Pathophysiology Test 1 Review

Front 1

Pathology

Back 1

branch of medicine that investigates the essential nature of disease especially the changes in body tissues and organs caused by disease

Front 2

What are the differences among acute, subacute, and chronic illness?

Back 2

Acute: rapid onset short duration

Chronic: cognitive or permanent disability

Front 3

Illness

Back 3

deviation from a healthy state

Front 4

Disease

Back 4

a biological or physiological alteration that results in a malfunction of a body organ or system

Front 5

Health

Back 5

state of complete physical, mental, and social well being

Front 6

Prognosis

Back 6

the prospect of recovery as anticipated by the usual course of a condition

Front 7

Etiology

Back 7

the cause or origin of a condition

Front 8

Impairment

Back 8

loss or abnormality of physiologic or anatomic structure or function

Front 9

Functional limitation

Back 9

occur as a result of impairments and relate to an individual’s inability to perform tasks and roles that are typical for the individual

Front 10

Disability

Back 10

a restriction or lack of ability to perform an activity in a typical manner or range; describes how impairments impact activities

Front 11

How do the Nagi model and ICF model differ? How are they the same?

Back 11

Nagi model: represents a system often used by health care professionals to classify the impact of disease or trauma. It suggests that pathology produces pain and impairments, which then lead to functional limitations and disability.

ICF model:

Differences:

Similarities:

Front 12

Define the four theories of health and illness (germ, biomedical, genetic aspects, and multicausal).

Back 12

1. Germ theory: promoted our understanding of infectious disease and helped reduce deaths from infection.
2. Biomedical theory: explains disease as a result of malfunctioning organs or cells; cause-and-effect relationships
3. Genetic Aspects of Disease:

4. Multicausal theories: it’s how recognized that lifestyle, diet, and stress response contribute to the development of diseases, and treatment interventions are focusing more on the relationship of the individual with his/her external and internal environment.

Front 13

Give examples for the three different levels of disease prevention (primary, secondary, and tertiary)

Back 13

1. Primary prevention: geared toward removing or reducing disease risk factors; Example—use of seat belts
2. Secondary prevention: techniques are designed to promote early detection of disease and to employ preventive measures to avoid further complications; Example—mammogram
3. Tertiary prevention: measures are aimed at limiting the impact of established disease. It involves rehabilitation and may end when no further healing is expected. The goal is to return the person to the highest possible level of functioning and to prevent severe disabilities; Example—chemotherapy or radiation

Front 14

List the benefits of exercise.

Back 14

1. When prescribed appropriately, exercise including cardiovascular training, endurance training, and strength training, is effective for developing fitness and health, for increasing life expectancy, for the prevention of injury and disease, and for the rehabilitation of impairments and disabilities.
2. It plays a significant role in reducing factors associated with disease states (osteoporosis, diabetes mellitus, heart disease), the risk of falls and associate injuries and the morbidity associate with chronic disease.
3. Evidence also suggests that involvement in regular exercise can provide a number of psychological benefits related to preserved cognitive function. Alleviation of depression symptoms and behavior and an improved concept of personal control and self-direction.

Front 15

Define pharmacodynamics and give an example of it.

Back 15

The effect and reaction of medications within the body; what the drug does to the body
Example—aging

Front 16

Define pharmacokinetics and give an example of it.

Back 16

The way that medications are absorbed, distributed, localized transformed and excreted within the body; what body does to the drug Example—

Front 17

What are adverse drug reactions and how do they differ from side effects?

Back 17

-Adverse drug reactions (ADR): unwanted and potentially harmful effects produced by medications/drugs

-Side effects: predictable pharmacologic effects that occur within therapeutic dose ranges; are undesirable in the given therapeutic situation; they educate patient’s effects on them

Front 18

What are causes and risk factors for ADRs?

Back 18

-Age
-Gender
-Ethnicity
-Concomitant alcohol consumption
-New drugs
-Number of drugs
-Duration of treatment
-Non-compliance
-Small stature
-Underlying medical conditions

Front 19

What is tardive dyskinesia?

Back 19

You should report any signs of this to patient’s MD

Front 20

What do you do if you suspect your patient is having an ADR?

Back 20

Make the appropriate referral

Front 21

NSAIDs: discuss purpose, indications, side effects, and implications for the PTA.

Back 21

--Purpose: reduce inflammation, relieve pain, reduce fever
--Indications: commonly used post-op, musculoskeletal conditions,& treatment of inflammatory rheumatic diseases
--Side effects: GI symptoms ranging from dyspepsia to GI bleeding, ulceration, Edema; Hypertension; Prolonged bleeding time; Suppression of cartilage repair & synthesis
---Implications for the PTA: Produce modest increases in blood pressure-avoid using w/ borderline or hypertensive patients; Renal vasoconstrictive- can cause fluid retention especially with lower extremity edema; Reduce antihypertensive effects of beta-blockers & ACE inhibitors

Front 22

What effect does exercise have on medication?

Back 22

-Can produce changes in pharmacokinetics

-These changes are dependent on the characteristics of the medication and on exercise related factors such as Intensity, Duration, and Mode.

Front 23

Immunosuppressants: discuss purpose, indications, side effects, and implications for the PTA.

Back 23

--Purpose: organ and bone marrow transplantation; other serious, debilitating, & non-responding diseases (RA, psoriasis)
--Indications: maintain immunosuppression during transplantations or to combat debilitating disease
--Side effects: Anaphylactic reactions; Renal failure; Hepatoxicity; Cytokine-release syndrome; Neurotoxicities
--Implications for PTA: Careful hand washing essential!; Do not worth w/ the immunosuppressed patient if you have a known infectious or contagious condition; Wear masks (both patient & therapist) in presence of upper respiratory infection; Nurotoxicities & subsequent functional impairments- may need to be addressed w/ appr splinting/orthotic management

Front 24

What is inflammation?

