pathologies related to k ee Flashcards
Deep vein overview
*Overview- partial or complete occlusion of a vein by a clot
*Risk Factors/Etiology
-50% unknown
-Conditions involving at LEAST two of the following:
1.Venous stasis
2. Hypercoagulability
3.Damage to the venous wall
*Possible contributors
-Prior DVT
-Hx of cancer, CHF, or lupus
-Recent and major infection, surgery, or trauma
-Present chemotherapy, immobility, or pregnancy
-Use of oral contraceptives or hormone therapy
-Clotting disorder
-> 60 yrs. of age
Incidence and prevalence of deep vein thrombosis
*3rd MOST common cardiovascular dz
*< 2% of cases following THA/TKA2
*MOST common in LE deep veins (90%)
what are Pathogenesis
of Deep vein thrombosis
*Greater exposure of platelets and clotting factors to damaged venous wall
*Fibrin, leukocytes, and erythrocytes adhere and form thrombus
*Basically, the reparative process goes bad
Deep vein thrombosis
*DVT Prevention and Treatment per MD direction
-MOST preventable cause of hospital related death
-Early and regular exercise
-As prevention for sure
-May need to wait on anticoagulant therapy to take effect to avoid a PE from motion with treatment
*Anticoagulants
*Compression stockings
*Intermittent Pneumatic Compression devices
*Avoid SAD
*Eliminate persistent smoking and drinking
what are PT implications and *Clinical manifestations and S&S of DVT?
- Hx including
~50% asymptomatic in early stages
Typically, gradual onset of dull ache, tightness, and P! in the calf with prior mentioned risk factors
*See CDR including:
Edema
-Likely pitting (70% of patients)
-Increased calf girth
Calf pain and tenderness
-50% of patients
-Worsened with walking and possibly with dependent positions; why?
-Less and less relief with rest and elevation as condition worsens
Possible redness and warmth
How would you assess for these findings?
CDR example…
Deep vein thrombosis PT Implications
*Referral to MD per CDR
-Urgent if ≤ 17% probability of DVT with ≤ 2
-Emergency if 75% probability of DVT with ≥ 3
*A “Do Not Want To Miss” condition
*May lead to Pulmonary Embolism which is…?
Etiology and Pathogenesis Pulmonary embolism
- DVT that moves and lodges into smaller artery supplying the lungs
-Risk Factor- similar as for DVT
Pulmonary embolism PT Implications Clinical manifestations and S&S
*Often non-specific… “the great masqueraders”
*MOST common
-SOB, wheezing, and/or rapid breathing may be the only symptom
-Pleuritic chest P! (T2-4 shared innervation)- sudden, sharp and stabbing chest P! possibly exacerbated by:
-Deep inspiration
-Coughing
-Mechanical pain may occur due to lung fascia attaching to ribs and thoracic vertebra
-Trunk motion
-UE motion
-Thoracic and rib accessory motion testing
what is Pulmonary embolism: PT Implications
Other clinical manifestations and S&S
*Bloody cough
*P!ful breathing at rest
*Fainting
*Tachycardia and palpitations
*Referral per CDR
-Urgent if < 2/6
-Emergency if ≥ 2/6
Peripheral arterial disease
*Overview- ischemia leading to symptoms in the MOST distal area from the blocked a.
*Incidence/Prevalence- MOST often in LEs and in calf
*Risk Factors/Etiologies
-≥ 45 yrs. of age
-Family hx of MI or sudden cardiac death before 55 yrs.
-Recent or current smoker
-Physical inactivity
-Metabolic syndrome
*Pathogenesis
-Atherosclerosis or plaque build up in aa that also promotes vascular constriction thus further limiting circulation
-Symptoms begin once 50% of a. is narrowed
What should be some S&S?
