Week 6

Question 1

Define Neoplasm

Answer 1

New or abnormal growth of cells (same as Tumor but does not indicate if benign or malignant)

1) can present as MSK pain initially
2) extreme consequences if missed
3) when pt doesn’t respond to therapeutic interventions and exhibit bone or night time pain that disrupts sleep. Check for Neoplasm

Question 2

What is needed to diagnose primary MSK tumors?

Answer 2

Biopsy

Question 3

Explain “Oma” and give examples

Answer 3

Oma: tumor (usually benign)

Exceptions:
1) sarcoma: CT malignancy
2) carcinoma: epithelial tissue malignancy
3) myeloma: hematopic tissue malignancy
4) lymphoma: lymph tissue malignancy
5) glioma: malignancy of NS

Question 4

Explain benign

Answer 4

1) resembles normal tissue
2) well differentiated (cells look like intended tissue)
3) do not invade
4) low growth potential
5) still potentially problematic

Question 5

Explain malignant

Answer 5

1) abnormal cells
2) not well differentiated (loose appearance of intended tissue)
3) likely invasive
4) growth potential

Question 6

What is the most common way to have a bone tumor?

Answer 6

Secondary spread from another tissue

Question 7

Why is bone a common place for metastases?

Answer 7

High vascularity and high metabolic activity

Question 8

Is bone secondary neoplasm benign or malignant?

Answer 8

Always malignant

Question 9

Give some examples of bone metasteses

Answer 9

(Bone is the third most common location for “Mets” behind lung and liver)

It usually spreads hematogenous.
Ex: Brest -> pelvis, ribs, prox femur
Lung -> brain, bone

Question 10

What bone tumors are benign/malignant? And where do they affect bone?

Answer 10

1) Osteoid osteoma: (BENIGN) local persistent pain at diaphysis
2) Osteoblastoma: (BENIGN) local pain at metaphysis
3) Osteochondroma: (BENIGN) lump or sell at metaphysis
4) Osteosarcoma: (MALIGNANT): pain and swell at metaphysis
5) Chondrosarcoma: (MALIGNANT) swell and hard growth on metaphysis
6) Ewing sarcoma: (MALIGNANT) pain and swelling on long shaft of bon, diaphysis

Question 11

List the etiology, pathogenesis, diagnostics, and clinical presentation (signs & symptoms) of Osteochondroma

Answer 11

Pathogenesis: (35%) Most common benign bone tumor of bone. The tumors take the form of cartilage capped bony projections or outgrowth that can occur in any bone where cartilage forms bone. It mostly affects
long bones (distal femur, prox humerus, prox tibia) stops growing when skeletalmaturity
1. Etiology:
* Benign bone tumor formed from cartilage (cartilegous cap) overgrowth near epiphyseal plates
* Self limiting when pt reaches skeletal maturity
2. Pathogenesis:
* Abnormal growth of cartilage leads to the formation of a bony protrusion (exostosis) (90%)
* Most common primary neoplasm of bone (35%).
3. Clinical Presentation (Signs and Symptoms):
* Often asymptomatic, detected incidentally.
* Painless, hard, immobile mass near a joint.
* Possible pain or discomfort if it compresses nearby tissues, nerves, or blood vessels.
* commonly long bones (distal femur, prox humerus, prox tibia)
4. Diagnostics (Labs, Imaging, and Other Methods):
* X-ray: Initial imaging to visualize bone structure and location of exostosis.
* MRI/CT scan: Assess soft tissue involvement or complications (e.g., nerve or vessel compression).
* Biopsy: Rarely needed, only if malignancy is suspected.

Question 12

List the medical/surgical, precautions & red flags, and PT management of Osteochondroma

Answer 12

5. Medical and Surgical Treatments/Medications:
   
   • non unless it creates an issue like impingement or NS impairment
6. Precautions and Red Flags:
   
   • Sudden increase in size, pain, or functional impairment could suggest malignant transformation (rare, but possible into chondrosarcoma).
   • Nerve compression symptoms: numbness, tingling, or weakness.
   • Vascular compression signs: swelling or changes in limb color.
7. Physical Therapy Management:
   
   • Post-surgical rehab to restore joint function and strength.
   • Stretching and strengthening exercises for adjacent muscles.
   • Joint mobility and proprioception training.
   • Monitoring for recurrence or complications, especially post-surgery.

Question 13

List the etiology, pathogenesis, diagnostics, and clinical presentation (signs & symptoms) of Osteoid Osteoma

Answer 13

1. Etiology: (10% of benign tumors)
   
   • Benign bone tumor commonly affecting long bones.
   • Occurs more frequently in males, typically active and younger than 25 yo.
2. Pathogenesis:
   
   • A small, oval shaped sclerotic lesions of bone (reactive lesions)
   • Most commonly affects the cortex of bones like the femur and tibia.
3. Clinical Presentation (Signs and Symptoms):
   
   • Localized pain, at diaphysis
   • Pain is typically relieved by NSAIDs (e.g., aspirin).
   • Swelling or tenderness may be present at the tumor site.
   • NO POTENTIAL to convert to malignancy
4. Diagnostics (Labs, Imaging, and Other Methods):
   
   • X-ray: Shows a small radiolucent nidus with surrounding sclerosis.
   • CT scan: Best imaging for visualizing the small nidus.
   • MRI: Helps assess soft tissue involvement.
   • Bone scan: Shows increased uptake at the site of the lesion.

Question 14

List the medical/surgical, precautions & red flags, and PT management of Osteoid Osteoma

Answer 14

5. Medical and Surgical Treatments/Medications:
   
   • Conservative treatment: NSAIDs for pain relief, often effective due to the tumor’s inflammatory nature. (MAINLY JUST MANAGING SYMPTOMS)
   • Radiofrequency ablation: Minimally invasive procedure to destroy the nidus.
   • Sometimes needs Surgical removal: Indicated if pain is unmanageable or if there are complications.
6. Precautions and Red Flags:
   
   • Persistent or worsening pain despite NSAIDs may indicate a need for further intervention.
   • Sudden changes in symptoms or neurological signs suggest possible complications.
7. Physical Therapy Management:
   
   • Post-surgical rehabilitation if resection or ablation is performed.
   • Pain management strategies if the patient is undergoing conservative treatment.
   • Focus on restoring full function and range of motion in the affected limb.
   • Strengthening exercises to support the affected area, especially after surgical procedures.

Question 15

List the etiology, pathogenesis, diagnostics, and clinical presentation (signs & symptoms) of Osteoblastoma

Answer 15

1. Etiology: (2% of bone tumors)
   
   • Rare Benign bone tumor arising from osteoblasts (bone-forming cells).
   • More common in males, typically affecting adolescents and young adults (ages 10-30).
   • Often found in the spine, sacrum, or flat bones.
2. Pathogenesis:
   
   • Tumor produces osteoid and immature bone, leading to a slowly growing mass.
   • Larger and more aggressive than osteoid osteoma and less responsive to NSAIDs.
3. Clinical Presentation (Signs and Symptoms):
   
   • Dull, persistent pain not relieved by NSAIDs (in contrast to osteoid osteoma).
   • Pain at metaphysis
   • In spinal lesions: may present with scoliosis, nerve root irritation, or neurological symptoms (e.g., numbness or weakness).
   • 1 variant is a border line malignancy like osteosarcoma
4. Diagnostics (Labs, Imaging, and Other Methods):
   
   • X-ray: Radiolucent lesion with possible sclerosis around the tumor.
   • CT scan/MRI: Better visualization of tumor size, location, and surrounding soft tissue involvement.
   • Biopsy: Often required to confirm the diagnosis and differentiate from more aggressive lesions.

Question 16

List the medical/surgical, precautions & red flags, and PT management of Osteoblastoma

Answer 16

5. Medical and Surgical Treatments/Medications:
   
   • Surgical removal (curettage): Treatment of choice to completely remove the tumor and prevent recurrence.
   • Spinal fusion or stabilization: May be necessary if the tumor compromises spinal stability.
   • Radiotherapy: Rarely used, only in cases where surgery is not feasible.
6. Precautions and Red Flags:
   
   • Progressive pain, deformity, or neurological symptoms suggest urgent evaluation.
   • Risk of recurrence after surgery, though lower than in more aggressive tumors.
   • Sudden onset of neurological deficits (especially in spinal lesions) requires immediate attention.
7. Physical Therapy Management:
   
   • Post-surgical rehab to restore strength, range of motion, and function.
   • Spinal rehabilitation programs if the spine was affected (e.g., posture correction, core strengthening).
   • Pain management strategies, including stretching and strengthening exercises.
   • Monitoring for any signs of recurrence or complications post-surgery.

Question 17

List the etiology, pathogenesis, diagnostics, and clinical presentation (signs & symptoms) of Osteosarcoma

Answer 17

1. Etiology: (35% of all malignant bone tumors. most frequent behind myeloma)
   
   • Extremely Malignant bone tumor (sclerotic lesion). most common in adolescents and young adults (under 30 yo)
   • Typically affects long bones (femur, tibia, humerus), especially near growth plates.
   • Risk factors include genetic syndromes (e.g., Li-Fraumeni, retinoblastoma), prior radiation therapy, and rapid bone growth.
2. Pathogenesis:
   
   • associated with active epiphyseal growth
   • Can invade nearby tissues and metastasize (commonly to lungs).
3. Clinical Presentation (Signs and Symptoms):
   
   • Progressive bone pain, often worse at night or with activity.
   • Swelling, tenderness, and possible palpable mass over the affected bone.
   • Limited range of motion or functional impairment if near a joint.
   • Pathologic fractures in weakened bones.
   • Systemic symptoms like fever, weight loss, or fatigue in advanced cases.
4. Diagnostics (Labs, Imaging, and Other Methods):
   
   • X-ray: Shows a destructive lesion with mixed radiolucent and radiopaque areas, often with a “sunburst” pattern or Codman’s triangle (periosteal reaction).
   • MRI: To assess tumor extent and soft tissue involvement.
   • CT scan: Especially for checking lung metastases.
   • Bone scan: For detecting bone metastases.
   • Biopsy: Required to confirm diagnosis and determine tumor grade.

