Final Exam Cram Flashcards
What is the most sensitive indicator of joint disease?
ROM Testing
Describe Apprehension test
- Patient seated
- Dr beside patient abducting their shhulder to 90 and then push it into external rotation
- Positive is if they show apprehension
- Glenohumeral instability
Empty can test
- Flex shoulders 90 and abduct to 45, internally rotate arms so thumbs face down
- Push down on forearm ask patient to resist
- is if pain or weakness indicating supraspinatus pathology
Drop arm test
- Abduct arm to 90 slowly return it to neutral
- is if arm drops uncontrolled indicates supraspinatus pathology
Painful arc test
- Abduct arm from neutral
- is pain btw 60-120 indicating subacromial bursa impingement or rotator cuff
Neer Impingement
- Stabilize shoulder and pronate forearm, passively flex shoulder into full flexion
- is pain indicates subacromial bursa impingement or rotator cuff impingement
Hawkins test
- Flex shoulder to 90 and elbow to 90 (make a hawk wing)
- Passively internally roate shoulder
- pain for subacromail bursa impingement or rotator cuff impingement
Cross Arm test
- Passively adduct arm across patients chest and rest hand on their opposite shoulder
- Monitor posterior AC joint
- AC joint pain or increased TTA indicating AC pathology
Spencers Technique?
Elephantss Fart Constantly To Annoy All Intelligent Tigers
- Extension
- Flexion
- Compression w/ circumduction
- Traction Circumduction
- ABduction w/ ext rotation
- ADDuction
- Internal Rotation
- Traction with inferior glide
Patient is lateral recumbent with injured shoulder UP
Patient has tenderness and pain when raising arm above head, pain is more prevalent at night and pain over lateral deltoid. What could this be?
Rotator Cuff injury
What can cause Referred shoulder pain?
- MI
- Pulmonary issues such as embolism or apical lung tumor
- Abdominal issues uch as hepatobiliary disease or intraperitoneal blood
- Herpes Zoster
- Spinal cord lesion
- TOS
- Radiculopathy
When the scapula depresses what happens to hte AC and SC joint?
- AC: inferiorly glides
- SC: Superiorly glides
The GH flexes so the scapula ____ making the AC joint____ and SC joint ___.
- Protracts
- Anteriorly glides
- Posteriorly glides
If the SC joint is in an inferior glided position what is happening to the AC, shoulder and scapula?
- Abduction of shoulder
- Superior glide of AC joint
- Elevation of scapula
What happens to the SC joint with internal and external rotaion?
NOTHING trick question, only the AC joint does internal and external rotation
Patient presents with neck pain and denies any trauma to cause it. Her sx inculde pain, spasm, decreased ROM and a headache stemming from the occipital region. What could her problem be?
Myofascial neck pain such as whiplash or muscle strain
What is a SCIWORA?
- Spinal Cord Injury Without Radiographic Abnormality
- Rare and requires a high suspicion as the patient has normal CT, but continues to have neuro signs and symptoms
- It is more common in kids and elderly
- Must keep spine immobilized until Neurosurgeon consult and MRI
What are the three kinds of Torticollis?
- Congenital: from musclar fibrosis of SCM
- Adult: Acquired from SCM or Traps injury/inflammation, cervical muscle spasm or cervical nerve irritation
- Life threatening causes: Retropharyngeal abscess, C spine injury, CNS turmor or spinal epidural hematoma
What is the most common cause of acute and chronic neck pain in adults?
Cervical Spondylosis
Differnece between Myelopathy and Radiculopathy?
- Myelopathy is a defecit related to the spinal cord, has emergent symptoms requiring immediate MRI such as loss of bladder or bowel control, or patient complains weakness numbness bilaterally, clumsy hands, gait distrubances, sexual dysfunctions
- Radiculopathy is a “pinched nerve”, a neurologic deficit occuring at/near the root. Sharp radiating pain down arm, weakness or paresthesia can develop
- C5-6 are most commmon
What are the 11 redflags in patients with neck pain?
- Recent neck trauma
- Sx that suggest spinal cord injury such as loss bladder/bowel control
- Shock like paresthesia
- Fever chills
- Hx of IV drug
- Immunosuppression
- Chronic glucocorticoid use
- Unexplained weight loss
- Heachache shoulder hip pain or visual sx in older adults
- Anteior neck pain
- Hx of cancer
Describe the 3 specialty tests for suspected Radiculopathy?
- Neck compression: seated pt, dr behind place hands on top of head and press down, pain is positive
- Neck Distraction: seated pt, dr behind place one hand under chin other on occiput and pull upwards, positive is alleviation of pain
- Spurlings: essentially the compresion test only in three stages, first stage is neutral, second extend and compress, third extend SB to affected side and compress
- DO NOT continue if pain is reproduced
What are the special tests for TOS? Describe the short ones.
