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Musculoskeltal I > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

intra-articular fracture

A 
within the joint
K wire (Kirshner wire for temporary repairs)
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2
Q

green stick fracture

A

incomplete fracture often seen in children

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3
Q

avulsion fracture

A

tendon pulled bone away, common in fingers

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4
Q

compression fracture

A

bones press together (Elderly) typically in the vertebrae

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5
Q

monteggia fracture dislocation

A

dislocated radial head

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6
Q

glaeazzi fracture dislocation

A

dislocated distal radioulnar joint

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7
Q

colle’s fracture

A

FOOSH, distal radius fracture, dorsal displacement

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8
Q

smith’s fracture

A

FOOSH, distal radius fracture, volar displacement

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9
Q

barton’s fracture

A

can be FOOSH, distal radius fracture, dorsal or volar displacement, also has dislocation so more severe

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10
Q

carpal fractures

A

less common than distal radius fractures

scaphoid fracture is most common, 90% occur due to FOOSH

then lunate and triquetrum

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11
Q

metacarpal fractures

A

neck of 4th and 5th (boxer’s) metacarpal is most common

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12
Q

elbow fracture

A

most common: radial head fracture- caused by a valgus force on the forearm
olecranon- can be caused by passive flexion of the arm and forceful contraction of the triceps causing an avulsion fracture

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13
Q

humeral fracture

A

radial nerve injury often
humeral neck fracture- impacted: common in elderly women with osteoporosis after a fall on hand transmits force up the extended arm
non-impacted: more common after trauma in younger adults

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14
Q

clavicle fracture

A

caused by FOOSH that transmits force up the arm to the clavicle
more common in children because smaller clavicle

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15
Q

carpal fractures tx phases

A

(thumb spica cast for carpal)
phase I: edema control, immobilization
phase II: AROM with some splinting
phase III: increase strength

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16
Q

principles of fracture management: 3 R’s

A

Recognition: identifying fractures, using imaging and palpation
Reduction: installing plates, casts, fixation
Retention: healing rates (young vs old), edema and pain control, immobilization, restoring ROM

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17
Q

goniometer placements

A

Axis— close to joint
Stationary arm— does not move
Moving arm— moves

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18
Q

rotary force

A

Occurs around a center axis, Rotating objects change orientation during motion, Two points moving in a circle move at different speeds, the
point further away from the center moves faster than the point closer to the center

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19
Q

linear force

A

Occurs along a straight line, Linear motion keeps its original orientation through the movement, Two points in a segment moving a line from one place to another move at the same speed.

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20
Q

active rom (AROM)

A

active muscle contraction moving joint

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21
Q

active assist rom (AAROM)

A

muscle actively move the joint, but external assistance is required (therapist or strap)

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22
Q

passive rom (PROM)

A

no muscle contraction while the joint is passively moved by either a therapist or external equipment
OT doing all the work

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23
Q

passive stretch

A

passive over-pressure to a joint to reach end range
Moving the joint past its end range
OT helping stretch further

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24
Q

scaption

A

30-45 deg in front of coronal plane; Congruency of humeral head and glenoid fossa; where people are successful
- about halfway between shoulder flexion and shoulder abduction

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25
Q

arches of the hand

A

transverse arch curves from radial to the ulnar side of the hand

longitudinal arch from wrist to fingers

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26
Q

wrist and hand mobility

A

prolonged hold/joint mobilization increase ROM promoting capsular mobility
distal carpal row is immobile while mobility occurs at proximal carpal row

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27
Q

intrinsic hand muscles

A

(18) muscles that begin and end within the hand

Intrinsics are stabilizers and balance motions
Lumbricals flex MCP joints and extend IP joints

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28
Q

intrinsic plus and minus

A

Intrinsic plus: immobilize the hand into a safe position for healing
Approximately 60-90 degrees flexion

Intrinsic minus: making a claw
Extensor digitorum hyperextends the MCP joints and simultaneously flexes the IPs with profundus
Happens when interossei and lumbricals are not working

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29
Q

extrinsic hand muscles

A

(18 tendons) muscles that terminate in the hand but have muscle bellies in the forearm

they cross the wrist and flex and extend the digits

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30
Q

mobile rays of hand

A

thumb, ring, and small digit metacarpals

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31
Q

fixed rays of hand

A

index and long fingers metacarpals

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32
Q

flexor tendon pulley system

A

annual pulleys and cruciate ligaments prevent the extrinsic digit flexor tendons from bowstringing
annular pulleys (5) in each finger
A1-A5 → prevent bowstringing
3 cruciate ligaments (C1-C3)
prevents outer sheath from collapsing
positioned around the flexor digitorum profundus and superficialis

