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Musculoskeletal > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Capsular patterns

A

pattern of movement restriction in more than one direction with interarticular effusions, swelling, and fibrosis of the joint capsule

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2
Q

non capsular patterns

A

not a problem with the joint

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3
Q

hip capsular pattern

A

limited flexion, abduction, and medial rotation in that order

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4
Q

glenohumeral capsular pattern

A

limited ER, abduction, and IR in that order

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5
Q

knee capsular pattern

A

limited flexion more than extension

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6
Q

likely cause of pain in every motion

A

referred pain (originating from an outside area)

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7
Q

how to test for referred pain?

A

fortin finger test

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8
Q

what does positive fortin finger test point to?

A

S1 joint problems

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9
Q

what does it mean if AROM and PROM do not recreate symptoms?

A

likely not a muscle problem
could be dermatome, myotome, sclerotome

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10
Q

how to assess dermatomes

A

use light touch
evaluation: assess upper and lower extremity and trunk

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11
Q

how to test for muscle function?

A

myotomes

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12
Q

irritation/weakness on only one side could mean

A

chronic irritation of nerve

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13
Q

central lesion

A

pushing towards back and normally on one side

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14
Q

Symptoms of L5 nerve being indicated

A

inability to extend great toe w/ 3/5 strength
inability to walk on heels, foot drop
inability to resist prone knee flexion or prone hip extension, 3/5 strength
only on one side

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15
Q

what other nerves have similar symptoms to L5?

A

L4 or S1

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16
Q

areas of the body to look for pain and weakness and sensation for L5

A

Butt, hamstring, shin, toes

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17
Q

sclerotomes

A

deep somatic tissues innervated by the same vertebral segmental nerve

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18
Q

will musculoskeletal injury cross the midline?

A

no

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19
Q

will a neurological injury cross the midline?

A

yes

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20
Q

superficial injury is more likely

A

referred pain

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21
Q

deeper injury travels?

A

in one direction, less likely to travel

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22
Q

muscle injury pain travels

A

along length of the muscle but doesn’t go through many joints

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23
Q

groin pain is a sign of

A

deep labral tear

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24
Q

what can organ problems cause

A

back pain

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25
Q

when to look elsewhere for cause/ injury

A

cannot reproduce symptoms or relieve pain with AROM, PROM, joint play, or resisted isometric motions

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26
Q

patient red flags

A

unexplained weight loss
malaise
pain and symptoms that dont change with MS tests
MS problem not responding to usual treatment
symptoms out of proportion to injury
night pain, sweats, fever

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27
Q

Cancer warning signs

A

change in bowel/ bladder habits
a sore that doesnt heal in 6 weeks
unusual bleeding or discharge
thickening/ lump in breast or elsewhere
indigestion or difficulty swallowing
obvious changes in wart/ mole
nagging cough or hoarseness

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28
Q

strongest ligament in body

A

iliofemoral ligament

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29
Q

ischiofemoral ligameent

A

limits flexion and extension
superior fibers limit abduction

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30
Q

closed pack of hip joint

A

full extension (20 degrees)
ligaments tightened
not boney congruency

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31
Q

open pack of hip joint

A

flexion, abduction and ER

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32
Q

iliofemoral ligament limits

A

hip extension

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33
Q

psoas major action

A

flexion and lateral rotation of the hip

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34
Q

psoas minor action

A

trunk flexion

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35
Q

iliacus action

A

flexion and ER of femur

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36
Q

rectus femoris action

A

hip flexion
knee extension

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37
Q

lumbar origin nerves

A

L2-L4

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38
Q

local nerve

A

femoral nerve

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39
Q

what does major weakness of glute max look like?

A

leaning back

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40
Q

what does major weakness of glute med look like?

A

hip drop w/ Trendelenburg test

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41
Q

hip flexion ROM

A

120

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42
Q

hip extension ROM

A

20

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43
Q

hip abduction ROM

A

45

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44
Q

hip adduction ROM

A

15

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45
Q

hip internal rotation ROM

A

45

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46
Q

hip external rotation ROM

A

45

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47
Q

coxa vara

A

angle of femoral head is less than 125 degrees

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48
Q

results of coxa vara

A

distal leg shifted medially into adduction
femur adducted
genu valgum (knock knees)

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49
Q

coxa valga

A

angle of femoral head is greater than 140

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50
Q

results of coxa valga

A

distal leg shifted laterally into abduction
femur abducted
genu varum (bow leg)

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51
Q

normal femur angle in hip

A

126-139

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52
Q

coxa valga and leg length

A

coxa valga on one side creates longer leg length
causes genu varum
smaller moment arm
less torque from glutes

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53
Q

coxa varum and leg length

A

coxa varum on one side creates shorter leg length
causes genu valgum
longer moment arm –> mechanical advantage
more susceptible to femoral neck fractures

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54
Q

angle of torsion

A

angle of femoral neck

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55
Q

larger angle of torsion

A

femoral antiversion
head in front of where it should be
internal rotation
knees IR

