423 final exam Flashcards
What type of joint is the hip?
A multi axial ball and socket joint
Structures that support the joints
Muscles
Ligaments
Bones
What is the function of the labrum?
Deepens and stabilizes the hip
What is the general function of the iliofemoral ligament?
Extensive extension
What is the general function of the ischiofemoral ligament?
Helps maintain stabilization
What is the general function of the pubofemoral ligament?
Limits extension
What are risk factors for hip injuries?
Age Impaired performance Use of adaptive equipment Fear Bone weakness
Stages of hip fractures
Type 1
- a stable fracture with impaction in
valgus
Type 2
- complete but non-displaced
Type 3
- partially displaced (often externally
rotated and angulated) with varus
displacement but still has some
contact b/w the 2 fragments
Type 4
- completely displaced and there is
no contact b/w the fracture
fragmentsTypes of hip fractures
Femoral neck
Intertrochanteric
Subtrochanteric
Femoral neck hip fractures
Risk factors:
- female
- 60 years or older
- osteoporosis
Complications:
- poor blood supply
- thin periosteumIntertrochanteric hip fractures
Between the greater and lesser trochanters
Usually occurs from direct trauma
Subtrochanteric hip fractures
Located 1 to 2 inches below the lesser trochanter
Most often in ppl over 60
Direct trauma
Fall or MVA
NWB
Non-weight bearing
TTWB
Toe touch weight bearing
PWB
Partial weight bearing
Often seen as 50% of weight can be placed on affected extremity
WBAT
Weight bearing as tolerated
Uses pain as a guide for weight through the extremity
FWB
Full weight bearing
Pt can fully bear weight through the affected extremity with no injury
Total hip replacement precautions with posterior approach
Hip flexion > 90*
No crossing your legs (no adduction/internal rotation)
Total hip replacement precautions for anterior approach
Do not step backward with surgical leg (no hip extension)
Do not allow surgical leg to externally rotate
Do not cross legs, use pillow between legs when rolling
Sleep on surgical side when side laying
Goals of therapy with THR
Maintain or increase ROM
Increase strength of musculature
Decrease edema
Educate on assistive/adaptive equipment and alternative/compensatory techniques
Increase independence with ADLs
Three bones of the pelvis
Ilium
Top 1/2 of pelvis; iliac crest
Pubis
Middle of the pubis
Ischium
Bottom of pelvis; forms lower and
back part of hip bone; below ilium
Factors contributing to pelvic floor dysfunction
MVA Back surgeries Hip surgeries Childbirth Muscle weakness/balance
Therapy goals for pelvic injury
For any injury, surgery, or dysfunction, the overall goal for therapy is to improve function.
EDUCATION is the #1 thing you can do for your pt
Name the 3 primary types of tissues that support the human spine
Muscles
Bones
Tendons
List the 2 muscle groups that are most effective at stabilizing the lumbar spine
The multifidus
The transverse abdominus
What is the strongest and safest position for the lumbar spine to function in?
Neutral position
What interventions have strong research evidence that demonstrate a long term benefit for the tx of pts with low back pain?
Exercise
Manual therapy (stretching)
Education
Relaxation/stress management
Ppl with osteoporosis should avoid what position of the spine? Why?
Flexion of the spine Why? Bones become weaker and easier to fracture Crush/wedge fractures, codfishing
Ppl with spondylolisthesis should avoid what position of the spine? Why?
Extension of the trunk
Why?
To prevent further anterior slippage
What percent of pts have positive findings for disc herniations on MRI?
53%
What percent of disc herniations require surgical intervention?
0-5%
What are potential “red flags” for lumbar radiculopathy?
Significant myotomal weakness
Numbness
Changes in bowel/bladder contol
Surgical rates for lumbar fusions have increased by what percent from 2000-2010?
100%
Stages of healing…
acute vs subacute vs settled vs chronic - when do we initiate exercise programs?
Acute (0-72 hrs)
Condition is getting worse
Subacute (72 hrs - 2 wks)
50% of healing has occurred
Settled (2-6 wks)
80% of healing is in 1st 6 wks
Chronic (12 wks or more)
100% of healing has occurred by
12-15 weeks
Attitudes and beliefs about back pain
Belief that pain is harmful or disabling resulting in fear-avoidance behavior
Belief that all pain must be abolished before trying to return to work/normal activity
Passive attitude to rehabilitation
Avoid normal activity, progressive substitution of lifestyle away from productivity
5 steps for a successful goniometric measurement
Position and stabilize
Move body part thru ROM
Determine the end feel
Find bony landmarks & line up goni
Read & record the measurement
What is end feel?
The barrier to further motion at the end of a passive ROM
Soft end feel
Structure
Soft tissue approximation
Ex: elbow/knee flexion
Firm end feel
Structures:
Muscular stretch
Ex: hip flexion
Capsular stretch
Ex: MCP extension
Ligamentous stretch
Ex: forearm supinationHard end feel
Structure:
Bone on bone
Ex: elbow extension
Factors impacting the amount of tension generated during MMT
of firing rate of motor units activated
Length of muscle fiber at time of contraction
Muscle cross-sectional area
Fiber type
Point of application of resistance
Stabilization techniques used
Motivation of the pt
Intra-rater reliability, inter-rater reliability and their relationship to MMT and goniometric measurements
Intra: when diff ppl take measurements
Inter: when same person takes measurements (on same pt)
Better consistency with measurements when taken by the same person; they know where they measured last time
Planes of motion
Sagittal plane
Frontal plane
Transverse plane
How the sagittal plane divides the body and its axis
Right and left halves
Medial-lateral axis
How the frontal plane divides the body and its axis
Front and back halves
Anterior-posterior axis
How the transverse plane divides the body and its axis
Top and bottom halves
Ventrical axis
Reasons behind use of MMT and goniometric measurements in clinical practice
They allow the practitioner to assess the available motion at the joint
MMTs measure muscle strength - the ability of the muscle to develop tension against resistance
AROM measurements
The amount of joint motion attained by a subject during unassisted voluntary joint motion
Info they provide the clinician:
Willingness to move
Coordination
Muscle strength
Available joint ROM
Shoulder flexion/extension
POM: sagittal plane
COR: acromion process
SA: midline of thorax
MA: lateral epicondyle of humerus
EF: extension - firm
ROM: flexion - 150-180
extension - 50-60
Shoulder abduction
POM: frontal plane
COR: acromion process
SA: parallel to sternum
MA: midline of humerus
EF: firm
ROM: 180
Shoulder IR/ER
POM: transverse plane
COR: olecranon process
SA: perpendicular to floor
MA: ulna, including ulnar styloid proces
EF: IR - firm
ER - firm
ROM: IR - 70-90
ER - 90
Elbow flexion/extension
POM: sagittal plane
COR: lateral epicondyle of humerus
SA: lateral midline of humerus
MA: lateral midline of radius
EF: flexion - soft
extension - hard
ROM: flexion - 140-150
extension - 0