Back 24

-The coordinated reaction of body tissues to cell injury and cell death that involves vascular, neurological and cellular responses

-Regardless of the type of cell injury or death, the inflammatory response follows similar patterns

-Inflammation only occurs in living organisms

Front 25

What are the three main purposes of inflammation?

Back 25

1. Inactivate the injurious agent
2. Break down and remove the dead cells
3. Initiate the process of tissue healing

Front 26

How does acute and chronic inflammation differ?

Back 26

Acute inflammation: inflammation of sudden onset and short duration

Chronic inflammation: inflammation that does not resolve but persists overtime

Front 27

What happens during vasoconstriction following an injury?

Back 27

-Results in decreased blood flow to the affected area

-Decreased blood flow promotes aggregation of platelets which leads to the formation of a blood clot which results in a reduction in blood loss

Front 28

When does vasodilation take place after an injury and what does it involve?

Back 28

-Takes place after initial vasoconstriction

-Involves increased blood flow and increased permeability of small vessels allows white blood cells (WBCs) to squeeze through vessel wall, WBCs to area of injury, Phagocytosis begins

Front 29

List the cardinal signs and symptoms of inflammation.

Back 29

1. Erythema (Redness): vasodilation and increased blood flow

2. Heat: vasodilation and increased blood flow

3. Edema: fluid and cells leaking from local blood vessels into the extracellular spaces

4. Pain: direct trauma, chemical mediators, pressure secondary to edema, swelling of nerve endings

Front 30

What effects might NSAIDS or corticosteroids have on inflammation?

Back 30

They treat inflammation

Front 31

During synthesis of extracellular matrix, what is the purpose of collagen, fibroblasts, proteyglycans, and elastin? What impact can therapists have during this period?

Back 31

-Collagen: protein that provides structural support to all tissues in the body; 18 different types

-Fibroblasts: secretes proteins that provide foundation for healing tissue

-Proteyglycans and Elastin: provide energy/water and aide in stability of tissues, also provides tissues with elasticity

-Impact:

Front 32

What is the purpose of the migration of endothelial cells?

Back 32

-Replace necrotic tissue with new cells (regeneration)

-Endothelial cells provide vascular network for cell nutrients, forms granulation tissue

Front 33

What is the difference between tissue contraction and tissue contracture?

Back 33

-Shrinking of healing tissue through specialized fibroblasts (myofiborblasts—contain contractile proteins)

-Margin approximation and wound closure

-Excessive cases of wound contracture—can impair function

Front 34

Define tissue regeneration.

Back 34

--Some instances of wound healing—mild wounds like skin abrasions

--Occurs by regrowth of original tissue with little or no scarring

Front 35

Define tissue repair.

Back 35

--Formation of scar tissue
--Replacement of connective tissue after removal of necrotic tissue
--Minimizing scarring to avoid functional impairment
--Scars are less stable than original tissue

Front 36

When does scarring occur?

Back 36

Occurs when

Front 37

How much time is required for tissue to mature and what is the strength of this tissue?

Back 37

12 to 18 months

Front 38

What factors influence tissue healing?

Back 38

1. Box 6-4, page 213
2. Physiological variables
3. General health
4. Presence of co-morbid conditions
5. Nutrition
6. Type of tissues injured
7. Use of tobacco/alcohol/caffeine/drugs or medications
8. Medical treatment

Front 39

What are the four general categories of bone fractures?

Back 39

1. Fracture by sudden impact
2. Stress or fatigue fracture
3. Pathologic fracture
4. Insufficiency fracture

Front 40

Describe displaced vs. nondisplaced fractures and open vs. closed fractures.

Back 40

--Displaced vs. Nondisplaced fractures:

--Open vs. Closed fractures:

Front 41

Define and identify the six classifications of fractures discussed in lecture.

Back 41

1. Transverse: fracture line at a right angle to the long axis of the bone

2. Oblique: results from a twisting or torsional force; fragments displace easily

3. Spiral: also results from twist/torsion; nonunion rare

4. Comminuted: bone is broken into more than two pieces

5. Segmental: fragment of free bone is present between the two main fragments

6. Butterfly: separation of a wedge-shaped piece of bone

Front 42

What are the general signs and symptoms of fractures?

Back 42

--Pain and tenderness

--Increased pain with weight bearing

--Edema

--Ecchymosis

--Loss of general function and mobility

--Deformity (may not always see especially in certain fractures)

Front 43

List the healing sequence for fractures.

Back 43

1. Hemptoma formation: (48-72 hours after fracture); clotting factors

2. Cellular proliferation: osteogenic cells (regenerate new blood cells)

3. Callus formation: cartilage gets replaced by bone, osteoblasts come in and rebuild bone cells

4. Ossification: “same as above”

5. Consolidation/remodeling: excess bone gets absorbed

Front 44

What are the healing times for fractures in the three age categories discussed in lecture?

Back 44

--Children: 4-6 weeks

--Adolescents: 6-8 weeks

--Adults: 10-18 weeks

Front 45

Define and identify the following fractures: Colles, Jones, Nightstick, and Pott’s.

Back 45

1. Colles Fracture: fracture of distal radius and ulnar styloid (fall on outstretched hand)

2. Jones fracture: fracture of the base of the 5th metatarsal

3. Nightstick fracture: fracture of mid-shaft of ulna

4. Pott’s fracture: oblique fracture of lateral malleous and the transverse fracture of the medial malleolus; talus may be displaced posteriorly

Front 46

Describe two complications that can occur with healing fractures.

