PTA 1.4 Flashcards
more commonly injured meniscus and why?
medial, because it has ligaments attached to it
function of meniscus
joint stability, distribution of loads, shock absorption
if an injury does occur, where would it be better for it to occur? (location on meniscus) and which meniscus
on the outter part of the lateral meniscus, as its better vascularised
which meniscus is more commonly injured in young people?
lateral
which treatment is used for lateral meniscus tear in young people?
meniscal repair /meniscopexy
which injury of the meniscus occurs more often in older people? which treatment is used?
medial meniscus tear. meniscectomy (meniscal removal)
are lesions always symptomatic?
can also be asymptomatic
how does ana ctue trauma most often occur( which movements of the knee happen)?
flexion + rotation
how do you treat chronic tears of the knee?
NSAIDs, PT
name 3 types of tears
longitudinal (bucket handle), radial (parrot beak), horizontal (flap tear)
BMI, age and gender wise who is more likely to get a meniscus injury?
high BMI, older, men
do track and field athletes have a high risk for meniscus injury?
no
which tool/measurement instrument to use to screen if Xray is needed
Ottawa ankle rules
explain ottawa knee rules
age >55, tenderness at head of fibula, at patella, inability to flex 90degr knee, inability to bear weight
signs and symptoms of a meniscal tear?
pain along joint line, delayed onset of swelling (12-24hr), locking of the knee, knee weakness
whats special about swelling after a meniscal tear?
delayed onset, 12-24hrs
describe the CPRS lowery
history of knee locking; joint line tenderness; + mcmurrays sign; + thessalys sign; pain with hyperext of knee; pain with max passive knee flexion
how many tests in CPR lowery should be positive to have at least 90% chance of meniscal tear?
3/5
does CPR lowery have high specificity or sensitivity
specificity - rule in meniscal tear
whats the thessalys test
patient a bit bent in the knees, pt rotates them sideways. pain provocation during rotations
if meniscal injury is medially located, what type of treatment do you do? why
meniscectomy /meniscal removal. less blood supply
is recovery time faster meniscectomy or meniscopexy
meniscectomy
recovery time of meniscectomy and meniscopexy?
Meniscectomy: 6-12wks; meniscopexy: 12-24 months
max 3mo vs 2 years
after which treatment is RTS more likely
meniscopexy, 96%
name the most important negative prognostic factor
posterior part of meniscus removed
after which meniscal op can you not do 90degree flexion for 4-6 wks?
meniscectomy
criteria to go from phase 1 to phase 2 after meniscetomy
normal gait; no swelling, full knee ROM
which test is most sensitive and specific to diagnose meniscal injury?
thessalys
how long are inflammation, prolif, early remodel and late remodelling phase?
infl: 0-3days; prolif 4-11; early remodel: 11-21; late remodel 3-6weeks
during proliferation phase of acute ankle sprain, whats the treatment and criteria?
put weight on foot. exercises like forward lean into a lunge, world arounds, stand on heels (toes off), stand on toes, heel raises
during early remodeling phase of acute ankle sprain, whats the treatment?
lunges on tippy toes, balance exercises: on bosu ball (heel to toe movement, rock back and forth), standing ABD
during late remodelling phase of acute ankle sprain, whats the treatment
jump from bosu ball to bosu ball, sport specific eg side lunge and serve volleyball ball, rope jumps
which test tests for tibia-fibula syndesmosis rupture?
syndesmosis squeeze test
whats the anterior drawer test testing for?
tibial anterior translation (>6mm) and pain, checks for ACL tears
which test tests for ACL rupture?
anterior drawer test
whats the talar tilt test?
moving foot from PTF, neutral and DFL into inversion and testing talar ligament integrity (lateral ankle sprain)
which test do you use to check anterior ankle impingement?
forced dorsiflexion test
name syndesmosis injury tests
- fibular translation test; 2. external rotation test
name ankle ligament injury tests
anterior drawer test, talar tilt test (inversion stresst test), squeeze test
whats is APAS
acute primary anterior shoulder dislocation
where does a dislocation in shoulder most often occur
anterior part
explain what happens during a shoulder trauma regarding anatomical structures
humerus slides away from the glenoid socket in some direction
which gender dislocates their shoulder more often?
males
the cause of shoulder dislocation
sports with high risk to traumas (men) and falls in elderly (women)
which aged population has a high recurrence rate of APAS/shoulder trauma?
