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NPTE > Pathologies of MSK > Flashcards

Pathologies of MSK Flashcards

1
Q

What can also help achilles tendonitis?

A

Iontophoresis with dexamethasone
heel lift

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2
Q

What should you avoid when treating achilles tendonitis?

A

complete rest
night splints
elastic taping

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3
Q

Shoulder mobility/stretching exercises are most effective when combined with what in frozen shoulder?

A

corticosteroid injection

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4
Q

Peak incidence of frozen shoulder is

A

40-60 y/o females with diabetes

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5
Q

When does frozen shoulder resolve on its own?

A

1-2 years

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6
Q

What is a unique way to know it is frozen shoulder?

A

capsular pattern of restriction

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7
Q

What should you avoid in frozen shoulder treatment?

A

overstretching

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8
Q

What is the surgical method for treating frozen shoulder?

A

suprascapular nerve block and closed manipulation

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9
Q

What grade is an ACL considered completely torn?

A

III

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10
Q

What are some signs that an ACL has torn?

A

loud pop or feeling like the knee is giving way or buckling followed by dizziness, sweating and sweling

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11
Q

When is surgery required for an ACL tear?

A

III tear

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12
Q

Types of reconstruction for ACL?

A

IT band, patellar tendon, hamstring tendon

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13
Q

When is congenital hip dysplasia developed?

A

last trimester in utero

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14
Q

What are some signs and symptoms of congenital hip dysplasia?

A

asymmetrical hip abd with tightness and apparent femoral shortening of the involved side.

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15
Q

Testing for congenital hip dysplasia?

A

ortolani’s or barlow’s tests
diagnostic US

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16
Q

Treatment for congenital hip dysplasia?

A

constant use of harness, bracing, splinting or traction. Open reduction with subsequent application of hip spica cast if conservative treatment fails. PT after cast removal for stretching, strengthening, and caregiver education.

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17
Q

Congenital limb deficiencies are classified as..

A

longitudinal or transverse

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18
Q

Longitudinal limb deficiency refers to

A

reduction or absence of an element or elements within long axis of bone

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19
Q

Transverse limb deficiency refers to

A

limb that has developed to a particular level beyond which no skeletal elements exist.

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20
Q

Treatment of congenital limb deficiencies

A

symmetrical movements
strengthening
ROM
WB
prosthetic training

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21
Q

Congenital torticollis is from contracture unilaterally from which muscle?
When is it identified?

A

SCM
first 2 months of life

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22
Q

Presentation of congenital torticollis?

A

lateral cervical flexion to the same side as contracture and rotation toward the opposite side
facial asymmetries

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23
Q

Treatment of congenital torticollis?

A

surgical management when conservative treatment has failed and child is over one year of age. surgical release followed by PT

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24
Q

Subluxation is when there is

A

more than 50% of the humeral head translating over the glenoid rim without dislocation

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25
Q

what percentage of dislocations detach the glenoid labrum aka Bankart lesion?

A

85

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26
Q

What causes GH instability?

A

forces stress the anterior capsule and it moves anteriorly out of the glenoid fossa
anterior is most common and assoc with abd and lateral rotation (ER)

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27
Q

Treatment for GH instability

A

sling for 3-6 weeks
strengthening IR, ER, scaps

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28
Q

Impingement syndrome in shoulder

A

repetitive microtrauma from UE above horizontal plane

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29
Q

Painful arc is

A

70-120 degrees abduction

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30
Q

Systemic JRA is

A

least common
high fevers, rash, enlargement of spleen and liver, inflammation of lungs and heart

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31
Q

Polyarticular JRA is

A

more common than systemic
high female incidence
significant RA factor
arthritis in 4+ joints with symmetrical joint involvement

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32
Q

Oligoarticular JRA is

A

most common
affects less than 5 joints with asymmetrical involvement

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33
Q

How to treat JRA

A

paraffin, US, warm water, cryotherapy, surgical intervention when indicated secondary to pain or if there are contractures

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34
Q

Lateral ankle sprain ligaments most frequently affected

A

anterior talofibular
calcaneofibular

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35
Q

How are lateral ankle sprains done?

