Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
336 Cards in this Set
- Front
- Back
|
Osteoarthritis
|
-Degenerative, chronic, inflammatory -Largely due to wear and tear -Occurs mostly in ages over 45 -Incidence increases with age -Under 55: more men but over 55: more women -Causes influsion |
|
|
Influsion
|
Fluid build up inside the joint
|
|
|
Two types of Osteoarthritis
|
1. Primary OA 2. Secondary OA |
|
|
Primary Osteoarthritis
|
-Etiology unknown -Related to aging process -Normal wear and tear |
|
|
Secondary OA
|
-Result of known factors -Blood destroys cartilage -Develops because of a known cause |
|
|
Result of known factors
|
Obesity, previous injury or infection to joint, repetitive stress, hemophilia with bleeding in joint, hyperthyroidism
|
|
|
Osteoarthritis continued
|
-OA is usually unilateral, may end up moving to the other side as well -Associated with loss of cartilage in joint -Reduced joint space between bone ends -Loss of mobility if the joint is really narrow -Non-inflammatory |
|
|
OA is usually unilateral, may end up moving to the other side as well
|
Due to placing weight on other side
|
|
|
Non-inflammatory
|
Gradual degeneration
|
|
|
Signs and Symptoms of OA
|
-Damage to hyaline cartilage -Fibrillation -Reduced ROM -Eburnation -Cysts develop in subchondral bone -Osteophytes -Synovitis |
|
|
Fibrillation
|
-Cracks developing in surface of the cartilage -Almost like a dry hinge |
|
|
Reduced ROM
|
Locking due to loose piece
|
|
|
Eburnation
|
Bone damage (smooth and shiny bone)
|
|
|
Osteophytes
|
Bone spurs
|
|
|
OA Etiology
|
-Synovial membrane hypertrophies -Loss of synovial fluid production, bone becomes dry (poor nutrition) -Reduced nutrition to hyaline cartilage -Capsular ligaments (as well as others closely related to joint) inflamed/degenerate -Muscle atrophies |
|
|
Clinical Presentation of OA
|
-Pain (soreness/nagging) c weight bearing -Stiffness -Reduced ROM caused by stiffness -Muscle atrophy -Joint deformity and enlargement, a lot of bone changes -Crepitus -Reduced function |
|
|
Crepitus
|
When you move, you hear grinding and crunching
|
|
|
Interventions
|
What we as therapists can do
|
|
|
Interventions for OA
|
-Focus on improving function -Strengthening, stretching, endurance, HEP (home exercise program) -Encourage weight loss if appropriate Modalities for reduction of pain -Assistive devices as needed -Education |
|
|
Spondylosis
|
Arthritis of spine, DDD
|
|
|
DDD
|
Degenerative Disc Disease
|
|
|
Signs and Symptoms of Spondylosis
|
-Intervertebral disc deterioration with cracking of annulus fibrosis -Loss of height -Lipping of vertebrae and osteophyte formation, vertebrae gets wider which can decrease size of vertebral foramen -Ligamentous thickening -Impingement of nerve roots |
|
|
Spondylosis Interventions
|
-Medical -PT |
|
|
Medical
|
NSAIDS and/or decompressive surgery
|
|
|
Decompressive surgery
|
Go in and clean out space so nerve root can move freely
|
|
|
PT
|
-Postural reeducation (core stability) -Strengthening, stretching -Mobilization -Modalities (heat) -HEP and patient education |
|
|
Spondylolysis
|
-Defects of pars interarticularis (posterior arch) little fracture -Affects both children and adults, don't necessarily have signs and symptoms until later -Athletes (especially those involved with contact sports and gymnastics) increased incidence -Heredity plays a significant role |
|
|
"Spotty dog"
|
Bilateral fracture in Spondylolysis
|
|
|
Etiology of Spondylolysis
|
-Often caused by repeated trauma -Produce stress fracture in that area -Can be due to genetic defect -Spina Bifida |
|
|
Spina Bifida
|
Increased risk of developing condition
|
|
|
Signs and Symptoms of Spondylolysis
|
-Discovered on X rays -Often without symptoms -Usually occurs L4,5 or L5,S1 -It is the area that takes the most stress |
|
|
Prognosis of Spondylolysis
|
-Defect can slip anteriorly (Spondylolisthesis) -Often symptom free during teenage years |
|
|
Interventions of Spondylolysis
|
-Core strengthening (transverse abdominis muscle) -Posture reeducation -Functional rehab if needed |
|
|
Spondylolisthesis
|
-Vertebral body slips anteriorly on the one below -Retrolisthesis may occur -Slippage may cause stenosis -Usual age of onset = 40 years -Can be found in children = birth defect (Spina Bifida) |
|
|
Retrolisthesis
|
If body of vertebra moves posteriorly
|
|
|
Stenosis
|
Pressure on nerve roots
|
|
|
Etiology of Spondylolisthesis
|
-Trauma -Subluxation of apophyseal joints (facets)... arthritic changes -Pathology of bone- Osteoporosis, malignancy (metastasis) |
|
|
Signs and Symptoms of Spondylolisthesis
|
-LBP lying supine -Muscle spasm -Increased lumbar lordosis (step off) -Radicular pain |
|
|
Prognosis of Spondylolisthesis
|
-80% success with therapy, analgesics, exercise -Flexion exercises -Spinal fusion- 85-90% success -Surgery with intractable pain, nerve root symptoms |
|
|
Intractable
|
So much pain that pt. cannot function anymore
|
|
|
