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Therax > exam 3 > Flashcards

exam 3 Flashcards

1
Q

dynamic process which body position maintained in equilibrium

A

balance

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2
Q

at rest

A

static

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3
Q

steady state of motion (surface/ person)

A

dynamic

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4
Q

COM / COG is maintain over BOS

A
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5
Q

corresponds to center of total body mass is point where body is in equilibrium

A

center of mass

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6
Q

vertical projection of COM to ground
anterior to S2
55% person height

A

Center of gravity

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7
Q

base of support is perimeter of contact area between body & support surface

wider stance/ increase stability
narrow stance / decrease stability

wide stance can increase rate of falling- need good posture

A
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8
Q

limits of stability LOS
sway of boundaries in which individual can maintain equilibrium w/o change BOS

A
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9
Q

sensory processes are

A

visual
vestibular
somatosensory (proprioception)

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10
Q

sensorimotor intergration
motor response
adaptive / anticipatory of posture control

motor- Conscious- plan program excute balance response

A
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11
Q

sensation (GTO MSF) mechanorecptors
touch pressure vibration

A
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12
Q

contextual / environment
closed predictable - no distractions
open predictable - distractions

support surface
firm vs slippery stable vs unstable
lighting , task - new or learned

A
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13
Q

visual
- position of head to environment
-orientation of head to maintain gaze level
-direction/ speed of head

A
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14
Q

somatosensory
- muscle spindle
muscle length (joint position sense)

GTO muscle tension

joint receptors (muscle tone, stiff, posture adjustment)

skin receptors

A
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15
Q

balance control is visual , vestibular, sensation

A
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16
Q

Vestibular SCCs

-semicircular canals
angular/ rotatory accerelation- fast head movement
* head tilts, motion sick bc body going faster than inner ears can keep up

-otoliths (utricle/ saccule)
linear acceleration- slow head movement
*linear - treadmill , walk pad
* vertical - diving board

A
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17
Q

neuropathy- can’t feel sensation in feet , systems can compensate

A
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18
Q

Vestibulospinal reflex- compensates tilts
vestibulospinal tract- inner ear
helps body adjust for any tilts / changes in posture that body needs

keeps body upright

A
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19
Q

vestibulcular reflex : keep eye stabilize
stabilize head during movements from vestibular nuclei
*keep object in focus

A
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20
Q

fast to slow is

A

somatosensory
visual
vestibular

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21
Q

CNS- turns off / suppress inaccurate input
*selects / combines appropriate sensory input from other 2 systems

A
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22
Q

automatic postural reaction
- change in position , need to respond

A
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23
Q

activation of postural muscles in perform skill movement

  • reach high cup off shelf
    have to get on toes
A

anticipatory balance

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24
Q

movement occur too fast to rely on sensory feedback

*lose balance before fall

A

reactive

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25
Q

infancy some reflexes will intergrate / go away or stay with us

A

pre program

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26
Q

CNS to regain balance after body is perturbed

  • reflex (muscle contract, independent)
    stretch reflex 1st response <70ms and same response everytime
  • autonomic postural reaction
    80-120 ms 1st response to falls
  • Voluntary movement
    80-120ms longest latency , dependent
    produce higher variables , motor outputs (reach for stable support )
A
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27
Q

ankle - distal to proximal
forward- gastro/ hamstring
backward- ant tib/ quad/ abs

hip flex
forward- quad/abs
backward- hamstring

stepping * to catch yourself

Weight shift- Lateral either side to accommodate
- abductors and adductors

A
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28
Q

suspension - during balance task
get lower to lower COM

flex knee- flex hip, ankles

combine w ankle / weight shift

A
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29
Q

sensory input impairment - neuropathies, ankle sprain, lack of joint awareness

sensory processing defects- visual loss, peripheral vision

bio mechanical/ motor deficits- posture aging meds

A
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30
Q

reach to touch, catch lift

A

anticipatory

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31
Q

unexpected perturbation, sway

A

reactive

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32
Q

reduce visual / somatosensory cues

A

sensory

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33
Q

stairs specific is Functional

A
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34
Q

gait locomotion balance is for

A

safety

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35
Q

Tell patient to look at external focus for attention while balancing

A
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36
Q

DLS- double limb support
Eyes open / eyes close

SLS- single limb support
Eyes open/ eyes close

tandem walk- feet have to touch, narrow , anterior to posterior

perturbation- gait belt: back up

proprioception - stable vs unstable
vestibular
static vs dynamic

A
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37
Q

use strength / speed to increase Power

A

plyometrics

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38
Q

stretch shortening drill
high velocity eccentric to concentric activation

A

Plyometrics

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39
Q

time beteeen stretch and shortening should be quick is

A

Amortization phase
*eccentric to concentric

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40
Q

Work produced by muscle per unit of time

A

power

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41
Q

more intense, less time= more

A

power

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42
Q

taking up elasticity energy to create force to move us it enhances
physical performance / decrease injury

