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Ortho Review > Ortho NEED TO KNOW > Flashcards

Ortho NEED TO KNOW Flashcards

1
Q

What is part vs. whole practice?

A

Practice of an individual component versus practice of an entire task

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2
Q

Intrinsic (Inherent) Feedback

A

all feedback that comes through the sensory systems including visual, vestibular, proprioceptive, and somatosensory input

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3
Q

Extrinsic (augmented) feedback

A

information provided while a task or movement in in progress or subsequent to the movement
Usually verbal feedback or manual contacts

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4
Q

Sternoclavicular Joint

A

3 degrees of freedom
Elevation Depression
Protraction Retraction
Rotation

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5
Q

What does the subclavius muscle do?

A

depresses clavicle and stabilizes it

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6
Q

Which ligament does the clavicle use as a pivot point in elevation of the distal clavicle?

A

Costoclavicular Ligament

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7
Q

Acromioclavicular Joint consists of…

A

distal clavicle and acromion process of the scapula

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8
Q

What are the motions of the AC joint?

A

Elevation Depression
Retraction Protraction
Rotation

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9
Q

What is the Scapulothoracic Joint

A

Not a true joint
but is a functional joint
DIRECT RESULT OF MOTION WITHIN THE AC AND SC JOINTS
Contributes 1/3 of elevation in scapulohumeral rhythm
Elevation Depression
Protraction Retraction
Scap Upward Downward Rotation

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10
Q

What is winging?

A

Internal rotation of the shoulder

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11
Q

What is tilting

A

Anterior or Posterior
Most common impairment is anterior tilting

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12
Q

What 3 ligaments support the GH joint?
(Anteriorly, Intrascapular)

A

Superior
Middle
Inferior GH ligaments

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13
Q

Which ligament combats the pull of gravity in the GH joint?

A

Coracohumeral Ligament

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14
Q

Which ligament holds the long head of the bicep tendon on to the bicipital grove?

A

Transverse Humeral Ligament

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15
Q

What does the clavicle do when the scapula elevates (shrugging, flexion, or abducting)

A

the distal clavicle elevates
proximal clavicle rolls superiorly and glides inferiorly on the sternum
pivoting the costoclavicular ligament

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16
Q

When UE goes into flexion what does the clavicle do?

A

must rotate posteriorly to achieve full elevation

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17
Q

What muscles work as a team to rotate, elevate depress, and protract retract the scapula?

A

Traps, Levator Scap, Rhomboids, Serratus Anterior, Pec Minor

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18
Q

What nerve innervates Serratus Anterior

A

Long Thoracic Nerve

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19
Q

What happens if Serratus Anterior is weak

A

Can cause winging of the scapula

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20
Q

Excessive Anterior tipping is cause by what?

A

tightness of pec MINOR
(sometimes short head of biceps and coracobrachialis)

or
Weakness of SA and/or lower trap

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21
Q

What are the extensors of the GH joint?

A

Posterior Delt (axillary n)
Lats (thoracodorsal n)
teres major (subscap n)

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22
Q

What are the flexors of the GH joint

A

Anterior Delt (Axillary n)
Coracobrachialis ( Musculotaneous n)

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23
Q

What are the Abductors of the GH joint?

A

Middle Delt (axillary)
Supraspinatus (suprascapular n)

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24
Q

What is the function of the Rotator Cuff?

A
  1. Create rotation at the joint
  2. increase compressive forces between humeral head and socket
  3. Fascilitate gliding while humeral head rolls in the opposite direction
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25
Q

What is Shoulder impingement?

A

Compression of structures in sub acromial space between humeral head and acromion process and coracoacromial ligament.
Can be primary (structural) and secondary (functional)

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26
Q

What is primary impingement?

A

impingement due to decreased sub acromial space
Due to shape of the acromion, osseous changes, changes to acromioclavicular ligament.

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27
Q

What is secondary impingement?

A

results from GH joint instability, and/or muscle imbalance
Deltoid working alone, it will pull humeral head superiorly
Rotator cuff and humeral depressors must co-contract to glide humeral head inferiorly to avoid impingement

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28
Q

Patients with secondary impingement tend to demonstrate what?

