Random Review MUSCULOSKELETAL Flashcards
1
Q
spondylolisthesis
A
the forward displacement of one vertebra upon the stationary vertebra beneath it
2
Q
Spondylolysis
A
a stress fracture through the pars interarticularis of the lumbar vertebrae
3
Q
Pes cavus
A
high-arched foot
4
Q
Clubfoot
A
- talipes equinovarus
- a congenital deformity (environmental and genetic) that includes components of forefoot adductus, hindfoot varus, and ankle equinus
- The primary distinguishing factor is the equinus component
5
Q
Calcaneovalgus
A
- an intrauterine “packaging” deformity
- The ankle is in excessive dorsiflexion, the forefoot is curved out laterally, and the hindfoot is in valgus
6
Q
Metatarsus adductus
A
- an intrauterine “packaging” deformity
- The hindfoot is in valgus, and the forefoot is in varus
7
Q
What purpose does performing radial nerve glides serve?
A
treat symptoms related to shoulder girdle depression, radial nerve distribution, and disorders such as tennis elbow (lateral epicondylalgia) and de Quervain syndrome
8
Q
Sever disease
A
a calcaneal apophysitis
9
Q
Treatment for Sever disease
A
benefit from stretching to improve flexibility of the gastrocnemius and soleus and use of a heel wedge to decrease the stress and traction of the Achilles insertion
10
Q
Marked ulnar drift is a hallmark sign of what?
A
rheumatoid arthritis
11
Q
Why might patients with RA need cervical stabilization exercises?
A
Because cervical spine ligaments can be affected in this population
12
Q
ROM recommendation 4-6 weeks post-op for meniscal repair
A
Limit knee flexion to 90 degrees to limit shear stress
13
Q
The clinical presentation of anterior acetabular labral tears most often includes pain on which movements?
A
passive adduction, flexion, and medial (internal) rotation
14
Q
What is Scheuermann disease?
A
- AKA Scheuermann kyphosis, juvenile kyphosis, or juvenile discogenic disease, - a condition of hyperkyphosis
- involves the vertebral bodies and discs of the spine
- identified by anterior wedging of >/= 5 degrees in 3+ adjacent vertebral bodies
15
Q
Scheuermann disease usually affects which spinal segments?
A
T7-T10
16
Q
Structural scoliosis
A
when the patient’s spine actually has a physical curve
17
Q
Functional scoliosis
A
when the spine appears to be curved, but the apparent curvature is actually the result of an irregularity elsewhere in the body (e.g. different leg lengths)
18
Q
arthrogryposis
A
- children develop severe contractures.
- It is unlikely that a child with arthrogryposis would be able to stand, and, if so, joint stiffness and lack of muscle development would affect the joints of the foot and hip most.
19
Q
Sever disease
A
- AKA calcaneal apophysitis
- an overuse syndrome caused by microtrauma at the insertion of the Achilles tendon at the calcaneal apophysis
20
Q
Freiberg disease
A
an idiopathic segmental avascular necrosis of the head of a metatarsal
21
Q
Symptoms of spondylolisthesis include
A
low back pain, sciatic type pain, hamstring tightness, local tenderness, and, in severe cases, torso shortening,
22
Q
The purpose of humeroulnar distraction is to
A
increase flexion (or extension) of the elbow joint
23
Q
High Fowler position
A
a position in which the head of the patient’s bed is raised 80° to 90° with knees flexed
24
Q
Posterior hip precautions after a total hip arthroplasty
A
avoiding hip flexion greater than 90°, medial (internal) rotation of the hip, and adduction of the hip
25
Symptoms of sacroiliac joint dysfunction
- pain with walking, ascending or descending stairs
- hopping or standing on the involved leg
- pain with transitional movements such as rising to standing position from a sitting position or getting in and out of a car
- pain that is worsened with long periods of sitting or standing if lumbar lordosis is not maintained
26
The diaphragm is innervated by which nerve?
the phrenic nerve (C3–C5)
27
Is trunk flexion or extension contraindicated in patients with spondylolisthesis?
Trunk extension
28
High-velocity manipulation is contraindicated for patients who have which LBP diagnoses?