easy- difficult
slower progress w rest in between sessions

plyometrics be high function, no injuries

A
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43
Q

48-72 hrs between plyometrics
eccentric to concentric is doms

usually 6 different activities and change Reps/ time

for 2x 8/10 weeks

A
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44
Q

cartilage between bodies and disc

A

intervertebral disc

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45
Q

synovial joints between superior / inferior articular process

A

zygopophyseal

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46
Q

DJD in common in ____ joints

A

zygopophyseal/ facet / synovial

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47
Q

most anterior ligament
hyperextend injury

A

anterior longitduinal

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48
Q

posterior to anterior longitudinal

A

posterior longitudinal

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49
Q

intervertebral process

A

ligamentum flavum

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50
Q

in between transverse processes

A

intertransverse ligament

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51
Q

most posterior
whiplash
- ligamentum nuchae

A

supraspinous

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52
Q

two structures in intervertebral disc

A

annulus fibrosis
nucleus pulposus

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53
Q

annulus fibrosis- collage rings, compress/ shear forces

nucleus pulposus- fluid filled

A
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54
Q

Plumb line:
head- COG anterior to AO joint

trunk- LOG through Cervical/ Lumbar vertebrae

hip- LOG posteoor to hip joint, through greater trochanter

knee- LOG anterior
ankle- LOG anterior

A
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55
Q

without trunk stabilizing muscles then the spine would ____

A

collapse

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56
Q

superficial muscles are

A

global

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57
Q

deep muscles are

A

core

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58
Q

cross segments
help produce motion: provide guy wire function

Compress load with strong contact

A

Global

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59
Q

Global:
lumbar- rectus abd. obliques. QL. erector spinae. iliopsoas

cervical-SCM. levator scap. scalene. upper trap. erector spinae

A
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60
Q

attach to each vertebrae segment
control segmental motion
segmental guy wire

greater % of type 1 muscle fiber for endurance

A

Core

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61
Q

Core:
lumbar- transverse abd. multifudus. QL. deep rotators

cervical- rectus capitis ant/ lay. longus colli

A
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62
Q

tight hip flex
weak abs
tight trunk ext

Anterior pelvic tilt

A

excessive Lordosis

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63
Q

faulty lumbar poor sitting excessive tip of head

A

forward head

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64
Q

weak abs/ obliques
tight pect
tight trunk ext

A

relaxed slouched posture

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65
Q

excessive flexion, weak trunk ext, tight trunk flex. hip ext

A

flat back

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66
Q

exaggeration of correct posture - military

A

flat neck

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67
Q

protract scapulae
rounded back

osteoporosis / congenital/ postural
pain/ increase thoracic

A

Increased kyphosis posture

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68
Q

abnormal lateral curvature
named for convexity of curve
S curve
right thoracic
left lumbar

A

scoliosis

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69
Q

congenital / irresversible scoliosis
posterior rib hump w forward flexion

A

Structural scoliosis

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70
Q

reversible , diminishes w postural changes. stretch concave . strengthen convex . stand tall, pull umbilical towards spine

A

functional / postural

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71
Q

convex -
concave -

A

strengthen
stretch

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72
Q

sitting bending forward w weight - 185+
- sitting picking up load is worst pressure

HNP L4-L5 Posterior Lateral
slipped disc - does not slip out, just pushed in certain direction

A
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73
Q

nucleus bulges against intact annulus fibrosis

A

protrusion

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74
Q

hernation; jelly pushing out against annulus within PLL

A

extrusion

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75
Q

hernation; jelly going into spinal canal, leaking

A

Sequestration

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76
Q

long term flexed posture
sustain loading of joint/ disc/ ligament

disc pressure increases - fluid movement
cannot move back into ext bc can cause injury

A

Fluid Stasis

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77
Q

narrowing of spinal canal (central stenosis)
nerve root canal or forman (lateral stenosis)

congenital / acquired
caused by soft tissue structure / fibrotic scars

ext motions increase symptoms

A

spinal stenosis

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78
Q

vertebral degeneration of OA of spine

A

Spondylosis

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79
Q

pars interarticularis fx “scotty dog”

