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Musculo 3 Midterm > Midterm MSK > Flashcards

Midterm MSK Flashcards

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1
Q

What can cause a prosthetic gait deviation?

A

patient causes and prosthetic causes

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2
Q

What types of contractures are common with TTA?

A

knee flexion and hip flexion

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3
Q

What types of contractures are common with TFA?

A

hip flexion, ER, and hip adduction

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4
Q

What should the height be for a normal prosthesis?

A

5-10 deg of flexion

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5
Q

Transtibial prosthetic

A

Socket flexion, foot inset in relation to socket and socket translated anterior in relation to foot

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6
Q

Transfemoral prosthetic

A

Socket flexion, socket adduction, foot inset in relation to socket, and knee posterior to socket.

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7
Q

What are the main concerns of TFA ?

A
  • Loss of knee extensor mechanism
  • Loss of ADD power
  • Decreased pelvic stability
  • Disruption of normal femoral alignment
  • Decreased hip muscular force generation
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8
Q

What major muscles do you lose with someone with TTA?

A

Gastroc and eccentric control of ankles

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9
Q

What major muscles do you lose with TFA?

A

Adductors

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10
Q

What are the big problems post ampuation ?

A

changes in center of gravity
loss of sensory feedback
loss of primary balance reaction - ankle strategy
increased time to respond to perturbations

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11
Q

Stance phase: terminal stance to pre-swing Possible Prosthetic Causes of Early Heel Rise:

A
  • Excessive socket extension
  • Excessive ankle PF
  • Foot too anterior
  • DF bumper too stiff
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12
Q

Stance phase: terminal stance to pre-swing Possible Patient Causes of Early Heel Rise:

A

Knee or hip flexion contracture not accommodated in alignment

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13
Q

Swing Phase: Possible Prosthetic Causes of Decreased Toe Clearance Prosthetic Causes

A
  • Inadequate suspension/pistoning
  • Prosthesis too long
  • Excessive ankle PF
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14
Q

Swing Phase: Possible Prosthetic Causes of Decreased Toe Clearance Possible Patient Causes

A
  • Improper donning of suspension
  • Contralateral gluteus medius weakness
  • Insufficient hip and knee flexion
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15
Q

Common Gait Deviations Related to Decreased

Weightbearing

A
  • Midline shift to the intact side
  • Adduction of the intact limb
  • Decreased step length of the intact limb • Decreased stance time on the prosthesis • Limited weight shift on the prosthesis
  • Increased upper extremity support
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16
Q

Swing Phase: Terminal Swing Gait Deviations Possible Causes of Decreased Stride Length on Intact Side

A
  • Socket causing residual limb pain
  • Factors that limit rollover
  • Socket too extended
  • Foot too forward
  • Foot too PF
  • Anterior bumper too stiff • SACH heel too soft
  • Fear/inability to weight bear on prosthesis
  • Hip flexion contracture on the prosthetic side
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17
Q

Indications to perform a grade V mobilization or high velocity thrust

A 
Pain ( sub-acute, acute, or chronic)
force progression (mobilizations provide translent pain relief)
decreased ROM/ joint mobility
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18
Q

Contraindications for grade 5 manipulations (bone weakening pathology)

A

Metastatic disease

Infection (Osteomyelitis, tuberculosis)

Congenital (i.e. dysplasia)

Iatrogenic (long-term use of corticosteroids)

Inflammatory (rheumatoid arthritis)

Trauma/suspected or confirmed
Fracture

Spondylolysis/spondylolisthesis

Osteoporosis/osteopenia

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19
Q

Contraindications for grade 5 manipulations (neurological symtoms)

A

Cord compression

Cervical myelopathy

Nerve root compression with increasing neurological deficits

Cauda equina compression

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20
Q

Contraindications for grade 5 manipulations (vascular symtoms)

A

diagnosed or suspected carotid artery dsyfunction or vertebrobasilar insufficientcy

aortic aneurysm

blood disorder (hemophilia)

Use of anticoagulants

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21
Q

Relative contraindications

A

History of intervertebral disc injury

pregnancy

liagmentous laxity/ hypermobility

advanced degenerative joint disease

vertigo

psychological dependence on joint manipulation

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22
Q

Adverse Events: Transient

A

increased local pain or discomfort

stiffness, headaches, tiredness/fatigue, radiating/pain, dizziness, tinnitus and nausea/ vomit

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23
Q

Adverse Events: Serious

A

HNP, fracture of vertebra or ribs, vertebral artery dissection, CVA, cauda equina syndrome, spinal cord compression, Death

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24
Q

What are the pscyhological effects of manual therapy ?

A

Demonstrate we have found source of their pain and can reproduce it, strengthens therapeutic alliance with patients, placebo

