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Orthopedic Rehab > Midterm Review > Flashcards

Midterm Review Flashcards

1
Q

What is the PTA responsible for carry out?/

A

prescribed selected interventions, pt. supervision, data collection, and appropriate problem solving and clinical decision making

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2
Q

Swelling measured? (2)`

A

water displacement, circumferential measurement

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3
Q

DTR- 0

A

Areflexia or hyporeflexia

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4
Q

DTR- 1-3

A

Average

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5
Q

DTR- 3+ to 4

A

Hyperreflexia

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6
Q

normal respiration

A

12-16 breathes per min

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7
Q

Normal SPO2?

A

95%-100%

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8
Q

Normal pulse rate range?

A

60-100bpm; average 72bpm

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9
Q

Normal BP?

A

less than 120/80

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10
Q

difference between open and closed ended questions

A

Open ended: Invite the pt to share feelings thoughts, concerns and opinions
Closed Ended: Are directed toward finding facts, obtaining specific responses and feeling in the details

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11
Q

Cardinal signs and symptoms of inflammation

A

localized heat, redness, swelling, ans pain

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12
Q

What is the difference between acute and chronic inflammation

A

Acute lasts 4-6 days while the chronic phase last 6 months to a year

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13
Q

A loss of skin color associated c a change temp changes, edema, or pain may indicate??

A

An occlusion in the blood vessel

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14
Q

Weight gain of 3lbs or greater or gradual, continuous gain over several days that results in swelling of the ankles, abdomen, and hands combined c shortness of breath, fatigue and dizziness… This symptoms might be associated c….

A

“red flag” symptoms of congestive heart failure

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15
Q

Red flag pain symptoms for what pathology…Pain or feeling of heaviness in the chest, pulsing pain anywhere in the body, constant and severe pain in calf or arm, discolored or painful feet

A

Cardiovascular

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16
Q

Red flag pain symptoms for what pathology..persistent pain at night, and constant pain anywhere in the body

A

Cancer

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17
Q

Red flag pain symptoms for what pathology..frequent or severe abdominal pain

A

Gastrointestinal

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18
Q

Red flag pain symptoms for what pathology..frequent or severe headaches c no history or injury

A

Neurological

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19
Q

excessive pooling of the fluid in the spaces between tissues

A

edema

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20
Q

grade 1 Mobilization

A

Small amplitude movement performed at the beginning of the available ROM

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21
Q

grade III Mobilization

A

Large amplitude movement performed at the end of the ROM

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22
Q

grade IV Mobilization

A

Small amplitude movement performed at the end of the ROM

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23
Q

grade II Mobilization

A

Large amplitude movement through middle of the ROM

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24
Q

Indication for Grade I-II mobilization

A

Pain and muscle spasms

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25
Q

Indication for Grade III and IV mobilizations

A

Increased ROM and stretch

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26
Q

Contraindications for Mobilizations

A

RA, malignancy, Tuberculosis, Osteoporosis, herniated disk, bone fx, joint effusion, vascular disorder, neurological development

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27
Q

Precautions for mobilization

A

OA, pregnancy, Flu , total joint replacement, severe scoliosis, poor general health, pts inability to relax

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28
Q

Concave-convex rule

A

Concave joint surfaces slides in the SAME direction as the bone movement. CONVEX is STABLE

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29
Q

Convex-concave rule

A

Convex joint surfaces slide in the OPPOSITE direction of the bone movement. CONCAVE IS STABLE!

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30
Q

Effects of joint mobilization (NEUROLOGICAL EFFECTS

A

stimulates type 1 + 2 mechanoreceptors to decrease pain, affects muscle spasms and muscle guarding -nociceptive simulations, increase in awareness of position ans motion b/c of afferent nerve impulses, and nutritional effects

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31
Q

Effects of joint mobilization (Tissue responses)

A

Improve mobility, maintains extensibility and tensile strength of articular tissue

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32
Q

Shoulder Test- Empty Can

A
  • A Positive test for rotator cuff tear is weakness, pain or both, particularly of the supraspinatus.
  • The pt elevates the arms to 90 degrees and horizontally adducts 30 degrees to the scapular plane with thumbs down to the empty can position. The PT provides downward pressure to test the pt’s strength in this position.
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33
Q

Shoulder Test- Full Can

A

The patient elevates the arms to 90 degrees and horizontally adducts 30 degrees to the scapular plane with thumbs up to the full can position.

The physiotherapist provides downward pressure to test the patient’s strength in this position.

