Pathology of musculoskeletal system

Question 1

What patient population is more predisposed to Achilles tendinitis

Answer 1

Patients with limited flexibility and strength in the gastroc and Soleus complex pronated or cavus feet

Question 2

Who is more likely to have adhesive capsulitis?

Answer 2

• Patients with diabetes
• women more than men
• individuals between 40 and 60 years old

Question 3

Should you avoid during treatment with a patient diagnosed with adhesive capsulitis?

Answer 3

The therapist should be mindful of overstretching and increasing pain intensity. May lead to an increased loss of motion

Question 4

What is congenital hip dysplasia?

Answer 4

Malalignment of the for moral head within the acetabulum which develops during the last trimester need a Roo
- clinical presentation asymmetrical hip abduction with the tightness for moral shortening on involves side positive or Ortilani, Barlow or diagnostic ultrasound

Question 5

And congenital torticollis lateral cervical flexion will happen on which side of the contracture?

Answer 5

Lateral cervical flexion will be on the same side as a contracture rotation will be to the opposite side-
child may have facial asymmetry’s

Question 6

How is congenital torticollis initially managed?

Answer 6

Emphasis on stretching active range of motion positioning and education

• surgical management occurs when conservative has failed past one year of age
• surgical release can be followed by physical therapy

Question 7

Subluxation and dislocation are considered to be part of glenohumeral instability what is the difference between the two?

Answer 7

Subluxation :feeling of popping paresthesia sensation of feeling dead positive apprehension test capsular tenderness

Dislocation: severe pain paresthesias limited range of motion weakness visible shoulder fullness I am supported by other side

Question 8

What are the three test that can be used to identify impingement syndrome?

Answer 8

___ tests—

Signs and symptoms include deep pain in the shoulder pain with overhead activity painful arc of motion within 70 to 120° of EF duction positive impingement sign tenderness over greater to tuberosity and bicipital Grove

Question 9

What are signs and symptoms of systemic juvenile rheumatoid arthritis

Answer 9

Occurs in 10 to 20% of cases

• acute onset with high fevers, rash
• enlargement of the spleen and liver
• inflammation of the lungs and heart

Question 10

What are the signs and symptoms of polyarticular juvenile rheumatoid arthritis

Answer 10

• Accounts for 30 to 40% of JRA cases
• high female occurrence
• arthritis in more than four joints with symmetrical joint involvement

Question 11

oligio articular Juvenile rheumatoid arthritis

Answer 11

or Pauarticular JRA accounts for 40 to 60% of cases

-affects less than five joints with asymmetric all joints involvment

Question 12

Lateral epicondylitis affects which muscles?

Answer 12

Eccentric loading of the wrist extensor muscles usually the extensor carpi radialis brevis leads to pain
- most commonly seen in 30 to 50 years of age

Question 13

What is leg calve Perthes disease?

Answer 13

Degeneration of the femoral head due to disturbance of blood supply; avascular necrosis

• 4 stages consist of condensation fragmentation ratification and remodeling
• patient will show decreased range of motion antalgic gait the positive Trendelenburg sign

Question 14

Will wait and bearing and rotation all forces increase or decrease meniscus tear related symptoms

Answer 14

increase

-

Question 15

Is osteoarthritis more common in men or women? What is the typical population this affects?

Answer 15

• More common in men than women up to age 55
• more common in women later on in life
• risk factors overweight fractures other joint injuries occupational or athletic overuse

Question 16

What is osteogenesis imperfecta

Answer 16

Connective tissue disorder affecting collagen formation during bone development four classifications vary in level of severity

• Genetic causes types 1 and 4 are autosomal dominant
• type 2 and 3 are considered Autosomal Recessive

-signs/ symptoms include pathological fractures osteoporosis hyper mobile joints bowing of long bones weakness scoliosis and impaired respiratory function

Question 17

Physical therapy management of osteogenesis imperfecta includes

Answer 17

• Focus on active range of motion emphasis on symmetrical movement positioning, functional mobility, fracture management, use of orthotics,
• severe cases require wheelchair prescription and training

Question 18

Patients with patella for moral syndrome or chondromalacia patella will demonstrate increased or decreased tibial torsion or femoral anteversion?

