Misc Trivia 2 Flashcards
What portion of the scaphoid is most susceptible to avascular necrosis/non-union after fracture?
- proximal pole
How many stages are there for posterior tib tendon dysfunction?
- 4
The following is most consistent with which stage of PTTD:
Posterior tibial tendon intact and inflamed, no deformity, mild swelling
- Stage I
The following is most consistent with which stage of PTTD:
Posterior tibial tendon dysfunctional, acquired pes planus but passively correctable, commonly unable to perform a heel raise
- Stage II
The following is most consistent with which stage of PTTD:
Degenerative changes in the subtalar joint and the deformity is fixed
- Stage III
- starting to see arthritis
The following is most consistent with which stage of PTTD:
Valgus tilt of talus leading to lateral tibiotalar degeneration
- Stage IV
What’s the difference between a neurotmesis, axonotmesis, and neuropraxia?
- neuropraxia: local myelin damage; usually due to compression
- axonotmesis: axon damage, but epineurium is intact. Allows for Wallerian regeneration; the nerve can regrow in it’s tube.
- neurotmesis: complete disruption of both the axon and the epineurium; most severe
What is 2nd rib syndrome? What is it also known as?
- Tietze syndrome
- inflammatory disorder of the cartilage, typically at the costochondral junction of the upper ribs at the sternum. Causes pain with coughing, sneezing, strenuous activity. Can cause pain in the neck/shoulder sometimes.
What is Scheuermann’s disease?
- pediatric condition
- usually occurs in teenagers, with the vertebrae growing unevenly in the sagittal plane (usually more posteriorly), resulting in increased thoracic kyphosis
What does the sural nerve supply? What is a helpful characteristic for differential dx to see if it’s involved?
- pure sensory nerve
- supplies the posterolateral sensation to the distal third of the leg, and the lateral ankle, heel, and foot
A foot deformity that looks like a “rocker” foot (inverted arch) is characteristic of what deformity?
- Charcot foot
What pediatric condition is characterized by ischemic damage of the navicular?
What ages are usually impacted?
- Kohler’s disease
- 6-9yo
- usually self-resolving
Which two muscles are innervated by the posterior branch of the obturator n?
- adductor brevis
- adductor magnus
- other adductors innervated by the anterior branch
What is the CPR for success with C-spine traction?
5
- patient reported periperalization with lower cervical spine (C4-7) mobility testing
- positive shoulder abduction test,
- age > 55,
- positive upper limb tension test A,
- positive neck distraction test
What is the CPR for hip mobs for knee OA? (5)
- Hip or groin pain or parasthesias
- Ipsilateral anterior thigh pain
- Passive knee flexion < 122 deg
- Passive hip internal rotation < 17 deg
- Pain with hip distraction
What is occurring with a “dead arm” with pitchers?
- a sudden, sharp, paralyzing pain when teh shoulder is moved into ER with elevation
- thought to be associated with anterior instability, causing a subluxation and subsequent transient traction injury to the brachial plexus
An entrapment of the superficial branch of the radial nerve is called what? What does it look like?
- Wartenberg’s syndrome
- sensory deficits ONLY
Kiloh-Nevin syndrome is also known as…?
- anterior interosseous nerve syndrome (AINS). Motor deficits of the AIN of the median nerve
What is the Slocum test? What does it look at?
- modification of the anterior drawer to look at anteromedial vs anterolateral rotary instability
During a Dial test, when there is >10* of tibial ER difference at 30* of knee flexion, but not at 90*, this is indicative of instability in what structure? What about the opposite?
- Posterolateral corner (PLC)
- when there’s >10* at 90*, it’s more indicative of a PCL injury that’s isolated.
Often it’s combined, so you’ll see the difference at both ranges of flexion. ACL tear will also contribute to ER laxity (up to 7*)
Research supports which specific interventions for “multimodal” treatment of cervical radiculopathy?
