MSK Flashcards
1
Q
what are 3 examples of viscerogenic pain ?
A
Myocardial infarct - may have pain in mid- back shoulder, arm chest, LEFT arm/ body, jaw, neck
Kehr’s sign - ruptured spleen; leads to blood pooling in body cavity, and refer pain to L shoulder due to irratation of phrenic nerve (C 3,4,5.) + Kehrs sign = pressure to upper ab causes L shoulder pain
Gallstones - May refer pain to the R shoulder
2
Q
What are descriptors of non MSK or viscerogenic pain?
A
this type of pain is described as dull, diffuse, non specific (hard to localize) due to the multiple levels of innervation. Position changes to not change pain intensity, weight, night pain, N/V, pallor, sweating, fever and off vitals.
3
Q
what is the loose and closed pack position of the spinal facets?
A
open: midway btwn flexion and extension
closed: extension
4
Q
What is the loose and closed pack position of the TMJ?
A
open: slightly open
closed: clenched teeth
5
Q
What is the loose and closed pack position of the GH joint?
A
open: 55 ABD, 30 horizontal add
closed: full ABD and external rotation
6
Q
What is the loose and closed pack position of the AC joint?
A
open: arm by side
closed: arm ABD to 90*
7
Q
What is the loose and closed pack position of the SC joint?
A
open: arm resting by side
closed: max shoulder elevation
8
Q
What is the loose and closed pack position of the Ulnohumeral joint (elbow)?
A
open: 70* flexion, 10* supination
closed: extension
9
Q
What is the loose and closed pack position of the radiohumeral joint
A
open: full ext and supination
closed: 90* flexion 10*little bit of supination
10
Q
What is the loose and closed pack position of the proximal radio ulnar joint?
A
open: 70* flexion and 35* supination
closed: 5* supination
11
Q
What is the loose and closed pack position of the distal radio ulnar joint?
A
open: 10* supination
closed: 5* supination
12
Q
What is the loose and closed pack position of the radiocarpel (wrist) joint ?
A
open: neutral with slight ulnar dev
closed: extension and radial deviation
13
Q
What is the loose and closed pack position of the carpo-metacarpal joint ?
A
open: mid way btwn ADD/ABD and flex/ext for thumb
closed: not mentioned maybe opposition
14
Q
What is the loose and closed pack position of the metacarpalphalageal joint ?
A
open: slight flexion
closed: full flexion
thumb closed: full opposition
15
Q
What is the loose and closed pack position of the interphalageal joint ?
A
open: slight flexion
closed: full extension
16
Q
What is the loose and closed pack position of the hip joint ?
A
open: FABER Flex, AB, ER
closed: Ext, IR
17
Q
What is the loose and closed pack position of the knee joint ?
A
open: flexion (20*)
closed: extension, lateral rot of tibia
18
Q
What is the loose and closed pack position of the joint talocrual ankle?
A
open: PF mid btwn inv/ evr
closed: DF
19
Q
What is the loose and closed pack position of the subtalar joint ?
A
open: neutral
closed: supination
same for the tarsal, tarsometatarsal joints
20
Q
What is the loose and closed pack position of the mid tarsal joint ?
A
open: neutral
closed:supination
same for the subtalar and tarsometatarsal joints
21
Q
What is the loose and closed pack position of the joint tarsometatarsal joint ?
A
open: neutral
closed: supination
same for the subtalar and tarsal
22
Q
What is the loose and closed pack position of the metatarsal phlangeal joint ?
A
open: neutral
closed: full extension
23
Q
What is the loose and closed pack position of the inter phalangeal joint of the toes ?
A
open: slight flexion
closed: full extension
24
Q
What is the capsular pattern of the TMJ?
A
mouth opening
25
What is the capsular pattern of the A-O?
ext, side flexion =ly (equally) as limited
26
What is the capsular pattern of the c-spine?
lateral flexion and rotation =ly as limited < extension
27
What is the capsular pattern of the GH joint?
ER< ABD< IR
28
What is the capsular pattern of the SC joint ?
pain at extreme ranges
29
What is the capsular pattern of the AC joint?
pain at extreme ranges
30
What is the capsular pattern of the elbow (ulnohumeral) ?
flexion< ext
31
What is the capsular pattern of the radiohumeral?
Flexion< ext< sup< pronation
32
What is the capsular pattern of the proximal radioulnar?
supination< pronation
33
What is the capsular pattern of the distal radio ulnar?
pain at extreme ranges of motion and rotation
34
What is the capsular pattern of the radio carpal (wrist)?
flexion= extenstion
35
What is the capsular pattern of the t-spine?
lateral flexion= rotation< extension (same as C-spine)
36
What is the capsular pattern of the L-spine?
lateral flexion= rotation< extension (same as c-spine and T-spine)
37
What is the capsular pattern of the SI, symphysis pubis, saccrococygeal?
pain when joints are stressed, such as in unilateral standing
38
What is the capsular pattern of the HIP?
Flex< AB < IR
39
What is the capsular pattern of the knee?
Flexion>Ext
40
What is the capsular pattern of the tibiofibular joint ?
pain when joint is stressed
41
What is the capsular pattern of the subtalar?
limited varus ranges
42
What is the capsular pattern of the talocrual?
PF>DF
43
What is the capsular pattern of the midtarsal?
| 1st Metatarsal phalageal ?
DF flexion > PF > adduction > medial rotation
| 1 MTP Ext> flexion
44
An abnormal end feel of empty can be which type of pathology?
joint inflamation
fracture
bursitis
45
An abnormal end feel of firm can be which type of pathology?
increased tone
tightening of capsule
ligament shortening
46
An abnormal end feel of hard can be which type of pathology?
Fracture, osteoarthritis, osteophytes
47
An abnormal end feel of soft can be which type of pathology?
edema, synovitis, ligament instability/ tear
48
What stages are included in stance phase for rancho los amigos? How much is spent in this phase?
```
initial contact (heel strike)
loading response (foot flat)
mid stance (midstance)
terminal stance (Heel off)
Pre-swing (toe off)
(60%)
```
49
What stages are in the swing phase? How much is spent in this phase?
Initial swing ( acceleration)
Mid-swing (mid swing)
Terminal swing (De acceleration)
(40%)
50
What is initial contact? What muscles are involved ? What ROM is needed at which joints?
the beginning of stance phase when the heel touches the floor.
- Hip: 30* flexion
- Knee: extension
- Ankle: heel first ankle neutral
Gait and muscle activity
Ankle Dorsi flexors: ant-tib, flexor hallisuc longus, extensor digitorum longus, and peroneus tertius prep the heel to lower down. The quad contract to extend the knee. Hamstrings help to stabilize the knee to prevent hyperextension. The hip extensors and ABDs stabilize the trunk.
51
What is loading response? What muscles are involved ? What ROM is needed at which joints?
The time btwn initial contact, and the beginning of swing of the other foot. The time it takes for the entire foot to make floor contact (foot flat)
- Hip: 30* flexion
- Knee: 15* flexion
- Ankle: 15* PF
Gait and muscle activity
Ankle dorsiflexors act eccentrically to lower the foot to the ground. Quads will work eccentrically flex to accept body weight. Towards the end, PFs eccentrically work to control DF as the tibia moves over the foot. TIb posterior eccentrically controls pronation. Eventually the quads work concentrically to move the femur over the tibia. Hip extensors contract for hip extension (coming up)
52
What is Mid-stance ? What muscles are involved ? What ROM is needed at which joints?