A

Spondylolysis

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80
Q

can occur as Spondyloylosis

anterior slippage of vertebrae onto the one directly below bc fracture

A

Spondylolis

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81
Q

Neck; 66% of population affected by cervical spine
women affected more than man
results in quadriplegic

acute strains/ sprains- Whiplash (extreme flex / ext)

A
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82
Q

compression of nerve root with numb, tingling, pain in UE
disc hernation / spondylosis

peripheral pain/ cervical scap pain

reduce pain / swell, control muscle spasm, centralize symptom

A
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83
Q

facets stick together
not in alignment
can do mob to get into alignment

cricks can be impingement

A

cervical facet syndrome

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84
Q

partial/ fall removal of lamina in order to relieve pressure form disc protrusion/ stenosis

A

laminectomy

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85
Q

-spinal stenosis
- pinched nerve
can be by

A

laminectomy

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86
Q

due to pain/ instability/ OA
reduces mechanical stress, eliminates segmental motions

cause hyper mobility

eliminate hyper mobility

A

Fusions

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87
Q

faulty posture
TMJ dysfunction
allergies / sinuses
vascular / hormonal headaches (Migranes)

A

Tension/ cervical headache

88
Q

chin tuck is

A

capital flexion
cervical extension

89
Q

direct contact (contusion activities)
or indirect (overstretch/ contraction of thoracic muscles) - control pain/ swell

treat as acute injury

A
90
Q

activating muscles to pull bones (ribs) back into place

A

muscle energy technique

91
Q

traumatic / insidious onset localized pain to region may include radiopafbg

relived with rest/ off loading joint
- muscle energy techniques
- core stabilization
- high velocity thrust- not covered leg pull

work on stabilization

A
92
Q

most common in thoracolumbar from sudden compression, fall/ trama doing ADLs
losing bone mass
plopping down

low back pain/ ab pain w/o radiopathy
thoracic kyphosis (dowagers hump)
pain dictates exercise level - avoid flexion
surgical intervention- Vertebroplasty

A
93
Q

compression fx more female elderly bc

A

osteoporosis

94
Q

flexion opens up more

A

space

95
Q

Fracture- realign and stabilize / close space

ankylosing spondylitis- ossification of soft tissue around spine. joints fused. ALL and PLL facet joints

pain in SI/ thoracolumbar/ shld/ foot

A
96
Q

making area more hupomobile
more acceptable to fx
in flex, shift position

A

ankylosing spondylitis

97
Q

rare congenital weakening of vertebral endplated
T10-T12

nucleus pulposus protrudes vertically into vertebral end plates cause bony necrosis (schmoris nodes)

vertical instead of ant/ post
seen in teens/ growing pains

A

Scheurmanns Disease

98
Q

increasing in surface area

A

peripheralization

99
Q

recede up leg/ arm and become localized
ask pain location/ level of pain prior to intiate fx

A

centralization

100
Q

increases size of forman
decrease nerve root irritation
to create more space

  • spondylosis- OA within spine
  • spinal stenosis - narrow spinal canal
  • extension load injures
  • facet joint inflammation
  • ext posture w increased spinal lordosis

Williams flexion: pelvic tilt- mobility not strength
single / double knee to chest
partial sit up

A

flexion bias

101
Q

closing space
HNP
intervertebral disc lesion
flexion injury
flexed postural dysfunction
fluid status - fluid stagnant there
vertebral compression fx
flex posture / lat devation posture

Mckenzie:
prone lying 5 to 10 min
prone on elbows 5 to 10 min
prone press ups 10x
standing extension hold for 20sec

A

extension bias

102
Q

spinal instability
hyper mobile
muscle ligament laxity
spondylolisthesis - anterior vertebral slippage
spondylolysis- pars articularis fx
excessive lordosis , prefer ext posture to relieve pain

activate TA/ multifuids

rectus abdomins/ erector spinae like to take over

A

stabilization

103
Q

forward head doing

A

capital extension and cervical flexion

104
Q

ext mob- up towards you
lat flex mob- push from same side
rot mob- horizontal / upwards

for good posture do an anterior pelvic tilt

segmental/ cat cow- each vertebrae moving at once

thread the needle- rotational thoracic
reach opp and pull arm up

open the book
foam roller/ ball- side stretch Scolosis

thoracic roller/ foam roller parallel with spine retract/ protect

A
105
Q

P AM I Add
displace posterior : anterior medial force : ipislateral: resist horz add

A PL C Abd
displace anterior: posterior lateral force: contra lateral : resist horz abd

A
106
Q

myelopathy affects the entire spinal cord. In comparison, radiculopathy refers to compression on an individual nerve root.

