General Flashcards
0
Q
Strain tears to small number of fibres, localised pain, no loss of function
A
GRADE I
Strain/tear
1
Q
Amenorrhea
A
Absence of menstral period
2
Q
Strain or tear to a significant number of fibres, associated pain and swelling. Pain produced on muscle contraction, reduced strength and limited ROM
A
GRADE II
Muscle strain/tear
3
Q
Complete tear of muscle
A
GRADE III
Muscle injury
4
Q
What is a Stryker device
A
Used to measure the intracompartmentalise pressure
5
Q
Normal intracompartmental pressure
A
0 - 4mmHg (some consider 10mmHg)
6
Q
When using a Stryker device what do you inject into the appropriate compartment?
A
Saline solution
11
Q
Contraindications for soft tissue manipulation
A
Acute inflammation, infection, endangerment sites Nerve/blood vessels/lymph Varicose veins (cause thromboemboli) Areas of skin conditions Tumours (could cause metastasis)
14
Q
Unhappy female athlete triad
A
Low energy
Amenorrhea
Low bone mineral density
15
Q
Components of treatment
A
Initial treatment Immobilisation Therapeutic drugs Heat and cold Manual therapy Others (electro therapy/surgery)
16
Q
When is immobilisation indicated
A
Fractures
Severe soft tissue (grade 3 lig tear)
17
Q
Rigid braces, air splints, plaster cast, fibreglass cast - these rigid structures are indicated for
A
Immobilisation
18
Q
When is heat contraindicated in treatment?
A
At least the first 48 hours
19
Q
Laser treatment MOA
A
Physiological changes to tissue
20
Q
Transcutaneous electrical nerve stimulation (TENS)
A
Selective depolarisation of peripheral nerve fibres.
21
Q
Ultrasound electro therapy MOA
A
Hearing through vibration of tissues encourage tissue growth and remodelling (better evidence for fractures)
22
Q
First phase of seyles GAS
A
Shock/soreness
23
Q
Second phase of seyles GAS
A
Adaption to stimulus
24
Q
Third phase of seyles GAS
A
Staleness
25
Q
Seyles GAS
A
General adaption syndrome (3 phases)
26
Q
Gas in bone is indicative of
A
Gangrene
27
Q
Five stages of bone remodelling
A
Quiescence Activation Resorption Reversal Formation
28
Q
Bone remodels in response to mechanical stresses:
A
Wolffs law
29
Q
Common sites for acute articulate damage
A
Superior articulate surface of the talus
Femoral condyle a
Patella
30
Chondroplasty
Smoothing of loose edges of the cartilage
31
Treatment for a stress fracture on the anterior cortex of the tibia
Immobilisation (non Wb cast for 6wks) or surgery
32
Treatment for a stress fracture on the medial malleolus
Pneumatic cast (6wks) or surgical screw fixation
33
Treatment for a stress fracture on the lateral process of the talus
Immobilisation (non-WB cast 6wks) or surgery
34
Treatment for a stress fracture of the navicular
Immobilisation (non WB 6-8wks) or surgery
35
5th met stress fracture treatment
Cast immobilisation or surgical screw fixation
36
Treatment for a stress fracture to the sesamoids (hallux)
Non wb for 4wks
37
Osteitis
Inflammation of pubic symphysis
38
Periostitis/tenoperiostitis
Pain and inflammation at te tendinous attachment to the bone e.g. Medial tibial stress syndrome
39
Apophysis
Bony pertuberences
40
DOMS
Delayed onset muscle soreness
41
Three main types of radio pharmaceuticals used in bone scan
Technetium-99m
Gallium66
Indium111
42
Phase one of a bone scan
Flow study (2-3seconds for 30secpnds)
43
Blood pool study
Phase 2 approximately 5mins
| Tracer has entered extra vascular space
44
Phase 2 of a bone scan
Blood pool phase
| Indicative of soft tissue inflammation or infection
45
Phase 3 of a bone scan
Delayed phase
2-4hrs post injection
Concentration now on the bone
46
Gallium scan 67ga is absorbed by?
White blood cells
| Therefore shows infecting very well.