When the other foot is off of the floor and until the body is directly over the leg.
- Hip: extending to neutral
- Knee: extending to neutral
- Ankle: from PF to 10* DF (the most ankle activity here going from 15* PF to 10* DF)
Gait and muscle activity:
PFs continue to act eccentrically to control DF in order to control the body moving forwards over stance limb. Min knee musc activity, but the quads contract to produce CKC knee extension . Hip ABDs stabilize the trunk and *contralateral* hip drop. Illiopsoas eccentrically control hip extension.
53
What is terminal stance? What muscles are involved ? What ROM is needed at which joints?
When the heel of the stance limb rises, and the other foot touches the ground. (heel off)
- Hip: 10* hyperexntension
- Knee: extension
- Ankle: neutral (with tibia stable and heel off by the time the other foot is in initial contact *ankle reaches neutral not PF* however PF is achieved in order to move ankle from 10* DF to neutral)
- Extended toes
Gait and muscle activity
PF work to propel the body forwards. Hip ABDs stabilize the hips and illipsoas continues to control rate of hip extension.
54
What is pre-swing? What muscles are involved ? What ROM is needed at which joints?
The time from terminal stance to before toe off. Begin when the other foot reaches IC.
- Hip: neutral
- Knee: 35* flexion
- Ankle: 20* PF
- Extended toes
Gait and muscle activity
Peak PF activity for toe off . Hamstrings kick on for knee flexion to prep for swing, illiopsoas and other hip flexors kick on for hip flexion to prep for initial swing. Body momentum also aids in this motion.
55
What is initial swing? What muscles are involved ? What ROM is needed at which joints?
- the first phase in the swing phase. Begin when the toe comes off and end with terminal knee flexion 60*
- Knee: 60* flexion
- Hip: 20* flexion
- Ankle: 10* PF
-Gait and muscle activity
Ankle DFs clear foot from ground and decrease the PF created in preswing. Hamstrings help with foot clearance via knee flexion. Hips flexors on to advance limb forward.
56
What is mid-swing? What muscles are involved ? What ROM is needed at which joints?
the time it takes for the tibia to be perpendicular with the floor
- Knee: goes form 60-30* flexion
- Hip: 20-30* flexion
Gait and muscle activity
Ankle Df contract to maintain DF knee and hip activity are minimal 2/2 forward momentum (wow)
57
What is terminal swing? What muscles are involved ? What ROM is needed at which joints?
when the tib is perpendicular to the floor and ends with the foot touch ing the floor.
- Knee: extension 0*
- Hip: 30* flexion
Gait and muscle activity
Ankle DF and inverters prep the foot for heel strike. Quads contract for knee extension and hamstrings work eccentrically to control rate of knee extension. Hip extensors slow hip flexion for heel to slowly return to ground.
58
When the Right foot is in initial contact, what will the left foot be in? What happens after initial contact with the right foot?
Preswing
| the right foot will enter single leg stance
59
What ROM do you need for gait ?
Hip flexion 0-30
Knee flexion 0-60
dorsiflexion 0-10
plantar flexion 0-20
Hip Extension 0-10
Knee Extension 0
60
How does base of support change as cadence increases? whats the norm?
2-4 inches in norm
| BOS decreases with increased cadence
61
What is cadence and what is the norm for an adult
```
# of steps in a min
110-120 steps/min
```
62
What degree of toe out is normal
7*
63
How long should step length and stride length be ?
step length: distance btwn L and R heel strike: 28 inches
| stride length: length btwn 2 consecutive heel strikes on same side; 56 inches
64
What are the ottawa knee rules?
if any of these are present
- over 55 years
- TTP over patellar tendon
- TTP over fib head
- Cant flex knee past 90*
- cant WB immediately or in ER for 4 steps
65
what are the pitsburg rules?
Blunt trauma or a fall as MOI plus either of the following: •Age > 50 years or
Younger than 12 years
-Inability to walk 4 weight-bearing steps in the emergency department
66
What is the Salter-Harris Classification of Epiphyseal Complex Fractures type 1?
•Type I - fracture through the physis (widened physis)
67
What is the Salter-Harris Classification of Epiphyseal Complex Fractures type 2?
•Type II - fracture partway through the physis extending up into ** metaphysis **
68
What is the Salter-Harris Classification of Epiphyseal Complex Fractures type 3?
•Type III - fracture partway through the physis extending down into the **epiphysis **
69
What is the Salter-Harris Classification of Epiphyseal Complex Fractures type 4?
IV - fracture through the metaphysis, physis, and epiphysis can lead to angulation deformities when healing
70
What is the Salter-Harris Classification of Epiphyseal Complex Fractures type 5?
Type V - crush injury to the physis
71
What is the acromioclavicular cross over test?
| position and postive sign
The pt is placed into 90* of shoulder flexion and full horizontal adduction. This test can be done actively by the patient.
+ for AC joint pathology if pain is reproduced over the AC joint.
72
What is the active compression test? (obrein's test) t?
| position and postive sign
Pt stands with shoulder flexed, medially rotated with thumb pointing down. The PT places a downward force. then the shoulder is externally rotated with thumb pointing up, the PT places a downward pressure
+ -pain is felt while in internal rotation, but not in external rotation. Pain shouldnt be over AC joint. Indicative of superior labral tear.
73
What is the gleniod labrum test (clunk test)?
| position and positive sign
pt is in supine. The therapist keeps one hand on the posterior humerus, and then other hand holds the humerus just proximal to the elbow. The elbow is bent as the PT raises the arm in the 90-90 ABD position with lateral rotation. An anterior F is placed on the humerus, so the HH is directed anteriorly by the hand that is holding the arm.
+ -for labral tear if a clunk or grinding is felt
74
What is the Jerk test?
| position and positive sign
Pt is seated in 90* shoulder flexion, IR with the elbow bent. An axial compresion f is applied through the shoulder with horizontal adduction.
+ -clunk or jerk as the HH subluxes posteriorly. Indicstes posterior instability due to a posterior labral tear.
75
What is the Upper limb tension test 1a?
| position and positive sign
tests the median nerve, anterior interosseous nerve
position: shoulder depression> 110* abduction> elbow extension > forearm supination, wrist extension> finger and thumb extension.
76
What is the Upper limb tension test 1b (2) test?
| position and positive sign
Tests the median nerve and the musculcutaneous nerve.
Position: Shoulder depression> 10* ABD> elbow extension, forearm supination > wrist extension> finger and thumb extension> shoulder ER
77
What is the Upper limb tension test 3 test?
| position and positive sign
Tests: Radial Nerve
Position: Shoulder depression> 10* ABD> elbow extension, forearm pronation, wrist flexion and ulnar deviation, finger and thumb flexion, shoulder IR
78
What is the Upper limb tension test 4 test?
Tests ulnar nerve
Postion: Position: Shoulder depression> 10-90* ABD> elbow flexion, forearm supination> wrist extension and radial deviation > finger and thumb extension, shoulder ER
79
What is the Cozen test ?
pt is seated with elbow in slight flexion. PT palpates lateral epicondyle. Pt makes a fist and and pronates forearm, radially deviates and extends the wrist
+ -indicative of lateral epicondylitis if pain or weakness is on the lateral epi region
80
What is the lateral epicondylitis test ?
the patient is sitting, the PT stabilizes at the elbow and distal to the PIP of the 3rd digit. The patient extends the 3rd digit agaisnst resistance
+ -pn in the lateral epicondyle region or weakness in the lateral epi region
81
what is the medial epicondylitis test?
pt is sitting. PT palpates the medial epicondyle and supinates the forearm, and extends the wrist and elbow
+ pn in the medial epicondyle, may be medial epicondylitis
82
what is Mill's test?
pt is in sitting. Pt palpated the lateral epicondyle and pronates the forearm, flexes the wrist, and extends the elbow
+ -pn in the lateral elbow my be lateral epicondylitis
83
what is the elbow flexion test?
