Summary on common pathologies/coniditions Flashcards
Osteoporosis Summary
- Increased bone resorption causes a decrease in bone density, brittle, weak bones
- More osteoclast activity than osteoblast
-Fractures in L and T spine. Distal arm, femoral neck - Do extension and core strengthening to improve postural stability
- AVOID flexion w/ resistance or deep flexion, heavy resistance, and ballistic movements. avoid rotation Too much stress in the spine due to flexion moment
- DO weight-bearing and resistance training as tolerated, aquatic therapy for conditioning but need WB/strengthening specifically (lunges, rows, leg press, etc.)
- Medications include calcium, Vit D. Raloxifene, Fosamax
- DEXA less than -2.5 is osteoporosis, -1 to -2.5 is osteopenia
Peripheral Arterial Disease
Narrowing of the lumen in blood vessels due to arteriosclerosis
- Intermittent claudication (cramping/pain, pallor w/ elevation and rubor in dependent position b/c blood flow is stuck due to occlusion), relieved with rest
- Other sx are Hair loss in the region, pain at rest, slow healing changes in skin color decreased temp, weakened pulse
- Higher risk for other circulatory issues
- Anticoagulants, anti platelets, thrombolytica to prevent clots
Exercise Program
4-6 weeks includes intermittent walking close point of max pain, then rest until fully relieved then repeat. Working up to 30 min straight. Include dynamics resistance and aerobics
=Leads to collateral circulation
For night sx, lift bed 4-6 inches for perfusion in legs
A type of PVD
Multiple Sclerosis
CNS disease with demyelination of neurons specifically in CNS. Impacts motor and sensory.
Sensitive to heat
Cognitive changes
Motor and sensory issues
Balance issues
Loss of coordination so closed chain exercise is better
Key sx - optic neurits (vision issues b/c optic nerve involved), UMN signs, weakness, coordination
Exercise 50-70% moderate intensity
Need breaks and days off
Alternate body parts within session
Type
- clinically isolated is first time and/or only time
- Relapsing remitting includes attacks followed by some level of recovery and no decline in between
- Secondary progressive is when it goes from relapsing remitting with recovery periods to constant decline aka disease progression-
- Primary progressive is when there is a constant decline throughout
Guillain-Barre Syndrome
-Often in response to infection
- RAPID onset with demyelination of peripheral nerves
- Distal to proximal weakness
- Decreased DTR, sensory disturbances
GBS typically involves rapid onset, bilateral ascending weakness or paralysis, as well as changes in sensation in a stocking-glove pattern (typically).
Myasthenia Gravis Summary
- Damage to neuromuscular junctions due to increase in anti-acetylcholine receptors
- Women ins 20s, 30s
- Cranial nerves impacted first= eye weakness, ptosis, chewing and facial weakness
- Proximal muscle like neck
- Severe fatiguing throughout day due to issues with nerve firing
- No UMN
Weakness in BULBAR muscles (difficulty speaking, chewing, swallowing).
Reflexes: Normal deep tendon reflexes.(PROXIMAL)
Timing: Symptoms worsen as the day progresses or with repetitive use.
Diagnostics:
Positive edrophonium (Tensilon) test (temporary improvement in weakness).
Electromyography (EMG): Decremental response with repetitive stimulation.
ptosis that may fluctuate, and often, muscles involving speech, chewing, or swallowing are affected, as well.
Osteoarthritis
Always consider age in diff dx
Heberden’s nodes in fingers (more distal than bouch)
Stiffness less than 30 min morning
NO TENS
Cauda Equina syndrome
Anything L2 and below including sacral levels
Bowel and bladder changes
More radicular pain than lower back (makes sense because more distal nerve roots)
Saddle anesthesia
Absent reflexes
GRADUAL AND UNILATERAL
Severe pain Spinchther dysfunction is later
Conus Medullaris syndrome
L1-L2 level
Greater lower back pain than radicular (makes sense b/c more proximal in lumbar region)
Hyperreflexia (UMN)
SUDEEN AND BILATERAL
Early change in sphincter
Juvenile Rheumatoid Arthritis
Similar to RA
16 years or younger, girls more than boys
The most common type is pauciarticular which includes 4 joints or less and is seen is girls 8 or younger, Asymmetrical
vs
more severe polyarticular JRA is symmetrical and more than 4 joints
Expect contractures and periarticular damage and symptoms
Expect less ROM in functional activities like gait
Diabetes
Understand that if uncontrolled, then concerns are hyperglycemia b/c no insulin so no uptake into muscles
But if controlled and taking insulin, then concern is hypoglycemia, especially with exercise b/c increased uptake into other tissues. Important to have carbs before or during exercise.
