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Physical Medicine > Lectures 1-3 > Flashcards

Lectures 1-3 Flashcards

1
Q

Palpation - explain TART acronym

A

Tissue texture change
Asymmetry of landmarks
Restriction of motion
Tenderness on palpation

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2
Q

define isometric

A

generate force without changing length of muscle

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3
Q

define isotonic

A

generate force by changing length of muscle

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4
Q

define concentric

A

type of isotonic contraction

shorten in response to greater opposing force

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5
Q

define eccentric

A

type of isotonic contraction

elongate in response to greater opposing force

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6
Q

describe active ROM

A

contractile, nervous and inert tissues moved

if AROM full, apply overpressure for end feel
negates need for passive

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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

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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.

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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
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10
Q

What does a grade of 3 on muscle strength testing indicate?

A

Fair

complete ROM against gravity with no resistance

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11
Q

What does a grade of 5 on muscle strength testing indicate?

A

Normal

complete ROM against gravity with full resistance

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12
Q

What does a grade of 1 on muscle strength testing indicate?

A

Trace

evidence of slight muscular contraction; no joint motion evident

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13
Q

What does a grade of 4 on muscle strength testing indicate?

A

Good

complete ROM against gravity with some resistance

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14
Q

What does a grade of 2 on muscle strength testing indicate?

A

Poor

complete ROM with some assistance and gravity eliminated

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15
Q

What does a grade of 0 on muscle strength testing indicate?

A

Zero

No evidence of muscle contraction (let alone joint motion!)

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16
Q

What would a contractile tissue pattern of “strong and pain-free” indicate?

A

no lesion to contractile tissue being tested

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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

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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

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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!

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20
Q

What is the spinal level of Biceps DTR?

A

C5

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21
Q

What is the spinal level of brachioradialis DTR?

A

C6

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22
Q

What is the spinal level of achilles DTR?

A

S1

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23
Q

What is the spinal level of patellar DTR?

A

L4

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24
Q

What is the spinal level of triceps DTR?

A

C7

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25
Q

What grade would you assign to a “normal” DTR?

A

2+

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26
Q

What grade would you assign to a “hyperactive with clonus” DTR?

A

4+

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27
Q

What grade would you assign to a “absent” DTR?

A

0

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28
Q

What grade would you assign to a “hypoactive” DTR?

A

1+

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29
Q

What grade would you assign to a “hyperactive without clonus” DTR?

A

3+

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30
Q

Upper Limb Dermatomes

C3 Spinal Level corresponds to?

A

supraclavicular fossa

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31
Q

Upper Limb Dermatomes

T2 Spinal Level corresponds to?

A

medial upper arm and 2nd rib

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32
Q

Upper Limb Dermatomes

C4 Spinal Level corresponds to?

A

lateral upper humerus

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33
Q

Upper Limb Dermatomes

T1 Spinal Level corresponds to?

A

medial arm - medial arm near elbow

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34
Q

Upper Limb Dermatomes

C5 Spinal Level corresponds to?

A

lateral mid humerus

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35
Q

Upper Limb Dermatomes

C8 Spinal Level corresponds to?

A

ring and little finger, medial forearm

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36
Q

Upper Limb Dermatomes

C6 Spinal Level corresponds to?

A

lateral arm, thumb, index, and half middle finger (dorsal web b/t thumb and index)

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37
Q

Upper Limb Dermatomes

C7 Spinal Level corresponds to?

A

middle finger

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38
Q

Lower Limb Dermatomes

L1 Spinal Level corresponds to?

A

groin and suprapubic area

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39
Q

Lower Limb Dermatomes

S3,4,5 Spinal Level corresponds to?

A

bulls eye around anus

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40
Q

Lower Limb Dermatomes

L2 Spinal Level corresponds to?

A

anterior thigh

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41
Q

Lower Limb Dermatomes

S2 Spinal Level corresponds to?

A

plantar surface of heel

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42
Q

Lower Limb Dermatomes

L3 Spinal Level corresponds to?

