Common MSK conditions

Adhesive capsulitis characteristics

Restricted AROM and PROM; dense adhesive fibrosis and scarring in capsule; chronic inflammation may be seen in rotator cuff, biceps tendon and synovial tissue

Adhesive capsulitis presentation

Ages 40—65; females; commonly associated with DM and thyroid disease, self-limiting, resolves on its own; capsular pattern loss

Adhesive capsulitis treatment

Increase ROM with GH mobilizations; may need closed manipulation under anesthesia

Impingement syndrome characteristics

Throwing, swimming, and/or racquet sports; humeral head and rotator cuff tendons moving proximal and becoming impinged under acromion coracoacromial arch

Impingement syndrome presentation

Painful arc 60—120; + special tests

Impingement syndrome treatment

RICE; NSAIDs; rotator cuff strengthening; scapular stability; improved biomechanics

Rotator cuff tear characteristics

Impaired blood supply to tendon, microtrauma and resulting degeneration

Rotator cuff tear presentations

Night or resting pain; limitation of abduction and lateral rotation; + special tests

Rotator cuff tear treatment

RICE; NSAIDs; PROM, AAROM and AROM; isometrics; strengthen UE mm;

wait to return to light functional activities: 6 wk for arthroscopic,

12wk for traditional,

avoid returning to functional activities with heavy resistance for 6—12mo after massive tear repair

Lateral epicondylitis characteristics

Chronic degenerative condition due to overuse injury to common extensor muscles; often from racquet sports or throwing

Lateral epicondylitis presentation

Ages 30—50; pain over lateral epicondyle of humerus mainly with gripping activities; poor mechanics or faulty equipment, + special tests

Lateral epicondylitis treatment

RICE; NSAIDs; cryo; thermo; TENS; increase strength, flexibility, and endurance of wrist flexors; may use a strap for assist

Medial epicondylitis characteristics

Chronic degenerative condition due to overuse injury to flexor tendons; baseball pitching, golf club swing

Medial epicondylitis presentations

Pain over medial epicondyle, including forearm and wrist, mainly with gripping and excessive pronation activities, + STs

Medial epicondylitis treatment

RICE; NSAIDs; cryo; thermo; TENS; increase strength, flexibility and endurance of wrist flexors; may use strap

Colles fx characteristics

Fx of distal radius due to FOOSH or blow to palmar side of wrist; fragment often displaced in the dorsal and posterior direction, can lead to dinner fork deformity

Colles fx presentation

Wrist pain, swelling, dinner fork deformity, tender over distal radius, CRPS, decreased grip strength; loss of ROM, extensor pollicis longus tendon tear

Colles fx treatment

NSAIDs; closed or open reduction; external or internal nail fixations; casting splint; edema reduction; isometrics; ROM; stretching, modalities; increase strength, edurance and coordination

Smith Fx (reverse Colles fx) characteristics

Fx of distal radius due to fall on the back of flexed hand or blow to dorsal side of wrist; fragment often displaced in the palmar and anterior direction, can lead to garden spade deformity

Smith Fx (reverse Colles fx) presentation

Wrist pain, swelling, garden spade deformity, tender over distal radius, CRPS, malunion

Smith Fx (reverse Colles fx) treatment

NSAIDs; closed reduction; external or internal nail fixation; casting; splint; edema reduction; isometrics; ROM; modalities; increase strength, endurance and coordination

Achilles tendinitis characteristics

Repetitive overuse; seen in patients with limited flexibility, weakness, foot pronation; runners, gymnasts, dancers, basketball players

Achilles tendinitis presentation

Aching or burning in heel, tenderness of achilles tendon, morning stiffness; can lead to rupture

Achilles tendinitis treatment

RICE; heel lift; cross-training; heel cord stretching; eccentric strengthening of gastroc soleus

Plantar fasciitis characteristics

Inflammation of plantar fascia at calcaneus; acute injury from excessive loading of foot or excessive pronation

Plantar fasciitis presentation

heel pain, heel spur, morning pain, postactivity pain, pain when walking barefoot

Plantar fasciitis treatment

RICE; NSAIDs; heel cup; massage using tennis ball; heel cord stretching; taping medial longitudinal arch

ACL sprain characteristics

contact or non contact twisting injury associated with hyperextension and valgus stress

ACL sprain presentation

knee buckling and/or popping; + STs

ACL sprain treatment

RICE; NSAIDs; strengthen quadriceps and hamstrings; derotation brace; mini squats

MCL sprain characteristics

Contact or non contact, fixed foot, tibial rotation injury associated with valgus force and tibial ER, football, skiiing, soccer

MCL sprain presentation

Swelling, antalgic gait, decreased ROM, instability; + STs

MCL sprain treatment

RICE; NSAIDs; progressive strengthening; increase ROM

1st degree ligament sprain definition

Few fibers of ligament torn, overstretch/overload injury, acute, minor limitations of strength and motion, painful on stretch.

2nd degree ligament sprain definition

About half of the ligament is torn, overstretch/overload injury, acute, minor to moderate strength and motion limitations, painful on stretch.

3rd degree ligament sprain definition

All ligament fibers or torn (rupture), overstretch/overload injury, acute, minor to moderate weakness, moderate to major loss of function, normal to excessive joint play, palpable defect if early, no pain on stretch, increased ROM (dependent on swelling severity)