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NTPE > MSK differential Dx > Flashcards

MSK differential Dx Flashcards

1
Q

(Males or Females) Who commonly experiences OA more often before 50 y/o?

A

Men

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2
Q

(Males or Females) Who commonly experiences OA more often after 50 y/o?

A

Women

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3
Q

What is the leading cause of disability in the elderly?

A

Knee OA

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4
Q

Signs and symptoms

  • pain
  • swelling
  • decreased ROM
  • bony deformity
A

OA

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5
Q

What medications are commonly used for OA?

A
  • NSAIDS
  • corticosteroid injections
  • oral analgesics
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6
Q

What is Ankylosing spondylitis?

A

Progressive inflammatory disorder that initially affects the axial skeleton

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7
Q

Where in the body does ankylosing spondylitis initially affect?

A

axial skeleton

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8
Q

When is the initial onset of ankylosing spondylitis?

A

before 40 y/o

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9
Q

What are commonly the first symptoms of ankylosing spondylitis?

A
  • mid/low back pain
  • morning stiffness
  • sacroiliitis
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10
Q

Are males or females more commonly affected by ankylosing spondylitis?

A

Males

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11
Q

What medications are commonly used for ankylosing spondylitis?

A
  • NSAIDS
  • corticosteroids
  • cytotoxic drugs
  • TNF inhibitors
  • immunosuppresion drugs
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12
Q

What do cytotoxic drugs do?

A

Block cell growth

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13
Q

What is gout?

A

Genetic disorder of purine metabolism characterized by elevated serum uric acid (hyperuricemia) that changes into crystals and deposits into joints and other tissues

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14
Q

Where is gout commonly seen?

A
  • Knees
  • Great toe
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15
Q

What medications are used for gout?

A
  • NSAIDS
  • COX-2 inhibitors
  • colchicine
  • corticosteroids
  • adrenocorticotropic hormone (ACTH)
  • allopurinol
  • proenecid
  • sulfinpyrazone
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16
Q

What is psoriatic arthritis?

A

Chronic, erosive inflammatory disorder associated with psoriasis

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17
Q

What lab value can be used to rule in ankylosing spondylitis?

A

HLA-B27 antigen

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18
Q

What tests are used to look for gout?

A

Samples inspecting monosodium urate crystals in synovial fluid and connective tissues

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19
Q

Are males or females affected more by psoriatic arthritis?

A

Equally affected

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20
Q

What medications are commonly used to treat psoriatic arthritis?

A
  • NSAIDS
  • corticosteroids
  • acetaminophen
  • DMARDs
  • biological response modifiers (BRMs)
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21
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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22
Q

Are men or women affected more by RA?

A

women

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23
Q

When is the avg onset of RA?

A

40-60 y/o

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24
Q

Signs and symptoms

  • periods of exacerbation and remission
  • bilateral and symmetrical synovial joint involvement
  • inflammation
  • weight loss
  • fever
  • extreme fatigue
A

RA

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25
Q

What joints are commonly affected by RA?

A

hands, feet, cx spine

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26
Q

When is the onset of juvenile RA (JRA)?

A

before 16 y/o

Remission in 75% of cases

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27
Q

What diagnostic tests are used to diagnose RA?

A
  • tadiographs
  • increased WBCs
  • increased ESR
  • anemia
  • increased Rheumatoid factor
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28
Q

What medications are used for RA?

A
  • DMARDs
  • NSAIDS
  • corticosteroids
  • immuosuppresive agents
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29
Q

Are men or women more commonly affected by osteoporosis?

A

women

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30
Q

What are common sites of fx caused by osteoporosis?

A
  • Thoracic and lumbar spine
  • femoral neck
  • proximal humerus
  • proximal tibia
  • pelvis
  • distal radius
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31
Q

What primarily causes primary or postmenopausal osteoporosis?

A

decreased estrogen production

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32
Q

What causes senile Osteoporosis?

