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KIN 3160 > Chronic MSK injuries > Flashcards

Chronic MSK injuries Flashcards

1
Q

what are the three challenges with chronic MSK injuries?

A

1) diagnosis
- requires comprehensive history of onset, nature, and pain
- as well as an assessment of risk factors such as training and technique
2) understand exactly how the injury occurred (etiology)
- can be quite evident or very subtle
- causes can normally be divided into extrinsic or intrinsic factors
3) treatment
- address the cause
- as well as activity modification, specific exercises to promote tissue repair, and manual therapy

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2
Q

7 extrinsic predisposing factors for chronic MSK injuries

A

1) training errors
- excessive volume or intensity
- rapid increase
- sudden change in type
- excessive fatigue
- inadequate recovery
- faulty technique
2) surfaces
- hard/soft
3) inappropriate/worn out shoes
4) inappropriate equipment
5) environmental conditions
6) psychological factors
7) inadequate nutrition

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3
Q

6 intrinsic predisposing factors to MSK injuries

A

1) malalignment
- pes planus/cavus, rearfoot varus
- genu valgum/varum
- patella alta
- femoral neck anteversion
- tibial torsion
2) leg length discrepancy
3) muscle imbalance/weakness
- can lead to pelvic rotation/ quad/hamstring balance
4) lack of flexibility
- general muscle tightness
- focal areas of muscle thickening
- restricted joint ROM
5) sex, size, and body composition
6) other:
- genetic factors
- endocrine factors
- metabolic conditions

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4
Q

muscle cramp - def./etiology

A

def: painful involuntary muscular contractions that occur suddenly and are temporarily debilitating
- most common in muscle that are overloaded and fatigued during high demand activities (calf, hamstrings, quadriceps, or abdomen)

Due to altered NM control rather than fluid/electrolyte imbalance:

  • increased muscle spindle activity, and decreased GTO activity (mechanoreceptors) - over fatigued muscles
  • causes continued muscle contraction
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5
Q

muscle cramps: treatment

A
  • regular stretching
  • correct muscle imbalances and posture
  • good fitness levels (S and C program)
  • incorporate plyometric exercises into training
  • CHO diet
  • massage or trigger pointing therapy
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6
Q

muscle guarding - def.

A

muscle surrounding an injury site contract to splint and protect the area
-minimize pain my limiting movement

-common in whiplash and low back pain

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7
Q

muscle soreness - def

A

result of unaccustomed or repetitive activity participation

-older athletes are more susceptible

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8
Q

what are the two types of muscle soreness?

A

1) acute onset: accompanies fatigue; immediate and transient
2) delayed onset (DOMS): most intense 24-48 hours after activity
- appears 12 hours after activity, can last for 3-4 days
- S&S: pain leading to increased muscle tension, swelling, and stiffness/resistance to stretching

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9
Q

what are the causes of DOMS?

A
  • very small tears in the muscle tissue, due to eccentric isometric contractions
  • disruption of the connective tissue surrounding muscle.tendon fibers
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10
Q

how can we prevent DOMS?

A
  • properly planned training program (periodization)

- proper warm up/cool down

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11
Q

how can we treat DOMS?

A

-massage, cryotherapy, stretching and active recovery

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12
Q

tendinopathy - def.

A

any pathology in a tendon

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13
Q

tendinitis - def

A

inflammation of a tendon

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14
Q

tendinosis - def

A

tendon degeneration without inflammation

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15
Q

tenosynovitis - def

A

inflammation of the synovial sheath of a tendon

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16
Q

what are the three stages of tendon pathology

A

1) reactive tendinopathy
- non inflammatory response to tendon cells and matrix proteins; proliferation of tendon cells to get short term thickening to reduce stress
2) tendon dys-repair
- matrix breakdown; tendon cells that are present in larger numbers and changed appearance; protein production increases (collagen and matrix); collagen separates and matrix become disorganized
3) degenerative tendinopathy
- tendon cells and matrix continue to change (cell death); matrix becomes more disorganized; collagen is weak (type 3) and decreased

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17
Q

tendinitis - etiology and S and S

A

etiology: with repeated movements, a tendon becomes irritated or inflamed from sliding over other structures

S&S: pain on movement, swelling, warmth, and crepitus

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18
Q

what are the common injury sites of tendinitis?

A

achilles tendon in runners, shoulder in swimmers, and elbow in racquet sports

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19
Q

how can we treat tendinitis?

A

REST

  • allow the normal healing process (inflammatory phase) to occur
  • perform cross-training activities

-swimming takes stress off tendons, don’t need to be completely sedentary

20
Q

tendinosis - etiology and S&S

A

etiology: when repetitive overuse movement continues and the inflamed tendon fails to heal

S&S:

  • pain after exercise, or more frequently, the following morning
  • pain-free at rest and becomes more painful with activity
  • pain disappears when warm up, but returns after cool down
  • in early stages, can still full train (although it interferes with healing)
  • local tenderness and or thickening on examination
  • swelling and possibly crepitus (crepitus more typical of tendinitis)
21
Q

tendinosis: treatment

A

1) strengthening
- progressive loading
- isometric - eccentric - plyometric
2) stretching
- static, dynamic of PNF (proprioceptive neuromuscular facilitation) depending on the individual and activity participation

22
Q

tenosynovitis: etiology and treatment

A

etiology: tendons that have a tight space through which they move are surrounded by a synovial sheath
- hand and wrists, feet and ankles, proximal biceps tendon
- repetitive movements cause inflammation when tendon rubs over the bony prominence

treatment: similar to tendinitis (rest)
- anti-inflammatory drugs

23
Q

osteoarthritis - def

A

degeneration of the articular (hyaline) cartilage

-most common in weight bearing joints (knees, hips, and lumbar spine)

24
Q

what are the causes of osteoarthritis?

