Ocs misc Flashcards
Lysholm scale is for?
Ideal for meniscus/cartilage lesions/ knee ligament injury
Mdc is 10
International knee documentation committee IKDC is for…?
Ideal for knee ligament i jury
Mcid 11
Tegner scale is for…?
Knee ligament injury
Mdc is 1
Anterior knee pain scale AKPS is for…?
Patellofemoral pain
2010 cpr for cervical spine myelopathy
Gait deviation Hoffmans test Inverted supinator sign Babinski Age >45
In order to apply the laslett sacroiliac joint diagnostic cluster, what first must be completed
Centralization of pain not achieved during mckenzie evaluation of repeated movements/sustained positions
What treatment strategy has the most potential for success in managing patients with articular SIJ pain
Exercises aimed at stabilizing lumbopelvic mechanism and fluoroscopically guided intra articular cortisone injection
Ottawa knee
If one of the following is present, radiographs are indicated
Age >55 Patellar tenderness Tenderness to fibular head Inability to flex the knee to 90 Inability to WB immediately after injury and in ED
Ottawa knee rules vs PDR
Okr and pdr had identical sensitivity but the PDR had higher specificity than OKR
Regarding post operative ambulation and WB restrictions what is recommended in patients with meniscal repairs?
2018 CPG update states that clinicians may consider early progressive WB in patients with meniscal repairs
What evidence based intervention is best indicated at this time for carpal tunnel management
Wrist orthosis is the only intervention for carpal tunnel syndrome given level B evidence
No intervention is awarded level A
Arthroscopic findings for frozen shoulder by stage
Stage 1 diffuse synovial reactions without adhesions or contracture
Stage two aggressive St. Vitus angiogenesis and some laws of motion
Stage III moderate cellulitis capsule ligamentous fibrosis resulting in loss of the axillary fold and reduced passive range stage four capsule low ligamentous complex fibrosis and moderate minimal synovitis
Which special test is most specific for ruling in a femoral stress fracture
Patellar pubic percussion test has sensitivity of 95% and specificityof 86% for identifying femoral stress fractures
Fulcrum test has sensitivity of 93% and specificity of 75%
Which two questions are most useful to assist with differential diagnosis and ruling in a musculoskeletal cause of abdominal pain
Does taking a deep breath aggravate your symptoms?
And does twisting your back aggravate your symptoms?
Has a significant positive indication of a domino symptoms of musculoskeletal origin combination of these questions gave96% specificity
Asterixis
“Liver flap” is observed by having the patient extend the arms, spread the fingers, extend wrist and observe for the abnormal “ flapping” tremor at the wrist
If a tremor is not readily apparent ask the client to keep the arms straight while the therapist gently provides overpressure into wrist extension. Asterixis may also be observed when releasing the pressure in the arm cuff during blood pressure readings.
Sports hernia
Or hockey hernia or athletic pubalgia
Patients experience a “weakening or tearing of the transversalis fascia, conjoined tendon, and/or internal oblique fibers, creating an inside out hernia within the dorsal wall of the inguinal canal.
Associated with twisting, turning or directional changes in speed causing the hip to move into abduction adduction or extension
Ballistic movements such as frequently observed in soccer and ice hockey players leads to shearing at the pubic symphysis and resultant stress on the above structures
Pectineus tendinopathy
Presents with greatest pain provocation during resisted hip flexion and resisted hip adduction with the hip positioned in 90 degof flexion
Cpr for responding to mechanical cervical traction
Age >55
+ shoulder abduction test
+ ULTT A
Symptom peripheralization with lower cervical PA motion testing
+ neck distraction
Strength of evidence : I
evidence obtained from high quality diagnostic studies perspective studies or randomized controlled trials
strength of evidence: II
evidence obtained from lesser quality diagnostic studies, perspective studies or randomized controlled trials
—eg: weaker diagnostic criteria and reference standards; improper randomization; no blinding or less than 80% follow up
strength of evidence: III
case control studies or retrospective studies
strength of evidence: IV
case series
strength of evidence: V
expert opinion
p value definition
- comparing two or more groups
tells you the probability that the difference between groups occurred due to chance
almost always settle for 95% certainty
–which means any pvalue lower than 0.05 is statistically significant
alpha value
the point at which the researchers decide the results are statistically significant is called alpha level
ex a= 0.05 any pvalue less than 0.05 is statistically sign
type I error
- backing a loser
- concluding that their is a significant difference when there is not
typer II error
- missing a winner
- when researchers do not find a statistical sign differences when in reality there is. often due to too few subjects so they are unable to detect differences.
effect sizes
–” how much better?”
