

6 wks in full ext

165
Q

How long is a patient immobilized after lateral ankle reconstruction?

A

4-6 wks with cast and/or rigid walking boot

166
Q

How long is a patient immobilized for after a flexor tendon repair within the hand? How are they positioned?

A

3-4 weeks with digit FLX

167
Q

When is AROM initiated after a flexor tendon reconstruction in the hand?

A

week 4

168
Q

How long are joints immobilized after distal hand repair? How are they positioned?

A

6-8 wks in neutral

169
Q

When is AROM initiated after DIP hand repairs?

A

wk 6 while PIP is in neutral

EXT initially and progress to FLX

170
Q

What ligaments of the ankle are commonly repaired?

A

ATFL, CFL

171
Q

What ligament of the elbow is normally repaired after injury?

A

UCL

172
Q

How long are joints immobilized after proximal hand repair? How are they positioned?

A

4 wks while in EXT

Early AROM/PROM can occur with FLX while MCP joints are in EXT

173
Q

When is full AROM initiated into FLX and EXT after proximal hand repair?

A

6 wks

174
Q

How long is a pt immobilized after RTC repair?

A

4-6 wks

175
Q

How long can a pt not WB or perform AROM after a RTC repair?

A

4-6 wks

176
Q

When are isometric exercises initiated after RTC repair?

A

wk 6

177
Q

What positions must you avoid immediately after knee meniscal repair?

A

WB with FLX

178
Q

What positions must you avoid immediately after hip labral repair?

A
  • PROM hip EXT
  • excessive FLX/ABD/ER
179
Q

What positions must you avoid immediately after anteroinferior shoulder labral repair (Bankart)?

A

ER

180
Q

(true/false) there is an optimal treatment for pts with articular cartilage injury

A

FALSE

181
Q

What is a osteochondral autograft transplantation (OAT)?

A

transferring articular cartilage from low loading areas to high loading areas

Purpose: preserve/restore articular cartilage

182
Q

What is an autologous chondrocyte implantation (ACI)?

A

healthy articular cartilage is harvested from the pt and injected under a periostral flap that is then closed with sutures and glue

Purpose: preserve/restore articular cartilage

183
Q

What is an osteotomy?

A

Surgical cutting of a bone to correct a bony alignment

commonly performed at knee to correct genu valgum/varum

immobilized for 6-8 weeks post-op to allow for bone healing

184
Q

What positions should pts avoid after THR surgery?

A
  • hip FLX >90
  • hip ADD
  • hip IR

Precautions last for 6 weeks

185
Q

How long can a pt not actively perform post-surgical THR precautions?

A

3-6 months

186
Q

What is the goal for knee ROM by weeks 3 to 4 post-THR?

A

0-120 degrees

0-90 degree goal for weeks 1-2

187
Q

When can resistance exercises start after a THR surgery?

A

weeks 2-3

188
Q

When can isometric and active exercises begin after THR/TKR surgery?

A

immediately (depending on surgeon guidelines)

189
Q

What is considered as the foundation for spinal procedure rehab?

A

walking program

190
Q

What interventions should be implemented after Harrington rod placement for idiopathic scoliosis?

A

Early bed mobilization and effective coughing

191
Q

When should ambulation start after Harrington Rod placement for idiopathic scoliosis?

A

POD 4-7

192
Q

What are the surgical precautions for laminectomy/discectomy, miceodiscectomy?

A

end range ROT and FLX

NO joint mobilizations for at least 3 months

193
Q

What are precautions for lumbar fusions?

A
  1. avoid end range ROT and EXT
  2. no intensive abdominal exercises
  3. no impact loading for approx. 3 months
194
Q

What are precautions for cervical fusions?

A

No lifting > 5-10 pounds for 4 wks.

195
Q

What are the precautions for total disc replacements?

