MSK Misc Flashcards
Hill Sachs Lesion
Being hit fro P-A in closed pack (Abduction and ER) overhead causes ant dislocation and damage to posterolateral HUMERAL HEAD H goes with H. SO ant dislocation damaged post HH
Could be reverse and impact posterior capusle and ant hum head if hit from A-P
Bankart Lesion
Tear in LABRUM, the usually lower part. Due to disloaction
What happens to cadence and step length with age
Cadence decreases b/c less steps required due to incincreased reased step length
Extensor tendon repairs
Early intervention
Active flexion of MCP and passive extension of wrist allowed
Flexor tendon repairs
Active extension, passive flexion
Active in opposite
Free nerve endings (Joint receptors)
All joints (think pain)
Noxious and non noxious mechanical and biochemical stimuli to capsule, ligaments, synovium, fat pad
Pacinian corpuscles (joint receptors)
All joints (think velocity, accel joint position)
detects different joint position changes in the fibrous layer of capsule
Golgi ligament endings
Ligaments specific, detect the amount of stretch
Ruffini Endings
Detects stretch of entire joint capsule (rather than ligament specific)
Golgi-Mazzoni corpuscles
Mazzoni compression of joint capsule
Synovial joints
All major joints we address in PT. Have free movement
1. joint cavity (fluid filled part)
2. Articular cartilage
3. Synovial membrane
4. Synovial fluid
5. Fibrous capsule
Cartilaginous joints
Have hyaline or fibrocartilage
Slight mobility
e.g sternum articulation w/ true rib
Fibrous joint
Barely oves
e.g bones in skull
syndesmosis of tibia and fibula
Type 1 fibers
Slow
Smaller
Slow oxidative
Less fatiguing/fatiguability
More mitochondria
e.g marathon, swim
Recruited first in natural contraction
Type 2 fibers
Recruited first with E STIM
Larger
faster
More fatigable
Lower capillary, mitochondria,
high jump, sprint
Muscle spindle
Muscle belly, send info about muscle length or rate of change
Golgi tendon organs
Detect tension especially with active contraction3
Levator Scap action and innervation
ELEVATES SCAP but dowanrdly roates it as well
Anterior rami
Dorsal scap nerve, Rhomboids too
What muscles do upward rotation
Lower and UT, SA
What muscles do doward ro
Rhomboids, levator scap, pec minor
Extensor carpi ulnar innervation
Posterior interosseous nerve (b/c starts more dorsal than medial)
Flexor carpi ulnaris innervation
Ulnar nerve
Extensor policis brevis and longus innervation
Posterior interosseous nerve (both deep muscles)
Abductor policis brevis innervation
median nerve, recurrent branch
Abductor policis longus innervation
Posterior interosseous nerve (b/c on dorsal side) deep
Flexor pollicis brevis innervation (superficial vs deep head)
Superficial (median recurrent)
Deep (ulnar)
Flexor pollicis longus innervation
Anterior interosseous nerve b/c deep
Adductor pollicis innervation
Ulnar nerve
Oponens pollicis innervation
Median nerve
Pad and Dab (interossei muscles)
Palmar, adduction
Dorsal abduction
All innervated by ulnar nerve
Lumbricles action and innervation
MCP flexion and IP extension
Ulnar vs median nerve side
Main hip IR
TFL
then glute med
Main glute ER
Glute max
Obturator bros
Gemelli bros
Tib ant vs tib post distinction
both invert but df and pf rerspectively
Boxers fracture
fx pinkey finger
Toe flexion vs extension
Think the same as hand
If unsure of capuslar pattern, think about what goes first
e.g Cervical sb and rot goes first typically and that is capuslar pattern. Extension is next
SAME FOR all of spine
C8 myotome
Thumb ext ( makes sense b/c radial)
T1 myotome
Finger abduction (ulnar)
Patella deep tendon reflex
L4
R hand dominant
R shoulder lower and R hip higher is normal and vice versa=”They come towards eachother because used more”
Normal lumbar curves
Lordosis of neck and low back
Kyphosis of thoracic spine and sacrum (sacrum is nonflexible)
Protruded tummy is normal in kids up to 10 yo
Scapula 4 inches apart is norm
Head should be erect
Normal Plumb line order
Post to coronal suture
Through external auditory meatus
Through axis of odontoid process
Midway through tip of shoulder
Through bodies of lumbar vertebrae
Slight Post to hip
Slight Ant to axis of knee
Slight ant to lat malleolus
Through calcaneocuboid joint
Capsular patterns (in order starting with most restricted
Shoulder ER ABD IR
Knee Flex EXT
Spine ROT AND SB equal, then ext
TMJ mouth cant open as well
AO Ext, side flex equal
At elbow flex then ext (then sup then pron for rh)
talocrural PF then DF
Hip Flexion abd, IR (sometimes IR most limited)
Empty endfeel
Cant reach due to pain
Boggy end feel
Mushy due to edema, hemarthrosis
MMT 3-
partial ROM against gravity
MMt 2+
Able to initiate against gravity
MMT 2
Full ROM in gravity min
MMt 2 -
Partial in gravity min
MMT 1
palpable contraction
MMT 0
No contraction
Pronation is linked with what LE alignment
Tibial Internal rotation causing knee valgus (tilting ankle inward focres tibia to move inward which causes knee valgus at top of tibia
Gout locations
Knee, big toe joint, MP joints of fingers
ankle, medial foot, elbow
Scoliosis
25-45 orthosis
45 and up spinal fusion
surgery should not occur unless kid is about 12 years old
Stretching is not plan A but if so should focus on
iliopsoas, low back extensors, lateral trunk flexors of concave side
Tendinopathies
painful with contraction
e.g supraspinatus abd to 90 and IR b/c supraspinatus abducts
Always consider tissue healing phase
6week 6week 6 months rule for
but inflammatory phase 1-5
proliferative phase 5-30 days
Maturation 30 days to years
Disorganized tissue cannot withstand tensile forces.
Collagen formation and granulation tissue develops in subacute proliferative phase
Collagen fibers reoritent to stresses in chronic stage of maturation and remodeling
acute - pain w/ movement in general
subacute - pain in relation to tissue resistance
Consider the type of contraction with MSK interventions.
Example why are wall sits good for someone struggling with stair descension
Isometric but eccentric contraction
Quadriceps need eccentric strength going down steps b/c knees bent and gravity is opposing force on knee extension
Pec major actions
Power grip requires
wrist extension and ulnar deviation
For chronically inflamed muscles
Eccentric contraction is pain free range. Eccentric contractions put less stress on contractile units at same level of ork
Anteversion vs retroversion
Antevesrion (causes toe in) because femur is internally rotated and tibia is as well.
Retroversion is opposite (LESS than 8)
Whiplash
Mobs, patient education, submaximal exercise
