MSK W1 Flashcards
What are the three stages of healing?
- Inflammation 2. Repair 3. Remodelling
What is the duration of the inflammation stage?
Immediately following injury to 3-5 days
What does the acronym PRICE stand for?
Protection, Rest, Ice, Compression, Elevation
What occurs during the repair stage?
Phagocytosis of necrotic fibers, regeneration of myofibers, formation of scar tissue, capillary ingrowth
How long does the remodelling stage last?
14 to 21+ days, complete healing may take up to 2 years
What is the key factor in an exercise program designed to increase muscle strength?
Intensity
What are some types of resistance exercises?
- Manually applied * Isometric * Isotonic * Elastic resistance * Isokinetic * Body weight * Circuit training
What are the benefits of regular patient exercise?
- Decrease in serum lipid levels * Improvement in maximum oxygen consumption * Increase in HDL levels * Decrease in high blood pressure * Improved or relieved angina * Improved aerobic capacity or decreased depression following a myocardial infarction
What are contraindications to resistance exercises?
- Acute inflammation * Joint effusion * Severe cardiovascular disease * Fracture * Joint/muscle pain during AROM or muscle testing
What is eccentric exercise?
Dynamic muscle contraction that causes joint movement as the muscle lengthens under tension
What is concentric exercise?
Dynamic muscle contraction that causes joint movement as the muscle contracts and shortens
What are open chain exercises?
Unrestricted movement in space of a peripheral segment
What are closed chain exercises?
The peripheral segment meets with considerable external resistance
What is the force-length curve of muscle?
Optimal length where sarcomere can generate greatest force
What is Exercise Induced Muscle Damage (EIMD)?
Damage to muscle fibers resulting from strenuous exercise, typically eccentric
What is DOMS?
Delayed onset muscle soreness, peaks 48 hours after eccentric exercise
What is the ‘Repeated Bout Effect’?
Adaptation of muscle after eccentric EIMD, leading to reduced markers of muscle damage
What are key components to stretching?
- Proper alignment
- Stabilization
- Intensity
- Duration, speed, frequency, & mode of stretch
What are contraindications to stretching?
- Acute infection/inflammation
- Unhealed fractures *
- Joint effusion
- Recent corticosteroid injection
- Hypermobility/instability
What is a contusion?
Muscle injury caused by sudden external force, resulting in bleeding in deep muscle regions
What is the recovery time for a grade I contusion?
2-3 weeks
What is myositis ossificans?
Formation of bone within muscle, often from direct blow or repeat injury
What are the grades of muscle strains?
- Grade I: Microscopic tearing
- Grade II: Partial tearing
- Grade III: Complete tear
What is the recommended initial treatment for muscle strains?
PRICE (Protection, Rest, Ice, Compression, Elevation)
What is the difference between weakness and myotomal weakness?
Weakness is no pain, while myotomal weakness shows step-like patterns with no pain
What is the treatment for delayed onset muscle soreness (DOMS)?
- Light activity
- Massage/bath
- Avoid anti-inflammatories if possible
What is a laceration?
Cutting of the muscle fibers requiring surgical repair with sutures
What is the role of stretching in rehabilitation?
To promote proper alignment and function during healing
What are the symptoms of compartment syndrome?
- Pain
- Pallor
- Pulselessness
- Paralysis
- Paresthesia
What is the importance of warming up before activities?
To prepare the body and reduce injury risk
Fill in the blank: The majority of muscle strains occur during _______ loading or high intensity activities.
eccentric
What gait pattern is associated with weak Tibialis Anterior?
Increased hip and knee flexion during swing to prevent toe drag
This compensatory mechanism helps avoid tripping due to weak dorsiflexion.
What compensatory movement occurs with weak hip abductors?
Excessive pelvic rotation and lateral bending toward the weak side during midstance to prevent excessive hip drop
This adjustment maintains balance during walking.
What is a consequence of weak knee extensors?
Inability to take full weight on limb without knee buckling
This can lead to instability and increased risk of falls.
What effect does a contracture of hip flexors have on gait?
Limits the ability to extend hip, resulting in shortened step length on the opposite side
This can lead to asymmetrical walking patterns.
What is the classification of a Grade 1 ligament sprain?
Mild stretch, no instability, single ligament involved, minimal pain and swelling, minimal functional loss
This is considered a minor injury.
What characterizes a Grade 2 ligament sprain?
Mild to moderate instability, laxity in ligament with stretch, moderate pain and swelling, moderate functional loss
An example would be a limp while walking.
