Readings (1st 20 days) & Lectures 1-5 Flashcards
Injury to what nerve can cause the claw hand deformity?
Ulnar n (C8, T1)
What nerve is vulnerable to injury w/ dislocation of shoulder and fx of surgical neck of humerus?
Axillary n (C5, C6)
What nerve is vulnerable to injury with shoulder dislocations and midshaft of the humerus?
Radial n (C5- T1)
“Crutch Palsy” caused by compression of what nerve while leaning on axillary crutches?
Radial n (C5-T1)
Lateral Epicondylitis (“Tennis Elbow”) is result of what affected n?
Radial n (C5-T1)
Trauma/fx of upper femur or pelvis during dislocation of hip can cause injury to what n?
Femoral n L2-L4
Person with who has difficulty crossing their legs may have damage to what n?
Obturator n (L2-L4)
Piriformis Syndrome caused by compression of what n?
Sciatic n
What n occupies a groove behind the medial malleolus along T,D & H creating Tarsal Tunnel?
Posterior Tibial n
What muscles are invovled in Tarsal Tunnel?
Tom, Dick and Harry
-Tibialis posterior
-Flexor Hallucis Longus
-Flexor Digitorum Longus
Capsular pattern of Shoulder (GH jt)
Max= ER
Mod= ABD
Min= IR
Capsular pattern of Elbow
Flexion > Ext loss
Capsular pattern of hip
Max= IR, Flex, ABD
Min= Ext
Capsular pattern of Knee (Tibiofemoral jt)
flexion> ext loss
Capsular pattern of ankle (Talocrural jt)
PF> DF loss
Caudal glide of the GH jt is meant to increase what motion?
Abduction
Posterior glide of the GH jt is meant to increase what motion(s)?
Flexion, IR
Anterior glide of the SC jt is meant to increase what motion?
scapular protraction
Caudal (inferior) glide of the SC jt is meant to increase what motion?
elevation
Distal glide of the humeroulnar jt is meant to increase what motion?
flexion
Radial glide of the humeroulnar jt is meant to increase what motion(s)?
varus; flexion
Ulnar glide of the humeroulnar jt is meant to increase what motion(s)?
valgus; Extension
Dorsal glides of humeroradial jt increase what motion?
extension
Volar glides of humeroradial jt increase what motion?
flexion
Dorsal glides of the proximal radioulnar jt are meant to increase what motion? *****
pronation
Volar glides of the proximal radioulnar jt are meant to increase what motion? **
supination
Dorsal glides of the distal radioulnar jt are meant to increase what motion?
supination
Volar glides of the distal radioulnar jt are meant to increase what motion?
pronation
Dorsal glides of the Radiocarpal joint are meant to increase what motion?
flexion
Volar glides of the Radiocarpal joint are meant to increase what motion?
Extension
Radial glides of the Radiocarpal joint are meant to increase what motion?
ulnar deviation
Ulnar glides of the Radiocarpal joint are meant to increase what motion?
Radial deviation
Ulnar glides of the CMC jt increases what motion?
radial adduction
Radial glides of the CMC jt increases what motion?
radial abduction
Dorsal glides of the CMC jt increases what motion?
palmar abduction **
Volar glides of the CMC jt increases what motion?
palmar adduction **
Volar glides of the MCP and IP jt increase what motion?
flexion
Dorsal glides of the MCP and IP jt increase what motion?
extension
Radial/ulnar glides of the MCP and IP jt increase what motion?
abduction/adduction
Posterior glides of the hip are meant to increase what motion(s)?
Flexion; IR
Anterior glides of the hip are meant to increase what motion(s)?
extension; ER
Posterior glides of the tibiofemoral jt are meant to increase what motion(s)?
flexion
Anterior glides of the tibiofemoral jt are meant to increase what motion(s)?
Extension
Anterior (Ventral) glides of the tibiofibular jt are meant to increase what motion?
reposition post subluxed head
Posterior (dorsal) glides of the talocrural jt are meant to increase what motion?
