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Clinical Skills - MSK > MSK Pathologies > Flashcards

MSK Pathologies Flashcards

1
Q

What is the function of the rotator cuff?

A

Stabilises the humeral head in the glenoid fossa

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2
Q

What muscles make up the rotator cuff?

A

Subscapularis
Infraspinatus
Supraspinatus
Teres minor

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3
Q

What is the clinical presentation of tennis elbow?

A

Pain located around the lateral epicondyle of the elbow, usually radiating in line with the extensors

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4
Q

What movement aggravates tennis elbow?

A

Wrist / finger extension

Forearm supination

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5
Q

How can you manage tennis elbow?

A

Physiotherapy
Surgery
Corticosteroid injections

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6
Q

What physiotherapy techniques can you use to help tennis elbow?

A

Load management
Exercise
Brace /taping
Education

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7
Q

What is golfers elbow?

A

An overuse tendinopathy affecting the common origin of the flexors and Pronators

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8
Q

What is the clinical presentation of golfers elbow?

A

Pain on medial aspect of the elbow

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9
Q

What movements aggravate golfers elbow?

A

Wrist Flexion

Pronation

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10
Q

How can golfers elbow be managed?

A

Physiotherapy
NSAIDS
Surgery
Corticosteroid injections

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11
Q

What physiotherapy interventions can help treat golfers elbow?

A

Load therapy
Exercise
Education
Taping / bracing

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12
Q

What is De Quervains tenosynovitis?

A

Reactive thickening of the tendon sheath around EPB and APL

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13
Q

What causes De Quervains tenosynovitis?

A

Can occur spontaneously

Initiated by overuse of the thumb

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14
Q

What is the pathophysiology behind De Quervains tenosynovitis?

A

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

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15
Q

What is the clinical presentation of De Quervains tenosynovitis?

A

Pain on the radial side of the wrist that can be referred to the thumb

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16
Q

What movements aggravate De Quervains tenosynovitis?

A

Reissued thumb extension / abduction

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17
Q

What physiotherapy interventions can help patients with De Quervains tenosynovitis?

A

Splinting
Load management
Education
Exercises

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18
Q

What is a strain?

A

A muscle or tendon injury, involving over contracting or lengthening a muscle causing test ring of collagen

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19
Q

How many grades of muscle strain are there

A

3

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20
Q

What is the management of strains?

A 
POLICE
Mobilisation 
Strength / loading
Proprioception 
Endurance training 
Surgery
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21
Q

What is a sprain?

A

A stretch or tearing of a ligament

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22
Q

What can cause a sprain?

A

A joint being suddenly forced outside its usual ROM, and the inelastic fibres are stretched too far

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23
Q

What interventions can help heal ligament sprains?

A 
POLICE 
Early mobilisation 
Early weight bearing 
Exercises 
Education 
Return to sport 
Surgery
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24
Q

What is carpal tunnel syndrome?

A

The median nerve is compressed, where it passes through the carpal tunnel

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25
Q

What is the clinical presentation of of carpal tunnel syndrome?

A

Loss of sensation
Weakness of median nerve innervated muscles
Pain
Intermittent nocturnal paraesthesia

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26
Q

How can a patient manage carpal tunnel syndrome?

A 
Education 
Load management 
Night time splinting 
Exercise 
Surgery (severe cases)
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27
Q

What are avulsion injuries?

A

Where a capsule, ligament, tendon or muscle attachment site is pulled from a bone

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28
Q

What are the symptoms of an avulsion injury?

A

Pain
Swelling
Limited movement
Instability / loss of function of a joint

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29
Q

What is a stress fracture?

A

A small crack or break in weight bearing bones due to overuse

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30
Q

What are the symptoms of a stress fracture?

A

Pain that gets worse during exercise

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31
Q

What is avascular necrosis?

A

When there is a loss of blood supply to the bone

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32
Q

What are the symptoms of avascular necrosis?

A

Stiffness
Night pain
Limp
Pain in the groin, buttocks and front of thigh

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33
Q

What is hip dysplasia?

A

Where the hip socket doesn’t fully cover the femoral head, this may allow the hip to partially or fully dislocate

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34
Q

What are labral tears?

