Musculoskeletal and Neuromuscular Pathologies and common Rx
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| Achilles Tendonitis: Etiology | Caused by repetitive overload of the Achilles tendon. Often associated with changes in training intensity.
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| Achilles Tendonitis: Signs and Symptoms | Aching, burning in posterior heel. Tenderness of AT. Pain with increased activity.
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| Achilles Tendonitis: Rx | Initial: RICE, NSAIDs PRN. Heel lift and cross training may be used to limit tensile loading through the tendon. Eccentric strengthening of gastrocnemius and soleus complex. Avoid sudden changes in intensity of training.
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| Adhesive Capsulitis: Etiology (frequency? onset? Duration? | insidious onset or may be related to a direct injury to the shoulder. Occurs most frequently with females between 40-60 years of age. Resolves in 1-2 years.
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| Adhesive Capsulitis: Signs and Sx | Insidious onset of localized pain. Often extends down arm. Pt reports stiffness, night pain, restricted ROM in a capsular pattern.
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| Adhesive Capsulitis: Rx (how does PT treat? What should PT avoid? What surgical options are available to treat?) | Increase ROM using GH mobs, ROM ex, palliative modalities. Therapist should avoid overstretching and increasing pain (to avoid further decreased ROM). Surgical options include suprascapular nerve block, closed manipulation under anesthesia.
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| ACL Sprain: Etiology (what other structures may be affected?) | Caused by non contact twisting injury associated with hyperextension, varus/valgus stress to the knee. Often involves injury to other knee structures (medial capsule, MCL, and menisci).
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| ACL Sprain: Signs and Sx (what does pt report? what special tests can ID presence of ACL sprain?) | Pt may report loud pop or feeling the knee "giving way" or "buckling". Special tests to identify ACL tear include anterior drawer test, Lachman test and lateral pivot shift test.
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| ACL Sprain: Rx | Initial: RICE, NSAIDs PRN. Conservative Rx: LE strengthening ex emphasizing Quads and hams. Surgery warranted if grade III.
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| Congenital Torticollis: Etiology | Cause is unknown. May be associated with malpositioning in utero (eg: breech baby) and birth trauma
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| Congenital Torticollis: Signs and Sx | Clinical presentation includes lateral cervical flexion same side as unilateral contracture of SCM. Rotation toward opposite side, and facial asymmetries may exist.
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| Congenital Torticollis: Rx | Rx conservative initially: stretching, AROM, positioning, and caregiver education. Surgical management is indicated when consrvative options fail (child is over 1 years of age).
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| Glenohumeral Instability: Etiology (what force stress what structure? What happens? What movements usually cause this?) | Combo of forces stress the anterior capsule GH ligament and rotator cuff causing the humerus to move anteriorly out of the GH fossa. Anterior dislocation is most common cause (shldr ABD + ER)
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| Glenohumeral Instability: Signs and Sx | SUBLUXATION: feeling the shoulder "popping" out and back into place, pain, paresthesias, capsular tenderness, swelling. DISLOCATION: severe pain, paresthesias, limited ROM, weakness, arm supported by other limb.
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| Glenohumeral Instability: Rx | Initial immobilization w/ sling for 3-6 weeks. RICE, NSAIDs prn. After immob: ROM & isometric strengthening, progressive resistive ex.
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| Impingement Syndrome: Etiology (what structures are involved? What movement causes it?) | Repetitive microtrauma from UE activity performed above horizontal plane. RTC attachments migrate proximally and become pinched on the undersurface of the acromion and coracoacromial ligament.
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| Glenohumeral Instability: Signs and Sx | Discomfort/mild deep pain w/in the shoulder. Pain w/ OH activities. Painful arc of motion (70-120 degrees of ABD). Positive impingement sign and tenderness over greater tuberosity and the bicipital groove.
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| Glenohumeral Instability: Rx | Initially: RICE, NSAIDs prn, activity modification. Once tolerated: RTC strengthening, scapular stability ex. LT prevention: continued strengthening of RTC and scapular stabilizers, improved biomechanics related to R2S or R2W activities.
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| JRA (Juvenile Rheumatoid Arthritis): Etiology | cause unknown. Theories include virus, infection or trauma may trigger autoimmune response producing JRA in a child w/ genetic predisposition.
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| JRA (Juvenile Rheumatoid Arthritis): What are the three classifications? | 1. Systemic- affects whole body; least common.
2. Polyarticular- arthritis in 4+ symm. joints.
3. Oligoarticular- < 5 asymmetrical joints
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| JRA (Juvenile Rheumatoid Arthritis): Rx | Drugs to relieve inflammation and pain: NSAIDs, corticosteroids, antirheumatics, and immunosuppressive agents. PT management: PROM, AROM, positioning, postural training, functional mobility, etc. Surgery may be necessary.
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| Lateral Epicondylitis: Etiology | Caused by eccentric loading of the wrist extensor m. (usually extensor carpi radialis brevis) causing microtrauma. Most common age: 30-50 years old.
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| MCL Sprain: Etiology | Noncontact fixed foot tibial rotational injury associated with valgus force and external tibia rotation. Activities this injury is often assoc: football, skiing, and soccer.
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| MCL Sprain: Signs and Sx | Knee pain, swelling, antalgic gain, decreased ROM, and feeling instability. Valgus stress test can be used to assess integrity of MCL.
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| MCL Sprain: Rx | initially: RICE, NSAIDs prn. Conservative Rx: decrease inflammation, protect knee jt and ligament. ROM, strengthening progressing as tol. Surgery is RARE since MCL is well vascularized.
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| Meniscus Tear: Etiology | usually associated w/ fixed foot rotation while weight bearing on a flexed knee. This action produces compression and rotational forces on the meniscus.
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| Meniscus Tear: Signs and Symptoms (and what special tests can confirm meniscus tear?) | Jt line pain, swelling, catching or locking sensation. Special tests: Apley's compression test, bounce home test, and McMurray test.
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| Meniscus Tear: Rx | Initial Rx: Rice, NSAIDs, prn. Conservative Rx: Palliative modalities and strengthening ex. Surgery ranging from a partial menisectomy to a meniscal repair for active people.
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| Meniscal Repairs are most commonly made on tears at what portion of the meniscus? | Tears located at the outer edges of the meniscus due to the increased vascularity at the lateral edges.
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| Osgood-Schlatter Disease: etiology | condition caused by repetitive tension to the patellar tendon over the tibial tuberosity. Usually occurs in young athletes.
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| Osgood-Schlatter Disease: Signs and Sx | Point tenderness over the patella tendon at the insertion on the tibial tubercle, Antalgic gait, pain with increasing activity.
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| Osgood-Schlatter Disease: Rx | Conservative: focuses on education, icing, flexibility ex, and eliminating activities that place strain on the patella tendon (squatting, running, jumping, etc).
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| Osteoarthritis: What is it? | Chronic disease that causes degeneration of articular cartilage in weight bearing joints. Thickening bone beneath the cartilage grows resulting in decreased function.
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| Osteoarthritis: Etiology | Cause is unknown. Affects middle age, and affects nearly all individuals by age 70 in some way.
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| Osteoarthritis: Signs and Sx | Gradual onset of pain at joint. Increased pain after exercise, with weather changes. Enlarged joints, crepitus, stiffness, limited joint ROM, nodes at joints.
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| Osteoarthritis: Rx | P/AROM, heating and cooling agents, patient education, strengthening ex, TENS units, energy conservation techniques, weight loss, etc.
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| Osteogenesis imperfecta: What is it? | Connective tissue disorder that affects the formation of collagen during bone development. AKA "brittle bone disease"
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| Osteogenesis imperfecta: Etiology | genetic inheritance (different types are dominant or recessive depending on the type of OI).
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| Osteogenesis imperfecta: Signs and Sx | pathological fractures, osteoporosis, hypermobile joints, bowing of the long bones, weakness, scoliosis, impaired respiratory function
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| Osteogenesis imperfecta: Rx | Rx begins at birth: caregiver education on proper handling/facilitation of movement. PT: AROM, symmetrical movements positioning, functional mobility, fracture mgmt, and orthotics.
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| Patellofemoral Syndrome: etiology | Repetitive overuse injury from increased force at the PF joint. Weak quads, decreased LE flexibility, Patellar instability, increased tibial torsion or femoral anteversion may increase incidence.
