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NPTE > MSK Pathology > Flashcards

MSK Pathology Flashcards

1
Q 
Degenerative joint disease (DJD)
Degenerative osteoarthritis (OA)
A

Degeneration of articular cartilage with hypertrophy of subchondral bone and joint capsule of weight-bearing joints

Meds: corticosteroids, NSAIDs, glucocorticoid injections, acetaminophen (mild pain)

Diagnostic tests: plain film (diminished joint space, decreased height of articular cartilage, osteophytes) and lab tests (rule out RA)

PT GOALS:
joint protection strategies

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2
Q

Ankylosing spondylitis

Marie-Strumpell disease, Bechterew’s disease, rheumatoid spondylitis

A

Progressive inflammatory disorder that initially affects the axial skeleton
Initial onset before 4th decade; men 3x more
First sx = mild and low back pain, morning stiffness and sacroilitis (3+ months duration)
Leads to kyphotic deformity of CS/TS and decreased lumbar lordosis
Degeneration of peripheral and costovertebral joints in advanced stages

Meds: NSAIDs, corticosteroids, cytotoxic drugs, tumor necrosis factor inhibitors

Diagnostic tests: HLA-B27 antigen

PT GOALS:
flexibility exercises
relaxation activities–breathing strategies

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3
Q

Gout

A

Genetic disorder of purine metabolism –> elevated serum uric acid (hyperuricemia) which forms crystals that deposit in peripheral joints (knee/great toe) and other tissues (kidneys)

Meds: NSAIDs, COX-2 inhibitors, colchicine, corticosteroids, ACTH, allopurinol, probenecid and sulfinpyrazone

Diagnostic tests: lab tests identify monosodium rate crystals in synovial fluid and/or connective tissue samples

PT GOALS:
pt education for injury prevention

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4
Q

Psoriatic arthritis

A

Chronic, erosive inflammatory disorder (digits and axial skeleton) associated with psoriasis

Meds: acetaminophen, NSAIDs, corticosteroids, disease-modifying antirheumatic drugs (DMARDs), biological response modifiers (BRMs)–Enbrel

Diagnostic tests: lab tests rule out RA

PT GOALS:
joint protection strategies

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5
Q

Rheumatoid Arthritis (RA)

A

Chronic systemic disorder in a symmetrical pattern of dysfunction in synovial tissues and articular cartilage of hands, wrists, elbows, shoulders, knees, ankle and feet
Women 2x more than men
**MCP/PIP: panes formation (inflamm granulation tissue covering joint surface), ulnar drift, volar subluxation of MCP
**swan neck and boutonniere deformity, Bouchard’s nodes (excess bone formation on dorsal PIP)

JRA: onset

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6
Q

Osteoporosis

A

Metabolic disease that depletes bone mineral density/mass predisposing individual to fracture
Women 10x > men
Common fracture sites: TS/LS, femoral neck, proximal humerus/tibia, pelvis, distal radius
Primary = decreased estrogen production
Senile = decreased bone cell activity due to genetics or acquired abnormalities

Meds: calcium, vitamin D, estrogen, calcitonin, and biophosphonates

Diagnostic tests: CT, single and dual photon absorptiometry

PT GOALS:
joint/bone protection strategies

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7
Q

Osteomalacia

A

Decalcification of bones due to vitamin D deficiency
Sx: severe pain, fractures, weakness, deformities

Meds: calcium, vitamin D, vitamin D injections (calciferol–vitamin D2)

Diagnostic tests: plain film, lab tests, bone scan, bone biopsy

PT GOALS:
joint/bone protection strategies

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8
Q

Osteomyelitis

A

Inflammatory response within bone caused by infection (staphylococcus aureus)
Children and immunosuppressed adults (male)

Meds: antibiotics, proper nutrition, surgery if spreads to joints

Diagnostic tests: lab tests (infection), bone biopsy

PT GOALS:
joint/bone protection strategies and cast care

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9
Q

Arthrogryposis multiplex congenita

A

Congenital deformity of skeleton and soft tissues limiting joint motion and “sausage-like” appearance of limbs; normal intelligence

Diagnostic tests: plain films

PT GOALS:
joint/bone protection strategies
pt education regarding adaptive devices
flexibility exercises

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10
Q

Osteogenesis imperfecta

A 
Inherited disorder (autosomal dominant) leading to abnormal collagen synthesis creating imbalance between bone deposition and reabsorption
Cortical and cancellous bone become thin leading to fractures/deformity of WB bones

Meds: calcium, vitamin D, estrogen, calcitonin and biophosphonates

Diagnostic tests: bone scan and plain film, serological testing

PT GOALS:
joint/bone protection strategies

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11
Q

Osteochondritis dissecans

A

Separation of articular cartilage from underlying bone (osteochondral fracture) usually medial femoral condyle near intercondylar notch or humeral capitellum
Surgery indicated if displaced

Diagnostic test: pain film or CT scan

PT GOALS:
joint/bone protection strategies
flexibility exercises

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12
Q

Myofascial pain syndrome

A

“Trigger point”: focal point of irritability within a muscle; taut, palpable band within muscle
Active = tender, referral pattern of pain when provoked
Latent = palpable taut bands, not tender, can become active
Onset: sudden overload, overstitching and/or repetitive/sustained muscle activities

Medical intervention: dry needling, injection of analgesic, corticosteroid

PT GOALS:
flexibility exercises
manual therapy: soft tissue, jt mobs, “spray and stretch” technique, dry needling, modalities and manual pressure
strength, power and endurance exercises

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13
Q

Tendonosis/Tendonopathy

A

Common tendon dysfunction (supraspinatus, common extensor tendon of elbow, patella, Achille’s tendon)
Histological charac: hypercellularity, hypervascularity, no inflammatory infiltrates, poor organization/loosening of collagen fibrils

Meds: acetaminophen, NSAIDs, and/or steroid injection

Diagnostic tests: possibly MRI

PT GOALS:
flexibility exercises
manual therapy: soft tissue and joint mobs
endurance and strengthening (ECCENTRIC)
modalities
pt education for IADLs
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14
Q

Bursitis

A

Inflammation of bursa due to overuse, trauma, gout or infection
S/S: pain with rest, limited motion due to pain (non-capsular pattern)