A

Anterior tilting
Excessive internal rotation
Decreased upward rotation of the scapula
*increased kyphosis

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29
Q

What position narrows subacromial space

A

Protracted scapula

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30
Q

Someone with impingement may have contributing factors like….

A
  1. Decreased inferior gliding of the humerus
  2. Weakness/Inhibition of RC
  3. Poor GH Joint Stability
  4. General Scapular dyskinesia /weakness
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31
Q

What is a hypovascular zone and where is it located in the shoulder

A

Area of poor blood supply and is located in the supraspinatus tendon. This also grows larger as we get older.
Contributes to poor healing and tears

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32
Q

3 Types of partial thickness tears

A

Articular Surface
Infrasubstance
Bursal Surface

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33
Q

3 Types of GH Instability

A
  1. Anterior dislocation
  2. Labral Tear
  3. Posterior Dislocation
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34
Q

Common symptoms of GH instability

A

Frequent Sub Luxation
Slipping
Shifting
Pinching
Ache at Rest
difficulty lying on shoulder
occasional numbness in UE

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35
Q

What are bankart tears?

A

happen with anterior dislocation and occur anterior inferior portion of the labrum

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36
Q

What is a SLAP tear?

A

Superior Labral Anterior-Posterior
involves superior labrum and biceps tendon and broken down into 4 groups

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37
Q

How are tendons organized?

A

Organized
Long-Axis
Scarce Elastin

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38
Q

How are ligaments organized?

A

Randomly organized
Weaving pattern
2x Collagen Elastin

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39
Q

What are severe contusions at a risk for?

A

10% risk of Myositis Ossificans

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39
Q

What are the 3 types of muscle injuries?

A

Contact - Contusion
Muscle Tendon - Traumatic
Overuse - Repetitive Microtrauma

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39
Q

What modalities are best for sub-acute injury to reabsorb hematoma?

A

Diathermy
US
Laser

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39
Q

What dysfunction can increased pressure from blood and edema lead too?

A

Compartment Syndrome

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39
Q

What kind of exercises are used for sub acute CONTACT INJURIES?

A

ROM
Gentle Stretch
Light ISO
**Progress to more advanced stretch and strengthen to return to normal function

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39
Q

Supination =

A

Adduction
Inversion
Plantar Flexion

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39
Q

Ortho diagnosis fall into 3 categories?

A

Post Surgical
traumatic
Idiopathic

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39
Q

Tendonitis is a ________________ problem

A

deceleration problem

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39
Q

What does the articular disc between the radial and ulnar joint do?

A

(TFCC)
1. Stability
2. Joint Congruency
3. Provides shock absorption against compressive forces

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39
Q

Pronation =

A

Abduction
Eversion
Dorsiflexion

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40
Q

What are the 3 main things you need for posture?

A
  1. Rom
  2. Awareness
  3. Strength
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40
Q

What do you movement do you want to avoid with spondylolisthesis?

A

Avoid extension
It can cause a shift
We want to stabilize

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40
Q

What does leg extension lag mean?

A

Weakened quads
Need to strengthen the quad

40
Q

If someone has a trendelenburg gait, what does that mean?

A

Weak hip abductors
Weak in the FRONTAL plane because they cannot abduct

40
Q

In cardio rehab, what is the threshold/target heart rate?

A

HR 60-80
70%
If we don’t hit 60 we aren’t doing anything

40
Q

the ulnar collateral ligament (UCL) is a primary stabilizer against what?

A

Valgus of the elbow

40
Q

What is the primary goal for nerve injuries?

A

Decompress the nerve and centralize

*traction
Do you want to gap the facets/foremen

40
Q

the radial collateral ligament (RCL) is a primary stabilizer against what?

A

Varus of the elbow

41
Q

The MCL ligament stabilizes the knee against what?

A

Valgus stress

42
Q

The LCL ligament stabilizes the knee against what?

A

Varus of the knee

43
Q

what are some factors for those with increased q angle?

