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Ortho PTA > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Is ballistic stretching really stretching?

A

No, it is more of a contraction. Therefore, the individual is more at risk for injury

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2
Q

Definition of creep

A

Tissue continues to deform during stress until the load is balanced, which is known as the creep phenomenon

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3
Q

What are some benefits to stretching and flexibility?

A
  • Improve balance
  • Easier to strengthen and endurance train
  • Injury prevention
  • Quicker recovery
  • Reduce soreness
  • Facilitate relaxation
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4
Q

What is Tropocollagen?

A

AKA collagen

Provide strength to withstand tension and force of movement

Protein building block in CT

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5
Q

Where is collagen found?

A

Bone, tendon, skin, muscle, cartilage, and joints

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6
Q

What is Type I collagen?

A

Thick fibers

Most abundant

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7
Q

What is Type II collagen?

A

Thinner

Less tensile strength

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8
Q

What is Type III collagen?

A

Found in organs

Wound repair

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9
Q

What is elastin?

A

Protein in tendons that allow for more flexibility

Assist collagen after stress recovery

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10
Q

What is viscoelasticity?

A

Stress strain curve

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11
Q

What is elasticity?

A

Ability to return to original state following deformation

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12
Q

What is viscosity?

A

Ability to resist change of form or lessen shearing force

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13
Q

What is the toe region?

A

Take up slack in tissue

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14
Q

What is the elastic region?

A

Linear increase in response to stress

Pulled at different levels

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15
Q

What is the plastic region?

A

Plateau on strain and then hit where you have enough stress for injury

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16
Q

T/F stiff tissue reach faliure a lot quicker

A

True

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17
Q

What does rate of stretch affect?

A

Affect strain

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18
Q

What does slower rates of stress affect?

A

Greater strain

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19
Q

What does faster rates of stretch affect?

A

Smaller elongation

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20
Q

What is stress-relaxation?

A

AKA force-relaxation

No change in length is produced

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21
Q

How does temp affect creep?

A

High temp = increase creep

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22
Q

How do you produce creep with high temps?

A

High temp and large load over a period of time

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23
Q

What are benefits of a warmup?

A

Increase blood flow
Increase Mm temp
Cardiac response improvement
Breakdown of oxyhemoglobin for delivery of O2 to working Mm increased

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24
Q

What are advantages to static stretch?

A

Reduce chance to exceed strain
Reduced energy requirement
Reduce potential for Mm soreness
Easy to teach

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25
Q

What is ballistic stretching?

A

Least desirable
Place tissue at risk
Stimulate Mm spindles during the stretch = continuous resistance to further stretch

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26
Q

What is dynamic stretching?

A

Use Mm contraction to stretch

Increase/decrease jt angle where Mm cross = elongate MT unit at the end of ROM

Activity specific movements

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27
Q

What is PNF?

A

Use different techniques to promote neuromuscular response

Increase ROM by decreasing resistance caused by spinal reflex pathways

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28
Q

How many weeks is needed of stretching to see significant change in flexibility?

A

6 weeks

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29
Q

How many minutes of light exercise is needed prior to stretching?

A

About 5 min

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30
Q

How to stretch soft-tissue contractures?

A

Long-duration and low-load

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31
Q

How long is immature scar tissue adaptable for?

A

8 weeks

Becomes less changeable up to 14 weeks after that

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32
Q

When do you have a mature scar?

A

14 weeks

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33
Q

What is scar tissue?

A

Collagen fibers become highly unorganized and randomly arranged

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34
Q

What are some critical components of scar tissue?

A

Time-dependent, stress-reactive nature

Fragility of immature scars

New scar tissue organizes and aligns itself along lines of stress

Low-load with long duration combined with preheating

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35
Q

What is the low-load, prolonged stretch technique?

A

Preheat involved areas

Place structure in comfortable position

Apply MHP 20-60 min

Apply stress or load gradually but minimally

Allow rest and recovery

Maintain heat app for 5-10 min after removal of load

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36
Q

What is muscle strength determined by?

A
  • Neural control
  • Cross-sectional area
  • Mm fiber arrangement
  • Mm length
  • Angle of pull
  • Fiber type distribution
  • Energy stores, recovery from exercise, fatigue, age, gender, and state of health
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37
Q

When is it least likely that you are strengthening Mm?

A

At max ROM

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38
Q

What are slow twitch Mm fibers?

A

Type I - red oxidative

Large, numerous mitochondria, triglycerides, enzymes for aerobic work

Low ATPase and glycolytic activity, lower Ca handling ability, shorter speed

Good for ENDURANCE

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39
Q

What are fast twitch Mm fibers?

A

Type II - white glycolytic

Anaerobic, contract at higher speed

High levels of myosin ATPase provides energy for speed of contraction

Low myoglobin and few mitochondria

3 subtypes

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40
Q

What are the muscle fiber types from slowest to fastest?

A 
Slow twitch
Fast twitch
Fast twitch A
Fast twitch AB
Fast twitch B
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41
Q

What is isokinetic exercise?

A

Speed held constant regardless of magnitude of force applied to resistance

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42
Q

How do we measure strength?

A 
MMT
Cable tensiometry
Dynamometry
One-rep max
Isokinetics
Functional assessment
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43
Q

What are functional tests that can be done for strength?

A

One-leg hop for distance
Single-leg triple hop for distance
Timed single-leg hop (MT)
Vertical jump

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44
Q

Strengthening exercises from least to most amount of force

A

Concentric
Isometric
Eccentric

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45
Q

Strengthening exercises from most to least ATP released

A

Eccentric
Isometric
Concentric

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46
Q

What is the overload principle?

A

Application of load that exceeds metabolic capacity of Mm

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47
Q

What is SAID principle?

A

Specific adaptations to highly specific demands

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48
Q

What is the progression principle?

A

Intensity of program must become progressively greater to continue to make gains

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49
Q

What is the reversibility principle?

A

Changes are transient unless training induced improvements are regularly used

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50
Q

How do we know when to increase weight?

A

Gold standard = 1 rep max

Find a weight they can do 8-12 reps with without fatigue

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51
Q

What are signs of fatigue?

A

Poor form
Speed
Shaking

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52
Q

What is DOMS?

A

Pain, swelling, tenderness, reduced ROM, and stiffness

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53
Q

What are some theories about DOMS?

A 
Lactic acid
Torn tissue
Tonic Mm spasm
CT damage
Tissue fluid

Most likely torn tissue

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54
Q

What is DeLorme PRE?

A

3 sets x 10 reps max

Arbitrary increase in resistance each week

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55
Q

What is the Oxford program?

A

Establish pt 10 RM for first set, move to 75% RM for second set, and 50% of 10 RM for third set

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56
Q

What is Knight daily adjustable PRE?

A

4 sets with variable reps and varying weights

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57
Q

What is the rule of tens?

A

Isometric exercise protocol

10 sec hold for 10 reps with 10 sec rest in between

Should be gradual tension for first 2 sec, max at 6, and decrease for 2

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58
Q

What is circuit training?

A

Predetermined and organized sequence of exercise

General body condition and total fitness

1 or 2 exercises to each body part

30-60 sec rest period between sets

Use resistance and aerobic metabolism

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59
Q

What is the proper contraction order?

A

Isometric - concentric - eccentric

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60
Q

What are plyometrics?

A

Intense power-generating exercise (sport-specific)

Adaptable with general ortho

High-intensity, task specific, dynamic

Based on GTO response and muscle spindle response

IE. Jumping, skipping, hopping, throwing, catching

For power and speed

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61
Q

When would you not use CKC exercise?

