Final Exam Flashcards
Biopsychosocial Model
Biology: how does their body work
Psychology: current mindset
Social: what do they do, what is around them, who is around them
Open-Ended questions
-use at the beginning
-use when difficulty opening up
-use when clarifying any missing information
Close-Ended questions
-clarify questions
-get specific answers
Graded-Response questions
-quantify experience with a range
-clarify vague answers
-use for goal setting
Multiple-Option Questions
-often visual
-use for patients with difficulty describing
-identify patterns
Pre-Interview
-review chart and Hx
-observe patient’s posture, demeanor, company, movements
-establish first impression
Chief Complaint
-Onset
-Location
-Description/Duration
-Intensity
-Behavior
Injury Descriptions: Aching
Muscular
Injury Descriptions: Burning
Muscular or neural
Injury Descriptions: Shooting, lightning, electrical
Nerve root irritation
Injury Descriptions: Coldness
Blood flow issues
Injury Descriptions: Hotness
inflammation or infection
Injury Descriptions: Clicking, snapping, popping
ligament or tendon dysfunction
Injury Descriptions: Joint locking
Cartilage tear, looseness, misalignment
Injury Descriptions: Global weakness or fatigue
Cardio or pulmonary dysfunction
Injury Descriptions: Whole body pain
-central somatization: chronic pain
Injury Onset: Acute
-quick
Injury Onset: Subacute
-has no timeline, but not chronic
Injury Onset: Chronic
-long term
Injury Onset: Episodic
-Chronic with recent exacerbation
Injury Onset: Insidious
- no plausible explanation
Injury Location
-show location
-describe any movement
Injury Intensity
-pain tools/scales
-numbers
Injury Behaviors
-exacerbating factors
-Alleviating factors
-changes in 24h
24h Pain Pattern
-“Over the course of 24h how does your pain change?”
-joint and back pain
-how does it effect sleep
-how often do you think about your pain
Jt pain worse in AM
-inflammatory
-Ex: RA
Jt pain worse with movement
-degenerative
-OA
Back pain worse in AM and then again in late PM
Disc
Red Flag for Malignancy
Constant intense pain, worse PM, awakes from sleep without relief
Red Flags Requiring Immediate Attention
-anginal pain no relieved in 10-20min
-angina with sweating, nausea, vomiting
-Diabetic client that is confused or lethargic
-onset of incontinence or saddle anesthesia
-anaphylactic shock
Yellow Flags
-proceed with caution
-psychological
ABCs of Radiographs
A: alignment or structures
B: Bone density and textures
C: Cartilage
S: soft tissues
Patient History
-Determine understanding of condition
-determine current interventions from other clinicians (current and other conditions)
-prior level of function
-health habits/risks
-Medications
-past PT experiences
-Family Hx
Patient Environment
-Physical environment
-Living environment/Assistance
-Work/recreation/social/school/sport
Mental Orientation Assessment
-AOx3
-Name, location, current date
Nominal Measures
-categorized
-one or the other
Ordinal Measures
-order/rank is important
Interval Measures
-real numbers that can be manipulated
-have no real 0
ex: ankle circumference
Ratio Measures
-real numbers that can be manipulated
-real 0
ex: goniometer reading, pain scale
Test-Restest Reliability
-reliable accurately and consistently
-stability over time
Intra-Rater Reliability
-reliable accurately and consistently
-same for the same person
Inter-Rater Reliability
-reliable accurately and consistently
-Same for all raters
Face Validity
-does it measure what it claims to
-Does a scale measure weight?
