Common MSK Conditions/Surgery Recovery

What is the onset of adhesive capsulitis

40 to 60 years old with no clear traumatic incident

Describe the 4 phases of adhesive capsulitis

Initial: gradual onset on loss ROM, weak ER and lasts less than 3months

Freezing: pain at rest and limited in all directions; 3-9 months

Frozen: only pain with movement, atrophy of shoulder muscles 9-15 months, shoulder hike

Thawing: minimal pain, and gradual ROM gains, lasts 15 to 24 months

Phase 1 treatment adhesive capsulitis

sling

passive ROM

grade I-II mobilizations

pendulums

Phase 2 treatment adhesive capsulitis

self-assisted ROM

grade III to IV

manual stretching

correct posture

strengthen IR and ER

Phase 3 treatment adhesive capsulitis

stretching and strengthrening as tolerated

introduce more vigorous manual treatment

Boggy end feel

edema or joint swelling

Springy end feel

meniscal displacement

Rubbery end feel

muscle spasms

Empty end feel

muscle guarding or pain

Timeline for return following mini-open vs traditional repair from rotator cuff tear?

6 weeks

12 weeks traditional, avoiid heavy resistance 6-12 montha

Colle's vs Smith Fracture

Colle = dinner fork deformity and radius moves posteriorly

Smith = garden spade deformity and radius moves anterior

Typical Rehab following hand flexor repairs

-immobilization 3-4 weeks, protective splint and IP joint at 30-50 degrees

-AROM at 4 weeks with ext then flexion

Typical rehab following hand extensor repairs

DIP in neutral for 6-8 weeks

Extension AROM 6 weeks with PIP in neutral

full AROM in 6 weeks

Precautions with THR

no IR, add or flexion past 90

Weight bearing progression for total hip replacements

partial at 3 weeks

cane at 4 weeks

full weight bearing at 5 weeks

When can resisted exercises begin with total hip replacements

4 weeks

When should 120 degrees of knee flexion be reached for total knee replacements

120 degrees in 3-4 weeks

When can resisted exercises begin with total knee replacements

2-3 weeks

Weight bearing for partial meniscectomy vs meniscus repair

partial: AROM day 1

meniscus repair NWB for 3-6 weeks

non-Weight bearing following ACL

1 weeks

When is the greatest indicator of recovery after ACL surgery in girls

skeletal maturity

What typically heals faster, patellar or hamstring grafts for ACLs

patellar due to bone to bone healing faster than tissue to bone

How can you avoid stress on new ACL early on?

avoid OKC in short sititng, keep knee within 90 to 45 degrees

Bracing progression with ACL reconstructions

6 weeks: hinged orthosis with locking mechanism

functional brace for advanced rehab (11-24 weeks)

Interventions weeks 0-2 following ACL reconstruction

PRICE

WBAT

grade 1-2 patellar mobs

assisted SLR

Interventions week 2-4 following ACL reconstruction

full weight bearing if full knee ext and quad strength

CKC exercises

trunk stabilization

stationary bike

Weeks 5-6 ACL reconstruction interventions

CKC strengthening and OKC if resistance is above knee

SLS

elastic band exercises

Weeks 7-10 ACL reconstruction internvetions

PNF patterns and advanced strengthening

unstable surfaces

jogging program

should be at 75% of other limb

Weeks 11-24 ACL reconstruction interventions

start plyometrics

progress agility

full speed

simulated tasks

What two motions does the ACL prevent

anterior translation and medial translation of tibia on femur

What should be avoided PCL sprains

hamstring exercises

Common examination findings with patellofemoral pain syndrome

-decreased quad strength

-decreased LE flexibility

-increased tibial IR

-weak VMO

What is OA

degeneration of articular cartilage leading to thickening of subchondral gon

Common finger deformities with RA

swan neck

boutonniere

What is congential hip dysplasia

femoral head does not fit into acetabulum

asymmetric hip abd and femoral shortening

Treatment congential hip dysplasao

pelvic harness

hip spica after reduction

stretching

strengthen

What is the timeline for congential torticollis

SCM contracture within first 2 months

juvenile idiopatihic arthritis

inflammation of joints

poly more than 5

Oligoarticular 4 or less

What is the most common type of juvenile idiopathic arthritis

asymmetrical oligoarticular

What muscles are usually damaged in medial epicondylitis

pronator teres and flexor carpi radialis

What wrist movements are painful with golfer's elbow

passive wrist ext and active wrist flexion

What is a supracondylar fracture and what are the implications

distal humeral fracture common in children

usually damaged the AIN (median nerve) and brachial artery and can lead to gun stock defomrity and lack of re-union

