Common Musculoskeletal Conditions Flashcards
Common Conditions
Osteoarthritis
Rheumatoid arthritis
Osteoporosis
Fibromyalgia
Low back pain
Nerve injuries
What is osteoarthritis?
Breakdown of joint cartilage and/or bone overtime causing local inflammation.
Very normal part of aging regardless of activity levels, not a wear and tear condition.
Common joints this occurs in include hands, knees, hips, spine.
Diagnostic Criteria for Osteoarthritis
Clinical ssx = pain, stiffness, decreased ROM, swelling, grinding, or crepitus.
Imaging = xrays showing narrowing of joint space, osteophyte formation, etc.
Laboratory = inflammatory markers.
Treatment of Osteoarthritis
Strengthening and exercise.
Weight management
Nutrition
Injections
Bracing
Joint replacements (total hip replacement and total knee replacement)
GL:AD Program = looks at strengthening and exercise as number 1 focus, and offset surgery for as long as possible.
Common Clinical Assessments of Osteoarthritis
Posture
Gait pattern
Questionnaires
40m walk test (gait speed)
TUG
30s STS
Static balance (DL, SL, tandem)
Joint ROM
Grip strength
Back extension
What is rheumatoid arthritis?
Chronic, inflammatory, autoimmune condition affecting joints.
Inflammation of synovial membrane.
Typically affects hands and feet bilaterally (but can affect other joints too).
Diagnostic Criteria for Rheumatoid Arthritis
Diagnostic criteria involves score of >6/10 on ACR/EULAR scale.
Treatment for Rheumatoid Arthritis
Medications (NSAIDs, anti-rheumatic drugs, corticosteroids).
Strengthening of muscles
Aerobic exercise
Clinical Assessments for Rheumatoid Arthritis
Posture
Gait
Joint ROM
MMT
Grip strength
Pain scales
Questionnaires
What is osteopenia/osteoporosis?
Lower bone density and strength.
DEXA T-scores:
-> -1 = normal; -1 to -2.5 = osteopenia; <-2.5 = osteoporosis.
Treatment for Osteopenia/Osteoporosis
Weight bearing exercises
Low impact exercise
Resistance exercise
Calcium and vitamin D rich diets
Medications
Novel/new exercises
Clinical Assessments for Osteopenia/Osteoporosis
DEXA
Posture
Gait
Joint ROM (especially if spine is affected)
-note if there are any possible ROM restrictions put in place by doctors.
Fracture risk assessment tool (FRAX)
Balance and functional mobility tests
General strength tests (30s STS)
What is fibromyalgia?
Widespread musculoskeletal pain and fatigue, as well as sleep disturbances and cognitive changes (light and noise sensitivity, concentration and memory issues).
Causes is unknown = possible sensitivity and changes in neural pathways.
More common in younger (25-55y/o) women.
Diagnostic Criteria for Fibromyalgia
Widespread pain index (WPI) score greater than or equal to 7 and symptom severity scale score greater than or equal to 5, or WPI of 4-6 and symptom score greater than or equal to 9.
Symptoms present a similar level for at least three months.
No other explanation for the symptoms
Diagnostic sheet on slide 20.
Clinical Assessments for Fibromyalgia
Medical and injury history
Pain assessment and scales
Posture and gait
Joint ROM
Muscle strength testing (MMT or functional testing).
Aerobic fitness testing
Questionnaires (examples on slide 21).
What are the types of low back pain?
Mechanical Pain
Radicular Pain
Flexion dominant pain
Extension dominant pain
Neurogenic claudication
Inflammatory back pain
Chronic pain
Mechanical Pain
Originates from the muscles, ligaments, joints, or bones in the spine (mostly muscle and most common).
Radicular Pain
Occurs when a spinal nerve root is impinged or inflamed.
Referral of pain down legs is common.
More of a burning type of pain (ie. sciatica).
Flexion Dominant Pain
Often associated with disc injuries, this pain typically worsens with bending forward or sitting for long period of time (ie. herniation).
Extension Dominant Pain
This type of pain usually increases with standing or walking and may be related to conditions like spinal stenosis (impacts nerves a little more).
Neurogenic Claudication
A type of pain associated with spinal stenosis, characterized by leg pain that worsens with walking or standing.
Inflammatory Back Pain
This type is often associated with conditions like ankylosing spondylitis.
Is characterized by pain that improves with activity and worsens with rest
Chronic Pain
persistent pain lasting over 12 weeks, often severe.
Clinical Assessments for Low Back Pain
Medical and injury history
Pain levels and description
Posture and gait
Spine, pelvis, and hip ROM
Nerve assessments for L4-S1 motor nerves and dermatomes.
Straight leg raise (SLR)
Slump test.
What are nerve injuries?
Any injury where the nerve is compressed or stretched that causes damage to the nerve and its connective tissue.
Neuropraxia (class 1) - axonotmesis (class 2) - neurotmesis (class 3)
Ssx will differ depending on nerve impacted and if the motor or sensory nerve is involved.
-motor deficits, lack of strength, abnormal sensations (pins and needles, numbness, hot or cold), pain
Common nerves injured include brachial plexus bundle, sciatic nerve, femoral nerve, medial nerve (carpal tunnel syndrome), radial nerve.
Neuropraxia
Class 1
Nerve is compressed
Axonotmesis
Class 2
damage to axon is starting to occur
Neurotmesis
Class 3
Lots of damage to nerve
Irreversible
Myotomes
Groups of muscles innervated by a single spinal nerve.
Dermatomes
Areas of the skin that are innervated by a single spinal nerve root.
Clinical Assessments for Nerve Injuries
Medical and injury history
Pain and ssx descriptions
Posture and gait
Joint ROM and MMT
Dermatome and myotome testing
Special tests exist for specific nerves (ie. sciatic, median (carpal tunnel), bracial plexus injuries).
