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Clinical Skills - MSK > MSK Pathologies > Flashcards

MSK Pathologies Flashcards

(128 cards)

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1
Q

What is the function of the rotator cuff?

A

Stabilises the humeral head in the glenoid fossa

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2
Q

What muscles make up the rotator cuff?

A

Subscapularis
Infraspinatus
Supraspinatus
Teres minor

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3
Q

What is the clinical presentation of tennis elbow?

A

Pain located around the lateral epicondyle of the elbow, usually radiating in line with the extensors

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4
Q

What movement aggravates tennis elbow?

A

Wrist / finger extension

Forearm supination

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5
Q

How can you manage tennis elbow?

A

Physiotherapy
Surgery
Corticosteroid injections

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6
Q

What physiotherapy techniques can you use to help tennis elbow?

A

Load management
Exercise
Brace /taping
Education

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7
Q

What is golfers elbow?

A

An overuse tendinopathy affecting the common origin of the flexors and Pronators

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8
Q

What is the clinical presentation of golfers elbow?

A

Pain on medial aspect of the elbow

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9
Q

What movements aggravate golfers elbow?

A

Wrist Flexion

Pronation

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10
Q

How can golfers elbow be managed?

A

Physiotherapy
NSAIDS
Surgery
Corticosteroid injections

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11
Q

What physiotherapy interventions can help treat golfers elbow?

A

Load therapy
Exercise
Education
Taping / bracing

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12
Q

What is De Quervains tenosynovitis?

A

Reactive thickening of the tendon sheath around EPB and APL

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13
Q

What causes De Quervains tenosynovitis?

A

Can occur spontaneously

Initiated by overuse of the thumb

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14
Q

What is the pathophysiology behind De Quervains tenosynovitis?

A

Swelling of the sheaths of EPB and APL leading to eventual thickening of the sheaths
Adhesions can develop between the tendon and the sheath which restricts normal tendon movement

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15
Q

What is the clinical presentation of De Quervains tenosynovitis?

A

Pain on the radial side of the wrist that can be referred to the thumb

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16
Q

What movements aggravate De Quervains tenosynovitis?

A

Reissued thumb extension / abduction

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17
Q

What physiotherapy interventions can help patients with De Quervains tenosynovitis?

A

Splinting
Load management
Education
Exercises

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18
Q

What is a strain?

A

A muscle or tendon injury, involving over contracting or lengthening a muscle causing test ring of collagen

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19
Q

How many grades of muscle strain are there

A

3

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20
Q

What is the management of strains?

A 
POLICE
Mobilisation 
Strength / loading
Proprioception 
Endurance training 
Surgery
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21
Q

What is a sprain?

A

A stretch or tearing of a ligament

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22
Q

What can cause a sprain?

A

A joint being suddenly forced outside its usual ROM, and the inelastic fibres are stretched too far

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23
Q

What interventions can help heal ligament sprains?

A 
POLICE 
Early mobilisation 
Early weight bearing 
Exercises 
Education 
Return to sport 
Surgery
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24
Q

What is carpal tunnel syndrome?