- herniated disc
- spondylolisthesis
29
active trunk flexion is contraindicated for patients who have which LBP diagnosis?
an acute disc lesion, such as a herniated disc
30
Capsular patterns for the shoulder
ER --> abduction --> IR
31
Position for gastroc MMT of poor (2/5) or less
Prone
32
Gastroc MMT fair (3/5)
1 heel raise correctly
33
Gastroc MMT good (4/5)
2-24 correct heel raise
34
Gastroc MMT normal (5/5)
25 correct heel raise
35
Pain associated with disc herniations
acute pain in the back and leg (unilaterally)
36
Pain associated with spinal stenosis
insidious, not acute, onset as well as bilateral, not unilateral, symptoms
37
Pain location for central disc herniation during SLR
In the back
38
The symptoms associated with calcific tendinopathy
generally very severe subacromial lateral shoulder pain with more sudden onset in patients who are middle aged
39
A boggy end-feel is produced by
fluid or blood in the joint
40
Meniscal displacement would bring about a __ end-feel
springy
41
The symptoms of vertebral artery compression include
dizziness, slurred speech, and confusion
42
The push-up against a wall works which muscle?
serratus anterior
43
Abduction in the scapular plane works to strengthen which muscle?
deltoid and supraspinatus
44
Normal IR during Craig test
8-15 degrees
45
Calcaneal apophysitis
- Inflammation of the growth plate at the calcaneus in growing children
- Caused by repetitive stress to the heel
46
Legg-Calve-Perthes disease
- Avascular necrosis to the femoral head due to lack of blood supply
- Occurs in children, not adults
- Can be seen w/ radiograph
47
Labral tear of the hip presents w/
- Difficulty w/ WB
- Associated click
- MOI: excessive extension + ER
48
Movements occurring in the sagittal plane
- Flexion
- Extension
49
Movements occurring in the frontal plane
- Abduction
- Adduction
50
Windswept deformity
- Fixed deformity of the LE
- One LE is adducted + IR
- Other LE is abducted + ER
51
Dupuytren's contracture
- Thickening of the palmar fascia in the hand
- Contracture pulls fingers into flexion
- Restricts finger extension
52
Effects of superficial heat
- Analgesia
- Increased cell activity
- Increased blood flow
- Increased tissue flexibility
53
first cmc joint type
Saddle
54
Which muscles are the primary muscles of expiration?
Abdominals and internal intercostals
55
Which muscles are the primary muscles of inpiration?
Diaphragm and external intercostals
56
Normal TMJ motion
- Opening: 40-50 mm (functional is 25-35)
- Protrusion: 7 mm
- Retrusion: 3-4 mm
- Lateral deviation: 8-11 mm
57
At the SC joint, which is concave and which is convex?
- Clavicle --> concave
- Sternum --> convex
58
What sensations will a patient feel with cryotherapy, and in what order?
1) intense cold
2) burning
3) aching
4) numbness/analgesia
59
Limited ROM and a hard end feel are consistent with which diagnosis?
Impingement
60
Which bone is just distal to the navicular?
Medial cuneiform
61
If the goal is to get deeper muscle stimulation, how should electrodes be placed for estim?
Wider spacing
62
What is genu recurvatum?
- Hyperextension of the knee
- Can occur in standing or during gait
- If ankle's can't dorsiflex tibia angulates posteriorly to get heels on the ground
63
Lisfranc fracture
- Fracture or dislocation of any part of the tarsometatarsal complex
- Pain will likely be present in the midfoot
64
What is the procedure for the passive lumbar extension test?
