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PCE - Neuromusculoskeletal > Joint Derangements/Dysfunction > Flashcards

Joint Derangements/Dysfunction Flashcards

1
Q

A loose body is often the result of…

A

OA or chip fracture

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2
Q

Loose body S&S

A

Locking/catching

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3
Q

Loose body Ax

A

ROM end feel as a bony block or may be springy

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4
Q

Hypermobility Rx

A
  • Mobilize stiff or hypomobile tissue/joint/segment
  • Strengthen to stabilize the hypermobile segment/tissue
  • Movement retraining - maintenance
  • Supportive devices (brace/tape)
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5
Q

What is spondylosis

What can it lead to

A

OA of spine -> degeneration of joints

Can lead to disc herniation &/or stenosis

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6
Q

What is spondylolysis

A

Pars interarticularis (fibrous tissue) defect

  • Degeneration of spine joints
  • Seen in younger patients w/ hyper extension & rotation sports
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7
Q

Is spondylolysis mostly symptomatic or asymmptomatic

A

asymmptomatic

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8
Q

What may bilateral spondylolysis lead to

A

spondylolisthesis

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9
Q

What is the most common segment for spondylolisthesis

A

L5/S1

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10
Q

spondylolisthesis MOI

A

Hyper extension

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11
Q

spondylolisthesis types:

A 
Spondyloytic spondylolisthesis 
- Progressive period of rapid growth
- Rarely progresses to adult life
- Younger population
Degenerative spondylolisthesis
- 2° to DJD + Z-joint subluxation -> OA of joints in spine, foramina narrowing
- Older population
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12
Q

Grading of spondylolisthesis

A

1-4 25% of each grade of slippage

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13
Q

spondylolisthesis S&S

A
  • Central LBP +/- referred pain, associated with weak abs +/- tight hamstrings
  • Aggravating factor: EXT
  • Easing factor: FLEX
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14
Q

Spondylolisthesis Rx

A

Stability

  • Flexion exercises (open IVF to decrease pressure on nerve roots)
  • Inner unit strengthening: TA/multifidus/PF
  • Brace if needed
  • Work into painful range with proper stability - avoid hyperextension
  • Surgery?
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15
Q

When is surgery needed for spondylolisthesis

A
  • Increased slippage or instability even with brace
  • hard neurological signs
  • evidence of spinal cord involvement
  • intractable pain despite treatment
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16
Q

Hypomobility MOI

A

Adaptive shortening or soft tissue (tightness or contracture) or joint

  • Muscle: atrophy & weakness
  • Tendon: Decreased tensile strength
  • Ligament: Decreased tensile strength, Increased stiffness/adhesions
  • Cartilage: decreased synovial fluid, H2O content
  • Bone: Increased resorption, decreased bone mass/mineral content
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17
Q

Study capsular pattern, resting position, closed packed position table

A

Pg 9

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18
Q

Dislocation S&S

A

Increase ROM
Soft end feel
+/- pain

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19
Q

Complications of GH dislocation

A

Rotator cuff tears

Axillary nerve damage

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20
Q

Dislocation types

A

TUBS: Traumatic onset, unidirectional anterior, bankart lesion, surgery
AMBRI - Atraumatic, multidirectional, bilateral shoulder findings, rehab appropriate, INF capsule shift

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21
Q

TUBS dislocation MOI

A

Abduction + ER

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22
Q

Bankart lesion

Definition + S&S

A
  • Avulsion + of ant/inf capsule & ligaments

S&S: Clicking, apprehension, deep vague pain

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23
Q

Slap Lesion

  • Def
  • MOI
  • Major cause of pain in _)___
A

Superior labrum lesion ant-> post
Elevated position w/ sudden concentric + eccentric biceps contraction
- Major cause of pain in throwers

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24
Q

Hill sachs lesion

A
  • Compression Fracture post/lateral humeral head
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25
Q

Fracture dislocation usually occurs where?

S&S ?

A

Usually acromion, humeral head

S&S -> deformity, constant pain, systemic signs (nausea)

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26
Q

Which ligaments stabilize the AC joint

A

Trapezoid and conoid ligaments

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27
Q

S&S of an AC joint subluxation

A
  • Step deformity

- Osteolysis (bone resorption d/t repetitive microtrauma or post trauma

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28
Q

Is an AC joint subluxation surgical

A

no

29
Q

Growth plate closure - proximal and distal femur

A

Prox: 18yrs
Dist: 20yrs

30
Q

Growth plate closure - proximal and distal tibia

A

Prox: 16-18yrs
Dist: 15-17 yrs

31
Q

Growth plate closure - proximal and distal Humerus

A

Prox: 20yrs
Dist: 16yrs

32
Q

Growth plate closure - proximal and distal radius

A

Prox: 18yrs
Dist: 20 years

33
Q

Fracture types and causes

A
  • Spiral: twisting injury
    o Transverse/oblique  direct blow
  • Compression/crush: longitudinal force
  • Comminuted: fragments of bone
  • Greenstick: young kids - malleable bones, # on only 1 side
  • Avulsion: piece of bone pulled off - de-attachment of soft tissue (ligaments)
  • Impact: compression force (usually more stable)
34
Q

Colles fracture

A

Distal radius + subluxation of distal ulna

35
Q

Bennetts Fracture

A

Fractura dislocation of CMC thumb joint

36
Q

Scaphoid fracture MOI

A

FOOSH

37
Q

Complications of fractures

A
  • Avascular necrosis

- Muscle weakness, contractures, re-#, infection, delayed union, malunion, CRPS

38
Q

Where is there a high rate of avascular necrosis

A
  • proximal femur
  • 5th MT
  • Scaphoid
  • Proximal humerus
  • talus neck
  • Navicular
39
Q

