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Peripheral Joints > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

How long does it take for bone to achieve clinical union?

A

three weeks

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2
Q

What are sources of bias in clinical research?

A
  1. examiner
  2. Patient being assessed
  3. Measurement device
  4. Examination procedure
  5. Clinical importance of differences
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3
Q

What are sources of error in clinical reasoning?

A
  1. Pragmatic inferences
  2. Considering too few hypotheses
  3. Failure to sample enough information
  4. Confirmation bias
  5. Errors in detecting covariance
  6. Confusing covariance with causality
  7. Confusion between deductive and inductive logic
  8. Premise conversion
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4
Q

Joint Pain of Systemic Origin

A
  • awakens the patient at night
  • typically is described as deep-aching or throbbing
  • may be reduced by pressure

Symptoms include:

  • jaundice
  • migratory arthralgias
  • skin rash
  • fatigue
  • unexplained weight loss
  • low-grade fever
  • muscular weakness
  • cyclical, progressive symptoms
  • hx of infection
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5
Q

Joint Pain of Musculoskeletal Origin

A
  • decreases with rest; “stiff”
  • may be described as “sharp”
  • reduced or eliminated when stressful action is stopped
  • may increase with activity
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6
Q

Frish “5-5” format

A
  1. Inspection
  2. Function
  3. Palpation
  4. Neurological Examination
  5. Special Tests
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7
Q

Composite Motion

A

swing combined with spin

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8
Q

Consequential Movement

A

spin due to successive swings

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9
Q

Cyriax Interpretation for Resisted Motion

A
  1. painless and strong = no lesion
  2. painful and strong = minor lesion
  3. painful and weak = major lesion
  4. painless and weak = complete rupture
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10
Q

Strength/Training Principles

A

0-3 weeks = neural adaptation
6-12 weeks = muscle response
10-12 weeks = tendon response

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11
Q

Tendonitis

A
  • macrotrauma and inflammatory
  • single event
  • extrinsic overload
  • macroscopic injury (ie bleeding)
  • significant event
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12
Q

Tendonitis Timeline

A
  • acute = less than 2 weeks
  • subacute = 2-6 weeks
  • chronic = 6 or more weeks
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13
Q

Tendinosis

A

focal area of intra-tendinous degeneration that is initially asymptomatic and may remain such unless a specific stress is brought forth

  • microtraumatic and degenerative
  • repetitive action
  • intrinsic trauma
  • often eccentric demand
  • stabilizing/absorbing
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14
Q

What are the three areas of potential tendonosis?

A
  • extensor radialis brevis tendon
  • supraspinatus tendon
  • patellar tendon
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15
Q

Tenosynovitis

A

inflammation of paratenon surrounding tendon

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16
Q

Treatment of Tenosynovitis

A

wrist cockup splint and NSAIDs for 3-4 days

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17
Q

Stress-Strain Curve

A 
1% = toe-in region
1-3% = linear region
3-6% = failure
6-8% = complete rupture
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18
Q

Effects of Aging on Tendon

A
  • increased cross links
  • tougher collagen
  • decreased tensile strength (stiffness and weaker)
  • fewer enzymes - slower turn over and collagen deposition
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19
Q

Repair Process (macrotrauma)

A
  • inflammation = 3-5 days
  • collagen generation = 5-21 days
  • proliferation followed by cross linkage
  • maturation is long term (months) “Wolff’s Law”
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20
Q

Repair Process (microtrauma)

A
  • repetitive loading - submaximal activity - function
  • minimal reparative response (failed response)
  • often vascular mediation
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21
Q

Tendon Composition

A
  • Collagen - Type 1 - 25-30%
  • Elastin - 2% - decreases with age
  • Water - 70+%

Note: fibroblasts control healing

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22
Q

Principle 1

A

The Challenge of Homeostasis; Equilibrium of Exercise (i.e. patient must be challenged enough to properly load the tendon, but not overly challenged to cause re-injury)

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23
Q

Principle 2

A

Transitions (i.e. most injuries occur during transitions); Wolff’s Law

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24
Q

Principle 3

A

Pick Your Parents Wisely; impact on genetics, aging, adaptability

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25
Q

Isometric Contraction

A

Concentric Component - Series Elastic Component = Amount of Force Produced

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26
Q

Concentric Contraction

A

Concentric Component - Series Elastic Component = Amount of Force Produced

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27
Q

Eccentric Contraction

A

Concentric Component + Series Elastic Component = Amount of Force Produced

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28
Q

In terms of MT load vs. Tendon load, what happens as you increase the load?

