Final Exam Flashcards
Preclinical Disability
-progressive and detectable but unrecognized decline in physical function in older adults
-decreased task efficiency
Phenotypes
-describes how an individual’s characteristics are a result of their genotype interacting with the environment
Musculoskeletal system and aging
-Skeletal muscle of older people is more easily damaged with the loading
-Aging collagen increased cross-links between molecules, increasing the mechanical stability and tissue stiffness
-Tendons exhibit a lower metabolic activity that compromises healing
-joint increased stiffness and decreased flexibility and proprioception
Bone Remodeling influences
-mechanical stress
-Calcium and phosphate
-hormonal levels
4 causes of Fractures
Traumatic, stress, insufficiency, pathologic
Traumatic Fractures
-sudden impact
-Transverse, oblique, spiral
-mostly radius and ulna
-most affected 5-14
Stress Fractures
-partial break
-rhythmic repeated microtrauma
-most in tibial shaft and metatarsal
- Compressive: forceful heel strike during prolonged marching
- Distractive: muscle pull on bone
RF
-increase intensity of training
-females: pelvic and sacral fractures
Insufficiency Fracture
-normal stress applied to abnormal bone
-decreased elastic resistance or decreased mineralization
-minor trauma
Pathologic Fracture
-abnormally fragile bone by disease
Classification of Fractures
Transverse: right angle line, shearing
Oblique/Spiral: twisting force
Comminuted: broken into fragments
Segmented: broken with a segment of free bone is left
Butterfly: separation of a wedge
Greenstick: splintering of bone
Torus: bone bulges out from stress
Hairline/crack: skinny crack
Vertebral Compression Fracture
-most common osteoporosis related fracture
-minor
-pain worse with spinal extension
-height loss and respiration dysfunction
Fracture Healing
- Hematoma (6-12h): Blood clot forms and inflammation
- Proliferation (1-2d): granulation tissue and fibrocartilage
- Callous Formation (1-3w):
Soft callous - Ossification (6w): Soft callous replaced by bony callous
- Remodeling (4m-1y): restoration of medullary canal
Factors to Hinder Fracture Healing
-inadequate blood supply
-poor nutritional status
-poos apposition
-infection
-corticosteroid
Clinical Manifestations of Fractures
-point tenderness
-pain with weight bearing
-swelling and bruising
-loss of mobility
Complications of fractures
-malunion
-delayed union
-nonunion: fibrous union or false joint
Bone Grafting
-enhance bone repair
Autogenous: taken from self, iliac crest of fibula
Allogeneic: donor bank
Tissue Engineering: Porous scaffolds and biodegradable plastics
Bone Healing Prognosis (time)
Children: 4-6w
Adolescents: 6-8w
Adults: 10-18w
Negative Predictors:
-Calcium channel blockers and NSAIDs
PT Implications for LE Fractures
-can begin rehab within 1 week
-immobilized until callus formation
-treat swelling, pain, and ROM deficits
-Weight bearing limitations
Look for
-compartment syndrome
-fat embolisms
-nerve issues
Radiologist
-physicians specializing in radiology
Radiographers
-technicians who produce images
Highest Radiodensity
-Metal/lead
Lowest Radiodensity
-air
Lowest Radiographic density
-Metal
Highest Radiographic density
-air
High Radiodensity Color
-white image
High Radiographic Density Color
-black image
Contrast-Enhanced Radiographs
-contrast medium injected into body and radiograph taken
Arthrography
-joint and soft tissues
Myelography
-spinal cord
-nerve root
-dura
L2-L3, L3-L4, C1-C2
CT Scan
-Conventional Tomography
-different depths of bone
-computer msthmatically reconstructs image
Nuclear Imaging
-radiopharmaceuticals to see changes in anatomy structure by emmiting gamma rays
PET Scan
-Positron Emission Tomography
-inject glucose to see abnormal cells
Radionuclide Bone Scan
-distribution of disease in bone
Ultrasonograph
-refkected sound waves and tissue absorption
-leision to muscles and tendons
Chrondrolysis
-degeneration and narrowing of the joint space
-trauma, surgery, immobilization
Sx: Joint stiffness and loss of motion
Tx: pain reflief, surrgery, weight bearing precautions
Osteoarthritis
-Degeneration fo joint cartilage that affects underlying bone (subchondral)
