MT 1 Flashcards
WHat is patellofemoral pain syndrome
messed up tracking of the patella into the femoral trochlear groove, usually due to the groove not being deep enough etc
cant treat, just treat the pain
WHat are the risk factors for patellofemoral pain syndrome
risk factors - decreased quad/hamstring strength, navicular drop, dynamic valgus
What is the clinical presentation of patellofemoral pain syndrome
pain w sitting, stairs, squatting at medial/lateral borders of patella
What is patellar tendinopathy
microtears along tendon, usually caused during eccentric overloading during deceleration (jumping/downhill running)
treated by overloading the tendon for acute inflamation triggering, or by modifying activity
What are the risk factors for patellar tendinopathy
high body weight, pes planus, tightness in quads/hamstrings
What is the clinical presentation of patellar tendinopathy
pain w squats/jumps at tibial tuberosity
What is a meniscus tear? what are the types?
degenerative, longitudinal, flap tear, horizontal, radial
occurs when axial load is transmitted through a flexed/extended knee that is also rotating
can remove meniscus as it wont heal
WHat are the risk factors for meniscus tears
sports or jobs that need kneeling, squatting, or climbing stairs
no arterial supply, so will eventually degenerate
What is the clinical presentation of a meniscus tear?
Pain with knee bending, alongside swelling, popping, clicking, or locking
what is an Anterior cruciate ligament (ACL) tear
partial tear or rupture of ACL caused by deceleration, change in direction, or rotary force while the foot is fixed
What are risk factors for ACL tear
decreased hip strength
*wide Q angle
WHat is the clinical presentation for ACL Tear
pain with weightbearing and swelling due to tearing of arterial supply - lots of redness as well
What is osgood-schlaters disease
traction apophysitis (growth plate) of tibial tubercle for teens
repeated tension and torquw on tibial tubercle, causing bone to grow and cause pain
What is the clinical presentation of osgood-schlatter’s disease
pain with stairs/squats
What is the Trendelenburg sign?
indicates weak gluteus medius during unilateral weight-bearing
What is dynamic valgus
internal rotation and adduction of femur , causes contralateral pelvic drop
is also associated with increased risk for anterior knee pain
What is pes planus
collapse of the medial longitudinal arch, associated with a navicular drop
10mm navicular drop associated with an inceased risk of patellofemoral pain syndrome
what is antalgic gait
limping, with the injured side having a decreased stance phase to eliminate the weight bearing of injured side
most proximal joint will compensate for injured joint
What is the lachman test
assesses stability of ACL, holds pt knee between full extension and 30 degrees of flexion. If there is a mushy or soft end feel when tibia is moved forward, or if the infrapatellar tendon slope disappears, then the test is positive
the test has a high sensitivity and specificity for ACL injury detection
What is the Thessaly test
pt flexes the knee to 20 degrees while standing on one foot and rotates the femur on tibia medially and laterally 3 times
positive if pain medially or laterally on the joint line
high sensitivity and specificity
What is the q angle and why is it important?
angle between tibial tuberosity and asis, is the angle of the hip, a greater q angle gives higher ACL risk due to increased torque during impacts
WHat is specificity?
