MSK Flashcards
1
Q
If a patient has Adhesive Capsulitis, what joint mobilization should you do to improve their shoulder ROM?
A
Posterior-inferior glide
2
Q
The coracohumeral ligament prevents a dislocation in which direction?
A
Inferior or caudal
3
Q
The superior glenohumeral ligament limits which shoulder motion(s)?
A
Limits ER and inferior translation of the humerus
4
Q
The middle glenohumeral ligament limits which shoulder motion(s)?
A
Limits ER and anterior translation of the humerus
5
Q
The inferior glenohumeral ligament limits which shoulder motion(s)?
A
Anterior band: limits ER, anterior, and superior translation
Posterio band: limits IR and anterior translation
6
Q
Purpose of the transverse humeral ligament.
A
Protect the long head of the biceps tendon in the groove.
7
Q
Does the ulna supinate or pronate when the elbow goes into flexion?
A
Supinates
8
Q
Does the ulna supinate or pronate when the elbow goes into extension?
A
Pronates
9
Q
How is the distal radius shaped in regard to the carpal bones?
A
Biconcave
Convex scaphoid and lunate articulate with concave radius
10
Q
How is the distal ulna shaped in regard to the triquetrum?
A
Convex relative to the triquetrum
11
Q
First CMC is what kind of joint? Describe how it changes when moving in the medial/lateral direction vs the anterior/posterior direction.
A
Saddle joint
In the medial/lateral direction the trapezium is convex; in the anterior/posterior direction, the trapezium is concave.
12
Q
What is the orientation of the glenoid fossa?
A
Anterior, superior, and lateral
13
Q
What is the orientation of the femur in the acetabulum?
A
Anterior, superior and medial
14
Q
What is normal angle of inclination?
A
115 to 125 degrees
15
Q
Coxa valga angle is what value?
A
> 125
16
Q
Coxa vara angle is what value?
A
< 115
17
Q
Anteversion is considered excessive if it is what value?
A
> 25-30 degrees
18
Q
Retroversion is considered excessive if it is what value?
A
< 10 degrees
19
Q
If someone has excessive anteversion at the hip, what will they do to compensate and WHY?
A
They will perform in-toeing because if they don’t, they place the femur too far anterior, risking a sublux or dislocation. After a patient does in-toeing, the femoral head is placed more posteriorly.
20
Q
If someone has excessive retroversion at the hip, what will they do to compensate and WHY?
A
They will perform out-toeing because if they don’t, they place the femur too far posterior, risking a sublux or dislocation. After a patient does out-toeing, the femoral head is placed more anteriorly.
21
Q
Glute max is innervated by what nerve?
A
Inferior gluteal nerve
22
Q
The superior band of iliofemoral ligament is taut with adduction or abduction?
A
Adduction
23
Q
The inferior band of iliofemoral ligament is taut with adduction or abduction?
A
Abduction
24
Q
The ischiofemoral ligament is taut with what motions at the hip?
A
Medial rotation, extension, and abduction
25
Normal gait on level ground requires at least the following hip joint ROMs: flexion, extension, abduction/adduction, and IR/ER
30 flexion
10 extension
5 abduction/adduction
5 IR/ER
26
The ACL limits what?
Anterior translation of the tibia on the femur
27
The MCL and LCL of the knee both limit IR or ER?
ER
28
The PCL limits what?
Posterior translation of the tibia on the femur
29
What ligament pulls the menisci forward with extension?
The meniscopatellar ligaments
30
Describe the shape of the medial meniscus.
It is large, C-shaped, and fairly stable.
31
What does the medial meniscus attach to?
MCL and fibrous capsule
32
Describe the shape of the lateral meniscus.
It is smaller than the medial meniscus and more circular.
33
Does the medial or lateral meniscus move more?
Lateral
34
Unlocking of the screw-home mechanism into knee flexion occurs through action of what?
Popliteus
35
Twisting of the cruciate ligaments limit ER or IR?
IR
36
If you want to improve inversion at the ankle, what joint mobilization should you perform?
Lateral glide of calcaneus on talus
37
If you want to improve eversion at the ankle, what joint mobilization should you perform?
Medial glide of calcaneus on talus
38
Which nerve roots are being assessed when having the patient toe walk for a lower quarter screen?
S1, S2
39
Which nerve roots are being assessed when having the patient heel walk for a lower quarter screen?
L4, L5
40
Resisted hip flexion for a lower quarter screen assesses which nerve roots?
L2, L3
41
Resisted knee extension for a lower quarter screen assesses which nerve roots?
L3, L4
42
What does the Alar ligament attach to? What motions does it limit?
