MSK differential Dx Flashcards
(297 cards)
1
Q
Signs and symptoms
- pain
- swelling
- decreased ROM
- bony deformity
- asymmetrical
A
OA
2
Q
What is Ankylosing spondylitis?
A
Progressive inflammatory disorder that initially affects the axial skeleton
3
Q
Where in the body does ankylosing spondylitis initially affect?
A
axial skeleton
4
Q
When is the initial onset of ankylosing spondylitis?
A
before 40 y/o
5
Q
What are commonly the first symptoms of ankylosing spondylitis?
A
- mid/low back pain
- morning stiffness
- sacroiliitis
6
Q
What is rheumatoid arthritis?
A
Chronic systemic autoimmune disorder
–> Individuals produce antibodies to their own immunogloulins, such as rheumatoid factor and ACPA.
thought to have genetic etiology
Commonly characterized by periods of exacerbation and remission
7
Q
When is the avg onset of RA?
A
40-60 y/o
8
Q
Signs and symptoms
- bilateral and symmetrical synovial joint involvement
- inflammation
- weight loss
- fever
- extreme fatigue
A
RA
9
Q
When is the onset of juvenile RA (JRA)?
A
before 16 y/o
remission in 75% of cases
10
Q
What diagnostic tests are used to diagnose RA?
A
- radiographs
- increased WBCs
- increased ESR
- anemia
- increased Rheumatoid factor
11
Q
What diagnosis is characterized by decalcification of bones due to vitamin D deficiency?
A
Osteomalacia
s/s
- severe pain
- Fx
- weakness
- deformities
12
Q
What diagnosis is characterized by trigger points?
A
myofascial pain syndrome
13
Q
What are the histological characteristics of tendinosis/tendinopathy?
A
- hypercellularity
- hypervascularity
- no indication of inflammatory infiltrates
- loose collagen fibers
14
Q
When is surgery warranted to treat myositis ossificans?
A
- Only in patients with hereditary myositis ossificans
- after maturation of the lesion (6-24 months)
- when lesions mechanically interfere with joint movement or cause nerve impingement
15
Q
What diagnosis is commonly referred to as reflex sympathetic dystrophy (RSD)?
A
CRPS
Thought to be related to trauma or precipitating event
16
Q
What triggers CRPS I?
A
Tissue injury
17
Q
Diagnosis
Dysfunction of sympathetic nervous system including pain, circulation, and vasomotor disturbances WITHOUT nerve injury
A
CRPS I
18
Q
What is the difference between CRPS I and II?
A
CRPS II involves a nerve injury
19
Q
What medications can be used to treat CRPS?
A
- antiseizure drugs
- antidepressants
- corticosteroids
- opioids
- topical drugs
20
Q
What are the long term results of CRPS?
A
- atrophy and weakness in close proximity to affected area(s)
- skin changes
- osteoporosis
- decreased proprioception
- contractures
- pain
- ## edema
21
Q
What clinical diagnostic tests are used to diagnose CRPS?
A
None
22
Q
What is the common name for Osteitis Deformans?
A
Paget’s disease
23
Q
What is Paget’s disease?
A
Metaobolic bone disease involving abnormal osteoblastic and osteoclastic activity - characterized by initial phase of excessive bone reabsorption followed by a reactive phase of excessive abnormal bone formation
24
Q
What does Paget’s disease commonly result in?
A
- spinal stenosis
- facet arthropathy
- possible spinal Fx
New bone structure is fragile and weak. Causes painful deformities of external and internal structures
25
What is the presentation of torticollis?
SB **toward** the affected side
+
ROT **away** from the affected side
26
Most traumatic GH instability occurs in what direction of dislocation?
anteroinferior
27
(true/false) Posterior dislocations of the GH joint are common
FALSE
28
What is a hill-sachs lesion?
compression Fx of posterior humeral head
29
What is a bankart lesion?
avulsion of anteroinferior capsule and glenoid labrum
30
(true or false) Immobilization for a greater tuberosity fracture is not needed
True
31
With what diagnoses is adhesive capsulitis most common?
DM and thyroid disease
32
What is de-quervain's synovitis?
inflammation/degeneration of extensor pollicis brevis and abductor pollicis longus tendons
| located in first dorsal compartment
33
What causes de-quervains synovitis?
Repetitive microtrauma or complication of swelling during pregnancy
34
What action can relieve symptoms of carpal tunnel?
Shaking hands
35
What interventions are allowed to treat de-quervain's synovitis?
- heat
- microwave diathermy
- IFC
36
What is the most common wrist fracture?
Colle's
| Dorsal dislocation fx of radius (Dinner Fork deformity)
37
How long are colle's fractures immobilized for?
5-8 weeks
38
What are complications of a colle's fracture?
Median nerve impingement caused by excessive edema
39
What is the most common carpal to be fractured?