A

increased EMG amplitude

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29
Q

How much more does concentric recruit than eccentric?

A

30%

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30
Q

How should isometrics be incorporated in exercises? Why?

A

isometric holds should be added to exercises because they increase the number of fibers recruited

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31
Q

T/F: EMG = muscle tension

A

False

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32
Q

T/F: EMG = muscle tension

A

False

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33
Q

What are the two underlying reasons for tendinosis?

A

aging and significant use

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34
Q

What is the organization of tendon?

A 
macroscopic = longitudinal orientation; crimped at rest
microscopic = tightly arranged parallel fibers

Tropocollagen - Microfibril - Subfibril - Fibril - Fascicle - Endotenon - Epitenon - Paratenon - Tendon

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35
Q

Treatment Concepts

A
  • Rest (tincture of time)
  • Thermo/Cryotherapy
  • Wolff’s Law
  • NSAIDs for 3-4 days
  • Pain: bad if with concentric/isometric; discomfort with isometric may be appropriate (Stanish; Alfredson)
  • E-stim blasting: isometrics afterwards
  • Exercise: Pain Guided Approach
  • Isokinetics
  • Isotonics
  • ## Plyometrics
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36
Q

Isokinetic Different Responses

A
  • multiple patterns (open/closed)
  • sub-maximal efforts (concentric/eccentric)
  • minimal high speed concentrics
  • use multiple eccentric modes

*be progressive but monitor closely

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37
Q

Treatment of Strains

A
  • recognize the limiting factors
  • may use modalities to increase blood flow after initial phase
  • NSAIDs from MD for 2-3 days
  • PRICE
  • no aggressive stretching
  • progressive strengthening
  • progressive function
  • usually have a strong eccentric program (at low-levels)
  • working at end-range (Mullaney, 2006)
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38
Q

Tendonitis Treatment in the Acute Stage

A
  • Rest
  • Ice
  • NSAIDs
  • Progressive adaptation
  • Functional Sequence
  • Maximal eccentrics
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39
Q

Tendonitis Treatment in the Subacute Stage

A
  • Delayed or insufficient response, careful not to maintain status quo
  • Progression with monitoring
  • Isotonics to increase resistance - before speed
  • Preload concentric/eccentric isokinetics
  • Eccentrics
  • Plyometrics (late)
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40
Q

Tendonitis Treatment in the Chronic Stage

A
  • Education
  • Eccentric emphasis
  • Increase speed slowly
  • Plyometrics
  • Ice post-treatment
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41
Q

Rupture Treatment Post-Operatively

A
  • get long operative report
  • quality of tissues and repair
  • passive/assistive/aquatics
  • active
  • 3 mos = protection; 6 mos = endurance; 12 = power
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42
Q

Elements of Functional Stability at the Shoulder

A
  1. Passive Ligamentous Restraints (superior glenohumeral lig, middle glenohumeral lig, inferior glenohumeral lig)
  2. Joint Geometry
  3. Muscular Restraints
  4. Joint Compressive Forces (deltoid and rotator cuff)
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43
Q

What controls the vertical displacement of the clavicle?

A

coracoclavicular ligaments (trapezoid and conoid)

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44
Q

Snyder Classification of SLAP Lesion

A

1: labral fraying w/ anchor intact; surgical debridement
2: labral fraying w/ detached biceps tendon; surgical repair
3: bucket-handle tear extends into the joint space causing “catching,” “clicking,” etc.; surgical debridement
4: bucket-handle tear extends into the biceps tendon; surgical repair

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45
Q

Musculature of the Shoulder in Concert

A 
0-30˚ = roll and translation
30-60˚ = often as above
60-180˚ = primarily rotation
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46
Q

The Six Step Progression

A
  • proximal muscles
  • work individual muscles
  • work muscles in patterns
  • monitor patient and tissue response
  • base rehabilitation on needs
  • functional progression

*integrate, caution with closed-chain, compromise of shear and compression, functional progression related to specific actions or needs (SAID)