A
  1. avoid end range ROT and EXT
  2. no intensive abdominal exercises
  3. no impact loading for approx. 3 months
  4. no lifting > 5-10 pounds for 4 wks
196
Q

Describe the classifications for tissue injuries.

A

Grade 1:
- mild pain and swelling
- pain with soft tissue tension

Grade 2:
- moderate pain and swelling requiring activity modification
- focal TTP
- partial ligament tear w/ possibly joint laxity

Grade 3:
- near-complete or complete tear with severe pain
- minimal or no pain with tissue tension
- palpable defect
- complete ligament tear and joint instability

197
Q

What are the stages of soft tissue healing and when do they occur?

A
  1. Inflammatory (3 to 5 days)
  2. Proliferative (2 days to 2 months)
  3. Remodeling (1-2 years after injury)
198
Q

Describe the inflammatory phase of healing.

Immediately to day 5

Acute phase

A
  • vascular changes mobilize and transport cells to initiate inflammatory response
  • platelets form a clot
  • vasodilation occurs and increases blood flow while capillary permeability was altered to allow cellular exudation
  • damaged tissues and microorganisms are removed (phagocytosis)
  • pain before tissue resistance
199
Q

Describe the proliferation stage of healing.

Day 2 to month 2

subacute phase

A
  • fibroblasts resorb collagen and synthesize new collagen
  • new tissue is vulnerable to overloading - pain is synchronous with tissue resistance
  • decreased macrophages and fibroblasts with scar formation
  • removal of noxious stimuli
  • growth of capillary beds
  • granulation tissue
200
Q

Describe the remodeling stage of healing.

Years 1-2

chronic phase

A
  • increased organization of ECM
  • collagen is organized into randomly-placed fibrils
  • tension is required for tissue orientation (contracture of scar tissue)
  • absence of inflammation
  • pain after tissue resistance
201
Q

What is the healing time for Grade I muscle strains?

A

0-4 weeks

202
Q

What is the healing time for Grade 2 muscle strains?

A

3-12 weeks

202
Q

What is the healing time for grade 3 muscle strains?

A

1 month - 6 months

203
Q

How long does a tendon take to heal?

A

2-6 months

204
Q

How long does it take a grade I ligament sprain to heal?

A

0-4 weeks

205
Q

How long does it take for a grade 2 ligament sprain to heal?

A

3 weeks - 6 months

206
Q

How long does it take for a grade 3 ligament sprain to heal?

A

5 weeks to >1 year

207
Q

How long does it take for a bone injury/Fx to heal?

A

6-12 weeks

208
Q

How long does it take for cartilage to heal?

A

2-12 months

depends on structure

209
Q

What are the contraindications for performing soft tissue/myofascial techniques?

A
  • soft tissue breakdown
  • skin disease/infection/cellulitis
  • osteomyelitis
  • contagious illness
  • malignant tumor
  • aneurysms
  • sensory impairment
  • hemophilia
  • DVT
  • hematoma
  • lymphagitis
210
Q

Why is transverse friction massage used?

A

To initiate an inflammatory response for a tissue that is in metabolic stasis

ex: tendinosis

Note: movement is perpendicular to muscle fibers

211
Q

Which mobilization grades are used to improve joint lubrication/nutrition along with decreasing pain?

A

Grades I and II

212
Q

Which mobilization grades are used to stretch tight muscles, capsules, and ligaments?

A

Grades III and IV

213
Q

What mobilization grade is used for restoration of normal joint mechanics, decrease pain, and decrease guarding?

A

Grade V

214
Q

What are the contraindications for joint mobilization/manipulation/traction?

A
  • joint ankyloses and spondylolisthesis
  • malignancies
  • disease of ligaments (RA, down syndrome)
  • arterial insufficiency
  • active inflammatory process
  • infection
  • arthrosis
  • metabolic bone disease (OP, paget’s, TB)
  • hypermobility
  • joint replacements
  • pregnancy
  • steroid use
  • radicular symptoms
215
Q

What grade of mobilization should be used when mobilizing irritated neurologic tissue?

