Neuromusculoskeletal Flashcards
1
Q
How long does inflammation last?
A
24 hrs to 3-4 days
2
Q
3 key features of inflammation?
A
- myofiber rupture and necrosis
- hematomas
- inflammatory cell reaction
3
Q
How long does repair last?
A
5 - 14 days
4
Q
4 key features of repair stage?
A
- phagocytosis of necrotic fibers
- regeneration of myofibers
- formation of scar tissue
- capillary ingrowth
5
Q
How long does remodelling last?
A
14 - 21 + days
6
Q
3 key features of remodelling stage?
A
- maturation of myofibers
- contraction and organization of scar tissue
- recovery of function
7
Q
_____ = muscle injury caused by sudden extneral force
A
contusion
8
Q
Result of a contusion?
A
bleeding in deep muscle regions
9
Q
Treatment for contusions first 48 hours ?
A
- PRICE no HARM (heat, alcohol, running, massage)
- put muscles on as much stretch as possible
- crutches if necessary
- gentle pain free ROM/stretch
- progressive exercise after acute phase
10
Q
Recovery time for grade I (mild) contusion?
A
2 - 3 weeks
11
Q
Recovery time for grade II (moderate) contusion?
A
4-6 weeks
12
Q
Recover time for grade III (severe) contusion?
A
8 weeks
13
Q
2 complications of contusions ?
A
- compartment syndrome
2. myositis ossificans
14
Q
3 things to check for compartment syndrome?
A
- capillary refill
- sensation
- muscle strength
15
Q
Majority of strains and tears mainly occur in _______ muscles at the muscle - tendon junction
A
biarticular
16
Q
Strains and tears mainly occur during ________ loading or high intensity, ______ activities
A
eccentric; explosive
17
Q
Long head of biceps femoris strains/tears occur during?
A
terminal swing phase of high speed running
18
Q
Semimembranosus strains/tears occur during?
A
concurrent hip flexion + knee extension
19
Q
5 risk factors for strains and tears?
A
- prior injury
- age
- unaccustomed activity
- training errors
- biomechanics
20
Q
Suspect MO if contusion hasn’t healed within __-__ weeks
A
2-3
21
Q
Grade __ strain and tear = microscopic tearing, pain / tightness, NO weakness; relative rest to protect tissues
A
I
22
Q
Grade __ strain and tear = partial macroscopic tearing ; pain and structural change ( decreased strength, laxity)
A
II
23
Q
Grade __ strain and tear = complete tear / painless and weak, may see lump
A
III
24
Q
Dx of grade III muscle tear?
A
myotomal weakness (neuro impairment)
25
To include in Ax of strains and tears?
1. AROM
2. PROM
3. strength
4. muscle length
5. ligament/ stability tests
26
Rx for acute stage of strain?
PRICE , crutches for LE's
27
Rx for repair stage of strain?
modalities, DTF, strength, stretching
28
Rx for remodelling stage of strain?
strength + stretching
29
When can pt RTP post strain?
1. symmetrical muscle length, strength, power, no s/s. core control
2. completion of progressive functional progressions + sport specific drills + practice session
30
Rx for inflammatory stage of laceration?
optimize gait so scar tissue aligns properly for healing
31
Rx for repair stage of laceration?
gradual ROM + strength
32
Rx for remodelling stage of laceration?
gradual increase in load and velocity
33
DOMS possibly due to local nerve endings response to altered environment including what 4 things?
1. acid
2. pH
3. swelling
4. inflammation
34
You should avoid anti-inflammatories during DOMs if possible (T/F)
TRUE
35
Pelvic floor innervation?
Pudendal (S2-S4)
36
7 methods for Ax pelvic floor (PF) dysfunction?
1. digital
2. EMG
3. manometer
4. dynamometer
5. real time US
6. MRI
7. biofeedback
37
Chronic pelvic pain = pain > __ months between what 2 areas?
3; diaphragm and knees
38
4 possible causes of pelvic pain?
1. MSK
2. neuro
3. urogenital
4. gynecological
39
Common age range for chronic pelvic pain?
25-35 years
40
Ax for what 3 things in pt with chronic pelvic pain?
1. urogenital s/s
2. lumbar / pelvic/ groin mechanical presentation
3. core activation difficulty
41
Rx for chronic pelvic pain (4)?
1. decrease PF resting tone
2. increase PF proprioception
3. increase motor control
4. decrease pain sensitization
42
___ % of pregnancies = weakness/ laxity of PFM during pregnancy / childbirth
50
43
Hx of PGP?
previous hx of back pain / trauma
44
3 causes of PGP?
1. laxity
2. asymmetry
3. inadequate motor control
45
PGP may be felt ant/lat/post pelvis, groin, ant/post thigh, abdomen and coccyx, with what 2 positions?
1. sustained positions OR
| 2. transitional movements
46
3 signs of PGP?