The patient fully flexes their elbow and and extends their wrist
+ if tingling or parethesia is noted in ulnar nerve distribution of hand/forearm
- for cubbital tunnel syndrome
84
what is the pinch grip test?
| What nerve does Tinnels test, test?
Pt is asked to pinch the thumb and index finger together, if they can not pinch tips together and instead press pads together then the anterior interouseous nerve can be implicated
+ cant pinch with tips
- Tinnels sign
tapping over the olecranon process and the medial epicondyle Well the patient is in sitting with slight elbow flexion, prodices tingling may indicate ulnar nerve compression/ compromise
85
What is the medicare functional classification levels MFCL ?
Known as K levels to classify patient function levels
- determines which componementry will be used in a prothesis.
- determined objectively with amputee mobility predictor AMPPRO or through thorough hx and exam
- k level decision made by Doc, prothetist and PT
86
What is K level 0 ?
Description: Prosthesis will not enhance QoL/ mobility
Knee unit: not eligible
Foot unit: not eligible
87
What is K level 1 ?
Description: Can be used for transfers, ambulation of level surfaces, fixed cadence. Good for a limited or unlimited household ambulator.
think household.
Knee unit: single axis, constant friction mechanism
Foot unit: SACH, single axis
88
What is K level 2?
Description: Transverse low level barriers, curbs, stairs, uneven surfaces. Limited community ambulator
Knee unit: Polycentric, constant friction mechanism
Foot unit: multiaxial foot/ankle, flexible heel foot
89
What is K level 3 ?
Description: Variable cadance ambulator, unlimited community ambulator, transverse most enviromental barriers, prosthetic use beyond simple locomotion
Knee unit: hydraulic/pneumatic, micropressor, variable friction mechanism
Foot unit: energy strong, dynamic response foot, multiaxial foot /ankle
90
What is K level 4 ?
Description: exceeds basic ambulation skills, high stress/impact/energy, **typical of child, athlete or active adult**
Knee unit: any system
Foot unit: any system
91
single axis knee influence on knee prosthesis
- hard to reciprocate during gait
- may or may not have knee extension assist or weight activated stance phase control
- constant friction mechanism (knee will not buckle when putting on and off)
- used in level k 1
92
polycentric influence on knee prosthesis
- heavier than single axis
- reciprocoal gait is more fluid
- may or may not have knee extension assist or weight activated stance phase control
- constant friction mechanism (knee will not buckle when putting on and off)
93
hydraulic influence on knee prosthesis
- variable friction for improved swing and stance phase control
94
microprocessor influence on knee prosthesis
- multiple programs to accommodate activity level for user
- allows to go down stairs easier
- needs to be charged
- variable friction for improved swing and stance phase control
95
SACH influence on foot prothesis
non articulating with rigid heel
- inexpensive
- low maintenance
- cushioned heel for shock absorption
- lacks energy return
- cant accommodate to uneven surfaces
96
single axis on influence on foot prothesis
allows for motion in singular plane
- improved knee stability during weight acceptance
- lacks energy return function if not paired with dynamic response foot
97
dynamic respsonse influence on foot prothesis
- can be articulating or non articulating
- heel has the ability to store and return some energy
- may have a split heel to allow for improved surface accommodation
98
hydraulic/micropressor influence on foot prothesis
- finer control over stability/ mobility
- improved shock absorbtion
- not appropriate for all environmental conditions and demands
99
what is a socket for a prosthesis ?
interface btwn residual limb and prosthesis
- good fit= WB throughout limb and total surface area contact.
- some areas are more pressure tolerant; muscles bones
100
what is a liner for a prosthesis ?
provide cushion for the limb, can be made out of silicone gel to help relieve irritation
- can include a suspension mechanism such as a lanyard or pin
- can be made to maintain suspension through negative pressure (like with a transferal seal in liner)
- non breathable; build precipitation throughout day. results in friction issues and skin irritation
- liners should be donned and offed throughout day, and washed to hygenic care
101
what is an insert for a prosthesis?
a soft or flexible insert that be be used to fill left over space in a prosthesis
- made of foam or similar to cushion and absorb shock limb in weight bearing
- can also be made of plastic to relieve pressure
102
what is a sock for a prosthesis?
used to maintain congruent and comfy fit bc limb shrinks in size esp in 1st year.
- socks come in plys
- prostheist should be called if plys exceed 12-15 for recasting
- make sure sock is applied without wrinkles to avoid skin breakdown
103
In a transtibial residual limb, where are pressure tolerant areas?
- mid fib shaft
- lateral and medial tib shaft
- patellar tendon
104
In a transtibial residual limb, where are pressure sensitive areas?
- fib head
- lateral tib flare
- tibial crest
- distal end of tibia and fibula
- patella
- anterior tib tubercle
- peroneal nerve
- adductor tubercle
105
In a transfemoral residual limb, where are pressure tolerant areas?
- ishial tuberostiy
| - soft tissue of residual limb (outter and inside thigh and bottom, but not considered the distal end of femur)
106
In a transfemoral residual limb, where are pressure sensitive areas?
_ greater trocanter
- pubic tubercle
- pubic ramus
- pubic symphysis
- distal end of femur
- perineum
107
what are some complications that may occur following amputation?
contracture- will happen in joint above. equinus deformity with symes or a transmetatarsal amputation. knee flexion for trans tibial amputation
transfemoral- hip flexion and ABDUCTION
DVT- heparin can be used
Hypersensitivity- can impede early fitting and fxn use. Use desensitization techniques; wrapping massage, tapping
neuroma- bundle of nerves that group together and produce pain due to scar tissue
Phantom limb- pt feels that limb is still present. Will subside after desensitization and use
Phantom pain- perception of pain in in the form of affecting the residual limb. Tx with TENS, US, icing, mirror, relaxation techniques, desentsization and pro use
physchological impact
wound infections
108
What are causes of lateral bending as gait deviations form the prothesis and amputee ?
```
Prosthetic causes:
prothesis too short
improperly shaped lateral wall
high medial wall
prothesis aligned in ABD
```
```
Amputee causes:
poor balance ABD contracture
improper training
short residual limb
weak hip ABD on prosthetic side
hypersensitive and painful residual limb
```
109
What are causes of Abducted gait as a gait deviations form the prothesis and amputee ?
```
ABD gait, walking on the lateral portion of the foot
Prosthetic causes:
Prothesis too short
improperly shaped lateral wall
high medial wall
prothesis aligned in ABD
inadequte suspension
excess knee friction (resistance)
```
```
Amputee causes:
ABD contracture
improper training
short residual limb
weak hip ABD on pros side
pain over lateral residual limb
```
110
What are causes of Circumduction as a gait deviations form the prothesis and amputee ?
