Final Frontier - everything Flashcards
Convex/concave rule: Convex = what arthrokinematics
Convex = Roll and Glide in OPPOSITE directions
Convex/concave rule: Concave = what arthrokinematics
Concave = Roll and Glide in SAME direction
what are the 3 mvmts needed for ankle supination?
“Sup IPAD”
SUPination = Inversion, Plantar flexion, ADDuction
what are the 3 mvmts needed for ankle pronation?
Pronation = Eversion, DF, ABDuction
(opposite of SUP IPAD)
What mobilization will you use with Adhesive Capsulitis/Frozen Shoulder?
mobilizations in directions that improve mvmts in CAPSULAR pattern as it will have limitations in a capsular pattern of the shoulder –> ER > flex/ABD> IR = shoulder mobilization towards Posterior - inferior
What mobilization grades should you use to address PAIN?
grade I and II, out of resistance; ANY AMPLITUDE (Large or small)
What mobilizations should you use to improve ROM?
Grade III and IV, INto resistance; ANY amplitude
What is weak and tight in lower cross syndrome?
weak glutes and abdominals, tight lumbar extensors and hip flexors
What should you do if you see trendelenburg gait? (intervention)
What other gait deviation will they have?
Trendelenburg = opposite hip affected; Lt hip trendelenburg = Rt hip ABD weakness –> Tx: Rt hip ABD strengthening
ipsilateral trunk lean in stance
What are general post surgical procedures?
Rule of 6’s:
-first 6 weeks = protective phase
-next 6 weeks = moderate (resistance)
-next 6 months = back to ADLs
What is weak and tight in upper cross syndrome?
weak deep cervical flexors and scap stabilizers (lowe trap + serratus ant);
tight upper trap, levator, SCM, pecs and upper cervical extensors
How do you lock the knee during a sit-to-stand? (screw-home mech in CKC)
what happens when sitting back down (flex in CKC)?
CLOSED kinetic chain
K. extension: femur -> IR
K. flexion: femur -> ER
How do you lock the knee during a LAQ? (screw-home mech in OKC)
what happens when flexing the knee back down?
OPEN kinetic chain
K. extension: tibia -> ER
K. flexion: tibia -> IR
what muscles do you have to strengthen to complete full upward scapular rotation?
what mvmts require upward scapular rotation?
upward rotation:
-upper/llower trap and serratus anterior
mvmts: shoulder Flex/ABD
what muscles do you have to strengthen to complete full downward scapular rotation?
what mvmts require downward scapular rotation?
Downward rotation:
-Pec minor, rhomboids, levator scap, latissimus dorsi
Mvmts: shoulder Ext/ADD/IR
What is active insufficiency?
active = SHORTEN, inability for 2-JOINT muscle to SHORTEN simultaneously at BOTH joints
What is Passive insufficiency?
Passive = LENGTHEN, inability for 2-JOINT muscle to LENGTHEN simultanously at both joints
What is a normal response to exercise? (Vitals)
HR increases
SBP increases
DBP goes up/down by 10
SpO2 = same
RR increases
what is an ABNORMAL response to exercise? (vitals)
HR: abnormal increase/decrease
any changes in heart rhythm
SBP: >200 OR decrease >15 mmHg
DBP: > 110
SPO2: decrease
RR: decreases
What are the stages of hypertension?
Normal: <120/80
Elevated: 120-129/80-89
Stage I: 130-139/80-89
Stage II: 140+/90+
hypertensive crisis: >180/>120 (emergency!)
What does the sympathetic nervous system do to the heart?
increase HR through SA node
What does the parasympathetic nervous system do to the heart?
decreases HR through SA node
What are the by products of anaerobic exercise?
Lactic acid
What changes occur INITIALLY during high altitudes to vitals?
HR increases
BP increases
Cardiac Output increases
Stroke Volume No change
Initially = acute hypoxia = ↑ CO -> ↑ HR, so that SV can stay the same
What changes occur after a period in high altitudes with vitals?
HR increases
BP drops down back to normal
cardiac output drops down to normal
stroke volume decreases
Acclimatization = X acute hypoxia = ↑HR ↓ CO , SV ↓
What happens to your vitals once you’re used to training at high altitudes when coing back to lower altitudes?
HR decreases
RR decreases
BP decreases
CO increase
SV increase
CO ↑, SV ↑ (because now they have a lot of oxygen available)
What happens to vitals underwater/aquatic therapy?
HR decreases
BP decreases
vital capacity decreases (less lung expansion from pressure)
work of breathing increases
stroke volume increases
cardiac output increases
SV increases bc CO increases which means it’s pumping out more blood per pump
where do you auscultate for heart valves?
All - Aortic, Rt 2nd IC space
P - pulmonary, Lt 2nd IC
T’s - Tricuspid - 4th IC
Move - Mitral - 5th IC lateral to mid clavicular line
Erbs point - 3rd IC space, can hear both
What is S1 heart sound, which valves are closed, and what is happening in the heart?
“Lub”
Ventricles contract (systole)- AV valves close
(tricuspid and mitral valves)
What is S2 heart sound, which valves are closed, and what is happening in the heart?
“Dub”
Ventricles relax (diastole) - aortic and pulmonary valves close
What is an S3 heart sound and what is it indicative of?
S3 is after S1, S2
“SLOSH-ing IN”
IN = S3
indicative of CHF
What is an S4 heart sound and what is it indicative of?
S4 is before S1, S2
“ A-STIFF wall”
indicative of MI
What happens during heart valve stenosis?
What happens during systolic and diastolic stenosis?
stenosis = valve that is closed, should be open
systolic stenosis: systolic = ventricles contract = aortic and pulm valves should be open but are not
diastolic stenosis: diastole = ventricles relax/fill = mitral and tricuspid should be open but are not
What happens during heart valve regurgitation?
What happens during systolic and diastolic regurgitation?
regurgitation = valves are open when they should be closed
systolic regurgitation: ventricles contract = aortic and pulm are open; mitral and tricuspid SHOULD be closed
diastolic regurgitation: diastole = ventricle relaxation/ filling = mitral and tricuspid are open; aortic and pulmonary SHOULD be closed
What does the frontal lobe do?
Frontal lobe = in the front
“A CEO”
Apraxia/Aphasia w/ injury
Controls, plans, programs
Emotional/behavior, personality
Olfaction
What does the temporal lobe do?
temporal lobes = touch temporal lobes -> ears
hearing
language and comprehension
injury = Aphasia: Wernicke’s
What does the Parietal lobe do?
Parietal = Perception, sensory perception
graphesthesia, tactile, sharp
injury= sensory loss, unilateral neglect
(unable to perceive sensation)
What does the Occipital lobe do?
Occipital = O-SEE-pital
See = vision
injury = visual field deficits
visual agnosia = can’t ID what thing is
Prosopagnosia = can’t name/ID people’s faces
What is Broca’s aphasia?
Where is it located?
Describe impairment?
Treatment?
BROca’s –> BROken speech
slow, hesitant speech
have trouble EXPRESSING themselves with words –> EXpressive aphasia or NON-fluent aphasia
“BEAN” = Broca’s Expressive Aphasia Non-fluent
located in Frontal lobe - Left
tx: have trouble speaking –> NO open ended questions, yes/no/simple questions only.
What is Wernicke’s aphasia?
Where is it located?
Describe impairment?
Treatment?
Wernickes = lang comprehension
Wernicke aphasia = not understanding what was said/asked
RECEPTIVE aphasia -> have trouble RECEIVING information said
Can speak in sentences –> fluent aphasia
WORD SALAD - wowsome
Tx: have trouble understanding words –> use demonstrations, gestures, visual cues
Temporal lobe - Left
What is conduction/disconnection aphasia?
can understand language but has difficulty with language output.
impaired association b/w Wenicke’s and Broca’s
What is global aphasia?
“total aphasia”
cannot speak fluently or understand language
Affects Wernicke’s, Broca’s, Cortical and subcortical areas
What is the location of all 12 CN pairs?
