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Exam Prep > Orthopedic & Musculoskeletal > Flashcards

Orthopedic & Musculoskeletal Flashcards

1
Q

Cervical spine ROM

A

Flexion 0-45
Extension 0-45
Lateral flexion 0-45
Rotation 0-60

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2
Q

Thoracic/lumbar ROM

A

Flexion 0-80
Extension 0-30
Lateral flexion 0-40
Rotation 0-45

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3
Q

Shoulder ROM

A

Flexion 0-180
Extension 0-60
AB 0-180
Horizontal AD 0-145
Horizontal AB 0-45
IR 0-70
ER 0-90

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4
Q

Wrist ROM

A

Flexion 0-80
Extension 0-70
Ulnar deviation 0-30
Radial deviation 0-20

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5
Q

Elbow/forearm ROM

A

Flexion 0-150
Supination/pronation 0-80

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6
Q

Hip ROM

A

Flexion 0-120
Extension 0-30
AB 0-40
IR/ER 0-45

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7
Q

Thumb ROM

A

MP flexion 0-50
IP flexion 0-80
AB 0-50

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8
Q

Finger ROM

A

MP flexion 0-90
MP hyperextension 0-45
PIP flexion 0-110
DIP flexion 0-80
AB 0-25

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9
Q

Knee ROM

A

Flexion 0-135

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10
Q

Foot/ankle ROM

A

Plantar flexion 0-50
Dorsiflexion 0-15
Inversion 0-35
Eversion 0-20

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11
Q

FWN

A

No limits or restrictions

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12
Q

WBAT

A

Pain to guide tolerance

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13
Q

PWB

A

30-50%

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14
Q

TDWB

A

10-15%

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15
Q

NWB

A

0%

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16
Q

Isometric contraction

A

No movement or change in angle (static holds, contract/relax)

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17
Q

Isotonic contraction

A

Movement over joint with change in angle
- Eccentric
- Concentric

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18
Q

Eccentric

A

Muscle lengthening (down)
- Elbow extension
- Stand to sit

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19
Q

Wheelchair consideration for bilateral LE amputation

A

Large rear facing wheels with anti-tippers for residual limb support/ counter balance missing limbs

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20
Q

Terminal device

A

UE: hand
LE: foot

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21
Q

Passive TD

A

realistic and non functional worn for cosmetic purposes

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22
Q

Active TD

A

Body-powered, externally powered through electrical signal or hybrid powered

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23
Q

Prosthetic wearing schedule

A
  • Initially have patient wear for 15 to 30 minutes
  • Remove to check for redness
  • If no redness apparent post wear increase time by 15-30
    min intervals until prosthetic is worn for entire day
  • If redness does not disappear after 20 minutes report to
    prosthetist
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24
Q

Symptoms of fibromyalgia

A

Widespread pain, poor sleep, fatigue, inability to think clearly, joint swelling

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25
Q

Fibromyalgia diagnosis

A

of painful areas
Severity of fatigue
Presence of cognitive problems
Symptoms last for 3+ months
Symptoms not explained by other health issues

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26
Q

Common evaluation for fibromyalgia

A
  • Daily activity log
  • COPM
  • Pain assessment
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27
Q

Treatment for fibromyalgia

A

Trigger management
Stress management
Myofascial release & trigger point massage
Daily stretching and light aerobic exercise
Progressive strengthening
Sleep hygiene
Energy conservation

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28
Q

OA

A

Noninflammatory condition resulting in breakdown of articular cartilage and reduced joint space causing painful bon-to-bone contact

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29
Q

Types of OA

A

Primary: localized or generalized joint involvement with no known cause
Secondary: related to trauma, infection or congenital abnormalities

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30
Q

Bouchard’s nodes

A

PIP bony overgrowths due to OA

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31
Q

Herberden’s nodes

A

DIP bony overgrowths due to OA

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32
Q

Surgical treatment options for OA

A
  1. Arthroscopic debridement to remove broken cartilage to reduce pain and improve movement
  2. Resection or perforation of subchondral bone to stimulate formation of cartilage
  3. Graft to replace damaged cartilage
  4. Joint fusion
  5. Arthroplasty (knee, hip replacement)
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33
Q

