lectures Flashcards
ABCs of radiographic evaluation
A: alignment
B: bone density
C: cartilage spaces
S: soft tissues
what are Clinical-based/performance-based (clinician performs) vs. patient centered/self-report
outcome measures
if a response is formated with yes or no questions , asking if you are independent or dependent , able to do or unable to do something this is an example of what format
nominal measures
what response format is Points awarded based onf self report , outcome is measured in rank order
Ex: describe ability to take shower: no difficulty (0), some (1), etc, patient satisfaction
ordinal
what is the difference between interval and ration
interval is real numbers and ratio has to have a 0
if the test does the same thing every time then it is what
reliable
what is face validity
measures what it claims to
what validity is Subcomponents adequately cover entire construct
content validity
what is the difference between ceiling and floor effect
ceiling is to easy and floor is to hard
Minimal clinically important difference: smallest diff in measured variable that signifies an important diff in pt’s condition .. how much does the score change by
10
what Measures overall disability or quality of life
Global disability/QoL
Health Status Questionnaire/SF-36
SF-12
Sickness Impact Profile
Patient-Specific Functional Scale
Global Rating of Change
Functional Status Questionnaire
are all examples of what
Global disability/QoL
what does ADL measure
function of patient
Barthel Index
Katz ADL
Lawton Brody Instrumental Activities of Daily Living
Functional Status Index
OPTIMAL (Outpatient PT Improvement in Movement Assessment Log)
are examples of what
ADL measures
*Roland Morris LBP Disability Questionnaire
*Neck Disability Index
*Oswestry Disability Index
are examples of what
spine specific measures
*Disabilities of the Arm, Shoulder, & Hand (DASH)/quick DASH
*Upper Extremity Functional Scale (UEFS)
are examples of what
Global upper quarter:
*6 min walk test
*UQ test
are examples of what test
Aerobic capacity/endurance
*Dynamic gait index
*TUG
*Functional gait assessment
are example of what perfromance based outcome measures ?
gait
*Tinetti
*Star excursion
*Y-balance
are examples of what performance based outcome
balance
how is gait speed determined
10 meter walk test
Household ambulator:
Limited community ambulator:
Community ambulator:
Household ambulator: <0.4 m/s
Limited community ambulator: 0.4-<0.8 m/s
Community ambulator: >=0.8 m/s
Crude/coarse touch, pain, temp, sharp/dull are all examples of what tract when testing
anterolateral
Light touch, fine touch, vibration, position sense, protective sensation… are all examples of what tract when test neurosensory
posterior
T/F: Rare to have complete loss of sensation bc of peripheral nerve overlap
T
will you have weakness or paralysis when testing for myotomes
weakness
Rapid alternating (forearm sup vs. pron) is part of what coordination test and what is it testing
upper and dysdiadochokinesia
Finger opposition (rapid touch pad of thumb to each other finger) is apart of which coordination testing
upper
Finger to nose eyes closed (alternate nose touches from each arm) and Finger to nose eyes open (alternate nose touches from each arm) is apart of which coordination test and what is it testing for
upper and dysmetria
Rapid alternating (ankle DF/PF) is apart of which coordination testing and what is it testing for
lower and dysdiadochokinesia
what is lack of control of body movements defined as
Ataxia
define dysmetria
error in trajectory
define Dysdiadochokinesia
cant do rapid alternating movements
what test should be performed for UMNL for pathologic relexes
clonus
babinski
hoffmans
pronator drift
shimizu relfex
what is cervical myelopathy
sc is being squeezed in the central region
will have UE , LE and trunk issues
