MSK - Upper Body Flashcards
Muscles, bones and stuff...
Whiplash Associated Disorder: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions
MOI: Abrupt acceleration-deceleration to the c-spine. Typically MVA or contact sports.
S/S: Decreased neck ROM, pain, increased tone in cervical spinal muscles, headaches, jaw pain, could have neuro symptoms
Diagnositc tests: No specific tests
General appraoch to treatment: Strengthening, stretching, traction, soft tissue
Education points: Importance of gentle movement. POLICE. Rest.
Precautions: 5 D’s, bilateral arm numbness, signs of concussion, C spine rules
Cervicogenic Headaches: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions
MOI: From C-spine – bony, disc or soft tissue elements. Commonly associated with neck pain. Originates from AO joint and upper cervical joints, C1-C3 spinal nerves
S/S: Unilateral dominant headache, worse with neck movements and postures, tenderness of the upper c spine, increase tighness and trigger points in upper traps, LS, scalenes and suboccp extensors, splenius capitis and SCM.
Diagnositc tests: PROM and AROM. Flexion rotation test. Strength testing of DNF.
General appraoch to treatment: C spine mobilization, traction, DNF, thoracic spine mobilization, stretch suboccp
Education points: Posture education, reduce forward head posture, proper desk egronomics.
Precautions: Rule out sinister cause of headaches. Asl red flag questions.
Cervical Disc Herniation: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions
MOI: Bulge from a c spine disc, increases inflammation and pressure around c spine nerve roots causing a radiculopathy.
S/S: Radiating symptoms down arm, myotomal weakness, dermatomal sensation changes, diminished deep tendon reflexes. Worse with coughing or sneezing. Referral pain around scapula.
Diagnositc tests: MRI is gold standard. ROM.
General appraoch to treatment: DNF, lower fiber of traps strengthening, postural awareness, traction, pain control.
Education points: Posture, exercises. Medical imaging education.
Precautions: Bilateral numbness, tingling and significant muscle weakness, loss of DTR and/or presence of Babinski
Temporomandibular Myofasical Pain: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions
MOI: Correlated to teeth grinding, head forward posture leads to many symptoms.
S/S: TMJ would have no pain, no symptoms with mouth opening, normal mouth opening 35-40mm or 3 fingers
Diagnositc tests: Tenderness of master, temporalis, medial and lateral pterygoid, sub occipitals.
General appraoch to treatment: Intra oral soft tissue release, education on posture, dentist for mouth guard
Education points: AP jaw anatomu
Precautions:
Jaw Anterior Disc Displacement (with and without reduction): MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions
MOI: With reductio - condyle can move forward, rolls over disc cause click when opening, condyle moves back also causing a click. Without reduction - lock jaw, condyle is blocked by the disc and unable to role and slide forward
S/S: Palpable reciproca click during opening and closing, lateral deviation towards the symptomatic TMJ, pain or tenderness of jaw, aching pain in or around your ear, difficulty chewing or pain with chewing, aching facial pain, locking of the joint
Diagnositc tests: Palpation, click, MRI
General appraoch to treatment: mobilizations, manual therapy, STR, HEP, postural education.
Education points: Posture, avoid biting or chewing nails, don’t rest hand under chin, place fingers on chin to while yawning to avoid anterior translation
Precautions: Superior lateral pterygoid is overworking and eccentrically not allowing disc to go fully back.
Frozen Shoulder (Adhesive Capsulitis): MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions
MOI: The ligaments and capsule surrounding the shoulder joint undergo an inflammatory process resulting in swelling and stiffening. Primary = idiopathic, no known cause. Secondary = due to traumatic event, surgery.
Risk Factors: Prolonged immobilization, diabetes, Dupuytren’s disease (genetic contractors), hypothyroidism, women more than men, age 40-65.
S/S: Hallmark signs 1) pain: dull, diffuse, often occurring at the deltiod insertion. 2) muscle atrophy 3) limited ROM: abduction, ER and IR
Diagnositc tests: Hx of onset, MOI and pain, loss of ER, abduction and IR, shoulder hike with AROM. Night pain.
General appraoch to treatment: Massage, acupuncture, modalities, mobilizations (posterior-lateral glides for ER, inferior for abduction), passive stretching,
Education points: HEP, duration to heal
Precautions: Other common shoulder injuries - tendinopathy, biceps tenditis, subacromical bursitis.
Shoulder Instability: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions
MOI: Trauma or ligament laxity that decreases stability. Labral tears are commonly associated.
