Quiz #4 Flashcards
1
Q
what causes myofascial compartment syndrome?
A
increased institial pressure w/closed myofascial compartment
2
Q
where is myofascial compartment syndrome likely to occur?
A
in the envelopes of the lower leg, forearm, thigh, and foot where the fascia can’t give or expand
3
Q
why is myofascial compartment syndrome most likely to occur in the lower leg?
A
the tibia and fibular create harder barriers than fascia
4
Q
what can the following conditions cause:
fractures
severe contusions
crush injuries
excessive skeletal traction
reperfusion injuries and trauma
shin splints?
A
myofascial compartment syndrome
5
Q
what are some other risk factors for myofascial compartment syndrome?
A
burns
circumferential wraps/restrictive dressings
cast/other unyielding immobilizer
6
Q
what are the pain descriptors of myofascial compartment syndrome?
A
deeping, throbbing pressure
7
Q
t/f: compartment syndrome can cause sensory deficits/paresthesia distal to the area of involvement
A
true
8
Q
what are the objective signs of severe compartment syndrome?
A
swelling w/smooth shiny, red skin
extremity is tense on palpation
passive stretch increases pain
9
Q
what is the standard intervention for compartment syndrome?
A
prompt surgical decompression
10
Q
what is a subluxation?
A
partial disruption of anatomic relationship w/in a jt
11
Q
what joints are at risk for subluxation?
A
mobile jts
12
Q
what is a dislocation?
A
complete movement of a bone out anatomical jt alignment
13
Q
what are the general guidelines for soft tissue injuries?
A
immediate immobilization but shouldn’t last too long
14
Q
what is the treatment for soft tissue injury?
A
early movement
15
Q
why is early movement important in treatment of soft tissue injuries?
A
it allows induces rapid intensive capillary ingrowth into injured area
better repair of muscles fibers
more parallel orientation of regenerating myofibers compared w/immobilization
16
Q
what should be avoided in the first week post soft tissue injury?
A
stretching
17
Q
what is the PT role in soft tissue injuries?
A
prevention of detrimental effects of immobilization
promote tissue flexibility
minimize inflammation
enhance tissue healing
18
Q
in 7-10 days post soft tissue injury, what can be done?
A
gradual progression in using injured muscles more actively
pain and tolerance as guide in setting limits
isometric training should be started 1st then progressed to isotonic training
19
Q
what is the damaging role of fluoroquinolone use in soft tissue injuries?
A
tendinopathy
jt tenderness
swelling
20
Q
when do the damaging effects of fluoroquinolone usually set in?
A
6 months post use
21
Q
what are possible side effects of creatine use?
A
muscles cramping
diarrhea and other GI symptoms
dehydration
22
Q
how are soft tissue injuries prevented?
A
early participation of young children in sports
PTs identify risk factors b4 injuries
23
Q
what is heterotopic ossification (HO)?
A
bone formation in non-osseous tissues
ectopic bone formation
24
Q
what often occurs following fractures, surgery, SCI, TBI, burns, and amputations?
A
heterotrophic ossification (HO)
25
who is more at risk for HO, men or women?
men
26
t/f: there seems to be some kind of link b/w the severity of injury and formation of ectopic bone?
true
27
why is HO common in military personnel?
from blast injuries
28
what are the risk factors for HO?
serious traumatic injury
previous history of HO
ankylosing spondylitis (AS)-fused vertebrae
diffuse idiopathic skeletal hyperostosis-bone growth down the anterior vertebrae
29
what are the most common locations affected by HO?
hip, elbow, knee, shoulder, and TMJ
30
what a common feature of both HO and myositis ossificans (MO)?
deposits of mature lamellar bone
31
what is the location of HO?
non-osseous tissue
32
what is the location of MO?
bruised, damaged, or inflammed muscle
33
what most likely affects pluripotent mesenchymal (stem) cells that could differentiate intocartilage, bone, or tendon/ligament become osteoblasts instead?
