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Ortho Lecture > Introduction to Orthopedic Diagnosis > Flashcards

Introduction to Orthopedic Diagnosis Flashcards

1
Q

a working knowledge of the MS system forms the foundation of every

A

orthopedic exam
physical examination
evaluation
intervention (care plan)

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2
Q

_____ and ____ and how they relate to _____ is the key to diagnosis

A

biomechanics and anatomy
function

  • what is normal versus abnormal for that patient
  • what structures an tissues are functioning properly versus not working or only partially functioning
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3
Q

a fundamental skill of a chiropractor is to _____, _____ and ____ _____ related to human movemetn

A

identify
analyze
solve problems

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4
Q

when describing movements there is a need for starting position=

A

reference position

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5
Q

starting position is referred to as

A

anatomical reference position (anatomical position)

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6
Q

the anatomical position for the human body=

A

erect standing position feet slightly separated, arms hanging by the side, elbows straight and palms of the hand facing forward

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7
Q

superior or cranial

A

closer to the head

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8
Q

inferior or caudal

A

closer to the feet

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9
Q

anterior or ventral

A

toward the front of the body

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10
Q

posterior or dorsal

A

toward te back of the body

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11
Q

medial

A

toward the midline of the body

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12
Q

lateral

A

away from eh midline of the body

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13
Q

there are 3 planes of the body =

A

3 dimensions of space:
sagittal
frontal
transverse

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14
Q

sagittal plane

A

aka anterior-posterior or median plane

divides the body vertically into left halves of equal size

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15
Q

frontal plane

A

aka lateral or coronal plane

divides the body equally into front and back halves

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16
Q

transverse plane

A

aka horizontal plane

divides the body equally into top and bottom halves

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17
Q

3 reference axes are used to describe human motion

A

front
sagittal
longitudinal

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18
Q

the axis around which the movement takes places is always ______ to the plane in which it occurs

A

perpendicular

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19
Q

frontal axis of body

A

aka transverse axis, is perpendicular to the sagittal plane

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20
Q

sagittal axis of body

A

perpendicular to the frontal plane

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21
Q

longitudinal

A

aka vertical axis

perpendicular to the transverse plane

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22
Q

occur in the sagittal plane around a frontal-horizontal axis

A 
flexion
extension
hyperextension
dorsiflexion
plantar flexion
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23
Q

occur int he frontal plane around a sagittal-horizontal axis

A 
abduction
adduction
side flexion of the trunk
elevation and depression of        
       the shoulder girdle
radial/ulnar deviation of wrist
eversion/inversion of foot 
     occur in the frontal plane
     around a sagittal-horizontal
     axis
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24
Q

occur in the transverse plane around the longitudinal axis

A 
rotation of head, neck & trunk
internal rotation or 
external rotations of arm/leg
horizontal adduction/abduction 
     of the arm or thigh
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25
Q

involves an orderly sequence of circular movements that occur in the sagittal, frontal and oblique planes

so that segment as a whole incorporates a combination of 
flexion
extension
abduction
adduction
A

circumduction

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26
Q

study of motion

A

kinematics

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27
Q

two major types of motion involved

A

osteokinematic

arthrokinematic

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28
Q

osteokinematic motion occurs when

A

any object forms the radius of an imaginary circle about a fixed point

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29
Q

the axis of rotation for osteokinematic motions is

A

oriented perpendicular to the plane in which the rotation occurs i.e.:
abduction/adduction of arm
flexion of hip/knee
side flexion of trunk

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30
Q

arthrokinematic movements

A

the motions occurring at joint surfaces

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31
Q

direction of movement based on the _____ of the joint surfaces

A

shape

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32
Q

generally, joint surfaces can be either _____ or ____ in shape (ovoid), or a ______

A

concave (female)
convex (male)

combination of both shapes (sellar)

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33
Q

3 types of movement occur at the articulating surfaces

A

roll
slide
spin

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34
Q

osteokinematic and arthrokinematic motions are

A

directly proportional to each other and one cannot occur completely without the other

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35
Q

if motion is reduced

A

one, or both of osteokinematic or arthokinematic motions is at fault

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36
Q

the number of independent modes of motion at a joint is called the

A

degrees of freedom (DOF)

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37
Q

a joint that can swing in one direction or can only spin =

A

1 DOF

ie: PIP joint

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38
Q

a joint that can spin and swig in one way only or it can swing in two completely distinct ways, but not spin=

A

2 DOF

ie: tibiofemoral joint

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39
Q

if the joint can spin and also swing in two distinct direction then =

A

3 DOF

ie: glenohumeral joint

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40
Q

the position of maximum congruity of the opposing joint surfaces

A

close-packed position of the joint (table 3-1 pg. 83)

