Musculoskeletal Pathologies Flashcards
Arthrogryposis Characterized By:
- Rigid joints of the extremities
- Shapeless limbs
- Weak or non functioning muscles
Arthrogryposis Common Impairments:
- Hip dislocations
- Hip contractures
- Shoulder contracture
- Club Feet
Arthrogryposis Onset
- Congenital
- Non Genetic
- Non Progressive
Arthrogryposis Differential Diagnosis
- Recognition of inheritance patterns is important as disease is not typically inherited.
- Be sure to rule out or in other disorders that can present like Arthropryposis.
Arthrogryposis Treatment
- Surgery
- ROM
- Splinting
- Positioning
- ADL’s
- Adaptive Devices
Complex Regional Pain Syndrome Characterized By
- Abnormal sympathetic reflex resulting from persistent painful lesion.
Complex Regional Pain Syndrome Clinical Signs
- Pain
- Edema
- Decreased circulation
- Osteoporosis
- Skin dryness
- Decreased proprioception
- Atrophy of proximal muscles to involved area
Complex Regional Pain Syndrome Differential Diagnosis
- Trophic changes in the skin, bones and joints
Complex Regional Pain Syndrome Treatment
- Modalities
- Joint Mobs
- WB or closed chain exercises
- Massage
- MLD
- Splinting
Colle’s Fracture Characterized By
Most common wrist fracture resulting from a fan on an outstretched hand
Colle’s Fracture Pathology
The distal segment of the radius has a dorsal displacement with a radial shift of the wrist and hand
Colle’s Fracture Differential Diagnosis
- Radiographs
- Observation of wrist’s radial shift
Colle’s Fracture Treatment
- Casting
- Early AROM
- Passive ROM
- Progressive Resistance
- Mobs
- Closed kinetic chain exercises
- Stabilization of the wrist
Osteoarthritis Characterized By:
- Morning stiffness
- Gradual onset
- More common in elderly women
Osteoarthritis pathology
Degeneration of the articular cartilage of weight bearing joints.
Osteoarthritis Onset
- Non rheumatoid
- Non systemic
Osteoarthritis Progression
- Joint motion becomes diminished
- Flexion contractures
- Tenderness
- Crepitus
- Grating Sensation
Osteoarthritis Differential Diagnosis
- Normal Erythrocyte Sedimentation Rate
- Abnormal joint radiographs
- Problems in weight bearing joints
Osteoarthritis Treatment
- NSAIDS
- Functional training
- ROM exercises
- Resistance exercises
- Postural Exercises
- ADL training
- Continue PA as tolerated
- Surgery or joint replacement if necessary
Fibromyalgia Characterized By
- Aching or burning in the muscles
- Diffuse pain
- Tender points on both sides of the body
Fibromyalgia Presentation
- Often related to stress, anxiety, fatigue, and sleeplessness in women
Fibromyalgia Classification
- Immune system disorder of unknown origin
Fibromyalgia Differential Diagnosis:
- Widespread pain in at least 11 of 18 tender points in the body
- Recognition of typical pattern of non-rheumatic symptoms and sleep deprivation
- Exclusion of other systemic diseases
Fibromyalgia Treatment
- ADL education and training.
- Stress management
- Medications
- Local Modalities
- Aerobic conditioning
- Improve sleep patterns
Gout Characterized By
- Severe Joint Pain
- Commonly at night
- Warmth
- Erythema
- Tenderness
- Hypersensitivity
Gout Common Impairments
Most often affects the feet, especially;y the great toe, ankle, and mid foot
Gout Pathology
- Metabolic disease
- Elevated level of serum uric acid
- Disposition of crate crystals in the joints, soft tissue, and kidneys
Gout Differential Diagnosis
- Tentatively history and physical examination
- Diagnostic support includes elevated serum rate content and x-ray
Gout Treatment
- Anti-Inflammatory medication
- Daily colchicine
- Lowering urate in body fluids through diet, weight loss, and moderate alcohol intake
- Allopurinol to reduce hyperuricemia
- Rest, joint elevation, and protection during the acute phase
Hemophilia Pathology
- Deficiency in specific clotting factors
Hemophilia Presentation
- Hereditary hemorrhagic disorder
Hemophilia Physical Therapy Concerns
- Hemiarthrosis
- Muscle bleeds that can cause
- Pain, swelling, tenderness, and potential permanent deformity
- Bleeding near peripheral nerves can cause peripheral neuropathy, peristhesia, and muscle atrophy.