Interventions of Spondylolisthesis
|
-Strengthening -Postural Reeducation -Decreased lumbar extension, work on flexion -Modalities -Lumbar support or abdominal binder |
|
|
Modalities
|
Lumbar traction as well as pain relief
|
|
|
Herniated disc
|
-Protrusion of the nucleus pulposus with bulging or rupture of annulus fibrosis -Disc is made up 90% water at infancy and decreases as we age -Becomes firm and more stiff -Posterior/lateral most common but central/posterior more common in cervical spine |
|
|
Structural deficiencies
|
-Posterior disc narrower in height than anterior -Posterior longitudinal ligament not as strong and only centrally located in lumbar spine -Posterior lamellae of annulus are thinner |
|
|
Etiology of herniated discs
|
-Over stretching/tearing of annular rings or vertebral endplate, due to compressive forces or micro trauma -Flexion with rotation -Most common between ages 30-50 yr -Poor body mechanics -Poor posture -Repetition and over loading |
|
|
Prognosis of herniated discs
|
-90% improve with conservative treatment -10% will require surgery -Not a major surgery -Extension exercises |
|
|
Signs and symptoms of herniated discs
|
-Back or neck pain -Radicular symptoms -Numbness and tingling (paresthesia) -Decreased motor strength -Decreased DTR -Limited function |
|
|
Clinical manifestations
|
-Determined by location/size -Onset sudden or gradual -Symptoms usually unilateral -Large protrusion may be bilateral, very rate -Muscle spasm -Lateral shift |
|
|
Lateral shift
|
Decreases the pressure on the nerve root
|
|
|
Interventions with herniated discs
|
-Exercise- core stability -Postural gapping -Traction -Strengthening -Postural reeducation and body mechanics -McKenzie techniques -Modalities for pain control |
|
|
McKenzie techniques
|
#1 treatment for Herniated discs
|
|
|
Medical intervention
|
-NSAIDS or steroids (for extreme pain) -Muscle relaxants -Trigger point injections -Corticosteroid injections, or by mouth -Surgery |
|
|
Steroids
|
Help the inflammation
|
|
|
Surgery
|
-10% -Microdisectomy |
|
|
Spinal stenosis
|
-Congenital narrowing or spinal canal or intervertebral foramen -Result from DDD or Spondylosis -Coupled with hypertrophy of spinal lamina and ligamentum flavum or facets as result of age related degenerative processes or disease -Results in vascular and/or neural compromise -Onset 50-60 yrs |
|
|
Signs and symptoms of Spinal stenosis |
-Bilateral pain and paresthesia LE -Stiffness and decreased ROM -Pain is decreased in spinal flexion, extension increased -Claudication -Pain may persist for hours after assuming resting position, but prolonged rest will decrease -Irritable conditions |
|
|
Claudication
|
Pain increase with walking
|
|
|
Irritable conditions
|
A little bit of movement, a lot of pain that lasts really long
|
|
|
Prognosis of Spinal Stenosis
|
Not curable but treatable with PT or surgery
|
|
|
Interventions with Spinal Stenosis
|
-Joint restriction = Joint mobs (making joints more movable) -Flexion-based exercises -Avoid extension- it narrows spinal canal -Traction -Posture and patient education |
|
|
Scoliosis
|
-Abnormal curvature of the spine -Girls > boys -Functional versus structural scoliosis |
|
|
Structural Scoliosis
|
-Can be congenital or idiopathic -Causes permanent change within spine -Curves do not alter with movement |
|
|
Functional Scoliosis
|
-Can be caused by poor posture or pain -Does not affect the structure of the spine -Movement- scoliosis seems to change -Can be fixed, looking at muscle imbalances |
|
|
Signs and Symptoms of Scoliosis
|
-Curvature S or C-shaped -One shoulder may appear higher than other; waistline uneven -Rotation of spine- rib hump...sticks out in the back -Increased kyphosis and Lordosis |
|
|
Increased Kyphosis and Lordosis
|
Curvatures
|
|
|
Prognosis of Scoliosis
|
-Varies with degree of curvature, restrictive lung disease and function
|
|
|
Varies with degree of curvature
|
-Cobbs method -Spinal orthosis -Surgery |
|
|
Cobbs method
|
< 25 degrees conservative
|
|
|
Spinal orthosis
|
Between 25 and 45 degrees
|
|
|
Surgery
|
-Harrington rods, pedicle screws, and instrumentation for fusion -More than 45 degrees |
|
|
Types of Braces for Scoliosis
|
-Boston Brace -Milwaukee -Charleston -Spinacor brace |
|
|
Boston Brace
|
-Type of TLSO -"Low profile" -Custom molded -Mid to low back |
|
|
Milwaukee
|
-High thoracic curves -Extends neck to pelvis -Contoured plastic over pelvis -Neck ring -Less commonly used |
|
|
Charleston
|
-Works only at night -"Part time brace" -Curvatures of 20-35 degrees -Below level of shoulder blade |
|
|
Spinacor brace
|
Dynamic brace
|
|
|
Functional Scoliosis therapy
|
Postural retraining with strengthening and stretching
|
|
|
Structural scoliosis therapy
|
Emphasis on maintaining function
|
|
|
Definition of a fracture
|
-A break in the rigid structure and continuity of a bone -Can range from a small crack to a complex fracture with multiple fragments |
|
|
What does a fracture result from?