- Pt lies prone
- PT holds both legs, applies gentle traction
- PT extends hips to 30 cm while maintaining knee extension
- Pain or heavy feeling in low back is positive and suggests spinal instability
65
Plumb line for posture relative to important landmarks
- Through ear lobe
- Through shoulder joint
- Midway through trunk
- Posterior to hip AXIS, but through greater trochanter
- Anterior to knee axis
- Anterior to lateral malleolus
66
Ely test
- AKA prone knee flexion test
- Pt lies prone and PT flexes knee
- Anterior pelvic tilt indicates short rectus femoris
67
Galeazzi fracture
- Fracture of the middle to distal 1/3 of the radius
- Associated w/ the dislocation or subluxation of the distal radioulnar joint
68
Counterforce bracing
- An arm band that provides compression distal to elbow laterally on the proximal extensor musculature
- Has been shown to help manage symptoms w/ lateral epicondylalgia
69
The coracohumeral ligament becomes most taut with
an inferiorly directed force with the humerus by the side
70
The inferior glenohumeral ligament becomes most taut with
an anteriorly directed force with the shoulder abducted 90 degrees
71
Oswestry Disability Questionnaire (ODQ)
- 10-item self-report outcome measure on how LBP impacts functional activities
- Asks about changing levels of pain
- Higher score --> more difficulty and pain
72
Ehlers-Danlos Syndrome
- Associated w/ congenital hyperlaxity
- Cervical manip contraindicated
73
Signs of developmental dysplasia of the hip
- Asymmetric thigh folds
- + Galeazzi sign
- + Barlow sign
- + Ortolani sign
74
What is a positive Galeazzi sign?
One femur appears shorter when the pt is in hook lying (knees and hips bent in supine)
75
What is a positive Barlow sign?
- Hip is flexed to 90 degrees w/ pt in supine
- Gentle adduction of the hip + posteriorly directed force through femur
- Palpate for femur head falling out the back of the acetabulum
76
What is a positive Ortolani sign?
- Hip is flexed to 90 degrees w/ pt in supine
- Gentle abduction + upward force through greater trochanter
- Palpable clunk as femur is reduced into the acetabulum
77
Signs of Osgood-Schlatter syndrome
- Pain and swelling at the tibial tubercle
- Patella alta
- Occurs during a growth spurt
78
Patella alta
an abnormally high patella in relation to the femur
79
Patella baja
an abnormal low-lying patella that remains distal in relation to the femoral trochlea
80
Typical post-op protocol for Bankart repair week 1
- Hand and elbow ROM
- Pendulums
- Shoulder shrugs
- Wear sling
81
Typical post-op protocol for Bankart repair weeks 1-2
- AAROM flexion and abduction to 90
82
Typical post-op protocol for Bankart repair weeks 2-4
- AAROM flexion and abduction to ~110
83
Typical post-op protocol for Bankart repair weeks 4-6
- AAROM flexion and abduction >120
84
Typical post-op protocol for Bankart repair weeks 6-9
- Begin working on full AROM in all directions
- Discontinue the sling
85
Typical post-op protocol for Bankart repair weeks 9-12
- Strengthen rotator cuff
86
Typical post-op protocol for Bankart repair weeks 12-16
Begin running and doing push-ups
87
Typical post-op protocol for Bankart repair weeks 16-24
- Resume all activities
- No contact sports until ~6 months post-op
88
Common complication for glenohumeral dislocation
Axillary nerve injury, can lead to deltoid atrophy
89
What movement is used to test for acromioclavicular joint dysfunction?
Passive horizontal adduction
90
What sequence should be used with a reciprocating gait orthosis?
1) Shift wt R
2) Extend upper trunk to tuck pelvis
3) Push on crutches to unweight L leg
4) Swing through w/ L leg
5) Repeat with switched legs for next step
91
Symptoms associated w/ spinal stenosis
- Pain decreases w/ flexion, increases w/ extension, ipsilateral side bend/rotation
- Numbness, tightness, or cramping
- Walking usually brings on symptoms
- Positive quadrant test to affected side
- Positive bicycle test of van Gelderen
92
Common symptoms of facet dysfunction
- Stiffness upon rising
- Pain usually eases in a few hours
- Loss of ROM accompanied by pain that is sharp w/ certain movements
- Stationary position usually increase symptoms
- Quadrant test will have pain occurring with side bending and rotating different directions
93
Symptoms of lumbar disc herniation
- Pain w/ flexion, eased w/ extension
- Increased pain w/ sitting, lifting, and bending
- Radicular symptoms w/ nerve compression
- Pain w/ spinal loading
- + slump and/or SLR tests
94
Role of the lower traps w/ shoulder abduction
- To assist w/ scapular upward rotation, both upper and lower traps conract
- If lower traps are weak, the upper traps may excessively elevate as the arm abducts
95
ODI score interpretation
- 0-20 --> minimal disability
- 21-40 --> moderate disability
- 41-60 --> severe disability
- 61-80 --> crippled
- 81-100 --> bed-bound
96
Where does the tendon for the flexor digitorum superficialis insert? What is its action:
- On the base of the middle phalanx
- Flexes the PIP
97
Action of the flexor digitorum profundus
Flexion of the DIP
98
How is scoliosis named right or left?
