OS3 year 2 exam 1 -Hannah Flashcards
systemic causes of compression neuropathy
pregnancy
hypothyroidism
diabetes
three sites of radial nerve entrapment and associated symptoms
- high on the humerus
sx: wrist drop, weak elbow flexion, tricep weakness - radial tunnel
sx: pain and tendernesss 5cm distal to lateral epicondyle , wrist drop , pain with resisted supination - at the wrist
sx: sensation changes over posterolasteral hand
what nerve causes pronator syndrome
sx: achy pain in the mid/proximal forearm, pain with resisted forearm pronation and cramping in the fingers
median N.
-compression by the pronator trees muscle
anterior interosseous syndrome
- anterior interreouses N. from the MEDIAN N.
sx: NO sensory symptoms, cannot make “OK” sign with thumb and index finger properly - weak flexion of the index finger DIP and thumbs IP
sx: parathesia to the 4th and 5th digits, medial elbow pain radiating to the hand with decreased intrinsic muscle strength (can’t turn a key in the door)
* + Tinel sign at elboww
ulnar nerve entrapment in cubital tunnel syndrome
*reproduction with elbow flexion, wrist extension
what is froments sign and when do you see it
patient must flex thumb in order to pinch paper between 1st and 2nd digit
seen in cubital turner syndrome of ulnar n. entrapment
what is the most common compression syndrome
median N entrapment at the CARPAL TUNNER SYNDROME
sx of carpal tunnel syndrome
nighttime numbness of lateral 3 1/2 digits, tingling, wrist pain, dropping things, thenar atrophy
dx gold standard for carpal tunnel syndrome
EMG
sx of thoracic outlet syndrome
weakness, parathesia of medial arm forearms and hand worsened by overhead activity
what causes a positive tinnels sign 1cm medial and inferior to ASIS
meralgia parasthetica (lat fem cutaneous n.)
what compression is caused by “strawberry pickers palsy” (time spent in squatting position), or leg hooked over a rail, or ANKLE SPRAINS
common fibular nerve compression
sx: pain along proximal third of lateral leg, steps make louder sound on affected side (foot drop) , pain worsened with plantar flexion and inversion of the foot
plantar flexion and foot inversion makes the fibular head go _____
posterior
*PIP
tarsal turner syndrome (assoc with autoimmune diseases and diabetes)
compression of the posterior tibial n. in the tarsal tunnel behind the medial malleolus and overlying flexor retinaculum
sx: affects motor to plantar (bottom) muscles of foot and sensation to plantar aspect of the foot and toes
anterior tarsal tunnel syndrome
- compression of deep fibular nerve by the inferior extensor retinaculum
- sx: pain over dorsomedial aspect of foot and worse at rest, weakness of extensor digitorum braves
- caused by prolonged plantar flexion or compression from shoes, or soccer
cervical nerve root compression is caused by
2 degree to cervical disc disease
(herniated or bulging disc)
= radiculopathy
bulging disc vs herniated disc
bulging
-compresses every without tearing to cartilage rings
herniated
-tearing of cartilage rings
(protrusion- few tearing, no leakage)
(extrusion- torn in a small area, nucleus pulposus is able to flow out of disc space)
technique: extending and rotating the neck toward the symptomatic side, look for exacerbation of radicular pain
dx: cervical radiculopathy (herniated disc)
spurling test
technique: elevate patient chin (extend neck) and rotate head toward affected side while inspiring deeply, look for decrease in radial pulse on affected side
dx: thoracic outlet syndrome (plexopathy)
adsons test
technique: firmly grasp the middle finger and quickly snapping or flipping the dorsal surface, look for quick flexion of both the thumb and index finger
dx: cervical myelopathy (c-spine stenosis)
hoffmann tets
compression of the superficial radial N., (cheiralgia parathestica, wartenbergs syndrome, “HANDCUFF NEUROPATHY”)
numbness, pain, tingling in the posterolateral hand and distal forearm
-compression of the radian n. at the wrist between the ECRL, and brachioradialis M.
baseball players and dentist are likely to get what compression neuropathy
median n. entrapment as PRONATOR SYNDROME
what muscle is weak in anterior interrosseous syndrome as seen with with pts with forearm casts
flexion pollicus longus muscle and flexor digitorum M.
