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PCE - Neuromusculoskeletal > Ligament sprains/tears & Tendinopathies > Flashcards

Ligament sprains/tears & Tendinopathies Flashcards

1
Q

Ligament sprain grades

A

I: minor rupture  few fibers torn, stability maintained
II: partial rupture  increased laxity, NO gross instability
III: complete rupture  gross instability

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2
Q

Ligament sprain Ax

A
  • Stability testing - laxity + end feel

- Pain

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3
Q

Ligament sprain Rx

A

Acute: PRICE, structural support, offload area -> orthotics, braces
Repair:
- Stability w/ muscle strength (especially if chronic sprain)
- DTFM, modalities
- Progressive loading (strength/stretch)  linear movement
Remodelling
- DTFM
- Progressive loads + dynamic movement (multidirectional)
- Sport/function specific

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4
Q

Syndesmotic ankle sprain MOI

A
  • Planted foot + IR of leg (ER of talus in mortise)
  • Also hyper DF (splays mortise), inversion, PF
  • Falls, twisting, MVA (slamming foot onto brake pedal)
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5
Q

Syndesmotic ankle sprain ligaments affected:

A
  • AITFL, PITFL, Interosseous

- Possible tearing of other ligaments depending MOI

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6
Q

Syndesmotic ankle sprain S&S

A
  • Limited swelling, antalgic gait (pain with WB/push-off, short stance phase, toe walking to limit DF)
  • TOP @ injury site  AITFL, PTFL, anterior distal tib-fib area (length of tenderness indicates severity
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7
Q

Syndesmotic ankle sprain Dx

A
  • ER stress test (foot), squeeze test (proximal tib-fib), crossed-leg test, ant/post translation of fibula
  • squat test - DF reproduces pain, decreased with compression/stabilization of malleoli
  • heel thump test, one-legged hop test
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8
Q

Syndesmotic ankle sprain Rx

A

Phase 1 (0-2wks) - PROTECTION PHASE
- inflammation with PRICE, modalities for edema/ROM, immobilization (cast, boot, tape)
- Light ROM exercises (ankle pumps/circles/alphabets, toe curls, bike arcs)
- NWB with crutches
Phase 2 (2-4wks) - MANAGEMENT PHASE
- Regain normal mobility
- Inc. strength & fx (resistance bands in all 4 directions, aquatic therapy, low tension cycling)
- Joint mobs to restore DF
- PWB ambulation (must be pain free, can use heel lift), bilateral balance training
Phase 3 - MANAGEMENT
- inc. function
- unilateral balance & strength (stable to unstable surface, double to single heel raise)
Phase 4 - RETURN TO SPORT
- cutting, jumping, more aggressive strengthening, increase walking speed (w/o heel lift)

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9
Q

Syndesmotic ankle sprain recovery = ___x longer than regular ankle sprain

A

2x

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10
Q

What is tendon composed of

A
  • tenocytes

- ECM (Collagen, glycosaminoglycan)

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11
Q

Tenocytes crave ___

A

Mechanical load

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12
Q

What is the result of loading tendons

A

Increased collagen synthesis, Cellular proliferation, alignment
Too much = fiber disruption

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13
Q

What is tendinopathy/tendinosis

A

Chronic microtrauma leading to loss of collagen organization (lose alignment)

  • Presence of glycosaminoglucan, variable tenocyte density, increase vessels and nerves
  • NOT Tendinitis - No evidence of inflammation - NSAIDS dont work
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14
Q

Tendinopathy Rx

A

Proper loading/resting of tissue

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15
Q

Achilles tendinopathy Risk factors

A
  • Age, BMI, Diabetes, Male
  • Sport (running), training errors, footwear
  • Pronation, decrease DF, decrease LE strength, tight/weak calf mm
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16
Q

Achilles tendinopathy S&S

A
  • Thickened tendon, TOP
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17
Q

Achilles tendinopathy Rx

A
  • Nsaids if acute
  • Alter contributing factors- pronation, muscle imbalance, myofascial restrictions, core
  • Progressive ex program  ECCENTRIC LOADING NECESSARY
    • Only drop to neutral foot
    • Pain level <5/10
    • Don’t want pain next day or loss of function
  • Footwear w/ heel lift, orthotics/brace
  • Stretching, manual therapy
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18
Q

What is De Quervain’s tenosynovitis

A

Tendinosis or inflammation of the sheath surrounding the extensor pollicis brevis and abductor pollicis longus

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19
Q

Extensor pollicis brevis O, I, and function

A

O - Poster lower 1/3 of radius
I - Base of proximal thumb phalanx
F - Ext + abd thumb

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20
Q

Abductor pollici longus O, I, and function

A

O - Ulna, radius, interosseous membrane
I - Base of 1st Metacarpal
F - Abd thumb

21
Q

Who is most likely to get de quervains tenosynovitis

A

Women age 30-40 years who use the wrist repetitively

22
Q

What is the pathophysiology leading to de quervains tenosynovitis

A

Inflammation caused by constant friction -> microtrauma -> leads to scarring/fibrosis

23
Q

De quervains S&S

A

Pain (over anatomical snuffbox) worse with repetitive hand/wrist movement
Tendon thickening
Swelling
Decreased grip and/or pinch strength

24
Q

De Quervains Ax/Dx

A

Finkelstein test

- Tuck thumb in fist -> ulnar wrist deviation -> +ve if pain along distal radius

25
Q

De Quervains Rx

A
  • Acute: off load tissue, PRICE, risk factor education

- Corticosteroid injection (50% effective)

26
Q

Tennis elbow = medial or lateral elbow pain?

