Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Extremity Clet > IRAT 1 > Flashcards

IRAT 1 Flashcards

1
Q

Shoulder complaints are classified most commonly into

A

Sports injuries
Wear and tear repetitive stress injuries
Traumas
Certain arthridities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

In the case of trauma, what damage must be suspected

A 
Fracture
Dislocation
Tendon
Labrum 
Ligament
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

The shoulder can also be the sight of pain from referred

A

Cervical spine or thoracic spine injury or subluxation and/or from visceral sources such as heart, lung, diaphragm, or gallbladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Less common sources of shoulder pain might be from

A

Tumors or infection and peripheral nerve entrapments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

The most common presentation of soulder complaints include

A

Instability - trauma/non-truama
Impingement: tendons, bursae, ligament
Tendinitis/bursitis
Osteoarthritis
Adhesive capsulitis (frozen shoulder) - esp age 40-60ish
AC joint separations (look at ligament derangement)
C/spine referred pain patterns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Arthritidies that commonly affect the shoulder are

A

AS and rheumatoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

In severe cases of arthritidies of the sohoulder, the ___ can rupture

A

Supraspinatus tendon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

In seniors, ___ is common and so is ____.

A

OA

Adhesive capsulitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

OA can also appear in younger populations following

A

Truama

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Always take a thorough history so as to establish

A 
Quality of the complaint
Site
Trauma
MOI
Activities of patient
ROM
Past injuries
Weakness
Instability
Sensory loss
High or low-end user
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

High end user

A

Athlete

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Low-end user

A

Sedentery office worker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Pain localization anterior traumatic

A

Fracture, dislocation, sub-ac bursitis, capsular spriain, tendon rupture (long head of biceps), labrum tear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Non-traumatic pain locatlization

A

Impingement, biceps tendinitis, sub-ac bursitis, subscapularis tendonitis, subluxation, etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Trauma

A

Look for dislocation/separation and fracture.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Typical types or presentaions of trauma are

A

Blows (contusion)
Falls (AC separation, clavicle fractures)
FOOSA/H injuries (AC separation, dilocation, and labrum tears)
Traction of the arm (brachial plexus injuries, subluxation)
Sudden pain when lifting heavy object (tendon rupture, labrum tear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Blows

A

Contusions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Falls

A

AC separation, clavicle fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

FOOSA/H injuries

A

AC separation, dislocation, labrum tears, rotator cuff tears

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Arm forced into certain positions and jammed or wrenched

A

Dislocation and labrum tears

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Traction on the arm

A

Brachial plexus injuries, subluxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Sudden pain when lifting heavy object

A

Tendon rupture, labrum tear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Pain

A

Acute or chronic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Acute pain without trauma may indicate

A

Burisitis if ROM is decreased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Chrnoic pain without trauma

A

Adhesive capsulitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Weakness or instability is highly suggestive of

A

Un-rehabilitated capsular ligament injury and can lead to concomitant damage to the labrum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Nerve damage will show

A

Evident atrophy of the associated muscle.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Brachial plexus controsl

A

Upper extremity and subluxation or nerve root damage will result in weakness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

With weakness might also be possibility of

A

Inherent shoulder capsule weakness which is usually bilateral and can be determined with orthopedic testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Stiffness and restriction must be assessed initially with

A

Thorough history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Acute pain without any recent trauma that lasts for weeks before eventually becoming stiff is likely to be

A

Adhesive capsulitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Post-traumatic pain will lead to other obvious conclusions such as

A

Dislocation or separation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

History of trauma and/or surgery with resultant pain/restriction leads to

A

OA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Restriction due to pain and weakenss is likely caused by

A

Bone blockage or labrum pathology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Overuse or trauma to a muscle can lead to

A

Scar tissue and restriction in the direction of stretch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Painful arc is considered to be

A

Between 70-110 degrees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

X-ray is generally filmed based on

A

Suspected underlying condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Most common x-ray for shoulder

