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Musculoskeltal I > FINAL EXAM > Flashcards

FINAL EXAM Flashcards

1
Q

test for intrinsic tightness

A

(Brunnel Littler Test)
Passively flex PIP joint of finger, initially with MCP in flexion and then with the MCP in extension
If there is more PIP flexion when the MCP is flexed than when it is extended, intrinsic tightness exists
If there is no increase in PIP flexion, this implies a capsular tightness

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2
Q

exercises for intrinsic tightness

A

Interosei and lumbricals

The PIP and DIP joints are held in flexion as the MCP joints are extended

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3
Q

tightness of oblique reticular ligament

A

This runs palmar to the axis of rotation of the PIP joint and dorsal to the DIP joint axis
This is like the “distal intrinsics”
The DIP joint is flexed passively first with PIP in flexion and then with PIP in extension
If there is more DIP flexion with PIP flexion than extension, you have contracture of the oblique retinacular ligament

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4
Q

extrinsic flexor tightness - to test

A

Test for this by looking at the adherence or contracture of extrinsic flexors when you maintain fingers and thumb in full extension and passively extend the wrist – increasing flexor tension will occur and cause the fingers to pull into flexion the further the wrist is extended if there is extrinsic flexor tightness

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5
Q

extrinsic flexor exercise

A

The DIP, PIP and MCP joints are extended with fingers pulling them back
Wrist is slowly extended until the patient feels a stretch in the anterior forearm

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6
Q

extrinsic extensor tightness

A

Assessed by keeping all of the digits in full flexion passively and then passively flexing the wrist
If the fingers begin to pull into extension, then this is a positive sign for extrinsic extensor tightness
To test for extrinsic extensor tightness distal to the wrist, all PIP and DIP joints are flexed as the MCP is passively flexed and then you note extensor tension

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7
Q

exercise for extrinsic extensors

A

DIP, PIP and then MCP are flexed after the wrist is slowly flexed until the patient feels a stretching sensation in the dorsum of the forearm

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8
Q

tendon gliding exercises

median nerve glides

A

hook
full fist
straight fist

median nerve - 6 positions

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9
Q

finger deformities

A

swan neck: Hyperextension PIP, flexion DIP
boutinniere: Flexion PIP, hyperextension DIP
mallet finger

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10
Q

inflammation

A
  • first phase of tissue healing

4 Signs of Inflammation:

  • Redness
  • Swelling
  • Heat
  • Pain

Acute Inflammation: lasts for about 3-5 days, but can last for 10
Chronic inflammation occurs if the inflammatory phase continues from 4-6 weeks

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11
Q

scar tissue

A

normal process, Scar tissue is weak and unable to handle normal stresses
Scar tissue becomes problematic when it attaches to adjacent structures and prevents normal movement
This is a contracture → anything that limits joint ROM
Contractures may occur with muscle, tendon, ligament, joint capsule, bursa or skin

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12
Q

colors of wounds

A

Red: Uninfected, properly healing, definite borders
Yellow: Draining, purulent, slough that is semi-liquid to liquid, Contains pus
Black: Covered with necrotic tissue, debridement is needed to prevent infection

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13
Q

cellular events in healing

A

Phase 1 is the Inflammatory/Edudative or Oozing Stage
Phase 2 is Fibroplasia or Collagen Deposition
Phase 3 is Maturation → Remodeling

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14
Q

pelvic tilts

A

Posterior pelvic tilt = hip flexion
Anterior pelvic tilt = hip extension
Pelvis moves medially when the hip is abducted and laterally when it is adducted

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15
Q

angle of inclination (hip)

A

femur-pelvis

125 degrees

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16
Q

increase in angle of inclination

A

coxa valga, anteversion, CAM impingement

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17
Q

decrease in angle of inclination

A

coxa vara, retroversion, pincer impingement

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18
Q

angle of torsion

A

about 8-30, or 15 degrees on average

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19
Q

roles of knee ligaments

A

Overall, knee ligaments control: Excessive knee flexion, Varus and valgus stresses at the knee, Anterior or posterior displacement of the tibia beneath the femur, rotary stability

