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Written Prep > Neuromusculoskeletal > Flashcards

Neuromusculoskeletal Flashcards

1
Q

How long does inflammation last?

A

24 hrs to 3-4 days

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2
Q

3 key features of inflammation?

A
  1. myofiber rupture and necrosis
  2. hematomas
  3. inflammatory cell reaction
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3
Q

How long does repair last?

A

5 - 14 days

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4
Q

4 key features of repair stage?

A
  1. phagocytosis of necrotic fibers
  2. regeneration of myofibers
  3. formation of scar tissue
  4. capillary ingrowth
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5
Q

How long does remodelling last?

A

14 - 21 + days

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6
Q

3 key features of remodelling stage?

A
  1. maturation of myofibers
  2. contraction and organization of scar tissue
  3. recovery of function
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7
Q

_____ = muscle injury caused by sudden extneral force

A

contusion

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8
Q

Result of a contusion?

A

bleeding in deep muscle regions

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9
Q

Treatment for contusions first 48 hours ?

A
  1. PRICE no HARM (heat, alcohol, running, massage)
  2. put muscles on as much stretch as possible
  3. crutches if necessary
  4. gentle pain free ROM/stretch
  5. progressive exercise after acute phase
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10
Q

Recovery time for grade I (mild) contusion?

A

2 - 3 weeks

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11
Q

Recovery time for grade II (moderate) contusion?

A

4-6 weeks

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12
Q

Recover time for grade III (severe) contusion?

A

8 weeks

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13
Q

2 complications of contusions ?

A
  1. compartment syndrome

2. myositis ossificans

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14
Q

3 things to check for compartment syndrome?

A
  1. capillary refill
  2. sensation
  3. muscle strength
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15
Q

Majority of strains and tears mainly occur in _______ muscles at the muscle - tendon junction

A

biarticular

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16
Q

Strains and tears mainly occur during ________ loading or high intensity, ______ activities

A

eccentric; explosive

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17
Q

Long head of biceps femoris strains/tears occur during?

A

terminal swing phase of high speed running

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18
Q

Semimembranosus strains/tears occur during?

A

concurrent hip flexion + knee extension

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19
Q

5 risk factors for strains and tears?

A
  1. prior injury
  2. age
  3. unaccustomed activity
  4. training errors
  5. biomechanics
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20
Q

Suspect MO if contusion hasn’t healed within __-__ weeks

A

2-3

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21
Q

Grade __ strain and tear = microscopic tearing, pain / tightness, NO weakness; relative rest to protect tissues

A

I

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22
Q

Grade __ strain and tear = partial macroscopic tearing ; pain and structural change ( decreased strength, laxity)

A

II

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23
Q

Grade __ strain and tear = complete tear / painless and weak, may see lump

A

III

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24
Q

Dx of grade III muscle tear?

A

myotomal weakness (neuro impairment)

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25
Q

To include in Ax of strains and tears?

A
  1. AROM
  2. PROM
  3. strength
  4. muscle length
  5. ligament/ stability tests
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26
Q

Rx for acute stage of strain?

A

PRICE , crutches for LE’s

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27
Q

Rx for repair stage of strain?

A

modalities, DTF, strength, stretching

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28
Q

Rx for remodelling stage of strain?

A

strength + stretching

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29
Q

When can pt RTP post strain?

A
  1. symmetrical muscle length, strength, power, no s/s. core control
  2. completion of progressive functional progressions + sport specific drills + practice session
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30
Q

Rx for inflammatory stage of laceration?

A

optimize gait so scar tissue aligns properly for healing

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31
Q

Rx for repair stage of laceration?

A

gradual ROM + strength

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32
Q

Rx for remodelling stage of laceration?

A

gradual increase in load and velocity

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33
Q

DOMS possibly due to local nerve endings response to altered environment including what 4 things?

A
  1. acid
  2. pH
  3. swelling
  4. inflammation
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34
Q

You should avoid anti-inflammatories during DOMs if possible (T/F)

A

TRUE

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35
Q

Pelvic floor innervation?

A

Pudendal (S2-S4)

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36
Q

7 methods for Ax pelvic floor (PF) dysfunction?

A
  1. digital
  2. EMG
  3. manometer
  4. dynamometer
  5. real time US
  6. MRI
  7. biofeedback
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37
Q

Chronic pelvic pain = pain > __ months between what 2 areas?

A

3; diaphragm and knees

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38
Q

4 possible causes of pelvic pain?

A
  1. MSK
  2. neuro
  3. urogenital
  4. gynecological
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39
Q

Common age range for chronic pelvic pain?

A

25-35 years

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40
Q

Ax for what 3 things in pt with chronic pelvic pain?

A
  1. urogenital s/s
  2. lumbar / pelvic/ groin mechanical presentation
  3. core activation difficulty
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41
Q

Rx for chronic pelvic pain (4)?

A
  1. decrease PF resting tone
  2. increase PF proprioception
  3. increase motor control
  4. decrease pain sensitization
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42
Q

___ % of pregnancies = weakness/ laxity of PFM during pregnancy / childbirth

A

50

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43
Q

Hx of PGP?

A

previous hx of back pain / trauma

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44
Q

3 causes of PGP?