0.8 and up = large
0.5 - 0.799= moderate
0.2 - 0.499 = small
below 0.2 = trivial
test reliability
Kohen kapp: K
- runs on scale from 0-1 0 = no reliability <0.4 = poor 0.4-0.6 = fair 0.6-0.75 = good >0.75 = excellent 1 = perfect reliability
positive likelyhood ration
how much you should increase your suspicion of a certain condition based on pos test result
> 10 = large shift in prob
5- 10 = moderate shift towards diagnosis
<5 = small shift in probability
1 = no change
negative likelyhood ratio
how much you should decrease your suspicion of a certain condition based on neg test result
<0.1 large shift away from diagnosis
0.1 -0.2 moderate
>0.2 = small
1 no change
hawthorne
- quasi experiments outside of hawthorne illinois
- conclusion subjects that know they are being observed as part of a research study tend to work harder that they would otherwise.
john Henry effect
- railroad worker. worked so hard to beat steam drill that he died in process
- control group perceives that they are disadvantaged compared to experimental group that they work harder than they otherwise would have. they might seek out other treatments or perform more self treatments on their own
best thing to do would be to blind studies to knowing if they are in control group or experimental group
Pygmalion / rosenthal
- pigmelion effect describes how the expectation of those in authority shapes the outcome of their subjects.
this is why we blind clinicians
red flags associated with a back related tumor /Cancer
- constant pain not affected by position or activity
- age >50
- hx of CA
- failure to improve in 30
- no relive with bed rest
- unexplained weight loss
at least 2 or 3 together might call for referral out
types of cancer most likely to metastasize to spine
PT. BARNUM loves kids
- prostate
- thyroid
- breast
- lungs
- kidney
history of these cancer should increase suspicion
-ESR - erythrocyste sedimentation rate blood test
- ESR >20 : starts suspecting
- ESR>50 positive likelyhood ratio of 19.2 for CA
ODI
- most common low back pain outcome measure 100% complete disability 41-60: severe disability 21- 40: moderate disability 0-20: minimal disability 0 no disability
MCID: 10 points
roland morris disability questionnaire
list of 24 statements about back pain
- add up all responses. Score 24 is high disability
- MCID: 5 points
cauda equina red flags
- bowel& bladder changes
- saddle anesthesia
- sensory or motor deficits in the L$ L% S1 area
- urinary retention: is the most sensitive and specific
back related infection red flags
- recent infection
- IV drug user
- concurrent immunosupressant disorder
- deep constant pain that increase with WB
- fever malaise or swelling
- spine rigidity
–spine rigidity is least useful; fever and swelling most useful
—classic triad: back pain fever and neurological dysfunction.
spinal compression fracture red fags
- hx of major trauma: MVA or fall from height or direct blow to spine
- age >50 with >75 being even higher
- prolonged use of corticoid steroids
- point tenderness over site of fx
- increase pain with WB
Fenuken article: adds hx of osteoporosis and hx spinal fracture are high risk factors for subsequent fractures, trauma is even greater risk factor if spinal flexion; female sex; strength of evidence: prolonged corticosteroid use >3 months; thoracic pain
abdominal aneurysm red flags
- back/abdominal/groin pain
- presence of PVD or coronary artery disease and associated cardiovascular risk factors
- smoking hx
- family hx
- age >70
- non-caucasian
- female
- symptom not related to movement stresses associated with somatic low back pain
- presence of Bruit in central epigastric area upon auscultation
- palpable aortic pulse of 4cm or greater
–Er referral: 5cm aortic pulse with throbbing low back pain unrelated to movement stressed
Q angle
The structural relationship between the quadriceps muscle and patella is represented by the Q angle
A line extending from ASIS to patellar midpoint and from the the midpoint to the tibial tuberosity
Angles of 10-15 for male and 15-20 for women are normal
WOMAC indicis
Western ontario and mcmaster universities osteoarthritis index
Sen 77%
Spec 78%
24 items in 3 categories
0-100 ; 0 represents the highest level of knee function
Koos index
Knee injury and osteoarthritis outcome score
Extension of womac and designed to be more responsive to those of a higher activity level.