Meds: acetaminophen, NSAIDs, and/or steroid injection

PT GOALS:
flexibility exercises
manual therapy: soft tissue and joint mobs
modalities
pt education for IADLs
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15
Q

Muscle strains

A

Inflammatory response within muscle due to micro tearing of musculotendinous fibers
Pain and tenderness within muscle

Meds: acetaminophen and/or NSAIDs

Diagnostic tests: MRI if necessary

PT GOALS:
flexibility exercises
manual therapy: soft tissue and joint mobs
modalities
pt education for IADLs
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16
Q

Myositis ossificans

A

Painful condition of abnormal calcification within muscle belly (quadriceps, brachial and biceps brachii) due to direct trauma leading to a hematoma and calcification
**Can be induced by early mobilization and stretching

Meds: acetaminophen and/or NSAIDs

Surgery: if nonhereditary and after maturation of the lesion (6-24 months) when lesions interfere with joint movement or impinge on nerves

Diagnostic tests: plain films, CT scan or MRI

PT GOALS:
flexibility exercises
manual therapy: soft tissue and joint mobs
NOTE: avoid aggressive soft tissue/massage techniques which may worsen condition

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17
Q

Complex regional pain syndrome (CRPS)

A

Dysfunction of SNS: pain, circulation and vasomotor disturbances
CRPS I: frequently triggered by tissue injury; its with above sx but no underlying nerve injury
CRPS II: same sx but clearly associated with a nerve injury

Medical intervention: sympathetic nerve block, surgical sympathectomy, spinal cord stimulation, intrathecal drug pumps

Meds: topical analgesics, anti seizure drugs, antidepressants, corticosteroids and opioids

Long term changes: muscle wasting, trophic skin changes, decreased bone density, decreased proprioception, loss of muscle strength from disuse and joint contractors

PT GOALS:
pt education for injury prevention/reduction
desensitization activiies 
flexibility exercises
TENS for pain relief
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18
Q

Paget’s disease

osteitis deformans

A

Metabolic bone disease involving abnormal osteoclastic and osteoblastic activity leading to spinal stenosis, facet arthropathy and possible spinal fracture
Unknown etiology: possibly viral infection and/or environmental

Meds: acetaminophen, calcitonin and etidronate disodium (limit osteoclastic activity)

Diagnostic test: plain film, lab tests (increased serum alkaline phosphatase and urinary hydroxyporline)

PT GOALS:
joint/bone protection strategies

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19
Q

Idiopathic scoliosis

A

Structural: irreversible lateral curvature of spine with a rotational component
Nonstructural: reversible lateral curvature of spine without rotational component and straightening as individual flexes spine

Intervention (structural): bracing and possible surgery (Harrington rods placement)
45 deg: surgery

Diagnostic test: plain film (full-length Cobb’s method), CT scan and/or MRI to rule out associated conditions

PT GOALS:
flexibility exercises
application/pt education with orthoses

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20
Q

Torticollis

A

Spasm and/or tightness of sternocleidomastoid
SB toward and rotation away from affected SCM

Meds: acetaminophen, muscle relaxants and/or NSAIDs

PT GOALS:
flexibility exercises
manual therapy: soft tissue, joint mobs

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21
Q

Glenohumeral Subluxation and Dislocation

A

95% in anterior-inferior direction: when abducted UE is forcefully ER causing tearing of the inferior GH ligament, anterior capsule and occasionally glenoid labrum
Posterior dislocation: horizontal add and IR

Complications:
Hill-Sachs lesion: compression fracture of posterior humeral head
SLAP lesion: tearing of superior glenoid labrum from anterior to posterior
Bankart’s lesion: avulsion of anteroinferior capsule and ligaments associated with glenoid rim
Bruising of axillary nerve

Following surgical repair: AVOID apprehension position (flexion>90, horiz abd>90, ER to 80)

Diagnostic tests: plain film, CT scan, MRI

Meds: acetaminophen, NSAIDs

PT GOALS:
joint mobs
exercise focused on regaining scapulothoracic, GH stabilization and muscular re-ed

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22
Q

Instability (Shoulder)

A

Traumatic: young throwing athletes
Atraumatic: congenitally loose connective tissue around shoulder

Popping/clicking and repeated dislocation/subluxation of shoulder
Unstable injuries require surgery

Meds: acetaminophen, NSAIDs

PT GOALS:
return of function without pain

POST SURGERY:
Sling 3-4 wks
After 6 wks: sports-specific training
Full fitness: 3-4 months

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23
Q

Labral Tears

A

Superior: toward the top of glenoid socket
Inferior: toward bottom of glenoid socket
SLAP: tear of rim above middle of socket that may also involve biceps tendon
Bankart’s lesion: tear of rim below middle of glenoid socket

S/S:  
Pain cannot be localized
Pn incr with OH activities or arm behind back
Weakness
Instability
Pn on resisted flexion of biceps
Tenderness over front of shoulder

Diagnostic tests: MRI arthrogram, “gold” standard: arthroscopic surgery

Meds: acetaminophen, NSAIDs

POST SURGERY:
Sling 3-4 wks
After 6 wks: sports-specific training
Full fitness: 3-4 months

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24
Q

Thoracic Outlet Syndrome (TOS)

A

Compression of neuromuscular bundle (brachial plexus, subclavian A/V, vagus and phrenic nerves and sympathetic trunk)

Common areas of compression:
Superior thoracic outlet
Scalene triangle
Between clavicle and first rib
Between p. minor and thoracic wall

Surgery: remove cervical rib or release anterior and/or middle scalene

Diagnostic tests: plain film, MRI, EMG

Special tests: Adson’s, Roo’s, Wright, Costoclavicular

Meds: acetaminophen, NSAIDs

PT GOALS:
Postural re-ed
Manipulations (first rib)

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25
Q

Acromioclavicular and Sternoclavicular joint disorders

A

MOI: fall onto shoulder with UE add OR collision with another individual in a sporting event

Acute phase: UE pos. in neutral in a sling; AVOID shoulder elevation

Diagnostic tests: plain film

Special tests: Shear test

Meds: acetaminophen, NSAIDs

PT GOALS:
manual therapy: soft tissue, joint mobs

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26
Q

Subacromial and Subdeltoid Bursitis

A

Subacromial and sub deltoid bursae (may be continuous) have close relationship to RC tendons–susceptible to overuse
Impinged under acromial arch

