Musculoskeletal Review
nutation
flexion of the sacrum and posterior rotation of ilium
capsular pattern of iliofemoral joint
flexion, abduction, internal rotation (sometimes internal rotation is most limited)
which hip ROM are decreased with avascular necrosis of the hip?
flexion, internal rotation, abduction (capsular pattern)
excessive knee flexion with swing
flexor withdrawal reflex lower extremity flexor synergy
humeroulnar closed packed position
full extension and supination
radiohumeral jt open packed position
full extension and supination
transverse humeral ligament
helps maintain the tendon of the long head of the biceps w/in bicipital groove
what is the primary glide to gap the TMJ?
inferior, it stretches the capsule and allows relocation of the anterior displaced disc
L3 myotome
knee extension
pulp to pulp pinch
pad of thumb to pad of one or more fingers
Six P's of compartment syndrome
pain palpable tenderness paresthesias paresis pallor pulselessness
which shoulder special test is the MOST useful to diagnose a bicipital tendonosis/tendonopathy? a. bicep load II b. speed's c. yergason d. compression-rotation
pt 89 speeds compression-rotation=crank test
elbow extension test
test to rule out fracture or joint injury, positive if patient is unable to fully extend the elbow
innervation of the hip joint comes from what four nerves
1. femoral 2. obturator 3. sciatic 4. superior gluteal nerves
ABI 0.4-0.79
Moderate blockage; may be associated with intermittent claudication during exercise
Which modality is best for pain relief when treating a patient with CPRS? 1. effleurage 2. parafin 3. TENS 4. STM
TENS - CRPS is a sympathetic nervous system dysfunction, therefore TENS is the best for pain relief
mill's test
The patient is instructed to extend the forearm, make a fist, and flex the wrist, and then maximally pronate the forearm. This test can be passively performed by the doctor. Positive sign is pain in lateral elbow indicating lateral epicondylitis
thoracic outlet syndrome
compression of neurovascular bundle -common areas of compression: superior thoracic outlet, scalene triangle, between pec minor and thoracic wall, between clavicle and first rib -Clinical Examination/Special Tests: Roos, Adsons, Wrights, Costoclavicular -Diagnostic Tests: plain film imaging=bone, MRI=soft tissue, electrodiagnostic test=nerve PT goals/intervention: -dependent on cause -manipulation of first rib -postural reeducation -exercise and manual therapy to address joint mobility restrictions -functional/resistive training
why are anterior bulge/herniations rare?
due to the structural integrity of the anterior intervertebral disc
acute respiratory distress syndrome (ARDS)
fluid leaking from the smallest blood vessels in the lungs leading to fluid accumulation in the alveoli, severe shortness of breath develops w/in a few hours to days. ARDS is fatal in 25-40% of people who develop it. may not regain full lung function for a year.
sternoclavicular joint Arthrokinematics: protraction
(Concave on convex) anterior roll, anterior glide
sternoclavicular joint Arthrokinematics: retraction
(Concave on convex) posterior roll, posterior glide
sternoclavicular joint Arthrokinematics: elevation
(Convex on concave) superior roll, inferior glide
labral tears (categories, s/s, PT goals/intervention)
- 2 categories: either toward the top of the glenoid socket or toward the bottom of the glenoid socket --SLAP: above the middle of the socket w/ possible bicep tendon involvement --Bankhart: below the middle of the socket w/ inferior glenoid humeral ligament involvement -signs/symptoms: pain in front of the shoulder but unable to pinpoint location, pain with overhead activities and reaching behind, weakness and instability, pain with resisted biceps flexion -Diagnostic testing: AROM/PROM, resistive testing, palpation MRI but arthroscopic sx of the shoulder is the gold standard PT goals/intervention: -functional/resistive training -exercise and manual therapy for joint mobility restrictions -no apprehension position for 12 wks s/p glenoid labrum repair -address underlying causes (like shoulder instability) -sling for 3-4 wks -after 6 wks, mm specific training can occur, but it can take 3-4 months to return to full fitness
Arthrogryposis Multiplex Congenita
- It is a congenital deformity of skeleton and soft tissues which is characterized by limitation in joint motion and a "sausage-like" appearance of limbs - Intelligence develops normally - ongoing communication with family and school is important in therapeutic management
biceps load II test
- SLAP lesion - pt is supine, shoulder abduct 120 , elbow flex 90, full SUPINATION - move shoulder into full external rotation - pt is asked to resist elbow flexion (+) pain
hip ROM and pain deficits seen in hip osteoarthritis
- hip internal rotation less than 24 degrees or internal rotation/flexion 15 degrees less than nonpainful side -passive internal rotation increases pain -moderate anterior or lateral hip pain when WB
symptoms observed with vascular claudication
- pain consistent w/ all spinal positions - pain brought by physical exertion - pain is relieved promptly by rest (1-5 minutes) - pain is described as numbness - patient usually has decreased or absent pulses
alar ligament test
- patient is seated (or supine) PASSIVELY (or paraspinals contract) flex the upper cervical spine and palpate C2 SP. - perform sidebeinding/rotation -(+) inability to palpate C2 movement
gillet's test
-Assessing posterior movement of the ilium relative to sacrum Patient is standing. Place your thumb of your hand under PSIS of limb to be tested and place your other thumb on center of sacrum at same level as thumb under PSIS. Ask patient to FLEX hip and knee of limb being tested as if bringing their knee to chest. Assess movement of PSIS via comparison of positions of your thumbs. Make sure your eyes are level with your thumbs. PSIS should move in an INFERIOR direction (+) TEST: no identified movement of PSIS as compared to sacrum
osteomalacia
-BONE DECALCIFICATION due to VITAMIN D DEFICIENCY (malacia means softening) -symptoms: frx, severe pain, weakness, deformities -meds: vitamin D, vitamin D2 injection, calcium PT GOALS: jt/bone protection, maintain/improve jt mobility and CT function, aerobic/endurance conditioning
compression-rotation test
-SLAP lesion -also the crank test -patient is supine, shoulder passively abducted to 20-90 degrees -compression applied to humerus (at the elbow) while passively IR/ER the GHJ to attempt to pinch the torn labrum (+) clicking or catching or pain
vertebral artery test
-assess the integrity of the vertebrobasilar vascular system -patient is supine with head supported over end of table, EYES OPEN -passively extend head and neck and hold for 30 seconds. If no symptoms progress to passively rotation and side-bending with extension in both directions. Hold each position for 30 seconds. -causes reduction of the lumen of the vertebral artery, resulting in decreased blood flow in the intracranial vertebral artery on the contralateral side -s/s: drop attacks, dizziness, dysphasia, dysarthria, diplopia, ataxia gait, numbness, nausea or nystagmus
in what patient scenario would a cemented total joint arthroplasty would be better for the individual
-fragile bones -benefit from immediate ability to bear weight (dementia, significant debilitation)
Ortolani test
-hip abduction w/a resulting clunk as the head relocates into the joint
maximum cervical compression test
-identifies compression of neural structures at intervertebral foramen and/or facet dysfunction -patient sitting. passively move head into side-bending and rotation toward nonpainful side, followed by extension. repeat this toward painful side -be careful since this is very similar to vertebral artery test -positive finding is pain and/or paresthesia in dermatomal pattern for involved nerve root or localized pain in the neck if face dysfunction
shoulder abduction test
-indicates compression of neural structures w/in intervetebral foramen - patient is sitting and asked to place hands on top of head, no side bending - positive finding is a decrease in symptoms into upper limb
bursitis
-inflammation of bursa secondary to overuse, trauma, gout, or infection -signs/symptoms: pain at rest, PROM + AROM are limited due to pain NOT CAPSULAR PATTERN, PT GOALS: flexibility exercise for maintain/improve normal jt motion and mm length, manual therapy, aerobic capacity/endurance training , thermal agents for pain reduction, edema reduction, and mm performance, edu and training/retraining for IADLS
five aberrant movements test
-instability catch, painful arc in flexion, painful arc return in flexion, gower's sign (thigh climbing), reversal of lumbopelvic rhythm -CAN be a sign of lumbar instability CAUTION: Can also be a sign of acute injury, muscle strain, facet joint capsule entrapment, prolonged weakness
external rotation lag sign
-patient is seated or standing; passively abduct shoulder to 90 degrees and externally rotate shoulder to end-range (at the wrist) -ask patient to hold the position positive if unable to maintain externally rotated position
pubofemoral ligament
-taut w/ extension, ER, abduction -runs from illiopectineal eminence, superior rami of pubis, obturator crest, and obturator membrane, laterally blending with capsule,
x-rays
-used to demonstrate bony tissues; shows bony anatomy well; inexpensive -negative: exposure to radiation -used for viewing dysfunction and or disease of bones -not good for demonstrating soft tissues
what are the 3 common etiologies of a stress fracture?
1. abnormal biomechanics 2. poor conditioning 3. improper training methods
where are central posterior herniations most commonly seen? 1. cervical spine 2. thoracic spine 3. lumbar spinal 4. sacrum
1. cervical spine
At what degree should the cervical spine be positioned to provided optimal intervertebral foramina opening when treating a patient diagnosed with spinal stenosis?
15 degrees
At what age do the knees maximally drift into valgus? And when does the genu valgum correct itself to adult alignment?
3-4 years adult alignment by 7 years (3+4=7)
normal gait on level ground requires at least the following hip jt ranges of motion
30 degrees of hip flexion, 10 extension, 5 abduction/adduction, and 5 internal/external rotation
the diagnosis of the femoroacetabular impingement syndrome can be suspected with the following findings EXCEPT: 1. hip internal rotation less than 20 deg with hip at 90 deg of flexion 2. mechanical symptoms like popping, snapping 3. imaging findings of CAM or pincer impingement 4. anterior groin or hip pain produced by the scour test
4 is incorrect anterior groin or hip pain produced by the FADIR/FABER TEST
after post harrington rod sx, when should ambulation begin?
4-7 days post op
distal radioulnar closed packed
5 degrees of supination
What age range is maximal varum present? When do the lower limbs gradually straighten to zero tibialfemoral angle?
6-12 months of age straighten=18-24 months' (goes by 3)
When should full weight bearing be reached following articular cartilage surgery?
6-8 weeks
humeroulnar open packed position
70 degrees of flexion and 10 degrees of supination
what age range should splinting be considered when treating congenital muscular torticollis?
