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BPK 481 > Final > Flashcards

Final Flashcards

1
Q

The shoulder has increased mobility at the cost of what

A

decreased stability, due to a shallow socket

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2
Q

how should we prioritize the mobilization of joints

A

mobilize proximal joints before distal ones

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3
Q

what muscle is the most commonly injured in rotator cuff injuries

A

supraspinatus

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4
Q

what is a watershed area in the shoulder

A

area that has no arterial supply, the point where the supraspinatus tendon connects

has bad healing potential

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5
Q

What is adhesive capsulitis
and what are extrinsic/intrinsic types of AC

A

Frozen shoulder, when the joint capsule gets smaller due to restriction of ROM

if it is extrinsic to the GH joint it is usually caused by systemic diseases (diabetes), and if intrinsic then it is caused by immobilization

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6
Q

What are some risk factors for adhesive capsulitis

A

female (around early menopause)
older age
trauma
diabetes
prolonged immobilization

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7
Q

What is the clinical presentation of adhesive capsulitis

A

capsular pattern of ROM loss (losing external rotation first, followed by losing abduction, and then internal rotation (exabin*))

ER has the greatest loss as arm is usually in a sling, and this causes increased tension for the back of the shoulder causing increased compression of the capsule

pain in all motions with less pain in flexion

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8
Q

What are the 3 stages for adhesive capsulitis

A

Freezing stage: symptom management phase - limited rom due to pain, lasts 2-9 months

Frozen stage: lessened pain, but shoulder is stiffer and using it is harder, lasts 4-12 months. Recommended to introduce aggressive protocols to regain ROM, as earlier mobilization leads to improved thawing stage improvement and regaining of ROM. If not done, ROM losses may be permanent

Thawing stage: thoulder starts to improve ROM, lasts from 5-24 months as the joint capsule starts to loosen up

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9
Q

How is adhesive capsulitis managed?

A

hot/cold compress

NSAIDs

Physical therapy (usually painful and deep)

TENS

Manipulation under anesthetic

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10
Q

What is subacromial impingement syndrome

A

increased superior translation with active elevation leading to compression of supra-humeral structures

caused by anterior instability and posterior capsule tightness, as well as mechanical abrasions of acromion

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11
Q

what are the risk factors for subacromial impingement syndrome

A

increased age (arthritis)

scapular dyskinesia (irregular shoulder blade movement, moves with flexion to 120 degrees)

postural dysfunction (rounded shoulders, shoulder be 1 hand space between blades)

overhead athletes

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12
Q

What is the clinical presentation of subacromial impingement syndrome

A

painful arc due to poor scapular rhythm

decreased willingness to move shoulder due to pain

anterolateral arm pain

pain lifting things above head

pain with abduction over 90 degrees

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13
Q

How is subacromial impingement syndrome managed

A

physical therapy

PRICE

NSAIDs

activity restriction

  • *this is the general baseline and can be applied to a lot of other injuries too**
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14
Q

What is a SLAP Lesion

A

a superior labral lesion that is both anterior and posterior

results from single traumatic events from a FOOSH injury

can also be due to multiple repetitive microtraumatic injuries

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15
Q

What are the 4 types of SLAP lesions

A

Type 1 - fraying of labrum, lose horizontal abduction and external rotation

Type 2 - aka bankart (most common) pathalogical detachment of labrum and biceps tendon anchor leading to decreased stabilization, also includes fraying/peeling off of biceps tendon

Type 3 - Bucket handle tear, vertical tear of labrum, but the remaining labrum and biceps are intact

Type 4 - bucket handle tear with torn biceps tendon , involves extension of bucket handle tear into biceps tendon, causing displacement into the GH join causing pain

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16
Q

What is the clinical presentation for a SLAP Lesion

A

pain w overhead activities

catching/locking of the bucket handle in the subacromial space

loss of shoulder stability

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17
Q

How is a SLAP lesion managed

A

type 1 - non operative, physical therapy

Type 2/3/4 - operative, requires resect/reattach surgery and then PT for 16-20 weeks

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18
Q

What is rotator cuff pathology

A

damage to rotator cuff, usually the supraspinatus due to it being a watershed area and its location

caused by repetitive stress, compression, and tensile overload

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19
Q

What are the risk factors for rotator cuff pathology

A

being older than 40, and being an overhead athlete

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20
Q

what is the clinical presentation of rotator cuff pathology

A

pain, weakness/loss of ROM, painful arc, dull ache radiating into upper arm, worse pain when lying on affected side