Question 18

List the medical/surgical, precautions & red flags, and PT management of Osteosarcoma

Answer 18

5. Medical and Surgical Treatments/Medications:
   
   • Surgical resection with limb salvage and chemotherapy
   • 5 year survivability (70-80%) if addressed before metastasis
   • Medications: Pain management, antibiotics if infection complicates surgical recovery.
6. Precautions and Red Flags:
   
   • Persistent, unexplained bone pain should be evaluated for possible malignancy.
   • Sudden increase in pain, swelling, or fracture requires immediate attention.
   • Post-surgical complications: infection, poor healing, recurrence, or metastasis (lung surveillance is crucial).
7. Physical Therapy Management:
   
   • Post-surgical rehabilitation to restore mobility, strength, and function.
   • Prosthetic training if amputation occurs.
   • Range of motion exercises to prevent contractures.
   • Gradual strength and endurance training, depending on surgery type.
   • Pain management strategies and psychosocial support due to the emotional impact of the diagnosis and treatment.

Question 19

List the etiology, pathogenesis, diagnostics, and clinical presentation (signs & symptoms) of Chondrosarcoma

Answer 19

1. Etiology: (second most common solid malignancy of bone)
   
   • slow growing, Malignant tumor of neoplastic cartilage cells. (Produces cartilage in bone resulting in lesion of long bone)
   • Common in males (40-60 yo)
   • Can arise de novo or from pre-existing benign cartilaginous lesions (e.g., enchondroma, osteochondroma).
2. Pathogenesis:
   
   • Abnormal proliferation of cartilage cells leading to tumor formation.
   • Slow-growing, but can be aggressive in higher-grade forms.
   • Primarily affects the pelvis, femur, shoulder girdle, and ribs.
3. Clinical Presentation (Signs and Symptoms):
   
   • Deep, dull pain that progressively worsens over time.
   • Swelling or palpable mass, often painless initially.
   • Limited range of motion or joint stiffness if near a joint.
   • Rarely, neurological symptoms (e.g., numbness or weakness) if the tumor compresses nerves.
   • Fractures may occur if the bone becomes weakened by the tumor.
4. Diagnostics (Labs, Imaging, and Other Methods):
   
   • X-ray: Shows a radiolucent area with possible calcifications, “popcorn” or “ring-and-arc” pattern of calcification.
   • MRI: Best for assessing soft tissue involvement and extent of the tumor.
   • CT scan: To evaluate bone destruction and lung metastases.
   • Biopsy: Necessary for definitive diagnosis and to determine tumor grade.

Question 20

List the medical/surgical, precautions & red flags, and PT management of Chondrosarcoma

Answer 20

5. Medical and Surgical Treatments/Medications:
   
   • Wide surgical resection with limb salvage.
   • Chemotherapy/Radiation: Generally ineffective for low- to intermediate-grade chondrosarcoma but may be considered for high-grade or metastatic cases.
   • 80% survivability with diagnosis prior to metastasis
   • Medications: Pain management with analgesics.
6. Precautions and Red Flags:
   
   • Persistent, worsening pain, especially at rest or night, should raise suspicion.
   • Any palpable mass that enlarges over time or causes functional impairment needs evaluation.
   • Post-surgical monitoring for local recurrence, as the tumor may recur even years after treatment.
   • Watch for metastasis, most commonly to the lungs.
7. Physical Therapy Management:
   
   • Post-surgical rehabilitation to restore function and mobility.
   • Strengthening and range-of-motion exercises tailored to the affected area.
   • Pain management strategies and gradual reintroduction to weight-bearing activities.
   • Gait training and balance exercises if limb function is compromised.
   • Psychosocial support and patient education regarding the importance of follow-up and monitoring for recurrence.

Question 21

List the etiology, pathogenesis, diagnostics, and clinical presentation (signs & symptoms) of Ewing’s Sarcoma

Answer 21

1. Etiology:
   
   • Malignant bone and soft tissue tumor, primarily affecting under 20 yo (average age is 15 yo)
   • Non osteopenia primary tumor
   • Caused by a specific chromosomal translocation, most commonly t(11;22), which results in the EWSR1-FLI1 fusion gene.
2. Pathogenesis:
   
   • Tumor arises from primitive neuroectodermal cells, affecting bones (especially long bones, pelvis, and ribs) and surrounding soft tissues.
   • Aggressive tumor with potential for early metastasis, especially to lungs and bone marrow.
3. Clinical Presentation (Signs and Symptoms):
   
   • Localized bone pain that presents in pelvis and LE
   • Swelling, tenderness, and sometimes a palpable mass.
   • Systemic symptoms: fever, fatigue, weight loss, and anemia.
   • Pathologic fractures may occur due to bone weakening.
   • In advanced cases, symptoms related to metastasis (e.g., respiratory issues if lung metastases).
4. Diagnostics (Labs, Imaging, and Other Methods):
   
   • X-ray: Shows a destructive lesion with a characteristic “onion-skin” or layered periosteal reaction.
   • MRI/CT scan: Provides detailed visualization of the tumor’s extent and soft tissue involvement.
   • Bone scan: Used to check for bone metastasis.
   • Biopsy: Required for definitive diagnosis; genetic testing confirms the specific chromosomal translocation (t(11;22)).
   • Blood tests: Can show anemia or elevated inflammatory markers (e.g., ESR).

Question 22

List the medical/surgical, precautions & red flags, and PT management of Ewing’s Sarcoma

Answer 22

5. Medical and Surgical Treatments/Medications:
   
   • Chemotherapy: Initial treatment to shrink the tumor and address micrometastases.
   • Surgical resection: Wide excision of the tumor if possible; limb-sparing surgeries are preferred, but amputation may be necessary in some cases.
   • 5 year survivability up to 80% if caught before metastasis
   • Medications: Chemotherapy drugs include vincristine, doxorubicin, cyclophosphamide, and ifosfamide/etoposide combinations for treatment.
6. Precautions and Red Flags:
   
   • Persistent bone pain or swelling should be evaluated, especially in children and adolescents.
   • Watch for symptoms of metastasis (e.g., respiratory problems, fatigue).
   • Post-treatment complications: infections, impaired wound healing, and long-term effects of chemotherapy (e.g., infertility or secondary cancers).
7. Physical Therapy Management:
   
   • Post-surgical rehabilitation to restore function and mobility.
   • Strengthening, range-of-motion exercises, and endurance training as part of recovery.
   • Prosthetic training if amputation occurs.
   • Gait training and balance exercises, especially if limbs are affected.
   • Pain management strategies, including techniques to manage chemotherapy-related fatigue and weakness.
   • Psychosocial support and education for both patients and families, as this diagnosis can be emotionally challenging.

Question 23

List benign and malignant soft tissue tumors

Answer 23

1) Benign:
lipoma (tumor of fat)
ganglia (joint cap or tendinous sheath)
Popliteal cyst “Baker’s cyst” (hamstring tendon & often degenerative changes within knee joint)

2) Malignant:
Sarcomas

Question 24

List the etiology, pathogenesis, diagnostics, and clinical presentation (signs & symptoms) of Lipoma

Answer 24

1. Etiology:
   
   • Benign tumor composed of mature fat cells.
   • Common in middle-aged adults, but can occur at any age.
   • Exact cause is unknown, though genetics may play a role (familial multiple lipomatosis).
2. Pathogenesis:
   
   • Slow-growing, soft, and mobile mass of fat tissue under the skin.
   • Usually occurs in subcutaneous tissue but can form deeper in muscles or internal organs.
   • Generally non-invasive and non-cancerous.
3. Clinical Presentation (Signs and Symptoms):
   
   • Soft, painless, and mobile lump under the skin.
   • Most commonly found on the neck, shoulders, back, abdomen, and thighs.
   • Typically small (under 2 inches), but some lipomas can grow larger.
   • Rarely causes discomfort unless it presses on nerves or other structures.
4. Diagnostics (Labs, Imaging, and Other Methods):
   
   • Physical examination: Often sufficient for diagnosis due to the characteristic feel of a lipoma.
   • Ultrasound: Can be used to confirm diagnosis and assess size and depth.
   • MRI/CT scan: Used for deeper or atypical lipomas to differentiate from other soft tissue masses.
   • Biopsy: Rarely needed unless there is suspicion of a liposarcoma (malignant counterpart).

Question 25

List the medical/surgical, precautions & red flags, and PT management of Lipoma

Answer 25

5. Medical and Surgical Treatments/Medications:
   
   • Observation: Most lipomas do not require treatment unless they cause pain or cosmetic concerns.
   • Surgical excision: Complete removal is the definitive treatment, typically done for larger or symptomatic lipomas.
   • Liposuction: Can sometimes be used to remove fat tissue in larger lipomas, though recurrence is possible.
6. Precautions and Red Flags:
   
   • Sudden growth, pain, or firmness of a lipoma may suggest a more serious condition like liposarcoma and warrants further evaluation.
   • Recurrence after removal is rare but possible.
   • Compression of nerves or other structures may cause functional impairments or discomfort.
7. Physical Therapy Management:
   
   • Not usually required unless the lipoma causes nerve compression or functional limitations.
   • Post-surgical rehabilitation if the lipoma was located near a joint or caused muscle weakness.
   • Pain management strategies if there is discomfort before or after removal.