-inflammation causes more changes and swelling
-most common msk disorder
Sx: pain, bony enlargements, edema, stiffness, loss of ROM
Tx: behavior, education, meds, surgery
Rheumatoid Arthritis
-systemic inflammatory disease
Articular: destruction of joints
Extraarticular: pulmonary, CVD, GI
-associated with graves and hashimotos
-rheumatoid factors found in synovial membranes
-Thickened synovium form destructive granulation tissue Pannus that disolves the joint
Clincial Manifestations of RA: Cervical Instability
-C1-C2 subluxation and brainstem compression
Sx: head falling forward, syncope, vestib issues
-posittive Lhermitte sign, shocklike sensations
Clincial Manifestations of RA: Cutaneous
-rhumatoid nodules: asymptomatic
-can appear in heart, lungs, GI
-joint contractures
-small vessel vasculitis
Clincial Manifestations of RA: Neurologic
-myelopathy
-neck pain
-incontinence
-peripheral neuropathies
Clincial Manifestations of RA: Extra Articular
-cardiopulmonary function
Degenerative Intervertebral Disc Disease
-age related changes
-decline of blood supply to peripheral disc
-issues with nerves
-spondylolisthesis
Juvenile Idiopathic Arthritis
-paurarticular most common
-pain of joints
Spondyloarthropathies
-group of disorders formerly considered RA
-inflammation of joints of the spine
Ankylosing Spondylitis
-inflammation to the axial skeleton
-leads to fusion and calcification
-pain in back, inflammation fo tendons
-bamboo spine
Diffuse Idiopathic Skeletal Hyperotosis (DISH)
-idiopathic variant of OA
-ossification of ligaments
-commonly effects thoracic spine
-no degeneration of vertebreal joints
Sjogren Syndrome
-chronic immune disease causes arthritis effects in organ
-moisture producing glands
-second most common autoimmune rheumatic
Sx: dry eyes and mouth
Psoriatic Arthritis
-seronegative inflammatoy joint disease
-20% of psoriasis havers
Sx:
-joint destruction
-hand deformities
Reactive Arthritis
-arthritis after an infectious process
-nailsR
Reiter Syndrome
-reactive arthritis
-triad: urethritis, conjunctivitis, arthritis
Gout
-joint pain at night
-poroduces uric acid
-deposition of crystals
-diet of purines
Neuroarthropathy
-articular abnormality related the neurologic deficits
Osteochondroses
-aka epiphysitis, osteochondritis, necrosis
-affects epiphyses
Osteochondritis Dissecans
-subchondral softening and necrosis followed by recalcification
-cartilage and subchondral can become loose
-microtrauma
Sx: activity related pain
Osteonecrosis
-death of bone and bone marrow
-avascular necrosis
Sx: prevent weight bearing
Legg-Calve-Perthes
-necrosis of proximal femur
-high chance of labral tears
-common in children
Sx: abnormal posture and pain
Osgood-Schlatter
-fibers of patellar tendon on tibia
-tendonitis
-boys >girls
Heterotopic Ossification
-aka myositis ossificans
-bone formation in non osseous tissue
-after trauma
Sx: loss of ROM, muscle pain
PT: motion, function, no stretching
Polymyalgia Rheumatica
-diffuse pain and stiffness of muscle groups
-mostly shoulder and pelvic girdle
-most decelop arteritis
Myopathy
-nonspecific proximal progressive muscle weakness after illness
-associated with critical illness myopathy
Hereditary: Musclar dystrophy, myotonia, charcot-marie-tooth
Acquired: inflammatory myopathy, endocrine, illness related, drug induced
Myofascial Pain Syndrome
-trigger points: irritable spots of skeletal muscle
-related to pain diagnoses
-can restrict ROM and movement activation patterns
PT: dry needling, ultrasound, flexibility, address posture
Coccygodynia
-pain of coccyx and muscles attached
-trauma
S/S: pain with sitting
Connective Tissue Disease
Mixed
or
Overlap (overlaing feature):
-similar to SLE, RA, polymyositis
Rhabdomyolysis
-break down of muscle due to injury
-proteins in blood cause acute renal failture
-coke colored urine
Pelvic Floor Dysfuction
Supericial: STP, BS,
Middle: urogenital diaphragm
Deepest: :Levator ani and coccygeus
Under Active: incontinence and prolapse
-surgery
-pregnancy
-SC
Over Active: cannot relax obstructive voiding
-injury or trauma
-nerve entrapment
-psychology
Cervical Disc Pathology
