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Musculoskeletal: Pathology
| Pathology | Description | Etiology | Signs andSymptoms | Treatment |
|---|---|---|---|---|
| achilles tendonitis | repetitive overuse disorder resulting in microscopic tears of collagen fibers of the achilles tendon | -repetitive overuse disorder -limited gastroc/soleus flexibility and strength -pronated or cavus foot -achilles tendonitis increases likelihood of achilles rupture later in life | -aching, burning on posterior heel tenderness in achilles tendon -pain with increased activity -swelling and thickening in the tendon area -muscle weakness due to pain -morning stiffness | -initially RICE, NSAIDs, analgesics as needed -heel cord stretches, proper footwear, eccentric strengthening of gastroc/soleus, avoiding sudden changes in training intensity |
| adhesive capsulitis | soft tissue contracture often caused by adhesive fibrosis and scarring between the shoulder capsule, rotator cuff, subacromial bursa, and deltoid, resulting in loss of passive and active ROM | -insidious, or related to direct shoulder injury -females, people 40-60 years old, and people with diabetes more likely to develop adhesive capsulitis -typically resolves in 1-2 years but may leave residual ROM limitations | -insidious onset of localized pain often extending down the arm -subjective reports of stiffness, night pain -loss of ROM in capsular pattern | -glenohumeral mobilization, stretching and strengthening exercise -avoid overstretching and elevating pain- can cause further loss in ROM -surgical intervention includes suprascapular nerve block, closed manipulation under anesthesia |
| ACL sprain | sprain to the ACL, which prevents anterior displacement of the tibia in relation to the femur. ranges from microscopic tears (grade I) to complete rupture (grade III) | -nontwisting injury associated with hyperextension, varus, or valgus stress to the knee -often associated with injury to other structures such as medial capsule, MCL, and menisci | -pt reports loud pop or feeling of knee buckling/giving way, followed by dizziness, sweating, swelling -positive Lachman test, anterior drawer test | -initially RICE, NSAIDs, analgesics as needed -LE strengthening, primarily for quads and hamstrings -grade III usually requires surgical reconstruction involving patellar tendon, IT band, or hamstring graft |
| congenital hip dysplasia | malalignment of the femoral head within the acetabulum; also known as developmental dysplasia | -cultural predisposition -mispositioning in utero -environmental and genetic influences | -asymmetrical hip abduction with tightness and apparent femoral shortening on involved side -positive Ortolani's test, Barlow's test | -treatment depends on age, severity -conservative treatment includes bracing, splinting, traction -surgical intervention involves an open reduction and subsequent hip spica casting |
| congenital limb deficiencies | malformation that occurs in utero secondary to an altered developmental course. classified as longitudinal (reduction/absence of an element within the long axis of the bone) or transverse (development to a level beyond which no skeletal elements exist) | -usually idiopathic or genetic in origin -possible poor blood supply, maternal drug use, nutrient deficiencies | -structural or acquired limb abnormality -phantom limb pain | -symmetrical movement, strengthening, ROM, weight bearing activities -prosthetics when appropriate |
| congenital torticollis | unilateral contracture of the sternocleidomastoid muscle | -idiopathic -mispositioning in utero -positioning preferences post-natally | -lateral cervical flexion on involved side and rotation toward contralateral side | -conservative treatment involves stretching, AROM, positioning, caregiver education -surgical intervention indicated when conservative treatment fails and child is older than 1 |
| glenohumeral instability | excessive translation of the humeral head on the glenoid during active movement. ranges from subluxation to complete dislocation | -combination of force stresses to the anterior capsule, glenohumeral ligament, and rotator cuff -anterior dislocation the most common | -subluxation: feeling of shoulder 'popping' out and back into place, pain, parasthesias, 'dead' feeling in arm, positive apprehension test -dislocation: severe pain, parasthesias, limited ROM, weakness, visible shoulder fullness | -initial immobilization for 3-6 weeks, NSAIDs and analgesics as needed -ROM, isometric exercises progressing to resistive exercise, emphasis on IR, ER, large scapular muscles |
