MSK W3 Flashcards
gait, balance, joint mobilizations
What type of joint permits motion in 1 plane, typically flexion/extension?
Hinge joint
Example: elbow joint
Which joint type is limited to rotation and is uniaxial?
Pivot joint
Example: AA joint, proximal radio-ulnar
What type of joint allows for slide or slide & rotation and is triaxial?
Planar joint
Example: intercarpal joints, AC joint, Z joints
What joint type allows motion in two planes, typically flexion/extension and abduction/adduction?
Condyloid joint
Example: knee, TMJ, atlanto-occipital
Fill in the blank: A joint type that allows flexion, extension, adduction, and abduction but no axial rotation is a _______.
Saddle joint
Example: carpometacarpal joint of the thumb, sternoclavicular
What joint type is triplanar and allows for flex/ext, abd/add, IR/ER?
Ball and Socket joint
Example: GH joint and hip joint
When should joint mobilization be considered?
Pain, muscle guarding, spasm, functional immobility, progressive limited, positional faults, reversible joint hypomobility
List conditions under which joint mobilization should NOT be performed.
- Hypermobility
- Joint effusion
- Inflammation
- Cancer
- Acute arthritis
- Fracture or osteoporosis
- Dislocation
- Bone disease
- Empty/bony end feel
- Anticoagulant/steroid use
- Sign of buttock
- Vertebral artery insufficiency
- Craniovertebral ligament instability
What does the Concave-Convex Rule state?
Convex surface is stationary and concave surface moves in the opposite direction; concave surface moves in the same direction as osteokinematic and arthrokinematic motion.
what are the glides for the knee joint?
convex is stationary: flexion = posterior glide, extension = anterior glide
What is the glide for the subtalar jt?
concave is stationary: inv/supination = lateral, ev/pronation = medial
What is the treatment grade for small amplitude at the beginning of the range?
Grade 1
What is an end feel in joint mobilization?
The quality of movement perceived at the end of the available range of motion.
What characterizes a capsular end-feel?
Hard leather-like stoppage with slight give
Example: Frozen Shoulder
What is the definition of active insufficiency?
When a muscle that crosses two or more joints becomes too shortened to develop effective tension.
What is passive insufficiency?
Lengthening of a muscle that prevents further movement at the joints it crosses.
What is the full range of motion of a muscle divided into?
- Outer range
- Inner range
- Middle range
What does a Grade 5 muscle test indicate?
Full ROM against gravity with MAXIMAL resistance
What is the purpose of deep tendon friction massage?
Break adhesion and align collagen, prevent scar adhesion, mechanoreceptor stimulation to decrease pain
What is a contraindication for deep tendon friction massage?
Infection/Skin breakdown, inflammatory joint disease, recent local injection, ossification/calcification, bursitis
What is a limitation of pain and movement in a joint specific ratio known as?
Capsular pattern
What is the capsular pattern for the glenohumeral joint?
External/Lateral rotation, abduction, Internal/medial rotation
What is a knee flexion contracture?
Shortening of soft tissue causing restriction in knee extension
Example: Tightness of hamstrings
What does the term ‘contracture’ refer to?
Shortening of soft tissue
what is the glide used at the talocrural jt?
concave surface is stationary
*DF = posterior glide
*PF = anterior glide
what muscles need to be strong in order for a person to ambulate with crutches?
Latissimus dorsi, traps, triceps.
as we age what balance strategy do we use more and why?
hip strategy - because often have decreased ankle mobility
what muscles become active when someone receives a large push forward in order to maintain balance?
would go straight to hip strategy and activate erector spinae and hip extensors.
What is the definition of a gait cycle?
Heel strike to heel strike on same leg.
What is a stride in gait mechanics?
Distance between successive points of heel contact of the same foot (~1.4m).
What is the distance for a step in gait mechanics?
Right heel strike to left heel strike (~0.7m).
What is the average velocity of walking?
Total distance traveled in a given amount of time; avg = ~1.3m/s.
What occurs during the initial contact phase of gait?
Foot contacts the ground; hip extensors stabilize the hip.
What is the loading response phase in gait?
Occurs after initial contact until elevation of opposite limb; bodyweight is transferred onto supporting limb.
Which muscular contractions occur during loading response?
- Ankle dorsiflexors contract eccentrically
- Quads contract eccentrically.
What defines mid-stance in the gait cycle?
From elevation of opposite limb until both ankles are aligned in coronal plane.
What are the muscular contractions during mid-stance?
- Hip extensors and quads undergo concentric contraction
- Glute medius contracts eccentrically.
What occurs during the terminal stance phase?
Begins when the supporting heel rises from the ground until the opposite heel touches the ground.
What muscles are most active during the terminal stance?
