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AGPC 4 > Soft Tissue Injury > Flashcards

Soft Tissue Injury Flashcards

1
Q

What are ligaments?

A

fibrous tissues that connect bone to bone and provide joint stability => very elastic and have a better blood supply than tendons so are less prone to chronic injury

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2
Q

What are tendons?

A

fibrous tissues that connect muscles with bone and allow for joint movement

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3
Q

What are bursae and menisci?

A

soft tissues that reduce friction between moving parts in a joint => bursae are fluid filled sacs while menisci are soft cartilaginous tissues

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4
Q

What are the common types of acute soft tissue injuries?

A

sprains (ligaments) and strains (tendons) - due to acute trauma (can be partial or full tears)

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5
Q

What are the common types of chronic soft tissue injuries?

A

tendonitis/tendinopathy (there is no inflammatory component in the pathophysiological process) and bursitis - due to overuse (usually an insidious onset)

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6
Q

What is tendinopathy?

A

injury to tendons due to repetitive mechanical load that does not provide sufficient time for healing => leads to micro-tears, improper healing, degenerative changes (e.g., loss of collagen), and tears

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7
Q

How do acute soft tissue injuries present?

A

clearly defined cause/onset, localized pain with activities and at rest, “popping” sensation (if a tear), edema, ecchymosis

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8
Q

How do chronic/overuse soft tissue injuries present?

A

gradual onset/no clearly defined cause/trauma, localized pain only with specific movements (at rest in late stages), no edema

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9
Q

What is the approach to diagnosing soft tissue injuries?

A

diagnosed clinically, x-ray is the best initial test when diagnostic tests are needed (some acute injuries, no improvement after 6 weeks, r/o fracture/tumor/arthritis => NOT used to diagnose a problem), MRI is the most accurate diagnostic test for soft tissue injuries, nerve conduction tests are most accurate tests for peripheral mono-neuropathy

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10
Q

What is the treatment for acute soft tissue injuries?

A

RICE (rest, ice for 20 minutes at a time, compression bandage, elevation) for the first 2-3 days, physical therapy when pain/swelling subside (usually after 1 week) to prevent chronic instability and recurrent injury, surgical repair is last resort

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11
Q

What is the treatment for chronic soft tissue injuries?

A 
#1 relative rest (not absolute rest) - rest from activities that reproduce the pain (need to move to build muscles/stretch and rebuild collagen)
#2 pain control - short course of NSAIDs (despite the fact that there is no inflammation)
#3 physical therapy - strength and muscle training
#4 corticosteroid injections - if no response to pain control and relative rest for 6 weeks
#5 surgery (debridement of degenerative tissues) - if no response to conservative therapy for 6 months (surgery is a last resort)
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12
Q

What is unique about the shoulder joint?

A

it lacks ligaments so its stability comes from muscles

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13
Q

How is rotator cuff tendonitis diagnosed?

A

gradual onset, pain with overhead activities (painful arc - lifting arm laterally causes pain when arm is at around 90 degrees), pain on lateral shoulder, night pain, + impingement sign, + Neer’s test, + Hawkins’ test => ROM and strength usually normal

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14
Q

What is Neer’s test?

A

press on PT’s scapula to prevent motion and raise PT’s arm with the other - compresses the head of the humerus against the acromion process => pain = + (rotator cuff tendonitis)

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15
Q

What is Hawkins’ test?

A

flex PTs shoulder and elbow to 90 degrees with palm down and rotate forearm internally - compresses the greater tuberosity against the acromion process => pain = + (rotator cuff tendonitis)

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16
Q

How is a rotator cuff tear diagnosed?

A

follows acute trauma or chronic overuse, pain and weakness on abduction, + open can test, + drop arm test => ROM and strength decreased

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17
Q

What is the open can test?

A

elevate arm to 90 degrees and rotate internally (thumb down) and ask PT to resist as you place downward pressure on the arm => inability to hold arm at 90 degrees (shoulder level) = + (rotator cuff/tendon tear)

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18
Q

What is the drop arm test?

A

ask PT to fully abduct arm to shoulder level and slowly lower it or hold arm up against resistance => PT cannot hold arm fully abducted at shoulder level = + (rotator cuff/tendon tear)

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19
Q

How does adhesive capsulitis of the shoulder present?