```
Prosthetic causes:
Pro is too long
excess knee flexion
socket too small
excess planter flexion
```
```
Amputee causes:
Abd contracture
improper training
weak hip flexors
lacks confidence to flex knee
painful anterior distal residual limb
inability to initiate knee flexion
```
111
What are causes of excess knee flexion during stance as gait deviations form the prothesis and amputee ?
```
Prosthetic causes:
socket set forward in relation to foot
excess DF
stiff heel
pro too long
```
```
Amputee causes:
knee flexion contracture
hip flexion contracture
pain anteriorly in residual limb
decreased quad strength
poor balance
```
112
What are causes of vaulting as gait deviations form the prothesis and amputee?
```
Prosthetic causes:
pro too long
not enough suspension
excess alignment stability
too much PF
```
```
Amputee causes:
discomfort in residual limb
improper training
fear of stubbing toe
short residual limb
pain in hip or residual limb
```
113
What are causes of rotation of forefoot at heel strike as a gait deviations form the prothesis and amputee ?
```
Prosthetic causes:
excess toe out built in n
loose fitting socket
not enough suspension
ridgid SACH heel cushion
```
```
Amputee causes:
poor mus control
improper training
weak medial rotators
short residual limb
```
114
What are causes of forward trunk flexion as gait deviations form the prothesis and amputee ?
Prosthetic causes:
socket too big
poor suspension
knee instability
```
Amputee causes:
hip flexion contracture
weak hip extensors
pain with ischial weight bearing
inability to initiate knee flexion
```
115
What are causes of medial or lateral whip as gait deviations form the prothesis and amputee ?
```
Prosthetic causes:
excess rotation of the knee
tight socket fit
valgus in pro knee
improper alignment of toe break
```
Amputee causes:
improper training
weak hip rotators
knee instability
116
what are the 5 ligaments in the clavicle region ? Which movements do they limit?
- Acromioclavicular; limits horizontal movement
- Coracoacromial; limits superior movement, the roof of the rotator cuff
- Coracoclavicular; made up of the conoid and trapezoid ligaments; main stabilizer of AC joint and prevents supperiro translation
- Coracohumeral- unites supra and infra tendons together, part of the joint capsule, prevents inferior motion
- Costoclavicular ligament; attaches between the medial clavicle to the first true primary support for the SC joint
117
What are the glenohumeral ligaments?
make up the capsule.
Superior band: prevents ER and ABD
inferior band: prevents IR and ER rotation above 90* by 2 bands, the anterior (limits ER) and inferior (limits IR)
Lateral band: limits ER when the shoulder is in 45*
118
what is the rotator cuff interval?
space in the anterosuperior shoulder that is bordered by the coracohumeral ligament, superior gleniod lig, joint casule, supraspintus and subscap tendons
119
What is the transverse humeral ligament?
ligament that goes over the greater and lesser tuberosities of the humerus to hold the long head of biceps tendon in place
120
What function does the subacromial bursa serve?
goes over the supraspinatus tendon and under the acromion and deltoid muscle. Facilitates movement of the deltoid over the capsule and supra tendon
- can be involved in RC impingement
121
What does the subscapular bursa do?
is btwn the anterior capsule and subscap tendon to prevent friction.
Fullness in the anterior shoulder may be an inflammed bursa or articular effusion
122
what does the head of radius articulate with in flexion?
in its closed back state, 90* flexion, the head of radius articulates with the capitulum.
The radio humeral joint is made up of the distal humerus; the capitulum (convex) and concave head of radius.
123
What does the proximal ulna articulate with in closed pack postion ?
closed pack position will be extension, the trochlea of the humerus and trochlear notch of ulna articulate
124
What forms the proximal radioulnar joint
the trochlear notch and the rim of the radial head articlaute with each other to perform supination adn pronation.
the notch is concave and the rim of the head is convex.
125
what does the annular ligament do?
allows for controlled rotation of radial head in the trochlear notch.
126
what makes up the radiocarpal joint?
distal radius, radioulnar articular disc (connects distal radius medial side to the ulna).
the carpals that articulate with the radius include: triquetrum scaphoid and lunate (the proximal row of carpals)
127
what makes up the mid carpal joint?
the proximal row of carpals; the triquetrum, scaphoid and lunate
and the distal row (from lateral to medial) trapezium, trapezoid, capitate, hamate, pisiform.
128
what borders the anatomical snuff box?
Abd pollicus longus, extensor polliscus longus extensor pollicus brevus
129
which ligament limits wrist flexion?
dorsal radiocarpal ligmament
| attaches to the lunate and triquetrum form the distal/ posterior part of the radius and the styloid process
130
what nerve goes through the carpel tunnel?
median nerve
131
what ligament limits hyperextension of the wrist?
palmar radiocarpal ligament
originates from the anterior portion of the distal radius (the dorsal comes from the posterior) and attches to the capitate, lunate and schapoid.
132
Where is the TFCC located?
sits btwn the ulna, lunate and triquitrum.
- provides stability to wrist, connects radius and ulna together to allow for better loads to be tolerated thro the wrist.
133
What goes through the tunnel of guyon?
the Ulnar Nerve and Artery
| the tunnel is btwn the hook of hammate, pisiform, palmar carpal ligament and flexor retinaculum.
134
what fingers does the ulnar N innervate ?
pinky and 1/2 of 4th digit
135
what fingers does the Median N innervate ?
digits 1-3 and 1/2 of 4th digit
| radial nerve innervates the dorsal digits 1-3 but not fingertips
136
what makes up the femoral triangle ?
sartorius, inguinal ligament and adductor longus
| the Femoral nerve, vein, and artery and lymphatic glands
137
What ligaments reinforce the capsule of the hip
illiofemoral, ishiofemoral, ligamentum teres and pubofemoral ligament.
138
Is the illiofemoral the strongest or weakest ligament in the hip capsule?
- the strongest.
- reinforces the anterior capsule
- goes from the AIIS to the intertrochanteric spine of the femur
- prevents excess hip extension and maintains upright posture
139
Is the ishiofemoral ligament the strong or weakest ligament in the hip capsule
- weakest
- goes from the ischial wall of the acetabulum to the neck of femur
- reinforces the articular capsule
140
What motion does the pubofemoral ligament prevent?
limits excess ABD
| limits hip extension
141
what does the ligamentum teres attach to? Does it offer min or max stability?
attaches the head of femur to the inferior acetabulum
- blood vessles and nerves travel in this ligament for nurishment
- minimal stability
142
What surfaces are convex and concave at the tibiofemoral joint
the femur medial and lateral condyles are convex, the and the concave medial and lateral condyles of the tibia
143
What is hoffas syndrome
the infrapatellar fatpad, when irratated is a source of anterior knee pain when impinged
other fat pads of the knee include quadriceps and prefemoral
144
What insets in the pes anserine and where is this landmark?
gracillus, semitendinosis, sartorious
| - located medial and distal to the tibial tuberosity
145
What forms the talocrural joint?
- the distal tibia, fibula and talus make us this joint.
- it is a synovial hinge joint
- Very stabile in DF, mobile in PF
146
What forms the subtalar joint?
formed by articulations btwn the calcaneous and talus
147
What forms the midtarsal joint?
offers triplanar movement around the
| taloclaneoneonavcular joint and the calcaneocuboid joint
148
what does the forefoot consist of?
tarsometatarsal joints, metatarsal phalgeal joints and interphalageal joints
149
When is the anterior talofiblar ligament taught ? What motion does it resist?