Horners syndrome vs bells palsy
Horners is Loss of sympathetic nerve function to one side of face causeds loss of sweat (anhidrosis), ptsosis, miosis (pupil size smaller)
Bells palsy is facial nerve palsy on one side
Spinal stenosis
Prefers flexion, not extension
Supine positioning and encouragement of core training in order to increase muscular support for the lower back would be recommended for a patient with spinal stenosis.
In patients with spinal stenosis, exercises that encourage low back extension should be avoided; therefore long-distance ambulation on a flat surface would not be the most appropriate exercise for the PT to recommend.
Duchenne Muscular Dystrophy
Fat and CT begin to replace muscle due to the mutation of the dystrophin
Stretch Hip flexors and plantar flexors
2-5 yo
Gowers maneuver
Fatty deposit (pseudohypertrophy in calf)
Rapid progression cant walk by 10
hamstrings become contracted, not the quadriceps
No limitations in range of motion are typically noted before 5 years of age in children who have Duchenne muscular dystrophy. By age 8, the deficits listed would be clearly present. The normal lordotic standing posture is increased, and winging of the scapulae is seen as compensation to keep the center of mass behind the hip joint to promote standing ability.
Tensor fasciae latae contractures
Myelopathy
LMN at the level of lesion
UMN below the lesion
BL involvement (both motor and sensory)
Poly neuropathy
Motor, sensory, and autonomic changes BL in distal regioins
CRPS 1 vs 2
- (no known nerve injury)
- (known nerve injury)
Stage 1 - Hyperalgesia, allodynia, hyperpathia , edema, sweating, thin shiny skin
Stage 2 - pain gets worse Everything from stage 1 plus nail changes
Stage 3 - Cont to worsen, hardening, cool, dry, cyanotic skin, osteoporosis, anklylosis
RA
related to cervical myelopathy
Gold therapy with methotrexate (DMARD)
MCP POP bilaterally
Progressive muscle weakness
Stiffness greater than 30 min
Swan neck and boutinneires
Low impact activity due to lig laxity
AA instability due to damage to transverse ligament of c spine
DONT stretch swollen joints
Modailites, gentle massage, immobilize
PROM AAROM within limits of pain
Cerebellar disease
Does not do UMN signs like babinski
Just ataxia tone, coordination etc.
Pagets Disease
Metabolic bone disorder
Drug therapy required
PT is for joint and bone protection strategies
Impacts spine, pelvis, femur, skull, tibia
Osteogenesis Imperfecta
Type 1: Mildest. A little fragile fractures (normal life)
Type 2: worst. Dies in vitro or early childhood. Many deformities
Type 3: Severe Notable signs are triangular face and bleu sclera, many diff deformities
Type 4: Mild but still mild signs and symptoms, fractures, brittle teeth, barrel rib cage, etc. (normal life expectancy)
In general they are hypermobile, joint laxity, and osteoporosis etc.
Interventions is all about safety, stability etc.
Oshgood Slatters interventions
Patellofemoral syndrome
Stair climbing, jumping, and prolonged sitting make it worse
They have increased Q angle
Normal Q angle 13 for men 18 for women
Strengthen glutes especially post-lateral , use orthotics to prevent overpronation
Mob for medial glide patella
NO deep squats
Patellar taping for tracking
Diff than patellar tendonitis (overuse injury)
Lyme Diseases
Bullseye rash
Large joints effected like knee
Myofascial pain syndrome vs fibromyalgia
MPS = Localized trigger points with referred pain (to unrelated regions)
Fibromyalgia = fatigue generalized tendon points, IBS, sleep issues
Psoriatic arthritis
SIlvery scaly knees., elbows
Skin rash red spots
Mouth ulcers
Symmetrical distal arthritis like fingers and toes
Reactive arthritis
= Reiters syndrome
Autoimmune due to bacterial and venereal diseases including Chrons
Dactylyitis = sausage swelling in fingers
DO NOT STRETCH SWOLLEN JOINTS
Cant see (conjunctivitis)
Cant pee
Cant bend the knee
Somatoform Disorders
Conversion - Real mental condition leads to physical symptoms
Malingering - Made up symptoms (fabricated)
Waddell signs help detect the faker
Tenderness test
Simulation test
Distraction test
Not reflective of neuroanatomy
Body dysmorphic disorder
Huntington disease
Causes unwanted movements (chorea)
Progressive hereditary
Excessive motor excitation
BG atrophy
Issues with voluntary movements
Choreic movements
“Cerebellar like issues”
Treated with anticonvulsants, and agents to block dopamine
Auditory curing for gait, sx based
Charcot-Marie-Tooth disease (CMT)
is a group of genetic conditions that affect the nerves in the body, including the nerves in the hands and feet.
