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National Physical Therapy Examination: Musculoskeletal > Musculoskeletal Pathologies > Flashcards

Musculoskeletal Pathologies Flashcards

1
Q

Arthrogryposis Characterized By:

A
  • Rigid joints of the extremities
  • Shapeless limbs
  • Weak or non functioning muscles
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2
Q

Arthrogryposis Common Impairments:

A
  • Hip dislocations
  • Hip contractures
  • Shoulder contracture
  • Club Feet
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3
Q

Arthrogryposis Onset

A
  • Congenital
  • Non Genetic
  • Non Progressive
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4
Q

Arthrogryposis Differential Diagnosis

A
  • 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.
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5
Q

Arthrogryposis Treatment

A
  • Surgery
  • ROM
  • Splinting
  • Positioning
  • ADL’s
  • Adaptive Devices
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6
Q

Complex Regional Pain Syndrome Characterized By

A
  • Abnormal sympathetic reflex resulting from persistent painful lesion.
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7
Q

Complex Regional Pain Syndrome Clinical Signs

A
  • Pain
  • Edema
  • Decreased circulation
  • Osteoporosis
  • Skin dryness
  • Decreased proprioception
  • Atrophy of proximal muscles to involved area
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8
Q

Complex Regional Pain Syndrome Differential Diagnosis

A
  • Trophic changes in the skin, bones and joints
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9
Q

Complex Regional Pain Syndrome Treatment

A
  • Modalities
  • Joint Mobs
  • WB or closed chain exercises
  • Massage
  • MLD
  • Splinting
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10
Q

Colle’s Fracture Characterized By

A

Most common wrist fracture resulting from a fan on an outstretched hand

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11
Q

Colle’s Fracture Pathology

A

The distal segment of the radius has a dorsal displacement with a radial shift of the wrist and hand

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12
Q

Colle’s Fracture Differential Diagnosis

A
  • Radiographs

- Observation of wrist’s radial shift

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13
Q

Colle’s Fracture Treatment

A
  • Casting
  • Early AROM
  • Passive ROM
  • Progressive Resistance
  • Mobs
  • Closed kinetic chain exercises
  • Stabilization of the wrist
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14
Q

Osteoarthritis Characterized By:

A
  • Morning stiffness
  • Gradual onset
  • More common in elderly women
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15
Q

Osteoarthritis pathology

A

Degeneration of the articular cartilage of weight bearing joints.

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16
Q

Osteoarthritis Onset

A
  • Non rheumatoid

- Non systemic

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17
Q

Osteoarthritis Progression

A
  • Joint motion becomes diminished
  • Flexion contractures
  • Tenderness
  • Crepitus
  • Grating Sensation
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18
Q

Osteoarthritis Differential Diagnosis

A
  • Normal Erythrocyte Sedimentation Rate
  • Abnormal joint radiographs
  • Problems in weight bearing joints
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19
Q

Osteoarthritis Treatment

A
  • NSAIDS
  • Functional training
  • ROM exercises
  • Resistance exercises
  • Postural Exercises
  • ADL training
  • Continue PA as tolerated
  • Surgery or joint replacement if necessary
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20
Q

Fibromyalgia Characterized By

A
  • Aching or burning in the muscles
  • Diffuse pain
  • Tender points on both sides of the body
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21
Q

Fibromyalgia Presentation

A
  • Often related to stress, anxiety, fatigue, and sleeplessness in women
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22
Q

Fibromyalgia Classification

A
  • Immune system disorder of unknown origin
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23
Q

Fibromyalgia Differential Diagnosis:

A
  • 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
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24
Q

Fibromyalgia Treatment

A
  • ADL education and training.
  • Stress management
  • Medications
  • Local Modalities
  • Aerobic conditioning
  • Improve sleep patterns
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25
Q

Gout Characterized By

A
  • Severe Joint Pain
  • Commonly at night
  • Warmth
  • Erythema
  • Tenderness
  • Hypersensitivity
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26
Q

Gout Common Impairments

A

Most often affects the feet, especially;y the great toe, ankle, and mid foot

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27
Q

Gout Pathology

A
  • Metabolic disease
  • Elevated level of serum uric acid
  • Disposition of crate crystals in the joints, soft tissue, and kidneys
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28
Q

Gout Differential Diagnosis

A
  • Tentatively history and physical examination

- Diagnostic support includes elevated serum rate content and x-ray

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29
Q

Gout Treatment

A
  • 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
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30
Q

