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physio > MSK > Flashcards

MSK Flashcards

1
Q

Ulnar Collateral Ligament (medial) tear elbow

A

restricts valgus stress
MOI: excessive valgus force
s/s: pain, TOP, effusion, < ROM, instability, “pop”
special test: valgus stress test
intervention: reduce pain/swelling, bracing, strengthen forearm flexors/pronators, restore ROM

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2
Q

Nursemaids elbow

A

subluxation of radial head children 1-4, annular ligament tear
MOI: longitudinal traction with wrist pronation
s/s: refusal to move arm, held against body in slight flexion

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3
Q

Olecranon bursitis

A

inflammation of bursa
MOI: trauma, pressure, infection
s/s: swelling, redness
interventions: ice, compression, NSAIDS, cortisone injection, aspiration, antibiotics, bursectomy

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4
Q

lateral epicondylitis (tennis elbow)

A

degenerative changes/inflammation commonly at ECRB tendon of lateral epicondyle (common extensor tendon)
MOI: repetitive use, heavy ball/racquet, load > capacity for recovery
s/s: aching pain lateral epicondyle to proximal forearm extensor muscle mass, insidious, TOP, pain resisted wrist extn/gripping, pain wrist extn stretch
special tests:
cozens - resisted wrist extn with pronation + radial deviation
mills - passive wrist flexion + pronation with elbow extension
maudsleys - 3rd finger extn
interventions: eccentric wrist extn strengthening, stretching, counterforce brace, cross-frictions, mobilizations, pain modalities, reduce inflammation (cortisone, NSAIDS)

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5
Q

medial epicondylitis (golfers elbow)

A

degenerative/inflammation to wrist flexor tendons at medial epicondyle (common flexor tendon), PRONATOR TERES, FCR tendon
MOI: repetition, load > capacity
s/s: aching pain medial epicondyle to proximal forearm flexor muscle mass, insidious, TOP, pain resisted wrist flexion/forearm pronation/gripping, flexion stretching
special tests:
med epic. (reverse mills): passive wrist extension stretch, resisted pronation/flexion at wrist
interventions: eccentric wrist flexion strength, stretching, counterforce brace, cross-frictions, mobilizations, pain modalities, reduce inflammation (cortisone, NSAIDS)

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6
Q

anterior interosseous nerve syndrome

A

median nerve branch entrapment between two heads of pronator teres muscle
MOI: forearm fracture
s/s: pinch deformity (motor nerve injury)
interventions: nerve mobilizations, NSAIDS, cortisone

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7
Q

cubital tunnel syndrome (elbow)

A

entrapment of ulnar nerve at cubital tunnel between two heads of the flexor carpi ulnaris
special tests:
cubital tunnel compression test, tinnels tap at elbow (cubital tunnel), elbow flexion test (90/90 at elbow + hold like ULTT)
interventions: nerve mobilizations, NSAIDS, cortisone

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8
Q

radial tunnel syndrome

A

entrapment of posterior interosseous nerve
interventions: nerve mobilizations, NSAIDS, cortisone

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8
Q

Colles fracture

A

distal radial fracture with dorsal displacement
complications: median nerve compression, CRPS, arthritis
MOI: FOOSH injury, osteoporotic women
s/s: dinner fork deformity
interventions: spica brace, mobilization above/below, strengthening
**no pronation/supination ROM

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9
Q

CRPS

A

chronic pain disorder by SNS malfunction pain>stimulus
s/s: allodynia, hyperalgesia, burning pain, abnormal blood flow, abnormal sweating, stiffness (hallmark sign), edema, mottled skin, nail/hair growth, shiny tight skin, osteoporosis

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10
Q

days/weeks after injury
pain, hyperhydrosis, warmth, erythemia, rapid nail growth, edema distal extremity

A

stage 1 (acute/reversible)

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11
Q

3 to 6 months after injury
burning pain, sympathetic hyperactivity, hyperesthesia to cold weather, mottling and coldness, brittle nails, osteoporosis

A

stage 2 (dystrophic or vasoconstriction (ischemic) stage)

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12
Q

6 months to 1 year after injury
pain decreasing or increasing, severe osteoporosis, muscle wasting, contractures

A

stage 3 (atrophic stage)

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13
Q

CRPS interventions

A

education, TENS, mobility, ADL encouragement, desensitization. RICE, mirror therapy, avoid passive treatments

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14
Q

de quervains tenosynovitis

A

painful inflammation of sheath around tendons of thumb (abductor pollicis longus + extensor pollicis brevis)
MOI: chronic overuse, repetitive use wrist/thumb movements - golfing, carpentry, gripping, pinching
s/s: radial sided wrist pain, tenderness, swelling, pain stretching/contraction of EPB+APL
special tests: finkelstein test
interventions: activity modification, cryotherapy, thumb spica, gradual stretching/strengthening, NSAIDS, cortisone

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15
Q

Muscle innervation of median nerve

A

Lumbricals 1 + 2
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis

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16
Q

Radial nerve muscle innervation

A

Brachioradialis
Extensors of wrist
Supinators
Triceps (anconeus)

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17
Q

Ulnar nerve muscle innervation

A

Adductor pollicis
lumbricals 3 + 4
hypothenar muscles - flexor digiti minimi, opponens digiti minimi, palmaris brevis
interossei muscles - PAD (palmar adductors), DAB (dorsal abductors)

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18
Q

median nerve palsies

A

APE hand (low level lesion - carpal tunnel)
inability to abduct thumb - opposed muscles

HAND OF BENEDICTION (high level lesion)
inability to flex D1-D3 - will remain in extn when making a fist

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19
Q

ulnar nerve palsy

A

CLAW HAND
hyperextension of MCP and flexion of IP joints D4-5
unopposed muscles

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20
Q

radial nerve palsy

A

WRIST DROP
inability to extend the wrist or MCP joints
muscles are unopposed (BEST)

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21
Q

what makes up the carpal tunnel

A

carpal bones (floor)
flexor retinaculum (roof)
*9 tendons: flexor pollicis longus, 4 tendons of the flexor digitorum profundus, 4 tendons of flexor digitorum superficialis
median nerve

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21
Q

carpal tunnel risk factors/populations

A

insidious onset, repetitive stress, associated conditions (RA + inflammatory conditions), colles #, lunate subluxation, pregnancy, hypothyroidism, DM, obesity

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22
Q

carpal tunnel s/s

A

paresthesia median nerve distribution (palmar - 1, 2, 3, half ring finger)
increasing pain with repetitive hand movements, nocturnal pain/numbness, relieved by “flicking wrist”, weakness in grip strength, severe = atrophy of thenar eminence + 1/2 lumbicals

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23
Q

carpal tunnel special tests

A

tinels tap @ carpal tunnel (@ the wrist) *not guyons canal
phalens test (fingers down)
reverse phalens test (prayer test)
carpal compression test
resisted APB -only muscle exclusively innervated median nerve
ULTT median nerve
nerve conduction velocity test

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24
Q

carpal tunnel interventions

A

activity modification, splinting in neutral, nerve mobilizations, tendon gliding, joint mobilization, isometrics, resistance + endurance exercise progression, fine-finger dexterity, NSAIDS, cortisone, carpal tunnel release

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25
Q

double crush syndrome

A

nerve compression at more than one site along same nerve
eg. compression median nerve at carpal tunnel + cubital tunnel
ulnar nerve at guyons canal + cubital tunnel at elbow

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26
Q

ulnar tunnel syndrome (location, MOI, s/s), interventions

A

compression as it passes through guyons canal (between pisiform and hook of hamate)
MOI: FOOSH, chronic pressure (cycling*), ganglion cyst, extended use of crutches, baseball catchers, jackhammers
s/s: paresthesia ulnar nerve (half ring + pinky finger), motor weakness, claw hand, atophy hypothenar eminence
interventions: activity modification, cock-up splint, padded equipment, change handle bar positioning, nerve mobilizations, NSAID, cortisone

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27
Q

ulnar tunnel special tests

A

froments sign (paper between thumb and pointer finger + thumb flexes) tests adductor pollicis innervated by ulnar
guyons canal compression test
guyons canal tinel tap
ULTT ulnar nerve

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28
Q

Gamekeepers thumb

A

sprain of ulnar collateral ligament of thumb (thumb jam)
MOI: valgus force to MCP of thumb - skiers, volleyball players, gamekeepers
s/s: tenderness/pain base of thumb, pain with movement + stretch, reduced pinch/grip strength, swelling/bruising
special tests: thumb UCL laxity or instability
interventions: activity modification, splint MCP in slight flexion, gentle ROM, strengthening - theraputty

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29
Q

thumb carpometacarpal OA (CMC)

A

pain base of thumb at CMC, worse at night with weather or overuse, decreased pinch/grip, muscle wasting at thenar eminence, possible instability due to joint space narrowing
special test: grind test
interventions: activity modification, splinting, larger grip handles, AROM within tolerance, strengthening, paraffin wax, NSAID, cortisone

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30
Q

dupuytrens contracture

A

contraction of the palmar fascia not flexor tendons
fixed flexion of MCP/PIP joint
usually D3/D4
skin adheres to fascia

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31
Q

trigger finger

A

thickening flexor tendon sheath
nodule formation, tendon sticks, catching, locking when attempting to flex the finger
usually D3/D4

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32
Q

mallet finger

A

flexion of the DIP at rest
due to rupture/avulsion of extensor tendon resulting in flexors unopposed + pulls into flexion due to hyperextension injury
splint 6-8 weeks with DIP straight

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33
Q

bouchard node

A

OA enlargement at the PIP on dorsal side *not RA

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34
Q

heberdens node

A

OA enlargement at the DIP on dorsal side *not RA

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35
Q

hip anteversion

A

neck faces forward and inwards, internal rotation of the hip causes intoeing. “W sitting”

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36
Q

hip retroversion

A

neck is pointed back and goes outwards, external rotation of the hip and out-toeing

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37
Q

Hip OA signs/symptoms

A

pain in the groin, hip, buttock, thigh, knee
pain with weightbearing
reduced pain in loose packed (30 degrees flexion, 30 abduction, slight ER)
limited ROM with firm capsular end-feel
capsular pattern (FAM)
difficulty with sit to stand, ADLs

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38
Q

HIP OA special tests

A

scour test
Patricks (FABER) test
flexion-adduction (hip quadrant) test

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39
Q

HIP OA interventions

A

Education (safe ambulation)
Decrease pain - grade 1/2 with hip resting position, cane in contralateral side, shoe lift for LLD, modalities TENS, heat, reduce deep squat
Increase ROM - within tolerable limits, grade 3/4 mobs stretch capsule, stretching
Strengthening - as tolerated, begin OKC than CKC functional

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40
Q

Hip total arthroplasty posterior approach

A

soft tissues: glute max, short ERs and piriformis released and repaired - no high impact running

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41
Q

Hip post-op precautions (posterior approach)

A

no flexion >90, no hip IR > neutral, no hip adduction > neutral
wedge between legs when rolling
roll towards good side
exit same side as surgical side
stand up straight/tall from bed
highest risk subluxation/dislocation

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42
Q

Hip post-op precautions (anterior/direct approach)

A

no hip flexion >90, no hip extension, no hip adduction > neutral, no combined hip mvmts (FABER)
if glute med cut through - no anti-gravity hip abd 6-8 weeks
direct approach walking same day as surgery

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43
Q

Hip post-op maximum protection phase

A

4-6 weeks
ankle pumps, deep breathing, secretion clearance, strengthen quads, glut max, hamstrings, hip abds (if not lat. approach), AROM/AAROM within protected ranges
CKC weight-shifting, balance, heel raises, mini squats
assistive devices:
WALKER (older pop, reduced balance)
CRUTCHES (young, good balance, upper body strength)

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44
Q

loose packed position of hip

A

30 degrees flexion, 30 abduction, slight ER

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45
Q

hip fractures

A

fracture of proximal femur
generally 75 years + F>M, osteoporotic fractures
risk factors: falls, sudden twist of lower extremity, sarcopenia

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46
Q

hip fracture signs/symptoms

A

pain in groin or hip region
pain with AROM/PROM hip
pain with weight bearing
leg length discrepancy
leg held in ABDUCTION + EXTERNAL ROTATION

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47
Q

signs/symptoms hip internal fixture failure post-op

A

severe, persistent groin, thigh, knee pain that increases with weight bearing or hip movements
shortening of that limb that was not present after surgery
positive trendelenberg sign even after strengthening – could be due to damage to superior gluteal nerve (alt. hip drop)
persistent ER at operated hip

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48
Q

developmental/congenital dysplasia of the hip

A

babies! instability of the hip joint, resulting in increased risk of hip dislocation
signs/symptoms: gluteal fold asymmetry, LLD, hip abduction limitations, hip clicking

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49
Q

hip dysplasia baby tests

A

barlow maneuver (dislocation): babies hip adducted with AP force resulting in palpation subluxation/dislocation
ortolani maneuver (relocation): hip and knees flexed to 90 degrees + gently abducted with PA force to proximal femur resulting in palpable + audible clunk as the hip reduces

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50
Q

hip dysplasia interventions

A

ultrasound gold standard for diagnosis
pavlik harness - maintains hip in flexion/abduction
hip spica cast 6-24 months used if pavlik harness fails

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51
Q

legg-calve perthes disease

A

children 2-15 years old (common 4-8)
avascular necrosis of the femoral head resulting in interruption of blood supply to neck of femur

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52
Q

legg-calve perthes disease s/s

A

limp of insidious onset
+ve trendelenberg sign
pain aggravated by activity + relieved by rest
referral pain to anteromedial thigh/knee
reduced ROM ABD/IR++

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53
Q

legg-calve perthes disease interventions

A

petrie cast or abduction wedge (bar between legs)
low impact exercises, strengthening, ROM
reduction of WB if pain severe - crutches/wheelchair

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54
Q

slipped capital femoral epiphysis

A

ADOLESCENTS
fracture through the growth plate (physis) causing anterior slipping of the end of the femur (metaphysis), head of femur will sit posterior to slippage
OBESITY

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55
Q

slipped capital epiphysis signs/symptoms

A

pain in hip/anterior thigh
pain with activity
ROM reduced in flexion/abduction/internal rotation (FABDIR)
intervention = surgery

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56
Q

round back

A

increased posterior pelvic tilt ~20 degrees with increased thoracolumbar or thoracic kyphosis, rounded shoulders, head forward posture

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57
Q

scheuermanns disease

A

congenital and/or degenerative weakening of vertebral end plates in adolescents
uneven growth in sagittal (AP) direction with excess wedging
more rounded kyphotic structure T10-L2

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58
Q

flat back

A

loss of kyphosis, increased posterior pelvic tilt ~20 degrees and decreased curve in thoracic spine

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59
Q

dowagers hump

A

anterior wedge fractures in upper to middle thoracic spine causing increased kyphosis in older/post menopausal women
osteoporosis leading cause

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60
Q

interventions of thoracic kyphotic deformities

A

posture education, extension approach for hyperkyphosis in PRONE unless cardiopulmonary conditions
stretching tight structures
mobilizations unless low bone density (scheuermanns disease and dowagers hump)

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61
Q

spine compression fractures contraindications

A

trunk flexion, mobilizations if due to low bone density or steroid use

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62
Q

scoliosis

A

lateral curvature in the spine
labeled in direction of CONVEX at level of APEX
cobb angle >10 degrees = scoliosis

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63
Q

non-structural scoliosis
postural/functional scoliosis

A

curve disappears with forward flexion (Adams test)
due to poor posture, muscle guarding/spasm, nerve root irritation, inflammation, LLD (thoracic scoliosis towards longer leg side)

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64
Q

structural scoliosis

A

changes to the bones, typically congenital (does not disappear with forward flexion) Adams test
severe = cobb angle > 60 degrees = cardiorespiratory system compromised
RESTRICTIVE DISEASE
irreversible curvature with fixed rotation of vertebrae
vertebral bodies rotate to side of CONVEXITY
rub hump more prominent posteriorly

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65
Q

shingles

A

painful skin rash following dermatomal pattern

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66
Q

visceral pain referral to right neck and shoulder, right upper quadrant

A

liver and gallbladder

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67
Q

visceral pain referral to left neck and shoulder

A

lung and diaphragm

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68
Q

visceral pain referral left chest and arm, bwtn shoulder blades

A

heart

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69
Q

visceral pain referral left upper quadrant

A

pancreas

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70
Q

visceral pain referral to right lower quadrant

A

appendix

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71
Q

interventions scoliosis

A

posture education - mirror
stretch side of CONCAVITY - shortened erector spinae on concave side, side bending to shortening side
strengthen side of CONVEXITY (lengthened side)with rotation to opposite side of scolosis
scapular stabilization exercises

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72
Q

nerve roots exit ABOVE corresponding vetebrae

A

cervical spine C1-C8

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73
Q

cervical radiculopathy definition/causes

A

signs/symptoms of nerve root compression or irritation
disc herniation

stenosis:
spondylosis
ligamentum flavum thickening - central stenosis UMN signs
inflammation/swelling

74
Q

hand dermatomes (radial to ulnar aspect)

A

star trek fingers (test PROXIMAL TO DISTAL)
C5 -radial head
C6 - thumb
C7 - middle + pointer fingers
C8 - ring + pinky fingers
T1 - ulnar head

75
Q

Myotomes C1-T1

A

C1-C2: neck flexion
C3: neck lateral flexion
C4: shrug
C5: shoulder abduction
C6: elbow flexion, wrist extension
C7: elbow extension, wrist flexion
C8: thumb extension, ulnar deviation
T1: finger abduction/adduction

76
Q

LMN reflexes (upper body)

A

Jendrassik maneuver
C5 - Deltoid
C6 - Biceps/Brachioradialis
C7 - Triceps
C8 - Pronator Quadratus
T1 - Abductor Digiti Minimi

77
Q

UMN reflexes

A

Clonus - dorsiflex ankle quickly + forcefully and hold in DF
positive - sustained clonus of 5 beats or more

Babinski - scrape bottom of foot lateral to medial from heel and across ball of foot
positive - splaying of toes and/or extension of big toe

78
Q

order of upper limb tensioning for testing

A

shoulder > forearm > wrist > fingers > elbow

79
Q

ULTT1

A

MEDIAN NERVE, ant. interosseous nerve, C5, C6, C7
1. shoulder depression + abduction to 110’
2. forearm supination
3. wrist extension
4. finger + thumb extension
5. elbow extension

80
Q

ULTT2

A

MEDIAN NERVE, musculocutaneous nerve, axillary nerve
1. shoulder depression + abduction to 10’
2. forearm supination
3. wrist extension
4. finger + thumb extension
5. elbow extension

81
Q

ULTT3

A

RADIAL NERVE
1.shoulder depression + abduction to 10’
2. forearm pronation
3. wrist flexion + ulnar deviation
4. finger + thumb flexion
5. elbow extension

82
Q

ULTT4

A

ULNAR NERVE, C8, T1 nerve roots
1. shoulder depression + abduction to 10’
2. forearm pronation
3. wrist extension + radial deviation
4. finger + thumb extension
5. elbow flexion

83
Q

Erb-Duchenne Paralysis

A

WAITERS TIP
injury to nerve roots C5-C6 (upper brachial plexus)
paralysis of shoulder and elbow (arm) not hand
commonly due to shoulder dystocia during birth

arm hangs by side, shoulder IR, elbow extension, forearm pronated

84
Q

Klumpke’s Paralysis

A

injury to lower nerve roots C8, T1
weakness in the triceps, forearm and hand
may present with Horner’s Syndrome (T1) drooped eyelid, excessive pupil constriction
reduced sensation ulnar forearm/hand
due to traction on abducted arm during birth

elbow flexion, forearm supination, wrist + MCP extension, PIP + DIP flexion&raquo_space; claw hand

85
Q

facet syndrome

A

pain with compression of facet joints in c-spine
referral to scapula/neck
side bending/rotation occur towards SAME SIDE
add extension to coupled movements above to rule out facet

non-coupled movements (side bend + rotation in OPPOSITE DIRECTIONS - most provocative

86
Q

VBI symptoms (5D’s + 3 N’s)

A

dizziness
diplopia
drop attacks
dysarthria
dysphagia

nystagmus
nausea
neurological symptoms

87
Q

VBI definition

A

compression of vertebral artery causing reduced blood flow to the brain stem
pons, medulla, cerebellum

88
Q

torticollis

A

congenital or acquired unilateral shortened SCM muscle
ipsilateral side flexion + contralateral rotation of c-spine

interventions: stretch side of affected SCM, strengthen weakness to improve muscle balance
positioning/handling to more neutral

89
Q

upper cross syndrome tight + weak muscles

A

tight: pecs, upper traps, levator scapulae
weak: deep neck flexors, serratus ant., lower traps, rhomboids

90
Q

interventions upper crossed syndrome

A

postural correction*
strengthen weak + elongated structures (chin tucks, serratus)
stretch tight structures (pecs, upper traps, lev scap)

91
Q

cervical instability

A

excessive motion between 2 vertebrae
causes: ligament/joint damage, fracture, dislocation, weak muscles, trauma, long-term steroid use, RA, osteoporosis, down syndrome

mobilizations/manipulations contraindicated**

92
Q

cervical instability signs/symptoms

A

dizziness
facial numbness
lump in throat*
nausea/vomiting
nystagmus
hesitancy to move neck - flexion most
pupil changes
severe headache
soft end-feel*
severe muscle spasm
spinal cord signs - cord compression signs UMN

93
Q

nerve roots exit BELOW the corresponding vertebrae

A

lumbar spine

94
Q

lumbar spine dermatome L4

A

across the patella, big toe

95
Q

dermatome L5

A

toes on the dorsum + plantar surface, lateral heel

96
Q

dermatome S1

A

posterior thigh, pinky toe

97
Q

dermatome S2

A

medial calf, medial heel

98
Q

myotome L1-L2

A

hip flexion

99
Q

myotome L3

A

knee extension

100
Q

myotome L4

A

ankle dorsiflexion

101
Q

myotome L5

A

big toe extension

102
Q

myotome S1

A

ankle plantar flexion, ankle eversion, hip extension

103
Q

myotome S2

A

knee flexion, hip extension, ankle plantar flexion

104
Q

deep tendon reflexes L3-S2 LMN

A

L3-L4 patellar
L5-S1 medial hamstring
S1-S2 achilles

105
Q

how to stress sural nerve

A

SID - inversion + dorsiflexion

106
Q

how to stress tibial nerve

A

TED - eversion + dorsiflexion

107
Q

how stress peroneal nerve

A

PIP - inversion + plantar flexion

108
Q

spinal stenosis

A

narrowing of central canal or intervertebral foramen
age of onset >60 y/o, insidious onset
cause: osteophytes, spondylosis, or ligament thickening
may cause neurogenic claudication

109
Q

spinal stenosis aggs/eases

A

aggs: extension.. standing, walking, especially downhill
eases: flexion.. sitting, leaning forward - opens up intervertebral foramen

shopping cart sign, foot on stool, fetal position
interventions: flexion based exercises
laminectomy

110
Q

intermittent claudication

A

pain/cramping in the buttocks/legs (calves) as a result of poor circulation to the affected area
cause: peripheral artery disease (PAD)
increased pain during activity
reduced pain at rest
DISTAL to PROXIMAL
UNILATERAL

111
Q

neurogenic claudication

A

nerve root compression due to lateral stenosis
immediate onset
burning, tingling
worse in spine extension, walking downhill
eases with flexion
PROXIMAL to DISTAL
usually BILATERAL

112
Q

disc herniation

A

migration of nucleus polposus through annulus fibrosus
posterio-lateral herniation = flexion mechanism injury
acute onset 30-50 years old
aggs: flexion, sitting, lifting from floor, worse is AM, coughing, sneezing, lateral shift away (listing) if herniated to side
eases: extension, walking, prone lying

113
Q

4 stages of disc herniation

A
  1. protrusion - bulges posteriorly with no rupture
  2. prolapse - covered by thin layer of annulus fibrosis
  3. extrusion - disc material moves into epidural space
  4. sequestration - disc segments form outside disc
114
Q

disc herniation interventions

A

McKenzie approach with directional preference
extension protocol 10x each waking hour
lumbar roll in sitting to promote extension
green, yellow, red light system

prone lying > prone on elbows > extensions in lying > extension in lying with OP > extensions in standing

lateral bulge - side glides towards direction of bulge
anterior bulge - flexion based exercises (knees to chest)

115
Q

lower crossed syndrome

A

increased lumbar lordosis
overactive hip flexors compensate for weak abdominals causing ant. pelvic tilt
overactive hamstrings and erectors compensate for weak glutes to assist with hip extension
ASIS low, PSIS high

tight: erectors (multifidus + rotatores), hip flexors, hamstrings
weak and lengthened: abdominals, glutes

116
Q

spondylosis

A

degenerative changes in vertebral body and disc
age > 50, insidious onset
DDD, fibrosis in disc, osteophyte formation
loss of lordosis
increased stiffness, back aching, potential muscle spasms
worse with prolonged positions: sitting, standing, flexion, extn
better with unloaded positions: lying supine, side lying, position changes

117
Q

facet syndrome

A

pain worst with compression on facets
referral to low back, glutes, hips, groin, or thighs (not below the knee*)
tested using coupled or combined movements
interventions: flexion based exercises and positioning, avoid aggravating movements

118
Q

physiological coupled movements (lumbar spine)

A

rotation + side flexion to the same side with flexion
» flexion + right side flexion + right rotation
rotation + side flexion to the opposite side with neutral/extn
» extn + right side flexion + left rotation

119
Q

spondylolysis

A

defect in the pars interarticularis
PARS # with no slippage

120
Q

spondylolisthesis

A

forward displacement of one vertebrae over another
bilateral pars #

121
Q

retrolisthesis

A

backwards displacement of one vertebrae over another

121
Q

isthmic spondylolisthesis

A

due to repetitive micro-trauma causing a fracture of the pars interarticularis
most common at L5/S1
athletes in sports involving hyperextension (gymnasts)

122
Q

pathological spondylolithesis

A

secondary to another disease/pathology
» osteoporosis, pageants bone disease, brittle bones, steroids

123
Q

grades of spondylolisthesis

A

grade 1: < 25% slippage
grade 2: 25-50% slippage
grade 3: 50-75% slippage
grade 4: >75% slippage
grade 5: 100% slippage (spondyoptosis)

Core stabilization exercises grade 1-3
fixation (spinal fusion) required grade 4/5

124
Q

signs/symptoms spondylolisthesis

A

pain with hyperextension
hyperlordotic posture
tight hamstrings
“scotty dog with collar” sign or “scotty dog with decapitation”
+/- step deformity
+/- s/s of lateral or central stenosis

125
Q

maximum protection phase (laminectomy/fusion)

A

6 weeks to 3 months
no heavy lifting >10lbs up to 3 months
signs of inflammation/infection
avoid wetting incision up to 2 weeks
rotation contraindicated 1st week, avoid excessive flex/extn
extension contraindicated laminectomy
bed mobility, exercises in supine, walking

126
Q

moderate/minimum protection phase (laminectomy/fusion)

A

4-6 weeks+ after maximum protection
scar tissue mobilization
progressive stretching + joint mobilizations on restricted tissue
grade 1/2 mobs on adjacent segments for pain
walking, strengthening segmental to global
joint mobs at levels of fusion CONTRAINDICATED
extension exercises for laminectomy CONTRAINDICATED

127
Q

cauda equina syndrome

A

damage to long nerve roots below L1
flaccid paralysis LMN lesion - areflexive bowel/bladder
saddle anesthesia (detrusor muscle not working, trickles out)
send to ER immediately

128
Q

malignancy

A

spinal pain common in patients with spinal metastasis

age >50
previous history cancer
unexplained weight loss
constant, unrelenting pain, unrelieved with rest
night pain
failure to improve with consecutive therapy (within 1 month)

129
Q

medial meniscus

A

lateral 1/3 vascular, medial 2/3 avascular
medial meniscus: C shaped, thicker posteriorly/anteriorly
attached to MCL, ACL, PCL, semimembranosus muscle
terrible triad - valgus force to knee (MCL, ACL, med. meniscus)

130
Q

lateral meniscus

A

O shaped, moves more posteriorly during flexion: less risk tear
attached to: PCL, tendon of popliteus muscle

131
Q

function of menisci

A

aid in lubrication
shock absorbers
increase congruency of joint surfaces
improve weight distribution
reduce friction during movement
aid the ligaments + capsule in preventing hyperextension

132
Q

meniscus tear mechanisms

A

loaded shearing/ twsiting forces in tibiofemoral joint
WB + compression with hyper flexion >90’ (deep flex + twist)
early flexion = anterior meniscus
deep flexion = posterior meniscus
TIBIAL ER = medial meniscus
TIBIAL IR = lateral meniscus

133
Q

meniscus signs/symptoms

A

joint line tenderness
joint effusion
“locking” bucket handle tear
clicking noise
knee “giving away”
reduced ROM
“springy block” end feel

134
Q

meniscus interventions

A

decrease inflammation
pain-free ROM
strengthening
partial/total meniscectomy - WB as tolerated, caution > 90’ flexion 1st six weeks, no deep squatting or cutting sports 3-4 months

135
Q

ACL

A

medial tibial plateau, superior posterior-lateral to lateral femoral condyle (BUL = BACK, UP and LATERAL)
restrains anterior tibial translation, medial tibial rotation, tibial varus/valgus

136
Q

ACL MOI

A

excessive anterior translation
contact - valgus stress on lateral knee (terrible triad)
non-contact - pivot/cutting mvmts tibia ER or tibia IR on fixed femur planted foot
rapid deceleration
forceful hyperextension - skiiiers jump

137
Q

ACL signs/symptoms

A

audible “pop” or “snap”
pain - constant throbbing, aching, increased WB
hemarthrosis
joint effusion
knee “giving out” or instability
reduced ROM

138
Q

ACL interventions

A

decrease pain
decrease swelling - ultrasound, ice
bracing
crutches
strengthening - CKC to OKC - quarter squats
proprioception training
increase ROM
surgery - ACL reconstruction (no blood supply)

139
Q

PCL

A

attaches from lateral tibial plateau, runs superior-anterior-medial to the medial femoral condyle
restrains excessive posterior tibial translation, medial tibial rotation, tibial valgus/varus
stronger + thicker than ACL - less likely to tear

140
Q

PCL MOI

A

deep flexion
dashboard knee
falling on flexed knee - ice skater falling on knees
sudden forceful hyperflexion/hyperextension

141
Q

PCL signs/symptoms

A

pain - constant, throbbing, with mvmt, kneeling, stairs
hemarthrosis after injury
joint effusion
limited ROM acutely
increased passive extension ROM, or in standing

142
Q

PCL interventions

A

decrease pain, swelling
bracing
strengthening
proprioception
restore ROM

143
Q

MCL

A

restrains valgus, lateral tibial rotation (ER), anterior/posterior translation
all fibers taut in full extension

144
Q

MCL MOI

A

valgus force with tibial ER ++

145
Q

MCL signs/symptoms

A

pain - constant, throbbing, WB, mvmt
joint effusion
knee “giving out” or instability
limited ROM

146
Q

MCL interventions

A

same as ACL, PCL
conservative management - blood supply can heal on its own

147
Q

LCL

A

runs from lateral epicondyle of femur to fibular head
restrains varus, lateral tibial rotation, ant/post tib. translation
taut in extension, loosing at > 30’ flexion

148
Q

knee OA non-modifiable risk factors

A

age
gender (F>M)
heredity
congenital malformations

149
Q

knee OA modifiable risk factors

A

OBESITY*
high impact activities
inactivity
muscle weakness
trauma
decreased proprioception
joint mechanics

150
Q

knee OA s/s

A

insidious onset
morning stiffness <30 minutes
pain increased WB, squatting, stairs, static postures, rising from prolonged sitting, walking, fall in barometric pressure
joint line tenderness
reduced ROM, strength, ADL
bony enlargement
crepitus
swelling with no erythema
instability
genu varus/valgus

151
Q

knee OA interventions

A

strengthening
low impact exercise - swimming, cycling, elliptical
reduce swelling, pain
increase ROM
walking aid - cane to unload knee
bracing if needed
weight loss

total knee replacement - 90’ required by 6 weeks or MUA

152
Q

varus knee deformity (effect on knee + correction)

A

gapping at lateral knee joint with increased compression at medial joint line which can cause degeneration. Lateral wedge orthosis will reduce impact on lateral foot and level out foot position to reduce load on medial knee.

153
Q

Patellofemoral Pain Syndrome

A

diffuse pain around kneecap from abnormal patellar tracking
chondromalacia patellae - if degeneration of articular cartilage
common in runners, adolescents, F>M

154
Q

PFPS risk factors

A

extrinsic: increased FITT drastically + suddenly
increased distance, surface, footwear, distance

intrinsic: abnormal patella tracking, inceased q angle, muscle and fascial tightness, hip muscle weakness, VMO insufficiency, lax medial retinaculum

155
Q

Q angle

A

from the ASIS to the midpoint of the patella
other line tibial tubercle to midpoint of the patella

156
Q

PFPS s/s

A

insidious onset
anterior knee pain
pain with kneeling, squatting, stairs, prolonged knee flexion (movie theater sign), knee “buckling” or “giving way”, crepitus, patellofemoral joint pain, swelling and tenderness

157
Q

PFPS interventions

A

reduce activity involving high loads/prolonged loads
bracing/taping to reduce lateral pull
lateral retinaculum stretch
VMO strengthening
glute med strengthening
orthotics

158
Q

patellar subluxation/dislocation interventions

A

early:
immobilization (3-6 weeks)
decrease inflammation
crutches until full extn achieved
normalize gait
isometrics and ROM exercises

later:
CKC - emphasis on VMO/glute med
patellar bracing

159
Q

patellar tendinitis (jumpers knee)

A

degeneration to the patellar tendon causing pain in the infrapatellar region
MOI: jumping sports, repetitive quad overloading
eccentric quads contraction - rapid deceleration, cutting, landing from jump

160
Q

jumpers knee s/s

A

pain with quads contraction - jumping, squatting, resisted knee extension
TOP
localized swelling
quads weakness

161
Q

jumpers knee interventions

A

patellar tendon strap
avoid overloading
progressive loading - eccentric quads (decline squat)

162
Q

osgood-schlatter disease

A

traction apophisitis of the tibial tuberosity
common overuse injury in adolescents (growth spurts)
repeated tension of growth plate of upper tibia
increased FITT in sports involving running/jumping

163
Q

bakers cyst

A

excess fluid collection
intra-articular knee pathologies (OA, RA, meniscus tear)
swelling in popliteal fossa, joint stiffness, decreased ROM, warmth, pain - mvmt, knee extn, standing
interventions - manage inflammation, compression sleeve, self-limiting (will resolve on its own)