Question 26

List the etiology, pathogenesis, diagnostics, and clinical presentation (signs & symptoms) of Ganglia Cyst

Answer 26

1. Etiology:
   
   • Benign, fluid-filled cysts that form near joints or tendons.
   • Commonly occur in the wrist, hand, or fingers, but can also appear in the ankle or foot.
   • The exact cause is unknown, but repetitive motion or joint irritation may contribute.
2. Pathogenesis:
   
   • Develops when synovial fluid leaks from a joint or tendon sheath, creating a cystic structure.
   • Cysts are filled with thick, gel-like fluid and may vary in size over time.
   • They are non-cancerous and do not spread to other areas.
3. Clinical Presentation (Signs and Symptoms):
   
   • Visible, soft, and round lump near a joint or tendon.
   • May fluctuate in size, and often painless, though some cause discomfort or limited range of motion.
   • Pain or tingling can occur if the cyst compresses nearby nerves.
   • Cysts are most noticeable when they grow on the dorsal (back) of the wrist.
4. Diagnostics (Labs, Imaging, and Other Methods):
   
   • Physical examination: Diagnosis often based on location and characteristic features (e.g., soft, compressible lump).
   • Ultrasound: Can confirm the cystic nature and differentiate from solid masses.
   • MRI: Used in rare cases to assess deeper cysts or rule out other conditions.
   • Aspiration: Fluid removal for diagnosis, if needed, or to reduce size.

Question 27

List the medical/surgical, precautions & red flags, and PT management of Ganglia Cyst

Answer 27

5. Medical and Surgical Treatments/Medications:
   
   • Observation: Many ganglion cysts resolve on their own and may not require treatment if asymptomatic.
   • Aspiration: Non-surgical removal of the fluid to reduce size, but recurrence is common.
   • Surgical excision: Complete removal of the cyst, including its root, is the most effective way to prevent recurrence, but it carries typical surgical risks.
   • Splinting: May be recommended to reduce joint movement and alleviate symptoms.
6. Precautions and Red Flags:
   
   • Sudden changes in size, persistent pain, or limitation of movement should be evaluated.
   • If the cyst causes nerve compression, symptoms like numbness, tingling, or weakness may develop, requiring further assessment.
   • Recurrence is possible, even after surgical removal.
7. Physical Therapy Management:
   
   • Range-of-motion exercises to maintain or restore joint mobility, especially if the cyst limits movement.
   • Strengthening exercises to support joint function and reduce the likelihood of recurrence.
   • Splinting or taping techniques may help offload stress from the affected joint.
   • Pain management strategies if the cyst causes discomfort or impacts function.

Question 28

What does the pt need during inflammation phase?

Answer 28

Max protection in Acute inflammation. Little PT + rest)

Question 29

What does the pt need in proliferation phase?

Answer 29

Controlled motion to avoid ROM limitations while gradually introducing mechanical stress

Question 30

What does the pt need in remodeling phase?

Answer 30

To progress to full tolerance gradually

Question 31

Define mechanotransduction

Answer 31

Cellular response by mechanical loading

(The art of how and when to apply mechanical stress)

Question 32

What are the grades of muscle strain?

Answer 32

1. Grade 1 (Mild): A small number of muscle fibers are overstretched or slightly torn, causing mild discomfort and tenderness, but with minimal or no loss of strength and movement.
   
   2. Grade 2 (Moderate): A larger number of muscle fibers are torn, resulting in more noticeable pain, swelling, bruising, and a moderate loss of strength and range of motion.
   3. Grade 3 (Severe): The muscle is completely torn or ruptured, leading to severe pain, significant swelling, and a complete loss of muscle function. Surgery may be necessary to repair the damage.

Question 33

What are the grades of ligament sprain?

Answer 33

1. Grade 1 (Mild): The ligament is excessively stretched (minimal loss of ligament)
   
   2. Grade 2 (Moderate): excessive stretch and some tears. Some structural weakness present
   3. Grade 3 (Severe): The ligament is completely torn, and disrupted

Question 34

What are some types of tendon strain?

Answer 34

1. Tendonitis: An acute inflammation of a tendon caused by overuse or injury. It leads to pain, swelling, and tenderness around the affected tendon, typically resolving with rest and treatment.
   
   2. Tendinosis: A chronic degenerative process with little inflammation. Can set up for future tears
   3. Tendon Laceration: A partial or complete tear of a tendon caused by a sharp injury, such as a cut. It results in pain, loss of function, and often requires surgical repair to restore tendon integrity and function.

Question 35

Describe ligament graft

Answer 35

taking a piece of tissue (graft) from either the patient’s own body (autograft) or a donor (allograft) to replace a damaged ligament. This is commonly done in surgeries like ACL reconstruction to restore stability and function to the affected joint. The graft acts as a scaffold for new tissue growth, allowing the ligament to heal and regain strength over time.

Question 36

Describe articular cartilage repair

Answer 36

surgical techniques used to restore damaged cartilage in joints, which helps reduce pain and improve function. Since cartilage does not heal well on its own, procedures like microfracture, autologous chondrocyte implantation (ACI), or osteochondral grafting are used to stimulate new cartilage growth or transplant healthy cartilage. The goal is to regenerate or replace the damaged cartilage, promoting smoother joint movement and reducing the risk of further joint degeneration.

Question 37

What is the care routine for muscle strain?

Answer 37

1) short period of immobilization
2) proliferating phase can last 6-8 weeks (after 8 fibrosis can happen)
3) immature CT is adaptable for 2 mo (stretching during it is beneficial because it helps produce more organized tissue fibers and less adhesion)

Question 38

What are the stages of bone fracture?

Answer 38

Inflammatory stage lasts roughly to end of 1st week.

1) Cellular stage (inflammatory phase)
2) Vascular stage (inflammatory phase)
3) Primary callus “soft” (proliferation phase)
4) Bony callus “hard” (proliferation phase) (6-12 weeks when WB starts)
5) mature callus (remodeling phase)

Question 39

What week post fracture to release pt from NWB?

Answer 39

Around the 6-8 week mark (can vary by injury with some taking months)

Question 40

Describe tendinopathy

Answer 40

Tendinopathy = tenditis

can be from acute or chronic events

Question 41

what is the timeframe of the healing stages for tendons?

Answer 41

1) Inflammation: 72 hrs after injury/surgery
2) proliferation: 2-3 weeks (random collagen alignment)
3) remodeling: ~ 3 weeks

Question 42

For the tendon conditions, contraction forces should be avoided for at least ____

Answer 42

8 weeks
(8-12 weeks) then passive, passive assisted, active…

Question 43

What is tenosynovitis?

Answer 43

Pathology of synovial sheath

Question 44

What is the timeframe for the healing stages for ligaments?

Answer 44

(Extra articular ligaments heal very well) (intro articular, challenging due to circulation factors)

1) inflammation: 24-48 hrs
2) proliferation: 1 week, fibroblasts produce collagen
3) remodeling: A) 50% of tensile strength 6 months. B) 80% 1 year. C) as long as 3 years for near normal

Question 45

Describe ligament subluxation and dislocation

Answer 45

1) subluxation: some disruption but still connects to articulate surface
2) dislocation: most extreme form of subluxation. Full disruption

Question 46

What are some characteristics of cartilage repair?

Answer 46

1) painful from effects on underlying tissue
2) They are aneural, avascular, alymphatic, so it relies on migration of cells from the synovial membrane
3) fibrocartilge (meniscus & vertebral disc) low potential for regeneration
4) some healing at periphery (because minimal vascularization)
5) articular cartilage (hyaline, joint surface, type II collagen) frays, blisters, fissures
6) can scar down but often needs surgery

Question 47

Is immobilization needed?

Answer 47

It is needed to heal but is detrimental if prolonged
issues: muscle atrophy, lower collagen alignment, lower nutrition of cartilage, adipogenesis

Question 48

List the etiology, pathogenesis, diagnostics, and clinical presentation (signs & symptoms) of Myofascial Compartment Syndromes

Answer 48

1. Etiology:
   
   • Occurs when increased pressure within a closed muscle compartment impairs blood flow and nerve function.
   • Can be caused by trauma (fractures, crush injuries), overuse, burns, or prolonged compression.
   • Compartment syndrome can be acute (often due to trauma) or chronic (associated with repetitive activities like running).
2. Pathogenesis:
   
   • Pressure builds up in a closed muscle compartment (enclosed by fascia), reducing blood flow and oxygen supply to tissues.
   • This leads to ischemia, muscle and nerve damage, and potentially tissue necrosis if untreated.
   • Acute compartment syndrome is a medical emergency, while chronic cases develop more slowly and are related to exercise.
3. Clinical Presentation (Signs and Symptoms):
   
   • Acute:
   • Severe, persistent pain out of proportion to the injury.
   • Pain worsens with passive stretching of the muscles.
   • Tense, swollen, or shiny appearance of the affected limb.
   • Numbness, tingling, or weakness (late signs).
   • Decreased pulse or cold extremities in severe cases (indicating vascular compromise).
   • Chronic:
   • Gradual onset of pain, tightness, or cramping during exercise, relieved by rest.
   • Possible numbness or tingling.
   • Swelling or visible bulging of the muscle during activity.
4. Diagnostics (Labs, Imaging, and Other Methods):
   
   • Clinical examination: Diagnosis is primarily based on clinical signs and symptoms.
   • Compartment pressure measurement: A needle is inserted into the compartment to measure pressure, confirming diagnosis.
   • MRI/Ultrasound: Sometimes used to assess muscle and soft tissue damage or to rule out other conditions.