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47
Q

The Six Step Progression

A
  • proximal muscles
  • work individual muscles
  • work muscles in patterns
  • monitor patient and tissue response
  • base rehabilitation on needs
  • functional progression

*integrate, caution with closed-chain, compromise of shear and compression, functional progression related to specific actions or needs (SAID)

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48
Q

Anterior Glenohumeral Dislocation

A

90% of glenohumeral dislocations; d/t:

  • weak area of the capsule
  • position of weakness
  • unstable position
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49
Q

Possible positions of the humeral following anterior dislocation

A
  • subcoracoid
  • subglenoid
  • subclavicular
  • luxatio recta
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50
Q

TUBS

A

Traumatic
Unidirectional and Unilateral
Bankart lesion
Surgery (90% in younger pts.; 70+% in total)

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51
Q

AMBRI

A 
Atraumatic
Multidirectional
Bilateral
Rehabilitation (70% respond, but it's not perfect)
Inferior shift
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52
Q

AMBRI

A 
Atraumatic
Multidirectional
Bilateral
Rehabilitation (70% respond, but it's not perfect)
Inferior shift
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53
Q

GH Lesions

A

1) Detached labrum-capsule (Bankart’s lesion)
2) Erosion fx. of anterior glenoid
3) Post/lateral humeral head deflection (Hill-Sachs lesion)

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54
Q

Shoulder dislocation relates to:

A

1) age (relates to strength)
2) activities
3) cause of initial injury
4) stability status
5) initial treatment (newer concepts point to early surgery)

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55
Q

Dislocation Treatment Prior to Surgery

A

1) Restrict ROM (ER for anterior; IR for posterior)
2) Progressive strengthening (IR and Depressors for anterior; ER, RC, posterior deltoid for posterior)
3) Modify activities
4) Functional progression

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56
Q

Rehabilitation for Bankart Lesion - Direct Approach

A
  • IR sling for 10-14 days
  • isometrics but no ER
  • 2-4 weeks continue to wear sling at night
  • active ROM to 90˚
  • restrict ER forces
  • 4-8 weeks light function
  • 8+ weeks functional progression
  • return to work/play in 3-4 mos
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57
Q

When should a Laterjet approach be used?

A

when a patient has lost >15% of the anterior-inferior glenoid; surgeons may bring a piece of the coracoid (or iliac crest) and rebuild the glenoid

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58
Q

Rehabilitation for Bankart Lesion - Laterjet Approach

A
  • IR sling for 3 wks (up to 4-6 wks)
  • forward flexion in scapular plane to tolerance; elbow flexed
  • care with isometrics and elbow, plus limit extension and ER
  • 4-6 wks passive-assist ROM and slow start of strengthening - 6 wks before pushing of loads
  • 6-12 wks functional progression
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59
Q

Capsular Shifts

A

incision of the capsule at either the humeral head or the glenoid, followed by a longitudinal cut to create two flaps in the capsule; one side is folded down while the other is pulled tight and anchored to reduce redundancy in the capsule and make a thicker portion

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60
Q

Rehabilitation for Capsular Shifts

A
  • support with a sling for 2 weeks, stay below 90˚
  • 2-4 weeks: AROM but staying below 90˚ and no ER
  • 4-6 weeks: protected increase in functional activities slowly increasing patterns of motion and utilizing aquatic therapy to work multiple patterns
  • 6-8 weeks: slowly increasing functional progression leading into return to function in 8-12 weeks
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61
Q

Rehabilitation for Capsular Shifts

A
  • support with a sling for 2 weeks, stay below 90˚
  • 2-4 weeks: AROM but staying below 90˚ and no ER
  • 4-6 weeks: protected increase in functional activities slowly increasing patterns of motion and utilizing aquatic therapy to work multiple patterns
  • 6-8 weeks: slowly increasing functional progression leading into return to function in 8-12 weeks
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62
Q

What are potential complications of shoulder surgery?

A

infection, recurrent instability, nerve injury, hardware problems, loss of rotation

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63
Q

Instability Severity Index Score (ISIS)

A

examines factors such as age, sports level, pre-op sport, shoulder hyperlaxity, Hill-Sachs visible on ER film, and loss of bone; if 4+ points = don’t perform the surgery arthroscopically (70% failure rate)

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64
Q

According to Dr. Malone, what tenets for RC rehabilitation are important to know before initiating therapy?

