Midterm Review Flashcards
What is the PTA responsible for carry out?/
prescribed selected interventions, pt. supervision, data collection, and appropriate problem solving and clinical decision making
Swelling measured? (2)`
water displacement, circumferential measurement
DTR- 0
Areflexia or hyporeflexia
DTR- 1-3
Average
DTR- 3+ to 4
Hyperreflexia
normal respiration
12-16 breathes per min
Normal SPO2?
95%-100%
Normal pulse rate range?
60-100bpm; average 72bpm
Normal BP?
less than 120/80
difference between open and closed ended questions
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
Cardinal signs and symptoms of inflammation
localized heat, redness, swelling, ans pain
What is the difference between acute and chronic inflammation
Acute lasts 4-6 days while the chronic phase last 6 months to a year
A loss of skin color associated c a change temp changes, edema, or pain may indicate??
An occlusion in the blood vessel
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….
“red flag” symptoms of congestive heart failure
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
Cardiovascular
Red flag pain symptoms for what pathology..persistent pain at night, and constant pain anywhere in the body
Cancer
Red flag pain symptoms for what pathology..frequent or severe abdominal pain
Gastrointestinal
Red flag pain symptoms for what pathology..frequent or severe headaches c no history or injury
Neurological
excessive pooling of the fluid in the spaces between tissues
edema
grade 1 Mobilization
Small amplitude movement performed at the beginning of the available ROM
grade III Mobilization
Large amplitude movement performed at the end of the ROM
grade IV Mobilization
Small amplitude movement performed at the end of the ROM
grade II Mobilization
Large amplitude movement through middle of the ROM
Indication for Grade I-II mobilization
Pain and muscle spasms
Indication for Grade III and IV mobilizations
Increased ROM and stretch
Contraindications for Mobilizations
RA, malignancy, Tuberculosis, Osteoporosis, herniated disk, bone fx, joint effusion, vascular disorder, neurological development
Precautions for mobilization
OA, pregnancy, Flu , total joint replacement, severe scoliosis, poor general health, pts inability to relax
Concave-convex rule
Concave joint surfaces slides in the SAME direction as the bone movement. CONVEX is STABLE
Convex-concave rule
Convex joint surfaces slide in the OPPOSITE direction of the bone movement. CONCAVE IS STABLE!
Effects of joint mobilization (NEUROLOGICAL EFFECTS
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
Effects of joint mobilization (Tissue responses)
Improve mobility, maintains extensibility and tensile strength of articular tissue
Shoulder Test- Empty Can
- 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.
Shoulder Test- Full Can
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.
Shoulder Test-Neer’s Impingement test
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
Shoulder Test-Hawkins - Kennedy
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
Shoulder Test-Speed’s Test
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.
Shoulder Test- Sulcus Sign
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
Primary shoulder impingement causes
structural/mechanical EX. bone spurs
2ndary shoulder impingement
Functional- occurs when moving, reducing space and out of alignment
Difference between intrinsic and extrinsic shoulder impingement
Intrinsic- RTC disease–> tendonpathy, (the tissues inside)
Extrinsic- mechanical compression of tissues (mechanical forces-bones)
RTC impingement stage 1 Management
stretching/ strengthening and manage edema
RTC impingement stage 2 Management
Inflammation around tendon, identify what is causing the impingement to limit the activity and reduce inflammation
RTC impingement stage 3 Management
Complete tendon degeneration, age-related, overuse activities related
RTC impingement stage 2
the fibrosis (hardening of tissue) and tendinitis stage, which usually affects pts between the ages 25-40
RTC impingement stage 3
characterized by tendon degeneration, muscle weakness/ atrophy rotator cuff tears and ruptures
Associated postural dysfunctions c RTC tears and impingement
Elevated and protracted scapula
GHJ internal rotation
Winging scapula
Increased Thoracic kyphosis (slouched posture
Rehabilitation of Primary and Secondary RTC exercises
Scapular stabilization exercises
Modification of activities
Local and systemic methods to control pain and swelling
Ice, ultrasound, iontophoresis, phonophoresis
Stretching and strengthening exercises
Bankart lesion
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
Hill-Sachs lesion
a compression or “impaction fracture” of the poster lateral aspect of the humeral head as a result of anterior shoulder instability
Adhesive capsulitis Causes
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
Adhesive capsulitis early stage interventions
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
Grade 1 AC joint sprain
minimal loss of function
Grade 2 AC joint sprain
moderate pain, some dysfunction
Work on stability, keep immobilized to protect
Grade 3 AC joint sprain
ligament injury-may include surgical intervention
Grade 2 AC joint sprain Interventions
Work on stability, keep immobilized to protect
Grade 3 AC joint sprain Interventions
Initial course of treatment in physical therapy is to minimize pain and swelling
GHJ Instability Nonoperative Management
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
GHJ Instability post op precautions
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
Scapular fx- Cause and treatment
direct severe trauma, Treatment depends on whether or not there is associated glenohumeral instability
Clavicle Fx- treatment
Care focused on reducing the fracture fragments, maintaining the reduction, and minimizing the immobilization of the glenohumeral joint of the affected arm
Complications from proximal humeral fx
Avascualar necrosis
Not getting blood supply to the area & will die
Avascualar necrosis
TSA Consideration
Rheumatoid arthritis & advanced osteoarthritis
TSA interventions
protective limited motion and a longer program of rehabilitation
joint surfaces are brought closer together
Compression
joint surfaces are pulled further apart
Distraction
new points on one joint surface meet new points on another joint surface
Roll
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
Slide/ glide
Tennis Elbow?