-Degenerative processes to disc
S/S: pain over cervical spine, limited ROM and motor control, imbalances
Cause: progressive degeneration, repetitive mmts
Better: Laying down
Worse: Sitting, neck motions, coughing
Treatment:
-Surgical: discectomy, fusion
-PT: mobilization, strengthening, manipulation
Disc Bulge
-nuc pulposus bulges into fiibrosis
Disc Protrusion
-pulosus breaks past fibrosis
Disc Extrusion
-pulposes breaks past outer lamina of annulus
Disc Sequestration
-pulposus detaches from annulus near SC canal
Thoracic Disc Pathology
-Degenerative processes to disc
S/S: asymptomatic, non specific pain, limited motor control, neurological changes, positive neural tension
Cause: progressive degeneration, repetitive flexion mmts, trauma
Better: Laying down, standing
Worse: Sitting, bearing down, coughing
Treatment:
-Surgical: laminectomy
-PT: decrease symptoms, walking, stabilization
Cervical Facet Dysfunction
-facets on nerve roots or degeneration
S/S: Non specific neck pain, limited ROM and mobility
Cause: Degeneration or trauma, poor posture
-Primary: older pop, degeneration, hx of trauma
-Secondary: younger pop, trauma, acute injuries
Better: lying down, opening pattern
Worse: closing pattern, repetitive motions, sleeping position
Treatment: changing motions, posture, decrease imbalances, increase ROM
Cervical Muscle Strain
-soft tissue injury
S/S: pain over cervical spine, limited ROM and muscle spasms
Cause: trauma, repetitive mmts, stretch or compression
Better: Laying down, modalities
Worse: Sitting, stretching, neck motions, sleeping
Treatment:
-PT: modalities, massage
Cervical Radiculopathy
-spinal root dysfunction
S/S: pain and limited ROM numbness and tingling, weakness of musculature
Cause: progressive degeneration that cause impingement, herniation,a cute injurry
Better: open movements, UE above head to unload
Worse: pattern of limitation, neck motions
Degenerative Joint Disease
-Degenerative processes to facet surfaces with loss of cartilage
S/S: unilateral pain, stiffness, cracking, loss of normal spine curvature
Cause: progressive degeneration, repetitive mmts, breakdown of hyaline cartilage
Better: stretching, modalities
Worse: inactivity, activities, close down facet joints, more wear and tear
Whiplash
-quick trauma where head is forcefully displaced
S/S: neck pain, headache, shoulder pain, anxiety days after trauma, limited ROM, guarding
Cause: head displacement (extension) causing tissue damage
Better: rest
Worse: neck motions
Scoliosis
lateral curve of spine >10deg
-Idiopathic: structural with no cause
-Infantile Idiopathic: <3yrs, can grow out of
-Juvenile: 3-10, second most common, risk for poorest outcomes
-Adolescent: >10, most common
-Functional: abnormalities that affect spine
-Neuromuscular: probelms occuring during spine development, cannot correct
-Degenerative: as the body ages
S/S: pain
Cause: progressive degeneration, repetitive mmts
Treatment:
-Surgical: >45
-Bracing: 25-40
-PT: mild, treating contributing factors, focused on injury in tissues
Lumbar Disc Pathology
-Degenerative processes to disc (L4/5 and L5/S1)
S/S: dull pain over lumbar spine, nerve pain, guarding
Cause: bending forward, falling, coughing, bearing down, repetitive mmts, poor posture (tight hip flxors and hamstrings)
Better: Laying down with knees and hips flexed, walking, extension
Worse: Sitting, bending forward, lifting
Treatment:
-PT: decrease symptoms, inflammation
-extensor based exercises
Lumbar Degenerative Joint Disease
-Degenerative processes to facet surfaces with loss of cartilage
S/S: unilateral pain, stiffness, cracking, loss of lumbar lordosis
Cause: progressive degeneration, repetitive mmts, breakdown of hyaline cartilage
Better: sitting, flexion based, restt
Worse: inactivity, activities, close down facet joints, more wear and tear
PT: thoracic extension, conditioning, education
Interforaminal Stenosis
-loss of interforaminal space and disc height
S/S: shooting pain over lumbar spine, nerve pain, weakness
Cause: bone spurs, wear and tear, inflammation, progressive
Better: openinng space, beinding forward, decompression
Worse: closing mmts, walking, compression
Treatment:
-PT: improve joint and muscle mobility,
-flexion based exercises, education
Lumbar Radiculopathy
-spinal root dysfunction
S/S: shooting pain and numbness and tingling, weakness of musculature, leg pain
Cause: progressive degeneration that cause impingement, herniation,a cute injurry, DDD, DJD, Spondylolisthesis, leg lengths
Worse: coughing, sitting
PT:
-surgery
-releiving symptoms
-exercise
-education
Lumbar Ligament Strain
-tearing of fibers of lumbar ligaments (80% of lumbar cases)
S/S: localized LBP without referral
Cause: forces exceed tissue capacity, fails at weakest point, overuse, hyper ROM,
Better: rest, neutral postures
Worse: stretching of ligs, end range positions
PT: pain free motion, strength, stabilization of trunk
Lumbar Muscle Strain
-soft tissue injury, most common LB injury (errector spinae)
S/S: pain over low back, pain with resisted extension, does not radiate to leg,
Cause: trauma, repetitive mmts, stretch or compression, body mechanics
Better: neutrtal posture, rest
Worse: Sitting, twisting, lifting, flexionn
Treatment:
-PT: rest, modalities, mobility, strenghening
Lumbar Spondylolysis/Spondylolisthesis
Spondylolysis: fracture at pars interarticularis (MC: L5)
Spondylolisthesis: superior verttebra slips forward (MC: L4/S1)
-Dysplastic: congenital
-Isthmic: stress fracture, hyperextension
-Degenerative: slippage due to facets
-Traumatic: acute fx
-Pathological: damage due to tumor
S/S: back and/or leg pain with extension, asymptomatic
Cause: forced extension of some kind; degeneration
Better: flexion, rest
Worse: extension
Treatment:
-PT: flexion exercises, bracing
-surgery
SI Joint Pathology
-pain in the region
S/S: pain in low back to butt to thigh (not lumbar)
Cause: pregnancy, arthropathy, falling
Better: hooklying
Worse: Sitting, walking, cycling
Treatment:
-PT: manipulation, hip ROM, strengthening core
Primary Scapular Stabilizers
-serratus
-rhomboids
-traps
-levator
Secondary Scapular Stabilizer
-lats
-pec minor
Impingement Syndrome
-scompression and damage to soft tissue within the structure (MC: subacromial and superior humeral head)
S/S: ant/lat pain and flx/abd for external inpingement, pos pain and ER/IR issues for internal, weakness of RTC muscles, ROM issues
Cause:
Primary: structure abnormalities (internal impingement), dimished space
Secondary: excessive acromion curve
Better: rest
Worse: overhead activities
Treatment:
-PT: inflammation, scapular increase strength, normalize scapulothoracic rhythm
Rotator Cuff Tears
-SITS
I: Bursitis or tendonitis, pain
II: partial rotator cuff
III: full thickness, loss of ROM and strength
S/S: deltoid pain, greater tub, upper trap
Cause: chronic and degenerative
Intrinsic: blood supply
Extrinsic: acromion morphology, acute injury
Better: out of aggravating position, retraction
Worse: recruitment of supra, protraction, hands behind back
Treatment:
-PT: increase ROM, prevent freezing, strength
-Non surgical: loss of strengthh
-Surgical: immobilized, no AROM for 4-6w, PROM, scap mobilization
Biceps Tendon Pathology
Tendonitis: acute inflammatory
Tendonosis: degenerative; microtrauma
Rupture
Tendinopathy
S/S: anterior GH pain, weakness in shoulder, can radiate to elbow
Cause: mechanical stress, overhead mmt, functional factora
Better: avoidance of lifting, stretching
Worse: overhead lifting
Treatment:
-PT: 6-8w recovery, rest < massage < mobilization < stabilitty < stength (closed then open)
-surgery: usually not used
Shoulder Labral Tears
-SLAP (superior labrum ant to post)
-Bankheart (2-6oclock, bicep tendon ass. witth ant dislocation)
-Psterior Labral Lesions (internal impingement)
S/S: aching, instability, catching, popping
Cause: FOOSH, overhead mmt, traction, trauma, dislocation, impingement
Better: out of agg. position, retracion
Worse: overhead activity, liting, hands behind back
Treatment:
-PT: prehab: ROM, prevent freezing, strength
-Surgical: Slap (no PROM ER, no bicep AROM 4w), Bankhart (no ER past 30 4w)
-isometrics, scap mobilization
Shoulder Instability
-laxity of joint capsule
S/S: pain over deltoid, weakness, neural irritation
Cause: overhead repetitive mmts, dislocations/subluxations, trauma
Better: avoid aggr.
