Exam 2 Flashcards
1
Q
Concepts of selective tissue tension:
A
- pain from soft tissue lesions is provoked by the application of a tensile load
- The use of AROM, painful arc, PROM and resisted testing to provide tension
- positive test: provocate or alter the symptoms
- negative tests as important as positive
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
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
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
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
6
Q
TMJ capsular pattern
A
: deviation to the ipsilateral side with opening and protrusion, and limited side glide contralaterally
7
Q
cervical capsular pattern
A
: extension, ipsilateral lateral flexion and rotation, flexion full but painful EROM
8
Q
lumbar/thoracic capsular pattern
A
: flexion full and painful, extension and ipsilateral lateral flexion
9
Q
SC and AC joints capsular pattern
A
pain at extremes of ROM
10
Q
shoulder capsular pattern
A
ER>ABD>IR
11
Q
elbow capsular pattern
A
somewhat more limitation of flexion than extension
-early on pro/supination full and painless
12
Q
distal radioulnar capsular pattern
A
full ROM with pain at extremes of ROM
13
Q
wrist capsular pattern
A
equal limitation of flexion and extension
14
Q
1st CMC capsular pattern
A
limited abduction and extension
15
Q
IP and DIP joints capsular pattern
A
somewhat more limited flexion than extension
16
Q
SI, syphysis pubis, sacrococcygeal capsular pattern
A
pain when stress falls on the joint
17
Q
hip capsular pattern
A
gross limitation of flexion, abduction and IR
-slight limitation of extension and little to no limitation of ER
18
Q
Knee capsular pattern
A
flexion more limited than extension
19
Q
tibiofibular joints capsular pattern:
A
-pain with contraction of lateral hamstrings, -pain with dorsiflexion
20
Q
talocrural capsular pattern
A
plantarflexion > dorsiflexion
21
Q
subtalar capsular pattern
A
limitation of varus ROM
22
Q
mid tarsal capsular pattern
A
limitation of DF, PF, add, MR
23
Q
1st MTP capsular pattern
A
marked limitation of extension (slight flexion limitation
24
Q
2-5 MTP joints capsular pattern
A
limited flexion
25
2-5 IP joints capsular pattern
extension limited
26
non-capsular patterns
1. ligametnous/partial capsular
2. internal derangement
3. extra-articular limitation
27
ligamentous/partial capsular:
- 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
28
Internal derangement
- 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)
29
extra-articular limitations
- 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)
30
knee extension end feel:
springy block
31
spasm:
subconscious effort to protect joint structures at consistent point in ROM
32
guarding:
more conscious effort for joint structure protection
33
interpretation of resisted movement strong but painful:
- minor lesion or 1st degree strain
| - contraction hurts but damage minimal so no apparent weakness
34
interpretation of resisted movement weak and painful:
- 2nd degree strain (partial rupture)
- gross lesion
- contraction hurts and weakness apparent
35
resisted movement interpretation of weak and painless:
- 3rd degree strain (complete rupture)
- neurological (nerve root/UMN/peripheral)
- contraction not painful but weakness apparent
36
interpretation of resisted movement of painful on repetition:
- poor arterial patency/intermittent claudication
| - not a contractile problem
37
causes of weakness:
1. local contractile lesion
2. neurological
3. pain/reflex inhibition
4. disuse
5. psychologic (hysteria, anxiety)
6. serious medical problem
38
what we are assessing with PROM/AROM/RROM and palpation:
- contractile
- inert
- severity
- chronicity
39
assessing with palpation:
- provocation of symptoms
- swelling (effusion; edema)
- crepitation
- tissue defect
- tissue defect
- tissue mobility
- hypertrophy/atrophy
40
localized disc protrusion:
localized annular bulge
| -mostly posterolateral protrusion (bulging through one part of annulus
41
diffuse disc protrusion:
diffuse annular bulge
| -multidirectional; general degeneration of disk
42
circumferential annular tears:
non-alignment tears in one or more of the annular rings
43
radial annular tears:
circumferential annular tears that align with each other, allowing nuclear pulposis movement
44
prolapse disk
nuclear material has gone through everything except one last ring, or PLL
45
extruded disk
all layers are torn but nuclear material still continuous with rest of the disk
46
sequestrated disk
loose fragment of nuclear material of disk
47
risk factors of low back pain:
- poor postures
- age
- sedentary lifestyles
- obesity
- smoking
48
simple backache:
- 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
causes of mechanical LBP:
1. disk injury
2. facet joint injury
3. spondylosis
4. spondylolysthesis (instability)
5. spinal stenosis
6. myofascial injury
50
nerve root pain:
- 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
Williams Exercises
* flexion
- posterior pelvic tilt
- SKTC
- Bilateral knee to chest
- partial sit ups
52
McKenzie approach
- flexion postures overly stressful to spine
- emphasize improved spinal extension
- maintain overall spinal flexibility
53
postural syndrome
- mechanical deformation
| - sx's better/worse with static, postural changes
54
dysfunction syndrome
- adaptive shortening of tissues and loss of mobility
| - pain/symptoms when tissue stretched EROM
55
derangement syndrome
-alteration in position and function of intervertebral disk
56
effects of spinal traction:
- stretch mm's, ligaments, capsules
- opens lateral IV foramen
- straightens spinal curves
- facet movement
- alters IVD pressure
57
most common spinal level to have spondylosis:
L4-5
| L5-S1
58
spondylosis effect on L-spine:
flattened lordosis
59
ROM presentation with spondylosis:
WB ROM less than NWB ROM
60
discogenic symptoms
- 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
discogenic signs:
1. loss of lordosis
2. lateral shift
3. ROM symptoms flexion, then lateral flexion, rotation
4. + neurology
5. + PA testing
6. hip EROM sx's (flexion)
62
segmental instability symptoms:
- catch in back
- periods of little to no pain
- back pops/cracks a lot
- better with dynamic activity versus static
63
segmental instability signs
- 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
spondylosis:
IVD degeneration (DDD)
65
spondylolysis
unilateral or bilateral fracture of pars interarticularis region
66
spondylolisthesis
anterior slip of vertebrae
67
phase 1 of segmental instability treatment:
- symptomatic treatment
- rest (bracing; taping)
- graded mobilization (PA's, rotation, extension, traction)
68
phase 2 of segmental instability treatment:
- normalize ROM (muscle stretching; mobilization; AROM/PROM)
- static strengthening
- general exercise
- HEP
69
phase 3 of segmental instability treatment:
- continued static strengthening (stabilization exercises)
- dynamic strengthening
- functional training (ADL's, ergonomics)
70
clinical presentation of facet joint dysfunction:
- flexed posture (loss of lordosis)
- capsular pattern of ROM
- unilateral PA's symptomatic
71
clinical presentation of spondylolysthesis:
- excessive lordosis
- posterior pelvic tilt
- muscle guarding
- tight hamstrings
- pain and limited flexion >extension
72
most common level for cervicap HNP:
C5-^, C6-7 more than C4-5
73
intra-foraminal HNP
- most common
| - primary sensory changes
74
posterolateral HNP
- near entrance to foramen
| - primary motor changes
75
central HNP
- compress cord and/or nerve roots
| - myelopathy
76
upper motor neuron myelopathy signs
- diffuse UE>LE weakness
- ataxic, broad based gait
- spasticity; clonus
- decrease sensory below level of lesion
- hyper DTR's
77
soft HNP clinical presentation:
- usually younger patient
- kyphotic posture
- non capsular pattern ROM
- compression painful (traction + ?)
- NWB extension better than WB
- central vs peripheralization of sx's
78
hard HNP clinical presentation
- 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