A

If there is pain, swelling, dysfunction, or weakness

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62
Q

What are considerations a PTA should have when helping the elderly strengthen?

A

Natural decline in Mm performance, force-generating capabilities, and Mm mass

Focus on delaying Mm atrophy, improve function, and increase force-generating capabilities by stimulating Mm hypertrophy

You can see similar gains to younger individuals

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63
Q

General recommendations for strengthening older adults?

A 
MD approved
Close supervision initially
Monitor vitals
Low resistance, low reps initially
Progress reps 
Avoid high resistance to decrease stress
Train 2-3x/wk with 48 hr rst intervals
Use balance of flex/ext exercise
Use supported positions if balance is a problem
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64
Q

When to start strengthening prepubescent/child

A

Girls: 11

Boys 13

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65
Q

When to start strengthening prepubescent/adolescents?

A

Girls: 12-18
Boys: 14-18

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66
Q

Define muscular endurance

A

Ability for Mm to perform at a certain level for prolonged periods of time

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67
Q

Define CV endurance

A

Ability for one’s CV system to allow performance for a prolonged period of time

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68
Q

Define catabolism

A

Creates energy for the body

Fuel converted to ATP
3 metabolic pathways
Continuation of endurance-based activity requires constant supply of O2 to produce ATP

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69
Q

What is the oxidative system?

A

Produce 19x the ATP produce in phosphagen energy system

2 ATP

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70
Q

What are the guidelines for the talk test?

A

Moderate intensity - able to talk

  • 5 hrs/wk
  • IE walk briskly, water aerobics, doubles tennis, cycling at less than 10 mi/hr

Vigorous - pause to talk

  • Intensity exercise 2.5 hr/wk
  • IE. running, swimming laps, singles tennis, and cycling greater than 10 mi/hr
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71
Q

What is the recommended amount of exercise for children?

A

60 min of mod-intensity exercise each day

Vigorous intensity for 3x/wk

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72
Q

How to measure exercise intensity?

A

VO2 max
Talk test
THR

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73
Q

How do you calculate target HR?

A

THR = MHR x desired intensity

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74
Q

What is target HR?

A

50-70% of one’s max HR

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75
Q

What is Borg Rating of Perceived Exertion?

A

Assess exercise intensity based on person’s perception of exertion

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76
Q

How do you determine HR from Borg scale?

A

Multiply perceived rating by factor of 10 (loose association)

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77
Q

What should someone’s Borg scale rate?

A

Between 12-14

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78
Q

How do we perform aerobic muscular endurance?

A

Sets of high reps

15 reps per set

Each rep should be performed at or below 67% of 1 RM max - 1-2 min rest period between each set

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79
Q

What are CV assessments for older adults?

A 
6 min walk test
2 min walk test
400 m walk test
1 min sit to stand
2 min step test
3 min step test
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80
Q

What is the 6 min walk test?

A 
Multiple pt pops
Take vitals before
Walk behind them
Provide encouragement
Keep time - can stop and rest, but need to stand
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81
Q

What is the 2 min walk test?

A

Mod to severe CP disease, more frail, and those who cannot walk for long periods of time

Similar to 6-min test, but shorter

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82
Q

What is the 400 m walk test?

A

Instruct pt to complete 10 laps

Pt seem more motivated to complete distance

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83
Q

What is the 1 min sit to stand test?

A

Adding endurance component compared to 30 sec

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84
Q

What is 30 sec sit to stand test?

A

More about power and strength

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85
Q

What is 2 min step test?

A

Marching test

Take measurement b/t ASIS and mid-patella - measure on the wall and that is how high they have to march

Adds value of SLS

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86
Q

What is 3 min step test?

A

Faster HR returns to resting = healthier you are

Typically done in healthy adults

Done to metronome

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87
Q

What should post-op exercise entail in ortho?

A
  • Lost strength
  • Pain
  • Swelling
  • Flexibility
  • Local Mm endurance
  • Build CV fitness
  • Gait and balance
  • Motor control and NM elements of function
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88
Q

What is the #1 indication of falls in elderly?

A

Lack of DF

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89
Q

What is the #1 strength indicator in elderly?

A

Weak quads

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90
Q

What factors contribute to balance and coordination?

A
  • Visual
  • Vestibular
  • Somatosensory
  • ROM and flexibility
  • Strength
  • Posture
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91
Q

Why do we look at the ground as we age?

A

Depend more on visual component of balance = lean forward

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92
Q

What is balance?

A

Ability to maintain COM over BOS

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93
Q

What is BOS?

A

Area within the body to make physical contact with external environment

Base not fixed

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94
Q

How do we maintain postural equilibrium?

A

Postural nervous system and MS system

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95
Q

What is the definition of coordination?

A

Ability to produce patterns of body and limb motions in context with environmental objects and events

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96
Q

What is proprioception?

A

Sensory (afferent) info regarding jt position

Movement (kinesthetic)

Movement resistance and tension

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97
Q

What is neuromuscular control?

A

Subconscious activation of Mm occurring in preparation for and in response to jt motion and loading

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98
Q

What are mechanoreceptors?

A

Sensory receptors that are responsible for converting mechanical events into neural signals that can be conveyed to CNS

Each mechanoreceptor response to specific stimuli and has its own threshold

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99
Q

Where are mechanoreceptors located?

A

Musculotendinous structures

IE. Muscle spindles and GTO

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100
Q

What are the mobility tests?

A
  • TUG
  • Gait speed
  • Backward walk test
  • Timed up and down stairs
  • Tandem walk test
  • 4 square step test
  • Dynamic gait index
  • Functional gait index
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101
Q

What is the benefit of the TUG?

A
  • Good first test
  • General mobility of LE function
  • Minimal detected change
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102
Q

What is a dual task TUG?

A

Pt is able to do another task while walking

IE subtraction task, carrying glass of water, etc

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103
Q

What is the benefit of the gait speed test?

A

Considered 6th vital sign

Slow gait = #1 predictor of functional decline

Valid for health status, mortality, falling, and fear of falling

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104
Q

What is the benefit of the backward walk test?

A

Helps to see how one’s ability is to open doors, open the oven, backup to sit, etc

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105
Q

What is the benefit of the timed up and down stairs test?

A

Functional mobility

Go up/down 4-12 stiars

Can use AD

Do not time the turnaround

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106
Q

What is the benefit of the tandem walk test?

A

Measure of gait, mobility, and balance

Do it with EO vs EC

10 steps on a line

More specific for those with vestibular or peripheral neuropathy issues

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107
Q

What is the benefit of the 4 step square test?

A

Quantify balance in 4 different directions and its reversal

Good cognitive data to follow instructions

Ability to pick up feet

Greater than 15 sec = greater fall risk

Very good specificity and sensitivity

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108
Q

What is the benefit of the dynamic gait test?

A

Used on individuals with vestibular issues

8 and 4 item test - 4 item has same validity as 8

Scored 0-3 - higher the score the better

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109
Q

What is the benefit of the functionality gait test?

A

7 items

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110
Q

What are the various balance tests?

A
  • Functional reach
  • One-leg stance
  • Romberg and sharpened Romberg
  • CTSIB and mCTSIB
  • Berg Balance Scale
  • Four stage balance test
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111
Q

What is the functional reach test and its benefits?

A

Slide hand down the ruler and measure in inches

Look at DF

Look at how the COG of shift is

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112
Q

What is the one-leg stance and its benefits?

A

Portrays static postural control

Help establish fall risk

Very difficult for elderly

Fail = hop, touch of foot to leg, or arms move dramatically

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113
Q

What is the Romberg and its benefits?