SPIN - specificity when positive rules in
if positive, for sure has the injury
What is sensitivity
SNOUT - sensitivity, when negative rules out
if negative, for sure no injury
What is the modified thomas test
test knee is at 90 degrees off a table, while opposite knee is flexed to chest. If test knee moves, contracture is present (could be a lot of things, very low specificity)
What is manual muscle testing
subjective approach where pt contracts muscle against manual resistance
what are the MMT scores
0-5, 3+ to 5 very subjective tho
0=no movement and no muscle action
1=muscle action but no movement
2=partial rom
3=full rom
3+=min break force
4-=almost mod break force
4= mod break force
4+almost max break force
5=max break force
What is the role of a family doc
general care for all people over all domains
What are the associations and regulatory bodies for doctors
association = canadian medical association/doctors of BC
regulatory= BC college of family physicians/college of physcians and surgeons of BC
WHat is ibuprofen
NSAID (nonsteroidal anti inflammatory) inhibiting prostaglandin synthesis
used for headaches, fever, pain
not to be taken by those with asthma or allergies/hypersensitivity to ibuprofen
What are some adverse effects of ibuprofen
hypotension
hypernatremia
heart burn
headache
pneumonia
What is the numeric pain rating scale
11 point scale (0-10) for pain intesnity
valid and reliable measure
MCID is 1.2 points
What is the visual analogue scale
same as nprs but 0-100
*patient draws line to indicate pain
WHat is the patient specific functional scale
11 point scale (0-10) assessing ability to perform activity, with an average score being taken over 3-5 activities
MDC was 2.5 points
WHat is a lateral ankle sprain
tear of anterior talofibular ligament, calcaneal fibular ligament, and posterior talofibular ligament
due to forced varus stress in neutral plantar flexed or internally rotated position
What are the risk factors for lateral ankle sprain
indoor sports, decreased lateral ankle strength and dorsiflexion
WHat is the clinical presentation of lateral ankle sprain
pain with weightbearing, as well as swelling, warm, less strength
What is a syndesmosis sprain
distruption to ligaments between fibula and tibia above the ankle (high ankle sprain)
happens during external rotation of foot, eversion of talus, and excessive dorsiflexion
WHat is the clinical presentation of a high ankle sprain
pain with external rotation and high heel gait (avoiding dorsiflexion)
WHat causes a fracture of the base of the 5th metatarsal
traction of fibularis brevis and lateral band of plantar fascia during inversion, caused by weight bearing activities
poor blood supply so slow healing
What is the clinical presentation of 5th metatarsal base fracture
tender and swollen
What is the clinical presentation of achilles tendinitis
pain with activities that require rapid start/stop, end range dorsiflexion, weight bearing
swelling/tenderness of achillies
What are risk factors for achilles tendinitis
higher bmi and decreased plantar flexion strength
What is the clinical presentation of an achilles rupture
inability to weightbear
audible pop when rupture
fibers bunch up (mop fibers)
WHat is the clinical presentation of compartment syndrome
Pain on outside of shin
weak tib ant/dorsiflex weakness
stretch of tib ant elicits symptoms
if acute = medical emergancy
What are the 4 types of nurses
licensed practical nurse (frontline)
Nurse practitioner
RN (can perform restricted activities without order)
registered psychiatric nurse
What is the role of an ER triage nurse
to priorize care for the most severely ill patients
conflicting results if it helps with wait times
what are the associations and regulatory bodies for nurses
British Columbia College of
Nursing Professionals - RG
Canadian Nurses Association/Nurses and Nurse Practitioners of
British Columbia - Ass
how does an xray work
higher density objects absorb more radiation, show up on imaging (metal, then bone, then soft tissue, then water, then fat, then air)
xrays are first order imaging, can detect causes of bony lesions, but not tumors/infections/soft tissue lesions
WHat are the ottawa ankle rules
rules to prevent unnecessary xrays
ankle xray if : pain in malleolar zone, or if bony tenderness along distal 6cm of posterior edge of tibia/tip of malleoli, or if cant weightbear for 4 steps
foot xray if: tenderness at base of 5th metatarsal, or tenderness at navicular bone, or cant weightbear for 4 steps
can rule out ankle fracture presence, less specific in kids, more false positives in kids
What are axillary crutches
easily adjustable cheap crutches that can be used for stair climbing
they are awkward in small areas and hard to use in crowded areas
2in below axilla and 2in lateral/6in anterior to foot
*more stable than the other ones
what is the forearm crutch
allows use of hands and easier to fit into a car
less lateral support due to no axillary bar and cuffs can be hard to remove
2in lateral/6in anterior to foot, 20-30 degrees of elbow flexion, and 1-1.5in below elbow
compare the 3 point and 4 point gait pattern
4 point uses both feet, is more stable, used when there is bilateral issues, uses crutch then opposite etc
3 point is one leg, with body weight through hands
What is the ankle squeeze test
squeeze tibia and fibula together down the leg to assess for syndesmosis injury, if fracture, contusion, and compartment syndrome are ruled out
good sensitivity, okay specificity
WHat is the anterior drawer test
test for injuries to anterior talofibular ligament
pulls foot forward, by increasing inversion you can stress the ligaments
100% sensitivity, 67% specificity
* For a ATFL/CFL Injury
What is the lower extremity functional scale
20 item questionnaire to examine functional status of pt, each item ranked 0-4
MDC is 15 points in pt with traumatic injuries and 8 in pt w anterior knee pain
MCID is 9 points
What are the 4 types of labral tears
radial flap - most common, usually traumatic but can also be caused by w-sitting, makes a clicking noise as the fold flaps in/out of acetabulum
-radial fibrilated - pain with stairs/jumping
-longitudinal peripheral - pain with stairs/jumping
-abnormally mobile
type of tear determines type of treatment
WHat causes labral tears?