Back 46

1. Compartment Syndrome: Significant swelling around fracture site but if contained within closed soft tissue compartment, compartment syndrome may occur; Pain decreased motor function, burning, paresthesia, decreased reflexes

2. Fat Emboli: Fat from marrow can migrate into pulmonary or cerebral circulation and block blood vessels; SOB, chest pain, cyanosis, rash on anterior chest wall/neck/axillae/shoulders; Symptoms typically appear 1-3 days after injury but can occur up to 1 week later

Front 47

Define the four types of abnormal healing of a fracture.

Back 47

1. Malunion

2. Delayed union

3. Nonunion

4. Psudoarthrosis

Front 48

What effects does immobilization have on tissue?

Back 48

--“three weeks of bed rest has more effects than 30 years of decading”

--

Front 49

Define dislocation and subluxation.

Back 49

1. Dislocation: Complete loss of joint integrity with loss of anatomical relationship; Typically results in severe ligamentous damage and possible vascular damage; Can be a late manifestation of chronic disease (Rheumatoid Arthritis); Most common at gleno-humeral joint and congenitally at the hip

2. Sublaxation: Partial disruption of anatomic relationship within a joint; Most commonly seen at mobile joints

Front 50

Define contusion and hematoma.

Back 50

1. Contusion: Direct trauma; Overlying skin intact but underlying tissue becomes ecchymotic due to local hemorrhages

2. Hematoma: Areas of localized hemorrhage; Blood accumulates due to rupture of capillaries

Front 51

Define strains and sprains. What is the difference between them?

Back 51

--Strain: stretching or tearing of the musculotendinous unit

--Sprain: ligament injury from abnormal or excessive joint motion

--Difference:

Front 52

What is Pathology?

Back 52

Branch of medicine that investigates the essential nature of disease especially the changes in body tissues and organs caused by disease

Front 53

The doctor tells Mrs. Smith that her Osteomyelitis is caused by staphylococcus bacteria entering into her bloodstream. What is he telling her about Osteomyelitis?

Back 53

Etiology

Front 54

My ankle fracture will take 10-18 weeks to heal. What is the term for this?

Back 54

For Adults

Front 55

What is a state of complete physical, mental, and social well being?

Back 55

Health

Front 56

What is a deviation from a healthy state?

Back 56

Illness

Front 57

What is a biological or physiological alteration that results in a malfunction of a body organ or system?

Back 57

Disease

Front 58

I have the flu and I feel better in 1.5 weeks and can return to my normal activities. This is an example of what kind of illness? (acute/chronic)

Back 58

Acute Illness

Front 59

True or False. The WHO Model for Disability states that an impairment causes a disability which results in a handicap.

Back 59

True

Front 60

Mr. Thomas has just been diagnosed with Rheumatoid Arthritis. What type of disease is this? (acute/chronic)

Back 60

Chronic Illness

Front 61

What occurs as a result of impairments and relate to an individual’s inability to perform tasks and roles that are typical for the individual?

Back 61

Functional Limitation

Front 62

List the 5 dimensions of the National Center for Medical Rehabilitation Research Model (NCMRR). What does this model focus on?

Back 62

--Impairment, Functional Limitation, Disability, Societal Limitation, and Pathophysiology.

--The model focuses on the Individual at Risk for Disability

Front 63

Janet’s doctor tells her that her myositis is caused by Staph aureus. What theory of health and illness is this?

Back 63

Biomedical model

Front 64

John runs 12 miles a week, eats a low fat diet and does not smoke. What form of prevention is this for heart disease? (primary, secondary, or tertiary)

Back 64

Primary prevention

Front 65

True or False. All listed are benefits of exercise.
1. Increase immune function
2. Increased sensitivity to insulin
3. Increased bone density
4. Increased neurological function
5. Increased body fat content
6. Decreased depression

Back 65

True

Front 66

The orthopedic doctor tells Maggie that the steroid injection in her knee with take up to 2-3 days to begin working. What is this an example of? (pharmacology/pharmacodynamics/pharmacokinetics)

Back 66

Pharmacokinetics

Front 67

Sara is taking ibuprofen for her low back pain and develops an ulcer. What medication type commonly has this adverse effect?

Back 67

NSAIDs

Front 68

What effects do long-term corticosteroid use have on musculoskeletal tissues?

Back 68

Growth retardation in children

Front 69

True or False. Exercise does not produce changes in pharmacokinetics.

Back 69

False, it can produce changes in pharmacokinetics

Front 70

True or False. A patient taking a NSAID for knee pain that is past its expiration date will have the same effects/adverse reactions as taking one from a new bottle.

Back 70

False

Front 71

What is the coordinated reaction of body tissues to cell injury and cell death that involves vascular, neurological and cellular responses?

Back 71

Inflammation

Front 72

True or False. Vasodilation is the initial inflammatory response.

Back 72

False, it’s vasoconstriction

Front 73

List the cardinal signs and symptoms of inflammation.

Back 73

1. Erythema (Redness)
2. Heat
3. Edema
4. Pain

Front 74

David asks you why he needs physical therapy for his ankle sprain, what do you tell him? (implications for PT re: inflammation)

Back 74

1. General Objectives: facilitate wound healing, maintain normal functions of non-injured tissue, return person to typical activities and routines ASAP without causing increased inflammation response
2. Maximize activity: DON’T OVERDUE!
3. Patient education
4. Edema control (especially if joint injury)
5. Take care with manual therapy and exercise

Front 75

List 5 factors that influence tissue healing.

Back 75

1. Synthesis of extracellular matrix
2. Proliferation and Migration of cells
3. Tissue contraction & contracture
4. Tissue repair (formation of scar tissue)
5.

Front 76

Martha is 80 years old, white woman presenting with a displaced fracture of her humeral neck from a fall. What may be the underlying cause of her fracture?

