exam #3 Flashcards
(121 cards)
1
Q
osteoarthritis is..
A
Errosion of articular cartilage (mechanical breakdown)
2
Q
what is the mechanism destruction of joint of OA
A
initiated by mechanical forces
3
Q
initiating factor in primary osteoarthritis is…
A
unkownn
4
Q
Secondary OA may arise in a variety of situations, including
A
after trauma, inflammatory joint diseases, and in metabolic disorders or endocrine disorders
5
Q
OA pathology fact
A
considered a non inflammatory arthropathy
6
Q
Clinical manifistation of osteoathritis
A
40 years old (age of onset)
cervical and lumbar spine 1st cmc pip’s dip’s hip knee, subtalar joint, and first mtp more affected (b/c lots of movemement)
7
Q
common symptom of OA
A
gelling (morning stiffness)
8
Q
herbedens nodeds
A
DIP joints
9
Q
bouchards nodes
A
PIP joints
10
Q
osteoarthritis pathology
A
Nonsystemic, mostly noninflammatory, localized pathology
11
Q
rheumatoid arthritis pathology
A
Systemic, inflammatory disease that usually involves multiple joints and often affects organ systems.
12
Q
rotator cuff injury is what occuring?
A
The function of the rotator cuff is essentially to keep the head of the humerus in close contract with the glenoid.
13
Q
if going back into sports how long is the rehab for a rotator cuff injury
A
3-6 months
14
Q
rotator cuff injury is diagnosed through…
A
mri or muscle involved
15
Q
SLAP tears stands for
A
Superior Labrum-Anterior and Posterior (to the biceps tendon).
16
Q
slap tears do not…
A
heal by themselves
17
Q
bankart lesions do not…
A
heal on their own and require surgical repair
18
Q
what is a bankart lesion?
A
A Bankart lesion is when the labrum becomes detached from the front of the glenoid socket.
19
Q
causes for IT band
A
- Weak abductors or core muscles
- Increase mileage or terrain in running or new to running
- Over-Pronation of the foot
- High or low arches
- Leg length dicrepancy
- Genu varum “Bow-legs”
20
Q
where is IT band pain felt?
A
The pain is usually felt in the distal end of the IT Band
21
Q
IT band treatment
A
Strengthen hip abductors
Stretch lateral hip rotators and ITB
Strengthen core muscles
Have PT check leg length and foot biomechanics
Reduce mileage or switch to swimming.
ITB strap?
Ultrasound and IFC may help in acute phase
22
Q
3 possible causes for shin splints
A
- Anterior or posterior tibialis muscle tendinitis
- Stress fractures of tibia
- Compartment syndrome
23
Q
most common types for shin splints: Anterior Shin Splints
A
Tibialis Anterior Muscle becomes inflamed. Usually this is due to forceful “slapping” of the feet in a new runner. The eccentric forces tear the muscles. Over-pronation can also be a cause. This pain is felt in the front within the TA muscle belly
24
Q
most common types for shin splints: Posterior Shin Splints
A
The muscles most affected in this type of pain are the Soleus and the Tibialis Posterior. If the foot is in a proper alignment to the leg, these muscles function efficiently and pain-free. This condition usually results from over-pronation or wearing shoes that have lost their ability to control for over-pronation.
25
shin splints treatment acute phase
RICE
26
shin splints treatment intermediate phase
tib post exercises and soleus exercises (Theraband), cycling and short distance (pain-free) running. Examine for correct footwear and hip abductors
27
shin splints treatment late phase
return to running and continue strength and stretch.
28
patellar tendonitis
- AKA “jumper’s knee”
- Pain around the insertion of the ligamentum patellae.
- Aggravated with running or jumping
29
patellar tendonitis acute phase rehab
PRICE – cycling or water exercises. US and IFC may help.
30
patellar tendonitis intermediate phase rehab
isotonic for quads and abductors. Also examine for overpronation (footwear/orthotics?)
31
patellar tendonitis late phase rehab
add more dynamic ex’s for quads. May add plyometrics!
32
how long is patellar tendonitis treatment
3-5 weeks for slow progression of rehab recovery
33
common muscles that are pulled
adductors (groin), hamstrings, quads, hip flexors, gastrocnemius.
34
what do the common muscles pulled all have in common?
all are 2 joint muslces
35
muscle pulls acute phase rehab
PRICE and modalities. Switch sport if need to maintain fitness
36
muscle pulls intermediate phase rehab
light isotonics on affected muscle, stretch the affected muscle and examine biomechanics. (feet in contact with the ground)
37
muscle pulls late phase rehab
return to sport, continue stretches and strength, examine training regime and amount of rest and warm-up.