Taught in PF
- resists inversion of talus and calcaneus
- resits anteriro translation of the talus on tibia
150
calcaneofibular ligament, What motion does it resist?
resists inversion
151
What makes up the deltoid ligament? What motion does it resist?
- resists eversion of talus
- made up of:
1. anterior tibiotalar ligament
2. posterior tibiotalar ligament
3. tibiocalcaneal ligament (in btwn ant/post tibtalar ligs)
4. tibionavicular ligament
152
What motion does the posterior talofibular ligament resist?
posterior displacement of the talus on tibia
153
Is the sinus tarsi on the medial or lateral side of the foot?
Lateral, Inferior talus, superior to the calcanueus. Can be injured in inversion ankle sprain.
154
What characterizes the atlas
C1 supports the weight of the head on 2 facets that make up the A-O joint
155
What motion is available at the A-O joint?
flexion and extension "yes"
156
What motion is available at the AA joint?
The majority of head rotation comes from the AA joint
permits flex, ext, side bend, rotation.
The dens articulates with the anterior arch of the atlas
157
How are ZPJ joints different from intervetebral joints?
ZPJ are formed by inferior facets of the superior vertebrae and the superior facets of the inferior vertebrae
intervertebral joints are formed btwn each vertebrae and disc
158
What motion does the alar ligament restrict
flexion and contralateral side bending and contralateral rotation and sagital plane movement of the atlas and occiput
- the alar ligament connects the dens to the occipital condyles
159
What motion does the anterior longitudinal ligament restrict
spine extension
160
What nerve roots make up the brachial plexus?
C5-T1 nerve roots innervate the entire upper quarter
| Nerve roots > trunks> Divisions> cords > Peripheral nerves
161
what does the cruciform ligament connect? What motion does it limit?
the ligament is made up a a vertical and horizontal portion
Vertical: connects the dens to the foramen magnum
Horizontal: Connects the dens to the atlas
limits upper cervical flexion and rotation of the spine
162
what motion increases the size of intra vertebral foramina ? Decreases?
increase size: flexion and contralateral side bending
| Decrease size: Extension and ipsi side bending
163
What motion does the ligamentum flavum restrict?
connects the spinous process together
| limits flexion and rotation of the spine
164
What motion does the ligamentum nuchae restrict?
cervical flexion
165
What motion does the posterior longitudinal ligament restrict
spine flexion
166
uncoveretebral joints are found where and help guide what motion?
in C3-T1 in the inferior or lateral surface of vertebrae
| help guide sagital plane movement
167
What does the anterior sacroiliac connect and What motion does it restrict?
connect anterior surface of illium to anterior sacrum
| - the weakest SI ligament and helps reinforce the SI joint capsule
168
What does the iliolumbar connect and What motion does it restrict?
- connects the posterior portion of the illium to the TP of L5
- limits all motion btwn L5 and S1
169
What does the interoseous sacroiliac connect and What motion does it restrict?
connects the sacrum and the illium and is deep to the posterior sacroiliac ligament.
- Strong lig that restricts anterior and inferior movements of SI
(what is nutation and counter nutation?)
170
Describe intervetralbral discs. What will flexion do ?
Dense collagen fibers and fibrocartilage make up the anuulus fibrosis with a flexible core; the NP.
the AF is connected to the VBody and provides tensile strength during movement.
Flexion causes the anterior portion to be compressed and the posterior disc to be decompressed
171
What nerve root form the lumbar plexus?
T12-L4 inncervates the anterior and medial mus of the thigh
172
What does the posterior sacroiliac ligament connect and What motion does it restrict?
- connect the PSIS with lateral part of S3/4 segments
- fibers of this lig eventually connect with the sacrotuberous
- limits all motions esp, posterior sacral rotation.
173
Which ribs are attaches to the sternum? via cartilage? are considered floating?
ribs 1-7 attach to the sternum; attach at costovertebral and costotransverse joints
ribs 8-10 attach to the cartilage of ribs 1-7
ribs 10-12 only attach to the VB but not the TP and are considered floating
174
what is the sacral plexus made up of?
ventral rami and S1-s3 and desendding portion of S4
| supplies innervation to butt and via sciatic nerve the lower leg and posterior thigh
175
What does the sacrospinous ligament connect and What motion does it restrict?
connects the ishial spine to the lateral sacrum and coccyx
- fibers will blend into the sacrotuberous ligament
- limits anterior rotation of the pelvis
176
What motion does the sacrotuberous ligamentt restrict?
anterior rotation and superior translation of sacrum
177
What motion does the supraspinous restrict?
flexion of the thoracic and lumbar spine
178
What is the function of the thoraco lumbar fascia
point of attachment for lumbar muscles
- separates lumbar muscles into 3 compartments
- provides spinal stability, transmits forces
- resists lumbar flexion
- Connects SP of lumbar spine to PSIS and illiac crest
179
what is the most accurate method to determine body composition?
hydrostatic weighing
180
What are examples of a firm end feel? Is this normal or abnormal?
Should feel like a stretch, normal
- ankle DF
- hip IR
- forearm supination
- finger extension
- ligmentous stretch like knee extension = firm
181
What are examples of a hard end feel? Is this normal or abnormal?
bone to bone, normal end feel
| - elbow extension
182
What are examples of a soft end feel ? Is this normal or abnormal?
Caused by soft tissue approximation
normal end feel
elbow flexion
knee flexion
183
Why would an empty end feel be felt and what are examples of an empty end feel?
Cant be reached, usually because of pain
joint inflammation
fracture
bursitis
184
what is an abnomral end feel
- end feel that is felt at a abnormal or inconsistent point in range of motion, or in a joint with usually a different end feel. Can be:
- empty
- firm*
- hard*
- soft *
* some are considered normal, the key is when the end feel is not expected.
185
Why would a firm end feel be felt What are examples of a firm abnormal end feel?
- increased tone
- tight capsule
- ligament shortening
186
Why would a hard end feel be felt What are examples of a hard abnormal end feel?
fracture
OA
osteophyte formation
187
Why would a soft end feel be felt What are examples of a soft abnormal end feel?
edema
synovitis
ligament instability/ tear
188
What elements of pateint education should be provided for mobilization ?
- Patient should be able to understand purpose of mob
- be relaxed
- explain technique before hand
- you may or may not feel a pop*
189
What should the PT consider with mobs
- comfy position
- use gravity when you can
- perform general exam
- maintain contact with the mobing hand as close as possible to the joitn throughout the mob
- allow one digit to palpate the joint if possible
- mob 1 joint in 1 direction at a time
- use belt or wedge if needed
- modify technique based on pt response
- compare joint play bilaterally
- reassess at every session at begining
190
How are mob usually initially performed?
in a loose packed position
191
What are indications to perform a joint mob
- restricted joint mobility
- restricted accessory joint motion
- desired neurophysiological effects
192
what are contraindications to perform a joint mob
- active disease
- infection
- advanced OA
- articular hyper-mobility
- fx
- acute inflammation
- muscle guarding
- joint replacement
193
What is the MMT description for a grade 0
no contraction no movement
194
What is the MMT description for a grade 1
contraction can be palpated but no movement can be felt
195
What is the MMT description for a grade 2- 2 and 2+
2- does not complete movement in gravity eliminated position
2 completes range of motion in gravtiy eliminated postion
2+ initiate movement against gravity (the first MMT grade against gravity)
196
What is the MMT description for a grade 3- 3 and 3+
3- more than 1/2 of ROM completed in against gravity
3 completes full ROM with *no* manual resistance against gravity
3+ completes ROM against gravity minimal manual resistance
197
What is the MMT description for 4- 4 4+
4- completes ROM against minimal- mod manual resistance
4 completes ROM againstg ravity moderate manual
4+ completes ROM against gravity mod- max manual
198
what is a 5/5 MMT grade
completed ROM against gravity with max resistance
199
Which muscles can be MMTd in sidelying
glut med
hipp add
glut min
lat abdominals
200
Which muscles can be MMTd in prone
```
back extnesoreds
glut max
ER IR shoulder
mid traps
posterior deltiod
rhomboids
teres major
gastroc
hamstrings
lat dorsi
neck extensors
QL
soleus
triceps
```
201
Which muscles can be MMTd in sitting
```
coracobrachillis
hip flexors
IR ER hip
upper traps
deltiod
quads
serratus anterior
```
202
Which muscles can be MMTd in standing
PFs
| serratus anterior
203
What is the action of disease modifying antirheumatic agents ?
