upper body Flashcards

Question

quadrangular space

Answer 1

on posterior shoulder lateral border: huumerus inferior border: teres major superior border: teres minor medial border: long head of triceps

Answer 2

superior lateral shoulder

Answer 3

O: lateral 1/3 of clavicle, acromion, spine of scap (delotoid helps you carry sacs I: deltoid tuberoisity of humerus ( lateral) A: shoudler abduction, felxion, extension N: axillary

Answer 4

O: lateral border of the scapula I: inferior facet of greater tubercle A: ER and adduction of arm N: axilary

Answer 5

1) inferior lateral cutaneous nerve of the arm-inferior lateral upper arm 2) posterior cutaneous nerve of the arm- inferio posterior upper arm 3) posterior cutaneous nerve of the forarm-posterior forarm 4) superficial branch-drosal surface of digits 3.5 excluding the tips

Answer 6

BEST nerve brachilradialis extensors supinator tricpes and acconeus

Answer 7

C5- T1 though triangular interval radial groove on humerus wraps around humerus anteriorly cubital fossa ( lateral) divides into two branches deep branch PIN: passes through the two heads of the supinator (motor for deep extensors of forarm) superfiscal branch is sensory: dorsal durface of lateral 3.5 digits.

Answer 8

medial to quandrangular space triceps (lateral) teres major (inferior) teres minor (superior)

Answer 9

triceps O: long head-infragelnoid tubercle, medial head-posterio humerus inferior to radial groove, lateral head- posterio humerus superio to raidal groove I: olecronon of the ulna and fascia of the forarm A: elbow extension, extesnsion and adduction of the arm N:radial nerve Aconeus O:lateral epicondyle of the humerus I: lateral surface of the olecranon A: elbow extesnion accesory, stabilize elbow joint n: radial nerve

Answer 10

O: lateral supraxondylar ridge of humerus I: styloid process of radius A: forarm flexion with arm in neutral pronation N: radial nerve

Answer 11

ECRB O: lateral epicondyle of the humerus (CET) I: D3 A: wrist extension and radial deviation N: radial nerve--> posterior innterosseus nerve ECRL O: lateral supracondylar ridge of humerus/lateral intramuscucular septum I: posterio of base of metacarpal 2 A: wrist extension and radial deviation N: radial nerve

Answer 12

O: lateral epicondyle of the humerus (CET) I: extensor expansion of D2-5 A: finger extension N: radial nerve--> posterior interoosseus nerve

Answer 13

O: posterior 1/3 of the of the ulna and interosseus memebrane I: extesnor expansion of the index finger A: extesnsion of D2 N: radial nerve--> posterio interosseus nerve

Answer 14

O: lateral epicondyle of the humerus (CET) I: extesno expansion of digit 5 A: D 5 extension N: radial nerve--> posterio interosseus nerve

Answer 15

O: lateral epicondyle of humerus, posterior border of ulna I: base of metacarpal bone 5 A: hand extension and adduction/ulnar deviation N: radial nerve-->posterior interoseaus nerve

Answer 16

O: crest of ulna, lateral epicondyle of humerus, radial collatoral l., annular lig I: proximal thrid of the radius anteriolateral and posterior surface A: Supination N: radial nerce which splits into deep and superfiscal branches here-> after passing underneat the supinator becomes the posterior interosseus nerve

Answer 17

common site of impingment of the PIN- branch of radial nerve. supinator muscle. results in motor deficits: innervates the supinnator, extensor carpi radialis breviw, extensor digitorium communis, extesnor digiti minimi, extesnor carpi ulnaris, abductor pollices, extensor polices brevis, extensor pollices longus, extensor indices

Answer 18

EPB O: posterior distal radius and interousseus membrane I: posterior base of proximal phalanx of the thumb A: thumb extension N: radial nerve--> posterio interosseus nerve EPL O: posterior ulna and interousseus mmebrane I: distal phalanx of the thumb A: excommontension of the thumb N: radial --> posterior interosseus

Answer 19

O: posterior proximal raridus/ ulnar; interosseous memebrane I base of metacarpal of the thumb A: abduct/ extend the thumb, wrist extension N: radial--> posterior interossueous nerve

Answer 20

courses into the forarm via th cubital fosssa (Medial elbow) beneath the liganment of struthers travels between the 2 heads of the pronator teres!! decends between flexor digitorum profundus and superficialis 2 forarm branches 1) anterior interrossesus nerve 2) palamar cutaneous nerve/digtal cutaneous eneters the hand through the carpal tunnel

Answer 21

2 LOAF 1st 2 lumbricals 1 and 2 opponens policis adductor pollicies brevis flexor pollicis brevis

Answer 22

palamer D1-3.5 and dorasal tips lateral/ventral palm

Answer 23

band of connective tissue on the media humerus median nerve runs beneath not a common site of intrapment-increases after a humeral fracture

Answer 24

O: medial supracondylar ridge, coronoid process of ulna I: laterl surface of radius A: pronation of forarm, flexion of forarm at elbow N:median nerve+

Answer 25

compression neruopathy of the median nerve ( and the anterior interosseus nerve) at the elbow pain over pronator teres and with resisted pronation, numbness and tinigling in the palm of the hand MOI repeitive forarm pronation especialiy with added finger felxion (tool use) leads to increased muscle bulk in pronator teres rest, ice for pain and swelling

Answer 26

small branch of median nerve that arises between the two heads of pronator teres I: Flexor pollicis longus muscle, flexor digitorum profundus, pronator quadratus muscle

Answer 27

O: distal anterior ulna I: distal anteriorradius A:forarm pronation N: median nerve--> anterior interosseus nerve

Answer 28

O: medial epicondyle of the humerus I: felxor retinaculum and palmaris aponeurosis A: wrist flexion, tenses aponeurosis N; median nerve

Answer 29

O: medial epicondyle of humerus I : bases of metacarpals 2 and 3 A: flexion at wrist , radial deviation N: median nerve

