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CLIN MED EXAM 2 > Pathologies Related to the Upper Extremity > Flashcards

Pathologies Related to the Upper Extremity Flashcards

1
Q

What is a pancoast tumor?

A

Lung cancer in the apical region (less common)

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2
Q

What population has the highest occurrence of pancoast tumors?

A

men over the age of 50 with a smoking history

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3
Q

What are the PT implications of pancoast tumors?

A
  • Lung cancer S&S
  • Shoulder pain due to t2-4 shared innervation
  • compression of subclavian vein, ribs, vertebrae, neck/trunk motion, C8, T1 spinal nerves and median/ulnar nerve
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4
Q

What is the most common symptom of a pancoast tumor?

A

Shoulder pain in 90% of cases due to shared T2-4 innervation

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5
Q

What mechanical pain can happen with a pancoast tumor?

A

Ribs, vertebrae with neck and trunk motion

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6
Q

Where would we have possible decreased sensation with a pancoast tumor?

A
  • C8- middle and little finger
  • T1- little finger and medial forearm
  • Median nerve - 1st 3 and a half digits, lateral hand
  • ulnar nerve - 4th and 1/2 of 5th digit, medial hand
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7
Q

Where would we have possible fatiguing weakness and hand atrophy with a pancoast tumor?

A

C8 - ulnar deviation, 5th finger flexion, thumb extension

T1- 2nd finger flexion, thumb flx/abd, finger abd

Median nerve - pronation, wrist flexion, thumb flexion/abd

Ulnar nerve - wrist flexion, ulnar deviation, 4th and 5th digit flexion

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8
Q

What can be some PT implications for a pancoast tumor?

A

Compression on sympathetic ganglion
ipsilateral facial flushing and sweating
Horner’s syndrome
Respiratory S&S

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9
Q

What is unique about horner’s syndrome with pancoast tumors?

A

Pain in T2-4 dermatomal region due to shared spinal nerve innervation area of pancoast tumor

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10
Q

What is psoriatic arthritis?

A

A type of spondyloarthropathy

Persistent inflammation targets the entheses and gradually thickens and erodes tissue

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11
Q

What is the etiology of psoriatic arthritis?

A

Unclear genetic and environmental factors

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12
Q

What population is psoriatic arthritis most common in?

A

Those in their late 30s and 40s

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13
Q

Which is more common psoriatic arthritis or rheumatoid arthritis?

A

Rheumatoid arthritis

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14
Q

What are risk factors for psoriatic arthritis?

A

Psoriasis

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15
Q

What can be the issue with fibrous tissue and psoriatic arthritis?

A

Can fill in the joint space

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16
Q

What are some PT implications for psoriatic arthritis?

A

Spondyloarthritide S&S plus
- dactylitis
- enthesis

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17
Q

What is dactylitis?

A

Inflammation of entire digit aka “sausage digit”
- with psoriatic arthritis

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18
Q

What is enthesis?

A

DIPs more affected due to greated number of entheses and very little synovial tissue

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19
Q

What kind of referral is psoriatic arthritis?

A

Urgent referral

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20
Q

Where is the most common area of metastasis?

A

Lung

** esp from colorectal region

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21
Q

Why are the lungs the most common place for metastasis?

A

They are the first organ to filter malignant cells through the circulation route

22
Q

What are the risk factors for lung cancer?

A

Long term smoker

23
Q

What are clinical manifestations and S&S of lung cancer?

A

Cancer S&S
Cough / respiratory S&S

24
Q

Symptoms of lung cancer may not arise until the disease is ___________

A

widespread

25
Q

What is the MOST common symptom of lung cancer?

A

Cough

26
Q

What type of referral is lung cancer S&S?

A

Urgent

27
Q

What can growth of a pancoast tumor lead to? (what can it compress?)

A

Compression on sympathetic ganglion at. cervicothoracic junction

28
Q

What are some S&S of a pancoast tumor?

A

Ipsilateral facial flushing
Horner’s syndrome
- ptosis
- sunken eyeball
- lack of face sweating
- miosis (constricted pupil)
- possibly pain in T2-T4 dermatomal region due to shared spinal nerve innervation area of pancoast tumor

29
Q

Why are respiratory S&S rare with a pancoast tumor?

A

Smaller apical location of the tumor

30
Q

What are some common features and S&S of spondyloarthropathies / spondyloarthritides?

A

Autoimmune S&S
Multi-joint inflammation and pain
familial predisposition
Extraarticular involvement of eyes, skin, GI tract, and renal and cardiac systems

31
Q

What are some characteristics of the pain with spondyloarthropathies / spondyloarthritides?

A
  • more than 30 mins of pain and stiffness after prolonged positions
  • improved pain with easy and regualar movement
  • chronic inflammation and pain of axial skeleton
  • asymmetric or unilateral extremity involvement
32
Q

What can psoriatic arthritis and rheumatoid arthritis both do?

A
  • both damage joints causing swelling and stiffness
  • both can damage other tissues and organs
  • both are an autoimmune disease
33
Q

What is the prevalence of rheumatoid arthritis?

A

Onset from age 30-60
females more than males

34
Q

What is the etiology of rheumatoid arthritis?

A

Unclear genetic and environmental factors
Positive rheumatoid factor in blood tests

35
Q

What is the pathogenesis for RA?

A
  • Auto-immunne disease, breaks down all loose connective tissue throughout the body
36
Q

What structures are involved with RA?

A

all loose connective tissue

37
Q

What is the most common type of tissue in the body?

A

connective tissue

38
Q

What does connective tissue do?

A

Holds organs in place and attaches skin to underlying tissue

39
Q

Where can we find connective tissue typically?

A

In the synovial membrane of synovial joints

40
Q

What are RA clinical manifestations S&S?

A
  • May present like age related joint changes, hypermobility, or hypomobility
  • starts in smaller peripherial joints, typically the hands
  • tendon ruptures and deformities
  • Carpal tunnel syndrome
  • reduced grip strength
41
Q

What are some examples of tendon ruptures and deformities with RA?

A
  • Synovitis -> enlarged finger joints, particularly MCPs
  • Swan neck and Boutonniere deformities
  • Nodules and Spurring
  • Ulnar drift at wrist
42
Q

What part of the body can RA progress to?

A

Cervical spine

43
Q

What are PT implications of RA?

A

Proceed with caution

44
Q

What can we prescribe for RA?

A

orthotics
ergonomic education
JM

45
Q

What is contraindicated with RA?

A

Aggressive stretches

46
Q

What is the goal of orthotics/ ergonomic education with RA?

A

Unload involved cartilage / support joints
Prevent greater deformity / ROM loss

47
Q

What is the goal of JM with RA?

A

Cartilage integrity / joint mobility

48
Q

Why are JM contraindicated in advanced cases of RA?

A

Joint brittleness

49
Q

What kind of MET do we prescribe with RA?

A

Depends on timing and stage
- cartilage integrity
- stabilization
- joint mobility

50
Q

What is the prognosis of RA?

A

Progressive
Secondary OA changes inevitable
Development of joint instability, of particular concern in upper cervical spine

51
Q

What are some differences in RA and OA?

A
  • RA affects many joints, OA is local to a joint
  • RA symptoms are not related to movement, OA happens with movement changes
  • RA is whole body edema, OA is just the joint involved
  • RA is connective tissue disorder, OA is articular cartilage disorder

CLIN MED EXAM 2 (4 decks)

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