- Roos/EAST: abduct shoulders 90 flex elbows 90 externally rotate 90 and alternate making a fist 3 minutes
- Costoclavicular: seated with elbow exttended and hand supinated find radial pulse place hand on top of shoulder and extend the patients arm and apply downard pressure
- tests entrapment of neurovasucalture btw 1st rib and clavicle
- Wright’s Hyperabduction: seated elbow extended and hand supinated, dr beside find radial pulse, abduct arm above head with slight extension
- Testing for neurovasculature compression by pec minor
- Adsons
Describe Adsons and what is it for?
- TOS
- patient seated with elbow extended and hand supinated
- dr monitor radial pulse and abduct extetnd and externally rotate arm
- Ask patient to extend and rotate their head towards that arm and hold their breath
- pain indicates subclavian compressed btw 1st rib and clavicle
- Return to neutral and then ask patient to look away from that arm and hold their breath
- pain indicates compression of subclavian btw anteriro and middle scalenes
HVLA cervical contraindications
- RA
- Down syndrome
- Carotid disease
- Osteoperosis
- Anticoagulatnts
- Osseous or ligamentous disruptions
Mechanics of C2-C7?
Rotation and side benidng occur in same direction due to the uncinate process
Restriction on C4 extension and rotation to the right. Discovered C4 is rotated left restricted in extension, and likes left to right translation. What is the SD?
C4 F RL SL
Typical Cervical vertebrae SB and rotate in same direction
OA mechanics?
- Joint btw occpiut and C1
- Major motions are flexion and extension minor motions are SB and rotationi
- SB and rotation occur opposite due to shape of the joint
AA joint mechanics?
- C1 on C2
- ONLY rotation
What does it mean to say difficult translation from left to right?
Difficulty side bending left
When doing OMT on AA what is the most important thing to remember?
Fully Flex the neck isolating rotation to the atlas locking C2-7
How do you treat C2-7 F SR RR with MET?
- Patient supine dr at head of table
- cradle head with hands and extend neck to level of dysfxn
- Press laterally on the left articular pillar inducing sidebending towards and up to restriction
- Rotate occiput to and up to restriction until vertebra moves engaging the barrier in 3 planes
- 3-5 seconds gently have patient SB or rotate head away while dr counters the force
- Relax and repeat 3-5 times moving to new barrier
- Reassess TART
How are pulses, reflexes, and strength graded?
- P: 2/3
- R: 2/4
- S: 5/5
Subluxation of radial head?
- Aka Nursemains elbow
- Common in kids due to sudden pulling, falling, or arm twisting causing the annular ligament to slip out from radial head
- Presents wit harm close to body elbow slightly flexed OR arm fully extended with forearm pronated
Hyperpronation has best success rates
What is golfers elbow?
- Medial epicondylitis, due to overuse and inflammation of flexor tendons
- Pain on medial aspect of elbow and tenderness wit hpassive extension of wrist and resisted flexion
- Perform medial epicondylitis test having the patient extend their elbow pronate arm and ask them to flex their wrist against you
Tennis elbow?
- Lateral epicondylitis due to overuse / inflammation of the extensor tendons, excessive hyperextension
- Pain on lateral aspect of elbow tendertnes with resisted wrist extension
- Perform lateral epidondylitis test, extend elbow pronate arm ask pt to extend their wrist against you
Olecranon Bursitis? How do you distinguish btw bursitis with effusion and without effusion?
Miner’s elbow/Student’s elbow
- Inflammation of olecranon bursa caused by inflammatory arthritis, gout, trauma, hemorrhage or sepsis
- pain and swelling on olecranon bursa
- Distinguish btw bursitis vs effusion- if the patient can fully extend at the elbow WITHOUT severe pain its bursitis w/o effusion. If effusion is present pain with extension will occur due to increased pressure
Carpal Tunnel specialty tests
Tinnel- tap over median nerve get pins and needle sensation
Phalens- flex wrists so that dorsal aspect of hands touch
What is DeQuervain Tenosynovitis? Specialty test?
- Radial wrist pain at base of thumb especially with thumb movement
- Caused by recurrent inflammation of tendon and synovial sheath covering extensor pollicis brevis and abductor pollicis longus from recurrent movements
- Finikelsteins test make a fist enclose the thumb and adduct wrist
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What is trigger finger?
- Pain, locking,clicking of MCP joint most common on ring finger in 50-60s
- Causes are idiopathic, risks include DM, RA, hyperthyroidism, amyloidosis, overuse
What is Dupuytren’s contracture
- Fibrosis of palmar fascia causing progressive stiffening of joint and inability to fully extend finger
- Idiopathic causes , thickening of palmer fascia due to fibroblastic proliferation and collagen deposition
- Presents with cord like structure and flesxed digit w/ palpable cord, more comon in white men
What causes a scaphoid fracture?
FOOSH
tenderness on anatomic snuff box is sensitive for this fracture
poor blood supply so nonunion is complication
Patient got in a fight and comes to office with pain in his fifth digit. Swelling, bruising and tenderness is presesnt . What is this?
Boxer’s fracture
Colles Fracture?
- Possibile “Dinner fork” deformity, but Xray can be normal
- Tenderness over fracture site on radial aspect of wrist
- Usually young patients due to sports injury or white women over 50 at risk for OA
- Caused by FOOSH