AH 381

1. AH 381 Documents for Student Review

2. RSD (1) Reflex Sympathetic Dystrophy • Reflex sympathetic dystrophy (RSD) is a complex, poorly understood disorder that is characterized by chronic, severe pain and progressive changes in skin, muscle, and bone. Although the precise causes of RSD are unknown, it often occurs following an injury, often minor in nature. • Some experts believe that RSD represents an exaggerated response of the sympathetic nervous system to some form of injury or insult (eg. surgery) to the area resulting in chronic, severe, sometimes debilitating pain. Although the signs and symptoms of RSD vary depending upon the clinical stage of the disorder, the one common feature shared by all 3 clinical stages (early, established, or late RSD) is pain.

3. (1) • Usually occurs in distal extremity when CNS produces continuous sympathetic stimulation of the limb; in the athletic setting, RDS most commonly follows a severe injury followed by immobilization or non weight bearing

4. Symptoms “confounding symptom” = severe localized pain Pain disproportional to injury Skin hypersensitivity ( even to clothes and bed sheets) Extreme reluctance to move joint or bear weight Signs Swelling Decreased ROM Increase skin temp. Atrophic skin, hair & nails change sin affected limb RDS S&S (1)

5. Over a period of time, you will see…(1) • Atrophy & poor peripheral vascular control (cyanosis, intolerance to cold, pallor) • After several months, sympathetic activity decreases and entire limb becomes atrophic, cool, pale, and so hypersensitive it can no longer function

6. Treatment of RSD (1) • Recognition and treatment are CHALLENGING • Can be prevented by encouraging movement and progressively weight bearing • Rehab includes : rhythmic weight bearing, gentle jt distraction, AROM, desensitization techniques, and joint mobs • Pain relief through transcutaneous nerve stimulation • In resistance cases, analgesics and anesthetic pain blockage have be utilized • Persistent and aggressive TX increases probability of successful outcome

7. Meningitis (2) • Meningitis is an infection of the fluid in the spinal cord and the fluid that surrounds the brain. Meningitis is usually caused by an infection with a virus or a bacterium. Knowing whether meningitis is caused by a virus or a bacterium is important because of differences in the seriousness of the illness and the treatment needed. • VIRAL MENINGITIS is usually relatively mild. It clears up within a week or two without specific treatment. Viral meningitis is also called aseptic meningitis. • BACTERIAL MENINGITIS is much more serious. It can cause severe disease that can result in brain damage and even death. • Antibiotics will be prescribed for bacterial meningitis; the type will vary depending on the infecting organism. Antibiotics are ineffective in viral meningitis. Treatment of secondary symptoms including brain swelling, shock, and convulsions will require other medications and intravenous fluids. Hospitalization may be required depending on the severity of the illness and the needed treatment.

8. (2) • Bacterial meningitis caused by streptococcus or meningococcus bacteria can be fatal within hours of infection • Other causes include: viruses, drugs, lead poisoning, and parasites

9. (2) • Symptoms • fever and chills • severe headache • nausea and vomiting (may be violent) • stiff neck ("meningismus") or rigid neck • sensitivity to light (photophobia) • Rapid coma • Altered cognition, syncope, seizures, & coma may occur over time • Additional symptoms that may be associated with this disease: • decreased consciousness • rapid breathing • severe neck stiffness, ultimately resulting in a characteristic arched posture-seen in infants or small children • "bulging fontanelles" may be seen in infants • poor feeding or irritability in children

10. Signs of Meningitis (2) • Rash on head • Inability to flex the neck passively without hip an knee flexion ( known as Brudzinski’s sign) • EMERGENCY TRANSPORT for antibiotics

11. Abdominal Quadrants (4, 12) • Upper right • Upper left • Lower right • Lower left • Palpation of organ will feel …

12. Using a Stethoscope (5, 6, 13)

13. Using and Otoscope (14)

14. Clinical S&S Associated with ENT conditions (180-187) • Common cold • Conjunctivitis • Laryngitis • Phayngitis • Rhinitis • Sinusitis • Tetanus • Tonsillitis

15. Common Cold • Viral • Head and throat mainly affected • Stuffy, sore throat, post nasal drip, fever possible but not required • AKA URI

