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MSK Clinical Templates > Gold Level Clinical Application Templates > Flashcards

Gold Level Clinical Application Templates Flashcards

1
Q

Why are persons over 30 at higher risk of an achilles rupture?

A

decreased blood flow to the tendon

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2
Q

What group is most at risk for rupturing their achilles tendon?

A

individuals between 30 and 50 years old with no history of calf or heel pain and commonly participate in recreational activities (weekend warriors)

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3
Q

What test can help confirm an Achilles tear?

A

Thompson Test

O’brien needle test can be used by physicians

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4
Q

What is the non-operative treatment method for managing a torn Achilles tendon?

A

serial casting for 10 weeks followed by the use of a heel lift to lessen stress on tendon for 3-6 months

Begin PT once cast is removed

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5
Q

How soon after an Achilles Tendon rupture would a normal patient be able to return to previous level of function?

A

6-7 months

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6
Q

What is the benefit of surgical intervention compared to non-surgical intervention for an achilles tendon rupture?

A

surgical repair results in far less likely chance of re-rupture (0-5% compared to 40% for non-surgical) and a higher rate of return to athletic activity

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7
Q

What is the difference between primary and secondary adhesive capsulitis?

A

Primary-occurs spontaneously

Secondary-results from an underlying condition

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8
Q

What is adhesive capsulitis?

A

inflammation within the joint capsule causes fibrous adhesions to form and the capsule to thicken which leads to a decrease in synovial fluid and increased irritation in the glenohumeral joint

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9
Q

What is the most at risk population for adhesive capsulitis?

A

Middle aged individuals

women more so than men

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10
Q

What conditions may increase a patient’s risk for developing adhesive capsulitis?

A 
Diabetes Mellitus (increases risk from 2% to 11%)
RA
Abdominal disorders
CRPS
Thyroid abnormalities
Cardiopulmonary issues
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11
Q

What is the classic clinical presentation for adhesive capsulitis?

A

decreased AROM of GH joint
pain at night that radiates below the elbow
PROM limitations due to pain and guarding

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12
Q

What is the usual course of recovery for adhesive capsulitis?

What are the long term effects of AC?

A

follows a non-linear path that usually takes 12-24 months to fully run its course

most people will fully regain AROM but 7-14% of patients experience some permanent loss of ROM in the shoulder

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13
Q

What ligament is most likely injured during a lateral ankle sprain?

A

anterior talofibular ligament

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14
Q

What test assesses the integrity of the anterior talofibular ligament?

Which test assesses the integrity of the calcaneofibular ligament?

A

Anterior drawer test

Talar tilt test

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15
Q

Which tests can help confirm a diagnosis of ACL tear?

A

Anterior drawer test
Lachman
Pivot shift test

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16
Q

What structure is usually damaged along with an ACL tear?

A

meniscal tear and sometimes the MCL as well which would form the ‘unhappy triad”

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17
Q

How long after an ACL repair can patients expect to return to their PLoF?

A

4-6 months

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18
Q

What is bicipital tendonitis?

A

an overuse injury which causes inflammation of the long head of the biceps and can result in symptoms of shoulder pain

the inflammation leads to degeneration and tendonitis when not given enough time to heal

repeated full abduction and ER of shoulder is most common MOI

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19
Q

What population is bicipital tendonitis common?

A

overhead athletes such as baseball players, swimmers, and tennis players

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20
Q

What tests can be performed to confirm a diagnosis of bicipital tendonitis?

A

biceps resistance test
speed’s test
yergason’s test

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21
Q

How long after injury can a patient with bicipital tendonitis usually return to their PLoF with the assistance of conservative therapy?

A

6-8 weeks

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22
Q

What is lateral epicondylitis?

What is the most common cause?

A

inflammation of the common extensor tendon which attaches to the lateral epicondyle of the elbow with the primary symptom being pain

overuse of the extensors/supinators of the wrist

23
Q

What population is most likely to develop lateral epicondylitis?

A

Men in their late 30-40s secondary to the normal loss of extensibility of connective tissue with age

24
Q

Which tests can be used to confirm a diagnosis of lateral epicondylitis?

A

Cozen’s
Mill’s
Lateral epicondylitis test

25
Q

What is osteoarthritis?

A

a heterogeneous group of conditions resulting in common physiological changes and is the most common type of joint disease

this is a chronic degenerative disorder resulting from the breakdown of articular cartilage in the synovial joints

26
Q

What is happening at the level of the joint in patients with OA?

A

articular cartilage breaks down creates a loss of joint space and causes new bone to form at the margin of the subchondral areas of the joint (bone spurs)

27
Q

What is the difference between primary and secondary osteoarthritis?

A

Primary- usually a result of advanced age

Secondary- result of a secondary condition or event such as trauma to the joint and usually occurs at a relatively young age

risk factors include age, weight, trauma, infection, genetics, inflammation, and metabolic disorders

28
Q

What is the most common clinical presentations for patients with OA?

A
  • bilateral symmetry is usually seen in primary OA
  • decrease ROM and crepitus in affected joints
  • deep and aching pain in affected joints increased with prolonged activity
  • Heberden’s nodes (palpable osteophytes in DIP) in women but not men
  • atypical movements and atrophy

erythema and warmth in joints in not typically seen in OA

29
Q

What is Osteogenesis Imperfecta?

A

a rare congenital disorder of the body’s collagen synthesis that affects all connective tissue in the body and reduces collagen production from 20-50% and can cause multiple defects including growth, hearing, and cardiopulmonary function

30
Q

What is type 1 Osteogenesis Imperfecta?

