Comprehensive Musculoskeletal Physiotherapy Study Guide

What is Femoroacetabular Impingement (FAI)?

A condition where abnormal contact occurs between the femoral head/neck and acetabular rim, leading to joint irritation, labral damage, and early cartilage wear. Types include Cam (excess femoral bone growth), Pincer (acetabular over-coverage), and Mixed.

What are the key symptoms of FAI?

Deep anterior groin pain, clicking, catching, or stiffness in the hip joint.

What is the mechanism of FAI?

Excessive bone growth on the femoral head or over-coverage of the acetabulum causes mechanical jamming during hip flexion, adduction, and internal rotation.

What are the symptom patterns of FAI?

Gradual onset, often linked to repetitive activity; worsens with prolonged sitting or deep hip flexion.

What are the risk factors for FAI?

Young, athletic individuals engaged in repetitive hip loading sports (such as football, hockey, or dance).

What are the aggravating factors for FAI?

Deep hip flexion, prolonged sitting, climbing stairs, squatting, running, pivoting, and crossing legs.

What are the objective assessment findings for FAI?

Reduced hip flexion and internal rotation; positive FADIR test, positive FABER test, positive Thomas test, and positive Resisted Straight Leg Raise.

What is the differential diagnosis for FAI?

Labral tear, Hip Osteoarthritis, and Sports Hernia.

What is the management for FAI?

Analgesia/GP advice, activity modification (avoiding deep squats and high impact), education on neutral pelvic alignment, and MRI imaging if required.

What are exercise examples for FAI?

ROM: Pelvic tilts, gentle hip flexor stretches, supine hip rotations. Strength: Glute bridges, clamshells, side-lying abduction, and core exercises (dead bugs/bird-dogs).

What is Hip Osteoarthritis (OA)?

Progressive degeneration of articular cartilage, subchondral bone remodelling, osteophyte formation, and inflammation causing pain, stiffness, and loss of function.

What are the key symptoms of Hip OA?

Joint stiffness, deep aching groin/hip pain, burning sensation, altered gait, and reduced step length.

What is the mechanism of Hip OA?

Degenerative articular cartilage breakdown and joint remodelling secondary to aging, historical trauma, or repetitive mechanical loading.

What are the symptom patterns of Hip OA?

Gradual degenerative onset; morning stiffness lasting under $30\text{ minutes}$; pain worsens with prolonged activity.

What are the risk factors for Hip OA?

Age $50+$ years, obesity, previous hip trauma/fracture, and leg length discrepancy.

What are the aggravating factors for Hip OA?

Prolonged walking, stairs, standing up from sitting, and squatting.

What are the objective assessment findings for Hip OA?

Capsular pattern loss (Internal Rotation > Flexion > Abduction), hard/bony end-feel in severe cases, positive FABER test, and positive Scour test.

What is the differential diagnosis for Hip OA?

Greater Trochanteric Pain Syndrome (GTPS) and Femoroacetabular Impingement (FAI).

What is the management for Hip OA?

Analgesia/corticosteroid injections, heat, walking aids/mobility devices, pacing, and structured exercise.

What are exercise examples for Hip OA?

ROM: Towel-assisted knee-to-chest, active hip rotations. Strength: Glute bridges, lunges, and abductor strengthening.

What is Greater Trochanteric Pain Syndrome (GTPS)?

An umbrella term for pain over the greater trochanter involving inflammation/irritation of the bursae, gluteal tendons, or weakness of gluteus medius/minimus.

What are the key symptoms of GTPS?

Lateral hip pain over the greater trochanter, pain lying on the affected side, pain climbing stairs, and radiation down the lateral thigh.

What is the mechanism of GTPS?

Gluteal tendinopathy or bursal irritation caused by overuse, friction, or repetitive lateral loading.

What are the symptom patterns of GTPS?

Gradual onset, typically unilateral; pain worsens with loading/activity and improves with rest.

What are the risk factors for GTPS?

Female sex (aged $40\text{--}60$ years), weak hip abductors, Trendelenburg gait, and leg length discrepancy.

