Npte - Musculoskeletal Conditions And Orthopedic Surgical Repairs(From Ier)

Front 1

RA

Back 1

Systemic disorder, unknown etiology
Dysfunction of synovial tissues and articular cartilage at hands, wrists, elbows, shoulders, knees, ankles, feet
Pannus formation
Ulnar drift and volar subluxation of MCPs
X-rays, lab tests (increased WBCs & erythrocyte sedimentation rate. Hemoglobin/hematocrit show anemia, elevated RF)
Rx:
Antireumatic drugs, NSAIDS, immunosurpressives
Joint protection strategies, improve/maintain joint mechanics and CT function
Aerobic fitness

Front 2

Osteoporosis

Back 2

Metabolic disease
Depletes bone density (=fractures)
Senile: Decrease in cell activity (genetic or aquired)
Post-menopausal: Decrease in estrogen production
CT scan (assess bone density)
Rx:
Calcium, vit D, calcitonin, estrogen, biophosphates
Joint/bone protection strategies, aerobic exercise, improve joint mechanics

Front 3

Osteomalacia

Back 3

Decalcification of bones due to vit D deficiency
Severe pain, fractures, weakness, deformities
X-ray, bone scan, possibly a bone biopsy
Rx:
Calcium, vit D, calciferol (form of vit D (D2) via injection)
Joint/bone protection strategies, aerobic exercise, improve joint mechanics

Front 4

Osteomyelitis

Back 4

Inflammatory response within bone due to infection
Usually staph aureus
More common in children, immunosrpressed, males
Lab tests for infection, possible bone biopsy
Rx:
Antibiotics, nutrition, possible surgery
Joint/bone protection strategies, cast care, improve joint mechanics

Front 5

Arthrogryposis multiplex congenita

Back 5

Congenital deformity of skeleton and soft tissues
Decreased joint ROM, "sausage-like" limbs
X-ray
Rx:
Joint/bone protection strategies, aerobic exercise, improve joint mechanics, education RE adaptive/assistive/orthotic/supportive devices, flexibility exercises

Front 6

Oseogenesis imperfecta

Back 6

Abnormal collagen synthesis, imbalance between bone deposition and reabsorption
Thinning of bone - fractures/deform
Genetic autosomal dominant
Bone scan, X-ray, serology
Rx:
Calcium, vit D, estrogen, calcitonin, biophosphonates
Joint/bone protection strategies, aerobic exercise, improve joint mechanics

Front 7

Osteochondritis dissecans

Back 7

Seperation of articular cartilage from bone (osteochondral #)
Usually medial femoral condyle, occasionally femoral head/talar dome/capitellum
X-ray, CT
Rx:
Possible surgery (if # displaced)
Joint/bone protection strategies, flexibility exercises (for normal joint motion) aerobic exercise, strength, power, endurance

Front 8

Myofacial pain syndrome

Back 8

Characterized by trigger points
Active TP: Tender, referal pattern
Latent TP: Not tender, can be converted to active
May be due to sudden overload, overstretch, repetitive/sustained muscle activities
No diagnostic tests
Rx:
Dry needling, analgesic/coticosteroid injection, flexibility exercises (for normal joint motion)

Front 9

Myositis ossificans

Back 9

Abnormal calcification within muscle belly
Usually due to direct trauma (hematoma-calcification)
CAN BE CAUSED BY EARLY STRETCHING/MOBILIZATION WITH AGGRESSIVE PT FOLLOWING MUSCLE TRAUMA
Usually quads, brachialis, biceps

Rx:
X-ray, CT, MRI
Acetaminophen, NSAIDS
Possible surgery (if non-hereditory and after lesion has matured - 6-24 months. Indicated if lesion interferes with joint or impinges nerves)
Flexibility (for normal joint motion), massage (reduces guarding/pain), mobilization (correct biomechanical faults), aerobic exercise
(AVOID BEING OVERLY AGGRESSIVE WITH ALL ABOVE TECHNIQUES)

Front 10

Complex regional pain syndrome (CRPS)

Back 10

Dysfuntion of sympathetic nervous system including pain, circulation and vasomotor disturbances
Long term: Muscle wasting, trophic skin changes, decreased bone density, decreased proprioception, contractures
Etiology unknown (thought to be related to trauma)
Two types:
1) Triggered by tissue injury; all patients with above symptoms but no underlying nerve injury
2) Same symptoms but clearly associated with nerve injury
Rx:
Sympathetic nerve block, sympathectomy, SC stim, intrathecal drug pumps, topical analgesics, antiseizures, antidepressants, corticosteroids, opioids.
Education to prevent injury, desensitization (focus on RTW), flexibility (for normal joint motion), TENS

Front 11

Paget's (osteitis deformans)

Back 11

Metabolic bone disease, abnormal osteoclast/blast activity
Etiology unknown (possibly viral)
Spinal stenosis, facet arthropathy, possible spine #
X-ray, lab tests (look for increased serum alkaline phosphatase and urinary hydrogenase)
Rx:
Acetaminophen, calcitonin and etidronate disodium (limit osteoclast activity)
Joint/bone protection strategies, improve mechanics, aerobic

Front 12

Idiopathic scoliosis

Back 12

Two types:
Structural: Irreversible lateral curvature with rotation
Nonstructural: Reversible lateral curvature without rotation which straightens with flexion
X-ray, CT, MRI
Rx (Structural):
Bracing, possible surgery depending on degree of curve (<25 conservative, 25-45 orthoses, >45 surgery)
Flexibility, strength, power, endurance, elec stim (for muscle performance), application and education RE orthoses

Front 13

Torticollis

Back 13

Spasm/tightness of SCM
Sidebend towards, rotation away from affected SCM
Rx:
Acetominophen, muscle relaxants, NSAIDS
Flexibility, manual therapy - massage, joint oscillations (to decrease muscle guarding/pain), mobilizations (to corrects biomechanics)

Front 14

Glenohumeral subluxation/dislocation

Back 14

Anterior-inferior:
Occurs with abduction and forcefull ER
Tearing of inferior GH lig, ant capsule, possibly labrum
Posterior:
Occurs with horizontal adduction and IR
Complications: Hill-Sachs, SLAP, Bankart, bruising of axillary nerve
AVOID APPREHENSION POSITION POST SURGERY
CT, MRI, apprehension tests
Rx:
Acetaminophen, NSAIDS, biomechanical correction (especially scapulohumeral rhythm, dynamic stabilization)

Front 15

Thoracic outlet syndrome (TOS)