A

Mild form in which child has near normal growth and appearance and frequency of fractures decreases significantly after puberty

usually presents with some fragility but no deformity and may have blue sclera, a triangular face, easily bruised, and possible hearing loss

most will become community ambulators

31
Q

What is type 2 Osteogenesis Imperfecta?

A

the most severe form in which the child dies in utero or by early childhood

child has multiple deformities, experiences multiple fractures, and has a soft skull

32
Q

What is type 3 Osteogenesis Imperfecta?

A

severe form but has greater ossification of the skull than type 2

characteristics include major growth retardation, progressive deformities, ongoing fractures, triangular face, blue sclera, and significant limitations in functional mobility

only 26% become household ambulators

33
Q

What is type 4 Osteogenesis Imperfecta?

A

is a milder form but more severe than type 1 in which there is mild to moderate fragility and osteoporosis, bowing of long bones, frequent fractures which improves after puberty, possibly a short stature, barreled rib cage and possible hearing loss

these children have a normal life expectancy

roughly 26% become community ambulators

34
Q

What is patellofemoral syndrome?

A

abnormal tracking of the patella on the femur which can damage the articular cartilage and produce pain

very common in adolescent population, especially females

35
Q

What is tests that can help confirm a diagnosis of patellofemoral syndrome?

A

Clarke’s sign test
Patellar grind test
Q angle measurement (higher than normal=increased risk)

36
Q

What is the normal Q angle in boys and girls?

A

Boys-13 degrees

Girls-18 degrees

37
Q

What is plantar fascitis?

A

A chronic overuse inflammatory condition that develops secondary to repetitive stretching of the plantar fascia through excessive foot pronation during the loading phase of gait resulting in stress at the calcaneal origin of the fascia

38
Q

What are risk factors for Plantar Fasciitis?

A

excessive pronation during gait, tightness of the foot and calf musculature, obesity, and possessing a high arch

39
Q

What is are common clinical presentations for Plantar Fasciitis?

A
  • severe heel pain during the first steps in the morning
  • pain subsides for a few hours but increases with prolonged activity or after the patient has been non-weight bearing for a while and becomes weight bearing
  • describes pain as “moving around”
  • point tenderness over the calcaneal insertion of the plantar fascia
  • typically unilateral
  • achilles tightness
  • heel spurs can develop secondary to inflammation of the plantar fascia
40
Q

What tests can help confirm a diagnosis of rotator cuff tear?

A

Drop arm sign
empty can test
Pain with muscle testing (more indicative of a partial tear)

41
Q

How soon can a patient return to their prior PLoF following a rotator cuff repair given an unremarkable recovery?

A

4-6 months

however, dynamic overhead activity and return to sport may be limited for upwards of one year

42
Q

What are common clinical presentations for rotator cuff tendonitis?

A
  • difficulty with overhead movements
  • dull ache following periods of activity
  • painful arc around the 60-120 deg. mark
  • pain with palpation along the musculotendinous junction of involved muscle
  • pain increases at night
  • difficulty with dressing and other activities which involve repetitive shoulder motions
43
Q

What tests can help confirm a diagnosis of a Rotator Cuff Tendonitis or impingement?

A
  • Neer’s
  • Hawkins-Kennedy
  • Jobe’s
  • Empty Can Test
44
Q

What are the 3 stages of Rotator Cuff Tendonitis?

A

Stage 1- found in patients under 25 and consists of localized inflammation, edema, and minimal bleeding around the rotator cuff

Stage 2- progressive deterioration of the tissue surrounding the rotator cuff and is common patients aged 25-40

Stage 3- end stage of disease present in patients over 40 and there is usually a disruption or rupture of numerous soft tissue structures

45
Q

Which side of a scoliotic spine will the rotation typically occur towards?

A

rotation will typically occur towards the convex side of the major curve

46
Q

What are the 4 types of idiopathic scoliosis?

A

infantile (0-3)
Juvenile (4-puberty)
adolescent (12 for girls or 14 for boys)
Adult (skeletal maturation)

47
Q

How can you determine the side of the curvature of a scoliotic spine?

A

Curve is named after the convex side

Rib hump will be on the convex side
Rotation will be towards the convex side

48
Q

How severe does a scoliotic curve need to be before typically causing significant impairments or problems?

A

Over 20 degrees of bend (Cobb Angle)

49
Q

What is the typical treatment plan for patients with a Cobb angle of less than 25 degrees?

What if the angle is between 25 and 40?

Greater than 40?

A

<25- patient should be monitored every 3 months

25-40- patient requires a spinal orthosis and ordered PT for posture, flexibility, strengthening, respiratory function and proper utilization of orthosis

> 40- usually requires surgical spinal stabilization via spinal fusion or a Harrington rod or both

50
Q

What is spondylolisthesis?

What is the most common cause of degenerative spondylolisthesis?

A

When one vertebrae ‘slips’ anteriorly on the vertebrae below

arthritic and degenerative changes in the spine

51
Q

What populations are more at risk for degenerative spondylolisthesis?

A

Patients over 50, women, and African Americans

52
Q

How is the direction of torticollis determined?

A

Head is laterally flexed towards side of impairment and chin is pointing to opposite side of impaired SCM muscle

there is usually a flattened area of the child’s skull on the contralateral side as well

53
Q

How soon after a THA should a patient who has been going to PT experience no pain, increased strength, and endurance as well as improved mobility?

A

6-8 weeks

54
Q

What movements should patient who underwent a postero-lateral THA avoid?

What about an antero-lateral approach?

A

Hip flexion greater than 90 degrees, hip adduction, Hip IR

Hip flexion and lateral rotation

MSK Clinical Templates (6 decks)

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