What are the aggravating factors for GTPS?

Standing on one leg, crossing legs, lying on the affected side, and walking uphill or on uneven ground.

What are the objective assessment findings for GTPS?

Localised tenderness over greater trochanter, positive Ober's test, positive Single Leg Stand, and positive Trendelenburg test.

What is the differential diagnosis for GTPS?

Hip Osteoarthritis, Neck of Femur fracture, and Lumbar radiculopathy.

What is the management for GTPS?

Load modification, education (avoid crossing legs and side-lying without a pillow), ice/heat, and analgesia.

What are exercise examples for GTPS?

Isometric hip abduction, side-lying clamshells, standing hip abduction with resistance band, and glute bridges.

What is Patellofemoral Pain Syndrome (PFPS)?

Pain arising from the patellofemoral joint or surrounding soft tissues, often associated with patellar maltracking, muscular imbalance, or overuse.

What are the key symptoms of PFPS?

Diffuse anterior knee pain behind or around the kneecap, pain with stair descent, and pain after prolonged sitting with bent knees.

What is the mechanism of PFPS?

Altered patellar tracking and biomechanics due to muscle imbalances (e.g., tight vastus lateralis/ITB, weak hip abductors) or increased Q-angle.

What are the symptom patterns of PFPS?

Gradual onset, common in active younger individuals; symptoms fluctuate with activity.

What are the risk factors for PFPS?

Younger age, female sex, increased Q-angle, weak quadriceps/hip abductors, and sudden training load increases.

What are the aggravating factors for PFPS?

Descending stairs, squatting, running, jumping, and prolonged sitting with knees flexed.

What are the objective assessment findings for PFPS?

Tenderness around patella, positive Clarke's (Patellar Grind) test, positive Step-down test, and altered Q-angle or patellar tracking.

What is the differential diagnosis for PFPS?

Patellar tendinopathy, Meniscal tear, and Knee Osteoarthritis.

What is the management for PFPS?

Load management, patellar taping/bracing, orthotics for overpronation, analgesia, and activity modification.

What are exercise examples for PFPS?

Inner range quads, banded knee extensions, clamshells, glute bridges, mini squats, and step-ups.

What is Achilles Tendinopathy?

Pain, swelling, and impaired function of the Achilles tendon caused by repetitive overload and tendon degeneration (tendinosis).

What are the key symptoms of Achilles Tendinopathy?

Localised pain and stiffness in the Achilles tendon, morning stiffness, and tendon thickening.

What is the mechanism of Achilles Tendinopathy?

Repetitive tensile overload leading to microtrauma, disorganised collagen, and tendon degeneration.

What are the symptom patterns of Achilles Tendinopathy?

Gradual onset; initially pain occurs after activity, progressing to pain during activity and eventually pain at rest.

What are the risk factors for Achilles Tendinopathy?

Sudden increases in running/jumping load, poor calf strength/flexibility, overpronation, and inappropriate footwear.

What are the aggravating factors for Achilles Tendinopathy?

Running (especially uphill), jumping, sprinting, first steps in the morning, and prolonged standing.

What are the objective assessment findings for Achilles Tendinopathy?

Tenderness and palpable thickening $2\text{--}6\text{ cm}$ above insertion or at insertion; positive Royal London Hospital test.

What is the differential diagnosis for Achilles Tendinopathy?

Tibialis posterior tendinopathy, Deep Vein Thrombosis (DVT), and Sural nerve irritation.

What is the management for Achilles Tendinopathy?

Activity modification, progressive loaded strengthening, supportive footwear, and avoidance of corticosteroid injections.

What are exercise examples for Achilles Tendinopathy?

Reactive Phase: Isometric calf raises ($5 \times 45\text{s}$ holds). Strength Phase: Eccentric heel drops (straight and bent knee) and seated calf raises.

What is Subacromial Pain Syndrome (Impingement)?

Pain arising from subacromial structures (supraspinatus tendon, bursa, biceps tendon) caused by irritation or compression during shoulder elevation.

What are the key symptoms of Subacromial Pain Syndrome?

