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Clinical Medicine II > Exam IV Study Guide > Flashcards

Exam IV Study Guide Flashcards

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1
Q

DVT

A

40-90% of all patients

Signs and symptoms
Swelling
Erythema
Pain
Homan’s sign (but not on its own)
Point tenderness in calf

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2
Q

Avascular Necrosis

A

Hip is most common joint
-Men ages 30-60 years
-*Trauma
-Long term steroid use
-RA/Lupus
-Alcoholism

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3
Q

Avascular Necrosis Symptoms

A

Antalgic gait

Pain in the groin down to medial knee

Throbbing deep hip pain

Restricted hip internal rotation, flexion, and abduction

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4
Q

Hip Osteoarthritis

A

Osteoarthritis: focal loss of articular cartilage with variable subchondral bone reaction. Joint pain and functional impairment seen.

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5
Q

Hip Osteoarthritis conservative treatments

A

Gait and balance training
Manual therapies
Systematically progressed therapeutic strengthening, flexibility and endurance, (Keeping an eye on symptoms)

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6
Q

Anterior THA

A

Access b/t sup gluteal & femoral nerves

Possibly assoc’d w/:
-Fewer dislocations
-Less time in hospital

Relatively muscle-sparing

Femur less exposed
-Could make it difficult to place hardware

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7
Q

Posterior THA

A

most common, Good femur visibility during procedure, Deep ER muscles get cut, May increase dislocation risk, May compromise sciatic nerve, No ABD muscle cuts, Preserves frontal plane gait mechanics.

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8
Q

Lateral/Direct lateral THA

A

Glut med and min reflected away from troch

Allows for better distal access if necessary

More proximal access from the entry point could risk neurovascular compromise

Again, dislocation risk lower than that for posterior approach

Frontal plane gait problems are possible

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9
Q

Greater Trochanteric Bursitis

A

Common in active patients

Bursa irritated from excessive compression/friction

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10
Q

Greater Trochanteric Bursitis treatment

A

Relieve pain and inflammation (rest, ice, NSAIDs)

Eliminate activities that make it worse

Focus on functional exercise

If truly shortened, stretching is advocated (Glutes/TFL)

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11
Q

Ischial bursitis (Weaver’s bottom)

A

Pain over the ischial tuberosity
Caused by direct pressure from prolonged sitting
Can mimic a hamstring strain
Affects thinner people and cyclists

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12
Q

Ischial bursitis (Weaver’s bottom) interventions

A

Rest, ice, NSAIDs
Injection with corticosteroids

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13
Q

Muscle strain acute phase rehab

A

1-7 days
-Initial: cold prn pain
-Avoid motions that cause pain (crutches may be used)
-Sleeping with pillows under both knees to support the injured limb
-PRICEMEM
-Painless PROM or AAROM

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14
Q

Muscle strain sub acute phase rehab

A

1-3 weeks
-Begin AROM and initiate strengthening
-Aquatic therapy to decrease weightbearing loads
-Pain free submaximal isometrics
-Pain free concentric (AROM)
-UE strengthening
-CV training- swimming with pull buoy

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15
Q

Muscle strain repair phase rehab

A

3-8 weeks
Isometric contractions at 100% without pain
No pain on full ROM
Minimal to no pain with palpation

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16
Q

muscle strain repair/function phase rehab

A

8 weeks-6 months
-Normal gait pattern without pain
-Begin fast walking
-Once ambulating 30 min at fast speed without pain, jogging can begin
-Once jogging 30 min, sprinting can begin
-Then adapt to sport/function

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17
Q

2 types of hamstring strain

A

High-speed running (biceps femoris)
-Associated with recurrence

Extensive lengthening, e.g. kick motions (proximal semimem)
-Associated with prolonged RTS

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18
Q

MCL Sprain (Grade I, II, III)

A

Mechanism = valgus force or tibiofemoral (external) torsion
Esp. w/ planted foot

Grade I = pain, but minimal tearing

Grade II = Grade I + partial macroscopic tear, swelling, ↓ ROM
-Medial capsular ligament involvement

