Misc Trivia Flashcards
What is temporal arteritis?
inflammation of the temporal artery.
- within the differential for cervical pain or TMJ, as it can create headaches and/or jaw pain, as well as vision loss, fever, and fatigue
- would expect labs to be off (e.g., a high ESR)
What is Horner’s syndrome?
- interruption of the sympathetic nerves to the eye/face
- characterized by 4 things:
- drooping eyelid (ptosis)
- pupil constriction (miosis)
- lack of sweating on affected side of face (anhidrosis)
- sinking of eyeball into socket
What is a Bell’s palsy?
- facial muscle weakness unilaterally; looks like a drooping face on one side
- often follows a viral infection
- typically will resolve within 6 months
What are Well’s Criteria for DVT? (8, +1)
- active cancer
- immobility for 3 days or major surgery within the past 4 weeks
- calf swelling > 3cm compared to CL limb
- entire leg swollen
- localized tenderness along deep venous system
- pitting edema > in symptomatic leg
- paralysis, paresis, or recent plaster immobilization
- previously documented DVT
- alternative diagnosis to DVT is more likely (-2 to score)
Describe the standard presentation for ankylosing spondylitis.
- more likely in men, usually in early (<30, can be early adulthood ~17 or so as well)
- inflammatory disease, usually impacting the SIJ first, often involving the spine. Pain often begins at hips or low back
- spine begins to stiffen, often in flexion
- pain worsens with lack of movement, improved with movement. Worse in the mornings
- can often involve other joints, such as the ankles, knees, etc
- can see swelling in joints as well
What is the standard presentation for psoriatic arthritis?
Will there be morning stiffness?
- inflammatory arthritis associated with the skin condition of psoriasis (red skin topped by silvery scales)
- characterized by fluctuating joint pain/stiffness/swelling; morning stiffness
- may have nail bed changes
What is the standard presentation for a reactive arthritis?
- arthritis that is triggered by infection in another part of the body.
- typically involves the knees, ankles, or feet
- subtype is Reiter’s syndrome is characterized by discomfort with urination and eye inflammation
Differentiate between Ehler’s Danlo’s, Marfan’s, and Morquio.
Ehler’s Danlo’s - people are generally bendy, and bruise easily. Impacts connective tissue, primarily skin, joints, and blood vessel walls.
Marfan’s - people wispy; tall, thin, and twiggy. Impacts connective tissue, primarily heart, eyes, blood vessels, and bones. Long arms, legs, fingers.
Morquio - progressive pediatric disorder, usually becoming symptomatic between 1-3 yo. Kids look like dwarves
What is the CPR for T-spine manips for shoulder pain?
o Pain-free shoulder flexion < 127* o Shoulder internal rotation < 53* at 90* abduction o Neer’s test negative o Not taking meds for shoulder pain o Symptoms < 90 days
Phalen’s test screens for _____.
- carpal tunnel syndrome
Berger’s (Buerger’s) test screens for _______.
- arteriole insufficiency.
- seems more typical for the LE, but has been referenced for other areas as well
Bunnel Littler test screens for ______.
- PIP capsular restriction
- basically comparing muscle length insufficiency vs capsular restrictions when PIP ROM is restricted. Flex the PIP with the MCP extended vs flexed. If it’s the same, the restriction is likely due to capsular restriction
A Herbeden’s node is at the _____ while a Bouchard’s node is at the ______.
- Herbeden’s is at the DIP
- Bouchards is at the PIP
What are the two CPRs for success vs improvement with a core stabilization program?
Success
- positive prone instability test
- aberrant movement present (Gower’s, painful arc, catching, etc)
- age <40
- SLR >91*
Improvement
- negative prone instability test
- aberrant movements absent
- FABQ physical activity score > 9
- no lumbar hypermobility w/ prone spring testing
What’s the best way to differentiate between deep vs superficial peroneal nerve involvement?
- Deep does toe extensors and cutaneous sensation between digits 1-2; also TA
- Superficial is mainly cutaneous, but does the peroneals (evertors)
A painful shoulder arc between 120-160* is most concerning with involvement of what structure?
- AC joint
What structures run through the quadrilateral space in the shoulder?
- axillary nerve (delts, teres minor, I think something else) and posterior circumflex artery
What’s the difference between an Erb’s and Duchenne’s palsy? What are they?
