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PTMMD > Arthrokinematics and Extra Info from Kinser and Colby > Flashcards

Arthrokinematics and Extra Info from Kinser and Colby Flashcards

1
Q

What is Hyperalgesia?

A

Increased pain response to a stimulus that normally causes pain

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2
Q

What is Allogynia?

A

Pain caused by a stimulus that does not usually causes pain

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3
Q

What is the Arthrokinematics of the OA?

A
  • Convex occipital condyles move on concave atlas

With Flexion:
- Condyles roll forward and glide backward

With Extension:
- Condyles roll backwards and glide forward

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4
Q

What is the Arthrokinematics of the AA?

A

This is responsible for 50% of cervical rotation
- Sliding motion of the atlas of the dens

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5
Q

What is the Arthrokinematics of Mid-Cervical Spine (C3-C7)?

Flexion, Extension, Sidebending/Rotation

A
  • Flexion: The inferior facets of the superior vertebra slide up and forward on the superior facets of the inferior vertebral
  • Extension: Inferior facets slide down and backward
  • Side-Bending/Rotation: Ipsilateral inferior facet slides down and back ; Contralateral inferior facet slides up and forward
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6
Q

What is the Arthrokinematics in Forward Head Posture?

What are the Compensatory Effects of FHP?

A
  • OA: In Extension
  • Mid Cervical Spine (AA-Everything else): Increased flexion (anterior compression)

Increased strain on posterior muscles (levator scapulae, suboccipital) and anterior structures like disc and ligamets

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7
Q

What are the S/S of DVT?

A

For the early stages
- dull ache or severe pain
- swelling
- changes of skin temperature and color
- Heat and redness

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8
Q

What is a common symptom of Deep Vein Thrombosis (DVT)?

A

Dull ache or pain usually in the calf

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9
Q

What are the signs of DVT upon palpation?

A

Tenderness, warmth, and swelling

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10
Q

List the first goal of the plan of care for DVT.

A

Relieve pain during the acute inflammatory period

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11
Q

When should mobility begin in the management of DVT?

A

When therapeutic levels of anticoagulant medication have been administered

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12
Q

What is the goal as acute symptoms of DVT subside?

A

Regain functional mobility

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13
Q

What is a key preventative goal in the management of DVT?

A

Prevent recurrence of the acute disorder

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14
Q

What is a recommended intervention for managing DVT?

A

Bedrest, pharmacological management, elevation of the affected lower extremity

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15
Q

What should patients wear while progressively increasing ambulation?

A

Graded compression stockings

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16
Q

What are the contraindications in the management of DVT?

A

Passive or active motion, application of moist heat, use of a sequential pneumatic compression pump

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17
Q

What precautions should be taken after discharge while on anticoagulant medication?

A

Avoid contact sports and activities with a high risk of falling or trauma

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18
Q

What is the optimal position for shoulder arthrodesis?

A

15°-30° of abduction and flexion and 45° of internal rotation

This position allows the hand to reach the mouth.

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19
Q

What is the recommended flexion angle for dominant upper extremity elbow arthrodesis?

A

70°-90° of flexion

This position is combined with midposition of forearm pronation/supination.

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20
Q

What is the optimal position for nondominant limb elbow arthrodesis?

A

Greater elbow extension than the dominant extremity

This position differs from that of the dominant limb.

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21
Q

What is the recommended wrist position for arthrodesis?

A

Slight extension

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22
Q

What is the optimal flexion angle for the MCP of the thumb in arthrodesis?

A

20° of flexion

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23
Q

What region does the brachial plexus course through?

A

The thoracic outlet

This region is significant for neurovascular structures.

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24
Q

Name the three primary sites for compression or entrapment of neurovascular structures in the thoracic outlet.

A
  • Interscalene triangle
  • Costoclavicular space
  • Retropectoralis minor space
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25
Q

What structures are contained within the interscalene triangle?

A
  • Subclavian artery
  • Upper trunk of the brachial plexus
  • Middle trunk of the brachial plexus
  • Lower trunk of the brachial plexus
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26
Q

What borders the interscalene triangle?