16. Conjunctivitis • Inflammation of the lining of the posterior eyelid and eyeball margins (the conjunctiva) • Can result from allergens or infection by bacteria or viruses • Burning (infection) or itching (allergy) with purulent (infection) or mucoid (allergy) drainage from the eye occurs • Commonly called “pink eye”

17. Laryngitis • Infection or inflammation of the vocal cords • Causes changes in the quality of the voice, such as hoarseness or inability to speak • Itching of the throat, fever, difficulty or pain with swallowing, or even dyspnea may occur with severe laryngitis

18. Pharyngitis • Infection or inflammation of the throat • Causes throat pain, painful or difficult swallowing, and pain in the ears when swallowing • Reveals a red (erythematous) throat with purulent or mucoid exudate covering the pharynx

19. Rhinitis • Viral -causes infection of mucous membranes causing mucous secretion • Allergic – AKA hay fever; experiences watery eyes • Sore throat, runny nose, congestion, nasal discharge (clear or light colored); fever

20. Tetanus • Lockjaw • Bacterial infection enters through puncture / wound and moves to CNS • S/S: pain around wound, local and regional hyper tonicity and spasm • Eventually difficulty opening mouth within 48 hours • Severe – fever • Must have vaccination!!!!

21. Tonsillitis • Infection or inflammation of the tonsils • Produces throat pain, painful or difficult swallowing, and pain in the ears when swallowing • Reveals a red (erythematous) throat with purulent or mucoid exudate covering the tonsils

22. Sinusitis • Inflammation of the paranasal sinuses • Caused by: URI from bacteria • Nasal mucous membranes swell and block paranasal sinus; resulting pressure causes pain

23. Clinical S&S Associated with GI conditions(188-197) • Appendicitis • Colitis • Constipation • Diarrhea • Esophageal reflux • Gastritis • Gastroenteritis • Indigestion • Ulcer • Irritable bowel syndrome

24. Appendicitis • Inflammation of the appendix • Caused by physical irritants or infection • Causes abdominal pain in the lower right quadrant, passive extension or active flexion of the right hip may be painful if psoas muscle is irritated • Loss of appetite and nausea are usually present, although vomiting is rare • Treatment is usually surgical removal

25. Colitis

26. Constipation The abnormal retention of feces as a result of hardened (dehydrated) stool or decreased bowel motility Poor diet (high sugar, low fiber), dehydration, medications, stress, inactivity, or GI disease can contribute Appropriate lifestyle changes relieve constipation due to diet or inactivity, although laxatives may be needed in more severe cases

27. Diarrhea • Frequent or loose bowel movements from increased motility, malabsorption syndromes, infection, or a combination of these factors • Some medications and drugs cause temporary diarrhea; for instance, antibiotics allow overproduction of intestinal bacteria, which increases intestinal motility

28. Esophageal Reflux

29. Gastritis Stomach inflammation that results from erosion of the entire mucosa, chronic use of medications, H. pylori infection, or autoimmune disease It can be acute or chronic, erosive or nonerosive Causes nausea, vomiting, and vague upper abdominal pain Treatments include dietary restrictions and and symptomatic treatment with antacids

30. Irritable Bowel Syndrome • Is thought to be a reaction to psychophysical stress and poor diet • Produces abdominal pain and cramping, and is most prevalent among young adult females • This disorder affects motility of the intestines, causing diarrhea, constipation, or alternating episodes of both • Bloating or abdominal distension may appear • Relief of abdominal pain usually occurs after defecation

31. Gastroenteritis • The inflammation of the mucosal lining of the stomach and intestines, usually a result of infection • Food poisoning, traveler’s diarrhea, and viral “stomach flu” are common manifestations of gastroenteritis

32. Gastritis • Stomach inflammation that results from erosion of the entire mucosa, chronic use of medications, H. pylori infection, or autoimmune diseases • Can be acute or chronic, erosive or nonerosive • Causes nausea, vomiting, and vague upper abdominal pain • Treatment includes dietary restrictions and symptomatic treatment with antacids