> 4 months
capillary refill time - normal return time vs compromised time
>2 seconds indicates capillary blood flow is compromised normal return of color is 2 seconds
cord segments and nerve(s) for dorisflexion
L4-L5; deep fibular nerve
cord segments and nerve(s) for plantar flexion
L5-S2, tibial nerve
foot eversion cord segments and nerve(s)
L5-S2; superficial fibuluar nerve
S1 reflex
PLANTAR FLEXION
AC resisted extension
Pt seated Shoulder 90o FLEX+IR Elbow 90o FLEX PT resists horizontal ABD
true/false reflexes are normal in the beginning of ankylosing spondylitis
TRUE
Which involves an avulsion of the extensor tendon at the DIP due to forced distal phalanx into flexed position? a. Mallet finger b. Jersey finger c. Swan neck d. Boutonniere
a. Mallet finger -a rupture/avulsion of extensor tendon at its insertion at the DIP which usually occurs from forced DIP flexion
newborn and infants typically have __________. a. genu varum b. genu valgum
a. genu varum
Which of these conditions may spinal manipulations be contraindicated? a. posterolateral bulge b. whiplashed associated disorder c. degenerative joint disease d. facet entrapment
a. posterolateral bulge
Which special test is used to confirm a spondylolisthesis? a. stork test b. standing flexion test c. Lhermitte d. Goldthwait
a. stork test pg 126
Wright's Test
aka Hyperabduction TESTING: TOS, Pinched between pectoralis minor and coracoid process POSITION: Palpate radial pulse, patient SUPINE and relaxed, abduct patients arm while palpating radial pulse (+) TEST: Pulse becomes thready or not as strong
apley's compression test
also known as apley's grind for the KNEE - pt is prone - flex the knee to 90 degrees and apply an axial load down through the tibia and compress the joint - Rotate into internal and external = We are trying to pinch the meniscus - (+) Pain or popping w/in the joint
how long are the immobilization period for colles' and smith fractures? a. 3-4 weeks b. 4-8 weeks c. 5-8 weeks d. 6-10 weeks
answer is c 5-8 weeks page 95
rotator interval
anterosuperior shoulder, borderd by coracohumeral ligament, superior glenohumeral ligament, jt capsule, and supraspinatus and subscapularis tendon
tests for glenohumeral joint anterior instability
apprehension test and relocation test Apprehension test: supine, shoulder abducted to 90, and passively taken to full ER; (+) pt looks or feels apprehensive/alarmed and resists further motion (apprehension > pain) relocation test: posterior glide on humeral head and (+) relief of symptoms
What shoulder motion should be avoided in early stages following subacromial decompression sx?
avoided shoulder elevation greater than 90 degrees
what age do children develop normal arches? a. 11 months b. 1-2 years c. 2-3 years d. 3-4 years
c. 2-3 years pg 126
while central spinal herniations have a similar presentation to posterolateral spinal herniations, what is the biggest difference in presentation?
central buldges/hernations exhibit central nervous system symptoms like hyperrreflexia and positive babinski reflex
when treating a 1 year old child with hip dysplasia , what procedure is most likely to take place in order to address the condition?
closed reduction under anesthesia followed by spica cast for 12 weeks (for children 6 months to 2 years=closed reduction under anesthesia)
dinner fork deformity (Immobilization time period and what can occur with it)
colles fracture, most common wrist fracture resulting from a FOOSH -immobilization for 5-8 wks and can occur with median nerve compression with excessive edema the dinner fork deformity of wrist and hand result from dorsal or posterior displacement of distal fragment of radius, with a radial shift of wrist and hand
hip circumduction during swing
compensation for hip flexors, weak dorsiflexors, weak hamstrings
hip hiking during swing
compensation for weak dorsiflexors compensation for weak knee flexors compensation for extensor synergy pattern
Pt c/o nagging, localiazed pain in anterior left lower leg that is consistently present at night and increases during activity and swelling. what are these complaints MOST characteristic of? 1. bone tumor 2. anterior compartment syndrome 3. shin splints 4. stress fracture
correct answer 4 s/s of stress fractures include pain and swelling, particularly with weight bearing on the injured bone. stress frx: present wtih tenderness or edema after recent increase in activity or repeated activity or limited rest.
Which of these conditions require an immediate referral to hand surgeon to avoid loss of finger function? a. Gamekeeper's b. Boxer's fracture c. Duputryen's Contracture d. Jersey Finger
d. Jersey Finger Jersey finger also flexor digitorum profundus tendon rupture/avulsion MOI: forced hyperextension of DIP with maximal finger flexion contraction, Ring finger accounts for 75% of cases Key exam finding of inability to produce isolated DIP flexion Immediate referral to hand surgeon to avoid loss of finger function
which symptom of spinal stenosis is incorrect? a. pain decreases with spinal flexion, and increases in extension b. pain increases with walking c. pain is relieved with prolonged rest d. unilateral pain and paresthesias in back, buttocks, thighs, calves, and feet
d. bilateral pain and parethesias in back, buttocks, thigh, calves, and feet
FEV1/FVC in obstructive diease
decreased
The following symptoms observed indicate what dysfunction? "no pain in reclined or semi-reclined position, pain increased with increasing weight-bearing activities, describes pain as shooting, burning, stabbing, altered strength and ability to perform ADLs" 1. degenerative joint disease 2. neoplastic disease 3. facet joint dysfunction 4. discal w/ nerve root compromise
discal w/ nerve root compromise
which direction causes the most pain with facet entrapment?
extension
closed packed of radiocarpal joint
extension with radial devation
closed packed position of glenohumeral joint
external rotation and abduction
The following symptoms observed indicate what dysfunction? "stiff upon rising, pain eases within the hour, loss of motion accompanied by pain, pain described as sharp with certain motions, movement in pain-free ranges usually reduces symptoms, stationary positions increase symptoms" 1. spinal stenosis 2. osteoarthritis 3. facet dysfunction 4. degenerative disc dieasee
facet dysfunction
true/false - spinal stenosis demonstrates a flexed posture of the entire spine
false - flexed posture of the lumbar spine a flexed posture of the entire spine is seen in ankylosing spondylitis
t/f internal (posterior) impingement is defined as an irritation between the rotator cuff and lesser tuberosity or posterior glenoid and labrum
false. internal (posterior) impingement is defined as an irritation between the rotator cuff and greater tuberosity or posterior glenoid and labrum
Lhermitte's sign
identifies dysfunction of spinal cord and/or an upper motor neuron lesion. Patient is long sitting on table. Passively flex patient's head and one hip while keeping knee in extension. Repeat this step with other hip (+) TEST: pain down the spine and into the UE or LE
ober's test
identifies tightness of tensor fascia latae and/or iliotibial band tightness
Passive Lumbar Extension Test
instability pt. lies prone PT lifts the legs while keeping knees extended (+) pain, heavy feeling, back is "coming off" has a 12.8 +LR
what are the contraindications to manual and/or mechanical traction
jt hypermobility pregnancy, rheumatoid arthritis down syndrome other systemic disease that affects ligamentous integrity
insufficient knee flexion with swing
knee effusion quadriceps extension spasticity plantar flexor spasticity insufficient knee flexion ROM
L4 Reflex
knee extension
exaggerated knee flexion at terminal stance
knee flexion contracture, hip flexion contracture
Halstead Maneuver
locate radial pulse, then apply downward traction on arm while pt. hyperextends neck and rotates to opposite side += diminished or absent pulse Indicates thoracic outlet pathology
loose packed/closed packed of acromioclavicular joint
loose: arm at neutral (resting by side) close: arm abducted to 90 degrees
loose packed/closed pack of sternoclavicular joint
loose: arm resting at neutral closed: maximal shoulder elevation
what are the long-term changes of complex regional pain syndrome?
muscle wasting trophic skin changes decreased bone density decreased proprioception loss of muscle strength from disues joint contractures
rate pressure product
myocardial O2 consumption and coronary blood flow, usually used w/ onset angina (Increased MVO2 = increased coronary blood flow)
open packed of radiocarpal joint
neutral with slight ulnar deviation
ABI 1.0-1.3
normal, no blockage
how old do children have to be in order to have an open reduction under anesthesia to address their hip dysplasia?
older than 2 years -open reduction under anesthesia followed by spica cast for 6-12weeks
what are the symptoms of AVN of the hip?
pain in groin and/or thigh and tenderness w/ palpation at the hip joint, coxalgic gait
which nerve is entrapped with tarsal tunnel syndrome? 1. superficial fibularis 2. anterior tibial 3. sciatic 4. posterior tibial
posterior tibial nerve tarsal tunnel syndrome -entrapment of the posterior tibial nerve or one of its branches w/in tarsal tunnel -over/excessive pronation, overuse problems result in tendonitis of the long flexor and posterior tibial tendon and trauma may compromise space in tarsal tunnel -s/s include pain, numbness, paresthesias along medial ankle to plantar surface of foot PT goals/interventions -orthoses to maintain neutral alignment of foot -abnormal neurotension=neurodynamics mobilizaitons
carpal compression test
pressure with examiner's thumb over patient's carpal tunnel for 30 seconds elicits symptoms
posterior sag sign
pt is positioned in supine with knee flexed to 90 degrees, hip flexed to 45 degrees. (+) tibia sagging back on femur and may be indicative posterior cruiciate ligament injury, could be false negative if both posterior cruciate ligaments are torn (perform the quad active test prior to posterior sag test)
ludington's test
pt is sitting and is asked to clasp both hands behind the head with fingers interlocked pt alternately contracts and relax the bicep muscles (+) test = absence of mvmt in the biceps tendon and may be indicative of a rupture of the long head of the biceps
Patellar apprehension test
pt is supine with knees extended. the PT places both thumbs on the medial border of the patellas and applies a lateral directed force. (+) look for apprehension or attempt to contract quadriceps, in effort to avoid subluxation and may be indicative patella subluxation or dislocation
Ulnomeniscotriquetral Dorsal Glide Test
pt- forearm pronated PT- Place thumb over ulna dorsally & place PIP joint of index of same hand over pisotriquetral complex anterior, apply posterior force through pisotriquetral complex (stressing TFCC) *pain or excessive laxity w/ pressure = + test for TFCC pathology
ely's test
rectus femoris tightness
what must you rule out with piriformis syndrome?
rule out involvement of lumbar spine and/or sacroilliac jt
obrien's test
sn=SLAP TEST Sp=AC pathology Pt holds shoulder 90o FLEX and 10o horizontal ADD and elbow full EXT Shoulder max IR first THEN ER Force applied downward
Game keepers thumb (what is it and what is the immobilization period)
sprain/rupture of ulnar collateral ligament of first digit -usually due to a fall when skiing -immobilization for 6 weeks
what are the activities that precipitate anterior torsion of innominate dysfunction? (4)
squatting/lifting/lowering, pregnancy, hip at 90 deg w/ axial loading, golfing/batting/tennis
which type of scoliosis has the rotational component? structural or nonstructural
structural pg 126
glenohumeral ligaments
superior glenohumeral ligament: limits adduction of the shoulder as well as lateral rotation with the shoulder during 0-45 abduction middle glenohumeral ligament: limits lateral rotation when shoulder is 45-90 abduction inferior glenohumeral ligament: anterior band: limits ER, anterior, and superior translation posterior band: limits IR, and anterior translation
anterior talofibular ligament
taut w/ plantar flexion and resist inversion of the talus and calcaneus, also resists anterior translation of the talus on the tibia
Which of the following is incorrect regarding club foot? a. nonpostural requires sx intervention b. the affected foot is half size smaller and more mobile c. denis-browne splints are worn at night for up to 3 years d. inversion is seen in the subtalar and talonavicular jts
the correct is answer is B "the affected foot is half size smaller and is LESS MOBILE. inversion is seen in the subtalar, talonavicular, talocalcaneal, calcaneocuboid jts
expiratory reserve volume
the maximal volume of air that can exhaled after a normal tidal exhalation
vital capacity
the volume change that occurs between maximal inspiration and maximal expiration VC=tidal volume+inspiratory reserve volume+expiratory reserve volume
total lung capacity
the volume of air in the lungs after maximal inspiration; the sum of all lung volumes
functional residual capacity
the volume of air in the lungs after normal exhalation FRC=expiratory reserve volume+ reserve volume
residual volume
the volume of gas remaining in the lungs at the end of maximal expiration
long term carpal tunnel syndrome causes atrophy and weakness of what muscles
thenar muscles and lateral two lumbricals
ischiofemoral ligament
thickened portion of articular capsule that extends from ischial wall of acetabulum to the neck of the femur, taut with extension and internal rotation and abduction
clawing of toes gait deviation
toe flexor spascity, positive support reflex
is the head rotated toward or away from the extremity being test when performing the adson's test?
