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MSK 1 > Intro to MSK > Flashcards

Intro to MSK Flashcards

1
Q

what are the 3 problem solving methods utilized within PT?

A
  1. Pattern recognition (System I)
  2. Hypothetico-deductive (System II)
  3. Mixed
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2
Q

what is pattern recognition (System I)?

A

developing scripts or prototypes based off of patterns

  • forward reasoning
  • faster
  • more efficient
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3
Q

what is hypothetico-deductive (System II) problem solving?

A

gathering a lot of info during examination and then going back to think about what the info means

  • backward reasoning
  • heavy reliance in novice practice
  • utilized by experts when faced with unfamiliar presentations
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4
Q

what is causal reasoning?

A

forming inferences from clinical findings

determing cause and effect relationship of variabels

based on normal/abnormal physiology

be careful! lots of assumptions can be made!

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5
Q

what is case-based reasoning?

A

knowledge stored in symbolic “script”

based on previous experiences with other cases, pattern recognition

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6
Q

what is narrative reasoning?

A

concerns the understanding of patients’ stories in order to gain insight into their experiences of disability or pain and their subsuquent beliefs, feelings, and health behaviors

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7
Q

how do PTs go about reducing uncertainty when forming a diagnosis?

A

utilizing an elimination, confirmation, and discrimination strategies at various points throughout the examination process

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8
Q

what is the elimination strategy?

A

seeking data to reduce suspicion of unlikely hypothesis

look for tests that have low negative likelihood ratios

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9
Q

what is a negative likelihood ratio? what is considered a significant ratio?

A

this tells us how many times more likely a negative test will be seen in those with the disorder than those without the disorder

values <0.2 of importance

values <0.1 of significant importance

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10
Q

what is a confirmation strategy?

A

seeking data to support a highly likely hypothesis

do these later in the examination

look for tests with a high positive likelihood ratio

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11
Q

what is a positive likelihood ratio? what is considered a significant ratio?

A

tells us how many times more likely a positive test will be seen in those with the disorder than those without the disorder

values of >5 of importance

values of >10 of significant importance

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12
Q

fill in the blank:

low (-LR) good for ___________

A

refuting a diagnositic hypothesis

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13
Q

fill in the blank:

high (LR+) good for _____________

A

confirming a diagnostic hypothesis

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14
Q

what is a discrimination strategy?

A

seeking info to discriminate between likely hypothesis

(“how to tell the difference between 2 different ducks”)

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15
Q

what are the elements to consider when forming an initial hypothesis?

A
  1. non-musculoskeletal health conditions and serious musculoskeletal conditions
  2. potential radicular and referral sources
  3. screening adjacent joint regions
  4. differentiating local MSK conditions
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16
Q

List the steps in the diagnostic process

A
  1. Chart Review/Patient Interview
  2. Visual Inspection
  3. Systems Review
  4. Elimination Tests
  5. Structural Stress Tests
  6. Palpation and Joint Mobility Tests
  7. Confirmation Tests
  8. Diagnostic Hypothesis
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17
Q

what is the PSFS?

A

Patient Specific Functional Scale

score of 0-10 in which an individual rates activites and their ability to perform that activity

0 = unable

10 = able to at the same level prior to injury

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18
Q

what do red flags during the diagnostic process mean?

A

s/s consistent with a non-musculoskeletal origin or a serious musculoskeletal health condition that requires referral to another clinician

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19
Q

what do yellow flags during the diagnostic process mean?

A

indicate need for more extensive examination or cautions/contraindications to certain tests/interventions

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20
Q

what is included during the visual inspection?

A
  1. status
  2. affect
  3. anthropometrics
  4. preferred positions
  5. integumentary
  6. posture
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21
Q

when assessing posture during the visual inspection, what are you looking for?

A
  1. gross abnormalities
  2. symmetry
  3. bony/soft contours
  4. resting posture vs ability to correct
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22
Q

what is the difference between the systems review and elimination tests?

A

systems review = test to determine if there is a need for further examination

elimination tests = screen for health conditions commonly associated with the diagnostic hypothesis

23
Q

What neurologic screens/tests are performed during elimination testing?

A
  1. sensation
    1. light touch
    2. pin prick
    3. proprioception
  2. Motor function
    1. myotome vs peripheral nerve
    2. coordination
  3. Reflexes
    1. DTR
    2. pathologic reflexes (present or absent)
  4. Considerations
    1. symmetry
    2. normal/diminished/absent
24
Q

what does the Beighton’s scale look at?

A

hyperlaxity

25
Q

What types of things are you assessing for during joint mobility testing?

A
  1. symptom provocation
  2. quality (normal, mechanical block, guarded)
  3. quantity (joint integrity, hyper/hypomobile, normal)
  4. willingness to move
26
Q

when are confirmation tests performed usually?

A

once hypothesis has been narrowed

these have a high +LR and high specificity

27
Q

what is the difference between repetitive stress injuries and trauma?