Question 49

List the medical/surgical, precautions & red flags, and PT management of Myofascial Compartment Syndromes

Answer 49

5. Medical and Surgical Treatments/Medications:
   
   • Acute Compartment Syndrome:
   • Fasciotomy: Emergent surgery to release pressure and restore blood flow by cutting the fascia around the compartment.
   • Pain management: Before and after surgery.
   • IV fluids: To maintain circulation and prevent further damage.
   • Chronic Compartment Syndrome:
   • Activity modification: Rest, avoiding activities that trigger symptoms.
   • Non-surgical management: Physical therapy, stretching, and strengthening exercises.
   • Surgical treatment: Fasciotomy may be performed in chronic cases if conservative measures fail.
6. Precautions and Red Flags:
   
   • Acute Compartment Syndrome: Requires immediate medical attention to prevent permanent muscle and nerve damage.
   • Red flags: Severe pain out of proportion to injury, numbness, tingling, or loss of pulses.
   • Chronic symptoms that do not improve with rest or activity modification may indicate the need for further evaluation or surgery.
7. Physical Therapy Management:
   
   • Post-surgical rehab: Following fasciotomy, PT focuses on restoring range of motion, strength, and functional mobility.
   • Chronic Compartment Syndrome:
   • Activity modification, gradual return to exercise.
   • Strengthening and flexibility exercises to reduce muscle tightness and improve circulation.
   • Education on proper body mechanics and techniques to avoid repetitive strain.
   • Pain management: Techniques like ice, massage, and stretching.

Question 50

List the etiology, pathogenesis, diagnostics, and clinical presentation (signs & symptoms) of Heterotopic Ossification

Answer 50

1. Etiology:
   
   • Abnormal formation of bone in soft tissues, particularly muscles, tendons, and ligaments.
   • Common causes include trauma, surgery (especially joint replacements), burns, spinal cord injuries, and traumatic brain injuries.
   • Genetic predisposition can lead to conditions like Fibrodysplasia Ossificans Progressiva (FOP).
2. Pathogenesis:
   
   • Soft tissues undergo abnormal ossification, leading to the formation of mature bone in non-skeletal areas.
   • Triggered by inflammation or trauma, causing stem cells to differentiate into osteoblasts (bone-forming cells) in soft tissue.
   • Can result in pain, joint stiffness, and decreased range of motion if bone formation impairs nearby joints or structures.
3. Clinical Presentation (Signs and Symptoms):
   
   • Swelling, warmth, and tenderness over the affected area.
   • Progressive loss of joint range of motion and stiffness.
   • Pain during movement, especially in the area surrounding the new bone formation.
   • In severe cases, significant functional impairment if joints or nerves are affected.
4. Diagnostics (Labs, Imaging, and Other Methods):
   
   • X-ray: Often shows mature bone formation in soft tissues, but only after several weeks.
   • Bone scan: Can detect early HO formation by identifying areas of increased metabolic activity.
   • CT scan/MRI: Useful for assessing the extent of ossification, especially in deeper tissues or near joints.
   • Lab tests: Elevated alkaline phosphatase levels may indicate increased bone formation, though not specific to HO.

Question 51

List the medical/surgical, precautions & red flags, and PT management of Heterotopic Ossification

Answer 51

5. Medical and Surgical Treatments/Medications:
   
   • NSAIDs (e.g., indomethacin): Commonly used to reduce inflammation and prevent bone formation post-surgery or trauma.
   • Bisphosphonates: May be prescribed to inhibit bone formation in certain cases.
   • Surgical excision: For significant or disabling HO after the bone has matured (typically performed after 6-12 months to minimize recurrence risk).
   • Radiotherapy: Occasionally used prophylactically in high-risk patients to prevent HO after joint replacement surgery.
6. Precautions and Red Flags:
   
   • Early signs of joint stiffness, swelling, or pain after surgery or trauma may indicate HO and should prompt early intervention.
   • Rapid loss of motion or significant pain despite healing should be evaluated for possible HO.
   • Recurrence is possible even after surgical excision, particularly if the surgery is performed too early.
7. Physical Therapy Management:
   
   • Early stages: Focus on gentle range-of-motion exercises to maintain joint mobility without aggravating inflammation.
   • Post-surgical rehab: Strengthening and mobility exercises once the bone is excised, with caution to avoid re-injury.
   • Pain management: Modalities like heat, cold therapy, or ultrasound to reduce pain and swelling.
   • Patient education: Importance of compliance with exercise programs and awareness of early signs of recurrence.

Question 52

List the etiology, pathogenesis, diagnostics, and clinical presentation (signs & symptoms) of Rhabdomyolysis

Answer 52

1. Etiology:
   
   • Breakdown of skeletal muscle fibers, leading to the release of muscle contents (e.g., myoglobin) into the bloodstream.
   • Common causes include traumatic injury (crush injuries), excessive physical exertion, drug or alcohol abuse, certain medications (e.g., statins), heat stroke, prolonged immobility, and infections.
2. Pathogenesis:
   
   • Muscle cell damage leads to the release of intracellular contents (myoglobin, potassium, creatine kinase) into circulation.
   • Myoglobin can cause kidney damage (acute kidney injury) by obstructing renal tubules and causing oxidative damage.
   • Electrolyte imbalances, including hyperkalemia, can lead to life-threatening arrhythmias.
3. Clinical Presentation (Signs and Symptoms):
   
   • Muscle pain, tenderness, or swelling, typically in large muscle groups (e.g., thighs, shoulders, lower back).
   • Dark, cola-colored urine (due to myoglobinuria).
   • Weakness, fatigue, or stiffness in the affected muscles.
   • Systemic symptoms such as fever, nausea, vomiting, or confusion in severe cases.
   • Potential for life-threatening complications, including kidney failure and cardiac arrhythmias.
4. Diagnostics (Labs, Imaging, and Other Methods):
   
   • Serum creatine kinase (CK): Elevated levels (often thousands of units per liter) indicate muscle breakdown.
   • Urinalysis: Presence of myoglobin (myoglobinuria) without red blood cells in the urine.
   • Blood tests: Monitor electrolytes (especially potassium), renal function (creatinine, BUN), and liver enzymes.
   • Electrocardiogram (ECG): To detect hyperkalemia-induced arrhythmias.

Question 53

List the medical/surgical, precautions & red flags, and PT management of Rhabdomyolysis

Answer 53

5. Medical and Surgical Treatments/Medications:
   
   • Aggressive intravenous fluids (IV): To flush myoglobin out of the kidneys and prevent acute kidney injury.
   • Electrolyte management: Especially for hyperkalemia, hypocalcemia, and hyperphosphatemia, which can cause serious complications.
   • Dialysis: For severe acute kidney injury if fluids alone are insufficient.
   • Medications: May include bicarbonate to alkalinize urine, diuretics (if appropriate), and drugs to manage electrolyte imbalances.
6. Precautions and Red Flags:
   
   • Signs of acute kidney injury (e.g., reduced urine output, swelling, and increased creatinine levels) require urgent intervention.
   • Hyperkalemia can cause life-threatening arrhythmias; ECG monitoring is essential.
   • Heat stroke, drug-induced rhabdomyolysis, or extreme physical exertion should be addressed promptly to prevent complications.
   • Watch for compartment syndrome (increased pressure in a muscle compartment) as a secondary complication.
7. Physical Therapy Management:
   
   • Initial phase: Physical activity should be minimized during the acute phase to prevent further muscle damage.
   • Post-recovery: Gradual reintroduction of activity with close monitoring of symptoms to avoid recurrent episodes.
   • Strengthening and conditioning: Once kidney function and electrolyte levels normalize, a carefully designed program can help restore muscle strength.
   • Education: On hydration, avoiding overexertion, and recognizing early signs of muscle damage, especially in high-risk populations (e.g., athletes, individuals on certain medications).

Question 54

List the etiology, pathogenesis, diagnostics, and clinical presentation (signs & symptoms) of Osteoarthritis

Answer 54

1. Etiology:
   
   • Degenerative joint disease caused by the breakdown of cartilage and subsequent joint damage.
   • Risk factors include aging, joint injury or overuse, obesity, genetics, and joint misalignment.
   • Can affect any joint but is most common in the knees, hips, hands, and spine.
2. Pathogenesis:
   
   • Gradual loss of cartilage in joints leads to bones rubbing against each other, causing pain, swelling, and stiffness.
   • As the cartilage deteriorates, the body attempts to repair the damage, resulting in bone spurs (osteophytes) and thickening of the joint capsule.
   • Inflammatory processes may play a role, but OA is primarily a non-inflammatory condition.
3. Clinical Presentation (Signs and Symptoms):
   
   • Joint pain and stiffness, often worse after periods of inactivity or in the morning.
   • Swelling and tenderness around the affected joint.
   • Reduced range of motion and function in the joint.
   • Crepitus (grating or cracking sound) with movement.
   • In advanced stages, visible joint deformities may develop.
4. Diagnostics (Labs, Imaging, and Other Methods):
   
   • X-ray: Shows joint space narrowing, osteophyte formation, and possible subchondral sclerosis (bone hardening).
   • MRI: Can assess cartilage damage and soft tissue involvement in more detail.
   • Physical examination: Checks for joint tenderness, crepitus, and limited range of motion.
   • Lab tests: Typically normal, as OA is non-inflammatory, but may be done to rule out other conditions (e.g., rheumatoid arthritis).

Question 55

List the medical/surgical, precautions & red flags, and PT management of Osteoarthritis

Answer 55

5. Medical and Surgical Treatments/Medications:
   
   • Medications: NSAIDs (e.g., ibuprofen) for pain relief, acetaminophen for mild pain, and corticosteroid injections for temporary relief of inflammation.
   • Viscosupplementation: Hyaluronic acid injections to improve joint lubrication (used in knee OA).
   • Surgical options:
   • Joint replacement (arthroplasty) for severe OA when conservative treatments fail.
   • Osteotomy (realignment surgery) or arthroscopy for certain cases.
   • Weight management: To reduce stress on weight-bearing joints (e.g., hips, knees).
6. Precautions and Red Flags:
   
   • Sudden worsening of symptoms, such as swelling or increased pain, may indicate joint damage or infection.
   • If conservative measures fail to provide relief, further imaging or surgical intervention may be necessary.
   • Obesity and inactivity can exacerbate symptoms, so weight control and physical activity are important.
7. Physical Therapy Management:
   
   • Exercise: Strengthening exercises for muscles surrounding the affected joint (e.g., quadriceps for knee OA), low-impact aerobic exercises (e.g., swimming, cycling), and flexibility exercises to maintain joint motion.
   • Manual therapy: To reduce stiffness and improve mobility.
   • Assistive devices: Canes, braces, or orthotics to reduce joint load and improve function.
   • Education: On joint protection techniques, posture, and body mechanics to reduce stress on the joints.
   • Pain management: Techniques like heat, cold therapy, and electrotherapy (e.g., TENS).

