other stuff not covered in lecture

What are the 2 types of complex regional pain syndrome (CRPS)?

• type 1: reflex sympathetic dystrophy

• type 2: causalgia

Describe type 1 CRPS

• develops after noxious event (crush or soft tissue injury, immobilization, surgery)

• spontaneous pain or hyperalgesia/allodynia

• edema, vascular abnormalities

• abnormal sudomotor activity

• non-nerve origin

Describe type 2 CRPS

• develops after nerve injury

• not limited to territory of injured nerve

• edema, skin blood flow abnormality

• abnormal sudomotor activity

What are the clinical features of CRPS?

• pain

• marked Sx’s more distally

• progress in intensity and spread proximally

What structural impairments are caused by CRPS?

• motor dysfunction (weakness, tremor, dystonia)

• edema or sweating asymmetry (hypo or hyperhidrosis)

• vasomotor instability (temperature or skin color asymmetry)

• trophic ∆s (increase/decrease hair & nail growth, or skin ∆s)

What functional impairments are caused by CRPS?

• pain avoidance behaviors → mm atrophy or osteopenia/osteoporosis

• slower at initiating movements

• abnormal gait

Describe Paget disease (osteitis deformans)

osteometabolic disorder characterized by accelerated skeletal remodeling that produces a slowly progressive enlargement & deformity of multiple bones

• asymptomatic or gradual Sx’s

• phase I (osteolytic phase): bone resorption & hypervascularization

• phase II (sclerotic phase): reflecting previously increased bone formation but currently decreased cellular activity & vascularity

• phase IIL (mixed phase): both active bone resorption & compensatory bone formation → disorganized skeletal architecture (bones become sponge-like, weakened, deformed)

What are the complications of Paget disease?

• fx

• delayed union

• chronic bone pain (achy, worse at night, better w/ activity)

• facial or ocular nerve compression

• spinal stenosis or myelopathy

• pagetic arthritis

How is Paget disease treated?

meds or surgery

Describe tethered spinal cord

fixation of the spinal cord in an abnormal caudal location d/t adhesions at the site of the original back lesion

• the child is growing rapidly but the cord is not free to slide up & reposition as it should

• excessive stretch to the spinal cord → metabolic ∆s & ischemia of the neural tissue → degeneration in mm function

What are the clinical features of tethered spinal cord?

• spasticity of mms w/ sacral nerve roots

• increased lumbar lordosis

• back or buttock pain

• scoliosis at a young age that rapidly progresses

• scoliosis above the level of paralysis

• bowel & bladder ∆s

• gait ∆s

• LE weakness & atrophy

What are the Ottawa ankle rules?

Ankle X-ray if any of the following:

• bone tenderness at posterior edge of distal 6cm or tip of lateral malleolus

• bone tenderness at posterior edge of distal 6cm or tip of medial malleolus

• inability to WB 4 steps immediately after injury or in the ED

Foot X-ray if any of the following:

• bone tenderness at the navicular bone

• bone tenderness at the base of the 5th metatarsal

What are the Canadian C-spine rules?

Any of these high risk factors? If yes → X-ray

• age ≥65 years

• dangerous MOI

• paresthesias in extremities

If none, any of these low risk factors? If none of these → X-ray

• simple rear-end MVA

• sitting in the ED

• ambulatory at any time

• delayed onset of neck pain

• no midline C-spine tenderness

If one of the above, able to rotate neck 45° on both sides? If unable to → X-ray

• If yes → no X-ray

Describe upper UTI & their Sx’s

inflammation or infection of the kidney or ureters (pyelonephritis, glomerulonephritis)

• unilateral costovertebral tenderness

• flank pain

• ipsilateral shoulder pain

Describe lower UTI & their Sx’s

inflammation or infection of the bladder or urethra (cystitis, urethritis)

• urinary urgency

• pain in low back, abdomen, pelvis

• dysuria (pain w/ urination)

What is primary prevention?

disease prevention

What is secondary prevention?

early detection & treatment in asymptomatic pts → reduce severity or duration of disease → improve outcomes

What is tertiary prevention?

reduce disease impact and manage Sx’s in diagnosed pts through rehab & management of existing conditions to prevent complications