A

Part of the labrum separates or pulls away from the socket

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35
Q

What are the 2 types of hip impingement?

A

Cam-type FAI

Pincer-type FAI

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36
Q

What is a cam-type FAI?

A

Caused by an irregular osseous prominence of the proximal femoral neck or head-neck junction

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37
Q

What is a pincer-type FAI?

A

Result of excessive acetabular coverage of the femoral head

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38
Q

What are the symptoms for a hip impingement?

A

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

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39
Q

What is greater trochanteric pain syndrome?

A

Tendinopathy of gluteus medius and/or minimus

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40
Q

Who are the typical GTPS patients?

A

Aged 40-60
Female
Post menopausal
Increased BMI

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41
Q

What are the 2 types of snapping hip syndrome?

A

Internal

External

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42
Q

What is internal snapping hip syndrome?

A

Caused by iliopsoas over iliopectineal eminence paralabral cysts

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43
Q

What is external snapping hip syndrome?

A

Caused by ITB snapping over greater trochanter or proximal hamstring tendon rolling over ischial tuberosity

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44
Q

What is an osteochondral defect?

A

Focal area of damage to a focal area of damage that involves both the cartilage and a piece of underlying bone

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45
Q

What is the synovial fluid intrusion theory in terms of subchondral cysts?

A

Articular surface defects and increased intra-articular pressure allow intrusion of synovial fluid into the bone, leading to the formation of cavities

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46
Q

What is the bone contusion theory in terms of subchondral cysts?

A

Non-communicating cysts arise from subchondral foci of bone necrosis that are the result of opposing articular surfaces coming into contact with each other

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47
Q

What tendons can have tendinopathies in the upper and lower limb?

A 
Patella 
Achilles 
Tibialis posterior 
Tibialis anterior 
Peroneus Longus and Brevis 
Rotator cuff 
Lateral / medial epicondyalgia 
EBL/B
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48
Q

What are the structural changes with tendinopathys?

A

Alterations to tendon cell population
Disorganisation of collagen
Ground substance change
Neovascularisation

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49
Q

What are some of the ways tendinopathys occur?

A 
Training overload 
Previous injury 
Muscle weakness 
Lower limb biomechanics 
Footwear 
Training surface 
Tendon structure 
Increased BMI
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50
Q

What is frozen shoulder?

A

Formation of excessive scar tissues or adhesions across the glenohumeral joint leading to stiffness, pain and dysfunction

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51
Q

What can cause frozen shoulder?

A

Spontaneously

After trauma

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52
Q

What are some of the risk factors of frozen shoulder?

A

Age
Trauma
Coronary heart disease
Hyperthyroidism

53
Q

What are the 4 stages of frozen shoulder

A

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

54
Q

What is the clinical presentation of a frozen shoulder?

A

Present first with pain
Gradual loss of ROM
Passive ROM with firm, painful end feel

55
Q

How can frozen shoulder be managed?

A

Physiotherapy - early mobilisation
Education
Surgery - capsular release
Corticosteroid injections

56
Q

How can a clavicle fracture be managed?

A

Sling use
Physiotherapy
Surgical

57
Q

What are the 3 types of distal humerus fracture?

A

Colles’ fracture
Smith’s fracture
Barton’s fracture

58
Q

How can a proximal humerus fracture be managed?

A

Collar and cuff (2-3/52)
Progressive active management
Surgery

59
Q

What is the management of a distal humerus fracture?

A

Splints
Cast
K-wires
Physiotherapy after a period of immobilisation

60
Q

What is the sign of a scaphoid fracture?

A

Pain over anatomical snuff box

61
Q

What is the management of a scaphoid fracture?

A

Cast
Surgery
Physiotherapy after a period of immobilisation

62
Q

What joints is osteoarthritis most common in?

A

Knees
Hips
Small joints of the hand

63
Q

What is the management of osteoarthritis?

A

Physiotherapy
Corticosteroid injections
Surgery (joint replacement)

64
Q

What is rheumatoid arthritis?