Question 56

List the etiology, pathogenesis, diagnostics, and clinical presentation (signs & symptoms) of Degenerative Intervertebral Disk

Answer 56

1. Etiology:
   
   • Degenerative condition of the intervertebral disks, typically caused by aging, wear and tear, or injury.
   • Risk factors include genetics, smoking, obesity, repetitive stress, and poor posture.
   • Can occur in any part of the spine but is most common in the lumbar (lower back) and cervical (neck) regions.
2. Pathogenesis:
   
   • The intervertebral disk loses its water content and elasticity over time, reducing its ability to absorb shocks.
   • The outer layer (annulus fibrosus) may weaken or tear, while the inner core (nucleus pulposus) may bulge or herniate.
   • Disk degeneration leads to reduced disk height, altered biomechanics, and increased stress on adjacent spinal structures (joints, ligaments, muscles).
3. Clinical Presentation (Signs and Symptoms):
   
   • Persistent or intermittent back or neck pain, often worsened with sitting, bending, or lifting.
   • Pain may radiate to the legs (sciatica) or arms if nerve roots are compressed by herniated or bulging disks.
   • Stiffness, reduced flexibility, and difficulty with certain movements.
   • Tingling, numbness, or weakness in extremities if nerve compression occurs.
4. Diagnostics (Labs, Imaging, and Other Methods):
   
   • MRI: Gold standard for visualizing disk degeneration, herniation, and nerve compression.
   • X-ray: Can show reduced disk space, osteophyte formation, or spinal misalignment.
   • CT scan: May be used to assess bony changes or stenosis (narrowing of the spinal canal).
   • Physical examination: Tests for range of motion, pain response, and neurological deficits (e.g., reflex changes, muscle weakness).

Question 57

List the medical/surgical, precautions & red flags, and PT management of Degenerative Intervertebral Disk

Answer 57

5. Medical and Surgical Treatments/Medications:
   
   • Medications: NSAIDs (e.g., ibuprofen) for pain relief, muscle relaxants, and corticosteroid injections for inflammation.
   • Physical therapy: Core strengthening, flexibility exercises, and postural training to alleviate pain and improve function.
   • Surgical options:
   • Discectomy: Removal of part of the disk to relieve nerve pressure.
   • Spinal fusion: Fusing adjacent vertebrae to reduce movement and pain in the affected area.
   • Artificial disk replacement: Maintaining motion while relieving pain by replacing the damaged disk with an artificial one.
   • Surgery is generally considered only after conservative measures fail.
6. Precautions and Red Flags:
   
   • Sudden, severe pain with neurological symptoms (e.g., numbness, weakness, loss of bowel or bladder control) may indicate cauda equina syndrome, a medical emergency requiring immediate intervention.
   • Progressive weakness, numbness, or worsening pain unresponsive to conservative treatments should be evaluated for possible surgical intervention.
7. Physical Therapy Management:
   
   • Core strengthening: Exercises to stabilize the spine and reduce strain on the disks.
   • Flexibility and stretching: To improve range of motion and alleviate stiffness.
   • Posture training: Correcting improper posture that can exacerbate symptoms.
   • Manual therapy: Soft tissue mobilization and joint manipulation to improve function and relieve pain.
   • Patient education: Teaching proper body mechanics and lifestyle modifications to prevent further degeneration.

Question 58

List the etiology, pathogenesis, diagnostics, and clinical presentation (signs & symptoms) of Rheumatoid Arthritis

Answer 58

1. Etiology:
   
   • Chronic autoimmune disease in which the body’s immune system mistakenly attacks the synovium (lining of joints).
   • Exact cause is unknown, but genetic factors, environmental triggers (e.g., smoking), and hormonal factors may contribute.
   • More common in women and typically begins between the ages of 30-50.
2. Pathogenesis:
   
   • Immune cells attack the synovium, causing inflammation and thickening of the joint lining.
   • Persistent inflammation leads to joint destruction, cartilage breakdown, and bone erosion.
   • Affects multiple joints symmetrically, typically in the hands, wrists, knees, and feet, but can also involve other organs (e.g., heart, lungs).
3. Clinical Presentation (Signs and Symptoms):
   
   • Joint pain, swelling, and stiffness, especially in the morning or after periods of inactivity (lasting >1 hour).
   • Symmetrical joint involvement (both sides of the body).
   • Fatigue, fever, and general malaise.
   • In severe cases, joint deformities (e.g., ulnar deviation, swan-neck deformities).
   • Extra-articular manifestations include nodules under the skin, lung or heart complications, and eye inflammation (scleritis).
4. Diagnostics (Labs, Imaging, and Other Methods):
   
   • Blood tests:
   • Rheumatoid factor (RF) and anti-CCP antibodies are commonly elevated in RA.
   • ESR and CRP levels indicate the presence of inflammation.
   • X-rays: Show joint erosion and narrowing of joint spaces over time.
   • MRI/Ultrasound: Useful in early detection of joint inflammation and damage.
   • Physical examination: Identifies joint swelling, tenderness, and reduced range of motion.

Question 59

List the medical/surgical, precautions & red flags, and PT management of Rheumatoid Arthritis

Answer 59

5. Medical and Surgical Treatments/Medications:
   
   • Medications:
   • NSAIDs: For pain relief and to reduce inflammation.
   • Corticosteroids: Short-term use for controlling acute inflammation.
   • Disease-modifying antirheumatic drugs (DMARDs): Methotrexate, hydroxychloroquine, sulfasalazine to slow disease progression.
   • Biologic agents: Target specific immune pathways (e.g., TNF inhibitors, IL-6 inhibitors) to reduce inflammation and joint damage.
   • Surgical options:
   • Joint replacement (e.g., hip or knee) for severe joint damage.
   • Synovectomy: Removal of inflamed synovium.
   • Physical therapy and lifestyle management: To maintain joint function and manage symptoms.
6. Precautions and Red Flags:
   
   • Untreated or poorly managed RA can lead to significant joint damage and disability.
   • Extra-articular involvement (e.g., lung or heart issues) should be monitored as RA can affect various organs.
   • Monitor for infection, especially in patients taking immunosuppressive therapies like biologics or corticosteroids.
7. Physical Therapy Management:
   
   • Joint protection techniques: To reduce stress on inflamed joints (e.g., using assistive devices, modifying daily activities).
   • Range of motion exercises: To maintain or improve joint mobility and reduce stiffness.
   • Strengthening exercises: Focus on low-impact activities to maintain muscle strength without aggravating joints (e.g., swimming, cycling).
   • Education: On energy conservation, proper body mechanics, and managing flare-ups.
   • Manual therapy: Techniques to improve joint function and reduce pain.
   • Splinting or bracing: To support joints during flare-ups or activities.

Question 60

List the etiology, pathogenesis, diagnostics, and clinical presentation (signs & symptoms) of Juvenile Idiopathic Arthritis

Answer 60

1. Etiology:
   
   • Chronic autoimmune disease in children under 16, characterized by persistent joint inflammation.
   • Exact cause is unknown, but genetic factors, environmental triggers, and immune system dysfunction may play a role.
   • Different subtypes include oligoarticular, polyarticular, systemic, enthesitis-related, and psoriatic arthritis, among others.
2. Pathogenesis:
   
   • Immune system attacks the synovium (joint lining), causing chronic inflammation.
   • This inflammation can lead to cartilage degradation, joint erosion, and altered bone growth in severe cases.
   • Affects the joints and sometimes the eyes, skin, and internal organs (depending on the subtype).
3. Clinical Presentation (Signs and Symptoms):
   
   • Joint pain, swelling, and stiffness, particularly in the morning or after rest (lasting >30 minutes).
   • Limping or difficulty with movement due to joint pain, often without complaint from the child.
   • Fever, rash, and fatigue, particularly in systemic JIA.
   • Eye inflammation (uveitis) in some subtypes, which can lead to vision problems if untreated.
   • Varying degrees of joint involvement depending on the subtype:
   • Oligoarticular JIA: Affects fewer than 5 joints.
   • Polyarticular JIA: Affects 5 or more joints symmetrically.
   • Systemic JIA: Involves fever, rash, and inflammation in internal organs.
4. Diagnostics (Labs, Imaging, and Other Methods):
   
   • Blood tests:
   • ANA (antinuclear antibodies) may be positive, especially in oligoarticular JIA.
   • RF (rheumatoid factor) and anti-CCP antibodies may be present in polyarticular JIA.
   • ESR and CRP to assess inflammation levels.
   • X-rays: To monitor joint space narrowing and damage over time.
   • MRI/Ultrasound: Can detect early joint inflammation and soft tissue involvement.
   • Eye exams: Important for detecting uveitis, especially in ANA-positive cases.

