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Therapeutic Exercise > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Concepts of selective tissue tension:

A
  1. pain from soft tissue lesions is provoked by the application of a tensile load
  2. The use of AROM, painful arc, PROM and resisted testing to provide tension
  3. positive test: provocate or alter the symptoms
  4. negative tests as important as positive
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2
Q

contractile tissue lesion will be provoked by:

A
  • active movement in SAME DIRECTION as tissue function; through most if not all ROM
  • Passive movement in opposite direction at EROM
  • Isometric contraction against resistance
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3
Q

inert tissue lesion provoked by:

A
  • active movement in same direction as tissue function at EROM (or painless)
  • Passive movement in the SAME DIRECTION at EROM
  • Isometric contraction non-painful (unless JRF)
  • Need to differentiate capsular/non-capsular
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4
Q

When assessing AROM take note of:

A
  • when and where onset/alter Sx’s
  • patient’s reaction to Sx’s
  • quantity of ROM
  • quality of ROM
  • movement of associated joints
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5
Q

When assessing PROM take note of:

A
  • when/where Sx’s begin
  • alterations in Sx’s
  • pattern of limitation
  • quantity and quality of movement
  • end feel
  • movement of associated joints
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6
Q

TMJ capsular pattern

A

: deviation to the ipsilateral side with opening and protrusion, and limited side glide contralaterally

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7
Q

cervical capsular pattern

A

: extension, ipsilateral lateral flexion and rotation, flexion full but painful EROM

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8
Q

lumbar/thoracic capsular pattern

A

: flexion full and painful, extension and ipsilateral lateral flexion

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9
Q

SC and AC joints capsular pattern

A

pain at extremes of ROM

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10
Q

shoulder capsular pattern

A

ER>ABD>IR

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11
Q

elbow capsular pattern

A

somewhat more limitation of flexion than extension

-early on pro/supination full and painless

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12
Q

distal radioulnar capsular pattern

A

full ROM with pain at extremes of ROM

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13
Q

wrist capsular pattern

A

equal limitation of flexion and extension

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14
Q

1st CMC capsular pattern

A

limited abduction and extension

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15
Q

IP and DIP joints capsular pattern

A

somewhat more limited flexion than extension

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16
Q

SI, syphysis pubis, sacrococcygeal capsular pattern

A

pain when stress falls on the joint

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17
Q

hip capsular pattern

A

gross limitation of flexion, abduction and IR

-slight limitation of extension and little to no limitation of ER

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18
Q

Knee capsular pattern

A

flexion more limited than extension

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19
Q

tibiofibular joints capsular pattern:

A

-pain with contraction of lateral hamstrings, -pain with dorsiflexion

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20
Q

talocrural capsular pattern

A

plantarflexion > dorsiflexion

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21
Q

subtalar capsular pattern

A

limitation of varus ROM

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22
Q

mid tarsal capsular pattern

A

limitation of DF, PF, add, MR

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23
Q

1st MTP capsular pattern

A

marked limitation of extension (slight flexion limitation

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24
Q

2-5 MTP joints capsular pattern

A

limited flexion

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25
Q

2-5 IP joints capsular pattern

A

extension limited

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26
Q

non-capsular patterns

A
  1. ligametnous/partial capsular
  2. internal derangement
  3. extra-articular limitation
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27
Q

ligamentous/partial capsular:

A
  • localized pain with movements that stretch the ligament or portion of capsule
  • some movements will be limited and painful; some movements are normal and pain free
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28
Q

Internal derangement

A
  • intra articular structures (menisci, disc, cartilage, bursa)
  • loose fragment occupies part of joint
  • movement engaging the gragment are limited and painful, others normal (may demonstrate painful arc)
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29
Q

extra-articular limitations

A
  • gross limitation of movement in one direction, combined with full, painless ROM in other directions
  • joint is normal, but overall ROM limited (fibrosis-shortening, edema, inflammation, 2 jt muscles)
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30
Q

knee extension end feel:

A

springy block

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31
Q

spasm:

A

subconscious effort to protect joint structures at consistent point in ROM

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32
Q

guarding:

A

more conscious effort for joint structure protection

33
Q

interpretation of resisted movement strong but painful:

A
  • minor lesion or 1st degree strain

- contraction hurts but damage minimal so no apparent weakness

34
Q

interpretation of resisted movement weak and painful:

A
  • 2nd degree strain (partial rupture)
  • gross lesion
  • contraction hurts and weakness apparent
35
Q

resisted movement interpretation of weak and painless:

A
  • 3rd degree strain (complete rupture)
  • neurological (nerve root/UMN/peripheral)
  • contraction not painful but weakness apparent
36
Q

interpretation of resisted movement of painful on repetition:

A
  • poor arterial patency/intermittent claudication

- not a contractile problem

37
Q

causes of weakness:

A
  1. local contractile lesion
  2. neurological
  3. pain/reflex inhibition
  4. disuse
  5. psychologic (hysteria, anxiety)
  6. serious medical problem
38
Q

what we are assessing with PROM/AROM/RROM and palpation:

A
  • contractile
  • inert
  • severity
  • chronicity
39
Q

assessing with palpation:

A
  • provocation of symptoms
  • swelling (effusion; edema)
  • crepitation
  • tissue defect
  • tissue defect
  • tissue mobility
  • hypertrophy/atrophy
40
Q

localized disc protrusion:

A

localized annular bulge

-mostly posterolateral protrusion (bulging through one part of annulus

41
Q

diffuse disc protrusion:

A

diffuse annular bulge

-multidirectional; general degeneration of disk

42
Q

circumferential annular tears:

A

non-alignment tears in one or more of the annular rings

43
Q

radial annular tears:

A

circumferential annular tears that align with each other, allowing nuclear pulposis movement

44
Q

prolapse disk

A

nuclear material has gone through everything except one last ring, or PLL

45
Q

extruded disk

A

all layers are torn but nuclear material still continuous with rest of the disk

46
Q

sequestrated disk

A

loose fragment of nuclear material of disk

47
Q

risk factors of low back pain:

A
  • poor postures
  • age
  • sedentary lifestyles
  • obesity
  • smoking
48
Q

simple backache:

A
  • 20 to 55 years old
  • lumbosacral, buttocks, and thigh pain (not down the leg)
  • non specific pain
  • mechanical pain
  • patient otherwise in good health
49
Q

causes of mechanical LBP:

A
  1. disk injury
  2. facet joint injury
  3. spondylosis
  4. spondylolysthesis (instability)
  5. spinal stenosis
  6. myofascial injury
50
Q

nerve root pain:

A
  • unilateral leg pain worse than LBP
  • radiates to foot or toes
  • numbness/paresthesia
  • SLR reproduces leg symptoms
  • localized neurological signs
  • can have femoral nerve irritation (not as common as sciatic)
51
Q

Williams Exercises

A
  • flexion
  • posterior pelvic tilt
  • SKTC
  • Bilateral knee to chest
  • partial sit ups
52
Q

McKenzie approach

A
  • flexion postures overly stressful to spine
  • emphasize improved spinal extension
  • maintain overall spinal flexibility
53
Q

postural syndrome

A
  • mechanical deformation

- sx’s better/worse with static, postural changes

54
Q

dysfunction syndrome

A
  • adaptive shortening of tissues and loss of mobility

- pain/symptoms when tissue stretched EROM

55
Q

derangement syndrome

A

-alteration in position and function of intervertebral disk

56
Q

effects of spinal traction:

A
  • stretch mm’s, ligaments, capsules
  • opens lateral IV foramen
  • straightens spinal curves
  • facet movement
  • alters IVD pressure
57
Q

most common spinal level to have spondylosis:

A

L4-5

L5-S1

58
Q

spondylosis effect on L-spine:

A

flattened lordosis

59
Q

ROM presentation with spondylosis:

A

WB ROM less than NWB ROM

60
Q

discogenic symptoms

A
  • local and/or radicular sx’s
  • sx’s greater WB than NWB
  • sit to stand difficult
  • sx’s with cough/sneeze/strain
  • flexion activities most Sx
61
Q

discogenic signs:

A
  1. loss of lordosis
  2. lateral shift
  3. ROM symptoms flexion, then lateral flexion, rotation
    • neurology
    • PA testing
  6. hip EROM sx’s (flexion)
62
Q

segmental instability symptoms:

A
  • catch in back
  • periods of little to no pain
  • back pops/cracks a lot
  • better with dynamic activity versus static
63
Q

segmental instability signs

A
  • reverse spinal rhythm on FB/BB
  • traction spurs
  • diffuse annular bulge
  • increased translation on x-ray
  • subluxed facets
  • encroachment of McNab’s line
  • increased PROM
64
Q

spondylosis:

A

IVD degeneration (DDD)

65
Q

spondylolysis

A

unilateral or bilateral fracture of pars interarticularis region

66
Q

spondylolisthesis

A

anterior slip of vertebrae

67
Q

phase 1 of segmental instability treatment:

A
  • symptomatic treatment
  • rest (bracing; taping)
  • graded mobilization (PA’s, rotation, extension, traction)
68
Q

phase 2 of segmental instability treatment:

A
  • normalize ROM (muscle stretching; mobilization; AROM/PROM)
  • static strengthening
  • general exercise
  • HEP
69
Q

phase 3 of segmental instability treatment:

A
  • continued static strengthening (stabilization exercises)
  • dynamic strengthening
  • functional training (ADL’s, ergonomics)
70
Q

clinical presentation of facet joint dysfunction:

A
  • flexed posture (loss of lordosis)
  • capsular pattern of ROM
  • unilateral PA’s symptomatic
71
Q

clinical presentation of spondylolysthesis:

A
  • excessive lordosis
  • posterior pelvic tilt
  • muscle guarding
  • tight hamstrings
  • pain and limited flexion >extension
72
Q

most common level for cervicap HNP:

A

C5-^, C6-7 more than C4-5

73
Q

intra-foraminal HNP

A
  • most common

- primary sensory changes

74
Q

posterolateral HNP

A
  • near entrance to foramen

- primary motor changes

75
Q

central HNP

A
  • compress cord and/or nerve roots

- myelopathy

76
Q

upper motor neuron myelopathy signs

A
  • diffuse UE>LE weakness
  • ataxic, broad based gait
  • spasticity; clonus
  • decrease sensory below level of lesion
  • hyper DTR’s
77
Q

soft HNP clinical presentation:

A
  • usually younger patient
  • kyphotic posture
  • non capsular pattern ROM
  • compression painful (traction + ?)
  • NWB extension better than WB
  • central vs peripheralization of sx’s
78
Q

hard HNP clinical presentation

A
  • usually middle to older
  • presents like lumbar stenosis
  • kyphotic posture
  • non capsular ROM but extension sx’s
  • compression +, traction improves
  • WB little difference in ROM
  • little centralization possible

Therapeutic Exercise (2 decks)

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