MSK PATHOLOGIES - Inert Structures and Neurological (msk) conditions Flashcards
Name 7 INERT STRUCTURE PATHOLOGY ?
- Femoral Acetabular Impingement (FAI)
- Ligament Injuries (Sprain)
- Frozen shoulder (adhesive capsulitis)
- Osteoarthritis (OA)
- Meniscal Issues
- Patellofemoral Pain Syndrome (PFPS)
- Shoulder Instability
What is Femoral Acetabular Impingement (FAI) ?
Its a pathological mechanical process by which morphological abnormalities of the acetabulum / femur combined with vigorous hip motion can damage the soft tissue structures within the hip.
What are the 3 different types of Femoral acetabular Impingement ?
- ) CAM IMPINGEMENT
- The affected part is the femoral neck (below head)
- ) PINCER IMPINGEMENT
- Affected side is the outside of the Acetabulum
- ) COMBINED/MIXER
- both cam + pincer
What are some possible cause of FAI ?
- CAM morphology is more common in MEN
- Repeated stress of supraphysiological Hip Rotation + Flexion (childhood/hockey)
- SURGICAL OVER CORRECTION
- History of childhood Hip Disease, followed by a femoral neck fracture.
What is a Ligament Injury (Sprain) ?
and what is the ligament function ?
Its an Injury to the band of Collagen Fibres.
- the function id to provide stability of the joint.
What causes a Ligament Injury ?
This occur when a joint is being forced suddenly outside its usual range of movement and the inelastic fibres are stretched through too great a range.
What are the classification of SPRAINS ?
and what are some of it signs and symptoms ?
GRADE I (overstretch w/ micro tears)
- No visible bruising
- Localised Pain
- Minimal Loss of function / muscle strength / ROM
- No ligament Laxity
GRADE II ( partial tear / immediate onset of Inflammatory signs )
- Bruising
- Poorly localised pain
- Impairment of function / muscle strength / Painful ROM
- Unstable joint due to Ligament
GRADE III ( complete rupture / later symptoms may be less than Grade II )
- Immediate acute pain / often w/ audible pop & crack
- Cardinal signs
- Inability to contract muscle ( separation may be evident )
- Unstable Joint
What are some non modifiable cause of ligament injuries ?
- INTRINSIC JOINT ANATOMY
- SEX & HORMONES
- JOINT LAXITY
What are some Modifiable cause of ligament injuries ?
- NEUROMUSCULAR CONTROL ( strength proprioception )
- ENVIRONMENT ( sport specific / fatigue resistance )
What is Frozen Shoulder (adhesive capsulitis) ?
Its an Inflammatory condition that causes FIBROSIS of Glenoid Humeral capsule with progressive stiffness and ROM restriction. ( External Rotation )
Who is more likely to get frozen shoulder ?
- Common in women (70%)
- Age 35 - 65
- Diabetic population
What are the different phases of Frozen Shoulder ?
1.) ACUTE / FREEZING / PAINFUL PHASE = (PAINFUL/FREEZING)
- Gradual onset of shoulder pain at rest with sharp pain at extremes of motion
( lasting 2 - 9 months )
2.) ADHESIVE / FROZEN / STIFFENING PHASE = (DECREASED ROM)
- Pain starts to subside, progressive loss of GH motion in capsular pattern.
Pain is only apparent only at extremes of movement ( 4 - 12 months )
- ) RESOLUTION / THAWING PHASE = (RESOLUTION)
- Progressive Improvement in Functional ROM ( 5 - 24 months )
What is Osteoarthritis (OA) ?
Its the most common chronic condition of the joints whereby the articular cartilage degenerates w/ fibrillation, fissures and full thickness loss of the joint surface.
- It only affects the cartilage but involves the entire joint
Name some OA risk factors.
- AGE
- FEMALE
- OBESITY
- ANATOMICAL FACTORS
- MUSCLE WEAKNESS
- JOINT INJURY
What are some OA signs and symptoms ?
- PAIN (weight bearing activities)
- REDUCED ROM/AROM/PROM
- SLIGHT SWELLING OVER THE JOINT
How can you manage OA
- Education & Self management
- (non) / Pharmacological Management
- Referral for Joint Surgery
What is the cause of a Meniscal tear / issues ?
Its due to an excessive force applied to a normal meniscus
(normal force acting on a degenerative meniscus)
- twisting motion during a semi-flexed limb
- associated with Ligament Injuries
What are some Signs and symptoms of a Meniscal Tear / Issue ?
- Pain in the knee joint
- Swelling / Catching / Locking of the knee
- Inability to fully EXTEND / BEND the knee
- Difficulty with Weight Bearing
What are the 2 different kinds of Meniscal tears ?
- ) ACUTE TEARS
- Due to trauma / sports injury ( different types )
- ) DEGENERATIVE TEARS
- often occur in elderly people, often after a minimal trauma on the knee
Name the different kinds of meniscal tears.
