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Orthotic Study > Pathologies > Flashcards

Pathologies Flashcards

1
Q

Accessory Navicular

A

Extra navicular

Incorporated into tibialis posterior tendon

Possible pain and tenderness in area

Associated with pes planus, putting strain on tib post tendon, leading to inflammation

Also possible irritation from side of shoes

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2
Q

Amyotrophic Lateral Sclerosis (ALS)

A

Amyotrophic Lateral Sclerosis AKA Lou Gehrig’s Disease

One of most common neuromuscular diseases, etiology unknown, not known to be autoimmune

Degeneration of upper and lower motor neurons

Unable to send messages to muscles which they control, which leads to atrophy

Nerves themselves degenerate, not myelin related (unlike MS)

LOSS of ability to control VOLUNTARY movement
Muscle Atrophy, Rapidly progressive weakness
Spasticity
Dysarthria (difficulty speaking)
Dysphagia (difficulty swallowing)
Dyspnea (difficulty breathing)

Cognitive function generally spared

Does not affect sensation

Steady decline, worsening symptoms

Fatal

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3
Q

Arthrogryposis

A

Congenital joint contractures

Rare 1 / 11 000 live births

Genetic/Environmental- intrauterine, decreased movement in womb

Abnormal fibrosis of the muscle tissue, causing shortening

Unable to perform passive extension/flexion in affected joints

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4
Q

Autonomic Dysreflexia

A

Sudden onset of excessively high blood pressure

Not treated promptly, may lead to seizures, strokes and death

Often occurs in spinal cord injured individuals with lesions above T6

Headache
Flushed face
Sweating
Slow heart rate

Reaction of autonomic (involuntary) nervous system to overstimulation (triggered by afferent stimuli), BP increases, HR slows and beomes irregular, BP cannot be restored to normal because of spinal cord damage

Causes 
Overfull bladder/bowel
UTI
Pressure sores
Broken bones
Tight clothing/DEVICES
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5
Q

Avascular Necrosis

A

Cellular death (necrosis) of BONE components due to interruption of blood supply

Without blood, bone tissue dies/collapses

If involves bones of a joint, often leads to destruction of joint articular surfaces

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6
Q

Blounts Disease

A

Growth disorder of the tibia

Causes lower leg to angle inward
AKA tibial bowing / vara

Can be rapidly progressive

Thought to be due to effects of weight on the growth plate

Inner part of the tibia just below the knee fails to develop normally, causing angulation of the bone

KAFO, or eventually surgery

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7
Q

Bunions/Bunionette

A

Hallux abducto valgus deformity

Lateral deviation of the great toe

Controversial etiology
Poorly fitting shoes, Genetic factors

Pressure applied to the side of the big toe, forces it inward toward and sometimes under or over the other toes

Bump is from swollen bursal sac or osseus anomaly, also part of the first met head tilted out

Tissue surrounding joint become swollen and tender
First met sesamoid bone may also become deviated

Orthotic splints
Toe spacers/separators
Orthotics (accommodative padding/shielding)

Surgery

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8
Q

Carpal Tunnel Syndrome (CTS)

A

Median entrapment neuropathy

Causes Paresthesia (tingling), Pain, Numbness

Palmar aspect of Thumb, index, middle, radial half of ring finger

Wrist pain

Sometimes through the night (seems to be aggravated when sleeping with flexed wrist)

Caused by crowding/irritation/compression of the median nerve within the carpal tunnel, thickening from irritated tendons or generalized swelling and irritation in the area can cause CTS

Carpal tunnel made up of carpal bones, 9 flexors tendons, connective tissue

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9
Q

Charcot Joint

A

AKA neuropathic arthropathy (joint disease)

Progressive degeneration of weight bearing joint

Bony destruction
Bony resorption
Joint Deformity

Decreased peripheral sensation, proprioception, fine motor control

Pathological process can result in

Ulceration
Superinfection

Loss of function
Amputation
Death

Underlying Mechanisms (2 theories)