DF
Anterior (ventral) glides of the talocrural jt are meant to increase what motion?
PF
Medial glides of the subtalar jt are meant to increase what motion?
eversion
Lateral glides of the subtalar jt are meant to increase what motion?
Inversion
Plantar glides of the intertarsal and TMT jts are meant to increase what motion(s)?
PF accessory motions; supination
Dorsal glides of the intertarsal and TMT jts are meant to increase what motion(s)?
pronation
Referred pain in upper trapezius region could be from _____
Diaphragm
Pain in the left axilla and pectoral region may be referred from_____
Heart
Pain at the tip of the shoulder and scapular region may be from
Gallbladder
Three common sites for compression with TOS
Scalene triangle, costoclavicular space, under coracoid process/pectoralis minor m
What disorder is characterize by development of dense adhesions, capsular thickening, capsular restrictions rather than arthritic changes in the cartilage and bone as seen with RA or OA?
Frozen Shoulder (Adhesive Capulitis/ Periarthritis)
Frozen Shoulder has…
______ onset
Occurs between___ & ___ years of age
Pts with _____ and ____ are at higher risk for developing this
insidious
40 & 65
Thyroid disease, diabetes mellitus
Three phases of GH jt arthritis:
-Acute Phase- Pain and protective muscle guarding
-Subacute Phase- capsular tightness w capsular pattern
-Chronic Phase- Progressive restriction of the GH jt capsule in capsular pattern; often localized to deltoid region
Four stages of Idiopathic Frozen Shoulder
Stage 1: gradual onset of pain increases w movement, present at night
Stage 2 “Freezing Stage”: persistent, more intense pain at rest (3-9 months after onset)
Stage 3 “Frozen Stage”: pain only w movement, 9-15 months after onset
Stage 4 “Thawing Stage”: minimal pain, significant capsular restrictions from adhesions, 15-24 months after onset
Soft Tissue and Joint Integrity Mobility with Frozen Shoulder
-PROM
-Passive jt distraction and glides grade I & II
-Pendulums
-Gentle Muscle setting
Tension tests designed to put stress on the neurological structures of the upper limb by stretching them are_____
Upper Limb Neurodynamic Tension Tests
Elbow extension stresses the ____ and ____ nerves
radial, median
Elbow flexion stresses the ____ nerve
ulnar
Wrist and finger extension stressed the ____ and ___ nerves
median, ulnar
During ULNTT, if sx are minimal or no signs appear, the head and cervical spine are taking into ______ side flexion
Contralateral (sensitizing test)
When performing SLR, patient complaints of pain primarily in the back indicate ________
disc herniation
Which ULNTT? And which nerve(s)?
ULNT2; median, musculocutaneous, axillary
Which ULNTT? And which nerve(s)?
ULNT 3; Radial
Which ULNTT? And which nerve(s)?
ULNT4; ulnar nerve
SLR (Basic) test involves hip flexion/adduction, knee extension, and ankle DF to test _____ & ____ nerves
Sciatic, tibial
SLR2 test involves hip flexion, knee ext, Ankle DF, foot eversion, and toes extension to test ____ nerve
tibial
SLR3 involves hip flexion, knee extension, ankle DF, foot inversion to test _____ nerve
sural
SLR4 involves hip flexion and medial rotation, knee extension, ankle PF, foot inversion to test _____ nerve
Common peroneal
During the SLR, pt complaints of pain in CL side indicates ______
herniated disc
Length of Maximum protection phase of ACL Rehab
4 weeks
Length of Moderate protection phase of ACL rehab
Weeks 4-10
Length of Minimum Protection phase of ACL rehab
Weeks 11-24
Controlled pain, joint effusion, full knee ROM, good muscle strength, and independent ambulation occurs in what stage of ACL rehab?
