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My Library > Musculoskeletal Injuries 2- midterm > Flashcards

Musculoskeletal Injuries 2- midterm Flashcards

1
Q

what is the lower quadrant scan?

A

a scanning examination is used to determine if we are dealing with a lower quadrant problem or spinal injury

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2
Q

what does soap stand for?

A

subjective
objective
analysis
plan

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3
Q

give an example of special question regarding safety

A

general health

medications

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4
Q

what are the spinal cord signs and symptoms (3)

A
  1. blow and bladder dysfunction
  2. bilateral or quadrilateral paresthesia
  3. hyper-reflexia below level of lesion
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5
Q

Approx at what level does the spinal cord end?

A

L1-L2

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6
Q

what is considered the horses tail?

A

cauda equina

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7
Q

what are cauda equina signs and symptoms?

A
  1. saddle area anesthesia (insensitive to pain)
  2. bowl and bladder dysfunction
  3. hypo-reflexia or a-reflexia
  4. positive dural signs
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8
Q

when do you test for end feel?

A

if the client has gone through active ROM with no pain

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9
Q

what is an end feel?

A

different sensations are imparted to the hand at the extremes of range, this sensation is defined as the end feel

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10
Q

what are the 6 types of end feel?

A
  1. bone to bone end feel
  2. spasm end feel
  3. capsular end feel
  4. springy block end feel
  5. soft tissue approximation end feel
  6. empty end feel
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11
Q

what is bone to bone end feel?

A

an abrupt halt to the movement when tow hard surfaces hit

ex. elbow extension

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12
Q

what is spasm end feel?

A

a sudden stop or the sensation of vibrant twang (elastic) to passive movement
often accompanied by pain
a protective mechanism the body uses to prevent further injury

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13
Q

what is capsular end feel?

A

a sensation like a thick piece of leather is being stretched

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14
Q

what is springy block end feel?

A

a rebound sensation is felt

indicates internal articular displacement or internal derangement by me present

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15
Q

what is soft tissue approximation end feel?

A

joint cannot be pushed any further because one part of the body hits another.
ex. elbow flexion (biceps)

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16
Q

what is empty end feel?

A

movement causes considerable pain before the extreme of the range is reached
indicates a very serious pathology, acute bursitis or a symptom magnifier

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17
Q

what is the squat test used to clear?

A

quick clearing test for the lower extremities

if positive it may suggest it is not a spinal problem and peripheral joint assessment is the next step

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18
Q

what level does the knee jerk reflex test?

A

L3-L4

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19
Q

what level does the Achilles tendon reflex test?

A

S1-S2

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20
Q

what is a dermatome?

A

an area of skin supplied by a single nerve root

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21
Q

how do you test for altered nerve conduction?

A

by assessing pain, temperature or light touch over the area of the skin

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22
Q

what is a myotome?

A

a muscle group that is predominantly supplies by a single spinal nerve

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23
Q

how do you test myotomes?

A

test for fatigue, strength and endurance in the particular muscle group

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24
Q

myotomes- what level would you test hip flexion and what muscle

A

L1-L2

iliopsoas

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25
Q

myotomes- what level would you test knee extension and what muscle

A

L3

Quadriceps femoris

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26
Q

myotomes- what level would you test for ankle dorsiflexion and what muscle?

A

L4

Tibialis anterior

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27
Q

myotomes- what level would you test for extension of D1 (big toe) and what muslce

A

L5

extensor hallucis longus

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28
Q

myotomes- what level would you test for ankle plantar flexion & ankle eversion and what muscle?

A

S1 -plantar flexion
gastrocnemius
S1- Ankle eversion
Peroneii

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29
Q

myotomes- what level would you test with knee flexion and muscle?

A

S2

hamstrings

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30
Q

what is the clonus test?

A

the rthythmic and rapid alternating contraction and relaxation of a muscle brought on by a sudden passive tendon stretching

  • can be tested on ankle wrist or patella
  • positive test suggest an upper motor neuron lesion
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31
Q

what is the babinski test?