A

muscle imbalance
ITB syndrome
Femoral anteversion
Genu Valgum
Lateral Rotation (External)

44
Q

What should you avoid when doing exercises with someone who has GH joint instability?

A

Anything with:
1. Horizontal ABduction
2. Extension
3. External Rotation behind back

45
Q

Early Exercises for GH Instability:

A

ISO in safe ranges
PNF Rhythmic Stabilization
Closed Chain Exercises (Wall pushup)
Arm bike
Body Blade

46
Q

What is the treatment focus for a FREEZING shoulder?

A

Reduce pain and inflammation
ROM/Functional Loss

47
Q

What is the treatment focus for FROZEN shoulder?

A

regaining ROM/Strength as tolerated
Joint Mobs
LAD
AAROM
Passive Stretch
ROM therex

48
Q

As frozen shoulder “THAWS” what is the treatment focus?

A

Restoring normal scapularhumeral rhythm
Proprioception
Function

49
Q

What is the most common shoulder complex fracture?

A

Clavicle

50
Q

What shoulder joints can commonly have osteoarthritis?

A

SC sterno-clavicular
AC acromio-clavicular
GH gleno-humeral

51
Q

NSAIDS

A

can mess with GI tract and organs
Asprin/Celebrx/Etodalac/Ibuprofen
Inhibits both COX pathways

52
Q

What are SAIDS

A

Corticosteroids
Cortisone/Prednisone/Hydocortisone/dexamethasone

inhibits both inflammatory pathways
Mediate immune function

53
Q

Long term Effects of using NSAID?

A

Gi
Renal/Liver Damage
Increased risk of CV events

54
Q

Long term Effects of using SAID?

A

Cataracts
Diabetes
Osteoperosis
Weakening of Connective Tissue
Weight Gain
Pyschiatric Disturbances
Impaired endocrine system
Organ Damage
Immune system impairment

55
Q

What are 3 ways someone can receive antibiotis?

A

Oral
IV
Implanted

56
Q

What are the types of analgesics?

A

NSAIDS
Opioids
Anti-Depressant
Anti-Anxiety

57
Q

Opioids

A

can impact PT treatment and patient alertness
attaches to opioid receptors

58
Q

What are Diuretics?

A

Treats peripheral edema
High blood pressure

Watch for dehydration/ electrolyte imbalances
cramping/arrythmias

59
Q

what are 3 types of Diuretics?

A

Thiazide
Loop
Potassium Sparing

60
Q

What are example of anticoagulants?

A

Warfarin
Heparin
Lovenox (injected)

Eliquis
Paradaxa

*Avoid bruising, high risk for bleeding

61
Q

Muscle Relaxers

A

Interrupt neuromuscular juntion
Diazepam (Valium), Baclofen
NImbex
Quelicin
**can affect patient alertness

62
Q

What is hyaluronan made from?

A

Rooster Combs
found naturally in our joints

63
Q

What is Platelet Rich Plasma PRP

A

used for chronic tendon issues
Blood is drawn from patient, platelets are seperated and then injected into the injury site
PAID OUT OF POCKET

64
Q

What motion should you avoid with compression fractures?

A

Flexion
because of increased compression on vertebral body with spinal flexion

65
Q

What exercises should be used for compression fractures

A

Spinal Stabilization

66
Q

What is spinal stenosis?

A

narrowing of spine or foreamen
(can affect any area of the spine)

67
Q

Treatment for Spinal Stenosis?

A

Decrease muscle tightness in:
iliopsoas
rectus femoris
erector spinae

WILLIAM FLEXION exercises

68
Q

What is spondylolysis

A

small fracture in pars articularis
can be uni or bilateral

69
Q

What is the treatment for spondylolysis?

A

Spine Stabilization
Heals within 3-6 Months

70
Q

What is spondylolisthesis?

A

forward slippage of vertebral body after bilateral pars articularis fractures

71
Q

What is the most common vertebral slippage in sondylolisthesis?

