pathologies Flashcards
what is a brusae
a flattened sac like structure that is line with synovial membrane and filled w/ synovial fluid which allows smooth and fricitonless motion b/w continguous ms, tendons, bones, ligaments and skin
in the case of injury to the bursae, will there be pain in AROM, PROM or both
both since its considered to be an inert structure
how is the bursae under normal conditions
not very palpable
flattened and smooth
what is a bursitis
results from the inflammation of the bursae which generally occurs when the synovial fluid gets irritated due to excessive movements or as a result of direct trauma to the bursae
what happens to the synovial cells in an injured bursae
the bursae will inflame and the synovial cells will thicken
what are signs and symptoms associated w/ a bursitis
inflammation localized tendernesswarmth edema redness of the skin in the case of a superficial bursitis loss of function from pain
what are some common bursae that get inflammed
-subacromial bursitis olecranon bursitis illiopsoas bursitis trochanteric bursitis ischial bursitis infrapatellar bursitis anserine bursitis
how can a PT treat a bursitis
-generally pts present during the acute/inflammatory phase and hence principles to reduce inflammation are used PRICEMEM
Once the inflammatory phase is finished its important to reassess the strength, posture and mvmt patterns ti determine why the bursae is irritated
should pain from an insidious onset bursae even after treatment be reoccuring?
it can if the mvmt or pain provoking action/posture is not resolved. as opposed to if onset was traumatic, its generally will not return
what is the role of a tendon
attacges ms to bone at the periosteum
what is the role of a ligament
connects bones together at a joint in order to strengthen and stabilize that joint
what are ligaments made out of
dense connective tissue
how does a tendon compare to a ligament
a tendon will become taut or slack depending on if its shortened or lengthened as the ms belly is contracting while a ligament should remain taut throughout full ROM
how do injuries to tendons generally arise?
due to microtrauma to the tissue of the tendon as a result of repeptitive load from external forces s/a the incorrect use of training techniques, improper use of equipment and innapropriate footwear
can anatomical predispositions results in tendon pathology?
inflexibility
weakness
malposition
what are the main causes to tendon pathologies
mechanical over use
aging and poor vascular supply which causes tendons to weaken and become stiffer
what is a tendinitis
an inflammatory rxn to a injured tendon due to microscopic tearing of the tendon. it generally results from fatigue
if the patients show’s up with a tendinitis in the sub-acture phase, will PROM be painful,
since a tendon is a contractile tissue, it shouldnt be painful in PROM if patient is properly relaxed
what is a tendinosis
its a degenerative process of the tendon due to thickening of the tendon which is characterized by the presence of dense populations of fibroblasts, vascular hyperplasia and disorganized collagen
there should not be any inflammatory cells present as this is not an inflammatory reactions but rather a continuous repair cycle of the tendon leading to scar tissue formation
in what population group are tendinosis commonly seen in
people over the age of 35
What are common sites for tendon pathology
- rotator cuff of the shoulder –> supraspinatus and bicep tendon get pinched
- wirst extensors and flexors (lateral epicondylitis/medial epicondylitis)
- patellar tendon of the knee –> common in teens due to growth spurt
- insertion of the posterior tibial tendon leading to shin splints
- achilles tendon
what are signs that are indicative of a tendon pathology
- RISOM will be strong but painful
- will usually be tender with palpation
what methods are generally used to treat an tendon pathology
-if present in the inflammatory phase PT must use PRICEMEME (not effective in the case of tendinosis)
-once inflammatory phase is over need to work on factors causing tendinosis which generally involves correction of posture, flexibility and ms strengthening
thus important to locate any imbalances
provide an example on treatment of a rotator cuff tendinosis (supraspiantus)
pt will generally present with rounded shoulder thus have a weak ER (infra/teres minor and tight IR (subscap) thus the RC muscles will need to be strengthened and improve posture
what is a sprain
a ligament injury
how do ligament injuries generally arise
MOI is generally traumatic
what is important for the PT to know/ask in the case of a ligament sprain?
- the position of the joint at the time of trauma
- direction and site of impact
- when the trauma happened
what is evaluated by the PT in an objective exam for a ligament sprain
- point of tenderness, joint effusion, presence of bruising (not always)
- presence of a positive sign for a ligament stress test
what is a grade 1 sprain injury
- ligament is stretched with minimal torn fibers
- on a ligament stress test there will be pain, no gap and a normal EF
- no bruising
- minimal loss of structural integrity
- minimal loss of function
how can a grade 1 sprain be treated
main treatment goal is to work on proprioception inorder to prevent lack of balkance and possibility of reoccurant sprains
what is a grade 2 sprain injury
- partial ligament tear
- ligament stress test will present with pain, gap, and normal EF
- shows significant structural weakness
- presence of bruising and swelling that can be treated with PRICEMEM
- greater tendency of reoccurance
- needs protection from further injury which can be provided by taping or a brace
what type of treatment is done to a grade 2 ligament sprain
work on proprioception and strengthen the ms around the joint to prevent reinjury
what is a grade 3 ligament sprain
complete ligament tear
initially lots of pain but generally not painful once the inflammatory phase passes
presence of bruising and swelkling
signs in the ligament stress test: pain (depending when assessed), gap and soft end feel (like breaking bread, mvmt is not inhibited)
loss of structural integrity
significant abnormal motion
permanent instability (may require surgical intervention depending on affected ligament)
what treatment does the PT use to fix a Grade 3 ligament sprain
improve proprioception and muscle strength
may need surgery s/a in shoulder but not in the ankle
what is a muscle strain?
a muscle that is pulled/overstretched or torn as a result of fatigue, overuse or improper use
what is a mild/1st degree strain
- tear of a few ms fibers with minor swelling and discomfort
- minimal or no significant loss of function and mvmt restriction
- presence of local tenderness
- pts can generally resume with normal activities just avoid overuse not to exacerbate pain and injury
what is a moderate/2nd degree strain
- greater ms damage
- obvious loss of strength
- pain that causes loss of function
- moderate/severe level or pain
- presnece of bruising and swelling
- loss of functional joint stability
- rehab b/w 3-28 days
how to treat first and 2nd degree strains
in the inflammatory phase: PRICEMEM
strengthen muscles w/ eccentric, concentric and functional work
improve proprioception
what is a3rd degree strain
- tear extends across entire ms belly
- severe pain and loss of function in inflammatory phase but once this resolves there may be no pain
- unable to contract ms, makes use of synergists to produce mvmt at joint
- pain increases with work
- surgery is often needed
- healing b/w 3 weeks to 3 motnhs
with a grade 1 and 2 ms strain when is pain generally felt
when the ms contracts or stretches
the amount of availible motion at a joint is based on a number of factors such as
shape of articulating surface
health of the joint and the surrounding tissues
load/deformation history of the joint
what is joint hypomobility
mvmt at the joint is less than normal compared to the other side
decreased ROM and early capsular EF
how to treat for hypomobility of a joint
ROM exercises and mobilisations
what is generalized hypermobility
results from hyperlaxity and increased ROM bilaterally and at multiple joints
what is local hypermobility
occurs as a rxn to neighboring hypomobility/stiffness
ROM is increased compared to the other side, EF is normal
how to treat for local hypermobility
find the stiffness that the patient is compensating for and work on the hypomobility
educate pt not to stay at end range for prolonged periods of time
strengthen ms around the joint
