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NPTE > MSK > Flashcards

MSK Flashcards

1
Q

Convex on Concave Joints

A
  • Humeral head on glenoid (shoulder)
  • Femoral head on acetabulum (hip)
  • Proximal carpal row on Radius (wrist)
  • Talus on the tibia (ankle)
  • Proximal radial head in radial notch (Proximal RUJ)
  • Costovertebral joints (ribs)
  • Occiput on Atlas (OA-C1)
  • Temporomandibular joint
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2
Q

Concave on Convex

A
  • Tibial plateau on femoral condyle
  • Distal phalanx on middle phalanx
  • Trochlear notch on trochlea
  • Radial head on capitulum
  • Distal radius (ulnar notch) on ulna
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3
Q

NPTE Principle

What direction do you perform joint mobilization

A

ALWAYS mobilize in the direction of the restricted glide.

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4
Q

A patient presents to physical therapy status post humeral neck fracture. The patient was in a sling for 8 weeks and has marked joint mobility restrictions. If the patient cannot achieve full shoulder extension, which of the following mobilizations is the MOST recommended:

A. Inferior glide

B. Posterior glide

C. Distraction

D. Anterior glide

A
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5
Q

A patient with left shoulder pain presents with difficulty achieving shoulder flexion and abduction above 150 degrees. No joint restrictions are found at the glenohumeral joint. Which of the following mobilizations would BEST improve the patient’s shoulder flexion and abduction?

A. Inferior glide at the GH jt

B. Inferior glide at the SC jt

C. Superior glide at the SC jt

D. Superior glide at the GH jt

A

NO GH PROBLEMS

Sternalclavicular joint (Convex on concave)

B is correct

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6
Q

BASIC THUMB MOTIONS

Flexion

Extension

Abduction

Adduction

A

“Extension & Flexion In The Same Direction”

Flexion of the thumb rolls medially and glides medially

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7
Q

What is the roll and glide for:

Proximal Radioulnar Joint?

A

Radial head moving on the ulnar

Convex on concave

Anterior roll and posterior glide

Proximal posterior Pronation -PPP

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8
Q

A patient who was immobilized in a cast for a broken hand currently has difficulty fitting their hand around a cup. Which of the following mobilizations of the first CMC joint would BEST address this limitation?

A. Volar Glide

B. Dorsal Glide

C. Radial Glide

D. Palmar Glide

A
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9
Q

With knee flexion and extension, will the tibia internally or externally rotate

A

Tibia will ALWAYS Externally rotate with Extension, and Internally rotate with Flexion.

Femur will do the opposite.

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10
Q

A patient is performing a squat as a part of their lower extremity strengthening exercises. Which of the following motions is the MOST associated with closed chain knee flexion?

A. Posterior roll and posterior glide of the femur

B. Anterior roll and posterior glide of the femur

C. Posterior roll and anterior glide of the femur

D. Anterior roll and anterior glide of the femur

A

C. Posterior roll and anterior glide of the femur

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11
Q

A patient injured his left knee during a deep squat a month ago. Upon examination, the therapist finds decreased knee flexion on left. Which of the following tibiofemoral mobilizations would be the MOST effective to improve the left knee flexion?

A.Internal rotation and posterior glide of the tibia

B.External rotation and anterior glide of the tibia

C.Internal rotation and anterior glide of the tibia

D.External rotation and posterior glide of the tibia

A

A.Internal rotation and posterior glide of the tibia

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12
Q

During a stand to sit transfer assessment, the therapist notices the patient’s inability to slowly lower themselves down to the seat. The therapist would like to improve the patient’s control during this functional task. Addressing which of the following would provide the GREATEST improvement in the patient’s ability to perform a controlled stand to sit transfer?

A. Eccentric strength of the quadriceps

B. Concentric strength of the quadriceps

C. Concentric strength of the gluteus maximus

D. Eccentric strength of the hip abductors

A

Eccentric move.

CONTROL – ECCENTRIC

A: CORRECT

B: NO, they are moving eccentric

C: NO, it is eccentric

D: Not the right plane

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13
Q

A patient demonstrates knee buckling during early stance phase. The therapist would like to address this abnormality. Which of the following interventions would provide the MOST improvement in the patient’s gait deviation?

