nms opd sport Flashcards
1.1 Mr Tandwa injured his right hip when bending down to pick up a cement bag. The intensity of his pain is 2/10 at rest and goes up to 7/10 when he bends his hip. His pain subsides to 2/10 immediately upon returning to the starting position.
At the same time, however, he also had a heavy pull on his arm as he underestimated the weight of the bag. Since the incident, he is also experiencing intermittend paraesthesia down his arm and is noticing atrophy in his deltoid muscle. Interpret the irritability of Mr Tandwa’s condition. (4)
the irritability is condisdered an irritable joint and therefore caution needs to be taken with the objective assesment and treatment as its eay to flare up.
the reason- the activity when he bends down increases his pain from 2-7 and the pain subsides immediatly when he returns, thus high irritbility.
Mr Tandwa injured his right hip when bending down to pick up a cement bag. The intensity of his pain is 2/10 at rest and goes up to 7/10 when he bends his hip. His pain subsides to 2/10 immediately upon returning to the starting position.
At the same time, however, he also had a heavy pull on his arm as he underestimated the weight of the bag. Since the incident, he is also experiencing intermittend paraesthesia down his arm and is noticing atrophy in his deltoid muscle.
1.2 An important part of a subjective interview is to ask about the patient`s medical history as well as what medication they are taking. List three classes of medication which are relevant to a musculoskeletal subjective interview of an out-patient, and reason why each is important. (3x2=6)
steriods- as after long term use it weakens the tissues and predisposes to to osetoprosis
analgesics- this can conceal how much pain the patient is under and thus the pain described during the assessment may be less then their actual pain
anti-depresents- side affects of the medication can cause the patient to be agitated therefore need to treat with caution to not cause patient to increase in their agitation
1.4 Indicate the tests to be included in the physical assessment to determine the involvement of the C5 and C6 branches of the brachial plexus. (6)
shoulder abduction test for ax nerve
full can abduction test for suprascapular
external roatation test for supra nerve
elbow flextion test for musculotaneous
foramrm pronation test for median
refelex testing of bicepts brachi
shoulder abduction c5 30 degrees myotome
c6 elbow flexion
dermetome c5 lateral inferior to deltoid insertion
c6 thumb tip
2.1 Mr Khumalo is a 27 year old rugby player who was tackled in the training match five days ago. He presents with medial right knee pain (6/10 VAS), slight swelling, flexion ROM of 10º-100º, grade 3 muscle strength for knee extensors and limping when walking.
What is the test to confirm to medial collateral ligament? (2)
valgus stress test
Mr Khumalo is a 27 year old rugby player who was tackled in the training match five days ago. He presents with medial right knee pain (6/10 VAS), slight swelling, flexion ROM of 10º-100º, grade 3 muscle strength for knee extensors and limping when walking.
2.2 Discuss the treatment parameters when using ultrasound at this stage and progression. (10)
depth- 1mhz
pulse ration- acute pulse 4/3 20%,25%
intensity 01-0.3 w/cm2
1-2 minutes dependent on how big the area is compared to head of us
Mr Khumalo is a 27 year old rugby player who was tackled in the training match five days ago. He presents with medial right knee pain (6/10 VAS), slight swelling, flexion ROM of 10º-100º, grade 3 muscle strength for knee extensors and limping when walking.
2.3 Prescribe one open and one close chain exercise to strengthen the quadriceps muscle. (8)
bridge exercise with straight leg raise for open chain, 2 sets times 10 reps
closed exercise- wall squat 3 sets and 20-30sec hold 3 times a day
Question 2
Themba is a 32-year-old 100m sprinter who presents with type 1 acute hamstring strain. He reports to you with sudden onset of pain in the hamstring region that usually stops him from running.
2.1 Explain why do hamstrings fail during sprinting? (3)
in the second half of the swing phase the hamstrings are at their greatest lenghth and at this point they generate max tension. they contract eccentrically at this point to decelerate hip flex and exten of the lower leg. at this point a peak is reached in the activty of the muscle spindles in the hamstrings. a strong contraction of the hamstings and relaxsation of the quades is needed. a beakdown of coordination between the opposite muscles can cause the tear. the greatest musculo-tendon stretch is incurred by the biceps femoris, which may contribute to the tendency to be more often injured thean the semim and semit during high speed running
Themba is a 32-year-old 100m sprinter who presents with type 1 acute hamstring strain. He reports to you with sudden onset of pain in the hamstring region that usually stops him from running
2.2 Name two special tests you will include during your examination. (2)
- mid rom isometric hamstring contraction progress to resisted knee flex at 90 or 120 degrees of hip flexion
- stretch into hip flexion to 90 or 120 degrees with knee ext to the point of protective spasm
- take shoe off
Themba is a 32-year-old 100m sprinter who presents with type 1 acute hamstring strain. He reports to you with sudden onset of pain in the hamstring region that usually stops him from running
2.3 List five risk factors to acute hamstring strain. (5)
intrinsic- exessive or limited flexibility
lack of muscle endurance
tight hip flexors
neural tention
muscle imbalance, esp hamstring;quad less then 0.6
extrinsic
playing surface, insufficient loading short pre/previous injuries, no warm up, bad training tech, sudden overstretching
Themba is a 32-year-old 100m sprinter who presents with type 1 acute hamstring strain. He reports to you with sudden onset of pain in the hamstring region that usually stops him from running
2.4 Discuss the management of hamstring injury during the subacute/conditioning phase. (10)
goal- regain pain free hamstring strength, progressing through full rom
develop neromuscular control of trunk and pelvis with progressive increase in movement increase and speed preparing for funtional activities movements
- ice post exercisse, treadmil; at moderate to high intensity pain free speed and stride
isokinetic eccentrics in the non lenghend state, suppine hamstring curls, shuttle jumps,
once non weight bearing exercises are tolerated start low velocity eccentric activities such as stiff leg deadlifts