Calf toe flexors.
What is the pre-swing phase in gait?
The start of the second double limb stance in the gait cycle.
What muscular contractions occur during pre-swing?
Hip flexors contract to propel advancing limb.
What defines the initial swing phase?
From elevation of limb to point of maximal knee flexion.
What muscular contractions occur during initial swing?
Hip flexors concentrically contract.
What is the mid-swing phase in gait?
Following knee flexion to point where tibia is vertical.
What muscles contract during mid-swing?
Ankle dorsiflexors contract.
What defines terminal swing?
From point where tibia is vertical to just prior to initial contact.
What muscular contractions occur during terminal swing?
Eccentric activation of hamstring muscles.
What are the four main challenges of gait?
- Maintaining upright posture
- Maintaining equilibrium
- Control of foot trajectory and ground clearance
- Control of multiple body segments.
What are the three main tasks in gait?
- Weight acceptance
- Maintenance of stability during single leg support
- Limb advancement (swing).
What is the normal wear pattern on shoes?
- Increased wear over lateral portion of outer sole at the heel
- Even wear along 1st, 2nd, and 3rd MTP joints
- Even wear over 1st, 2nd, and 3rd MT heads.
What is an antalgic gait?
Reduced weight bearing on the injured lower extremity; decreased step length of unaffected limb.
What characterizes steppage gait?
Patient cannot dorsiflex, resulting in lifting the knee high.
What is foot slap in gait mechanics?
Weak or absent dorsiflexors causing the foot to slap down on the ground.
What is an abducted lurch?
Patient leans over the hip to compensate for gluteus medius muscle weakness.
What is gluteus maximus gait?
Backward trunk lean or throwing the trunk backward after initial contact due to weakness of hip extensors.
What are the characteristics of Parkinsonian gait?
- Trunk, head, neck forward and flexed
- Narrow base, small shuffling steps.
What is scissoring gait associated with?
Spastic cerebral palsy due to spasticity of adductors.
What does Trendelenburg gait indicate?
Weak abductors cause the contralateral side to dip during gait.
What is compensated Trendelenburg?
Patient side flexes ipsilaterally over standing leg to compensate for weak glute medius.
What does the Trendelenburg sign indicate?
Opposite pelvis drops when standing in single leg stance; indicates gluteus medius weakness.
What are the cardio status criteria for when not to mobilize?
- Mean Arterial Pressure <65 or >110
- Systolic drop >20 mm Hg or disproportionate rise.
What neurological status criteria indicate not to mobilize?
Severe agitation, distress, or inability to understand instructions.
What are hip precautions for the posterolateral approach after hip replacement?
- No flexion above 90 degrees
- No internal rotation
- No adduction past midline.
What recommendations are made for home after joint replacements?
- Raised toilet seat with rails
- Tub bench
- Hand held shower.
When is surgery recommended for knee issues?
- Severe knee pain or stiffness limiting activities
- Moderate or severe knee pain at rest
- Chronic knee inflammation not improving with treatment.
What is a key characteristic of cemented components in total arthroplasty?
Better stability, suitable for sedentary elderly with poor bone quality
Cemented components provide immediate fixation and stability for patients with compromised bone quality.
What is the advantage of uncemented components in total arthroplasty?
Coated with beads allowing for new bone growth, better for younger patients
Uncemented components promote biological fixation as the bone grows into the porous surface.
What is the revision time frame for uncemented components in total arthroplasty?
10 years
Regular follow-up is required to monitor the longevity and integrity of uncemented components.
Describe the hybrid approach in total arthroplasty.
Femoral component is cemented, acetabular component is uncemented
This approach combines the benefits of both cemented and uncemented techniques.
What is the post-operative precaution for total arthroplasty using the post-lateral approach regarding hip flexion?
No hip flexion past 90°
This precaution helps prevent dislocation and other complications after surgery.
What are the restrictions for hip internal rotation (IR) after total arthroplasty?
No internal rotation
This is to maintain proper alignment and prevent dislocation.
What is the hip adduction restriction for total arthroplasty patients for the first 3 months?
No hip adduction past midline
Adherence to this restriction is crucial for the safety of the surgical site.
What is the primary movement restriction after a lateral approach in total arthroplasty?
No hip flexion past 90°
Similar to the post-lateral approach, this restriction is essential for recovery.
What are the post-operative movement restrictions for the anterior approach in total arthroplasty?
No hip extension, no external rotation, no hip adduction past midline for 1st 3 months
These restrictions are necessary to ensure proper healing and prevent complications.
What are the typical movement restrictions after hemiarthroplasty, cannulated screws, DHS & gamma nails?
Typically no restrictions with movement & weight-bearing as tolerated (WBAT)
Always check MD orders for specific patient guidelines.