A

inversion stress to ankle

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36
Q

What should you avoid in treating lateral ankle sprains?

A

US in acute ankle sprains
bracing/taping as a standalone treatment in chronic lateral ankle sprains

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37
Q

tennis elbow cause

A

eccentric loading of the wrist extensor muscles: extensor carpi radialis brevis

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38
Q

Most common ages for tennis elbow

A

30-50

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39
Q

Treatment for tennis elbow

A

strap placed two to three inches distal to elbow joint

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40
Q

Legg-Calve-Perthes disease is

A

degeneration of femoral head due to disturbance in blood supply (avascular necrosis)

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41
Q

Four stages of Legg-Calve-Perthes disease

A

condensation
fragmentation
re-ossification
remodeling

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42
Q

A sign of LCP

A

trendelenburg

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43
Q

Treatment of LCP

A

stretching, splinting, crutch training, aquatic therapy, traction and exercise. Orthotic devices and surgical intervention maybe

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44
Q

MCL sprain in knee is often associated with

A

ACL or medial meniscus

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45
Q

Is surgery required for MCL?

A

rarely since its well vascularized

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46
Q

Medial or lateral meniscus more common injury?
Why?

A

medial
less mobile due to attachment to joint capsule.

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47
Q

Medial meniscus injuries increase over time because

A

of ACL deficiency

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48
Q

Signs and symptoms

A

catching or locking sensation

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49
Q

Meniscal repairs are usually done

A

on the outer edges due to increased vascularity

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50
Q

Osgood-schlatter disease is aka
and it is..

A

traction apophysitis
repetitive traction on the tibial tuberosity apophysis

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51
Q

Osgood-schlatter disease results in

A

small avulsion of tuberosity and subsequent swelling

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52
Q

Signs and symptoms of osgood-schlatter disease

A

point tenderness over patella tendon and at the insertion on tibial tubercle, antalgic gait, pain with increasing activity

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53
Q

Avoid for treatment for hip OA

A

bracing
tens unit or other e-stim

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54
Q

avoid in knee OA

A

lateral wedge insoles or patellofemoral braces
elastic taping
footwear modifications
interferential e-stim
US

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55
Q

Osteogenesis imperfecta

A

affects formation of collagen during bone development

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56
Q

How is osteogenesis imperfecta gained

A

genetic inheritance with types I and IV considered dominant and types II and III recessive

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57
Q

Signs and symptoms of osteogenesis imperfecta

A

pathological fxs
bowing of the long bones
impaired respiratory function

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58
Q

Treatment of osteogenesis imperfecta

A

AROM emphasizing symmetrical movements
positioning
functional mobility
fracture management
orthotics
w/c training sometimes

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59
Q

Patellofemoral syndrome

A

chondromalacia patella
softening of articular cartilage of patella

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60
Q

How is patellofemoral syndrome formed?

A

decreased quad strength
decreased LE flexibility
patellar instability
increased tibial torsion or femoral anteversion

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61
Q

What to avoid in patellofemoral syndrom?

A

manual therapy as a standalone intervention
knee orthoses, braces and straps
electromyography-based feedback for VMO
visual feedback for correcting leg alignment
biophysical agents-US, cryotherapy, phonophoresis, iontophoresis, e-stim

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62
Q

Plantar fasciitis is caused by

A

excessive amount of pronation or prolonged duration of pronation in ages 40-60 mostly

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63
Q

Treatment for plantar fasciitis

A

heel cup to cushion heel
taping/foot orthoses to support medial longitudinal arch
soft-soled footwear and avoiding sudden changes in intensity of training

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64
Q

PCL tears are how common

A

not

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65
Q

Signs and symptoms of PCL tear

A

feeling like femur is sliding off tibia
often asymptomatic

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66
Q

Treatment for PCL tear

A

surgical can occur but not evolved enough.
If they do, hamstring is used and isolated hamstring exercises are avoided for 6 weeks