Neurotrauma

  • loss of peripheral sensation
  • leads to progressive microtrauma to the joint
  • damage goes unnoticed by patient
  • resultant inflammatory resorption of traumatized bone renders region weak and susceptible to further trauma
  • poor fine motor control generates unnatural pressure on certain joints
  • leading to additional microtrauma

Neurovascular

  • neuropathic patients have dysregulated autonomic nervous system
  • desensitized joints receive significantly greater blood flow
  • hyperemia leads to osteoclastic

Treatment

immobilization total contact cast
Pneumatic AFO
Surgical correction

Takes 6-9 months for edema/erythema to recede

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10
Q

Charcot Marie Tooth (CMT)

A

Hereditary Motor and Sensory Neuropathy, Demyelinating neuropathy

One of most common inherited neurological disorders affecting approx 1 / 2500

Characterized by
Progressive loss of muscle tissue
Touch sensation

Symptoms usually begin late childhood, early adulthood

Initial symptom is foot drop
Claw toe/Pes Cavus
Atrophy muscle tissue in legs
Weakness in hands and forearms
Loss of touch sensation
Neuropathic pain

Possible respiratory/GI problems

Must avoid prolonged periods of immobility as it can accelerate symptoms of CMT

Mutations cause defects in neuronal proteins

Cause Demyelinating neuropathy

SCHWANN CELLS demyelinated, Myelin sheath may be damaged, may lead to axonal degeneration

Schwann/Myelin/Axon damage leads to poor nerve conduction

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11
Q

Chondromalacia Patella (CMP)

A

Inflammation of underside of the patella and cartilage softening

AKA patellofemoral pain syndrome

Condition may result from acute injury to the patella or chronic friction between the patella and groove in the femur through which it passes during knee flexion

Overuse, injury, neuromas, malignment, patellar maltracking etc.
can cause deterioration and break down of the cartilage

Cartilage no longer smooth, making movement painful

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12
Q

Club foot - Talipes Equinovarus

A

Congenital deformity involving one foot or both

Inversion of subtalar joint, complete hindfoot inversion
Adduction of forefoot at talonavicular joint and calcaneo cubiod joinit
Equinus and varus ankle
Supination of entire fotot
Plantarflexed

May appear to be walking on ankles, lateral sides of their feet

No single known cause, usually single isolated birth defect, associated with other birth defects such as spina bifida

Serial casting has shown to be effective

Followed by AFO orthosis to hold feet in plantargrade position

Denis Browne Bar, AFO, FO

Surgery usually not necessary however 2 are performed

Tenotomy- release of achilles tendon

Anterior tibial tendon transfer- tendon moved from first ray to the first ray to the third ray in order to release inward traction of foot

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13
Q

Compartment Syndrome

A

An acute (trauma) or chronic (repetitive activity) condition affecting an upper or lower extremity

Characterized by increased pressure within a muscle compartment causing severe pain

Swelling within compartment contained by fascia causes increased intracompartmental pressure

Compression of muscles, nerves and blood vessels within a closed space can lead to muscle, nerve and circulatory system damage

If left untreated, extensive tissue death can occur, amputation may be necessary

Can lead to volksmans contracture

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14
Q

Congenital Diaphragmatic Hernia (CDH)

A

Congenital malformation of the diaphragm

Most common type is Bochdalek hernia (95% of cases) - hole is posterolateral corner of diaphragm, allows passage of abdominal viscera into chest cavity

Malformation of diaphragm allows abdominal organs to push into the proper lung formation

Life threatening pathology in infants

Causes death due to 2 complications

Pulmonary hypolasia- incomplete development of the lungs

Pulmonary hypertension - excessively high blood pressure in pulmonary artery/vein

Associated with scoliosis

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15
Q

Depuytren’s Contracture

A

Fixed flexion contracture of the hand due to palmar fibromatosis (palmar fascia abnormally thick)

Inherited proliferative connective tissue disorder

Palmar fascia thickens and shortens so that tendons connected to fingers cannot move freely

Fingers bent toward the palm, cannot be fully extended

Decreased ability to grip objects

Usually painless

Ring and little finger most commonly affected, middle finger in more advanced cases, index and thumb usually spared

