Exam 2: Medical Conditions PDF

EXAM 2: MEDICAL CONDITIONS ORTHOPEDICS Orthopedic cause SXS TX clinical issues: Rickets Lacking calcium/vitamin D resulting in Soft bones Cal...

EXAM 2: MEDICAL CONDITIONS ORTHOPEDICS Orthopedic cause SXS TX clinical issues: Rickets Lacking calcium/vitamin D resulting in Soft bones Calcium diet to correct deformities childhood Deformities of skull, legs, Genu vaglum vs genu varum rib cage, pelvis & teeth Windswept deformity Muscle cramps Scoliosis Stunted growth Sucken chest Osteomalacia Lacking calcium/vitamin D resulting in Soft bones Increase vitamin D in diet adulthood Prone to fractures Increase sun exposure Bone pain in LEs Calcium Muscle weakness Pagets disease Unknown (may be viral) Excessive bone formation Calcitonin & biphosphonates & breakdown Located in spine, femur or Increase bone density and bone mass skull Very high ratio of spongy to compact bone Osteopenia Unknown, genetics, malnourishment, Reversible weakening of bone Calcium- enriched diet and associated conditions supplements Weight bearing activities Bone density screens Osteoporosis Progressive osteopenia Early - none the silent killer None No longer reversible Later- pain, kyphosis, height loss, skeletal fx Risks factors: women, history of falls, quadriceps weakness, posture Heterotropic Unknown Pain Iontophoresis (weak electrical ossification Abnormal bone formation in Warmth at joint current to pass a therapeutic agent soft tissues Edema thru the skin) acetic acid w/ area Redness ROM electropad over v. Induration (changes to Pain management tissue beneath surface) Decreased ROM Spina bifida Birth defect due to incomplete closure Varies based on type of bone/ membrane around spinal Leg weakness/ paralysis cord Orthopedic issues bowel / bladder issues Neurological issues All with MMGC TYPES: Occulta (least severe) Meningcele (most severe)  Myeloma (most severe) Common upper cause SXS TX extremity fractures Humeral Osteoporosis Humeral displacement + location Closed reduction (manual) fractures Aging ○ Distal end = Open reduction internal fixation Injury supracondylar fx(elbow) (ORIF) Loss of wrist extension and Sling dorsum hand sensation in ⅕ cases Immobilization and mobilization (20%) of radial N being damaged. schedule varies Distal radius Falling on outstretched hand Loss of sensation, strength, and Open reduction (manual) fractures ROM Open reduction internal fixation Classified based on: articular Splint or cast and/or ulnar involvement, soft Immobilization and mobilization tissue involvement, displacement schedule varies (case specific ) Scaphoid Wrist hyperextension Pain and tenderness that non -displaced: fractures >90’ + radial deviation intensifies when trying to pinch or ○ Non surgical, requires Common in sport grasp objects thumb spike splint (8-10 injuries Avascular necrosis - death to bone wks) could have an tissue due to lack of blood supply additional 6-8 wks if more distal Displaced: ○ surgical , requires splint 2-4 weeks Other Orthopedics Chronic Neck pain Cause SXS TX is caused by: Cervical Wear and tear on cervical spine Herniated disc (leaks degenerative Disc Disc are less hydrated → out) decreased cushioning and shock Pinched nerve Disease absorption ** someone w/ this will Facet joint changes & feel better in the morning due to arthritis having more fluid. Cervical herinated Nucleus pulposus leaks out through a tear in None, pain & numbness in arm Non surgical - NSAIDS, rest, Disc disc outer layer modalities, exercise, OT/PT Surgical- repair the disc and Better when they are up and moving around nucleus pulposus from leaking out Cervical Aging leads to increased stiffness in discs Pain, stiffness, decreased ROM, non - surgical: rest breaks, activity Osteoarthritis and abnormal growths form on bones of headache, crepitus (moving a jt modification neck and hearing it pop or crack) Spinal stenosis Narrowing