Answer 30

FDS O: Humeroulnar head: Medial epicondyle of humerus, coronoid process of ulna Radial head: Proximal half of anterior border of radius I: tendon splits (FDP passess through split) and attaches to sides of middle phalanges of 2-5 A: MCP and PIP flexion N:median FDP O: proximal half of anterior ulna and interosseus memebrane I: palmer surface of distal phalanges A: finger flexion (DIP), erist felxion N: D2&3 median nerve--> anterior interouseus nerve D 4 and 4 ulnar nerve

Answer 31

site of compression of the median nerve as it travels through , most common nueropathy numbness tingling in plamaer D1-3.5- no senesation changes in the palm ( palmer cutaneous branch tavels above the tunnel) sevrer--> weakness and atrophy of thenars floor is the carpal bones, roof is the felxor retinaculum- attaches to pisoform/hook of hamate and scaphoid and trapezium contents: median nerve, flexor pollices longus, FDs adn FDP tendons,

Answer 32

occurs as the result of prolonged compression of th emedian nerve damage to the nerve leads to inability to flex D1-D3 when trying to make a fist

Answer 33

thumb permenatly rotated and adducted damage to distal median nerve that supplies the muscles that control the thumb imparied opposition and abduction

Answer 34

opponens pollices o: carpal bones I: lateral aspect of first metacarpal A: opposition of the thumb N: median flexor pollices brevis O: carpal bones I: superfiscal and deep head that attach to proxial phalanx of the thumb A: thumb flexion N: superfiscal head-median and deep head innervated by ulnar nerve abductor pollices brevis O: carpal bones I: lateral side of proximal pahalanx of the thumb A; thumb abduction N: median nerve

Answer 35

4 short muscles in the hand between the metacarpals O: tendons of FDP I: extesnor expansion of hand A: flex the fingers at the MCP joints and extend at the IP's N: lateral 2 lumbricals median, medial to lumbricals ulnar

Answer 36

C8- T1 descends down the medial arm pases to posterior compartment, passes beneath ligament of struthers between medial epicondyle and olecronanon (cubital tunnel) 2 muscular brnaches in proximsl forarm ( medal FDP, FCU) decends in the medial forram above the FDP distal forarm doral and plamer cutaneous branches to medial hand motor innervation of the hand ( interossi, medial 2 lumbricals, hyothenars, deep head of aductor pollices brevis, and adductor pollices enter the hand just lateral to pisform through guyons cannal (pisform to hook of hamate)

Answer 37

medial hand and 1. 5 digiits

Answer 38

lumbricles 3 and 4 hypothernars ( dlexor digiti minim, abductor digit minimi, opponesns difiti minimi, plamaris brevis) interossei adductor pollicis!! (thenar mucles)

Answer 39

O: carapl bones/ metacarpals I: medial proximal phalanx A: thumb adduction, assists in late opposistion N: ulnar

Answer 40

O: proximal half of anterior ulna and interosseus memebrane I: palmer surface of distal phalanges A: finger flexion (DIP), erist felxion N: D2&3 median nerve--> anterior interouseus nerve D 4 and 4 ulnar nerve

Answer 41

Abductor digiti minmi O: carpalsI: ulnar base of prximal phalanx A; abduction of D5 N: ulnar flexor digit minimi O: carpals I: medial base of proximal phalanx A: flexion of D5 at MCP N; ulnar opponens digit minimi O: carpals I: ulanr base of MCP A: opposition of D5, felxion of D5 N: ulnar

Answer 42

orofascail pain crepitus restricted jaw movment

Answer 43

degernative changes highly used joint-thats why there is a disc for extra protection diffuse pain that increases when bitting firm foods decreased ROM, stiffness morning pain that decreases as day goes on weakness and atrophy of muscles of masticaption CREPTIUS is halmark for OA grinding/clenching increases wear goals decrease inflammation and pain, preserve and prevent further degeneration strengthen supporting muscles, massage to increase bloodflow and healing night guard if grinding

Answer 44

anterior disc displacement is the most common instability in ligaments supporting disc inflamamtion in the joint space click when opening= reduction click when closeing=displacment CLICKING

Answer 45

closed lock can not fully open the jaw, it is locked due to anterior displacment of the disc Tx j stroke: caudal distraction to reposition the disc, followed by a caudal anterior glide open lock can not close jaw due to posterior displacment of the disc much less common will often present to emergency soon after locked, more uncomrftable cuadal distraction, posterior cuadal glide

Answer 46

decreased ROM, localized pain at end range, signs of contracture, Hx of truama, deviation towards affected side, may have secondary myofascial syndrom manual therapy: streching, soft tissue techniques, mobilizations, strengthening,

Answer 47

excessive anterior translation, increased ROm > 50mm of opening generalized laxity, pain with opening, deviation towards unaffected side ay have joint nose at end range

Answer 48

pain that increases with opening, no joint noise, traumatic or insidious, tirgger points may result in referred pain to other ares may result in decreased ROM due to spasm and pain trigger point release streching coordiation

Answer 49

funtional opening 4omm, 2 flexed knuckles maximal opening 50 mm lateral deviation 9 mm protrusion 9 mm retrusion 1-2 mm

Answer 50

1) glenoid humeral 2) Acromioclavicular 3) sternoclavicular 3) scapular throacic

Answer 51

ER> abduction> IR

Answer 52

40-55 degrees of abduction, 30 degrees of horizonal adduction

Answer 53

borders anterior: clavicle/corocoid process, pec minor posterior: UFT/scapula medial: scalene muscles and first rib lateral axialla contains: brachial plexus,subclavian artery, sublcavian vien

Answer 54

true TOS patient presents with an anatomic anomoly compresing the brachial plexus (cercial rib, elongated C7 TP rare paresthesia/numbness/weak grip/loss of manual dexterity and precision movments in hands

Answer 55

no evidence of antomical anomolyies Dx based on signs and symptoms maladapive postures, shortening of scalenes and pec- most paresthesia/numbness/weak grip/loss of manual dexterity and precision movments in hands

Answer 56

compression of subclavian artery typically agravated by arm motions cool skin, pale extremity, diminished or absent pulse, raipid fatuge of limb, lower BP on the affected side

Answer 57

compression of subclavian vien painful swelling n arm mottled blusih discoloration thrombus