Meds: acetaminophen, NSAIDs

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27
Q

Rotator Cuff Tendonosis/Tendonopathy

A

Relatively poor blood supply near insertion of muscles makes them more susceptible
Mechanical impingement of distal attachment of rotator cuff on anterior acromion and/or coracoacromial ligament with repetitive overhead activities

Diagnostic test: MRI

Special tests: Supraspinatus tet, Neer’s impingement test

Meds: Acetaminophen, NSAIDs

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28
Q

Impingement Syndrome

A

Soft tissue inflammation of shoulder from impingement against acromion with repetitive overhead AROM

Diagnostic tests: arthrogram or MRI

Special tests:
Neer’s impingement test
Supraspinatus test
Drop arm test

Surgical repair: AVOID shoulder elevation >90

Meds: acetaminophen, NSAIDs

PT GOALS:
restoration of posture
joint mobs

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29
Q

Internal (Posterior) Impingement

A

Irritation between the RC and greater tuberosity or posterior glenoid and labrum
Overhead athletes
Pain in posterior shoulder

Special test: Posterior internal impingement test

Meds: acetaminophen, NSAIDs

PT GOALS:
joint mobs

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30
Q

Bicipital Tendonosis/Tendonopathy

A

Inflammation of long head of biceps
Mechanical impingement of proximal tendon between anterior acromion and bicipital groove of humerus

Diagnostic test: MRI

Special test: Speed’s test

Meds: acetaminophen, NSAIDs

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31
Q

Proximal humeral fractures

A

Fall onto an outstretched UE among older osteoporotic women

Diagnostic test: plain film

Meds: acetaminophen, NSAIDs

PT GOALS:
joint mobs
early PROM to prevent capsular adhesions

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32
Q

Adhesive capsulitis

Frozen shoulder

A

Restriction in shoulder motion as a result of inflammation and fibrosis of the shoulder capsule due to disuse or repetitive microtrauma
*Capsular pattern: ER > abd & flex > IR
Common with diabetes mellitus

Meds: acetaminophen, NSAIDs

PT GOALS:
joint mobs

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33
Q

Elbow Contractures

A

Loss of motion in capsular pattern (flex>ext)
Loss of motion in non capsular pattern: loose body, ligamentous sprain and/or CRPS

Meds: acetaminophen, NSAIDs

PT GOALS:
joint mobs
soft tissue techniques
splinting (for capsular restrictions)

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34
Q

Lateral Epicondylosis/Epicondylopathy

A

Chronic degenerative condition of ECRB at its proximal attachment on lateral epicondyle
Onset is gradual with repetitive wrist extension or strong grip with wrist extended
RULE OUT involvement/relationship to cervical spine condition

Special test: Lateral epicondylitis test

Meds: acetaminophen, NSAIDs

PT GOALS:
ECCENTRIC exercise
joint mobs
education regarding prevention
modalities
counterforce bracing to reduce forces on ECRB
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35
Q

Medial Epicondylosis/Epicondylopathy

A

Degenerative condition of the pronator teres and flexor carpi radials tendons at their attachment to the medial epicondyle of the humerus
Overuse with strong hand grip and excessive pronation of the forearm

Special test: medial epicondylitis test

PT GOALS: 
ECCENTRIC exercise
joint mobs
education regarding prevention
modalities
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36
Q

Distal Humeral Fractures

A

Complications: loss of motion, myositis ossificans, malalignment, neuromuscular compromise, ligamentous injury, CRPS

Supracondylar fractures: examine quickly for neuromuscular status (radial nerve involvement) may lead to Volkmann’s ischemia; youth: growth plate; high incidence of malunion

Lateral epicondyle fractures: young people, require ORIF to ensure alignment

Diagnostic test: plain film

Meds: acetaminophen, NSAIDs

PT GOALS:
pain reduction, reduce inflammation
flexibility exercises

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37
Q

Osteochondrosis of humeral capitellum

A

Osteochondritis dissecans: central and/or lateral aspect of capitellum or radial head

  • Osteochondral bone fragment becomes detached from articular surface forming a loose body in the joint
  • Repetitive compressive forces between radial head and humeral capitellum
  • 12-15 years old
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38
Q

Ulnar collateral ligament injuries

A

Repetitive valgus stresses to medial elbow with overhead throwing

S/S:
pn along medial elbow at distal insertion of lig
paresthesias in ulnar nerve distribution

Diagnostic test: MRI

Special test: medial ligament instability test, Tinel’s sign

Meds: acetaminophen and NSAIDs

PT GOALS:

initial: rest and pain management
later: strength elbow flexors, taping

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39
Q

Ulnar nerve entrapment

A

Direct trauma at cubital tunnel
Traction due to laxity at medial elbow
Compression due to thickened retinaculum
Hypertrophy of flexor carpi ulnaris muscle
Recurrent subluxation or dislocation
DJD affecting cubital tunnel

S/S: medial elbow pain, paresthesias in ulnar distribution

Diagnostic test: EMG

Special Test: Tinel’s sign

Meds: acetaminophen, NSAIDs, Neurontin

PT GOALS:
early: rest, avoiding activities, modalities, soft tissue
neurodynamic mobilization
protective padding and night splints

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40
Q

Median nerve entrapment

A

Pronator teres muscle and under superficial head of flexor digitorum superficial with repetitive gripping activities

S/S: aching pain with weakness of forearm muscles

Diagnostic test: EMG

Special Test: Tinel’s sign with paresthesias in median nerve distribution

Meds: acetaminophen, NSAIDs, Neurontin

PT GOALS:
early: rest, avoiding activities, modalities, soft tissue
neurodynamic mobilization
protective padding and night splints

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41
Q

Radial nerve entrapment

A

Distal branches (posterior interosseous nerve) within radial tunnel (radial tunnel syndrome) due to overhead activities and throwing

S/S:
lateral elbow pain that can be confused with lat epicondylitis
pain over supinator muscle
paresthesias in radial nerve distribution

Diagnostic test: EMG

Special Test: Possible Tinel’s sign

Meds: acetaminophen, NSAIDs, Neurontin

PT GOALS:
early: rest, avoiding activities, modalities, soft tissue
neurodynamic mobilization
protective padding and night splints