of spinal cord→ compression of Pain & numbness non - surgical - OT/PT, spinal cord Possible myelopathy NSAIDS → weakness and Surgical- cervical decreased coordination depression in arms or legs Risks of surgery: paraysis Impaired bowel and bladder function Why in the neck? Cervical region - super mobile Foraminal stenosis Narrowing of cervical disc space at one Intermittent localized pain, Non- surgical: NOT helpful, nerve root on ONE side - nerve root getting weakness, numbness modify modification pinched Surgical: traction, decompression surgery Back pain caused cause SXS TX by: Whiplash Sudden jerking forward and back of head Neck pain, decreased Non-surgical - NSAIDS, OT/PT results in trauma to muscles and ligaments in mobility, spasms, vision neck changes, nausea, migraine headaches Thoracic or Nucleus pulposus leaks out through a tear in None, pain & numbness in Non surgical; rest, NSAIDS, lumbar herniated disc’s outer layer buttocks, legs or feet modalities, massage, exercise, steroids, OT/PT disc Surgical: go in and repair the tears. Compression Structural collapse of vertebrae Pain Non surgical - rest, heat fracture Widow’s hump (big kyphosis - bc Surgical - if vertebrae has all these of everyday life compression fractures occupations) Upper extremity Orthopedic issues Common Cause SXS TX Types Complicatio shoulder ns or most problems: common/ other: Bursitis Excessive use Inflammation of Activity Bursa: a cushion b/w bones + subacromial bursa, modifications soft tissues reduces friction painful, swollen Associated w/ rotator cuff tendonitis Tendonitis Overuse Pain, inflammation Acute: happens due to an Common incident (e.g I.E played 4 basball culprits: rotator Associated w: games back to back) cuff and biceps bursitis tendon Chronic: wear and tear from aging, degenerative issue like arthritis Tendon tearing Sudden injury ***, Sharp pain, audible Non-surgical: partial - part of tendon is still in Most common: degenrative changes, pop, weakness, tendon could heal tact bicep, rotator long term use bruising, cramping on its own, cuffs NSAIDS, ice, rest, Complete- tendon is pulled therapy away from bony attachment Surgical: pain doesnt resolve ; restrictions: follow what surgeons recommend Impingement Acromion puts Pain, decreased Soft tissue complication: if pressure on ROM management, not treated: underlying soft ROM, joint bursitis, tissues when mobilizations tendonitis can shoulder is flexed or occur abducted *** supinate forearm to get acromion out of way Instability Sudden injury or Pain, frequent Non surgical: Partial- subluxation (shoulder Risks: repetitive use dislocations, feelings modify activities comes partially out) development of of shoulder giving anti- inflammatory arthritis in joint out or just hanging meds, therapy Complete- dislocation (ligment prone to sublux there. or tendon tear) or dislocation Surgical: repair - sling, immobilize, and rehab Thoracic outlet trauma , repetitive Pain in the non - surgical: rest, Risks: syndrome use, pregnancy, shoulders and neck, activity modification development of anatomical numbness & tingling, arthritis in joint differences, poor and coldness in the Surgical: cutting out prone to sublux posture fingers, weakened part of the rib to or dislocation grip, thumb atrophy open up space shoulder/ chest musculature weakened→ clavicle slips down compressing blood vessels and nerves  in SUPERIOR THORACIC OUTLET Fracture of Floor level falls, Pain, swelling and Non-surgical: Risks: if dont shoulder sports injury, MVA brusing at shoulder, immobilized, ice, rehab deformity, grinding NSAIDs appropriately—> sensation ROM and Surgical: plates, strength can be screws, internal affected fixation Elbow Cause SXS TX AKA Risks Triggers disorders Medial Inflammation of Usually NSAIDs, rest, ice, Golfer’s Playing throwing Shaking hands, turning door epicondyli medial tendon of dominant