Answer 58

contenital anatomical anomaly muscle hypertrophy (scalene, subclavis, pec minor) inflammation/scar tissue in strucutures surrounding the plexus truamatic (fracture/WAD-scalene spasm) posture- maladaptive posturing shoretning of scalenes and pec - excessive overhead acivities thrmnbus-venous TOS pancoast tumor

Answer 59

site of compression: interscalene triangle between scalen anterior and scalenus medius supracalvidulary

Answer 60

site of compression constoclavicular space between the clavicle and first rib

Answer 61

site of compression axillary interval under the coracoid process and behind the pec minor-infraclavicular

Answer 62

type of lung cancer location =top of R or L lung can compress brachial prelxus and sympathetic ganglia horners syndrome: miosis (constricted pupil), partial ptosis ( weak droopy eyelid), aparent anhydrosis (decreaed sweating), enopatholmos (inset eyebal)

Answer 63

The arm patient is abducted 30 degrees at the shoulder and maximally extended. The radial pulse is palpated and the examiner grasps the patient's wrist. The patient then extends the neck and turns the head toward the symptomatic shoulder and is asked to take a deep breath and hold it. The quality of the radial pulse is evaluated in comparison to the pulse taken while the arm is resting at the patient's side The test is positive if there is a marked decrease, or disappearance, of the radial pulse. It is important to check the patient's radial pulse on the other arm to recognize the patient's normal pulse. A positive test should be compared with the non-symptomatic side.

Answer 64

tests for TOS-arterial positive tests have a disperance of radial pulse

Answer 65

test for TOS anducted to 90 degreess, open and close fists for 3 min + test is reproductino of symptoms minor fatigue is normal

Answer 66

sitting position. The therapist stands behind the patient and grasps under the forearms holding the elbows at approximately 80-90°, while maintaining the forearms, wrists, and hands in neutral. The therapist then leans the patient’s trunk posteriorly, approximately 15° from vertical, and elevates the patient’s shoulder girdle close to end range. This passive shoulder girdle elevation position of both shoulder girdles is held for up to three minutes. This test is considered positive if either a release phenomenon occurs or the patient’s familiar symptoms are reproduced.

Answer 67

trauma to the ligaments holding the acromion and clavicle together cuaseing seperation betweent the two MOI: downward force on the acromion, directly falling and hitting the acrominon, fallinf on outstreached hand, falling on elbow S/S: step deformity ( distal end of calvicle is sticking up), grade 3 sprain (both acromiocalvicular and coracoclavicular ligament shance been torn, deltoid and traps may be torn from end of calvicle. tenderness and swlling over the AC joint pain with shoudler horixontal adduction, elevation and Hand behaind back pain between 160-180 degrees of abudctino due to lack of calvicle rotation cross body horizontal adduction test ( + reproduces symptoms) stress view x ray- xray of ac while holding weight in arm so seperation is apperent.

Answer 68

type 1: sprain, capsule is intact, no speration or excessive spacing is seen, all strucutres are intact type2:subluxation, increased AC joint spacing, AC lig ruptured CC is sprained, capsule is ruptured, minimal damage to traps and deltoid type 3: dislocation, increased Ac joing and coracoclavicular space, joint surfaces are not in contact with each, AC and CC ruptured, capsule ruptured, deltoid and traps detached

Answer 69

what direction, degree-subuxation/dislocation, truamatic/atruamatic, acute/reoccurent males, younger then 30 years

Answer 70

seperation of the humerus from the scapula-most common in the body anterior dislocation is the most common anterior dislocation occurs in ER and abduction, stability hear is provided by long head biceps and subscap. anterior dislocation may damage subscapularis, long head of bicepsm GH ligaments, anterior capsule and andterior glenoid labrum

Answer 71

incomplete dislocation

Answer 72

truamatic: direct truama to humeral head, inderect trauma, most common when in abduction and ER atruamatic: general laxity of the shoudler cuases it to become unstable. hypermobile

Answer 73

feeling slipage with pain feeling insecuirty with specific activities paossible pain and apprehension when appraching extremes ROM decrease ROm during acute pashe due apprehension increased Rom in chronic phase due to instability may apperar normal on clinical examination-may be apperent after repeated activity when fatigue sets in possible atrophy due to disuse-chronic sulcus sign may be present

Answer 74

inferior traction of the humerus feeling dislocation dip benath the acromion

Answer 75

1) axillary nerve injury- must check before relocating-innervates teres minor and deltoids 2) axillary artery- may be damaged with injury and reduction 3) brachial plexus- les commonly damaged. posterior cord most common 4) bankart leision- most anterior dislcations damage the labrum resulting in chronic instability and may require sx repair 5) hillsachs leision- poseterolatera humeral head compression (indentation) fracture, may occur secondary to anterior dislocationdue to forcefull inpect of the humeral head against the anterioinferior glenoid rim

Answer 76

AMBRI " born loose" -Atruamatic etiology, multidirectional with bilateral shoudler findings with reahbhilatation as a tratment choice and rarely inferior capsule shift surgery if required -hypermobile (beightons scale) TUBS "torn loose" truamatic onset unideirectional anterior with a bankart leision responding to surgery -sx to tighten anterio capsule and subscaoularis to prevent relocation anteriorly

Answer 77

1) crank (Apprehension and relocation test-passive ER in abduction, will be apprehesive to movent, apply posterior glide to relocate 2) apprehension release (suprise test)-release posterior glide- will cuase pain =+ test 3) load shit test- stabilize scapula glide humerus anterior to assess laxity/stabiliyt

Answer 78

superior labrum anterior to posterior ( 10 -2 oc clock) -a forceful pull by long head of biceps if it becomes detached shoudler will be unstable MOI rep overuse like baseball injury, thorwing, deacceleration while throwing, direct truama, FOOSH, traction injury to biceps sensation of clicking and or popping with mocment, pain with overhead activity and lying on affected side, GH IR deficit, loss of strength and endurance of rotator cuff and scapular stabilizers, dead arm syndrome in pitchers-decreased velocity and pain clunk test- abduction and ER with anterio shoudler glide +clunk/grinding/pain active compression test of obrien-flex to 90, IR adduct 10 degrees ressist downward motion bicep load test- iin aprrehsion test position- resisted elbow flexion + if apprehsion doesnt change or if increaed pain