HO
34
what phase of HO is being described: inflammatory process resulting in edema and degeneration of muscle tissue?
acute phase
35
in HO, after a few weeks, the inflammed tissue is replaced with ____ and ____
cartilage and bone
36
what is the Hallmark sign of HO?
progressive loss of jt motion at a time when post traumatic inflammation should be resolving
37
as ectopic ossification advances...
acute symptoms may subside
motion continues to decrease even with intervention
38
t/f: ectopic ossification can result in abnormal hard end feels
true
39
how can HO be prevented?
radiation
40
what are the potential side effects of HO treatment with radiation?
GI disturbance and osteomalacia
41
what is used to reduce frequency and magnitude of ectopic bone formation in some areas?
NSAIDS
42
what is contraindicated in rehab of HO?
forcible jt manipulation as this could create more inflammation and perpetuate the problem
43
what is rehab phase 1 of HO?
1-2 weeks post
minimize swelling and scar formation, pain management, PROM and AROM
44
what is rehab phase 2 of HO?
2-6 weeks post
some modalities, self-passive stretching, weighted stretches, static/dynamic progressive splinting, functional use of affected area, strengthen if appropriate
45
when are bone fractures usually healed, allowing more aggressive splinting?
week 6
46
when is scar tissue fully formed but still malleable?
6-12 weeks
47
what is the 3rd phase of rehab in HO?
6-12 weeks post
healed bone=more aggressive splinting
fully formed malleable scar tissue
splinting an resistive exercises can continue to maximize gains in motion
48
what is the last phase of rehab in HO?
3-6 months post
organized fibrotic scar tissue
may get small gains, but often motion has reached plateau
49
what is polymyalgia rheumatica?
bilateral symmetrical diffuse pain and stiffness primarily in shoulder and pelvic girdle musculature
50
what structures does polymyalgia rheumatica affect?
neck, SC, shoulders, hips, low back, and buttocks
51
t/f: polymyalgia rheumatica can start with upper or lower symtoms
true
52
what are the Hallmark features of polymyalgia rheumatica?
painful stiffness lasting greater than an hour in the morning
53
why is diagnosis of polymyalgia rheumatica often delayed?
bc it can look like normal aging
54
polymyalgia rheumatica can indicate what endocrine disorder, malignancy, or infection?
giant cell arteritis
55
what is giant cell arteritis?
inflammation of arteries of the head and neck
56
what are the s/s of giant cell arteritis?
blurred or lost vision
headaches
jaw pain
57
what % of ppl with polymyalgia rheumatica can develop giant cell arteritis?
15-20%
58
t/f: polymyalgia rheumatica has a known etiology
false
59
what muscle testing can be done for polymyalgia rheumatica?
serum creatinine-kinase levels
electromyograms
muscle biopsy
60
what are the s/s of polymyalgia rheumatica?
aching and stiffness
flu-like symptoms
sometimes peripheral manifestations
61
how is polymyalgia rheumatica diagnosed?
rapid response to Prednisone
ESR > 30-40 mm/hr
diagnosis of exclusion
MRI/US when ESR is normal
62
when would a PT do an immediate referral on a patient in regards to polymyalgia rheumatica?
when the patient develops a temporal headache, temporal tenderness, scalp sensitivity, or visual complaints
63
what are the side effects of Prednisone?
weight gain
mood swings
cataracts
glaucoma
diabetes
easy bruising
rounding of the face
difficulty sleeping
HTN
64
what is rhabdomyolysis?
rapid breakdown of skeletal muscle tissue caused by a large release of creatine phosphokinase (CPK) enzymes and other cell byproducts into the bloodstream
65
what can these all be a cause of:
accumulation of muscles proteins
high dose statins
herbal supplements
strenuous exercise
toxic effects (ethanol, methanol, heroine)
metabolic abnormalities
rhabdomyolysis
66
what is statin induced rhabdomyolysis?