Attaches the dens to the occiput. Limits neck flexion, contralateral sidebending, and contralateral rotation.
43
Where is the costovertebral angle found?
Below the angle of the 12th rib
44
What does the Iliolumbar ligament attach to? What motions does it limit?
Attaches from the ilium to the transverse processes of L5. It limits the motion of L5 on S1.
45
At what level does the spinal cord terminate? What is it anatomically called?
L1-L2
Conus medullaris
46
What occurs at the facet joints when performing spine flexion?
Upper facets move anteroproximally and tilt forward
47
What occurs at the facet joints when performing spine extension?
Upper facets move downward, posterior, and tilt backward
48
What is the difference between cervical and lumbar rotation in regard to the facet joints?
The cervical facet joints will approximate on the ipsilateral side the patient is rotating towards; the lumbar facet joints will gap on the ipsilateral side the patient is rotating towards.
49
Nutation vs counternutation
Nutation: describes movement that involves flexion of the sacrum and posterior rotation of the ilium
Counternutation: describes movement that involves extension of the sacrum and anterior rotation of the ilum
50
When you begin to open the jaw, it is a roll or glide FIRST?
Roll first then glide
51
Is the dense connective tissue that covers the articulating surfaces of the TMJ, vascular or avascular? Neural or aneural?
Avascular and aneural
52
Is the disc of the TMJ vascular or avascular? Neural or aneural?
Avascular and aneural
53
As the mandible slides anteriorly with jaw opening, the disc of the TMJ does what?
Slides anteriorly
54
Anteriorly, the disc of the TMJ is attached to what two structures?
Joint capsule and superior lateral pterygoid muscle
55
Does the disc of the TMJ usually dislocate anteriorly or posteriorly? And during what motions is this most susceptible?
Anteriorly
Occurs with yawing or taking a large bite of something
56
Functional opening combines what two kinematic movements and is approximately what range?
Rotation and translation
40 mm
57
Which muscles elevate the mandible during closuring?
Masseter, temporalis, and medial pterygoid
58
Which muscles protrude the mandible?
The lateral and medial pterygoid muscles
59
Which muscles retrude the mandible?
The posterior fibers of the temporalis muscle
60
What is a likely possibility if a patient presents as strong and painful with resisted muscle testing?
Minor structural lesion of the muscle-tendon unit
61
What is a likely possibility if a patient presents as weak and painless with resisted muscle testing?
Complete rupture of muscle-tendon unit or neurological deficit present. Further testing is needed.
62
What is a likely possibility if a patient presents as weak and painful with resisted muscle testing?
Partial disruption of muscle-tendon unit. Pain response due to serious pathology or concurrent neurological deficit.
63
What MMT grade is considered Fair?
3
64
What MMT grade is considered Poor?
2
65
How is a 3+/5 MMT grade described?
Able to move against gravity and resist minimal pressure
66
How is a 3-/5 MMT grade described?
Can only move into the test position against gravity but gradual release against gravity
67
How is a 2+/5 MMT grade described?
Can move against gravity in a small ROM
68
Nerve roots tested for Biceps DTR?
C5, C6
69
Nerve roots tested for Brachioradialis DTR?
C6
70
Nerve roots testing for Triceps DTR?
C7
71
Nerve roots tested for Patellar Tendon DTR?
L3, L4
72
Nerve roots tested for Achilles Tendon DTR?
S1, S2
73
A 1+ for DTR testing is considered what?
Hyporeflexia
74
A 2+ for DTR testing is considered what?
Normal
75
A 3+ for DTR testing is considered what?
Hyperreflexia
76
How do you perform the Vertebral Artery Test?
The patient fully extends and rotates the neck to one side and holds the position for AT LEAST 10 SECONDS!
77
The Quadrant test is also known as what test?
Spurling's
78
If the Quadrant test is positive, what does this imply and what should happen afterwards?
The cervical spine requires further examination for cervical radiculopathy, cervical disc prolapse, and neck pain.
79
A prone knee bend assesses what?
Femoral nerve
80
What are the steps of the slump test?
The patient slumps into lumbar thoracic flexion while looking straight ahead. The patient then fully flexes the neck and extends one leg. The patient next DFs the ipsilateral foot of extended leg.
81
What does your radial nerve innervate?
Triceps
Anconeus
Abductor pollicis longus
Supinator
Brachioradialis
All the extensors
82
The radial nerve passes under what muscle in the forearm?
Extensor carpi radialis brevis
83
Wrist drop is associated with injury to what nerve?
Radial
84
How would a patient present if they had Cubital Tunnel Syndrome?
