Pathologies Related to the Upper Extremity Flashcards
What is a pancoast tumor?
Lung cancer in the apical region (less common)
What population has the highest occurrence of pancoast tumors?
men over the age of 50 with a smoking history
What are the PT implications of pancoast tumors?
- 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
What is the most common symptom of a pancoast tumor?
Shoulder pain in 90% of cases due to shared T2-4 innervation
What mechanical pain can happen with a pancoast tumor?
Ribs, vertebrae with neck and trunk motion
Where would we have possible decreased sensation with a pancoast tumor?
- 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
Where would we have possible fatiguing weakness and hand atrophy with a pancoast tumor?
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
What can be some PT implications for a pancoast tumor?
Compression on sympathetic ganglion
ipsilateral facial flushing and sweating
Horner’s syndrome
Respiratory S&S
What is unique about horner’s syndrome with pancoast tumors?
Pain in T2-4 dermatomal region due to shared spinal nerve innervation area of pancoast tumor
What is psoriatic arthritis?
A type of spondyloarthropathy
Persistent inflammation targets the entheses and gradually thickens and erodes tissue
What is the etiology of psoriatic arthritis?
Unclear genetic and environmental factors
What population is psoriatic arthritis most common in?
Those in their late 30s and 40s
Which is more common psoriatic arthritis or rheumatoid arthritis?
Rheumatoid arthritis
What are risk factors for psoriatic arthritis?
Psoriasis
What can be the issue with fibrous tissue and psoriatic arthritis?
Can fill in the joint space
What are some PT implications for psoriatic arthritis?
Spondyloarthritide S&S plus
- dactylitis
- enthesis
What is dactylitis?
Inflammation of entire digit aka “sausage digit”
- with psoriatic arthritis
What is enthesis?
DIPs more affected due to greated number of entheses and very little synovial tissue
What kind of referral is psoriatic arthritis?
Urgent referral
Where is the most common area of metastasis?
Lung
** esp from colorectal region
Why are the lungs the most common place for metastasis?
They are the first organ to filter malignant cells through the circulation route
What are the risk factors for lung cancer?
Long term smoker
What are clinical manifestations and S&S of lung cancer?
Cancer S&S
Cough / respiratory S&S
Symptoms of lung cancer may not arise until the disease is ___________
widespread
What is the MOST common symptom of lung cancer?
Cough
What type of referral is lung cancer S&S?
Urgent
What can growth of a pancoast tumor lead to? (what can it compress?)
Compression on sympathetic ganglion at. cervicothoracic junction
What are some S&S of a pancoast tumor?
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
Why are respiratory S&S rare with a pancoast tumor?
Smaller apical location of the tumor
What are some common features and S&S of spondyloarthropathies / spondyloarthritides?
Autoimmune S&S
Multi-joint inflammation and pain
familial predisposition
Extraarticular involvement of eyes, skin, GI tract, and renal and cardiac systems
What are some characteristics of the pain with spondyloarthropathies / spondyloarthritides?
- 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
What can psoriatic arthritis and rheumatoid arthritis both do?
- both damage joints causing swelling and stiffness
- both can damage other tissues and organs
- both are an autoimmune disease
What is the prevalence of rheumatoid arthritis?
Onset from age 30-60
females more than males
What is the etiology of rheumatoid arthritis?
Unclear genetic and environmental factors
Positive rheumatoid factor in blood tests
What is the pathogenesis for RA?
- Auto-immunne disease, breaks down all loose connective tissue throughout the body
What structures are involved with RA?
all loose connective tissue
What is the most common type of tissue in the body?
connective tissue
What does connective tissue do?
Holds organs in place and attaches skin to underlying tissue
Where can we find connective tissue typically?
In the synovial membrane of synovial joints
What are RA clinical manifestations S&S?
- 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
What are some examples of tendon ruptures and deformities with RA?
- Synovitis -> enlarged finger joints, particularly MCPs
- Swan neck and Boutonniere deformities
- Nodules and Spurring
- Ulnar drift at wrist
What part of the body can RA progress to?
Cervical spine
What are PT implications of RA?
Proceed with caution
What can we prescribe for RA?
orthotics
ergonomic education
JM
What is contraindicated with RA?
Aggressive stretches
What is the goal of orthotics/ ergonomic education with RA?
Unload involved cartilage / support joints
Prevent greater deformity / ROM loss
What is the goal of JM with RA?
Cartilage integrity / joint mobility
Why are JM contraindicated in advanced cases of RA?
Joint brittleness
What kind of MET do we prescribe with RA?
Depends on timing and stage
- cartilage integrity
- stabilization
- joint mobility
What is the prognosis of RA?
Progressive
Secondary OA changes inevitable
Development of joint instability, of particular concern in upper cervical spine
What are some differences in RA and OA?
- 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
