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Ortho I > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Level of Irritability - Red

A

Pain before resistance

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2
Q

Level of Irritability - Yellow

A

Pain and resistance happening at the same time - perform isometrics

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3
Q

Level of Irritability - Green

A

Pain after resistance, good to go

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4
Q

Stage of Healing

A

Acute: 7-10 days
Sub-acute: 10 days to several weeks
Chronic: several weeks

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5
Q

MS problems are typically influenced by?

A

Movement or positions

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6
Q

Intermittent pain is usually caused by?

A

Prolonged postures, loose intra-articular body, impingement of a MS structure

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7
Q

Peripheralization

A

getting worse

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8
Q

Centralization

A

getting better

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9
Q

System Review

A

Determine if the patient is appropriate for PT

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10
Q

Red flags for cancer

A

Night pain
Unexplained weight loss
Constant pain

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11
Q

Tests and Measures are used to?

A

confirm or reject a clinical hypothesis
Support clinical judgement

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12
Q

Scanning Examination Purpose

A

rule out symptom referral
rule out serious pathology
ensure correct diagnosis
assess contractile/lnert tissues

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13
Q

When do you perform scanning examination?

A

no history of trauma
no history to explain signs & symptoms
redicular sign present
trauma with radicular sign
spinal cord signs
abnormal patterns or movement
suspected psychogenic pain

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14
Q

When can scanning be hold off?

A

history of trauma
recent surgery

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15
Q

What is included in a scanning?

A

PROM, AROM, ARM with resistance

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16
Q

Altered sensation

A

dermatome

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17
Q

Weakness in the nerve root

A

Myotome

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18
Q

Grading of Deep Tendon Reflex

A

0 - absent
1- diminished
2 - normal
3 - exaggerated
4 - clonus

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19
Q

Informal Observation

A

Body Language
Facial Expression
Fear
Attitude
Assistance

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20
Q

Contraindictions - Precautions with AROM

A

Suspected fracture
Fracture Healing Process
surgical considerations
irritable joint
excessive pain

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21
Q

Limitation in AROM

A

Strength
flexibility of anatagonist
arthro
neuromuscular control
nerve innervation
pain

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22
Q

limitation in PROM

A

Flexibility
arthro
pain

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23
Q

contractile

A

muscle belly
tendon
injury to anything that creates tension

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24
Q

inert

A

joint capsule
ligaments
bursa
articular surfaces of the joint
bone

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25
Q

contractile lesion

A

pain with Active contraction, PROM stretching, AROM resisted
Passive movement is painful in opposite direction
Active movement is painful in one direction

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26
Q

Inert Lesion

A

Active and passive movements painful in the same direction
Pain at end range
Resisted movements are not painful at neutral position

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27
Q

Full ROM & No pain

A

no lesion of the tested inert tissue

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28
Q

Pain & Limited ROM in every direction

A

Entire Joint affected / Capsular pattern

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29
Q

Pain & Excessive or limited ROM in a non-capsular pattern

A

Lesion of inert tissue (ligament)

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30
Q

Painfree, limited ROM

A

Precursor OA

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31
Q

Contractile Tissue Lesion

A

AROM or PROM is painful in the opposite direction
Normal Joint play
Hurts with resistance

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32
Q

Inert Tissue lesion

A

AROM and PROM limited and painful in the same direction
Resistance at neutral can be pain free

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33
Q

Capular Patterns

A

Pattern of limitation or restriction in ROM
Restricted in most or ALL ROM, whole capsule

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34
Q

Purpose of MMT

A

Testing muscle weakness / injury
Peripheral nerve injury

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35
Q

Myotome assessment

A

nerve root injury- radiculopathy
Fatigable weakness

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36
Q

Isokinetic strength testing

A

General muscle strength

Example: Post ACL Injury

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37
Q

Resisted Isometrics

A

distinguish between cotractile lesion vs Inert Lesion

At Neutral/ Open Pack position (most relaxed position) - discomfort : contractile injury, because Inert structures are at rest

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38
Q

Resisted Isometric testing

A
  • Strong & Painless: Contractile tissue not involved
  • Strong & Painful: Minor lesion of contractile tissue
  • Weak & Painless: complete rupture of contractile tissue
  • Weak & Painful - Major lesion of contractile tissue
  • Painful on Repetition: Intermittent Claudication
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39
Q

Muscle weakness

A

peripheral nerve damage
within muscle belly itself

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40
Q

Fatigable weakness

A

Nerve root Issue
Muscle with the same innervation level will experience the same issue

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41
Q

Closed Pack Position

A

Maximally congruent - Most stability
Twist of Joint capsule & ligaments

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42
Q

Fractures & Dislocations typically occur in?

