EXAM I

Question 1

typical NMES settings and purpose

Answer 1

to strengthen muscles
35-50 pps
1:4 ratio

100-200ms for small mx and 300-400 for larger

Question 2

typical TENS settings and purpose

Answer 2

for pain
low frequency endogenous - 10Hz
high frequency gate theory - 100 Hz

100-200ms for small mx and 300-400 for larger

Question 3

typical ultrasound settings

Answer 3

size head 3 or 5cm
1Hz for deep, slow
3Hz for shallow, heat, fast

pulsed (non thermal) vs continuous (thermal)

0.8

Question 4

heat superficial/deep condition and convection

Answer 4

superficial/conduction: hot packs, paraffin

convection: whirlpool, fluidotherapy

deep/conversion: ultrasound

Question 5

cold conduction and convection

Answer 5

conduction: cold packs, ice massage
convection: cold water baths and whirlpools

Question 6

uses for biofeedback

Answer 6

To assist in facilitation of weak or paralyzed muscles
To assist in the reduction of activity levels of spastic muscles
As a monitor to prevent overuse.

Question 7

LLLT

Answer 7

Low-level laser therapy is used to increase local blood circulation, relief of minor muscle aches and joint aches, pain and stiffness, relaxation of muscles, muscle spasm and minor pain and stiffness associated with arthritis.

Question 8

iontophoresis

Answer 8

A method of administering ionized drugs via electrical current
Like electrical charges repel, so a positively charged drug using the positive setting of the device will push the drug into the system

dose:

Question 9

clinical hand presentations of UE nerve injuries

Answer 9

radial: wrist drop (radial nerve palsy)
median: ape hand, hand of benediction
ulnar: claw hand

Question 10

acute phase

Answer 10

orthosis to protect nerve repair
maintain AROM in uninvolved joints
scar management

Question 11

recovery phase

Answer 11

orthosis at night
digit/wrist motion
neuromuscular reeducation
desensitization

Question 12

chronic phase

Answer 12

adaptive techniques for ADL
surgery
biofeedback
psychosocial therapy

Question 13

phases of treatment for sensory return

Answer 13

1st:
Pain/temp
vibration 20 cps
moving touch
constant touch
vibration 256 cps
touch localization
2 pt discrimination
last: stereognosis

Question 14

process of desensitization, and sensory re-education

Answer 14

vibration thresholds, semmes weinstein, 2 point discrimination, ten test
OT process treatment: prevent rupture after surgical repair with orthosis fabrication and client education, control edema and scarring, maintain motion safely, promote healing.
work on sensory return and desensitization. work on strengthening avoiding fatigue when MMT is ⅗ or less
Phase I: sensory re-education and cortical remapping
silent phase (early)
mirror box, anesthesia
Early phase: return of vibration 30 cps and beginning to identify moving touch
then use textures/different stimuli
Late phase: transfer gains made into function
object recognition, prehension of objects, maintenance of force during transport off objects, object manipulation
Advanced late stage: proprioceptive activities, hypersensitivity (massage, textures, immersion to address this)

Question 15

clinical tests, symptoms, etiology and treatment for Thoracic Outlet Syndrome

Answer 15

20-30 years old
women 3-4x more likely to develop neurogenic TOS
neurogenic is >90%, vascular 2-5%, arterial 1%
congenital anomaly related to extra 1st rib
post traumatic structure
post traumatic posture structures

clinical index for diagnosis of TOS (3 of 4 symptoms)
history of possible pain patterns
palpation: supra and infra clavicular fossa, distal nerve palpation to rule out peripheral nerve involvement, coracoid process
tests: elevated arm stress, supraclavicular pressure, costoclavicular maneuver, wright’s, cyriax release test (sleep), upper limb tension test (elvey test)
1. symptom control
2. specific postural control exercises
3. general maintenance exercises

Question 16

causes, presentation and treatment for compartment syndrome

Answer 16

1. Pain
2. Paresthesis
3. Passive stretch
4. Pressure
5. Pulselessness

Use a Stryker Device to measure the pressure (2-10 mm of mercury is normal)

fasciotomy - surgery that relieves swelling and pressure on a compartment in the body

Question 17

kinesiology descriptions of normal forearm and wrist motion

Answer 17

Sagittal plane: 11 degree palmar tilt
Frontal plane: radial inclination 23 degrees
Radiocarpal joint: 80% → radioscaphoid 45% and radiolunate 35%
Ulnocarpal joint: 20% → ulnolunate 14% and ulnotriquetral 8%
Midcarpal joint: → STT 31%, SC 19%, lunocapitate 29%, triquetrohamate 21%