A

Systemic autoimmune disease characterised by inflammatory arthritis with extra-articular involvement

65
Q

What are the risk factors of Rheumatoid arthritis?

A

Genetic factors
Smoking
Air pollution
Obesity

66
Q

What is the clinical presentation of rheumatoid arthritis?

A 
Insidious onset over a period of months 
Joint stiffness in the morning 
Fatigue 
Deformity 
Pain
Weakness
67
Q

How can a patient manage rheumatoid arthritis?

A

Physiotherapy
Pharmacological management
Nutrition
Symptom management

68
Q

What position is the shoulder in for a anterior shoulder dislocation?

A

Abduction and external rotation

69
Q

What causes a posterior shoulder dislocation?

A

Blow to the front of the shoulder

70
Q

What is shoulder instability?

A

Disruption of the dynamic and static stabilisers of the GHJ leading to dislocation, subluxation and apprehension

71
Q

What is the clinical presentation of Shoulder instability?

A 
Clicking 
Pain 
Sub-acromial signs 
Rotator cuff signs 
Increased accessory motion
72
Q

How can you manage shoulder instability?

A

Physiotherapy - education, motor control, strength training and Proprioception

73
Q

What is dupuytren disease?

A

Nodular hypertrophy and contracture of the superficial palmar fascia

74
Q

How does dupuytren disease begin?

A

Thickening of the skin, then Bands of fibrotic tissue form in the palmar area, eventually leading to affected fingers being pulled into flexion

75
Q

What is the physiotherapy intervention for duputren disease?

A

Post operative
Splinting
Exercise - passive stretching, active exercises and function
Education and advice

76
Q

What are the environmental factors associated with dupuytren disease?

A

Alcohol intake
Smoking
Manual labour
Low body weight / BMI

77
Q

What are the mechanisms of injury for meniscus tears/lesions?

A

Involves Flexion and rotational forces under compression e.g. twisting

78
Q

What are the classifications of meniscus injury?

A 
Vertical longitudinal 
Vertical radial 
Horizontal 
Oblique 
Complex / degenerative
79
Q

What other structures are commonly injured along with an ACL?

A

Meniscus tears
Articular cartilage damag e
MCL injury
Bone bruising

80
Q

What are PCL sprains or tears associated with?

A

Posterolateral corner injuries

81
Q

What are the static stabilisers of the knee?

A

Superficial MCL
Deep MCL or medial capsular ligament
Posterior oblique ligament

82
Q

What are the dynamic stabilisers of the knee?

A

Semimembranosus
Quadriceps
Pes anserinus

83
Q

What are the lateral supporting structures?

A

Lateral collateral ligament
ITB
Popliteal
Bicep femoris

84
Q

What is apophysitis?

A

A normal development outgrown of a bone, which fuses later in adult development

85
Q

Where can apophysitis found?

A

Where tendon and ligaments attach to bone

86
Q

What are the lateral ankle ligaments?

A

Posterior talofibular ligament
Anterior talofibular ligament
Calcaneofibular ligament

87
Q

What ligament is the most commonly injured?

A

Anterior talofibular ligament

88
Q

What are the signs and symptoms of an ankle sprain?

A 
Pain 
Tenderness 
Swelling 
Bruising 
Inability to bear weight
89
Q

What is plantar fasciitis?

A

Pain affecting the heel that is worse in the morning and after weight-bearing all day

90
Q

What is the test for plantar fasciitis?

A

Palpation with twisting motion to MCT will cause discomfort and pain

91
Q

What are the risk factors for plantar fasciitis?

A

Flat foot
High arch
Obesity / underweight
Reduced dorsiflexion

92
Q

What is a metaphyseal fracture?

A

Fracture to the base of the 5th metatarsal

93
Q

What deficiency does a metaphyseal fracture indicate?

A

Vitamin D

94
Q

How long is the recovery from a metaphyseal fracture?

A

4-16 weeks depending on intervention

95
Q

What is the presentation of posterior tibial tendon dysfunction / rupture?

A

Pain in posterior medial malleolus extending to the navicular, lowered medial longitudinal arch

96
Q

What is the test for posterior tibial tendon dysfunction/ rupture?