Back 76

Osteoporosis

Front 77

True or False. All are types of immobilization. Bed rest, non-weight bearing status, splinting, casting, disuse due to pain, and stationary biking.

Back 77

False, all except stationary biking.

Front 78

What are the 2 classifications of Scoliosis?

Back 78

1. Functional or Postural Scoliosis—caused by factors other than vertebral such as pain, poor posture, leg length discrepancy, muscle spasm; these curves disappear when cause is relieved

2. Structural—fixed curvature of the spine associate with vertebral rotation and asymmetry of ligamentous structures such as congenital, musculoskeletal, neuromuscular, and idiopathic (most common).

Front 79

True or False. Scoliosis treatment can include bracing, surgery, physical therapy, along with electrical stimulation.

Back 79

1. True, the goal in treatment of scoliosis is to prevent severe and progressive deformities that can compromise internal organs.

2. Treatment also includes
--curves < 25 degrees: observe and monitor

--curves 25-40 or 45 degrees: Spinal Orthoses (bracing)

--curves > 45 degrees: surgical correction.

Front 80

What type of exercise should a PTA include in their treatment of a Pt. with Osteoporosis?

Back 80

Weight bearing exercise

Front 81

During treatment for his total knee arthroplasty (TKA), I begin to suspect Jeremy has Osteomyelitis. When should he begin treatment for this? (tomorrow/next week/next month)

Back 81

Tomorrow, immediately

Front 82

What is death of bone and marrow cellular components as a result of lost blood supply without presence of infection? Where is this commonly seen?

Back 82

--Osteonecrosis.

--Most commonly seen at femoral head but also seen at the scaphoid, talus, proximal humerus, tibial plateau and the small bones of the wrist and foot.

Front 83

A PTA instructs 12 year old Jerome in squats, stair climbing, and box jumping during his treatment for Osgoog-Schlatter disease: this would be expected to increase or decrease his reports to pain?

Back 83

--increase

--to treat Osgood-schlatter disease you should rest from aggravating activites (sports), non-stressful (pain free) quad exercises, avoid squatting and jumping activities, ice, neoprene sleeves/casting, and typically the condition is self-limiting and resolves when the tubercle fuses to the main body of the tibia (typically around 15 years of age).

Front 84

True or False. Legg-Calve-Perthes Disease commonly occurs in 15 year old girls.

Back 84

False, occurs approximately 1 in 1200 children 3-12 years of age; more frequently seen in boys (5:1 ratio).

Front 85

Name that diagnosis.

Back 85

A. Slow, progressive degeneration of joint surfaces, Commonly in hip, knee, lumbar/c-spine, Stiffness after periods of inactivity, Loss of motion due to contractures, osteophytes, and loss of joint congruity.
------Osteoarthritis (OA)

B. Chronic, systemic inflammatory disease, Resulting from an infiltration of immune cells into synovial fluid, Development of a pannus is common, Frequently in wrists, knees, fingers, hands and feet, Associated with swan-neck, and boutonniere deformities.
------Rheumatoid Arthritis (RA)

Front 86

True or False. PT treatment for OA should include: Decreased loading of the joint, Patient education, aquatics, stationary biking, NSAIDs, low load (opened chain exercise)

Back 86

True, with NSAIDS be aware of the side effects.

Front 87

What is the narrowing between the vertebrae due to decreased disc height, associated with spinal stenosis, lytic/degenerative spondylolisthesis, pain and decreased mobility, and radiculopathy?

Back 87

Degenerative Intervertebral Disk Disease

Front 88

What is an inflammatory arthropathy of the axial skeleton including sacroiliac joints, apophyseal joints, costovertebral joints, and intervertebral disk articulations, leading to a fused/rigid “bamboo spine”?

Back 88

Ankylosing Spondylitis (AS)

Front 89

Remus is being seen for PT treatment for gait abnormality and reports having acute, severe pain last night in his great toe area, you suspect that he also has?

Back 89

Gout

Front 90

What is the diagnosis characterized by trigger points that are rope-like, nodular, or crepitant within a muscle, and are also self perpetuating?

Back 90

Myofascial Pain Dysfunction

Front 91

A fracture at the base of the 5th metatarsal. What is this called?

Back 91

Jones Fracture

Front 92

Kevin is in a shoulder sling for 6 weeks following rotator cuff repair, what effects will this have on his shoulder joint? (Tissue responses to immobilization)

Back 92

1. Synovium—proliferation of fibrofatty connective tissue into joint space
2. Cartilage—adherence of fibrofatty connective tissue to cartilage surfaces, loss of cartilage thickness, pressure necrosis at area of compressed cartilage
3. Ligament—disorganization of parallel arrays of fibrils and cells, weakening and destruction of ligament fibers where they attach to the bone
4. Bone—generalized osteoporosis
5. Muscle—disorganization of parallel arrays of fibrils and cells; weakening; possible loss of sacromeres

Front 93

Clinical manifestations

Back 93

signs & symptoms

Front 94

Incidence

Back 94

frequency with which something, such as disease, appears in a particular population or area

Front 95

Pathogenesis

Back 95

development of a disease; origin of a disease and the chain of events leading to that disease

Front 96

Prognosis

Back 96

1. expected course of a disease, patient's chance of recovery

2. outcome of a disease and therefore the future for the patient

Front 97

SCOLIOSIS

(DEFINITION)

Back 97

1. Abnormal curvature of the spine
A) Infantile: 0 to 3 years of age
B) Juvenile: skeletal age of 4 years through puberty
C) Adolescent: skeletal age of: 12 years old for females; 14 years old for males

2. Curve may be towards the right (more common in thoracic curves) or towards the left (more com in lumbar curves)

3. Often associated with kyphosis and lordosis

Front 98

SCOLIOSIS

(CLASSIFICATIONS)