Question 61

List the medical/surgical, precautions & red flags, and PT management of Juvenile Idiopathic Arthritis

Answer 61

5. Medical and Surgical Treatments/Medications:
   
   • Medications:
   • NSAIDs: To reduce inflammation and relieve pain.
   • Corticosteroids: For short-term inflammation control, especially during flare-ups.
   • DMARDs (Disease-modifying antirheumatic drugs): Methotrexate and sulfasalazine to slow disease progression.
   • Biologics: TNF inhibitors, IL-1 or IL-6 inhibitors for more severe or resistant cases.
   • Surgical options:
   • Rare in children, but joint replacement or corrective surgery may be necessary in severe cases of joint damage.
   • Physical therapy and lifestyle management: Integral for maintaining joint function, preventing deformities, and improving quality of life.
6. Precautions and Red Flags:
   
   • Monitor for growth disturbances, as prolonged inflammation can affect bone growth in children.
   • Regular eye exams are critical to detect and treat uveitis early, especially in oligoarticular JIA.
   • Watch for side effects of long-term medication use, especially corticosteroids and biologics (e.g., infection risk).
7. Physical Therapy Management:
   
   • Range of motion exercises: To maintain joint mobility and prevent contractures.
   • Strengthening exercises: Tailored to the child’s abilities, focusing on low-impact activities (e.g., swimming, cycling).
   • Joint protection techniques: To minimize stress on affected joints and prevent deformities.
   • Splinting or orthotics: May be used to support joints and correct posture or alignment.
   • Education: For the child and family on managing flare-ups, proper body mechanics, and balancing activity with rest.
   • Pain management: Techniques like heat, cold therapy, and gentle stretching.

Question 62

List the etiology, pathogenesis, diagnostics, and clinical presentation (signs & symptoms) of Ankylosing Spondylitis

Answer 62

1. Etiology:
   
   • Chronic inflammatory disease primarily affecting the spine and sacroiliac joints.
   • Exact cause is unknown, but strong genetic links, particularly with the HLA-B27 gene, are associated with the disease.
   • More common in males and usually begins in late adolescence or early adulthood.
2. Pathogenesis:
   
   • Inflammation begins in the sacroiliac joints and spreads to the spine, leading to pain, stiffness, and fusion of the vertebrae (ankylosis).
   • Over time, the inflammation causes new bone formation along the spine (syndesmophytes), leading to reduced mobility and a characteristic “bamboo spine” appearance.
   • Other joints, such as the hips, shoulders, and peripheral joints, can also be affected.
3. Clinical Presentation (Signs and Symptoms):
   
   • Chronic low back pain and stiffness, typically worse in the morning and improves with activity.
   • Pain often begins in the sacroiliac joints and may radiate to the buttocks and thighs.
   • Limited spinal mobility and reduced range of motion as the disease progresses.
   • Postural changes, such as a forward-stooped posture, as spinal fusion progresses.
   • Fatigue and, in some cases, systemic symptoms such as fever and weight loss.
   • Extra-articular manifestations: Eye inflammation (uveitis), heart, lung involvement, and gastrointestinal issues (e.g., inflammatory bowel disease).
4. Diagnostics (Labs, Imaging, and Other Methods):
   
   • HLA-B27 test: Commonly positive, though not exclusive to AS.
   • X-ray: Shows sacroiliitis (inflammation of the sacroiliac joints) and, in later stages, the characteristic “bamboo spine” appearance due to vertebral fusion.
   • MRI: Sensitive in detecting early inflammation in the sacroiliac joints and spine before changes appear on X-rays.
   • Physical examination: Identifies reduced spinal flexibility, tenderness over the sacroiliac joints, and limited chest expansion due to thoracic involvement.

Question 63

List the medical/surgical, precautions & red flags, and PT management of Ankylosing Spondylitis

Answer 63

5. Medical and Surgical Treatments/Medications:
   
   • Medications:
   • NSAIDs: First-line treatment for pain and inflammation relief.
   • Biologics: TNF inhibitors (e.g., infliximab, etanercept) and IL-17 inhibitors (e.g., secukinumab) for patients who do not respond to NSAIDs.
   • DMARDs: Used for peripheral joint involvement, but less effective for spinal symptoms.
   • Corticosteroid injections: For localized joint inflammation, though not commonly used long-term.
   • Surgical options:
   • Joint replacement (e.g., hip) for severe peripheral joint damage.
   • Spinal surgery: Rare, but may be required for severe deformities or spinal fractures.
6. Precautions and Red Flags:
   
   • Spinal fractures: Due to weakened, fused spine segments, AS patients are at higher risk for fractures, particularly with trauma.
   • Loss of chest expansion and difficulty breathing can occur with thoracic spine involvement.
   • Uveitis: Eye inflammation requires prompt treatment to prevent vision loss.
   • Cardiovascular complications: Monitor for heart issues such as aortic regurgitation and conduction abnormalities.
7. Physical Therapy Management:
   
   • Postural training: Emphasizes maintaining proper posture to prevent kyphotic deformities.
   • Range of motion exercises: Daily stretching, particularly for the spine and hips, to maintain flexibility.
   • Strengthening exercises: Core and back strengthening to support the spine and improve posture.
   • Breathing exercises: To maintain chest expansion and improve lung function.
   • Low-impact aerobic exercises: Swimming, cycling, and walking to maintain cardiovascular health and joint mobility.
   • Education: On proper body mechanics, managing symptoms, and maintaining an active lifestyle.

Question 64

List the etiology, pathogenesis, diagnostics, and clinical presentation (signs & symptoms) of DISH Diffuse Idiopathic Skeletal Hyperostosis

Answer 64

1. Etiology:
   
   • A non-inflammatory condition characterized by excessive calcification and bone formation along the ligaments and tendons, particularly in the spine.
   • Exact cause is unknown, but risk factors include aging, obesity, metabolic conditions (e.g., diabetes), and genetic predisposition.
   • More common in men and typically occurs after age 50.
2. Pathogenesis:
   
   • Excess bone formation occurs along the ligaments, especially the anterior longitudinal ligament of the spine, leading to “flowing” bony growths.
   • While the condition primarily affects the spine, it can also affect peripheral joints such as the hips, knees, and shoulders.
   • DISH does not cause significant inflammation or erosion, distinguishing it from other conditions like ankylosing spondylitis.
3. Clinical Presentation (Signs and Symptoms):
   
   • Stiffness in the spine, especially in the morning or after periods of inactivity.
   • Back pain, usually mild and chronic, often worse with movement.
   • Reduced spinal mobility, particularly in the thoracic and lumbar regions.
   • In severe cases, difficulty swallowing (dysphagia) if bony overgrowths compress the esophagus, particularly in the cervical spine.
   • Possible pain or limited movement in peripheral joints if involved (e.g., shoulder or hip stiffness).
4. Diagnostics (Labs, Imaging, and Other Methods):
   
   • X-ray: The hallmark feature is “flowing” bony growths along the sides of at least four contiguous vertebrae, usually in the thoracic or lumbar spine.
   • CT scan/MRI: May be used to assess the extent of bone formation and to rule out other conditions like spinal stenosis or ankylosing spondylitis.
   • Physical examination: Identifies reduced spinal flexibility and discomfort in affected joints, but no signs of inflammation.

Question 65

List the medical/surgical, precautions & red flags, and PT management of DISH Diffuse Idiopathic Skeletal Hyperostosis

Answer 65

5. Medical and Surgical Treatments/Medications:
   
   • Medications:
   • NSAIDs: For mild pain relief, though the condition is non-inflammatory.
   • Analgesics: To manage chronic pain if NSAIDs are not effective.
   • Surgical options:
   • Rarely needed but may include surgical removal of bony overgrowths if they compress the esophagus or spinal nerves, causing severe symptoms like dysphagia or nerve impingement.
   • Weight management: Important to reduce stress on affected joints.
6. Precautions and Red Flags:
   
   • Dysphagia: Difficulty swallowing due to cervical spine involvement may require evaluation for esophageal compression.
   • Reduced spinal mobility can lead to postural issues or increased fall risk.
   • Although DISH is non-inflammatory, it can co-exist with other conditions like osteoarthritis, requiring careful differentiation.
7. Physical Therapy Management:
   
   • Stretching exercises: To maintain spinal flexibility and reduce stiffness, focusing on the thoracic and lumbar regions.
   • Strengthening exercises: Core and postural muscle strengthening to support the spine and prevent postural changes.
   • Posture training: To minimize the impact of reduced spinal mobility and prevent compensatory movements that could cause further discomfort.
   • Low-impact aerobic exercises: Swimming, walking, and cycling to maintain overall mobility and cardiovascular health.
   • Patient education: On the importance of staying active and managing weight to reduce stress on joints.

Question 66

List the etiology, pathogenesis, diagnostics, and clinical presentation (signs & symptoms) of Psoriatic Arthritis

Answer 66

1. Etiology:
   
   • Chronic inflammatory autoimmune disease that affects some people with psoriasis (a skin condition characterized by scaly, red patches).
   • The exact cause is unknown, but genetic predisposition, immune system dysfunction, and environmental triggers (e.g., infections, trauma) play a role.
   • Can occur at any age, but most commonly affects individuals between 30-50 years old.
2. Pathogenesis:
   
   • The immune system mistakenly attacks healthy joint tissue, leading to inflammation, joint damage, and changes in the skin.
   • Both the skin (psoriasis) and joints (arthritis) are affected, often simultaneously, although joint symptoms may precede or follow skin symptoms.
   • Enthesitis (inflammation where tendons and ligaments attach to bone) and dactylitis (swelling of entire fingers or toes) are common.
3. Clinical Presentation (Signs and Symptoms):
   
   • Joint pain, stiffness, and swelling, commonly in the hands, feet, knees, and spine.
   • Asymmetrical joint involvement is typical (unlike rheumatoid arthritis).
   • Morning stiffness that lasts more than 30 minutes, improving with activity.
   • Dactylitis (sausage digits) affecting fingers or toes, causing severe swelling.
   • Enthesitis, particularly in the Achilles tendon or plantar fascia.
   • Psoriasis: Red, scaly patches on the skin, commonly on the scalp, elbows, or knees.
   • Nail changes: Pitting, thickening, or separation of the nails from the nail bed (onycholysis).
   • Possible eye inflammation (uveitis).
4. Diagnostics (Labs, Imaging, and Other Methods):
   
   • Blood tests: No specific blood test for PsA, but RF (rheumatoid factor) is typically negative, helping to differentiate from rheumatoid arthritis.
   • ESR and CRP: Elevated levels may indicate inflammation.
   • X-rays: May show joint damage, erosion, and new bone formation (bone proliferation).
   • MRI/Ultrasound: Useful in detecting early joint or tendon inflammation and to evaluate soft tissue involvement.
   • Physical examination: Identifies tender, swollen joints, nail changes, and skin lesions.

