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Pathophysiology for physiotherapy > Topic 4 - Metabolic, rheumatic and degenerative bone disorders > Flashcards

Topic 4 - Metabolic, rheumatic and degenerative bone disorders Flashcards

1
Q

Define myopathy

A

Muscle disease

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2
Q

Myopathy common symptoms

A

Weakness, pain, muscle enlargement or atrophy

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3
Q

List and describe inherited myopathies

A

Dystrophies - degeneration and regeneration.
Congenital myo. - microscopic muscle changes.
Mitochondrial myo. - defects in mitochondria.
Inflammatory myo. - autoimmune disease.
Metabolic myo. - defects in biochemical metabolism

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4
Q

List and describe acquired myopathies

A

Drug-induced/alcoholic - includes other toxic agents.
Dermatomyositis - muscle weakness and skin changes.
Polymyositis - inflammation of many muscles.
Inclusion body myositis - slow progressive weakness hand grip and knee extension.
Myositis ossificans.
Rhaldomyolysis and Myoglobinurias

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5
Q

Describe Fibromyalgia

A

Muscle and connective tissue pain.
Fatigue, sleep disturbances, joint stiffness.
Frequent co-morbidity with psychiatric conditions.

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6
Q

Describe Muscular dystrophy

A

Group of hereditary progressive, multisystem diseases.
Progressive muscle weakness, defects in muscle proteins, muscel cell/tissue death.
No cure

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7
Q

Describe Myasthenia Gravis

A 
Autoimmune neuromuscular disease. 
Fluctuating muscle weakness/fatigue. 
ACH receptors blocked. 
Progressive weakness during activity. 
Facial, postural, swallowing/chewing, breathing muscles all susceptible.
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8
Q

Osteogensis imperfecta

A 
Defective synthesis of type 1 collagen. 
Extreme skeletal fragility. 
Thin poorly developed bones. 
Short limbs and soft cranium with bifrontal prominences. 
Defective connective tissue
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9
Q

Define osteochondroses

A

Diseases of the joint where blood supply to a bone is disrupted, particularly the epiphysis.
Occurs in children and adolescents

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10
Q

Scheurermann’s Disease

A

Uneven vertebral growth -> wedging and Tx kyphosis.
Causes low/mis back pain.
Excessive Lx lordotic curve.
Often have tight hamstrings.

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11
Q

Legg-Calve-Perthes disease

A

Idiopathic osteonecrotic disease of proximal femoral epiphysis.
Unknown cause, associated with acute trauma.
Mani: short stature, hip knee groin pain, decreased hip ROM, thigh atrophy.

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12
Q

Osgood-Schlatter disease

A

Microfractures at pattella tendon insertion to tibial tubercle.
From growth spurts - bone longer than muscle length.
Mani: Front knee pain, swelling/tenderness, prominence on tibial tubercle.

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13
Q

Congenital Scoliosis

A

Failure of formation or segmentation

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14
Q

Neuromuscular Scoliosis

A

eg Cerebral palsy, Duchenne muscular dystrophy

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15
Q

Idiopathic Scoliosis

A

No cause. Grouped by age

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16
Q

Scoliosis Manifestations

A

Deformity - High shoulder, prominent hip, projecting scapula.
Usually painless.
Shortness of breathe.
GIT disturbances.

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17
Q

Define osteopenia

A

Reduction in bone mass greater than expected for age, race, gender.
Common to all metabolic bone diseases.

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18
Q

Osteoporosis risk factors

A

Personal - age, race, gender, family Hx, post menopausal.
Lifestyle - sedentary, smoker, nutrition.
Drugs/Diseases - RA, diabetes, corticosteriods
Hormones - Oestrogen, Growth factors,

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19
Q

Osteoporosis manifestations

A

Loss of minerilsed bone mass - loss of trabeculae/thinning of cortex.
Vertebral compression, wedging, collapse, kyphosis.
Fractures with less force.

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20
Q

Osteoporosis diagnosis

A

Bone mineral density scan - DEXA

Esp spine and hip joints.

21
Q

Osteomalacia vs Rickets Causes

A

Osteomalacia: Inadequate Ca absorption/intake, kidney issues, Coeliac.
Rickets: Lack of Vitamin D, inadequate Ca.

22
Q

Osteomalacia vs Rickets Manifestations

A

Osteomalacia: Weak bones, bone pain, muscle weakness, hypocalcemia, compressed Vx, bone softening, bendy bones.
Rickets: Dental problems, bone pain, skeletal deformities, growth disturbances, tetany, soft skull, hypocalcemia.

23
Q

Define Systemic autoimmune rheumatic disease

A

Group of 100+ chronic disorders.
Diffuse inflammatory lesions.
Degenerative changes in connective tissue.

24
Q

Rheumatoid arthritis - Features

A

Development of excessive blood vessel network in synovial membrane.
Destructive granulation tissue b/w cartilage and subchrondral bone.
Destroys cartilage and bone.
Decreased joint ROM - structural and pain

25
Q

Rheumatoid arthritis - Joint Manifestations

A

Pain/stiffness for more than 30mins.
Swollen, warm, tender joints.
Decreased ROM initially from pain, then fibrosis.
Joint deformity.
Progressive joint destruction that may lead to subluxation/instability.
Tendon tethering erosion and destruction of joint surface

26
Q

Rheumatoid arthritis - Organ manifestations

A

Lungs - fibrosis, Pleural effusions & rheumatoid lung disease.
Kidneys - Renal amyloidosis.
Heart/vessels - More prone to atherosclerosis, increase myocardinal infarction/stroke risk, Pericarditis, Endocarditis, L ventricular failure, Valvulitis and Fibrosis.

