MSK - Upper Body Flashcards
Muscles, bones and stuff...
Whiplash Associated Disorder: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions
MOI: Abrupt acceleration-deceleration to the c-spine. Typically MVA or contact sports.
S/S: Decreased neck ROM, pain, increased tone in cervical spinal muscles, headaches, jaw pain, could have neuro symptoms
Diagnositc tests: No specific tests
General appraoch to treatment: Strengthening, stretching, traction, soft tissue
Education points: Importance of gentle movement. POLICE. Rest.
Precautions: 5 D’s, bilateral arm numbness, signs of concussion, C spine rules
Cervicogenic Headaches: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions
MOI: From C-spine – bony, disc or soft tissue elements. Commonly associated with neck pain. Originates from AO joint and upper cervical joints, C1-C3 spinal nerves
S/S: Unilateral dominant headache, worse with neck movements and postures, tenderness of the upper c spine, increase tighness and trigger points in upper traps, LS, scalenes and suboccp extensors, splenius capitis and SCM.
Diagnositc tests: PROM and AROM. Flexion rotation test. Strength testing of DNF.
General appraoch to treatment: C spine mobilization, traction, DNF, thoracic spine mobilization, stretch suboccp
Education points: Posture education, reduce forward head posture, proper desk egronomics.
Precautions: Rule out sinister cause of headaches. Asl red flag questions.
Cervical Disc Herniation: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions
MOI: Bulge from a c spine disc, increases inflammation and pressure around c spine nerve roots causing a radiculopathy.
S/S: Radiating symptoms down arm, myotomal weakness, dermatomal sensation changes, diminished deep tendon reflexes. Worse with coughing or sneezing. Referral pain around scapula.
Diagnositc tests: MRI is gold standard. ROM.
General appraoch to treatment: DNF, lower fiber of traps strengthening, postural awareness, traction, pain control.
Education points: Posture, exercises. Medical imaging education.
Precautions: Bilateral numbness, tingling and significant muscle weakness, loss of DTR and/or presence of Babinski
Temporomandibular Myofasical Pain: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions
MOI: Correlated to teeth grinding, head forward posture leads to many symptoms.
S/S: TMJ would have no pain, no symptoms with mouth opening, normal mouth opening 35-40mm or 3 fingers
Diagnositc tests: Tenderness of master, temporalis, medial and lateral pterygoid, sub occipitals.
General appraoch to treatment: Intra oral soft tissue release, education on posture, dentist for mouth guard
Education points: AP jaw anatomu
Precautions:
Jaw Anterior Disc Displacement (with and without reduction): MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions
MOI: With reductio - condyle can move forward, rolls over disc cause click when opening, condyle moves back also causing a click. Without reduction - lock jaw, condyle is blocked by the disc and unable to role and slide forward
S/S: Palpable reciproca click during opening and closing, lateral deviation towards the symptomatic TMJ, pain or tenderness of jaw, aching pain in or around your ear, difficulty chewing or pain with chewing, aching facial pain, locking of the joint
Diagnositc tests: Palpation, click, MRI
General appraoch to treatment: mobilizations, manual therapy, STR, HEP, postural education.
Education points: Posture, avoid biting or chewing nails, don’t rest hand under chin, place fingers on chin to while yawning to avoid anterior translation
Precautions: Superior lateral pterygoid is overworking and eccentrically not allowing disc to go fully back.
Frozen Shoulder (Adhesive Capsulitis): MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions
MOI: The ligaments and capsule surrounding the shoulder joint undergo an inflammatory process resulting in swelling and stiffening. Primary = idiopathic, no known cause. Secondary = due to traumatic event, surgery.
Risk Factors: Prolonged immobilization, diabetes, Dupuytren’s disease (genetic contractors), hypothyroidism, women more than men, age 40-65.
S/S: Hallmark signs 1) pain: dull, diffuse, often occurring at the deltiod insertion. 2) muscle atrophy 3) limited ROM: abduction, ER and IR
Diagnositc tests: Hx of onset, MOI and pain, loss of ER, abduction and IR, shoulder hike with AROM. Night pain.
General appraoch to treatment: Massage, acupuncture, modalities, mobilizations (posterior-lateral glides for ER, inferior for abduction), passive stretching,
Education points: HEP, duration to heal
Precautions: Other common shoulder injuries - tendinopathy, biceps tenditis, subacromical bursitis.
