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OS II Final > LE various treatments > Flashcards

LE various treatments Flashcards

1
Q

What is proper treatment position for femorotibial dysfunction BLT?

A

Pt: Supine, Doc: Ipsi to dysfunction

Hand: Ceph palm over anterior femur, caudad hand over tibial tuberosity

Tech:

  1. Begin with posterior force
    - more pressure caudal hand for ACL, Cephalad for PCL
  2. Add internal/external rotation to obtain BLT (and have pt breath)
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2
Q

Tibia on Femur Supine HVLA

A

Position: patient supine w knees flexed to 90, doc seated on foot of dysfunctional side

Hand: thenar eminences over anterior tibia and thumbs on plateaus with fingers wrapped around leg

Tech:

  1. Engage RB and deliver thrust parallel to long axis of femur
    - anterior: posterior thrust with thumbs
    - posterior: anterior (tug) thrust with fingers
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3
Q

Tibia on Femur Seated HVLA

A

Position: patient seated w legs off table, pillow under thigh; doc seated in front of patient

Hands: thumbs on anterior tibial plateau with fingers wrapped around

Relaxation method: spring leg up and down 2-3x (may relax thigh and provide running start)

Tech:

  • Anterior: deliver posterior thrust with thumbs with simultaneous inferior traction
  • Posterior: deliver anterior (tug) with fingers with simultaneous inferior traction
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4
Q

Tibia on Femur Prone HVLA

A

Position: patient prone, w dysfunctional knee flexed to 90; doc at end of table with dorsiflexion of pts foot on shoulder

Hand: fingers interlaced around tibia just distal to popliteal region

Technique:

  1. Lead forward to flex knee to 90, plantar flex foot to relax gastrocnemius
    - Ant: Thrust (tug) through 4th and 5th finger with both hands parallel to thigh
    - Post: deliver superior/cephalad direction thrust w palms on tibial plateaus
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5
Q

Supine Anterior/Posterior Fibular Head

A

Position: pt supine w pillow under knee; doc standing contra to dysfunction

Hand:

  • Cephalad: thenar eminence on anterior aspect of fibular head to push posterior/pull anterior
  • Caudad: on ipsi foot at malleoli

Localizing force: IR if anterior, ER if posterior

Activating Force:

  • ME: Pt activating force is ER
  • HVLA: direct posterior medial thrust at fibular head or anterior lateral pull (posterior)
  • ART: rhythmic pressure at barrier
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6
Q

Posterior Fibular Head Technique 1 (supine)

A

Pos: pt supine ipsi hip and knee flex to 90; doc ipsi

Hand:

  • Ceph: 1 MCP on posterior aspect of fib head, flex knee over hand
  • Caudad: on ipsi foot

Technique:

  1. Evert, dorsiflexion, and ER foot
    - MET: pt supinate foot
    - HVLA: abruptly flex knee to create anterior thrust on fib head
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7
Q

Posterior Fibular Head Technique 2 (Prone)

A

Pos: pt prone, DF knee flexed to 90; doc contra

Hand:

  • Ceph: index finger on posterior fibular head w hypothenar eminence on hamstrings
  • Caud: on malleoli of foot

Tech:

  1. Evert, dorsiflexion, and ER foot
    - thrust: further flex knee
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8
Q

Fibula and interosseous BLT

A

Pos: pt supine; doc ipsi resting elbows on table

Hand:

  • ceph: thumb on fib head, palm supporting proximal calf; avoid fibular nerve
  • caud: thumb on malleoli, palm supports distal heel

Tech:

  1. move leg distally puts pressure on proximal fib/proximal puts pressure on malleoli
  2. extending wrists puts pressure and stretch on interosseous membrane;
  3. Find position of greatest ease or stretch and await tissue release
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9
Q

Talotibial Dorsiflexion/Plantarflexion HVLA

A

Pos: pt supine; doc at foot of table

Hand: fingers interlaced on dorsum of foot, thumbs on ball of foot

Tech:

  1. Caudal traction
  2. Dorsiflex foot if plantarflexion SD, Plantarflex if dorsiflexion SD
  3. Thrust: Caudal traction, with thrust into barrier
    - Plantarflex: use scooping potion with 4th and 5th finger to disengage talus from tibia
    - dosriflexed: place more force on 2nd and 3rd finger
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10
Q

Talotibial Inversion/Eversion HVLA

A

Pos: Pt supine; doc at foot of table

Hand: One hand on calcaneous, other on dorsum of foot

Tech: HVLA traction (Tug) after positioning

  • Inversion: caudal traction with eversion/abduction of ankle
  • Eversion: caudal traction with inversion/addiction of ankle
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11
Q

Plantarflexed talus MET

A

Pos: pt supine, doc at foot of bed

Hand: One hand on heel of foot, other on plantar side with thumb on lateral malleoulus

Technique:

  1. Dorsiflex foot into restrictive barrier, instruct pt to plantar flex for 3-5s
  2. Relax for 3-5, repeat 2-3x, or until final barrier
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12
Q

Dorsiflexed Talus MET

A

Pos: pt supine, doc at foot of bed

Hand: One hand on heel of foot, other on plantar side with thumb on lateral malleoulus

Plantar flex foot, instruct pt to plantar flex
-apply principles of MET

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13
Q

Inverted Talus MET

A

Pos: pt supine, doc at foot of bed

Hand: One hand on bottom of foot, the other stabilizing the tibia/fib

Tech:

  1. evert foot to RB, have pt invert
    - apply principles of MET
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14
Q

Everted Talus MET

A

Pos: pt supine, doc at foot of bed

Hand: One hand on bottom of foot, the other stabilizing the tibia/fib

Tech:

  1. Invert foot to RB, have pt evert
    - apply principles of MET
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15
Q

Inverted calcaneous MET

A

Pos: pt supine, doc at foot of bed

Hand: One hand on heel of foot, the other stabilizing the tibia/fib

Tech:

  1. evert foot to RB, have pt invert
    - apply principles of MET
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16
Q

Everted calcaneous MET

A

Pos: pt supine, doc at foot of bed

Hand: One hand on heel of foot, the other stabilizing the tibia/fib

Tech:

  1. Invert foot to RB, have pt evert
    - apply principles of MET
17
Q

Plantar glide navicular, cuboid, cuneiform MET

A

Pos: pt supine, doc at foot of bed

Hand: Thumbs crossed over area of concern

Tech:
ME: dorsiflex foot to RB, have pt plantar flex (apply principles)

18
Q

Plantar glide navicular, cuboid, cuneiform HVLA

A

Pos: pt supine, doc at foot of bed

Hand: One thumb over area of concern at bottom of foot, other hand plantar flex at dorsum of foot

Tech:
-abrupt plantar flexion

19
Q

Hiss Whip (HVLA)

A

Pos: pt prone with hip and knee of affected leg off table; doc at foot

Hand: both thumbs over plantar surface of affected foot, fingers on dorsum

Tech:

  1. Slightly abduct pts lower extremity and flex knee
  2. Thrust down through thumbs with “whip-like” motion at ankle and knee
20
Q

Cuneiform and Metatarsal Dysfunction BLT

A

Pos: pt supine, doc at foot of bed

Hand: Thumbs on dorsum of distal metatarsal, fingers on plantar aspect of foot

Tech:

  1. Flex/extend, ER/IR, compress/distract as needed
  2. Once n BLT, await relaxation
21
Q

Phalanx Dysfunction BLT

A

Pos: pt supine, doc at foot of bed

Hand: use index finger and thumb of one hand to grasp proximal end of phalanx, use index finger and thumb of other hand to grasp the distal metatarsal

Tech:

  1. Add compression/traction, rotation, flexion, extension, SB
  2. Add translation superior/inferior, medial/lateral to balance
  3. Maintain position until release is felt
22
Q

Counterstrain steps:

A
  1. Structural Exam to find SD
  2. Find tenderpoint
  3. Establish pain scale
  4. Wrap pt around TP while monitoring
  5. Find 70% ease
  6. Maintain position for 90s
  7. Slowly return to neutral
  8. Reassess
23
Q

Lateral Trochanter (TFL) location and Tx

A

Lasted just inferior to Iliac Crest in body of TFL

Pos: pt supine/prone, doc ipsi to TP

FABD (flex, abduct)

24
Q

IT Band CS Location and Tx

A

Located in IT band distal to greater trochanter

Pos: pt supine, doc Ipsi

fABD
-maybe some slight IR/ER

25
Q

Lateral Hamstring TP Location and Tx

A

Located distal aspect of biceps femoris near attachment on fibular head

Pos: pt supine/prone, doc ipsi to TP

F ER ABd knee with compression of calcaneous to plantar flex ankle

26
Q

Medial Hamstring TP location and Tx

A

Located at distal aspect of medial hamstrings near posterior/medial surface of tibial condyle (inner leg)

Pos: pt supine or prone, doc ipsi to TP

F IR ADd knee with compression of calcaneous to add plantar flexion

27
Q

Lateral Meniscus/LCL TP Location and Tx

A

Located lateral aspect of joint line on posterior surface of knee

Pos: pt supine, doc ipsi and seated near TP

F ER ABd thigh, while tibia is ER/IR ABd until tenderness is reduced to 70%

28
Q

Medial Meniscus/MCL TP Location and Tx

A

Located on medial joint line on posterior aspect of knee

Pos: pt supine, doc ipsi and seated

F ABd thigh, ADd and IR tibia

29
Q

ACL TP Location and Tx

A

Located on superior aspect of popliteal fossa adjacent to hamstring tendons

Pos: pt supine, doc ipsi
-towel under distal femur, apply posterior force to proximal tibia with hand with other hand on TP

30
Q

PCL TP Location and Tx

A

Located slightly below center of popliteal fossa

Pos: pt supine, doc ipsi
-towel under proximal tib, apply posterior force to distal femur with hand while other hand monitors

31
Q

Popliteus TP Location and Tx

A

Located in belly of poplitues inferior to popliteal space

Pos: pt prone, doc ipsi
-flex knee, IR tibia

32
Q

Extension ankle (Gastrocnemius) TP Location and Tx

A

Location: within one of the heads of gastrocnemius just distal to popliteal margin

Pos: pt prone, doc ipsi
-flex knee, put dorsum of foot on thigh, add compression through calcaneus until 70% reduction

33
Q

Medial Ankle (Tibialis Anterior): Inversion TP Location and Tx

A

Located anterior and inferior to the medial malleoli along deltoid lig

Pos: pt lat recum with pillow under leg, doc at foot of table
-apply inversion force to foot and ankle w slight IR

34
Q

Lateral Ankle Fibularis Longus, Brevis, and Tertius: Eversion TP Location and Tx

A

Located anterior and inferior to the lateral malleoli along talocalcaneal sulci

Pos: pt lat recum with pillow under leg, doc at foot of table
-apply eversion force to foot and ankle w slight ER

35
Q

Flexion Calcaneuous (quadratus plantae) TP Location and Tx

A

Located anterior aspect of plantar surface of calcaneous

Pos: pt prone, doc ipsi to TP
-Flex knee with dorsum of foot on docs thigh; flex while translating calcaneous toward forefoot

36
Q

Navicular TP Location and Tx

A

Located medial aspect of plantar surface over navicular bone

Pos: pt supine, doc ipsi to TP
-Flex knee with dorsum of foot on docs thigh; plantar flex subtalar joint while supination forefoot

OS II Final (5 decks)

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