Physical Medicine Hard

Physical Medicine and Rehabilitation

• ICF: International Classification of Functioning, impairment: deviation/loss of body structure or function.

Therapeutic Exercises

• Vasodilation: in exercising muscles.
• Vasoconstriction: in non-exercising areas.
• Vascular resistance: in muscles to meet demand.
• BP increase: in isometric exercises.
• Cardiovascular effects: increase in isotonic/isometric exercises.
• Hormones and androgens: stabilize after prolonged exercise.
• Endurance exercises: ↑TG, ↓HDL, ↑HDL in endurance exercises, type 1 fibers.
• Strength exercises: high resistance, low repetition, both type 1 & 2 fibers, increased ventricular cavity wall thickness.

Contraindications to ROM Exercises

• Tears, unhealed fractures, surgery.
• Deep vein thrombosis.
• Active heterotopic ossification.
• Cardiovascular instability.
• Myocardial infarction.

Stretching Exercises

• Pathology: (if fibrous or osseous contracture) slight force causes some collagen fiber elongation.
• Prolonged stretching: CT undergoes plastic deformation, and cannot return to original size without force.

Complications of Stretching

• Tissue damage: painful conditions lasting more than 1 hour.
• Subluxation: misalignment, partial dislocation resulting from inappropriate stretching/pressure overload.

Muscle Strength Exercises

• Isometric: resistance, static, muscle contraction without movement.
• Isotonic: same tonus, muscle lengthens and shortens within ROM, dumbbells.
• Isokinetic: dynamic speed of muscle contraction, controlled by mechanical device, constant velocity.
• Eccentric contractions: muscle tightening when lengthening.

Physical Activity

• Duration, intensity, frequency: continuous movement using large muscle groups.
• Aerobic activity: causes heart, lung, and vascular system to work harder, walking, swimming, soccer etc.
• Strength training: Muscles work against resistance, free weights(dumbbells), body weight (push-ups).
• Flexibility training: Ability to move a joint through its range of motion, yoga, pilates, etc.

Inflammatory Conditions

• Pain pattern: maximal pain on morning, waking up at night due to pain, morning stiffness for over 1 hour.
• Inflammatory arthritis: group of diseases caused by overactive immune system (joint pain and stiffness), joint may feel warm, swollen, tender.
• Rheumatoid arthritis: most common inflammatory arthritis, multiple small joints of hand and feet, symmetrical, inflamed synovium (warmth, pain, stiffness), RF, anti-CCP, antibodies.
• Psoriatic arthritis: Spondylarthropathy - combination of psoriasis, pain, swelling large/small joints, sometimes spine, can cause complete swelling of fingers/toes.
• Juvenile idiopathic arthritis: inflammation in joints, sometimes spine and ligaments, last >6 weeks, Swelling or mobility problems, limping if leg affected, some types of eye inflammation without symptoms.
• Ankylosing spondylitis: primarily affects spine, hip, sternum, large joints. Over time motion reduction in spine, HLA-B27 gene presence.
• Gout: elevated uric acid crystals, risk of kidney stones (big toe).
• Pseudogout: calcium pyrophosphate dehydrate, affects wrist/knee.
• Sjogren's syndrome & Lupus: can cause inflammatory arthritis.

Treatment

• NSAIDs: Ibuprofen, corticosteroids, disease-modifying antirheumatic drugs (DMARDs), methotrexate, biological DMARDs.

Osteoarthritis

• Degenerative: disease of synovial joints, breakdown of articular cartilage, proliferation of changes.
• Pathology: fibrillation, eburnation (polished surface due to cartilage loss), osteophytes.
• Subchondral cysts: primary (idiopathic) osteoarthritis.
• Secondary osteoarthritis: due to some other diseases.
• Risk factors: age, female, obesity, genetic predisposition (e.g., COL2A1 gene), trauma.

Osteoporosis

• Loss of bone density: reduced bone structure.
• Primary osteoporosis: Type 1 (postmenopausal due to estrogen), Type 2 (senile).
• Secondary osteoporosis: caused by meds like steroids, methotrexate, anti-cancer drugs, or immobilization.
• Diagnostic tests: blood tests (vitamin D, serum calcium, phosphorus, parathyroid hormone), DEXA (bone mineral density), and X-ray
• Treatment: drugs to stop bone breakdown (bisphosphonates-first choice), Teriparatide (PTH analog), denosumab (RANKL inhibitor). No alcohol, caffeine, or smoking.

Osteomalacia

• Vitamin D abnormality: reduced bone resorption.
• Diagnostic Tests: DEXA, blood tests, calcium, vitamin D.
• Treatment: vitamin D and calcium replacement.
• Paget's Disease: osteitis deformans (bone remodeling disorder), often asymptomatic but can cause pain, tenderness, nerve entrapment, and cortical thickening.

Electrotherapy

• Electrical stimulation: for muscle strengthening, pain relief, functional improvement.
• TENS: Transcutaneous electrical nerve stimulation
• Pain control: modulation of pain, uses gate control theory
• Contraindications: cardiac pacemaker, unstable angina, carotid sinus applications, thrombosis.

Neuronal Plasticity

• Brain and nervous system's ability to modify and reorganize their activities: Enables reconstruction and gain function of damaged nerve cells.
• Short term: Within seconds/minutes, changes in synaptic communication and excitability.
• Medium term: Hours/days, reshaping and strengthening synaptic connections.
• Long term: Weeks/months, changes in gene expression and neurological alterations.

Orthotics and Prosthetics

• Orthotics: External devices that support, align, and protect parts of the body.
• Prosthetics: Artificial devices that initiate and perform functions of amputated limbs/organs.

Other Conditions

• Sprain: soft tissue injury caused by stretching or tearing ligaments around joint.
• Strain: stretch or tear in muscle or tendon fibers.
• Tendinitis: inflammation of tendon
• Synovitis: inflammation of synovial membrane in joint capsule
• RICE method: Rest, Ice, Compression, Elevation for acute soft tissue injuries
• Immobilization: acute phase pain relief.
• Synarthrotic joints: Fixed joints (skull, pelvic bones).
• Amphiarthrotic joints: Partially moveable joints (vertebrae, ribs, sternum).
• Diarthrotic joints: Freely moveable joints (e.g., hyoid bone, eyeball).
• Muscular dystrophy: genetic diseases causing muscle weakness, myopathy.

This quiz covers key concepts in Physical Medicine and Rehabilitation, including the International Classification of Functioning (ICF), therapeutic exercises, and contraindications to range of motion exercises. It will test your knowledge on vasodilation, cardiovascular effects, and different types of exercises. Prepare to enhance your understanding of rehabilitation techniques and their implications.