Scaphoid
40
What wrist pathology has a "garden spade" deformity?
smith's Fx
| Anterior dislocation fx of the radius
41
How long are carpals immobilized after a scaphoid fx?
4-8 wks
42
What special tests can be positive in the presence of ITB tightness/syndrome?
- Noble compression test
- Ober's test
- Palpation over ITB insertion
- excessive hip IR in stance phase
43
Most people with trochanteric bursitis also have what?
RA
44
What is the common cause for coxa vara and coxa valga?
Necrosis of femoral head occurring from septic arthritis
45
What degree of hip ER is indicative of possible piriformis syndrome?
< 60 degrees
46
When does the piriformis become an interal rotator and abductor of the hip?
90 degrees of hip FLX
47
# Signs and symptoms
- acute or gradual onset of pain in the groin
- pathology with 1+ of the following: adductors, iliopsoas, inguinal, pubic
sports hernia
48
What are the 6 P's of acute compartment syndrome?
- pain
- pallor
- paresis
- parasthesia
- palpable tenderness
- pulselessness
49
(true/false) Acute compartment syndrome is a medical emergency requiring an emergent fasciotomy
true
50
What is the cause of acute compartment syndrome?
direct trauma and/or fracture
51
What is the most common LE compartment to experience chronic exertional compartment syndrome?
anterior
| results in anterolateral pain and possible paresthesia
52
(true/false) Medial ankle ligaments are commonly sprained
FALSE
| lateral is more common
53
What is medial tibial stress syndrome?
Overuse injury of the posterior tibialis and/or medial soleus resulting in periosteal inflammation at muscle attachment sites
54
What are the criteria for diagnosis of carpal tunnel syndrome?
- age > 45 y/o
- shaking hands relieves symptoms
- sensory loss in thumb
- wrist ratio index > .67
- CTQ-SSS score is > 1/9
55
What digits are commonly affected by dupuytren's contracture in those **with** diabetes?
3rd and 4th digits
56
What digits are commonly affected by dupuytren's contracture in those **without** diabetes?
4th and 5th digits
57
Describe boutionniere deformity.
Rupture of central tendinous slip of the extensor hood -- MCP EXT, PIP FLX, DIP EXT
58
What commonly causes boutionniere deformity?
1. trauma
2. RA w/ central extensor tendon degeneration
59
Describe swan neck deformity.
MCP FLX, PIP EXT, DIP FLX
## Footnote
Results from contracture of intrinsic mm with dorsal subluxation of lateral extensor tendons
60
When does swan neck deformity commonly occur?
1. Trauma
2. RA w/ degeneration of lateral extensor tendons
60
Describe Ape hand deformity.
Muscle wasting of thenar eminence - parallel to 2nd digit
61
Describe mallet finger.
DIP FLX due to avulsion of extensor tendon
## Footnote
Caused by trauma forcing the digit into FLX
62
What is another name for Flexor digitorum profundus tendon rupture?
Jersey finger
62
Describe jersey finger.
DIP hyperEXT
## Footnote
Caused by excessive hyperEXT w/ maximal finger FLX contraction
63
What digit commonly experiences jersey finger?
Ring finger
63
Describe gamekeeper's thumb
Sprain/rupture of UCL in the 1st digit MCP joint -- medial instability of the thumb
64
Describe boxer's Fx?
5th metacarpal Fx (at the neck)
| casted for 2-4 wks
65
Femoroacetabular impingement (FAI) is frequently associated with what other pathology?
Labral tear
66
What combined movements cause the unhappy triad?
| ACL, MCL, medial meniscus injury
1. Valgus
2. FLX
3. ER
| When foot is planted
67
What combination of movements can cause Meniscal injury?
1. ROT
2. FLX
3. compression
68
When can NMES be used for ACL sprains?
6-8 weeks after ACL reconstruction
69
When can concentric and eccentric exercises start after ACL reconstruction?
4-6 wks for up to 10 months
70
What are the criteria used for diagnosis of meniscal tear?
- twisting injury
- tearing sensation
**- delayed effusion**
- Hx of catching/locking
- pain with HyperEXT
- pain with max. FLX
- (+) McMurrays
- (+) Thessaly's
- joint line tenderness
71
What is PFPS a result of?
Elevated patellofemoral joint loading caused by one or more of the following:
1. trauma
2. biomechanics
3. muscle tightness
4. muscle weakness
## Footnote
Can also be assoc. with patellar tendinopathy and/or chondromalacia patellae
72
What is another name for "Fat pad syndrome of the knee"?
Hoffa's syndrome
73
What is jumper's knee?
Patellar tendinosis/tendinopathy
| degenerative condition of patellar tendon; commonly deep aspect
74
What commonly causes pes anserine bursitis?
1. Overuse
2. contusion
75
What criteria should be used for diagnosis of PFPS?