- If bleeding impairs major vessls, ischemia and gangrene can occur
Hemophilia Differential Diagnosis
- Prolonged bleeding tests
- Other blood tests
Hemophilia Treatment
- Splinting
- Ice, Rest and elevation in acute stage
- In chronic situations PTs should use functional adaption for the patients deficits.
Iliotibial Band Syndrome Characterized By
- Irritation of the IT band over the lateral epicondyle of the femur.
Iliotibial Band Syndrome Presentation
- Often occurs in runners from an overuse injury
Iliotibial Band Syndrome Differential Diagnosis
- Positive Ober’s test
- Excessive hip internal rotation in stance
- Palpation over IT band insertion
- Positive noble compression test
Iliotibial Band Syndrome Treatment
- Stretching exercise program
- Modalitites
- Soft tissue mobilizations
- Shoe orthosis if necessary
Myositis Ossificans Characterized By
- Trauma to a muscle that causes a hematoma that may calcify or ossify in the muscle.
Myositis Ossificans Presentation
- Frequently in the quadriceps, brachial, and biceps brachii.
Myositis Ossificans Physical Therapy Concerns
- Can be induced by early mobilizations and stretching with aggressive PT following trauma to the muscle
Myositis Ossificans Differential Diagnosis
- Radiology of the affected muscle will show calcium deposits
Myositis Ossificans Treatment
- Conservative AROM
- Passive stretching NOT indicated
- NO manual pressure
- NO over pressure at end range
Osteochondritis Dissecans Characterized By
- Separation of the articular cartilage from the underlying bone
Osteochondritis Dissecans Location
- Most often involving the medial femoral condyle near the intercondyler notch
- Less frequently in the femoral head and taller dome
Osteochondritis Dissecans Differential Diagnosis
- X-Ray
Osteochondritis Dissecans Treatment
- If fracture is displaced then surgery is required
Osteochondritis Dissecans Physical Therapy Following Surgery
- Gait training
- Functional strengthening
- Conditioning
Osteomalacia Characterized By
- Bone de-calcification
Osteomalacia Pathology
- Vitamin D deficiency
Osteomalacia Treatment
- Pain control
- Functional mobility training
Osteomyelitis Characterized By
- Acute or chronic bone infection
Osteomyelitis Pathology
Combination of traumatic injury and acute infection
Osteomyelitis Pediatrics
- Most commonly distal femur and proximal tibia, humerus, and radius
Osteomyelitis Adults
- Most commonly localized In the pelvis, and vertebrae
- Often a result of contamination following surgery
Osteomyelitis Treatment
- His doses of IV antibiotics
- Immobilization of the infected extremity
- Traction or bed rest
- Sometimes surgery to drain the infection
- Chronic infection may require amputation
Osteoperosis Characterized by
- Bone mineral density depletion
- Most common metabolic disease
- Most common in postmenopausal white females who have a lack of estrogen production
Osteoperosis Location
- Thoracic
- Lumbar
- Femoral Neck
- Proximal Humerus
- Proximal Tibia
- Pelvis
- Radius
Osteoperosis Treatment
- Pain management
- Postural reeducation
- Breathing exercises
- General conditioning
- Pectoral stretching
- Abdominal strengthening without repeated flexion to avoid spinal fracture
- Weight bearing exercises
Paget’s Disease Characterized By
- An initial phase pf excessive bone reabsorption followed by a reactive phase of excessive and abnormal bone formation
Paget’s Disease Presentation
- A slow progressive metabolic bone disease
- Unknown etiology
Paget’s Disease Location
- Spine
- Pelvis
- Femur
- Skull
Paget’s Disease Complications
- Can be fatal when associated with congestive heart failure
- Involved sights can fracture easily, heal slowly or incompletely