mild myopathy following initiation of statin therapy
67
what are risk factors for rhabdomyolysis?
over 80 y/o
small, frail body structure
kidney or liver disease
drinking excessive grapefruit juice (over a quart a day)
use of other meds
alcohol abuse
68
how is rhabdomyolysis diagnosed?
patient reported muscles pain and mild to severe weakness
urine color change to tea or cola color
urine dipstick (blood but no cells-myoglobinuria)
lab test confirmation
69
how is rhabdomyolysis medically managed?
rehydration and correction of electrolyte imbalances
dialysis for renal failure
70
how does acute care PT treat rhabdomyolysis?
AROM and AAROM w/in limits of pain
71
how is rhabdomyolysis treated in outpatient PT?
strength and functional limitations
72
what does the prognosis for rhabdomyolysis depend on?
kidney damage
73
in mild cases of rhabdomyolysis, when can patients return to normal activities?
within a few weeks to a month
74
what is a developmental disorder?
a collection of syndrome that are either present or in the process of developing at birth
75
what is the most common chromosomal disorder?
Down syndrome
76
with Down syndrome, maternal age of <30 y/o has an incidence of __ in __ births
1/2000
77
with Down syndrome, maternal age of >40 y/o has an incidence of __ in __ births
1/20
78
what is the etiology of Down syndrome?
trisomy 21 (47 chromosomes instead of 46)
deterioration of oocyte, environmental factors, viruses
translocation of chromosome 15, 21, 22
79
what are the clinical manifestations of Down syndrome?
flat nose and occiput
almond eyes
congenital heart disease
language, cognitive, and motor delays
short limbs and broad hands and feet
simian crease in the palm just below the metacarpals
otitis media (ear infections)
compromised respiratory system
decreased antibody response
decreased feeding ability
increased risk of Alzheimers at a younger age
increased risk for eye problems and cancer
heart septum defects
80
what are musculoskeletal manifestations of Down syndrome?
soft laxity and muscle hypotonia
patellar subluxations
risk of patella riding laterally with knee valgus
foot overpronation
knee valgus
trendelenburg sign
scoliosis
SCFE
hip dislocation
OA or AA instability
SC compression
decreased step length
decreased knee flexion at heel strike
knee hyperextension
decreased single limb support
decreased push off at terminal stance
slower rxns
delayed developments of midline UE movement
obesity and OA later in life
81
what is the Trendelenburg sign?
hip drop from weak gluteus medius
82
what is the atlantooccipital joint?
joint between C0 and C1
"yes joint"-flexion and extension
50% total flex/ex ROM in cervical spine
occipital condyles and superior articular facet of the atlas
ellipsoid jt
83
what is the atlanto-axial jt?
jt b/w C1 and C2
"no jt"-rotation
50% total rotation of cervical spine
anterior arch of atlas, transverse ligament, and dense
pivot and plane jts
84
t/f: a fractured dens is a contraindication for PT
true
85
due to AA instability in Down syndrome, what are some activity avoidances?
direct downward, traction, and translatory motions in the cervical spine
manual therapy, some surgeries, tumbling, diving, horseback riding, football, soccer, wrestling, and trampoline
86
what are some precautions with Down syndrome?
carnival rides, roller coasters, and spinning rides
87
cord compression can lead what UMN signs?
clonus
hyperreflexia
Babinski sign
b/b signs
weakness
altered sensation
88
what is a PT role in Down syndrome activity limitations?
educating the family and public of risks and precautions
promoting active lifestyle early to decrease risk of obesity, DM, and CVD
89
how do cardiac defects in Down syndrome impact activity levels?
they have to work harder due to increased HR, O2 consumption, and minute ventilation
need to work closely with PTs to guide activity safely
need to keep peak HR and VO2 lower
90
what are the 2 upper cervical tests?
transverse ligament sharp purser test
alar ligament test
91
what is the sharp purser test?