towards
SIJ cluster of provocation tests
two of the following four tests should be positive to indicate SIJ, three out of the five when gaenslens's test is included SI gapping SI compression gaseslen's test sacral thrust thigh thrust (ortho notes: Clearing of the Lumbar Spine with addition of: Distraction Test Compression Thigh Thrust Test Gaenslen's Test Sacral Thrust Test)
which salter-harris fracture classifications generally require surgery like ORIF to restore alignment? a. I b. II c. III d. IV e. V
type III and type IV TYPE III Typically occurs when the growth plat is partially fused. Rare, but most commonly occurs to the distal tibia in adolescents. -may lead to long-term problems secondary to frx, crossing the epysis and extending into the articular surface of the bone. even with this potential, the prognosis is typically favorable since these frx rarely result in a significant deformity. TYPE IV most commonly seen at distal humerus. - this frx interferes w/ cartilage growth, it may lead to premature focal fusion of the involved bone causing deformity of the jt
elbow/extension of elbow screw-home mechanism
ulna external rotates/supinates during elbow flexion (volar glide on radioulnar jt) and internally rotates (or pronates) during elbow extension (dorsal glide on radioulnar jt)
relationship of ulnar collateral and radial collateral ligament in elbow
ulnar collateral ligament provides strong resistance to valgus forces, resistance of radial collateral ligament to varus forces is minimal due to its attachment to another soft tissue structure (annular ligament) -functional activities place tensile forces medially and compressive forces laterally. therefore the lateral ligament does not have to be strong as the medial
jerk test (posterior shoulder)
used for glenohumeral joint posterior and inferior instability; similiar to the load and shift - patient is seated, shoulder flexed to 90 degrees and internally rotated - axial load or compress the humerus into the glenoid and horizontally adduct the arm and move into ER/IR -(+) production of sudden jerk or clunk as humeral head subluxes off the back of glenoid
magnetic resonance imaging (MRI)
uses magnetic fields rather than radiation -offers excellent visualization of tissue anatomy -T1: demonstrates fat w/in tissues; used to assess bony anatomy (T one = bone) -T2: suppresses fat and demonstrates tissues with high water content; used to assess soft tissue structures -negatives: family expensive, not good w/ claustrophobic patients, may not be used w/ patients with metallic i plants
joint capsule of GHJ
vol of the jt capsule is 2x as the humeral head, arises from the glenoid fossa and the labrum to blend w/ the muscles of the rotator cuff. it is reinforced by the glenohumeral ligaments and the coracohumeral ligament
sternoclavicular joint Arthrokinematics: depression
(Convex on concave) inferior roll, superior glide
combinations of tests for hip OA:
- Symptoms increasing with squatting -lateral pain with active hip flexion -(+) scour test -pain with active hip extension -passive IR <25 deg
speed's test
-SLAP lesions and biceps tendinosis/tendinopathy -patient sitting or standing w/ elbow extended and forearm in supination -resist shoulder flexion from 0-60 degrees -may also place shoulder in 90 degrees in flexion and push upper limb in extension, causing an eccentric contraction of biceps
cross straight leg raise
-Very specific test for HNP (disc hernation) (88-100%) or neural tension/radiculopathy -Will cause inferior and medial tension on nerve roots -pt is supine with head, neck, and torso in neutral, maintain knee extension and neutral dorsiflexion and lift the leg to the point of symptom provcation -perform on the contralateral, non-involved lower extremity -(+) finding is reproduction of low back pain during the straight leg raise of the non-involved lower extremity
myositis ossificans
-abnormal calcification w/in mm belly -usually by direct trauma that result in a hematoma and calcification of mm -can also be due to early mobilization and stretching with aggressive physical therapy following trauma to mm -common places: quads, brachialis, biceps brachii -sx is only warranted if non-hereditary myositis ossificans and maturation of lesion (6-24 months) PT GOALS: DON'T BE TOO AGGRESSIVE SINCE IT MIGHT AGGRAVATE SYMPTOMS flexibility, manual therapy, aerobic/endurance conditioning
Lasegue's sign
-also known as the straight leg test -identifies dysfunction of neurological structures that supply the lower limb -special lumbar test that is performed with the patient in supine position and is used to identify if the patient's neurological structures that supply his lower limbs are functioning correctly. if the PT is able to reproduce the patient's pathological neurological symptoms while his/her foot is dorsiflexed, then the test is positive
bone scans
-chemical laced with radioactive tracers are injected -isotope settles in areas with high level metabolic activity of bone -radiograph used to identify "hot spots" of increased metabolic activity -used for rheumatoid arthritis, possible stress fractures, bone cancer, infections in bone, often receive a bone scan since these dysfunctions increase metabolic activity of bone in affected regions
traumatic glenohumeral instability (common in what population, which direction is most common, PT intervention/goals)
-common in young athletes -anterior-inferior is most common instability and occur with forced abduction and external rotation - tears: inferior glenohumeral ligament, anterior capsule, and possibly glenoid labrum -Hill-Sachs, Bankhart, Slap Tear, axillary nerve injury Pt goals/intervention -specific to patient's impairments -exercise and manual therapy to address joint movement restrictions -functional and resistive training -avoid apprehension position (90-90 abd/external rotation) for 12 weeks post sx for glenoid labrum repair
transient synovitis
-common insidious causes of hip joint pain *under 12 years old* -sudden onset of pain and limited mobility -The disease causes arthralgia and arthritis secondary to a transient inflammation of the synovium of the hip
degenerative joint disease (djd)/degenerative osteoarthritis (OA)
-degeneration of articular cartilage w/ hypertrophy of subchondral bone and joint capsule of WB jts -before 50 y/o M>M, after 50 y/o W>M -slowly progressive condition w/ episodic pain -eventually becomes chronic; knee OA most common -s/s: pain, swelling, loss of ROM, bone deformity -meds: oral analgesics, NSAIDS, corticosteroid injection PT goal/intervention: maintain soft tissue and jt mobility, aerobic conditioning, flexibility and strength PT is most valuable during exacerbation. however sx are sometimes required (arthrodesis, arthroplasty)
Goldthwait's test
-differentiates between dysfunction in lumbar spine vs SIJ -pt is supine with examiner's fingers between the spinous process of lumbar spine. with the other hand, passively performing straight leg raise -if pain presents prior to palpation of movement in lumbar segments, dysfunction is related to SIJ
Bicycle (van Gelderen's) test
-differentiates between intermittent claudication and spinal stenosis -patient is seated on stationary bike. patient rides bike while sitting errect. -time how long the patient can ride at a set pace/speed. -after sufficient rest period, have the patient ride bike at the same speed while in a slumped position -determination is based on the length of time patient can ride bike sitting up right versus sitting slumped. -if pain is related to spinal stenosis, patient should be able to ride bike longer while slumped
vertebral-basilar artery dysfunction signs and symptom
-dizziness/vertigo -dysphagia (difficulty swallowing) -dysarthria -dipolopia -drop attacks -Ataxia -numbness -nausea -nystagmus -severe unconcousiness, disorienteaetion, lightheadness -hearing difficulties -facial paralysis (Very Big DAN Hears FUN)
acute compartment syndrome
-elevated compartment (anterior, lateral, posterior) pressure that results in local ischemic conditions - usually result of direct trauma and/or fracture -Six P's: paresthesias, pulselessness, pallor, pain, palpable tenderness, paresis -MEDICAL EMERGENCIES and may require immediate sx (fasciotomy) to relieve the pressure of the mm and neurovascular compartments of the compartment
Flexion rotation test (cervical)
-for atlantoaxial dysfunction and/or cervicogenic headache -supine, passively perform maximally flexion and then fully rotate head in each direction -(+) reproduction of HA symptoms, or loss of 10 degrees ROM from one side to another
gout
-genetic disorder of purine metabolism -increased serum uric acid -uric acid changes into crystals and deposits in jts and other tissues like kidneys - early detection and intervention are important PT GOALS: edu for injury prevention and reduction involved limb as well as dietary effects
atraumatic instability
-global hypermobility -with testing, patients will demonstrate pain>apprehension PT goals/Intervention -specific to patient's impairments -functional and resistive training -exercise and manual therapy to address joint movement restrictions -avoid apprehension position (90-90 abd/external rotation) for 12 weeks post-sx to glenoid labrum
diagnostic ultrasound
-high-frequency sound waves -interpretation of data dependent on skill of operature -limited by poor contrast resolution, small viewing field, and how deep it penetrates -provides real-time dynamic images
medial subtalar glide test
-hold talus in subtalar neutral position with one hand and translate the calcaneus medially on the fixed talus with the other hand
femoral nerve traction test
-identifies compression of femoral nerve anywhere along its course -patient lies on NONPAINFUL SIDE with trunk in neutral, head slightly flexed, lower limb's hip and knee flexed -passively extend hip while knee of painful limb is in extension -if no reproduction of symptoms, flex the knee -(+) neurological pain along anterior thigh
osteomyelitis
-inflammatory response within bone due to infection typically MRSA -more common in children and immunocompromised adults -tx: antibiotics, proper nutrition, sx might be necessary due to infection spreading PT goals: -jt/bone protection and cast care -maintain/improve jt/bone mechanics and CT flexibility
arthrography
-invasive technique that involves injecting a dye into area and is observed w/ radiograph -surrounds tissues, demonstrating anatomy where fluid moves within joint -identify abnormalities within joints such as tendon ruptures -negatives:expensive and invasive risk
myelography
-invasive technique using water-soluble dye -dye is visualized as it passes through vertebral canal to observe anatomy within region -negative: very expensive, seldom used b/c of side effects versus using MRIs or CT which provide good, if not better information
schober test
-measures the mobility of the lumbar spine -pt standing. PT marks a point 5 cm below and 10 cm above S2. -Measure in the upright position and the full flexion -Used to measures the mobility of the spine and assess the degree of motion at the lumbar spine in ankylosing spondylitis
osteoporosis
-metabolic disease that depletes BONE MINERAL DENSITY -common place of frx: t-spine and L-spine, prox humerus, prox tibia, distal radius, pelvis, femur neck -primary or postmenopausal osteoporosis is due to LOW LEVELS OF ESTROGEN -meds: calcium, calcitonin (made by thyroid), estrogen, vitamin D, biophosophates PT GOALS: edu on dietary changes to improve mineral intake, jt/bone protection strategies, maintain/improve jt mechanics and connective tissue mobility, aerobic/endurance conditioning
computed tomography scan (CT)
-multiplanar image so tissue can be viewed from multiple directions -used to assess complex fractures as well as facet dysfunctions, disc disease, or stenosis of the spinal canal or intervetebral foramen -demonstrates soft tissue structures but not as well as MRIs -negative: fairly expensive, exposure to radiation
clarke's sign
-patient is positioned in supine w /knees extended. -therapist applies slight pressure distally with the web space of their hand over the superior pole of the patella. -the therapist then asks the patient to contract the quadriceps muscles while maintaing pressure on the patella. (+) indicated by failure to complete the contraction w/o pain and may be indicative of patellofemoral dysfunction
paxinos sign
-patient is seated with arm relaxed to side -PT places thumb under the posterior-lateral aspect of the acromion and the index/long fingers of the same hand over the middle part of the clavicle -pressure applied with both the thumb and fingers -positive test is localized pain at the AC joint (this is similar to the AC shear test - PT cups spine of scap and clavicle with both hands)
anterior slide test
-patient is seated with hands on waist, thumbs posterior -with scapula stabilized, an anterior-superior force is applied to the elbow to GHJ -SLAP lesion -(+) pain or click reproduced deep in shoulder
McMurray's Test
-patient is supine, tested knee in max flexion -combo of IR/ER of tibia and flex/ext of knee with valgus/varus force -passively, internal rotate and extend the knee (tests lateral mensicus) -passively, external rotate and extend the knee (tests medial meniscus) - we are trying to trap and pinch the torn mensicus as we go to varus and valgus
moving valgus stress test
-patient is upright position and the shoulder is abducted to 90 degrees. -with the elbow in full flexion of 120 degrees with valgus force applied at elbow until the should reaches full external rotation -move through elbow flexion and extension -(+) pain with extension for chronic MCL tear of the elbow
Watson (scaphoid shift) test
-patient seated, elbow resting on table, forearm pronated, wrist placed in full ulnar deviation with slight extension while stabilizing metacarpals -place pressure on scaphoid while radially deviating and slight flexing of patients hand -painful "shift" of the scaphoid with a "clunk" when pressure is removed indicates carpal instability
how do you perform positional gapping for posterolateral bulge on the left?