CE MI PONS MEDU
1,2 3,4 5,6,7,8 9,10,11,12
cerebrum
midbrain
pons
medulla
what is CN 1?
located?
type?
Lesion?
CN 1: olfactory N.
Location: frontal lobe of cerebrum
Type: sensory
Lesion: anosmia, loss of sense of smell
what is CN 2?
function?
located?
type?
Lesion?
CN 2: optic N
function: vision -
- visual acuity (clarity), color, peripheral vision
- pupillary reflex (afferent)
location: occipital lobe of cerebrum
type: sensory
Lesion: blindness, myopia/presbyopia, hemianopsia
what is CN 3?
function?
located?
type?
Lesion?
CN 3: oculomotor
function: moves eye, opens eyelids, constric pupil
-pupillary reflex (Efferent)
Location: midbrain
type: motor
Lesion: ptosis (eyelid drooping)
-dilated pupils
-lateral strabismus (nothing can pull eye IN –> ABDucens pulls it laterally)
what is CN 4?
function?
located?
type?
CN 4: Trochlear N.
Fx: moves eye down + in
-“SO4” superior oblique innervated by CN 4
Located: midbrain
type: motor
what is CN 5?
function?
located?
type?
Lesion?
CN 5: trigeminal N.
Fx:
- sensation of face through opthalmic and maxillary branch -> corneal reflex (afferent - touched eyeball)
-sensation to 2/3 Ant Tongue
-close jaw/M. of mastication –> temporalis, masseter, and Med/Lat pterygoids
located: pons
type: mixed
Lesion:
-paresthesia/numbness in face
-inability to chew
what is CN 6?
function?
located?
type?
Lesion?
CN 6: Abducens
Fx: ABDuces eye ball
-“LR6” -> lateral rectus supplied by CN 6
location: pons
(CE MB PONS MEDU)
type: motor
lesion: medial strabismus
what is CN 7?
function?
located?
type?
Lesion?
CN 7: facial
fx: motor muscles of face and closing eyelids
(EXCEPT M. of mastication -> CN 5)
“restaurant opens at 3’ and closes at 7’ “ –> eyelids open w/ CN 3 and close w/ CN 7
-Corneal reflex (Efferent) - touched eyeball –> closes eyelids
Sensory: taste to ANT tongue
type: mixed
location: pons
Lesion: Bell’s Palsy
What supplies innervation to the tongue?
Anterior 2/3 = 2 CN’s
-S5 = sensation by CN5
-T7 = taste by CN7
Posterior 1/3 = 1 CN
backwards P = 9 (P for POSTerior tongue)
-sensation and taste by CN 9
motor fx: CN 12 - hypoglossal
what is CN 9?
function?
located?
type?
Lesion?
CN 9: glossopharyngeal
Fx:
-sensory: “P = 9” post 1/3rd of tongue
- gag reflex - uvula sensation (Afferent)
-motor: swallowing
location: medulla
type: mixed
lesion: dysphagia
-diff tasting post 1/3 of tongue
-NO gag reflex (if you don’t have sensation, cannot have motor output CN10)
uvula = CN 9 sen + CN 10 motor
what is CN 10?
function?
located?
type?
Lesion?
CN 10: Vagus N.
Fx: - sensation of pharynx and larynx
motor: gag reflex (efferent)
type: mixed
location: medulla
Lesion: - no gag reflex
-uvula deviation to OPPOSITE SIDE –> uvula deviation Rt = Lt CN 10 lesion
uvula = CN 9 sen + CN 10 motor
what is CN 11?
function?
located?
type?
Lesion?
CN 11: acessory N.
Fx: innervation to upper trap and SCM
type: motor
Location: medulla
Lesion: atrophy and weakness to upper trap and SCM
what is CN 12?
function?
located?
type?
Lesion?
CN 12: hypoglossal
function: tongue mvmt
location: medulla
type: motor
lesion: tongue will not move
“lick your lesion” ->
Rt CN 12 lesion = tongue STAYS Rt
what is CN 8?
function?
located?
type?
Lesion?
CN 8: vestibulocochlear
fx: vestibulo = balance
cochlear = hearing
type: sensory
location: medulla
lesion: hearing loss
either conductive: plugging your ears (outer passage) OR
sensorineural: inner ear
how can you tell when you have conductive hearing loss using Rinne and Weber test for CN 8?
Rinne test:
“Rinne behind Pinna” (mastoid process)
conductive hearing loss = can hear bone conduction LONGER than ear/air conduction
conductive = BC > AC,
ex. 10 sec > 5 sec
Weber’s test to test for SIDE:
“CANS”
-Conductive HL -> Louder in Affected ear
-Sensorineural -> louder in Normal Ear
how can you tell when you have sensorineural hearing loss using Rinne and Weber test for CN 8?
Rinne test:
“Rinne behind Pinna” (mastoid process)
Sensorineural hearing loss = can hear air conduction LONGER than bone conduction
(can be normal or SN)
AC > BC =
-normal OR
-Sensorineural HL
ex. bone = 5 sec, air 10 sec
Weber’s test to test for SIDE:
“CANS”
-Conductive HL -> Louder in Affected ear
-Sensorineural -> louder in Normal Ear
IF can hear equally on both sides during Webers = Normal hearing, NO HL
If shine was lit on LEFT eye, which CN is damaged if BOTH eyes constrict (#1)?
None, both pupils constricting = Normal response
If shine was lit on LEFT eye, which CN is damaged if RIGHT eye does NOT constricts (#2)?
1 eye constricts - Lt = normal
Lt CN 2 (shine lit on Lt) and
Lt CN 3
Right eye = CN 2 intact (because other eye constricted = it got the message) ->
Rt CN 3 affected
If shine was lit on LEFT eye, which CN is damaged if LEFT eye does NOT constricts (#3)?
1 eye constricts - Rt = intact Lt CN 2 (shine lit on Lt) and Rt CN 3
since one eye constricted = Lt CN 2 is intact (side light is shining on) ->
Lt CN 3 affected
If shine was lit on LEFT eye, which CN is damaged if Neither eye constricts (#4)?
No response = CN 3 could not respond because it did not receive the message/sensation
Affected/lesion = Lt CN 2
-> couldn’t sense the light
(and light is shining on Lt eye)
What is inspiratory reserve volume?
Max air in (voluntary)
What is expiratory reserve volume?
max air out (voluntary)
What is residual volume?
air stuck in lungs (after max expiration)
What is tidal volume?
avg air in/out, relaxed breathing
What is functional residual capacity?
“residual” = amt of air in lungs after you breathe out
FRC = ERV + RV
= expiratory reserve volume + residual volume
What is inspiratory capacity?
inspiratory = max air you can breathe IN
IC = IRV + TV
= inspiratory reserve volume + tidal volume
What is vital capacity?
max amt of air exhaled after max inhale
VC = tidal vol. + IRV + ERV
(≈ 80% total lung capacity)
What is total lung capacity?
Max air that can fill lungs
TLC = TV + IRV + ERV + RV (all values added)
What happens in the lungs with COPD or any other obstructive lung disease? (to lung volumes)
COPD = can’t get air out
-residual volume increases
-functional residual capacity increases
-total lung capacity increases
What happens to lung volumes with restrictive lung diseases?
restrictive = difficulty getting air IN
-everything goes down/decreases
List different diagnoses that are classified as obstructive lung diseases?
(anything affecting the lungs)
asthma
COPD
Emphysema
Pneumonia
Cystic fibrosis
Respiratory distress syndrome (infants) …
List different diagnoses that are classified as restrictive lung diseases?
(anything affecting other systems that impair the lungs getting air in)
Sarcoidosis
idiopathic pulm fibrosis
pneumothorax
atelactasis
MSK alterations: arthritis, AS, scoliosis, arthrogryposis, burns, scleroderma
Neuro alterations: CVA, SCI, MS, Parkinsons, M. dystrophy
What is FEV1?
Forced expiratory volume 1 = max expiration in 1 sec
how do you position a patient for postural drainage?
Bad lung UP
What is Stage I from the GOLD standard classification system for COPD ?