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21
Q

What is a AC joint sprain

A

acromioclavicular joint sprain

injury to AC and CC joint

caused by trauma (car accidents, sports injury like FOOSH, or direct trauma)

FOOSH most common

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22
Q

WHat are the grades for AC joint sprain

A

grade 1 - partial tear, but still usable

grade 2 - full or partial AC tear with partial CC tear, pain and limited ROM

grade 3 - full AC and CC tear, full loss of function/no strength or stability and a visible bump

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23
Q

What is the clinical presentation of an AC sprain

A

assymetry of injured and noninjured side

tenderness on palpation of the AC joint

positive cross-arm adduction test

decreased flexion and abduction

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24
Q

how is an AC joint sprain managed

A

PRICE

physical therapy

surgery

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25
Q

What is the empty can test

A

pt stands while examiner forward flexes the arm to 90 degrees, then forcibly medially rotates the shoulder

tests for impingement, very poor specificity tho

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26
Q

WHat is the Speeds test

A

pt tries to flex shoulder while examiner holds arm down while pt is in supinated, pronated, and then fully extended

positive test causes tenderness in bicipital groove, especially with supination, due to biciptal paratendonitis

poor specificity

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27
Q

What is the hawkins-kennedy test

A

examiner forward flexes arm to 90 degrees and then forcibly medially rotates the shoulder

positive pain indicates supraspinatus tendonosis or secondary impingement

poor specificity

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28
Q

What is the Neer impingement test

A

pt arm is passively fully elevated in scapular plane with arm being medially rotated by examiner, forcing GH head into subacromian space

indicates overuse injury to supraspinatus muscle

poor specificity

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29
Q

What is a diagnostic ultrasound

A

used to assess shoulder

uses transducers (device that sends and receives ultrasound waves) and measures time it takes for waves to be reflected back to produce an image

high frequency imaging with low amplitude

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30
Q

What are the indications for a diagnostic ultrasound

A

can be used to diagnose superficial pathologies

used for soft tissue injures, tumors, bone infections, arthropathy, and to evaluate bone mineral density

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31
Q

What are the advantages to diagnostic ultrasound

A

readily available,

cheaper than other modalities,

no ionizing radiation

non invasive

allows for real time imaging

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32
Q

what are the disadvantages to diagnostic ultrasound

A

small field of view, high presence of artifacts

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33
Q

What is Naproxen

A

NSAID used to treat tendonitis, arthritis, gout, and pain

must ask if pt has heart conditions before giving

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34
Q

what are the contraindications for naproxen

A

asthma or use during coronary artery bypass surgery

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35
Q

What are the side effects of naproxen

A

edemas, rashes, abdominal pain/constipation, dizzyness, headache, dyspnea

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36
Q

What is the shoulder pain and disability index?

A

13 item questionaire that assesses pain (5 item) and disability (8 item)

0-100 scale

can detect change in pts with shoulder injury, with no floor/ceiling effect

MDC = 19.7 points
MCID = 20 points

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37
Q

What is the role of a sport psychologist

A

enhance performance using mental strategies

cope with competition pressures

recover from injuries/deal with pain

keep up with exercise program

enjoy sports again and promote healthy self esteem

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38
Q

What is an integrated support team

A

team of people that support coaches/athletes

may include : physiologist, sports psychologist, biomechanist, nutritionist, physical therapist/athletic therapist, and physician

goal to ensure athletes are ready for optimal performance

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39
Q

WHat are the 3 phases of rehabilitation

A

acute - inflammatory tissue healing

recovery - strengthening and correcting biomechanical abnormalities

functional - requires adequate strength and full ROM, involves advanced strengthening of scapular stabilizers

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40
Q

What are the components to return to sport

A

promote return to previous activity level

sport specific goals

typically return once full ROM and strength is obtained

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41
Q

What is the percentage of tear for the 3 grades of muscle injuries

A

grade 1 - 0-19%

grade 2 - 20-99%

grade 3 - 100%

better to just say complete or incomplete tear

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42
Q

What are the 3 stages of muscle healing

A

destruction - muscle fibre and connective tissue sheaths are disrupted

repair - hematoma/collagen/ matrix formation and satellite cells proliferate/differentiate into myofibrils

remodelling phase - regenerated muscle matures and contracts with reorganization of scar tissue

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43
Q

Anatomy of the hand that is vulnerable if you have a fall

A

Distal Radial region
Scaphoid on ulnar side => the hook of hamate or pisiform
*hint

