MSK PATHOLOGY Flashcards
What are the Aetiology / Prevalence of the MENISCAL TEAR ?
- EXCESSIVE FORCE
Twisting injury / at flexed knee
-
What is LATERAL EPICONDYLAGIA ?
(Tennis Elbow)
Its a common overuse syndrome in the elbow, involving the EXTENSOR MUSCLE of the forearm.
Its caused by excessive overuse.
What are the Prevalence / Aetiology of the Tennis Elbow ?
- Affect 1 - 3% of population, male = female.
- 40 - 50 y/o
- Self Limiting
- Smoking / Obesity
What are the Signs and Symptoms of Tennis Elbow ?
- Pain on the EXTENSOR MUSCLES of the forearm.
(ECRB / ECRL / EDM) - Pain located on the lateral epicondyle.
- Aggravated by resisted wrist + finger EXT
- Aggravated by forearm supination
- Pain on Gripping.
What are the Possible management for Tennis Elbow ?
Load Management / Exercise
What is MEDIAL EPICONDYLALGIA ?
(GOLFERS ELBOW)
Its an overuse syndrome of the elbow affecting the FLEXORS + PRONATORS of the arm.
PRONATOR TERES + FCR
What are the Prevalence / Aetiology of the Golfers Elbow ?
- Common between the age of 40 - 60 y/o
- Female are more prone
- Golfers
- Manual Worker
What are the Signs and Symptoms of Golfers Elbow ?
- Pain on the medial side
- Tender on palpation
- Reduced Grip Strength
- AGGS : Throwing / Gripping
What are the possible management of Golfers Elbow ?
Load management / Exercise
What is Plantar Fasciopathy ?
Its a Contractile issue of the sole of the foot.
What are the Prevalence / Aetiology of Plantar Fasciopathy ?
45 - 60 y/o
Increased BMI
Over Pronated Foot
Reduced Gastroc Length
Hallux Valgus
What are the Signs and Symptoms of Plantar Fasciopathy ?
- Painful in the morning and after activities
- Pain on proximal insertion of Plantar Fascia (calcaneus)
- Pain with Big toe EXT + ankle Dorsi Flexion
What are the possible management for Plantar Fasciopathy ?
Orthotics / Steroid Injection / Shockwave
What is Adhesive Capsulitis ?
Its an inflammatory condition whereby, the fibrosis of the GH joint capsule gradually and progressively become stiff.
What are the Signs and Symptoms of each stage for ADHESIVE CAPSULITIS ?
1.) ACUTE/FREEZING PHASE (2-9 months)
- Gradual onset of pain at rest
- Sharp pain on motion
- Night pain
2.) FROZEN STAGE (4-12 months)
- Pain subsides
- Loss of ROM
- Pain on extreme movement
3.) RESOLUTION PHASE (5-24 months)
- Spontaneous improvements in ROM
- Possible long term pain + disability.
What are the AETIOLOGY of Adhesive Capsulitis ?
- Pain + stiffness in the shoulder.
- Gradually becomes hard to move .
- Common in age 40-60 y/o.
- FEMALES
- Diabetes
- Insidious Onset
What are the possible management for Adhesive Capsulitis ?
- Mobility Exercise
- Eccentric loading to lengthen tissues
- High SIN Steroids injection
What is SPONDYLOLISTHESIS ?
Its the anterior translation of the superior vertebra to the inferior vertebra.
most common at L4/L5 L5/S1.
What are the signs and symptoms of SPONDYLOLISTHESIS ?
- Back pain
- Nerve symptoms (P+N / numbness)
- May have no symptoms
What are the Prevalence of Spondylolisthesis ?
- Trauma
- Degeneration
- Spondylolisis Pars #
- Bone tissue disorders
- Genetics (hypermobile / spina bifida)
What are the possible management for Spondylolisthesis ?
- Nerve Decompression
- Stabilisation Surgery
- Reassurance
- Increase strength (Graded exposure)
What is SPONDYLOSIS ?
(normal age related changes)
Its a term for osteoarthritic changes in the spine. It can affect the:
- Vertebra
- Intervertebral discs
- Ligaments
- Facet joints
What are the signs and symptoms of Spondylosis ?