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67
Q

RA is

A

inflammation of synovial tissues which results in erosion of cartilage and supporting structures

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68
Q

How many people have RA

A

1-2 women 3x more than men and 40-60 y/o

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69
Q

Signs and symptoms of RA

A

symmetrical involvement
decreased appetite, malaise, swan neck deformity in hands, boutonneire deformity

70
Q

swan neck deformity

A

DIP flexion
PIP hyperextension

71
Q

boutonniere deformity

A

DIP extension
PIP flexion

72
Q

Patients who are 50+ are susceptible to what

A

RTC tears due to degenerative pathology

73
Q

small RTC tear
large

A

1 cm
5 cm

74
Q

Primary focus of therapy in a RTC tear is

A

preventing adhesive capsulitis and strengthening UE

75
Q

Large tear requires how many weeks

A

6-8 of immobilization

76
Q

Return to dynamic functional activities with OH movement

A

9-12 months

77
Q

Scoliosis is quantified using the

A

Cobb method with X ray

78
Q

Scoliosis is classified 3 ways

A

functional, neuromuscular, degenerative

79
Q

functional scoliosis is from

A

abnormalities from the body that indirectly impact the spine like leg length discrepancy, muscle imbalance, poor posture
nonstructural scoliosis since curves can be corrected

80
Q

Neuromuscular scoliosis is from

A

developmental pathologies resulting in alterations within the structure of the spine
cerebral palsy or Marfan syndrome

81
Q

Degenerative scoliosis is from

A

normal aging that causes osteophyte formation, bone demineralization and disc herniation

82
Q

Neuromuscular and degenerative scoliosis are considered forms of

A

structural scoliosis since curves are inflexible and do not reduce with lateral bending

83
Q

Diagnosis of scoliosis ages

A

10-13

84
Q

mild curve

A

10 degrees or less

85
Q

girls have a significantly higher risk of acquiring a curve greater than

A

30 degrees

86
Q

How to spot scoliosis

A

shoulder level asymmetry with or without presence of rib hump.
pain is not typically associated rather it is a result of abnormal forces

87
Q

If the curve is not progressing…

A

no formal action is taken

88
Q

PT helps with

A

shoe lifts and bracing among regular stuff

89
Q

Spinal orthosis warranted if curve is between

A

25-40 degrees

90
Q

surgical intervention is required for curves

A

greater than 40 degrees

91
Q

Talipes Equinovarus is aka

A

clubfoot

92
Q

clubfoot is characterized as

A

heel pointing downward and forefoot inward

93
Q

clubfoot is associated with

A

neuromuscular abnormalities like spina bifida and arthrogryposis

94
Q

Signs and symptoms of clubfoot

A

adduction of forefoot
varus positioning of hindfoot
equinus at ankle

95
Q

Treatment of club foot

A

medical management begins shortly after birth and includes splinting and serial casting.
failed management or severe involvement may require surgical intervention and subsequent casting

96
Q

THA cementing allows

A

WBAT immediately

97
Q

Cementless and hybrid fixation requires

A

bone growth and dictates PWB or NWB initially

98
Q

Anterolateral approach THA

A

between TFL and glute med
Abductors are released to dislocated anteriorly
precautions: extension, ER, adduction

99
Q

Direct lateral THA

A

leaves posterior portion of glute med attached to trochanter
longitudinal division of TFL and vastus lateralis with anterior portion of glute med
minimizes dislocation risk
precautions: flexion beyond 90 degrees, extension, ER, adduction. glute med repair avoid abd for 6-8 weeks

100
Q

Posterolateral THA

A

splits glute max and short ER are released and hip abductors are retracted
maintains integrity of glute med and vastus lateralis muscles. femur is dislocated posteriorly. Most common approach.
precautions: hip flexion over 90, adduction, IR

101
Q

THA lasts

A

15-20 years

102
Q

Complications for THA

A

DVT
infection
pulmonary embolus
heterotropic ossification
femoral fxs
dislocation
neurovascular injury