|
When a force exceeds the strength of bone
|
|
|
Signs and symptoms of a fracture
|
-Pain and tenderness -Deformity -Edema -Ecchymosis -Loss of function -Loss of mobility |
|
|
Ecchymosis
|
Bruising
|
|
|
Bone Fractures are classified by
|
1. Completeness of break 2. Position of the bone ends after fracture 3. Orientation of the bone to the long axis of bone 4. Whether or not bone-end penetrates the skin |
|
|
Common types of fractures
|
1. Greenstick fracture 2. Comminuted 3. Compression 4. Impacted 5. Pathologic 6. Stress/fatigue fractures |
|
|
Greenstick fracture
|
-Incomplete -Perforates cortex -Splinter -Spongy bone is involved -Occurs when a bone bends and cracks, instead of breaking completely into separate peices |
|
|
Comminuted
|
Multiple fragments
|
|
|
Compression fracture
|
-Two bone ends crush a third in between -Vertebrae with Osteoporosis |
|
|
Impacted
|
One end of the bone is forced into another (hip)
|
|
|
Pathologic
|
Bone weakened by abnormal condition
|
|
|
Abnormal condition
|
Tumors/infection
|
|
|
Stress/fatigue fracture
|
An accumulation of stress-induced micro fracture
|
|
|
An accumulation of stress induced micro fracture
|
Often occur in weight-bearing bone
|
|
|
Stages healing bone fractures
|
1. Week 1 2. Week 2-3 3. Week 4-16 4. Week 17 and on |
|
|
Week 1
|
Hematoma formation as bleeding ceases and clot forms
|
|
|
Weeks 2-3
|
Soft callus forms
|
|
|
Weeks 4-16
|
Osteogenesis, fibrous union and hard callus formation
|
|
|
Weeks 17 and on
|
Remodeling of medullary canal and organized lamellar bone
|
|
|
What is bone replaced with?
|
Bone
|
|
|
Should healed bone be as strong as pre-injury?
|
True
|
|
|
What does rate of repair depend on?
|
Proximity of bone ends, type of fracture, particular bone and age
|
|
|
Time frame
|
Long bones
|
|
|
Long bones lower extremity
|
6-12 weeks
|
|
|
Long bones lower extremity
|
4-8 weeks
|
|
|
Fracture complications
|
-Muscle spasm -Infections -Ischemia -Compartment syndrome -Fat emboli -Nerve damage -Failure to heal |
|
|
Fat emboli
|
-Fatty marrow escapes from bone marrow -More common with fracture of pelvis and long bones -Within 1 week post injury -Emboli travels to lungs in circulatory system -Obstruction |
|
|
Signs and symptoms of fat emboli
|
-Respiratory distress -Pallor -Cyanosis -Chest pain -Petechial as late sign |
|
|
Petechiae as a late sign
|
Pin point bleeding, little red dots
|
|
|
Compartment Syndrome
|
-Done by fascia -Shortly after fracture occurs when there is more extensive inflammation -Crush injuries -Increased pressure of fluid within fascia -Compression of nerves and blood vessels -Causes severe pain and ischemia or necrosis of muscle- watch for effect of cast! |
|
|
Crush injuries
|
a lot of soft tissue damage
|
|
|
Signs and symptoms of Compartment Syndrome
|
-Severe increase in pain, nerve issues -Burning -Parasthesia -Decreased reflexes -Decreased motor function -Medical emergency |
|
|
Medical emergency
|
Surgery needed
|
|
|
Ischemia
|
-Done by a cast -Edema increases during first 48 hours after trauma and casting -Peripheral area becomes pale and cold and numb -Peripheral pulse decreased/absent -Circulation compromised |
|
|
Circulation compromised
|
Cast might be too tight
|
|
|
Muscle spasm
|
May pull fragments out of position
|
|
|
May pull fragments out of position
|
More soft tissue damage, bleeding, inflammation
|
|
|
Infection
|
-Potential with open fractures or if surgery is required -Osteomyelitis |
|
|
Osteomyelitis
|
Infection of bone
|
|
|
Malunion
|
Healing with deformity |
|
|
Causes of malunion
|
-Muscle imbalance -Inadequate protection of fracture |
|
|
Delayed or Non-union
|
-Failure to heal -May fill with dense fibrous and fibrocartilagenous tissue instead of new bone |
|
|
What does Non-union cause?
