OSCE Station 4 and 5 practice Flashcards
35 year old tennis player presents with anterior thigh pain P1 (0-6/10) that came on suddenly during a match 1/52 ago, while sprinting for a ball.
o/e
Knee ROM:
Active extension = full range & slight (+) P1
Passive extension = full range & painfree
Active flexion = 100degs & slight (+) P1
Passive flexion = 110degs & more (+) P1
Resisted tests:
Knee extension = (+) P1
Knee flex = (-) P1
What is the most appropriate manual technique for treatment today?
quads effleurage
consider location of the pain - instead of location of action involved
35 year old tennis player presents with anterior thigh pain P1 (0-6/10) that came on suddenly during a match 1/52 ago, while sprinting for a ball.
o/e
Knee ROM:
Active extension = full range & slight (+) P1
Passive extension = full range & painfree
Active flexion = 100degs & slight (+) P1
Passive flexion = 110degs & more (+) P1
Resisted tests:
Knee extension = (+) P1
Knee flex = (-) P1
Why would dynamic hamstring massage be unhelpful?
The location of pain (anterior thigh) and resisted tests (pain on engaging quads for knee extension) point to a Quads STI
35 year old tennis player presents with anterior thigh pain P1 (0-6/10) that came on suddenly during a match 1/52 ago, while sprinting for a ball.
o/e
Knee ROM:
Active extension = full range & slight (+) P1
Passive extension = full range & painfree
Active flexion = 100degs & slight (+) P1
Passive flexion = 110degs & more (+) P1
Resisted tests:
Knee extension = (+) P1
Knee flex = (-) P1
Why would AP Tib-Fem joint Grade II?
The location of pain (anterior thigh) and resisted tests (pain on engaging quads for knee extension) point to a Quads STI.
A 66 year old retired GP complaining of functional stiffness due to osteoarthritis.
Physical exam reveals hip flexion = 105degs, limited by stiffness
what is the most appropriate MT technique?
Lateral distraction Hip joint at 90 degrees flexion x Grade IV
A 58 year old office worker complaining of functional stiffness due to osteoarthritis.
Physical exam reveals hip abduction = 20degs, limited by stiffness
Longitudinal caudad Hip joint at 90 degrees flexion x Grade IV
45 year old woman presents with residual complaints of stiffness 6/12 after sustaining a conservatively managed undisplaced tibial plateau fracture. She reports moderate EOR knee pain P1 (0-4/10) that is non-irritable.
o/e
Knee ROM: Active = Passive
Extension: (-) 10˚ limited by stiffness & EOR P1
Flexion: WNL
Resisted tests:
Knee extension = (-) P1
Knee flex = (-) P1
Identify all of the possibly appropriate manual techniques for treatment?
PFJ - Superior glide x Gr II-III
Tibio-femoral joint - PA glide x Gr II-III
Quads tapotement
Quads effleurage
45 year old woman presents with residual complaints of stiffness 6/12 after sustaining a conservatively managed undisplaced tibial plateau fracture. She reports moderate EOR knee pain P1 (0-4/10) that is non-irritable.
o/e
Knee ROM: Active = Passive
Extension: (-) 10˚ limited by stiffness & EOR P1
Flexion: WNL
Resisted tests:
Knee extension = (-) P1
Knee flex = (-) P1
Accessory exam:
PFJ = NAD
Tibiofemoral joint = hypomobile glide (accompanying knee extension), otherwise NAD
With the addition of the accessory exam, now identify the most appropriate manual technique(s) for treatment?
Tibio-femoral joint - PA glide x Gr II-III
19 year old ballet dancer presents 3/12 post Grade II ATFL ligament sprain (R) with residual complaints of stiffness, making it difficult to get back ‘en pointe’ i.e. on her toes to dance.
o/e
Ankle ROM:
Dorsiflexion - WNL, L = R
Plantarflexion - L = 60degs, R 40degs
Resisted tests: NAD
Identify all of the possibly appropriate manual techniques for treatment?
Talocrural joint - PA glide x Gr IV
DTF ATFL
Talocrural joint - Physiological plantarflexion x Gr IV
19 year old ballet dancer presents 3/12 post Grade II ATFL ligament sprain (R) with residual complaints of stiffness, making it difficult to get back ‘en pointe’ i.e. on her toes to dance.
o/e
Ankle ROM:
Dorsiflexion - WNL, L = R
Plantarflexion - L = 60degs, R 40degs
Accessory glides: NAD talocrural joint.