-perform for 10 minutes -have the pt sidelying on the R with pillow under R trunk -hips and knees flexed -rotate torso to the L
Elbow dislocations -which are most common, what will be ruptured, common MOI, clinical signs, PT goals/intervention
-posterior dislocations are the most common, and commonly occur with an avulsion fracture at the medial epicondyle secondary due to traction of MCL -posteroinferior dislocation is the most common as a result of hyper extension from a FOOSH -with a complete dislocation, there will be a rupture of the UCL, and possible rupture of anterior capsule, brachilas, wrist flexor/extensor muscles, lateral collateral ligament -clinical signs: rapid swelling, severe pain at elbow, deformity with the olecranon pushed posteriorly PT goals/intervention -reduce the dislocation -period of immobilization followed by rehabilitation focusing on flexibility within stability and strengthening -if not stable, sx is required
ankylosing spondylitis (pt goals/intervention)
-progressive inflammatory disorder that initially affects axial skeleton -first symptoms: mid and low back pain, morning stiffness, sacroilitis -results in kyphotic deformity of cervical and thoracic spine, and decrease of lordosis in lumbar spine; degeneration of peripheral and costovertebral jts in advance stages PT goals/intervention: flexibility, aerobic/endurance conditioning, relaxation activities to maintain/improve respiratory function, breathing strategies to maintain/improve vital capacity
discography
-radiopaque dye is injected into the disc to identify abnormalities w/in the disc (annulus or nucleus) -needle is inserted in disc (fluroscopy) -not commonly used, requires high level of skill -negatives: expensive, risk of infection since it is invasive
general PT treatment for osteochondritis dissecans
-rest and avoidance of aggravating factors -jt/bone protection -correct biomechanical faults -when the patient is pain-free, implement flexibility, strength, endurance, and coordination exercise to maintain/improve normal jt motion and length of mm -implement strength, power, endurance exercises to increase load on jts in late phase of rehab -flexibility exercises are begun immediately following sx, followed by progressive strengthening
cervical instability signs and symptoms
-severe mm spasm -pt does not want to move head (especially into flexion) -lump in throat -lip or facial paresthesia -severe headache -dizziness -nausea -vomiting -soft-end feel -nystagmus -pupil changes
how do use the quadrant test to compress the intervertebral foramen on the left?
-sidebend left, rotate left, extend maximally to close the intervertebral foramen on the L
rule of 3
-spinous process of T1-T3 even with transverse process of the same vertebra; SP straight posterior -T4-T6 spinous processes are found one-half level below transverse processes of same level; SP inferior 1/2 segment -T7-T9 spinous processes are one full level below transverse process of same level; SP inferior 1 segment -T10 is full level below; -T11 is one half level below; 1/2 segment inferior -T12 is level
lateral pivot shift test
-tests the integrity of ACL -Most specific, not as sensitivity for ACL - patient is supine, knee in extension, hip flexed/abducted to 30 degrees Internally rotate the tibia, Which will move the tibia forward -Flex the leg up and apply a little bit of a valgus force -Move through flex and extend -Trying to sublux the lateral tibial plateau anteriorly (+) for anterolateral rotatory instability, a clunk that you feel going into knee flex around 30-40 degrees b/c the ITBAND WILL BE TAUGHT IN FLEXIONWHICH WILL BE PULLING THE TIBIA POSTERIORLY
hornblower sign
-used for rotator cuff pathology -patient is standing, passively elevate the arm to 90 degrees in scapular plane and flex elbow to 90 degrees -patient externally rotates shoulder against resistance -(+) if unable to external rotate arm
brush (stroke) test for the knee
-used for swelling -patient is supine, knee in full extension -starting at the medial tibiofemoral joint, stroke upward two to three times toward the suprapatellar pouch -then stroke downward on the distal lateral thigh, just superior to the suprapatellar pouch, toward the lateral joint line -positive if fluid is observed on the medial knee -quantified with a 5-point scale: 0=no wave produced on down stroke trace=small wave 1+=larger on bulge 2+=spontaneous return after upstroke 3+=unable to move effusion out of medial knee
EXAGGERATED KNEE FLEXION AT CONTACT CAUSES
-weak quads -quads paralysis -hamstrings spasticity -insufficient extension ROM
positive test of Patrick/FABER test
-when involved knee is unable to assume relaxed position and/or reproduction of painful symptoms
normal calcaneal varus during initial contacts
0-4 degrees once weight bearing begins during transition from heel strike/initial contact through loading response, the calcaneus then starts to evert from that initial varus position at the subtalar joint to allow the foot to pronate and get the medial side down
adverse responses to cardiac inpatient exercise termination
1. diastolic BP >110 mm Hg 2. dropping systolic BP >10 mm Hg during exercise 3. significant ventricular or atrial dysrhythmias w/ or w/o associated signs/symptoms 4. 2nd or 3rd degree heart block 5. signs of exercise intolerance - angina, dyspnea, ECG suggest ischemia (ST depression more than 2mm) (page 269)
which is the most important intervention when treating fractures of foot and ankle? 1. early PROM 2. progressive strengthening 3. gait training 4. gastroc soleus flexiblity
1. early PROM is important in preventing capsular adhesions
special tests for meniscus
1. forced overpressure into flexion and extension 2. apley's grind 3. McMurray's/Joint Line Compression 4. Joint Line Tenderness 5. Thessaly (3/5 indicate meniscus tear with s/s of pop, clicking, and catching)
Which is NOT an effect of forward head posture? 1. hyoid is depressed with suprahyoids lengthen, infrahyoids shorten 2. first and second ribs are elevated 3. TMJ is in posterior closed-packed position 4. extension in upper cervical spine 5. scapular stabilizers are stretched
1. hyoid is elevated with suprahyoids shorten, infrahyoids lengthen
which is not a result of posterolateral herniation? 1. loss of ROM 2. loss of strength 3. radicular pain 4. paresthesias 5. inability to perform ADLs
1. loss of range of motion
4 tests for subacromial impingment
1. neers 2. hawkins kennedy 3. empty can 4. painful arc
tests for SLAP tears
1. obrien's test/active compression 2. biceps load II test 3. anterior slide test 4. compression-rotation test (crank) 5. yergason test 6. speed's test (bicep's straight arm)
which one of these skeletal/soft tissue conditions has the PT focus on cast care? 1. osteomyelitis 2. osteoporosis 3. osteomalacia 4. ostetis deformans
1. osteomyelitis osteomyelitis occurs due to an inflammatory response within the bone from an infection, typically MRSA -more common in children and immunocompromised adults -tx: antibiotics and proper nutrition, possible sx if infection spreads -PT focus on: jt/bone protection with cast care and maintain/improve jt mechanics and connective tissue function
what are 3 structural deficiencies that may lead to a posterolateral bulge/herniation in th lumbar spine
1. posterior disc is narrower in height than the anterior disc 2. posterior longitudinal ligament is not a strong and only centrally located in the L spine 3. posterior lamellae of annulus is thinner
what are the activities that precipitate posterior torsion of innominate dysfunction? (4)
1. vertical thrust onto extended LE 2. sprinting starting position 3. fall onto ischial tuberosity 4. unilateral standing
Recommended Order for Fixing Dysfunction
1.Pubic symphysis dysfunction 2.Non adapting lumbar spine lesions 3.Sacral dysfunction* 4.Innominate dysfunction *If the sacrum does not "move" fix the innominate dysfunction first and then reassess sacral and innominate positioning
loose pack of talocrural joint
10 degrees of plantar flexion midway between max inversion and eversion
distal radioulnar open packed
10 degrees of supination
match 1. inversion of forefoot when subtalar is neutral 2. eversion of forefoot when subtalar is neutral 3. eversion of calcaneous with neutral subtalar 4. rigid inversion of calcaneous when subtalar is neutral a. rearfoot valgus b. forefoot valgus c. rearfoot varus d. forefoot varus
1=forefoot varus d 2=forefoot valgus b 3=rearfoot valgus a 4=rearfoot varus c
which of the following is NOT a physical therapy goal/intervention for chronic exertional compartment syndrome? 1. orthoses for a gradual return to activity and loading 2. run retraining to rearfoot strike 3. functional and resistance training 4. initial reduction in loading
2 is incorrect it is recommended run retraining to NONREARFOOT strike may decrease forces in anterior compartment (chronic exertional compartment syndrome: result of elevated compartment (anterior, lateral, posterior) pressure that restricts blood flow to muscles. Anterior is most common with resulting pain in the anterolateral leg region but may also present with paresthesias) pg 106
which is not a test for glenohumeral joint instability? 1. sulcus sign 2. external rotation lag sign 3. apprehension test 4. relocation test
2. external rotation lag sign: used for RC pathology patient seated or standing, passively abduct shoulder to 90 and external rotate shoulder to end range positive if unable to maintain external rotated position
which test must you differentiate between reproduction of glenohumeral versus acromoclavicular joint symptoms? 1. empty can 2. obrien's test 3. cross body adduction 4. anterior slide
2. obrien's test
which ligament is partially torn in a grade III lateral ankle sprain 1. anterior talofibular 2. posterior talofibular 3. calcaneofibular 4. deltoid
2. posterior talofibular ligament is partial torn, the anterior talofibular and calcaneofibular are completely torn
Which test is primarily tests the integrity of the calcaneofibular ligament? 1. anterior drawer test 2. talar tilt test 3. posterior drawer test 4. kleiger test
2. talar tilt
tibofemoral open pack position
25 degrees of flexion
which is not recommended in the patellofemoral pain clinical practice guideline? 1. hip exercises should target posterolateral hip muscles 2. should not prescribe patellofemoral orthoses 3. may use dry needling to reduce pain 4. should not use ultrasound and cryotherapy 5. body-weight management when appropriate
3 is correct answer. should not use dry needling (box 2-9 p 106) (should include hip and knee exercises, should consider additional foot orthoses, patlelar taping, patella rmobilizaitons, LE stretching, should not use visual feedback on LE, running gait retrainng, adopting a forefoot strike pattern rearfoot strike runners, may use cueing to increase running cadence, reduce peak adduction while running, blood flow restriction training)
coxa vara and coxa valgus may result from necrosis of femoral head occuring with _____ 1. osteoarthrits 2. avascular necrosis 3. septic arthritis 4. sepsis
3. septic arthritis (Septic arthritis is an infection in the joint (synovial) fluid and joint tissues. It occurs more often in children than in adults. The infection usually reaches the joints through the bloodstream. In some cases, joints may become infected due to an injection, surgery, or injury.)