- Vertebral Collapse or vascular changes can cause paraplegia
Paget’s Disease Treatment
- None if asymptomatic
- Drug therapy if symptoms are present
Patellofemoral Dysfunction Characterized By
- Anterior and Retro- patellar pain
Patellofemoral Dysfunction Pathology
- Quad weakness
- Overloading the joint
- Malalignment
- Hip dysfunction
- Ankle dysfunction
Patellofemoral Dysfunction Aggravated By
- Stairs
- Prolonged sitting
- Squatting
- Jumping
Patellofemoral Dysfunction Treatment
- Quad and hip/gluteal strengthening
- Taping
- Stretching of tight lower extremity muscle groups
- Foot orthosis
- Patellar mobilization, medial glide+stretching deep fibers of lateral retinaculum to decrease tilt
Patella Positions: Normal
- Patella is evenly against the anterior femur
Patella Positions Patella Baja
- Patella is inferior to its normal position
Patella Positions: Patella Alta
- Patella is superior to its normal position
- May see a camel sign (Two “humps” the patella itself and the infra patellar fat pad that is exposed due to the patella being too high
- Less efficient for knee extension forces
Progressive systemic sclerosis (scleroderma) Characterized By
- Chronic fibrotic changes to the internal skin and organs
Progressive systemic sclerosis (scleroderma) Associated Conditions
- Polyarthralgia is a common early symptom
- Heartburn and dyspnea are common early manifestations of the disease
- Frequently accompanied by Raynaud’s
Progressive systemic sclerosis (scleroderma) Differential Diagnosis
- Positive Rheumatoid factor test
- Other blood tests
- Multiple effected systems: Skin, GI, cardiorespiratory system, kidneys
Progressive systemic sclerosis (scleroderma) Treatment
- ROM
- Strengthening
- Medications
Pronator Teres Syndrome Characterized By
- Median Nerve Entrapment in the Pronator Teres muscle
Pronator Teres Syndrome Differential Diagnosis
- Pronator Teres Syndrome Test: The clinician strongly resists pronation while the patient starts at 90 degrees of elbow flexion and moves to full extension
- Positive if there is tingling or parathesia in the forearm in the median nerve distribution
Pronator Teres Syndrome Treatment
- Nerve Glides
- Stretching
- AROM
- Ultrasound
- NMES for nerve healing
Rheumatoid Arthritis Characterized by
- Chronic systemic inflammation
- Immunological mechanism plays a role
- Occurs in women with peak onset in 30s and 40s
- Symmetrical pattern of dysfunction in synovial tissues and articular cartilage of the joints
Rheumatoid Arthritis PT Concerns
- Can involve cervical joints causing potential subluxation and spinal cord compression
Rheumatoid Arthritis Associated Conditions
- Extra articular systems may be involved
- Eye lesions
- Infection
- Osteoperosis
Juvenile Rheumatoid Arthritis Characterized By
- Same symptoms as Rheumatoid Arthritis
- Onset prior to 16 with complete remission in 75% of children
- Affects any number of joints but is characterized chiefly by fever and rash
Rheumatoid Arthritis Differential Diagnosis
- Rule out other arthritic diseases
- Positive rheumatoid factor
- Insidious symptom onset
- Slow progression
- Complaints of fatigue, weight loss, weakness, and general diffuse MSK pain
- Pain localized to specific joints
- Symmetrical bilateral presentation
- After periods of rest joints can be painful for 30 minutes or longer with activity
- Deformities of fingers is common
Rheumatoid Arthritis Treatment
- Reduce Pain
- Maintain mobility
- Minimize joint stiffness, edema, and dystruction
- Prevent deformities with orthoses
- Patient education and continual adherence to treatment
- Energy conservation
- Acute phases: Medication, rest, ambulatory devices, and ice
Scaphoid Fracture Characterized By
- A fall onto an outstretched hand in a younger person