Content Validity
-does it measure the full construct
-Does an ADL insttrument include all ADLs
BATTED
-ADLS: activities of daily living
-Bathing
-Ambulation
-Toileting
-Transfers
-Eating
-Dressing
MDC
-Minimal detectable change
-amount of change that must be achieved to reflect true statistical difference
MCID
-Minimal clinically important difference
-smallest difference in a measured variable that signifies and importance
Global Disability/QoL
-measures overall disability and quality of life
-patient perceptions of how conditions affects their role in society
-broad range of health
Ataxia
-lack of control of body movements
Dysmetria
-error in trajectory
-inability to touch target
Anesthesia
-complete loss of sensation
Hypoesthesia
-abnormally low sensitivity to sensation
Hyperesthesia
-abnormally high sensitivity to sensation
Hypalgesia
-diminished sensitivity to pain
Graphesthesia
-recognizing writing on skin
Hyperalgesia
-incrreased sensitivity to pain
Astereognosis
-inability to recognize familiar object by touch
Atopognosis
-inability to corrrectly locate sensation
Abaragnosis
-inability to distuingiush different weights
Paresthesia
-Abnormal sensation
Dysethesia
-impairment of any sensation
Paralysis
-loss of motor function
Hemiparaplegia
-paralysis of lover half of one side of body
Hemiparesis
-muscular weakness or partial paralysis on one side
Hemiparaesthesia
-pertaining to hemiparesis
Hemiplegia
-paralysis on one side of body
Paraparesis
-partial paralysis of LEs
Paraplegia
-paralysis of LEs
Tetraplegia
-paralysis of all extremities
Quadriplegia
-paralysis of all extremities
Triplegia
-paralysis of 3 extremities
Diplegia
-paralysis of either both UEs or LEs
AROM
-muscle strenth, coordination, willingness to move
-contractile tissue integrity
-if they can do AROM, no need for PROM
PROM
-integrity of joints, extensibility of CT, endfeels of joints
-diagnostic
-slightly > AROM
Capsule Pattern
-pattern/order of restriction involving most ROMs in a joint
Hip Capsular Pattern
-IR then Flexion
Elbow Capsular Pattern
-ER then flexion
Empty End Feel
-no resistance
-presence of pain
Shoulder Capsular Pattern
-ER, AB, IR
Injury Severity
Strong & Painless: intact
Strong & Painful: minor
Weak & Painful: Major
Weak & Painless: complete lesion or neuro deficit
Thomas Test
-LE flexibility
-edge of plinth
-bend both knees
-bend one, let other down and check for discrepancies
-flexed hip with knee 90: iliopsoas
-ext hip with >90 knee: rectus
-abducted: ITB
-flx hip and ER: short sartorius
Ely’s Test
-short rectus fem
-prone, passive knee flexion
-check for hip rise
Craig’s Test
-femoral retro/anteversion
-prone, knee flexed
-ER and IR until Greater troch is parallel with mat
-light reliable
Piriformis Flexibility Test
-hip flexed to 100, maximally ER
-slowly adduct to get stretch of piriformis
-stand on opp side
Testing Order For Class
- Dermatome
- Periperal N.