Kyphosis

A

Abnormal rounding outward of upper back in thoracic region

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34
Q

Lordosis

A

Abnormal rounding inwards of lower back in lumbar region

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35
Q

Kyphosis impact on ADL

A

Deficits in eating including manipulation and swallowing

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36
Q

Osteoprosis

A

Progressive low bone density that leads to bone fragility and frequent fx in weight bearing bones

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37
Q

Risk factors of osteoporosis

A

Osteopenia, inadequate calcium intake, estrogen deficiency, sedentary lifestyle, alcoholism, diabetes, RA medications, malnutrition, post menopausal, women

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38
Q

Treatment for osteoprosis

A
  • Anti-resorptive medications to slow bone loss
  • Hormone related therapy
  • Calcium supplement with vitamin D to assist with absorption
  • Exercise and reduced smoking, alcohol, caffeine intake
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39
Q

Presentation of RA

A

Polyarticular

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40
Q

RA

A

Systematic and inflammatory condition with resulting in progressive synovitis of diarthrodial joints due to excessive synovial build up and joint deformities due to uneven distribution of weakened tendons and ligaments

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41
Q

Age group for juvenile RA

A

1-6

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42
Q

Common RA deformities

A

Boutonniere
Swan neck
Mallet
Ulnar deviation
Subluxation
Joint fusion
Extensor tendon rupture
Trigger fingers
Mutilans deformity
Subcutaneous nodules
Claw toe
Hammer toe
Cock-up toe
Hallux valgus (bunion)

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43
Q

Boutonniere deformity

A

PIP flexion DIP hyper-extnesion

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44
Q

Swan-neck deformity

A

PIP hyper-extenion DIP flexion

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45
Q

Mallet figner

A

DIP flexion

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46
Q

Ulnar drift

A

MCP ulnar deviation, wrist radial deviation

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47
Q

Mutilans defomirty

A

Very floppy joints with shortened bones and redundant skin

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48
Q

Claw toe

A

Hyperextension of MTP and flexion of IP

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49
Q

Hammer toe

A

Hyperextension of MTP and PIP and DIP flexion

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50
Q

Early phase RA

A

No destructive change on x-ray
Possible osteoporosis

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51
Q

Moderate phase RA

A

Radiographic evidence of osteoporosis
Slight cartilage and bone destruction
No joint deformity
Possible limitations with ROM
Muscle atrophy

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52
Q

Severe phase RA

A

Cartilage and bone destruction
Joint deformity
Expensive atrophy
Possible soft-tissue lesions

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53
Q

Terminal phase RA

A

Fibrous or bony ankylosis in addition to stage 3

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54
Q

Neuroma

A

Ball of nerve tissue when axons attempt to regrow in distal limb that is painful with pressure on residual limb

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55
Q

Sebaceous cyst

A

Keratin-filled sac causes by skin irritation and torque forces when prosthetic that are raised and usually painless

56
Q

Desensitization technique for hypersensitivity

A

Start with least sensitive area with tolerating but irritable texture for short periods of time multiple times per day

57
Q

Prosthesis control training

A

Operating each component of prosthetic, learning to open/close prosthetic

58
Q

Prosthetic use training

A

Integration of prosthetic components for efficient assist during functional use

59
Q

Pre-positioing prosthetic training

A

Identification of optimal position of each joint component to perform an activity

60
Q

Prehension prosthetic training

A

TD control durig grasp activities

61
Q

Functional prosthetic training

A

Control and use of prosthetic during functional bilateral activities using TD as functional assist

62
Q

MMT rule for applying resistance against gravity

A

If patient can achieve 50% AROM antigravity therapist can apply resistance to further assess

63
Q

When do OOB activities start post-hip replacement

A

24 hours post-op

64
Q

Purpose of therapeutic exercise with arthritis

A

Prevent atrophy
Maintain or increase ROM
Maintain muscle strength

65
Q

PROM > AROM

A

Muscle weakness

66
Q

Splinting for recent CTS dx

A

Immobilization splint to rest and reduce inflammation

67
Q

What to do during RA flareup

A

Avoid placing stress on joints with grip or strengthening exercises, AROM preferred but PROM is indicated if pain makes it difficulty to complete AROM

