midterm theory exam Flashcards
_______ are composed of flexible, non-contractile connective tissue
ligaments
________ limit and control the ROM at the joint while still allowing movements to occur
ligaments
name the cause of a sprain
sudden twist/wrench of a joint beyond its normal range
contributing factors to sprains
congenital ligamentous laxity
previous sprains
altered biomechanics causing stress on ligament/joint
connective tissue pathologies
grade 1 (mild or first degree sprain)
MINOR stretch/tear to ligament
NO instability on PR testing
CAN CONTINUE w/ activity with some discomfort
grade 2 (moderate or second degree sprain)
TEARING of ligament
SNAPPING sound @ time of injury & joint gives way
joint HYPERMOBILE yet stable on PR testing
difficulty continuing activity due to px
grade 3 (severe or third degree sprain)
- COMPLETE RUPTURE/AVULSION of ligament
- SNAPPING sound @ time of injury & joint gives way
- instability w/ no end point on PR testing
- person cannot continue activity due to instability & px
- px is present in acute stage and hypermobile in direction the ligament is meaning to test in chronic phase
- palpable gap
joint effusion
injury is severe enough to inflame the synovium
hemarthrosis
bleeding into the synovial space
most common ankle sprain
inversion sprain
anterior talofibular ligament
what ligament is most frequently sprained in conjunction with the anterior talofibular ligament?
calcaneofibular ligament
eversion sprain of the ankle? what is injured?
ankle is forced into eversion
deltoid ligament is affected
what type of fracture is common with an eversion sprain of the ankle? (deltoid ligament sprain)
avulsion fracture @ tibia
out of the two collateral ligaments of the knee, which one most commonly injured?
medial collateral ligament
what are the 4 ligaments that can be sprained in the knee?
medial collateral
lateral collateral
anterior cruciate
posterior cruciate
mechanism of injury for medial collateral ligament of the knee
foot fixed the the ground, knee is struck by a medially directed/valgus force
mechanism of injury for the lateral collateral ligament of the knee?
lateral directed/varus force to the knee
mechanism of injury to the anterior cruciate ligament of the knee
tibia is forced anteriorly
mechanism of injury for the posterior cruciate ligament of the knee
tibia is forced posteriorly
what is the most common mechanism of injury for a wrist sprain?
forced hyperextension
what are the 6 ligaments that can be affected with a wrist sprain?
palmar radiocarpal
dorsal radiocarpal
ulnar collateral
radial collateral
inter carpal
triangular fibrocartiaginous
what is damaged during a hyperflexion injury of the wrist?
dorsal radiocarpal ligaments
also the extensor tendons and wrist bones
what is injured during a forced hyperextension sprain of the wrist?
all 6 ligaments are possible
flexor muscle tendons and bones of the wrist
grade 1 shoulder sprain (what is affected)
AC sprain, tearing of the joint capsule
grade 2 shoulder sprain (what is affected)
tear of the joint capsule and the AC ligament
grade 3 shoulder sprain (what is affected)
tear of the joint capsule
AC ligament tear
conoid and trapezoid ligament tears
fracture is possible
most common mechanism of injury for shoulder sprain
falling on to the shoulder itself
what is tendinitis?
inflammation of a tendon
what are tendons made of?
regularly arranged dense collagen fibers
a tendon that moves in a straight line
paratendon
a tendon that runs across a bony prominence is surrounded by
tendon sheath
what is paratendinitis
inflammation of the paratendon or tendon sheath
tendinosis
degeneration changes occurring with chronic tendon injuries. such as tennis elbow
tendons appear in two shapes:
cord like structures
broad sheet like structures-called aponeurosis
what do tendons attach
muscle to bone, they are part of the musclotendinous unit
cause of tendinitis
chronic overload of tendon which leads to micro tearing and inflammation of the tendon
contributing factors to tendinitis
mm imbalances
poor biomechanics
lack of flexibility
chronic degenerative changes in tendon
poor blood supply to tendon
improper equipment
training errors
what are the 4 grades of tendinitis
grade 1: px ONLY after activity
grade 2: px @ beginning of activity, disappears during activity, returns after
grade 3: px @ beginning of activity, during & after. px may restrict activity
grade 4: px with ADL, continues to get worse
activities that may cause biceps long head tendinitis
swimming, throwing sports where arm is abducted causing compression to tendon
- usually secondary to other pathologies
common activities that may cause common extensor (lateral epicondylitis) tendinitis
tennis/racket sports, poor technique, wheelchair athletes, plumbing, electrical
“tennis elbow”
what tendon is the most commonly injured with a common extensor/later epicondylitis tendinitis
extensor carpi radialis brevis
activities that may cause common flexor/medial epicondylitis tendinitis
repetitive activity such as hammering, screwdriver, golf, overhead serve in tennis
“golfers elbow”
what specific weakness is specific to medial epicondylitis/common flexor tendinitis
weak grip
what nerve compression is common with medial epicondylitis/common flexor tendinitis
ulnar nerve compression
what two muscles are involved in DeQuervains tenosynovitis
abductor pollicis longus and extensor pollicis brevis
activities that cause DeQuarvains Tenosynovitis
activities that require thumb use, factory work, massage therapy, racquet sports
what activities cause patellar tendinitis
running, jumping, track and field
where is the pain located with patellar tendinitis
at the tendon itself.
