Test 2 Content Flashcards
1
Q
what is the adam’s forward bend test?
A
- a rotational deformity (rib hump) can be easily identified when a patient bends over
- this is the hallmark sign of a curve greater than 10 degrees (scoliosis)
- send for an x-ray
2
Q
what are the symptoms of sesamoiditis?
A
- pain under the great toe with weight bearing
- improved when not weight bearing
- worse with dorsiflexion of the great toe
3
Q
what are the characteristics of an anterior dislocation?
A
- 95% of dislocations occur anteriorly
- MOI = forced external rotation, usually abducted or FOOSH
- signs/symptoms = arm held slightly externally rotated and abducted, restricted ROM, altered contour of the shoulder
4
Q
What are the four muscles (dynamic stabilizers) of the rotator cuff?
A
- subscapularis (internally rotates)
- supraspinatus
- infraspinatus
- teres minor
- all for humeral head centralization, so movement can occur
5
Q
what is tendonitis?
A
- tendon inflammation (which is rare)
6
Q
how do overuse injuries usually occur?
A
- aerobic sports
7
Q
what are the characteristics of muscle cells?
A
- contractile tissue
- generates power
- well vascularized
- heals well
8
Q
what are the characteristics of a grade II strain?
A
- 20-80% torn
- decreased ROM
- significant pain
- 2-3/5 on the oxford scale
- palpable
9
Q
Describe the Neer Impingement test
A
- supraspinatus pinched beneath coracoacromial arch
- arm above head
10
Q
what are the characteristics of a grade III sprain?
A
- no ROM
- pain (variable)
- high laxity
- no endpoint present
11
Q
neurological testing L2
A
- reflex = N/A
- myotome/dermatome = hip flexion
12
Q
what is normal knee twisting motion?
A
- takes place between the bottom of the menisci and the tibia
13
Q
what structures anteriorly support the shoulder?
A
- minimal bony support
- biceps
- joint capsule
- ligaments
14
Q
define overuse/chronic criteria
A
- overtime and overloading
15
Q
what are the scapula stabilizers’ jobs?
A
- to position the scapula for max stability
16
Q
neurological testing C5
A
- reflex = biceps/brachioradialis
- myotome/dermatome = shoulder abduction
17
Q
what are the characteristics of a grade III strain?
A
- 80-100% torn
- PROM only
- 0-1/5 on the oxford scale
- lots of pain (or none at all if completely torn)
- palpable divot
18
Q
what does the term “itis” imply?
A
- inflamed
19
Q
impingement causing RC tendinitis/ tendinopathy: signs
A
- painful arc (70-120 degrees)
- ok below 90 degrees
- weak RC, especially external rotators with the scapula stabilized
- poor scapulohumeral rhythm
- poor joint stability (potentially anterior humeral head)
- positive Hawkins-Kennedy and Neer tests
20
Q
What is excessive pronation in the gait cycle?
A
- at the subtalar joint
- causes internal rotation of the tibia
- delayed resupination
- affects screw-home mechanism (no tibia external rotation)
- femur must internally rotate more (to get to extension)
- cause of patellar tracking issues
21
Q
what is turf toe?
A
- forced hyperextension of the great toe >100 degrees
- tears plantar capsule and plantar ligaments of the great toe
- caused by artificial turf (stopping dead) or soft footwear
- can be overuse or trauma
22
Q
how do you manage an anterior sternoclavicular injury?
A
- lateral traction (slight to prevent posterior movement of the clavicle)
- POLI and peace and love
- brace (to keep shoulders back, for healing)
- removal from sport (only if continuous re-injury because there is a high incidence of reinjury)
23
Q
what are the characteristics of a 0 on the oxford scale?
A
- no contraction occurs when a patient tries to contract
- could be fully torn or a neurological problem
24
Q
what is the transverse arch of the foot?
A
- extends across the tarsal bones
- provides protection to soft tissue and increases the foots mobility
25
what movements can be assessed best on the sagittal plane?
- flexion/extension
- at the spine, shoulder, hip, knee and ankle (dorsi/plantar)
26
which joint does shoulder dislocation occur at?
- glenohumeral joint and sternoclavicular joint
27
how do you diagnose a high ankle sprain?
- exclusion of fracture and medial/lateral ankle injuries
- MOI is appropriate
- combination of tests is required due to not one test being definitive
28
what are the MOIs of sternoclavicular injury?
- a direct blow to the clavicle
- indirect (through arm/shoulder, force moves along the collarbone)
- moves clavicle upward and forward (usually)
29
what is the function of the ATFL? (anterior talofibular ligament)
- communicate with the capsule
- 2 bundles (superior and inferior, at 90 degrees from each other)
- weakest of the lateral ligaments
- most injured
- increased strain in plantar flexion as talus glides forward out mortise
30
what are the passive stabilizers of the ankle?
- fibrous capsule (surrounds ankle, allows movement)
- ligaments (strengthen talocrural joint) --> ATFL, PTFL, deltoid
31
how to differentiate between grades of sprains
- unable to bear weight = potential fracture, significant injury
- able to walk not run = grade 2 injury
- able to run = grade 1 injury
- hear a pop/crack = fracture or complete tear
32
what is the drop arm test?
- tear of cuff
- emphasis on the supraspinatus
- cannot hold arm at 90 degrees after lowering from above the head (light tap if necessary to cause arm to drop)
33
what are the two types of muscle injuries?
- distension (strains)
- contusion/laceration (ecchymosis/bruise or cut) --> aka direct trauma
34
what are the types of scoliosis? (2)
- structural and non-structural
35
how do you treat plantar fasciitis for late repair/remodelling?
- idealize strength through range
- add power and agility (push-off)
- taping, shoes or insole for return to play
36
management of a grade I AC injury
- stable but painful
- can participate if they can handle the pain
- NO SLING --> keep the shoulder moving
- tape for comfort (to hold things together)
- POLICE and PEACE & LOVE
- maintain ROM, strength and function
- ice --> move when numb if too painful otherwise
37
what is the function of the extracapsular ligament?
- provide stability to the lateral talocrural joint (into dorsiflexion)
- 3.5x stronger than the ATFL
38
where do muscle injuries usually occur?
- at the musculotendinous junction
39
how plantar fasciitis is caused by tight posterior structures
- the connection between plantar fascia and the Achilles
- if the Achilles is tight, may pull plantar fascia
- tight plantar flexors = affect dorsiflexion ROM and motion through foot contact
40
what structures are anterior invertors at the ankle?