Back 98

1. IDIOPATHIC: Unknown cause; Accounts for 80% of all cases

2. MYOPATHIC: Results from weakness

3. OSTEOPATHIC: Results from spinal disease or bony abnormality

4. NEUROGENIC: Associated with various neurological disorders

5. Functional or Postural Scoliosis:
A) Caused by factors other than vertebral: (Pain, Poor posture, Leg length discrepancy, Muscle Spasm)
B) These curves disappear when cause is relieved

6. Structural:
A) Fixes curvature of the spine associated with vertebral rotation and asymmetry of ligamentous structures: (Congenital, Musculoskeletal, Neuromuscular, Idiopathic (most common))

Front 99

OSTEOPOROSIS
(DEFINITION)

Back 99

1. Literally means “porous bone”

2. A combination of decreased bone mass/density and microdamage to the bone structure that results in an increased susceptibility to fracture

3. Most common metabolic bone disease affecting over 10 million people in the USA

4. More common in women (especially postmenopausal women)

5. Osteoporosis in men represents a major health problem that has been largely unrecognized

Front 100

OSTEOPOROSIS
(CLASSIFICATIONS)

Back 100

1. Primary:
A) Idiopathic
B) Postmenopausal (most common)
C) Senile (old age)

2. Secondary:
A) Endocrine disorders
B) Rheumatoid arthritis
C) Disuse
D) Side effects of medications

Front 101

OSTEOPOROSIS
(PATHOGENESIS)

Back 101

1. Between the ages of 25 and 35 years, bone mass peaks and the rate of bone Resorption begins to exceed the rate of bone formation

2. Diagnosis made when changes in bone density are visible on x-ray (> 30% bone density loss must occur before changes seen on x-ray)
A) Osteopenia refers to decreased bone density

3. Estrogen deficiency in postmenopausal women
A) Women lose bone at a typical rate of 1% a year after peak bone density has been achieved
B) For 5 to 8 years after menopause, bone loss accelerates to varying degrees (depending on factors such as calcium intake and absorption, hormonal balance, and activity level)

Front 102

OSTEOPOROSIS
(CLINICAL MANIFESTATIONS)

Back 102

1. Most patients unaware of condition until fracture occurs

2. Most common: fractures of vertebral body, ribs, radius, or femur

3. Back pain

4. Increased kyphosis

5. Decreased height associated with vertebral compression fracture

Front 103

OSTEOPOROSIS
(TREATMENT)

Back 103

1. No cure

2. Prevention is key
A) Adequate calcium intake
--Peak adult bone density depends on factors associated with growth and development
--Prevention thus begins with providing necessary calcium intake in childhood and adolescence
B) Weight bearing exercise
C) Falls prevention

Front 104

OSTEOPOROSIS
(IMPLICATIONS FOR PT)

Back 104

1. Patient education

2. Role in prevention
A) Exercise
B) Preventing fractures secondary to falls

3. Take care with evaluation and treatment techniques
A) Mobilizations
B) Falls
C) Avoid flexion exercises (pelvic tilt and partial sit-ups don’t appear to increase anterior compressive forces)

Front 105

PAGET'S DISEASE
(DEFINITION)

Back 105

1. A progressive disorder of the adult skeletal system

2. Characterized by excessive bone Resorption and formation due to a proliferation of osteoclasts

3. Bone Resorption is so rapid that osteoblasts cant keep up

4. Fibrous tissue replaces bone

5. Affected bone looks larger and thicker but is actually weaker

6. Lesions occur at multiple sites particularly the skull, spine, pelvis, femur, and tibia

Front 106

PAGET'S DISEASE
(CLINICAL MANIFESTATIONS)

Back 106

1. 20% of patients asymptomatic

2. If pain is present, described as a vague, deep, dull ache

3. If skull involved, frequently see tinnitus, vertigo, hearing loss

4. Diagnosis by X-rays or bone scan

5. Postural deformities
A) Increase kyphosis
B) Bowing of femur or tibia

Front 107

PAGET'S DISEASE
(IMPLICATIONS FOR PT)

Back 107

1. Similar to osteoporosis

2. Joints adjacent to involved bone may function at a mechanical disadvantage

3. Extremity deformities may require splinting

Front 108

OSTEOMYELITIS
(DEFINITION)

Back 108

1. Inflammation of bone cause by an infectious organism (typically bacteria)

2. Types:
A) Exogenous: (primary) related to open fracture/penetrating wounds/surgery (THA)
B) Hematogenous: (secondary) related to UTI/URI/other infections. Most common in lumbar spine
C) Acute: rapidly destructive infection
D) Chronic: results from a relapse, persistent infection or undiagnosed acute disease

2. Acute far more common in children (boys > girls)

3. Chronic form more common in adults and those with compromised immune systems

4. Typically caused by Staphylococcus but also streptococcus, E Coli, pseudomonas or pneumoccus

Front 109

OSTEOMYELITIS
(PATHOGENESIS)

Back 109

1. Exogenous or hematagenous source
2. Inflammatory response
3. Infection spreads easily through porous metaphysis of long bone
4. Organisms grow and pus forms
5. Pus squeezes through Haversain canals in bone
6. Subperiosteal abscess occurs and deprives bone of blood which results in necrosis
A) Can be pain free as Cancellous bone is aneural
7. Necrotic bone is a fertile bed for organisms to grow
8. Osteoblasts create new bone which forms sheath around necrotic tissue

Front 110

OSTEOMYELITIS
(CLINICAL MANIFESTATIONS)

Back 110

1. Initially patient may not have any pain

2. When periosteum involved, patient typically has deep, constant pain that increases with weight bearing

3. Spinal Osteomyelitis may result in intermittent or constant back pain aggravated by motion. May have throbbing at rest.