Shoulder Instability: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions
MOI: Trauma or ligament laxity that decreases stability. Labral tears are commonly associated.
Types: Anterior (most common), posterior, inferior (occurs when the impact causes arm hyper-abduction, superior (very rare)
S/S: Pain, decrease ROM, swelling, shoulder may be depressed on affected side, slipping or popping when in position of apprehension. Axilla nerve may be damaged if severe dislocation.
Diagnositc tests: Apprehension test, axilla nerve symptoms (weakness in deltoids and tires minor)
General appraoch to treatment: shoulder stabilizing exercises, strengthen adductors and internal rotators, postural education, rotator cuff strengthening
Education points: Rotator cuff are common with anterior dislocations.
Precautions: Stay out of positions of apprehension
Impingement Syndrome: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions
MOI: Compression of –> supraspinatus, long head of biceps or subacromial bursa. Can occur from a change in coracoacromial arch. Poor posture.
S/S: Pain during elevation on anterior and lateral aspect of shoulder. Painful arc 60-120 degrees. Weakness. No pain below elbow. Pain with rolling onto shoulder.
Diagnositc tests: Hawkins Kennedy, Neers
General appraoch to treatment: POLICE, scap stabilization, strengthen rotator cuff
Education points: do NOT immobilize
Precautions: DD: cervical Spondylosis
Lateral Epicondylagia: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions
MOI: 90% involve ECRB - originates at lateral epi. 10% ECRL. Most common overuse/repetitive use injury at the elbow.
S/S: Usually symptomatic with activities involving wrist and/or finger extension.
Diagnositc tests: Maudsley’s (3rd finger), Cozens (radial deviation and wrist extension), Mills (passive pronation and flex wrist.
General appraoch to treatment: AP
Education points: Check mid C spine for nerve irritation. Lateral antebrachial distrubution, C6 myotome.
Precautions: Tendinopathy/Tendinosis
Condition: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions
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Medial Epicondylagia: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions
MOI: Pronator teres and flexor carpi radialis. Repetitive motions to the wrist.
S/S: Pain at elbow using wrist flexors, pain when muscle is stretched or contracts against resistance. Decreased grip strength, limited by pain.
Diagnositc tests: Palpation tenderness on or near the medial epicondyle. Pain with resisted wrist flexion (with elbow extended). Pain with passive wrist extension while elbow is extended. Ulnar neuropathy is often an associated finding.
General appraoch to treatment: Flexion exercises. Eccentric.
Education points: Check mid C spine, C8-T1 sensory, C8-T1 myotomal.
Precautions:
Colles Fracture: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions
MOI: Distal radius, linear transverse fracture of the distal radius.
Risk factors: young or elderly, more common in females.
S/S: Dinner fork demerit, FOOSH, dorsal wrist pain, swelling, inability to graps objects.
Diagnositc tests: X ray
General appraoch to treatment: Casted until ready, keep fingers and shoulder moving, strengthen, ROM and functional exercises.
Education points:
Precautions: Often assoicated with ulnar styloid #, TFCC tear and scapholunate dislocation.
Scaphoid Fracture: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions
MOI: FOOSH fal, most common # of carpal bone.
S/S: Pain with pinch or graps, visible swelling and/or bruising. Poor blood supply. Complications are common. Arthritis overtime.
Diagnositc tests: X ray
General appraoch to treatment: Initially casting or surgery.
Education points: Wrist guards.
Precautions:
Condition: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions
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Condition: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions
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De Quervains Tenosynovitis: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions
MOI: Irritation of APL EPB. Over use, radial deviation. Chronic overuse.
S/S: Pain with radial deviation as well as pain with stretch.
Diagnositc tests: Finkelstein’s test.
General appraoch to treatment: Splinting, activity modification.
Education points: Change limitng mechanics, keep wrist in neutral and avoid radial deviation.
Precautions:
Condition: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions
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Copy Above
Stages of Frozen Shoulder: Freezing, Frozen & Thawing
Freezing: Painful, progressive. Intense pain at rest and limitation of movement. Reduced abduction < 100, ER < 5, IR < 55. Restriction normally begins before pain.
Frozen: Reduction in pain and progressive stiffness of shoulder. Pain only with movement and significant adhesions, limited GH motions. Atrophy of deltoid, triceps, and biceps.
Thawing: Mobility of shoulder returns, no pain and no synovitis but significant capsular restrictions from adhesions. Some patients never regain full ROM.
