-
Mild pain
some torn fibers
full ROM
Grade I Strain
-
Active contraction painful
many torn fibers
palpable divot or depression
swelling and discoloration
Grade II strain
-
Intense pain
complete muscle rupture
significant/complete loss of ROM
Grade III strain
-
Pain
Minimal loss of function
mild point tenderness
little/no swelling
no abnormal motion
Grade I Sprain
-
Pain
Poderate loss of function
swelling
slight/moderate instability
Grade II sprain
-
Extremely painful initially
loss of function
severe instability
tenderness
swelling and discoloration
Grade III sprain
-
Osteochondrosis
- degenerative changes in epiphyseal ossification centers
- interrupts blood supply - necrosis
-
Osteoarthritis
- Degeneration of cartilage
- Wear & Tear
- Pain and stiffness at rest
- Prominent in the AM
-
Legg-Calve-Perthes Disease
- AVN of femoral head normally from trauma
- Commonly boys ages 4-10
-
Rotator Cuff Injury
- + drop arm test
- + empty can test
- dull, aching pain over deltoid & arm/back
- Rarely under 40
-
Drop arm test
- Raise arms with help to 90 degrees and then lower slowly on their own
- + will not be able to slowly drop past 30 degrees
-
Empty can test
- Abduct 90 degrees
- horizontallly adduct 30 degrees
- internally rotate arm like pouring out a can
- Apply resistance at 30 degrees
- + abduction hard, weaker when adducted
-
Adhesive Capsulitis
- idiopathic restriction of shoulder movement
- contracted & thickened joint capsule
- pain with movement in all directions
- decreased ROM (A/P)
-
Tx for Adhesive Capsulitis
- aggressive joint Mobs
- relieve discomfort
- stretch tight muscles
- Estim for pain/Ultrasound
-
Thoracic Outlet Syndrome
- Pain in neck and shoulder
- numbness/tingling of fingers
- compression of nerves/vessles in thoracic outlet
-
S&S of Thoracic Outlet Syndrome
- Paresthesias
- Pain
- Cold sensation
- Atrophy
- Radial nerve palsy
- Decreased circulation in fingers
-
Tests for Thoracic Outlet Syndrome
- Adson's test
- Roo's Test
- Allen Test
-
Adson's Test
- Tests Anterior Scalenes
- Deep breath, chin towards affected side, neck extended
- + decreased radial pulse or stimulated pain
- For Thoracic Outlet Syndrome
-
Roo's Test
- Costoclaviculars tested
-
- + Unable to maintain position or pain/weakness/tingling
- For Thoracic Outlet Syndrome
-
Allen Test
- + decrease in radial pulse
- For Thoracic Outlet Syndrome
-
Biceps Rupture
- Tear of tendon(s)
- Commonly long head
- Excessive loading or sudden stress on tendon
-
S&S of Biceps Rupture
- Hear/feel "snap"
- intense pain @ injury
- visible mass between shoulder & elbow
- weak elbow flex/supination
- Bruising/swelling,
- decreased ROM (A/P)
- indentation of bicipital groove on palpation
-
-
Bicipital Tendonitis
- Long headl commonly
- Repeitive overhead motion
- Tender palpation anter upper arm over groove
- Crepitus
- Swelling
- Warmth
-
Tx for Bicipital Tendonitis
- Rest
- Cold/US therapy
- NSAIDs
- PT
-
Tests for Bicipital Tendonitis
- Yergason's
- Speed's
- Ludington's
-
Yergason's Test
- + pain/tender in bicipital groove
- For Bicipital Tendonitis
-
Speed's Test
- Arm supinated, resist shoulder forward flexion and pronation
- + pain in bicipital groove, rupture/strain if weak
- For Bicipital Tendonitis
-
Ludington's Test
- Hands behind head, flex/relax biceps
- + non-palpable biceps tendon
- For Bicipital Tendonitis
-
Shoulder Dislocation
- MOI - Abduction Extension Rotation, FOOSH
- Divot on shoulder
- Pop
- Sudden/severe pain
- Unable to touch opposite shoulder with affected hand
-
Tx of Shoulder Dislocation
- Immobilize
- Sling
- X-ray
- Reduction
-
Clavicle Fx
- FOOSH, direct impact
- common in children
- Protective splinting, pain, deformity, swelling