Moderate Protection
No pain/swelling, full knee ROM, 75% mm function, symmetrical gait, unrestricted ADLs occur in what stage of ACL rehab?
Minimum Protection
Pain, hemarthrosis, decreased ROM, diminished quad activation, ambulate w crutches occur in what stage of ACL Rehab?
Maximum Protection
PRICE, gait training with crutches WBAT, PROM/AAROM, patellar mobs gd I/II, isometrics are used during what phase of ACL rehab?
Maximum protection
multiple angle isometrics, CC strength & PRE, LE stretching, endurance training, Proprio, stabilization exercises, elastic bands occur during what phase of ACL rehab?
Moderate protection
Advanced PRE, CC exercise, plyo, advance balance/proprio occur in what phase of ACL rehab?
Minimum Protection
Protect healing tissues and reflex inhibition, decrease joint effusion, ROM 0-110 deg, Active control of ROM, 75% WB are goals of what ACL rehab phase?
Maximum Protection
Full pain free ROM, 4/5 MMT, dynamic control of knee, normalized gait are goals of what ACL rehab phase?
Moderate protection
Increase mm strength, endurance, and power, improve NM control, dynamic stability, and balance, Regain CP endurance, transition to maintenance program, regain highest functional level desired, reduce re-injury are goals of what ACL rehab phase?
Minimum protection
Assisted SLRs, ankle pumps, work to full WB, CC squats, heel/toe raises, SLRs in 4 planes, Low load PRE of HS, OC knee extension (90-40deg), trunk/pelvis stabilization, aerobic conditioning are interventions for what ACL rehab phase?
Maximum protection
Proprio training (high speed steps, unstable surface, balance beam), walk/jog program at end of phase are interventions for which ACL rehab phase?
Moderate protection
Progressive agility drills, work/sport specific training, full speed jogging, sprints, running, cutting are interventions for what phase of ACL rehab?
Minimum protection
The hinged orthosis brace is typically used for how long post ACL surgery?
6 weeks
Full, active knee extension and 90-110 deg of flexion ROM is expected ____ to ____ weeks post-op ACL
4 to 6
ACL Precautions: Progress exercise more gradually for reconstruction with ______ graft then _____ graft
hamstring tendon graft; bone-patellar tendon-bone graft
ACL Precautions: Progress Knee flexor strengthening exercises cautiously if ______ tendon graft was harvested
HS
ACL Precautions: Progress Knee extensor strengthening exercises cautiously if ______ tendon graft was harvested
patellar
ACL Precautions: When squatting, avoid knees moving ___ to _____ to avoid increasing shear forces on the tibia
anterior; toes
ACL Precautions: Avoid CC strengthening of quads between __ and ___ degrees of knee flexion
60;90
ACL precautions: During PRE to strengthen hip musculature, initially place resistance _____ knee until knee stability is established
above
ACL precautions: Avoid resisted, OC knee ext between ___ and ___ deg to ____ extension for 6-12 weeks
45;30; full
ACL precautions: Avoid applying resistance to ____ tibia during quad strengthening
distal
Want to achieve ___ deg of flexion and ___ passive ext by the first 2 weeks of ACL rehab
90, full
Want to achieve ___ to ____deg of flexion by the 3-4 weeks of ACL rehab
110-125
Minimal pain/swelling, full active knee ext (no lag), 110 deg flexion, Quad strength 50-60% CL side, no jt laxity are criteria to progress from ____ protection to ____ protection phase of ACL rehab?
