Lecture 2: Introduction

Question 1

What is an example of contractile tissue and non contractile tissues and how can you distinguish which type is damaged?
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Answer 1

Contractile: Muscle and tendon. Resisted isometrics will be painful, so will stretching that muscle. Passive contraction will not.
Non-contractile: ligaments, bone, cartilage, capsule, blood vessels, nerves- resisted isometrics shouldn’t be painful so long as the structure isn’t been stretched or shortened and its at neutral.
If you have enflamed joint it will be painful in closed pack position. 70degree elbow flexion has greatest capability for capsule to retain water so will be least painful here.
Must understand for exam

Question 2

Your examination will include what? And why do we do a phys exam?

Answer 2

We do it to confirm your suspicions of the history.

• Indicated vitals (if any)
• indicated systems if any
• local inspection and palpation
• orthopaedic evaluation
  
  • ROM
  • orthopaedic tests (if indicated)
• Neurological examination
• Chiropractic examination
  
  • motion palp
  • soft tissue palpation/evaluation

Question 3

Range of Motion helps us identify what?
ROM is divided into?

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Answer 3

helps us identify if the painful tissue is:
contractile (muscular, tendinous)
-non contractile (nervous, ligamentous, capsular)

ROM is divided into:
1. Active:
Contractile tissues will be painful with contraction or stretching
Non-contractile tissues will be painful when stretched or ‘pinched’
2. Passive
Contractile tissues will be painful with stretch
Non-contractile tissues will be painful when stretched or ‘pinched’
3. Resisted isometrics
Contractile tissues will be painful with contraction; stretching not likely to occur due to contraction preventing end-range movement
Non-contractile tissues not likely to be stretched or ‘pinched’ due to mm contraction preventing end-range movement

Question 4

What is an orthopaedic Evaluation?

Answer 4

Designed to help you create or relieve pain
History, observation, passive and active and resisted isometrics, special tests, neurological testing, motion palp, soft tissue

Question 5

What is the Differential diagnosis list to think about when doing history and exam on someone.
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Answer 5

VINDICATE

• Vascular
• Infection
• Neoplasm
• degenerative
• Inflammation
• congenital
• Arthritic
• Traumatic
• Endocrine

Question 6

Must find out which tissue/ structures are involved

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Answer 6

• ligaments
• tendons
• bone (or cartilage)
• Vascular
• Neurological
• Syetemic

Question 7

Severity and Character of the Pain
How does visceral and parietal pain differ?
reffered pain?
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Answer 7

Pain gives us clues as to which structures are involved
Visceral pain eg hepatitis
-contraction or distention of viscera 
-gnawing, cramping or aching
-often difficult to localise 

Parietal pain eg appendicitis

• inflammation of viscera which affects parietal peritoneum
• more severe than visceral
• usually easy to localise

Referred pain e.g. acute cholecystitis
-originates at different sites but shares embryological innervation from same spinal level
-usually dull aching pain
-difficult to differentiate from MSK pain at times!
When pain signals to CNS can’t differentiate were pain is coming from so it projects it to both areas.

Question 8

What are the 3 corners of the triangle you would think about when making a diagnosis?

Answer 8

• local
• remote- i.e. refferd pain
• visceral - eg anemic, hypothyroidism etc

Question 9

What are the RED FLAGS in MSK Medicine?

Answer 9

Common red flags:

• age >50
• progressive neurological deficit
• pathological changes in bowel or bladder function- caudal equine, cervical myelopathy etc
• UMN signs
• history of cancer-metastisis
• recent significant trauma
• long term corticosteroid use- hip fracture
• presence of constitutional symptoms e.g. Night sweats, fever, lethargy, weight loss