- retropatellar or peripatellar pain
- reproduction of pain with squatting, stairs, prolonged sitting, or other loading activities
- exclusion of other possible dx
76
What femoral condyle is commonly fractured?
Medial
77
What are the Ottawa Knee rules?
- age > 55 y/o
- isolated patellar tenderness
- TTP of fibular head
- Unable to perform Knee FLX > 90 degrees
- Unable to WB immediately after injury and in ED
78
What are the Ottawa knee and ankle rules used for?
To rule-in the need for XR series
79
What is the common MOI for tibial plateau Fx?
combination of valgus and compression during knee FLX
80
What is the common MOI for epiphyseal plate Fx?
WB torsional stress
81
Most stress Fx occur in what LE bone?
Tibia
82
What is a grade I lateral ankle sprain?
- no loss of function
- minimal tearing of ATFL
- minimal tearing of calcaneofiular ligaments
83
What is a grade II lateral ankle sprain?
- some loss of function
- partial disruption of ATFL and CF ligaments
84
What is a grade III lateral ankle sprain?
- complete loss of function
- complete rupture of ATFL and CF ligaments
- partial tear of PTFL
85
What are the ottawa foot rules?
1. TTP base of 5th metatarsal
2. TTP at navicular
3. Inability to take 4 steps immediately after and in ED
86
What causes tarsal tunnel syndrome?
1. excessive pronation
2. overuse resulting in tendonitis of long flexor and posterior tibialis tendon
3. trauma
| Entrapment of the posterior tibial nerve within the tarsal tunnel
87
# Signs and symptoms
Experiencing the following along the medial ankle to the plantar surface of the foot:
- parasthesia
- pain
- numbness
Tarsal tunnel syndrome
88
What test can be used to rule-in tarsal tunnel syndrome?
Tinel's sign
89
What tendinopathy is commonly seen in ballet dancers?
Flexor hallucis tendinopathy
90
What is the deformity observation for pes cavus (hollow foot)?
- Increase longitudinal arch
- drop of anterior arch
- metatarsal heads lower than hindfoot
- PF and splaying of forefoot
- claw toes
91
What is the deformity observation for equinus?
foot PF
92
what is the cause of equinus?
- congenital bone deformity
- neuro disorders (Ex: CP)
- triceps surae contracture
- trauma
- inflammatory disease
93
What is observed with hallux valgus?
- medial deviation of 1st metatarsal
- 1st metatarsal head and base move medially
- 1st distal phalanx moves laterally
94
What is metatarsalgia?
Inflammation of the plantar aspect of the 1st and 2nd metatarsal heads
95
What is charcot-marie tooth disease?
peroneal muscular atrophy affecting the sensory and motor nerves
96
(true/false) progressive stages of charcot-marie tooth disease can affect the muscles of the hands and forearms
true
97
# Signs and symptoms
- bilateral paresthesia and pain in back, buttocks, thighs, calves, and feet
stenosis
98
What movement increases pain when stenosis is present?
- EXT
- ipsilateral SB
- ipsilateral ROT
- walking
99
What movement decreases pain when stenosis is present?
- FLX
- prolonged rest
- activity modification
100
What medications are used for stenosis and disc conditions?
- NSAIDS
- acetominophen
- corticosteroids
- muscle relaxants
- trigger point injections
101
What degree of FLX should the cervical spine be placed in to provide optimum IV foraminal opening?
15 degrees
102
What are contraindications for Traction when treating stenosis?
- pregnancy
- hypermobility
- RA
- down syndrome
- systemic diseases affecting ligament integrity
103
# Signs and symptoms
- constant, deep, aching pain in back
- increased pain with movement in back
- referred LE pain
- no neuro findings
IV disc disruption
| annulus is disrupted but external structures are **not**
104
Why is herniation in the posterolateral aspect most common?
- posterior disc is narrow in height
- PLL is not as strong as ALL
- posterior lamellae of annulus is thinner
105
Where in the spine is central posterior herniation commonly observed?
cervical spine
106
(true/false) Those with central posterior herniation experience CNS symptoms
True
107
What movement is **most** comfortable in patients with facet entrapment?
FLX
108
What are the early signs and symptoms of whiplash injury?
- HA
- neck pain
- limited movement
- reversal of lower cervical spine lordosis
- decreased upper cervical kyphosis
- vision and hearing changes
- noise and light irritability
- nausea
- swallowing difficulty
- emotional lability
109
What are the later symptoms of whiplash injury?
- chronic head and neck pain
- decreased ROM
- TMJ dysfunction
- disequilirium
- anxiety and depression
110
What are the primary bone tumors?
- multiple myeloma
- Ewing's sarcoma
- malignant lymphoma
- chondrosarcoma
- osteosarcoma
- chondromas
111
What are the primary sites of metastatic bone cancer?
- lungs
- prostate
- breast
- kidney
- thyroid
112
What are s/s of esophageal cancer?
