MSK PATHOLOGIES - Inert Structures and Neurological (msk) conditions Flashcards by Gian Avila

Name 7 INERT STRUCTURE PATHOLOGY ?

Femoral Acetabular Impingement (FAI)
Ligament Injuries (Sprain)
Frozen shoulder (adhesive capsulitis)
Osteoarthritis (OA)
Meniscal Issues
Patellofemoral Pain Syndrome (PFPS)
Shoulder Instability

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What is Femoral Acetabular Impingement (FAI) ?

Its a pathological mechanical process by which morphological abnormalities of the acetabulum / femur combined with vigorous hip motion can damage the soft tissue structures within the hip.

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What are the 3 different types of Femoral acetabular Impingement ?

) CAM IMPINGEMENT
- The affected part is the femoral neck (below head)
) PINCER IMPINGEMENT
- Affected side is the outside of the Acetabulum
) COMBINED/MIXER
- both cam + pincer

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What are some possible cause of FAI ?

CAM morphology is more common in MEN
Repeated stress of supraphysiological Hip Rotation + Flexion (childhood/hockey)
SURGICAL OVER CORRECTION
History of childhood Hip Disease, followed by a femoral neck fracture.

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What is a Ligament Injury (Sprain) ?

and what is the ligament function ?

Its an Injury to the band of Collagen Fibres.

- the function id to provide stability of the joint.

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What causes a Ligament Injury ?

This occur when a joint is being forced suddenly outside its usual range of movement and the inelastic fibres are stretched through too great a range.

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What are the classification of SPRAINS ?

and what are some of it signs and symptoms ?

GRADE I (overstretch w/ micro tears)

No visible bruising
Localised Pain
Minimal Loss of function / muscle strength / ROM
No ligament Laxity

GRADE II ( partial tear / immediate onset of Inflammatory signs )

Bruising
Poorly localised pain
Impairment of function / muscle strength / Painful ROM
Unstable joint due to Ligament

GRADE III ( complete rupture / later symptoms may be less than Grade II )

Immediate acute pain / often w/ audible pop & crack
Cardinal signs
Inability to contract muscle ( separation may be evident )
Unstable Joint

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What are some non modifiable cause of ligament injuries ?

INTRINSIC JOINT ANATOMY
SEX & HORMONES
JOINT LAXITY

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What are some Modifiable cause of ligament injuries ?

NEUROMUSCULAR CONTROL ( strength proprioception )

- ENVIRONMENT ( sport specific / fatigue resistance )

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What is Frozen Shoulder (adhesive capsulitis) ?

Its an Inflammatory condition that causes FIBROSIS of Glenoid Humeral capsule with progressive stiffness and ROM restriction. ( External Rotation )

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Who is more likely to get frozen shoulder ?

Common in women (70%)
Age 35 - 65
Diabetic population

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What are the different phases of Frozen Shoulder ?

1.) ACUTE / FREEZING / PAINFUL PHASE = (PAINFUL/FREEZING)
- Gradual onset of shoulder pain at rest with sharp pain at extremes of motion
( lasting 2 - 9 months )

2.) ADHESIVE / FROZEN / STIFFENING PHASE = (DECREASED ROM)
- Pain starts to subside, progressive loss of GH motion in capsular pattern.
Pain is only apparent only at extremes of movement ( 4 - 12 months )

) RESOLUTION / THAWING PHASE = (RESOLUTION)
- Progressive Improvement in Functional ROM ( 5 - 24 months )

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What is Osteoarthritis (OA) ?

Its the most common chronic condition of the joints whereby the articular cartilage degenerates w/ fibrillation, fissures and full thickness loss of the joint surface.

It only affects the cartilage but involves the entire joint

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Name some OA risk factors.

AGE
FEMALE
OBESITY
ANATOMICAL FACTORS
MUSCLE WEAKNESS
JOINT INJURY

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What are some OA signs and symptoms ?

PAIN (weight bearing activities)
REDUCED ROM/AROM/PROM
SLIGHT SWELLING OVER THE JOINT

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How can you manage OA

Education & Self management
(non) / Pharmacological Management
Referral for Joint Surgery

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What is the cause of a Meniscal tear / issues ?

Its due to an excessive force applied to a normal meniscus
(normal force acting on a degenerative meniscus)

twisting motion during a semi-flexed limb
associated with Ligament Injuries

What are some Signs and symptoms of a Meniscal Tear / Issue ?

Pain in the knee joint
Swelling / Catching / Locking of the knee
Inability to fully EXTEND / BEND the knee
Difficulty with Weight Bearing

What are the 2 different kinds of Meniscal tears ?

) ACUTE TEARS
- Due to trauma / sports injury ( different types )
) DEGENERATIVE TEARS
- often occur in elderly people, often after a minimal trauma on the knee

Name the different kinds of meniscal tears.

