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Advanced Orthopedics > Foundations of Musculoskeletal Practice > Flashcards

Foundations of Musculoskeletal Practice Flashcards

1
Q

What does SAC stand for

A
  • Screen: red/yellow flags, neuro screen, & movement screen
  • Acuity: how vigorous can the physical exam be (SINSS)
  • Classification: diagnosis for treatment, CPG’s
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2
Q

What are the types of referrals

A
  • Emergent referral: immediate termination of exam & send patient to hospital/ED
  • Urgent referral: immediate termination of exam & have patient see specialist within the next couple of days
  • Watchful Waiting: continue with exam & treatment but make patient aware of signs/symptoms to look out for
  • Treat: all is well treat as normal
  • Self-care Management
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3
Q

What are some general pain related red flags that could possibly be a serious pathology

A
  • Uncontrolled with analgesics
  • Not reproduced/exacerbated by your evaluation
  • Worsens at night or with rest
  • Exacerbates with general activity
  • Bilateral
  • Encompasses several dermatomes
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4
Q

What are the 9 “Do not want to miss” serious pathologies

A
  • Major depression
  • Suicide risk
  • Femoral head & neck fractures
  • Cauda Equina Syndrome
  • Cervical myelopathy
  • AAA (abdominal aortic aneurysm)
  • DVT (deep vein thrombosis)
  • PE (pulmonary embolism)
  • Atypical MI (myocardial infarction)
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5
Q

What is the first question for any new initial exam

A
  • Is the patient appropriate/right for PT
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6
Q

Good tools to screen for yellow flags

A
  • High fear avoidance
  • High pain catastrophization
  • Presence of central sensitization
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7
Q

What are some yellow flags that can be discovered from the interview

A
  • Passive attitude
  • Extended rest
  • Family enablement
  • Lack of financial incentive to return to work
  • High intake of other substances
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8
Q

Define yellow flags

A
  • Psychosocial indicators suggesting an increased risk of progression to long term distress, disability, & potential drug misuse
  • Includes patient’s attitudes, beliefs, emotions, behaviors, & family and work place factors
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9
Q

What does SINSS stand for

A
  • Severity: what level (intensity)
  • Irritability: how high, quick, & how long (intensity/quality), amount of activity to stir up symptoms
  • Nature: Aggies & eases (location/MOI), hypothesis of structures involved
  • Stage: acute, sub-acute, chronic (temporal characteristics)
  • Stability: symptom behavior over time (temporal characteristics), getting better or getting worse
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10
Q

What are the 3 basic mechanisms of injury (MOI)

A
  • Acute trauma
  • Repetitive overload
  • Insidious/Unknown
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11
Q

Describe the levels of acuity

A
  • Low: all systems go
  • Medium: proceed with caution; intense, sharp pain that is brief
  • High: lots of caution and pain with next steps of exam
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12
Q

Describe mobility

A
  • Consistent: same ROM limit in ANY position & across activities
  • AROM > PROM: end feel = tight, springy, block
  • Tissue extensibility dysfunction (TED): scarring & fibrosis, neural tension, fascial tension, muscle shortening, hypertrophy
  • Joint mobility dysfunction (JMD): OA, osteoarthritis, dislocation, fusion, adhesive capsulitis, subluxation
  • Accessory Joint Glide: hypomobile/restricted
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13
Q

Describe stability

A
  • Inconsistent: change of position improves ROM limits; some activities OK
  • PROM > AROM: end feel= empty or pain restricted
  • Stability & motor control dysfunction (SMCD): True stabilization is reflex driven & relies on proprioception & timing; Compensatory patterns create pseudo-stabilization
  • Accessory Joint Glide: Normal L to R
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14
Q

Define high threshold strategy for stability

A
  • Use global muscles to accomplish tasks more suited to local muscles as a result of pain, previous injury, or chronic dysfunction
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15
Q

What are the phases of healing (exercise prescription framework)

A
  • Tissue healing
  • Mobility
  • Stability & motor control
  • Performance improvement
  • Advanced skill, agility, & coordination
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16
Q

