Musculoskeletal conditions

 Published: 21/10/2020

My concise summaries of MSK conditions. This is to be used as a revision resource. 

Classic Frozen Shoulder

Caused by thickening and contraction of the joint capsule. The conditions occurs either idiopathically or secondary to other conditions such as trauma. 

At risk populations

• Diabetics
• Thyroid disorders (hypo and hyperthroidism)

3 stages

• Freezing (0-6 months)
• Frozen (6-12 months)
• Thawing (12-18 months)

Freezing stage

• Capsule thickening occuring
• Pain dominant (complain of pain particularly at night)

Frozen stage

• Stiffness dominant (restricted ROM most obvious feature)
• Acute pain may subside during this phase

Thawing stage

• Also known as the recovery phase
• Patient gradually regains ROM

Diagnosis

• Usually between 40 to 60 yrs old (average = 50)
• Active and passive stiffness, particularly at end of range
• Stiffness presents in capsular pattern (external rotation particularly affected)
• No crepitus
• X-ray confirmation (to rule out other conditions)

Management

Pain dominant phase

• Analgesia
• Gentle ROM exercises
• Manual therapy (in pain-free range)
• ?Steroid inject (if in severe pain)

Stiffness dominant phase

• Analgesia
• Stretching exercises to increase ROM
• Manual therapy (focus on increasing ROM)

Recovery phase

Aim: return to as much range of motion as possible

• Stretching exercises (particularly external and internal rotation)
• Strengthening to regain muscular power

Summary video from Clinical Physio (includes management exercise ideas)

Long Head of Biceps Tendinopathy

Subjective Assessment clues

Increased loading pattern

• Increased activity
• Increased over-load
• Increased repetitive use

Over-working

• Increased shoulder protation --> increased anterior chain activity

Diagnosis

Objective Ax

• Clear the cervical spine and elbow
• Ax shoulder ROM

Special test

• Speed's test

Management

• Education
• Advice on reduced tendon loading with activities
• NSAIDs (talk to GP)
• Rehab

Rehab

• Gradual increase in tendon loading 
• Exercise progression (isometrics --> eccentrics --> concentrics)

Summary video

Gluteal Tendinopathy

Condition usually caused by excessive hip adduction

Note: 25 to 30% of people with LBP also present with gluteal tendinopathy

Subjective signs

• Pain located posterolaterally to the greater trochanter (lateral hip)
• Pain can radiate into the lateral thigh or posteriorly towards the buttock

Activities (e.g. walking, running or going up and down stairs)

Timing of onset

• sudden increase in activity?
• Sudden burst of overload?

Objective assessment

Look out for signs of hip abduction during gait or lunge

• AROM
• Functional testing (gait and lunge)
• Palpation of greater trochanter --> Positive sign: reproduction of lateral hip pain

Special tests

30s single leg stand

• Positive sign: reproduction of lateral hip pain

FABER's test

• Positive sign: reproduction of lateral hip pain

Resisted hip abduction in side-lying

• Positive signs: reproduction of lateral hip pain, reduced abduction strength

Resisted internal rotation

• Positive sign: reproduction of lateral hip pain

Summary video