Comprehensive MSK Review (all classes)

DF-EV test

*Tarsal Tunnel* -DF, EV foot and toes -hold 5-10 seconds -*(+) changes in symptoms (esp numbness)*

Tinel sign at ankle

*Tarsal Tunnel* -percus tibial nerve (behind medial malleolus

Triple Compression Test for Tarsal Tunnel

*Tarsal Tunnel* -position pt. ankle in full PF and inversion -apply pressure for 30s to post tibial nerve *(+) is reproduction or intensifying of clinical symptoms*

Fairbanks's apprehension test

*Testing Patellar instability* -pt. supine w/ knee flexed to 30 -examiner pushes patella laterally slowly and carefully -positive if pt. feels the patella is going to dislocate, quads contract to bring patella back into position -may also have apprehensive look

WOMAC

*Western Ontario McMaster Universities Osteoarthritis Index* -self administered questionnaire used with patients who have hip or knee osteoarthritis. -24 Q's on pain, stiffness, and function

Abnormal Aortic Aneurysm (AAA)

*abnormal dilation in a weakened or diseased arterial wall* - > 3 cm is considered aneurysmal -most common vascular cause of acute LBP -generally asymptomatic until rupture -often have negative physical exam

Q angle

*angle btwn ASIS and midpoint of patella on same side and from tib tubercle to midpoint of patella* -angle formed by crossing these lines NORM: -M: 13 degrees -F: 18 degrees

L4 myotome

*ankle DF* and Knee Exension (heel walking)

what causes tarsal tunnel syndrome (6)

-chronic biomechanical mal-alignment -acute trauma -direct blow -soft tissue mass -bony exostosis -tight shoe gear

Legg-Calve Perthes Disease

*avascular necrosis of femoral head* -children 4-10 -unilateral 90% of time -4xboys>girls -ache in groin that radiates to medial thigh and inner aspect of knee -*muscle spasm and trendelenburg sign* -*decreased hip ABD and IR*

RA

-chronic inflammatory disease affecting synovium of the joints -3 stages (swelling, thickened synovium, enzyme release causing bone/cartilage destruction) -systemically affects other organs, skin, and bones

piriformis syndrome

*compression neuropathy of the sciatic nerve at level of piriformis* Traumatic or gradual onset with: -Primary: Anatomic anomaly -Buttock contusion/blunt trauma -prolongued sitting -running *can treat with lumbar spine and SIJ*

Lateral excursion primary muscles (2)

*contralateral* medial & lateral pterygoid

Royal london hospital test

*differentiate btwn tendinopathy from peritendinitis* -prone w/ feet off edge of table -identify area of maximal tenderness -pt. actively DF ankle -palpate previously identified area *(+) for tendonapathy if dec or absence of pain*

Slipped Capital Femoral Epiphysis (SCFE)

*displacement of femoral head* -typically occurs during adolescent growth spurt -most common disorder of hip in in adolescent -girls:12/boys: 14 -*dull/achy groin/medial thigh pain* -*limp w/ ER often* -*decreased IR* -*Leg length discrepancy of 1-3cm*

L5 myotome

*great toe extension* ankle EV, Hip Abd

L2 myotome

*hip flexion* & hip ADD

innervation of iliopsoas

*iliacus*: Femoral nerve (L2-L4) *psoas*: ant rami of lumbar plexus L1-L3

Most running injuries relate to...

*insufficient fitness OR inefficient technique LEADING TO exhausted adaptive potential

Patellar Tendinopathy (8)

*jumpers knee* -anterior knee pain usually *inferior pole patella* -overuse injury w/ gradual onset -worsened w/ loading of quads -15-30 y.o men>women -tender to palpation -stiff in AM -crepitus

L3 myotome

*knee extension* and hip add

immediate referral and initiation of PT within 3 days of acute LBP may lead to:

*lower health care utilization and LBP related costs* -seeing a pt with acute LBP with less than 2 weeks from onset is cost effective

Femoral Acetabular Impingement Syndrome

*misshaped hip leads to breakdown of intrarticular structures, causing pain and assoc dysfunction* -leads to premature development of OA -unilateral pain -deep pain w/ squat, prolonged sitting, crossing legs -positive C sign -less pain w/ rest and NSAIDs *-FADIR only clinically useful test*

how does FAIS affect step down?

*more adduction than normal people* -adduction is painful

It is imperative to consider what when unstable biceps tendon is detected??

*must rule out subscapularis tear* because the 2 structures are so closely linked (subscap tendon is soft tissue restraint over biceptial groove)

type 2 SLAP tear

- Detachment of superior labrum and biceps insertion from gleoid rim

What issues might be present that cause compression of nerves/vessels in TOS? (2)

-clavicle movement disturbance -costoclavicular narrowing

ulnar nerve compression findings (7)

-claw hand -unable to extend distal phalanges -unable to ABD/ADD fingers -froment's sign -loss of sensation in ulnar distribution -atrophy in interosseous spaces -local pain

Intra-articular pathology key features (2)

-clicking or catching w/ elbow motion -MRI or arthroscopy may detect cartilage defects or intra-articular bodies

Secondary external impingement

-clinical phenomenon presenting as scapular dyskinesis or muscle imbalance changing center of rotation

Neck pain w/ radiating pain: chronic interventions (3)

-combined exercise: stretching & strengthening plus manual therapy for c or t spine -education: encourage normal activity -intermittent traction

prognosis of DRUJ instability

-combined injury dec chances for success -high complication rates following complex forearm fracture & distal radius fracture management -no studies on conservative care success

lateral pelvic shift

-common in McKenzie derangement classification -SMP: side glide technique + for centralization or peripheralization

Stress fracture (hip)

-common in military recruits and runners/athletes (female triad) -sudden hip pain assoc w/ recent changes in training -pain is in *deep groin/anterior thigh* -can also occur in lateral aspect of thigh -*occurs w/ WB or extremes of motion* -*night pain* -*(+) patellar pubic compression/fulcrum test*

Colles Fracture

-complete fracture of distal radius w/ post or dorsal displacement of distal fragment -FOOSH -lateral film diagnostic -silver fork deformity -treated with closed reduction of fracture and immobilization

ulnar compression test

-compress wrist into radius and go from radial to ulnar deviation -see and feel rows reduce

Rotator cuff functions (4)

-compression -primary mover for rotation -provide muscular balance & dynamic stability of GH joint when other muscles across shoulder joint contract -may assist in humeral glide

glute med/min involvement in GTPS

-compression of the glut med/min tendons against greater trochanter -ITB exerts progressively higher compressive load at GT as *hip is adducted* -atrophy and fatty infiltrates identified in glute med/min

What is Scheuermann's disease?

- most common cause of idiopathic thoracic pain in adolescents -vertebral end plate abnormalities -deformity in thoracic or thoracolumbar spine

What is the evolving viewpoint regarding knee OA? (4)

-"wear and REPAIR" of variable speed & effect -involves all structures w/in a joint: cartilage, bone, synovium, ligaments, muscles, new tissue formation of bone adjacent to synovial joint, osteophyte formation at joint margins -may be an inflammatory component although controversial -variability in clinical & radiographic presentation yield management strategies targeting the biopsychosocial approach

hamstring strain S&S (7)

-(+) past hamstring injury -pain w/ resisted knee flexion -dec hamstring length -tenderness to palpation - +/-swelling/ecchymosis -usually partial and takes place during ECC phase of muscle usage -most at musculotendinous junction

Neck pain w/ movement coordination impairments: expected exam findings (8)

-*+ cranial cervical flexion test* -*+ neck flexor endurance test* - + pain pressure -dec strength & endurance of cervical muscles -pain at mid ROM that increases @ end ROM -myofascial trigger points -sensorimotor impairments -neck & referrred pain produced w/ segment provocation

femoral nerve test

-*L2-L4* -*sensitive in those w/ upper lumbar severe disc herniation* -*(+) is reproduction of anterior thigh pain and/or back pain between 80-100 degrees of knee flexion* -can be performed prone or side lying -sensitizing maneuver (cervical flexion and or hip extension

Anterior interosseous syndrome key feature

-*Pain and motor function loss only* -no paresthesia!