|
Infection, poor vascularization, stress to fracture site, inadequate blood supply, poor general health and nutrition, poor apposition of fracture bone ends, foreign bodies, infection or necrotic tissue, corticosteroid therapy
|
|
|
Treatment of fractures
|
1. Acute 2. Reduction of fracture (if necessary) 3. Closed reduction 4. Open reduction |
|
|
Acute
|
Immediate splinting immobilization to minimize risk of complications
|
|
|
Closed reduction
|
-Skin not open -Use traction and pressure |
|
|
Open Reduction
|
-ORIF -Surgical intervention |
|
|
Surgical intervention
|
-Screws -Nails -Bolts -Rods -Plates |
|
|
Immobilization of fracture site
|
1. Traction 2. Internal Fixation 3. External immobilization |
|
|
Traction
|
To maintain alignment (before surgery), prevent muscle spasm (before cast)
|
|
|
Types of traction
|
1. Skeletal traction 2. Skin traction |
|
|
Skeletal traction
|
Pin or wire through bone below fraction site
|
|
|
Skin traction
|
Wrap with bandages and pull on it with weights
|
|
|
Internal fixation
|
-Immobilizer or sling can be worn -WB restrictions |
|
|
External immobilization
|
-Cast -Splint -External fixation device |
|
|
Cast
|
Complication caninclude nerve compression
|
|
|
PT intervention- What doRes this mean to me?
|
-1st priority is protection of fracture site -KNOW and MAINTAIN weight bearing status -NMB, TTMB, PMB, WBAT -Use of splints/slings and/or positioning -Control pain and swelling -Decrease the effect of immobility -Strengthen and mobilize to premorbid level |
|
|
Rheumatoid Arthritis
|
-Systemic, Autoimmune disorder of connective tissue -Chronic inflammation of the synovial membranes, tendon sheaths and articular cartilage |
|
|
What is RA characterized by?
|
Bilateral, symmetrical arthritis
|
|
|
What does RA affect?
|
-Many joints -Affects organs -May experience impaired posture, gait, joint mobility, motor function, muscle performance -Predominantly affects females |
|
|
Affects organs
|
Heart, liver, eyes, skin, bone, and lungs
|
|
|
Impaired posture
|
Pain
|
|
|
Age of onset
|
Varies but 25-55
|
|
|
Etiology of RA
|
-Largely unknown -60% with genetic trait -Rubella and Epstein Barr viruses and are suspect to playing a role -Even hormones are considered a factor in some patients |
|
|
60% with genetic trait
|
HLA-DR4
|
|
|
Epstein Barr
|
Mono
|
|
|
Hormones
|
Sex hormones
|
|
|
Signs and symptoms of RA
|
-Insidious onset -Usually begins symmetrical in distal joints like hands and feet -General body illness can be a first sign of disease -Acute onset also possible |
|
|
Insidious onset
|
Mild, general aching and stiffness (acute/gradual)
|
|
|
Acute onset also possible
|
Severe pain and stiffness
|
|
|
Joint pathology of RA
|
1. Synovitis 2. Pannus formation 3. Destruction of hyaline cartilage |
|
|
1. Synovitis
|
-Hypertrophy -Thickening of the synovium with excessive production of synovial fluid |
|
|
Pannus formation
|
-Villi from synovial membrane -Forms on the synovial membrane and grow along joint margins |
|
|
Leads to destruction of hyaline cartilage
|
-And bone underneath -Caused by enzymes stimulated by the pannuys |
|
|
Reduced joint space and rubbing of bone ends
|
True
|
|
|
Ankylosed bones
|
-Some bones may become ankylosed by fibrous tissue or bone -Fused together |
|
|
Inflammation
|
-Break down of ligamentous tissue -Subluxation |
|
|
Subluxation
|
Dislocation
|
|
|
What is the most dangerous? |
C1/C2 vertebrae
|
|
|
Pressure on tendons causes?
|
Tendon rupture
|
|
|
Early stages of RA |
-Mainly inflammatory -Joints swollen -RF is present in blood and synovial fluid -Loss of function of joints |
|
|
Joints swollen
|
Effusion, soft tissue edema, hot, painful and skin around joint- erythema
|
|
|
RF
|
Rheumatoid Factor
|
|
|
Loss of function of joints
|
PIPs fingers and feet MCP and MTP
|
|
|
Later manifestation
|
-Pain experienced at rest, at night, and early in morning -Joint effusion in fingers -Early morning stiffness (function-dressing) |
|
|
What do later manifestations affect?
