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THY 415 ExRx Musculoskeletal Disorder > Musculoskeletal 1 & 2 > Flashcards

Musculoskeletal 1 & 2 Flashcards

1
Q

What is the musculoskeletal system?

A

the muscles, bones, tendons, and ligaments that support and control posture and body movement

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2
Q

What is soft tissue classified as?

A

muscles, tendons, ligaments, fascia, nerves, fibrous tissues, fat, blood vessels, and synovial membranes

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3
Q

Tendons attach ________ to _________.

A

muscles to bones

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4
Q

Ligaments attach _______ ________ to stabilize a joint structure.

A

across bones (bone to bone)

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5
Q

True or False:
Muscle contractions cause, control, or prevent joint movement when initiating, decelerating, or restraining a body segment movement.

A

True

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6
Q

True or False:
Muscle contractions are isotonic (static) or isometric (concentric/eccentric).

A

False;
Muscle contractions are isometric (static) or isotonic (concentric/eccentric).

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7
Q

Which of the contractions (concentric, eccentric, isometric) are known as each of the following:
- control
- power
- stabilize

A

eccentric = control
concentric = power
isometric = stabilize

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8
Q

What does concentric contraction (positive) mean?

A

the muscle shortens to generate tension and contract against resistance
(e.g. lifting an object/pushing an object/throwing an object)

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9
Q

What does eccentric contraction (negative) mean?

A

the muscle lengthens of while controlling motion against an external force
(e.g. the lowering phase of a concentric movement)

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10
Q

What does isometric contraction (static) mean?

A

the muscle develops tension, but no mechanical work occurs
(e.g. holding a weight in a fixed position/pushing against a fixed immoveable object)

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11
Q

True or False:
All skeletal movements involve varying degrees of concentric, eccentric, and isometric muscle actions

A

True

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12
Q

How does a therapist usually begin treatments with contractions? Which one do they use?

A

pain free isometric

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13
Q

In treatments, what is the progression order following pain free isometrics?

A
  • progress to AAROM
  • progress to AROM
  • progress to concentric/eccentric with PRE protocol
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14
Q

A maximum concentric contraction produces _____ force than a maximum eccentric contraction under the same circumstances.

A

less

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15
Q

A greater resistance load can be lowered ____________ than can be lifted __________.

A

eccentrically, concentrically

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16
Q

True or False:
Placing a muscle on stretch prior to a concentric contraction increases the force generation potential.

A

True

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17
Q

The greatest level of tension is developed when a muscle is stretched no more than ____% of its resting length

A

30%

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18
Q

Which point of the ROM is the greatest muscle force output?

A

mid portion
(think of dumbbell curls, the midpoint is the strongest concentric reaction)

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19
Q

What is a musculoskeletal injury?

A

damage to the muscular or skeletal structure that impairs dynamic movement or body stabilization

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20
Q

What do musculoskeletal injuries include?

A
  • bone fracture
  • muscle/tendon and ligament injury
  • nerve damage
  • vertebral disc injury
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21
Q

What are some theraputic exercises for musculoskeletal injuries?

A
  • strength, power, and endurance training***
  • flexibility and ROM***
  • postural stabilization***
  • balance training
  • coordination exercises
  • gait and locomotion training
  • neuromuscular re-education (retraining)
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22
Q

What is neuromuscular re-education?

A

a series of repetitive movements, posturing, and nerve stimulation designed to reinforce nerve signals to restore functional movements

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23
Q

True or False:
When nerve signals are “retrained”, coordinated muscle movements can be restored through repetitive training

A

True

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24
Q

When developing a patient’s therapeutic regimen, what are things that are important to take into account?

A
  • current functional level
  • current stage of healing
  • prior activity and fitness level
  • comorbidities
  • setting (home, SNF, hospital, gym)
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25
Q

What should you always do to the patient before you ever begin an exercise regimen? And why should you do this?

A

Evaluate them to determine the level of:
- muscular strength (MMT)
- endurance
- flexibility and ROM
- functional movement status (TUG, Tinetti, Berg)

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26
Q

What can flexibility restrictions result from?

A
  • joint structure
  • muscle tightness
  • neuromuscular deficits
  • decreased muscular strength
  • imbalanced agonist/antagonist relations across joints
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27
Q

What are some methods to restore flexibility?

A
  • static stretch
  • ballistic stretch
  • mechanical stretch
  • PNF stretch (hold relax and agonist contract)
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28
Q

What is strength training exercise?

