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MSK Interventions by Tissue Healing Stage Cheat Sheet by

MSK Interventions By Tissue Stage

Tissue Healing & Interv­entions

 
Signs
Interv­entions
Inflam­matory (Injury -> 2-4 days)
Pain (dolor), heat (calor), redness (rubor), swelling (tumor), and loss of function (functio laesa
Rest
Immobilize and protect the affected area; exercise the unaffected areas; NWB or PWB; PROM if applic­able; continuous passive motion (CPM) postop­era­tively
   
Cryoth­erapy
(ice or cold)
   
Compre­ssion
taping, bracing, or orthotics
   
Elevation
   
Decrease pain:
Physical agents and modalities for pain management and swelling
   
Patient education:
Educate about avoidance of activities and how to protect the area
Fibrob­lastic (3 weeks)
  
Protect:
Bracing or orthotics; progre­ssive WB such as PWB or WBAT
   
Decrease Pain:
Physical agents and modalities for pain management and swelling
   
Increase ROM and function:
use scar mobili­zation techni­ques; PROM, AAROM, AROM; isometric exercises; stretching exercises (start with light stretching because tissue is delicate in the beginn­ing); CKC if pain and swelling subsided; ADLs
   
Patient education:
how to protect the affected area; avoid excessive motion for tissue irrita­tion/ destru­ction
Remodeling Phase (3 weeks -> 3 months)
  
Increase strength and function to normal:
restore stability, mobility, joint arthro­kin­ema­tics, gradual return to work/s­cho­ol/­hobbies
   
Patient education:
how to avoid future injury

Evaluating Special Tests

Statis­tically signif­icant would mean the result is likely NOT due to chance.
Sensitive
Correctly identifies the number of true positive
Specif­icity
Correctly rules out negatives
If a Lachman's test correctly identifies 95% of patients as positive for anterior cruciate ligament tears, then the MRI is:
Sensitive, as it rules in

Vertebral Artery Test

Instru­ctions:
Patient rotates head opposite to tested side maximally and holds position for 10 seconds. Patient returns to neutral for 10 seconds.
 
Patient extends head for 10 seconds. Patient returns to neutral for 10 seconds.
 
Patient extends and rotates head (again opposite tested side) maximally for 10 seconds
Positive symptoms:
Include (The 5 D’s) dizziness, diplopia, dysart­hria, dysphagia, drop attacks
 
And (The 3D's) nausea, numbness, and nystagmus
 

Upper Limb Range of Motion

Shoulder
Flexion
180
 
Extension
60
 
Abduction
70
 
IR
70
 
ER
80
 
Adduction
135
Elbow
Flexion
150
 
Extension
60
Radioulnar
Pronation
80
 
Supination
80
Wrist
Flexion
80
 
Extension
70
 
Radioulnar
20
 
Ulnar
30

Elbow Range of Motion

Lower Limb Range of Motion

Hip
Flexion
120
 
Extension
0
Knee
Flexion
135
 
Extension
0
 
Internal Rotation
25
 
External Rotation
35
Ankle
Planta­rFl­exion
50
 
Dorsif­lexion
20

Upper Limb Nerve Routes

Dermatomes
  
Myotomes
  
Reflexes
C4
Collar
C5
Lateral Shoulder
Shoulder Abduction
C5
Biceps & brachi­ora­dialis (C5–C6)
C6
Thumb
Elbow Flexion
C6
C7
No Heaven!
Elbow Extension (triceps)
C7
Triceps (C7-C8)
C8
Little Finger
Wrist Flexion (FDS)
C8

Upper Limb Reflexes

Lower Limb Nerve Routes

Myotomes
  
Dermatomes
Reflexes
 
L1
Inguinal region and the very top of the medial thigh
Patella (l3/L4)
Hip Flexion
L2
Middle and lateral aspect of the anterior thigh.
Knee Extension
L3
Medial epicondyle of the femur.
Ankle Dorsif­lexion
L4
Medial malleolus.
Great Toe Extension
L5
Dorsum of the foot at the third metata­rso­pha­langeal joint.
Ankle Platar­flexion
S1
Lateral aspect of the calcaneus.
Ankle (S5/S1)

lower Limb reflexes

Full Thickness Rotator Cuff Cluster

Painful Arc
GHJ
45-120
 
ACJ
170-180
Drop Arm
Passively or actively elevate into abduction
 
Patient lowers arm
 
Tests for loss of eccentric control
Resist ER
 

Shoulder Range

.

Wrist Range

Lower Limb Range

UL Dermatomes

Upper Myotomes

Lower Limb Dermatomes

Lower Limb Myotomes

Meniscal Injury Cluster

Joint Locking
Joint line Tenderness
McMurray Test
Flexion & Extension OP
               
 

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  • Published: 9th July, 2023

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