|
Hips, knees, shoulders, elbows, cervical spines and TMJ
|
|
|
Joint effusion fingers
|
Spindle fingers or fusiform shaped fingers
|
|
|
RA causes muscle atrophy
|
Due to inactivity
|
|
|
C spine RA
|
Most commonly affected C1,C2
|
|
|
Inflammation to C1,C2 can lead to subluxation
|
Most dangerous aspect of articular disease process
|
|
|
Most dangerous part of articular disease process
|
No traction
|
|
|
RA non-articular pathological changes
|
-Severe fatigue -Felty's syndrome -Can also include splenomegaly, liver enlargement, swollen lymph nodes -RA skin nodules -Eye problems |
|
|
Severe fatigue
|
May be related to anemia
|
|
|
Felty's syndrome
|
Weight loss anorexia
|
|
|
Can also include splenomegaly, liver enlargement, swollen lymph nodes
|
Due to active destruction in the body
|
|
|
RA skin nodules
|
Can also be in heart and lungs
|
|
|
Eye problems
|
Sjogrens syndrome
|
|
|
RA also causes
|
-Osteoporosis -Raynaud's Phenomenon |
|
|
Osteoporosis
|
-Due to long term steroid use -Long-term steroid use degenerates bone |
|
|
Raynaud's Phenomenon
|
Vasospasm of the peripheral extremities
|
|
|
Prognosis of RA
|
Early detection |
|
|
Early detection
|
Can be well controlled
|
|
|
Non articular signs and symptoms can lead to early mortality
|
True
|
|
|
Determining diagnosis of RA is very important
|
-Criteria developed by the ARA -Early morning stiffness of 1 hour or more -Symmetrical arthritis of at least 3 joints with swelling of more than 6 weeks -RA skin nodules, positive results on RA factor |
|
|
|
|
|
|
How many of the above criteria need to be met to be diagnosed with RA?
|
At least 4 of the above
|
|
|
What we can do - Interventions
|
-Full systems approach -Improved functional activity -Minimizing joint deformity -Joint preservation -Increasing ROM, and strength -Decrease pain |
|
|
Therapy ASAP
|
Holistic approach
|
|
|
Team approach
|
True
|
|
|
Gait pattern
|
Assisted devices
|
|
|
Passive Stretching?
|
-Caution -May need gentle exercise, splinting and positioning |
|
|
Cannot do traction
|
No severe work on the C-spine
|
|
|
Traction?
|
No traction on patients
|
|
|
Exercise with RA
|
Within pt. tolerance, no exacerbation of pain, or increasing fatigue
|
|
|
No heavy resistant exercises with RA
|
True
|
|
|
Treat these patients with "tender loving care"
|
True
|
|
|
Modalities with RA
|
-NMES with active exercises -IFC -US -TENS -Thermal |
|
|
NMES with active exercises
|
-Increase strength (CI in acute stages) -Neuromuscular Electro Stimulation |
|
|
IFC
|
-Pain relief -Can be used during acute exacerbations -Intraflourential Current |
|
|
US
|
-Reduce pain and edema -Increase joint mobility during an acute exacerbation |
|
|
TENS
|
For pain in acute and non-acute
|
|
|
Thermal
|
-Relief of pain and swelling Hot/cold modalities |
|
|
Hydrotherapy
|
-Great medium for patients with RA -Limit exercise in water -10-15 min sessions for starters, can gradually build this up -Good posture and quality exercise with emphasis on control and body mechanics -CI? During acute stages |
|
|
Juvenile RA aka Still's Disease
|
-RA with systemic manifestations -Etiology unknown -Thought to be autoimmune, similar to RA -Some cases precipitated by infection |
|
|
Signs and Symptoms of Juvenile RA
|
-Onset more acute than adult form -Identified in children under age 16 -Connective tissue, autoimmune affecting multiple areas and is seronegative for RF factor -Tends to affect larger peripheral joints |
|
|
Larger peripheral joints
|
-Hips, knees -Different from adult RA |
|
|
General classification of JRA |
-Having symptoms lasting from 6 weeks to 6 months or more -Affecting 4 or less joints, 5 or more joints -Systemic with fever, persistent for 2 weeks |
|
|
Symptoms
|
-Pain and stiffness in affected joints with contractures in severe cases -Bone retardation may occur -Systemic symptoms -Fatigue, loss of aerobic conditioning, muscle spasm, atrophy, and osteoporosis |
|
|
Bone retardation may occur
|
Long bones
|
|
|
Systemic symptoms |
Skin rash, heart pathologies
|
|
|
Still's Disease
|
-Rapid progression of disease process -Systemic symtpoms -Often called Still's disease |
|
|
Systemic symptoms
|
Worse prognosis
|
|
|
Often called Still's disease
|
Fluctuating high fever, enlargement of spleen and liver, heart problems, enlarged nodes, pleural effusion
|
|
|
Prognosis
|
-More joints, more severe -However, 75% of all children= remission by adolescence with minimal loss of function -Still's= may have lasting damage to heart and lungs -Joint damage- ROM-Function |
|
|
What to do?