A

apply the principles of progressive overload training to restore muscular strength and endurance

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29
Q

What is progressive resistive exercise (PRE)?

A

calculated resistance applied to muscle contraction, and progressively increase commensurate with the muscle’s increased contractile force potential (by sets, reps, and time)

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30
Q

What is the difference between open kinetic chain and closed kinetic chain?

A

OKC: distal end is not fixed
CKC: distal end is fixed

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31
Q

True or False:
The hip joint is more stable and less vulnerable to dislocation (as compared to the shoulder joint)

A

True

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32
Q

What are the movements of the hip joint?

A

flex/ext
ab/add
ex rot/int rot

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33
Q

What type of joint is the hip?

A

enarthrodial ball and socket

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34
Q

True or False:
the femur is the longest bone is the body

A

True

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35
Q

The hip joint is ___ to the shoulder joint in regards to mobility

A

2nd

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36
Q

What is the iliotibial band (IT band)?

A

a wide sheath of fibrous connective tissue surrounding the lateral thigh

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37
Q

Where does the IT band originate and insert?

A

O: TFL and glute max
I: lateral epicondyle of tibia (Gerdy’s tubercle)

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38
Q

What is IT band syndrome?

A

a painful condition caused by connective tissue abrades against the femur (rubbing)
- this is a leading cause of lateral knee pain incurred during running and cycling

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39
Q

What is trochanteric bursitis?

A

inflammation of the trochanteric bursa located between the greater trochanter of the femur and glute med

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40
Q

What is a bursa?

A

a closed, fluid-filled sac that funtions as a gliding surface to reduce friction between body tissues

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41
Q

What is the form of treatment for trochanteric bursitis?

A

rest and cryotherapy (cold ice), along with stretching exercises

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42
Q

What is snapping hip syndrome?

A

condition in which a person feels a snapping sensation or hear a popping sound in hip (dixie)

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43
Q

True or False:
snapping hip syndrome is usually painless and harmless, however, the sensation is annoying and can lead to bursitis

A

True
outside – ITB (most common)
front – rectus femoris or iliopsoas
back – hamstring

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44
Q

What is a hip impingement (femoralacetabular impingement)?

A

occurs when the femoral head pinches against the acetabulum
- can results in damage to labrum
- can lead to OA

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45
Q

What is a total hip arthroplasty (THA)?

A

a surgical replacement of the femoral head and the acetabular surface with a prosthetic component

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46
Q

Why is a THA performed?

A

to correct damage from OA, RA, hip fracture, avascualr necrosis, and cerebral palsy

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47
Q

What are contraindications for a THA?

A
  • osteoporosis (will break bone more)
  • ligament laxity (more dislocation prone, continue to fall out)
  • infection (even more risk of infection)
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48
Q

True or False:
THA is an end stage procedure performed when conservative measures to manage joint pain and joint function fail

A

True

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49
Q

What are the 5 primary THA procedures?

A
  1. Posterior lateral approach
  2. Direct lateral approach
  3. Anterior lateral approach
  4. Anterior approach
  5. Transtrochanteric approach
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50
Q

How is the Posterior lateral approach performed?

A
  1. glute max is split in line with the muscle fibers
  2. the interval between the glute max and med is split
  3. the piriformis and short external rotator tendons are transected near their insertion
  4. the capsule is incised and the glute max tendon is released from its insertion in prep for insertion of the replacement components
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51
Q

What is the primary benefit of the posterior lateral approach?

A

Hip abductors are preserved

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52
Q

True or False: the posterior lateral approach is most commonly used

A

True

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53
Q

What movements should be avoided to prevent dislocation in the posterior lateral approach?

A
  • hip flex past 90 degrees
  • no adduction past midline
  • no internal rotation past neutral
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54
Q

How is the direct lateral approach performed?

A
  1. TFL is divided longitudinally
  2. a portion of the proximal insertion of the glute med is released
  3. vastus lateralis is split longitudinally
  4. glute mini is partially detached from the trochanter
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55
Q

What can the direct lateral approach involve?

A

a trochanteric osteotomy

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56
Q

What is an osteotomy?

A

removal of a wedge of bone to change alignment or angle to alter bone stresses

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57
Q

What is an uncompensated positive Trendelenburg sign?

A

when the right leg moves to weight bearing (stance phase), the unsupported left hip (swing phase) drops down

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58
Q

What is deliberate compensation for a positive Trendelenburg sign (weak glute med)?

A

during weight bearing on the side of glute med weakness the person leans laterally to the weak side, resulting in a waddling gait

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59
Q

How is the Anterior lateral approach performed?

