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Ortho > Lab exam 1 > Flashcards

Lab exam 1 Flashcards

1
Q

which special test of the shoulder is being described?

PURPOSE: tests for bicep tondenitis & assesses the integrity of the bicep tendon

HAND PLACEMENT: stabilize same side shoulder

FORCE: resisted shoulder extension

+ SIGN: pain in bicipital groove is reproduced

A

speeds test

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2
Q

which special test of the shoulder is being described?

PURPOSE: tests for full thickness RC tear

HAND PLACEMENT: passively raise arm to 90 degrees of abduction

FORCE: slowly lower arm

+ SIGN: can’t slowly control downward descent

A

drop arm test

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3
Q

which special test of the shoulder is being described?

PURPOSE: tests for supraspinatus weakness

HAND PLACEMENT: patient is in caption (thumbs down/IR)

FORCE: downward pressure

+ SIGN: pain is reproduced

A

empty can test

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4
Q

which special test of the shoulder is being described?

PURPOSE: general shoulder impingement test

HAND PLACEMENT: (patient is standing or sitting) depress or stabilize scapula

FORCE: passive IR of shoulder & then passively range into maximal flexion

+ SIGN: pain is reproduced

A

neer’s

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5
Q

which special test of the shoulder is being described?

PURPOSE: subacromial impingement test

HAND PLACEMENT: shoulder & elbows are flexed 90 degrees

FORCE: passively MR shoulder

+ SIGN: pain is reproduced

A

kennedy hawkins test

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6
Q

which special test of the shoulder is being described?

PURPOSE: tests for subscapularis tear

HAND PLACEMENT: arm is behind the back with the dorsal surface of hand against the back

FORCE: ask patient to lift hand from back

+ SIGN: unable to lift hand off of back/away from body

A

lift off sign

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7
Q

Q
which special test of the shoulder is being described?

PURPOSE: tests for anterior instability of GH joint

HAND PLACEMENT: (patient is in supine) shoulder in 90 degrees of abduction & elbow in 90 degrees of flexion

FORCE: slowly ER patient’s shoulder

+ SIGN: patient is apprehensive & feels like their is instability

A

anterior apprehension test

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8
Q

when treating an impingement syndrome with conservative treatment, which phase is being described?

Decrease/modify pain
Meds for pain/inflammation
Rest
Stretching/strengthening
Scapular strengthening & stabilization exercises
Pendulum exercises
Isometrics
Patient education
Modalities

A

protection phase

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9
Q

when treating an impingement syndrome with conservative treatment, which phase is being described?

Increased use of injured area
Increased intensity of isometrics
Stretch & strengthen RC muscles
Scapular stabilization
Open & closed chain endurance exercises

A

controlled motion phase

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10
Q

when treating an impingement syndrome with conservative treatment, which phase is being described?

Functional training
Increased duration & intensity of exercises
plyometrics

A

return to function phase

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11
Q

when treating an impingement syndrome with non-conservative treatment, which phase is being described?

Lasts 3-4 weeks
Control pain & inflammation
Almost ALWAYS address mobility
Pendulum
Posture
About 1-week post-op: pain-free, low intensity isometrics
Submax isometrics
AAROM of shoulder & AROM of wrist, hand & elbow

A

max protection phase

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12
Q

when treating an impingement syndrome with non-conservative treatment, which phase is being described?

restore & maintain full/pain-free ROM
self-stretching
postural exercise
develop dynamic stability, strength (low-load with a slow increase in reps), endurance, & control of GH joint & scapulothoracic joint
stabilization exercises
functional activities

A

mod protection phase

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13
Q

when treating an impingement syndrome with non-conservative treatment, which phase is being described?

Begins ~8 weeks post-op & lasts 12-16 weeks
Strength
Endurance
Functional activities

A

min protection phase

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14
Q
  • used to eliminate/decrease the abnormality causing an impingement
  • allows increased movement of tendons with pain/compression
A

SAD (Subacromial Decompression)

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15
Q

are the following treatments of tendonitis conservative or non-conservative?