-
Tx of Clavicle Fx
- Sling/swathe
- Analgesia
- immobilization
- limit overhead movement
-
Humeral Fx
- Proximal - Low energy fall. Ice cream off cone
- Mid-shaft - Direct force to UE
- Distal - FOOSH, direct blow to elbow
-
Tx of Humeral Fx
- Stabilize
- RICE
- Reduce w/ immobilization
-
Lateral Epicondylitis
- Tennis Elbow
- Repetitive overuse of wrist/finger extensors
- Pain with wrist extension & forearm pronation
-
Tx of Lateral Epicondylitis
- RICE
- PT
- Analgesia
- NSAIDs
- Steroid injections
-
Medial Epicondylitis
- Overuse of flexors/valgus force on elbow
- Pain with resisted wrist flexion/pronation
-
Tx of Medial Epicondylitis
-
Olecranon Bursitis
- From trauma, hemorrhage, sepsis, rheumatic fever
- Pain, swelling, point tender
-
-
Carpal Tunnel Syndrome
- Compresion of median nerve with repeated wrist flexion
- Burning, tingling, pain
- Bothersome at night
-
Tests for Carpal Tunnel Syndrome
- Tinel Sign
- Phalen Sign
- Carpal Compression
-
Tinel Sign
- Tingling/shock-like pain elicited by tapping the flexor surface of the wrist
- For Carpal Tunnel
-
Phalen Sign
- Pareesthesia when pt flexes wrists to 90 degrees for 1 min
- For Carpal Tunnel
-
Carpal Compression
numbness/tingling induced by pressure over carpal tunnel
-
De Quervain's Disease
- Inflammation of sheath surrounding abductor pollicis longus & extensor pollicis brevis
- pain on radial wrist, pain on ROM, crepitus, tingling/numbness
- + Finkelstein Test
-
-
Finkelstein Test
- For De Quervain's Disease
-
Dupytren's Contracture
- Pope Sign
- Proliferative disorder of subcutaneous palmar fibrosis
- Contracture of finger joints, painless, digits 4&5, nodules
- + Table Test
- Tx: PT and Splinting
-
Table Test
- Placing palm on table and extending fingers
- + affected digits curve on fingertips
-
Trigger Finger
- Later adulthood
- Catching/snapping/locking of finger flexor tendon
- Dysfunction & pain
- Swelling, crepitus, nodule in hand, pain, locking of digits
-
Colles' Fx/Smith's Fx
- Distal radius fx when extended/flexed&pronated
- FOOSH
- Pain, swelling, ecchymosis, deformity
- Tx: splint, narcs, reduction, cast
-
Scaphoid/navicular fx
- Extension fall
- "snuffbox" pain
- Difficulty healing due to thin blood supply - AVN risk
- not usually visible on xray
- Pain/clicking w/ ROM, tender palpation
- Tx: Immobilize, surgical screws if displaced
-
Boxer's Fx
- Neck of 5th metacarpal
- MOI - Direct blow
- pain, tenderness, swelling, spliting x 3-4 wks
-
Bennett's Fx
- fx at base of thumb
- unstable
- Thumb is abducted
- Surgical stabilization & pinning
-
Rolando Fx
- Base of thumb - comminuted (crushed)
- Surgical stabilization required
-
Tuft Fx
- commonly middle finger
- crushing force like from a cleat
- painful/swollen
-
Trendelenburg limp
- pelivic tilt during stance phase
- + lean to affected side
-
Osteoarthritis
- Pain in AM, stiffness, deep groin pain, pain with hip flexion and internal rotation
- decreased ROM (A/P)
- XR - decreased joint space, osteophytes
- Tx: NSAIDs, PT, replacement
-
Greater Trochanteric Bursitis
- lateral hip pain
- tender to palpation
- pain with resisted hip abduction
- tx: Ice NSAIDs, steroid injection
-
Femoral Avascular Necrosis
- death of femoral head
- 20-40s and 6-10s
- Eventually need surgery
- pain in hip, groin pain, vague pain 4-6 mon prior, pain w/ internal rotation, norma neuro exam
-
Faber (Patrick's) Test
- Flex, abduct and externally rotate hip
- + hip or sacroiliac jt pain
-
Gaenslen's Test
- Supine @ edge of table. Opposite leg flexed, pressure on near leg
- + pain in ipsilateral SI joint
-
Trendelenburg Test
- Pt stands on one leg, one leg WB
- PSIS/Iliac cres on leg lifted will dro = weak gluteal mm.
