59
Lesson Plan: Musculoskeletal Pathology 5 minutes: Breath of Arrival and Attendance 50 minutes: Musculoskeletal Pathology

5 minutes: Breath of Arrival and Attendance 50 minutes ... · Musculoskeletal Conditions List (Werner Page 61) Muscle Disorders Muscular dystrophy Spasms Cramps Strains Bone Disorders

Embed Size (px)

Citation preview

Lesson Plan: Musculoskeletal Pathology

5 minutes: Breath of Arrival and Attendance

50 minutes: Musculoskeletal Pathology

Classroom Rules Punctuality- everybody's time is precious:

  Be ready to learn by 9:00, we'll have you out of here by 1:30

  Tardiness: arriving late, late return after breaks, leaving early

The following are not allowed:

  Bare feet

  Side talking

  Lying down

  Inappropriate clothing

  Food or drink except water

  Phones in classrooms, clinic or bathrooms

You will receive one verbal warning, then you'll have to leave the room.

Musculoskeletal Pathology

Musculoskeletal Conditions List (Werner Page 61)

Muscle Disorders   Muscular dystrophy   Spasms   Cramps   Strains

Bone Disorders   Osteosarcoma   Osgood-Schlatter   Osteoporosis   Hyperkyphosis   Hyperlordosis   Scoliosis   Rotoscoliosis

Musculoskeletal Conditions List (Werner Page 61)

Joint Disorders   Adhesive Capsulitis   Baker cysts   Gout   Dislocations   Subluxations   Dysplasia   Joint replacement surgery   Lyme disease

  Osteoarthritis   Patellofemoral syndrome   Spondylolisthesis   Spondylosis   Sprains   Temporomandibular joint

dysfunction

Musculoskeletal Conditions List (Werner Page 61)

Fascial Disorders   Compartment syndrome   Dupuytren contracture   Ganglion cyst   Hammertoe   Hernia   Plantar fasciitis   Pes planus   Pes cavus

Neuromuscular Disorders   Carpal tunnel syndrome   Disc disease

  Herniation   Degenerative disc

disease   Internal disc disruption

  Myofascial pain syndrome   Thoracic outlet syndrome

Musculoskeletal Conditions List (Werner Page 61)

Other Connective Tissue Disorders   Bunions   Bursitis   Shin splints   Tendinitis   Tendinosis   Tenosynovitis   De Quervain tenosynovitis   Whiplash

Spasms and Cramps

Spasms and Cramps

Spasms Involuntary contraction of skeletal muscle. Low-grade and long- lasting.

Cramps (AKA: charley horse) Involuntary contraction of skeletal muscle. Strong, painful, and short-lived.

Spasms and Cramps

Etiology   Nutrition deficiency   Ischemia   Vigorous exercise   Splinting   Underlying conditions

Spasms and Cramps

Treatment   Massage (circulation, attachment sites, and stretching)   Heat   Ice   Ointments creating hot and cold sensations

Medications   Analgesics   Muscle relaxants (if severe)

Spasms and Cramps

Massage

  Avoid direct and aggressive bodywork to the muscle bellies

  Consider underlying conditions if cramping is frequent

  Painkillers and relaxants can mask pain and stretch limitations

  If splinting is due to injury, wait for acute stage to pass

Spasms and Cramps

Pain-spasm-ischemia cycle Chronic contraction of a muscle begins a cycle of decreased oxygen supply, pain, and spasm.

Strains

Strains

Strains Injuries to muscle fibers. Torn myofibers. Scar tissue production.

Strains

Etiology   Trauma (sudden and specific)   Overuse (chronic and cumulative)

Strains

Implications of scar tissue   Impaired contractility   Adhesions

Strains

Signs and Symptoms   Local pain   Stiffness   Pain on resisted movement or passive stretching   No palpable heat or swelling unless severe.

Strains

Treatment   Accurate diagnosis   PRICES (to control inflammation)   Rehabilitation (realign scar tissue)   Exercise, cross-fiber and linear friction, and passive stretching   Prevent further injury   Lymphatic drainage (limits edema)   Avoid vigorous deep massage to a new or acute injury

Medications NSAIDS (for pain and inflammation)

Sprains

Sprains

Sprains Tears to ligaments.

Etiology   Not warming up results in a sudden snap   Prolonged but extreme stretch after activity

Sprains

Graded by severity   1st degree (just a few fibers)   2nd degree   3rd degree (complete rupture)

Sprains

Acute Stage   Inflammation (including loss of function)   Pain with passive stretches   Duration of 24-48 hours   Common sprains are anterior talofibular and sacroiliac ligaments

Sub-acute Stage   Inflammation (with regaining function)

Sprains

Treatment   RICE (limits edema and tissue damage)   Moving the joint within range of pain tolerance ASAP   Lymphatic massage during acute stage   Linear and cross-fiber friction when sub-acute and post-acute   May be a bone fracture if the “sprain” is not much better within a few

days.

Medications   NSAIDs (for pain and inflammation)

Osteoporosis

Osteoporosis

Osteoporosis Loss of bone mass and density.

Osteopenia Pathological thinning of bones. Precursor to osteoporosis.

Osteoporosis

Etiology   Endocrine imbalances   Poor metabolism of calcium   Nutritional deficiency

Non-controllable risk factors   Smaller stature, white and Asian females with a family history

Osteoporosis

Signs and symptoms   No signs in early stages. Test regularly if high-risk   Fractures   Hyperkyphosis   Chronic or acute back pain

Osteoporosis

Treatment   Light pressure massage to increase movement and decrease pain   Pharmaceutical intervention   Weight-bearing exercise   Dietary adjustments   Pressure light enough to prevent fractures   Positioning and bolstering for comfort

Postural Deviations

Postural Deviations

Hyperkyphosis (AKA: humpback) Overdeveloped thoracic curve due to muscular imbalance or osteoporosis of ankylosing spondylitis.

Postural Deviations

Hyperlordosis (AKA: swayback) Overdeveloped lumbar curve.

Postural Deviations

Scoliosis Lateral curvature of the spinal column in a C or S shape.

Rotoscoliosis Lateral curvature and twist of the spinal column.

Postural Deviations

Etiology   Functional (soft tissue tension)   Structural (bony distortion)

 Congenital  Cerebral palsy  Polio  Muscular dystrophy  Osteogenesis imperfecta  Spina bifida

Postural Deviations

Signs and symptoms   Muscle tension   Nerve impingement   Chronic ache   Loss of range of motion   Impaired rib movement   Cardiac and respiratory problems

Postural Deviations

Treatment   Osteopathy, chiropractic, physical therapy, and exercise therapy

Massage   If hyperkyphosis is due to osteoporosis, use light pressure   If lung or cardiac function is impaired, consult a doctor

Joint Disruptions

Joint Disruptions

Joint disruptions Articulating bones of a joint are not in correct relationship.

Joint Disruptions

Dislocation Articulating bones are no longer touching, usually due to trauma.

Joint Disruptions

Subluxation Bones are out of best alignment, but the joint capsule is intact.

Joint is functional, but lacks full range of motion.

Joint Disruptions

Dysplasia A congenital anomaly involving the formation of an abnormal acetabulum or femoral head.

Joint Disruptions

Signs and symptoms   Acute, traumatic cause:

 Pain, swelling, damage, bleeding, fractures, damaged tissues, nerves, ligaments, muscles, and tendons.

  Chronic, progressive cause:  Low-level pain  Referred pain due to nerve root pressure

Joint Disruptions

Medications   NSAIDs (for acute pain and inflammation)

Massage   Massage locally contraindicated if acute.   If sub-acute or chronic, respect the limitations of range of motion.   Massage adjoining tissues to manage pain, and improve tissue

function.

Osteoarthritis

Osteoarthritis

Osteoarthritis (AKA: degenerative joint disorder) Joint inflammation due to wear and tear of articular cartilage. Most common form of arthritis.

Osteoarthritis

Etiology   Aging   Weight-bearing stress   Repetitive movements   Inflammation and damage at synovial joints (especially weight-

bearing)

Osteoarthritis

Triggers and factors   Old age and overweight   History of trauma or surgery   Repetitive pounding stress   Hormonal imbalances and nutritional deficiencies

Osteoarthritis

Signs and symptoms   Deep pain and stiffness   Thickening of phalangeal epiphyses

Osteoarthritis Treatment

  Counterirritant ointment   Exercise

Medications   NSAIDs (for pain)   Steroidal anti-inflammatories

Massage   Acute inflammation contraindicates massage that promotes local

circulation   Do not focus specifically on the affected joints

Tendinopathies

Tendinopathies Tendinopathy Umbrella term that covers injury and damage to tendons

and tenosynovial sheaths.

Tendinopathies Tendinitis (AKA: acute tendinopathy ) Acute injury of tendons.

Inflammation, edema, and pain sheaths. Less common.

Tendinopathies Tendinosis Long term degeneration of tendons involving no inflammation,

collagen degeneration, and loss of weight-bearing capacity.

Tendinopathies Tenosynovitis Irritation developing where tendons slide through their

synovial sheaths. Characterized by crepitus (gritty sensation during movement).

Tendinopathies DeQuervain tenosynovitis Tenosynovitis specifically of the abductor and

extensor pollicis tendons.

Tendinopathies Intrinsic factors

  Direct or shearing forces through tendon   Overuse without recovery time   Poor flexibility   Underlying disease   History of corticosteroid injections

Tendinopathies Extrinsic factors

  Training errors   Problems with equipment   Fall or blow (trauma) that damages from the outside

Tendinopathies Medications

  NSAIDs (for pain)   Steroid injection (may be appropriate in some circumstances)

Massage   Acute injuries with inflammation locally contraindicate deep massage   Lymphatic work may be helpful   Linear and cross fiber friction promote scar maturation

Musculoskeletal Pathology