Pathology

Question 1

Achilles Tendonitis-Overview

Answer 1

• repetitive overs druse disorder

- most often impacted in an avascular zone 2-6cm above tendon insertion

Question 2

Achilles Tendonitis-at risk individuals

Answer 2

• limited flexibility/strength in Gastroc/soleus complex

- pronated or caves foot

Question 3

Achilles Tendonitis-sx and symptoms

Answer 3

• aching or burning or posterior heel
• swelling and thickening in tendon area
• morning stiffness

Question 4

Achilles Tendonitis-tx

Answer 4

• initial RICE
• NSAIDs
• analgesics

Question 5

Adhesive Capsulitis-overview

Answer 5

• loss of ROM in active/passive shoulder motion 2* soft tissue contracture
• caused by adhesive fibrosis and scarring between the capsule, rotator cuff, subacromial bursa and deltoid

Question 6

Adhesive Capsulitis-symptoms

Answer 6

• night pain
• capsular pattern restricted motion
• insidious onset

Question 7

ACL Sprain- overview

Answer 7

• ligament prevents anterior translation of the tibia in relation to the femur
• etiology: non-contact twisting injury with s or valgus stress

Question 8

ACL Sprain-signs and symptoms

Answer 8

-report loud pop or knee “giving way” or buckling followed by dizziness, sweating and swelling

Question 9

ACL Sprain- tx

Answer 9

• RICE
• NSAIDs
• conservative tx
• surgery (for a complete grade III tear)

Question 10

Congenital Hip Dysplasia-overview

Answer 10

-malalignment of the femoral head within the acetabulum (develops in the last trimester in utero)

Question 11

Congenital Hip Dysplasia-presentation

Answer 11

-asymmetrical hip abduction with tightness and apparent femoral shortening of the involved side

Question 12

Congenital Hip Dysplasia-tx

Answer 12

• 1st: harness, splinting, bracing, traction

- open reduction with subsequent application of a hip spica cast (if conservative tx fails)

Question 13

Congenital Limb Deficiencies-etiology

Answer 13

• idiopathic or genetic in origin

- could also be due to poor blood supply, constricting amniotic bands, infection, maternal drug exposure

Question 14

Congenital Limb Deficiencies- symptoms

Answer 14

• structural or acquired abnormality of limb

- phantom limb pain

Question 15

Congenital Limb Deficiencies- tx

Answer 15

-focus on symmetrical movements, strengthening, ROM, WBing activities, prosthetic training when appropriate

Question 16

Congenital Torticollis-etiology

Answer 16

Unknown, malpositioning in utero, birth trauma

Question 17

Congenital Torticollis-clinical presentation

Answer 17

• lateral cervical flexion to SAME side as contracture
• rotation toward the OPPOSITE side
• facial asymmetries

Question 18

Congenital Torticollis-tx

Answer 18

• conservative: stretching, AROM, positioning, education

- surgery if kid >1 yo, when conservative tx failed

Question 19

Glenohumeral Instability-etiology

Answer 19

-combination of forces causing humeral to move anteriorly (anterior dislocation is most common and associated with abduction/ER)

Question 20

Glenohumeral Instability-signs and symptoms

Answer 20

• subluxation:popping in/out, pain, numbness/tingling, positive apprehension test
• dislocation: severe pain, paresthesias, decrease ROM, weakness

Question 21

Glenohumeral Instability-tx

Answer 21

• initially immobilization with sling 3-6 weeks
• RICE, NSAIDs
• progress to ROM, isometric strengthening, progressive resisted exercises (emphasis on IR/ER)

Question 22

Impingement Syndrome-etiology

Answer 22

caused by the humeral head and rotator cuff attachments migrate proximally and become impinged under acromion and the coracoacromial ligament

Question 23

Impingement Syndrome- signs and symptoms

Answer 23

• deep pain
• painful arc (70-120*) abduction
• (+) impingement sign
• tenderness over greater tuberosity and bicipital groove

Question 24

Impingement Syndrome- tx

Answer 24

• initially: RICE, NSAIDs
• RTC strengthening, scap stab
• continue prevention and alter activities

Question 25

Juvenile Rheumatoid Arthritis-etiology

Answer 25

- unknown | - theories include-> virus, infection, or trauma may trigger an autoimmune response

Question 26

Juvenile Rheumatoid Arthritis- signs/symptoms (systemic JRA)