apex of knee cap to tib tub
activities that can cause popliteus tendinitis
downhill running/walking combined with pronation of the foot
what can be confused with popliteus tendinitis
IT band friction syndrome
activities that can cause tibilais posterior tendinitis
running, step aerobics, stepping machines, combined with excessive pronation
impingement syndrome
inflammation, pain and deems of tissues between the AC and GH joints
what is affected with impingement syndrome
supraspinatus
biceps
subacromial bursa
what are the 3 progressive stages of impingement syndrome
stage 1: edema & hemorrhage of subacromial bursa.
stage 2: tendinitis & fibrosis. both stages are reversible with rest (stop doing activity that causes it) stretching and strengthening
stage 3. incomplete tears or complete tendinous rupture. may be bony changes of acromion & AC joint. surgery usually indicated
what is calcification tendinitis
late occurring stage of RC tendinitis, usually occurring in the supraspinatus tendon
trigger finger
overuse of flexor tendons of any finger that may develop thickened nodular swelling. swelling unable to move through tendon sheath & gets stuck. finger gets stuck in flexion until it is passively extended by an external force
what position do fingers get stuck in trigger finger
in flexion
a bursa is not palpable unless…
it is inflammed
what is bursitis
inflammation of a bursa
what is the function of a bursa
reduce friction, usually between tendons and bones
what is a bursa
small flat sac lined with synovium. separated by lubricating fluid
cause of bursitis
overuse of the surrounding structures which leads to excessive friction and inflammation of the bursal walls
what is a secondary cause of bursitis
tendinitis
contributing factors to bursitis
poor biomechanics, mm imbalance, postural dysfunction & lack of flexibility
less common: acute trauma, infection, pathologies (RA, OA, gout)
what is the most common cause of subacromial bursitis
working with arms overhead (carpenters, electricians, etc)
subacromial bursae location
lies between the acromion and supraspinatus tendon, portion of the bursa is between the deltoid mm and humerus
how is the subacromial bursa irritated
as it’s compressed between the RC tendons, coracoacromial ligament and the acromion or by the biceps tendon
where is the subcoracoid portion of the shoulder bursae palpated
through the anterior deltoid mm near the acromion
where is the subscapular bursa located
between the scapula and subscap mm. not easily palpable
where is the olecranon bursa located
between the olecranon and the subcutaneous fascia
what activities irritate the olecranon bursa
repetitive weight bearing or trauma such as dragging the elbow on the ground when wrestling (hitting elbow/blunt force)
where is the trochanteric bursa located (2 of them)
1) between the glute max tendon and trochanter
2) between the glute med tendon and trochanter
where will the pain be located in someone with trochanteric bursitis
local to lateral hip and client will not be able to sleep on involved sign
what action will make pain worse in someone with trochanteric bursitis
climbing stairs and getting out of the car (causes contraction of glute max, pulling on bursa)
where is the iliopectineal bursa located
between the iliopsoas mm and iliofemoral ligament
how would you palpate the iliopectineal bursa
client lies supine with hip flexed to 90. bursa is located 1-2cm inferior to middle third inguinal ligament
what causes iliopectineal bursitis
hip flexor tightness and repetitive activity
where is the pain located with iliopectineal bursitis
anterior hip and may radiate down anterior leg due to pressure on femoral nerve
what nerve may be affected in someone with iliopectineal bursitis
femoral nerve
where is the ischial bursa located
between the glute max and ischial tub
how is the ischial bursa palpated
through the glute max
What referral pain is present with ischial bursitis
referral down posterior leg that mimics sciatic pain
what action may be painful in someone with ischial bursitis
standing in toes
what is the cause for ischial bursitis
- sitting for long periods in a hard surface
- excessive sprinting due to hamstring contracture
where is the pes anserine bursa located
between the tendons of sartorius, gracilis and semitendenosis mm and medial tibia
where is the infrapatellar bursa located
between the patella ligament and the tibia
how are the knee bursae palpated
through overlying tendons
where is the prepatellar bursa located
between the lower half of the patella, patellar ligament and the skin
what can cause knee bursitis
frequent kneeling
____ bursae are communicating and ____ are non communicating
4, 4
where is the retrocalcaneal bursa located
between the achilles’ tendon and calcaneous
how is the retrocalcaneal bursa palpated
on either side of the achilles tendon
what can cause retrocalcaneal bursitis
overuse and tight gastroc & soleus complex are causes of inflammation
bakers cyst
synovial cyst that appears on the lateral side of popliteal space
where does a bunion occur
at the first metatarsophalangeal joint capsule
what is a bunion
a former excessive bone growth, a callus and an inflamed, thickened bursa developing over the joint
what causes a bunion
hypermobile joint and poor biomechanics allowing the first metatarsal bone to deviate medially. the phalanges deviated laterally forming hallux valgus