3 signs of Horner's syndrome

-*Ptosis*: moderate droop of ipsilateral eyelid -*Miosis*: decrease in ipsilateral pupil size -*Anhidrosis*: lack of sweat production to ipsilateral head/body/forehead

hip ADD strain (6)

-*adductor longus most common* -11% recurrence rate -soccer and hockey highest -opposes rectus abdominus -sports hernia implications -*adequate length and tissue quality is dependent on anterior core*

FAIS treatment (6)

-*decrease swayback posture* (verbal cues) -(dec hip extension which dec anterior hip joint force) -*stretching to improve hip ER and ABD* -*avoid W sitting* -*avoid running on treadmill* -*avoid cycling* -*avoid prolonged sitting*

retroversion of hip

-*limited hip IR and excessive ER* were related to decreased FNA -generally *toeing out*

MRI and LBP

-*many people have abnormal MRI w/o symptoms* -can be beneficial for those with radiating pain

risk factors for low back pain (4)

-*obesity* -nicotine dependence -alcohol abuse -depressive disorders

What is the "wind up effect" and how can different muscles affect this?

-*wind up effect* = scapula moves w/ humerus during IR -pec minor & biceps muscle length short/stiff -serratus anterior & traps weak/long -can look at AC & SC joint mobility also

Migraint w/ Aura - at least 2 attacks meeting this criteria: (2)

-1 or more of following reversible aura symptoms: visual, sensory, speech or language, motor, brainstem, retinal -3 or more of following: at least one aura symptom spreads over 5 or more mins, 2 or more aura symptoms in succession, each individual symptom lasts 5-60 mins, 1 or more aura symptom unilaterally, 1 or more symptom is pins & needles, aura is accompanied or w/in 60 min or HA

WB PF strength scale

-1 rep 3/5 -2-9 reps 4/5 -10 reps 5/5

putting foot on opposite thigh requires what ROMs

-120 flexion -20 ABD -20 ER

hip step test

-15 cm high step (5 inches) -15 seconds

cyriax release test

-15 deg of posterior trunk lean -passive elevation of shoulder girdle -hold up to 3 minutes positive if reduction of symptoms -prone to false positives

Bone/Joint intervention considerations (4)

-1st rib -other ribs -upper thoracic segments -UE chain

Tension headache must meet these 2 criteria, regardless of chronicity:

-2 or more of the following: bilateral location, pressing or tightening quality, mild-mod intensity, not aggravated by routine PA -both of following: no n/v, no more than one of photo or phonophobia

what should AROM and endfeel be for radial deviation?

-20-25 -bone on bone

lumbar derangement (disk herniation) S&S (11)

-20-55 y.o -recent onset -often constant pain/severe radicular pain -often neurologic deficits -directional preference -change w/ repeated movement -loss of movement and function -severe movement restriction -improved w/ unloading -antalgic gain -SLR

Elbow injury demographics in youth (4)

-23% overuse injury -30% pain = less fun playing -half encouraged to keep playing despite arm pain -pitchers > position players

gait requires what ROMs?

-25-35 flexion -10 extension

Risk Factors for LCP (4)

-2nd hand smoke -small build -low birth weight -slow development

Common running injuries: distal ITB pain (2)

-2nd most common injury in funners (F 2x > M) -associated w/ excessive hip ADD & tibial IR, possibly crossing over midline during stride

Mini-open rotator cuff repair (3)

-3 cm slit in deltoid -some residual stiffness -quicker mobilization & better fixation

patellar glides

-30 degrees of knee flexion w/ relaxed quads -normal medial and lateral glide is approx half its width -can also do superior and inferior

timed single leg stance

-30 seconds -hands on hips -visual fixation

Marx activity rating scale

-4 points: running, deceleration, cutting, and pivoting -5 point scale -MCID not known

tinel sign

-4-6 taps to ulna -just proximal to cubital tunnel -+ for tingling in ulnar distribution

Piriformis Syndrome cluster (7)

-40-50 y.o -dull posterior buttock pain -may radiate down leg in sciatic distribution -aggravated by sitting -HIP IR: may ease w/ ER -palpation over piriformis -slumped positions such as driving in car

Common running injuries: achilles tendinopathy (3)

-40-50% of runners over lifetime -structurally associated w/ high or low arch -mechanically associated w/ forefoot strike, excessive rearfoot eversion

Plantar Fasciitis (6)

-40-60 y.o Female > male -many at medial calcaneal tubercle along w/ plantar fascia -pain upon rising from bed/chair -made worse w/ prolonged WB, poor footwear, overweight, pregnancy -decreased DF -calcaneal bone spur is often present but is only a source of pain in minority of cases

adhesive capsulitis illness script

-40-65 years -female>male -gradual onset -multi-directional loss of motion (capsular patterns) ER most limited -joint glides restricted in all directions -pain at end range -previous episode in contra arm -PMH DM or thyroid

Pincer deformity - incidence

-42% of those w/ FAIS -88% of those w/ FAI have *mixed* (cam and pincer)

posterior glide GH (needs picture)

-45 and 90 degrees

normal standing craniovertebral angle

-48.8

where and how do you test chest expansion

-4th intercostal space -1-3 inches normal -link with ankylosing spondylitis

Scapular dyskinesis test

-5 Repetitions of bilateral, active, weighted shoulder flexion and abduction -Need to observe scapula -Patient elevates both arms thorugh full ROM 3 second up and 3 second down -3# if weight less than 150# -5# if weight greater than 150# -graded as normal, subtle dyskinesis, obvious dyskinesia

how to test for effort during grip strength testing?

-5 position grip strength test -rapid exchange grip test

as you move to full overhead motion, what should the scapula do?

-50-60 deg of up rot -IR reduces from 30-40 to 10-20 -posterior tilt of 10 degrees -lateral border of scap to mid-axillary line

PCL Tear incidence (3)

-57% of PCL tear from MVA -2% of high school knee injuries -M > F

ischemic signs of VBA dissection

-5Ds -anhidrosis -malaise

Hip OA CPG - physical performance measures (4)

-6 MWT -30" chair stand test -TUG -Stairs

Incidence of Cam Deformity (2)

-78% of those w/ FAIS -may increase risk of future OA

Consequences of no biceps repair (2)

-88% losss of flexion strength -74% loss of supination strength

retear rate for ACL

-9.6-25% -only 33% return to previous level of function

Debridement of SLAP tear indicated for what %?

-< 25% tendon involved or < 50% in older, sedentary adults

RTC tear risk factors

->40 yo -repetitive overhead lifting -trauma

shoulder referral pain from heart disease if (4)

->50 years -post menopausal women -first generation family hx -younger individuals have more atypical symptoms

when should you be esp worried about heart disease?

->50 yo -postmenopausal women -first gen family hx -younger individuals have more atypical symptoms

full thickness RTC tear cluster 2

->60 -painful arc -drop arm -ER resisted test

Supporting SC joint structures (3)

-A & P SC ligaments -costoclavicular ligament -joint capsule

MWM for DF

-A belt (padded) is placed over distal posterior tibia/fibula and around the clinician buttock -Apply stabilizing force over anterior talus with your hands. -A static force is applied to the talus while the patient slowly, actively leans into DF -This is done in a PAINFREE range, then they return to normal stance -Repeat 3- 4 sets of 10 reps

Medial ankle sprain

-ABD and ER of ankle -sometimes assoc w/ lateral malleolus fracture or syndesmotic injury -rare

females with PFPS demonstrate what?

-ABD and ER weakness

UCL sprain test

-AKA gamekeeper's or skiers thumb -stabilize pts. hand with one hand -take thumb into ext -apply a valgus stress to MCP joint to stress UCL + for valgus movement 30-35

what to assess during ROM assessment portion of t-spine exam

-AROM w/ overpressure and resistance? -overhead squat -compression -distraction -thoracic rotation SFMA -rib mobility during breathing

red flag cluster for lumbar (4)

-Age > 50 -Hx of cancer -unexplained weight loss -failure of conservative therapy

Hip OA Clinical Presentation (5)

-Age > 50 -moderate anterior or lateral hip pain w/ WBing -morning stiffness < 1 hour -Hip IR < 24 deg, or Hip IR (in flexion) < 15 than non-painful side -pain increased w/ passive hip IR

ICF classifications in ankle/foot

-Ankle stability w/ movement coordination impairments (lig sprain) -Heel pain (plantar fascitis) -ankle muscle power deficits (achilles tendinopathy) -Ankle and foot radiating pain (tarsal tunnel) -Great toe mobility deficits

What are the primary physiological motions of the SIJ? (2)

-Ant Rotation of Innominate = Post Sacrum Rotation -Post Rotation of Innominate = Ant Rotation of Sacrum

MWM after inversion ankle sprain

-Apply a dorsal cranial mobilization force (causes slight DF and EV) and uses opposite hand to support the ankle mortise -Patient PF and inverts foot -At end of range clinician applies overpressure with abdomen or patient with a band

risk factors for plantar fasciitis (3)

-BMI>30 -on feet majority of day -recreational jogger

how should we be careful of artery dissections?

