NPTE Musculoskeletal Conditions Notes

Characteristics:
- Restricted AROM (Active Range of Motion) and PROM (Passive Range of Motion).
- Dense adhesive fibrosis and scarring in the capsule.
- Chronic inflammation may be present in the rotator cuff, biceps tendon, and synovial tissue.
Presentations:
- Ages 40–65 years.
- More common in females.
- Commonly associated with diabetes mellitus (DM) and thyroid disease.
- Self-limiting condition that typically resolves on its own.
- Capsular pattern of motion loss is observed.
Treatment:
- Increase ROM with glenohumeral (GH) mobilizations.
- May require closed manipulation under anesthesia.

Characteristics:
- Common in throwing, swimming, and/or racquet sports.
- The humeral head and rotator cuff tendons move proximally and become impinged under the acromion and coracoacromial arch.
Presentations:
- Painful arc of motion, typically in the range of $60^{\circ}$ to $120^{\circ}$ .
- Positive special tests.
Treatment:
- RICE (Rest, Ice, Compression, Elevation).
- NSAIDs (Non-Steroidal Anti-Inflammatory Drugs).
- Rotator cuff strengthening exercises.
- Scapular stabilization exercises.
- Improvement of biomechanics.

Characteristics:
- Impaired blood supply to the tendon.
- Microtrauma leading to degeneration.
Presentations:
- Night pain or pain at rest.
- Limitation of abduction and lateral rotation.
- Positive special tests.
Treatment:
- RICE.
- NSAIDs.
- PROM, AAROM (Active-Assisted Range of Motion), and AROM exercises.
- Isometric exercises.
- Strengthening of upper limb muscles.
- Return to light functional activities should be gradual:
  - 6 weeks post-arthroscopic or mini-open repair.
  - 12 weeks post-traditional repair.
- Avoid returning to functional activities with heavy resistance for 6–12 months after a massive tear repair.

Characteristics:
- Chronic degenerative condition due to overuse injury of the common extensor muscles.
- Often seen in racquet sports or throwing activities.
Presentations:
- Ages 30–50 years.
- Pain over the lateral epicondyle of the humerus, mainly with gripping activities.
- Poor mechanics or faulty equipment may contribute.
- Positive special tests.
Treatment:
- RICE.
- NSAIDs.
- Cryotherapy (cold therapy).
- Thermotherapy (heat therapy).
- TENS (Transcutaneous Electrical Nerve Stimulation).
- Increase strength, flexibility, and endurance of wrist extensors.
- May use a strap or brace.

Characteristics:
- Chronic degenerative condition due to overuse injury of the flexor tendons.
- Common in baseball pitching and golf club swinging.
Presentations:
- Pain over the medial epicondyle, including the forearm and wrist, mainly with gripping and excessive pronation activities.
- Positive special tests.
Treatment:
- RICE.
- NSAIDs.
- Cryotherapy.
- Thermotherapy.
- TENS.
- Increase strength, flexibility, and endurance of wrist flexors.
- May use a strap or brace.

Characteristics:
- Fracture of the distal radius due to a FOOSH (Fall On Out-Stretched Hand) or a blow to the palmar side of the wrist.
- The fragment is often displaced in the dorsal and posterior direction, leading to a "dinner fork" deformity.
Presentations:
- Wrist pain, swelling, and deformity.
- Limited ROM.
- Tenderness over the distal radius.
Complications:
- Complex Regional Pain Syndrome (CRPS).
- Decreased grip strength.
- Loss of ROM.
- Carpal Tunnel Syndrome (CTS).
- Extensor Pollicis Longus (EPL) tendon tear.
Diagnosis:
- X-ray is used for diagnosis.
Treatment:
- NSAIDs.
- Closed or open reduction.
- External or internal nail fixations.
- Casting or splints.
- Edema reduction.
- Isometrics.
- PROM, AROM, and AAROM.
- Stretching.
- Modalities (hot pack, paraffin wax, cryotherapy, TENS).
- Increase strength, endurance, and coordination.

Characteristics:
- Fracture of the distal radius due to a fall on the back of a flexed hand or a blow to the dorsal side of the wrist.
- The fragment is often displaced in the palmar and anterior direction, leading to a "garden spade" deformity.
Presentations:
- Wrist pain, swelling, and deformity.
- Limited ROM.
- Tenderness over the distal radius.
Complications:
- Complex Regional Pain Syndrome (CRPS).
- Carpal Tunnel Syndrome (CTS).
- Malunion.
Diagnosis:
- X-ray is used for diagnosis.
Treatment:
- NSAIDs.
- Closed reduction.
- Casting or splints.
- Edema reduction.
- Isometrics.
- PROM, AROM, and AAROM.
- Stretching.
- Modalities (hot pack, paraffin wax, cryotherapy, TENS).
- Increase strength, endurance, and coordination.

Characteristics:
- Repetitive overuse injury.
- Seen in patients with limited flexibility, weakness, or foot pronation.
- Common in runners, gymnasts, dancers, and basketball players.
Presentations:
- Aching or burning pain in the heel.
- Tenderness of the Achilles tendon.
- Morning stiffness.
- Can lead to rupture.
Treatment:
- RICE.
- Heel lift.
- Cross-training.
- Heel cord stretching.
- Eccentric strengthening of the gastrocnemius and soleus muscles.

Characteristics:
- Inflammation of the plantar fascia at the calcaneus.
- Acute injury from excessive loading of the foot or excessive pronation.
Presentations:
- Heel pain.
- Heel spur.
- Morning pain.
- Post-activity pain.
- Pain when walking barefoot.
Treatment:
- RICE.
- NSAIDs.
- Heel cup.
- Massage using a tennis ball.
- Heel cord stretching.
- Taping of the medial longitudinal arch.

Characteristics:
- Contact or non-contact twisting injury associated with hyperextension and valgus stress.
Presentations:
- Knee buckling and/or popping.
- Positive special tests.
Treatment:
- RICE.
- NSAIDs.
- Strengthen quadriceps and hamstrings.
- Derotation brace.
- Mini-squats.

Characteristics:
- Contact or non-contact, fixed-foot, tibial rotation injury associated with valgus force and tibial external rotation (ER).
- Common in football, skiing, and soccer.
Presentations:
- Swelling.
- Antalgic gait (limping to avoid pain).
- Decreased ROM.
- Instability.
- Positive special tests.
Treatment:
- RICE.
- NSAIDs.
- Progressive strengthening exercises.
- Increase ROM.