MSK clinical skills

Question 1

What are the contraindications to check for with ultrasound non thermal

Answer 1

Active DVT
Current tissue bleeding
cancer
pregnancy
Tuberculosis
electronic implants

Question 2

What are the contraindications to check for with ultrasound thermal

Answer 2

Active DVT
acute injury/inflammation
current tissue bleeding
impaired circulation/sensation
pregnancy
skin disease (eczema)
tuberculosis
electronic implants

Question 3

What are some risks associated with ultrasound

Answer 3

superficial burns (with thermal)
Internal bleeding/scarring
no clinical benefit alone, needs to be used with exercise

Question 4

How does ultrasound therapy work

Answer 4

sound waves generated by machine cause oscillation in tissue

does not increase inflammatory response but optimizes it to help move onto next stage of healing

targets mast cells which release arachidonic acid, causing an increase of prostaglandins and leukotriene which act as inflammatory mediators

best used on soft tissue injuries

Question 5

What are the 3 ways ultrasound therapy helps

Answer 5

Micromassage
The sound waves cause the tissue to vibrate and micromassage, which heats the tissue and improves blood circulation.

Cavitation
The sound waves cause microscopic bubbles to form in the tissue, which expand and contract, creating a microstreaming effect. This microstreaming causes nearby cells to rotate and twist, which can help reduce edema.

Acoustic streaming
The sound waves cause tissue fluids to move along cell walls, which can increase cellular metabolic activity and permeability.

Question 6

When are different intensities used

Answer 6

acute - 0.1-0.3
subacute - 0.2-0.5
chronic - 0.5-1.0

Question 7

When do you use different pulse rates

Answer 7

continuous is for most chronic, then 1;1 , then 1;2, 1;3, etc as it gets more acute

machine offers 2ms output followed by 2ms x second number in pulse rate rest

Question 8

When do you use different frequencies

Answer 8

1MHz - deeper applications
3MHz - superficial applications

Question 9

how do you know how long to do ulltrasound for

Answer 9

number of times head fits into tissue to treat x pulse factor with both numbers added together =time in min

Question 10

How do you use the ultrasound machine

Answer 10

Avoid bones, and keep moving in circular motions

Question 11

What is PNF stretching

Answer 11

when stretched, muscle spindles activate the sensory neurons and synapse onto alpha motor neurons, causing activation and contraction of the stretched muscle to limit it. at the same time inhibitory interneurons in the spinal cord are also synapsed onto, which causes inhibitory impulses onto the antagonistic muscle to relax it. (reciprocal inhibition)

when the muscle contracts, the golgi tendon organ is activated and a type 1b afferent signal is sent to the spinal cord, where it synapes on the inhibitory interneuorns for the alpha motor neurons for the agonist muscle to inhibit the contraction (autogenic inhibition)

doing this in quick succession will lead to increased ROM

Question 12

How is PNF for hamstring performed

Answer 12

muscle stretched to the resistance point, hold for 10s

20% strength contraction for 5s (isometric)

stretch forward and hold for 10s

strength for 5s

hold for a 30s stretch

Question 13

what are the contra indications for PNF

Answer 13

acute inflammation
local infection
bony block
haematoma
disruption of surgical repair
increased pain
increased inflammation

Question 14

what are precautions for PNF

Answer 14

Recent fracture
osteroporosis
elderly
recent prolonged immobilization

Question 15

what is joint ROM used for

Answer 15

joint stiffness
immobilization
nerve injury
muscle weakness, etc

Question 16

what are the 2 types of joint ROM?

Answer 16

Active - moving joint with no external resistance/assistance, just the use of muscles surrounding the joint

active assisted - mobility exercise performed with muscles and some external assistance (other limb, belt, towel, etc)

use active assisted when pt isnt allowed to or cannot fully activate muscles, or extra force is needed to obtain desired range

Question 17

How does joint ROM help

Answer 17

increase ROM and maintain elasticity

reduce pain

prevent DVT

restore mechanical and structural properties of ligaments, joint capsules, and tendons

