Bone bruising

• Local pain and tenderness
• May present as a visual, hard palpable lump
• Swelling
• Joint stiffness
• Decreased mobility
• Change of colour (black and blue)
• Common in contact sports, physically demanding job, or lack of protective equipment worn
• Rest from aggravating activities, ice, compression, moon boot
• MRI scan

Fracture fibula, talus

• History of trauma
• Immediate swelling
• Tender to touch
• Bruising
• Limping
• May have visible signs of deformity
• Unable to weight bear
• Diagnosed via X-ray

Stress fracture – fibula

• Tenderness over region
• May not walk with a limp
• Sore to weight bear, but can still walk
• Minor swelling
• May have no visible sign of deformity
• Sore to move ankle actively
• Common in repetitive activity, sports, and running
• Diagnosed via: X-ray, MRI, Bone scan
• Treated with moon boot for 6-8 weeks

Osteophyte / Spurs

• Stiffness feeling in ankle joint
• Loss of mobility, feels restricted
• Painful to weight bear
• No sign of visible deformity
• May cause locking of ankle joint
• May produce swelling
• Diagnosed via X-ray

Post trauma swelling (Unresolved 1-9 months)

• Pain on lateral ankle
• Painful to push on
• May have dough like feeling on palpation
• Decreased ankle movements
• May have bruising
• Painful to walk after 20 minutes
• Common after ankle sprains or surgery
• Diagnosed through case history of trauma, observation, and palpation
• Treatment: Effleurage massage combined with inhibition pressure point therapy to help break down congestion and increase blood flow and lymphatic drainage

Congested Oedema

• Swelling or puffiness
• Skin often becomes stretched or shiny
• May present with varicose veins

Caused by:

• blocked veins
• Lymphodema
• Overweight
• High salt diet
• Pregnancy
• Overweight
• Kidney disease
• Liver disease
• congestive heart failure
• Medications (blood pressure, contraceptive pill, anti-depressants, hormone therapy, steroids)

Osteoarthritis (F > M 50+)

Degeneration of joint cartilage and underlying bone

• Stiff, tender, and swollen joints
• Morning stiffness lasting up to 30 minutes
• Aches and pains in muscles
• Decreased joint range of motion
• Fatigue feeling or tiredness
• Can cause physical deformity

Caused by

• Increased weight (obesity)
• Females > Males
• Increased age
• Joint injuries
• History of fractures
• Repeated stress on joints (repetitive activities)
• Genetics
• Bone deformities
• Metabolic disorders

Diagnosed via: X – rays, observation for physical deformity

Treatment: Condition can not be reversed. Treatment is aimed at reducing symptoms and increasing range of motion

• Manual therapy to help with surrounding soft tissue structures
• Exercise to help strengthen muscles and joints
• Medications to help reduce inflammation
• Cortisone injections into joint
• Surgery for joint replacements

Rheumatoid arthritis

Definition: an autoimmune disease, where the body mistakes its own cells as foreign invaders.

This causes an attack of the body’s joint synovium by inflammatory chemicals. Flare ups may

last from months to a lifetime with symptoms being episodic in nature.

Symptoms: (mimics many other arthritic conditions in early stages)

• Insidious onset of pain and stiffness, swelling and warmth that begins with thesmall joints of the hands and/or feet.
• Commonly affects people aged 25-45 years old.
• More than 1 joint is affected, usually bilateral involvement
• Symmetrical involvement of the metacarpophalangeal or metatarsophalangeal joints
• Symptoms may come and go
• Morning stiffness which can last hours
• Fatigue, low-grade fever, weakness
• Soft tissue swelling
• Joint effusion and synovial swelling
• Tenderness on palpation or movement of joint
• Joint Deformities (Boutonniere, Swan Neck, Z deformity of wrist, Ulnar deviation)

Caused by:

• Genetics: gene HLA-DR1
• May be associated with poor diet (high in red meats, processed meats, refined grains, fried foods, high fat dairy and sugar can increase chances of developing RA

Examination:

• Physical examination of joints observing for swelling, warmth, redness, tenderness, decreased range of motion, palpation of joint line irregularities, and joint deformity.
• Morning stiffness lasting more than 30 minutes
• Blood tests will be looking to diagnose:
  1. Rheumatoid factor
  2. Erythrocyte sedimentation rate (ESR)
  3. Full blood count (CBC)
  4. CCP antibodies
  5. Antinuclear antibody (ANA)
  6. C – reactive protein (CRP)

Treatment:

• Disease Modifying Anti -Rheumatic Drugs (DMARDs)
• Analgesics and NSAIDs
• Education on exercises
• Hydrotherapy
• Diet – introducing omega3 and fish oils
• Acute flare ups require rest
• Rheumatologist management

Prognosis:

• Fair to poor. Depending on number of symptoms. Can last for months to a lifetime depending on flare ups and management.

Psoriatic arthritis (M=F 30-55)

Definition: chronic, autoimmune form of arthritis that causes joint inflammation and occurs with the skin condition psoriasis. Immune system attacks healthy cells in the body by mistake causing symptoms

Symptoms:

• Red patches of skin topped with silvery scales
• Multiple joint pain, stiffness, and swelling
• Swollen fingers and toes
• Nails may form pits, crumble, or separate from the nail beds.
• May present similarly as Ankylosing spondylitis

Caused by:

• Genetic predisposition (HLA-B27 gene)
• May be triggered by a viral or bacterial infection when genetically predisposed
• Physical trauma to joints may predispose to Psoriatic arthritis
• Psoriasis skin condition often predisposes Psoriatic arthritis

Examination:

• Observe for signs of swelling and tenderness around joint
• Pitted fingernails
• May present unilaterally or bilaterally
• PsA should be suspected in any patient who has psoriasis and arthritis, however it may be present in both
• Blood tests provide negative Rheumatoid factor
• Joint fluid test. Small fluid is aspirated from affected joint and examined for uric crystals which will indicate gout rather than PsA )
• X- ray to examine for joint destruction

Treatment

• DMARDS
• NSAIDS
• Management through Rheumatologist
• UV Light therapy for skin issues
• Steroid injections
• Joint replacement surgery
• Manual therapy to help increase joint ROM and reduce muscle HT

Prognosis:

Fair to poor. Although a chronic condition with no cure, condition can be managed conservatively with Rheumatologist, medications, and manual therapy

Reactive arthritis (Reiter’s syndrome M>F 20-50)

• Auto immune condition that develops in response to an infection
• Common infections found are Sexually transmitted (Chlamydia Trachomatis)
• Currently no cure
• Sausage-like swelling in fingers and toes
• Morning joint stiffness
• Pain, tenderness, swelling in your joints and tendons
• Low back pain
• Eye irritation
• Burning sensation on urination
• Symptoms may only last up to 6 months
• HLA-B27 genotype is predisposing factor in 65% of patients
• Blood and infection tests
• Antibiotics, Non steroid anti inflammatory medications, Steroids, Immunosuppressive medications, rest, and light exercise to help strengthen muscles and improve joint function

Reflex sympathetic disorder / Complex regional pain syndrome (CRPS)

• Chronic limb pain
• Pain is greater than expected than injury that may have caused it
• Continuous throbbing, burning, numbness and tingling
• Sensitive to touch (painful)
• Skin colour and temperature changes
• Not well understood
• May be post-surgery, injury, stroke, or heart attack
• May involve abnormal inflammation or nerve dysfunction

Treatment: Challenging to manage as results vary between patients. Some options may include:

• Acupuncture
• Pain relief medication, anti inflammatory medication
• Nerve block injection, morphine
• Intravenous Ketamine
• Manual / Physical / Exercise therapy
• Meditation, relaxation therapies