Anterolateral shoulder pain over the deltoid, painful arc during arm elevation, difficulty with overhead reaching, and night pain when lying on side.

What is the mechanism of Subacromial Pain Syndrome?

Compression or friction on subacromial tissues during overhead movements due to poor rotator cuff/scapular control or structural narrowing.

What are the symptom patterns of Subacromial Pain Syndrome?

Gradual onset; pain worsens with overhead activity and repeated elevation.

What are the risk factors for Subacromial Pain Syndrome?

Overhead sports or occupations, poor postural alignment (rounded shoulders), rotator cuff weakness, and age.

What are the aggravating factors for Subacromial Pain Syndrome?

Reaching overhead, heavy lifting, lying on the affected shoulder, and repetitive reaching.

What are the objective assessment findings for Subacromial Pain Syndrome?

Tenderness over subacromial area/greater tuberosity, painful arc ($60\text{--}120^\circ$), positive Neer's test, and positive Hawkins-Kennedy test.

What is the differential diagnosis for Subacromial Pain Syndrome?

Rotator cuff tear, Adhesive capsulitis (Frozen shoulder), and AC joint pathology.

What is the management for Subacromial Pain Syndrome?

Activity modification, postural correction, pain relief, and progressive rotator cuff and scapular stabilization training.

What are exercise examples for Subacromial Pain Syndrome?

ROM: Pendulum swings, wall slides, stick flexion. Strength: Banded external/internal rotation, scaption, rows, and prone T/Y exercises.

What is Lateral Epicondylitis (Tennis Elbow)?

An overuse injury leading to microtears and degeneration of the common extensor tendon origin at the lateral epicondyle, primarily involving ECRB.

What are the key symptoms of Lateral Epicondylitis?

Localised pain over the lateral elbow radiating down the forearm, reduced grip strength, and pain with wrist extension.

What is the mechanism of Lateral Epicondylitis?

Repetitive wrist extension and gripping leading to microtrauma and collagen degeneration at the tendon origin.

What are the symptom patterns of Lateral Epicondylitis?

Gradual onset of pain, aggravated by activities requiring sustained gripping or wrist extension.

What are the risk factors for Lateral Epicondylitis?

Repetitive manual work, racquet sports, typing, poor lifting technique, and sudden load increases.

What are the aggravating factors for Lateral Epicondylitis?

Gripping, twisting objects (opening jars, shaking hands), lifting with pronated forearm, and typing.

What are the objective assessment findings for Lateral Epicondylitis?

Local tenderness over lateral epicondyle, positive Cozen's test, positive Mill's test, and positive Maudsley's test.

What is the differential diagnosis for Lateral Epicondylitis?

Radial tunnel syndrome, Cervical radiculopathy ($C6$), and Elbow osteoarthritis.

What is the management for Lateral Epicondylitis?

Load modification, heat, ergonomic adjustments, analgesia, and progressive tendinopathy loading.

What are exercise examples for Lateral Epicondylitis?

Phase 1: Isometric wrist extension holds. Phase 2: Isotonic wrist extension/flexion/pronation. Phase 3: Heavy slow eccentric wrist extension lowering and grip strengthening.

What is Carpal Tunnel Syndrome?

Entrapment and compression of the median nerve within the carpal tunnel at the wrist.

What are the key symptoms of Carpal Tunnel Syndrome?

Numbness, tingling, or paresthesia in the thumb, index, middle, and radial half of ring finger; night pain; motor weakness/clumsiness.

What is the mechanism of Carpal Tunnel Syndrome?

Increased pressure within the carpal tunnel causing ischemia and nerve compression of the median nerve.

What are the symptom patterns of Carpal Tunnel Syndrome?

Symptoms brought on by sustained wrist flexion or repetitive hand use; nighttime awakenings due to numbness.

What are the risk factors for Carpal Tunnel Syndrome?

Female sex, repetitive wrist/finger tasks, pregnancy, obesity, diabetes, thyroid disease, and age $40\text{--}60$ years.

What are the aggravating factors for Carpal Tunnel Syndrome?

