CS written Exam Flashcards
Adaptive pain?
helpful or protective pain that promotes tissue healing and recovery
maladaptive pain?
as pain felt in the absence of obvious tissue damage. This includes functional pain and central/peripheral sensitisation and is typically pain that is disproportionate to the tissue injury or pain that persists well after tissues have healed.
Yellow flag?
psychological and social factors that could potentially reduce a patients ability to adequately recover. These include patient attitudes and beliefs, emotions, behaviours and family and workplace factors
Red flag?
are indicators of possible serious pathology such as inflammatory or neurological conditions, structural musculoskeletal damage or disorders, circulatory problems, suspected infections, tumours or systemic disease. If suspected, these require urgent further investigation and often surgical referral.
Things to look for on a cervical AP Xray:
- SP rotation
- IVDs and joint spaces
- Trachea in midline
- lung apices
AP open mouth X-ray?
- exclude tumours
- lateral masses dont overlap more than 2mm
- dens tilt <5 degrees
- tongue can create false # line
Cervical lateral X-ray?
- cX lordosis
- 4x lines
- 3 x spaces
4 lines on cervical lateral X-ray?
Anterior and posterior VB lines
spinolaminar line
post. cervical line
3 spaces on lateral cervical X-ray?
atlantodental space: <2mm
retropharyngeal space (@C2) - <7mm
retrotracheal line @C7 - <2mm
Apprehension/relocation test
- Positive:
- indicates:
- Positive: pain or inability to resist
- indicates: infraspinatus strain/tear
Lift off test
- Positive:
- indicates:
- Positive: inability to lift hand or pain
- indicates: subscapularis lesion
Hawkins kennedy test
- Positive: pain
- indicates: impingement
Neers Impingement
arm in IR and raised forcibly in the scapular plane
- Positive: reproduction of pain
- indicates: impingement
Empty can
- Positive:
weakness to resistance indicates supraspinatus tear
Pain suggests tendinosus
Painful arc & weakness of resisted ER can indicate?
impingement
Whiplash grade 1?
neck pain with no physical findings
Whiplash grade 2?
neck pain with physical findings but no neuro signs
Whiplash grade 3?
neck pain with neuro deficit
Whiplash grade 4:
neck pain with evidence of fracture or dislocation
Recommendations for neck pain?
- return to normal activities
- exercise and ROM exercises
- low load isometrics
NSAIDS and simple analgesics
labral tear orthopedic tests?
- FADDIR
- FABER
- clicking, catching or locking
labral tear treatment?
- unloading damaged labrum
- reduce repetitive hip movements
- increase motor control in deep stabilisers of the hip
Terrible or unhappy triad?
ACL, MCL, medial meniscus
2 orthos for ACL tears?
anterior draw
lachmans
Thessaly test?
single leg stance and rotation with knee bent at 5 degrees and then 20 degrees
Thessaly test positive?
joint line tenderness
locking or catching
indicates meniscal damage
plantar fasciitis risk factors?
- high BMI, excessive pronation, long periods of standing
- decrease hamstring and ankle flexibility
plantar fasciitis treatment?
- reduce agg factors: footwear, taping
- strengthening of midfoot, gastrocs and intrinsic mm.
- towel pick up exercises, dry needling
Medial tibial stress syndrome RFs?
biomechanial loading issues:
- excess pronation, overloading of tib post, FDL and soleus
- high levels of plantar flexion
- increased load, poor footwear
MTSS treatment?
load managment, ankle mobilisation, K tape
Varus?
lower bone angled inwards
Valgus?
lower bone angle outwards
Achilles tendinopathy treatment?
- load management
- biomech. compensations of hips, Lx, ankles knees
- isometric contractions
- slow concentric heel raises
Lateral ankle sprain treatment?
- decrease swelling : RICER in acute
- gradually return to normal activity with gait as normal as possible
- biomech compensations
- mobilisation of ankle, subtalar and midtarsal joints
what are the 3 lower limb neurodynamic tests?
Slump: sciatic +/- tibial
SLR: SC stenosis/ meningeal CT’s and sciatic +/- tibial
Prone knee bend: femoral nerve
Upper limb ND test 1:
abduct 110
median, anterior interosseous and C5-7
Upper limb ND test 2:
abduct 10
median, musculocutaneous
Upper limb ND test 3:
abduct 110/10 with pronation
radial nerve
Upper limb ND test 4:
abduct and flex elbow to 90 each and hand to ear with wrist extension
- ulnar nerve, C8-T1 nerve roots
ULND mnemonic?
MI5-7
MAM RU 81
SIJ orthopedic tests?
- flamingo (SL stance)
- active SLR
- thigh thrust
Hip orthos
FADDIR Flexion IR FABER Trendelenburg resisted hip abduction patella pubic percussion
FADDIR positive indicates?
FAI
Flexion IR positive indicates?
labral tear and/or FAI
Trendelenburg positive indicates?