| impingement syndrome | repetitive overuse injury often caused by microtrauma from repetitive UE extremity use above the horizontal plane | -humeral head and associated rotator cuff attachments migrating proximally and becoming impinged on the undersurface of the acromion and coracoacromial ligament | -discomfort or pain deep within shoulder -pain with overhead activities -painful arc of motion (70-120 degrees abduction) -positive impingement sign, tenderness over greater tuberosity and bicipital groove | -NSAIDs, RICE, activity modification initially -rotator cuff strengthening, scapular stability exercises |
| juvenile rheumatoid arthritis | most common rheumatic disease amongst children and presents with inflammation of the joints and connective tissue | -unknown -theorized a virus, infection, etc. triggers an autoimmune response and results in JRA in children with a genetic predisposition | -systemic: acute onset, high fever, rash, enlargement of spleen+liver, inflammation of lungs+ heart -polyarticular: high female incidence, significant rheumatoid factor, arthritis in 4+ joints -oligoarticular: asymmetrical joint involvement in <5 joints | -NSAIDs, corticosteroids, antirheumatics, immunosuppressive agents -passive and active ROM, positioning, splinting, strengthening, endurance training, functional mobility, weight bearing activities |
| lateral epicondylitis | inflammation of the common extensor muscles at their origin on the lateral epicondyle of the humerus | -eccentric loading of the wrist extensor muscles resulting in microtrauma -common in individuals 30-50 years of age | -pain immediately distal to the lateral epicondyle -pain typically worse with repetition or resisted wrist extension | -NSAIDs, RICE, activity modification initially -strengthening, endurance training -strap placed three inches distal to elbow joint can help reduce symptoms |
| Legg-Calve-Perthes disease | self-limiting disease caused by degeneration of the femoral head due to a disturbance in blood supply | -trauma, genetic predisposition, synovitis, vascular abnormalities, infection | -pain, decreased ROM, antalgic gait, positive Trendelenburg sign | -focus is to relieve pain, maintain proper femoral head position, improve ROM -stretching, splinting, crutch training, aquatic therapy, traction, exercise -possible surgery or orthotics |
| MCL sprain | sprain to the MCL, often seen in combination with ACL or meniscus injuries | -valgus force resulting in lateral tibial rotation on a fixed foot | -swelling, antalgic gait, decreased ROM, feeling of instability | -initially RICE, NSAIDs, analgesics as needed -decrease inflammation, protect joint, ROM and strengthening exercise -surgery rare |
| meniscus tear | tears to the menisci of the knee commonly seen in combination with other injuries such as ACL or MCL tears. medial meniscus injuries more common that lateral | -fixed foot rotation in weight bearing with a flexed knee, resulting in compressive and rotational force | -joint line pain, swelling, catching or locking sensation -positive Apley's test, McMurray test | -RICE, NSAIDs, analgesics as needed initially -palliative modalities and strengthening -surgery warranted for active individuals |
| Osgood-Schlatter disease | self-limiting condition that results from repetitive traction on the tibial tuberosity apophysis | -repetitive tension of the patellar tendon over the tibial tuberosity | -point tenderness over the patellar tendon at the insertion on the tibial tuberosity -antalgic gait -increased pain with activity | -education, icing, flexibility exercises -limit stressful activity (jumping, squatting, running) |
| osteoarthritis | chronic disease that results in degeneration of the articular cartilage, primarily in weight bearing joints. subsequent deformity and thickening of subchondral bone results in impaired function | -unknown cause -begins appearing around middle age and is seen in virtually all people above the age of 70 -risk factors include chronic overuse, fractures or other joint injuries, and being overweight | -gradual onset of pain at affected joint, increased pain after exercise or with weather changes, enlarged joints, crepitus, stiffness, limited ROM, Heberden's and Bouchard's nodes | -focus on reducing pain, protecting the joint and increasing function -NSAIDs, corticosteroids, -passive and active ROM, patient education, heating and cooling agents, strengthening exercise, TENS, energy conservation |
| osteogenesis imperfecta | connective tissue disorder that affects the formation of collagen during bone development | -genetic inheritance -types I and IV are autosomal dominant -types II and III are autosomal recessive | -pathological fractures, osteoporosis, hypermobile joints, bowing of long bones, weakness, scoliosis, impaired respiratory function | -begins at birth with caregiver education on proper handling and facilitation of movement -AROM emphasizing symmetrical movement, positioning, functional mobility, fracture management, use of orthotics -wheelchairs used when ambulation is not realistic |
