Deck 10 Flashcards
17F athlete 2 days s/p inversion ankle injury during a soccer game. Moderate ecchymosis and swelling about lateral ankle. Able to limp off field immediately after the injury and ambulates into clinic using arm support of her father with significant antalgic gait with early heel off, reduced WB, and shortened stance time of the involved side. Objectively, has pain with ROM in all planes, most notably into PF and inversion. DF of approximately 2˚ on involved side, 12˚ on uninvolved.
Pt has ttp of ATFL and CFL, no ttp at base of 5th met, malleoli, or navicular bone. Anterior drawer, talar tilt reveals pain and laxity.
Based on the above and best current evidence, what tx is recommended at this time?
A. Dispense axillary crutches and recommend ambulation as tolerated
B. AP mobs and ankle pumps
C. Cryocuff and pulsed US
D. Lymphatic drainage to reduce swelling and OTC NSAIDs for inflammatory reduction
A. Dispense axillary crutches and recommend ambulation as tolerated
Ankle sprains: level of recommendation for early progressive WB with use of external support as needed
A
Ankle sprains: level of recommendation for joint mobilizations
B
Ankle sprains: level of recommendation for lymphatic drainage
B
Ankle sprains: level of recommendation for pulsed US
not recommended
22F distance runner presents to PT with c/o retropatellar and peripatellar knee pain when training for ½ marathon. Reports inc pain with jumping, running, stair descent > ascent, and sitting with knee flexed > 30 minutes.
What is the most appropriate self-reported outcome measure for this pt?
A. Lysholm knee scale
B. International Knee Documentation Committee (IKDC)
C. Anterior Knee Pain Scale (AKPS)
D. Tegner activity scale
C. Anterior Knee Pain Scale (AKPS)
The Lysholm knee scale is ideal for
meniscus/cartilage lesions
knee ligamentous injury
The IKDC is ideal for this type of injury
knee ligament
The Tegner activity scale is ideal for this type of injury
knee ligament
22F distance runner presents to PT with c/o retropatellar and peripatellar knee pain when training for ½ marathon. Reports inc pain with jumping, running, stair descent > ascent, and sitting with knee flexed > 30 minutes.
What is the best intervention day 1 for the pt in order to resolve her knee pain and return to volleyball?
A. Standing hip abd and resisted knee ext training
B. BFR training with high rep knee ext strengthening
C. Tibiofemoral and patellofemoral knee mobilization with medial glide taping
D. DN quadriceps femoris and prefabricated foot orthosis prescription
A. Standing hip abd and resisted knee ext training
Level of evidence for BFR for patellofemoral pain
F - expert opinion
DN for PFPS recommendation
NOT recommended
22F distance runner presents to PT with c/o retropatellar and peripatellar knee pain when training for ½ marathon. Reports inc pain with jumping, running, stair descent > ascent, and sitting with knee flexed > 30 minutes.
What gait retraining modification would NOT be recommended for this pt to reduce her anterior knee pain?
A. Adopt a forefoot strike pattern rather than a rearfoot strike pattern
B. Inc cadence
C. Reduce peak hip add during gait
D. Barefoot mimicking footwear for 10% of training volume
D. Barefoot mimicking footwear for 10% of training volume
Barefoot mimicking footwear worn (%) of the time has been shown to be helpful in combination with increasing _____ as compared to foot orthoses in treatment of anterior knee pain
20%
cadence
Anterior knee pain: Level of recommendation for use of forefoot strike pattern rather than rear strike
C
Anterior knee pain: Level of recommendation for increasing cadence
C
Anterior knee pain: Level of recommendation for reducing peak adduction during gait
C
13M (African American) presents with c/o worsening medial knee pain. Has observable antalgic gait pattern with WB on involved side. Has reduced step length when leading with CL limb as you walk back to the exam room. His parents report progressive worsening of his limp. Medical hx reveals juvenile obesity with BMI of 37.1. Based off of the above, what pathology is most likely?