What defines a Grade 3 ligament sprain?
Significant instability, complete tear, no end feel when ligament testing, possible avulsion fracture, significant functional loss
Patients may be unable to weight bear.
What is the mechanism of injury (MOI) for a syndesmotic ankle sprain?
Planted foot with internal rotation of the leg, external rotation of talus, hyper dorsiflexion, inversion, and plantarflexion
This injury often occurs during activities involving sudden changes in direction.
What ligaments are typically affected in a syndesmotic ankle sprain?
AITFL, PITFL, interosseous ligament
These ligaments stabilize the syndesmosis between the tibia and fibula.
What does the Squeeze Test assess?
Pain radiating to the high ankle ligament area when squeezing the leg just below the knee suggests a high ankle sprain
This test evaluates syndesmotic injuries.
What are the Ottawa Ankle Rules used for?
To rule out ankle fractures
An x-ray is needed if specific tenderness or inability to bear weight is present.
What is the primary goal of Phase 1 in ankle sprain treatment?
Protect and decrease inflammation using PRICE and modalities
NWB with crutches is often advised during this phase.
What is the focus of Phase 2 in ankle rehabilitation?
Increase mobility and strength with bilateral stance training and joint mobilizations
This phase typically occurs 2-4 weeks post-injury.
What is the common mechanism of injury for ACL sprains?
Plant and twist, often during changes in direction, sudden stops, or direct impact
ACL injuries are more common in females than males.
What are the signs and symptoms of an ACL tear?
Pain, feeling of instability, giving way of the knee, loss of range of motion, swelling, hemarthrosis
These symptoms indicate a significant injury.
What is the Unhappy Triad?
ACL, MCL, and medial meniscus injuries
This term describes a common combination of knee injuries.
What is a key precaution after ACL repair with hamstring graft?
No isolated hamstring strengthening for 4 weeks if the graft is from the hamstring tendon
This helps prevent stress on the healing tissue.
What does the screw home mechanism refer to?
Occurs at full extension where the tibia externally rotates for maximal stability
This mechanism is essential for knee stability during standing.
What is the mechanism of injury for MCL sprains?
Valgus force with or without external rotation
Injuries can occur from contact or non-contact situations.
What are the early goals of treatment for a Grade 2 MCL sprain?
Control swelling, regain ROM, preserve strength, optimize gait
Treatment involves a gradual return to function.
What characterizes tendinopathy?
Clinical syndrome of tendon pain and thickening
It is different from tendinitis, which is acute inflammation.
What are intrinsic risk factors for Achilles tendinopathy?
inc Age
* Sex: M>f
* Flat feet or high arches
* Tight calf muscles
* psoriasis, high blood pressure, diabetes, and rheumatoid arthritis can increase risk.
* Family History:
* Obesity, high blood pressure, diabetes, and prolonged steroid use
These factors increase the likelihood of developing tendon issues.
What is a common complaint of Achilles tendon rupture?
A sensation of being kicked or shot in the lower calf
This is often accompanied by a positive Thompson’s test.
What is the treatment protocol for Achilles tendon rupture?
Initially NWB with crutches and/or boot, followed by progressive loading and strength training
The rehabilitation process typically spans several weeks.
What is Tibialis Posterior Tendinopathy?
Compressed under medial malleolus, can irritate with hyperpronation
Key structures running under the medial malleolus include Tibialis Posterior, Flexor Digitorum Longus, Posterior Tibial Artery, Tibial nerve, and Flexor Hallucis Longus.
What are the causes of Tarsal Tunnel Syndrome?
Trauma, space occupying lesion, inflammation, inversion, pronation, valgus deformity
Tarsal Tunnel Syndrome is a condition affecting the tibial nerve and associated structures.
Where is the complaint of pain with Tarsal Tunnel Syndrome?
Medial heel and medial longitudinal arch
Pain is often aggravated by standing, walking, and at night.
What type of pain is associated with Plantar Fasciitis?
Plantar aspect of foot, anterior calcaneus
Pain is typically worse with walking, running, and in the morning.
What are the AROM findings for Tarsal Tunnel Syndrome?
Full: but may have pain with inversion and PF
Active range of motion (AROM) is generally not restricted.
What are the AROM findings for Plantar Fasciitis?
Full; likely will complain of pain with walking (windlass mechanism)
Active range of motion (AROM) remains intact.
What are the sensory deficits in Tarsal Tunnel Syndrome?