A

stiffness, pain and extreme limitation of ROM (both active and passive - true joint injury)

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20
Q

How does osteoarthritis present?

A

pain in anterior shoulder with activity relieved by rest, crepitus, limited ROM (active and passive - true joint injury)

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21
Q

How does cervical radiculopathy present?

A

pain in posterior shoulder radiating to neck/forearm (poorly localized), sensory deficits (numbness/parasthesia), motor deficits (very rarely), reduced deep tendon reflexes (biceps C5-6 and triceps C7-8) => peripheral neuropathy causes diminished reflexes (hyporeflexes) because problem is in the spinal nerve

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22
Q

How does central neuropathy present?

A

increased (hyper) reflexes and weakness below the lesion - problem is in the spinal cord itself

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23
Q

What are the signs and symptoms of spinal cord compression?

A

hyperreflexia, weakness, urinary incontinence - requires emergency MRI

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24
Q

Which patients are at risk for spinal cord compression?

A

those at risk for metastatic cancer or epidural abscess (cancer, HIV, IDU)

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25
Q

What effect does injury to bursae and menisci have on ROM?

A

none - they are outside the joint itself

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26
Q

How does olecranon bursitis present?

A

swollen elbow (“ball hanging out”), minimal tenderness, full ROM

27
Q

How does septic olecranon bursitis present?

A

swollen elbow, tenderness, redness, warmth, full ROM (active and passive)

28
Q

How does lateral epicondylitis (Tennis elbow) present?

A

pain over the lateral aspect of the elbow (lateral epicondyle/funny bone) with wrist extension (gripping), pain with hyperextension of wrist (arm extended with hand up “STOP”) against resistance

29
Q

How does median epicondylitis (Golfer’s elbow) present?

A

pain over the median (inner) aspect of the elbow with wrist flexion (lifting), pain with flexion of wrist against resistance

30
Q

How does septic arthritis present?

A

swollen joint, redness, fever, limited ROM (active and passive)

31
Q

What are the tests for hand motor function?

A

rock (median nerve) - paper (radial) - scissors (ulnar)

32
Q

What is carpal tunnel syndrome?

A

compression of the median nerve - numbness/pain in first 3 fingers (never 4th or 5th), + Tinel sign, + Phalen sign, atrophy of thenar prominence (pad on palm at base of thumb)

33
Q

What is Tinel’s sign?

A

tapping lightly over the course of the median nerve in the carpal tunnel => numbness/pain in median nerve distribution (1st 3 fingers) = + carpal tunnel

34
Q

What is Phalen’s sign?

A

ask PT to hold wrists in flexion (folded in and down) for 60 seconds => numbness/pain in median nerve distribution (1st 3 fingers) = + carpal tunnel

35
Q

What are the risk factors for carpal tunnel syndrome?

A

uncontrolled DM, uncontrolled hypothyroidism, poorly controlled RA, pregnancy

36
Q

What is the most accurate diagnostic test for carpal tunnel syndrome?

A

nerve conduction test

37
Q

What is the treatment for carpal tunnel syndrome?

A

wrist splint with wrist in neutral position, with slight extension

38
Q

What is De Quiervain’s tendinitis (washerwoman’s thumb)?

A

pain over the radial side of the hand exacerbated by thumb movements, + Finkelstein’s test

39
Q

What is Finkelstein’s test?

A

ask PT to grasp thumb against palm and move wrist toward midline in ulnar deviation => pain over thumb extensor = + De Queirvain’s tensosynovitis

40
Q

What is acute infectious tenosynovitis?

A

symmetric swelling of a digit (“sausage-like”) following a puncture wound, pain with passive extension and slightly flexed digit at rest => surgical emergency requiring IV Abx (can lead to adhesions/necrosis of all tendons in hand)

41
Q

What is a scaphoid fracture?

A

+ snuff box tenderness after fall on outstretched hand => assume scaphoid fracture with any snuff box tenderness (put into spica cast/thumb up and send to orthopedist) - x-rays will be negative initially

42
Q

How does ulnar nerve compression present?

A

pain and numbness over 4th and 5th digits, night symptoms, + Tinel’s sign, + Phalen’s sign, atrophy of hypothenar eminance

43
Q

What is trochanteric bursitis?

A

lateral hip pain worse with direct pressure, unaffected by weight bearing, no limitations in ROM, + trochanteric tenderness

44
Q

How does hip osteoarthritis present?