103
Q

Precautions for THA lasts

A

1-3 months

104
Q

TKA three types

A

unicompartmental
bicompartmental
tricompartmental

105
Q

Unicompartmental TKA

A

medial or lateral joint surface

106
Q

Bicompartmental TKA

A

entire surface of femur and tibia

107
Q

Tricompartmental TKA

A

femur, tibia and patella

108
Q

TKA constraints

A

unconstrained
semiconstrained
fully constrained

109
Q

unconstrained TKA

A

usually a unicompartmental arthroplasty
no inherent stability and relies on soft tissue integrity for stability

110
Q

semiconstrained TKA

A

some degree of stability without compromising mobility
most common

111
Q

fully constrained TKA

A

most stability and restricts one or more planes of motion
results in greater implant stress and higher likelihood of implant problems

112
Q

TKA length

A

15-20 years

113
Q

Most common fixation of TKA

A

cemented

114
Q

Complications of TKA

A

DVT
infection
pulmonary embolus
fibular nerve palsy
restricted ROM
periprosthetic fxs
chronic joint effusion

115
Q

Knee flexion for ADLS
for STS

A

90
105

116
Q

Laminectomy done when

A

disc protrusion or spinal stenosis

117
Q

complete laminectomy

A

removal of entire lamina, spinous process and ligamentum flavum

118
Q

partial laminectomy

A

one lamina

119
Q

Restrictions on what after laminectomy

A

weight lifted
active motions especially extension

120
Q

How is a spinal fusion usually done

A

bone grafts from iliac crest

121
Q

cervical fusion done which kind of approach and lumbar fusion is done in what kind of approach

A

anterior
posterior

122
Q

Spinal fusion leads to

A

hypermobility at adjacent segments and will hasten onset of degeneration

123
Q

Restrictions for spinal fusion

A

lifting, active motion-bending or twisting

124
Q

If surgeon does not use instrumentation for spinal fusion then what is more likely to be used

A

brace

125
Q

OP PT does not occur with spinal fusions until

A

6 weeks

126
Q

If instrumentation is used in spinal fusion therapy can

A

begin sooner and progressed more aggresively

127
Q

SA replaces

A

glenoid and humeral components

128
Q

hemi-SA

A

only one component

129
Q

What kind of approach for TSA?

A

anterior
cuts into subscapularis

130
Q

Avoid what movements after TSA

A

extension and ER to protect healing of subscapularis muscle
resisted IR

131
Q

Subacromial decompression is open and what muscle is detached
mini open is when…

A

deltoid
deltoid is only split

132
Q

Subacromial decompression involves

A

acromioplasty
bursectomy
removal of distal clavicle (when degenerated)
release of coracoacromial ligament

133
Q

Recovery from subacromial decompression

A

rapid
sling only 1-2 weeks
if delt was performed, passive extension is initially avoided

134
Q

RTC small partial thickness tears only require

A

debridement

135
Q

Shoulder stabilization strategies surgically

A

capsular shift

136
Q

Capsular shift involves

A

tightening of joint capsule by cutting it and overlapping the ends to reduce capsular redundancy

137
Q

Other options for capsular tightening of shoulder

A

electrothermal
shrinks and tightens the capsule

138
Q

Anterior is the most common type of stability so..

A

anterior portion is tightened

139
Q

What also happens with capsular shift

A

labral repairs

140
Q

Bankart requires repair of

A

anterior labrum

141
Q

SLAP requires repair of

A

superior labrum

142
Q

If labrum repairs are done openly ….

A

subscapularis may need to be detached

143
Q

When having a shoulder stabilization surgery and the anterior portion was utilized, what kind of sling and what positions should be avoided?

A

normal sling
ER
extension
horizontal adduction
resisted IR if subscapularis was detached

144
Q

When having a shoulder stabilization surgery and the posterior portion was utilized, what sling and what positions should be avoided?