A
  1. the joint is incised lateral to the TFL
  2. the IT band is split
  3. the anterior third of the flute med and mini are detached from their insertion and reattached at closure
  4. the anterior third of the vastus lateralis may be detached
  5. a capsulotomy is performed and the hip is dislocated anteriorly
60
Q

What is a capsulotomy?

A

incision of a capsule

61
Q

True or False:
The incidence os postoperative dislocation of the Anterior lateral approach is lower than with the posterior approach

A

True
- indicated for patients with stroke or cerebral palsy whose standing posture is characterized by hip flexion and internal rotation

62
Q

How is the Anterior approach performed?

A
  1. an incision is made lateral to the ASIS, slightly anterior to the greater trochanter, and medial to the TFL
  2. the capsule is incised and the hip is dislocated anteriorly
    (no muscles are detached by rectus femoris and sartorius are retracted medially)
63
Q

True or False:
Concerning the anterior approach, weight bearing as tolerated is permitted immediately after surgery.

A

True

64
Q

How is the transtrochanteric approach performed? (kinda sketchy)

A
  1. used primarily in complex revision arthroplasty
  2. involves an osteotomy of the greater trochanter at the insertion of the glute med and mini
  3. after component placement, the trochanter is reattached and wired in place to stabilize the osteotomy site (ORIF)
  4. the trochanter is often reattached in a position that improves the mechanical efficiency of the glute med
65
Q

True or False:
In a trochanteric approach, it involves an extended period of non-weight bearing and adherence to abduction precaution

A

True (very slow healing for this approach)

66
Q

What do THA postoperative exercises include?

A
  • ankle pumps, quad set, short arc quads…
  • ambulation with assistive devices, WBAT)
  • progress from passive to active movement
  • gradually increase to AROM
  • continue to progress to ambulation with least restrictive devices
67
Q

What is the Thomas Test used for?

A

labral tear (looking for click or catch)

68
Q

What is the Trendelenburg Sign used for?

A

weak glute med

69
Q

What is Ober’s used for?

A

tight ITB or TFL

70
Q

What is FABER’s used for?

A

SI joint dysfunction or impingement/labral (reproduce pain)

71
Q

What is FADIR’s used for?

A

impingement/labral (reproduce pain)

72
Q

What is patellofemoral pain syndrome?

A

anterior knee pain involving the patella and retinaculum

73
Q

What is retinaculum?

A

fibrous bands of fascia that pass over or under tendons to maintain their position

74
Q

What is overuse syndrome?

A

most often asociated with repetitive activities as running, jumping, ascending and descending hills

75
Q

What is chondromalacia?

A

softening of the cartilage underneath the patella

76
Q

What is Pes planus?

A

(flat arch) the flattening of the foot causing a compensatory internal rotation of the tibia that alters the dynamics of the patellofemoral joint

77
Q

What is Pes cavus?

A

(high arch) results in uneven weight bearing distribution leads to excessive stress to the patellofemoral joint

78
Q

What is the Q-angle?

A

(the quadriceps angle) the angle between the quadriceps muscles and the patella tendon
- formed by lines drawn from the ASIS trough the center of the patella and from the center of the patella to the center of the tibial tubercule

79
Q

True or False:
A large Q-angle is associated with patellofemoral pain syndrome

A

True

80
Q

Q-angles greater than ___ degrees are problematic

A

15

81
Q

Do women or men have larger Q-angles?

A

Women

82
Q

How can meniscal injuries occur?

A

trauma or degeneration (also ACL, MCL)

83
Q

What does the unhappy triad consist of?

A

torn meniscus
ACL tear
MCL tear

84
Q

Which part of the menicus is repaired and which part is cut out if needed>

A

outer section is repaired due to good blood supply
inner two-thirds is cut out due to bad blood supply

85
Q

Which ligament in the knee is most commonly injured?

A

ACL

86
Q

How do most ACL injuries occur?

A

during deceleration combined with twisting/pivoting/side stepping
- a pop noise is heard

87
Q

True or False:
You can still function without an ACL.

A

True

88
Q

What is the treatment for an ACL?

A
  • maintain adequate ROM an balanced strength of quads and hammies
  • knee brace
89
Q

What are the causes of PCL tears?

A
  • fall onto bent knee
  • dashboard injury
  • hyperflexion
  • dislocation
90
Q

What are surgical considerations for ACL tears?

