Soft Tissue & Joint Disorders

What is a strain?

• Muscle/tendon injury due to overstretching or overworking

• Often in muscles crossing 2 joints

What are the 3 grades of a strain?

• Grade I = minor swelling, discomfort, intact muscle

• Grade II = partial tear, decreased contraction, edema, point tenderness, hemorrhaging

• Grade III = complete rupture, surgery usually required

What are s/sx of a strain?

• Delayed pain/soreness

• Pain with palpation

• Mild, moderate, severely limited ROM

• Decreased strength

• Edema

• Muscle spasm/stiffness

What is a sprain?

• Ligament injury due to excessive stretch or stress

• Common in ankles

What are the 3 grades of a sprain?

• Grade I = minimal tear, little pain/swelling/stiffness, stretch to ligament

• Grade II = some tearing, instability, joint stiffness, moderate/severe pain

• Grade III = complete tear, gross laxity, swelling, may need surgery

What is the difference between a dislocation and subluxation?

• Dislocation = complete loss of joint alignment

• Subluxation = partial dislocation with some contact still present

What is tendinopathy?

• Chronic tendon pathology

• Often from microtrauma

What is the difference between tendinitis and tendinosis?

• Tendinitis = inflammation (no longer used)

• Tendinosis = degeneration from chronic overuse

What is tenosynovitis?

Inflammation of tendon sheath (synovial lining)

What is synovitis?

• Inflammation of synovial membrane

• Excess synovial fluid in joint or tendon sheath

• Caused by trauma or disease

What is hemarthrosis?

• Bleeding into joint

• Usually from severe trauma

What is a ganglion?

• Cyst from joint capsule or tendon sheath

• May come from trauma

• Seen in RA

What is bursitis?

Inflammation of a bursa (friction-reducing sac)

What is overuse syndrome?

• Repeated submaximal load or friction causing microtrauma

• Usually not noticed until s/sx exacerbate

• Leads to inflammation & pain

What can cause muscle weakness?

• Nerve injury (central/peripheral nerve lesion)

• Disuse

• Muscle injury

What is joint dysfunction?

• Loss of joint play

• Pain & impaired mobility

• Caused by trauma, immobilization, disuse, aging, pathology

What is joint contracture?

• Permanent shortening of skin/fascia/muscle/joint capsule

• Loss of flexibility

What is joint adhesion?

• Scar tissue limits gliding of tissue structures

• Caused by immobilization, trauma, or complication of surgery

What is myofascial compartment syndrome?

• Increased interstitial pressure within muscle compartments

• Compresses nerves/vessels = ischemia & damage

• Most common in anterior compartment of leg

What are risk factors for myofacial compartment syndrome?

• Fractures/Trauma

• Severe contusions/Burns

• Crush injuries

• Strenuous exercise

• Restrictive dressing

• Snake bites

• Gunshot wound

What is the difference between acute and chronic compartment syndrome?

• Acute = trauma-related, EMERGENCY

  • S/Sx: deep throbbing extreme pain, paresthesia, edema, faint pulse, paralysis/paresis

• Chronic = exercise-induced, poor footwear, uneven training surfaces, resolves with rest

What are the classic symptoms (5 P’s) of chronic compartment syndrome?

• Pain

• Pulselessness

• Paresthesia (numbness & tingling)

• Paresis (partial loss of muscle function)

• Pallor

What are PT implications for myofascial compartment syndrome?

• Promote flexibility & healing

• Strengthening (after acute phase)

• Scar mobilization, isometrics —> resistance

• Patient education

What is heterotopic ossification?

• Abnormal bone growth in soft tissue post-trauma or surgery

• Common in hip, elbow, shoulder knee

• Causes: fractures, surgery, SCIs, TBI, burns, amputations, also genetics

• S/Sx: progressive loss of ROM with pain 2 weeks after injury

• PT: ROM & functional ability, splinting, prevent ankylosis, education on activity level

What is myositis ossificans?

Abnormal bone formation that forms in bruised, damaged, or inflamed muscle

What is neurogenic heterotopic ossification?

HO in people with SCIs (complete)

What is myopathy?

• Muscle disease resulting in nonspecific weakness

• Causes: hereditary, acquired, inflammatory, endocrine, metabolic, autoimmune, critical illnesses

• S/Sx: proximal weakness, decreased coordination/endurance, fatigue, pain/tenderness, decreased aerobic capacity

• Dx: electromyography (EMG)

• PT: early rehab, PROM, avoid over-fatiguing, functional activities, low intensity aerobic

What is idiopathic inflammatory myopathies (myositis)?

Immune-mediated processes triggered by environmental factor in genetically susceptible people

What is critical illness myopathy (CIM)?

• Disorders associated with prolonged stays in ICUs

• Fiber atrophy, fatty degeneration of muscle fibers, fibrosis

What is osteoarthritis?

• Most common MSK disorder worldwide

• Irreversible degeneration joint disease from cartilage breakdown and joint remodeling

• Cause: risks + mechanical stress + abnormal joint mechanics

• S/Sx: decreased cartilage, joint space narrowing, bone sclerosis, crepitus, pain, stiffness <30 mins, less motion, bony growth

• Risk factors: age, female, obesity, joint injury, muscle weakness, high-impact sports

• PT: exercise, pain management, improve gait/strength, delay surgery, patient education

What is the difference between primary and secondary osteoarthritis?

• Primary = unknown cause; lack of known trauma

• Secondary = preexisting joint abnormality from trauma, injury, or metabolic disorders

What is rheumatoid arthritis?

• Chronic systemic autoimmune inflammatory disorder affecting joints symmetrically

• Inflammation/destruction of joint capsule & throughout body

• Mostly genetic (80% positive for it)

• Etiology: infiltration of inflammatory cells into joints

• PT: correct/prevent joint deformity, increase motion & strength, decrease fatigue, increase functional status, NO mobilizations/manips

What is pannus?

• Invasive granulation tissue that erodes cartilage & bone in RA

• Blocks synovium from lubricating joints or providing nutrients to cartilage

What body systems are affected by rheumatoid arthritis?

• Cardiovascular

• Pulmonary

• Neurological

• Gastrointestinal

• Musculoskeletal

• Eye lesions

• Infection (higher risk due to immunosuppressants)

• Osteoporosis

What is swan neck deformity?

• 50% of hand RA cases

• Hyperextension of PIP & flexion of DIP (witch finger)

• Thumb not involved

What is boutonniere deformity?

• Occurs with progressive hand RA

• Flexion of PIP & hyperextension of DIP

• Also get ulnar drift (fingers drift to ulnar side)