Types: Anterior (most common), posterior, inferior (occurs when the impact causes arm hyper-abduction, superior (very rare)
S/S: Pain, decrease ROM, swelling, shoulder may be depressed on affected side, slipping or popping when in position of apprehension. Axilla nerve may be damaged if severe dislocation.
Diagnositc tests: Apprehension test, axilla nerve symptoms (weakness in deltoids and tires minor)
General appraoch to treatment: shoulder stabilizing exercises, strengthen adductors and internal rotators, postural education, rotator cuff strengthening
Education points: Rotator cuff are common with anterior dislocations.
Precautions: Stay out of positions of apprehension
Impingement Syndrome: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions
MOI: Compression of –> supraspinatus, long head of biceps or subacromial bursa. Can occur from a change in coracoacromial arch. Poor posture.
S/S: Pain during elevation on anterior and lateral aspect of shoulder. Painful arc 60-120 degrees. Weakness. No pain below elbow. Pain with rolling onto shoulder.
Diagnositc tests: Hawkins Kennedy, Neers
General appraoch to treatment: POLICE, scap stabilization, strengthen rotator cuff
Education points: do NOT immobilize
Precautions: DD: cervical Spondylosis
Lateral Epicondylagia: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions
MOI: 90% involve ECRB - originates at lateral epi. 10% ECRL. Most common overuse/repetitive use injury at the elbow.
S/S: Usually symptomatic with activities involving wrist and/or finger extension.
Diagnositc tests: Maudsley’s (3rd finger), Cozens (radial deviation and wrist extension), Mills (passive pronation and flex wrist.
General appraoch to treatment: AP
Education points: Check mid C spine for nerve irritation. Lateral antebrachial distrubution, C6 myotome.
Precautions: Tendinopathy/Tendinosis
Condition: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions
MOI:
S/S:
Diagnositc tests:
General appraoch to treatment:
Education points:
Precautions:
Medial Epicondylagia: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions
MOI: Pronator teres and flexor carpi radialis. Repetitive motions to the wrist.
S/S: Pain at elbow using wrist flexors, pain when muscle is stretched or contracts against resistance. Decreased grip strength, limited by pain.
Diagnositc tests: Palpation tenderness on or near the medial epicondyle. Pain with resisted wrist flexion (with elbow extended). Pain with passive wrist extension while elbow is extended. Ulnar neuropathy is often an associated finding.
General appraoch to treatment: Flexion exercises. Eccentric.
Education points: Check mid C spine, C8-T1 sensory, C8-T1 myotomal.
Precautions:
Colles Fracture: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions
MOI: Distal radius, linear transverse fracture of the distal radius.
Risk factors: young or elderly, more common in females.
S/S: Dinner fork demerit, FOOSH, dorsal wrist pain, swelling, inability to graps objects.
Diagnositc tests: X ray
General appraoch to treatment: Casted until ready, keep fingers and shoulder moving, strengthen, ROM and functional exercises.
Education points:
Precautions: Often assoicated with ulnar styloid #, TFCC tear and scapholunate dislocation.
Scaphoid Fracture: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions
MOI: FOOSH fal, most common # of carpal bone.
S/S: Pain with pinch or graps, visible swelling and/or bruising. Poor blood supply. Complications are common. Arthritis overtime.
Diagnositc tests: X ray
General appraoch to treatment: Initially casting or surgery.
Education points: Wrist guards.
Precautions:
Condition: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions
MOI:
S/S:
Diagnositc tests:
General appraoch to treatment:
Education points:
Precautions:
Condition: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions
MOI:
S/S:
Diagnositc tests:
General appraoch to treatment:
Education points:
Precautions:
De Quervains Tenosynovitis: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions
MOI: Irritation of APL EPB. Over use, radial deviation. Chronic overuse.
S/S: Pain with radial deviation as well as pain with stretch.
Diagnositc tests: Finkelstein’s test.
General appraoch to treatment: Splinting, activity modification.
Education points: Change limitng mechanics, keep wrist in neutral and avoid radial deviation.
Precautions:
Condition: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions
MOI:
S/S:
Diagnositc tests:
General appraoch to treatment:
Education points:
Precautions:
Copy Above
Stages of Frozen Shoulder: Freezing, Frozen & Thawing
Freezing: Painful, progressive. Intense pain at rest and limitation of movement. Reduced abduction < 100, ER < 5, IR < 55. Restriction normally begins before pain.