Question 18

Analyse all aspects of the physical examination and treatment of the wrist

Answer 18

Stabilizers of the ulnar wrist: static stabilizers (sigmoid notch - TFCC) and dynamic stabilizers (pronator quadratus, FCU, ECU)
Triangular fibrocartilage complex (TFCC): connects ulnar side of the wrist

Question 19

radial dorsal zone

Answer 19

• de quervains
• thumb CMC osteoarthritis
• thumb MP (gatekeeper’s thumb)
• scaphoid fracture (S-L and L-T)
• distal radius fracture

Question 20

ulnar dorsal zone

Answer 20

• lunotriquetral instability
• TFCC
• ECU tenditnits
• distal radioulnar joint instability

Question 21

radial volar zone

Answer 21

• carpal tunnel
• scaphoid fracture
• distal radius fracture
• ganglion cysts

Question 22

ulnar volar zone

Answer 22

• guyons canal
• hamate fracture
• FCU tenditnits
• ganglion cysts
• distal radioulnar joint instability

Question 23

central dorsal zone

Answer 23

• scaphoid lunate instability
• capitate fracture
• ganglion cysts

Question 24

ulnar + and -

Answer 24

Ulnar +: distal ulnar longer than radius causing ulnar sided pain
Ulnar -: distal ulnar shorter than radius causing radial sided pain

Question 25

amount of motion necessary for a functional elbow joint

Answer 25

functional elbow motion: -30 deg to 130 deg | functional forearm 50 deg pronation 50 deg supination

Question 26

Analyze the position and significance of all elbow ligament

Answer 26

ulnar collateral ligament: connects medial elbow to distal proximal ulna radial collateral ligament complex (annular, lateral ulnar collateral, radial collateral, and accessory lateral collateral ligaments) functions of elbow capsule: •Resists joint distraction, hyper-extension and valgus stress. (Safran & Baillargeon, 2005) •Most lax at 80 degrees of flexion •Position of comfort after injury •Risk of flexion contracture •Ligaments inter-digitate with the capsule and contribute to reinforcing the capsule. •Wrist and hand muscles contribute to reinforcing the capsule.

Question 27

medial collateral ligament injury

Answer 27

pain with resisted wrist flexion, tenderness with palpation to medial epicondyle

Question 28

osteochondritis

Answer 28

edema and possible flexion contracture, pain and stiffness, arthritis

Question 29

common fractures of the elbow

Answer 29

radial head, coronoid process of the ulna, epicondyle of humerus, lower humerus, upper ulna, upper radius

Question 30

Identify the annual ligament, medial collateral ligament, and parts of the lateral collateral ligament complex.

Answer 30

ulnar collateral ligament, radial collateral ligament complex (annular, lateral ulnar collateral, radial collateral, and accessory lateral collateral ligaments)

Question 31

Identify the functional motions of the limb girdle. Contributions of scapula, glenohumeral joint & scapula.

Answer 31

G-H: traps and serratus anterior static stabilizers: ligaments, capsule, labrum Rotator cuff: SITS and deltoid * Functional motions of the shoulder girdle: 1. scapulothoracic joint not a true synovial joint, provides rotation of the scapula on the chest wall 2. sternoclavicular joint acts as a radius of limb-girdle motion 3. acromioclavicular joint: provides adaptive motion between the clavicle and scapula

Question 32

sequential shoulder evaluation

Answer 32

history - insidious (sleeping, sports, working) - traumatic (mechanism, surgery) - upper quarter screen --> AROM --> PROM --> palpation, mobilization, special tests --> treatment plan

Question 33

pathology, underlying causes, clinical phases and principals of rehab for frozen shoulder

Answer 33

Underlying pathology of Frozen shoulder: adhesive capsulitis, impingement syndrome, peri arthritis Clinical phases: Freezing/inflammatory: 3-9 mo, pain worse at night, starts as dull ache and becomes more severe over time Frozen: loss of motion, dull achy pain, capsular fibrosis Thawing: regained motion, decreased pain, increased ADLs, capsular hypovascularity

Question 34

structural and functional factors contributing to Impingement Syndrome

Answer 34

45-65% of all complaints of shoulder pain correlate with bursal sided tendinopathy increase incidence with age and more with dominant arm ``` Intrinsic: degeneration of rotator cuff, tears bursa inflammation mal union fractures anatomic variations of acromion from trauma (type II or III) ``` ``` Extrinsic: poor posture glenohumeral muscle imbalance (weak RC) tightness in glenohumeral joint capsule encroachment of greater tuberosity on subacromial tissue periscapular muscular imbalance ```

Question 35

post-operative rotator cuff surgery precautions to cases and general post-op treatment interventions.

