Msk: Differential Diagnosis Of Common Disorders

Front 1

What is arthrogryposis?

Back 1

-nonprogressive, nongenetic, congenital disorder

-characterized by rigid joints of extremitis (usu. symmetrical), sausage-like shapeless limbs, and weak or nonfunctioning mms

-hip dislocations and contractures (ABD, Flex, ER), shoulder contractures (adduction and iR) and club feet are common

-disease not inherited

-differential dx: RA and spina biifida

-treatment: surgery, ROM, positioning, splinting, ADL training, use of adaptive devices

Front 2

What is Complex Regional Pain syndrome?

Back 2

CRPS (reflex sympathetic dystrophy RSD)

-abnormal sympathetic reflex resulting from a persistent painful lesion

-symptoms: pain, edema, decr circulation, osteoporosis, skin dryness, decr proprioceptoin, and atrophy of mm in close proximity to involved area.

-Type I: triggered by tissue injury (no nn injury

-Type II: same symptoms but are associated with nn injury

Tx: modalities to decr pain

joint mobilization

desensitization

flexibility

WB or CKC exercises

splinting

Front 3

What is a Colles' fracture?

Back 3

-most common wrist fracture: from FOOSH

-distal fragment of radius is dorsally displaced with a radial shift of the wrist and hand

-tx: casting of wrist

2. early AROM and PROM

3. PRE

4. mobs

5. CKC stabilization exercises

Front 4

What is Degenerative Joint disease?

Back 4

OA/DJD

-non rheumatoid, non systemic

-degeneration of articular cartilage in WB joints

-no morning stiffness. or stiffness improves with exercise

-gradual onset, involving one or a few jts

-progression causes diminished jt motion, flexion contractures, tenderness, crepitus

-normal ESR

-abnormal joint radiographs

TX

-NSAIDS

-functional training and education

-PROM, AAROM, AROM

-Isometric, isotonic, isokinetic, and postural exercises

-ADL training

-sx or jt replacement if necessary

Front 5

What is fibromyalgia?

Back 5

-immune disorder of unknown cause

-diffuse pain, tender points on both sides of body, and stiffness in muscles, aching or burning in mm

-related to anxiey, stress, fatigue, and sleeplessness(women>men)

differential dx

-widespread pain in 11 of 18 tender points

-nonrheumatic sxs and sleep deprivation

-exclusion of other systemic diseases

Tx

Holistic and multidisplanary

-ADL education and training

-stress management

-meds: analgesics and antidepressants

-local modalities and techniques for mm pain relief

-Aerobic/conditioning exercises

-improve sleep patterns

Front 6

What is Gout?

Back 6

-inherited metabolic disease

-elevated level of serum uric acid and deposition of urate crystals in joints, soft tissue and kidneys

-most often effects feet, esp great toe, ankle, and mid-foot

-severe joint pain (esp at night), warmth, erythema, and extreme tenderness/hypersensitivity

-diagnosis via elevated serum urate content and radiological evidence

TX

1. anti-inflammatory meds

2. daily use of colchicine

3 lowering urate concentration with diet, weight loss, and moderation of alcohol intake

4. allopurinol to reduce hyperuricemia

5. rest, elevation, and joint protection during acute phase

Front 7

What is Iliotibial band friction syndrome?

Back 7

-irritation caused by the rubbing of the ITB over the lateral epicondyle of the femur

-often occurs as overuse injury in runners

-differential dx:

1. (+) Ober's

2. Excessive hip IR in stance

3. Palpation over ITB insertion

4. Positive Noble compression test

TX

1. stretching exercise program

2. modalities for pain and inflammation

3. soft tissue mob techniques

4. possibly shoe orthosis

Front 8

What is myositis ossificans?

Back 8

-caused by trauma to a mm resulting in hematoma that may calcify or ossify

-can be induced by early mobilization and stretching with aggressive PT following trauma to a muscle

-frequent locations: quads, brachialis, biceps brachii

-radiological studies will show calcium deposits

TX

1. conservative with gentle AROM and AAROM

2. aggressive passive stretching is not indicated

3. no manual stretching with OP at end-range

Front 9

What is osteochondritis dissecans?

Back 9

-separation of the articular cartilage from the underlying bone (osteochondral fracture)

-usu involves medial femoral condyle near intercondylar notch and observed less frequently at femoral head and talar dome

Tx: if fracture is displaced then sx is indicated

PT following sx:

1. Gait training

2. Functional strengthening

3. Conditioning

Front 10

What is Osteomalacia?

Back 10

Decalcification of bones

-results from vitamin D deficiency

-may cause deformities, fractures, and severe pain

TX:

1. pain control

2. functional mobility training

3. joint/bone protection strategies

Front 11

What is Osteomyelitis?