A
  • type of surgery
  • deltoid, size
  • fixation - suture, staple
  • anchor (single vs. double row - bridge - other materials)
  • quality of tissue
  • specifics (ex: biceps tenodesis, etc.)
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65
Q

What are the two ways to reattach a torn RC?

A

bone tunnel or an anchor

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66
Q

Important treatment concepts following RC repair:

A
  • centered humeral head (rotator role)
  • proper sequence of recruitment
  • balance of active and passive structures
  • proximal stability
  • neuromuscular integration
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67
Q

Size of Rotator Cuff Tear

A

small: <1 cm
medium: 1-3 cm
large: 3-5 cm
massive: >5 cm

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68
Q

6 and 12 Month Rule

A

6 mos to have the motion and 12 months to have the power to use the motion; supraspinatus 60-70% compared to normal side at 6 mos, within 10-20% of normal side at 12 mos

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69
Q

PRE progression following RC repair

A
  • multiple angle isometric - submaximal to maxmimal
  • isotonic restricted ROM - concentric & eccentric efforts
  • isokinetic - speed and ROM progressed

*have patient flex the elbow to decrease difficulty

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70
Q

Factors Relating to Success in RC Repairs

A
  • age of patient and onset of injury
  • size of tear
  • surgical procedure (Deltoid, open, etc.)
  • work or activity levels
  • specifics of patient (motivation, quality of tissues)
71
Q

General Time Frame for Post-Operative RC Repair

A

Phase 1: 3-8 wks
Phase 2: 6-12/16 wks
Phase 3: 15-24/30 wks
Phase 4: 6 mos to 1 yr

72
Q

Phase 1

A

primary healing, passive motion, and pain modulation

73
Q

Phase 2

A

active motion, normalization of ROM

74
Q

Phase 3

A

strengthening isolated-integrated-functional progression (pattern of six)

75
Q

Phase 4

A

advanced as required by patient-sports activities

76
Q

Normal Biomechanics of the Shoulder

A
  • centered humeral head
  • proper sequence of recruitment
  • balance activities and passive structures
  • proximal stability
  • neuromuscular integration
77
Q

Impingement - Stage 1

A
  • edema and hemorrhage
  • age 25 or less
  • reversible with treatment
  • painfree exercise
78
Q

Impingement - Stage 2

A
  • fibrosis and tendinosis
  • age 25-50
  • pain with activity
  • surgery???
79
Q

Impingement - Stage 3

A
  • spurs and ruptures
  • age > 40-50
  • progressive disability
  • acromioplasty with cuff repair
80
Q

Jobe Scheme - Classification

A
  1. primary impingement - no instability
  2. secondary impingement - traumatic instability
  3. hypermobility - secondary impingement
  4. pure instability - no impingement
81
Q

Tests for Impingement

A
  1. Elevation overpressure
  2. Painful arc of motion with AROM at 60-120˚
  3. Hawkins-Kennedy test
82
Q

Systemic Origins (non-self limiting) of Pain in the Neck

A
  • bone tumors
  • metastasis
  • tuberculosis
  • nodes in neck
  • cervical cord tumors
83
Q

Systemic Origins (non-self limiting) of Pain in the Chest

A
  • angina, MI
  • lung cancer
  • breast disease
  • aortic aneurysm
  • hiatal hernia
  • pancoast tumor
84
Q

Systemic Origins (non-self limiting) of Pain in the Abdomen

A
  • liver disease
  • ruptured spleen
  • spinal metastasis
  • upper UTI
  • dissecting aortic aneurysm
  • gall bladder disease
85
Q

Systemic Disease and Origins (non-self limiting) of Pain

A
  • gout
  • sickle-cell anemia
  • rheumatic disease
  • metastatic lesions (breast, prostate, lung)
86
Q

Causes of muscle atrophy and dysfunction around the shoulder

A
  • mechanical lesions
  • C5, 6 radiculopathy
  • Brachial plexopathy
  • Neuralgic amyotrophy (Parsonage-Turner syndrome)
  • Isolated nerve lesions
  • muscle disease
  • Post-traumatic neurogenic inflammation
87
Q

Clinical Presentation of Suprascapular Nerve Entrapment

A
  • posterior shoulder pain
  • isolated muscle atrophy
  • rotator cuff weakness
  • insidious onset
88
Q

What are the recognized locations of suprascapular nerve entrapment?