Answer 18

Will show increased tibial torsion and tomorrow anteversion

Question 19

Who is more at risk for developing patella for moral syndrome

Answer 19

• Females individuals experiencing growth spurt’s
• runners who have recently increase mileage
• overweight individuals

Question 20

Signs and symptoms of patellofemoral syndrome

Answer 20

Anterior knee pain 
pain with prolong sitting
 swelling
 crepitus 
pain when going up and downstairs

Question 21

Rehabilitation of patella femoral syndrome includes

Answer 21

Strengthening of the vastus medialis oblique 
Medial patellar glides
 lower extremity Flexibility exercise 
help pain control 
 Patellar  taping

Question 22

Where does the PCL connect to an originate from

Answer 22

The PCL runs from the posterior intercondylar of the tibia to the lateral aspect of the medial femoral condyle in the intercondylar notch

Question 23

Who is most likely to have rheumatoid arthritis

Answer 23

Women 40 to 60 years old

Question 24

A patient presents with tenderness in her hand with morning stiffness, decrease in appetite, increase fatigue, swan neck deformity and boutonniere deformity, And fever what could be her diagnosis?

Answer 24

Rheumatoid arthritis these are symptoms and signs that could be present for a patient who had rheumatoid arthritis

• may initially occur at any joints but it’s common in small joints like hand foot and ankle wrist
• Swan neck deformity: DIP flexion PIP hyperextension
• Boutonniere: DIP extension PIP flexion

Question 25

How long will a patient be in a sling who has a large rotator cuff tear?
When will they return to functional activity requiring dynamic overhead motion?

Answer 25

• May be in a sling for 4-6 weeks of immobilization

- may return to functional activity within 9 to 12 months

Question 26

What is the difference between functional neuromuscular and degenerative scoliosis

Answer 26

• Functional scoliosis: indirect impact to the spine such as leg leg discrepancy, muscle inbalance, poor posture. Also known as non-structural scoliosis
• neuromuscular scoliosis: seen in patients with cerebral palsy or marfans syndrome. results in alterations within the structure of the spine
• Degenerative scoliosis occurs in normal aging facilitated by changes such as osteophyte formation bone demineralization and disc herniation

neuromuscular and degenerative scoliosis considered to be forms of structural scoliosis; Inflexible and do not reduce with lateral bending

Question 27

Who is more at risk for developing a scoliosis curve greater than 30°

Answer 27

girls

-However boys and girls between 10 and 13 years are at similar risk for developing a mild current of 10° or less

Question 28

Which point in scoliosis is a breeze or surgical intervention considered

Answer 28

• Scoliosis curve between 25 and 40° or treated with a spinal orthosis
• curves greater than 40° require surgical intervention

Question 29

What is a tailpes equinovarus

Answer 29

clubfoot deformity; heal points downwards and the forefoot points inwards

Question 30

What type of medical conditions are often associated with the need for a total hip arthroplasty

Answer 30

OA
RA
osteomyelitis
avascular necrosis

Question 31

What are surgical precautions for a Antero lateral approach for a total hip

Answer 31

Access to his occurs through the interval between the TFL and glutamine portion of hip abductors earliest so the hip may be dislocated
- Avoid flexion beyond 90° extension external rotation and addduction

Question 32

Surgical precautions for the direct lateral approach for a total hip replacement

Answer 32

This approach spares posterior soft tissues and instead requires longitudinal division of TFL vastus lateralis with release of anterior gluteus medius

• Minimizes probability of dislocation and may be ideal for noncompliant patients
• precautions avoid hip flexion beyond 90° ,extension external rotation and adduction

Question 33

What are the surgical precautions for a Postero lateral approach for total hip replacement

Answer 33

Access to hip occurs by splitting gluteus maximus.

• Gluteus medius / vastus lateralis integrity maintained
• percautions: Flexion past 90, internal rotation and adduction

Question 34

What are the different types of total knee arthroplasty replacements

Answer 34

unicompartment bicompartmental and tricompartment indicate different replacement areas; Medial or lateral joint surfaces both. Tricompartmental includes replacement of tibia and femur with patella

• Implant design also classified by degree of constraint
• Unconstrained design offers no stability and relies on soft tissue integrity for stability used for unicompartmental arthroplasty
• Semi constrain design is most often used some degree of stability without compromising mobility
• Fully constrained design offers most ability but restricts one or more planes of motion results in greater implant stress and problems

Question 35

Patient in rehab for post total knee arthroplasty what are the minimum knee flexion requirements

Answer 35

Minimum of 90° for ADLs

105° to comfortably rise from sitting

Question 36

What are surgical and rehab considerations for a laminectomy

Answer 36

• Usually performed in the presence of disc patrician or spinal stenosis
• Removal of entire lamina spinous process and associated ligamentum flavum= complete And results in less stability
• Partial laminectomy equals removal of one lamina
• posterior approach used
• Rehab considerations: restrictions on weight that can be lifted and active motion especially extension