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44
Q

Arterial Supply of the hand (and watershed areas)

A

there are watershed areas around the scaphoid causing avascular necrosis becasue blood flows DISTAL to PROX (less flow)
- if a fall occurs the artery gets severed
*hint

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45
Q

Triangular Fibrocartilage complex tear classes

A

Class 1A: central tear of the fibrocartilage disk tissue (I)
Class 1B: ulnar-sided peripheral detachment (II)
Class 1C: tear of the volar ulnar extrinsic ligament (III)
Class 1D: radial sided peripheral detachment (IV)
*hint

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46
Q

Triangular Fibrocartilage complex tear etiology

A

axial loading, ulnar deviation, and forced extremes of forearm rotation
eg. pushups w/wide grip

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47
Q

Triangular Fibrocartilage complex tear presentation

A

ulnar-sided pain between the carpal bone and ulnar bone
- pain doing the mechanism that caused the injury
- swelling, crepitus (only 1B and 1D)
- weakness/instability
- TOP and very localized

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48
Q

Triangular Fibrocartilage complex tear treatment

A

activity modification
- wrist strngthening
- PRICE (can apply to anything with enough justification)
- endurance training if RSI related

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49
Q

Scaphoid Fracture

A

Un-displaced/displaced fragment of the scaphoid

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50
Q

Scaphoid fracture etiology

A

FOOSH

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51
Q

Scaphoid fracture complications

A

Avascular necrosis (watershed area) => degeneration and loss of bone density

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52
Q

scaphoid fracture clinical presentation

A

posterior radial sided wrist pain
- tenderness over snuff box
- swelling
- dec concavity of snuff box

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53
Q

scaphoid fracture treatment

A

fracture protocol
- progressve loading
-protocol is dependent bc load bearing bone

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54
Q

standard scaphoid fracture treatment

A

first xray even if negative - immobilize for 7-10 days
- the xray is shit at picking up the fracture
get 2nd xray after 7-10 days
- if +ve => 6 weeks cast
*hint

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55
Q

is xray for acute scaphoid fracture able to detect

A

no they not

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56
Q

Distal radial fracture types

A

Colles: whole wrist moves posteriorly
Smith: whole wrist moves anteriorly
barton: articular wrist fracture of the distal radius
*hint

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57
Q

distal radial wrist fracture eitiology

A

colles: FOOSH
smith: fall on flexed wrist
barton: direct and violent injury to wrist or sudden pronation of the distal forearm on the fixed wrist

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58
Q

Distal radial fracture risk factors

A

inc age
female

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59
Q

distal wrist fracture clinical presentation

A

swelling
gross deformity
dec ROM
TOP

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60
Q

distal radial fracture treatment

A

splint?
progressive overload - est for barton bc its low recovery and icn bony growth dec rom

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61
Q

wrist sprain

A

a ligament is stretched, twisted, lacerated, or torn

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62
Q

wrist sprain eitiology

A

FOOSH

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63
Q

wrist sprain clinical presentation:

A

swelling around wrist joing
- pain on ulnar or radial deviation
- bruising, difficulty w wrist movemement

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64
Q

wrist sprain treatment

A

activity mod
wrist strengthening
PRICE (bc you cant narrow down injury w/o imaging)
NSAID

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65
Q

complex regional pain syndrome (CRPS) types

A

CRPS Type 1: pain syndrome reflex sympathetic - dystrophy pain syndrome is triggered by a harmful event - not limited to damage to a single peripheral nerve

CRPS type 2: pain syndrome causalgia - direct or partial or complete injury to a nerve or 1 of it’s major branches

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66
Q

CRPS aetiology

A

exaggerated inflamm response or autonomic dysregulation with an overly active sympathetic nervous system

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67
Q

CRPS Clinical Presentation (stages)

A

Stage 1: sever pain; pitting edema; redness; warmth; inc hair and nail growth; hyperhydrosis; OA may begin

Stage 2: continued pain; brawny edema (hard); periarticular thickening; cyanosis or pallor (lack of O2 = blue fingers); inc OA

stage 3: pallor; dry; cool skin; atrophic soft tissue (dystrophy); contractures; bad OA
*Hint

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68
Q

CRPS clinical diagnosis requirements

A

didnt have CRPS before noxious event or without nerve lesion
- spontatneous pain, hyperalgesia
- edema, skin flow, sudomotor abnormalities, motor symptoms

