Pathophysiology for RMT II - Vocabulary Flashcards

Muscular Dystrophy

• Definition: Degeneration and wasting of skeletal muscle tissue.

• Etiology: Genetic abnormalities leading to dystrophin deficiency; Duchenne type is X-linked and diagnosed around $3{-}5$ years; Becker type milder and later onset; both affect males predominantly (Becker can involve both sexes with later, milder symptoms).

• Major Symptoms: Progressive muscle weakness, muscle wasting, pseudohypertrophy, difficulty walking, contractures; respiratory/cardiac complications.

• Meds/Interventions: Massage and physical therapy; steroids, muscle relaxants, NSAIDs; surgery for contractures; consider tissue fragility and cardiac/respiratory weakness when prescribing; meds often require modifications.

Scoliosis

• Definition: Lateral curvature of the spine.

• Etiology: Idiopathic or habitual; congenital; neuromuscular (e.g., CP); unequal limb length can contribute.

• Major Symptoms: Abnormal rib hump, uneven shoulders/hips, back pain, potential respiratory compromise in severe cases.

• Meds/Intervention: Mild (10{–}20°): physical therapy; moderate (20{–}30°): bracing; severe (40{–}45°): consider surgery.

• Additional notes: Massage aims to decrease tone on the concave side and strengthen the convex side; mobilize non-fused joints; be cautious of visceral compression in severe cases.

• Minimally Invasive Scoliosis Surgery (MIS): 3 small incisions can replace a long incision; faster return to activity; example curve reduced from $55^{\u00b0}$ to $12^{\u00b0}$ with three small scars.

Osteoporosis

• Definition: Reduction of bone mass with increased bone porosity and fragility.

• Etiology: Aging; mineral deficiencies; imbalance between bone resorption and formation; secondary to medications or endocrine disorders.

• Major Symptoms: Fragility fractures; height loss; kyphosis; back pain; generally decreased bone strength; may be asymptomatic until fracture.

• Meds/Intervention: Calcium, magnesium, vitamin D supplements; antiresorptive medications; treat underlying pathology; weight-bearing exercise.

• Massage/CIs: Risk of fracture means avoid aggressive techniques; emphasize strengthening and pain reduction; use pillows/supports as needed.

Osteomalacia / Rickets

• Definition: Inadequate bone mineralization leading to soft bones (malacia).

• Etiology: Deficient calcium absorption/utilization; vitamin D deficiency; phosphate deficiency; GI or renal issues; Rickets in children due to failure to calcify growth plates.

• Major Symptoms: Bone pain, fractures, muscle weakness, deformities during growth.

• Meds/Intervention: Treat underlying cause; supplementation to support mineralization; avoid aggressive techniques in massage if fracture risk is high.

• Note: May co-exist with other pathologies affecting mineral metabolism.

Paget’s Disease / Osteitis Deformans

• Definition: Excessive bone turnover with disorganized formation.

• Etiology: Genetic and environmental factors; possible viral involvement; usually 40+ years; more common in northern Europe.

• Major Symptoms: Bone pain, fractures; nerve involvement, mental/cardiovascular symptoms; risk of osteogenic sarcoma in rare cases.

• Meds/Intervention: NSAIDs/analgesics; supplementation to aid regrowth; antiresorptives to slow turnover; massage precautions to avoid fractures; focus on strengthening and pain reduction; pillows/supports as needed.

Adhesive Capsulitis (Frozen Shoulder)

• Definition: Glenohumeral joint capsule adhesions causing hypomobility; also called frozen shoulder.

• Etiology: Idiopathic or related to immobilization; diabetes, thyroid disease and other conditions can contribute.

• Major Symptoms: Freezing phase (night pain, loss of ROM), Frozen phase (severe ROM loss), Thawing phase (gradual ROM return); can take months to years.

• Meds/Intervention: Analgesics; steroid injections; surgery to loosen capsule or under anesthesia mobilization.