Peripheral arterial disease PT Implications
Clinical Manifestations and S&S
*Intermittent claudication
-LE P!, MOST often the calf, with walking and elevated positions
-Unilateral or bilateral
-Often described as cramping but also may be weakness, pressure, or aching
-Relieved with rest and dependent position
Peripheral arterial disease PT Implications
Clinical Manifestations and S&S
-Distal to ischemic area
-Loss of pulses
-TTP
-Muscle atrophy and weakness
-Loss of hair
-Cool and bluish skin
-Bruit on auscultation
-Possible necrosis/wound
-In the presence of SEVERE ischemia, the P! may also occur at rest and create sleep interruptions
Peripheral arterial disease PT Implications
Clinical Manifestations and S&S
*Ankle Brachial Index cuff test in supine
*Assess posterior Tibial/Brachial SYSTOLIC BP in all 4 extremities
–Invalid with hx of HTN
–Divide ankle by brachial pressure
*Abnormal
-< .9 (the lower the worse the dz)- LR+ = 1.6-7.6; LR- = .0-.86
-≥ 1.4 (aa. unable to be compressed vv. due excessive hardening from atherosclerosis)
Example on next slide
Peripheral arterial disease PT Implications
Clinical Manifestations and S&S
*Differential diagnosis
-Lumbar stenosis with Bicycle Test
-DVT which is more P!ful in a dependent position and relieved with elevation
-What could be a MSK cause of calf pain?
Urgent referral to vascular MD
Osteochondritis dissecans
*Overview- changes to subchondral bone
*Incidence/Prevalence
-Rare
-MOST common in…
… younger biological boys through early adulthood
… in medial Femoral condyle and Talus
Etiology
*MOSTLY unknown
*Joint rotational or shearing trauma, like a sprain; think about it? Who can describe these pathomechanics?
Osteochondritis dissecans Pathomechanics and pathogenesis
*Fracture to subchondral bone involving cortical plate and cancellous bone
*Possible ischemia (AVN) then separation of subchondral bone from convex weightbearing end of bones
*Overlying articular cartilage can remain viable
Osteochondritis dissecans PT Implications
Clinical manifestations and S&S
*Persistent pain, not progressing as expected
*May progress into severe pain if fragment displaces with joint locking, catching, and swelling
*S&S of hypermobility/instability of involved ligament but with persistent age-related joint-like changes
Osteochondritis dissecans PT Implications
Clinical manifestations and S&S
*S&S of hypermobility/instability of involved ligament but with persistent age-related joint like changes
*Scan
-ROM- limited and painful, particularly with ext
-Resisted/MMT- may be weak and painful, particularly at end range ext
-Compression likely (+) and distraction relieving
*Biomechanical Exam
-Stability tests (+) for specific ligament(s)
-TTP over femoral condyle
Urgent referral to MD- BEST imaged by MRI
Osteochondritis dissecans
*May take up to 2-3 years to revascularize and heal if the following joint stresses are present:
-Higher BMI
-Deficient passive restraints
-M. imbalances
-Impaired proprioception
*Protection to avoid separation of subchondral bone and articular cartilage into the joint
-aka a joint mouse
-Common at the knee
-Loss of joint joint surface congruency
*Non-operative management for stable lesion- Rx as joint hypermobility/instability with Age-related Joint Changes
*
Surgery for resurfacing or fixation needed for unstable lesion
Reactive arthritis
Overview
-Aka Reiter’s Syndrome
-Acute, infection at a site remote from the primary infection
-Septic arthritis is an infection at the site of primary infection
*Risk Factors
-IV drug users
-High sexual activity
-Infrequent pelvic examinations
-Weaker immune system
*Incidence/Prevalence- targets larger joints in the LE and primarily the knee and ankle
Etiology
-MOST commonly from a respiratory infection
-Also, may occur from GI, genitourinary, and colon infections
Reactive arthritis
*Pathogenesis- bacteria stimulates antibody and protein factor production that creates inflammation and tissue damage leading to an arthritic joint
*PT Implications
-Clinical manifestations and S&S
-Begin 1-4 weeks after a recent infection
-Infection S&S
-May progress to incapacitating illness
Reactive arthritis, PT Implications
Clinical manifestations and S&S
*Observation
–Redness
–Swelling
*Vital signs- temperature
*Scan and Biomechanical Exam
-Like for Age-related Joint Changes
-Palpation
–TTP and warmth
–Swollen and tender lymph node(s)
Urgent referral to MD