Possible: if tibial nerve is compressed as it passes through the tarsal tunnel
Sensory deficits to heel, sole of the foot (medial & lateral) and bottom of the toes.
What are the sensory deficits in Plantar Fasciitis?
None
This condition typically does not involve sensory deficits.
What is a common overuse injury of the elbow?
Lateral Epicondylagia
This injury primarily affects the ECRB muscle.
What diagnostic test is used for Lateral Epicondylagia?
Maudsley’s test, Cozens test, Mills test
These tests evaluate pain related to wrist and finger extension.
What is the primary cause of Medial Epicondylagia?
Repetitive motions into wrist flexion
Common activities include swinging a golf club or work-related grasping.
What is the main symptom of De Quervain’s Tenosynovitis?
Pain with radial deviation and stretch (ulnar deviation)
Thickening and swelling over ABL(abductor pollicus longus) and EPB may also be present.
What is the Finkelstein’s test used for?
To diagnose De Quervain’s Tenosynovitis
The test involves tucking the thumb in a fist and ulnar deviating the wrist.
What is the early treatment goal for Lateral Epicondylagia?
Control pain/inflammation
Strategies include rest, ice, modalities, and patient education.
What is the treatment approach for Rotator Cuff Tendinopathy?
Strengthening proximal muscles before starting dynamic strengthening
This is crucial to avoid faulty mechanics.
What are the risk factors for Rotator Cuff Tendinopathy?
Obesity, metabolic disorders, muscle imbalance, decreased flexibility, advanced age
These factors can contribute to the development of the condition.
What does the Drop Arm test assess?
Infraspinatus and supraspinatus function
A positive test indicates potential rotator cuff injury.
What is a common finding in Medial Epicondylagia?
Palpation tenderness on or near the medial epicondyle
Pain is often exacerbated during resisted wrist flexion.
What is the first phase of treatment for Rotator Cuff Tendinopathy?
Scapular Stabilization
Focus on middle and lower fibers of trapezius & serratus anterior.
What is the primary muscle involved in Lateral Epicondylagia?
ECRB (Extensor Carpi Radialis Brevis)
This muscle originates from the lateral epicondyle.
True or False: Pain with passive wrist extension is associated with Medial Epicondylagia.
True
Pain occurs while the elbow is extended.
Fill in the blank: The treatment for De Quervain’s Tenosynovitis includes _______.
[activity modification, splinting]
Change lifting mechanics and keep the wrist in neutral.
What is the primary cause of plantar fasciitis?
Overuse injury caused by pulling on the medial calcaneal tuberosity by the plantar fascia.
List three risk factors for plantar fasciitis.
- Excessive or repetitive weight bearing work
- Obesity
- Flat feet or high arches
What are common signs and symptoms of plantar fasciitis?
- Pain over plantar fascia and calcaneal tuberosity
- Pain first thing in the morning
- Antalgic gait
What is the Windlass Mechanism?
The winding of the plantar fascia shortens the distance between the calcaneus and metatarsals to elevate the medial longitudinal arch.
What are the Ottawa ankle rules? (5)
- TOP lateral malleolus + 6cm
- TOP medial malleolus + 6cm
- TOP navicular
- TOP base of 5th metatarsal
- inability to walk 4 steps, both immediately and at Ax.
List two risk factors for IT Band Syndrome.
- Weak hip abductors
- Rapid training increases
What is the common pain pattern for mechanical low back pain?
Unilateral pain with no referral below the knee.
Name one easing factor for mechanical low back pain.
Changing position or laying down.
What characterizes degenerative disc disease?
Narrowing of the spinal canal due to degeneration of the vertebral disc and/or lumbar facet joints.
What is a common direction for lumbar disc herniation?
Posterior-lateral
What is radiculopathy?
A neurological symptom that can cause pain, tingling, numbness, and weakness.
What is a common treatment approach for lumbar spine disc herniation?
- movements that promote lumbar flexin ie. cycling
- Lumbar stabilization exercises
- Core activation
- Traction
What are the symptoms of greater trochanteric hip bursitis?
- Lateral hip pain
- Pain with palpation of GT bursa
- Unable to lay on affected side
What is piriformis syndrome?
Peripheral neuritis of the branches of the sciatic nerve caused by an abnormal piriformis muscle.
What is the recommended elbow angle for proper workplace ergonomics?
90° or slightly greater.
What does the Bicycle Test assess?
Neurogenic Intermittent Claudication indicative of Spinal Stenosis.