if a patient presents with hyporeflexia , muscle weakness, muscles atrophy, or sensory changes along dermatome or peripheral n distribution then what do they have
LMNL
what is a positive test of clonus
Beats observed into PF
what is positive testing for pronator drift
1 or both arms drop out of flexion &/or sup
*More severe is there’s elbow or finger flexion
*If R arm drops → L lesion (bc this is for UMNL)
what is a positive test for babinski
great toe extends & toes splay or if pt withdraws LE
*Normal in infants
*Suspect opposite side UMNL
what is a positive test for hoffmans
thumb flexes & adducts &/or 2nd digit flexes
Suspect opposite side UMNL
what is the positive finding for shimizu testing
scap elevation or humeral abduction
Lesion @ craniocervical junction or higher cervical levels
what comes first in testing … myotomes or reflexes
myotomes
what comes first in testing … MMT or ROM
ROM
what is done last in testing
MMT
what is inability to recognize familiar objects by touch
Asterognosis
what is the inability to correctly locate sensation
Atopognosis
what is the inability to distinguish b/t diff weights
Abaragnosis:
what is defined as paralysis of lower half of 1 side of body
Hemiparaplegia:
Hemiparesis vs. hemiplegia:
paresis is weakness, plegia is paralysis
what is partial paralysis of LE
Paraparesis:
NDI
ODI
STaRT back tool
Cervical deep flexor muscle endurance test
5x StS
Prone plank endurance
Side plank endurance
Sorensen endurance (functional lumbar index)
all of these are outcome measures for what
the spine
what is the difference between lordosis and kyphosis
lordosis is an anterior curve of C and L
kyphosis is a posterior curve of S and T
Where are the common spinal areas for hinge points?
Transition points (b/t diff spinal levels)
Which areas of the spine are most common for disc pathologies?
Cervical C6-C7
Lumbar L4-L5
Foraminal stenosis:
MOI:
Later in life
Prior injuries & repetitive motions
*Pain relieved w/ foraminal opening & increased w/ closing
*Unilateral radiating symptoms
these are common presentation for what pathology
Foraminal stenosis:
Foraminal stenosis:
subjective questions to ask?
Pain down arm
Arm weakness
24 hour pain behavior
Imaging
outcome measures for foraminal stenosis
NDI
Grip strength dynamometer
Cx flexor endurance test
MOI for Central stenosis:
*Same as foraminal stenosis
*Can be anterior from disc pathology or posterior from ligamentum flavum hypertrophy
what is the presentation for central stenosis
bilateral
anterior: motor and some sesnory
posterior: sensory
outcome measures for central stenosis
NDI
Hand grip dynamometer
Cx flexor muscle endurance test
Cervicogenic headache is what type of dysfunction
upper cervical spine start at the neck and going to the head
Prolonged flexion or whiplash and Usually central protrusion/herniation are MOI for what
disc pathology C spine
presentation for disc path C spine is what
Bilateral
Motor symptoms first then some sensory but can be all sensory
Sensitive to weightbearing
if someone presents with Depends on movable levels,
Muscle spasm/tightness, Disc-like symptoms in lower cervical spine, and Brain stem type injury in upper cervical spine what are they presenting with
whiplash
Nucleus pulposis dehydrates & becomes less distinct w/ annulus → disc more convex and lost of overall heigh is with what pathology
lumber DDD
disc pathology for L spine presents w what MOI
typically flexion and rotation
Hypertrophy of lig flavum & compression from disc,
Motor &/or sensory ,
Symptoms can come on after short period of time walking/standing & relieved w/ sitting in flexed/slouched position describe what pathology
lumbar spinal stenosis
what are functional outcomes for lumbar spinal stenosis
6 MWT
Timed treadmill test
Treadmill incline test
what is the Lumbopelvic rhythm
lumbosacral flexion > anterior pelvic tilt → hip flexion (reverses to stand up)
what is the presentation of someone with disc path in L spine
Unilateral
Motor & sensory
