Guidelines/studies Flashcards
Kellgren guidelines
Grade 1 shows NO Radiographic changes,
Grade 2 Small osteophytes, but doubtful joint space narrowing
Grade 3 Moderate joint space narrowing and moderate osteophytes
Grade 4 most Severe osteophytes, severe joint space narrowing, bone contour, subchondral schlerosis
Neer Impingment classification
Stage 1 under 25 young active minimal changes inflammation, oedema, and hemorrhage
Stage 2 25-40 undergoes fibrosis and tendonitis
Stage 3 Over 40 mechanical disruption - coracoacromial osteophyte formation, dec subacromial space
Lumbar traction
New patient 5-10 min static,
40-60% of body weight for a maximum of 12 minutes
60 sec hold 10 sec rest
PHQ-2 Questions
Little interest in doing things
Feeling down, depressed or hopeless
Risk for Myelopathy
Larger vertebral body, smaller spinal canal, Torg/pavlol ration difference small 0.8 stenosis
CPR carpal tunnel
- Shaking hands for symptom relief
- Wrist-ratio index greater than .67
- Symptom Severity Scale score greater than 1.9
- Reduced median sensory field of digit 1
- Age greater than 45 years
CPR Cervical manipulation Tseng
Tseng
- Neck Disability Index < 11.5
- Bilateral involvement
- Not performing sedentary work > 5 hours a day
- Feeling better while moving neck
- Did not feel worse with cervical extension
- Diagnosis of spondylosis without radiculopathy
CPR Cervical manipulation
Puentedura et al., 2012:
- Symptom duration of less than 38 days
- Positive expectation that manipulation will help
- Side-to-side difference in cervical rotation ROM of 10° or greater
- Pain with posteroanterior spring testing of the middle cervical spine
ACL/PCL function
ACL - Post lateral bundle - provides ant restraint 0-20 deg, rotational stability
Ant medial taught in flexion
PCL - limits post translation - Ant lateral bundle taught in flexion, Post medial ext
Factors affecting the outcome of arthroscopy in medial-compartment osteoarthritis of the knee.
OA for greater than 24 months (OR, 3.6), obesity (OR, 8.8), smoking (OR, 3.1), medial tibial osteophytes (OR, 5.4), medial joint space width on standing radiographs of less than 5 mm (OR, 7.3), absence of effusion (OR, 6.5), absence of synovitis (OR, 6.1), presence of crystal deposits (OR, 4.3), deep tibial cartilage defect (OR, 12.5), and need for subtotal or total meniscectomy (OR, 2.2).
PCL HEP
Eccentric and Quad strengthening
After surgery 4 weeks in brace
Arcuate complex -
lateral and little medial stability - static
Posterior medial knee stabilty
OPL - Reinforces the posteromedial knee joint capsule obliquely on a lateral-to-medial diagonal from proximal to distal
POL - Reinforces the posteromedial knee joint capsule obliquely on a medial-to-lateral diagonal from proximal to distal
Lag signs for RTC tear,
ER + SP Infraspinatus, low SN, IR + SN subscap
Wedge for medial knee OA
Lateral
Adhesive capsulitis
40-65,
5-34% chance contralat shoulder
factors include: trauma, prolonged immobilisation, thyroid disease, stroke, myocardial infarcts, and presence of autoimmune disease
Abd Anyurism -
There is often a rapid, severe onset of groin pain that occurs along with the low back pain in individuals who have an abdominal aortic aneurysm. They will describe the pain as throbbing, pulsating, tearing or ripping. (Small 2005)
Carotid Artery direction
- 5D’s 3 N’s + pregnancy
Pt MVA neck sx 6 months
It is likely this patient will have a larger relative cross sectional area of the cervical paraspinals
Reason:In patients who have chronic whiplash associated disorder, a larger relative cross sectional area of the cervical paraspinals has been seen, and it is possible due to the fatty infiltrate that fills this area after chronic whiplash associated disorder. (Elliott 2008 1, Elliott 2008 2 and Childs 2008)
RTC tear size
small <1, Med 1-3, large 3-5 and Massive >5
Types of hand deformities
Swan neck - flexion DIP, extension PIP
Boutonniere deformity ext DIP, flex PIP
Mallett finger flexion DIP
Levels of Evidence
Evaluate the Strength of Evidence
I Evidence obtained form high-quality diagnostic studies prospective
studies, or randomized controlled trials
IIfEvidence obtained from lesser-quality diagnostic studies, prospective
studies, or randomized controlled trials (for example, weaker diagnostic
criteria and reference standards, improper randomization, no blinding,
<80% follow-up)
III Case-controlled studies or retrospective studies
IV Case series
V Expert opinion
Grades of Recommendation Strength of Evidence
A Strong Evidence A prepoderance of level I and/or level II studies support the recommendation. This must include at least 1 level I study.
B Moderate Evidence A single high-quality randomized controlled trial or a preponderance of level II studies support the recommendation
C Weak Evidence A single level II study or a preponderance of level III and IV studies including statements of consensus by content experts support the recommendation
D Conflicting Evidence Higher-quality studies conducted on this topic disagree with respect to thier conclusions. The recommendation is based on these conflicting studies
E Theoretical/ Foundational Evidence A preponderance of evidence from animal or cadaver studies, from conceptual models/principles, or from basic sciences/bench research support this conclusion
F Expert Opinion Best practice based on the clinical experience of the guidelines development team
Carpal tunnel
Guyon Tunnel
Cubital tunnel
Carpal Tunnel -
flexor digitorum profundus (four tendons)
flexor digitorum superficialis (four tendons)
flexor pollicis longus (one tendon)
Median nerve
Guyon Tunnel- Ulnar Nerve
Presentation varies based on location of compression within Guyon’s canal and may be
pure motor
pure sensory
mixed motor and sensory
Symptoms
pain and paresthesias in ulnar 1-1/2 digits
weakness to intrinsics, ring and small finger digital flexion or thumb adduction
Cubit Tunnel - Ulnar tunnel
the little finger
ulnar half of the ring finger
intrinsic muscles of the hand
Types of Arthritis
Psoriatic - distal interphalangeal joints of the fingers and toes is one of the five possible clinical presentations of this type of arthritis. Iritis is also seen in individuals with psoriatic arthritis, along with other possible inflammatory eye conditions.
Reactive arthritis- Reactive arthritis is commonly seen in the larger joints in the lower extremities, but it is possible that it could be seen in smaller joints also. It is possible to have ocular involvement, but with this patient, the presence of symptoms only in the distal interphalangeal joints of the fingers and toes points away from reactive arthritis
RA- Rheumatoid arthritis is not commonly seen in just the distal interphalangeal joints of the fingers and/or toes. In fact, it rarely is seen in the distal interphalangeal joints at all, and is instead located in the proximal interphalangeal joints.
Joint separation for sprains MCL
Normal 1-2cm
Nearly normal 3-5
Abnormal 6-10
Severely abnormal
PCL ER Grades
Grades
1 1-5
2 5-10
3->10
Cervical Myelopathy
male Gender, >70, Thickening of ligamentous tissue,
Asians
Development of Knee OA
1 Irreversible matrix degradation
- Synovitis
- Loss of cartilage
- Development of osteophytes