A. Open chain knee extension with emphasis on concentric training

B. Step downs with an emphasis on eccentric training on the quadriceps

C. Supine straight leg raises emphasis on isometric training of the quadriceps

D. Closed chain squats held at 90-90 with an emphasis on isometric training of the quadriceps

A

Instability into knee flexion – eccentrically.

What is going to help the patient

Not letting knee to flex gradually

What is going to improve Closed chain, quad weakness, that is eccentric.

ISOMETRIC - STABILIZATION

A: NOT OPEN CHAIN or Concentric

B: CORRECT

C: Don’t need isometric,

D: Squats wouldn’t help functionally

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14
Q

A patient presents to physical therapy with complaints of neck pain and an inability to achieve full cervical rotation bilaterally. Which of the following is the MOST likely present?

A. Tightness of the left SCM

B. Unilateral downglide restriction on the left

C. Unilateral upglide restriction on the right

D. Alanto-axial joint hypomobility

A

D. Alanto-axial joint hypomobility

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15
Q

Concentric/Eccentric:

  • Squatting
  • Quadriceps
  • Gluteus Maximus
  • Lunges (rear leg)
  • Hamstrings
  • Quadriceps
  • Push ups
  • Pectoralis Major
  • Triceps

Shoulder abduction

Serratus Anterior

Levator Scapulae

Midstance – Terminal stance

Gastrocnemius

Gluteus Maximus

A
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16
Q

A therapist observes a patient performing hamstring curls in standing. The therapist notices that the patient is unable to achieve full knee flexion actively but has full passive knee range of motion bilaterally. Which of the following is the MOST likely reason for the diminished knee flexion in standing?

A. Active insufficiency of the quadriceps

B. Active insufficiency of the hamstrings

C. Passive insufficiency of the hamstrings

D. Passive insufficiency of the quadriceps

A

B. Active insufficiency of the hamstrings

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17
Q

A therapist observes a patient performing knee flexion in standing. The therapist notices that the patient is unable to achieve full knee range of motion and reports anterior thigh discomfort. Which of the following is the MOST likely reason for the diminished knee flexion in standing?

A. Active insufficiency of the quadriceps

B. Active insufficiency of the hamstrings

C. Passive insufficiency of the hamstrings

D. Passive insufficiency of the quadriceps

A

D. Passive insufficiency of the quadriceps

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18
Q
A
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19
Q

Spinal flexion or extension is also called what?

For example, flexion/extension of C2 on C3

A

Upglide/Downglide

Neck Flexion = Bilateral upglide

Neck Extension = Bilateral downglide

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20
Q

If your patient presents with a unilateral downglide restriction on the left how will the patient present?

A

LIMITED LEFT SIDE-BEND (LATERAL FLEXION) & LIMITED LEFT ROTATION

Sidebending and rotation are to the same side.

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21
Q

Cervical Thoracic and Lumbar facet orientation (degrees)

A

Cervical: 45 degree

Thoracic: 60 degree

Lumbar: 90 degree

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22
Q

A patient is performing a sit up with the arms crossed to test for abdominal strength. During the test, the patient is seen rotating to the right incorrectly. Despite verbal and tactile cues, the deviation remains. Which of the following is the MOST likely cause?

A. Weak rectus abdominus

B. Weak left external obliques

C. Weak right internal obliques

D. Weak right external obliques

A
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23
Q
A
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24
Q

Spondylolysis

What is it and how does it happen

A

•Definition

⚬a defect or stress fracture in the pars interarticularis

•Pathophysiology

⚬Acute high stress or prolonged overloading

Most likely younger with a lot of hyperextension.