A

Standing with legs together and test EO/EC

Test integrity of proprioceptive pathway and vestibular function

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114
Q

What is the Sharpened Romberg and its benefits?

A

Same as Romberg, but in tandem stance

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115
Q

What is the CTSIB and mCTSIB and what are their benefits?

A

Putting a dome on pt head. Don’t normally do in mCTSIB

Done a lot in home health

1st test feet together EO
2nd test feet together EC
3rd test feet together on foam EO
4th test feet together on foam EC

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116
Q

What are self reported scales on balance?

A
  • Activities specific balance confidence scale
  • Modified gait efficacy scale
  • Falls efficacy scale
  • Fear of falling avoidance behavior questionnaire
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117
Q

What is the Y Balance Test?

A

Test a person’s risk for injury

Can be used for UE and LE

AKA star excursion

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118
Q

What are the factors that contribute to balance dysfunction?

A
  • Perception
  • Behavior
  • ROM
  • Biomechanical alignment
  • Weakness
  • Sensory
  • Synergistic organization strategy
  • Coordination
  • Adaptability
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119
Q

What is the definition of mobilization?

A

Restore joint motion or mobility, or decrease pain associated with joint structures

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120
Q

What is closed packed position?

A

When a joint is most congruent

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121
Q

What is close packed good for?

A

Testing integrity and stability

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122
Q

What is loose-packed position?

A

Joint capsule and ligaments are most relaxed and least congruent

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123
Q

What is loose-packed position good

A

Ideal for joint mobs

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124
Q

Which joint mob grades are used for pain?

A

Grades I and II

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125
Q

Which joint mob grades are used for ROM?

A

Grades III and IV

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126
Q

What is a grade I mob?

A

Small oscillations

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127
Q

What is a grade II mob?

A

Start to midway

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128
Q

What is a grade III mob?

A

Midway to end

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129
Q

What is grade IV mob?

A

All the way and knock on the door

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130
Q

What is a grade V mob?

A

PTA does not do

High velocity thrust of small amp at the end of available ROM

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131
Q

What is joint play?

A

Motion available within the joint

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132
Q

How long are joint oscillations involved?

A

3-6 sets of oscillations

Perform 2-3 oscillations per second

Last 20-60 sec for tightness

Last 1-2 min for pain with 2-3 oscillations per second

For painful joints apply distraction for 7-10 sec with few sec rest in between

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133
Q

How long should mobs be done for restricted joints?

A

Apply min of 6 sec stretch, followed by partial release and then repeat with slow, intermittent stretches at 3-4 sec intervals

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134
Q

What is a muscle spasm end feel?

A

Pain with sudden halt of movement that prevents full ROM

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135
Q

What is a springy block end feel?

A

Internal derangement - full motion limited by soft springy sensation with pain

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136
Q

What is a loose end feel?

A

Min resistance is felt at end range - jt hypermobility

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137
Q

What is capsular end feel?

A

Normal tissue stretch before normal ROM

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138
Q

What are absolute contraindications to joint mobs?

A

Osteoporosis, RA, jt hypermobility, and neurologic symptoms

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139
Q

How long are Grade I or Grade II mobs?

A

1-3/sec or 60-180/min

Applied for 0-60 sec (only 4-5x)

Treat painful conditions daily or until pain is reduced

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140
Q

What are the 4 stages of pharmacokinetics?

A

Absorption
Distribution
Metabolism
Excretion

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141
Q

What is half-life?

A

Amount of time it takes to reduce the drug’s blood concentration to half

Liver metabolism and renal clearance can slow a half-life and impair secretion

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142
Q

What is duration of action of a drug?

A

Length of time it is active in the body

Longer half life = longer duration

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143
Q

What are pharmacodynamics?

A

Describes what the med does in the body

IE. Dose-response relationship, therapeutic window, adverse effects, toxicity, tolerance, and dependency

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144
Q

What is the therapeutic window of a drug?

A

Min needed for therapeutic use without toxicity

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145
Q

What causes someone to be dependent on a drug?

A

Withdrawal symptoms

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146
Q

What is considered a 5th vital sign?

A

Pain

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147
Q

What is nociceptive pain?

A

Pain resulting from tissue damage

Inflammatory, noninflammatory, or both
IE. Bone pain, sprains, and postsurgical pain

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148
Q

What treats inflammatory pain?

A

Antiinflammatory
NSAIDS
Cox-2 inhibitors

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149
Q

What is neuropathic pain?

A

Pain resulting from damage or dysfunction of nerves

Relatively resistant to opioids, acetaminophen, and antiinflammatory agents

Use meds that will cross BBB and target CNS

Use meds to slow or block nerve conduction (antidepressants and anticonvulsants)
- IE. Cymbalta, Lyrica, Tegretol, Lidocaine, Ultram

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150
Q

How to treat acute pain?

A

Round the clock dosing

- IE. opioids, acetominophen, NSAIDS (quick onset)

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151
Q

How to treat chronic pain?

A

May be prescribed long-acting release meds

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152
Q

What is “breakthrough pain”?

A

Pain can be treated with short-acting meds

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153
Q

What do opioid analgesics do?

A

Work by blocking CNS transmission of pain and create a euphoric feeling

IE. Morphine, oxycodone, hydrocodone, codeine

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154
Q

What are common side effects of opioids?

A

Nausea, vomiting, allergic reaction, sedation, drowsiness, dizziness, constipation, impaired judgment, risk of injury from falling

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155
Q

What is acetaminophen?

A

Most commonly used OTC fever reducer and analgesic

Used for HA, sinus pain, back pain, OA, and toothaches

No strong antiinflammatory properties

Can contain other meds

Can be given to someone with GI bleed, CHF, and HTN

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156
Q

What is the max dosage of acetaminophen?

A

No more than 4000 mg/day

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157
Q

What happens if you overdose on acetaminophen?

A

Hepatotoxicity

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158
Q

What are NSAIDS?

A

OTC - IE. aspirin, ibuprophen, naproxen, and kefoprofen

Fever reducer and antiinflammatory

Found in cold meds and some sleep aids

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159
Q

Can you use NSAIDS in children?

A

NEVER = could cause fatal illness (Reye’s Syndrome)

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160
Q

What are Cox-2 inhibitors?

A

Lower risk of side effects compared to NSAIDS

Inhibit production of prostaglandins by inhibiting COX enzyme

Fewer bleeding and stomach related side effects

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161
Q

Who would not be eligible for COX-2 inhibitor?

A

Someone with an allergy to sulfonamide antibiotics

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162
Q

What are corticosteroids?

A

Glucocorticoids produced naturally by adrenal cortex

Powerful antiinflammatory and immunosuppressuant used in RA, OA, gout, CTS, bursitis, and lupus

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163
Q

What should happen after corticosteroid injection?

A

Pt should minimize activity and stress for several days

Pain decrease within 24-72 hr after injection

Can benefit for 4-8 weeks

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164
Q

What are side effects of corticosteroids?

A

Elevated blood glucose

Edema, cataracts, glaucoma, stomach ulcers

Insomnia, risk of infection, and mood changes

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165
Q

What is the most common joint to get corticosteroid injection?

A

Knee

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166
Q

Who would not receive a corticosteroid shot?

A

Someone with diabetes

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167
Q

What are examples of CV meds?

A
  • Beta blockers
  • Ca channel blockers
  • Digitalis
  • Bronchodilators
  • Diuretics
  • Lipid-lowering drugs
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168
Q

What are beta blockers?

A

Blunts HR and BP response

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169
Q

What are Ca channel blockers?

A

Decrease resting and exercise BP response

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170
Q

What is Digitalis?