33
Q

extensor mechanism (mx and function)

A

lumbricals, interossei, and extensor communis

function: to safely extend digits, provide shortcuts for extensor tendons across joints, permits full flexion

3 bands: 2 lateral and 1 central

34
Q

primary wrist flexors

A

flexor carpi ulnaris and radialis

35
Q

primary wrist extensors

A

extensor carpi ulnaris, extensor carpi radialis longus and brevis

36
Q

measures for intrinsic tightness

A

Bunnell test: if the mcp is extended and you do passive pip flexion and it’s limited, but if you switch to flexion for both and it’s better that tells you there is intrinsic tightness (table top)
positive test finding for PIP restriction: increased PIP flexion with MCP flexion (implies intrinsic restriction)
full PIP flexion with MCP extension is a normal test finding

37
Q

measures for extrinsic tightness

A

digit extension increases as wrist moves towards flexion, or digit flexion increases as the wrist moves towards extension due to tightness at extrinsic wrist flexors
hold a fist, extend their wrist and then have them drop out of their fist and if they have trouble with it, they have issues with extrinsic extensor tightness

38
Q

grip strength

A

Measure on dynamometer

3 times and take average

39
Q

pinch strength

A

Chuck pinch – two fingers on top, thumb on bottom
Lateral pinch – a scissor grasp with the thumb on top and lateral border of the index finger on the bottom
Tip to tip – tip of index on top, tip of thumb on bottom

40
Q

edema measures

A

Skin creases
Volumetric
Putting hand in water to measure difference in water volume
Girth/circumference

41
Q

peripheral v nerve root injuries

A

Peripheral nerve injury: decreased sensation in the peripheral pattern; decreased strength in specific peripheral nerve muscle innervations
Nerve root injury: dermatomal patterns of decreased sensation; myotome patterns of decreased strength

42
Q

sunderland 1st degree

A

disruption: intact axon and preserved structures
prognosis: full recovery in days to week
therapy: short term, focused
tx: observe, conservative

43
Q

Sunderland 2nd degree

A

disruption: disrupted axon with intact endoneurium
prognosis: variable recovery, worse with proximal injuries
therapy: short term/moderate
tx: surgical or conservative intervention

44
Q

sunderland 3rd degree

A

disruption: endometrium disrupted with perineum intact
prognosis: 60-80 recovery, incomplete
therapy: moderate
tx: surgical may be required

45
Q

sunderland 4th degree

A

disruption: endometrium and perineurium disrupted and epineuruem intact
prognosis: nerve grating required
therapy: long term comprehensive
tx: surgical intervention

46
Q

sunderland 5th degree

A

disruption: loss of nerve trunk continuity, complete disorganization/transection
prognosis: nerve grating required
therapy: long term comprehensive
tx: surgical intervention

47
Q

capsular patterns and related conditions

A

predicted loss of motion;
limited movement in a joint specific ratio

Arthritis: inflammation when the entire capsule is involved

glenohumeral: more limited ER, abduction, IR (In order)
elbow: more limited flexion
distal radioulnar: full ROM with pain at extreme ends
wrist: flex/ext limited

48
Q

non capsular patterns

A

Limitation of ROM that do not involve the entire capsule/joint
ex) ligament adhesions

gleno: acute deltoid bursitis
elbow: internal derangement
wrist: subluxated capitate bone

49
Q

clinical reasoning process

A

initial referral → additional information → check: occupational profile performance, occupational tasks, activities, component performance → problem definition → patient and OT understanding roles → treatment selection → treatment → reevaluating → treatment modification → discharge planning → treatment termination

50
Q

ADL

A

bathing, showering, toileting, dressing, eating, feeding, functional mobility, personal hygiene and grooming, sexual activity

51
Q

IADL

A

care of others, pets, children, communication management, driving and community mobility, financial management, home establishment and management, meal prep and cleanup, religious and spiritual activities and expression, safety and emergency maintenance, shopping

52
Q

spinal curves

A

2 Primary Curves: Thoracic & Sacral / Posterior convexity / Kyphosis
2 Secondary Curves: Cervical & Lumbar / Anterior convexity / Lordosis