Maximum; moderate
No pain/swelling, full active ROM, 75% strength compared to CL side, hamstring/quad ration >65%, functional hop text >70% of CL side, and no instability are criteria to move from ___ protection to ____ protection phase of ACL rehab
Moderate; minimum
Recommended timeline for returning to sports/vigorous activity post ACL reconstruction is ____ to ____ months post-surgery
6;12
Spoon Shaped Nails
-fungal infection, anemia, iron deficiency, long-term diabetes, chemical irritants, psoriasis, developmental abnormality
Clubbed Nails
-hypertrophy of underlying soft tissue, COPD, emphysema, congenital heart defects, cor pulmonale
Ape hand deformity
Bishop’s Hand (Benediction hand deformity)
-wasting of hypothenar mm of hand, interossei mm, and medial lumbrical mm d/t ulnar nerve palsy
Boutonniere Deformity
-Ext of MCP and DIP jts and flexion of PIP joints
-result of rupture of central tendinous slip of extensor hood (common after trauma or w RA)
Claw Fingers
-Loss of intrinsic mm action and overaction of extrinsic extensor mm on proximal phalanx
-MCP jts hyperexten and PIP/DIP jts are flexed
-“Intrinsic Minus Hand” if intrinsic fx is lost
Dinner Fork Deformity
-malunion distal radial fx (Colles Fracture)
Drop Wrist Deformity
-Wrist ext mm paralyzed d’t radial nerve palsy
-wrist and fingers can’t extend actively
Mallet Finger
-rupture or avulsion of extensor tendon insertion on distal phalanx
Polydactyly
-presence of more than the normal # of fingers or toes
Swan Neck Deformity
-flexion of MCP and DIP jts, ext of PIP joint
-contracture of intrinsic mm or tearing of volar plate
-RA or trauma
Spyndactyly
- congenital
- fingers or toes may be united, joined, or webbed
Trigger Finger
-thickening of the flexor tendon sheath
-sticking of finger when pt tries to flex finger
-common in middle aged women
-RA
-Worse in morning
Stroke, TBI, SCI are examples of ____ Lesions
UMN
Polio, Guillain-Barre, Peripheral n injury, peripheral neuropathy, radiculopathy are examples of ____ Lesions
LMN
A lesion affecting the CNS, cortex, brain stem, corticospinal tracts, and spinal cord are ____ lesions
UMN
Lesions affecting the cranial nn, spinal tools, anterior horn cells, or peripheral nerves are ____ lesions
LMN
hypertonia and velocity dependent tone is associated with ____ lesions
UMN
hypotonia, flaccidity, and non-velocity dependent is associated with ___ lesions
LMN
Hyperreflexia, clonus, positive babinski are associated with ___ Lesions
UMN
hyporeflexia is associated with ____ lesions
LMN
Muscle spasms are associated with ___ lesions
UMN
Fasciculations are associated with ___ lesions
LMN
oral hygiene, showering, dressing, toilet hygiene, feeding, personal device care are examples of ______
ADLs
money management, functional communication, socialization, functional and community mobility, health maintenance are examples of ___
IADLs
bed mobility transfers, walking, stair climbing are examples of _____
Functional mobility skills
When the BOS and COM are moving simultaneously, this is an example of ____
mobility
Maintaining posture in a stable, unchanging position with COM over BOS is ____
Stability
Stability is adjusted and maintained while limbs are moving is an example of____
dynamic postural control
disorder of motor components of speech articulation
-scanning speech
Dysarthria
impaired ability to perform rapid alternating movements
Dysdiadochokinesia
Inability to judge the distance or range of movement to reach an object
Dysmetria
Movement performed in a sequence of component parts rather than a single, smooth activity
Dyssynergia
-index finger to nose
Loss of ability to associate mm together for complex movements
Asynergia
