Differential Diagnosis for Physical Therapy: Hematological, Cardiovascular, Immune, and Digestive System Disorders: Summary 125
• Signs and symptoms: fever, chills, genral weakness, headaches, inflammation and painful swelling of one or more joints of the body Fibromyalgia: Generalized musculoskeletal pain and tenderness to touch, sleep disturbances, and fatigue • Signs and symptoms: generalized fatigue, reduced physical endurance, generalized aches and pains of muscles, tendons, and ligaments (tender points), insomnia, temperature deregulation, headache, morning stiffness Guidelines for Physician Referral • New onset of joint pain within six weeks of surgery, especially when accompanied by constitutional symptoms, rash, or skin lesions • Symmetric swelling and pain in peripheral joints may be early sign of RA • Development of progressive neurologic symptoms within one to three weeks of a previous infection or recent vaccination • Evidence of spinal cord compression in anyone with cervical RA who has progressed from generalized stiffness to new onset of cervical laxity • Presence of incontinence (bowel or bladder) in anyone with AS requires medical referral • Positive ptosis tests for MG SCREENING FOR DIGESTIVE SYSTEM DISORDERS • Can cause referred pain to left shoulder, scapula, mid-back, and hip • Pain in left shoulder (Kehr’s sign): Referred pain ○ Occurs as a result of free air/blood in abdominal cavity (e.g., ruptured spleen) ○ Diagnostic interview helpful in determining if trauma has occurred prior to experiencing shoulder pain ○ Test: Supine/lower extremity elevated
○ Joint pain: Typically first symptom ○ Raynaud’s
• Prognosis: Varies widely • Diagnosis: Antibody tests
Polymyositis/Dermatomyositis: Illnesses that result in damage to connective tissue, skin, and muscles, causing weakness • Cause is unknown, though environmental factors (viral infections) may play a role, as may genetic factors • Seen most commonly in 5- to 14-year-olds and 45- to 64-year-olds • Signs and symptoms: skin rash cardinal symptom that precedes weakness (proximal), weight loss, fever/malaise, periods of flares or relapses Ankylosing Spondylitis (AS): “Marie- Strumpell” disease: Inflammation of fibrous tissue affecting the insertions of ligaments and capsules into bone (sacroiliac joints, spine, etc.) • Unknown etiology, possibly a genetic link, typically affecting men under 40 years old • Chronic, progressive, systemic • Insidious onset of low back pain/stiffness for more than three months • Prone to fractures
LEARNING TIP! Ankylosing Spondylitis signs and symptoms: • Fatigue • Anorexia • Fever • Loss of lumbar lordosis • Low back pain
Bacterial Arthritis: Can be caused by gonococci, staph, strep, and enterobacteria • Begins with infection such as pneumonia, sinusitis, or urinary tract infection • Bacteria travel through bloodstream to invade and infect synovium
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