Pathology IV Flashcards
Tendonitis of what other two tendons commonly co-exists with supraspinatus tendonitis?
Infraspinatus and bicipital tendonitis
What are the three stages of Rotator Cuff Tendonitis?
Stage I: usually <25 years old, localized inflammation, edema, and minimal bleeding around rotator cuff
Stage II: progressive deterioration of tissues surrounding cuff and common in 25-40 year old patients
Stage III: end-stage, patients >40 years old, disruption or rupture of numerous soft tissue structures
What are the 3 types of scoliosis and are they structural vs. nonstructural?
what is structural vs. non-structural?
- Functional: from abnormalities in body that impact spine (leg length, muscle imbalance, poor posture)
- Nonstructural - Neuromuscular: developmental pathology resulting in alternations within structures of the spine (CP/Marfan’s)
- Degenerative: facilitated by osteophyte formation, bone demineralization, and disk herniation
Non-Structural: curves are flexible and corrected with lateral bending
Structural: curves are inflexible and do not reduce with lateral bending
In addition to strengthening exercises for the trunk and pelvic muscles what should also be included for a patient with scoliosis?
Breathing exercises
The curve does not typically progress is it remains less than 40 degrees by what time?
by the time of skeletal maturity
What is primary spinal stenosis?
Stenosis as the result of congenital malformation of spinal structures
what is the primary factor for the development of secondary spinal stenosis?
age
In addition to pain what other symptoms may be experienced with spinal stenosis (4)
- nerve root radiculopathy
- paresthesia
- weakness
- diminished reflexes
What is the medical term for “Clubfoot” and how does it present?
Talipes Equinovarus
Adduction of forefoot, varus of hindfoot, equinus of ankle
Varus is inversion (calcaneus tips in just like knee tips in with varus)
What structures pass through the tarsal tunnel (5)?
T: Tibialis posterior D: Flexor Digitorum Longus A: tibial artery N: tibial nerve H: flexor hallucis longus
What are some tension factors that could contribute to tarsal tunnel syndrome (2)?
- pes planus
2. hindfoot valgus
tarsal tunnel may be initially mistaken for what other diagnosis?
plantar fascitis
According to research what is one factor for why there may be a greater incidence of TMD in women?
gender specific hormones increase risk for TMD
What 4 symptoms are common with TMD?
- pain
- headache
- muscle spasm
- tinnitus
What type of fixation for a THA allows for immediate weight bearing and what type does not?
Cemented fixation allows for immediate WB and cementless does not
What muscles are cut with an anterolateral approach and what are the precautions? (4)
TFL and gluteus medius
Avoid
- hip flexion past 90
- extension of hip
- external rotation
- adduction
What muscles are cut with a direct lateral approach and what are the precautions? (4)
Longitudinal division of TFL and vastus lateralis and release of anterior portion of gluteus medius
Avoid
- hip flexion beyond 90
- extension of hip
- external rotation
- adduction
What muscles are cut with an posterolateral approach and what are the precautions? (4)
split glut max in line with muscle fibers, release short external rotators and hip abductors are retraction anterior (pulled forward)
avoid
- flexion past 90
- adduction
- medial rotation
What type of THA is most commonly used? Which type of THA approach has the highest dislocation rate?
Posterolateral approach is most used and has highest dislocation rate
Which THA approach keeps the abductor muscles intact? downside?
Posterolateral approach
Downside is that the posterior capsule is more unstable
What surgical method is preferred for patients that may be non-compliant?
Direct lateral approach
What is the most common TKA design in terms of stability: unconstrained, semiconstrained, and fully constrained?
semiconstrained - offers some degrees of stability without compromising mobility
What is the most common type of fixation with a TKA?
cemented
What is the minimum amount of knee flexion knee for daily activities for a TKA? What about to sit comfortably?
90 degrees for daily living
105 degrees to rise comfortably from a chair
What is a common pain pattern associated with an individual that requires a TKA?
night pain that is localized or diffuse
A noncemented TKA will be toe touch weightbearing for how long?
up to 6 weeks
What precautions should be followed for several months following a TKA? (4)
- avoid squatting
- avoid quick pivoting
- do not use pillow under knee while in bed
- avoid low seating
How long after TSA shoulder isometric shoulder exercises be initiated?
How long after TSA shoulder active shoulder exercises be initiated?
3 weeks for isometrics
6 weeks for active shoulder exercises
What is the precaution for IR/ER after TSA? for how long?
avoid any form of internal or external rotation beyond 35 to 40 degrees during the first 2-3 weeks post surgery
What is a shoulder hemiarthroplasty?
replacement of head and neck of humerus leaving the glenoid fossa intact
What part of the bone are osteosarcomas commonly located in?
Where is it commonly seen?
Metaphysis (growth plate)
Commonly seen in knee region
What are common signs and symptoms of an osteosarcoma?
symptoms include pain and swelling in extremity, with a mass in the femur or tibia. Pain may worsen at night
what is one difference in the etiology of Osteosarcomas and Ewing’s Sarcoma?
Osteosarcomas: they are an osteogenic sarcoma located in the metaphysis
Ewings: NON-osteogenic that infiltrates the bone marrow
What is a another term for peripheral artery disease (PAD)?
arteriosclerosis obliterans
Why does intermittent claudication typically present in the gastrocnemius-soleus complex?
high oxygen demand in the muscle
Where is the femoral trochanteric bursa located?
between the trochanteric process, gluteus medius, and the IT band
What passive and resisted motions will reproduce symptoms with Trochanteric Bursitis?
Passive hip external rotation and abduction
Resisted hip flexion and abduction
PT interventions for trochanteric bursitis should emphasize stretching what muscles? (4)
- TFL/IT band
- lateral hip rotators
- quadriceps
- hip flexors
An injury to the ulnar collateral ligament of the thumb is what type of force? Applied where?
names for it?
valgus force applied at the MCP
Gamekeepers and skiers thumb
What test is used to assess an ulnar collateral ligament sprain of the thumb and what is positive?
Ulnar collateral ligament instability test
(+) Valgus movement at MCP greater than 30-35 degrees indicates complete tear
What are the 3 types of THA approaches?
- Posterolateral
- Anterolateral
- Direct Lateral
Does arteriosclerosis obliterans affect small or large vessels?
small
