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IPAP > Ortho Block 1 > Flashcards

Ortho Block 1 Flashcards

1
Q

What are the types of amputations?

A 
Toe Amputation
Ray Resection 
Midfoot Amputation- at transmetatarsal or tarsometatarsal level
Hindfoot Amputation 
Ankle Disarticulation - Syme ankle diart. 
BKA
Knee Disarticulation 
AKA 
Hip Disarticulation
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2
Q

If Ulcer/Skin Infection occurs on an amputation stump, how is it managed?

A

From inadequate soft tissue envelope/poor fitting prosthetic
Stop use and modify/add non-bulky dressing
ABX only if systemic Sxs present
Resistant/lingering/exposed soft tissue=surgery

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3
Q

How are irritative skin conditions that develop on an amputated limb manged?

A

Keep dry w/ non-talcum powder/cream
Tx Folliculitis w/ warm soak/compress
Cellulitis= PO ABX
Chronic folliculitis/cystic lesions= surgery
Hyperemic/weeping- topicals, ABX and adjustment of prosthetic

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4
Q

What are the 4 types of sensation issues felt w/ amputations?

A

Non-painful- telescoping sensation
Residual- pain in remaining limb from prosthetic, spurs or Sx nerve endings; modify prosthetic or surgery
Phantom- 55-85% of ALL PTs, Tx w/ Gaba/Pregabalin and transcutaneous electrical stimulation for flare ups
Neck/Back- more function limiting than phantom or residual, Tx w/ PT, rehab and stretching

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5
Q

What are the leading causes of amputations:

A

Systemic Dz: DM, PVD, Infections

Trauma

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6
Q

Define OA

Where is it most commonly seen and affecting?

It’s associated with what 4 factors?

A

Irreversible loss of articular cartilage of lower extremities/spine

Most common arthritis and leading cause of impaired mobility of elderly PTs

Genetics, Obesity, Age, Trauma

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7
Q

What are the common Sxs of OA

Where is it commonly and rarely seen?

A

Pain*, stiffness (Loss of A/PROM), Deformity

Common= Finger, Knee, Spine
Rare= Ankle, Wrist, Elbow
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8
Q

A knee effusion from OA will have what type of lab results returned?

What are the nodules seen on the hands form OA?

A

Mild Pleocytosis, Normal Viscosity, slightly elevated protein

DIP- Heberden
PIP= Bouchard

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9
Q

What is the most common location in the hand for OA to be found?

Where is OA commonly found in the feet?

A

1st carpometacarpal joint w/ swelling and dec ROM

1st metatarsophalangeal joint: Hallux valgus and rigidus

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10
Q

Where does OA like to reside within the knee?

What derm issue can be seen from OA?

A

Genuine Varum- Medial compartment between femur and fibia

Baker’s Cyst- communicates between gastrocnemius and semimembranous muscles

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11
Q

PTs w/ OA in their hip will demonstrate what type of walking gait?

Where will they have radiating pain to?

A

Toe out walking w/ limited/decreased medial rotation

Groin or anterior knee

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12
Q

What four findings will be seen on x-rays of PTs w/ OA

What is the Kellgren-Lawrence Grading scale for OA

A

Sclerosis, Osteophytes, Narrowing of joint space and Subchondral Cysts

0- no OA
1- doubtful; questionable spurs/narrowing
2- minimal; spurs and mild narrowing
3- moderate; spurs and narrowing 50% or more
4- severe; severely impaired spacing and sclerosis of subchondral bone

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13
Q

What are the general management strategies of OA?

A 
Weight management*
Avoidance of impact/torsion exercises
PT for strength/ROM
PO NSAIDs
Hyaluronic injection
Definitive= arthroplasty
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14
Q

Define Rheumatic Arthritis

What joints does it effect?

What body systems can be affected?

A

Autoimmune d/o of inflammation and excess of synovium around eroded capsules

Joints of hands (DIP spared), wrist, knees, feet and ankles

Pulmonary, CV, MSK, Ocular

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15
Q

What are the Sxs of RA that brings PTs in to be seen

What is the College of Rheumatology’s definition of RA

A

Pain, Morning stiffness +60m (warm up period), Swelling, Systemic Sxs

Unexplained inflammatory arthritis in one peripheral joint and short duration of Sxs that would find relief from early intervention

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16
Q

What will be seen upon exam in PTs w/ RA?

What are the four criteria included in the Dx of RA??

A

Synovial hypertrophy causing boggy feeling of joints

Joint involvement, Serology, Acute phase reactants, PT self reporting

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17
Q

What are common sites effected by RA?

What cervical issues can be seen due to the erosion process?

A

Periarticular osteopenia and erosion of joint margins that correlates to insertion site of the synovium

C1-C2 instability from erosion of ligaments holding onto the odontoid process
Caution during intubation/surgery to prevent internal decapitation

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18
Q

What lab tests would be seen on an RA PT?

A

Rheumatic factor, which is IgM Ab agonist Fc portion of IgG, will be inc x 75-90%
Anti-CCP- as sensitive as RF and more specific
CRP and ESR correlate to degree of inflammation
Elevated platelets in acute flare ups
Dec serum albumin and correlates w/ Dz

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19
Q

PTs w/ RA with often develop what other Ortho related Dz?