Iliofemoral joint loose packed position
30 degrees of flexion, 30 degrees abduction, slight external rotation
normal gait on level ground requires at least the following hip joint
30 hip flexion 10 extension 4 abduction/adduction 5 internal/external rotation
which of the following structures is not typically related to groin pain in athletes? 1. adductor 2. pubic 3. inguinal 4. pectineus 5. iliopsoas
4. pectineus page 100
for sacral dysfunction, which are the following are NOT activities that precipitate the dysfunction? 1. long-term postural abnormalites 2. trauma during childbirth 3. loss of balance during ambulation 4. unilateral standing 5. sitting combined with rotation and lifting 6. fall on sacrum/coccyx
4. unilateral standing precipitates posterior torsion of innominate
as relates to back pain, repetitive trauma disorders account for ___% of all reported occupational diseases
48% as relates to back pain, repetitive trauma disorders account for 48% of all reported occupational diseases. diagnosis of these conditions is difficult, and up to 85% of back pain is nondiagnosed
proximal radioulnar closed packed
5 degrees supination
loose packed position of glenohumeral joint
55 deg abduction 30 deg horizontal adduction (scapular plane) (think of Bill and putting a pillow underneath pt's elbow when they are laying down)
which skeletal/soft tissue condition(s) does not have the emphasis of joint/bone protection strategies? 1. osteomyelitis 2. complex regional pain syndrome 3. osteoporosis 4. paget's disease 5. osteomalacia 6. myofascial pain syndrome
6. myofasical pain syndrome -PT goals/intervention: flexibility exercise to improve/maintain normal ROM, manual therapy including spray and stretch, dry needling, STM, joint mobilizations, cryotherapy, thermotherapy, TENS, hydrotherapy, and desensitization of trigger points with manual pressure, and implementation strength, power, and endurance exercises 2. complex region pain syndrome -PT goals/intervention: pt edu for injury prevention and reduction, desensitization activities to return to work/school/home activities, TENS for pain relief
what is the total length of rehabilitation period for groin pain in athletes (sports hernia)
8-12 weeks
radiohumeral jt closed packed position
90 degrees of flexion, 5 degrees of supination
which of the following is incorrect when examining a patient with signs of adhesive capsulitis? a. resisted isometric movement demonstrates weakness and pain with abduction and lateral rotation b. palpation is not painful unless the capsule is stretched c. shoulder hiking with shoulder flexion d. PMH of thyroid disease
A is incorrect. patients with RC lesions demonstrate weakness and pain with abduction and lateral rotation with resisted isometric movement. adhesive capsulitis: normal resisted isometric movement when arm is at the side
You are treating a 13 y/o patient with osteochondrosis of humeral capitellum. Which of the follow treatment interventions is NOT recommended for this patient? a. strength exercises are begun immediately following surgery b. avoiding throwing a baseball a practice c. abstain from performing pushups d. focus on minimizing pain and swelling after surgery
A is the correct answer. After surgery, the initial focus of rehab is to minimize pain and swelling using modalities. Flexibility exercise are begun immediately following sx. Then a progressive strength program. Jt movement restrictions should be addressed and/or manual therapy tailored to impairments. pg 92 osteochondritis dissecans affect central and/or lateral spect of capitellum or radial head. -osteochondral bone fragment bone detached from articular surface, forming a loose body in joint. -caused by repetitive compressive forces between radial head and humeral capitellum. occurs in adolescents between 12 and 15 y/o panner's disease: avascular necrosis of capitellum leading to loss of subchondral bone, children 10 years or younger
A contracture of intrinsic muscles with dorsal subluxation of lateral extensor tendons leads to... a. extension of MCP and DIP, flexion at PIP b. extension of DIP and PIP, flexion at MCP c. flexion of MCP and PIP, extension at DIP d. flexion of PIP and DIP, extension at MCP
A. flexion of MCP AND DIP W/ EXTENSION OF PIP this describes swan neck deformity -caused by a contracture of intrinsic muscles with dorsal subluxation of lateral extensor tendons which leads to flexion of MCP and PIP and DIP extension -commonly occurs from trauma, RA following degeneration of extensor tendons
which of the following is NOT a late sign/symptom of Whiplash Associated Disorder? a. limited tolerance to ADLs b. difficulty swallowing c. TMD d. anxiety/depression e. disequilibrium
B. difficulty swallowing Difficulty swallowing is an early sign of WAD. Along with: HAs, neck pain, limited flexibility, reversal of lordosis of lower C-spine and decrease of upper cervical kyphosis, vertigo, change in vision and hearing, irritability to noise and light, dysethesias of face and bilateral upper extremities, nausea, difficult swallowing, and emotional ability pg 118
A 72 y/o patient complains of pain in 1st digit with a gradual onset. Upon examination you observe extension of the MCP and DIP with flexion of PIP. Which finger deformity matches with your observation? a. Ape hand b. Boutonniere c. Swan neck d. Mallet finger
Boutonniere
Calcitonin
Calcitonin inhibits (blocks) the activity of osteoclasts, which are cells that break down bone.
colles vs smith fracture
Colles': fx of distal radius with DORSAL displacement Smith: VOLAR displacement
talar tilt test
Grab the calcaneus and talus -patient is sidelying; knee slightly flexed, ankle in neutral position, invert (think tilting to inversion) -place in plantar flexion, neutral, or more dorsiflexion to test different ligaments -(ATFL = slight plantar flexion, CFL = neutral DF, PTFL=DF) -Ask about pain, ad see how much gapping is occurring -There is usually a CFL torn, ATFL is usually torn as well ATFL> CFL> PTFL -ATFL usually has a frx of the lateral malleoli
lateral rotation stress test (kleiger test)
Kleiger - more forefoot External rotation stress test - calcaneus -patient is seated; knees flexed to 90 degrees -If you maximallyDF and ER, taking wide anterior talus and bring it back into the mortius. We are looking for the syndesmosis sprain or the high ankle sprain (pain over the anterior and posterior tibiofibular ligaments and the interosseous membrane) -More PF and ER, now assessing deltoid lig on the other side (patient has pain medially, and the therapist can feel the talus shift away from the medial malleolus)
foot inversion cord segments and nerve(s)
L5-S2; tibial nerve
Yergason's Test
LH Biceps pathology Subacromial impingement SLAP tear Labral pathology stability of biceps tendon in groove Pt standing or sitting Elbow FLEX to 90 degrees, Forearm PRO, Pt forcefully SUP forearm with resistance at wrist - the tendon of the biceps long head will "pop out" of the groove, may also reproduce pain in long head of biceps tendon
ankle anterior drawer test
Looking at ATFL which resist anterior translates Put a little PF (approximately 20 degrees), stabilize tibia and fingers are wrapped calcaneus and perform a straight translation Make sure there is no DF or PF Compare translation on both sides, see if there is pain Look for divot sign - complete rupture at the sinus tarsi
Duputryen's contracture usually involves which joints (PT interventions)
MCP and PIP due to palm and finger finger contractures from contracture of palmar fascia -3rd and 4th finger seen in non-diabetic -4th and 5th finger seen in diabetic PT interventions: flexibility exercise to prevent further contracture, splinting application. once contracture is under control, promote normal hand function
mean 6MWT distance of community-dwelling adults without assistive device (60-69; 70-79; 80-90)
Male 60-69 y/o: 572 m Female 60-69 y/o: 538m Male 70-79 y/o: 527m Female 70-79 y/o: 471m Male 80-90 y/o: 417m Female 80-90 y/o: 392m
Noble's Compression test
Patient is supine There is a void of the lateral femoral condyle - apply pressure Have leg flexed 30-40 with a bolster Then the patient extends (+) pain popping where your pressure is at the void and maybe indicative of illiotibial band friction syndrome
bounce home test
Patient is supine with knee flexed completely, the knee is then dropped into extension. Positive sign is incomplete extension indicating torn meniscus
hughston's plica test
Patient is supine, and testing knee is flexed with tibia in int. rot. Passively glide the patella medially while palpating the medial femoral condyle. Feel for "popping" as you passively flex and extend the knee (+) TEST: pain and/or popping noted during test
Gaenslen's Test
Patient sidelying at edge of table while holding bottom leg in maximal hip and knee flexion (knee to chest). Stand behind the patient and passively extend hip of upper most limb. This places stress on SIJ associated with upper most limb. (+) TEST: pain in SIJ --we learned in supine
Charcot-Marie-Tooth disease
Peroneal muscular atrophy that affects motor and sensory nerves initially affects lower leg and foot, but progresses to mm of hands and forearm pt intervention: prevent contractures, orthoses, braces, ambulatory devices
tibial torsion test
Purpose: Lateral rotation of the tibia Method: Pt is sitting with legs off of the edge of the mat. PT places his/her thumb and index finger over the lateral & medial malleoli. PT measures the angle formed by the axes of the knee and ankle. Positive Test: Normal lateral rotation of the tibia = 12-18 degrees in adults.
