MSK

Question 1

What is the pathology of a sub-acute ankle sprain?

Scenario 1

Answer 1

An ankle sprain is one of the most common sports-related injuries, particularly involving the lateral (outer) side of the ankle. Typically, the injury occurs when the foot rolls inward excessively, causing an inversion sprain.

Question 2

What is the pathophysiology of a sub-acute ankle sprain?

Scenario 1

Answer 2

The lateral ligaments, primarily the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL), are most affected in inversion injuries. Excessive stretching or tearing of these ligaments occurs when the ankle is forced into an unnatural position, often during activities like running, jumping, or sudden directional changes.

During the sub-acute phase of healing (usually 3-6 weeks post-injury), the body is in the proliferative stage. This involves tissue repair, where fibroblasts lay down new collagen fibres, and the tissue starts to regain some tensile strength, though it remains weaker than normal.

Question 3

What is the prognosis of a sub-acute ankle sprain?

Scenario 1

Answer 3

If managed appropriately, a sub-acute ankle sprain can heal within 6-8 weeks. However, a history of recurrent sprains may suggest ligament laxity, muscle weakness, or impaired proprioception, potentially increasing the risk of future injuries.

Full recovery involves restoring range of motion (ROM), strength, and proprioceptive abilities.

Question 4

What are the signs and symptoms of a sub-acute ankle sprain?

Scenario 1

Answer 4

Swelling, pain around the outer ankle, and tenderness over the affected ligaments. Patients may also report feelings of instability, especially during weight-bearing activities.

Weakness and limited ROM can persist in the sub-acute phase, alongside residual swelling.

Question 5

What are risk factors to sub-acute ankle sprains?

Scenario 1

Answer 5

Previous ankle sprains, inadequate rehabilitation, improper footwear, participation in sports with high physical demand (e.g., basketball, football), and muscle imbalance.

Question 6

How does a sub-acute ankle sprain clinically present?

Scenario 1

Answer 6

The patient may present with mild swelling, pain on palpation of the lateral ligaments, weakness in the muscles around the ankle, and feelings of instability.

Question 7

How would you assess for a sub-acute ankle sprain?

Scenario 1

Answer 7

Ligament Integrity: Anterior drawer test to assess the ATFL, Talar tilt test for CFL involvement.

ROM and Strength: Measure active and passive ROM; test for muscle strength, especially the peroneal muscles.

Proprioception: Single-leg balance tests, including eyes open and closed.

Question 8

How would you treat a sub-acute ankle sprain?

Scenario 1

Answer 8

Strengthening Exercises: Focus on the peroneal muscles to enhance ankle stability. Include resistance band exercises like eversion and dorsiflexion.

Proprioceptive Training: Single leg stands on uneven surfaces, balance board exercises, and agility drills to improve coordination.

Manual Therapy: Joint mobilisations to restore ROM and reduce stiffness.

Factors Influencing Choice: Severity of the sprain, patient’s pain level, and history of recurrent injuries.

Question 9

What is the pathology of osteoarthritis of the right knee?

Scenario 2

Answer 9

Osteoarthritis (OA) is a degenerative joint disease that commonly affects the knee. It involves the gradual breakdown of cartilage, leading to joint pain, stiffness, and loss of function.

Question 10

What is the pathophysiology of OA in the knee?

Scenario 2

Answer 10

In OA, the cartilage that cushions the bones within the joint deteriorates, causing bones to rub against each other. This leads to inflammation, pain, and the formation of bone spurs (osteophytes).

Early-stage OA is marked by the thinning of cartilage, while advanced stages can involve significant cartilage loss and joint deformity. Synovial inflammation may also contribute to pain and stiffness.

Question 11

What is the prognosis for knee OA?

Scenario 2

Answer 11

OA is a chronic, progressive condition. While it cannot be cured, early intervention can slow its progression and manage symptoms, allowing patients to maintain function.

With appropriate management, including lifestyle changes, physical therapy, and sometimes surgical interventions, patients can achieve significant symptom relief.

Question 12

What are signs and symptoms of knee OA?

Scenario 2

Answer 12

Pain during weight-bearing activities, stiffness (especially in the morning or after inactivity), reduced ROM, crepitus (grating sensation), and swelling around the joint. Over time, muscle weakness, particularly in the quadriceps, may develop.

Question 13

What are risk factors of knee OA?

Scenario 2

Answer 13

Age, obesity, previous joint injuries, genetic predisposition, joint misalignment, and repetitive stress on the knee from activities or occupations.

Question 14

How does someone with knee OA clinically present?

Scenario 2

Answer 14

The patient may report pain during activities such as walking, climbing stairs, or getting up from a seated position. There may also be visible swelling or changes in gait.

Question 15

How do you assess for knee OA?

