Clinical Syndromes Flashcards
Defn: Avascular Necrosis of the Femoral Head
Progressive eschemia and death of bone cells of the femoral head
Etiology: Avascular Necrosis of the Femoral Head
Disruption of arterial circulation due to trauma
MOI: Avascular Necrosis of the Femoral Head (2)
- Trauma - falls causing fx and dislocation causing damage to vessels
- Non-traumatic - long term corticosteroids, excessive alcohol causing occlusion of vessels
Symptoms: Avascular Necrosis of the Femoral Head (4)
- Pain: groin, prox thigh, glutes, increases with WB
- Limited ROM
- Axial loading increases symptoms
- Limb/Antalgic Gait
Modalities: Avascular Necrosis of the Femoral Head (2)
- Pulsed electromagnetic therapy
- Extracoporeal Shock Wave Therapy
TherEx: Avascular Necrosis of the Femoral Head (4)
- Stretch/ROM
- Strengthen
- Balance
- Gait training
Manual Therapy: Avascular Necrosis of the Femoral Head
Possible glides to facilitate ROM (depending on exam)
Education: Avascular Necrosis of the Femoral Head (3)
- Rest
- Limit smoking/drinking/steroid use
- Watch cholesterol levels
AD: Avascular Necrosis of the Femoral Head
Any device to offload the involved bone (femur)
HEP: Avascular Necrosis of the Femoral Head
Emphasis on gait and ROM
Defn: Piriformis Syndrome
Irritation or compression of the sciatic nerve caused by spasm or contracture of the piriformis muscle
MOI: Piriformis Syndrome (5)
- Overuse of glutes
- Inadequate stretching before/after activity
- Poor posture
- Prolonged sitting
- Trauma
Q: Who is Piriformis Syndrome more common in?
Women
Symptoms: Piriformis Syndrome (3)
- Pain, Numbness, and tingling over buttocks and down back of thigh
- Difficulty sitting
- Feeling of soreness
Manual Therapy: Piriformis Syndrome (3)
- Muscle Energy Techniques
- ST massage
- Myofasical release
TherEx: Piriformis Syndrome
Stretching - Figure 4 stretch
Modalities: Piriformis Syndrome (4)
- Moist Heat
- Ultrasound (+ stretching)
- Cold pack
- E-stim (after exercise/MT)
Education: Piriformis Syndrome (3)
- Rest
- Light and gradual stretching
- Posture
Q: What is the bimodal distribution of Femoral Neck Stress Fx?
- Young and active
- Elderly and osteoporotic
T/F: Men are more affected than women by femoral neck stress fx.
False, flip it
Defn: Femoral Neck Stress Fx
A Fx of the femoral neck that can be classified as either a compression or tension fx and puts the femoral head at a high risk of avascular necrosis
Classifications: Femoral Neck Stress Fx (2)
- Compression: inferior aspect of femoral neck
- Tension: superior aspect of femoral neck
MOI: Femoral Neck Stress Fx
Young = trauma
Older = falls/twisting
Typically fx 1-2 inches from the hip joint
Symptoms: Femoral Neck Stress Fx (4)
- Groin pain with activities
- Deep thigh pain
- May limp
- Pain eases with rest
TherEx: Femoral Neck Stress Fx (3)
Progressive, always with an emphasis on PAIN FREE movement
Acute (4-6 wk): NWBing to PWBing
Rehab (8-12 wk): FWB, progress from walk to run
Maintenance (12+wk): Monitor activities/form, increase distance
Manual Therapy: Femoral Neck Stress Fx
Joint mobilization once fx is healed
Modalities: Femoral Neck Stress Fx
Ice
Education: Femoral Neck Stress Fx
WB restrictions
AD: Femoral Neck Stress Fx
Crutches
Defn: Pubalgia
Groin pain in athletic individuals withouth inguinal hernia,