A

Closed Pack Position

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43
Q

Compression

A

movement into CPP

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44
Q

Distraction

A

Movement out of CPP

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45
Q

Open Pack Position

A

Capsule & Ligaments on Maximum Slack
Maximal “Joint play”

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46
Q

Capsular or ligamentous sprains typically occur in?

A

Loose or open packed position

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47
Q

Physiological motion

A

Result of concentric or eccentric active muscle contractions

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48
Q

Accessory Motion

A

Occurs inside the joint

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49
Q

Roll

A

Series of points in contact with a series of points

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50
Q

Spin

A

rotating around an axis

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51
Q

Slide

A

Specific point in contact with a series of points

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52
Q

Compression

A

Decrease in space between two joint surfaces

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53
Q

Distraction

A

Two Joint surfaces pulled apart

54
Q

Maitland’s Joint Play assessment

A

0 - mobilization is not indicated
1- 2 Hypomobility
3 Normal
4-5 Hypermobile
6 Unstable

55
Q

Normal End Feels

A

Bone to bone - at full ROM
Soft tissue - Compression of soft tissues
Tissue Stretch - Elastic or springy resistance at end range of movement

56
Q

No stretching when

A

Pain before ROM where resistance is met

57
Q

Management Plan

A

Goals
Progonosis
Intervention
Summary of plans

58
Q

Joint Play Assessment: Glides

A

Unrestricted & Normal - Soft tissue mobs
Unrestricted & Excessive - stabilization exercises
Restricted: Joint mobilization

59
Q

Joint Play Assessment: Distraction

A

Limited: connective tissue contracture
Increase Pain: Connective tissue tear
Decrease Pain: Implicates Joint surface

60
Q

Neurophysiological effects

A

Stimulates Mechanoreceptors to decrease pain
Nociceptive stimulation

61
Q

Nutritional Effects

A

Exchange of fluids to improve joint mobilization

62
Q

Mechanical effects

A

Breakup adhesions to increase glide

63
Q

Absolute contraindications to passive movements

A

Malignancy of target area
Rheumatoid collagen necrosis
Unstable upper cervical spine
Vertebral basilar insufficiency

64
Q

Relative contraindications to passive movements

A

Active, acute inflammatory conditions
Acute nerve root irritation
Blood clotting disorder
Condition is worsening with treatment

65
Q

Rules of Mobilization

A

Both therapist and patient are relaxed
Don’t move through pain
one hand stabilizes one hand mobilize
One movement at one joint
Re-assess after each maneuver

66
Q

Maitland Joint Mobilization grading Scale

A

Grade I - Small amplitude oscillating movement at beginning of range of movement (Decrease pain)
Grade II - Large Amplitude within midrange of movement (Decrease Pain)
Grade III - Large Amplitude up to point of limitation (Improve ROM)
Grade IV - Small amplitude at very end range of movement (gain motion within the joint)
grade V - Thrust technique

67
Q

Indications for Mobilization

A

Grades I and II - primarily used for pain
Grades III and IV - primarily used to increase motion

68
Q

Direction of movement during treatment is either

A

Parallel - compression
Perpendicular - Glides

69
Q

Kaltenborn Traction Grading

A

Grade I - loosen
Grade II - take up slack
Grade III - stretch

70
Q

Kalternborn grade I

A

Used initially to reduce chance of painful reaction

71
Q

Kalternborn Grade III

A

used in conjunction with mobilization glides for hypomobile joints

72
Q

Inflammation (stage I)

A

Avoid painful positions
AAROM or general PROM
Grade I joint mobilization
Prevent Arthrofibrosis
Sub isometrics

73
Q

Migration and Proliferation (Stage 2)

A

Controlled activities
Isometrics to Isotonic
Prevent scar contracture
Grade II joint mobilization
Progress ROM

74
Q

Remodeling (Stage 3)

A

Concentric & eccentric training
SAID principle - customized to the activity
Grade II - IV joint mobilization

