MSK W2 Flashcards
UE conditions
what is the first step in the Canadian Cspine rules?
what is step 2 in the Canadian Cspine rules?
what is step 3 in the Canadian Cspine rules?
What is Whiplash Associated Disorder (WAD)?
Abrupt acceleration-deceleration injury to the cervical spine.
Commonly occurs in motor vehicle accidents or contact sports.
List the acute signs and symptoms of Whiplash Associated Disorder.
- Decreased ROM
- Pain
- Increased tone in cervical spinal muscles
- Headaches
- Jaw pain
- Neurological symptoms depending on grade
What factors can affect chronic symptoms of Whiplash Associated Disorder?
- Psycho/Emotional Trauma
- Pending monetary gain (litigation)
- Pre-existing injury
- Pre-injury level of fitness
If there is a disc herniation of C5/C6, what nerve root is anticipated to be affected and what are the expected findings?
C6 nerve root
*myotomal = elbow flexion, wrist ext weakness
*dermatomal = lateral elbow
*DTR = biceps brachii or brachioradialis
What is the definition for Cervicogenic Headaches?
Disorder of the cervical spine involving bony, disc, and/or soft tissue elements.
Often originates from the atlanto-occipital and upper cervical joints.
Identify the hallmark signs of Frozen Shoulder (Adhesive Capsulitis).
- Pain – dull, diffuse
- Muscle atrophy
- Limited ROM (Abduction, ER, IR)
- Loss of arm swing during gait
What are the three stages of Frozen Shoulder?
- Freezing
- Frozen
- Thawing
What happens with an Anterior Disc Displacement in the TMJ?
The condyle is blocked by the disc and unable to roll and slide forward (lock jaw).
Can be chronic (reduce on its own) or acute.
What are common signs of Temporomandibular Myofascial Pain?
- Tenderness of Masseter, Temporalis, Medial pterygoid, lateral pterygoid, suboccipitals
- Pain or tenderness of the jaw
- Difficulty chewing
- Locking of the joint
What is the main treatment approach for Shoulder Instability?
- Stabilization exercises of scapula
- Strengthening adductors and internal rotators
- Postural education
What should be avoided in the treatment of Impingement Syndrome?
Immobilizing the arm in a sling, as it could lead to adhesive capsulitis.
What is a Colles Fracture?
Fracture to the distal radius, often associated with a FOOSH injury.
Characterized by a linear transverse fracture of the distal radius.
What are the risk factors for a Scaphoid Fracture?
- FOOSH injury
- Commonly occurs in young and elderly
- More prevalent in females with osteoporosis
True or False: There are specific risk factors that make one more likely to experience a scaphoid fracture.
False
There are no specific risk factors or diseases associated with scaphoid fractures.
What is the typical treatment approach for a scaphoid fracture?
- Initially casting or surgery
- Use of wrist guard when returning to activities involving falling
What are the WAD red flags to look out fot?
Bilateral arm numbness and tingling in arms, signs of concussion.
What is the role of education in the treatment of Frozen Shoulder?
Reduce frustration and encourage patient compliance; teach home exercise program.
What grade is assigned for no complaint about the neck and no physical signs?
Grade 0
What grade is assigned for a neck complaint of stiffness, pain, or tenderness only with no physical signs?
Grade I
What grade involves a neck complaint with MSK signs such as decreased ROM and point tenderness, but no neurological signs?
Grade II
What grade includes a neck complaint with peripheral neurological signs but no fracture or dislocation?
Grade III
What grade indicates a neck complaint with confirmed fracture or dislocation via medical imaging?
Grade IV
Which cranial nerve innervates the muscles of mastication?
Cranial nerve V (trigeminal)
What is the function of the masseter muscle?
Closes the jaw and clenches teeth
What is the role of the lateral pterygoid muscle?
Assists in depressing the mandible and chewing
What does the medial pterygoid muscle do?
Functions for elevation and protraction of the lower jaw
What does the three finger test assess in relation to TMJD?
Jaw should be able to open three finger widths
How many joints are in the shoulder complex?
Four joints
Name the four joints of the shoulder complex.
- Glenohumeral joint
- Acromioclavicular joint
- Sternoclavicular joint
- Scapulothoracic joint
What type of joint is the sternoclavicular joint?
Saddle joint
What is passive ROM?
Movement produced entirely by an external force with little to no muscle contraction
What are indications for passive ROM?
- Active is contraindicated
- Acute inflamed tissue
- Patient unable to move
What is the goal of passive ROM exercises?
Maintain joint and connective tissue mobility
What is active ROM?
Movement produced by active contraction of the muscle crossing that joint
When is active ROM indicated?
When the patient can actively contract the muscle and move a segment
What are the goals of active ROM?
Same as passive ROM, with additional benefits of active muscle contraction
What is active-assistive ROM?
A type of ROM where assistance is provided manually or mechanically
What is the aim of scapular stabilization exercises?
Focus on middle and lower fibers of trapezius and serratus anterior
What does the serratus punch exercise involve?
Using a TheraBand to pull forwards causing scapular protraction
What is the role of the trapezius in scapular movement?
Agonist in retraction and elevation of the scapula
What is a Bankart lesion?
Avulsion of the capsule and ligament complex from the anterior-inferior lip of the glenoid
What is a Hill Sachs lesion?
Results from a force posteriorly leading to anterior dislocation
What is the common symptom of a Pancoast tumor?
Severe pain in shoulder region radiating toward the axilla and scapula
What are the characteristics of scapular winging?
