Diseases affecting the MSK system (1).docx

**Briefly define the following and be aware of the effects on the musculoskeletal system and PT implications with exam/intervention:** **Ankylosing Spondylitis** - **Definition**: chronic rheumatoid disorder. Anterior longitudinal ligament involvement, and ossification of joints in thoracic...

**Briefly define the following and be aware of the effects on the musculoskeletal system and PT implications with exam/intervention:** **Ankylosing Spondylitis** - **Definition**: chronic rheumatoid disorder. Anterior longitudinal ligament involvement, and ossification of joints in thoracic spine - **S/S**: flattening of lumbar lordosis, kyphosis of thoracic spine, hyperextension of cervical spine- result in flexion contractures of hips and knees - Characteristic feature: back pain at night! Back pain and stiffness intermittent- regardless of exertion or rest - **PT implications**: exercise program to maintain functional spinal outcomes. Goal: maintain mobility of the spine and involved joints, prevent spine from stiffening into more kyphosis. Recommend: lie prone for 5 minutes several times a day, avoid side lying **Arthrogryposis** (info from Physiopedia) Arthrogryposis Multiplex Congenita \... - **Definition**: joint contractures in tow or more areas of the body- not a specific diagnosis - **S/S:** decreased/absent movement around small and large joints due to contractures, muscles of affected limbs are underdeveloped with decreased strength and bulk, fragile bones, cleft palate, slender build, usually painless for child - Typical presentation: flexed and dislocated hips, extended knees, clubfeet, internally rotated shoulder, flexed elbows, flexed and ulnar deviated wrists - **PT implications**: goal: maintain and maximize function, improve joint ROM, prevent further atrophy. Treatment: casting, orthotics, stretching contractures, joint manips, trunk strengthening, standing programs **[Bone tumors (Benign and Malignant)]** (info from Physiopedia) Bone tumors (overview) \| Radiology Reference Article \| Radiopaedia.org **Chondrosarcoma**  - **Definition**: malignant bone tumor - **S/S:** pain, maybe fracture, palpable lump or local mass effect - **PT implications**: most often after surgery- want to decrease pain, decrease edema, and improve quality of life. Manual therapy & soft tissue mobilization to improve tissue extensibility, reduce edema, improve ROM, gait training **Ewing sarcoma** - **Definition**: malignant bone tumor (10-20 y/o) - **S/S**: local pain at site, pain worse during exercise, or at night. Swelling, lump, redness, warmth. Common to see fatigue, weight loss, decrease appetite, weakness, numbness, fever - **PT implications**: be cautious when patients symptoms of injury are abnormal/out of proportion. POC should be strengthening of affected limb, aerobic conditioning (avoid weight bearing on tumor). Lots of precautions - Ewing sarcoma \| Radiology Case \| Radiopaedia.org **Giant cell tumor** - **Definition**: benign multi-nucleated cell masses that can turn malignant - **S/S**: pain that increases progressively, increases with activity- decreases with rest, decrease ROM, tender hard mass, muscle atrophy, hot to touch, mass/swollen - **PT implications**: more for overall wellbeing of pt. important for us to detect tumor early. We will manage any impairments, functional limitations, disabilities present secondary to tumor complications. Improve QOL - pain reduction, improve mobility, resorting previous level of function -  **Multiple myeloma** - **Definition**: cancerous plasma cells incurable & bad prognosis - **S/S:** can be asymptomatic or severely ill - **PT implications**: manage and treat related symptoms, improve QOL, prevent further complications. Exercise programs to improve function, decrease muscle wasting, cancer-related fatigue. Short, low intensity exercise programs may be helpful. Fall prevention programs can be life-saving intervention! - Multiple myeloma \| Radiology Reference \... **Osteoid Osteoma** - **Definition**: benign osteoblastic tumor consisting of vascular osteoid tissue - **S/S**: local pain- more frequent and severe at night, increases with activity, local swelling and tenderness - **PT implications**: improve QOL -  - **Definition**: most common benign bone tumor - **S/S:** painless, palpable mass near joint, numbness, tingling, restricted ROM, loss of pulse - **PT implications**: post op- functional mobility will be primary focus= ROM, strength, proper biomechanic - Osteochondroma - femur \| Radiology Case \| Radiopaedia.org **Osteoblastoma**  - **Definition**: rare, benign bone tumor - **S/S**: pain! Tenderness, swelling, bony enlargement, scoliosis, ms spasms, decrease ROM - **PT implications**: post-op= strengthening, ROM, posture, flexibility, proprioception, gait, wound care, education - **Definition**: malignant primary cancer of long bones - **S/S**: pain (main), soft tissue swelling, enlarging bone mass - **PT implications**: manage musculoskeletal, neuromuscular, integumentary, cardiopulmonary rehab needs. Early mobility, strength and endurance restoration, pain control, balance training, educate **Chondromalacia** - **Definition**: affliction of the hyaline cartilage coating of articular surfaces of the bone (most common is the patella) - **S/S**: pain that is exacerbated by common daily activities that load the joint involved. Tenderness