FEV %?
FEV/FVC?
s/s?
Stage I (mild COPD):
FEV >80%
FEV/FVC: <70% or 0.7
s/s: chronic cough + sputum
What is Stage II from the GOLD standard classification system for COPD ?
FEV %?
FEV/FVC?
s/s?
Stage II (moderate COPD):
FEV 50-80% (-30 from previous stage)
FEV/FVC: <70% or 0.7
s/s: chronic cough + sputum + DOE (dyspnea on exertion)
What is Stage III from the GOLD standard classification system for COPD ?
FEV %?
FEV/FVC?
s/s?
Stage III (severe COPD):
FEV 30-50% (-30 from previous stage)
FEV/FVC: <70% or 0.7
s/s: chronic cough + sputum + DOE (dyspnea on exertion)
increased fatigue and exacerbations
What is Stage IV from the GOLD standard classification system for COPD ?
FEV %?
FEV/FVC?
s/s?
Stage IV (very severe COPD):
FEV <30% (-30 from previous stage)
FEV/FVC: <70% or 0.7
s/s: chronic cough + sputum + DOE (dyspnea on exertion)
+ RESPI failure or Rt CHF
What are some interventions for COPD or obstructive lung diseases?
Pursed-lip breathing
Huffing (stacked huffing)
Paced breathing
strengthen inspiratory/expiratory M.s
Describe the abnormal breath sound wheezing?
high pitched, musical quality
mostly during expiration
heard in: asthma, COPD
Describe the abnormal breath sound stridor?
sounds like a whistle - peanut stuck in airway
during both inspiration and exhalation
indicative of aspiration/obstruction to airway
Describe the abnormal breath sound Crackles/rales?
bubbles/popping sounds
during both inhalation/exhalation
indicative of fluid in lung like COPD and CHF
Describe the abnormal breath sound in pleural rub?
sounds like velcro or sand paper rubbing
both inspiration/expiration
indicative of pleural inflammation
What is bronchophony?
when voice sounds loud and clear during lung auscultation
Ex. “99”
= abnormal, normal lungs should not sound super clear, it means there is fluid in the lungs
(increases vocal resonance)
What is Egophony?
EEEEEgophony for hearing an “A” instead of “E”
Ask pt to say “E” ->you hear “A”
= abnormal, indicative of secretions/fluid
What is whispered pectoriloquy?
Pt whispers “1,2,3” and it sounds loud and clear
= abnormal, fluid in lungs/infection
(increases vocal resonance)
What happens during respiratory acidosis?
How do you calculate ABG?
Respiratory = something abnormal w/ CO2
respiratory ACIDosis = ↑ in CO2
pH ↓
HCO3 stays the same
Calculate:
write norms in # line and add given values to that number line
Ex.
COPD = air stuck, can’t get air out = ↑ CO2
↑ CO2 = respiratory + ↑ acidic
pH = ↓
How do you calculate ABG?
What happens if pH is NORMAL?
What happens if all 3 are ABNORMAL?
Calculate:
write norms in # line and add given values to that number line
pH normal = compensated
NONE normal = partially compensated
What happens during respiratory alkalosis?
How do you calculate ABG?
Respiratory = CO2 abnormal
Alkalosis = decreased CO2
pH = increases (more basic)
HCO3 = normal
Calculate:
write norms in # line and add given values to that number line
What happens during metabolic alkalosis?
How do you calculate ABG?
metabolic = HCO3 abnormal
alkalosis = HCO3 increases
pH = increases (more basic)
PaCO2 = normal
Calculate:
write norms in # line and add given values to that number line
What happens during metabolic acidosis?
How do you calculate ABG?
metabolic = HCO3 abnormal
acidosis = HCO3 decreases
pH = decreases (more acidic)
PaCO2 = normal
Calculate:
write norms in # line and add given values to that number line
What lymph duct does the RUE and face drain to?
RULE =
RUE drains to Lymphatic duct
everything else drains through THORACIC duct
What is the difference b/w primary and secondary lymphedema?
primary = congenital/hereditary
Secondary = acquired
ex. infection, chronic venus insufficiency, etc.
What is stage 0 (latency stage) of lymphedema?
no edema, occasional heaviness
tissue = normal
What is stage I (reversible stage) of lymphedema?
edema: soft/pitting
edema increases in dependent positions (standing, walking)
reduces w/ elevation = REVERSIBLE
What is stage II (Spontaneously Irreversible) of lymphedema?
Brawny edema (hard, fibrotic changes)
Irreversible w/ elevation
Stemmers sign positive
tissue appears fibrotic, proliferation of adipose tissue
What is stage III (lymphostatic elephantiasis) of lymphedema?
brawny, non-pitting edema (hard, fibrotic edema)
Stemmers sign positive
skin changes: papillomas, hyperkeratosis, deep skin folds
infections common
What is the pitting edema grade scale?
grade 1: barely visible, immediate rebound
grade 2: slight indentation 3-4 mm, lasts < 15 sec
grade 3: indentation 5-6mm, lasts <30 sec
grade 4: indentation of 8mm+, lasts >30sec
What are the characteristics of lymphedema?
-usually unilateral, may be bilateral
-infections such as cellulitis are common
-no pain
-Stemmer’s sign = present (positive)
What are the characteristics of lipedema?
-bilateral LE’s
-pain
-hands and feet usually spared
What is a normal and an abnormal lymph node palpation?
normal: soft, non-tender
abnormal: tender, hard/immobile
What do you do in rhythmic initiation?
- guide mvmt
- active participation of guided mvmt
What do you do in rhythmic stabilization/stabilizing reversals?
stabilizing = pertubations
What do you do in slow reversals/isotonic reversals/dynamic reversals?
Concentric all the way!
(of both agonist and antagonist)
What do you do in combination of isotonics?
combination = combination of concentric and eccentric M. action
(of ONE M. group)
What is Medial scapular winging?
AKA “open book”
put hands in front of you and “open a book”
indicative of serratus anterior weakness -> long thoracic N. palsy (C5,C6, C7)
What is lateral scapular winging?
AKA “sliding door palsy”
put hands in front of you and “slide door laterally”
indicative of trapezius weakness -> accesory CN 11 palsy
What are the norms for ABG values?
pH?
PaCO2?
HCO3?
pH: 7.35-7.45
CO2: 35-45
HCO3: 22-26
What are the 3 parts in a Glascow Coma Scale and how is it graded?
Eyes = 4 letters, = 4 pts
Verbal = V = 5, 5 pts
Motor = 6 pts
How do you grade the Eyes portion of the Glascow coma scale?
Eyes = 4 letters, = 4 pts
Ben’s life: Eyes = Ben as an adult
can married Ben wake up?
4 = spontaneous - wakes himself up
3= speech - you tell him to wake up
2= pain stimuli - you throw cold water at him to wake up
1= no response
How do you grade the Verbal portion of the Glascow coma scale?
Verbal - V = 5 pts
Ben’s life = Ben as a baby learning how to talk
1 - no response
2 - babbling, incoprehensible sounds
3 - inappropriate words
4 - sentences, confused conversation
5 - oriented, normal sentences
How do you grade the Motor portion of the Glascow coma scale?
Motor = last, 6 pts
Ben’s life = OLD BEN
6 - Obeys commands
5 - Localizes (pain)
4 - withDraws
3 - Bends, abnormal flexion
2 - Extends, abnormal extension
1 - No response
What is spondylosis?
age?
pain?
agg?
Ease?
SLR?
imaging?
spondylosis = OA/DJD
age: >50
LBP: unilateral
Agg: extension/stand
Ease: flexion/sitting
SLR: NEGATIVE
imaging: X-ray
involvement in spine ONLY!
What is spinal stenosis?
age?
pain?
agg?
Ease?
SLR?
imaging?
Spinal stenosis –> progression of spondylosis (OA/DJD)
age: >60 y/o
pain: LBP - bilateral + legs
Agg: extension/stand/walk
Ease: flexion - sitting, bending
SLR: POSITIVE
imaging: X-ray = bone
-MRI + CT = N. involvement
What is spondylolysis (LYSIS)?
age?
pain?
agg?