A

the skin on the sole of the foot is slowly stroked along the lateral border of the heel towards to the big to

  • positive test toes spreading
  • positive test indicates a disorder of motor pathways of brain and spinal cord
  • exception of children 2 years and younger
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32
Q

what is dura?

A

a thick membrane that is the outermost of the three layers of the meninges that surround the brain and spinal cord

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33
Q

what are two dura tests?

A

straight leg raise

femoral nerve stretch

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34
Q

what is the straight leg rasie testing for?

A

integrity of the dura of the sciatic nerve and various branches

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35
Q

what is the degree range for a postive straight leg raise test?

A

35-70 degrees if pain is felt within this range

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36
Q

what does the patient usually complain of when we use the straight leg raise

A

posterior leg pain

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37
Q

how do you perform the femoral nerve stretch?

A

passively flex the patients knee looking for pain or onset of symptoms

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38
Q

what is the femoral nervse stretch also known as?

A

prone knee bend

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39
Q

what level is the lumbosacral plexus?

A

L2-L4

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40
Q

what do patients typically complain of when we decide to use the femoral nerve stretch

A

anterior thigh pain

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41
Q

what are the two components of the vertebral disc

A 
Nucleus pulposus (dics)
Annulus Fibrosus (crisscrossing fibers)
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42
Q

what does VAN stand for?

A

veins
artery
nerves

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43
Q

how prevalent is LBP

A

4/5 people will experience it in their life time

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44
Q

what is the typical age range for people with LBP and what gender is it most common?

A

30-50

equal between men and women

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45
Q

is there an agreed upon LBP definition?

A

no

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46
Q

for LBP how long do symptoms need to be present before it is considered chronic

A

3 months

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47
Q

what are the 5 conditions of the lumbar spine?

A
  1. spondylogenic
  2. neurogenic
  3. vascular
  4. viserogenic
  5. psychogenic
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48
Q

what are the six spondylogenic back pain injuries we dicussed?

A
  1. intervertebral disc derangement
  2. postural syndrome
  3. mechanical
  4. spinal stenosis
  5. spondylolisthesis
  6. fractures
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49
Q

_____ provide a pathway for the nucleus to bulge or herniate

A

fissures

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50
Q

what age group and sex does intervertebral disc derangement(IDD) in the thoracolumbar spine occur in?

A

30-40 males

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51
Q

what is a cause for IDD?

A

lifting, bending or twisting

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52
Q

does the pain with IDD get better or worse throughout the day? what is the pain pattern?

A

subsides the day of injury and worsens the following day

  • pain is worse in the morning
  • pain and paresthesia may be present centrally or peripherally and unilaterally or bilaterally
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53
Q

what is an aggravating factor for IDD

A

sitting, bending, sustained postures, coughing, sneezing and bowl movements

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54
Q

what is an easing factor for IDD

A

standing, supine lying and extension of the lumbar spine

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55
Q

what are some objective assessment findings with IDD

A
  • lumbar spine appears flat or flexed
  • flexion rotation increase pain
  • extension decreases pain
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56
Q

what is the treatment for IDD

A
  • education
  • postural correction
  • rest
  • brace or corset
  • surgery
  • traction/spinal compression
  • pain relieving modalities
  • walking
  • stretching
  • strengthening
  • mods to bio mechanics
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57
Q

what is postural syndrome?

A

over stretching and mechanical deformation of the normal spinal tissue results in postural pain after prolonged static loading

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58
Q

what is the age range and sex for PS

A

under 30 males and females

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59
Q

what would your findings be on objective testing with PS

A

nothing, just visual of poor posture

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60
Q

what is the most common LBP cause

A

mechanical

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61
Q

what is the age and sex for mechanical LBP

A

30+ males?