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69
Q

CRPS treatment

A

meds
psycho/behavior therapy
pt/ot
lifestyle changes
alternative therpy
- its a lifelong condition not curable

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70
Q

what is osteopenia

A

dec in bone mineral density between 1-2.5 standard deviations below yound/adult mean of BMD

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71
Q

what is osteoporosis

A

a bone mineral density more than 2.5+ standard deviations under the normal mean
- type 1 - postmenopausal
- type 2 involutional (aging)
- occurs in 50% women 50+y/o
- inc risk of vertebral wedge, hip fracture, wrist fracture

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72
Q

Osteoporosis and osteopenia risk factors

A

Non-modifiable: genetics, female, family history

modifiable: pregnancy at early age
smoking/ alcoholism
sedentary / prolonged bed rest
dec Ca+ intake
anorexia
*hint

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73
Q

does eating calcium supplementation inc regional bone mineral density

A

no - neither in femur or spine

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74
Q

does eating vit D supplementation inc TOTAL bone mineral density

A

no but there was an inc in femoral neck BMD

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75
Q

lift test

A

for triangular fibrocartilage complex
- place palms flat on backside of table and aksed to lift table
- local pain in ulnar side of wrist and difficulty applying force pos+ tear of TFCC

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76
Q

press test (sitting hands test)

A

placing both hands on chair arm rests to get up nad apply pressure
- stress of axial load on wrist - synovitis or wrist pathology

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77
Q

watson test

A

put wrist in full ulnar deviation
press thumb and pinch on scaphoid on palmer side
radially deviate
- should cause sublux of scaphoid if its unstable (wtf thas wild)

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78
Q

watson test in predicting scaphoid injury

A

no - shit specificity and ok sensitivity

79
Q

patient rated wrist evaluation

A

2 scales : pain and function
- 5 items - severity, intensity, and frequency of pain
- 10 items for function
- everything is 0-10 scale (10 is worst) calculated /100

80
Q

can the patient rated wrist evaluation detect change in pain and function in wrist fractures

A

yes it can detect meaningful change in patients w/wrist fractures

81
Q

DEXA Scan

A

duel xray absorptiometry
- high precision, short scan time, low radiation and accurate

82
Q

when is thumb spica cast indicated

A

pain with anatomical snuff box pain - 3 weeks then xray

83
Q

is spica thumb cast good for fracture healing

A

no (ded) its actually detrimental to healing (wtf)
- you atrophy and regression of the ROM and joint thats fractures

84
Q

what is a dietician and who would u send to a dietician

A

regulated health professionsla about potential of food
- science of nutrition
- pateints with:
diabetes, malnutrition, cancer, heart health, preggo

  • not the same as nutritionist
    *hint
85
Q

What is lateral epicondylitis

A

tennis elbow (hella common)

inflammation with degeneration at the origin of extensor muscles

affects the extensor carpi radialis brevis and usually due to gradual overuse

86
Q

what are the risk factors for lateral epicondylitis

A

35-50 years old

female (less muscle mass and more torque to elbow)

smoking history

87
Q

what is the clinical presentation for lateral epicondylitis

A

distal swelling and pain in the area distal to epicondyle

tenderness

increased pain with resisted wrist extension

cant lift or carry shit on that side

88
Q

what is the treatment for lateral epicondylitis

A

PRICE
physical/active therapy
NSAIDs
Bracing - can lead to dependance on bracing due to psychosocial reasons
steroids

89
Q

WHat is triceps tendonitis

A

asympotmatic tendinosis to complete rupture

tendon thickening and degeneration, progressing to collagen fibre rupture

caused by repetitive extension of arm

90
Q

what are the risk factors for triceps tendonitis

A

weightlifting

steroid use

91
Q

what is the clinical presentation for triceps tendonitis

A

localized tenderness of the triceps insertion that is aggravated with resisted elbow extension