- intermittent traction
- manual therapy
- deep neck flexor therex
What is the CPR for short term outcome success with cervical radiculopathy and multimodal treatment? (4)
- age < 54
- dominant arm not affected
- looking down does not worsen symptoms
- multimodal treatment of traction, manual therapy, and deep neck flexor therex
What are the types of validity? (4, in general…there are more)
- construct validity: Does the test measure what it’s supposed to measure?
- content validity: Is the test representative of what aims to measure?
- face validity: Does the test appear to measure what it says it will measure?
- criterion validity: Do the results correspond to a different test of the same thing?
What are the Ottawa knee rules? (5)
Get imaging if any of the following are present:
▪ Age greater than 55
▪ TTP over patella
▪ TTP fibular head
▪ Inability to flex greater than 90 degrees
▪ Unable to WB immediately or in ED for 4 steps
What is the classification grading for arthrofibrosis following knee surgery?
▪ I - less than or equal to 10 degrees extension loss, normal flexion
▪ II - greater than or equal to 10 degrees of extension, normal flexion
▪ III - greater than 10 degrees of extension loss, greater than 25 degrees of flexion loss without shortening of patellar tendon
▪ IV –greater than 10 degrees of extension loss, greater than 30 degrees of flexion loss with patellar tendon contracture
A Segond fx is common with what type of injury?
- ACL injury
- Segond fx is a lateral tibial plateau avulsion fx
What is transverse myelitis?
- inflammation in the spinal cord
- presents like a variable cord injury
A neuritis involving the brachial plexus is named what syndrome?
What nerves does it usually affect?
- Parsonage Turner syndrome or neuralgic amyotrophy
- usually axillary, suprascapular, long thoracic, and upper trunk of the brachial plexus
What does the “terrible triad” of the elbow consist of?
Combination of:
- elbow dislocation
- coranoid fx
- radial head fx
Requires surgical fixation to restore stability, often with poorer outcomes
Lumbar thrust manips were found to have what effects on each of the following muscles:
- TrA
- internal obliques
- multifidus
- had transient effects on the thickness of all muscles
- only multifidus seemed to have improved contractile quality that endured following the manips
- another study looked at the TrA specifically, and didn’t find any effect
T or F;
Cauda equina syndrome can result in either/both urinary incontinence or retention.
- T. Weird. Just incontinence for bowel movements though. Still a lower motor neuron issue.
What’s the difference between a suprascapular nerve entrapment at the suprascapular vs spinoglenoid notch?
- the suprascapular notch is superior to the spinoglenoid notch.
- If spinoglenoid entrapment, then the supraspinatus will be spared, but will see infraspinatus atrophy
What is a “fat pad sign” indicative of on xray of the elbow?
What does it look like?
- fracture
- effusion lifts the anterior fat pad, so that there looks like there’s a billowing sail
What’s the scaphoid shift test used for?
- examines dynamic stability of the scaphoid and assesses symptom reproduction
- essentially looking at scapholunate laxity/instability
- more sensitive than specific
What position should the ankle be in for an anterior drawer test?
- ~20* plantar flexion
An axillary nerve injury/palsy will impact which movements? Why?
- external rotation and overhead
- deltoid and teres minor innervation
What is the “optimal” time limit vs the “likely permanent damage” time limit to receive surgical intervention for something like cauda equina?
- optimal: w/in 48 hrs
- to avoid permanent damage: w/in 72 hrs
What are the 3 grades of ligamentous sprain?
- Grade 1: Mild. Minimal to no swelling/pain/disability.
Minor tearing/injury to ligament. No instability in weight bearing. - Grade 2: Moderate. Mild-moderate swelling/pain/disability. Partially torn ligament. May be some moderate instability in weight bearing. Knee can buckle/give out.
- Grade 3: Severe. More significant swelling/pain/disability. Fully torn/separated ligament with instability at the joint.
What are the Ottawa ankle rules?
X ray required if:
Pain in the malleolar zone AND:
- TTP on the POSTERIOR edge or tip of either malleolus
- unable to bear weight
Pain in midfoot zone AND:
- TTP at navicular or base of 5th met
- unable to bear weight
What is the testing cluster for subacromial impingement? (3)
- Hawkin’s-Kennedy
- painful arc
- infraspinatus weakness
What is the testing cluster for anterior instability of the shoulder?
