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Musculoskeletal > Muskuloskeletal disorders > Flashcards

Muskuloskeletal disorders Flashcards

1
Q

OA general

A
  • also called DJD and DDD (spine)
  • chronic and degenerative
  • localized articular cartilage degeneration usually through wear and tear, non inflammatory and non systemic.
  • genetically related OA is inheritable particularly OA of the hands and hips
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2
Q

OA presentation

A
  • one of the first presentations is hypermobility and capsular laxity and then it progresses to hypomobility and limited motions.
  • average age is usually over 50. Up to 50 y/o most OA cases are men, then after 50 most are women
  • x-ray will show osteophytes, sclerosis (hardening of joint margins), exposure of subchondrol bone (bone under cartilage), and joint space narrowing
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3
Q

OA causes

A

•age/ wear and tear (though not considered part of the natural aging process), obesity, trauma, congenital joint issues, sports, repetitive actions, strong grip, grasp, and/or rotation, weak quads (knee OA), occupations that require a lot of lifting (spine, hip, and knees)

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4
Q

OA joints impacted

A
  • most common at the knees (medial affected more often-leads to genu varum), hips, and spine (cervical and lumbar), and the hands (CMC, DIP- herberdons nodes, PIP- bouchards nodes), foot MTP- hallux rigidus (decreased great toe extension, treat with clogs)
  • usually asymmetrical (sometimes bilateral but one side is usually worse)
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5
Q

OA fall risk

A

OA is associated with 52% more falls.

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6
Q

OA pain and modalities

A
  • pain with activity especially with WB, relieved by rest. Stiffness post sleep and inactivity (stiffness usually goes away within 30 minutes), relieved by ROM. Crepitus and grinding noises may be present.
  • Modalities for pain relief: traction, distraction (grades I and II), heat, decreased WB (aquatics and lose weight, AD, bicycling), splints and other forms of support, rocking chair, ROM post inactivity, strengthen and stretch muscular imbalances, balance activities (because of increased fall risk), aerobic activity because of fatigue
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7
Q

OA meds

A
  • Tylenol (acetominophen)- renal and liver toxicity
  • NSAIDS (motrin, advil, neproxin): GI beeding and renal toxicity
  • Cortisone injections: weakening of tissues and tears/ruptures
  • Surgery: osteotomies= cutting out a piece of bone to realign, joint replacement
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8
Q

OA PT treatment

A

decrease WB, energy conservation, joint protection, aquatics, AD, strengthen and stretch muscular imbalances, bicycling, in the morning ROM to relieve stiffness

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9
Q

OA deformities

A
  • Herberdon’s nodes: DIP joints
  • Bouchard’s nodes: PIP
  • Genu varum at the knee
  • femoroacetabular impingement=OA of the hip
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10
Q

RA general

A
  • systemic inflammatory disorder, chronic erosive synovitis, produces pannus that leads to cartilage destruction and tenosynovitis of tendons leading to ruptures. Because it is systemic besides the joints it also affects the heart vascular system, integumentary and nervous systems, and eyes
  • Constitutionally you will see fever, malaise, and cachexia (muscular wasting)
  • Average age: 15 to 50
  • W > M because is is an autoimmune disease
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11
Q

RA joints affected

A

•small joints affected first (hands and feet)
• usually symmetrical involvement
•stiffness upon awakening, takes over an hour to resolve
• usually affects all or most of the joints of the body including:
- TMJ
- Cervical spine (can cause atlantoaxial subluxation, which causes immediate death)
- can be unstable= especially with traction
- hands
- hips
- knees
- feet

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12
Q

RA deformities

A

•Wrist & Hands:
- radially deviated wrist, MCPs ulnarly drift, fingers get swan neck deformity (PIP extension and DIP flexion) and boutonniere’s deformity (PIP flexion and DIP extension)
- De Quarvains (stenosing tenovitis of the abductor pollicis longus and extensor pollicis brevis thumb tendons)
- trigger finger (also called stenosing tenosynovitis- inflammation narrows the space within the sheath that surrounds the tendon in the affected finger. If trigger finger is severe, your finger may become locked in a bent position. Pain and catching or locking of the fingers)
•Cervical spine: can cause an atlantoaxial sublaxation- which causes immediate death
Can be unstable- especially no cervical traction
•Shoulders:
- shoulders tend to get bursitis
•Elbows:
- olecranon bursitis
•Knee:
- genu valgum at the knees
•Foot & Ankle:
- calcaneovalgus (hyperpronation), hammer and claw toes of the foot, hallux valgus
• Extensor tendon ruptures throughout
•Carpal tunnel development