degenerative, traumatic, or idiopathic, can be caused by femoral acetabular impingement, or hypermobility
What is the clinical presentation of a labral tear
pain with activities that involve adduction, walking, pivoting
sharp pain in groin or butt
clicking/instability
pain with FADDIR (flex, add, int rotate)
WHat is femoral acetabular impingement
head of femur isnt fitting in the pocket, associated with labral tear
two types:
Pincer - acetabulam too deep
Cam - too big head of femur
what is the clinical presentation of femoral acetabular impingement
pain with prolonged sitting/pivoting, deep anteroir groin pain, clicking/locking with stiffness
structural issue - cant be treated with physio
What is osteoarthritis
wear/tear damage of articular cartilage and increased osteophyte activity
primary - degenerative over time
secondary - due to underlying cause (infection, trauma, etc)
WHat are the risk factors for osteoarthritis
obesity, developmental dysplasia, and trauma, AGE
what is the clinical presentation for osteoarthritis
pain with activities
WHat is snapping hip syndrome
iliopsoas rubbing against bony tissue due to tightness (internal)
can be snapping of IT band or glutes over greater trochanter (external)
can be loose bodies/labral tear (intraarticular)
What are the risk factors for snapping hip syndrome
weight lifting/dancing
what is the clinical presentation for snapping hip syndrome
painless, with audible pop
WHat is a groin strain
strain of hip adductors (adductor magnus is most common, causes bleeding/bruising)
Occurs usually with directional change, due to high torque
WHat are risk factors for groin strains
sports with kicking/decrease in hip adduction strength
What is the clinical presentation of groin strain
hard to weight bear, especially on one leg
stabbing pain in groin
edema
bruising
pain with resisted adduction or passive abduction
What is MO
Myositis ossificans
bone formation inside soft tissue (muscle belly), developing after a traumatic injury
What are the risk factors for MO
likely to occur in paralyzed people and young athletes
what is the clinical presentation of MO
fast growing swollen lump
may limit movement/ROM
What is hip dysplasia
Hip socket doesnt fully cover ball portion of upper thigh bone, allowing hip to become dislocated partially or fully
what are the risk factors for hip dysplasia
babies born in breech position/swaddled too tightly
checked for by moving infants legs in a variety of positions that help indicate if the hip joint fits well together
what is atenolol
beta blocker that lowers BP and BPM, taken to treat hypertension, cannot be taken by those with sinus bradycardia
cauases bradyarrhytmia, hypotension, dizzyness, depression
WHat is a celebrex
anti-inflammatory drug (* NSAID) , used for acute pain treatment, osteoarthritis, ankylosing spondylitis, etc
inhibits prostaglandin synthesis, not to be taken by people with asthma/ allergies
can cause hypertension, nausea, and headaches
Who is elegible for home care
must be a Canadian citizen, resident of bc, and 19+
must be unable to function independently due to chronic, health-related problems
each service has own assessment criteria
What is an OT
occupational therapist, their role is to adjust individuals abilities to allow them to be able to perform certain tasks
What are the regulatory bodies and associations for OTs
canadian association of occupational therapists
college of occupational therapists of BC
What is the WOMAC
3 dimensional (pain, stiffness, and physical function) survey,
on a scale from 0-4
has a moderate reliability
What is the FADDIR Test
tests for anterior/superior impingement syndrome, anterior labral tear, and iliopsoas tendinitis
positive if pain, stresses the anterolateral labrum
cannot determine presence of pathology
What is the FABER
test to dectect femoral acetabular impingement, however it is not good at detecting
WHat are the indications for a total hip arthoplasty (THA)
pain with motion and weight bearing/mechanically limited ROM
joint deterioration and loss of articular cartilage
How is a THA performed
hip into an open packed position, dislocated, head of femur is cut, prosthesis is shoved into hollow opening, femur is shoved back into socket
What are the contraindications for THA
absolute: active infection, cancer, etc
relative: localized infection, insufficient glute med muscle function, dental work/surgery in the last year (increased infection risk)
WHat are the 2 types of fixation for THA
cemented - press fit, goal is to get weight bearing asap for shorter recovery. has a greater prosthetic survival rate compared to cementless/hybrid
uncemented - porous implants that allow bone ingrowth to fixate the prosthesis, takes longer for this growth to occur tho (longer time to weight bearing) but introduces less foreign objects (less infection) .worse prosthetic survival rate than hybrid and cemented
WHat are the 2 approaches to THA