Ease?
SLR?
imaging?
Spondylolysis = unilateral Fx of pars articularis
age: 15-20 y/o
pain: LBP - local
Agg: extension/stand/walk
& flexion during standing or lifting wt
Ease: bend -> seated (off loaded, X wt bearing)
SLR: negative
imaging: X-ray, OBLIQUE view –> scotty dog = +
What is spondylolisthesis?
age?
pain?
agg?
Ease?
SLR?
imaging?
Sponylolisthesis = bilat Fx of pars articularis -> Ant dislocation of VB (UNSTABLE)
age: 20, can worsen w/ age
pain: LBP - local
Agg: extension/stand & flexing during standing or lifting wt
Ease: bend -> seated (off loaded, X wt bearing)
SLR: negative ( no N. )
imaging: X-ray - LATERAL view
What is disc herniation?
age?
pain?
agg?
Ease?
SLR?
imaging?
disc herniation = nucleus pulposus
age: 30-50
pain: LBP unilateral + leg (N. involvement)
Agg: flexion, sitting, bending, ASCENDING stairs
Ease: extension, stand, DESCENDING stairs
SLR: POSITIVE
imaging: MRI + CT
What is anterior cord syndrome in SCI?
Anterior cord injury
MOI: hyper-FLEXION injury
s/s: loss of pain + temp
s/s: loss of motor bilaterally
( lateral spinothalamic tract)
What is Central cord syndrome in SCI?
Central cord syndrome
MOI: hyper-EXTENSION
s/s: loss of motor in neck and UE’s bilat
(both ascending and descending tracts medially = neck and UE)
What is posterior cord syndrome in SCI?
posterior cord syndrome = posterior cord injury
MOI: compression injury
ex. tumors, OA/DJD of C spine
s/s: loss of propioception (dorsal columns) = ataxia
MOTOR fx preserved!
What is Brown-Sequard syndrome in SCI?
brown-sequard = injury to half of SCI
MOI: hemisection injury - bullet, stab-wound, etc.
s/s:
- IPSILAT: loss of motor and propioception
-CONTRALAT: loss of pain and temp
What are the norms for ABI? (ankle-brachial index)
ABI = ankle BP/brachial BP
= claudication or PAD severity
abnormal high = >1.4, false elevation, noncompliant arteries, vessel calcification
normal = 1.0
mild = 0.7-0.9
mod = 0.5 - 0.7
severe = < 0.5 = MEDICAL EMERGENCY!!
severe arterial disease, risk for limb ischemia, gangrene, ulcers, pain at REST
What are the 3 categories for the Rancho Los Amigos levels of consciousness and what are the levels of each category?
RLA -> Response, L -> Confused, Appropriate
Lvls 1-3 = response
Lvls 4-6 = confused
Lvls 7-8 = appropriate
List all 8 of Rancho los amigos levels of consiousness.
RLA -> Response, L -> Confused, Appropriate
Lvls 1-3 = response
1 = No response
2 = generalized response
3 = localized response
Lvls 4-6 = confused
4 = confused + agitated
5 = confused + inappropriate
6 = confused appropriate
Lvls 7-8 = appropriate
7 = automatic appropriate
8 = purposeful appropriate
how to facilitate muscle tone? (how to increase M. tone, ex. flaccid)
-approximation
-manual resistance
-quick icing
-light touch
-tapping
-high frequency vibration
-quick stretch
-fast spinning
how to inhibit muscle tone? (how to decrease M. tone, ex. spasticity)
-deep pressure
-prolonged stretch
-neutral warm or prolonged cold
-maintained touch
-low frequency vibration
-slow stroking
-slow rocking
What does the modicied Ashworth scale measure and what are the values?
Modified Ashworths = spasticity ONLY (CANNOT measure riggidity or flaccidity or synnergies)
0 = normal
1 = resistance at END-range
1+ = resistance at last 1/2 of end-range
2 = resistance through MOST range
3 = passive mvmt difficult
4 = RIGID
What is the norms for the peripheral pulse grading scale and when is it used for?
used for severity of PAD and claudication
0 = absent pulse
1+ = barely perceptible
2+ = easily palpable/NORMAL
3+ = full pulse/ increased strength
4+ = bounding pulse
What are the 5 P’s s/s for intermittent claudication?
Pain (at rest, worse at night)
pallor
pulselessness
paresthesia: n/t
paralysis
usually in thigh, but can be in hip and glutes
what are the cardinal sx of heart disease?
-pain: chest, neck, jaw, arm, –indigestion
-palpitations
-dyspnes/SOB
-dizziness
-cardiac syncope (fainting/OH)
-fatigue
-cough
-diaphoresis (sweating)
-cyanosis
-edema
what is the difference b/w primary and secondary HTN?
primary HTN = idiopathic;
obesity, family hx, diet, etc
secondary HTN = acquired as a result from other medical condition - “secondary” to medical cond. ;
thyroid, kidney dx, pregnancy, etc.
what are the s/s of orthostatic hypothension (OH)?
-BP drop upon changing positions
-HR increases (to compensate)
-lt headed, dizziness, fainting
-pallor + diaphoresis
-weakness
action: “if head is pale -> LIFT the tail” = return to supine
What are improtant labs for myocardial infarction or cardiac disease?
-Troponin = GOLD standard
-Cratine Kinase
-Total cholesterol
-LDL
-HDL
-triglycerides
-high sensitivity C-reactive protein (CRP)
What is the norm for troponin levels for heart disease?
troponin is: Heart M. protein, heart death(infarct -> heart releases proteins (and potassium in cell = high potassium/hyperkalemia)
Normal = 0.0-0.5
MI = > 0.5
What is the norm for creatine kinase (CK-MB) for MI?
Creatine kinase is also a protein in muscle cells, can be released with injury to skeletal or cardiac muscle
important in rhabdomyolysis and MI
CK-MB: >3 = MI
CK-MB: < 3 = skeletal M. damage
what are the lab values for total cholesterol?
Normal = < 200 mg/dL
High = > 200 = higher risk for heart dx
What are the lab values for LDL and what does it mean?
Normal = < 130
higher = high plaque buildup
IF high risk for MI, desired = < 70
LDL = LOW is BETTER for heart
What are the norms for HR?
Normal: 60-110 bpm
High: > 130 bpm
Low: < 60bpm
What are the norms for BP?
Normal: < 120/80
Too High: >180/110
Too low: <90/60
What are the norms for SPO2?
Normal: 95-100%
too low: < 90%
What are the norms for RR?
Normal: 12-20 breaths/min
too high: > 25
too low: < 12
What are the lab value norms for RBCs?
Normal RBC (mill/uL): 4-6
What are the lab value norms for WBCs?
WBCs in (Th/uL):
Normal: 5-10 OR 5,000-10,000
Too high: > 11 or 11,000 = leukocytosis (infection, chronic inflamm., surgery/trauma, allergy)
Too low: < 4 or 4,000
Leukopenia: viral, chemo, anemia, autoimmune
Lower: < 1.5 or 1,500
Neutropenia: stem cell dx, bacterial, radiation = NEUTROPENIC PRECAUTIONS!
What are the lab value norms for platelets?
Platelets = (Th/uL)
Normal = 140-400 OR 140,000 - 400,000
too high: > 450 or 450,000
thrombocytosis: inflammation, stress, cancer, iron deficiency, hemorrhage meds = HIGH CLOT RISK, DVT/PE
too low: < 150 or 150,000
thrombocytopenia: infection, leukemia radiation, liver dx, anemia = HIGH RICK FOR BLEEDING, FALL RISK!
What are the lab value norms for Hematocrit (Hct)?
Hct: % of RBCs in blood, fluid balance
normal: 40-50%
too high: > 60%
CAD, dehydration, burns = HIGH CLOT RISK, DVT/PE
too low: < 15%
anemia, bld loss, bone marrow suppression = CHECK SPO2, low perfusion, cardiac failure!