Scenario 2

Answer 15

Pain and Function: Visual analog scale (VAS) for pain, functional assessments like the 30-second sit-to-stand test.

ROM and Strength: Measure knee flexion and extension; test quadriceps and hamstring strength.

Gait Analysis: Observe the patient’s walking pattern to identify compensatory mechanisms antalgic gait (painful) or flexed knee gait.

Question 16

How would you treat knee OA?

Scenario 2

Answer 16

Strengthening Exercises: Focus on the quadriceps, hamstrings, and hip abductors. Straight-leg raises, step-ups, and leg presses.

Manual Therapy: Joint mobilisations to improve ROM, especially in cases of stiffness.

Education: Advice on weight management, activity modification, and use of assistive devices (e.g., cane) if needed.

Factors Influencing Choice: Severity of pain, patient’s functional goals, and any comorbid conditions affecting exercise tolerance.

Question 17

What is the pathology of OA in the hip?

Scenario 3

Answer 17

Hip Osteoarthritis (OA) is a degenerative joint condition that affects the hip joint, characterised by the breakdown of the articular cartilage and subsequent changes in the underlying bone, leading to joint pain, stiffness, and loss of function.

Question 18

What is the pathophysiology of hip OA?

Scenario 3

Answer 18

The cartilage in the hip joint cushions the femoral head and acetabulum. In OA, this cartilage wears down, leading to bone-on-bone contact, which causes pain and inflammation.

Over time, the joint space narrows, osteophytes may form, and there can be thickening of the bone (subchondral sclerosis). These changes limit movement and contribute to pain and stiffness.

Question 19

What is the prognosis of hip OA?

Scenario 3

Answer 19

Hip OA progresses gradually, and while there is no cure, symptom management can help maintain mobility. In severe cases, hip replacement surgery may be necessary.

With conservative treatment, many patients can continue normal activities with reduced discomfort.

Question 20

What are signs and symptoms of hip OA?

Scenario 3

Answer 20

Pain in the groin or anterior thigh, stiffness (especially after rest), reduced hip ROM (particularly in internal rotation and abduction), and difficulty with activities such as walking, bending, and getting up from a seated position.

Pain may also be referred to the knee, and patients might exhibit a Trendelenburg gait (waddling).

Question 21

What risk factors is there for hip OA?

Scenario 3

Answer 21

Age, obesity, prior hip injuries or surgeries, genetic factors, joint misalignment, and certain sports or occupations that involve repetitive stress on the hip.

Question 22

How would you assess for hip OA?

Scenario 3

Answer 22

Pain and Function: Assess using a pain scale, functional assessments like the timed up and go (TUG) test (tenderness of greater trochanter).

ROM and Strength: Measure hip flexion, extension, abduction, and internal/external rotation. Test muscle strength of the hip abductors and flexors. Test glute strength?

FADER test to feel for grinding of the bones.

Gait Analysis: Check for signs of a Trendelenburg gait or compensatory movements.

Leg length check

Muscle wastage in the glutes.

Question 23

How would hip OA clinically present?

Scenario 3

Answer 23

The patient may present with pain during activities like walking, getting in and out of cars, and putting on socks. There may be visible changes in gait and reduced hip movement.

Question 24

How would you treat hip OA?

Scenario 3

Answer 24

Strengthening Exercises: Target the hip abductors, flexors, and extensors to support joint stability. Examples include side leg raises, bridges, and hip flexor stretches.

Manual Therapy: Soft tissue mobilisation and joint mobilisation to improve ROM and reduce stiffness.

Activity Modification: Education on avoiding high-impact activities and using supportive footwear.

Factors Influencing Choice: Severity of symptoms, extent of joint damage, and the patient’s activity level.

Question 25

What is the pathology of lateral epicondylalgia? Scenario 4

Answer 25

Lateral Epicondylalgia, commonly known as "Tennis Elbow," is a condition characterised by pain around the outer part of the elbow. It is usually caused by overuse and involves degeneration of the tendons attached to the lateral epicondyle of the humerus.

Question 26

What is the pathophysiology of lateral epicondyalgia? Scenario 4

Answer 26

The extensor carpi radialis brevis (ECRB) tendon is most often involved. Repetitive wrist extension or heavy lifting can lead to microtears and degeneration of this tendon. Unlike acute inflammation (tendinitis), lateral epicondylalgia is more degenerative (tendinosis), marked by the disorganised collagen and the formation of scar tissue. Over time, the tendon loses elasticity and strength, making it more prone to pain and dysfunction.

Question 27

What is the prognosis of lateral epicondylalgia? Scenario 4

Answer 27

With appropriate management, many patients recover fully within 6-12 weeks. However, if untreated, symptoms can persist for months or even years. Prognosis is generally good if patients adhere to a treatment plan that includes activity modification, strengthening, and therapeutic interventions.

