GOLD Musculoskeletal Conditions Flashcards
Where does a rupture of the Achilles tendon typically occur?
1-2 inches above its tendinous insertion on the calcaneus
List 3 of the most common MOIs for Achilles tendon rupture.
Pushing off of a weightbearing extremity with an extended knee
Unexpected dorsiflexion while weightbearing
Forceful eccentric contraction of the plantarflexors
When is the incidence of Achilles tendon ruptures the greatest? Why?
In adults 30-50 years old without history of heel or calf pain
Why?: Decreased blood flow to the area of the tendon, secondary to aging, increases susceptibility to rupture
List 5 characteristics of the clinical presentation of an Achilles tendon rupture.
- Pop or snap associated with severe pain at time of injury
- Swelling over the distal tendon
- Palpable defect in the tendon above the calcaneal tuberosity
- Pain and weakness with plantarflexion
- Positive Thompson test
Describe the most effective management of a patient with an Achilles tendon rupture.
Immobilization through casting or surgical approach for repair or reconstruction
Non-surgical treatment includes serial casting for ~10 weeks with heel lift to take stress of the tendon
PT is initiated following removal of the cast
What is Achilles tendinopathy?
Acute or chronic condition due to repetitive microtrauma that builds scar tissue in the area over time
What is adhesive capsulitis?
Characterized by restriction of shoulder ROM due to inflammation and thickening of the shoulder capsule
What is the difference between primary and secondary adhesive capsulitis?
Primary = occurs spontaneously Secondary = occurs secondary to an underlying condition (i.e. disuse following repetitive trauma)
Adhesive capsulitis is commonly associated with _____ and ______.
Diabetes
Thyroid disease
List 3 characteristics of the acute phase of adhesive capsulitis.
Pain that radiates below the elbow
Pain that awakens the patient at night
PROM limited due to pain and guarding
List 3 characteristics of the chronic phase of adhesive capsulitis.
Pain localized around the lateral brachial region
Pain does not awaken patient at night
PROM is limited due to capsular stiffness
What motions are typically most limited in patients with adhesive capsulitis?
Shoulder abduction and ER
What imaging study can be used to detect the presence of adhesive capsulitis?
Arthrogram can detect decreased volume of fluid within the joint capsule
What medications are typically prescribed to treat the symptoms associated with adhesive capsulitis?
Acetaminophen for pain
NSAIDs for pain/inflammation
What differentiates adhesive capsulitis from bursitis?
Pain and throbbing over the lateral brachial region
Lasts a few days and usually resolves itself within a few weeks
What is the most common MOI for ankle sprains?
Inversion and plantarflexion
What ligaments make up with lateral complex of the ankle?
Anterior talofibular ligament (ATFL)
Calcaneofibular ligament (CFL)
Posterior talofibular ligament (PTFL)
What ligaments make up the medial complex of the ankle?
Deltoid ligament
What ligament is most likely to sustain damage during a lateral ankle sprain?
ATFL
What injury typically occurs prior to sprain or injury to the deltoid ligament? Why?
Fracture of the medial malleolus
Part of the deltoid ligament attaches to the medial malleolus, so there must be significant valgus stress at the ankle (which usually fractures the medial malleolus), to injure the deltoid ligament
List 4 characteristics of a lateral ankle sprain.
Pain or tenderness along the lateral aspect of the ankle
Antalgic gait
Limitations in ankle ROM (inversion and PF)
Ecchymosis and possible edema
What special tests can be used to confirm the diagnosis of an ankle sprain?
Anterior drawer test
Talar tilt test
List 4 of the most common motions that lead to an ACL injury.
Hyperflexion
Rapid deceleration
Hyperextension
Landing in an unbalanced position
Describe the 3 degrees of an ACL injury.
First degree = little to no instability
Second degree = minimal to moderate instability
Third degree = extreme instability
What is the unhappy triad? What is the most common MOI for this injury?
Injury to the ACL, MCL and medial meniscus
MOI = Combination of valgum, flexion and ER forces applied to the knee when the foot is planted
2/3 of the time there is also injury to the ____ when the ACL is torn.
Meniscus
What site is most commonly used for an ACL graft?
Patellar tendon
What is the most common MOI for a PCL tear?
Dashboard injury or forced knee hyperflexion as the foot is plantar flexed.
List 3 signs and symptoms of a PCL tear.
Effusion
Posterior tenderness
Positive posterior drawer test
What is bicipital tendonitis? What repetitive motions typically lead to this condition?
Inflammation of the long head of the biceps tendon
Excessive abduction and ER can lead to inflammation of the tendon
List 3 signs and symptoms of bicipital tendonitis/tendinopathy.
Deep ache directly in front and top of the shoulder
Exacerbated by lifting heavy or reaching overhead
Positive Speed’s and/or Yergason’s test
A labral tear is most susceptible with ______.
Anterior damage or subluxation
What labral tear most commonly leads to anterior glenohumeral joint instability?
Bankart lesion = a tear of the labrum below the middle of the glenoid socket
List 6 characteristics of a glenoid labral tear.
- Shoulder pain that can not be localized to a specific point
- Pain is made worse with overhead activities or internal rotation
- Weakness
- Instability in the shoulder
- Pain with resisted elbow flexion
- Tenderness over the front of the shoulder
What motion should be avoided for 12 weeks after a glenoid labral repair?
90 abduction and 90 of ER (apprehension position)
What is lateral epicondylitis? Cause?
Inflammation or degenerative changes at the common extensor tendon
Cause: Repeated overuse of the wrist extensors, particularly the extensor carpi radialis brevis, leading to microtears and damage to the extensor tendon
What conditions must be ruled out to confirm a diagnosis of lateral epicondylitis?