75
Q

Anterior to Greater Troc

A

Glute min

76
Q

Lateral to Greater Troc

A

Glute Med

77
Q

Posterior to Greater Troc

A

Bursa

78
Q

Location of Lumbar Spine Pathology

A

Buttock and LBP

79
Q

Hyaline Cartilage

A

Allows frictionless motion
The higher the peak pressure, the thicker the cartilage
Avascular - no blood pressure
Aneural - no nerves
Alymphatic

80
Q

Elastic cartilage

A

Highly specialized

81
Q

Articular Cartilage Injury

A

Lesions generally do not heal
Believed to progress to severe forms of OA

82
Q

Importance of Articular Cartilage Injury

A

Constant repair but a slow process
Gradual thinning of the articular layer occurs

83
Q

Outerbridge Classification of Cartilage Damage

A

Grade 0 -Normal
Grade 1- cartilage softening and swelling, blisters
Grade 2 - Partial- thickness loss, less than 1.5 cm in diameter
Grade 3 - Fissuring to the level of subchondral bone more than 1.5 cm
Grade 4 - exposed subchondral bone

84
Q

Cartilage healing

A

Limited ability to repair itself
Closer to blood supply - better healing
No inflammatory stage, no blood supply
Defects less than 3mm wide tend to heal completely
Defects greater than 9 mm wide do not heal completely
Motion enhances the healing of chondral defects (Active motion vs. Passive motion)

85
Q

Osteochondritis Dissecans

A

Most common - Medial portion of the medial femoral condyle

86
Q

Fractures of the proximal and distal segments are either

A

Extra-articular or articular

87
Q

Extra-articular fractures

A

do NOT involved the articular surface

88
Q

Partial articular fractures

A

involve only one part of the articular surface, while the rest remains attached to the diaphysis

89
Q

Complete articular fractures

A

the articular surface is disrupted and completely separated from the diaphysis

90
Q

Types of Forces that Commonly Produce Fractures

A

Tension - Avulsion, transverse fractures
Compression - Impaction fractures
Bending - short oblique fractures
Torsion - Spiral fractures
Comminuted - High energy forces

91
Q

Cartilage healing doesn’t have which phase?

A

Inflammatory phase

92
Q

Bone healing

A
  1. Inflammatory phase
  2. Reparative Phase - Soft callus Formation
  3. Remodeling Phase - Hard callus Formation, up to 1 year, Wolf’s Law
93
Q

items that affect the rate of fracture healing

A

Blood Supply - better blood supply, better healing
Location - closer to the blood supply - better healing
Age

94
Q

Displacement of fracture fragments

A

Small space between the fracture structure - Better Healing

95
Q

Slow Healers

A

Patients with Diabetes
Smokers
long-term steroid use
Poor Nutritional state

96
Q

Phases of fracture Management

A
  1. Diagnosed - confirmed exp: X-ray
  2. Reduced if needed: put it back in place
  3. Stabilize / Immobilize
  4. Rehab
97
Q

Delayed Union
Non-union
Mal-union

A

Delayed union: Taking longer to heal, still healing
Non-union: Healing is finished, fracture still there
Mal union: Healed, but not in good alignment

98
Q

Pathologic Fracture

A

Tumor in the femur - femur fractures
Structure affecting the fracture

99
Q

Osteoporosis
Osteopenia
Osteomalacia
Osteomyelitis

A

Osteoporosis - softning of the bone
Osteopenia - Precursor of Osteoporosis
Osteomalacia - Softning of the bone, but different than osteoporosis
Osteomyelitis - inflammation around the Bone

100
Q

Non-Operative treatment of Fractures

A

Casting - closed reduction
Splints/ Fracture Braces

101
Q

Surgical Treatment of Fractures

A

Precutaneous Pinning - small fracture, pins outside
External Fixation - pins on the outside, increase pressure
Intramedullay Nailing - femoral fracture

102
Q

Immobilization

A

small bones - 3 weeks
long bones - 8 weeks

103
Q

While in a cast

A

submax isometrics

104
Q

Cast removed

A

Controlled stresses - gaining strength in the new motion

105
Q

Salter Harris Classification

A

type I: separation between metaphysis & epiphysis
type II: separation and fracture on metaphysis
type III: separation and fracture on epiphysis
type IV: on both metaphysis and epiphysis
compression: on growth plate itself