A Positive test for rotator cuff tear is weakness, pain or both, particularly of the infraspinatus.

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34
Q

Shoulder Test-Neer’s Impingement test

A

Pt in standing, shoulder flexed to 20 degrees and fully med rotated. The PT (standing in front of pt) then takes arm passively through flexion. Positive test = pain anterolateral between 80-140 degrees

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35
Q

Shoulder Test-Hawkins - Kennedy

A

The pt stands while the examiner forward flexes the arm to 90 degrees and then forcibly medially rotates the shoulder. The test may be performed in different degrees of forward flexion or horizontal adduction. Positive test = pain

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36
Q

Shoulder Test-Speed’s Test

A

The patient’s elbow is extended, forearm supinated and shoulder is flexed to approximately 60 deg. The patient resists shoulder flexion force provided by clinician.

A Positive test elicits increased tenderness in the bicipital groove.

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37
Q

Shoulder Test- Sulcus Sign

A

Patient’s arm is placed in a neutral position at the side of the body
Clinician pulls the arm downward at the distal humerus or wrist
Positive test is a visible sulcus (dent or groove) inferior to the acromion compared to the opposite side

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38
Q

Primary shoulder impingement causes

A

structural/mechanical EX. bone spurs

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39
Q

2ndary shoulder impingement

A

Functional- occurs when moving, reducing space and out of alignment

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40
Q

Difference between intrinsic and extrinsic shoulder impingement

A

Intrinsic- RTC disease–> tendonpathy, (the tissues inside)

Extrinsic- mechanical compression of tissues (mechanical forces-bones)

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41
Q

RTC impingement stage 1 Management

A

stretching/ strengthening and manage edema

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42
Q

RTC impingement stage 2 Management

A

Inflammation around tendon, identify what is causing the impingement to limit the activity and reduce inflammation

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43
Q

RTC impingement stage 3 Management

A

Complete tendon degeneration, age-related, overuse activities related

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44
Q

RTC impingement stage 2

A

the fibrosis (hardening of tissue) and tendinitis stage, which usually affects pts between the ages 25-40

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45
Q

RTC impingement stage 3

A

characterized by tendon degeneration, muscle weakness/ atrophy rotator cuff tears and ruptures

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46
Q

Associated postural dysfunctions c RTC tears and impingement

A

Elevated and protracted scapula
GHJ internal rotation
Winging scapula
Increased Thoracic kyphosis (slouched posture

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47
Q

Rehabilitation of Primary and Secondary RTC exercises

A

Scapular stabilization exercises
Modification of activities
Local and systemic methods to control pain and swelling
Ice, ultrasound, iontophoresis, phonophoresis
Stretching and strengthening exercises

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48
Q

Bankart lesion

A

an avulsion (ligament pulls a part of the bone off) of the capsule & glenoid labrum off of the anterior rim (pulls off of anterior section) of the glenoid resulting from traumatic anterior dislocation of the shoulder

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49
Q

Hill-Sachs lesion

A

a compression or “impaction fracture” of the poster lateral aspect of the humeral head as a result of anterior shoulder instability

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50
Q

Adhesive capsulitis Causes

A

Characterized by decreased shoulder ROM, pain, inflammation, fibrous synovial adhesions, and reduction of the joint cavity
Among older patients, secondary adhesive capsulitis can develop because of limited immobilization for as few as 1 or 2 days
Hormonal changes

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51
Q

Adhesive capsulitis early stage interventions

A

treatment is focused on controlling inflammation and symptoms of pain
Pain-free motion and decrease muscle guarding of the glenohumeral joint, cervical area, and scapulothoracic muscles

Exercise with both wand and rope and pulley systems if performed in a slow, controlled, pain-free ROM (AAROM

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52
Q

Grade 1 AC joint sprain

A

minimal loss of function

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53
Q

Grade 2 AC joint sprain

A

moderate pain, some dysfunction

Work on stability, keep immobilized to protect

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54
Q

Grade 3 AC joint sprain

A

ligament injury-may include surgical intervention

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55
Q

Grade 2 AC joint sprain Interventions

A

Work on stability, keep immobilized to protect

56
Q

Grade 3 AC joint sprain Interventions

A

Initial course of treatment in physical therapy is to minimize pain and swelling

57
Q

GHJ Instability Nonoperative Management

A

Immobilization may be needed to promote healing
Management of pain and swelling
If nothing else is torn
Stabilizing first & then into additional mobility and strength
No mobs just yet wait until it is stable and healed