47
Why perform a 67Ga & a 99mTc
To differentiate reactive & inflammatory bone lesions
48
Advantages of bone scans
Immediate picture of bone activity
High sensitivity
Different chemical for different pathologies
Cheaper than MRI/CT
49
Disadvantages of bone scan
Poor specificity
High radiation dose
Time consuming
50
Most common mode of bone scan
99mTc
51
Bone scan is highly sensitive but not specific true or false
True
52
Bone scan is specific but not very sensitive t/f
False
53
Why are gallium and indium bone scans commonly used?
As Adjunctive diagnostic tool
54
Purpose of a scout view
Make sure the region of interest is included
Check exposure technique
As a baseline prior to administration of contrast material
55
A preliminary image obtained prior to performing the major portion of a particular study
Scout view
56
Contraindications of CT scans
Allergy
Pregnancy
Metformin
57
Advantages of CT scan
```
No superimposition of bones
Demonstrates soft tissue better than X-ray
Gives 3D image
Any body plane
Distance between images can be varied
```
58
Disadvantages to a CT scan
Increased radiation dose
| Cost
59
5main criteria of diagnosing myofascial pain syndrome
- Regional pain
- Taut band of skeletal muscle
- Exquisite spot of tenderness in taut band
- Pain or altered sensation in expected distribution of referred pain from tender spot
- Some restriction of ROM
60
Active trigger point
Source of ongoing pain
61
Latent trigger point
Only painful when compressed
62
Satellite trigger point
Formation of another TrP in zone of referred pain
63
Techniques of soft tissue therapy (massage)
Effleurage
Friction
Petrissage
Digital ischaemic compression
64
Effleurage
Gliding
| E.g muscle relaxation/strain, lymphoedema
65
Friction therapy is indicated for
Disrupt lesions, analgesia
66
Petrissage
Kneading
| Reduce muscle tension
67
Digital ischaemic compression is indicated
To release trigger points
68
What affects does increasing the axial load have on core stability?
Stimulate trunk muscle activity. Increases to IV stiffness and improved spinal stability
69
What represents the largest contribution of muscle activity to spinal stability?
Hip & trunk stiffness
70
Inner core muscles
Stabilisation with a TONIC contraction
71
Outer core muscles
Produce movement and some are secondary stabilisers through PHASIC contraction
72
Secondary stabilisation in the Sagittal plane
Rectus abdominis
Erector Spinae
Gluteus maximus
Hamstrings
73
Sagittal plane secondary stabilisers are responsible for what movement?
Flexion/extension
74
Secondary stabilisation in the frontal plane
Glut med
Glut min
Quadratus lumborum
Hip adductors
75
Hip adductors
Magnus
longus
brevis
pectineus
76
Primary lateral hip stabilisers
Glut med and glut min
77
Trunk rotation is produced and stabilised by:
Internal/external obliques
78
What is the most important passive structure involved in stabilising the lumbar spine and abdominal musculature?
Posterior thoraco-lumbar fascia
79
Which muscles are at peak periods of activation associated with foot strike?
All
80
Transversus abdominis is tonically or phasically active throughout the gait cycle?
Tonically
81
Which muscles are phasically active?
Superficial abdominal muscles and all paraspinal muscles
82
What gait pathologies is hip abductor weakness associated with?
Trendelenberge gait
| Dynamic knee valgus
83
How would you confirm a sacral stress fracture?
MRI
84
When is intermediate treatment for osteitis pub is appropriate
When patient is pain free
85
What muscles group do you focus on for treatment of an osteitis pubis?
Adductors
86
ACL injuries commonly occur in
Hyper extension
| Tibia moving forward under the femur
87
PCL injuries commonly occur
Hyper flexion with internal tibial rotation
88
What type of force causes acute MCL injury
Valgus force
89
What type of force causes acute LCL injury?