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42
Q

Elbow dislocations

A

Posterior: position of olecranon relative to humerus; cause avulsion fractures of medial epicondyle due to pull of MCL
Posterolateral: most common due to elbow hyperextension from a FOOSH

Anterior/radial head: 1-2%

Complete dislocation: UCL will rupture, possible rupture of anterior capsule, LCL, brachialis muscle, and/or wrist flex/ext mm

S/S: rapid swelling, severe elbow pain and deformity with olecranon pushed posterior

Diagnostic tests: plain film

Meds: acetaminophen and NSAIDs

PT GOALS:
initial: reduction of dislocation
if stable: initial phase of immobilization
if not stable: surgery

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43
Q

Carpal tunnel syndrome

Repetitive stress syndrome

A

Compression of median nerve at carpal tunnel of wrist due to inflammation of flexor tendons and/or median nerve
Occurs with repetitive wrist motions or gripping, pregnancy, diabetes and RA
*RULE OUT cervial spine dysfunction, TOS or peripheral nerve entrapments

Diagnostic test: EMG

S/S:
exacerbation of burning, tingling, pins/needles
numbness in median nerve distribution at night
Long term: atrophy/weakness of thenar mm and lateral 2 lumbricals

Special test: Tinel’s sign, Phalen’s test

Meds: acetaminophen and NSAIDs

PT GOALS:
joint mobs
soft tissue

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44
Q

DeQuervain’s tenosynovitis

A

Inflammation of extensor policies brevis and abductor policies longus tendons at first dorsal compartment due to microtrauma or swelling during pregnancy

Diagnostic test: MRI

S/S:
pain at anatomical snuffbox
swelling
decreased grip and pinch strength

Special test: Finkelstein’s test

Meds: acetaminophen and NSAIDs

PT GOALS:
joint mobs
soft tissue

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45
Q

Colles’ fracture

A

Most common, due to a FOOSH
Immobilized 5-8 wks
Complication of median nerve compression with excessive edema

“Dinner fork” deformity: dorsal or posterior displacement of radius, with a radial shift of wrist and hand

Diagnostic test: plain film

Complications: decreased motion, grip strength, CRPS, carpal tunnel syndrome

Meds: acetaminophen, NSAIDs

PT GOALS:
early: normalizing flexibility
joint mobs
soft tissue

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46
Q

Smith’s fracture

A

Distal fragment of radius dislocates in a volar direction causing a “garden spade” deformity

Diagnostic test: plain film

Meds: acetaminophen and NSAIDs

PT GOALS:
early: normalizing flexibility
joint mobs
soft tissue

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47
Q

Scaphoid fracture

A

Most commonly fracture carpal bone; FOOSH in a younger person

Diagnostic test: plain film

Complications: avascular necrosis of proximal fragment of scaphoid due to poor vascular supply
Immobilized 4-8 weeks

Meds: acetaminophen and NSAIDs

PT GOALS:

early: maintenance of flexibility in distal/proximal joints while UE is casted
later: strength, stretching, soft tissue/joint mobs

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48
Q

Dupuytren’s contracture

A

Banding on palm and digit flexion contractors due to contracture of plamar fascia that adheres to skin
Men > women

Contractures:
MCP and PIP of 4th/5th digits (nondiabetics)
MCP and PIP of 3rd/4th digits (diabetics)

Meds: acetaminophen and NSAIDs

PT GOALS:
flexibility and splints
post-surgery: wound management, edema control and progression of exercise

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49
Q

Boutonniere deformity

A

Rupture of central tendinous slip of extensor hood following trauma or with RA
MCP extension
DIP extension
PIP flexion

Meds: acetaminophen and NSAIDs

PT GOALS:
edema management
flexibility
splinting or taping

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50
Q

Swan neck deformity

A

Contracture of intrinsic muscles with dorsal subluxation of lateral extensor tendons following trauma or with RA
MCP flexion
DIP flexion
PIP extension

Diagnostic test: plain film

Meds: acetaminophen and NSAIDs

PT GOALS:
edema management
flexibility
splinting or taping

51
Q

Ape hand deformity

A

Thenar much wasting with 1st digit moving dorsally until it is in line with second digit due to median nerve dysfunction

Diagnostic test: EMG

Meds: acetaminophen and NSAIDs

PT GOALS:
edema management
flexibility
splinting or taping

52
Q

Mallet finger

A

Rupture or avulsion of extensor tendon at its insertion into distal phalanx of digits due to trauma forcing distal phalanx into flexion
DIP flexion

Diagnostic test: MRI

Meds: acetaminophen and NSAIDs

PT GOALS:
edema management
flexibility
splinting or taping

53
Q

Gamekeeper’s thumb

A

Sprain/rupture of UCL of MCP joint of 1st digit leading to medial instability of thumb due to a fall while skiing when increasing forces are placed on thumb through ski pole
Immobilized 6 weeks

Diagnostic test: MRI

Meds: acetaminophen and NSAIDs

PT GOALS:
edema management
flexibility
splinting or taping

54
Q

Boxer’s fracture

A

Fracture of neck of 5th metacarpal due to a fight or punching a wall in anger/frustration
Casted 2-4 weeks

Diagnostic test: plain film

Meds: acetaminophen and NSAIDs

PT GOALS:
edema management
flexibility

55
Q 
Avascular necrosis (AVN) of the hip
Osteonecrosis
A

Impaired blood supply to femoral head
Hip ROM decreased in flexion, IR, abd

Diagnostic test: plain film, bone scans, CT and/or MRI

S/S:
pain in groin/thigh
tenderness with palpation at hip joint
coxalgic gait

Meds: acetaminophen and NSAIDs
**corticosteroids are contraindicated

PT GOALS:
joint/bone protection
post-surgery: flexibility, strength, gait training

56
Q

Legg-Calve-Perthes disease

Osteochondrosis

A

2-13 years old (avg age = 6 years)
Males 4x > females

Psoatic limp due to weakness of psoas major: affected LE moves into ER, flex, add
Gradual onset of “aching” at hip, thigh, knee
AROM limited: abd and ext

Diagnostic test: MRI (positive bony crescent sign–collapse of subchondral bone at femoral neck/head)

Meds: acetaminophen and NSAIDs

PT GOALS:
joint/bone protection
post-surgery: flexibility, strength, gait training