Question 18

How should joint ROM exercises be performed

Answer 18

free from restrictive clothing

make movement as easy as possible/remove as much resistance as possible

isolated joint/movement, moving through complete ROM

short hold at 3s, 5-10 reps 3 times a day daily

Question 19

what are some joint ROM contraindicationss

Answer 19

disruption of surgical repair
increased pain or inflammation

Question 20

how can resistance be added with strength exercises

Answer 20

manipulating body position to alter gravity effects

consider weight of limb

free weights (less stable but more freedom)

resistance bands (not constant resistance)

ankle weights (limited by total resistance)

self resistance

machine weights (stable but locked position with less development of stabilizer and accessory muscles, so less functional strength)

Question 21

what are open and closed kinetic chains

Answer 21

open - distal segments free to move

closed - distal segments not able to move

stronger muscles take over with a closed chain

Question 22

How does resistance training increase strength

Answer 22

more neural activation (more motor units recruited)

hypertrophy of muscle (growth of muscle fibers after microtears are formed and regrown)

increased PCr, ATP, and glycogen content

increased glycolytic activity

decreased mitochondrial density

Question 23

what is the dosage

Answer 23

ideally 8-12 reps per exercise, with 3-5 sets

ideal rep range for hypertrophy of the muscle, leading to strength increases while being balanced with muscular endurance.

depends on types of fibres, muscle groups mainly made up of type 1 fibres would benefit from endurance training, while type 2 fibre muscles would benefit from hypertrophy strength training

Question 24

what are the contraindications to strengthening

Answer 24

movements shouldnt increase pain/inflammation and shouldnt disrupt healingprocess

should be careful prescribing to kids and those with CVD/hypertension

Question 25

describe when and how you would use walking stick

Answer 25

used to take some weight of impaired leg, but nearly full WB arm opposite to bad leg and lined up to wrist crease stick moves with bad leg (2point)

Question 26

describe when and how you would use axillary crutches

Answer 26

only NWB, for those who have more upper body strength 5cm below armpit, with handgrip at wrist crease height pt should bear through the andles and not armpits to avoid nerve damage, upper portion of the ribs should. be squeezed between arms and ribs swing to gait - More stable but slower Pt moves both crutches forwards, has affected leg lifted up, and then the sound leg swings upto the crutches swing though gait - Faster but less stable Same as swing to gait but sound leg swings past the crutches and lands infront ot them

Question 27

describe when and how you would use elbow crutches

Answer 27

pwb mainly, as they cant bear as much weight pt must be less than 25 stone and crutches must be new handles at wrist crease and cuff just below elbow PWB gait consists of Crutches, followed by affected leg and then the sound leg

Question 28

describe when and how you would use zimmer frames

Answer 28

Can be PWB or NWB, mainly for pts who need a lot more stability compared to crutches Cant be used on stairs Line up handles with wrist creases Frame, affected leg, sound leg Ensure that the pt remains inside the base of the frame to promote stability

Question 29

how do patients turn with aids

Answer 29

3-point turn, keeping aids in front of them at all times

Question 30

how do pts go from sit to stand with aids

Answer 30

To stand up from a seated position, hold both crutches on affected side in h-position, extend affected leg, push up using sound leg and the other hand on the chair, not using walking aid to stand

Question 31

how do pts go from stand to sit with aids

Answer 31

Sitting down is the exact same process, only opposite (crutches on affected side, lift up affected leg, hold chair with hand, and sit using the sound leg and hand to lower urself down)

Question 32

should pts hold zimmer frames when sitting or standing

Answer 32

no

Question 33

how do PWB pts go up and down stairs with crutches

Answer 33

Non affected side holds railing, other hand holds crutches in t-shape, then up with the good (good leg, bad leg, crutch Going down stairs is the same, just opposite (crutch, bad leg, good leg)

Question 34

how do NWB pts go up and down stairs with crutches

Answer 34

Same hand position, going up is hop up on good leg, then crutch Going down is a crutch, then hop down good leg

Question 35

How do walking aids help patients

Answer 35

assist in keeping pt stable and allows them to maintain the ability to continue walking with varied degrees of weight bearingg

Question 36

what are the contraindications to walking aids

Answer 36

floor should be dry and pt should have proper footwear aids should be new take pts strength into account when prescribing stay at pts side w arms ready when teaching, and have another person follow pt with wheelchair incase they feel faint