A

AP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Utilized for AC spot shot and osteolysis of the distal clavicle

A

Zanca or Z view (15 degrees cephalad)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

View for Bankart lesion (glenoid lip avulsions associated with labrum teras)

A

West Point view

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

view for a Hill-Sachs lesion also a labrum tear findings

A

Stryker-notch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Used as a tool when patients are not responding to conservative care and can be helpful in discerning labrum tears, but not entirely reliable

A

MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Views used for labrum tears and rotator cuff tears and tend to be the imaging methods of choice

A

CT and CT arhtrogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Used to determine full-thickness rotator cuff tears

A

US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

If AS rheumatoid or other arthitides are suspected based on plain film

A

Lab exams for HLAB27 and rheumatoid factor may be ordered but appropriate referral to rheumatologist is suggested

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

If x-ray reveals infeciton, fracture or tumor

A

Referral to orthopedic specialist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

If patient is unable to tolerate an un-medicated course of care and treatment, then

A

Referral out is necessary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

PT is beneficial in causes of

A

Acute pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Therapeutic rehab might consist of

A

PNF stretching, cross friction massage, myofscial release, isometrics, stabilization (strapping/taping) and strenghtening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Stability and technique must be strong considerations to adjustments to

A

Shoulder and upper extremity kinetic chair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

The shoulder joint type

A

Ball and socket joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Shoulder joint complex

A

Articulation of the humerus and the glenoid fossa of the scapula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

4 joints in shoulder joint complex

A

Gleno-humeral
Acromio-clavicular
Sterno-clavicular
Scapulo-thoracic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Nerve supply shoulder joint complex

A

Fifth through seventh cervical nerve roots via its formation into the brachial plexus.

On the lateral aspect of the shoulder, the skin is innervated by a cutaneous branch of the axillary nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

ROM shoulder

A

Ext rotation 108
Int rotation 72
With the arm at 90 of abduction, total rotational arc is 120

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Primary muscles in shoulder joint complex

A 
Trapezius
Levator scapulae
Rhomboid major and minor
Serratus anterior
Deltoid provides shearing force, pushing humerus upward on the glenoid labrum at abduction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Rotator cuff muscles

A

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Protector muscles helping compress the humeral head into the glenoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Impingement syndrome

Typical signs and symptoms

A

***Pain with overhead activites

Medial AC joint osteophyte formation commonly associated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Impingement Syndrome

Anatomy/structures involved

A 
Biceps tendon
Superior labrum
Supraspinatus tendon
Subacromial bursa
Above all antero-lateral type

Subscapularis
Subcoracoid
Infraspinatus or teres minor
Posterior impingement type above

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Impingement syndrome

Causes/etiology

A

***Over use
Degenerative changes
Inflammatory processes
Variant structure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Impingement syndrome co-exists with

A

Instability and excessive superior movement of the humeral head

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Impingement evaluation

A

***Hawkins-Kennedy and Neer test for impingmeent assessment

***Relocation test for underlying accompanying instability

Impingement sign to rule in tendinitis or supra-spinatus overuse injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Hawkins-Kennedy test

A

Supraspinatus tendon jammed up against the anterior surface of the coraco-acromial ligament due to the narrowing of the subacromial space. Posterior pain implicates stretch of the teres minor and infraspinatus tendons

Indicates: local pain indicates supraspinatus tendinitis and impingement

Anterior pain = anterior impingement syndrome

Posterior pain = posterior impingement syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Neer test

A

End range pain causes the greater tuberosity to jam up against the anterior inferior border of the acromion

Indicates impingement with overuse injury of the supraspinatus muscle or biceps tendon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Instability tests

A

Anterior apprehension with relocation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Jobe relocation test confirms the

A

Anterior instability of the GH joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Painful arc test

A

Pain between 70-110 degrees is impingement syndrome with supraspinatus pathology

Pain worse with 160 or above is AC joint involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Shoulder impingement management protocols/goals

