ABDUKADIL, AMIRA M.

L.I.: AFFECTATION PER REGION

DISORDERS OF THE SPINE

DISORDER PATHOPHYSIOLOGY MANIFESTATIONS MANAGEMENT
Cervical Multifactorial degenerative - Back pain that increases -Immobilization of cervical
Spondylosis changes in the intervertebral with movement spine
disks and facet joints of the -Stiffness -Mechanical traction
cervical spine cause narrowing -Better when inactive -Isometric exercises
of spinal canal and neural -Sensory dysfunction, if -Surgery, if with intractable
foramina. This causes with cervical pain and progressive
subsequent collapse as a result radiculopathy neurologic deficit
of biomechanical incompetence,
causing the annulus to bulge
outward. As the disk space
narrows, the annulus bulges, and
the facets override.
Spondylolisthesis Multifactorial events -May be asymptomatic -Rest
(degeneration, trauma) causes -Low back pain -Physical Therapy
anterior slippage of the vertebral -Hamstring tightness -Surgery, if not responding
body, pedicles, and superior -Tenderness (most often to conservative therapy or in
articular facets, leaving the L4 or L5) cases with progressive
posterior elements behind, neurologic deficit and
causing nerve root injury postural deformity
Ankylosing Inflammation, cartilage erosion, -Insidius onset of low -Exercise therapy to
Spondylitis and an additional process, which back pain which is maintain range of motion
is subsequent ossification of chronic -NSAIDs
sacroiliac joint and axial -Morning stiffness -Anti-TNF alpha drugs
skeleton. Inflammation is -Limited spinal mobility
initially dominated by -Improvement with
mononuclear cell infiltrates and exercise
by increased number of
 osteoclast
Slipped Repetitive use of spine due to -Back pain aggravated by -Bed rest
(Herniated) Disc frequent heavy lifting causes motion or bending -Avoidance of strenuous
injury to intervertebral discs -Abnormal posture labor
(L4-L5 or L5-S1). With tear of -Limitation of spine -Strengthening and
ligament and posterior capsule motion stretching exercises
of disc, nucleus pulposus will -Focal neurologic deficit -Acetaminophen or NSAIDs
extrude with compression of -Weakness, atrophy, for pain
nerve root. fasciculations
Pott’s Disease Secondary infection from an -Back pain -Long-term
extraspinal source via -Stiffness antimycobacterial drugs
hematogenous spread. -Immobility -Patients with spinal
Progressive bone destruction -Mild fever instability or neural
leads to vertebral collapse and -Leukocytosis compression from
kyphosis. The spinal canal can epidural inflammatory
be narrowed by abscesses, tissue should undergo
granulation tissue, or direct debridement and fusion as
dural invasion, leading to spinal needed
cord compression and
neurologic deficits.
Scoliosis Idiopathic: unknown etiology -High shoulder, prominent - Curves between
but may involve collagen hip, or projecting 30 and 40 degrees: Braces,
abnormalities, abnormal growth, Scapula -Curves greater than 40 to
or genetic bases with incomplete -Idiopathic scoliosis is 45 degrees: Surgery
penetrance usually painless - Combined anterior
Neuromuscular: not well and posterior surgery (for
understood but may be a result more severe curvatures)
of muscle weakness

