final exam Flashcards
list your protocols for applying friction technique:
area warmed with GSM
adhesions found by stripping
CFF applied
fingers dont glide
hand placement/ergonomics correct
pain scale established
check in w/ client about px
flush after frictions
stretch
ice massge CBAN
list protocols for applying trigger point therapy technique:
warm w/ GSM
TP found by stripping
pain scale
ischemic compressions
check in w/ client about px
pressure released after cx says px/referral diminished to 2/10
heat & stretch
hand placement and ergonomics
what homecare would be appropriate for someone experiencing acute plantar fasciitis? what about chronic plantar fascitis?
acute:
- forzen water bottle/marbles
- MLD
- PR ROM
- elevate
- rest
chronic:
- DMH on calf
- stretch gastroc/soleus/toe extensors
- self massage
- stretch intrinsic mm
- orthotics
what happens with the medial longitudinal arch when someone with functional pes planus is NOT weight bearing? what about with structural pes planus?
functional: will change
structural: wont change
transverse fracture
stays in place after reduction. clean break of bone across. heals more rapidly
oblique fracture
angle force to bone. hard to keep in place after injury
spiral fracture
when the bone twists/spirals during injury. hard to keep in place, small tissue damage
comminuted fracture
often unstable. consist of 2 or more fragments
avulsion fracture
ligament pulls a portion of bone away that it is attached to
osteochondral fracture
fragments of articular cartilage are sheared from joint surface
compression fracture
the bone is crushed. occurs in cancellous bone (ie. vetebral body)
greenstick fracture
“hair line fracture” bone is bent or partially broken. most common in children younger than 10
perforation fracture
result of a gunshot would to bone
stress fracture
cracks in the bone due to overuse or repetitive actions, common in runners to the tibia
MOI for colles fracture
FOOSH in extension (fork looking)
MOI for Galeazzi fracture
fall on hand w/ some rotational component. rotation causes the fracture
MOI for pott’s fracture
lateral blow causing over pronation of foot (eversion)
MOI for Dupuytrens fracture
eversion with external rotation of the ankle
what intake quesitons would be useful to ask your client when suspecting tendinitis?
- what activities/movements cause pain?
- where is the pain?
- what are the present symptoms? how long have these symptoms been present?
- what is the clients recreational/occupational posture?
- previous injury to affected limb?
- new activity/increase in duration.speed of activity?
- has condition been diagnosed by physician?
- supports/brace during activity?
- NSAIDS? steroids?
- does cx have a stretching/strengthening program and is is being followed?
does tendinitis heal quickly or slowly? why?
slowly, limited blood supply
list and describe the grades of tendinitis
1: px after activity
2: px before and after
3: px before, during and after. px may restrict acitivity
4: px with ADL’s, continues to get worse
speeds test
purpose: bicipital tendonitis if pain, strain if weak
action: standing. they resist shoulder flexion while supinating and then pronating
positive: tenderness in the bicipital groove and/or weakness
drop arm test
purpose: tear in rotator cuff
action: we abduct the shoulder 90 degrees, cx slowly lowers
positive: unable to return arm slowly or px
hawkins kennedy
purpose: supraspinatus tendontitis
action: client seated, flex their arm and elbow then medially rotate shoulder
positive: face shows pain
cozens test
purpose: tests for lateral epicondylitis
action: stabilize elbow (sitting), palpate lateral epicondyle with one hand. they make a fist and forearm pronated. resist radial deviation and extension
positive: pain over lateral epicondyle
mills test
purpose: tests for lateral epicondylitis
action: arm out (flexed) a little, elbow extended, wrist flexed an resist wrist flexion
positive: pain over lateral epicondyle
medial epicondylitis test
purpose: test for medial epicondylitits
action: forearm supinated, extend wrist for them while palpating medial epicondyle
positive: pain over medial epicondyle
mortons test
purpose: test for neuromas/stress fracture
action: client supine. therapist grasps foot around metatarsal heads and squeezes the together
positive: pain between bones= neuroma’ pain on bone= stress fracture
thompsons test
purpose: achilles tendon rupture
action: prone with feet over the edge of the table and leg mm relaxed. squeeze the affected gactroc/soleus mm
positive: absence of plantar flexion when mm is squeezed
fabers test
purpose: hip joint pathology. iliopsoas spasm or SI may be affected
action: client supine, test leg ankle over knee of opposite leg, push on test leg and stabilize hip with other hand
positive: if leg remains above opposite leg or pain in hip/SI indicates SI/hip/iliopsoas
obers test
purpose: IT band/TFL contracture or trochanteris bursitis
action: side lying. lower leg is flexed for stability. upper leg abducted and extended back, knee flexed and slowly lower to the table
positive: contracture= leg will not lower. bursitis=pain over GT
(consider functional pes planus) how will the medial longitudinal arch be affected?
decreased
(consider functional pes planus) which mms will likely be lengthened/weak?
tib anterior
tib posterior
extensor hallucis longus
(consider functional pes planus) which mms will likely be shortened/hypertonic
gastroc
soleus
peroneals
(consider functional pes planus) what are some associated conditions with pes planus?
plantar fasciitis
(consider functional pes planus) will the joints in the medial longitudinal arch be hyper- or hypomobile?
hypermobile
(consider functional pes planus) what ranges may be limited with AF ROM?