NSAIDS (anti-inflammatory meds)
Avoid activities that place a load on the tendon
Isometric exercise
Once pain decreases, work on building strength

A

conservative

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16
Q

when treating an RC tear with non-conservative treatment, which phase is being described?

Prevent loss of ROM of peripheral joints
Prevent shoulder stiffness
PROM (as allowed)
Self-assisted/wand exercise
Postural training
Scapular stabilization

A

max protection phase

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17
Q

when treating an RC tear with non-conservative treatment, which phase is being described?

Self or AAROM with end range hold
Pain-free AROM
Look for substitution motions
Isometric & dynamic scapulothoracic stabilizers
Gradually increase resistance with submax isometrics
Scar mobilization
Use of UE for light, functional activities

A

mod protection phase

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18
Q

when treating an RC tear with non-conservative treatment, which phase is being described?

Full ROM of shoulder
Strengthening continues
Return to functional activities
Task specific training
No high demand activities for 6 months – 1 year
Endurance training
Phase may begin 12-16 weeks post op

A

min protection phase

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19
Q

when treating GH joint instability/dislocation with conservative treatment, which phase is being described?

Compression fracture of the posterolateral aspect of the humeral head because of anterior shoulder instability
Pain control
Avoid any position that reproduces the mechanism of dislocation of the arm
Maintain range/strength in joints below that are non-compromising to shoulder
Once immobilization is over, gradually return to ROM (still protecting shoulder from abduction/ER)

A

protection phase

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20
Q

when treating GH joint instability/dislocation with conservative treatment, which phase is being described?

Submax isometrics
* Pain free
* Neutral position: add,abd/ IR, ER/ elevation, extension
* Partial WB & stabilization exercises
* Limited ER from neutral to 50 degrees
* Avoid dislocation positions
* Work up to full IR & 90-degree flexion
* DO NOT PUT IN 90 DEGREES ABDUCTION
* AVOID COMBINATION OF ABDUCTION & ER

A

controlled motion phase

21
Q

when treating GH joint instability/dislocation with conservative treatment, which phase is being described?

Scapular & RC strengthening
Anterior shoulder strengthening
Look at scapulohumeral rhythm: focus on normal scapular motion & stabilization
Avoid prohibited motions for up to 3 months after original injury
Full, pain free ROM
No palpable tenderness
Machine, CKC, OKC, cable systems
Progress from easy to hard
Discuss with PT when progression is appropriate
Endurance activities
May take up to 4 months for patient to be able to return to full activity

A

return to function phase

22
Q

when treating adhesive capsulitis with conservative treatment, which phase is being described?

Educate pt
Activity modification
Passive or assisted ROM in pain free range available
Joint mobs
Isometrics
Grip ball squeezes

A

protection phase

23
Q

when treating adhesive capsulitis with conservative treatment, which phase is being described?

Progress ROM to point of pain for shoulder & scapula
Wand exercise, table stretches, pulleys
Self-mobs
Stretching (manual & self)
Postural changes
Modalities as needed

A

controlled motion phase

24
Q

when treating adhesive capsulitis with conservative treatment, which phase is being described?

Stretching
Strengthening
Posture
Prepare for real life

A

return to function phase

25
Q

when treating an AC joint sprain/dislocation with non-conservative treatment (after a TSA), which phase is being described?

Control pain
PROM: surgical guidelines
AROM: scapula
Supine self-assisted ROM
Codman’s (NO CIRCLES)
Functional activity with elbow at waist level
Maintain above/below joint integrity

A

maximum protection phase

26
Q

when treating an AC joint sprain/dislocation with non-conservative treatment (after a TSA), which phase is being described?

Avoid aggressive stretching or resistance exercises or overuse of involved shoulder with ADLs
AAROM
Transition gradually to AROM
Wand exercises behind back
Low intensity, pain-free stretching
Pain-free submax isometrics
Dynamic scapular strengthening

A

moderate protection phase

27
Q

when treating an AC joint sprain/dislocation with non-conservative treatment (after a TSA), which phase is being described?