Answer 26

- 10-20% cases | - acute onset, high fevers, rash, enlargement of the spleen and liver, inflammation of the lungs and heart

Question 27

Juvenile Rheumatoid Arthritis- signs/symptoms (polyarticular JRA)

Answer 27

- 30-40% of cases - high female incidence - significant RF and arthritis in >4 joints symmetrically

Question 28

Juvenile Rheumatoid Arthritis- signs/symptoms (oligoarticular JRA)

Answer 28

- 40-60% of cases | - affects <5 joints asymmetrically

Question 29

Juvenile Rheumatoid Arthritis- tx

Answer 29

- meds to manage pain/inflammation | - PT: A/PROM, positioning, splinting, strengthening, endurance, WBing activities, postural training, functional mobility

Question 30

Lateral Epicondylitis-etiology

Answer 30

-eccentri loading of wrist extensors (usually extensor capri radialis brevis) resulting in microtraumas

Question 31

Lateral Epicondylitis-signs/symptoms

Answer 31

- pain immediately anterior or distal to the lateral epicondyle of the humerus - pain worsens with repetition and resisted wrist extension

Question 32

Lateral Epicondylitis-tx

Answer 32

- initially RICE, NSAIDs, activity modifications | - PT: improve strength, flexibility, endurance of wrist extensors

Question 33

Legg-Calve-Perthes Disease-etiology

Answer 33

-trauma, genetic predisposition, synovitis, vascular abnormalities, infection

Question 34

Legg-Calve-Perthes Disease- overview

Answer 34

- characterized by degeneration of the femoral head due to a disturbance in the blood supply (avascular necrosis) - pain, decreased ROM, antalgic gait, Trendelenburg gait

Question 35

Legg-Calve-Perthes Disease-sign/symptoms

Answer 35

-pain, decreased ROM, antalgic gait, Trendelenburg gait

Question 36

Legg-Calve-Perthes Disease-tx

Answer 36

- vary, main focus is on pain | - orthotics or surgery may be indicated based on severity

Question 37

Medial Collateral Ligament Sprain-complete

Answer 37

- etiology: fixed foot associated with valgus force - knee pain, swelling, antalgic gait, decreased ROM - strengthening gradually progressing (surgery is rarely required due to being highly vascularized)

Question 38

Meniscus Tear-complete

Answer 38

- medial meniscus is more commonly injured - fixed foot rotation while WBing on flexed knee - conservative tx and surgery ranging from partial meniscectomy to repair

Question 39

Osgood-Schlatter Disease-complete

Answer 39

- repetitive traction on the tibial tuberosity apophysis (patellar tendon) - can result in a small avulsion - point tenderness - tx: conservative, icing, eliminating exercises

Question 40

Osteogenesis Imperfecta-overview

Answer 40

-connective tissue disorder that affects the formation of collagen during bone formation/development

Question 41

Osteogenesis Imperfecta-etiology

Answer 41

- genetic inheritance: type I/IV | - autosomal dominant: type II/III

Question 42

Osteogenesis Imperfecta-sx/tx

Answer 42

- pathological fx, osteoporosis, hypermobile, bowing of long bones, weakness, scoliosis, impaired respiratory function - tx: begins at birth, emphasize symmetrical movements, fx management, use orthotics if necessary

Question 43

Osteogenesis Imperfect Types

Answer 43

``` most severe to least II III IV I ```

Question 44

Plantar Fascitis-overview

Answer 44

- inflammation of the plantar fascia of the proximal insertion on the medial tubercle of the calcaneus - excessive tension over time creates chronic inflammation and microtears

Question 45

Posterior Cruciate Ligament Sprain

Answer 45

- most common causes of this injury is landing on the tibia with a flexed knee or hitting a dashboard in MVA with flexed knee - swelling, mild pain, typically asymptomatic - conservative tx, or surgery (isolated hamstrings avoided for min 6 weeks if surgery)

Question 46

Scoliosis

Answer 46

- a spinal orthosis is often warranted with a curve 25-40* | - surgical intervention may be required with curves >40*

Question 47

Talipes Equinovarus

Answer 47

- "clubfoot": heel pointing downward and the forefoot turning inward - unknown etiology - adduction of forefoot, varus hindfoot, equinus at the ankle - tx:splinting, serial casting (failed may result in surgery)