92
Q

What is the treatment for triceps tendonitis

A

PRICE physical/active therapy

NSAIDS
Bracing
steroid injections

93
Q

WHat is radial tunnel syndrome

A

compression of the deep branch of the radial nerve in the radial tunnel

radial tunnel shrinks when supinator muscle swells up

caused by direct nerve trauma, compressive neuropathies, neuritis

94
Q

What is the clinical presentation of radial tunnel syndrome

A

poorly localized burning or shooting pain over radial aspect of proximal forearm

weakness of finger/thumb extensors

tenderness in extensor muscles in forearm

95
Q

how is radial tunnel syndrome treated

A

PRICE
physical therapy
NSAIDs
Bracing
steroid injection surgery

96
Q

what is olecranon impingement syndrome

A

mechanical abutment of bone and soft tissues in posterior compartment of elbow

caused by fibrous deposits and chondral injury, or excess bone growth

97
Q

what are the risk factors for olecranon impingement syndrome

A

boxing/throwing

98
Q

what is the clinical presentation of olecranon impingement syndrome

A

crepitus

swelling

posterior elbow pain

locking/stiffness

99
Q

how is olecranon impingement syndrome treated

A

depends on cause, if inflammation then control, tightness then stretch, bone spur needs surgery, and rupture of surrounding structures needs removing of scar tissue and structures

100
Q

What is de quervains tenosynovitis

A

inflammation of abductor pollicis longus and extensor pollicis brevis tendon sheaths, the tendons pass thru sheath and that can be compressed leading to this

very common, can be caused by wringing towels, over exertion with any hand intensive activities

101
Q

what is the clinical presentation for de quervains tenosynovitis

A

pain in lateral wrist during grasp and thumb extension with tenderness

stiffness and local swelling around radial radial styloid

102
Q

What is carpal tunnel syndrome

A

fiberous hypertrophy of synovial flexor sheath

caused by repetitive wrist activities or sustained wrist flexion

103
Q

what are the risk factors for carpal tunnel syndrome

A

being 35-55 years old

104
Q

what is the clinical presentation for carpal tunnel syndrome

A

muscle atrophy, pain/numbness in medial nerve distribution, nocturnal pain

105
Q

what is throacic outlet syndrome

A

compression of neural or vascular anatomic structures that pass thru thoracic outlet

usually compressed in interscalene triangle, first rib/clavicle/subclavious, or the coracoid process/pec minor

can be
traumatic
chronic (muscle sprain of scap stabilizers)
developmental (improper decending of scap on posterior thorax

106
Q

what is the clinical presentation for thoracic outlet syndrome

A

pain when arm elevated above 90 degrees

pain localized in neck, face, head, and chest

can lead to numbness, weakness, tingling, swelling, etc

107
Q

What is trigger finger

A

swelling of flexor tendon sheath that doesnt let the tendon glide normally

caused by repetitive trauma

108
Q

what are risk factors for trigger finger

A

diabetes and arthritis

very correlated to systemic diseases

109
Q

what is the clinical presentation of trigger finger

A

snapping, triggering or locking of finger as it is extended and flexed

tenderness and tender nodule over metacarpal head

110
Q

what is olecranon bursiitis

A

swelling of bursa, caused by trauma or repetitive grazing

111
Q

what are the risk factors for olecranon bursitis

A

aged 20-50
students

112
Q

what is the clinical presentation of olecranon bursitis

A

swelling over elbow and discomfort when elbow is flexed past 90 degrees

warmness and redness indicated infection

113
Q

What is cervical radiculopathy

A

dysfunction of nerve roots exiting spinal cord, causing compression of roots

caused by poor posture and pathologies that cause lateral stenosis (hole gets smaller)

114
Q

What is the clinical presentation of cervical radiculopathy

A

triceps, wrist, and finger extension weakness

pain in arm

115
Q

how is cervical radiculopathy treated

A

correct posture
physio/rehab
steroid injections
surgery

116
Q

What is cozens test

A

examiner resists pronation, radial deviation, and extension of wrist. if pain then positive, shitty test tho

117
Q

what is mills test

A

forearm is passively pronated, flexed, and elbow extended, lateral epicondyle pain is positive

shitty test

118
Q

what is the finkelstein test

A

used to determine if dequervains exists

1st proximal interphalangeal joint is flexed, positive if pain over abductor pollicis longus and extensor pollicis brevis

high false positives

119
Q

what is the write test

A

arm is elevated above head to test for compression in costoclavicular space

very sensitive, but not accurate in detecting TOS

120
Q

what is the phalen test

A

wrists are flexed and pushed together for 1 min, positive is indicated by tingling in median nerve fingers, caused by carpal tunnel

not good test for carpal tunnel syndrome

121
Q

What is tinels sign

A

area of ulnar nerve in the groove is tapped and should cause tingling in forearm

most distal point of tingling is limit of nerve regeneration

poor specificity and sensitivity

122
Q

what are neural tension tests

A

tests to determine if neural tension exists, poor specificity/sensitivity due to poor setups

