Final Flashcards
1
Q
What changes occur in the neck as you age
A
After age 50, nucleus purposes becomes fibrocartilaginous and has characteristics similar to annulus fibrosis
2
Q
What are the neck pain comorbidities seen in elderly
A
Autonomic failure, CV dz, concentration problems, digestive dz, dizziness, HA, low back pain, OA, orthostatic hypotension, shoulder pain, TMJ, trap m ischemia
3
Q
What is the leading cause of LE disability in older adults
A
OA; rapid increase >50
4
Q
What are common OA complains
A
Pain in one joint, deep ache, stiffness after inactivity, night pain
5
Q
What is the treatment for OA
A
Weight management, walking aids, NSAIDs, duloxetine, topical capsaicin, intraarticular injections, orthopdic intervention; prevention
Multi-disciplinary approach: PCP, rheumatologist, physiatrist, orthopedist, psychologist, psychiatrist, nurse, dietician, social worker
6
Q
What happens to the aging nervous system
A
- decreased brain weight - drug toxicities and delirium
- alteration in NT
- decreased memory
- decreased reaction time- decreased IQ
- altered sleep
- decreased vibratory sense
- decreased righting reflex, increased postural instability, altered gait leading to falls
7
Q
What reflex might be absent in older adults
A
Ankle
8
Q
What are the treatments for Parkinson’s
A
Levodopa, amantidine, MAO-B inhibitors, anticholinergics; education, emotional support, exercise, PT/OT/speech therapy, meditation, nutrition
9
Q
What are the pulm changes with aging
A
Decreased chest wall compliance, loss of lung parenchyma support, decreased resp m strength (less effective cough), increased alveolar dead space, increased perception of SOB -> anxiety
10
Q
What are the CV changes with age
A
Calcification and sclerosis, increased symp tone, decreased hemodynamic response to inotropic agents leading to fatigue, increase in BP, LVH, orthostatic hypotension
11
Q
What are the categories for HTN
A
- pre-HTN: 120-139/80-89
- HTN stage 1: 140-159/90-99
- HTN stage 2: 160/100
12
Q
What are exacerbating factors of HTN
A
Obesity, sleep apnea, polycythemia, NSAIDs, excessive alc, low potassium, smoking
13
Q
What are the sx of HTN
A
HA, accelerated HTN - somnolence, confusion, visual disturbances, N/V
14
Q
What effect can OMT have on HTN
A
15
Q
Where were SD found in patients with heart failure
A
T4
16
Q
What are the treatments for pneumonia in the elderly
A
Abx, corticosteroids, statins/ACE, O2 support
17
Q
What is the altered febrile response in frail older adults
A
- healthy community dwelling: >100.4 (38)
- frail: >100 single oral temp or 2 degrees above baseline (>1.1C)
18
Q
What did preventative OMT study in nursing homes show
A
Reduced number of hospitalization and medication usage
19
Q
What is the effect of OMT on blood cell count
A
OMT, lymphatic pump decreases platelet count
20
Q
What OMT was used on patient with LE ulcers
A
Thoracic inlet, dome diaphragm, pelvic release, popliteal release, pedal pump
21
Q
What are the viscerosomaticcs for symp for colon
A
T10-L2
22
Q
What do you do for a fall risk assessment
A
Watch them stand from a sitting position without using arms for support, walk several paces, turn and return to chair, sit down without using arms
23
Q
What are the risk factors for fall
A
Vit D def, decreased strength, SD, meds, depression
24
Q
What is the geriatric depression scale
A
If >5/15 - probable depression
25
What is the scoring for mini mental status exam
Max score 30; mild impairment - 21-29, moderate 10-20, severe <9
26
How do you treat depression with OMT
SD related to pain, balance autonomic (OA/AA sacrum), cranial
27
What can US be used for
Tendon injuries, short term pain relief - warms superficial soft tissue
28
What is phonophoresis for
Inflammatory conditions such as tendonitits, arthritis, bursitis; U/S used to deliver med to tissue under skin
29
What is iontopheresis
Electric current delivers substances through skin to deeper tissues; used for inflammatory conditions