What are the lab value norms for Hemoglobin (Hgb)?
Hgb: (gm/dL) O2 carrying capacity, fl balance
normal: 12-17
too high: > 20
CAD, dehydration, hypoxia, COPD, burns = HIGH RISK OF CLOTTING/CLOGGING –> ischemia, MI, CVA
too low: < 8
anemia, bld loss, bone marrow suppression
= PT CUTOFF, NO pt, monitor SPO2
<7 = TRANSFUSION! –> CHF or death
what is the medical tx for confirmed acute coronary syndrome?
-anticoagulants: antiplatelets -> aspirin
-beta-blocker: -lol’s
-Ace inhibitor: -pril’s
-Statins
How do beta-blockers work?
block B1 receptor in SA node (sympathetic NS) to reduce HR
AE: also reduce heart conduction -> heart blocks
meds: atenolol, metropolol, nadolol, propanolol
PT: cannot use HR to measure exercise vigor –> RPE
How do calcium-channel blockers work?
block Ca+ channel in heart = no action potential = decreased HR
-reduces M. contractility
-vasodilation
meds: verapamil, nifedipine, amlodipine
How do organic nitrates work?
release nitric oxide (NO) = powerful vasodilator = reduced heart workload
sublingual = immediate, short duration
oral meds = slow speed, long duration; prevent angina
meds: nitroglycerin, nitrostatin, isosorbides
What are the levels of dyspnea scale and what is your stop value?
0 = no dyspnea
1 = mild, noticeable
2 = mild, some difficulty
3 = moderate difficulty, can continue
4 = severe difficulty, cannot continue
What are the levels of angina scale and what is your stop value?
0 = no angina
1 = light, barely noticeable
2 = moderate, bothersome
3 = severe, uncomfortable, preinfarction
4 = most pain, infarction pain
What does Berg Balance Scale test for and what is it’s cutoff?
BBS = measures static and dynamic balance using functional activities
0 = unable
4 = independent
cutoff: < 45 = high fall risk
What does Tinetti test for and what is it’s cutoff?
tests for balance
cutoff: < 18 = high fall risk
What are the 6 stages of ALS?
Stage I: early LMN
-mild weakness
-asymmetrical
Stage II: Mod I w/ AD
-mod. atrophy in groups of M.s
-use of AD
Stage III: amb w/i functional limits
-severe weakness, fatigue
mild/mod functional limitations
-ambulatory
Stage IV: WC
-severe weakness and wasting of LEs
-Mod A + AD’s required
-WC user
Stage V: (UMN)
-progressive weakness of limbs and trunk
-spasticity, hyperreflexia, loss of head control
-Max assist
Stage IV: bedridden
-dependent in all ADLs
-respi distress
What are the subtypes of MS presentation?
Relapsing-remitting:
discrete attacks + full/partial remission
Primary progressive: disease progression from onset, no discrete relapses
Secondary-progressive: initially relapse-remitting, changes to -> steady decline of fx
Progressive-relapsing: steady deterioration from onset w/ occassional acute attackts
Clinically isolated syndrome (CIS): first episode lasting > 24 HOURS, CAN develop into MS
What are the Brunnstrom stages of stroke recovery?
Stage I: flaccid paralysis
Stage II: emergence of spasticity, hyperreflexia, synergies (mass patterns of mvmt)
Stage III: Peak spasticity, voluntary mvmt IN synergies ONLY
Stage IV: emerging isolated jt mvmt
Stage V: increased control OUT of synergies
Stage VI: control and coordination NORMAL
How do you calculate burn percentage using the rule of 9’s on an ADULT?
-entire head = 9% (front = 4.5, back = 4.5)
-entire arm = 9% each (front = 4.5, back = 4.5)
-entire leg = 18% each (front = 9%, back = 9%)
-entire trunk front = 18% (9% thoracic, 9% abdominal)
-entire trunk back = 18% (9% thoracic, 9% abdominal)
How do you calculate burn percentage using the rule of 9’s on an CHILD?
-Head + neck = 18% (front = 9%, back = 9%)
-Trunk front = 18% (thoracic = 9%, abdominal = 9%)
-Trunk back = 18% (thoracic = 9%, abdominal = 9%)
-Whole arm = 9% (front = 4.5, back = 4.5)
-Whole leg = 14% (front = 7%, back = 7%)
What is involved in an epidermal burn?
just epidermis = pink/red “erythamous”
-1st degree sunburn
-DRY
EPIdermal = EPIdermis
Burn = layer of SKIN
pressure ulcer = layer of TISSUE
What is involved in a superficial-partial thickness burn?
-epidermis + papillary part of dermis = RED/PINK + WET
“mottled red”
-BLISTER
-WET
-edema
-BLANCHING of skin
brisk capillary refill
epidermis: free N. endings + merkel
= X pain/itch + soft touch
Papillary: Meissner + Krause + Rufini
= X cold/hot temp sensation
Burn = layer of SKIN
pressure ulcer = layer of TISSUE
What is involved in a deep-partial thickness burn?
Epidermis + papillary + reticular = mixed red/waxy white
-2nd degree burn
-BROKEN BLISTER
-WET
-excessive scarring -> keloid/hypertrophic
Burn = layer of SKIN
pressure ulcer = layer of TISSUE
What is involved in a full thickness burn?
complete burn of epidermis + dermis layers = only hypodermis left
= WHITE ISCHEMIC/CHARRED (black) color
-NO blanching
-poor distal circulation
-leathery, rigid-dry skin
-Anesthetic = loss of all nerves (NO pain)
-requires skin graft
Burn = layer of SKIN
pressure ulcer = layer of TISSUE
Describe a stage I pressure ulcer?
-just red (nonblanchable)
-skin intact
Stage I = amt of tissue
1 = 1 skin layer
Describe a stage II pressure ulcer?
-Red + blanchable (turns white to pressure)
-closed OR open wound
-partial thickness ulcer = epidermis + dermis = WET
blister + fluid
(serosanguineous or serum)
-may have slough (cheese)
Stage II = amt of tissue
2 = 2 skin layers
(epi + dermis)
Describe a stage III pressure ulcer?
-OPEN
-full thickness = epidermis + dermis + hypodermis
-up to connective tissue (full skin loss)
-can have necrosis
Stage III = amt of tissue
3 = 3 tissues
(epi + dermis + fat)
Describe a stage IV pressure ulcer?
-full thickness skin loss + tissue damage
(skin + muscle/tendon/bone)
-underminint and tracts present
-mat have slough and eschar but does not obscure tissue depth
Stage IV = amt of tissue
4 = 4 tissue layers
(epi + dermis + fat + bone)
Describe an unstageable pressure ulcer?
-depth of damaged tissue involved is obscured by necrosis/eschar/slough
Describe a deep pressure injury stage in pressure ulcers?
-discolored area (bruise/purple) where damage to tissue underneath is not reversible
-will progress to full-thickness injury
(epidermis + dermis)
What organs are in the Right Upper Quadrant?
-liver
-gallbladder
What organs are in the Left Upper Quadrant?
-spleen
-pancreas
-stomach
What organs are in the Right Lower Quadrant?
-large/small intestine
-appendix
What organs are in the Left Lower Quadrant?
-Pancreas
-colon
What are the C-spine rules?
imaging IF:
-Age > 65
-dangerous MOI
-paresthesia in UE’s
-able to rotate neck >45 degrees bilat
and None of:
-simple rear end MVC
-sitting in ED
-ambulatory
-delayed (not immediate) neck pain
-absence of midline C-spine tenderness
What are the ottawa knee rules?
Need X-ray IF: (high indication for fracture)
-Age > 55
-isolated patellar tenderness
-tenderness at head of fibula
-inability to flex knee to 90 degrees
-inability to bear weight for 4 steps immediately after injury
What are the ottawa ankle rules?
NEED X-ray IF: (high indication for fracture)
PAIN IN MALLEOLAR + ANY:
-TTP @ posterior medial or lateral malleoulus to 6cm up from malleoulus
-inability to bear weight for 4 steps after injury
What are the Ottawa FOOT rules?