- they’re the same thing
- waiter’s tip position, C5-6 injury
What Cobb angles are considered abnormal and appropriate for management via bracing? Via surgery?
- > than 20* is when bracing begins to be a consideration
- > than 40* is when surgery begins to be a consideration
Where is the relative position of the odd facet on the patella?
- medial
A Morton’s neuroma occurs where?
- on the foot.
- typically between the 3rd and 4th toes
What does Sinding Larsson Johannson syndrome look like?
- irritation under the patella tendon; avulsion fx of the inferior pole of the patella
What are normal/abnormal values for ABI?
- normal: 0.90-1.30
- moderate PAD: 0.40-0.90
- severe PAD: < 0.40
What is Sever’s disease?
- a traction apophysitis of the calcaneus posteriorly
- most commonly a pediatric condition
With McMurray’s test, if the tibia is externally rotated, which meniscus is being biased for provocation?
- medial meniscus
What is the directional relationship for upper cervical arthrokinematics in a neutral position for SB/rot?
- opposite
What is Bakody’s sign?
- alleviation of UE symptoms when placing hand on the top of the head; can be active or passive.
- indicative of C4-6 radiculopathy
What is Kemp’s test?
- test to rule in facet generated pain in the lumbar spine
- Pt can be seated or standing. Is “passively” directed into flexion, rotation, lateral flexion, and then extension.
- looking for pain and/or paresthesias in the lower back or LEs
- if pain is relatively local, more likely due to facet irritation, especially if above the knee. Otherwise greater potential for nerve irritation
What demographics are common with an anterior ankle impingement syndrome?
- football (soccer) players and dancers
What is thought to be the pathophysiology behind anterior ankle impingement syndrome?
- osteochondrosis of soft tissue/cartilage structures in the anterior ankle
- cause relative thickening/tightening of the anterior ankle tissue
- result of repetitive microtrauma
What movements/positions are likely to be irritating with anterior ankle impingement syndrome?
- end range plantarflexion or dorsiflexion
What is the inverted supination test? What is it used for?
o Used to identify cervical myelopathy/upper motor neuron signs
o Forearm in slight pronation
o Tap near the styloid px at the brachioradialis attachment
o Quick finger flexion is positive; essentially hyperreflexivity
What are the primary differences between a vascular vs neurogenic claudication in terms of:
- posture
- positional relief
- walking distance/symptom irritation
- pulses
- back pain
- LE pain
- inclines vs declines
Neurogenic claudication:
- alleviated with flexion, aggravated with extension
- alleviated with sitting (flexion)
- provoked with varied walking distances
- intact pulses
- back pain is common
- LE pain is often B
- worse on declines, better on inclines (ext vs flx)
Vascular claudication:
- unaffected by spinal position
- alleviated with rest, regardless of position
- provoked with consistent walking distances
- diminished pulses
- back pain uncommon
- LE pain variable
- incline vs decline more related to exertion; more likely aggravated with incline
Which entrapment has no cutaneous sensory involvement? Posterior interosseous nerve syndrome or anterior interosseous nerve syndrome?
- both are motor syndromes
What are the hallmarks of a posterior interosseous nerve syndrome?
- wrist/finger extensor weakness with vague forearm pain
- has some slow sensory afferent fibers, but no cutaneous
What are the hallmarks of an anterior interosseous nerve syndrome?
- weakness of FLP and FDP; positive pinch grip test
- vague pain in the distal forearm/cubital fossa
What is the difference between a type 1 and type 2 error?
- Type 1 error: false positive. Disproving the null hypothesis, when the null is in fact correct. Finding an effect when there is none.
- Type 2 error: false negative. Proving the null hypothesis, when in fact the null is incorrect. Not finding an effect when there is one.
What is an alpha level in statistics?
- sets the probability of rejecting the null hypothesis when it is true; essentially a Type 1 error
- sets the significance level
What is a p value in statistics? How is it different than the alpha level?
- p value is calculated, describing the probability that is as extreme or more extreme when the null hypothesis is true
- alpha is your comfort level with a false positive
- p value is the probability of a false positive based on your findings
What is a Clarke test? What is it used for?
- essentially a patellar grind test; long sitting or supine with the knee extended. Therapist webspace superiorly bracing patella. Pt gently contracts quad, looking for provocation. Can make more sensitive by adding compression during same test.
- PFPS, chondromalacia patella, PF DJD
What are the differences between a Baxter’s nerve entrapment vs Tarsal Tunnel Syndrome?
Baxter’s nerve entrapment
- Entrapment of the first branch of the lateral plantar nerve; mixed motor and sensory.
- Weakness in the abductor digiti minimi.
- Pain pattern similar to plantar fasciitis distribution.
Tarsal tunnel syndrome
- entrapment of the posterior tibial nerve, posterior to the medial malleolus beneath the flexor retinaculum
- burning, tingling, and/or pain t/o the plantar surface of the foot (could be lateral, medial, and/or heel distribution)
- potential weakness/atrophy of toe abductors/flexors
- often worsened with forced eversion and dorsiflexion
What type of mobilization would be most appropriate to improve someone trying to regain ROM for overhead sports (e.g., volley ball serve, tennis serve)?
- posterior glides to improve ER while overhead
What are two tests for stress fractures at the hip for younger athletic patients?
- patellar pubic percussion test (better sensitivity)
- fulcrum test
How is a patellar pubic percussion test performed?
- pt holds stethoscope on pubic symphysis
- therapist percusses each patella when pt is supine with knees extended
- if there is bony disruption, affected side will sound duller/more diminished
What are the L2-S1 myotomes?
- L2: hip flexion
- L3: knee extension
- L4: dorsiflexion
- L5: GT extension
- S1: plantarflexion
Is there a concern for corticosteroid injection in elderly populations?
- yes; increased risk of fx by 21% per one study
What is currently thought of as the most effective care for spinal stenosis?
- manual therapy
- exercise
- BW supported treadmill training
What is the difference in demographics between a spondylolysis and a spondylolysthesis? (ages? genders?)
- spondylolysis is a pars defect that happens more often in a younger population (15-16yo)
- spondylolisthesis is more often older population (> 50 yo) if degenerative and more often female (3:1). Can be related to a B spondylolysis in a younger population
What are the 3 treatment approaches in the rehab management triage level of the low back pain treatment based classification?
- symptom modulation
- movement control
- functional optimization
What are the primary interventions used for pts that are in the symptom modulation category of treatment based classification for LBP?
- manual therapy
- traction
- immobilization
- directional preference exercises
What are the primary interventions used for pts that are in the movement control category of treatment based classification for LBP?
- stabilization exercises
- sensorimotor therex
- flexibility
What are the primary interventions used for pts that are in the functional optimization category of treatment based classification for LBP?
- context/activity specific exercise
- e.g., getting back to sports or specific professional tasks
For pts in the symptom modulation category, what is the hierarchy for treatment? What criteria define progression?
- active rest: symptoms are more highly irritable/inflammed
- traction: symptoms peripheralize with flexion AND extension, or a (+) crossed leg SLR
- directional preference exercise: symptoms peripheralize with flexion OR extension
- manipulation: plateau with centralization and no symptoms distal to the knee
Which category would be defined by the following for a treatment based classification approach to LBP:
- high to moderate pain severity
- high disability rating
- volatile symptoms
- symptoms predominate presentation
- symptoms modulation
Which category would be defined by the following for a treatment based classification approach to LBP:
- moderate to low pain severity
- moderate disability rating
- stable symptoms
- movement impairments predominate presentation
- movement control
Which category would be defined by the following for a treatment based classification approach to LBP:
- low to absent pain severity
- low disability rating
- well-controlled symptoms
- performance deficits predominate presentation
- functional optimization
With a mixed presentation (e.g., lower pain but high disability), which category should be prioritized for a TBC approach to LBP?
- prioritize disability
- psychosocial factors and comorbidities will also play into the prioritization at a secondary level
What is the traditional norms for functional elbow ROM?
- 30 to 130* of elbow flx/extension
- 50* of supination and pronation (~100* total rotation)
A hx of trauma and c/o clicking or popping with elbow extension/flexion and aggravation of symptoms with shoulder abduction is most consistent with which elbow ligamentous injury?
- varus posteromedial rotary instability
A pt w/ c/o vague elbow discomfort, lateral elbow pain with clicking, snapping, or clunking that is worse with supination is most consistent with which elbow ligamentous injury?
- posterolateral rotary instability
What is a primary difference in expected aggravating movements between a varus posteromedial rotary instability vs a posterolateral rotary instability?
- VPMRI likely most aggravated with abduction
- PLRI most likely aggravated with supination
What are the two most likely locations effected by a tarsal coalition?
- calcaneonavicular coaltion
- middle facet talocalcaneal coalition
What demographics are most likely to suffer from a tarsal coalition?
- usually in adolescents (12-16), corresponding with when the tarsal coalition begins to ossify
- Can also occur in adults following trauma, surgery, or arthritis
What regions are most likely to be TTP with a tarsal coalition?
- sinus tarsi (for calcaneonavicular coalition)
- sustantaculum tali (for talocalcaneal coalition)
What are some of the expected c/o or findings with a tarsal coalition?
- repeated ankle sprain
- vague hindfoot pain (worse with activity, alleviated with rest)
- TTP over the sinus tarsi or sustantaculum tali
- hindfoot valgus
- limited subtalar movement
- fibularis muscle spasm
What occurs with a tarsal coalition?
- fibrous, cartilaginous, or osseous fusion of two or more bones in the midfoot and hindfoot
What are the 5 treatment categories from Childs et al’s TBC for neck pain?
- mobility
- centralization
- conditioning and increasing exercise tolerance
- pain control
- reduce headache
What are the hallmarks of a pt most appropriate for the mobility category of the Child’s et al TBC for neck pain?
- recent onset of symptoms
- restricted rotation or SB
- lack of referred or radicular symptoms
What are the recommended interventions for someone in the mobility category of the TBC for neck pain?
- cervical and thoracic mob/manip
- AROM therex
What are the hallmarks of a pt most appropriate for the centralization category of the Child’s et al TBC for neck pain?
- radicular signs/symptoms
- peripheralization and/or centralization with ROM
What are the recommended interventions for someone in the centralization category of the Childs et al TBC for neck pain?
- mechanical/manual traction
- repeated movements to centralize symptoms
What are the hallmarks of a pt most appropriate for the conditioning and increasing exercise tolerance category of the Childs et al TBC for neck pain?
- longer duration of symptoms
- lower pain/disability scores
- no signs of nerve root compression
- no centralization/peripheralization w/ movement
What are the recommended interventions for someone in the conditioning and increasing exercise tolerance category of the Childs et al TBC for neck pain?
- strength/endurance exercise for neck and upper quarter
- aerobic conditioning exercises
What are the hallmarks of a pt most appropriate for the pain control category of the Childs et al TBC for neck pain?
- very recent onset of symptoms
- high pain and disability scores
- precipitating trauma
- referred or radiating symptoms into the UE
- poor tolerance to exam or most interventions
What are the recommended interventions for someone in the pain control category of the Childs et al TBC for neck pain?
- gentle AROM w/in tolerance
- ROM for adjacent regions
- modalities
- activity modification to control pain
What are the hallmarks of a pt most appropriate for the reduce headache category of the Childs et al TBC for neck pain?
- unilateral headache preceded by neck pain
- headache triggered by neck position or movement
- headache elicited by pressure on posterior neck
What are the recommended interventions for someone in the reduce headache category of the Childs et al TBC for neck pain?
- c-spine manip/mobilization
- strengthening of neck and upper quarter muscles
- posture education
What musculature should be targeted for emphasis with stabilization therex?
- TA
- multifidus
What 4 factors are indicative of a pt being in a subgroup for LBP that would benefit from traction?
- presence of sciatica
- s/sxs of nerve root compression
- peripheralization w/ extension
- positive crossed SLR
A “ram’s horn” presentation of pain for unilateral headache is most consistent with which type?
- cervicogenic
The following is characteristic of what type of headache:
- pressure or tightness
- band around the head
- bilateral
- tension headache
The following is characteristic of which type of headache:
- moderate-severe intensity
- unilateral
- pulsatile
- nausea
- migraine
The following is characteristic of which type of headache:
- severe intensity
- unilateral
- orbital, supraorbital, or temporal (around the eye)
- can be associated with nasal congestion, miosis, ptosis, facial sweating
- cluster headache
