Lectures 1-3 Flashcards
1
Q
Palpation - explain TART acronym
A
Tissue texture change
Asymmetry of landmarks
Restriction of motion
Tenderness on palpation
2
Q
define isometric
A
generate force without changing length of muscle
3
Q
define isotonic
A
generate force by changing length of muscle
4
Q
define concentric
A
type of isotonic contraction
shorten in response to greater opposing force
5
Q
define eccentric
A
type of isotonic contraction
elongate in response to greater opposing force
6
Q
describe active ROM
A
contractile, nervous and inert tissues moved
if AROM full, apply overpressure for end feel
negates need for passive
7
Q
describe passive ROM and what differences between AROM and PROM may be caused by
A
joint is put through its ROM by examiner while patient is relaxed
assess hypo/hypermobility
often one direction of joint is hypo mobile with another is hyper
differences from AROM may be caused by spasm, mm def, neuro deficit, contractures or pain
8
Q
What is a “capsular pattern”?
A
result of a total joint reaction, with mm spasm, capsular contraction, and generalized osteophyte formation being possible mechanisms at fault
only joints controlled by mm have capsular pattern. Joints such as sacroiliac and distal tibiofibular do not exhibit this pattern.
9
Q
what does resisted ROM help you assess?
A
- problems in contractile tissues
- testing always done with patient in neutral position
- both AROM and PROM demonstrate symptoms if contractile tissue is affected
- PROM is usually normal, full and pain free with possible pain at end of ROM when contractile or nervous tissue is stretched
10
Q
What does a grade of 3 on muscle strength testing indicate?
A
Fair
complete ROM against gravity with no resistance
11
Q
What does a grade of 5 on muscle strength testing indicate?
A
Normal
complete ROM against gravity with full resistance
12
Q
What does a grade of 1 on muscle strength testing indicate?
A
Trace
evidence of slight muscular contraction; no joint motion evident
13
Q
What does a grade of 4 on muscle strength testing indicate?
A
Good
complete ROM against gravity with some resistance
14
Q
What does a grade of 2 on muscle strength testing indicate?
A
Poor
complete ROM with some assistance and gravity eliminated
15
Q
What does a grade of 0 on muscle strength testing indicate?
A
Zero
No evidence of muscle contraction (let alone joint motion!)
16
Q
What would a contractile tissue pattern of “strong and pain-free” indicate?
A
no lesion to contractile tissue being tested
17
Q
What would a contractile tissue pattern of “strong and painful” indicate?
A
local lesion of muscle or tendon
1st or 2nd degree mm strain
18
Q
What would a contractile tissue pattern of “weak and painful” indicate?
A
severe lesion around the joint (e.g. fracture)
weakness d/t reflex inhibition of mm around joint secondary to pain
19
Q
What would a contractile tissue pattern of “weak and pain-free” indicate?
A
rupture of a muscle (3rd degree strain)
rupture of the muscle’s tendon or peripheral nerve supplying that muscle
suspect near involvement or tendon rupture first!
20
Q
What is the spinal level of Biceps DTR?
A
C5
21
Q
What is the spinal level of brachioradialis DTR?
A
C6
22
Q
What is the spinal level of achilles DTR?
A
S1
23
Q
What is the spinal level of patellar DTR?
A
L4
24
Q
What is the spinal level of triceps DTR?
A
C7
25
What grade would you assign to a "normal" DTR?
2+
26
What grade would you assign to a "hyperactive with clonus" DTR?
4+
27
What grade would you assign to a "absent" DTR?
0
28
What grade would you assign to a "hypoactive" DTR?
1+
29
What grade would you assign to a "hyperactive without clonus" DTR?
3+
30
Upper Limb Dermatomes
| C3 Spinal Level corresponds to?
supraclavicular fossa
31
Upper Limb Dermatomes
| T2 Spinal Level corresponds to?
medial upper arm and 2nd rib
32
Upper Limb Dermatomes
| C4 Spinal Level corresponds to?
lateral upper humerus
33
Upper Limb Dermatomes
| T1 Spinal Level corresponds to?
medial arm - medial arm near elbow
34
Upper Limb Dermatomes
| C5 Spinal Level corresponds to?
lateral mid humerus
35
Upper Limb Dermatomes
| C8 Spinal Level corresponds to?
ring and little finger, medial forearm
36
Upper Limb Dermatomes
| C6 Spinal Level corresponds to?
lateral arm, thumb, index, and half middle finger (dorsal web b/t thumb and index)
37
Upper Limb Dermatomes
| C7 Spinal Level corresponds to?
middle finger
38
Lower Limb Dermatomes
| L1 Spinal Level corresponds to?
groin and suprapubic area
39
Lower Limb Dermatomes
| S3,4,5 Spinal Level corresponds to?
bulls eye around anus
40
Lower Limb Dermatomes
| L2 Spinal Level corresponds to?
anterior thigh
41
Lower Limb Dermatomes
| S2 Spinal Level corresponds to?
plantar surface of heel
42
Lower Limb Dermatomes
| L3 Spinal Level corresponds to?
lower anterior/medial thigh and knee
43
Lower Limb Dermatomes
| S1 Spinal Level corresponds to?
lateral foot
44
Lower Limb Dermatomes
| L4 Spinal Level corresponds to?
lower leg and medial foot
45
Lower Limb Dermatomes
| L5 Spinal Level corresponds to?
lower leg and dorsum of foot
46
elbow flexion tests which myotome & corresponding muscle?