A
  • patellar tendon graft (take middle third of patellar tendon to replace damaged ACL) GOLD STANDARD
  • hamstring tendon graft (take strands of semitendinosus to reconstruct ACL)
  • allograft (cadaver graft from Achillies tendon, tib ant, and patellar tendon to replace ACL
91
Q

What is a total knee arthroplasty (TKA)?

A

a surgical procedure to replace components of the knee joint with artificial components
- peformed when conservative treatment fails to restore mobility or reduce chronic pain

92
Q

What components of the knee are replaced in a TKA?

A
  • femoral
  • tibial
  • patellar
93
Q

What is a partial knee replacement?

A

replaces the medial or lateral component but not the patellar component
- not recommended if 2 or more compartments within the knee are damaged
- typically done for older individuals with sedentary lifestyle

94
Q

What are the special tests for the knee?

A
  1. Patellar grind (patellofemoral pain)
  2. Lachman (ACL)
  3. McMurray (meniscus)
  4. Thessaly (meniscus)
  5. Anterior drawer (ACL)
  6. Posterior drawer (PCL)
95
Q

What is an ankle sprain?

A

an injury inwhich the ligaments of the ankle tear partially or completely due to a sudden stretch force
- pain is severe and can be associated with a popping sensation
- immediate swelling

96
Q

What is a lateral ankle sprain?

A

involves inversion with plantar flexion (most common type)

97
Q

What are the grades of a sprain?

A

Grade 1: structural damage on microscopic level with mild pain and swelling
Grade 2: partial tear of fibers associated with moderate pain and swelling (may have instability)
Grade 3: a complete tear (rupture) of a ligament with severe pain and swelling (associated with instability

98
Q

What are medial ankle sprains?

A

results from forced dorsiflexion and eversion of the ankle (less common)
- medial deltoid ligament is most common structure involved
- requires further examination to rule out fracture (fibular fractures)

99
Q

What is plantar fasciitis?

A

result of collagen degeneration of the plantar fascia at the calcaneal tuberosity and surrounding structures
- presents as heel pain

100
Q

What are the risk factors for plantar fasciitis?

A
  • tight or weak plantar flexors
  • pes cavus or pes planus
  • excessive pronation
  • overuse
  • improper footwear
101
Q

How does plantar fasciitis present itself?

A
  1. heel pain with first steps in morning
  2. tenderness to anterior medial heel
  3. limmited DF
  4. painful gait or toe walk
  5. pain increases with barefoot and stairs
  6. patients typically had sudden increase in activity prior to onset (grandma goes to disney)
102
Q

What does PRICE stand for?

A
  • Protection
  • Rest/Restricted activity
  • Ice
  • Compression
  • Elevation
103
Q

How do you improve flexbility for the ankle?

A

stretch the gastroc and soleus
- avoid stretching the ankle in motions that stress the injured ligaments

104
Q

How do you strengthen the ankle?

A

particular emphasis is placed on strengthening the muscles that control the foot an ankle
- plantar flexors, dorsiflexors, inverts, and everts

105
Q

What are the special tests for the ankle?

A
  1. Anterior drawer (talocrual laxity)
  2. Squeeze test (syndesmotic injury) (fib and tib)
  3. Figure 8 (swelling)
  4. Talar tilt (ATFL and calcaneofibular ligament)
106
Q

What is a joint?

A

an axial structure consisting of adjacent bones articulating with muscle tendons attached to each bone

107
Q

What type of joint is the shoulder?

A

ball and socket

108
Q

The ______ surrounding the glenoid socket provides increased stability of the shoulder joint.

A

Labrum

109
Q

What are the 8 movements of the shoulder joint?

A

flex/ext
int/ext rot
ab/ad
horizontal ab/ad

110
Q

True or False:
The shoulder is the most stable joint in the body

A

False, it is the most mobile

111
Q

In which movement is the shoulder joint the most stable?

A

Extension

112
Q

When does dislocation in the shoulder joint occur?

A

when the proximal portion of the humeral head slips out of the glenoid fossa

113
Q

What are some exercises to strengthen the anterior deltoid?

A
  • overhead press
  • push ups
  • bench press (horizontal and incline)
  • front raises
  • resisted scaption
114
Q

What are some exercises to strengthen the medial deltoid?

A
  • resisted lateral raises
  • upright rows
  • resisted scaption
115
Q

What are some exercises to strengthen the posterior deltoid?

A
  • bent over lateral raises
  • bent over horizontal row
  • chin ups/pull ups/lat downs
  • rope climbing
116
Q

The _____ ______ and the ___________ work in tandem during shoulder abduction.