4. May see systemic reactions such as fever

Front 111

OSTEOMYELITIS
(TREATMENT)

Back 111

1. Treatment must be immediate!!!

2. IV or oral antibiotics (usually for 6 or more weeks)

3. Emergency orthopedic surgery may be required to drain pus and debride (especially if infections spreads to a joint)

Front 112

OSTEOMYELITIS
(IMPLICATIONS FOR PT)

Back 112

1. When working with patients staus post total joint replacement, be alert for s/s of infection

2. Increased risk of fracture if infection in joint; know restrictions with exercise and weight bearing

3. Focus on non-involved areas to prevent effect of immobilization

4. Monitor wounds (color and drainage)

Front 113

OSTEONECROSIS
(DEFINITION)

Back 113

1. Death of bone and marrow cellular components as a result of lost bone supply without presence of infection

2. Avascular necrosis and aseptic necrosis are symptoms of this condition

3. Avascular necrosis is the underlying cause of 10% of all total hip replacements

4. Most commonly seen at femoral head but also seen at the scaphoid, talus, proximal humerus, tibial plateau and the small bones of the wrist and foot

Front 114

OSTEONECROSIS
(PATHOGENESIS)

Back 114

Some more susceptible

Front 115

OSTEONECROSIS
(IMPLICATIONS FOR PT)

Back 115

1. Osteonecrosis is difficult to diagnosis early

2. Differential diagnosis of lumbar, hip, thigh, groin or knee pain is essential as osteonecrosis may present as referred pain

3. If sudden, worsening of pain is followed by a sudden loss of ROM; must consider fracture

Front 116

LEGG-CALVE-PERTHES DISEASE
(DEFINITION)

Back 116

1. Avascular or aseptic necrosis of the epiphysis at the proximal end of the femur
2. Occurs in the approximately 1 in 1200 children 3 to 12 years of age; more frequently seen in boys (5:1 ratio)
3. Typically unilateral but may be bilateral
4. Cause unknown although genetic coagulopathy that may possibly be triggered by exposure to cigarette smoke in utero and during early childhood
5. Condition may vary from a mild self-healing problem to a condtion that will destroy the hip unless serious action is taken
6. Disease consists of 4 Stages lasting from 2 to 5 years:
A) Stage I: Avascular 1-2 weeks
B) Stage II: Revascularization 6 to 12 months
C) Stage III: Reparative 2-3 years
D) Stage IV: Regenerative final months

Front 117

LEGG-CALVE-PERTHES DISEASE
(CLINICAL MANIFESTATIONS)

Back 117

1. Insidious onset

2. Intermittent limp on involved side

3. Positive Trendelenburg from pain or hip abduction weakness

4. Hip, groin or knee pain

5. Pain with activity that eases with rest

6. Decreased ROM especially in hip adduction and internal rotation

7. Eventual weakness

Front 118

LEGG-CALVE-PERTHES DISEASE
(TREATMENT)

Back 118

1. Controlled weight bearing with femur abducted and internalled rotated will keep head of femur well seated in the acetabulum, decreasing focal areas of increased load: maintains ROM and prevents deformity

2. Splints/bracing/surgery

Front 119

LEGG-CALVE-PERTHES DISEASE
(IMPLICATIONS FOR PT)

Back 119

Goal of Physical Therapy Intervention is to preserve ROM and prevent premature degenerative joint disease

Front 120

OSGOOD-SCHLATTER DISEASE
(DEFINITION)

Back 120

1. Patellar tendon pulls small bits of immature bone off the tibial tuberosity
2. Considered to be a form of tendonitis
3. Characterized by activity related pain and swelling at the insertion of the patellar tendon
4. Associated with patellar alta: increases patellar height requires increased forced from the quads for full extension which may result in the apophyseal lesion
5. The tibial tuberosity is often enlarged
6. Three times more common in boys (10-15 years) but can occur in girls (8-13 years)
7. Etiology: indirect trauma; repetitive stress before fusion of epiphysis
8. Aggravated by the longitudinal traction associated with bone growth

Front 121

OSGOOD-SCHLATTER DISEASE
(TREATMENT)

Back 121

1. Rest from aggravation activities (sports)

2. Non-stressful (pain free) quad exercises

3. Avoid squatting and jumping activities

4. Ice

5. Neoprene sleeves/casting

6. Typically the condtion is self-limiting and resolves when the tubercle fuses to the main body of the tibia (typically around 15 years of age)

Front 122

OSTEOARTHRITIS
(DEFINITION)

Back 122

1. “Wear and tear arthritis”
2. Slow, progressive degeneration of joint surfaces
3. Most commonly seen in hip, knee, lumbar spine, cervical spine and first MTP
4. Primary OA: unknown cause (joint degeneration/defect in cartilage)
5. Secondary OA: known cause (trauma, infection, hemarthrosis)
6. 60-85% of people over 60 years old have dome degree of OA
7. Deep ache (can occur at rest or at night of severe); pain typically will gradually worsen
8. Stiffness after periods or inactivity
9. Loss of motion due to contractures, osteophytes, loss of joint congruity

Front 123

OSTEOARTHRITIS
(TREATMENT)

Back 123

1. Decreased loading of the joint (splinting/assistive devices)
2. Patient education (avoid exercise loading of joint)
3. Exercise: ROM/strengthening/endurance with joint protection (Low load, Aquatics, Stationary bike)
4. Be aware of side effects of NSAIDS
5. Emphasize decreasing stress on joints (Proper posture and body mechanics, Avoid prolonged weight bearing, Proper exercise form)
6. Pain may not necessarily correlate with X-ray findings
7. Complete clinical exam necessary; other conditions may be causing increased stress on the affected joints (Example: pes planus)