A

wear and tear from normal ADLs (common in older individuals)

-mechanical changes to the joint due to acute or chronic trauma

25
Q

stage I osteoarthritis

A

-minimum disruption, there is already 10% cartilage loss

26
Q

stage II osteoarthritis

A

joint space narrowing

  • the cartilage begins to break down
  • occurrence of osteophytes
27
Q

stage III osteoarthritis

A

moderate joint space reduction

-gaps in the cartilage can expand until they reach the bone

28
Q

stage IV osteoarthritis

A

joint space greatly reduced

  • 60% of the cartilage is already lost
  • large osteophytes
29
Q

what are the S&S of osteoarthritis

A
  • pain with activity, relieved with rest
  • stiffness, especially in the morning) decrease with activity)
  • localized tenderness, creaking, and grating sensations
30
Q

osteoarthritis: treatment

A
  • decrease body weight (puts more force on the joint - more wear and tear)
  • anti-gravity treadmill (decreases a person’s weight so they can exercise with less pain)
  • glucosamine sulfate (promotes healthy cartilage)
  • joint replacement (partial or full)
31
Q

capsulitis and synovitis - etiology

A
  • chronic inflammatory following repeated joint injuries or improperly managed injury
  • joint capsule tightens
  • synovium irregularly thickened and exudation present (joint edema)

-typically comes from another injury, when immobilized for long periods of time

32
Q

what are the S&S of capsulitis and synovitis?

A

-restricted joint ROM, grinding or creaking noises

33
Q

capsulitis/synovitis: treatment

A

-joint mobilization, ROM exercises, and stretching surrounding musculature

34
Q

stress fracture

A
  • inability of bone to withstand repetitive mechanical loading (osteoCLASTIC activity surpasses the osteoBLASTIC activity)
  • resulting in structural fatigue (micro damage) and bone marrow edema
  • body will try to form new periosteal bone to reinforce (stress reaction, to stress fracture, to complete bone fracture
35
Q

stress fracture: S&S

A
  • swelling
  • focal tenderness
  • pain with activity, but not at rest - later pain is constant, including at night
36
Q

what are the 4 main causes of a stress fracture?

A

1) overtraining
- frequency, volume, or intensity
2) faulty posture and biomechanics
- leads to abnormal bone loading
3) training surface
- recent changes to a surface the athlete is unaccustomed to
- less compliant, very compliant, downhill, or altered terrains
4) footwear and equipment
- old or worn out shoes lose shock absorption
- orthotics influence mechanics of foot, ankle, and kinetic chain

37
Q

stress fracture classification: low risk

A

usually just requires rest or activity modification

  • pelvis
  • femoral shaft
  • medial tibia
  • calcaneus
  • metatarsals (1-4)
38
Q

stress fracture classification: high risk

A

can experience non-union or complete fractures

  • femoral neck
  • anterior tibia
  • medial malleolus
  • talus
  • navicular
  • 5th metatarsal
  • sesamoid bones of big toe
39
Q

stress fracture: diagnosis

A

-early detection is difficult

Clinically:

  • complaint of localized pain during or after activity and persists if activity is continued
  • review of training history (volume or intensity), surfaces and equipment (i.e. footwear)
  • physical examination looking for point tenderness and special tests (percussion fracture test)
  • bone reaction can take several weeks to detect via imaging
  • X-ray may appear normal, might require a bone scan or an MRI
40
Q

stress fracture: treatment

A
  • rest and activity modification
  • gradual RTP to adapt to loads or stress once pain free and no point tenderness upon palpation
  • maintain fitness levels without impact
  • correct any training or biomechanical errors
  • consider cushioned shoes or rigid orthotics (if abnormal biomechanics in foot)

Therapy options:

  • electric stimulation or shockwave therapy
  • drugs (i.e. pamidronate)
41
Q

what are the locations in which a stress fracture would require specific treatment other than rest?

A

femoral neck, talus, navicular, metatarsal - 2nd base, sesamoid bone of the foot, metatarsal - 5th base, and anterior tibial cortex

42
Q

periostitis - def

A
  • inflammation of the periosteum (outer layer of bone)
  • at the interface between the muscle and the bony attachment
  • most common condition: medial tibial stress syndrome (MTSS)
  • “shin splints”
  • pain on lower medial aspect of tibia
43
Q

apophysitis - def

A
  • irritation and inflammation of the apophysis, a secondary ossification center which acts as an insertion site for a tendon
  • common overuse injury in young athletes (susceptible because of repetitive stress or an acute avulsion injury) (before you’ve reached full growth potential - skeletally mature)
44
Q

what are two examples of apophysitis?

A

1) Osgood Shlatter’s disease: inflammation of the patellar ligament at the tibial tuberosity
2) Sever’s disease: inflammation of the growth plate in the heel of growing children (calcaneal apophysitis)

45
Q

neuritis - def

A
  • inflammation of a nerve
  • symptoms can range from minor to severe

minor: pain, paresthesia (pins and needles), paresis (weakness), hypoesthesia (numbess)
severe: anesthesia (sensory loss), paralysis (motor loss), muscle wasting, and disappearance of the reflexes

46
Q

blisters - def

A
  • collection of fluid below or within the epidermis
  • due to horizontal shearing and compressive forces
  • common on hands, feet, depending on sport
47
Q

bursitis - def

A

Inflammation of bursa

  • bursa facilitates movement of tendons over bony prominences, reducing friction
  • excessive shearing and/or compressive forces causes inflammation

common in knee, hip, and shoulder

KIN 3160 (10 decks)

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