Lateral epicondylitis
Golfers Elbow?
Medial epicondylitis
Condition that affects common flexors (pronator teres, flexor carpi radialis, flexor digitorum sublimis, flexor carpi ulnaris)
Medial epicondylitis
Condition that affects common wrist extensors (extensor carpi radialus longus, extensor carpi radialis brevis, extensor digitorum and digiti minimi)
Lateral epicondylitis
Initial acute management of epicondylitis
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
What are considerations when beginning exercises for epicondylitis management
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
Cozens test
Subject pronates and radially deviates the arm extending the wrist against the examiners resistance
Mills test
Examiner passively pronates the forearm and flexes the subject wrist
What ligament is injured or stressed by athletes with valgus stress overload
Ulnar collateral ligament
management of medial valgus stress overload
LLLD stretch
primary cause of disability in working class adult
low back pain
Spinal vertebrae have two portions
body and vertebral arch
assists in weight bearing in spine
Body
protects the spinal cord
Vertebral Arch
Guide range of motion (ROM) in the spine
Zygapophyseal (Facet) joints
found in between the vertebral bodies
Intervertebral discs
provides stability, enhances movement between vertebral bodies and minimal shock absorption
Annulus
a mucopolysaccharide gel that transmits forces, equalizes stress, and promotes movement
Nucleus pulposus:
disc has a limited capacity to heal and repair
Intervertebral discs
Largely avascular and aneural
Intervertebral discs
The 3 McKenzie method classifications
Posture syndrome, Dysfunction syndrome and Derangement
Dysfunction syndrome
Treatment ?
elongate adaptively shortened tissue
derangement treatment is aimed at?
Aimed at disc tissue
Where distal limb pain is immediately
Centralization
Serves to support the weight of the upper body and dissipate compressive loads
Lumbar Spine
semispinalis, multifidi, rotatores, interspinales, and intertransversarii
Deep paravertebral muscles
iliocostalis, longissimus, and spinalis (erector spinae)
Superficial paravertebral muscles
rectus abdominis, the internal and external obliques, and the transversus abdominis
Anteriorly positioned
Muscle strains general treatment goals
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
Both short- and long-term goals for recovery from lumbar strains and sprains emphasize
protecting the spine from unwanted forces and positions
Mechanical compression or inflammation of a nerve root…Symptoms may include
pain, numbness and tingling (paresthesias), weakness in a myotomal pattern or sensory loss in a dermatomal pattern, loss of reflexes
Mechanical compression or inflammation of a nerve root
Radiculopathies
When the uninvolved leg is tested in the same manner
More specific for disc herniation
Crossed straight leg raise test:
Requires the patient to be supine while the symptomatic leg is raised passively with the knee completely extended
Straight leg raise test:
Slipped disc
Herniated disc
Degrees of HNP what symptoms to expect….back pain and leg pain
Prolapse
Degrees of HNP what symptoms to expect…..LBP, LP and hard neuro findings
Extrusion
Degrees of HNP what symptoms to expect…..mostly leg pain
Sequestration
a bony defect (stress fracture) in the pars interarticularis of the posterior elements of the spine
Spondylolysis
a forward slippage of one superior vertebra over an inferior vertebra
Spondylolisthesis
Classification of Slippage…..congenital spondylolisthesis
Type 1
Classification of Slippage…isthmic spondylolisthesis (mechanical stress) – most common
Type 2
Classification of Slippage….degenerative spondylolisthesis (most commonly affecting the older population)
Type 2
Classification of Slippage….traumatic spondylolisthesis
Type 4
Classification of Slippage….pathologic spondylolisthesis - characterized by bone tumors that affect the pars interarticularis
Type 5
Patients primarily report pain with extremes of lumbar motion, especially extension
HNP
Management of Spondylolisthesis
Abdominal and paravertebral muscle strengthening and avoidance of extreme lumbar extension
Osteoarthritis of the spine
Lumbar Spondylosis
Narrowing of the spinal canal
Spinal Stenosis
Radicular ache into the thigh and less frequently into the calf
Paresthesias into the lower extremity
Disturbances in motor function
Spinal Stenosis Symptoms
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
Vertebral Compression Fractures
Most common osteoporosis-related spinal fracture
Vertebral Compression Fractures….Goal of interventions
Ensure that no rapid deceleration occurs when an elderly patient transfers to a bedside commode or any other hard surface
Vertebral Compression Fractures..symptoms
Acute local pain with essentially no signs at all
Fundamental Mechanics of Lifting
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)
Increase in the thoracic posterior convexity that is manifested by a rounded-back
Hyperkyphosis
: irreversible lateral curve of the spine with fixed rotation of the vertebrae
Structural scoliosis:
(reversible with positional changes)
Non-structural scoliosis
When does rehab begin for for a radius fx
As soon as stale immobilization has began
What is encouraged for radius fx as long as no pain
Light gripping, pinching and use of the fingers
**They can do any rotation that is available in the cast
Most common carpal fx
Scaphoid fx
Least common carpal fx
Trapezoid fx
For a phalanx fx what is the most common complication
Loss of PIP joint extension
Dislocation of the elbow…loss of what motion
Extension
Spondylolisthesis avoid what motion
avoid EXTENSION
Spinal Stenosis avoid what motion
Avoid EXTENSION
How to help CRPS
Desensitization techniques
HOw to help carpal tunnel
Median nerve glides, avoid extension, night splints, and watch body mechanics