Answer 79

Jerk test- horizontall adduction then abduct with force on humeral head- clunk indicates instability load shift test- stabilize scapula and shift humeral head posteriorl to assess for instability posterior apprehension test- flex humerus to 90bend elebow, apply posterior force to humerus in suppine with hand underneath

Answer 80

suclus sign- inferior force to humerial shaft will see spacing beneath acromion feagin test- same as above but with arm abducted to 90

Answer 81

anteior inferior tear of the labrum (3-7 oclock)) commonly occurs with anterior dislocation of the GH common in overhead sports/occupations ( in abduction and ER over head) snensation of clicking/poopping. diffuse pain, worse with hand behind head, feeling weakness and instability

Answer 82

idopathic conditon charctirized by shoulder pain followed by progressive loss of GH ROM following a capsular pattern due to the development of dense adhesions/capsular thicking surrounding the GH idopathic or secondary to other conditions involving pain/decreased ROM highly correlated with psychosocial issues capsular pattern ER abd IR hallmark sign, difficultu with shoulder mvts leading to activity and functional limitations, reverse scapular humeral rhythm present (more scap mvt then GH, trick mvts, muscle weakness poor endurance

Answer 83

1) gradual onset of pain that increase with mvt and at night , loss of ER ROM with intact strength in rotator cuff , 3months duration 2) freezing- persistent and more intense pain even at rest (dull and achy), restricted ROM in all diretions ER Abd IR, 3-9 months 3) Frozen- pain only with movment, night pain decreases, sig adhesions, hard capsular end feel, restricted ROmin all directions, increase in scapular compensatino mvtsm atrophy of deptoid rotoatr cugg biceps tirceps, 9 -15 months, disuse, 4) thawing- minimal pain, sig restrections at start but gradual return of ROMm some patients never regain full, 15-24 months ** most benefit from PT eraly frequent ROM

Answer 84

signs and symptoms from increased pressue on the sturcutres running under a narrowed sub acrominal space. subacromial bursa, supraspinatus tendomn, long head biceps tendon, coracoacromial lig, joint capsule primaey impingment: result of congenital abnormailities or degneerative changees to acromion process, corocoid process, greater tuberosity, rotator cuff, or anterior tissues due to stress overload cusing impingment Secondary: functional impingment, result of abnoraml force couping action leading to muscle imba,aaces and abnormal movment pattersn, may result after instability, kyphotic posturing, tight pec minor pulls scap foward narrows space, LFT not pulling scap down and back narrows space, winging-weak SA decreased space calcific tendonitis: calcific depostis within a tendon (supraspiniatus) deposts produce bulge in tendon which increases likelyhood of impingment S/S: painful arc 60-120, pain anterior lateral shoudler worse with overhead activities, does not radiate below elbow, no pain at rest, tendernoss to strucutres passing below arch, reversed scap humeral rhythm, decreaesd HBB and HBH, anterior supeerio humeral head at rest, may present with decreaseed posterio inferio gilde tests: hawkin kennedy impingment , neers impingment (passice arm elevation, scapular assist test (humerus mvt with assisted scap movt will decrease paiin

Answer 85

inflammation of a tendon

Answer 86

inflammation of the synoviu,-the fluid filled sheath surrounding the tendon

Answer 87

degenerative changes within a tendon without inflammation, though to be asa result of overuse and repetive stress on the tendon cuasing degnerative microdamage, typically takes loniger to heal then tendinitis

Answer 88

tear of a tendon, occurs when the forces placed on the tendon are greater than the tensile strength and capcity of the tendon, may be partial or complete

Answer 89

pain and dysfuntion in tendon due to impaired healing( tendititis, tnensynovitis tendinosis) s/s: pain with contraction, tenderness at origin and insertion, pain with passive stretch

Answer 90

speeds test- resisted shoudler flxion palm up yergasons teset- resisted supination with palaptino of biceps insertion

Answer 91

drop arm test- slow controlled lower of abducted arm, can add min resitance look for strength deficiets, and inability to controll the decent empty can test in scaptionu

Answer 92

belly press test-resisted IR lift off sign - HBBm lift, resist

Answer 93

infraspinatus test -resisted ER open door, weakness lateral rotation lag sign- elbow bend arm in 30 degreess abduction in ER asked to hold position. if they drop, move =lag

Answer 94

hornblower sign - 90 abduction, ER with elbow bent, hold position if drops +

Answer 95

an alteratio in the noraml position or movment of the scapula

Answer 96

static- winging at rest, typically as a rsly of structureal defromity of the scapula, clivicle ribs or spine dynamic winging- winging with movement, may be due to the lesion of the long thorisc nerve (serratus), spinal accesroy nerve (traps), C3 4 traps, C5 rhomoboids, C7 serratus anteior/rhomboids, SA weakness, rhomboid weakness, or mulitidirectioni instability wall push up test, scapular lod test, punch out test ( SA weakness)

Answer 97

loose packed: 40-55 abduction, 30 horizontal adduction closed packed: max abduction and ER capsular pattern ER, abd IR

Answer 98

ulnahumeral joint- ulnar and radial collateral ligs radiohumeral joint- ulnar and radial collateral lig procimal radioulanr joint-annular ligament

Answer 99

normal 5-15 ( women greater angle in women) excessive cubitus valgus- greater then 30 cubitos varus- less then 5

Answer 100

Grade 1 minimal swelling and pain , no lig laxity, microtear Grade 2 moderate swelling, eccymosis and pain, increased lig laxity but with frim end feel, partial tear Grade 3 sig swelling, eccymosis, pain, gross laxity present, no end feel, complete tear

Answer 101

fan shaped lig ament that has anterior posterio and transvers portions, restrains valgus tear in UCL MOI valgus stress-acute or chronic s/s pain, localized tenderness, joint effusion, instability with valgus stres test, limited ROM, may have heard an audible pop Tx activty modification-avoid mvts that stress ligs correcting fualty technique- elbow may be compensating for lack of mvt elsewhere-eg shoudler rotation decrease pain- modalitites decrease swelling- pulsed ultrasound, ice, compression, elevation braching- medial strapping of the elbow, external support strengthing of foramflexors/pronators tp stabilize area restore ROM after immbilization period Sx lig reconstruction from tendon, peroid of immobilization