1. posture
2. asymmetry
3. gait
47
Posture that might be seen in someone with PGP?
1. locked knees
2. L spine lordosis
3. thoracic kyphosis
4. FHP
48
Gait abnormalities that might be seen in a pt with PGP?
1. shuffling
2. waddling
3. leg drag
49
6 things to Ax in pt with PGP?
1. ASLR with form/force closure
2. hip quadrants (ER/IR)
3. SIJ stability (P4, gaenslens, FABERS, palpation of long dorsal lig)
4. TOP SP
5. TOP piriformis
6. resisted hip add/abd
50
5 categories of treatment for PGP?
1. education
2. posture
3. manual therapy
4. exercise
5. movement strategies (glutes)
51
Maintenance in terms of PF exercises?
8-12 contractions 2x/week
52
________ = herniation of bladder into vagina
cystocele
53
_______ = herniation of rectum into vagina
rectocele
54
_____ ______ = herniation of uterus into vagina
uterine prolapse
55
_____ = pain with activity + PROM, possibly asymmetry
sprain
56
Grade __ sprain = minor rupture, few fibers torn, stability maintained
I
57
Grade __ sprain = partial rupture, increased laxity, NO gross instability
II
58
Grade ___ sprain = complete rupture, gross instability
III
59
Ax (2) for sprains?
1. stability testing (laxity + EF!)
| 2. pain
60
Rx for acute stage of sprain? (3)
1. PRICE
2. structural support
3. offload area
61
Rx for repair stage of sprain ? (3)
1. stability w/ muscle strength
2. DTFM, modalities
3. progressive loading (linear movement)
62
Rx for remodelling stage of sprain? (3)
1. DTFM
2. progressive loads + dynamic movement (multidirectional)
3. sport / function specific
63
3 MOI's for high ankle sprain?
1. planted foot + IR of leg (ER of talus in mortise)
2. hyper DF
3. falls, twisting, MVA
64
3 ligaments affected in high ankle sprain?
1. AITFL
2. PITFL
3. interosseous
65
S/S of high ankle sprain? (3)
1. limited swelling
2. antalgic gait
3. TOP @ injury site (AITFL, PITFL, anterior distal tib-fib area)
66
Dx of high ankle sprain? (7)
1. ER stress test
2. squeeze test
3. crossed - leg test
4. ant / post translation of fib
5. squat test
6. heel thump test
7. one legged hop test
67
Rx for phase 1 high ankle sprain (0-2 weeks)?
1. decrease inflammation w/ PRICE, modalities for edema/ROM, immobilization
2. light ROM
3. NWB w/ crutches
68
Rx for phase 2 high ankle sprain (2-4 weeks?)
1. regain normal mobility
2. increase strength and function
3. joint mobs to restore DF
4. PWB ambulation
5. bilateral balance training
69
A pt can PWB in phase 2 of high ankle sprain but they MUST be ___ ____ and you can use a heel lift
pain free
70
Rx or phase 3 high ankle sprain ?
1. increase function
| 2. unilateral balance and strength
71
Rx for phase 4 high ankle sprain (RTS!) ?
1. cutting, jumping
2. more aggressive strengthening
3. increase walking speed
72
Recovery for high ankle sprains = __ x as long as regular
2
73
Tendon is composed of _____ and _____
tenocytes; ECM
74
_____ = part of tendon, crave mechanical load
tenocytes
75
____ = part of tendon, collagen and glycosaminoglycan
ECM
76
Loading tendons leads to what 3 things ?
1. increase collagen synthesis
2. cellular proliferaion
3. alignment
77
Tendinopathy = chronic ______ and loss of collagen _______
microtrauma; organization
78
There is evidence of inflammation in tendinopathy (T/F)
FALSE
79
4 things you see with tendinopathies?
1. collagen disorganization
2. glycosaminoglycan
3. variable tenocyte density
4. increase vessels/nerve
80
Rx for tendinopathy?
proper loading and resting of tissue
81
9 risk factors for achilles tendinopathy ?
1. age
2. BMI/diabetes
3. male
4. sports (running)
5. training errors
6. footwear
7. pronation
8. dec DF and LE strength
9. tight / weak calf mm
82
S/S of achilles tendinopathy?
1. thickened tendon
| 2. TOP
83
DDx of achilles tendinopathy? (2)
1. achilles tendon partial rupture
| 2. sever's disease
84
____ disease = inflamed calcaneal apophysis, pulls on tendon at insertion
Sever's
85
Severs disease effects growing active children b/w __ - ___ years ish
9-14
86
Rx for severs disease?
1. activity modification
| 2. rest
87
Rx for achilles tendinopathy? (5)
1. NSAIDs (if acute)
2. alter contributing factors (pronation, muscle imbalance, myofascial restriction, core)
3. progressive exercise program
4. footwear w/ heel lift
5. stretching / manual therapy
88
In the exercise program for achilles tendinopathy, _______ loading is necessary!