Wrist flexion, prolonged typing, gripping, and holding objects for long periods (e.g., steering wheel, phone).

What are the objective assessment findings for Carpal Tunnel Syndrome?

Positive Tinel's sign at wrist, positive Phalen's test, positive Durkan's compression test, and possible thenar eminence wasting.

What is the differential diagnosis for Carpal Tunnel Syndrome?

Cervical radiculopathy ($C6\text{--}C7$) and Pronator teres syndrome.

What is the management for Carpal Tunnel Syndrome?

Night wrist splinting in neutral, activity modification, tendon/nerve glides, and GP referral for corticosteroid injection or surgery if severe.

What are exercise examples for Carpal Tunnel Syndrome?

Wrist and finger tendon glides, median nerve sliding/gliding exercises, and gentle isometric wrist exercises.

What is Lumbar Spinal Stenosis?

Narrowing of the central spinal canal or intervertebral foramina leading to compression of the spinal cord or cauda equina/nerve roots.

What are the key symptoms of Lumbar Spinal Stenosis?

Low back and leg pain, numbness, tingling, heaviness, and neurogenic claudication (leg cramping/weakness when walking).

What is the mechanism of Lumbar Spinal Stenosis?

Degenerative changes including osteophyte formation, disc bulging, facet joint hypertrophy, and ligamentum flavum thickening.

What are the symptom patterns of Lumbar Spinal Stenosis?

Aggravated by standing and walking; rapidly relieved by sitting or leaning forward ('shopping trolley sign').

What are the risk factors for Lumbar Spinal Stenosis?

Older age ($50+$), spinal degenerative disease, or congenital narrow spinal canal.

What are the aggravating factors for Lumbar Spinal Stenosis?

Lumbar extension, standing upright, and walking downhill or extended distances.

What are the objective assessment findings for Lumbar Spinal Stenosis?

Flexed standing posture, painful/restricted lumbar extension, and symptom relief with lumbar flexion.

What is the differential diagnosis for Lumbar Spinal Stenosis?

Peripheral Vascular Disease (vascular claudication) and Lumbar disc prolapse.

What is the management for Lumbar Spinal Stenosis?

Flexion-based activity management, GP pain relief, physical therapy, and MRI imaging.

What are exercise examples for Lumbar Spinal Stenosis?

Flexion exercises: Double knee-to-chest, Cat-Cow (flexion focus), pelvic tilts. Aerobic: Stationary cycling or swimming.

What is Cervical Radiculopathy?

Compression, irritation, or inflammation of a cervical spinal nerve root leading to radiating arm pain and neurological deficits.

What are the key symptoms of Cervical Radiculopathy?

Unilateral neck, shoulder, and arm pain following a dermatomal pattern; paresthesia (pins and needles); myotomal weakness; reduced reflexes.

What is the mechanism of Cervical Radiculopathy?

Mechanical compression or chemical irritation of a nerve root secondary to cervical disc herniation, osteophytes, or foraminal stenosis.

What are the symptom patterns of Cervical Radiculopathy?

Sharp, radiating pain exacerbated by specific neck movements or positions.

What are the risk factors for Cervical Radiculopathy?

Cervical spondylosis, heavy lifting, repetitive neck movements, and age-related disc degeneration.

What are the aggravating factors for Cervical Radiculopathy?

Neck extension, side flexion/rotation towards the affected side, and prolonged sitting/looking up.

What are the objective assessment findings for Cervical Radiculopathy?

Positive Spurling's test, positive Cervical Distraction test (relief), dermatomal sensory deficits, myotomal weakness, and diminished DTRs.

What is the differential diagnosis for Cervical Radiculopathy?

Subacromial impingement, Rotator cuff tear, Carpal tunnel syndrome, and Peripheral nerve entrapment.

What is the management for Cervical Radiculopathy?

Patient education, posture/ergonomic correction, pain relief, and progressive deep neck flexor and scapular control training.

What are exercise examples for Cervical Radiculopathy?

ROM: Gentle chin tucks, controlled cervical flexion and rotation away from affected side. Strength: Deep neck flexor holds, scapular retraction, and wall angels.