stabilize C2 and provide slight neck flexion and posteriorly directing force to feel for a clunk
92
what is a negative sharp purser test?
no movement
93
what is a positive sharp purser test?
clunk feel/production of symptoms
94
what is the alar ligament test?
stabilize C2 and provide SB force from the head and allow no rotation to feel for excessive motion
95
what is a negative alar ligament test?
about 10 deg w/firm end feel
96
what a positive alar ligament test?
excessive motion/reproduction of symptoms
97
how is Down syndrome managed?
specific medical management
- antibiotics for infection
- cardiac surgery
- monitoring thyroid function
- address gross and fine motor development
- promote physical activity early
98
what is scoliosis?
abnormal lateral curvature in the frontal place which includes abnormal rotation of the spine in the transverse plane
99
is an S curve or C curve more common in scoliosis?
S curve
100
what is the most common scoliosis?
idiopathic scoliosis
101
what is idiopathic scoliosis?
unknown cause
most common scoliosis
102
what is osteopathic scoliosis?
bone abnormality
103
what is myopathic scoliosis?
muscle imbalance
104
what is neuropathic scoliosis?
CNS disorder
105
what is neuromuscular scoliosis?
a combo of myopathic and neuropathic scoliosis (muscle imbalance with CNS disorder)
CP, polio, muscular dystrophy, myelomeningocele
106
what % of scoliosis cases are infantile (0-3 yo)?
1%
107
what is the most common curve in infantile scoliosis?
L thoracic curve
108
is infantile scoliosis more common in males or females?
males
109
what is the most common curve in juvenile scoliosis (3-10 yo)?
R thoracic curve
110
what is the most common age for scoliosis diagnosis?
adolescence (age 10-20)
111
what is adult scoliosis?
over 20 yo
curve over 30 deg
112
what % of cases of scoliosis are over 50 yo?
6-10%
113
what % of children have scoliosis?
0.4-5.5%
114
what proportion of those with scoliosis need intervention?
1/4
115
what is the ratio of male to female scoliosis cases with a curve over 30 deg?
10:1
116
what is functional scoliosis?
caused by factors outside the spine like pain, posture, leg length discrepancy, and muscle spasm
117
what is structural scoliosis?
fixed curve w/vertebral body deformity
118
what are the 4 types of structural scoliosis?
congenital
musculoskeletal
neuromuscular
idiopathic
119
what is congenital scoliosis?
wedge vertebra, fuse rib/vertebra, hemi-vertebrae
120
what is musculoskeletal scoliosis?
osteoporosis, spinal tuberculosis, RA
121
the earliest changes in scoliosis are seen in ____ tissues
soft
122
what is the pathogenesis of scoliosis?
abnormal forces w/muscles on convex side lengthened and muscles on concave side shortened
hypertrophy on the side of concavity
mechanical advantage on the side of concavity
bony deformity overtime due to assymetric forces resulting in assymetric bone density
123
what is a primary curve in scoliosis?
where the problem starts
124
what is a secondary curve in scoliosis?
the result of the primary curve
L lumbar curve is the most common
125
what are some clinical manifestations of scoliosis?
rotational deformity on the convex side (rib hump)
assymetric shoulder and pelvic position may be the 1st indicator
back pain-primary presenting symptom
126
<__deg rarely produces problems in scoliosis
20
127
>__deg results in pulmonary insufficiency, back pain, disc disease, sciatica etc.
60
128
what is usually the 1st indicator of scoliosis?
assymetric shoulder and pelvic positions
129
what is the primary presenting symptoms in many patients with scoliosis?
back pain!