|
-Family is part of team -Pain relief -Control/reduction of contractures -Function -Acute |
|
|
Family is part of team
|
Teach parents to do stuff for kids
|
|
|
Pain relief
|
Steroids, modalities, anything can reduce pain, IFC
|
|
|
Modalities
|
TENS
|
|
|
Acute
|
CI exercises, mobs, electrical modalities (heat)
|
|
|
School needs to be informed to assist as needed
|
-True -Such as stiffness in the morning -Getting ready for school can be quite a challenge |
|
|
Ankylosing Spondylitis
|
-Progressively, inflammatory, Rheumatoid-related disease -Affecting joints and ligaments ofthe spine (S1) -Seronegative spondyloarthropathies -Between ages 15 and 40, affects men more than women -Also known as Bamboo Spine |
|
|
Affecting joints and ligaments of spine (S1)
|
Occasionally other joints and internal organs
|
|
|
Signs and symptoms
|
-Ankylosis of spine and SIJ -Can involve the shoulders, hips, and knees -Not RA -Seronegative for RF in blood -But 90% tissue genetic marker |
|
|
Starts with pain and stiffness in LB
|
-True -Due to inflammation of SIJ and joints in spine |
|
|
Fatigue
|
Also a systemic issue
|
|
|
Sciatic nerve pain often noted
|
True
|
|
|
Can have spasm of paravertebrals
|
True
|
|
|
When is pain and stiffness worse?
|
In the morning
|
|
|
How can it be alleviated?
|
With exercise and movement
|
|
|
Enthesitis
|
Inflammation of junction of bone and ligament, place that begins to fuse
|
|
|
Affected areas by enthesitis
|
Annulus fibrosis at margins of vertebral bodies, symphysis pubis, sternal joints
|
|
|
All joints of the spine involved
|
-Ligaments fibrosed and then converting to bone -Bamboo spine -Process starts in SIJ and lumbar spine |
|
|
Process starts in SIJ and lumbar spine
|
Sacroilitis and progresses up spine to include costovertebral and manubriosternal joints
|
|
|
After ankylosing
|
Spine fused and immobile
|
|
|
Does pain increase of decrease after ankylosing?
|
-Decreases -Pain most severe during acute phase |
|
|
Loss of chest expansion
|
Decreased vital capacity
|
|
|
Forward flexion with increased thoracic kyphosis and flattened lumbar spine, forward head
|
True
|
|
|
Reduced shock absorbing
|
-Fractures -No cushioning in the spine anymore |
|
|
Prognosis
|
-Periods of exacerbation and remission -Progressive worsening -Does not reduce life expectancy -Functional loss -Surgical intervention |
|
|
Functional loss
|
Can also affect hips and shoulders
|
|
|
Surgical intervention
|
Total Hip Replacement
|
|
|
Intervention
|
-Education -Extension exercises -Acute -Aqua therapy -Breathing exercises |
|
|
Education
|
Retain mobility as long as possible, proper positioning
|
|
|
Extension exercises
|
Want to keep the mobility in the spine
|
|
|
Acute
|
Modalities and posture
|
|
|
Fibromyalgia
|
-Multiple areas of muscle tenderness and joint pain -Incidence higher in women than in men -More commonly diagnosed |
|
|
Multiple areas of muscle tenderness and joint pain
|
But does not directly affect joints
|
|
|
Incidence higher in women than men
|
Especially between ages early teen to mid-60
|
|
|
More commonly diagnosed
|
Middle aged women, people with RA, autoimmune diseases
|
|
|
Etiology of fibromyalgia
|
-Associated with trauma, stress hyperthyroidism or infection Sleep disorders, dietary factors, psychosocial and environmental factors -Genetic predisposition (families) -Hormonal dysfunction |
|
|
Hormonal dysfunction
|
High levels of substance P in spinal fluid, decreased serotonin
|
|
|
Substance P
|
Chemical responsible for pain nerve impulses to and from brain, and is though to increase the pain signals, resulting in heightened sensation of pain
|
|
|
Signs and symptoms of fibromyalgia
|
-Specific sites of tenderness on palpation -11/18= positive diagnosis -Headaches, migraines, fatigue, chest pain, profuse sweating, cognitive defects, early morning stiffness, swelling, LBP, neck pain, urinary and bowel symptoms, restless leg syndrome, anxiety, depression, dizziness |
|
|
Cognitive defects
|
Poor memory, inability to concentrate
|
|
|
What are symptoms aggravated by?
|
Cold and damp
|
|
|
What are symptoms relieved by?
|
Warm and dry weather
|
|
|
Lack of sleep and stress may cause symptoms
|
True
|
|
|
Where are main tender spots located?
|
Shoulders and neck with some LB and hips
|
|
|
Is there pain?
