HOC / HOK - Theme 10 Flashcards
Describe the structure of a physiotherapeutic methodical approach.
- Direct access or Admission via General Practitioner
- Registration
3 a. Discovering the ‘Request for Help’
b. Screening (Worrisome/Non-worrisome)
c. Inform and advise - Initial hypothesis
- Anamnesis (RPS form)
- Adjusted hypothesis.
- Examination
- Definitive hypothesis
- Treatment plan
- Treatment
- Evaluation
- Conclusion
What is the difference between a screening and diagnosing?
Screening: is a process to establish whether a patient can continue through the physiotherapeutic process or whether they need to be referred back to a GP, this is done by answering a series of questions to see whether there are ‘red-flags’, which indicate serious / potentially sinister pathologies.
Diagnosing: is the process of identifying the nature and cause of a certain phenomenon.
What is the concept of an ‘initial hypothesis’ and PIPs/NPIPs.
Initial hypothesis: is established by use of hypothetico-deductive reasoning, this starts by gaining clues/insight from the moment a patient presents to you.
PIPs: these are ‘patient identified problem(s)’, either in a symptom AND/OR functional limitation/disability level.
NPIPs: this is essentially a problem list generated by the clinician. This is an ongoing process of evaluation as the subjective examination and physical examination is taking place.
Describe the ‘General principles’ described in the Movement contiuum model by Cott.
- Movement is essential to life.
- Movement occurs on a continuum from the microscopic level to the level of the individual in society.
- Movement levels on the continuum are influenced by physical, psychological, social and environmental factors.
Describe the ‘Physical Therapy principles’ described in the Movement continuum model by Cott.
- Movement levels on the continuum are interdependent.
- At each level on the continuum there is a maximum achievable movement potential (MAMP) which is influenced by the MAMP at the other levels of the continuum and physical, social, psychological and environmental factors.
- Within the limits set by the MAMP, each human being has a preferred movement capability (PMC), and a current movement capacity (CMC) which in usual circumstances are the same.
- Pathological and developmental factors have the potential to change the MAMP and/or to create a differential between the PMC and the CMC
- The focus of physical therapy is to minimise the potential and/or existing PMC/CMC differential.
- The practice of physical therapy involves therapeutic movement, modalities, therapeutic use of self, education and technology and environmental modifications.
What is the general gist of the Movement continuum model by Cott.
This theory consists of eight principles of movement, three of which are shared with other movement sciences and five of which are specific to physiotherapy. These general principles are that movement is essential to human life, movement occurs on a continuum from the microscopic level to the level of the individual in society and movement levels on the continuum are influenced by physical, psychological, social and environmental factors.
https://www.researchgate.net/publication/284671257_The_movement_continuum_theory_of_physical_therapy
What are the contents of a physiotherapeutic diagnosis (Basis for the indication, the essence of the health problem, the prognosis and the treatment plan)?
- Supplementary anamnesis.
- Supplementary examination.
- Anamnesis.
–> Leads to adjusted hypothesis.
Describe the concept “tangential surface”
The plane opposite to the direction of the normal.
Describe the concept “normal”
The direction of traction.
Describe the concept “capsular pattern”
Order of movement limitations in a joint typical to inflammation of the entire joint capsule (arthritis).
Please note: the order is important!
Describe the concept “closed pack position”
Maximal fitting ball and socket.
Capsular ligament system maximally contracted
Describe the concept “maximal loose pack position”
Ligaments and capsule are in the maximally relaxed position.
This allows for great mobility
which is
important for examinations and treating the joint (non-specific traction and translation techniques)
Describe the Concave/Convex rule.
The direction in which sliding occurs depends on whether the moving surface is concave or convex.
Concave = hollowed or rounded inward
Convex = curved or rounded outward
If the moving joint surface is CONVEX, sliding is in the OPPOSITE direction of the angular movement of the bone.
If the moving joint surface is CONCAVE, sliding is in the SAME direction as the angular movement of the bone.
Describe “open chain movement”
When the distal end is not fixed. i.e. kicking a ball (The foot is not fixed on anything).
Describe “closed chain movement”
When the distal end is fixed. i.e. a push up (hands are fixed on the floor), or standing up from a chair (feet are fixed on the floor).