Worse: 90/90, overhead activity
Treatment:
-PT: reduce chance of redislocation, ROM, strength
Adhesive Capsulitis
-inflamed and stiff shoulder capsule
S/S: loss of ROM, pain in deltoid, nocturnal pain hallmark
Phase 1: insidious, nocturnal pain
Phase 2: diminished pain, ROM loss
Phase 3: pain gone, ROM increases 12-24
Cause:
Primary: insidious
Secondary: response to trauma
-DM, hyperthyrpidism, hypertriglyceridemia
Better: pendulum exercises, steriod injections
Worse: moving arm
Treatment:
-PT: ROM,
-closed manipulation under anesthesia
Medial Epicondylitis
-tendinosis of flexor tendons
S/S: weak grasp, local tenderness over medial epicondyle
Cause: Insidious, repetitive mmts, young age
Primary: FCRB, pronator teres
Secondary: FDC, palmaris longus
Better: rest
Worse: throwing, gripping
Treatment:
-PT: reduce stress, strength
Phase 1: 1-2w, modification, isometrics, pain free stretching
Phase 2: 2-4w, stretching, concentric
Phase 3: 4-6w, eccentrics, endurance, technique
Phase 4: 6-12w, progressive return to sport, isokinetic
Lateral Epicondylitis
-tendinosis of extensor tendons
S/S: local tenderness over lateral epicondyle, pain with gripping, stretching pain
Cause: Insidious, repetitive mmts
Primary: ECRB, ECRL
Secondary: EDC, Anconeus
Better: rest
Worse: gripping, turning
Treatment:
-PT: reduce stress, strength
Phase 1: 1-2w, modification, isometrics
Phase 2: 2-4w, stretching, concentric
Phase 3: 4-6w, eccentrics, endurance, technique
Phase 4: 6-12w, progressive return to sport, isokinetic
Cubital Tunnel Syndrome
-mononeuropathy cause by entrapment of ulnar nerve
-second most common nerve compression injury
S/S: local tenderness over medial elbow, numbness and tingling, claw hand
Cause: direct trauma, stretching, compression
Stage 1: Neuropraxia; myelin sheath
Stage 2: Axonotmetris; interruption of axon
Stage 3: Neurotmesis, neurron disruption
Better: rest
Worse: compression, stretching, sports, position, sleep
Treatment:
-PT: decompression, lifestyle mods, education
Elbow Dislocation
-discontinuity of ulnohumeral articulation
-most common in children and posteriorly
-leads to lateral instability
S/S: pain, swelling, forearm looks shorter
Cause: fall with hyperextension
Better: rest
Worse: use
Treatment:
-PT: initial immobilization, isometrics
Carpal Tunnel Syndrome
-compression of median nerve
-ischemia of nerve
S/S: numbeness in index and middle fingers, weakness
Cause: repetittive mmt, decrease in volume of tunnel (spurs, tumor, RA, position), increase in volume of contents (edema, inflammation)
Better: rest
Worse: prolonged wrist flexion, vibration
Treatment:
-PT: nerve glides, mobilization
-surgery
De Quervain’s Syndrome
-inflammation of EPB and APL tendons
-mom’s hand
S/S: pain on radial side of wrist, weakness
Cause: overuse, repeated radial deviation, thumb abduction
Better: rest
Worse: wide gripping
Treatment:
-PT: reduce stress, strength
Trigger Finger
-tenosynovitis of flexor digits
S/S: catching of finger, pain and tenderness on volar side
Cause: repetitive forceful gripping, systemic disease, nodules
Better: rest
Worse: gripping
Treatment:
-PT: ROM
-surgical release
X-Ray
-conventual radiography
-xray penetrates tissues to produce image
-first order imaging
-skeletal images
-high radiation, poor soft tissue visualization
CT
-computed Tomography
-poor cisuals of soft tissues
-x ray that a computer makes
-primary for traumatic injury
-soft tissueS and bone
-short time
-expensive, high radiation
MRI
-magnetic Resonsance imaging
-magnetic field affects hydrogens in body
-soft tissues and hematomas no radiation
-long time, expensive, no pacemakers/aneruysms
Bone Scintigraphy
-injection of radioactive isotrope
-detect fractures, tumors
Diagnostic Ultrasound
-no contraindictions, low cost
-dependent on skill
-only outline of bone
Greater Trochanter Bursitis
