MSK Pathologies Flashcards
What is the function of the rotator cuff?
Stabilises the humeral head in the glenoid fossa
What muscles make up the rotator cuff?
Subscapularis
Infraspinatus
Supraspinatus
Teres minor
What is the clinical presentation of tennis elbow?
Pain located around the lateral epicondyle of the elbow, usually radiating in line with the extensors
What movement aggravates tennis elbow?
Wrist / finger extension
Forearm supination
How can you manage tennis elbow?
Physiotherapy
Surgery
Corticosteroid injections
What physiotherapy techniques can you use to help tennis elbow?
Load management
Exercise
Brace /taping
Education
What is golfers elbow?
An overuse tendinopathy affecting the common origin of the flexors and Pronators
What is the clinical presentation of golfers elbow?
Pain on medial aspect of the elbow
What movements aggravate golfers elbow?
Wrist Flexion
Pronation
How can golfers elbow be managed?
Physiotherapy
NSAIDS
Surgery
Corticosteroid injections
What physiotherapy interventions can help treat golfers elbow?
Load therapy
Exercise
Education
Taping / bracing
What is De Quervains tenosynovitis?
Reactive thickening of the tendon sheath around EPB and APL
What causes De Quervains tenosynovitis?
Can occur spontaneously
Initiated by overuse of the thumb
What is the pathophysiology behind De Quervains tenosynovitis?
Swelling of the sheaths of EPB and APL leading to eventual thickening of the sheaths
Adhesions can develop between the tendon and the sheath which restricts normal tendon movement
What is the clinical presentation of De Quervains tenosynovitis?
Pain on the radial side of the wrist that can be referred to the thumb
What movements aggravate De Quervains tenosynovitis?
Reissued thumb extension / abduction
What physiotherapy interventions can help patients with De Quervains tenosynovitis?
Splinting
Load management
Education
Exercises
What is a strain?
A muscle or tendon injury, involving over contracting or lengthening a muscle causing test ring of collagen
How many grades of muscle strain are there
3
What is the management of strains?
POLICE Mobilisation Strength / loading Proprioception Endurance training Surgery
What is a sprain?
A stretch or tearing of a ligament
What can cause a sprain?
A joint being suddenly forced outside its usual ROM, and the inelastic fibres are stretched too far
What interventions can help heal ligament sprains?
POLICE Early mobilisation Early weight bearing Exercises Education Return to sport Surgery
What is carpal tunnel syndrome?
The median nerve is compressed, where it passes through the carpal tunnel
What is the clinical presentation of of carpal tunnel syndrome?
Loss of sensation
Weakness of median nerve innervated muscles
Pain
Intermittent nocturnal paraesthesia
How can a patient manage carpal tunnel syndrome?
Education Load management Night time splinting Exercise Surgery (severe cases)
What are avulsion injuries?
Where a capsule, ligament, tendon or muscle attachment site is pulled from a bone
What are the symptoms of an avulsion injury?
Pain
Swelling
Limited movement
Instability / loss of function of a joint
What is a stress fracture?
A small crack or break in weight bearing bones due to overuse
What are the symptoms of a stress fracture?
Pain that gets worse during exercise
What is avascular necrosis?
When there is a loss of blood supply to the bone
What are the symptoms of avascular necrosis?
Stiffness
Night pain
Limp
Pain in the groin, buttocks and front of thigh
What is hip dysplasia?
Where the hip socket doesn’t fully cover the femoral head, this may allow the hip to partially or fully dislocate
What are labral tears?
Part of the labrum separates or pulls away from the socket
What are the 2 types of hip impingement?
Cam-type FAI
Pincer-type FAI
What is a cam-type FAI?
Caused by an irregular osseous prominence of the proximal femoral neck or head-neck junction
What is a pincer-type FAI?
Result of excessive acetabular coverage of the femoral head
What are the symptoms for a hip impingement?
Sitting crossed leg is difficult or painful
Difficulties putting him shoes and socks
Unable to sit for a long period of time
Limp
Walking long distances are painful
Lower back pain
What is greater trochanteric pain syndrome?
Tendinopathy of gluteus medius and/or minimus
Who are the typical GTPS patients?
Aged 40-60
Female
Post menopausal
Increased BMI
What are the 2 types of snapping hip syndrome?
Internal
External
What is internal snapping hip syndrome?
Caused by iliopsoas over iliopectineal eminence paralabral cysts
What is external snapping hip syndrome?
Caused by ITB snapping over greater trochanter or proximal hamstring tendon rolling over ischial tuberosity
What is an osteochondral defect?
Focal area of damage to a focal area of damage that involves both the cartilage and a piece of underlying bone
What is the synovial fluid intrusion theory in terms of subchondral cysts?
Articular surface defects and increased intra-articular pressure allow intrusion of synovial fluid into the bone, leading to the formation of cavities
What is the bone contusion theory in terms of subchondral cysts?
Non-communicating cysts arise from subchondral foci of bone necrosis that are the result of opposing articular surfaces coming into contact with each other
What tendons can have tendinopathies in the upper and lower limb?