A
  1. suprascapular notch ligament = “sling effect”

2. spinoglenoid notch - highly repetitive motions

89
Q

Treatment for Suprascapular Nerve Entrapment

A
  1. Benign neglect
  2. Surgical release
  3. Muscle stimulation
  4. Other PT
90
Q

Scapular Dysfunction “Winging” Scapula

A
  • spinal muscular atrophy
  • spinal accessory nerve lesion (upper trap)
  • long thoracic nerve lesion (serratus anterior)
  • scapular dyskinesis
91
Q

How do you distinguish between spinal accessory and long thoracic nerve lesions?

A

spinal accessory nerve lesion will show scapular winging in abd; long thoracic nerve lesion will show scapular winging in flex

92
Q

How do you distinguish between spinal accessory and long thoracic nerve lesions?

A

spinal accessory nerve lesion will show scapular winging in abd; long thoracic nerve lesion will show scapular winging in flex

93
Q

Instability

A
  • decreased IR strength

- excessive ER mobility

94
Q

Impingement

A
  • decreased ER strength

- posterior capsule tightness (dec IR ROM)

95
Q

What are the four methods for relocating a dislocated shoulder?

A
  • Hippocratic (“unshod” foot in axilla; NAVL injury)
  • Kocher (most likely to fx proximal humerus)
  • Stimson (prone, weighted arm)
  • Milch (gentle)
96
Q

Mid-humerus Fracture

A

Rx: often ORIF
Complications: radial n. injury; delayed union, mal-union, non-union

97
Q

Characteristics of Primary Frozen Shoulder

A
  • patient age, 40-65 yrs
  • insidious or minimal event resulting in onset
  • significant limitations of active and passive shoulder motion in more than 1 plane
  • 50% or greater than 30% loss of passive ER
  • all end ranges painful
  • significant pain and/or weakness of the IR
98
Q

Gross Anatomical findings of Adhesive Capsulitis

A
  • adhesions (inferior capsule recess, humeral head, no synovial fluid)
  • rotator cuff changes
  • pectoral fibrosis
  • no inflammatory cells; doesn’t respond to NSAIDs
99
Q

Adhesive Capsulitis Diagnosis

A
  • pain
  • lose of AROM and PROM
  • capsular pattern (ER>ABD>IR>Flex)
  • loss of shoulder joint play
  • loss of component motion
100
Q

What tests can be used to diagnose adhesive capsulitis?

A
  • ROM
  • VAS; NPRS
  • Arthrography (normal = 15-20ml; dec to 5-10 ml
  • examination under anesthesia
  • MRI findings
101
Q

What is the rationale for joint mobilization in patients with adhesive capsulitis?

A
  1. histopathology (capsular fibrosis, dec joint capacity, and marked reduction in synovial fluid)
  2. pathomechanics
  3. treatment (enhance AROM/PROM by improving joint play, avoid traumatization of thickened fibrotic capsule between acromion process and greater tuberosity)
102
Q

Why is the elbow mechanically “compound”

A
  • 3 axes in same joint
  • axes aren’t at right angles
  • “plane” gliding joints w/o the usual axes
103
Q

Humeroulnar joint

A

bi-axial sellar

104
Q

Humeroradial joint

A
  • tri-axial spheroid
  • un-modified ovoid (like “ball and Socket”)
  • held together by ligaments
105
Q

Proximal radioulnar joint

A
  • bi-axial trochoid
  • modified ovoid
  • “rotating”
  • “wheel-like”
106
Q

What is the resting position of the humeroulnar joint?

A

70˚ flexion; 10˚ supination

107
Q

What is the closed packed position of the humerolunar joint?

A

extension with supination

108
Q

Capsular pattern

A

flexion > extension; pronation and supination WFL

109
Q

What is the resting position of the radiocapitellar joint?

A

full extension and full supination

110
Q

What is the closed packed position of the radiocapitellar joint?

A

90˚ flexion; 5˚ supination

111
Q

What is the capsular pattern of the radiocapitellar joint?

A

flexion, extension; pronation and supination WFL

112
Q

What is the resting position of the superior radioulnar joint?

