Common Musculoskeletal Pathologies - Therapeutic Exercise and Rehabilitation I

Comprehensive vocabulary flashcards covering soft tissue lesions, healing stages, exercise interventions, and specific musculoskeletal pathologies from Therapeutic Exercise and Rehabilitation I.

Strain

Overstretching, overexertion, or overuse of soft tissue.

Sprain

Severe stress, stretch, or tear of soft tissues, such as joint capsule, ligament, tendon, or muscle.

Dislocation

Displacement of a part, usually the bony partners in a joint, resulting in loss of the anatomical relationship and leading to soft tissue damage, inflammation, pain, and muscle spasm.

Subluxation

An incomplete or partial dislocation of the bony partners in a joint that often involves secondary trauma to surrounding soft tissue.

Partial Muscle or Tendon Rupture

An incomplete tear of muscle or tendon tissue where pain is experienced during contraction or stretch of the involved structure.

Synovitis

Inflammation of a synovial membrane characterized by an excess of normal synovial fluid in a joint or tendon sheath caused by trauma or disease.

Hemarthrosis

Bleeding into a joint or synovial cavity; identified in the context of traumatic soft tissue lesions causing swelling and inflammation.

Ganglion

A ballooning of the wall of a joint capsule or tendon sheath; ganglia may arise after trauma and sometimes occur with rheumatoid arthritis.

Bursitis

Inflammation of a bursa; classified alongside soft tissue lesions that may arise from trauma or associate with conditions such as rheumatoid arthritis.

Contusion

Bruising from a direct blow, resulting in capillary rupture, bleeding, edema, and an inflammatory response.

Overuse Syndromes

Also termed cumulative trauma disorders and repetitive strain trauma; repeated, submaximal overload and/or frictional wear to a muscle or tendon resulting in inflammation and pain.

Tendinopathy

The general term that refers to tendon injury affected by mechanical loading.

Tenosynovitis

Inflammation of the synovial membrane covering a tendon.

Tendinitis

Inflammation of a tendon; there may be resulting scarring or calcium deposits.

Tenovaginitis

Inflammation with thickening of a tendon sheath.

Tendinosis

Degeneration of the tendon caused by repetitive microtrauma.

Dysfunction

Loss of normal function of a tissue or region; may be caused by adaptive shortening of soft tissues, adhesions, muscle weakness, or any condition resulting in loss of normal mobility.

Joint Dysfunction

Mechanical loss of normal joint play in synovial joints that commonly causes loss of function and pain, precipitated by trauma, immobilization, disuse, aging, or a pathological condition such as rheumatoid arthritis.

Contracture

Adaptive shortening of skin, fascia, muscle, or a joint capsule that prevents normal mobility or flexibility of that structure.

Adhesion

Abnormal adherence of collagen fibers to surrounding structures during immobilization, after trauma, or as a complication of surgery, which restricts normal elasticity and gliding of the structures involved.

Reflex Muscle Guarding

Prolonged contraction of a muscle in response to a painful stimulus; functionally splints the injured tissue against movement when not referred, and ceases when the painful stimulus is relieved.

Muscle Weakness

A decrease in the strength of muscle contraction; can result from a systemic, chemical, or local nerve lesion (central/peripheral nervous system or myoneural junction), direct muscle insult, or inactivity.

Myofascial Compartment Syndromes

Increased interstitial pressure in a closed, nonexpanding myofascial compartment that compromises blood vessels, muscles, and nerves, resulting in ischemia and irreversible muscle loss if untreated.

Intrinsic Muscle Spasm

Prolonged contraction of a muscle in response to local circulatory and metabolic changes occurring during continued contraction; the resulting pain makes the contraction self-perpetuating even after the initial guarding lesion resolves.

Grade 1 (First Degree) Tissue Injury

Mild pain at the time of injury or within the first $24\text{ hours}$, accompanied by mild swelling, local tenderness, and pain when the tissue is stressed.

Grade 2 (Second Degree) Tissue Injury

Moderate pain requiring cessation of activity, where stress and palpation greatly increase pain; in ligament injuries, some fibers are torn, resulting in some increased joint mobility.

Grade 3 (Third Degree) Tissue Injury

Near-complete or complete tear or avulsion of tissue (tendon or ligament) with severe pain initially; stress to the torn tissue is usually painless, palpation may reveal a defect, and a torn ligament results in joint instability.

Acute Stage of Tissue Healing

Inflammatory stage typically lasting $4\text{ to }6\text{ days}$ (with vascular changes predominating the first $48\text{ hours}$), characterized by cellular/chemical exudation, clot formation, phagocytosis, and pain before tissue resistance.

Subacute Stage of Tissue Healing

Proliferation, repair, and healing stage lasting $10\text{ to }17\text{ days}$ ($14\text{ to }21\text{ days}$ after injury onset, up to $6\text{ weeks}$), characterized by capillary ingrowth, collagen formation, fragile granulation tissue, and pain synchronous with tissue resistance.