- tib anterior
41
neurological testing C4
- reflex: N/A
- myotome/dermatome: shoulder shrug
42
what are the characteristics of posterior dislocations?
- 4% of dislocations
- easily missed (only see on an x-ray from a side angle)
- often due to seizure or electric shock (aggressive pull of muscle)
- MOI = flexion and adduction, force taken on the hand causing the head of the humerus to push out the glenoid
- S/S = elbow held at the side with hand on stomach, can't externally rotate or abduct (humerus into ribcage)
43
Describe the transverse arch anatomy
- nerve splits into two (sensory for the bottom of the foot)
- good arch = more space for nerves
- low arch = less nerve space --> bones drop causing mechanical inflammation
44
what is an open fracture?
- a "compound" fracture
45
what is sesamoiditis?
- injury of the two sesamoid bones beneath the 1st MTP joint
- caused by forces between the ground and hallicus longus
- 30% of sesamoid injuries are sesamoiditis (could be a fracture, arthritis or irritation/stress)
- caused by repetitive stress/ hyperextension of the great toe
- common in basketball and dancing
46
characteristics of non-structural scoliosis
- caused by tightness in muscle, postural problems, muscle spasm, tight on concave side and weak on convex side, leg length discrepancy, hip contracture
- no bony deformity
- not progressive
- can be treated clinically
- disappears on forward or side flexion
47
neurological testing L1
- reflex: N/A
- myotome/dermatome: hip flexion
48
Why does the shoulder complex have so much mobility?
- due to articular surfaces having minimal bony congruity
49
what are the signs of turf toe?
- swelling, red, ecchymosis
- pain with movement in the big toe (limited ROM) - both passive and resisted
- pain and laxity with dorsoplantar drawer test
50
how do you manage clavicle fractures?
- POLICE/ PEACE & LOVE
- sling (B tube to keep the arm closer to the body and not have all the weight on the broken bone)
- managed conservatively
- heals in 4-6 weeks
- keep the arm moving below 90 degrees
51
what are the characteristics of abnormal end feel?
- springy = joint
- spasm/stretch = hamstrings (guarding)
- prior to end = capsular
- empty = no end feel (no resistance and lots of pain)
52
how/why do you observe postural evaluation?
- important to assess static posture
- observe the entire body from all angles (improved by use of plumb line or screen)
- significant variability (only obvious asymmetries should be considered)
53
how do you treat mild cases of ingrown toenails?
- tape method = tape lateral nail fold pulled with space between the nail and the nail fold
- attach tape to toe pad without excessive pulling
54
what are the normal movement patterns of the shoulder (abduction)?
- setting phase = initial 30 degrees scapula doesn't move
- movement = 2:1 ratio between humerus and scapula
55
what are the characteristics of a deltoid ligament sprain?
- least common, usually with a break
- eversion MOI
- stability of medial ankle
- fibula often breaks because main medial stabilizer
56
What is shoulder impingement?
- the humerus is pulled too far up and pinches the supraspinatus or subacromial bursa
- (causes pain between ROM 70-120 degrees, aka the painful arc)
57
what is the function of the PTFL? (posterior talofibular ligament)
- communicates with capsule
- at 180 degrees from ATFL
- extends medial posterior talus
- supports TC joint in dorsiflexion
- provides secondary support through range (TC joint)
- communicates with ATFL
58
what are the classical postural deviations in the sagittal plane with forward rounded shoulders?
- humeral head in front of the plumb line (glenohumeral internal rotation)
- tight pec minor (attached to coracoid process on the humerus)
- elongated/weak rhomboid and mid-trapezius muscle
- restricted scapular upward rotation and posterior tipping, may affect shoulder movements
59
what are the characteristics of tendon tissue?
- muscle to bone
- muscle force transferred to the skeleton
- 65-80% type 1 collagen
- parallel bundles
60
ingrown toenail injuries characteristics
- more common in males than females
- large toe is most often affected
- inflamed skin grows over the lateral nail fold
- moderate to severe lesions may have foul-smelling discharge
- result from lateral pressure of poorly fitted shoes, improper trimming or repeated trauma
- severe cases are treated surgically
61
Describe the Fowler Reduction/Relocation test
- A-P pressure on GH joint
- centralizes the humeral head
- takes pressure off anterior capsule
- feels better
62
what is the gait cycle?
- walking
- 60% stance and 40% swing
- weight bearing in the closed kinetic chain
- at initial contact and early loading there is double contact
- at mid-stance and terminal stance, body support by only a single limb
63
what is tendinosis caused by/what are the characteristics?
- repetitive microtrauma
- without inflammation
- collagen breaks down like a rope fraying
- increase in vascularity (but poor quality)
- a decrease in nuclei
64
what are the characteristics of the linear region?
- < 50% = grade 1
- 50-80% = grade 2
- causes damage
- irreversible elongation
65
neurological testing S3
- reflex: N/A
- myotome/dermatome: intrinsics of the foot
66
what does the term "osis" imply?
- overuse without the chance for healing
- eventually leads to degeneration
67
what are the symptoms of a CFL sprain?
- inversion MOI (neutral or dorsiflexion)
- pain on the lateral side of the ankle (below the malleolus)
- potential instability (high grade)
68
what are objective notes for?
- observing physical phenomenon indicative of a condition
- selective tissue tension testing
- assessing end feel
69
what is the plantar fascia?
- originates from the medial tubercle on the plantar surface of the calcaneus
- travels toward the toes as a solid band of tissue dividing just prior to the MT heads into 5 slips
- support foot vs. downward forest
- functions as a muscle to move the arch up
- has a dynamic function (short when toes are extended, around each MT head)
- responsible for transferring weight from the medial to lateral side of the foot during the gait cycle
- responsible for arch support and shock absorption
70
neurological testing S1
- reflex: Achilles
- myotome/dermatome: plantar flexion
71
how common is syndesmosis/high ankle sprain?
- ~10% of ankle sprains (tib/fib joint)
- more common in "boots" sports (skates, boots, etc.)
- difficult to diagnose and treat
- up to 55 days for recovery
72
why is the clavicle one of the most common fractures in sports?
- can be injured with any force that brings the should to the midline or direct from the superior or anterior direction
- direct = fall on the shoulder
- indirect = FOOSH
73
neurological testing C2
- reflex: N/A
- myotome/dermatome: neck flexion
74
what are the symptoms of plantar fasciitis?