-BP -UQS -Cranial nerve exam -eye exam -handheld doplar -pre-manipulative hold

Swelling special tests (3)

-Ballottement -Modified stroke -Girth measures

Functions of Breathing (5)

-Biomechanical *(Movement)* --respiratory pump --changes in intra-abdominal & intra-thoracic pressure -any movement can be dysfunctional or compensated for -Biochemical *(Gas Exchange)* --effects on blood gases & chemistry (O2,CO2,pH)

Brief Pain Inventory

-CA pain -HIV -neuropathy -LBP -OA *no MCID*

Lumbar Disc Herniation Classification based on Anatomic location (central, lateral recess, foraminal, extraforaminal)

-Central: w/in borders of dural sac -Lateral Recess: bordered by the lateral margin of dural sac & the medial aspect of pedicle and neural foramen -Foraminal: space between ipsilateral adjacent pedicles -Extraforaminal: lateral to the pedicles

Functional Tests for TOS

-Cervical Rotation Lateral Flexion for 1st Rib -others, such as muscle length/tone

The ZOA is controlled by what muscles and directs what muscle?

-controlled by abdomen & obliques and directs diaphragm

What are s/sx of arterial TOS? (4)

-cool -pale -numbness -cold temp increases symptoms

Neck pain with movement coordination impairments

-cranial cervical flexion test -deep neck flexor endurance -moderate evidence -trigger points -WAD

where can the ulnar nerve become entrapped?

-cubital tunnel -guyon's canal (btwn pisiform and hamate)

What is the zone of apposition?

-cylindrical aspect of diaphragm that apposes the inner aspect of lower mediastinal wall

Neck pain w/ mobility deficits: expected exam findings (5)

-dec ROM -pain produced @ end P/AROM -dec segment mobility of C &/or T spine -neck & referred pain produced w/ segment provocation -may have dec neck & scapulothoracic strength, endurance, motor control

What issues might be present that cause tension on nerves/vessels in TOS? (3)

-dec shoulder elevation -downward scapular positioning -increased S-pathway

Muscle and Soft Tissue changes with aging (5)

-decline in water, elastin, and proteoglycan content -dec collagen diameter, fibril size, and aggregation -dec type II muscle fibers -increased crosslinks causing stiffness lack of extensibility -alterations in muscle length and strength capabilities (sarcomere #'s)

Contained vs Uncontained Disc Herniation

-Contained: (subligamentous) the herniation has not progressed beyond the outer fibers of annulus and not through the PLL -Uncontained: the herniation has progressed through annular fibers & PLL

Sympathetic Management modalities (3)

-E stim -manual therapy to thoracic region -activity

what makes up the anatomical snuff box

-EPB -APL -FCR

ECHOWS

-Establish rapport -Chief complaint -Health history -Obtain psychosocial perspective -Wrap-up -Summary of performance

Impaired stability is correlated with what 5 things?

-decreased muscle endurance -insufficient motor control -diminished lumbar position sense -poor postural control -longer muscle reaction time to perturbation

Cluster for Vascular Claudication (2)

-decreased walking complaints w/ standing rest -symptoms located below knees

What is the historical viewpoint regarding knee OA? (2)

-degenerative "wear & tear" of the joint -progressive destruction of articular causing joint destruction & pain

Common running injuries: stress fx / metatarsalgia (3)

-F > M -context: associated w/ quick changes in mileage, poor health/nutrition, amenorrhea -mechanics: associated w/ poor force attenuation, low arch w/ rearfoot EV, high arch w/ rearfoot INV, forefoot striker

classic subjective complaints for scaphoid fracture/carpal instability

-FOOSH -pain with loading wrist

Rotator Cuff MOI (5)

-FOOSH -jerking motion -degeneration (dec blood supply & bone spurs as age) -repetitive motion, especially overhead -s/p dislocation

anterior interosseous syndrome can affect what muscles (3)

-FPL -FDP -pronator quadratus

other MSK process that can refer to knee: (4)

-degenerative joint disease at hip -spinal stenosis (leg cramps, buringing, neurogenic claudication) -lumbar radiculopathy -SIJ dysfunction (rare)

what to look for when forward bending (4)

-delayed hip movement in first 50% of range -lack of curve reversal when returning to upright -amount of kyphosis - < 70 degrees of hip flexion at end of movement

Muscles causing elevation (3)

-deltoid -infraspinatus, teres minor, subscapularis -supraspinatus is *least effective* to offset deltoid

Mulligan cervical snag guidelines

-determine side of pain -determine direction of restriction -determine level of pain/restriction -first SNAG the side of pain or tightness and into direction of most restricted position -make adjustments if needed to pressure, level, side, etc

positive alar ligament test

-Failure to feel the movement of the C2 spinous process away form the side of rotation or lateral flexion -Cervical ROM does not change with stabilization of C2 (Side bend or rotation to the RIGHT tests the LEFT ligament)

yellow flags for LBP (2)

-Fear avoidance -psychosocial factor

Charcot Foot - risk factors (4)

-diabetic neuropathy (by far biggest factor) -any cause of protective sensation -trauma -recent foot surgery or infection

Osteoporosis - modifiable risk factors

-diet -inactive lifestyle -smoking -alcohol abuse -meds -health conditions

illness scripts

-differential diagnostic tool used in medical education -involves pattern recognition and hypothesesi testing -conveys experiential knowledge in a clinical matter -minimalist strategy using only key info

Ligament sprain 3rd degree (6)

-diffuse tenderness -swelling -hemorrhage -complete disruption -marked instability -severe disability

Radial tunnel syndrome - key features (5)

-diffuse, aching pain over wrist extensor muscles or sharp/shooting pain in dorsal forearm region, worse @ night -rarely sensory or motor changes -pain may be inc by resisted supination, neurodynamic tests, and/or nerve palpation -inconclusive electrodiagnostic tests -US may show nerve compression

treatments for symptom modulation TBC

-directional preference exercises -manipulation/mobilization -traction -active rest

what does the ICF model take into account

-disability -functioning -health conditions -contextual factors -environmental factors

McKenzie derangement

-disc -20-55 -variable pain pattern -onset varies -can have loss of motion in at least 1 plane -neurologic deficts and positive dural signs -*directional preference with repeated movement is hallmark* -rapid change in symptoms -goal is to reduce, centralize, abolish -once centralized, mvmt loss is treated w/ repeated end-range movements in direction of movement loss

Common causes of cauda equina (7)

-disc herniation -ankylosing spondylitis -spinal stenosis -trauma -tumors -infection -post surgery (basically, anything that can compress cord)

What is the prognostic indicator continuum for types of TOS from better to worse? (5)

-disputed neuro (posture, whiplash, double crush) -true neruo -vascular arterial -vascular venous -posttraumatic clavicle fracture, scalenes

volar intercalated segmental instability (VISI) (3)

-disruption of lunotriquetral ligament -lunate translates dorsally -scapholunate angle < 30 degrees confirms via x-ray

two forms of carpal instability

-dissociative -non-dissociative

axial load test (scaphoid)

-distal Radioulnar joint stabilized -axial compression is applied through thumb and trapezium into scaphoid -positive for pain

stride length

-distance btwn 2 successive placements of same foot (2 step lengths) -IC to next IC of same foot

stance width

-distance btwn heel centers -approx 2-4 inches

what structures reinforce the GH joint?

