Ortho NEED TO KNOW Flashcards
What is part vs. whole practice?
Practice of an individual component versus practice of an entire task
Intrinsic (Inherent) Feedback
all feedback that comes through the sensory systems including visual, vestibular, proprioceptive, and somatosensory input
Extrinsic (augmented) feedback
information provided while a task or movement in in progress or subsequent to the movement
Usually verbal feedback or manual contacts
Sternoclavicular Joint
3 degrees of freedom
Elevation Depression
Protraction Retraction
Rotation
What does the subclavius muscle do?
depresses clavicle and stabilizes it
Which ligament does the clavicle use as a pivot point in elevation of the distal clavicle?
Costoclavicular Ligament
Acromioclavicular Joint consists of…
distal clavicle and acromion process of the scapula
What are the motions of the AC joint?
Elevation Depression
Retraction Protraction
Rotation
What is the Scapulothoracic Joint
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
What is winging?
Internal rotation of the shoulder
What is tilting
Anterior or Posterior
Most common impairment is anterior tilting
What 3 ligaments support the GH joint?
(Anteriorly, Intrascapular)
Superior
Middle
Inferior GH ligaments
Which ligament combats the pull of gravity in the GH joint?
Coracohumeral Ligament
Which ligament holds the long head of the bicep tendon on to the bicipital grove?
Transverse Humeral Ligament
What does the clavicle do when the scapula elevates (shrugging, flexion, or abducting)
the distal clavicle elevates
proximal clavicle rolls superiorly and glides inferiorly on the sternum
pivoting the costoclavicular ligament
When UE goes into flexion what does the clavicle do?
must rotate posteriorly to achieve full elevation
What muscles work as a team to rotate, elevate depress, and protract retract the scapula?
Traps, Levator Scap, Rhomboids, Serratus Anterior, Pec Minor
What nerve innervates Serratus Anterior
Long Thoracic Nerve
What happens if Serratus Anterior is weak
Can cause winging of the scapula
Excessive Anterior tipping is cause by what?
tightness of pec MINOR
(sometimes short head of biceps and coracobrachialis)
or
Weakness of SA and/or lower trap
What are the extensors of the GH joint?
Posterior Delt (axillary n)
Lats (thoracodorsal n)
teres major (subscap n)
What are the flexors of the GH joint
Anterior Delt (Axillary n)
Coracobrachialis ( Musculotaneous n)
What are the Abductors of the GH joint?
Middle Delt (axillary)
Supraspinatus (suprascapular n)
What is the function of the Rotator Cuff?
- Create rotation at the joint
- increase compressive forces between humeral head and socket
- Fascilitate gliding while humeral head rolls in the opposite direction
What is Shoulder impingement?
Compression of structures in sub acromial space between humeral head and acromion process and coracoacromial ligament.
Can be primary (structural) and secondary (functional)
What is primary impingement?
impingement due to decreased sub acromial space
Due to shape of the acromion, osseous changes, changes to acromioclavicular ligament.
What is secondary impingement?
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
Patients with secondary impingement tend to demonstrate what?
Anterior tilting
Excessive internal rotation
Decreased upward rotation of the scapula
*increased kyphosis
What position narrows subacromial space
Protracted scapula
Someone with impingement may have contributing factors like….
- Decreased inferior gliding of the humerus
- Weakness/Inhibition of RC
- Poor GH Joint Stability
- General Scapular dyskinesia /weakness
What is a hypovascular zone and where is it located in the shoulder
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
3 Types of partial thickness tears
Articular Surface
Infrasubstance
Bursal Surface
3 Types of GH Instability
- Anterior dislocation
- Labral Tear
- Posterior Dislocation
Common symptoms of GH instability
Frequent Sub Luxation
Slipping
Shifting
Pinching
Ache at Rest
difficulty lying on shoulder
occasional numbness in UE
What are bankart tears?
happen with anterior dislocation and occur anterior inferior portion of the labrum
What is a SLAP tear?
Superior Labral Anterior-Posterior
involves superior labrum and biceps tendon and broken down into 4 groups
How are tendons organized?
Organized
Long-Axis
Scarce Elastin
How are ligaments organized?
Randomly organized
Weaving pattern
2x Collagen Elastin
What are severe contusions at a risk for?
10% risk of Myositis Ossificans
What are the 3 types of muscle injuries?
Contact - Contusion
Muscle Tendon - Traumatic
Overuse - Repetitive Microtrauma
What modalities are best for sub-acute injury to reabsorb hematoma?