57
Q

Slipped capital femoral epiphysis

A

Males: 10-17 y/o (avg age = 13)
Females: 8-15 y/o (avg age = 11)
Males 2x > females

AROM limited in abd, flex and IR
Vague pain at knee, thigh, hip
Chronic: Trendelenburg sign

Diagnostic test: plain film (positive displacement of upper femoral epiphysis)

Meds: acetaminophen and NSAIDs

PT GOALS:
joint/bone protection
post-surgery: flexibility, strength, gait training

58
Q

Femoral anteversion

A

25-30 deg or more anteversion leads to squinting patellae and toeing-in

59
Q

Coxa Vara and Coxa Valga

A

Coxa vara: 125 deg
Both can result from necrosis of femoral had with septic arthritis

Diagnostic test: plain film

60
Q

Trochanteric bursitis

A

Inflammation of deep trochanteric bursa from a direct blow, irritation by ITB and biomechanical or gait abnormalities causing repetitive microtrauma
Common with RA

AROM vs PROM and resistive tests

Meds: acetaminophen and NSAIDs

61
Q

Iliotibial band tightness/friction disorder

A

Tight ITB, abnormal gait pattern leads to inflammation of trochanteric bursa

Special test: Noble compression test, Ober’s test

Meds: acetaminophen and NSAIDs

PT GOALS:
reduce pain/inflammation with modalities
correct muscle imbalances
joint mobs
gait training/patient education
62
Q

Piriformis syndrome

A

ER of hip can become overworked with excessive pronation of foot causing abnormal femoral IR
Tightness/spasm can compress sciatic nerve or lead to SIJ dysfunction

Diagnostic test: possible EMG

S/S:
restriction in IR
pain with palpation of piriformis
referral of pain to posterior thigh
weakness in ER, + piriformis test
uneven sacral base
**RULE OUT lumbar spine and/or SIJ

Meds: acetaminophen, NSAIDs and Neurontin

PT GOALS:
pain reduction with modalities
correct muscle imbalances
patient education
orthotic device for feet
63
Q

ACL laxity leads to…

A

anterior instability

64
Q

PCL laxity leads to…

A

posterior instability

65
Q

ACL and MCL laxity leads to…

A

anteromedial rotary instability

66
Q

ACL and LCL laxity leads to..

A

anterolateral rotary instability

67
Q

PCL and MCL laxity leads to…

A

posteromedial rotary instability

68
Q

PCL and LCL laxity leads to..

A

posterolateral rotary instability

69
Q

Classification of ligament injury

A

First degree: little or no instability

Second degree: minimal to moderate instability

Third degree: extreme instability

70
Q

“Unhappy triad”

A

Injury to MCL, ACL and medial meniscus

Results from a combination of valgum, flexion and ER forces applied to knee when foot is planted

71
Q

Knee Ligament Injury

A

Diagnostic test: MRI

Special tests: Lachman’s, anterior drawer, collateral ligament instability tests, pivot shift, posterior sag test, posterior drawer test, reverse Lachman

Meds: acetaminophen and NSAIDs

PT GOALS:
reduce pain/inflammation with modalities
correct muscle imbalances
joint mobs

72
Q

Mensical Injuries

A

Combination of forces: TF joint flexion, compression and rotation placing abnormal shear stress on meniscus

S/S:
lateral and/or medial joint pain
effusion
joint popping
knee giving way during walking
limitation of knee joint
joint locking

Diagnostic test: MRI

Special tests: McMurray, Apley

Meds: acetaminophen and NSAIDs

PT GOALS:
reduce pain/inflammation with modalities
correct muscle imbalances

73
Q

Patella alta

A

Patella tracks superiorly in femoral intercondylar notch, may lead to chronic patellar subluxation

Positive camel back sign: 2 bumps over anterior knee instead of one

Diagnostic test: plain film including “sunrise” view

PT GOALS:
functional strength (VMO)
flexibility of ITB and hamstrings
orthoses
patella bracing/taping
74
Q

Patella baja

A

Patella tracks inferiorly in femoral intercondylar notch, leads to restricted nee extension with abnormal cartilaginous wearing–> DJD

Diagnostic test: plain film including “sunrise” view

PT GOALS:
functional strength (VMO)
flexibility of ITB and hamstrings
orthoses
patella bracing/taping
75
Q

Lateral patellar tracking

A

Could result if increased “Q-angle” with tendency for lateral subluxation or dislocation

Diagnostic test: plain film including “sunrise” view

PT GOALS:
functional strength (VMO)
flexibility of ITB and hamstrings
orthoses
patella bracing/taping
76
Q

Patellofemoral pain syndrome (PFPS)

A

Abnormal patellofemoral tracking ends to abnormal patellofemoral stress
May be related to chorndromalacia patellae and/or patella tendonitis

Diagnostic test: MRI

Meds: acetaminophen and NSAIDs

PT GOALS:
patellofemoral taping
patella mobilization
correct muscle imbalances
DO NOT USE: quad sets, single-leg raise flexion, isolated quads exercises
77
Q

Patellar tendonosis/tendonopathy

“Jumpers knee”

A

Degenerative condition of patellar tendon (deep aspect)
Related to overload and/or jumping activity and interrelated to patellofemoral dysfunction

Meds: acetaminophen, NSAIDs, corticosteroid

78
Q

Pes anserine bursitis

A

Due to overuse or contusion
*Differentiate from tendonitis

AROM vs PROM and resistive tests

Meds: acetaminophen, NSAIDS and corticosteroids

79
Q

Osgood Schlatter disease

A

Mechanical dysfunction leading to traction apophysitis of tibial tubercle at patellar tendon insertion

Diagnostic test: plain film (irregularities at epiphyseal line)

Meds: acetaminophen and NSAIDs

early flexibility is important in prevention

PT GOALS:
modify activities to decrease excessive stress

80
Q

Genu varum and valgum

A

NORMAL tibiofemoral shaft angle: 6 deg valgum
Genu varum: excess medial tibial torsion “bow legs”; excess medial patellar positioning and pigeon-toed orientation of feet
Genu valgum: excess lateral tibial torsion “knock knees”; excess lateral patellar positioning

Diagnostic test: plain film

PT GOALS:
decreased loading at knee

81
Q

Femoral condyle fracture

A

Medial femoral most often involved
Trauma, shearing, impacting, avulsion forces
MOI: fall with knee subjected to shearing force