C6
| biceps
47
neck side flexion tests which myotome & corresponding muscle?
C3
| scalenes
48
pull patients adducted fingers apart tests which myotome & corresponding muscle?
```
T2
interossei (PAD)
```
49
shoulder abduction tests which myotome & corresponding muscle?
C5
| deltoid
50
shoulder elevation tests which myotome & corresponding muscle?
C4
| trapezius
51
elbow extension (in arm flexion and elbow flexion) tests which myotome & corresponding muscle?
C7
| triceps
52
thumb extension tests which myotome & corresponding muscle?
C8
| thumb extensors
53
squeeze patients abducted fingers together tests which myotome & corresponding muscle?
```
T1
interossei (DAB)
```
54
knee flexion tests which myotome & corresponding muscle?
S2
| hamstrings
55
plantar flexion in standing tests which myotome & corresponding muscle?
S1
| gastrocnemius
56
hip flexion tests which myotome & corresponding muscle?
L2
| iliopsoas
57
knee extension in prone tests which myotome & corresponding muscle?
L3
| quadriceps
58
dorsiflexion and inversion tests which myotome & corresponding muscle?
L4
| tibialis anterior
59
dorsiflexion of big toe tests which myotome & corresponding muscle?
L5
| hallucis longus
60
explain RICEE acronym for acute healing
```
Rest
Ice
Compression
Elevation
Education
```
61
what are the 4 processes that occur simultaneously to achieve coalescence and closure of injured area?
epithelialization
collagen production
wound contracture
neovascularization
62
what are your 2 goals in the subacute phase of healing?
- continue to decrease effects of inflammation, pain and spasming
- works towards returning ROM, and muscle strength
63
what is the difference between an active trigger point and a latent trigger point?
Active: painful at rest and with movement of muscle containing it; prevents muscle from fully lengthening; when muscle at rest there is no spasm
Latent: produces pain only on palpation not at rest, all other characteristics of active trigger points apply
Latent points can be reverted to active by overuse, overstitching, chilling, leaving muscle in shortened position for extended period of time (e.g. overnight)
64
"A local ______ response is a reliable indication of the correct position for needling."
twitch
65
what are the 3 types of scar tissue?
contracture
hypertrophic scarring
keloid
66
which type of scarring is this?
- dermal scar tissue that extends beyond the boundaries of the original wound in a tumour like growth
- may grow for several years
keloid
67
which type of scarring is this?
| "overgrowth of dermal tissue that remains within the boundaries of the wound"
hypertrophic scarring
68
what type of scarring is this?
| "shortening of connective tissue supporting structures over or around a joint."
contracture
| adhesion, fibrotic adhesions, irreversible contracture
69
what is an irreversible contracture
occurs when fibrotic tissue or bone replaces muscle and connective tissue
70
what is a fibrotic adhesion
occurs with ongoing chronic inflammation and can cause moderate to severe restrictions in ROM which are difficult to eradicate
71
what is an adhesion
occurs with injury, acute inflammatory process or with reduced motion at a joint
cross-links form among the collagen fibres within and between the skin, muscles, tendons, groups of muscles, and joint capsules, reducing the range of motion.
72
describe a contusion
crush injury to a muscle
damage to mm fibres and resultant bleeding into subcutaneous tissue and skin
possible for periosteum to be contused
73
what is myositis ossificans
occasional complication of contusion
blood within muscle calcifies
74
why are applications of heat or contrast hydrotherapy contraindicated in the first 7-10 of healing for a contusion?
risk of rebleeding
75
ultrasound is what kind of energy?
mechanical (vs electrical)
76
ultrasound head should ideally be held perpendicular. angle must be less than ___ degrees or there will be no penetration of tissue.
15
77
continuous ultrasound: will give you thermal or non thermal effect?
thermal
78
pulsed ultrasound: will give you thermal or non thermal effect?
non thermal
79
what are characteristics of tissues with high absorption of ultrasound?
high collagen content - tendons, ligaments, joint capsules, fascia
80
what are characteristics of tissues with low absorption of ultrasound?
high water content
81
what is ultrasound penetration like for cartilage and bone?
upper end of absorption scale but wave reflection occurs due to dense content of bone
if intensity too high, waves will penetrate periosteum, strike deeper bone, and reflect back of periosteum again causing aching sensation
82
what is ultrasound penetration like for adipose tissue?
very little transmission
83
what is ultrasound penetration like for connective tissue?
very good absorption, can be used to treat scar tissue (follow with stretch)
84
what is ultrasound penetration like for nervous tissue?