Back 15

Compressiong of neurovascular bundle (brachial plexus, subclavian artery and vein, vagus and phrenic nerves, sympathetic trunk) between soft and boney structures
Occurs when size or shape of TO is altered
Areas of compression:
Scalene triangle
Superior TO
Between clavicle and 1st rib
Between pec minor and thoracic wall
X-ray, MRI, electrodiagnostic (nerve dysfunction), Adson, Roos, Wright, Costoclavicular
Rx:
Surgery, acetaminophen, NSAIDS, postural reeducation, biomechanical restoration, manips/mobs (esp 1st rib)

Front 16

AC & SC disorders

Back 16

Fall/collision onto shoulder with arm adducted
Classified from 1st-3rd degree:
1: AC ligament stretched
2: AC ligament tear, clavicle may move if pushed
3: AC and CC ligs torn, AC joint displacement

Or Rockwood classification system:
Type I - Sprain of the AC ligaments.
Type II - Complete rupture AC ligaments.
Type III - Complete rupture AC and CC ligaments.
Type IV - Complete rupture AC and CC ligaments. with displacement of clavicle posteriorly through Trapezius
Type V - Complete rupture AC and CC ligaments with gross displacement of ACJ and detachment of Deltoid and Trapezius
Type VI - Sub coracoid displacement

X-ray, shear test
Rx (acute):
Position in neutral with sling, no elevation
Rx:
Surgery rare due to tendancy for ACJ to degenerate
Acetaminophen, NSAIDS, functional training, restore strength and biomechanics (manual therapy, exercises)

Front 17

Internal (posterior) impingement

Back 17

Rotator cuff impingement on greater tuberosity or posterior labrum
Often in athletes performing overhead activities
Pain at posterior shoulder
Posterior impingements test
Rx:
Acetaminophen, NSAIDS, correct biomechanics (manual therapy, massage)

Front 18

Bicipital tendonitis

Back 18

Usually inflammation of long head
Impingement of proximal tendon between anterior acromion and bicipital groove
MRI (may not be sensitive enough), speed's
Rx:
Acetaminophen, NSAIDS, general Rx for tendonitis

Front 19

Proximal humeral fractures

Back 19

Humeral neck : Occur with fall onto outstretched arm, elderly
Greater tuberosity: Fall onto shoulder, middle-aged/eldery
X-ray
Rx:
Acetaminophen, NSAIDS, generally doesn't need surgery (stable fracture), functional training, restore biomechanics (manual therapy, exercise)
EARLY PROM IMPORTANT TO PREVENT ADHEISIONS

Front 20

Adheisive capsulitis (frozen shoulder)

Back 20

Inflammation and fibrosis of shoulder capsule due to disuse or repetitive microtrauma
Restricted motion (capsular pattern - ER, abd & flxn, IR)
Common with DM
AROM, PROM, resistive tests, palpation
Rx:
Acetaminophen, NSAIDS, functional training, restore biomechanics (manual therapy, exercise)

Front 21

Elbow contracture

Back 21

Loss of motion in capsular pattern (flxn, extn)
Loss of motion in non-capsular pattern = loose body in joint, ligament sprain or CRPS
AROM, PROM, resistive tests, palpation
Rx:
Acetaminophen, NSAIDs, functional training, restore biomechanics (manual therapy, exercise), splinting (to regain loss of motion for capsular restrictions)

Front 22

Distal humeral fractures

Back 22

Complications: Decreased ROM, myositis ossificans, malalignment, neurovascular compromise, ligament injury, CRPS
Supracondylar: Check neurovascular status quickly due to high number of neurovascular structures (eg radial nerve). May lead to Volkmann's ischemia. Assess growth plate in youth. High incidence of malunion.
Lateral epicondyle: Require open reduction and internal fixation
X-ray
RX:
Acetaminophen, NSAIDS, pain reduction, limit inflammation, improve flexibility of shortened structures, functional training, strengthening

Front 23

Osteochondrosis of humeral capitellum

Back 23

Osteochondritis dissecans: Affects central/lateral capitellum or radial head. Osteochondral bone fragment becomes loose body. Caused by repetitive compressive forces. 12-15yrs.

Panner's disease: Avascular necrosis of capitellum, loss of subchondral bone, fissuring and softening of articular surfaces.
Unknown etiology. <10yrs.
Rx:
Rest, avoidance of throwing or UL loading
Once pain-free begin strengthening, endurance, flexiblity
If symptoms persist - surgery
Post-surgery: Minimize pain and swelling, flexibility. Move into strengthening and biomechanical corrections.

Front 24

Ulnar collateral ligament injuries

Back 24

Due to repetitive valgus strain (overhead throw)
Pain at medial elbow at distal insertion, sometimes paresthesia in ulnar nerve distribution with positive tinel's sign.
MRI, medial ligament instability test
Rx:
Acetaminophen, NSAIDs, initially rest and pain management, then strengthening (esp elbow flexors), taping for RTW.

Front 25

Nerve entrapment - ulnar nerve

Back 25

Various causes including direct trauma to cubital tunnel, traction due to laxity at medial elbow, copmression due to thickened retinaculum, hypertrophy of FCU, recurrent subluxation/dislocation, DJD affecting cubital tunnel.
Medial elbow pain, paesthesias in ulnar distribution, positive tinnel's sign.
Rx: Acetaminophen, NSAIDs, neurotonin (for neuropathic pain)
Initially rest, avoid aggravating activities, modalities etc. Protective padding, splints, to maintain slackened position of nerve.
Then, strengthening, endurance, coordination, biomechanical correction, functional training, self-management techniques.

Front 26

Nerve entrapment - median nerve

Back 26

Occurs within pronator teres and under superficial head of FDS with repetitive gripping.
Aching pain with weakness of forearm muscles, positive Tinnel's sign, paresthesias in median distribution.
Rx: Acetaminophen, NSAIDs, neurotonin (for neuropathic pain)
Initially rest, avoid aggravating activities, modalities etc. Protective padding, splints, to maintain slackened position of nerve.
Then, strengthening, endurance, coordination, biomechanical correction, functional training, self-management techniques.

Front 27

Nerve entrapment - radial nerve

Back 27

Entrapment of distal branches (posterior interosseus) within radial tunnel (radial tunnel syndrome) due to overhead activities.
Lateral elbow pain (can be confused with lateral epicondylitis), pain over supinator, paresthesias in radial distribution. Tinnel's may be positive.
Electrodiagnostic tests
Rx: Acetaminophen, NSAIDs, neurotonin (for neuropathic pain)
Initially rest, avoid aggravating activities, modalities etc. Protective padding, splints, to maintain slackened position of nerve.
Then, strengthening, endurance, coordination, biomechanical correction, functional training, self-management techniques.