A

The median nerve is compressed, where it passes through the carpal tunnel

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25
What is the clinical presentation of of carpal tunnel syndrome?
Loss of sensation Weakness of median nerve innervated muscles Pain Intermittent nocturnal paraesthesia
26
How can a patient manage carpal tunnel syndrome?
``` Education Load management Night time splinting Exercise Surgery (severe cases) ```
27
What are avulsion injuries?
Where a capsule, ligament, tendon or muscle attachment site is pulled from a bone
28
What are the symptoms of an avulsion injury?
Pain Swelling Limited movement Instability / loss of function of a joint
29
What is a stress fracture?
A small crack or break in weight bearing bones due to overuse
30
What are the symptoms of a stress fracture?
Pain that gets worse during exercise
31
What is avascular necrosis?
When there is a loss of blood supply to the bone
32
What are the symptoms of avascular necrosis?
Stiffness Night pain Limp Pain in the groin, buttocks and front of thigh
33
What is hip dysplasia?
Where the hip socket doesn’t fully cover the femoral head, this may allow the hip to partially or fully dislocate
34
What are labral tears?
Part of the labrum separates or pulls away from the socket
35
What are the 2 types of hip impingement?
Cam-type FAI | Pincer-type FAI
36
What is a cam-type FAI?
Caused by an irregular osseous prominence of the proximal femoral neck or head-neck junction
37
What is a pincer-type FAI?
Result of excessive acetabular coverage of the femoral head
38
What are the symptoms for a hip impingement?
Sitting crossed leg is difficult or painful Difficulties putting him shoes and socks Unable to sit for a long period of time Limp Walking long distances are painful Lower back pain
39
What is greater trochanteric pain syndrome?
Tendinopathy of gluteus medius and/or minimus
40
Who are the typical GTPS patients?
Aged 40-60 Female Post menopausal Increased BMI
41
What are the 2 types of snapping hip syndrome?
Internal | External
42
What is internal snapping hip syndrome?
Caused by iliopsoas over iliopectineal eminence paralabral cysts
43
What is external snapping hip syndrome?
Caused by ITB snapping over greater trochanter or proximal hamstring tendon rolling over ischial tuberosity
44
What is an osteochondral defect?
Focal area of damage to a focal area of damage that involves both the cartilage and a piece of underlying bone
45
What is the synovial fluid intrusion theory in terms of subchondral cysts?
Articular surface defects and increased intra-articular pressure allow intrusion of synovial fluid into the bone, leading to the formation of cavities
46
What is the bone contusion theory in terms of subchondral cysts?
Non-communicating cysts arise from subchondral foci of bone necrosis that are the result of opposing articular surfaces coming into contact with each other
47
What tendons can have tendinopathies in the upper and lower limb?
``` Patella Achilles Tibialis posterior Tibialis anterior Peroneus Longus and Brevis Rotator cuff Lateral / medial epicondyalgia EBL/B ```
48
What are the structural changes with tendinopathys?
Alterations to tendon cell population Disorganisation of collagen Ground substance change Neovascularisation
49
What are some of the ways tendinopathys occur?
``` Training overload Previous injury Muscle weakness Lower limb biomechanics Footwear Training surface Tendon structure Increased BMI ```
50
What is frozen shoulder?
Formation of excessive scar tissues or adhesions across the glenohumeral joint leading to stiffness, pain and dysfunction
51
What can cause frozen shoulder?
Spontaneously | After trauma
52
What are some of the risk factors of frozen shoulder?
Age Trauma Coronary heart disease Hyperthyroidism
53
What are the 4 stages of frozen shoulder
1 - Primary complaint of shoulder pain, especially at night 2 - Patient begins to develop stiffness 3 - Profound global loss of ROM, pan at EOR 4 - persistent stiffness, minimal pain
54
What is the clinical presentation of a frozen shoulder?
Present first with pain Gradual loss of ROM Passive ROM with firm, painful end feel
55
How can frozen shoulder be managed?
Physiotherapy - early mobilisation Education Surgery - capsular release Corticosteroid injections
56
How can a clavicle fracture be managed?
Sling use Physiotherapy Surgical
57
What are the 3 types of distal humerus fracture?
Colles’ fracture Smith’s fracture Barton’s fracture
58
How can a proximal humerus fracture be managed?
Collar and cuff (2-3/52) Progressive active management Surgery
59
What is the management of a distal humerus fracture?
Splints Cast K-wires Physiotherapy after a period of immobilisation