| patellofemoral syndrome | general term for pain or discomfort in the anterior knee | -repetitive overuse disorder -decreased quad strength, decreased LE flexibility, patellar instability, increase tibial torsion or femoral anteversion -females, individuals experiencing a growth spurt, runners, overweight individuals more likely | -anterior knee pain -pain with prolonged sitting -crepitus -pain with ascending or descending stairs | -varies depending on cause of abnormal tracking -modalities to decrease pain and inflammation, LE stretching and strengthening, medial patellar glides, biofeedback, patella taping |
| plantar fasciitis | inflammation of the plantar fascia at the proximal insertion on the medial tubercle of the calcaneus | -often associated with an acute injury from excessive loading of the foot or chronic irritation from excessive pronation -seen most often in 40-60 year olds | -tenderness at insertion point of plantar fascia -presence of heel spur -pain worse in morning or after prolonged inactivity -pain walking on bare feet -difficulty with prolonged standing | -initially RICE, NSAIDs, analgesics as needed -heel cup, massage, medial longitudinal arch taping, joint mobilization -heel cord stretches, proper footwear, orthotics, proper progression of training programs |
| PCL sprain | sprain to the PCL, which prevents posterior displacement of the tibia in relation to the femur. ranges from microscopic tears (grade I) to complete rupture (grade III) | -landing on tibia with knee flexed -hitting dashboard in MVA with knee flexed -isolated tears rare | -feeling of femur sliding off tibia -swelling, mild pain possible -often asymptomatic -positive posterior sag test, posterior drawer test | -NSAIDs, analgesics, RICE as needed initially - strengthening and functional exercise progression -surgery rare; isolated hamstring exercise avoided first 6 weeks |
| rheumatoid arthritis | systemic autoimmune disorder of unknown etiology and characterized by periods of exacerbation and remission; can begin in any joint but mostly involves the small joints of the hand, foot, wrist, and ankle | -unknown; females 3x more likely to develop RA -typically diagnosed at 40-60 years | -onset can be gradual or sudden -symmetrical involvement -pain and tenderness at effected joints -morning stiffness -warm joints; decreased appetite -malaise -increased fatigue -swan neck deformity -boutonniere deformity -low grade fever | -reduce pain and inflammation, prevent joint destruction and deformity -NSAIDs and corticosteroids -antirheumatic medications to slow progression -PROM, AROM, splinting, heating/cooling agents, pt education, energy conservation |
| rotator cuff tear | tear to the rotator cuff caused by acute trauma or chronic degeneration. tears can span only a portion of the tendon (partial thickness) or the entire tendon (full thickness) | -intrinsic: impaired blood supply to tendon -extrinsic: trauma, microtrauma, postural abnormalities | -shoulder level asymmetry -possible rib humping -pain due to abnormal pressures placed on tissues | -conservative: RICE, NSAIDs, analgesics; prevent adhesive capsulitis and strengthen UE -post surgical: pt in sling; length of immobilization varies depending on surgeon and extent of tear. progress PROM, AROM, functional activities |
| scoliosis | lateral curvature in the spine that can result from structural, non-structural, or degenerative causes | -usually idiopathic; commonly diagnosed between 10-13 years of age -males and females equally likely to develop mild (>10 degree) curve; females more likely to develop curves greater than 30 degrees | -shoulder level asymmetry -possible rib humping -pain due to abnormal pressures placed on tissues | -non progressive curves typically receive no formal intervention -muscle strengthening and flexibility exercises -25-40 degree curves often warrant bracing/orthotics -curves greater than 40 degrees typically require surgery |
| talipes equinovarus | deformity characterized by the heel pointing downward and the forefoot turning inward; also known as clubfoot | -unknown; possibly genetics, positioning in utero, or defect in ovum -accompanies other neuromuscular abnormalities such as spina bifida and arthrogryposis and may result form lack of movement in utero | -adduction of the forefoot -varus positioning of the hindfoot -equinus at the ankle | -serial casting and splinting begin shortly after birth -severe cases or failed conservative treatment requires surgery and subsequent casting |
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saram6450
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