A

grade II

should not be painful

216
Q

What grade of mobilization should be used when mobilizing non-irritated neurologic tissue?

A

grade III

217
Q

What are the contraindications when performing neural tissue mobilization?

A
  • increase in neurological symptoms
  • excessive pain
218
Q

What intervention is also referred to as “intramuscular manual therapy (IMT)”?

A

dry needling

219
Q

What is indicated when there is a low score on the Patient Specific Functional Scale (PFPS)?

A

increased disability

Rating 1-5 different functional tasks on a scale of 0-10

220
Q

What is indicated when a patient has a high Neck Disability Index (NDI)?

A

higher disability

based off of 10 tasks rated from 0-5 (scores range from 0-100)

221
Q

A (low/high) score on the Modified Oswestry Disability Index (Modified ODI) indicates increased disability

A

high

based off of 10 tasks rated from 0-5 (scores range from 0-100)

222
Q

What structure(s) is the Modified Oswestry Disability Index (modified ODI) used to assess?

A

lumbar spine

223
Q

What does a higher score on the Western Ontario and McMaster Universities OA index (WOMAC) mean?

A

more pain, stiffness, and disability

Symptom presence rated on 0-10 scale (0-4 scale can also be used)

Subscales:
- Pain: 5 items
- Stiffness: 2 items
- Physical function: 17 items

224
Q

A (low/high) score on the LE Functional scale (LEFS) means increased disability.

A

low

20 functional tasks rated from 0-4

0: extreme difficulty or unable to perform
4: no difficulty

225
Q

What does a higher score mean on the Knee Oucome Survey and activity of daily living scale?

A

fewer symptoms and higher functioning

0: unable to perform
5: no challenge/barriers

226
Q

What does a higher score on the Foot and Ankle Ability Measurement (FAAM) mean?

A

higher functioning

21 Item ADL subscale - 8 item sports subscale (29 items in total)

Subscales:
- ADL: 21 items
- Sports: 8 items

227
Q

What does a higher score on the Foot Functioning Index (FFI) mean?

A

more impairment

23 items tested - overall score: 0-100

Subscales:
- pain
- disability
- activity restriction

228
Q

What does a high DASH score correlate to?

A

higher disability

229
Q

What does a high score on the Shoulder Pain and Disaility Index (SPADI) mean?

A

higher disability

Rate 0-10 ; Overall score: 0-100

13 items total:
- pain: 5
- disability: 8

230
Q

What is the Penn Shoulder Score (PSS) used for?

A

Rating level of pain, satisfaction, and function

overall score: 0-100

Subscales:
- Pain: 0-10 NRS (no pain –> pain)
- Satisfaction: 0-10 NRS (not satisfied –> satisfied)
- function: 0-4 likert scale (unable to perform –> no barriers)

231
Q

What does a higher score on the Penn Shoulder Score mean?

A

low pain, high satisfaction, and high function

232
Q

What does a higher Score on the Michigan Hand Outcome Questionnaire mean?

A

Better hand function

overall score: 0-100 (0-5 point likert scale)

Subscales:
- overall hand function
- ADLs
- work performance
- pain
- aesthetics
- satisfaction w/ hand function

233
Q

What does a higher score on the Mandibular function impairment questionnaire mean?

A

more disability

17 questions - Overall score: 0-68

0-4 likert scale (no barriers –> unable/great difficulty)

234
Q

What is Malingering (Symptom Magnification Syndrome)?

A

A behavioral response where the presentation of symptoms control the life of the patient, leading to functional disability

235
Q

On a XR, structures that are radiodense will absorb (less/more) x-rays and will appear (white/black/gray)

Ex: bone

A
  1. absorbs more
  2. appears white
236
Q

On a XR, structures that less radiodense will absorb (less/more) x-rays and will appear (white/black/gray)

ex: air and fat

A
  1. absorb less
  2. Black
237
Q

What are the ABCs to examining radiographs?

