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MS Disorders
Differential diagnosis and treatment of common MS disorders
| Disorder | Definition/Characteristics | Differential Diagnosis | Treatment |
|---|---|---|---|
| Colles Fracture | Most common wrist fracture resulting from FOOSH; The distal fragment of the radius has a dorsal displacement with a radial shift of the wrist and hand | Radiographs show a fracture and displacement, observation of wrists radial shift/deformity | Casting of wrist joint, early AROM and PROM are essential for ultimate functional recovery, progressive resistive exercises, mobilizations, closed chain stabilization exercises |
| Degenerative Joint Disease (DJD/Osteoarthritis) | A nonrheumatoid, nonsystemic disease; Often affects weight bearing joints by the degenaration of the articular cartilage; Morning stiffness is not usually present; Stiffness improves with exercise; Onset is usually gradual, involving only a few joints | Normal erythrocyte sedimentation rate (ESR); abnormal joint radiographs; problems in weight bearing joints | NSAIDS, functional training and education, ROM exercises, isometric, isokinetic, isotonic, and postural exercises, ADL training, continue physical therapy as permitted, surgery or joint replacement if necessary |
| Fibromyalgia | Immune disorder of unknown origin; causes tenderness, pain, and stiffness in the muscles; Often related to stress, anxiety, fatigue, and sleeplessness in women more than men; Characterized by aching or burning of the muscles, tender points billaterally | Widespread pain in at least 11 of 18 tender points throughout the body; recognition of typical pattern of nonrheumatic symptoms and sleep deprivation; exclusion of other systemic diseases | Holistic and multidisciplinary approach; ADL education and training, stress management, analgesics and antidepressants, local modalities and techniques for muscle pain relief , aerobic/conditioning; Improve sleep patterns |
| Gout/Gouty Arthritis | Metabolic disease marked by elevated level of serum uric acid and deposition of urate crystals in the joints, soft tissues, and kidneys; Most often affects the feet, especially the great toe, ankle and midfoot; Severe joint pain commonly at night | Because of the distinct clinical features, tentative diagnosis can be made by history and physical examination; Diagnostic support includes elevated serum urate content and radiological examination | Anti-inflammatory medications, daily use of colchicine, lowering of urate concentration in body fluids with diet, weight loss, and moderation of alcohol intake, allopurinol to reduce hyperuricemia, rest/elevation and joint protection during acute phase |
| Hemophilia | Hemorrhagic disorder that is hereditary; Results from a deficiency of specific clotting factors; Concerns include hemiarthrosis and muscle bleeds | Prolonged bleeding tests, other blood tests | Splinting, ice, rest, and elevation are needed in the acute stage; In chronic situations, joint protection, maintaining joint function, daily exercises for ROM, endurance and strength, ADL training, and the use of appropriate splints and assistive device |
| Iliotibial Band (ITB) Friction Syndrome | An irritation caused by the rubbing of the ITB over the lateral epicondyle of the femur; Often occurs in runners from an overuse syndrome | Positive Ober's test; excessive hip internal rotation in stance; palpation over ITB insertion; Positive noble compression test | Stretching exercise program, modalities for pain and inflammation, soft tissue mobilization and techniques, shoe orthosis may be necessary |
| Myositis Ossificans | Often caused by trauma to a muscle resulting in hematoma that may calcify or ossify; Can be induced by early mobilization and stretching with aggressive PT following trauma to the muscle; Frequent locations are the quads, brachialis, and biceps brachii | Radiological studies of the injured body part will show calcium deposits | Conservative with gentle active and active assisted ROM, passive stretching is NOT indicated, No manual stretching with overpressure at end range |
| Osteochondritis Dissecans | Separation of the articular cartilage from the underlying bone (osteochondral fracture); Usually involving the medial femoral condyle near the intercondylar notch and observed less frequently at the femoral head and talar dome | Radiological studies of the injured body part | If fracture is displaced then surgery is indicated; PT after surgery includes: Gait training, functional strengthening, conditioning |
| Osteomalacia | Decalcification of bones; Results from vitamin D deficiency, which may cause deformities, fractures, and severe pain | None | Pain control and functional mobility training |
| Osteomyelitis | Acute or chronic bone infection. Commonly the result of combined traumatic injury and acute infection. In children, most common site includes distal femur & proximal tibia, humerus, & radius. In adults, the disease commonly localizes in the pelvis & spine | None | High doses of IV antibiotics, the infected extremity is immobilized by a cast, traction or bed rest, sometimes surgical intervention is indicated to drain infection, chronic infection may require amputation |
| Osteoporosis | Most common metabolic bone disease. Affects mostly white females. Depletes bone mineral density, which may predispose to fracture. Common sites of fracture include T/L spine, femoral neck, prox. humerus, prox. tibia, pelvis, distal radius. | None | Pain management, postural reeducation, breathing exercises, general conditioning, pectoral stretching, abdominal strengthening (with caution - no repeated flexion as this can lead to wedging fractures), WB exercises |
| Paget's Disease (Osteitis Deformans) | A slow progressive metabolic bone disease characterized by initial phase of excessive bone reabsorption followed by excessive abnormal bone formation. New bone is fragile, weak, painful. Can be fatal when associated with CHF. Unknown etiology. | None | If a patient is asymptomatic, treatment is not needed. If symptoms are present, patient will require drug therapy |
