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NeuroMSK Flashcards

1
Q

Contusion:

  • Rx:
  • complications
A

Rx: 1st 48hrs:

  • PRICE, no harm (heat, alcohol, running, massage)
  • put mm on as much stretch as possible (prevent healing in short ROM)
  • Crutches if necessary
  • pain free ROM/ stretch
  • progress exercises after acute phase

Complications:

  • compartment syndrome: check capillary refill + sensation, mm strength
  • myositis ossificans: suspect if no improvement in 2-3 weeks
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2
Q

Strains and tears:

  • where and when?
  • grades
  • Rx phases
A

Majority in bi-articular mm at mm tendon junction during eccentric loading
Ax: A/PROM, strength, length, stability, special tests

Grade:
1= micro tearing, pain/ no weakness
2= macro tearing, pain + structural changes (laxity, dec strength)
3= complete: painless + weak, may see lump

Rx:

  • Acute/inflammation: PRICE
  • Repair: Strength, stretching, modalities, DTF
  • Remodelling: Strength (inc load and velocity), stretch, stability
  • RTP: symmetrical mm length, strength, power, core control, sport specific RTP program.
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3
Q

DOMS

  • pathology
  • Rx
A

Possibly due to local nerve endings response to altered pH, swelling, inflammation)

Rx: light activity, massage, avoid anti-inflammatories,

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4
Q

Pelvic floor dysfunction:

  • nerve
  • how to ax
A
  • Pudendal nerve: S2,3,4 off sacral plexus
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5
Q

Chronic pelvic pain:

  • causes?
  • Rx goals
A

Causes: msk, neuro, gynaecological, urogenital

Rx:
- decrease PF resting tone
- Increase PF proprioception
- increase PF motor control
- decrease pain sensitization
-
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6
Q

Pelvic girdle pain:

  • pregnancy and pathology
  • s/s
  • signs
A

50% pregnancies = weakness/laxity of PFM during pregnancy and childbirth

S/s:
- pelvic, groin, thigh, abdomen pain with sustained posture and transitional movements

Signs:

  • Posture: locked knees, Lumbar lordosis, thoracic kyphosis, FHP
  • Asymmetry: standing and supine
  • gait: shuffling, waddling, leg drag
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7
Q

Pelvic girdle pain:

  • Ax
  • Rx
A

Ax:

  • ASLR with force and form closure
  • hip quadrant (IR/ER)
  • SI joint stability (P4, ganslens, FABER, long dorsal lig palpation
  • TOP spinous processes, Piriformis
  • resisted hip ADD/ abd

Rx:

  • Education
  • Posture: standing: soft knee, equal weight, sitting: knees at hip heigh or lower, sleeping: pillows to maintain neutral
  • Manual Therapy:
  • exercise: PFM (endurance w/ functional activities), maintenance = 8-12 contractions, 2x/week
  • movment strategies:
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8
Q

Syndesmotic ankle sprain

  • MOI
  • ligaments affected
A

MOI: planted foot + IR of leg = ER of mortise OR/ hyperDF or hyperPF

Ligs affected:
commonly: ATFL, PTFL, interosseous
+ others,#, bone bruise / OA

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9
Q

High ankle sprain:

  • Dx
  • Rx
A

Dx:
- PROM foot ER stress test, squeeze test, fibular PA translation, squat test, heel thump, SL hop test
Rx:
1) protection phase (2 weeks): PRICE, decrease inflammation, modalities for edema, NWB with crutches
2) Management phase: joint mobs, regain ROM, strength & fxn, PWB , bilateral stance training
3) Management: increase fxn; unilateral balance + strength
4) RTP: 2x as long as regular ankle sprains. Cutting, jumping etc

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10
Q

Muscle injury and repair:

- phases of healing

A

1) Inflammation: 24hrs- 4 days after
- myofibres rupture and necrosis
- Hematomas
- inflammatory cell reaction
2) Repair: 5days- 2 weeks
- phagocytosis of necrotic fibres
- regeneration of myofibres
- formation of scar tissue
- capillary in growth
3) remodelling: 14 days +
- maturation of myofibres
- contraction and organization of scar tissue
- recovery of function

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11
Q

Tendon:

  • composed of?
  • loading response?
A

Composed of:
- Tenocytes (crave mechanical load) + collagen, glucosaminoglycan (Extracellular matrix)

Loading response:
- increased collagen synthesis, cellular proliferation, alignment

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12
Q

Tendonopathy:

  • defined
  • do and don’t see?
  • Rx
A

Chronic micro trauma causing loss of collagen organization

  • no inflammation
    Do see: collagen disorganization, glucosaminoglycan, variable Tenocyte density, increase vasularity.