Diathermy
US
Laser
What dysfunction can increased pressure from blood and edema lead too?
Compartment Syndrome
What kind of exercises are used for sub acute CONTACT INJURIES?
ROM
Gentle Stretch
Light ISO
**Progress to more advanced stretch and strengthen to return to normal function
Supination =
Adduction
Inversion
Plantar Flexion
Ortho diagnosis fall into 3 categories?
Post Surgical
traumatic
Idiopathic
Tendonitis is a ________________ problem
deceleration problem
What does the articular disc between the radial and ulnar joint do?
(TFCC)
1. Stability
2. Joint Congruency
3. Provides shock absorption against compressive forces
Pronation =
Abduction
Eversion
Dorsiflexion
What are the 3 main things you need for posture?
- Rom
- Awareness
- Strength
What do you movement do you want to avoid with spondylolisthesis?
Avoid extension
It can cause a shift
We want to stabilize
What does leg extension lag mean?
Weakened quads
Need to strengthen the quad
If someone has a trendelenburg gait, what does that mean?
Weak hip abductors
Weak in the FRONTAL plane because they cannot abduct
In cardio rehab, what is the threshold/target heart rate?
HR 60-80
70%
If we don’t hit 60 we aren’t doing anything
the ulnar collateral ligament (UCL) is a primary stabilizer against what?
Valgus of the elbow
What is the primary goal for nerve injuries?
Decompress the nerve and centralize
*traction
Do you want to gap the facets/foremen
the radial collateral ligament (RCL) is a primary stabilizer against what?
Varus of the elbow
The MCL ligament stabilizes the knee against what?
Valgus stress
The LCL ligament stabilizes the knee against what?
Varus of the knee
what are some factors for those with increased q angle?
muscle imbalance
ITB syndrome
Femoral anteversion
Genu Valgum
Lateral Rotation (External)
What should you avoid when doing exercises with someone who has GH joint instability?
Anything with:
1. Horizontal ABduction
2. Extension
3. External Rotation behind back
Early Exercises for GH Instability:
ISO in safe ranges
PNF Rhythmic Stabilization
Closed Chain Exercises (Wall pushup)
Arm bike
Body Blade
What is the treatment focus for a FREEZING shoulder?
Reduce pain and inflammation
ROM/Functional Loss
What is the treatment focus for FROZEN shoulder?
regaining ROM/Strength as tolerated
Joint Mobs
LAD
AAROM
Passive Stretch
ROM therex
As frozen shoulder “THAWS” what is the treatment focus?
Restoring normal scapularhumeral rhythm
Proprioception
Function
What is the most common shoulder complex fracture?
Clavicle
What shoulder joints can commonly have osteoarthritis?
SC sterno-clavicular
AC acromio-clavicular
GH gleno-humeral
NSAIDS
can mess with GI tract and organs
Asprin/Celebrx/Etodalac/Ibuprofen
Inhibits both COX pathways
What are SAIDS
Corticosteroids
Cortisone/Prednisone/Hydocortisone/dexamethasone
inhibits both inflammatory pathways
Mediate immune function
Long term Effects of using NSAID?
Gi
Renal/Liver Damage
Increased risk of CV events
Long term Effects of using SAID?
Cataracts
Diabetes
Osteoperosis
Weakening of Connective Tissue
Weight Gain
Pyschiatric Disturbances
Impaired endocrine system
Organ Damage
Immune system impairment
What are 3 ways someone can receive antibiotis?
Oral
IV
Implanted
What are the types of analgesics?
NSAIDS
Opioids
Anti-Depressant
Anti-Anxiety
Opioids
can impact PT treatment and patient alertness
attaches to opioid receptors
What are Diuretics?
Treats peripheral edema
High blood pressure
Watch for dehydration/ electrolyte imbalances
cramping/arrythmias
what are 3 types of Diuretics?
Thiazide
Loop
Potassium Sparing
What are example of anticoagulants?
Warfarin
Heparin
Lovenox (injected)
Eliquis
Paradaxa
*Avoid bruising, high risk for bleeding
Muscle Relaxers
Interrupt neuromuscular juntion
Diazepam (Valium), Baclofen
NImbex
Quelicin
**can affect patient alertness
What is hyaluronan made from?