A

Decreased bone cell activity secondary to genetics or acquired abnormalities

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33
Q

What medications are used for osteoporosis?

A
  • calcium
  • vitamin D
  • estrogen
  • calcitonin
  • biophosphonates
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34
Q

What diagnostic tests are used to detect osteoporosis?

A

CT scan

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35
Q

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

A

Osteomalacia

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36
Q

Signs and symptoms

  • severe pain
  • Fx
  • weakness
  • deformities
A

osteomalacia

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37
Q

What medications are used to treat osteomalacia?

A
  • vitamin D
  • calcium
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38
Q

What diagnostic tests are used to detect osteomalacia?

A
  • bone scans
  • urinalysis and blood work
  • bone biopsy
  • plain films
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39
Q

What is osteomyelitis caused by?

A

infection

commonly staphylococcus aureus

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40
Q

What populations commonly experience osteomyelitis?

A
  • Children
  • immunosuppressed adults
  • males
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41
Q

What diagnosis is characterized by trigger points?

A

myofascial pain syndrome

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42
Q

What are the histological characteristics of tendinosis/tendinopathy?

A
  • hypercellularity
  • hypervascularity
  • no indication of inflammatory infiltrates
  • loose collagen fibers
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43
Q

What medications are used for tendinosis/tendinopathy and bursitis?

A
  • NSAIDs
  • Acetaminophen
  • steroid injections
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44
Q

What is the common cause of myositis ossificans?

A

Direct trauma resulting in hematoma and calcification within the muscle belly

Can also be caused by early mobilization and stretching w/ aggressive PT following trauma to the muscle

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45
Q

What are the common locations to experience myositis ossificans?

A
  • quads
  • brachialis
  • biceps
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46
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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47
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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48
Q

What does CRPS result in?

A

Dysfunction of sympathetic nervous system to include pain, circulation, and vasomotor disturbances

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49
Q

What triggers CRPS I?

A

Tissue injury

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50
Q

Diagnosis

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

A

CRPS I

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51
Q

What is the difference between CRPS I and II?

A

CRPS II involves a nerve injury

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52
Q

What medications can be used to treat CRPS?

A
  • antiseizure drugs
  • antidepressants
  • corticosteroids
  • opioids
  • topical drugs
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53
Q

What are the long term results of CRPS?

A
  • atrophy and weakness
  • skin changes
  • decreased bone density
  • decreased proprioception
  • contractures
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54
Q

What clinical diagnostic tests are used to diagnose CRPS?

A

None

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55
Q

What is the common name for Osteitis Deformans?

A

Paget’s disease

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56
Q

What is Paget’s disease?

A

Metaobolic bone disease involving abnormal osteoblastic and osteoclastic activity

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57
Q

What does Paget’s disease commonly result in?

A
  • spinal stenosis
  • facet arthropathy
  • possible spinal Fx
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58
Q

What is the presentation of torticollis?

A

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

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59
Q

Most traumatic GH instability occurs in what direction of dislocation?

A

anteroinferior

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60
Q

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

A

FALSE

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61
Q

What is a hill-sachs lesion?

A

compression Fx of posterior humeral head

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62
Q

What is a bankart lesion?

A

avulation of anteroinferior capsule and glenoid labrum

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63
Q

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

A

True

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64
Q

With what diagnoses is adhesive capsulitis most common?

A

DM and thyroid disease

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65
Q

What is de-quervain’s synovitis?

A

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

located in first dorsal compartment

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66
Q

What causes de-quervains synovitis?

A

Repetitive microtrauma or complication of swelling during pregnancy

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67
Q

What action can relieve symptoms of carpal tunnel?

A

Shaking hands

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68
Q

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

A
  • heat
  • microwave diathermy
  • IFC
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69
Q

What is the most common wrist fracture?

A

Colle’s

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70
Q

How long are colle’s fractures immobilized for?

A

5-8 weeks

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71
Q

What are complications of a colle’s fracture?