Chronic Stage of Tissue Healing

Maturation and remodeling stage lasting from Day $21$ to Day $60$ (and up to $6\text{ months to }1\text{ year}$), characterized by connective tissue maturation, scar remodeling, collagen alignment along lines of stress, and pain after tissue resistance.

Chronic Inflammation

A state of prolonged inflammation resulting from repeated stress beyond tissue repair capacity; marked by pain, swelling, and guarding lasting more than several hours post-activity, morning stiffness, and loss of ROM $24\text{ hours}$ post-activity.

Chronic Pain Disorder

A condition with pain persisting longer than the typical $3\text{ to }6\text{ months}$ required for musculoskeletal tissue healing, or persistent pain related to neurological, oncologic, systemic, or endocrine diagnoses.

Phase I PT Management (Maximum Protection)

Acute stage rehabilitation focused on controlling inflammation effects (selective rest, ice, compression, elevation) and preventing deleterious rest effects with nondestructive movement, PROM, Grade I/II joint mobilizations, and muscle setting.

Phase II PT Management (Moderate Protection / Controlled-Motion)

Subacute stage rehabilitation focused on developing a mobile scar (selective stretching, mobilization of restrictions) and promoting healing with active, resistive exercises, stabilization, muscular endurance, and balance drills.

Phase III PT Management (Minimum to No Protection / Return to Function)

Chronic stage rehabilitation focused on increasing the tensile quality of scar tissue and developing functional independence through progressive strengthening, endurance, functional exercises, and specificity drills.

Figure 10.2: Relationship of Pain to Tissue Resistance

Diagnostic concept illustrating pain relative to tissue resistance during ROM: pain occurs before tissue resistance in the acute stage (A), synchronous with tissue resistance in early subacute (B), and after tissue resistance with overpressure in late subacute/chronic (C).

Signs of Excessive Stress with Exercise (Box 10.3)

Clinical warning signs indicating excessive exercise intensity, including soreness not decreasing after $4\text{ hours}$ or unresolved after $24\text{ hours}$, pain appearing earlier, progressive stiffness, decreased ROM, swelling, redness, and progressive weakness.

Achilles Tendonitis

Repetitive overuse disorder resulting in microscopic tears of collagen fibers on the surface or substance of the Achilles tendon, causing aching/burning in the posterior heel, morning stiffness, and tenderness.

Avascular Zone of the Achilles Tendon

The specific region located $2\text{ to }6\,\text{cm}$ above the calcaneal insertion of the Achilles tendon, which is most susceptible to tendinitis and tendon rupture due to hypovascularity.

Adhesive Capsulitis

Self-limiting condition typically resolving in $1\text{ to }2\text{ years}$ resulting in loss of active and passive ROM from adhesive fibrosis and scarring between the joint capsule, rotator cuff, subacromial bursa, and deltoid; common in females aged $40\text{ to }60$ and patients with diabetes.

Capsular Pattern of the Glenohumeral Joint

The characteristic pattern of proportional passive ROM limitation indicative of joint capsule restriction (as seen in adhesive capsulitis): external rotation is most limited, followed by abduction, then internal rotation.

Anterior Cruciate Ligament (ACL) Sprain

Injury resulting from noncontact twisting with varus or valgus stress to the knee; the ACL runs from the anterior intercondylar tibia to the lateral femoral condyle, preventing anterior displacement of the tibia on the femur.

Unhappy Triad

A severe composite knee injury involving simultaneous trauma to the anterior cruciate ligament (ACL), medial collateral ligament (MCL), and medial meniscus.

Hamstrings (in ACL Rehabilitation)

Muscle group acting as vital dynamic stabilizers of the knee by providing posterior shear force on the tibia, thereby protecting an ACL-deficient or reconstructed knee.

Congenital Hip Dysplasia

Developmental malalignment of the femoral head within the acetabulum occurring during the last trimester in utero, presenting with asymmetrical hip abduction, tightness, and apparent femoral shortening.

Longitudinal Congenital Limb Deficiency

A congenital limb malformation in utero characterized by the reduction or absence of a skeletal element or elements within the long axis of a bone.

Transverse Congenital Limb Deficiency

A congenital limb malformation in utero where a limb develops normally to a particular anatomical level beyond which no skeletal element exists.

Congenital Torticollis

Also called 'wry neck,' a unilateral contracture of the sternocleidomastoid (SCM) muscle causing ipsilateral lateral cervical flexion and contralateral cervical rotation, most often identified in the first $2\text{ months}$ of life.

Glenohumeral Instability

Excessive translation of the humeral head on the glenoid during active rotation; encompasses subluxation ($>50\%$ passive translation without dislocation) and dislocation (complete articular separation, detaching the glenoid labrum in approximately $80\%$ of cases).

Shoulder Impingement Syndrome

Repetitive microtrauma condition from upper extremity activity above the horizontal plane, causing proximal migration of the humeral head and rotator cuff to impinge under the acromion and coracoacromial ligament.