ECCENTRIC
89
4 examples of components of exercise program for achilles tendinopathy ?
1. bilateral --> unilateral
2. only drop to neutral foot
3. pain level < 5/10
4. don't want pain next day or loss of function
90
DeQervains tenosynovitis iis an inflammation of the sheath / tunnel surrounding which 2 muscles?
1. extensor pollicis brevis
| 2. abductor pollicis longus
91
Main test for Ax of DeQuervains?
Finkelstein
92
Rx for DeQuervains?
1. acute = offload tissue, PRICE, risk factor education
| 2. corticosteroid injection
93
90% of cases of tennis elbow involve which muscle ?
ECRB
94
10% of cases of tennis elbow involve what 2 muscles ?
1. common extensor tendon
| 2. origin of ECRL
95
Tennis elbow is wore with what 3 activities ?
1. gripping
2. repetitive reach / grasp
3. repetitive overload
96
3 tests to use for tennis elbow that are + if there is pain over the lateral epicondyle?
1. resist 3rd finger PIP EXT (MAUDSLEY's TEST)
2. resist active wrist EXT + RAD dev w/ elbow at 90 aka COZEN's test
3. passive pronation of forearm, wrist FLEX + elbow EXT
97
Tennis elbow has nerve S/S (T/F)
FALSE
98
How to rule out nerve involvement with tennis elbow?
radial nerve ULTT
99
Ddx for tennis elbow includes C spine referral of C__-__
5-7
100
When to start eccentric muscle training with tennis elbow?
repair stage!
101
Avoid NSAIDS in acute stage of tennis elbow (T/F)
TRUE
102
RC tendinopathy usually involves which 2 muscles?
1. long head biceps tendon
| 2. surpaspinatus
103
___ RC impingement = narrowed subacromial space, usually in older pt
primary!
104
___ RC impingement = instability, usually younger patients
SECONDARY
105
3 tests for RC impingement?
1. Neers
2. Speeds
3. Empty can
106
5 main categories for Rx or RC tendinopathy?
1. correct biomechanical faults
2. modalities
3. DTFM
4. manual therapy
5. education
107
______ ______ = due to repetitive loading in extensor mechanism of knee
patellar tendinopathy
108
6 risk factors for patellar tendinopathy?
1. male
2. jumping athletes
3. jump height
4. reduced DF
5. age
6. BMI
109
Rx for patellar tendinoapthy?
1. slow heavy load (eccentric and concentric)
2. scan ( find muscle imbalances and biomechanical faults)
3. determine if knee is in valgus position
110
_______ _____ syndrome = TOP found within muscle, onset = sudden overload / over stretching and/or repetitive strain, sustained mm activities
myofascial pain
111
____ ____ = free floating piece of bone of cartilage
loose body
112
ROM end feel due to loose body may be what 2 things?
1. bony block
| 2. springy
113
________ = excessive laxity or length of a tissue
hypermobility
114
Hyermobility = increase _____ ____ of joint
neutral zone
115
______ ______ = ROM in position where osteoligamentous structures provide minimal resistance ie joint glide is most free
neutral zone
116
_______ = excessvie ROM of arthrokinematics or osteokinematics
instability
117
_______ = OA of spine, degeneration of joints
spondylosis
118
_______ = pars interarticualaris defect
spondylolysis
119
Spondylolysis is seen in what population(s)?
younger patients w/ hyper EXT and ROT sports
120
Spondylolysis is mostly asymptomatic (T/F)
TRUE
121
Is a spondylolysis is bilateral, it may lead to _______
spondylolisthesis
122
Spondylolisthesis (increases/decreases) the intervertebral foramen
DECREASES!
123
Where is a spondylolisthesis most common?
L5/S1
124
_____ spondylolisthesis = during progressive period of rapid growth, rarely progresses to adult life
spondylolytic
125
_______ spondylolisthesis = secondary to DJD + Z joint subluxation, OA of joints in spine, older population
degenerative
126
S/S of spondylolisthesis?
1. central LBP +/- referred pain
| 2. weak abs + / - tight hamstrings
127
Aggravating factors for spondylolisthesis?
extension
128
Easing factors for spondylolisthesis?
flexion
129
4 Rx's for spondylolisthesis?
1. FLEXION exercises
2. inner unit strengthening
3. brace if appropriate
4. work into painful range with proper stability
130
4 spondylolisthesis cases where you might need to get surgery?