A
  1. laxity
  2. asymmetry
  3. inadequate motor control
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45
Q

PGP may be felt ant/lat/post pelvis, groin, ant/post thigh, abdomen and coccyx, with what 2 positions?

A
  1. sustained positions OR

2. transitional movements

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46
Q

3 signs of PGP?

A
  1. posture
  2. asymmetry
  3. gait
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47
Q

Posture that might be seen in someone with PGP?

A
  1. locked knees
  2. L spine lordosis
  3. thoracic kyphosis
  4. FHP
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48
Q

Gait abnormalities that might be seen in a pt with PGP?

A
  1. shuffling
  2. waddling
  3. leg drag
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49
Q

6 things to Ax in pt with PGP?

A
  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
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50
Q

5 categories of treatment for PGP?

A
  1. education
  2. posture
  3. manual therapy
  4. exercise
  5. movement strategies (glutes)
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51
Q

Maintenance in terms of PF exercises?

A

8-12 contractions 2x/week

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52
Q

________ = herniation of bladder into vagina

A

cystocele

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53
Q

_______ = herniation of rectum into vagina

A

rectocele

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54
Q

_____ ______ = herniation of uterus into vagina

A

uterine prolapse

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55
Q

_____ = pain with activity + PROM, possibly asymmetry

A

sprain

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56
Q

Grade __ sprain = minor rupture, few fibers torn, stability maintained

A

I

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57
Q

Grade __ sprain = partial rupture, increased laxity, NO gross instability

A

II

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58
Q

Grade ___ sprain = complete rupture, gross instability

A

III

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59
Q

Ax (2) for sprains?

A
  1. stability testing (laxity + EF!)

2. pain

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60
Q

Rx for acute stage of sprain? (3)

A
  1. PRICE
  2. structural support
  3. offload area
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61
Q

Rx for repair stage of sprain ? (3)

A
  1. stability w/ muscle strength
  2. DTFM, modalities
  3. progressive loading (linear movement)
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62
Q

Rx for remodelling stage of sprain? (3)

A
  1. DTFM
  2. progressive loads + dynamic movement (multidirectional)
  3. sport / function specific
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63
Q

3 MOI’s for high ankle sprain?

A
  1. planted foot + IR of leg (ER of talus in mortise)
  2. hyper DF
  3. falls, twisting, MVA
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64
Q

3 ligaments affected in high ankle sprain?

A
  1. AITFL
  2. PITFL
  3. interosseous
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65
Q

S/S of high ankle sprain? (3)

A
  1. limited swelling
  2. antalgic gait
  3. TOP @ injury site (AITFL, PITFL, anterior distal tib-fib area)
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66
Q

Dx of high ankle sprain? (7)

A
  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
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67
Q

Rx for phase 1 high ankle sprain (0-2 weeks)?

A
  1. decrease inflammation w/ PRICE, modalities for edema/ROM, immobilization
  2. light ROM
  3. NWB w/ crutches
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68
Q

Rx for phase 2 high ankle sprain (2-4 weeks?)

A
  1. regain normal mobility
  2. increase strength and function
  3. joint mobs to restore DF
  4. PWB ambulation
  5. bilateral balance training
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69
Q

A pt can PWB in phase 2 of high ankle sprain but they MUST be ___ ____ and you can use a heel lift

A

pain free

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70
Q

Rx or phase 3 high ankle sprain ?

A
  1. increase function

2. unilateral balance and strength

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71
Q

Rx for phase 4 high ankle sprain (RTS!) ?

A
  1. cutting, jumping
  2. more aggressive strengthening
  3. increase walking speed
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72
Q

Recovery for high ankle sprains = __ x as long as regular

A

2

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73
Q

Tendon is composed of _____ and _____

A

tenocytes; ECM

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74
Q

_____ = part of tendon, crave mechanical load

A

tenocytes

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75
Q

____ = part of tendon, collagen and glycosaminoglycan

A

ECM

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76
Q

Loading tendons leads to what 3 things ?

A
  1. increase collagen synthesis
  2. cellular proliferaion
  3. alignment
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77
Q

Tendinopathy = chronic ______ and loss of collagen _______

A

microtrauma; organization

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78
Q

There is evidence of inflammation in tendinopathy (T/F)

A

FALSE

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79
Q

4 things you see with tendinopathies?

A
  1. collagen disorganization
  2. glycosaminoglycan
  3. variable tenocyte density
  4. increase vessels/nerve
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80
Q

Rx for tendinopathy?

A

proper loading and resting of tissue

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81
Q

9 risk factors for achilles tendinopathy ?

A
  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
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82
Q

S/S of achilles tendinopathy?

A
  1. thickened tendon

2. TOP

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83
Q

DDx of achilles tendinopathy? (2)

A
  1. achilles tendon partial rupture

2. sever’s disease

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84
Q

____ disease = inflamed calcaneal apophysis, pulls on tendon at insertion

A

Sever’s

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85
Q

Severs disease effects growing active children b/w __ - ___ years ish

A

9-14

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86
Q

Rx for severs disease?

A
  1. activity modification

2. rest

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87
Q

Rx for achilles tendinopathy? (5)

A
  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
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88
Q

In the exercise program for achilles tendinopathy, _______ loading is necessary!

A

ECCENTRIC

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89
Q

4 examples of components of exercise program for achilles tendinopathy ?

