Musculoskeletal Pathologies Flashcards
Adhesive Capsulitis Etiology
onset related to direct injury of shoulder/begin insidiously. Most prevalent in females 40 to 60 yrs, pts w/ diabetes. Self-limiting, resolves in 1 to 2 years, some pts have residual loss of motion
ACL Sprain Etiology
Noncontact twisting injury W/hyperextension, varus/valgus stress to knee. Usually includes injury to other knee structures, medial capsule, MCL, menisci
Congenital Torticollis Etiology
unilateral contracture of sternocleidomastoid, seen 0-2 mos old
etiology unknown, associated w/ malpositioning in utero, birth trauma
Glenohumeral instability Etiology
Combination of forces stress anterior capsule, glenohumeral ligament, rotator cuff = humerus moves interiorly out of glenoid fossa. Anterior dislocation most common, associated with shoulder ABD & lat rotation
Juvenile Rheumatoid Arthritis Etiology
unknown, theorized that external source = virus/ infection/ trauma triggering autoimmune response in child w/ genetic predisposition
Impingement Syndrome Etiology
humeral head & associated rotator cuff attachments migrate approximately, become impinged on undersurface of acromion & coracoacromial ligament
Lateral epicondylitis Etiology
Microtrauma to EXT carpi radialis brevis from eccentric loading. Most common 30 to 50 years old
MCL sprain Etiology
contact/noncontact, fixed-foot, external tibial rotation injury w/ valgus force
Associated w/ football, skiing, soccer
Meniscus tear Etiology
fixed foot rotation + weight bearing on the flexed knee produces compression & rotation force on meniscus
Osgood-Schlatter disease Etiology
repetitive tension to patellar tendon over tibial tuberosity in young athletes = small avulsion of tuberosity & swelling
Osteoarthritis Etiology
unknown. Appears in middle age, affects nearly all individuals by 70 yrs. More common in men than women up to 55, more common in women 55+ yrs. Risk factors = overweight, fractures/other joint injuries, occupational/athletic overuse
Osteogenesis imperfecta Etiology
connective tissue disorder that affects formation of collagen during bone development: 4 classes
genetic inheritance- types I and IV = autosomal dominant , types II and III = autosomal recessive
Patellofemoral syndrome Etiology
pain/discomfort in anterior knee a.k.a. chondromalacia patella
increased force @patellofemoral joint = repetitive over use disorder.
Factors = decreased quad strength, decreased LE flexibility, patellar instability, increased tibial torsion/femoral anteversion.
Increased risk = females, growth spurts, runners w/recently increased mileage, overweight
Plantar fasciitis Etiology
acute injury from excessive loading of foot/chronic irritation from excessive pronation. Most common 40-60 yrs
PCL sprain Etiology
most common = landing on tibia W/flexed knee/hitting dashboard in MVA w/ flexed knee. Usually involve other knee structures like ACL, MCL, LCL, menisci
Achilles Tendonitis Etiology
repetitive overload of Achilles tendon caused by changes in training intensity/faulty technique.
Activities associated = running, basketball, gymnastics, dancing
Rheumatoid arthritis Etiology
unknown. 1 to 2% of American population affected. Women affected 3X more than men, most common age onset = 40 to 60 years
Rotator cuff tear Etiology
intrinsic factors = impaired blood supply to tendon resulting in degeneration. Extrinsic factors = trauma, repetitive microtrauma, postural abnormalities
Scoliosis Etiology
idiopathic, usually diagnosed between 10-13 yrs- girls have greater risk of acquiring curve > 30 degrees
Total hip arthropasty Etiology
elective surgery to treat osteoarthritis, rheumatoid arthritis, osteomyelitis, a vascular necrosis
Total Knee Arthroplasty Etiology
elective surgery to treat osteoarthritis, osteomyelitis
Adhesive Capsulitis Signs/Symptoms
localized pain extending down arm, reported stiffness, night pain, restricted ROM in capsular pattern
Adhesive Capsulitis Treatment
increase ROM w/ Glenohumeral mobilizations, ROM exercises, palliative modalities. Avoid overstretching, elevating pain = further loss of motion.
Surgical options = subscapular nerve block, closed manipulation
ACL Sprain Signs/Symptoms
reported loud pop/feeling of knee “giving way,” “buckling,” dizziness, sweating, swelling. Use anterior drawer test, Lachman test, lateral pivot shift test to diagnose
ACL Sprain Treatment
RICE, NSAIDs, analgesics.
Conservative: LE strengthening W/emphasis on quads and hamstrings.
Surgery for complete ACL tear= intra-articular reconstruction using patellar tendon/ IT band/ hamstrings tendon.