- may / may not cause pain
- local pain / muscle spasm
- Xray shows osteophytes formation
- Can cause Stenosis
What are the possible management for spondylosis ?
- Address individuals beliefs + Goals
- Reassurance that it’s normal
- Encourage normal MVT + Function
- Increase ROM
- Graded Exposure
What is SPINAL STENOSIS ?
Its the central / Foraminal canal narrowing.
What is the Prevalence / Aetiology of Spinal stenosis ?
- Normal with ageing (50 y/o +)
Can be due to :
Osteophytes
Disc Herniation
Thickening of Lgt
Tumours
What are the signs + symptoms of Spinal Stenosis ?
- May look normal on scans
- Neck or low back pain
- potentially nerve symptoms
- IMPROVES WITH FLEXION
RED FLAG:
- Cx = Myelopathy
- Lx = CES
What are the possible management for spinal stenosis ?
- Decompression Surgery
- Advice + Education on pathology
- Pain management
- Exercise
What is ANKYLOSING SPONDYLITIS ?
Its an inflammatory arthritis that is all over the body. It’s characterised as dysregulation of the immune system resulting in tissue damage.
Mainly affects Lgt/Tendons attached to the bones. (Lower back pain)
What are the signs and symptoms of Ankylosing Spondylitis ?
- Gradual back pain and stiffness.
- Persistent for 3 months
- Feels better with exercise
- Weight loss
- Fatigue
- Fever / Night sweats
- Morning stiffness
XRAY = osteophytes / fusion
MRI = Inflammation
What are the Prevalence of Ankylosing Spondylitis ?
- Genetic (HLAB- gene)
- Men
- Late Adolescent
- Smoking
What are the possible management for Ankylosing Spondylitis ?
- Low impact exercise (walking/swimming/pilates)
- Medication (NSAID’S)
- AROM / PROM (maintain ROM + keep good posture)
What is Iliotibial Band Syndrome ?
Its a non traumatic over use injury, usually when hip ABD are weak.
What causes ITBS ?
Repetitive bending of the knee during a physical activity.
Also can be caused by compression of the innervated local adipose tissue.
impingement between heel strike and early stance.
What are the signs and symptoms of ITBS ?
- Gradual onset
- Burning pain at the lateral femoral epicondyle .
- Inflammation
- Pain worsens going down the stairs / running
- audible snapping sensation during FLEXION
What are the Risk factors of ITBS ?
- Repetitive Knee Flexion + Extension
- Long Distance Running
- Sudden increase in activity levels
- weakness in hip ABDUCTORS
What are the possible management for ITBS ?
- Activity modification
- Education on active rest
- Heat therapy for pain relief
- Stretching Glutes if Its too short
- Shockwave Therapy (stimulates soft tissue healing)
- Strengthen ABD muscles
What are some clinical presentations of Anterior Knee Pain ?
- Functional Deficit
- Crepitus
- Instability
- Pain worsens when walking downstairs / squatting / instability (giving way)
What is the AETIOLOGY of Anterior Knee pain?
- Knee pain is multifactorial
- Patellar abnormality/muscular imbalance or weakness
- overuse injury.
What are some anterior knee pain management ?
- Surgery for bone abnormalities.
- Re alignment
- Re education for any maladaptive pattern
- Exercise paired w/Taping
- QUAD / HAMS strengthening exercise
What is shoulder Instability ?
The labrum or Lgt stretch or tear, then the shoulder has a greater tendency to dislocate and sublux.
What is Bankart Lesions in shoulder instability ?
Its when the injury occurs at such a force that the labrum is torn from the bone.
What are the possible management for Shoulder Instability
- Muscle control + Strengthening exercises
- Surgery for Chronic instability (keyhole/openshoulder)
What is Femoral Acetabular Impingement ?
(FAI)
Its a mechanical process by which abnormalities of the acetabulum/femur combined with vigorous hip motion can damage soft tissue structures.
What are the signs and symptoms of FAI?
- Hip or Groin pain
- Pain in thigh / back / bum
- Stiffness
- Reduced ROM
- Clicking or catching
- Locking / giving way
What are the prevalence / Risk FACTOR of FAI ?
- CAM = MEN
- PINCER = WOMEN
- Repetitive Hip Flexion
- Hx of hip disease
- surgical overcorrection
What are the possible management for Femoral Acetabular Impingement ?