on palpation, crepitus, minor swelling - **PT implications**: conservative treatment, ice, taping, strengthen surrounding areas to increase blood supply to the area improving nutrition supply to cartilage **Diabetes** - **Definition**: type 1 (insulin-dependent) and type 2 (diabetes mellitus) - **Type 1**: autoimmune disease that destroys insulin producing beta cells. Need lifelong insulin replacement therapy - **Type 2**: non-insulin dependent, chronic condition that affects how the body metabolizes glucose. Insulin resistance- blood sugar doesn't get transported into cells to be stored for energy and builds in the bloodstream - **S/S:** - Type 1: always tired, hungry, frequent urination, sudden weight loss, numbness, tingling, thirsty, blurry vision, weakness (4 T's: tired, toilet, thin, thirsty) - Type 2: increase thirst, urination, lethargic, weight loss, slow healing wounds, blurry vision - **PT implications**: regular exercise! Education! Feet checks! Check insulin levels! **Down\'s Syndrome** - **Definition**: genetic, chromosomal condition. Extra chromosome 21 typically - **S/S**: growth failure, hypotonia, ligamentous laxity, poor posture control, sensory issues - **PT implications**: improve physical abilities, strength, balance, education for family, sensory integration, conditioning **Fibromyalgia** - **Definition**: poorly understood, characterized by widespread and generalized body aches of at least 3 months duration, which can cause pain or paresthesia's, or both, in a non-radicular pattern. "characterized by [chronic pain](https://www.physio-pedia.com/Chronic_Pain?utm_source=physiopedia&utm_medium=search&utm_campaign=ongoing_internal), stiffness, and tenderness of [muscles](https://www.physio-pedia.com/Muscle), [tendons](https://www.physio-pedia.com/Tendon_Anatomy), and [joints](https://www.physio-pedia.com/Joint_Classification), without detectable [inflammation](https://www.physio-pedia.com/Inflammation_Acute_and_Chronic)." - **S/S**: constitutional symptoms of fatigue, nonrestorative sleep, and presence of a defined number of tender points - **PT implications**: cardiovascular fitness training, spray and stretch, strength and endurance training, massage, modalities. Education, reassurance, activity management (avoid exacerbation), relaxation techniques (minimize stress) **Gout** - **Definition**: most common form of inflammatory arthritis. High blood levels of uric acid, symptoms caused by deposits of sodium urate or calcium pyrophosphate crystals in joints - **S/S**: inflammation, joint swelling, severe pain. Sudden onset during night or early morning. Classic: warmth. Swelling, cutaneous erythema, severe pain of the 1^st^ MTP joint - **PT implications**: usually pharmacologic treatment. **Heterotopic ossification** - **Definition**: formation of mature lamellar bone in nonosseous tissues (soft tissue) - **S/S**: 3-12 weeks after MSK trauma, loss of joint mobility or loss of function. Swelling, erythema, heat, palpable mass. - - **PT implications**: ROM exercises and strengthening will help prevent muscle atrophy and preserve joint motion. Do not be too aggressive or will aggravate the condition. Post op: emphasis on edema control, scar management, infection prevention **Myositis** - **Definition**: immune system destroys healthy muscle tissue instead of building new muscle tissue. Also called idiopathic inflammatory myopathy - **S/S**: subacute weakness, myalgia in UE and LE and extra muscular manifestations - **PT implications**: restore muscle strength, limit inflammation, prevent other organ damage, improve endurance **Myositis ossificans** - **Definition**: occurs after trauma, new bone form between the torn muscle fibers - **S/S**: painful, tender, enlarged mass - **PT implications**: focus on rest from aggravating activities and the implementation of gentle pain free ROM exercise **Osteochondritis dissecans** - **Definition**: idiopathic disease which affects the subchondral bone and its overlying articular cartilage due to loss of blood flow, resulting in separation and instability of a segment of cartilage and free movement of fragments in the joint space - **S/S**: catching sensation with knee flexion, extensor weakness. Nonspecific presentation with vague pain and swelling. Swelling with onset of pain, activity exacerbated. Mechanically: giving way, clicking, locking - **PT implications**: conservative therapy goals" pain reduction, promote repair of cartilage and prevent degeneration of the surface of the knee joint **Osteochondrosis** - **Definition**: a grouping of diseases "injury to the ossification center, resulting in inflammation, degeneration, recalcification, necrosis, fragmentation" most common in kids- can be from stress to the bone, reduce blood supply or trauma - **S/S**: activity related pain - **PT implications**: restriction of activity and exercises (?) **Osteonecrosis (AKA: avascular necrosis)** - **Definition**: death of the bone due to interruption of subchondral blood supply - **S/S**: pain, decrease ROM, asymptomatic limp - **PT implications**: for prevention of further deterioration of joint, cannot sure the disease but can decrease associated pain. 3 main goals: relief of symptoms, prevention of disease progression, improvement of functionality. Maintain joint mobility and strengthen surrounding muscles, avoid excess compressive and shear forces **Osteomalacia** - **Definition**: metabolic bone disease, impairment of bone mineralization (bone softening) - **S/S**: progressive generalized bone pain, muscle weakness, hypocalcemia, fracture - **PT implications**: strengthening of major muscle groups, weight bearing exercises (similar to osteoporosis) **Osteomyelitis** - **Definition**: (bone infection) inflammatory process involving the bone secondary to infection - **S/S**: pain, tenderness, inflammation, redness, warmth, fever, chills, sweating nausea, swelling, fatigue. Most common: constant pain with marked tenderness over involved bone - **PT implications**: prevention, post op: strengthen, ROM, proprioception **Osteoporosis** - **Definition**: insufficient bone formation, excessive bone resorption (low bone mass) - **S/S**: fractures, back pain, compression fracture, decrease activity tolerance - **PT implications**: weight bearing exercises, flexibility and strengthening exercises, postural exercises, balance, education (increase calcium & vit D, avoid heavy lifting, avoid tripping hazards). Contraindicated: manipulations **Paget disease** - **Definition**: accelerated skeletal remodeling, produces a slowly progressive enlargement and deformity of multiple bones - **S/S**: pathologic fractures, progressive skeletal deformities, chronic bone pain, diffuse joint stiffness, MSK deformities, enlarged skull - **PT implications**: educate pt to stay active, and how to manage pain, make home modifications **Polymyositis** - **Definition**: chronic inflammatory myopathy, persistent inflammatory muscle disease (autoimmune) - **S/S:** proximal muscle weakness, difficult swallowing (dysphagia), difficulty speaking, arthralgia, fatigue, SOB - **PT implications**: key: maintain function and reduce fall risk. Pts need to remain active to maintain function, reduce atrophy, ROM, stretching, relaxation, pt education **Psoriatic arthritis** - **Definition**: inflammatory form of arthritis associated with psoriasis. Can manifest as distal joint disease, asymmetric symptoms - **S/S**: pain, stiffness, swelling. DIP dominant, spondylitis, arthritis mutilans, skin lesions, - **PT implications**: improving quality of life, focus on education, improvement of ROM, strength, and general CV training, and modalities for pain **Reiters Syndrome (reactive arthritis)** - **Definition**: autoimmune response to an infection from a GI infection caused by salmonella, shigella, campylobacter or chlamydia - **S/S**: urethritis, conjunctivitis, arthritis (classic triad). Back pain, enthesitis, skin lesions - **PT implications**: symptom relief and prevent chronic complications. pt education to improve conditioning, function and QOL **Rhabdomyolysis** - **Definition**: muscle injury and breakdown causing an increase in CK in the blood and dark urine - **S/S**: dark urine, local edema, cramps, hypotension, malaise, fever, tachycardia, nausea - **PT implications**: do not overexert the pt. ROM, aerobic training and gradual resistance training **Rheumatoid arthritis** - **Definition**: chronic, progressive, systemic, inflammatory disease of connective tissue characterized by fare ups. autoimmune - **S/S:** fatigue, anorexia, low grade fever, mild weight loss. Hand and finger deformities, palpable subcutaneous nodules - **PT implications**: rest and energy conservation. Pacing activities, positioning, strengthening and pain relief modalities- ice for hot, inflamed joints, heat for painful noninflamed joints **Sarcoidosis** - **Definition**: growth of collections of inflammatory cells in different parts of the body - **S/S**: depends on body part affected - **PT implications**: breathing exercises, strengthen training and endurance exercises **Sarcopenia** - **Definition**: not a disease, refers to the universal, involuntary decline in lean body mass that occurs with age- loss of skeletal muscle volume - **S/S**: decrease in muscle mass - **PT implications**: exercise program is the cornerstone in treatment! Resistance & strength train! **Schwannoma** - **Definition**: rare (usually benign) tumor that forms in the nervous system (Schwann cells) - **S/S**: intermittent or consistent pain in the area when tumor is located. Numbness and tingling sensations around the affected nerve - **PT implications**: depends on what nerve is affected. Improve QOL **Septic arthritis (also called bacterial or infectious arthritis)** - **Definition**: inflammation/infection of synovial membrane or joint - **S/S:** acute, rapid onset of pain, unable to move joint through ROM, unable to wear weight, effusion, warmth, rash, fever - **PT implications**: more so recognizing S/S for referral. PROM, functional training, **Spina bifida occulta** - **Definition**: neural tube defect that results when the inferior neuropore doesn't close. Occulta: benign closed posterior vertebral defect without a meningeal sac - **S/S**: usually asymptomatic but has depression or dimple in low back, small patch of hair, soft fatty deposit - **PT implications**: no treatment needed in occulta **Tuberculosis** - **Definition**: extremely contagious airborne pathogen pulmonary disease ("inflammatory, infectious disease that is spread by bacteria called **mycobacterium tuberculosis")** - **S/S:** productive cough, weight loss, fever, night sweats, fatigue, malaise, rales, dull chest pain - **PT implications**: have to wear PPE! Percussion, postural drainage, breathing exercises