A
107
Q

Hip- decrease flexibility from WB forces form hip joint up into spine/ down into knee

tight hip ext, increase lumbar flex, when thigh is flexed

muscle weakness/ imbalance - increase stress being transferred to other joints
* affected by strength, length, proprioception, neuromuscular facilitation

A
108
Q

weak hip abd
IT band takes over

A

patellofemoral impairment

109
Q

weak hip ext during loading

A

ACL strain

110
Q

weak hip ext and abd lead to overuse piriformis

A

Piriformis syndrome

111
Q

APT slouch back/ flat back/ overuse IT band at knee , trochnateric buristis

A

Short TFL / Glute max

112
Q

TFL can take over Glute med
two joint hip flexor over iliopsoas

hamstring over glute max
lateral trunk over hip abd
unilateral short leg

coxa valga +125
coxa vara -125

A
113
Q

genu valgum knock knees and short limbs is

A

coxa vara

114
Q

genu varum bow leg and leg length discrepancy with wider side being longer

A

coxa valga

115
Q

ankle beteeen shaft and neck of femur

A

Coxa vara / valga

116
Q

rotated in too much cause toe in
increased angle 35+

A

anteversion

117
Q

rotated out too much cause for out
decreased angle 10-0

A

retro version

118
Q

angle at torsion at head and neck of femur

A

anteversion/ retro version

119
Q

sciatic nerve compression, acute/ enlarge piriformis
course of sciatic nerve , pain in butt with sitting/ radioculopathy
RO lumbar spine and SI
stretch piriformis

SI- Fabre test is hip flex / abd/ ex rot
thomas and ely

A
120
Q

osteoarthritis / RA/ Fx/ pain, no walking, JRA. decrease in ADL
no flex past 90, no add past midline, no joint in rot

posterior lateral approach
femoral head w acetablum cup replaced

most common/ Cemented

A

THR

121
Q

allow gone stock to grow into place
younger and more NWB time

A

Uncemented

122
Q

glued in place

A

cemented

123
Q

THR will have thigh pain, Anatalgic gt- limp

loosing of hardware 10-40% by 10 yes
profascility - ahead of time decrease risk of clot of Blood thinners

Thromboembolic disease- clot do muscle pump and get OOB

dislocating 1-4% (hardware/surgery/fixation/ patient compliance)

A
124
Q

avoid hip add / in rot / flex past 90

A

posterior lateral and lateral

125
Q

avoid hip add / ex rot/ hip ext

A

anterior approach

126
Q

procedure is replacing head of femur and replacing socket of pelvis acetablum

A
127
Q

signs of loosening/ ORIF
- constant pain / increase WB
- surgical leg shorter than others
- persistent ER of limb
- positive trendelenburg that doesn’t get better

A
128
Q

MAX PROTECT THR
rice mods joint mobs 1&2
isometrics at hip
ROM of hip w precautions
ROM at ankle knee pelvis
balance seated if WB
gait wb status and Ad train
assess incision
education on precautions / procedures
bed mobility / transfers

ankle pumps quad sets / Glute sets

active knee flex not beyond 90 AAROM

A
129
Q

to move to mod phase must

A

decrease pain and inflammation

130
Q

MOD THR
arom of hip w precaution
open chain - isolate glute med
stretch TFL to not compensate
closed chain- overall
check incision- scar mobilization
gait train w WB status treadmill
have to keep up w speed so no limb (3.0)
joint move 3/4 w no precautions

A
131
Q

to move to Min phase must be

A

full ROM no pain

132
Q

MIN THR
12-16 weeks after surgery
functional activities stairs w weight
plyomeyrics
discontinue hip precautions
max resitsnace exercise - med ball slams (picking up kids)
PLOF activities

A
133
Q

bridge up set pelvis
lay supine and look for malleolus to line up for leg length discrepancy

then look at ASIS supine
then look at PSIS prone
* do they line up or is one side rotated more

PPT- hip flexors (quad)
APT- hip extensors (hamstrings)

A
134
Q

intracaspsular feacture- risk of avascular necrosis bc it cuts off blood supply

extracapsular - great trochanter to lesser

subtrochanteric- malunion, delayed union, non union - poor blood supply

A
135
Q

patients put on blood thinners - 40-90% DVT w/o Prophylatic meds
ORIF- rods screws plates
THA- total hemi arthroplasty

hip fractures are most common in elderly women bc osteoporosis

A
136
Q

lesser trochanteric fx- less common common in adolescents treatment depend on amount of fragment displacement

surgery required for more than 2cm

A
137
Q

dislocations fx or isolated event
ant/ post

anterior avoid Abd and ex rot
posterior avoid Add and in rot and flex

A
138
Q

hemi arthroplasty is just changing of femoral head

itis- do eccentric training stretch while strengthen

A
139
Q

MAX HIP FX
strengthen surround areas
Prom
wound care check incision
isometrics
NO SLR AND SUPINE GLUTE BRIDGE
dislocation restriction
rice mods balance aerobic
transfers gait train AD
education - piccolo
wb restriction