Paralysis of Flexor carpi ulnaris, flexor digitorum profundus (ulnar half), hypothenar eminence, interossei, and the 3rd and 4th lumbricals. All sensations affected. Inability to grasp paper.
85
What is the presentation of an Ulnar Claw Hand?
Hyperextension at 4th, 5th, MCP; flexion at 4th, 5th IP due to weakness of flexor digitorum profundus.
86
Hypertrophy of what forearm muscle can compress the median nerve?
Pronator teres
87
Supraspinatus performs shoulder abduction up to how many degrees?
15
88
Action of Infraspinatus?
ER and abduction of shoulder
89
Action of Teres Major?
IR, extension, and adduction
90
Action of Subscapularis?
IR and adduction
91
What three muscles are scapular elevators?
Upper trap, levator scap, and rhomboids
92
What muscles perform scapular protraction?
Pec minor and major, serratus anterior,
93
What muscles are scapular depressors?
Pec minor and major; lattisimus dorsi; serratus anterior; lower trap
94
Which carpal bone is the most frequently fractured?
Scaphoid
95
The radiocarpal joint is stabilized medially by which structure?
The triangular fibrocartilage complex (TFCC)
96
The wrist is naturally positioned in flexion or extension? How many degrees?
20-30 degrees extension
97
What type of fracture can result in damage to the radial artery?
Supracondylar
98
A power grip requires what motions?
Slight wrist extension, ulnar deviation, and finger flexion.
99
When the MCPs are stable, what muscle flexes the PIPs? When the PIPs are stable, what muscle flexes the DIPs?
FDS flexes the PIPs
FDP flexes the DIPs
100
What two muscles are most important in IR at the hip?
Anterior fibers of the glute med and min
101
Blood supply of the menisci?
Inner 2/3rds is avascular; outer 1/3rd is mostly vascular
102
The superior angle of scapula is at what vertebral level?
T2
103
The spine of the scapula is at what vertebral level?
T3
104
The inferior angle of the scapula is at what vertebral level?
T7
105
The xiphoid process is at what vertebral level?
T7
106
The iliact crest/umbilicus is at what vertebral level?
L4
107
The PSIS is at what vertebral level?
S2
108
ROM value for pronation/supination at the wrist?
90 degrees
109
ROM value for ankle DF?
20 degrees
110
ROM value for hip extension?
10-15 degrees
111
A forward lean of the trunk during stance phase may be performed by a patient because?
They may have weak quadriceps
112
Jerk Test
Assesses for posterior instability of the shoulder
Patient is seated with their arm in 90 degrees of shoulder flexion and IR. The therapist then provides axial compression through the joint and horizontally adducts the arm.
Positive test: the production of a sudden jerk or clunk as the humeral head slides off the back of the glenoid. When the arm is returned to the original 90 degree abducted position, a second jerk may be felt as the head reduces.
113
Neer's Test
For impingement of supraspinatus and biceps tendon.
The patient's arm is passively and forcibly fully elevated in the scapular plane with the arm IR by the examiner. This passive stresses causes the greater tuberosity to jam against the acromion.
Positive test: reproduces symptoms of pain in the shoulder region.
114
Supraspinatus Test
AKA Empty Can/Jobe Test.
Identify tear/impingement of supraspinatus tendon or suprascapular nerve neuropathy.
The patient's arm is abducted to 90 degrees with no rotation and the examiner resists abduction. The shoulder is then IR and angled forward 30 degrees so that the patient's thumbs point toward the floor.
Positive: reproduces pain in supraspinatus tendon or weakness in empty can position.
115
External Rotation Lag Sign
Test Teres Minor and Infraspinatus.
The patient is seated or in standing with the arm by the side and the elbow flexed to 90 degrees. The examiner passively abducts the arm to 90 in the scapular plane and ER the shoulder to end range. The patient is asked to hold the position.
Positive: inability of patient to hold the position.
116
Infraspinatus Test
Testing Infraspinatus.
Patient resists ER with arm neutrally rotated and adducted to the trunk.
Positive: patient gives way
117
Hornblower Sign
To detect rotator cuff tears involving the teres minor
PT passively elevates the arm to 90 degrees in scapular plane and flex elbow to 90 degrees. Patient externally rotates the shoulder against resistance.
Positive: the patient is unable to ER the shoulder in this position.
118
Horizontal Adduction Test
AC joint pathology
Patient actively or passively is brought into shoulder horizontal adduction with shoulder flexed to 90 degrees.
Positive test: pain is localized to over the AC joint.
