Common Musculoskeletal Disorders in Adults PDF

Common musculoskeletal disorders in adults Common Hand Problems Common hand problems include:- Carpal tunnel syndrome Scapholunate De Quervain sprains tenosynovitis Hand and Thumb and wrist finger...

Common musculoskeletal disorders in adults Common Hand Problems Common hand problems include:- Carpal tunnel syndrome Scapholunate De Quervain sprains tenosynovitis Hand and Thumb and wrist finger fractures injuries  Carpal tunnel syndrome Definition Compression of the median nerve in the carpal tunnel at the wrist due to direct trauma, repetitive use, or anatomic anomalies. Most commonly affects middle-aged or pregnant women. May lead to thenar atrophy Symptoms/Exam  Vague ache into the thenar eminence and sometimes the forearm.  Numbness, tingling and pain in a median nerve distribution (thumb, index, middle and radial half of the ring fingers).  Late symptoms: weakness, dropping objects, persistent numbness, and thenar atrophy. Diagnosis: EMG (median nerve conduction velocity study) confirms the diagnosis and indicates severity Up to 25% of patients with carpal tunnel syndrome have normal EMG results.  De Quervain tenosynovitis: Swelling and stenosis of the sheath that surrounds the thumb extensor tendons. More common in middle-aged women. Often precipitated by repetitive use of the thumb and activities requiring a forceful grip (eg, cleaning tasks, racket sports). Presents with pain, tenderness ± swelling over the radial styloid, especially with use of the thumb and ulnar deviation of the wrist. Positive Finkelstein test is pathognomonic. Avoid activities that provoke pain. Consider a thumb spica splint to immobilize the wrist and thumb. Consider corticosteroid injection into the tendon sheath for acute relief. Surgical decompression is appropriate if no improvement with conservative measures. Scapholunate sprains: Usually caused by falls onto an outstretched hand. Presented with Pain in the wrist with movement, grip, lifting. Obtain radiographs: Must rule out carpal dislocation, carpal instability, scaphoid fracture, displaced intra-articular distal radius fracture.  Hand and wrist fractures In a fall onto an outstretched hand (FOOSH), approximately 80% of the force goes through the radial side of the wrist. Subtypes of wrist fractures include: Distal radius fractures: Most frequently occurring fracture in adults. Colies fracture: Fall onto an extended wrist; distal fragment of the radius is tilted dorsally. Smith fracture: Fall onto a flexed wrist; distal fragment of the radius is tilted volarly. Galeazzi fracture: Diaphyseal fracture of radius with dislocation of distal radial- ulnar joint. Caused by direct blow to radius. Ulnar fractures: “Nightstick fracture": Fracture of ulnar shaft, often from self-defense with arm against blunt force. Monteggia fracture: Diaphyseal fracture of proximal ulna with subluxation of the radial head. Scaphoid fractures: Most commonly fractured carpal bone; most common in young men. Clinically presents with snuff box tenderness. If initial x-ray films are negative for fracture, still immobilize the area with thumb spica cast and repeat imaging after 10 to 14 days Thumb and finger injuries Ulnar collateral ligament (UCL) tear: Fall onto an abducted thumb, causing an acute rupture of the UCL of the thumb MCP joint presented with Instability of the MCP joint of the thumb accompanied by pain and weakness with pinch grasp. Mallet finger: Forced flexion of an actively extended DIP joint. causing disruption of the extensor mechanism at its insertion into the distal phalanx. Full passive ROM but an inability to actively extend the DIP joint. Clinical diagnosis, but obtain x-rays to evaluate for bony avulsion versus tendon rupture. Boutonniere deformity: Disruption of the central slip of the extensor tendon where it inserts into the middle phalanx. If not properly treated, the head of the middle phalanx may buttonhole through the defect between the lateral bands of the extensor tendon mechanism, causing fixed flexion at the PIP joint. Obtain radiographs to rule out fracture Trigger finger: Inflammation of the flexor tendon, with thickening and stenosis of the first annular (A1) pulley, causing pain and catching with flexion/extension of the finger. Most cases are degenerative, although there