38
examples of traumatic sports injuries
lateral ligament sprain of the ankle
Shoulder separation – AC injuries
Knee soft tissue trauma (ACL, MCL and med meniscus)
39
Lateral ligament Ankle Sprains graded:
1=minor tear with no loss of stability
2=moderate tear with some stability loss
3=rupture with complete loss stability
40
ankle sprains facts
The ankle sprain is the most common athletic injury.
Nearly 85% of ankle sprains occur laterally
The most common MOI is an inversion sprain
41
3 most common ligaments affected in ankle sprains
anterior talofibular ligament
posterior talofibular ligament
calcaneofibular ligament
42
ankle sprain acute phase rehab
PRICE. Brace or crutches may be needed
43
ankle sprain intermediate phase rehab
cycling, pool, isotonics for inverters and everters, stretches to gastroc and soleus, early balance (2 feet)
44
ankle sprain late phase rehab
return to sport, plyometrics, high level balance exercises.
45
shoulder seperation means it happened in which ligament?
AC ligament
46
coracoclavicular MOI is...
a fall
47
shoulder seperation graded...
1=AC only
2=AC and either conoid or trapezoid
3=all 3 ruptured
48
shoulder seperation acute phase rehab
PRICE. Bracing as shown may be useful. Isometrics and ROM
49
shoulder seperation intermediate phase rehab
Isotonic RC ex’s and scapular stabilization ex’s (rhomboids and pec minor)
50
shoulder seperation late phase rehab
Return to sport, dynamic strengthening exercises.
51
main function of ACL
to prevent internal rotation of the femur on a fixed tibia
52
ACL injury facts
Frequently when the ACL is torn, the MCL is also torn.
| Since the MCL is attached to the medial meniscus, all three can be torn at the same time = terrible triad
53
ACL MOI
medial rotation with feet planted
54
ACL diagnosis and tests names..
a test called a Lachman (30 dreeges of flexion)test or an Anterior Drawer (90 degrees of flexion) test to examine for anterior translation.
55
what is the focus of rehab for ACL injuries?
the quads and hams in a co-contraction.
56
the method for ACL injury is...
closed chain
57
ACL acute rehab treatment and weeks..
Acute (1-2 weeks): PRICE, ROM muscle setting, isometrics, Bike (used for ROM)
58
ACL intermediate rehab treatment and weeks...
(2-8 weeks): work on regaining full ROM. Reduce flexion deformity (see right), isotonic, CKC ex’s
59
ACL late rehab treatment and weeks...
(8 weeks +): gradual return to sport, functional training, balance exercises, plyometrics.
60
spinal curves
lordosis: cervical, lumbar/sacral
kyphosis: thoracic
61
pedicle loaction
The pedicle is a stub of bone that connects the lamina to the vertebral body to form the vertebral arch
62
lamina location
The lamina is the flattened or arched part of the vertebral arch, forming the roof of the spinal canal
63
3 ligaments that stabilize the spine
- ligamentum flavum
- posterior longitudinal ligament
- anterior longitudinal ligament
64
DDD parts that are affected
facet joints, and ligaments cause the spinal segment to become loose and unstable
65
what are bone spurs and what do they cause...
develop around the facet joints and around the disc. These bone spurs can cause problems by pressing on the nerves of the spine where they pass through the neural foramina. This pressure around the irritated nerve roots can cause pain, numbness, and weakness in the neck, arms, and hands.
66
MOI of disc herniation
repetitive bending, twisting, and lifting can place extra pressure on the shock-absorbing nucleus of the disc
67
main categoriesin order for disc herniation
protrusion, then herniation, then sequestration is a rupture
68
PT treament for herniated disc
traction (manual or mechanical, and mckenzie excercizes
69
causes of a pinched berve
```
Disc herniations
DDD
Bone spurs
Tumors
Ligament buckling in the foramen
```
70
what is a lamictomy?
a surgical procedure to relieve pressure on the spinal cord due to spinal stenosis
-a small section of bone (lamina) covering the back of the spinal cord is removed
71
what is spinal stenosis
bone spurs press against the spinal cord, leading to a condition called myelopathy.
72
what is myelopathy
can produce problems with the bowels and bladder, gross and fine motor strength and coordination as well as sensory deficits
73
acute rehab for laminectomy
At first, treatments are used to help control pain and inflammation. Ice and electrical stimulation treatments are commonly used to help with these goals
74
intermediate rehab for lamiectomy
Active treatments are added slowly. These include exercises for improving heart and lung function. Walking, stationary cycling, and arm cycling are ideal cardiovascular exercises. Therapists also teach specific exercises to target muscles of the core and erector spinae.