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20
Q

degrees of freedom of LE

A 
Hip: 3
Knee: 6
Talocrural (Ankle): 1
Talocalcaneal/Subtalar: 1
Tarsometatarsal: 1
Metatarsophalangeal: 2
Interphalangeal: 1
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21
Q

tibiofemoral alignment

A

The femur and tibia intersect to create a valgus angle at the knee joint of about 185-190 degrees

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22
Q

genu valgum

A

occurs when there is an angle of 165 degrees or less that increases compressive forces on the lateral condyle producing “knock knee”

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23
Q

genu varum

A

occurs when the angle is 180 degrees or more and increases compressive forces on the medial condyle making the person bow legged

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24
Q

patellofemoral joint

A

tilts medially until about 11 degrees as the knee flexes from 25-130 degrees

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25
Q

ankle joint

A

Neutral position is at 90 degrees
Dorsiflexion is about 20
Plantar flexion is 30-50

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26
Q

subtalar joint

A

(talus and calcaneus)
Inversion: 0-20
Eversion 0-10
Contributes 10 degrees to dorsiflexion

27
Q

acute pain

A

rapid and sudden, lasts as long as the noxious stimulation is present
identifiable cause like injury, surgery or disease
Typically resolves after a successful intervention or healing

28
Q

tissue type/localization of pain

A

Cutaneous: more accurate localization and with greater precision
Deep somatic (muscles, tendons, ligaments, bones, joints, arteries): localized less accurately
Visceral: typically poorly organized unless the organ is innervated by spinal nerves

29
Q

chronic pain

A

Lasts 3-6 months to years and adversely affects an individuals well being
Can be due to chronic conditions such as fibromyalgia and rheumatoid arthritis
Starts as acute pain, but doesn’t resolve in the usual time despite treatment or apparent healing
May be persistent OR intermittent
Clients with prolonged, severe or very disabling acute pain are at increased risk for developing chronic pain
Due to lack of success with pain relief, the client’s behavioral response may appear to be inconsistent, inappropriate, or exaggerated

30
Q

6 D’s of chronic pain syndrome

A 
Drug abuse and misuse
Dysfunction in occupations
Disuse (not using the part of the body they should be using due to pain)
Depression
Disturbed sleep patterns
Disability
31
Q

verbal rating scales

A

Client rates pain on a continuum that is sub-divided into gradually increasing intensities
Words are used as descriptors of intensity
Advantages: quick, easy measure with subdivisions
Limitations: insensitive to small changes in pain intensity that occur over time

32
Q

visual analog sale

A

Client rates pain on a horizontal or vertical continuum (10 cm in length) that has no subdivisions, but is continuous
Measure from left to right, using the following as an interpretive guide for intensity
Advantages: quick, easy measure
Limitations: coordination deficits may hinder marking accurately, difficulty transferring subjective experience of pain to a straight line continuum with no subdivisions

33
Q

numeric pain scale

A

Client rates pain on a scale of 0-10, where 0=no pain and 10=worse pain possible
Numbers are used and can be used in combination with words
This scale is the most sensitive to small changes in pain intensity than either the verbal rating scale or the visual analog scale because it has more subdivisions
Can be administered verbally or using pen and paper

34
Q

wong-baker faces pain rating scale

A

Designed for use with children over three and adults
Often used with cognitively impaired older adults
Offers a visual description for those with limited verbal skills to explain how their symptoms make them feel: happy, sad, etc.
Client is asked to choose the face that best describes how he/she feels

35
Q

McGill pain questionnaire

A

Select words that best describe present symptoms
Descriptors fall into four major groups: sensory, affective, evaluative, miscellaneous
The rank value for each descriptor is based on its position in the word set
The sum of the rank values is the pain rating index
The present pain intensity is based on a scale of 0-5
Advantages: allows for quantification of various pain aspects (scope, quality, intensity), total number of words chosen provides a quick range of pain severity, provides an index for 4 major categories
Limitation: time consuming, clients must be cognitively intact and highly literate