1. increased slippage or instability even with brace
2. hard neuro signs
3. evidence of SC involvement
4. intractable pain despite treatment
131
Change to tendon due to hypo mobility?
decreased tensile strength
132
Change to ligaments due to hypo mobility?
decreased tensile strength and increased stiffness/adhesions
133
Change to cartilage due to hypomobility?
decreased synovial fluid, H2O content
134
Change to bone due to hypo mobility?
increased respiration, decreased bone mass/ mineral content
135
Instability test for scapula?
wall push up
136
instability test for anterior GHJ?
anterior apprehension test
137
Instability test for posterior GHJ?
posterior apprehension test
138
Instability test for inferior GHJ?
sulcus sign
139
2 complications of instability in the GHJ?
1. RC tears
| 2. axillary nerve damage
140
What does TUBS stand for?
traumatic onset, unidirectional anterior, Bankart lesion, surgery
141
_____ lesion = # of anterior / inferior capsule and ligaments
Bankart
142
S/s of Bankart lesion?
1. clicking
2. apprehension
3. deep vague pain
143
_____ lesion = superior labrum lesion anterior --> posterior
SLAP
144
MOI is SLAP lesion?
elevated position with sudden concentric and eccentric biceps contraction
145
_____ lesion = major cause of pain in throwers
SLAP
146
____ - ____ lesion = compression # of posterior / lateral humeral head
Hill-Sachs
147
___ + _____ in shoulder may present with deformity, constant pain and systemic sings such as nausea
#; dislocation
148
What does AMBRI stand for
atraumatic, multidirectional, bilateral shoulder findings, rehab appropriate, INF capsule shift
149
Sx often done in AMBRI conditions due to laxity (T/F)
TRUE
150
In an AC joint subluxation, the clavicle moves _____ and ____ in relation to acromion
posterior / superior
151
What 2 ligaments are the main stabilizers of the AC joint?
1. trapezoid
| 2. conoid
152
AC joint subluxation will present with a ____ ______
step deformity
153
2 conditions which was present with AC joint subluxation?
1. RA
| 2. multiple myeloma
154
Femur growth plate closure: proximal at ___ years and distal at __ years
18;20
155
Tibia growth plate closures: proximal at __ - __ years, distal at __ - __ years
16 - 18; 15 - 17
156
Humerus growth plate closure: proximal at __ years and distal at ___ years
20 ; 16
157
Radius growth plate closure: proximal at __ years and distal at ___ years
18;20
158
_______ = end of long bone
epiphysis (where joint is!)
159
_______ = shaft of long bone
diaphysis
160
_____ # = twisting injury
spiral
161
_____/_____ # = direct blow
transverse / oblique
162
_____ / ____ # = longitudinal force
compression / crush
163
______ # = fragments of bone
comminuted
164
_____ # = young kids, # only on one side
greenstick
165
_______ # = piece of bone pulled off
avulsion
166
_____ # = d/t compression of force
impact
167
Colles # ?
distal radius + subluxation of distal ulna
168
Bennetts #?
dislocation of CMC thumb joint
169
Scaphoid # usually due to _____
FOOSH
170
6 areas where avascular necrosis post # is common?
1. proximal femur
2. 5th MT
3. scaphoid
4. proximal humerus
5. talus neck
6. navicular
171
3 Rx for #'s?
1. joint mobility above / below
2. isometric strength
3. CV fitness maintenance
172
3 locations for hip #'s?
1. femoral neck
2. intertrochanteric
3. subtrochanteric
173
Conservative Rx for hip #'s = (slower/longer) rehab
SLOWER
174
____arthoplasty = femoral head replacement
hemi
175
____arthroplasty = femoral head + acetabular replacement
total
176
_____ type of hip replacement = better stability, better for sedentary elders with poor bone quality
cemented
177
_______ type of hip replacement = better for younger pts
uncemented
178
Uncemented THA will need replacement within __ years
10
179
____ hip replacement = femoral component is cemented, acetabular component is not cemented
hybrid
180
Precautions for post-lateral THA?
1. no hip FLEX past 90
2. no hip IR
3. no hip ER
4. no hip ADD past midline for first 3 months
181
Precautions for lateral THA?
1. no hip FLEX past 90
2. no IR
3. no hip ADD past midline for first 3 months
182
Precautions for anterior THA?
1. no hip EXT
2. no ER
3. no hip ADD past midline for first 3 months
183
Precautions for hemiarthoplasty, cannulated screws, DHS and gamma nails?
typically NO restrictions with movement an WBAT!
184
2 indications for a shoulder hemiarthroplasty?
1. arthritic conditions without glenoid involvement
| 2. severe # of proximal humerus head
185
4 indications for a total shoulder arthroplasty?
1. OA
2. inflammatory arthritis
3. osteonecrosis involving the glenoid
4. post traumatic degenerative joint disease
186
To have a TSA the pt MUSt have an intact ____ ____ _____
rotator cuff complex
187
Post op precautions for TSA?
immobilization daily for 1 week, nightly for 1 month, sling for 4 weeks
188
2 indications for a reverse total shoulder arthroplasty?