30
What is low level laser therapy
Absorption of photon radiation, altering cellular oxidative metabolism which decreases prostaglandin E2; used for minor MSK pain, carpal tunnel , OA RA
31
What is electric stimulation
Generates action potential in n tissue causing muscle contraction or altering sensory input; used for muscle spasm or contusion and neuropathic pain
32
What is a closed kinetic chain
Prox segment of extremity moves on fixed distal segment (ie: squats); used for shoulder and knee rehab
33
What is open kinetic chain
Distal segment of extremity moves about prox segment; ie: UE weight lifting; used for functional improvement in ADLs
34
What is core stability exercise
Targets low back, trunk and ab mm: ie back extension and Pilates; relives low back pain or pregnancy related pelvic pain
35
What is eccentric exercise
Muscle contracts as it lengthens; ex extension phase of biceps or hamstring curl; used to prevent injury
36
What is concentric exercise
Muscle contracts as it shortens ie: flex bicep; used to increase strength
37
What is isometric exercise
Muscle contracts but its length stays the same; ie: hold weight stationary; used for m toning and strength when joint mobility not advised (ie: patellofemoral pain syndrome)
38
What is isotonic exercise
Constant resistance through a joint ROM; ie free weights; used for mm toning
39
What are the different techniques acupuncturists use
- guasha: deep pressure with japanese soup spoon; TTA that results in very taught thickened mm
- cupping: TTA that results in hypertonic mm recalcitrant to OMT or massage
- acupressure: deep pressure technique or circular masasage
- reflexology: absorption of photon radiation; used for minor MSK pain
- NAET: used for allergies, idiopathic illnesses; uses mm testing to identify allergies
40
Why would a DO refer to an acupuncturist
If feels that patient needs more frequent treatment, knows that has a physically related problem but lab findings are negative
41
When would a DO refer to chiropractor
If the DO lost skills or feels unskilled in OMT, feels that the patient needs more frequent treatments, specializes in another area of practice
42
What can occupational therapist do for early childhood patients
Play based activities, rehearsal of social behaviors, oral stimulation, infant massage, improve motor coordination
43
What are the styles of massage
- Swedish: effleurage and Petrissage; hypertonicity, stress, fatigue
- deep tissue- slow deliberate strokes; trouble spots
- sports
- chair
- shiatsu: rhythmic pressure on certain precise points of body; indicated or anything acupuncture may address
- lymph massage
44
What is Rolfing
Deep tissue approach; ten sessions - each one builds upon last; need high school diploma
45
What is the recommendation for yoga
Daily starting at 5-15 min and increase every 2 weeks by 5 min
46
What is feldenkrais
Uses gentle movement and directed attention to help people learn new and more effective ways of living with their bodies *use in patients who are too focused on their own pain
47
What are causes of leg length discrepancy
Trauma, **THA, TKA, pes planus, knock knees, blow legs, OA, childhood problems
48
What is legg-calve-perthes
Idiopathic avascular necrosis of femoral head; young boys; progressive painless limp; often self limiting
49
What is slipped capital femoral epiphysis
“Ice cream falling off a cone”; assoc with obesity, teenage boys; painful limp and decreased internal rotation; treat with surgery
50
What are the findings of long leg
Posterior innominate, high iliac crest, posterior sacral sulcus, concavity of lumbar spine (SB towards), convexity of thoracic spine, shoulder is low early on then goes higher, foot is pronated, ankle is dorsiflexed exerted and abducted, femur is internally rotated, knee is flexed, pelvic shift is towards (COG shit)
51
What kind of torsion is physiologic
Forward
52
How does L5 move during gait