A. Transient synovitis
B. LCPD
C. SCFE
D. Septic arthritis
C. SCFE
Pts with SCFE often have ROM restrictions in this motion
hip ext
Is LCPD an inflammatory condition?
no
54F presents with severe, acute, unilateral jaw pain and stiffness. When chewing her pain increases to 9/10 and is located over temporal region. Pt adamant this is more than just “sore muscles.” D/t severity and location of sx, what additional dx must be considered?
A. Apical odontalgia
B. Temporal arteritis
C. Trigeminal neuralgia
D. Trismus
B. Temporal arteritis
What is temporal arteritis?
subacute inflammation of superficial temporal artery
temporal arteritis: presentation
- severe unilateral or bilateral HA over temporal artery region
- jaw claudication with pain and stiffness during chewing
Suspicion for temporal arteritis requires consult where?
ophthalmology
76F presents via direct access with 3 year hx of neck pain and B hand paresthesias. Concerned d/t recent inc in falls over the past several mos. Further questioning reveals sphincter dysfunction and intermittent LE pain and paresthesias. Pt is most concerned about her inability to continue knitting due to her numb, clumsy hands.
Key objective findings:
- cervical AROM lim all planes, most notably into ext which reproduces B hand paresthesias
- spasticity with quick stretch to ankle PF
- triceps brachii B
- 3+ DTR
(+) Babinski
(+) Hoffman
What dx most clearly matches the pt’s presentation?
A. Cervical radiculopathy
B. Degenerative cervical myelopathy
C. MS
D. Intramedullary SC ependymoma
B. Degenerative cervical myelopathy
What is the most common cause of SC impairment worldwide and is associated with advancing age?
degenerative cervical myelopathy (DCM)
76F presents via direct access with 3 year hx of neck pain and B hand paresthesias. Concerned d/t recent inc in falls over the past several mos. Further questioning reveals sphincter dysfunction and intermittent LE pain and paresthesias. Pt is most concerned about her inability to continue knitting due to her numb, clumsy hands.
Key objective findings:
- cervical AROM lim all planes, most notably into ext which reproduces B hand paresthesias
- spasticity with quick stretch to ankle PF
- triceps brachii B
- 3+ DTR
(+) Babinski
(+) Hoffman
What is the proper imaging study to be ordered with concern for degenerative cervical myelopathy?
A. Radiographs
B. MRI
C. CT
D. myelogram
B. MRI
76F presents via direct access with 3 year hx of neck pain and B hand paresthesias. Concerned d/t recent inc in falls over the past several os. Further questioning reveals sphincter dysfunction and intermittent LE pain and paresthesias. Pt is most concerned about her inability to continue knitting due to her numb, clumsy hands.
Referral made to ortho spine physician. MRI showed ligamentum flavum hypertrophy at C4-5, C5-6, and C6-7, osteophytic spur at C4-5 resulting in severe stenosis. Based off imaging findings in concordance with clinical findings, she was dx with mod-severe degenerative cervical myelopathy
Based on the CPG for mgmt of pts with DCM, what recommendations are made for mgmt of mod to severe DCM?
A. Surgical intervention
B. Thoracic manipulation and traction
C. AROM exercises and DNF strengthening
D. Use of cervical collar and passive modalities
A. Surgical intervention
A supervised trial of structured rehabilitation is recommended for pts with ___ DCM
mild
What is true regarding athlete’s ability to return to competitive sports after ACLR with a thorough rehab program post-operatively?
A. Most all (>90%) return to pre-injury competitive sports
B. Majority (>50%) return to pre-injury competitive sports
C. Majority (>50%) do not return to pre-injury competitive sports
D. Athletes rarely (<25%) return to pre-injury competitive sports
C. Majority (>50%) do not return to pre-injury competitive sports
Only (%) return to competitive sports following ACLR
44%