The questionnaire asks about pain other symptoms activities of daily living, function in sport and recreation, and quality of life. On a 0 to 100 scale, 100 represents best function. It has been validated on patient status post total knee receiving physical therapy. The minimal detectable change is dependent on section pain is 22 stiffness is 29, and physical function subscale is 13
Knee outcome scale KOS
Non specific knee condition
Mdc 8.8
Lower extremity functional scale
Lefs
All lower extremity conditions
Mdc 9
Useful with patients following arthroplasty and lowe extremity conditions of musculoskeletal origin
Measuring knee joint effusion
0 - none. Milk out swelling distal to proximal several times. Sleep proximal to distal on the lateral side and view the medial sulcus for return of swelling
Trace- Milk mediately sweep laterally, small amount back
1+ : You can milk out the swelling and it does not return on its own but returned with a lateral sweep
2+ : You milk out the swelling and it returned immediately to fill the pouch
3+ you cannot milk out swelling
Special test for
MCL
Valgus stress full extension > 5 mm ; check pcl and acl
Most specific: valgus stress at 30 flexion > 5 mm
If valgus stress at 30 >10 mm check ACL
Special test for
Lcl
Initial: varys stress full extension; check lcl pcl acl
Most specific: varus stress at 30 flexion isolates lcl
If laxity exists, LCL is injured
Special test for
Pcl
Initial test: Posterior drawer
Most specific: posterior sag and quadriceps activation test shows anterior translation of tibia
If laxity increases with posterior drawer in ER evaluate posterolateral corner
Special test for
Acl
Initial: lachman
Most specific lachman test with empty endfeel
Results: +pivot shift; arthometer difference >3mm side to side indicates ACL tear
Special test for
Meniscal
Initial test : mcMurray test, apley compression, joint line tenderness, thessaly test
Most specific: history: catching or locking, joint line tenderness, pain with forced hyperextension, pain with maximal knee passive flexion and pain or audible click with mcMurray
Results: if 5/5 present on history 92.3% of positive meniscal tear
Special test for
Posterolateral corner
Initial: posterior drawer increased at 30 and normal at 90 deg
Most specific test: prone external rotation test > 10 deg compared to uninvolved
Results: prone external rotation test increased at 30 not at 90; if pis at both check pcl
Special test for
Patellofemoral
Initial: quadriceps make test, step down test, patellar tilt test
Most specific: pain during resisted iso quad contraction, squatting and palpation
Results: history and + response to patellofemoral taping support diagnosis
Cervical myelopathy CPR
Gait deviation Positive hoffmann’s test Positive inverted supinator sign Positive babinski Age >45
With at least 3 pos prob is94%
Age 45 is most sensitive finding (86%) meaning cervical myelopathy is very unlikely in individuals 45 and younger
Sij pain CPR
Laslett 2006: SI distraction SI compression Thigh thrust Gaenslen’s Sacral thrust
With at least 3 pos cluster is 91% sensitive and 78% specific for SIJ pain.
-LR:0.08
+LR: 4.3
Viceral pain
Where does the gallbladder refer to?
T7-9
Pain is often referred to inferior angle of scapula right side
Pain after eating (~2-3 hrs) vs stomach (~1hr)
Viceral pain
Where does the kidney refer to?
T 10-L1
Viceral pain
Where does the bladder refer to?
T11-12
Cervical traction &exercise CPR
Peripheralization with C4-7 mobility testing
Positive shoulder abductiontest
Age>/= 55
Positive ULTTA median nerve
Pos cervical distraction test
Traction was followed by seated posture and supine deep neck flexor exercises
3pos probability 79.2%
4 pos probability 94.8%
Carpal tunnel cpr
Shaking hands improves symptoms
Wrist ratio index > .67 (ap/ml)
Symptom severity score>1.9
Diminished sensation in median nerve sensory field of thumb
Age >45 years
We are looking for at least 4 pos
With less than 3 pos sensitivity is 98%
*patients with true cts should have intact sensation in thenar eminence
Specificity
SPIN
In a specific test, pos results rule it in. Pos findings are valuable
Sensitivity
SNOUT
In sensitive test, neg results rule it out
Neer 3 stages of primary impingement
Stage 1 edema and hemorrhage results from mechanical irritation of the tendon by impingement incurred with overhead activity
Stage 2fibrosis and tendonitis. Occurs from repeated episodes of mechanical inflammation and may include thickening-of subacromial bursae 25-40 years old
Stage3. Bonespurs and tendon rupture. Results of continued mechanical compression of the rotator cuff tendons.
Secondary impingement
Because of increased humeral head translation the biceps tendon in the rotator cuff can you come impinched as the result of the ensuing instability. A progressive loss of joint stability is created when a dynamic stabilization functions of the rotator cuff or diminished to fatigue and tendon injury. The effects of secondary impingement can lead to rotator cuff tears of instability and impingement continue.