Front 124

DEGENERATIVE INTERVERTEBRAL DISK DISEASE
(DEFINITION)

Back 124

1. Intervertebral disks undergo “wear and tear” as well
A) Nucleus Pulposis: Loses water
B) Annulus Fibrosis: fissuring, clefts, bulge

2. Narrowing between the vertebrae due to decreased disk height results in:
A) Pain
B) Decreased mobility
C) Increased weight bearing on the facet joints
D) Narrowing of intravertebral foramen and vertebral canal (bulging/stenosis)
E) Radiculopathy

Front 125

DEGENERATIVE INTERVERTEBRAL DISK DISEASE
(CLINICAL MANIFESTATIONS)

Back 125

1. Disk degeneration is most often asymptomatic

2. Spinal stenosis

3. Lytic spondylolisthesis
A) Anterior slippage of one vertebra over another with a defective posterior neural arch
B) Most commonly seen at the L5-S1 spinal segement

4. Degenerative spondylolisthesis
A) Anterior slippage of one vertebra over another with an intact posterior neural arch
B) Most commonly seen at the L4-L5 spinal segment

Front 126

RHEUMATOID ARTHRITIS
(DEFINITION)

Back 126

1. Chronic, systemic inflammatory disease

2. 1-2% of adults have RA

3. Onset may be at any age
A) More common in the 3rd and 4th decade of life
B) Two to three times more common in females
C) Women who have had children or who take oral contraceptives have a decreased incidence/severity of RA

4.. 80% of patients with RA are rheumatoid factor (RF) positive

5. Pannus develops
A) An abnormal synovial granulation which proliferates
B) Contains inflammatory cells which are destructive to cartilage, bone, the joint capsule and ligaments

Front 127

RHEUMATOID ARTHRITIS
(CLINICAL MANIFESTATIONS)

Back 127

1. Multiple joints: symmetrical and bilateral presentation
2. Most frequently occurs in the wrists, knees, fingers, hands, feet, cervical spine (instability)
3. Signs of inflammation
4. Rheumatoid nodules
A) Occur in areas of repeated mechanical pressure (extensor surface of elbow/Achilles tendon/extensor surface of fingers
B) Can also occur in the heart, lungs, GI tract
5. Swan-neck Deformity
A)Flexion of DIP/Extention of PIP
6. Boutonniere
7. Deformity
A) Extension of DIP/Flexion of PIP
8. C1-C2 Joint
A) Lhermitte Sign: neck flexion leads to shock-like sensation

Front 128

RHEUMATOID ARTHRITIS
(TREATMENT)

Back 128

1. No cure

2. Control inflammation
A) NSAIDS
B) Coritcosteriods
C) Gold compounds

3. Hand surgery to correct deformities

4. Rest

5. Splints

Front 129

RHEUMATOID ARTHRITIS
(IMPLICATIONS FOR PT)

Back 129

1. Goals:
A) Decrease pain
B) Maintain mobility
C) Minimize stiffness/edema/joint destruction

2. Patient education

3. Joint protection

4. Be aware of possible joint stability (especially C1-C2)

5. Be aware of fatigue

Front 130

SEPTIC ARTHRITIS
(DEFINITION)

Back 130

1. Infectious arthritis

2. Bacteria, viruses or fungi can be responsible for septic arthritis

3. Can affect people of any age but children and older adults are at greatest risk

4. Microorganisms can be introduced into the joint by direct inoculation, direct extension, or by hematogenous spread (the most common route)

Front 131

SEPTIC ARTHRITIS
(CLINICAL MANIFESTATIONS)

Back 131

1. Acute joint pain
2. Fever, chills and other systemic symptoms
3. Examination of the joint may reveal classic signs of inflammation (Increased temperature, Swelling, Redness, Loss of function)
4. Pus may drain through a sinus formed from the joint to the outside
5. A child may refuse to weight bear through the affected extremity
6. Destruction of the joint can proceed rapidly and have long-lasting effects
7. In addition to the infection, the WBC’s that enter the joint to fight the infection release enzymes that have a negative effect on articular cartilage

Front 132

SEPTIC ARTHRITIS
(TREATMENT)

Back 132

1. Any joint infection is considered to be medical emergency

2. IV antibiotics with follow up oral antibiotics

3. Aspiration or surgical drainage of the joint may be indicated

4. If a prosthetic joint is infected, the hardware and cement may have to be removed

5. Early in the course of treatment, the joint is typically rested (splinting, traction or casting)

6. Care in application of the splint and removal of the splint for periodic ROM exercise can help to prevent joint contractures

Front 133

MYOSITIS
(DEFINITION)

Back 133

1. Inflammatory muscle disease caused by viral, bacterial, or parasitic agents

2. Most frequently caused by S. aureus or by parasites such as trichinella and the tapework larva Taenia solium

3. The most common forms of myostitis are polymyositis and dermatomyositis

Front 134

MYOSITIS
(CLINICAL MANIFESTATIONS)

Back 134

1. Malaise, fever, and lethargy

2. Muscle swelling

3. Pain

4. Tenderness

5. Muscle weakness

6. Increased levels of creatine kinase

7. Electromyography demonstrates muscle irrability and myopathic changes

Front 135

MYOSITIS
(TREATMENT)

Back 135

1. Often includes the use of immunosuppressive therapy and corticosteroids

2. Resulting muscle weakness typically means that aggressive and potentially prolonged physical and occupational therapy intervention may be indicated

Front 136

ANKYLOSING SPONDYLITIS
(DEFINITION)

Back 136

1. Inflammatory arthropathy of the axial skeleton including the sacroiliac joints, apophyseal joints, costovertebral joints and intervertebral disk articulations