A
  • Anterior scalene muscle
  • Middle scalene muscle
  • First rib
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27
Q

What structures are contained within the costoclavicular space?

A
  • Subclavian vessels
  • Divisions of the brachial plexus
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28
Q

What are the boundaries of the costoclavicular space?

A
  • Clavicle
  • Subclavius muscle
  • Costocoracoid ligament (anteriorly)
  • First rib
  • Anterior scalene muscle
  • Middle scalene muscle (posteriorly)
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29
Q

What structures are contained within the retropectoralis minor space?

A
  • Cords of the brachial plexus
  • Axillary artery
  • Axillary vein
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30
Q

What are the anatomical boundaries of the retropectoralis minor space?

A
  • Inferior to the coracoid process
  • Anterior to the second through fourth ribs
  • Posterior to the pectoralis minor
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31
Q

What structural anomalies may compress or entrap the brachial plexus?

A
  • Cervical rib
  • Elongated C7 transverse process
  • Malunion of a clavicular fracture
32
Q

What is the primary focus during the Maximum Protection Phase of rehabilitation?

A

To protect the repaired tendon and prevent adverse effects of immobilization

The repaired tendon is at its weakest approximately 3 weeks after repair.

33
Q

How long should the repaired tissue be avoided from loading after surgery?

A

A minimum of 6 weeks

Failure of the repaired tendon through retearing or nonhealing is common.

34
Q

What is the duration of the Maximum Protection Phase after a small or medium tear repair?

A

3 to 4 weeks

This phase can extend to 6 to 8 weeks after repair of large or massive tears.

35
Q

What should be attained by 6 to 8 weeks postoperatively after an arthroscopic repair of a small or medium tear?

A

Nearly full passive shoulder ROM, particularly elevation and external rotation.

36
Q

What are the goals during the Maximum Protection Phase? List at least three.

A
  • Control pain and inflammation
  • Prevent loss of mobility of adjacent regions
  • Prevent shoulder stiffness/restore shoulder mobility.
37
Q

What interventions can be used to control pain and inflammation during the Maximum Protection Phase?

A
  • Periodic cryotherapy
  • Transcutaneous electrical neuromuscular stimulation (TENS)
  • Medically prescribed medications.
38
Q

What is the purpose of pendulum exercises in the rehabilitation process?

A

To prevent shoulder stiffness and restore shoulder mobility

Pendulum exercises typically begin the first postoperative day or when the immobilizer is removed.

39
Q

What is the ‘balance point position’ of the shoulder?

A

The position where the arm is placed in 90° of shoulder flexion if pain-free

In this position, the effect of gravity on the shoulder musculature is minimal.

40
Q

What initial exercises are recommended for passive ROM of the shoulder?

A

Exercises in the supine position, beginning with arm elevation and external rotation in the plane of the scapula.

41
Q

How soon can self-assisted ROM using the opposite hand or a wand begin for patients with small to medium tears?

A

1 to 2 weeks

For large tears, it begins at 3 to 4 weeks.

42
Q

What are the three categories of cuff repair?

A
  • Arthroscopic
  • Mini-open (arthroscopically assisted)
  • Traditional open

Each category is defined by the surgical approach and techniques used.

43
Q

Describe the arthroscopic repair technique.

A

The entire procedure is performed arthroscopically with only a few small skin incisions.

This technique minimizes soft tissue disruption and promotes quicker recovery.

44
Q

What are the two variations of the mini-open repair technique?

A
  • Subacromial decompression performed arthroscopically
  • A portion of the cuff repair performed arthroscopically

Both variations involve an anterolateral incision and splitting of the deltoid.

45
Q

What is the purpose of the anterolateral incision in mini-open repair?

A

To visualize the cuff tear without detaching the deltoid from its proximal insertion.

The incision is extended distally between 1.5 to 4 cm along the fiber orientation of the deltoid.

46
Q

What is the traditional open repair technique?

A

An anterolateral incision that extends obliquely from the middle one-third of the inferior aspect of the clavicle to the anterior aspect of the proximal humerus.

This technique requires detaching and reflecting the proximal insertion of the deltoid.