-GH ligs -coracohumeral ligaments

Talocrural Distraction Manipulation

-Grasp the dorsum of foot with interlaced fingers -Provide firm pressure with both thumbs mid plantar surface -Engage restrictive barrier by DF and Ev the ankle & applying long axis distraction. -Fine-tune the barrier with Pro, Ev and DF of the foot -Apply a high velocity, low amplitude thrust in a caudal direction.

symptoms of carotid artery dysection

-HA -5Ds -3 Ns

CAD Pain Symptoms (5)

-HA -neck pain -unilateral > bilateral -severe > moderate > mild -*ischemic symptoms: 5 D's and 3 N's*

What complaints are often associated w/ TMJ disorders? (4)

-HA -neck pain -ear complaints -altered posture

TMJ Disorders - HA Attributed to TMD

-HA in temporal region modified by jaw movement or function -TMJ dysfunction dx AND familiar pain w/ palpation of TMJ or temporalis muscle, and pain w/ max opening &/or lateral or protrusive movements -more Sn (0.89)

CAD - medical history

-HTN -hyperlipidemia -smoker -DM

cluster for SIJ (4)

-distraction -compression test (side lying) -thigh thrust -sacral thrust if centralization does not occur with 3+ LR=7+ (CLINEMETRIC ARE BETTER)

how to test rib expansion in upper vs. lower ribs

-Hi-Low test -pt. sitting -pt. places one hand on sternum and one on upper abdomen -5 breathing cycles -lower rib motion should be dominant

step length

-IC of one foot to IC of other foot

Thomas test test length of:

-IP -TFL -RF

Motions @ AC joint (3)

-IR/ER -tipping -rotation

Establish rapport

-Intro and Greeting -orient pts. to flow of visit

What clinical tests have been deemed to have strong clinical utility to diagnose cervicogenic dizziness? (10) (think lots of vestibular tests)

-dix hallpike -ortho hypo -spontaneous nystagmus -head impulse test -roll test -gaze hold nystagmus -saccade testing -VOR testing -head shake test -smooth pursuit test

What is cervicogenic dizziness?

-dizziness complaints that are associated w/ disorders of the cervical spine. --headache --cervical ROM (something funky about it) --neck pain --abnormal joint position sense --frequently w/ whiplash &/or concussion

what additional subjective questions do you want to know during an elbow exam?

-dominant arm -assoc pain in neck/shoulder -catching/locking -loose body/instability -sensory changes -occupation

how to test for first rib mobility?

-drape pt. arm over your leg (if seated) -cervical spine in slight flexion, SB, ipsi rotation -provide inf, medial, anterior glide on first rib towards opp. ASIS (testing for mobility and pain)

full thickness RTC tear cluster 1

-drop arm -painful arc -ER resisted test

cardinal signs during AROM

-drop attacks -facial or lip parasthesia -bilateral or quadrilateral parathesia-Lhermitte's sign -nystagumus

What are the ischemic symptoms?

-dysarthria -dizziness -diplopia -drop attacks -dysphagia -numbness -nystagmus -nausea

Based on STIFF end feel, what would be expected dysfunction and manual treatment?

-dysfunction = capsular restriction -Tx = Grade III & IV Mobs

Based on NORMAL end feel, what would be expected dysfunction and manual treatment?

-dysfunction = extra-capsular restriction -Tx = ID & stretch restricted tissue

Based on JAMMED end feel, what would be expected dysfunction and manual treatment?

-dysfunction = joint lock -Tx = Grade V or IV+ jerky mobs

Based on SPASM/GUARDED end feel, what would be expected dysfunction and manual treatment?

-dysfunction = pain, possible guarded instability -Tx = grade I & II Mobs

Running intervention - regional exam purpose (4)

-dysfunction, impairment, pain behavior -"test" for gauging hypothesis -body regions for local exam -continue working hypotheses

wrist and hand intervention

-early stage exer -active repositioning -mirror therapy -textured dowels -hand in bucket with textures

Triceps tendon injury MOI

-eccentric, deceleration injury

What are s/sx for venous TOS? (6)

-edema -feeling of heaviness -excruciating deep pain in the chest, shoulder, arm -cyanotic -distended collateral veins -*exercise increases symptoms*

Radial tunnel syndrome interventions (5)

-education -rest -activity mod -stretching -nerve glides

conservative care for FAIS (5)

-education -watchful waiting -lifestyle changes -activity modification -analgesia, NSAIDs, injection

Neck pain w/ movement coordination impairments: subacute interventions (3)

-education on activation & counseling -combined exercise: AROM, low load isometrics, PLUS manual therapy (mob or manip) -impairment based exercise

Management items for recurrent instability / laxity (3)

-education on self management techniques -strengthening -symptom focused to dec pain

Neck pain w/ movement coordination impairments: chronic interventions (6)

-education regarding prognosis, reassurance, pain management -cervical mob -individualized exercise -cognitive behavioral training -vestibular rehab -TENS

Neck pain w/ movement coordination impairments: acute intervention (4)

-education to remain active -HEP = ROM & postural training -monitor progress -minimize collar use

GRIT test for TFCC

-elbow at 90 deg of flexion -measure grip in full pronation / supination -GRIT ratio is pronation/supination ->1 indicates possible ulnar impaction syndrome

ICF classifications for the elbow

-elbow pain with mobility deficits -lateral and medial elbow pain with muscle power deficits -elbow and forearm radiating pain

acceleration evaluation

-elbow positioning -scapular dyskinesis =eccentric and concentric trunk control

How is posterior instability classically seen?

-electrocution & seizures -slowly over time from bench pressing & push ups; constantly in position of flexion & IR

What orientation of the ribcage will decrease the zone of apposition?

-elevated, anterior, and externally rotated ribs

Motions @ SC joint

-elevation/depression -protraction/retraction -rotation

Barrel chest

-emphysema

FUPs for females (5)

-endometriosis -ovarian cysts -menstrual history for back pain of unknown cause & young female athletes -pregnancy -changes in urination, bowel, gait, balance

For vulnerability of nerve tissue, what factors indicate worse prognosis? (4)

-endoneurium involvement ("true" nerve damage) -deep nerve involvement -localized compression -motor deficits

Cervical Exam Big Picture purpose (2)

-ensure patient safe for PT -begin formulating hypothesis

Running intervention - intake & big picture purpose (2)

-ensure safe for PT -begin formulating hypotheses

radial tunnel syndrome

-entrapment of posterior interoseous nerve (motor) -pareses of extensors thumb and fingers -ache and tenderness lateral forearm -sympt. w/ resisted supination -sensation intact -repetitive forearm pronation and supination -space occupying lesion or inflammation -most common at arcade of froshe->supinator -difficult to diff from lateral epicondy.

Pain & disability driver model - see powerpoint to discuss

-environmental factors = drivers of disability -BSF deficits = drivers of pain -personal factors = drivers of pain & disability

Neck pain w/ HA: common symptoms (2)

-episodic, unilateral neck pain & HA -HA precipitated by neck movement or sustained postures

ICF classifications for knee (2)

-Knee pain and mobility impairments (meniscal and articular cartilage lesions) -Knee movement coordination impairments (knee ligament sprain)

SLR Nerve Testing

-L4-S2 nerve roots -positive is reproduced radicular pain < 70 degrees hip flexion -more restricted SLR the more likely HNP -pt. supine w/ leg straight -flex hip to point of symptoms -sensitizing or differentiation (DF and EV/cervical flex and ext)

S/Sx of Central Lumbar Stenosis (7)

-LBP -LE pain into buttock and thigh (bilateral) -LBP w/o LE complaints, unlikely to be LSS -Neurogenic claudication -+/- symmetrical -+/- radicular complaints -dull ache to sharp character

S/Sx Lateral Lumbar Stenosis (7)

-LBP -LE pain into buttock and thigh (unilateral) -LBP w/o LE complaints, unlikely to be LSS -Neurogenic claudication -+/- symmetrical -+/- radicular complaints -dull ache to sharp character

ICF classifications for LBP (6)

-LBP w/ mobility deficits -LBP w/ movement coordination impairments -LBP w/ related or referred LE pain -LBP with radiating pain -LBP w/ related cognitive or affective tendencies (acute/subacute) -LBP with related generalized pain (chronic)

Differential Dx for IT Band Syndrome

-LCL -Lateral meniscus -Bicep Femoris

regional interdependence in Hip intervention

-Lumbopelvic manipulation reduces hip pain -hip involvment with primary complaintes of LBP -hip involvement in primary complaints of knee pain

Bicep tendon injury demographics (3)

-M>F -5th decade -sudden load

Neck pain w/ movement coordination impairment: common symptoms (5)