-pain over greater trochanter
-bursitis, tendinopathy, ITB syn
-Glut min bursa (MC): above and anterior to GT
-Subgluteus med bursa: under glut med, pos and sup GT
-Subgluteus max bursa: lat to GT under max and TFL
S/S: pain in post lat hip, referred pain from L2-L4
Cause: glut tendinopathy, atrophy, ITB on glut med tendon, inflammation, trauma, hyperabduction, fall, tight muscles, gait
Better: rest, pillow between knees
Worse: ipsi sidelying, walking uphill, running, ER, abduction
Treatment:
-PT: ROM, decrease injury, decrease inflammation, mechanics, STM, strengthening
Hamstring Strain and Tendinopathy
-microtears due to stress
-common due to biarticular
-mostly at musculotendinous junction, eccentric
S/S: pop or tearing sensation, post thigh pain, gluteal pain
Cause: non-contact eccentric rep loading. poor blood supply, degeneration, poor mechanics, imbalances, poor lumbars
Better: rest, slow walking, neutral hip w/ knee flx
Worse: running, eccentrics
Treatment:
-PT: ROM, decrease injury, decrease inflammation, mechanics, STM, strengthening (iso, con, ecc)
Hip Labral Tears
-tear of labrum
-ass with hip issues
-Radial flap (antersuperior) MC
-Longitudinal LC
S/S: groin pain, locking, stiffness, painful ROM
Cause: disclocation, twisting, hyperflexion, hip abnormalities, rep mmts, degeneration, lax capsule
Better: distraction, open pack
Worse: twisting, squatting, walking
Treatment:
-PT: decrease pain, decrease inflammation, distraction
Piriformis Syndrome
-sciatic n compression from piriformis
S/S: gluteal pain, sitting pain, PF pain, positive Lasegue’s sign, dyspareunia, pain with BM
Cause: compression, muscle strain, trauma, pregnancy, sitting, weak glutes, weak core
Better: standing ER, traction
Worse: sitting, squatting, lunging
Treatment:
-PT: address impairments, education, ROM, STM
ACL Sprain
-tear of ACL (85% of resistting ant. translation)
-females more likely
-athletic ppl
S/S: pop or tearing sensation, pain, knee giving out
Cause: violent twist w/o contact, joint laxity, large q angle, weak hamstrings, femoral notch stenosis
Better: elevation
Worse: walking, pivoting, stairs, cutting
Treatment:
Surgery: Hamstring, quad, gastroc, patellar tendon grafts
-1-2 years
-necrosis, revascularization, cellerular proliferation, collagen formation
PT:
Stage 1: Inflammatory 0-14d
-ROM, inflammation
Stage 2: Reparative 15-21d
-ROM, full extension, swelling, flexibility, walking
Stage 3: Remodeling 22-60 60-360d
-pain free ROM, no limitations, return to sport
MCL Sprain
-tearing of MCL by valgus force at femoral attachment
-combined wiith ACL and med meniscus
-most common lig injury
-well vascularized
S/S: tearing sensation, medial knee brusing, instability
Cause: valgua stress, non contact decceleratioono andc utting
Better: elevation
Worse: running, extension of knee, downhill
Treatment:
-Surgery: rare due to vascularity, bracing instead
-PT:
Phase 1: Acute inflammatory 0-14d
- ROM, protect joint
Phase 2: Reparative 15-21d
-ROM, full extension
Phase 3: Remodeling 22-60 60-360
-pain free ROM, no limitations, return to sport
LCL Sprain
-tearing of LCL by varus force at fibular attachment
-combined wiith fibular n, PCL
-least common knee lig injury
S/S: pop sensation, lateral knee pain, instability
Cause: varus stress, add flx and ER
Better: elevation
Worse: running, extension of knee, uneven ground
Treatment:
-PT:
Phase 1: Acute inflammatory 0-14d
- ROM, protect joint
Phase 2: Reparative 15-21d
-ROM, full extension
Phase 3: Remodeling 22-60 60-360
-pain free ROM, no limitations, return to sport
Meniscal Injury
-tearing of meniscus by arthroscopy
-often with ACL
-Medial more common (less mobile)
-Longitudinal tear MC
-Bucket Handle Tear with ACL
-Radial Tear with trauma
-Horizonatal with OA
S/S: popping, clicking, giving away, joint line tenderness