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41
Q

movements toward the close-packed position of a joint involve

A

an element of joint compression (approximation)

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42
Q

position of maximum joint stability

A

ie: elbow= extension

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43
Q

close-packed position

-end of travel in a joint =

A

the surfaces are at maximum congruency, the ligaments are taut, and further movement in that direction of travel may result in dislocation or fracture

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44
Q

the position of least joint congruity

A

open-packed position (table 3-2 pg. 84)

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45
Q

open-packed position

-movements away from the close-packed position involve an element of joint distraction

A

separation

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46
Q

open packed-position

A

position of least joint stability i.e: elbow= 70 degrees flexion and 10 degrees supination

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47
Q

loose or open-packed position

A

the positions of travel of a joint away from eh close packed position where by the capsule and ligaments are NOT TAUT

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48
Q

loose or open packed pos.

-extreme movement in that direction usually results in

A

sprain/strain

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49
Q

if a joint moves less than what is considered normal, or when compared to the same joint on the opposite extremity

A

hypomobile

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50
Q

a joint that moves more than considered normal, or when compared to the same joint on the opposite extremity

A

hypermobile

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51
Q

instability of a joint involves disruption of the ____ and ____ structures of that joint, resulting in a _____ ___ ______

A

osseous
ligamentous structures
loss of function

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52
Q

factors of joint integrity (bone fits bone)

A

elastic energy
passive stiffness
muscle activation

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53
Q

elastic energy

A

stored energy that allows elastic tissue to return to original

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54
Q

passive stiffness

A

found at end range when lost = laxity

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55
Q

muscle activation

A

correct synergistic and antagonistic balance both in timing an strength - otherwise= buckling or shear translation

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56
Q

during daily activities, ____ and _____ forces are either generated or resisted by the body

A

external

internal

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57
Q

external forces

A

ground reaction force, friction, and gravity

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58
Q

internal forces

A

muscle contraction, joint contact and joint shear forces

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59
Q

tissues must demonstrate the ability to withstand _____ or ____ stresses if musculoskeletal health is to be maintained

A

excessive

repetitive

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60
Q

the capacity of tissue to withstand STRESS is dependent on a number of factors

A
  • age
  • the proteoglycan and collagen content of tissue
  • the ability of the tissue to undergo adaptive change
  • the speed at which the adaptive change must occur- depends on the type and severity of insult to tissue
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61
Q

kinetics

A

the study of FORCES created as motions change (kg)

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62
Q

mass

A

the QUANTITY of matter composing a body

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63
Q

inertia

A

the RESISTANCE to action or to change

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64
Q

center of gravity

A

a point around which the weight and mass are equally balanced in all directions

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65
Q

force

A

a VECTOR QUANTITY, with magnitude, direction and point of application to a body

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66
Q

load

A

the TYPE of force applied

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67
Q

stress

A

the FORCE PER UNIT area that occurs on the cross section of a structure in response to an externally applied load

68
Q

strain

A

the deformation that occurs within a structure in response to externally applied loads

69
Q

hysteresis

A

the difference in the behavior of a tissue when it is being loaded versus unloaded

70
Q

the load- deformation curve

A

a stress-strain curve, of a structure depicts the relationship between the amount of force applied to ta structure and the structure’s response in terms of deformation or acceleration

71
Q

collagen fibers at rest are

A

wavy

72
Q

when a force lengthens collagen fibers

A

straighten, the slack is no longer there

73
Q

slack

A

crimp

74
Q

___ is different for each type of CT, and this provides each tissue with different____ ____

A

Crimp

viscoelastic properties

75
Q

if a load is applied to CT and then removed

A

the material recoils to its original size

76
Q

if the load remains the material continues to ___

A

stretch

77
Q

after a sustained stretch

A

the material plateaus- collagen fibers realign in the direction of stress, H20 and proteoglycans are displaced from between the fibers= creep

78
Q

gradually occurs and is time dependent (less than 15 minutes- not going to occur)

A

creep

79
Q

once creep occurs

A

tissue has difficulty returning to its initial length

80
Q

stress in CT can result in

A

no change
semi permanent change
permanent change

81
Q

occurs when a tissue remains deformed and does not recover its prestress length

A

plastic deformation

82
Q

once all possible realignment occurs any further loading

A

breaks tissue

83
Q

on average collagen fibers are able to sustain ____% increase in elongation or strain before microscopic damage occurs

A

3

84
Q

after a stretch (chemicals bonds and fibers intact)

A

the collagen fibers recover but at a slower rate and extent

85
Q

loss of energy that occurs between the lengthening force + the recovery activity=

A

hysteresis

86
Q

the more chemical bonds broken with applied stress

A

the greater the hysteresis

87
Q

if stretch is enough so the tissue is unable to return to its original length, the new length then has increased strain resistance