123
Q

What is the DASH questionaire

A

30 item survey to describe disability of upper extremity over time

MDC is 19.0, if less than that likely due to chance so better to observe n wait

124
Q

What is RULA

A

used to identify risk factors for upper limb, comprises 3 stages :

recording of working posture
scoring system
scale of action levels

high score=bad

125
Q

What is ROSA

A

quanitfy risks of computer work for office workers

includes 3 sections:

chair

monitor/telephone

keyboard/mouse sections

no correlation w ROSA and upper limb disorders

126
Q

What is lyrica

A

med that helps treat fibromyalgia, neuropathic pain, and diabetic neuropathy

cant take if hypersensitive to pregabalin

lots of side effects (dont need to know)

127
Q

what is zoloft

A

used for depression, panic disorder, OCD and PTSD

cant be taken with MAOIs, pimzide, or disulfiram

inhibits serotonin uptake and acts as anti depressant

causes low sex drive, constipation/vomitting, and dizziness

128
Q

What is physiotherapy

A

assess, treat, and manage pain, movement dysfunction, and chronic conditions

goal to empower, promote indepenance, and improve quality of life

many areas of practice

129
Q

what are the 7 controlled acts a physio can do

A
  1. communicate a diagnosis identifying a disease or disorder
  2. move joints of spine beyond physiological range using fast, low amplitude thrust
  3. tracheal suctioning
  4. treating open wounds
  5. rehab/assess pelvic musculature
  6. order application of prescribed energy form
  7. administer substance by inhalation
130
Q

what is worksafe BC

A

no fault insurance for workplace

promote prevention of injury illness and disease

provide fair compensation to those injured

131
Q

what is the role of a worksafe bc case manager

A

show care and compassion while building successful relationships

apply law and policy to make decisions that address management/benefits

record and explain detailed/complex info

manage varied caseload w input from dif team members

132
Q

what are the qualifications of a case manager

A

undergrad degree

min 3 years of adjudication experience

disability management experience

133
Q

what are demographic risk factors for work related injuries

A

low education and high BMI

134
Q

what are physical risk factors for work related injuries

A

high repetitive work, over 50kg lifted overhead per hour, and standing for over 30min per hour

135
Q

what are psychosocial risk factors for work related injuries

A

low job satisfaction

136
Q

why is there a relationship between workplace injuries and depression

A

losing job due to injury is like losing a part of identity, and this often results in depression

137
Q

what ligament is responsible for resisting side head movement

A

alar ligament

138
Q

what ligament prevents posterior/anterior sheering of head and keeps dens in place

A

transverse ligament of atlas

139
Q

What are the 3 types of cervical fractures

A

occipital condyle fracture - head compression

dens fracture - anterior/posterior trauma

hangmans fracture - hyperextension of the neck (traumatic spondylolisthesis)

140
Q

what are the risk factors for a cervical fracture

A

young males

141
Q

what is the clinical presentation of a cervical fracture

A

constant cervical region pain

muscle spasms over a long period of time

may or may not lead to spinal cord injury

142
Q

what is a cervical disk herniation

A

combination of mechanical compression of nerve by bulging nucleus pulposis and inflammatory cytokines

more likely to occur posteriolaterally due to thinner annulus fibrosis and less structural support

caused by repetitive trauma or microtrauma

143
Q

Cervical disc herniation risk factors

A
  • 45-55 y/o
  • heavy manual labour
  • smoking
  • driving or operating vibrating equipment (sus)
144
Q

cervical disc herniation clinical presentation

A

*radiculopathy presentation
- severe pain preventing comfortable position
- arm pain
-sensory and motor deficits
- neck pain and scapular pain

145
Q

what is whiplash associated disorder

A

Injury going from extension => flexion forcefully
resulting damage can cause injruies to:
- soft tissue, joint capsule, ligament, Zjoint, central/peripheral nerves, interverbal disc & vascular structure

146
Q

grades of whiplash associated disorder

A

Grade 1: subjective neck
- complaints of pain, stiffness, and tenderness - no physical signs

grade 2 (most common): musculoskeletal signs: dec ROM and TOP

Grade 3: neurological symptoms - muslce weakness or sensory deficits

Grade 4: fracture/dislocation

147
Q

whiplash disorder aeitology

A

Motor vehicle accidents
- sport injuries that involve blow to head/neck region or heavy landing (diving)
- pulls and thrusts of the arms
- falls/landing on the trunk or shoulder