A

Care plan based on severity of symptoms - acute vs sub-acute vs chronic
Stability, progressive rehabilitation, stretching and strenghtening and modification of activity
Open chain v closed chain exercise, proprioceptive training
Chiro spinal adjustments
Chiro extremity adjustments
Modalitis - cryotherapy
2 week out assessment
Re-exam and re-eval
Prognosis/outcomes assessment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Traumatic instability

Presentation/signs/symptoms

A

***past history of shoulder dislocation

*** pain/weakness when arm placed overhead or in apprehension position of 90 degrees flexion coupled with external rotation and horizontal extension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Traumatic instability

Anatomy/structures involved

A

Gleno-humeral joint dislocation causes damage to the glenoid labrum and the humerus itself. The glenoid capsule will also incur damage along with teh intrinsic ligaments (coracohumeral and coracoacromial)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Traumatic instability

Pathophysiology/etiology

A

Acute/subacute anterior dislocation of the GH joint in 90-95% of cases. Posterior instability can be found in patient who chronically dislocate or those who suffer seizures

Clavicular fractures, muscle contusions and direct blows to the base of the neck can also be included as trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Traumatic instability evaluation

A

Apprehension test and it’s variants

** sulcus sign with L &S test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

SUlcus sign with L & S test

A

A sulcus that appears on teh antero-lateral aspect indicates shoulder instability that is graded

\+1 = 1 cm
\+2 = 1-2 cm
\+3 = >3 cm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Labrum tears

Presentation

A

Presents with reported painful clunking and locking with specific movments. Loss of strength, decreased ROM and pain at night.

Sense of instability in the shoulder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Labrum tears

Anatomy and structures involved

A

Soft fibrous rim surrounding the head of the humerus where it articulates with the glenoid fossa. Stabilizes the joint and deepens the rim to add extra support. Important attachment site for several ligaments.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Labrum tears

Cause/etiology

A

**SLAP lesion
Acute trauma, blow or fall on outstretched arm. Sudden pulls such as lifting heavy object. Repetitisve motions such as weight lifting or throwing
**tears of the rim below the middle of the glenoid socket involving the inferior GH ligament are called Bankart lesions
***tears of the labrum often accompanying dislocation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

SLAP lesions

A

Superior labrum anterior to posterior tear above the middle of the socket that involves the biceps tendon in some cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Bankart lesions

A

Tears of the rim below the middle of the glenoid socket involving the inferior GH ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Tears of the labrum often accompany

A

Dislcoation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Labrum tears

Evaluation

A

Clunk test, O’Brien sign, anterior slide test and biceps load test to rule in a labrum tear

Rule out dislocation using apprehension, dugas tests

Speed, abbotts saunder and yergason tests to confirm any bicep tendon tears that might accompany a labrum tear. Can do apley adn codman if tolerable to R/O rotator cuff teras

Assess both spinal and extremities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Medical assessment for labrum tears includes

A

MRI
CT
Arhtroscopic surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Glenoid LAbrum testing

A

***O’Brien sign

O’Brien, anterior slide test for pain or determine snapping or clunking felt in the joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

O’Brien Sign

A

Pain deep in the joint indicates labrum tear. Pain felt superficially indicates AC joint issue

84
Q

Anterior slide test

A

Popping, cracking, and crepitus is noticed with pain on the antero-superior aspect of the shoulder = superior or anterior glenoid labrum tear

85
Q

Labrum tears management

A

Referral to an orthopaedic surgeon for assessment - most severe tears will require surgery for repair especially if the biceps tendon is involved.

Small tears will respond to conservative treatment including rest (sling), rehab, strengthening and mobilization after acute pain subsides.