- apprehension test
- relocation test
- anterior drawer test
There are two clusters for RC pathology…what are they? (3 for both)
- painful arc
- drop arm
- infraspinatus MMT
- age >65
- nighttime pain
- external rotation weakness
What is the Foot Lift Test for balance? What condition has it been studied in? What are the cutoffs?
- stand on one leg for 30 seconds. Count the number of times a portion of the foot lifts up to maintain balance (“wobbles”).
- Studied for CAI
- > /= 3 wobbles (points) associated w/ CAI
What is the Time in Balance Test? What condition has it been studied in? What are the cutoffs?
- 3 trials of 60 seconds each in EO and EC in SLS
- studied for CAI
- <26” associated w/ CAI
Is it important to train the unaffected LE with CAI?
- yes; currently thought of as having a strong sensorimotor contribution. Thus training the strong side can still drive central improvements.
How long does Sever’s disease usually last? What is recommended intervention?
- usually resolves in 2-4 weeks with relative rest.
- stretching exercises and use of heel cups (increased cushioning) are recommended
How long does it usually take to recover from plantar fasciopathy?
Can people expect a complete resolution of symptoms?
- 10 months is the natural course for most adults
- 80% of people experience significant symptom relief, but complete resolution is elusive to many
What are the current theories for structural causes of medial tibial stress syndrome?
- periosteal remodeling to reinforce the tibia where it bears the greatest stress
- inflammation of the periosteum due to excessive traction
- of note, they do not currently see this is a primary sensorimotor or muscle imbalance issue
Relative rest for a medial tibial stress syndrome is recommended for how long?
- can be up to 4 months
What are two key risk factors for developing medial tibial stress syndrome?
- higher BMI
- navicular drop (increased pronation)
Is decreased DF ROM a risk factor for developing medial tibial stress syndrome?
- hasn’t been established as a risk factor
Is stretching expected to be an effective preventative measure for medial tibial stress syndrome?
- no; since limited DF doesn’t seem to be a risk factor
What are two primary differential dxs for a medial tibial stress syndrome?
- stress fracture
- posterior compartment syndrome
What are differentiating characteristics between a medial tibial stress syndrome and a stress fracture or a posterior compartment syndrome?
- a stress fracture would be expected to have a focal point of TTP
- Posterior compartment syndrome will likely be aggravated by activity, but will be alleviated more fully with rest. MTSS when severe can remain aggravated after exercise for hours/days.
- Posterior compartment syndrome also may have some paresthesias associated with it.
What type of research design is most appropriate for trying to identify:
- best treatment
- prevention
- diagnosis
- prognosis
- causation
- treatment: RCT
- prevention: RCT or prospective cohort study
- diagnosis: RCT or cohort study
- prognosis: cohort study or case control
- causation: cohort study
After a total shoulder arthroplasty, which muscle is most at risk for damage during early phase recovery?
What limitations are typically in place? For how long?
- subscapularis; typically released to conduct the surgery. Will have ER limitations to avoid damage. Typically 30-45* for the first 6 weeks.
What may be a reason for limited AROM compared to PROM following a complex shoulder fx surgery?
- greater tuberosity migration
- i.e., don’t assume muscular issue
What are the types of SLAP lesions?
- Type I: partial tear and degeneration, but labrum is not completely separated from the glenoid. Treated with debridement.
- Type IIa: complete detachment, anteriorly (does not go past biceps tendon midpoint)
- Type IIb: complete detachment, posteriorly (does not go past biceps tendon midpoint)
- Type IIc: complete detachment, with tear going past the biceps tendon midpoint. Combination anterior and posterior. All Type IIs are typically treated with anchors.
- Type III: Bucket handle tear. Torn labrum hangs in the joint. Treated with debridement/anchors
- Type IV: Tear involves the biceps tendon
What type of SLAP tear is most commonly diagnosed?
- Type II
Is oral contraceptive use a risk factor for DVT?
- yes
What is the cut-off score for the Well’s criteria that would indicate that an ultrasound should be conducted?