Why does this Dz present?

A

Osteoporosis

Dz process and non-biological DMARDs used during treatment that lower PTs immune system

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20
Q

What is the main treatment for RA?

Why do Seronegative Spondyloarthropathies have the term “seronegative” in the name?

A

Non-biological DMARDs= first line Tx choice

Negative RF

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21
Q

Seronegative Spond. Encompasses what four disease processes?

All of these will have PTs presenting of ? Issue?

A

Ankylosis Spondylitis
Arthritis associated IBDz
Psoriatic arthritis
Reiter Syndrome

Back pain- some form of SI impact that works superiorly
Enthesitis- inflammation at tendon attachment site on bone

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22
Q

Arthritis associated IBDz PTs will present with what Hx of issues?

How does Psoriatic Arthritis present and what caution/investigation needs to be done?

A

Crohns, UC, enthesitis

Skin lesion, Nail involvement, Dactylitis, Iritis, Enthesitis
Little kids shouldn’t have psoriasis at birth, check FamHx

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23
Q

Reiter Sydrome is AKA ?

What Hx do these PTs all have?

A

Reactive arthritis

Recent STI causing systemic reaction
“Can’t See, Can’t Pee, Can’t Bend the Knee”

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24
Q

What will be seen on x-ray of “bamboo spine”

What creates the “poker” spine?

Lab results on any of the Seronegative Spondyloarthropathies will show what results?

A

Anterior and Posterior vertebrae fusions

Ossification of anterior long. ligament and autofusion of facets= poke spine

Negative RF, Anti-CCP, Anti-nuclear Abs
Pos HLA-B27- genetic markers specifically for Seronegative Spond., strongest association w/ Ank.Spon at 88%

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25
Q

What peripheral joints are commonly affected by ankylosing spondylitis?

What are the common predecessors to Reiters?

A

Ankle, Hip, Shoulder

Chlamydia, Shigella, Salmonella, Yersinia, C Diff, Campylobacter

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26
Q

What radiograph finding of the hands is seen in psoriatic arthritis

How is Psoriatic Arthritis treated?
How is Reiter’s treated?

A

Resorption of terminal phalanges

Biological DMARD
Derm w/ phototherapy

Treat underlying STI

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27
Q

What general treatments are given for PTs w/ Seronegative Spondyloarthropathies

A

NSAIDs- Indomethacin
A-TNF inhibitors Etanercept, Infliximab, Adalimumab for Ank. Spond not responding to NSAIDs
Sulfasalazine for chronic reactive arthritis
Phototherapy for Psoriatic Arth.
Arthroplasty for end stage pain

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28
Q

What are the re flags for referrals of Seronegative Spondyloarthropathies

How much pressure is needed for a Dx of Compartment Syndrome?

A

PTs w/ kyphosis
Pain at rest/night in weight bearing joint
Eye/Derm/Pulm referral

35mmHg

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29
Q

What are the two most common sites for Compartment Syndrome?

How is a Dx made?

A

Forearm and Calf

Measuring compartment pressure before and after exertion

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30
Q

What are the 6 Ps used to Dx acute Compartment Syndrome

What measurements are used to Dx Chronic Exertional Compartment Syndrome?

A

Pain OOP, Pallor, Paresthesia, Paresis, Poikilothermia (cool distal extremity) and no pulse (pulseless and paresis- late findings)

Exercise on treadmill:
Resting pressure +15mmHg
30mmHg or higher after 1m of exercise
20mmHg or higher after 5m of exercise

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31
Q

Complex Regional Pain Syndrome is AKA ?

What are the two different types?

A

Reflex Sympathetic Dystrophy
Algodystrophy- burning sensation
Causalgia

Type 1- RSD, algodystrophy if no identifiable nerve injury
Type 2- causalgia, if nerve lesion exists

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32
Q

How is the presentation of CRPS different than other issues seen in Ortho

A

CRPS= entire limb involvement
START: Swelling, Temp, Agony, Redness, Tremors
Hot, swollen, alloy if and manifested autonomic dysfunction
Hallmark= burning, searing, tearing throbbing pain

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33
Q

How is CRPS treated?

A 
PO sympatholytics
PT for AROM
Contrast baths
TENS therapy
Iontophoresis
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34
Q

What are the two Crystalline Disorders

All of these PTs will have elevated ? But not all will have elevated ?

A

Pseudo/Gout

All gout PTs have elevated hyperuricemia, not all hyperuricemia PTs have gout

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35
Q

Gout is a product of ? Metabolism

How does UA come into the gout algorithm

A

Purines

Classifies PTs as over producers or under secretors

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36
Q

Gout is an accumulation of ? Crystals and causes what manifestations

Pseudo gout is accumulated ? Crystals

A

Mono sodium urate monohydrate (needles), negative birefringence; monoarticular arthritis in 1st MTP (1st), knee (2nd) or ankle (3rd)

Ca pyrophosphate (thromboids), positive birefringence; mono/oligoarticular arthritis in knee (1st) or wrist (2nd)

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37
Q

How is gout and pseudo gout treated?

Lab results screen for what contents of serum?