- Inferior dysfunction
- Medial dysfunction
- Superior dysfunction
What causes scapular dyskinesia?
An alteration or deviation in the normal resting or active position of the scapula
What are the components of elbow extension?
- Distal movement of the radius on ulna
- Abduction of ulna relative to humerus
- Pronation of ulna relative to humerus
What is bursitis?
Inflammation of the bursa, small sacs that lubricate surfaces and facilitate movement
What are common causes of bursitis?
- Overuse
- Direct injury/trauma
- Gout
- Infection
What is the primary treatment goal for tennis elbow in the acute phase?
Control pain/inflammation
What should be avoided during the treatment of tennis elbow?
Gripping and wrist extension
What does the term ‘fracture’ refer to?
A structural break in the continuity of a bone or joint surface
What is a common complication of fractures?
Local or systemic complications related to the injury or treatment
What should an exercise program for a patient with an olecranon fracture include?
Gentle ROM exercises and avoid stress on the fracture site
List the carpal bones from proximal to distal, lateral to medial.
- Scaphoid
- Lunate
- Triquetrum
- Pisiform
- Trapezium
- Trapezoid
- Capitate
- Hamate
what would be a positive thomas test for TFL?
when the hip is abducted, pt is able to acheive full hip ext.
What 3 muscles does the modified thomas test assess?
TFL, rectus femoris and Iliopsoas
what is the purpose of the modifed thomas test?
to investigate the cause of reduced hip extension (normal range is 15-20 deg)
what is the sign of the buttock used to test for?
serious gluteal pathology ie. RONFISS
How do you perform a sign of the buttoc test?
SLR in supine, at end range pt’s knee is flexed to see if more hip flexion can be obtained.
what is the thompson test of the ankle?
Used to assess for achilles tear by squeezing the calf muscle.
Describe Apley’s test for the knee.
pt is laying in prone; therapits fixes thigh with knee bent to 90deg and rotates the tibia internally and externally with either distraction or compression.
Pain with distraction = ligamentous
pain with compression = meniscal
What is the set up of a Mcmurray test for the medial meniscus?
valgus stress + External (lateral) rotation - extend the knee
What is the main cause of dislocations?
Usually result of instability
What are the signs and symptoms (S/S) of dislocations?
Increased range of motion (ROM), soft end feel, +/- pain
What test assesses scapular stability?
Wall push up
What is the anterior apprehension test used for?
To assess anterior glenohumeral instability
What is the relocation test?
Push glenohumeral head posteriorly
What does the sulcus sign indicate?
Inferior glenohumeral instability
What are the complications associated with dislocations?
- Rotator cuff tears
- Axillary nerve damage
What does TUBS stand for in dislocation types?
Traumatic onset, Unidirectional anterior, Bankart lesion, Surgery
What is the mechanism of injury (MOI) for TUBS?
ABD/ER
What is a Bankart lesion?
Avulsion fracture of anterior/inferior capsule & ligaments
What are the signs of a Bankart lesion?
- Clicking
- Apprehension
- Deep vague pain
What is a SLAP lesion?
Superior labrum lesion anterior to posterior
What is a common cause of pain in throwers?
SLAP lesion
What is a Hill-Sachs lesion?
Compression fracture of posterior/lateral humeral head
What is AMBRI?
Atraumatic, Multidirectional, Bilateral shoulder findings, Rehab appropriate, Inferior capsule shift
What is the epiphysis?
End of long bone (where joint is)
What is the diaphysis?
Shaft of long bone
What are the types of fractures?
- Spiral
- Transverse/oblique
- Compression/crush
- Comminuted
- Greenstick
- Avulsion
- Impact
What is a Colles fracture?
Distal radius fracture with dorsal subluxation of distal segment
What is the healing time for adults with fractures?
10-18 weeks
What is avascular necrosis?
High rate in some areas, particularly proximal femur, 5th MT, scaphoid, proximal humerus
What defines good posture?
State of muscular and skeletal balance protecting against injury or deformity
What is the plumb line?
Line of gravity
Where is the center of gravity located?
Slightly anterior to S2
What is anticipatory postural control?
Pre-tuning sensory and motor systems based on previous experience
What is postural pain syndrome?
Pain from mechanical stress due to prolonged faulty posture
What is postural dysfunction?
Adaptive shortening of soft tissues and muscle weakness from prolonged poor postural habits
What are the types of scoliosis?
- Structural
- Functional
What is the normal range of scoliosis degrees?
5-7 degrees is considered normal
What is the treatment for scoliosis of 15 degrees or less?
Exercises
What type of postural fault is exaggerated lumbar lordosis?
Anterior pelvic tilt with excessive hyperextension of lumbar spine
What muscles are short in exaggerated lumbar lordosis?
- Erector spinae
- Hip flexors
What is the neutral sitting position?
Equal weight bearing on ischial tuberosities with level ASIS’s and PSIS’s
What are the important landmarks at T2?
Superior angle of scapula
What dermatome corresponds to T4?
Nipple level
What is Genu Recurvatum?
Knee hyperextension
What are common postural muscle imbalances?
- Forward head posture
- Excessive cervical lordosis
- Exaggerated thoracic kyphosis
What is the effect of a posterior pelvic tilt?
Reduction of the natural lumbar curvature
What is a common cause of Genu Valgus?
Knee joint alignment issues
What is the effect of tight abdominals in posterior pelvic tilt?
Contributes to reduced lumbar curvature