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56
Q

smaller angle of torsion

A

femoral retroversion
head is behind where it should be
external rotation

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57
Q

results of femoral anteversion

A

greater risk of anterior dislocation
causes pes caves foot if uncompensated
pes plants foot if compensated

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58
Q

results of femoral retroversion

A

increased posterior dislocation risk
causes pes plants foot if uncompensated
pes caves if compensated

59
Q

intracapsular fracture

A

femoral neck

60
Q

extra capsular fracture

A

intertrochanteric
femoral shaft

61
Q

causes of femoral shaft fractures

A

trauma
sports collision
MVA
workplace injury

62
Q

open reduction internal fixation

A

IM nail
IM rod
single fixation
double fixation
plate and screws fixation

63
Q

exercise post femoral shaft fracture

A

start with open chain b/c short lever arm
muscles spastic and inhibited
improve mobility

64
Q

acute treatment phase femoral shaft fracture

A

PROM and AAROM to engagee
isometric exercises will be uncomfy
carry over from opposite side
crutch training
stairs

65
Q

subacute treatment phase femoral shaft fracture

A

50% WB for a couple of weeks
work up to WBAT
progress to AROM
extend against gravity
open chain then work towards closed chain

66
Q

surgical treatment for intertrochanteric fracture

A

ORIF
compression screw- WB sooner
dynamic compression screw

67
Q

PT for intertrochanteric fracture

A

similar
want OP notes
NWB to PWB to FWB

68
Q

femoral neck fracture surgery

A

hemi arthroplasty to replace bone that has died
blood supply at risk (circumflex femoral a. and obturator artery)

69
Q

hemiarthroplasty process

A

femoral half fits into acetabular socket
cemented or uncemented
cut off head and neck that has necrosis and ream it in

70
Q

how long does a hemiarthroplasty last?

A

15-20 years

71
Q

options to hold a hemiathroplasty in place

A

boney ingrowth or cementing

72
Q

bipolar endoprothesis

A

lower rate of acetabular erosion
atmospheric pressure and muscle and capsules hold it in place

73
Q

considerations with bipolar endoprothesis

A

tissues need to head and get muscles strong
more likely to dislocate

74
Q

total hip arthroplasty

A

acetabulum is cut and replaced with a socket
femoral head fits in plastic liner within acetabular component

75
Q

when to do total hip arthroplasty

A

acetabulum is not healthy enough to keep

76
Q

arthritis of the hip

A

wearing down of articular surfaces (cartilage) and uneven weight on surfaces that becomes painful
boney overgrowth around joints and bone spurs

77
Q

what can develop on surface of bone with arthritis

A

cysts, pits, groves, atrophy

78
Q

symptoms of arthritis of hip

A

irritation of bone, atrophy, sclerotic, inflammation, synovium hypertrophies, capsule thickening, shortening and thickening in capsular pattern, spastic muscles, increased vascularity, fibrosis of capsules

79
Q

impacts of hip arthritis

A

painful
development of adaptations that wear down the rest of the kinetic chain

80
Q

PT interventions for arthritis

A

patient education
realistic activities with rest
assistive devices as needed
thermal modalities
joint mobilizations
meds

81
Q

function and treatment of arthritis

A

is functioning okay, then leave it

82
Q

hip osteoarthritis symptoms

A

groin pain
referred knee pain
stiffness
antalgic gait (glute med)
limited hip extension, IR, flexion
muscle weakness (quads, glute med, glute max)

83
Q

functional limitations of hip OA

A

sit to stand
walking
stairs
squatting
in and out of car
dressing

84
Q

PT treatment for arthritis

A

ROM: joint mob, stretching, ROM exercises
muscle strength
independence (ADLs, progressing)

85
Q

posterior approach total hip

A

glute max is divided
ERs released and repaired
posterior capsule released and repaired
most common approach
no damage to abductors

86
Q

anterior approach total hip

A

no muscles cut
access between TFL and RF
more difficult, newer

87
Q

posterior approach hip dislocation precautions

A

no IR
no adduction
no Flexion >90
avoid crossing legs
avoid sitting in low chairs
avoid pivoting on and towards operative leeg
avoid sleeping without abd pillow
avoid donning shoes and socks normally

88
Q

anterior approach hip dislocations precautions

A

no ER
no extension
no flexion >90
avoid combo flex, abduction, ER
avoid crossing leegs
avoid large steps with ambulation
do step to gait
avoid pivoting on and away from operative leg

89
Q

acute care THA

A

hospitalization 2-5days
PT day of or day afteer
abduction pillow in supine
no pillow under knee/thigh
early movement
WBAT or PWB
education

90
Q

acute care exercises THA

A

ankle pumps
deep breathing
bed mobility and transfers
submax isometrics (quads, ext., abduction)
resistance for intact UE and LE
ambulation with assistive device
AAROM of hip
AROM of knee
clamshells
standing hip flex/ext of operative leg
weight shifting
heel raises