The apex of the curve points in the direction of the name
99
In order to create a left pointing curve with functional scoliosis, what needs to take place?
- R LE needs to be longer than the L LE
- L LE needs to be shorter than the R LE
100
When is NMES appropriate to use for strengthening?
When weakness is limited to a few muscles
101
In addition to winging, injury to the long thoracic nerve can present with what functional deficit?
Inability to flex the shoulder, because the shoulder flexors do not have a stable base to work with, the scapula against the thorax
102
Use for a Jewett thoracolumbar orthosis
Provides sagittal-coronal control by controlling thoracic flexion
103
Use of the cruciform anterior spinal hyperextension (CASH) brace
Places the pt into hyperextension to prevent thoracic flexion
104
Use of a custom-molded thoraco-lumbar spinal orthosis (TLSO)
Provides total contact to restrict motion in all planes
105
Use of a halo vest immobilizer
- A cervicothoracic-level orthosis
- Surgically attached to the cranium
- Restricts cervical motion in all planes
- Appropriate for upper cervical injuries
106
Use of a Minerva cervical thoracic orthosis
- Provides aggressive control of gross and intersegmental motion of cervical and upper thoracic spine
107
Use of a sternoccipitomandibular immobilizer (SOMI)
- For pts w/ instability at or above C4 vertebral level
108
Use of an Aspen cervicothoracic orthosis
For pts presenting w/ instability or injury below the C4 vertebral level
109
Use of a Philadelphia collar
- Cervical-level orthosis
- Limits cervical flexion and extension
- Allows for rotation
110
What can happen if an orthosis is in 5 degrees of fixed DF?
The knee can buckle
111
Long sitting test
- Used to ID dysfunction of SI joint that might be caused by functional leg length discrepancy
- Pt lies supine w/ legs straight, clinician assesses medial malleoli symmetry
- Pt moves to long sitting, medial malleoli symmetry is reassessed
- Asymmetry in long-sitting indicates functional leg length discrepancy
112
How to test the anterior talofibular ligament (ATFL)
Anterior drawer test of the ankle
113
How to test the anterior tibiofibular ligament
- Squeeze the tibia and fibula together firmly and slowly, hold and then quickly release
- pain upon release at the area of the anterior tibiofibular ligament, then a sprain of that ligament is highly suspected
114
How to test the calcaneofibular ligament
Ankle inversion w/ talocrural joint in neutral
115
How to test the deltoid ligament
Lateral tilt test
116
When strengthening the hamstring w/o weights, like with early hamstring tear rehab, why does knee flexion in standing provide an advantage compared to knee flexion in supine?
During standing, the entire ROM has the tibia moving against gravity
117
Grade I Mobilization
- Small amplitude movement performed at the beginning of range
- Think w/in first 50% of the range
118
Grade II Mobilization
- Large amplitude movement performed w/in the range
- Not reaching limit of the range and not returning to the beginning of range
- Think w/in first 50% of the range
119
Grade III Mobilization
- Large amplitude movement performed up to the limit of range
120
Grade IV Mobilization
Small amplitude movement performed at the limit of range
121
Grade V Mobilization
Small amplitude, high velocity thrust technique performed to snap adhesions at the limit of range
122
Plica syndrome
- The knee capsule might have additional folds of tissue called plica at the anteromedial side of the knee joint
- These folds can irritate the medial femoral condyle with excessive knee flexion and extension
123
How to modify a stretch to the posterior shoulder via horizontal adduction when the pt cannot control scapular protraction
Have the pt perform the stretch in sidelying w/ the trunk rolled posteriorly 30 degrees to stabilize the scapula
124
How to isolate the hip flexors in pt's w/ a positive Thomas test
- Maintain knee extension
- Supine static stretch to psoas
125
Purpose of the active straight leg raise (ASLR) test
- Used primarily to diagnose pregnancy-related pelvic pain
126
Procedure for the ASLR test
- Grade the difficulty of ASLR
- Repeat the test while compression is applied in either an anterior or posterior direction to assist force closure
127
Implication of ASLR is easier w/ anterior pelvic compression
Transversus abdominis is targeted
128
Implication of ASLR is easier w/ posterior pelvic compression
Multifidis is targeted
129
How long can TENS be used for relieving chronic low back pain?