Patella Achilles Tibialis posterior Tibialis anterior Peroneus Longus and Brevis Rotator cuff Lateral / medial epicondyalgia EBL/B
What are the structural changes with tendinopathys?
Alterations to tendon cell population
Disorganisation of collagen
Ground substance change
Neovascularisation
What are some of the ways tendinopathys occur?
Training overload Previous injury Muscle weakness Lower limb biomechanics Footwear Training surface Tendon structure Increased BMI
What is frozen shoulder?
Formation of excessive scar tissues or adhesions across the glenohumeral joint leading to stiffness, pain and dysfunction
What can cause frozen shoulder?
Spontaneously
After trauma
What are some of the risk factors of frozen shoulder?
Age
Trauma
Coronary heart disease
Hyperthyroidism
What are the 4 stages of frozen shoulder
1 - Primary complaint of shoulder pain, especially at night
2 - Patient begins to develop stiffness
3 - Profound global loss of ROM, pan at EOR
4 - persistent stiffness, minimal pain
What is the clinical presentation of a frozen shoulder?
Present first with pain
Gradual loss of ROM
Passive ROM with firm, painful end feel
How can frozen shoulder be managed?
Physiotherapy - early mobilisation
Education
Surgery - capsular release
Corticosteroid injections
How can a clavicle fracture be managed?
Sling use
Physiotherapy
Surgical
What are the 3 types of distal humerus fracture?
Colles’ fracture
Smith’s fracture
Barton’s fracture
How can a proximal humerus fracture be managed?
Collar and cuff (2-3/52)
Progressive active management
Surgery
What is the management of a distal humerus fracture?
Splints
Cast
K-wires
Physiotherapy after a period of immobilisation
What is the sign of a scaphoid fracture?
Pain over anatomical snuff box
What is the management of a scaphoid fracture?
Cast
Surgery
Physiotherapy after a period of immobilisation
What joints is osteoarthritis most common in?
Knees
Hips
Small joints of the hand
What is the management of osteoarthritis?
Physiotherapy
Corticosteroid injections
Surgery (joint replacement)
What is rheumatoid arthritis?
Systemic autoimmune disease characterised by inflammatory arthritis with extra-articular involvement
What are the risk factors of Rheumatoid arthritis?
Genetic factors
Smoking
Air pollution
Obesity
What is the clinical presentation of rheumatoid arthritis?
Insidious onset over a period of months Joint stiffness in the morning Fatigue Deformity Pain Weakness
How can a patient manage rheumatoid arthritis?
Physiotherapy
Pharmacological management
Nutrition
Symptom management
What position is the shoulder in for a anterior shoulder dislocation?
Abduction and external rotation
What causes a posterior shoulder dislocation?
Blow to the front of the shoulder
What is shoulder instability?
Disruption of the dynamic and static stabilisers of the GHJ leading to dislocation, subluxation and apprehension
What is the clinical presentation of Shoulder instability?
Clicking Pain Sub-acromial signs Rotator cuff signs Increased accessory motion
How can you manage shoulder instability?
Physiotherapy - education, motor control, strength training and Proprioception
What is dupuytren disease?
Nodular hypertrophy and contracture of the superficial palmar fascia
How does dupuytren disease begin?
Thickening of the skin, then Bands of fibrotic tissue form in the palmar area, eventually leading to affected fingers being pulled into flexion
What is the physiotherapy intervention for duputren disease?
Post operative
Splinting
Exercise - passive stretching, active exercises and function
Education and advice
What are the environmental factors associated with dupuytren disease?
Alcohol intake
Smoking
Manual labour
Low body weight / BMI
What are the mechanisms of injury for meniscus tears/lesions?
Involves Flexion and rotational forces under compression e.g. twisting
What are the classifications of meniscus injury?
Vertical longitudinal Vertical radial Horizontal Oblique Complex / degenerative
What other structures are commonly injured along with an ACL?
Meniscus tears
Articular cartilage damag e
MCL injury
Bone bruising
What are PCL sprains or tears associated with?
Posterolateral corner injuries
What are the static stabilisers of the knee?
Superficial MCL
Deep MCL or medial capsular ligament
Posterior oblique ligament
What are the dynamic stabilisers of the knee?
Semimembranosus
Quadriceps
Pes anserinus
What are the lateral supporting structures?
Lateral collateral ligament
ITB
Popliteal
Bicep femoris
What is apophysitis?
A normal development outgrown of a bone, which fuses later in adult development
Where can apophysitis found?
Where tendon and ligaments attach to bone
What are the lateral ankle ligaments?
Posterior talofibular ligament
Anterior talofibular ligament
Calcaneofibular ligament
What ligament is the most commonly injured?
Anterior talofibular ligament
What are the signs and symptoms of an ankle sprain?
Pain Tenderness Swelling Bruising Inability to bear weight
What is plantar fasciitis?
Pain affecting the heel that is worse in the morning and after weight-bearing all day
What is the test for plantar fasciitis?
Palpation with twisting motion to MCT will cause discomfort and pain
What are the risk factors for plantar fasciitis?