Diagnostic test: plain film unless complex fracture (CT)

Meds: acetaminophen and NSAIDs

PT GOALS:
return to function without pain

82
Q

Tibial plateau fracture

A

MOI: valgum and compression forces when knee is in a flexed position
Often occurs with MCL injury

Diagnostic test: plain film unless complex fracture (CT)

Meds: acetaminophen and NSAIDs

PT GOALS:
return to function without pain

83
Q

Epiphyseal plate fracture

A

MOI: weight bearing torsional stress
More frequent in adolescents

Diagnostic test: plain film unless complex fracture (CT)

Meds: acetaminophen and NSAIDs

PT GOALS:
return to function without pain

84
Q

Patella fracture

A

MOI: direct blow to patella due to fall

Diagnostic test: plain film unless complex fracture (CT)

Meds: acetaminophen and NSAIDs

PT GOALS:
return to function without pain

85
Q

Anterior compartment syndrome (ACS)

A

Increased compartmental pressure resulting in a local ischemic condition due to direct trauma, fracture, overuse and/or muscle hypertrophy

Sx (chronic or exertion): produced by exercise or exertion = deep, cramping feeling
Sx (acute): produced by sudden trauma causing swelling within compartment

**Acute ACS = medical emergency and requires immediate surgical intervention with fasciotomy

86
Q

Anterior tibial periostitis

Shin splints

A

Musculotendinous overuse condition

3 common etiologies:
abnormal biomechanical alignment
poor conditioning
improper training methods

Muscles involved: anterior tibialis and extensor hallucis longus

Pain elicited with palpation of lateral tibia and anterior compartment

Meds: acetaminophen and NSAIDs

PT GOALS:
correct muscle imbalances
flexibility

87
Q

Medial tibial stress syndrome

A

Overuse injury of posterior tibias and/or medial soles resulting in periosteal inflammation at the muscular attachment due to excess pronation

Pain elicited with palpation of distal posteromedial border of tibia

Meds: acetaminophen and NSAIDs

PT GOALS:
correct muscle imbalances
flexibility

88
Q

Stress fracture

A

Overuse injury resulting in microfracture of the tibia (49%) or fibula (10%)

3 common etiologies:
abnormal biomechanical alignment
poor conditioning
improper training

Diagnostic test: plain film and bone scan

Meds: acetaminophen and NSAIDs

PT GOALS:
correct muscle imbalances
flexibility

89
Q

Ankle ligament sprains (lateral)

A

95% of sprains: foot is plantarflexed and inverted

Grade I: no loss of function, minimal tearing of ATFL
Grade II: some loss of function, partial disruption of ATFL and calcaneofibular ligg
Grade III: complete loss of function, complete tearing of ATFL and calcaneofibular ligg with partial tear of posterior talofibular lig

Diagnostic test: MRI

Special test: anterior drawer and talar tilt

Meds: acetaminophen and NSAIDs

PT GOALS:
reduce pain/inflammation with modalities
correct muscle imbalances
joint mobs

90
Q

Achilles’ tendonosis/tendonopathy

A

Degenerative condition of Achille’s tendon

Special test: Thompson’s test

Meds: acetaminophen, NSAIDs and corticosteroids

91
Q

Fractures of foot and ankle

A

Unimalleolar: medial or lateral malleolus
Bimalleolar: medial and lateral malleoli
Trimalleolar: medial and lateral malleoli and posterior tubercle of distal tibia

Diagnostic test: plain film

  • *Growth plate fractures are a concern since bone growth can be affected
  • Types III and IV fractures and Salter Harris classification are of most concern with high complication rate

Meds: acetaminophen and NSAIDs

PT GOALS:
return of function without pain
correct muscle imbalances
early PROM to prevent capsular adhesions

92
Q

Tarsal tunnel syndrome

A

Entrapment of posterior tibial nerve or one of its branches within the tarsal tunnel due to over/excess pronation, overuse problems (tendonitis of long flexor and post tib) and trauma

S/S: pain, numbness, paresthesias along medial ankle to plantar surface of foot

Diagnostic test: EMG

Special tests: Tinel’s sign at tarsal tunnel

Meds: acetaminophen, NSAIDs and Neurontin

PT GOALS:
foot orthoses
neurodynamic mobilization

93
Q

Flexor hallucis tendonopathy

A

Acute stage: tendonitis
Can be chronic tendonosis
Common in ballet dancers

Meds: acetaminophen, NSAIDs and corticosteroids

94
Q

Pes cavus

Hollow foot

A

Genetic predisposition, neurological disorders resulting in muscle imbalances and contracture of soft tissues leading to decreased ability to absorb forces through foot

Deformity:
Increased height of longitudinal arches Dropping of anterior arch
Metatarsal heads lower than hind foot
PF and splaying of forefoot
Claw toes

PT GOALS:
patient education: limit high impact sports, proper footwear, orthosis fitting

95
Q

Pes planus

Flat foot

A

Genetic predisposition, muscle weakness, ligamentous laxity, paralysis, excessive pronation, trauma or disease (RA) leading to decreased rigid level for push-off
*Normal in infant/toddler feet

Deformity: reduction in height of medial longitudinal arch

PT GOALS:
pt education: proper footwear and orthotic fitting

96
Q

Talipes equinovarus

Clubfoot

A

Postural: intrauterine malpositioning
Talipes equinovarus: abnormal development of head and neck of talus due to heredity or neuromuscular disorders (spina bifida)

Postural deformity: foot is in….
plantarflexion
inversion
adduction

Talipes equinovarus deformity: 3 components

(1) plantarflexion at talocrural joint
(2) inversion at subtler, talocalcaneal, talonavicular and calacaneocuboit joints
(3) supination at midtarsal joints

PT GOALS:
manipulation followed by casting/splinting
talipes equinovarus requires surgery to correct deformity followed by casting/splinting

97
Q

Equinus

A

Congenital bone deformity, neurological disorders (CP), contracture of gastrocnemius and/or soleus, trauma or inflammatory disease

DEFORMITY: plantarflexed foot

Compensation secondary to limited dorsiflexion includes subtalar or midtarsal pronation

PT GOALS:
flexibility exercises
joint mobs

98
Q

Hallux valgus

A

Biomehcanical malalignment (excess pronation), ligamentous laxity, heredity, weak muscles, tight footwear