Chiro adjustments to restore functional proprioception and alignment

86
Q

Traumatic instability management protocols/goals

A 
Initial/intermediate/advanced
Stabilize/rehabilitation/strengthen
Chiro adjustments
Chiro extremity adjustments
Open v closed chain exercises
Cryotherapy
2 week out assessment
Re-exam/re-eval
Prognosis/outcome assessments
Lifestyle modifications
87
Q

Non-traumatic instability/looseness

Signs/symptoms and presentations

A

***usually asymptomatic. Pain is felt when there is sudden traction or pulling on the arm. Supporting the arm provides relief.

***Patient reports fatigue and discomfort when working overhead rather than actual pain

88
Q

Non-traumatic instability/looseness

Anatomy and structures involved

A

Inherent looseness in the shoulder capsule - born that way

89
Q

Non-traumatic instability/looseness

Etiology

A

Patients asymptomatic unless distraction force subluxates the shoulder. Aggravated by sports/activity that continuously stretches the capsule.

Ex: swimming or throwing

90
Q

Non-traumatic instability/looseness

Evaluation/assessment

A

L&S tests*** most appropriate and practical

  • **apprehension test if accompanied by impingement
  • **pain is reduced by the relocation test (jobe test) where an AP force is placed on the proximal humerus as the arm is abducted and ext. rotated
91
Q

Non-traumatic instability/looseness management

A

Strengthening rotator cuff and serratus anterior for stability. Taping can help

92
Q

Adhesive capsulitis

A

Frozen shoulder

93
Q

Adhesive capsulitis

Signs/symptoms and presentations

A

Usually over 40 years of age

94
Q

Adhesive capsulitis

Acute phase

A

Moderate to severe pain that limits all shoulder use, pain when sleeping or with minimum activity

95
Q

Adhesive capsulitis

Middle phase

A

Possible past history of acute phase 1-3 months prior, pain has decreased but discomfort and restricted motion persists when liftin garm or turning out

96
Q

Adhesive capsultiits

Final phase

A

Very slow increase in ROM but still significantly reduced

97
Q

Adhesive capsulitis

Anatomy and structures involved

A

Inflammation and swelling of the shoulder capsule

Adhesions develop which stiffen the jhoint

Synovial fluid decreases and joint lubrication is hampered

98
Q

Adhesive capsulitis

Cause/etiology

A

The cause remains unkown

More common in patients with diabetes, thyroid pathologies, and COPD.

The acute phase is inflammatory in nature leading to a stiffening stage and finally a thawing phase months or years later. In stage 3, some ROM is restored.

99
Q

Adhesive capsulitis

Evaluation/assessment

A

Positive mazion shoulder maneuver - most pts present in the stiffening phase or stage 2***

***restriction and pain are reliable indicators especially in abduction and ext. rotation. Muscle tests are strong within the range the patient can tolerate

Confirmatory test is improvement in motion following reciprocal contraction or rhythmic stabilization.

If the patient does not improve at all, a bony blockage is suspected due to possible OA.

100
Q

Mazion shoulder maneuver

A

Adhesive capsulitis

Inabiilty to actively raise the elbow to the forehead due to pain and of stiffness indicates early adhesive capsulitis or non-inflammatory capsular adhesions

101
Q

Adhesive capsulitis management

A

Cryotherapy
Extremity adjustment to improve ROM (later stages)
Modalitis - E-Stim and TENS. US in stiffening stage
Rhythmic stabilization

102
Q

TENS

A

Transcutaneous electrical nerve stimulation

103
Q

Rhythmic stabilization

A

Passive nad active therapy with contraction and ROM while alternating patterns

104
Q

Rotator cuff tears

Presentation

A

Typically following an **acute trauma such as heavy lifting, a fall or high impact injury. Older patients might not recall an event. *pain and or weakness is experienced while *lifting the arm or performing overhead activities

105
Q

Rotator cuff tears

Anatomy/structures involved

A

Most commonly associated with tears of the supraspinatus articular and bursal sided tears are generally involved, while the articular type are more frequently partial

106
Q

Rotator cuff tears

Cause/etiology

A

Trauma, can occur secondary to chronic degenerative changes in the tendinous attachments

