Musculoskeletal Flashcards
1
Q
The female athlete triad is an underdiagnosed disorder composed of what three underlying and inter-related conditions.
A
Eating disorders
Osteoporosis
Amenorrhea
2
Q
Why would a lack of estrogen in the body play a role in the female athlete triad
A
estrogen is essential for bone health, a lack of estrogen leads to recurrent stress fractures or osteoporosis
3
Q
Amenorrhea is a lack of menstruation that can occur in the female athlete triad. Changes to what body structure is responsible for amenorrhea
A
hypothalamus
4
Q
When can an end feel be classified as empty
A
when movement stops due to the pain although no real mechanical resistance is being detected
5
Q
True or False
Canes have good stability compared to other AD’s.
A
false, poor stability
6
Q
How is the height of a cane appropriately selected
A
the handle of the cane should be at the height of the greater trochanter, ulnar styloid, or wrist creast
7
Q
Your patient had ACL surgery a week ago and his physical therapist assistant is trying to get him to ambulate with a cane. You intervene and tell the PTA to train with crutches instead, why
A
canes should be avoided when the patient has LE weight bearing precautions.
8
Q
When are loftstrand crutches selected as the appropriate AD
A
when the pt currently has or is likely to have an injury to the axillary nerves and blood vessels
9
Q
When are loftstrand crutches avoided as the appropriate AD
A
when higher level of functional standing balance and UE strength are needed, like with the elderly.
10
Q
True or false
axillary crutches are more stable than loftstrand crutches
A
true
11
Q
When is a walker selected as the appropriate AD for a patient
A
When maximal stability and support are required, good for elderly
12
Q
Whatt is the most restrictive assistive device
A
walker
13
Q
What type of AFO is composed of calf component that articulates with a separate foot plate
A
hinged or articulated AFO
14
Q
What motions are unrestricted and restricted with a hinged/articulated AFO
A
unrestricted pf/df
restricted medial/lateral movement
15
Q
What is the purpose of adding a buttress to the posterior aspect of the AFO
A
it stops excessive plantarflexion
16
Q
What is the purpose of a dorsiflexion stop, which is a velcro strap on the posterior aspect of the AFO
A
It limits excessive dorsiflexion
17
Q
When would a PT prescribe a hinged/articulated AFO to a patient
A
When a SAFO is too much support but a pt still needs medial/lateral support like in a pt with spastic cp or knee hyperextension
18
Q
When would a PT prescribe a posterior leaf split to a patient
A
to assist with ankle df and foot clearance during swing phase
and if the pt doesn’t need medial/lateral support
19
Q
What is a posterior leaf split made out of
A
polypropylene or carbon fiber
20
Q
What is a ground reaction force AFO made out of
A
solid plastic material with a solid ankle
21
Q
What motions are restricted and unrestricted with a ground reaction AFO
A
This restricts df during stance by preventing the knee from collapsing into flexion
22
Q
What type of patient population would a ground reaction AFO be good for
A
pts who knees buckle or those with crouched gait, as well as neuro conditions that cause quad weakness.
23
Q
What 4 conditions are a part of the cervical radiculopathy clinical prediction rule
A
1.positive upper limb tension test A - ULNTa
2. cervical rotation less than sixty degrees
3. positive distraction test
4. positive spurlings test A
24
Q
According to the clinical prediction rules of carpal tunnel 4 out of what 5 conditions will be present
A
- shaking hands to relieve hands
- wrist ratio greater than .67
- symptom severity scale greater than 1.9
- diminished sensation in median sensory field 1 or the thumb
- older than 45
25
According to the Ottawa ankle rules, an x ray is only required if there is pain in the malleolar zone and if any one of the following three conditions are present
1. bone tenderness along distal tibia
2. bone tenderness along distal fibula
3. inability to bear weight for four steps
26
According to the Ottawa foot clinical prediction rules, a foot x-ray is only required if there is pain in the midfoot and one of the following 3 conditions are present
1. bone tenderness at the base of the fifth metatarsal
2. tenderness at the navicular bone
3. inability to bear weight for four steps
27
If I rotate my head to the right, is the right or left SCM doing the work
left, the SCM is responsible for ipsilateral side bending and contralateral rotation
28
What is another condition that is likely to present with congenital torticollis
Deformational Plagiocephaly (DP) is a common condition that occurs in
conjunction with torticollis in children. Typically children with CMT
will present with contralateral flattening of the skull.