148
Q

Whiplash disorder risk factors

A

(all MVA related)
- whether the seat back breaks
- the occupant hits the front of the occupant space (read end)
- differential motion between seat back and occupant
- hyperextension of neck in a restrain
- rebound neck flexion as head rebounds off the headrest

149
Q

Whiplash presentation

A
  • upper motor neuron syndrome
  • periodic loss of consciousness
  • dizziness
  • doesnt move neck even slightly = fractured dens
    -painful weakness of neck uscles (fracture)
  • gentle traction and compression of neck = pain (fracture)
  • severe muscle spasm (fracture)
150
Q

what is Z joint sprain/dysfunction

A

any acquired degeneration of trauma of the facet joints in teh cervical region of the head
- also entrapment of the synovial membrane by thte z-joint

151
Q

zjoint dysfunction aeitology

A

trauma such as fall or MVA

152
Q

treatment of zjoint dysfunction

A

PRICE, mobilize, strengthen

153
Q

zjoint dyfunction clinical presentation

A

-unilateral neck pain
-locking of the neck after sudden movement

-muscle spasm/guarding

-dec rom in extension or ipsilateral rotation

-usually flexion makes it worse and ext makes it better bc the muscles of the vertebrae

154
Q

what is acute torticollis (Wry neck)

A

injury to the muscles, joints or ligaments thru sleeping with the neck in unusual position

155
Q

acute torticollis aetiology

A

acute form - over night in young and middle age adults

156
Q

acute torticollis clinical presentation

A

-sore/painful neck - visible and palpable

-marked limitation in a ROM of neck

  • pateint may hold head in a comfy position TOWARD stiff muscle
157
Q

treatment of acute torticollis

A

dont do anything it resolves itself lmao

rest, stretch, hot/ice pack, not really an injury just a fuckin sore neck bitch

158
Q

what is icbc

A

a group of money laundering assholes

  • an insurance agency across BC (legislative) that gices people support after MVAs, vehicle repairs, settlements, and care and recovery
159
Q
A
160
Q

icbc care process

A

report it

go to dr get assessment

treatment

icbc will pay

recovery

161
Q
A
162
Q

what is the alar ligament stress test and spec/sen

A

patient lies supine, head in neutral and the pt stabilizes the axis and the side flexes the head and axis

spec = 0.90

sen = 0.91(depending on good/bad set up)

163
Q

what is the neck diability index

A

-NDI is self-rated disability for neck pain

  • pain intensity, personal care, lifiting, work, headache, concentration, sleep, driving, ,and reading and rec
  • 0-5 (total = 50 - high score = disable like nav)
164
Q

transverse ligament stress test

A

pt puts 2 thumbs on the ant. transverse process of C2 to stabilize it and a finger on the occiput applying a posterior force

spec= 0.99
sen= 0.65 depending on setup

165
Q

spec/sen of NDI

A

NDI is reliable and is able to detect change in patients with neck pain
MCID: 10-19

166
Q

what is cervical vertigo

A

originates from a neck disturbance of the tonic neck reflex from the vestibular nucleus
-from cervical joint dysfunction or SCM
- alteration to the proprioceptive spinal afferents from the mechanorecpetors of the neck

167
Q

cervical vertigo aetiology

A

trauma and whiplash disorder

168
Q

cervical vertigo clinical presentation

A

(lick my) neck, back, (pussy and crack) and suboccipital pain
- stiffness (in cock region)
- vertigo
- nystagmus
-headaches
cervical motion abnormalities
(sorry navie pls dont kick me off the flashcards <3)

169
Q

cervical vertigo types and symptoms

A

Type 1: Barre-Lieou syndrome:
- sympt: headache pain dizziness nausea, tinnitus
- phys therapy and pain management
- not seen as medical condition

type 2 cervical proprioceptive vertigo:
-sympt: dizzy, neck pain, headache
- medical history, phys exam, imaging
- manage underlying cervical issues - therapy, exercises, medication

type 3 rotational vertebral artery vertigo:
- sympt: dec blood flow thru vertebral arteries during neck pos change (rotation) - vertebrobasilar artery insufficiency

type 4 migraine associated cervicogenic vertigo:
-sympt: vertigo, pain, migraines, light sensitivity, nausea,
cause: interaction between migraine and Cerv spine dysfunct
diagnosis: med image, history
treatment: migraine and cervical spine - physical therapy
*hint know

170
Q

vertigo vs dizziness

A

dizzy = you cant stop moving after spinning
vertigo = the world is spinning but youre not moving

