Pathologies

Question 1

OA

Answer 1

A

Question 2

Sprained ankle

Answer 2

Mechanism is excessive PF and inversion which damages the lateral ligaments structures.

ATFL is the weakest lateral ligament which is damaged 65% of the time, ATFL and PTFL are damaged 20% of the time.

Up to 85% restrain
Up to 33% still have pain
Up to 53% have instability (Van Rijn et al., 2008)

 Grade 1 = Partial stretch, microscopic tearing, slight oedema
 Grade 2 = Stretch with partial tearing of ligament, moderate oedema, difficult to walk without crutches, minor instability
 Grade 3= complete rupture, significant oedema, impossible to WB without significant pain

Question 3

Whiplash

Answer 3

An acceleration then deceleration of energy transfer to the neck. A hyperextension then hyperflexion injury to the neck. Could be due to hyperextension of the lower cervical spine with a relatively flexed upper cervical spine which creates an ‘S’. Up to 83% of RTA incidents in collisions.

Mainly spraining the nuchal and anterior longlitudinal ligament. Car crashes from the back compress the kyphosis of the thoracic spine which provides excessive load into the cervical spine

Interestingly: Could be due to a concentric contraction of the upper traps or supraspinatus impingement resulting in impingement (Yamaguchi et al., 2006)

Possible injuries: 
Facet joint damage
Ligament tear
Cervical spine fracture
Dura tear
Spinal cord
MSK tear
Nerve root impingement
Discogenic

Grade 1 - Neck stiffness, tenderness but no positive findings on physical exam (no loss of movement)

Grade 2 - MSK signs including decrease ROM and point tenderness

Grade 3 - Hypersensitivity to pain, cold and poor sleep due to pain, trigger points in the muscles

Question 4

ACL Injury

Answer 4

ACL prevents anterior translation of the tibia. Mechanism is usually: hip adduction and internal rotation of tibia. Usually seen in pivot, turning, jumping etc.

 Grade 1 = Partial stretch, microscopic tearing, slight oedema
 Grade 2 = Stretch with partial tearing of ligament, moderate oedema, difficult to walk without crutches
 Grade 3= complete rupture, significant oedema, impossible to WB without significant pain

Because the ACL goes to lateral femoral condyle –> around 50% of ACL sufferers have a lateral meniscus tear

Question 5

Anterior knee pain/ patellofemoral pain

Answer 5

aa

Question 6

Frozen shoulder

Answer 6

a

Question 7

MCL

Answer 7

a

Question 8

Non specific arms pain

Answer 8

a

Question 9

LBP with sciatica

Answer 9

a

Question 10

NSLBP

Answer 10

a

Question 11

Supraspinatus impingement

Answer 11

a

Question 12

Tennis elbow

Answer 12

Lateral epicondylitis: Chronic overuse injury of the extensor tendons of the elbow, is the result of repeated microtrauma to the tendon leading to disruption and degeneration of the tendons internal structure. It is secondary to eccentric overload of the common extensor tendon at the origin of the extensor carpi radialis brevis (ECRB). Usually to do with strain and task, for example repetitive gripping, wrist extension, radial deviation and forearm supination.

Smoking, obesity, a repetitive movement for at least 2 hours a day and vigorous activity are risk factors.

The natural course of the condition is favourable with spontaneous recovery within one to two years in 80-90% of patients.