Summary

Summary McTimoney College of Chiropractic – Musculoskeletal Medicine (Conditions)

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University Of Ulster

This summary contains every condition you will need to know for your MSM exam, including definition, presentation (symptoms) and examination (signs) per category. In my testing summary you will find all MSM testing, but also a overview of generalized answers for conditions categories of cause, epid...

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Uploaded on March 10, 2024
Number of pages 4
Written in 2022/2023
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Anatomy Condition Definition Presentation Examination
Positional asymmetry OP - asymmetry, tenderness
Torticollis Rotation & lateral flexion of head due to Cx muscle spasm Unequal ROM ROM - unilateral reduced A/PROM
With/without neck pain Ortho - shoulder depression, screen
OP - hypertonicity
Slowly progressive dull, achy neck pain
Progressive loss of articular cartilage, osteophyte formation, ROM - may be reduced, may be pain on either flexion (disc
Cervical DJD Morning stiffness
reduced disc height, loss of Cx lordosis herniation/damage) or extension (facet/IVF encroachment)
Aggravated by repetitive use
Ortho - distraction, compression
OP - head/neck tilt away from injury, Bakody's sign, paraspinal
Deep aching/burning pain in neck/arm tenderness, hypertonicity
Weakness in hand/arm ROM - reduced extension, rotation & lateral flexion. Pain on lateral
Cervical Radiculopathy Neuro-compressive disorder of cervical nerve roots (disc herniation)
Bakody's sign: symptoms reduced with the painful arm placed on flexion
top of head Ortho - Valsalva, compression, distraction, shoulder depression,
brachial plexus stretch
Insidious progression
Gait disturbance +/- clumsy hands
Lhermitte's sign: neck flexion causes electric shocks down the spine
Cervical Myelopathy Spinal cord injury due to severe pressure
Legs UMN & arms LMN signs
Loss of vibration & proprioception
Loss of sexual & B&B function
Cervical Spine
Dull, achy pain (sharp when acute) Observe, palpate - head leans away from pain, hypertonicity
(10) Cervical facet joint irritation/damage causing
Cervical Facet Syndrome Localised, pin-point pain ROM - extension/flexion pain
cranial/Cx/shoulder/back pain
Possible neck spasm Ortho - compression, distraction
Neck pain & potential radiation to occiput or shoulder/arm OP - local tenderness, spasm, hypertonicity
Whiplash ST damage to ligaments, muscles, discs or other CT Non-dermatomal ROM - reduced
Headache & possible tinnitus Ortho - distraction (local pain)
Jaw/facial/neck pain
Pain/tenderness due to TMJ dysfunction or surrounding OP - jaw asymmetry, hypertrophy, tenderness
TMJ Syndrome Pain on chewing & locking/catching
musculature ROM - reduced jaw opening (3 finger rule), clicking/popping
Headache & ear ache
New or sudden onset severe pulsitile headache OP - facial asymmetry, artery asymmetry
ST brain ischaemia causing focal neuro effects (10-20 min) with full Potential visual changes, speech disturbances & Neuro - MMSE, CN, SMR, cotton wool/pin prick, CAD
TIA
resolution in 24hr weakness/numbness Systems - BP, heart auscultation
Either ACA, MCA or PICA symptoms A&E referral via ambulance
New or sudden onset severe pulsitile headache
OP - gait, Bell's palsy, artery asymmetry
Potential visual changes, speech disturbances &
Stroke Permanent interruption of BF to part of the brain MMSE - MMSE, CN, SMR, Babinski
weakness/numbness
Emergency referral via ambulance
Either ACA, MCA or PICA symptoms
Neck stiffness without loss of ROM
OP - symptoms
BF reduction to basilar artery, typically due to compression 5D’s/3N’s + ataxia
VBAI Systems - BP, carotid auscultation
(atheroma) or tear (dissection) of the vertebral artery New or worst ever headache referring upwards from neck to
Neuro - CAD
occipital & forward
Pain at rest & at night, esp. when lying on affected side
Most common muscle of the rotator cuff to tear (rotator cuff = OP – tender to palpate
Pain/weakness with lifting arm