Contractures progress slowly

Table top test for diagnosis, hand on table, see if fingers touch the table

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16
Q

Dequervain’s Tenosynovitis

A

Pain inflammation of 2 tendons in the thumb (extensor pollicus brevis, abductor pollicus Longus)

Pain, swelling, tenderness over thumb side of the wrist and base of the thumb

Motion may be difficult and painful especially when pinching/grasping objects

Difficulty gripping

From Overuse, Repetitive Hand or wrist movement, or possibly trauma

Finkelstein Test
Make fist with thumb placed in palm
Wrist ulnarly deviated

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17
Q

Down’s Syndrome

A

Genetic disorder caused by presence of all or part of a third copy of chromosome 21

Most common chromosome abnormality in humans

Physical growth delays

Muscle hypotonia

Excessive joint laxity, atlanto-axial instability

Excessive space between large toe and second toe

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18
Q

Lateral Epicondylitis

A

AKA Tennis elbow

Painful condition of elbow caused by OVERUSE (racquet sports or other activity) or trauma

NON inflammatory, Degeneration of tendon’s attachment, weakening of anchor site, placing greater stress on area

Point of soreness/tenderness over lateral epicondyle

Pain from gripping movements of the wrist, especially wrist extension

Extensor muscles/tendons on lateral epicondyle of humerus damaged from overuse

Tendon usually involved is Extensor Carpi Radialis Brevis (ECRB)

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19
Q

Medial Epicondylitis

A

AKA golfer’s elbow, pitcher’s elbow

Overuse injury (or trauma) affecting flexor-pronator muscles originating on medial epicondyle

Repetitive flexing, gripping, swing, can cause microtears in tendons

Pain and inflammation of tendons

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20
Q

Femoral Anteversion/Retroversion

A

Anteversion - Inward twisting of the femur
Retroversion- Outward twisting of the femur

Often occurs symmetrically

In toeing gait, look to see if patella turned inward
Bow-legged appearance

Caused by position in uterus, genetic?

Normal child born with 40 degrees femoral anteversion

Gradually decreases to 10 to 15 degrees at adolescense

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21
Q

Guilian-Barre

A

Rare neurological disorder where body’s immune system attacks its own peripheral nerves

Often follows viral/bacterial infection

3 / 100 000, mostly age 30-50

Results in inflammation of the myelin and blockage of nerve conduction

Motor, sensory, autonomic nerve failure

Acute symptoms can take place over few hours or days

Muscle weakness/paralysis
Difficultly breathing/swallowing
Inability to move eyes
Shortness of breath
Sensation may be affected

Severity of nerve damage range greatly, most experience ascending symmetrical muscle weakness in lower and upper extremity

Following acute onset of condition, most patients gradually improve and recover, but some are left with life long disability

Orthoses to aid in weakness (most commonly drop foot), prevent contracture

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22
Q

Haglunds Deformity

A

Bony Enlargement at the back of the heel

Also swelling and redness at back of heel

Most often leads to painful bursitis (inflammation of fluid filled sac between tendon and bone)

Soft tissue near the Achilles tendon insertion becomes irritated when bony enlargement rubs against shoes

“pump bump”

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23
Q

Hammer toes

A

Deformity of PIP joint of the 2nd, 3rd or 4th toe, causing it to be permanently bent, resembling a hammer

Most frequently results from wearing poorly fitting shoes
Having toes flex for long periods can cause muscles to shorten

Doctor can prescribe orthosis to push down on toes to force them to stretch out muscles

Physical therapy, shoes with soft spacious toe boxes, surgery

Related to claw toes
which is dorsiflexion of MTP joint and flexion of PIP and DIP

24
Q

Kohlers Disease

A

Rare pediatric bone disorder of the foot

Found in children between 6-9. typically boys

Avascular necrosis of the navicular

Navicular bone temporarily loses blood supply, Tissue in bone dies and bone collapses

Pain, tenderness and swelling in in-step

Treatment usually involves resting affecting foot, pain relievers, avoid putting pressure on foot

