What is the difference between an Intra-articular lesion vs. an Extra-articular lesion?

An intra-articular lesion stops the joint space so a pt. would experience a decrease in Active and Passive ROM. Inspection - a few examples are OA, labral tear, adhesive capsulitis, and rheumatoid arthritis OP painful at articulation STP NSF ROM active and passive will be painful Orthos / ST compress An extra-articular lesion is a problem not in the joint space is it is outside, so a pt. would experience a decrease in active ROM and an increase/normal passive ROM. The doctor would be able to pick up the lesion and move during passive, which is why there is a possibility for it to be normal or have an increase. Inspection change in contour, swelling, discoloration, guarding, atrophy, and deformities OP problem will be across the joint space for ligaments and tissue connects at the origin/insertion for the muscle STP sore, tender, pain, swelling, myospasm ROM decrease in active but increase/normal passive, plane of motion of different tissue Orthos/ST stretch (ligaments), contracts (muscles) What are the 3 types of lesions? TUFF comes from anterior impingement due to the supraspinatus being impinged by the action of 90 degrees abduction and ext. rotation. BANCART ostephyte changes, this action occurs via anterior & inferior HILLSAC anything else that is not a Bancart/Slap lesion How do you take a proper patient history? Clarify if the mechanism is traumatic or nontraumatic. Trauma can occurs in four different ways: 1. Fracture, 2. Dislocation, 3. Sprain, 4. Avulsion. Even more so, if it was a fall onto a specific region or structure it would be a fracture, dislocation or contusion. If an excessive valgus/varus force, internal/external rotation, flexion/extension was applied then it may be a ligament/capsule or muscle/tendon type of injury. If a sudden axial traction to the joint occurred then it would be a sprain/strain. If axial compression (force where the body weight falls central to the bone) to the joint occurred, then it may be a fracture, meniscal tear or synovitis. Nontrauma would be manifested as tendonitis, instability, labral tear, adhesive capsulitis (insidious), and rheumatoid arthritis. *** RA is inflammation of the whole joint and is a uniform decrease of the entire joint space so there is a global loss of movement. Osteoarthritis is a non-inflammatory process that is a breakdown of the joint due to its loading that equivocates in a osteophytic reaction and can be caused by the following factors: 1. Joint mice, 2. Unilateral loss of joint space, and 3. Subchondral change to bone. A good example of OA is the observance of football players gait that exhibits the ostephytic changes from the high impact activity. Is the onset insidious? The following questions will be assessed in the patients inspection in order to differentiate conditions. Are there any associated systemic signs of fever, malaise/fatigue,

lymphadenopathy, multiple affected areas? Are there local signs of inflammation including swelling, heat or redness? Is there local deformity? Is there associated weakness, numbness, tingling, or other associated neurological dysfunction? Is there a history of overuse? Selective Tension Approach Condition Arthritis/Capsulitis Active ROM Passive ROM Painful at limit of range Resisted Mvmt Usually painless w/in range of motion Key Points Often specific capsular pattern of one or two restricted movement patterns Insertion of tendon is often tender or slightly proximal to insertion Note displaced muscle belly Overpressure laxity may indicate degree of damage Check with resistance through-out full range of movement An arc of pain with a catching or blockage is highly suggestive Positional relief is less common than with muscle/tendon injury

Painful at limit of range (since cartilage is broken down & articulation of joints does not occur smoothly) Tendinitis/Tendinosis Variable

Pain on stretch

Tendon Rupture Ligament Sprain

None Decreased; limited by pain Painful;often midrange

Full/painless Pain on stability challenge Passive stretch may increase pain Sudden onset of pain in a specific range of motion is also possible Empty end-feel is often present

Painful, esp if contracted in stretched position (joins muscle to bone) Weak; painless Painless; if full rupture, painful if partial If resistance is sufficient; pain is produced Usually painless

Muscle Strain

Intraarticular body

Sudden onset of pain in a specific range of motion Painful in most directions

Acute bursitis (deep)

Isometric testing is often painful

Normal End-Feel:

Soft-tissue approximation Muscular Bone-on-bone cartilaginous Capsular

Abnormal End-Feel: Spasm Springy block/rebound Empty Loose Pain felt before end-range Acute Pain felt at same time of end-range Subacute Pain felt after end-range Chronic Special Tests to consider are MRI, CT, bone scan, electrodiagnostic studies if neurological findings are present. Laboratory if systemic findings are present or synovial fluid analysis if swelling is present or if arthritide is suspected. Injuries can occur via compression or stretch: Compression fracture, labral tears, and neural dysfunction Stretch varying degrees of sprain/strain, neural and vascular damage, joint luxation, subluxation or dislocation Weight Bearing vs non-weight bearing Weight bearing joints are more susceptible to compression (ending in chronic degeneration and osteoarthritis) while non-weight bearing joints are more susceptible to stretch but can be transformed into weight bearing by occupation and activity Common Conditions of Joint Arthritis Subluxation/fixation chiropractic Synovitis Infection Joint Mice Dislocation/Subluxation medical Common Conditions of Bone Tumor Osteochondrosis/apophysitis Fracture Osteopenia Ostemyelitis Common Conditions of Muscle Strain/Rupture Trigger points

Atrophy Myositic Ossificans Muscular Dystrophy Rhabdomyositis

Common Conditions of Tendon Tendonitis Tendinosis Tenosynovitis Rupture Common Conditions of Ligament Sprain/Rupture Bursa Bursitis Fascia Myofascitis Type of Complaint Pain Numbness Tingling Stiffness Looseness Crepitus Popping /Snapping Sound Locking Shoulder Anatomy affords a great deal of motion because it has little form and force closure. It has a shallow fossa that allows all ranges of motion. Gleno-humeral joint is compose of the Rotator Cuff muscles, capsule/ligaments, glenoid labrum, and long head of biceps AC Joint SC Joint Scapulo-thoracic articulation (in relation to the humerus the scapula is a 1:2 movement) Biceps Tendon pain is located in the anterior shoulder. Pain is felt when the arm and shoulder are moved forward over shoulder height. Pain can be exacerbated during certain activities. Repetitive action cause overuse of the biceps tendon and damages the cells, which cannot repair themselves since they dont have time to recuperate. The pain causes inflammation on the biceps tendon and show signs of degeneration. Collagen loses its normal arrangement and is jumbled; fibers break, and loose their strength. Adhesive Capsulitis Abduction and External Rotation are mostly affected