- a gradual onset of pain
- "stabbing pain" first couple steps of the day --> tearing of newly healed tissue
- pain lessens after the first few steps, but worsens with prolonged activity
75
what are the characteristics of the glenohumeral joint?
- unstable (due to the humeral head being 3x larger than the glenoid)
- labrum deepens the socket (but it is still unstable)
- scapula rotates under to support the humerus
- coordinates movement with the scapula and scapular stabilizers
76
what type of muscles do injuries usually occur on?
- 2-joint muscles
77
neurological testing C3
- reflex: N/A
- myotome/dermatome: neck side flexion
78
what is in the shoulder complex?
- all bones and joints of the shoulder
79
what is the external rotation test (for fibular fractures)?
- turn ankle outwards (external rotation), hand medial, supporting knee
- if pain (bones are spreading) need an x-ray
80
what is an atraumatic shoulder dislocation?
- BORN LOOSE, AMBRI = atraumatic, multidirectional, frequently bilateral, responds to rehabilitation and rarely requires an inferior capsular shift
- rehab = muscle control
- lax individuals or lax secondary repetitive microtraumas
- lead to loose capsule
81
how do you treat plantar fasciitis for fibroblastic/repair?
- no inflammation stage because an osis
- correct training errors
- manual therapy/soft tissue work and exercise
- stretching (2-4 months) --> before getting out of bed
82
what does a grade II sternoclavicular injury look like?
- sublux with deformity
- swelling and pain
- unable to abduct or bring arm across chest
83
what type of tissue will have tension when only stretched?
- inert
- ligaments, bursa, capsule, fascia, nerve roots, dura mater
84
what is the treatment for Morten's neuroma?
- acute/inflamed = POLICE/ PEACE & LOVE or corticosteroid injection
- chronic/overuse = avoid trigger "shoes" and aggravating activities, correct transverse flatfoot (foot mobilization, pad keeping foot in transverse arch position)
- gradually return to activity
- last resort treatment = remove a long segment of the nerve
85
what are the signs of plantar fasciitis?
- pes planus (twisting) or pes cavus (more force)
- decreased ROM for dorsiflexion (caused by gastroc/soleus tightness or poor joint mobility)
- weakness of tib posterior (medial side)
- pain on palpation over origin of PF (medial calcaneus)
86
what are the characteristics of the repair/fibroblastic phase?
- days 3 - week 6
- scar tissue (unorganized) is laid down as repair
- fibroplasia
- lack of O2 causes endothelial capillary buds
- type 3 collagen (is weak)
87
what is a "healthy" ankle injury?
- an eversion without deltoid ligament tear
- MOI = in skate/boot
- noticeable deformity
- no pain in palpation over deltoid ligament, malleoli (or higher)
- +ve squeeze test (above/below)/ ER tests on the lower leg if no deformity present
88
neurological testing C6
- reflex: biceps/brachioradialis
- myotome/dermatome: elbow flexion/wrist extension
89
what are the signs of sesamoiditis?
- swelling
- redness
- pain with dorsiflexion of toe
- pain and weakness with resisted plantar flexion of toe
- pain with direct palpation of sesamoids
90
gait cycle running
- no simultaneous foot contact
- at heel strike, the foot is a shock absorber
- the foot is a rigid lever at toe-off
- 80% of runners have a lateral heel strike
- sprinters have a forefoot strike
91
What is pes planus?
- flat foot
- decreased medial longitudinal arch height
- associated with excessive pronation
92
lower chain alignment definitions
- valgus = knee pushes out laterally
- neutral = knee follows low bearing axis
- varus = knee pushes medially
93
what structures are posterior inverters?
- achilles tendon
- flexor hallucis longus
- flexor digitorum longus
- tib posterior
94
what are the characteristics of a grade I sprain?
- high ROM
- low pain
- no laxity
95
what is the cross-flexion/scarf test?
- patient will bring the arm across chest to rest on the opposite shoulder
- if pain is present, there is likely a clavicle fracture
96
characteristics of rotator cuff strain in the young athlete (teens/YA)
- sudden onset
- usually from acute overload (traumatic event)
- twinge felt in the shoulder
- limitation in function
- +ve STTT (with contraction and stretching)
- graded 1-3
- responds quickly to rest and rehab
97
what is the windlass mechanism?
- the foot is flat on the ground, dorsiflex or extend the toes (higher arch height, weight transfers laterally), toes go into dorsiflexion and heel lifts off the ground (tightening of the plantar fascia)
- dynamic function to affect the arch height
- transfers weight from medial to lateral for arch support and shock absorption
98
what are the characteristics of ligaments?
- bone to bone
- made of collagen and elastin
- stabilizers
- usually have traumatic MOIs
- high innervation (good for proprioception and rehabilitation)
99
what causes anterior dislocations at the SC joint?
- when a force is applied to the anterolateral clavicle and the shoulder is rolled backwards (rarely from direct trauma)
100
what structures posteriorly and superiorly support the shoulder?
- spine of scapula and acromion
- thick capsule
- RC muscles crossing posterior joint
101
where do fractures occur in the shoulder complex?
- clavicle
- humerus
- scapula
102
what are the two types of shoulder impingement?
- primary = due to the shape of the acromion (peaked/hooked), or build up from sports
- secondary = cause by one or both of the following
1. weakness of scapular stabilizers (change scapulas position)
2. poor centralization of the humeral head (weak rotator cuffs)
103
what affects pressure distribution in the foot?
- articulation of the bones (faulty mechanics in the joint or above/below the joint)
- surrounding soft tissues
104
define scoliosis
- a deformity in which there are one or mote lateral curves of the spine
- C or S curve
- may occur in thoracic, thoracolumbar or lumbar spine
- easily measured on x-ray
- may be non-structural or structural
- greater than 10 degrees
- more common in females
- present in 2-4% of children ages 10-16
105
what is the most common cause/MOI of sternoclavicular injury?
- moderate-vigorous activity and sports injuries
106
where does shoulder separation occur?
- acromioclavicular joint (AC joint)
107
what parts of the body pass through the sagittal plane during basic postural observation?
