3 - Common Orthopedic Conditions + Degen. Disease of Jt./Spine

Myofascial pain syndrome

• Definition

• Frequency

• Source

• Myo = muscle, Fascia = the connective tissue that wraps around muscle, In total = Pain from a muscle/a group of nearby muscles and their fascia.

• 85% of general population will experience it at some point

• Trigger point

What is the trigger point in myofascial pain syndrome, and what are the types?

• Trigger point: A small, hyperirritable spot inside a taut band of skeletal muscle. A taut band is a spot in the muscle that stays tight even when the muscle is relaxed

• Can be active, causing pain on their own, or latent, which hurts only when pressed

Osteoporosis

• Definition

• How it usually presents

• A disease of decreased bone strength(bone density + bone quality)

• Fractures/breaks of bone that a normal, healthy bone would’ve been able to handle

Osteoporosis diagnosis

1. Hip or vertebral fragility fracture(falling from less than standing height) = no other criteria needed

2. T-score of -2.5 deviations or more in a BMD test compared to the peak mean bone mass of young healthy adults = no other criteria needed

3. T-score between -1 and -2.5 = requires a fragility fracture of prox. humerus, pelvis, or distal forearm OR a FRAX 10-y probability of hip fracture of 3% or more

Frozen shoulder

• Other name

Adhesive capsulitis

Frozen shoulder

• Cause

• Result

• Demographic and risk factors

• Inflammation and fibrosis of the capsule of the glenohumeral joint

• Decreased ROM, pain

• Age >40, DM, hypothyroid, immobility

Tennis elbow

• Affected bone

• Affected functions

• Pain main location

• Tests to help diagnosis

• Lateral epicondyle of humerus

• Extensors and supination

• Lateral epicondyle

• Tests: Cozen, Mill

Golfer’s elbow

• Affected bone

• Affected functions

• Pain main location

• Medial epicondyle of humerus

• Flexors and pronation

• Medial epicondyle

What is more common, Tennis or Golfer’s elbow?

• Tennis elbow

What are the joints in the finger, and what muscles flex them?

MCP, PIP, DIP, and these are flexed by the tendons of the flexor digitorum superficialis and flexor digitorum profundus

What are pulleys, what role do they play, and what condition are they affected in?

Pulleys are fibrous tissue that hold tendons tight to the bone and stops them from lifting loosely away from the bone. They are affected in a condition called trigger finger

Trigger finger

• Other name

• Cause

• Symptoms

• Stenosing Tenosynovitis

• Inflammation and thickening of A1 pulley and the tendon thickening and forming a nodule

• Symptoms:

  • Finger gets pulled in when bending, but can’t slide thru the thickened ring because extensor muscles are weaker → finger stuck bent, snaps/clicks when finally extends out

  • Tenderness/nodule at A1/MCP level

DeQuervain’s tenosynovitis

• What is it

• Symptoms

• Demographic

• Diagnosis

• Thickening of the extensor retinaculum’s first dorsal compartment which causes pain as the extensor pollicus brevis and abductor pollicus longus passes through

• Radial styloid pain in movements like wringing or cradling

• New mothers or people who use their wrist a lot

• Finkelstein’s testj

Carpal Tunnel Syndrome

• What is it

• Symptoms

• Diagnosis

• Compression of the median nerve via thickening of the flexor retinaculum(Transverse carpal ligament)

• Tingling and numbness of the lateral 3 ½ fingers, thenar muscle atrophy

• Tinel and Phalen’s test

Main locations of spinal pain

Neck, low back

Plantar fascia

• What is it?

• Origin and insertion

• A thick band of connective tissue connecting the heel to the front of the foot

• Medial calcaneal tubercle to bases of each toe

Plantar fasciitis

• What is it?

• Symptoms

• Diagnosis

• Microtears and degeneration of the plantar fascia, especially at the origin

• Pain at the medial, bottom of the heel that is worse in the morning/after a rest period

• Clinical, can use the windlass test

What are joints, simply?

Places where 2 bones meet

Joint types

• What connects them

Fibrous: Dense connective tissue

Cartilaginous: Cartilage

Synovial: Cavity with fluid

Joint types

• Movement

Fibrous: None

Cartilaginous: Very little

Synovial: The most

Joint types

• Examples

Fibrous: Brain sutures

Cartilaginous: Intervertebral discs, public symphysis

Synovial: Hip, knee, shoulder, fingers

What is articular cartilage?

• Functions

• Key characteristics

The smooth layer covering the surfaces where the two bones meet in a capsule

• Creates 0 friction, absorbs load

• No blood supply, no nerves, no lymph drainage

What is the synovium?

The inner lining of the capsule in a synovial joint, produces synovial fluid

Osteoarthritis

• Definition

• Degenerative disease of synovial joints involving loss of articular cartilage and reactive change in surrounding bone underneath and around the joint

OA relation to arthritis

• Most common type of arthritis

• Defined as non-inflammatory

OA types

• Primary: No underlying identifiable cause, more general like age, lack of estrogen after menopause, or obesity

• Secondary: An identifiable cause like trauma or a joint disease

OA symptoms

• Pain: Deep/aching, worsens with movement and as we use the joints throughout the day gets better with rest(unless it’s late stage, then it can be at rest too)

• Stiffness: In the morning, goes away in 30 minutes

• Crepitus

• Reduced range of motion

• No systemic symptoms

Spondylosis is ___

Degenerative disease of the spine(facet joints and intervertebral disc) with age

HNP

• Stands for

• What is it

• Herniated nucleus pulposus

• The nucleus squeezes through tears in the annulus and presses on a nerve root and causes radicular pain

Sprain vs strain

• What they are

• Typical cause

• Sprain is an injury to a ligament, usually from a ligament forced beyond it’s normal range

• Strain is an injury to a muscle or tendon, usually from overstretching/forceful contraction

Ligament vs tendon

Ligaments connect bone to bone, tendon connects muscle to bone

What is a fracture?

A break in continuity of a bone

Pathological fracture

• What it is

• Causes

Fracture through bone already weakened by disease, via a minimal/normal force

• Osteoporosis, osteomalacia, primary or metastatic bone tumors

Fracture healing stages

• Hours to days: Hematoma and fibrin mesh

• Days to 2 weeks: Procallus, aka fibroblasts and new capillaries forming soft granulation tissue

• 2-3 weeks: Soft callus, chondroblasts now lay down fibrocartilage and collagen

• 3 weeks to 3 months: Hard callus with osteoblasts creating new bone, now visible on X-ray

• Months to years: Remodeling: Bone becomes lamellar

Stress fracture

A fracture from repeated loads that individually are too small to break the bone on it’s own

Osteonecrosis

• Definition

• Other name

• Death of bone tissue caused by loss of blood supply

• Avascular necrosis

Common cause and location of osteonecrosis

Femoral neck fracture damages the lateral circumflex artery and causes ischemia of the femoral head

Avascular necrosis would cause what type of osteoarthritis?

Secondary