1. OA
| 2. compound #'s of humerus w/ deficiency of rotator cuff
189
Post op precautions for reverse TSA?
1. flexion / elevation in scapular plane passively up to 90 degree
3. pure abduction
190
What position is CI for reverse TSA, and for how long ?
AVOID IR! for 6 WEEKS!
191
______ bone is most affected by OP
cancellous
192
OP = decrease in bone ____ and especially bone ______ = increased risk of #
density ; QUALITY
193
WHO OP categories normal T score?
0-1 SD of young adult mean
194
WHO OP categories low bone mass T score?
1-2.5 SD below young adult mean
195
What T score is classified as osteopenia?
1-2.5 SD below young adult mean
196
WHO OP categories OP T score?
2.5+ SD below the young adult mean
197
Severe / established OP = presence of ______ _____
fragility #
198
Primary type 1 OP?
post menopausal women
199
Primary type 2 OP?
70+ years
200
Risk of primary type 2 OP is = for men and women (T/F)
TRUE
201
Secondary OP is due to what?
other medical condition or treatment
202
7 risk factors for OP?
1. family hx
2. lifestyle
3. gender
4. age
5. lifetime exposure to estrogen
6. breast ca
7. fragility # under 40 years
203
Dx of OP?
1. bone scan
| 2. # assessment tools
204
2 # ax tools?
1. FRAX
| 2. CAROC 2010
205
Common OP # sites?
1. wrist
2. humerus
3. vertebrae
4. hip
206
3 possible side effects of OP medication?
1. vertigo
2. dizziness
3. muscle / back / LE / UE pain
207
5 possible PT Rx for OP?
1. posture
2. aerobic
3. resistance exercise
4. balance
5. extension exercises
208
With OP, what movement do you really want to avoid (ESP w/ spine OP?)
NO spine flexion + flexion + rotation
209
Tumor/pathological #'s can manifest as _____ / _____ injuries
sports / mechanical
210
Primary malignant tumors of soft tissue / bone are rare but they may occur in _____
youth
211
______ = at ends of long bone, pain @ joint, worse with activity
osteosarcoma
212
Rx for osteosarcoma?
Sx (Terry Fox)
213
How would an osteosarcoma display on an X ray?
moth eaten appearance
214
_______ ______ = in larger joints like knee and ankle; pain at night and worse with activity; swelling / instability
synovial sarcoma
215
Rx for synovial sarcoma?
1. Sx
| 2. chemo / radiation
216
______ _______ = benign bone tumor; pain in bone at night, worse with exercise; often mistaken for bone #
osteoid osteoma
217
KEY sign of osteoid osteoma?
NO pain with ASPIRIN!
218
How would an osteoid osteoma show on CT scan?
w/ central focus point
219
Rx for osteoid osteoma ?
1. ablation
2. ethanol
3. laser
220
_____ _____ _______ = due to mechanical change, joint disease or joint trauma
degenerative joint disease
221
DJD is mostly seen in pts > ____ years
40
222
spinal stenosis = decreased IVF, increased ______ s/s
radicular (myotome, dermatome)
223
central stenosis = increase in spinal canal compression, increase in _____ s/s
central (central cord signs like b/b)
224
_______ = spine OA effected Z joints and foramen
spondylosis
225
________ = pars interarticularis defect, may start as stress #
spondylolysis
226
4 outcome measures for spondylolisthesis?
1. pain w/ lumbar EXT in SLS
2. pain free lumbar EXT ROM
3. facilitated segment
4. lumbopelvic control
227
OA leads to hypertrophy of ______ bone
subchondral
228
4 signs of OA?
1. dec joint space
2. dec cartilage height
3. inc osteophytes
4. inc subchondral bone sclerosis + proliferation
229
Normal plumb line surface marks?
1. thru ear lobe
2. thru shoulder joint
3. midway of trunk
4. thru greater trochanter
5. slightly ant to knee joint
6. slightly ant to ankle joint
230
Sway-back = pelvis shifted ____ in relation to thorax, leading to increased lumbar ____, thoracic _____ and hip _____
forward; lordosis; kyphosis; extension
231
What muscles are short and strong in sway-back postures?
1. hamstrings
| 2. upper fibers of internal oblique
232
What muscles are long and weak in sway-back postures?
1. single joint hip flexors
2. external oblique
3. upper back extensors
4. neck flexors
233
What muscles are short and strong in head forward posture?
1. lev scap
2. SCM
3. scalenes
4. suboccipitals
234
What muscles are long and weak in head forward posture ?
1. deep neck flexors
| 2. erector spinae at CT junction
235
3 types of scoliosis?
1. idiopathic
2. congenital
3. neuromuscular
236
_______ scoliosis = actual boney changes
sctructural
237
_______ scoliosis -= due to LLD
functional
238
2 S/S of scoliosis?
1. decreased nerve conduction
| 2. decreased nerve mobility
239
Degree of scoliosis s/s depends on ____ of ______
degree of constraint
240
Ax of scoliosis?