107
Q

Rotator cuff tears

Evaluation/assessment

A

Supraspinatus: weakness with empty can test or codman’s drop arm (unabl eto perform) and a positive apley test

Subscapularis: lift-off test weakness. Radiograph: superior head migration on AP view

108
Q

EMpty can test

A

Resistance to the abduction and downward pressure stresses the supraspinatus muscle and tendon insertion, indicates tear or rupture of the supraspinatus muscle or tendon with possible suprascapular neuropathy

109
Q

Rotator cuff tears management

A

Rehab gradually with isometrics then progressing ot strengthening. Rotator-cuff full thickness tears might need surgical repair

110
Q

AC joint separation

Presentation

A

Taruma/fall/high impact injury on an outstretched arm or on top of the shoulder type onset. Very common in atheltes such as football or rugby players. Pain, tenderness and swelling over the AC joint.

111
Q

AC joint separation

Anatomy/structures involved

Grade 1

A

Some tearing of the acromio-clavicular ligament without instability.

112
Q

AC joitn separation

Anatomy

Grade 2

A

Rupture of AC ligmaent

113
Q

AC joint separtion

Anatomy

Grade 3

A

Torn AC ligament with a tear of the coraco-clavicular (conoid and trapezoid) ligament. Both grade 2 and 3 are considered unstable

114
Q

AC joint separation

Anatomy

Grade 4

A

The clavicle is pushed posterior to the AC joint, fairly unusual in presentation

115
Q

AC joint separation

Grade 5

A

This is an exaggerated grade 3 with the muscles above the AC joint punctured by the clavicle causing a significant bump over the injury site

116
Q

Grade 6 AC joint separation

A

Fairly rare, this type of injury sees the clavicle pushed or forced interior where is becomes lodged below the corocoid

117
Q

AC joint separation

Etiology/cause

A

Trauma/fall/high impact sports injury that tears partially or completely the AC or coraco-clavicular ligaments

118
Q

AC joint separation

Evaluation/assessment

A

** positive o’brien sign

X-ray to rule out distal clavicular fracture and determine severity of injury. More than 1.3cm** widening of hte coraco-clavicular space would indicate a grade 3 separation

Weighted and non-weighted bilateral views would be ordered

119
Q

AC joint separation managment

A

Support with kinney-howard sling for short period. Mild isometrics followed by isotonics. Emphasis on deltoid and upper trap exercises incorporating biceps and pectoral exercises to restore near proper function.

Taping and support would be recommended for future sports activity

Chiro adjustments to assist in functional proprioception

120
Q

Osteolysis of distal clavicle

Presentation

A

Can be secondary to AC trauma or heavy weight lifting regimens. Typically a weight lifter will present with diffuse pain felt while bench-pressing. Clean and jerking or dipping. Pain on shoulder abduction beyond 90 degrees.

121
Q

Osteolysis of the distal clavicle

Anatomy/structures involved

A

Distal end of the clavicle

122
Q

Osteolysis of the distal clavicle

Cause/etiology

A

Trauma/repetititive compression forces and heavy lifting that cause resorption of the distal end of the clavicle

123
Q

Osteolysis of distal clavicle

Evaluation/assessment

A

Zanca view*** or AC spot shot looking for increased widening of the joint space and resorption. Most orthopedic tests are unremarkable. History is crucial to help rule out differential diagnosis

124
Q

Osteolysis of the distal clavicle managment

A

Modification of exercises with some rest recommended

Chiro spinal and extremity evaluation

125
Q

Acute calcific bursitis and tendinitis

Presentation

A

***severe shoulder pain increasing with any shoulder movement. Patients have a supportive posture holding the arm to their sides to avoid movement

126
Q

Acute calcific bursitis and tendinitis

Anatomy/structures involved

A

Bursae include: subacromial, sub-deltoid and sub-scapular.

All shoulde tendinous attachments of the can be involved.