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62
Q

what are the clinical findings with mechanical LBP

A
  • early morning stiffness
  • intermitten pain
  • pain greatest at the ends of range
  • pain is eased with movement
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63
Q

what are the objective findings with LBP

A
  • no deformities, poor posture may be present
  • decrease active ROM in lumbar spine
  • pain greatest at end of range but eased when moving in the opposite direction
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64
Q

what is the treatment for mechanical LBP

A
  • postural correction
  • stretching exercises to regain mobility
  • joint mobilization
  • education
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65
Q

what is spinal stenosis?

A

a bony narrowing of the spinal canal centrally or in the lateral recesses

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66
Q

what are the clinical presentation for spinal stenosis?

A
  • primary complaint is vague an intense bilateral LEG PAIN
  • client is comfortable at rest in a flexed position
  • walking increases leg symptoms and must stop to bend over or sit
  • extension increases their leg pain
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67
Q

what LBP condition do people only compain about leg symptoms about?

A

spinal stenosis

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68
Q

what is the treatment for spinal stenosis

A
  • postural correction
  • traction
  • cycling
  • flexion type exercises
  • education
  • surgery decompression
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69
Q

what is spondylolisthesis

A

forward slip one vertebra on the adjacent vertebra due to insufficiency of the facets, neutral arch or structural weakening of the bone

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70
Q

what are the clinical findings for spondyloisthesis

A
  • low back pain that radiate to butt and legs bilaterally
  • depending on grade my present with neurological symptoms
  • pain increases with lumbar extension
  • pain decreased with lumbar flexion
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71
Q

what are the objective assessment findings for spondyloistheis

A
  • visible and palpable step deformity
  • may see an abdominal crease anterior
  • pain with resisted hip flexion
  • pain with accessory glide over the painful segment
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72
Q

what is the treatment for spondylolistheis

A
  • stabilization exercises
  • posture correction
  • joint mobilization
  • stretching
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73
Q

what is a wedged compression fracture of the vertebral body

A

-fracture of the thoracolumbar spine
-severe flexion force crushes the anterior aspect of the vertebral body
posterior facets may be misaligned

74
Q

does wedging get better with time?

A

no it does not go away

ex. hump back grandma

75
Q

what is neurogenic pain?

A

nerve is the source of pain

76
Q

what is the clinical presentation for neurogenic pain?

A
  • severe sharp electric pain
  • deep burning pain
  • peristsent numbness, tingling or weakness
  • travels along nerve into arm or leg
77
Q

what is a common cause for neurogenic back pain

A

spinal cord tumor: Nurofibroma (fibruous tissue) or Lipoma (fat tissue)

78
Q

what is a common complaint for neurogenic back pain?

A

clients report they have to get out of bed and walk around at night to relieve pain

79
Q

what is abdominal aortic aneurysm

A

weakening of the atrial wall causing the artery to expand and left untreated to rupture

80
Q

what are the clinical presentation for abdominal aortic anuerysm

A
  • boring and deep seating pain in the groin/flank
  • feel a pulsating mass in abdomen
  • pain is affected by activity
  • minimal objective findings related to the pain
  • testicular pain often proceeds rupture
81
Q

what are the pain sites with abdominal aortic aneurysm

A

pain back

groin pain

82
Q

what is intermittent claudication

A

insufficiency of the superior gluteal artery

83
Q

what are the clinical presentations for intermiotten claudication

A
  • bilateral pain
  • increase pain with walking
  • pain decreases standing still
  • pain is unchanged in all spinal positions
  • no burning or numbness
  • decreased pulse is extremities
  • cold, numb, dry skin
  • poor hair and nail growth
84
Q

what is the population that is most affected by intermittent claudication

A

40-60 years

male and female

85
Q

what is viserogenic back pain?

A

diseases of the pelvic region organs

86
Q

what are the clinical presentation for viscerogenic back pain?