- Opposite Tracts
- Myotome
- Reflexes
- ROM Screen
- ROM Testing
- MMT
- Outcome Measure
Neck Outcome Measures
OM: NDI
Screens: Posture, Sitting Posture
Implication Tests: SLE with Dural Stretch, Slump Test
Performance: TUG, Cervical Deep Flexor Endurance
Shoulder Outcome Measures
OM: quickDASH, DASH
Screens: Scapulohumoral Rhythm, Posture, Overhead Reach
Implication Tests: Apley Scratch Test/Cross Body
Performance: Hand Grip Dynamometry, UE Y-Balance Test
Elbow Outcome Measures
OM: qDASH, UEFS, Carpal Tunnel Syndrome, Michigan Hand Questionnaire
Screens: Arm Curl, Carying Angle
Implication Tests:
Performance: Hand Grip Dynamometry, UE CKC Stability
Wrist/Hand Outcome Measures
OM: DASH, UEFS, Michigan Hand Questionnaire
Screens: Hands at Rest and Fist, Tinel’s Test, Phalen’s Test
Implication Tests:
Performance: Hand Grip Dynamometry, UE CKC Stability
Back Outcome Measures
OM: Oswestry Low Back Disability Index, Neck Disability Index, STaRT Back Tool, Functional Lumbar Index (projected)
Screens: Posture, Sitting Posture, Gait
Implication Tests: Slump Test,
Performance: TUG, Cervical Deep Flexor, 5x Sit to Stand or 30s, Sorensen Endurance, Prone Plank, Side Plank
Hip Outcome Measures
OM: LEAP, LEFS, LEAS, Harris Hip Function Scale, HOOS
Screens: Half/Full Squat, Gait, Posture, SLR, Leg length discrepancy
Implication Tests: Ober’s, Thomas, Ely’s, Quadrant Test (w or w/o Scour), SI Tests, FADIR, FABER,
Performance: TUG, 6 MWT, Hop Test, Y-Balance, Vertical Jump Test, 12’ Drop Jump Test
Knee Outcome Measures
OM: LEAP, LEFS, LEAS, KOOS,
Screens: Half/Full Squat, Gait, Posture
Implication Tests: Popliteal Angle, Ober, Thomas
Performance: TUG, Wall sit test, Hop Test, Y-Balance, Vertical Jump Test, 8’ Step Down, 12’ Drop Jump Test
Ankle/Foot Outcome Measures
OM: LEAP, LEFS, LEAS, FFI, FADI, FAOS, FAAM
Screens: Half/Full Squat, Gait, Foot Posture
Implication Tests: Feiss Line, Figure 8, Windlass Test
Performance: TUG, Vertical Jump, Hop Test, Y-Balance, 12’ Drop Jump Test
Most Common Areas of Spine for Disc Pathology
-C6-C7
-L4-L5
-L5-S1
Common Spinal Hinge Points
-transititon areas that that a lot of pressure
Cervicogenic Headache
-starts a neck, migrates to head
-upper cervical dysfunction
Sinus: around nose and eyes
Cluster: behind eyes
Neck: top and back of head
Tension: forehead
Migrane: 1 side
TMJ: temples
Tests:
-AROM
-MMT
-Sensation
-Reflexes
Questions:
-screen time
-MOI
-areas of head/face
Whiplash
-muscle tightness, brain stem-like Sx
Tests
-JPSE laser
-ROM
-Reflexes
-Myotomes/Dermatomes
Outcome Measures
-NDI
-Kinesiophobia
-Grip test
-Flexor endurance
Lumbopelvic Rhythm
1st lumbosacral flexion, then anterior pelvis tilt, hip flexion
SIJ Hypermobility
-common with pregnancy
-unilateral activities
-pain radiating behind leg
-inability to stand or sit for a while
Tests
-MMT (trunk and hip)
-AROM
Outcome Measures
-Plank
-Sorensen
Cervical AROM Values
Flx: 40
Ex: 50-70
LSB: 22
Rot: 70-90
Thoracolumbar AROM Values
Flx: 60
Ex: 25
LSB: 35
Rot: 45
Lumbar AROM Values
Flx: 40-50
Ex: 15-20
LSB: 25
Impingement Syndrome
-compression and damage to soft tissue within the structure (MC: subacromial, supra, infra, bicep)
S/S: pain 60-120 deg, pop or click, anterolareral pain
Cause:
-acromion shape
-overhead reach
-foosh
-RTC weakness
OM: DASH, UEFI, Grip, Wall overhead reach
Rotator Cuff Tears
-SITS
I: Bursitis or tendonitis, pain
II: partial rotator cuff
III: full thickness, loss of ROM and strength