Name the following aspects of the art. humeri;
- Ball/socket
- Capsular pattern
- Normal/traction direction
Ball: Caput humeri
Socket: Cavitas glenoidale
CP: Exorotation> abduction > endorotation
Normal:Lateral/ventral/ slightly cranial
Name the following aspects of the SC joint;
- Ball/socket
- Capsular pattern
- Normal/traction direction
Ball: (depends on the movement).
- Protraction/Retraction - Incisura clavicular sternale
- Elevation/Depression - Extremities sternale clavicular
Socket: (depends on the movement).
- Protraction/Retraction - Extremities sternale clavicular
- Elevation/Depression - Incisura clavicular sternale
CP: Max. ROM and pain
Normal: ±lateral, slightly cranial (from sternum)
Name the following aspects of the AC joint;
- Ball/socket
- Capsular pattern
- Normal/traction direction
Ball:
Socket:
CP: Max. ROM and pain
Normal: Lateral/ caudal/dorsal
Name the ligaments and inhibitions of these ligaments for the art. humeri.
Lig. glenohumeral superius: Limits external rotation and inferior translation of humeral head.
Lig. glenohumeral medium: Limits external rotation and anterior translation of humeral head.
Lig. glenohumeral inferius:
- Anterior portion limits external rotation and superior and anterior translation of the humeral head.
- Posterior portion: Limits internal rotation and anterior translation.
Lig. coracohumerale:
- Anterior portion limits extension while the posterior portion limits flexion.
- Both divisions limit inferior and posterior translation of the humeral head.
- Helps to support the weight of the resting arm against gravity.
Lig. transversum humeri: Serves to keep the tendon of the long head of the biceps in the bicipital groove.
Name the ligaments and inhibitions of these ligaments for the SC joint.
Lig. sternoclaviculare posterius: Limits protraction.
Lig. sternoclaviculare anterius: Limitis retraction.
Lig. costoclaviculare: Limits elevation, protraction and retraction.
Lig. interclaviculare: Resists excessive depression or downward glide of the clavicle
Name the ligaments and inhibitions of these ligaments for the AC joint.
Lig. coracoacromiale: Prevents upwards dislocation of the glenohumerale joint.
Lig. acromioclaviculare: Ensures stability of the AC joint.
Lig. coracoclavicualre;
- lig. trapezoideum: Limits posterior movement between the scapula and clavicle.
- lig. conoideum: Keeps the coracoid process of the scapula and the clavicle in close apposition.
Name the following aspects of the art. Humeri joint;
- CPP
- MLPP
CPP: max Abd + exorotation + horizontal extension
MLPP: 60 degrees Abd / 60 degrees anteflexion / forearm 30 degrees from horizontal plane
Name the following aspects of the SC joint;
- CPP
- MLPP
NONE
Name the following aspects of the AC joint;
- CPP
- MLPP
NONE
Explain Primary impingement.
Primary impingement is due to structural changes that mechanically narrow the subacromial space; these include bony narrowing on the cranial side, bony malposition after a fracture of the greater tubercle, or an increase in the volume of the subacromial soft tissues – due, e.g., to subacromial bursitis or calcific tendinitis – on the caudal side.
Explain secondary impingement.
Secondary impingement results from a functional disturbance of centring of the humeral head, such as muscular imbalance, leading to an abnormal displacement of the centre of rotation in elevation and thereby to soft tissue entrapment.
Name different pathologies that could cause impingement complaints.
- Bicep-SLAP pathology
- GIRD
- Scapular dyskinesis
- Instability
- Rotator cuff pathology
(according to Cools et al 2008)
Name the symptomatology of a shoulder impingement.
- Painful arc.
- Pain during overhead movements.
- Pain in the deltoid muscle area (top and outer side of your shoulder).
- Pain or aching at night, which can affect your sleep.
- Weakness in your arm.
Explain what an impingement is.
Impingement is when soft tissue(s) are trapped / compressed. This can be a result of bony narrowing or osteophyte formation, bony malposition after a fracture, or increase in the volume of subacromial soft tissue.
Explain the aetiology (causes) of impingement complaints of the shoulder.
Primary external impingement: related to structural changes, either congenital or acquired, that mechanically narrow subacromial space such as; shape of the acromion process of the scapula or shoulder blade may play an important role in recovery and treatment from primary impingement.