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25
Q

Spondylolysis

Signs and Symptoms

A

•Top 3 signs and symptoms

⚬Pain with extension

⚬Unilateral in nature

⚬Get worse towards end of day

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26
Q

Spondylolysis Testing

A

•Special Testing

⚬Stork Test - Stand on one leg and bend back

•Basic diagnostic imaging

⚬Radiographs (unilateral oblique view)**

•Advanced diagnostic imaging

⚬CT scan or bone scan

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27
Q

Spondylolysis Contraindications and Treatment

A

•Contraindications

￭Extension

￭Contralateral rotation/sidebending

￭End range motions

•Treatment

￭Education to avoid provocation

￭Postural training

￭Neural pelvic isometrics

￭Dynamic/Functional stabilization training

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28
Q

Spondylolithesis Definition and Pathophysiology

A

•Definition

⚬a progression of a pars fx that leads to a slippage of one vertebrae over another

•Pathophysiology

⚬Continued high stress or can be a repetitive stress that leads to a nonunion fracture

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29
Q

SPONDYLOLITHESIS - top 3 sign and symptoms

A

•Top 3 signs and symptoms

⚬Pain with extension

⚬Feeling of Instability

⚬Clunking or clicking

⚬Step-off deformity

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30
Q

Spondylolithesis Special Testing

A

•Special Testing

⚬Step off sign

LEVEL OF THE SLIP IS BELOW THE STEP OFF LEVEL

⚬Bilateral lateral radiographs

⚬CT Scan or Bone Scan

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31
Q

A patient presents with stage II anterograde spondylolisthesis is being instructed on activities that are appropriate to perform. Which of the following activities is considered ACCEPTABLE:

A. Bending down to retrieve an object and return to an erect posture

B. Watching TV in prone on elbows

C. Placing lumbar spine into 10 degrees of hyperextension before sneezing forcibly

D. Lifting heavy boxes overhead

A

A. Bending down to retrieve an object and return to an erect posture

Everything else is hyperextension

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32
Q

A 68-year-old female is receiving therapy services for her right shoulder pain and poor posture. The patient presents with severe thoracic kyphosis and a dowager’s hump. The therapist would like to improve the patient’s posture safely. Which of the following is the BEST intervention to address her posture?

A) Pectoral Stretching

B) Thoracic High-Velocity Low Amplitude Thrust (HVLAT)

C) Thoracic posterior-anterior grade IV mobilization

D) Cervical extension PRE’s

A

A: Is safe

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33
Q

DIFFERENTIAL DX FORMULA

A

Identify the Demographic

Categorize the Pathology (STT)

Recall Top 3 Differentiating Signs/Symptoms/Labs

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34
Q

ADHESIVE CAPSULITIS

A
  • Idiopathic inflammatory condition affecting the capsule of the GH joint causing severe pain and progressive loss of mobility
  • Age: 40 – 60
  • Gender: Female
  • Mechanism of Injury: Traumatic or Atraumatic
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35
Q

Adhesive Capsulitis Signs and symptoms

A
  • Active ROM = Passive ROM
  • Resisted testing = typically fair+ to good with no pain in later subacute phase
  • Joint mobility limited into posterior and inferior glide

Signs & Symptoms (Top 3)

  • Progressive worsening of shoulder mobility
  • Pain that gets worse and then better however mobility remains limited

•Capsular Pattern (ER<abd></abd>

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36
Q

When a patient has diagnosed adhesive capsulitis, and external rotation limitation is the primary impairment, which direction do you mobilize?

A

This is the exception to the rule – Going to mobilize posterior

IGLC

Iinferior glenohumeral ligamentous complex – bottom part of hammock.

All the inflammation settles in the hammock area. It sticks everything together, therefore, inferior glide is stuck.

Another part of the capsule gets tight. = Posterior, and it gets glued down a lot.

Humeral head will get pushed anteriorly

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37
Q

Adhesive Capsulitis Presentation

A
  • Active ROM = Passive ROM
  • Resisted testing = typically fair+ to good with no pain in later subacute phase
  • Joint mobility limited into posterior and inferior glide
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38
Q

SUPRASPINATUS TENDINITIS Demographics

A
  • Inflammation of the supraspinatus tendon
  • Age: 40 – 60 / 20 - 30
  • Gender: Female / Male*
  • Mechanism of Injury: Overuse
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39
Q

Supraspinatus Tendinitis Presentation

A
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40
Q
A
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41
Q

Supraspinatus Tendinitis Sign and Symptoms

A

Signs & Symptoms (Top 2)

  • Painful arc motion (60-120 degrees)
  • Pain with resisted scaption/abduction & external rotation
42
Q

SUPRASPINATUS BURSITIS Presentation

A
  • Active ROM and Passive ROM limited by pain
  • Resisted testing = good with initial contraction and painful upon immediate release
  • No joint mobility restrictions
43
Q