Resisted tests: NAD
Now identify the most appropriate manual technique for treatment?
DTF ATFL
A 40 year old male recreational runner presents for treatment for chronic Achilles tendinopathy. This will include addressing known risk factors for tendinopathy. Which of the following is NOT a risk factor for Achilles tendinopathy?
Reduced ankle plantarflexion
accessory glide of hip flexion
AP
Accessory glide of hip abduction
lateral distraction
longitudinal caudad
Accessory glide of hip lateral rotation
PA (extension and lateral rot go together)
Accessory glide of hip medial rotation
(flexion and medial rot go together)
Lateral distraction
Accessory glide of hip extension
PA
Accessory glide of knee flexion
AP
longitudinal caudad
Accessory glide of knee extension
PA
What types of accessory movement can be performed on the hip joint?
- AP
- PA
- Lateral distraction
- Caudad / Longitudinal
Pain in the anterior of thigh after 1 week means
quads effleurage
Pain in the posterior of thigh after 1 week means
hamstrings effleurage
pain in the posterior of calf muscle after 1 week means
calf effleurage
benefits of effleurage
movement of; lymph, venous blood, oedema, lung secretions
mobilisation of; muscle fibres, muscle belly, tendons, scar tissue tissue layers
reduce muscle tension
list 4 absolute contraindications of massage
cancer 48-72 hours post injury open wound/burn foreign body/bone fragment circulatory disease
list 4 potential contraindications of massage
Cancer – Malignant disease
Fragile skin
Collagenous weakening e.g. diabetes, advanced RA(rheumatoid arthritis), long-term steroid use
Cardiac pathology – increase BP, reflex fx (neck, chest, mid-thoracic)
MT for limited hip flexion
lateral distraction
MT for limited hip extension
anterior glide /PA
MT for limited hip abduction
longitudinal caudad
MT for limited hip adduction
lateral distraction
MT for limited hip external rotation
anterior glide for patient in prone 90 degree knee flexion towel in ant. of pelvis one hand in distal of posterior hip and other hand ankle push hand downward on posterior hip
MT for internal rotation
posterior glide
list movements hip are in when they are in a closed packed position
Extension
Abduction
Internal Rotation
patient is suffering from anterior groin pain or upper thigh pain pain on passive abduction and resisted or isometric hip adduction. what manual therapy treatment do you give them
adductor longus DTF treatment
knee flexed
hip partially abducted
place thigh against their thigh and ask them to apply resisted abduction to find adductor longus
patient feels pain in back of thigh (+) pain on hamstring flexibility test (90:90 test) (+) pain on resisted prone knee flexion (worse in IR for medial hams and in ER for BF).
Hamstring knee flexed prone with knee flexion to relax muscle. Reinforced fingers or elbow exert transverse friction
Deep transverse frictions are suitable for which type of injuries. give frequency and time duration of massage.
tendinopathy muscle strains ligament strains scar healing 2-3 times a week for 3 weeks never twice in a row for 5-10 minutes
patient feels pain on medial side of knee after GAA game
pain on knee extension
(+) pain on Valgus ligamentous stress test. - MCL
what manual therapy prescription is applied
MCL injury
DTF in maximum comfortable extension in supine.
May have to start in flexion – in flexion the
ligament is in line with tibia and so direction of DTF
is more diagonal than vertical. In extension, the
direction of DTF is horizontal. Technique is
performed with reinforced finger - week 5
kneading and box kneading massage - petrissage is conducted in what muscle group
quads
calf
wringing petrissage can be conducted in what muscle group
hamstring
quads
achilles tendon
picking up petrissage can be conducted in what muscle group
quads
calf
clapping and hacking tapotement can only occur in what muscle group
hamstrings
constituents of deltoid ligament
deep - posterior and anterior tibiotalar ligament
superficial - tibiocalcaneal and tibionavicular ligament
constituents of lateral ligament
posterior talofibular
anterior talofibular
calcaneofibular
origin and insertion of tibialis anterior
O = lateral surface of tibia I = Medial cuneiform
movements in tibialis anterior
inversion
dorsiflexion
patient is recovering from achilles tendinopathy 3/12
pain during dorsiflexion or plantarflexion
Ankle ROM:
Plantarflexion - WNL, L = R
Dorsiflexion - L = 60degs, R 40degs
pain during resisted dorsiflexion
what is the appropriate manual therapy prescription?
achilles tendon wringing
achilles DTF