Cause: degeneration, trauma (compressive twisting)
Better: non weight bearing
Worse: weightbearing
Treatment:
-Surgery:
-younger or older and physically active
Meniscectomy: avsacular region
Repair: vascular region
-PT:
-ROM, LE strength, limit compressive forces
Patellofemoral Pain Syndrome
-pain around or behind patella
-most common knee injury
S/S: pain during flexion and extension behind or around knee, swelling, pain with activity
Cause: overuse with force at patellofemoral, hip/foot/knee issues
Better: avoidance of knee flexion
Worse: prolonged sitting, running, walking
Treatment:
-PT: contributing factors, avoid flexion based things, avoid last 30 of extension
Patellar Tendinopathy
-Tendinitis: acute inflammation of the patella
-Tendinosis: chronic degeneration
-low metabolic rate
S/S: localized pain around patellar tendon, swelling, pain with activity, no referral
Cause: overuse activity (3-8%) of load applied, repetitive jumping and running, eccentric
Better: rest, bracing
Worse: squatting, running, squatting
Treatment:
-PT: correction of other factors, activity mod, flexibility, abnormalities
-Surgery: if PT fails after 6mon
Patellar Dislocation/Subluxation
-no contact btwn patella and trochlear groove
-usually young
S/S: pain during flexion and extension behind or around knee, swelling, pain with activity
Cause: trauma, non contact IR and valgus stress
Better: inactivity
Worse: jumping, running, quick stops
Treatment:
-PT: reduce add and hip IR when squatting, bracing, quad strength, footwear
-Surgery: recommended for recurrent dis/sub
Achilles Tendinopathy
-painful overuse of tendon; male athletes
-Tendinitis: presence of inflammatory cells
-Tendinosis: degeneration, absence of inflammatory cells
S/S: pain at insertion site, swelling of tendon
Cause: overuse, trauma, eccentric loading, pronation, flat floot, weakness
Better: rest
Worse: walking, running, jumping
Treatment:
-PT:
Acute: compression, cryotherapy, rest, heel wedge
Chronic: stretching, night splints, strengthening
Ankle Sprains
-sprain of ankle ligaments
-lateral ligaments MC
-Syndesmotic sprains: pain can mimic lateral ankle sprains
-Medial ligaments LC
S/S: pain, swelling, redness, loss of ROM, cannot bear weight
Cause: rapid inversion (L), eversion (M), planted DF with ER (H)
Better: NWB, immobilization
Worse: WB
Treatment:
-PT: mobilizations
Phase 1: inflammation, edema
Phase 2: decrease pain, ROM, proprioception
Phase 3: ROM, strength, return to function
Shin Splints
-pain on anterior/medial shins
-Medial tibial stress syndrome
-common in runners
S/S: pain over shin, increased with WB
Cause: training issues, biomechanical issues, shoes, obesity, increased pronation
Better: NWB, Rest
Worse: walking, jogging, running
Treatment:
-PT: contributing factors, activity modification, NWB, education, stretching, strengthening
-Surgery: fasciotomy
Plantar Fascitis
-inflammation of plantar fascia
-MC at proximal insertion
S/S: medial heel pain, morning pain
Cause: bone spurs, chronic use, obesity, mechanics, low arches, pronated foot
Better: avoidance of walking
Worse:, running, walking
Treatment:
-PT: contributing factors, strengthen dynamic stabilizers
Primary Tumors
-develop in the tissue
-75% in prostate, breast, lung
-pelvis, ribs, vertebrae, femur
-most commob bone are metastatic tumors from other places
Primary Benign Bone Tumor
-bone island, osteoid, osteoblastoma
Primary Malignant Bone Tumor
-osteo + sarcoma
-chord-
-Ewing
-Giant
-Multiple
Primary Benign Soft Tissue
-Oma
-cyst
-desmid
Primary Malignant Soft Tissue
-malignant
-sarcoma
-soft tissue
Metabolic Bone Diseases
-metabolically active
-peaks at 25-35
Osteomalacia
-softening of bone
Osteopenia
-low bone mass
Osteopetrosis
-increased bone density
Osteoporosis
-systemic decrease in bone density
Paget Disease
-2nd most common bone disease