47
Q

What has happened to the use of traditional open repair techniques in recent years?

A

The use has decreased as arthroscopic and arthroscopically assisted techniques have advanced.

This trend reflects improvements in minimally invasive surgical methods.

48
Q

What is Pulled Elbow also known as?

A

Nurse maid’s elbow

49
Q

What type of injury is Pulled Elbow?

A

A common minor soft-tissue injury of the radiohumeral joint

50
Q

What age group is primarily affected by Pulled Elbow?

A

Preschool-age children

51
Q

What causes the radial head to slip in a Pulled Elbow injury?

A

A sudden longitudinal traction force on the pronated wrist and extended elbow

52
Q

What happens to the annular ligament during a Pulled Elbow injury?

A

Fibers of the annular ligament become interposed between the radius and the capitellum of the humerus

53
Q

List common causes of Pulled Elbow.

A
  • An adult lifts the child from the ground by their hands
  • The child’s forearm, wrist, or hand is held firmly by a parent as the child attempts to walk away
  • A mother grabs a child’s hand to prevent a fall
  • The young child is lifted by the hand from a lying or sitting position
  • The child is swung around by the hands during play
54
Q

What are the clinical findings associated with Pulled Elbow?

A

Painful and dangling arm, hanging limply with elbow extended and forearm pronated

55
Q

What signs indicate a child has a Pulled Elbow?

A

Reluctance to use the arm and resistance to attempted supination of the forearm

56
Q

What are the common sites of pain in Pulled Elbow?

A
  • Forearm and wrist
  • Wrist alone
  • Elbow alone
57
Q

What is the intervention of choice for Pulled Elbow?

A

Manipulation

58
Q

What should be done before manipulating a Pulled Elbow?

A

Explain the procedure to the parents and win the child’s confidence

59
Q

Describe the manipulation technique for Pulled Elbow.

A

Hold the child’s wrist with one hand while supporting the elbow and palpating the radial head with the other hand, then forcibly supinate the forearm

60
Q

What indicates a successful reduction during manipulation of a Pulled Elbow?

A

A click in the region of the radial head

61
Q

What should parents be advised to avoid to prevent Pulled Elbow?

A

Avoid pulling on the hands or wrists of the child

62
Q

What should be done if a child experiences a delay in using the arm after manipulation?

A

Use a sling for comfort and to protect the arm from recurrence

63
Q

What are ganglia?

A

Thin-walled cysts containing mucoid hyaluronic acid that develop spontaneously over a joint capsule or tendon sheath.

64
Q

What is the most common soft-tissue hand tumor?

A

Ganglia

65
Q

Where are common sites for ganglia?

A

Anterior (volar) or posterior (dorsal) surfaces of the wrist and fingers.

66
Q

Do ganglia typically cause pain?

A

They may not cause pain.

67
Q

What symptoms may arise as a ganglion begins to grow?

A

Aching irritated by flexion and extension of the joint.

68
Q

How can ganglia affect nerves in the wrist?

A

They can cause ulnar or median nerve compression.

69
Q

What sensory symptoms may develop from nerve compression due to ganglia?

A

Sensory symptoms in the digits or intrinsic muscle weakness.

70
Q

What is the appearance of a ganglion upon examination?

A

Smooth, round, or multilobulated and tender with applied pressure.

71
Q

What test can be used to determine the presence of an occult ganglion?

A

Finger extension test.

72
Q

What indicates the presence of an occult dorsal wrist ganglion during the finger extension test?

A

Pain in the wrist’s third and fourth dorsal compartments.

73
Q

What alternative condition may the finger extension test indicate?

A

Scapholunate joint pathology.

74
Q

What is an effective method for symptom relief of a ganglion?

A

Immobilization of the wrist through splinting.

75
Q

Does immobilization usually resolve the ganglion?

A

It is uncommon for the immobilization to be effective in resolving the ganglion.

76
Q

What procedure can resolve a ganglion?

A

Needle aspiration.

77
Q

When is surgical excision indicated for ganglia?

A

For patients with significant pain or cosmetic irritation.

PTMMD (40 decks)

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