119
Active Compression (O'Brien's) Test
Detect SLAP or superior labral lesions
The patient stands with his or her involved shoulder at 90 degrees of flexion, 10 degrees of horizontal adduction, and maximum IR with the elbow in extension. In this position, the patient then resists a downward force applied by the PT to the distal arm. The test i s then repeated in the same manner but the arm is positioned in maximum ER.
Positive test: if pain on the joint line or painful clicking is produced inside the shoulder (not over the AC joint) in the first part of the test and eliminated or decreased in the second part, the test is considered positive for labral abnormalities.
120
Bicep's Load Test
Check integrity of the superior labrum.
The patient is supine or seated with the shoulder abducted to 120 degrees and ER with the elbow flexed to 90 degrees and the forearm supinated. The examiner performs and apprehension test on the patient by taking the arm into ER. If apprehension appears, the examiner stops ER and holds the position. The patient is then asked to flex the elbow against the examiners resistance at the wrist.
Positive: if apprehension decreases or the patient feels more comfortable, the test is negative for SLAP lesion. If the apprehension remains the same or the shoulder becomes MORE painful, the test is considered positive for SLAP lesion.
121
Yergason's Test
Test integrity of the transverse ligament
Patient is sitting with elbow flexed to 90 degrees and stabilized against the thorax and with the forearm pronated. The therapist resists the supination of the forearm and ER of shoulder.
Positive: tendon of long head of biceps will pop out of the groove. Tenderness in the bicipital groove alone without the dislocation may indicate bicipital tendinosis.
122
Speed's Test
Identify bicipital tendinosis/tendinopathy
Upper limb in full extension and forearm supinated, resist shoulder flexion. Alternate - place shoulder in 90 degrees flexion and push upper arm into extension.
Positive: pain in long head of biceps tendon/increased tenderness in the bicipital groove.
123
Patient positioning for ULTT1
What nerve is being assessed
Median nerve
Supine with shoulder depressed and abducted to 110; elbow extended; forearm supinated; wrist and fingers extended; cervical spine is contralateral side flexion.
124
Patient positioning for ULTT3
What nerve is being assessed
Radial nerve
Supine with the shoulder depressed, IR, abducted 40 degrees, and extended 25 degrees; elbow extended and pronated; wrist flexed and in ulnar deviation; fingers flexed; cervical spine is in contralateral side flexion.
125
Patient positioning for ULTT4
What nerve is being assessed
Ulnar nerve
Supine with the shoulder depressed and abducted (10 to 90 degrees), hand to ear; elbow flexed; supination or pronation; wrist is extended and radially deviated; fingers extended; cervical spine is in contralateral side flexion.
126
Adson's Test
Thoracic Outlet Syndrome
Patient is in sitting. Therapist finds radial pulse on side being tested. Rotate patients head towards the extremity and then extend and ER the shoulder while extending the head.
127
Lateral Epicondylitis Test
AKA Tennis elbow/Cozen's test
The patient is sitting with the elbow flexed to 90 degrees flexion and then asked to actively make a fist, pronate the forearm, and radially deviate and extend the wrist while the examiner resists the motion.
Positive: sudden severe pain in the area of the lateral epicondyle of the humerus.
128
Mill's Test
Lateral epicondylitis
While palpating the lateral epicondyle, the examiner passively pronates the patient's forearm, flexes the wrist fully, and extends the elbow.
Positive: pain over the lateral epicondyle of the humerus.
129
Maudsley's Test
Lateral epicondylitis
The examiner resists extension of the 3rd digit distal to the PIP joint, stressing extensor digitorum.
Positive: pain over the lateral epicondyle
130
Medial Epicondylitis Test
AKA Golfer's elbow test
While the examiner palpates the patient's medial epicondyle, the patient's forearm is passively supinated and the examiner extends the elbow and wrist.
Positive: indicated by pain over the medial epicondyle.
131
Finklestein's Test is used for what?
Determine the presence of de Quervain disease
132
Bunnel-Littler Test
Identifies tightness in structures surrounding the MCP joint.
The MCP joint is held in slight extension while the examiner moves the PIP joint into flexion, if possible.
Result: it is tight intrinsics if the examiner slightly flexes the MCP and is able to passively flex the PIP joint. It is capsular tightness if the therapist is still unable to flex the PIP joint while the MCP is slightly flexed.
133
Tight Retinacular Test
Identify tightness around the PIP joint
The PIP is held in a neutral position while the DIP is flexed by the examiner. If the DIP does not flex, the retinacular (collateral) ligaments or PIP capsule are tight. If the PIP is flexed and the DIP flexes easily, the retinacular ligaments are tight and the capsule is normal.
134
Warternberg Sign
Identify ulnar nerve neuropathy
The patient sits with his or her hands resting on the table. The examiner passively spreads the fingers apart and asks the patient to bring them together.