Ambulatory patterns demonstrating broad BOS, irregular stepping patterns, unsteady, irregular, staggering, veering, swaying
Gait ataxia
Rhythmic, quick, oscillatory, back and forth movement of the eyes
Nystagmus
Involuntary oscillatory movement resulting from alternate contractions of opposing mm groups
tremor
Inability to initiate movement
-seen in late stages of PD
-freezing episodes
Akinesia
Involuntary, slow, writhing, twisting movements
Athetosis
decreased amplitude and velocity of voluntary movement
Bradykinesia
involuntary, rapid, irregular and jerky movement involving multiple jts
-HD
Chorea
Increased mm tone causing greater resistance to passive movement
Rigidity
CN I and function
Olfactory
-smell
CN II and function
Optic
-vision
CN III and function
Oculomotor
-elevate eyelids
-up, down, in (eyes)
-constricts pupil
-accommodates lens
CN IV and function
Trochlear
-adduction and downward motion of eye and inward rotation
CN V and function
Trigeminal
- Sensation of face, cornea, anterior tongue
-mm of mastication
-Dampens sound
CN VI and function
Abducens
-Turns eye out
CN VII and function
Facial
- Ant tongue taste
-mm of facial expression
-dampens sounds
-tearing
-salivation
CN VIII and function
Vestibulocochlear
- Balance
-hearing
CN IX and function
Glossopharyngeal
-Post tongue taste
-sensation of post tongue and oropharynx
- salivation
CN X and function
Vagus
- Thoracic and abdominal viscera
-mm of larynx and pharynx
-Decreases HR
-Increase GI Motility
CN XI and function
Spinal Accessory
- Head movements (STM & Trap)
CN XII and function
Hypoglossal
-Tongues movements and shape
CN I test
odors like lemon oil, coffee, cloves, tobacco
CN II Test
Snellen chart visual acuity
CN III, IV, and VI Test
-Eqaulity and size of pupils, reaction to light
-“H” test
CN V test
-Sensory test of face (sharp/dull, light touch)
-opening & closing jaw against resistance
CN VII test**
asymmetry of face
-smile?
CN VIII test
-tuning fork (webers test)
-rub fingers
-Rinne test **
CN IX test
-taste post 1/3 of tongue
-gag reflex
CN X test
-Examine swallow
-observe uvula for asymmetry
CN XI test
strength of SCM and trap
CN XII test
tongue protruded and moving side to side
Trendelenburg positioning is optimal for facilitating secretion drainage from the ____ lobes of the lungs
lower
sensation of difficult or labored breathing
dyspnea
dyspnea at rest and/or with exertion, wheezing are indications for what breathing technique?
Pursed lip breathing
Hypoxemia, tachypnea, atelectasis, anxiety, excess pulmonary secretions are indications for what breathing technique?
diaphragmatic breathing
HR traditionally increases ___ beats/min per MET level increase in activity
10
SOB that increases in the recumbent position
Orthopnea
-need more pillows
Normal heart sounds are lub (S___) which occurs at the time of closure of the ____& _____ valves and mark the beginning of systole and dub (S___) which occurs at time of ______/______ valve closure and marks end of systole
S1; mitral & tricuspid
S2; aortic/pulmonic
Valve best auscultated at 2nd IC space, right sternal border
Aortic
Valve best auscultated at 2nd IC space, left sternal border
Pulmonic
Valve best auscultated at 4th IC space, left sternal border
Tricuspid
Valve best auscultated at 5th IC space, midclavicular line
Mitral
The angina scale goes from ___ (No angina) to ___(most pain ever experienced)
0;4
The dyspnea scale goes from ___ (No dyspnea) to ___ (Severe difficulty, cannot continue)
0;4
Cardiac Rehab is traditionally begun in the ____ setting
acute hospital
What phase of Cardiac rehab focuses on assessing pt’s hemodynamic response to activity and increased ind in functional mobility?