Question 67

List the medical/surgical, precautions & red flags, and PT management of Psoriatic Arthritis

Answer 67

5. Medical and Surgical Treatments/Medications:
   
   • Medications:
   • NSAIDs: For pain and inflammation relief in mild cases.
   • DMARDs (Disease-modifying antirheumatic drugs): Methotrexate, sulfasalazine, or leflunomide to control joint damage and inflammation.
   • Biologic agents: TNF inhibitors (e.g., adalimumab, etanercept), IL-12/23 inhibitors, and IL-17 inhibitors for more severe or resistant cases.
   • Corticosteroids: For short-term control of severe inflammation or flare-ups.
   • Surgical options:
   • Joint replacement surgery may be considered for severe joint damage.
   • Tendon repair: In cases of severe enthesitis or tendon damage.
   • Skin treatments: Topical medications, phototherapy, and systemic treatments for psoriasis lesions.
6. Precautions and Red Flags:
   
   • Monitor for progressive joint damage, as untreated PsA can lead to permanent deformities and disability.
   • Uveitis (eye inflammation) can cause vision problems and requires prompt treatment.
   • Increased risk of cardiovascular disease, so regular screening and management of risk factors (e.g., high blood pressure, cholesterol) are important.
7. Physical Therapy Management:
   
   • Joint protection strategies: To reduce stress on affected joints during daily activities.
   • Range of motion exercises: To maintain flexibility and prevent stiffness, particularly in the hands, spine, and feet.
   • Strengthening exercises: Low-impact exercises to build muscle support around joints, reduce pain, and improve function.
   • Stretching and flexibility exercises: Particularly important for the spine and affected tendons (e.g., Achilles or plantar fascia).
   • Posture training: Especially for those with spinal involvement (spondylitis).
   • Low-impact aerobic exercises: Such as swimming, walking, or cycling to maintain cardiovascular health and reduce stress on joints.
   • Patient education: On managing flare-ups, understanding medication side effects, and the importance of exercise to prevent stiffness.

Question 68

List the etiology, pathogenesis, diagnostics, and clinical presentation (signs & symptoms) of Gout

Answer 68

1. Etiology:
   
   • Metabolic disorder caused by the buildup of uric acid crystals in the joints, leading to inflammation and intense pain.
   • Uric acid is a waste product formed from the breakdown of purines, which are found in certain foods (e.g., red meat, seafood) and produced by the body.
   • Risk factors include high purine diet, alcohol consumption, obesity, genetics, certain medications (e.g., diuretics), and medical conditions (e.g., kidney disease, hypertension).
2. Pathogenesis:
   
   • Uric acid levels become elevated in the blood (hyperuricemia), either due to overproduction or under-excretion by the kidneys.
   • When uric acid crystallizes, the sharp crystals deposit in the joints and surrounding tissues, triggering an inflammatory response.
   • Most commonly affects the big toe (podagra), but other joints like the ankles, knees, and elbows can be involved.
3. Clinical Presentation (Signs and Symptoms):
   
   • Sudden, severe joint pain, often occurring at night or early in the morning.
   • Redness, swelling, and warmth over the affected joint, which becomes extremely tender to touch.
   • Tophi: Hard, uric acid crystal deposits under the skin in chronic or untreated gout.
   • Limited joint movement due to pain and swelling.
   • Fever may accompany severe attacks.
4. Diagnostics (Labs, Imaging, and Other Methods):
   
   • Serum uric acid levels: Elevated, though not all hyperuricemia cases result in gout.
   • Joint fluid analysis: Aspiration of synovial fluid to detect uric acid crystals, confirming the diagnosis.
   • X-rays: May show joint damage or tophi in chronic gout but are not diagnostic for early gout.
   • Ultrasound: Can identify uric acid crystal deposits in joints and soft tissues.

Question 69

List the medical/surgical, precautions & red flags, and PT management of Gout

Answer 69

5. Medical and Surgical Treatments/Medications:
   
   • Medications:
   • NSAIDs: First-line treatment to reduce inflammation and relieve pain during acute attacks.
   • Colchicine: Used to reduce pain and inflammation, especially if taken early in the attack.
   • Corticosteroids: Either oral or injected into the joint to control severe inflammation.
   • Urate-lowering therapies (ULT): Long-term medications like allopurinol or febuxostat to reduce uric acid levels and prevent future attacks.
   • Surgical options:
   • Rare, but surgical removal of tophi may be necessary in cases of chronic gout with large tophaceous deposits causing joint or skin damage.
6. Precautions and Red Flags:
   
   • Untreated or recurrent gout can lead to chronic gouty arthritis, with joint damage and deformities.
   • Kidney stones: Elevated uric acid can lead to the formation of urate kidney stones.
   • Rapid changes in uric acid levels, either from diet or medications, can trigger gout flares.
   • Watch for infections in the joint if fever persists, as this could indicate septic arthritis.
7. Physical Therapy Management:
   
   • Rest during acute attacks: Joint should be rested and protected from further strain during flare-ups.
   • Range of motion exercises: After the acute phase to maintain joint flexibility and prevent stiffness.
   • Strengthening exercises: Once inflammation subsides, focus on strengthening muscles around the affected joints to improve function and stability.
   • Weight management: Assisting in creating an exercise plan to maintain a healthy weight, which can reduce gout risk and lower joint stress.
   • Patient education: On lifestyle modifications such as dietary changes (reducing purine-rich foods and alcohol), hydration, and the importance of medication adherence to prevent future attacks.

Question 70

List the etiology, pathogenesis, diagnostics, and clinical presentation (signs & symptoms) of Osteochondritis Dissecans

Answer 70

1. Etiology:
   
   • Joint condition where a segment of bone and cartilage separates from the joint surface due to a loss of blood supply (ischemia).
   • The exact cause is unclear, but contributing factors include repetitive trauma, genetics, and possible vascular abnormalities.
   • Most commonly affects the knee (medial femoral condyle), but can also occur in the elbow, ankle, and other joints, particularly in adolescents and young adults.
2. Pathogenesis:
   
   • A small section of bone beneath the cartilage loses blood supply, leading to weakening and separation of the bone-cartilage fragment.
   • This fragment may stay in place or become loose, leading to pain, swelling, and mechanical symptoms (e.g., joint locking or clicking).
   • Can progress from stable (fragment remains attached) to unstable (fragment detaches and may become a loose body within the joint).
3. Clinical Presentation (Signs and Symptoms):
   
   • Joint pain: Gradual onset, often worsened by physical activity.
   • Swelling and tenderness over the affected joint.
   • Locking, catching, or giving way of the joint, especially if a loose fragment is present.
   • Reduced range of motion and stiffness in the joint.
   • In young athletes, symptoms may appear after sports involving repetitive stress on the joint.
4. Diagnostics (Labs, Imaging, and Other Methods):
   
   • X-rays: Show a visible lesion where the bone and cartilage are separating from the joint surface.
   • MRI: Provides detailed images of the cartilage and bone, helps assess the stability of the OCD lesion, and identifies loose bodies in the joint.
   • CT scan: May be used for detailed visualization of bone structure if surgery is being considered.
   • Physical examination: Reveals joint tenderness, swelling, and possibly reduced range of motion.

Question 71

List the medical/surgical, precautions & red flags, and PT management of Osteochondritis Dissecans

Answer 71

5. Medical and Surgical Treatments/Medications:
   
   • Non-surgical treatment:
   • Rest and activity modification: To reduce stress on the affected joint, particularly in younger patients with stable lesions.
   • Immobilization: May be recommended for a short time to allow healing.
   • Physical therapy: Strengthening and stretching exercises to improve joint mechanics and reduce symptoms.
   • NSAIDs: To manage pain and inflammation.
   • Surgical treatment:
   • Arthroscopic drilling: Stimulates new blood flow to the affected area to promote healing.
   • Fixation: Securing the fragment back in place with screws or pins.
   • Debridement or removal of loose bodies: If the fragment has detached.
   • Osteochondral grafting: Replacing the damaged area with healthy cartilage from another part of the joint (used in severe cases).
6. Precautions and Red Flags:
   
   • If left untreated, unstable OCD can lead to joint degeneration and early osteoarthritis.
   • Joint locking or persistent pain despite conservative measures should prompt further investigation and possible surgery.
   • Recurrence of symptoms after treatment may indicate instability of the OCD lesion or additional damage to the joint.
7. Physical Therapy Management:
   
   • Activity modification: Avoid high-impact activities and sports until healing is confirmed.
   • Range of motion exercises: Early intervention to maintain or restore joint flexibility, particularly after immobilization.
   • Strengthening exercises: Focus on the muscles supporting the affected joint to improve stability and function.
   • Progressive weight-bearing: Gradual return to weight-bearing activities under supervision.
   • Patient education: On the importance of adhering to rehabilitation protocols and avoiding activities that could delay healing or cause re-injury.