Positive: inability to squeeze the little finger to the remainder of the hand.
135
Murphy's Sign
Identify lunate dislocation
The patient is asked to make a fist. If the head of the 3rd metacarpal is level with the second and fourth metacarpals, the sign is positive and indicative of a lunate dislocation.
136
What is normal discrimination distance recognition for the 2-point discrimination test?
6 mm
137
Allen's Test
Identify vascular compromise
The patient is asked to open and close the hand several times as quickly as possible and then squeeze hand tightly. The examiner's thumb and index finger are placed over the radial and ulnar arteries, compressing them. The patient then opens the hand while pressure is maintained over the arteries. One artery is tested by releasing the pressure over that artery to see if the hand flushes. The other artery is then tested in a similar fashion.
138
Is OKC or CKC preferred following an ACL reconstruction?
Begin this during weeks 2-4. More so CKC, but you want to avoid CKC quadriceps strengthening between 60 to 90 degrees of flexion. If you do OKC, the knee should stay between 90 to 45 degrees of flexion.
139
For Laslett's cluster, how many of the tests have to be positive to rule in SIJ pain?
3/5 if it includes Gaenslen's
2/4 if it does not include Gaenslen's
140
When the MCPs are stable, what muscle flexes the PIPs?
FDS
140
When the PIPs are stable, what muscle flexes the DIPs?
FDP
140
What would happen to function of the hand if the radial nerve became damaged?
Affects the ability to maintain functional wrist position and to release an object
140
What would happen to function of the hand if the median nerve became damaged?
Affects flexion of digits on radial side and precision grip
141
What would happen to function of the hand if the ulnar nerve became damaged?
Affects flexion of digits on ulnar side and power grip.
141
What fracture is most common in the elderly after a fall?
Femoral neck fracture
142
What condition is associated with edema, pain, decreased circulation, osteoporosis, skin dryness, decreased proprioception, and atrophy of muscle surrounding the area?
Complex regional pain syndrome
143
What are some treatment options for patients with CPRS?
WBing or CKC exercises, massage, and manual lymphatic drainage
144
What is the ONE thing we should absolutely ask someone about if they have or we suspect Fibromyalgia?
Sleep!!!
145
What three extrinsic factors are often related to patients with fibromyalgia?
Stress, fatigue, and sleeplessness
146
If you were looking to view complex fractures, facet dysfunction, disc disease, or stenosis, what imaging would you complete?
CT scan
147
Which T-weighted MRI image is better for viewing soft tissue?
T2
148
Which T-weighted MRI image is better for viewing bone?
T1
149
Arthrography
Dye injected to view abnormalities within the joint
150
Myelography
Dye injected and visualized as it passes through the vertebral canal.
151
FADIR test is used for which conditions?
Hip impingement, labral, or iliopsoas tendinitis
152
Ely test
Used to test rectus femoris tightness
153
What landmarks are used for true leg length discrepancy?
ASIS to medial or lateral malleoli
154
Which femoral fracture is considered a red flag?
Femoral neck stress fracture due to the circumflex artery, leading to possible avascular necrosis.
Femoral shaft fracture is also a red flag because it will injure neurovasculature.
155
Pivot-shift test is used to test what? How do you perform it?
Integrity of ACL
Have the patient supine with the knee extended and the hip flexed/abducted to 30 degrees with slight IR. You place valgus force through the knee and flex it. A positive test would be the tibia relocating during the test.
156
How do you perform the patellar apprehension test?
Supine with the knee flexed to 30 degrees, passively translating the patella laterally
157
How can you differentiate between a meniscus vs ligamentous injury with Apley's?
The patient is supine with the knee flexed to 90. If rotation and distraction is more painful or shows increased rotation relative to other side, it is probably ligamentous. If rotation and compression is more painful or shows decreased rotation relative to other side, the lesion's probably meniscus.
158
What is the normal Q-angle for males? Females?
Males is 13 degrees
Females is 18 degrees
159
To compress the neural structures at the IV foramen, what movements close them off?
SB ipsilateral, rotate ipsilateral, and extend to close the same side IV foramen
160
To compress the neural structures at the facet, what movements close them off?
SB ipsilateral, rotate contralateral, and extend to close the same side facet
161
Aberrant movement testing includes what?
Instability catch, painful arc in flexion, painful arc in return from flexion, Gower's sign, reversal of lumbopelvic rhythm
162
Does Ankylosing Spondylitis start in the axial or appendicular skeleton?
Axial
163
What will the spine look like for someone with Ankylosing Spondylitis?