Front 28

Elbow dislocations

Back 28

Usually posteriolateral or posterior.
Posteriolateral usually occur due to fall on hyperextended UL
Posterior often cause avulsion of medial epicondyle due to pull of MCL
Anterior and radial head dislocations are rare.
With complete dislocation ulnar collateral ligament will rupture, possible rupture of anterior capsule, LCL, brachialis, wrist flexors/extensors.
Rapid swelling, severe elbow pain, deformity (posterior olecranon)
X-ray
Rx:
Acetaminophen, NSAIDs. Initially: Reduction, immobilization. Then: Strengthening, flexibility (within limits of stability).
If not stable - surgery

Front 29

Carpal tunnel

Back 29

Compression of median nerve due to inflammation of flexors or median nerve.
Usually result of repetitive wrist motions with pregnancy, RA and DM.
Must rule out CxSp involvement, TOS, peripheral nerve entrapment.
Long-term causes atrophy and weakness of thenar muscles and lateral lumbricals.
Exacerbation at night, positive tinnel's and phalens.
Electrodiagnostic testing.
Rx:
Acetaminophen, NSADs, correct biomechanics, strengthening, flexibility, functional training.

Front 30

DeQuervain's tenosynovitis

Back 30

Inflammation of EPB and AbPL
Due to repetitive microtrauma or complication of swelling during pregnancy
MRI (usually not needed), pain at snuff box, swelling, decreased grip and pinch strength, Finkelstein's
Rx:
Acetaminophen, NSAIDs, correct biomechanics, flexbility, strength, endurance

Front 31

Colles Fracture

Back 31

Most common fracture caused by fall onto outstretched UL
"Dinner fork" deformity of wrist and hand with posterior displacement of distal fragment of radius and radial shift of wrist and hand.
Complications: Median nerve compression due to edema, decreased grip strength, CRPS, carpal tunnel
Immobilized from 5-8 weeks
Rx:
Acetaminophen, NSAIDs. Initially: Normalize flexibility (paramount to functional recovery). Correct biomechanical faults caused by joint restrictions, manual therapy, flexibility exercises, strengthening, endurance, coordination.

Front 32

Smith's fracture

Back 32

Similar to Colles except distal radius displaces volarly causing "garden spade" deformity.
X-ray
Rx: Acetaminophen, NSAIDs. Initially: Normalize flexibility (paramount to functional recovery). Correct biomechanical faults caused by joint restrictions, manual therapy, flexibility exercises, strengthening, endurance, coordination.

Front 33

Scaphoid Fracture

Back 33

Results from fall onto outstretched UL in younger person
X-ray
Complications: High incidence of avascular necrosis of proximal fragment.
Carpals immobilized for 4-8 weeks.
Rx: Acetaminophen, NSAIDs. Initially: Maintain flexibility of other joints while casted. Later, strengthening, stretching, manual therapy.

Front 34

Dupuytren's contracture

Back 34

Banding on palm and digit flexion contractures from palmar fascia contracture which adheres to skin. Men>Women.
Usually affects MCPs and PIPs of 4th and 5th digits (3rd and 4th in patients with DM).
Rx:
Acetaminophen, NSAIDs. Flexibility, spinting. Once contracture under control - restore normal function.
Intervention following surgery: Wound management, edema control, functional exercise.

Front 35

Boutonniere deformity

Back 35

Results from rupture of central tendinous slip of extensor hood
Extension of MCP and DIP, flexion of PIP.
Commonly occurs following trauma or in RA with degeneration of extensor hood
Rx:
Acetaminophen, NSAIDs. Edema management, flexibility (of involved and uninvolved joints), spinting/taping, strengthening, functional training, endurance, coordination.

Front 36

Swan neck deformity

Back 36

Results from contracture of intrinsic muscles with dorsal subluxation of lateral extensor tendons.
MCP flexion and DIP, extension of PIP.
Commonly occurs following trauma or with RA degeneration of lateral extensor tendons.
X-ray (may not be necesary).
Rx:
Acetaminophen, NSAIDs. Edema management, flexibility (of involved and uninvolved joints), splinting/taping, function training, strengthening, endurance, coordination.

Front 37

Ape hand deformity

Back 37

Thenar muscle wasting with first digit moving dorsally in line with second digit.
Due to median nerve dysfunction.
Electrodiagnostic testing.
Rx:
Acetaminophen, NSAIDs. Edema management, flexibility (of involved and uninvolved joints), splinting/taping, function training, strengthening, endurance, coordination.

Front 38

Mallet finger

Back 38

Rupture/avulsion of extensor tendon at insertion into distal phalanx = flexion of DIP.
Usually occurs with trauma forcing distal phalanx into flexion.
MRI
Rx:
Acetaminophen, NSAIDs, edema management, flexibility (of involved and uninvolved joints), splinting/taping, function training, strengthening, endurance, coordination.

Front 39

Gamekeeper's thumb

Back 39

Sprain/rupture of ulnar collateral ligament of MCP of thumb.
Results in medial instability of thumb.
Frequently occurs during a fall when skiing (force from pole).
MRI
Rx:
Immobilized for 6 weeks.
Acetaminophen, NSAIDs. Edema management, flexibility (of involved and uninvolved joints), splinting/taping, function training, strengthening, endurance, coordination.

Front 40

Boxer's fracture

Back 40

Fracture of neck of 5th metacarpal.
Frequently sustained in fight or punching a wall
X-Ray
Rx:
Casted for 2-4 weeks
Acetaminophen, NSAIDs. Edema management, flexibility exercise initially at uninvolved joints followed by involved joints once sufficient healing has occurred.
Initiation of strengthening/functional training/endurance/coordination occurs once flexibility is restored.

Front 41

Avascular necrosis of the hip

Back 41

Multiple etiologies
Decreased ROM in hip flexion, IR, abduction
Groin/thigh pain, TOP at hip joint
Coxalgic gait
X-ray, bone scan, MRI, CT
Rx:
Acetaminophen, NSAIDs (CORTICOSTEROIDS CONTRAINDICATED AS MAY BE CAUSITIVE FACTOR)
Joint/bone protection strategies, maintain/improve joint mechanics and CT function, aerobic exercise. Post-surgical: Regain flexibility, improve strength, coordination, endurance, gait training.