-increased bone resorption and excessive new bone formation
Hip Dysplasia
-infants and children
-unstable hip that subluxes/dislocation
-positive ortolani or barlow signs
Osteogenesis Imperfecta
-skeletal fragility and growth deficiency
-brittle bone disease
-bruising and increased laxity
Osteomyelitis
-inflammation of bone by an infectious organism
-affects spine, pelvis, and legs
-pyrogenic
Infections of Prosthesis
-primary cause of prosthetic failure is strep
-common sign is persistent joint pain
Hematogenous infection: primary infection elsewhere in body
Contiguous: secondary to nearby infection
Spondylodiscitis
-infection that affects vertebral spine
-affects discs MC
S/S: pain in spine with radiation to LE
-unusual postures, spine pain and fevers in children
ACL Sprain
-tear of ACL (85% of resistting ant. translation)
-females more likely
-athletic ppl
S/S: pop or tearing sensation, pain, knee giving out, decreased quad
Cause: violent twist w/o contact, joint laxity, medial blow to knee, weak hamstrings
Better: elevation
Worse: walking, pivoting, stairs, cutting
Treatment:
Surgery: Hamstring, quad, gastroc, patellar tendon grafts
-1-2 years
-necrosis, revascularization, cellerular proliferation, collagen formation
PT:
Stage 1: Inflammatory 0-14d
-ROM, inflammation
Stage 2: Reparative 15-21d
-ROM, full extension, swelling, flexibility, walking
Stage 3: Remodeling 22-60 60-360d
-pain free ROM, no limitations, return to sport
MCL Sprain
-tearing of MCL by valgus force at femoral attachment with tibal ER
-well vascularized and not under tension, can heal own on in 6w
S/S: tearing sensation, medial knee brusing, instability
LCL Sprain
-tearing of LCL by varus force at fibular attachment
-least common knee lig injury
S/S: pop sensation, lateral knee pain, instability, swelling, n/t from superficial fib
Meniscal Injury
-tearing of meniscus
-often with ACL
-Medial more common (less mobile)
S/S: popping, clicking, giving away, joint line tenderness, delayed swelling
Cause: degeneration, trauma (compressive twisting)
Patellofemoral Pain Syndrome
-pain around or behind patella
-above and below
S/S: pain descending stairs, pain during flexion and extension behind or around knee, swelling, pain with activity, grinding, clicking
Cause: overuse with force at patellofemoral with compression of knee, weak abd extensors and ERs
Better: avoidance of knee flexion
Worse: prolonged sitting, running, walking
Treatment:
-PT: contributing factors, avoid flexion based things, avoid last 30 of extension
Patellar Tendinopathy
-Tendinitis (jumper’s knee): acute inflammation of the patella
-Tendinosis: chronic degeneration
-low metabolic rate
S/S: pain ascending stairs, localized pain ant patellar tendon, swelling, pain with activity, no referral
Cause: overuse activity (3-8%) of load applied, repetitive jumping and running, eccentric
Better: rest, bracing
Worse: squatting, running, squatting
Treatment:
-PT: correction of other factors, activity mod, flexibility, abnormalities
-Surgery: if PT fails after 6mon
ITB Syndrome
-lateral knee deviations
-tight TFL, weak glutes, Positive ober
PCL Tear
-dashboard injuries
-hyperextension injury
S/s: knee swelling, instability
Pronation MMts
-eversion, abduction, df
Supination MMTs
-inversion, adduction, PF
Hallux Valgus
-bunion
-lacking extension
-angle btwn metatarsal and phalanx >15 is abnormal
Hallux Rigidus
-great toe MTP is rigid
-inflammation
Functional Capacity Evaluation
-worker’s comp
-residual capacity to perform work
-~4 hrs
-phychometric, physical and functional tests
-compares abilities to work description
Industrial PT
-promote wellness at worksites with early access
-ergonomics, prevention
Y-Balance Stats
-difference in legs with anterior position are most prredictive for non contact injuries
LESS
-12 inch box jump