- should be a straight line running down the entire body
- ear lobes
- body of cervical spine
- humeral head
- greater trochanter (PSIS is higher than ASIS)
- anterior to knee, but posterior to patella
- anterior to malleolus
- gastrocs are postural muscles
108
explain the muscular imbalance of the deltoid and supraspinatus for abduction
- deltoid cannot initiate movement because the line of pull is parallel to the humerus (starts after 30 degrees)
- supraspinatus initiates abduction because its perpendicular (first 30 degrees alone)
- once started, the deltoid has a strong superior pull on the humerus with the glenoid
109
what movements can be assessed on the coronal plane?
- side flexion, abduction, adductionand inversion/eversion
- at the spine, shoulder, hip, and ankle
110
what do you test in the observation step?
- inflammation
- general demeanor
- posture
- deformity/asymmetry
- quality of movements
111
what is the apprehension test?
- tell = tell you to stop
- roll = roll their body towards the arm
- fight = fight what you are doing
- pull = pull the arm to the body
- if any of these occur, stop because laxity could cause dislocation
112
what are the characteristics of a grade II sprain?
- decreased ROM
- increased pain
- some laxity
- endpoint present
113
why should it technically be called plantar fasciosis?
- overuse condition
- not "red, hot, swollen"
- changes in collagen structure
- degenerative condition
114
when do ankle sprains usually occur?
- with loading and unloading
- with CKC plantar flexion, talus anterior in the ankle mortise
- ATFL is the primary restrain for excessive talar glide
- ankle is more stable in mortise (due to shape)
115
what are the basic postural observations in the coronal plane? (anterior view)
- head straight (eyes/ears level)
- shoulders (dominant side may be slightly lower, acromion level, equal distance from body to arm)
- hips level (ASIS)
- knees level and straight (facing forward)
- malleoli equal
116
sesamoiditis treatment
- inflammatory = police/peace and love, restrict activity and dancers pad
- prior to return to play = correct training errors, slow return to training
117
what are the two types of factors that cause injuries?
- extrinsic (external)
- intrinsic (internal)
118
what are capsular ligament injuries?
- projections at the joint capsule
- heal well
- very high blood supply
- act as "cling film"
119
what is the theory of STTT?
- that tension will give rise to pain
120
neurological testing c8
- reflex: triceps
- myotome/dermatome: thumb extension
121
what do you test in the special tests step?
- manual muscle testing (oxford) and differential diagnosis
122
what is the sternoclavicular joint important for?
- movements, especially abduction
- shoulder move freely forward, backward, up and rotation
123
where does stability come from in the ankle?
1. shape of the bones
2. passive stabilizers (capsule and ligaments)
3. dynamic stabilizers (muscles that cross the joint)
124
what is a subungual hematoma?
- bleeding underneath the toenail
- causes pressure and pain
- common in distance running and squash (toe hits end of toe box)
- also can be acute (drop something or get stepped on)
125
what causes/contributes to overuse injuries in the lower extremity?
- multifactorial with many causes
- lower chain alignment (static and dynamic control at hip/knee)
- foot-interface with the ground (static - standing, or dynamic - walking/running)
126
how to treat an ingrown toenail
- soak in warm water
- push back the skin
- dry with cotton and trim
- 2x per day
- this relieves stress
127
describe the Hawkins-Kennedy Impingement Test
- supraspinatus pinched beneath coracoacromial arch
- elbow bent at 90 degrees, arm abducted and internally rotated to directly in front of the body, you push down the forearm from horizontal
128
how do you measure scoliosis?
- most tilted vertebrae above and below the apex of the curve
- angle between perpendicular = cobb angle
129
what are the characteristics of the rupture region?
- ~10% = grade 3
- if fully torn, low pain (because no tension)
130
What are the Ottawa ankle rules?
- obtain x-rays if pain at the malleolus or midfoot plus one of the following:
1. tenderness at posterior edge/tip of lateral malleolus
2. tenderness at posterior edge/tip of medial malleolus
3. tenderness at the base of the 5th metatarsal
4. tenderness at navicular bone
5. inability to take 4 steps --> immediately and in ED
131
what are the static stabilizers (capsule/ligaments) of the shoulder?
- thickenings (ligaments) around the shoulder within the capsule
- SGHL (superior glenohumeral ligament)
- MGHL (medial glenohumeral ligament)
- IGHL (inferior glenohumeral ligaments)
- these rotate with movement (abduction and external rotation, anterior IGHL "fans-out" and rotates anteriorly and superiorly to prevent subluxation)
132
what is the role of dynamic stabilizers?
- stiffness and protection at the joint
- contract to provide dynamic support to slow/stop movement
- controls supination and inversion
- anterior muscles may contract to slow plantar flexion to protect ligaments
- prevent eversion sprains
133
what is Morten's neuroma?
- not a true neuroma
- compressed neuropathy of the common plantar digital nerve of the 3rd webspace
- thickest nerve (branches from medial and lateral plantar nerves)
134
what are the characteristics of an intramuscular injury?
- compartment syndrome
- no fascia injury
- chemical irritation
- decreased oxygen, blood, and nutrients
- longer healing time
135
what are the characteristics of a calcaneofibular ligament sprain?
- 3.5x stronger than ATFL
- inversion in dorsiflexion MOI
136
How common are ankle sprains?
- most common injury in sports
- 37/1000 per year in the general population
- 23% of sports injuries
- 85% lateral, 10% syndesmosis (high) and 5% medial
137
what are the symptoms of a deltoid ligament sprain?
- eversion MOI
- pain on medial side of ankle
- instability (if high grade)
138
how do you test for fractures?
- test with indirect pressure above/below the injury
- positive if pain
139
what are the signs of a CFL sprain?
- pain with active and passive inversion in neutral
- pain, laxity and endpoint (talar tilt test)
- possible pain with resisted eversion
- pain on palpation of CFL
140
what are the course of action for tibia and fibular fractures?
- stabilize joint
- monitor for shock
- transport to the hospital (ambulance if tib-fib and foot. is sideways/backwards)
141
characteristics of rotator cuff strains/tears in older athletes (+35)
- shoulder pain during activity above the shoulder
- slower onset (not traumatic)
- inability to sleep on the shoulder or with arm above head
- usually weak rotator cuff
- +ve impingement signs
- tendinosis
142
Morten's neuroma - symptoms
- pain/burning in 3rd webspace of forefoot
- worse from forefoot weight bearing (dancers/high heels)
- describe as walking on a stone/pebble
- worse with narrow-fitting footwear
143
what are the two types of dislocated shoulder causes?