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13
Q

RA labs (blood work)

A

ESR: erythrocyte sedimintation rate (shows inflammation, it is not just specific to RA)
RF: rheumatoid factor
CRP: creactive protein

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14
Q

RA meds

A

•Corticosteroids for inflammation
-AE: HTN and hyperglycemia, weight gain and skin fragility
•DMARDS (disease modifying anti-rheumatics): slow the progression of the disease- methotrexate
-AE: bone marrow supression
•Biological response modifiers: to suppress the immune system
-AE: infection
•NSAIDS- motrin, advil, neproxen
- GI bleeding, renal toxicity
•Corticosteroids: to reduce inflammation
- AE: osteoporosis, thinning of the skin, HTN, hyperglycemia

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15
Q

RA medical management

A

synovectomy or joint replacements (much more common than synovectomies)

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16
Q

RA PT tx

A

joint protection and energy conservation education, adaptive equipment (splints and braces, ROM *no stretching (this could cause tendon rupture)

17
Q

Juvenile RA (Still’s disease)

A

3 main types

1) Systemic (20%): major high spiking fevers, night rashes, mainly affects organs
2) Pauciarticular: F>M, involves larger joints (knees, elbows, and ankles), 1 to 3 joints involved, may develop a leg length discrepancy due to hyperemia (increased blood flow)
3) Polyarticular: resembles adult RA

18
Q

Systemic Lupus Erythmatosus (SLE)

A

chronic inflammatory autoimmune disease
•commonly appears with joint pain
•most common in 30-40 y/o women
•butterfly mask
• etiology unknown
• have hemopoietic, renal and cardiac involvement
Management:
• marked by remissions and exacerbations/relapses
•PT ed: relapses less likely if activities are controlled and sometimes limited, after exacerbations return to activity should be slow and pain free

19
Q

Fibromyalgia

A

•11-18 tender points (myofascial pain syndrome has trigger points*), non-restorative sleep (wake up fatigued), noninflammatory, nondegenerative, widespread pain, and fatigue, restless leg syndrome, IBS, migraines
•for many s/s appear after MVA or viral infection
*Be very careful not to be too aggressive with treatment as you could prolong or cause issues. Myofascial work, aerobic and stretching, cognitive restructuring (calm down, deactivate the fight or flight response to normal every day stressors)

20
Q

Myofascial pain syndrome

A

trigger point, referred pain, bands of muscle tightness, not associated with fatigue.
TX: generally consists of myofascial release, postural education, and strengthening + stretching muscular imbalances

21
Q

Gout

A
  • protein metabolism producing uric acid, which produces sodium urate needle shaped crystals, that are very painful.
  • Hallmark s/s are pain and redness
  • 1st joint attacked is usually the 1st MTP
  • it is an inherited disease ttriggered by high intake of protein and alcohol
  • M>F
  • can cause multiple joint damage
22
Q

Pseudogout (chondrocalconosis)

A

rhomboid shaped calcium pyrophspates, dehydrate crystals, usually attacks fibrocartilage of joints
•most common joint affected is the knee

23
Q

Ankylosing (natural fusion) spondylitis/Marie-Strumpell disease

A
  • anterior and posterior longitudinal ligaments and the annulus fibrosis start to fuse
  • Men 15-30 y/o most common patient population.
  • Ossification of the anterior longitudinal ligament and calcification of the annulus fibrosis leading to bamboo spine appearance on x-ray.
  • eventually becomes a respiratory issue due to fusion of the costal cartilage of the ribs. Decreased chest expansion= restrictive lung disease
  • SI joint is one of the first joints that begins to display issues. Eventually peripheral joints are affected, hips are the main joints affected usually leading to necessity of hip replacements
  • PT: aquatics, postural training, increase trunk extensor strength, stretch the trunk flexors, no high impact activities, gentle joint mobs (grade 1 to 11 for oain at the non ankylosed segments
24
Q

