MSK Interventions By Tissue Stage
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Signs
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Interventions
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Inflammatory (Injury -> 2-4 days)
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Pain (dolor), heat (calor), redness (rubor), swelling (tumor), and loss of function (functio laesa
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Rest
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Immobilize and protect the affected area; exercise the unaffected areas; NWB or PWB; PROM if applicable; continuous passive motion (CPM) postoperatively
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Cryotherapy
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(ice or cold)
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Compression
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taping, bracing, or orthotics
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Elevation
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Decrease pain:
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Physical agents and modalities for pain management and swelling
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Patient education:
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Educate about avoidance of activities and how to protect the area
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Fibroblastic (3 weeks)
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Protect:
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Bracing or orthotics; progressive WB such as PWB or WBAT
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Decrease Pain:
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Physical agents and modalities for pain management and swelling
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Increase ROM and function:
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use scar mobilization techniques; PROM, AAROM, AROM; isometric exercises; stretching exercises (start with light stretching because tissue is delicate in the beginning); CKC if pain and swelling subsided; ADLs
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Patient education:
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how to protect the affected area; avoid excessive motion for tissue irritation/ destruction
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Remodeling Phase (3 weeks -> 3 months)
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Increase strength and function to normal:
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restore stability, mobility, joint arthrokinematics, gradual return to work/school/hobbies
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Patient education:
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how to avoid future injury
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Statistically significant would mean the result is likely NOT due to chance.
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Sensitive
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Correctly identifies the number of true positive
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Specificity
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Correctly rules out negatives
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If a Lachman's test correctly identifies 95% of patients as positive for anterior cruciate ligament tears, then the MRI is:
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Sensitive, as it rules in
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Instructions:
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Patient rotates head opposite to tested side maximally and holds position for 10 seconds. Patient returns to neutral for 10 seconds.
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Patient extends head for 10 seconds. Patient returns to neutral for 10 seconds.
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Patient extends and rotates head (again opposite tested side) maximally for 10 seconds
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Positive symptoms:
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Include (The 5 D’s) dizziness, diplopia, dysarthria, dysphagia, drop attacks
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And (The 3D's) nausea, numbness, and nystagmus
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Shoulder
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Flexion
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180
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Extension
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60
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Abduction
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70
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IR
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70
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ER
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80
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Adduction
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135
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Elbow
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Flexion
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150
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Extension
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60
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Radioulnar
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Pronation
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80
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Supination
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80
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Wrist
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Flexion
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80
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Extension
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70
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Radioulnar
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20
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Ulnar
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30
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Hip
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Flexion
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120
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Extension
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0
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Knee
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Flexion
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135
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Extension
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0
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Internal Rotation
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25
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External Rotation
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35
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Ankle
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PlantarFlexion
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50
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Dorsiflexion
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20
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Dermatomes
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Myotomes
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Reflexes
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C4
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Collar
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C5
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Lateral Shoulder
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Shoulder Abduction
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C5
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Biceps & brachioradialis (C5–C6)
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C6
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Thumb
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Elbow Flexion
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C6
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C7
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No Heaven!
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Elbow Extension (triceps)
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C7
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Triceps (C7-C8)
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C8
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Little Finger
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Wrist Flexion (FDS)
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C8
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Myotomes
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Dermatomes
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Reflexes
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L1
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Inguinal region and the very top of the medial thigh
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Patella (l3/L4)
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Hip Flexion
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L2
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Middle and lateral aspect of the anterior thigh.
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Knee Extension
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L3
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Medial epicondyle of the femur.
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Ankle Dorsiflexion
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L4
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Medial malleolus.
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Great Toe Extension
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L5
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Dorsum of the foot at the third metatarsophalangeal joint.
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Ankle Platarflexion
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S1
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Lateral aspect of the calcaneus.
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Ankle (S5/S1)
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Painful Arc
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GHJ
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45-120
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ACJ
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170-180
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Drop Arm
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Passively or actively elevate into abduction
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Patient lowers arm
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Tests for loss of eccentric control
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Resist ER
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Joint Locking
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Joint line Tenderness
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McMurray Test
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Flexion & Extension OP
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