MSK pathologies Flashcards
What is adhesive capsulitis?
Chronic fibrosis condition characterised by insidious, progressive and severe restriction of both active and passive shoulder range of motion. Many patients experience shoulder pain however it depends on which stage of the condition it is. Lateral rotation is the most commonly affected.
Women aged between 40-60 are most at risk and is more likely to occur when diabetes is prevalent.
Physiotherapy management of adhesive capsulitis includes mobility exercises, potentially eccentric loading based exercises to help lengthen tissue. It may need onward referral for steroid injection if pain is too severe and irritable.
What is Ankylosing spondylitis?
It is a chronic progressive inflammatory condition where parts of the spine become inflamed.
Patients present with severe pain and spinal stiffness.
Progression of the disease leads to spinal fusion. It affects the SIJ predominately.
24 hour pattern shows it is worse in the morning
Eases include walking.
Treatment include exercises, group exercise programme, hydrotherapy, nsaids, surgery
LIKE OSTEOARTHRITIS OF THE SPINE
Appears like a bamboo stick under an x ray
What is an anterior crucial ligament injury?
The ACL prevents the tibia from sliding out in front of the femur. The injury is characterised by a sudden and painful pop noise. It is often tender at the lateral femoral condole, lateral tibial plateau and the tibiofemoral joint lines. After occurrence, rapid development of effusion is common. Lots of partial tears progress to complete tears with a higher risk of meniscal and cartilage injuries.
Risk factors include 15-25 year olds on lobed in sports and women. It often occurs in pivoting sports.
Treatments of ACL injuries include POLICE, braces, loading modification or surgical reconstruction
What is carpal tunnel syndrome?
Carpal tunnel syndrome is a collection of symptoms which is caused by compression of the median nerve. Females aged between 40-60 are most commonly affected. Other risk factors include smoking, high bmi The typical symptoms include numbness of the thumb and radial fingers. There is less gripping capability and weakness in the hand is common.
Treatments include wrist splints, pain meds, strengthening the surrounding muscles or surgery
What is iliotibial band syndrome?
It is the result of repetitive friction of the ilitobilial band sliding over the lateral femoral epicondyle, moving anterior to the epicondyle as the knee extends and posterior as the knee flexes, it remains tense in both positions, it causes lateral knee sharp and burning pain. Key diagnostic factors include a positive nobles test, positive Ober’s test and positive modified Thomas test.
In acute phase- treatment ice, NSAIDS, steroid injection.
In sub-acute phase, emphasis is on stretching itb and soft tissue therapy for any myofascial restrictions
What is medial collateral ligament injury?
The MCL is a supporting structure on the medial part of the knee joint. It’s primary function is to resist valgus and external forces of the tibia. Injury occurs when excessive stresses or external forces are placed on the knee joint. Risk factors include young people and weak muscles that cross the medial aspect of the knee.
Treatment options include SSTM, DTFM, ROM, EXERCISE AND EDUCATION, MOBILISE ASAP BECAUSE MUSCLE ATROPHY OCCURS IN 2 WEEKS.
What is posterior crucible ligament injury?
The PCL prevents the tibia from excessive displacement in relation to the femur and prevents hyper extension. The most frequent mechanism of injury is a direct blow to the anterior aspect of the proximal tibia on a flexed knee with the ankle in plantarflexion.
Possible treatments include SSTM, DTFM, ROM STEROID INJECTIONS, EXERCISE AND EDUCATION AND QUICK MOBILISATION BEFORE MUSCLE ATROPHY OCCURS
What involves a LCL ligament injury?
LCL is one of the major stabilisers of the knee joint which prevents excess varus motion of the knee,
sprained (grade 1)
Partially ruptured (grade 2)
Completely ruptured (grade 3)
Main symptoms include pain, swelling,instability and giving way (grade 3)
It mainly occurs in sports with high velocity such as tennis basketball football or skiing. Young adults are more at risk.
Special tests for the LCL include varus stress test and posterolateral draw test.
Grade H2 can be treated with POLICE AND NSAIDS
Grade 3 requires surgery
Oedema management
Bracing
Early mobilisation of knee should be encouraged
TENS also prevents muscle wastage
What happens in a meniscal tear?
The medial and lateral meniscus are shock absorbers and force distributors located between the femur and tibia. The meniscus tear due to traumatic injury or degenerative wear. Common symptoms include catching, locking or buckling of the knee, pain.
Risk factors may include acute trauma, knee joint arthritis and knee instability.Most tears do not heal spontaneously and require surgery.
What is involved with anterior knee pain?
It is pain that occurs in the anterior and central aspect of the knee. It can be caused by patellofemoral pain syndrome, osgood-schlatters disease, knee bursitis and patellofemoral subluxation. Patients c/o functional deficit like going downstairs, squaring or sitting for long periods of time with the knee in a flexed position. instability, pain and giving way.
Diagnostic - positive Clarke’s test
Treatment exercises for this pain include taping, brace, joint mob, patella glide test, pain meds and strengthening exercises.
What happens in a medial and lateral ankle ligament sprain?
In the lateral compartment, the ligament most affected is the anterior talofibular ligament. It occurs due to a rapid shift of body centre of mass over landing or the weight bearing foot. The main symptoms include pain, tenderness, swelling and bruising, passive inversion or pf with inversion replicates the symptoms.
Special tests include the anterior draw test of AFTL.
Talar tilt test for calcaneo-fibulae ligament
Posterior draw- test for PTFL
Some treatments for ankle ligament injuries include Theraband, body weights, braces, strengthening exercises to strengthen the dorsiflexors.
The tissue healing process starts with….
1.Inflammatory phase
2. Proliferative phase
3. Early remodelling
4. Late maturation and remodelling
What happens during an Achilles tendinopathy?
It is a common overuse injury caused by repetitive energy storage and release with excessive compression. Risk factors include obesity, hbp, type 2 diabetes, prolonged steroid use and genetics.
Symptoms include morning pain, sensitivity and pain increases when the tendon is out under pressure.
Potential physiotherapy treatment includes isometric loading, isotonic loading, balance board, education and advice, patient should continue with activities within pain range
What does CREEP involve?
Uncrymping of crympted collagen fibres. There is a transient increase in length, so stretch doesn’t recoil back to its original length. There is hysteresis, arthrokinematics of movement and pain gate.
What is plantar fasciopathy?
Plantar fasciitis is an acute or chronic pain in the inferior heel at the attaché,ten of the medial of plantar fascia to medial calcaneal tubercle. It is an overuse inflammatory condition. It affects 40-60s primarily. The main symptoms include stabbing or knife like heel pain, pain is relieved with rest.
What is Femoral Acetabular Impingement?
FAI- it is a clinical disorder of the hip involving premature contact between the acetabulum and the proximal femur.
FAI describes a flattening or conceding of the femoral head- neck junction.
CAM- describes a flattening or convexity of the femoral head-neck junction
Pincer- occurs when excessive bone grows at the edge of the hip socket. The excessive bone tissue can prevent the femoral head from rotating in its socket.
Degenerative changes like OA may develop in the long term. There are 2 types including CAM and PINCER. Patients with suspected FAI syndrome typically report stiffness and pain in the hip groin.
Symptoms include hip, groin, back and buttock pain.
Additional symptoms are stiffness, restricted ROM, clicking, locking or giving way.
Some physiotherapy interventions for this condition include education, manual therapy and 6-8 weeks post operative functional and sports specific drills.
Improving neuromuscular function of the hip should be a goal of conservative protocols for FAI syndrome.
Full treatment and exercise programme, manual therapy, motor control.