• Massage/CIs: In freezing stage, inflammation present; modify techniques accordingly; aggressive work may be needed in later stages; monitor for muscle atrophy from disuse.

Baker’s Cyst

• Definition: Synovial cyst behind the knee (posterior) usually medial.

• Etiology: Weakening of the posterior knee joint capsule near gastrocnemius/semimembranosus; often accompanies OA, RA, lupus, or injuries.

• Major Symptoms: Usually asymptomatic; can be painful or impair blood flow if large; may rupture; can contribute to posterior compartment syndrome.

• Interventions: NSAIDs; aspiration; cortisone injection; treat underlying issues (OA, ligament injuries, etc.).

• Massage/CIs: Watch for thrombosis; address muscles crossing the cyst and underlying conditions.

Lyme Disease

• Definition: Bacterial infection transmitted by ticks that can affect joints, nervous system, and heart.

• Etiology: Borrelia burgdorferi; requires tick bite and feeding; early tests can be negative; rash often present (bullseye).

• Major Symptoms: Stage-based progression: Stage 1 (rash, fever, lymph node swelling, fatigue); Stage 2 (cardiac palpitations, dizziness; neurologic symptoms); Stage 3 (arthritis in large joints, neuropathy, cognitive effects).

• Interventions: Antibiotics; caution with activity during acute infection; remove ticks safely and consult public health if found; treatment is often effective; late neurological/cardiac symptoms require careful management.

Osteoarthritis / Patellofemoral Syndrome (Chondromalacia Patella)

• Osteoarthritis Definition: Wear/heavy use damaging articular cartilage in weight-bearing joints; may progress to bone changes and synovial irritation.

• Osteoarthritis Etiology: Aging, obesity, prior injury, overuse, chronic inflammation, nutrition/hormonal factors.

• Osteoarthritis Major Symptoms: Pain, stiffness (especially with initial activity), crepitus, decreased ROM, possible bony enlargement; late-stage may involve cartilage loss with loose osteophytes.

• Osteoarthritis Meds/Intervention: NSAIDs/analgesics; corticosteroid injections; hyaluronic acid injections; massage precautions to avoid aggressive joint mobilization during active inflammation; ROM-maintenance strategies.

• Patellofemoral Syndrome / Chondromalacia Patella

  • Definition: Patellar cartilage irritation potentially progressing to degeneration.

  • Etiology: Overuse with malalignment (e.g., genu valgum/varum), pes planus, quad weakness.

  • Major Symptoms: Anterior knee pain, especially with stairs; crackling/grinding; stiffness after immobility.

  • Interventions: NSAIDs; bracing; surgery to smooth cartilage or lateral release; PT to rebalance muscles and address alignment; retraining quadriceps (especially vastus medialis).

  • Massage/CIs: Avoid prolonged compression through patella; focus on quadriceps balance and addressing causative factors.

Spondylolisthesis / Spondylosis / Spondylolysis

• Spondylolisthesis

  • Definition: Slippage of one vertebra over the one below it.

  • Etiology: Pars interarticularis defect; degenerative changes; congenital or traumatic; may involve facet joints.

  • Major Symptoms: Low back pain, hamstring tightness, step-off deformity, radiculopathy with nerve compression.

  • Interventions: NSAIDs; bracing; surgical stabilization of the lumbar spine; massage considerations: avoid hyperextension and excessive pressure during acute instability; address muscle tension.

• Spondylosis

  • Definition: Degenerative arthritis of the spine (non-synovial joints).

  • Etiology: Similar to OA; ligamentous laxity; possible ossification; facet arthropathy; disc thinning; stenosis.

  • Major Symptoms: Slow, painless stiffening of the spine; pain with nerve involvement or muscle spasm.

  • Interventions: NSAIDs; muscle relaxants; steroid injections; nerve blocks as needed; massage: accommodate nerve compressions; avoid removing protective spasm.

• Spondylolysis

  • Definition: Stress fracture of the pars interarticularis.

