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osteoporosis definition
disease causing architectural deterioration of bone tissue leading to increased bone fragility
affects cancellous bone most
primary osteoporosis
due to aging
secondary osteoporosis
side effect of medication
osteoporosis clinical manifestations
loss of height
affects curvature of spine
postural changes
back pain
fractures
osteoporosis risk factors
age >50
low estrogen levels
low testosterone levels
genetics/family history
long periods of immobilization
sedentary lifestyle
malabsorption disorders
eating disorders
poor nutrition
excess alcohol, tobacco, caffeine, consumption
hyperthyroidism
diabetes mellitus
medications
chemotherapy
heparin
glucosteroids
how estrogen affects bone growth
estrogen facilitates osteoblasts and inhibits osteoclasts
osteoporosis PT intervention
WB exercise & ROM
change diet
increase balance - decrease risk of falls
osteoporosis medical management
bisphosphonates
inhibit osteoclasts, facilitate osteoblasts
estrogen replacement therapy
selective estrogen receptor modulators (SERMs)
calcium supplementation
categories of arthritis
infectious
septic arthritis
degenerative
osteoarthritis
inflammatory
rheumatoid arthritis
ankylosing spondylitis
juvenile idiopathic arthritis
polymyalgia rheumatica
metabolic
gout
osteoarthritis
degenerative pathology within synovium, articular cartilage, and underlying subchondral bone
progressive damage/loss of cartilage
due to abnormal mechanical loading
osteoarthritis risk factors
obesity
prolonged stresses on joints
previous injuries/surgeries
hypermobility
infection
other diseases
gout
diabetes mellitus
primary osteoarthritis
idiopathic
potentially due to genetics and/or increased age
secondary osteoarthritis
due to pre-existing joint abnormalities
trauma, injury, disease
osteoarthritis signs and symptoms
unilateral involvement
pain
swelling without warmth/redness
crepitus
loss of ROM
locking
short-term stiffness
worsening with inactivity or overactivity
Heberden’s and Bouchard’s nodules
affects distal and proximal IP joint, spares carpometacarpal joint
osteoarthritis diagnostic criteria
pain with radiologic findings
>50 years of age
morning stiffness >30 minutes
crepitus with motion
blood tests rule out rheumatologic diseases
osteoarthritis radiograph findings
joint space narrowing
subchondral sclerosis
subchondral cyst formation
osteophyte formation
loose bodies
osteoarthritis treatment
medications
acetaminophen
NSAIDs
supplements
glucosamine
chondroitin
injections
corticosteroids
hyaluronic acid
PT/OT
surgery
arthroplasty
partial replacement
microfracture
fusion (arthrodesis)
rheumatoid arthritis
chronic, systemic autoimmune disease characterized by both articular and extra-articular findings
rheumatoid arthritis effects
synovial hypertrophy
increased macrophages and fibroblasts
inflammatory cell infiltration
angiogenesis
pannus formation
rheumatoid arthritis joint clinical manifestations
insidious onset
joints
bilateral
edematous and warm
prolonged stiffness
irreversible deformities
ulnar deviation
boutonniere deformity
swan-neck deformity
spine
cervical spine
atlantoaxial subluxation
rheumatoid arthritis constitutional symptoms
fatigue
weight loss
generalized, diffuse pain
weakness
depression
rheumatoid arthritis integumentary clinical manifestations
palmar erythema
petechia and purpura
rheumatoid nodules
rheumatoid arthritis neurologic clinical manifestations
peripheral neuropathies
compressive cervical myelopathy
stocking glove myelopathy
rheumatoid arthritis cardiopulmonary clinical manifestations
myocardial infarction
congestive heart failure
airway inflammation
rheumatoid arthritis medications
analgesics
NSAIDs
corticosteroids
disease modifying anti-rheumatic drugs (DMARDs)
cytokine inhibitors
gout
characterized by deposition of urate crystals in joints
urate crystals are a byproduct of nucleotide breakdown
urate crystal deposits (tophi) disrupt osteoclast/osteoblast homeostasis and trigger cell damage and inflammation
gout risk factors
diet
high in alcohol
high in red meat
high in seafood
genetics
AMAB
increasing age
comorbidities affecting heart and metabolic system
gout clinical manifestations
severe pain, swelling, and inflammation of LE joints
1st MTP frequently affected
flare ups at night or early morning
fever
tachycardia
gout medical management
diet and lifestyle modifications
corticosteroids
NSAIDs
juvenile idiopathic arthritis
A type of arthritis that occurs in children <16 y.o.a (1-4 & 9-14) and is characterized by persistent joint inflammation, pain, and swelling. It can affect growth and development and may have various subtypes.