Rotator cuff tear cpr
Drop arm
Painful arc
Infraspinatus MMT (gives way to weakness,pain;or +external lag sign)
TUBS instability
Traumatic unilateral dislocation with bankart lesion requiring sx
AMBRI
Atraumatic multidirectional bilateral, reehabilitation and occasionally requiring inferior capsular shift
Labral tear types
Which ones include biceps repair?….bucket handle repair?
Type1 debridement
Type 2repair biceps anchor attachment
Type 3 debridement of bucket- handletype tear
Type 4 same as 3 plus repair biceps anchor biceps tendonesis
Types 2 and 4 biceps invollvement
Types3 and 4 bucket handle
Bankart lesion
Anterior dislocation causing Anterior inferior labrum
Hill sachs lesion
Bony deformity that happens with anterior dislocation on posterolateral humeral head.
Xray position to detect this lesion: stryker (hand on head) or IR (hand behind back) . Y scapular view maybe to pick up a dislocation that isnot obvious in AP view
TOS entrapment sites
As brachial plexus and subclavian artery pass through interscalene triangle; also possible cervical rib
Subclavian vein bypasses this entrapment site
- 1st rib, clavicle subclavius
- Under corocoid, pec minor (pain with overhead)
TOS symptomsof compression upper brachial plexus
Pain in anterolateral neck andshoulder, jaw , ear
Pain / patesthesias in c5-7 dermatome
TOS symptomsof compression lower brachial plexus
Pain in supra/infra clavicular fossa, posterior neck and SG, axilla, medial arm
Pain/ paresthesias in c8-t1 dermatomes
TOS symptomsof compression in subclavian artery vs vein
Artery: coolness of UE , ischemic episodes, exertional fatigue of the UE
Vein: edema of UE, cyanosis of UE
Adsons test
Scalene triangle
Pt extens and ipsilateral rotates head, takes deep breath and holds
Costoclavicular test
Actively draws shoulder girdle down and back in exaggerated military position to reduce costoclavicular space
1st rib and clavicle
Halstead maneuver
PT passively depresses pt’s SG and tractions tested UE toward floor. Pt extends and contra rotates head neck
1st rib and clavicle
Wright’s test
Pt’s shoulder placed in 90/90 position. Pt rotates head away from side tested
Pec minor and under coracoi
Hyperabduction text
Pt actively assumes 90/90 position of shoulder and holds it for 1min
Pec minor and under coracoid
Median nerve entrapment
Median nerve entrapments
● Pronator Teres Syndrome
● Anterior Interosseous syndrome
● Carpal Tunnel Syndrome
Pronator teres syndrome
Between two heads of the pronator teres
● Sensory AND motor
○ Weakness: Technically any median n. distribution distal to PT, but most common weakness is FPL, AbdPB, FDP (dig 2-3), OP,
○ Numbness/paresthesia: Dig 1-3 and half of 4th, lateral palm INCLUDING thenar eminence
● Pain over pronator teres/anterior forearm
● Symptoms increase with activity, not typically nocturnal
● Test: Palpation, Pronator teres stress test, could be unable to make “OK” sign
Anterior interosseous entrapment
Entrapment typically as it exits the PT, tendinous edge of deep head
● Runs between FDP and FPL
● MOTOR ONLY
○ Weakness: FPL, FDL (dig 2-3), and PQ
○ Numbness/paresthesia: NONE
● Pain/tenderness anterior forearm at/distal to pronator teres
● Test: Unable to make “OK” Sign
Carpal tunnel syndrome
Most common median neuropathy
● Motor AND sensory
○ Weakness: FPB, AbdPB, OP, Lumbricals 1-2
○ Numbness/paresthesia: Dig 1-3 and radial half of 4
● Hallmarks: nocturnal symptoms, shaking hands for relief
● Test: Phalen’s, Carpal compression, Tinel
● Cluster–3 or more of:
○ >45 yo
○ Shaking hands provides relief
○ Wrist ratio >.67
○ CTQ-SSS >1.9
○ Decreased light touch median nerve distribution
Ulnar nerve entrapment
Cubital Tunnel Syndrome
● Guyon’s canal
Cubital tunnel syndrome
Ulnar nerve as it passes posterior to medial epicondyle, or as it dives between heads of flexor carpi radialis
● Motor AND sensory
○ Weakness (only if severe): FCU, FDP (dig 4-5), adductor policis, interossei, Hypothenar mm
(AbdDM, FDM, ODM), lumbricals 3-4
○ Numbness/paresthesia: 5th and ulnar half of 4th dig
● May have medial elbow/forearm pain, but not sensory changes
● Test: Tinel’s, Elbow flexion test
● If severe:
○ Froment’s Sign
○ Wartenburg’s sign
Guyons canal entrapment
Ulnar N. between hook of hamate and pisiform
● Can be Motor and sensory, pure motor, or pure sensory depending on
location
○ Weakness: adductor policis, interossei, Hypothenar mm (AbdDM, FDM, ODM), lumbricals 3-4
○ Numbness/paresthesia: 5th and ulnar half of 4th dig