53
Q

common causes of lumbar pain

A

spinal stenosis and fractures !!!

others:

spondylosis: nerve root compression
spondylolysis: fracture of lumbar vertebrae
spondylolisthesis: vertebrae slippage
stenosis: narrowing of spinal canal

54
Q

herniation: protrusion

A

nucleus protrudes into ruptured inner fibers of annulus; peripheral fibers intact but a general bulging of the disc occurs

55
Q

herniation: extrusion

A

nucleus penetrates outer walls of the annulus, but the protruding tissue is still connected to the central portion of the disc

56
Q

herniation: sequestration

A

posterior longitudinal ligament is ruptured, and one or more fragments of the herniated material protrude in the spinal cord

57
Q

herniation: schmorl’s node

A

rupture of the disc through the cartilaginous end plate due to a congenital weakness

58
Q

pelvic-spinal movement

A

anterior pelvic tilt = spinal extension

posterior pelvic tilt = spinal flexion

lateral pelvic tilt = scapular elevation in rhythm with the lower side of the pelvis
= scapular depression in rhythm with the higher side of the pelvis

59
Q

spinal-scapular movement

A

extension of spine = adduction of scapula

flexion of spine = abduction of scapula

60
Q

scapulo-humeral movement

A

adduction of scapula = external rotation of humerus
abduction of scapula = internal rotation of humerus
upward rotation of scapula = humeral flexion/abduction
downward rotation of scapula = humeral extension/adduction

61
Q

Identify the order of muscle return following a median nerve surgical repair (proximal to distal innervated muscles)

A

median nerve is medial side of the biceps tendon, proximal to carpal tunnel
the muscles most proximal to the lesion will return first and that muscle’s motion will be first as well
motor return continues proximal to distal
- superficial volar forearm (pronator teres, FCR, palmares longus), intermediate group (FDS), deep group

62
Q

contraindications for performing AROM

A
  • many types of tissue injury and/or treatment
  • cardiac status
    precautions: pain, cognition, movement into end range
63
Q

benefits of AROM

A
  • maintain tissue length, increase circulation, proprioception
  • decrease rate of atrophy
64
Q

benefits of PROM

A
  • preserves soft tissue length
  • prevents contractures
  • allows tissue gliding
65
Q

median nerve injury

A

will not be able to oppose thumb or flex radial 3 fingers, pinky and ring finger will be flexed
(ape hand)

66
Q

ulnar nerve injury

A

will not be able to extend 4th & 5th digits, index & middle will be extended (“claw hand”)

  • crossed finger sign, froment’s, duchenne, claw
67
Q

radial nerve injury

A

wrist drop

68
Q

tenodesis

A

starts with relaxed digits and wrist flexion, active wrist extension results in the digits flexing due to passive insufficiency

69
Q

hutchinson’s fracture

A

(chauffeur’s)

radial styloid fracture

70
Q

distal radius fracture phases

A

phase I: edema and pain control, not moving, some passive movement
phase II: edema control, restore ROM to AROM in wrist, light ADL
phase II: passive stretching, some resistance, strengthening wrist

71
Q

most common UE fracture

A

distal radius

72
Q

slipped disk

A

doesn’t actually slip, vertebra can slide forward due to excessive shear forces

73
Q

Tangential strain (disc)

A

posterior fibers of annulus are stretched to a point of damage (deformation); strain is without tearing

74
Q

strains vs sprains

A

Strains: pulling of ligamentous, capsular, or tendinosis structure without tearing
Sprains: tearing or excessive stretching with microscopic contusion (bruising) or hemorrhage or both

75
Q

types of bone in the vertebral column and their function

A

Trabeculae (spongy) bone supports weight
Covered with cortical bone thickened around the rim where the epiphyseal plates located in the center by the cartilaginous end plate

76
Q

proximal phalanx fracture tx phases

A

Phase I: edema control, immobilize
Phase II: AROM, scar message, gliding exercises
Phase III: PROM and progressive resistance

77
Q

middle phalanx fracture tx phases

A

same as proximal phalanx EXCEPT:

  • special attention to DIP joint function
  • phase II emphasis on FDP blocking and gliding
    phase III flexing into therapy putty, dynamic splinting
78
Q

greatest risk for rupture of disk

A

torque (twisting) with axial compression and bending

Musculoskeltal I (12 decks)

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