(+) reproduction w/ valsalva/weightbearing
MOI of what pathology presents with
Young females (esp preg)
Unilateral activities or pts w/ pelvic obliquities
Macrotrauma aggravates
SIJ hypermobility
someone who presents with Pain directly @ SIJ & radiates down posterior limb → knee and is Hypermobile patient has what pahtology
SIJ hyermobility
Thoracolumbar:
Flex:
Ext:
SB:
Rot:
Flex: 60
Ext: 25
SB: 35
Rot: 45
Cervical AROM:
Flex:
Ext:
SB:
Rot:
Flex: 40
Ext: 50-70
SB: 22
Rot: 70-90
Lumbar:
Flex:
Ext:
SB:
Flex: 40-50
Ext: 15-20
SB: 25
how do you document if someone has 20° of hyperextenstion and 130 ° of flexion at the elbow joint
20-0-130
what does this documentation read at the C spine , 50-42
50 degress of extension and 42 flexion
AROM provides info abt:
-Subject’s willingness to move
-Coordination
-Muscle strength
-Joint ROM
-Contractile tissue integrity
-If inert tissues are stretched or pinches
PROM provides info about:
-Integrity of joint surfaces
-Extensibility of capsule, ligaments, muscles, fascia, & skin
-Endfeels
for ROM do you test involved side or uninvolved side first
uninvolved
during MMT if someone is weak and it was painful what type of lesion
major
what is the grade If they can move in full active range in gravity resisted
3/5
during MMT if someone is strong but it was painful what type of lesion
minor
during MMT if someone is weak and painless what type of lesion
complete lesion
Hand dynamometry grip strength
Upper quarter y-balance test
Apley scratch test
UE CKC stability test
these performance measures are all for what
shoulder
what are some common outcome questinonaire for shoulder
quick dash
ucla shoulder scale
upper extremity function scale
what vertebrae levles is the scap in between
T2-T7
if you have an elevated scap what is stretched and what is tight
Stretched: rhomboid, mid/lower trap
Tight: upper trap, levator scap
if you have a depressed scap what is tight and stretched
stretched: upper trap and levator scap
tight: rhomboid , mid/lower trap
if you have a protracted scap what is tight
Tight: serratus anterior
if your scap is UR what is tight
Tight: serratus anterior, upper & lower trap
if you have an retracted scap what is tight
Tight: rhomboid, middle trap
if your scap is DR what is tight
Tight: rhomboids
what causes AC joint sprain
FOOSH
Downward force on acromion or upward force on clavicle
Pop during injury
Pain & weakness @ endrange elevation, 90 deg shoulder flx, HADD
Piano key sign (severe, clavicle elevated position)
these are presenations for what pathology
AC joint sprain
what are causes for joint arthrtis
Repetitive overhead or cross-body
Prior AC joint sprain, RC tear, scap dyskinesia
Pain in 60-120 deg shoulder abd (painful arc) or reaching overhead or out
Click or pop
Pain over anterolateral shoulder & maybe down humerus
these are presentation of someone with what pathology
shoulder impingement
Bony growth or acromion shape
Poor mech w/ overhead reaching (not enough scap UR & too much humeral IR)
Prior RC injury
FOOSH
these are all causes of what pathology
shoulder impingement
what are the causes for Rotator cuff tendinopathy
Repeated microtrauma
Progression of shoulder impingement
what are the causes for RC tear
FOOSH
Rep microtrauma
how many weeks post RC sx does the patient have limited PROM flexion , abd, ER & IR and NO AROM
4-6
what is the presentation for labral tear
pop, cliick
heavy arm about to dislocate
Pain w/ overhead reach esp abd & ER
FOOSH
Direct blow to shoulder
Violent pull on shoulder
Loaded lifting
these are all causes for what pathlogy
labral tear (bankart lesion)
Overhead throwing
Forced hyperextension
FOOSH
Heavy lifting
these are all causes of what pathology
SLAP
people with a SLAP lesion have pain w what movement
flexion or IR
what are the causes for Adhesive capsulitis (frozen shoulder):
Insidious
Middle aged women, T2D, hypothyroidism
what is the shoulder end feel
firm always