A

Gout- Colchicine, Indomethacin*, NSAIDs (w/in 1st 48hrs of Sx onset), Allopurinol (Can worsen if Sxs aren’t controlled)
Pseudo- Aspiration, intra-articular steroids, NSAIDs

Ca, Phosphorous, Mg, Alkaline phosphatase, Ferritin, Fe, Transferrin, TSH

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38
Q

Chronic hyperuricemia can lead to what two kidney issues?

End stage arthritis is possible with what form of CDDz but is rare

A

Nephropathy and Renal stones

CPPD

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39
Q

What are the typical findings of x-rays of gout and pseudo gout?

The goal of long term gout management is limiting hyperuricemia with dugs such as what two?

A

Bone spurs in toe
Pseudo- subtle; calcifies in meniscus of knee or any cartilage joint

Probenecid and Allopurinol- don’t give to acute issues, will worsen Sxs

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40
Q

What can be done as Dx and TX for pseudo gout?

What are the 3 parts of Virchow’s Triad?

A

Aspiration followed by steroid injection if 1 or 2 joints are involved
PO NSAID or Colchicine if multiple joints involved

Venous stasis, Hypercoagulability, Venous damage

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41
Q

How do PTs present w/ DVTs?

What is the most preventable cause of in-hospital deaths and are #3 cause of death in poly trauma PTs?

A

Pain distal to block and worse pain when fluid is pushed through (squeezing calf)

PEs

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42
Q

What is one of the first screening assessments for DVTs?

What imaging modality is used in PTs w/ suspected DVT Sxs such as edematous limb?

A

US

Venography- Dx test
EKG, CXR, Ventilation Perfusion Scan

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43
Q

What DVT prophylaxis is used during hip or knee arthroplasty?

What is used in poly trauma or long bone Fxs?

Which one is better for PTs w/ renal issues?

A

Enoxaparin

Enoxaparin and heparin

Heparin

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44
Q

What is used for short and long term prophylaxis against DVTs?

What is the goal INR range?

A

Enoxaparin, Warfarin (most commonly use for anti-coag), ASA

2-2.5

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45
Q

Warfarin has been shown best at preventing what types of clots?

What is the mechanical prophylaxis used during DVT treatment?

A

Better at preventing proximal clots- popliteal and superior

Compression devices

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46
Q

Define DISH

A

Idiopathic disease characterized by striking osteophyte formation in the spine

PTs have ossification spanning 3 or more discs/4 vertebral bodies usually in thoracic or thracolumbar

Ossification usually follow anterior longitudinal ligament and peripheral disc margins

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47
Q

What is the principal Sx of DISH

What Sx is seen if DISH spreads to cervical area?

A

Stiffness, especially in morning and evening

Dysphasia from osteophyte on anterior cervical spine pressing behind esophagus

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48
Q

What lower extremity finding my be seen on exam in PTs with DISH

How does DISH differ from Spondyloarthropathies

A

Reduced hip motion or knee arthritis

No posterior fusions/involvement
No HLA association
Exception- cervical spine posterior ligament may ossify
Spondyloarthropathies works inferior to superior, DISH move out from a common point

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49
Q

What are the two most common causes of cervical myelopathy

How is DISH treated?

A

1- cervical spondylitis
2- DISH

Exercise program- 1st
NSAIDs

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50
Q

What post-surgical hip issue is seen in PTs w/ DISH?

What are the 3 Sxs of Fibromyalgia

A

Hetertrophic ossification

Generalized pain, fatigue and tender areas of soft tissue

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51
Q

What makes the Dx criteria for fibromyalgia specific

A

Pain in 4 quadrants w/ waxing and waning x 3mon
Pain/tenderness needed at 11 or more of the 18 sites with 4kg of pressure
PT must say palpitation was painful and not tender

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52
Q

What are the 3 FDA approved drugs for treating fibromyalgia?

What other treatments have been shown to help with Sxs?

A

Pregablain, Duloxetine, Milnacipran

Anti depressant/convulsants
Non-bentos
Relaxants
Dopamine agonists
NSAIDs
Needling and infiltration w/ lidocaine
Electrical stimulation
Cryotherapy
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53
Q

Where does osteomyelitis usually occur in Peds and Adult PTs?

A

Peds= hematogenous etiology most commonly in metaphysic of long bones with more than half of cases in PTs under 5y/o

Adults- organisms gain acces from open Fx or from surgical fixation of Fxs

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54
Q

How do osteomyelitis infections present?

What microbes are most likely the culprits?

A

Older PTs/adults- fever, pain, swelling at site
Previous open Fx- drainage or substantial delay of healing
Kids- present MORE sick w/ Systemic Sxs, deep/poorly localized pain

Adults- Staph A, Pseudomonas Aeruginosa
Peds- Staph A, GAS, Hemo. Influenza but less often due to imms
Immunocompromised- atypical microbes

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55
Q

How are osteomyelitis infections best seen on imaging?

How are these infections seen for Dx?

A

MRI- sensitive and specific

NucMed bone scan- high sensitivity, low specificity, used to differentiate from Charcot Arthropathy- destructive condition from denervated limbs but can be confused as osteomyelitis

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56
Q

What type of lab results will be seen in PTs with osteomyelitis infections?

How are these infections Tx?