Locations of a hip fracture

A

Femoral neck
Intertrochanteric
Subtrochanteric

40
Q

Hip fracture conservative vs. surgical management

A

Conservative: less complications, increased bed rest, decreased healing time, slower rehab

Surgical: Decreased length of stay, improved rehab, risks

41
Q

Hemiarthroplasty vs total arthroplasty

A

Hemi : just femoral head

Total: femoral head + acetabulum

42
Q

Types of hip fracture surgery

A
  • Cemented: Increased stability, better for sedentary elderly w/ poor bone quality
  • Uncemented: components coated w/ beads - where new bone can grow, better for younger Pts, revision in 10yrs
  • Hybrid - Femoral component = cemented, acetabular component = uncemented
43
Q

Precautions following total arthroplasty - post-lateral approach

A
  • NO hip flexion past 90
  • NO IR
  • NO ER
  • NO hip add past midline for 1st 3months
44
Q

Precautions following total arthroplasty - lateral approach

A
  • No hip flex past 90
  • NO IR
  • No hip add past midline for 1st 3 months
45
Q

Precautions following total arthroplasty - Anterior approach

A
  • No hip ext
  • NO hip ER
  • NO Hip adduction past midline for 1st 3 months
46
Q

Precautions following hemiarthroplasty -

A

No restrictions with movement & WBAT

Check MD Orders

47
Q

Indication for hemi, total, and reverse shoulder arthroplasty

A

Hemi: Arthritic conditions (w/out glenoid involvement, severe fractures of proximal humerus
Total: OA, inflammatory arthritis, osteonecrosis involving the glenoid, post-traumatic degenerative joint disease
Reverse: OA or compound fractures of the humerus w/ deficiency of the rotator cuff.

48
Q

Patients must have _____ in order to receive a total shoulder arthroplasty

A

rotator cuff

49
Q

Post op precautions for a total shoulder arthroplasty

A

Immobilization daily for 1 week nightly for 1 month, sling 4 weeks

50
Q

Post op precautions for a reverse shoulder arthroplasty

A

flexion/elevation in scapular plane passively up to 0- degrees, pure abduction

51
Q

Post op contraindication for a reverse shoulder arthroplasty

A

Avoid IR for 6weeks

52
Q

Types of bone

A
  • Cortical - outside long bones

- Cancellous - inside, more affected by OP

53
Q

OP Categories

A
  • Normal: 0-1.0 SD of young adult mean
  • Low bone mass: 1-2.5 SD below young adult mean (Osteopenia)
  • Osteoporosis - 2.5+ SD below young adult mean
54
Q

OP Types

A

Primary type 1 - Post menopausal women
Primary type 2 - 70+ years risk women=men
Secondary OP - Due to another med condition or treatment, any age

55
Q

OP risk factors

A 
Family history, lifestyle 
Gender 
Age 
Lifetime exposure to estrogen, breast cancer 
Fragility fracture under 40yrs
56
Q

OP Dx

A

Bone scan

Fracture assessment tools - FRAX, CAROC 2010

57
Q

OP Ax

A

Vertebroplasty -> fusing of 3+ segments- Risk of subsequent fracture

58
Q

OP Rx

A
  • Pharmacological - anti-absorption agents, anabolic bone formation (hormone treatment). Side effects = vertigo, nausea, dizziness, muscle/back/ue/le pain
  • Nutrition: Ca+, Vit D
  • PT: posture, aerobic (WB), resistance exercises, core, balance, extension exercises, no spinal flex or flex + rot
59
Q

S&S of tumor fractures

A

Asymptomatic but can show cancer signs

60
Q

Primary malignant tumors of soft tissues/bone are common or rare?

Most likely population?

A

RARE

May occur in youth

61
Q

Types of soft tissue/bone tumors

A

Osteosarcoma
Synovial sarcoma
Malignant tumors
Osteoid osteoma

62
Q

Where do Osteosarcomas occur? S&S? Rx?

A

At ends of long bones
Pain - at joint, worse with activity
Imaging- xray moth eaten appearance
Rx: surgery

63
Q

Where do Synovial sarcomas occur? S&S? Rx?

A

In larger joints - knee/ankle
Pain - at night, w/ activity
Swelling/instability
Rx: Surgery, chemo/radiation

64
Q

Rx for malignant bone tumors

A

Metastasize from elsewhere

Rx: Thorough PMx & FHx

65
Q

Are osteoid osteoma malignant or benign? S&S? Key sign? Rx?

A 
Benign 
Pain in bone, At night, w/ exercise
Key sign: no pain w/ aspirin 
Imaging: CT scan shows a central focus point 
Rx: ablation, ethanol, laser
66
Q

Degenerative joint disease:

  • Cause
  • Population
  • Result
A

Due to mechanical change, joint disease, joint trauma
Seen in Pts >40 yrs
Result: ++ Loading on surfaces that are weight bearing

67
Q

Types of vertebral degenerative joint disease

A
  • Spinal (lateral) stenosis
  • Central stenosis (canal)
  • Spondylosis - spine OA
  • Spondylolysis - Pars interarticularis defect, may start as stress #
  • Spondylolisthesis
68
Q

Degenerative joint disease Rx

A
  • Joint protection
  • Increase joint mechanics
  • aquatics = Decrease WB

PCE - Neuromusculoskeletal (8 decks)

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