Front 42

Legg-Calve-Perthes disease (osteochondrosis)

Back 42

Between 2-13 yrs (usually around age 6)
Males>Females
Psoatic limp (weak psoas major), affected LL moves into ER, flexion and adduction
Gradual onset of aching pain at hip, thigh and knee
ROM limited in abduction and extension
MRI (technique of choice)
Rx:
Acetaminophen, NSAIDs, joint/bone protection strategies, maintain/improve joint mechanics and CT functions, aerobic exercise. Post-surgical: Regain flexibility, improve strength, coordination, endurance, gait training.

Front 43

Slipped capital femoral epiphysis

Back 43

Unknown etiology, most common in adolescents, male>female
AROM restricted in abduction, flexion and IR
Vague pain at knee, thigh and hip
If chronic may have trendelenburg gait
X-ray
Rx:
Acetaminophen, NSAIDs, joint/bone protection strategies, maintain/improve joint mechanics and CT functions, aerobic exercise. Post-surgical: Regain flexibility, improve strength, coordination, endurance, gait training.

Front 44

Femoral anteversion and antetorsion

Back 44

Anteversion/antertorsion (25-39) or >30 degrees = patella squinting and toe-in
Retroversion <0 degrees: Femoral neck rotated backwards in relation to the condyles
X-ray, craig's test
Rx:
Maintain/improve joint mechanics and CT functions

Front 45

Coxa vara/coxa valga

Back 45

Angle of femoral neck with shaft of femur
<115 = coxa vara
>125 = coxa valga
Coxa vara causes: Defect in ossification of head of femur (most common); necrosis of femoral head with septic arthritis

Coxa valga causes: Necrosis of femoral head with septic arthritis.
X-ray
Rx:
Maintain/improve joint mechanics and CT functions

Front 46

Trochanteric bursitis

Back 46

Causes: Direct blow, irritation by ITB, biomechanical/gait abnormalities (repetitive microtrauma).
Common with RA
Differentiate from contractile condition by comparing: AROM, PROM, resistive tests.
Rx:
Acetaminophen, NSAIDs, correct biomechanics (manual therapy, exercise, flexibility), modalities.

Front 47

Piriformis syndrome

Back 47

Piriformis can become overworked with overpronation (due to hip IR). Tonic muscle, active with SIJ motion.
Tightness/spasm can compress sciatic nerve.
Restriction of IR, TOP, pain referral to post thigh, weakness in ER, positive piriformis test, uneven sacral base.
Examine LL for abnormal biomechanics.
Must rule out LxSp/SIJ involvement.
Rx:
Acetaminophen, NSAIDs, neurotonin (nerve pain). Reduce pain with modalities and manual therapy (massage jt oscillations). Correct biomechanics, education RE protection of SIJ (don't step down onto affected limb etc), possible foot orthoses.

Front 48

Knee ligament sprains

Back 48

ACL: Anterior instability
PCL: Posterior instability
ACL/MCL: Anteromedial rotary instability
ACL/LCL: Anterolateral rotary instability
PCL/MCL: Posteromedial rotary instability
PCL/LCL: Posterolateral rotary instability

MRI, knee special tests.
Rx: General for ligament injury. Post-op CPM may be used to promote flexibility. Correctiong of biomechanics etc.

Front 49

Meniscal injuries

Back 49

Result from tibiofemoral flexion, compression and rotation
Lateral/medial joint pain, effusion, popping, giving way, decreased ROM, joint locking.
MRI (may not be sensitive enough)
Special Tests: McMurrays, Apley.
Rx:
Acetaminophen, NSAIDs. Modalities/manual therapy to reduce inflammation, biomechanical correction, progression to funcitonal training.

Front 50

Patella alta

Back 50

Patella riding high
"Camel hump" appearance of knee
X-ray
Rx:
Regain functional strength of structures around knee, especially VMO, regain normal flexibility of ITB and HS, possibly orthoses, taping/bracing.
May result in chronic patella subluxation

Front 51

Patella baja

Back 51

Patella tracks inferiorly
Restricted knee extension, abnormal cartilage wear = DJD
X-ray
Rx:
Regain functional strength of structures around knee, especially VMO, regain normal flexibility of ITB and hamstrings, possibly orthoses, taping/bracing.

Front 52

Lateral patella tracking

Back 52

Causes: Increased Q-angle
X-ray
Rx:
Regain functional strength of structures around knee, especially VMO, regain normal flexibility of ITB and hamstrings, possibly orthoses, taping/bracing.

Front 53

Patellar tendonosis/tendinopathy (Jumper's knee)

Back 53

Mechanical dysfunction resulting in traction apophysitis of tibial tuberosity at patellar tendon insertion.
X-ray
Rx:
Occasionally need surgery. Acetaminophen, NSAIDs. Modify activities to decrease stress to irritated site.

Front 54

Genu varum

Back 54

Normal tibiofemoral shaft angle is 6 degrees of valgum
Genu varum is excessive medial tibial torsion "bow-legs"
Results in excessive medial patellar positioning and "pigeon-toed" foot orientation.
X-Ray
Rx:
Decrease loading of knee while maintaining strength and endurance.

Front 55

Genu valgum

Back 55

Normal tibiofemoral shaft angle is 6 degrees of valgum
Genuc valgum is excessive lateral tibial rotation, "knock-knees"
Results in lateral positioning of patella
X-Ray
Rx:
Decrease loading of knee while maintaining strength and endurance.

Front 56

Femoral condyle fracture

Back 56

Medial femoral condyle most common
Etiology: Shearing, impacting, avulsion forces
Mechanism: Fall with knee subjected to a shearing force.
X-Ray, CT (if complex fracture)
Rx:
Aceaminophen, NSAIDs, emphasize return of function without pain. Early flexibility if important to prevent capsular adhesions.

Front 57

Tibial plateau fracture

Back 57

Mechanism: Valgus and compressive forces to knee with knee in flexion.
Often in conjunction with MCL injury
X-Ray, CT (if complex fracture)
Rx:
Aceaminophen, NSAIDs, emphasize return of function without pain. Early flexibility if important to prevent capsular adhesions.

Front 58

Epiphyseal plate fracture (knee)

Back 58

Mechanism: Weight-bearing torsional stress.
More frequent in adolecents where an ACL injury would occur in adults.
X-Ray, CT (if complex fracture)
Rx:
Aceaminophen, NSAIDs, emphasize return of function without pain. Early flexibility if important to prevent capsular adhesions.

Front 59

Patella fracture

Back 59

Mechanism: Direct blow to patella (e.g. fall)
X-Ray, CT (if complex fracture)
Rx:
Aceaminophen, NSAIDs, emphasize return of function without pain. Early flexibility if important to prevent capsular adhesions.