Rx: proper loading

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13
Q

Achilles Tendinopathy

  • Risk factors
  • s/s
A

Risk factors: age, BMI, Male, running, foot wear, pronation, decrease DF, decrease LE strength, tight/weak calf mm

s/s:
- thickened tendon, TOP

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14
Q

Achilles tendinopathy

- DDX

A

DDX:

  • Achilles’ tendon partial rupture
  • Sever’s disease (peds):
  • ->inflamed calcaneal apophysis causing pulling on tendon at insertion. Effects growing active children. Rx = activity modification, gentle exercises
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15
Q

Achilles tendinopathy

- Rx:

A

NSAID if acute

  • alter contributing factors ( pronation, mm imbalances, myofacial restrictions, core
  • Progressive exercise program: eccentric loading is necessary
  • orthotics, heel lifts
  • stretching, manual therapy
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16
Q

De Quervain’s Tenosynovitis:

  • defined
  • mm OIF
A
  • Tendinosis of sheath/tunnel surrounding Extensor Pillicis Brevis + abductor pollicis longus.

EPB:

  • O: post lower 1/3 of radius
  • I: base of proximal thumb phalanx
  • F: extension + abduction of thumb

Abd PL:

  • O: ulna, radius, interosseous membrane
  • I: base of 1st metacarpal
  • F: abduct thumb
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17
Q

De Quervain’s synovitis:
- s/s:
-

A

S/s: chronic pain, tendon thickening, worse with repetitive hand/wrist movements

Ax:
- Finkelstein test: tuck thumb in fist, ulnar wrist deviation, +ve if pain along distal radius

Rx:

  • acute = offload tissue, PRICE, education
  • chronic = corticosteroid injections (50% success)
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18
Q

Lateral elbow pain:

  • mm involved OIF
  • s/s
A

ECRB:

  • O: lateral epicondyle
  • I: base of 2nd metacarpal
  • F: ext/ abduction of hand
  • N: deep branch of radial

(10%) Common extensor tendon + ECRL:

  • O: Lat supracondylar ridge
  • I: 2nd metacarpal base (radial side)
  • F: ext + Abd hand
  • N: radial
  • symp: with wrist/finger extension & gripping

S/s: gripping/ repetitive reaching and grasp, typing/ overload

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19
Q

Tennis elbow:

  • Ax:
  • DDx
A

Ax:

  • resisted 3rd finger PIP extension (maudsley’s test)
  • resisted active wirst extension + radial deviation
  • passive pronation wrist flexion + elbow extension
  • TOP, pain over lateral epicondyle
  • No nerve s/s: check radial ULTT

DDx:
- Cspine referred (C5-7), shoulder referred, nerve entrapment, bursitis of radio-humeral), LCL sprain, proximal radio-ulna joint issue

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20
Q

Tennis elbow

- Rx

A

Acute:
- PRICE, modalities (US, TENS), ROM, offload tissue, education (avoid NSAIDS, rest)
Repair Phase:
- gentle stressing of collagen: DTFM, stretching, eccentrics, manual therapy,

Outcome measure:
- pain free grip w/ handheld dynamometer

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21
Q

Rotator cuff tendonopathy:

  • structures at fault
  • types of impingement: + risk factors
A
  • long head of biceps + supraspinatus (impingement)

Types:
1st impingement: narrowed subacromial space (older pt)
- anatomical abnormalities, degenerative changes, mm imbalances, postural faults
2nd impingement: instability ( instability –> subluxation of humeral head –> impingement
- overhead sports cause trauma of stabilizers
- anterior capsule laxity + posterior capsule tight = anterior humeral head sublux