130
how do you measure Cobb's angle for measuring the curve in scoliosis?
on a radiograph of the spine, choose the most tilted vertebrae above and below the apex and draw a parallel line coming out of them
then draw perpendicular lines through those lines and measure the angle created
131
____ and ____ _____ may prevent severe deformity in scoliosis
bracing, surgical intervention
132
what is the management for scoliosis with a curve of <25 deg?
observation and monitoring every 6 months
133
what is the management for scoliosis with a curve of 25-40 deg?
spinal orthoses
134
what is the management for scoliosis with a curve >45 deg?
segmental stabilization or Herrington surgery (entire spine length)
135
exercise may be effective in ____ scoliosis and for secondary effects in _____ scoliosis
functional, structural
136
what does exercise for scoliosis focus on?
trunk extensors
abdominals
gluteals
137
what is developmental dysplasia of the hip?
abnormally formed acetabulum and malpositioned femoral head
138
what is the unstable form of developmental dysplasia of the hip?
positioned normally but may be displaced manually
139
what is the subluxation form of developmental dysplasia of the hip?
the femoral head remains in contact with the acetabulum but is partially displaced
140
what is the dislocation form of developmental dysplasia of the hip?
the femoral head isn't in contact with the acetabulum but stays within the capsule
slopping roof of the acetabulum
141
what is the treatment for hip dysplasia with dislocation?
splinting, surgery, rehab
142
are females or males more likely to be affected by hip dysplasia?
females
143
what is the etiology of hip dysplasia?
effects of relaxin on fetus
hereditary systemic laxity
infant positioning pre and postnatally
144
what does FABER stand for?
flexion, abduction, and external rotation for slinging a baby for better contact and stability of the femoral head in the acetabulum
145
what are risk factors for hip dysplasia?
twins
breech delivery
large birth size
CP
spina bifida
idiopathic scoliosis
arthrogryposis (congenital jt contraction where one/more jts are contracted at birth)
torticolis
feet adducted in
family history
gohydramnois (deficient amniotic fluid limiting fetal movement)
146
what is arthrogryposis and what is it a risk factor for?
congenital jt contraction where one/more jts are contracted at birth
risk factor for hip dysplasia
147
what is gohydramnois and what is it a risk factor for?
deficient amount of amniotic fluid limiting fetal movement
risk factor for hip dysplasia
148
what is the pathogenesis of subluxation in hip dysplasia?
shallow acetabulum
acetabular roof slopping at increased angle
149
what is the pathogenesis of dislocation in hip dysplasia?
femoral head is on iliac wing and ligamentum teres is elongated
150
what can delayed correction of hip dysplasia lead to?
avascular necrosis
151
what is the pathogenesis of hip dysplasia?
subluxation or dislocation
stretched hip capsule
contracted structures at the hip
change in blood supply to the hip
flattened femoral head
acetabulum dysplasia
false acetabulum
152
what are clinical manifestations of hip dysplasia?
significant abduction
gluteal fold assymetry
leg length discrepancy
153
how is hip dysplasia diagnosed?
Ortolani test (1st month of life)
Barlow test
Galeazzi sign
154
what is the Ortolani test?
confirms DDH in first month of life
flex hips, abduct, traction, and anterior pressure
(+) if hip pops back in
(-) requires serial exams
155
what is the Barlow test?
confirms DDH in first month of life
flex hips, adduct, and downward pressure
(+) pop out the hip
(-) requires serial exams
156
what is the Galeazzi sign?
in older infants, the femur is off and makes the leg look shorter
157
what is the primary goal in management of DDH?
ensure stability of the femoral head in the acetabulum through approximation of bony structures
158
what is the pavlick harness?
used for infants with DDH
allows 100-110 deg flexion, 40-60 deg abduction to keep femoral head properly aligned
159
what is management of DDH in 6 months to 2 years?
closed reduction with adductor release and psoas tenotomy
160
what is management of DDH at >18 months?
open reduction w/derivational osteotomy
161
what is PT management of DDH pre op?
LE and trunk strengthening
parent/caregiver education
proper positioning and handling
flexion no more than 120 deg, abduction no more than 70 deg, and relative ER
no force to reduce the risk of avascular necrosis
162
what is the safe zone for harnessing with DDH?