A
  • activity does not alter pain
  • rest does not relieve pain
  • other symptoms may include nausea, vomiting fever, bladder dysfunction, vaginal discharge, unexplained weight lose and bleeding
87
Q

how much of a tissue needs to be consumed by a tumor before it shows up on an xray

A

40%

88
Q

what is psyhcogenic pain?

A

pain that is due to central sensitization “all in your head”

89
Q

what are the clinical presentation for psychogenic?

A
  • orginal pain spreads
  • mirror pain on the opposite side
  • often reports sudden stabs of pain
  • pain has a mind of its own
  • unpredictable response to input and treatment
  • all movements hurt
  • associated with depression and anxiety
90
Q

what type of patients get labeled as irritable and unstable

A

pyshcogenic patients

91
Q

what is the treatment for psychogenic back pain

A
  • multiply number of professionals (physio, psychologist..)
  • counselling
  • education
92
Q

what are some other condsiderations when dealing with LBP

A
  • diet modifications/weight lose
  • positive attitude
  • meditate
  • dietary supplements
  • maintain cardiovascular fitness
  • maintain flexibility
  • seek medical attention of problems occur or questions arise
93
Q

What thoracic spine region is generally through a watershed area

A

T4-T9

94
Q

severe bilateral nerve root pain in the elderly could be caused by?

A

neoplasm

95
Q

what would wedging be caused by?

A

osteoporotic, neoplastic r traumatic fracture

96
Q

what could the onset of offset of pain related to general activity or tress

A

cardiac

97
Q

what could the onset of offset of pain unrelated to trunk movements

A

ankylosing spondylities and visceral

98
Q

what could the decreased active contralateral side flexion painful with both rotations full

A

neoplasm

99
Q

what could cause severe chest wall pain without articular pain

A

visceral

100
Q

what could cause spinal cord signs

A

cord pressure or ischemia

101
Q

what could cause pain onset related to eating or diet

A

visceral

102
Q

what is scoliosis

A

abnormality to the lateral curvature of the spine

103
Q

what is non structural scoliosis?

A
  • no bony deformities
  • non progressive
  • normal spinal flexibility
  • scoliotic curve disappears with forward flexion
104
Q

what spinal region is non structural scoliosis usually present?

A

thoracic

105
Q

what are the five causes of non structural scoliosis

A
  • postural
  • hysterical
  • nerve root irritation
  • inflammatory
  • compensatory
106
Q

what is structural scoliosis

A
  • scoliotic curve lacks normal flexibility
  • may be progressive
  • curve does not disappear with forward flexion
107
Q

what are the causes of structural scoliosis

A
  • idiopathic
  • congenital
  • neuromuscular
  • neurofibromatosis
  • trauma
  • infection
  • tumors
  • inflammatory
108
Q

what is the treatment for scoliosis

A
  • bracing
  • surgery
  • exercise
  • neuromuscular electrial stimulation
109
Q

what is dowagers hump?

A

assoicated with post menopausal osteporosis (exaggerated kyphosis)

110
Q

what is hump back/Gibbus

A

assoicated with a wedge fracture of the thoracic spine or with schenurmann’s disease (exaggerated kyphosis)

111
Q

what is a thoracic spine disc derangement

A
  • Tears occur in the inner and outer annulus
  • Fissures provide a pathway for the nucleus to bulge
  • usually due to flexion and rotational injury
112
Q

what are the clinical presentations for thoracic disc derangement

A
  • sever arching, burning or shooting pain in posterior anterior aspect of the thorax
  • may be admitted to hospital due to suspect of cardiac involvement
  • all movments are limited and painful
  • due to small size of the spinal cord, may present with spinal cord signs
  • positive compression and sural testing
  • pain eased with traction
  • muscle spasms when accessory glides over the spinous prpcresses of thoracic spine
113
Q

what are the aggravating factors for thoracic disc derangement

A 
movement
prolonged flexion
deep breathing
coughing
sitting or lying in extension
114
Q

what is the treatment for thoracic spinal dis derangement

A
  • medical clearance for spinal cord compression

- treat as per lumbar spine(after ruling our cardiac issues)

115
Q

where is it most common in the thoracic spine is get a vertebral fracture or dislocation

A

T12-L1

116
Q

what is a rib fracture

A
  • usually involve a traumatic event

- presents with crepitus and pain with breathing

117
Q

what is teh treatment for a rib fracture

A

rest

118
Q

what is costochnodritis

A
  • local inflammation of the costochondral junctions anteriorly
  • presents as hot and swollen joint on the anterior aspect of thorax
119
Q

what is contortionists called when more ribs are involved?