NEED X-ray IF: (high indication for fracture)
PAIN IN MIDFOOT + ANY:
-bone tenderness at navicular bone (medial)
-bone tenderness at base of 5th met (lateral)
-inability to bear weight for 4 steps after injury
Special test for hip femoroacetabular impingement/labral tests?
FADDIR
+ = hip pain reproduction
What does the prone knee bend test?
femoral nerve tension or quad muscle length:
+: reproduction of unilateral pain in lumbar/buttock/posterior thigh or combination
What does the Thomas test do?
Test for hip flexor length:
rectus femoris and iliopsoas
+ = one thigh higher than the other
IF knee straight = rectus femoris shortening
IF knee bent = iliopsoas shortening
What does the modified Ober’s test?
test tensor fascia latae length
+ = leg can’t lower to table
What does the supine 90/90 or popliteal angle test?
test hamstring length
+ = cannot extend up to 20 degrees of full extension
implications of patella alta?
nothing there to give it horizontal/lateral stability
can partially/fully dislocate with knee flexion
implications of patella baja?
-limited knee ROM
-Ant knee pain
-Quad weakness w/ extensor lag
What are the clinical findings (s/s) for a knee miniscus injury according to the CPG?
MOI: twisting injury
-tearing sensation at time of injury
-DELAYED EFFUSSION (6-24 hrs pos injury)
-sx of catching or locking
-p! w/ passive hyper-extension
-pain w/ max knee flex
-pain or audible click w/ McMurrays
-jt line tenderness
-pain/ locking/catching w/ thessaly’s
What are the clinical findings (s/s) for a knee articular cartilage injury according to the CPG?
-acute trauma w/ hemarthrosis
(IMMEDIATE SWELLING 0-2 hrs) -> indicative of Fx
-insidious onset aggravated w/ REPETITIVE impact
-intermittent pain and swelling
-hx of catching/locking
-jt line tenderness
What does the Lachman test do?
Test for ACL injury
knee in 10 and 20 degrees of knee flexion
+ = anterior translation of tibia
What are wheals?
Wheals are HIVES!!
-irregular borders
-not raised (slightly)
-sign of allergic rxn
skin is mad, but doesn’t know what it’s mad about -> irregular
What are Vesicles?
Vesicles are BLISTERS!!
-dome shaped
-small
-thin walled sac filled w/ CLEAR fluid
What are pustules?
PUStule = PUS filled
Ex. zit/cystic acne (bigger)
What is Herpes SIMPLEX and what are its characteristics?
Herpes simplex = herpes virus = cold sores
Type 1 = above the waist
Ex. lips, face, UE
Type 2 = below the waist
Ex. STD
What is herpes ZOSTER and how does it appear on the skin?
Zoster = Shingles
sx: pain and paresthesia (n/t)
-rash
-unilateral
-raised to palpation
-pink w/ silvery white appearance
-spread in DERMATOMAL pattern
Herpes ZOSTER:
precautions?
modalities?
contraindications?
what CN are affected?
Zoster = Shingles
precaution: airborne
modalities: TENS, in dermatomal pattern
contraindications: NO HEAT, cold ok
CN?: CN 3 and CN 5
What kind of dressing should you use for VERY MILD exudate?
transparent films
What kind of dressing should you use for MINIMAL exudate?
-hydrogel
-hydrocolloid
What kind of dressing should you use for MODERATE exudate?
Foams
What kind of dressing should you use for HEAVY exudate?
-calcium alginate
-hydrofiber
Describe a hyperthrophic scar?
hypertrophic = hypertrophy (Ex. muscles)
= thicker skin
-stays WITHIN margins of original scar
Describe a keloid scar?
Keloid = confused skin
-goes outside of original scar borders
-irregular in shape
-may be raised
Describe the different patient positioning in bed for the list below:
Fowlers?
Semi-Fowlers?
Trendelenburg?
Reverse trendelenburg?
Fowlers: HOB at 45 degrees up (half-sitting up in bed)
Semi-Fowlers: HOB at 15-30 degrees up (head up slightly)
Trendelenburg: flat back, entire bed angled, feet raised higher than head by 15-30 degrees
Reverse Trendelenburg: flat back, entire bed angled, head raised higher than feet by 15-30 degrees
**Important incase they ask you for postural drainage or contraindicated positions for CHF, PVD/PAD, etc. ***
What is considered “Bowstringing” in the hand and fingers?
Bowstringing is a rupture of pulley
Ex. Flexor digitorum Profundus tendon (on image)
What is trigger finger and what are different treatments?
Trigger finger = tenosynovitis of flexor tendon
swollen tendon cannot pass through annulus pulley
-conservative treatment = finger splint in neutral to allow tendon inflammation to reduce
-cortisone injection
-severe = surgery cut tendon sheath
What is mallet finger?
DIP looks like a mallet
MOI: forced hyper-flexion in sports from catching a ball
-ruptures Extensor Digitorum tendon at DIP jt –> DIP can no longer exten, stuck in flexion
-Central slip is preserved
-CAN PROGRESS to swan neck deformities if not treated (central slip injured)
-Tx = splint of DIP in extension for 4-8wks for tendon to heal
What is swan neck deformity?
Swan neck deformity =
-distal interphalangeal FLEXion and
–proximal IP EXTension
structures injured:
-extensor tendon rupture (mallet finger) +
-lax volar plate
common in RA
What is a Boutonniere deformity?
Boutonniere Deformity = central slip is torn
The interphalangeal (IP) jt pops through the lateral bands (like a button) –> causing hyperextension of proximal interphalangeal jt
what is Jersey finger?
Jersey finger = due to holding on to jersey and hyperextends the PIP (MOI)
Flexor digitorum profundus tendon avulsion
-Pt unable to flex DIP jt
What is Gamekeepers thumb?
MOI?
sx?
special tests?
Tx?
Gamekeeper’s thumb = rupture of ulnar collateral ligament of the thumb
-causes laxity of medial side of IP jt of thumb
MOI: FOOSH w/ thumb in hyper-ABD at IP jt
-has weak pincer grasp
-valgus stress test at thumb
-instability/laxity
tx = thumb spica splint
What is the difference b/w Rheumatoid arthritis and Osteoarthritis at the hands?
OA = nodes at the 2 most distal jts
-Bouchard = IP jt
-Heberden’s nodes = at DIP jt
RA = nodes at MCP jt (metacarpal phalangeal, aka knuckles, most proximal jt)
WITH ULNAR DRIFT
What are the mvmts of the thumb?
Do it with your hand
thumb flexion = in the hand (E)
thumb ext = away from hand (F)
thumb ABD = hamburger (G)
thumb ADD = back with fingers (H)
thumb oposition = touching each finger
What is the arthrokinematics of the thumb in ABD and ADD?
saddle jt = ABD + ADD = convEX
ABD = hamburger = cowboy slumps FWD on saddle =
-anterior roll + post glide
head rolls fwd, butt slides back
ADD = thumb together to hand = cowboy slumps BACK on saddle =
-POST roll + ANT glide
head rolls backwards/post, butt slides fwd
What is the arthrokinematics of the thumb in flexion and extension?
saddle jt = flex + ext = conCAVE
-extension = cowboy sliding off the SIDE (lat) =
-lateral roll + lateral slide
-flexion = cowboy sliding back to MIDDLE =
-medial roll + medial slide
What is the arthrokinematics of the thumb in opposition?
thumb opposition = 2 phase mvmt
- ABD of thumb
- flexion w/ medial rotation of thumb
What does it mean when you loose the angle/slope of the 4th and 5th knuckles?
i think it’s lunate dislocation or AVN of lunate …… fact check it!!
What is spoon nails significant for?
(medical diagnosis)
spoon nail = koilonychia
-anemia
-DM
-protein deficiency
Always refer back to MD if not already documented or known by MD, especially w/ multiple sx
What is a central nail ridge significant for?