A

Alignment (size, contour, alignment w/ other bones)

Bone density (density and texture)

Cartilage (joint space width, presence of subchondral bone, epiphyseal plates)

238
Q

What forms of diagnostic imaging utilize ionizing radiation?

A
  • XR
  • CT/CAT
  • Bone scan / Bone Scintigraphy
239
Q

What forms of diagnostic imaging do NOT utilize ionizing radiation?

A
  • US
  • angiography
  • MRI
  • PET scans
240
Q

How many planes of view are required when taking a XR?

A

At least 2

241
Q

(true/false) XR is a good way to visualize small Fx and soft tissues

A

FALSE

242
Q

What kind of diagnostic imaging provides high-quality imaging of almost any structure of the body?

A

MRI

243
Q

(true/false) CT/CAT scans have a better anatomical resolution of the chest and abdomen compared to XR

A

true

244
Q

(true/false) A physician may not be able to distinguish between edema and cancer on an MRI

A

true

245
Q

What type of imaging can diagnose fractures not detected on an XR and image areas with damage to the bone caused by cancer, trauma, infection, etc?

A

bone scan / bone scintigraphy

Has improved detection of abnormal bone metabolism

246
Q

On a bone scan, areas that have increased uptake of the injected radionuclide appear as (black/white/grey).

A

black

247
Q

What kind of scan is the gold standard for measuring bone mineral density?

A

DEXA scan

differentiates between osteoporosis and osteopenia

248
Q

On an ultrasound, structures with more collagen appear (white/black).

Hyperechoic image

A

white

Muscles appears as black due to increased collagen (darker than tendons)

249
Q

On an ultrasound, structures with less collagen appear (white/black).

hypoechoic image

A

black

Ex: blood

250
Q

(true/false) US has better resolution to image soft tissue lesions compared to an MRI

A

true

251
Q

What is a PET scan used for?

A
  1. Detection of non-perfusing areas of the heart
  2. evaluate the brain in cases of undetermined stroke, Sz, memory disorders, or suspected tumors
252
Q

What is an ultrasound used for?

A

Diagnosis of fluid pockets, masses, partial tendon tears, and muscle development/activation

253
Q

In a T1 MRI, fat and bone marrow are (brighter/darker) and is helpful in defining anatomy

A

brighter

Black: bone cortex, air

white: bone marrow, fat

254
Q

In a T2 MRI, fluid appears (brighter/darker) than the fat which helps with identifying various joint pathologies

A

brighter

Grey: bone marrow, fat
Black: bone cortex, air

255
Q

(true/false) CT/CAT scans can measure bone density and identify tumors

A

true

256
Q

What structural changes can result from arthrogryposis?

A
  • hip dislocations
  • contractures of the hip and/or shoulder
  • club feet

hip: ABD, FLX, ER
Knee: ADD and IR

257
Q

(True/false) ESR is elevated in those with DJD (OA)

A

false - normal ESR

258
Q

Diagnosis

Metabolic disease marked by elevated levels of serum uric acid and deposition of urate crystals into joints, soft tissue, and kidneys

A

gout

259
Q

When do those with gout commonly have severe pain?

A

At night

warmth, erythema, and extreme tenderness/hypersensitivity

260
Q

What can induce myositis ossificans regarding PT treatment?

A

early mobilization and stretching with aggressive PT following trauma

261
Q

definition

Acute or chronic bone infection that is commonly the result of combined traumatic injury and acute infection

A

osteomyelitis

262
Q

(true/false) Chronic osteomyelitis can lead to amputation

A

true

263
Q

Paget’s disease (osteitis deformans) can be fatal when associated with what diseases?

A
  • CHF
  • bone sarcoma
  • giant cell tumors
264
Q

Vertebral collapse or vascular changes as a result of paget’s disease can result in what?