- traumatic and atraumatic
144
what do you test in the neuro/reflex and sensation step?
- reflexes
- sensations
- key muscles (myotomes, dermatomes and reflexes)
145
what should you assess when dealing with trunk/lower limb issues?
1. posture
2. alignment
3. functional movements
4. question them regarding extrinsic factors
146
what are the 3 movements of pronation?
1. eversion (transverse)
2. dorsiflexion (sagittal)
3. abduction (frontal)
147
what are the 7 objective steps of selective tissue tension testing?
1. observation
2. AROM
3. PROM
4. resisted movements
5. neuro/reflex and sensation
6. special tests
7. palpation
148
characteristics of an ATFL sprain
- most common sprain
- inversion in plantar flexion MOI
149
what are the characteristics of the remodelling/maturation phase?
- week 3 for scar tissue
- week 6 to years
- breakdown of type 3 collagen and replace with type 1
- increase of AROM to promote realignment
- look for pain and swelling (okay during, but don't want after)
150
characteristics of structural scoliosis
- actual change in shape and structure of bone
- can't go back --> preventative measures (so it doesn't get worse)
- bony deformity
- hump present (adam's forward bend test)
- progressive (may be)
- vertebral bodies rotate to the convexity of curve
- may be causes by genetics, congenital issues, and idiopathic
151
what are the characteristics of normal end feel?
- soft tissue = spongy and painless
- bones = abrupt and painless
- capsular = abrupt (with give) and leathery
152
ankle sprain prognostic indicators
- older, poor weight-bearing status, higher injury grade = poorer outcomes
- no full ROM within 2 weeks = potential accompanying injury
- medial pain on palpation = bone bruise
153
neurological testing L4
- reflex: N/A
- myotome/dermatome = ankle dorsiflexion
154
what is the sub-cycle of atrophy?
- pain --> spasm --> ischemia (and repeat)
155
how to avoid ingrown toenail injuries
- proper trimming (not rounded, short, or v-shaped)
- cut once a week, leave long enough to clear skin but not long enough to hit sock
156
what are the characteristics of an intermuscular injury?
- fascia is injured
- no chemical irritation
- no increase in pressure (no compartment syndrome)
- heals quickly
- increase in blood flow
157
turf toe - treatment (remodelling phase)
- functional training for return to play
- idealize strength through range
- add power and agility
- decide on return to play taping, showed, insoles (rigid), etc.
158
what causes posterior dislocations at the SC joint?
- direct force to the anteromedial clavicle
- force applied to the posterolateral shoulder (causing shoulder to roll forward)
159
mortens neuroma signs
- squeeze test (sides)
- web space tenderness
- plantar percussion (tinel's tap test)
- toe-tip numbness
160
what are extra-capsular ligament injuries?
- occur outside the joint capsule
- floating
- low blood supply
- require surgery if fully torn
161
turf toe - treatment (repair phase)
- protect tissue and idealize healing
- increase blood flow (heat)
- idealize ROM
- progress weight-bearing
- begin gentle strengthening
162
what are the characteristics of a 2 on the oxford scale?
- poor
- full ROM when gravity is eliminated (change the plane of movement)
163
plantar fasciitis assessment findings
- shape of foot (arch)
- over-pronators (turn in too far, can't maintain arch, slow resupination, twist during repulsion)
- supinators (decreased shock absorption, lack of pronation, fascia absorbs shock)
164
what do you test in the AROM step?
- both contractile and inert tissue
- stretching and contracting
165
what is the anterior drawer test?
- determines damage to ATFL
- tested in slight plantar flexion
- positive test = foot slides forward or makes noise at end point
- ligament test so look for pain, laxity and endpoint
166
management of shoulder dislocations
- inflammatory (traumatic only) = police/peace and love, sling, gentle ROM, isometric strength
- repair (traumatic and atraumatic) = gain ROM, functional strengthening and range, proprioception exercise
- remodelling (traumatic and atraumatic) = idealize strength through ROM (position sense), add power, bracing and taping for proprioception
167
how are muscle injuries classified (pain)?
- oxford scale
168
what is secondary damage?
- damage that occurs as a result of injury
- caused by edema, decreased blood flow or decreased oxygen
- can be avoided
169
neurological testing S2
- reflex: N/A
- myotome/dermatome: knee flexion
170
neurological testing C7
- reflex: triceps
- myotome/dermatome: elbow extension/ wrist flexion
171
what are the classical postural deviation in the sagittal plane with forward head posture?
- ears in front of plumb line
- chin poke forward
- extended upper c-spine
- flexed lower c-spine
- protracted scapulae
- rounded shoulders and usually kyphosis
- suboccipital, levator scapulae and trapezius muscle tightness
- elongated/weak anterior neck flexors
172
what are the signs of an ATFL sprain?
- pain with inversion in plantar flexion (active and passive)
- pain, laxity and endpoint (anterior drawer test)
- possible pain with resisted eversion
- pain on palpation over ATFL
173
what are the bones of the ankle?
1. talocrural joint (ankle joint)
2.talus
3. fibula
174
what are the characteristics of the talocrural joint?
- made up of the tibia, lateral and medial malleolus
- u-shaped ankle mortice
- lateral (fibula) is longer and posterior to the medial malleolus
175
what are the characteristics of the talus?
- no muscle attached
- articular surface convex at top and concave on sides
- trochlear surface (top) is wider (between malleoli) --> for a tighter bony fit in dorsiflexion than plantar flexion (more stable)
176
what are the characteristics of the fibula?
- with dorsiflexion, externally rotates and moves superiorly
- external rotation increases tension (opposite in dorsiflexion)
177
neurological testing L5
- reflex: N/A
- myotome/dermatome: 1st toe extension
178
turf toe - symptoms
- MOI includes hyper-dorsiflexion of the great toe
- pain and swelling at first MTP joint
- worse with movement and weight-bearing
- weak "push-off"
179
supination of the gait cycle
- made up of 3 movements
- mid-tarsal joints are locked
- foot is more stable for toe-off
- allows greater force
- achieved with aid of the cuboid pulley (rigid lever)
- tibia is externally rotated
180
what is the most common MOI of a high ankle sprain?
- external rotation of foot with internal rotation of leg
- 55% due to foot planted and dorsiflexion with external rotation
- can be eversion or hyperdorsiflexion
181
neurological testing L3
- reflex: knee jerk
- myotome/dermatome: knee extension
182
how to test for a high ankle sprain?