Question 37

What are surgical and rehab considerations for a spinal fusion

Answer 37

• Indicated with actual pain due to unstable spinal segments advanced arthritis or uncontrolled peripheral pain
• Vertebrae fused together with bone graft usually from iliac crest
• predicle screws are used to immobilize segments while a callus forms
• Cervical fusion uses into your approach lumber fusion uses posterior approach
• Mobility at one segment leads to hyper mobility at adjacent segments which can increase on de generation
• Rehab considerations outpatient PT begins about six weeks after surgery sooner if instrumentation is not used for aggressive approach
• emphasis that placed on proper body mechanics posture and core stabilization

Question 38

What are surgical and rehab considerations for a Total shoulder arthroplasty

Answer 38

Total shoulder performed when joints are arthritic secondary to fracture or rotator cuff.

• Total shoulder replaces glenoid and humeral components
• hemi arthroplasty replaces only one of those components
• Reverse total shoulder used when rotator cuff is dysfunctional.
• Reverse total shoulder reverses concave convex relationship.
• All total shoulder arthroplastys involve anterior approach with subscapularis detached for easy access
• Rehab Considerations: subscapularis is protected by avoiding ER and extension, avoid resisted IR
• Patient may use sling for several weeks or longer if repair involves tendons

Question 39

What are surgical and rehab considerations for a Sub acromial decompression

Answer 39

Surgical considerations:

• Round when conservative PT has not worked for impingemnt
• Approach may be anterior; deltoid is detached mini open; deltoid is split or arthroscopic
• Procedure could include acromioplasty, bursectomy, removal of distal clavicle if degenerated, and release of coraco acromial ligament

Rehab considerations: But recovery sling is used one to two weeks

• Early rehab emphasis on pain control gentle range of motion and strength training later
• If Deltoid repair was performed passive extension is avoided initially to protect repair site.
• Treatment focus also on interventions to reduce likelihood of impingement return; posture, strengthening, scapular upward rotators

Question 40

What are surgical and rehab considerations for a rotator cuff repair

Answer 40

Surgical considerations:

• Graded according to depth (partial V full )and width: Small >1cm, Medium1-3cm, Large 3-5cm, massive>5cm
• Small tears may be managed with debridement
• larger, likely require repair with approximation and fixation with sutures, anchors, tacks, staples
• Open, open mini, arthroscopic approach is available

Rehab considerations:

• Patient will be immobilized in a sling for several weeks with abduction pillow.
• Passive and active ROM initially with strength later.

Question 41

What are surgical and rehab considerations for a Shoulder stabilization surgery

Answer 41

Surgical considerations:

• Capsular shift procedure used with chronic shoulder instability. Blush by tightening the capsule by cutting and overlapping ends traduce redundancy.
• Electrothermally assisted capsular shift procedure uses heat to shrink and tighten capsule
• Capsule is tightend depending on direction of instability’ anterior instability most common; anterior capsule is most often tightened.
• Labral repairs repaired often; labral tears often occur with dislocation
• Bankart repair; repairs the anterior labrum.
• Slap repair fixes the superior labrum.
• If procedure is open then subscap muscle is detached

Rehab considerations:
If anterior capsule is repaired ER, extension, horizontal abduction, Resisted internal rotation (If sub scab was detached) is avoided
-Patient will be immobilize in the “shake hand position” if posterior capsule is repaired To maintain neutral rotation
-posterior repair precautions : avoiding IR, flexion and horizontal adduction
-AROM begins soon after surgery
- PT should not wait for full AROM before beginning strength exercises.
- Do not be too aggressive with full motion early.
-Slap tear repair; patient should avoid contracting or stretching biceps because biceps attaches to superior labrum

Question 42

What are surgical and rehab considerations for a hip ORIF

Answer 42

Surgical considerations:
Fracture is common in the femoral neck or intertrochanteric region
-Femoral neck fx are intracapsular, may disrupt blood supply to femoral head.Osteonecrosis and nonunion are common
-Intertrochanteric hip fractures or extracapsular do not affect blood supply implant failure is more of an issue because fixation need is greater
-Dictation method depends on fracture location, pt fxn level and displacement
-Total hip replacement is considered for older patients with poor healing capacity.
-Surgery is always open procedure depending on approach TFL,Glut Med, vastus lateralis may be affected

Rehab considerations:

• Weight-bearing early as possible some weight-bearing restrictions are based on age.
• Early rehab includes ambulation range of motion isotonic strengthening is postponed until muscles have been given chance to heal
• Fractures of the greater trochanter will affect gluteus media’s lesser trochanter fracture’s will affect Ilios so as.
• Be aware of fixation failure; persistent thigh or groin pain, new leg length discrepancy, positioning of limb in ER or Trendelenburg that does not improve with strengthening

Question 43

What are surgical and rehab considerations for a Surgical management of articular cartilage defect

Answer 43

Surgical considerations:

• Procedure may include micro fracture to penetrate subchondral bone causing an in growth of fibrocartilage
• Osteochondral auto graft transplant; cartilage harvested from non-weight bearing surface to form plug to fill defect
• Autologous chondrocyte implantation; healthy cartilage is harvested and cultured to grow then implanted into cartilage defect

Rehab considerations:

• WB restrictions likely in place depending on size and location of Legion.
• Weight-bearing restriction adherence is critical for healing.
• Patient will be in brace usually locked into extension.
• ROM progression varies depending on lesion extent.
• Large lesions require slow progression.

Question 44

What are surgical and rehab considerations for ACL reconstruction

Answer 44

Surgical considerations:

• Bone patellar graft is gold standard; uses bone to bone healing, considered stronger with good fixation.
• Gracils and or semi tendinosis is also common, fixation not as strong due to tendon to bone healing

Rehab considerations:
Phase 1 : immobilization with hinged brace locked in extension WB restrix. Brace is unlocked with good quadriceps control is achieved. ROM interventions emphasis on knee/ hamstring ex. Strength occur soon after surgery includes isometric quadricep strengthening hamstring and CKC.
-OKC exercises between 0 to 45° of flexion or avoided due to excess graft stress.
-Hamstring graft should be considered during strengthening exercises
-patellar tendon bone graph may have anterior knee pain; be cautious with quad strengthening
-Graph tissue most Bonable 6 to 8 weeks post surgery.
-Tendon transforms into ligamentous tissue and becomes weak before stronger. Graft failure occurs to poor compliance with protocol.
-Good percent graft maturation occurs 12 to 16 months postop sport return possible at six months
-Return to sport criteria: quad strength 85 to 90% , hamstring strength 90 to 100% functional testing 85 to 90% of oppostie leg.

Question 45

What are surgical and rehab considerations for a PCL

Answer 45

Surgical considerations:
-Less common than ACL tears.
-If PCL occurs in isolation surgery is not needed.
-Surgery indicated if pain or instability does not improve with therapy
- graph similar to ACL surgery
Rehab considerations:
-Protocol is similar to ACL.
-WB Progression is more gradual
-Exercises should limit posterior sheer force.
-Repetitive knee flexion should be avoided

Question 46

What are surgical and rehab considerations for a Meniscus repair

Answer 46

Surgical considerations:

• Partial meniscectomy; chosen for older patients with inner 2/3 of meniscus is torn and healing capacity is poor
• This repair; chosen for young patients, meniscus is sutured, performed when tear is in outer third

Rehab considerations:
Meniscus repair; restricted WB and brace. Limitation on progression of ROM specifically flexion.
Partial meniscectomy; patient is full WB no brace.
- No rehab restrictions rehab time is quick

Question 47

What are surgical and rehab considerations for a Lateral ankle reconstruction

Answer 47

Surgical considerations:

• Performed after complete tear of anterior talo fibular ligament or CF calcaneofibular ligament or chronic ankle instability
• Ligament repair or auto graft is used.
• Autographed used when original ligaments cannot be repaired due to deterioration.
• Surgery may include arthroscopy or some kind of drilling due to high percent of unstable ankles with chondral lesions

Rehab considerations:
-Protective cast for one week, NWB.
Walking cast/ boot for several read weeks after bracce. Progression to partial WB and full WB when in walking boot.
-Inversion will play stress and repair tissues. Brace may be required long-term if patient returns to sport or high-level activity
-Therapy does not begin soon after surgery early rehab focus on increase of ROM and tissue protection

Question 48

What are surgical and rehab considerations for a Kelly’s tendon repair

Answer 48

Surgical considerations:

• Graft may use flex your house is longest Pernice Brothers plantaris.
• If used if tendon unable to be sutured together soon after initial injury

Rehab considerations:

• Initially patient will be kept casted into slight plantar flexion
• NWB for several weeks. Transitioned to cast/boot and ankle neutral for PWB.
• Knee rehab approach considers ankle casted in neutral and PWB much sooner. Leads to less motion restriction long-term.
• Avoid active plantar flexion until tendon is well healed