Adson Maneuver
Purpose: Thoracic Outlet Syndrome Method: Pt. in seated position. PT finds radial pulse and passively brings shoulder into abd. and extension. Pt. then rotates head and looks over ipsilateral shoulder. Pt takes deep breath and hold the position. Positive Test: Diminished pulse, and symptoms of pain, numbness, tingling, weakness, & coldness in the upper extremity.
Which therapeutic exercise is BEST to give to a patient who is 9 weeks post ulnar collateral ligament injury (at the elbow)? a. Overhead shoulder carry with kettlebell b. Repeated prone on elbows back extension c. Standing cable column external rotation with 90 degree elbow bent at the side d. Seated theraband eccentric wrist extension
Repeated prone on elbows back extension involved elbow flexion a. elbow is in extension c. although the elbow is flexed to 90 degrees, focuses on strengthening the RC d. strengthens the wrist extensors pg 92 After resolution of pain and inflammation, strengthening exercises that focus on elbow flexors are initiated. taping can be used for protection during return to activitirs
torticollis
SCM spasm/tightness affected SCM is sidebent toward and rotated away PT goals/intervention: -flexibility exercise to maintain/improve jt motion and -length of mm -manual therapy with jt oscillations and mobilizatoins
ABI <0.4
Severe blockage suggesting severe peripheral artery disease; may have claudication pain at rest
90-90 straight leg test
Sitting with knees flex to 90 degrees flexion, knees relaxed Instruct patient to alternately extend each knee as much as possible while maintaining hips in 90. Positive test: knee remaining in 20 degrees or more flexion Indication: hamstring tightness
prone instability test
Step 1: The patient lays only half way up the bed, with the hips flexed, the trunk muscles relaxed and the feet resting on the floor. A PA pressure is applied over the most symptomatic spinous process. Step 2: The PA pressure is let go and the patient is requested to slightly lift the feet off the floor. The patient requires holding on to the sides of the bed for support as this will produce a co-contraction of the global abdominal, gluteal and erector spinae muscles. Step 3: The PA pressure is re-applied over the same level spinous process. If a dramatic reduction or the complete elimination of the symptoms is noted compared to step 1, it is considered a positive prone instability test.
forced expiration comes from what cord segments?
T1-L1 (intercostal nerves) (muscles involved: internal and external obliques, transverse abdominis, posterior internal intercostals, rectus abdominis)
Karvonen Formula
Target Heart Rate = ((max HR − resting HR) × %Intensity) + resting HR
barlow test
Test for a hip that is dislocatable but not dislocated in infants. With infant supine and hip and knees flexed, push posteriorly in line with the shaft of femur. An unstable femoral head will dislocate posteriorly from acetabulum.
Lachman's Test
The best test to rule out, if you had one test Block above femur from moving anteriorly and Pull up on the tibia, it should be a quicker motion Relax leg, put the knee in 20-30 degrees of knee flexion Should feel the end feel -is it a definitive, firm end-feel and Compare translation of each leg!!! Could periodically do a lachman's test post-op to make sure we are not stretching the ACL during tx
INSPIRATORY CAPACITY
The maximum volume of air that can be inspired after reaching the end of a normal, quiet expiration. It is the sum of the TIDAL VOLUME and the INSPIRATORY RESERVE VOLUME. Common abbreviation is IC.
ulnar collateral ligament instability test for thumb
The patient is positioned in sitting. The therapist holds the patient's thumb in extension and applies a valgus force to the metacarpophalangeal joint of the thumb. A positive test is indicated by excessive valgus movement and may be indicative of a tear of the ulnar collateral and accessory collateral ligaments. This type of injury is referred to as gamekeeper's or skier's thumb.
tight retinacular test
This test differentiates between a tightness in the capsule and tight rectinacular ligaments. -PIP is stabilized in neutral while DIP is flexed. then PIP is flexed and DIP is flexed -if flexion is limited in both cases, capsule is tight. If more DIP flexion with PIP flexion, then retinacular ligaments are tight
Bunnel-Littler test
This test evaluates the source of PIP flexion motion limitation by differentiating between intrinsic muscle or capsular tightness in the affected digit. A typical patient presentation may include pain located in the distal intermetacarpal space and with prolonged gripping or making a fist. ---- The MCP joint is held in an extended position and the therapist passively flexes the PIP making note of the available range. The test is then repeated with the MCP joint flexed. If no change in motion is detected between the two tests, then capsular restriction at the PIP joint is implicated. If the motion increases when the MCP joint is flexed, then lumbricale muscle tightness is implicated.[2]
which is the most common type of salter harris fracture classification? a. I b. II c. III d. IV e. V
Type II - deformity: entire epiphysis and portion of metaphysis - usually caused by a shear or avulsion with angular force. - may cause decreased bone growth, but typically minimal so limited negative impact on long-term function -relocated and immobilized with cast
which type of salter-harris fracture classification has a poor functional prognosis? a. I b. II c. III d. IV e. V
Type V fractures are associated with growth disturbances at the physis, and generally will have a poor functional prognosis - caused by a compression or crush injury of the epiphyseal plate, with no associated epiphyseal or metaphyseal fracture -these are usually found "after the fact" so no immediate intervention is provided. if it is identified acutely, pt is placed on NWB protocols
iliofemoral ligament
Y ligaments - two bands both starting from AIIS -medial running to distal intertrochanteric line. lateral running to proximal aspect of intertrochanteric line -very strong -both bands taut w/ extension and ER. superior band taut w/ adduction. inferior band taut with abduction -taut w/ full ext and full ER, can help maintain upright posture
A parked car's door hit a 22 y/o food delivery biker as it opened. The biker does not complain of any neck pain or tenderness. Should the patient receive radiography?
Yes. the patient needs radiography. even though the biker is younger and does not complain of neck pain/tenderness, the biker experienced what is considered a dangerous mechanism.
Ottawa Knee ankle Rules (5)
a knee x-ray series is only required for patients with knee injury and who have any of the following: 1. age 55 y/o or older or 2. isolated patellar tenderness w/o any other bony tenderness or -3. enderness of fibular head or -4. nability to flex knee to 90 degrees or 5. inability to bear weight immediately after injury and in the emergency department To apply the Ottawa Knee Rules accurately: -test is designed to rule out frx after acute knee injury -advised to order radiography with one or more positive answers -negative test results are considered highly diagnostic of the absence of frx
Match a. ulnar nerve entrapment b. median nerve entrapment c. radial nerve entrapment 1. compression due to thickening of retinaculum 2. occurs within pronator teres muscle 3. pain over supinator muscle 4. hypertrophy flexor carpi ulnaris 5. occurs under superficial flexor digitorum superficialis 6. aching pain with weakness of forearm muscles 7. entrapment of posterior interoseous nerve 8. repetitive gripping activities 9. entrapment due to overhead activities and throwing 10. recurrent subluxation of elbow
a. 1, 4, 10 b. 2, 5, 6, 8 c. 3, 7, 9
A 13-year-old patient reports moderate knee pain persisting more than 3 weeks, with no trauma noted. The patient exhibits an out-toeing gait pattern, leg length discrepancy, and restriction in medial (internal) rotation of the involved leg. Which of the following test findings would MOST likely be present? a. Pain with palpation of the trochanteric region b. Pain and instability during the application of valgus stress to the knee in full extension c. Pain in the groin region with hips flexed 80° to 90° and then medially (internally) rotated with adduction d. Pain in the gluteal region with combined movements of hip flexion to 45° to 60°, abduction, and lateral (external) rotation
a. Palpation is not likely to reproduce symptoms for a capsular dysfunction. Palpation is more likely to identify a muscle or soft tissue condition or bursitis. (p. 901) b. The case presentation indicates hip dysfunction, specifically slipped capital femoral epiphysis. Special tests of the knee are not likely to provoke symptoms. c. The stem describes a case of suspected slipped capital femoral epiphysis. Signs and symptoms are typically found in adolescent patients (10-16 years old) and include leg shortness, knee pain, and pain when the hip is medially (internally) rotated. Groin pain will be triggered with the anterior impingement test (hips flexed to 80° to 90° and medially [internally] rotated with adduction) if slipped capital femoral epiphysis exists. d. . The stem describes a case of suspected slipped capital femoral epiphysis. The flexion, abduction, external rotation test (FABER) described in this option is used to indicate lumbar, sacroiliac joint, or posterior hip dysfunction associated with the hip capsule. Although it is a femoroacetabular impingement test, it is a better indicator of posterior hip dysfunction than anterior hip dysfunction.
A 8 year old child is experiencing painful R hip and groin pain, and is walking with a limp. His mother said he is constantly crying at night. His hip range is normal except in internal rotation and abduction. Which of the following diagnoses is MOST likely? a. Transient synovitis b. Trochanteric bursitis c. Anterior acetabular labral tear d. Femoral head stress fracture
a. transient synovitis most likely to occur in children ages 3-10 . Transient synovitis is associated with an active antalgic gait and with pain that is aggravated by medial (internal) rotation and abduction.
With a complete elbow dislocation, what structure will absolutely rupture? a. ulnar collateral ligament b. brachilas muscle c. wrist flexor muscles d. lateral collateral ligament e. wrist extensor muscle f. anterior capsule
a. ulnar collateral ligament will rupture with a complete elbow dislocation p 93
Borders of anatomical snuff box
abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus
paget's disease
also known Ostetis deformans -etiology unknown, thought to be linked to viral infection and environmental factors - abnormal activity of osteoclasts and osteoblasts - meds for pain relief and to decrease osteoclast activity (acetaminophen, calcitonin, and etridonate disodium) PT goals/intervention: -jt/bone protection strategies -maintain/improve jt mechanics and CT function -aerobic/endurance conditioning
complex regional pain syndrome
also known as reflex sympathetic dystrophy (RSD) -unknown etiology -can affect upper and lower extremities, head, neck, and trunk -sympathetic nervous system dysfunction with symptoms including: pain, vasomotor and circulation disturbances CRPS 1: followed by tissue trauma and no nerve involvement CRPS 2: followed by tissue trauma WITH NERVE INVOLVEMENT PT goals/intervention: -desensitization activities to focus on return to ADLs/IADLS -pt edu on injury prevention and reduction -TENS for pain relief
FEV1/FVC in restrictive disease
an increase or normal
ottawa ankle and foot rules
ankle xray is only required if there is any pain in the malleolar zone and any of these findings: 1. bone tenderness from posterior edge or tip of the lateral malleolus extending 6 cm proximally or 2. bone tenderness from posterior edge or tip of the medial malleolus extending 6 cm proximally or 3. inability to take 4 complete steps both immediately and in the emergency department a foot x-ray series is only required if there is any pain in the midfoot zone and any of these findings 1. bone tenderness at the base of the fifth metatarsal or 2. bone tenderness of the navicular or 3. inability to take 4 complete steps both immediately and in the emergency department to apply the owttawa ankle rules accurately: palpate the entire distal 6 cm of fibula and tibia, do not neglect the importance of medial malleolar tenderness, do not use for patients under 18 years old
deltoid ligmaent
anteiror tibiotalar ligament, tibiocalcaneal ligament, posterior tibiotalar ligament, tibionavicuar ligament, provides medial ligamentous support resisting eversion of the talus
Froment's sign
asked to hold a piece of paper between thumb and index finger. the therapist attempts to pull the piece of paper away from patient. (+) patient is flexing distal phalanx of the thumb due to adductor pollicis muscle paralysis. If at the same time, the patient hyperextends the metacarpophalangeal joint of the thumb, and is termed the jeanne's sign.