Osteoporosis

A

person has decreased bone mineral density, tested through DEXA scan by a T-score and z-score, the most common sites for pathological fractures are vertebrae, hips, and wrists.
• affects F>M
•Type I: type generally develops in women who have gone through menopause and have decreased levels of estrogen. This leads to an increase in bone resorption, meaning the bones lose structure, and there is a decrease in the amount of trabecular bone
•Type II: Chron’s, IBS, Celiac disease, corticosteroids, anticonvulsants, anticoagulants
•instruct the patient to avoid high impact and high velocity torsion of the trunk on stationary femurs, end range flexion, and flexion with rotation.
•Deformities/deviations: spine leads to anterior wedging of vertebrae and a dowager’s hump
• Meds: biphosphonates once you already have the disease. Prevention includes vitamin D and calcium filled diet in childhood and adolesence as well as WB activities throughout life
Bone mineral density score (BMD):
•-1 or higher is normal
•Osteopenia: -1 to -2.5
•Osteoporosis:-2.5 or less

25
Q

Paget’s disease

A

• an overgrowth of pathological or weak bone
leading to fx. These patients have large heads, they can be hearing impaired (because it can affect the bones of the ears)
•Characterized by repeated episodes of bone destruction and excessive attempts at repair- which results in weakened bone of increased mass.
• tend to have genu varum deformity
•enlarged skull
•osteoporosis
•decreased hearing (affects bones of the ears)
•unknown etiology
•bone pain is usually the first symptom

26
Q

Lyme disease

A

spirochete bacteria from deer tick bite. The early stages present with flu like symptoms and bulls eye rash, the later stages, presents with neurological symptoms such as Bell’s palsy, cardiac conditions, and musculoskeletal involvement with the knees being most often affected

27
Q

RA nodules

A

the most common extra-articular manifestations of RA. Most often seen in areas with repeated mechanical pressure- olecranon bursa, extensor surfaces of forearm, and Achilles tendon

28
Q

Fibromyalgia management

A
  • evidence supports that aerobic exercise was beneficial in reducing FM symptoms and improving exercise capacity
  • emphasize pacing
  • decreased alcohol and caffeine consumption
  • modalities: including heat prior to stretching, aerobics and strengthening (avoid lifting overhead and shoulders to reduce risk of shoulder girdle injury or overuse
  • Aquatics because of warmth and decreased pressures leading to increased relaxation
29
Q

Pseudogout / Chondroclacinosis

A
  • Condition resembling gout with similar symptoms but occurring in large joints (i.e knee)
  • Occurs from deposition of calcium pyrophosphate rhomboid shaped crystals in joint hyaline and fibrocartilage
  • Age of onset 60-70
  • Condition is frequently familial and occasionally seen with diabetes, renal disease and other systemic conditions.
  • In addition to gout like symptoms calcification of the knee meniscus is common and may be seen at the annulus fibrosis, radioulnar disc and pubic symphysis.
  • Tx: aspiration and cortisone injections. Meds: NSAIDS
30
Q

Primary osteoporosis

A 
Post-menopausal
•Caucasian or Asian descent
•Family history
• Low body weight
•Little or no physical activity/ 
•Diet low in calcium and Vit. D
•Smoking
•Advanced age
31
Q

Secondary osteoporosis

A

Due to other medical disorders
GI diseases (i.e malabsorption)
Endocrine diseases: Hyperthyroidism, Cushing’s syndrome, •Hyperparathyroidism
•Chronic renal failure
•Excessive alcohol consumption
•Drugs: alcohol, steroids, anticonvulsants, cytotoxins, litium, total parenteral nutrition
•Malignancy
•Prolonged immobilization –paralysis
•Amenorrheic athlete/eating disorders i.e. anorexia nervosa

32
Q

resistance training to prevent pathological fracture

A
  • Avoid high intensity, High load activities
  • Intially perform only one set of various exercises 8-12 for 6-8 weeks. Progress intensity and volume gradually
  • Perform weightlifting exercise 2-3 x / week
  • Avoid high impact activities such as jumping or hopping
  • Avoid high velocity movement of the spine or extremities
  • Avoid trunk flexion with rotation and end range resisted flexion
  • Avoid LE weightbearing activities that involve torsional movements of the hips
  • Avoid loss of balance i.e. hold onto stable surface4, or perform exercises in a chair
  • Group exercise , participant- instructor ratios are kept low- direct one on one supervision from trained personnel.

Musculoskeletal (11 decks)

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