A
140
Q

MOD HIP FX- 6 to 8 weeks
Arom
resistance, gt, train AD
PRE
strengthen hip/ knee
stretch balance / aerobic

A
141
Q

MIN
functional ADLs w resistance
plyometrics
aerobic / balance

A
142
Q

fracture ischial tuberosity need surgery
risk of malunion and pain

stable -AVULSION fx non surgical
where muscle is inserted
don’t strengthen at tissue
muscle tears away pieces of bone

Unstable/ rotational unstable - rotational and vertically unstable

A
143
Q

Legg Calve Perthes Disease LCP
coxa plans at WB
flattened femoral head/ acetablum
disrupts a vascular necrosis

young boys- DJD

treatment-Put femoral head into acetablum for abduction position

A
144
Q

Bursitis: fluid filled sac that absorbs / prevents friction

can inflame bursa
strains / contusions - bruise form hit

A
145
Q

______ bursitis is excessive compression/ repated friction as IT hand snaps over bursa superior - greater trochanter

Obtubers stretch ITB
hams quad add - strengthen & stretch wo stress

Rest TFL bc ITB

A

Trochanteric bursitis

146
Q

________ bursitis is pain or radiating in anterior thigh caused by overextension or tight hip flexors
stretch ham/ add/ ITB
Strengthen quad

A

Iliopectinal

147
Q

_________ bursitis pain over ischial tiberosity under glute max (tailor/weaver)

Contusion/ extended sitting

will mimic hamstring strain
pinpoint ischial tuberosity to see

stretch hams ; strengthen Quad

A

Ischial (ischiogluteal)

148
Q

__________strain is sudden force contraction by decelerating lower leg during running

avoid full knee ext w forward trunk flexion
and full leg flexion - put ham on stretch

= supine sleep with pillow under both knees

A

Hamstring

149
Q

not enough flexibility so it strains
make sure you warm up tissue

plasticity: stretch to get ROM
stretched past range - strain elasticity

A
150
Q

________ muscle strain adductor longus
avoid stretching
pain subsides active hip flex/ abd/add

A

Adductor

151
Q

_________ muscle strain hip flexor pull
extreme hip ext by forced hip flex
against resistance

Avoid hip ext, slow static - hurdler stretch

A

iliopsoas

152
Q

Contusion with ________ hit to iliac crest from ext force

rest no WB/ avoid stress/ rice

A

Hip pointer

153
Q

Tramua , larval impingement, laxity in capsule dysplasia ,

catching of tear between femoral head and acetabulum

clicking/ locking groin pain for Ant tear and butt pain for post tear

A

impingement

154
Q

Toe in, large angle is

A

Antervsion

155
Q

Toe out, smaller angle is

A

Retro version

156
Q

Symmetry of SI TEST
toward bend test
touch toes

shot gun - leg length dis. / pubic symphysis

A
157
Q

ANTERIOR ROTATED
supine to sit
supine- leg longer
sit - leg shorter

POSTERIOR ROTATED
supine to sit
supine- leg shorter
sit- leg longer

A
158
Q

MET- Activate hamstring on Ant rotated and have them push against hand/ shoulder into PPT

MET - Activate iliopsoas on Post rotated and have them pull against hand / shoulder into APT

A
159
Q

Anterior rotation can also be prone and pull quad up then push down

Prone push outward on ASIS for hypomobile

PRESS ON ASIS FOR POSTERIOR TILT IT OPENS SPACE

PRESS ON SIDE OF ASIS FOR ANTERIOR TILT TO CLOSE SPACE

piriformis syndrome- strengthen glute max

A
160
Q

anterior rotated - push with hand on hamstring to bring it back neutral

posterior rotated- push with hand on thigh to bring it back neutral

A
161
Q

knee 130 flexion- soft tissue
O extension - important for WB
stairs- 80/90
sitting-90
walking-60
high activities - 115

knee flexion- concave tibia on convex femur

ext lag- amount of ext actively vs passively

A
162
Q

Total knee arthroplasty - removing femoral condyles/ replace

shaving tibia plateau and replace
cut patella sometimes / replace

unicomparent- femoral condyle
Most common is bicompartment/ fem con/ tibia plateau
tricomparyment- fem con/ tib pla/ patella