-MOI associated w/ trauma or whiplash -may have shoulder girdle or UE pain -may have concussion s/sx -dizziness/nausea -HA, concentration difficulty, memory, confusion, hypersensitivity to stimuli

ACL tear (6)

-MOI: deceleration with noncontact valgus or near full extension -hear or feel pop -hemarthrosis w/in 2 hours -Hx of giving away -loss of end range extension - (+) Lachman

gastroc/soleus muscle length

-Measure ankle DF with the knee extended and flexed -*Differences of greater than 5-7 degrees* may indicate shortened gastric -Can be done open or closed chain -If DF is more limited with the knee extended, gastroc length may be an issue -If DF is equally limited with knee flexed or extended, consider ankle joint, ligaments, or soleus

Neck pain recovery

-Mild problems: rapid (45%) -moderate problems: incomplete recovery (40%) -severe problems: no recovery (15%)

PROs for tspine

-NDI -ODI -PSFS -FABQ -NPRS

Breathing Exercises for Intervention (3)

-Nasal Breathing (tongue behind teeth on roof of mouth): 4-7-8- or 2-4-2 -breathing w/ hands on patient for cueing -crocodile breathing (inhale 3", pause, exhale 4-6", pause)

How does dysfunction present for the 3 aspects of the spinal subsystems?

-Neural: disordered recruitment, proprioception, inhibiiton -Passive: tissue damage or degeneration -Active: muscle atrophy, lost endurance

What is the neutral zone & elastic zone as it pertains to spinal ROM?

-Neutral Zone = part of the ROM w/in which spinal motion is produced w/ low internal resistance -Elastic Zone = that part of the ROM w/in which spinal motion is produced under significant internal resistance

ICF classifications in the hip (2)

-Non-arthritic hip pain -Hip stiffness and mobility deficits

Normal breathing pattern vs paradoxical breathing pattern

-Normal = expansion, outward motion during inhalation -Paradoxical = contraction, inward motion during inhalation

Cervicogenic HA - any HA meeting following criteria: (2)

-evidence of a disorder in c-spine or soft tissues of the neck, known to cause HA -evidence of causation evidenced by 1 or more of: HA developed in temporal relation to onset of cervical disorder, HA improved or resolved in parallel w/ improvement or resolution of neck pain, dec cervical ROM and HA is worsened w/ provocation, HA abolished w/ injection to cervical structure or nerve supply

scapular reposition test

-examiner introduces posterior tilt and scapular ER -test/retest is strength of shoulder elevation -if positive indicates scapular contribution to SAP

mill's test

-examiner passively pronates forearm -flexes wrist -extends elbow -pain provocation -also puts strain on radial nerve

maudsley test

-examiner resists third digit ext -distal to PIP -stressing ED -pain provocation

what can affect PFPS distally? (2)

-excessive pronation -limited DF

LCL injury (4)

-excessive varus force -localized effusion over LCL -pain & laxity w/ varus stress at 0 and 30 -pain w/ palpation

S&S of venous TOS

-excruciating deep pain in UE, chest, shoulder -heaviness that is worse after activity -significant UE swelling -cyanotic discoloration

Neck pain w/ radiating pain: acute interventions (2)

-exercise: stabilizing & mobilizing -possible short-term collar use

Abnormal breathing - Inhalation Schema (6)

-exhalation is restricted -flexion restricted -inhalation position of rib cage -rib flaring -tension @ T/L junction -diaphragm dysfunction

SFMA pattern 2

-ext rotation flexion-superior border of scap

Cluster HA general info

-extremely unpleasant -individual may not be able to lay down, often pacing the floor -age 20-40, men 3x > women -often periods of remission prior to weeks or months of attacks

Scapular Functions (3)

-facilitate congruency through full range -provide stable surface for optimal activation of scapular muscles -energy transfer from trunk to the hand

Indications for surgical treatment of rotator cuff tear (5)

-failed conservative treatment -symptoms for 6-12 mos -large tear w/ good tissue quality -significant loss of function -recent acute injury as cause

McKenzie other category

-failure to meet criteria -presence of red flags -nonmechanical symptoms -pregnancy related LBP -LBP after surgery

AC joint illness script (7)

-fall on apex with shoulder esp with GH ADD -pain with horizontal add -pain at extremes of motion -pain usually well localized -crepitation -+/-step off -joint tenderness to palpation

How can the TFCC be injured?

-fall on supinated and outstretched wrist -chronic repetitive rotational loading -80% of individuals s/p distal radius fracture

Potential causes of medial epiconsylosis? (2)

-fatigue -underlying ligamentous injury/instability

Elbow instability common complaints (3)

-fatigue -popping/clicking w/ movement - especially loaded -pseudolocking or catching at some point through ROM

Shoulder instability - open capsular shift

-favored in revision cases, bony deficits, contact athletes

risk factors for Dequervain's syndrome

-female -+40 -african -pregnancy

Osteoporosis - non modifiable risk factors

-female -older age -family Hx of osteoporosis -hx fracture -petite w/ low body mass -white/asian/latino -low sex hormones

Strongest predictors for neck pain (2)

-female sex -previous neck pain history

Common running injuries: hip/thigh stress fx (2)

-femoral neck most likely in hip (F >> M) -associated w/ quick mileage changes, excessive stride length, poor health/nutrition, amenorrhea

components of the TFCC

-fibrocartilage disc -dorsal & palmar radioulnar ligaments -sheath of extensor capri ulnaris -ulnar collateral ligament -origin of ulno-lunate and ulno-triquitral ligaments

Posterior interosseous nerve syndrome compression sites (4 possible)

-fibrous bandes that connect brachialis to brachioradialis -vascular leash of Henry (radial neck) -medial proximal portion of ECRB -proximal edge of supinator (Arcade of Frohse)

thoracic spine self mob

-first rib MWM -strap over first rib -6-10 reps -3-5 sets -can apply overpressure

Functions of long head of biceps (7)

-flex arm -ABD if UE in ER -reinforce GH joint through connections w/ RC interval -centers head in fossa -reduces vertical & anterior translations -aids in stability -prominent role in cocking & deceleration phases of throwing

latissimus dorsi muscle length testing

-flex knees until lumbar spine is flat on bed or pelvic tilt -have pt. elevate arm in ER as far as they can -let legs down or IR UE and re-assess ROM

First Stage (Cognitive) of Stabilization Therapy (4)

-focus on learning muscle function & overcoming fear of activity due to pain -isolation of TA, multifidi -neutral spine positions -low intensity, endurance focus

2nd Stage (Associative) of Stabilization Therapy (3)

-focus on refining motor pattern & muscle recruitment -begin to challenge stability w/ limb movements in neutral position -progress to dynamic motion (high reps, smooth, controlled, pain free full or partial ROM)

when is DRUJ instability most common? (3)

-following distal radius fracture (malalignment) -1/3 have painless instability -or after surgery to correct fractures

fracture

-foosh -pain -swelling -loss of motion -ecchymosis -+/- deformity

components of frontal plane hip kinematics in running and ROM (3)

-foot strike 10 deg Add -loading w/ 5-10 deg more of Add -5-20 deg of ABD in propulsion

Components of sagittal plane ankle kinematics in stance phase and ROM (4)

-foot strike 5 DF -followed by quick PF to 5 deg -loading into 15 DF -propulsion w/ 35 deg PF

Components of transverse plane hip joint kinematics during running & ROM (3)

-foot strike 5-10 deg IR -loading 0-5 deg IR -propulsion 5-10 deg ER

Components of sagittal plane Knee joint kinematics in running and ROM (3)

-foot strike in 15 deg flexion -loading to 20-25 deg flexion -propulsion 20-25 deg extension

Components of sagittal plane hip joint kinematics during running & ROM (3)

-foot strike to 30 deg flexion -loading to 0-5 deg flexion -propulsion 45-50 deg extension

Components of frontal plane ankle kinematics during running and ROM (3)

-foot strike w/ 5-10 deg inv -loading to 10-15 deg eversion -propulsion 10-15 deg inv

Shoulder instability - conservative treatment approach

-for older & less active pop -immobilization & rehab

Osteokinematic Techniques

-force applied in direction to facilitate the roll or physiological motion -more difficult to appreciate end feel, limited use in c-spine