127
Q

Acute calcific bursitis and tendinitis

Cause/etiology

A

Following trauma or of insidious onset**. Bursitis pain occurs often due to a resorption of calcium deposition. This is typically an inflammatory phase and is very painful. Direct rtrauma or injury assocaited iwth cuff rupture is considered another common cause.

128
Q

Acute calcific burtsitis and tendinistis evaluation/assessment

A

All active and passive movement is painful. **dawbarn test will determine a sub-acromial bursitis

**abbott saunders, speed and yegason tests are all positive for bicipital tendinitis

**apley test will determine degenrative tendinitis while the impingement sign will assist in assessing overuse injuries to the bicveps tendon. Deep palpation is often sufficient to elicit a response.

**Patte test (hornblower sign) will be positive for infraspinatus or teres minor tendinopathy. Lift off test will be positive for subscapularis tendinopathy.

X-rays following trauma

129
Q

Patte test (hornblower sign

A

Pain and inability to actively externally rotate against resistance due to weakness indicates infraspinatus or teres minor tendinopathy

130
Q

Lift off test

A

Inability to actively lift the hand off or away from the back indicates subscapularis tenddinopathy

131
Q

Acute calcific bursitis and tendinitis managemnet

A

Pulsed US to resorb calcific depostis for short term therapy can be considered.

Chiro spinal and extremity adjustments to assist with recuperative healing and functional proprioception.

In acute and inflammatory stages, referral to a medical practitioner is recommended due to severe pain.

Cryotherapy is recommended to reduce swelling and manage pain.

132
Q

Little leaguer’s shoulder

Presentation

A

Young, 12-15 yo male baseball pitchers***

Pain felt when throwing hard and comes on gradually - sometimes up to as long as 7 months before diagnosis

133
Q

Little leaguer’s shoudler

Anatomy/structures involved

A

**prosimal humerus pain and tenderness

Triangular metaphyseal avulsion fracture (salter-harris type 2)

134
Q

Little leaguer’s shouder

Etiology/cause

A

Excessive rotational stresses on the growth plate of the proximal humerus from pitchers who **overptich or pitch too frequently. (Salter-harris type 1). Type 2 is less common

135
Q

Little leaguer’s shoulder evaluation

A

Swelling/loss of ROM

***weakness on ext rotation and positive empty-can test (thumbs down abduction

X-ray shows widening of the proximal humeral physis with sclerosis of the proximal humeral metaphysis.

136
Q

Little leaguer’s shoulder management

A

Rest

Rehabilitation with EASY throwing and pain as the limiting factor

137
Q

4 types of passive end-range or end-feels (provocation) as described by Cyriax

A

Soft
Muscular
Bone-on-bone or cartilaginous
Capsular

138
Q

Soft type of passive end-range or end-feels

A

Bicep to forearm

139
Q

Muscular type of passive end-range or end-feels

A

Hamstring stretch

140
Q

Bone-on-bone or cartilagenous

A

Elbow extension

141
Q

Capsular

A

Hip rotation (capsular stretch)

142
Q

Abnormal end-feels include

A

Spasm
Springy or rebound
Empty
Loose

143
Q

Spasm

A

Pain prevents full ROM

144
Q

Springy or rebound

A

Mechanical blockage such as labrum or meniscus

145
Q

Empty

A

Acute pain such as bursitis preventing movement to end-range

146
Q

Loose

A

Capsular or ligamentous damage seen with grades of sprain

147
Q

Timing of onset

A

acute, subacute and chronic (passive provocation)

148
Q

Acute time of onset

A

Pain felt before end range. Therapy required

149
Q

Subacute timing of onset

A

Pain at the same time as end-range. Stretch and mobilize

150
Q

Chronic timing of onset

A

Pain felt after end-range. Stretch and adjust/manipulate

151
Q

When a joint is not free to move, the muscles that move it

A

Are not free to move

152
Q

Muscles cannot be restored to normal if the joint which they move

A

Is not free to move

153
Q

Normal muscle function is dependent on

A

Normal joint movement

154
Q

Impaired muscle function perpetuates and may cause

A

Deterioration in abnormal joints

155
Q

Isometric

A

No lengthening or shortening of muscle at all. For example, shoulder flexion as when you hold an object out in front of you

156
Q

Isotonic

A

Also called concentric by some sources. Here the muscle shortens - origin to insertion. The best example is biceps curl. Other examples include anterior deltoid shortening when lifting an object overhead.