A

paraplegia

265
Q

What is pronator teres syndrome?

A

Median nerve entrapment in the pronator teres muscle where the nerve passes through

266
Q

s/s

  • insidious onset with slow progression
  • fatigue
  • weight loss
  • weakness
  • general diffuse MSK pain
  • pain localized to specific joints with symmetrical bilateral presentation
A

Juvenile RA

267
Q

After resting, how long can pain and stiffness last in those with JRA?

A

30 minutes to several hours

268
Q

What is the MOI of a smith’s fracture?

A

Falling onto a flexed wrist

269
Q

(true/false) A second degree sprain includes altered joint stability

A

false- joint stability remains intact

270
Q

Describe a March Fx of the tibia.

A

Fx of the distal 1/3 of tibial shaft

271
Q

What causes a tibial spiral fx?

A

excessive tibial torsion

272
Q

What is nurse-maid’s elbow?

A

Pulled elbow with pain localized to the superior radioulnar joint

273
Q

What is the MOI of nurse-maid’s elbow?

A

Longitudinal pull on the forearm

274
Q

What position will a person hold their arm if they have nurse-maid’s elbow?

A

Pronation

unable to supinate forearm

275
Q

What is volkmann’s contracture? What is the cause?

A
  1. Severe pain in the forearm with the sensation of pressure if there is compartment syndrome
  2. nerve and muscle ischemia secondary to arterial compromise

  • Pain is produced within 2 hours and is increased by passive finger EXT
  • pallor
  • paresis
  • pulselessness
276
Q

What contractures are seen with Volkmann’s contracture?

A

Wrist EXT and finger FLX

contracture and paralysis are late complications

277
Q

diagnosis

Insidious onset of flexion contractures in the 4th and 5th digits secondary to palmar contracture; unable to EXT fingers

A

dupuytren’s contracture

278
Q

definition

wrist disorder that occurs when the lunate loses its blood supply due to trauma

A

kienbock’s disease

279
Q

What motions are limited with kienbock’s disease?

A

Wrist FLX/EXT

pain also induced by palpation of the lunate

280
Q

What motions can result in trochanteric bursitis?

A

Excessive/repetitive ADD and muscle imbalance

Hip will be in IR/ER and ADD or resisted ABD

281
Q

s/s

  • asymmetrical skin folds
  • limb shortening
  • posterosuperior prominence of proximal femur
  • Trendelenburg gait
  • decreased hip ABD ROM and strength
A

Congenital Hip dysplasia

282
Q

What are predisposing factors for congenital hip dysplasia?

A
  • interuterine crowding
  • excessive capsular laxity
  • genetics
283
Q

What tests are utilized for diagnosis of congenital hip dysplasia?

A

Ortelani and Barlow

284
Q

s/s

  • gradual onset
  • hip pain and stiffness
  • antalgic and psoatic limp due to weak psoas mj (movement into ER, FLX, and ADD)
  • disuse atrophy of hip and thigh muscles
  • limited ROM for hip ABD, IR, and EXT
A

Legg-calve perthes disease

285
Q

What is the common age of onset for legg-calve perthes disease?

A

3-12 y/o

286
Q

s/s

  • hip pain and tenderness
  • vague hip and anterior thigh pain that can radiate to the knee
  • decreased ABD and IR
  • shortened limb
  • trendelenburg gait
A

SCFE

287
Q

What is the difference between acute and chronic SCFE?

A

ACUTE: result of trauma that results in pt being unable to WB; severe pain

CHRONIC: insidious development of limp with no pain or intermittent discomfort

288
Q

What is the common age range for onset of SCFE in boys?

A

10-16 y/o

289
Q

What kind of contracture will be seen in those with piriformis syndrome?

A

ER

  • Sensation and blood supply to the perineum and genitalia may be decreased due to pressure on the sacral plexus and internal iliac vessels
  • pain with sitting, squatting, or ER of hip
290
Q

Where does pain radiate to when piriformis syndrome is present?