S/S: pain when ER/IR, , upper trap atrophy, Shrug Sign (shrug needed for flexion to compensate torn supra)
Cause: chronic and degenerative
Intrinsic: blood supply
Extrinsic: acromion morphology, acute injury
Better: out of aggravating position, retraction
Worse: recruitment of supra, protraction
-Surgical: immobilized, no AROM for 4-6w, limited PROM ER, Ab, IR
Shoulder Labral Tears
-SLAP (superior labrum ant to post): overhead throwing, hyperextension, pain with flx
-Bankheart: labral tear (2-6oclock, bicep tendon ass. anteriorinferior)
-Psterior Labral Lesions (internal impingement)
S/S: aching, instability, catching, popping, feels heavy
Cause: FOOSH, overhead mmt, traction, trauma, dislocation, impingement
Worse: overhead activity, liting, hands behind back, flexion
Adhesive Capsulitis
-inflamed and stiff shoulder capsule
S/S: loss of ROM, pain in deltoid, nocturnal pain hallmark
Phase 1: insidious, nocturnal pain
Phase 2: diminished pain, ROM loss
Phase 3: pain gone, ROM increases 12-24
Cause:
Primary: insidious
Secondary: response to trauma
-DM, hypothyrpidism, hypertriglyceridemia
OM: DASH, UEFI, hand grip, overhead reach
Shoulder ROM Values
Flexion: 180
Extension: 50-60
Abd: 180
Internal Rot: 70-80
External Rot: 90
Scapular Resting
-T2-T7
-3 in from SP
-slight upward rotation
AC Joint Sprain
-FOOSH, downward force on acromion
Sx: weakness with elevation, piano key sign (severe), pop, pain @90
Posture @ Rest
-clavicle elevated 20
-Shoulders elevated 20
-acromion under ear
-khyphosis
-elbow under humeral head
-scapular T2-T7
Elbow ROM Values
Flexion: 140-150
Extension: 0
Supination: 80
Pronation: 80
Wrist ROM Values
Flexion: 80
Extension: 70
Rad Dev: 20
Ulnar Dev: 30
Finger ROM Values
-MCP:
Flex/ext: 90/45
-PIP:
-Flx/Ext: 100/0
-DIP:
-Flx/Ext: 90/0
Elbow, wrist, hand Outcome Measures
-qDASH
-UEFS
-Carpal Tunnel Syndrome Instument
-Mischigan Hand
-Hand grip
-Jebsen test of hand function
-Arm curl
-hand grip
-lateral pinch
Normal Elbow Position
-8-15 degrees of Cubital Valgus
Median Nerve Entrapment
Pec minor, scalenes, 1st rib, humeral head, cubital tunnel, carpal tunnel
-thumb and fingers 2-3, tips of fingers
Phalen’s Test: Stretch median nerve
Tinel’s Test: tap nerve
Radial Nerve Entrapment
Scalenes, triangular space, lat epi, supinator
-back of hand
Tinel’s Test
Resisted Supination
-thumbs up
Tennis Elbow
-Lateral Elbow Tendinopathy
-repetitive wrist extension and radial dev
-no inflammation
Grip Strength
-lateral pinch
Golfer’s Elbow
-medial eppicondylalgia
-repetitive wrist flexion, twisting
Grip Strength
Telephone Elbow
-Cubital Tunnel
-ulnar nerve entrapment
Sx: ulnar side gripping
Osteochondritiis Dessicans
-Lesion on capitulum
-forceful valgus
-loss of extension, catching and locking
Ulnar Nerve Compromise
-crossing fingers
-intrinsic muscle atrophy
-last 2 finger and thumb adductors
UCL Sprain
-valgus force
-Snap and ain over medial elbow
LCL Sprain
-varus force
-chronic crutch user
-radial head sublux
-unstable feeling
-popping, clicking, catching
Post-Op Elbow Patient
-brace
-ORIF AROM only
-tendon PROM only
Postural Responses
Ankle: small disturbances, most common, distal to proximal
Hip: larger disturbances, proximql to distal
Stepping: COM is displaced beyond BOS
Reaching: moving to tocuh down
Gait Cycle
Stance:
-Initial contact (Preswing): heel contact, flexion hip (20)
-Loading response (initial swing): weightshift, flexed knee (15), DF (7 lack of will show)
