pathologies related to knee - exam 3 Flashcards
what is DVT
partial or complete occlusion of a vein by a clot
causes of DVT:
conditions involving at least two of the following:
- venous stasis
- hypercoagulability
- damage to the venous wall
risk factors of DVT
prior DVT
hx of cancer, CHF, or lupus
major infection, surgery, or trauma
present chemo, immobility, pregnancy
use of oral contraceptives
genetic clotting disorder
> 60 years
3rd most common cardiovascular disease
DVT
where are DVTs most commonly found
LE deep veins
popliteal, femoral, tibial, peroneal
DVT is the most preventable cause of _____
DVT is the most common cause of ______
hospital related death
readmissions and death after THA/TKA
pathogenesis of DVT
greater exposure of platelets and clotting factors to damaged venous wall
fibrin, leukocytes, erythrocytes adhere and form thrombus
DVT prevention and treatment per MD direction
early and regular exercise
anticoagulants
compression stockings
intermittent pneumatic compression devices
avoid SAD
eliminate persistent smoking and drinking
true or false. ~50% DVTs asymptomatic in early stages
true
S&S DVT
gradual onset of dull ache, tightness, & P! in calf
edema, possibly pitting (70%)
increased calf girth
calf pain and tenderness (50%)
– Worsened with walking and calf down
possible warmth and redness
referral for DVT
urgent if </= 17% probability of DVT with </= 2 CDR
emergency if 75% probability of DVT with >/= 3 CDR
DVT may lead to:
pulmonary embolism
cause of pulmonary embolism
DVT that moves and lodges into smaller artery supplying lungs
risk factors for PE
same as DVT
what is known as “the great masqueraders”
PE
S&S of PE
respiratory S&S –> SOB, wheezing, rapid breathing
pleuritic chest P! - sudden, sharp and stabbing chest P! exacerbated by:
- deep inspiration
- coughing
- mechanical pain due to lung fascia attaching to ribs and thoracic vertebra (trunk motion, UE motion, thoracic & rib accessory motion testing)
blood with cough
painful breathing at rest
fainting
tachycardia and palpitations
referral for PE per CDR
urgent if < 2/6
emergency if ≥ 2/6
what is PAD
ischemia leading to symptoms in the most distal area from the blocked artery most often the calf
PAD most often found in the ____
LEs
risk factors of PAD
≥ 45 years
family hx of MI or sudden death before 55
recent or current smoker
physical inactivity
metabolic syndrome
pathogenesis of PAD
atherosclerosis or plaque build up in aa that also promotes vascular constriction thus further limiting circulation
symptoms begin once 50% of a. is narrowed
S&S of PAD
intermittent claudication
- LE P! most often the calf, with a similar amount of activity and elevated positions
- bilateral or unilateral
- relieved with rest and dependent positions
- cramping, weakness, pressure or aching
S&S distal to ischemic area of PAD
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, P! may also occur ____
at rest and create sleep interruptions
what test should you perform with PAD to assess the post. tibial/brachial systolic BP in all 4 extremities
** invalid with HTN
ankle brachial index cuff test in supine
what is an abnormal ABI result
< .9 (the lower the worse dz)
>/= 1.4 (poorly compressed veins due to hardened artery from atherosclerosis)
how could you differentiate calf pain due to PAD vs stenosis
bicycle test (lean forward goes away = stenosis)
how do you differentiate DVT vs PAD
DVT which is more painful in a dependent position and relieved with elevation
referral of PAD
urgent to vascular MD
what is osteochondritis dissecans
damage to subchondral bone
incidence/prevalence of osteochondritis dissecans
rare
younger boys through early adulthood
males
medial femoral condyle and talus
etiology of osteochondritis dissecans
mostly unknown
joint rotational or shearing trauma like a sprain
pathogenesis of osteochondritis dissecans
ischemia (AVN) then separation of subchondral bone from convex and weightbearing end bones
overlying articular cartilage can remain visible
S&S of osteochondritis dissecans
may be asymptomatic with incidental imaging
if symptomatic, persistent pain not progressing as expected
may progress into severe pain if fragment displaces with joint locking, catching and swelling
S&S of osteochondritis dissecans: hypermobility of involved ligament but with persistent ARJC
- ROM:
- resisted:
- stress tests:
- palpation:
- limited and painful, part. w ext
- may be weak and painful, part. at end range ext
- compression likely (+)
- TTP over femoral condyle
referral of osteochondritis dissecans
urgent to MD
osteochondritis dissecans may take 2-3 years to revascularize and heal due to the following:
higher BMI
deficient passive restraints
muscle imbalances
impaired proprioception
PT implications for osteochondritis dissecans
protection to avoid separation of subchondral bone and articular cartilage into the joint (joint mouse)
non-operative management for stable lesion
surgery for resurfacing or fixation needed for unstable lesion
what is reactive arthritis aka Reiters syndrome
acute, infection at site remote from the primary infection (spreads unlike septic arthritis)
risk factors of reactive arthritis
IV drug users
high sexual activity
infrequent pelvic examinations
weaker immune system
incidence/prevalence of reactive arthritis
targets larger joints in the LE and primarily knee and ankle
etiology of reactive arthritis
most commonly from respiratory infection
may occur from GI, genitourinary, and colon infections
pathogenesis of reactive arthritis
bacteria stimulates antibody and protein factor production that creates inflammation and tissue damage leading to an arthritic joint
S&S of reactive arthritis
begin 1-4 weeks after reccent infection
infection S&S
autoimmune S&S
may progress to incapacitating illness
PT implications of reactive arthritis
- observation:
- vitals:
- scan/biomechanical exam:
- redness, swelling
- temp
- like for ARJC
TTP and warmth
swollen and tender lymph nodes
referral for reactive arthritis
urgent to MD
