Overstretch without tear to 20% ligament tear - Joint stability - Minimal swelling and pain - bruising is absent or light - patient can put weight on affected joint

Tear from 20 - 75% of the ligament, bruising, moderate pain, and swelling. Some loss of functure and difficulty putting weight on affected joint.

75% or greater ligament tear, moderate to severe pain, pronounce bruising and swelling, definite loss of function, and unable to put weight on affected joint.

Need further testing and examination to determine which muscles and tendons are involved

The supraspinatus muscle is responsible for moving the arm up and away from the body within a range 60 and 120 degrees. When supraspinatus is injured, pain appears in this range of arm motion. Pain begins midway when lifting the arm and disappears once the arm is completely lifted - this phenomenon is called the painful arc syndrome.
Supraspinatus tendonitis is usually characterized by the pain and weakness on the tip of the shoulder when the arm is moved sideways or upward above the head. The onset of the condition is gradual. A severe tear is often acute and interferes with function

Orthopedic Exam: --- Empty Can Test
Palpation of muscle groups

Symptoms of Infraspinatus Injuries.  Although the infraspinatus is located behind your shoulder, pain is usually felt in your front shoulder.

Front Shoulder Pain.  Pain down into biceps. Pain feels as if it's deep in the joint. Side shoulder, neck & shoulder-blade can also hurt.

Stiff/Weak Shoulder.  Shoulder & arm tire out more easily on one side than the other. Muscle imbalances. Stiffness. Arm going numb.

Restricted Mobility.  Reaching back – like when putting on your jacket – is difficult. Lying on your shoulder when sleeping hurts.

Orthopedic Test: External Rotation Test

This condition requires surgury

• Pain or tenderness in the front of the shoulder, which worsens with overhead lifting or activity
• Pain or achiness that moves down the upper arm bone
• An occasional snapping sound or sensation in the shoulde

Speed Test

Yergason's Test

• Pain in the back of the upper arm
• Pain over the shoulder blade area
• Pain can extend down the back of the arm
• Persistent aching in the back of the wrist

In its early stages, AC joint osteoarthritis usually causes pain and tenderness in the front of the shoulder around the joint. The pain is often worse when the arm is brought across the chest, since this motion compresses the joint. The pain is vague and may spread to include the shoulder, the front of the chest, and the neck. If the joint has been injured in the past, there may be a bigger bump over the joint on the affected shoulder than on the unaffected shoulder. The joint may also click or snap as it moves. The AC joint may separate and become very painful.

Cross Over Test

AC Sheer Test

It’s easy to test yourself for a supraspinatus injury using the “empty can” test. Fully extend your arm to shoulder height at your side, then rotate it forward 30 degrees. Point your thumb down (empty the can) and have someone press down on your hand. Then put your thumb up and have someone press down on your hand again. If it was weaker and hurt more the first time, then supraspinatus is probably involved in your shoulder injury. If you cannot even place your arm in the “empty can” test position, you may have completely torn your supraspinatus tendon

Empty Can Test - Youtube

Supraspinatus Pathology - Youtube

Yergason's Test

Speed Test

AC Sheer Test

Cross Over Test

If you have a hard time reaching into your back pocket, a subscapularis injury is likely.  
If you flex your elbow to 90 degrees at your side, you can test infraspinatus and teres minor by rotating your fists outward against pressure. Look for pain and weakness

Lateral epicondylitis occurs most commonly in the tendon of the extensor carpi radialis brevis muscle at approximately 2cm below the outer edge of the elbow joint or lateral epicondyle of the humerus bone.

Specific inflammation  is rarely present in the tendon but there is an increase in pain receptors in the area making the region extremely tender.

Golfer's elbow is pain and inflammation on the inner side of your elbow, where the tendons of your forearm muscles attach to the bony bump on the inside of your elbow. The pain may spread into your forearm and wrist.

The triceps tendon is the one at the back of the upper arm - as shown opposite. It inserts into the back of the elbow. If you fall onto your hands you can rupture this tendon. If you over-do the weights or try to push something too heavy you can also rupture the tendon or it could become inflamed through over use.

An elbow hyperextension injury occurs when the elbow is bent back the wrong way. This type of injury will occur more frequently in contact sports such as Rugby Football or certain martial arts e.g. JuJitsu. The elbow pain is caused when the elbow is forced to bend the wrong way or hyperextend causing damage to the ligaments and structures of the elbow.

The elbow pain originates from below the tip of the elbow where there is a sack of fluid called a bursa. A bursa is used to help lubricate the movement of tissues in joints. However if you take a hard impact onto the back of the elbow or are constantly leaning on the elbows the bursa can become inflamed or bleeding can occur in the bursa. The result is elbow pain and swelling on the bony bit at the back of the elbow.

Pronator Teres Syndrome is an entrapment neuropathy of the median nerve, where is passes between the two heads of the Pronator Teres muscle.