three test to dx carpal tunnel syndrome
tinels, phalens, 2 point discrimintion
lumbosacral radiculopathy (sciatica) vs piriformi syndrome sx
sciatica travels down to foot, and low back pain, and caused by herniated disc most often at the left of L5-S1 (affects L5 nerve)
piriformis syndrome - pain stops at or above kneee and radiates from the gluteal region, contralateral sacroiliac pain (SI JOINT PAIN) can have gait problems (foot drop) and weakness in ipsilateral LE
lat fem cutaneous comes from what lumbosacral nerve roots
L2 -L3
and nerve is compressed by inguinal ligament
common fibular N. lumbosacral nerve roots
L4-S2
tx for tarsal turner syndrome (posterior tibial N.)
gastrocnemius counterstain , calcaneal HVLA, talar tug HVLA, ankle figure 8
if there is a thoracic and rib TP, which do you treat first?
thoracic
2 cm lateral to medial end of the clavicle
AC 7
(clavicular head of the SCM)
(F StRa)
medial end of the clavicle
AC 8
(sternal head of SCM at the sternal notch )
(F SaRa)
inferior tip of xiphoid or 1/4 of the way between the xiphoid tip and umbilicus
AT 7
tx: patient sitting- knee on opposite side of TP, FSTRA
3/4 way between xiphoid and umbilicus
AT 9
tx: patient sitting- knee on opposite side of TP, FSTRA
1/4 way between unblicius and pubic symphysis
AT 10
tx: F STRT
- patient supine; same side as TP, pull ankles and knees toward you
halfway between umbilicus and pubic symphysis
AT 11
tx: F STRT
- patient supine; same side as TP, pull ankles and knees toward you
anterior superior surface of the iliac crest at the midaxillary line
AT 12
tx: F STRT
- patient supine; same side as TP, pull ankles and knees toward you
medial ASIS
AL1
-F STRT
(stand same side pull ankles and knees toward you )
1 = STaRT
medial, lateral and inferior AIIS
medial ( AL 2) lateral AL3 inferior AL 4 tx= F SARA (stand opposite side and pull ankles and needs to you/away from TP)
superior aspect of pubic ramus just lateral to the pubic syphysis
AL 5
tx= F-SART
stand same side and push ankles away and rotate knees towards you/TP
lower quadrant, medial to ASIS, deep in iliac fossa
1/3 from ASIS to midline
iliacus Tender point
tx: “frog leg” [ F-ER ]
- same side and flex hips and knees to 90 crossing ankles over doc knee and inducing marked ER
“FrogER”
superior pubic ramus where psoas muscle crosses the pelvic rim
(superior surface of iliopubic/iliopectineal eminence)
low ilium tender point
tx= same side and flex hip and knee to 90
lateral pubic tubercle
inguinal ligament tender point
-tx= “cross good over bad” and pull ankles toward
[internal rotation of dysfunctional hip]
-associated with inguinal L. and pectineus M.
2/3 distance from ASIS to midline, pressing deep
psoas major tender point
tx: F STRT
(same side, flex and pull ankles and feet towards you/TP)
on the inferior nuchal line, lateral to the inion
PC1 inion
tx= F.STRA
on the inferior nuchal line, 1/2 way between the inion and mastoid process (splenius Capitis M. )
PC1 occiput
tx: E-Sara
on the inferior nuchal line , in the semispinalis capitis M.