Frozen: Reduction in pain and progressive stiffness of shoulder. Pain only with movement and significant adhesions, limited GH motions. Atrophy of deltoid, triceps, and biceps.
Thawing: Mobility of shoulder returns, no pain and no synovitis but significant capsular restrictions from adhesions. Some patients never regain full ROM.
WAD Grading
Grade 0: No complaints about the neck, no physical signs
Grade 1: Neck complaints of stiffness, pain or tenderness only. No physical signs.
Grade 2: Neck complaints AND MSK (objective) signs (decreased ROM, point tenderness, NO neuro signs). No fracture/dislocation.
Grade 3: Neck complaints AND peripheral neurological signs (motor or sensory) such as decreased/absent DTR, weakness, sensory deficits. No fracture or dislocation.
Grade 4: Neck complaints AND fracture or dislocation, confirmed with medical imagine.
Canadian C Spine Rules
- Any High Risk Factors: age 65 or above, dangerous mechanism, paresthesias in extremities
- Any Low Risk Factors that allow safe assessment of range of motion: simple rear end OR sitting positions OR ambluatory at any time OR delayed onset of neck pain OR absense of midline c-spine tenderness
- Able to assess neck: 45 right to left
Temporomandibular Anatomy
- Muscle of mastication innervated by cranial nerve V (trigeminal)
- Masseter: thick and rectangular muscle in the cheek that functions to close jaw and clench teeth
- Temporalis
- Medial Pterygoid: elevation (closing) and protraction and side to side movement of the lower jaw: assists in chewing
- Lateral Pterygoid: only muscle of mastication that assists in depressing the mandible (opening the jaw) + assists in chewing and protraction
Shoulder Anatomy
- 4 joints: GH, SC, scap thoracic, AC
- SC joint: saddle joint with a fibrocartilage disc between articular surfaces; get 30 deg of axial rotation
- Scap Thoracic: physiological joint between ant surface of scapula and post surface of the thorax; supported by muscle movement
- AC joint: plane (gliding) supported by acromioclavicular and coracoidclavicular ligament
Frozen Shoulder Exercises
PROM: Pt performs PROM, towel IR, pendulums
AROM: finger wall walking, AROM ER
AAROM: abduction and flexion with broom stick
Shoulder Stabilization Exercises
- Strengthen the proximal muscles of the thorax, neck and shoulders before starting any dynamic strengthening of the muscles that move the GH in order to avoid faulty mechanics.
Phase 1: Scapular Stabilization: Middle and lower fibers of traps & SA
Phase 2: Rotator Cuff Stability: Isometrics through range, thera band exercises
Pancoast Tumor
- Difficult to diagnose early on
- S/S: severe pain in shoulder regions radiating towards the axilla and scapula along the ulnar aspect of the muscles of the hand, atrophy of hand and arm muscles, Horner Syndrome (dropping or falling eyelid, inability to sweat, constricted pupil), compression of the blood vessels with edema, neck pain, pain relieved when propping arm up on table or with other arm
- 40 to 60 y/o
Scapular Winging
- Inferior dysfunction: anteriorly tipped
- Medial dysfunction: internal rotation of the scapula in the transverse plane
- Superior dysfunction: excessive and early elevation of the scapula during elevation
Causes:
- Lesion of long thoracic nerve affecting weak SA
- Trap palsy
- Strain of rhomboids
- Tight pec minor and/or short head of biceps
- Multidirectional instability
- Voluntary action
- Painful shoulder causing muscle inhibition
Shoulder Labral Tears
- Bankart Lesion: avulasion of the capsule and ligament complex from the ANTERIOR INFERIOR lip of the glenoid (3-7 o’clock), common with ANTERIOR shoulder dislocations, causes anterior instability and loss of stability from inferior glenoihumeral ligaments
- Hill Sachs Lesions: Results from a force posteriorly, leading to anterior dislocation
- SLAP: Detachment of labrum from 10-2 o’clock, when the biceps tendon is involved = further instability
AC Joint Subluxation
- Formed by medial aspect of the acromion process of the scapula and the lateral end of the clavicle.
- Plantar Joint
- Ligaments: acromioclavicular, coracoclavicular
- Support: capsule, deltoid, traps
- Men 5x more (sporting - hockey)
- Incomplete seperation more common than complete
- Usually caused by direct hit or landing on the shoulder (arm normally adducted)
- TREATMENT: deltoid and trap cross the joint so strengthen thoses muscles for support
Bursa
- Inflammation of the bursa (small sacs of serous membrance that form at sites of compression or friction and produce watery fluid to lubricate surfaces and facilitate movement of tendons against bone)
- Caused by overuse, direct trauma/injury, gout, infection
- Most frequent location is subacromial area
- S/S: pain at rest, AROM and PROM are painful
Postures that can lead to shoulder pathology
- Increased thoracic kyphosis
- Forward head posture
- Decreased thoracic mobility
- Abducted and forward tipped scapula
Cervical Spondylosis
- Age 50+, acute or chronic
- Minimal or no cervical spine movement. May present with torticollis.