people of <20 years of age
whats a huge risk factor for a recurrence of APAS
a previous trauma in the shoulder. and also returning to a high risk sport.
what are the 2 mechanisms of APAS? explain each
direct (force goes through shoulder dislocating it) and indirect trauma (when shoulder is in certain position e.g. abd and horizontal ext rot, and force of the arm will dislocate it as a result)
name symptoms/signs of APAS
acute pain, complete loss of function, movement painful, visible dislocation, patient will support the arm
name the 4 different steps of examination for APAS
inspection of shoulder, palpation, basic examination (impossible-pain), special tests
are you able to perform basic examination of the shoulder with APAS?
no, impossible due to pain
name the 2 different structural lesions with APAS
Bankart (avulsion/detachment of anterior and inferior labrum) and Hill Sachs (compression fracture of posterior part humeral head)
whats bankart lesions?
Bankart (avulsion/detachment of anterior and inferior labrum)
whats Hill sachs lesions?
Hill Sachs (compression fracture of posterior part humeral head)
which examination diagnoses bankart vs hill sachs?
MRI -bankart; CT for hill sachs
which 2 types of ‘lesions’ can you have after APAS
structural/bony (hills and bankart) and soft tissue (muscles, rotator cuff tear)
would you perform surgery for someone who has an asymptomatic RC tear (soft tissue lesions after APAS)?
if they can live with it they might not need surgery!!
what structure predominantly stabilize the shoulder?
muscles (as there are not many ligaments in the shoulder)
whats instability in the shoulder? inability to..
inability to center humeral head in the glenoid
describe difference between instability and hyperlaxity
hyperlaxity (hypermobility= normal, they can control it, increased ROM but able to center humeral head); instability (pathology= not able to center humeral head within glenoid)
name symptoms of instability
feeling of instability/apprehension; decreased strength; pain; shoulder fatigue
4 different techniques to reposition the shoulder
hippocrates, kocher, stimson, milch
after reposition of shoulder, shoulder’s in inflammation phase. what should you do with the shoulder? (reduces pain)
immobilize for a short time with the use of a sling
is rehab needed for patients with APAS + normal course?
no
who is more likely to receive a surgery after APAS: an athlete who will return to high risk sport or an elderly woman?
an elderly woman due to less risk for reoccurence
what happens to the chances of APAS reoccurence with surgery?
decrease drastically
what should APAS rehab focus on ? (which structure)
shoulder muscles (and their strength)
name the 5 P’s aka categories/muscles of APAS rehab
- preparators 2. pivoters 3. protectors 4. positioners 4. propellers (mneunomic: prepare the pivoters to protect the position and propel)
what are the preparators? (1)
muscles of lower extremities and trunk that prepare sports performance
APAS REHAB: which muscles do you train first, which last?
first ones away from shoulder (lower extremities and trunk), then progressively get closer to the shoulder
what are pivoters, name them (2 from 5P’s) - APAS REHAB
all muscles that move the scapula: trapezius, rhomboids, pectoralis minor, levator scapula, serratus anterior
what are protectors (3 from 5P’s) - APAS REHAB
local muscles that centralize the humeral head:
- subscapularis
- infraspinatus
- teres minor
- biceps caput longum
- (supraspinatus).
if you train protectors, what parameter are you training?
stability
what are positioners (4 from 5P’s) - APAS REHAB
muscles positioning the humerus in space
- deltoids
- supraspinatus
what are propellors (5 from 5Ps) - APAS REHAB
muscles that propel force, big cross section -> movement. muscles of huge interest to athletes.
- pectoralis major
- latissimus dorsi
- triceps brachii
where does ultrasound fit in the ICF model?
body functions & structures (impairments)
name some advantages of ultrasound
high resolution soft tissue imaging, can see image in real-time, enables rapid contralateral (healthy) limb examination for comparison.
for what is cold therapy used and why
for achilles tendinitis, for neovascularisation (new blood vessels)
of the 4 stages of analgesia induced y cryotherapy, what do you feel between 0-3minutes?
cold sensation
of the 4 stages of analgesia induced y cryotherapy, what do you feel between 2-7minutes?
burning or aching
of the 4 stages of analgesia induced y cryotherapy, what do you feel between 5-12minutes?
local numbness or analgesia
of the 4 stages of analgesia induced y cryotherapy, what do you feel between 12-15minutes?
deep tissue vasodilation
how cold should the icepack be and what should you use between the pack and skin?
