NeuroMSK Flashcards
Contusion:
- Rx:
- complications
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
Strains and tears:
- where and when?
- grades
- Rx phases
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.
DOMS
- pathology
- Rx
Possibly due to local nerve endings response to altered pH, swelling, inflammation)
Rx: light activity, massage, avoid anti-inflammatories,
Pelvic floor dysfunction:
- nerve
- how to ax
- Pudendal nerve: S2,3,4 off sacral plexus
Chronic pelvic pain:
- causes?
- Rx goals
Causes: msk, neuro, gynaecological, urogenital
Rx: - decrease PF resting tone - Increase PF proprioception - increase PF motor control - decrease pain sensitization -
Pelvic girdle pain:
- pregnancy and pathology
- s/s
- signs
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
Pelvic girdle pain:
- Ax
- Rx
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:
Syndesmotic ankle sprain
- MOI
- ligaments affected
MOI: planted foot + IR of leg = ER of mortise OR/ hyperDF or hyperPF
Ligs affected:
commonly: ATFL, PTFL, interosseous
+ others,#, bone bruise / OA
High ankle sprain:
- Dx
- Rx
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
Muscle injury and repair:
- phases of healing
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
Tendon:
- composed of?
- loading response?
Composed of:
- Tenocytes (crave mechanical load) + collagen, glucosaminoglycan (Extracellular matrix)
Loading response:
- increased collagen synthesis, cellular proliferation, alignment
Tendonopathy:
- defined
- do and don’t see?
- Rx
Chronic micro trauma causing loss of collagen organization
- no inflammation
Do see: collagen disorganization, glucosaminoglycan, variable Tenocyte density, increase vasularity.
Rx: proper loading
Achilles Tendinopathy
- Risk factors
- s/s
Risk factors: age, BMI, Male, running, foot wear, pronation, decrease DF, decrease LE strength, tight/weak calf mm
s/s:
- thickened tendon, TOP
Achilles tendinopathy
- DDX
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
Achilles tendinopathy
- Rx:
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
De Quervain’s Tenosynovitis:
- defined
- mm OIF
- 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
De Quervain’s synovitis:
- s/s:
-
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)
Lateral elbow pain:
- mm involved OIF
- s/s
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
Tennis elbow:
- Ax:
- DDx
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
Tennis elbow
- Rx
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
Rotator cuff tendonopathy:
- structures at fault
- types of impingement: + risk factors
- 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
Rotator cuff tendinopathy:
- s/s
- ax
- Rx
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
Patellar tendinopathy:
-
” 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
Fasciitis/ myofascial restriction:
Pain syndrome s/s + Rx
TOP (trigger point)
- onset from sudden overload, over-stretching, repetitive strain,
Rx:
- IMS
- flexibility, ROM
- Soft tissue massage
- manual therapy
- modalities
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”
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
Lysis vs. Listhesis of spine
- Lysis = pars #
- Listhesis = # or slip of cranial vertebrae anteriorly
Spondylosis
- defined
OA of spine = degeneration of joints
- can lead to stenosis or disc herniation
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
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
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
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
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
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
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
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
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
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)
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
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
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,
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
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
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
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,
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
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
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
Plumb line test:
- bony and surface landmarks
Ear lobe, shoulder , mid trunk, greater trochanter, anterior to knee and ankle.
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
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
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?
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
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)
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.
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
Bursitis:
- cause
- s/s
- Rx:
Cause: overuse, trauma, gout, infection
S/s: pain w/ rest, dec AROM/PROM
Rx: flexibility, manual therapy, thermal agent
Amputation:
- common causes
- DM, PVD
- trauma
- congenital deformity
- tumors
- infected TKR
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
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
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
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
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
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
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
Radiculopathy:
- Defined + s/s
- pain due to nerve compression
S/s: pain, tingling/ numbness, decreased myotomes and dermatomes.
Spinal stenosis:
- defined
- Rx
Hypertrophy of spinal lamina, ligamentum flavum, facets
- vascular or neural compromise
Rx: joint mobilizations, flexion bias exercises (avoid extension), traction
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.
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
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,
Radial nerve entrapment:
- location
Radial tunnel
- distal branches = posterior interosseous nerve
Nerve entrapment Rx
- decrease mm imbalances, inspect the neck, stretch tight mm, brace at night, biomechanical modifications, reduce swelling
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
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.
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
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
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.
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
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
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
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
Scars:
- types and features
Keloid:
- thick scar: extends beyond margins of original wound
Hypertrophic:
- thick scar: excess tissue but within border of original wound
