Practical#4 Flashcards
Which nerve roots are affected in Erb’s Palsy
C5-C6
Positioning for Erb’s Palsy
Supine: Place pillow under arm to open it up a bit and to move it closer into resting position for the GH PJM
Hydro for Acute Erb’s Palsy
Cool compress on Pec Major
Techniques for Acute Erb’s Palsy
Light Fascial on Pec Major
Fine Vibes
Tapotement to stimulate Biceps
Techniques for Chronic Erb’s Palsy
Fascial & Petrissage on Pec Major
Petrissage on C/S
GTO on Coracoid Process for Pec Minor
Tapotement to stimulate Biceps
What structures are affected in Erb’s Palsy
Chronic deformity due to unopposed contracture of the wrist flexors
GH Joint is Adducted & Internally Rotated
Elbow/Forearm Extended & Pronated
Wrist/Finger are in Flexion
Treatment of Erb’s Palsy
Neck & Shoulder Girdle to reduce HT due to compensatory & holding patterns
PJM for Erb’s Palsy
State you are working within client’s range, therefore not able to get them completely in resting position, but try to open the GH up a bit with a pillow
Acute: Grade 1-2 to decrease pain
Chronic: Grade 3: GH anterior glide to increase external rotation
REMEX for Erb’s Palsy Homecare
Stretch: Pec’s, Pronator Teres, Triceps, Forearm Flexors
Strengthen: Gentle, progressive resistance exercises to increase strength and functionality of weakened mm: Rhomboids, Biceps, Lev Scapula, Deltoids, Supraspinatus
Positioning for Sacral Plexus Injury
Prone
Hydro for Acute Sacral Plexus Injury
Cool Compress on L/S
Techniques for Acute Sacral Plexus Injury
Light Fascial, Light stroking, Fine vibes on QL’s, Erectors and into Gluteus
Or instead of Fascial, do tapotement down dermatomal pattern on leg
Hydro for Chronic Sacral Plexus Injury
Hydrocollator on L/S
Techniques for Chronic Sacral Plexus Injury
Petrissage, mm stripping on low back, stimulatory over dermatomal pattern or straight leg raise in supine (b/w 35-70 degrees where tissue resistance is felt: hold for 1 minute, you want a slight increase sx’s but px should decrease after 1 minute
GTO, MLD, MTP
PJM for Sacral Plexus Injury
Acute: Grade 2 lumbar traction to decrease pain
Chronic: Lumbar PACVP
REMEX for Sacral Plexus Injury Homecare
Stretch: Cat stretch, client on the floor, on hands and knees & arch back
Positioning for TOS
Supine
Hydro for TOS
Acute: Cool compress
Chronic: Warm compress
Techniques for Acute TOS
MLD, Fine Vibes
Tapotement to stimulate tingling pattern in arm
GTO, MTP
Techniques for Chronic TOS
Petrissage, mm stripping, and tapotement to stimulate tingling pattern in arm
GTO, MTP
PJM for TOS
Acute: Grade 1-2 C/S distraction to decrease pain
Chronic: Grade 3 SC glides - stabilize sternum with one hands glide the joint with the other (inferior of anterior glide)
REMEX for TOS Homecare
Stretch: Pec minor, Anterior Scalene, Pec major, Suboccipitals
Strengthen: Rhomboids or Traps
Techniques & Hydro for Anterior/Posterior Compartment Syndrome
Acute: Cool compress, MLD, Light Fascial, Vibes on Anterior/Posterior leg
Chronic: Warm compress, Fascial, Petrissage, mm stripping on Anterior/Posterior leg
GTO, MTP, Tapotement
PJMs for Anterior/Posterior Compartment Syndrome
Anterior: Posterior glide to increase Dorsiflexion
Posterior: Anterior glide to increase Plantar Flexion
REMEX for Anterior/Posterior Compartment Syndrome
Strengthen
Anterior: Gastrocnemius (heel raises)
Posterior: Tibialis Anterior
Techniques & Hydro for Piriformis Syndrome
Acute: Cool compress, MLD, fine vibes, light stroking on Glutes & Hamstrings
Chronic: Hydrocollator on Glutes, Fascial, Petrissage, mm stripping on Glutes, GTO at Greater Trochanter