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22
Q

Rotator cuff tendinopathy:

  • s/s
  • ax
  • Rx
A

S/s:
- pain with overhead activity, penetrative motion, longstanding

Ax: neers, speeds, empty can

Rx:

  • correct biomechanical faults, mm imbalances
  • modalities, DTFM, manual therapy, education
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23
Q

Patellar tendinopathy:

-

A

” jumpers knee”

Risk factors:
- male, jumping athlete, jump height, reduced DF, age, BMI

Rx: slow heavy loads (concentric and eccentric), mm imbalance, avoid knee valgus

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24
Q

Fasciitis/ myofascial restriction:

Pain syndrome s/s + Rx

A

TOP (trigger point)
- onset from sudden overload, over-stretching, repetitive strain,

Rx:

  • IMS
  • flexibility, ROM
  • Soft tissue massage
  • manual therapy
  • modalities
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25
Q

Loose body:

  • defined
  • s/s
  • Ax
A

Free floating piece of bone or cartilage often from OA or chip fracture

s/s
- locking/ catching
Ax:
- ROM end feel as a bony block or “springy”

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26
Q

Hypermobility:
- defined + features

Instability:
- defined

A

Excessive laxity or length of tissue
- increase ROM/ neutral zone (osteoligamentous structures provide minimal support)

Instability:

  • excessive ROM of arthrokinematics or osteokinematics
  • no mm control, (form vs. Force closure)

Causes:
- trauma vs non trauma ( genetic, adjacent hypo mobility, habitual movements

Rx:

  • mobilize a stiff joint/ tissue ( IMS, manual, massage, stretch)
  • strengthen to. Stabilize hyper-mobile segment
  • movement retraining, tape and braces
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27
Q

Lysis vs. Listhesis of spine

A
  • Lysis = pars #

- Listhesis = # or slip of cranial vertebrae anteriorly

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28
Q

Spondylosis

- defined

A

OA of spine = degeneration of joints

  • can lead to stenosis or disc herniation
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29
Q

Spondylolysis:

  • defined
  • population at risk
A
  • Pars interarticularis (fibrous tissue) defect = degeneration

Seen in younger ppl with hyperEXT and rotation sports

  • most are assymptomatic
  • if bilateral it may lead to spondylolithesis
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30
Q

Spondylolithesis:

  • defined
  • common location
  • MOI
  • types
  • grades
A

Slippage of one vertebrae on another
- common L5/S1
MOI: hyper extension, in young athlete

Types:

  • Spondyloytic spondylolistesis: progressive period of rapid growth, rarely progressive to adult life, younger population
  • Degeneration spondylolistesis: 2nd to DJD + Z-joint subluxation = OA of joints in spine, foramina narrowing, older population

Grades: 1-4: 25% of each grade of slippage

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31
Q

Spondylolisthesis:

  • s/s
  • Rx
  • when to get surgery
A

S/s:

  • Central LBP +/- referred pain
  • aggravating factors = extension
  • easing factors = flexion

Rx: stability

  • Flexion exercises
  • inner unit exercise = DNF + TA/multifidus/ PF
  • brace if appropriate

Surgery:

  • increased instability or slippage
  • hard neuro signs
  • evidence of SC involvement
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32
Q

Hypomobility:

  • MOI
  • structures
  • Contributing factors
A

MOI: adaptive shortening of soft tissue, inappropriate end feel

Structural:

  • muscle: atrophy and weakness
  • tendon: decrease tensile strength
  • ligament: decrease tensile strength + increase stiffness/adhesions
  • cartilage: decrease synovial fluid, H2O content
  • Bones: increase resorption, decrease done mass/mineral content

Countributing factors:

  • prolong immobilization, postural dysfunction,
  • sedentary lifestyle/ aging
  • paralysis/ tone abnormalities
  • mm imbalances
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33
Q

Capsular patterns of loss:

  • spine
  • GH
  • AC
  • Humeral ulnar
  • Humeral radial
  • proximal radioulnar
  • distal radioulnar
A
  • GH: ER >Abd> IR
  • AC: pain at extreme ROM
  • Humeral ulnar: Flex > ext
  • Humeral radial: Flex>ext>sup>Pronation
  • proximal radioulnar: sup = pron
  • distal radioulnar: Pain at extreme end range
34
Q

Capsular pattern:

  • Radiocarpal
  • 1st MCP
  • MCP 2-5th
  • IP’s
A
  • Radiocarpal: flex = extn
  • 1st MCP: flex > extn
  • MCP 2-5th: Flex > extn
  • IP’s: Flex > extn
35
Q

Capsular pattern:

  • hip
  • knee
  • Talocrural
  • Subtalar
  • 1st MTP
  • MTP 2-5
  • IP’s
A
  • Hip: Flex> Abd> IR ( order may vary)
  • Flex> extension
  • Talocrural: DF>PF
  • Subtalar: Inversion>Eversion
  • 1st MTP: Ext> flexion
  • MTP 2-5: variable
  • IP: Flex> Extn
36
Q

Dislocations:

  • s/s
  • Instability tests
  • complications
A

Usually the result of instability
- s/s: increase ROM, soft endfeel, +/- pain

Instability tests:

  • Scapula: wall push up
  • Ant GH: anterior apprehension, relocation test (push GH head posteriorly)
  • Post GH: posterior apprehension
  • Inferior GH: sulcus sign

Complications:

  • Rotator cuff tears
  • Axillary nerve damage: teres minor/ deltoid mm + sensation loss
37
Q

Dislocations:

- Types: MOI, population, related lesions/complication

A

TUBS: traumatic onset, unidirectional anterior, bankart lesion, surgery

  • MOI = Abd/ER in young males (high reoccurrence)
  • Lesions
  • -> Bankart: avulsion # of ant/inferior capsule + ligaments (s/s = clicking, apprehension, deep vague pain)
  • -> SLAP: Superior Labrum lesion ant-post ( ++ pain for pitchers, elevated position w/ sudden concentric + eccentric bicep contraction
  • -> Hill-Sachs: compression # of post/lateral humeral head
  • -> # dislocation: usually acromion or humeral head ( s/s deformity, constant pain

AMBRI: Atraumatic, multidirectional, bilateral shoulder findings, Rehab appropriate, Inferior capsule shift

38
Q

Subluxation of AC joint:

  • position of sublux
  • supporting ligaments
  • s/s
A
  • clavicle = posterior/superior translation on acromion
  • joint stabilized by Trapezoid + conoid ligs
  • s/s = step deformity, referral from shoulder, RA, multiple myeloma, osteolysis ( bone resorption d/t repetitive micro trauma, leads to vascular comprimize + nervous system dysfunction + #’s)
39
Q

Growth plate closure times

  • Femur
  • Tibia
  • humerus
  • redius
A

Femur: prox = 18, distal = 20
Tibia: prox = 16-18, distal = 15-17
Humerus: prox = 20, distal = 16
Radius: prox = 18, distal = 20

  • Epiphysis = end of long bone
  • Diaphysis = shaft of long bone
40
Q

Fractures:

  • MOI of pathological #’s
  • types of #’s
A

Pathological #’s = OP, Metastatic, infection, osteomalacia

Types:

  • Spiral = twisting injury
  • Transverse = direct blow
  • Compression = longitudinal forces
  • Greenstick = young kids, malleable bones, # on one side only
  • Avulsion = piece of bone pulled off, detachment of soft tissue
41
Q

Fractures:

  • common #’s
  • healing time
  • complications
A

Common #’s:

  • Colles = distal radius + sublux of distal ulna
  • Bennetts = # + dislocation of CMC of thumb
  • Scaphoid = d/t FOOSH

Healing time: kids 4-6, adolescent 6-8, adult 10-18 Rx

Complications:

  • Avascular necrosis: proximal femur, 5th MT, scaphoid, proximal humerus, talus
  • mm weakness, contractures, infection, delayed Union, CRPS,
42
Q

Hip Fractures:

  • locations
  • Rx types
A
  • femoral neck, inter trochanteric, sub-trochanteric
    Rx:
  • conservative = bed rest, slow healing time, slow rehab
  • Surgery =
    Cemented: more stable, good sedentary elderly w/ poor bone quality
    Uncemented: component grow around beads, revision in 10 years
    Hybrid: femoral component = cemented, acetabulum uncemented
43
Q

THR:

- precautions per approach

A

Posterior-lateral (75%)
- no hip flex > 90, no IR, ER, ADD past midline (3 months)
Lateral approach:
- same but allowed to ER
Anterior approach:
- no hip Ext, ER, ADD past midline (3 months)

Typically no restrictions + WBAT for hemiarthroplasty, cannulated screws, DHS, Gamma nails = see MD orders

44
Q

Bone:

  • components
  • Types
  • relationship with load
A

Components:

  • Osteoclasts = bone resorption
  • Osteoblasts = build/form bone

Types:

  • Cortical bone = outside of long bones
  • Cancellous bone = inside bone, more affected by OP

Bones need to be loaded, intensity + duration critical prior to 30

45
Q

Osteoporosis:

  • WHO OP categories
  • OP types
  • Risk factors
A

Categories:

  • Normal = 0.0- 1 SD of young adult mean
  • Low bone mass = 1- 2.5 SD below = Osteopenia
  • Osteoporosis = 2.5 + SD
  • Severe/ established OP = presence of fragility #’s

Types:

  • 1st type 1 = post menopausal women
  • 1st type 2 = 70+ y.o.
  • 2nd OP = d/t another condition

Risk factors: FHx, lifestyle, gender, age, exposure to estrogens breast CA,

46
Q

Osteoporosis:

- Rx

A

Pharmacological: anti resorption agents, bone formation hormones
- side effects = vertigo, dizzy, pain

Nutrition: Ca++, Vit D

PT:
- posture, exercise, balance, extension exercise okay but not flexion/rotation

47
Q

Tumor/pathological #’s

  • s/s
  • types:
A

S/s: sudden weight loss/gain, night pain, sweats, malaise, fatigue

Types:

  • Osteosarcoma: terry fox
  • -> at end of long bones
  • -> pain at joint, worse w/ activity
  • -> moth eaten appearance on X-ray

Synovial sarcoma: in larger joints (knee, ankle), pain at night + w/ activity, swelling + instability. Rx = sugery, chemo, radiation

Malignant tumors: May metastases to bone from breast, lung prostate, kidney

Osteoid Osteoma: Benign bone tumor, pain in bone, at night + w/ activity. Mistaken as #. No pain with aspirin. CT = central focus point, Rx = ablation, ethanol, laser

48
Q

Degenerative Joint disease:

Types:

  • vertebrae
  • joint
  • OA

Rx

A

Vertebral:

  • Spinal Stenosis: decrease IVF space = ++ radicular s/s (dermatome + myotomes)
  • Central Stenosis: ++ spinal canal compression = ++ central s/s ( central cord signs, b/b)
  • Spondylolysis: Pars interarticularis defect, may start as stress #
  • Spondylolisthesis: slippage of superior vertebrae d/t hyperEXT

Joint:
- articular cartilage degeneration (OA) = hypertrophy of subchondral + joint capsule

OA:
- dec joint space, dec cartilage height, ++ osteophyte, ++ subchondral bone sclerosis and proliferation

Rx: joint protection, joint mechanics, pool exercises

49
Q

Plumb line test:

- bony and surface landmarks

A

Ear lobe, shoulder , mid trunk, greater trochanter, anterior to knee and ankle.

50
Q

Scoliosis:

  • types
  • s/s
  • Ax
  • Rx
A

Types:

  • idiopathic: most common (gene identified)
  • Congenital: vertebral deformities
  • Neuromuscular: 2nd to other conditions (CP, spinabifida, injury)

S/s: decreased nerve conduction (myotome, dermatome, reflexes, organs), decrease nerve mobility (slump, SLR)

Ax: forward bend test (rib hump), mm imbalance, dec proprioception

Rx: posture, stretch, strengthen, CV training, brace/ sugery

51
Q

Low back pain + postural dysfunction

  • structures to maintain posture
  • cause of postural back pain
  • S/s
  • Rx
A

Posture obtained by = dynamic (mm) + static stabilizers ( bone, lig, fascia, joint)

Pain caused by tissue creep!