A

tietz’e syndrome

120
Q

what is the treatment for costochondritis

A

local modalties for pain relief

121
Q

what is a barrel chest

A
  • sternum projects forward and upward with increased anterior to posterior diameter
  • associated with chronic obstructive pulmonary diseases such as emphysema
122
Q

what is pectus excavatum

A
  • also known as funnel chested
  • sternum pushed posterior by the ribs
  • resuls in altered inspiratory pattern
  • associated with a increased kyphosis
123
Q

what is herpes zoster also known as

A

shingles

124
Q

what is herpes zoster

A

-an acute viral infection that lives in the sensory never bodies and at times of stress or illness travels to the skin and attaches to its resulting in scores on the skin and pain

125
Q

what is scheurmanns disease

A

osteochondrosis of the anterior intervertebral ring epiphyses

126
Q

what is scheurmanns disease also known as

A

vertebral epipyitis or adolescent kyphosis or round back

127
Q

what population is most susceptible to scheurmanns disease

A

females

10-16years old

128
Q

what is teh treatment for scheurmanns disease

A

postural correction
education
extension exercises
surgery

129
Q

what is the upper quadrant scan

A

scanning examination to determine if a person symptoms are of a spinal origin in the cervical spine or in the periphery

130
Q

what are the 5 d’s

A 
Dizziness
Diplopia
Drop attacks
Dysarthria 
Dysphagia
131
Q

what is dysarthria

A

troubles speaking

132
Q

what is dysphagia

A

difficulty swallowing

133
Q

what do the 5 D’s detect for

A

vertebral artery signs

134
Q

what nerve interbates the biceps

A

C5-6

135
Q

what nerve intervates the brachioradialis

A

C6

136
Q

what nerve inervates the triceps

A

C7

137
Q

what cervical vertebra has two nerves come out of it?

A

C7

138
Q

what are myotomes

A

a muscle group of muscles that is predominantly supplied by a single spinal nerve

139
Q

what do myptomes test?

A

for fatigue and altered nerve conduction by testing strength and endurance

140
Q

what is the only true myotome

A

C1

141
Q

myotomes C1-C2

A

neck flexion

142
Q

Myotome C3

A

NECK SIDE FLEXION

143
Q

Myotome C4

A

shoudler elevation

144
Q

Myotome C5

A

shoulder abduction

145
Q

Myotome C6

A

elblow flexion and wrist extension

146
Q

Myotome C7

A

elbow extension and wrist flexion

147
Q

Myotome T1

A

Finger abduction and adduction

148
Q

what levels of the cervical spine do we not test if the person it sitting breathing and talking

A

C1-C4

149
Q

what are dermaomes

A

an area of skin supplied by a sngle nerve root

150
Q

what is the test for sesnstaion such as temperature

A

deramtomes

151
Q

what is similar test to the straight leg rasie

A

slump test

152
Q

what is the accessory movements of the cervical spine

A

joint mobilization techniques used to identify the level of involvement in the cervical spine

153
Q

what is teh vertabral artery test

A

patients head taken into extension and rotation held for 30 seconds
looking for 5 D’s

154
Q

what is whiplash assicated disorder

A
  • the head and neck moves into extension in relation to the shoulders
  • followed by flexion
  • the brain is forced against the skull
155
Q

can whiplash cause jaw problems?