33. Indigestion

34. Ulcer

35. General Terms and Concepts This information is assigned “float” due dates. The student may complete the proficiency through the accepted method at any time between Jan 19 and March 8, 2005 Due March 8, 2005

36. Observe and ID the Clinical S&S associated with elbow… (26, 27, 28, 29, 30,31, 32, 33, 34) • Dislocation or subluxation • Fracture • efficiency of movement • bursitis • epicondylitis • Tenosynovitis and tendonitis • Osteochondritis dissecans • Sprain • strain

37. ID S&S of overuse injuries – ankle (58) • Bursitis • Exostosis • Fascitis • Stress fracture • Tarsal syndrome • Tendonitis/tenosynovitis • Tibial stress syndrome

38. ID clinical S&S associated with..-ankle (59-63) • Dislocation or subluxation • Fracture • Sprain • Strain • atrophy

39. ID clinical S&S associated with- knee (64-68) • Atrophy • Bursitis • Fracture • Sprain • Strain • tendonitis

40. ID clinical S&S associated with (69-78) • Atrophy • Bursitis • Dislocation and subluxation • Efficiency of movement • Fracture • Sprain • Nerve injury • Strain • Symmetry • Tendonitis / tenosynovitis

41. ID Clinical S&S associated with…(102-112) • Leg length discrepancy • Apophysitis • Dislocation & subluxation • Fracture • Stress fracture • Bursitis • Contusion • Sprain • Strain • Tendonitis

42. Unit 2

43. Functional &Activity specific test for the cervical spine (3) • Goniometry not always used to assess functional ability here b/c of difficulty measuring • Gross movement patterns should be completed; if any limitations are noted there, conduct a more specific, focused assessment of that motion and related anatomy • Active, passive, then resistive ROM

44. Postural assessment of Cervical Head and spine (18) • Normal position: chin in line with throat, throat centered, should be able to draw an imaginary line through the ears through the shoulder, hip, knee, and ankle • Abnormal positions • Forward head: ears in front of acromium • Accentuated cervicothoracic hump – head in constant flexed position over the spine

45. Torticollis (20) • AKA wryneck or stiffneck • S&S • Pain on side of neck upon awakening • Acquired spasm of sternocleomastoid

46. Commonly used test for Nerve Root Compression ( 21) • Distraction test • Pt seated, examiner has 1 hand on chin and other around occiput; examiner distracts head from trunk directly away from trunk • Positive test if pain decreases of disappears & inidctaes nerve root; increase in pain may indicate muscle / ligament damage • Note: vertebral artery test should be done prior to this test and do not use this test if possibility of cervical instability exists • Compression test • Same position as above; examiner has hands on top of patient’s head and compresses • Positive if pain is produced • Spurling’s test ( Compression) • Pt seated; examiner’s palms on pt’s head, examiner applies downward pressure while pt laterally flexes to each side (AROM & PROM used) • Positive finding is pain to flexed side • Shoulder abduction tests • Pt seated / stand • Patient abducts shoulder until palm is resting n top of head • Decrease in symptoms may indicate nerve root compression; possibly resting from herniated disk

47. Commonly used tests for neurovascular dysfunction (24) • Vertebral Artery Test • Subject lies supine, examiner supports head • Examiner slowly extends, rotates and laterally flexes subject head • Observe subject for dizziness, blurred vision, slurred speech, LOC • This position pathologically occludes artery if those present

48. Commonly used testes for Brachial Plexus Neuropathy (22) • Brachial tension test • Must rule out bony trauma before performing • Examine stands behind athlete and passively flexes head to one side while applying downward pressure through the patient's opposite shoulder • Positive test if pain increases or radiates down arm • Tinel’s sign • Tap skin over superficial nerve • Patient sits or lies supine • Tap Erb’s point(2cm superior to clavicle and anterior to transverse process of C6 • Positive if sensation on that side changes; indicates brachial plexus pathology

49. Commonly used tests for Cervical Disk Herniation (23) • Valslva Maneuver • Deep breath, bear down • Used to determine the presence of space occupying lesion (herniateddisc, tumor, tec) • May decrease pulse, increase intracranial pressure, decreases venous return, cause fainting • Positive test if pain increases

50. Commonly used tests for neurovascular dysfunction (24) • See previous slide