Radial nerve entrapment
Cervical radiculopathy
What is medial epicondylitis? Cause?
Inflammation or degenerative changes at the flexor carpi radialis and pronator teres tendons
Cause: Repeated overuse of the wrist flexors and pronators, leading to microtears and damage to the tendons at the medial epicondyle
What is the most common MOI of an MCL strain at the knee?
Direct blow against the lateral surface of the knee causing valgus stress and subsequent damage to the medial aspect of the knee
List 3 signs and symptoms associated with an MCL strain.
Inability to fully flex or extend the knee
Pain and tenderness localized to the medial knee
Positive valgus stress test
What is osteoarthritis?
Degenerative chronic disorder resulting from the biomechanical breakdown of articular cartilage in the synovial joints
What is the difference between primary and secondary OA?
Primary = idiopathic and due to age related changes Secondary = occurs secondary to a predisposing condition (i.e. trauma), that has adversely altered the articular cartilage and subchondral bone of the affected joints
List 2 characteristics of OA.
Deep joint pain exacerbated with prolonged activity
Morning stiffness
What is psoriatic arthritis?
Inflammatory arthritis often associated with psoriatic skin lesions
List 4 symptoms of psoriatic arthritis.
- Silver or grey scaly spots on the scalp, elbows, knees and spine
- Pitting of fingernails and toenails
- Pain
- Swelling in one or more joints, fingers and toes
What is osteogenesis imperfecta?
Rare congenital disorder characterized by abnormal collagen synthesis leading to imbalance between bone deposition and resorption
Cortical and cancellous bones become very thin, leading to fractures and deformity of weight bearing bones
What is a strong predictor of a child’s ability to ambulate in the future?
Ability to sit independently by 10 months of age
What is arthrogryposis multiplex congenita?
Congenital deformity of skeleton and soft tissues leading to several non-progressive contractures at birth
What is patellofemoral syndrome?
Abnormal tracking of the patella between the femoral condyles which can lead to damage or softening of the articular cartilage
Most commonly occurs when the patella is pulled too far laterally with knee extension
List 3 characteristics of patellafemoral pain syndrome.
Retropatellar pain
Tenderness to lateral border of the patella
Crepitus when the patella is compressed into the trochlear groove (Clarke’s sign)
What is plantar fasciitis?
Chronic overuse injury characterized by inflammation of the plantar fascia (aponeurosis) at its origin on the calcaneus
List 4 symptoms associated with plantar fasciitis.
- Point tenderness over the calcaneal insertion of the plantar fascia
- Pain in the heel when first standing up in the morning
- Positive windlass test
- Limited DF ROM
What tendon is most commonly involved with RTC tears?
Supraspinatus tendon
What special tests can be used to identify a supraspinatus tear?
Drop arm test
Empty can test
Describe the symptoms associated with a RTC tear.
- Pain in the lateral aspect of the shoulder, with sxs radiating into the upper arm and deltoid region
- Pain is exacerbated by generalized movement
List 2 characteristics of a biceps tendon rupture.
- Pain with overhead reaching
2. Palpable mass in upper arm where the muscle mass has retracted (Popeye’s sign)
What is the most common cause of RTC impingement and RTC tendinitis?
Repetitive overhead AROM leads to inflammation/impingements of the RTC tendons
What is the difference between structural and nonstructural scoliosis?
Structural = an irreversible lateral curvature of the spine with a rotational component
Nonstructural = reversible lateral curvature of spine without a rotational component which straightens as the individual flexes the spine
List 4 common postural findings seen in patients with scoliosis.
- Increased spacing between the elbow and trunk during standing
- Leg length discrepancy
- Uneven shoulder and hip heights
- Prominence on one side of the shoulder or breast (due to rotation of the curve)
Describe the treatment for scoliotic curves <25 degrees, 25-45 degrees, and >45 degrees.
Less than 25 degrees = conservative treatment
25-40/45 degrees = bracing and orthosis
Greater than 40-45 degrees = Surgical spinal stabilization using a Harrington rod
What is the difference between spondylosis and spondylolisthesis?
Spondylosis = fracture of the pars interarticularis (Scotty dog fracture)
Spondylolisthesis = anterior or posterior slippage of one vertebrate on another
What occurs as a result of spondylolisthesis?
Stenosis of the spinal canal occurs secondary to vertebral slippage
What motion should be avoided with patients with spondylolisthesis?
Extension
Focus on FLEXION!!
What is the most common site for degenerative spondylolisthesis?
L4-L5 segment
List 6 signs and symptoms associated with temporomandibular joint dysfunction.
- Pain
- Muscle spasm
- Limited ROM during depression/elevation of the jaw
- Headache
- Tinnitus
- Clicking or popping
What condition can mimic the symptoms associated with TMD?
Myofascial pain syndrome affects the TMJ but produces pain secondary to muscle spasms
What is torticollis?
Spasm and/or tightness of the SCM muscle
Results in lateral flexion towards the affected side and rotation away from the affected side
List 3 possible causes of torticollis.
Fibrosis related to birth trauma
Forceps birth
Breech birth
List 3 symptoms associated with osteosarcoma.
- Pain and swelling within the extremity
- Pain worse at night or with exercise
- Fracture in the affected extremity
In 90% of cases of osteosarcoma, metastases appear in the _____ in early stages.
Lungs
What is the primary type of bone cancer that affects those under the age of 20 and requires VERY AGGRESSIVE treatment?
Ewing’s sarcoma