AC Joint Lesion (OA)

A
  • Degenerative wear and tear on the AC joint or FOOSH/FOOSA
  • Age: 40+
  • Gender: Female / Male*
  • Mechanism of Injury:

Traumatic or degenerative

44
Q
A
45
Q

AC Joint Lesion (OA) Sign and Symptoms

A

Signs & Symptoms (Top 3)

  • Pain at extreme ranges of motion (>150 deg abduction & flexion)
  • Pain with horizontal adduction (cross body motions)
  • Step deformity (AC joint separation)
46
Q

Labral Tear

A
  • Degenerative wear and tear or traumatic rotational injury
  • Age: 20 – 60+
  • Gender: 1:1
  • Mechanism of Injury: Traumatic or degenerative
47
Q

Labral Tear Signs and Symptoms

A

Signs & Symptoms (Top 3)

  • Catching, clicking or popping with shoulder movements
  • Shoulder pain with elbow flexion
  • Feelings of instability
48
Q

Labral Tear Examination

A
  • Active ROM and passive ROM painful and limited
  • Resisted testing – fair strength and painful
  • Impaired GH joint mobility
49
Q

An adolescent swimmer presents with bilateral shoulder pain and denies any specific mechanism of injury. The patient is observed to have gross hypermobility and scapular dyskinesis bilaterally. Which of the following is the MOST likely cause of the patient’s symptoms?

A. C7 bilateral radiculopathy

B. Secondary Impingement

C. Lengthened Pectorals

D. Primary Impingement

A

Adolescent swimmer

Not normal for adolescent to have shoulder pain? no

A: Where does C7 innervate – elbow extension, hands – not shoulder related; would entertain if it was C4-C5. Also, NO NERVE SIGNS

B: Subacromial impringement – why does it happen? Fits

C: No one really has lengthened pectorals – almost no one

D: Person who is older, structural issue

50
Q

Primary Impingement

A
  • Congenital or age-related changes of the sub-acromial space that causes an impingement.
  • Age: 60+
  • Gender: 1:1
  • Mechanism of Injury: Degenerative
51
Q

Primary Impingement Signs and symptoms

A

Signs & Symptoms (Top 3)

  • Sharp pain in the painful arc during elevation and lowering
  • Shoulder pain that is dependent on activity overhead
  • Poor posture/Hypomobile
52
Q

Primary Impingement findings

A
  • Active ROM and passive ROM limited
  • Resisted testing – strong and painless if below painful arc
  • Decreased joint mobility
53
Q

Secondary Impingement

A
  • Age: Adolescent/Young Adults
  • Gender: 1:1
  • Instability of the GH joint secondary to

⚬Hypermobility

⚬Rotator Cuff Weakness

⚬Scapular Dyskinesias

54
Q

Secondary Impingement Sign and Symptoms

A

Signs & Symptoms (Top 3)

  • Sharp pain in the painful arc during elevation and lowering
  • Shoulder pain that is dependent on activity overhead
  • Poor posture/Hypermobile
55
Q

Secondary Impringement Presentation

A
  • Active and passive range of motion excessive
  • Resisted testing – weak rotator/scapular muscles
  • Increased joint mobility - hypermobile
  • Scapular dyskinesias

Difference for partial and full thickness tear

Pain, non for full. Mod pain for partial

Weakness – partial above 3; full thickness is below 3

56
Q

NPTE Application - Intervention Flow

A

Pain/Swelling -> Restore PROM -> Motor Control

  • > AAROM -> AROM -> Coordinative Training -> Endurance/Strength Training -> Power Training
  • > Functional Based/RTF Training
57
Q

A patient suffered a blunt force trauma to the right quadriceps 2 weeks ago. The patient currently has minimal pain but a significant limitation in knee flexion. The MOST appropriate intervention to treat this patient is:

A. Aggressive stretching

B. Cryotherapy

C. Deep soft tissue massage

D. Passive range of motion

A

Think Mystitis Ossificans.

Bone in tissue

Minimal pain – don’t select intervention that addresses pain.