36
Q

body diagrams

A

Client is asked to indicate the location and nature of pain on an anatomical diagram
Specific musculoskeletal dysfunction will produce an anatomical pattern appropriate to the structure involved
Widespread or non-anatomically correct pain can identify potentially chronic or inappropriate pain clients (malingerers)
Advantages: aids in locating spatial distribution of pain, provides information about pain quality, and can identify malingerers
Limitations: confusion over symbols used to indicate type and location

37
Q

daily activity/pain logs

A

Advantages: activity specific, can provide info about treatment planning
Limitations: patient may feel like they have to record pain with every activity even if they don’t have it
Focus constantly on pain
May forget to do it

38
Q

pain disability index

A

Appropriate for use with adults with chronic pain
Designed to measure pain related disability
7 subscales related to ADL/Participation
family/home, recreation, social, occupation, sex, self-care, life support activity
Scores are added together for a total score
The higher the score, the more pain related disability perceived
Advantages: useful information about pain impacting functional status
Limitations: clients may rate at extreme end of scale and may not be willing to answer all items

39
Q

referred pain

A

Pain originating from one site in the body that is perceived as being localized in a different site
Can come from a nerve, dermatome, or same embryonic segments
When pain that is either visceral or musculoskeletal in origin converges on the same neuron in the spinal cord, it is usually interpreted as musculoskeletal pain
It is theorized that pain due to musculoskeletal injury is more common, so the brain learns that activity arriving along the same pathway is associated with a stimulus in a particular musculoskeletal area (convergence-projection theory)

40
Q

Radicular pain

A

pressure on a spinal nerve close to the intervertebral foramina may lead to pain along some part of the course of the spinal nerve

pins and needles

41
Q

Viscerally-Referred pain

A

Afferent information traveling away from an organ is misperceived as coming from another body part

42
Q

musculoskeletal and myofascial pain

A

confined to a particular area

presents in muscles etc

43
Q

trigger finger

A

A type of tendinitis which develops in the flexor tendons causing pain and a catching, snapping, clicking or triggering and then a locking sensation in the affected finger
Occurs most often in long or ring fingers, occasionally in the thumb
Palpation may reveal a tender nodule over the metacarpal head
Most commonly affects the ring fingers of middle aged women
Signs/symptoms
Popping/clicking sensation as you move your finger
Tenderness or bump at the base of the affected finger
Finger catching/locking in a bent position, which suddenly pops straight
Finger locked in a bent position, which you are unable to straighten
More commonly in the dominant hand
Causes: repetitive gripping actions or with pressure over the palm, Irritation of flexor tendons, Infection of synovium causes the nodule to form in the tendon

44
Q

treatment for trigger finger

A

Conservative
Orthosis wear
MP joint block, full digit extension
Ice massage, make activity changes, NSAIDS, massage
Injection: corticosteroid into tendon sheath (improve in individuals with shorter term trigger finger 6mo or less, diabetics, and those with more than one digit triggering)
Surgery
A1 pulley is released

45
Q

Dupytren’s contracture

A

This is a disease of the palmar fascia that results in the progressive thickening and contracture of fibrous bands on the palmar surface of the hand and fingers
Inflammation and thickening/tightening of the diseased fascia
Occurs most often in the fourth and fifth digits
Signs/symptoms
Arises at the base of the middle finger and ring finger in the distal palm crease region
Usually first notices a painless small hard lump below the skin in the mid palm or at the base of the ring or little finger
May also occur at the base of the thumb
Nodule is a lump
Disease progresses and the overlying skin becomes increasingly puckered and rough bands of thickened tissue can be felt over the affected area

46
Q

conservative management for dupytrens

A

Discuss adaptive techniques
Biomechanical interventions that do not reserve the process
Most will gradually have an increased flexion contracture
Heat, stressing, massage
Orthosis will not reverse the process

47
Q

surgical options for dupytrens

A

When contracture is greater than 30 degrees
- Percutaneous Needle Aponeurotomy:
Go in with a needle to try to break up the tissue
- Enzyme Injection (Xiaflex): Enzyme is left to digest the cord overnight, Next day the cord is manually released
- Fasciectomy: Open procedure that removes the disease tissue of the cord
Zig zag incision to limit scar and skin contracture
- Dermofasciectomy: Skin graft closes the wound