- squeeze test
- mimic MOI
- tenderness over AITFL
- stabilization test
- tenderness along interosseus membrane
183
what is the squeeze test?
- compresses tibia and fibula
- positive if pain, pain will only be positive if severely compromised
184
how do you mimic the MOI of a high ankle sprain?
- externally rotate and dorsiflex the ankle
- check for fracture first
- lowest false positive rate (dave's fav)
185
what is the stabilization test for high ankle sprains?
- tape just above the ankle joint to stabilize distal syndesmosis
- this keeps the bones together
- test patients' ability to stand, walk, jump, etc.
- if the tape helps, it is a positive test
186
what are "symptoms"?
- physical manifestations only the patient is aware of (what they tell you)
187
what is SOAP?
- subjective
- objective
- assessment/analysis
- plan/program
188
what is a grade I AC injury?
- small tear of the capsule of the AC joint
- no instability
- no laxity
- pain on palpation
- full AROM with pain and end
189
what are the characteristics of a 4 on the oxford scale?
- good
- near full strenth
- full ROM
190
what is the longitudinal arch of the foot
- medial attached to spring ligament (medial calcaneonavicular ligament) for support
- reinforced by tibialis posterior
- also lateral longitudinal arch - lower and less flexible
191
what are the 3 sections of the stress-strain curve (for ligaments and tendons)
1. toe region
2. linear region
3. failure/rupture region
192
explain the anatomy of the plantar fascia
- located at the medial longitudinal arch
- composed of 3 segments (central, medial and lateral)
- originates from the medial tubercle on the plantar surface of the calcaneus
- travels toward the base of the toes (solid band of tissue)
- structure supports the foot against downward forces
193
management of a grade II/III AC injury during the repair phase
- gentle AROM or AAROM
- progress to full ROM
- shoulder isometrics, progression to concentric
- scapular stabilizer strengthening (not injured so can be worked)
194
what is primary damage?
- damage that occurs at the time of injury (sudden and irreversible)
195
what causes distension injuries?
- forcible stretching (passive or active)
- passive stretch + active contraction = muscle strain
196
what structures are anterior evertors of the foot?
- fibularis tertius
- extensor digitorum longus
- extensor hallicus longus
197
what causes/triggers tendon injuries?
- rub over bone (internal)
-"too much too soon" (external)
198
impingement causing RC tendinitis/tendinopathy: Symptoms
- diffuse pain around the acromion and over the deltoid (referral pain travels down)
- overhead activities increase pain
- feels ok below shoulder height
- difficulty sleeping on shoulder
199
what is a grade II AC injury?
- complete tear of the AC joint capsule/ligaments and a small tear of the coracoclavicular ligaments
- slight AP spring (no stability, use paxinos test)
- 45-90 degrees of AROM abduction
200
what are subjective notes for?
- developing an assessment strategy
- gathering basic information
- learning history (past injuries)
- includes the patient's symptoms
- interview them to evaluate the injury
201
what structures are posterior evertors of the foot ?
- fibularis longus
- fibularis brevis
202
what are the characteristics of the toe region?
- 0-2% of the length and 2-4$ (early linear region)
- when stretched will return to normal (flattens crimp)
203
what are the classical postural deviations in the sagittal plane with kyphosis?
- excessive thoracic curve (tight pec major and minor, weak rhomboid, trapezoids and erector spinae)
- protracted scapulae
- usually associated with forward head posture (increased c-spine extension --> keeps eyes level)
204
what structures contribute to shoulder support?
- static = labrum, capsule, glenohumeral ligaments
- dynamic = rotator cuff, scapular stabilizers
205
what are the principles of wound healing? (order of actions)
1. injury
2. chemical mediators
3. vascular reactions
4. margination
5. diapedesis
6. phagocytosis
7. clot formation
206
what does the clavicle do during sternoclavicular joint movement?
- as the arm moves through flexion/abduction
- the clavicle retracts
- elevates and rotates posteriorly
207
what do you test in the PROM step?
- end of ROM/end feel
- stretching only
208
what is the purpose of the costoclavicular ligament?
- prevent the clavicle from dropping down
209
what are the characteristics of the inflammatory/destruction phase?
- within the first 3-4 days
- cellular injury
- inflammatory response
- primary or secondary damage can occur
210
what type of tissue will have tension when either contracted or stretched?
- contractile (muscles, tendons)
211
what are the characteristics of inflammation?
- red
- hot
- swollen
- painful
- (decrease in function)
212
what are the characteristics of the sternoclavicular joint?
- the one bony attachment
- clavicle articulates with the manubrium
- only 25% of the clavicle surface area is in contact
- least bony stability
- joint integrity comes from the two ligaments
- the disc between the two surfaces is for shock absorption
- it is the only direct connection between the arm and trunk
213
what are the return to play time estimates? (for grades 1,2,3,4-6)
1 = 7-10 days
2 = 2-3 weeks
3 = 4-12 weeks
4 = surgical (depends)
214
what basic information do you need to get from a subjective assessment?
1. primary complaint
2. MOI and symptoms
3. immediate and delayed issues
4. medical history (MSK injuries, allergies, medical conditions, red flags)
215
how can you prevent a subungual hematoma?
- pad forefoot (to hold the foot back in the shoe)
216
what are the signs of a deltoid ligament sprain?
- pain with eversion (active and passive)
- pain, laxity, endpoint (talar tilt test)
- possible pain with resisted inversion
- increased pronation (possibly)
- pain on palpation over deltoid ligament
217
what is the criteria for return to play following shoulder girdle injuries?
- medical clearance
- full ROM
- strength within 90% of the unaffected side
- full function (sport specific mechanisms)
- able to protect themselves (from falls/hits)
- protect the joint (donut sponge to disperse, etc.)
218
what is the treatment for a high ankle sprain in the acute phase?
- (hot, swollen, painful, red)
- restrict ROM, ice, compression, elevation
- plantar flexion
- crutches
219
what is the treatment for a high ankle sprain in the sub-acute (repair) phase?
- (pain and swelling subside, tissue healing)
- heat
- ROM exercise (careful in dorsiflexion)
- increase weight bearing
- dynamic stabilizer strengthening
- balance and proprioception
220
what is the treatment for a high ankle sprain in the remodelling phase?