- referred back pain
- pain with swallowing
- dysphagia
- weight loss
113
What does pain radiate in the presence of pancreatic cancer?
deep, gnawing pain radiating to the chest and back
114
# signs and symptoms
Mid-epigastric pain radiating to the back
acute pancreatitis
115
# signs and symptoms
- abrupt, severe RUQ pain
- N/V
- fever
Cholecystitis
116
# Definition
Angle made by the foot with respect to a straight line plotted in the direction the child is walking
Foot progression angle (gait angle)
117
# Definition
Angle between the axis of the foot and thigh measure with the child prone and knees at 90 degrees
Thigh-foot angle
118
What does the thigh-foot angle describe?
angle of tibial torsion
119
In what position is toe-in/pigeon toe most prominent?
W sitting
120
What are the 3 types of deformity causing pigeon toe?
1. metatarsus adductus
2. internal tibial torsion
3. increased femoral anteversion (25-30 degrees FWD)
121
What is the most common congenital foot deformity?
Metatarsus adductus
| Greater in females and on the L side
122
What is talipes equinovarus?
| "Clubfoot"
- PF
- midtarsal ADD
- subtalar, talocalcaneal, talonavicular, and calcaneofibular INV
## Footnote
Cause: intrauterine malpositioning - abnormal development of head and neck of the talus
123
What is genu valgum?
Excessive lateral tibial torsion and patellar positioning
| ("Knock knees")
124
What is genu varum?
excessive medial tibial torsion
| ("Bow-legs")
125
What population is genu varum normal in?
Infants and toddlers
## Footnote
- maximum genu varum present at 6-12 months
- gradually straighten by 18-24 months
126
What infant populations are likely to develop hip dysplasia?
- Females
- hip dysplasia while in utero
- low levels of amniotic fluid
- Swaddled too tightly
126
What is the normal angle of genu valgum in males and females?
Males: 7 degrees
Females: 8 degrees
127
What is the gold standard of treatment for hip dysplasia in infants?
Pavlik-harness
128
How does the pavlik harness position the LEs?
hip FLX and abduction to maintain formal head acetabulum
129
When should a pavlik harness be used?
newborns to 6 months
130
When can closed reduction surgery be performed on children for correction of hip dysplasia?
6 months to 2 yrs
| Spica cast applied for 12 weeks
131
When can open reduction surgery be performed on children for correction of hip dysplasia?
> 2 y/o
| Spica cast applied for 6-12 weeks
132
# signs and symptoms: pediatric population
- unilateral hip or groin pain
- crying at night
- antalgic limp
- recent history of upper tract infection
Transient synovitis
| inflammation of synovium in the hip
133
What does treatment consist of for transient synovitis?
NSAIDs and rest for 7-10 days
134
What is the cause of Legg-Calve Perthes disease?
Decreased blood supply to femoral head
135
What is the age of onset for legg-calve-perthes disease?
2-13 y/o
| more common in males
## Footnote
imaging will show bony crescent sign
136
How long is casting applied for legg-calve perthes disease?
4-6 wks
| use of NSAIDs and acetaminophen
137
What is the most common hip disorder in adolescents?
SCFE
| unknown etiology
138
What is SCFE?
Slipped femoral head posteriorly and inferiorly within the acetabulum
139
What is the avg age range of onset for SCFE in **females**?
8-15 y/o
| avg. 11 y/o
140
# signs and symptoms: pediatrics
- AROM restriction of hip ABD, FLX, and IR
- vague knee, thigh, and hip pain
- Trendelenurg gait
SCFE
141
# definition: pediatrics
Mechanical dysfunction resulting in traction aphophysitis of the tibial tubercle at patellar tendon insertion
Osgood-schlatter disease
142
What is the most common cause of heel pain in growing children **before or during** their peak growth spurt?
| Bilateral in 60% of cases
Sever's disease (calcaneal apophysitis)
143
What causes sever's disease?
Repetitive microtrauma due to increased traction by the achilles tendon at its insertion site
144
What is sinding-Larsen Johannson's disease?
Traction apophysitis at the patella-patellar tendon junction
| Occurs due to repetitive overuse, after sig. growth, or inc. activity
145
# definition: pediatrics
a joint disorder in which a segment of bone and cartilage starts to separate from the rest of the bone after repeated stress or trauma
| usually involved medial femoral condyle
Osteochondritis dissecans
146
When does osteochondritis dissecans commonly occur?
12-15 y/o
147
# defintion: pediatrics
Localized **avascular necrosis of the humeral capitulum** leading to loss of subchondral bone with fissuring and softening of articular surfaces at the humeroradial joint.
Panner's disease
148
When can panner's disease occur
< 10 y/o
149
What is structural scoliosis?
Irreversible scoliosis with lateral curvature of the spine with a ROT component
| curve becomes apparent when flexing the spine
150
What is nonstructural scoliosis?