A

lower anterior/medial thigh and knee

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43
Q

Lower Limb Dermatomes

S1 Spinal Level corresponds to?

A

lateral foot

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44
Q

Lower Limb Dermatomes

L4 Spinal Level corresponds to?

A

lower leg and medial foot

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45
Q

Lower Limb Dermatomes

L5 Spinal Level corresponds to?

A

lower leg and dorsum of foot

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46
Q

elbow flexion tests which myotome & corresponding muscle?

A

C6

biceps

47
Q

neck side flexion tests which myotome & corresponding muscle?

A

C3

scalenes

48
Q

pull patients adducted fingers apart tests which myotome & corresponding muscle?

A 
T2
interossei (PAD)
49
Q

shoulder abduction tests which myotome & corresponding muscle?

A

C5

deltoid

50
Q

shoulder elevation tests which myotome & corresponding muscle?

A

C4

trapezius

51
Q

elbow extension (in arm flexion and elbow flexion) tests which myotome & corresponding muscle?

A

C7

triceps

52
Q

thumb extension tests which myotome & corresponding muscle?

A

C8

thumb extensors

53
Q

squeeze patients abducted fingers together tests which myotome & corresponding muscle?

A 
T1
interossei (DAB)
54
Q

knee flexion tests which myotome & corresponding muscle?

A

S2

hamstrings

55
Q

plantar flexion in standing tests which myotome & corresponding muscle?

A

S1

gastrocnemius

56
Q

hip flexion tests which myotome & corresponding muscle?

A

L2

iliopsoas

57
Q

knee extension in prone tests which myotome & corresponding muscle?

A

L3

quadriceps

58
Q

dorsiflexion and inversion tests which myotome & corresponding muscle?

A

L4

tibialis anterior

59
Q

dorsiflexion of big toe tests which myotome & corresponding muscle?

A

L5

hallucis longus

60
Q

explain RICEE acronym for acute healing

A 
Rest
Ice
Compression
Elevation
Education
61
Q

what are the 4 processes that occur simultaneously to achieve coalescence and closure of injured area?

A

epithelialization
collagen production
wound contracture
neovascularization

62
Q

what are your 2 goals in the subacute phase of healing?

A
  • continue to decrease effects of inflammation, pain and spasming
  • works towards returning ROM, and muscle strength
63
Q

what is the difference between an active trigger point and a latent trigger point?

A

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
Q

“A local ______ response is a reliable indication of the correct position for needling.”

A

twitch

65
Q

what are the 3 types of scar tissue?

A

contracture
hypertrophic scarring
keloid

66
Q

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
A

keloid

67
Q

which type of scarring is this?

“overgrowth of dermal tissue that remains within the boundaries of the wound”

A

hypertrophic scarring

68
Q

what type of scarring is this?

“shortening of connective tissue supporting structures over or around a joint.”

A

contracture

adhesion, fibrotic adhesions, irreversible contracture

69
Q

what is an irreversible contracture

A

occurs when fibrotic tissue or bone replaces muscle and connective tissue

70
Q

what is a fibrotic adhesion

A

occurs with ongoing chronic inflammation and can cause moderate to severe restrictions in ROM which are difficult to eradicate

71
Q

what is an adhesion

A

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
Q

describe a contusion

A

crush injury to a muscle

damage to mm fibres and resultant bleeding into subcutaneous tissue and skin

possible for periosteum to be contused

73
Q

what is myositis ossificans

A

occasional complication of contusion

blood within muscle calcifies

74
Q

why are applications of heat or contrast hydrotherapy contraindicated in the first 7-10 of healing for a contusion?

A

risk of rebleeding

75
Q

ultrasound is what kind of energy?

A

mechanical (vs electrical)

76
Q

ultrasound head should ideally be held perpendicular. angle must be less than ___ degrees or there will be no penetration of tissue.

A

15

77
Q

continuous ultrasound: will give you thermal or non thermal effect?