● Prolonged compression, wrist extension and ulnar deviation (ie. cyclist), trauma, ganglion cyst, fracture
● Froment’s sign
● Wartenburg’s sign - abduction of 5th digit
Radial tunnel syndrome
Primarily pain, rare, can have radial distribution weakness, can have radial HAND sensory
deficits
○ Often confused with Lateral Epicondylalgia, but symptoms more distal
Posterior interosseous membrane entrapment
Most common at arcade of Frohse, pain posterior forearm, MOTOR only - some weakness in
extension (ECRL/B spared), weakness in ECU
○ Pain with resisted supination, passive wrist flexion and elbow extension
Wartenburg’s syndrome
(not to be confused with Wartenburg’s sign)
○ “Handcuff palsy”
○ Superficial branch of radial nerve at distal radius
○ Sensory loss only - radial dorsum of hand, posterior aspect of thumb
To be able to try for copers…
To be able to participate in screening process, the patient must gave an isolated tear of the ACL, full painfree knee ROM and no knee joint effusion
Mvic of quadriceps at least 70% of the uninvolved
Tolerate single leg hopping on the involved without pain
Copers
1) noyes hop test score >80%
2) no more than 1 giving away episodes
3) the KOS ADLs scale and sport activity scale >80%
4) global eating of knee function >60%
CPG: for patient with ACUTE neck pain with mobility deficits…
B– Clinicians should provide thoracic manipulation, a program
of neck ROM exercises, and scapulothoracic and upper
extremity strengthening to enhance program adherence.
C –Clinicians may provide cervical manipulation and/or
mobilization.
For patients with SUBACUTE neck pain with mobility deficits:
B– Clinicians should provide neck and shoulder girdle endurance
exercises.
C– Clinicians may provide thoracic manipulation and cervical
manipulation and/or mobilization
For patients with chronic neck pain with mobility deficits:
B Clinicians should provide a multimodal approach of the
following:
• Thoracic manipulation and cervical manipulation or
mobilization
• Mixed exercise for cervical/scapulothoracic regions: neuromuscular exercise (eg, coordination, proprioception, and postural
training), stretching, strengthening, endurance training, aerobic
conditioning, and cognitive affective elements
• Dry needling, laser, or intermittent mechanical/manual traction
C Clinicians may provide neck, shoulder girdle, and trunk endurance exercise approaches and patient education and
counseling strategies that promote an active lifestyle and address
cognitive and affective factors.
For patients with acute neck pain with movement coordination
impairments (including WAD)
B Clinicians should provide the following:
• Education of the patient to
- Return to normal, nonprovocative preaccident activities as
soon as possible
- Minimize use of a cervical collar
- Perform postural and mobility exercises to decrease pain and
increase ROM
• Reassurance to the patient that recovery is expected to occur
within the first 2 to 3 months.
B Clinicians should provide a multimodal intervention approach including manual mobilization techniques plus exercise (eg, strengthening, endurance, flexibility, postural, coordination,
aerobic, and functional exercises) for those patients expected to experience a moderate to slow recovery with persistent impairments.
C Clinicians may provide the following for patients whose
condition is perceived to be at low risk of progressing
toward chronicity:
• A single session consisting of early advice, exercise instruction,
and education
• A comprehensive exercise program (including strength and/or
endurance with/without coordination exercises)
• Transcutaneous electrical nerve stimulation (TENS)
F Clinicians should monitor recovery status in an attempt to
identify those patients experiencing delayed recovery who
may need more intensive rehabilitation and an early pain education
program
For patients with chronic neck pain with movement coordination impairments (including WAD):
C Clinicians may provide the following:
• Patient education and advice focusing on assurance, encouragement,
prognosis, and pain management
• Mobilization combined with an individualized, progressive submaximal exercise program including cervicothoracic strengthening,
endurance, flexibility, and coordination, using principles of cognitive behavioral therapy
• TENS
For patients with acute neck pain with headache:
B– Clinicians should provide supervised instruction in active
mobility exercise
C Clinicians may provide C1-2 self-sustained natural apophyseal
glide (self-SNAG) exercise.