SURGERY
- reshaping acetabulum
- labral repair
- LL strengthening
How does a Meniscal issue occur ?
Excessive force applied to a normal meniscus or a normal force on a degenerative meniscus.
Twisting on a semi-flexed limb weight bearing through knee.
What are the signs and symptoms of a Meniscal Issue ?
- Clicking + Grinding
- Instability
- True Locking
- Minimal Swelling
- 50y/o +
Degenerative tears - Pain worse on flexed / wb activities
What are the different types of Meniscal tear?
ACUTE TEARS
- Usually from trauma injury and may require surgery.
DEGENERATIVE TEARS
- occur in elderly w/ minimal trauma
- Treated with physio // NSAIDs
What are the possible management for Meniscal Issue ?
- Meniscal repair surgery / meniscectomy
- Strengthen surrounding muscles
- Exercise (ROM)
- RICE (pain + swelling)
- Joint Mobs
What is a Ligament Injury (sprain) ?
Its an injury to the collagen tissue, which affects the stability and proprioception at a joint.
Its usually caused by a sudden force on the inelastic fibres pushing them outside their normal ROM.
What are the possible management for Ligament injuries ?
- Strength and Proprioception
- Sport specific skill
- Ice therapy
- Graded exposure
- Progressive overload education
What is Osteoarthritis ?
Its a Chronic condition of the joints.
It affects articular cartilage / joint capsule / Ligaments / Synovial Membrane .
The articular cartilage degenerates due to fibrilation and full thickness loss of the joint.
What are the Signs + Symptoms of Osteoarthritis
- Pain on weight bearing
- Reduced AROM + PROM
- Swelling
- Clicking / Grinding
- Morning stiffness
- Aggravated by cold/wet weather
- Improves with Activity
What are the possible Management for Osteoarthritis ?
- Education
- Pharmalogical management
- Referral to joint surgery
- Activity Modification
What is Radiculopathy ?
Its a mechanical compression of a nerve root usually at the foramen exit.
This may be secondary to
- degenerative disc disease
- OA
- Facet joint degeneration
- Tumour
What are the Signs and symptoms of Radiculopathy ?
- Pain
- Numbness
- Tingling
- Localised neck / back pain
- Hypersensitivity
- weakness
What are the Prevalence / Risk of Radiculopathy ?
40 - 50 y/o
- Female
- Car accident
- Smoking
- Diabetes
What are the possible management for Radiculopathy ?
- Anti inflammatory medications
- Epidural steroid injection
(Decreases inflammation + Irritation) - Heat therapy to relax tight muscles.
What is Rotator Cuff Tendinopathy ?
Its a pathology caused by overuse / underuse of the muscle.
What are the signs and symptoms of Rotator Cuff Tendinopathy ?
- Gradual onset
- Pain / on elevation + ABD
- Lifting is an Aggs
- weakness
- Localised swelling
What are the possible management for Rotator cuff Tendinopathy ?
- NSAIDS
- Manual therapy
- ROM + Strengthening
- Education
- Isometric Exercise decreases pain
What is Carpal Tunnel Syndrome ?
Its a peripheral nerve entrapment of the median nerve.
This can be due to physical compression (Bones / Oedema) or an Irritation due to lack of nerve mobility.
What are the signs and symptoms of Carpal Tunnel syndrome ?
- Pain / Burning (EXT)
- Paraesthesia / Anaesthesia on cutaneous distribution of the median nerve.
- Worse at night
- Difficulty gripping
- Atrophy of Thenar eminance
What are the Prevalence and Risk of Carpal Tunnel Syndrome ?
- Hx repetitive wrist movements
- Obesity
- RA
- Pregnancy
- Female
What are the possible management of Carpal Tunnel Syndrome ?
- Education
- Activity modification
- Strengthening
- Soft tissue Mobs
- Splinting
What is Achilles Tendinopathy ?
Its a pain and dysfunction of the achilles tendon generally, due to overload / underload.
What are the signs and symptoms of Achilles Tendinopathy ?
- Pain and swelling around the tendon.
- Pain worse before + after exercise
- Eases during the activity
- Tender
- Swelling
What are the possible Management for Achilles Tendinopathy ?
- Education
- Load Management
- Exercise (graded exposure)
- surgery