Answer 35

Protection phase: 0-2 weeks post op patient education no exercise Protection phase: 2-6 weeks post op protected PROM (avoid passive or active extension and internal rotation) Protection to Mobilization phase: 6-12 weeks AAROM-AROM and protected PROM Mobilization phase: 8-12 weeks and 12-120 weeks exercises with increased EMG supraspinatus activity Strengthening phase: 20 weeks

Question 36

Recognize the characteristics of CRPS

Answer 36

Etiology: trauma, crush injuries, vascular damage, electrical injuries, edema, coagulopathies, abnormal sympathetic reflex 5 “Ps”: pain, paresthesia, passive stretch, pressure, pulselessness classification: Type I: Reflex Sympathetic (injury that did not directly involve the nerves) Type II: Causalgia (over damage to peripheral nerve) painful lesion from trauma or disease process, predisposition female to male 3:31

Question 37

Analyze Pain, stiffness, edema, skin temperature, color change, bone demineralization and the spreading of symptoms in CRPS. What is the most common characteristic?

Answer 37

``` burning pain in 97% of patients joint stiffness in 88% of patients edema in 69% skin color changes trophic (shiny, thin, sweaty) in 60% nail and hair growth patterns change hyperesthesia in 69% ```

Question 38

Recognize the which CRPS symptoms occur in which of the 3 stages

Answer 38

Stage I acute (3 to 6 months): burning pain, sweating, tenderness. Possible patchy bone thinning on x-ray. Stage II dystrophic (3 to 6 months): skin changes (shine and/or thickened), contractures and pain Stage II atrophic: loss of motion and function, contractures and thinning of skin

Question 39

Analyze all aspects of OT treatment for RSD/CRPS

Answer 39

prevention, elevation, dressings, cast fasciotomy pain and scar management, maintain/gain soft tissue mobility, progressive activity and strengthening

Question 40

Pre-prosthetic evaluation and training

Answer 40

``` Patient education = psychosocial adjustment Pain, sensation Management of residual limb Strength and ROM ADL/IADL, balance, endurance ``` 1) wash limb daily with mild soap and dry; 2) provide wound cleansing; 3) use appropriate creams to massage at the suture line to loosen crust

Question 41

types of prosthetics

Answer 41

Passive prosthesis: systems that do not possess the ability to actively position/grasp/release; functions to protect limb, support/stabilize objects, social acceptance Conventional body-powered prosthesis: uses motions from the proximal body to operate the device) simple, low cost, reliable, may restrict some movement, patient exerts effort voluntary opening: colitional force and excursion of the cable, prehension force is dictated by number of rubberbands voluntary closing: allows for graded prehensile force, higher forces can be applied through cabling system Externally powered prosthesis/myoelectric: uses power external to the body; muscle contractions to operate wrist units: hook and hand, ball and socket no harness, can get more types of motions, frequently prescribed for transradial amputations, electrode alignment Hybrid prosthesis: combination of body powered and myoelectric electrically powered elbow with a body powered terminal device; use proprioceptive feedback from the cable system and inputs from electromechanical stimulation Activity specific prosthesis

Question 42

levels/causes of amputation

Answer 42

primary cause of arm amputation: trauma Transhumeral: above elbow Transradial: below elbow primary cause of leg amputations: vascular disease and diabetes

Question 43

Know goals of residual limb shaping for prosthetic.

Answer 43

Goals: shrink and shape residual limb so that it is tapered at the distal end; want rounded end Rigid dressings: protects limb from trauma, early prosthetic fit, effective in controlling edema, requires skill to put on and off Shrinkers: easily applied, more consistent pressure, easier to maintain, loses elasticity when washed, more expensive Elastic wraps: pressure can be customized and graded to reduce edema, adjustable compression, inexpensive, cannot self apply with UE, needs frequent reapplying

Question 44

mechanical properties of wound healing

Answer 44

tissue regeneration: primary intention/closure; wound edges are close with little/no tissue loss (sutures) tissue repair: secondary intention/closure; wound is beyond superficial later When wounds won’t heal: grafts (skin/tendon/bone), flaps (share blood supply) Factors that influence wound healing: humidity/temp, infection, edema, hematoma, depressed immune system, nutrition, smokers

Question 45

Overlapping phases of wound healing

Answer 45

Hemostasis: immediate, lasts a few minutes, clotting cascade occurs and platelets adhere to collagen to seal and stop bleeding, produce thrombin and fibrinogen to clot Inflammatory: 1-6 days, edema and pain, vasodilation, neutrophils and macrophages, prepares wound for closure Proliferative: 3-20 days filling the wound (granulation tissue replaces fibrin) contraction of wound margins (pull together) epithelialization (cover wound bed with epithelium) Remodeling/maturation: 14 days-1 year, max strength is limited to ~80% of pre-injured strength collagen cross linking is a key factor