27
Q

Rheumatoid arthritis - Other manifestations

A

Haematological - Anaemia.
Neurological - peripheral neuropathy, carpel tunnel syndrome, atlanto-axial subluxation.
Constitutional - Fatigue, low grade fever, malaise, loss of appetite and weight.

28
Q

Rheumatoid arthritis - Treatment

A

No cure - symptomatic Rx.
Education, Rest (physical splints), Positioning posture body mechanics and shoes.
Therapeutic exercise, Heat/Cold.
Pharmacology: NSAIDs, corticosteriods.
Surgery - synovectomy, arthrodesis, arthroplasty.

29
Q

Define Seronegative spondyloarthropathies

A

Group of multi-system inflammation disorders.
Primary affect axial skeleton
Absence of rheumatoid factor (seronegative).

30
Q

Ankylosing spondylitis - Features

A

Pain and progressive stiffening of spine.
Inflammatory erosion of tendon/ligament attachment.
Ultimately destruction of bone or posterior fusion of the spine.
Usually in adolescence/early adult.

31
Q

Ankylosing spondylitis - Manifestations

A

Persistent or intermittent low back pain, worse with rest.
Prolonged stiffness after rest.
Progressive stiffening of spine.
Weight loss, fever, fatigue, interrupted sleep.
Decreased lung volume, ROM.
Loss of Lx lordosis -> increased Kyphosis and neck ext.

32
Q

Ankylosing spondylitis - Treatment

A

Symptomatic - control pain and mobility.

Positioning, Posture, extensor muscle strengthening, heat, hydro, NSAIDs.

33
Q

Osteoarthritis - Pathology

A

Change in cartilage architecture.
Progressive disruption of smooth surface.
Erosion articular cartilage, develop surface cracks.
Exposure of subchrondrial bone - dislodgement of fragments/free bodies.
Develop bone cysts, abnormal bony spurs at joint margins

34
Q

Osteoarthritis - Manifestations

A

Sudden/insidious onset.
Pain - aching, difficult to localise, worse with use, relieved by rest.
Crepitus/grinding.
Limited ROM, joint instability and enlargement.

35
Q

Osteoarthritis - Common sites

A

Hips, knees, Lx, Cx, PIP, DIP, 1st MTP, 1st MCP

36
Q

Osteoarthritis - Risk factors

A

Age, gender, race, obesity.

37
Q

Osteoarthritis - Treatment, non physio

A

No cure, symptom relief.
Pharmacological - NSAIDs, corticosteriod injection.
Surgical - Lavage and debridement, joint replacement, arthodesis.

38
Q

Osteoarthritis - Physio Management

A 
Supporting joint - strengthen muscle groups. 
Balance rest/activity. 
Splints/orthoses/walking aids. 
Heat/cold for muscle spasms. 
Weight reduction. 
Modifications of ADLs
39
Q

Fracture classifications

A 
Simple vs Compound.
Partial vs complete. 
Compression/impacted #. 
Comminuted # - 2+ pieces. 
Location, pattern of # line.
40
Q

Fracture causes

A

Sudden injury - most common, direct injury or force.
Fatigue/Stress # - Repeated wear on bone.
Pathologic # - Already weakened by disease or tumour.

41
Q

Fracture manifestations

A

Deformity of long bones - Angulation, shortening, rotation.
Pain, tenderness, swelling, loss of function.
Blood loss and hypovolemic shock.
Nerve function loss - numbness.

42
Q

Fracture treatment

A

Determined by nature of #.
Reduction - restoring bone to normal position.
Immobilisation - prevent movement. eg splints, casts.
Preservation - Rehab to restore function and ROM.

43
Q

Bone healing stage 1

A

Haematoma formation.
Fibrin network seals off # site.
Framework for inflammatory cells.
Develops capillary bed.

44
Q

Bone healing stage 2

A 
Fibrocartilaginous callus formation. 
Capillaries continue to develop. 
Tissue -> granulation tissue. 
Outside cells invade. 
Fibroblasts produce fibrocartilaginous soft callus bridge. 
Not strong enough for weight bearing.
45
Q

Bone healing stage 3

A

Bony callus formation.
Ossification = bridge -> boney callus.
Trabeculae produced, slowly reach # site until bony sheath covers it.
Replaced by mature bone, 3-4 weeks post injury.

46
Q

Bone healing stage 4

A

Remodelling.
Dead portions replaced/removed by osteoclasts.
Compact replaces spongy bone.
Minerised bone reorganised along mechanical stress.
May heal thicker than before #.

47
Q

Define malunion

A

Healing with deformity, angulation, rotation.
Visible on X-ray.
Poor reduction or alignment.

48
Q

Define delayed union

A

Failure of # to unite within normal period.

49
Q

Define nonunion

A

Failure to produce union, mobility at # site, pain on weight bearing.

Pathophysiology for physiotherapy (7 decks)

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