What are the tissue healing phases

A
  • Protection
  • Remodeling
  • Repair
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17
Q

What are the 3 rehab approaches using provisional classification

A
  • Symptom modulation
  • Movement control
  • Functional optimization
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18
Q

Exercise prescription framework + rehab approach to choose interventions

A
  • Symptom modulation = tissue healing & mobility
  • Movement control = mobility & stability and motor control & performance improvement
  • Functional optimization = performance improvement & advanced skill, agility, and coordination
19
Q

Interventions based on symptom modulation rehab approach

A
  • Modalities (C-traction)
  • Education
  • Relative rest/controlled exercise
  • Joint & soft tissue mobilization/HVLA
  • McKenzie
  • Mulligan
  • PNE (pain neuroscience education) *if signs of chronic
20
Q

Interventions based on movement control rehab approach

A
  • <Modalities
  • Education
  • Sensorimotor (activation-Acquisition), Stabilization, Flexibility (loading)
  • <Joint & soft tissue mobilization (self)
  • <McKenzie
  • <Mulligan
  • PNE (pain neuroscience education) *if signs of chronic
21
Q

Interventions based on functional optimization rehab approach

A
  • No Mo, No Modalities
  • Education (Prevention)
  • Assimilation: LOADING for return to work &/or sport
  • Fitness
  • Endurance
  • PNE (pain neuroscience education) *if signs of chronic
22
Q

Describe the tissue differentiation classification

A
  • Functional & non-painful
  • Contractile tissue: AROM and PROM limited or painful in opposite directions
  • Inert tissue: AROM and PROM limited or painful in the same direction
  • Motor control: stability; AROM limited and PROM improves slightly
23
Q

What are considered body functions in the IFC model

A
  • Think of as “what it does”
  • Ex: sensory, pain, mental, voice, or speech functions
24
Q

What are considered activities & participation in the ICF model

A
  • Ex: Learning and applying knowledge, General tasks and demands, Communication, Mobility, Self-care, Domestic life, Interpersonal interactions and relationships, Major life areas, Community, social and civic life
25
Q

What are considered environmental factors in the ICF model

A
  • Ex: Products and technology, Natural environment and human-made changes to environment, Support and relationships, Attitudes, Services, systems and policies
26
Q

What are some appropriate, inappropriate, and preventable reasons for cervical spine manipulations

A
  • Appropriate: Neck pain, neck stiffness, HA, or cervical radiculopathy
  • Inappropriate: low back pain, otitis media, asthma, non-radicular shoulder pain
  • Preventable reasons: C-spine pathology RA, osteoporosis, spondylosis, vascular cardiac & atherosclerosis
27
Q

Risks and benefits of orthopedic manipulative therapy of the neck

A
  • Risks: very low absolute risk 0.006%, less risk compared to alternative Tx from NSAIDS and analgesics 6%
  • Benefits: moderate to large effect sizes for neck pain, disability, functional outcomes, cervical radiculopathy, favorable outcomes for tension type HA, & adding OMT to exercise enhances effect
28
Q

Slide 13 wait 48 hours to a week to manipulate the cervical spine if showing these signs

A
29
Q

What are the DAN’s (5Ds, 2As, and 3Ns)

A
  • 5D’s: dizziness, diplopia, drop attacks, dysarthria (hoarseness and hiccups), dysphagia
  • 2A’s: ataxia of gait and anxiety
  • 3N’s: nausea, numbness (ipsilateral face and/or contralateral body), and nystagmus
30
Q

C-spine subjective red flags

A
  • Trauma (MVA or other consider C-spine x-ray rules/ACR)
  • Report of the DANs even if transient (lasts for a short time)
  • Sudden onset in the absence of trauma described as unlike any other
  • Transient or current Horner’s syndrome
  • Patient history of cardiac risks and/or tobacco use
31
Q