Increased kyphosis of thoracic and cervical spine, decreased lumbar lordosis
164
What is one important treatment intervention a PT should include for someone with Ankylosing Spondylitis? And why?
Breathing strategies to improve/maintain vital capacity since later on in the disease, the peripheral and costovertebral joints are affected
165
What two places are most affected with Gout?
Knee and big toe
166
Psoriatic arthritis is usually in what kinds of joints?
Digits as well as axial skeleton
167
What drugs can help slow the progression of psoriatic arthritis?
DMARDs
168
What joints are most commonly affected with RA?
Hands, feet, and c-spine
169
Which condition shows elevated WBC and erythrocyte sedimentation rate for lab values?
RA
170
Which population commonly has tronchanteric bursitis?
RA
171
What sites in the body are more commonly affected with osteoporosis?
T and L-spine, femoral neck, proximal humerus, proximal tibia, pelvis, and distal radius
172
What is Osteomalacia?
Decalcification of bone because of vitamin D deficiency
173
Myofascial pain syndrome is more commonly known as?
Trigger points
174
Is there typically a MOI for Myositis Ossificans?
Yes, it is usually precipitated by trauma
175
What do you need to be careful of when working with someone with Myositis Ossificans?
You do NOT want to be too aggressive with muscle flexibility.
176
Difference between Type I and II CRPS?
Type I: frequently triggered by tissue injury but NO underlying nerve injury.
Type II: same as above but associated with nervy injury
177
What modality is recommended for a patient with CRPS?
TENS
178
Paget's Disease
Slowly progressive metabolic bone disease. Abnormal osteoclastic and blastic activity. Labs will show increased levels of serum alkaline phosphatase and urinary hydroxyproline.
179
Which shoulder condition/injury is associated with complaints of night pain?
Rotator cuff lesions
180
What is level A evidence for patients with Adhesive Capsulitis?
Corticosteroid injections with shoulder mobility and stretching
181
What is the "gold" standard for diagnosing a labral tear? What is also very effective?
Gold standard is arthroscopic surgery and MRI arthrogram is very effective
182
What are the common areas of compression for Thoracic Outlet Syndrome?
Between the first rib and clavicle
Scalene triangle
Thoracic outlet
Between pec minor and thoracic wall
183
Why are the rotator cuff muscles more susceptible to tendonitis?
Due to the relatively poor blood supply near insertion of muscle
184
Humeral neck fractures are more common in what population, and how does it typically occur?
Older osteoporotic women by falling onto an outstretched hand
185
Capsular pattern at the elbow
Flexion is more limited than extension
186
Is an orthosis recommended for patients with CTS? If so, when should it be worn?
Yes; it should be worn at night for short-term relief with the wrist in a neutral position
187
What are three populations that are more commonly affected by CTS?
Diabetics, RA, and repetitive wrist motions or gripping with pregnancy
188
What muscles are involved for deQurvain's Tenosynovitis?
Abductor pollicis longus and extensor pollicis brevis
189
What is the opposite of a Colles Fracture?
Smith fracture
190
What is Dupuytren's contracture?
Banding on palm and digit flexion contractures due to palmar fascia adhering to skin
191
Boutonniere vs Swan Neck Deformity
Boutonniere: caused by rupture of the central tendinous slip, leading to extension at the MCP and DIP, and flexion at the PIP
Swan neck: caused by contracture of the intrinsic muscles with dorsal sublux of lateral extensor tendons, leading to hyperextension of MCP, extension of PIP, and flexion of the DIP.
192
What position at the foot can lead to the piriformis being overworked?
If the foot is overly pronated
193
CAM vs Pincer impingement
CAM: too large femoral head
Pincer: too large acetabular rim
194
Is NMES considered level A evidence for ACL reconstruction?
Yes and can be used up to 6-8 weeks
195
A meniscus injury will have immediate or delayed effusion?
Delayed (6-24 hours)
196
Patella alta
Patella baja
Alta: too high; can lead to chronic patellar subluxation
Baja: too low; can lead to DJD
197
When would you want to use a sunrise view on x-ray?
To view the alignment of the patella
198
What activities are bothersome for a patient with PFPS? What about for patellar tendinopathy?
Squatting, prolonged sitting, stair climbing, other functional activities. Patellar tendinopathy will be more so jumping.
199
Ottowa Knee Rules
Patient had a knee injury and one of the following:
Unable to WB immediately after and in ED
Unable to flex knee to 90
Age 55 years or older
Tenderness of fibular head
200
Acute Compartment Syndrome occurs following?
Trauma and/or fracture
201
What are the 6 P's?