Arthrokinematic Techniques

-force applied parallel w/ joint glide facilitating "normal" kinematics -easiest to appreciate end feel

MCL injury (4)

-force applied to lateral aspect of LE (valgus) -tibial ER (trauma) -pain and laxity w/ valgus stress at 30 degrees -pain w/ palpation

General Gapping / Distraction techniques

-force is applied perpendicular to the joint surface -intended to improve movement & reduce pain

muscle length lumbricals, P interossei, D interossei

-forearm in neutral pronation/supination -compare PIP flexion w/ MCP in ext and flex if PIP flexion is less w/ MCP ext pos for lumbrical muscle shortening-> *intrinsic plus* if PIP flexion is equal it is capsular or ligamentous restriction

how to test muscle length for FDP/FDS

-forearm in pronation -elbow extended -compare PROM wrist extension with MCP, PIP, DIP extension to wrist extension with MCP, PIP, DIP joints in relaxed position if less when in full extension, may be shortening in these muscles if equal, limitation is wrist or palm capsule, ligaments, FCU, FCR

how to test ED, EI, EDM muscle length

-forearm in pronation w/ elbow ext -compare wrist flexion with full finger flexion with relaxed position if ROM is less with fingers flexed, there may be shortening of these muscles if limitation is equal-> shortening of dorsal joint capsule, dorsal radiocarpal lig, ECRL, ECRB, ECU

what to look for in cervical area with regards to posture

-forward head -torticollis -horner syndrome (nastagmis)

type 1 SLAP tear

-frayed or degenerative labrum

Exercise prescription - aerobic (freq, intensity, time, type, progression)

-freq: 2 or more times per week for at least 6 weeks -intensity: low to mod RPE (8-13) -time: <20 mins if exercise intolerant (short bouts), goals is 20-60 mins continuous -type: any continuous exercise using major muscles unaffected by pain -progression: *duration before intensity* (manipulate intensity to maintain RPE <13)

Resistance exercise prescription (freq, intensity, time, type, progression)

-freq: 2-3x/wk for at least 6 wks -intensity: low to mod RPE (8-13) -time: consider endurance dosing (20-30 rep range for 1-2 sets) -type: major muscle groups unaffected by pain, consider isometric exercises for pain reduction (10-20% MVIC) -progression: duration before intensity, manipulate intensity to maintain RPE (<13)

McKenzie postural syndrom

-full ROM -pain is local -pain after prolonged static posture -pain gone with change in pos -younger -gradual onset -*never referred* -*never constant* -*never reproduced with movement* -treatment is lumbar roll with ext pref or treat own neck/back book

intervention (4)

-functional bracing (rarely used) -dec primary movers (biceps brachii & pronator teres) -emphasize pronator quadratus and supinator -work in supination or forearm neutral (avoid pronation)

Running intervention - regional exam components (2)

-functional testing -AROM/PROM & overpressure

cervical myelopathy cluster

-gait deviation -present hoffman reflex -present inverted supinator -present babinski -age >45 3/5+LR 30.9

Cervical myelopathy Clinical prediction rule

-gait deviations -(+) Hoffmann's -(+) inverted supinator -(+) Babinski -age > 45 years

Common items important to address in running exam / interventions (5)

-general fitness & wellness -running history (freq, progression, changes) -normal MSK exam -running exam -targeted interventions

Bankart repair prognosis

-generally good clinical outcomes & complete restoration of labrum to glenoid 8 years after surgery

treatment of spondys (4)

-grade 1 & 2 do well with conservative treatment -bracing can be utilized if symptomatic or active -physical therapy 8-12 weeks w/ focus on lumbar stabilization -surgery for more severe cases

Dequervain's syndrome (tenosynovitis)

-gradual and insidious onset- repetitive overuse -dull ache over radial aspect of wrist -localized swelling radial styloid process -severe pain with wrist UD and thumb flexion/adduction -crepitus of tendons -involves the extensor pollicis longus and ABD pollicis tendons -positive finkelstein

Cervical disc herniation - natural history

-gradual onset of herniation over time -meaningful recovery w/in 4-6 mos for most -central cord symptoms make outcomes more challenging

What is the purpose of running retraining (2)

-gradual return after resting (begin w/ small intensity & duration - even less than they think they can do; progress 10-15% per week) -alterations in technique: use minimal cueing and gradual return

HIP OA illness script (7)

-groin pain w/ active ABD/ADD -pain w/ passive hip ABD -post pain w/ squat -mod ant/lat hip pain WB -morning stiffness <1 hour after walking -hip IR < 24 -hip flexion and IR 15 degrees less than nonpainful side

poor outcome indicators associated w/ ulnar neuritis conservative treatment (3)

-hand numbness, weakness, atrophy (hard neuro signs) -ulnar nerve subluxation -UCL injury/laxity

closed kinetic chain upper extremity stability test

-hands 36 inches apart in push up position -record number of taps in 15 seconds - 18.5 touches males, 20.5 (modified pushup)

test cluster for subacromial pain (3)

-hawkin's kennedy -painful arc -infraspinatus resisted test

UCI Symptoms (6)

-head/neck pain of variable intensity -UE / LE weakness &/or paresthesia -lump in throat -metallic taste -need to support head -relief w/ lying down

Cervical radiculopathy risk factors (5)

-heavy manual labor -frequent driving (head trauma) -driving / operating equipment that vibrates -playing golf -not usually a single traumatic event

pain pressure threshold in ankle/foot

-heel for plantar fasciitis and heel pain -gastroc for achiles tindinopathy

Characteristics of "traditional" running (3)

-heel strike in DF, in front of COM -long stride -vertical displacement of COM & head

TBC symptom modulation

-high disability -high to moderate pain -volatile symptoms

symptom modulation (TBC)

-high disability -mod to high pain -volatile symptoms *include McKenzie Exercise*

red and yellow flags for LBP

-history of CA -failure of conservative treatment w/in 30 days -siatica may be first symptom of prostate cancer metastasized -+50 -LBP of unknown cause -younger with LBP less than 3 weeks -UTI -LBP unrelieved by rest or change in position -non-mechanical back pain -constitutional symptoms

Criteria for neuropathic pain in central sensitization (6)

-history of a lesion or disease of nervous system -evidence from diagnostic investigations to reveal abnormality of nervous system or post-traumatic/surg damage to NS -often related to an established medical cause -pain is neuroanatomically logicial -*pain described as burning, shooting, pricking* -location of sensory dysfunction is neuroanatomically logical

Posterolateral rotary instability key features (2)

-history of acute trauma, or overuse injury -painful snapping, clicking, or feeling of instability during elbow flexion/extension w/ forearm supinated

Red flags in the hand

-history of cancer -heart disease -serious or worsening neural compromise -cold and sweaty hand -worsening pain

risk factor red flags for LE (5)

-history of cancer -joint replacement w/ recent infection (osteomyelitis) -alcoholism -long term corticosteroid use -immunosuppressants

risk factors for cancer

-history of cancer -unexplained weight loss -failure to improve in 1 month -age > 50

hand elevation test

-hold for at least 2 minutes -symptoms in median nerve distribution

anterior shear test (transverse ligament test)

-hold occiput in flexion and apply an anterior shear force to C1 -lift C2 and head towards ceiling -positive test is sensation of lump in throat or presence of cardinal signs

CAD signs (4)

-horner's syndrome (ptosis, miosis, anhidrosis) -CN abnormalities -ischemic signs -vascular signs (carotid bruit)

joint mobility scale

-hypermobile-difficult to detect -normal -hypomobile-testing becomes treatment

Secondary causes of UCL injury (3)

-iatrogenic -medial epicondylectomy -ulnar neuritis

objectives of human movement system? (4)

-identify normal/abnormal posture -identify faulty movement patterns -identify tissue impairment and contributing factors to movement faults -provide treatment directed towards improving proper patterns and muscle imbalances

FUPs for wrist/hand

-if trauma, position of hand -pop/click -hand dominance -RA -location of pain

Hip Flexor Strain (5)

-iliopsoas (reinforces anterior aspect of joint -may become hyperactive and compress hip joint/lumbar spine -soccer and hockey highest -usually non-contact -10% recurrence

treatment of TFCC

-immobilization and splinting followed by PT

ICF Hip stiffness and mobility deficits

-OA

common conditions of > 45 y.o (2)

-OA -spondylosis

There is a statistical correlation between rupture of the Posterior Tibial Tendon and: (2)

-Obesity -HTN

Hill-Sachs fracture

-impaction fracture of the *posterior superior humeral head* -frequently diagnosed in patients who have *repeatedly sustained anterior glenohumeral dislocations*

Clinical Instability IS what? (3)

-impaired performance of the 3 subsystems of spinal stability -leads to pain, altered muscle function, impaired activtiy/function -controversial in that measurement & classification of the condition is difficult

Osteoporosis vs Osteopenia via bone mineral density (BMD) values

-Osteoporosis = BMD > 2.5 SD from normal -Osteopenia = BMD > 1-1.5 SD from normal

Lumbar Motion Assessment Progression (3)

-PA or UPA Provocation -> -Passive Physiological Motion Testing -> -Passive Arthro Motion Testing

ACL tear prevention

-PEP program -FIFA 11

risk factors for cervical artery dysfunction

-PMH of trauma -Hx migraine -HTN -high cholesterole -DM

what joint mobility can we perform in the neck?