157
Q

Isokinetic

A

The muscle shortens and gains tension through a motion at a constant speed such as a swimming stroke

158
Q

Eccentric

A

Here the muscle lengthens as when you place an object down or walk downshill - the quads flex and lengthen during heel strike

159
Q

Passive stretch

A

This is also lengthening however done in a passive state such as lying on your back and having a hamstring stretch performed on you

160
Q

Agonist muscles

A

Called prime movers, they cause movement to occur. They create a normal ROM in a joint by contracting.

161
Q

Antagonist

A

Acts in opposition to the agonist and returns the limb to it’s initial position - it can be an extensor or a flexor

162
Q

Examples of agonists and antagonists are

A

Biceps flexion - tricep extension

Pec major/trap - rhomboid

Deltoid flexion - latissimus dorsi

163
Q

PNF techniques

A 
Rhythmic initiation
Hold relax
Contract relax
Rhythmic stabilization
Repeated contractions
Slow reversals
164
Q

The one exception to active motion in PNF

A

Rhythmic initiation

165
Q

Progression used for those who are very weak or unable to initiate a motion

A

Rhythmic initiation

166
Q

Rhythmic motion through a desired ROM beginning with passive motion

A

Rhythmic initiation

167
Q

Rhythmic initiation

A

Goals
Indications
Contraindications
Description of technique

168
Q

Description of technique - rhythmic initiation

A

Therapist moves the patient passively through a desired ROM, using speed and verbal commands to cue movement

Patient is asked to move actively with therapist through ROM

Therapist then begins to apply resistance

169
Q

Hold relax

A 
Goals
Indications
Contraindications
Description of technique
Example
170
Q

Description of technique

A

Patient actively contracts agonist in available ROM
Therapist provides resistance to an isometric contraction of the antagonist
Patient again actively contracts agonist to new available ROM

171
Q

Example hold relax

A

Hamstring ROM (increase hip flexion)

Patient flexes hip using hip flexors, therapist resists a hamstring contraction, then redo

172
Q

Contract relax

A

Goals
Indications
Contraindications
Description of technique

173
Q

Description of technique contract relax

A

Active contraction of agonists to end of available ROM followed by concentric contraction of antagonists, then another active contraction of agonists to new available ROM

174
Q

Rhythmic stabilization

A

Alternating isometric contraction against resistance, no motion intended

Therapist slowly increases resistance of agonist which patient resists until maximum, then slowly decrease add resistance in opposite direction

175
Q

Repeated contractions description of technique

A

Therapist provides resistance of agonists during concentric contraction

No resistance is given to antagonists

176
Q

Slow reversals

A

Therapist resists motion of agonist and antagonist through ROM in pattern

177
Q

When to use PNF techniques

A 
Increase ROM
Increase initiation of ROM
Increase strength
Increase joint stability
Increase relaxation
178
Q

Increase ROM

A

Contract-relax
Hold-relax
Rhythmic initiation
Rhythmic stabilization

179
Q

Increase initiation of ROM

A

Repeated contraction

Rhythmic initiation

180
Q

Increase strength

A

Slow reversal
Repeated contractions
Rhythmic stabilization

181
Q

Increase joint stability

A

Repeated contractions

Hold-relax

182
Q

Increase relaxation

A

Hold relax

Contract relax

183
Q

Diagonal patterns

A

Upper extremity = D1 and D2 flexino and extension

Lowe rextremity = D1 and D2 flexion and extension

184
Q

Upper extremity D1 flexion starting position

A

Shoulder extension, abduction and int rotation; forearm pronation; wrist extension and ulnar deviation; finger extension