Varus force
90
Clinical tests for the ACL
Lachmans test
Anterior drawer test
Pivot shift test
91
Clinical testing for PCL
Posterior sag
Reverse lachmans test
Posterior drawer test
External rotation active and passive
92
Clinical assessments for the patella
Medial and lateral translation
| Patella apprehension test
93
Functional test to do a clinical assessment of the knee
Squats and hops
94
Jumpers knee
Localised anterior knee pain - inferior pole of the patella
| Patella tendinopathy
95
Features of patella tendinopathy
```
No inflammation
Loss of collagen continuity
Increase in ground substance
increase in vascularity
Increase in cellularity
```
96
Muscles most likely to be the cause of MTSS
FDL &/or Soleus
97
What is the likely reason for the FDL & Soleus muscle involvement in MTSS
Based in the muscle attachments
98
Signs of acute compartment syndrome
```
Pain
Pallor
Paralysis
Parenthesis
Pulselessness
```
99
Type of pain for compartment syndrome
Severe cramping, diffuse pain and tightness
100
Type of pain for MTSS
Diffuse along lower two thirds of tibial border
101
Type of pain for stress fracture
Localised deep, nagging with minimal radiation
102
Type of pain for tumour
Deep nagging (bone) with some radiation
103
Pain at rest for compartment syndrome
Decreases or disappears
104
Pain at rest for MTSS
Decreases or disappears
105
Pain at rest for stress fracture
Present, especially night pain
106
Pain at rest for tumour
Present, often night pain
107
Pain with activity for compartment syndrome
Increases
108
Pain with activity for MTSS
Increases
109
Pain with activity for stress fracture
Present, may increase
110
Pain with activity for tumour
PResent
111
Pain with warm up for compartment syndrome
May become present, may increase
112
Pain with warm up for MTSS
May disappear
113
Pain with warm up for stress fracture
Unaltered
114
Pain with warm up for tumour
Unaltered
115
ROM for compartment syndrome
Limited in acute phase
116
ROM for MTSS
Limited ROM
117
ROM for stress fracture
Normal
118
ROM for tumour
Normal
119
Onset for compartment syndrome
Gradual to sudden
120
Onset for MTSS
Gradual
121
Onset for stress fracture
Gradual
122
Onset for tumour?
Unknown?
123
Affect of stretching on compartment syndrome
Increases pain
124
Affect of stretching on MTSS
Increases pain
125
Affect of stretching on stress fracture
Minimal pain alteration
126
Affect of stretching on tumour
No increase in pain
127
Affect of palpating on compartment syndrome
Tender, right compartment
128
Affect of palpating on MTSS
Diffuse tenderness
129
Affect of palpating on stress fracture
Point tenderness
130
Affect of palpating on tumour
Point or diffuse tenderness
131
What position is the ankle least stable?
Plantar flexed and inverted
132
What is the biggest risk factor for ankle injury
Previous injury
133
Bone injury imaging in trauma
X-ray
Ct
MRI
Bone scan
134
Imaging for soft tissue in trauma
Ultrasound
| MRI
135
Vascular injury imaging in trauma
Duplex ultrasound
| Angiogram/arteriography
136
A nuclear scanning test that detects areas of increased or decreased bone metabolism
Bone scan
137
3main radio pharmaceuticals used in bone scan
Technetium 99m
Gallium 67
Indium 111
138
Phase 1 of a bone scan
Flow study
| Picks up areas of increased vascularity- inflammation shows up quickly
139
Phase 2 of a bone scan
Blood pool phase
Extra vascular space
Soft tissue infection or inflammation
140
Phase 3 of a bone scan
Delayed (bone) phase
| 2-4hrs post injection
141
Disadvantages of a bone scan
Poor specificity
High radiation dose
Time consuming
142
In podiatry CT scans are used for
Fractures & stress fractures of the talar dome, calc & nav
Osteochondritis dissecans
Tarsal coalition
Bone cysts and tumours
143
Purpose of a scout view
Make sure the region of interest is included
Check the exposure technique
Baseline prior to administration of contrast materials
144
Contraindications of a computed tomography
Allergy to contrast agents
Pregnancy
Metformin
145
Disadvantages of CT
Increase in radiation dose
| Cost
146
Briefly describe the process of an MRI
Magnetic pulses excite mobile hydrogen ions
Different number of ions for different tissue & state
As hydrogen returns to baseline it emits a magnetic signal which is interpreted by a computer
147
Longitudinal relaxation time for an MRI
T1 relaxation time
148
Transverse relaxation time
T2 relaxation
149
A measure of how long transverse magnetisation would last in a perfectly uniform external magnetic field
T2 relaxation
150
The time required for a substance to become magnetised after first being placed in a magnetic field
T1 relaxation
151
Which image weighting demonstrates normal anatomy?