100-110 deg flexion and 40-60 deg abduction
163
what is PT management of DDH post op?
cast care
check capillary refill, dusky color, cool to touch, and numbness
education for patient and caregiver
164
PT roles in DDH management
pain control
gait training
proximal hip PREs
165
what is the prognosis for DDH dependent on?
age
166
what are musculoskeletal neoplasms?
new/abnormal growth of cells
tumor
cancer
167
what are the characteristics of a benign neoplasm?
no tendency to metastasize
non-invasive
slow-growing
168
what are the characteristics of a malignant neoplasm?
invasive
cancer
metastasizes
169
what are primary tumors?
tumors that develop within tissue in a localized area
benign or malignant
soft tissue or bone
170
what is a benign neoplasm
well differentiated
rarely invade locally
low potential for autonomous growth
not innocuous
can cause pathologic fxs
rarely can become malignant
171
what is a malignant neoplasm?
spreads to other sites
can be aggressive and destroy adjacent tissues
can metastasize to other sites
not as common
difficult to manage
cancer centers
172
t/f: most cases of osteosarcoma are unknown
true
173
what is Paget's disease?
bone production disease
174
what is Li-Fraument syndrome?
predisposed to cancers
175
what are bone tumors?
malignant cells uncouple the balance b/w bone formation and resportion
176
where are bone tumor often 1st noticed?
in cortical bone bc it has higher metabolic activity than cancellous bone
177
osteoclastic resorption...
thins bones
178
what is reactive bone?
osteoblastic deposition of normal bone growth
179
what is an osteoid?
a young bone that's not undergone calcification
180
what are 4 genetic disorders that cause sarcomas?
1. translocations
2. gene amplifications
3. mutations
4. complex genetic imbalances
181
are benign or malignant tumors more superficially located?
benign
182
are benign or malignant tumors deeper?
malignant
183
are abdominal or extremity tumors larger with poorer outcomes?
abdominal
184
what is the Hallmark of tumor development?
pain
185
what pain is associated with bone tumors?
intense pain w/rapidly growing lesions
pressure/tension on periosteum and endosteum
186
what is constant tumor pain?
pain not dependent on position/activity
increased with weight bearing activities
187
what is night pain with tumors?
pain that wakens the pt from sleep rather than difficulty falling asleep
188
t/f: pain is always a sign of progression
false
189
what is mechanical pain
pain that changes with changes in movement
190
pain patterns can vary w cancer based on...
nature, change, site, and rate of tumor growth
191
t/f: pts may not notice tumors in extremities as much
true
192
t/f: pathologic fxs are rare in primary neoplasms
true
193
there is an increased risk for fractures if the lytic lesion affects more than __% of cortex or occupies __% of bone diameter
50, 60
194
t/f: the risk for fracture can depend on location
true
195
what are miscellaneous manifestations of tumors?
swelling
fever
presence of a mass
unexplained weight loss
failure of rest to provide pain relief
age
history of cancer
196
what are the clinical manifestations of tumors?
pain, fractures, miscellaneous, swelling, and mass
197
what may be one of the first signs of ST tumors?
ST swelling
198
how do sarcomas spread?
through hematogenous routes (through the bloodstream) rather than lymphatics
199
what are the most common places for extremities to metastasize?
lungs, then liver, then other bone sites
200
what should one be looking for in a physical exam for tumors?
cafe au lait sports (common in neofibromatosis)
skin ulceration
Neuro findings
lymph nodes with palpation
201
what do sharp geographic margins on a radiograph indicate?
slow growing
202
what does destruction of the cortex on a radiograph indicate?
fast growing
203
what are some treatment options for tumors?
observation
radiation
chemotherapy
complete resection of the cancer
limb sparing
amputation
204
what is osteochondroma?
the most common benign neoplasm
located at the metaphysis
typically stops growing when skeletal growth ceases
dx with radiographs
205
what are bone islands?
small oval sclerotic lesions bone
206
what are the primary benign bone tumors?