- strength through range
- balance and coordination
- perception and action (using aids)
- taping and bracing for return to play
221
what is normal knee flexion-extension?
- takes place between the bottom of the femur and the top of the menisci
222
what is the talar tilt test (for CFL)?
- determines the extent of the calcaneofibular ligament (inversion) or deltoid ligament (eversion) injury
- 90 degrees, invert to test calcaneus, evert to test deltoid
- pain and excessive motion indicate injury
223
what are examples of symptoms?
- swelling
- pain (and how it is described)
224
management of a grade II/II AC injury during the remodelling stage
- full strength at shoulder
- good scapulothoracic mechanics
- full function as per return to play criteria
225
what are the two abnormal foot types?
- pes cavus and pes planus
226
what may get injured during ankle eversion?
- fracture of the fibula
- deltoid ligament sprain (50%)
- anterior tib fib ligament sprain (58%)
- medial malleolus fracture (37%)
- posterior tibia fracture (80%)
(in order, for example, 58% of those with a deltoid sprain also sprain ant tib fib)
- deltoid is most likely to go, a fracture is least likely
227
what is the anatomy of a high ankle sprain?
- articulation between the tibia and the fibula
- in the neutral position AITFL and interosseus membrane are oblique, become neutral/horizontal with dorsiflexion
- fibula externally rotates and moves superiorly, which increases tension
- talus is wider anteriorly and is jammed during dorsiflexion --> if forced past range of dorsiflexion, stress and injury will occur to the structures holding the tibia and fibula together
228
turf toe - treatment (inflammation phase)
- police/peace and love
- crutches/tape for protection
- optimize healing, palliate pain and decrease swelling
229
what is a traumatic shoulder dislocation?
- TORN LOOSE (tubs)
traumatic
unilateral lesion with
bankart and requiring
surgery
- single force applies excessive overload to the passive restraints
- often damages the glenoid (bankart) ad humerus (hills-Sachs)
230
what do you test in the resisted movement step?
- isometric/middle of ROM
- contractile only
231
what are the classical postural deviations in the sagittal plane with lordosis?
- increase lumbar spine curve
- increase in the anterior pelvic tilt (tight hip flexors and lumbar paraspinal muscles, elongated abdominal musculature and hamstrings (weak))
- we need a little lordosis and kyphosis to act as a spring
232
neurological testing l1
- reflex: N/A
- myotome/dermatome = spread fingers
233
what are the characteristics of a 1 on the oxford scale?
- trace
- able to palpate muscle contraction (but the muscle doesn't shorten)
234
what are the characteristics of a 3 on the oxford scale?
- fair
- the full range of motion without resistance
- moves against gravity only
235
what are the symptoms of an ATFL sprain?
- inversion MOI
- pain on lateral ankle, anterior to the malleolus
- instability (if high grade)
236
where do strains occur in the shoulder complex?
- rotator cuff and scapular stabilizers
237
How do you manage a posterior sternoclavicular injury?
- send to the ER immediately
- potentially life-threatening due to vein, artery, trachea, and esophagus
238
where does tendonitis/osis occur in the shoulder complex?
- rotator cuff (common in overhead athletes)
239
What is a grade III AC injury?
- complete tear of the AC ligament
- complete tear of the coracoclavicular ligament
- clavicle will pop up/shoulder will fall down (deformity)
- 45 degrees or less of AROM abduction
240
What is a grade V AC injury?
- complete tear of all ligaments and stabilizers
- trapezial and deltoid fascia stripped off
- more sticking up than 3, may damage muscles
241
what are injuries to the muscle called?
- strains
242
what is the purpose of the interclavicular ligament?
- prevent the clavicle from popping up
243
what is a grade VI AC injury?
- downward displacement of clavicle (c5-6/brachial plexus)
244
what is the purpose of the sternoclavicular ligament?
- prevent the clavicle from popping up forward
245
what is pes cavus?
- high arch
- excessive (stiff/high) medial longitudinal arch
- associated with supination
246
what is paratenonitis?
- paratenon inflammation (vascularized tendons)
247
what is the treatment for RC tears?
- palliate pain (police if acute)
- idealize/maintain ROM
- strengthen scapular stabilizers
- strengthen RC
- reinforce proper movement patterns (job/sport specific)
248
characteristics of inferior dislocations
- 1% of dislocations
- MOI = excessive abduction and force is taken pushing the head of the humerus inferiorly out of the glenoid
- similar S/S to anterior dislocation
249
what are heel spurs?
- ossification on base of calcaneus
- present in 80% of PF patients
- due to repetitive micro-trauma
- spur length correlated to age, BMI, pain and symptoms
250
what are the classical postural deviations in the sagittal plane with flatback?
- increased postural pelvic tilt
- decreased lumbar lordosis (tight hip extensors, weak (long) hip flexors, poor postural sense, stooped forward appearance)
- lose balance
251
what are the signs and symptoms of a clavicle fracture?
- middle 1/3 with outer fragment dropping down (can be distal tip)
- lots of pain
- localized tenderness and swelling
- loss of function
- spasm of trapezius and SCM (sternocleidomastoid)
- arm held to body with shoulder elevated (reduces pull through joint)
- scapula stays protracted
- may heal with a slight overlap in the ebone (so a slight bump)
252
what is the hallmark sign of scoliosis
- hump on one side (one side higher than the other when leaned over)
253
how to name the curve of scoliosis
- designated according to the level of apex
- right thoracic curve = convex to the right in the thoracic spine
- named to the side of convexity/the direction of apex
- 90% are right so left thoracic should be a red flag
- causes = Chiari malformations (inferior pull on spinal cord, spinal cord tumors, neuromuscular disorders)
254
what are assessment/analysis notes for?
- findings to help form a clinical opinion/diagnosis
- should know whether it is contractile or inert or both
- should have a good idea of what the injury is and the degree
255
what is medial collapse mechanism?
- hip adduction, femoral internal rotation and knee valgus
- glute medius pulls the leg out and stops pelvis from dropping in (adduction)
- poo multi-plane lumbo-pelvis/pelvo femoral control
- changes in femur under patella (decreased joint contact, increased joint stress)
- patella tries to turn inwards
256
what happens to the foot during pronation?
- tibia rotates internally with the talus and calcaneus and acts to convert the torque
- unlocks the foot to distribute force
257
what movements can be assessed best on the transverse plane?
- internal and external rotation
- pronation/supination
- at shoulders, hips and feet
258
what is pronation in the gait cycle?
