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6 ORTHO > LECTURE MIDTERM > Flashcards

LECTURE MIDTERM Flashcards

1
Q

Lateral Epicondylitis aka

A

Tennis Elbow

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2
Q

What is Lateral Epicondylitis thought to begin with?

A

Tearing of extensor carpi radialis brevis

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3
Q

What lateral epicondylitis extend to?

A

Extensor digitorum communis or extensor carpi radialis longus

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4
Q

What is the mechanism of injury for Lateral Epicondylitis?

A

Wrist extension, radial deviation, supination

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5
Q

Types of patients you’ll see for lateral epicondylitis?

A

Carpenters, plumbers, and maids

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6
Q

What would you do to evaluate lateral epicondylitis?

A

palpatory tenderness, ortho tests, radiographs may demonstrate calcification (25%)

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7
Q

Medial epicondylitis aka?

A

Golfer’s elbow/ little leaguer’s elbow

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8
Q

What is the etiology of medial epicondylitis?

A

Tendinopathy of wrist flexors and pronator teres at origin

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9
Q

What types of patients will you have for medial epicondylitis?

A

carpenters, plumbers, maids

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10
Q

Upon evaluation of medial epicondylitis, what will you notice?

A

Palpatory tenderness, ortho tests, radiographs may demonstrate calcification

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11
Q

What also may coexist with medial epicondylitis?

A

Ulnar neuropathy may co-exist

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12
Q

What is the treatment for Epicondylitis?

A

Initially, treatment involves reducing symptoms of pain and inflammation through rest and applying ice or cold therapy

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13
Q

What would you do after the initial phase of Epicondylitis?

A

Gradually increase the load through the elbow through exercises to a point where normal training and completion can be resumed

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14
Q

When should you use Ice and Compression?

A

In the first 72 hours post injury, you should apply the principles of P.R.I.C.E. (Protection, Rest, Ice, Compression and Elevation)

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15
Q

Apply a cold compression wrap for no more than ________ minutes as the injured tissues are very close to the skin

A

11 minutes

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16
Q

What type of protection is used in the treatment of epicondylitis?

A

Wearing a special elbow brace or support can help reduce the strain on the tendon enabling healing to take place

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17
Q

How does wearing an elbow brace work?

A

By applying compression around the upper arm which puts pressure on the injured tendon, changing the way forces transmitted through it allowing the injured tissues to rest

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18
Q

What is probably the most important part of treatment and is often difficult due to compliance issue?

A

REST

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19
Q

When should the strengthening exercises be performed?

A

As soon as pain allows and then continued until and after full fitness has been achieved

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20
Q

What are other conservative therapies for epicondylitis?

A

ultrasound, EMS, cold laser, OTC’s, NSAIDs, Steroid injections

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21
Q

What is the diaphragm referred to?

A

Phrenic nerve to supraclavicular region

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22
Q

The stomach/pancreas is refers to ?

A

Interscapular region

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23
Q

What is the spine of scapula divided unevenly by?

A

Spine of scapula

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24
Q

What does the posterior scapula provide attachment for?

A

Supraspinatus and infraspinatus

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25
Q

The spine of scap expands into ______

A

acromion

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26
Q

THe anterior scapula has what?

A

Large subscapular fossa

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27
Q

T/F, the the glenuhumeral joint is larger that the head of scap?

A

FALSE

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28
Q

What is the clavicle attached to?

A

1st rib on the underside

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29
Q

What is the AC joint reinforced by?

A
  • capsule
  • disk
  • synovial membrane
  • AC ligament - superior AC lig/inferior AC lig
  • Coracoclavicular lig - trapezoid lig/coracoid lig
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30
Q

What is the GH joint?

A

true synovial line diarthrodial joint

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31
Q

What is special about the GH joint inferiorly?

A

joint capsule is lax inferiorly to permit full elevation of the arm

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32
Q

What are the reasons for seeking care for shoulder?

A

RC pathology, C-spine dysfunction, Adhesive capsulitis, OA

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33
Q

What are the 3 types of Grades in the shoulder?

A
  • Grade 1: stretch of fibers
  • Grade 2: Tear of fibers
  • Grade 3: Avulsion from bone
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34
Q

What is the order of examination?

A
  1. Hx
  2. Inspection
  3. Palpation
  4. Instrumentation
  5. ROM
  6. Ortho
  7. Neuro
  8. Examine related areas
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35
Q

What % of shoulder issues are related to rotator cuff?

A

50-70

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36
Q

Problems of the rotator cuff occur where?

A

From trauma, attrition, and the anatomical structure of the subacromial space

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37
Q

What is Primary compression of the rotator cuff due to?

A

Reduction in size to the subacromial space

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38
Q

Primary Tensile Overload occurs when ______ ?