DMARDs slow the progression of rhematic deseases from spreading to joints that have not been affected yet, used before wide spread progression and to slow it down. Used early in TX.
- act to indice remission by pathology modication and imuune inhibition to control the reposnse of the disease
204
what are side effects of DMARDs
nausea. headache, joint pain and swelling, toxicity, GI distress, sore throat, fever liver dysfxn, hairless, sepsis potential, retinal damage
205
what are PT implications for DMARDs
many of the agents have toxic effects
206
what are examples of DMARDs
```
Rhematrex, (methotrexate)
Arava,
Antimalarials; Aralen, Plauqnil
Gold compounds
Tumor necrosis factor inhibitors: humira, enbrel
```
207
What is the mechanism of action for (corticosteriods)
| glucocorticoids?
provide hormonal anti-inflamatroy and metabolic effects to supress articualr and systemic disease.
- reduce inflammation that cause reactions on healthy tissues
- vasoconstriction results from lysosomal membrane stabilzation and increased effects of catecholemines
208
when are gluccocorticoids (corticosteriods) indicated?
replacement for endocrine dysfxn
- anti inflammatory
- immuno suppresive effects
- Tx of rhuematic respiratory and other disorders
209
What are side effects of gluccocorticoids?
mus atrphy, GI distress, glaucoma, adrenocorticosupression, drug indiced cushing syndrome, weakening and breakdown of supporting tissues (bone, tendone, ligament skin) mood changes, HTN
210
in what direction are the cervical, thoracic and lumbar facets oriented?
C: 45
T: 60
l: 90
211
What are the implications for PT for patients using a glucocorticoid?
-PTs should wear a mask, pts will have a compromised immune system while on the medication.
-PTs should look out for signs of toxicity like buffalo hump, moon face and personality changes.
- pts are at risk for osteoporosis and muscle wasting
Injection at a joint will require monitoring for tendon and ligament weakening/ laxity
212
What are examples of Glucocorticoids?
```
Dermacort; hydrocortisone, cortisol
prednisone
prednisolone
medrol; mythylprednisolone
dexamethasome
nasonex; momtasoen
```
213
what is the action of nonopiod agents
- reduce fever, pain and inflammation
provide analgesia and pain relief
provide antiinfmaltory effects
initiate antipyretic properties to reduce fever
promote a reduction of prostaglandins to decrease teh inflammation process
lowers impulse information for pain fiber
decreases uterine contractions
214
What are indications to use no opiod agents
mild- mod pain
fever headache, muscle ache, inflammation (expect for aceteminophen, will not help with inflam)
dysmenorrhea
redux for MI (asprin only)
215
What are the side effects of Non opiod agents
N/V vertigo, ab pain, GI distress/bleeding, ulcers,
- potential for reye syndrome in children; Inflammation of the brain and liver noted by change of mental status seizures, Occurs in children recovering from viral infections and may be linked to aspirin
216
What are implications for PTs for pts using non opiod agents ?
Pts are at risk for masked pain
| complaints of stomach pain should be taken serriously
217
What are examples of non opiod agents?
```
tylenol acetominohin
NSAIDS
asprin
Aleve, naproxen
advil ibprophen
celebrex celecoxib
```
218
What is the action of opioid agents, narcotics ?
provide anagesia for acute to severe pain.
meds stimulate opiod receptors in the CNS to prevent pain impulses
certain drugs can help with chemical dependance adn withdrawl
219
when are opioids indicated
mod-severe pain
to sedate
relief of cough
help with addiction
220
what are side effects of opioids
mood swings, sedation, confusion, vertigo, dulled cognitive function, orthostatic hypotension, constipation, incoordination, physical dependance, tolerance
221
What are implications for PT for pts who are using opioids ?
watch for respiratory depression
| Tx should be scheduled 2 hours after admin of drug for max analgesic effect
222
what is the location, sensitivity and distribution of free nerve endings?
location: joint capsule, ligaments, synovium fat pads
sensitivity: noxious or non noxious stimulus
primary distribution: all joints
223
what is the location, sensitivity and distribution of pacinian corpuscles
location: fibrous layer of joint capsule
sensitivity: high frquency vibration, acceleration, high velocity changes, in joint postion
primary distribution: all joint s
224
what is the location, sensitivity and distribution of golgi ligament endings
location: ligaments near the bony attachment
sensitivity: tension or stretch on ligaments
primary distribution: majority of joints
225
what is the location, sensitivity and distribution of ruffini endings
location: fibrous layer of joint capsule
sensitivity: stretching of joint capsule amplitude and velocity of joint position
primary distribution: greater density of proximal joints in capsular regions
226
what is the location, sensitivity and distribution of golgo mazzoni corpusles ?
location: joint capsule
sensitivity: compression of joint capsule
primary distribution: knee joint and joint capsule
227
what recpetors are in the joint capsule
golgi- mazzoni, pacinian corpuscle, ruffini endings, and free nerve endings
228
when is the ATP-PC system used?
high intensity short duraction activities
100 m sprint
phosphocreatien is stored in muscle (stored directly in the contractile mechanisms of the muscle) and then broken down into energy to make ATP. There is enough for 15 seconds of energy.
non aerobic
229
when is glycolysis used?
this system supplies ATP in high inteisity short duraction activities sich as 400 800m sprint.
Glycogen is split into glucose and is made into pyruvate by glycolysis. this makes ATP.
no O2 needed
- glycolysis cuases lactic acid to build up which caises muscle fatigue
230
when is the aerobic metabolism system used
```
used in low intensity long duration activities
several complex (therefore it takes longer) steps, more ATP is produced
- as long as nutrients are available to use, ATP will be made
- glusoce, fatty acids and aminos are oxidized (combine with O2) to provide E to form ATP
```
231
Describe type 1 muscle fibers
Areobic, red, tonic, slow twitch, slow oxidative
low fatigue high capillary and myoglobin density, small fibers, extensive blood supply
large mitochondria
used in marthon and swimming
232
Describe type 2 muscle fibers
```
non aerobic
type 2a appear red 2b appear white
phasic
fast twitch (fast twitch 1a)
fast glycolytic
```
high fatiguability, low myoglobin and capillary density, larger fibers less blood supply fewer mitchondria
high jump sprint
Type II B has larger muscle fibers, less blood supply, and fewer mitochondria than the other fiber types. Use of the fast-glycolytic energy system allows the muscle fiber to produce a large total peak power, quickly, in about 25 milliseconds, however, fatigue occurs rapidly.