Carpal tunnel syndrome is a neuropathy caused by compression of the median nerve in the wrist. The median nerve is one of the nerves which supplies the hand (shown opposite). It passes through the wrist in a narrow channel called the carpal tunnel, along with theflexor digitorum superficialis and flexor pollicis longus tendons

RSI stands for Repetitive Strain Injury and is usually associated with injuries to the forearm, wrist and hand. However, repetitive strain injuries can occur throughout the body. RSI is caused by repetitive movements of the wrist or fingers and is an umbrella term for a whole range of conditions, which include:

• Carpal tunnel syndrome
• Tendonitis (various forms)
• Bursitis
• Muscle inflammation

The scaphoid is one of the small group of bones in the wrist called the carpal bones. It is the most common carpal bone to fracture among athletes and is often caused by falling onto and outstretched arm.

When the thumb is bent out of it's normal range of movement (usually backwards), damage occurs to the ligaments supporting the joint at the bottom of the thumb (metacarpo-phalangeal joint).

Thumb arthritis, also called basal joint arthritis, occurs when the joint at your wrist and the base of your thumb (carpometacarpal joint) develops osteoarthritis.
Having thumb arthritis can cause debilitating hand pain, swelling, and decreased strength and range of motion, making it difficult to do simple household tasks, such as turning doorknobs and opening jars.

Trigger finger is a condition in which one of your fingers or your thumb catches in a bent position. Your finger or thumb may straighten with a snap — like a trigger being pulled and released. If trigger finger is severe, your finger may become locked in a bent position. Treatment of trigger finger, also known as stenosing tenosynovitis, varies depending on the severity.

Causes of Low Back Pain
and/or Sciatica

The most common cause of low back pain or sciatic pain is the irritation of L4 and L5. This occurs from many causes, such as, low back trauma, strains and sprains, disc issues, lumbar and sacral issues, etc.

A stretching injury to the tendons, and/or muscles of the low back. The stretching incident results in microscopic tears of varying degrees in these tissues. Lumbar strain is one of the most common causes of low back pain. The injury can occur because of overuse, improper use, or trauma. It is classified as "acute" if it has been present for days to weeks. If the strain lasts longer than 3 months, it is referred to as "chronic."

Back sprains usually result from overstretching a ligament, most often due to twisting, heavy lifting, or sustained postural loading. Like sprains elsewhere in the body, back sprains are graded from mild to severe, depending on the degree of damage to the ligaments or other muscular. See Grade Level on top of page

As a disc degenerates, it can herniate (the inner core leaks out), which is known as a disc herniation or a herniated disc. The weak spot in the outer core of the disc is directly under the spinal nerve root, so a herniation in this area puts direct pressure on the nerve, which in turn can cause sciatica. Pain that radiates down the leg and is caused by a herniated disc is called a radiculopathy.

The process of degeneration of the intervertebral discs causes many problems in the spine. Everything you do during the day while being upright tests the spine's ability to support your body weight. Minor injuries to the disc may occur and not cause pain at the time of the injury. These repeated daily stresses and minor injuries can add up over time and begin to affect the discs in your spine. The disc eventually begins to suffer from the wear and tear-it begins to degenerate.

In lumbar stenosis, the spinal nerve roots in the lower back are compressed, or choked, and this can produce symptoms of sciatica -- tingling, weakness or numbness that radiates from the low back and into the buttocks and legs -- especially with activity.

Foraminal stenosis. As the nerve root is about to leave the canal through a side hole (lateral foramen), a bone spur  (osteophyte) that has already developed from a degenerating disc can press on that nerve root. This type of stenosis is also called lateral spinal stenosis, which is by far the most common form of spinal stenosis. 72% of cases of foraminal stenosis occur at the lowest lumbar level. With this type of lumbar stenosis, the emerging nerve root is trapped (thus comprising a major part of the sciatic nerve.

The term "subluxation" depicts the altered position of the vertebra and subsequent functional loss, which determines the location for the spinal manipulation. "Subluxation" has been defined medically as "...a partial abnormal separation of the articular surfaces of a joint."14

Spinal arthritis is one of the common causes of back pain. Spinal arthritis is the mechanical breakdown of the cartilage between the aligning facet joints in the back portion (posterior) of the spine that quite often leads to mechanically induced pain. The facet joints (also called vertebral joints or zygophyseal joints) become inflamed and progressive joint degeneration creates more frictional pain. Back motion and flexibility decrease in proportion to the progression of back pain induced while standing, sitting and even walking.