A

Acute=Elevated leukocytes
Chronic= normal leukocytes
Both have elevated CRP and ESR

Surgical excision- definitive
ABX- impregnated methyl methacrylate beads after surgery- key

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57
Q

What are the two types of septic arthritis?

What are the 3 ways the infections originate?

A

Pyogenic, Suppuarative

Direct innoculation
Hematogenous spread from infection
Extension of rom bone infection

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58
Q

What is the most likely microbe of septic arthritis in adults and kids over 2yrs old

Septic arthritis in kids is usually occurring from ?

A

Staph Aureus

Hematogenous spread

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59
Q

What are the hallmark Sxs of septic arthritis?

What will labs are ordered?

A

Tenderness, Effusions, Erythema w/ limited PROM

WBC w/ differential
EST
CRP

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60
Q

Septic arthritis joints MUST be aspirated and tested for ?

If it’s a native joint w/ an infection, what results is diagnostic?

A

Crystals, Gram stain, cell count, Cultures w/ sensitivity

WBC higher than 50,000^3

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61
Q

What is the sequence of treatment for septic arthritis?

What are the adverse outcomes of this issue and can even occur w/ TX?

A

Aspirate, ABX, surgery

Degeneration of joint
Soft tissue injury/contracture
Osteomyelitis
Fibrous/bony ankylosis
Sepsis/death
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62
Q

WHat’s the difference in presentation of septic arthritis and bursitis/cellulitis

A

Septic arthritis= swollen, painful joint w/ dec PROM

Cellulitis/Bursitis- no decreased ROM

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63
Q

Lyme Dz is what microbe and carried by ? Bug

What are the 3 phases of this Dz?

A

Borrelia Burgdoreri
Ixodes Dammini

Early localized- viral Sxs
Early disseminated- cardiac/neuro involvement (meningitis, cranial neuropathy, radiculopathy)
Bell’s palsy- most common neuro manifestation

Late- Arthritis and Neurlogic manifestation, Lyme encephalopathy, radicular pain and distal paresthesia

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64
Q

What is the characteristic feature of early localized Lyme Dz?

Any PT presenting with this finding should be investigated for ?

A

Erythema Migrans

Synovits and restricted joint motion

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65
Q

Which joints are heavily affected by Lyme Dz?

What other adverse outcomes can occur?

A

Heavy weight bearing

Facial paralysis, Chronic Fatigue, Concentration defects, Cardiac block, Peripheral neuritis

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66
Q

What ABX are used to TX Lyme Dz?

A

Doxy 100mg BID x 28 days
Amoxicillin 500mg TID x 28 days
Peds under 8yrs- Amoxicillin 20mg/kg

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67
Q

What are the two types of Osteoporosis

A

Primary- post-menopausal and 6x more common in women than men
Hormone changes causing bone loss
Secondary- senile osteoporosis, occurs twice as much in men and commonly in PTs older than 70
Metabolic, bone doesn’t form
Also commonly seen in long term steroid use PTs

68
Q

How is osteoporosis identified in clinic?

A

Pt seeks help for back pain, Fx, loss of height or spinal deformity
ID’d through DEXA scan
Fx risk assessment- FRAX from bone density and other 10yrs Fx risk assessment

69
Q

What are the ranges of DEXA results for normal, -penia and -porosis

Other than metabolic and steroid use, what other issues can lead to Secondary Osteoporosis?

A

0- -1= normal

  • 1 - -2.5= osteopenia
  • 2.5 or more= osteoporosis

Hypo/per thyroid
Multiple myeloma- neoplastic issues
Osteomalacia- metabolic
Osteogenesis imperfecta- CT d/o

70
Q

What are the common Fxs from osteoporosis

Overuse Syndrome is AKA ?

A

Compression Fx, Hip and FOOSH

Cumulative trauma d/o
Repetitive strain injury

71
Q

In order for the Dx tendinitis to be give, what part of the tendon has to be involved?

Define Apophysitis
Define Epiphysiolysis

A

Epitenon

A- inflammation at the growth plate
E- traumatic widening of the physis

72
Q

How is overuse syndrome Tx?

How are sprains classified/graded?

A

Progressive exercise helps treat tendinitis
NSAIDs
Analgesic creams

1- partial tear, no instability of joint; Sx Tx only
2- partial tear with some laxity; Tx by motion protection
3- complete tear w/ laxity; Tx by protected motion or repair

73
Q

How are strains classified/graded?

A

1- <10% muscle fibers torn w/ intact fascia
2- 10-50% torn w/ intact fascia
3- all muscle fibers torn but fascia intact
4- all muscle fibers torn and disrupted fascia

74
Q

Define sprain

Define strain

A

Injured ligaments connecting bones together

Trauma to muscle or musculotendinous unit

75
Q

How should sprains and strains be evaluated in clinic?

How are their Dx confirmed/severity evaluated?

A

Sprain- joint examined for stability
Strain- stretch injured muscle to identify muscle defects

Most sensitive for soft tissue eval, used sparingly to grade and evaluate suspected ruptures or severe sprains

76
Q

How are sprains/strains TX?

When are these referred due to red flags?

