Musculoskeletal Conditions - Gold

Question 1

Achilles tendon rupture

Answer 1

Most common in males 30-50 y.o.
Nonsugical treatment includes serial casting for 10 weeks followed by use of heel lift for 3-6 months. Greater risk for re-tearing (40%)
Surgical treatment requires cast or brace after surgery for 6-8 weeks. Re-tear risk (0-5%)
Return to prior function in 6-7 months

Question 2

Adhesive capsulitis

Answer 2

Most common in middle ages, women > men.
Primary (etiology unknown) or secondary
PT usually prescribed for 3-5 months
Recovery takes 12-24 months 
Most patients experience full recovery and ROM

Question 3

Ankle sprain - grade II

Answer 3

Can return to recreation/sport within 2-6 weeks

Question 4

ACL Sprain - grade III

Answer 4

Complete tear
Most common in 14-29 y.o.
Can return to prior functional level within 4-6 mo after surgery
Without surgery, likely increased instability and joint surface degeneration

Question 5

Bicipital tendonitis

Answer 5

Often caused by repeated full abduction and lateral rotation of the humeral head or overhead movements
Higher risk in throwing, swimming, and swing racket sports
Deep ache in front and on top of shoulder
Catching or slipping feeling may indicate a tear of the transverse humeral ligament
Can usually return to activity with 6-8 weeks of PT
Surgical intervention indicated if no progress with conservative treatment after 6 months (decompression with acromioplasty/acriomionectomy)

Question 6

Lateral epicondylitis

Answer 6

Overuse of wrist extensors, especially extensor carpi radialis brevis
More common for those in late 30s and 40s due to loss of extensibility of connective tissue with age
Surgery may be indicated if symptoms do not improve with 2-3 months of PT

Question 7

Medial collateral ligament sprain - grade II

Answer 7

Partial tearing of ligament
Inability to fully extend and flex knee, pain along medial knee, possible decrease in strength, loss of proprioception
May show 5-15 deg of laxity with valgus stress at 30 deg flexion
PT should increase ROM, quad strengthening, transverse friction massage (not at proximal attachment to avoid periosteal disruption)
Return to prior level within 4-8 weeks

Question 8

Osteogenesis Imperfecta

Answer 8

Rare congenital disorder of collagen synthesis that affects all connective tissue, reduces collagen production by 20-50%
4 Types
-Type I: mildest form where child has near normal growth and appearance with fractures usually stopping after puberty. Mild to mod frailty, easily bruised, hearing loss, but no deformity. Community ambulators.
-Type II: Most sever form where child dies in utero or by early childhood. Multiple fractures with extreme deformities and soft skull.
-Type III: severe but with greater ossification of the skull. Growth retardation, progressive deformities, fractures, severe osteoporosis. 26% household ambulators.
-Type IV: Usually milder but greater than type II.Some fractures prior to puberty . May have shorter stature, bowing of long bones, barrel shaped rib cage, hearing loss, brittle teeth. Near normal life expectancy. 57% household ambulators, 26% community ambulators.

Treatment: Orthotics, WB, fracture recognition and prevention, handling techniques, strengthening, swimming. Avoid strengthening with rotational forces, long lever arms, or resistance near joint.

Ability to sit by 10 months suggests ability to ambulate.

Question 9

Patellofemoral syndrome

Answer 9

Caused by abnormal tracking of the patella between the femoral condyles. May be caused by patella alta, insufficient lateral femoral condyle, weak VMO, excessive pronation, excessive knee valgus, and tight iliopsoas, hamstrings, gastroc, and vastus lateralis.
Symptoms include pain behind patella, pain with stairs, jumping, prolonged sitting, point tenderness over lateral patella, crepitus when compressed into trochlear groove.
Positive Clarke’s test. Increased Q angle.
Return to prior function may take 4-6 weeks

Question 10

Plantar fasciitis

Answer 10

Inflammation of plantar fascia due to overuse as a result of repetitive stretching through excessive foot pronation during loading phase
Tightness of foot and calf muscles, obesity, and high arch associated with plantar fasciitis
Pain can radiate into toes or calf. Pain worse in morning, with prolonged weightbearing activity, and when weight bearing after prolonged non-weight bearing. Pain that “moves around.” Pain with palpation at calcaneal insertion.
Return to more functional level within 8 weeks; total resolution may take up to 1 year

Question 11

Rotator cuff tear

Answer 11

May recover in 4-6 weeks. Full return to sport after surgery may be at least a year.