Front 60

Anterior compartment syndrome (ACS)

Back 60

Increased compartmental pressure causing local ischemic condition
Etiologies: Direct trauma, fracture, overuse and/or muscle hypertrophy.
Chronic/exertional: "deep cramping feeling" on exertion/exercise
Acute: Sudden trauma causes swelling in compartment. Considered medical emergency and requires immediately surgery (fasciotomy)

Front 61

Anterior tibial periostitis

Back 61

Musculotendinous overuse condition
Etiologies: Abnormal biomechanics, poor conditioning, improper training methods
Muscles: Tibialis anterior, extensor hallucis longus.
TOP anterior compartment and lateral tibia
Rx:
Acetaminophen, NSAIDs, biomechanical correction, flexibility exercises for anterior compartment and triceps surae to restore normal function.

Front 62

Medial tibial stress syndrome

Back 62

Overuse injury of posterior tibialis and/or medial soleus resulting in periosteal inflammation
Etiology: Excessive pronation
TOP distal posteromedial border of tibia
Rx: Acetaminophen, NSAIDs, biomechanical correction, flexibility exercises for anterior compartment and triceps surae to restore normal function

Front 63

Tibial/fibular stress fractures

Back 63

Overuse injury with microfractures of tibia/fibula
Etiologies: Abnormal biomechanics, poor conditioning, improper training methods.
X-Ray, bone scan
Rx:
Acetaminophen, NSAIDs, biomechanical correction, endurance, coordination, flexibility exercises for anterior compartment and triceps surae to restore normal function

Front 64

Foot/ankle ligament sprains

Back 64

95% involve lateral ligament (DF, inversion injury)
Grade 1: No loss of function, minimal tearing
Grade 2: Some loss of function with partial disruption of ATFL and CFL
Grade 3: Complete loss of function, complete tear of ATFL, CFL, partial tear of PTFL.
MRI, anterior tilt, talar tilt
Rx:
Acetaminophen, NSAIDs, modalities & manual therapy to reduce pain, biomechanical correction, mobilizations to correct specific restrictions, progress ot functional training and RTW.

Front 65

Fractures of foot/ankle

Back 65

Unimalleolar/bimalleolar
Trimalleolar (med/lat malleoli and tibial post tubercle)
X-ray
Aceaminophen, NSAIDs, emphasize return of function without pain, biomechanics correction, EARLY PROM IMPORTANT TO PREVENT ADHEISIONS

Front 66

Tarsal tunnel syndrome

Back 66

Entrapment of posterior tibial nerve (or a branch) within tarsal tunnel
Etiology: Overpronation, tendonitis of long flexor and tibialis posterior tendons, trauma.
Pain, numbness, paresthesias along medial ankle to plantar surface of foot
Electrodiagnostic tests, positive tinnel's at tarsal tunnel
Rx:
Acetaminophen, NSAIDs, neurotonic (nerve pain). Orthoses.

Front 67

Pe cavus (hollow foot)

Back 67

Increased height of longitudinal arch, dropping of anterior arch, met heads lower than hindfoot, PF and splaying of forefoot, claw toes.
Decreased ability to absorb forces through foot
Etiologies: Genetics, neurologic disorders causing muscle imbalance, soft tissue contracture.
Rx:
Education emphasizing limitation of high-impact sports, use of proper footwear, orthotics.

Front 68

Pes planus (flat foot)

Back 68

Decreased height of medial longitudinal arch.
Etiologies: Genetics, muscle weakness, ligament laxity, paralysis, overpronation, trauma, disease (RA)
Normal in infant/toddler feet
Decreased ability to form rigid lever for push-off
Rx:
Education emphasizing limitation of high-impact sports, use of proper footwear, orthotics.

Front 69

Talipes equinovarus (club foot)

Back 69

Postural: Due to uterine malposition (PF, inversion, adduction)
Talipes equinovarus: Abnormal development of head and neck of talus as result of heredity or neuromuscular disorders (e.g. myelomeningocele) (PF at talocrural jt; inversion at subtalar, talocalcaneal, talonavicular & calcaneocuboid jts; supination at midtarsal jts).
Rx:
Manips, casting/splinting for postural condition.
Surgical intervention then casting/splinting for talipes equinovarus.

Front 70

Hallux valgus

Back 70

Medial deviation of 1st met head, met and base of proximal 1st phalanx move medially, distal phalanx moves laterally.
Etiologies: Biomechanical malalignment (overpronation), ligament laxity, heredity, weak muscles, tight footware.
Rx:
Early orthotic fitting & education, later requires surgery followed by flexibility exercises, strengthening and possible mobilizations.

Front 71

Metatarsalgia

Back 71

Etiologies: Tight triceps surae/achilles, collapse of transverse arch, short first ray, pronation of forefoot, structural changes to transverse arch causing vascular and/or neural compromise, changes in footwear.
Pain at 1st & 2nd met heads after long periods of WB
Rx:
Acetaminophen, NSAIDs, neurotonin (nerve pain), biomechanical correction, modalities to decrease pain, orthoses, education RE footware.

Front 72

Metatarsus adductus

Back 72

Rigid: Medial subluxation of tarsometatarsal jts. Hindfoot slightly in valgus with navicular lateral to head of talus.
Flexible: Adduction of all 5 metatarsals at tarsometatarsal jts.
Etiologies: Congenital, muscle imbalance, neuromuscular disease (e.g. polio)
Rx:
Strengthening and regaining proper foot alignment (orthoses).

Front 73

Charcot-Marie-Tooth

Back 73

Peroneal muscular atrophy affecting motor and sensory nerves. Initially affects leg/foot, progresses to forearm/hand.
Slowly, progressive disorder.
Electrodiagnostic tests
Rx:
Acetaminophen, NSAIDs, neurotonin (nerve pain), no specific PT Rx as is inherited disorder: prevent contractures/skin breakdown, maximize function, education/training RE braces, ambulatory aids.

Front 74

Plantar fasciitis

Back 74

Chronic irritation of plantar fascia from overpronation
Limited ROM of 1st MTP and talocrural joint
Tight triceps surae
Acute injury from excessive loading of foot
Rigid caves foot
Results in microtears if attachment of plantar fascia
Differentiated from tarsal tunnel syndrome by negative tinel's
Rx:
Aceaminophen, NSAIDs, corticsteroids, correct biomechanics, flexibility of plantar fascia, modalities to reduce pain and inflammation careful flexibility exercises of triceps surae, mobilizations, night splints, strengthening of inverters, education RE footwear, orthoses.