58
Q

GHJ Instability post op precautions

A

Require a prefunctional phase of rehabilitation that emphasizes protection range of motion (ROM)
Receive slow and protective external rotation up to 12 weeks postoperatively to ensure healing of all soft tissue
Shoulder extension may also be avoided in early stages

59
Q

Scapular fx- Cause and treatment

A

direct severe trauma, Treatment depends on whether or not there is associated glenohumeral instability

60
Q

Clavicle Fx- treatment

A

Care focused on reducing the fracture fragments, maintaining the reduction, and minimizing the immobilization of the glenohumeral joint of the affected arm

61
Q

Complications from proximal humeral fx

A

Avascualar necrosis

62
Q

Not getting blood supply to the area & will die

A

Avascualar necrosis

63
Q

TSA Consideration

A

Rheumatoid arthritis & advanced osteoarthritis

64
Q

TSA interventions

A

protective limited motion and a longer program of rehabilitation

65
Q

joint surfaces are brought closer together

A

Compression

66
Q

joint surfaces are pulled further apart

A

Distraction

67
Q

new points on one joint surface meet new points on another joint surface

A

Roll

68
Q

One joint surface moves across a 2nd surface so that the same point one on surface is continually in contact c new points on the 2nd surface

A

Slide/ glide

69
Q

Tennis Elbow?

A

Lateral epicondylitis

70
Q

Golfers Elbow?

A

Medial epicondylitis

71
Q

Condition that affects common flexors (pronator teres, flexor carpi radialis, flexor digitorum sublimis, flexor carpi ulnaris)

A

Medial epicondylitis

72
Q

Condition that affects common wrist extensors (extensor carpi radialus longus, extensor carpi radialis brevis, extensor digitorum and digiti minimi)

A

Lateral epicondylitis

73
Q

Initial acute management of epicondylitis

A

Ice massage over affected area
rest, protection of area from unwanted stress to allow healing, splint or brace to increase tolerance of activities, avoid aggravated motions

74
Q

What are considerations when beginning exercises for epicondylitis management

A

Perform all exercises w/n pain free motion, progress from pain-free ISOM - concentric and eccentric muscle contractions, light resistance when having these pts perform these exercises for first time and perform in slow controlled eccentric contraction

75
Q

Cozens test

A

Subject pronates and radially deviates the arm extending the wrist against the examiners resistance

76
Q

Mills test

A

Examiner passively pronates the forearm and flexes the subject wrist

77
Q

What ligament is injured or stressed by athletes with valgus stress overload

A

Ulnar collateral ligament

78
Q

management of medial valgus stress overload

A

LLLD stretch

79
Q

primary cause of disability in working class adult

A

low back pain

80
Q

Spinal vertebrae have two portions

A

body and vertebral arch

81
Q

assists in weight bearing in spine

A

Body

82
Q

protects the spinal cord

A

Vertebral Arch

83
Q

Guide range of motion (ROM) in the spine

A

Zygapophyseal (Facet) joints

84
Q

found in between the vertebral bodies

A

Intervertebral discs

85
Q

provides stability, enhances movement between vertebral bodies and minimal shock absorption

A

Annulus

86
Q

a mucopolysaccharide gel that transmits forces, equalizes stress, and promotes movement

A

Nucleus pulposus:

87
Q

disc has a limited capacity to heal and repair

A

Intervertebral discs

88
Q

Largely avascular and aneural

A

Intervertebral discs

89
Q

The 3 McKenzie method classifications

A

Posture syndrome, Dysfunction syndrome and Derangement

90
Q

Dysfunction syndrome

Treatment ?

A

elongate adaptively shortened tissue

91
Q

derangement treatment is aimed at?

A

Aimed at disc tissue

92
Q

Where distal limb pain is immediately

A

Centralization

93
Q

Serves to support the weight of the upper body and dissipate compressive loads

A

Lumbar Spine

94
Q

semispinalis, multifidi, rotatores, interspinales, and intertransversarii

A

Deep paravertebral muscles

95
Q

iliocostalis, longissimus, and spinalis (erector spinae)

A

Superficial paravertebral muscles

96
Q

rectus abdominis, the internal and external obliques, and the transversus abdominis

A

Anteriorly positioned

97
Q

Muscle strains general treatment goals

A

Reduce or eliminate inflammation (pain & swelling)
Restore muscle strength and control
Restore flexibility
Enhance aerobic fitness
Restore function
Protect the affected area from further injury through education and supervised practice of proper lifting mechanics