Grade III = Grade II + complete tear; marked instability, swelling, and loss of ROM
-Possible ACL and PCL involvement

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19
Q

Grade I MCL management

A

Crutches if needed, progressive ROM & exercise as permitted by pain
RTP by 1 month

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20
Q

Grade II MCL management

A

-Crutches during acute phase
Splint or immobilizer (< 1 week)
-Progress from isometrics to full-range resistance as pain allows
-Use brace when running

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21
Q

Grade III MCL management

A

Conservative care if isolated (plan on ~ 7 weeks for return to activity)
Surgical repair more if ACL or PCL involved

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22
Q

LCL Sprain

A

Mechanism = varus force, esp. when tibia is internally rotated

Managed similarly to MCL injury, but with prolonged timeframe (~ 6 months) for conservative care

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23
Q

ACL Sprain

A

Mechanism = Noncontact with multiplanar forces (e.g. valgus collapse); other mechanisms possible

Risk factors include female gender, fatigue, various weakness, alignment, laxity, and/or joint position sense characteristics

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24
Q

ACL Injury Management

A

Conservative and surgical (repair/reconstruction) approaches are both common
-Highly dependent on patient & nature of injury

Return to activity may range 2 – 6 months

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25
PCL Sprain
Mechanism = fall on bent knee or direct, posteriorly-oriented blow to proximal anterior tibia Favorable outcomes with conservative management for grade I and II If surgically repaired, patient may be immobilized in extension for 6 weeks, followed by ROM, and finally PRE at ~4 months.
26
Meniscus injuries
medial more commonly injured than lateral, mechanisms of injury are femur-on-tibia internal rotation with planted foot and forced knee extension while tibia is rotated Surgical resection more common than repair -Partial meniscectomy preferred Resistance exercise at full ROM ~ 6 weeks
27
Plica
Plica (synovial folds) are vestiges of embryological cavities, inflamed or damaged plica may cause, catching, snapping, pain going up/down stairs. If serious, can be resected; otherwise, rest
28
Osteochondritis Dissecancs
Usually refers to floating piece of articular cartilage -May involve other soft tissue like meniscus or synovium In children, conservative care may be sufficient In adults, surgery more likely
29
Patellofemoral Pain Syndrome
General label describing many kinds of anterior knee/patellar pain, often associated with lateral patellar tracking, activity modification should be first approach
30
Chondromalacia Patella
Deterioration of posterior patellar cartilage -Progresses from swelling/softening to cartilaginous fragmentation will lead to arthritis if not addressed Earlier on, conservative care may work -Activity modification, anti-inflammatories Sometimes, surgical realignment, resurfacing, or even patellar removal will be necessary
31
Patellar Subluxation/Dislocation
May occur as a result of forceful plant-and-twist maneuver (e.g. cutting), or direct trauma Repeated subluxations may compromise capsule and restrict ROM Dislocation (lateral) -Painful -Requires reduction followed by extension immobilization for a month
32
Osgood-Schlatter
Tibial tubercle avulsion fracture caused by repetitive tensile stress Usually occurs in youth and is resolved by growth of a callus End result is a larger-than-normal tubercle Conservative management
33
Larsen-Johansson
Like osgood schlatter but its at the apex of the patella, conservative management
34
Jumper’s Knee
Overuse-mediated degeneration anywhere along the patellar tendon Early on, pain after activity As it progresses, pain becomes more intense and/or more constant Management involves decreasing training volume, reducing pain, and graded exercise w/ eccentric contraction modes
35
Knee Osteoarthritis risk factors
Age Sex -Females @ greater risk (65+) -Males @ greater risk before age 50 Previous knee injury Obesity Malalignment(s) -Varus/valgus -Recurvatum -Patellar tracking Occupation
36
Knee OA idiopathic