Front 75

Rearfoot varus (subtalar & calcaneal varus)

Back 75

Rigid inversion of calcaneus when subtalar joint is in neutral
Etiology: Abnormal mechanical alignment of tibia, shortened rearfoot soft tissues, malunion of calcaneus
Rx:
Regain proper mechanical alignment, improve flexibility of shortened soft tissues, orthoses, education RE footwear.

Front 76

Rearfoot valgus

Back 76

Eversion of calcaneus with neutral subtalar joint
Etiologies: Abnormal mechanical alignment of knee (genu valgum), tibial valgus
Fewer musculoskeletal problems develop from this deformity than with varus due to increased mobility of hindfoot
Rx:
Regain proper mechanical alignment, improve flexibility of shortened soft tissues, orthoses, education RE footwear.

Front 77

Forefoot varus

Back 77

Inversion of forefoot when subtalar joint in neutral
Etiology: Congenital deviation of head and neck of talus
Regain proper mechanical alignment, improve flexibility of shortened soft tissues, orthoses, education RE footwear.

Front 78

Forefoot valgus

Back 78

Eversion of forefoot when subtalar joint in neutral
Etiology: Congenital abnormal development of head and neck of talus
Regain proper mechanical alignment, improve flexibility of shortened soft tissues, orthoses, education RE footwear.

Front 79

Spinal muscle strain

Back 79

Related to sudden trauma, chronic overload, abnormal biomechanics. May resolve without intervention. Dx and Rx as per general muscle strain.
Manipulations generally indicated for pain inhibition

Front 80

Spondylolysis/spondylolysthesis

Back 80

Spondylolysis: Fracture of par interarticularis with positive "scotty dog" sign on oblique X-ray
Spondylolysthesis: Anterior/posterior slippage of one vertebra on another following bilateral spondylolysis
Grade 1: 25% slippage; 2: 50%; 3: 75%; 4: 100%

Etiology: Thought to be congenitally defective PI
X-ray, stork-test
Rx:
Acetaminophen, NSAIDs, corticosteroids, muscle relaxants, trigger point injections, correct biomechanics (mobilizations), dynamic trunk stabilization (abdominals, extensors, multifidus from full flexion to neutral (NOT EXTENSION)
AVOID EXTENSION, IPSILATERAL SIDEBEND, CONTRALATERAL ROTATION). Reducation RE positioning, postural reeducation, Boston brace/TLSO traditionally used but frequency decreasing. MANIPULATION CONTRAINDICATED.

Front 81

Spinal/intervertebral stenosis

Back 81

Congenital narrow spinal canal or IV foramen with hypertrophy of spinal lamina and ligamentum flavor or facets as the result of age-related DJD.
Results in vascular and/or neural compromise
Bilateral pain and paresthesia (back & LLs)
Pain decreased in flexion, increased in extension
Pain increases with walking, relieved with long rest
X-ray, MRI, CT, occasionally myelography, van Geldren test.
Rx:
Acetaminophen, NSAIDs, corticosteroids, muscle relaxants, trigger point injections, correct biomechanics (mobilizations), flexion biased exercise, dynamic stability, avoid extension, ipsilateral sidebend, ipsilateral rotation, manual/mechanical traction: CxSp @ 15 degrees flexion togive optimum vertebral canal opening; CONTRAINDICATIONS: Hypermobility, pregnancy, RA, Down Syndrome or other disease affecting ligament integrity.

Front 82

Internal disc disruption

Back 82

Internal structure of annulus disrupted, external structures remain normal
Usually LxSp
Contrant, deep ache, increases with movement, no objective neuro signs though pt may have pain referral to LL
MRI, CT discogram
Rx:
Acetaminophen, NSAIDs, muscle relaxants, trigger point injections, corticosteroids, correct biomechanics (mobilizations), MANIPULATION MAY BE CONTRAINDICATION, education RE proper body mechanics, positions to avoid, limiting repetitive bending/twisting, overhead and sitting activities and carrying heavy loads.

Front 83

Posterolateral bulge

Back 83

Most common LxSp disorder due to:
Narrower posterior disc than anterior
Weak post longitudinal ligament located only centrally
Posterior lamellae of annulus are thinner
Etiology: Overstretching/tearing of annular rings, vertebral endplate or ligamentous structures from high compressive forces or repetitive microtrauma.
Loss of strength, radicular pain, paresthesia
MRI
Rx:
Acetaminophen, NSAIDs, muscle relaxants, trigger point injections, corticosteroids, dynamic stability (exercise also stimulates disc regeneration), positional gapping for 10 minutes (e.g. if left posterolateral bulge: Lie on R side, pillow under trunk, hip/knee flexion, L trunk rotation or pelvis R rotation). MANIPULATION MAY BE CONTRAINDICATED. education RE proper body mechanics, positions to avoid, limiting repetitive bending/twisting, overhead and sitting activities and carrying heavy loads. manual/mechanical traction: CxSp @ 15 degrees flexion to give optimum vertebral canal opening; CONTRAINDICATIONS: Hypermobility, pregnancy, RA, Down Syndrome or other disease affecting ligament integrity. (efficacy currently under scrutiny)

Front 84

Central posterior bulge

Back 84

Most common at CxSp, also seen at LxSp
Etiology: Overstretching/tearing of annular rings, vertebral endplate and/or ligaments from high compressive forces and/or long term poor posture.
Loss of strength, radicular pain, paresthesia, possible SC compression with CNS symptoms: Hyperreflexia, positive Babinski.
MRI
Rx:
Acetaminophen, NSAIDs, muscle relaxants, trigger point injections, corticosteroids, dynamic stability (exercise also stimulates disc regeneration), positional gapping for 10 minutes (e.g. if left posterolateral bulge: Lie on R side, pillow under trunk, hip/knee flexion, L trunk rotation or pelvis R rotation). MANIPULATION MAY BE CONTRAINDICATED. education RE proper body mechanics, positions to avoid, limiting repetitive bending/twisting, overhead and sitting activities and carrying heavy loads. manual/mechanical traction: CxSp @ 15 degrees flexion to give optimum vertebral canal opening; CONTRAINDICATIONS: Hypermobility, pregnancy, RA, Down Syndrome or other disease affecting ligament integrity.

Front 85

Facet entrapment (acute locked back)

Back 85

Abnormal movement of fibroadipose meniscoid in facet during extension (from flexion). Meniscoid does not properly re-enter joint cavity and bunches up, becoming space-occupying lesion.
Flexion decreases pain; extension increases pain
Quadrant test
Rx:
Acetaminophen, NSAIDs, muscle relaxants, trigger point injections, corticosteroids, positional facet gapping, manipulation.