A
  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
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90
Q

DeQervains tenosynovitis iis an inflammation of the sheath / tunnel surrounding which 2 muscles?

A
  1. extensor pollicis brevis

2. abductor pollicis longus

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91
Q

Main test for Ax of DeQuervains?

A

Finkelstein

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92
Q

Rx for DeQuervains?

A
  1. acute = offload tissue, PRICE, risk factor education

2. corticosteroid injection

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93
Q

90% of cases of tennis elbow involve which muscle ?

A

ECRB

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94
Q

10% of cases of tennis elbow involve what 2 muscles ?

A
  1. common extensor tendon

2. origin of ECRL

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95
Q

Tennis elbow is wore with what 3 activities ?

A
  1. gripping
  2. repetitive reach / grasp
  3. repetitive overload
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96
Q

3 tests to use for tennis elbow that are + if there is pain over the lateral epicondyle?

A
  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
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97
Q

Tennis elbow has nerve S/S (T/F)

A

FALSE

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98
Q

How to rule out nerve involvement with tennis elbow?

A

radial nerve ULTT

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99
Q

Ddx for tennis elbow includes C spine referral of C__-__

A

5-7

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100
Q

When to start eccentric muscle training with tennis elbow?

A

repair stage!

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101
Q

Avoid NSAIDS in acute stage of tennis elbow (T/F)

A

TRUE

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102
Q

RC tendinopathy usually involves which 2 muscles?

A
  1. long head biceps tendon

2. surpaspinatus

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103
Q

___ RC impingement = narrowed subacromial space, usually in older pt

A

primary!

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104
Q

___ RC impingement = instability, usually younger patients

A

SECONDARY

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105
Q

3 tests for RC impingement?

A
  1. Neers
  2. Speeds
  3. Empty can
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106
Q

5 main categories for Rx or RC tendinopathy?

A
  1. correct biomechanical faults
  2. modalities
  3. DTFM
  4. manual therapy
  5. education
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107
Q

______ ______ = due to repetitive loading in extensor mechanism of knee

A

patellar tendinopathy

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108
Q

6 risk factors for patellar tendinopathy?

A
  1. male
  2. jumping athletes
  3. jump height
  4. reduced DF
  5. age
  6. BMI
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109
Q

Rx for patellar tendinoapthy?

A
  1. slow heavy load (eccentric and concentric)
  2. scan ( find muscle imbalances and biomechanical faults)
  3. determine if knee is in valgus position
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110
Q

_______ _____ syndrome = TOP found within muscle, onset = sudden overload / over stretching and/or repetitive strain, sustained mm activities

A

myofascial pain

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111
Q

____ ____ = free floating piece of bone of cartilage

A

loose body

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112
Q

ROM end feel due to loose body may be what 2 things?

A
  1. bony block

2. springy

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113
Q

________ = excessive laxity or length of a tissue

A

hypermobility

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114
Q

Hyermobility = increase _____ ____ of joint

A

neutral zone

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115
Q

______ ______ = ROM in position where osteoligamentous structures provide minimal resistance ie joint glide is most free

A

neutral zone

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116
Q

_______ = excessvie ROM of arthrokinematics or osteokinematics

A

instability

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117
Q

_______ = OA of spine, degeneration of joints

A

spondylosis

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118
Q

_______ = pars interarticualaris defect

A

spondylolysis

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119
Q

Spondylolysis is seen in what population(s)?

A

younger patients w/ hyper EXT and ROT sports

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120
Q

Spondylolysis is mostly asymptomatic (T/F)

A

TRUE

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121
Q

Is a spondylolysis is bilateral, it may lead to _______

A

spondylolisthesis

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122
Q

Spondylolisthesis (increases/decreases) the intervertebral foramen

A

DECREASES!

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123
Q

Where is a spondylolisthesis most common?

A

L5/S1

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124
Q

_____ spondylolisthesis = during progressive period of rapid growth, rarely progresses to adult life

A

spondylolytic

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125
Q

_______ spondylolisthesis = secondary to DJD + Z joint subluxation, OA of joints in spine, older population

A

degenerative

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126
Q

S/S of spondylolisthesis?

A
  1. central LBP +/- referred pain

2. weak abs + / - tight hamstrings

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127
Q

Aggravating factors for spondylolisthesis?

A

extension

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128
Q

Easing factors for spondylolisthesis?

A

flexion

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129
Q

4 Rx’s for spondylolisthesis?

A
  1. FLEXION exercises
  2. inner unit strengthening
  3. brace if appropriate
  4. work into painful range with proper stability
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130
Q

4 spondylolisthesis cases where you might need to get surgery?

A
  1. increased slippage or instability even with brace
  2. hard neuro signs
  3. evidence of SC involvement
  4. intractable pain despite treatment
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131
Q

Change to tendon due to hypo mobility?

A

decreased tensile strength

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132
Q

Change to ligaments due to hypo mobility?

A

decreased tensile strength and increased stiffness/adhesions

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133
Q

Change to cartilage due to hypomobility?

A

decreased synovial fluid, H2O content

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134
Q

Change to bone due to hypo mobility?

A

increased respiration, decreased bone mass/ mineral content

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135
Q

Instability test for scapula?

A

wall push up

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136
Q

instability test for anterior GHJ?

A

anterior apprehension test

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137
Q

Instability test for posterior GHJ?