171
Q

cervicogenic headache what is it

A

referred pain percieved in any part of the head - nociceptive source of the musculoskeletal tissues innervated by cervical terms
(its a fuckin headache)

172
Q

aeitology of cervicogenic headache

A

whiplash
postural dyfunction

173
Q

cervicogenic headache risk factor

A

desk/computer work dec cervical spine rom, inc neck pain, high NDI score

174
Q

cervicogenic headache presentation

A

pain localized to neck and occipital -projecting to the head

pain aggravated by specific movement or sustained neck posture

resistance or limitation of active/passive physiological neck movement TOP or muscle tenderness

175
Q

traumatic brain injury (concussion) what is it (primary and secondary)

A

Primary: diffuse axonal injury - laceration, contusion, hemorrhage casuing damage to neurofilament subunits within the axonal cytoskeleton

secondary: brain swelling (vasogenic/cytotoxic edema)
- release of excitotoxic levels of excitatory neurotransmitter
- impaired Ca+ homeo
- Oxy free radicals, and inflamm
=> leads to cerebral blood vessel constriction (ischemic neuronal death)

176
Q

concussion aeitology

A

fall, strike by somthing, MVA

177
Q

concussion clinical presentation

A

loss of cosciousness, Post trauma amnesia, sensory impairment
motor function impariment
impaired balance
minimally conscious or vegetative state

(concussion presentation is like youre absolutely plastered)

178
Q

Benign paroxysmal positional vertigo (BPPV)

A

benign = nonthreat life
paroxysmal = suddenly
positional - triggered by certain head opsitions
vertigo - false sense of movement (rotational or swaying/rocking etc)

179
Q

vestibular system overview (what is it does and the anatomy)

A

filled with endolymph

enlarged at one end = ampula - inside that = cupula with hairs and jello

saccule and utricle = otolith organ linear accel response thru the otoconia (crystals on the hairs)

180
Q

BBPV Pathophysiology (2types)

A

cupulolithiasis: fragments of the otoconia break (crystal) and stick to the cupula (in jello) in the semicircular canals

canalithiasis: crystal (otoconia) floating freely in the semicircular canals

181
Q

BPPV aeitology

A

-head trauma
-vestibular neutritis
- degeneration of the inner ear
-vestibular artery compromise

inc age = risk factor

182
Q

BPPV Clinical presentation

A
  • vertigo
  • nystagmus
  • sypt are 30-60 sec long
183
Q

vertebrobasilar artery insufficiency (what is it)

A

damage or occlusion to the vertebral arteries, bc they are tooo close to the bony and ligaments of cervical spine
*hint (know for sure)

184
Q

vertebrobasilar artery insufficiency aeitology

A

external: extracranial pressure, extracranial dissection due to trauma

internal: atherosclerosis or thrombosis in teh arteriovenous fistulas (tubes like arteries that connect vessels)

185
Q

signs and symptoms of BPPV

A

-drop attacks
-dizzy
-dysphagia, diplopia, dysarthria
- nystagmus
- nausea/numbness

186
Q

whats a ct scan and indicationsq

A

soft tissue imaging
- 3D Xray

  • head trauma, stroke, headache
  • lesions, seizures
    hydrocephalus and hematoma
187
Q

cranial nerve assessment tells us

A

about what nerve might be affected/injured depending on the abnormal response found by clinician

188
Q

vertebrobasilar artery positional test and what the major downsides are

A

testing positions:
- sustained full neck and head extension
- sus full neck/head rotation right and left
- sus N&H rotation with left/right extension

=> lack of validity to detect dec blood flow
conflicting systematic responses cant predict or detect arterial disseciton and risk for manipulation

189
Q

Dix-Hallpike test

A
  • used to identify BPPV
  • test is performed by having patient on a seated up table head rotated 30-45 deg
  • patient is assisted into supine below horizontal and held for 30-60 sec
  • do both side rotations and dizziness/nystagmus = pos test
190
Q

cerebellar finger to nose /finger to finger

A

pos:
delay in movement initiation
terminal tremor (contractions)
dysmetria (inaccurate speed, force or distance)

191
Q

cerebellar heel to shin (same as finger to nose but inclusive)

A

dysmetria
dyssynergia - flexing hip and knee in sequence cannot occur in a smooth pattern
= pos

192
Q

rebound test

A

slap in the face test - braking the movement

193
Q

rapid alternating movement

A
  • Dysdiadochokinesia – difficulty
    performing rapid alternating
    movements by alternating thru pronation/supination

BPK 481 (2 decks)

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