osteochondroma
bone islands
osteoid osteoma
207
how are bony island managed?
assure pts that there is no significant health concern
208
what is osteoid osteoma?
rare, benign vascular osteoblastic lesion
primarily in young men
immature bone surrounded by osteoblasts and cysts
reactive bone forming lesion
round small nidus (nest) of osteoid tissue surrounded by reactive bone sclerosis
209
how does osteoid osteoma manifest?
local pain
symptomatic for 2-3 years w/recovery for 3-7 years as the osteoid nidus ossifies
jt pain and dysfunction
may appear like normal LBP
210
what is the treatment of osteoid osteoma?
NSAIDS/ASA for symptom control
serial radiographs to track nidus progress
surgical excision of nidus
211
do osteoid osteomas have the potential for malignant transformation?
no!
212
what is an osteoblastoma?
reactive but benign bone leasion that is larger than osteoid osteoma
common in the spine, sacrum, and flat bones
more common in men
less painful than osteoid osteoma
poorly localized, dull, aching pain
213
t/f: NSAIDS are ineffective in treating osteoblastoma
true
214
how is osteoblastoma managed?
radiographs, CT, and MRI
long bones: curettage
cervical spine: complex
215
what is the prognosis for osteoblastoma?
95% cured by initial Rx
10-20% recurrence rate
can become malignant
may need chemo/radiation
216
t/f: primary malignant bone tumors are rare
true
217
what are low grade primary malignant bone tumors?
chondroma and chondrosarcoma
218
what are high grade primary malignant bone tumors
osteosarcoma and Ewing sarcoma
219
what is the most frequent type of bone tumor?
osteosarcoma
220
who is more prone to primary malignant bone tumors, males or females?
males
221
what is osteosarcoma?
the 2nd most frequent malignant condition of bone behind myeloma
extremely malignant tumor
222
what are the manifestations of osteosarcoma?
pain and swelling near metaphysis
early lung metastasis in 90% of cases
appears in bone undergoing active growth phase
223
what bones are more vulnerable in osteosarcoma?
long bones of the LE
224
osteosarcoma occurs primarily in males <__ years old
30
225
what is the pathogenesis of osteosarcoma?
rapid growth and locally destructive
lifts periosteum as the tumor grows
226
how is osteosarcoma diagnosed?
dull aching pain, nigh pain persistent over months
227
why is osteosarcoma often delayed in diagnosis or misdiagnosed?
often though to be "growing pains"
228
what are treatment options for osteosarcoma?
chemo
surgery
limb salvage
expandable prosthesis
rotationplasty
tibial turn up
229
what is a rotationplasty?
using the foot backwards as a replacement for the knee jt
230
what is a tibial turn up?
the residual tibia is fused to the femur to lengthen the femur for better prosthesis fit and therefore better functional outcomes
231
what is Ewing sarcoma?
malignant, non-osteogenic primary tumor in bone or ST
3rd most common primary malignant bone tumor of children, adolescents, and young adults
232
80% of Ewing sarcoma occurs in pts <__ years old
20
233
what are the most common sites effected by Ewing sarcoma?
pelvis and LE
234
what are the risk factors for Ewing sarcoma?
caucasian
parental occupations (exposure to pesticides, fertilizers)
parental smoking
extraosseous tumors of the trunk and extremities
235
95% of Ewing sarcoma tumors are derived from translocation b/w what 2 chromosomes?