A

posterior apprehension test

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138
Q

Instability test for inferior GHJ?

A

sulcus sign

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139
Q

2 complications of instability in the GHJ?

A
  1. RC tears

2. axillary nerve damage

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140
Q

What does TUBS stand for?

A

traumatic onset, unidirectional anterior, Bankart lesion, surgery

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141
Q

_____ lesion = # of anterior / inferior capsule and ligaments

A

Bankart

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142
Q

S/s of Bankart lesion?

A
  1. clicking
  2. apprehension
  3. deep vague pain
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143
Q

_____ lesion = superior labrum lesion anterior –> posterior

A

SLAP

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144
Q

MOI is SLAP lesion?

A

elevated position with sudden concentric and eccentric biceps contraction

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145
Q

_____ lesion = major cause of pain in throwers

A

SLAP

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146
Q

____ - ____ lesion = compression # of posterior / lateral humeral head

A

Hill-Sachs

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147
Q

___ + _____ in shoulder may present with deformity, constant pain and systemic sings such as nausea

A

; dislocation

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148
Q

What does AMBRI stand for

A

atraumatic, multidirectional, bilateral shoulder findings, rehab appropriate, INF capsule shift

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149
Q

Sx often done in AMBRI conditions due to laxity (T/F)

A

TRUE

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150
Q

In an AC joint subluxation, the clavicle moves _____ and ____ in relation to acromion

A

posterior / superior

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151
Q

What 2 ligaments are the main stabilizers of the AC joint?

A
  1. trapezoid

2. conoid

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152
Q

AC joint subluxation will present with a ____ ______

A

step deformity

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153
Q

2 conditions which was present with AC joint subluxation?

A
  1. RA

2. multiple myeloma

154
Q

Femur growth plate closure: proximal at ___ years and distal at __ years

A

18;20

155
Q

Tibia growth plate closures: proximal at __ - __ years, distal at __ - __ years

A

16 - 18; 15 - 17

156
Q

Humerus growth plate closure: proximal at __ years and distal at ___ years

A

20 ; 16

157
Q

Radius growth plate closure: proximal at __ years and distal at ___ years

A

18;20

158
Q

_______ = end of long bone

A

epiphysis (where joint is!)

159
Q

_______ = shaft of long bone

A

diaphysis

160
Q

_____ # = twisting injury

A

spiral

161
Q

_____/_____ # = direct blow

A

transverse / oblique

162
Q

_____ / ____ # = longitudinal force

A

compression / crush

163
Q

______ # = fragments of bone

A

comminuted

164
Q

_____ # = young kids, # only on one side

A

greenstick

165
Q

_______ # = piece of bone pulled off

A

avulsion

166
Q

_____ # = d/t compression of force

A

impact

167
Q

Colles # ?

A

distal radius + subluxation of distal ulna

168
Q

Bennetts #?

A

dislocation of CMC thumb joint

169
Q

Scaphoid # usually due to _____

A

FOOSH

170
Q

6 areas where avascular necrosis post # is common?

A
  1. proximal femur
  2. 5th MT
  3. scaphoid
  4. proximal humerus
  5. talus neck
  6. navicular
171
Q

3 Rx for #’s?

A
  1. joint mobility above / below
  2. isometric strength
  3. CV fitness maintenance
172
Q

3 locations for hip #’s?

A
  1. femoral neck
  2. intertrochanteric
  3. subtrochanteric
173
Q

Conservative Rx for hip #’s = (slower/longer) rehab

A

SLOWER

174
Q

____arthoplasty = femoral head replacement

A

hemi

175
Q

____arthroplasty = femoral head + acetabular replacement

A

total

176
Q

_____ type of hip replacement = better stability, better for sedentary elders with poor bone quality

A

cemented

177
Q

_______ type of hip replacement = better for younger pts

A

uncemented

178
Q

Uncemented THA will need replacement within __ years

A

10

179
Q

____ hip replacement = femoral component is cemented, acetabular component is not cemented

A

hybrid

180
Q

Precautions for post-lateral THA?

A
  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
Q

Precautions for lateral THA?

A
  1. no hip FLEX past 90
  2. no IR
  3. no hip ADD past midline for first 3 months
182
Q

Precautions for anterior THA?

A
  1. no hip EXT
  2. no ER
  3. no hip ADD past midline for first 3 months
183
Q

Precautions for hemiarthoplasty, cannulated screws, DHS and gamma nails?

A

typically NO restrictions with movement an WBAT!

184
Q

2 indications for a shoulder hemiarthroplasty?

A
  1. arthritic conditions without glenoid involvement

2. severe # of proximal humerus head

185
Q

4 indications for a total shoulder arthroplasty?

A
  1. OA
  2. inflammatory arthritis
  3. osteonecrosis involving the glenoid
  4. post traumatic degenerative joint disease
186
Q

To have a TSA the pt MUSt have an intact ____ ____ _____

A

rotator cuff complex

187
Q

Post op precautions for TSA?

A

immobilization daily for 1 week, nightly for 1 month, sling for 4 weeks

188
Q

2 indications for a reverse total shoulder arthroplasty?

A
  1. OA

2. compound #’s of humerus w/ deficiency of rotator cuff

189
Q

Post op precautions for reverse TSA?