SB towards axis, rotates opposite (towards deep sulcus)
53
What is essential in the treatment of short leg syndrome
Home stretching
54
How do you treat a structural LLD
Same as functional plus heel left therapy; rules - only when femoral head discrepancy is >5mm, max 1/2 inch heel lift then progress to whole foot, final lift height should be 1/2-3/4 of measured discrepancy
55
What is the heilig lift formula
Total lift needed = sacral base unleveling/duration+compensation
Duration - <10 years =1 10-30 = 2, >30=3
compensation: none=0, L spine rotation/SB =1, wedging of vertebrae =2
56
What are the functions of the psoas m
Flexion of femur, maintains orientation of pelvis during erect posture, medially rotates hip when laterally rotated and vice versa
57
What are the etiologies of psoas syndrome
Flexion stress of lumbar spine (prolonged siting or bending), sit ups, deadlifts/squats, quick elongation of psoas, arthritis of hip, pregnancy, short leg syndrome, flat lumbar lordosis, viscerosomatic reflexes (lower GI/GU)
58
What is the symp innervation to kidney
T12-L2
59
What are the sx of psoas syndrome
Can’t sit or stand upright, difficulty lying prone, pain stopping at knee, protruberant abdomen, tight hamstrings, increased lumbar lordosis
60
What should you find on OSE of someone with psoas syndrome
Tight psoas and L1 F R and SB to side of tight psoas
61
What is stage 1 of psoas syndrome
B/l spasm; lumbar flexed, increased or flat lordosis, trouble standing up straight, positive Thomas, pain on extension, pain at belt line, treat with indirect techniques and passive stretch
62
What is stage 2 of psoas syndrome
U/l spasm; key lesion is L1 FRrSr; right hip external rotation; pain at R belt line, positive lateral flexion test - cannot SB to opposite side; treat L1 then L2-5 then psoas stretch
63
What is stage 3 of psoas syndrome
Sacral torsion and side shift; dysfunction axis on side of SD; pelvic side shift away from SD causes SB toward; R post innominate leading to short leg; pain in lumbo-sacral junction at site of sacral axis; treat torsion
64
What is stage 4 of psoas syndrome
Piriformis spasm on opposite side of psoas; external rotation of opposite leg; treat Piriformis with counterstrain, trigger point injection
65
What is stage 5 of psoas syndrome
Sciatica of opposite leg; pain in butt, ,SI and hip radiates to knee; treatment - add low dose steroid
66
What are the dos and donts of stretching for psoas syndrome
- do: passive stretch with rolled towel TID, active stretch 5-20x a day, supine leg lifts, push ups, swimming
- dont: sleep on stomach, use heat to treat, slump when sitting, Bend forward, lean toward, perform sit-ups, lean backward when standing
67
What are the red flags of LBP
Major trauma, age <20 or >50, hx of cancer, cauda equine sx, consistutional sx (Fever, chills, weight loss, recent bacterial infection, IV drugs, immune suppression, severe nighttime pain)
68
What is the most common type of spina bifida
Myelomeningocele
69
What are causes of spinal canal compromise
Hypertrophy of posterior longitudinal ligament, thickening of ligamentum Flavum, OA, exostoses, osteophytes, tumors, disc rupture
70
What maintains the spasm in Piriformis sydrome
Abnormal gamma motor neuron stimulation
71
What is facilitation
Enhancement of response of neuron to a stimulus following stimulation
72
What aspects of the CNS lower pain threshold
Symp stimulation and vasoconstriction
73
What is Nervi neuvorum
Derived from dorsal roots forming sciatic n; unmyelinated free nerve endings
74
What are the functions of Piriformis
Hip ext rotator when hip extended and abductor when hip flexed
75
Where does the Piriformis insert
Superior medial aspect of greater trochanter
76
What exists superior to Piriformis vs inferior
- superior: superior gluteal vessels and n
- inferior: inferior gluteal vessels and nerves, pudendal bv and n, post femoral cutaneous n, nerves to short external rotators of femur