1. forward bend test
2. muscle imbalance
3. dec proprioception
241
4 categories of Rx for scoliosis?
1. posture
2. stretch/strengthen
3. CV training
4. if severe --> bracing and surgery
242
Posture is obtained from ______ (muscle) and _____ stabilizers (bone, ligament, fascia, joint)
dynamic; static
243
Postural back pain is caused by tissue _____
creep!
244
6 s/s of postural back pain?
1. pain increases w/ prolonged postures
2. poor posture / ergonomic set up
3. pain not specifically caused by FLEX or EXT
4. NO neuro s/s!
5. better in AM worse as day goes on
6. associated with dec fitness
245
WSBC recommendations for ergonomics: eyes looking slightly ______ (~__ degrees) with screen __ - __ cm from floor
downward; 30; 64-75
246
WSBC recommendations for workplace ergonomics: top of line of text should be at ____ level
eye
247
WSBC recommendations for workplace ergonomics: there should be an ____ length between eyes and screen
arms
248
WSBC recommendations for workplace ergonomics: minimum height for backrest ?
45 cm
249
Healing time in desc lesions?
ligaments usually take ~ 3 months to heal
250
4 potential s/s of disc lesion?
1. central back pain +/- leg pain
2. +/- lateral shift
3. loss of normal lordosis
4. b/b changes ?
251
Lateral shift sometimes seen in disc lesions is named relative to the ______
shoulders
252
2 agg factors for disc lesions?
1. coughing
| 2. FLEX
253
S/s of stenosis ?
1. bilateral radiation to legs and feet
| 2. X ray changes
254
Agg position for stenosis?
EXT!
255
______ = inflammatory response d/t infection in bone
osteomyelitis
256
Osteomyelitis is usually due to ____ ____ infection
staph aureus
257
Osteomyelitis in children is often found in _____ _____
long bones
258
Osteomyelitis in adults may be found in ____ or _____
veterbrae ; feet
259
When should you suspect osteomyelitis ?
```
if pt has ...
1. localized swollen joint
2. no trauma hx
3. no other affected joints
SEND TO ER
```
260
5 s/s of osteomyelitis?
1. prominent night pain
2. effusion in and around joint
3. weight loss
4. appetite loss
5. malaise
261
________ = tendon inflammation d/t repetitive microtrauma
tendonitis
262
_______ = chronic tendon dysfunction
tendinosis
263
Bursitis will result in decreases in both AROM and PROM (T/F)
TRUE
264
2 most common causes of amputations?
1. DM
| 2. PVD
265
Are symes amputations more or less functional than trans tibial?
MORE
266
What is a large con of a symes amputation?
HIGH risk of skin breakdown
267
Prosthesis for symes amputation?
1. similar to trans tibial
| 2. partial patellar WB posible
268
Transtibial prosthesis: socket can be what two things?
1. total surface bearing
| 2. patellar tendon bearing
269
Medial/lateral flares of transtibial amputation are pressure ______ areas
tolerant
270
3 suspension systems for TT amputees?
1. supracondylar
2. suprapatellar cuff
3. sleeve
4. locking pin
5. suction
271
4 gait deviations in stance phase TT amputees ?
1. foot flat
2. foot slap
3. knee hyperextension / buckling
4. early heel rise
272
4 gait deviations in swing phase TT amputees ?
1. decrease stride length (less WB on amputated side)
2. toe drag
3. lat/med whip
4. vaulting
273
WB for TF amputees?
through ISCHIAL TUBEROSITIES
274
TF amputations require __% more energy to ambulate w/ prosthesis
60
275
Adductors tendon is a pressure _______ area in TF amputees
sensitive
276
3 types of prosthetics for TF amputees?
1. manual lock
2. mechanical / friction
3. hydraulic / pneumatic / microprocessor
277
5 gait deviations in stance phase in TF amputees?
1. ABD,
2. lat trunk shift
3. Inc trunk lordosis
4. hip flex
5. dec stance time
278
4 gait deviations in swing phase in TF amputees?
1. med/lat whips
2. circumduction
3. hip hike
4. vaulting w/ good leg
279
Hip disarticulation: requires __% energy expenditure compared to able body individual
210%
280
Knee / hip flexion contraction > __ deg = not open for prosthesis!
20
281
Typical contractors for TT amputation?
knee and hip FLEX
282
Typical contractors for TF amputation?
hip FLEx and hip ABD
283
3 things NOT to do for TT/TF amputees?