the "no" joint
atlanto-axial joint; nonsynovial articulation between the dens of C2 and anterior arch of C1. -majority of head rotation comes from this artiulation
coracoacromial ligament
attaches between the coracoid process and acromion and forms a roof over the humeral head limits superior translation of humeral head and also prevents separation of AC jt
coracohumeral ligament
attaches proximally to the coracoid process and splits distally to the greater and lesser tuberosities - found between and units the subscapularis and supraspinatus tendons - limits inferior translation of humeral head
bankhart lesion
avulsion of anterior-inferior capsule and glenoid labrum
bankart lesion
avulsion of anterior-inferior capsule and glenoid labrum; a tear of the rim below the middle of the glenoid socket
A pt demonstrates inability to abduct arm with neutral rotation. Which peripheral nerve is possibly involved? a. spinal accessory b. axillary nerve c. long thoracic nerve d. suprascapular nerve
b
how long is the immobilization period for a scaphoid fracture a. 3-4 weeks b. 4-8 weeks c. 5-8 weeks d. 6-10 weeks
b. carpals are immobilized for 4-8 weeks
How long is someone with a boxer fracture casted for? a. 1-2 weeks b. 2-4 weeks c. 3-5 weeks d. 5-7 weeks
b. 2-4 weeks page 97 (scaphoid frx is double of boxer frax)
During the examination, which functional outcome measure is BEST to measure mobility and risk of falls for a patient with proximal femur fracture in an 88 y/o woman due to a fall? a. 6-minute walk test b. TUG c. 30 second STS d. Functional Gait Assessment
b. TUG box 2-5 pg 99
Which condition may present with abrupt, severe abdominal pain and right upper quadrant tenderness, nausea, vomiting, and fever? a. constipation b. cholecystitis c. acute pancreatitis d. GERD e. IBS
b. cholecystitis presents as this acute pancreatitis - epigastric pain radiating through to the back
Which of the following is incorrect regarding internal disc disruptions in the lumbar spine? a. internal structure of the annulus is disrupted, external structures remain normal b. diminished reflexes upon examination c. c/o constant, deep, achy pain that is also increase with movement d. preferred imaging is CT discogram or MRI e. spinal manipulations may be contraindicated
b. diminished reflexes upon examination internal disc disruptions - internal structure of the annulus is disrupted, but the external structures remained nomral -s/s: constant, deep, achy pain that increases with movement -no objective neurological findings, although there may be referral pain in LE -imaging: CT or MRI, not myelogram or regular CT PT Interventions: -jt restrictions should be corrected -spinal manipulations may be contraindicated -pt edu regarding proper body mechanics, positions to avoid, limiting repetitive bending/twisting, limiting UE overhead and sitting activities and carrying heavy loads
where would the visceral tumor be MOST LIKELY located with symptoms described as "pain radiating to the back, pain with swallowing, dysphagia, weight loss" a. thyroid b. esophagus c. pancreas d. stomach e. lung
b. esophagus
which is not a primary site of a metastic bone cancer a. thyroid b. liver c. lung d. breast e. kidney f. prostate
b. liver liver is not a primary site of metastic bone cancer pg 120
Upon examination, you noticed muscle atrophy of a patient's left thenar muscles compared to the right. And the patient is unable to abduct or oppose the thumb. Which nerve is most likely affected? a. radial b. median c. ulnar d. posterior interosseous
b. median nerve this is describing ape hand deformity
which of the following is false regarding supracondylar fractures? a. high incidence of malnutrition b. the median nerve is typically involved c. examination must be performed quickly d. the radial nerve is typically involved e. may lead to Volkmann's ischemia
b. the median nerve is not typically involved, the radial nerve is typically involved A Volkmann's contracture is deformity of the hand, fingers, and wrist which occurs as a result of a trauma such as fractures, crush injuries, burns and arterial injuries. Following this trauma, there is a deficit in the arterio-venous circulation in the forearm which causes a decreased blood flow and hypoxia can lead to the damage of muscles, nerves and vascular endothelium. This results in a shortening (contracture) of the muscles in the forearm. pg 92
which is the most common cause of in-toeing? a. femoral retroversion b. anterior pelvic tilt c. internal tibial torsion d. posterior tibialis weakness e. gastroc/soleus spasticity
c. internal tibial torsion
what is the most common primary bone tumor? a. Ewing's sarcoma b. chondrosarcoma c. multiple myeloma c. chondromas e. osteosarcoma
c. multiple myeloma
rheumatoid arthritis
chronic autoimmune disorder, RA individuals develop antibodies to their OWN immunoglobulins (rheumatoid factor, anti-citrullinated protein antibody) -juvenile RA -> onset prior to 16 y/o -periods of exacerbation and remission -bilateral and symmetrical synovial jt involvement (radiographs used to detect symmetrical presentation) -limited mobility -signs of inflammation (pain, swelling, redness, increased in temp) -most common jts: hands, feet, c-spine -systemic features of RA: Weight loss, extreme fatigue, fever -PT GOALS: reduce pain and inflammation, maintain/improve jt function, jt mechanics, and connective tissue mobility, aerobic condition
hyperextension in stance gait deviation
compensation of weak quadriceps plantar flexor contracture
hill-sachs lesion
compression fracture of the posterior humeral head
hill sachs lesion
compression frx of posterior humeral head
angle of femoral neck with shaft of femur is _____ coxa vara angle of femoral neck with shaft of femur is _____ coxa valgus
coxa vara <115, coxa valgus >125
which diagnostic imaging is used for spinal stenosis? 1. xrays 2.CT scans 3.MRI 4.bone scans
ct scan (page 81)
elbow flexion test
cubital tunnel test; hold elbow in flex for 5 min with wrist neut to elicit symptoms
how do you use the quadrant test to assess a facet dysfunction on the Left?
cue patient to sidebend L, rotate R, and extend maximally to compress the facet joint on the L
what degrees of scoliosis would be considered to be treated conservatively/with bracing/with sx placement of Harrington rod instrument
curvature less than 25 = conservative curvature 25-45 = bracing curvature greater than 45 = sx with harrington rod
which is NOT an early sign/symptom of whiplashed-associated disorder? a. limited flexibility b. vertigo c. nausea d. disequilibrium e. changes in vision and hearing
d. disequilibrum disequilibrium is a late sign. along with chronic head and neck pain, limitation in flexibility, tmj dysfunction, limited tolerance to ADLs, anxiety, and depression
what is the most common congenital foot deformity? a. Vertical talus b. Syndactyly c. Clubfoot d. Metatarsus adductus
d. metatarsus adductus is the most common -it has two types: rigid and flexible -treatment includes stretching exercises and casting if needed -sx option is release of abductor hallucis tendon -strengthening and regaining proper alignment of foot by using orthoses -85-90% of cases identified at birth resolve w/o tx by 1 year vertical talus - flat feet with "rocker bottom" Syndactyly, joined or "webbed" toes Clubfoot, foot points in and down
which is not a low-risk factor that allows safe assessment of ROM featured in the Canadian c-spine rules? a. absence of midline cervical spine tenderness b. delayed onset of neck pain c. ambulatory at any time d. mild paresthesias in fingers e. sitting in the ED f. rear-ended MVC
d. mild paresthesias - paresthesias are a high-risk factor
children with transient synovitis show a decrease of ROM in what motions?
decreased abduction and internal rotation
The following symptoms observed indicate what dysfunction? "pain and stiffness upon rising with pain easing through the morning (4-5 hours), pain is increased the repetitive bending activities, constant awareness of discomfort w/ episodes of exacerbation, describes pain as more soreness and nagging" 1. degenerative joint disease 2. facet joint dysfunction 3. disc with nerve root compromised 4. spinal stenosis
degenerative joint disease
counternutation
describes a movement that involves extension of sacrum and anterior rotation of ilium
what are the similarities and differences between humeral neck fractures and greater tuberosity fractures?
differences: -humeral neck fractures commonly occur with older, osteporotic women and FOOSH -greater tuberosity fractures are more common in middle-aged and elder adults, usually related to falling ONTO the shoulder similarities: -generally does not require immobilization or sx repair -EARLY PROM IS IMPORTANT IN PREVENTING CAPSULAR ADHESIONS, emphasize on return to function w/o pain
metatarsalgia
etiologies mechanical: tight triceps surare group and/or achilles tendon, collapse of transverse arch, over pronation of forefoot, short first ray -structural changes in transverse arch, possibly leading to vascular and/or neural compromise in tissues of forefoot -changes in foot wear c/o frequently heard: pain, pain in metatarsalheads after prolonged periods of WB, pt goals/intervention: edu of footwear selection, orthrosis, decrease pain and address biomechanical abnormalities (improving flexibility of triceps surae)
which tendons are inflammed with deQuervain's tenosynovitis
extensor pollicis brevis and abductor pollics longus
lateral epicondyle frxs (population, sx)
fairly common in young ppl, typically require ORIF to ensure absolute alignment
true/false there are usually temporary sensory deficits with ankylosing spondylitis in the beginning of diagnosis
false with beginning stages of ankylosing spondylitis, there are usually no sensory deficits. with spinal stenosis, there are usually temporary sensory sensory deficits
t/f fibula stress fractures are more common than tibia stress fractures
false - 49% of all stress fractures involve the tibia, 10% involve the fibula
T/f the tendons of the rotator cuff have good blood supply near insertion point of muscles
false - the tendons of the rotator cuff are suscpectible to tendonitis b/c of relatively POOR blood supply near the insertion point of the muscles
true/false - thomas test differentiate between tightness in iliacus versus psoas major
false ]it does not differentiate between tightness in iliacus versus psoas major
T/f metatarsus adductus cases require the surgical release of the abductor hallucis tendon
false. most cases (85-90%) resolve without tx in a year
innervation of hip joint (what nerves)
femoral obturator sciatic superior gluteal nervees
S1 myotome
foot inversion and eversion
no toe off gait deviation causes
forefoot/toe pain weak plantar flexors weak toe flexors insufficient plantar flexor ROM
iliofemoral joint closed packed position
full extension and internal rotation
tibofemoral closed packed position
full extension, lateral rotation of tibia
subtalar closed packed
full inversion
midtarsal joint closed packed
full supination
L5 myotomes
hip abduction, flexion, internal rotation great toe MTP extension
L2 myotomes
hip flexion, abduction, external rotation
Finkelstein's Test
identifies de quervain's tensynovitis (tendonitis of abductor pollicis longus and/or extensor pollicis brevis) -examiner PASSIVELY grasps the thumb and ulnar deviates the hand sharply -(+)reproduce pain in wrist
Eichhoff's test
identifies de quervain's tensynovitis (tendonitis of abductor pollicis longus and/or extensor pollicis brevis) -patient makes a fist with thumb flexed within confines of fingers, examiner passively moves ulnar deviation -(+) reproduce pain in wrist, often painful with no pathology, so compare to uninvolved side
wrist hyperabduction and abduction of the thumb test (WHAT)
identifies de quervain's tensynovitis (tendonitis of abductor pollicis longus and/or extensor pollicis brevis) -patients wrist is hyperflexed with thumb abducted in full MCP and IP extension -Resistance is applied against examiner's index finger -(+)reproduces pain in the wrist
Lhermitte's sign
identifies dysfunction of spinal cord and/or an upper motor neuron lesion. -patient is long sitting on table, passively flex patients head and one hip, while keeping in the knee in extension -repeat with other hip - (+) electrical pain down the spine
pinch grip test
identifies entrapment of anterior interosseous nerve -patient asked to pinch tips of index finger and thumb -(+) if patient is unable to pinch tip to top, or pulp to pulp pinch appears
axillary pouch
in between the anterior and posterior bands of the inferior glenohumeral ligament, resist inferior translation when the shoulder is above 90 abduction
signs of decompensation (special considerations of heart failure)
increased SOB increased weight increased LE edema abdominal swelling pain fatigue pronounced cough lightheadness/dizzines
ABI >1.4
indicates rigid arteries and needs an ultrasound to check peripheral artery disease; An ankle-brachial index greater than 1.1 relates to arterial calcification in the leg. With arterial calcification, the artery cannot be fully compressed for valid measurement of arterial pressure at the ankle. An ankle-brachial index greater than 1.1 is mostly found in patients who have diabetes.