A

Median nerve impingement caused by excessive edema

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72
Q

What is the most common carpal to be fractured?

A

Scaphoid

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73
Q

What wrist pathology has a “garden spade” deformity?

A

smith’s Fx

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74
Q

How long are carpals immoilized after a scaphoid fx?

A

4-8 wks

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75
Q

Are males or females more likely to experience a Dupuytren’s Fx?

A

Males

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76
Q

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

A

Noble compression test
Ober’s test

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77
Q

What is coxa vara usually a result of?

A

defect in femoral head ossification

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78
Q

Most people with trochanteric bursitis also have what?

A

RA

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79
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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80
Q

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

A

< 60 degrees

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81
Q

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

A

90 degrees of hip FLX

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82
Q

Signs and symptoms

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

sports hernia

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83
Q

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

A
  • pain
  • pallor
  • paresis
  • parasthesia
  • palpable tenderness
  • pulselessness
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84
Q

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

A

true

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85
Q

What is the cause of acute compartment syndrome?

A

direct trauma and/or fracture

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86
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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87
Q

(true/false) Medial ankle ligaments are commonly sprained

A

FALSE

lateral is more common

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88
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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89
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 ration index > .67
  • CTQ-SSS score is > 1/9
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90
Q

What is dupuytrens contracture?

A

Contracture caused by palmar fascia affecting the MCPs and PIP joints

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91
Q

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

A

3rd and 4th digits

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92
Q

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

A

4th and 5th digits

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93
Q

Describe boutionniere deformity.

A

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

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94
Q

When commonly causes boutionniere deformity?

A
  1. trauma
  2. RA w/ central extensor tendon degeneration
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95
Q

Describe swan neck deformity.

A

MCP FLX, PIP EXT, DIP FLX

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

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96
Q

When does swan neck deformity commonly occur?

A
  1. Trauma
  2. RA w/ degeneration of lateral extensor tendons
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96
Q

Describe Ape hand deformity.

A

Muscle wasting of thenar eminence - parallel to 2nd digit

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97
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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98
Q

What is another name for Flexor digitorum profundus tendon rupture?

A

Jersey finger

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98
Q

Describe jersey finger.

A

DIP hyperEXT

Caused by excessive hyperEXT w/ maximal finger FLX contraction

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99
Q

What digit commonly experiences jersey finger?

A

Ring finger

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99
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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100
Q

Describe boxer’s Fx?

A

5th metacarpal Fx (at the neck)

casted for 2-4 wks

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101
Q

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

A

Labral tear

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102
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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103
Q

What combination of movements can cause Meniscal injury?

A
  1. ROT
  2. FLX
  3. compression
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104
Q

When can NMES be used for ACL sprains?

A

6-8 weeks after ACL reconstruction

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105
Q

When can concentric and eccentric exercises start after ACL reconstruction?

A

4-6 wks for up to 10 months

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106
Q

ACL injury prevention programs should be stressed with what population due to a higher risk of experiencing ACL injury?

A

Females 12-25 y/o

involved in high-risk sports

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107
Q

What are the criteria used for diagnosis of meniscal tear?

A
  • twisting injury
  • tearing sensation
  • delated effusion
  • Hx of catching/locking
  • pain with HyperEXT
  • pain with max. FLX
  • (+) McMurrays
  • (+) Thessaly’s
  • joint line tenderness
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108
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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109
Q

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

A

Hoffa’s syndrome

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110
Q

What is jumper’s knee?

A

Patellar tendinosis/tendinopathy

degenerative condition of patellar tendon; commonly deep aspect

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111
Q

What commonly causes pes anserine bursitis?

A
  1. Overuse
  2. contusion
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112
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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113
Q

What femoral condyle is commonly fractured?

A

Medial

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114
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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115
Q

What are the Ottawa knee and ankle rules used for?

A

To rule-in the need for XR series

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116
Q

What is the common MOI for tibial plateau Fx?

A

combination of valgus and compression during knee FLX

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117
Q

What is the common MOI for epiphyseal plate Fx?