Can be used up to 24 hrs/day if necessary
130
How intense should TENS be?
Comfortable sensation only
131
Parameters for conventional TENS
- 50-80 microseconds pulse duration
- 100-150 pulses/second for pulse frequency
132
In kids, which is more likely to fail, the bone or the ligament?
The bone
133
Which bones are broken with a boxer's fracture?
Fracture of the neck of the 5th metacarpal
134
Which modality should be used for patients w/ localized pain?
Pulsed ultrasound w/ lidocaine
135
Impact of heat via continuous ultrasound on tissue w/ active inflammation
Further heat and possible irritation
136
Salter-Harris Classification Types for Fractures
- Type I
- Type II
- Type III
- Type IV
- Type V
137
Salter-Harris Classification Type Type I Description
fracture line through the physis only (zone of hypertrophy)
138
Salter-Harris Classification Type Type I Significance
- low chance of growth disturbance
- occurs most commonly in the hypertrophic zone of physis
139
Salter-Harris Classification Type Type II Description
fracture line through the physis and extending to include a portion of the metaphysis
140
Salter-Harris Classification Type Type II Significance
- most common type
- variable growth disturbance (depends on location)
141
Salter-Harris Classification Type Type III Description
fracture line through the physis and exiting through the epiphysis into a joint
142
Salter-Harris Classification Type Type III Significance
- variable growth disturbance
- anatomic reduction important as fracture involves the joint
143
Salter-Harris Classification Type Type IV Description
vertical fracture line through the epiphysis, physis, and metaphysis
144
Salter-Harris Classification Type Type IV Significance
- physeal bar formation possible as fracture line traverses cartilage reverse zone of physis
- anatomic reduction important as fracture involves the joint
145
Salter-Harris Classification Type Type V Description
crush injury to the physis
146
Salter-Harris Classification Type Type V Significance
- rare, hard to distinguish from non-displaced Salter-Harris type 1
- high chance of growth disturbance
147
Salter-Harris Mnemonic (in relation to the growth plate)
S --> straight across (type I)
A --> above (type II)
L --> lower (type II)
TE --> through everything (type IV)
R --> cRush (type V)
148
Best spacing for biofeedback
1-2 cm allows for less noise to be recorded and increases the specificity of the muscle
149
Can biofeedback be used with home training?
Yes
150
Biofeedback vs manual palpation for teaching pelvic floor muscle contractions
Manual palpation is the gold standard
151
Can biofeedback indicate which muscle is being contracted?
No, this is why initial education and palpation by the clinician is important
152
Why is 100% duty cycle a bad idea w/ mild redness, swelling, and tenderness over a surgical scar?
Thermal effects are achieved w/ 100% duty cycle, which should not be used on inflamed tissue
153
Supraspinatus and deltoid's respective role in shoulder abduction
- Initiated by supraspinatus for about 15 degrees
- Deltoid then has ideal line of pull for continued abduction
- All of this requires the rest of the rotator cuff to work to keep humerus in the glenoid
- Test all RC muscles
154
Normal lowering of the arch during navicular height testing
When the foot goes from non-weight-bearing to weight-bearing, there should be some lowering of the arch
155
March fracture
- a fracture of a metatarsal due to repetitive stress such as prolonged hiking or marching
- frequently the second metatarsal
156
Where will sesamoid pain be felt in the foot
at the location of the sesamoid bones at the first metatarsal head
157
Demographics common to slipped capital femoral epiphysis (SCFE)
- 10-14 years old
- Male > female
- Obesity
158
Waveform for NMES
Russian current (biphasic pulsed current or burst-modulated alternating current)
159
Pulse duration for NMES
200–600 µsec
160
Frequency for NMES
200–100 pps (burst per second)
161
Amplitude for NMES
Obtain a strong muscle contraction (*at least 50% of MVC)
162
Ramp-up time for NMES
1–5 seconds
163
Ramp-down time for NMES
1–2 seconds
164
Duty cycle for NMES
1:3 to 1:5
165
Treatment time/duration for NMES
Minimum of 10 contractions
3–5 times/week
4–8 weeks
166
Antalgic gait
- Painful gait
- Pt avoids WB on involved extremity
167
Arthrogenic gait
- seen due to abnormal joint motion, which may or may not be accompanied by pain
- Elevated pelvis and circumduct involved side
- Non-involved side will show increased PF
168
Equinus gait
Characterized by forefoot strike to initiate gait cycle
- AKA "toe-walking" gait
169
Hip extensor gait
- AKA lurching gait
- Posterior leaning of the trunk at heel strike
- Keeps hip extended during stance
- Caused by weakness of glute max
170
Cathode
Negative lead (attracts positive ions, or cations)
171
Anode
Positive lead (attracts negative ions, or anions)
172
Effective drug delivery dosages for iontophoresis
40-80 mA-min
173
What neurological deficit can cause leaning forward during initial contact?
