Musculoskeletal Problems... 7

Transcription

1 Contents IVii Introduction... 1 CHAPTER ONE Musculoskeletal Problems Introduction Prevalence Health care The site of the problems Natural history and clinical course Systematic reviews of commonly used treatments The problem of diagnosis.... Conclusions CHAPTER TWO Soft Tissue Properties Introduction Tissue injury Recovery following trauma Inflammation Tissue repair Remodelling Failure to remodel repair tissue Degenerated tissue in which healing is suspended The effects of stress deprivation and exercise on connective tissue.... Factors restricting a normal return to [unction Cumulative postural stresses on musculoskeletal tissue Contractile tissue loading Clinical im plications.... Sir Astley Cooper's engravings CHAPTER THREE Pain Introduction Pain and nociception Sources of pain Activation of nociceptors Differentiating between chemical and mechanical pain.63 Constant pain - chemical cause (Constant Chemical Irritation) Cause and onset 63 Behaviour of pain Key factors in the identification of pain of an inj1ammatory nature "... 66

2 viii I Stage and status of disorder Constant pain - mechanical cause (Constant Tissue Deformation) Cause and onset Behaviour of pain Key factors in identifying constant pain of mechanical origin Intennittent pain - mechanical cause (Intennittent Tissue Deformation) Cause and onset Behaviour of pain Postural pains - normal tissue Abnormal tissue Key factors in identifying intermittent pain of mechanical origin Failure to remodel repair tissue Derangement Chronic pain states Conclusion - the state of the tissues CHAPTER FOUR Mechanical Diagnosis Introduction The medical model The role of diagnosis in musculoskeletal problems Making a non-specific diagnosis The postural syndrome The dysfunction syndrome The derangement syndrome Non-mechanical conditions Acute pain Chronic pain Conclusion CHAPTER FIVE History Introduction Aims of history-taking The interview Age Work and leisure activities Functlonal disability.... Where is the present pain?

3 How long has the pain been present?.. "... "... "" 92 Did the pain commence following injury! " "".".. ".. " Did the pain commence for no apparent reason? Is the problem improving, worsening or unchanging!.. 96 Is the pain constant? "",,... """"".,, Is the pain intennittent? " ,,"" " ". 98 What activities produce or worsen the pain! What activities stop or reduce the pain? Does it remain worse or better afterwards? "... ""... "... "",,...."."". 98 Does continued use of the affected area increase, decrease or have no effect on your pain!.... "...,,"... ".,,"" 99 Do Y0Lt have pain if the limb or part is relaxed at rest?.... " 100 Can you find a position that stops your pain? If so, please describe "... """,, Do you get better or worse as the day progresses? Is it a proble m at night?.... ""... "... ".. "... ""... " 100 Have you had any previous treatment for this episode? Have YOll ever had this problem before? "..."""..,,..."" 10 1 What treatment was given for that problem? Do you get back or neck pain? " Are you taking any medication for this problem?......" Is your general health good or poor? Have you been x-rayed for this problem? Conclusion CHAPTER SIX Physical Examination Introduction " los Aims of physical examination Observmion Mechanical evaluation Role of palpation Use of the assessment form Active movement Active movement summary Passive movement Passive movement summmy ""......""... "" "... " III.."".."... " "... "".."., 112 Passive movement with overpressure "..."...,," 112 Passive movement with overpressure summary "... "... "" 114 Resisted tests " ".""",, Resisted tests sllmmary "..."... 11S Repeated movement or loading... " lis

4 xl Repeated movement in the postural syndrome ".". 118 Repeated movement in the dysfunction syndrome Repeated movement in the derangement sy ndrom e SummCllY Neurological examination Conclusions Inconclusive resu lts CHAPTER SEVEN Assessment of Symptomatic and lviechanical Presentations and Responses Introduction Symptomatic presentation Mechanical presentation and its assessment Assessment of the symptomatic presentation Use of symptom responses to determine loading strategies Chronic pa in Review process CHAPTER EIGHT Patient Management lntroduction Education component of management Active mechanical therapy componen t Compliance or therapeutic alliance:> To treat or not to treat:> Condition improving Condition unchanging Condition worsening Conclusions l CHAPTER NINE Management and Self-Treatment lntroduction '5... l45 Normal tissues, abnormal stresses - Postural Syndrome EdLtwtion towards self-management Self-treatment procedures required Acute p resentations l49 Traumatic onset - tissue injury Management...., ".,.... """.,,. Sub-acute presentations " Post-trauma - tissue healing Education towards self-management Self-treatment procedures 149., ". 152