-Midstance (Middle Swing): Neutral hip
-Terminal Stance (Terminal Swing): extended hip (20 backwards rotation of pelvis will show it flexors are tight), DF (10 at highest)
-Pre-Swing (Initial contact): full extension, flexion (40), PF (15 need toe extension for windlass)
Swing:
-Initial Swing (loading response): toe off, most knee flexion (60), pelvis rotates to catch up
-Middle Swing (Midstance): most flexion (25)
-Terminal Swing (Terminal Swimg): right before initial contact
Double Limb Support
-20%
Single Limb Support
-80%
-running is 100%
Pelvis MMT During Gait
-3deg ant/post
-2deg sup/inf
Step
-distance foot advances in relation to the other (heel to heel)
-18 inch norm
Stride Length
-distance from one foot back to the same foot
-Right heel to right heel
-3 ft norm
Step Width
-horizontal disrance between heels
-2-4 inches
Cadence
-number of steps per min
-117/min
Velocity
-speed of walking
-1.2-1.4 m/s
Circumduction Gait
-trunk and pelvis rotate anteriorly
-propels leg forward to avoid knee flx
Foot Drop
-toes drag with no DF
-cast or fibular fx can cause
Hemiplegic Gaitt
-one side of body is weak
-cerebral palsy, tbi, stroke
Antalgic Gait
-short stance on pain side
Ataxic Gait
-lack of coordination
Scissor Gait
-crossing over
-tightness of hib adductors
-cerebral palsy
Parkinsonian Gait
-shuffling feet with flexion placing weight on balls of feet
Steppage Gait
-excessive hip and knee flexion to clear limb
Vaulting Gait
-rapid ankle PF to clear limb
Plumb Line
-ant to mastoid
-anterior acromion
-post to hip
-anterior to knee
-anterior to malleolus
Crossed Syndrome
-anterior superior to posterior inferior= weak and stretched
-posterior superior to anterior inferior= tight and contracted
Postural Sway
-anterioposterior is 5-7mm
-mediolateral is 3-4mm
Pressure on Lumbar Discs
-sitting with flexion while carrying = 275lbs
-standing with flexion while carrying= 220lbs
-laying on back= 25lbs
Anterior Pelvic Tilt
-tight errectors and hip flexors
-weak glutes and abs
Posterior Pelvic Tilt
-weak errectors and hip flexors
-tight glutes and abs
Coxa Valga
-greater angle of inclination >125
-straighter
-longer limb
-increase dislocation
-genu varum
Coxa Varum
-lesser angle of inclination <125
-shorter limb
-improved congruence
-more stress on neck
-genu valgum
Anteversion
-greater torsion than normal >20
-head more anterior
-more IR, toe in
Retroversion
-lesser torsion than normal <10
-head more posterior
-more ER, toe out
ROM Needed to rise from sitting
-hip flexion 120
ROM needed to tie shoes
-hip flx 115
-ER 13
-abd 18
ROM needed to sit cross legged
-hip flx 85
-abd 35
-ER 45
Lateral Femoral Cutaneus Neuralgia
-brittany spears
-73-81%
-L2-L3 dermatomes
Hip Dysplasia
-acettablum doesnt cover femoral head
-babies
-groining pain, possible limp, unstable, LLD
Femoral Acetabular Impingement
-FAI
-bony overgrowth
-can lead to labral tears
CAM: head and neck, athletes
Pincer: pelvis and acetabulum, females
Mixed: both, more common
Hip Osteoarthritis
-coxa valga, hip dysplasia, trauma
-hip flx posture
-decreased extension
- Squatting
- Hip flx causing lat hip pain
- Scour test
- Extension lateral pain
- Passive IR <25
3 or 4/5
Tibiofemoral Angle
-angle btwn femoral shaft and tibial shaft
-165-175
Valgum: <165
Varum: >174
Q Angle
-estimate of tibiofemoral angle
-10-15 normal, >20 malalignment
-asis, patella, tib tub
Knee ROM to Ride a bike
-115
Knee ROM to get up from a chair
-120
Knee ROM to descend stairs