Scoliosis that has reversible lateral curvature of the spine without a ROT component
| straightens as the individual performs FLX
## Footnote
Can be managed by stretching, show lifts, and postural reeducation
151
At what degree of scoliosis can conservative treatment be used?
< 25 degrees
152
At what degree of scoliosis are braces used?
25-45 degrees
153
At what degree of scoliosis is surgery warranted?
| Placement of Harrington rod instrumentation
> 45 degrees
154
When do infants develop normal arches in the foot?
2-3 y/o
155
What are different causes of congenital muscular torticollis?
1. breech position
2. forceps birth
3. vacuum birth
4. restrictive intrauterine environment
5. genetics
6. cervical abnormalities
156
What is spasmic torticollis?
Torticollis with CNS pathology
157
What is arthrogryposis multiplex congenita?
Congenital deformity of the skeleton and soft tissues (contractures, weakness, etc)
158
(true/false) Intelligence is affected by arthrogryposis multiplex congenita
false
159
What is osteogenesis imperfecta?
Inherited autosomal dominant gene disorder that is characterized by abnormal collagen synthesis leading to an imbalance between bone deposition and reabsorption
## Footnote
Cortical and cancellous bones become thin, leading to FX and deformity of WB bones
160
What medications are used to treat osteogenesis imperfecta?
1. vitamin D
2. estrogen
3. bisphosphanates
4. calcitonin
161
What is spondylolysis?
Fx of the pars interarticularis
| "scotty dog fx"
162
What is spondylolithesis?
anterior or posterior slippage of a vertebrae on another due to bilateral pars interarticularis fracture
163
Describe the grades of spondylolithesis.
Grade 1: 25% slippage
grade 2: 50% slippage
grade 3: 75% slippage
grade 4: 100% slippage
164
How long is a pt immobilized after PCL reconstruction? How are they positioned?
6 wks in full ext
165
How long is a patient immobilized after lateral ankle reconstruction?
4-6 wks with cast and/or rigid walking boot
166
How long is a patient immobilized for after a flexor tendon repair within the hand? How are they positioned?
3-4 weeks with digit FLX
167
When is AROM initiated after a flexor tendon reconstruction in the hand?
week 4
168
How long are joints immobilized after distal hand repair? How are they positioned?
6-8 wks in neutral
169
When is AROM initiated after DIP hand repairs?
wk 6 while PIP is in neutral
| EXT initially and progress to FLX
170
What ligaments of the ankle are commonly repaired?
ATFL, CFL
171
What ligament of the elbow is normally repaired after injury?
UCL
172
How long are joints immobilized after proximal hand repair? How are they positioned?
4 wks while in EXT
| Early AROM/PROM can occur with FLX while MCP joints are in EXT
173
When is full AROM initiated into FLX and EXT after proximal hand repair?
6 wks
174
How long is a pt immobilized after RTC repair?
4-6 wks
175
How long can a pt not WB or perform AROM after a RTC repair?
4-6 wks
176
When are isometric exercises initiated after RTC repair?
wk 6
177
What positions must you avoid immediately after knee meniscal repair?
WB with FLX
178
What positions must you avoid immediately after hip labral repair?
- PROM hip EXT
- excessive FLX/ABD/ER
179
What positions must you avoid immediately after anteroinferior shoulder labral repair (Bankart)?
ER
180
(true/false) there is an optimal treatment for pts with articular cartilage injury
FALSE
181
What is a osteochondral autograft transplantation (OAT)?
transferring articular cartilage from low loading areas to high loading areas
| Purpose: preserve/restore articular cartilage
182
What is an autologous chondrocyte implantation (ACI)?
healthy articular cartilage is harvested from the pt and injected under a periostral flap that is then closed with sutures and glue
| Purpose: preserve/restore articular cartilage
183
What is an osteotomy?
Surgical cutting of a bone to correct a bony alignment
| commonly performed at knee to correct genu valgum/varum
## Footnote
immobilized for 6-8 weeks post-op to allow for bone healing
184
What positions should pts avoid after THR surgery?
- hip FLX >90
- hip ADD
- hip IR
| Precautions last for 6 weeks
185
How long can a pt not actively perform post-surgical THR precautions?
3-6 months
186
What is the goal for knee ROM by weeks 3 to 4 post-TKR?
0-120 degrees
| 0-90 degree goal for weeks 1-2
187
When can resistance exercises start after a THR surgery?
weeks 2-3
188
When can isometric and active exercises begin after THR/TKR surgery?
immediately (depending on surgeon guidelines)
189
What is considered as the foundation for spinal procedure rehab?
walking program
190
What interventions should be implemented after Harrington rod placement for idiopathic scoliosis?
Early bed mobilization and effective coughing
191
When should ambulation start after Harrington Rod placement for idiopathic scoliosis?
POD 4-7
192
What are the surgical precautions for laminectomy/discectomy, miceodiscectomy?
end range ROT and FLX
| NO joint mobilizations for at least 3 months
193
What are precautions for lumbar fusions?