Sometimes cast that stops below the knee is worn for 6-8 weeks

When cast is taken off, patient prescribed arch support for 6 months

Once navicular returns to normal, symptoms abate

When treated, causes no long term problems in most cases

Rarely, can return in adults

25
Q

Legg Calve Perthes Disease

A

Childhood hip disorder

Initiated by a interruption of blood flow to the femoral head

Due to lack of blood flow, bone dies (avascular necrosis)

Healing occurs when new blood vessels revascularize dead bone, removing dead bone, however leads to loss of bone mass and weakening of head

Can lead to deformity of the femoral head
Secondary changes to the shape of the hip socket

Treatment - Traction

Muscle/ligaments around hip usually very tight
Cannot properly position head in acetabulum

Traction gradually stretches muscles allow femur to position itself well in socket

Secondly, child is casted or braced to hold position in place

Goals

Hold head of thigh bone in hip socket, so that head can remold itself in round shape
Permit limited joint ROM

Scottish Rite Orthosis
Toronto Legg Perthes Orthosis (tries to get internal rotation)
Trilateral socket hip abduction orthosis (ischial weight bearing)

Best success if child < = 6 yr old

26
Q

Median Nerve Palsy

A

Median nerve damaged

Caused by deep, penetrating injuries to the arm, forearm, or wrist

May also be due to blunt force trauma or neuropathy

Lack of ability to abduct and oppose thumb due to paralysis of the thenar muscles, “ape hand deformity”

Sensory loss in the thumb, index finger, long finger, and radial aspect of ring finger

Weakness in forearm pronation, wrist and finger flexion

ADLs difficult (brushing teeth, tying shoes, turning door knobs etc.)

Dynamic splint which pulls thumb into opposition can help prevent further deformity

Resting WHO maintains C-space

Thumb spica for function

Tendon transfers shown to be effective in restoring function

27
Q

Mortons Neuroma

A

AKA Morton’s metatarsalgia

Benign neuroma of an intermetatarsal plantar nerve

Most commonly between
2nd - 3rd
3rd - 4th

Characterized by pain and/or numbness when weight bearing

Burning, paresthesiae (tingling)

Direct pressure between the metatarsal heads will replicate the symptoms

As will compression of the forefoot between the finger and thumb, as to compress the transverse arch of the foot (Mulder’s sign)

Foot orthotics prescribed, arch support and metatarsal pad positioned under the space between the two affected metatarsals

Pad helps splay metatarsal bones, create more space for nerve so as to relieve pressure and irritation

Sometimes corticosteroids prescribed to relieve inflammation and to help end symptoms

28
Q

MRSA

A

Methicillin-Resistant Staphylococcus Aureus

Bacterium responsible for several difficult to treat infections in humans

Through process of natural selection, has become resistant to antibiotics

Weakened immune systems are at greater risk of infection than general public

Typically colonizes respiratory tract, open wounds, urinary tract, catheters

Can cause small red bumps accompanied by fever, rash can become deep, pus-filled boils

Can also infect vital organs and lead to widespread infection (sepsis), necrotizing pneumonia

29
Q

Osteogenesis Imperfecta

A

Congenital bone disorder

Genetic, 1 / 20 000 live births

Characterized by brittle bones that are prone to fracture, loose joints, poor muscle tone

Defective connective tissue, or absent ability to make it, usually Type I Collagen deficiency

8 Types

No cure

Treatment aimed at increasing overall bone strength to prevent fracture and maintain mobility

30
Q

Patella Femoral Syndrome

A

Pain caused by patella being pushed against side of femoral groove

Cause of pain often results from

Abnormal forces, increased pull of vastus lateralis relative to vastus medialis, with acute or chronic lateral patello femoral subluxation/dislocation)

OR

Prolonged repetitive compressive or shearing forces (running or jumping) on PF joint

Thinning and softening of articular cartilage under patella (chondromalacia) or medial or lateral femoral condyles

Synovial irration/inflammation
Subchondral bony changes in distal femur or patella

Typically seen in active populations (runners, bikers, basketball players etc.) presenting as localized anterior knee pain