A
  1. flexion / elevation in scapular plane passively up to 90 degree
  2. pure abduction
190
Q

What position is CI for reverse TSA, and for how long ?

A

AVOID IR! for 6 WEEKS!

191
Q

______ bone is most affected by OP

A

cancellous

192
Q

OP = decrease in bone ____ and especially bone ______ = increased risk of #

A

density ; QUALITY

193
Q

WHO OP categories normal T score?

A

0-1 SD of young adult mean

194
Q

WHO OP categories low bone mass T score?

A

1-2.5 SD below young adult mean

195
Q

What T score is classified as osteopenia?

A

1-2.5 SD below young adult mean

196
Q

WHO OP categories OP T score?

A

2.5+ SD below the young adult mean

197
Q

Severe / established OP = presence of ______ _____

A

fragility #

198
Q

Primary type 1 OP?

A

post menopausal women

199
Q

Primary type 2 OP?

A

70+ years

200
Q

Risk of primary type 2 OP is = for men and women (T/F)

A

TRUE

201
Q

Secondary OP is due to what?

A

other medical condition or treatment

202
Q

7 risk factors for OP?

A
  1. family hx
  2. lifestyle
  3. gender
  4. age
  5. lifetime exposure to estrogen
  6. breast ca
  7. fragility # under 40 years
203
Q

Dx of OP?

A
  1. bone scan

2. # assessment tools

204
Q

2 # ax tools?

A
  1. FRAX

2. CAROC 2010

205
Q

Common OP # sites?

A
  1. wrist
  2. humerus
  3. vertebrae
  4. hip
206
Q

3 possible side effects of OP medication?

A
  1. vertigo
  2. dizziness
  3. muscle / back / LE / UE pain
207
Q

5 possible PT Rx for OP?

A
  1. posture
  2. aerobic
  3. resistance exercise
  4. balance
  5. extension exercises
208
Q

With OP, what movement do you really want to avoid (ESP w/ spine OP?)

A

NO spine flexion + flexion + rotation

209
Q

Tumor/pathological #’s can manifest as _____ / _____ injuries

A

sports / mechanical

210
Q

Primary malignant tumors of soft tissue / bone are rare but they may occur in _____

A

youth

211
Q

______ = at ends of long bone, pain @ joint, worse with activity

A

osteosarcoma

212
Q

Rx for osteosarcoma?

A

Sx (Terry Fox)

213
Q

How would an osteosarcoma display on an X ray?

A

moth eaten appearance

214
Q

_______ ______ = in larger joints like knee and ankle; pain at night and worse with activity; swelling / instability

A

synovial sarcoma

215
Q

Rx for synovial sarcoma?

A
  1. Sx

2. chemo / radiation

216
Q

______ _______ = benign bone tumor; pain in bone at night, worse with exercise; often mistaken for bone #

A

osteoid osteoma

217
Q

KEY sign of osteoid osteoma?

A

NO pain with ASPIRIN!

218
Q

How would an osteoid osteoma show on CT scan?

A

w/ central focus point

219
Q

Rx for osteoid osteoma ?

A
  1. ablation
  2. ethanol
  3. laser
220
Q

_____ _____ _______ = due to mechanical change, joint disease or joint trauma

A

degenerative joint disease

221
Q

DJD is mostly seen in pts > ____ years

A

40

222
Q

spinal stenosis = decreased IVF, increased ______ s/s

A

radicular (myotome, dermatome)

223
Q

central stenosis = increase in spinal canal compression, increase in _____ s/s

A

central (central cord signs like b/b)

224
Q

_______ = spine OA effected Z joints and foramen

A

spondylosis

225
Q

________ = pars interarticularis defect, may start as stress #

A

spondylolysis

226
Q

4 outcome measures for spondylolisthesis?

A
  1. pain w/ lumbar EXT in SLS
  2. pain free lumbar EXT ROM
  3. facilitated segment
  4. lumbopelvic control
227
Q

OA leads to hypertrophy of ______ bone

A

subchondral

228
Q

4 signs of OA?

A
  1. dec joint space
  2. dec cartilage height
  3. inc osteophytes
  4. inc subchondral bone sclerosis + proliferation
229
Q

Normal plumb line surface marks?

A
  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
Q

Sway-back = pelvis shifted ____ in relation to thorax, leading to increased lumbar ____, thoracic _____ and hip _____

A

forward; lordosis; kyphosis; extension

231
Q

What muscles are short and strong in sway-back postures?

A
  1. hamstrings

2. upper fibers of internal oblique

232
Q

What muscles are long and weak in sway-back postures?

A
  1. single joint hip flexors
  2. external oblique
  3. upper back extensors
  4. neck flexors
233
Q

What muscles are short and strong in head forward posture?

A
  1. lev scap
  2. SCM
  3. scalenes
  4. suboccipitals
234
Q

What muscles are long and weak in head forward posture ?

A
  1. deep neck flexors

2. erector spinae at CT junction

235
Q

3 types of scoliosis?

A
  1. idiopathic
  2. congenital
  3. neuromuscular
236
Q

_______ scoliosis = actual boney changes

A

sctructural

237
Q

_______ scoliosis -= due to LLD

A

functional

238
Q

2 S/S of scoliosis?

A
  1. decreased nerve conduction

2. decreased nerve mobility

239
Q

Degree of scoliosis s/s depends on ____ of ______

A

degree of constraint

240
Q

Ax of scoliosis?