For patients with subacute neck pain with headache:
B Clinicians should provide cervical manipulation and
mobilization.
C Clinicians may provide C1-2 self-SNAG exercise
For patients with chronic neck pain with headache:
B Clinicians should provide cervical or cervicothoracic manipulation or mobilizations combined with shoulder girdle and
neck stretching, strengthening, and endurance exercise
For patients with acute neck pain with radiating pain:
C Clinicians may provide mobilizing and stabilizing exercises,
laser, and short-term use of a cervical collar
Chronic
For patients with chronic neck pain with radiating pain:
B Clinicians should provide mechanical intermittent cervical
traction, combined with other interventions such as stretching
and strengthening exercise plus cervical and thoracic mobilization/
manipulation.
B Clinicians should provide education and counseling to
encourage participation in occupational and exercise
activities.
Knee Pain and Mobility
Impairments
– progressive knee motion
B Clinicians may use early progressive active and passive knee
mo tion with patients after knee meniscal and articular cartilage surgery
Knee Pain and Mobility
Impairments
-progressive weight bearing
C Clinicians may consider early progressive weight bearing in
patients with meniscal repairs.
B Clinicians should use a stepwise progression of weight bearing
to reach full weight bearing by 6 to 8 weeks after matrixsupported autologous chondrocyte implantation (MACI) for articular
cartilage lesion
Knee Pain and Mobility
Impairments
- progressive return to atcivity
C Clinicians may utilize early progressive return to activity
following knee meniscal repair surgery.
E Clinicians may need to delay return to activity depending on
the type of articular cartilage surgery.
Knee Pain and Mobility
Impairments
NEUROMUSCULAR ELECTRICAL
STIMULATION/BIOFEEDBACK
B Clinicians should provide neuromuscular stimulation/
re-education to patients following meniscus procedures
to increase quadriceps strength, functional performance, and
knee function.
Knee Stability and Movement
Coordination Impairments:
Knee Ligament Sprain
continuous passive motion
C Clinicians may use continuous passive motion in the immediate postoperative period to decrease postoperative pain after
anterior cruciate ligament (ACL) reconstruction.
Knee Stability and Movement
Coordination Impairments:
Knee Ligament Sprain
early WB
C Clinicians may implement early weight bearing as tolerated
(within 1 week after surgery) for patients after ACL
reconstruction
Knee Stability and Movement
Coordination Impairments:
Knee Ligament Sprain
KNEE BRACING
C Clinicians may use functional knee bracing in patients with
ACL deficiency.
D Clinicians should elicit and document patient preferences
in the decision to use functional knee bracing following ACL
reconstruction, as evidence exists for and against its use.
F Clinicians may use appropriate knee bracing for patients with
acute posterior cruciate ligament (PCL) injuries, severe medial collateral ligament (MCL) injuries, or posterolateral corner (PLC)
injuries.
Knee Stability and Movement
Coordination Impairments:
Knee Ligament Sprain
IMMEDIATE VERSUS DELAYED MOBILIZATION
B Clinicians should use immediate mobilization (within 1 week)
after ACL reconstruction to increase joint range of motion,
reduce joint pain, and reduce the risk of adverse responses of surrounding soft tissue structures, such as those associated with knee
extension range-of-motion loss.
Knee Stability and Movement
Coordination Impairments:
Knee Ligament Sprain
cryotherapy
B Clinicians should use cryotherapy immediately after ACL
reconstruction to reduce postoperative knee pain.
Knee Stability and Movement
Coordination Impairments:
Knee Ligament Sprain
therex
A Weight-bearing and non–weight-bearing concentric and eccentric exercises should be implemented within 4 to 6 weeks,
2 to 3 times per week for 6 to 10 months, to increase thigh muscle
strength and functional performance after ACL reconstruction.
