Term
| Pregnancy Musculoskeletal Changes |
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Definition
There are changes in the female’s anatomy and physiology during pregnancy, including increased mobility of all pelvic joints, due to increased relaxin and progesterone levels. This leads to the posture typical for the pregnant female:
Increased lumbar lordosis
Anterior tilt of the pelvis
Outflare of ilia
External rotation of the hips
Low back pain is common during pregnancy. Musculoskeletal complaints can be minimized by exercises for strength, posture, and flexibility. In the latter stages of the pregnancy there may be complaints of upper extremity weakness and paresthesia, possibly due to forward head posture and increased thoracic kyphosis. Other changes:
There is an average weight gain of 25-30 pounds, which may contribute to fatigue and low back pain
Diastasis recti, as a result of increased levels of relaxin and/ or mechanical stretch, occurs more frequently in the last trimester.
The physical therapy implications of diastasis recti include:
Decreased performance of the abdominal musculature
There is a need to protect the muscles against further stretching while performing exercises |
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Term
| Pregnancy Vascular Changes |
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Definition
Vascular changes: a 50% increase in intravascular volume, primarily due to increase in plasma, resulting in a fall in hematocrit
There are changes in blood chemistry and hematological values
Blood pressure usually drops (8-10 mmhg), mostly during 20th to 24th week, gradually rising thereafter up until the 40th week
Heart rate is increased 12-18 bpm and cardiac output increased 1/3
There is increased risk of hemorrhoids and varicose veins
A decrease in venous return from the lower extremity, because of fetal pressure.
Physical therapy implications of decreased venous return include:
There may be hypotension in the supine position, so keep that in mind when positioning the patient for treatment; left side lying preferred
Exercises should not be performed in supine in the later stages of the pregnancy
Physical therapist needs to advise patient to change position if dizzy in the supine position |
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Term
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Definition
There is dilatation of the urinary tract during pregnancy, due to biomechanical and hormonal factors. There is also a partial obstruction of the ureter because of the enlarging fetus. The physical therapy significance of this includes:
Patient should empty the bladder before and after exercise
Strong pelvic floor musculature helps to support these structures |
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Term
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Definition
Because of insulin resistance that occurs early in pregnancy, elevation of glucose levels is prolonged after meals. There may be abnormal carbohydrate metabolism, sometimes diagnosed as having pregnancy induced glucose intolerance. Risk factors include:
Previous glucose intolerance
Higher age
Family history of diabetes
Birth weight of previous baby above 9 pounds
Recurrent urinary tract infection |
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Term
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Definition
There are changes in respiration during pregnancy, both due to increased oxygen demand, mechanical effects (pressure of fetus on diaphragm) and hormonal effects, including the stimulating effect of progesterone. Some consequences of this include:
Increased demand on accessory respiratory muscles, possibly resulting in thoracic outlet syndrome
Dyspnea |
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Term
| Pregnancy Osteonecrosis And Osteoporosis |
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Definition
Transient osteoporosis, with hip and leg pain made worse with weight bearing, occurs in the last trimester. This is typically a self-limited condition. Another rarely occurring condition is osteonecrosis. This results in prolonged rehabilitation, requiring limited weight bearing and possibly surgical intervention. The etiology of both conditions is unclear. Referral to a physician is recommended if these conditions are suspected.