75
what does WAD stand for
whiplash associated disorder
76
why is BC highest rate for whiplash/ car accidents
high alpine roads and driving conditions, muti cultural population who don’t know how to drive in this environement, have an aging population,
77
what are some symptoms of whiplash
```
Neck pain or neck pain that travels down the arm (radiculopathy)
Headaches
Low back pain (LBP)
Jaw pain (TMJ)
Dizziness
```
78
it can take up to how many hours to develop pain in neck?
24 to 72 hours to develop inflammation.
79
WAD classification grading
Grade 0: No complaint or physical sign
Grade I: Neck complaint of pain, stiffness or tenderness, no physical signs
Grade II: Neck pain and musculoskeletal signs
Grade III: Neck pain and neurological signs
Grade IV: Neck pain and fracture or dislocation
80
Factors Affecting the Severity of WAD
-Head turned one way or the other at the time of the impact (increases risk of nerve involvement with radiculopathy)
-Getting hit from behind (rear-impact collision)
-Previous neck pain or headaches
-Previous similar injury
-Poor posture at the time of impact (head, neck, or chest bent forward)
-Poor position of the headrest or no headrest
-Crash speed under 10 mph
-Being in the front seat as opposed to sitting in the back seat of the car
-Collision with a vehicle larger than yours
-Being of slight build
-Wearing a seatbelt (a seat belt should always be worn)
a lap and shoulder type seat belt will increase the chances of injury)
81
Scheuermann's disease facts
It affects less than one percent of the population and occurs mostly in children by the age of 11.
It affects boys and girls equally.
Those who do not get proper treatment for the condition during childhood often experience back pain from the spinal deformity as adults.
the anterior longitudinal ligament typically thickens in patients with Scheuermann's disease
82
what are Schmorl's nodes
Sometimes one or more discs in patients with Scheuermann's disease squeeze through the vertebral end plate, which is often weaker in patients with Scheuermann's disease.
This forms pockets of disc material inside the vertebral body
83
etiology of schermans disease
genetics
childhood osteoporosis
mechanical reasons
84
lumbar instability can happen for the following reasons
DDD
Trauma - such as fall or rotation injury at work in sports
Disc herniation
85
lumbar instability pain is usually...
The pain is frequently worse in extension or with rotation***
The pain often radiates down the leg.
86
what cuases lumbar instability pain
The pain is caused by stress placed on joint capsules, ligaments, tendons and other soft tissues.**
87
what is spodelolisthesis
forward slippage of vertebrae as a result of a fracture or degeneration of the facet joints or congenital.
88
what is sacroiliac joint dysfunction...
because it is still unclear why this joint becomes painful and leads to low back pain.
89
Classification of Functional Status of Patients with RA
**Class I: Completely able to perform usual activities of daily living.
Class II(2): Able to perform usual self-care and vocational activities, but limited in avocational activities.
Class III(2): Able to perform usual self-care activities, but limited in vocational and avocational activities.
**Class IV(4): Limited in ability to perform usual self- care, vocational, and avocational activities.
90
Classification of Progression of RA stage 1 early
No destructive changes on roentgenographic examination.
| Roentgenologic evidence of osteoporosis may be present.
91
Classification of Progression of RA stage 2 intermediate
Roentgenologic evidence of osteoporosis, with or without slight subchondral bone destruction; slight cartilage destruction may be present.
No joint deformities, although limitation of joint mobility may be present.
Adjacent muscle atrophy.
Extra-articular soft tissue lesions, such as nodules and tenosynovitis.
92
Classification of Progression of RA stage 3 severe
Roentgenologic evidence of cartilage and bone destruction in addition to osteoporosis.
Joint deformity, such as subluxation, ulnar deviation, or hyperextension, without fibrosis or bony ankylosis.
Extensive muscle atrophy.
Extra-articular soft tissue lesions, such as nodules and tenosynovitis, may be present.
93
Classification of Progression of RA stage 4 terminal
Fibrous or bony ankyloses (fusion).
| Criteria of stage III (plus everything from stage 3).