Example: Right CMT will present with left plagiocephaly
29
What is normal femoral anteversion
8-15 degrees
30
what is normal femoral retroversion
less than 8 degrees
31
Will femoral anteversion create in-toeing or out-toeing
in toeing
32
Will a patient with femoral anteversion will have genu valgum or genu varus
this then creates subtalar supination/pronation
genu valgum creates subtalar pronation
33
What is normal femoral anteversion at birth
thirty to forty degrees
34
What is forefoot varus and its normal rom
forefoot varus is inversion of the forefoot, normal is 0-10 degrees
35
The goal of the foot is to remain level with the ground until what phase of gait
toe off during pre swing
36
What is the appropriate intervention for rigid forefoot varus
add a medial wedge into the shoe
37
What is the appropriate intervention for flexible forefoot varus
add a lateral wedge that rotates the big toe down to the ground
38
What is forefoot valgus
the foot is everted
39
True or False
Forefoot varus can cause pes planus
false, forefoot valgus causes pes planus or flat foot
40
What is the appropriate intervention for rigid and flexible forefoot valgus
place a wedge on underneath ipsilateral deformity for rigid, and on the contralateral side/medial side for flexible forefoot valgus
41
42
What phase of gait does vaulting occur in
midstance of stance limb and swing phase of contralateral limb
43
Vaulting is a gait deviation characterized by active plantarflexion of the stance limb in order to clear the contralateral limb. What are 3 common causes of vaulting
leg length discrepancy
contralateral prosthesis too long
contralateral foot stuck in plantarflexion
44
What phase of gait does a knee thrust occur in
loading response to midstance
45
A knee thrust is a gait deviation characterized by a rapid hyperextension of the knee. What are 3 common causes of a knee thrust.
Weak quadriceps
spastic quads
plantarflexor contracture
46
If a patient walks with a trendelenburg gait deviation, which way will the patient laterally lean
towards the weakened side
47
Trendenenburg is a gait deviation characterized by a marked lateral trunk lean towards the weakened LE. What are 3 common causes of trendelenburg gait
weak glute med/min
ipsilateral hip adductor tightness
superior gluteal nerve palsy
48
what phase of gait does Trendelenburg occur in
midstance
49
Delayed heel off is a gait deviation characterized by a lack of plantarflexion that results in an inability to transfer weight onto the forefoot in preparation for swing. What are 4 common causes of delayed heel off
weak pf's
excessive df
tibial nerve palsy
anterior foot pain
50
what phase of gait does delayed heel off occur in
during terminal stance to pre-swing
51
An early heel off is a gait deviation characterized by an inability to acieve adequate dorsiflexion during the late stance phase. What are 3 common causes of early heel off
heel pain
tight/spastic pf's
limited posterior talocrural mobility
52
Backward trunk lean is a gait deviation characterized by marked trunk extension in order to shift the center of mass posteriorly and reduce load on the glute max. What are 2 common causes of backward trunk lean
glute max weakness
inferior gluteal nerve palsy
53
What phase of gait does early heel off occur in
midstance
54
What phase of gait does backward trunk lean occur in
during initial contact through midstance
55
Gout causes painful episodes in joints with an increase in redness, warmth, and swelling. How would a doctor determine if a pt has gout
high levels of uric acid
56
what patient population is most likely to get gout
male over thirty with purine rich diet and/or excessive alcohol use.
purine rich foods include fish, mushrooms, sweetbreads, liver, peas, mussels, asparagus, red meat
57
What are the major causes of gout
obesity
alcohol use
hypothyroidism
purine rich diet
58
A pt with gout will have elevated uric acid in the blood. What are normal uric acid levels in males and females
M - 3.4 to 7 mg/dL
FM - 2.4 - 6.0 mg/dL
59
What are signs and symptoms of gout
sudden sharp pain that starts in the night located mainly in the big toe and can also be in the ankle, knee, wrist/hand, fingers or elbows.