A

instability

88
Q

increased excursion is needed before the tissue develops

A

tension

89
Q

destabilizing the connective tissue- if enough force is applied to the CT a

A

complete rupture occurs

90
Q

ligamentous injury- characteristics can be=

A

point tenderness
joint effusion
history of trauma

91
Q

usually ligaments are graded by

A

severity of injury (sprains)

see page 93 table 4-2

92
Q

Grade 1

A

painful, but not unstable or swollen

93
Q

O’Donoghue says “grade 1=

A

mild, tearing of a few fibers with minimal hemorrhage, no laxity or residual instability, full function and strength is maintained.
Return to sports =within 1-2 weeks, complete healing expected in 4-6 weeks

94
Q

Grade II

A

moderate, sprain is incomplete tear of the ligament with mild laxity and instability, marked swelling and pain resulting in reduction of function, decrease in strength and loss of proprioception

  • in a lower extremity, patients should crutch walk until comfortable to walk
  • usually return to sports in 8-12 weeks
95
Q

Grade III

A

severe, complete disruption of the ligament with gross instability and laxity, marked swelling, and much pain. Loss of full function, strength and proprioception, especially if rehab is not complete or inadequate

96
Q

Grade III injuries can lead to

A

greater risk for chronic instability or osteochondral lesions, which may lead to future surgeries

97
Q

connects bone to bone

A

tendons

98
Q

the causes of a tendon injury center around ____ to the tendon tissue due to ____ ____ ____ from external factors (like incorrect use of equipment, improper training techniques, inappropriate shoe wear), or _____

A

microtrauma
repetitive mechanical loading
macrotrauma

99
Q

inflammatory reaction to a tendon injury
-a microscopic tearing and inflammation of the tendon tissue, commonly resulting from tissue fatigue rather than direct trauma

A

tendinitis

100
Q

indicate an inflammatory disorder of tissues surrounding the tendon such as the tendon sheath- usually the result of a repetitive friction of the tendon and its sheath

A

tensoynovitis/tenovaginitis
peritendinitis
paratenonitis

101
Q

refers to a degenerative process of the tendon (rather than inflammatory disorder)

A

tendinosis

102
Q

tendinosis is characterized by

A

presence of dense population of fibroblasts, vascular hyperplasia, disorganized collagen

103
Q

degenerative tendonpathy occurs in approximately

A

1/3 of the population 35 years or older

104
Q

tendinosis

-the degree of degeneration increases with ____ and may represent part of the “___” ___ ____

A

age

“normal” aging process

105
Q

tendinosis dgeneration is

A

actively related

106
Q

tendinosis

-resistance to the involved musculotendinous tissue is

A

pain

107
Q

bone is ___ with __ ___

A

solid

elastic properties

108
Q

bone is ___ and ___ than other tissues at higher strain levels

A

stiffer and stronger

109
Q

bone is better able to withstand compressive forces than ___ or ____ forces

A

tensile or torsional

110
Q

this law attempts to predict bone adaptation to stresses

A

Wolff’s Law

111
Q

what happens if the adaptations of bone to stress to not occur fast enough

A

bone is resorption (bone lysis) faster than it is replaced (osteoid synthesis), and bone strength is compromised

112
Q

causes of decreased bone adaptation include:

A
  • an increase in the applied load
  • an increase in the number of applied stresses
  • a decrease in the size of the surface area over which the load is applied
113
Q

as bone strength and mass decreases this can result in

A

stress fractures

114
Q

the distribution and frequency of stress fracture is greatest in the

A

tibia

115
Q

inflammation of the bursa from repeated micro trauma or direct injury

A

Bursitis

116
Q

when bursa inflame especially chronically they become

A

tough, thick, fibrous

117
Q

when bursa become tough, thick and fibrous they make

A

the structure fluid filled and easier to palpate- this is termed “boggy”

118
Q

muscle injury can result from

A 
excessive strain
excessive tension
contusions
lacerations
thermal stress
myotoxic agents 
pg. 96 table 4-4
119
Q

excessive strain

A

contribute > 90% of all muscle injuries

120
Q

excessive tension

A

resulting in overstretch

121
Q

contusions

A

also contribute to muscle injuries

122
Q

myotoxic agents

A

local anesthetics, excessive use of corticosteroids, snake and bee venoms

123
Q

contusion to a muscle belly

A

hematoma

124
Q

two types of hematoma

A

intramuscular

intermuscular

125
Q

associated with a muscle strain or bruise. The size of the hematoma is limited by the muscle fascia

A

intramuscular

126
Q

this type of hematoma develops if the muscle fascia is ruptured and the blood spreads into the interfacial and interstitial spaces

A

intermuscular

127
Q

muscle strains are often graded according to

A

severity

128
Q

Involves a tear of a few muscle fibers with minor swelling and discomfort. Associated with no or minimal loss of strength and restriction of movement

A

Grade I muscle strain

129
Q

greater damage of the muscle and clear loss of strength and some loss of function

A

Grade II muscle strain

130
Q

Involves a tear extending across the whole muscle belly. Characterized by severe pain or loss of function.