Question 12

Rotator cuff tendonitis

Answer 12

Caused by repetitive overhead activities
Supraspinatus tendon most often involved
Most common in 25-40 y.o.
Painful motion between 60-120 deg abduction, difficulty sleeping on affected side, dull ache after overhead activities
Strengthening and ROM exercises should be pain free b/c RTC relies on appropriate blood supply and oxygen
Strengthen serratus and upper trap to promote elevation of acromion
Return to prior level of function within 4-6 weeks
3 Types

Question 13

Scoliosis

Answer 13

A curve < 25 degrees should be monitored every 3 months. Breathing exercises and strengthening for the trunk and pelvic muscles is indicated.
Curve 25-40 degrees requires spinal orthosis and PT for posture, flexibility, strengthening, respiratory function.
Curve > 40 degrees usually requires surgical spinal stabilization (often spinal fusion with Harrington rod). PT after surgery includes breathing exercises, posture, flexibility, general strengthening, respiratory muscle strengthening.

Question 14

Spondylolithesis - Degenerative

Answer 14

Forward slippage of one vertebra on another. Can by congenital, isthmic (fracture), degenerative, post-traumatic, and pathologic. Degenerative caused by arthritis and weakening of ligaments and subluxation of hypertrophic facet joints.
Most common site is L4-5, which can cause compression of L4 nerve root. Can irritate disk, posterior and anterior longitudinal ligaments, and vertebral periosteum/bone.
Symptoms include back pain that is worse with exercise, lifting overhead, prolonged standing, getting in/out of car, walking upstairs/incline, extension
Positioning, core strengthening, flexibility

Question 15

Temporomandibular joint dysfunction

Answer 15

Occurs due to changes in joint structure. Inflammation and muscle spasm surrounding joint cam produce symptoms. Overtime, meniscus of the TMJ become compressed and torn, causing bony portion of the joint to deteriorate.
Risk factors: chewing on one side, eating touch food, clenching/grinding teeth, chewing gum, biting nails.
Usually between 20-40 y.o., greater incidence in females.
Symptoms: pain, muscle spasm, abnormal or limited jaw motion, headache, tinnitus, clocking or popping or locking.

Question 16

Torticollis - Congenital

Answer 16

Contraction of the SCM
May be due to birth trauma, breech position, or intrauterine malpositioning. Possible venous occlusion and pressure on the neck or hematoma of muscle causing contracture.
Not evident until days or weeks after birth, when swelling over SCM is noted.
May also present with facial asymmetries and plagiocephaly (flattening of skull) and hip dysplagia
Treated 12-24 months conservatively before surgery considered
Passive stretching, massage, heat, TENS, AROM, and strengthening. Manual stretching 3x/day for 3-6 months

Question 17

Transfemoral amputation due to osteosarcoma

Answer 17

Second most common bone tumor.
Primarily affects young children (especially males), adolescents, and young adults under 30 y.o. Incidence often during growth spurt. Located at epiphyseal growth plate often in distal femur, proximal tibia, proximal humerus, and pelvis.
Symptoms include pain and swelling, worse pain at night and with exercise, possible lump or fracture.
May require chemotherapy after amputation.
PT should begin immediately after amupation - positioning, prone lying, ROM, strengthening, desensitization, mobility and gait.

Question 18

Transtibial amputation due to arteriosclerosis obliterans

Answer 18

Also known peripheral arterial disease (thickening, hardening, and narrowing of arteries).
Symptoms indicating need for amputation include intermittent claudication, resting pain, decreased pulses, ischemia, pallor skin, and decreased skin temp.
Should have PT immediately after amputation - strength, ROM, functional mobility, desensitization, AD, positioning.