77
Who is Piriformis more common in
Women (larger Q angle)
78
What is the most common cause of Piriformis syndrome
Macrotrauma to buttocks
79
What are the sx of Piriformis syndrome
Pain radiating down to knee, better with ambulation, worse with sitting, pain when rising from seated position, ontralateral SI pain, difficulty walking
80
How is the sacrum rotated in Piriformis syndrome
Anteriorly rotated toward ipsilateral side on contralateral oblique axis; leads to physiologic short leg
81
What are the special tests for Piriformis
- straight leg
- Freiburg sign: pain during passive internal rotation of hip
- pace sign: patient is seated and abducts against physicians resistance reproduces pain
- FAIR test: can perform supine or lateral recumbent with affected side up - flex, adduct and internally rotate patients affected side
- beatty test: patient lies on unaffected side lifting and holding the superior knee 4 inches off exam table - positive if return sciatic sx
82
What PT can you do for Piriformis syndrome
Stretching, strengthening of adductor mm, heat or cold therapy
83
What are systemic causes of neuropathy
Pregnancy, hypothyroidism, DM
84
What are the categories of nerve injuries
- 1st degree: neuropraxia; involves focal damage of myelin fibers; connective tissue sheath in tact; limited course
- 2nd degree: axonotmesis; disruption to axon itself; myelin sheath remains in tact; regeneration possible but moths without recovery
- 3rd-5th: neurotmesis
85
How do you distinguish 3rd-5th degree nerve injuries
- 3rd: disruption of axons and endoneurium; recovery through axonal regeneration cannot occur
- 4th: disruption of axon and endoneurium+perineurium (fascicles); no improvement in function; surgery used to restore
- 5th: disruption of endoneurium+perineurium+epineurium; perineurial hemorrhage; surgery required
86
What does C6 do
Wrist extension and elbow flexion
87
What is the most common cause of cervical n root compression
Cervical disc dz - bulging (no damage to cartilage rings)or herniated disc
88
What are the types of herniated disc
Protrusion - only few cartilage rings torn; no leakage of central material
Extrusion: cartilage rings have torn in small area; nucleus purposes is able to low out of disc space
89
What are the cervical nerve root tests
- spurling
- adson: have patient elevate chin and rotate head toward affects side while inspiring deeply - look for obliteration of radial pulse on affected side; dx = thoracic outlet
- Hoffmann: grasp middle finger and quickly snap or flip dorsal surface - look or quick flexion of thumb and index finger; dx = cervical myelopathy (cervical spinal stenosis)
90
What is the treatment of cubital tunnel
Always with surgery b/c causes nerve damage
91
What are the functions of radial n
Motor to triceps, anconus, wrist extensors; sensation to dorsum of hand
92
Where can the radial n be entrapped
- high on humerus secondary to fracture - sx wrist drop, weakness of elbow flexion, possible triceps involvement, pain/numbness; function usually returns in 4-5 months
- radial tunnel: caused by repetitive rotatory movements (rowing, racket sports); sx pain and tenderness 5cm distal to lateral epicondyle wrist drop or pain with supination
- at the wrist - sup branch binched btw brachioradialis and ECRL during pronation; sensation lost over posterolateral hand
93
What is compression of superficial radial n called
Cheiralgia parestheticca aka wartenberg’s syndroem aka handcuff neuropathy
94
What are the functions of median n
Forearm flexion and pronation, wrist flexion and radial deviation, thumb abduction and opposition, index and middle finger abduction and flexion
95
What motions would cause pronator syndrome
Pianists, baseball players, dentists, weight trainers, fiddlers; sx: achy pain in mice forearm and pan with resisted forearm pronation
96
What is the treatment for anterior interosseous syndrome