- AROM and PROM limited by pain
- Resisted isometrics: normal, myotome may be affected
- Special tests: Spurlings +ve, distraction test eases, ULTT +ve
- Sensory function and reflexes: dermatomes and reflexes affected
- Palpation: tender over appropriate vertebrae or facet
- X ray: narrowing osteophytes
Tennis Elbow Treatment: Acute Phase
Goals: control pain/inflammaion & maintain length/ROM
- Rest, ice, modalities, patient education, tennis elbow strap
- Avoid gripping and wrist extension
Tennis Elbow Treatment: Repair Phase
Goals: Gently stress collagen & increase muscle length
- Deep tendon friction massage, eccentric exercises, joint mobilization
- Stretching exercises for elbow/wrist/hand, massage
Tennis Elbow Treatment: Remodelling Phase
Goals: Increase collagen strength, increase tissue extensibility & return to activity
- Progress eccentric exercises (increase reps before weight)
- DTF massage, stretching
- Global strength, functional and task specific drills
How to rule of Cervical Referral Pain?
PMHx: CSP disc herniation, stenosis, osteophytes, neck pain, spondylosis
Pain/Paresthesia: sharp, burning, numbness or pins and needles in affected dermatomes
Tenderness: over affect area of posterior cervical spine
Other signs: ROM decreased, myotomal weakness, reflexes depressed in nerve root
Positive special tests: pain with side flexion, rotation, extension with compression increasing pain, cervical traction decreases symptoms, ULTT positive
Elbow Anatomy
Elbow extension: distal movement of radius on ulna, abduction of ulna relative to humerus, pronation of ulna relative to humerus
- Before age of 10, annular ligament that holds head of radius on the ulna is not fully formed – can result in pulled elbow.
- Cubital fossa: (Radical BBM) = radial nerve, biceps tendon, brachial artery, median nerve
Fractures
- Defines by: site, extent, configuration, relationship of fragments, relationship to environment, complications
- Precautions post fracture: radiologically healed, no stretch or resisted forces around the fracture site until bone is healed
- No excessive joint compression or shear for several weeks after the period of immobilization
- Use protection, weight bearing cannot begin until fracture is healed
Wrist Anatomy
Proximal row (lat to med): Scaphoid, Lunate, Triquetrum, Pisiform
Distal row (lat to med): Trapezium, trapezoid, capitate, hamate
- ECRL to 2nd MC
- ECRB to 3rd MC
Cervical Spine Scan
Subjective Questions: 5D’s - dizzineaa, dysphagia, dysarthria, diplopia, drop attacks + 2 N’s - nausea, nystagmus
Observation: front, back, side to side, sitting
ROM: C spine flexion, extension, side flexion, rotation, shoulder and t spine
Neurological: myotomes, dermatomes, reflexes, Babinski, clonus
Neurodynamic: Slump, ULTTs
Provocative: Spurlings compression, distraction
Pulses: Carotid
Reflexes
Biceps: C5/6
Brachioradialis: C5/6
Triceps: C7
Patella: L3
Achilles: S1
Lumbar Spine Scan
Subjective Questions: saddle paresthesia/loss of bowel or bladder control/bilateral leg numbness and tingling
Observation: front, back, side, squat, one leg stance
ROM: Lumbar spine, hip, knee, ankle
Neurological: myotomes, dermatomes, reflexes, Babinski, clonus
Neurodynamic: SLR, Slump, prone knee bend (femoral nerve)
Provocative: compression, distraction
Pules: femoral and popliteal
Myotomes: Upper Body
C4: resisted shoulder shrug
C5: shoulder abduction
C6: elbow flexion or wrist extension
C7: elbow extension or wrist flexion
C8: thumb extension or finger flexion
T1: fingers abduction or adduction
Myotomes: Lower Body
L1-L2: hip flexion
L3: knee extension
L4: dorsiflexion
L5: great toe extension
S1: plantar flexion or hip extension
S2: knee flexion
Dermatomes
C4: over AC joint
C5: on lateral side of antecubital fossa, just proximal to the elbow
C6: dorsal surface of thumb
C7: dorsal surface of the proximal middle phalanx
C8: dorsal surface of the proximal little phalanx
T2: apex of axilla
T4: mid clavicular line at the level of the nipples
T10: level of umbilicus
L1: Inguinal line
L2: medial upper thigh
L3: medial knee
L4: medial malleolus
L5: dorsum of the foot at the third MTP joint
S1: lateral calcaneus
S2: posterior knee
S3: ischial tuberosity
S4-5: perineum
Symptoms of decreased neural mobility
Pain, paresthesia, spams
ULTT: Medial
- Shoulder: depression and abduction to 110
- Elbow: extension
- Forearm: supination
- Wrist: extension
- Fingers and thumb: extension
ULTT: Radial
- Shoulder: depression and abducted to 10
- Elbow: extension
- Forearm: pronation