-18degrees; a towel
explain what makes up MCI in cervical case
- muscle properties (eg fiber composition type; muscle atrophy, fatty infiltration)
- control strategies (decreased activation of deep neck flexors; prolonged muscle activity)
- pain
what are outcomes of MCI cervical
less strength, more fatigue, limited endurance, reorganization of muscle coordination
first, there is changes in muscle fibers. then fatty infiltration and then atrophy of deep neck flexors. what happens to the fiber composition of these?
type 1 turn into type 2b fibers which are not meant for endurance. they are fast twitch, tire quickly, low aerobic metabolism, little mitochondria, lots of power, not efficient.
whats the problem with deep neck flexors changing from type 1 to type 2b?
not meant for holding posture, tire quickly
3 main subsystems of spine (MCI topic)
passive subsystem: spinal column
active subsystem: spinal muscles
control subsystem: neural
what type of changes can occur with MCI cervical spine, regarding 3 subsystems?
spine: changes in cervical posture
spine muscles; atrophy, hypertension, reduced reaction time
neural system: proprioception changes
name and function of local stabilisers of the cervical spine?
anterior: longus capitis, longus colli
posterior: m multifidus, m spinalis, m semispinalis, rectus capitis posterior, obliquues capitis
function: segmental stability
describe what happens with dysfunction of local stabilisers in cervical spine
loss of neutral vertebral position
loss of segmental motor control
atrophy of local stabilisers, fatty infiltration, changes in muscle fiber type
name global stabilizers of the neck
sternocleidomastoid, trapezius descendens, levator scapula, longissimus, scalenii, hyoids, splenius
which type of muscles (global or local stabilisers) are the prime movers, function in ROM ?
global stabilisers
result of dysfunction of global stabilisers?
poor eccentric control; disability of concentric contraction, poor isometric endurance and strength, increased muscle tension
specific red flags for cervical spine
trouble swallowing, headaches, vomiting,
signs and symptoms of neck pain
Intolerance to long term static postures
Tiredness, inability to keep head up
Better with external support
Continuous need for self manipulation
Sensation of instability, shaking or loss of head control (places arms under chin for support)
Pain worse at the end of the day
Episodes of acute neck pain complaints
Neck makes clicking sound
Heavy feeling of the head
whats CCFT and what are norm outcomes/values?
cranio cervical flexion test
norm values: Men 39sec
W 29sec
how do you treat neck pain grade 1 and 2 with normal course
Treatment profile A; inform and advise, advise on work related risk factors (sedentary work,
whats recommended as most important therapy for neck treatment profile B and C
stability exercises
whats spondylolisthesis
forward slipping of a vertebrae
whats sponylolysis
stress fracture of an intervertebral disc
spondylolisthesis and spondylolysis: which leads to which?
first spondylolysis, then spondylolisthesis
how does panjabi describe MCI in lumbar spine
loss of spine’s ability to maintain its pattern of displacement under normal physiological loads
with MCI lumbar spine, can you see that there is radiophacically something wrong with the spine? (abnormalities)
no
describe. local muscles
type1 , red, aerobic, attached directly to lumbar verterbae
examples: multifidus, transverse abdominis
describe global muscles
not directly attached to the lumbar spine
type 2 fibers, white
function: initiation of movementy
examples: quadratus lumbrom, erecto spinae
gowers sign is a sign of what?
LSI
explain why with prone instability test there is less pain when legs are raised up
back extensors counteract the instability
name local muscles in lumbar spine
Transversus abdominis
Multifidus
Internal oblique
Psoas major
Lumbar ilicostalis lumborum
Diaphragm
explain the draw-in maneuver: with the stabiliser
activation of tranvs. abd.
pump stabiliser to 70mmHg
ask patient to lie prone on it and lower it by 6-10mmHg and hold for 10 seconds.
whats is form closure
stability created via shape of sacrum fitting within ilium
whats force closure
SIJ gains further stability from input forces around sacrum through ligaments, tendons and muscles
name clinical symptoms of groin injury
dysfunction, swelling, sensation impairments, muscle insufficency (abd and add ratio); hypermobility
what increases the risk of low back injuries? (oftenn seen in soccer players with groin problems(
delayed onset of transverseu abdominis; delayed trunk muscle reflex response