-PPIVM (palpate btwn spinous processes during movement) -CPA -UPA -Lateral glide

Interventions for bursitis (3)

-PRICE -corticosteroid injection -surgical excision in rare, severe cases

Hip OA CPG Physical Impairment Measures (3)

-PROM hip flexion, extension, IR, ER, ABD, ADD -Pain NPRS -Joint Irritability - FABER

sharp-purser test

-PT passively flexes the upper cervical spine -PT stabilizes C2 spinous process posteriorly -PT places opposite hand on forehead -PT applies gradual force in AP direction

why is Posterior Tibialis so important? (3)

-important for firm base during push off -most active stabilizer of the arch -During gait initiates both ankle *PF* and subtalar *IN* which helps to create a rigid midfoot stabilizing the transverse tarsal joint

classic subjective complaints for dupuytren contracture

-inability to extend MCP/IP joints

dec ankle DF is assoc w/ what?

-inc frontal plane hip motion -inc transverse plane knee motion -dec sagittal plane knee motion the greater the loss of DF: -less knee flexion during lateral step down -inc hip add -inc PFPS, ITBand syndrome

what do you use grade IV anterior glide for? (2)

-inc hip ABD -inc gluteus max strength

Common running injuries: compartment syndrome (3)

-inc pressure in a compartment of the leg -numbness, weakness, "hard muscle", can be progressive -associated w/ hypertrophy, overtraining, quick inc in miles, overstriding

risk factors for non-contact ACL

-inc shoe-surface interface -increased BMI -narrow femoral notch width -inc joint laxity -pre-ovulatory phase of menstrual cycle -combined loading in valgus -strong quad activation durring ECC contraction

UCI MSK signs (5)

-inc tone/spasm in suboccipital muscles -poor control of ROM -aberrant cervical motions -dec cervical muscle strength -apprehension to movement

What are the 3 big viewpoints from literature to address running technique issues?

-increase the forward trunk lean -take shoes off & run -increase cadence by 10%

Non-modifiable risk factors for AAA (4)

-increased age (male > 50, female 60-70) -family history of disorder -male 4x > female -caucasian > AA > asian > hispanic

Cluster for Neurogenic Claudication (4)

-increased complaints w/ standing -relief w/ sitting -symptoms located above the knees -shopping cart sign

Exercise induced analgesia - descending changes (4)

-increased release: --internal opiates --internal cannabinoids --other CNS healthy chemicals -suppression of: --nociceptive signal propagation

ACL Tear Risk Factors (3)

-increased substantially w/ pro athletes & military -increased moderately w/ amateur athletes -1.57x > risk for females

Knee OA Management Strategies (8)

-individualized plan (ICF) -may use pharma interventions -exercise -education -weight loss -other impairments -supportive surroundings -manual interventions

Complications following elbow instability surgery (2)

-infection -degeneration post traumatic arthritis (if all the parts are not lined up right in surgery)

Ankylosing Spondylitis

-inflammatory disease affecting the low back and pelvis ("bamboo spine") -complications = spinal fusing, eye pain, light sensitivity, blurred vision -pain and stiffness in the spine and ribs if affected

common conditions of 15-40 y.o (2)

-inflammatory spondyloarthropathy -herniated nucleus pulposus (HNP)

Abnormal Breathing - Exhalation Schema (4)

-inhalation restricted -extension restriction -ribs in exhalation position -may have fwd head

rancho los amigos gait terminology

-initial contact -loading response -midstance -terminal stance -pre-swing -initial swing -midswing -terminal swing

Standing Contralateral Lat Flexion - procedure & expected motion

-Palpate PSIS & lateral sacrum, active contralateral lateral trunk flex -expect posterior innominate rotation

Standing Ipsilateral Stepping - procedure & expected motion

-Palpate PSIS & lateral sacrum, active ipsi hip flex -Expect Posterior innominate rotation

Standing Fwd Flexion - procedure & expected motion

-Palpate PSIS & lateral sacrum, do active trunk flexion -Expect Ant Inominate Rotation

alar ligament testing

-Patient is sitting or supine with mild upper cervical flexion -PT stabilizes C2 spinous process with firm grasp -PT imparts ether a passive side-flexion or rotation moment to the cervical spine -PT attempts to "feel" the movement of C2 spinous process

anterior shear

-Patient is supine -PT places fingers in space between occiput and C2 spinous process -PT attempts the translate the occiput and C1 anterior on C2 by lifting hands

Criteria for RTP following acute grade I syndesmosis injury (8)

-initial injury resolved -pain & swelling resolved -injured joint has full ROM -full or close to full (90% strength) -patient feels they can "trust" the injured leg -sense of instability has resolved -athlete & family understand risk of reinjury associated w/ RTP -precautions have been taken to reduce risk of reinjury

Hallux Rigidus Progression (3)

-initial swelling & pain -gradual ROM loss -eventual joint space narrowing & dorsal osteophyte formation

Nijmegen Questionnaire (use and score implications)

-initially developed as screening tool to ID patients w/ hyperventilation complaints -score > 20 indicates dysfunctional breathing

phase 1 throwing program: long toss program

-initiate at 45 feet & progress to at least 120 and up to 180 feet

Pronator teres syndrome presentation (3)

-insidious onset -anterior elbow pain w/ symptoms in median nerve distribution distally -heaviness of forearm

classic subjective complaints for CTS

-insidious onset of numbness and tingling in first 3 fingers -worse at night

Reverse TSA risks (7)

-instability or dislocation -nerve damage -intraoperative fx -infection -hematoma -hardware failure -scapular notching (glenoid cup impinges on scapular neck > 50% cases)

Intervention/Exam flow (3)

-intake & big picture -regional exam -localized exam

Running intervention - intake & big picture components (4)

-intake paperwork -OM's -observation -med screen / exam

Where can thoracic outlet syndrome occur?

-interscalene triangle -costoclavicular space -retropectoralis minor

phase 2 throwing program: off the mound

-intiate at 45 feet and increase to 60 feet

ICF: Non-arthritic hip pain

-intra-articular structures of hip -femoroacetabular impingement -structural instability -labral tears -chondral lesions -ligamentous teres tears

accessory joint motion

-involuntary -amount of arthrokinematic glide/joint play -try to isolate a single plane

Open rotator cuff repair (2)

-involves deltoid detachment, is virtually obsolete because of damage caused to deltoid -no AROM 8-12 weeks

non ischemic signs of VBA dissection

-ipsilateral posterior neck pain/occipital HA -C2-6 cervical root impairment (rare)

Wartenberg Syndrome (4)

-irritation of superficial radial nerve at tunnel 1 -painful finklestein's in pronation -many time hypermobile pronation creating excessive scissoring of BR over ECRL -painful wrist flexion and UD

CAD late presentation (4)

-ischemic s/sx more likely -5 D's and 3 N's could be present -profound ischemic signs may be present (CVA, unilateral/bilateral paresthesia) -less likely to be confused w/ MSK dysfunction

Why is the cervical flexion-rotation test a "good" test?