Pain from pubic symphsis to ASIS, can involves abdominal muscles/tendons/sheaths, inguinal ligament, adductor muscles, gracilis, pectineus, and iliopsoas
May also be known as a “sports hernia” (not an actual hernia)
Grades of Pubalgia (3)
1 = single/mutliple tears of rectus abdominis or adductor muscles
2 = partial avulsion from pubic symphsis
- = comples avulsion with micro tears
MOI: Pubalgia
Muscular imbalances between abdominals and adductors
Symptoms: Pubalgia (3)
- Insidious onset groin pain
- Hx of sudden tearing sensation
- Pulling sensation in groin with activity
Education: Pubalgia (3)
- Warm Up
- Rest
- NSAIDS
Modalities: Pubalgia (4)
- Ultrasound
- E-stim
- Hot pack
- Cold pack
TherEx: Pubalgia (3)
- Stretching as tolerated
- Strengthening (adductors, hip flexors/IR, abs, glutes)
- Proprioceptive training
Manual Therapy: Pubalgia
Transverse friction massage
Term: used to describe chronic, intermittent pain accompanied by tenderness to palpation overlying the lateral aspect of the hip
Trochanteric bursitis (TB)
Q: What is another name for trochanteric bursitis?
Greater trochanteric pain syndrome (GTPS)
Q: What can GTPS associted with? (4)
- Tendinitis
- Muscles tears
- Trigger points
- IT band disorders
MOI: GTPS (6)
- Chronic microtrauma
- Regional muscle dysfunction
- Overuse
- Acute injury
- Obesity
- Muscle fatigue
Q: What’s the profile for GTPS? (2)
- Femal:Male = 4:1
- 40-60 yo
Symptoms: GTPS (3)
- Persisent pain inthe lateral hip/buttocks
- Lying on affected side or prolonged standing provokes pain
- Sit>stand, stair climbing, high impact probokes pain
T/F: PT alone will cure GTPS.
False: need to eliminate the cause (prolonged standing)
Education: GTPS
Avoid MOI, side laying, hard surfaces and lose wieght
Modalities: GTPS (2)
- TENS
- US
AD: GTPS
Cusion/pads for protection, insoles if leng length discrepancy
TherEx: GTPS (3)
- Stretching
- Strengthening
- Functional exercises
MT: GTPS
Manipulations for mobility if needed
Symptoms: Hip Muscular Strain (Pull or Tear) (4)
- Pain over injured muscle
- Increased pain with contraction
- Swelling
- Loss of strength
Q: What muscles are commonly affected in Hip Muscular Strain (Pull or Tear) (3)
- Hamstrings (high speed movement)
- Quadriceps
- Adductors (socer/ice hockey)
MOI: Hip Muscular Strain (Pull or Tear) (6)
- Stretched muscled forced to suddenly contract
- Overstretching/Overuse
- Fall/direct blow
- Inadequate warm up
- Lack of flexibilty
- Poor posture
Grade 1 Hip Muscular Strain (Pull or Tear) (2)
- Small tears in fibers
- Pain but minimal strength and ROM loss
Grade 2 Hip Muscular Strain (Pull or Tear) (3)
- More fibers torn, but lesion not complete
- Pain, swelling, and bruisin may occur
- Compromised strength, but still within NFL
Grade 3 Hip Muscular Strain (Pull or Tear) (2)
- Most fibers torn, in some cases complete ruptured
- Movement is difficult, not impossible, but loss of function
Education: Hip Muscular Strain (Pull or Tear)
RICE 48 hours after injury
Modalities: Hip Muscular Strain (Pull or Tear) (2)
- TENS
- US
MT: Hip Muscular Strain (Pull or Tear)
Gentle massage
TherEx: Hip Muscular Strain (Pull or Tear) (4)
- Isometric > isotonic > functional
- Subacute: cycling, treadmill
- Plyometric training
- Improve flexibility/posture
Defn: Trochanteric Bursitis
Inflammation of the bursa located on the superior lateral part of the thigh bone
Q: Apart from the greater trochanteric bursa, what is the other major bursa in the hip?