A
163
Q

increase mobility , decrease pain, got stability/ realign

Constrained- get surfaces close together and take out ACL PCL and get stability - more stable , less mobility

ligaments stabilize knee while moving

usual should be Semi Constrained
- get rid of ACL/ keep PCL balance between stable and mobile

non constrained- save PCL ACL or replaced

cemented - cement pieces together/ more WB

uncemented- porous/ wanting bone to grow in PWB NWB

A
164
Q

contraindication- osteoporosis not enough bone stalk for strength
obesity cormobities for surgery (heart disease , circulatory )

neurological dysfunction: complication- contracture infection neuroma

more people have harder time in Ext

A
165
Q

fractures : immobilization, restrict WB, ORIF, mal union / non union —

soft tissue injury
epipsheal fx - change in growth plate Kids

patella fx- linear break can fixate can be vertical break
direct not to patella / falls possible necrosis
might have limit flexion

A
166
Q

patellar tracking- soft tissue injury, train VMO bc imbalance
ITB syndrome pulls patella lateral from overuse or tight

Q angle ASIS to middle patella 13-19
females wider - cause pull bow string affect
middle patella to tibial tuberiostu

A
167
Q

miserable mal alignment- femoral anteversion, proximal ext rot of tibia
int rot of femur

A
168
Q

ORIF
TKR
max phase:
prom
quad flute ham sets
patellar mobilization
strength train above / below
hamstring stretch
gait 60 flex
cardio

can stretch strengthen just not involved tissue

A
169
Q

MOD
PRE QUAD
stretch
JM
gait
walk - cane - none transfer
scar mobilization
hep

A
170
Q

MIN
functional adl’s cardio endurance

A
171
Q

High Tibial Osteomy- VARUS knock knees, inward rotation

taking piece of bone out & put wedge in there to make stable.
delays getting TKA

A
172
Q

lateral tracking: fire VMO
strengthen Hip Abd/ Ext/ ER
saq- TKE quad insufficiency

3 levels of SLR w 45 hip ER toe out
patellar mobilization/ taping

valgus with wb
MAX- SLR & SAW
mod - strengthen abd/ ext/ er

A
173
Q

Patellar tendonitis- front knee pain (overuse of extension of patellar tendon)
LE PAIN FREE CLOSED CHAIN ONLY

hip condition : SLR w profess resist / hamstring stretch / balance / endurance / aerobic / skill

IT BAND SYNDROME: runners / leg length discrepancy Obers
lateral side pain; overdue of IT
transition to ITB at 30 knee flexion , strengthen IT / hip and

A
174
Q

Osgood Schlatters 11-18 males more
growth spurt
stress of quad contraction / avulsion fx at tibial tuberosity

pain with run : jump : squat RICE & quad stretch

Plica- peripatellar thickening of synovial tissue
tender to touch, trama caused or patella tendonitis
medial to patella - alar ligament
suprapatellar plica
inferior plica

A
175
Q

Bursitis inflammation in synvoial fluid filled sacs excessive motion/ infection

Pes anserinus - runners
deep to sartorius / gracilis / semitendinous

Pre patella - housemaids superficial to patella

Posteromedial -meniscal tear
deep to gastro and semimembranous

stretch hams / quads ,compress

A
176
Q

Non operative rehab of Ant Knee Pain
strengthen : sub max isometrics
VMO stabilize and superior medial

Stretch tight lateral structure
stretch hams / IT band
closed chain/ shallow step up

Quad strength use open chain
hamstring stretch / strengthen

Wb balance

A
177
Q

Postoperative Proximal distal realignment
establish ext function/ reduce patellofemoral force

A
178
Q

Meniscus: shock absorption, transfer load even across area, nurtuon/ lubrication

collagen type I , extension of tibia
Catching with meniscus
younger active
5 types of tears
medial / C shape
Lateral Circle
Menisectomy total or menisectomy partial

Younger - longitudinal 50-90%
Older - horizontal

non contact/ knee flexion / compress / shear “lock and catch swell”. or contact

last test- bounce home - blockage with rubbery spring end feel

A
179
Q

McMurray/ medial valgus force with external tibial rotation

lateral varus force with internal tibial rotation

both with Knee extend

A
180
Q

Apley’s distraction > ligament tear
compress > meniscal tear

check for ligament laxity

terrible triaid / acl mcl and medial meniscus

A
181
Q

10-30% repair itself , the rest is avascular / a neural

I red on red - outer 1/3 vascular repairable
II red on white- partial avascular / repairable
III white on white- avascular no repair (menisectomy)