A

PRICE is mainstay
Early cryotherapy
NSAIDs
Minor sprains- elastic compression bandages
Strains- immobilized w/ muscle in stretched position

Grade 4 strains
Grade 3 sprains
Severe grade 2 sprain/strain

77
Q

What is the treatment protocol/time frame for strains

A

Acute- Day 1-5= limit swelling/hemorrhage
After day 5= prevent adhesions
Subacute- Day 3-3wks= gain, pain, full AROM
Remodeling- 1-6wks= strength, flexibility
Function- 2wks-6mon= return to duty
Return- 3wks-6mon= avoid reinjury

78
Q

Osteoid osteoma

A

Benign/incidental finding In long bones and posterior elements of the spine
Age: 10-35
Appears sclerotic w/ <1cm lucent nidus; “drill hole” in cortex of bone
PT presents w/ night pain that is responsive to NSAIDs/ASA

79
Q

Osteochondroma

A

Mushrooms growing off of metaphysis and point away from bone

Child/young adults

80
Q

Fibrous Dysplasia

A

Late childhood-young adult and can appear on any bone
Polyostotic fibrous dysplasia earlier
Muddled appearance w/ poorly defined edges

81
Q

Osteosarcoma

A

Obliterates cortex of bone and appears like ray burst on x-ray

82
Q

What imagine modalities are used for assessing bones and their issues?

A

X-ray: bone lesions
MRI: soft tissue and marrow
CT: bone detail (cortical continuity, erosion, endosteal scalloping)
Bone scans: infection, trauma, tumor but don’t show if activity is related to trauma, infection or tumor

83
Q

Who is more likely to be seen for growing pains?

How is it treated?

A

Boys, ligamentous laxity, 2-5yrs old usually noticed/increased at night

Education, stretches and analgesics

84
Q

How is pediatric complex regional pain syndrome managed?

What child demographic is more likely to be abused?

A

Rehab- first
TCAs- Amitriptyline
Pain management

Under 3yrs old- first, premature, step children, handicapped

85
Q

When gathering history of suspected child abuse, how is the change added to the note?

What images are taken for these cases?

A

Revised date and recorded as an addendum to the record

AP/Lat of all long bones, hands, feet, spine, chest and skull are all standard for PTs under 2yrs

86
Q

What types of Fxs are considered highly suspicious of abuse?

What two factors present in a home increase the risk of abuse?

A

Posterior ribs, scapula, spinous processes, sternum Fxs
Chip/Corner Fxs of metaphysis of long bones from traction/downward pulling of extremity

Alcohol, maternal cocaine use

87
Q

What imaging modality can be used to assess for suspected rib Fxs that have healed?

What is the down side of this modality?

A

Bone scan

Difficult detecting Fx of skull or long bones

88
Q

What radiological findings are more indicative of an accident than abuse?

What type of Fx is rarely the result of abuse?

A

Walking age w/ spiral Fx of tib/fib are accident, not abuse, indicative

Buckle Fx- usually result from simple falls and can present late due to low amount of pain

89
Q

What other imaging test is ordered for suspected child abuse during the head to toe exam with positive abdominal tenderness of elevated LFT results?

How are kids MSK sprains treated differently than adults?

A

Abd CT

Kids don’t sprain, they break
Any sprain treated as a Fx, f/u 7-10 days w/ repeat films

90
Q

How fast are ped Fx healed?

What Fxs are casted?

A

4-6wks

Salter 1 and 2
3-4= surgery w/ 1yr f/u
Minimally displaced= immobilization
15y/o+ male, 13yo+ female= mild displacement acceptable because if premature arrest occurs, little growth is remaining to be completed

91
Q

Displaced peds Fxs older than __ should not be reduced because ?

What is a healing risk that is seen in open Fxs in peds?

A

7 days
Reinjury to growth plate

Physeal bars

92
Q

Lecture skipped

A 
Juvenile Idiopathic arthritis
Osteochondritis dissecans
Osteomyelitis
Septic arthritis
Seronegative spondyloarthropathies
93
Q

Define Radiculopathy

Define Myelopathy

A

Dz of nerve roots after exiting main body of spinal cord

Dz of the spinal cord

94
Q

What is the distal end of the spinal cord called and where does it terminate?

What is below this ending?

A

Conus medullaris, @ L1-2

Cauda equina, contains L2-L4 nerve roots

95
Q

Define Cauda Equina

What unique Sx does this present with?

A

Lumbar problem, Compression of nerves while in the canal distally to conus medularis

Paralysis w/out spasticity
Changes in S2-S4- bowel/bladder, saddle anesthesia,

96
Q

What are the 4 causes of Cauda Equina

How quickly does it develop?

A

Herniation, Abscess, Hematoma, Trauma

Immediate- Fx
Over time

97
Q

What are the Sxs present w/ Cauda Equina?

A

Radicular pain/numbness in both legs but more severe in one leg
Stumbling gait, difficulty standing (quad/hip extensor weakness), + symmetric foot drop

98
Q

What imaging modalities can be used to Dx Cauda Equina

Are Sxs limited to myatomes or dermatomes?

A

MRI- compression of thecal sac
CT/myelogram- if unable to do MRI

No, crosses both

99
Q

Look into/check if numerous

“what are surgical emergencies?

A

Look up

100
Q

Define Cervical Radiculopathy

What causes these in young and older PTs?