T1
152
Fluid is high intensity white in which image weighting?
T2
153
Contraindications for MRI
```
Bain aneurysm clip
Implanted neural stimulator
Implanted cardiac pacemaker or defibrillator
Cochlear implant
Ocular foreign body (metal shavings)
Implanted medical devices
Insulin pump
Metal shrapnel/bullet
Heavy metal ink tattoo
```
154
Consider exclusion for MRI for
Pregnant women
Patients where the presence of metal clips cannot be excluded
Patients with unstable angina
155
Contraindications for MRI contrast agents
Lactating women
Renal disease
Haemoglobonopathies
156
Indications for MRI
Musculoskeletal system
| Good soft tissue contrast
157
```
Tendon pathology
Infection
Neoplasm
Avascular necrosis
Ligament damage
Neuromas
tarsal coalition
Plantar fasciitis
Fracture stress fracture
Osteochrondritis dissecans
```
MRI
158
Disadvantages of MRI
```
Cost
Number of absolute contraindications
Claustrophobia
Prolonged imaging time
Availability
```
159
Briefly describe the process of ultrasound production
Passing a current through a piezoelectric transducer producing a waveform
160
Advantages of ultrasound
No radiation
Low cost
Dynamic capabilities
161
Traditional ultrasound
Uses sound waves that bounce off blood vessels to create pictures
162
Doppler ultrasound
Uses sound waves reflecting off moving objects such as blood, to measure their speed and aspects of flow
163
PET
Combination of modalities
164
What would you test for dynamic postural control
Star excursion balance test
165
Lower back and hip assessment
Lumbar spine assessment
ROM
Gross symmetry
Palpating
166
Positive signs for kemps test
When low back pain radiates into the lower extremity, indication facet syndrome, fracture or disc involvement
167
Pt experiences pain when examiner lifts leg to between 30-70degrees with the knee straight
Positive sign for a straight leg raise
| Indicative of ridiculopathy
168
Slump test positive sign
Reduction of symptoms following cervical flexion release
| Indicative of neural involvement
169
Positive test for fortins finger test
Pt indicates pain in area medial to the PSIS - which is indicative f a sacroiliac joint dysfunction
170
Gaenslen's test positive sign
Increased pain from the pelvis
171
Gaenslen's test positive sign
Increase in pain from the pelvis
172
Valsalva test
Increase in intrathoracic pressure resulting in increase in cervical pain when of coughs, bears down, laughs, sneeze
173
What does fabers test for
Flexion
ABduction
External
Rotation
174
Positive fabers
Increasing hip/groin pain as pressure is applied indicates hip joint pathology. Increasing deep unilateral pain around SIJ indicates sacroiliac pathology.
175
Clarkes sign positive sign
Positive test is when pain is reproduced indicative of patellofemoral joint dysfunction
176
Obers test positive sign
Leg remains abducted and does not drop
177
Soft tissue therapy contraindications
```
Acute inflammation
Infection
Endangerment sites
Varicose veins
Avoid areas of skin conditions
Tumours
```
178
Joint Mobilisation
Passive movement applied which the patient is able to prevent within the elastic barrier of joint resistance
179
Manipulation
Sudden thrust of small amplitude but high velocity, which your patient is not able to prevent, within or beyond the elastic barrier
180
Contraindications of joint mobilisation and manipulation
Tumours
Infections
Fractures
181
ACL reconstruction what muscles may be inhibited?
Quads (VMO)
182
Principles of injury prevention
```
Warm up
Stretching
Taping/bracing
Protective equipment
Suitable equipment
Appropriate training
Appropriate recovery
```
183
What is alredsons prescription?
3 sets of 15 2x daily; 7 days a week for 12 weeks
184
What is tarsal tunnel syndrome
Entrapment of the tibial nerve under the flexor retinaculum
185
Treatment of a mortons neuroma
```
Footwear
Met some
Antipronatory device
NSAIDs
Corticosteroid injection
LA
Surgery
```