Treatment, strengthen vastus medialis to balance out lateralis force

Rest

Orthosis
KO may allow patella to track better, reduce lateral drift of patella
FO arch support may reduce over pronation which reduces knee balgus

31
Q

Peripheral Vascular Disease

A

Obstruction of large arteries

Causes acute or chronic ischemia

Can result from atherosclerosis, inflammatory processes leading to stenosis/embolism/thrombus formation

Claudication- pain, weakness, numbness, cramping of muscles

Impaired healing
Sores, wounds, or ulcers heal slowly or not at all

Diminished hair growth and nail growth on affected limb and digits

Causes- smoking, diabetes, high cholesterol, hypertension

32
Q

Plantar Fascitis

A

Painful inflammatory process of the plantar fascia, connective tissue, or ligament on the plantar surface of the foot

Pain usually felt on underside of heel

Often most intense with first steps of the day

Overuse of plantar fascia

10% will experience it in their lifetime

Associated with long periods of weight bearing, hyper-pronated, flat feet

Also associated with heel spurs, small bony calcification on the calcaneus (plantar fasciitis causes spur no vice versa)

Trauma
Lack of fat pad
Abnormal biomechanics (over-pronation)

33
Q

Psoriatic Arthritis

A

Type of inflammatory arthritis that appears in people with skin disease psoriasis

10-30 % of individuals with psoriasis will get it

Cause unknown

Pain, swelling, warmth in joints

Swelling in fingers and toes

Pain in and around feet and ankles

Achilles tendinopathy/ Plantar Fasciitis

Extreme exhaustion that does not go away with adequate rest

Arthritis may be mild, or may progress to more destructive joint disease

No cure

34
Q

Radial Nerve Palsy

A

AKA wrist drop

Person cannot extend wrist, hangs flaccidly

Penetrating wound (at or below clavicle, damage to posterior cord which terminates as the radial nerve)
Humerus fracture
Lead poisoning
Repetitive injury, applying pressure along route of the radial nerve

Depending on level of lesion (diagnosis with nerve conduction test)

Inability to abduct shoulder beyond 15 degrees
Inability to extend forearm
Reduced ability to supinate hand
Reduced ability to abduct thumb
Sensory loss

Dynamic splint

35
Q

Reflex Sympathetic Dystrophy

A

AKA Complex regional pain syndrome (CRPS)

Intense burning pain, stiffness, swelling, discoloration that most often affects the hands

Arms legs pain can also be affected

2 Types

1 - occurs after an illness or injury that did not directly damage nerve in the affected area

2- follows a distinct nerve injury

Cause unknown, commonly occur after injury or surgery, pressure on nerve, infection, cancer, stroke etc.

Orthosis for protection?

36
Q

Sever’s Disease

A

AKA calcaneal apophysitis

Inflammation of growth plate at the back of the heel heel (wear Achilles attaches) of growing children, typically adolescents, during growth spurt

Pain in the heel

Caused by repetitive stress on achilles tendon, damages growth plate to heel

Thus particularly common with physically active children

37
Q

Shin Splints

A

AKA medial tibial stress syndrome

pain in lower part of leg between knee and ankle

caused by repeated trauma to connective muscle tissue surrounding tibia

Usually attributed to overloading of muscles of the lower extremities or to biomechanical irregularities

Muscle imbalance, inflexibility

Increasing activity/intesity/duration too quickly can lead shin splints

Tendons and muscles unable to absorb impact of shock forces as they fatigue

Disruption of Sharpey’s fibers connecting medial soleus fascia to periosteum of tibia, impact force eccentrically fatigues soleus, create tibial bending or bowing

Excessive pronation at subtalar joint is associated factor, causes tibial twisting and overstretching of lower extremity muscles

38
Q

Spondylosis

A

Degenerative osteoarthritis between center of spinal vertebrae and or neural foramina

As space between 2 adjacent vertebrae narrows, compression of nerve roots emerging from spinal cord can cause subsequent sensory/motor disturbances (radiculopathy)

Pain
Paresthesiae
Muscle weakness

Direct pressure on spinal cord can cause myelopathy

Global weakness
Gait dysfunction
Loss of balance
Loss of bladder/bowel control

Labelled by area of back involved (cervical, thoracic, lumbar)

39
Q

Spondylolysis

A

Defect of pars interarticularis of the vertebral arch

Fracture in thin piece of bone that connects upper and lower segments of the facet joints

Great majority of cases occur in lowest of lumbar vertebrae (L5), but can occur in other lumbar and thoracic vertebrae

May be asymptomatic for a long time

Symptoms often appear during teenage growth spurt, often those participating in sports involving hyperextension of back (gymnastics, weightlifting, football etc.)