1. avoid end range ROT and EXT
2. no intensive abdominal exercises
3. no impact loading for approx. 3 months
194
What are precautions for cervical fusions?
No lifting > 5-10 pounds for 4 wks.
195
What are the precautions for total disc replacements?
1. avoid end range ROT and EXT
2. no intensive abdominal exercises
3. no impact loading for approx. 3 months
4. no lifting > 5-10 pounds for 4 wks
196
Describe the classifications for tissue injuries.
Grade 1:
- mild pain and swelling
- pain with soft tissue tension
Grade 2:
- moderate pain and swelling requiring activity modification
- focal TTP
- partial ligament tear w/ possibly joint laxity
Grade 3:
- near-complete or complete tear with severe pain
- minimal or no pain with tissue tension
- palpable defect
- complete ligament tear and joint instability
197
What are the stages of soft tissue healing and when do they occur?
1. Inflammatory (3 to 5 days)
2. Proliferative (2 days to 2 months)
3. Remodeling (1-2 years after injury)
198
Describe the inflammatory phase of healing.
| Immediately to day 5
## Footnote
Acute phase
- vascular changes mobilize and transport cells to initiate inflammatory response
- platelets form a clot
- vasodilation occurs and increases blood flow while capillary permeability was altered to allow cellular exudation
- damaged tissues and microorganisms are removed (phagocytosis)
- pain before tissue resistance
199
Describe the proliferation stage of healing.
| Day 2 to month 2
## Footnote
subacute phase
- fibroblasts resorb collagen and synthesize new collagen
- new tissue is vulnerable to overloading - pain is synchronous with tissue resistance
- decreased macrophages and fibroblasts with scar formation
- removal of noxious stimuli
- growth of capillary beds
- granulation tissue
200
Describe the remodeling stage of healing.
| Years 1-2
## Footnote
chronic phase
- increased organization of ECM
- collagen is organized into randomly-placed fibrils
- tension is required for tissue orientation (contracture of scar tissue)
- absence of inflammation
- pain after tissue resistance
201
What is the healing time for Grade I muscle strains?
0-4 weeks
202
What is the healing time for Grade 2 muscle strains?
3-12 weeks
202
What is the healing time for grade 3 muscle strains?
1 month - 6 months
203
How long does a tendon take to heal?
2-6 months
204
How long does it take a grade I ligament sprain to heal?
0-4 weeks
205
How long does it take for a grade 2 ligament sprain to heal?
3 weeks - 6 months
206
How long does it take for a grade 3 ligament sprain to heal?
5 weeks to >1 year
207
How long does it take for a bone injury/Fx to heal?
6-12 weeks
208
How long does it take for cartilage to heal?
2-12 months
| depends on structure
209
What are the contraindications for performing soft tissue/myofascial techniques?
- soft tissue breakdown
- skin disease/infection/cellulitis
- osteomyelitis
- contagious illness
- malignant tumor
- aneurysms
- sensory impairment
- hemophilia
- DVT
- hematoma
- lymphagitis
210
Why is transverse friction massage used?
To initiate an inflammatory response for a tissue that is in metabolic stasis
| ex: tendinosis
## Footnote
Note: movement is perpendicular to muscle fibers
211
Which mobilization grades are used to improve joint lubrication/nutrition along with decreasing pain?
Grades I and II
212
Which mobilization grades are used to stretch tight muscles, capsules, and ligaments?
Grades III and IV
213
What mobilization grade is used for restoration of normal joint mechanics, decrease pain, and decrease guarding?
Grade V
214
What are the contraindications for joint mobilization/manipulation/traction?
- joint ankyloses and spondylolisthesis
- malignancies
- disease of ligaments (RA, down syndrome)
- arterial insufficiency
- active inflammatory process
- infection
- arthrosis
- metabolic bone disease (OP, paget's, TB)
- hypermobility
- joint replacements
- pregnancy
- steroid use
- radicular symptoms
215
What grade of mobilization should be used when mobilizing irritated neurologic tissue?
grade II
| should not be painful
216
What grade of mobilization should be used when mobilizing non-irritated neurologic tissue?
grade III
217
What are the contraindications when performing neural tissue mobilization?
- increase in neurological symptoms
- excessive pain
218
What intervention is also referred to as "intramuscular manual therapy (IMT)"?
dry needling
219
What is Malingering (Symptom Magnification Syndrome)?
A behavioral response where the presentation of symptoms control the life of the patient, leading to functional disability
220
What are the ABCs to examining radiographs?
Alignment (size, contour, alignment w/ other bones)
Bone density (density and texture)
Cartilage (joint space width, presence of subchondral bone, epiphyseal plates)
221
What forms of diagnostic imaging utilize ionizing radiation?