60
If you have a pt with suspected pelvic innominate rotation dysfunction, what special test would you use to confirm your findings?
The supine to sit test
measure leg length via medial malleoli while in supine
measure leg length in long sitting position
61
What do the findings of the supine to sit test say about pelvic innominate rotation dysfunction
1. if the right leg is longer in supine and shorter in long sitting, there is a right anterior innominate rotation
2. if the right leg is shorter in supine and then appears longer in long sitting, there is a right posterior innominate rotation
62
You determine your patient has an innominate rotation dysfunction, how do you treat it
First determine the direction of the rotation and think about what muscles are capable of returning the pelvis to its original position.
example- a right posterior rotation requires the hip flexors to kick on stronger
63
What is the difference between isokinetic and isotonic exercises
isokinetic is same speed with variable resistance
isotonic is same resistance and variable speeds
64
Genu valgum is commonly referred to as knock-knee in which the knees are angles inward while standing. What are 3 major causes of this
Coxa vara - less than 120 degrees femoral neck angulation
Excessive femoral anteversion - greater than 15 degrees
Hip abductor/external rotation weakness
65
You're examining a patient with genu valgum deformity. What are 3 secondary complications your patient is at risk for
lateral knee pain due to lateral compartment compression
retro-patellar pain - PPS
ACL/MCL laxity
66
What are common treatments for genu valgum deformity
strengthening hip abductors/ERs
medial patellar taping
knee brace with lateral buttress
medial heel wedge
medial arch support
67
Genu varum is a deformity in which the knee are angled outward and is commonly called bow-legged. What are 4 major causes of genu varum.
Coxa valga - greater than 135 femoral neck angulation
Femoral retroversion - less than eight
Rickets - softening of bone in children due to severe vitamin D deficiency
Congenital hip deformity
68
On the NPTE, genu (valgum/varum) can be referred to as Blount's disease
varum - bow legged
69
Your examining a patient with genu varum. What secondary conditions do you expect to see
medial knee pain
OA of medial compartmental compression
70
What are 4 common treatments for genu varum deformity
surgical correction
vitamin D and calcium
bracing
lateral heel wedge
71
What is genu recurvatum and what are 4 major causes of
Genu recurvatum is knee hyperextension and can be caused by weak quads, quadriceps/pf spasticity, ligamentous laxity, and decreased LE proprioception
72
You're examining a patient with genu recurvatum. What secondary conditions do you expect to see
posterior knee pain
knee giving way into hyperextension
pinching sensation in the anterior knee/anterior compression
73
When utilizing lumbar mechanical traction, greater than ___% of the patient's body weight is required to achieve separation of joint surfaces in the lumbar spine
fifty percent
74
When attempting lumbar mechanical traction for the first time, a maximum of ___lbs should be trialed to determine patient response
thirty pounds
75
In acute phases, mechanical lumbar traction should be done in ___min with interrmittent traction and ___min with sustained traction
In subacute/chronic phases, a maximum duration of ___min of lumbar mechanical traction should be peformed
less than fifteen with intermittent
less than ten with sustained
thirty minutes with chronic phases
76
A PT would like to try mechanical traction with a patient. How should they determine whether to use sustained traction or intermittent traction
use sustained traction when a pt has pain with lumbar movement
77
True or False:
A pt with a diagnosis of spinal stenosis, is not a candidate for mechanical lumbar traction
False, traction is indicated for spinal stenosis
78
Is the medial or lateral meniscus torn more often
the medial meniscus, which is why the answer on the NPTE will likely be medial meniscus if the choices are between medial and lateral meniscus
79
Is the inner or outer one-third of the meniscus vascularized? What does this mean
The outer one third is vascularized so a tear here will likely heal well. The inner one third is not vascularized so a tear here will require surgery.