Rotator Cuff Tear - Supraspinatus supraspinatus, infraspinatus, teres minor, subscapularis = stabilise ROM – reduced, painful, weak
Acute tears = sudden severe pain
glenohumeral joint & allow deltoid to abduct arm) Ortho – Empty Can, Painful Arc, Drop Arm, Neer, Hawkins-Kennedy
Degenerative = progressive & arm weakness
Severe acute pain aggravated with any shoulder movement O – Px may hold their arm to avoid moving it
Rotator Cuff Formation of small calcium deposits within the rotator cuff tendons
Calcific Tendonitis Stiffness, snapping, catching or weakness P – subacromial bursa (passively extending the shoulder)
(most commonly supraspinatus)
May wake Px up from sleep ROM – restricted/painful A/PROM
Achy anterior shoulder pain aggravated by lifting or overhead
OP – bicipital groove tenderness
activities
Biceps Tendonitis Inflammatory process of the long head of the biceps tendon ROM – painful/weak resisted flexion
A complete rupture will cause the belly of the muscle to bulge (like
Ortho – Speeds, Yergasons, Neer's, instability assessment
Popeye)
Inflammation of the subacromial bursa which results in an increase Gradual onset deep superior shoulder pain OP – severe localised bursa tenderness, swelling
Subacromial Bursitis
in synovial fluid production Unable to lay on affected side ROM – painful, abduction & flexion limited
Sharp pain on abduction (90o GH, end range AC)
AC Joint OP – swelling, wasting, tenderness
Joint pain aggravated by exercise, relieved by rest
AC/GH Osteoarthritis Inflammation of the AC/GH joints due to ‘wear and tear’ of cartilage ROM – reduced & painful
Morning stiffness (<30 min)
Ortho – Dugas’, Neer’s
Swelling, crepitus, instability, muscle wasting
OP – visible structural deformity
Dislocation due to tearing of the local ligaments, most commonly Shoulder pops out of joint ROM – restricted to none
Glenohumeral Dislocation
anterior Extreme pain Ortho – Dugas’
Neuro – sensation loss axillary nerve
Point tenderness & swelling OP – pain, swelling, bruising, prominent clavicle
Dislocations Tearing of the local ligaments (AC ligament most commonly,
AC Dislocation Prominent distal clavicle ROM – reduced & painful
possibly coracoclavicular too)
Pain at night & when lying on affected side Ortho – Cross Body Abduction, Dugas's
OP – head tilt towards affected side, holding arm, deformity,
Chest & shoulder pain
SC Dislocation Dislocation due to tearing of the local ligaments tenderness
Aggravated by arm movement or laying supine
ROM – painful
OP – muscle mass asymmetry, tenderness
Shoulder Mechanical impingement of the rotator cuff tendon beneath the Hx repetitive use or trauma followed by a gradual increase in ROM –stiffness, abduction pain >90°
Rotator Cuff Impingement
anteroinferior acromion (subacromial impingement) shoulder pain with overhead activities Ortho – Dugas’ (may show AC pathology), Painful Arc, Empty Can,
(16)
Lift Off, Neer, Hawkins-Kennedy
Slow onset shoulder pain
Discomfort near the deltoid insertion
Unable to sleep on affected side OP – guarding shoulder, tenderness
Inflammatory
Reduced ROM ROM – reduced A/PROM (= diagnostic)
Adhesive Capsulitis Painful & significant restriction of shoulder AROM/PROM
3 progression phases, may take 2 years Ortho – Apley Sctratch, Painful Arc, SITS (hugely restricted or
1. Freezing – gradually more & more pain, reducing ROM impossible)
2. Frozen – pain may reduce, stiffness remains
3. Thawing – ROM slowly improves
Inflammation of the scapulothoracic bursitis which results in painful OP – crepitus, tenderness, audible snap, winging scapula
Scapulothoracic Bursitis Pain during overhead activities, crepitus with shoulder movement
snapping of the scapula ROM – normal with audible snapping/crepitus
OP – potential tenderness
Most common labral tear injuring both aspects of the joint & also Locking, popping or grinding
ROM – reduced/painful globally (esp. IR/ER & abduction)
SLAP Labral Tear possibly the biceps tendon (SLAP = superior labrum anterior & Pain with movement & lifting (esp. overhead)
Ortho – O’Brien’s, McCarthy, Log Roll, FADIR (Speeds, Anterior
posterior) Reduced strength & ROM, feeling of instability
Apprehension)