What is spondylosis?
Arthritis of the spine.
What is the most common site for spondylolysis?
Lower lumbar (L5-S1).
Fill in the blank: The _______ is the primary structure affected in lumbar disc herniation.
nucleus pulposus
True or False: Traction and TENS have been shown to help with mechanical low back pain.
False
What is a common easing position for patients with spinal stenosis?
Sitting or fetal position.
What is a common treatment for greater trochanteric hip bursitis?
Avoid activites that cause pain
Myofascial release of IT Band/TFL.
What is the primary goal of postural control in managing mechanical low back pain?
To stabilize the spine during movement.
What is a defining characteristic of degenerative disc disease?
Age-related loss of intervertebral disc height and hydration.
What are common mechanisms of injury for meniscal tears?
Repetitive or forceful rotation at the knee combined with flexion and varus/valgus stress
Traumatic injuries are common mechanisms.
What are some signs and symptoms of a meniscal tear?
- Joint line pain
- Loss of flexion more than 10 degrees
- Loss of extension more than 5 degrees
- Swelling (synovial)
- Crepitus
- Positive special test
- Patient reports “locking” in knee
What is the goal of treatment for a meniscal tear within 4 weeks?
- Restore normal knee extension
- Decrease swelling (effusion)
- Safe use of protection equipment (brace, crutches)
What is medial tibial stress syndrome commonly known as?
Shin splints
This condition is often associated with running or vigorous sports activities.
What are the common signs of medial tibial stress syndrome?
- Pain on medial aspect of tibia
- Tenderness on palpation
- Pain with resisted movement
What are some risk factors for medial tibial stress syndrome?
- Increase in unaccustomed activity or training load
- Flat feet or high arches
- Wearing improper footwear
What are the ‘5 P’s’ associated with compartment syndrome?
- Pain
- Pallor
- Pulselessness
- Paresthesia
- Paralysis
What is the conservative treatment for chronic compartment syndrome?
Biomechanical correction and soft tissue therapy (stretching, massage)
Surgical treatment may involve fasciectomy.
What is patella femoral pain syndrome also known as?
Runners’ knee
This syndrome implies pathology affecting the patellofemoral joint.
List two external risk factors for patella femoral pain syndrome.
- Vigorous physical activities that stress the knee
- A sudden change in physical activity
What internal risk factors can contribute to patella femoral pain syndrome?
- Poor patellar tracking
- Patella alta or baja
- Weak or imbalanced quadriceps
What is Osgood Schlatter’s disease?
Traction apophysitis stress on the developing tibial tuberosity at the patellar tendon insertion
Often occurs bilaterally in active children.
What are common symptoms of Osgood Schlatter’s disease?
- Warmth
- Tenderness on palpation
- Swelling
- Pain with squatting, stairs, and jumping
What should be avoided in the treatment of Osgood Schlatter’s disease?
High intensity exercises to strengthen the quadriceps
These can increase stress on the tibial tuberosity.
What are the menisci made of and what is their role?
Fibrocartilaginous structure
They act as shock absorbers and increase congruency of the joint.
What is a common differential diagnosis for meniscal tears?
Plica syndrome
This is an embryological extension of the synovial capsule of the knee.
What is a common sign of patella femoral pain syndrome during activities?
Pain with climbing or descending stairs
Pain can also occur during prolonged sitting.
What is compartment syndrome?
A condition that occurs when there’s increased pressure within a compartment of muscles, nerves, and blood vessels, leading to potential damage.
It often affects the arms and legs.
Where does compartment syndrome most often occur?
In the anterior compartment of the lower leg (calf).
It can also occur in other compartments of the leg, arms, hands, feet, and buttocks.
What are the common causes of compartment syndrome?
Fracture, badly bruised muscle, crush injuries, constricting bandages.
These factors lead to increased pressure in the compartment.
What are the ‘5 P’s’ of compartment syndrome?
- Pain: disproportionate to activity
- Pallor: pale skin color
- Pulselessness: tight or full muscle feel
- Paresthesia: tingling or burning sensations
- Paralysis: loss of use
These symptoms help in diagnosing compartment syndrome.
What characterizes acute compartment syndrome?
Pain that is disproportionate to activity, with passive stretching causing pain.
It may also involve other symptoms like pallor and pulselessness.
What characterizes chronic compartment syndrome?
Pain comes on acutely with activity and ceases with rest.
It typically affects individuals during specific activities.