Red on Red meniscal repair (suturing torn meniscus together)

total menisectomy - DJD have to replace

A
182
Q

MENISECTOMY - strengthen quad
it is arthroscopic, Will be WB

do SLS for proprioception awareness and brings surfaces more closer together

A
183
Q

Meniscal repair will be NWB bc suture
increase amount of flexion in brace

Ligament injuries / degree of sprain/ rupture that lead to loss of function

ACL- limits anterior translation of tibia
PCL/ limits posterior translation of tibia
MCL- provides medial stability
LCL/ provides lateral stability

I- microtear stretched
II partial tear start rice
III- complete tear go into surgery

A
184
Q

MCL- direct external force contact from Valgus (lateral side)
no contact/ abduction w rotation
tibia exteranl rot and valgus force on knee

can tear unhappy triad
Acl feeds into medial meniscus so it tears
will feel unstable and gap if tore
do 30 knee flexion

VALGUS STRESS TEST- most sensitive for MCL
avoid valgus / rotational
Valgus MCL
Varus LCL
do SLR and ankle pump

A
185
Q

ACL strengthen quad , stretch hams
non contact tibia external rotated on planted foot
forceful hyperextension

injury: usual no contact / deceleration / closed chain

develop hemartnrosis require arthrocentesis- removal of blood indicates tear

synovial fluid w/o blood - meniscus tear
blood w fat drops/ fx or ligament sprain

intracapsular - cruciate (fluid trapped within capsule)
extracapsular - easy to be removed - collagen rings

Hughston/ 3 degrees of instability
Lachman/ displace ant post femur on knee * gold standard for instability
anterior drawer- like JM
measures anterior translation

Lachman- 25 flex w one hand stabilize bone

A
186
Q

ACL STRNEGTHEN HAMS QUADS IN KNEE FLEX DO GASTRO

Replacement/ hamstring or patellar tendon
autograph - patient own tissue
(patellar tendon)

allograft/ another body (risk disease / infection)

synthetic- high failure (chronic synovitus )

A
187
Q

ACL DO NOT DO OPEN CHAIN TKE
bc it goes through Avascular necrosis
* No LAQ SAQ
ACL: open chain - no full knee extension

PCL: open chain- no full knee flexion

PCL DO NOT DO OPEN CHAIN KNEE FLEX
once it gets to MOD you can do hamstring curl (limit flexion 60-90)

A
188
Q

PCL allows knee not to go into hyperextension
direct force on anterior aspect of flexed knee
Pt falls on flexed knee
landing on tibial tuberosity
forced posterior translation
-hyper flexion of knee
ACL/ PCL involve knee hyperextension w foot planted

Tibia sags if PCL tears
godfrey- supine 90 hip knee flex and tibia will drop posterior

QUAD STRENGTH
use achilles tendon for surgery

MCL- full ext with stability - grade III tear

A
189
Q

IT BAND SYNDROME
SIDE LYING ADDUCTOR WORKOUT
STRENGTHEN GLUTE MED BC TFL DOMINANTS

-banded bridge clams
IT stretch standing / side lying / prone

A
190
Q

ACL
hamstring curls
SLR w cuff
hamstring stretch

Meniscal tear
quad stretch prone w band
band around feet do marches

PCL
leg raise with theraband and around foot then step on it w other foot
-strengthen quad

Prone : thera and around ankle / foot
- hamstring curl
- gastro stretch

A
191
Q

PF/ DF convex over concave
triceps surae- primary PF
insert at calcaneal tuberosity

posterior tibialis- investor / flex digitorum longus/ hallicus
- primary flexor of toe
push off

peroneus/ fibularis longus- brevis primary evertor, PF

anterior tibialis- DF, invertor
ext hallicus longus/ brevis
plantar fascia - helps to support

A
192
Q

Lateral/ Inversion sprain
anterior talofibular
calcaneofibular
posterior talofibular

what motions when injuried?