Pain spreads across lower back
Generally worse with vigorous exercise or activity

Back orthosis for support (intraabdominal pressure) and prevention of flexion/anterior translation

40
Q

Spondylolysthesis

A

Spondylolysis with anterior translation of the superior vertebrae over the inferior one

41
Q

Tar Syndrome

A

Rare genetic disorder

Characterized by absence of radius bone in forearm

Dramatically reduced platelet count, can lead to bruising and potentially life-threatening hemorrhage

42
Q

Tibial Torsion

A

Inward twisting of tibia

Most common cause of intoeing

Medial torsion improves with time

Lateral torsion worsens

Can occur due to position of the baby in the uterus

Denis-Browne Bar worn at night

43
Q

Torticolis

A

Abnormal, asymmetrical, fixed or dynamic tilt, rotation or flexion of the head and/or neck

Variety of causes

Congenital- etiology uncertain, birth positioning
Damage to sternocleidomastoid muscle
Shortening, excessive contraction
Sometimes sternocleidomastoid tumor, may disappear but leaves musce fibrotic

Acquired
Muscular- pain to neck muscles (sternocleidomastoid, trapezius)
Tumors in base of the skull
Infections (ear, posterior pharynx)
Certain Drugs

TOT collar- irritant, encourages child to laterally flex and rotate to the opposite side
Soft PVC tubing with tubes positioned anterior and posterior to crest of the trapezius

44
Q

Triple Arthrodesis

A

Surgical procedure whose purpose is to

Relieve pain in the rear part of the foot
Improve stability of the foot
Correct deformity of the foot

Commonly carried out on patients with joint degeneration resulting from arthritis or severe flat foot deformity

Creation of a stable, balanced, plantargrade foot for ambulation

Fuses 3 main joints of the hindfoot:

Subtalar joint
Calcaneocuboid joint
Talonavicular joint

45
Q

Ulnar Nerve Palsy

A

Decreased sensation to little finger part of ring finger
Pain
Tingling, Numbness
Weakness

Cause
Illness that damages nerve
Direct trauma
Long term pressure on the nerve, could be caused by swelling or injury of nearby body structure

Froments Sign
Specifically test adductor pollicis (innervated by ulnar)
Patient holds flat object like piece of paper between thumb and index finger
Examiner attempts to pull object out of the subject’s hand

46
Q

Wind Swept Deformity

A

Describes abnormal valgus deformity in one knee in association with varus deformity in the other

May also occur at the hip
Abduction and external rotation of one hip with opposite hip in adduction and internal rotation, may occur in association with hip dislocation and scoliosis

47
Q

Ehlers Danlos syndrome

A

Inherited connective tissue disorder

Defect in collagen leading to hypermobility

Abnormal collagen renders skin, joints, muscles, ligaments, blood vessels more elastic

Severity of mild to life threatening

Joints may subluxate/dislocate easily, braces can help control ROM to prevent unnatural joint positions

Bracing also helps to support injuries/pain related to the condition

48
Q

Pectus Carniatum

A

AKA pigeon chest

Deformity of the chest characterized by a protrusion of the sternum and ribs (oppose is pectus excavatum)

Overgrowth of cartilage cause sternum to protrude forwards

Usually occurs

  • post open heart surgery, way that it heals
  • congenital
  • during male puberty growth spurt

Relatively common, Occurs 1/400

Heart and lung function may be affected
Associated with scoliosis
May be a cosmetic issue, self image