1. NO pillow under legs / hips in supine
2. NO pillow bw legs TF
3. NO raising foot of bed
284
Prosthesis fit: ______ = interface bw socket and limb
liner
285
Prosthesis fit: ______ = system keeps prosthesis on residual limb
suspension
286
Prosthesis fit: _____ = gel or foam
liners
287
____ liner can be right next to skin for amputees, ____ liner must have sock underneath
gel; foam
288
Prosthesis fit: _____ ensure proper fit
socks
289
Prosthesis fit: _____ / _____ connects socket to foot, provides height
shank / pylon
290
Compression bandages are wrapped distal to proximal, with horizontal passes and worn at ALL times, changed every 6 hours (T/F)
FALSE - wrapped DIAGONALLY and changed every 4 HOURS
291
Results of developmental dysplasia of the hip (DDH)?
acetabulum and femur not i close contact = subluxation and dislocation
292
Spontaneous recovery of DDH w/in the first __ weeks of life is common
2
293
4 risk factors for DDH?
1. female
2. family history
3. breech position
4. tight swaddling
294
3 S/S of DDH?
1. LLD
2. muscle weakness
3. waddling gait
295
2 Ax for DDH?
1. barlow maneuver
| 2. ortlani maneuver
296
_____ maneuver = FLEX then ABD then ADD w/ POST pressure
barlow
297
_______ maneuver = FLEX then ADD + slight traction
ortlani
298
Rx for DDH = keep hip in Flex and ABD w/ ____ harness, and whats 1 thing to no do?
Pavlik; double diapering
299
3 things club foot might be due to ?
1. congenital bone deformity
2. cerebral palsy
3. calf mm contracture
300
4 types of club foot?
1. idiopathic
2. neurogenic
3. syndromic
4. postural
301
Most common type of club foot ?
idiopathic
302
_____ type of club foot resolves quickly with minimal intervention
postural
303
1 risk for developing club foot?
intrauterine growth restriction
304
3 Rx for club feet?
1. manipulation
2. serial casting + splinting
3. Sx
305
_______ _______ = autosomal dominant connective tissue disorder
osteogenesis imperfecta
306
OI = issue converting pro-collagen --> collagen type __
1
307
Type __ OI = most common and least severe
1
308
Type __ OI = lethal in perinatal period
2
309
Type __ OI = severe, progressive deformity, very short
3
310
Type __ OI = rare and mild, moderate deformity, can ambulate
4
311
Pt w/ OI will have diffuse _______ leading to multiple recurrent #'s
OP
312
_____ ____-_____ disease = avascular necrosis of femoral head
legg calve-perthes disease (LCP)
313
LCP disease most commonly effects active males between the ages __ - __ years
5-7
314
LCP disease is usually (uni/bilateral)?
uni
315
LCP disease S/S = hip, knee and groin pain, usually in ___ first
knee
316
LCP disease = + trendelenburg (T/F)
TRUE
317
LCP disease = decrease ROM in what 2 positions?
1. ABD
| 2. IR
318
_________ = pain due to nerve root compression
radiculopathy
319
S/S of radiculopathy depend on degree of _______, but may include pain, numbness/tingling and decreased nerve ______
compression; conduction
320
Spinal stenosis = hypertrophy of spinal ______, ______ _____ and facets
lamina; ligamentum flavum
321
Spinal stenosis can lead to _____ or _____ compromise
vascular; neural
322
3 Rx for spinal stenosis ?
1. joint mobs
2. flex based exercises
3. traction
323
3 things thoracic outlet could be due to?
1. impinged brachial plexus
2. vagus nerve compression
3. subclavian artery / vein compression
324
4 common impingement sites for TOS?
1. superior thoracic outlet
2. scalene triangle
3. b/w clavicle and 1st rib
4. b/w pec minor and thoracic wall
325
4 Ax tests for TOS?
1. adson
2. allen / wrights
3. military test
4. costoclavicular test
326
2 areas ulnar nerve can become trapped?
1. cubital tunnel
| 2. tunnel of Guyon
327
Cause of ulnar nerve becoming trapped in cubital tunnel may be due to compression due to thicken retinaculum/hypertophy of which muscle ?
FCU
328
2 S/S of ulnar nerve entrapment?
1. medial elbow pain
| 2. parasthesias in ulnar distribution
329
Test for ulnar nerve entrapment ?
posterior Tinel's sign
330
Location of median nerve entrapment?
within pronator teres + under FDS; carpal tunnel
331
Cause of proximal median nerve entrapment ?
repetitive gripping activities
332
3 S/S of proximal median nerve entrapment ?
1. aching pain
2. weakness of forearm muscles
3. parasthesia in median distribution
333
Test for proximal median nerve entrapment?
Tinels sign
334
Cause of carpal tunnel and 3 conditions it may be associated with?
compression due to inflammation of flexor tendons w/ repetitive wrist activity -
1. pregnancy
2. diabetes
3. RA
335
Test for carpal tunnel syndrome?