- Wrist: flexion and ulnar deviation
- Fingers: flexion
ULTT: Ulnar
- Shoulder: depression and abduction to 10-90
- Elbow: flexion
- Forearm: pronation
- Wrist: extension and radial deviation
- Fingers: extension
Spinal Nerve Plexus
- Cervial C1-C4: serves the head, neck and shoulders
- Brachial plexus C5-T1: serves the chest, shoulders, arms and hands
- Lumbar plexus T12-L4: serves the back, abs, groin, thighs, knees and calves
- Sacral L4-S4: serves pelvis, butt, genitals, thighs, calves and feet
Erb’s Palsy
- Injury to C5-C6 nerve roots: upper trunk of brachial plexus
- Due to increased angle between head and shoulder. Often in new borns from out of the canal or sporting injuries
- Loss of EF, WE, most movements of shoulder
- Can affect rhomboids, LS, supinator, SA, delts, supraspinatus, intraspinatus, biceps, brachioradialis, brachalis, long extensors of wrist, fingers and thumbs
- S/S: loss of sensation in the arm and paralysis and atrophy of the deltoids, biceps, and brachialis muscles.
- Position: affected arm is adducted, internally rotated, elbow extended and forearm pronated.
- Treatment: immobilization initially, gentle ROM, play exercises, prevent contracture
Klumke’s Palsy
- Claw hand
- Injury to C8, T1 (lower trunk of the bracial plexus)
- Often seen in falling accidents when person tries to hang on to avoid falling
- Weakness of wrist flexors and finger flexors and intrinsic hand muscles
Median Nerve Palsy
- Ape hand
- Injury to C5-8, T1 medial nerve
- Impairment of the thenar muscles, can’t abduct or oppose thumb
Carpel Tunnel Syndrome
- Compression of the median in palmar aspect of the wrist, can atrophy the thenar muscles
- Carpal tunnel consists of flexor pollucis longus, FDS, FDP, contained by transverse carpal ligament anteriorly
- Causes: anterior dislocation of lunate, tenosynovitis of the flexor tendons, direct trauma, obesity, pregnancy, #, occupation demands, overuse
- S/S: sesnory changes in the median nerve (excluding the palm), night numbness, thenar atrophy, weakness, weakness of opponens pollicis muscles
- Paresthesia of palmar surface of thumb, index fingers, pain distally
- Special tests: positive phalen’s (sustained wrist flexion), loss of two point discrimination, positive Tinel sign (tapping on medial nerve)
- Treatment: tendon gliding, median nerve mobilizations, activity modification, patient education, wrist brace
Thoracic Outlet Syndrome
- Entrapment syndrome cause by pressure on brachial plexus
- Thoracic outlet is comprised of: subclavian artery + vein, brachial plexus, vagus/phrenic nerve and sympathetic trunk
- Causes: compression at neuromuscular structures in scalene triangle, 1st rib pulled closer to clavicle by tight scalenes, poor posture, trauma, body composition, chronic compression (neuropraxia and Wallerian degeneration can occur)
- S/S: pain, paresthesia, numbness, weakness, discoloured, swelling, loss of pulse. Raynaud’s
- Special tests: Wright Test or Allen’s Maneuver (arm abducted to 90, look away, palpate radial pulse, look for it to diminsh or go away), Military Brace (palpate radial pulse then draw patients shoulder down and back. Positive if diminished or loss of a pulse) and Adson’s (locate radial pulse, head rotate to the test shoulder and extends head while examiner laterally rotates and extends shoulder)
- Treatment: regain normal muscle length, improve endurance, patient education - posture, nerve mobility
Double Crush Syndrome
- Nerve irritability
- Develop symptoms at other areas along the course of the nerve as well as at the primary site
- Ex: TOS and carpal tunnel
Posture
- Optimize posture to avoid energy expenditure of muscles
- Postural control: anticipatory, reactive
Plumb Line
Bony landmarks
- slightly behind coronal suture, thru external auditory meatus, thru dens of the axis, thru cervical vertebral bodies
- thru lumbar vertebral bodies, thru sacral promontory, slightly behind hip joint
- slightly anterior to the knee joint
- slightly anterior to the ankle joint thru the calcaneocuboid joint
Surface landmarks:
- thru the ear lobes, thru shoulder joint, midway of the trunk, thru greater trochanter, slightly anteruor to the knee joint, slightly anterior to the ankle joint
Scoliosis
- Named relative to the convexities of the curves, with apex of the curve defining the verbral level
- Rotation of the spine towards side, causes ribs to the more prominent posteriorly on convex side, especially with flexion of the spine. Shoulder may also be elevated on convex side.