ROM problem

2 weeks out

A: not effective or efficient

B: Used for pain, but this is not pain

C: Can be used for pain, decrease tone, ROM, or break up adhesions. But only at 2 weeks

D: Can do, addresses beyond pain, and mobility

58
Q

A therapist is treating a patient with bilateral subacromial impingement and upper crossed syndrome. Which of the following should be addressed FIRST:

A. Tightness of the pectoralis major and minor

B. Weakness of the deep neck flexors

C. Tightness of the serratus anterior

D. Tightness of the latissimus dorsi

A

FIRST – there are two or more correct, but which ones first.

A: Makes sense, want to stretch before strengthen

B: Would you want to address it? YES, but stretch before strengthen

C: Typically weak

D: not a major player in upper cross

59
Q

Lumbar Stenosis S+S

A
60
Q

Lumbar Stenosis

A

•Encroachment of bone or soft tissue into the spinal canal (spinal cord compression) or intervertebral foramina (nerve root compression) in the lumbar spine.

61
Q

Herniations - 2 types

A

An HNP in the lumbar spine can hit two different areas on the NPTE

•A Lateral L4-5 HNP

hits L4

•A Posterolateral L4-L5 HNP hits L5

62
Q

A patient’s recent MRI confirms in acute L4 - L5 posterolateral disc herniation. Upon examination, which of the following findings is the MOST likely be present?

A. Diminished knee jerk reflex

B. Impaired sensation along the lateral thigh, anterior knee, extending down the medial tibia and into the medial malleolar region

C. Delayed heel off

D. Impaired sensation between the web space of the first and second digits

A

D. Impaired sensation between the web space of the first and second digits

63
Q

An injured worker presents to physical therapy for lower back pain after lifting a 50-lbs box. The patient complains of intermittent shock-like sensations into the lateral left foot, extending to the distal 5th digit along the dorsum of the foot. Which nerve root is the MOST likely impaired:

A. S1

B. L5

C. L4

D. L3

A

Medial side of foot is L4

Top of dorsum of foor L5

Lateral side is S1

A. S1 is correct

64
Q

BICYCLE TEST OF VAN GELDEREN

A

Purpose: Assess a patient for the presence of spinal stenosis

(1) Patient rides on a stationary bike in the upright position while distance and time is recorded.
(2) The patient has to pedal a second time in a slumped position with lumbar delordosing. The distance the patient has pedaled in the same time is recorded again.

If the patient can pedal further in slumped position than in upright position, lumbar spinal stenosis is indicated

65
Q

TWO STEP TREADMILL TEST

A

Purpose: Assess a patient for the presence of spinal stenosis

(1) Patient walks on a flat (0 deg) treadmill with their back in an extended posture. The walking distance and time is recorded.
(2) The patient has to ambulate a second time in a with an uphill sloped (flexed position). The distance the patient has pedaled in the same time is recorded again.

If the patient can ambulate further when ambulating uphill lumbar spinal stenosis is indicated.

66
Q
A
67
Q

JOINTS OF THE FOOT

A
  • Hindfoot (rearfoot)
  • Hindfoot – tibiofibular joint & talocrural joint aka “ankle joint”, subtalar joint
  • Midfoot (midtarsal)
  • Midfoot – talocalcaneonavicular jt, cuneonavicular jt, cuboidnavicular jt, intercuneiform jts, cuneocuboid jt, calcaneocuboid jt.
  • Forefoot
  • Tarsometatarsal jt, intermetatarsal jts, MTP jts, IP jt
68
Q

A patient is observed to have poor propulsion during the pre-swing phase of gait on the right. Upon examination, the patient lacks right calcaneal inversion. Which of the following is the MOST effective to improve the patient’s propulsion?

A.Lateral glide of the calcaneus

B.Medial glide of the calcaneus

C.Distraction of the talocrural joint

D.Posterior glide of the talocrural joint

A

Supination makes the foot rigid.