(medical diagnosis)
central nail ridge = middle line of nail is raised
indicative of:
-Fe deficiency
-folic acid deficiency
-protein deficiency
Always refer back to MD if not already documented or known by MD, especially w/ multiple sx
What is nail beading significant for?
(medical diagnosis)
nail beading = several raised ridges along the nail
significant for:
-endocrine conditions such as:
-DM
-thyroid
-Addison’s
Always refer back to MD if not already documented or known by MD, especially w/ multiple sx
What is sandpaper nails significant for?
(medical diagnosis)
Rough/sandpaper nails, dull appearance
seen in:
-chemical exposures (work related?)
-psoriasis
-autoimmune Dx
-lichen planus
Always refer back to MD if not already documented or known by MD, especially w/ multiple sx
What is pitting nails significant for?
(medical diagnosis)
pitting nail =
indicative of:
-autoimmune dx
-psoriasis
-eczema
-lichen planus
Always refer back to MD if not already documented or known by MD, especially w/ multiple sx
What is onycholysis significant for?
(medical diagnosis)
onycholysis = splitting of the nail from skin underneath
associated w/:
-thyrotoxicosis
-trauma
-contact dermatitis
-chemicals exposure
-porphyria cutanea tarda
need to see medical provider –> not-emergency but requires medical tx
What is digital clubbing significant for?
(medical diagnosis)
digital clubbing = distal finger and nail is bulbous
indicative of:
-pulmonary dx
Shamroths sign = no window b/w fingers
Always refer back to MD if not already documented or known by MD, especially w/ multiple sx
What is a sign for Melanoma on the fingernail?
straight black line down the middle,
especially if you can see it in more than one finger
What is De Quervain’s Tenosynovitis?
what muscles?
MOI?
special tests?
tx?
inflammation of the tendon sheaths of the Extensor Pollicis Brevis and ABDuctor Pollicis Longus
MOI: overuse/repetitive gripping, grasping or wringing
-golfing
-typing
-playing piano
-fishing
-carpentry
Special tests: Finkelsteins
tx:
-splinting
-US
-ice/heat
-strengthening
List all the special tests for Scaphoid fracture?
-Axial loading of the thumb
-pain in anatomical snuff box
What is the Watson Scaphoid test?
Tests for Scaphoid instability
- grip scaphoid b/w fingers
- passively move wrist into radial deviation and slight flexion
- press scaphoid down (out of normal alignment)
- Let go - (+) = loud “Thunk” when scaphoid moves back into place or subluxation
What is the TFCC Load test?
TFCC = triangular fibrocartilage complex
Tests for TFCC tear –> laxity/instability
TFCC = ulnar side, cartilage at ulnar side b/w ulna and carpals
- grab space b/w ulna and carpals b/w two fingers
- provide dorsal glide
(+) = reproduction of pain or laxity
What is a test for hip or femur fracture?
patellar-pubic percussion test
(+) one side sounds dimmer or muffled than the other
What is a test for hip impingement?
FADDIR –> tests for Femoroacetabular impingement (FAI) and labral
tears
(+) = reproduction of pain/sx
3 types of FAI:
-CAM (@ neck of femur) –> pinches labrum and damages cartilage
-Pincer (@ acetabulum) –> pinches labrum
-Mixed
pt profile:
-growing children, growth spurts
-involved in athletics
-OA, middle aged woman
https://www.youtube.com/watch?v=CNgQpbZPflU
What are the hallmark signs and MOI for heterotrophic ossificans (myositis ossificans)?
myositis ossificans/heterotrophic ossifican = muscle starts calcifying
MOI:
-complication post surgery (involving bone/jt, example ORIF or THA)
-trauma
-blast injuries
Hallmark:
-progressive loss of ROM when postratumatic inflammation should be resolving
-pain on palpation
-firm mass palpable
What are some pain descriptors for bony tissue involvement?
Deep ache, boring
What are some pain descriptors for muscle/fascia tissue involvement?
dull
achy
sore
burning
cramping
What are some pain descriptors for nerve tissue involvement?
sharp
shooting
lancinating
tingling
burning
numbness
weakness
What are some pain descriptors for vascular tissue involvement?
burning
stabbing
throbbing
tingling
cold
What are some pain descriptors for visceral tissue involvement?
deep pain
cramping
stabbing
visceral = usually lean towards injury
MSK = usually lean away
What are the stages for the Wagner pressure ulcer scale?
Scale for diabetic foot ulcers
grade 0 = skin intact, possible bone deformation/ hyperkeratosis
grade 1 = superficial ulcer (skin tissues only)
grade 2 = deep ulcer, into tendon/bone/jt capsule
grade 3 = tissue abcess, presence of tendonitis, osteomyelitis, cellulitis
grade 4 = wet/dry localized gangrene
grade 5 = extensive gangrene w/ necrosis (indicative for amputation)
What is the CPR for ankle impingement?
must have 5+/6
-anterolateral ankle jt tenderness
-anterolateral jt swelling
-pain w/ forced DF
-pain w/ SL squat on affected side
-pain w/ activities
-absence of ankle instability
What are the key clinical findings for Plantar Fasciitis according to the CPG?
-plantar medial heel pain w/ initial steps & worsening w/ prolonged WB
-heel pain from increase in WB activity
-reproduction of heel pain w/ palpation or provocation of plantar fascia (WINDLASS)
-Positive windlass test
-negative tarsal tunnel tests as well as other LE peripheral N. entrapment
-negative findings suggesting referral from lumbar, pelvis, lower limb tension, or other neurological exam
What are some interventions for plantar fasciitis according to the CPG?
Therapeutic exercises:
-plantar fascia stretching
-gastroc/soleus stretching
Manual:
-jt mobes for talocrural DF
-soft tissue mob of plantar fascia
-soft tissue mob of gastroc/soleus trigger pts
Taping:
-antipronation taping
Foot orthoses:
-IF pt has excessive pronation –> foot orthoses w/ support for medial arch and/or heel cushion
-IF excessive supination –> foot orthoses w/ heel cushion (due to decreased shock-absorption capacity)
Night splints:
-for 1-3 month period
What are some other interventions for plantar fasciitis to improve walking and running gait abnormalities according to the CPG?
Manual:
-jt mobilization/manual stretch to restore normal mvmt at -
-1st metatarsophalangeal jt
-tarsometatarsal jts
-talocalcaneal jt
-talocrural
-knee
-hip mobility
-soft tissue mob and manual stretching to restore normal M. length to -
-calf
-thigh
-and hip myofascia for terminal stance (DF)
Therapeutic ex. and NM-reed:
-strenghtening muscles that work eccentrically to control mid-tarsal pronation (tib post + fibularis longus)
-“ “ that control eccentric ankle PF (tib ant)
- ” “ control eccentric knee flexion (quads)
- ” “ control eccentric hip ADD (glute med)
- ” “ control eccentric LE internal rotation (hip ER’s) at loading responce
goal of therex/NMRE:
-reduce pronation during WB
-improve and distribute shock absorption during WB
According to the CPG, what patient examination findings should there be to diagnose Achilles Tendinopathy?
-gradual onset of pain
-pain 2-6 cm to achilles insertion
-pain w/ tendon palpation
-positive arc sign
-+ Royal London Hospital test
According to the CPG, what are some ACUTE diagnostic indicators of Achilles Tendinopathy?
-redness, warmth swelling
-<3 mo in duration
-pain limiting low-lvl activity
+ examination findings
According to the CPG, what are some NON-ACUTE diagnostic indicators of Achilles Tendinopathy?
-No redness, warmth, swelling
->3mo duration
-p! during/after high lvl activity
-tendon pain w/ palpation w/ or w/o nodules
What are the 4 prevention stages for lateral ankle sprains according to the CPG?
(look at image)
According to the lateral ankle sprain CPG, what are the timelines of return to sport/work for ligament distortion, partial/total ligamen rupture, and surgery?
(image)
According to the lateral ankle sprain CPG, what are the pt examination findings for ACUTE lateral ankle sprain?