juvenile idiopathic arthritis clinical manifestations
pathological changes similar to RA
increased synovial fluid viscosity
pannus formation
asymmetric joint involvement
pain
edema
erythema/warmth
rash
conjuctivitis
fever
fatigue
weight loss
juvenile idiopathic arthritis treatment
NSAIDs
corticosteroids
DMARDs
biologic immunomodulators
surgery
joint replacement
synovectomy
juvenile idiopathic arthritis prognosis
~70% experience full remission with treatment
lack of treatment = permanent joint damage, osteoporosis, joint contractures
septic arthritis
joint inflammation triggered by bacteria, viruses, or fungi
septic arthritis risk factors
recent surgery
RA
shared needles
unprotected sex
immunocompromise
septic arthritis clinical manifestations
severe 10/10 pain
edema
erythema
fever
lack of treatment of septic arthritis can lead to
permanent joint damage and disability
death
polymyalgia rheumatica
a condition characterized by widespread muscle pain and stiffness, especially in the shoulders and hips
polymyalgia rheumatica clinical manifestations
pain, aching, stiffness in bilateral axial joints
prolonged morning/inactivity stiffness
weakness
fatigue
low-grade fevers
weight loss and anorexia
polymyalgia rheumatica risk factors
AFAB
age >50
genetics
smoking
polymyalgia rheumatica treatment
corticosteroids
DMARDs
ankylosing spondylitis
chronic inflammatory arthritis of axial joints involving inflammation, fibrosis, and calcification of attachment points for skeletal muscle, ligaments, synovium, and cartilage
ankylosing spondylitis risk factors
AMAB
genetics
smoking
30-50 years of onset
ankylosing spondylitis clinical manifestations
back pain, stiffness, reduced mobility
SIJ and hip pain
relief of pain and stiffness with movement
postural abnormalities
chest pain and shortness of breath
uveitis
inflammatory bowel disease
ankylosing spondylitis treatment
NSAIDs
DMARDs
corticosteroids
spinal osteotomy
diffuse idiopathic skeletal hyperostosis (DISH)
ossification of ligaments, typically in cervical spine among 4 consecutive segments
diffuse idiopathic skeletal hyperostosis (DISH) medical management
no cure
surgery is rare
medications
acetaminophen
opioids
Therapeutic exercise utilized to slow progression and reduce symptoms
degenerative disc disease
degeneration of intervertebral disc due to the loss of proteoglycans
disc becomes more fibrotic
thinning disc leads to increased loading of articular facets
osteophyte formation and narrowing of intervertebral foramen
degenerative disc disease clinical manifestations
In a dermatomal pattern
weakness
pain
numbness
paresthesias
degenerative disc disease treatment
pain management - NSAIDs, acetaminophen, corticosteroids
muscle relaxants
laminectomy
spinal fusion
heterotopic ossification
abnormal formation of bone within soft tissues occuring 3 weeks to 3 months post initial injury
heterotopic ossification risk factors
trauma
surgery
spinal cord injury
genetics
heterotopic ossification clinical manifestations
loss of ROM
pain
swelling
tenderness
warmth
heterotopic ossification treatment
NSAIDs and bisphosphonates prevent formation
AROM/PROM
surgical resection
osteomalacia (rickets)
softening of bones caused by a lack of calcium phosphate in the bone matrix due to a prolonged deficiency of Vitamin D
How is vitamin D linked to calcium
Vitamin D facilitates absorption of calcium
osteomalacia clinical manifestations
bone pain felt over a large area
myalgias and muscle spasms
weakness
waddling gait
bowing of long bones
fractures
osteogenesis imperfecta
fragile bones that break easily due to genetic mutation in type 1 collagen gene resulting in a lack of flexibility that collagen normally provides
osteogenesis imperfecta clinical manifestations
frequent manifestations
blue sclera
recurrent nosebleeds
weakness
hypermobility
hearling loss
cardiovascular complications
osteogenesis imperfecta treatments
bisphosphonates
Vitamin D and calcium supplements
intramedullary rod placement surgery
bracing and assistive devices
water based exercise
paget’s disease
skeletal remodeling disorder that causes bones to become bigger
increased osteoclasts/osteoblast activity
paget’s disease clinical manifestations
bone pain
enlarged bones
abnormal curvatures in bones
hearing loss
abnormal pain and constipation due to increased calcium levels
paget’s disease treatments
bisphophonates
ORIF and/or joint replacements
avoidance of intense physical activity