68
Q

Arthritis compensatory interventions

A

Joint protection
Pacing

69
Q

Cumulative trauma disorder compensatory interventions

A

Activity modification
Proper body mechanics

70
Q

Respiratory and cardiac disease compensatory interventions

A

Energy conservation
Work simplification

71
Q

Signs of cubital tunnel syndrome or nerve compression

A

Wartenburg’s ding
Froment’s sign

72
Q

What improves the fit of prosthetic socket

A

Prosthetic sock or gel liner

73
Q

Contracture

A

fixed position of shortening of skin, ligaments, joint capsule, tendons and muscles due to burns, wound healing, muscle imbalance

74
Q

Types of contracture

A

Soft tissue: responds to therapy
Body block: requires surgical release

75
Q

Five steps to contracture treatment

A
  1. Superficial and deep heat to increase tissue extensibility
  2. Slow stretch
  3. Static splinting
  4. Serial or progressive static splinting
  5. Dynamic splinting
76
Q

Posterolateral hip precautions

A
  • No hip flexion greater than 90 degrees
  • No IR
  • No ADDuction
77
Q

Anterolateral approach precautions

A
  • No extension (do not step back with impaired side)
  • No ER
  • No ADDuction
78
Q

Anterolateral approach precautions

A

No extension
No IR/ER

79
Q

Static LB pain

A

nerve trapped by herniated disc

80
Q

Spinal stenosis LB pain

A

Narrowing of intervertebral foramen

81
Q

Facet joint pain

A

inflammation or changes of spinal joints

82
Q

Spondylolysis

A

Age related wear and tear if cartilage and bone in the spine (degenerative arthritis of spine)

83
Q

Spondylolisthesis

A

Slippage of vertebra out of position

84
Q

Herniated nucleus pulposus

A

Tearing of disc fibers causing outward bulge

85
Q

Standards of body mechanics

A

Maintain straight back
Bend from the hip
Avoid twisting
Maintain good posture
Carry loads close to the body
Lift with the legs
Lift with a wide base of support
Lift in sagittal plane
lift slowly

86
Q

OA Symptoms

A

Joint pain
Stiffness
Limited ROM
Local inflammation
Crepitus of joint
Bone spurs

87
Q

Factors that increase OA pain

A

Continues breakdown of cartilage
Osteophyte formation where ligaments attach to bone
Change in joint shape
Fluid-filled cysts near joint
Bone particles and cartilage float into loose joint space

88
Q

Total knee replacement precautions

A
  • No sleeping with pillow under knee while in bed
  • Feet flat on the floor in sitting
  • Immobilizer use as instructed
  • No kneeling, squatting or twisting knee joint
89
Q

Common interventions for OA

A

AROM (PROM only used if AROM is precluded)
Isometric/isotonic strengthening to tolerance
Low impact aerobic conditions

90
Q

Contraindication for CMC OA

A

Pinching exercises due to stress on the joint

91
Q

10 principles of joint protection

A
  1. Respect pain
  2. Maintain muscle strength and joint ROM
  3. Use each joint in most stable anatomical plane
  4. Avoid positions of deformity
  5. Use the strongest joint available
  6. Ensure correct patterns of movement
  7. Avoid staying in on position for long periods of time
  8. Avoid starting an activity that cannot be stopped immediately if it becomes to stressful
  9. Balance rest and activity
  10. Reduce force and effort
92
Q

Osteopenia

A

Reversible weakening of bone that is a precursor to osteoporosis

93
Q

Progression of osteoporosis symptoms

A

Initially no symptoms
Later in disease process clients may experience severe back pain, recurring fractures, spinal deformities such as kyphosis, loss of height

94
Q

Big concern with osteoprosis

A

Falling and need for home evaluation for fall prevention

95
Q

RA criteria for diagnosis

A

Four of seven diagnostic criteria:
- Morning stiffness
- 3/14 swollen joints
- Swollen joints of hands
- Symmetric swollen joints
- Rheumatoid nodules
- Serum for rheumatoid factor via labs
- Radiographic changes hand and wrist

96
Q

Ankylosis

A

Abnormal stiffening or immobility due to fusion of bone

97
Q

DMARDS (disease-modifying anti-rheumatic drugs)