94
some examples of Inflammatory Arthropathies
Rheumatoid arthritis
Spondyloarthropathies
SLE (lupus)
Scleroderma
Vasculitis: inflammation of blood vessels
Infectious: septic joint, Lyme, gonococcal, hepatitis (monoarticular)
Post-infectious: Reactive arthritis, rheumatic fever, parvo B19
95
group 1 drug NSAID and an example
Non Steroidal Anti-Inflammatory Drugs
| ex: ibprofen
96
group 2 drugs DMARDS and an example
Disease Modifying Anti-Rheumatic drugs
| ex: gold compounds and Methotrexate
97
group 3 Cortico-Steroids and an example
ex: Prednisone
98
groups 4 drugs BMR's and an example
Biological Response Modifiers
ex:Etanercept – Marketed as Enbrel
Infliximib – Marketed as Remicade
99
aquatherapy benefits
Allowing performance of movement patterns that may not be possible on land because of balance or strength deficits.
Providing muscle relaxation.
Modifying pain perception through sensory stimulation.
100
what is ankylosing spondylitis
a chronic inflammatory disease of the axial skeleton manifested by back pain and progressive stiffness of the spine.
101
ankylosing spondylitis facts
20 and 30 years. (men more than women)
| the site of ligament insertion into bone) and an association with the human leukocyte antigen HLA-B27
102
PT treatment for ankylosing spndylitis
```
Reduce inflammation (meds) (modalities)
Exercise program to maintain/improve mobility.
Most important to focus on extension exercises – why?
ROM, stretching strengthening
```
103
what is uveitis
inflammation of the uveia
104
symptoms of uveitis
unilateral pain, photophobia, and blurring of vision
105
what is fibromyalgia
The term myalgia indicates muscular pain.
| by achy pain, tenderness, and stiffness of muscles, areas of tendon insertions, and adjacent soft tissue structures.
106
symptoms of fibromyalgia
```
concentration problems
fatigue
headaches
irritable bowel syndrome
joint discomfort
morning stiffness
muscle spasms
muscle weakness
musculoskeletal pain
numbness in hands and feet
sleep disturbances
temperature sensitivities
tingling sensation that may travel throughout the body
widespread pain in joints, muscles, tendons, and other soft tissues
```
107
fibromyalgia etiology
physical or mental stress, poor sleep, trauma, or exposure to dampness or cold and occasionally by a systemic, usually rheumatic, disorder. A viral or other systemic infection (eg, Lyme disease) may precipitate the syndrome
108
criteria for diagnosing fibromyalgia
least three months, and pain and tenderness in at least 11 of 18 tender-point sites.
109
tender spots while u have bibromyalgia
```
*Similar to acupuncture points (large area of nerves entering muscles)
Neck (sub occipital)
Shoulders (upper trapezius)
Chest (inferior to SC jt)
Rib cage (3-5 ribs to sternum)
Lower back (PSIS)
Thighs (vastus medialis)
Knees (MCL)
Arms (elbows) – (lateral epicondyle)
Buttocks (greater trochanters)
```
110
dianosis for chronic fatigue syndrome
requires that the tiredness is severe enough for at least a 50% decrease in the patient’s ability to participate in ordinary activities.
111
what is chronic fatigue syndrome
condition characterized by the primary symptom of a prolonged, persistent debilitating fatigue not relieved by rest and not directly caused by other conditions.
112
define Reactive Arthritis/Reiter’s Syndrome
peripheral arthritis lasting longer than 1 month, associated with inflammation urethritis, cervicitis, or diarrhea (bacterial arthritis).
113
define gout
deposition of sodium urate crystals in one or more joints.
114
predisposition to get gout
genetic predisposition, alcohol abuse, obesity, use of pharmacologic agents, age, and duration of hyperuricemia
115
lupus symptoms
Unexplained nonspecific symptoms such as fever, fatigue, weight loss, or anemia.
Photosensitive rash
Arthralgia or arthritis
Raynaud's phenomenon
Serositis (pericarditis, pleuritis, peritonitis)
Nephritis or nephrotic syndrome
Neurologic symptoms such as seizures or psychosis
Alopecia
Phlebitis: inflammation of veins, often with thrombus, with edema, stiffness and pain in the affected part.
Recurrent miscarriages.
116
symptoms of butterfly rash
```
hair loss
oral ulcers
Raynaud’s
Nailfold erythema/crust
livedo on hands/legs
Bullous rash on legs
dermatitis on fingers
```
117
scleroderma is a ...
collagen disorder
118
scleroderma clinical features
early edematous hands
late hidebound hands
atrophic skin ulcers
mouse like face
119
main vasculitides types
- Takayasu
- Giant cell/temporal
- Polymyalgia Rheumatica
- Churg Strauss Syndrome
- Behcet’s Disease
- Polyarteritis Nodosa
120
treatment of vasulitides
surgery
anticoagulants
anti viral agents
121
how does Kawasaki disease present its self
red eyes, cracked lips, red tongues