233
what does the muscle spindle do?
in the muscle belly to tel inffo about the rate of length change or muscle length.
Controls posture. The help of the gamma system helps control involuntary system
234
what does the golgi tendon organ do
in the muscle tendon
V sensitive to tension esp. when produced by an active muscle contraction. Stimulated by the tension produced by the muscle fibers. Arranged in very small units of 10-15 fibers
235
what is the difference btwn and eccentric and concetric muscle action?
An eccentric contraction occurs when the muscle lengthens while developing tension. In comparison, a concentric contraction occurs when the muscle shortens while developing tension.
236
what are types of mechanoreceptors?
Examples of mechanoreceptors include free nerve endings, Merkel’s disks, Ruffini endings, hair follicle endings, Meissner’s corpuscles, and Pacinian corpuscles.
237
What is the difference btwn edema and effusion?
edema is an increase of volume in the soft tissue outsode the joint capsule
effusion is increase of fluid INSIDE the joint capsule
238
What structure is compressed with genu valgum ? increased stress over what?
the lateral tibial condyle is compressed
the medial stxs are stressed
- the oppostite is true for genu varum
239
What could cause kyphosis ? lordosis ?
common causes of kyphosis 2/2:
osteporosis
compression fracture
poor posture 2/2 paralysis
common causes of lordosis 2/2:
weak abs, pregnancy, excess weight gain, hip flexion contracture
240
What is the Q-angle ?
| what is a norm value?
degree of angulation from mid patella to ASIS and to tibial tuberacle
norm: 13 males 18 females
- increased angle can lead to altered tracking patterms
241
What are the different degrees of sprains ?
G1 localized pain, min swelling, tenderness
G2: localized pain, moderate swelling, tenderness, impaired motor fxn
G: palpable muscle defect, severe pain, poor motor fxn
242
wha tis the difference btwn a compound, closed and a comminuted fracture ?
compund- goes thro the skin
comminuted- crushed into several pieces
closed: break in the bone where the skin over the injury stays intact
243
what is a nonunion fracture
break in bone that failed to heal and unite after 9-12 months
244
How does a spiral fracture occur
torrison and twisting will cause a "S" shapped break in the bone
245
what is a transverse fx?
transverse fracture occurs at a right angle to the long axis of the bone. Fractures heal in varying time frames based upon age, comorbidities, and fracture site. Normal average healing times range from 3 weeks for the phalanges to 12 weeks for the femur.
246
Pts with osteoporosis are most at risk for which type of fx?
compresion fx
-Fractures typically occur secondary to the vertebral bodies assuming a wedged shape structure and an increased kyphosis of the thoracic spine.
247
What does a + ulnar collateral ligament test indicate?
gamekeepers thumb or skeirs thumb
disruption of MCP (thumb)
- excess valgus movement of the UCL
-Shin is seated and thumb is extended while valgus force is placed on thumb
248
The allen test for the wrist and hand indicates what if + ?
- Have the pt open and close the fist repeatedly
- the pt keeps the hand closed and the PT compresses the radial or ulnar artery and observes if there is a flushing radial or ulnar 1/2 hand After one of the artery pressure is released
- + If there is a delay in flushing after the radio or ulnar 1/3 of hand
- indicates occlusion
249
What is the bunnel littler test ?
the patient is seated with the 1st finger slighly extended
- the PIP is flexed
- if the PIP does not flex wihtout the thumb finger extended there might be a tight intrisic or capsular tightness
250
what is the median nerve compression test, or the carpel compression test?
pressure is placed on the median N in the carpel tunnel with both the PTs hands. Patient's hand can be flexed for further compression
+ If patient feels pain in median N distribution
251
what is froments sign?
pt holds paper with index and thumb, the PT tries to pull a piece of paper away from the patient. Patient should be able to apply pressure with the thumb and index finger. If not the adductor pollicis is weak
+ the pts thumb flexes in response 2/2 ADD pollicus paralysis
- if the pt hyperextends thumb at the same time, it is known as jeanne's sign
- both are indicative of ulnar nerve compromise/ paralysis
252
What is tinnels sign for the wrist
tap over the volar aspect of the wrist
+ tingling in the thumb, index. middle finger or lateral 1/2 of ring finger
+ for carpal tunnel syndrome for median N compression
253
what is the finkelstein test
ulnar deviation with thumb in fist
| + pain in APL EPB de quevains tendons, Decorative of tenosynovitis in the thumb
254
what is the grind test (in the hand)
axial load through thumb causes pain may be indicative of degenerative joint disease
255
What is murphys sign (in the hand)
The patient makes a fist and the 3rd MC is in line with the 4/th MC.
- indicates lunate dislocation
256
What is the difference btwn Elys test and Obers test
ely- PT passivly flexes the patients knee while in prone. + if hip flexes happens at same time, indicates rectus femoris contracture
Ober- up and ober. indicates IT band tension if leg cant adduct
257
What is the piriformis test?
The pt is in sidelying with the involved side on top
- the hips are bent to 60* flexion
- pt holds the pelvis and the presses the knee into adduction. + test if pain or tighness runs along the piriformis. The sciatic nerve rusn thro the piriformis
258
What is the tripod sign ? what is the 90-90 test ?
- both indicate hamstring tightness
Tripod:
the PT passivly extends the knee while the pt is seated
+ if the patient extension of the trunk or has tight hammies
90-90:
The pt is in supine and flexes the hips to 90*. the pt will actively extend 1 knee at a time max knee flexion is reached, + if 20* or more of flexion remain
259
What is barlows test?
Pediatric test
pt is supine hips at 90* flexion and knees flexed. 1 hip is checked at a time by having anterior F placed on posterior greater trocanter. Indicated a reducign hip dislocation adn is a variation of ortolanis test
260
What is ortolanis test
pt is supine hips at 90* flexion and knees flexed.Grasps the legs so the PT thumb is along the medial thigh and fingers on the lateral thigh towards the butt.PT will ABD the hips with pressure placed on the greater trocanters until resistnace is felt at 30*. + test will have a clunk and may be indicative of hip being reduced
261
what is the anterior labral tear test (hip)?
pt hip is placed in full flexion, ER, and ABD
- hip is moved into ext, IR and ADD. + test will be a click or pain and indicative for anterior labral tear of the hip
may also be indicative of iliopsoas tendonitis or anterior superior impingement
262
What is craigs test ?
pt is in prone with test knee flexed to 90*
- pt palpated posterior aspect of greater trochanter and IR and ER rotates hip till GT is parallel with table
- degree of femoral anteversion corresponds with anlge formed by lower leg and perpendicualr axis of the table
- normal anterversion is 18-15*
263
What si the hip scour test
the PT places the hip into max flexion/ add with knee in max flexion. Compressive F is added through hip
+ for grinding, crepitus and clicking and may be indicative of arthrits, avascualr necrosis or osteochondral defect
264
What is the trendelenburg test?
stand on 1 leg for 10 seconds
+ drop of pelvis on unsupported side
indicates weak glut med on supported side
265
what is the lateral pivot shift test ?
knee test:
pt is in supine with hip flexed and ABD to 30* and slight IR, the leg is stright and supported in PTs hands. A valgus F is placed on the knee while the knee is in/ out of flexion.
+ anterolateral *rotary* instability if clunk is heard from reduction of tibia on femur
266
How is anteromedial and lateral stability tested?