A

Pain in cervical nerve root/s w/ possible numbness, weakness or loss of reflexes

Young- herniation
Older- osteophytes, stenosis, arthritis of uncovertebral joint

101
Q

What are the S/Sxs of Cervical Radiculopathy

What imaging modality is used for Dx

A

Weakness, lack of coorindation, changes in handwriting and decreased grip
Unilateral numbness/parasthesia of upper extremity

Axial MRI
CT w/ myelogram

102
Q

What type of ROM is decreased with cervical radiculopathy

What movements will cause increased pain and indicate further eval needed of ? nerves

A

Lordosis

Extension/axial rotation
C5-T1

103
Q

How is cervical radiculopathy Tx?

What are the red flags for referral?

A

Radicular pain- NSAID w/ traction therapy
Avoid narcotics and spine manipulation

Non-surgical Tx failure
Atrophy, weakness, myelopathy 
Demyelinatings Sxs
Infection
Tumor
104
Q

Define Cervical Spondylosis

What can cause this?

A

Degenerative disc dz

Osteophyte growth
Buckling/thickening of ligamentum flavum
Herniation

105
Q

What Sxs will PTs with Cervical Spondylosis present with?

What does this do to their ROM

A

Neck pain that inc w/ upright activity
Dec palmar sensation- difficult buttoning shirts
Gait changes seen by tandem walking

Dec AROM and PROM

106
Q

What nerve roots need to be assessed in PTs w/ Cervical Spondylosis

Define Lhermitte sign
What other signs may be seen?

A

C5-T1 (degernation usually occurs at C5-7) and L1-S1

Flexion of neck produces electrical shocks down spine/arm/leg
Hoffmann, clonus, hyperflexia, Babinski

107
Q

When do cervical spondylosis PTs need MRIs?

How are they treated?

A

Progressive neurological Sxs

NSAIDs
Anti-depressants
Cervical pillow/roll w/ rehab
No opioids
Long term/definitive= fusion
108
Q

Define Cervical Strain

What usually causes these?

A

Muscle/ligament injury of the neck

Acceleration-deacceleration MVAs causing rapid flexion-extension

109
Q

What are the Sxs of Cervical Strains

Where do PTs complain of pain?

A

Pain worse w/ motion and possible paraspinal spasm
Occipital HAs- can linger x months

From base of skull to cervicothoracic junction

110
Q

What findings may be seen on imaging of cervical strain PTs?

How much instability is concerning?

A

Anterior displacement of pharyngeal shadow= soft tissue swelling from spinal Fx, disc injury or Ant. Ligament

Translation of vertebral body more than 3.5mm and/or 11* of angulation of adjacent vertebrae

111
Q

How are cervical strains treated?

What rehab care is contraindicated in these PTs?

A

1-2wks= NSAIDs, relaxants, soft collar
Short term use of Anti-depressants
Unstable Fxs= surgery

Spinal manipulation

112
Q

How much anterior swelling is allowed/considered non-pathological in cervical strains

What if increased swelling is seen beyond an acceptable/non-pathological amount?

A

1/3 width of C3 vertebral body

MRI stat, no flex ion/extension films

113
Q

What are the common causes of cervical Fxs?

When are the majority of these Fxs missed?

A

MVA, Fall, diving accident

Obtunded from closed head injury, unconscious, intoxicated

114
Q

What are the 3 most common presenting Sxs of Cervical Fxs?

What types of Sxs suggest an involved spinal cord injury?

A

Pain, Paraspinous spasms, point tenderness

Global sensory/motor deficits

115
Q

What does a gap/step off found in the cervical spine suggest?

What follow on sensory tests need to be performed?

A

Injury and instability to the posterior ligament outs complex

Perinatal, sphincter and bulbocavernosus reflex

116
Q

What is the most important image needed when assessing multiple injuries in a PT w/ potential cervical Fxs?

If PTs w/ a normal radiograph and neurological exam but still have persistent pain should take what precaution?

A

Cross table lateral x-ray from C1-T1
Odontoid

Wear cervical collar x 7-10 days

117
Q

When can a trauma PT be declared to have a cleared C-spine?

What type of rehab can be started once they’re cleared and released?

A

Completion of exam on coherent/conscious PT

Neck stretching and strengthening w/ scapular stabilization

118
Q

When are suspected cervical Fxs referred?

What area is of the most concern when looking at thoracic/lumbar Fxs

A

Instability
Dislocations/subluxations
Any neurological deficit during coherent exam

Posterior 1/3 of vertebral body
Anterior half involvement and burst Fxs usually considered stable

119
Q

Thoracic/lumbar Fxs are often associated with that other injury?

What is the most common presenting Sx?

What may be delayed symptom in these PTs?

A

Abdominal- bowel lacerations

Pain that is exacerbated by motion

Bowel ileus

120
Q

What are the hallmark signs of an unstable flexion-distraction or burst Fx in a thoracic/lumbar Fx?

What types of imaging modality is used?

A

Hematoma and step off/gap

CT modality of choice, AP/Lat x-rays of thoracic/lumbar
Anything other than simple compression Fx needs additional studies

121
Q

What type of imaging modality offers the best/most amount of info for PTs w/ suspected thoracic/lumbar Fxs?

How are these types of Fxs treated?