if you have an empty end feel for the shoulder what does that mean
subacromial bursitis
if you have a hard capsular end feel for the shoulder what does that mean
frozen shoulder
what 2 patholgies are common w/ dominant hand
carpal tunnel and tennis elbow
if hand pain is in morning then
disc, arthritis, tendons
Normal cubitus valgus:
8-15°
If too big carrying angle:
Stretched:
Compressed:
Stretched: MCL, ulnar n, FCU
Compressed: LCL, radial head
If too little carrying angle:
Stretched:
Compressed:
Stretched: LCL, brachiorad
Compressed: ulnar trochlea
what does claw hand present with
ulnar nerve issure
what does adductor pollicis atrophy present with
ulnar nerve issue
what does bishops and apes hand present with
median nerve issure
Entrapment: nerve roots, 1st rib, pec minor, humeral head, cubital tunnel, guyon’s canal, arm over head
these are all common for what nerve
ulnar
what does thenar atrophy present with
median nerve issue
how do you screen for median nerve
OK sign
how do you screen for ulnar nereve
open & close, cross finger, or hold paper b/t fingers
what clinical test would you do for median nerve issue
tinel’s and phalen’s and reverse phalens
Entrapment: nerve roots, b/t scalenes, pec minor, humeral head, pronator teres, carpal tunnel
these are all comon are what nerve
median
what does wrist drop present with
radila nerve issue
how do you screen for radial nerve
thumb up
Entrapment: nerve roots, b/t scalenes, triangular space, spiral groove, lateral epi, ECRB, arcade of froshe w/ supinator
these are all common for what nerve
radial
what are clinical testing for radial nerve issues
tinels and reisister supination
Lateral elbow tendinopathy (tennis elbow) is related to which spinal level
C5
Repetitive wrist ext w/ radial deviation (ECRL & ECRB) can cause what pathology
Lateral elbow tendinopathy (tennis elbow)***:
someone with Lateral elbow tendinopathy (tennis elbow) will present w what
Crepitus w/ wrist flx/ext
Pain w/ ecc control wrist flx & gripping
what spinal level is Medial epicondylalgia (golfer’s elbow) correlated with
T1
Repetitive wrist flexion, gripping/twisting
Acute tissues inflamed, chronic tissues degenerative
these are causes of what pathology
Medial epicondylalgia (golfer’s elbow):
CANNOT DO LATERAL PINCH GRIP with what pathology
Medial epicondylalgia (golfer’s elbow):
Ulnar n entrapment
Repetitive microtrauma (flx, valgus force)
Direct blow to posteromedial elbow
these are all causes of what pathology
Cubital tunnel syndrome (telephone elbow):
if a patient presents with Numbness/tingling in n distribution, Weakness in ulnar side gripping & fine motor control and Ulnar n snapping in front of medial epi then what pathology can you suspect
Cubital tunnel syndrome (telephone elbow):
Rep, forceful valgus &/or weightbearing is a cause of what pathology
Osterochondritis dessicans:
If alvused → little leaguer’s elbow
Valgus force esp if loaded & quick
these are causes of what type of pathology
Ulnar collateral lig sprain:
Varus and Crutch users are causes of what pathology
Lateral collateral lig sprain:
Radial head compression fracture is caused how?
FOOSH
Elbow ext, forearm pron
someone with Radial head compression fracture will present with what
Limited pron/sup
DRUJ/ligamentous issues
what causes DeQuervain’s tenosynovitis:
rep radial dev
how do you screen DeQuervain’s tenosynovitis:
thumb tuck
what causes Scaphoid fractures:
FOOSH esp w/ wrist hyperext
if someone has Pain in snuffbox, w/ ext & rad dev and Weak grip what pathology do the have
Scaphoid fractures
CMC hyperextn and being Female & older are causes of what
CMC arthritis:
what tendon is deformity for mallet finger
ED tendon
normal wrist ROM
flex:
ext:
Rad dev:
Uln dev:
flex: 80
ext: 70
Rad dev: 20
Uln dev: 30
normal elbow ROM:
flex
ext
pro
sup
flex: 150
ext: 0
pro: 80
sup: 80
MCP ROM:
flex
ext
flex: 90
ext: 45
PIP ROM:
flex
ext
flex: 100
ext: 0
DIP ROM
flex:
ext:
flex: 90
ext: 0