A

insidious onset of anterior hip/groin pain, worse with weight bearing, pain relieved by rest, + crepitus, + limited ROM

45
Q

What is avascular necrosis of the hip?

A

compromised vascular supply causes necrosis of proximal femur and bone collapse, anterior hip/groin pain worse with weight bearing, pain relieved by rest, + limited ROM => presents same as hip osteoarthritis - have to assess risk factors (chronic alcoholics, chronic steroid use, sickle cell disease) - requires surgery (most accurate Dx with MRI - perform x-ray first)

46
Q

How does lumbosacral radiculopathy present?

A

posterior hip/buttocks pain extending to knee, normal hip ROM, + straight leg test, + motor/sensory deficits, reduced reflexes => spinal cord terminates at L1 (below L1 is only spinal nerves) - lower back pain is not due to spinal cord compression

47
Q

How does a ligamentous knee injury (sprain) present?

A

history of trauma, “popping” sound in the knee, pain and swelling, laxity (no end point - joint lacks stability)

48
Q

What is McMurray’s test?

A

PT supine with knee flexed - stabilize knee and twist knee in rotational movement => pain and clicking = + test (meniscal tear)

49
Q

How does a meniscal tear present?

A

follows vigorous sport activity, lateral or medial knee pan exacerbated by twisting movements, knee “gives way” or locks, + McMurray test

50
Q

What are the tests for an ACL injury?

A

anterior drawer test and Lachman’s test

51
Q

What is the test for a PCL injury?

A

posterior drawer test

52
Q

What is Lachman’s test?

A

place knee in 15 degrees of flexion, stabilize femur, pull tibia forward to assess amount of anterior motion (intact ACL has a firm endpoint) => laxity/lack of endpoint = + (ACL tear)

53
Q

What is patellar bursitis?

A

anterior knee pain exacerbated by activity (repetitive knee flexion) - no history of injury, no limitation in passive ROM

54
Q

What is Osgood-Schlatter disease?

A

pain and swelling in the tibial tubercle exacerbated by activity and relieved by rest - common in young athletes who have undergone rapid growth spurt

55
Q

How does slipped capital femoral epiphysis (SCFE) present?

A

chronic or intermittent pain in the hip or knee exacerbated with activity, painful limp, no history of trauma, limited ROM, leg may be externally rotated - common in obese children 12-14 years old

56
Q

What is the treatment for SCFE?

A

avoid weight bearing until seen by orthopedist - 50% of time affects both hips (best x-ray view is lateral/frog leg) => only treatment is surgery

57
Q

How does an ankle sprain present?

A

pain, swelling, instability, maybe a popping sensation following acute inversion (sole turns in) or eversion (sole turns out) of ankle, laxity on stretch test and anterior drawer test => avulsion fracture likely with an inversion injury

58
Q

What are the Ottawa rules for ankle x-ray?

A

only perform an ankle x-ray if there is pain in the malleolar zone (ankle) and one of the following findings hold:
=> bone tenderness in posterior part of the lateral malleolus (distal fibula)
=> bone tenderness in posterior part of the medial malleolus (distal tibia)
=> inability to bear weight immediately and in ED

59
Q

What are the Ottawa rules for foot x-ray?

A

only perform a foot x-ray if there is pain in the mid-foot zone and one of the following findings hold:
=> bone tenderness at base of the 5th metatarsal (pinky toe)
=> bone tenderness on the top of the foot near the base of the ankle (navicular zone)
=> inability to bear weight immediately and in ED

60
Q

How does Achilles tendon tear present?

A

pain in the back of the ankle/popping sensation following forceful ankle dorsiflexion, + Thompson test

61
Q

What is Thompson’s test?

A

PT lies prone on table with foot extended off the edge, squeeze base of calf muscle => no flexion of foot = + test (Achilles tendon rupture)

62
Q

How does plantar fasciitis present?

A

chronic heel pain with first few steps in the morning or following periods of inactivity, pain improves with walking, common in runners and PTs with inappropriate footwear

63
Q

How does Morton neuroma present?

A

burning pain (“walking on pebbles”) in the ball of the foot/sole, numbness between 3rd and 4th toes, + squeeze metatarsal joints test - common in women who wear high heels with a narrow toe box

AGPC 4 (22 decks)

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