98
Q

Both short- and long-term goals for recovery from lumbar strains and sprains emphasize

A

protecting the spine from unwanted forces and positions

99
Q

Mechanical compression or inflammation of a nerve root…Symptoms may include

A

pain, numbness and tingling (paresthesias), weakness in a myotomal pattern or sensory loss in a dermatomal pattern, loss of reflexes

100
Q

Mechanical compression or inflammation of a nerve root

A

Radiculopathies

101
Q

When the uninvolved leg is tested in the same manner

More specific for disc herniation

A

Crossed straight leg raise test:

102
Q

Requires the patient to be supine while the symptomatic leg is raised passively with the knee completely extended

A

Straight leg raise test:

103
Q

Slipped disc

A

Herniated disc

104
Q

Degrees of HNP what symptoms to expect….back pain and leg pain

A

Prolapse

105
Q

Degrees of HNP what symptoms to expect…..LBP, LP and hard neuro findings

A

Extrusion

106
Q

Degrees of HNP what symptoms to expect…..mostly leg pain

A

Sequestration

107
Q

a bony defect (stress fracture) in the pars interarticularis of the posterior elements of the spine

A

Spondylolysis

108
Q

a forward slippage of one superior vertebra over an inferior vertebra

A

Spondylolisthesis

109
Q

Classification of Slippage…..congenital spondylolisthesis

A

Type 1

110
Q

Classification of Slippage…isthmic spondylolisthesis (mechanical stress) – most common

A

Type 2

111
Q

Classification of Slippage….degenerative spondylolisthesis (most commonly affecting the older population)

A

Type 2

112
Q

Classification of Slippage….traumatic spondylolisthesis

A

Type 4

113
Q

Classification of Slippage….pathologic spondylolisthesis - characterized by bone tumors that affect the pars interarticularis

A

Type 5

114
Q

Patients primarily report pain with extremes of lumbar motion, especially extension

A

HNP

115
Q

Management of Spondylolisthesis

A

Abdominal and paravertebral muscle strengthening and avoidance of extreme lumbar extension

116
Q

Osteoarthritis of the spine

A

Lumbar Spondylosis

117
Q

Narrowing of the spinal canal

A

Spinal Stenosis

118
Q

Radicular ache into the thigh and less frequently into the calf
Paresthesias into the lower extremity
Disturbances in motor function
Spinal Stenosis Symptoms

A

Radicular ache into the thigh and less frequently into the calf
Paresthesias into the lower extremity
Disturbances in motor function
**Extension of the lumbar spine in a patient with stenosis further compresses the spinal canal, thereby increasing pain and paresthesias

119
Q

Vertebral Compression Fractures

A

Most common osteoporosis-related spinal fracture

120
Q

Vertebral Compression Fractures….Goal of interventions

A

Ensure that no rapid deceleration occurs when an elderly patient transfers to a bedside commode or any other hard surface

121
Q

Vertebral Compression Fractures..symptoms

A

Acute local pain with essentially no signs at all

122
Q

Fundamental Mechanics of Lifting

A 
Load = Weight appropriate to task/person
Lever = Keep object close
Lordosis = Maintain neutral spine
Legs = Lift with legs, not the back
Lungs = Use proper breathing (do not use Valsalva maneuver)
123
Q

Increase in the thoracic posterior convexity that is manifested by a rounded-back

A

Hyperkyphosis

124
Q

: irreversible lateral curve of the spine with fixed rotation of the vertebrae

A

Structural scoliosis:

125
Q

(reversible with positional changes)

A

Non-structural scoliosis

126
Q

When does rehab begin for for a radius fx

A

As soon as stale immobilization has began

127
Q

What is encouraged for radius fx as long as no pain

A

Light gripping, pinching and use of the fingers

**They can do any rotation that is available in the cast

128
Q

Most common carpal fx

A

Scaphoid fx

129
Q

Least common carpal fx

A

Trapezoid fx

130
Q

For a phalanx fx what is the most common complication

A

Loss of PIP joint extension

131
Q

Dislocation of the elbow…loss of what motion

A

Extension

132
Q

Spondylolisthesis avoid what motion

A

avoid EXTENSION

133
Q

Spinal Stenosis avoid what motion

A

Avoid EXTENSION

134
Q

How to help CRPS

A

Desensitization techniques

135
Q

HOw to help carpal tunnel

A

Median nerve glides, avoid extension, night splints, and watch body mechanics

Orthopedic Rehab (8 decks)

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