A

PF
inversion
adduction

193
Q

flex knee ankle PF
calcaneus pulled forward

Talar tilt- inversion position cause pain or lax

inversion ankle sprain- take into neutral/ inversion

max- ice, isometric, AROM avoid PF inversion

MOD- rom w/o pain, FWB, conc/ ecc, heel Cord stretch
proprioception/ stand exercise

DF AND EVERSION STRENGTH
PF STRENGTH
min- pylometrics

A
194
Q

grade 3 sprain is surgery

A
195
Q

Deltoid ligament sprain- medial
deltoid ligament ruptured occur with lateral ankle fx

partial- therapy
complete- surgery, NWB

Anataglic gait

A
196
Q

Ligament instablites : swell pain unstable
mechanical:
lax ligaments , chronic unstable bad tissue

might be in boot, passive DF/ PF
stay away from active bc peroneus brevis scar
no DF PF inversion for a while

functional- strength, proprioception, ligament, stability

A
197
Q

ligament instablites
can reroute peroneus brevis
or shorten cut reattach

A
198
Q

Subluxing peroneal tendon
passive DF and slight eversion
misdiagnosed for lateral sprain

due to loose retinaculum
shallow groove
treat: deepen groove or bone block, reroute, periosteal fibers

3 weeks after surgery
isometrics active PF DF

be careful with DF / eversion

strength at 80% w ROM to start running

A
199
Q

achilles tendonitis
repetive use of triceps surae
intrisnic in tissue
extrinsic things you’re doing ;shoes or surface

rice , eccentric load , stretch heel cord and plantar fascia

heel lifts , increase DF
severe put in boot

usually in males 20-50 yes old
can feel gap in distal 3rd tendon

Thompson- squeeze calf and should see achilles tendon if not then it ruptured

A
200
Q

surgical- immobilize for 6 weeks
get more strength + power
repair 2 ends together

augment with graft

avoid high PF and re rupture small heel lift

theraband
proprioception
progress to closed chain

A
201
Q

Compartment syndrome
elevated tissue pressure within closed facial space
leads to occlusion of vessels

associated with tibial fx
direct hit
muscle reupture
muscle hypertrophic
circumference burns

emergency acute elevated intracompartment in lower leg
Shiny swelling pain tense parathesis

stretch will increase pain

A
202
Q

Chronic compartment syndrome is Dull ache tingling numbness

exercise induced
long distance duration
anterior lateral superior posterior deep posterior

acute do Fasciatomy open more space

A
203
Q

Ankle fractures
unimalleolar
bimalleolar - lateral and medial
trimalleolar- lateral medial and post tib

do ORIF. no surgery -boot

NO inversion/ eversion

2 weeks later do PF/ DF

isokinetic proprioception

A
204
Q

Total Ankle Arthroplasty
- OA JRA RA
domed compartment resurface talus
how demand still has ligamentous instability

can’t go back to plyometrics bc Stablity over mobility
Stretch posterior muscles

A
205
Q

Ankle Arthrodesis- fusion of ankle more common than TAA
pain unstable deform
failed TAA
fuse talus go tibia
fuse talus to talonavicular / calcaneocuboid/ subtalar
hallucis rigidus / valgus

A
206
Q

Distal Tibial compression fx (PILON)
vertical axial loads that drive or compress
tibia into talus

surgery ORIF or external fixation
traction w pin
NWB for 12 weeks
Secondary OA common complication
w severe multi fragment - Compression fx

A
207
Q

Calcaneal / Talar fx
caused from height and falling on crouched foot
cast in PF ORIF
NWB for 3 months

calcaneal fx get PF back
Talar fx- OA risk

A
208
Q

Plantar fasciitis - inflammation of plantar aponeurosis
with or without calcaneal heel spur
repetitive microtrauma
cause stiffness

pain on medial border - Calcaneal
stretch gastro soleus and toe flex

A
209
Q

Arch deformities
Pes planus- flat foot medial longitudinal reduce medial border contact to ground when standing

strengthen intrisnic - pull arch up

A
210
Q

Pes cavus- abnormal high arch
Neurogenic or structure difference
affects medial / lateral arch

Painful under metatarsal head w callus OA
decrease pressure with pads
stretch tight

A
211
Q

Morton’s neuroma
burn cramp between 3 and 4 toes
get wider soft shoes
Get rid of neuroma
anterior glide - ext
posterior glides - flex

talocrual PF DF
subtalar Inversion/ eversion

A
212
Q

hammer toe is

claw toe is

mallet toe is

A
213
Q

hamstring set bend knees and push heels into table

supine roll witn theraband then bridge up with hall

stool scoots forward hamstring push backward for quad

execsion lag - retro walk forces ext
walking/ heel stroke doing DF

self perturbation
SL balance dynamic
on dominant leg

theraband cable foam tramp

A
214
Q

ankle joint mobility - stretch soleus knee bent take out gastro insufficiency

A
215
Q

Inversion pull up heel towards you
eversion push down heel

roll on lateral portion on foot - inversion
roll on medial portion on foot- eversion

can do seated big toe stretch - put pressure through big toe

A

Therax (8 decks)

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