Tinels / Phalens
336
2 S/S of CTS?
1. altered sensory function in median nerve distribution
| 2. atrophy/weakness of thenar muscles and lateral 2 lumbricals
337
Where does the posterior interosseous nerve get entrapped?
radial tunnel
338
Cause of post interosseous nerve entrapment ?
overhead activities
339
3 S/S of post interosseous entrapment?
1. lateral elbow pain
2. pain over supinator
3. parasthesias in radial nerve distribution
340
Test for post interosseous nerve entrapment?
Tinels
341
For post interosseous entrapment, first rule out what 2 things?
1. cervical spine dysfunction
| 2. TOS
342
_______ = any nerve disease characterized by decreased neural function
neuropathy
343
______ = nerve compression, segmental demyelination + transient disruption
neuropraxia
344
Neuropraxia recovery?
FAST; mins to weeks
345
_______ = disruption of axon, myelin sheath still intact, likely a CRUSH injury
axonotmesis
346
_______ = completely severed axon + sheath
neurotmesis
347
Result of ______ = prolonged disruption, may cause paralysis of the motor, sensory and autonomic systems
axonotmesis
348
Recovery of axonotemesis?
fair; may take months (wallerian degeneration!)
349
Axon regrowth = __ mm/ day
1
350
Axon regrowth for upper arm?
4-6 months, up to 2 years
351
Axon regrowth for lower arm?
7-9 months, up to 4 years
352
_______ = completely severed axon and sheath
neurotemesis
353
Recovery of neurotemesis = only with _____
surgery
354
______ ______ = process occurs with laceration / crushing of a nerve, axon separated from cell body
wallerian degneration
355
Wallerian degeneration = degeneration occurs ____ to site of injury w/in 24-36 hours
DISTAL
356
Wallerian degeneration can affect PNS and CNS (T/F)
TRUE
357
_______ _______ = myelin breakdown for a few segments, but axons are preserved
segmental demyelination
358
Segmental demyelination = mostly reversible because _____ cells make new myelin
schwann cells
359
Example of condition where segmental demyelination takes place?
GBS
360
(distal) _____ ______ = degeneration of axon cylinder and myelin possible due to inability of neuronal body to keep up with metabolic demands of axon
axonal degeneration
361
S/S of distal axonal degeneration ?
characteristic DISTAL sensory loss and weakness
362
________ _______ = autoimmune attack of ACh receptors at the NMJ
myasthenia gravis
363
4 effects of myasthenia graves?
1. progressive mm weakness
2. dec CR function
3. atrophy
4. fatigue
364
PT role in myasthenia gravis?
1. activity within tolerance
| 2. prevent secondary conditions
365
_____ _____ ___ _____ = hereditary condition of the PNS; extensive demyelination of motor and sensory nerves of hands and feet
charcot marie tooth disease
366
5 S/S of charcot marie tooth disease ?
1. distal SYMMETRIC muscle weakness
2. dec deep tendon reflexes
3. pes cavus
4. hammer toes
5. lose wrist/finger extension
367
Charcot marie tooth disease = foot _______ atrophy
intrinsic
368
Charcot marie tooth disease= decrease ___ and ___ mm
DF; eversion
369
3 PT Rx's for charcot marie tooth disease ?
1. contrature management
2. foot care education
3. ID and retrain muscle imbalance
370
Pain around what area may preclude development of bells palsy?
mastoid!
371
S/S of bells palsy?
1. unilateral facial paralysis
2. weakness in muscles of facial expression
3. inability to close one eye, WINK or WHISTLE
4. drooping of mouth
5. tears / salivation
372
3 PT Rx for bells palsy?
1. PROTECT EYE (eye patch / eye drops)
2. massage
3. PROM / AROM of facial muscles
373
Chronic compression in TOS leads to edema, ischemia of nerve roots, _____ and _____ _____
neoropraxia; wallerian degeneration
374
Does diabetic neuropathy occur without any other neuropathy cause ?
YES
375
Diabetic neuroapthy = chronic ______ disturbance
metabolic
376
Diabetic neuropathy affects nerves and what type of cells?
SCHWANN
377
3 S/S of diabetic neuropathy?
1. symmetric and distal sensory loss pattern
2. painless paresthesia
3. minimal motor weakness
378
4 tests for dural tension?
1. slump
2. SLR
3. PKB
4. ULTT
379
5 S/S of neurodynamic dysfunction?
1. history of increased speed / reps of sport or work
2. pain distribution does not match myotome or dermatome
3. stretching does NOT feel good
4. cannot describe / point to pain area well
5. recurrent injury that does not change with rehab
380
______ scar = thick scar that extends beyond margins of original wound (hyper proliferation)
keloid
381
_______ scar = not extending beyond original wound margins but has excessive tissue amount
hypertrophic scar
382
What phase of scar formation does not really occur in a hypertrophic scar?
contraction!