hand, ROM, taping, elbow sports, playing knobs, picking up objects w palm elbow due to radiating pain OT/PT instrument, painting down tis repetitive use of from medial wrist and forearm elbow down forearm, weakness, pain, stiffness Lateral Inflammation of Usually NSAIDS, rest, ice, Tennis plumbers , Shaking hands, turn wrench, epicondyli lateral tendon of dominant hand, ROM, brace, elbow carpenters, holding a racket/ garden hose elbow due to pain or burning steroid injections, painters, tis repetitive use of on lateral side of OT/PT mechanics, chefs, wrist and forearm elbow, weak grip butchers strength Complete Repetitive use, fall Pain at medial Non-surgical- Types: UCL on outstretched arm elbow, “pop” NSAIDS, ice, partial or after throwing, therapy complete rupture point tenderness, Surgical: tommy swelling, john surgery inability to (taken tendon from throw/ perform another park of activity, body) numbness in ring/pinky fingers Posterior Formation of bone Pain in elbow w/ Surgery to remove Manual labor jobs, olecranon spurs on posterior no mechanism bone spurs and athletes olecranon of injury, debridement of osteophyt decreased osteophytes e ROM, catching or locking of PT/OT elbow joint w/ movement Elbow Fall on outstretched Partial- pain w non - surgical: Types: dislocatio arm ROM, “shifting”, relocation and n (Not common) tingling/ possible partial - numbness immobilization relocates  on its own (not Complete- Surgical: repair deformity, ligaments, external common) extreme pain, hinge Complete: NO ROM does not replicate on its own Radial Fall on outstretched Pain on lateral Type I: non head arm or in elbow, swelling, -surgical (rest conjunction w elbow decreased +sling for days) fracture fx ROM, decreased Type II: surgery to supination & remove bone pronation fragments + sling for weeks Type III: Surgery to remove bone & repair ligaments + OT/PT Olecranon Direct injury, Painful elbow, non - surgical: Jobs or activities bursitis prolonged pressure, edema, infection that require infection, other redness, warm antibiotics, NSAID, prolonged prop on medical problems skin elbow pods elbows (gout, RA) Surgical: take the bursa out, splint (safety net) Elbow Breakdown of Pain, decreased Non- surgical: arthritis cartilage on ROM, locking/ NSAIDS, OT/PT, articulating surfaces grating corticosteroids of bones sensation, edema Surgical: arthroscopy or joint replacement Ulnar Subluxed nerve, Pain, numbness Non-surgical: nerve prolonged pressure, in elbow, hand modify activities swelling, direct or wrist, (wear a brace), entrapme injury weakened grip, nerve glide, nt atrophy or hand NSAIDS musculature, reduced FM coordination Surgical: cubital tunnel release, transportation ulnar nerve, medial epicondylectomy Radiocarpal joint Cause SXS Assess TX RISKS disorders Carpal tunnel Increased pressure or Numbness, (+) tinel sign Non-surgical: Repetitive hand use, hand/wrist syndrome entrapment of the tingling, and pain (taping) NSAIDS, positioning, pregnancy, genes median nerve at wrist in fingers, hand bracing/ ↓ and arm splinting, steroids, activity Gradual onset, modifications, often complains at nerve glides night Surgical: carpal tunnel surgery, & cut the ligament to create more space Dequervains Overuse of wrist causes Pain and swelling (+) finkelstein Non-surgical: Child rearing, pregnancy, Tenosynovitis irritation of sheath at base of thumb, test ( place NSAIDS,. splint carpenter, mechanic around APL and EPB decreased thumb thumb in a close full time, tendons of your thumb, movement, fist and tilt down steroids, activity - or scar tissue trouble grasping ) pain felt is a modifications, objects positive indicator ice/heat Surgical: cut sheath around tendon, then OT/PT Ganglion cysts Unknown Small lump, (+) tinel sign Non-surgical: painless, typically noncancerous resolves on its lump often by own tendons/ joints in wrist or hand Surgical: may