80
Your pt is a 14 year old male who is being treated for a non-surgical medial meniscal tear. What would his initial treatment plan look like
1. Refer for surgery
2. HEP focusing on deep squats and pivoting to maintain available ROM and strength
3. Utilize modalities and light mobility-based exercise
4. Immobilize knee for 4 weeks before starting functional strengthening program.
3. Utilize modalities and light mobility-based exercise
patients should avoid deep squats or pivoting on the affected knee.
81
What would be the expected MOI of a medial meniscus tear
pivoting on a planted foot, stepping into a hole in the ground, hyperextension, traumatic lateral blows.
82
What movements do ribs 1-6 make during inspiration
anterior and superior roll with inferior glide
83
What movements do ribs 1-6 make during expiration
posterior and inferior roll with superior glide
83
Your pt is having difficulty with inhalation, you decide to perform (inferior/superior) glides
inferior
HINT-
Inferior Improve Inhalation
Superior glides Improve Exhalation
83
Your pt is having difficulty with exhalation, you decide to perform (inferior/superior) glides
superior
HINT-
Inferior Improve Inhalation
Superior glides Improve Exhalation
84
What is the innervation of the diaphragm
phrenic nerve
85
What is the innervation of the scalenes
ventral rami of spinal roots
86
What is the innervation of the intercostals Externi
Intercostal nerves
87
Which set of muscles work to increase intrathoracic volume during inspiration
1. Scalenes and Intercostales Externi
or
2. Abdominals and Intercostals Interni
1. Scalenes and Intercostales Externi
88
Which set of muscles work to decrease intrathoracic volume during expiration
1. Scalenes and Intercostales Externi
or
2. Abdominals and Intercostals Interni
2. Abdominals and Intercostals Interni
89
What is the innervation of the abdominals
Intercostal nerves
90
What is the innervation of the Intercostales Interni
Intercostal nerves
91
What imaging technique does the NPTE refer to as the best initial study for musculoskeletal disorders
x-ray
92
True or False:
MRI does not use radiation
True
93
Where should the plumb line fall in relation to the following joints
alanto-occipital
cervical
thoracic
lumbar
SI joint
hip
knee
ankle
anterior to alanto- occipital
posterior cervical
anterior thoracic
posterior lumbar
anterior SI joint
posterior hip
anterior to knee
anterior ankle
94
You notice your patient with a transtibial prosthetic is demonstrating excessive knee extension during initial contact to loading response. Where is he more likely to feel pain.
1. Posterior distal stump
2. Medial distal stump
3. Lateral distal stump
4. Anterior distal stump
anterior distal stump
95
You notice your patient with a transtibial prosthetic is demonstrating excessive knee extension during initial contact to loading response. What are two likely prosthetic causes of this
too soft cushioned heel forcing the foot to pf too quickly
posteriorly displaced socket or anteriorly set foot
96
You notice your patient with a transtibial prosthetic is demonstrating knee instability during initial contact to loading response with the knee buckling into flexion. What are two prosthetic causes of this
1. too hard cushioned heel not allowing for adequate pf
2. anteriorly displaced socket or posteriorly displaced prosthetic foot
97
You notice your patient with a transtibial prosthetic is demonstrating wide based gait during midstance. Where is he more likely to feel pain.
pain at the proximal lateral brim of socket and medial distal end of stump
97
You notice your patient with a transtibial prosthetic is demonstrating wide based gait during midstance. What are two likely prosthetic causes of this
1. outset foot, the foot is placed too far laterally
2. medially leaning pylon - the top will be leaning medially causing lack of medial support
