Kin 428 Flashcards
(Neuro) Musculoskeletal Disorders definition
Injuries and disorders of the muscles, nerves, tendons, ligaments, joints, cartilage and bone.
MSD magnitude estimation for hand and wrist
9.4% overall population, 22% working population.
MSD magnitude estimation for elbow pain
7-12% of working population
Carpal tunnel prevalence
0.6-61% (modifiers include: type of person and work.)
shoulder pain prevalence
7-21%
Wide variation in UEMSD prevalence estimates due to
reporting, definition of disorder, population studied.
tissue types for UED’s
tendon, muscle, nerve, vascular system, bursa, bone and cartilage.
Thoracic outlet syndrome by tissue type
Nerve
Rotator cuff tendinitis by tissue type
tendon
bicipital tendinitis by tissue type
tendon
Radial tunnel syndrome by tissue type
Nerve
medial epicondylitis by tissue type
tendon
lateral epicondylitis (tennis elbow) by tissue type
tendon
Posterior/anterior interosseous syndrome by tissue type
Nerve
hypothenar hammer syndrome by tissue type
Vascular
de quervains syndrome by tissue type
tendon
digital neuritis (bowlers thumb) by tissue type
Nerve
trigger finger (stenosing tenosynovitis) by tissue type
tendon
focal dystonia (writers cramp) by tissue type
Muscle
Dupuytern’s contracture by tissue type
tendon
Carpal tunnel syndrome by tissue type
Nerve
flexor tenosynovitis by tissue type
tendon
flexor tendinitis by tissue type
tendon
cubital canal syndrome by tissue type
nerve
Raynauds syndrome by tissue type
Vascular
White finger by tissue type
Vascular
Ganglionic cysts by tissue type
tendon
radiculopathy (cervical syndrome) by tissue type
Nerve
tension neck syndrome by tissue type
muscle
guyon canal syndrome by tissue type
nerve
extensor tenosynovitis by tissue type
tendon
extensor tendinitis by tissue type
tendon
Bursitis by tissue type
joint
shoulder tendinitis (rotator cuff) by tissue type
tendon
Review of tendon role
transmit force from muscle to bone
tenosynovitis
inflammation of the tendon and tendon sheath
tendinitis
inflammation of only the tendon
Enthesopathy
“insertional tendinitis” occurs at the bone tendon junction. low inflammation.
Peritendinitis
inflammation of the sheath
Myotendinitis
inflammation of the muscle tendon interface
Mechanisms of tendon disorder development
Excessive typically repetitive tensile loading (increased capillaries (need more blood to enhance healing), inflammation (immune response), edema (bruising), micro-tears (stack enough of these = total tear), fiber separation), compression (transverse) with tension (rapid structure deformation), tendon strength decreases as age increases.
Review of muscle function
Activators of the lever system of the skeleton initiate movements and produce force, also stabilize joint.
myalgia
muscle soreness and pain. Localized regions are tender to the touch.
Myositis
muscle inflammation
myofascial pain syndrome
Chronic myalgia usually due to insufficient recovery and excessive use.
Fibromyalgia/ fibrositis
End stage of myalgia. The symptoms include: spastic muscles, tingling, nervousness and sleeplessness.
Mechanisms of muscle disorder development
external forces on passive tissues (stretch in eccentric contractions = (L-T relationship) compounds total force, sarcomeric strain. Generally recovery is quick, except in elderly.
Nerve function review
Sends signals throughout the body. Central and peripheral; Commands and feedback.
Neural entrapment
Nerve is trapped between two tissues, could be muscles, bones, ligaments and other tendons. Leads to impaired blood flow and oxygenation, mechanical blocking of depolarization.
Double Crush syndrome
One entrapment raises likelihood of another axonal flow disruption.
Digital Neuritis
Nerve inflammation and swelling due to direct contact/direct pressure. Generally in the thumb. While contact neuritis involves the palm of the hand.
Financial burden MSD
total in Canada = 25.6 billion (7.5 direct, 18.1 indirect); 19.9-30.8 billion range.
Fincancial burden UE
average claim in US = 21, 500 direct, compensible = 563 million (1993)
Mechanisms of nerve disorder development
compression to inflammation (also increases compression) to fibrin deposits to fibrous tissue causing axonal degeneration. Vibration exposure accelerates the process (HAVS hand arm vibration syndrome). Direct pressure (external) also accelerates.
Roles of Vasculature
Provides material to cells for normal function, especially oxygen. Also removes waste products.
Ischemia
Decrease in blood supply to a body part caused by vessel constriction/obstruction- No/diminished oxygen.
Examples of vascular disorders
HAVS, Raynauds syndrome, White fingers, hypothenar hammer syndrome
Precipitating factors for vascular disorders
Vibration, cold, direct pressure, smoking and diabetes.
Definition of Bursa
A sack or sack like body cavity. Usually contains fluid. Usually around joints. Its primary role is to reduce friction and distribute forces.
Bursitis
inflammation of the Bursa
Causes of Bursitis
Friction, trauma, inflammatory diseases (rheumatoid arthritis) and bacterial infections.
Bursitis locations in the UE
Shoulder (subacromial), and elbow.
Role of bone
form, factories and function (attachment sites)
Role of cartilage (articular)
cushioning (force distribution), support, shock absorption and joint conformity/congruency.
Arthritis
Joint inflammation. Associated symptoms include pain, swelling, stiffness, osteoarthritis.
Rheumatoid
generalized inflammation. For example, gout.
osteoarthritis
Cartilage degeneration
Fractures
usually traumatic. The exception is stress fractures.
Causes of bone/cartilage disorders
trauma, repetitive joint motion (cumulative), systemic diseases and ideopathic.
Epidemiology definition
Branch of medicine that studies epidemic diseases.
Relevance to MSDs (in and out of work)
MSDs are reaching “epidemic” proportions. its getting worse because of older population, increased reporting and increased awareness.
Incidence is
Frequency of development of a new “case” of an illness in a certain time period. Usually 1 year “new cases.”
Prevalence is
current total number of people suffering from an illness in a given time period. Usually 1 year.
Manipulation
control of an exposure level (or duration)
Randomization
use of chance to assign exposures
Experimental
Also, closely related to “interventional” type studies. high control over exposure and participants.
Quasi-experimental
manipulate study factors (i.e. exposures), but not participants. non- random population.
Observational
examining exposure patterns and outcomes. cross sectional. retrospective. drawing inferences about disease etiology.
Factors related to epidemiological study quality
temporality, temporal contiguity, covariance, congruity-(dose-response relationship), plausibility