need to be drained or removed MCP joint joints cause SXS TX disorders: Swan-neck MCP jt Rheumatoid arthritis Mallet finger Non-surgical: splinting, HEP, deformity ○ Flexed at DIP, ROM, OT/PT, NSAIDS PIP jt limited ○ Extended mobility, Surgical: soft tissue surgery or DIP jt pain finger joint fushion ○ Flexed Boutonniere MCP jt Forceful blow to PIP can’t be Non-surgical: splinting, HEP Deformity ○ Extended dorsum of bent PIP or straightene (home exercise programs)  PIP jt slicing of central d, DIP ○ Flexed tendon, arthritis cannot be Surgical: tendons are severed Distal jt bent, and need repair ○ Extended swelling & pain at PIP Depuytren Risks: diabetes, Unknown, but Lumps, Non-surgical: splinting, steroids contracture alcoholism, epilepsy something triggers nodules, the fascia of the palm and cords→ Surgical: fasciotomy (take out to thicken and it contracture some) or subtotal palmer eventually tightens s that pull fasciectomy (take all out) fingers inward, toward the palm Arthritic Diseases Rheumatoid Rheumatoid arthritis Juvenile Osteoarthr Fibromyalgia Gout diseases: Idiopathic itis arthritis Cause Untreated synovitis and genetics + unknown Crystallization + build tenosynovitis + infection= environment up of uric acid in the inflammatory response → al, aging, joint → elevated uric immune reaction chondropeni acid (hyperuricemia) a SXS swelling + warmth around Joint tissue, Localized Widespread Rapid onset, joint jts, redness, prevalence swollen, pain, CHRONIC specifc pain, warmth, of pannus (substance that rash, palpable severe pain, swelling, reddish causes tissue cirrhosis, edema, tender points, discoloration, breakdown), BILATERAL inflammation point NO tenderness, “attacks” involvement, malaise, , tendernes, inflammation, that last hours to days, fever, weight loss, contractures stiffness, headaches, intermittent, trophi symmetrical or (knee) inflammatio malaise, poor (fancy word for uric asymmetrical, joint n of bones + sleep, abdominal acid build up) guarding, decreased joints, cramps, mood ROM, abnormal gait ASYMMETI disorder  RCAL involvement, Common joints affect: weight MCP and proximal IP jts bearing joints + hands most affected, crepitus during ROM Categories Before 16 yrs OR 25-50 yrs old Prevalence 1% worldwide, no gender/ 1:2 - 1:3 M:F 10-15% of 1-5 % worldwide, 1-4 % worldwide; 8.3 race bias worldwide women> men million in US More US is 3:1 common in caucasian women Skeletal features 1. Subchondral cysts of RA 2. Erosions of sinuses in joints 3. Presence of osteophytes 4. Severe periarticular bone fragmentation 5. Ulnar deviation of MCP jts 6. Traces in cartilage supporting bone tissues of MA jt 7. Osseous anklyosis 8. BILATERAL jt movement Types Single jt Oligoarticular Primary: Unilateral or Most common- the big ○ Rare : involves general bilateral toe hallux - great toe bilateral one side of ware tare, elbow body, most lifestyle, Polyarticular common, 4 getting older ○ Most or less big common, jts, girls multiple more secondary : surface affected external fatigue + ware, overall Polyarticular: trauma, gout weakness Involves both  Remit (flare ups) sides of vs progressive body, 5 or (baseline) more small Seropositive joints, girls (worse prognosis) more vs seronegative affected (less progressive diseases) Psoriatic: Red,flaky patchy rash and pain/swelling , involves multiple joints, girls more affected Assess Physical examiation, use Patient Patient history, Medical history, of diagnostic criteria, history, physical physical exam, blood Blood work, synovial fluid MRI/x-ray, examination, work, MRI/ x-ray/ CT testing, MRI/x-ray, tissue leg length WPI biopsy discrepancy, anatomical WPI- frequency bony + location of abnormalitie pain/point s tenderness Symptom severity scale - level of fatigue + cognitive drain onset/ age 25-50 yrs old Gradually, widespread , 30-50 yrs old series over unilateral → risk as. you age