Spondylitis is a disease in which inflammation of the vertebrae leads to partial or total fusion of the joints and bones of the spine. The condition begins with inflammation at a point of attachment for ligaments in the spine. As the inflammation heals, the process of new bone growth is set off and bone replaces the connective tissue. The fusion can spread throughout the column of vertebrae merging the segments. Spondylitis typically occurs at the sacroiliac joint of the pelvis as well as the neck and lower back. As the spine becomes more rigid, multiple small stress fractures may develop and the patient may adopt a flexed forward posture. Back pain caused by spondylitis is treated conservatively with NSAIDs and acupuncture

Pain is thought to be caused by sacroillitis an inflammation of one of the sacroiliac joint(s), which is a common cause of unilateral low back pain With sacroiliitis, the individual may experience pain in the low back, buttock or thigh, depending on the amount of inflammation. Common problems of the sacroiliac joint are often called sacroiliac dysfunction (also termed SI joint dysfunction; SIJD). The cause of sacroiliac joint dysfunction is likely a disruption of the correlative movements between the left and right sacroiliac joints (from either too much or too little movement creating an antagonistic position of the left and right innominate bones creating a pelvic obliquity, when they normally should appear symmetrical).

Symptoms

In general, patellofemoral pain syndrome occurs when the patella does not move or 'track' in a correct fashion when the knee is being bent and straightened. This movement can lead to damage of the surrounding tissues, such as the cartilage on the underside of the patella itself, which can lead to pain in the region. This injury is quite common in people who do a lot of sport, in particular adolescent girls.

A torn ACL is an injury or tear to the anterior cruciate ligament (ACL). The ACL is one of the four main stabilising ligaments of the knee, the others being the Posterior Cruciate Ligament (PCL), Medial Collateral Ligament (MCL) and Lateral Collateral Ligament (LCL). The ACL attaches to the knee end of the Femur (thigh bone), at the back of the joint and passes down through the knee joint to the front of the flat upper surface of the Tibia (shin bone)

Iliotibial band syndrome is often referred to by other names, most commonly, runners knee and Iliotibial band friction syndrome, sometimes shortened to ITBS or ITBFS. All of these names refer to the same condition.

The patella tendon / ligament joins the kneecap (patella) to the shin bone or tibia. This tendon is extremely strong and allows the quadriceps muscle group to straighten the leg.  The quadriceps actively straighten the knee in jumping to propel the individual off the ground as well as functioning in stabilizing their landing.

Osgood Schlatters disease is a very common cause of knee pain in children and young athletes usually between the ages of 10 and 15. It occurs due to a period of rapid growth, combined with a high level of sporting activity. These changes result in a pulling force from the patella tendon, on to the tibial tuberosity (bony protrusion at the top of the shin). This area then becomes inflamed, painful and swollen. This is frequent in younger people due to the remaining softness in their bones (from childhood)

The knee is stabilized by four main ligaments: 2 collateral ligaments (medial and lateral) and 2 cruciate ligaments both anterior (front) and posterior (back). The cruciate ligaments attach to the femur (thigh bone) and travel within the knee joint to the upper surface of the tibia (shin bone). The ligaments pass each other in the middle of the joint forming a cross shape, hence the name 'cruciate'.
The posterior cruciate ligament (PCL) functions mainly in preventing the tibia from traveling backwards on the femur, known as posterior drawer. It also helps to prevent the tibia from twisting outwards. Injury to the ligament leads to knee instability with the shin bone having a tendency to 'sag' backwards when the knee is bent at 90 degrees.

Each knee joint has two crescent-shaped cartilage menisci. These lie on the medial (inside) and lateral (outside) of the upper surface of the tibia (shin) bone. They are essential components of the knee, acting as shock absorbers as well as allowing for the proper interaction and weight distribution between the tibia and the femur (thigh bone). As a result, injury to either meniscus can lead to critical impairment of the knee itself.

Within a joint there is a very smooth fibrous connective tissue, known as articular cartilage. This covers the areas where each bone comes into contact with one another (articular surfaces). Osteoarthritis (also called degenerative joint disease) is the degradation and degeneration of this articular cartilage. As the disease progresses, the cartilage itself becomes thinner and in some cases may wear away altogether. In addition to this cartilage is another tissue, known as the synovial membrane, which produces synovial fluid that lubricates the joint.

Prepatellar bursitis is the inflammation of the pre-patellar bursa, which lies in front of the patella or kneecap. Under normal conditions its function is to reduce the friction between the patellar tendon and overlying skin when bending the knee. Prepatellar bursitis is the inflammation of this bursa which can either be an acute (sudden onset) injury or chronic (longer term) injury.

Tendinopathies are diseases of the tendon. These can come in many forms, including tendonitis (inflammation of the tendon) and tenosynovitis (inflammation of the sheath surrounding the tendon). The term tendinopathy is used to cover most tendon injuries.
The insertion of a muscle is its lower attachment point. The quadriceps muscles insert at the top of the patella (kneecap). This injury is an overuse injury, as the pain tends to develop gradually over a period of time, rather than at a specific point. Pain in this area is more common in older athletes and in weightlifters.