Elbow can be splinted in 90 degrees of flexion for 12 weeks
97
What is the gold standard for dx of carpal tunnel
EMG
98
What makes up the initial tunnel
Medial epicondyle, medial trochlea, olecranon, ulnar collateral lig
99
What are the sites of compression for thoracic outlet
Scalene triangle, costoclavicular passage, at pectoralis minor attachment at Coracoid process
100
What test should you order for suspected thoracic outlet
Cervical XR and chest XR if not diagnostic then EMG
101
What are the nerve roots for the LE nerves at risk of compression
Common fib, deep fib and post fib are all L4-S2; lateral fem cutaneous is L2-L3
102
What do each of the n roots of the LE do
- L2,L2: hip flexion; sensation of inguinal crease (L1) and ant thigh (L2)
- L2,L3: knee extension; L3 - ant thigh just above knee
103
Where is the tinel’s sign for meralgia paresthetica
1 cm medial and inf to ASIS
104
What is the etiology of common fibular n compression
Bedridden, squaring, ankle sprains or trauma, new meditators, lithotomy position
105
What exacerbates common fib n sx
Plantarflexion and inversion
106
What is the treatment for common fib n entrapment
Post fib he’d, ME on gastroc biceps femoris
107
What is ant tarsal tunnel syndrome
Deep fib n compression at inf extensor retinaculum; pain over dorsomedial aspect of foot and worse at rest; weakness of extensor digitorum brevis; caused by trauma, talonavicular dysfuntion, prolonged plantar flexion, compression from shoes
108
What is the treatment for anterior tarsal tunnel syndrome
Remove compressive forces, myofascial release of extensor retinaculum; traction tug of talonavicular joint; hiss whip for navicular cuneiform and 1st and 2nd metatarsla
109
What is tarsal tunnel syndrome
Compression of post tibial n in tarsal tunnel behind medial malleolus and overlying flexor retinaculum; sx: pain on plantar surface of foot; no gait changes; treat with MFR, HVLA
110
What is the majority of sciatica caused by
SI ligament weakness
111
What is important when treating sciatica
Hamstring needs to be treated during same treatment as quads; adductors need to be released first
Tight hamstrings will increase laxity of ACL and increase tension on PCL
112
What is compressing the structures in adsons when looking towards vs when looking way
Scalene looking away; rib one looking towards
113
What mm would be hyper vs hypo tonic in lower crossed
- hyper: iliopsoas, rectus femoris, hamstring, Piriformis, LE short adductors, QL, TFL
- hypo: peroneals, abdominals, vastus medialis, ant tibialis, gluteals
114
What is the stretch for iliopsoas
Knee, contract butt mm (rectus femoris same but pull back leg up)
115
What does upward dog stretch
Iliopsoas
116
What is the quadratus lumborum lateral recumbent stretch
Drop leg off like ober test and reach up over head
117
When should strengthening exercises be done
Only if patient is pain free
118
How do you retrain ab/adduction
Start on all fours and lean back toward right and then left
119
What are the hyper vs hypo Tonic mm in upper crossed
- hyper: upper trap, levator scalp, lat, pectorals, subscap, UE flexors, SCM, scalene
- hypo: mid and lower trap, rhomboids, Supra and infra spinatus, serratus anterior, deltoids, UE extensors, deep neck flexors
120
How do you stretch the diff scalene
No rotation: middle, rotate towards: anterior, rotate away: post
121
What is the scalene self tx
Anchor 1st and 2nd ribs sidebnd way and rotate toward; posteriorly translate
122
What is self ME for lats
Lay on side, raise arm above head and behind head
123
What is the prayer stretch for
Latissimus Dorsi; use chair
124
What is the subscap gravity self stretch
Lay on back, raise arm midway in palm up position
125
How do you retrain scapular stabilization
Use wall; push wall away then allow body to go forward while uncurling neck
126
What are the “dos and donts of scalenes”
Do: use elbow rest, reading light, elevate bed 3-31/2 inches , use pillow that is nor foram rubber, keep neck and shoulders warm at night