S/s: ++pain w/ sitting or prolonged postures, poor posture/ergonomics, pain not specific to flex or extn, no neuro signs, better in AM but worse during the day, associated with dec fitness

Rx: correct…

  • posture and ergonomics
  • mm imbalances
  • fitness issues
  • education on posture/ rest + activity breaks
52
Q

Low back pain: Disc lesion

  • disc anatomy
  • typical presentation
  • healing time
  • s/s
A

Disc = inner nucleus pulposis + outer annulus fibrosis (pain fibres only in outer annulus)
presents: 25-40, dec mm bulk not able to support disc segment
Healing time = 3 months

S/s: central back pain +/- leg pain

  • +/- lateral shift (named via shoulders)
  • loss of normal lordosis = flat back + loss of mm supporting extension
  • b/b?
53
Q

Low back pain: Disc lesion

  • aggravating and easing factors
  • Rx:
A 
Aggravating = flexion activities, coughing (++ disc pressure)
Easing = Extension

Rx:

  • centralize pain
  • correct shift
  • support lordosis
  • posture education
  • avoid flexion postures w/ time
  • traction (gentle)
  • correct mm imbalance, posture, ergonomics
54
Q

Low back pain: Stenosis

  • causes
  • s/s
  • aggravating / easing factors
  • Rx:
A

” IVF or central canal narrowing”

  • Causes: swelling, disc, osteophyte, bony changes
  • s/s: bilateral radiation, Xray ( bone hypertrophy, DDD, Spurs)
  • Aggravating = extension but eased by flexion

Rx: posture avoidance, mm imbalance (core, hamstrings)

55
Q

Spondylolisthesis:

  • s/s
  • Rx
A

S/s:

  • central low back pain +/- referred pain
  • weak abdominals
  • +/- tight hamstrings

Rx: LE mm imbalance, abdominal strengthen, biomechanical counselling, avoid hyper extension.

56
Q

Osteomyelitis

- defined

A
  • Inflammatory response d/t infection in bone (staph aureus usually)

Population: most common in Male children + immunosuppressed.

  • children = long bones
  • adults = vertebrae, feet (DM consequences)
S/s: 
" suspect in pt has localized swollen joint w/ no trauma --> ER visit!
- prominent night pain
- effusion in/around joint
- weight loss, appetite loss, malaise

Rx:
- antibiotics, surgery if in joint, maintain function

57
Q

Bursitis:

  • cause
  • s/s
  • Rx:
A

Cause: overuse, trauma, gout, infection
S/s: pain w/ rest, dec AROM/PROM

Rx: flexibility, manual therapy, thermal agent

58
Q

Amputation:

- common causes

A
  • DM, PVD
  • trauma
  • congenital deformity
  • tumors
  • infected TKR
59
Q

Effects of amputation at:

  • Toe:
  • partial foot
A

Toe:

  • dec push off power
  • dec balance d/t proprioception + BOS deficits
  • prosthesis: orthoses or filler to prevent migration

Partial foot:

  • lose forefoot lever
  • dec balance
  • increase pressure on remain WB surface
  • prosthesis: molded insole show filler, carbon fibre AFO, complete prosthesis
60
Q

Amputation:

  • ankle
  • Transtibial
A

Ankle:

  • distal tib-fib intact
  • Pros: long lever, bulbous end, better than trans-tib, good fxn
  • cons: high risk of skin breakdown
  • -> prosthesis:

Transtibial:

  • NWB through end
  • some achieve normal gait pattern
  • gait deviations: stance (foot flat, foot slap, knee hyper extn) swing (altered stride length, toe drag, Lat/med whip, vaulting
  • -> prosthesis:
  • socket = total surface or patella tendon bearing
  • suspension = supracondylar, suprapatellar cut, sleeve, locking pin
61
Q

Amputations: PT Education:

  • contractures
  • prosthesis fit
A

Contractures:

  • post-op day 1 = hip/knee flexion > 20 degrees = no prosthetic eligibility
  • typical contractures: TT (knee flex, hip flex), TF (hip flex, hip Abd)

Prosthesis fit:

  • liner = interface b/w socket and limb
  • suspension = system prosthesis on limb
  • liners = gel , sock, foam
  • socks = ensure fit
  • shank, connects socket to foot/ adds height
62
Q

Congenital malformations: Developmental dysplasia of the Hip

  • Defined
  • recovery timeline?
  • Risk factors
  • s/s
  • Ax
  • Rx
A

Abnormality in head of femur or acetabulum shape at birth

  • poor form closure results in subluxation/dislocation
  • spontaneous recovery w/in 1st 2 weeks of life is common

Risk factors: Breech birth,tight swaddling, F>M, FamHx

S/s: hip dislocated, LLD, mm weakness, waddling gait (can lead to hip arthritis)
Ax:
- Barlow maneuver: Flex –>Abd–>ADD w/ posterior pressure
- Ortani maneuver: Flex –> ADD w/ slight traction

Rx: keep hip in Flexion + abduction, use Pavlik harness

63
Q

Developmental abnormalities: Club foot

  • cause
  • types
  • presentation
  • Rx
A

D/T: congenital bone deformity, CP, calf mm contracture

Types:

1) idiopathic: most common, healthy kid but picked up in ute rom intensive rehab
2) Neurogenic: spinabifida, CP
3) Syndromic: Möbius syndrome or arthrogryposis (multiple contractures)
4) Postural: feet squished in Usero, resolves quickly

presentation:
- PF w/ talus in equine + varus, Adduction of forefoot, Inversion + varus of hind foot, small calcaneous, smaller calf

Rx: manipulation, serial casting/ splinting, surgery

64
Q

Osteogenesis Imperfecta:

  • define
  • s/s
  • Rx:
A
  • genetic connective tissue disorder: difficulty converting procollagen into collagen type 1 = Bones are brittle

S/s: joint laxity, mm weakness, long bone bowing, kyphosis, diffuse OP, decreased stature

Rx: Meds, # prone, surgery often, immobilization. Need good social integration, education

65
Q

Legg Calve-Perthes Disease:

  • defined
  • s/s
  • Rx
A

Avascular necrosis of femoral head, 3-12 y.o. M>F “ flattened femoral head”

S/s:

  • small for age
  • unilateral hip, knee, groin pain (usually)
  • +ve trendelenberg
  • limp
  • decreased ABD, IR ROM

Rx: “controversial” - ROM, bracing, containment to preserve femoral head

66
Q

Radiculopathy:

- Defined + s/s

A
  • pain due to nerve compression

S/s: pain, tingling/ numbness, decreased myotomes and dermatomes.

67
Q

Spinal stenosis:

  • defined
  • Rx
A

Hypertrophy of spinal lamina, ligamentum flavum, facets
- vascular or neural compromise

Rx: joint mobilizations, flexion bias exercises (avoid extension), traction

68
Q

Thoracic outlet syndrome:

A

Due to impinged: brachial plexus, vagus nerve, subclavian artery/vein

Where:
- superior thoracic outlet, scalene triangle, clavicle and 1st rib, pec minor and thoracic wall

S/s: pain in arms/hands, neck, Axillary, pec, upper back, tingling, vascular (one had colder)

Ax: Adson, Allen, military test, costoclavicular test

Rx:
Posture education, mobilizations of 1st rib, soft tissue release, restore mechanics and function to mm.