Uncontrolled diabetes vs diabetic ketoacidosis
Given this patient’s relevant past medical history of DM and current status, it is more likely that this patient is experiencing uncontrolled DM. The patient reports an increase in thirst and urination, along with sensory changes in the hands and feet. That, along with the PT’s observation of poor wound healing, makes this the most likely diagnosis in this case.
Diabetic ketoacidosis is a life-threatening state and would require immediate medical intervention. Patients experiencing ketoacidosis often present with a fruity odor to their breath and may be confused - they may also appear flushed and have an elevated temperature. This patient has symptoms that are more consistent with uncontrolled DM rather than this emergency state.
Duchenne Muscular Dystrophy
Signs
- Gowers sign
- Weak hip ext
- Tight hip flex, gastroc
- pesudohypertrophy of calves
- Lorddosis
Fat and CT replace muscle
Dx 2-5 yo
Cannot ambulate by age 8-10
Death by 20 usually if not they are not functional, require power wheelchair
Understand disease will progress rapidly, cant walk by 10
Interventions focused on maintaining what they do have and staying as independent as possible
Spondy
Lumbar flexion will not reverse lordosis b/c actual slippage
extension makes worse b/c more pressure on slippage area.
stepp off derformity
NO EXTENSION
Abdominal strengthing and stabilization are key
Ankylosing Spondylitis = Marie- Strumpell Disease
Men 20-40 most liekly
Spine and large peripheral joints affected with inflammation and fibrosis
Starts with low back and extends t thoracic, cervical, impacting posture, flattening back, hip contractures ], etc. can impact chest breathing
Other systematic. issues later on cause is systemic.
POSTURAL EXCERCISES WITH EXTENSION TO WORK ON POSTURE, like osteoporosis
Low impact exercises with extension and rotation are GOOD unlike spondy and unlike osteoporosis
AvOID high impact flexion activities like osteoporosis
Swimming highly recommended
No surgery
= Similar interventions to osteoporosis except add extension
actually may lead to osteoporosis
UNLIKE spondy
Varying prognosis, may stay to one area, but not a death sentence
Breast Cancer
May be asymptomatic when only at breast
Usually upper quadrant for woman
or behind areola (dark part around nipple)
Symptoms symptoms of metastasizing include bone pain, upper extremity edema and weight loss. A mammogram graph is used to detect the mass. Physical therapy interventions would be lymphedema management post, surgical breathing exercises, positioning, pain, management strengthening, and endurance activities on a case by case basis metastasizing locations are typically the lungs and bony skeleton.
Diabetes
Oshgood slotters
Limit stress and strain so stop jumping running squatting for a while, and do flexibility exercises.
PCL
No HS for 6 weeks
Scoliosis
25-40 orthosis
40 and up surgery
Breathing restrictions on opposite side of curve
TSA with subscap involvement
Think avoid ant capsule strss/ subscap by avoiding extension and ER
Slap tear dont
contract or stretch biceps
Mallet finger
Extensor tendon damaged, splint should be in slack
Gamekeepers thumb vs skiers
Both UCL of thiumb involved, gamekeepers is chronic, skiers is acute as makes sense with name.
Metatarsialgia
Use meal tarsal bar to transfer force off joint to shaft
Rocker bar
for metatarsal head pain and related to terminal stance. Rocking helps.
Parkinsons
Strengthen antigravity muscles