| Patellofemoral Dysfunction | The patella fails to track properly in the trochlear groove in the femur. Instability or pain usually occurs in the first 30 degrees of knee flexion. Stair climbing, prolonged sitting, squatting, or jumping will aggravate. | Q angle greater than 18 degrees. Positive chondromalacia test: Pain under patella with compression of patella and quadriceps muscle contraction. Abnormal tracking patella during knee flexion and extension | McConnell's taping technique, strengthening of the vastus medialis, stretching of the IT band and TFL. Shoe inserts to decrease genu valgum and pes planus. On-track brace to reposition patella. Patellar mobilization: Medial patellar glide |
| Progressive Systemic Sclerosis (Scleroderma) | A chronic disorder characterized by fibrosis and changes in the internal organs and skin. Frequently, accompanied by Raynaud's phenomenon. Polyarthralgia is prominent early symptom. Heartburn and dyspnea occasionally are the first manifestations | Positive rheumatoid factor test. Other blood tests. Multiple system problem in the skin, GI tract, cardio system, and kidneys | Maintain joint ROM, medications, strengthening exercises |
| Pronator Teres Syndrome | Median nerve entrapment in the pronator teres muscle | Pronator teres syndrome test: Clinican strongly resists pronation of the elbow as the patient's elbow is extended from 90 degrees of flexion toward full extension. The test is positive if tingling or parasthesia is provoked in median nerve dist. | Manual nerve glides, stretching exercises, AROM exercises, ultrasound, Neuromuscular e-stim for nerve healing |
| Rheumatoid Arthritis (RA) | Chronic, systemic inflammatory disease of unknown etiology. Occurs most often in women with peak onset in 30s & 40s. Usually involves symmetrical pattern of dysfunction. | Rule out other disease hat cause arthritis and positive blood tests. Symptoms usually begin insidiously and progress slowly. Fatigue, weight loss, weakness common initially. Pain is localized to specific joints symmetrically. Ulnar drift, swan neck, bout. | Reduce pain, maintain mobility, minimize joint stiffness/edema/destruction, provent deformities with orthoses, patient education and continual adherence to program is crucial. Medication, rest, ambulatory devices, and ice are used in acute phase |
| Scaphoid Fracture (Navicular) | Results from FOOSH in younger individuals. Because of poor vascularization to this bone, there is a high risk of avascular necrosis of the proximal fragment of the scaphoid | Radiological studies | Early maintenance of AROM of the distal and proximal joints while the upper extremity is casted. Later treatment emphasis is on regaining full functional use of the wrist and hand |
| Scoliosis | Can be caused by structural discrepancies (leg length). Structural scoliosis is irreversible with a rotational component. Nonstructural is a reversible lateral curve without rotation that straightens as individual flexes the spine | Radiological studies, postural analysis, forward flexion test | Bracing and/or surgery for placement of Harrington rods along the spine. Nonstructural can be managed with stretching, show lifts, and postural reeducation. Respiratory care may be needed if Cobb's angle is 40 degrees or more |
| Sjogren's Syndrome | A rheumatoid like disorder characterized by dryness of the mucous membranes, joint inflammation, and anemia. More common than SLE, less common than RA. | Dryness of the eyes and mouth along with joint inflammation. Arthritis occurs in about 33% of the patients and is similar in distribution as RA, but milder and without joint destruction | Sipping fluids throughout the day, chewing sugarless gum, using mouthwash for mouth dryness, medications for pain and inflammation occasionally needed, maintain mobility and function through a regular exercise program |
| Smith's Fracture (Reverse Colles Fracture) | Distal fracture of the radius, which dislocates in the ventral direction. Results from fall onto a flexed wrist as opposed to a Colles fracture, which occurs with wrist extension. | None | Same as Colles fracture |
| Systemic Lupus Erythematosus | Chronic, systemic, rheumatic, inflammatory disorder of connective tissues. Affects multiple organs including skin, joints, kidneys, heart, blood forming organs, NS, and serous membrane | Symptoms include malaise, overwhelming fatigue, arthralgia, fever, arthritis, skin rashes (butterfly rash), photosensitivity, anemia, hair loss, Raynaud's, kidney involvement | Topical corticosteroids, patient education for energy conservation, good nutrition, and skin care. ROM exercises, Ergonomic and postural training |
| Tibial Fracture | March fracture: Inferior third of the tibia from long walks when not used to walking; Spiral fracture: Junction of the middle & inferior thirds resulting from tibial torsion; Compound fracture: Direct blow to the tibia | None | Leg casting; Possible ORIF with hardware, May take up to 6mon. to heal; After healing, AROM and PROM are essential; Progressive resistive exercises, mobilizations, and closed chain stabilization exercises are needed to complete rehab process |
| Torticollis | Occurs when SCM continuously contracts; Results in lateral bending of the head to the affected side with rotation to the opposite side; Usually develops in utero. | None | Modalities to reduce the muscle spasm, stretching exercises, biofeedback, postural education and training |
| Arthrogryposis | A nonprogressive, nongenetic, congenital disease; Characterized by rigid joints of the extremities (usually symmetrical), sausage like shapeless limbs, and weak or nonfunctional muscles | Recognition of inheritance pattern is diagnostically important since disease is usually not inherited; Other conditions (spina bifida) can cause joint contractures, and acquired disorders (Juvenile RA) can present with joint rigidity | Options include: Surgery, ROM exercises, splinting, positioning, ADL training, use of adaptive devices |
| Complex Regional Pain Syndrome (CRPS) | Abnormal sympathetic reflex resulting from a persistent painful lesion; Clinical signs include: pain, edema, decreased circulation, osteoporosis, skin dryness, decreased proprioception, and atrophy of muscles in close proximity to area | Trophic changes in the skin, bones, and joints | Modalities to decrease pain, joint mobilization, weight bearing or closed-chain activities, massage, manual lymphatic drainage, splinting |
Created by:
jvlassov
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