PC2 occiput
tx: E-SARA
on the inferior or inferolateral aspect/tip of the spinous process of C2
PC3
tx: F-sara
(C2 has 2 tender points)
is seated or standing flexion test for the sacrum
seated flexion test
for sacral torsion, what is the relationship between the axis and the seated flexion test
the axis is opposite to the positive side of the seated flexion test (dysfunctional side)
when is pedal pump ABSOLUTELY contraindicated in a surgical patient
if DVT, lower extremity fracture, recent abdominal surgery
facilitated segments are often a result of ____ ___ ____ and reproduction of dysfunction occurs rapidly therefore frequency of treatment is ____
acute visceral processes
-very frequent, often more than once daily until the process improves and the frequency can decrease
tx of ____ may have greater effect in segmental facilitation vs ____ because of the high concentration of nociceptors in the joint capsules vs muscle bodies
articular tissues treatments vs soft tissue techniques (MFR or counterstain)
rule of W’s
in post op fever
- wind (Lungs)
- water (kidneys)
- walking (DVT, PE)
- wound
- wonder drug
thoracic duct is under SNS control and therefore hyper sympathetic tone may ____ lymphatic flow
decrease
what is the caution with CHF patients
do not overwhelm the circulatory system and exacerbate symptoms
neurologic tx for CHF patient
paraspinal inhibition at T1-T6 (decrease SNS)
sub occipital release (increase PNS tone)
chapmans points (2 ICS anteriorly, 2-3 TP posteriorly)
scoliosis grading
mild : 5-15
moderate: 20-45
severe: >50
* cobb angle measurement
measure of the angle between a line parallel to the superior end plate of the most cephlad vertebrae in a particular curve and a line parallel to the inferior end plate of the most caused vertebra of the curve
Cobb angle
in FPR the activating force is applied ___ in pelvic tx, and ____ in rib tx ; what is the one exception
after in pelvic, before in rib
except in INH/EX seated FPR you add activation force after position indirectly
FPR of sacral SD (restriction in cephalad motion on one side)
neutralize the curve, flex hip off table, knee extended abduct and add activation force by pushing cephalad on the ILA
FPR of piriformis TP/hypertonicty (associated with sacral torsion)
neutralize the curve, flex hip off table, knee bent, and adduct duct, add activation axial compression through the palm at the kneee to shorten the muscle
FPR of gluteus maximus TP/hypertonicty
neutralize the curve, flex hip off table, bend knee to 90 degree, extend hip with doctors knee until motion is felt at the TP, add TORSIONAL force by external rotating the hip by contact at the ankle and knee as fulcrum
FPR of hamstring TP/hypertonicity
neutralize the curve, extend hip off table on top of doctors knee, flex knee until relaxation of the hamstring, induce IR/ER rotation with distally placed hand, add axial compression or traction with proximal hand as activating force
FPR for quads (left vests lateraled hypertonicity SD)
neutralize the curve (with pillow under head in supine position) flex hip with knee maximally extended and calf of patient on doctors thigh. direct patella towards the monitoring hand, and induce IR/ER and AB/ADuct of hip as needed, add axial compression or traction activating force using the Dr.s thigh
seated FPR of costochondral SD
neutralize curve, add compression at shoulders, rotate towards until motion felt or TP releases
seated FPR of posterior rib SD
neutralize curve, add compression at shoulders, Flex, sideband towards, rotate towards (F STRT)
where do you start and end in a stills technique
start at the shifted neutral position of ease, end at the ANATOMIC barrier or the direct position (not restrictive barrier)
Stills technique for posterior rib
monitor costotransvere segment (posteriorly) abduct arms, add compression through elbows to the rib, and adduct the arm across the body
tensor fascia lata TP ( at lateral trochanter)
F- AB (maybe IR)
ITB TP
F-AB
medial vs lateral hamstring TP
Lateral - F-AB-ER of tibia
medial - F-AD-IR of tibia
*follows same for menisci
popliteus TP
F-IR (flex knee and IR tibia)
gastrocnemius TP
flex knee and place dorsal of foot on doc thigh, add compression through calcaneous
medial ankle (tibialis anterior) vs lateral ankle (fibularis m.s) TP
medial ankle= inversion
lateral ankle = eversion
(pt is lateral recumbent with pillow underneath for both)
navicular TP
knee flex, dorsum of foot on doc thigh, plantarflexsion and supination (inversion) of foot
supra spinatus, and upper and lowe infrapsinatus TP
all are FABER
supra- 45 degree
upper infra- 90-120
lower infra- >135
levator scapula tp
rotate head away,
IR AB and traction on shoulder
subscapulris TP
E and IR shoulder (maybe traction)
biceps brachi TP short and long head
F-AB-IR
(flex should and elbow, min abduct, and IR)
**SHORT HEAD MIGHT BE FADDIR
medial epicondyle (pronator teres) TP
Flex elbow, pronate, adduct forearm
abductor policus brevis TP
flex wrist Abduct thumb
FAB
when is an ankle series indicated according to the ottawa rules
if there is pain in the malleolar zone, and
1. tenderness at the posterior edge or tip of the medial or lateral malleolus
or
2. can not bear weight immediately after injury or for 4 steps in ER
when is an foot series indicated according to the ottawa rules
if there is pain in the mid foot zone, and
1. bone tenderness at the base of the 5th metatarsal (pinky toe) or navicular
or
2. can not bear weight immediately after injury or for 4 steps in ER
