MSK Pathology 2 Flashcards
GH instability refers to
Excessive translation of the humeral head during active rotation
GH instability: subluxation
Joint laxity: allows for more than 50% of humeral head to passively translate over the glenoid rim without dislocation
GH instability: dislocation
Complete separation of the articular surfaces of the glenoid and humeral head
GH instability: approximately 85% of dislocations detach the
Glenoid labrum
GH instability: most common type
Anterior dislocation
- stress on the anterior capsule, GH ligament, and RC
- causes humerus to move anteriorly out of the glenoid fossa
GH instability: s/s subluxation
- feeling shoulder “popping” out and back into place
- pain
- paresthesia
- dead arm
- positive apprehension test
- capsular tenderness
- swelling
GH instability: dislocation s/s
- severe pain, paresthesias
- limited ROM
- weakness
- visible shoulder fullness
- arm supported by contralateral limb
GH instability: tx
- initial immobilization with sling for 3-6 weeks
- RICE and NSAIDs in early phase
- after immobilization: ROM/isometric strengthening followed by progressive resistive exercises
GH instability: later tx should focus on these muscles
Internal/external rotators
Scapular muscles
Impingement syndrome: etiology
humeral head and RC attachments migrate proximally and become impinged on the undersurface of the acromion and coracoacromial ligament
Impingement syndrome: s/s
- pain/discomfort deep in shoulder
- pain with OH activities
- painful arc of motion
- positive impingement sign
- top over greater tuberosity and bicipital groove
the most common rheumatic disease in children
Juvenile RA
JRA etiology
External source (virus, injection, trauma) triggers autoimmune response and JRA in children with genetic predisposition
Juvenile RA: most to least common types
- oligoarticular (40-60%)
- polyarticular (30-40%)
- systemic (10-20%)
JRA s/s: systemic
Acute onset Fevers Rash Enlarged spleen, liver Inflammation of lungs/heart
Juvenile RA: polyarticular s/s
Higher incidence in females
Significant rheumatoid factor
Arthritis in more than 4 joints with symmetrical involvement
Juvenile RA: oligoarticular s/s
Affects less than 5 joints
Asymmetrical
Juvenile RA: treatment
- pharmacological mgmtfor pain and inflammation
- PROM/AROM
- positioning/splinting
- strengthening/endurance/WB activities
- postural training
- pain mgmt: modalities
Juvenile RA: surgical mgmt
May be indicated 2/2 pain, contractures, or irreversible joint destruction
Lateral epicondylitis: irritation of these muscles
Common extensor muscles at origin on the lateral epicondyle
Lateral epicondylitis: common sports
Throwing sports
Lateral epicondylitis: etiology
- Eccentric loading of wrist extensor muscles, usually ECRB
- Results in microtrauma
*tennis: handle too small, strings with too much tension
Most common between 30-50 years old
Lateral epicondylitis: s/s
- pain immediately anterior or distal to lateral epicondyle
- worsens with repetition and resisted wrist extension
Lateral epicondylitis: use of strap
Strap may be placed 2-3 inches distal to elbow jt to reduce muscular tension placed on the epicondyle
May diminish or eliminate symptoms
Legg-Calve-Perthes disease: what is it?
Degeneration of the femoral head due to disturbance to blood supply (AVN)
4 stages of Legg-Calve-Perthes disease:
- Condensation
- Fragmentation
- Re-ossification
- Remodeling
Disease is self-limiting
Legg-Calve-Perthes disease: etiology
- trauma
- genetic predisposition
- synovitis
- vascular abnormalities
- infection
Legg-Calve-Perthes disease: s/s
- pain
- decreased ROM
- antalgic gait
- positive Trendelenburg sign
Legg-Calve-Perthes disease: treatment focus
- reduce pain
- maintain position of the femoral head in proper position
- improve ROM
MCL sprain: also involves injury to these other structures
- ACL
- medial meniscus
MCL sprain: etiology
Contact or noncontact, fixed foot, tibial rotational injury associated with:
- valgus force
- tibial ER
MCL sprain: surgical intervention
Rarely required because MCL is well vascularized
Meniscus tear: which one is most commonly injured and why?
Medial most commonly injured due to its attachment to the joint capsule (less mobile)
Meniscus tear: Those with this injury have a higher predisposition for subsequent meniscus tear
Deficient ACL
Meniscus tear: etiology
Usually associated with fixed foot rotation in WB on a flexed knee (produces compression and rotation forces on the meniscus)
Meniscus tear: s/s
- joint line pain
- catching/locking sensation
Meniscus tear: when are repairs performed?
Tears at outer edges of meniscus due to increased vascularity