2. 1/3 of patients with AS have asymmetric joints (knee, hip, shoulder)

3. Typically affects young people (15-30 years old); Rare after 40 years old

4. Men are affected two to three times more often than women

5. AS is marked by chronic nongranulomatous inflammation at the area where the ligaments attach to the vertebrae

6. The replacement of inflamed cartilaginous structures by bone contributes to progressive ossification with bony growth between the vertebrae; this leads to a fused, rigid or “bamboo” spine that is characteristic of end-stage disease

Front 137

ANKYLOSING SPONDYLITIS
(CLINICAL MANIFESTATIONS)

Back 137

1. Limitations in spinal mobility (especially in forward flexion)

2. Early loss of typical lumbar lordosis

3. Hip flexor contractures often present bilaterally

4. Loss of chest wall excursion

5. Osteoporosis

6. May have sublaxtion at C1-C2

Front 138

ANKYLOSING SPONDYLITIS
(TREATMENT)

Back 138

1. Primary focus is to reduce inflammation in the joints, maintain mobility and proper postural alignment at the spine

2. Relieve pain

3. NSAIDS

Front 139

ANKYLOSING SPONDYLITIS
(IMPLICATIONS FOR PT)

Back 139

1. Avoid high impact and flexion activities

2. Emphasize low impact aerobic exercise with extension and rotation components

3. Avoid contact sports

4. Over-exercising can be potentially harmful

5. Firm, supportive mattress recommended to maintain spinal alignment; soft mattresses or water beds should be avoided as these can contribute to excessive flexion and the development of stooped postures

Front 140

GOUT
(DEFINITION)

Back 140

1. Heterogeneous group of metabolic disorders marked by an elevated level of serum uric acid and the deposit of urate crystals in the joints, soft tissues and kidneys

2. Uric acid is normally formed when the body breaks down cellular waste products; typically dissolves in the blood and is excreted through urine; if the body produces more uric acid than the kidneys can handle, the blood levels or uric acid rise; it may then precipitate out and accumulate the body tissues including joints

3. Typically monoarticular

Front 141

GOUT
(CLINICAL MANIFESTATIONS)

Back 141

1. Acute, inflamed joint manifested by exquisite pain that occurs suddenly at night

2. Gout is common in the first MTP but also seen in the ankle, instep, knee, wrist, elbow and fingers

3. Chills and fever may accompany joint pain

4. After recovering from an initial episode of gout, the patient enters an asymptom

5. Treatment of Goutatic phase called the intercritical period which can last for months or even years

6. Gout attacks return suddenly with increasing severity and frequency and often in different joints

7. “Attacks” may be precipitated bu trauma, surgery, alcohol consumption, or eating certain foods

Front 142

GOUT
(TREATMENT)

Back 142

1. NSAIDS

2. Corticosteroids may be used

3. Treatments of hyperuricemia
A) Diet
B) Weight loss
C) Moderation of alcohol consumption

Front 143

MYOFASICAL PAIN DYSFUNCTION
(DEFINITION)

Back 143

1. Regional pain disorder marked by the presence of myofascial trigger points within the taut band of muscle

2. “Hyper-irritable” foci in skeletal muscle or its fascial components

3. Trigger points may be active or latent

4. A latent trigger point may become active in the presence of an acute overload of the muscle or with chronic strain

5. Trigger points are different from the tender points associated with fibromyalgia

6. Trigger points have been described as a rope-like, nodular, or crepitant area within a muscle

7. Trigger points are self-sustained and self-perpetuating

8. Local twitch response and “jump” sign

Front 144

MYOFASCIAL PAIN DYSFUNCTION
(IMPLICATIONS FOR PT)

Back 144

1. Vapocoolant spray

2. Low volt electrical stimulation

3. Ultrasound (continuous mode appears to be more effective)

4. HEP: sustained stretch

Front 145

SCOLIOSIS
(CLINICAL MANIFESTATIONS)

Back 145

1. < 20 degrees: functional problems rare
2. > 60 degrees: decreased lung capacity, back pain, vertebral subluxation, sciatica, degenerative spinal arthritis, or disk disease
3. Asymmetrical shoulders and pelvis
A) Earliest findings may be shortening of tissues in concave side
4. Named for convexity (left curve would be convex to the left)
5. Typically see 1st degree and 2nd degree (compensatory) curves
6. May see rotational deformities develop on the convex side (results in a rib hump)
7. Forwards Bend Test
A) Structural: no changes in curve with forward bend
B) Functional: curve typically straightens with forward bend

Front 146

SCOLIOSIS
(MEASUREMENTS)

Back 146

1. Use of Scoliometer
A) Measures the angle of trunk rotation in forward bend position (90 degrees)

2. Cobb’s Method
A) Measures degree of curve using X-ray films
B) Measures angle formed by intersection of the perpendicular lines drawn from lines parallel to the vertebrae at the apex and base of the curve

Front 147

SCOLIOSIS
(TREATMENT)

Back 147

1. Goal: to prevent severe and progressive deformities that can compromise internal organs

2. Curves < 25 degrees: observe and monitor

3. Curves 25-40 or 45 degrees: Spinal Orthosis

4. Curves > 45 degrees: Surgical correction

5. Curves < 45 degrees: exercise can work!

6. Exercise programs have not been shown to be effective in halting or improving Scoliosis even when used in conjuction with a Spinal orthosis

Front 148

SCOLIOSIS
(IMPLICATIONS FOR PT)

Back 148

1. Scoliosis screenings

2. Electrical stimulation
A) Theorectically strengths muscles on convex side of curve and pulls spine back into alignment
B) Large scale trials have not supported this intervention

3. Post-operative care
A) Deep breathing exercises/AROM
B) After healing (4-6 weeks): work on flexibility, strength, endurance