A

CT w/ reconstruction

Compression Fx less than 20* and no posterior involvement= thoracolumbosacral orthosis for 8-10wks
Unstable burst, flexion-distraction, fracture-dislocation= internal fixation and fusion

122
Q

Define Acute Lower Back pain

What feature does the PT present with?

A

Ligamentous injury involving annulus fibrosis w/ no hernia Timon causing pulposus to leak and irritate nerves

Self-splinting: limited movement to reduce pain

123
Q

How is acute lower back pain treated?

When does acute pain transfer to the category of chronic?

A

W/ or w/out sciatic Sxs and no neurological defects=
Initial phase- Sx relief
Second phase- return to activity

Pain longer than 3mon

124
Q

What is the hallmark PE finding for chronic lower back pain?

What do x-rays show in these PTs?

A

Pain radiating down one/both buttocks w/
lumbar/sacroiliac tenderness

AP/Lat x-rays, osteophytes, and reduced disk height

125
Q

Degenerative disc disease may show what odd finding on x-rays and MRI?

PTs w/ chronic lower back pain need to be evaluated by what specialists?

A

Nitrogen gas in disc spaces

Spine, internist, Family Med, Gyn

126
Q

How do lumbar herniations occur?

Where are they more common to occur?

A

Posterior part of annulus fibrosis weakens and allows herniations through causing herniated disc syndrome (sciatica)

L4-5, L5-S1

127
Q

What PE exam has a high correlation to a lumbar herniations?

When are images ordered?

A

Pos contralateral straight leg raise

Pain longer than 4wks, neurological defect, pre-op eval

128
Q

What are the difference between vascular and neurogenic claudication?

A

Neurogenic:
Pain relieved w/ sitting-flexed
Numb, aching, sharp pain
No bruit

Vascular:
Pain relieved w/ standing
Cramping/tight pain
Skin is shiny and no hair

129
Q

How are lumbar herniations treated?

A

PO NSAID
Limited seating, standing
Keep walking

130
Q

Define lumbar stenosis

How does it normally present?

A

Impingement of space for spinal cord canal usually at L2-L5

Neurogenic claudication that causes radicular Sxs in legs

131
Q

What special test may be positive in PTs w/ lumbar stenosis

How is it treated?

A

+ Romberg test

Keep them mobile w/:
Water exercise/PT
Epidural steroid injections

132
Q

When are lumbar stenosis PTs referred for surgery?

Lumbar stenosis is a progressive degenerative dz associated w/ ?

A

Non ambulatory or decreased QOL

OA

133
Q

Spinal metastatic dz often originate from ?

What types of tumors are common and rare?

A

Breast, thyroid, lung, prostate, colon, kidney

Primary- rare, originate from 6 above areas
Metastatic- common

134
Q

Most likely etiology of spinal metastatic DMS are ? Spread and are deposited into the ?

What are the 4 ways these present and are found?

A

Heatogenous
Batson’s plexus- collateral connections of IVC and lacks valves

Stenosis
Known primary tumors, evaluated via MRI/CT
Neurological finding w/ or w/out Hx
Pain in PTs unaware they had CA

135
Q

What type of symptom is highly suspicious for neoplasms

What PE exam can be done to magnify pain and point out focus to a neoplasm?

A

Pain that prevents sleep and persists through the night

Percussion on spinal processes

136
Q

What x-ray sign is seen in spinal metastasis?

When would bone scans be ordered?

A

Winking owl sign

Tc-99 scan to assess depth of tumor involvement and see if it’s spread to pelvis or extremities

137
Q

What is the treatment for spinal metasteses

What are common post-surgical issues with these PTs?

A

Chemo, Hormone therapy, Radiation in ASx tumors
Radiation for painful tumors

Wound complications if surgery follows radiation or if PT is on steroids

138
Q

Define scoliosis

What part of the spine is affected

A

Lateral/coronal curvature of spine that can involve axial and sagittal planes

Radicular pain from L4-5 compression
Rarely have neurological Sxs

139
Q

What it’s he chief presenting complaint/Sx of PTs with scoliosis

How is scoliosis decompression evaluated?

A

Progressive spine deformity or they’re Getting shorter

Measuring distance of plumb line from C7 deviates to L/R of gluteal fold

140
Q

What type of images are taken to assess scoliosis

How is it treated?

A

Weight bearing PA and lateral on 36” cassette

NSAIDs and exercise, starting w/ water therapy, trunk strengthening,

141
Q

When are scoliosis PTs referred for surgery

A

Progressive neurological deterioration
Can’t walk 2 block due to pain
Respiratory dysfunction
Weakness

142
Q

Define Spondylolisthesis

A

Forward slippage of L4 or 5 vertebral body due to degeneration/alteration of the facet joint and disk but keep laminate and pars interarticularis intact

143
Q

What type of PE findings will be seen in PTs w/ Spondylolisthesis

What type of images are needed?

A

Pain worse w/ lifting, twisting
Diminished knee/ankle reflexes
Decreased strength in toe/heel walking or toe extension

AP and Lateral radiographs

144
Q

How is Spondylolisthesis treated?

Define Isthmic Spondylolisthesis

A

NSAIDs
Exercise/weight loss

Usually in football/cheerleader kids at L5-S1 from cyclical loading event (fatigue Fx) that fails to heal
Once slippage occurs, classified as isthmi

145
Q

What are the S/Sxs of Spondylolisthesis Isthmic

How is this Dx on imaging?