- LONGITUDINAL TEAR
- HORIZONTAL TEAR
- RADIAL TEAR
- BUCKET HANDLE TEAR
- FLAP TEAR
- DEGENERATIVE TEAR
What is Patellofemoral Pain Syndrome (PFPS) ?
Its an umbrella term used for pain arising the Patellofemoral Joint.
- This can be a chronic condition.
What are some causes of Patellofemoral pain Syndrome ?
- Overuse / Overload of PF joint
- Anatomical / Biomechanical Abnormalities
- Patella Orientation and alignment
- Muscular weakness
What are some risk factor that can cause Patellofemoral pain Syndrome ?
- KNEE HYPEREXTENSION
- Valgus + Vera knee
- Tightness in the ITB / HAMSTRING / GASTROCNEMIUS
- Pronation and Supination can provoke PFPS
- Increased Q-Angle
How do you manage Patellofemoral Pain Syndrome ?
- Education
- Open + Closed Chain Exercise
- Quads / Ham / Glutes / Calf strengthening
- Manual Therapy
- Patellar Taping
What is Shoulder Instability ?
Its when the labrum and / or the ligament stretch or tear, the shoulder has a greater tendency to dislocate.
What are the different types of Shoulder Dislocation ?
1.) BANKHART LESIONS
- Due to the amount of force, labrum is torn from the bone resulting in unstable
shoulder. ( require surgery )
2.) HILL SACHS LESIONS
- Dent in the back of the humeral head which occurs during the dislocation as the
humeral head impacts against the front glenoid.
- ) SLAP TEAR
- A tear at the top of the labrum.
- ) BONY BANKHART
- Fragment of bones breaks off.
How do you manage Shoulder Instability ?
1.) PHYSIOTHERAPY
- Train the shoulder muscles to control the shoulder correctly and prevent further
instability.
- ) SURGERY (depends on the cause and findings)
- ARTHROSCOPIC PROCEDURE ( keyhole surgery )
- OPEN SHOULDER Procedure (depends on the problem)
What is MYELOPATHY ?
Its the compression on the spinal cord in the central canal (Vertebral Foramen).
What causes Myelopathy ?
- Central stenosis
- Central Disc Herniation
- Trauma
- Spondylolisthesis
- Ligament Thickening
- Age related changes ( Bony spurs / Osteophytes )
What are some signs and symptoms of Myelopathy ?
- GAIT DISTURBANCE (Ataxia = loss of coordination)
- Changes in Fine motor skills and Co-ordination.
- Possible neck & lower back pain.
- HYPER-REFLEXIA (overactive / overresponsive )
- Bladder and Bowel Disturbances
What are some risk factors of Myelopathy ?
- Older age (degenerative changes)
- Stenosis
- RA & ANKYLOSING SPONDYLITIS (systemic autoimmune)
- Trauma
What are some Myelopathy Management ?
Conservative / Surgical
Fusion / Stabilisation
What is Cauda Equina Syndrome (CES) ?
The compression on the collection of nerves at the bottom of the spinal cord.
(HORSE TAIL )
What are some signs and symptoms of Cauda Equina Syndrome ?
- Retention of Urine (urology)
- Loss of Anal tone
- Sexual Dysfunction
- Bilateral leg pain / numbness
- SADDLE ANAESTHESIA ( reduced sensation )
What is a possible management for Cauda Equina Syndrome ?
Spinal Decompression.
What is RADICULOPATHY ?
Its a change in neurological function from nerve root compression, irritation or sensitivity.
(the nerve root is where the intervertebral foramen comes out)
What are some common signs and symptoms of Radiculopathy ?
- (CERVICAL) = Arm symptoms
- (LUMBAR) = Leg symptoms
- Pain in Dermatomal Distributions
- Sensory symptoms in Dermatomes
( Paraesthesia / Anaesthesia / Allodynia = pain & extremely sensitive to touch ) - Motor loss in the relevant Nerve root
-Reflex Changes
What is Peripheral Nerve Entrapment / Irritation. ?
An area in the Peripheral nerves (not in the spine) in which the nerve becomes irritated or compressed by a bone or oedema.
What are some signs and symptoms of Peripheral Nerve Irritation ?
Its all depends on the level of irritation of compression and the type of nerves that is irritated.
- CARPAL TUNNEL
Median Nerve = Fingers 1&2 / Thumb / wrist - CUBITAL TUNNEL SYNDROME
Ulnar Nerve = medial aspect of the elbow - PERONEAL NERVE
Irritated with Fractures - GLUTEAL
Sciatic Nerve = passes through the Piriformis - ELBOW
Radial Nerve = Radial tunnel syndrome commonly mistaken as the Tennis Elbow.
What are some Peripheral Nerve Entrapment / Irritation Management ?
- PHYSIOTHERAPY ( non invasive )
- EDUCATION
- Oral Medication
- Splinting ( carpal tunnel syndrome )
- Steroid Injections
- Surgery ( decompression / release )
What is the difference between DERMATOMES + MYOTOMES ?
DERMATOMES
- Its a specific area of skin that is supplied by a specific nerve root level.
MYOTOMES
- Specific set of muscles that are supplied by a specific nerve root level.