Pain
Pallor
Paraesthesia
Pulselessness
Palpable tenderness
Paresis
202
Ottowa Foot and Ankle Rules
Ankle: pain in malleolar zone and any of the following:
Bone tenderness from posterior edge or tip of lateral/medial malleolus, extending 6 cm proximally
Unable to take 4 steps immediately after and in the ED
Foot: pain in the midfoot zone and any of the following:
Bone tenderness at the base of the 5th met
Bone tenderness at the naviular
Unable to take 4 steps immediately after and in the ED
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Charcot Marie Tooth Disease
Peroneal muscular atrophy that affects motor and sensory nerves. Initially it is the lower leg and foot but eventually progresses to muscles of hands and forearm.
204
What is level A evidence for Plantar Fasciitis?
Manual therapy (joint and soft tissue mob)
Stretching
Should tape (1-3 weeks)
Should use foot orthoses (2 weeks-1 year)
Night splints (1-3 months)
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Risk factors for neck pain
Female
History of neck pain
History of LBP
Smoking history
Poor work/social support
High demand job
Older age
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What is van Gelderen's test?
The bicycle test for spinal stenosis vs intermittent claudication
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Is the posterior or anterior disc more narrow in height?
Posterior
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Does the Canadian C-spine rules have high sensitivity or specificity?
Sensitivity
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Are spinal manipulations generally indicated for patients with whiplash?
Yes
210
Metastatic bone tumors typically arise from what primary tumor sites?
Thyroid, lung, kidney, breast, and prostate
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Most common primary bone tumor is?
Multiple myeloma
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If a restriction is present at the TMJ, what is the primary glide that should be performed?
Inferior because it stretches the capsule, gaps the joint, and allows relocation of the anterior displaced disc.
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What TMJ condition is associated wtih pain in the periauricular area, inability to fully close the teeth, pain with rest, and < 40 mm opening secondary to pain?
Synovitis and capsulitis
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Will a patient with TMJ hypermobility have > or < 40 mm of mandible depression? Will they deviate towards one side?
They will open > 40 mm with deviation towards the non-involved side
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If a patient has a disc displacement without reduction, will they deflect towards the involved or non-involved side?
Involved
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What are the Rocabado exercises? Parameters?
6 x 6
Tongue clucks, controlled TMJ rotation on opening, mandibular rhythmic stabilization, scapular retractions, chin tucks, and stabilized head flexion (nodding).
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What is normal anterior angle of the femoral head in the acetabulum?
10-25
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Foot position of a child with Talipes Equinovarus
PF, adducted, and inverted foot
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What is the most common cause of Talipes Equinovarus?
It is mostly postural due to intrauterine positioning
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If Talipes Equinovarus is postural, what is the treatment?
Manipulation followed by casting (Ponsetti method) or splinting. After the cast is removed, you will stretch the foot and the child will wear an orthoses (Denis-Brown splint) throughout the day for up to 3 months then at night for up to 3 years.
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If Talipes Equinvarus is non-postural, what is the treatment?
They will require surgery, followed by casting or splinting.
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If a child presents with Genu Valgum at the knee, what is the most likely reason?
Due to excessive lateral rotation at the tibia. By going into Genu Valgum, the tibia will go into more medial rotation.
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If a child presents with Genu Varus at the knee, what is the most likely reason?
Due to excessive medial rotation at the tibia. By going into Genu Varus, the tibia will go into more lateral rotation.
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What is the gold standard for a child with Hip Dysplasia?
Pavlik Harness
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Barlow vs Ortolani tests
Barlow: subluxes the hip (flex, adduct, and IR hip)
Ortolani: reduces the hip (flex, abduct, and ER hip)
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Legg-Calve Perthes Disease
Avascular necrosis of the hip in children due to blood supply interruption to the femoral head.
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Typical age onset for Legg-Calve Perthes Disease? Are males or females more affected?
2-13 years
Males are 4 times more likely
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Slipped capital femoral epiphysis
Femoral head is displaced posterior and inferior in relation to the femoral neck.
229
Osgood Schlotter's
Traction apophysitis of tibial tubercle at patellar tendon insertion. You want to stretch the hamstrings in the acute phase then you can progress to strength and stretching of the quads in subacute/chronic. Limit squatting, running, or jumping.
230
Sever's Disease
AKA calcaneal apophysitis
Most common cause of heel pain in growing children
Caused by repetition microtrauma due to increased traction by the Achilles tendon on its insertion site
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Sinding-Larsen Johannson's Disease
Traction apophysitis at patella-patellar tendon junction. It is an overuse injury due to repeated stresses.
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Osteochondritis Dissecans
Separation of articular cartilage from underlying bone (osteochondral fracture) usually involving the medial femoral condyle
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What are the angles for scoliosis that indicate conservative treatment? Bracing? Surgical?