Flat foot
High arch
Obesity / underweight
Reduced dorsiflexion
What is a metaphyseal fracture?
Fracture to the base of the 5th metatarsal
What deficiency does a metaphyseal fracture indicate?
Vitamin D
How long is the recovery from a metaphyseal fracture?
4-16 weeks depending on intervention
What is the presentation of posterior tibial tendon dysfunction / rupture?
Pain in posterior medial malleolus extending to the navicular, lowered medial longitudinal arch
What is the test for posterior tibial tendon dysfunction/ rupture?
Tiptoe single phase support
What is the treatment for posterior tibial tendon dysfunction/ rupture?
Rest
Orthotics
Rehab
Surgery
What is the procedure for a total hip replacement?
Incision made postero-laterally to expose the joint
Surgeon dislocates the hip
Femoral head cut off, and a special tool used to bring down and reshape the acetabulum
Acetabular cup placed into socket, then an insert / liner placed inside the cup
The prosthetic femoral stem is placed into the shaft of the femur, and the prosthetic femoral head sits on top
What is a hemiarthroplasty?
Surgical procedure that involves replacing half of the hip (femoral head portion)
What is hip resurfacing?
Replaces the surfaces of the hip joint
How is a total knee replacement performed?
An incision made down the front of the knee to expose kneecap
Kneecap is moved to the side to allow access to the knee joint
Distal femur and proximal tibia are cut away
The distal end of the femur is replaces with a curval metal prosthesis and the proximal tibia is replaced with a flat prosthesis
Plastic spacer in between the 2 components
What is the post-op physiotherapy for a total knee and hip replacement?
FWB after surgery Start mobilising day 0 ROM / strength exercises Hip precautions sometimes followed for 6/52 Swelling & pain management
What does a total shoulder replacement aim to do?
Reduce pain
Restore mobility
What is a traditional total shoulder replacement?
GHJ accessed anteriorly Deltoid and pecs are separated to access the shoulder joint Arthritic areas removed Implants inserted Muscles repaired and reattached Incisions closes
What is a reverse shoulder replacement?
Shoulder accessed anteriorly
Humerus prepared for a new socket and glenoid replaced for a ball shaped prosthesis
Humeral stem inserted, humerus cup and glenospherre attached
Movement of joint checked
Muscles repaired
Incision closed
What soft tissue is used for an ACL reconstruction?
Hamstring
Patella tendon
What is the outcome from using the hamstring for an ACL reconstruction?
Higher risk of hamstring injury post-op
Smaller wound
High strength of graft
What are the outcomes from using the patella tendon for an ACL reconstruction?
Increase of tendinopathy
Anterior knee pain
How is a rotator cuff repair performed?
Joint / tendon will be debribed, sometimes alongside a subacromial decompression
Rotator cuff tendon will then be reattached to the bone using an anchor and sutures
What is the test to check is an Achilles’ tendon is ruptured?
Thompson test
How is an Achilles’ tendon repair performed?
Posterior incision made
Ruptured ends on Achilles stitched together
How long is the patient in a boot for after an Achilles’ tendon repair?
8-12/52 in plantarflexion
What is a discectomy/ decompression?
Surgery to reduced compression to the nerve and/or spinal cord
How do you perform a discectomy?
Removing disc material that is extruding into the foramen / spinal canal
How do you perform a decompression?
Includes removal of osteophytes, laminectomy, removal of thickened ligament, foraminotomy or facetectomy
What is the post-op physiotherapy for a discectomy / decompression?
Sitting often restricted to 30 minutes at a time for first 1-2/52
Gentle ROM and isometric exercises given initially
Walking encouraged immediately post-op
Strength and mobility exercises progressed from 4-6/52 post-op depending on symptoms
What is spinal fusion surgery?
Surgeon uses screws and rods to fix vertebrae in place
What physiotherapy is done after a spinal fusion?
Immediate post-op physio aimed at regaining mobility
Chest physio
What are open reduction internal fixations?
Surgery to fix broken bones that are displaced or unstable
What are the different types of internal fixation?
IM nails
Plates
Screws
What are external fixations?
Surgical treatment where the rods are screwed into the bone, and exit the body to be attached to a stabilising structure
What are external fixators used for?
Severe open fractures
Infected non-unions
Correction of malalignments
Poly trauma
What are the 2 different types of arthritic conditions (not OA or RA)?
Inflammatory
Degenerative
What is hip osteoarthritis?
Loss of joint space Osteophyte formation Subchondral sclerosis Subchondral cysts Deformity
What are the risk factors for hip OA?
Joint mobility Muscle BMI Gender Age Race Pain perception Genomics
What are other causes of joint pain?
Malignancy or infection
Inflammatory arthritis
Metastatic
Septic arthritis
What is the pathogenesis of BMLs?
Result of synovial fluid penetrating through defects within the articular cartilage and entering the subchondral bone leading to micro fracture and oedema
What are the clinical symptoms of knee OA?
Pain Inactivity stiffness lasting no longer than 30 mins Crepitus on moving the joint Bony tenderness Limitation of movement No palpable warmth Bony enlargement