|
Considerable pain that interferes with ADL
|
|
|
Prognosis of fibromyalgia
|
-Not life threatening -Debilitating -Reduced functional capacity |
|
|
Interventions of fibromyalgia
|
-Stress reduction, work place adaptation, aerobic exercises -Increased symptoms with no or too much exercise -Balanced activity important -Pain management strategies -Modalities -Frequent rest periods |
|
|
Modalities
|
Low level laser use successful
|
|
|
Frequent rest periods
|
Due to fatigue
|
|
|
Myofascial pain syndrome
|
-Often confused with fibromyalgia and Polymyalgia Rheumatica -Association with RSS -Causes can also be infection and stress |
|
|
Signs and symptoms
|
-Trigger points -Pressure on the TP results in referred pain -Localized to just one or couple other areas |
|
|
Trigger Points
|
-TP -Latent |
|
|
TP
|
-Hyperirritable locus within a taut band of skeletal muscle, located in muscular tissue or fascia -Active when causing pain |
|
|
Latent
|
When not causing pain, but easily activated into pain when muscle is stressed as result of minimal trauma or muscle pull
|
|
|
Prognosis of fibromyalgia
|
-Severe amounts of muscular pain- can be difficult to treat -Chronic pain syndrome can result from this condition -Can be medically treated by TP injections -Dry needling can also be effective |
|
|
What can we do?
|
-ID TP's -Desensitization of TP with manual pressure, e-Stim, US, stretching -Studies showed good results with US and stretching -Postural reeducation, aerobic conditioning |
|
|
Gout
|
-Form of arthritis that can affect anyone -Uric acid accumulates in joints over a long period of time -Men are more susceptible than woman -Gout can occur suddenly with the sensation that the affected joint is on fire |
|
|
Uric acid accumulates in joints over a long period of time
|
Monosodium urate monohydrate crystals
|
|
|
Men are more susceptible to be affected than women
|
Women become more susceptible to gout after menopause
|
|
|
Gout can occur suddenly with the sensation that the affected joint is on fire
|
The joint is hot, swollen, and extremely tender due to inflammation
|
|
|
Urate crystals
|
-Elongated and sharp, accumulate in the joint from high levels of uric acid in the blood -Causes inflammation and intense pain -Inherit metabolic inability to process uric acid |
|
|
Inherit metabolic inability to process uric acid
|
X-linked recessive genetic condition called Lesch-Nyhan syndrome
|
|
|
When is uric acid produced?
|
-When the body metabolizes purines -Found naturally in the body |
|
|
When is uric acid dissolved?
|
Dissolves in blood and passes through the kidneys into urine
|
|
|
Dissolves in blood and passes through kidneys
|
-But sometimes the body either produces too much uric acid The kidneys may excrete too little uric acid |
|
|
Uric acid then can build up, forming crystals in a joint or surrounding tissue
|
True
|
|
|
Symptoms of Gout
|
-Can occur suddenly and usually at night -Intense joint pain -Prolonged discomfort -Inflammation and redness -Limited range of motion -Systemic symptoms |
|
|
Intense joint pain
|
-Can affect feet, ankles, knees, hands and wrists -Usually most severe within the first four to 12 hours |
|
|
Prolonged discomfort
|
-After initial pain subsides some joint discomfort may last from a few days to a few weeks -Later attacks are likely to last longer and affect more joints |
|
|
Inflammation and redness
|
Swollen, tender, warm, and red
|
|
|
Limited range of motion
|
Joint mobility may decrease as gout progresses
|
|
|
Systemic symptoms
|
-Tachycardia -Fever -Fatigue |
|
|
Chronic gout
|
Less painful but is associated with bony deformities
|
|
|
Toph
|
Bumps beneath the skin caused by the build up of uric acid as the bone erodes
|
|
|
The build up of uric acid can also cause kidney dysfunction and kidney stones
|
True
|
|
|
Risk factors of Gout
|
1. Diet 2. Obesity 3. Medical conditions 4. Certain medications 5. Family history of gout 6. Age and sex 7. Recent surgery or trauma 8. Hyperthyroidism |
|
|
Diet
|
-A lot of red meat, seafood, and beverages sweetened with fruit sugar promotes higher levels of uric acid -Heavy alcohol consumption |
|
|
Heavy alcohol consumption
|
Especially beer
|
|
|
Medical conditions
|
-High BP -Diabetes -Metabolic syndrome -Heart and Kidney disease |
|
|
Tests to diagnose Gout
|
1. Joint Fluid Test 2. X-ray 3. Ultrasound 4. Blood test 5. Dual energy CT scan |
|
|
Joint Fluid Test
|
A needle is used to draw fluid from the affected joint and when examined under a microscope the fluid will reveal urate crystals
|
|
|
Blood test
|
Measures the level of uric acid in your blood
|
|
|
Medications to treat and prevent future attacks
|
1. Nonsteroidal anti-inflammatory drugs 2. Stronger anti-inflammatory drugs 3. Corticosteroids |