A

WB torsional stress

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118
Q

Most stress Fx occur in what LE bone?

A

Tibia

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119
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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120
Q

What is a grade II lateral ankle sprain?

A
  • some loss of function
  • partial disruption of ATFL and CF ligaments
121
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
122
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
123
Q

What causes tarsal tunnel syndrome?

A
  1. excessive pronation
  2. overuse resulting in tendonitis of long flexor and posterior tibialis tendon
  3. trauma
124
Q

What causes tarsal tunnel syndrome?

A

Entrapment of the posterior tibial nerve branches within the tarsal tunnel

125
Q

Signs and symptoms

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

A

Tarsal tunnel syndrome

126
Q

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

A

Tinel’s sign

127
Q

What tendinopathy is commonly seen in ballet dancers?

A

Flexor hallucis tendinopathy

128
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
129
Q

What is the deformity observation for equinus?

A

foot PF

130
Q

what is the cause of equinus?

A
  • congenital bone deformity
  • neuro disorders (Ex: CP)
  • triceps surae contracture
  • trauma
  • inflammatory disease
131
Q

What is oserved with hallux valgus?

A
  • medial deviation of 1st metatarsal
  • 1st metatarsal head and ase move medially
  • 1st distal phalanx moves laterally
132
Q

What is the normal MTP angle?

A

8-20 degrees

133
Q

What is metatarsalgia?

A

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

134
Q

What is charcot-marie tooth disease?

A

peroneal muscular atrophy affecting the sensory and motor nerves

135
Q

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

A

true

136
Q

Signs and symptoms

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

stenosis

137
Q

What movement increases pain when stenosis is present?

A
  • EXT
  • ipsilateral SB
  • ipsilateral ROT
  • walking
138
Q

What movement decreases pain when stenosis is present?

A
  • FLX
  • prolonged rest
  • activity modification
139
Q

What medications are used for stenosis and disc conditions?

A
  • NSAIDS
  • acetominophen
  • corticosteroids
  • muscle relaxants
  • trigger point injections
140
Q

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

A

15 degrees

141
Q

What are contraindications for Traction when treating stenosis?

A
  • pregnancy
  • hypermobility
  • RA
  • down syndrome
  • systemic diseases affecting ligament integrity
142
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

143
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
144
Q

Where in the spine is central posterior herniation commonly observed?

A

cervical spine

145
Q

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

A

True

146
Q

What movement is most comfortable in patients with facet entrapment?

A

FLX

147
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
148
Q

What are the later symptoms of whiplash injury?

A
  • chronic head and neck pain
  • decreased ROM
  • TMJ dysfunction
  • disequilirium
  • anxiety and depression
149
Q

What is the purpose of the canadian C-spine rules?

A

Provide guidelines to determine if a patient needs a referral for imaging

150
Q

What are the primary bone tumors?

A
  • multiple myeloma
  • Ewing’s sarcoma
  • malignant lymphoma
  • chondrosarcoma
  • osteosarcoma
  • chondromas
151
Q

What are the primary sites of metastatic bone cancer?

A
  • lungs
  • prostate
  • breast
  • kidney
  • thyroid
152
Q

What are s/s of esophageal cancer?

A
  • referred back pain
  • pain with swallowing
  • dysphagia
  • weight loss
153
Q

What does pain radiate in the presence of pancreatic cancer?

A

deep, gnawing pain radiating to the chest and back

154
Q

signs and symptoms

Mid-epigastric pain radiating to the back

A

acute pancreatitis

155
Q

signs and symptoms

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

Cholecystitis

156
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)

157
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

158
Q

What does the thigh-foot angle describe?

A

angle of tibial torsion

159
Q

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

A

W sitting

160
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)
161
Q

What is the most common congenital foot deformity?

A

Metatarsus adductus

Greater in females and on the L side

162
Q

What can cause toe-out?

A
  1. femoral retroversion ( <10 degrees)
  2. external tibial torsion
163
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

164
Q

What is genu valgum?