OP – Px hold arm if wary of stability
Generalised arm/shoulder pain with feeling of instability
ROM – bilateral guarding, but no restrictions
Shoulder Instability Generally bilateral, atraumatic condition, capsular laxity Aggravated by overhead activity, relieved by rest
Ortho – Drawer, Apprehension, possibly labral tests (FADIR, Log
Trauma Possible night pain
Roll, McCarthy, O'Briens)
OP – swelling, tenderness, visual deformity, cradling arm
Clavicle Fracture Fracture of the clavicle Pain, swelling & tenderness over the clavicle ROM – painful, reduced, guarding
Systems – lung sounds (risk of pneumothorax)
OP – tenderness, holding arm, unable to move, guarding
Pain, paraesthesia & weakness over the humerus ROM – severely reduced
Humeral Fracture Fracture of the humerus
Loss of function Ortho – tuning fork, percussion
Neuro – axillary nerve sensation changes
Proximal muscle pain of the shoulder +/- Hip girdles Vitals – low-grade fever
Inflammatory condition that causes muscle pain & stiffness, esp.
Systemic Polymyalgia Rheumatica Morning stiffness >1hr OP – tenderness, atrophy
shoulders/hips
Can be unilateral but becomes bilateral after a few weeks ROM – limited
OP - ant. head carriage, hypertonic SCM/scalenes, tender
scalenes/lower Cx/brachial plexus
Compression of brachial plexus by scalene muscles, 1st rib & Unilateral pain, numbness and/or paraesthesia (P&N) in neck,
Thoracic Outlet Syndrome (TOS) ROM - normal
clavicle (= thoracic outlet) shoulder & upper limb (commonly medial aspect)
Neuro - cotton wool & pin prick, muscle strength testing
Ortho - Roos, Adson’s, Halstead’s, Wright’s, Costoclavicular
OP - scapular winging during upright wall pushup
Neck/shoulder pain/spasm
Damage to the long thoracic nerve, from C5-C7, which innervates ROM - limited shoulder flexion (90) & abduction (110)
Long Thoracic Nerve Palsy Shoulder weakness
serratus anterior muscle Neuro - deltoid weakness
Scapular winging
Ortho - TOS tests
Sudden onset usualy in right shoulder (can be bilateral) OP - affected arm held as if in sling, muscle atrophy, pain
Acute brachial neuritis (inflammation of peripheral nerves) which
Parsonage Turner Syndrome Constant sharp/throbbing pain ROM - painful shoulder movements
results in pain & loss of function
Aggravated by shoulder movement Neuro - axillary numbness, shoulder weakness, a/hyporeflexia
Insidious onset (except when trauma)
OP - supraspinatus/infraspinatus atrophy
Vague posterolateral shoulder ache
Suprascapular Nerve Palsy Entrapment, compression or friction of suprascapular nerve ROM - weak abduction & IR
Worse with throwing
Neuro - axillary numbness, deltoid weakness
Infra/supraspinatus weakness
Intermittent paraesthesia in ring/small finger OP - claw hand
Elbow
A mononeuropathy causing entrapment of the ulnar nerve at the Clawing of digits & atrophy ROM - normal or weak RROM
Cubital Tunnel Syndrome (CuTS)
elbow Weak wrist flexion, ulnar deviation, finger flexion & finger Neuro - little finger numbness
ab/adduction Ortho - Tinel's, Wartenburg's, Elbow Flexion
OP - tenderness underneath lateral epicondyle
Tendinosis (tendon degeneration due to overuse without Pain over lateral elbow with radiation down posterior forearm
Lateral Epicondylitis (Tennis Elbow) ROM - painful supination/extension RROM
inflammation) of extensor carpi radialis brevis Worsens with activity, improves with rest
Ortho - Resisted Middle Finger Extension, Tinel's
OP - medial epicondyle tenderness
Tendinopathy (tendon injury) of interface between pronator teres Ache over medial elbow
Medial Epicondylitis (Golfer's Elbow) ROM - painful pronation/flexion RROM
and flexor carpi radialis origins Grip weakness
Ortho - Golfers Elbow, Tinel's, Ligament Instability
OP - lump/swelling, redness, warmth, pain/tenderness
Posterior elbow swelling, often painless
Olecranon Bursitis Inflammation of the olecranon bursa ROM - painful end range flexion
Fever (if infective)
Vitals - fever

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Summary

Summary McTimoney College of Chiropractic – Musculoskeletal Medicine (Conditions)

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