Scaphoid Fracture PT Concerns
- Poor vascular supply to the the bone results in a high risk of avascular necrosis to the scaphoid
Scaphoid Fracture Differential Diagnosis
- Radiological studies
Scaphoid Fracture Treatment
- Early maintenance of AROM to the distal and proximal joints while the upper extremity is casted
- Later treatment emphasis on regaining full functional use of the wrist and hand
Scoliosis Characterized By
- Abnormal curvature of the spine in the frontal plane
Scoliosis: PT Concerns
- Can be caused by several factors like leg length discrepancy or lumbar herniated disc
Scoliosis: Types
- Structural: Is an irreversible curvature with a rotational component demonstrated upon forward flexion
- Non-structural: Reversible lateral curve without rotation that straitens as an individual flexes the spine
Scoliosis Differential Diagnosis
- Radiological studies
- Postural analysis
- Forward Flexion
Scoliosis: Treatment
- Bracing and or surgery for placement of rods along the spine
- Non structural can be managed by stretching, shoe lifts, and postural education
- Respiratory care ay be needed if Cobb’s angle is 40 degrees or more
Sjogrens Syndrome Characterized By
- Rheumatoid like disorder characterized by dryness of the mucus membranes, joint inflammation, and anemia
Sjogrens Syndrome Differneital Diagnosis
- Dryness of the eyes and mouth with joint inflammation
- Arthritis occurs in about 33% of patients and is similar in distribution to RA but milder and without joint destruction
Sjogrens Syndrome Treatment
- Hydration
- Chewing sugarless gum
- using mouthwash for mouth dryness
- Medications
- Maintaining mobility and function through regular exercise program
Smith’s Fracture Characterized By
- Distal fracture of the radius which dislocates ventrally (opposite direction of Colle’s Fracture)
- Results from a fall onto a flexed wrist
Smith’s Fracture Treatment
- Casting
- Early AROM
- Passive ROM
- Progressive Resistance
- Mobs
- Closed kinetic chain exercises
- Stabilization of the wrist
Sprain Characterized By
- An injury to ligament or joint capsule
Sprain Degrees: First Degree
- Some fibers torn
- A small amount pf hemorrhaging is present
- Joint stability remains intact
Sprain Degrees: Second Degree
- A portion of the ligament or capsule is torn
- Moderate hemorrhaging
- Some functional loss
- Joint stability remains intact
Sprain Degrees: Third Degree
- Complete avulsion of the ligament or joint
- Loss of function
- Joint instability
- Pronounced hemorrhaging and swelling in the area
- Weight bearing is undesirable.
Sprain Differential Diagnosis
- Palpation of ligaments
- Joint stability special tests
- Amount of swelling and ecchymosis
- Functional strength tests
Sprain Treatment
- Acutely RICE
- Chronically the degree of ligament sprain dictates the treatment program.
Sprain Treatment: First Degree Treatment
- Prevent hypomobility, and atrophy with pain free AROM
- Modalities to decrease pain, edema, and promote healing
- Gradual returns normal function
Sprain Treatment: Second Degree Treatment
- Guard against re-injury.
- Limited WB
- Bracing as needed
- AROM in the range pain free range
- Mobs
- Modalities
- After 2-3 weeks the joint has typically healed and resistance exercises can usually be reintegratd
Sprain Treatment: Third Degree Treatment
- Possible surgery to avoid permanent joint instability
- Bracing or splinting for immobilization
- Proprioception exercises and controlled motion exercises
- Functional activities
- Strength and mobility following healing which can take 5-6 months following surgical repair of a ligament
- Postoperatively, a constant passive motion machine may be used following surgery.