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25
What are the mechanical effects of manual therapy ?
stretch tight tissue snap intra-articular adhesions release entrapped meniscoid tissue with facets increases arthorkinematics and osteokinematics motion
26
What are the neurophysiological effects of manual therapy ?
endogenous pain relief decreased muscle guarding decreased muscle inhibition decreased sensitivity to pain: thermal, deep pressure and pin prick and temporal summation
27
Spinal arthrokinematics: mid cervical flexion
right facet upslide | left facet upslide
28
Spinal arthrokinematics: mid cervical extension
right facet downslide | left facet downslide
29
Spinal arthrokinematics: right sidebend
Left facet upslide | right facet downslide
30
Spinal arthrokinematics: left sidebend
left facet downslide | right facet upslide
31
Spinal arthrokinematics: right rotation
left facet upslide | right facet downslide
32
Spinal arthrokinematics: left facet
left facet downslide | right facet upslide
33
spinal arthrokinematics right rotation lumbar spine
left facet compression | right facet gap
34
spinal arthrokinematics left rotation lumbar spine
lacet facet gap | right facet compression
35
coupled motion: upper cervical spine
rotation and sidebending occur in opposite direction
36
Coupled motion: mid cervical
rotation and sidebending occur in the SAME direction
37
Thoracic and lumbar spine:
rotation and sidebending occur in opposite directions in neutral/extended positioning
38
Thoracic and lumbar spine:
rotation and sidebending occur in the same direction in flexed positioning
39
5 D's
``` Dizziness Drop attacks Diplopia Dysarthria Dysphagia ```
40
3 N's
Numbness Nausea Nystagmus
41
What is strength?
the ability to exert a force on an external object
42
What is the purpose of the joint disc?
attaches to the condyle via the medial and lateral collateral ligaments
43
What are the three ligaments of the TMJ joint?
– Temporomandibular ligament | – Sphenomandibular ligament – Stylomandibular ligament
44
What structures innervate the TMJ joint?
– Trigeminal Nerve | – Trigemino-cervical complex
45
What are the actions of temporalis?
elevation and ipsilatearl deviation
46
what are the actions of the masseter?
Elevation
47
What are the actions of medial pterygoid?
elevation and contralateral deviation, protrusion
48
what is the action of lateral pterygoid?
depression, protrusion, contralateral deviation
49
Attachments for suprahyoids?
manidble to hyoid
50
what is the purpose of digastric?
depression and swallowing
51
attachments for infrahyoids?
hypoid to sternum/calvicle
52
Infrahyoids help with?
swallowing
53
What is normal mandibular depression?
40-50mm normal
54
What is functional mandibular depression?
30mm functional
55
Two phases of opening the mouth?
• Anterior rotation of the condyle accounts for the first 11-25mm of opening • Translation of the disc/condyle complex accounts for the remainder of opening
56
What muscles control mandibular depression (opening)?
– Controlled by the digastrics, inferior head of the lateral pterygoid, and gravity
57
What are the kinematics of mandibular elevation (closing)?
Superior/posterior translation of upper joint followed by rotation of the condyle below the disc in the lower joint
58
What are the muscles that control mandibular elevation?
Controlled by the temporalis, masseter, medial pterygoid, and superior head of the lateral pterygoid muscle
59
What is normal protrusion and what muscles control it?>
normal 5-10mm Controlled by bilateral action of the masseter, medial pterygoid, and lateral pterygoid muscles
60
What muscles control retrusion?
Controlled by deep masseter, posterior temporalis, diagstric & suprahyoid muscles
61
What is normal lateral deviation and what muscles control it?
– 8-12mm normal | – Controlled by lateral pterygoids and ipsilateral temporalis
62
If someone has anterior disc derangement with reduction what occurs during opening?
The disc is recaptured and you will click
63
If someone has anterior disc derangement with reduction what occurs during closing?
The disc will slip out and click "reciprocal click"
64
With anterior disc derangement with reduction where does the disc rest?
the disc rests more anteriorly
65
What occurs during abnormal depression?
Deviation, the mandible tracks off midline and back to normal once the mouth full opens
66
What is C shaped deviation?
off to the side then back to midline
67
What is S shaped deviation?
can be caused by an add w reduction or muscle imbalance
68
What occurs with anterior disc derangement without reduction?
at rest the disc is far anteriorly, opening the disc too far anteriorly and cannot be recaptured, no click, deflection to side of derangement, LOM into opening and contralateral lateral deflection
69
What occurs during mandibular deflection?
the mandible goes off to one side during opening can be caused by an ADD w/o reduction, asymmetrical capsular tightness or muscle imbalance
70
What occurs with TMD subluxation?
excessive translation of condyles, HYPERMOBILITY, capsule is overstretched and deflection occurs away from the hypermobile side and can cause OPEN LOCK
71
What is the range of opening with someone suffering muscle spasm or trismus?
oral opening <20mm
72
How to treat someone with high irritability TMD pain?
``` – Modalities – Talk talk talk – Soft diet – Rest position, cervical posture – Manual techniques ```
73
How to treat someone with low irritability TMD Pain?
– Address pain: moist heat unless pt s/p radiation – Teach normal jaw kinematics, muscle function, and ROM – Eliminate/minimize/control parafunctional habits – Improve posture – Eliminate/minimize myofascial trigger points via manual techniques
74
What does it mean if someone is clenching?
holding your teeth together and tightening the jaw muscles while grinding involves moving the jaw with the teeth held together
75
what can cause myalgia?
caused by trauma, posture and pscyhological factors
76
If there is pain at site with patients with myalgia what would be pain at site?
2lbs of pressure for 2 seconds
77
If the patient with myalgia is having referred myofascial pain how much pressure would you apply?
2lbs of pressure for 5 sec
78
Indications for high grade velocity thrusts or manipulations?
pain: sub-acute, acute, chronic force progressions decreased ROM/ joint mobility
79
Conditions to rule out manipulations?
cervical arterial dysfunction cervical instability cauda equina syndrome
80
What are signs and symptoms of cauda equina syndrome?
LBP, urinary retention, fecal retention, paresthesias, motor or sensory loss and gait dysfunction
81
When do you decide to utilize manipulations?
Rule out serious pathology/ contraindications follow force of progression obtain consent
82
CPR lumbar manipulations
Symptoms 16 days no symptoms distal to knee Hypomobility > 1 lumbar segment FABQ work subscale <19 hip IR > 35 deg at least one side

Musculo 3 Midterm (1 decks)

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