PJMs for Piriformis Syndrome
Acute: Grade 1-2 Long Axis Hip Traction to decrease pain
Chronic: Grade 3 Long Axis Hip traction to increase mobility
REMEX for Piriformis Syndrome Homecare
Stretch
Piriformis: Client lies on back with both knees and hips flexed, cross one foot over the other knee and pull it towards the opposite shoulder
Techniques & Hydro for Intervertebral Disc Herniation
*Usually has hyperlordosis posture - similar treatment
Acute: Cool compress (not directly on site), MLD, Vibes, light stroking on back around the affected area
Chronic: Hydrocollator on L/S, Fascial, Petrissage, mm stripping to QL’s
PJMs for Acute & Chronic Intervertebral Disc Herniation
Acute: Grade 1 spinal traction (like hip traction but leg is Adducted and held over top the other one, positional tractioning for hypomobile vertebrae, or SI Joint mobs
Chronic: TVP, PACVP
REMEX for Intervertebral Disc Herniation Homecare
Strengthen
Extension exercise - Lift themselves up by getting on their elbows
Techniques & Hydro for Acute/Chronic C/S Facet Dysfunction
Supine
Acute: Cool compress, MLD, Vibes, Light fascial, O&I, GTO to Lev Scapula or SCM
Hypermobile side of neck: Tapotement to stimulate
Chronic: Hydrocollator, Petrissage, mm stripping, O&I to SCM, Subboccipital release
Hypermobile side of neck: Tapotement to stimulate SCM, Scalenes
Techniques & Hydro for Acute/Chronic L/S Facet Dysfunction
Prone
Acute: Cool compress, MLD, Light stroking
Chronic: Hypomobile side: Hydrocollator, Fascial, Petrissage, mm stripping
Hypermobile side: Tapotement to stimulate
PJM for C/S Facet Dysfunction
Positional tractioning, Flexion, Side Bend to unaffected side then Rotate neck to affected side, apply slight traction for 7-10 seconds
PJM for L/S Facet Dysfunction
TVP to hypomobile side
REMEX for C/S Facet Dysfunction Homecare
Scalenes - client sits on chair; holds bottom of it with hand on affected side of neck, Side bend C/S toward other side, and extend if needed
REMEX for L/S Facet Dysfunction Homecare
Childs pose to stretch Latissimus Dorsi but walk hands over to the hypermobile side to stretch the Hypomobile side
Techniques & Hydro for DDD
Early stage: Warm compress, Fascial, Petrissage, mm stripping on affected area
Late stage: Cool compress, MLD, Light fascial, fine vibes
PJMs for DDD
Early stage: Grade 3 traction to increase ROM
Late stage: Grade 1-2 traction to decrease pain
REMEX for DDD Homecare
Late stage: mm setting
Techniques & Hydro for Osteoarthritis
Early stage: Warm compress, Fascial, Petrissage, mm stripping on Thenar eminence as well as forearm flexors and extensors
Late stage: Cool compress, MLD, light fascial, fine vibes
PJM’s for Osteoarthitis
Early stage: Grade 3 traction of thumb saddle joint to increase ROM
Late stage: Grade 1-2 traction to decrease pain
REMEX for Osteoarthritis Homecare
Early stage: Squeeze an exercise ball in affected hand
Late stage: mm setting of Thenar eminence
Common Carotid
Mm structures: SCM, Thyroid cartilage
Palpation: Palpate between SCM & thyroid cartilage at level of C6
External Carotid
Mm structures: SCM, Angle of Mandible
Palpation: Palpate Anterior to SCM at level of angle of mandible
Proximal Brachial
Mm structures: Coracobrachialis
Palpation: Palpate medial aspect of brachium posterior to Coracobrachialis
Distal Brachial
Mm structures: Bicipital tendon, cubital fossa
Palpation: Palpate medial side of bicipital tendon at medial cubital fossa
Radial
Mm structures: Flexor carpi Radialis tendon, snuffbox