A
  1. forward bend test
  2. muscle imbalance
  3. dec proprioception
241
Q

4 categories of Rx for scoliosis?

A
  1. posture
  2. stretch/strengthen
  3. CV training
  4. if severe –> bracing and surgery
242
Q

Posture is obtained from ______ (muscle) and _____ stabilizers (bone, ligament, fascia, joint)

A

dynamic; static

243
Q

Postural back pain is caused by tissue _____

A

creep!

244
Q

6 s/s of postural back pain?

A
  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
Q

WSBC recommendations for ergonomics: eyes looking slightly ______ (~__ degrees) with screen __ - __ cm from floor

A

downward; 30; 64-75

246
Q

WSBC recommendations for workplace ergonomics: top of line of text should be at ____ level

A

eye

247
Q

WSBC recommendations for workplace ergonomics: there should be an ____ length between eyes and screen

A

arms

248
Q

WSBC recommendations for workplace ergonomics: minimum height for backrest ?

A

45 cm

249
Q

Healing time in desc lesions?

A

ligaments usually take ~ 3 months to heal

250
Q

4 potential s/s of disc lesion?

A
  1. central back pain +/- leg pain
  2. +/- lateral shift
  3. loss of normal lordosis
  4. b/b changes ?
251
Q

Lateral shift sometimes seen in disc lesions is named relative to the ______

A

shoulders

252
Q

2 agg factors for disc lesions?

A
  1. coughing

2. FLEX

253
Q

S/s of stenosis ?

A
  1. bilateral radiation to legs and feet

2. X ray changes

254
Q

Agg position for stenosis?

A

EXT!

255
Q

______ = inflammatory response d/t infection in bone

A

osteomyelitis

256
Q

Osteomyelitis is usually due to ____ ____ infection

A

staph aureus

257
Q

Osteomyelitis in children is often found in _____ _____

A

long bones

258
Q

Osteomyelitis in adults may be found in ____ or _____

A

veterbrae ; feet

259
Q

When should you suspect osteomyelitis ?

A 
if pt has ... 
1. localized swollen joint
2. no trauma hx
3. no other affected joints 
SEND TO ER
260
Q

5 s/s of osteomyelitis?

A
  1. prominent night pain
  2. effusion in and around joint
  3. weight loss
  4. appetite loss
  5. malaise
261
Q

________ = tendon inflammation d/t repetitive microtrauma

A

tendonitis

262
Q

_______ = chronic tendon dysfunction

A

tendinosis

263
Q

Bursitis will result in decreases in both AROM and PROM (T/F)

A

TRUE

264
Q

2 most common causes of amputations?

A
  1. DM

2. PVD

265
Q

Are symes amputations more or less functional than trans tibial?

A

MORE

266
Q

What is a large con of a symes amputation?

A

HIGH risk of skin breakdown

267
Q

Prosthesis for symes amputation?

A
  1. similar to trans tibial

2. partial patellar WB posible

268
Q

Transtibial prosthesis: socket can be what two things?

A
  1. total surface bearing

2. patellar tendon bearing

269
Q

Medial/lateral flares of transtibial amputation are pressure ______ areas

A

tolerant

270
Q

3 suspension systems for TT amputees?

A
  1. supracondylar
  2. suprapatellar cuff
  3. sleeve
  4. locking pin
  5. suction
271
Q

4 gait deviations in stance phase TT amputees ?

A
  1. foot flat
  2. foot slap
  3. knee hyperextension / buckling
  4. early heel rise
272
Q

4 gait deviations in swing phase TT amputees ?

A
  1. decrease stride length (less WB on amputated side)
  2. toe drag
  3. lat/med whip
  4. vaulting
273
Q

WB for TF amputees?

A

through ISCHIAL TUBEROSITIES

274
Q

TF amputations require __% more energy to ambulate w/ prosthesis

A

60

275
Q

Adductors tendon is a pressure _______ area in TF amputees

A

sensitive

276
Q

3 types of prosthetics for TF amputees?

A
  1. manual lock
  2. mechanical / friction
  3. hydraulic / pneumatic / microprocessor
277
Q

5 gait deviations in stance phase in TF amputees?

A
  1. ABD,
  2. lat trunk shift
  3. Inc trunk lordosis
  4. hip flex
  5. dec stance time
278
Q

4 gait deviations in swing phase in TF amputees?

A
  1. med/lat whips
  2. circumduction
  3. hip hike
  4. vaulting w/ good leg
279
Q

Hip disarticulation: requires __% energy expenditure compared to able body individual

A

210%

280
Q

Knee / hip flexion contraction > __ deg = not open for prosthesis!

A

20

281
Q

Typical contractors for TT amputation?

A

knee and hip FLEX

282
Q

Typical contractors for TF amputation?

A

hip FLEx and hip ABD

283
Q

3 things NOT to do for TT/TF amputees?