  • Etiology: Repetitive extension/overuse in young athletes; sometimes traumatic.

  • Major Symptoms: Low back pain; hamstring tightness; exam may show step-off; pain with extension.

  • Interventions: Rest and immobilization; progressive rehab; massage considerations similar to other pars injuries.

Legg-Calvé-Perthes Disease

• Definition: Femoral head osteonecrosis in children.

• Etiology: Idiopathic avascular necrosis; predominantly boys, usually white, age $3{-}12$.

• Major Symptoms: Necrosis/deformity of femoral head during healing; pain and limp.

• Interventions: Rest in abduction and internal rotation; assistive devices; potential pluripotent stem cell therapy; hip replacement in severe cases; NSAIDs/analgesics; risk of fracture/dislocation; massage considerations: caution with circumference and alignment; support postural changes as needed.

Osgood-Schlatter Disease

• Definition: Microfracture at the tibial tubercle where the patellar tendon inserts.

• Etiology: Overuse during growth of quadriceps muscles.

• Major Symptoms: Enlarged tibial tubercle; pain and swelling at patellar tendon insertion.

• Interventions: Rest/decreased activity; braces; NSAIDs/analgesics; usually self-resolves over time.

• Massage/CIs: Focus on reducing tone in quadriceps; avoid excessive inflammation; monitor tibial tubercle region for bone deformity.

Normal Development and Developmental Torsions

• Normal Development (lower limbs):

  • Infants often have varus bowing of femur/tibia.

  • By $18{-}24$ months, lower leg approaches neutral axis.

  • Valgus (knock-knee) typically develops, most apparent $3{-}4$ years; by $7$ years, slight valgus with minimal change thereafter.

  • Varus should not recur; valgus should not continue to increase.

• Torsions (developmental):

  • Femoral torsion is normally anteverted at birth; mature value around $15^\circ$.

  • Tibial torsion: $5^\circ$ at birth to about $15^\circ$ at maturity.

  • Toe-in/toe-out can stem from hip, knee, or ankle/foot alignment.

• Common alignments: Genu varum/valgum, Blount's disease (tibia vara), Pes planus (flat foot).

Congenital / Developmental Conditions (examples)

• Polydactyly: extra digits.

• Syndactyly: webbing or missing bones (digits).

• Osteogenesis Imperfecta: defective type I collagen; thin, fragile bones with growth defects.

• Dysplasia (congenital dislocation of hips): hereditary ligament laxity.

• Clubfoot (talipes): deformity of the foot.

• Osteochondrosis: growth-plate ossification dysfunction.

• Slipped Capital Femoral Epiphysis (SCFE): displacement at the head of the femur.

Key Concepts to Recall

• Early Duchenne muscular dystrophy: onset around $3{-}5$ years; wheelchair by $12$.

• Scoliosis management thresholds: $10{-}20^\circ$ PT; $20{-}30^\circ$ braces; $40{-}45^\circ$ surgery.

• Osteoporosis management emphasizes weight-bearing and vitamin D/calcium; consider fracture risk with aggressive techniques.

• Osteomalacia involves mineralization defects; vitamin D and calcium/phosphate balance essential.

• Paget’s disease management focuses on reducing turnover; risk of fractures and rare malignancy; avoid aggressive joint loading.

• Adhesive capsulitis progresses through freezing, frozen, and thawing stages; staged treatment and careful mobilization.

• Baker’s cysts require addressing underlying OA/arthritis and monitoring for DVT risk.

• Lyme disease early antibiotic treatment is important; watch for neuro/cardio involvement in later stages.

• Spondylolisthesis/osis/lysis require awareness of spinal nerve involvement and safe movement strategies; posterior elements stability matters.

• MIS scoliosis demonstrates potential faster recovery with limited incisions.

• Legg-Calvé-Perthes and Osgood-Schlatter reflect growth-related vascular/mechanical issues requiring load modification and supportive care.