Back 11

-acute or chronic bone infection

-usu staph A.

-commonly result of combined traumatic injury and an acute infection

-children common sites = distal femur, proximal tibia, humerus, and radius

-in adults: pelvis and vertebrae and usu relates from contamination resulting from trauma or surgery

TX:

1. high doses IV antibiotics

2. immobilization of extremity in cast

3. traction or bed rest

4. sometimes sx to drain infection

5. chronic infection may require amputation

Front 12

What is osteoporosis?

Back 12

-most common metabolic bone disease

-white females most commonly effected

-primary postmenopausal osteoporosis = directly related to decr production of estrogen

-depletes bone mineral density and predisposes to fracture

-common sites of fx:

1. thoracic and lumbar spine

2. femoral neck,

3. proximal humerus,

4. proximal tibia,

5. pelvis,

6. distal radius

TX:

1. pain mgmt

2. postural re-education

3. breathing exercises

4. general conditioning

5. pectoral stretching

6. abdominal strengthening (caution: do not want excessive or repeated flexion which can cause wedge vertebral fractures)

7. WB exercises

emphasize on maintaining extension

Front 13

What is Paget's Disease?

Back 13

aka Osteitis Deformans

-slow progressive metabolic bone disease

-initial phase of excessive bone reabsorption followed by reactive phase of excessive abnormal bone formation

-new bone is fragile and weak and causes painful deformities of the external contour and the internal structures

-affects several skeletal areas: spine, pelvis, femur, and skull

-can be fatal when associated with CHF (widespread disease creates continuous need for high CO), bone sarcoma, or giant cell tumors

-unknown etiology

-involved bone can fracture easily and heal slowly and incompletely

-vertebral collapse or vascular changes can cause paraplegia

TX:

1. if pt is asymptomatic, tx not needed

2. if sx present, pt will require drug therapy

PT tx: implement aerobic capacity/endurance conditioning with low impact (e.g. aquatic program), joint/bone protection strategies

Front 14

What is Patellofemoral dysfunction?

Back 14

-patella fails to track properly in trochlear groove of femur

-instability or pain occurs in first 30 deg of flexion

-Aggrativing factors: stair climbing, prolonged sitting, squatting, or jumping

-Q-angle > 18 deg

(+) Chondromalacia test (Clark's Test): compression of patella with pt attempting quad ctx elicits pain

(+) abnormal tracking of patella during knee flex and ext

TX

1. McConnell's Taping technique (medially glide patella)

2. Strengthening of vastus medialis

3. Stretching of ITB and TFL

4. shoe inserts to decr genu valgum and pes planus

5. On-track Brace to reposition patella

6. Transverse friction massage over lateral retinaculum

7. Patellar mobs: medial patellar glide and stretching deep fibers of lateral retinaculum to decr patellar tilt

Front 15

What are abnormal patella positions?

Back 15

1. Normal = patella articular surface evenly against anterior femur

2. Patella Baja = lower than normal placement of patella

3. Patella Alta: higher than normal & "camel sign" = high patella is one hump and infrapatellar fat pad is 2nd hump

-patella alta = less efficient in exerting forces for knee ext

mob techniques:

inf glide for patella alt

sup glide for patella baja

Front 16

What is progressive systemic sclerosis? (Scleroderma?

Back 16

-chronic disorder

-fibrosus & changes in skin and internal orrgans

-Raynaud's phenomenon

-polyarthralgia

-1st manifestations = heart burn and dyspnea

(+) rheumatoid factor test and other blood test

-affects multiple systems

TX

maintain joint ROM

meds

strengthening exercises

Front 17

What is Pronator Teres syndrome?

Back 17

-Median nn entrapment in the PT mm

(+) pronator teres syndrome test: resist pronation as pt's elbow is extend from 90 deg to full ext = tingling or paresthesia in forearm & hand in median nn distribution

TX

1. Manual nn glides

2. STretching

3. AROM

4. US

5. NMES for nerve healing

Front 18

What is Rheumatoid arthritis symptoms? (differential dx and tx in other flashcard)

Back 18

chronic, systemic inflammatory disease

-onset most often in women with peak in 30-40s

-symmetrical pattern of dysfunction in synovial tissues and articular cartilage of joints of

1. hands

2. wrists

3. elbows

4. shoulders

5. knees

6. ankles

7. feet

8. Cervical spine = may lead to subluxation and SC compression

-extra-articular systems involved = CV, pulm, GI

-other symptoms = eye lesions, infection, and osteoporosis

Front 19

What are the differential diagnosis symptoms of RA?