A

Back pain radiating posterior lay to/below knees and worse w/ standing
Hamstring spasms limit forward bending

Scotty dog only on oblique x-ray

146
Q

What are the 3 steps of the development of Isthmic Spondylolisthesis

Due to the young age of PTs this present in, what imaging modality is used to assess the back?

A

Pars interarticularis- Scotty dog has collar
Spondylolysis-
Spondylolisthesis- decapitated Scotty dog

SPECT scan

147
Q

How is Isthmic spondylolisthesis treated?

A

Young/still developing- rigid brace

NSAIDs/exercise

148
Q

? And ? Are bacterial infections in kids involving anterior elements of the spine

What PT populations are these seen in ?

A

Discitis and Osteomyeltis

Discitis- Kids under 5y/o
Vertebral Osteomyelitis- older kids/adolescents
Most commonly from Staph A
Could be: Kingella, GAS, E Coli

149
Q

What are the most common causes of pediatric thoracic and lumbar pain

What type of info leads us to believe these are result of mechanical cause or organic cause

A

Muscle strain

Mechanical=Pain during/after activity that is relieved w/ rest
Organic= neuro, systemic Sxs (neuro may be late findings)

150
Q

What type of PE tests can be done to assess Peds back pain?

A

Hyper extension- loads posterior elements in compression (spondylolysis) and spinal flex ion that loads anterior column in compression (discitis, compression Fx)

151
Q

What types of images are gathered when assess Peds back pain?

What labs are drawn?

A

Weight bearing PA and lateral x-rays of entire spine

CBC w/ differential
ESR
CRP
RF, Lyme titer, HLA, anti-nuclear Ab

152
Q

What are common clinical Sxs in kids w/ discitis

What special tests are done?

A

Fever, malaise, back pain

Percussion and passive spinal flexion to compress anterior elements and causes pain

153
Q

What is the imaging modality of choice in kids w/ discitis

What labs are drawn?

A

MRI- proves involvement and assess potential rare complications

Serum culture
WBC w/ differential
ESR/CRP

154
Q

What is a common adverse outcome of Peds discitis

How is Peds discitis Tx

A

Persistent disc space narrowing and spontaneous fusion of adjacent vertebrae

Admitted and IV ABX

155
Q

Define normal range of Peds Kyphosis

What are the most common causes of hyperkyphosis

A

20-50* w/ Cobb angle from T3-12
Greater than 50*= hyperkyphosis

Postural- flexability d/o in females corrected w/ passive treatment
Scheurmann Dz- common in boys and not passively correctable

156
Q

What special tests are done for Peds kyphosis

What is the difference of kyphosis between Scheuermann and postural?

A

Adams forward bend test-

Scheuremann- sharp angulation at apex
Postural- genial curvatures at apex

157
Q

What images are taken for Peds kyphosis

Adverse outcomes are ? And seen at ?*

A

AP lateral radiographs while standing

Back pain, rarely neuro Sxs, decreased pulmonary function +90*

158
Q

How is Scheuermann Dz treated

How is congenital kyphosis treated?

A

Skeletal immature- brace (Milwaukee brace)
>70*= surgery

Surgery

159
Q

Define Peds scoliosis

What are the 3 classifications

A

Curvature worse on coronal plane, >10* on Cobb angle more common in girls

Infantile: birth - 3yrs
Juvenile: 3-11
Adolescent: 11+

160
Q

What is the predominant effect of Peds scoliosis deformities?

What two symptoms are rarely seen in these cases?

A

Loss of sitting balance, possible respiratory function impairment

Pain and neuro Sxs

161
Q

What additional exams/findings need to be evaluated in Peds w/ scoliosis?

A 
Trunk and lower extremeties
Cafe-au-lait spots
Auxiliary freckling
Lesions on spine
Cavus feet- suggest neuromuscular dz
Limb length discrepancy
Joint laxity- suggests Marfan’s
162
Q

What is the standard method for quantifying degree of curvature in pediatric scoliosis

What test is the most sensitive for screening?

A

Cobb angle

Adam forward bend test

163
Q

What cases of Peds scoliosis need MRIs?

A

Age- infant/juvenile
Abnormal finding- pain/neurological findings
X-ray findings- L sided curvature, excessive thoracic kyphosis, widening of spinal canal, erosive vertebral changes, rib abnormalities

164
Q

How is Pediatric scoliosis managed and treated?

How are progressive/Sx curves treated?

A

Observation- immature/less than 25*
25-45= immature soft brace
25-45 Stable neuromuscular d/o- braces
25-45* and skeletal mature= PT and observe

Soft spinal orthosis

165
Q

When are Peds scoliosis referred to surgery?

When are Peds w/ scoliosis referred to Ortho?

A

Immature PTs w/ curves greater than 45*
Skeletal mature PTs- greater than 50*

Upon giving Dx, all scoliosis PTs go for monitoring and tracking

166
Q

How often do Peds w/ scoliosis f/u with orthO

A

6mon w/ neuromuscular conditions expected to progress rapidly

Annually if not expected to progress

167
Q

When is amitryptyline the first line choice of treatment in PTs not responding to conservative methods?

A

Fibromyalgia

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