Answer 102

the most common, disocation of the olecranon posteriorly, often invovles disruption of UCL/RCL often invovles a fracture of the coronoid porcess or radial head ( top of distal foram segment) major complications can occur including impairment of vascular supply to forearm-check distal pulse

Answer 103

subluxation of the radial head-partial dislocation, disruption of the anular ligament, commonin young children 1- 4 years (older children have a mature annular lig), s/s child reufses to move ar,m arm is common ly held at the side in slight flexion Tx reduction

Answer 104

inflammation of the olecranon bursa turma, pressure, infection s/s swelling , redness, tender on palpation, Tx activity modification- decreased comprsesion and painful mvts ice for selling compression sleeve for swelling NASAIDS, coroticosteriod injections, aspiration-draininage, antibiotic if infected, bursectomy- Sx removal

Answer 105

itis= inflamation, losis is dengeneration one of the most common ortho conditions degernerative changes to wrist extensor tendons inserteing into the lateral epiconcdyle ot the humerus most commonly invovles ECRB, AKA tennis elbow >35 yers repetitive use, poor technique, heave racquet, heave ball samll grip load>> capacity to recover=degeneration poor blood supply impairs recovery s/s aching pain, insidious onset, tender palapation at insertion, pain with stretching of wrist extensors. decreased wrist extension and grip strength COzens test, maudsleys test, mills test Tx activity modification decrease loading coutnerforce brace stretch strengthen eccentric mobilizations cross friction massate pain modialities- US, ice, compression, elvation. NSAIDS, corticosteriods

Answer 106

degenerative changes the wrist flexor tendons inserting into the medial epicondyle of the humerus commonly invovles pronator teres and flexor carpi radialis tendon golfers elbow > 35 years repetive use s/s aching pain, tender on palpation at medial epicondyle, pain with resisted wrist flexion/resisted pronation and gripping, pain with stretch on wrist flexors, decreased wrist flexion, pronation and grip strenght reverse mills Tx: activity modifiction, stretching, eccentric strength, mobilization, cross friction massage, pain modialities nsaids and cortiocosterof injections

Answer 107

radial medial ulna

Answer 108

humerus supracondylar process syndrome- underneath of the ligment of struthers, medial humerus, rare pronator syndrome- between to heads anterior interosseioua nerve syndrome- branch of median nerve, between two heads of pronator teres, , may oaccur with forarm fracture, pinch deofrmity- cant tip to tip but pulp to pulp

Answer 109

cubitol tunnel syndrome lateral or between two heads of flexor carpiulnaris muscle nerve mobilizations nasaids, cortiocosteriods, ulnar nerve transposition sx

Answer 110

radial humeral groove- disrputed often with humeral fractures entropment of PIN betweem 2 heads of supinatory in the arcade of Froshe, radial tunnel, may mimi tennis elbow superfiscal brach -traped under the tendon of the brachioradilais nerve mobilizations NSAIDS, Corticosteriods, radial tunnelrelease sx

Answer 111

radiocarpal joint, the ulna does not articulate with the carpal bones, the ulna articulates with the TFCC

Answer 112

distal radail fracture resulting in dorsal displacment of the distal fragment complication include compresion neruopathy from swelling (median), CRPS and arthritis -FOOSH -common in osteoporitic women -dinner fork deformity, dorsal wrist pain and tenderness, swelling, may present with bruising, may present paresthesia, difficulty lifting and grasping Tx immobilization ( move everything above and below- no pro/sup, if stable in a closed reduction and thumb spica, unstable and displaced will require ORIF at least 2 weeks immboization, begin AROM/PROM, progressive loading ( will be atrophy due to immobilization)

Answer 113

distal segment moves palmer foosh with wrist in flexion

Answer 114

a chronic pain disorder cuased by sympoathetic nervous system malfunction and is characterized by pain that is out of proportion to the original insult or injury CRPS type1 occurs after injury to tissue/regional sympathetic dytrophy CRPS type 2 occurs after injury to nerve, formaly know as cuasaligia unkwon cuase, symptoms developin association with an injury to th affected area s/s: severe pain (burning),, sesnory abdnormalities ( allodynia, hyperalgisia), abnormal blood flowm abnormal sweating, abnormal motor function -weak/stiff/poor cordination, ,trophic changes (colour changes, temp changes, edema, shiny tight skin, abnormal hair and nail growth

Answer 115

Stage 1: several days after an injury or insidous over weaks, pain/ hypehidrosis/ warmth/ erythema/rapid nail growth, edema in distal extermeity stage 2: dystrophic/vasoconstriction, 3 months after intial injury and lasts 3-6 months, burning pain/ sympythetic hyperactivity, hyperestheisa exacerbated by cold wather, mottling and coldness, brittle nails and osteoporisis stage 3: atrophic stage. typically begins 6 months- 1year, can last for months or years, pain either decreaseing or becoming wrose, sever osteoporisis, muscle wasting, contactures

Answer 116

education, mobility (early AROM, tendon gliding, nerve mobilization), encourage ADLS, compreseive loading, dsitraction, dessenitization, edema control (elvate, compression, retrograde massage), modalities (TENS, US, Ice), mirron therapy, areriobic activity (PA benef its) ACTIVE appraoach, use hand as much as tolerated

Answer 117

warning signs: increased pain, cast tightness, cast loosesness, changes in surrounding skin colour/sensation, increased swelling, Do! maintain ROM of joints above and below, check skin integrity above and below, check capillary refill, education on how to reduce selling, educate on warning signs/precuations, remove any tight jewlery DONT! stick things inside a cast, get cast wet

Answer 118

fracrue of scaphoid bone, most commonly fractured carpal bone, requires MRI BONE scane- not seen on reg x ray FOOSH -in younger indifivivduals, old osteoporitic will get colles fracture, MVA complicatinos include avascular necorsis ( damage to radial artiery- can be grafted), non union of fracture and arthritis s/s: radial side wrist pain, tnderness in anatomical snuff box, may have swelling in anatomical snufff box, pain with longitudinal compression of thumb sstable: cast thumb spica, unstable: ORIF + 2 weeks of imobility adn rexray tto see if there is healing mobilization, strengthening