Pain at night when lying on that shoulder. Since osteophytes are a common reason it’s normal in 50+ers. But malposition after a fracture is common as well.
Secondary external impingement: related to abnormal scapulothoracic kinematics, strength balance alteration resulting in functional disturbance in the centering of the humeral head, leading to an abnormal displacement of the center of rotation when the arm is elevated. Generally caused by weakness of the RC muscle (functional instability) combined with a GHJ capsule and ligaments that are too loose (micro-instability).
Pain at secondary impingement generally occurs at the coracoacromial space during anterior translation of the humeral head. Typically occurs in younger individuals with pain is located in the anterior or anterolateral aspect of the shoulder. The symptoms are usually activity-specific and involve overhand activities (though the OH goes for primary as well ofc).
Internal impingement: is probably the most common cause of posterior shoulder pain in the throwing or overhead athlete. Caused by impingement of the articular surface (intra-articular) of the RC (posterior edge of the supraspinatus and the anterior edge of the infraspinatus) against the posterior-superior-glenoid and glenoid labrum. Mainly seen with repetitive overhead activities, this positioning becomes pathologic during excessive external rotation, anterior capsular instability, scapular muscle imbalances, and/or upon repetitive overload of the RC musculature. These deficiencies result in poor scapulohumeral control.
Describe the physiological recovery processes after a connective tissue trauma. - INFLAMMATION PHASE
Inflammation: 0-5 days
The body’s natural response to tissue damage Characteristics: - Rubor: redness - Dolor: pain - Tumor: swelling - Calor: heat - Functio laesa: Restricted function
Inflammatory mediators:
- Bradykinin
- Histamine
- Prostaglandin
- Substance P
Describe the physiological recovery processes after a connective tissue trauma. - PROLIFERATION PHASE
Proliferation: 5-21 days
- Production of new functional connective tissue is the main objective.
- Intensive collagen production
- Stimulating local blood circulation (massage/ultrasound)
- ‘Keep the moving’
Describe the physiological recovery processes after a connective tissue trauma. - REMODELLING PHASE
Remodelling: 21-365 days
- Collagen becomes more stable and thicker as its reconstructed from type 3 to type 1.
- Increased production of base substance
Cross-linking
Explain what a frozen shoulder is…
Characterised by initially painful and later progressively restricted active and passive GH joint ROM with spontaneous complete or nearly-complete recovery over a varied period of time.
This inflammatory condition causes fibrosis of the GH joint capsule, accompanied by gradually progressive stiffness and significant restriction of ROM (typically external rotation).
Describe the different stages of a frozen shoulder.
Freezing: gradual onset of shoulder pain at rest with sharp pain at extremes of motion, and pain at night with sleep interruption which may last anywhere from 2-9 months
Frozen: pain starts to subside, progressive loss of GH motion in capsular pattern. Pain is apparent only at extremes of movement. This phase may occur at around 4 months and last until about 12 months
Thawing: Spontaneous, progressive improvement in functional ROM which can last anywhere from 5-24 months. Despite this, some studies suggest that it’s a self limiting condition, and may last up to three years.
Though other studies have shown that up to 40% of patients may have persistent symptoms and restriction of movement beyond three years.
It is estimated that 15% may have persistent pain and long term disability. Effective treatments which shorten the duration of the symptoms and disability will have a significant value on reducing the morbidity.
Describe different stages of an AC dislocation.
These injuries often result from falling on the shoulder or an outstretched arm. According to Tossy they can be classified into three types;
Tossy I - The ligg. acromioclaviculare and coracoclaviculare are stretched but still intact.
Tossy II - The lig. acromioclaviculare is ruptured with subluxation of the joint.
Tossy III - Ligaments are all disrupted, with complete dislocation of the art. acromioclavicularis.
Rockwood added three more types that occur less frequently;
Rockwood IV - Dislocation of the clavicle shifts dorsally, due to the pars clavicularis of the m. deltoideus being pulled off the clavicula.
Rockwood V - Dislocation of the lateral end of the clavicle is increases in the cranial direction, due to the mm. deltoideus and trapezius being pulled off the clacviclua.
Rockwood IV - The lateral end of the clavicula underneath the acromium or proc. coracoideus is dislocated (Very rare).