A

Rotator cuff resists adduction, internal rotation, anterior translation, and other forces during throwing

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39
Q

What occurs when your force exceed strength of tendon?

A

Macrotrauma

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40
Q

What are the signs of “sudden occurence” in Rotator cuff Hx?

A
  • intense pain
  • snapping sensation
  • immediate weakness in upper arm
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41
Q

Long term overuse of the rotator cuff results in what?

A
  • Pain in shoulder on abduction
  • Pain when sleep on affected side
  • Eventually, OTC’s not helpful
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42
Q

Rotator cuff injury =

A

Pain with use above eye level

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43
Q

Rotator cuff tendon, what are you palpating for?

A

“cuff tendon defect”

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44
Q

When does pain occur during rotator cuff palpation?

A

pduring active arc 90 to 120

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45
Q

Find rotator cuff factoids in _______ of 50 and older

A

25%

46
Q

_______ of RC factoids are painless?

A

2/3

47
Q

What is the main cause of pain?

A

inflammation

48
Q

Whats the ortho tests for rotator cuff?

A

codman, apley, impingement

49
Q

What should you do for partial tears of Rotator cuff?

A
  • treat inflammation
  • refrain from activity
  • adjust spine
  • adjust shoulder
50
Q

When should you introduce isometric excercises?

A

During partial tears of shoulder, begin with isometric exercises progressing to strengthening exercises to ROM exercises

51
Q

Impingement classic presentation =

A

Pain with overhead activities

52
Q

What are the structures that can be impinged at the shoulder?

A

Biceps tendon, supraspinatus tendon, subacromial bursa

53
Q

What is impingement of the shoulder due to?

A

Variant acromion, DJD of acromion, inflammation of subacromial space

54
Q

subacromial impingement =

A

pain at anterior/ biceps tendon

55
Q

supraspinatus impingement =

A

pain at greater tuberosity or under AC joint

56
Q

WHat is the way to chiropractically manage impingement syndrome?

A

Long term goal is to stabilize shoulder with progressive rehab, stretching posterior capsule

  • MANIPULATION - S to I may be helpful check cervical spine and scap. continue through subacute and symptom free stage
  • TAPING - discontinue during subacute and symptom free stage
  • EXERCISE - begin Codman exercise to stretch capsule. Continue through subacute and symptom free stage
57
Q

If patient doesn’t respond after several months of trying to treat impingement syndrome what should be done

A

MRI is ordered or planning surgical managment

58
Q

What are open chair exercises for impingment syndrome?

A

isometrics performed 20 - 30 degrees

  • during SYMPTOM FREE stage, perform plyometric exercises if patient is an athlete and uses upper body
59
Q

CMoIS (chiro managment of impingment syndrome) closed chain exercises -

A

none in acute stage

60
Q

CMoIS wall/wobble board?

A

push ups, press ups, during subacute stage

61
Q

CMoIS balance ball and wobble board push ups during:

A

symptom free stage

62
Q

PNF =

A

proprioceptive neuromuscular facilitation (PNF) training

63
Q

Begin PNF diagonal patterns during -

A

subacute stage

64
Q

Incorporate functional patterns specific to sport or occupation during ____

A

symptom free stage

65
Q

what % of acute dislocation are anterior?

A

90%

66
Q

Talk about inferior dislocations in the shoulder?

A

Inferior dislocations are rare and are often accompanied by neurovascular injury

67
Q

How do you fall to create acute dislocation?

A

Fall with external rotation or abduction force is usual cause

68
Q

when would you see “cradle arm”?

A

acute dislocation

69
Q

What are the 3 main bullets in regards to acute dislocation of the shoulder?

A
  • Myospasm sets in quickly making reduction difficult
  • Reduction should be performed promptly (often before radiographs are obtained)
  • Souza suggests the MILCH MANEUVER IS EASIEST
70
Q

What is important about bicipital tendinitis?

A
  • Every attempt must be made to identify contributing factors, e.g. , a poorly stabilized scapula, hypomobile C-spine, hypomobile T-spine, or altered muscle recruitment
71
Q

How would you manage bicipital tendinits?

A
  • mild manipulation
  • C - spine manipulation
  • exercise
  • PNF
72
Q

Name all the types of bicipital tendinits (usually from secondary condition) ***** :

A
  1. Type A: secondary to impingement syndrome or RC disease
  2. Type B: subluxation of the biceps tendon
  3. Type C: attrition tendinitis
73
Q

How would you rule out for bicipital tendinitis?

A

Every attempt must be made to identify contributing factors, a poorly stabilized scapula, hypomobile C-Spine, Hypomobile T-Spine, or altered muscle recruitment

74
Q

Most common peripheral nerve entrapment is due to:

A
  • overuse
  • hormonal
  • RA
  • genetic
  • diabetes
  • others
75
Q

Dont confuse CTS with _____

A

pronator teres syndrome or brachial neuritis

76
Q

What will the patient present with in CTS?

