Chapter 4 Musculoskeletal System

Front 1

Achilles Tendonitis

Back 1

a repetitive overuse disorder resulting in microscopic tears of collagen fibers

S/S: aching/burning in posterior heel, tenderness along tendon, pain with increased activity, swelling in area, morning stiffness

Tx: initially RICE, NSAIDs, stretching, eccentric strengthening of gastrocs/soleus

Front 2

Adhesive Capsulitis

Back 2

loss of ROM due to soft tissue contracture

S/S: insidious onset with pain down the arm, stiffness, night pain

Tx: focus is to increase ROM, avoid over stretching, surgery for nerve block or manipulation

Front 3

ACL Sprain

Back 3

prevents anterior displacement of the tibia in relation to the femur

S/S: loud pop, knee feels like it't buckling, dizziness, sweating and swelling. testing: anterior drawer test, Lachman test, lateral pivot shift test

Tx: Initially RICE, NSAIDs, LE strengthening (quads/hamstrings), surgery for grade III

Front 4

Congenital Torticollis

Back 4

aka wry neck, unilateral contracture of the SCM muscle, usually in first 2 months of life

S/S: lateral cervical flexion to the same side of the contracture, rotation toward opposite side, facial asymmetries.

Tx: stretching, AROM, positioning, caregiver edu, surgery when everything else has failed,

Front 5

Glenohumeral Instability

Back 5

subluxation and dislocation

S/S: subluxation: feeling the shoulder popping out, pain, paresthesias and arm feeling dead. Dislocation: severe pain, limited ROM, weakness, arm supported by other arm

Tx: immobilization with sling (3-6wks), RICE, NSAIDs, ROM, isometric strengthening

Front 6

Impingement Syndrome

Back 6

caused by repetitive microtrauma, with above head activities

S/S: mild pain deep in shoulder, pain with overhead activities, tenderness over bicipital groove and greater tuberosity.

Tx: Initially RICE/NSAIDs, rotator cuff strengthening, scapular stability exercises, biomechanics

Front 7

Juvenile Rheumatoid Arthritis

Back 7

inflammation of joints and connective tissues

S/S: acute onset, high fevers, rash, enlarged spleen/liver,

Tx: NSAIDs, corticosteroids, antiheumatics, immunosuppresants. PT: PROM/AROM, positioning, splinting, strengthening/endurance, functional mobility, paraffin, warm water and cryotherapy

Front 8

Lateral Epicondylitis

Back 8

inflammation of extensor muscles origin at lateral epicondyle.

S/S: pain worsens with repetition and resisted wrist extension

Tx: initially RICE/NSAIDs, activity modification, strength/flexibility of wrist extensors

Front 9

MCL Sprain

Back 9

S/S: knee pain, swelling, antalgic gait, decreased ROM, instability

Tx: initially RICE/NSAIDs, decrease inflammation, ROM, strengthening

Front 10

Meniscus Tear

Back 10

S/S: joint line pain, swelling, catching/locking sensation, tests: apley's compression test, bounce home test and McMurray Test

Tx: Initially RICE/NSAIDs, strengthening, surgery

Front 11

Osgood-Schlatter Disease

Back 11

self-limiting condition that results from repetitive traction on tibial tuberosity apophysis

S/S: point tenderness over patella tendon, antalgic gait, pain with activity

Tx: education, icing, flexibility exercises, eliminate squatting running or jumping activities

Front 12

Osteoarthritis

Back 12

chronic disease that causes degeneration of articular cartilage, in WB joints

S/S: gradual onset of pain, enlarged joints, stiffness, limited ROM

Tx: reduce pain, promote joint function
Meds- acetaminophen, NSAIDs, corticosteroids
PT: PROM/AROM, heating/cooling agents, pt edu, strengthening ex, body mechanics etc.

Front 13

Patellofemoral Syndrome

Back 13

pain/discomfort in anterior knee

S/S: anterior knee pain, swelling, crepitus, pain with going up and down stairs.

Tx: decrease inflammation/pain, patella glides, biofeedback and LE strengthening (quads)

Front 14

Plantar Fasciitis

Back 14

inflammation of plantar fascia at the insertion

S/S: tenderness, heel spurs, pain worse in the morning, pain when walking with bare feet

Tx: Initially RICE/NSAIDs, massage using tennis ball, joint mobs, stretching, correct footwear, orthotics

Front 15

PCL Sprain

Back 15

PCL posterior displacement of tibia in relation to the femur

S/S: feeling of femur sliding off tibia, swelling/mild pain, but pt is often asymptomatic. tests: posterior drawer test, posterior sag sign

Tx: Initially RICE/NSAIDs, LE strengthening

Front 16

Rheumatoid Arthritis

Back 16

A systemic autoimmune disorder, erosion of cartilage, mostly in joints of the hand, foot, wrist and ankle

S/S: symmetrical, pain and tenderness, warm joints, malaise, increased fatigue, low grade fever

Tx: reduce inflammation/pain, promote joint function, NSAIDS, corticosteroids, PT: PROM/AROM, splinting, pt edu, energy conservation, body mechanics.

Front 17

Rotator Cuff Tear

Back 17

can either be partial thickness or full thickness

S/S: point tenderness at greater tubercle and acromion, limited shoulder flexion and abd,

Tx: RICE/NSAIDs, strengthen UE, surgery - immobilization after - PROM, isometrics, moving to functional exercises per protocol.

Front 18

Scoliosis

Back 18

curvature of the spine, more common in girls

S/S: shoulder level asymmetry, pain due to abnormal forces placed on other tissues of the body

Tx: muscle strengthening and flexibility exercises, shoe lifts and bracing, surgery - 40 degrees or more of a curvature

Front 19

Total Hip Arthroplasty

Back 19

removal of hip and replaced with implant

S/S: prior to surgery: pain with WB, loss of mobility, instability, limited ROM

Tx: decreases inflammation, hip precautions, PROM, ankle pumps, quad/glute sets, AD training, progress to walking, work on independence

Precautions: hip flexion beyond 90, adduction, hip internal rotation.

Front 20

Total Knee Arthroplasty

Back 20

removal of knee and replaced with implant

S/S: Prior to surgery - severe pain with WB, loss of mobility, limited ROM, deformity of knee

Tx: healing/decrease inflammation, PROM, Knee flex 90 for ADLs and 105 to rise from sitting, ankle pumps, quad/glute sets, AROM, CPM, AD training, ambulation, strengthening, endurance