164
Q

osteochondritis dissecans

A

cracks from the articular cartilage and subchondral bone due to avascular necrosis
causes pain, crepitus, swelling
catching/locking if loose body in joint
increased pain with squatting, walking, going down stairs

165
Q

myositis dissecans

A

formation of bone inside muscle-tendon unit, capsule or ligamentous structures
calcification after injury typically in quads following contusion, strain, or other traumatic injury to the muscle

contraindications: MASSAGE, PASSIVE STRETCHING, RESISTED EXERCISES**

166
Q

TMJ max opening / functional opening

A

max = 50mm/5cm/3 flexed proximal interphalangeal joint
functional = 40mm/4cm/2 flexed proximal interphalangeal joints

167
Q

TMJ hypomobility

A

pain is on same side as deviation (ipsilateral)
wheechair locked - R side = left will pull towards right

168
Q

TMJ hypermobility

A

pain on opposite side on deviation
deviation towards unaffected side

169
Q

TMJ lateral deviation muscles

A

iplsilateral temporalis
contralateral masseter, medial pterygoid, lateral pterygoid

170
Q

nerves of the TMJ

A

trigeminal nerve (CN 5) - difficulty with shaving for men

171
Q

TOS - costoclavicular syndrome

A

costoclavicular space - between clavicle and 1st rib (subclavicular)

172
Q

TOS - anterior scalene syndrome
interscalene triangle

A

between scalenus anterior and medius (supraclavicular) and the rib at the base

173
Q

resting position of shoulder

A

40-55’ abd, with slight (30’) horizontal add, ER

174
Q

hyperabduction syndrome TOS

A

axillary interval - under coracoid process and behind pec minor (infraclavicular)

175
Q

neurogenic “true” TOS
nonspecific “symptomatic” neurogenic TOS

A

anatomical anomaly compressing brachial plexus - cervical rib
similar signs/symptoms with no evidence of anatomical anomaly, muscle atrophy of EMG findings.&raquo_space; maladaptive posture = shortening of scalene muscles and pec minor (hypertrophy scalenes)
athletes with overhead sports abd + ext rotation
pressure of bra strap, backpack

paresthesia
numbness
weak grip strength
loss of manual deterity/fine motor mvmts in hands

special tests - relief of symptoms
roo’s test (90/90 hold open close fists), shoulder girdle passive elevation (cyriax release test)

176
Q

vascular arterial TOS

A

compression of subclavian artery due to cervical rib or thrombus
aggravated by arm motion, overhead activity. Pancoast tumor

cool skin
pale colour extremities
reduced/absent pulse
rapid fatigue/heaviness of limb
lower BP on affected side

special tests - radial pulse disappears
> Adson’s, military brace, Halstead, wright, Allen

177
Q

Vascular Venous TOS

A

compression of subclavian vein does not cause complaint, tyically due to thrombus or another cause. Pancoast tumor

painful swelling in arm
mottled, bluish discoloration

special tests - radial pulse disappears
> Adson’s, military brace, Halstead, wright, Allen

178
Q

shoulder separation (AC)

A

step deformity -distal end sticking up
grade 3 sprain - both acromioclavicular and coracoclavicular ligaments torn. deltoid + traps muscles may be torn from distal clavicle

cross body/horizontal adduction test

179
Q

frozen shoulder

A

progressive loss GHJ ROM in capsular pattern (LAM) due to development of dense adhesions and capsular thickening
F>M 40-60 years
primary: idiopathic
secondary: other conditions with shoulder pain/restricted ROM (stroke, trauma, immobilization, surgery, MI, DM, OA, RA)

180
Q

frozen shoulder s/s

A

loss ROM ++ HBB, HBH, overhead activities
capsular pattern
reverse scapulohumeral rhythm 1:2 GHJ:scapula (normal=2:1)
trick mvmts - shoulder hiking, side bending
general muscle weakness with low endurance

181
Q

frozen shoulder stages

A

1 = (< 3 months) gradual onset pain, increasing with mvmt/at night, loss ER
2 = “freezing” (3-9 months) persistent increased pain even at rest (dull and achy), restricted ROM all directions capsular
3 = “frozen” (9-15 months) pain only with mvmt, significant adhesions, hard capsular end feel, restricted ROM with scapula compensations, muscle atrophy deltoid, rotator cuff, biceps, triceps
4 = “thawing” (15-24+ months) minimal pain, significant capsular restrictions with gradual return ROM, may never recover ROM

ultrasound = deep and thermal settings

182
Q

subacromial impingement

A

impingement of the structures (subacromial bursa, supraspinatus tendon, LHB, coracoacromial ligament, joint capsule) from increased pressure on a narrowed space
due to structural, functional, or calcific tendinitis (supraspinatus tendon)

183
Q

subacromial impingement s/s

A

painful arc 60-120 degrees
pain with overhead activities, side lying in anterior/lateral shoulder
no radiation below elbow*
no pain at rest
reversed scapulohumeral rhythm, HBB, HBH
pain/weakness resisted abduction and ER

184
Q

palpation shoulder structures

A

supraspinatus tendon - HBB
subacromial bursa - passive shoulder extension

physio (9 decks)

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