Palpation: Palpate lateral to flexor carpi Radialis at wrist (can also be palpated in snuffbox)
Ulnar
Mm structures: Flexor carpi Ulnaris tendon
Palpation: Palpate lateral to flexor carpi Ulnaris tendon at wrist
Abdominal Aorta
Mm structures: Umbilicus
Palpation: Palpate left of the midline superior to umbilicus
Femoral
Mm structures: Inguinal ligament, femoral triangle
Palpation: Palpate midway along Inguinal ligament in femoral triangle
Popliteal
Mm structures: Popliteal fossa
Palpation: Palpate deep on medial side, flex the knee to facilitate deeper palpation
Posterior Tibial
Mm structures: Flexor digitorum tendon, medial malleolus
Palpation: Palpate posterior to flexor digitorum tendon, posterior to medial malleolus
Dorsalis Pedis
Mm structures: Extensor Hallucis Longus & extensor digitorum longus tendons
Palpation: Palpate between Extensor Hallucis longus & extensor digitorum longus tendons, over proximal dorsal foot
Attachments of Supraspinous Ligament
Between the tips of SP’s from C7 - Sacrum
Function of Supraspinsous Ligament
Limits flexion of vertebral column
Attachments of Medial Collateral Ligament of Wrist
- Ulnar styloid Process
- Pisiform & Triquetrum
Function of Medial Collateral Ligament
Limits Radial deviation of the wrist
Starting landmark for Medial collateral ligament of wrist
Styloid process of radius
Attachments of Lateral collateral ligament of wrist
- Styloid process of radius
- Scaphoid & Trapezium
Function of Lateral collateral ligament of wrist
Limits Ulnar deviation of the wrist
Starting landmark for Lateral collateral ligament of wrist
Ulnar styloid process
Attachments of (Radial) Annular Ligament
- Anterior & Posterior Radial Notches
Function of (radial) Annular ligament
Supports head of radius in radial notch of ulna
Attachments of Transverse Humeral Ligament
- Greater tubercle of humerus
- Lesser tubercle of humerus
Function of Transverse Humeral Ligament
Stabilizes long head of biceps brachii
Attachments of Coracoacromial ligament
- Lateral border of coracoid process
- Edge of Acromion
Function of coracoacromial ligament
Prevents superior displacement of humeral head
Attachments of Sacrotuberous ligament
- Dorsal surface of sacrum, coccyx, PSIS
- Ischial Tuberosity
Function of Sacrotuberous Ligament
Forms greater sciatic notch
Attachments of Iliolumbar ligament
- Tip of L5 TVP
- Iliac Crest
Function of Iliolumbar ligament
Limits rotation on sacrum, prevents anterior gliding of L/S on sacrum
Attachments of Medial Collateral Ligament of Knee
- Medial femoral condyle
- Medial tibial condyle
Function of Medial collateral ligament of knee
Protects against valgus stress
Starting landmark for Medial Collateral ligament of knee
Apex of Patella
Attachments of Lateral collateral ligament of Knee
- Lateral femoral condyle
- Fibular head
Function of Lateral collateral ligament of knee
Protects against varus stress of knee
Starting landmark for Lateral collateral ligament of knee
Apex of patella
Attachments of Deltoid Ligament
- Medial malleolus
- Talus, Calcaneus, Navicular
Function of Deltoid ligament
Limits Eversion
Starting landmark for Deltoid ligament
Lateral malleolus
Attachments for Anterior Talofibular ligament
- Neck of talus
- Lateral malleolus
Function of Anterior Talofibular ligament
Limits inversion
Starting landmark of Anterior Talofibular ligament
Medial Malleolus
Attachments of Posterior Talofibular ligament
- Lateral tubercle of talus
- Distal fibula
Function of Posterior Talofibular ligament
Limits inversion
Starting landmark of Posterior talofibular ligament
Lateral malleolus