Answer 119

painful inflammation of the sheath (synovium) surrounding the tendons of the 1st dorsal compartment ( abducror pollicies and extensor pollicies brevis ( most radial boundary of snuff box) chornic overuse, direct trauma s/s radial sided wrist pain extending porximal or distal tendons, tenderness, swelling, worse with wrist and thumb movments, may have crepitus finklesteint test- thumb enclosed in fist + ulnar deviation activitiy modification (avoid aggrvation), cyrotherapy, splomting- may decrease irritation, gradual stretch and strenght nsaids, coroticosterioids!!!, surgical release

Answer 120

triangular fibrocartilage complex stablizes/transmitts loads to ulna a tear in th eligamentous and cartilaginous strucutres of the TFCC resulting in ulnar sided wrist pain compressive loads to wrist especially with ulnar deviation can be degernative or traumatic distal radial ulnar fracture s/s ulnar sided wrist pain, may have tenderness and selling oer dorsal aspect of wrist, may have clicks with wrist mvt, pain with wrist extensino and ulnar deviation, pain with resisited extension and ulnar deviation activity modifications, bracing, ice, progreesive strength and mobility NSAIDS, cortiocosteriods, Sx TFCC load test (compressive load with ulnar deviation), press test (tricep dip, pushing chiar)

Answer 121

PAD-palmer adduct DAB- dorsal abduct innervated by ulnar nerve

Answer 122

inability to abduct or oppose the thumb, thumb is held in the same doesal ventral plane as D2-5 median nerve leison

Answer 123

inability to flex D1-3, remain in extension when atempting to make a fist, only seen during active flexion, median nerve leision

Answer 124

hyper extension od MCP and flexion of IP joints of D4/5 , ulnar nerve lesion

Answer 125

wrist dropp, inabitliy to extend wrist or MCP joints of hands

Answer 126

a compression of the median nerve as it passes through the carpal tunnel a narrow passageway for tendons and the median nerve on the volar side of the hand created by th carpal bones (floor and the flexor reteinaculum) contents ( FDS and FDP tendons, flexor pollices longus, median nerve)

Answer 127

insidous onset typically, repetitve hand mvts, vibration, ass with ( RA other inflammatory conditions, colles fracture, lunate subluxation, hypothyroidism, pregnancy DM, obestiy), femaile paresthesia and pain in median nerve distribution of hand, worse with sustained or repetitive wrist mvts, nocturnal numbness and pain, relived by "flicking the wrist", weakness and clumsiness in hand, decreased grip strength, frequent dropping of objects, severe: attrophy of thenar and first 2 lumbricals,

Answer 128

tinel's test (Tappig)-elicits pins and needles in distribution distal also indicates nerve regeneration pahlens test-press dorsal hands together for 30-60 sec, will increase compression and elecit symptoms reveres phalens - praryer pose will 30- 60 sec will also elicit symptoms carpal compression- applie compression 30- 60 sec will elicit symptoms resisted APB- deed head is ulnar nerve ULTT with median nerve bias-shoulder depression, abduction to 110, ER with elbow bent, finger and wrist extension, ebow extensino nerve conduction velocity test EMG

Answer 129

activity modification- decrease aggrvating acitiviities splinting wrist in neutral mobilty- nerve mobilization, tendon gliding, joint movilization if restricted gentle multi angle muscle setting, progeress to resitance and endurance, fine finger dexterity NSAIDS, corotocosterioids, carpal tunnel release sx- to increase space, not always efective

Answer 130

wrist immobilization 7 - 10 days (slight extension with the fingers free to move), possibly splint may be removed for therapy

Answer 131

patient education wound managment control of edema control of pain active tendon gliding exercises nerve gliding exercises active finger and thumb ROM active wrist extesnion, radial and ulnar deviation with wrist in extension pronation supination of the forearm all elbow and shoulder movments

Answer 132

sutures are usually removed around post op day 10-12 return to full activity by 6 -12 weeks residual impariemtns may include weakness/sensory dificits, persistent edema, limited ROM, hypersensitivity and pain scar tisssue mobilization progressive streching and joint mobilizations progressive strengthening-isometrics at 4 weeks, grip and pinch 6 weeks, dexterity sensory reducation

Answer 133

nerve compression at more than one site along th same nerve, procimal compression or pathology of a nerve is usggested to increase vulnerability of a nerve at a distal point

Answer 134

a condition cuased by localized compression of the ulnar nerve as it passes through guyons cannal a semi rigid cannal created by the connections between the pisiform bone and the hook of hamate risks: trauma (FOOSH with or with out hook a of hamate fracture), chronic pressure (cycling), space occupying leision (ganglion cyst), extended use of crutches, anything that increases perssure or repetitive compression s/s: presthesia and pain in nerve distribution (palmer lateral d4 and 5) , decreased grip strength, fatigue with repetive activities, clap hand and atrophy of hypthenars in severe cases forments sign-tests strength of adductor polices, + will felx DIP guyons canal compression reproduce symptoms tinnels- tingling, symptoms in ulnar distribution ULTT- likley postive nerve conduction velocity test Tx: activity modification, cock up splint, padded equiptment/tools, frequent hand position changes, nerve mobilization nsaids, corticostreriods, guyins cannal release sx

Answer 135

sprain of UCL of thumb moi: valgus force to thumb-skiers, volleyball test for for lig laxity with valgus stress s/s: pain and tenderness at base of thumb on ulnar side of MCP joint, pain with mvt-wrose with abduction/extension, decreaed pinch/grip, swelling discolouration at base of thumb Tx: activity modification, splint MCP in slight flexion, gentle ROM as tolerated, strenghting (theraputty) Sx repair if tear is repair or complete avulsion fracture