Customized orthosis
Direct pressure applied over protruding area can produce excellent outcomes
Front and back compression plates anchored to aluminum bars bound by tightening mechanism
Can be worn under clothes

49
Q

Peripheral Neuropathy

A

Damage or disease of nerves of the Peripheral nervous system

Causes
Diabetes
Alcoholism
Immune system disease
Infection
Trauma

Motor/sensory loss

50
Q

Plagiocephaly

A

Misshapen infant head

Develops in response to prenatal and postnatal force acting on infants head

Plagio- parallelogram shape
Scapho- long A-P
Brachy - wide M-L

Cause
Multiple births
First born
Premature birth
Vacuum/Forceps delivery
Torticolis
Sleep position preference

Flattened side corresponds with anterior positioning of ipsilateral ear and forehead

Appropriate time to treat with helmet is 4-6 months

Orthotist creates space between helmet and skull over short dimension

Infant’s head grows in path of least resistance

51
Q

Neurofibromytosis

A

Genetic disorder that disturbs cell growth in your nervous system

Causes tumor to form in nerve tissue, usually benign (non cancerous)

Possible symptoms

Bowed legs

Bone abnormalities (scoliosis)

Hypotonia

Motor Incoordination

52
Q

Parkinson’s disease (PD)

A

Degenerative disorder of the CNS

Result from death of dopamine generating cells in substantia nigra, region of midbrain

Lack of formation and activity of dopamine

Leads to Parkinsonism

Tremor
Rigidity- stiffness from increased muscle tone
Hypokinesia- decreased bodily movement
Bradykinesia -slowness of movement
Postural Instability
Difficulty walking

Cause is unknown

53
Q

Huntington’s Disease

A

Neurodegenerative genetic disorder

Affects muscle coordination and leads to cognitive decline and psychiatric problems

Chorea

Abnormal involuntary writhing movements

54
Q

Erb’s Palsy

A

Paralysis of arm caused by injury to upper group of brachial plexus, specifically upper trunk (C5-C6)

Most commonly occurs in infants due to difficult delivery (1-2/1000 live births)

  • forceps delvery
  • prolonged birth
  • breach birth

4 types

  • Neuropraxia- stretches but does not tear nerves, usually heals on its own
  • Neuroma - damages some nerve fibers, causes scar tissue that may impinge remaining tissue
  • Rupture - nerve torn, will not heal on its own
  • Avulsion - nerve torn from spinal cord, impossible to repair

Signs and Symptoms

  • paralysis of structures innervated by C5-C6 nerve roots, most commonly suprascapular, musculocutaneous, and axillary nerves
  • paralysis of subscapularis, deltoid, biceps, brachialis
  • loss of sensation of the arm
  • arm hangs, shoulder medially rotates, elbow extended, forearm pronated

Surgical treatment

Gunslinger brace

55
Q

Congenital Hip Dysplasia AKA Developmental Hip Dysplasia

A

Refers to continuum of abnormalities of the immature hip

Diagnosed after birth

Subluxation, Dislocation, Acetabular dyplasia (shallow acetabulum), Unstable hip (excessive laxity, prone to subluxation)

If left untreated can lead to painful debilitating degenerative arthritis

Exact cause not known, possible genetic predisposition

Ortholani Test- put back in, medially against greater trochanter audible clunk
Barlow’s Test- try to push out laterally and posteriorly against lesser trochnater

Hip flexion of 90 degrees and abduction of 45 is best to seat femoral head well into acetabulum

Pavlik Harness
Freika Pillow

Possible use of Scottish Rite Orthosis, for older ambulators

Treatment time 3,4 months

56
Q

Volksmann’s ischemic contracture

A

Lack of blood flow to forearm

Usually due to increased pressure from compartment syndrome

Trauma to the arm can also be a cause

Decreased blood flow causes muscle damage, leaves them scarred and shortened

Decreased sensation//weakness

MIld- contracture of 2 or 3 fingers
Moderate - all fingers flexed, thumb stuck in palm, loss of some feeling in hand
Severe- muscles in forearm that both flex and extend the wrist are involved

Orthotic Study (45 decks)

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