End range of self-stretching
Strengthening: pain-free, low load, high rep
Functional activity training

A

minimum protection phase

28
Q

which special test of the elbow is being described?

o PURPOSE: looks at integrity of MCL of the elbow (is it intact?)
o POSITION: supine with elbow flexed at 20 degrees (clinician stands towards feet)
o HAND PLACEMENT: stabilize above joint line
o FORCE: abduction of the FA
o + SIGN: pain or excessive movement

A

valgus stress test

29
Q

which special test of the elbow is being described?

o PURPOSE: looks at integrity of LCL at the elbow
o POSITION: supine with elbow flexed at 20 degrees (clinician stands towards head)
o HAND PLACEMENT: stabilize above joint line
o FORCE: adduction of the FA
o + SIGN: pain or excessive movement

A

varus stress test

30
Q

which special test of the elbow is being described?

o PURPOSE: Tests for ulnar entrapment (provocation/tapping nerve test)
o POSITION:
o HAND PLACEMENT: support FA
o FORCE: Tapping the groove between the olecranon process & medial epicondyle
o + SIGN: pain, numbness, tingling

A

tinel’s sign

31
Q

which special test of the elbow is being described?

o PURPOSE: tests for medial epicondylitis
o POSITION: elbow fully extended & supinated; then passively extend wrist
o HAND PLACEMENT: stabilize UE
o FORCE: push hand back into further extension
o + SIGN: reproduce pain/symptoms

A

golfer’s elbow test

32
Q

which special test of the elbow is being described?

o PURPOSE: tests for lateral epicondylitis
o POSITION: extend elbow & pronate FA
o HAND PLACEMENT: on dorsum of wrist
o FORCE: resist further extension against clinician’s hand
o + SIGN: reproduces pain/symptoms

A

tennis elbow test

33
Q

which special test of the elbow is being described?

o PURPOSE: tests for lateral epicondylitis
o POSITION:
o HAND PLACEMENT:
o FORCE: resists middle finger extension
o + SIGN: reproduces pain/symptoms

A

lateral epicondylitis test

34
Q

when treating lateral/medial epicondylitis with conservative treatment, which phase is being described?

o Decrease pain
- Immobilization
- Avoid aggravating activities
- Ice

o Develop soft tissue & joint mobility
- Cross friction massage
- If nn symptoms are present: implement nn gliding/mobilizations
- Soft tissue mobilization: decrease tightness
- Isometrics in pain-free ranges
- Gentle passive stretching

o Maintain UE function
- Active ROM: to all joints to maintain integrity of the UE
- Resistive exercises: to shoulder & scapular stabilization exercises

A

protection phase

35
Q

when treating lateral/medial epicondylitis with conservative treatment, which phase is being described?

o Manual stretching
o Continue with cross friction massage
o Joint mobs by PT
o Force dispersing strap/brace
o Increased strengthening
o Initiate concentric & eccentric exercise with caution
o Make sure they are appropriate & don’t “flare up” the pt
o Activity modification
o Promote gradual return to all functional activities
o Plyometric if appropriate

A

controlled motion/return to function phase

36
Q

the following treatment parameters are for what pathology?

focus on gentle active motion that doesn’t stress the fracture site
Typically immobilized 4-6 weeks
Gentle AROM after cast is removed
no resistance exercise or progressive ROM allowed until x-ray shows healing
above/below joints are maintained
passive stretching is contraindicated during early healing phase
o DO NOT PUT STRESS OVER HEALING FX SITE

A

supracondylar fracture

37
Q

when recovering from a TEA, which phase is being described?

Control pain, inflammation, & edema
Maintain careful inspection of wound
Protect soft tissue as it begins to heal
Maintain mobility of shoulder, wrist & hand
Regain motion of FA & elbow (if permitted by procedure used)
Goals can include maintaining mobility of shoulder, wrist & hand (if allowed ROM to elbow & FA)
Minimize atrophy of UE musculature
o Isometrics may be used to achieve this
first 4 weeks

A

maximum protection phase

38
Q

when recovering from a TEA, which phase is being described?