DEFORMITY: metatarsal and base of proximal 1st phalanx move medially; distal phalanx moves laterally

NORMAL metatarsophalangeal angle: 8-20 deg

PT GOALS:
early orthotic fitting and patient education
later: surgery

99
Q

Metatarsalgia

A

Mechanical=tight triceps surae group and/or Achille’s tendon, collapse of transverse arch, short first ray, pronation of forefoot
Structural=changes in transverse arch leading to vascular and/or neural compromise of forefoot tissues

Pain at 1st/2nd metatarsal heads after long periods of weight bearing

Meds: acetaminophen, NSAIDs, and neurontin

PT GOALS:
correction of biomechanical abnormalities
modalities to decrease pain
orthotics
pt education on footwear
100
Q

Metatarsus adductus

A

Congenital, muscle imbalance or neuromuscular disease (polio)

DEFORMITY OBSERVED:
Rigid=medial subluxation of tarsometatarsal joints; hind foot valgus with navicular lateral to head of talus
Flexible=adduction of all 5 metatarsals at the tarsometatarsal joints

PT GOALS:
strengthening
regaining proper alignment (orthotics)

101
Q

Charcot-Marie-Tooth Disease

A

Peroneal muscular atrophy that affects motor and sensory nerves
Initially lower leg and foot, progresses to hands and forearm

Diagnostic test: electrodiagnostic

Meds: acetaminophen, NSAIDs, neurontin

PT GOALS:
prevent contractures/skin breakdown
pt education regarding braces/assistive devices

102
Q

Plantar fascitis

A

Chronic irritation of plantar fascia from excess pronation, Limited ROM of 1st MTP and talocrural joint, Tight triceps surae, Acute injury from excessive loading of foot, Rigid cavus foot

Differentiate from tarsal tunnel syndrome by a negative Tinel’s sign

Meds: acetaminophen, NSAIDs, corticosteroid

PT GOALS:
proper mechanical alignment
modalities to reduce pain/inflammation
flexibility of plantar fascia for pes caves foot
flexibility exercises for triceps surae
joint mobilization
night splints
strengthen invertors
pt education regarding footwear/orthotics
103
Q

Rearfoot varus

A

Abnormal mechanical alignment of tibia, shortened rearfoot soft tissues or malunion of calcaneus

DEFORMITY: rigid inversion of calcaneus while subtalar joint is in neutral

PT GOALS:
proper mechanical alignment
improve flexibility
orthotic fitting and pt education (footwear/orthotics)

104
Q

Rearfoot valgus

A

Abnormal mechanical alignment of knee (genu valgum) or tibial valgus

DEFORMITY: eversion of calcaneus with neutral subtalar joint
*Increase mobility of hind foot, fewer MSK problems develop than with rearfoot virus

PT GOALS:
regain proper alignment
improve flexibility
orthotic fitting
pt education (footwear/orthotics)
105
Q

Forefoot varus

A

Congenital abnormal deviation of head and neck of talus

DEFORMITY: inversion of forefoot when subtalar joint is neutral

PT GOALS:
regain proper alignment
improve flexibility
orthotic fitting
pt education (footwear/orthotics)
106
Q

Forefoot valgus

A

Congenital abnormal development of head and neck of talus

DEFORMITY: eversion of forefoot when subtalar joint is neutral

PT GOALS:
regain proper alignment
improve flexibility
orthotic fitting
pt education (footwear/orthotics)
107
Q

Spondylolysis

Spondylolisthesis

A

Congenitally defective pars interarticularis
SPONDYLOLYSIS: fracture of pars interarticularis with positive “Scotty dog” sign on oblique x-ray of spine
SPONDYLOLISTHESIS: ant or post slippage of one vertebra on another following B fracture of pars interarticularis

Diagnostic test: plain film (oblique and lateral views)

Special tests: Stork tests

Meds: acetaminophen, NSAIDs, corticosteroids, muscle relaxants, trigger point injections

PT GOALS:
joint mobilization
dynamic stabilization (abdominals)
AVOID extension and other postures that add stress
pt education
braces
108
Q

Spinal or intervertebral stenosis

A

Congenital narrow spinal canal or IV foramen, coupled with hypertrophy of spinal lamina and ligamentum flavum or facets due to age-related degenerative process leading to vascular and/or neural compromise

S/S:
B pain/paresthesia in back, buttocks, thighs, calves and feet
Pain dear in flexion, Incr in ext
Pain incr with walking
Pain relieved with prolonged rest

Diagnostic test: plain film, MRI, CT scan, myelography

Meds: acetaminophen, NSAIDs, corticosteroids, muscle relaxants, trigger point injections

PT GOALS:
joint mobs
flexion based exercise
AVOID extension
Manual therapy: traction
109
Q

Internal disc disruption

A

Internal structure of disc annulus is disrupted; external structures remain normal (most common in LS)

S/S:
constant deep achy pain increased with movement
referred pain to LE

Diagnostic test: CT discogram or MRI

Meds: acetaminophen, NSAIDs, muscle relaxants, trigger point injections and corticosteroids

PT GOALS:
joint mobs
pt education: body mechanics, positions to avoid, limit repetitive bend/twist, etc.
spinal manipulation may be CONTRAINDICATED

110
Q

Posterolateral bulge/herniation

A

Most common disc disorder of LS because:

(1) post disc narrower in height than ant
(2) post long leg not a s strong in LS
(3) post lamellae of annulus is thinner

Overstitching and/or tearing of annular rings, vertebral endplate and/or ligg from high compressive forces or repetitive microtrauma leads to loss of strength, radicular pain, paresthesia and inability to perform ADLs

Diagnostic test: MRI

Meds: acetaminophen, NSAIDs, muscle relaxants, trigger point injections and corticosteroids

PT GOALS:
promote dynamic stability
positional gapping x 10 min
pt education: body mechanics, positions to avoid, limit repetitive bend/twist, etc.
manual and/or mechanical traction
**spinal manipulation may be CONTRAINDICATED

111
Q

Central posterior bulge/herniation

A

More common in CS than LS
Overstitching and/or tearing of annular rings, vertebral endplate and/or ligamentous structures (PLL) from high compressive forces and/or long-term postural malalignment leads to loss of strength, radicular pain, paresthesias, inability to perform ADL, compression of spinal cord