Don’t: carrying awkward packages, lift head when rolling over, using glasses that have thick lower rims, turn he’d to hear someone with better ear
127
What is the firing sequence for shoulder abduction
Supraspinatus, deltoid, infraspinatus, mid and lower trap, contralateral quad lumborum
128
What is the firing pattern for LE abduction
Ipsilateral gluteus medius, ipsilateral TFL, ipsilateral QL, ipsilateral e spinae
129
What is counterstrain for scalene
FStRt
130
What is counterstrain for levator scapula
Extend arm and add traction or compression
131
What is the counterstrain for SCM
FSTRA
132
What is the counterstrain for AC
AC1: RA
AC2-6:FSara
AC7:FSTRA
AC8: FSara
133
Where is the TFL counterstrain point
Inferior to iliac crest in body of TFL; treat - knee abducted and flexed
134
Where is the IT band counterstrain
Distal to lateral trochanter; treat - hip abducted and flexed
135
Where is the lateral hamstring counterstrain
Distal aspect of biceps femoris; treat - knee flexed and tibia externally rotated with slight abduction; compression on calcaneus is addd to plantarflex ankle
136
What is the medial hamstring counterstrain
Distal aspect of medial hamstring tendons; grasp lateral ankle to control lower leg; knee flexed and tibia internally rotated with slight adduction; compression on calcaneus added
137
What is the lateral meniscus/LCL counterstrain
Lateral knee joint line; patient supine; thigh abducted so leg is off table, flex knee 35-40 degrees, tibia abducted and ext or int rotated may require dorsiflexion and eversion
138
What is medial meniscus/MCL counterstrain
Medial knee joint line; patient supine; thigh abducted so leg is off table, flex to 35-40 degrees, tibia addicted and internally rotated may required plantarflexion and inversion
139
What is the anterior cruciate counterstrain
Superior aspect of poplital fossa adjacent to hamstring tenons; supine; towel roll under distal femur - apply force to prox tibia to translate posteriorly
140
What is the counterstrain for posterior cruciate
Slightly below center or pop fossa; supine; towel roll or pillow under prox tibia apply force to distal femur posteriorly
141
What is the popliteus counterstrain
Prone; knee flexed and tibia internally rotated
142
What is the gastroc counterstrain
Prone; patient knee flexed and dorsum of foot on doc’s thigh; add compressive force through calcaneus
143
What is the tibialis anterior counterstrain (medial ankle)
Anterior inferior to medial malleolus along deltoid lig; lateral recumbent with pillow under affected leg; apply inversion with slight internal rotation
144
What is the fibularis counterstrain (lateral ankle)
Anterior and inferior to lateral malleolus in sinus tarsi; lateral recumbent with pillow under affected leg; apply eversion force to foot and ankle with slight internal rotations
145
What is the flexion calcaneus (quadratus plantae) counterstrain
Anterior aspect of plantar surface of calcaneus at attachment of plantar fascia; supine or prone; patients knee flex, dorsum of foot on doc’s thigh; marked flexion while translating calcaneus toward forefoot
146
What is the navicular counterstrain
Patient supine or prone; patients knee flexed, dorsum of foot on doc’s thigh plantar flexion of subtalar joint supination of forefoot
147
What is the supraspinatus counterstrain
Superior to spine of scapula; supine arm flexed abducted and externally rotated
148
What is the infraspinatus counterstrain
Upper: inf and lat to spine of scapula (post med aspect of GH joint); supine; arm flexed 90-120 degrees and abducted Er/Ir
Lower: lower portion of m inf to spine and lat to medial border; lateral recumbent TP up; doc in front or behind patient; flexed 135-150 degrees abducted and Er
149
What is the levator scapulae counterstrain
Prone head rotated away; IR shoulder add traction with min abduction
150
What is the rhomboid counterstrain.