Back 19

1. rule out other arthritic diseases & (+) blood test for rheumatoid factor

2. sx begin insidiously and progress slowly

3. c/o fatigue, weight loss, and general diffuse MSK pain = initial presentation

4. pain localized to specific jts with bilat/symm presentation

5. joint pain and stiffness with acitivyt that can last 30 min to several hours after rest

6. Finger deformities: ulnar deviation, swan neck or boutonniere deformities

Front 20

What are tx for RA?

Back 20

1. Reduce pain

2. maintain mobility

3. minimize jt stiffness, edema, and destruction

4. prevent deformities with orthoses

5. pt education and adherence to tx program. Energy conservation

6. Acute phases: rest, meds, ambulatory devices and ice

Front 21

What are symptoms, differential dx, and tx of Scaphoid Fracture?

Back 21

-MOI = FOOSH in younger person

- poor vascular supply = high risk AVN of proximal fragment

(+) x-ray to show fx

TX

1. early maintenance of AROM of distal and proximal joints while UE casted

2. later, regain full functional use of hand and wrist

Front 22

What is scoliosis?

Back 22

-unknown etiology = majority of time

-can be causes by structural abnormalities (e.g. LLD or herniated lumbar disc)

-Structural scoliosis = irreversible curvature with a rotational component demonstrated upon forward flexion of the spine

-Non-structural = reversible lateral curve without rotation that straightens as the individual flexes the spine (no bony abnormality)

Differential Dx:

1. radiological studies

2. postural analysis for convexity and concavity of spine

3. forward flexion test: prominence of rib occurs on convex side (ribs on convex side are more posterior)

Tx

1. structural: < 25 = conservative tx

25-45= bracing/spinal orthosis

>45 = surgery

2. nonstructural managed with stretching (concave side), shoe lifts, postural re-education

3. respiratory care if Cobb's angle > or = 40 deg

4. strengthening esp mm on convex side

5. estim

Front 23

What is Sjogren's Syndrome?

Back 23

-rheumatoid-like disorder

-dryness of mucous membranes (mouth and eyes), jt inflammation, and anemia

-artiritis in 33%, distribution like RA but milder and no jt destruction

-more common than SLE but less than RA

Tx

1. sipping fluids t/o day

2. chewing sugarless gum

3. mouthwash for mouth dryness

4. meds for pain and inflammation

5. maintain function and mobility through regular exercise program

Front 24

What is a Smith's Fracture?

Back 24

-distal fracture of radius, which dislocates ventrally

-aka reverse Colles' fracture

-MOI: fall on flexed wrist (Colles' = fall on extended wrist)

TX: same as Colles' (immobilization followed by regaining wrist and hand function)

Front 25

What is a Sprain symptoms? (differential dx and tx in another slide)

Back 25

-injury to ligament or jt capsusles from overstress that damages the fibers partially or completely

-1st degree: some fibers are torn; small amount of hemorrhaging, joint remains stable

-2nd degree: portion of ligament or jt capsule is torn, mod amount hemorrhagins, some functional loss, joint stability intact

-3rd degree: complete rupture or avulsion of the ligament or jt capsule with loss of function and joint instability, severe hemorrhaging and swelling, WB undesirable

Front 26

What is the differential diagnosis of Sprain?

Back 26

1. palpation

2. jt stability tests (ant drawer for knee and ankle)

3. amount of swelling and ecchymosis

4. functional/strength tests

Front 27

What is tx of sprains?

Back 27

-first 48-72 hours for all sprain should be rest, ice, compression, elevation. After that the degree of sprain dictates tx

1st degree =

1. prevent jt hypomobility and disuse atrophy with movements with pain-free AROM

2. modalities for pain, edema, and promote healing

3. gradual return

2nd degree

1. guard agains reinjury with limited WB and bracing

2. pain-free AROM and jt mobs

3. physical agents to reduce pain and edema

4. after 2-3 weeks, jt has usu healed (pain free and normal mob) and strengthening exercise used to reduce reinjury

3rd degree

1. may require sx to avoid jt instability

2. bracing or spinting to immobilize and allow healing

3. proprioception ex and controlled moiton -->gradual return

4. strength and mobility to complete program

5. recovery = 5-6 months following sx repair

6. post-op, CPM utilized (esp for knee)

Front 28

What is Systemic Lupus Erythematosus?

Back 28

-chronic, systemic, rheumatic, inflammatory disorder of connective tissue

-multiple organ involvement: skin, jts, kidneys, heart, blood-forming organs, NS, & serous membranes & may affect membranes lining walls of body cavities and enclosing contained organs

Differential dx

1. malaise

2. fatigue

3. arthralgia

4. fever

5. arthritis

6. skin rahes (butterfly rash over nose and cheeks)

7 photosensitivty

8. anemia

9. hair loss

10. Raynaud's

11. kidney involvement

12 skin manisfestations: vasculitis resulting in lesions in the digits, necrotic leg ulcers, and digital gangrene

TX

1. topical corticosteroid creams for skin lesions

2. pt education for energy conservation, good nutrition and skin care

3. ROM

4. ergonomic and postural training

Front 29

What are 3 diagnostic categories of Temporomandibular joint syndromes?