What do you need to know. Convex calncaneous on concave talus

A.Lateral glide of the calcaneus

69
Q

Subtalar Joint

A
  • Convex calcaneus on concave talus
  • In Open Kinetic Chain

–Calcaneus rolls medial and glides lateral

–Calcaneus rolls lateral and glides medial

•In Closed Kinetic Chain (focus on the moving part)

–Talus rolls medially (internally rotates), glides medial and adducts DURING PRONATION

»Bottom line the talus rolls medial glides medial

–Talus rolls laterally (externally rotates), glides lateral and abducts DURING SUPINATION

»Bottom line the talus rolls lateral glides lateral

70
Q

Closed Kinetic Chain for Forefoot

A
  • In Closed Kinetic Chain (#1 goal = maintain foot on floor)
  • When rearfoot moves into eversion (pronation) the forefoot moves into supination
  • When rearfoot moves into inversion (supination) the forefoot moves into pronation
71
Q

Fixed FF Varus

A

Fixed Forefoot Varus - FIXED

Forefoot is rigid therefore it does not move

Therefore, always bring the ground up to the foot.

Use the medial forefoot wedge/post

“FIll the gap”

72
Q

FLEXIBLE FF VARUS DEFORMITY

A

Post/wedge on the opposite side

Posting opposite allows for proper alignment of the forefoot during weight bearing

Flexible deformities can return to neutral alignment with the proper orthotic.

73
Q

WHAT DOES UNCOMPENSATED AND COMPENSATED MEAN?

A

•When a patient has a foot deformity (e.g., rigid forefoot varus) and the rearfoot and/or lower extremity changes in position in order to bring the forefoot flat on the ground.

Are the toes on the ground? = Compensated

74
Q

A patient is found to have a 13 degree rigid forefoot varus upon examination. Which of the following compensations would be the MOST likely present?

A. Rearfoot eversion
B. Rearfoot inversion
C. Forefoot valgus
D. Genu Varum

A

A. Rearfoot eversion

75
Q

CLINICAL PREDICTION RULES

A

1.Ottawa Knee and Ankle Rules

2.Lumbar Thrust Manipulation

3.Cervical Radiculopathy

4.Cervical Myelopathy

5.Carpal Tunnel Syndrome

6.Well’s DVT Clinical Prediction Rule

  1. Canadian C-Spine Rules
  2. Sacroiliac Joint Cluster
  3. Thoracic Manipulation for Neck Pain
76
Q

Ottawa Knee

A
77
Q

Ottawa Ankle Rules

A

An ankle X-Ray series is only required if there is any pain in the malleolar zone and…

Bone tenderness at the posterior edge or tip of the lateral malleolus (A)

OR

Bone tenderness at the posterior edge or tip of the medial malleolus (B)

OR

An inability to bear weight both immediately and in the emergency department for four steps

78
Q

Ottawa Foot Rules

A

A foot X-Ray series is only required if there is any pain the midfoot zone and…

Bone tenderness at the base of the fifth metatarsal (C)

OR

Bone tenderness at the navicular (D)

OR

And inability to bear weight both immediately and in the emergency department for four steps

79
Q

A patient presents to physical therapy with lower back pain that began 10 days ago after reach down to pick up a child. The patient reports discomfort into the left buttocks which radiates into the posterior knee. The patient is found to have a 16 on the FABQ and no hip mobility restrictions were noted. Which of the following findings would improve the confidence that the patient will benefit from a lumbar manipulation?

A.Positive prone instability test

B.Lumbar flexion < 30 degrees

C.Lumbar hypomobility

D.Centralization with repeated lumbar extension

A

A: Do not do manips on instability

B: Very Broad

C: Definitely manip, better than B

D: McKenzie technique – if they are doing well… continue to do that

80
Q

LUMBAR MANIPULATION CPR

A
  • Pain lasting less than 16 days
  • No symptoms distal to the knee
  • FABQ score less than 19
  • Internal Rotation of > 35 degrees for at least one hip
  • Hypomobility of a least one level of the lumbar spine
81
Q

CERVICAL RADICULOPATHY

A

Clinical Prediction Rule Findings:

  1. Positive Upper Limb Tension Test A (Median Nerve)

•Why median nerve? Largest Distribution

  1. Involved-side cervical rotation range of motion less than 60 degrees
  2. Positive Distraction Test
  3. Positive Spurling’s Test (compression and side bending)
82
Q

CERVICAL MYELOPATHY

A

Clinical Prediction Rule Findings:

  1. Gait Deviation (Clumsy Gait, Ataxia)

•Spinocerebellar tracts: relay position sense to cerebellum

•

  1. Positive Hoffmann’s Test

•No reflex inhibition at spinal cord level

  1. Inverted Supinator Sign

•Impaired C5-6 segment of the spinal cord

  1. Positive Babinski Test
  2. Age 45 Years or Older

•Physiological causes are more commo

83
Q

CARPAL TUNNEL SYNDROME

A

Entrapment of the median nerve in the CT by tendon hypertrophy, fluid retention, or joint hypomobility.