Pain in the inguinal area or around greater trochanter, possibly radiating to the anterior thigh
Limited hip range of motion
Limited functional weight bearing
Condition is self-limiting in 2-12 months |
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Term
| Pregnancy Other signs and symptoms during pregnancy : |
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Definition
Nausea and vomiting
Urinary frequency
Edema of hands and feet
Breast tenderness
Fatigue |
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Term
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Definition
1. Classic triad
Pain
Gross hematuria
Abdominal mass
2. Pain is located in the flank or abdominal areas
3. Weight loss
4. Anemia
5. Fever
6. Metastasis occur in approximately 10% of the patients
Lungs (60%)
Local nodes (35%)
Liver (30%)
Bone (30%)
Adrenal (20%) |
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Term
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Definition
Inability to concentrate
Increased deep tendon reflexes
Proximal muscle weakness
Paresthesias
Note that these changes will neither follow normal dermatomal or myotomal patterns, nor peripheral nerve distribution. |
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Term
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Definition
Pain complaints related to locally decreased bone density
Fracture risk with manual therapy techniques |
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Term
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Definition
1. Azotemia: elevation of blood urea nitrogen (BUN) and creatinine due to decreased in glomerular filtration rate (GFR)
2. Uremia: azotemia plus clinical signs and symptoms associated with renal failure
3. Prerenal azotemia: occurs with hypo-perfusion of the kidney, congestive heart failure, shock, volume-depletion, and hemorrhage
4. Post-renal azotemia: occurs with urinary outflow obstruction below the level of the kidney |
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Term
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Definition
B. Clinical Presentation
1. Asymptomatic testicular masses
2. Significant delay in diagnosis is common
3. Masses may or may not be painful
4. Other presenting signs/symptoms:
● Back/abdominal pain secondary to retroperitoneal adenopathy
● Weight loss
● Dyspnea (lung metastases)
● Gynecomastia
● Supraclavicular lymphadenopathy |
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Term
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Definition
1. Generalized symptoms:
-malaise
-fever
-chills
-arthralgia
2. Perineal pain
3. Irritative voiding symptoms
4. Obstructive voiding symptoms
5. Low back pain
-very low location, mid sacral area
-central location
-frequent missed diagnosis in patients with “mechanical LBP” |
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Term
| Benign Prostatic Hyperplasia |
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Definition
C. Clinical Presentation
1. Obstructive voiding symptoms, usually starts in the central part of the gland
2. Acute urinary retention
3. Urinary tract infection
4. No association between BPH and cancer
5. 25% need surgery |
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Term
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Definition
1. Early disease, 5 to 10% present in this stage:
● No symptoms, cancer usually starts at the periphery of the gland
● Diagnosed by screening rectal examination
2. Late disease, 75% of patient present in this stage:
● Frequently present with obstructive voiding symptoms
● Local pain due to local spread to the pelvis and regional lymph nodes:
● Periaortic nodes
● Mediastinal lymph nodes
● Supraclavicular lymph nodes
3. Late metastatic stage:
● Bone (osteoblastic lesions), resulting in bone pain
● Lung
● Liver
● Brain
● Other systemic complaints (see unit 1)
o anemia
o weight loss |
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Term
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Definition
1. Symptoms varied depending on growth, site and severity
2. Classic triad:
Dysmenorrhea: occurs in 1/3 of the patients (not correlated with severity)
Dyspareunia, that will not change with a change in position
Infertility
3. Pain is diverse:
Low back and pelvic pain common
Lower thoracic pain
Thigh/sciatic pain
Shoulder strap pain, bilateral or unilateral
4. Pain is increased around the time of menstruation |
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Term
| Pelvic Inflammatory Disease |
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Definition
1. Vaginal discharge
2. Frequently associated with dysuria/frequency
3. Pain, anorectal, midline abdominal, bilateral, lower abdominal pain
4. Referred pain to the shoulder area
5. Usually low grade fever |
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Term
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Definition
1. 40% will present with life threatening, acute rupture
2. 60% will present with chronic tubal rupture
3. woman may or may not have suspected pregnancy
4. menstrual periods frequently replaced with variably, delayed, slight vaginal bleeding
5. 80% of patients will have some vaginal bleeding
6. symptoms frequently vague and inconclusive
7. classically:
-sudden onset of sharp stabbing pain
-pain may be of gradual onset
8.pain location:
-lower back
-one or the other hip
-shoulder strap pain, especially with inspiration |
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