Derotation brace for patient with ACL deficient knee, limited benefit for patient post surgery
Congenital Torticollis Signs/Symptoms
lateral cervical flexion to same side as contracture, rotation toward opposite side, facial asymmetry
Congetinal Torticollis Treatment
Conservative = emphasis on stretching, AROM, positioning, caregiver education. Surgical= conservative options fail, child is 1 yr+ old. Surgical release + physical therapy for ROM and proper alignment
Glenohumeral Instability Signs/Symptoms
subluxation – feeling shoulder “popping” in & out, pain, paresthesia, sensation of arm feeling “dead”, positive apprehension test, capsular tenderness, swelling. Dislocation – severe pain, paresthesia, limited ROM, weakness, visible shoulder fullness, arm supported by contralateral limb
Glenohumeral Instability Treatment
1st- immobilization W/sling for 3 to 6 weeks. RICE, NSAIDs. 2nd-immobilization, ROM, isometric strengthening, Progressive resistance W/emphasis on internal/external rotators +large scapular muscles
Juvenile Rheumatoid Arthritis Signs/Symptoms
10 to 20% = Systemic- acute onset, high fevers, rash, enlargement of spleen & liver, inflammation of lungs & heart.
30 to 40% = Polyarticular- high female incidence, significant rheumatoid factor, arthritis in 4+ joints with symmetrical joint involvement.
40 to 60% = Oligoarticular- affects less than 5 joints w/ asymmetrical joint involvement
Juvenile Rheumatoid Arthritis Treatment
relieve inflammation w/ NSAIDs, corticosteroids, anti-rheumatics, immunosuppressants
PT: passive/active ROM, positioning, splinting, endurance training, WB activity, postural training, functional mobility
Pain management: paraffin, ultrasound, warm water, cryotherapy
Surgery 2ndary to pain/contracture/irreversible joint damage
Impingement Syndrome Signs/Symptoms
discomfort/mild pain deep in shoulder, pain with overhead activity, painful arc of motion (70 to 120° ABD), positive impingement sign, tenderness over the greater tuberosity & bicipital groove
Impingement Syndrome Treatment
1st RICE, NSAID, activity modification.
2nd rotator cuff strengthening, scapular stability exercise, improved biomechanics
Lateral Epicondylitis Signs/Symptoms
pain anterior/distal to lateral epicondyles of humerus. Pain increases w/repetition, resisted wrist extension
Lateral Epicondylitis Treatment
1st RICE, NSAIDs, activity mod. 2nd PT = increase strength, flexibility, endurance of wrist EXT. Strap placed 2-3” distal to elbow can reduce muscle tension placed on at the condyle, may diminish/eliminate symptoms
MCL Sprain Signs/Symptoms
knee pain, swelling, antalgic gait, decreased ROM, feeling of instability. Use valgus stress test to diagnose
MCL Sprain Treatment
1st RICE, NSAIDs, analgesics
2nd conservative = decrease inflammation, protect knee joint & ligament, ROM, strengthening as tolerated.
Surgery rarely required, MCL = well vascularized
Meniscus Tear Signs/Symptoms
joint line pain, swelling, catching/locking sensation. Special test = Apley’s compression test, bounce home test, McMurray test
Meniscus Tear Treatment
1st RICE, NSAIDs, analgesics
2nd conservative = palliative modalities & strengthening exercise.
Surgery = partial meniscectomy – meniscal repair for active individuals.
Repairs for outer edge of meniscus due to increased vascularity
Osgood-Schlatter Disease Signs/Symptoms
point tenderness over patellar tendon @ insertion on tibial tubercle, antalgic gait, pain w/increasing activity
Osgood-Schlatter Disease Treatment
conservative = education, icing, flexibility, eliminating activities that place strain on patella tendon a.k.a. squatting, running, jumping
Osteoarthritis Signs/ Symptoms
gradual onset of pain @ affected joint, increased pain post exercise, increased pain w/weather change, enlarged joints, crepitus, stiffness, limited ROM, Heberden’s nodes & Bouchard’s nodes.
Osteoarthritis Treatment
GOAL: reduce pain, promote joint function, protect joint.
Drugs = acetaminophen, NSAIDs, corticosteroids.
PT = passive/active ROM, Hot/cold agents, pt education, strengthening, TENS, energy conservation, weight-loss, body mechanics, joint protection, bracing.
Surgery = from arthroscopic – total joint arthroplasty
Osteogenesis Imperfecta Signs/Symptoms
pathological fractures, osteoporosis, hypermobile joints, bowing of long bones, weakness, scoliosis, impaired respiratory function
Osteogenesis Imperfecta Treatment
begins at birth w/caregiver education on proper handling/facilitation of movement.