Answer 136

osteoarthritis of the CMC joint most common OA in the hand repetitve mvt, joint injury, F>M, advanced age s/s: pain at base of thumb, worse at night/changes in weather/overuse, tenderness at CMC, decreased pinch /grip, muscle wasting in thenars due to disuse, possible instability joint space narrowing increases lig laxity GRIND test Tx: activity modification, splinting, larger grip handles, AROM within tolerable limits, strengthening Nsaids, coroticosteriod, 1st CMC athoplsty ( remove trapezium), 1st CMC arthrodesis( fuse- dcreased rom but decreased pain)

Answer 137

contracture of palmer fascia, fixed flexion deofermity of the MCP and PIP joints, usually seen in D4 and 5 sin gis often adherent to the fascia

Answer 138

thickening of the flexor tendon sheath results in the tendon sticking, catching or locking when atempting to flex the affected finger, more common in D3-D4, often assicated with RA

Answer 139

flexion of the DIP at rest, due to rupture or alvulsion of the extensor tendon at its insertion in the distal phalanx from hyper flexion injury, tx splint the DIP strait for 6- 8 weeksb

Answer 140

OA enlargment of the PIP on dorsal surfacehe

Answer 141

OA enlargement of the DIP on the dorsal surface

Answer 142

there are 7 cervical vertebra, 8 cervical nere roots that exit above the coressponding nerve root. C8 exits below C7vertebrae ( the rest of the spine, nerve roots exit below the corresponding vertebrae)

Answer 143

a condition decribing a group of signs and symptoms related to compressed or irritated nerve imaging does not always correlate with pathology closing down of the IVF will cuase symptoms cuases: constant flexion or flexion under load, disc herniation, lateral stenosis (narrowing) osteophytes, ligament thicking, swelling/inflammation 1. dermatomes- a area of skin mostly innervated by a single nerve root 2. myotomes- a muscle or group of muscles supplied by a single nerve roots 3. refelxes- an involuntary and almost instant response to a stimuli 4. special tesets

Answer 144

degeneration in the spine, OA

Answer 145

comfrotably positionined with tested areas exposed, confirm understanding, test on in tact skin, as patient to close eyes, test dermatome proximal to distal bilaterally, start with light touch- if impaired can do crude touch (sharp/dull) and temperature.

Answer 146

patient is positioned in an appropriate position to test joint to be tested is placed in neutral position therapist instructs ( hold and dont let me move you) manual resisitance for 5-8 sec test bilateral when possible C1-2 flexion of the neck C3 lateral felxion of the neck C4 elevation of the shoulder C5 shoudler abduction and ER C6 biceps elvow flexion, wrist extension C7 elbow extension, wrist flexion C8 themb extension ulnar deviation T1 finger abduction adduction

Answer 147

patient needs to be completely relaxed place tendon under slight strech and sttiem with hammer use distractions to increase refllex response C5 deltoid C6 biceps/brachioradialis C7triceps C8pro quad T1adductordigit mini 0 no response 1+ decreased response 2+ normal response 3+ exagerated 4+ clonus very brisk

Answer 148

quick and forcefully dorsi fleci and ankle and hold in position, abnormal response indicatespossible lesion of spinal cord, brainstem or brain

Answer 149

run a pointed object along the lateral aspect of the foot from heel across the ball to big toe base abnormal response: splaying toes and or extension of big toe indicates a possible leison of the spinal cord, brainstem or brain

Answer 150

when a patient is currently experincing radicular symptoms, traction to cervical spine postive will lead to symptom decreased/abolished

Answer 151

foraminal compression test- applies axial loadby pressing straigh down on patients head, if no symptoms in neutral progress to extension and rotation to unaffected side then extesnion and rotation to affected side, side flecion to affected side postive= symptoms towards side of side flexion

Answer 152

Median nerve /AIN shoulder depression/abducton 110 forarm supination wrist extension finger and thumb extensino elbow extension

Answer 153

median nerve 2 shoulder depression abduction to 10 forearm supination wrist extension finger and thumb extension elbow extesnion

Answer 154

radial nerve shoudler depression and abduction 10 pronation wrist felxion and ulnar deviation finger flexion, thumb flxion elbow exension

Answer 155

ulnar nerve shoulder depression and abduction 110 forarm supination wrist extension, radial deviation finger and thumb extension elbow flexion

Answer 156

C5/C6 upper brachial plexus injury paralysis of arm, hand is not affected waiters position: arm handging besi8de shoudler IR, elbow extesnsion and forearm pronation sesnsatino of deltoid area and radial surface of the forarm affected lateral traction of neck affects axillary, muscultaneous, supracalvicular nerves

Answer 157

injury to lower neve roots C8 and T1 weakness in the muscles of forearm hand and tricpeps horners syndrome * ptosis, miosis, ( dropping eyelid and pupil constriction) elbow felxion, forearm supination, wrist and MCP extension PIP and DIP felxion claw hand sensation on ulnar side of foram and hand affected traction and abducted arm

Answer 158

cuased by facet joints pain aggravated by compression stress on joints, pain may refer to neck of scapula region etiology: spondylosis (degeneration, OA), secondaary to trauma, secondary to other conditons RA/anklosising spondolytis, spondylolisthesis ( subluxation) physiological movemnts into extension can be used to rule out uncoupled non physiological mvts can be symptoms provocative

Answer 159

side flexion and rotation to the same side

Answer 160

vertebrabasiler insuffienciey!! RED FLAG qeustions!! screen before treating the C/S, manual therapy is contraindicated if present, refer to physican to rule out VBI compression of the vertebral artery can lead to decreased bllodd flow to areas of the brain ( posterior: stem, cerbellum) 5d"s: drop attacks, dysphagia, dysarthria, diploplia, dizziness 3n's: nyatagmus, nausea/vomiting, nerological symptoms

Answer 161

OH OH OH to touvh and feel very good velvelt ah heavenly 1olfactiry 2optic SMEL 3oculomotor 4trochlear 5trugeminal FACIAL SENSATION, JAW MUSCLES RIM 6abducens 7facial-MUSCLES OF FASCIAL EXPRESSION 8vestibocular _HEARING 9glossopharngeal- SWALLOW 10vagus-AH UVUAL DEVIATION 11accesory-TRAPS MMT 12hypoflossal- TOUGNE STENGTH 346 H Eye tracking