- XR
- CT/CAT
- Bone scan / Bone Scintigraphy
222
What forms of diagnostic imaging **do** **NOT** utilize ionizing radiation?
- US
- angiography
- MRI
- PET scans
223
(true/false) XR is a good way to visualize small Fx and soft tissues
FALSE
224
What kind of diagnostic imaging provides high-quality imaging of almost any structure of the body?
MRI
225
(true/false) CT/CAT scans have a better anatomical resolution of the chest and abdomen compared to XR
true
226
(true/false) A physician may not be able to distinguish between edema and cancer on an MRI
true
227
What type of imaging can diagnose fractures not detected on an XR and image areas with damage to the bone caused by cancer, trauma, infection, etc?
bone scan / bone scintigraphy
| Has improved detection of abnormal bone metabolism
228
What kind of scan is the gold standard for measuring bone mineral density?
DEXA scan
| differentiates between osteoporosis and osteopenia
229
(true/false) US has better resolution to image soft tissue lesions compared to an MRI
true
230
What is a PET scan used for?
1. Detection of non-perfusing areas of the heart
2. evaluate the brain in cases of undetermined stroke, Sz, memory disorders, or suspected tumors
231
What is an ultrasound used for?
Diagnosis of fluid pockets, masses, partial tendon tears, and muscle development/activation
232
In a T1 MRI, fat and bone marrow are (brighter/darker) and is helpful in defining anatomy
brighter
Black: bone cortex, air
| white: bone marrow, fat
233
In a T2 MRI, fluid appears (brighter/darker) than the fat which helps with identifying various joint pathologies
brighter
| Grey: bone marrow, fat
Black: bone cortex, air
234
(true/false) CT/CAT scans can measure bone density and identify tumors
true
235
What structural changes can result from arthrogryposis?
- hip dislocations
- contractures of the hip and/or shoulder
- club feet
## Footnote
hip: ABD, FLX, ER
Knee: ADD and IR
236
(True/false) ESR is elevated in those with DJD (OA)
false - normal ESR
237
# Diagnosis
Metabolic disease marked by elevated levels of serum uric acid and deposition of urate crystals into joints, soft tissue, and kidneys
gout
238
When do those with gout commonly have severe pain?
At night
| warmth, erythema, and extreme tenderness/hypersensitivity
239
What can induce myositis ossificans regarding PT treatment?
early mobilization and stretching with aggressive PT following trauma
240
# definition
Acute or chronic bone infection that is commonly the result of combined traumatic injury and acute infection
osteomyelitis
241
(true/false) Chronic osteomyelitis can lead to amputation
true
242
Paget's disease (osteitis deformans) can be fatal when associated with what diseases?
- CHF
- bone sarcoma
- giant cell tumors
243
Vertebral collapse or vascular changes as a result of paget's disease can result in what?
paraplegia
244
What is pronator teres syndrome?
Median nerve entrapment in the pronator teres muscle where the nerve passes through
245
# s/s
- insidious onset with slow progression
- fatigue
- weight loss
- weakness
- general diffuse MSK pain
- pain localized to specific joints with symmetrical bilateral presentation
Juvenile RA
246
After resting, how long can pain and stiffness last in those with JRA?
30 minutes to several hours
247
What is the MOI of a smith's fracture?
Falling onto a **flexed** wrist
248
(true/false) A second degree sprain includes altered joint stability
false- joint stability remains intact
249
Describe a March Fx of the tibia.
Fx of the distal 1/3 of tibial shaft
250
What causes a tibial spiral fx?
excessive tibial torsion
251
What is nurse-maid's elbow?
Pulled elbow with pain localized to the superior radioulnar joint
252
What is the MOI of nurse-maid's elbow?
Longitudinal pull on the forearm
253
What position will a person hold their arm if they have nurse-maid's elbow?
Pronation
| unable to supinate forearm
254
What is volkmann's contracture? What is the cause?
1. Severe pain in the forearm with the sensation of pressure if there is compartment syndrome
2. nerve and muscle ischemia secondary to arterial compromise
## Footnote
- Pain is produced within 2 hours and is increased by passive finger EXT
- pallor
- paresis
- pulselessness
255
What contractures are seen with Volkmann's contracture?
Wrist EXT and finger FLX
| contracture and paralysis are late complications
256
# diagnosis
Insidious onset of flexion contractures in the 4th and 5th digits secondary to palmar contracture; unable to EXT fingers
dupuytren's contracture
257
# definition
wrist disorder that occurs when the lunate loses its blood supply due to trauma
kienbock's disease
258
What motions are limited with kienbock's disease?
Wrist FLX/EXT
| pain also induced by palpation of the lunate
259
What motions can result in trochanteric bursitis?
Excessive/repetitive ADD and muscle imbalance
| Hip will be in IR/ER and ADD or resisted ABD
260
# s/s
- asymmetrical skin folds
- limb shortening
- posterosuperior prominence of proximal femur
- Trendelenburg gait
- decreased hip ABD ROM and strength
Congenital Hip dysplasia
261
What are predisposing factors for congenital hip dysplasia?