91
Q

meds THA

A

NSAIDs
COX 1 and 2 inhibitors (aspirin, Motrin, Advil)
Tylenol

92
Q

discharge criteria THA

A

achieve independent functional mobility
bed mobility
sit to stand
transfer
ambulations with assistive devices
stairs with assistive devices

93
Q

what do special tests tell you in general

A

ligament tests and grading
sensitivity
specificity
clinical predication values

94
Q

ligament stress test grade I

A

0-5mm

95
Q

ligament stress test grade II

A

6-10mm

96
Q

ligament stress test grade III

A

11-15mm

97
Q

ligament stress test grade IV

A

15mm +

98
Q

what to look for during ligament stress test with valgus and varus

A

gaping

99
Q

valgus knee stress test restraints

A

MCL is primary restraint
Medial capsule is secondary restraint

100
Q

when are capsule and MCL tight

A

0 degrees extension

101
Q

when is MCL most tight

A

30 degrees knee flexion

102
Q

Valgus knee stress test in acute stage

A

not very valid because of inflammation and muscle guarding

103
Q

primary restraint is typically?

A

a ligament or group of ligaments

104
Q

secondary restraint is typically?

A

the joint capsular ligaments or capsule itself

105
Q

passive test for ligament stress testing

A

no muscle guarding

106
Q

what to do when there is joint stiffness?

A

joint mobilization (grade 3 sustained or grade 3 or 4 oscillating )

107
Q

positioning for 2 joint muscles

A

put on slack to get more ROM

108
Q

what muscles will be affecting by gravity?

A

weak muscles

109
Q

PT intervention for joint dysfunction

A

mobility and stability first
progress to adding load to improve strength

110
Q

painful joints and ROM

A

will not want to move in passive
end feel is empty

111
Q

how to identify irritated nerve?

A

neural tension tests

112
Q

treatment intervention for irritated nerve?

A

neural mobilization
move joints to allow nerve to go proximal and vital and mobilize the area

113
Q

how to identify soft tissue restrictions

A

palpation

114
Q

how to identify tight muscles

A

ROM affected by proximal or distal joint positioning

115
Q

how to identify intra articular adhesions

A

ROM not affected by joint positioning

116
Q

treatment for tight muscles

A

stretch

117
Q

treatment for soft tissue restrictions

A

soft tissue mobilization

118
Q

special tests are used to

A

assess the integrity of the joint, surrounding structures, and musculature as stabilizers and the patient’s level of anxiety during the injury and the trust of their PT

119
Q

Specificity rule

A

High specificity, rule in

120
Q

ordering of special tests

A

start with high sensitivity to rule things out and then move on to highly specific tests

121
Q

highly sensitive tests are good at finding?

A

patients with a condition
likely to test positive on someone who has the condition

122
Q

sensitivity rule

A

if a high sensitivity test is negative
rule out

123
Q

high specificity is good at picking up?

A

for one certain condition

124
Q

benefits of sensitive tests

A

good to rule things out
easy clinical tests

125
Q

specific tests of high value examples

A

x-ray, MRI

126
Q

PPV

A

positive predictive value

127
Q

what does PPV show us?

A

probability that a person with positive results actually has the condition

128
Q

NPV

A

negative predictive value

129
Q

what does NPV show us?

A

probability that a person with negative results will likely show they do not have the condition

130
Q

why are predictive values useful?

A

to assess feasibility
save time, resources on testing

131
Q

likelihood ratios assess

A

assess the potential utility of a particular diagnostic test
assess the likelihood that a patient has a disease or condition

132
Q

likelihood ratio

A

ratio of the probability that a test result is correct to the probability that the test result is incorrect

133
Q

does LR rely on symptoms?

A

no
it is a stand alone calculation

134
Q

high LR means

A

large and significant increase in the probability of a disease given a positive test

135
Q

do nerves elicit pain with light stimulation?

A

no

136
Q

what happens with compression or stretching of irritated nerves?

A

sharp and shooting pain

137
Q

Slump test

A

gives tension to nerve and DF increases

138
Q

sciatic nerve tests

A

slump test, SLR, Bowstring

139
Q

Bowstring test

A

bend knee and press it into back of knee to reproduce pain

140
Q

SLR sensitivity and specificity

A

91% sensitive- if negative, rule out
26% specificity- if positive, could be due to other reasons

141
Q

what can SLR indicate if ankle DF or cervical flexion increases symptoms?

A

L5-S1 nerve entrapment

142
Q

Positive SLR could be

A

tight hamstrings, weak muscles, nerve damage, posterior joint capsule of hip

143
Q

Tinel’s sign

A

thumping on nerve and having pain at 30 degrees of SLR

144
Q

nerve and vascular compression test groupings

A

carpal tunnel and tinel’s
carpal tunnel and phalen’s
radial and ulnar artery sufficiency, Allen’s

Musculoskeletal (6 decks)

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