DISORDERS OF THE SHOULDER

DISORDER MECHANISM MANIFESTATIONS MANAGEMENT
Rotator Cuff Forceful or repeated overhead or -Pain -Rest
Tears pulling movements produce -Tenderness - Pain management with
 significant stress on the -Muscle atrophy NSAIDs
glenohumeral complex of the -Difficulty abducting or -Immediate surgery for
rotator cuff, causing it to tear. rotating the arm extensive acute traumatic
This will eventually lead to tears
instability of the shoulder joint. -Rehabilitation
a. Immobilization: using a
sling, 4-6 weeks after
surgery
b. Passive Exercise:
moving the arm n
different positions to
improve range of
motions, 4-6 weeks after
surgery
c. Active Exercise: more
than 4-6 weeks
d. Surgery: for acute
traumatic tears
Supraspinatus Trauma or repetitive stress on the -Pain -Range of motion exercises
Tendinitis shoulder allowing inflammatory -Tenderness -Strengthening exercises
fluid to accumulate causing -Muscle atrophy -Avoidance of overhead
swelling of the tendon and activities
thickening of its closing sheath. - Pain management with
NSAIDs
Subacromial Repetitive overhead activities or -Pain -Ice and rest
Bursitis causing inflammation of the -Tenderness -Immobilization with a sling
bursa. This causes synovial cells -Muscle atrophy - Pain management with
to multiply and thereby increases -Impaired arm abduction NSAIDs
collagen formation and fluid -Strengthening and range of
production motion exercises
Shoulder Physical trauma to the shoulder -Pain -Closed Reduction
Dislocation can cause the humeral head to be -Swelling -Immobilization with a sling
 separated from the glenoid -Limited range of motion -Passive ROM exercises
cavity. Anterior dislocation (most -Joint deformity after initial period of
common) is due sudden violence -Minimal ability to immobilization
applied to the humerus with the elevate the arm
joint fully abducted, tilting the
humeral head downward onto the
inferior weak part of the capsule,
causing it to tear. The humeral
head comes to lie inferior to the
glenoid fossa.
Adhesive Inflammation in the joint -Insidious onset of pain -Usually self-limiting
Capsulitis capsule followed by development -Gradual decrease in -Physiotherapy
of adhesions and fibrosis of the active and passive range -Home exercise
synovial lining. Thickening and of motion - Pain management with
contraction of the glenohumeral NSAIDs
joint capsule and formation of
collagenous tissue surrounding
the joint reduces joint volume. 
Following the synovial
inflammatory process, there is
contracture of the capsule of the
glenohumeral joint, which causes
pain and stiffness.
Impingement Chronic repetitive mechanical -Gradual increase in -Initial therapy will include
Syndrome process in which the conjoint shoulder pain with rest, NSAIDs, and physical
tendon of the rotator cuff overhead activities therapy
undergoes repetitive compression - Patients tend to -Injection of a local
and micro trauma as it passes externally rotate the arm anesthetic and a cortisone
under the coraco-acromial arch in order to allow the cuff preparation
to occupy the widest part -Bursectomy and
of the subacromial space subacromial decompression
thereby relieving the via acromioplasty (if
 symptoms conservative treatment if
unsuccessful)

DISORDERS OF THE ELBOW

DISORDER PATHOPHYSIOLOGY MANIFESTATIONS MANAGEMENT
Tennis Elbow Overexertion of the extensor -Pain on the lateral aspect - Rest, ice, compression,
muscle while performing a of the elbow and elevation
backhand stroke in a game of -Local tenderness over the -Avoidance of painful
tennis or other activity causing lateral epicondyle activities
repetitive forearm muscle -Decreased movement on - Pain management with
contractions. passive elbow extension, NSAIDs
wrist flexion and ulnar -Elbow counterforce brace
deviation and pronation
Golfer’s Elbow Repeated wrist flexion or -Pain over the medial -Rest, ice, compression, and
forearm pronation and high- elbow elevation
energy valgus forces created by - Local tenderness over -Physical therapy to
the overhead throw seen in the medial epicondyle maintain range of motion
sports. -Weakness of hand and -Pain management with
wrist NSAIDs
-Elbow braces
Nursemaid Elbow Low-energy trauma occurring -A child will tend to hold -Immobilization
from brisk axial traction of the the elbow in slight flexion -Closed reduction
forearm, often by an adult who and the forearm pronated
holds the child’s hand as the -Pain and tenderness
child pulls away. May also be localized to the lateral
due to falls, wrestling, and abuse aspect of the elbow