A

Excessive lateral tibial torsion and patellar positioning

(“Knock knees”)

165
Q

What is genu varum?

A

excessive medial tibial torsion

(“Bow-legs”)

166
Q

What population is genu varum normal in?

A

Infants and toddlers

167
Q

When is maximum genu varum present in infants and toddlers?

A

months 6-12

gradually straighten by 18-24 months

168
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
168
Q

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

A

Males: 7 degrees
Females: 8 degrees

169
Q

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

A

Pavlik-harness

170
Q

How does the pavlik harness position the LEs?

A

hip FLX and abduction to maintain formal head acetabulum

171
Q

When should a pavlik harness be used?

A

newborns to 6 months

172
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

173
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

174
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 synoviun in the hip

175
Q

What does treatment consist of for transient synovitis?

A

NSAIDs and rest for 7-10 days

176
Q

What is the cause of Legg-Calve Perthes disease?

A

Decreased blood supply to femoral head

177
Q
A
178
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

179
Q

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

A

4-6 wks

use of NSAIDs and acetaminophen

180
Q

signs and symptoms: pediatrics

  • psoatic limp due to weak psoas mj (movement into ER, FLX, and ADD)
  • gradual onset of aching pain at hip, thigh, and knee
  • limited ROM for hip ABD and EXT
A

legg-calve-perthes disease

181
Q

What is the most common hip disorder in adolescents?

A

SCFE

unknown etiology

182
Q

What is SCFE?

A

Slipped femoral head posteriorly and inferiorly within the acetabulum

183
Q

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

A

10-17 y/o

avg. 13 y/o

184
Q

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

A

8-15 y/o

avg. 11 y/o

185
Q

signs and symptoms: pediatrics

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

SCFE

186
Q

definition: pediatrics

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

A

Osgood-schlatter disease

187
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)

188
Q

What causes sever’s disease?

A

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

189
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

190
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

191
Q

When does osteochondritis dissecans commonly occur?

A

12-15 y/o

192
Q

defintion: pediatrics

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

A

Panner’s disease

193
Q

When can panner’s disease occur

A

< 10 y/o

194
Q

What is structural scoliosis?

A

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

195
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

196
Q

At what degree of scoliosis can conservative treatment be used?

A

< 25 degrees

197
Q

At what degree of scoliosis are braces used?

A

25-45 degrees

198
Q

At what degree of scoliosis is surgery warranted?

Placement of Harrington rod instrumentation

A

> 45 degrees

199
Q

When do infants develop normal arches in the foot?

A

2-3 y/o

200
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
201
Q

What is spasmic torticollis?

A

Torticollis with CNS pathology

202
Q

What is arthrogryposis multiplex congenita?

A

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

203
Q

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

A

false

204
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

205
Q

What medications are used to treat osteogenesis imperfecta?

A
  1. vitamin D
  2. estrogen
  3. bisphosphanates
  4. calcitonin
206
Q

What is spondylolysis?

A

Fx of the pars interarticularis

“scotty dog fx”

207
Q

What is spondylolithesis?

A

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

208
Q

Describe the grades of spondylolithesis.

A

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

209
Q

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

A

6 wks in full ext

210
Q

How long is a patient immobilized after lateral ankle reconstruction?

A

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

211
Q

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

A

3-4 weeks with digit FLX

212
Q

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

A

week 4

213
Q

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

A

6-8 wks in neutral

214
Q

When is AROM initiated after DIP hand repairs?

A

wk 6 while PIP is in neutral

EXT initially and progress to FLX

215
Q

What ligaments of the ankle are commonly repaired?

A

ATFL, CFL

216
Q

What ligament of the elbow is normally repaired after injury?

A

UCL

217
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

218
Q

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

A

6 wks

219
Q

How long is a pt immobilized after RTC repair?

A

4-6 wks

220
Q

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

A

4-6 wks

221
Q

When are isometric exercises initiated after RTC repair?

