MSK injuries Flashcards
joint space is a type of potential space
similar to pleural or pericardial space
negative hydrostatic pressure → draws fluid into it
most common type of hip dislocation
posterior dislocation:
femoral head slips out of acetabulum posteriorly
can occur from MVA
structures injured in posterior hip dislocation
medial and lateral circumflex femoral arteries: br. of deep femoral artery (below greater trocanter, ring around upper femur, supplies femoral neck)
femoral vein
femoral nerve
head of femur
tx of posterior hip dislocation
closed (no surgery) reduction (put bone back in place) by pulling on femur with continous traction
unhappy triad
lateral force applied to planted leg
MCL
ACL
lateral meniscus (more common) or medial meniscus (attached to MCL, part of original definition)
anterior drawer test
pull tibia anteriorly
suggests ACL injury
ACL
attaches to tibia anteriorly
PCL
attaches to tibia posteriorly
most common cause of knee pain
patellofemoral syndrome
anterior knee pain that worsens with activity
no tender tendon
patellofemoral syndrome
cause of patellofemoral syndrome
contact between back of patella and distal femur
pain when palpate inferior patellar tendon
patellar tendonitis
treatment of patellofemoral syndrome
strengthen quad muscles
stretch exercises: hamstrings, calves, hip, iliotibial band
minimize activities that put stress on knee (squat, kneel, jog, bike)
maximize walking: keep knee moving
caused by friction/pressure anterior to patella
prepatellar bursitis = “housemaid’s knee” = on knees to clean floor
caused by friction/pressure on tibial tuberosity (inferior to patella)
infrapatellar bursitis = “clergyman’s knee”
what is the name for the pad of tissue between a bone + tendon
bursa: ↓friction with movement
what is the name for the pad of tissue between bones
cartilage: ↓friction with movement
what is name for stretching ligaments too far and causing microtears
sprain
what is name for stretching muscle and possibly its tendon
strain
treatment for an ankle sprain
RICE Rest - no weight bearing, crutches Ice - 20 minutes q 2 hrs for 1st 48 hrs Compression - ACE bandage Elevation - ↓swelling due to gravity NSAIDs within 1st 48 hrs ROM exercises: marbles with toes, circles with foot, trace alphabet
most common type of ankle sprain
lateral ankle sprain
most common ligaments injured in ankle sprain (most common → more severe injury)
1) anterior talofibular liagment (ATFL - Always Tears First Ligament)
2) calcaneofibular ligament
3) posterior talofibular ligament
medial ankle ligaments
deltoid ligament (rarely injured)
name this condition:
heal pain beneath the calcaneus or in medial arch
local point tenderness at medial tubercle of calcaneus
worse with first steps in morning and after weight bearing
+/- heel spur on xray
plantar fasciitis
plantar fascia attaches
calcaneus to proximal phalanges of each toe
treatment of plantar fasciitis
can take 2 years to recover:
NSAID
dorsiflexion with night splints
stretching of plantar fascia and achilles tendon
OTC heel insert
local steroid injection
surgical release of plantar fascia in severe cases
what are the rotator cuff muscles
SItS Supraspinatous - most common rotator cuff injury Infraspinatous teres minor Subscapularis
action of supraspinatous m.
initiates first 15° of arm abduction (raise arm up from side of body) (before deltoid m.)
action of infraspinatous m.
lateral rotation of arm (external rotation)
injured with pitching
action of teres minor m.
lateral rotation of arm (external rotation)
adduction
action of subscapularis m.
medial rotation of arm (internal rotation)
adduction
test for supraspinatous m. function
empty can test
abduct to 90, 30 degrees of forward flexion, pronate arm with thumb to ground, add resistance to forearm
positive test: pain + weakness with resistance
name the condition:
rotator cuff muscles + tendon + bursa trapped by acromion process during abduction
most commonly involves: subacromial bursa + supraspinatous tendon/muscle
shoulder impingement
repetitive overhead activity (baseball pitch, tennis, swimming) can cause
shoulder impingement
impingement between head of humerus + coracoacromial arch can cause
subacromial bursitis
treatment of subacromial bursitis
NSAIDs
steroid injection in bursa
name this condition:
head of humerus rotates out of glenoid cavity
dislocated shoulder
name this condition:
clavicle separates from acromion and coracoid process of scapula
separated shoulder
name the condition:
severe shoulder adhesions that lock the shoulder in place after disuse of shoulder (cast, splint) or prolonged immobilization
normal xray
arthrogram (inject dye in joint) shows constriction of joint capsule and loss of axillary + subscapularis spaces
common in >50 yo, women, diabetics
adhesive capsulitis (frozen shoulder)
treatment of adhesive capsulitis
can take 1 year to recover:
glenohumeral joint injection: ↓inflammation/adhesions
subacromial joint injection: ↓pain, ↑ ROM
heat + analgesia
PT to ↑ROM
break adhesions under anesthesia
“popeye” lesion
biceps tendon rupture
injury after lifting heavy item
can tear at elbow or shoulder
after injury: muscle bulge when contract
biceps tendon rupture
treatment for biceps tendon rupture
older: still can function, no surgery
younger: limited function, need surgery
↑fluid/inflammation over olecranon process on elbow
not tender
olecranon bursitis
inject needle to remove fluid
most commonly fractured carpal bone
scaphoid
punched someone with knuckles of clenched fist
tender anatomical snuff box
+/- normal xray
scaphoid racture
complication of scaphoid fracture
avascular necrosis: presents with painful arthritis
blood supply to scaphoid is distal to proximal
fall on outstretched hand causes
damage to hook of the hamate → ulnar nerve injury
painless thickening/contraction of flexor tendon on palm of 1 or more fingers (ring finger - 4th finger most common)
may have family hx
>40 yo, male, alcoholism, diabetes, smoking
depuytren contracture
treatment for depuytren contracture
radiation
inject with bacterial collagenase
definitive: surgery → PT
repetitive wrist extension
lateral epicondylitis ("tennis elbow")
wrist extensor tendon attached to elbowrepetitive wrist flexion
medial epicondylitis (“golfers elbow”)
