Clinical Application (Gold)

Achilles Tendon Rupture

Typically occurs within one to two inches above the tendinous insertion on the calcaneus

incidence is greatest between 30-50 years of age without history of calf or heel pain

patients with an achilles tendon rupture will typically be unable to stand on their toes and tend to exhibit a positive thompson test

Adhesive Capsulitis

occurs more in a middle-aged population with females having a greater incidence than males

arthrogram can assist with diagnosis by detecting decreased volume of fluid within the joint capsule

range of motion restriction typically in a capsular pattern (lateral rotation, abduction, medial rotation)

Ankle Sprain - lateral - grade II

typically occurs due to significant inversion and involves the lateral ligament complex, most common = ATFL

will likely present with significant pain or tenderness along the lateral aspect of the ankle especially at the ATFL

should hel fairly quickly if no other structures are involved and will return to the previous functional level within two to six weeks

anterior cruciate ligament sprain - grade III

injury most commonly occurs during hyperflexion, rapid deceleration, hyperextension or landing in an unbalanced position

females involved in selected athletic activities have significantly higher ligament injury rates compared to males

approximately two-thirds of complete ACL tears have an associated meniscal tear

bicipital tendonitis

increased incidence of injury is associated with selected athletic activities such as baseball pitching, swimming, rowing, gymnastics and tennis

characterized by subjective reports of a deep ache directly in front and on top of the shoulder made worse with overhead activities or lifting

examination may reveal a positive speed’s test or yergason’s test

Lateral epicondylitis

characterized by inflammation or degenerative changes at the common extensor tendon that attaches to the lateral epicondyle of the elbow

repeated overuse of the wrist extensors, particularly the ECRB, which can produced tensile stress and result in microscopic tearing and damage to the extensor tendon

clinical symptoms include difficulty holding or gripping objects, and insufficient forearm functional strength

medial collateral ligament sprain - grade II

grade 2 injury is characterized by partial tearing of the ligament’s fibers resulting in joint laxity when the ligament is stretched

mechanism of inury is usually a blow to the outside of the knee joint causing excess force to the medial side of the joint

return to previous functional level should occur within 4-8 weeks following the injury if no other associated structures are involved

osteoarthritis

degenerative process primarily involved articular cartilage resulting from excessive loading of a healthy joint or normal loading of an abnormal joint

prevalence is higher among women than men with the large majority of individuals older than 65.

osteogenesis imperfecta

classified into 4 types with a wide range of clinical presentations ranging from normal appearance with mild symptoms to severe involvement that can be fatal during infancy

bone densitometry may be used to measure bone mass and estimate the risk of fx for specific sites within the body.

child with OI often have delayed developmental milestones secondary to ongoing fractures with immobilization, hypermobility of joints and poorly developed muscles

patellofemoral syndrome

causes damage to the articular cartilage of the patella ranging from softening to complete cartilage destruction resulting in exposure of subchondral bone

etiology is unknown however it is extremely common during adolescence, is more prevalent in females than males and has a direct association with activity level.

management including controlling edema, stretching, strengthening, improving ROM, and activity modification

plantar fasciitis

chronic overuse condition that develops secondary to repetitive stretching of the plantar fascia through excessive foot pronation during the loading phase of gait

characterized by severe pain in the heel when first standing up in the morning

intervention consists of ice massage, deep friction massage, heel insert, orthotic prescription, activity modification, and gentle stretching program of the achilles tendon and plantar fascia

rotator cuff tear

may occur as a result of an acute traumatic incident or due to a chronic degenerative pathology such as chronic supraspinatus tendonitis.

the drop art test and empty can test can assist in identifying supraspinatus pathology which may be indicative of an RC tear.

failure to adequately treat a RC tear may necessitate significant activity modifications, additional surgical management, adhesive capsulitis, or degenerative changes

rotator cuff tendonitis

caused by an inability of a weak supraspinatus muscle to adequately depress the head of the humerus in the glenoid fossa during elevation of the arm

participating in activities that require excessive overhead activity and other manual labor activities increases the risk of rotator cuff tendonitis.

patients may experience a feeling of weakness and identify the presence of a painful arch of motion most commonly occurring between 60-120 degrees of active abduction

scoliosis

curvature is usually found in the thoracic or lumbar vertebrae and can be associated with kyphosis or lordosis

a patient with scoliosis that ranges between 25-40 degrees requires a spinal orthosis and PT intervention for posture, flexibility, strengthening, respiratory function, and proper utilization of the spinal orthosis

scoliosis does not usually progress significantly one bone growth is complete if a curvature remains below 40 deg at the time of skeletal maturity

spondylolisthesis - degenerative

caused by the weakening of joints that allows for forward slippage of one vertebral segment on the one below due to degenerative changes.

Most common site is L4-L5 level

William’s flexion exercises may be indicated to strengthen the abdominals and reduce lumbar lordosis

Temporomandicular joint dysfunction

females are at greater risk than males with most common age ranging from 20-40 yo

clinical presentation includes pain (persistent or recurring), muscle spasm, abnormal or limited jaw motion, headache, and tinnitus

intervention includes patient education, posture retraining, modalities and massage

torticollis - congenital

causes the neck to involuntarily contract to one side secondary to contraction of the SCM muscle

the head is laterally flexed toward the contracted muscle, the chin faces the opposite direction and there may be facial asymmetries

studies indicate that the large majority of patients with congenital torticollis respond to conservative treatment and passive stretching within the first year of life

total hip arthroplasty

patients are typically over 55 yo and have experienced consistent pain that is not relieved through conservative measures which serve to limit the patient’s functional mobility

posterolateral approach allows the abductor muscles to remain intact, howevere there may be a higher incidence of post op joint instability due to the the interruption of the posterior capsule

cemented hip replacement usually allows for partial weight bearing initially while a noncemented hip replacement required TTWB up to 6 weeks.

total knee arthroplasty

primary indication for TKA is the destruction of articular cartilage secondary to OA

post op care may include a knee immobilizer, elevation of the limb, cryotherapy, ROM and initiation of knee protocol exercise

patient education may include items such as avoid excessive stress to the knee, squatting, quick pivoting, using pillows under the knee while in bed, and low seating.

total shoulder arthroplasty

surgical candicates typically have irreparable damage, deterioration, and destruction to the humeral head and the glenoid fossa within the shoulder complex

surgical complications include mechanical loosening of the prosthesis, instability, RC tear, implant failure, heterotopic ossification and intraoperative fracture

life expectancy is longer for the shoulder compared to the knee or hipsince the shoulder is a non-weight bearing joint

transfemoral amputation due to osteosarcoma

a highly malignant cancer that begins in the medullary cavity of a bone and leads to the formation of a mass

a patient status post transfemoral amputation may present with fatigue, loss of balance, phantom pain or sensation, hypersensitivity of the RL, and psychological issues regarding the loss of a limb

lying in a prone position is beneficial to decrease the incidence of a hip flexion contracture

transtibial amputation due to artiosclerosis obilterans

arteriosclerosis results in ischemia and subsequent ulceration of the affected tissues

a patient status post transtibial amputation may have a decrease in cardiovascular status depending on the frequency of intermittent claudication experienced prior to the amputation

preprosthetic intervention should focus on strength, ROM, functional mobility, use of assistive devices, desensitization, and patient education for care of the RL