106
Q

Treatment for Salter Harris Classification

A

Type I: Non displaced - immobilization
Displaced: closed reduction & immobilization

Type II: Closed reduction & immobilization - cast
Type III: Open Reduction & immobilization
Type IV: need surgery
Type V: stop growth plate

107
Q

Tendon Injuries (Strain)

A

Tendonitis: Inflammation, Microscopic Tearing
Tendinosis: Degenerative process, increased risk for Rupture, lack of inflammatory cells

108
Q

Tendon Rupture

A

Pain free
Tendon Degeneration - decreased elasticity + Acceleration/deceleration force

109
Q

Tendinopathy

A

absent or minimal inflammation
failed healing response

110
Q

Causes of Tendinopathy

A

Mechanical Theory - Overload (overuse)
Vascular Theory - Poor Blood Supply
Neural Theory - Neurotransmitters / Mediators

111
Q

Tendons that are vulnerable to Overuse injuries

A

-Wrap around a convex surface or the apex of a concavity
-Cross two joints
- low vascular supply
- repeptitive tension

112
Q

Phases of pain

A

Phase I: pain less than 24 hours after exercise
Phase II: pain after exercise 48 hours
phase III: Tolerable pain with exercise activity
Phase IV: pain with exercise that alters activity
Phase V: pain caused by heavy activities of daily living
Phase VI: Intermittent pain at rest does not disturb sleep
Phase VII: Pain disturb sleep

113
Q

Ligaments

A

Connect bones across joints
Guides/ checkreins to normal motion

114
Q

Ligamentous injury

A

Point Tenderness
Joint Effusion
History of Trauma

115
Q

Ligament Injuries (Sprains)

A

First degree - hurt to touch, no increased excursion
Second Degree - stretch increase excursion
Third Degree - gone, no end feel

116
Q

Muscle injuries

A

Strains
Contusions (Bruise Injury)
Exercise-induced muscle injury

117
Q

Muscle Strains

A

All degrees hurt with palpation
-First degree: strong & painful (a few fibers torn)
-Second degree - Bruises
-Third degree - torn, muscle tear

118
Q

3 Phases of Healing

A

-Phase I Inflammatory: 48-72 hours to 14 days
-Phase II Reparative & Proliferation: 2-6 weeks
-Phase III Remodeling & Maturation: 6 weeks - 1 year

119
Q

Subluxation

A

Partial or incomplete dislocation

120
Q

Dislocation

A

bone is forced out of the joint as a result of tearing of the ligaments & joint capsule

121
Q

Bursae

A

Fluid-filled sac
Reduce friction between surfaces
Primary: Degenerative changes, RA, Gout, Infection
Secondary: inflammatory, Repeated microtrauma

122
Q

Classification of Nerve injuries

A
  • Neuropraxia: Transient paralysis, temporary compression
    -Axonotmesis: Complete paralysis, recovery can be complete
    -Neurotmesis: Complete loss of axon & Schwanna Sheath, Recovery is rarely complete
123
Q

Clinical Signs of Nerve Compression

A

-Pain on stretch
- Provocation of pins & needles
- Tenderness & swelling of sheath
- Postural deformity (Lateral trunk shift)
- Decreased conduction (weakness)
- Relief following steroid infiltration

124
Q

Somatic Referred Pain

A

Ligaments, Joint Capsule, Annulus

125
Q

Improvement in pain in a sitting position

A

ruling out the hip
Lumbar stenosis

126
Q

Hips Symptoms get worse with

A

-Activities
- Twisting, turning, or changing directions
- Seated positions with hip flexed
- Rising from the seated position

127
Q

Trochanteric Bursitis

A

inability to lie on their side

128
Q

Intra-articular hip pathology

A

Clicking, snapping, or pain with movement of the hip

129
Q

Patients with pain caused by hip pathology

A
  • 7x more likely to have a limp and groin pain
  • 14x more likely to have limited IR
130
Q

Strongest predictors of Cancers in patients with complaints of hip and LBP

A
  • previous history of cancer
  • age over 50
  • failure to improve with conservative care
  • unexplained weight loss
131
Q

Red Flags for the Hip

A
  • Hip pain in men with testicular cancer
  • Pain at MC Burney’s point
  • Blumberg’s Sign - rebound tenderness for visceral pathology

Ortho I (1 decks)

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