48
Q

clinical test for De Quervain’s, Carpal Tunnel Syndrome and Lateral Epicondylitis

A
  • De Quervain’s: Finklestein’s (tuck thumb, ulnar deviation)
  • Carpal Tunnel: Phalen’s test
  • Lateral epicondylitis: Cozen’s test (resist wrist extension, elbow flexed and extended) and Mill’s test (passive over pressure in wrist flexion, elbow flexed and extended)
49
Q

Describe when (how many weeks from the fracture) to perform AROM, PROM with over pressure and strengthening following a distal radius fracture.

A
  • AROM: week 1 uninvolved, cast, phase 2: 4 weeks, continue throughout
  • PROM with over pressure and strengthening: 6-8 weeks
50
Q

3 different common pinch positions that are tested in the clinic.

A
  • Lateral pink
  • 3 jaw chuck
  • Tip to tip
51
Q

Describe and give examples for items you will place in the S, O, A and P sections of a daily note.

A
  • S: pain, anything patient says with quotes
  • O: observations, what you do with client: ROM, strengthen exercises
  • A: tolerated treatment – why?, rehab potential, problem list
    o Why things are the way they are? How is that affecting their function
  • P: recommendations for continued therapy, interventions you may use in the future
52
Q

Describe which muscles are involved in client s/p CVA with a sub-laxed shoulder. Describe which muscles are involved in client’s s/p CVA with hypertonic shoulders

A
  • Subluxed shoulder: supraspinatus, posterior deltoid

- Hypertonic shoulder: subscapularis, pec major

53
Q

Demonstrate scapular upward rotation. What are the muscles that create a force couple for scapular upward rotation?

A
  • Raise hand

- ALL fiber of trapezius, serratus anterior

54
Q

how much motion is needed for functional wrist AROM. Wrist flexion? Wrist extension? Total arc of wrist motion?

A
  • Flexion: 10*
  • Extension: 35*
  • Total arc: 45*
55
Q

Describe tenodesis and which type of patient population can use tenodesis to their advantage.

A
  • SCI (no active finger flexion and extension – use wrist motions)
  • Way to pick up and release items
  • Extend wrist, fingers flex, grasp
  • Flex wrist, fingers extend, release
56
Q

What are the arches of the hand and why are the hand arches important?

A
  • Transverse (distal and proximal)
  • Longitudinal
  • Grasping, orthoses functional position fabrication
    o Want ulnar mobile side to be able to reach radial side
    o Want to conform to arches when making orthoses
  • Distal more mobile – allows us to flatten hand on table
57
Q

What is the difference between capsular and non-capsular patterns when motion is decreased?

A

Capsular: specific pattern

Non capsular: Limit of ROM in one area of capsule/joint

58
Q

Describe the type of orthosis or cast appropriate for a distal radius fracture and a wrist fracture. Which joints are included in each orthosis?

A
  • Distal radius fracture
    o Colles, Smith, Barton
    o FOOSH
    o Immobilize, casting, start applying resistance
    o Orthosis: want to immobilize wrist, intrinsic plus position – distal radioulnar joint included
     Thumb not included
     Want to clear distal palmar crease so hand can move and make a fist
59
Q

GG code examples

A
  • Verbal cues: 4
  • Complete independence: 6
  • Complete dependence: 1
60
Q

phases of wound healing

A
  1. hemostasis
  2. inflammatory
  3. fibroplasia - collagen, repair
  4. maturation or remodeling
61
Q

cellular events with wound healing

A
  1. clotting, thrombocytes
  2. leukocytes, phagocytes
  3. fibroblasts, collagen deposition
  4. collagen remodeled to scar (strength is 80% of skin)
62
Q

hip hike and drop

A

hike: weak glut med, tight QL and ADD
drop: tight glut med, weak QL and ADD

63
Q

OT assistants

A

OTRs always does evaluationsand research. They are responsible for signing off at note.

OTA learn more about treatments and activities to use with patients.
Supervision: varies from state to state ►2 year program with most of the focus on intervention and treatments

Musculoskeltal I (12 decks)

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