-
Slipped Capital Femoral Epiphysis
- Adolescent, femoral head displaced relative to femur
- Still in acetabulum
- M>F, obeses, AA
- Weakened growth plate with higher than normal stress or endocrine conditions
-
S&S of Slipped Capital Femoral Epiphysis
- Pain in groin, thigh, knee
- decreased internal rotation
- limp, trendelenburg gait, increased pain with internal rotation
-
Anterior/Posterior Drawer Test
- Pt supine knee flexed, sit on foot.
- Push/pull lower leg while holding hamstrings
- Tests ACL/PCL
-
Lachman's Test
- Grasp femur and proximal tibia. Push femur down, pull tibia up
- Tests ACL
-
McMurray's Test
- For meniscal tears
- Hold knee and heel
- Rotate heel @ 90 degrees, 30 degrees and figure 8
- + pain/click around meniscus
-
Varus/Valgus Stress
- Abduct hip, knee @ 30 degrees, apply stress against ligament
- Tests MCL/LCL
-
Apley's Test
- Compression/distraction of menisci and capsule
- Prone, knee @ 90 degrees
- Compress tibia into femur and roate
- Hold thigh down and lift up and rotate
-
Meniscal Injury
- Episodic painful popping/locking/givign way
- focal tenderness to palpation @ affected joint
- MRI
- Tx: PT, NSAIDs, surgery
- Pain, swelling and inability to straighten knee
-
ACL Injruy
- Increased in female, typically non contact
- pain, "pop", swelling, instability
- + Lachmans, Pivot shift, Ant Drawer
- MRI to visualize
- RICE, splint, crutches, PT/OT
-
PCL injury
- M > F, young adulte
- hyperextension injury
- Possible popliteal artery injury
- Blow to anterior tibia with knee flexed and foot planted
- minimal instability, pain, swelling
- ROM, PT, Surgery if grade 3
-
MCL/LCL Injury
- blow to medial/lateral knee
- pain ando/or laxity @ 0-30 degree valgus/varus stress
- r/o fx
- RICE, hinged knee brace, PT
- LCL - figure 4 position
-
Osgood-Schlatter Disease
- Microfractures of the tibial tubercle
- Repetitive jumping, leg extension. 8-15 y/o M>F
- Dull, aching pain over patellar tendon - exacerbated by resisted knee extension
- Tx: rest, ice, PT, gradual activity return
- NO CORTICOSTEROIDS
-
Baker's Cyst
- Herniation of synovium into popliteal region
- Children & > 55 y/o
- Meniscal tear/arthritis/rheumatoid
- Mimics DVT - Duplex US to r/o
- Asympt normally
- Symptoms - discomfort/stiffness of knee
-
Achilles Rupture
- Rupture of terminal segment of gastroneumis and soleus
- young adults & 30-40s
- "snap"/"pop", severe localized pain. Swelling w/ palpable divot
- r/o fx of calcaneus
- Splint, RICE, WB @ 4-6 wks w/ PT
-
Compartment Syndrome
- Increased interestitial pressure within the closed compartment
- Swelling, impaired venous & lymphatic return, > 30 mmHg pressure
- Pain, Pallor, Paresthesias, paralysis, pulses, stryker needle
- Fasciotomy, NSAIDs, Surgical
-
Osteomyelitis
- Bone infection - bacterial/fungal
- Bone pain, fever, malaise, swelling/redness/warmth
- IV antibiotics, surgery to remvoe dead tissue
-
Scoliosis
- Lateral deviation of spine, most common in girls
- scapula prominence, waist assymmetry, shoulder/pelvis not level
-
Tenosynovitis
- Inflammation of tendon & surrounding synovial sheath
- pain with passive extension of digit - Hallmark
- Tenderness, swelling & limited movement
- worse on awakening, tender sheaths on palpation
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