- 5 to 7 degrees of scoliosis is considered normal
- 15 degrees or less is treatable with exercise
- Usually right handed: mild right thoracic, left lumbar s-curve or mild thoracolumbar c-curve.
- Structurally: irreversable, involves lateral curvature with fixed rotation of the vertebrae – 3 kinds: idiopathic, congenital, neuromuscular
- Functional: reversible
- Structures compresses on concave side and stretched on convex side
- Example: R scoliosis - R side convex - R side stretched - L side compressed
- Treatment: education on exercise and posture, bracing, stretch tight muscles, strengthen weak muscles, postural exercises, deep breathing
Forward Head Posture
- SHORT: cervical extensors, UFT, LS, SCM and scalenes
- LONG: cervical flexors
Exaggerated Lumbar Lordosis
- SHORT: erector spine, hip flexors
- LONG; abdominals, hamstrings and glute max
Posterior Pelvic Tilt
SHORT: tight abs, hip extensors (hamstrings and glute max)
LONG: hip flexors and erector spinae
Exaggerated Thoracic Kyphosis
SHORT: pec minor and major
LONG: stretched PPL, stretched erector spine, scap retractors
Genu Recurvatum
- Knee hyperextension, greater extension moment
- Causes shortened gastric, spasicity of quads, weakness in quads, APT
Important Landmarks
T2 - second rib - superior angle of scapula
T3 - spine of scapula
T7 - rib 7 - inferior angle of scapula
S2 - level of PSIS
S5 - inferior lateral angle
Concussion: Overview
- A complex pathological process affecting the brain induced by traumatic biomechanical forces
- Mild form of TBI (most common TBI)
Concussion: Causes
- Direct blow
- Coup contrecoup mechanism
- Rapid onset of short lived impairments for neurological function that resolves spontaneously in most cases
- Risks: contact sports anti-coagulants, prior brian injury
Concussion: Signs and Symptoms
- Headahce, drowiness, confusion, neck pain, dizziness, low energy, emotional problems, vision problems, light/noise sensitivity
- Vomitting, poor vision tracking, balance impairments, trouble with memory recall, slurred speech
- Symptoms typically resolve on their own within 7-10 days but some can prolong for longerC
Concussion: SCAT 5
- For 13 years or older
- Symptoms, congition, balance and coordination
Concussion: ImPACT
- Immediate Post-Concussion Assessment and Cognitive Test
- Baseline and post injury testing
Concussion: King Device Test
- Sideline concussion screening
- Less than two minutes
- Assess eye movement, attention and language
Concussion: Secondary Impact Syndrome
- Extremely rare
- Fatal uncontrolled swelling of the brain
- Occurs when someone suffered a minor second blow before the symptoms of a prior brain injury are resolved
- More common in young males
Concussion: Post Concussion Syndrome
- Persistent concussion symptoms for > 1 month
- Cumulative effects: 3+ concussions 5x greater risk of Alzheimer’s, 3x memory deficits
Concussion: Initial Treatment
- Physical and cognitive rest
- DO NOT stay in a dark room with no stimulus
- Education: restrict - TV, phone, intense PA, school, sports, driving, reading
- Education: allow - increase sleep, slow walks, hydration, proper nutrition, listening to audiobooks, gentle yoga,
- Graduated return to cognitive and physical activities
Concussion: Gradual Return to Play
- Guided by symptoms
- Physician gives final okay to play
- Progression to next step if only symptoms free for 24 hours
- Must go back to asymptomatic level for least 24 hours if symptoms occur