A

L5-S1

72
Q

Treatment for Spondylolisthesis

A

Stabilization
Posture
TX for pain/spasm

73
Q

What muscles are we working for SI Hypermobility

A

Glute Max
Erector Spinae
Biceps Femoris
Lats
Piriformis
Multifidi

74
Q

Angle of inclination: Coxa Vara

A

Angle is less than 120 degree

75
Q

Angle of Inclination: Coxa Valga

A

Angle is greater than 120 degrees

76
Q

Angle of Inclination Norm

A

120-125 degrees

77
Q

What is the angle of inclination measuring?

A

The femoral head and femoral shaft in the transverse plane

78
Q

What is scapular rhythm?

A

IF the arm is abducted 180 degrees:
Scapula rotates 60 degrees
Glenohumeral rotates 120 degrees

79
Q

What tendon is ruptured in Mallet Finger?

A

Distal Extensor Tendon

80
Q

What is ruptured in a jersey finger?

A

rupture of:
Flexor Digitorum Profundus
loss of DIP function

81
Q

What tendon is injured in Boutonniere

A

injury to the central extensor tendon at PIP
*May require surgery

82
Q

What is De Quervains?

A

inflammation of APL and EPB

83
Q

Muscle Strains:
Grades and Recovery

A

Grade 1= 2-3 Weeks recovery
Grade 2= 6-8 Weeks recovery
Grade 3= Call Doctor

84
Q

What causes osteoarthritis?
PRIMARY

A

Age

85
Q

What causes osteoarthritis? Secondary

A

Trauma
Obesity
Joint Injury
Neuro

86
Q

What motion should be restored in the elbow first?

A

Extension

87
Q

What motion should be restored in the forearm first?

A

Supination

88
Q

What is tendonitis?

A

Inflammation of the tendon
DFM followed by ICE
Ionto or Phono

89
Q

Medial Epicondylitis

A

Golfer Elbow
Flexors weak
Extensors Tight

Poor eccentric Control

90
Q

Lateral Epicondylitis

A

MOST COMMON
Tennis Elbow
Extensors weak
Flexors Tight

91
Q

What movement should be restored first in the hand?

A

Finger Flexion

92
Q

What are 3 elbow fracturs?

A

Radial Head
Olecranon
Distal Humerus

93
Q

With a radial fracture we gain rom for what first?

A

Supination
then pronation

94
Q

Most common ligament sprain in the elbow?

A

Medial UCL (tommy john)
common due to throwing/hitting

95
Q

Donor Sites for a ligamentous surgery?

A

Palmaris Longus
Hamstring

96
Q

Symptoms of Rheumatoid Arthritis in the hand?

A

Am Stiffness
Pain
Weakness
Swelling
Fatigue
Decrease Mobility
Joint Deformity

*ulnar drift

97
Q

A patient with spondylolisthesis would need Williams flexion or Mckenzie extension exercises?

A

Williams FLEXION for Spondylolisthesis

98
Q

Cervical Traction: Muscle Spasm

A

Pulling 11-15lbs

99
Q

Cervical Traction Joint Distraction

A

20-30 pounds
Do not exceed 30 lbs

100
Q

Lumbar traction: Muscle Spasms

A

25% BW

101
Q

Lumbar Traction: Joint Distraction

A

50% BW

102
Q

Most common disc herniation area

A

L4-L5 or L5-S1

103
Q

How does a disc herniation present?

A

Pain with flexion
Unilateral
Possible radicular symptoms
MRI confirmed

104
Q

Do disc herniation patients prefer flexion or extension

A

Extension
Prone Press up can help push disc back in

105
Q

What is the unhappy triad

A

MCL ACL and meniscis

106
Q

Which menisci is most likely to be injured

A

Medial Meniscis

107
Q

Higher q angle means greater risk for what injury?

A

ACL tear

108
Q

Auto-graft

A

Comes from you the patient
Hamstring/tendon

109
Q

Allograft

A

from cadaver

110
Q

Why do patients who had a recent ACL repair avoid open chain exercises

A

Open chain exercises cause a sheering on the ACL. PATIENTS NEED CLOSED CHAINED after ACL surgery (mini squats)

111
Q

Genu Valgum has Coxa _________ and ________________ of the feet.

A

Genu Valgum= Coxa Vera and Pronation of the feet

Ortho Review (8 decks)

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