- Weakness of quads
- Leaning forward produces knee extension moment
- Damage to L3/L4 and/or the femoral nerve
174
Best application area for ultrasound
2-4x effective radiating area
175
Recommended aerobic exercise intensity for individuals w/ asthma
Moderate (40-59% heart rate reserve)
176
Restrictions post meniscal repair
2 weeks of toe touch WB and limited knee flexion to 90 degrees
177
Swan-neck deformity
- Increased PIP ext
- DIP flexion
178
Mallet finger
- Neutral PIP
- Flexed DIP
179
Boutonnière deformity
- Increased PIP flexion
- Increased DIP extension
180
Cotton test
- For high ankle sprain
- Widening syndesmosis via lateral pull on fibula
181
AC resisted extension test is
- Designed to provoke the AC joint via pain reproduction.
- raise the patient's arm up to 90° flexion + IR and a flexed elbow
- AC joint is compressed.
- patient isometrically horizontally ABDucts their arm against resistance
- The test is considered positive if there is pain at the AC joint
182
Most common direction of shoulder dislocation
Anterior
183
Injuries associated w/ ANTERIOR shoulder dislocation
- tearing of the rotator cuff
- nerve or vascular injuries
- damage to the anterior capsule or labrum
- Bankart lesion
- Hill–Sachs lesion
184
Bankart lesion
During anterior dislocation of the shoulder, tearing of the anterior capsule and glenoid labrum may occur
185
Hill–Sachs lesion
posterolateral surface of the humeral head may strike the anterior glenoid, causing a compression fracture
186
Quad vs glute strengthening w/ PFP
targeted hip strengthening (gluteals) produces better outcomes than targeted knee (quadriceps) strengthening
187
Best way to ID a stress fracture
MRI is able to ID the fracture PLUS it can rule out other soft tissue and bone injuries
188
Areas that can accept weight w/ a prothetic for a transtibial amputation
- Patella tendon
- Medial tibial shaft and flare
- Fibular shaft
- Anterior compartment
189
Areas that cannot accept weight w/ a prothetic for a transtibial amputation
- Patella
- Tibial tuberosity
- Tibial crest
- Distal end of tibia and fibula
- Fibular head
190
Medicare Functional Classification Levels for use of prosthesis
Functional Level 0
Functional Level 1
Functional Level 2
Functional Level 3
Functional Level 4
191
Medicare Functional Classification Level 0 for use of prosthesis
- Cannot ambulate or transfer without assistance
- Prosthesis will not enhance function
192
Medicare Functional Classification Level 1 for use of prosthesis
- Can use a prosthesis for transfers and household ambulation
- Can walk limited distances on level surface at a fixed cadence
193
Medicare Functional Classification Level 2 for use of prosthesis
- Characterizes the limited community ambulator
- Can encounter low-level barriers like curbs and uneven surfaces
- Ambulates with a more fixed cadence
194
Medicare Functional Classification Level 3 for use of prosthesis
- Characterizes the unrestricted community ambulator
- Ambulates with varied cadence and can traverse most community barriers
- Requires a prosthesis that can meet demands greater than simple ambulation
195
Medicare Functional Classification Level 4 for use of prosthesis
- Individual with the highest potential and who exceeds basic ambulatory needs
- Characterizes those who participate in higher-impact activities like athletics
196
Symptoms of patellofemoral pain syndrome
- Crepitus
- Medial knee pain
- Difficulty w/ stairs and squatting
197
What is the axial view for in radiography?