- eversion of the calcaneous is greater than 10 degrees
- dorsiflexion of the ankle may be limited with severe pes planus
(consider functional pes planus) what is your primary treatment goal/aim
- decrease SNS
- treat compensatory
- treat other conditions (tendonitis, ITB contractures)
- reduce fascial
- reduce HT, TP, adhesions
- stretch shortened mms
- increase local circulation
- encourage circulation to weak and taut structures
- mobilize hypomobile joints
(consider functional pes planus) list the causes of pes planus?
- hyper mobility of foot
- poor biomechanics
- shortened mms (gastroc, soleus, achilles)
- weakness in supporting structures ( tib pos)
- habitual poor posture
- nerve lesion to common peronal or posterior tibial nn
- trauma to foot/ankle
- foot weak with poor support to MLA
- congenital abnormalities in bones of foot/legs/thigh
if a client has a chronic sprain to the anterior talofibular ligament, which would you want to strengthen to act as a “splint” for the injured area
tibialis posterior and anterior, and the peroneals
what ligament is most commonly sprained in the knee?
MCL
which of the RC mm’s is most ocmmonly affected by tendinitis?
supraspinatus
in which position should the arm be to perform frictions to the supraspinatus tendon?
elbow flexion
humerus internally rotated and extended
in which position should the arm be to perform frictions to the tendon of long head biceps brachaii?
extension
define a bakers cyst
enlargement of the extracapsular bursa b/t the gastroc & semimembranosus mm or a herniation of the synovium through the posterior joint capsule wall
what is the most appropriate form of hydro for someone with acute bursitis? what are some CI’s with hydro and acute bursitis?
CI’s
- no compression of the bursa with the hydro
Hydro
- cold donut around the bursa
- frozen towel
location of trochanteric bursitis?
one is between the glute max tendon and trochanter
one is between glute med and trochanter
location of iliopectineal bursitis
between the iliopsoas mm and iliofemoral ligament
location of ischial bursitis
bewteen glute max and ischial tuberosity
location of infrapatella bursitis
between the patellar ligament and tibia
location of retrocalcaneal bursitis
between achilles and calcaneus
location of subacromial bursitis
between the acromion and the supraspinatus tendon
location of subcoracoid bursitis
through the anterior deltoid mm near acromion
location of subscapular burisitis
between scapula and subscap mm
list some complications associated with fractures:
compartment syndrome
nerve compression
vascular damage
bone and soft tissue infections
DVT
pressure/plaster sore
cast dermatitis
loose cast syndrome
list and describe the grades of sprains:
grade 1:
- minor stretch & tear to ligament
- no instability on PR testing
- can continue with some discomfort
grade 2:
- tearing of ligaments & fibers (several to majority)
- snapping sounds @ injury & joint gives way
- joint hypermobile yet stable on PR testing
- difficulty continuing activity due to px
grade 3:
- complete rupture or avulsion fracture
- snapping sound @ injury & joint gives way
- instability w/ no end point on PR testing
- person cannot continue due to px & instability
- px present in actue phase & hypermobile in the direction
what complications can result from prolonged ischemia to a tendon, usually due to compression of a nearby bony structure?
tendinosis
what is tendonosis and how is it different from chronic tendinitis?
tendonosis: tendon changed permanently
chronic tendonitis: hasn’t changed permanently
what is myositis ossificans?
when mm tissue eventually will ossify
how would you approach the treatment of an acute grade 3 sprain injury that has not yet been assessed by a MD?
refer them to MD
what type of force will injure the MCL? LCL?
MCL: knee is struck by a medially directed force/valgus force
LCL: knee is struck by a lateral directed force/varus force
what is loose cast syndrome?
end up with blisters between cast & skin from being loose
how long does it take for union of the bone to occur with a fracture?
4 weeks - stage 3
with AR ROM for a client experiencing plantar fasciitis, what ranges would you expect to show weakness?
sime weakness in metatarsophalangeal extension & plantar flexion
length of gastroc & soleus will likely reveal shortness
describe each stage of bone healing:
1: hematoma forms around ends of fractured bone within 72 hrs. a mash of fibrin forms around injury
2:inflammation & proliferation of osteoblasts at the periosteum. these cells create pfibrocartilginour bridge between the fragment ends
3: soft callus/splind is formed from the mass of proliferating osteoblasts.