Hemophilia Pathology

A
  • Deficiency in specific clotting factors
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31
Q

Hemophilia Presentation

A
  • Hereditary hemorrhagic disorder
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32
Q

Hemophilia Physical Therapy Concerns

A
  • 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
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33
Q

Hemophilia Differential Diagnosis

A
  • Prolonged bleeding tests

- Other blood tests

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34
Q

Hemophilia Treatment

A
  • Splinting
  • Ice, Rest and elevation in acute stage
  • In chronic situations PTs should use functional adaption for the patients deficits.
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35
Q

Iliotibial Band Syndrome Characterized By

A
  • Irritation of the IT band over the lateral epicondyle of the femur.
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36
Q

Iliotibial Band Syndrome Presentation

A
  • Often occurs in runners from an overuse injury
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37
Q

Iliotibial Band Syndrome Differential Diagnosis

A
  • Positive Ober’s test
  • Excessive hip internal rotation in stance
  • Palpation over IT band insertion
  • Positive noble compression test
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38
Q

Iliotibial Band Syndrome Treatment

A
  • Stretching exercise program
  • Modalitites
  • Soft tissue mobilizations
  • Shoe orthosis if necessary
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39
Q

Myositis Ossificans Characterized By

A
  • Trauma to a muscle that causes a hematoma that may calcify or ossify in the muscle.
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40
Q

Myositis Ossificans Presentation

A
  • Frequently in the quadriceps, brachial, and biceps brachii.
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41
Q

Myositis Ossificans Physical Therapy Concerns

A
  • Can be induced by early mobilizations and stretching with aggressive PT following trauma to the muscle
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42
Q

Myositis Ossificans Differential Diagnosis

A
  • Radiology of the affected muscle will show calcium deposits
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43
Q

Myositis Ossificans Treatment

A
  • Conservative AROM
  • Passive stretching NOT indicated
  • NO manual pressure
  • NO over pressure at end range
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44
Q

Osteochondritis Dissecans Characterized By

A
  • Separation of the articular cartilage from the underlying bone
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45
Q

Osteochondritis Dissecans Location

A
  • Most often involving the medial femoral condyle near the intercondyler notch
  • Less frequently in the femoral head and taller dome
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46
Q

Osteochondritis Dissecans Differential Diagnosis

A
  • X-Ray
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47
Q

Osteochondritis Dissecans Treatment

A
  • If fracture is displaced then surgery is required
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48
Q

Osteochondritis Dissecans Physical Therapy Following Surgery

A
  • Gait training
  • Functional strengthening
  • Conditioning
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49
Q

Osteomalacia Characterized By

A
  • Bone de-calcification
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50
Q

Osteomalacia Pathology

A
  • Vitamin D deficiency
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51
Q

Osteomalacia Treatment

A
  • Pain control

- Functional mobility training

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52
Q

Osteomyelitis Characterized By

A
  • Acute or chronic bone infection
53
Q

Osteomyelitis Pathology

A

Combination of traumatic injury and acute infection

54
Q

Osteomyelitis Pediatrics

A
  • Most commonly distal femur and proximal tibia, humerus, and radius
55
Q

Osteomyelitis Adults

A
  • Most commonly localized In the pelvis, and vertebrae

- Often a result of contamination following surgery

56
Q

Osteomyelitis Treatment

A
  • 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
57
Q

Osteoperosis Characterized by

A
  • Bone mineral density depletion
  • Most common metabolic disease
  • Most common in postmenopausal white females who have a lack of estrogen production
58
Q

Osteoperosis Location

A
  • Thoracic
  • Lumbar
  • Femoral Neck
  • Proximal Humerus
  • Proximal Tibia
  • Pelvis
  • Radius
59
Q

Osteoperosis Treatment

A
  • Pain management
  • Postural reeducation
  • Breathing exercises
  • General conditioning
  • Pectoral stretching
  • Abdominal strengthening without repeated flexion to avoid spinal fracture
  • Weight bearing exercises
60
Q

Paget’s Disease Characterized By

A
  • An initial phase pf excessive bone reabsorption followed by a reactive phase of excessive and abnormal bone formation
61
Q