-sudden onset p! w/ ankle inversion-related injury
-(-) Ottawa ankle rules
-(+) reverse anterolateral drawer test
-(+) anterolateral talar palpation test
-(+) anterior drawer test
According to the lateral ankle sprain CPG, what are the pt examination findings for CHRONIC ANKLE INSTABILITY (CAI)?
-hx of >1 significant ankle sprain
-reports of “giving way”
-episode of subsequent sprain and/or perception of ankle instability
-decreased performance of functional tests
-Discriminative instrument scores:
-Identification of Ankle Instability: score >11
-Cumberland Ankle Instability Tool: score <25
-4+ “yes” answers to the Ankle Instability Instrument
According to the lateral ankle sprain (LAS) CPG, what are interventions for LAS?
-progressively WB w/ external supports
-therex and HEP w/ ROM, stretching and NMRE
-Manual: (pain-free)
-lymphatic drainage
-soft tissue/jt mob
-A-P talar mobs
-improve ankle/foot mobility
-normalize gait
-Occupational/sports-related training w/ activity and participation restrictions
-low lvl laser
-US: pulsating short-wave diathermy for edema and gait
-NSAIDS
According to the lateral ankle sprain CPG, what are interventions for CHRONIC ANKLE INSTABILITY (CAI)?
-Propioceptive/NMRE to improve ankle stability
-Manual:
-jt mobes/manips in WB and non-WB to improve DF, propioception and WB tolerance
-trigger pt dry needling of peroneals (muscles)
What is the clinical algorithm to determine SIJ dysfunction?
-pain below L5
-pain unilateral AND NOT central
-No centralization/ peripheralation
-3/6 (+) SIJ provocation test
-(does not go beyond buttocks and thigh)
What are the 6 SIJ dysfunction provocation tests?
-Posterior shear/Thigh thrust
-SIJ distraction
-SIJ compression
-Gaenslen’s left
-Gaenslen’s right
-sacral thrust
What is the thigh thrust provocation test/posterior shear test?
For SIJ
(+) = reproduction of pain/sx on the side of the loaded femur
What is the SIJ distraction test?
for SIJ
(+) = reproduction of pain/sx
What is the SIJ Approximation/Compression test?
for SIJ
Pt sidelying - AFFECTED side UP!
(+) = reproduction of sx
(of hip on top)
What is the Sacral Thrust Provocation test?
for SIJ
pt prone, force on sactum down
(+) = reproduction of sx
What is the Gaenslen’s Provocation test?
for SIJ
-pt diagonal w/ one leg hanging off edge of table
-other leg to chest
-apply pressure to both legs:
-downward pressure to leg hanging off
-downward pressure to leg on chest
(increasing pelvic rotation on SI jt)
(+) = reproduction of sx
What is the Supine Active Straight Leg Raise test (ASLR)?
for SIJ instability/laxity
-pt does SLR –> pain
-PT compresses iliac crest –> no pain
(+) = pt able to perform active SLR with compression
What is the Cervical Radiculopathy Test cluster?
at least 3/4 (+)
-upper limb tension test A
-Spurlings A
-Cervical Distraction
-Cervical rotation < 60 degrees
What are some indications for traction?
-spinal disc bulge or herniation
-spinal N. root impingement
-joint hypomobility
-SUBacute jt inflammation
-muscle spasm
What are some contraindications for traction?
-when motion ins contraindicated (Ex. fracture/RTC repair)
-ACUTE injury/inflam
-jt hypermobility/instability
-peripheralizatino of sx w/ traction
-uncontrolled HTN
What are the dosing parameters for Lumbar traction in the initial/acute phase?
initial/acute phase:
Force:
13-20 kg (29-44 lbs)
Static hold
Total time: 5-10 mins
What are the dosing parameters for Lumbar traction for joint distraction?
Joint distraction:
Force:
22.5kg (50 lbs) OR 50% body wt
Hold/relax time: 15 sec/15 sec
Total time: 20-30 mins
What are the dosing parameters for Lumbar traction for decreased muscle spasm?
decreased muscle spasm:
Force:
25% body wt
Hold/relax time: 5 sec/ 5 sec
Total time: 20-30 sec
What are the dosing parameters for Lumbar traction for stretching of soft tissue/disc?
Force:
25% body wt
Hold/relax time: 60 sec/20 sec
Total time: 20-30 mins
What are the dosing parameters for Cervical traction for inital/acute phase?
initial/acute:
Force: 7-9lbs
Hold/relax: static hold
Total time: 5-10 mins
What are the dosing parameters for Cervical traction for joint distraction?
jt distraction:
Force: 20-29 lb OR 7% body wt
Hold/relax: 15 sec/15 sec
Total time: 20-30 mins
What are the dosing parameters for Cervical traction for decreased muscle spasm?
M. spasm:
Force: 11-15 lb (5-7 kg)
Hold/relax: 5 sec/5 sec
Total time: 20-30 mins
What are the dosing parameters for Cervical traction for soft tissue stretch/Disc?
Tissue stretch/disc:
Force: 11-15 lbs (5-7kg)
Hold/relax: 60 sec/20sec
Total time: 20-30 mins
What is the CPR for pts who may benefit from CERVICAL traction?
-Age > 55
-petipheralization w/ spine mobility
-(+) shoulder ABD test
-(+) ULTT A
-(+) Cervical Distraction test
What is the CPR for pts who may benefit from LUMBAR traction?
-Age >30
-not manual laboers
-low fear avoidance (FABQ)
-No neuro deficits
According to the Neck pain CPG, what are the common sx and expected exam findings for neck pain with mobility deficits?
Common sx:
-central/unilateral neck pain
-neck motion limitation that reproduces sx
-may have referred shoulder girdle/UE pain
Expected exam findings:
-limited cervical ROM
-neck pain reproduced at end-ranges of active and passive mvmt
-restricted cervical/thoracic mobility
-neck and referred pain reproduced
-deficits of scapulothoracic strength
According to the Neck pain CPG, what are some interventions for neck pain with mobility deficits?
According to the Neck pain CPG, what are the common sx and expected exam findings for neck pain with radiating pain/radicular pain?
According to the Neck pain CPG, what are some interventions for neck pain with radiating pain/radicular pain?
According to the Neck pain CPG, what are the common sx and expected exam findings for neck pain with cervicogenic headache?
Common sx:
-noncontinous unilateral neck pain w/ associated HA
-HA aggravated/precipitated by neck mvmts
Expected exam findings:
-(+) cervical flexion-rotation test
-HA produced w/ cervical segment provocation
-strength, endurance, coord deficits of neck M.
According to the Neck pain CPG, what are some interventions for neck pain with cervicogenic headache?
According to the Neck pain CPG, what are the common sx and expected exam findings for neck pain with movement coordination impairments (WAD)?
WAD = Whiplash
According to the Neck pain CPG, what are some interventions for neck pain with movement coordination impairments (WAD?
WAD = Whiplash
How do you screen for VBI?
pt seated, have pt fully extend neck then cervical rotation maintaining neck extension
(+) = nystagmus
What do you do if pt shows positive signs for VBI?
What is the modified Sharp-Purser test:
tests transverse ligament –> atlanto-axial instability
transverse ligament: holds dens back
keeps dens from moving anteriorly to SC
pt seated
1. grasp spinous process of C2
2. push head towards spinous process
(+) = reproduction of myelopathic sx during forward flexion that DECREASE w/ A-P mvmt
OR
(+) = excess displacement
IF (+), CALL 911
What is the alar ligament test?
tests Apical ligament of dens –> cervical instability
Apical ligament of dens: attaches dens vertically to atlas
pt seated
1. grab C2 spinous process
2. either SB or rotate head passively
(+) = C2 spinous process does NOT move
normal = C2 spinous process moves with mvmt
IF (+), CALL 911
What is the lateral shear test of the atlanto-axial jt?
tests alar ligament –> cervical instability
pt supine
1. grab transverse process of C1 w/ one hand
- grab transverse process of C2 with other hand
- apply force b/w 2 grips creating shear force
(+) = reproduction of myelopathic sx during translation
OR
(+) = excess displacement
IF (+), CALL 911