is an association with rheumatoid arthritis. A nodule (the thickened A1 pulley) is often palpable by the distal palmar crease Boxer fracture: Fracture of the neck of the fifth metacarpal due to punching an object with a closed fist. On radiographs: Up to 40° of angulation tolerated, as long as there is no extensor lag (the patient can fully extend the finger). Jersey finger: Forced extension of actively flexed DIP joint (eg, grabbing someone's jersey), causing an avulsion of the flexor digitorum profundus tendon from its insertion on the distal phalanx. ~ 75% of cases involve the ring finger presented with Inability to bend the finger down to the palm of the hand. Osteoarthritis  Definition Osteoarthritis is a common degenerative joint disease is characterized by the breakdown and eventual loss of cartilage in the joints. As the cartilage wears down, the bones may rub against each other, causing pain, swelling, stiffness, and reduced joint mobility. It typically occurs in weight-bearing joints such as the knees, hips, and spine Risk factors/ etiology 1. Age: The risk increases with age, as the wear and tear on joints accumulate over time. 2.Obesity: Excess weight puts additional stress on weight-bearing joints, increasing the likelihood of developing osteoarthritis. 3. Joint injuries: Prior joint injuries or repetitive stress on joints, such as from sports or certain occupations, can contribute to the development of osteoarthritis. 4. Genetics: Some genetic factors may predispose individuals to osteoarthritis. 5. Gender: Women are more commonly affected by osteoarthritis, particularly after menopause. 6. Certain medical conditions: Other conditions like rheumatoid arthritis, gout, and metabolic disorders can increase the risk of developing osteoarthritis. Presentation The clinical presentation of osteoarthritis can vary but commonly includes the following: 1. Joint pain: Persistent or intermittent pain in the affected joint(s) during movement or weight- bearing activities. 2. Joint stiffness: Stiffness in the joint, especially after periods of inactivity or rest. 3. Joint swelling: Mild to moderate swelling around the affected joint(s) may occur. 4. Reduced range of motion: Joint movement becomes limited, leading to difficulties in performing daily activities. 5. Joint instability: The affected joint(s) may feel unstable or give way, particularly in later stages of the disease. 6. Joint deformities: In advanced cases, osteoarthritis can cause visible joint deformities, such as bony outgrowths or knobby appearances Treatment Lines of management: The management of osteoarthritis focuses on relieving symptoms, improving joint function, and enhancing overall quality of life. Treatment options include: 1. Non-pharmacological interventions: These include weight management, exercise programs, physical therapy, occupational therapy, assistive devices (e.g., braces, canes), and the use of heat or cold therapy. 2. Medications: Over-the-counter pain relievers (e.g., acetaminophen, nonsteroidal anti- inflammatory drugs) can help manage pain and inflammation. In some cases, the doctor may prescribe hyaluronic or corticosteroid injections. 3. Lifestyle modifications: Adopting a healthy lifestyle can have a positive impact on osteoarthritis. This includes maintaining a balanced diet, regular exercise, avoiding excessive joint stress, and managing comorbidities like obesity or diabetes. 4. Surgical interventions: In severe cases where conservative treatments are ineffective, surgical options such as joint replacement surgery or joint fusion may be considered. Common Knee Injuries Common knees injuries: 1) Soft tissue injuries: Anterior Cruciate Ligament (ACL) Injuries/ tears Posterior Cruciate Ligament (PCL) Injuries (PCL tear) Collateral Ligament Injuries/tears Meniscus tear Tendon Tears 2) Fractures (Patellar Fractures, Distal Femur , Fractures of the Knee, Fractures of the Proximal Tibia): 3) Dislocation 4) Arthritis (e.g: osteoarhritis, rheumatoid arthritis) Presentation: Common symptoms and signs of knee injuries include: Pain and tenderness Swelling Limitation in the range of motion or stiffness Instability Weakness Joint deformity Management 1) investigatons: x-ray, CT or MRI 2) treatment: a) Non surgical: pain control with NSAIDs physiotherapy and rehabilitation b) surgical: refer to orthopedic surgeon Common shoulder and elbow injuries Common shoulder pathologies 1) Shoulder instability : happens most often in young people and athletes. When muscles and ligaments that hold it together are stretched beyond their normal limits, the shoulder becomes unstable. 