11 and 22
236
what are the clinical manifestations of Ewing sarcoma?
local bone pain post injury
long tubular bone and pelvis
swelling in 70% of cases
progressive pain
young children with flu-like symptoms
237
t/f: there is frequent later stage metastasis of Ewing sarcoma
true
238
how is Ewing sarcoma diagnosed?
radiographs with possible "moth eaten" appearance affecting the cortical bone and medullary canal
reactive bone formation on the cortex-"onion skin" appearance
CT, MRI, bone scan to stage the tumor
239
what are treatment options for Ewing sarcoma?
chemo, radiation, biotherapyh, embolization, surgery, limb sparing techniques
240
what is the prognosis for Ewing sarcoma?
steadily improving
5 year survival rate in 70% if no metastasis
5 year survival rate is 25% if metastasized
better at distal sites like hands and feet vs central sites
241
what is the initial Rx focus for Ewing sarcoma?
life-saving, extensive surgery, resection, limb salvage, amputation
242
what is the rehab focus with Ewing sarcoma?
improvement of impairment, function, and social reintegration
243
what are the bengign ST tumors?
lipoma
ganglia
popliteal cycst
nerve sheath tumor
neurofibromas
schwannomas
244
what is a lipoma?
common superficial tumor of mature fat cells
unlikely to be malignant
maybe be tender
can be excised but had to get all of it or it can come back
245
what is a ganglia tumor?
tumor arising from a jt capsule or tendon sheath
pain/tenderness may/may not be present
may not do anything if not interfering with function
246
what is a popliteal cyst?
a subtypes of ganglion tumor that of often palpated behind the knee in older adults with OA
Baker cysts
a rupture or hemorrhage would cause pain
swelling distal to lesion may occur
associated with irritation of knee jt
247
what is a nerve sheath tumor?
tumor that arises in peripheral nerve and grows concentrically form the center for the nerve
usually superficial, painless, and benign but can degenerate into cancer
248
what is neurofibroma?
single lesion or greater #s as part of collection of symptoms in association Von Recklinghausen disease (neurofibromatosis) and schwannomas
contain cells and features of schwann cells
benign, grow slowly, and can be cured surgically
249
what is a schwannoma?
tumor that arises from coverings of peripheral and cranial nerves
rare tumor of the sheath/lining around peripheral nerves
benign form: slow growth and tumor stays on outside of nerve
having multiple is common
harder to dx
cafe au lait spots
250
cancer commonly metastasizes to _____
bones
251
t/f metastatic tumors are more common than primary bone lesions
true
252
about ____ of all people w/cancer develop bone metastasis at some point
1/2
253
skeletal involvement is the ___ most common site for metastasis
3rd
254
what are the top 3 most common sites for metastasis?
lung, liver, and bone
255
t/f: all malignant tumors have the capacity to spread to bone
true
256
primary cancers responsible for 75% of all bone metastases include:
prostate
breast
pelvis
proximal femur
ribs
vertebrae
lung
kidneys
thyroid
257
what is the most common source of skeletal metastasis in men?
prostate
258
what are the 4 most common sites for breast cancer to metastasize?
pelvis, ribs, proximal femur, and vertebrae
259
t/f: the lung can metastasize to bone early in disease
true
260
where do the kidneys metastasize to?
vertebrae, pelvis, and proximal femur
261
what is the most common presenting symptoms in malignant tumors?
pain
262
__% of ppl with breast or prostate metastasis have no pain
50
263
how is the pain associated with malignant tumors described?
sharp, severe, worse at night
transient/intermittent in early course but eventually constant in more advanced cancer
mechanical
264
what is the most commonly affected place in the body for malignant tumors?
the spine
265
>__% of metastasis involving the spine
50
266
how are malignant tumors prevented?
adequate exercise
proper diet and nutrition
avoidance of tobacco
267
what are the 3 ways that cancer can spread?
hematogenous
lymphatic system
direct extension into adjacent tissue
268
with spinal metastasis, tumor cells from above the areas traverse throughout _____ to the spine
circulation
269
cells from primary tumor mass enter the circulation by traversing either the ____ of small blood vessels in _____ tissue, or ____ of vessels induced by the tumor itself
walls, normal, walls
270
t/f: after gaining access to vertebral venous system, tumor cells can travel to distant organ sites
true
271
what are the direct connections to the vertebrae that can be affected by metastasis via direct extension?
ribs
pelvis
skull
shoulder