What are the conservative treatments for chronic compartment syndrome?
- Biomechanical correction
- Soft tissue therapy (stretching, massage)
These treatments aim to alleviate symptoms without surgery.
What is a surgical treatment for chronic compartment syndrome?
Fasciectomy.
This procedure involves removing part of the fascia to relieve pressure.
What are the characteristics of the menisci?
Fibrocartilaginous structures that are avascular and lack nerve supply on their inner two thirds.
They act as shock absorbers and increase joint congruency.
How does the medial meniscus differ from the lateral meniscus?
- Medial meniscus: larger, shaped like ‘C’, more stationary, attaches to MCL
- Lateral meniscus: smaller, shaped like ‘O’, more mobile, not attached to lateral ligament
This difference affects their susceptibility to injury.
What role does the popliteus muscle play in relation to the lateral meniscus?
It pulls the lateral meniscus posteriorly during knee flexion to prevent entrapment between femur and tibia.
This action helps maintain proper joint function.
Fill in the blank: The menisci act as _______ and increase the congruency of the joint.
shock absorbers.
True or False: The lateral meniscus has a higher risk of injury than the medial meniscus.
False.
The lateral meniscus is less at risk of injury due to its mobility.
What is the tibial plateau?
The proximal end of the tibia terminates in a broad, flat region called the tibial plateau.
What separates the medial and lateral condyles of the tibia?
The intercondylar eminence runs down the midline of the plateau.
What causes a tibial plateau fracture?
A strong force on the lower leg while in a valgus or varus position OR simultaneous vertical stress and flexion of the knee.
What are the signs and symptoms of a tibial plateau fracture?
Swelling, unable to weight bear, stiffness, and history of trauma.
What is a patellar fracture?
A fracture of the patella, which can be classified into three types.
What is a sesamoid bone?
A bone embedded within a tendon, such as the patella.
What is the blood supply to the patella?
Geniculate Arteries.
What is a direct comminuted fracture?
A fracture with 2 or more separate bone fragments, caused by a blow or fall on a flexed knee.
What is a minor marginal fracture?
A fracture caused by a fall on the knee.
What are the symptoms of a patellar fracture?
Sharp, intense pain in anterior knee, limping to avoid pressure, and difficulty with functional activities.
What function does the patella serve?
Acts as a lever, improving efficiency of extension during the last 30 degrees of extension.
What is chondromalacia patella?
A degenerative process beginning with irritation and fragmentation of the hyaline cartilage of the patella.
What treatment is suggested for chondromalacia patella?
Performing quadriceps exercises in extension to prevent further degeneration.
What is the difference between PFPS and chondromalacia?
PFPS is typically an alignment issue, while chondromalacia involves degeneration of cartilage.
What tarsal bone does the tibialis posterior not attach to?
the talus.
What are the tendons palpated on the anterior ankle from medial to lateral?
Tibialis anterior, Ext Hallucis longus, EDL, peroneus tertius.
What structures are found in the tarsal tunnel?
TDANH: Tib post, flexor digitorum longus, posterior tibial artery, tibial nerve, FHL.
What is the axis of ab/adduction of the toes?
2nd toe.
What are the functions of the foot?
Support base, adaptable to uneven terrain, absorption of shock, lever during push off, aids in stance phase of gait.
How many arches are in the foot?
Three arches: two longitudinal (medial and lateral) and one anterior.
What forms the medial longitudinal arch?
Calcaneus, talus, navicular, three cuneiforms, and first three metatarsals.
What provides muscular support for the medial longitudinal arch?
Tibialis anterior, Tibialis posterior, Fibularis longus, Flexor digitorum longus, Flexor halluces, Intrinsic foot muscles.
What provides ligamentous support for the medial longitudinal arch?
Plantar ligaments, Calcaneonavicular (spring) ligament.
What forms the lateral longitudinal arch?
Calcaneus, cuboid, and 4th and 5th metatarsal bones.
What provides muscular support for the lateral longitudinal arch?
Fibularis longus, Flexor digitorum longus, Flexor halluces, Intrinsic foot muscles.
What forms the transverse arch?
Metatarsal bases, cuboid, and three cuneiform bones.
What provides muscular support for the transverse arch?
Fibularis longus, Tibialis Posterior.
What is pes cavus?
High medial longitudinal arch leading to decreased shock absorption.
What is pes planus?
Flat-footed condition where longitudinal arches have been lost.
At what age do arches typically develop?
Arches develop by 2-3 years of age.