185
Q

Upper extremity D1 flexion hand positions (for R side)

A

L hand in palm of patient had

R hand on distal anterior/medial arm

186
Q

Upper extremity D1 flexion movements

A

Shoulder flexion, adduction, and int rotation; scapular elevation and abduction; forearm supination; wrist flexion and radial deviation; finger flexion

187
Q

Upper extremity D1 extension - starting position

A

Shoulder flexion, adduction and external rotation; forearm supination; wrist flexion and radial deviation; finger flexion

188
Q

D1 extension upper - hand positions (for R side)

A

L hand on distal, posterior/lateral arm, R hand on dorsal/ulnar aspect of hand/fingers

189
Q

Upper extremity D1 extension movements

A

Shoulder extension, abduction and int rotation; scapular depression and adduction; forearm pronation; wrist extension and ulnar deviation; finger extension

190
Q

Upper extremity D2 flexion - starting position

A

Shoulder extension, adduction and int rotation; forearm pronation; wrist flexion and ulnar deviation; finger flexion

191
Q

Upper extremity D2 flexion hand positions for R side

A

L hand on dorsal aspect of hand, R hand on posterior arm

192
Q

Upper extremity D2 flexion movements

A

Shoulder flexion, abduction and ext rotation; scapular elevation and adduction; forearm supination; wrist extension and radial deviation; finger extension

193
Q

Upper extremity D2 extension starting position

A

Shoulder flexion, abduction and ext rotation; forearm supination; wrist extension and radial deviation; finger extension

194
Q

Upper extremity D2 extension hand positions for R side

A

L hand around distal humerus, R hand in athlete’s palm

195
Q

Upper extremity D2 extension movements

A

Shoulder extension, adduction and int rotation; scapular depression and abduction; forearm pronation; wrist flexion and ulnar deviation; finger flexion

196
Q

Lower extremity D1 flexion starting position

A

Hip extension, abduction and int rotation; ankle plantarflexion; foot eversion; toe flexion

197
Q

Lower extremity D1 flexion hand positions for R side

A

L hand on distal, anterior/medial thigh, R hand on medial dorsal aspect of foot

198
Q

Lower extremity D1 flexion movements

A

Hip flexion, adduction and external rotation; ankle dorsiflexion; foot inversion; toe extension

199
Q

Lower extremity D1 extension starting position

A

Hip flexion, adduction and external rotation; ankle dorsiflexion; foot inversion; toe extension

200
Q

Lower extremity D1 extension hand positions for R side

A

L hand on distal, posterior/lateral thigh ,R hand on lateral plantar aspect of foot

201
Q

Lower extremity D1 extension movements

A

Hip extension, abduction and internal rotation; anke plantargflexion; foot eversion; toe flexion

202
Q

Lower extremity D2 flexion starting position

A

Hip extension, adduction and ext rotation; ankle plantarflexion; foot inversion; toe flexion

203
Q

Lower extremity D2 flexion hand positions for R side

A

L hand on distal, anterior/lateral thigh, R hand on dorsal lateral aspect of foot

204
Q

Lower extremity D2 flexion movements

A

Hip flexion, abduction and int rotation; ankle dorsiflexion; foot eversion; toe extension

205
Q

Lower extremity D2 extension starting position

A

Hip flexion, abduction adn int rotation; ankle dorsiflexion; foot eversion; toe extension

206
Q

Lower extremity D2 extension hand positions for R side

A

L hand on distal posterior/medial thigh, R hand on plantar medial aspect of foot

207
Q

Lower extremity D2 extension movements

A

Hip extension, adduction and ext rotation; ankle plantarflexion; foot inversion; toe flexion

Extremity Clet (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions