Other MSK conditions

Osteoarthritis (OA) or degenerative joint disease (DJD)

• Chronic degenerative joint disease that causes the breakdown of cartilage, the protective tissue that cushions the ends of bones in joints
  • Characterized by articular cartilage with hypertrophy of subchondral bone and joint capsule of weight-bearing joints
  • Most common form of arthritis
  • Most common joints are cervical spine, lumbar spine, hips, knees, and great toe- weight bearing joints

• Symptoms
  • Slow, progressive with pain initial episodic and only presents when triggered by specific activity
    • Progressing to chronic with pain present with all weight bearing activities (including ambulation, standing, stair climbing)
  • Swelling in joints
  • Loss of range of motion of joints
  • Bony deformities can occur
• Diagnosis
  • Clinical presentation
  • X-ray
• Medical management
  • Acetaminophen or non-steroidal inflammatory (NSAIDs)
  • Corticosteroids
  • Intra-articular injections into joint space
• Physical therapy management
  • Joint mobility
  • Joint strengthening
  • Aquatic therapy
  • Aerobic/conditioning activities

Rheumatoid conditions

Rheumatoid arthritis (RA)

• Chronic autoimmune disease that causes inflammation and damage to the joints due to overproduction of antibodies
  • Etiology is unknown but thought to have genetic links
• Diseases is characterized by times of exacerbation and remission
• Most common areas are hands, feet, cervical spine

• Symptoms (bilateral, symmetrical)
  • Joint pain, especially in the hands, feet, wrists, and knees
  • Swelling and stiffness in the joints
  • Fatigue
  • Fever
  • Deformities in the joints
• Diagnosis
  • Clinical presentation
  • X-ray imaging
  • Lab values
    • White blood count, erythrocyte sedimentation rate , rheumatoid factor
• Medical management
  • Antirheumatic medications
  • Immonsuppressive agents
  • Corticosteroids medications
• Physical therapy management
  • Management of pain and inflammation (during exacerbation phase)
  • Improve joint mobility and mechanics (during remission phase)
  • Resistance training (only during remission phase; contraindicated in exacerbation phase)

Psoriatic arthritis

• Chronic, inflammatory arthritis that often, but not always, occurs in people with the skin condition psoriasis
  • Autoimmune disorder
• Typically occurring in axial skeleton and joints of digits

• Symptoms
  • Joint pain
  • Swelling
  • Stiffness
  • Fatigue
  • Skin psoriasis
  • Changes in fingernails and toenails (discoloration),
  • Inflammation where tendons and ligaments attach to bone
• Diagnosis
  • Clinical presentation
  • Lab tests only to rule out rheumatoid arthritis
• Medical management
  • Acetaminophen or non-steroidal inflammatory (NSAIDs)
  • Antirheumatic medications
  • Biological response modifier medication
• Physical therapy management
  • Improve joint mobility and mechanics
  • Joint protection strategies
  • Aquatic therapy
  • Aerobic/conditioning activities

Ankylosing spondylitis

• Chronic inflammatory disease that primarily affects the spine. It causes inflammation of the joints (vertebrae) and ligaments in the spine, leading to stiffness, pain, and eventual fusion of the bones

• Symptoms
  • Mid and low back pain
  • Morning stiffness of spine
  • Kyphotic deformity of cervical and thoracic spine
  • Decrease lordosis in lumbar spine
  • Degeneration of peripheral and costovertebral joints
• Diagnosis
  • Clinical presentation
  • Lab tests
    • HLA-B27 antigen
• Medical management
  • Acetaminophen or non-steroidal inflammatory (NSAIDs)
  • Corticosteroids medications
  • Cytotoxic drugs
• Physical therapy management
  • Improve joint mobility and mechanics
  • Joint protection strategies
  • Aquatic therapy
  • Aerobic/conditioning activities
  • Activities to maintain respiratory function
  • Avoidance of high impact sports, resistance activities

Gout

• Genetic disorder in which uric acid changes into crystal and deposits into peripheral joints
  • Characterized by elevated serum uric acid due to a disorder of purine metabolism
• Typically occurring in knees and great toes

• Symptoms
  • Sudden onset of severe, intense pain in one or more joints, typically the big toe.
    • Pain may feel like burning, throbbing, or crushing
  • Significant swelling and redness in the affected joint
  • The joint may feel hot to the touch and tender to the slightest touch
• Diagnosis
  • Clinical presentation
  • Lab rests
    • Identify uric acid levels
• Medical management
  • Non-steroidal inflammatory (NSAIDs)
  • Colchicine medications
  • Corticosteroid medications
  • Allopurinol medications
  • COX-2 inhibitors medications
• Physical therapy management
  • Prescription of assistive device as appropriate
  • Education on diet restrictions and medication adherence

Tendonosis/tendopathy

• Tendon dysfunction caused by overuse or repetitive motions that put excessive stress on the tendon
  • Can also be caused by sudden trauma or age-related degeneration

• Symptoms
  • Pain typically located over the affected tendon, often worse with activity.
  • Swelling present around the tendon.
  • Stiffness at the affected joint.
  • Weakness in joint
• Diagnosis
  • Clinical presentation
    • Special tests specific to joint
  • MRI
• Medical management
  • Acetaminophen or non-steroidal inflammatory (NSAIDs)
  • Corticosteroids medications
• Physical management
  • Flexibility; joint mobilization
  • Soft tissue techniques to reduce pain and inflammation
  • Progressive resistance training
  • Modalities to management pain and inflammation
  • Functional mobility training

Bursitis

• Inflammation of bursae due to overuse, trauma, gout, or infection

• Symptoms
  • Pain at rest
  • PROM and AROM limed by pain (no capsular pattern)
  • Swelling of the joint area
  • Redness over the inflamed bursa
  • Warmth to the affected area may feel hot to the touch
  • Tenderness over the affected area is pressed
• Diagnosis
  • Clinical presentation
• Medical management
  • Acetaminophen or non-steroidal inflammatory (NSAIDs)
• Physical therapy management
  • Flexibility; joint mobilization
  • Soft tissue techniques to reduce pain and inflammation
  • Progressive resistance training
  • Modalities to management pain and inflammation
  • Functional mobility training

Myofascial pain syndrome

• Chronic pain condition that affects muscles and the tissue that surrounds them. Characterized by trigger points in muscles that cause pain when pressed
  • Can be caused by sudden overload overstretching and increased repetition
  • Types of trigger points
    • Active trigger points are tender to palpation and can cause referred pain
    • Latent trigger points are taut bands that can be transitioned to active trigger points

• Symptoms
  • Deep, aching, or throbbing pain that can be localized or widespread.
  • Tender knots in the muscles that cause pain when pressed.
  • Pain that radiates to other areas of the body, such as from the neck to the head or shoulder.
  • Headaches
  • Sleep disturbances
  • Postural changes
• Diagnosis * Clinical presentation
• Medical management
  • Dry needling
  • Corticosteroid injections
  • Analgesic injections
• Physical therapy management
  • Soft tissue techniques to reduce pain and inflammation
  • Progressive resistance training
  • Modalities to management pain and inflammation
  • Functional mobility training
  • Dry needling

Complex regional pain syndrome (CRPS)

• Chronic pain condition characterized by persistent, severe pain; presentation of symptoms are disproportionate to the initial injury
  • Results in dysfunction of sympathetic nervous system
  • Can be caused by trauma or have unknown etiology
  • Types of complex pain syndrome
    • CRPS I- tissue injury with no nerve involvement
    • CRPs II- tissue injury with known nerve involvement

• Symptoms
  • Intense, burning, or throbbing pain that is disproportionate to the initial injury
  • Pain that worsens with movement or touch
  • Pain that may spread to other areas of the body
  • Allodynia (pain from normally non-painful stimuli, such as light touch or temperature changes)
  • Hyperalgesia (increased sensitivity to pain)
  • Numbness, tingling, or prickling sensation
  • Changes in skin color, temperature, or sweating
  • Swelling
  • Joint stiffness
• Diagnosis
  • Clinical presentation
• Medical management
  • Sympathetic nerve block
  • Spinal cord stimulation
  • Intrathecal drug pumps
  • Antiseizure medications
  • Antidepressants
  • Corticosteroids medications
  • Opioids medications
• Physical therapy management
  • Patient education on diagnosis and prevention of exacerbating activities
  • Desensitization activities for return to normal function
  • Modalities for pain relief

Muscle strains

• Injury to the muscle or tendon, the fibrous tissue that connects muscles to bones causing an inflammatory response
  • Typically due to overuse or overstretching caused by forceful movement

• Symptoms
  • Sudden, sharp, or throbbing pain that worsens with movement
  • Inflammation and fluid buildup in the affected area
  • Discoloration of the skin due to blood vessel damage
  • Difficulty or inability to use the injured muscle
  • Restricted movement in the affected area
  • Feeling tight or sore when the muscle is stretched or contracted
  • Involuntary muscle contractions that can cause sudden pain
  • Pain when the injured muscle is touched or pressed
• Diagnosis
  • Clinical presentation
  • MRI possibly
• Medical management
  • Acetaminophen or non-steroidal inflammatory (NSAIDs)
• Physical therapy management
  • Soft tissue techniques to reduce pain and inflammation
  • Progressive resistance training
  • Modalities to management pain and inflammation
  • Functional mobility training

Myositis ossificans

• Abnormal calcification within muscle belly
  • Can be caused by direct trauma- hematoma causes calcification
  • Frequently located in quadriceps or biceps

• Symptoms
  • Persistent, localized pain that worsens with activity
  • A firm, palpable lump or mass in the injured muscle
  • Limited range of motion
  • Warmth
  • Redness
• Diagnosis
  • Clinical presentation
  • X-ray imaging
  • CT scan
  • MRI
• Medical management
  • Acetaminophen or non-steroidal inflammatory (NSAIDs)
• Physical therapy management
  • Soft tissue techniques to reduce pain and inflammation
  • Progressive resistance training
  • Modalities to management pain and inflammation
  • Functional mobility training

Paget’s disease

• Chronic bone disorder characterized by abnormal bone remodeling
  • May be linked to viral infections

• Symptoms
  • Deep, aching pain in the affected bones, often worse at night or with activity.
  • Bowing of the legs or arms
  • Enlargement of the skull or jaw
  • Thickening of the bones in the spine or pelvis
  • Numbness, tingling, or weakness in the arms or legs
  • Headaches
  • Hearing loss
• Diagnosis
  • Clinical presentation
  • X-ray
  • Lab tests
    • Serum alkaline phosphatase and urinary hydroxyproline
• Medical management
  • Acetaminophen
  • Calcitonin
  • Surgery for bone deformities or joint replacements
• Physical therapy management
  • Joint protection strategies
  • Improve joint biomechanics
  • Aerobic capacity/conditioning

Osteoporosis

• ​​Bones become brittle and fragile from loss of tissue to metabolic changes resulting in bone mineral density loss
  • Affects women ten times more than men
    • Can be related to menopause (reduction in estrogen)
  • Common sites are thoracic and lumbar spine, proximal humerus, proximal tibia, pelvis, distal radius

• Symptoms
  • Bone fractures
  • Back pain
  • Loss of height
  • Brittle nails
  • Dental problems
• Diagnosis
  • Clinical presentation
  • CT scan
  • Dexa scan (bone density scan)
    • +1.0 or higher: Normal bone density
    • -1.0 to -2.5: Osteopenia (low bone mass)
    • -2.5 or lower: Osteoporosis (weak bones)
• Medical management
  • Calcium supplement
  • Vitamin D supplement
  • Estrogen - hormone replacement therapy
  • Calcitonin supplement
  • Bisphosphonates supplement
• Physical therapy management
  • Joint protection strategies
  • Improve joint biomechanics
  • Aerobic capacity/conditioning

Osteomyelitis

• Inflammation of bone caused by infection

• Symptoms
  • Pain and tenderness in the affected bone
  • Swelling, redness, and warmth over the infected area
  • Drainage of pus from a wound or abscess
  • Limited range of motion in the affected joint
  • Fever and chills
  • Fatigue
  • Malaise
  • Loss of appetite
  • Weight loss
• Diagnosis
  • Clinical presentation
  • Bone biopsy
  • Lab tests
• Medical management
  • Antibiotics
  • Surgical debridement if necessary
• Physical therapy management
  • Joint protection strategies
  • Improve joint biomechanics

Somatic dysfunction

Somatic dysfunction is an impaired or altered function of the body’s framework, **including muscles, joints, and fascia. It is commonly associated with pain, restricted movement, and abnormal tissue texture. **

Diagnosed using the TART criteria

• Tissue texture changes
• Asymmetry
• Restriction of motion
• Tenderness

Below is a description of somatic dysfunction within each segment type:

Cervical somatic dysfunction

• Location: Affects the neck (C1-C7).
• Common causes:
  • Poor posture, whiplash, prolonged screen time, stress-related muscle tension.
• Symptoms:
  • Neck pain, stiffness, headaches, dizziness, reduced range of motion, possible radiating pain to shoulders or arms.
• Treatment:
  • Soft tissue mobilization, cervical manipulation, stretching, and postural correction exercises.

Thoracic somatic dysfunction

• Location: Affects the mid-back (T1-T12).
• Common causes:
  • Poor posture, kyphotic spine patterns, prolonged sitting, rib dysfunction, respiratory issues.
• Symptoms:
  • Mid-back stiffness, difficulty taking deep breaths, rib pain, referred pain to chest or upper back, limited spinal rotation.
• Treatment:
  • Thoracic mobilization, rib articulation techniques, breathing exercises, and spinal extension exercises.

Lumbar somatic dysfunction

• Location: Affects the lower back (L1-L5).
• Common causes:
  • Heavy lifting, poor body mechanics, prolonged sitting, muscle imbalances, disc pathology.
• Symptoms:
  • Lower back pain, stiffness, restricted forward bending, muscle spasms, pain radiating to hips or legs, possible sciatic nerve involvement.
• Treatment:
  • Lumbar manipulation, core strengthening, stretching, and movement retraining.