Rooster Combs
found naturally in our joints
What is Platelet Rich Plasma PRP
used for chronic tendon issues
Blood is drawn from patient, platelets are seperated and then injected into the injury site
PAID OUT OF POCKET
What motion should you avoid with compression fractures?
Flexion
because of increased compression on vertebral body with spinal flexion
What exercises should be used for compression fractures
Spinal Stabilization
What is spinal stenosis?
narrowing of spine or foreamen
(can affect any area of the spine)
Treatment for Spinal Stenosis?
Decrease muscle tightness in:
iliopsoas
rectus femoris
erector spinae
WILLIAM FLEXION exercises
What is spondylolysis
small fracture in pars articularis
can be uni or bilateral
What is the treatment for spondylolysis?
Spine Stabilization
Heals within 3-6 Months
What is spondylolisthesis?
forward slippage of vertebral body after bilateral pars articularis fractures
What is the most common vertebral slippage in sondylolisthesis?
L5-S1
Treatment for Spondylolisthesis
Stabilization
Posture
TX for pain/spasm
What muscles are we working for SI Hypermobility
Glute Max
Erector Spinae
Biceps Femoris
Lats
Piriformis
Multifidi
Angle of inclination: Coxa Vara
Angle is less than 120 degree
Angle of Inclination: Coxa Valga
Angle is greater than 120 degrees
Angle of Inclination Norm
120-125 degrees
What is the angle of inclination measuring?
The femoral head and femoral shaft in the transverse plane
What is scapular rhythm?
IF the arm is abducted 180 degrees:
Scapula rotates 60 degrees
Glenohumeral rotates 120 degrees
What tendon is ruptured in Mallet Finger?
Distal Extensor Tendon
What is ruptured in a jersey finger?
rupture of:
Flexor Digitorum Profundus
loss of DIP function
What tendon is injured in Boutonniere
injury to the central extensor tendon at PIP
*May require surgery
What is De Quervains?
inflammation of APL and EPB
Muscle Strains:
Grades and Recovery
Grade 1= 2-3 Weeks recovery
Grade 2= 6-8 Weeks recovery
Grade 3= Call Doctor
What causes osteoarthritis?
PRIMARY
Age
What causes osteoarthritis? Secondary
Trauma
Obesity
Joint Injury
Neuro
What motion should be restored in the elbow first?
Extension
What motion should be restored in the forearm first?
Supination
What is tendonitis?
Inflammation of the tendon
DFM followed by ICE
Ionto or Phono
Medial Epicondylitis
Golfer Elbow
Flexors weak
Extensors Tight
Poor eccentric Control
Lateral Epicondylitis
MOST COMMON
Tennis Elbow
Extensors weak
Flexors Tight
What movement should be restored first in the hand?
Finger Flexion
What are 3 elbow fracturs?
Radial Head
Olecranon
Distal Humerus
With a radial fracture we gain rom for what first?
Supination
then pronation
Most common ligament sprain in the elbow?
Medial UCL (tommy john)
common due to throwing/hitting
Donor Sites for a ligamentous surgery?
Palmaris Longus
Hamstring
Symptoms of Rheumatoid Arthritis in the hand?
Am Stiffness
Pain
Weakness
Swelling
Fatigue
Decrease Mobility
Joint Deformity
*ulnar drift
A patient with spondylolisthesis would need Williams flexion or Mckenzie extension exercises?
Williams FLEXION for Spondylolisthesis
Cervical Traction: Muscle Spasm
Pulling 11-15lbs
Cervical Traction Joint Distraction
20-30 pounds
Do not exceed 30 lbs
Lumbar traction: Muscle Spasms
25% BW
Lumbar Traction: Joint Distraction
50% BW
Most common disc herniation area
L4-L5 or L5-S1
How does a disc herniation present?
Pain with flexion
Unilateral
Possible radicular symptoms
MRI confirmed
Do disc herniation patients prefer flexion or extension
Extension
Prone Press up can help push disc back in
What is the unhappy triad
MCL ACL and meniscis
Which menisci is most likely to be injured
Medial Meniscis
Higher q angle means greater risk for what injury?
ACL tear
Auto-graft
Comes from you the patient
Hamstring/tendon
Allograft
from cadaver
Why do patients who had a recent ACL repair avoid open chain exercises
Open chain exercises cause a sheering on the ACL. PATIENTS NEED CLOSED CHAINED after ACL surgery (mini squats)
Genu Valgum has Coxa _________ and ________________ of the feet.
Genu Valgum= Coxa Vera and Pronation of the feet