A

medial deltoid and the supraspinatus

117
Q

Which muscle pulls first in abduction? medial delt or supraspinatus?

A

supraspinatus

118
Q

What are the 5 shoulder joint injuries?

A
  1. labrum tears
  2. impingements
  3. tendonitis
  4. tendon tears
  5. OA
119
Q

What do labrum tears result from?

A
  • direct FOOSH
  • repetitive overuse like throwing or tennis serves
120
Q

What is a SLAP tear stand for and what does it mean?

A

Superior Labrum Anterior and Posterior
- most common type of labrum injury

121
Q

What else can be injured in a SLAP tear?

A

biceps tendon

122
Q

What is shoulder impingement syndrome?

A

compression of a tendon between the glenohumeral joint and the acromion

123
Q

True or False:
Shoulder impingement is often secondary to rotator cuff injury.

A

True

124
Q

True or False:
Impingement is a sign, not a diagnosis

A

True

125
Q

What are the two planes that rotator cuffs move in?

A

Frontal and transverse

126
Q

What do rotator cuff injuries result from?

A
  • trauma to shoulder
  • wear and tear
127
Q

What is the most commonly injured rotator cuff muscle?

A

supraspinatus

128
Q

When dealing with a rotator cuff injury, what is the one motion you should avoid?

A

the empty can
- shoulder abduction with thumb down (emphasizes internal rotation)

129
Q

What are the special tests for the shoulder?

A
  • full can
  • empty can (supraspinatus)
  • Hawkins kennedy (impingement)
  • liftoff (subscap)
  • speed’s (biceps tendinitis)
130
Q

What is shoulder subluxation?

A

(partial dislocation)
- results from joint laxity in weakness of rotator cuff muscles

131
Q

What are 4 exercise precautions to follow following a shoulder injury?

A
  • lat pull downs
  • biceps curl
  • bench press
  • overhead press
132
Q

True or False:
A torn rotator cuff cannot maintain the head of the humerus in the glenoid fossa resulting in the humerus moving upward and rubbing against the acromion

A

True

133
Q

What is avascular necrosis?

A

AVN
- occurs when the blood supply to the humeral head has been disrupted
- death of cells
- treatment is TSA (total shoulder arthroplasty)

134
Q

What are the two options for a TSA?

A
  • replace humeral head only
  • replace humeral head and glenoid fossa
135
Q

In a TSA, if the ___________ is detached and reattached, to complete the procedure, resisted internal and external rotation must be avoided until healing is complete.

A

Subscapularis

136
Q

What is biceps tendinitis?

A

occurs in the long head of the biceps tendon following the path on the anterior aspect of the humerus between the greater tuberosity and the lesser tuberosity.

137
Q

What is epicondylitis?

A

inflammation or damage to the area of an epicondyle of bone

138
Q

What is lateral epicondylitis and what else is it known as?

A

A.K.A Tennis elbow
- inflammation and micro-tearing of fibers in the extensor tendons of the forearm

139
Q

How is tennis elbow produced? (what motion makes it occur?)

A

pain is produced with passive wrist flexion and resistive wrist extension, most specifically with the elbow in extension

140
Q

How do you isolate the following elbow flexors?
biceps brachii
brachialis
brachioradialis

A

BB: supinated forearm
B: pronated forearm
BR: neutral forearm

141
Q

What are the special tests of the elbow?

A

Tinel’s: comrpression neuropathy
Elbow varus: integrity of LCL
Elbow valgus: integrity of UCL (MCL)

142
Q

What does the wrist movement involve the articulation of?

A
  • distal radius and proximal row of carpal bones
    1. scaphoid
    2. lunate
    3. triquetrum
    4. pisiform
143
Q

What are the 6 movements of the wrist?

A
  • flex/ext
  • rad dev/uln dev
  • pro/sup
144
Q

What is the acronym for the carpal bones

A

Some Lovers Try Postions That They Can’t Handle
- scaphoid
- lunate
- triquetrum
- pisiform
- trapezium
- trapezoid
- hamate

145
Q

Which carpal bone is the most frequently fractured and how does it occur?

A

scaphoid, FOOSH injury

146
Q

Which carpal bone is most frequently dislocated?

A

lunate

147
Q

What are the 3 deformities in the finger?

A

Mallet finger (curved DIP when typing)
Boutonniere (extended MCP and curved PIP)
Swan neck (hyper extended PIP and flexed DIP)

THY 415 ExRx Musculoskeletal Disorder (7 decks)

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