Diagnostic test: MRI

Meds: acetaminophen, NSAIDs, muscle relaxants, trigger point injections and corticosteroids

PT GOALS:
promote dynamic stability
positional gapping x 10 min
pt education: body mechanics, positions to avoid, limit repetitive bend/twist, etc.
manual and/or mechanical traction
**spinal manipulation may be CONTRAINDICATED

112
Q

Degenerative joint disease (DJD)

A

Normal aging process due to WB properties of facets and IV joints leads to bone hypertrophy, capsular fibrosis, hypermobility or hypomobility of joint and proliferation of synovium

S/S:
reduction in mobility of spine
pain, loss of strength and paresthesias
possible impingement of assoc. nerve root

Diagnostic test: plain film

Special test: LS quadrant test

Meds: acetaminophen, NSAIDs, muscle relaxants, trigger point injections, corticosteroids

PT GOALS:
promote dynamic stability
joint mobs
spinal manipulation

113
Q

Facet entrapment

acute locked back

A

Abnormal movement of fibroadipose meniscoid in facet during extension (from flexion)
Meniscoidal does not properly re-enter joint cavity and bunches up becoming a space-occupying lesion which distends capsule and causes pain
Flexion is most comfortable and extension increases pain

Special tests: LS quadrant test

Meds: acetaminophen, NSAIDs, muscle relaxants, trigger point injections, corticosteroids

PT GOALS:
positional facet joint gapping and/or manipulation

114
Q

Acceleration/deceleration injuries of cervical spine

“Whiplash”

A

Excess shear and tensile forces are exerted on cervical structures (facets/articular processes, facet jt capsules, ligg, disc, ant/post mm, fx to odontoid/spinous processes, TMJ, sympathetic chain ganglia and spinal/cranial nn)

S/S:
EARLY=H/A, neck pn, decr flexibility, reversal of LCS lordosis and decr in UCS kyphosis, vertigo, change in vision/hearing, irritability to noise/light, dysesthesias of face/BUE, nausea, diff swallow, emotional lability
LATE=chronic head/neck pain, limited flexibility, TMJ dysfunction, limited ADL too, disequilibrium, anxiety, depression

Clinical findings: postural changes, excess mm guarding with soft tissue fibrosis, segmental hyper mobility, gradual development of restricted segmental motion cranial to caudal

Diagnostic test: plain film, CT and/or MRI

Meds: acetaminophen, NSAIDs, muscle relaxants, trigger point injections, corticosteroids

PT GAOLS:
spinal manipulation
correct muscle imbalance
joint mobs
manual and/or mechanical traction (CS at 15 deg flexion)
115
Q

Hypermobile spinal segments

A

Abnormal increase in ROM at a joint due to insufficient soft tissue control

Diagnostic test: plain film (flex/ext views)

Meds: acetaminophen, NSAIDs, muscle relaxants, trigger point injections, sclerosing agents, corticosteroids

PT GOALS:
pain reduction modalities
passive ROM 
passive stabilization (corsets, splints, casts, tape and collars)
correct muscle imbalance
pt education
116
Q

Sacroiliac joint (SIJ) conditions

A

Need to closely examine BOTH LS and SIJ

Diagnostic test: plain film and possible MRI, occasionally double blind injections

Special tests: Gillet’s test, IPSI anterior rotation test, Gaenslen’s test, Long-sitting (supine to sit) test, Goldthwait’s test

Meds: acetaminophen, NSAIDs, muscle relaxants, trigger point injections and corticosteroids

PT GOALS:
spinal manipulation (SIJ gapping)
correct muscle imbalances
joint mobs
pt education
SIJ belts
117
Q

Repetitive/cumulative trauma to back

A

Disorders of nerves, soft tissues and bones precipitated/aggravated b repeated exertions or movements of back

Vocational factors: physically heavy static work postures, lifting, frequent bending/twisting, repetitive work and vibration

PT GOALS:
focus on prevention
pt education

118
Q

Bone tumors

A

Primary: multiple myeloma, Ewing’s sarcoma, malignant lymphoma, cohondrosarcoma, osteosarcoma and chondromas
Metastatic: primary sites in lung, prostate, breast, kidney and thyroid

S/S: pain unvarying and progressive, not relieved with rest or analgesics more pronounced at night

Diagnostic test: plain film, CT and/or MRI, lab tests

119
Q

Visceral tumors leading to LBP

A

Esophageal cancer: radiating pain to back, pain with swallowing, dysphagia, weight loss

Pancreatic cancer: deep, gnawing pain that may radiate from chest to back

Diagnostic test: plain film, CT and/or MRI and lab tests

120
Q

Gastrointestinal conditions leading to LBP

A

Acute pancreatitis: mid-epigastric pain radiating through to back

Cholecystitis: abrupt, severe abdominal pain and RUQ tenderness, N/V, fever

Diagnostic test: plain film, CT and/or MRI and lab tests

121
Q

Cardiovascular and pulmonary conditions leading to LBP

A

Heart and lung: chest, back, neck, jaw and UE

Abdominal aortic aneurysm (AAA): nonspecific lumbar pain

Diagnostic test: plain film, CT and/or MRI and lab tests

122
Q

Urological and gynecological conditions leading to LBP

A

Kidney, bladder, ovary and uterus reer to trunk, pelvis and thighs

Diagnostic test: plain film, CT and/or MRI and lab tests

123
Q

Temperomandibular joint conditions

A 
S/S: 
joint noise (click, pop, crepitation)
joint locking, limited flexibility
lateral deviation of mandible during depr/elev
decreased strength/endurance of mm
tinnitus, H/A, forward head posture
pain with mandible movement
**CS must be thoroughly examined**

3 diagnostic categories

(1) DJD (OA or RA in TMJ)
(2) myofascial pain: most common, discomfort or pain in mm controlling jaw/neck/shoulder
(3) internal derangement of joint: dislocated jaw, displaced articular disc or injury to condyle
- -Causes: trauma, congenital, abnormal fun

Diagnostic test: plain film and/or MRI

Meds: acetaminophen, NSAIDs, muscle relaxants, trigger point injections, corticosteroids

PT GOALS: 
postural re-ed
modalities
biofeedback
joint mobs
pt education
night splints

NPTE (16 decks)

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