CPG Patellofemoral Pain
specific modes of therex
A Clinicians should include exercise therapy with combined
hip- and knee-targeted exercises to reduce pain and improve patient-reported outcomes and functional performance in
the short, medium, and long term. Hip-targeted exercise therapy
should target the posterolateral hip musculature. Knee-targeted
exercise therapy includes either weight-bearing (resisted squats)
or non–weight-bearing (resisted knee extension) exercise, as both
exercise techniques target the knee musculature. Preference to
hip-targeted exercise over knee-targeted exercise may be given in
the early stages of treatment of PFP. Overall, the combination of
hip- and knee-targeted exercises is preferred over solely knee-targeted exercises to optimize outcomes in patients with PFP
CPG Patellofemoral Pain
PATELLAR TAPING
B Clinicians may use tailored patellar taping in combination
with exercise therapy to assist in immediate pain reduction, and to enhance outcomes of exercise therapy in the short
term (4 weeks). Importantly, taping techniques may not be beneficial in the longer term or when added to more intensive physical
therapy. Taping applied with the aim of enhancing muscle function is not recommended.
CPG Patellofemoral Pain
– PATELLOFEMORAL KNEE ORTHOSES (BRACING)
B Clinicians should not prescribe patellofemoral knee
orthoses, including braces, sleeves, or straps, for patients
with PFP
CPG Patellofemoral Pain
– FOOT ORTHOSES
A Clinicians should prescribe prefabricated foot orthoses
for patients with greater than normal pronation to reduce
pain, but only in the short term (up to 6 weeks). If prescribed,
foot orthoses should be combined with an exercise therapy program. There is insufficient evidence to recommend custom foot
orthoses over prefabricated foot orthoses
CPG Patellofemoral Pain
BIOFEEDBACK
B Clinicians should NOT use electromyography-based biofeedback on medial vastii activity to augment knee-targeted (quadriceps) exercise therapy for the treatment of PFP.
B Clinicians should NOT use visual biofeedback on lower extremity alignment during hip- and knee-targeted exercises
for the treatment of patients with PFP.
CPG Patellofemoral Pain
RUNNING GAIT RETRAINING
C Clinicians may use gait retraining consisting of multiple
sessions of cuing to adopt a forefoot-strike pattern (for rearfoot-strike runners), cuing to increase running cadence, or
cuing to reduce peak hip adduction while running for runners
with PFP
CPG Patellofemoral Pain
BLOOD FLOW RESTRICTION
TRAINING PLUS HIGH-REPETITION KNEETARGETED EXERCISE THERAPY
F Clinicians may use blood flow restriction plus high-repetition knee exercise therapy, while monitoring for adverse
events, for those with limiting painful resisted knee extension.
CPG Patellofemoral Pain
NEEDLING THERAPIES
A Clinicians should not use dry needling for the treatment of
patients with PFP.
C Clinicians may use acupuncture to reduce pain in patients
with PFP. However, caution should be exercised with this
recommendation, as the superiority of acupuncture over placebo
or sham treatments is unknown. This recommendation should
only be incorporated in settings where acupuncture is within the
scope of practice of physical therapy.
CPG Patellofemoral Pain
– MANUAL THERAPY
AS A STAND-ALONE TREATMENT
A Clinicians should NOT use manual therapy, including lumbar, knee, or patellofemoral manipulation/mobilization, in
isolation for patients with PFP.
Hip Pain and Mobility Deficits—
Hip Osteoarthritis:
PATIENT EDUCATION
B Clinicians should provide patient education combined with
exercise and/or manual therapy. Education should include
teaching activity modification, exercise, supporting weight reduction
when overweight, and methods of unloading the arthritic joints.
Hip Pain and Mobility Deficits—
Hip Osteoarthritis:
– FUNCTIONAL, GAIT, AND BALANCE TRAINING
C Clinicians should provide impairment-based functional, gait,
and balance training, including the proper use of assistive
devices (canes, crutches, walkers), to patients with hip osteoarthritis
and activity limitations, balance impairment, and/or gait limitations
when associated problems are observed and documented during the
history or physical assessment of the patient.
C Clinicians should individualize prescription of therapeutic
activities based on the patient’s values, daily life participation, and functional activity needs.
Hip Pain and Mobility Deficits—
Hip Osteoarthritis:
MANUAL THERAPY
A Clinicians should use manual therapy for patients with mild to
moderate hip osteoarthritis and impairment of joint mobility,
flexibility, and/or pain. Manual therapy may include thrust, nonthrust,
and soft tissue mobilization. Doses and duration may range from 1 to
3 times per week over 6 to 12 weeks in patients with mild to moderate
hip osteoarthritis. As hip motion improves, clinicians should add exercises including stretching and strengthening to augment and sustain
gains in the patient’s range of motion, flexibility, and strength.