Phase 1
MCID for the 6MWT in a patient with Heart failure is ____m
45
Beta blockers ______ HR and contractility therefore reducing energy demand
decrease
Calcium Channel Blockers ____ BP therefore decreasing work of the heart
Decrease
Nitrates are vaso______ that decrease preload and afterload and ______ coronary arteries; decreasing myocardial work
dilators; dilate
ACE inhibitors and ARBs normalize ___ and reduce workload on the heart
BP
____-sided Heart failure occurs with LV insult, reducing CO, and backup of fluid in lungs= SOB and cough
left
_____-sided heart failure occurs from direct insult to RV d/t increased PA pressure, increased afterload, and high demand on RV , backing blood up in the RA = jugular venous distention, and peripheral edema
Right
____ causes increased peripheral arterial pressure, increased afterload, and pathological hypertrophy of the LV
Hypertension
_____ is a result of acute injury to myocardial tissue, damaged ventricular contractility, systolic dysfunction
CAD
The usual abnormal heart sound associated with CHF is the presence of an S__ heart sound
3
-low frequency
-early diastole
Valve ______ involves narrowing of a heart valve limiting the flow of blood through the valve
Stenosis
Valve _______ involves enlarged valve cusps that become floppy and bulge backward, sometimes causing regurgitation
Prolapse
Valve ________ refers to the fwd/bkwd movement of blood resulting from incomplete valve closure
Regurgitation
the movement of air through the conducting airways
ventilation
Amount of air inspired or expired during normal resting ventilation
Tidal volume TV
Quantity of air that can potentially be exhaled beyond the end of a tidal exhalation
ERV Expiratory Reserve Volume
The volume of air remaining in lungs when ERV has been exhaled
RV Residual Volume
_____ = RV + ERV
FRC Functional residual capacity
Volume of air remaining in lungs at end of tidal exhalations
FRC Functional residual capacity
IRV + TV + ERV = _____
VC Vital capacity
All the possible volume of air within lungs that is under volitional control
VC Vital capacity
TV + IRV+ ERV + RV + _____
TLC Total Lung Capacity
Volume of air that can be forcefully exhaled during the first second of a forced vital capacity maneuver
FEV1 Forced expiratory volume in 1 second
In healthy ppl, the FEV1 is ___% or more of the total FVC
70
(FEV1/FVC>70%)
gas exchange within the body
respiration
decreased amount of oxygen in the arterial blood to tissues
hypoxemia
when hypoxemia is worsened it turns into ___
hypercapnea
increased amount of carbon dioxide within the arterial blood
hypercapnea
intermittent bubbling or popping sound that may be present form secretions in the airways
crackles
Partially obstructed bronchi and bronchioles may result in an expiratory _____
wheeze
Rapid, shallow breathing
limited chest expansion
inspiratory crackles
digital clubbing
cyanosis
are signs of _____ lung disease
restrictive
glide happens in the opposite direction of the roll if the moving surface is _______
convex
Roll and Glides:
1. Shoulder
2. Elbow
3. Prox RU
4. Distal RU
5. Wrist
6. Fingers
7. Hip
8. Knee
9. Ankle
- oppo
- Same
- O
- S
- O
- S
- O
- S
- O
EDAB
PRONATION
-eversion, DF, abd
*OC
IPAD
Supination (Superior product)
-inv, PF, ADD
*OC
Gd I Mobs
Baby
Small amp beginning of range
Gd II Mobs
Big
Large Amp, within range
Gd III Mobs
Big
Large amp, to limit of ROM, into tissue resistance
Gd IV Mobs
Baby
Small amp, rhythmic oscillation, at end range, in tissue resistance
- Cerebrum
- Brain stem
- midbrain
- Pons
- Medulla Oblongota
- Cerbellum
- Spinal Cord
- Frontal lobe
- Parietal lobe
- Occipital Lobe
- Temporal Lobe
- Broca’s area
- Wernicke’s area
A. Trochlear
B. Optic
C. Vestibulocochlear
D. Facial
E. Olfactory
F. Vagus
G. Oculomotor
H. Trigeminal
I. Hypoglossal
J. Glossopharyngeal
K. Accessory
L. Abducens
Describe what this response to PLR means:
Normal response
L CN2, L CN3, R CN3 intact
Describe what this response to PLR means:
R CN 3 effected, L CN 2 intact, L CN 3 intact
Describe what this response to PLR means:
L CN 3 effected
R CN 2 intact
R CN 3 intact
Describe what this response to PLR means:
L CN 2 effected