Use mnemonic BUD… Backwards, Upwards, Down.
Name the characteristics of nonspecific complaints of the lower back.
Non-specific low back pain is defined as low back pain for which no specific cause can be identified. This is the case in about 90% of all patients with low back pain.
The most obvious symptom in these patients is pain in the lumbosacral region. The pain may also radiate to the gluteal region and the upper leg. It may be increased when the patient adopts a particular position, makes certain movements or
lifts or moves heavy objects. The patient has no general symptoms of disease, such as fever or weight loss. The pain may be continuous or occur in episodes.
Name the characteristics of nonspecific complaints of the neck.
Non-specific neck pain is an unpleasant sensory and emotional experience that is associated with actual or potential tissue damage in the neck region (from the superior nuchal line to the scapular spine), potentially accompanied by pain in the head, shoulder, and/or arm. Neck pain usually decreases by 45%, accompanied by a decrease in the limitations in activities and/or participation, within 6 weeks of pain onset.
Name the characteristics of a cervical radicular syndrome.
Neurological deficits will present themselves because of impinged cervical radix, in the form of numbness, altered reflexes, or weakness. May radiate anywhere from the neck into the shoulder, arm, hand, or fingers.
Symptoms
• sensory symptoms in the arm, such as paresthesia, numbness, reduced sense of touch
• restricted cervical range of motion, defined as rotation <60 degrees or limited and painful rotation
• reduced muscle strength or muscle control
• radiating pain in the arm
Signs
• reduced tendon reflexes, muscle weakness, or sensory disorders
Recognise and identify the WAD categorisation from the guideline.
(Not likely to come up since the Whiplash guideline has been replaced)
WAD 0 - no complaints, no subjective or objective abnormalities
WAD 1 - Pain, stiff and sensitive area, but no objective abnormalities
WAD 2 - Neck complaints and other complaints of the postural and locomotor system (e.g. limited mobility, pressure point sensitivity)
WAD 3 - Neck complaints and neurological failure (e.g. limited or no tendon reflexes, muscle weakness and sensory disorders)
WAD 4 - Neck complaints and fractures or dislocations
Name the important prognostic factors from the guideline for whiplash.
(Not likely to come up since the Whiplash guideline has been replaced)
Prognostic factors in NEW guideline are: hypersensitivity, history of musculoskeletal disorders, previous episodes of neck pain, regular cycling, catastrophizing, depression, anxiety, need to socialize, advance age, PTSD at onset, passive coping, psychosocial stress, poor psychological health, high workload, low impact of own work.
Name the red flags of the CS.
Fracture - advanced age, trauma in medical history, use of corticosteroids, osteoporosis
Cervical arterial dysfunction - cerebrovascular symptoms such as dizziness, double vision, nausea, vomiting, weakness of the limbs, and papillary changes
Damage to spinal cord or cervical myopathy - neurological symptoms, including widespread neurological signs in both arms and/or legs, such as sensory disorders, loss of muscle strength in extremities, bowel and bladder dysfunction
Infection (including urinary tract infection or skin infection) - symptoms and signs of infection (e.g. fever, night sweats), risk factors for infection (e.g. underlying pathological process, in the case of immunosuppressants, an open wound, intravenous drug use, exposure to infectious diseases)
Malignant tumors - cancer in medical history, no improvement in symptoms after 4 weeks of treatment, unexplained weight loss, age >50 years, trouble swallowing, headaches, vomiting.
Systemic diseases (herpes zoster, spondylitis ankylosis, inflammatory arthritis, rheumatoid arthritis) - headache, fever, unilateral skin rash, burning pain, itching.
Name the different types of neck complaints/headache
Primary Headaches: Migraine Tension-Type Headache (TTH) Cluster Headache Other Primary Headaches
Secondary Headaches: Headache as a result of whiplash Medication-dependent headache Cervicogenic headache Temporomandibular headache
Name the signs and symptoms corresponding to cervicogenic headache (CH).
The main symptoms of a cervicogenic headache are a combination of;
- Unilateral pain
- Ipsilateral diffuse shoulder, and arm pain.
- ROM in the neck is reduced,
- Pain is relieved with anaesthetic blockades.
- Lasts hours up to weeks.