Paget’s Disease Presentation

A
  • A slow progressive metabolic bone disease

- Unknown etiology

62
Q

Paget’s Disease Location

A
  • Spine
  • Pelvis
  • Femur
  • Skull
63
Q

Paget’s Disease Complications

A
  • 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
64
Q

Paget’s Disease Treatment

A
  • None if asymptomatic

- Drug therapy if symptoms are present

65
Q

Patellofemoral Dysfunction Characterized By

A
  • Anterior and Retro- patellar pain
66
Q

Patellofemoral Dysfunction Pathology

A
  • Quad weakness
  • Overloading the joint
  • Malalignment
  • Hip dysfunction
  • Ankle dysfunction
67
Q

Patellofemoral Dysfunction Aggravated By

A
  • Stairs
  • Prolonged sitting
  • Squatting
  • Jumping
68
Q

Patellofemoral Dysfunction Treatment

A
  • 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
69
Q

Patella Positions: Normal

A
  • Patella is evenly against the anterior femur
70
Q

Patella Positions Patella Baja

A
  • Patella is inferior to its normal position
71
Q

Patella Positions: Patella Alta

A
  • 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
72
Q

Progressive systemic sclerosis (scleroderma) Characterized By

A
  • Chronic fibrotic changes to the internal skin and organs
73
Q

Progressive systemic sclerosis (scleroderma) Associated Conditions

A
  • Polyarthralgia is a common early symptom
  • Heartburn and dyspnea are common early manifestations of the disease
  • Frequently accompanied by Raynaud’s
74
Q

Progressive systemic sclerosis (scleroderma) Differential Diagnosis

A
  • Positive Rheumatoid factor test
  • Other blood tests
  • Multiple effected systems: Skin, GI, cardiorespiratory system, kidneys
75
Q

Progressive systemic sclerosis (scleroderma) Treatment

A
  • ROM
  • Strengthening
  • Medications
76
Q

Pronator Teres Syndrome Characterized By

A
  • Median Nerve Entrapment in the Pronator Teres muscle
77
Q

Pronator Teres Syndrome Differential Diagnosis

A
  • 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
78
Q

Pronator Teres Syndrome Treatment

A
  • Nerve Glides
  • Stretching
  • AROM
  • Ultrasound
  • NMES for nerve healing
79
Q

Rheumatoid Arthritis Characterized by

A
  • 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
80
Q

Rheumatoid Arthritis PT Concerns

A
  • Can involve cervical joints causing potential subluxation and spinal cord compression
81
Q

Rheumatoid Arthritis Associated Conditions

A
  • Extra articular systems may be involved
  • Eye lesions
  • Infection
  • Osteoperosis
82
Q

Juvenile Rheumatoid Arthritis Characterized By

A
  • 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
83
Q

Rheumatoid Arthritis Differential Diagnosis

A
  • 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
84
Q

Rheumatoid Arthritis Treatment

A
  • 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
85
Q

Scaphoid Fracture Characterized By

A
  • A fall onto an outstretched hand in a younger person
86
Q

Scaphoid Fracture PT Concerns

A
  • Poor vascular supply to the the bone results in a high risk of avascular necrosis to the scaphoid
87
Q

Scaphoid Fracture Differential Diagnosis

A
  • Radiological studies
88
Q

Scaphoid Fracture Treatment

A
  • 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
89
Q

Scoliosis Characterized By

A
  • Abnormal curvature of the spine in the frontal plane
90
Q

Scoliosis: PT Concerns

A
  • Can be caused by several factors like leg length discrepancy or lumbar herniated disc
91
Q

Scoliosis: Types

A
  • 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
92
Q

Scoliosis Differential Diagnosis

A
  • Radiological studies
  • Postural analysis
  • Forward Flexion
93
Q

Scoliosis: Treatment

A
  • 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
94
Q

Sjogrens Syndrome Characterized By

A
  • Rheumatoid like disorder characterized by dryness of the mucus membranes, joint inflammation, and anemia
95
Q

Sjogrens Syndrome Differneital Diagnosis

A
  • 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
96
Q

Sjogrens Syndrome Treatment

A
  • Hydration
  • Chewing sugarless gum
  • using mouthwash for mouth dryness
  • Medications
  • Maintaining mobility and function through regular exercise program
97
Q

Smith’s Fracture Characterized By

A
  • Distal fracture of the radius which dislocates ventrally (opposite direction of Colle’s Fracture)
  • Results from a fall onto a flexed wrist
98
Q

Smith’s Fracture Treatment

A
  • Casting
  • Early AROM
  • Passive ROM
  • Progressive Resistance
  • Mobs
  • Closed kinetic chain exercises
  • Stabilization of the wrist
99
Q