Canadian C-spine rules for high risk factors that mandate radiograph

A
  • Any of the below positive then X-ray
  • Age >65
  • Dangerous MOI: fall from >1 meter/5stairs, axial load to head, VMA high speed/rollover/ejection, motorized recreational vehicle
  • Parathesias in the extremities
32
Q

Canadian C-spine rules for low risk factors to see in need X-ray

A
  • If OK with the below then are they able to actively rotate neck 45º L/R: if yess then NO x-ray needed)
  • Simple rearer-end MVC
  • Sitting position in ED
  • Ambulatory at any time
  • Delayed onset of neck pain
  • No midline C-spine tenderness
33
Q

Slide 23

A
34
Q

Glasgow coma scale

A
35
Q

Signs of a skull fracturer

A
  • Raccoon eyes: bruises around the eyes/eye bag area
  • Battle’s sign: bruise on/near the mastoid right behind the ear
36
Q

4 tier remobilization screening process for the cervical spine

A
  • Historical review: PMH, MOI
  • Medical testing and diagnostic imaging
  • Clinical screening for segmental stability: upper ligamentous testing, stress testing
  • Clinical screening for VBI: rotation 1st, rotation and extension 2nd (deKleyn’s test), and pre-manipulation positional hold
37
Q

Testing for hypoglossal nerve (CN XII)

A
  • Stick out tongue
  • Strength test resist into cheek
38
Q

Testing for glossopharyngeal (CN IX)

A
  • Difficulty swallowing
  • Gag reflex
39
Q

Testing for vagus (CN X) and accessory (CN XI)

A
  • Say Ahhhhh (CN X) or hoarseness/poor cough (CN XI)
  • Or Horner’s syndrome: Ptosis (drooping eyelid), Mitosis (pupil constriction), and Anhydris of the face (dryness)
40
Q

Screening for osseous/ligamentous serious pathology in the c-spine

A
  • Fracture: Jefferson (C1), DENS (C2), lamina, or burst fracture (vertebral body)
  • Ligamentous disruption: Alar or Transverse ligament
  • Clues from history: any trauma (object size and force) - fall, MVC, sports HIT
  • Conditions that weaken the system: RA, osteoporosis, long steroid use, Down syndrome, Arnold Chiari malformation, bone & collagen disorders
41
Q

Describe symptom modulation, movement control, and functional optimization stages

A
  • Symptom modulation: high disability, high pain/volatile, symptoms dominate
  • Movement control: moderate disability, moderate pain/stable, movement impairments dominate
  • Functional optimization: low disability, low to no pain/controlled, performance deficits dominate
42
Q

Describe neck pain with mobility deficits presentation

A
  • Central or unilateral neck pain
  • Limited motion that consistently produces symptoms
  • Associated (referred) shoulder/UE pain may be present
  • ROM limited
  • Neck pain at end ranges
  • Restricted segmental mobility
  • Positive provocation testing
  • Deficits with cervicoscapulothoracic strength or motor control
43
Q

Describe neck pain with movement coordination impairments (WAD) presentation

A
  • MOI trauma/whiplash
  • Associated (referred) shoulder girdle or UE pain
  • Associated varied nonspecific concussive signs & symptoms
  • Dizziness/nausea
  • HA, concentration, memory, confusion
  • Increased affective distress, hypersensitivity to thermal, acoustic, light indoors
  • Positive: cranial cervical flexion test, neck flexor endurance test, pressure algometry
  • Point tenderness may include myofascial trigger points
  • Sensorimotor impairment may include altered muscle activation patterns, proprioceptive deficit, postural balance or control
44
Q

Describe neck pain with headache presentation

A
  • Non-continuous, unilateral neck pain & associated (referred) HA
  • HA is precipitated or aggravated by neck movements or sustained positions/postures
  • Positive cervical flexion rotation test
  • HA reproduced with provocation of the involved upper cervical segments
  • Limited cervical ROM
  • Restricted upper cervical segmental mobility
  • Strength, endurance, & coordination deficits of the neck muscles

Advanced Orthopedics (29 decks)

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