MSK pathologies Week 1 Flashcards
What does FAI stand for?
Femoralacetabular impingement
What is FAI?
A pathological mechanical process by which morphological abnormalities of the acetabulum and/or femur combined with vigorous hip motion can damage the soft tissue structures within the hip itself
What are the 3 types of FAI?
Cam
Pincer
Mixed/combined
Where is a cam impingement located?
On the femoral side of the hip joint
What happens with a cam impingement?
Extra bone formation at the anterior lateral head neck junction causing a non-spherical femoral head
What Happens with a pincer impingement?
There is an abnormality on the acetabulum leading to an over coverage of the femoral head. This can lead to cartilage damage
Which gender has higher instances of cam morphology?
men
Which gender has higher instances of pincer morphology?
women
Name some things that can cause FAI
exposure to repetitive and often supraphysiologic hip rotation and hip flexion during development in children and adolescence. Repeated stress of this type may trigger adaptive remodelling and eventually development of FAI associated morphologies and symptoms
History of childhood hip disease following femoral neck fractures which may have altered the contour of the femoral head/neck
Surgical over-correction of conditions such as hip dysplasia may lead to the pincer morphology
What is a sprain?
an injury to the band of collagen tissue i.e. a ligament, which connects two or more bones to a joint
What is the primary function of a ligament?
to provide passive stabilisation of a joint
What is a sprain usually caused by?
the joint being forced suddenly outside its usual range of movement and the inelastic fibres are stretched through too great a range
Describe a Grade 1 sprain
micro-tears
localised pain
no visible bruising#
minimal swelling
minimal loss of function
no loss of muscle or ROM
no ligament laxity
Describe a grade 2 sprain
partial tear of ligament
moderate swelling
bruising
poorly localised pain
impairment and painful ROM (with deficit)
decrease in strength and pain on contraction
joint may be unstable
Describe a grade 3 sprain
complete rupture
joint instability
immediate acute pain
later on symptoms may be less than a grade 2
may require immobilisation and/or surgery
Name some common sites of ligament injuries
ACL
PCL
LCL
MCL
ATFL
CTFL
ACJ ligaments
What is another name for a frozen shoulder?
Adhesive capsulitis
What is a frozen shoulder characterised by?
initially painful and later progressively restricted active and passive glenohumeral joint range of motion with spontaneous complete or nearly-complete recovery over a varied period of time
What does frozen should disease process affect?
antero-superior joint capsule, axillary recess and the coracohumeral ligament
What is the prevalence of a frozen shoulder?
70% are female
generally between the ages of 35-65
more common among the diabetic population
more likely to develop in the opposite shoulder if they have had a frozen shoulder before
What are the 3 phases of a frozen shoulder?
acute/freezing/painful phase
adhesive/frozen/stiffening phase
resolution/thawing phase
Describe the initial phase of a frozen shoulder
Gradual onset of shoulder pain at rest with sharp pain at extremes of motion, and pain at night with sleep interruption which may last anywhere from 2-9 months
Describe the second phase of a frozen shoulder
pain starts to subside, progressive loss of glenohumeral motion in capsular pattern (abduction and internal/external rotation). Pain is apparent only at extremes of movement. This phase may occur at around 4 months and last till about 12 months
Describe the third stage of a frozen shoulder
spontaneous, progressive improvement in functional range of motion which can last anywhere from 5 to 24 months
What is the most common chronic condition of the joints?
Osteoarthritis
What joints does osteoarthritis affect?
any joint, but it occurs most often in knees, hips, lower back and neck, small joints of the fingers and the bases of the thumb and big toe
What does osteoarthritis affect in terms of anatomical structures?
articular cartilage
subchondral bone
ligaments
capsule
synovial membrane
periarticular muscles
What are some of the risk factors for developing osteoarthritis?
age
female gender
obesity
anatomical factors
muscle weakness
joint injury
What are the two types of osteoarthritis?
primary and secondary
What are the signs and symptoms for osteoarthritis?
pain -> more on weight bearing activities such as walking
reduced ROM actively and passively
can cause slight swelling over the joint
clicking/grinding
How do we manage osteoarthritis?
education
self-management
pharmacological management
referral for joint surgery
What are meniscal tears due to?
an excessive force applied to a ‘normal’ meniscus or a normal force acting on a degenerative meniscus
What is the most common mechanism of injury for a meniscal tear?
a twisting injury on a semi-flexed limb through a weight bearing knee
What other injuries are meniscal tears usually associated with?
ligamentus injuries (typically the ACL and MCL)
What are the two types of meniscal tears?
acute tears
degenerative tears
What are acute meniscal tears?
They are commonly the result of a trauma or a sports injury
Which type of meniscal tear has different shapes and what are these shapes?
Acute
horizontal
vertical
radial
oblique
complex
What population do degenerative meniscal tears often occur in?
The elderly
What is PFPS?
Patellofemoral pain syndrom
What is patellofemoral pain syndrome?
an umbrella term used for pain arising from the patellofemoral joint itself, or adjacent soft tissues
What tends to worsen patellofemoral pain syndrome?
squatting
sitting
climbing stairs
running
(any weight bearing activities)
What causes patellofemoral pain syndrome?
It is most often a combination of several factors:
overuse and overload of the patellofemoral joint
anatomical or biomechanical abnormalities
muscular weakness
imbalance or weakness
What are some of the risk factors of patellofemoral pain syndrome?
knee hyperextension
lateral tibial torsion
genu valgum or varus
increased Q angle
tightness in the iliotibial band, hamstrings or gastrocnemius
How can we manage patellofemoral pain syndrome?
education
open vs closed chain exercises
quadriceps, hamstring, glutes, calf strengthening
patellar taping
orthotics
modalities
manual therapy
What causes a Bankart lesion?
due to the amount of force that is associated with dislocation, the labrum can be torn from the bone creating a Bankart lesion and this can result in an unstable shoulder which may lead to further dislocation
What is the surgery called that you would have if you had a Bankart lesion?
Anterior stabilisation