Back 29

1. joint abnormalities from trauma, arthritis, disease or neoplasm

2. congenital structural defects: may include meniscus, ligaments that control movemtn of disc, condyles, fossa or articular tubercles

3. Loss of functional mobility of unknown etiology: (possible from incr activity of mm of mastication as result of stress and anxiety)

Front 30

What is the differential diagnosis of TMJ syndromes?

Back 30

1. exam jt noise

2. jt locking

3. AROM of jaw

4. lateral deviation of mandible during depression and elevation

5. decr strength

6. tinnitus

7. HA

8. FHP

9. pain with movement

Front 31

What are specific TMJ conditions?

Back 31

1. synovitis and capsulitis

2. TMJ hypermobility

3. Disc displacement and reduction

4. Disc displacement without reduction

Front 32

What are symptoms of TMJ synovitis and capsulitis?

Back 32

1. pain in preauricular area (ant to ear)

2. unable to fully close back teeth

3. opening less than 40 mm secondary to pain

4. pain decr with rest

Front 33

What are symptoms of TMJ hypermobility

Back 33

1. reports "my jaw feels like it goes out of place."

2. reports of jt noises, short-term episodes of jaw "catching" in fully opened position

3. mandibular depression > 40 mm and deviates toward noninvolved side

4. palpable irregularities during closure

Front 34

What is TMJ disc displacement with reduction/

Back 34

1. joint noises with opening and closing equal to pop or click

2. palpation over lat poles reveals opening click (reduction of disc) and a closing click (disc displacing ant to condyles) = "reciprocal click"

Front 35

What is TMJ disc displacement without reduction?

Back 35

1. intermittent locking without joint noises

2. opening of mandible is limited to 20-25 mm with deflection toward involved side

3. limited lateral excursion toward opp side of involved jt

Front 36

What is treatment of TMJ dysfunctions?

Back 36

1. postural re-education

2. modalities for pain

3. inflammation reduction

4. biofeedback

5. jt mobs

6. AROM and strengthening ex

7. patient education for eating soft foods and decr habits that stress TMJ (e.g. biting nails or pencils)

8. instruct pt in maintaining rest position of tongue (upright postural position of tongue on the hard palate)

Front 37

What are the different types of tibial fractures?

Back 37

Tibia is most common long bone to be fractured and to suffer compound injury

1. March fractures

2. Spiral fractures

3. Compound fractures

Front 38

What is a march fracture of the tibia?

Back 38

-fracture of inf 3rd of tibia

-common in people who take long walks who are normally inactive

Front 39

What is a spiral fracture of the tibia?

Back 39

-occurs at junction of the middle and inf 3rd resulting from severe tibial torsion during skiing

Front 40

What is a compound fracture of the the tibia?

Back 40

-MOI: direct blow to tibia (e.g. bumper of car strikes the leg)

Front 41

What is treatment for tibial fractures?

Back 41

1. leg casting

2. possible ORIF

3. poor blood supply so even stable takes 6 mo to heal

4. after healing, early AROM and PROM

5. PRE

6. Mobs

7. CKC stabilization exercises

Front 42

What is torticollis (wry neck)?

Back 42

-occurs when SCM mm continuously contracts

-lateral bending of head to affected side with rotation of chin to opposite side

-develops in utero and considered congenital

-may be acquired by pressure on the spinal accessory nn, inflammation of glands of neck or mm spasm

TX

1. modalities to reduce mm spasm

2. stretching

3. biofeedback

4. postural education and training

Front 43

What are considerations, precautions, and contraindications for Total hip replacements?

Back 43

1. avoid excessive hip flexion and adduction past neutral

2. avoid ER if anterolateral approach and IR if posterolateral approach

3. Avoid low, soft chairs and crossing involved over uninvolved

4. WB orders and precautions determined by surgeon and type of prosthesis. Cemented = isia can proceed more rapidly than cementless

5. sleep with abd pillow and avoid vigorous stretchin

6. increase hip extensor and abductor strength for efficient gait pattern

7. Transfers away from involved place at greater risk of dislocation

Front 44

what are side effects of NSAIDS? What is prescribed when NSAIDs are contraindicated?

Back 44

-GI problems, fluid retention, kidney and liver problems, prolonged bleeding

-acetaminophen (tylenol) used for pain when NSAIDS contraindicated