with anterior-inferior dislocation of the glenohumeral jt, which structures are most likely torn?
inferior glenohumeral ligament, anterior capsule, and possibly the glenoid labrum
borders of the femoral triangle
inguinal ligament, satorius, and adductor longus
heel lift during midstance
insufficient dorsiflexion range, plantar flexor spasticity
insufficient hip extension at stance
insufficient hip extension ROM hip flexion contracture lower extremity flexor synergy
exaggerated hip flexion during swing
lower extremity flexor synergy compensation for insufficient ankle dorsiflexion
Murphy sign (hand/wrist)
make a fist, positive test is indicated by patient's third metacarpal level with the second and fourth metacarpals. positive test may be indicative a dislocated lunate
closed pack of talocrual joint
max dorsiflexion
tibial plateu frx commonly occurs with what knee ligamentous injury
mcl injury
trimalleolar fractures involves what strctures
medial and lateral and posterior tubercle of the distal tibia
subtalar loose packed
midway between extreme ranges of motion
midtarsal joint loose packed
midway of extreme ranges of motion
ABI 0.8-.99
mild blockage, beginning of arterial disease
slocum test
modification of anterior drawer test which tests anteromedial rotary instability (AMRI) and anterolateral rotary instability (ALRI) of the knee - the therapists internal rotates the tibia 30 degrees and stabilizes the lower leg by sitting on the forefoot - perform anterior directed force to the tibia on the femur - (+) indicates the movement of the tibia occurring primarily on the lateral side and may be indicative of anterolateral instability
what is the difference between treatment for non-postural vs postural talipes equinovarus
non-postural: requires sx intervention to correct deformit yfollowed by casting or splinting; achilles tenotomy may be necessary postural: manipulation followed by casting or spliting (Ponseti method), followed by casting, stretching is important. Orthoses (denis-browne splints) throughout the day for up to 3 months and then at night for up to 3 years
functional range of of TMJ opening, rotation, and translatory glide
opening: 40 mm rotation: 25 mm translatory glide: 15 mm
which one of these skeletal/soft tissue conditions does not have the emphasis of patient education and training/retraining of IADLS ? 1. osteoporosis 2. tendonopathy 3. bursitis 4. muscle strains
osteoporosis - PT goals/interventions focus on: jt/bone protection strategies, implementing aerobic/endurance conditioning, and edu on dietary changes to improve mineral intake
requirements of shoulder elevation
page 35 - scapular stabilization - inferior glide of the humerus - ER of humerus - rotation of the clavicle at the sternoclavicular joint - scapular abduction and lateral rotation of the acromioclavicular joint - straightening of the thoracic kyphosis
Which visceral tumor is most likely presents with deep, gnawing pain that may radiate from chest to back? a. thyroid b. esophagus c. pancreas d. stomach e. lung
pancreas esophagus tumor presents as pain radiating to the back, pain with swallowing, dysphagia, and weight loss
positive camel back sign
patella alta -two bumps over anterior knee region instead of typical one -two bumps since patella rides high within femoral condyles, creating a superior bump w/ tibial tuberosity forming second pump inferiorly
anterior labral tear test
patient is placed in full hip flexion, external rotation, and abduction to begin test. the therapist then moves the hip into extension, internal rotation, and adduction. (+) pain or click used for diagnosing an anterior labral tear, though it may be indicative of illiopsoas tendonitis or anterior-superior impingment
tripod test
patient is positioned in sitting with knees flexed to 90 degrees over the edge of test. therapist passively extends one knee. (+) indicates hamstring tightness or extension of the trunk in order to limit the effect of tight hamstrings
what is the gold standard for treatment for hip dysplasia?
pavlik harness -maintain hip in flex and abduction position to maintain femoral head in acetabulum 85-95% success rate with use in newoborns to 6 months
Klisic sign
performed by placing the index finger on the anterior-superior iliac spine and the middle finger on the greater trochanter. An imaginary line between these points passes through or above the umbilicus in a child without developmental dysplasia of the hip (negative Klisic test). The line passes below the umbilicus if the hip is dislocated (positive Klisic test) because the greater trochanter is in a more superior position.
Which are not deformities that can lead to pigeon toeing? a. internal tibial torsion b. femoral anteversion c. flat feet d. metatarsus adductus e. femoral retroversion
pigeon toeing is also known as toeing in the deformities that do not lead to pigeon toeing/toe ining are femoral retroversion and flat feet. femoral retroversion and flat feet lead to toe-out
toe down instead of heel strike
plantar flexor spascity, plantar flexor contracture weak dorsiflexors, dorisflexor paralysis, leg length discrepancy, hindfoot pain
craig's tests
positioned in prone, w/ test knee flexed to 90 degrees therapist palpates the posterior aspect of the greater trochanter and medially and laterally rotates the hip until the greater trochanter is parallel to the table. the degree of femoral anteversion corresponds to the angle formed by the lower leg w/ perpendicular axis of the table normal anteversion for an adult is 8-15 degrees
roos test
pt in sitting or standing. PT moves pts shoulder into ABD 90 deg, full ER, & elbow flexion 90 deg. pt instructed to open and close the hands slowly for 3 minutes. (+) pt unable to keep arms in starting position for 3 min, suffers ischemic pain, heaviness or profound weakness of the arm, numbness & tingling of the hand. (-) if only minor fatigue and distress. Indicates thoracic outlet pathology.
Costoclavicular syndrome test/MILITARY TEST
pt in sitting. PT monitors the patient's radial pulse and instructs pt to assume a military posture. PT draws the pt's shoulder down (w/ elbow fully extended) and back into shoulder extension. (+) absent or diminished radial pulse. Identifies thoracic outlet syndrome (costoclavicular syndrome) caused by compression of the subclavian artery b/w the first rib and the clavicle.
which rearfoot deformities results in more musculoskeletal problems? a. rearfoot valgus b. rearfoot varus
rearfoot varus due to increased mobility of hindfoot in REARFOOT VALGUS, fewer musculosketetal problems develop from this deformity with rearfoot varus
calcaneofibular ligament
resists inversion of talus w/ midrange of talocrual motion
cozen's test
sitting with elbow in slight flexion, PT places thumb on patient's lateral epicondyle while stabilizing the elbow joint. the patient is asked to makea fist, pronate the forearm, radially deviate, and extend the wrist against resistance. (+) may be indicative of lateral epicondylitis
dynamic arm exercise in cardiac rehabilitation
smaller muscle mass, resulting in lower VO2max (60-70% lower) than leg ergometry at given workload HR will be increased, SV will be decreased, systolic and diastolic blood pressure will be increased (page 267)
garden spade deformity
smith fx = distal radial fx with ventral (anterior) angulation (fragments are displaced on palmar side) note: MOI is fall on back of pt's hand, garden spade is a lil shovel (appearance with spade upright sitting flat)
hoover test
supine. Cup both calcaneouses. Active straight leg raise of one side. If cheating/lying, there wont be any downward pressure on the side that isn't being raised.
what are the positions of the following joints in talipes equinovarus calcaneocuboid midtarsal subtalar talocalcaneal talocrural talonavicular
talipse equinovarus is also known as clubfoot plantar flexion at the talocrural joint inversion at the subtalar joint, talocalcaneal, talonavicular, calcaneocuboid joints supination at the midtarsal joint
the piriformis is an external rotator of the hip at less than ___ deg of hip flexion and can be overworked with excessive ______ of the foot causing abnormal femoral __________ rotation. At ___ of hip flexion, the piriformis becomes an internal rotator and ______ of the hip.
the piriformis is an external rotator of the hip at less than 60 deg of hip flexion and can be overworked with excessive pronation of the foot causing abnormal femoral internal rotation. At 90 deg of hip flexion, the piriformis becomes an internal rotator and abductor of the hip.
which types of ankle fractures according to the salter harris classification are most concern and have a high complication rate?
type III and IV (table 2-31)
which test is important to perform before mobilizing/manipulating the cervical spine?
vertebral artery test; without performing this test beforehand would be considered, by most, to be a breach in standard of care even if current evidence demonstrates statistical limitations of this test
foot slap due to
weak dorsiflexors, dorsiflexor paralysis
insufficient hip flexion at initial contact
weak hip flexor, hip flexor paralysis, hip extensor spasticity, insufficient hip flexion range of motion
galeazzi sign
when inspecting the thighs and gluteal fold of the hips w/ knees flexed, a shortening of the femur w/asymmetrical skin folds is positive for DDH.
which one of these tests do not have have a high SN when combining 2 other tests for SLAP lesion? 1. yergason test 2. compress-rotation test 3. active compression test 4. apprehension test
yergason test yeargason test along with bicep load II test and speed tests have a high SP apprehension, compression-rotation, and active compression have a high SN when choosing 2
If a patient is 55 years old and who has been sitting in the emergency room after being rear-ended while driving. She has normal neck ROM on the right but limited ROM on the left, does the patient need radiography?
yes - the patient's age does not indicate a high risk factor that mandates a radiography - patient does have low risk factors including rear-ended motor vehicle collision and sitting in the ed - most importantly, the patient is unable to actively rotate 45 neck in both right and left, therefore needs a radiography
proximal radioulnar open packed
70 degrees flexion, 35 degrees supination