Systemic Lupus Erythematosus Characterized By
- A chronic systemic rheumatic, inflammatory disorder of the connective tissues
- Affects multiple organs and systems
Systemic Lupus Erythematosus Differential Diagnosis
- Symptoms include malaise, fatigue, arthralgia, arthritis, fever, skin rashes, photosensitivity, anemia, hair loss, Raynaud’s phenomenon, and kidney involvement
- Vasculitis
- Lesions in the digits
- Necrotic leg ulcers
- Digital gangrene
Systemic Lupus Erythematosus Treatment
- Topical corticosteroid creams for the sin lesions
- Patient education for energy conservation, good nutrition and skin care
- ROM exercises
- Ergonomic and postural training.
Tempomandibular Joint Syndromes: Diagnostic Categoris
- Joint abnormalities that result from trauma, arthritis, disease, neoplasm.
- Congenital structural defects
- Loss of functional mobility of unknown etiology, may result from increased activity in the muscles of mastication as a result of stress and anxiety
Tempomandibular Joint Syndromes: Differential Diagnosis
- Joint Noise
- Joint locking
- AROM of the jaw
- Lateral deviation of the mandible
- Decreased strength
- Tinnitus
- Headaches
- Forward head posture
- Pain with movement
Tempomandibular Joint Syndromes: Synovitis and Capsulitis
- Pain located in preauricular area
- Unable to fully close back teeth together
- Opening less than 40mm secondary to pain
- Pain decreases with rest
Tempomandibular Joint Syndromes: Hypermobility
- Report that Jaw feels like it goes out of place.
- Joint noises
- Jaw catching in fully opened position
- Mandible deviates toward the uninvolved side.
- Palpable irregularities during closure
Tempomandibular Joint Syndromes: Disc Displacement with Reduction
- Joint noises, popping and clicking
- Palpation over lateral poles reveals an opening click (reduction of the disc) and a closing click (disc displacing anterior to the condyle).
Tempomandibular Joint Syndromes: Disc Displacement without Reduction
- Patient reports intermittent locking without joint noises
- Opening of mandible is limited to 20-25mm with deflection toward the involved side
- Limited lateral excursion toward the opposite side of the involved joint
Tempomandibular Joint Syndromes: Treatment
- Postural reeducation
- Modalities
- Inflammation
- Biofeedback
- Joint mobilization
- AROM and muscle strengthening exercises
- Patient education on eating soft foods and avoiding habits that cause TMJ pain.
- Instruct the patient to maintain the rest position of the tongue
Tibial Fractures: Types: March
- Common in persons who take long walks who are not used to this activity
Lower third of the Tibia.
Tibial Fractures: Types: Spiral
- Tibial torsion (skinning injuries common)
- Between the middle and lower third of the Tibia
Tibial Fractures: Types: Compound
- Occur due to a direct blow to the tibia
Tibial Fractures: Treatment
- Leg casting
- Possible open reduction internal fixation with hardware
- Due to blood supply being lower than other areas healing can take up to 6 months.
- After healing AROM and PROM
- Progressive resistance exercises
- Mobilizations
- Closed chain stabilization
Torticollis Characterized By
- Contracture of the sternocleidomastoid
- Results in lateral bending of the head to the affected side with rotation.
Torticollis Development
- Can develop while in utero
- Pressure on the spinal accessory nerve
- Inflammation of the glands of the neck
- Facet dysfunction
- Muscle spasm
Torticollis Treatment:
- Modalities
- Stretching
- Biofeedback
- Postural education and training
Total Hip Replacement: Precautions: All approaches
- Avoid Excessive Flexion
- Avoid Adduction past neutral
- Avoid low soft chairs
- Avoid crossing the involved leg over the uninvolved leg
- Avoid vigorous stretching
Total Hip Replacement: Precautions: Anterolateral approach
- Avoid external rotation
Total Hip Replacement: Precautions: Posterolateral approach
- Avoid internal Rotation
Total Hip Replacement: Precautions: PT concerns for Rehab
- WB precautions determined by the surgeon and type of prosthesis.
- Cemented prosthesies=Earlier exercise and weight bearing
- Non-cemented=Later exercises and weight bearing
- Education on sleeping with and abduction pillow
- Patients rehab should focus on regaining hip extensor and abductor strength