  1. Shaking hands to relieve symptoms
  2. Wrist ratio >.67
  3. Symptom Severity Scale > 1.9
  4. Diminished sensation in median sensory field 1 (thumb)
  5. Age > 45 years old
84
Q

DVT Well’s Clinical Prediction Rule

A
  • A score of 1-2 is considered moderate risk
  • A score of 3 or higher suggests DVT is likely.
85
Q

What Are The 6x6x6 Post Op Guidelines?

A
  • Maximum Protection (0 – 6 weeks)
  • Resolve/Reduce pain and swelling
  • Prevent loss of mobility in surrounding joints
  • Lessen the effects of immobilization
  • Restore motor activation
  • Moderate Protection (6 – 12 weeks)
  • Restore mobility
  • Restore coordination
  • Increase strength & stability
  • Minimal Protection (12 – 6+ months)
  • Restore power
  • Return to function
86
Q

A patient is being evaluated for right shoulder pain. The therapist finds limited active shoulder range of motion in all planes. Which of the following should be assessed NEXT:

A.End-range shoulder flexion range of motion

B.Passive range of motion into all shoulder planes

C.Strength assessment of the flexors and external rotators

D.Anterior joint mobility assessment

A

B.Passive range of motion into all shoulder planes

87
Q

A 56 year old male underwent a 4 cm full thickness rotator cuff repair three weeks ago. Which of the following interventions is the MOST appropriate this time?

A.Full active elbow flexion and extension

B.Passive range of motion into end range shoulder internal rotation

C.Resisted side-lying shoulder external rotation with 1lb weight

D.Supine full shoulder flexion AROM

A

A.Full active elbow flexion and extension

88
Q

•What is the Supraspinatus OIA

A
  • What is the Supraspinatus OIA
  • (O) Supraspinous Fossa
  • (I) Sup Facet of Greater Tuberosity
  • (A) Abduction, Scaption
  • Supraspinatus tendon is stretched with passive motion into:
  • Internal rotation
  • Extension
  • Adduction
  • Vigorous stretching (12 weeks or later)
89
Q

A patient who is 8 weeks status post rotator cuff repair is being observed from behind performing shoulder abduction. The patient’s shoulder abduction ROM is limited and the scapula translates excessively into upward rotation. Which intervention is the MOST effective?

A.Strengthening of pectorals and upper trapezius

B.Strengthening the serratus anterior and lower trapezius

C.Grade IV posterior-inferior gleno-humeral mobilizations

D.Strengthening of the rhomboids and mid trapezius

A

Mod Protection phase

Cause is it at the GH joint

A: No, going to make problem worse

B: Upper rotation, don’t want it

C: Possible, the only thing that can get more motion

D: Pull shoulders back; Would have retraction

90
Q

A 45 year old construction worker underwent a rotator cuff repair of the supraspinatus tendon two weeks ago and presents with moderate pain and swelling. The therapist would like to position the patient to relieve the most stress on the repair. Which of the following is the MOST effective:

A.30 degrees of abduction with slight internal rotation

B.Shoulder adduction with full shoulder internal rotation

C.90 degrees of abduction with 90 degrees of external rotation

D.Shoulder adduction with arm at side

A

A.30 degrees of abduction with slight internal rotation

91
Q

TISSUE ANATOMY & PHYSIOLOGY

A
  • ACL reconstruction
  • ACL is stressed during internal rotation of the tibia and terminal knee extension (15 – 45 degrees)

(MCL and LCL are for more external rotation

  • Avoid squatting between 60 degrees – 90 degrees
  • Hamstring grafting requires slow progression of resisted knee flexion exercises (8 weeks or modPP)
92
Q

A 17 year old patient is participating in physical therapy after an ACL reconstruction 2 weeks ago. Which of the following activities is the safest to perform?