WAD Grading
Grade 0: No complaints about the neck, no physical signs
Grade 1: Neck complaints of stiffness, pain or tenderness only. No physical signs.
Grade 2: Neck complaints AND MSK (objective) signs (decreased ROM, point tenderness, NO neuro signs). No fracture/dislocation.
Grade 3: Neck complaints AND peripheral neurological signs (motor or sensory) such as decreased/absent DTR, weakness, sensory deficits. No fracture or dislocation.
Grade 4: Neck complaints AND fracture or dislocation, confirmed with medical imagine.
Canadian C Spine Rules
- Any High Risk Factors: age 65 or above, dangerous mechanism, paresthesias in extremities
- Any Low Risk Factors that allow safe assessment of range of motion: simple rear end OR sitting positions OR ambluatory at any time OR delayed onset of neck pain OR absense of midline c-spine tenderness
- Able to assess neck: 45 right to left
Temporomandibular Anatomy
- Muscle of mastication innervated by cranial nerve V (trigeminal)
- Masseter: thick and rectangular muscle in the cheek that functions to close jaw and clench teeth
- Temporalis
- Medial Pterygoid: elevation (closing) and protraction and side to side movement of the lower jaw: assists in chewing
- Lateral Pterygoid: only muscle of mastication that assists in depressing the mandible (opening the jaw) + assists in chewing and protraction
Shoulder Anatomy
- 4 joints: GH, SC, scap thoracic, AC
- SC joint: saddle joint with a fibrocartilage disc between articular surfaces; get 30 deg of axial rotation
- Scap Thoracic: physiological joint between ant surface of scapula and post surface of the thorax; supported by muscle movement
- AC joint: plane (gliding) supported by acromioclavicular and coracoidclavicular ligament
Frozen Shoulder Exercises
PROM: Pt performs PROM, towel IR, pendulums
AROM: finger wall walking, AROM ER
AAROM: abduction and flexion with broom stick
Shoulder Stabilization Exercises
- Strengthen the proximal muscles of the thorax, neck and shoulders before starting any dynamic strengthening of the muscles that move the GH in order to avoid faulty mechanics.
Phase 1: Scapular Stabilization: Middle and lower fibers of traps & SA
Phase 2: Rotator Cuff Stability: Isometrics through range, thera band exercises
Pancoast Tumor
- Difficult to diagnose early on
- S/S: severe pain in shoulder regions radiating towards the axilla and scapula along the ulnar aspect of the muscles of the hand, atrophy of hand and arm muscles, Horner Syndrome (dropping or falling eyelid, inability to sweat, constricted pupil), compression of the blood vessels with edema, neck pain, pain relieved when propping arm up on table or with other arm
- 40 to 60 y/o
Scapular Winging
- Inferior dysfunction: anteriorly tipped
- Medial dysfunction: internal rotation of the scapula in the transverse plane
- Superior dysfunction: excessive and early elevation of the scapula during elevation
Causes:
- Lesion of long thoracic nerve affecting weak SA
- Trap palsy
- Strain of rhomboids
- Tight pec minor and/or short head of biceps
- Multidirectional instability
- Voluntary action
- Painful shoulder causing muscle inhibition
Shoulder Labral Tears
- Bankart Lesion: avulasion of the capsule and ligament complex from the ANTERIOR INFERIOR lip of the glenoid (3-7 o’clock), common with ANTERIOR shoulder dislocations, causes anterior instability and loss of stability from inferior glenoihumeral ligaments
- Hill Sachs Lesions: Results from a force posteriorly, leading to anterior dislocation
- SLAP: Detachment of labrum from 10-2 o’clock, when the biceps tendon is involved = further instability
AC Joint Subluxation
- Formed by medial aspect of the acromion process of the scapula and the lateral end of the clavicle.
- Plantar Joint
- Ligaments: acromioclavicular, coracoclavicular
- Support: capsule, deltoid, traps
- Men 5x more (sporting - hockey)
- Incomplete seperation more common than complete
- Usually caused by direct hit or landing on the shoulder (arm normally adducted)
- TREATMENT: deltoid and trap cross the joint so strengthen thoses muscles for support
Bursa
- Inflammation of the bursa (small sacs of serous membrance that form at sites of compression or friction and produce watery fluid to lubricate surfaces and facilitate movement of tendons against bone)
- Caused by overuse, direct trauma/injury, gout, infection
- Most frequent location is subacromial area
- S/S: pain at rest, AROM and PROM are painful
