Musculoskeletal CAT

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BPT
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192769
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Musculoskeletal CAT
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2013-01-14 13:05:57
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Musculoskeletal CAT
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  1. Achilles Tendon Rupture
    • rupture 1-2 inches above tendon insertion on calcaneus
    • degenerative changes, impaired bloodflow, repetitive microtrauma
    • push off through WBing extremity, unexpected DF, forceful eccentric contraction
    • 30-50 yo, weekend warriors
    • positive Thompson Test, palpable defect, swelling, pain and weakness with PF, x-ray can rule out avulsion fractures
    • serial casting for ~ 10 weeks with heel lift
    • ROM, stretching, icing AD, gait training strengthening
    • previous level of function within 6-7 months
  2. Adhesive Capsulitis
    • inflammation and fibrotic thickening of anterior joint capsule of shoulder
    • primary (spontaneously occurring), secondary (underlying condition)
    • middle age females, DM, hypothyroidism, immobilization, reflex sympathetic dystrophy
    • restricted AROM and PROM, ROM initially restricted by pain, then ROM restricted by capsular stiffness (ER, abduction, IR)
    • NSAIDs, corticosteroids, heat/ice, joint mobs, strengthening
    • spontaneous recovery 1-2 years
  3. ACL sprain
    • ACL extends from anterior intracondylar region of the tibia to medial aspect of the lateral femoral condyle in the intracondylar notch
    • injury from: hyperflexion, rapid deceleration, hyperextension or landing unbalanced
    • risk factors: muscle strength, joint laxity, Q angle, narrow intercondylar notch
    • unhappy triad: ACL, MCL, medial meniscus
    • patellar tendon most common graft
    • improve ROM, control edema, pain modulation, then start with closed chain activities
  4. Bicipital Tendonitis
    • inflammatory process of long head of bicep in the bicipital groove
    • repititive overhead motion damage the cells and don't give time for the tendon to heal
    • MRI can detect it  but usually not done unless not responded to conservative treatment
    • deep ache directly on top and in front of shoulder
    • Speeds and Yeargesons' test
    • goal: relieve pain, reduce inflammation (ionto, phono), regain full ROM, strengthen affected muscule groups
    • average of 6-8 weeks of therapy
  5. Carpal Tunnel
    • carpal tunnel: transverse carpal ligament, scaphoid tuberosity, trapezium, hook of hamate & pisiform, volar radiocarpal ligament
    • entraps:median nerve, 4 flexor digitorum profundus tendons, 4 flexor digitorum superficialis tendons, flexor pollicis longus tendon
    • edema, inflammation, fibrosis cause compression
    • repetitive use, RA, pregnancy, diabtetes, trauma, tumor, hypothyroidism, 35-55, women
    • night pain, weakness, thenar muscle atrophy (abductor pollicis brevis), decreased grip strength, clumsiness, decreased wrist mobility
    • Tinel's sign, phalens test, EMG
    • corticosteroid injections, splinting, carpal mobilization, gentle stretching
    • decrease in symptoms generally in 4-6 weeks
  6. Tunnel of Guyon Compression
    • inflammation of ulnar nerve, between hook of the hamate and pisiform
    • parathesis along ulnar distribution, atrophy of hypothenar musculature
  7. Congenital Torticollis
    • unilateral contraction of SCM- ipsi SB contra rotation
    • usually treated for 12-24 before considering surgery
    • stretching program and proper handling
    • 85-90% respond to conservative treatment
  8. Duchenne Muscular Dystrophy
    • progressive neuromuscular degenerative disorder
    • fat and connective tissue replace muscle
    • X-linked recessive, only males affected
    • waddling gait, proximal muscle weakness, clumsiness, toe walking, excessive lordosis, pseudohypertrophy of calf, gowers sign
    • EMG to examine nerve activity within muscles
    • maintain function of unaffected musculature for as long as possible
    • death usually by teens or young 20s
  9. Lateral Epicondylitis
    • repeated overuse of wrist extensors, especially extensor carpi radialis brevis, but also include extensor carpi radialis longus, extensor digitorum, extensor carpi ulnaris
    • 30-40's, men, backhand in tennis
    • pain along lateral aspect of elbow, sometimes into dorsum of hand, pain increases with wrist flexion and elbow extension or resisted extension and radial deviation
    • Cozens, Mills, lateral epicondylitis (middle finger)
    • protect, rest, ice, compression, elevation, NSAIDs, resting splints, stretching and strengthening- as pt progresses introduce resistive, isokinetic, and sport specific exercises
  10. MCL Sprain
    • connects medial epicondyle of femur to medial tibia, resisting medial directed force
    • direct blow to lateral surface of knee- contact activities
    • inability to fully extend and flex knee, pain along medial aspect of knee, possible strength decrease, slight ot moderate swelling
    • valgus stress test in full extension and 30' flexion
    • unhappy triad: ACL, MCL, medial meniscus
    • RICE
    • grade II should return to previous level of function within 4-8 weeks
  11. Osteoarthritis
    • degenerative, chronic disorder resulting in biochemical breakdown of articular cartilage in synovial joints
    • primary OA (aging process), secondary OA (younger individuals)
    • generally in DIP, PIPs, thumbs, knees, hips, spine, morning stiffness, deep and aching jt pain exacerbated by prolong activity and use
    • can be seen on X-ray
    • NSAIDs, acetaminophen or glucocorticoid intra-articular injections
  12. Osteogenesis Imperfecta
    • affects all connective tissue's collagen-producing genes in the body so all bones and all forms of connective tissue are compromised
    • four different types: type 1 is the mildest 1/2 are community ambulators, Type 2 is the worst, type III 1/4 are household ambulators, type IV are1/4 community ambulators
    • improve optimal bone mass and muscle strength to prevent fractures and deformities, parent handling and positioning techniques
    • strong predictor of a child's ability to ambulate is their ability to sit by 10 months
    • skin biopsy will determine type of OI, x-rays and bone scans can show old fractures
  13. Patellofemoral Syndrome
    • abnormal tracking of the patella between the femoral condyles causing damage to articular cartilage
    • gradual onset of anterior knee pain, exacerbated by compressive forces (stairs, jumping) and prolonged static positioning
    • Imaging not commonly used, but X-ray to rule out other conditions
    • Clark's sign (hold down patella and contract quads- inability or pain)
    • control edema, stretching strengthening (HS, ITB, TFL, rec fem), improve ROM, activity modification
    • previous function within 4-6 weeks
  14. Plantar Fasciitis
    • inflammation of tough connective tissue supporting arch of foot
    • chronic overuse from repetitive stretching from excessive pronation
    • due to same origin on medial tubercle of calcaneus- abductor hallucis, flexor digitorum brevis, and quadratus plantae may also become inflamed and irritated
    • severe pain first standing up in the morning, can radiate proximally or distally, increased with prolonged activity, or when resumes Wbing position after being non WBing, tighteness of achilles tendon
    • EMG to rule out nerve root entrapment
    • corticosteroid injections, non WBing endurance activities, stretching program of Achilles, ongoing strengthening
    • total resolution of symptoms may be up to 12 months, often reoccurs
  15. Tarsal Tunnel Syndome
    • tibial nerve passes between the medial malleolus and calcaneus
    • pain experienced with WBing but not direct palpation
    • numbness, buring pain, tingling, parasthesia
  16. Rotator Cuff Tendonitis
    • repetitive overhead activities causes impingement from weak supraspinatus unable to adequately depress HH in the glenoid fossa during elevation so humerus translates superiorly
    • supraspinatus most commonly affected
    • 25-40 years old
    • difficulty with overhead activities, presence of painful arc (60-120 degrees), pain increases at night
    • MRI can be used to show tendonitis but rarely used due to cost
    • empty can, Neer, Hawkins Kennedy
    • acute therapy: cryotherapy, activity modification, ROM, rest then strengthening
    • prior level of function after 4-6 weeks of treatment
    • for full rotator cuff tear, can take upwards of 6 months
  17. Scoliosis
    • lateral curvature of the spine
    • 12-14 year old, typically rotation occurs toward the side of convexity
    • non-structural scoliosis is a REVERSIBLE curve caused from poor posture, leg length, etc
    • structural scolisosis is NOT reversable due to congenital, musculoskeletal, neuromuscular reasons (CP, muscular dystrophy, congenital defect)
    • X rays taken from anterior and lateral view standing up and bending over
    • <25' should be monitored, 25-40 can have spinal orthosis, >40 probably need surgery.
    • at skeletal maturity if curve is >50 will most likely continue to progress
  18. Spondylolisthesis
    • forward slippage of one vertebral body with respect to the vertebral body below
    • spondylolysis is a defect in the pars interarticularis
    • pain is the most common symptoms, palpable step off, HS tightness, lumbar spasm, trunk shortening, gait abnormalities
    • most common for degenerative spondylolisthesis is L4-L5
    • X rays with lateral & anteroposterior view, or an oblique view to view scottie dog with collar for spondylolysis
    • activity modification, patient education, bracing, therapeutic stretching, want exercises to reduce stress with spinal extension, possible bracing
  19. Temporomandibular Joint Dysfunction
    • complex joint- condylar, hinge, synovial
    • inflammation and muscle spasm surrounding the joint produces symptoms
    • 20-40 year olds, women
    • clicking or popping with motion at TMJ, pain, muscle spasm, limited/abnormal jaw motion, HA, tinnitus
    • NSAIDs, muscle relaxants, avoid teeth grinding, posture retraining, moist heat, US, estim, joint mob, ROM
  20. Myofascial pain dysfunction syndrome
    • nonarticular disorder that affects area surrounding the TMJ
    • grinding and jaw clenching increase tension in muscles of mastication and create spasm
    • can mimic TMD, but differential diagnosis will rule out TMJ involvement
  21. Osteosarcoma
    • primary bone tumor- accounts for 15-20% bone tumors, highly malignant
    • usually affects bones with an active growth phase and located in the metaphysis
    • primary or secondary cancers, young children, most often in long bones
    • risk factors for secondary: pagets, osteoblastoma, giant cell tumor, chronic osteomyelitis
    • survival rate is 70-80% 5 year cure rate
  22. Ewing's Sarcoma
    • malignant nonosteogenic primary bone tumor that infiltrates the bone marrow
    • usually affects people under 20 yo
    • extremely malignant with high frequency of metastasis
    • requires aggressive treatment- amputation and chemo
    • 5 year survival rate 70%
  23. Amputation from Arteriosclerosis Obliterans
    • PVD that produces thickening, hardening and narrowing/occlusion of arteries
    • results in ischemia, ulceration and may become necrotic, gangrenous and require amputation
    • risk factors: age, DM, male, HTN, high serum cholesterol and LDL, smoking, impaired glucose tolerance, obesity, sedentary
    • doppler, MRI, arteriography can examine degree of blood flow
  24. Glenohumeral dislocation
    • excessive translation of HH on glenoid during active rotation
    • 85% of dislocations detach the glenoid labrum (Bankart lesion)
    • anterior dislocation most common from shoulder abduction and lateral rotation
    • subluxation (laxity) vs. dislocation (visible shoulder fullness, popped out)
  25. Medial Epicondylitis
    • repeated microtrauma to the flexor carpi radialis and/or humeral head of pronator teres
    • pain with resisted wrist flexion and resisted pronation, point tenderness over medial epicondyle
    • don't want to immobilize, but counter force bracing may be good
  26. Meniscus Tear
    • Medial and lateral mensci are attached to proximal surface of tibia
    • medial more common than lateral
    • MRI can be used to diagnose
    • occurs fom fixed foot rotation while WBing on a flexed knee
    • joint line pain, swelling, catching, or locking sensation
    • meniscal repairs generally performed on out edges due to increased vascularity (red/red zone)
    • Apleys (prone), bounce home (flexion then passive extension), McMurrys (supine)
  27. Osgood Schlatter Disease
    • repetitive traction on tibial tuberosity apophysis
    • young athletes
    • point tenderness over the patellat at tibial tubercle, antalgic gait, pain with increasing activity
    • icing, flexibility exercises, eliminate activities that put strain on patella tendon (squatting, running, jumping)
  28. PCL Sprain
    • runs from posterior intercondylar area of tibia to lateral aspect of medial femoral condyle
    • landing on tibia with a flexed knee or hitting a dashboard with flexed knee
    • isolated PCL tears, not common
    • swelling and mild pain may be present, but often asymptomatic, knee extension often limited from effusion
    • posterior sag test, posterior drawer
    • if have surgery: avoid isolated HS exercises for minimum of 6 weeks
  29. Osteomyelitis
    • inflammatory response within bone caused by an infection
    • common in kids and immunosuppressed adults
    • surgery may be indicated if infection spreads
    • medical treatment consists of antibiotics
  30. Osteochondritis Dissecans
    • separation of articular cartilage from underlying bone
    • usually involves medial femoral condyle
    • surgery required if fracture is displaced
    • plain X-ray or CT scan can show it
  31. Bursitis
    • inflammation of bursa secondary to overuse, trauma, gout, infection
    • PROM/AROM limited due to pain, not in capsular pattern
    • flexibility exercises to maintain ROM, soft tissue massage/mobs, heat/ice/hydrotherapy for pain reduction
  32. Complex Regional Pain Syndrome
    • reflex sympathetic dystrophy
    • related to trauma- results in dysfunction of SNS including pain, circulation and vasomotor disturbances
  33. Ulnar Collateral Ligament Sprain
    repetitive valgus stresses to medial elbow with overhead throwing
  34. DeQuervains Tenosynovitis
    • inflammation of extensor pollicis brevis and abductor pollicis longus at first dorsal compartment
    • repetitive microtrauma
    • imaging not necessary but could do MRI
    • pain at snuff box, swelling, decreased grip and pinch strength, positive finkelsteins
  35. Colles Fracturs
    • most common wrist fractures resulting from FOOSH
    • immobilized 5-8 weeks
    • complication of median nerve compression can occur
    • dinner fork deformity- dorsal or posterior displacement of distal fragment of radius
    • loss of motion, decreased grip strength, CRPS, carpal tunnel
    • smiths fracturs is similar to colles but distal fragment of radius dislocates in volar direction- garden spade deformity
  36. Piriformis Syndrom
    • external rotator of hip that can be overworked with excessive foot pronation causing abnormal IR of hip
    • can result in compression of sciatic nerve
    • restriction in IR, pain with palpation of piriformis muscle, referral of pain to posterior thigh, weakness in ER- positive piriformis test, uneven sacral base
    • rule out invovlement of lumbar spine and SI joint
    • reduce pain, joint oscillations, correction of muscle imbalances, flexibility exercises
  37. Anterior Compartment Syndrome
    • increased compartmental pressure resulting in local ischemic condition
    • caused by direct trauma, fracture, overuse, muscle hypertrophy
    • acute- swelling within compartment- medical emergency requiring fasciotomy
    • chronic- deep, cramping feeling

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