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| Patellofemoral Syndrome: Signs and Sx | Ant knee pain, pain w/ prolonged sitting, crepitus, pain when ascending and descending stairs
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| Patellofemoral Syndrome: Rx | Dependent on factors causing pain. Rx may include stretching, strengthening, Patellar mobs, taping, VMO specific strengthening, etc.
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| Plantar Fasciitis: Etiology | Assoc with cavus foot (flat foot) w/ excessive torsion and hyperpronation. Most common in patients aged 40-60 years old.
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| Plantar Fasciitis: Signs and Sx | tenderness at the insertion point of plantar fascia. Heel spur may be present. Pain worse in the morning or after long periods of inactivity. Difficult to stand long times and walk barefoot.
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| Plantar Fasciitis: Rx | A heel cup, massage using a tennis ball or rolling pin, medial longitudinal arch taping, jt mobs. Prevention: stretching, soft soled footwear, avoiding sudden changes of intensity of training programs.
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| PCL Sprains: Etiology | Landing on the tibia with a flexed knee or hitting a dashboard in an MVA. (Since the ligament prevents posterior displacement of the tibia in relation to the femur).
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| PCL Sprains: Signs and Sx | Pt may report feeling as if the femur is sliding off the tibia. Swelling and mild pain, often pt is asymptomatic.
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| PCL Sprains: Special tests? | Posterior drawer test
Posterior sag sign
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| PCL Sprains: Rx | LE strengthening ex and functional progression. Surgery may be necessary-- if surgery is performed, isolated hamstring ex are often avoided for 6 weeks.
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| RA: what is it? | System autoimmune disorder. Presents with chronic inflammatory reaction in synovial tissues of a joint that results in erosion of cartilage and supporting structures with in the capsule.
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| RA: Etiology | Unknown; 1-2% of American population is affected. Women > Men, between 40-60 years of age.
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| RA: Signs and Sx | Onset may be gradual or immediate. Symmetrical involvement, pain, tenderness, swelling, morning stiffness, warm joints, decreased appetite, malaise, increased fatigue, swan neck deformity (ie: DIP flexion, PIP hyperextension), low grade fever.
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| RA: Rx | Mostly pharmacological Rx: disease modifying antirheumatic medications slow the progression of joint destruction.
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| RTC Tear: What is it? How are they characterized? | RTC classified as
Partial-thickness: extends only partially through a portion of the tendon.
Full-Thickness: complete tear of the tendon.
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| RTC Tear: Etiology | Intrinsic factors assoc w/ RTC tears are impaired blood supply to the tendon resulting in degeneration. Extrinsic factors include trauma, repetitive microtrauma, and postural abnormalities.
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| RTC Tear: Signs and Sx | Arm positioned in IR + ADD, point tenderness at greater tubercle and acromion. Marked limitation in shoulder flexion and abduction with upper trapezius recruitment evident. Increased tone in anterior shoulder structures.
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| RTC Tear: Rx | Conservative Rx: RICE, NSAIDs prn. Primary focus of therapy is to prevent adhesive capsulitis and strengthen UE m. Surgery is likely.
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| Scoliosis: Etiology | Typically idiopathic. Most common Dx between 10- 13. Girls > boys.
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| Scoliosis: Signs and Sx | Shoulder level asymmetry w/ or w/o presence of a rib hump. Pain isn't typically assoc with spinal curvature (usually b/c of abnormal forces placed on other body structures).
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| Scoliosis: Rx | Curve progressing? strengthening, flexibility ex, shoe lifts, and bracing. Curve not progressing? No formal Rx necessary.
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| THA: Etiology | elective surgical procedure.
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| THA: Signs and Sx | Prior to surgery- severe pain w/ weight bearing, loss of mobility, gross instability or limitation in ROM, failure of non-operative management or a previous surgical procedure
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| THA: Rx | decrease inflammation, allow tissues to heal, emphasizing THA precautions. Minimize m. atrophy, and regaining full ROM.
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| TKA: Etiology | elective surgical procedure. Osteoarthritis and osteomyelitis are causes for TKA.
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| TKA: Signs and Sx | Prior to surgery there is severe pain with weight bearing, loss of mobility, gross instability or limitation in ROM, marked deformity of the knee, failure of non-operative management or a previous surgical procedure.
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| TKA: Rx | Gaining ROM: Knee flexion requires a min of 90 for ADLs, 105 for sit--> stand. Progressive strengthening, stretching and increased ROM.
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