Question 28

What are the signs and symptoms of lateral epicondylagia? Scenario 4

Answer 28

Pain or burning sensation around the lateral elbow, particularly when gripping or lifting objects. The pain often worsens with activities involving wrist extension, such as using tools or lifting weights. Tenderness over the lateral epicondyle and weakness in grip strength are common. Symptoms are usually unilateral, affecting the dominant arm.

Question 29

What are the risk factors of lateral epicondylagia? Scenario 4

Answer 29

Repetitive activities involving the forearm and wrist, occupations requiring heavy or repetitive lifting (like firefighting), poor ergonomic techniques, and middle age (typically 30-50 years).

Question 30

How does lateral epicondylagia clinically present? Scenario 4

Answer 30

The patient may present with localised pain around the lateral epicondyle, reduced grip strength, and discomfort when lifting or gripping objects. Pain may also be reported when extending the wrist against resistance.

Question 31

How would you assess for lateral epicondyalgia? Scenario 4

Answer 31

Pain and Function: Assess pain levels using a visual analog scale (VAS) and functional ability through specific movements, such as gripping. Tenderness and Palpation: Palpate around the lateral epicondyle to identify areas of tenderness. Special Tests: Cozen’s test (resisted wrist extension), Mill’s test (stretching the wrist extensors), and Maudsley’s test (resisted middle finger extension) to provoke symptoms.

Question 32

What are the treatment methods for lateral epicondylalgia? Scenario 4

Answer 32

Eccentric Strengthening Exercises: Gradual loading of the wrist extensors through eccentric exercises to promote tendon healing. For example, wrist flexion and extension with a light dumbbell. Manual Therapy: Soft tissue massage, myofascial release, and mobilizations of the radial head to alleviate muscle tension and improve ROM. Activity Modification: Educate the patient on ergonomics, avoiding repetitive wrist extension activities, and using supportive bracing if needed. Factors Influencing Choice: Severity of symptoms, the patient’s occupation, and pain levels. Treatment may also include modalities like ultrasound or shockwave therapy for persistent cases.

Question 33

What is the pathology of a wrist fracture, just coming out of POP? Scenario 5

Answer 33

Distal Radius Fractures are one of the most common types of fractures, particularly in older adults. This injury often occurs when an individual falls onto an outstretched hand (FOOSH).

Question 34

What is the pathophysiology of a distal radius fracture? Scenario 5

Answer 34

The distal radius is the part of the radius bone near the wrist. A fracture in this area can vary in severity, from minor cracks (non-displaced) to complete breaks (displaced) that may involve the joint surface (intra-articular). After 7 weeks in a cast (POP), the bone typically shows significant healing, but surrounding soft tissues (muscles, ligaments) may still be weak and stiff. There can also be swelling and reduced ROM, especially in the wrist and fingers, due to immobilisation.

Question 35

What is the prognosis of a distal wrist fracture? Scenario 5

Answer 35

With appropriate rehabilitation, the prognosis is generally good, particularly for non-displaced fractures. Full recovery can take several months, as patients gradually regain strength and range of motion. Older adults might experience delayed healing due to osteoporosis, which can affect overall recovery and functionality.

Question 36

What are the signs and symptoms of a distal wrist break coming out of a pot? Scenario 5

Answer 36

Initially, symptoms include pain, swelling, and deformity of the wrist. After cast removal, patients often report stiffness, weakness, and difficulty performing daily activities that require wrist movement or grip. Reduced ROM and potential pain during passive and active movements, as well as muscle atrophy in the hand and forearm due to immobilisation.

Question 37

What are the risk factors of a distal radius fracture coming out of POP? Scenario 5

Answer 37

Advanced age (increased risk of falls), osteoporosis (weakened bones), and activities or conditions that increase the likelihood of falling or trauma (e.g., balance disorders, icy conditions).

Question 38

How does a distal wrist fracture, coming out of a pot clinically present? Scenario 5

Answer 38

Post-cast removal, the patient may present with stiffness, pain, reduced ROM, and weakness in the wrist and hand muscles. Swelling around the wrist may still be present.

Question 39

How would you assess for a distal wrist fracture coming out of POP? Scenario 5

Answer 39

ROM and Strength: Measure wrist flexion, extension, pronation, supination, and grip strength. Compare to the unaffected wrist. Pain and Swelling: Assess pain levels and check for residual swelling or tenderness. Functional Assessments: Evaluate the patient’s ability to perform tasks like buttoning, writing, or holding objects to gauge functional limitations.