|
|
Nonsteroidal anti-inflammatory drugs
|
-NSAIDS -Ibuprofen and naproxen -Prescribe higher dose to stop acute attacks followed by a lower daily dose to prevent future attacks |
|
|
Stronger anti-inflammatory
|
Colchicine
|
|
|
Corticosteroids
|
Reserved for people who cant take either NSAIDS or colchicine
|
|
|
Medications to prevent Gout complications
|
-Drugs that block uric acid production -Medication that improves uric acid removal |
|
|
Drugs that block uric acid production
|
Xanthine oxidase inhibitors
|
|
|
Medication that improves uric acid removal
|
Probenecid
|
|
|
Lifestyle treatment
|
-Limiting alcoholic beverages -Limiting drinks high in fructose -Limiting foods high in purines, such as red meat, organ meat and seafood -Exercising regularly and losing weight -Maintaining adequate levels of hydration |
|
|
Physical Therapy Intervention for Gout
|
-PT and PTA do not play a major role in the management of gout -May assist with positioning affected joints -Activity during an acute episode of gout is contraindicated because of severe pain -Might see the patients post-surgery |
|
|
Osteoporosis
|
-Metabolic bone disorder -Decrease in bone mass and density -Bone resorption surpasses bone formation -Causes major hip fractures -Affects more women than men |
|
|
Forms of Osteoporosis
|
1. Primary 2. Secondary |
|
|
Primary
|
-Postmenopausal -Senile -Idiopathic |
|
|
Secondary
|
Usually following a primary disorder
|
|
|
Usually following a primary disorder
|
Cushing's syndrome, extended period of immobility, malabsorption issues
|
|
|
Predisposing factors
|
-Increased age -Decreased mobility -Deficits of calcium, Vitamin D, or protein -Genetics -Caucasians and Asians most affected |
|
|
Decreased mobility
|
-Lack of mechanical stress on osteoblastic activity -Disuse osteoporosis |
|
|
Signs and symptoms
|
-Back pain -Kyphosis and Scoliosis -Spontaneous fractures -Slow healing of fractures |
|
|
Back pain
|
Increased pressure on nerves due to altered vertebrae
|
|
|
Spontaneous fractures
|
-Spine, pelvis, and head of femur -Most common location |
|
|
Treatment for Osteoporosis
|
-Bone cannot be restored -Low-impact, weight bearing exercises -Heat, massage, and extension exercises -Dietary supplements -Biophosphonates and fluoride supplements |
|
|
Bone cannot be restored
|
Therapy can slow down resorption process
|
|
|
Dietary supplements
|
Calcium, vitamin D, protein
|
|
|
Bisphosophonates and fluoride supplements
|
-Inhibit bone resorption -Promote bone deposition |
|
|
Characteristics of Still's Disease
|
Systemic inflammatory disease affecting body organs and multiple joints
|
|
|
Etiology of Still's Disease
|
Unknown
|
|
|
Still's Disease
|
Fever of 39 degrees C or more lasting more than two weeks
|
|
|
Other signs and symptoms of Still's Disease
|
-Skin rash on body and limbs -Pericarditis/hepatitis -Anemia -Growth retardation of bones |
|
|
Characteristics of JRA
|
-Chronic and inflammatory disease of joints -Pauciarticular -Polyarticular -Symptoms last from 6 weeks to greater than 6 months -Growth retardation of bones |
|
|
Etiology of JRA
|
Unknown
|
|
|
Pauciarticular
|
Involves four or fewer joints
|
|
|
Polyarticular
|
Involves five or more joints
|
|
|
Cellulitis
|
Infection and inflammation in the dermal and subcutaneous layers of the skin
|
|
|
Types of Cellulitis
|
1. Erysipelas 2. Parametritis 3. Necrotizing fasciitis |
|
|
Erysipelas
|
Superficial cellulitis
|
|
|
Parametritis
|
Affects the parametrium or tissue near the uterus
|
|
|
Necrotizing fasciitis
|
A severe form of infection which destroys the fascia
|
|
|
Incidence of cellulitis is higher in people with chronic diseases
|
-Diabetes -Malnutrition -Ulcerated lower extremities -Individuals taking steroid medications |
|
|
What is cellulitis caused by?
|
Bacterial infection with: 1. Streptococcus pyogenes 2. Staphylococcus aureus |
|
|
Signs and symptoms of cellulitis
|
-Skin erythema -Edema -Extreme tenderness to palpation -Presence of skin nodules |
|
|
Where is cellulitis seen the most?
|
Foot and lower leg
|
|
|
Prognosis of Cellulitis
|
-Resolves with oral or intravenous antimicrobial medications -Necrotizing fasciitis usually requires hospilization and can be fatal if not treated |
|
|
Medical intervention
|
-Antimicrobial medication -Surgery for complicated cases -Necrotizing fasciitis may require large areas of skin and underlying tissue to be excised to prevent the spread of infection |
|
|
Physical therapy intervention
|
-Not treated by PT or PTA-Very common to observe cellulitis in PT setting-PTAs should refer the patient to the supervising PT and to the physician if they suspect the patient has developed the condition
|