A

thermal

78
Q

pulsed ultrasound: will give you thermal or non thermal effect?

A

non thermal

79
Q

what are characteristics of tissues with high absorption of ultrasound?

A

high collagen content - tendons, ligaments, joint capsules, fascia

80
Q

what are characteristics of tissues with low absorption of ultrasound?

A

high water content

81
Q

what is ultrasound penetration like for cartilage and bone?

A

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
Q

what is ultrasound penetration like for adipose tissue?

A

very little transmission

83
Q

what is ultrasound penetration like for connective tissue?

A

very good absorption, can be used to treat scar tissue (follow with stretch)

84
Q

what is ultrasound penetration like for nervous tissue?

A
  • 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
Q

what is ultrasound penetration like for muscles?

A

greater absorption at tendons

increases elasticity when followed by stretch

86
Q

__ mhz freq u/s may be used to heat tissues up to 5cm deep

A

1 mhz

87
Q

__ mhz frequency may be used when the goal is to heat tissues only 1-2cm deep

A

3 mhz

88
Q

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?

A

3-4 times lower

89
Q

true or false -

the temperature increase within the u/s field is generally uniform

A

false

90
Q

true or false -

the highest temperature is produced at soft tissue-bone interfaces

A

true

91
Q

in regards to the non thermal effects of ultrasound, what is cavitation?

A

formations of gas filled voids within tissues and body fluids

92
Q

what is the definition of the “duty cycle” on an u/s machine?

A

the proportion of total treatment time that the u/s is on, expressed as a % or ratio (e.g., 20% duty cycle)

93
Q

regarding tissue repair, what effect does u/s have on the acute phase?

A

stimulates mast cells, platelets and white cells and phagocytic role of macrophages

94
Q

what are the primary targets of u/s in the sub-acute phase of tissue repair?

A

fibroblasts, endothelial cells, myofibroblasts

95
Q

what is phonophoresis?

A

application of u/s with a topical drug preparation as the U/S conduction medium

96
Q

what are the advantages of phonophoresis?

A

larger area than injection
first pass metabolism
avoids gastric irritation
higher initial drug concentrations at site of injury

97
Q

what is the mechanism of phonophoresis?

A

increases permeability of stratum corneum

98
Q

what is phonophoresis commonly used for?

A

bursitis and tendonitis (corticosteroids & NSAIDs)

99
Q

contraindications to u/s?

A 
malignant tumor
pregnancy and menstruation
laminectomy
joint cement or plastic components
pacemaker
eyes
thrombophlebitis - could dislodge clot
reproductive organs
100
Q

Electrical Current:

Explain a cathode

A

red
connected to -ve pole of battery
+ve ions move towards cathode (cations)

101
Q

Electrical Current:

Explain an anode

A

black
connected to +ve pole of battery
-ve ions move towards anode (anions)

102
Q

you will elicit a sensory-level response of electrical current at higher or lower frequencies?

A

higher

103
Q

you will elicit a motor-level response of electrical current at higher or lower frequencies?

A

lower

104
Q

regarding electrodes of unequal size, will the charge by unequal or equal in both?

A

equal

charge density and electrophysiological response will be greater in smaller one

105
Q

if you’re using electrical current, how does the distance between electrodes affect current density?

A

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
Q

what does TENS stand for

A

transcutaneous electrical neuromuscular stimulation

107
Q

what is the gate-control theory of pain control in relation to TENS?

A

TENS increases stimulation of large diameter fibres

108
Q

what is the opiate-mediated theory of pain control in relation to TENS?

A

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
Q

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?

A

sensory: gate control
motor: opiate-mediated

110
Q

what does MENS stand for

A

microcurrent electrical nerve stimulation

111
Q

how is MENS different from other electrical current?

A

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
Q

describe IFC - interferential current

A

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
Q

3 effects of interferential current?

A

improve circulation
edema control - promote lymphatic return by muscle pumping
wound healing

114
Q

what the heck is iontophoresis

A

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

Physical Medicine (1 decks)

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