traditional approach - long cuts to expose joint better and faster, however causes more soft tissue trauma and longer recovery
minimally invasive approach - more cosmetic benefits due to smaller cuts, but takes longer. damages less soft tissue so faster recovery
ultimately depends on surgeon
What are the precautions post THA
posterior approach - no bending forward more than 80 degrees, no crossing legs, no internal rotation
anterolateral approach - no bending forward more than 90 degrees, no external rotation, no crossing legs, no abduction (abductors are cut)
why are there hip precautions following a THA
dont cross/twist/bend to mitigate risk of early THA dislocation
no real evidence to support this tho
what is deep vein thrombosis
clot in deep calf/thigh/pelvic region, causing blocked veins
surgery increases the risk of this as clots float around more due to bleeding
WHat are the risk factors for DVT
weak pulse in foot
sedentary lifestyle
obesity
old age
heart failure
use of oral contraceptives
pregnancy
WHat are the signs/symptoms for DVT
dull ache/pain, especially with passive dorsiflexion
swelling/redness/warm skin (due to blood pooling) -> can cuase a broney edema, which is where the fluid cant mobilize and it can become hard and stiff
weak pulse in foot
only imaging can confirm
* And or pitting edema (you poke and the finger leaes an dindent – can still be mobilized)
WHat are complications of DVT
pulmonary embolism (shortness of breath/ rapid and shallow breathing, with lateral chest pain)
WHat is homan sign
foot is passively dorsiflexed with knee extended, with pain in calf indicating positive for DVT
not indicative of DVT tho, can be many reasons why this can be positive. should not be used to diagnose a DVT, still requires ultrasound
WHat is tylenol 3 with codeine
opiod (* aka narcotic) used for pain relief
not to be used by kids under 12, people with respiratory depression, acute/severe bronchial asthma, or gastrointestinal obstructions
can cause sweating, nausea/vomiting, dizzyness
WHat is heparin
blood thinner used to break down clots with embolisms and thrombosis, shouldnt be used for people with uncontrolled bleeding, pregnant people, or those with severe thrombocytopenia
inhibits formation of fibrin clots
can cause thrombocytopenia and uncontrolled internal bleeding
What is the purpose of a walker
improve balance and relieve weight bearing on lower extremity with very high stability
What are the types of walker
standard (no wheels) - most stable, but slowest, harder for people w low strength, ideal for uneven outdoor situations
front wheeled walker - less stable, but faster walking pattern, hard to turn though
4 wheeled walker - for those who dont need weight bearing relief, easy to move around but not ideal for those with balance issues
walker handles should be in line with patients wrist creases
WHat is the role of a social worker
works with people to achieve optimum psychological and social functioning
WHat are the regulatory bodies/associations for social workers
bc association of social workers
canadian association of social workers
BC college of social workers
What is the TUG test
Timed up and go - get up from chair, walk 3m, turn around and sit back down in chair, without physical assistance
10s is good, and if successful, you can dwell alone (aka you wont be hit by a car)
What is MRSA
methicillin resistant staphylococcus aureus
bacteria resistant to antibiotics
spread prevented by washing hands and chilling out on anti bacterial stuff
WHat are risk factors for MRSA
antibiotics within 3 months
hospital visit in the last 12 months
infections
WHat is radicular pain
pain from a nerve injury
What spinal levels are the Illiac crest, psis, and z-joints at
illiac crest - L4
PSIS - S2
z-joint - 2in left/right of spinous process
Why are most slipped disks slipped backwards
hella anterior ligaments creating a wall, while the posterior ligaments have exposed areas
What is zygapophyseal joint dysfunction
lesion to joint, usually caused by disk degeneration/narrowing via increased loading/osteoarthritis causing damage to nerve roots
can result from hyper/hypo mobility instability
pain w only extension and usually mechanically based
what are the risk factors for Z-joint dysfunction
degenerative disk disease and increased age
WHat is the clinical presentation of z-joint dysfunction
unilateral back pain/tenderness, stiffness, pain apon extension (due to joint space decreasing, touching the nerve)
no pain with flexion as this increases the joint space
can palpate the zjoint, causing pain
WHat is spondylosis
arthritis of the disks, with the posterior wearing away first which causes initial pain with extension
usually due to bad posture/prolonged immobilization
what are the risk factors for spondylosis
increased age and intervertebral disk degenration
what is the clinical presentation of spondylosis
pain with extension/side bending
progeressive hypomobility
cant palpate pain (cant touch vertebral body)
WHat are the types of lumbar disk herniation?