- AKA Merchant view or skyline view
- Allows for visualization of the patellofemoral joint
198
What is needed to get compact privileges? (w/ the PT Compact)
- Must be a member of the compact
- Pass the other state's jurisprudence exam (if applicable)
- Apply and pay a fee
199
Best steps for a MSK exam
1) PROM
2) Palpation (if needed)
3) AROM
4) MMT
5) Special tests
200
Recommendations for an Appropriate Workstation Sitting Position
- Top of computer screen just below eye level
- Forearms parallel to ground or slightly tilted up
- Wrists unsupported and in neutral position
- Adequate low back support
- 90-degree angles at the hips and knees
- Feet flat on floor
201
Use for pulsed diathermy
- Does not generate heat
- Reduces edema and pain
202
Purpose of non-thermal ultrasound
- Treat inflammation
- Thought to accelerate the inflammatory phase of healing
203
Normal end-feel
- Firm (stretch)
- Hard (bone to bone)
- Soft (soft tissue approximation)
204
Examples of a normal firm end feel
- Ankle DF
- Finger extension
- Hip IR
- Forearm supination
205
Examples of a normal hard end feel
Elbow extension
206
Examples of a normal Soft end feel
- Elbow flexion
- Knee flexion
207
Abnormal end feels
- Empty (cannot reach end-feel, usually due to pain)
- Firm
- Hard
- Soft
208
Examples of an abnormal empty end feel
- Joint inflammation
- Fracture
- Bursitis
- Unlikely when AROM and PROM is identical w/o a true restriction
209
Examples of an abnormal firm end feel
- Increased tone
- Tight capsule
- Ligament shortened
210
Examples of an abnormal hard end feel
- Fracture
- Osteoarthritis
- Osteophyte formation
211
Examples of an abnormal soft end feel
- Edema
- Synovitis
- Ligament instability/ tear
212
Can a plan of care be signed by a nurse practitioner?
Yes
213
How long does a doctor or a nurse practitioner have to sign an initial plan of care?
90 days or within the time the patient is still under care
214
Mobilization for adhesive capsulitis
- Pts may not tolerate mobilization at end-range early on
- When pain is intermittent grade 4 can be appropriate
215
Taping procedure to prevent an inversion moment
- Stirrups that run from medial to lateral to prevent inversion
- Heel locks to provide rear-foot stability
- Figure 8 strips to provide global stability
216
Single-leg stance and pregnancy
Exercises performed in single-leg stance can cause SIJ irritation
217
2-point gait
- 2 crutches or canes
- L crutch + R foot
- R crutch + L foot
218
3-point gait
- Walker or crutches
- 1 injured LE or non-WB
219
Modified 3-point gait
- Partial WB
- To help progress from 3-point gait
220
Tri-compartmental knee replacement
- Replaces all 3 compartments of the knee
- The tibial plateau (bilaterally) and femoral condyles (bilaterally) are replaced and a polyethylene spacer is placed on the posterior aspect of the patella
221
MMT Grade 0
No visible or palpable contraction
222
MMT Grade 1
Visible or palpable contraction w/ no motion
223
MMT Grade 2-
- Gravity-eliminated position
- Movement through partial test range
224
MMT Grade 2
- Gravity-eliminated position
- Movement through complete test range
225
MMT Grade 2+
- Gravity-eliminated position (Movement through complete test range)
- Gravity-resisted position (movement through up to 1/2 test range)
226
MMT Grade 3-
- Gravity-eliminated position (Movement through complete test range)
- Gravity-resisted position (movement through more than 1/2 test range)
227
MMT Grade 3
- Gravity-resisted position
- Movement through complete test range
228
MMT Grade 3+
- Gravity-resisted position
- Movement through complete test range
- Able to hold against minimum resistance
229
MMT Grade 4
- Gravity-resisted position
- Movement through complete test range
- Able to hold against moderate resistance
230
MMT Grade 5
- Gravity-resisted position
- Movement through complete test range
- Able to hold against maximum resistance
231
O'Brien Test
- Diagnoses AC joint injury
- Isometric flexion of humerus while in 10 degrees adduction
- First in IR, then in ER
