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Musculo 3 Midterm > Midterm MSK > Flashcards

Midterm MSK Flashcards

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
Q

What are the mechanical effects of manual therapy ?

A

stretch tight tissue

snap intra-articular adhesions

release entrapped meniscoid tissue with facets

increases arthorkinematics and osteokinematics motion

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26
Q

What are the neurophysiological effects of manual therapy ?

A

endogenous pain relief

decreased muscle guarding

decreased muscle inhibition

decreased sensitivity to pain: thermal, deep pressure and pin prick and temporal summation

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27
Q

Spinal arthrokinematics: mid cervical flexion

A

right facet upslide

left facet upslide

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28
Q

Spinal arthrokinematics: mid cervical extension

A

right facet downslide

left facet downslide

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29
Q

Spinal arthrokinematics: right sidebend

A

Left facet upslide

right facet downslide

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30
Q

Spinal arthrokinematics: left sidebend

A

left facet downslide

right facet upslide

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31
Q

Spinal arthrokinematics: right rotation

A

left facet upslide

right facet downslide

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32
Q

Spinal arthrokinematics: left facet

A

left facet downslide

right facet upslide

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33
Q

spinal arthrokinematics right rotation lumbar spine

A

left facet compression

right facet gap

34
Q

spinal arthrokinematics left rotation lumbar spine

A

lacet facet gap

right facet compression

35
Q

coupled motion: upper cervical spine

A

rotation and sidebending occur in opposite direction

36
Q

Coupled motion: mid cervical

A

rotation and sidebending occur in the SAME direction

37
Q

Thoracic and lumbar spine:

A

rotation and sidebending occur in opposite directions in neutral/extended positioning

38
Q

Thoracic and lumbar spine:

A

rotation and sidebending occur in the same direction in flexed positioning

39
Q

5 D’s

A 
Dizziness
Drop attacks
Diplopia
Dysarthria
Dysphagia
40
Q

3 N’s

A

Numbness
Nausea
Nystagmus

41
Q

What is strength?

A

the ability to exert a force on an external object

42
Q

What is the purpose of the joint disc?

A

attaches to the condyle via the medial and lateral collateral ligaments

43
Q

What are the three ligaments of the TMJ joint?

A

– Temporomandibular ligament

– Sphenomandibular ligament – Stylomandibular ligament

44
Q

What structures innervate the TMJ joint?

A

– Trigeminal Nerve

– Trigemino-cervical complex

45
Q

What are the actions of temporalis?

A

elevation and ipsilatearl deviation

46
Q

what are the actions of the masseter?

A

Elevation

47
Q

What are the actions of medial pterygoid?

A

elevation and contralateral deviation, protrusion

48
Q

what is the action of lateral pterygoid?

A

depression, protrusion, contralateral deviation

49
Q

Attachments for suprahyoids?

A

manidble to hyoid

50
Q

what is the purpose of digastric?

A

depression and swallowing

51
Q

attachments for infrahyoids?

A

hypoid to sternum/calvicle

52
Q

Infrahyoids help with?

A

swallowing

53
Q

What is normal mandibular depression?

A

40-50mm normal

54
Q

What is functional mandibular depression?

A

30mm functional

55
Q

Two phases of opening the mouth?

A

• 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
Q

What muscles control mandibular depression (opening)?

A

– Controlled by the digastrics, inferior head of the lateral pterygoid, and gravity

57
Q

What are the kinematics of mandibular elevation (closing)?

A

Superior/posterior translation of upper joint followed by rotation of the condyle below the disc in the lower joint

58
Q

What are the muscles that control mandibular elevation?

A

Controlled by the temporalis, masseter, medial pterygoid, and superior head of the lateral pterygoid muscle

59
Q

What is normal protrusion and what muscles control it?>

A

normal 5-10mm

Controlled by bilateral action of the masseter,
medial pterygoid, and lateral pterygoid muscles

60
Q

What muscles control retrusion?

A

Controlled by deep masseter, posterior temporalis, diagstric & suprahyoid muscles

61
Q

What is normal lateral deviation and what muscles control it?

A

– 8-12mm normal

– Controlled by lateral pterygoids and ipsilateral temporalis

62
Q

If someone has anterior disc derangement with reduction what occurs during opening?

A

The disc is recaptured and you will click

63
Q

If someone has anterior disc derangement with reduction what occurs during closing?

A

The disc will slip out and click “reciprocal click”

64
Q

With anterior disc derangement with reduction where does the disc rest?

A

the disc rests more anteriorly

65
Q

What occurs during abnormal depression?

A

Deviation, the mandible tracks off midline and back to normal once the mouth full opens

66
Q

What is C shaped deviation?

A

off to the side then back to midline

67
Q

What is S shaped deviation?

A

can be caused by an add w reduction or muscle imbalance

68
Q

What occurs with anterior disc derangement without reduction?

A

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
Q

What occurs during mandibular deflection?

A

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
Q

What occurs with TMD subluxation?

A

excessive translation of condyles, HYPERMOBILITY, capsule is overstretched and deflection occurs away from the hypermobile side and can cause OPEN LOCK

71
Q

What is the range of opening with someone suffering muscle spasm or trismus?

A

oral opening <20mm

72
Q

How to treat someone with high irritability TMD pain?

A 
– Modalities
– Talk talk talk
– Soft diet
– Rest position, cervical posture 
– Manual techniques
73
Q

How to treat someone with low irritability TMD Pain?

A

– 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
Q

What does it mean if someone is clenching?

A

holding your teeth together and tightening the jaw muscles while grinding involves moving the jaw with the teeth held
together

75
Q

what can cause myalgia?

A

caused by trauma, posture and pscyhological factors

76
Q

If there is pain at site with patients with myalgia what would be pain at site?

A

2lbs of pressure for 2 seconds

77
Q

If the patient with myalgia is having referred myofascial pain how much pressure would you apply?

A

2lbs of pressure for 5 sec

78
Q

Indications for high grade velocity thrusts or manipulations?

A

pain: sub-acute, acute, chronic

force progressions

decreased ROM/ joint mobility

79
Q

Conditions to rule out manipulations?

A

cervical arterial dysfunction

cervical instability

cauda equina syndrome

80
Q

What are signs and symptoms of cauda equina syndrome?

A

LBP, urinary retention, fecal retention, paresthesias, motor or sensory loss and gait dysfunction

81
Q

When do you decide to utilize manipulations?

A

Rule out serious pathology/ contraindications

follow force of progression

obtain consent

82
Q

CPR lumbar manipulations

A

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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