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
Loose body: - defined - s/s - Ax
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"
26
Hypermobility: - defined + features Instability: - defined
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
27
Lysis vs. Listhesis of spine
- Lysis = pars # | - Listhesis = # or slip of cranial vertebrae anteriorly
28
Spondylosis | - defined
OA of spine = degeneration of joints - can lead to stenosis or disc herniation
29
Spondylolysis: - defined - population at risk
- 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
30
Spondylolithesis: - defined - common location - MOI - types - grades
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
31
Spondylolisthesis: - s/s - Rx - when to get surgery
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
32
Hypomobility: - MOI - structures - Contributing factors
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
33
Capsular patterns of loss: - spine - GH - AC - Humeral ulnar - Humeral radial - proximal radioulnar - distal radioulnar
- 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
Capsular pattern: - Radiocarpal - 1st MCP - MCP 2-5th - IP's
- Radiocarpal: flex = extn - 1st MCP: flex > extn - MCP 2-5th: Flex > extn - IP's: Flex > extn
35
Capsular pattern: - hip - knee - Talocrural - Subtalar - 1st MTP - MTP 2-5 - IP's
- 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
Dislocations: - s/s - Instability tests - complications
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
Dislocations: | - Types: MOI, population, related lesions/complication
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
Subluxation of AC joint: - position of sublux - supporting ligaments - s/s
- 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
Growth plate closure times - Femur - Tibia - humerus - redius
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
Fractures: - MOI of pathological #'s - types of #'s
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
Fractures: - common #'s - healing time - complications
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
Hip Fractures: - locations - Rx types
- 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
THR: | - precautions per approach
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
Bone: - components - Types - relationship with load
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
Osteoporosis: - WHO OP categories - OP types - Risk factors
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
Osteoporosis: | - Rx
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
Tumor/pathological #'s - s/s - types:
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
Degenerative Joint disease: Types: - vertebrae - joint - OA Rx
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
Plumb line test: | - bony and surface landmarks
Ear lobe, shoulder , mid trunk, greater trochanter, anterior to knee and ankle.
50
Scoliosis: - types - s/s - Ax - Rx
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
Low back pain + postural dysfunction - structures to maintain posture - cause of postural back pain - S/s - Rx
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
Low back pain: Disc lesion - disc anatomy - typical presentation - healing time - s/s
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
Low back pain: Disc lesion - aggravating and easing factors - Rx:
``` 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
Low back pain: Stenosis - causes - s/s - aggravating / easing factors - Rx:
" 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
Spondylolisthesis: - s/s - Rx
S/s: - central low back pain +/- referred pain - weak abdominals - +/- tight hamstrings Rx: LE mm imbalance, abdominal strengthen, biomechanical counselling, avoid hyper extension.
56
Osteomyelitis | - defined
- 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
Bursitis: - cause - s/s - Rx:
Cause: overuse, trauma, gout, infection S/s: pain w/ rest, dec AROM/PROM Rx: flexibility, manual therapy, thermal agent
58
Amputation: | - common causes
- DM, PVD - trauma - congenital deformity - tumors - infected TKR
59
Effects of amputation at: - Toe: - partial foot
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
Amputation: - ankle - Transtibial
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
Amputations: PT Education: - contractures - prosthesis fit
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
Congenital malformations: Developmental dysplasia of the Hip - Defined - recovery timeline? - Risk factors - s/s - Ax - Rx
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
Developmental abnormalities: Club foot - cause - types - presentation - Rx
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
Osteogenesis Imperfecta: - define - s/s - Rx:
- 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
Legg Calve-Perthes Disease: - defined - s/s - Rx
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
Radiculopathy: | - Defined + s/s
- pain due to nerve compression S/s: pain, tingling/ numbness, decreased myotomes and dermatomes.
67
Spinal stenosis: - defined - Rx
Hypertrophy of spinal lamina, ligamentum flavum, facets - vascular or neural compromise Rx: joint mobilizations, flexion bias exercises (avoid extension), traction
68
Thoracic outlet syndrome:
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
Ulnar nerve entrapment: - location - cause - s/s - test
Location = cubical fossa Cause = trauma, compression, thickened FCU retinaculum S/s = medial elbow pain Test: posterior tinel tap
70
Median nerve entrapment: - where - cause - s/s - Result + s/s
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
Radial nerve entrapment: | - location
Radial tunnel - distal branches = posterior interosseous nerve
72
Nerve entrapment Rx
- decrease mm imbalances, inspect the neck, stretch tight mm, brace at night, biomechanical modifications, reduce swelling
73
3 types of neuropathy: - ethology - result - recovery
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
Wallarian degeneration: - define - degerate on location - healing
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.
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Segmental demyelination: - Defined - healing - example
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
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Distal axonal degeneration - defined - s/s
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
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Myasthenia gravis: - defined - effects - Rx:
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.
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Charcot Marie tooth Disease - defined - s/s - Rx
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
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Bell's Palsy: - defined - s/s - Rx
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
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Thoracic outlet syndrome: - defined - s/s
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
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Diabetic neuropathy: - defined - pathology - s/s - Rx
- 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
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Scars: | - types and features
Keloid: - thick scar: extends beyond margins of original wound Hypertrophic: - thick scar: excess tissue but within border of original wound