A

35˚ supination, 70˚ elbow flexion

113
Q

What is the closed pack position of the superior radioulnar joint?

A

5˚ supination

114
Q

What is the capsular pattern of the superior radioulnar joint?

A

equal limitation of supination and pronation

115
Q

What are the reasons for loss of motion of the elbow?

A
  1. capsular pattern plus antecubital fossa fibrosis

2. other causes (bony fusion/osteophytes, ligamentous adhesions, antecubital fibrosis, osteochondral fragment)

116
Q

What are Cyriax’s ten test movements to examine elbow pathologies?

A
  • passive (extension, flexion, pronation, supination)
  • resisted at the elbow (extension, flexion, pronation, supination)
  • resisted at the wrist (extension = tennis elbow; flexion = golfer’s elbow)
117
Q

Monteggia Fracture

A

combination of fracture of the proximal 1/3 of the ulna and radial head dislocation

118
Q

Galeazzi Fracture

A

combination of radius fracture and distal ulna dislocation

119
Q

What are the two indicators of a radial head fracture on a radiograph?

A
  • fat pad sign
  • radial head-shaft defect (angulation)

*extension deficit post-fracture

120
Q

What are potential complications following fracture at the elbow?

A
  • bony deformity
  • vascular compromise
  • nerve injury
  • CT loss of motion
121
Q

Supinator syndrome

A

sensation on the back of the wrist and hand is usually normal

122
Q

What are the potential sites of entrapment of the radial n.?

A
  1. fibrous band anterior to radial head
  2. Recurrent vessels anterior to lateral epicondyle
  3. Extensor carpi radialis brevis
  4. Arcade of Frohse
  5. arcade at distal edge of supinator
123
Q

Clinical signs of supinator syndrome

A
  • weak grip strength
  • tenderness
  • Tinel’s sign
  • AROM pain in wrist flexion and forearm supination
  • PROM pain in elbow extension with wrist and finger flexion
  • resisted supination with elbow extension
  • middle finger test
  • EMG/NCS findings
124
Q

Treatment for supinator syndrome

A
  • splint to limit wrist flexion
  • improve mm. flexibility
  • modalities
  • rest
  • anti-inflammatory medication
  • work modification
  • surgical release (rare)
125
Q

What are the three clinical tests that can be used to diagnose pronator syndrome?

A
  • resisted forearm pronation with elbow extended
  • resisted elbow flexion with forearm supinated
  • resisted middle finger
126
Q

Clinical signs of pronator syndrome

A
  • proximal forearm tenderness
  • occasional numbness in median n. distribution into hand (esp. thumb)
  • pain aggregated with repetitive motions
  • thumb opposition and flexion weakness
    • Tinel’s sign over pronator teres
127
Q

Treatment for pronator syndrome

A
  • rest
  • activity modification
  • injection
  • modalities
  • surgical release
128
Q

Clinical signs and symptoms of cubital tunnel syndrome

A
  • pain in medial proximal aspect of forearm
  • numbness, tingling, and falling asleep during repetitive elbow motions
  • less severe hand pain than with carpal tunnel syndrome
  • weakness and loss of dexterity
  • positive special tests: Tinel’s sign, neurotension tests, elbow flexion test, pinch grip test, Wartenberg’s sign
  • intrinsic hand atrophy
  • clawing of 4th and 5th digits
  • positive EMG/NCV tests
129
Q

Treatment for cubital tunnel syndrome

A
  • work and sleep position modifications
  • limit elbow flexion/compression activities
  • NSAIDs
  • iontophoresis; local steroid injection
  • splinting
  • neural mobilizations
  • surgical intervention
130
Q

Signs and symptoms of Volkmann’s ischemic contracture

A
  • excruciating pain with passive flexion and extension of fingers
  • persistent pain unrelieved by position
  • pallor
  • parasthesia
  • pulselessness
  • paralysis
  • muscle necrosis/nerve injury
131
Q

Treatment for Volkmann’s ischemic contracture

A
  • relieve the cause
  • fasciotomy (early)
  • muscle tendon transfer (late)
  • PT focuses on muscle “re-education”
132
Q

What two fractures of the upper extremity often result in myositis ossificans?

A

supracondylar humeral fracture and posterior elbow dislocation

133
Q

Signs and symptoms of myositis ossificans

A
  • pain
  • edema
  • increased tissue temperature
  • decreased AROM
  • decreased PROM
  • hard, palpable mass as pain decreases
  • mass viewable on x-ray (3-6 wks)
  • bone scan possible for earlier evidence
134
Q

Treatment for myositis ossificans

A
  • ice
  • TENs
  • pulsed ultrasound
  • gentle motion
  • surgical excision (later)
135
Q

Treatment for myositis ossificans

A
  • ice
  • TENs
  • pulsed ultrasound
  • gentle motion
  • surgical excision (later)
136
Q

Treatment for lateral epicondylitis

A
  • NSAIDs
  • rest
  • cortisone shot
  • surgery
  • rehabilitation
  • autologous blood injection
  • decrease pain (TENs, ice, iontophoresis, ultrasound?)
  • dry needling
  • isotonic exercises
  • multi-angle isometrics
  • isokinetics
137
Q

What are the three sensory organization options?

A
  • dermatomal
  • brachial plexus (cutaneous distribution)
  • autonomous distribution
138
Q

Greater arc

A

fractures with or without ligamentous disruption

139
Q

Lesser arc

A

ligamentous disruptions/dislocations

140
Q

What joint(s) does flexion and extension of the wrist come from?

A

flexion: 60% from proximal carpal row; 40% from intercarpal row
extension: 40% from proximal carpal row; 40% from intercarpal row

141
Q

Dinner-Fork deformity

A

2˚ to Colles’ fracture; abrupt dorsal prominence; gently rounded volar prominence; broadened wrist radially deviated hand

142
Q

Smith’s Fracture

A

may r/in garden-spade deformity = dorsal prominence of distal end of proximal fragment, volar “fullness” secondary to displaced distal fragment, radial deviation of hand

143
Q

What are the four types of scaphoid fracture?

A
  • tuberosity:
  • distal 1/3:
  • middle 1/3: 80%
  • proximal 1/3: 15%; most likely to r/in avascular necrosis
144
Q

How long does it take scaphoid fractures to heal? Why?

A

approximately 6-12 mos because of the retrograde blood supply

145
Q

What are the signs and symptoms of deQuervain’s disease?

A
  • insidious onset
  • pain primarily with thumb movements (wringing and grasping)
  • pain with resisted thumb extension and abduction
  • neural symptoms d/t spread of stimulus
  • pain with ulnar deviation of the wrist with the thumb fixed in flexion
  • tenderness over tendon sheath in the region of the radial styloid process
    • Finkelstein’s test
  • “silken crepitus”; visual edema
146
Q

Management of deQuervain’s disease

A
  • pain control; iontophoresis; ice
  • rest; thumb spica splint
  • ROM
  • strengthening (eccentrics)
  • functional progression
  • work modification
147
Q

What are the clinical signs and symptoms of Kienbock’s disease?

A
  • staged disease
  • more prevalent in males
  • occurs between 20-40 years of age
  • associated with manual laborers
  • wrist pain and stiffness
  • decreased grip strength
  • decreased wrist ROM
  • MRI, x-ray, bone scan, tomogram
148
Q

Management of Kienbock’s disease (surgically)

A
  • lunate excision
  • implant arthroplasty
  • immobilization
  • wrist arthrodesis
  • ulnar lengthening/radial shortening
149
Q

Management of Kienbock’s disease (PT)

A
  • recovering from the effects of surgical management
  • pain reduction
  • motion acquisition
  • strengthening
  • functional progression
150
Q

Clinical signs and symptoms of TFCC

A
  • pain on forced ulnar deviation causing ulnar impaction
    • supination lift test
  • grip dynamometry
  • bone contusion demonstrable on MRI
151
Q

What are the three basic functions of the volar plate?

A
  • restrains joint hyperextension
  • adds surface to base of proximal phalanx
  • limits “pinching” of long flexor tendons
152
Q

Clinical signs and symptoms of Gamekeeper’s thumb

A
  • weak, unstable thumb
  • sensitive to weather changes
    • valgus stress test to thumb UCL
153
Q

Dupuytren’s contracture

A

shortening of the palmar aponeurosis resulting in flexion contracture at the MPs or PIPs; affects men > women; age 50-70 yoa.; increased incidence in epileptics, alcoholics, diabetics, tobacco users

begins in distal palmar crease; most commonly affects 4th and 5th digits; decreased ROM in MPs/PIPs

154
Q

Management of Dupuytren’s contracture

A
  • surgical: “z plasty”
  • series of collagenase injections
  • wound and skin care
  • edema control
  • scar mobilization
  • joint ROM
  • strengthening
155
Q

Acute Stage of CRPS

A
  • increasing pain from an initial injury
  • burning and aching pain
  • edema
  • early trophic changes
156
Q

Dystrophic Stage of CRPS

A
  • edema in duration
  • increased dystrophy
  • bony changes
  • constant pain increased by ANY stimulus
157
Q

Atrophic Stage of CRPS

A
  • irreversible tissue damage
  • bony demineralization or ankylosis
  • tendency toward emotional instability
158
Q

Clinical signs and symptoms of carpal tunnel syndrome

A
  • numbness to median n. distribution
  • nocturnal symptoms
  • clumsiness and decreased hand dexterity
  • weakness of thenar musculature
    • phalen’s sign
    • tinel’s sign
    • carpal compression test
  • decreased 2-point discrimination
159
Q

What are the stages of CTS?

A
  1. Early: intermittent or position dependent sx.
  2. Moderate: intermittent and progressive sx.; motor weakness; hyperalgesia; + special tests
  3. Severe: persistent symptoms; muscle wasting; possible denervation of potentials in thenar muscles on electromyogram
160
Q

What are the three ways to measure the position of the scapula using the scapular slide test?

A
  1. hands at side; inferior angle to T7 spinous process
  2. hands on hips
  3. 90˚ ABD and IR
  • Greater than 1.5-2 cm is clinically significant
161
Q

What are the tests used to assess the capsule?

A
  • sulcus = tests superior GH lig. and coracohumeral lig.
  • load & shift = tests sup and middle portion of ant/post capsule
  • apprehension (relocation if +) = tests ant capsule
  • posterior drawer (Jerk test) = tests post capsule
162
Q

What tests are used to asses the AC joint?

A

palpation, cross arm adduction, O’Brien’s test, AP (acromioclavicular ligament) and horizontal (coracoclavicular ligements)

163
Q

What tests are used to assess the labrum?

A

audible clunks, slides, compressions, O’Brien’s test, biceps load II, etc.)

164
Q

What are the components of the Frisch’s 5-5 evaluation scheme?

A
  1. Inspection
  2. Function
  3. Palpation
  4. Neurological Exam
  5. Special Tests
165
Q

What are the five components of the inspection category from the Frisch’s 5-5 evaluation scheme?

A
  1. posture
  2. shape (deformity, shape, swelling)
  3. functional movements (gait, ADL activity)
  4. skin
  5. assistive devices
166
Q

What are the five components of the function category from the Frisch’s 5-5 evaluation scheme?

A
  1. AROM (painful arc)
  2. PROM (end-feel)
  3. Resisted motion (Cyriax interpretation)
  4. ROM with joint compression/gliding
  5. Gliding (accessory motion)
167
Q

What are the five components of the palpation category from the Frisch’s 5-5 evaluation scheme?

A
  1. skin and subcutaneous tissue
  2. bony landmarks, joints, capsule, ligaments, etc.
  3. muscle and tendons with attachments to bone
  4. tendon sheaths and bursae
  5. nerves and blood vessels
168
Q

What are the five components of the neurological exam category from the Frisch’s 5-5 evaluation scheme?

A
  1. neurotension signs
  2. motor exam (myotome)
  3. sensory exam (dermatome)
  4. reflexes (DTR/MSR)
  5. coordination (CNS involvement)
169
Q

What are the five components of the special tests category from the Frisch’s 5-5 evaluation scheme?

A
  1. imaging procedures
  2. Electrodiagnosis
  3. Laboratory tests
  4. Punctures
  5. Other medical specialties
170
Q

Sensitivity

A

= true positives/ true positives + false negatives

171
Q

Specificity

A

= true negatives/ true negatives + false positives

172
Q

Positive Likelihood Ratio

A

= Sensitivity/ 1-Specificity

173
Q

Negative Likelihood Ratio

A

= 1-Sensitivity/ Specificity

Peripheral Joints (2 decks)

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