- interuterine crowding
- excessive capsular laxity
- genetics
262
What tests are utilized for diagnosis of congenital hip dysplasia?
Ortelani and Barlow
263
# s/s
- gradual onset
- hip pain and stiffness
- antalgic and psoatic limp due to weak psoas mj (movement into ER, FLX, and ADD)
- disuse atrophy of hip and thigh muscles
- limited ROM for hip ABD, IR, and EXT
Legg-calve perthes disease
264
What is the common age of onset for legg-calve perthes disease?
3-12 y/o
265
# s/s
- hip pain and tenderness
- vague hip and anterior thigh pain that can radiate to the knee
- decreased ABD and IR
- shortened limb
- trendelenburg gait
SCFE
266
What is the difference between acute and chronic SCFE?
ACUTE: result of trauma that results in pt being unable to WB; severe pain
CHRONIC: insidious development of limp with no pain or intermittent discomfort
267
What is the common age range for onset of SCFE in boys?
10-16 y/o
268
What kind of contracture will be seen in those with piriformis syndrome?
ER
## Footnote
- Sensation and blood supply to the perineum and genitalia may be decreased due to pressure on the sacral plexus and internal iliac vessels
- pain with sitting, squatting, or ER of hip
269
Where does pain radiate to when piriformis syndrome is present?
posterior thigh
270
What are the common MOIs for ACL injury?
- hyperEXT
- Tibial ER
- acute trauma
271
What is the MOI for LCL injury?
sudden forceful ADD of the tibia or knee dislocation
272
What is the MOI for MCL injury?
forceful tibial ABD or tibial ER with the knee flexed or hyperextended
273
Osgood-schlatter disease has what kind of onset?
insidious
274
What is morton's neuroma?
Neuritis resulting in burning and aching pain on the **plantar surface of the foot and toes 3-5**.
| development of metatarsal head calluses and flat transverse arch
275
What causes morton's neuroma?
chronic pronation
276
# s/s
- soreness of the middle metatarsals caused by abnormal mechanical stress
- plantar foot pain and fatigue with WB
- antalgic gait with pronation compensatory strategies
- callus over middle metatarsals
- hypermobility
metatarsalgia
277
- continous paresthesia and burning pain on plantar surface of the foot and toes
- caused by direct trauma or chronic irritation
- tenderness over tarsal tunnel
- sensory loss
- valgus heel and pronated forefoot
- swelling
- bony deformity
Medial tarsal tunnel syndrome
278
What do the following findings indicate?
- affected LE is longer while in supine
- affected LE is shorter when long-sitting
Anterior innominate ROT
279
What do the following findings indicate?
- affected LE is shorter while in supine
- affected LE is longer when long-sitting
posterior innominate ROT
280
Describe sacral torsion (FWD or BWD)
1. Ipsilateral deep sacral sulcus while in prone
2. sacral inferior lateral angle is posterior and inferior on the opposite side
281
What is fibromyalgia?
Immune system disorder that causes tenderness, pain, and stiffness of the muscles
282
# s/s
- aching or burning muscles
- diffuse pain
- tender points on BOTH sides of the body (at least 11)
fibromyalgia
283
Describe the differential diagnosis to rule in fibromyalgia.
1. widespread pain in 11 out of 18 trigger points in the body
2. typical pattern of nonrheumatic symptoms and sleep deprivation
3. exclusion of other dx
284
What is fibromyalgia often related to?
- stress/anxiety
- fatigue/sleeplessness
285
Respiratory care may be warranted in those with scoliosis if the Cobb angle is ____.
> 40 degrees
286
# Diagnosis
Chronic, systemic, rheumatic inflammatory disorder of connective tissue and organs
Systemic lupus erythematosus
287
# s/s
- malaise
- fatigue
- arthralgia
- fever
- arthritis
- skin rash (butterfly)
- photosensitivity
- anemia
- hair loss
- raynaud's
SLE
288
# s/s
- pain located in periauricular area
- unable to fully close the mouth
- mouth opening less than 40 mm secondary to pain
- pain decreases with rest
synovitis and capsulitis
289
# s/s
- joint noises and catching while mouth is fully opened
- mandibular depression is > 40 mm and deviates toward the **uninvolved** side
- palpable irregularities during mouth closure
TMJ hypermobility
290
# s/s
- joint noises
- palpation over lateral poles of TMJ reveals an opening click and closing click ("reciprocal clicking")
Disc displacement with reduction
291
# s/s
- intermittent TMJ locking without noises
- manibular opening is limited to 20-25 mm with deflection **towards** the involved side
- limited lateral excursion toward the **opposite** of the involved joint
disc displacement without reduction
292
Symptoms of stenosis are typically worse with what motion?
EXT and prolonged walking