Conservative if < 25
Bracing if 25 to 45
Surgical if > 45
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Arthrogryposis Multiple Congenita
Congenital deformity of skeleton and soft tissues. "Sausage-like" appearance of limbs. Nonprogressive contractures! Limitation in joint motion
235
Spondylolisthesis
Actual anterior or posterior slippage of 1 vertebra after BILATERAL fracture of pars interarticularis
236
Do you want to really focus on extension or flexion ROM when restoring ROM after ACL reconstruction?
Extension
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Is bone to bone or soft tissue to bone faster at healing?
Bone to bone healing is faster than soft tissue to bone
238
What is something to keep in mind with Rotator Cuff Repairs in the first few weeks of rehab?
The patient is immobilized for 4-6 weeks with NO active shoulder motion or WBing for that time frame.
239
Is someone immobilized after PCL reconstruction?
Typically for 6 weeks in full extension
240
What ROM do you want to achieve for someone post TKR within 2 weeks? 3-4 weeks?
0-90 for 2 weeks
0-120 for 3-4 weeks
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When can you begin resisted exercise for a patient post TKR?
2-3 weeks post-op
242
What are the lumbar fusion precautions?
Avoid end-range rotation and extension, no intrinsic abs, and no impact loading for 3 months.
243
Besides grade I sprains and strains, does muscle or ligament take longer to heal?
Ligament
244
What type of drug is Celebrex?
Selective (COX-2) NSAID
245
What are the short-term and long-term implications of corticosteroids?
Short-term: weight gain, depression, anxiety, mood wings.
Long-term: may cause osteoporosis or avascular necrosis
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What type of drugs are Cyclobenzaprine HCl (Flexeril, Amrix), Methocarbamol (Robaxin, Carbacot), and Carisoprodol (Soma, Vanadone)?
Muscle relaxants
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What type of drug is Tramadol?
Opioid
248
What is one major implication besides addiction for opioids?
Constipation
249
What is the Opioid Overdose Triad?
Pinpoint pupils
Respiratory depression
Unconsciousness
250
What is Autologous Chondrocyte Implantation and what is the rehab after?
Chondrocytes harvested from lesser WBing joint used to treat full bone on bone articular cartilage defects. Rehab includes early protection from shear and compression loading, so no WBing for about 6-8 weeks.
251
Rehab after PRP?
Short period (1-2 weeks) of decreased intensity loading such as ROM and WBing.
252
What conditions may have benefit with PRP?
Tendinopathies, OA, UCL at elbow, meniscus repairs
253
What outcome measure should be used for the lumbar spine?
Modified Oswestry Disability Index
254
What outcome measure should be used for OA?
WOMAC
255
What is the one outcome measure used for TMJ?
Mandibular function impairment questionnaire
256
More radiodense structures show up how on x-ray?
White (bone)
257
Less radiodense structures show up how on x-ray?
Dark (air)
258
What is a bone scan used for?
To detect fracture that is not detected by x-ray and areas of bone damaged by cancer, trauma, or infection.
Increased uptake means increased metabolic activity (shows black)
259
Bone density or DEXA scan is used for?
Used to delineate between osteopenia and osteoporosis.
260
What is the highest level of evidence for intervention for patients who have neck pain with radiating pain?
Cervical mobilization and stabilization
261
Cervical radiculopathy is highly likely to be present if all 4 characteristics are present:
Positive ULTTa
Involved side cervical rotation ROM < 60
Positive distraction test
Positive Spurling's test A
262
Carpal Tunnel Syndrome is likely to be present if at least 4 out of 5 characteristics are present:
Shaking hands to relieve symptoms
Wrist ratio > .67
Symptom severity scale > 1.9
Diminished sensation in median sensory field 1( thumb)
Age > 45 years old
263
Lumbar manipulation should be considered/performed if at least 4 out of 5 characteristics are present:
Pain lasting < 16 days
No symptoms distal to the knee
FABQ score < 19
IR > 35 for at least 1 hip
Hypomobility of at least 1 level of the lumbar spine
264
At birth, how much femoral anteversion is normal?
30-40
265
What is the percentage of body weight required to achieve separation of joint spaces in the lumbar spine?
50%
266
When attempting lumbar mechanical traction for the first time, a maximum of how many pounds should be trialed?
30 lbs
267
If there is a diagnosed medial meniscal tear at the peripheral 1/3rd, what treatment will be used?
Conservative before surgery because of vascularization
268
What special tests are used for rotator cuff full-thickness supraspinatus tear?
Drop-arm test
Empty can or Jobe test
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