-with the slocum drawer test
-Not with the lateral pivot shift test
- similar to the anterior drawer test
- medial instability checked with foot turned laterally
lateral instability checked with foot turned internally
267
When should ROM exercises not be performed? (contrindications)
- when motion is detrimental to healing of tissues
- controlled motion in pain free range has been shown to be beneficial in early stages of healing
- increased pain and inflammation are signs ROM is too aggressive
268
when would you choose PROM for a patient?
- physically unabel to move 2/2 paralysis or comatose
- cognitive impairment
- AROM is painful
- Prepping for stretch teaching AROM to pt
269
When would you choose AAROM for a patient ?
- unable to fully contract through full ROM
- full AROM in contraindicated
- performed prior to movement initiation
270
What are 2 benefits that AAROM offers that PROM does not
- proprioception and kinesthetic awareness
- prevents joint contracture
- improves neuromuscular activity
271
can AROM increase strength in very weak muscles?
yes, can get up to a 3/5
272
When is stretching indicated or contraindicated?
indication: decreased ROM or mus flexibility
contraindications:
acute inflammation, soft tissue healing such as after a tendon repair, ROM limited by bone on bone contact, recent fx, hypermobility, hypomobility that allows for fxn like tenodesis
273
What happens in the elastic region in the stress strain curve ?
tissue returns to its previous length after a stretch is no longer applied. Deformation occurs if F not maintained, , tissues with greater stiffness will have steeper slope.
274
What happens in the toe region in the stress strain curve ?
wavy collagen becomes stright and aligns with one another
275
What is the difference btwn viscoelasticty and plasticity
viscoelasticity; time dependant property in which tissue resistance is high initially and decrease over time. Tissue will return to normal length p. F is taken away
Plasticity- the property in which tissue remains elongated even p. F/stretch is taken away. In the stress strain curve, the plastic region where where binds break and do not return to normal lengths even after F has been removed.
276
IS the same Force required to exert the same stretch over time according to the stretch strain principle?
Less. the longer the stretch F is maintained, the more the tension decreases and therefore less force is required to maintain tissue length
277
What are benefits of ballistic stretching ? How does it differ from dynamic stretching
- result in rapid cahnge in muscle length that activates muscle spindles
- not as effective for increasing tissue extensibility but is good for athletic activity prep- likely to cause muscle soreness/ injury due to intensity of stretch
- Dynamic stretching emphasizes movement based approach, ballistic stretch emphasizes bouncing movements
278
What are the 3 PNF techniques?
Contract- relax
Agonist contraction
Contract- relax with agonist contraction
279
What is the Delorme protocol and the Oxford Technique ?
- both are exercise programs based off 3 sets doen at different intensities of maximum rep. 10 reps are done at various intensities:
Delorme 50%>75%>100%
Offord 100% 75% 50%
280
How is the overload principle achieved/ applied in rehabilitation and for what purpose?
in order for a muscle to adapt and become stronger the load placed on it must be greater than what the mus is accustomed to.
volume and intensity can be changed to induce overload
281
Which is more beneficial, carry over effect form the transfer of training principle or the SAID principle?
adaptations from specific training are more beneficial than carry over effects
- need to be strong, work on strength
- improving strength may have carry over effects for endurance however
- carry over = effect of 1 exercise to another
SAID= body adaptation to specific demand placed on it
282
When is the reversibility effect seen ?
1-2 weeks of stopping an exercise program
283
What is the difference btwn the force velocity relationship and the length tension relationship?
force velocity- speed affects force generation
concentric contraction: as speed of contraction increases, the F decreases
During an eccentric contraction: as the speed of contrax goes up, so does the F prodiced by the muscle.
length tension- mus will generate F based on length, the closer it is to normal resting length the stonger the contraction. if lengthened or shorten it produces less F
284
what are the adaptations to strength training?
- Muscle fiber hypertrophy
- fiber type remodeling from type II b > type IIa
- Increased neuromuscular activity (number of motor units firing rate)
- decreased or no change in capillary bed density
- decreased mitochondrial density
- increased stores of ATP, creatine phosphate, and other energy sources
- increase tensile strength of tendons and ligaments
- increase bone mineral density
- increased lean body mass
- increased body fat percentage
285
what are the adaptations for endurance training?
- Increased capillary bed density
- Increased mitochondrial density
- Creased stores of ATP, creatine phosphate and other energy sources
- Increased tensile strength of tendons and ligaments
- Increase bone mineral density
- Decrease body fat percentage
286
Does strength training increase or decrease capillary bed density and mitochondrial density?
Strength training will decrease mitochondrial and capillary bed density parentheses no change in capillary bed density possible)
Capillary bed density and mitochondrial density will increase with endurance training
287
What are signs of muscle fatigue? What should the therapist do?
The therapist to try to avoid exerting the patient at this point
- Pain cramping tremors, slower jerking movement, inability to complete full movement, use of substitution patterns
- Decreased load being lifted allow rest breaks allowing the patient to further work may lead to injury
288
What is the bounce home test?
Patient is in supine the therapist grabs the heel and flexes then passively extends the knee.
- Positive indicated by incomplete extension or rubery and feel for meniscus lesion
289
Is the brush test?
- Examines effusion in the knee
- one hand sweeps up and medial to the patella the other hand sweeps down and lateral to the patella
- positive if swelling is observed medially
290
Is the patellar tap test?
- Patient is placed in knee flexion or extension to point of discomfort
- therapist taps tendon
- positive test as indicated in patella appears to be floating indicative of joint effusion
291
Ligament does the anterior drawer test of the ankle examined?
The test is performed in 20° of plantar flexion as a Talus is drawn forward on ankle mortise
-indicative of anterior talo fibular ligament sprain
292
How is the lateral rotation stress test or Klieger test of the ankle? what ligament does it test?
The therapist applies a lateral rotation force to the foot "draw a J laterally"
- pain over the anterior/ posterior tibio-fibular ligament and interosseous membrane is positive for a high ankle sprain or syndesmosis injury
- positive for a deltoid ligament tear if the patient has pain medially and the talus shifts away from medial malleolus
293
What ligament is tested by the Talar tilt test
Increased adduction indicates a calcaneofibular ligament sprain
294
What is the difference between the Homan sign and Thompson test ? what position are you placed in for the Thompson test?
Thompson test: Patient is prone with the over table squeezing the gastroc indicates ruptured Achilles tendon
Homan's sign: Test for DVT by placing the foot and passive dorsiflexion
295
Is the tibial torsion test
- Measures the angle difference of knee and ankle joint axis
- normal tibial torsion is 12 to 18° for adults
296
Measure true leg length discrepancy
Measure from the ASIS to the medial malleoli a difference from outside the side of greater than 1 cm is indicative of truly clean discrepancy
297
Is Clark sign
- Tests patella femoral dysfunction
- patient is supine with knees extended
- the examiner places pressure with Webb space on the superior pole of patella as patient contracts quadriceps
- positive test if patient cannot complete contraction without pain
298
What is Hughston's
test for plica and or plica irritability
- by having the patient flex and internally rotate tibia passively
- pain on the medial aspect as patella is moved away
299
What is the noble compression test\
Pain over the lateral femoral condyle during knee extension indicative of iliotibial to be a band syndrome
300
What is the patellar apprehension test
With the patient knees extended, therapist placed both thumbs on the medial border and applies a lateral force
- positive test is a apprehensive reaction or an attempt to contract the quadriceps to avoid subluxation
- indicative of subluxation or dislocation