A

Grade III muscle strain

131
Q

continuous _____ of connective and skeletal muscle tissues can cause some undesirable consequences of the tissues of the MS system

A

immobilization

132
Q

undesirable consequences to the tissues of the MS system

A
  • cartilage degeneration
  • a decrease in the mechanical and structural properties of ligaments
  • a decrease in bone density
  • weakness or atrophy of muscles
133
Q

How does the inter/examiner/ or chiropractor obtain the information from the patient

A

the chiropractor examination or evaluation

134
Q
  • the patient serves as the most valuable resource to the intern/student
  • each interaction with a patient is an opportunity to increase knowledge, skill, and understanding
  • communication involves interacting with the patient using terms he or she can understand
A

the examination and evaluation

135
Q

the success of any rehabilitation intervention depends on the _____ and ____ of the examination and the subsequent evaluation

A

quality

accuracy

136
Q

gathering of data and information concerning a topic

A

examination

137
Q

forming a value judgment based on the collected data and information

A

evaluation

138
Q

the examination consists of three components of equal importance

A

the history
the systems review
the tests and measures

139
Q

begins with meetings and greeting the patient- from the time the patient fills out forms to sitting, or standing in the clinic

A

observation

140
Q

can be so specific to isolate the muscle, movements or joint involved

A

changes in body shape or posture

ie: postero- lateral disc patient may prefer to stand rather than sit in the waiting or adjusting room

141
Q

formal observation can include

A
  • posture analysis
  • structural alignment and deformity
  • presence of asymmetry
  • scars
  • crepitus
  • color changes
  • swelling
  • muscle atrophy
142
Q

it is estimated that 80% of the necessary information in a presenting patient problem can be provided by a thorough

A

history

143
Q

this portion of the history taking can be the most challenging, it involves the gathering of both positive and negative findings, followed by the dissemination of the information into a working hypothesis

A

history of current condition

144
Q

part of the examination that identifies possible health problems that require consultation with, or referral to, another health care provider

A

systems review

145
Q

the purpose of this is to help RULE OUT the possibility of symptom referral from other areas, and to ensure ALL POSSIBLE causes of the symptoms are examined

A

Scanning Examination

146
Q

used when there is no history to explain the signs and or symptoms, or when the signs and/or symptoms are unexplainable

A

examination

147
Q

the TESTS part of the examination, serves as an adjunct to the history and systems review

A

physical examination

148
Q

disturbed sensation that causes suffering or distress

A

pain

149
Q

during physical examination the following factors must be investigated

A 
onset
intensity
location
perception
quality
behavior
nature
150
Q

this examination should determine the exact directions and types of motion that elicit the symptoms

A

ROM

151
Q

who performs active ROM?

A

patient

152
Q

who performs passive ROM?

A

Examiner

153
Q

active range of motion testing gives the intern information about

A
  • the quantity of available physiological motion
  • the presence of muscle substitutions
  • the willingness of the patient to move
  • the integrity of the contractile tissues
  • the quality of motion
  • symptom reproduction
154
Q

this testing gives the intern information about the integrity of the contractile tissues, and the END-FEEL

A

Passive ROM

155
Q

pain that occurs at the END-RANGE of active and passive movement is suggestive of a

A

capsular contraction, or scar tissue that has not been adequately remodeled

156
Q

why do we perform palpation

A
  • check for any vasomotor changes i.e.: increase in skin temperature that might suggest an inflammatory process
  • localized specific sites of swelling
  • identify specific anatomical structures and their relationship to one another
  • identify sites fo point tenderness
157
Q

during palpation identify soft tissue

A

texture changes or myofascial restriction

158
Q

during palpation locate changes in muscle

A

tone resulting from, trigger points, muscle spasm, hypertonicity, or hypotonicity

159
Q

during palpation determine circulatory status by checking

A

distal pulses

160
Q

during palpation detect changes in the

A

moisture of the skin

161
Q

these tests are only performed if there is some indication that they would be helpful in arriving at a diagnosis

A

Special Tests

162
Q

special tests are used to help

A

confirm or deny structures and may also provide information as to the degree of tissue damage

163
Q

a diagnosis can only be made when

A

all potential causes for the symptoms have been ruled out

164
Q

the prognosis is the predicted

A

level of function that the patient will attain within a certain time frame

165
Q

the prognosis helps

A

guide the intensity, duration, and frequency of the protocols, and aids in justifying the intervention

Ortho Lecture (11 decks)

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