Front 86

Acceleration/deceleration injuries (whiplash)

Back 86

Excess shear and tensile forces on CxSp
Potential damage to: Facets, ligaments, discs, muscles, # odontoid process and SPs, TMJ, sympathetic chain ganglia, spinal and cranial nerves.

Early symptoms: H/aches, CxSp pain, decreased ROM, reversal of lower CxSp lordosis, decreased upper CxSp kyphosis, vertigo, visual/auditory disturbances, noise/light sensitivity, dyesthesias of face and ULs, difficulty swallowing, emotional lability.
Late symptoms: Chronic head/neck pain, decreased ROM,TMJ dysfunction, decreased tolerance of ADL's, disequilibrium, anxiety, depression.

Postura changes, muscle guarding, fibrosis of soft tissues, segmental hypermobility, gradual development of restricted segmental motions cranial and caudal to the injury.

CT, MRI.
Rx:
Acetaminophen, NSAIDs, muscle relaxants, trigger point injections, corticosteroids, spinal manipulation generally indicated, correct biomechanics, progress to functional training and RTW, education RE positions to avoid, postural reeducation, manual/mechanical traction: CxSp @ 15 degrees flexion to give optimum vertebral canal opening; CONTRAINDICATIONS: Hypermobility, pregnancy, RA, Down Syndrome or other disease affecting ligament integrity.

Front 87

Hypermobile spinal segments

Back 87

Abnormal increase in ROM due insufficient soft tissue control (ligaments, discs, muscles)
X-ray
Rx:
Acetaminophen, NSAIDs, muscle relaxants, trigger point injections, corticosteroids, sclerosing injections,
modalities to decrease pain, pROM within normal ROM, corsets, splints, collars, casts, tape, increase strength/endurance/coordination (especially abdominals/multifidus/gluts), correct biomechanics, education RE limiting excessive loading, limiting sustained activities and end-range postures.

Front 88

Spinal bone tumors

Back 88

Multiple myeloma, Ewing's sarcoma, malignant lymphoma, chondrosarcoma, osteosarcoma, chondromas, metastatic (lung, kidney, prostate, breast, thyroid).
HISTORY SHOULD ALWAYS INCLUDE CANCER HISTORY
Pain which is unvarying and progressive, not relieved with rest or analgesics, worse at night.
X-Ray, CT, MRI, lab tests.

Front 89

Visceral tumors (pain referral to musculoskeletal system)

Back 89

1: Esophageal cancer pain may radiate to back or occur with swallowing. Also dysphasia and weight loss.
2: Pancreatic cancer pain may include deep, gnawing pain into chest and back.

Front 90

Gastrointestinal conditions (pain referral to musculoskeletal system)

Back 90

1: Acute pancreatitis may present with midepigastric pain which radiates through to back.
2: Cholecystitis may present with severe abdominal pain and R upper quadrant tenderness, nausea, vomiting, fever.

Front 91

Cardiovascular/pulmonary conditions (pain referral to musculoskeletal system)

Back 91

1: Heart and lung conditions can refer pain to chest, back, neck, jaw and ULs
2: AAA usually appears as non-specific lumbar pain

Front 92

Urologic and gynecological conditions (pain referral to musculoskeletal system)

Back 92

Kidney, bladder, ovary and uterus disorders can refer pain to trunk, pelvis and thighs.

Front 93

TMJ conditions: DJD, myofascial pain

Back 93

Common signs and symptoms: Clicking/popping/crepitation, locking, decreased ROM, lateral deviation of mandible on movement, decreased strength/endurance, tinnitus, h/aches, forward head posture, pain with mandible movement.
CxSp MUST BE THOROUGHLY EXAMINED
Dysfunctions:
DJD (OA/RA)
Myofascial pain (most common):
Dysfunction/pain in jaw, neck and shoulder muscles
(general Rx for DJD and myofascial pain)

Front 94

TMJ conditions: Internal derangement

Back 94

ID = Dislocated jaw, displaced articular disc or condylar injury.
Loss of functional mobility may result from increased activity in jaw muscles due to stress/anxiety
Causes:
- Trauma (edema, capsulitis, hypo/hypermobility, abnormal function of ligaments/capsule/muscles)
- Congenital anatomic anomalies (change palate shape)
- Abnormal function (repeatedly chewing ice/hard candy, para normal breathing (mouth breather), forward head posture
Common signs and symptoms: Clicking/popping/crepitation, locking, decreased ROM, lateral deviation of mandible on movement, decreased strength/endurance, tinnitus, h/aches, forward head posture, pain with mandible movement.
MRI, X-Ray
Rx:
Acetaminophen, NSAIDs, muscle relaxants, trigger point injections, corticosteroids
Postural reeducation, modalities for pain reduction, biofeedback to decrease effects of stress, mobilization (if restricted) (usually use inferior glide which gaps joint, stretches capsule and allows relocation of anteriorly displaced disc), flexibility/strengthening, education (food to avoid positional alignment), night splints, education RE resting position of tongue on hard palate. CRITICAL TO NORMALIZE NECK POSTURE PRIOR TO PERMANENT DENTAL PROCEDURES

Front 95

Surgical repairs: Rotator cuff tear

Back 95

Usually degenerative, occur over time with impingement
S&S: Significantly decreased abduction AROM, no decreased PROM, positive drop test, poor scapulohumeral/glenohumeral rhythm.
Arthrogram (ideally), MRI
Rx:
Rehabilitation initiated following immobilization
PT emphasizes return of normal strength/endurance/coordination/biomechanics/AROM/PROM/scapulothoracic and glenohumeral rhythm with overhead function.

Front 96

Surgical repairs: Flexor tendon repair (hand)

Back 96

1st 3-4 weeks distal extremity is immobilized with wrist and digits flexed and IPs in 30-50 degrees flxn.
PT Rx:
Resisted extension and passive flexion within contraints of splint. AROM to tolerance initiated at 4 weeks.
Manage soft tissues through wound-healing phases by providing collagen remodeling which preserves free tendon gliding.
Early intervention: Wound management, edema control, passive exercises.
Active extension initiated 1st followed by flexion
Resistive and functional exercises introduced when full AROM achieved.

Front 97

Surgical repairs: Extensor tendon repair (hand)

Back 97

Distal repairs are immobilized such that the DIPs are in neutral for 6-8 weeks.
PT Rx:
AROM initiated at 6 weeks with PIPs in neutral
Manage soft tissues through wound-healing phases by providing collagen remodeling which preserves free tendon gliding.
Early intervention: Wound management, edema control, passive exercises
Active extension initiated 1st followed by flexion
Resistive and functional exercises introduced when full AROM achieved.