- well absorbed
- caution directly over spinal cord in cases of spina bifida or laminectomy
- in cases of edema causing pressure on nerve roots, ultra sound can reduce edema by increasing permeability of phagocytes and increasing metabolite removal
85
what is ultrasound penetration like for muscles?
greater absorption at tendons
| increases elasticity when followed by stretch
86
__ mhz freq u/s may be used to heat tissues up to 5cm deep
1 mhz
87
__ mhz frequency may be used when the goal is to heat tissues only 1-2cm deep
3 mhz
88
when using 3mhz u/s, the intensity should be how many times lower than the 1mhz u/s to heat the tissues to a similar temperature?
3-4 times lower
89
true or false -
| the temperature increase within the u/s field is generally uniform
false
90
true or false -
| the highest temperature is produced at soft tissue-bone interfaces
true
91
in regards to the non thermal effects of ultrasound, what is cavitation?
formations of gas filled voids within tissues and body fluids
92
what is the definition of the "duty cycle" on an u/s machine?
the proportion of total treatment time that the u/s is on, expressed as a % or ratio (e.g., 20% duty cycle)
93
regarding tissue repair, what effect does u/s have on the acute phase?
stimulates mast cells, platelets and white cells and phagocytic role of macrophages
94
what are the primary targets of u/s in the sub-acute phase of tissue repair?
fibroblasts, endothelial cells, myofibroblasts
95
what is phonophoresis?
application of u/s with a topical drug preparation as the U/S conduction medium
96
what are the advantages of phonophoresis?
larger area than injection
first pass metabolism
avoids gastric irritation
higher initial drug concentrations at site of injury
97
what is the mechanism of phonophoresis?
increases permeability of stratum corneum
98
what is phonophoresis commonly used for?
bursitis and tendonitis (corticosteroids & NSAIDs)
99
contraindications to u/s?
```
malignant tumor
pregnancy and menstruation
laminectomy
joint cement or plastic components
pacemaker
eyes
thrombophlebitis - could dislodge clot
reproductive organs
```
100
Electrical Current:
| Explain a cathode
red
connected to -ve pole of battery
+ve ions move towards cathode (cations)
101
Electrical Current:
| Explain an anode
black
connected to +ve pole of battery
-ve ions move towards anode (anions)
102
you will elicit a sensory-level response of electrical current at higher or lower frequencies?
higher
103
you will elicit a motor-level response of electrical current at higher or lower frequencies?
lower
104
regarding electrodes of unequal size, will the charge by unequal or equal in both?
equal
charge density and electrophysiological response will be greater in smaller one
105
if you're using electrical current, how does the distance between electrodes affect current density?
the closer the electrodes, the more superficially the current will flow and the current density increases at the skin between the electrodes
if too close, the current may arc directly from one electrode to the other without reaching the tissues
recommend: no closer together than 1/2 the diameter of the electrode
the farther apart the electrodes, the deeper the stimulation can penetrate
106
what does TENS stand for
transcutaneous electrical neuromuscular stimulation
107
what is the gate-control theory of pain control in relation to TENS?
TENS increases stimulation of large diameter fibres
108
what is the opiate-mediated theory of pain control in relation to TENS?
endorphins released in the body and bind to specific receptor sites in the central and peripheral nervous systems to decrease pain perception and nociceptive responses
109
sensory level vs motor level stimulation - which one is though tot operate via gate control mechanism , and which is thought to work via opiate-mediated mechanism?
sensory: gate control
motor: opiate-mediated
110
what does MENS stand for
microcurrent electrical nerve stimulation
111
how is MENS different from other electrical current?
delivers current at intensities below threshold for nerve depolarization
intensity limited to 1000 micro amps or less (standard low-voltage equipment can be increased into milli amp range)
applications intended to mimic normal electrical field created during injury healing process (signal the tissue to grow in response to stress)
112
describe IFC - interferential current
produced by interfering two waveforms that differ in frequency
delivered to separate pairs of electrodes, through separate channels within same machine
electrode pairs are placed on skin so that the circuits and currents interfere
medium frequency
113
3 effects of interferential current?
improve circulation
edema control - promote lymphatic return by muscle pumping
wound healing
114
what the heck is iontophoresis
transcutaneous delivery of ions into body for therapeutic purposes using electrical current
alternative to oral or parenteral methods of drug delivery
need a referral and prescription for medication from a practitioner licensed to prescribe it