A

hand shake position with shoulder in neutral
IR
Flexion
horizontal adduction

145
Q

SLAP avoid

A

bicep contracting or stretching as it is attached to superior labrum

146
Q

Femoral neck fractures that are intracapsular may lead to…
which leads to nonunion and ____ is found more with these fractures

A

disruption of blood supply to femoral head
osteonecrosis

147
Q

Intertrochanteric hip fractures are ___ and do not affect blood supply. ____ _____ is more of a problem with these since fixation need is greater.

A

extracapsular
implant failure

148
Q

HIP ORIF is always

A

open

149
Q

Which muscles are affected with hip ORIF?

A

TFL, glute med, vastus lateralis

150
Q

If the fracture site of a hip is intracapsular a _____ will be performed.

A

capsulotomy

151
Q

With hip ORIF, new advances in surgery have allowed early…..
_____ strengthening is postponed until muscles have been given a chance to heal.

A

weight bearing
isotonic

152
Q

Fxs of greater trochanter will affect which muscle? While fxs of lesser trochanter will affect which muscle?

A

glute med
iliopsoas

153
Q

Signs of fixation failure in hip ORIF

A

persistent thigh or groin pain, leg length discrepancy that was not present initially, positioning the limb in ER, trendelenburg sign that does not improve with strenghtening.

154
Q

Surgeries to fix articular cartilage defects

A

microfracture procedure using an awl to penetrate subchondral bone which causes an ingrowth of fibrocartilage

osteochondral autograft transplantation: harvested from NWB surfaces to form a plug in the chondral defect

autologous chondrocyte implantation: grow healthy cartilage (MACI)

155
Q

In ACL is autograft or allograft preferred?

A

autograft

156
Q

Which graft is considered the gold standard in ACL repair? Why?

A

bone-patellar tendon-bone graft
uses bone-to-bone healing and considered stronger with good fixation

157
Q

What is another common fixation for ACL?

A

gracilis and/or semitendinosus but its not as strong since it uses tendon-to-bone healing.

158
Q

What exercises should be avoided between 0-45 degrees initially after ACL repair? Those with bone patellar tendon bone graft may experience ____ knee pain and should be careful with quad strengthening. Hamstring graft should be care with ____ exercises. Graft tissue is most vulnerable ___-___weeks after surgery. Graft becomes weaker before it gets stronger. Graft maturation is 100% around ____-____months.

A

open chain
anterior
flexion
6-8
12-16

159
Q

What are the criteria for return to sport after ACL?

A

no pain or effusion
full ROM
no instability
quad strength 85-90% of opposite leg
hamstring strength that is 90-100% opposite leg
functional testing that is 85-90% opposite leg

160
Q

Grafts for PCL and rehab are the same as ..but progression for PCL is….and exercises should…

A

ACL
slower/more gradual
limit posterior shear forces within knee. Repetitive knee flexion should be avoided

161
Q

Surgical choice for meniscectomy usually for older individuals

A

partial and when tear is in the inner 2/3 of the meniscus where healing is poor

162
Q

Surgical choice for meniscus usually for younger

A

repair
outer third of meniscusd

163
Q

Rehab after meniscus surgery restrictions on

A

flexion

164
Q

Rehab after partial meniscectomy pt is ___ without use of brace

A

WB no restrictions and recovery is quicker

165
Q

Lateral ankle reconstruction is done secondary to

A

complete tear of anterior talofibular ligament or calcaneofibular ligament or chronic ankle instability

166
Q

Two methods for lateral ankle reconstruction

A

1: repair where they are sutured
2: harvesting autograft from fibularis brevis to replace the ligaments

167
Q

second option for lateral ankle reconstruction is used when

A

original ligaments cannot be repaired due to deterioation

168
Q

Rehab progression for lateral ankle reconstruction

A

protective cast for one week
walking cast or boot for several weeks followed by a brace
PT not immediately after surgery. Focus on not ranging too much into inversion.

169
Q

Grafts used in achilles tendon repair

A

flexor hallucis longus
fibularis brevis
plantaris

170
Q

Rehab progression with achilles tendon repair

A

casted in slight PF initially
NWB first several weeks
cast or boot with ankle in neutral and PWB

171
Q
A

NPTE (54 decks)

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