Hip Pain and Mobility Deficits—
Hip Osteoarthritis:
– FLEXIBILITY, STRENGTHENING, AND ENDURANCE EXERCISES
A Clinicians should use individualized flexibility, strengthening,
and endurance exercises to address impairments in hip
range of motion, specific muscle weaknesses, and limited thigh (hip)
muscle flexibility. For group-based exercise programs, effort should
be made to tailor exercises to address patients’ most relevant physical
impairments. Dosage and duration of treatment for effect should
range from 1 to 5 times per week over 6 to 12 weeks in patients with
mild to moderate hip osteoarthritis.
Hip Pain and Mobility Deficits—
Hip Osteoarthritis:
MODALITIES
B Clinicians may use ultrasound (1 MHz; 1 W/cm2
for 5 minutes
each to the anterior, lateral, and posterior hip for a total of
10 treatments over a 2-week period) in addition to exercise and hot
packs in the short-term management of pain and activity limitation
in individuals with hip osteoarthritis.
Hip Pain and Mobility Deficits—
Hip Osteoarthritis:
BRACING
F Clinicians should NOT use bracing as a first line of treatment.
A brace may be used after exercise or manual therapies are
unsuccessful in improving participation in activities that require turning/pivoting for patients with mild to moderate hip osteoarthritis, especially in those with bilateral hip osteoarthritis.
Hip Pain and Mobility Deficits—
Hip Osteoarthritis:
WEIGHT LOSS
C In addition to providing exercise intervention, clinicians
should collaborate with physicians, nutritionists, or dietitians
to support weight reduction in individuals with hip osteoarthritis who
are overweight or obese.
CPG Carpal Tunnel Syndrome
assistive technology
C Clinicians may educate their patients regarding the effects
of mouse use on carpal tunnel pressure and assist patients in developing alternate strategies, including the use of arrow keys, touch screens, or alternating the mouse hand.
Clinicians may recommend keyboards with reduced strike force
for patients with CTS who report pain with keyboard use.
CPG Carpal Tunnel Syndrome
orthoses
B Clinicians should recommend a neutral-positioned wrist
orthosis worn at night for short-term symptom relief and
functional improvement for individuals with CTS seeking nonsurgical management.
C Clinicians may suggest adjusting wear time to include daytime, symptomatic, or full-time use when night-only use is
ineffective at controlling symptoms in individuals with mild to moderate CTS. Clinicians may also add metacarpophalangeal joint immobilization or modify the wrist joint position for individuals with
CTS who fail to experience relief. Clinicians may add patient education on pathology, risk identification, symptom self-management,
and postures/activities that aggravate symptoms.
C Clinicians should recommend an orthosis for women experiencing CTS during pregnancy and should provide a postpartum follow-up evaluation to examine the resolution of symptoms.
CPG Carpal Tunnel Syndrome
biophysical agents
C Clinicians may recommend a trial of superficial heat for
short-term symptom relief for individuals with CTS.
C Clinicians may recommend the application of microwave
or shortwave diathermy for short-term pain and symptom
relief for patients with mild to moderate idiopathic CTS.
C Clinicians may offer a trial of interferential current for
short-term pain symptom relief in adults without pacemakers with idiopathic, mild to moderate CTS. As with all electrical modalities, contraindications should be taken into
consideration before choosing this intervention.
B Clinicians should not use low-level laser therapy or other
types of nonlaser light therapy for individuals with CTS.
C Clinicians should not use thermal ultrasound in the treatment of patients with mild to moderate CTS.
B Clinicians should not use iontophoresis in the management of mild to moderate CTS.
C Clinicians may perform phonophoresis within nonsurgical
management of patients with mild to moderate CTS for
the treatment of clinical signs and symptoms.
B Clinicians should not use or recommend the use of magnets in the intervention for individuals with CTS.
CPG Carpal Tunnel Syndrome`
Manual therapy techniques
C Clinicians may perform manual therapy, directed at the
cervical spine and upper extremity, for individuals with
mild to moderate CTS in the short term.
D There is conflicting evidence on the use of neurodynamic
mobilizations in the management of mild to moderate CTS.
whiplash injury prognosis cpr
- WHat is the NDI score?
- AGe
- PDS hyperarousal subscale
NDI: = 32% ; age =35 full recovery; age >35 medial recovery
NDI : 33-39% medial recovery
NDI: >/= 40;
age = 35 medial recovery;
AGe >36 PDS <6 medial
AGe > 36 PDS >/= 6 chronic mod/severe disability