-90
Knee ROM to climb stairs
-83
Knee ROM to walk
-60-70
Knee Capsular End Feel
-extension then flexion
ACL Sprain
-tear of ACL (85% of resistting ant. translation)
-females more likely
-athletic ppl
S/S: pop or tearing sensation, pain, knee giving out, decreased quad
Cause: violent twist w/o contact, joint laxity, medial blow to knee, weak hamstrings
Better: elevation
Worse: walking, pivoting, stairs, cutting
Treatment:
Surgery: Hamstring, quad, gastroc, patellar tendon grafts
-1-2 years
-necrosis, revascularization, cellerular proliferation, collagen formation
PT:
Stage 1: Inflammatory 0-14d
-ROM, inflammation
Stage 2: Reparative 15-21d
-ROM, full extension, swelling, flexibility, walking
Stage 3: Remodeling 22-60 60-360d
-pain free ROM, no limitations, return to sport
MCL Sprain
-tearing of MCL by valgus force at femoral attachment with tibal ER
-well vascularized and not under tension, can heal own on in 6w
S/S: tearing sensation, medial knee brusing, instability
LCL Sprain
-tearing of LCL by varus force at fibular attachment
-least common knee lig injury
S/S: pop sensation, lateral knee pain, instability, swelling, n/t from superficial fib
Meniscal Injury
-tearing of meniscus
-often with ACL
-Medial more common (less mobile)
S/S: popping, clicking, giving away, joint line tenderness, delayed swelling
Cause: degeneration, trauma (compressive twisting)
Patellofemoral Pain Syndrome
-pain around or behind patella
-above and below
S/S: pain descending stairs, pain during flexion and extension behind or around knee, swelling, pain with activity, grinding, clicking
Cause: overuse with force at patellofemoral with compression of knee, weak abd extensors and ERs
Better: avoidance of knee flexion
Worse: prolonged sitting, running, walking
Treatment:
-PT: contributing factors, avoid flexion based things, avoid last 30 of extension
Patellar Tendinopathy
-Tendinitis (jumper’s knee): acute inflammation of the patella
-Tendinosis: chronic degeneration
-low metabolic rate
S/S: pain ascending stairs, localized pain ant patellar tendon, swelling, pain with activity, no referral
Cause: overuse activity (3-8%) of load applied, repetitive jumping and running, eccentric
Better: rest, bracing
Worse: squatting, running, squatting
Treatment:
-PT: correction of other factors, activity mod, flexibility, abnormalities
-Surgery: if PT fails after 6mon
ITB Syndrome
-lateral knee deviations
-tight TFL, weak glutes, Positive ober
PCL Tear
-dashboard injuries
-hyperextension injury
S/s: knee swelling, instability
Pronation MMts
-eversion, abduction, df
Supination MMTs
-inversion, adduction, PF
Hallux Valgus
-bunion
-lacking extension
-angle btwn metatarsal and phalanx >15 is abnormal
Hallux Rigidus
-great toe MTP is rigid
-inflammation
Functional Capacity Evaluation
-worker’s comp
-residual capacity to perform work
-~4 hrs
-phychometric, physical and functional tests
-compares abilities to work description
Industrial PT
-promote wellness at worksites with early access
-ergonomics, prevention
Y-Balance Stats
-difference in legs with anterior position are most prredictive for non contact injuries
LESS
-12 inch box jump
Hop Test Stats
-differences in leg percentages <90% is bad
Functional Movement Screen
-hard one
-screens for mmts sharbed btwn sports
-7 tests, 3-1
-14/21 or > is goal
Selected Functional Movement Assessment
-easy one in hall way
-7 tests
- can w/o pain, can w/ pain, cant w/ pain, cant w/o pain