A
  • Pain and parasthesia at median n. distribution
  • Pain worse in AM
  • Weakness with grip
77
Q

What is the etiology of CTS?

A
  • Usually Hx of prolonged wrist use in full flexion or extension
  • Pts deficient in B vitamins are predisposed
  • Obesity increases incidence of CTS
78
Q

What is the #2 WC injury?

A

CTS

79
Q

Who is most likely to develop CTS?

A

Women in 40s and 50s 4 x’s more likely to develop

80
Q

After age 50, men and women’s chance of CTS…..

A

equals eachother

81
Q

SS of choice for CTS is _____

A

EMG/NCS

82
Q

If CTS condition progresses to -______, surgery is likely

A

atrophy

83
Q

US (for CTS) -

A

after 7 weeks showed significant improvement

84
Q

What should be given to CTS patients?

A

B6

85
Q

When does DeQuervain’s disease occur?

A

As a result of trauma to synovium or sheath

86
Q

Dequervain’s disease, pt. has pain _____

A

gripping, ulnar deviation or repetitve use of thumb

87
Q

Underwater ultrasound is good for what?

A

DeQuervain’s disease (addresses inflammation)

88
Q

What does a splint for the wrist address?

A

Inactivity in DeQuervain’s disease management

89
Q

When should you refer out for DeQuervain’s disease?

A

Failure to respond in 3-4 weeks results in referral to ortho surgeon/hand specialist

90
Q

What is a bulge?

A

Any abnormality of annular fibers; apparent in 30% of population; 70% have 3 or more ; asymptomatic

91
Q

What is a protrusion?

A

Nucleus has slipped through and tears in annulus; there is pressure on thecal sac and/or nerve root; nucleus is contiguous

92
Q

What is a prolapse?

A

Nucleus is not contiguous; mother and daughter nucleus; pressure on thecal sac and/or nerve root

93
Q

What is a sequestation?

A

Nucleus held in place only by posterior longitudinal ligament; pressure on thecal sac and/or nerve root

94
Q

When does the cervical spine nucleus dehydrate?

A

by age 40-45

95
Q

Patient presents with ______ during cervical disc herniation

A

Pain and parasthesia in upper extremity

96
Q

Cervical disc herniation, yu can pinpoint dermatomal pattern, and patient will present with:

A

Arm above head (Bakody’s sign)

97
Q

Criteria for determining disc herniation:

A

3 or 4 must be present

  1. Primary complaint is arm pain (may have neck pain)
  2. Pain follows a specific dermatomal pattern
  3. Neural stretch tests are positive
  4. 2 of 4 neuron positive
98
Q

Order MRI for cervical if ______

A

no improvement after 3-4 weeks

99
Q

Thoracic outlet syndrome affects:

A
  • 1st rib
  • scalenes
  • atherosclerosis
  • pancost tumor
100
Q

What does the patient present with during TOS (thoracic outlet syndrome)

A
  • Pain and parasthesia at ulnar distribution of hand
  • awake at night
  • women more common
101
Q

What is foraminal encroachment?

A

Degeneration in the spinal column has caused obstruction in the foramina

102
Q

What is the etiology for foraminal encroachment?

A
  • Herniated discs
  • loss of disc height due to DDD
  • Loss of vertebral stability due to facet disease
  • Spondylolisthesis
  • Bone spurs caused by osteoarthritis
103
Q

What are the AKA’s for foraminal encroachment?

A

Foraminal stenosis; spinal foraminal stenosis

USUALLY UNILATERAL

104
Q

What are the symptoms of foraminal encroachment?

A
  1. radiating pain
  2. tingling
  3. numbness
  4. muscle weakness
  5. local spinal pain
105
Q

Foraminal Encroachment from Souza:

A
  • Souza - “Manipulation of the neck is the treatment of choice. If unsuccessful, cervical traction may be of benefit. Any myofascial contribution may be addressed with stretch-and –spray techniques, trigger point therapy or myofascial release.
  • Because the foramina are relatively isolated within the spinal column, many of the typical conservative treatment methods used for neck and back pain — including exercise, stretching and physical therapy — might not be as effective.
106
Q

What is the dural sleeve?

A

When the spinal nerve leaves the vertebral canal via an intervertebral foramen, 2 layers of the spinal meninges, the arachnoid and the dura invaginate the nerve to form a dural sleeve of connective tissue, which is the epineurium

107
Q

radiating pain:

A

pain emitting away from the source

108
Q

radicular pain:

A

pain radiating from the nerve root

109
Q

radiculopathy:

A

pathology of the nerve root

110
Q

radiculitis:

A

inflammation of the nerve root

6 ORTHO (16 decks)

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