60
What is the sign of a scaphoid fracture?
Pain over anatomical snuff box
61
What is the management of a scaphoid fracture?
Cast Surgery Physiotherapy after a period of immobilisation
62
What joints is osteoarthritis most common in?
Knees Hips Small joints of the hand
63
What is the management of osteoarthritis?
Physiotherapy Corticosteroid injections Surgery (joint replacement)
64
What is rheumatoid arthritis?
Systemic autoimmune disease characterised by inflammatory arthritis with extra-articular involvement
65
What are the risk factors of Rheumatoid arthritis?
Genetic factors Smoking Air pollution Obesity
66
What is the clinical presentation of rheumatoid arthritis?
``` Insidious onset over a period of months Joint stiffness in the morning Fatigue Deformity Pain Weakness ```
67
How can a patient manage rheumatoid arthritis?
Physiotherapy Pharmacological management Nutrition Symptom management
68
What position is the shoulder in for a anterior shoulder dislocation?
Abduction and external rotation
69
What causes a posterior shoulder dislocation?
Blow to the front of the shoulder
70
What is shoulder instability?
Disruption of the dynamic and static stabilisers of the GHJ leading to dislocation, subluxation and apprehension
71
What is the clinical presentation of Shoulder instability?
``` Clicking Pain Sub-acromial signs Rotator cuff signs Increased accessory motion ```
72
How can you manage shoulder instability?
Physiotherapy - education, motor control, strength training and Proprioception
73
What is dupuytren disease?
Nodular hypertrophy and contracture of the superficial palmar fascia
74
How does dupuytren disease begin?
Thickening of the skin, then Bands of fibrotic tissue form in the palmar area, eventually leading to affected fingers being pulled into flexion
75
What is the physiotherapy intervention for duputren disease?
Post operative Splinting Exercise - passive stretching, active exercises and function Education and advice
76
What are the environmental factors associated with dupuytren disease?
Alcohol intake Smoking Manual labour Low body weight / BMI
77
What are the mechanisms of injury for meniscus tears/lesions?
Involves Flexion and rotational forces under compression e.g. twisting
78
What are the classifications of meniscus injury?
``` Vertical longitudinal Vertical radial Horizontal Oblique Complex / degenerative ```
79
What other structures are commonly injured along with an ACL?
Meniscus tears Articular cartilage damag e MCL injury Bone bruising
80
What are PCL sprains or tears associated with?
Posterolateral corner injuries
81
What are the static stabilisers of the knee?
Superficial MCL Deep MCL or medial capsular ligament Posterior oblique ligament
82
What are the dynamic stabilisers of the knee?
Semimembranosus Quadriceps Pes anserinus
83
What are the lateral supporting structures?
Lateral collateral ligament ITB Popliteal Bicep femoris
84
What is apophysitis?
A normal development outgrown of a bone, which fuses later in adult development
85
Where can apophysitis found?
Where tendon and ligaments attach to bone
86
What are the lateral ankle ligaments?
Posterior talofibular ligament Anterior talofibular ligament Calcaneofibular ligament
87
What ligament is the most commonly injured?
Anterior talofibular ligament
88
What are the signs and symptoms of an ankle sprain?
``` Pain Tenderness Swelling Bruising Inability to bear weight ```
89
What is plantar fasciitis?
Pain affecting the heel that is worse in the morning and after weight-bearing all day
90
What is the test for plantar fasciitis?
Palpation with twisting motion to MCT will cause discomfort and pain
91
What are the risk factors for plantar fasciitis?
Flat foot High arch Obesity / underweight Reduced dorsiflexion
92
What is a metaphyseal fracture?
Fracture to the base of the 5th metatarsal
93
What deficiency does a metaphyseal fracture indicate?
Vitamin D
94
How long is the recovery from a metaphyseal fracture?
4-16 weeks depending on intervention
95
What is the presentation of posterior tibial tendon dysfunction / rupture?
Pain in posterior medial malleolus extending to the navicular, lowered medial longitudinal arch
96
What is the test for posterior tibial tendon dysfunction/ rupture?
Tiptoe single phase support
97
What is the treatment for posterior tibial tendon dysfunction/ rupture?
Rest Orthotics Rehab Surgery
98
What is the procedure for a total hip replacement?
Incision made postero-laterally to expose the joint Surgeon dislocates the hip Femoral head cut off, and a special tool used to bring down and reshape the acetabulum Acetabular cup placed into socket, then an insert / liner placed inside the cup The prosthetic femoral stem is placed into the shaft of the femur, and the prosthetic femoral head sits on top