What ligament is damaged with nursemaid's elbow

annular ligament

What muscles are associated with anterior interosseoous nerve syndrome

think median nerve

weakness flexor pollicis longus, FDP and pronator teres

What can cause myositis ossificans in the elbow

excessive stretching of brachialis muscle or trauam

What nerve is associated with ape hand and what motion cannot occur

median nerve

weak thumb flexion or opposition

Joint position with bishop's hand

MCP hyperextension

IP flexion

What are claw fingers and what causes it

MCP joint hyperextension and IP flexion

due to median and ulnar nerve damage leading to weak hand intrsincs

What finger is most likely damaged with duputyren's

ring or pinky finger

What causes mallet finger

rupture of extensor tendon at distal phalanx leading to DIP flexion

What is boutonniere deformity and what causes it

Ext of MCP and DIP with PIP flexion

due to rupture of the extensor hood

What is a swan neck defomity and what can cause it

extension PIP and MCP/DIP flexion

due to tear of Volar plate

What occurs more often as trigger finger progresses

patient will be able to flex their finger BUT they will not be able to actively extend it

What tendons are impacted with DeQuervain's

extensor pollicis brevis and abductor pollicis longus in the 1 st compartment

What is a first class lever

-two forces on either side of axis

-example: triceps

Second class lever

-two forces on one side of an axis (load is closer to axis)

-example: toe raises

What is a third class lever

effort force in between load and axis of rotation

What is the most common type of lever in the human body

third class

Bankart lesion

tear of the labrum due to anterior dislocation or subluxation of the GH joint

anterior-inferior location

Hill-Sachs lesion

superior and lateral damage from repeated anterior dislocations

Crutch palsy

radial nerve with the most involvement

High radial nerve palsy

within the humerus spiral groove with triceps spared

paresthesia into forearm and below

Radial tunnel syndrome

compression of PIN in radial tunnel and 5cm distal to lateral epicondyle

-pain with resisted supination, finger extension in elbow ext and wrist flexion

PIN Syndrome

-compressed within the supinator

-deep pain in forearm with weak wrist extensors

-no sensory loss

Wartenberg's Syndrome

-sensory disturbaence on the dorsum of the hand with no motor loss

Most important mobilization for adhesive capsulities

posterior

Most common shoulder instability

anterior

Special tests for inferior instability

sulcus sign

Most rare shoulder instabilities

inferior

Treatment for anterior instability

-posterior stretching

scapula and rotator cuff exercises

-avoid chest press and pull downs

Treatments for posterior instability

-stability

-avoid weight bearing exercises

Treatments for inferior instability

-avoid weighted shrugs and elbow curls

Symptoms of Clubfoot

-high longitudinal arch

-tight calf

-smaller foot

Interventions for clubfoot

casting begins several weeks after birth and splinting

Mechanism of injury for high ankle sprain

DF with ER or eversion

Acute anterior compartment syndrome

-trauamtic with pain and lack of pulses

-medical emergency

0weak DF and toe extensior

Chronic exertional compartment syndrome

-repetitive exercises induces swelling

-no pain at rest

-weakness of DF and toe ext

-interventiosn with stetching and activity modifications

McKenzie Method for Herniated Disc Program

prone with pillows under hips

prone position

prone on elbows

prone press ups

standing

William Flexion progression for spinal stenosis

PPT

single knee to chest

double knee to chest

partial sit up

hamstring stretch in long sitting

hip flexor stretch

squat

If the hips shift anteriorly how will a patient respond

spinal ext

If the hips shift posteriorly how will a patient respond

spinal flex

Low back manipulation criteria

duration of symptoms over 16 days

symptoms above knee

lumbar hypomobility

1 hip with greater than 35 degrees of IR

FABQ less than 19

Low back traction criteria

-low back with radiation into calf

-symptoms into legs with ext

-positive SLR

Precautions with anterior hip replacement

-avoid ext, ADD and ER

-avoid hip flexion over 90

-avoid combined flex, abd and ER

Precautions with posterior hip replacement

-avoid hip flexion over 90, add and hip IR

Benefits of posterior hip replacement

gait pattern returned sooner

What is the main priority following total knee replacement

increase ext

knee flexion for tying shoe laces

106 degrees

knee flexion for stairs

85 degrees

Shoewear following achilles tendon repair

.4-.6in heel lift

Acute lateral ankle sprain treatments

-posterior TC mobs

-AROM in pain-free range

What nerve controls power grip

ulnar nerve

Normal range of motion and muscles associated with opening of mouth

35-55mm

lateral pterygoid

Normal range of motion and muscles associated with closing of mouth

temproalis

masseter

medial pterygoid

Normal range of motion and muscles associated with protrusion of mouth

7mm with medial and lateral pterygoid

Normal range of motion and muscles associated with retraction of mouth

3-4mm with posterior temporalis

Normal range of motion and muscles associated with lateral deviation of mouth

10mm with CL lateral and medial pterygoid

What is a disc displacement without reduction

intermittent locking without noises and opening limited to 25mm

deviates towards the normal side

What is a disc displacment with reduction

-pops and clicks with opening and closing

-closing click is the disc displacing anteriorly

What has better outcomes total knee or hip

knee