Question 72

List the etiology, pathogenesis, diagnostics, and clinical presentation (signs & symptoms) of Osteonecrosis

Answer 72

1. Etiology:
   
   • Loss of blood supply to bone, leading to bone death (necrosis) and potential joint collapse.
   • Causes include trauma (fractures or dislocations), steroid use, excessive alcohol consumption, certain medical conditions (e.g., sickle cell disease, lupus), radiation therapy, and blood clotting disorders.
   • Most commonly affects the hip (femoral head), but can occur in other areas like the shoulder, knee, and ankle.
2. Pathogenesis:
   
   • Disruption of blood flow to the bone results in ischemia and eventual bone death.
   • As the dead bone weakens, it may collapse, causing joint dysfunction and arthritis.
   • If untreated, osteonecrosis progresses from early stages (asymptomatic or mild pain) to late-stage joint collapse and severe arthritis.
3. Clinical Presentation (Signs and Symptoms):
   
   • Pain: Gradual onset of pain in the affected joint, usually with weight-bearing activities (e.g., walking, standing) in the hip or knee.
   • Limited range of motion and joint stiffness as the disease progresses.
   • Limping: Particularly with hip involvement.
   • Pain at rest or night may develop in advanced stages.
   • Symptoms may be bilateral (both sides), especially in conditions like steroid-induced osteonecrosis.
4. Diagnostics (Labs, Imaging, and Other Methods):
   
   • X-rays: May show bone collapse or joint space narrowing in advanced stages but often normal in early stages.
   • MRI: The most sensitive tool for early detection, showing areas of bone necrosis and edema before visible on X-rays.
   • CT scan: Can assess the extent of bone collapse and joint damage in later stages.
   • Bone scan: May show decreased blood flow to the affected area, but is less specific than MRI.
   • Physical examination: Reveals joint tenderness, limited range of motion, and pain with movement or pressure.

Question 73

List the medical/surgical, precautions & red flags, and PT management of Osteonecrosis

Answer 73

5. Medical and Surgical Treatments/Medications:
   
   • Non-surgical treatment:
   • NSAIDs: To reduce pain and inflammation.
   • Bisphosphonates: May help slow bone damage progression.
   • Activity modification: Reducing weight-bearing on the affected joint.
   • Physical therapy: Strengthening and stretching exercises to improve joint function.
   • Core decompression: A minimally invasive procedure to reduce pressure within the bone and improve blood flow (used in early stages).
   • Surgical treatment:
   • Bone grafting: Replacing necrotic bone with healthy bone or synthetic material to support the joint.
   • Osteotomy: Reshaping the bone to relieve stress on the affected joint and preserve function.
   • Joint replacement (arthroplasty): Total hip or knee replacement for advanced stages where the joint is severely damaged.
6. Precautions and Red Flags:
   
   • Untreated osteonecrosis can lead to joint collapse, severe pain, and osteoarthritis, necessitating joint replacement.
   • Bilateral involvement is common, especially in cases related to steroid use or alcohol abuse, so both joints should be monitored.
   • Watch for worsening pain or limited movement, which may indicate disease progression or joint collapse.
7. Physical Therapy Management:
   
   • Weight-bearing restrictions: Avoid heavy weight-bearing activities to prevent further joint damage.
   • Range of motion exercises: To maintain joint mobility and prevent stiffness, particularly in early stages.
   • Strengthening exercises: Focus on supporting muscles around the affected joint (e.g., quadriceps for the knee, hip stabilizers for the hip).
   • Pain management techniques: Including modalities like ice, heat, and gentle stretching.
   • Patient education: On activity modification, lifestyle changes (e.g., limiting alcohol), and the importance of adhering to medical treatment to slow disease progression.

Question 74

List the etiology, pathogenesis, diagnostics, and clinical presentation (signs & symptoms) of Legg-Calve-Perthes Disease

Answer 74

1. Etiology:
   
   • Avascular necrosis of the femoral head in children, causing temporary loss of blood supply to the hip.
   • The exact cause is unknown, but it may be related to interrupted blood flow, trauma, or genetic factors.
   • Primarily affects boys between the ages of 4 and 10, though it can occur in girls as well.
2. Pathogenesis:
   
   • Loss of blood supply to the femoral head causes bone tissue to die (necrosis), leading to weakening of the bone.
   • Over time, the femoral head may collapse and become misshapen as the body attempts to heal and regenerate the bone.
   • The disease progresses through stages: initial necrosis, fragmentation, reossification (healing), and remodeling.
3. Clinical Presentation (Signs and Symptoms):
   
   • Limping: A painless limp or one associated with intermittent hip, groin, or knee pain.
   • Hip or groin pain, often referred to the knee or thigh.
   • Limited range of motion, particularly in abduction and internal rotation of the hip.
   • Muscle weakness or wasting around the hip and thigh due to disuse.
   • Symptoms typically worsen with activity and improve with rest.
4. Diagnostics (Labs, Imaging, and Other Methods):
   
   • X-rays: Show characteristic changes in the femoral head, including flattening or fragmentation in later stages. Early stages may show only subtle changes.
   • MRI or bone scan: Used for early detection of blood supply loss before X-ray changes are evident.
   • Physical examination: Reveals a reduced range of motion, particularly in hip abduction and internal rotation, and pain with movement.

Question 75

List the medical/surgical, precautions & red flags, and PT management of Legg-Calve-Perthes Disease

Answer 75

5. Medical and Surgical Treatments/Medications:
   
   • Non-surgical treatment:
   • Activity modification: Limiting high-impact activities that stress the hip.
   • Physical therapy: To maintain range of motion, improve strength, and reduce stiffness.
   • NSAIDs: For pain relief and inflammation control.
   • Bracing or casting: To maintain the femoral head in a proper position and reduce joint stress, especially in younger children.
   • Surgical treatment:
   • Osteotomy: Surgery to realign the hip joint and improve the fit of the femoral head in the socket.
   • Femoral head reshaping: To improve the shape of the femoral head and prevent long-term complications.
   • Surgery is often reserved for older children or those with severe deformities or poor joint alignment.
6. Precautions and Red Flags:
   
   • Early diagnosis and intervention are critical to prevent long-term joint damage and hip deformities.
   • Persistent limping, pain, or stiffness should prompt further evaluation to assess disease progression.
   • In severe cases, untreated Legg-Calvé-Perthes can lead to early-onset arthritis and chronic hip dysfunction.
7. Physical Therapy Management:
   
   • Range of motion exercises: Focus on maintaining hip mobility, particularly in abduction and internal rotation.
   • Strengthening exercises: To support the hip joint, especially the gluteal and thigh muscles.
   • Gait training: To improve walking mechanics and reduce limping.
   • Non-weight-bearing activities: Swimming and cycling can help maintain strength and cardiovascular fitness without stressing the hip.
   • Education: On activity modification to prevent excessive joint stress, and the importance of following treatment protocols.

Question 76

List the etiology, pathogenesis, diagnostics, and clinical presentation (signs & symptoms) of Osgood-Schlatter Disease

Answer 76

1. Etiology:
   
   • Overuse injury caused by repetitive stress on the tibial tubercle, where the patellar tendon attaches to the shinbone.
   • Common in adolescents, particularly during growth spurts (ages 10-15), and affects those involved in sports with frequent running, jumping, or kneeling.
   • More common in boys but also affects girls, especially those active in sports.
2. Pathogenesis:
   
   • Repeated stress from the quadriceps muscle pulling on the patellar tendon causes microtrauma at the tibial tubercle.
   • This results in inflammation and can lead to painful swelling or a bony prominence at the site.
   • The condition is self-limiting and typically resolves after the growth plates close, but it can cause temporary pain and dysfunction.
3. Clinical Presentation (Signs and Symptoms):
   
   • Pain and swelling over the tibial tubercle (just below the knee).
   • Pain worsens with physical activities, particularly running, jumping, squatting, or kneeling.
   • Tenderness to touch over the tibial tubercle and a visible or palpable bony bump.
   • Tightness in the quadriceps and hamstrings.
   • Symptoms typically occur in one or both knees and tend to improve with rest.
4. Diagnostics (Labs, Imaging, and Other Methods):
   
   • Physical examination: Key for diagnosis; reveals tenderness, swelling, and possibly a prominent tibial tubercle.
   • X-rays: Usually not necessary but can show fragmentation or irregularity of the tibial tubercle in severe cases.
   • MRI or ultrasound: Rarely used but may help evaluate soft tissue involvement or rule out other conditions.

Question 77

List the medical/surgical, precautions & red flags, and PT management of Osgood-Schlatter Disease

Answer 77

5. Medical and Surgical Treatments/Medications:
   
   • Non-surgical treatment:
   • Rest and activity modification: Reducing or avoiding high-impact activities that worsen symptoms.
   • Ice: To reduce pain and inflammation after activity.
   • NSAIDs: For pain relief and inflammation control.
   • Knee padding or bracing: To protect the tibial tubercle during activities.
   • Physical therapy: To stretch tight muscles (especially the quadriceps and hamstrings) and strengthen the surrounding muscles.
   • Surgical treatment:
   • Rarely needed; in very severe or persistent cases, surgery may be considered to remove bony fragments or smooth the tibial tubercle once the growth plates close.
6. Precautions and Red Flags:
   
   • Early management is important to prevent worsening symptoms and ensure continued participation in sports.
   • Persistent pain or swelling despite rest and conservative measures may require further evaluation.
   • Symptoms typically resolve after the growth plates close, but the bony prominence may remain permanently.
7. Physical Therapy Management:
   
   • Stretching exercises: Focus on improving flexibility in the quadriceps and hamstrings to reduce stress on the patellar tendon.
   • Strengthening exercises: Target the quadriceps, hamstrings, and hip muscles to support the knee joint and reduce pain.
   • Activity modification: Educating the patient to reduce high-impact activities and take breaks during flare-ups.
   • Ice therapy and pain management: Teaching proper use of ice and NSAIDs to manage symptoms after physical activity.
   • Patellar taping or bracing: To offload stress from the tibial tubercle and support the knee during sports.