Answer 162

supine pt neck extended and side flexed held for 10- 30 sec symptoms of dizziness or nystagmus indicate contralateral side vertibra arteriy is being compressed if no symptoms ipsi rotation is added and held for same

Answer 163

unilateral shortening of sternocleido mastoid mmuscle contralateal rotation and ipsilateal side bend arom prom: side flex away and rotate towards affected side strech SCM and strengthen opposing SCm postioning and handling to stimulate sympetry and prevent plagiocephaly baby helment if plogiocephaly is severe

Answer 164

a result of forward head psoture tight pectorails and upft lev scap, occipitals weak deep neck flexorsm LFT, rhomboids, SA

Answer 165

top of screen at eye level monitor arms length away head in neutral with chin paraleel to ground back rest comforably agains the backrest of the chair elbows bent at 90 and cloe to the body lower or remove arm rests fingers relxed with wrists straight hips and knees at 90 feet flat on ground or on foot rest

Answer 166

excessive motion between two adjacent vertebrae due to ligament damage, fracture, dislocation, joint damage or weak muscle mobilizations and manipulations are contraindicated s/s: dizziness, lip or facial parathesia, lump in throat, nausea vomiting, nystagmuss, hesitatnt to move neck, pupil, severe headache, severe muscle spasm, soft end feel Specail Test: anterior shear/sagital, lateral lfexion alar lig, lateral/transverse shear test, sharp purser, cervical felxion rotatino

Answer 167

patient in supine, stabilize with basak segmetn anterior to TPS with thumbs, superior segment is translated anteriorly with other digits + symptoms, excessive motions

Answer 168

tests the integretiy of the alar ligs sstabilize C2 in supine side flex occiput and C1 + symptoms, excessive side flexion intact lig should have strong capsular end feel

Answer 169

tests the integreuty of the lateral lifs and capsualr tissues supine radial aspect of second MCP on inferior vertibrae radial aspect of second MCP on superior vertbrae apply shear force + symptoms or excessive motion should have minimal motion and ot sumptoms

Answer 170

performed with extreme cuatioon test to determine subluzation of C1 and C2 , transverse lig maintains the position of the dens seated, thumb stabilizes C2 posteriorly at SP patient asked to slowly flex head while PT applies pressure to forehead + PT feels head slide backwards during movment which indicates relactation of subluzed atlas may be accompinaed by a clunk

Answer 171

supine, flex c spine chin to chest to lock lower C Spine rotation of upper C spine, increased or decreased c spine rotation indicates C1/2 dysfunctionor reprorduction o headache

Answer 172

1. high risk factor that mandates x ray -> 65 -paresthesia in extremities -danagerous mechanism ( fall from > 3 ft, axial compresion, MVC > 100 km, rollover, ejection, rec vehicles biclcyes) =x ray 2. presence of low risk factors that allows safe ax of neck ROM -simple rear end sitting position ambulatory delayed onset pain absense mid c spine tenderness =no xray 3.able to rotate 45 L and R =no x ray

Answer 173

inner unit musccular control attach segmentally, fucntion as stabilizers/not prime movers includes deep neck flexorm deep neck extensors, suboccipitals dysfunction can lead to segmental/clnical instability leading to abnormal movement between segments, may lead to recruitment of global muscles which can lead to over use Craniocervical flexion test: supine eithinflatable cuff beneath upper c spine. base pressure to 20 mmHg hold for 10 sec, increase by 2 sec intervals with 10 sec holds and each, + test unable to increase pressure to at least 26 mm Hg and hold 10 sec, inability to raise by incremnets compensatory patterns-use of superfiscal neck muscles like SCM, extention of the heads Tx: deep neck flexor training, coordiation and timing/not strength- unload global muscles

Answer 174

line through external auditory meatus of the ear, acromion process of scapula, greater trochanter of the femor, posterior to the patella, anterior to lateral malleolus

Answer 175

rare congential and/or dengenerative weaking of vertebral end plate most common structural kyphosis in adolecents, second decade uneven growth ot the growth of vertebrae in the sagittal plane resulting in excessive wedge shape leading to increase kyphosis, T10--L2 anterior wedgeing> 5 degress on three or more adjacent vertbrae, hyperkyphosis, adolescents, rigid deformity severe can cause heart and lung compromise irrgueular endplates, schmorl nodes Physio can help to impede progression, bracing, strecht strengthen into extension, pain managment

Answer 176

increased kyphosis seen in older women with postmenopasual osteoporosis, anterior wedge fractures occuring at several vertebrae, typically results of trunk flexion, upper to middle thoracic spine, decreased hieght,

Answer 177

posture education, extension approach, stabilization exercises, stretching as needed, mobization as needed joint manips and aggresive moiblizations are contraindicated

Answer 178

typically secondary to osteoporosis, 6-7th decade of life, Females, typicaly in anterior vertebral body, cuased by falls/truamas/ trunk flexion, tx posture education, extension appraoch, stabilization exercises, wb'ing activities and exrecises, light mobilixation as needed no trunk flexion, aggressive mobilization, joint manips

Answer 179

lateral curvature of the spine, curves are labled in the direction on the convexity and level of apex the lareger curve is labled major and smaller in the minor cobb angle > 10 degreees= scolosis

Answer 180

due to cuases outside the spine curve disapears with forward flexion relatively easy to correct once cause is found poor posture, muscle guarding/spasm, nerve root irritation,inflammation, leg lenght discrepency stretch and strength leg length-long leg side, hip adduction, hip hike, side of convexity short side: hip drop, leg abduction, side of concavity

Answer 181

structural changes in bone congenital or aquired, does not disapear with forward bend cobb angle >60 will compromise cardioresp system irreversible with fixed rotation vb bodies rotaate tto side of convexity-posterior rib hump on side if convexity more easily visible un forward flexion

Answer 182

posture education stretch side of concavity strengthen side of convexity rotatation to side of concavity stabilization exercises scap stailizer exercises mobilzation as needed bracing as needed sx in severe cases we can fix non structural by addressing cuase we can prevent non structural influences on top of structual

Answer 183

viral infection of a nerve cuasuing a painfuls kin rash following a dermatome patterns, in thoracic spine presnets in a stripe may be accompained by fever

upper body Flashcards

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