2) Rotator cuff tear: Patients are usually >50 years of age and will often have significant pain with abduction above the head and internal rotation. 3) Frozen shoulder: loss of both active and passive motion of the shoulder; Significant association with diabetes 4) Overuse/strains: A sudden increase in activity can place great stress on the shoulders and lead to a loss of flexibility. Rotator Cuff Muscles: 5) Arthritis (e.g: osteoarhritis, rheumatoid arthritis) SITS: Supraspinatus (abduction) Infraspinatus 6) Shoulder fractures and dislocation (external rotation) Teres minor (external rotation) Subscapularis (internal rotation) Presentation: Common symptoms and signs of shoulder injuries include: Pain and tenderness especially with movement or lying down over the affected shoulder Limitation in the range of motion or stiffness of the shoulder Instability Weakness Joint deformity Management 1) investigatons: x-ray, CT or MRI 2) treatment: a) Non surgical: pain control with NSAIDs physiotherapy and rehabilitation b) surgical: refer to orthopedic surgeon  Common elbow pathologies EPICONDYLITIS/ELBOW TENDINOSIS Repetitive stress across the common tendon of the wrist flexors (medial) or extensors (lateral), resulting in a tendinosis. Symptoms/Exam Activity-related pain (over medial vs lateral elbow) progressing to pain at rest. Management PT with focus on stretching and strengthening is superior to rest, NSAID, steroid injection, or bracing alone. OLECRANON BURSITIS Caused by repeat friction of olecranon against hard surface, or trauma; most common type of bursitis and common cause of painless elbow swelling. Exam notable for soft, fluctuant area of swelling over olecranon. Treat with compression and ice; avoid impact over olecranon and NSAID. Back pain  Definition Back pain is defined as pain felt in spine from thoracic spine to the pelvis Generally back pain is classified to mechanical and non- mechanical pain in nature Etiology There are numerous causes for back pain; Generally pain can be attributed to: 1- nerve root compression and subsequent inflammation. 2- Mechanical damage of spine components ( degenerative causes and bony changes) as disc prolapse, spondylosis or spondylolysis 3- Inflammatory causes ( spondylo-arthropathies) 4- Traumatic causes 5- Osteoporosis (compression fractures) 6- muscle spasm or strain 7- Others as, psychogenic causes, referred pain, pregnancy, bad posture or fibromylgia  presentation 2 main presentations - Mechanical back pain Age usually more than 40 years old Most patients reported sharp, burning and stabbing pain in back Radiating down to the leg (sciatica) Pain is intermittent but get worse by activity, straining and standing and relieved by rest. Paraesthesia and motor weakness may be associated ( their distribution may help in localizing site of injury) May neurological deficit in the form of bladder and anal canal abnormalities ( cauda equina syndrome) Inflammatory back pain Age usually less than 40 years old Most patients reported insidious onset low back pain associated with alternating buttocks pain Pain is increased by rest and relieved by exercise (pain increased at night and associated with morning stiffness) Paraesthesia and motor weakness and any other neurological deficit s ate unlikely may be associated with enthesitis, arthritis , skin lesions (symptoms of SPA )  Evaluation The key here to differentiate mechanical and inflammatory back pain By clinical examination and proper history - Radiology 1. plain x ray ( spine, hips and both sacroiliac joints) 2. MRI -Laboratory evaluation 1. HLA B 27 (SPA) 2. ESR, CRP Treatment According to cause 1- Mechanical back pain: Patient education( weight loss if obese, good posturing) Symptomatic treatment (analgesics, muscle relaxants, local injections) Physiotherapy and spinal orthosis (according to cause) Surgery indicated if; progressive neurological deficit. 2- Inflammatory back pain: Patient education( weight loss if obese, good posturing) Full dose NSAIDS May need for Biologic therapy.