- 3 or greater
Would contralateral or ipsilateral flexion be expected with a pneumothorax?
- neither. Look for general changes with chest expansion w/ inspiration, RR, HR, etc
Is a negative ultrasound sufficient to rule out DVT?
- not really. Currently there’s mixed evidence for the sensitivity, although Doppler seems pretty high (upper 90’s).
- thought to be good practice to also do a D-dimer
What should be high in the differential for any cyclist who has c/o buttock pain?
- pudendal nerve entrapment. Common in cyclists
When is it currently recommended to remove WB/ROM restrictions s/p Achilles tendon repair?
- ~7 weeks; better pt satisfaction and quicker return to work
What is the CPR for spinal stenosis?
- bilateral symptoms
- Leg pain > back pain
- pain during standing/walking
- relief with sitting
- age > 48
What is the SNOOPx4 acronym for red flags for cervicogenic headache screening?
- Systemic symptoms
- Neurologic signs
- Onset(abrupt)
- Older (giant cell arteritis)
- Previous headache history pattern change
- Postural/positional (decreases with decreased intracranial pressure)
- Precipitated by Valsalva
- Papilledema
What do AMBRI and TUBS stand for?
- Atraumatic, multidirectional, bilateral (frequently), rehabilitation (often responds to), inferior capsule shift (best alternative to non-op)
- Traumatic, unidirectional, Bankart lesion, Surgical repair
What is the CPR for MCL injury? (4)
- Trauma by external force to leg
- rotational trauma
- pain with valgus stress test at 30 degrees
- laxity with valgus stress test at 30 degrees.
What are the types for Kibler’s classification of scapular dysfunction?
- bottom to the top
- Type 1 - inferior angle
- Type 2 - medial border
- Type 3 - superior dysfunction
Is hip abductor strength better preserved with an anterior or posterior approach for THA?
- posterior approach
Does lumbar manipulation technique/direction matter for low back pain?
- no. Even with a directional hypomobility
What SIJ dysfunction cluster test has the highest sensitivity?
- thigh thrust
What is the prioritization for impairment categories for the movement control category of the TBC for LBP?
- neural mobility impairment
- joint and soft tissue impairment
- motor control impairment
- muscle endurance impairment
What are the Canadian C-spine rules?
High risk factors
- age 65 or higher
- dangerous mechanism
- paresthesias in extremities
Absence of low risk factors allowing c-spine ROM
- simple rear-end MVA
- sitting in the ED
- ambulatory at any time
- delayed onset of neck pain
- absence of midline c-spine tenderness
Unable to actively rotate 45* to R and L
What are considered dangerous mechanisms in the Canadian C-spine rules?
- fall from 3 feet or greater
- axial load to the head
- MVC high speed (>100kph), rollover, ejection
- bicycle accident
- motorized recreational vehicles
What is Rent’s sign? What does it look for?
Looking for RC pathology. Bring pt’s shoulder into extension and passively ER/IR. Other hand palpating at acromion. Looking for palpable GT or sulcus; indicative of full-thickness tear.
Paresthesias, numbness, or upper extremity pains associated with or without headaches and upper back stiffness characterize which diagnosis?
- T4 syndrome
What is the characteristic paresthesia pattern for a T4 syndrome?
- stocking glove
What is the standard presentation for T4 syndrome?
- Paresthesias
- numbness
- upper extremity pains associated with or without headaches
- upper back stiffness
A ruptured spleen can refer pain to which shoulder?
- L
Which of the following are less likely to refer to the shoulder or neck?
- stomach
- lung
- diaphragm
- gall bladder
- liver
- pancreas
- spleen
- heart
- stomach and pancreas
- liver and gallbladder are more likely on the R
- spleen more likely on the L
What are the Start Back Tool categories? How is it scored?
- Low, medium risk, and high risk for poor outcome.
- overall score of 3 or less is Low risk
- If score is 4 or greater, then look at the subscale score for Q5-9. If that score is 3 or less, then they are Medium risk
- if the subscore is 4 or more, then they are High risk
Overall, the tool is quick; just 9 questions.