protrusion - bulge but no escape AF
extrusion/prolapse - attached to disk but escapes AF
sequestration - fully out of disk (full collapse resulting in less pain, as there isn’t anything pressing on nerves)
caused by bending with twisting motion
what are the risk factors for lumbar disk herniation
smoking, previous herniation, diabetes (high arterial concentration, so diabetes/high bp/etc impacts degeneration)
what is the clinical presentation of lumbar disk herniation
may have radicular pain, pain with lumbar flexion, and pain in lumbar area
What is spondylolisthesis
progression of spondylosis (complete weardown)
anterior slippage and inability to resist shear forces of vertebral segment below it
can be caused by degeneration, pathologic process, or congentially
What are the risk factors for spondylolisthesis
ligament laxity/ twice as commen in women (heel height/hormonal interactions/lower muscle mass)
What is the clinical presentation for spondylolisthesis
chronic midline pain at lumbosacral junction
pain worsens with activity
leg pain with radicular pattern due to nerve root foramen being significantly more narrow
WHat is spinal stenosis
narrowing of spinal canal caused by disk protrusions, boney narrowing, or joint swelling, or bad posture (spondylolisthesis)
what are the risk factors for spinal stenosis
being over 50
what is the clinical presentation of spinal stenosis
history of lower back pain/leg pain
pain with standing/lumbar extension
short hip flexors
What is a myotome? what is the lower leg myotomes?
group of muscles that are supplied by a nerve root
to test for these, isometric strength test should be performed for 5s
SPARTAN KICK
L2-hip flexion
L3 - knee extension
L4- ankle dorsiflexion
L5 - big toe extension
S1 - ankle plantar flexion, ankle eversion, hip extension
S2-knee flexion
What are dermatomes
areas of the skin that supply nerve roots
lots of overlap with these
can sense light touch, proprioception, vibration, pain, and temperature (DCML and spinothalamic)
WHat are the deep tendon reflexes
patellar - tests L3/L4
achillies - tests S1/S2
medial hamstring - L5/S1
Lateral hamstring - S1/S2
How are deep tendon reflexes graded
0-absent
1-diminished (hyporeflexia)
2-average
3- exxagerated
4 - clonus (hyperreflexia) - tested with quick passive dorsiflexion of ankle -3+ beats is positive
WHat does the babinski test for
corticospinal tract impariment (positive is flaring of toes)
What are the signs for a UMN
disuse atrophy, hyperreflexia, spastic paresis, positive babinski
what are the signs for LMN
denervation atrophy, hyporeflexia, flaccid paresis, negative babinski
WHat are some red flags for lower back pain
bowel/bladder/genital dysfunction (s2 dysfunction)
saddle paraesthesia (pins/needled between asshole and genitals)
WHat is the slump test
assess neural sensitivity by getting pt to slump w hands at side, put head down, then raise leg, then dorsiflex in that order
not super specific due to setup of test
what are the wadell signs
signs that essentially individual is faking it, originally used to assess if pt would make a quick recovery post surgery
- widespread tenderness that doesnt make sense
- pain with simulated axial loading/spine rotation
- inconsistant test results
- myotomes/dermatomes dont add up
- overreactions dueing exam
3/5 mean positive, and is a poor prognosis
What is Lipitor
cholestrol meds used to treat hypertriglyceridemia
not to be used by those with active liver disease or nursing mothers
can cause diarreha, arthralgia, myalgia, pain
What is cyclobenzaprine
muscle relaxant, used to treat musculoskeletal conditions, dont use if have heart issues/hyperthyroidism
acts at brainstem
can cause constipation, dizzyness, and fatigue
What is hypercholestrolemia
high cholesterol >200mg/dl
risk factors include smoking, hypertension, low HDL, family history