A

wk 6

222
Q

What positions must you avoid immediately after knee meniscal repair?

A

WB with FLX

223
Q

What positions must you avoid immediately after hip labral repair?

A
  • PROM hip EXT
  • excessive FLX/ABD/ER
224
Q

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

A

ER

225
Q

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

A

FALSE

226
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

227
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

228
Q

What is an osteotomy?

A

Surgical cutting of a one 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

229
Q

What positions should pts avoid after THR surgery?

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

Precautions last for 6 weeks

230
Q

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

A

3-6 months

231
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

232
Q

When can resistance exercises start after a THR surgery?

A

weeks 2-3

233
Q

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

A

immediately (depending on surgeon guidelines)

234
Q

What is considered as the foundation for spinal procedure rehab?

A

walking program

235
Q

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

A

Early bed mobilization and effective coughing

236
Q

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

A

POD 4-7

237
Q

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

A

end range ROT and FLX

NO joint mobilizations for at least 3 months

238
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
239
Q

What are precautions for cervical fusions?

A

No lifting > 5-10 pounds for 4 wks.

240
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
241
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

242
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)
243
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
244
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
245
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
246
Q

What is the healing time for Grade I muscle strains?

A

0-4 weeks

247
Q

What is the healing time for Grade 2 muscle strains?

A

3-12 weeks

247
Q

What is the healing time for grade 3 muscle strains?

A

1 month - 6 months

248
Q

How long does a tendon take to heal?

A

2-6 months

249
Q

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

A

0-4 weeks

250
Q

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

A

3 weeks - 6 months

251
Q

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

A

5 weeks to >1 year

252
Q

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

A

6-12 weeks

253
Q

How long does it take for cartilage to heal?

A

2-12 months

depends on structure

254
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
255
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

256
Q

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

A

Grades I and II

257
Q

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

A

Grades III and IV

258
Q

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

A

Grade V

259
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
260
Q

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

A

grade II

should not be painful

261
Q

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

A

grade III

262
Q

What are the contraindications when performing neural tissue mobilization?

A
  • increase in neurological symptoms
  • excessive pain
263
Q

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

A

dry needling

264
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

265
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)

266
Q

What is indicated when a patient has a high score on the Modified Oswestry Disability Index (Modified ODI)?

A

increased disability

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

267
Q

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

A

lumar spine

268
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

269
Q

What do lower scores on the LE Functional scale (LEFS) mean?

A

increased disability

20 functional tasks rated from 0-4

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

270
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

271
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

272
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

273
Q

How many items does the DASH have?

Disabilities of the Arm, Shoulder, and Hand outcome measure (DASH)

A

30 items:
- physical function: 21
- pain: 5
- emotional/social: 4

Overall score: 0-100

274
Q

How many items does the Quick DASH have?

A

11 items: symptoms and physical function

Overall score: 0-100

275
Q

What does a high DASH score correlate to?

A

higher disability

276
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

277
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

278
Q

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

A

low pain, high satisfaction, and high function

279
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

280
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)

281
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

282
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
283
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
284
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)

285
Q

What forms of diagnostic imaging utilize ionizing radiation?

A
  • XR
  • CT/CAT
  • Bone scan / Bone Scintigraphy
286
Q

What forms of diagnostic imaging do NOT utilize ionizing radiation?

A
  • US
  • angiography
  • MRI
  • PET scans
287
Q

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

A

At least 2

288
Q

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

A

FALSE

289
Q

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

A

MRI

290
Q

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

A

true

291
Q

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

A

true

292
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

293
Q

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

A

black

294
Q

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

A

DEXA scan

differentiates between osteoporosis and osteopenia

295
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)

296
Q

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

hypoechoic image

A

black

Ex: blood

297
Q

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

A

true

298
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
299
Q

What is an ultrasound used for?

A

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

300
Q

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

A

brighter

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

301
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

302
Q

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

A

true

NTPE (13 decks)

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