Musculoskeletal Conditions - Silver

Question 1

Disk Herniation

Answer 1

Majority occur at L4-5 and L5-S1
Disks lose water overtime, making the annulus fibrosus more susceptible to tearing with age.
LBP followed by unilateral radicular leg pain; possible numbness, tingling, and weakness
Complete resolution may take months

Question 2

Glenohumeral Dislocation - Anterior

Answer 2

Usually due to forceful external blow or load when shoulder is in abduction, ER, and extension.
May hold shoulder in slight abduction and ER, and shoulder may appear more “square” after dislocation
Diminished radial pulses may indicate vascular damage.
Decreased sensation or motor function in the axillary, musculocutaneous, and radial nerve may be observed.
PT can include isometric and then stabilizer strengthening, stretching, joint mobs.

Question 3

Medial epicondylitis

Answer 3

Can be due to repetitive motion of the elbow or wrist and gripping. Can also be traumatic injury.
Common in golfers, throwing and racket sports.
Flexor carpi radialis and pronator teres most often affected
Ulnar nerve may also be irritated as it passes through the cubital tunnel

Question 4

Meniscal tear

Answer 4

Often due to twisting knee in slight flexion or hyperextension. In older patients, may be caused by degeneration, where pivoting or squatting can cause a tear.
Medial meniscus is more firmly attached to the tibia, so it is more commonly affected than lateral meniscus.
Joint line pain and tenderness, swelling, loss of ROM, catching or locking, feeling of instability.

Question 5

Osgood-Schlatter Disease

Answer 5

Traction apophysitis at the tibial tuberosity, causing inflammation. Exacerbated by running, jumping, and squatting.
Common in adolescents following rapid long bone growth, when soft tissue tension is increased.
Localized pain and edema with point tenderness over the patella tendon insertion. Reproducable symptoms with knee extension.
May use a knee immobilizer during acute phases and an infrapatellar strap with return to activity. Strengthening, stretching, and cross training after acute phase.

Question 6

Piriformis syndrome

Answer 6

Compression or irritation to the sciatic nerve due to piriformis muscle inflammation, spasm, or contracture.
May be due to trauma (contusion TKA), mechanical dysfunction, scarring, or entrapment.
Pain usually in mid-buttock and radicular symptoms of sciatic distribution. May have hip, coccyx, and groin pain.
Pain worse with prolonged sitting and activities with medial rotation and adduction. Pain and weakness with ER. Radicular symptoms with SLR, which are alleviated with LE traction.

Question 7

PCL Sprain

Answer 7

May hear an audible pop with immediate pain and swelling. Instability with walking and pain with descending stairs or squatting.
Avoid exercises that cause posterior shear (open chain hamstring)
Improve quad strength to stabilize knee

Question 8

Spinal stenosis - Lumbar

Answer 8

Narrowing of lumbar vertebral or intervertebral foramina. Causes compression on spinal cord or nerve roots.
Primary is congenital while secondary is acquired.

Question 9

Trochanteric bursitis

Answer 9

May occur from acute (contusion from fall or sports) or cumulative trauma/friction (like running) to lateral hip causing irritation to the trochanteric bursa.
Bursa located between femoral trochanteric process, glut med, and ITB.
Leg length discrepancy and lateral hip surgery may contribute to onset.
Pain in lateral hip and possibly lateral thigh. Point tenderness and reproduction of pain with palpation. Pain with WB.
Passive ER and abduction and resisted hip flexion and abduction can cause pain.
Stretching ITB , TFL, hip ERs, quads, and hip flexors. Avoid excessive unilateral activities. Correct gait abnormalities.
Local injection + PT shown to be very helpful.