LONGITUDINAL TEAR
HORIZONTAL TEAR
RADIAL TEAR
BUCKET HANDLE TEAR
FLAP TEAR
DEGENERATIVE TEAR

What is Patellofemoral Pain Syndrome (PFPS) ?

Its an umbrella term used for pain arising the Patellofemoral Joint.
- This can be a chronic condition.

What are some causes of Patellofemoral pain Syndrome ?

Overuse / Overload of PF joint
Anatomical / Biomechanical Abnormalities
Patella Orientation and alignment
Muscular weakness

What are some risk factor that can cause Patellofemoral pain Syndrome ?

KNEE HYPEREXTENSION
Valgus + Vera knee
Tightness in the ITB / HAMSTRING / GASTROCNEMIUS
Pronation and Supination can provoke PFPS
Increased Q-Angle

How do you manage Patellofemoral Pain Syndrome ?

Education
Open + Closed Chain Exercise
Quads / Ham / Glutes / Calf strengthening
Manual Therapy
Patellar Taping

What is Shoulder Instability ?

Its when the labrum and / or the ligament stretch or tear, the shoulder has a greater tendency to dislocate.

What are the different types of Shoulder Dislocation ?

1.) BANKHART LESIONS - Due to the amount of force, labrum is torn from the bone resulting in unstable shoulder. ( require surgery ) 2.) HILL SACHS LESIONS - Dent in the back of the humeral head which occurs during the dislocation as the humeral head impacts against the front glenoid. 3. ) SLAP TEAR - A tear at the top of the labrum. 4. ) BONY BANKHART - Fragment of bones breaks off.

How do you manage Shoulder Instability ?

1.) PHYSIOTHERAPY - Train the shoulder muscles to control the shoulder correctly and prevent further instability. 2. ) SURGERY (depends on the cause and findings) - ARTHROSCOPIC PROCEDURE ( keyhole surgery ) - OPEN SHOULDER Procedure (depends on the problem)

What is MYELOPATHY ?

Its the compression on the spinal cord in the central canal (Vertebral Foramen).

What causes Myelopathy ?

- Central stenosis - Central Disc Herniation - Trauma - Spondylolisthesis - Ligament Thickening - Age related changes ( Bony spurs / Osteophytes )

What are some signs and symptoms of Myelopathy ?

- GAIT DISTURBANCE (Ataxia = loss of coordination) - Changes in Fine motor skills and Co-ordination. - Possible neck & lower back pain. - HYPER-REFLEXIA (overactive / overresponsive ) - Bladder and Bowel Disturbances

What are some risk factors of Myelopathy ?

- Older age (degenerative changes) - Stenosis - RA & ANKYLOSING SPONDYLITIS (systemic autoimmune) - Trauma

What are some Myelopathy Management ?

Conservative / Surgical | Fusion / Stabilisation

What is Cauda Equina Syndrome (CES) ?

The compression on the collection of nerves at the bottom of the spinal cord. (HORSE TAIL )

What are some signs and symptoms of Cauda Equina Syndrome ?

- Retention of Urine (urology) - Loss of Anal tone - Sexual Dysfunction - Bilateral leg pain / numbness - SADDLE ANAESTHESIA ( reduced sensation )

What is a possible management for Cauda Equina Syndrome ?

Spinal Decompression.

What is RADICULOPATHY ?

Its a change in neurological function from nerve root compression, irritation or sensitivity. (the nerve root is where the intervertebral foramen comes out)

What are some common signs and symptoms of Radiculopathy ?

- (CERVICAL) = Arm symptoms - (LUMBAR) = Leg symptoms - Pain in Dermatomal Distributions - Sensory symptoms in Dermatomes ( Paraesthesia / Anaesthesia / Allodynia = pain & extremely sensitive to touch ) - Motor loss in the relevant Nerve root -Reflex Changes

What is Peripheral Nerve Entrapment / Irritation. ?

An area in the Peripheral nerves (not in the spine) in which the nerve becomes irritated or compressed by a bone or oedema.

What are some signs and symptoms of Peripheral Nerve Irritation ?

Its all depends on the level of irritation of compression and the type of nerves that is irritated. - CARPAL TUNNEL Median Nerve = Fingers 1&2 / Thumb / wrist - CUBITAL TUNNEL SYNDROME Ulnar Nerve = medial aspect of the elbow - PERONEAL NERVE Irritated with Fractures - GLUTEAL Sciatic Nerve = passes through the Piriformis - ELBOW Radial Nerve = Radial tunnel syndrome commonly mistaken as the Tennis Elbow.

What are some Peripheral Nerve Entrapment / Irritation Management ?

- PHYSIOTHERAPY ( non invasive ) - EDUCATION - Oral Medication - Splinting ( carpal tunnel syndrome ) - Steroid Injections - Surgery ( decompression / release )

What is the difference between DERMATOMES + MYOTOMES ?

DERMATOMES - Its a specific area of skin that is supplied by a specific nerve root level. MYOTOMES - Specific set of muscles that are supplied by a specific nerve root level.