What is replaced in a hemiarthroplasty of the shoulder?
Humeral surface replaced with a prosthetic
This is indicated for certain arthritic conditions and fractures.
What are the indications for total shoulder arthroplasty (TSA)?
Osteoarthritis, inflammatory arthritis, osteonecrosis involving the glenoid, post-traumatic degenerative joint disease
TSA involves replacing both the glenoid and humeral components.
What is a mandatory condition for a patient undergoing total shoulder arthroplasty?
Intact rotator cuff complex
The rotator cuff is critical for shoulder stability and function post-operatively.
What are the post-operative precautions for total shoulder arthroplasty?
Immobilization full time for 1 week, nightly for 4 weeks, sling for 4 weeks
These precautions help protect the surgical site during the initial healing phase.
What is the purpose of a reverse total shoulder arthroplasty (RTSA)?
To increase stability by switching the ball and socket components
This is particularly useful for patients with rotator cuff deficiencies.
What are the post-operative precautions for reverse total shoulder arthroplasty (RTSA)?
Flexion/elevation in scapular plane passively up to 90°, pure abduction
Avoiding internal rotation for 6 weeks is critical for recovery.
True or False: There are no movement restrictions after shoulder hemiarthroplasty.
True
Most patients can move freely and bear weight as tolerated unless otherwise specified by a physician.
What are the 5 things that make up the Cluster of Sutlive for hip OA?
- Hip scour test
* 2. passive IR <25
* 3. pain with squatting
* 4. painful active hip flexion
* 5. painful active hip ext
What causes cartilage loss in osteoarthritis?
Release of enzymes and abnormal biomechanical forces
What allows bones of the joint to rub together in osteoarthritis?
Loss of cartilage
What are the symptoms associated with osteoarthritis?
Pain, swelling, increased bone turnover, osteophyte formation
What are the two conditions that can lead to focal areas of increased loading in osteoarthritis?
Normal chondrocyte physiology with abnormal stress or abnormal chondrocyte physiology with normal stress
List 7 risk factors for osteoarthritis.
- Increased age
- Sex (W>M)
- Genetics
- Obesity
- Physical inactivity
- Injury
- Joint stress (e.g., occupation, kneeling, squatting, stair climbing)
What are the 4 main x-ray features used to diagnose osteoarthritis?
- Joint space narrowing
- Osteophytes
- Subchondral sclerosis (increased bone density)
- Subchondral cysts
What are the sources of pain in osteoarthritis?
- Bone
- Soft tissue
- Inflammation
- Muscle spasm
What are the 4 subjective questions used to diagnose osteoarthritis?
- Pain most days in last month
- Pain over the last year
- Worse with activity
- Relieved with rest
Which joint is the most commonly affected by osteoarthritis?
Knee
What test can indicate swelling in the knee joint?
Patellar tap test
What are the 3 tests indicative of osteoarthritis of the knee?
- Flexion contracture
- Abnormal gait
- Swipe test or patellar tap
What are loose bodies in the context of osteoarthritis?
Free floating pieces of bone or cartilage, often resulting from OA or chip fracture
What typical symptoms are associated with loose bodies?
Locking or catching
What is the first line of treatment for osteoarthritis?
Exercise (strengthen/stretch muscles around OA joint), activity modification, weight loss, acetaminophen
What are the red flags associated with arthritis indicating possible septic arthritis?
- Unable to move the limb
- Intense joint pain
- Joint swelling
- Joint redness
- Low fever
- Chills
- Possible tachycardia
True or False: Pain in inflammatory arthritis is worse in the morning.
True
What is a common feature of inflammatory back pain?
Morning stiffness usually prolonged >60 min
What autoimmune disease is characterized by synovitis?
Rheumatoid arthritis
What is the main feature of rheumatoid arthritis?
Swollen synovium and proliferation of cells into a dense cellular membrane (pannus)
What can the pannus in rheumatoid arthritis lead to?
- Fibrous scar tissue
- Adhesions
- Bony ankylosing (union of bones of a joint)
What are common presentations of rheumatoid arthritis?
- Symmetrical pattern
- Pain
- Fatigue
- Stiffness (decreased ROM)
- Swelling
- Joint deformity
- Muscle atrophy
What are the criteria for diagnosing rheumatoid arthritis?
4 of 7 criteria must be present for at least 6 weeks
What are the 7 criteria for rheumatoid arthritis diagnosis?
- Morning stiffness >1hr
- Arthritis of >/= 3 joints
- Radiographic changes
- Rheumatoid nodules
- Symmetric arthritis
- Arthritis of hand joints
- Serum rheumatoid factor
True or False: The presence of antibodies like HLA-DR4 is common in rheumatoid arthritis.