Medial border of scapula at attachment of rhomboid mm; seated or prone patients shoulder extend abducted by pulling elbow posterior and medially
151
What is the subscapularis counterstrain
Anterolateral border of scapula; supine; ext and int rotate shoulder (maybe traction)
152
What is the biceps long head counterstrain
In bicipital groove; elbow and shoulder flexed arm abducted and internally rotated
153
What is the counterstrain or short head biceps/coracobrachilias
Inferolateral aspect of coracoid process of short head; supine; elbow and shoulder flexed arm adducted and internally rotated
154
What is the radial head (supinator) counterstrain
Anterolateral aspect of radial head at supinator attachment; supine or seated; elbow full extension forearm supinated fine tune with valgus force
155
What is the medial epicondyle (pronator teres) counterstrain point
Supine or seated; patients elbow flexed pronated and adducted
156
What is the dorsal wrist (extensor carpi radialis) counterstrain
Dorsal surface of second metacarpal; supine or seated; wrist passively extended and abducted
157
What is the dorsal wrist (extensor carpi ulnaris) counterstrain
Dorsal surface of 5th metacarpal; supine or seated; wrist extend and adducted
158
What is palmar wrist (flexor carpi radialis) counterstrain
Palmar base of 2nd or 3rd metacarpal in flexor Carpi radialis m; supine or seated; wrist flexed and abducted
159
What is the palmar wrist (flexor carpi ulnaris) counterstrain
Palmar base of 5th metacarpal in flexor carpi ulnaris m; supine or seated; wrist flexed and adducted
160
What is the first CMP (abductor pollicis brevis)
Palmar base radial aspect of first metacarpal; supine or seated; wrist flexed thumb abducted
161
What is rib 1 inhalation MET
Flex sidebnd towards rotate away; inhale exhale
162
What is SC adducted SD MET
Extend and internally rotate arm
163
What is SC extension MET
Patient grabs arm - patient pulls shoulder down toward table
164
What is wrist isotonic MET
Cross thumbs; while patient flexes apply pressure; lighten force to allow patient to overcome force
165
Where is upper vs lower pole
Upper is superomedial border of PSIS
| Lower is inferior aspect of PSIS
166
What is posterior fibular head MET
Pronate foot; patient supinates
167
What is posterior fibular head HVLA
Monitor fib head with MCP of index finger; flex hip and knee to 90; evert, dorsiflexion and externally rotate ankle, rapidly flex knee while applying anterior thrust to fibular he’d
168
How do you do fibular head BLT
Thumb of cephalon hand on superolateral aspect of fib head; caudad hand distal fibula; thumb applies pressure toward foot while caudad hand inverts foot
169
What is calcaneus inv eversion HVLA
One hand holds calcaneus other holds dorsum of foot; apply caudad traction thrust
170
What are the sx of bursitis
Pain with activity, none at night; tender and warm to touch; caused by trauma, prolonged pressure, overuse
171
What are the sites of inflammation in dequarvains
Tendon sheath, abductor pollicis longus, extensor pollicis brevis
172
What is the tx for fibromyalgia
SSRI/SNRI sleep exercise
173
What is the criteria for fibromyalgia diagnosis
Pain and sx over past week plus fatigue, waking unrefreshd, cognitive problems; sx lasting at least 3 months, no other healt problems that wold explain
174
What is meloxicam used for
OA, RA; not in CABG
175
What is dolexitine used for
Depression, anxiety, diabetic neuropathy, fibromyalgia, GAD, chronic MSK pain
176
What is the SC adducted (elevated) still technique
Patient seated; physician behind; adduct and extend elbow add compression toward SC joint; move shoulder into superior glide and abduction engaging a post circumspection motion
177
What is the SC depressed still technique
Patient seated; physician behind; abduct and flex elbow add compression toward SC joint; move shoulder into adduction with anterior circumspection motion returning to adduction position
178
What is the AC separated still technique
Patient seated; doc in front; affected side abducted with extension apply traction and move arm into adduction and flexion
179
How do you grade an ankle sprain
- 1: microscopic tear; mild tenderness and swelling
- 2: partial tear; moderate tenderness and smelling; abnormal looseness
- 3: complete tear; if doctor pulls or pushes ankle substantial instability
180
What are the Ottawa ankle rules
Radiograph if point tenderness at post edge or tip of lateral malleolus, point tenderness at posterior edge or tip of medial malleolus or inability to bear weight (four steps) immediately and in ER
Foot pain - if point tenderness at base of 5th metatarsal, navicular or inability to bear weight (4 steps)
181
What lower extremity problems present with issues of ascending motion
Pes answerine bursitis, patellofemoral pain syndrome
182
What are the sx of lower crossed syndrome
Increased sacral flexion and lumbar lordosis, increased flexion of hips, knees
183
What ligaments does Talar tilt test
Calcaneofibular and deltoid