Painful Arc of Motion

A characteristic clinical sign of shoulder impingement where discomfort or pain is provoked during active shoulder abduction between $70^\circ\text{ and }120^\circ$.

Lateral Epicondylitis

Irritation or inflammation of the common extensor tendon origin at the lateral epicondyle caused by eccentric loading of wrist extensor muscles (predominantly extensor carpi radialis brevis [ECRB]), most common between ages $30\text{ and }50$.

Counterforce Strap (Elbow)

A supportive forearm band placed $2\text{ to }3\text{ inches}$ distal to the elbow to alter the length-tension relationship of the wrist extensors and dissipate tensile stress at the lateral epicondyle.

Legg-Calve-Perthes Disease

Self-limiting avascular necrosis and degeneration of the femoral head caused by blood supply disturbance, presenting with an antalgic gait and positive Trendelenburg sign across four stages: condensation, fragmentation, re-ossification, and remodeling.

Medial Collateral Ligament (MCL) Sprain

Injury to the knee ligament extending from above the medial femoral epicondyle to the medial tibial shaft, caused by valgus force and external tibial rotation with a fixed foot; rarely requires surgery because the MCL is well vascularized.

Meniscus Tear

Damage to knee fibrocartilage caused by fixed-foot rotation during weight-bearing on a flexed knee; medial tears are more common due to joint capsule attachment and present with joint line tenderness, swelling, and locking.

Osgood-Schlatter Disease

Traction apophysitis resulting from repetitive tensile forces applied by the patellar tendon onto the tibial tuberosity in young athletes, causing microavulsions, localized swelling, and pain with jumping or squatting.

Osteoporosis

A systemic bone disease affecting approximately $54\text{ million}$ Americans, characterized by decreased mineral content and bone weakening that predisposes to fractures, especially in the spine, hip, and wrist.

T-Score Criteria (WHO)

Bone mineral density standard deviation thresholds: Normal is $-1.0$ or higher; Osteopenia is $-1.0\text{ to }-2.4$; Osteoporosis is $-2.5$ or less (where a decrease of $1$ standard deviation represents a $10\%\text{ to }12\%$ loss of BMD).

Figure 11.9: Radiographic Manifestation of Osteoporosis (Thoracic Spine)

Lateral thoracic spine radiograph illustrating classic osteoporotic changes: marked cortical thinning, osteopenia (increased radiolucency), anterior wedge deformities of vertebral bodies (white arrow), and progressive kyphosis.

Osteoporosis Movement Precautions and Contraindications

Avoidance of spinal flexion exercises (supine curl-ups, sit-ups, abdominal machines) and combined trunk flexion with rotation, because anterior compressive forces on wedge-shaped vertebrae dramatically increase vertebral compression fracture risk.

Primary vs Secondary Osteoporosis

Primary osteoporosis is related to postmenopausal status, advanced age, low calcium/vitamin D, and inactivity; secondary osteoporosis develops due to medical conditions (e.g., gastrointestinal disease, hyperthyroidism, renal failure) or medications like glucocorticoids.

Osteoarthritis

A chronic disease causing degeneration of articular cartilage primarily in weight-bearing joints (hands, hips, knees), followed by subchondral bone thickening, spurring, crepitus, and diminished joint space on radiograph.

Heberden's and Bouchard's Nodes

Bony joint enlargements in osteoarthritis of the hands: Heberden's nodes occur at the distal interphalangeal (DIP) joints, whereas Bouchard's nodes occur at the proximal interphalangeal (PIP) joints.

Patellofemoral Syndrome

General term for anterior knee pain or discomfort (including chondromalacia patella) from abnormal tracking and compression, presenting with crepitus, pain on stairs, and pain with prolonged sitting ('movie goers sign').

Plantar Fasciitis

Inflammation of the plantar fascia at its proximal insertion on the medial tubercle of the calcaneus, presenting with heel spurs, tenderness, morning pain with initial steps, and pain walking barefoot.

Posterior Cruciate Ligament (PCL) Sprain

Injury caused by landing on the tibial tuberosity with a flexed knee or dashboard impact in a MVA; evaluated via posterior drawer and posterior sag tests, with isolated hamstring exercises restricted for at least $6\text{ weeks}$ after surgical repair.

Rheumatoid Arthritis

A chronic systemic autoimmune disease affecting synovial tissue with symmetrical joint erosion and morning stiffness; requires extreme caution due to cervical $C1/C2$ instability and steroid-induced ligamentous laxity/osteoporosis.

Rotator Cuff Tear

Partial- or full-thickness tendon disruption sized from small ($\le 1\,\text{cm}$) to large ($> 5\,\text{cm}$); presents with arm held in IR/ADD, greater tubercle tenderness, and shoulder hiking (upper trapezius recruitment) during attempted elevation.

Scoliosis

Lateral curvature of the spine quantified via the Cobb method on radiograph, divided into functional (nonstructural, flexible, correctable) or structural (neuromuscular/degenerative); curvatures of $25^\circ\text{ to }40^\circ$ typically indicate bracing, while $>40^\circ$ may require surgery.