4-6 weeks postoperatively
- Soft tissue has healed sufficiently to increase stress

12 weeks
- (Barring complications) only minimum protection is needed
- Increase ROM
- Regain functional strength & muscular endurance

A

moderate/minimum protection phase

39
Q

which special test of the wrist is being described?

o PURPOSE: tests for inflammation of APL & EPB
o POSITION: pronation; make a fist with the thumb tucked
o HAND PLACEMENT:
o FORCE: passively ulnar deviate
o + SIGN: reproduce symptoms

A

finkelstein’s test

40
Q

which special test of the wrist is being described?

o PURPOSE: puts pressure on median nerve
o POSITION: fully flex both wrists
o HAND PLACEMENT:
o FORCE: press opposite dorsums of hands together & hold for 1 minute
o + SIGN: reproduce symptoms

A

phalen’s

41
Q

which special test of the wrist is being described?

o PURPOSE: tests for CTS
o POSITION: wrists are fully extended with both palms together (prayer)
o HAND PLACEMENT:
o FORCE: lower hands & throw elbows out
o + SIGN: reproduce symptoms

A

reverse phalen’s

42
Q

which special test of the wrist is being described?

o PURPOSE: tests for CTS
o POSITION: sitting with FA fully supinated
o HAND PLACEMENT: hand & wrist are held in neutral position
o FORCE: tap at midpoint of carpal tunnel
o + SIGN: pain, numbness, or tingling

A

tinel’s sign

43
Q

the following is non-operative management of what pathology?

o Modify activity: home & work
o Educate patient & HEP
o MD prescribe medication:
o Possibly injections
o Splint wrist in neutral
o Allow inflammation to subside before starting resistance training
o Gentle ROM/gripping exercise that do not flare symptoms
o Postural exercises needed
o Joint mobs by PT if needed
o Tendon gliding exercises for extrinsic tendons
o Median nerve glides/mobilization
o EMG ordered for cases where compression may be coming from cervical root/BP issue

A

carpal tunnel syndrome

44
Q

the following is operative management of what pathology?

o Surgical release of transverse carpal ligaments/removal of scar tissue
- Can be open or endoscopic
- Open is a safer alternative
- Decreases risk that median nn or ulnar area will be damaged
- 80-90% of board-certified hand surgeons use open technique
- Surgery has a 90-93% success rate & is cost-effective to manage CTS
- Usually performed as an outpatient procedure with local sedation

A

carpal tunnel syndrome

45
Q

when treating carpal tunnel syndrome with non-conservative treatment, which phase is being described?

o Immobilization for 7-10 days
o Patient education
o Avoid active wrist flexion & extension past neutral
o Avoid active finger flexion with wrist flexion
o Pain/edema/wound management
o Active tendon gliding
o Maintain integrity of FA, elbow, & shoulder

A

maximum protection phase

46
Q

when treating carpal tunnel syndrome with non-conservative treatment, which phase is being described?

o AROM initiated as tissue heals & sutures are removed ( ~ day 10-12)
o Scar mobilization: to prevent scar tissue from forming
o Nerve glides
o Isometrics being around 4 weeks
o Grip/pinch around week 6
o Dexterity exercises & sensory stimulation
o Overall, CTS can return
o May see an increase in incidence of this 10-15 years after CT release

A

moderate protection phase

47
Q

the following is non-operative management of what pathology?

o Similar to that of CTS
o Avoid pressure to the base of the hand
o Possible use of hand-based ulnar orthosis to provide rest
o Ulnar nerve mobilization

A

compression in tunnel of guyon

48
Q

the follow is operative management of what pathology?

o Release of ulnar tunnel
o Immobilization of wrist for 3-5 days
o Gentle ROM
o Guidelines similar to CTS surgery (except use ulnar nn mob techniques)

A

compression in tunnel of guyon

49
Q

the following is conservative management of what pathology?

o NSAIDS
o Wrist/thumb immobilization
o Eliminate any activity that causes pain
o Ice
o Ionto/phono
o PROM progressing to AROM when pain free
 Emphasize concentric & eccentric
o PT for joint mobs if indicated
o Surgical decompression for chronic cases
o Post-op mobilization for 1 week
o If conservative tx fails
 Injection of the 1st dorsal compartment

A

De Quervain’s Tenosynovitis

Ortho (5 decks)

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