A

May cause dysrhythmias and/or tachycardia

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171
Q

What PT/INR level would not get exercise?

A

Less than 3

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172
Q

What is a Grade I ligament injury in the knee?

A

Incomplete stretch of collagen ligament fibers resulting in min pain, swelling, no loss of joint function, and no instability

173
Q

What is a Grade II ligament injury in the knee?

A

Partial loss of ligament fiber continuity; few torn, moderate pain, swelling, some loss of function and stability

174
Q

What is a Grade III ligament injury in the knee?

A

Rupture of ligament, profound pain, intense swelling, and loss of joint function and instability

175
Q

What is the function of the ACL?

A

Prevents hyperextension and rotational movement of the knee

176
Q

What occurs when ACL is injured?

A

Joint effusion

177
Q

Who tears ACL more?

A

Females

  • Weaker quads
  • Weaker pelvis
  • Wider Q angle
  • Increase genu valgum
  • More ligament laxity
  • Poor landing mechanics
178
Q

What are PT diagnostic tests for ACL tear?

A

Lachman
Anterior Drawer
Pivot shift test

179
Q

What is involved during conservative management of ACL?

A
  • Safe environment to protect knee
  • Therapeutic exercise and proximal strengthening
  • LE strengthening with CKC
  • OKC exercise
180
Q

What are types of surgical management?

A
  • Autograft reconstruction (from pt body) - use gracilis, TFL, semitendinosis, etc
  • Bone-patellar-bone
  • Allograft from human cadaver
  • Arthroscopic central 1/3 BTB autograft
181
Q

What considerations do you need when the repair is done with semitendinosis?

A
  • Rehab quads AND HS

- Limit HS strengthening early on

182
Q

What considerations need to be made with quad tendon repair?

A

Limit ROM early

183
Q

What are post-op considerations with ACL?

A
  • Avascular necrosis risk for 6-8 weeks
  • Early mobs
  • Fragile first 2 months
  • Graft undergoes periods of necrosis, revascularization, and remodeling
  • Grafts may take up to a year to fully mature
  • Need to get ROM back early
  • Only accelerate WB when improved results are seen
184
Q

What is the goal of post-op rehab for ACL?

A

Protect graft

Reduce pain and swelling

Increase joint motion

Improve strength and endurance

Flexibility and proprioception

185
Q

What is the sequence for ACL repair?

A

Immediate post-op rehab phase
Return to function phase
Return to sport phase

186
Q

T/F you do OKC for quad repair?

A

F - need to protect graft

187
Q

T/F you use SAQ and LAQ with ACL?

A

F - no you do not

188
Q

What progressions should pt expect with ACL repair?

A

Need good quad and HS strength before progressing

Progress to w/o crutches pretty quickly

Goal of 120 degrees of flexion

CKC and proprioception exercise early

Do not return to sports for 6-9 months

Make sure they meet criteria before next phase

189
Q

What activities can occur in phase 1?

A

Hip PRE
Isometric
Gait training
Proprioception training

190
Q

What activities can occur in phase 2?

A

SLS

Initiate step up/step down

191
Q

What activities can occur in phase 3?

A

Agility training

192
Q

What is the function of the PCL?

A

Restrict posterior tibial translation

193
Q

What are common causes of PCL injury?

A

Trauma to knee
MVA
Hyperextension injury

194
Q

What do you experience if you tear PCL?

A

Do not hear a pop or tear

Mild to moderate knee effusion, limp, pain in back of knee, and lack full ext

195
Q

What PT eval tests can be performed for PCL?

A

Posterior drawer test

Godfrey posterior tibial sag test

196
Q

What is conservative management for PCL?

A

Combat effects of inflammation and inhibition

Open brace, crutches, and cryotherapy

197
Q

What is done if there is surgery on a PCL?

A

Autologous grafts

Achilles allograft

198
Q

What happens during post-op rehab for PCL?

A

Begin day 1 post op

Knee immoblizer or hinged knee brace

Max protection = Avoid HS Iso greater than 30 degrees and flexion 60-90 degrees

199
Q

When does moderate protection phase occur for PCL?

A

6-12 weeks

200
Q

When can you return to sport after PCL repair?

A

8-12 months

201
Q

What kind of rehab would you expect with non-op PCL?

A

Isolated grade I or II PCL tear

Knee immobilizer or hinged knee brace and crutches

Begin therapy immediately - maintain quad tone, decrease inflammation, restore ROM

202
Q

When can someone with non-op PCL return to sports?

A

Between 6-8 weeks for low grade sprains

203
Q

What is MCL injury?

A

Most common

Common cause is vagus force applied to knee

204
Q

What sx/sx do you see with MCL injury?

A

Swelling, ecchymosis, walk with limp, hesitant to fully ext knee

205
Q

What PT test can be done on a MCL injury?

A

Valgus stress test

206
Q

What does rehab look like for MCL injury ?

A

Isolated grade 1-3: non-op

Crutches and knee brace

Apply correct therapeutic intervention at right time

Increase quad tone up to 2 weeks

Decrease inflammation and restore ROM

207
Q

When can someone return to sports with MCL injury?

A

Grade 2: 3-5 weeks

Grade 3: 8-12 weeks

208
Q

What is done with grade I MCL tear?

A

Introduce isometrics, no brace needed, OKC/CKC, ice, etc

209
Q

What is done with grade II MCL tear?

A

Hinged brace

210
Q

What is done with grade III MCL tear?

A

Longer periods of immobilization, bracing, and crutches

211
Q

What is the terrible triad?

A

Torn ACL, MCL, and medial meniscus

212
Q

What is the normal function of the meniscus?

A

Stability

Shock absorption

Load transmission

Nutrition

Lubrication

Reduce joint stress

213
Q

What kind of CT is the meniscus made out of?

A

Type I collagen

214
Q

What kind of tear patterns occur with the meniscus?

A

Horizontal

Longitudinal

Degenerative

Radial

215
Q

Which portion of the meniscus gets blood supply?

A

Lateral

216
Q

What is the cause of meniscus tear?

A

Sudden trauma or gradual degeneration

Can be subtle with some activity preceding pain, swelling, and locking of the knee

217
Q

What clinical examinations can be done for meniscus tear?

A

Apley’s compression test

McMurray test

Steinman test

Thessaly test

Joint line tenderness

218
Q

How to manage meniscus tear conservatively?

A

Cryotherapy, quad sets, AAROM, and so forth

219
Q

How would surgery benefit a meniscus tear?

A

Causes bleeding to help initiate natural repair/growth

220
Q

What are the zones of meniscus tears?

A

I: red on red (vascular on both sides)
II: red on white (vascular on one side)
III: white on white (no vascular side) - cannot heal itself

221
Q

What does post-op rehab look like with someone who had a meniscus repair?

A

Rehab guidelines are controversial

Strict protection phase: 4-6 weeks

222
Q

When can someone return to running after a meniscus repair?

A

No sooner than 4 months

223
Q

What is a meniscal transplantation?

A

Replaced by allografts

Excellent results in reducing pain

224
Q

What are indications for a meniscal transplantation?

A

Prior menisectomy, continued pain, normal alignment, and joint stability

225
Q

What does post-op rehab look like after meniscal transplantation?

A

Conservative approach - NWB and ROM limitations in flex

226
Q

When can someone return to sports after meniscal transplantation?

A

9-12 months

227
Q

What is the function of articular cartilage?

A

Protects subchondral bone and reduce friction with in a joint

228
Q

What is the goal of articular debridement?

A

Stimulate bleeding = stimulate natural healing and more cartilage is laid down

229
Q

What is the goal of microfracture surgery for articular cartilage?

A

Poke holes in subchondral bones
Stim bleeding = stim natural healing and growth
NWB 2-8 weeks

230
Q

What does post-op rehab look like for someone who had articular cartilage lesions?

A

Min WB if surgery was done (2-8 weeks)

CPM machine

FWB around 8-10 weeks and hopefully limp free - progress exercise from bilateral to unilateral

Normal gait, full ROM in 2-6 months

Return to sports 6-12 months (high impact closer to 12 months)

231
Q

What is the etiology of PFPS?

A

Difference in flexibility, strength, and neuromuscular control

232
Q

What are the symptoms of PFPS?

A

Ant knee pain with prolonged sitting, stair amb, and squats

233
Q

What causes baja PFPS?

A

Tight HS

234
Q

What causes alta PFPS?

A

Tight quads

235
Q

What is femoral anteversion?

A

IR and ABd - femur sits anteriorly

See valgus

During squats knee goes medial

236
Q

What are physical examinations that can be done for PFPS?

A

Femoral anteversion, genu valgum, genu recurvatum

TIbia varum, rearfoot pronation

Q angle - (ASIS, mid patella, and tibial tuberosity)

Tightness of quads and IT band

Observe gait, squat, SLS, and step down

237
Q

What is meant by squinting patella?

A

Patella turns medially

238
Q

What is important to strengthen with PFPS?

A

ABD

239
Q

What does non-op rehab look like for someone with PFPS?

A

Initially focus on pain and swelling

Avoid activities that cause pain

Ice and NSAIDS in acute phase

Strengthen quads with isometrics

Use clamshells and s/l hip abd

Address core to floor

Manual treatment of lateral tight structures

CKC strengthening exercise to promote higher level of function, hip strength, ROM, resistance, step height, modified to perform without pain

Supportive device with tape

240
Q

What occurs during phase one of post-op management for PFPS?

A

Between 0-6 weeks

Joint homeostasis

Reduce pain, inflammation, and joint effusion

Focus on ROM

Patella mobs and flexibility

Quad re-ed

WB

241
Q

What occurs during phase 2 of post-op management for PFPS?

A

Between 7-12 weeks

Gait training
ROM
Strength and balance
Flexibility

242
Q

What occurs during phase 3 of post-op management for PFPS?

A

Weeks 13-17

Maintain full ROM and patellar mob

243
Q

What occurs during phase 4 of post-op management for PFPS?

A

Weeks 18-25

Functional return to sports

244
Q

What occurs during distal realignment?

A

Osteotomy of tibial tubercle

245
Q

What are complications with distal realignment?

A

Associated fixation, wound healing, and DVT

246
Q

What are the phases of rehab for distal realignment?

A 
Phase I (0-6 wk): ROM and WB
Phase II (7-14 wk): gait, ROM, and strength
Phase III (15-22 wk): Strength and endurance
Phase IV *36-44 wk): return to sports
247
Q

What is chondromalacia?

A

Degeneration or softening of retropatellar cartilage

248
Q

What surgery is performed with chondromalacia?

A

Arthroscopic procedure to smooth rough surfaces and stimulate inflammatory response

249
Q

What does acute management look like for chondromalacia?

A 
Ice
Elevation 
Compression
NSAIDs
Protected WB
CPM
250
Q

What causes patellar fractures and what is a complication?

A

Direct or indirect trauma

Avascular necrosis in transverse fracture

251
Q

What happens during non-op rehab for patellar fracture?

A

Immobilized in full ext for 4-6 weeks with limited WB

Nondisplaced fractures treated conservatively

Unaffected limb can maintain strength

252
Q

Which fracture is most serious in a patellar fracture?

A

Horizontal

253
Q

What management occurs with post-op patellar fracture?

A

Knee immobilized at 20 degrees

1 week post-op = active knee et, submax quad sets, and SLR

Knee flex limited up to 6 weeks to allow healing

FWB at 6 weeks

Focus on normalizing gait through CKC step ups and squats like non-op

254
Q

What is a supracondylar femur fracture?

A

Muller’s AO classification system

255
Q

What is non-op management of supracondylar femur fracture

A

Incomplete or nondisplaced fractures

Nondisplaced = hinge brace for 6-12 weeks

Displaced = ORIF

256
Q

What is non-op management for tibial plateaus?

A

Hinged knee orthosis in ext

Focus on ROM and isometrics

257
Q

What occurs in post-op management of tibial plateaus?

A

AAROM between 1-2 weeks

FWB at 12 weeks

258
Q

What is a high tibial osteotomy?

A

Used in pt with advanced degeneration of one compartment of knee

Bow-legged

Done 10 years before TKA

More successful in pt under 60

AAROM can start right away

FWB at 8 weeks

259
Q

What are indications of a TKA?

A

Obesity, hemophilia, RA

260
Q

What are contraindications of TKA?

A

Active infection, compromised vascularity, and recurvatum deformity

261
Q

What is the goal of a TKA?

A

ROM

Relieve pain

Restore soft tissue

Max strength

Restore gait

Proprioception and balance

262
Q

What occurs during the acute phase of TKA?

A

Days 1-5

  • Blood thinners to prevent DVT
  • Avoid prolonged sitting, standing, and walking
  • Remedial exercises for quads, HS, glute, ankle pumps
  • CPM to improve ROM
  • WB depends on type of fixation
  • Start general conditioning
263
Q

What occurs in phase 2 of TKA?

A

Weeks 2-8

  • Focus on ROM, decrease swelling, improve strength, gait, and amb
  • Prevent athrofibrosis
  • Gastroc stretching
  • OKC and CKC exercises
  • Focus on normalizing gait, balance, and proprioception
  • TUG test
  • 6 min walk test
264
Q

What occurs in phase 3 of TKA?

A

Weeks 9-16

  • Focus on ROM, decrease swelling, improve strength, gait, and amb
  • 125 degrees flex
  • Strengthen and balance (bilateral and unilateral)
  • Focus on normalizing gait, balance, and proprioception
  • TUG test
  • Hydrotherapy
265
Q

What occurs in phase 4 of TKA?

A

16+ weeks

  • Return to sport with MD approval
  • SAID principle
  • Progress from bilateral to unilateral in strength and balance
  • Precautions when returning to golf, tennis, and other sports with more rotational force
266
Q

What are muscle length tests for the hip?

A

Thomas test

Ober test

SLR test

267
Q

What is the limiting factor of a positive Thomas test?

A
  • If more mobile in ext = rectus femoris is limiting
  • If leg goes into ER and Abd = sartorius is limiting
  • If leg goes into ABd and IR = TFL is limiting
  • If leg goes into ADD = pectineus and adductors are limiting
268
Q

What is the most common and significant complication of a hip fracture?

A

Osteonecrosis

269
Q

What are the types of hip fractures?

A
  • Malunion
  • Delayed union
  • Nonunion avascular necrosis
270
Q

What are treatment options for hip fractures?

A

Depends on person’s age, location and severity, quality of bone, activity level, associated soft-tissue injuries, specific goals for pt return to health

ORIF

Bed rest and protected WB and limited exercise for 3-4 weeks

271
Q

What are treatment options for hip dislocation?

A

Treated conservatively with bed rest, traction, protected WB up to 12 weeks

272
Q

What are the levels of mortality for hip fractures?

A

20% after 1 year

50% after 3 years

60% after 6 years

77% after 10 years

273
Q

What occurs during the max protection phase of post-op hip fracture?

A

1-21 days

Protect fracture site, reduce pain and swelling, isometric exercise, gentle protected ROM, and limited WB

274
Q

What occurs during mod protection phase of post-op hip fracture?

A

3-6 week

WB depended on bone healing and focus on improving strength

275
Q

What occurs during the late healing phase?

A

6-8 weeks

Normalized gait mechanics without AD

276
Q

What are examples of progressive hip exercises for 3-4 week post op hip fracture?

A
  • Sitting LAQ
  • Seated marches
  • Forward bend (controversial for elderly)
  • Armchair push-up
  • Supine hip rotations
  • Heel slides
  • Knee to chest
  • Hip ABd/ADD
  • TKE
  • Knee flexor stretch
  • Knee flexion
  • Hip ext
277
Q

What is a proximal femoral osteotomy?

A

DJD

Goal: reduce pain and improve function related to advanced OA

Change the femoral neck-shaft angle

278
Q

What does rehab look like for someone who had a proximal femoral osteotomy?

A
  • Jt protection (unloading force through hip)
  • WB progression with bone healing
  • Surgical incision and bone healing
  • PWB and underwater T-mill
  • Increase exercise after x-ray verify bone healing
279
Q

What occurs in a hip hemiarthroplasty?

A

When femoral head goes through osteonecrosis or severe fractures

Goal: eliminate pain and improve function

Procedure to replace femoral head

280
Q

What occurs in a THA?

A

Replace both the femoral head and acetabulum

281
Q

What are indications of THA?

A

OA or osteonecrosis

RA

Fractures

Pain, reduced amb

282
Q

What precautions do you have with non-cemented THA?

A

NWB

283
Q

What precautions do you have with cemented THA?

A

Takes longer for progression of WB and gait

284
Q

What are sx/sx of thrombosis?

A
  • Tenderness
  • Swelling
  • Redness
  • Look if large veins are swollen
285
Q

What are complications of THA?

A
  • Loosening components
  • Post-op dislocation
  • Surgical site infection
286
Q

What are precautions after posterior THA?

A

No ADD, flex past 90 degrees, and IR

287
Q

What are precautions of anterior THA?

A

No ext past normal walking and no ER

288
Q

How long is the recovery period for THA?

A

Up to 4 months

289
Q

What occurs during max protection phase of THA?

A
  • B ankle pumps, isometric quad sets, gluteal isometrics, active knee flex (avoiding hip flex), universal hip precautions
  • Transfer training and bed mob
  • Raised toilet seat and rigid w/c seat pad
  • TTWB or PWB with crutches or walker
  • FWB at 3 weeks
290
Q

T/F you do SLR with hip replacements?

A

F

291
Q

What occurs during mod protection phase of THA?

A
  • Begins when pt can demo quad control, active knee flex, reduced pain, and compliance with precautions
  • More challenging exercises with light resistance
  • Standing exercise to stress hip motion
  • THA precautions enforced
292
Q

What occurs during min protection phase of THA?

A

Occurs 12-16 weeks post-op

  • MD may discontinue therapy
  • Pt return to normal gait without AD
  • Rehab address proprioception, coordination, and balance
  • Return to higher levels of activity
293
Q

What are the advantages of anterior approach THA?

A
  • Less Mm damage
  • Decrease risk of dislocation
  • Less post-op pain
  • Faster recovery
294
Q

What are the disadvantages of anterior approach THA?

A
  • Harder to view
  • Potential nerve damage
  • Wound healing issues
  • Different approach if repair needed
  • Not for everyone
295
Q

What is hip OA?

A

Focal loss of articular cartilage with variable subchondral bone reaction

296
Q

What is the goal when someone comes in with hip OA?

A

Relieve symptoms, minimize disability, reduce disease progression, education, modification of activities, and maintain ROM

Evaluate diet, weight control, footwear, and use of AD

297
Q

What is part of the conservative interventions for hip OA?

A

Gait and balance training, manual therapies, systematically progressed therapeutic strengthening

Use of AD to improve WB function, at least until WB and gait neuroplasticity improves

Flexibility, strengthening, and endurance

298
Q

What is Legg-Calve Perthes Disease?

A

Hip condition affecting ages 4-8 years old

Non-inflammatory, self-limiting syndrome

Can heal spontaneously

Femoral head becomes flattened at WB surface and disrupts blood supply

299
Q

What is a long term complication of Legg-Calve Perthes Disease?

A

Incongruous jt surface and advanced DJD

300
Q

What is pubalgia?

A

Chronic pain of the pubic tubercle and inguinal region

Found in athletic peope

301
Q

What are symptoms of pubalgia?`

A

Lower ab pain with exertion and minimal to no pain at rest

302
Q

What is the treatment for pubalgia?

A

Conservative and aimed at addressing what is causing dysfunction

303
Q

What is osteitis pubis?

A
  • Pain and bony erosion of pubis symphysis
  • Pain in pubic area that radiates across anterior hip
  • Aggravated with striding, kicking, and pivoting
  • Pain with resisted ADd, hip rotation, SI dysfunction, and may be present with pelvic obliquity and imbalance
304
Q

What causes hip bursitis?

A

Irritated and inflamed from excessive compression and repeated friction

305
Q

What is the treatment for hip bursitis?

A
  • Relieve pain and inflammation (rest, ice, and NSAIDs)
  • Eliminate activities that make it worse
  • Focus on flexibility, strengthening, and stretching
306
Q

What are the types of bursitis?

A

Greater trochanteric
Ischial
Iliopectineal

307
Q

What has commonly been misdiagnosed as bursitis in the hip?

A

Glute medial tears

308
Q

What are common causes of ischial bursitis?

A

Contusion, a lot of sitting, and HS strain

309
Q

What is ischial bursitis?

A

Pain over ischial tuberosity

Can mimic HS strain

Affects thinner people and cyclists

310
Q

What are tx interventions for ischial bursitis?

A

Rest, ice, NSAIDs, stretching, and corticosteroid injections

311
Q

What is ileopectineal bursitis?

A

Local tenderness over iliopsoas and radiate to anterior thigh

Pain in hip flexion and ADd

312
Q

What is the goal with ileopectineal tx?

A

Reduce pain and irritation

313
Q

What are common tx from ileopectineal bursitis?

A

Rest, ice, NSAIDs, PT with thermal agents, stretching, and strengthening

314
Q

What muscles are commonly strained in the hip?

A

HS, iliopsoas, ADd, and rectus femoris

315
Q

How do we manage hip strains?

A

Initially with cold packs for 20 min 3-5 x/day

Avoid motion that causes pain

Sleep with pillows under both knees to support injured limb

Strength training proceeds with healing - time frame differs with pt

316
Q

What is tx for hip ADd strain?

A

Protection, ice, compression bandaging, crutches, protected WB during acute phase

317
Q

What intervention should be used after pain subsides?

A

Active hip flex, gentle hip ADd, and knee ROM

Seated butterfly with no pain

Progress to more dynamic exercises

318
Q

How do you get a iliopsoas strain?

A

“Hip flexor pull”

Sudden, forceful extreme hip ext or forced hip flex against resistance

319
Q

What is tx for iliopsoas strain?

A

Protection, rest, ice, compression bandage with crutches and limited WB

320
Q

What PT interventions will you see with iliopsoas strain?

A

Hurdler’s stretch

Stretches slow, static without pain

Correct Mm imbalance and joint dysfunction

321
Q

Where is the most common hip contusion?

A

Iliac crest

322
Q

What is initial tx for hip contusions?

A

Protection, rest, ice, gentle compression wraps, crutches, and PWB

Stretching and strengthening when soft-tissue has healed and pain is controlled

323
Q

What is conservative tx with fractures to pelvis and acetabulum?

A

Rest, hip extended and ER to avoid stress, protect WB at 6 weeks

After bone is healed can progress to flexibility and strengthening

324
Q

Why is a fracture to pelvis and acetabulum so painful?

A

Because the pelvis is a ring

Potentially life threatening

Stable vs unstable

ORIF with avulsion fracture

325
Q

What is an unstable pelvic fracture?

A

Rotationally unstable

Severe injury treated with external fixator, ORIF, or extended bed rest

326
Q

What does rehab look like in unstable pelvic fracture?

A

Depends on type and severity

WB deferred for 8 weeks

May exercise UE and limited LE

327
Q

What are complications of a pelvic fracture?

A

Hemorrhage

GI injury

Diaphragm rupture

Bony malunion

Nonunion

Neurologic damage

DJD

Infection

328
Q

What is involved in conservative rehab for acetabular fracture?

A

Protected WB at 9 weeks

329
Q

What rehab is involved with post-op acetabular fracture

A

PWB for 8-10 weeks

LE strength program right away

As bone heals the PT can progress

330
Q

What are symptoms of hip labral tear?

A

Groin pain, lock, click, catch, stiff joint and ROM

331
Q

What are tx options for hip labral tear?

A

Conservative
Injection
Surgery

332
Q

What diagnostic test can be done for hip labral tear?

A

FADDIR
Flexion-IR test
FABER

333
Q

What is femoral acetabular impingement?

A

Deformity of hip jt that limits ROM

D/t trauma, repetitive movemetns, and bony abnormality

334
Q

What is a Cam type acetabular fracture?

A

Excess bone around head or neck of femur

335
Q

What is Pincer type of acetabular fracture?

A

Socket angled in away that abnormal impact occurs between femur and acetabulum

336
Q

What are symptoms of acetabular fractures?

A

Groin pain after prolonged sitting, walking, dull ache, catch, sharp, popping, pain laterally

337
Q

How do you test for an acetabular fracture in PT?

A

FADDIR

338
Q

What tx options are there for acetabular fractures?

A

Conservative and surgery

339
Q

What are the signs of overmobilization?

A

Increased pain and swelling

Decreased mobility

340
Q

What is the mechanism of an inversion ankle sprain?

A

PF, inv, and ADd of foot and ankle

IE. Stepping off curb, into a small hole, or stepping on a rock

341
Q

What is the Leach classification of inversion ankle sprain?

A

First degree: single ligament rupture (ATF)

Second degree: double ligament rupture (ATF and FCL)

Third degree: all three ligaments tear (ATF, PTF, and FCL)

342
Q

What test is performed to see if someone has an inversion ankle sprain?

A

Anterior drawer test

Talar tilt test

343
Q

What is the intervention for an inversion ankle sprain?

A

Depends on severity

344
Q

What occurs during max protection phase for inversion ankle sprain?

A

RICE, jt protection and immobilization (ankle needs to be positioned properly)

WBAT

Isometrics as soon as patient can tolerate and proximal leg strength

345
Q

What occurs during mod protection phase for ankle inversion?

A

Starts when pt can WB w/o crutches, perform all ROM, and perform isometrics w/o pain and swelling

Inv and PF are added
Conc/Ecc contraction added
Toe and heel raise
Stretching
Stationary bike
Proprioception exercises
346
Q

What occurs during min protection phase of inversion ankle sprain?

A

Can start when amb w/o pain or limping, can perform all resistive exercise w/o pain, and swelling is reduced

Maturation can take up to 6-12 months

347
Q

What are ankle deltoid ligament strains?

A

AKA medial ligament or Spring ligament

Rare

Occur in combo with ankle fracture

348
Q

What are interventions for ankle deltoid ligament strain?

A

Partial tear = PT

Complete rupture = surgery and NWB for 6 weeks

Rehab focuses on jt protection

Ice, compression, and elevation for pain and swelling

Progressive strengthening

349
Q

What is a high ankle sprain?

A

Occurs when ankle is forced into DF or rotation with foot in WB position

350
Q

What are interventions for high ankle sprains?

A

Immobilization
Limit WB
Surgery

351
Q

What tests can help identify high ankle sprain?

A

Syndesmosis squeeze test

ER test

352
Q

What are interventions for chronic ankle ligament instabilities?

A

Immobilizations for 2-6 weeks

Passive DF/PF exercises

When tolerated add AROM with avoiding PF and inversion

Healing time is longer

Isometric stab exercise in all directions

Manual resistance

Isotonic resistance (with ankle wt)

Isokinetic training

Full ROM with eccentric contraction emphasis

Proprioceptive exercise

353
Q

What are interventions for functional ankle instabilities?

A

CKC resistance, proprioceptive maneuvers, dynamic muscular exercise, and bracing

354
Q

What are subluxing peroneal tendons?

A

Acute or chronic - passive DF with foot slightly ev. Can be misdiagnosed for lateral ankle sprain

Pt complains of posterior ankle pain and popping sensation in lateral ankle

355
Q

What is the intervention for subluxing peroneal tendons?

A

Conservative = rigid cast, NWB for 6 weeks

Surgical repair to correct

356
Q

What are post-op interventions of subluxing peroneal tendons?

A 
Immobilize for a few weeks
WBAT
PF and DF 3 weeks after surgery
ROM initiated 4-6 weeks post-op
General body conditioning while immobilized

As pain, swelling, and strengthen improve DF can be added

Proprioception after mobilization ends

357
Q

What is Achilles tendinopathy?

A

Overuse injury = repetitive microtrauma and overloading tendon

358
Q

What are signs of Achilles tendinopathy?

A

Localized pain to midportion, distal 3rd, and insertion to calcaneus

359
Q

What are risk factors to Achilles tendinopathy?

A

Decreased vascularity, malalignment of rearfoot or forefoot

360
Q

What are extrinsic factors contributing to Achilles tendinopathy?

A

Running-surface changes, poor or inappropriate footwear

361
Q

What are the interventions for Achilles tendinopathy?

A

Conservative: NSAIDs, progressive exercise, active rest, ice massage, US, and ionto

Flexibility exercise - active DF and progress towards standing heel cord stretch

Eccentric exercise

Rigid cast for severe cases

General body fitness

362
Q

What causes Achilles tendon rupture?

A

Sudden eccentric/concentric contraction of gastroc-soleus

363
Q

What test can help rule in or out an Achilles rupture?

A

Thomphson test

- Squeeze gastroc and look for PF

364
Q

What are interventions for Achilles tendon rupture?

A

Surgical or immobilization for 8 weeks

365
Q

What happens if an Achilles rupture is not surgically repaired?

A

Increased likelihood to rerupture

Loss of power, strength, and endurance

366
Q

What does rehab look like for non-surgical Achilles rupture?

A
  • General body conditioning
  • Aerobic exercise
  • Slow process regaining full DF and PF
  • Progressive exercise using latex band and proprioceptive exercise
  • Assess ROM, strength, pain, and swelling daily
  • Isokinetic test for PF, DF, ROM, strength, power, and local endurance
  • Isokinetic strengthening
367
Q

What does rehab look like post-op for Achilles rupture?

A

Timing, stability, patient variables differ

368
Q

What causes compartment syndrome occur?

A

Tibial fractures, muscle ruptures, muscle hypertrophy, burns, and direct trauma

369
Q

What are the symptoms of acute compartment syndrome?

A

Pain, palpable swelling, tenseness, paresthesias, warm/shiny skin, and tense passive stretching that may produce severe pain

370
Q

What are the symptoms of chronic compartment syndrome?

A

Dull aching in muscle during and after long term exercise and parasthesias may develop

371
Q

What is the intervention for compartment syndrome?

A
  • Fasciotomy within 12 hr
  • Walking as tolerated and PROM to ankle and knee 2 days post-op
  • General conditioning and early ROM
372
Q

What are the types of ankle fractures?

A
  • Lateral malleolar
  • Medial malleolar
  • Bimalleolar
  • Trimalleolar (both malleoli + talus)
373
Q

How is a simple malleolar fracture managed?

A

Immobilization

Other types = surgery

374
Q

What is a diagnostic test PT can do for an ankle fracture?

A

Ottowa Ankle rules

375
Q

What is a distal tibia compression fracture?

A

Vertical or axial loads that compress tibia into the talus

376
Q

What is initial tx for distal dibia compression fractures?

A

ORIF, external fixation, or skeletal traction

377
Q

What interventions occur with distal tibia compression fracture?

A

WB activities deferred for 12 or more weeks

General conditioning while immobile

378
Q

What interventions occur after immobilization?

A

Protect articular surface of distal tibia and talus

Recognize that the hardware is at or near jt

Initially NWB and ROM exercise are allowed

Progressive loading with caution

PWB repetitive motion activities

379
Q

What causes calcaneal fractures?

A

Depression fractures caused by falls from a height

380
Q

What are interventions for calcaneal fractures?

A

Conservative or surgical

Early ROM to reduce stiffness

Control pain and swelling

381
Q

What are long term interventions for calcaneal fractures?

A

Isometric PF
Full ROM manual resistance DF and PF
Gait retraining (heel-strike pattern)

382
Q

What causes talus fractures?

A

Falling from a height and landing in crouched position

383
Q

What are some interventions for talus fractures?

A

Closed reduction or ORIF
Immobilization
ROM and supportive measures for pain and swelling

384
Q

What is a stress fracture of the foot or ankle?

A

Partial or complete

Caused by unrelenting stress and force

385
Q

What are common sites for stress fractures of the foot and ankle?

A

Metatarsals, lateral malleolus, os calcis, navicular, and sesamoid bone

386
Q

What are symptoms of ankle and foot stress fractures?

A

Pain - increased with activity and subsides with rest

Occur as a result of continual stress on the bone and/or muscle

387
Q

What is at-risk management for foot and ankle stress fractures?

A

External support

Modification to aerobic exercise

388
Q

What is not-at-risk management for foot and ankle stress fracture?

A

Activity modification, rest and analgesics

Leg, ankle, foot stretching and strengthening

Low impact aerobic exercise

389
Q

What is medial tibial stress syndrome?

A

Musculoskeletal overuse injury

AKA shin splints

390
Q

What are symptoms of shin splints?

A

Tenderness over distal posteromedial tibia caused by inflammation, periosteal inflammation, and injury to tibia bone or muscles

391
Q

How do you grade shin splints?

A

Grade I: after activities
Grade II: during and after activities
Grade III: before, during, and after activities
Grade IV: so significant that no activities can be done

392
Q

What are treatments for shin splints?

A 
Ice or ice massage
NSAIDS
Active rest
Gradual stretching to lower leg
Activity level modified to accommodate pain and dysfunction
393
Q

What is plantar fasciitis?

A

AKA heel spur syndrome

Chronic inflammation of plantar aponeurosis

  • May be degenerative
  • May be related to shortening of gastroc
  • May be related to LB injury

Repetitive microtrauma

394
Q

What are symptoms of plantar fasciitis?

A

Pain along medial border of calcaneus

Pain worse in AM

DF of ankle provokes symptoms

395
Q

What are some interventions to plantar fasciitis?

A

Conservative PT
Active rest, stretching, manual therapy, exercise and ionto
Arch taping or orthotics
ROM and stretching
Local steroids to decrease pain and swelling
ETPS
Surgery = last resort

396
Q

What is pes planus?

A

AKA flat foot

Congenital or acquired

Muscular weakness, laxity in ligaments that support arch

397
Q

What is pes cavus?

A

AKA high arch

Results from neurogenic pathologic process, muscle imbalance, or congenital abnormalities

Complaints of painful calluses and OA change

Tx aimed at pain and shock attenuation

398
Q

What is posterior tibialis tendon dysfunction?

A

Dysfunction of posterior tib tendon

Results from flat foot

Can cause PF

Posterior tib: Originates on osseous memb of fibula and inserts on tibia

399
Q

What are symptoms of posterior tibialis tendon dysfunction?

A

Fallen arch
Hx of injury
Pain in foot
Difficult rising onto heel in SLS

400
Q

What are some interventions for posterior tib tendon dysfunction?

A

Intrinsic Mm exercise - toe curls or marble p/u

401
Q

What is Morton’s neuroma?

A

Ball of nerves between 2nd and 3rd MT

402
Q

What are the symptoms of Morton’s neuroma?

A

Diffuse radiating pain into toes

Occur between 2-3 or 3-4 interspace

Complains of burning, cramping, or catching sensation

403
Q

What interventions are there for Morton’s neuroma?

A 
MT pad
Wider footwear
Softer shoe
Cortisol shot
Surgical excision
404
Q

What is hallux valgus?

A

AKA bunion

Deviation of great toe with soft tissue and bony deformity

Exacerbated by improper foot wear

Pain relieved by modifying footwear

1st MT ext should be assessed

405
Q

What are the interventions for a bunion?

A

Bunionectomy

PT after

406
Q

What is the goal of PT after a bunionectomy?

A

Decrease pain
Improve first MTP ROM
Gait training

407
Q

What are some lesser toe deformities?

A

Hammer toe
Mallet toe
Claw toe

408
Q

What are interventions for lesser toe deformities?

A

Nonop = modify activities that cause pain, wider footwear, softer toe box, and padding

Surgical = followed by PT

409
Q

What is hallux rigiditis?

A

Big toe so rigid = improper gait

Refer to rocker bottom to assist in toe off

410
Q

What is the DVT prediction?

A

Clinical prediction rule

Cluster of tests - 3 or 4 sx/sx

411
Q

What is Homan’s test

A

Forced into DF and if they have major and minor criteria they may have DVT

412
Q

Definition of reliability

A

Extent to which the test or measure is free from error

413
Q

What is intra-rater reliability?

A

Same examiner can repeat test and get similar results

414
Q

What is inter-rater reliability?

A

Between 2 or more people that can repeat the test with similar outcomes

415
Q

What are dichotomous outcomes?

A

Test result is positive or negative

High possibility that two people get the same outcome due to chance alone

416
Q

What is Kappa (K)?

A

Measures amount of agreement beyond what is expected by chance alone

statistic used to adjust for chance agreement

417
Q

What is QUADAS?

A

AKA Quality Assessment of Diagnostic Accuracy Studies

418
Q

What is internal validity?

A

Improved when research design minimizes bias

419
Q

What is external validity?

A

Judged by whether the estimates of diagnostic accuracy can be applied to clinical setting

420
Q

What is a good QUADAS?

A

Greater than or equal to more than 10 yeses = high quality

421
Q

What is the difference between reliability and quality?

A

Reliability is measuring accurately

Quality is measuring what it reports to measure

422
Q

Define sensitivity

A

Probability of a positive test result

423
Q

Define specificity

A

Probability of a negative test result

424
Q

What is PLR+?

A

Ration of positive test result with pathology to positive results without pathology

425
Q

What is NLR?

A

Ratio of negative test with pathology to negative results without pathology

426
Q

What is PPV?

A

Proportion of people with disease of those with a positive test result

427
Q

What is NPV?

A

Proportion of people without the disease with negative test results

428
Q

How to remember sensitivity and specificity?

A

SNout
SPin

As SN increases = SP decreases

Ortho PTA (4 decks)

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