W1 - MSK inert Structures Flashcards
What does FAI stand for
Femoral acetabulum impingement
What is an FAI
Pathological mechanical process where there is a morphological abnormality of the acetabulum or femur and vigorous hip motion that damages soft tissue structures around the hip
What are the 3 types of FAI
Cam lesion = abnormality to the anterior, lateral femoral head/neck (non-spherical head shape)
Pincer lesion = abnormality to the acetabulum causing an over coverage of the femoral head shape
Combined lesion = cam & pincer at the same time
What are the 3 main causes for a FAI
- Exposure to repetitive hip flexion & rotation during childhood development as a result of a high impact activity (sport). This triggers adaptive remodelling of the hip
- History of childhood hip disease following a femoral neck fracture as this alters the contour of the femoral head/neck
- Surgical over correction (hip dysplasia) can cause a pincer FAI
What is a type of ligament injury
Sprain
What is a sprain
Injury to the band of collagen tissue due to being suddenly forced outside its usual range of movement and the inelastic fibres are stretched through too greater range
What is the primary function of a ligament
Provide passive stabilisation of a joint
Plays an important role in proprioceptive function
What is a grade I ligament tear
Grade I = overstretched with micro-tears. Localised pain/tenderness. No visible bruising. Minimal swelling. Minimal loss of function. No loss of muscle strength & no ligament laxity
What is a grade II ligament tear
Partial tear with immediate onset of all inflammatory signs. Moderate swelling. Raising. Poorly localised pain. Impairment and painful ROM. Decrease in muscle strength and pain on contraction. Joint may be unstable
What is a grade III ligament tear
Complete rupture. I ability to contract the muscle. Separation may be evident. Immediate acute pain. Pop, crack or click sound. Cardinal signs. Later symptoms become less then a grade II and may require immobilisation or surgery
Non modifiable factors of a ligament injury
Intrinsic knee anatomy
Sex and hormones
Joint laxity
Modifiable factors that effect ligament injuries
Neruromuscular control = strength & Proprioception
Environment = sport specific skills, fatigue resistance
What is a frozen shoulder
Adhesive capulitis has initial pain and later progressively restricts active & passive glenihumeral joint ROME with spontaneous complete or nearly-complete recovery over a period of time
This inflammatory condition causes fibrosis of the GH joint capsule causing gradual stiffness & significant restricted ROM (external rotation)
What part of the shoulder does a frozen shoulder effect
Anterior, superior joint capsule
Axillary recess
Coracohumeral ligament
What causes frozen shoulder
Synovial inflammation followed by capsular fibrosis in which type 1 & 3 collagen is laid down with subsequent tissue contraction
Elevated levels of serum sytokines facilitate tissue repair & remodelling during the inflammatory process
An imbalance between aggressive fibrosis & loss of normal collagenous remodelling leads to the stiffness of the capsule and ligament structure
Who’s more likely to have a frozen shoulder
Females
35-65 year olds
Diabetics
People who have had a previous frozen shoulder
What are the 3 phases of a frozen shoulder
- Acute/freezing/painful phase
- Adhesive/frozen/stiffening phase
- Resolution/thawing phase
What happens in the acute/freezing/painful phase of a frozen shoulder
Gradual onset of shoulder pain at rest
Sharp pain at extremes of motions
Painful at night and interrupts sleep
Last 2-9 months
What happens in the adhesive/stiffening/ frozen phase of a frozen shoulder
Pain subsides
Progressive loss of GH motion in capsular pattern
Pain apparent only at extremes of motions Painful
Lasts 4-12 months
What happens in the resolution/thawing phase of a frozen shoulder
Spontaneous progressive improvement in ROM
can last between 5-24 months and
Can last up to 3 years (self limiting condition)
15% of people will also have long term disability and persistent pain
What is osteoarthritis
Chronic conditions which involves the break down of cartilage and eventually bone on bone rubbing
Risk factors of osteoarthritis
Age
Female gender
Obesity
Anatomical factors
Muscle weakness
Joint injury
What are the 2 types of OA
Primary = due to age
Secondary = specific trigger (previous injury)
Clinical signs and symptoms ton of OA
Pain = when weight bearing and doing activities
Reduced ROM
Slight swelling
Clicking/grindimg
What in a meniscal issue
Meniscal tears due to excessive force applied to a normal meniscus OR normal force applied to a degenerative meniscus
Commonly occurs in a twisting injury on a semi lexed limb through a weight bearing knee
What are the 2 types of meniscus tears
Acute = result of trauma or sporting injury. Can have different shapes (horizontal, vertical, radial, complex). Treated with surgery in conservative management in ineffective
Degenerative = common in elderly. Minimal trauma to the knee. Treated with physio and anti-inflammatories
What does PFPS stand for
Patellafemoral pain syndrome
What is PFPS
Umbrella term for pain in the patellofemoral joint or adjacent soft tissue
Can be acute or chronic that’s characterised by overload
Worsens with activity (squatting, sitting, climbing)
What causes PFPS
Combination of factors:
Overuse & overload of the joint
Anatomical or bio mechanical abnormalities
Muscular weakness
Imbalance or dysfunction
Main cause = patella orientation and alignment
How does patella orientation and alignment cause PFPS
Different orientations cause it to glide more to one side of the femur causing overuse/overload on that part of the femur causing pain, discomfort or irritation
What are the risk factors for PFPS
Knee hyperextension
Lateral tibial torsion
Genu Valgum of varus
Increased Q angle (women)
Tight iliotibial band, hamstring or gastrocnemius
Pronation or supination can provoke PFPS
How would you manage PFPS
Education
Open vs closed chain exercises
Quads, hamstrings, glutes and calf strengthening
Patellar taping
Orthotics
Modalities
Manual therapy
What causes shoulder instability
When the shoulder labrum and/or ligaments are stretched or teared leading to a greater chance of dislocations or subluxation (front, back or bottom)
What is a bankart lesion
When the labrum is torn from the bone and results in an unstable shoulder leading to further episodes of dislocation
How do you treat a bankart lesion
Surgical procedure called an anterior stabilisation
What does an ALPSA lesion stand for
Anterior labral periosteal sleeve avulsion
What is an ALPSA
Displaced bankart tear where the labrum has displaced around the glenoid neck
Associated with higher risk of recurrent instability then an undisplaced bankart tear where
What is a HAGL tear
Humeral avulsion of glenohumeral ligament
What is a bony bankartt
Fragments of bone break off with a bankart tear where
What is a hill sachs lesion
Dent in the back of the humeral head that occurs during dislocation as the humeral head impacts against the front of the glenoid
What is a slap tear
A tear at the bottom of the labrum
