Imaging, Occupational Therapy, Spine Disorders Flashcards
Xray ways to describe fractures
Displacement
Angulation
Avulsion
Type of break
Intra-articular - have to treat more aggressively
Indication for Radiographs
Deformity of bone or joint
Inability to use a bone or joint
Unexplained pain in a bone or joint OR night pain
Suspicion of infection or foreign body
Evaluating Stress Fractures
Bone scan is most commonly used
Can use an MRI instead of bone scan for younger - avoid the radiation
Bone Scan Uses and Limitations
Pick up bone metabolic activity
-useful for evaluating osteoblastic activity, bone turnover, or metastatic disease, or stress fractures
Not useful for osteoclastic lytic lesions (MM)
Iontophoresis
Fluidotherapy
Paraffin Bath
Iontophoresis: Deliver a medication with DC waves - commonly for lateral and medial epicondylitis
Fluidotherapy: Dry physical agent to transfer energy to soft tissues by forced convection
Paraffin Bath: Applying heat to the hands via paraffin wax
Mallet Finger Treatment
Splint DIP joint in extension/slight hyperextension for 6-8 wks, then begin active ROM and wear splint another 2 weeks @ night
If they break out of extension before 6 weeks, they have to start at the beginning
Boutonniere Deformity
Splint PIP in extension for 6-8 weeks with DIP free
Do active DIP ROM several times a day
After 6-8 wks, active ROM to PIP
Usually caused by forceful blow to bent finger or cut to top severing central slip from bone attachment or RA
Skier’s or Gamekeeper’s Thumb
Thumb Ulnar collateral Ligament Injury
Caused by forceful radial blow to thumb
Beware of Stener lesion - refer to ortho w/ bone chip
Thumb spica splint for 6 weeks - can remove to shower, avoid lateral force
Carpal Tunnel Syndrome Treatment
Cubital Tunnel Syndrome Treatment
Night splinting, day if severe - in extension for either wrist or elbow
C5, C6, C7, C8 Neurologic evaluation
C5: innervates deltoid and biceps - bicep reflex; sensation to biceps and deltoid area
C6: Biceps and wrist extensors (carpi, radialis longus and brevis) with brachioradialis reflex; sensation from superior elbow to thumb and pointer finger
C7: Triceps, wrist flexors and finger extensors - triceps reflex; sensation to middle finger
C8: Interosei muscle (abd/adduction), finger flexors - no reflex; sensation from inferior elbow to ring and pinky fingers
Cervical Spondylosis
Degeneration of disk disease of C-spine
Spurs, herniation causing narrowing of neural foramen and stenosis of canal
Hoffman reflex, clonus, hyperreflexia, Babinski signs as well as gait disturbances and global weaknesses
Spondylolisthesis
Stenosis
Spondylolysis
Spondylolisthesis: anterior slip or bilateral pars defect
- L5-S1 = congenital
- L4-L5 = degenerative
Stenosis: narrowing of spinal canal/neural foramen producing root ischemia and neurogenic claudication
Spondylolysis: stress fracture of pars interarticularis
Lumbar Neurologic Evaluation
L1-L3: no reflex; hip flexion (iliopsoas) muscle tests; sensory between inguinal ligament and above patellae
L4: Patellar reflex; ankle muscle test; anterior tibialis for dorsiflexion; medial foot and leg sensory
L5: No reflex; Extensor hallucus longus muscle test; Lateral leg and dorsum of foot for sensory
S1: Achilles reflex; ankle eversion (peroneus longus and brevis) muscle test; lateral foot sensory
Spinal Stenosis
Narrowing at disc space - bilateral neural claudication
Standing erect and downhill ambulation and alleviated by lying supine and forward flexion
Different than vascular claudication - this is not exacerbated w/ exertion or relieved by resting/standing
Cauda Equina Syndrome
MC cause is disk herniation - also trauma, spinal cord injury, sacral nerve root compression
Emergent - need immediate referral
Get urinary retention with neurogenic bladder
Evaluate rectal tone, S1 2/3, perianal sensation, and bulbocavernosus reflex (tug on foley cause anal contraction)