PT= AROM w/emphasis on symmetrical movement, positioning, functional mobility, fracture management, orthotics
Patellofemoral Pain Syndrome Signs/ Symptoms
anterior knee pain, pain w/prolonged sitting, swelling, crepitus, pain w/ ascend/descend stairs
Patellofemoral Pain Syndrome Treatment
depends on contributing factors.
Possible treatment = modalities to decrease inflammation/pain, increase LE flexibility, medial patella glides, biofeedback, patellar taping. LE strengthening should emphasize quads, vastus medialis oblique, minimize patellofemoral compressive force
Plantar Fascitiis Signs/Symptoms
tenderness at insertion of plantar fashion, heel spur, pain that’s worse in morning/post prolonged inactivity, difficulty W/prolonged standing, pain in bare feet
Plantar Fasciitis Treatment
1st RICE, NSAIDs, analgesics.
2nd Heel cup, massage w/tennis ball/rolling pin, medial longitudinal arch taping, joint mobilization.
Prevention = heel cord stretch, soft sold footwear, avoid sudden change in intensity of training, orthotics
PCL Sprain Signs/ Symptoms
reported femur sliding off tibia, swelling/mild pain, patient mostly asymptomatic.
Special tests = posterior drawer test, posterior sag sign
PCL Sprain Treatment
1st RICE, NSAIDs, analgesics.
2nd PT = LE strengthening, functional progression.
Surgical procedure not evolved as ACL – post op, isolated hamstring exercise avoided for 6+ weeks
Achilles Tendonitis Signs/ Symptoms
aching/ burning in posterior heel, tenderness of Achilles tendon, pain w/ increased activity, swelling/ stiffness in tendon area, muscle weakness due to pain, morning stiffness
Achilles Tendonitis Treatment
RICE, NSAIDs, analgesics.
Heel lift/cross training used to limit amount of tensile loading.
Prevention = heel cord stretching, use of soft-soled footwear, eccentric strengthening of gastroc/ soleus, avoid sudden changes in training intensity
Rheumatoid arthritis Signs/Symptoms
onset = gradual/immediate, symmetrical involvement, pain/tenderness of affected joints, morning stiffness, warm joints, decreased appetite, malaise, increased fatigue, swan neck/boutonniere deformity, low-grade fever
Rheumatoid Arthritis Treatment
GOAL = reduce inflammation/pain, promote joint function, prevent joint destruction/deformity. Drugs = NSAIDs, corticosteroids for severe flareups/patient not responding to NSAIDs. Anti-rheumatics = slow acting, take weeks/months to be effective, can slow progression of joint destruction/deformity. PT = passive/active ROM, hot/cold agents, splinting, patient education, energy conservation, body mechanics, joint protection techniques
Rotator Cuff Tear Signs/Symptoms
arm @ IR &ADD, point tenderness @ greater tubercle & acromion, marked limitation in shoulder flex & ABD w/upper trapezius recruitment evident, increased tone in anterior shoulder structures
Rotator Cuff Tear Treatment
conservative= RICE, NSAID, analgesics.
PT= prevent adhesive capsulitis, strength and UE musculature, PROM, gradually moves to AAROM, AROM & isometrics w/surgeon approval. Return to functional activity w/dynamic overhead motion = 9 to 12 months
Surgery= arthroscopic/ mini–open W/arthroscopic assist/ traditional open approach to repair tendon.
Post op = immobilization time depends on surgeon preference, surgical procedure, & size of tear (large tear = 4 to 6 weeks)
Scoliosis Signs/Symptoms
shoulder level asymmetry, with or w/out rib hump. Pain = result of abnormal forces places on body due to curve
Scoliosis Treatment
determined based on magnitude of curve/ degree of progression- if no progression, no formal action.
PT = strengthening/ flexibility, shoe lifts, bracing. Orthoses for curve 25-40 degrees. Curve >40 = surgery
Total Hip Arthroplasty Signs/Symptoms
prior to surgery= severe pain w/ WB, loss of mobility, failure of non-operative Tx/ previous surgery
Total Hip Arthroplasty Treatment
PT= 1st, decrease inflamm/ allow for healing, adherence to Hip precautions, minimize atrophy, regain PROM.
2nd, regain strength/ endurance, attaining independence in home
Total Knee Arthroplasty Signs/Symptoms
prior to surgery= severe pain w/ WB, loss of mobility, gross instability/ limited ROM, marked deformation of knee, failure of non-operative management/ pervious surgery
Total Knee Arthroplasty Treatment
PT= 1st, decrease inflamm/ allow for healing, adherence to knee precautions, minimize atrophy, regain PROM (Functional ROM= 90 for ADLS, 105 for sit-stand)
2nd, regain strength/ endurance/ independence @ home