A

Lateral

27
Q

Tennis elbow must common in what age group?

A

35-55 years

28
Q

Tennis elbow is a tendinosis ___% of the time and a partial tear ___% of the time

A

80%

20%

29
Q

90% of cases of tennis elbow involve:

A

Extensor carpi radialis brevis

30
Q

10% of tennis elbow cases involve:

A

Common extensor tendon & origin of extensor carpi radialis longus

31
Q

EXT CARPI RADIALIS BREVIS O, I, F, N

A

O - Lateral epicondyle
I - Posterior base of 3rd metacarpal
F - Extension and radial dev of hand
N - Radial (deep branch)

32
Q

EXT CARPI RADIALIS LONGUS O, I, F, N

A

o - Lateral supracondylar ridge
I - 2nd metacarpal base (radial side)
F - Extension and radial dev of hand
N - Radial nerve

33
Q

Tennis elbow S&S

A

Worse with

  • Gripping
  • Repetitive reach/grasp
  • Repetitive overload (typing)
34
Q

Tennis elbow Ax

A

+ve is pain over lateral epicondyle

  • Maudsley’s Resist 3rd finger PIP extension (w/ elbow extended, shoulder at 90)
  • Cozen’s test Resist active wrist ext +radial dev (elbow at 90)
  • Passively pronate forearm, flex wrist + ext elbow

TOP common origin, trigger points in muscle belly
- NO nerve s&s - check with radial bias ULTT

35
Q

Tennis elbow DDs

A
  • Cspine referred (c5-7), shoulder referred, nerve entrapment
  • Bursitis, LCL sprain, proximal radioulnar joint affected
36
Q

Tennis elbow Rx

A

Acute
- PRICE - control pain & inflammation
- Modalities (US, TENS)
- Maintain muscle length/mobility (AROM @ elbow, wrist, hand)
- Offload tissue – tennis strap
- Education: avoid NSAIDs, posture, rest breaks
Repair
- Gentle stressing of collagen - DTFM + stretching
- Eccentric strength training
- Manual therapy as indicated
- Needling/Mulligans
Outcome measure
 Hand grip dynamometer

37
Q

Which structures are normally involved in rotator cuff tendinopathy

A

long head of biceps tendon & supraspinatus

38
Q

What are the 2 types of rotator cuff tendinopathy

A

1° impingement NARROWED SUBACROMIAL SPACE (older patient)
- Intrinsic factors: anatomical abnormalities, degenerative change
- Extrinsic factors: muscle imbalances, postural faults
2° impingement - INSTABILITY (patient <35)
- Microtrauma -> instability -> subluxation of humeral head -> impingement
• Overhead activities/sports -> microtrauma of stabilizers
• Ant capsule lax, Post capsule tight -> ant humeral head subluxation

39
Q

Rotator cuff tendinopathy S&S

A

Pain with overhead activity, repetitive shoulder motion, longstanding

40
Q

Rotator cuff Ax

A
  • Neers
  • Speeds
  • Empty can
41
Q

Rotator cuff Rx

A

o Correct biomechanical faults, muscle imbalances
o Modalities
o DTFM
o Manual therapy
o Education (training errors, position, self-management, stretches)

42
Q

Patellar tendinopathy is caused by…

A

Repetitive loading in extensor mechanism of knee

43
Q

What is another name for patellar tendinopathy

A

jumper’s knee

44
Q

Risk factors for patellar tendinopathy

A 
Male 
Jumping athletes 
Jump height 
Reduced DF 
Age 
BMI
45
Q

Patellar tendinopathy Rx

A
  • Slow heavy load (eccentric + concentric)
  • Scan to find muscle imbalances and faults
  • Knee may be in valgus position
46
Q

What is another name for gluteal tendinopathy

A

Greater trochanteric pain syndrome

47
Q

What is the key feature of myofascial pain syndrome

A

TOP – trigger point (focal irritation) found within a muscle

48
Q

What is the onset for myofascial

A

Sudden overload, over-stretching &/or repetitive strain, sustained mm activities

49
Q

Myofascial pain syndrom Rx

A
  • Dry needling, injections
  • Flexibility, ROM, mm length
  • Soft tissue massage
  • modalities, cryotherapy
  • manual therapy if poor joint mechanics

PCE - Neuromusculoskeletal (8 decks)

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