A.Independent gait training without a knee brace

B.Sitting on the edge of a table, kicking a deflated ball

C.Supine quadriceps muscle setting

D.Single leg stance on foam using the affected leg

A

C.Supine quadriceps muscle setting

93
Q

A patient with persistent lower back pain was prescribed an at-home TENS unit to assist with ADL’s. The patient brought the unit to therapy for instructions on how to use the device. The device should be worn:

A.At all times while at home

B.Only while the patient is in pain at home

C.Up to 1-hour at a time with a 30 minute break between each use

D.Only during performance of ADL’s

A

C: True, there is a risk for burning for the patient

94
Q

ACUTE Pain and TENS

A
  • Conventional or Traditional or High Frequency TENS
  • High-Frequency/Low-Intensity TENS
  • Frequency = at least 50 pps, 80 – 110 pps
  • Amplitude = strongest possible without motor contraction or increased pain
  • Pulse Duration = 50– 100 microseconds

•

95
Q

CHRONIC PAIN and TENS

A
  • Acupuncture-like TENS
  • Low-Frequency/High-Intensity TENS
  • Frequency = Below 10pps, usually 1-4 pps
  • Amplitude = performed with intensity high enough to evoke visible muscle contractions
  • Pulse Duration = 200 microseconds

•

96
Q

A patient is being treated for a grade II ankle inversion sprain that occurred 3 days ago. After 5 minutes of using TENS, the patient complains of “not feeling the tingling anymore”. Which of the following is the BEST course of action:

A.Explain that this is a normal response and continue treatment

B.Switch the unit over to brief-intense TENS

C.Switch the unit over to modulated TENS

D.Immediately terminate treatment secondary to faulty equipment

A

Modulated tens is also known as sweep

A: It is normal, but modify treatment. Not responding the problem

B: Brief-intense is for debridement

C: Doesn’t allow pt to adapt to it

D: NOT TRUE

97
Q
A
98
Q

Burst Train TENS

A
  • Burst-Train TENS
  • Combo of conventional and acupuncture-like
  • High frequency of pulses delivered at a low frequency of bouts
  • Frequency = 100 pps, delivered at 1 -5 pps
  • Amplitude = highest tolerated painful stimulus
  • Pulse Duration = 250+ microseconds

•

99
Q

PROCEDURE OR CHRONIC PAIN and TENS

A
  • Brief-Intense TENS
  • High-Frequency/High-Intensity TENS
  • Frequency = 100 – 150 pps
  • Amplitude = highest tolerable intensity for a short period of time
  • Pulse Duration = 150 -250 microseconds

**Clinical Note: used for only brief periods of <15 minutes

100
Q

TENS CONTRAINDICATIONS

A
  • Pacemaker (C, Local, physician approval)
  • Pregnancy (C, Local, abdomen, Low Back, Hips, Pelvis)
  • Lack of normal sensation (C, local)
  • Impaired Cognition (C)
  • DVT (C)
  • Malignant Tumors (C, local)
  • Active Epiphysis (P)
101
Q

A patient with neck pain was treated with conventional TENS up to the patient’s tolerance post exercise. After completion, the patient’s skin was observed and revealed bright red skin and slight blistering. Which of the following is the MOST appropriate response for future use of this modality:

A. Re-initiate TENS once skin is healed and at a lower intensity

B. Terminate all use of TENS

C. Re-initiate TENS on the next session adjacent to the affected area

D. Switch over to brief-intense TENS on the next session

A

A. Re-initiate TENS once skin is healed and at a lower intensity

102
Q

A patient with chronic lower back pain with central sensitization is being treated with transcutaneous electrical stimulation. The therapist would like to choose parameters that will yield the greatest impact on the patient’s pain levels. Which of the following frequencies is the MOST recommended:

A.80 - 100 pps

B.1 – 4 pps

C.50 – 100 pps

D.150 – 250 pps

A

Chronic pain

Central Sensitization – when a pt has the NS is ramped up so much that there is pain with no damage.

A: ACUTE PAIN

B: ACCUPUNTURE LIKE - GOOD

C: ACUTE SETTING

D: HIGH FREQUENCY – BREIF INTENSE = Procedural Pain

NPTE (12 decks)

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