years spread to be bilateral As you age increase your risk Prognosis Gradual onset, 20% Better “Silent” or Unclear remission, but most have prognosis traumatic, chronic, it varies overall, but joint location increased likelihood of depression in childhood Remission 2 consecutive months with 5+ requirements Complications Contractures, subluxation, ankylosis, dislocation, adhesions Comorbities Depression (dont tell Depression, OA, RA, Insulin resistance anyone) (get told nothing GI issues depression syndrome, is wrong) Get told hypertension, renal nothing is damage, depression wrong Treatments DMARDS NSAIDS, NSAIDS, Diet low in purines, ○ Disease CINODs, opioids, NSAIDS, xanthine modifying joint antidepressants oxidase inhibitors anti- replacement (XOI), comprehensive rheumatic surgeries planning drugs ○ Ex: methotrex ate Biologic agents ○ Help suppress immune system, prevent joint damage and decrease joint inflammati on ○ Ex: TMF, humira Steroids ○ Buffer between drugs Surgery ○ Less invasive vs more invasive Goals of Reduce pain + treatment joint stiffness Reduce edema Preserve normal joint function + musculature  Minimize medication interactions Promote normal growth + development Maintain ADL independence Qualifications Five or more of the for remissions following must be fulfilled for at least 2 consecutive months: 1. Duration of morning stiffness 2. No fatigue 3. No joint pain 4. No joint tenderness or pain in motion 5. No soft tissue swelling in joints 6. Erthrocyte sedimentation rate 3 weeks thickness burn dermis (capillary blanch, bloody to touch → electricity, + retinaculum) blisters, moist nerve chemicals (stays red) endings full - thickness 3rd Epidermis + Charred black, Insensate, Heat, friction, Requires skin graft, burn entire dermis + bright red, tan but can feel electricity months to years subcutaneous or pearly white, deep chemicals tissue fragile blisters, pressure, dry, leathery high risk of contractures deep full - 4th All skin layers + Charred or Insensate, Heat, friction, Requires skin graft, thickness burn tendon, muscle mummified, but can feel electricity, months to years or bone eschar deep chemicals pressure,  difficult to heal, possible loss of function, may require amputation L & Orthopedics apart spasm twitch mic tic involuntary.face purposeles ↑ muscles - rhy of in usually temer & p - Lvelocity dependent · involuntary contraction of single muscle. abnormal ex : Cp , Spinal cord injury contractions cramp painful / I Fascuilation abril ation involuntary twitch spasmodic involuntary of single motor unit contraction twitch of that is NOT visible multiple motor Beneath skin. units That are visible beneath - skin. ex : ALS other or tho sports /insure sleeping poorposture in weird position - Acute Neck pain j & causes repetitive movements I Prolonged - whiplash isometric contraction during activity. whiplash Osteo arthritis inflammation disc ↓ herniated & 3 I ack causes - pain compression tracture work-related / & scoliosis injuries stenosis cause: over stretching of ligaments + muscles in back. common accidents : improper lifting carrying pulling or pushing , , twisting · unexpected exertion · slips falls Shoulder impingement Syndrome Thoracic Outlet syndrome · or , common injuries herniated discs : , muscle strains or sprains Tension Neck , - Syndrome , Rotator Cuff Tendinitis ,  modified most , hinge synovial 3+ (3) largest. jtin FemorapatellarIt complex · lateral body · · medial Tibiofemoral It I / kneeasics / - Thin It capsule I Joint Capsule 12 bursae reinforced by tendons mich amentum patella d li9 ↑ ↑ popliteal oblique & prevent - hyperextension extracapsular a - pCh prevent anterior - displacement posterior intracapsular anterior Draw Sign- > see if tibia can more forwardfemurisfixed. ACL is damaged. posterior Draw Sign - see femur is fixed if tibich PCL is can move backward or posterior while. damage.