A
  1. NO pillow under legs / hips in supine
  2. NO pillow bw legs TF
  3. NO raising foot of bed
284
Q

Prosthesis fit: ______ = interface bw socket and limb

A

liner

285
Q

Prosthesis fit: ______ = system keeps prosthesis on residual limb

A

suspension

286
Q

Prosthesis fit: _____ = gel or foam

A

liners

287
Q

____ liner can be right next to skin for amputees, ____ liner must have sock underneath

A

gel; foam

288
Q

Prosthesis fit: _____ ensure proper fit

A

socks

289
Q

Prosthesis fit: _____ / _____ connects socket to foot, provides height

A

shank / pylon

290
Q

Compression bandages are wrapped distal to proximal, with horizontal passes and worn at ALL times, changed every 6 hours (T/F)

A

FALSE - wrapped DIAGONALLY and changed every 4 HOURS

291
Q

Results of developmental dysplasia of the hip (DDH)?

A

acetabulum and femur not i close contact = subluxation and dislocation

292
Q

Spontaneous recovery of DDH w/in the first __ weeks of life is common

A

2

293
Q

4 risk factors for DDH?

A
  1. female
  2. family history
  3. breech position
  4. tight swaddling
294
Q

3 S/S of DDH?

A
  1. LLD
  2. muscle weakness
  3. waddling gait
295
Q

2 Ax for DDH?

A
  1. barlow maneuver

2. ortlani maneuver

296
Q

_____ maneuver = FLEX then ABD then ADD w/ POST pressure

A

barlow

297
Q

_______ maneuver = FLEX then ADD + slight traction

A

ortlani

298
Q

Rx for DDH = keep hip in Flex and ABD w/ ____ harness, and whats 1 thing to no do?

A

Pavlik; double diapering

299
Q

3 things club foot might be due to ?

A
  1. congenital bone deformity
  2. cerebral palsy
  3. calf mm contracture
300
Q

4 types of club foot?

A
  1. idiopathic
  2. neurogenic
  3. syndromic
  4. postural
301
Q

Most common type of club foot ?

A

idiopathic

302
Q

_____ type of club foot resolves quickly with minimal intervention

A

postural

303
Q

1 risk for developing club foot?

A

intrauterine growth restriction

304
Q

3 Rx for club feet?

A
  1. manipulation
  2. serial casting + splinting
  3. Sx
305
Q

_______ _______ = autosomal dominant connective tissue disorder

A

osteogenesis imperfecta

306
Q

OI = issue converting pro-collagen –> collagen type __

A

1

307
Q

Type __ OI = most common and least severe

A

1

308
Q

Type __ OI = lethal in perinatal period

A

2

309
Q

Type __ OI = severe, progressive deformity, very short

A

3

310
Q

Type __ OI = rare and mild, moderate deformity, can ambulate

A

4

311
Q

Pt w/ OI will have diffuse _______ leading to multiple recurrent #’s

A

OP

312
Q

_____ ____-_____ disease = avascular necrosis of femoral head

A

legg calve-perthes disease (LCP)

313
Q

LCP disease most commonly effects active males between the ages __ - __ years

A

5-7

314
Q

LCP disease is usually (uni/bilateral)?

A

uni

315
Q

LCP disease S/S = hip, knee and groin pain, usually in ___ first

A

knee

316
Q

LCP disease = + trendelenburg (T/F)

A

TRUE

317
Q

LCP disease = decrease ROM in what 2 positions?

A
  1. ABD

2. IR

318
Q

_________ = pain due to nerve root compression

A

radiculopathy

319
Q

S/S of radiculopathy depend on degree of _______, but may include pain, numbness/tingling and decreased nerve ______

A

compression; conduction

320
Q

Spinal stenosis = hypertrophy of spinal ______, ______ _____ and facets

A

lamina; ligamentum flavum

321
Q

Spinal stenosis can lead to _____ or _____ compromise

A

vascular; neural

322
Q

3 Rx for spinal stenosis ?

A
  1. joint mobs
  2. flex based exercises
  3. traction
323
Q

3 things thoracic outlet could be due to?

A
  1. impinged brachial plexus
  2. vagus nerve compression
  3. subclavian artery / vein compression
324
Q

4 common impingement sites for TOS?

A
  1. superior thoracic outlet
  2. scalene triangle
  3. b/w clavicle and 1st rib
  4. b/w pec minor and thoracic wall
325
Q

4 Ax tests for TOS?

A
  1. adson
  2. allen / wrights
  3. military test
  4. costoclavicular test
326
Q

2 areas ulnar nerve can become trapped?

A
  1. cubital tunnel

2. tunnel of Guyon

327
Q

Cause of ulnar nerve becoming trapped in cubital tunnel may be due to compression due to thicken retinaculum/hypertophy of which muscle ?

A

FCU

328
Q

2 S/S of ulnar nerve entrapment?

A
  1. medial elbow pain

2. parasthesias in ulnar distribution

329
Q

Test for ulnar nerve entrapment ?

A

posterior Tinel’s sign

330
Q

Location of median nerve entrapment?

A

within pronator teres + under FDS; carpal tunnel

331
Q

Cause of proximal median nerve entrapment ?

A

repetitive gripping activities

332
Q

3 S/S of proximal median nerve entrapment ?

A
  1. aching pain
  2. weakness of forearm muscles
  3. parasthesia in median distribution
333
Q

Test for proximal median nerve entrapment?

A

Tinels sign

334
Q

Cause of carpal tunnel and 3 conditions it may be associated with?

A

compression due to inflammation of flexor tendons w/ repetitive wrist activity -

  1. pregnancy
  2. diabetes
  3. RA
335
Q

Test for carpal tunnel syndrome?

A

Tinels / Phalens

336
Q

2 S/S of CTS?

A
  1. altered sensory function in median nerve distribution

2. atrophy/weakness of thenar muscles and lateral 2 lumbricals

337
Q

Where does the posterior interosseous nerve get entrapped?

A

radial tunnel

338
Q

Cause of post interosseous nerve entrapment ?

A

overhead activities

339
Q

3 S/S of post interosseous entrapment?

A
  1. lateral elbow pain
  2. pain over supinator
  3. parasthesias in radial nerve distribution
340
Q

Test for post interosseous nerve entrapment?

A

Tinels

341
Q

For post interosseous entrapment, first rule out what 2 things?

A
  1. cervical spine dysfunction

2. TOS

342
Q

_______ = any nerve disease characterized by decreased neural function

A

neuropathy

343
Q

______ = nerve compression, segmental demyelination + transient disruption

A

neuropraxia

344
Q

Neuropraxia recovery?

A

FAST; mins to weeks

345
Q

_______ = disruption of axon, myelin sheath still intact, likely a CRUSH injury

A

axonotmesis

346
Q

_______ = completely severed axon + sheath

A

neurotmesis

347
Q

Result of ______ = prolonged disruption, may cause paralysis of the motor, sensory and autonomic systems

A

axonotmesis

348
Q

Recovery of axonotemesis?

A

fair; may take months (wallerian degeneration!)

349
Q

Axon regrowth = __ mm/ day

A

1

350
Q

Axon regrowth for upper arm?

A

4-6 months, up to 2 years

351
Q

Axon regrowth for lower arm?

A

7-9 months, up to 4 years

352
Q

_______ = completely severed axon and sheath

A

neurotemesis

353
Q

Recovery of neurotemesis = only with _____

A

surgery

354
Q

______ ______ = process occurs with laceration / crushing of a nerve, axon separated from cell body

A

wallerian degneration

355
Q

Wallerian degeneration = degeneration occurs ____ to site of injury w/in 24-36 hours

A

DISTAL

356
Q

Wallerian degeneration can affect PNS and CNS (T/F)

A

TRUE

357
Q

_______ _______ = myelin breakdown for a few segments, but axons are preserved

A

segmental demyelination

358
Q

Segmental demyelination = mostly reversible because _____ cells make new myelin

A

schwann cells

359
Q

Example of condition where segmental demyelination takes place?

A

GBS

360
Q

(distal) _____ ______ = degeneration of axon cylinder and myelin possible due to inability of neuronal body to keep up with metabolic demands of axon

A

axonal degeneration

361
Q

S/S of distal axonal degeneration ?

A

characteristic DISTAL sensory loss and weakness

362
Q

________ _______ = autoimmune attack of ACh receptors at the NMJ

A

myasthenia gravis

363
Q

4 effects of myasthenia graves?

A
  1. progressive mm weakness
  2. dec CR function
  3. atrophy
  4. fatigue
364
Q

PT role in myasthenia gravis?

A
  1. activity within tolerance

2. prevent secondary conditions

365
Q

_____ _____ ___ _____ = hereditary condition of the PNS; extensive demyelination of motor and sensory nerves of hands and feet

A

charcot marie tooth disease

366
Q

5 S/S of charcot marie tooth disease ?

A
  1. distal SYMMETRIC muscle weakness
  2. dec deep tendon reflexes
  3. pes cavus
  4. hammer toes
  5. lose wrist/finger extension
367
Q

Charcot marie tooth disease = foot _______ atrophy

A

intrinsic

368
Q

Charcot marie tooth disease= decrease ___ and ___ mm

A

DF; eversion

369
Q

3 PT Rx’s for charcot marie tooth disease ?

A
  1. contrature management
  2. foot care education
  3. ID and retrain muscle imbalance
370
Q

Pain around what area may preclude development of bells palsy?

A

mastoid!

371
Q

S/S of bells palsy?

A
  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
Q

3 PT Rx for bells palsy?

A
  1. PROTECT EYE (eye patch / eye drops)
  2. massage
  3. PROM / AROM of facial muscles
373
Q

Chronic compression in TOS leads to edema, ischemia of nerve roots, _____ and _____ _____

A

neoropraxia; wallerian degeneration

374
Q

Does diabetic neuropathy occur without any other neuropathy cause ?

A

YES

375
Q

Diabetic neuroapthy = chronic ______ disturbance

A

metabolic

376
Q

Diabetic neuropathy affects nerves and what type of cells?

A

SCHWANN

377
Q

3 S/S of diabetic neuropathy?

A
  1. symmetric and distal sensory loss pattern
  2. painless paresthesia
  3. minimal motor weakness
378
Q

4 tests for dural tension?

A
  1. slump
  2. SLR
  3. PKB
  4. ULTT
379
Q

5 S/S of neurodynamic dysfunction?

A
  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
Q

______ scar = thick scar that extends beyond margins of original wound (hyper proliferation)

A

keloid

381
Q

_______ scar = not extending beyond original wound margins but has excessive tissue amount

A

hypertrophic scar

382
Q

What phase of scar formation does not really occur in a hypertrophic scar?

A

contraction!

Written Prep (9 decks)

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