True
What are some deformities associated with rheumatoid arthritis?
- Hallux valgus
- MTP subluxation
- Claw toe
- Hammer toe
- Mallet toe
- Ulnar drift
- Swan neck deformity
- Boutonniere deformity
What is the management strategy for acute stage rheumatoid arthritis?
- Protect: use resting splints, brace joint during ADLs
- No stretching
- Energy conservation
- Gentle ROM (pain-free)
- Ice to reduce inflammation
- Heat briefly in AM
What are the 4 R’s of surgery for rheumatoid arthritis?
- Remove (MTP resection)
- Re-align (tendon rupture)
- Rest (arthrodesis)
- Replace (arthroplasty)
What is the purpose of the joint count assessment in rheumatoid arthritis?
An indicator of the disease activity
What does the acronym STOP stand for in joint assessment?
- Swelling Test
- Tenderness Test
- Over Pressure Test
what are the components that make up a postural Ax for ankylosing spondylitis?
- Tragus to wall
* 2. lateral trunk flexion
* 3. trunk flexion
* 4. trunk ext
* 5. trunk rotation
* 6. chest expansion
* 7. cervical mobility
* 8. shoulder and hip ROM
What is the umbrella term for a group of inflammatory diseases with common characteristics?
Spondyloarthritis
The most common type is Ankylosing Spondylitis.
What are the common conditions included in spondyloarthritis?
- Ankylosing Spondylitis
- Psoriatic arthritis
- Enteropathic spondylitis
- Reactive arthritis
- Juvenile Idiopathic Arthritis (JIA)
What is the hallmark sign of Ankylosing Spondylitis?
Sacroiliitis - deep, dull pain in buttocks due to inflamed SI joint.
Which genetic marker is associated with spondyloarthritis?
HLA-B27.
What are the common features of Ankylosing Spondylitis?
- Low back pain
- Inflammation in the spine
- Synovitis (typically unilateral)
- Inflammatory eye conditions (iritis/uveitis)
- Enthesitis
- Stiffness and fusing of the spine.
True or False: Ankylosing Spondylitis affects males more than females.
True.
What are the clinical criteria for diagnosing Ankylosing Spondylitis?
- Low back pain and stiffness for more than 3 months
- Limitation of motion of the lumbar spine
- Limitation of chest expansion.
What medications are commonly used to treat Ankylosing Spondylitis?
- NSAIDs
- Corticosteroids
- DMARDs
- Biologics.
What is dactylitis in relation to Psoriatic Arthritis?
Sausage-like swelling of fingers due to inflammation.
What are the two main types of inflammatory bowel disease associated with Enteropathic Spondylitis?
- Ulcerative colitis
- Crohn’s disease.
What characterizes Reactive Arthritis?
Painful, short-lasting inflammatory arthritis triggered by infections.
Fill in the blank: Gout is characterized by increased serum _______.
uric acid.
What is Pseudogout?
Similar to gout but caused by Calcium Pyrophosphate crystals.
What is the common presentation of a patient with osteoporosis?
Depleted bone mineral density (BMD).
What are the common fracture areas in osteoporosis?
- Thoracic spine
- Lumbar spine
- Femoral neck
- Distal radius.
What is a pathological fracture?
Broken bone caused by disease leading to weakness of the bone.
What is osteomalacia?
Softening of the bones caused by impaired bone metabolism.
What is Paget’s disease?
Excessive breakdown and formation of bone leading to weakened bones.
What is the primary cause of Osteogenesis imperfecta?
Genetic disorder causing defective development of connective tissue.
What is osteomyelitis?
Inflammation response in bone caused by infection.
What are the red flags indicating possible serious conditions?
- Non-mechanical pain
- Pain at night
- Systemic features like fever.
What characterizes chronic pain?
Pain that persists past the normal time of healing.
What is the diagnosis criterion for chronic fatigue syndrome?
Persistent fatigue for at least 6 months, not resolved with rest.
What are the common symptoms of fibromyalgia?
- Headaches
- Sensitivity to stimuli
- Fatigue
- Sleep disturbances.
What are the important types of amputations?
- Transfemoral (above knee)
- Transtibial (below knee)
- Ankle disarticulation.
What is phantom sensation?
Tingling, pressure, or itching in the part of the limb that has been removed.
What should be avoided in stump care?
- Lotion on open areas
- Exposure to extreme temperatures.
What are signs of stump infection?
- Redness or heat along the incision
- Green, yellow, or white drainage.
What are pressure tolerant areas for a transtibial amputation?
- Patellar tendon
- Anterior compartment.
What are pressure sensitive areas for a transfemoral amputation?
- Anterior distal tibia
- Fibular head.