A

repetitive stress - low intensity of loading, high frequency and or duration (ex. spondylolysthesis)

trauma - high intensity of loading, low frequency (ex. fractured vertebrae)

28
Q

list the phases of tissue healing

A
  1. phase 1 - acute inflammatory response
  2. phase 2 - repair and regeneration
  3. phase 3 (4) - remodeling and maturation
29
Q

what is required for healing to occur?

A
  1. controlled forces necessary to facilitate tissue synthesis
  2. protection from excessive and harmful stresses on tissues
30
Q

describe phase 1 of healing with a ligament injury

A

first 3 days

acute inflammatory response and hematoma formation

31
Q

describe phase 2 of healing with a ligament injury

A

2-3 days post-injury to 6 weeks

fibroblasts produce collagen

matrix is disorganized

32
Q

describe phase 3 of healing with a ligament injury

A

>/= 12 months post injury

collagen fibers become more parallel/organized

increased tissue contraction and tensile strength

33
Q

List the healing requirements for a ligament injury

A
  1. disrupted tissue must remain in continuity
  2. controlled forces necessary to facilitate collagen synthesis (tensile loading)
  3. protection from harmful stresses on tissues
34
Q

describe phase 2 of healing with a tendon injury

A

begins within the first week

increased fibroblasts/fibroblastic activity through week 4

collagen fibers initially formed disorganized and at random

cells and collagen become more aligned and perpendicular to long axis over time

35
Q

describe phase 3 of healing with a tendon injury

A

remodeling

collagen/cells re-alignment typically complete by ~2 months

36
Q

define tenosynovitis

A

inflammation of synovial sheath surrounding tendon

37
Q

how is tendonitis different from tendinosis?

A

tendonitis = inflammation of tendon

tendinosis = degeneration of collagen tissue in tendons due to aging, microtrauma, or vascular compromise

there is no inflammatory process in tendinosis

38
Q

what can cause an injury to articular cartilage?

A

loss of proteoglycans

mechanical injury

39
Q

what are the 2 subtypes of mechanical injury to cartilage (based on location)?

A

chondral

subchondral

40
Q

T/F: there is an inflammatory process during a chondral mechanical injury to articular cartilage

A

FALSE

limited response that doesn’t reach the blood supply to the cartilage thus no inflammatory response

41
Q

describe a subchondral mechanical injury to articular cartilage

A

injury is deeper and extends all the way to blood supply

fills in with tissue more like fibrocartilage (rather than hyaline cartilage) - known as a fibrin clot (forms by 48 hrs)

after 2 months it will resemble “normal cartilage”

42
Q

how is the fibrin clot suseptible to injury?

A

fibrocartilage accepts load differently than hyaline cartilage thus it won’t dissipate force in the same way

result is more load on border of the region which can lead to further injury or total dislodgement of the fibrocartilage plug

43
Q

how long should bone be immbolized following a fracture?

A

adults = 6-8 weeks

children = 4-6 weeks

44
Q

early excessive loading of a fracture bone can increase the risk of what?

A

pseudoarthosis - the region fails to fuse back together and the region of the bone growth fails to process into bone but rather stays cartilaginous

45
Q

What is the difference between fatigue and insufficency fractures?

A

fatigue fracture = normal bone put under abnormal stress

insufficency fracture = normal stress put on abnormal bone

46
Q

list symptoms for a stress fracture

A
  1. focal pain
  2. exercise-induced pain
  3. night pain
47
Q

When reviewing a pt chart, what Hx factors will prompt us to think a stress fracture is likely?

A
  1. insidious onset of pain that is progressive
  2. ADLs/performance affected more so with progression
  3. continual pain with later pathological progression
  4. pt had an increase in training intensity (prior 6-8 weeks)
  5. risk factors:
    1. female
    2. amenorrhea
    3. smoking
    4. prolonged steroid use
48
Q

what findings during a physical exam point towards a stress fracture?

A
  1. local tenderness
  2. limited ROM at joint area
  3. palpable guarding
  4. possible local swelling
  5. must be confirmed with imaging (MRI or bone scan)
49
Q

List several secondary response to injury

A
  1. arthogenic muscle inhibition
  2. guarding
  3. ectopic calcification
  4. atrophy
  5. contracture
  6. anxiety/fear
50
Q

what is arthogenic muscle inhibition?

A

described as a continued reflex inhibition of musculature surrounding a joint following injury or joint effusion

(*think how ACLr results in quads not being able to fire as much)

51
Q

what is guarding (how is it different than AMI)?

A

increase in the resting activity of a muscle related to a protective response from painful stimuli

AMI - inhibits muscles from activating around the joint vs Guarding - increases muscle activity around the joint

52
Q

what is ectopic calcification?

A

accumulation of osteoid material in soft tissue

ex: capsule calcified or bone is integrated into muscle

53
Q

what are the 2 types of instability?

A

Neuromuscular/Functional (what we think of)

Structural (what most HCP think of)

MSK 1 (17 decks)

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