Sprain Characterized By

A
  • An injury to ligament or joint capsule
100
Q

Sprain Degrees: First Degree

A
  • Some fibers torn
  • A small amount pf hemorrhaging is present
  • Joint stability remains intact
101
Q

Sprain Degrees: Second Degree

A
  • A portion of the ligament or capsule is torn
  • Moderate hemorrhaging
  • Some functional loss
  • Joint stability remains intact
102
Q

Sprain Degrees: Third Degree

A
  • Complete avulsion of the ligament or joint
  • Loss of function
  • Joint instability
  • Pronounced hemorrhaging and swelling in the area
  • Weight bearing is undesirable.
103
Q

Sprain Differential Diagnosis

A
  • Palpation of ligaments
  • Joint stability special tests
  • Amount of swelling and ecchymosis
  • Functional strength tests
104
Q

Sprain Treatment

A
  • Acutely RICE

- Chronically the degree of ligament sprain dictates the treatment program.

105
Q

Sprain Treatment: First Degree Treatment

A
  • Prevent hypomobility, and atrophy with pain free AROM
  • Modalities to decrease pain, edema, and promote healing
  • Gradual returns normal function
106
Q

Sprain Treatment: Second Degree Treatment

A
  • 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
107
Q

Sprain Treatment: Third Degree Treatment

A
  • 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.
108
Q

Systemic Lupus Erythematosus Characterized By

A
  • A chronic systemic rheumatic, inflammatory disorder of the connective tissues
  • Affects multiple organs and systems
109
Q

Systemic Lupus Erythematosus Differential Diagnosis

A
  • 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
110
Q

Systemic Lupus Erythematosus Treatment

A
  • Topical corticosteroid creams for the sin lesions
  • Patient education for energy conservation, good nutrition and skin care
  • ROM exercises
  • Ergonomic and postural training.
111
Q

Tempomandibular Joint Syndromes: Diagnostic Categoris

A
  • 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
112
Q

Tempomandibular Joint Syndromes: Differential Diagnosis

A
  • Joint Noise
  • Joint locking
  • AROM of the jaw
  • Lateral deviation of the mandible
  • Decreased strength
  • Tinnitus
  • Headaches
  • Forward head posture
  • Pain with movement
113
Q

Tempomandibular Joint Syndromes: Synovitis and Capsulitis

A
  • Pain located in preauricular area
  • Unable to fully close back teeth together
  • Opening less than 40mm secondary to pain
  • Pain decreases with rest
114
Q

Tempomandibular Joint Syndromes: Hypermobility

A
  • 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
115
Q

Tempomandibular Joint Syndromes: Disc Displacement with Reduction

A
  • 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).
116
Q

Tempomandibular Joint Syndromes: Disc Displacement without Reduction

A
  • 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
117
Q

Tempomandibular Joint Syndromes: Treatment

A
  • 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
118
Q

Tibial Fractures: Types: March

A
  • Common in persons who take long walks who are not used to this activity
    Lower third of the Tibia.
119
Q

Tibial Fractures: Types: Spiral

A
  • Tibial torsion (skinning injuries common)

- Between the middle and lower third of the Tibia

120
Q

Tibial Fractures: Types: Compound

A
  • Occur due to a direct blow to the tibia
121
Q

Tibial Fractures: Treatment

A
  • 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
122
Q

Torticollis Characterized By

A
  • Contracture of the sternocleidomastoid

- Results in lateral bending of the head to the affected side with rotation.

123
Q

Torticollis Development

A
  • Can develop while in utero
  • Pressure on the spinal accessory nerve
  • Inflammation of the glands of the neck
  • Facet dysfunction
  • Muscle spasm
124
Q

Torticollis Treatment:

A
  • Modalities
  • Stretching
  • Biofeedback
  • Postural education and training
125
Q

Total Hip Replacement: Precautions: All approaches

A
  • Avoid Excessive Flexion
  • Avoid Adduction past neutral
  • Avoid low soft chairs
  • Avoid crossing the involved leg over the uninvolved leg
  • Avoid vigorous stretching
126
Q

Total Hip Replacement: Precautions: Anterolateral approach

A
  • Avoid external rotation
127
Q

Total Hip Replacement: Precautions: Posterolateral approach

A
  • Avoid internal Rotation
128
Q

Total Hip Replacement: Precautions: PT concerns for Rehab

A
  • 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

National Physical Therapy Examination: Musculoskeletal (30 decks)

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