- glute medius weakness
- gluteal tendinopathy
- OA
resisted hip abduction?
gluteal tendinopathy
patellar-pubic percussion
femoral fracture
3 compression sites of TOS?
- between anterior and middle scalenes (scalene traingle)
- between first rib and clavicle
- under pec minor
orthos for TOS
- adsons - pulse with neck ext, ipsi SB and arm in ext, abd, supination
- roos test -5min
frozen shoulder treatment strategies
- keeping ROM.
- address biomech compensations
- advice/reassurance
cardiac pain sites and radiations
retrosternal parasternal jaw neck inner arms epigastrium interscapular
thoracic mobility exercises
cat/camels
thread the needle
book openers
knees to chest
T3-L5 neutral extension normal coupled motion
Type 1
T3-L5 flexion normal coupled motion
Type 2
Common structures causing groin pain
adductors, iliopsoas, inguinal, pubic regions
Common structures causing hip pain?
extraarticular: GTPS
Intraarticular: FAI, labral tear, osteonecrosis, acetabular dysplasia
GTPS management?
modify load (reduce by 50%) and agg factors progressive loading
carpal bones in proximal row? (lateral to medial)
Scaphoid
Lunate
Triquetrum
Pisiform
carpal bones in distal row (lateral to medial)
Trapezium
Trapezoid
Capitate
Hamate
Shoulder red flags
- tumour
- inflammatory arthropathy (RA, gout)
- visceral disease
- septic arthritis
- fracture/dislocation
- CV signs and symptoms
Which modality of imaging is used for what?
- X-ray: acute pain presentations
- ultrasound for RC pathologies
- MRI for capsule/ligament tears
Xray views of the shoulder
AP
lateral
axial
scapular Y
AP shoulder X-ray good for:
AC joint space subacromial space (~9mm)
lateral shoulder Xray good for:
evaluating dislocations
axial shoulder xray?
prevents clavicle superimposition
elbow xray views?
AP
lateral flexion
medial oblique
wrist xray views
PA
lateral
oblique
scaphoid
why is itimportant to image scaphoid in acute presentations?
necrosis: poor blood supply
why is itimportant to image scaphoid in acute presentations?
avascular necrosis: poor blood supply
Thoracic Xray views:
AP, lateral, specific rib views
AP TX Xray look for?
pedicle rotation, SP alignment
- Cobb-lipman: lines drawn across top and bottom Vx of scoli and an inverted angle is calculated
- Risser-Ferguson: centres of top and boom vertebra and angle is calculated
T1 weighted MRI show fat as?
bright white
Lumbar X ray views?
AP lumbopelvic lateral lumbosacral (sacral base angle = 35-45 degrees) posterior oblique (pars #)
shentons line?
Hip AP: curvilinear line traced under the surface of the femoral neck and continued across the joint of the inferior pubic ramus
general spinal red flags
- history of trauma
- corticosteroid use
- age over 50
- systemic signs of tumour
- risk factors/signs of infection
acute cervical pain red flags: not including general
- HA, dysphagia, vomiting
- neurological symptoms in the limbs (both)
- CV risk factors
acute thoracic pain red flags:
- major trauma or minor trauma if over 50 and RFs for weak bone)
- pain at multiple sites
- pain at rest, night pain
- chest pain without a reasonable explanation
acute low back pain:
- minor trauma if over 50 and RFs for weak bone
- pain at multiple sites and at rest
- AAA: absence of aggravating factors
transient side effects of HVLA?
- increase pain/discomfort
- stiffness
- HA
- Tiredness/fatigue
- radiating pain
sentence for transient side effects of HVLA
you may experience a temporary increase in pain, stiffness or pain that may radiate to other areas, you may feel an increase i levels of fatigue or a headache. However its important that you understand that these are usually temporary and these symptoms should reside within 24-72 hours if they present at all.
Substantiative reversible impairment: cervical
- disc herniation
- nerve root compression
- cervical/upper thoracic strain
Substantiative reversible impairment: Thoracic spine
- rib or vertebral fracture
- shoulder, thoracic, rib sprain
Substantiative reversible impairment: Lumbar
- vertebral fracture
- disc herniation
- shoulder, thoracic spine, rib or pelvic strain
Serious/unreversible risks cervical:
- unresolved disc herniation/nerve root compression
- spinal cord compression
- stroke
Serious/non-reversible risks: Thoracic
- fracture that may disrupt the spinal canal
- spinal cord compression
Serious/non-reversible risks: lumbar
- significant fracture causing a disruption tot he spinal canal
- unresolved nerve root compression or disc injury
- cauda equina syndrome (compression of the nerves of the lower spinal cord
signs of CAD?
- thunderclap headache
- Horner’s syndrome (miosis, sweating ipsilateral)
- severe unilateral neck and facial pain
- abnormal BP
- history or family history of migraine w/o aura
Signs of VBI?
signs of ischemia: - dizziness/vertigo nausea/vomiting blurred vision facial paraesthesia drop attack