Question 40

How would you treat distal wrist fracture just coming out of a pot? Scenario 5

Answer 40

ROM Exercises: Active and passive wrist mobilizations, including wrist flexion, extension, pronation, and supination exercises. Finger dexterity exercises to improve hand function. Strengthening Exercises: Light resistance exercises, such as squeezing a therapy ball, using putty, or performing wrist curls with a light dumbbell. Manual Therapy: Soft tissue massage, joint mobilizations, and gentle stretching to enhance flexibility and reduce stiffness. Education: Importance of gradual progression, fall prevention strategies, and the use of assistive devices (e.g., hand splints) if needed. Factors Influencing Choice: Patient’s age, pre-existing conditions (like osteoporosis), and any concerns about bone healing. Coordination with the patient’s physician to ensure safe progression.

Question 41

What is the pathology of left lateral shoulder pain following a FOOSH? Scenario 6

Answer 41

Shoulder injuries following a fall on an outstretched arm (FOOSH) can lead to several conditions, including rotator cuff tears, acromioclavicular (AC) joint injuries, or shoulder dislocations. The mechanism of injury often determines which structures are affected.

Question 42

What is the pathophysiology of shoulder injuries? Scenario 6

Answer 42

A rotator cuff tear occurs when one or more of the tendons of the rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) are damaged. Falls on an outstretched arm can cause acute tears, especially in younger, active adults. AC joint injuries are caused by direct impact to the shoulder, leading to damage to the ligaments that stabilize the acromioclavicular joint. This can result in a "step deformity" where the collarbone appears elevated. Shoulder dislocation involves the humeral head being forced out of the glenoid cavity, most commonly in an anterior direction. It can result in labral tears or damage to the surrounding ligaments, making the joint unstable. For this scenario, it seems likely that the patient has suffered a rotator cuff injury, given the lateral pain presentation and mechanism of injury.

Question 43

What is the prognosis of shoulder injury after a FOOSH? Scenario 6

Answer 43

Prognosis depends on the severity of the injury. Minor strains or partial tears of the rotator cuff may heal with conservative management, including physiotherapy and rest. Full-thickness tears, however, may require surgical intervention. AC joint injuries and shoulder dislocations can also vary in severity. Mild sprains may recover with rest and rehabilitation, while severe injuries may need surgical repair.

Question 44

What are the signs and symptoms of shoulder pain? Scenario 6

Answer 44

Rotator cuff tears: Pain, particularly when lifting the arm overhead or with movements that require external rotation. Weakness in the shoulder, especially in abduction and external rotation, is common. AC joint injuries: Tenderness over the top of the shoulder, visible deformity, and pain when reaching across the body or lifting objects. Shoulder dislocation: Intense pain, visible shoulder deformity, and a loss of normal shoulder contour. There may also be tingling or numbness if nerves are affected.

Question 45

What are the risk factors of FOOSH? Scenario 6

Answer 45

Rotator cuff tears: Age (more common over 40), repetitive overhead activities, previous shoulder injuries, and certain sports (e.g., tennis, swimming). AC joint injuries: Contact sports, falls, and high-impact activities. Shoulder dislocations: Previous dislocations, sports that involve throwing, or activities with a high risk of falling.

Question 46

How does shoulder pain after FOOSH clinically present? Scenario 6

Answer 46

The patient may present with pain along the lateral aspect of the shoulder, weakness when lifting the arm, and discomfort during activities that involve raising the arm overhead or rotating it outward.

Question 47

How would you assess for rotator cuff? Scenario 6

Answer 47

Pain and Range of Motion (ROM): Assess active and passive ROM of the shoulder, noting any limitations, pain, or weakness during movements like abduction, flexion, and external rotation. Strength Testing: Manual muscle testing for the rotator cuff muscles, especially the supraspinatus (abduction) and infraspinatus (external rotation). Special Tests: Neer’s and Hawkins-Kennedy tests to assess impingement, as well as the empty can test to isolate supraspinatus involvement. Palpation around the AC joint for tenderness may help rule out AC joint injuries Lift off test and drop arm test.

Question 48

How would you treat rotator cuff pathology? Scenario 6

Answer 48

Initial Pain Management: Use of ice, rest, and NSAIDs (as prescribed) to reduce inflammation and pain in the early phase. Educate the patient on avoiding aggravating movements. Strengthening and ROM Exercises: Pendulum exercises for early mobility without straining the shoulder. Isometric exercises to maintain muscle strength without causing further damage. Theraband exercises: Gradual strengthening, focusing on rotator cuff and scapular stabilizers. Manual Therapy: Soft tissue release and mobilization techniques to address tightness, improve joint mobility, and alleviate pain. Education and Activity Modification: Teach the patient ergonomic strategies to avoid overhead reaching or heavy lifting. Encourage maintaining a proper posture to reduce shoulder strain. Factors Influencing Choice: The specific structure injured (e.g., rotator cuff vs. AC joint), the severity of the tear or damage, the patient's pain level, and their functional goals. Persistent or severe cases may require referral for imaging or surgical consultation.