A

posterior thigh

291
Q

What are the common MOIs for ACL injury?

A
  • hyperEXT
  • Tibial ER
  • acute trauma
292
Q

What is the MOI for LCL injury?

A

sudden forceful ADD of the tibia or knee dislocation

293
Q

What is the MOI for MCL injury?

A

forceful tibial ABD or tibial ER with the knee flexed or hyperextended

294
Q

Osgood-schlatter disease has what kind of onset?

A

insidious

295
Q

What is morton’s neuroma?

A

Neuritis resulting in burning and aching pain on the plantar surface of the foot and toes 3-5.

development of metatarsal head calluses and flat transverse arch

296
Q

What causes morton’s neuroma?

A

chronic pronation

297
Q

s/s

  • soreness of the middle metatarsals caused by abnormal mechanical stress
  • plantar foot pain and fatigue with WB
  • antalgic gait with pronation compensatory strategies
  • callus over middle metatarsals
  • hypermobility
A

metatarsalgia

298
Q
  • continous paresthesia and burning pain on plantar surface of the foot and toes
  • caused by direct trauma or chronic irritation
  • tenderness over tarsal tunnel
  • sensory loss
  • valgus heel and pronated forefoot
  • swelling
  • bony deformity
A

Medial tarsal tunnel syndrome

299
Q

What do the following findings indicate?

  • affected LE is longer while in supine
  • affected LE is shorter when long-sitting
A

Anterior innominate ROT

300
Q

What do the following findings indicate?

  • affected LE is shorter while in supine
  • affected LE is longer when long-sitting
A

posterior innominate ROT

301
Q

Describe sacral torsion (FWD or BWD)

A
  1. Ipsilateral deep sacral sulcus while in prone
  2. sacral inferior lateral angle is posterior and inferior on the opposite side
302
Q

What is fibromyalgia?

A

Immune system disorder that causes tenderness, pain, and stiffness of the muscles

303
Q

s/s

  • aching or burning muscles
  • diffuse pain
  • tender points on BOTH sides of the body (at least 11)
A

fibromyalgia

304
Q

Describe the differential diagnosis to rule in fibromyalgia.

A
  1. widespread pain in 11 out of 18 trigger points in the body
  2. typical pattern of nonrheumatic symptoms and sleep deprivation
  3. exclusion of other dx
305
Q

What is fibromyalgia often related to?

A
  • stress/anxiety
  • fatigue/sleeplessness
306
Q

Respiratory care may be warranted in those with scoliosis if the Cobb angle is ____.

A

> 40 degrees

307
Q

Diagnosis

Chronic, systemic, rheumatic inflammatory disorder of connective tissue and organs

A

Systemic lupus erythematosus

308
Q

s/s

  • malaise
  • fatigue
  • arthralgia
  • fever
  • arthritis
  • skin rash (butterfly)
  • photosensitivity
  • anemia
  • hair loss
  • raynaud’s
A

SLE

309
Q

s/s

  • pain located in periauricular area
  • unable to fully close the mouth
  • mouth opening less than 40 mm secondary to pain
  • pain decreases with rest
A

synovitis and capsulitis

310
Q

s/s

  • joint noises and catching while mouth is fully opened
  • mandibular depression is > 40 mm and deviates toward the uninvolved side
  • palpable irregularities during mouth closure
A

TMJ hypermobility

311
Q

s/s

  • joint noises
  • palpation over lateral poles of TMJ reveals an opening click and closing click (“reciprocal clicking”)
A

Disc displacement with reduction

312
Q

s/s

  • intermittent TMJ locking without noises
  • manibular opening is limited to 20-25 mm with deflection towards the involved side
  • limited lateral excursion toward the opposite of the involved joint
A

disc displacement without reduction

313
Q

Symptoms of stenosis are typically worse with what motion?

A

EXT and prolonged walking

NPTE (20 decks)

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