69
Q

Ulnar nerve entrapment:

  • location
  • cause
  • s/s
  • test
A

Location = cubical fossa
Cause = trauma, compression, thickened FCU retinaculum
S/s = medial elbow pain
Test: posterior tinel tap

70
Q

Median nerve entrapment:

  • where
  • cause
  • s/s
  • Result + s/s
A

Location: in pronator teres under FDS
Cause: repetitive gripping activities
S/s: aching pain, in forearm

Carpal tunnel:
S/s: altered sensory function in median nerve distribution, decrease vibration/ 2pt diecrimination, the area mm atrophy,

71
Q

Radial nerve entrapment:

- location

A

Radial tunnel

  • distal branches = posterior interosseous nerve
72
Q

Nerve entrapment Rx

A
  • decrease mm imbalances, inspect the neck, stretch tight mm, brace at night, biomechanical modifications, reduce swelling
73
Q

3 types of neuropathy:

  • ethology
  • result
  • recovery
A

1) Neuropraxia:
- compression of the nerve
- transient disruption
- good prognosis are edema resolves

2) Axonotemesis:
- Disruption of axon, myelin sheath still intact (probs Crush injury)
- may cause paralysis of motor, sensory, and autonomic system
- fair prognosis (months), via Wallachian degeneration
- -> axon regrowth = 1mm/day… Upper arm = 6 month- 2 years, LE = 9-2 years
3) Neurotemesis:
- complete severed axon and sheath
- recovery only with surgery but variable success rate

74
Q

Wallarian degeneration:

  • define
  • degerate on location
  • healing
A

Occurs d/t crushing of nerve –>axon separates from cell body.

  • occurs with Axonotemesis
  • degeneration occurs distal to injury

Healing:

  • macrophages remove debri
  • proximal part: Prouts, grows +pruned off, myelin regrowth.
75
Q

Segmental demyelination:

  • Defined
  • healing
  • example
A

Myelin breakdown (demyelination) for a few segments but axons are preserved,

  • reversible b/c Swann cells make new myelin to restore function
  • some axons may be permanently loss

Ex: Guillain-Barre
- immune system attacks nerves –> 1st s/s = weakness + tingling then entire body paralysis

76
Q

Distal axonal degeneration

  • defined
  • s/s
A

Degeneration of axon Linder and myelin d/t inability of neuronal body to keep up w/ metabolic demands of axon.

Develops in the most distal part of the axon,

S/s: characteristic distal sensory loss + weakness

77
Q

Myasthenia gravis:

  • defined
  • effects
  • Rx:
A

Autoimmune attach of Ach receptor at the NMJ: signal can’ travel from nerve to mm.

Effects:
Progressive mm weakness: decreased cardioresp, atrophy, fatigue

Rx:
Medication to prevent Ach breakdown at NMJ
- activity within tolerance, prevent secondary conditions.

78
Q

Charcot Marie tooth Disease

  • defined
  • s/s
  • Rx
A

Hereditary neuropathy causing extensive demyelination of motor and sensory nerves of foot

S/s:

  • symmetrical mm weakness w/ slow progression + foot mm atrophy, decrease DF, everter mm.
  • decreased deep tendon reflex
  • Pes cavus (hammer toes)

Rx: stretching for contracture management + foot care

79
Q

Bell’s Palsy:

  • defined
  • s/s
  • Rx
A

Latent herpes virus causes inflammation response over facial nerve.

S/s: unilateral facial paralysis:
- decreased: facial expressions, shaped ius mm of inner ear, sensory + autonomic taste fibers, tears, saliva

Rx: Cortico steroids, protect eye

80
Q

Thoracic outlet syndrome:

  • defined
  • s/s
A

Entrapment due to pressure on brachial plexus:
- chronic compression caused edema, ischmia of nerve roots, neuropraxia + Wallachian degeneration

S/s:
- paraesthesia, UE weakness, pain, hand fatigue, neck pain, Raynaud’s, edema

81
Q

Diabetic neuropathy:

  • defined
  • pathology
  • s/s
  • Rx
A
  • perioheral vascular disorder in diabetes occuring w/o any other neuropathy cause

Chronic metabilic disturbance –> affects nerves + Schwann cells resulting in loss of both myelinated and unmyelinated axons

S/s:

  • symmetric + distal sensory loss
  • painless paraesthesia
  • minimal motor weakness

Rx: control hyperglycemia, skin care, amputation

82
Q

Scars:

- types and features

A

Keloid:
- thick scar: extends beyond margins of original wound

Hypertrophic:
- thick scar: excess tissue but within border of original wound

PCE (9 decks)

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