- the impact absorption phase of gait (good if at a good rate)
- too much is bad, too little (supination) is also bad
- occurs as the foot is loaded to allow for shock absorption, ground terrain changes and equilibrium
259
what is the treatment for an ankle sprain in the inflammation phase?
- (only if acute, hot, painful and swollen)
- crutches
- maintain ROM of uninjured tissue
- ice
- compress
- elevate
260
what is the treatment for an ankle sprain in the repair phase?
- (sub-acute, pain and swelling gone, tissue healing)
- heat
- ROM by 2 weeks
- the strength of uninjured tissue
- strengthening once ROM is achieved
- increase weight bearing
- proprioception exercise
261
what is the treatment for an ankle sprain in the remodelling phase?
- the strength of stabilizers
- balance and coordination
- taping/bracing for proprioception
262
what are the rotator cuff muscles jobs?
- to compress and centralize the humeral head (stabilization)
263
how do you treat plantar fasciitis for initial pain control?
- tape (overpronators) < 10 days
- orthotics < 1 year
- night splints > 6 months (no morning tearing)
264
what does a grade III sternoclavicular injury look like?
- complete displacement of clavicle (no end point)
- pain (popped) and laxity
265
during shoulder abduction, what is the "force couple"?
- force couple = scapulothoracic joint
- 0-90 degrees = upper fibres of trap and serratus anterior drive motion
- >90 degrees = lower fibres of trap and serratus anterior drive motion
266
characteristics of subluxing shoulders?
- chronic instability
- multiple joint laxities in multiple directions
- can be acquired (from repetitive trauma/motion and poor stretching through a joint)
- "dead arm" with humeral subluxation = traction/impingement of neurovascular structures causing transient weakness/numbness
267
what is a closed fracture?
- a "simple" fracture
268
what is the treatment for a subungual hematoma?
- evacuate blood to decrease pressure
- with a sterile heated paperclip
- press into nail (blood will release)
- manual pressure on nail to evacuate blood
- band-aid (to prevent infection)
- few days later, repeat (no heat)
- new nail will grow underneath and push old nail off
269
what are the characteristics of a 5 on the oxford scale?
- normal
- full ROM
- full strength
- light or no injury
270
what is the q-angle?
- the axis formed by the femur and the tibia
- greater q angle = greater lateral pull on the patella
- q angle > 20 degrees = risk of instability at PF joint
- can be a factor in pf pain syndrome, OA and ITB friction syndrome
- can be structural (but not always)
271
what are the 3 phases of tissue healing?
- inflammatory/destruction
- repair (fibroblastic)
- remodeling/maturation
272
what are the facts of plantar fasciitis?
- most common condition in the foot
- caused by overuse or excessive loading
- may be caused by active people with changes to FITT
- may be linked to BMI/BM in less active people
273
what are the characteristics of a grade I strain?
- 10-20% torn
- near full ROM
- some pain
- 4-5/5 on the oxford scale
274
what are the characteristics of the clavicle?
- an "s" shaped bone
- protects the neurovascular bundle (brachial plexus)
- a muscle attachment site and bony attachment site for the shoulder
275
what are intra-articular ligament injuries?
- occur inside the joint/joint capsule
- require surgery if ruptured/fully torn
- have low blood supply (can't heal)
276
traumatic/acute criteria
- sudden and irreversible
277
what is considered a "dangerous" sternoclavicular injury?
- posterior movement of the clavicle
- less common but dangerous because of structures like the trachea, esophagus, artery and vein
- this is a medical emergency
278
what is the function of the deltoid ligament?
- limits talar/subtalar abduction and lateral tilt (eversion)
- broad
- up to 6 bands
- anterior part is tight in plantar flexion
- middle part is neutral
- posterior part is tight in dorsiflexion
279
what causes AC joint separations?
- direct = hit point of shoulder with arm adducted (like body check)
- indirect = FOOSH
- graded 1-6 (1-3 are most common, 4-6 are surgical)
280
what are the classical postural deviations in the sagittal plane with swayback?
- anterior shift of the entire pelvis (relative hip extension)
- thoracic segment shift posteriorly to balance (thorax flexion/kyphosis with a sharp curve at lumbar-sacral junction)
- tight hip extensors and lower lumbar extensors
- weak hip flexors and abdominals
281
what happens at the tissue level when injury occurs?
- exceed tissue threshold/increased tissue loads
282
t are the 3 movements of supination?
- inversion (transverse)
- adduction (sagittal)
- plantar flexion (frontal)
283
what is a grade IV AC injury?
- complete tear of all ligaments and stabilizers
- posterior clavicle with teented trapezius
- surgical with screw
284
what is a grade IV AC injury?
- complete tear of all ligaments and stabilizers
- posterior clavicle with teented trapezius
- surgical with screwwhat are the basic postural observations in the coronal plane (posterior view)
285
what is a grade IV AC injury?
- complete tear of all ligaments and stabilizers
- posterior clavicle with tented trapezius
- surgical with screw
286
what are the basic postural observations in the coronal plane (posterior view)?
- ears level
- shoulders equal
- scapulae equal
- arms equal distance from the body
- hips equal (gluteal fold)
- knee creases equal
- malleoli equal
287
what structures provide stability in the acromioclavicular joint?
1. coracoclavicular ligaments (conoid and trapezoid) --> coracoid process to the clavicle
2. acromioclavicular ligaments --> acromium to clavicle, AP stability
3. capsule (skin layer)
288
where do traumatic injuries usually occur?
- high speed sports
289
what are the 3 types of ligament injuries?
- intra-articular
- capsular
- extracapsular
290
management of a grade II/III AC injury during the inflammation/destruction phase
- peace and low /police
- stabilize with tape
291
what does a grade I sternoclavicular injury look like?
- slight pain and tenderness
- no deformity
292
what is the screw home mechanism?
- rotation occurs during the last few degrees of extension because the medial femoral condyle is larger than the lateral
- foot is planted (femur rotates medially)
- femur is fixed (tibia rotates laterally)
- locks the joint to increase stability at knee and regulate patella alignment
- popliteus then must contract to externally rotate the femur on the tibia to unlock the knee
293
what is the shoulder girdle?
- connects the upper limb to the axial skeleton (aka the scapula and clavicle)
294
what injury results in a flat-looking shoulder?
- subcoracoid dislocation