A

Tiptoe single phase support

97
Q

What is the treatment for posterior tibial tendon dysfunction/ rupture?

A

Rest
Orthotics
Rehab
Surgery

98
Q

What is the procedure for a total hip replacement?

A

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

99
Q

What is a hemiarthroplasty?

A

Surgical procedure that involves replacing half of the hip (femoral head portion)

100
Q

What is hip resurfacing?

A

Replaces the surfaces of the hip joint

101
Q

How is a total knee replacement performed?

A

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

102
Q

What is the post-op physiotherapy for a total knee and hip replacement?

A 
FWB after surgery 
Start mobilising day 0
ROM / strength exercises 
Hip precautions sometimes followed for 6/52
Swelling & pain management
103
Q

What does a total shoulder replacement aim to do?

A

Reduce pain

Restore mobility

104
Q

What is a traditional total shoulder replacement?

A 
GHJ accessed anteriorly 
Deltoid and pecs are separated to access the shoulder joint 
Arthritic areas removed 
Implants inserted 
Muscles repaired and reattached 
Incisions closes
105
Q

What is a reverse shoulder replacement?

A

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

106
Q

What soft tissue is used for an ACL reconstruction?

A

Hamstring

Patella tendon

107
Q

What is the outcome from using the hamstring for an ACL reconstruction?

A

Higher risk of hamstring injury post-op
Smaller wound
High strength of graft

108
Q

What are the outcomes from using the patella tendon for an ACL reconstruction?

A

Increase of tendinopathy

Anterior knee pain

109
Q

How is a rotator cuff repair performed?

A

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

110
Q

What is the test to check is an Achilles’ tendon is ruptured?

A

Thompson test

111
Q

How is an Achilles’ tendon repair performed?

A

Posterior incision made

Ruptured ends on Achilles stitched together

112
Q

How long is the patient in a boot for after an Achilles’ tendon repair?

A

8-12/52 in plantarflexion

113
Q

What is a discectomy/ decompression?

A

Surgery to reduced compression to the nerve and/or spinal cord

114
Q

How do you perform a discectomy?

A

Removing disc material that is extruding into the foramen / spinal canal

115
Q

How do you perform a decompression?

A

Includes removal of osteophytes, laminectomy, removal of thickened ligament, foraminotomy or facetectomy

116
Q

What is the post-op physiotherapy for a discectomy / decompression?

A

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

117
Q

What is spinal fusion surgery?

A

Surgeon uses screws and rods to fix vertebrae in place

118
Q

What physiotherapy is done after a spinal fusion?

A

Immediate post-op physio aimed at regaining mobility

Chest physio

119
Q

What are open reduction internal fixations?

A

Surgery to fix broken bones that are displaced or unstable

120
Q

What are the different types of internal fixation?

A

IM nails
Plates
Screws

121
Q

What are external fixations?

A

Surgical treatment where the rods are screwed into the bone, and exit the body to be attached to a stabilising structure

122
Q

What are external fixators used for?

A

Severe open fractures
Infected non-unions
Correction of malalignments
Poly trauma

123
Q

What are the 2 different types of arthritic conditions (not OA or RA)?

A

Inflammatory

Degenerative

124
Q

What is hip osteoarthritis?

A 
Loss of joint space 
Osteophyte formation 
Subchondral sclerosis 
Subchondral cysts 
Deformity
125
Q

What are the risk factors for hip OA?

A 
Joint mobility 
Muscle 
BMI
Gender 
Age 
Race 
Pain perception 
Genomics
126
Q

What are other causes of joint pain?

A

Malignancy or infection
Inflammatory arthritis
Metastatic
Septic arthritis

127
Q

What is the pathogenesis of BMLs?

A

Result of synovial fluid penetrating through defects within the articular cartilage and entering the subchondral bone leading to micro fracture and oedema

128
Q

What are the clinical symptoms of knee OA?

A 
Pain 
Inactivity stiffness lasting no longer than 30 mins
Crepitus on moving the joint 
Bony tenderness 
Limitation of movement 
No palpable warmth 
Bony enlargement

Clinical Skills - MSK (2 decks)

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