Iliopectineal bursa - front of the hip joint
MOI: Trochanteric Bursitis (5)
- Prolonged pressure
- Overuse
- Arthritis
- Injury
- Infection
Symptoms: Trochanteric Bursitis (3)
- Pain/tenderness with motion and at rest
- Pain over outer thigh
- Difficulty walking
Education: Trochanteric Bursitis (2)
- Explain MOI
- Identify and change aggravting factors
Modalities: Trochanteric Bursitis (4)
- Ice (Massage)
- Heat
- Ultrasound
- TENS
TherEx: Trochanteric Bursitis
Emphasize stretching
MT: Trochanteric Bursitis
Mobs to improve motion
AD: Trochanteric Bursitis
If a leg discrepancy exists gradually increase the height of the insoles
Defn: Baker’s Cyst
a fluid filled cyst that causes a bulge and feeling of tightness behind your knee, typically develops in the gastrocnemius-semimembranosus bursa
Q: Who is a Baker’s Cyst more common in?
Typically unilateral and medial, twice as common in men
MOI: Baker’s Cyst
Inflammation of the joint can cause an excess of synovial fluid
Q: What is the difference between primary and secondary Baker’s Cyst?
Primary = no knee pathology
Secondary = underlying knee problem
Symptoms: Baker’s Cyst (4)
- Swelling
- Pain with flexion and extension
- Stiffness
- Clicking, locking, buckling
Modalities: Baker’s Cyst
Ice and Compression (RICE)
TherEx: Baker’s Cyst (2)
- Strengthening
- ROM
Education: Baker’s Cyst (3)
- RICE
- Educate about Cause
- Prognosis
Defn: Osgood-Schlatter’s Disease
A benign traction apophysitis (inflammation of an apophysis) that occurs in the tibial tubercle
MOI: Osgood-Schlatter’s Disease
During periods of rapid growth, stress from repetitive quad contractions is transmitted through the patellar tendon onto the partially developed apophysis
Can result in avulsion fx, inflammation of the tendon, and heterotrophic bone formation
Symptoms: Osgood-Schlatter’s Disease (3)
- Pain with activities
- Viisible lump over site
- Pain with knee extension
Q: What is the typical population of Osgood-Schlatter’s Disease?
11-18 yo, boys > girls, typically unilateral
Modalities: Osgood-Schlatter’s Disease
Ice
Education: Osgood-Schlatter’s Disease
- Avoid aggravating factors
- Rest
- Length of recovery (can be 1-2 years)
AD: Osgood-Schlatter’s Disease
Infrapatellar strap
MT: Osgood-Schlatter’s Disease
Patellar glides
TherEx: Osgood-Schlatter’s Disease (3)
- SLR
- Stretching
- Knee stabilization
Defn: Femoral Condyle Injury
Focal articular cartilage defect - osteochondritis dissecans lesion
Typical Profile: Femoral Condyle Injury (3)
- Sports trauma (most common cause)
- 12-35 yo
- Males > females
Symptoms: Femoral Condyle Injury (5)
- Focal tenderness
- Swelling/Joint effusion
- Catching
- Limited ROM
- Pain with WB
Conservative Treatment: Femoral Condyle Injury (4)
- Bracing
- ROM/Strength
- Pt Education
- Corticosteroid injections
T/F: Lateral meniscus injuries happen more often then medial meniscus injuries.
False: Flip It
MOI: Meniscus Injury (2)
- Trauma/Sports (Non-Contact)
- Degenerative
Q: What type of forces can cause traumatic meniscus injury? (3)
- Compression + rotation
- Flexion OR extension + rotation during WB
- Sudden acceleration/deceleration with direction change
T/F: Meniscal injuries are associated with cruciate ligament injuries.
True