Name that Disorder
Pain radiating down the leg below the knee along the distribution of the sciatic nerve is usually related to mechanical pressure or inflammation of lumbosacral nerve roots.
Sciatica
Lower leg pain with loss of knee or ankle motion, swelling of knee, calf, or ankle with calf tenderness and erythema.
DVT
Role of osteoclasts
Remove Bone
Effect of aging on bone mass
A balance between osteoblasts and osteoclasts is disrupted
Induces loss of bone mass and ultimately osteoporosis
Pain around the ankle that extends to the plantar surface of the toes. Possibly made worse by walking and may be the result of tibial nerve compression from a space-occupying lesion. Burning pain, numbness in the plantar surface of the foot.
Tarsal Tunnel Syndrome
A systemic skeletal disorder characterized by low bone mass and microarchitectural deterioration of bone.
Osteoporosis
Pain with urination, urinary frequency, low-grade fever, sweats, or blood in the urine and positive murphy percussion test if kidneys are involved
Obstruction, infection, inflammation, or compression of the ureters
Side Note: May cause pain into the low back and flank that radiates anteriorly to the ipsilateral lower abdomen and upper thigh
The cells mainly responsible for bone formation.
Osteoblasts
Two main sources of Vitamin D
1. Diet
2 UV light
Cause unilateral or bilateral low back, hip, buttock, groin, or leg pain along with intermittent claudication and trophic changes of the affected lower extremity. Burning, cramping, or sharp pain
Peripheral vascular disease (PVD)
Occurs when one or several cells in the parathyroid gland lose their ability to be regulated, developing excessive release of parathyroid hormone
Primary hyperparathyroidism (PHPT)
Unusual bleeding, easy bruising, unintentional weight loss,fatigue, fevers,worsening pain (duration and intensity), sweats, dyspnea, lymphadenopathy
Cancer- Lymphoma, Leukemia, Myeloma
Two factors that can influence bone remodeling cycles.
1.Aging
2. parathyroid hormone (PTH)
3. serum vitamin D
True or False: Anterior thigh pain produced by systemic cause is often the same as that presented for pain resulting from neuromusculoskeletal causes
True
Dull, aching discomfort, or sharp pain in the thoracolumbar area in a beltlike distribution with pain extending to the groin or legs. Can be unilateral or bilateral with or without radicular symptoms.
Spinal cord tumors
Lymph nodes in the groin area can become enlarged specifically as a result of sexually transmitted disease
Hodgkins
Night pain, localized swelling or warmth, history of trauma with persistent or worsening symptoms despite restricted loading of the area.
Tumors (Benign or Malignant)
Name three Red Flag Histories associated with lower extremity
Previous history of cancer
Previous history of renal or urologic disease such as kidney stones and urinary tract infections (UTIs)
Trauma/assault (fall, blow, lifting)
Femoral artery catheterization
History of infectious or inflammatory condition
Crohn’s disease (regional enteritis) or ulcerative colitis
Diverticulitis
Pelvic inflammatory disease (PID)
Reiter’s syndrome
Appendicitis
History of gynecologic condition(s):
Recent pregnancy, childbirth, or abortion
Multiple births (multiparity)
Other gynecologic conditions
History of alcoholism (e.g., hip osteonecrosis)
Long-term use of immunosuppressants (e.g., Crohn’s disease, sarcoidosis, cancer treatment, organ transplant, autoimmune disorders)
History of heart disease (e.g., arterial insufficiency, peripheral vascular disease)
Receiving anticoagulation therapy (risk factor for hemarthrosis)
History of acquired immunodeficiency syndrome (AIDS)-related tuberculosis
History Of Hematologic Disease Such As Sickle Cell Anemia or hemophilia
Two populations that are at increased risk for leg cramps.
Older adults, athletes, and pregnant women are at increased risk
Pain in the low abdominal, hip, or groin that may be involved in GI bleeding. Muscle spasms of iliopsoas with an increase in hip pain and flexion spasms or contracture. Other symptoms are melena, hematemesis, and fever.
Hemophilia
Considered a systemic bone disease that is most accurately described as a localized disorder of bone remodeling that may occur at multiple sites
Paget's Disease of bone (PDB)
A commonly asymptomatic disease but if symptoms are present the most common symptom is bone pain, bowing of a limb, thoracic kyphosis, and compression fracture, spinal stenosis, hypercalcemia, loss of hearing when the skull is involved, etc.,
Paget’s disease of bone (PDB)
Guidelines for immediate medical attention
Hint: Something the PT should be aware of for immediate medical help and imaging.
Painless, progressive enlargement of lymph nodes, or lymph nodes that are suspicious for any reason and that persist or that involve more than one area (groin and popliteal areas); immediate medical referral is required for a client with a past medical history of cancer
Hip or groin pain alternating or occurring simultaneously with abdominal pain at the same level (Aneurysm, colorectal cancer)
Hip or leg pain on weight-bearing with positive tests for stress reaction or fracture
The gold standard for diagnosis of osteoporosis
DXA
Chronic dull hip, thigh, or knee pain that is worse at night and is alleviated by activity and aspirin, and nonsteroidal anti-inflammatory drugs. Point tenderness over the lesion, restricted hip motion, antalgic gait.
Osteoid Osteoma