A

yes, when the head goes back the jaw opens stretching the musculature of the temporomandiulbur joint and the disc

156
Q

during the extension phase of whiplash what happens the the facet joints

A

compression resulting in damage ti the joint surface, capsule and ligaments

157
Q

what happens the to the anterior structurs of teh throat during whiplash

A

a strecth to all the structures such as esophagus can hemmorhage

158
Q

during the flexion stage of whiplash what happens to the vertebral bodies?

A

compression, may cause disc damages or a compressive fracture

159
Q

what are the clinical presnetations for whiplash

A
  • pain in neck,shoulders and inter scapular regions
  • headache
  • blurred vision
  • tinnitus(ringing in ear)
  • dizziness
  • numbness in upper extremities
  • dysphagia
  • facial anteriolateral throat and retro orbital pain
  • compulsive clearing of throat
  • depression and feels of fatigue
  • irrtability and insommia
160
Q

what is horner syndorme

A

a sinking in the eyeball, drooping of the upper eyelid, constriction of the pupil, lack of sweat production and facial flushing of the skin

161
Q

how many grades of whiplash are there

A

4

162
Q

what is grade 1 whiplash

A

complains of pain, stiffness and tenderness only. no physical signs of upper quad scan all came back negative

163
Q

what is grade 2 whiplash

A

complains of pain and musculoskeletal signs present including decreased ROM and point tenderness (nerves not involved)

164
Q

what is grade 3 whiplash

A

Complains of pain and neurological signs present including decreased or absent deep tendon reflexes,weakness and sensory deficits

165
Q

what is grade 4 whiplash

A

complains of pain and fracture or dislocation presnet

166
Q

what is the treatment for whiplash

A
  • RICE
  • NSAIDS
  • soft cervical collar
  • non weight bearing exercises initially and pressing to weight bearing exercises working in mid range
  • gentle isometric strengthening exercise
  • electrical modailities such as TENS
  • joint mobilization and manipulation
  • progress into stabilization exercises and end of range stretching exercises cautiously
  • ergonomic modifications
167
Q

what is acute torticollis

A
  • sudden onset of neck pain and stiffness upon awakening
  • may also be caused by a sudden rotation of the cervical spine
  • subluxation of the facet or uncinated process
168
Q

what level does acute torticollis usually occur at

A

C2-C3

169
Q

what is teh treatment for Acute toticollis

A
  • manual traction of the cervical spine
  • joint mobilization
  • soft collar
170
Q

what is acute torticollis called in children (ages 5-7)

A

Grisels syndrome

171
Q

what is teh treatment for Grisels

A

NO TRACTION

antibiotics

172
Q

what is the most common level for cervical disc derangement

A

C5-C7

173
Q

what is cervical spine and spinal stenosiss

A

stenosis due to disc prolapse is very uncommon but is more commonly caused by degeneration of the uncovertebral joint and due to the small size of the lateral foramen

174
Q

what is the symptom for cervical spinal spinal stenosis

A
  • NO NECK PAIN

- ARM PAIN

175
Q

what are the clinical presentaions for cervical spinal stenosis

A
  • segmental paraesthesia pain
  • age greater than 45
  • compression in extension aggravates symptoms
  • traction relieves symptoms
  • x-rays confirm clinical findings
176
Q

where is spondylothesis most common

A

-common at L5-S1

177
Q

what age group is most common for spondylothesis

A

-under 30

178
Q

what may be the cause for viscerogenic back pain

A

-tumors

179
Q

what is neoplasm

A

a new and abnormal growth of tissue in some part of the body, especially as a characteristic of cancer

180
Q

what region is disc derangement most rare? and why

A

-extremely rare in the thoracic spine due to the thick posterior longitudinal ligament and ribs

181
Q

What age group is mostly affected by thoracic spinal disc derangement

A
  • most common in 40s

- more common in males

182
Q

what level on the thoracic spine is disc derangment most common?

A

-most common levels affect are between T6-T10

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