A
98
Q

Cognitive areas often impacted due to pain

A

STM, attention span, problem solving

99
Q

How to calculate TAM

A

AROM MCP/PIP/DIP flexion -extension deficits

100
Q

MMT stabilization and resistance

A

Proximal to the joint the muscle belly crosses over with resistance gradually applied in opposite direction of movement

101
Q

Grip and pinch strength and testing positions

A

Should AD, elbow flexion to 90, forearm in neutral

102
Q

Options for grip strength testing

A
  • Dynamometer position #2 mean of 3 trials
  • Dynamometer 1 trial in all 5 positions
  • Bulb dynamometer for arthritis
103
Q

Types of edema

A
  1. Pitting (acute)
  2. Brawny (chronic)
104
Q

5

A

Full ROM against gravity with max resistance

105
Q

4

A

Full ROM against gravity with mod resistance

106
Q

4-

A

Full ROM against gravity with less than moderate resistance

107
Q

3+

A

Full ROM against gravity with minimal resistance

108
Q

3

A

Full ROM against gravity with no resistance

109
Q

3-

A

Less than full ROM against gracity

110
Q

2+

A

Full ROM in gravity eliminated with minimal resistance

111
Q

2

A

Full ROM in gravity eliminated with no resistance

112
Q

2-

A

Partial ROM in gravity eliminated

113
Q

1

A

Tension palpated in muscle but no movement

114
Q

0

A

No tension palpated in muscle

115
Q

What is considered significant change with volumeter

A

More than 10 mL

116
Q

Sensation testing for spinal cord injuries

A

Tested proximal to distal following dermatome pattern

117
Q

Sensation testing fors peripheral nerve injuries

A

Distal to proximal following peripheral nerve

118
Q

Order of return of peripheral nerve

A

Pain
Moving touch
Static touch
Touch localization

119
Q

Moving two point discrimination

A

Starts 5-8 mm apart
Proximal to distal
Longitudinal orientation
7/10 must be correct before decreasing distance of two points
Normal = 2 mm

120
Q

Static two-point discrimination

A

Starts 5 mm apart
Longitudinal orientation
Normal = 5 mm
Fair = 6-10
Poor = 11-15
Protective = one point detected
Anesthetic = no point detected

121
Q

Propriocpetion

A

Position sense - therapists positions involved extremity and patient duplicate position with contralateral extremity

122
Q

Kinesthesia

A

Movement sense - therapist moves segment and person responds up or down

123
Q

Eccentric

A

Lengthening

124
Q

Concentric

A

Shortening

125
Q

Concentric contraction takes place..

A

Anytime a person moves against gravity or away from the earth they are performing a concentric contraction

126
Q

Grocery contraction example

A

Lifting groceries from the car = concentric
Carrying groceries into kitchen = Isometric
Slowly lowering groceries onto table = eccentric

127
Q

Edema reduction strategies

A

Elevation
Manual edema mobilization (specialized)
Retrograde massage
Compression garments
Cold pack
Contrast bath
Intermittent compression pump

128
Q

Common contraindication for heat

A

Edema (but can be used cautiously if mild case in combination with elevation )

129
Q

Contraindications for edema reduction techniques

A

Infection
Grafts
Vascular/circulation damage
Blood clots
Unstable fx
CHF
Cardiac edema

130
Q

Scar management techniques

A

ROM /early mobilization
Massage
Compression
Scar pad
Splinting
Control edema

131
Q

Compression garments for UE

A

Hand = isotoner glove
Digits = coban
Forearm = tubi grip

132
Q

Desensitization for scar hypersensitivity

A

Start in periphery and move towards scar
- massage
- texture grading
- vibration
- fluidotherapy
- self times a day

133
Q

Sensory re-education

A
  • massage
  • texture grading
  • vibration
  • fluidotherapy
  • Education on safety precautions with loss of protective sensation
134
Q

Strategy for improving coordination

A

Begin with slow gross motor activities and gradually grade up to faster fine motor activities with focus on accuracy and speed

135
Q

What modality should you not use with RA during flare-up

A

HEAT!

Exam Prep (19 decks)

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