There is probably a mechanism, but TBD Possible involvement of genetics
37
Knee OA post-traumatic
Fracture or soft tissue injury Can include consequences of surgery (e.g. meniscectomy)
38
Knee OA inflammatory
Pigmented villonodular synovitis Psoriatic arthritis
39
Knee OA hemophilic
Caused by hemarthrosis-mediated degeneration Primary prevention is best (only) strategy, but $$$ and requires extreme vigilance Onset may be early (20s, 30s), and often TKA will be required
40
Stemmer’s Sign
A thickened skin fold at the base of the second toe or second finger that is a diagnostic sign for lymphedema A positive result occurs when this tissue cannot be lifted but can only be grasped as a lump of tissue In a negative result, it is possible to lift the tissue normally
41
Complete Decongestive Therapy (CDT)
Manual lymphatic drainage (MLD) Short-stretch multi-layer bandaging Limb Clearing Exercises/HEP 5 consecutive treatment days a week for 2-6 weeks.
42
Comprehensive Lymphedema Management
***Education on basic anatomy, skin care, self-massage, self-bandaging, garment care, and infection management*** Psychological and emotional support Custom compression garments (20 mm hg-60 mm hg)
43
Complete Decongestive Therapy (CDT) phase one
Phase One – decongestive phase (2-6 weeks) -Mobilize edema -Decrease volume/circumference as much as possible -Limit fibrosclerotic tissue
44
Complete Decongestive Therapy (CDT) phase two
self care (ongoing) Maintain gains made in Phase One Limit exacerbation of sx
45
Manual Lymph drainage
a gentle, manual treatment technique consisting of several basic strokes, designed to improve the activity of intact lymph vessels by providing mild mechanical stretches on the wall, does not kneading elements and is generally applied suprafascially, whereas massage is usually applied to subfascial tissues.
46
Manual lymph drainage indications
Edema Swelling Sports injuries High output failure Arthritis Wounds Lymphedema CRPS
47
Combined Insufficiency
Combination of a high output failure and a low output failure -High output failure due to infection, trauma or surgery -Low output failure due to previous injury to lymph vessels or nodes, i.e. radiation therapy
48
Stagnation or a blockage of lymph
immunoglobulins prevented from reaching the sites where they can perform their immune functions
49
Kinmonth syndrome
inguinal lymph node fibrosis
50
Primary lymphedema: Milroy disease
observed at birth due to gene mutation- RARE
51
Primary lymphedema: Lymphedema Praecox
developed before 35 y/o
52
Primary lymphedema: Lymphedema Tarda
developed after age 35
53
Symptoms of Lymphedema
Tightness/heaviness/discomfort in the area Not usually painful Swelling and decrease in skin mobility Loss of strength or flexibility in a limb Variations in skin temperature and/or color
54
Lipedema
Painful “Fluid in the fat” disorder Feet are not involved
55
Stewart-Treves syndrome
Rare angiosarcoma that develops in people with long-standing lymphedema. Usually people have a hx of breast CA that was treated with radical mastectomy.
56
Stage 0 or Latent lymphedema
lymph transport is impaired, but there is no clinical evidence of swelling. May last months or years.
57
Stage I lymphedema
chronic inflammatory response to the excessive protein in the interstitium pitting on pressure reverses with elevation Subcutaneous tissues begin to fibrose due to protein buildup, progressing the lymphedema from Stage I to II.
58
Stage II lymphedema
Non-pitting Does not reduce on elevation of the limb Clinical fibrosis is present- skin is thick and rigid Clear, sticky lymph fluid may ooze from pores Chronic inflammation can lead to recurrent bacterial and fungal infections
59
Stage III lymphedema/ lymphostatic elephantiasis
severe non-pitting Large lobular folds fibrotic edema with atrophic skin changes such as thickened, leathery, keratotic skin, skin folds with tissue flaps, papillomas (warty like overgrowth)
60
Functional Severity: Minimal
less than 3cm difference between limbs Less than 20% increase in limb volume
61
Functional Severity: Moderate
3-5 cm difference 20-40% increase in volume
62
Functional Severity: Severe
>5 cm difference AND a positive Stemmers sign >40% increase in volume

Clinical Medicine II (5 decks)

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