4: consolidation occurs as the immature bone is changed into mature lamellar bone
5: remodeling of irregular outer surface and reshaping of the marrow space inside the bone takes place through alterating osteoblastic & osteoclastic activity
what is wolff’s law?
where a bone responds to mechanical stress by becoming stronger and thicker the more strenuous its function
what are some CI’s for hydro for a client who has had a fracture repaired by metal implants?
no heat directly over the implants
review which structures support the medial longitudinal arch - some of these support passively and some dynamically
- long & short plantar ligmanets, plantar calcaneonavicular ligment & aponerosis
- tib pos, tib an, peroneals provide a muscular sling to support the arch
- flexor hallucis longus, flexor digitorum longus & the intrinsic mm of the foot
compare the different types of fractures and how their healing times differ. why to upper body fractures heal faster than lower body? why does a spiral fracture heal more quickly than a transverse fracture? what is the healing time for each? (rattray for further explanation)
a transverse fracture is a clean break, there is noting left intact. a sprial fracture still has some bone left intact, therefore there is less surface area to heal
what CI’s should you consider for frictions?
- not used over peripheral nerves
- acute injury
- RA
- infective arthritis
- structures that are to deep to reach
- anti-inflammatoris, anticoagulants, high dose long term steroid medications
- peripheral vascular disease
- fragility of the skin or soft tissue
what CI’s should you consider for TP’s?
- actue conditions
- hypotonis/atonic mms
- painful conditions
tissue “lumps” such as lipomas, cycts, and ganglions
tendinosis
degeneration changes with chronic overuse tendon injuries, such as tennis elbow
main cause of tendinitis
chronic overuse
what activities can cause rotator cuff injuries
swimming, golf, any throwing sports, overhead arm positions
MOI for biceps tendonitis
swimming, throwing sports where the arm is in adduction
where will adhesions form with long head of biceps of tendonitis
bicipital/intertubicular groove
laymans for lateral epicondylitis
tennis elbow
what acitivies may cause lateral epicondylitis
tennis/racket sports, poor technique, wheelchair athletes, plumbing, electrical
laymans for medial epicondylitis
golfers elbow
what is a common complaint for someone with medial epicondylitis
weak grip
anatomical teminology for mommy thumbs
dyquervians tendosynovitis
what tendons are afftered with dyquervians tenosynovitis
abductor pollicis longus and extensor pollicis brevis
MOI for dyquervians
anything with repetitive thumb use
where will pain be felt with patellar tenonitis
local to tendon it self
what can popliteus tendonitis be confused with
IT band syndrome
impingement syndrome
inflammation, pain and edema of tissues between AC & GH joints (supraspinatus, biceps, subacromial bursa)
3 stages of impingement syndrome
1: edema & hemorrhage of subacromial bursa
2: tendinits & fibrosis. both stages 1 & 2 are reversible with rest, stretching & strengthening
3: incomplete tears or complete tendinosus rupture. my be bony changes in acromion & AC joint. surgery indicated
at what point is surgery indicated with impingement syndrome
in stage 3
what is calcific tendonitis
late occurring stage of RC tendinitis, usually in supraspinatus tendon
trigger finger
overuse of flexor tendons that may develop a thickened, nodular swelling. swelling is unable to move through the tendon sheath and gets stuck
how will ROM be affected with tendonitis
AF: usually painless
PR: pain on actions that fully stretch the tendon
AR: px on contraction of the mm of affected tendon which increases with force of contraction, as well as possible weakness
tendonitis differentiation test
apply resistance. pain at the beginning=bursitis
pain as your increasing resistance= tendonitis
length test
put mm in stretched position, compare bilaterally
ROM tendonitis
PR PF mid range
exercise for chronic tendonitis
isotonic eccentrics
between which structures will you find bursa
usually between tendon and bones
causes of bursitis
overuse of surrounding structures which leads to excessive friction and inflammation of bursal walls
common associated condition with burisits
tendonitis
contributing factors to bursitis
poor biomechanics
mm imbalance
postural dysfunctions
lack of flexibility
(less common: acute trauma, infection & pathologies (ie. RA, OA, gout))
acute burisits- what most likely casues it
direct blow
what do px feel like with bursitis
burn
fiesse line test
purpose: test for plat feet
action: mark apex of mallelous & plantar aspect of 1st metatarsal MTP joint. which client is not weight bearing as well as the navicular tubercle. client stands with feet 3-6 inches apart. observce where the mark is made on the navicular tubercle
positive: navicular tubercle moves closer to floor