5 Ixi Ch ronic presentations ". " Late traumatic presentations - abnormal tissue. 154 Late insidious onset presentations - abnormal tissue.154 Intra-articular derangements Chronic pain states - abnormal tissue/abnormal response Abnormal tissue, normal stresses - Dysfunction Syndrome Articular dysfunction Education towards self-management Self-treatment procedures required to remodel articular dysfunction Musculotendonous or contractile dysfunction Education towards self-management Self-treatment procedures requi red to remodel musculotendonous dysfunction Treatment Articular Derangement Syndrome Education ill self-management Self-treatment procedures required to reduce il1temal derangement Chronic pain states Management Therapist techniques and passive modalities Clinician procedures Passive modalities CHAPTER TEN Common Disorders Introduction The spine and peripheral Joint problems Rotator cuff tendonitis Natural history and clinical course of rotator cu rf tendonitis Management and self-treatment exercises Capsulitis of the gleno-humeral joint (, frozen shoulder') Natural history Management.205 Self-treatment exercises Clinician mobilisations Late ral epicondylitis ('tennis elbow')

6 xiii The natural history and clinical course of lateral CHAPTER ELEVEN epicondylitis Self-treatment exercises 'Pseudo' tennis elbow or elbow derangement Self-management exercises.... Carpal Tunnel Syndrome Natural history Management Tenosynovitis - de Quervain's Syndrome, ('trigger finger') Management Dupuytren's Contracture Management Bursitis Overuse injuries Management of overuse injuries 'Groin strain' or adductor strain Management and self-treatment exercises Achilles' tendon injuries Management and self-treatment exercises Patellofemoral joint pain Clinical presentation Natural history Management Mechanical diagnosis and therapy Sell-treatment exercises Degenerative joint conditions losteoarthritis Management of degenerative joint condilions Self-management exercises Lateral ankle sprains Management of ligament ruptures and sprains Self-management Cl inical Reasoning Introduction Elements that inform the process of clinical reasoning Data-gathering , , Knowledge base Clinical experience..., Cognition and meta-cognition Errors in clinical reasoning.... An example of clinical reasoning

7 Ixiii History-taking Physical examination Education anel active mechanical therapy Conclusion References Glossary of Terms.311 Index

8 xiv I List of Figures 1.1 Chronic conditions in the general populalion. Rate of reporting selected conditions per 1,000 adults Prevalence of joint problems in the general population by age range Reported prevalence in the general population of certain joint problems by age groups Reported prevalence in the general population o[joint problems by men and women Musculoskeletal symptoms in those attending primary care Distribution of different locations of musculoskeletal symptoms in the general population Distribution of different locations of musculoskeletal symptoms in those visiting primary care Time course of cellular activity following tissue injury.. 26 Sir Astley Cooper engravings Plate II Plate III Plate IV Plate V Plate VI Plate XXII Plate fu'zlli Plate fuy...v Plate XXVll Plate XXVlll The McKenzie Institute Peripheral Assessment sheet. ' history-gathering The McKenzie Institute Peripheral Assessment sheet physical examination Assessment sheet - knee derangement Assessment sheet - rotator cuff suprinatus dysfunction Assessment sheet - capsulitis early stage Assessment sheet- frozen shoulder late stage

9 Ixv 10.4 Assessment sheet - tennis elbow Assessment sheet - anterior knee pain Assessment sheet - hip j oint OA Assessment sheet - ankle inversion sprain Photos

10 List of Tables 1.1 Prevalence of musculoskeletal problems by site in general population Prevalence of musculoskeletal problems in those who seek treatment Diagnosis given by clinicians for shoulder conditions Matching the stage of the condition to management The state of the tissues 61 Description of a shoulder joint dysfunction 6.2 Directional preference 71 Disability questionnaires 7.2 Traffic Light Guide 8.1 Classification chart