99
What is a hemiarthroplasty?
Surgical procedure that involves replacing half of the hip (femoral head portion)
100
What is hip resurfacing?
Replaces the surfaces of the hip joint
101
How is a total knee replacement performed?
An incision made down the front of the knee to expose kneecap Kneecap is moved to the side to allow access to the knee joint Distal femur and proximal tibia are cut away The distal end of the femur is replaces with a curval metal prosthesis and the proximal tibia is replaced with a flat prosthesis Plastic spacer in between the 2 components
102
What is the post-op physiotherapy for a total knee and hip replacement?
``` FWB after surgery Start mobilising day 0 ROM / strength exercises Hip precautions sometimes followed for 6/52 Swelling & pain management ```
103
What does a total shoulder replacement aim to do?
Reduce pain | Restore mobility
104
What is a traditional total shoulder replacement?
``` GHJ accessed anteriorly Deltoid and pecs are separated to access the shoulder joint Arthritic areas removed Implants inserted Muscles repaired and reattached Incisions closes ```
105
What is a reverse shoulder replacement?
Shoulder accessed anteriorly Humerus prepared for a new socket and glenoid replaced for a ball shaped prosthesis Humeral stem inserted, humerus cup and glenospherre attached Movement of joint checked Muscles repaired Incision closed
106
What soft tissue is used for an ACL reconstruction?
Hamstring | Patella tendon
107
What is the outcome from using the hamstring for an ACL reconstruction?
Higher risk of hamstring injury post-op Smaller wound High strength of graft
108
What are the outcomes from using the patella tendon for an ACL reconstruction?
Increase of tendinopathy | Anterior knee pain
109
How is a rotator cuff repair performed?
Joint / tendon will be debribed, sometimes alongside a subacromial decompression Rotator cuff tendon will then be reattached to the bone using an anchor and sutures
110
What is the test to check is an Achilles’ tendon is ruptured?
Thompson test
111
How is an Achilles’ tendon repair performed?
Posterior incision made | Ruptured ends on Achilles stitched together
112
How long is the patient in a boot for after an Achilles’ tendon repair?
8-12/52 in plantarflexion
113
What is a discectomy/ decompression?
Surgery to reduced compression to the nerve and/or spinal cord
114
How do you perform a discectomy?
Removing disc material that is extruding into the foramen / spinal canal
115
How do you perform a decompression?
Includes removal of osteophytes, laminectomy, removal of thickened ligament, foraminotomy or facetectomy
116
What is the post-op physiotherapy for a discectomy / decompression?
Sitting often restricted to 30 minutes at a time for first 1-2/52 Gentle ROM and isometric exercises given initially Walking encouraged immediately post-op Strength and mobility exercises progressed from 4-6/52 post-op depending on symptoms
117
What is spinal fusion surgery?
Surgeon uses screws and rods to fix vertebrae in place
118
What physiotherapy is done after a spinal fusion?
Immediate post-op physio aimed at regaining mobility | Chest physio
119
What are open reduction internal fixations?
Surgery to fix broken bones that are displaced or unstable
120
What are the different types of internal fixation?
IM nails Plates Screws
121
What are external fixations?
Surgical treatment where the rods are screwed into the bone, and exit the body to be attached to a stabilising structure
122
What are external fixators used for?
Severe open fractures Infected non-unions Correction of malalignments Poly trauma
123
What are the 2 different types of arthritic conditions (not OA or RA)?
Inflammatory | Degenerative
124
What is hip osteoarthritis?
``` Loss of joint space Osteophyte formation Subchondral sclerosis Subchondral cysts Deformity ```
125
What are the risk factors for hip OA?
``` Joint mobility Muscle BMI Gender Age Race Pain perception Genomics ```
126
What are other causes of joint pain?
Malignancy or infection Inflammatory arthritis Metastatic Septic arthritis
127
What is the pathogenesis of BMLs?
Result of synovial fluid penetrating through defects within the articular cartilage and entering the subchondral bone leading to micro fracture and oedema
128
What are the clinical symptoms of knee OA?
``` Pain Inactivity stiffness lasting no longer than 30 mins Crepitus on moving the joint Bony tenderness Limitation of movement No palpable warmth Bony enlargement ```

Clinical Skills - MSK (2 decks)

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