- Positive test = pain in IR and reduced during ER
232
Phases of rehab
- Protection phase
- Controlled-motion phase
- Return-to-function phase
233
Protection phase of rehab
- Manage and lower symptoms
- Promote gentle ROM
- Maintain joint integrity
234
Controlled-motion phase of rehab
- Acute symptoms are under good control
- Interventions advance w/o putting too much stress on the involved structures
235
Return-to-function phase of rehab
Goal is to increase endurance, speed, and power
236
Medicare Part A
- Inpatient Hospital Services
- Short-Term Skilled Nursing Care
- Home-Based Care
237
Medicare Part B
Outpatient Services
- Physical Therapy
- Diagnostic Tests
- Physician Visits
238
Medicare Part C
Medicare Advantage
- Health Maintenance Organizations (HMOs)
- Preferred Provider Organizations (PPOs)
- Health Savings Accounts (HSAs)
- Point of Service (POS)
- Provider-Sponsored Organizations (PPOs)
239
Medicare Part D
Prescription medications
240
Maximal elongation of the IT band
- Knee in 30 degrees flexion
- Adduction + extension of the hip
241
Cortical bone
- Dense, compact bone
- Found all throughout the bone, prominent in the shaft of long bones
242
Trabecular bone
- AKA cancellous
- Porous bone
- Found in the distal ends (epiphysis) of long bones
243
Approximation test procedure
- Patient sidelying
- Examiner applies downward pressure to patient’s upper iliac crest
244
Approximation test findings
Increased pressure indicates SI lesion or sprain to posterior SI ligaments
245
Gapping test procedure
- Patient supine
- Examiner applies outward and downward pressure to patient’s bilateral iliac crests
246
Gapping test findings
Unilateral pain in buttock or posterior leg indicates sprain of anterior SI ligaments
247
Sacral thrust test procedure
- Patient prone
- Examiner applies pressure with the base of their hand to patient’s sacral apex
248
Sacral thrust test findings
Pain over the joint indicates an SI joint issue
249
Thigh thrust test procedure
- Patient supine
- Examiner flexes patient’s hip to 90°
- While palpating the SI joint, examiner applies a longitudinal force through patient’s femur towards hip
250
Thigh thrust test findings
Pain in SI joint while thrusting indicates an SI joint issue
251
Gaenslen test procedure
- Patient sidelying, with upper leg in hip hyperextension and lower leg held in flexion against chest
- Examiner stabilizes pelvis and extends the upper leg further into hip extension
252
Gaenslen test findings
- Pain indicates an SI joint lesion, hip pathology, or L4 nerve root lesion
253
SI joint palpation procedure
Palpate the sacral sulcus medial to PSIS
254
SI joint palpation findings
Pain with palpation indicates an SI joint issue
255
Purpose of TENS
Pain relief, CANNOT BE USED FOR MUSCLE RE-ED
256
Is Osgood-Schlatter more common in males or females?
males
257
Is patellofemoral pain syndrome more common in males or females?
females
258
Is an ACL rupture more common in males or females?
females
259
Is patellar instability more common in males or females?
Females
260
Patient safety when administering hot packs
- Hot packs should be stored in water maintained at 70–75°C (158–167°F)
- Hot packs must be covered by at least 6 layers of towels
- Therapist should monitor patient after 5 minutes of hot pack application, for heat tolerance and skin reaction
- Total treatment time: 15–20 minutes
261
Consideration for non-weight bearing
Involved LE should not bear weight OR touch the floor
262
Consideration for toe-touch weight-bearing
Toes may contact the floor for balance, but may not bear any weight
263
Consideration for partial WB
Predetermined % of the patient's body weight may be place through the involved LE
264
Consideration for WB as tolerated
a patient may put as much weight as comfortable through the involved extremity
265
Noble test
- IT band friction syndrome
- Examiner passively moves knee into flexion and extension, while applying pressure to the lateral IT band
266
The medial and lateral pterygoids function to perform what function?
Contralateral mandibular deviation