Front 98

ase: Surgical repairs: THR

Back 98

Cemented hips:
Can tolerate full WB immediately
May crack with age causing loosening of prosthesis
Better for fragile bones ad those who will benefit from immediate WB
Non-Cemented hip:
For younger/more active people

Bed position with wedge to prevent adduction
AVOID >90deg FLEXION WITH ADDUCTION AND IR
Partial WB to tolerace initiated on 2nd day post-surgery with crutches or a walker.

PT Rx:
Bed mobility, transitional movements, ambulation, RTW

Front 99

Surgical repairs: Open reduction internal fixation (ORIF) following femoral fracture

Back 99

Typically non-WB for 1-2 weeks (crutches/walker)
Then partial WB as tolerated

PT Rx:
Bed mobility, transitional movements, ambulation, RTW

Front 100

Surgical repairs: TKR

Back 100

Cemented: WB to tolerance
Non-cemented: WB progressed according to time-frame for fracture healing:
1-7 weeks 25%
by week 8 50%
by week 10 75%
by week 12 100% (without assistive device)

PT Rx:
1-3 weeks: Muscle reeducation, soft tissue mobs, lymphedema reductio, PROM (e.g. CPM), AROM, reduce swelling
2d phase: Regain endurance, coordination, strength of muscles around knee. Functional activities (walking, stairs, transitional training)
3rd phase: RTW/ADLs, function and endurance training, proprioception.

Correct biomechanics caused by joint restrictions with mobilizations.

AVOID FORCEFULL MOBILIZATION AND PROM >90 DEGREES FLEXION (due to restraints of prosthesis)

Front 101

Surgical repiars: Ligamentous knee repairs

Back 101

ACL/PCL surgery
Immediately post-surgery: CPM with PROM 0-70 flxn
Increased 0-120 by week 6
Recontruction usually protected with hinged brace initially (set at 20-70 flxn for ACL, 0 for PCL)
Non-WB for 1 week
Weaned from brace between 2nd and 4th weeks
6 phases:
1) Preoperative 2) Maximum protection 3) Controlled motion 4) Moderate protection 5) Minimum protection 6) Return to activity

PT Rx:
Massage quads/hamstrings to decrease guarding; oscillations to decrease pain and guarding; biomechanical correction; mobilization of jt restrictions; progress to functional training RTW

Front 102

Surgical repairs: Discectomy/Laminectomy

Back 102

Early movement and activation of paraspinal muscles (especially multifidus) is necessary.

Back protection program, early mobilization exercises initiated prior to surgery.
Avoid prolonged sitting, heavy lifting, long car trips for ~3 mos.
Repetitive bending with twisting should always be avoided.

PT Rx:
Massage to reduce guarding
Oscillations to decrease joint pain and guarding
Mobilize joint restrictions
Biomechanical correction (strength/flexibility/coordination)
ENSURE RESTORATION OF MULTIFIDUS
Dynamic stabilization of trunk/pelvis during ADLs

Front 103

Surgical repairs: Microdiscectomy

Back 103

Rehabilitation time is decreased compared to full discectomy because annular fibers are not damaged.

Back protection program, early mobilization exercises initiated prior to surgery.
Avoid prolonged sitting, heavy lifting, long car trips for ~3 mos.
Repetitive bending with twisting should always be avoided.

PT Rx:
Massage to reduce guarding
Oscillations to decrease joint pain and guarding
Mobilize joint restrictions
Biomechanical correction (strength/flexibility/coordination)
ENSURE RESTORATION OF MULTIFIDUS
Dynamic stabilization of trunk/pelvis during ADLs

Front 104

Surgical repairs: Multi-level vertebra fusion

Back 104

Typically requires 6 weeks of trunk immobilization with bracing.
Once brace removed and movement allowed it is important to regain as much normal/functional movement as possible
With combined anterior/posterior surgical approach, bracing is seldom used.

Back protection program, early mobilization exercises initiated prior to surgery.
Avoid prolonged sitting, heavy lifting, long car trips for ~3 mos.
Repetitive bending with twisting should always be avoided.

PT Rx:
Massage to reduce guarding
Oscillations to decrease joint pain and guarding
Mobilize joint restrictions
Biomechanical correction (strength/flexibility/coordination)
ENSURE RESTORATION OF MULTIFIDUS
Dynamic stabilization of trunk/pelvis during ADLs

Front 105

Surgical repairs: Harrington rod placement for idiopathic scoliosis

Back 105

Goals focus on early mobilizatio in bed and effective coughing.
Begin ambulation 4-7 days post-op

Back protection program, early mobilization exercises initiated prior to surgery.
Avoid prolonged sitting, heavy lifting, long car trips for ~3 mos.
Repetitive bending with twisting should always be avoided.

PT Rx:
Massage to reduce guarding
Oscillations to decrease joint pain and guarding
Mobilize joint restrictions
Biomechanical correction (strength/flexibility/coordination)
ENSURE RESTORATION OF MULTIFIDUS
Dynamic stabilization of trunk/pelvis during ADLs

Front 106

Ankylosing spondilitis

Back 106

Initially axial skeleton
1st symptoms usually mid and low back pain, morning stiffness, sacroilitis
Degeneration of peripheral an costovertebral joints in advanced stages
Men>Women
Before 4th decade

NSAIDS (e.g. aspirin)
Corticosteroids - symptom management/immunosupression
Cytotoxic drugs - of don't respond well to steroids or on high steroid dose

Front 107

Gout

Back 107

Genetic disorder or purine metabolism
Increased serum uric acid - deposits in joints and kidneys

NSAIDS, ACTH, cox-2-inhibotors (limited due to cardiac side-effects)

Front 108

Psoriatic arthritis

Back 108

Errosive, inflammatory
Associated with psoriasis
Digits and axial skeleton

NSAIDs, corticosteroids, acetaminophen

Front 109

Subacromial bursitis ROM

Back 109

<60 abduction
<90 flexion

Front 110

RC tendonitis painful arc

Back 110

60-120 degrees abduction

Front 111

Classification of Knee Lig. Injury

Back 111

1st degree: Little/no instability
2nd degree: Minimal to moderate instability
3rd degree: Extreme instability

Front 112

"Unhappy Triad" in the knee

Back 112

Injury to the ACL, MCL and medial meniscus
2/2: Valgum, flexion and ER when foot is planted