-it stresses the deep cervical muscles that are typically the root cause of cervical headaches -when a (+) test is seen, you can confidently say the upper c-spine has been tested because the maximum flexion "locks in" the lower c-spine so you are primarily rotating at C1-2

Supporting AC joint structures (4)

-joint capsule -superior & inferior AC ligs -coracoclavicular ligaments -trapezius & deltoid

CMC OA S&S

-joint pain at base of thumb -pain inc with use/esp pinching and gripping -usually insidious onset -restricted ROM (capsular ABD>ext) -joint crepitus -women>men -45+ yo

indications for P->A tibial glide

-knee OA -decreased extension ROM -hypomobility -pain

MCL Sprain subjective complaints (2)

-knee giving way -acute onset of pain (known injury onset)

Lateral ankle sprain diagnosis/presentation (9)

-known onset or MOI -limited ability to stand comfortably - +/- limp -likely ecchymosis -variable swelling -point tenderness to palpation @ ligaments -pain inc w/ PROM INV in PF (ATFL & CFL) -pain inc w/ PROM calcaneal INV in DF (PTFL) - + anterior drawer test & inversion stress test

What factors are associated w/ poorer prognosis for RTC repair? (4)

-labor intensive occupation -younger age -lower education level -BWC claims

Migraine w/o Aura - at least 5 attacks meeting this criteria: (3)

-lasts 4-72 hrs untreated -has 2 or less of following: unilateral location, pulsating quality, moderate or severe, aggravated by routine PA -during HA, 1 or less present: N/V, photophobia

PIN syndrome presentation (4)

-lat elbow pain w/ radiation to distal forearm -tenderness 5cm distal to epicondyle -painful resisted supination -weakness of MCP joints 1-5 & thumb extension

Cervical radiculopathy - epidemiology: age, gender

-late 30's - mid 50's -male 1.5x > female

cervical arthrokinematic movements basic assumptions

-lateral flexion & rotation to same side are similar segmental movements -movement in the cervical spine can be symmetric or asymmetric -lateral flexion to right is essential is essentially extension on right and flexion on left articular pillars

Primary Muscles of TMJ Depression (opening) (2)

-lateral pterygoid -suprahyoids

SMPs to inc grip strength

-lateral/medial glide -extensor grip test -radial head mob

Lumbar Disc Herniation - Classification Based on Nuclear Material Movement (Protrusion, Prolapse, Extrusion, Sequestration)

-Protrusion: bulge through an intact annulus -Prolapse: nuclear material bulges through annulus fibrosis -Extrusion: nuclear material has crossed through annular fibers, but remains intact w/ central material and has either passed through PLL or migrated up/down from disc -Sequestration: nuclear material has crossed through annular fibers & is no longer continuous w/ central nuclear material

Bursitis can be associated w/ what other disease processes? (3)

-RA -gout -synovial cyst

Bicipital-radial bursitis (4)

-RARE -no visible signs of edema present -most pain w/ resisted flexion and forearm pronation -pain dec w/ forearm supination

pathoanatomic diagnoses included in subacromial pain of the star model (7)

-RTC disease -RTC partial tear -labrum -bursitis -tendinitis -tendinopathy -subacromial impingement

deceleration evaluation

-RTC strength -scapular dyskinesis

Indications for reverse TSA (9)

-RTC tear & end stage OA -massive RTC tear -proximal humeral non-union or malunion -acute or complex fx -fixed GH dislocation -posttraumatic arthritis -tumor -revision arthroplasty -chronic pseudoparalysis w/o arthritis

FMS Breathing Questionnaire Scoring

-Red = score of 2 or 3 -Yellow = score of 1 -Green = score of 0

Provocation Tests for Disputed TOS (3)

-Roos (EAST) -Cyriax Release -Neuro Mobility (ULTT's)

Provocation Tests for True TOS (4)

-Roos (EAST) -Adson -Eden -Wright

AAA rupture survival: out of hospital & in hospital

-Rupture out of hospital: lethal 85-90% -Make to hospital: 50-70% survival

SLAP lesion can fall under what PT diagnoses? (2)

-SAP -shoulder pain w/ stability & movement coordination impairments

retroverision is associated with what two pathoanatomic diagnoses?

-SCFE -Labral tear

SIJ Motion Assessment Progression (3)

-SIJ Cluster -> -Kinetic Motion Testing -> -Passive Arthro Motion Testing

4 Tests in SIJ Cluster & Clinometrics

-SIJ compression -Thigh thrust -SIJ distraction -Sacral thrust -------------------------------- 2/4 positive tests: 0.88 Sn, 0.78 Sp, LR+ 4.0, LR- 0.16

Rotator cuff tear classifications in STAR & ICF

-STAR = SAP -ICF = muscle power deficits

anterior shear positive test

-Sensation of a "lump" in the throat -Presence of cardinal signs -This is a "provocation test"

treatment of CTS

"The use of neurodynamic techniques has a better therapeutic effect than sham therapy in the treatment of mild and moderate forms of CTS" 3 sets of 60 reps 2 x per week x 10 weeks

how to test CN10

"ahhh" look for displace uvula -uvula points toward normal side

T spine rule of 3s

-T1-3 spinous process is at same level as trans process -T4-6 spinous process is half level below -T7-10 spinous process is full level below -T11 is half level below -T12 SP is at same level

Thoracic & Rib Manip Manual Therapy Red Flags (9)

-T3-9 narrowest part of SC -UMN lesion -bilateral pain & paresthesia -spastic gait -hyperreflexia -clonus/Babinski -slump -facture -osteoporosis/bone weakening

DRUJ instability is dependent upon what for stability? (3)

-TFC integrity -radioulnar ligaments -surrounding soft tissue

iliopsoas muscle length can affect what? (4)

-TL junction -lumbar spine -SI joint -hip joint -muscle wasting in psoas found in individuals w/ LBP

TMJ Disorders - Disc Displacement w/o Reduction WITH limited opening: history, exam findings, more Sn or Sp?

-TMJ locking w/ limited opening, *currently* severe enough to limit eating -max assisted opening of < 40 mm -more Sp (0.97)

TMJ Disorders - Disc Displacement w/o Reduction WITHOUT limited opening: history, exam findings, more Sn or Sp?

-TMJ locking w/ limited opening; limits eating *previously* -max assisted opening < 40 mm -more Sp (0.79)

TMJ Disorders - DJD: history, exam findings, more Sn or Sp?

-TMJ noises present -crepitus during max active or passive opening, lateral excursion, or protrusion -More Sp (0.61)

TMJ Disorders - Disc Displacement w/ Reduction: history, exam findings, more Sn or Sp?

-TMJ noises w/ movement -clicking, popping or snapping w/ opening, closing, or lateral/protrusive movements -more Sp (0.92)

S1 myotome

*Ankle EV*, PF, knee flexion (toes walking)

S2 myotome

*Ankle PF*, toe flexion (toe walking)

most common ankle sprain

*Anterior Talofibular ligament* -PF and IN

Patellofemoral Pain Syndrome (PFPS) (9)

*Anterior knee pain* -usually aggravated by knee flexion, squatting, stair ambulation, running -pain with ECC motions -pain w/ prolonged sitting in > 50% pts. -prefer knee extension as resting position -VMO:VL <1:1 in PFPS -most common injury in runners -70-90% have chronic or recurrent pain -40% persistent complaints 1 year

Anterior drawer (ankle)

*Anterior talofibular ligament* -talocural joint -comfortable position close to PF -fix midfoot and push tibia posterior (+) for anterior talofibular if ER occurs (+) for deltoid ligament is IR occurs (+) for both/avulsion fracture if posterior glide occurs

Craig's test

*Anteversion* -prone w/ knee flexed to 90 -palpate GR and rotate hip -determine position of hip when trochanter is most prominent laterally -anteversion is >15 in direction of IR USE ROM for anteversion and retroversion over craig's test

Tarsal Tunnel Syndrome (4)

*Compression of posterior tibial nerve* -pain, weakness, sensory changes of foot and ankle esp bottom of foot -worse w/ walking and better w/ rest -NCV and clinical exam to dx

TMJ Disorders - Disc Displacement w/ Reduction w/ Intermittent Locking: history, exam findings, more Sn or Sp?

-TMJ noises w/ movement, jaw locks w/ limited opening then unlocks -click, pop, snap noises w/ opening, closing, or lateral/protrusive movements; may require manual unlocking of TMJ -more Sp (0.98)

subtalar pronation in open chain (3)

-Talar ABD -Calcaneal EV -DF

subtalar joint supination in closed chain (3)

-Talar ABD -Calcaneal inversion -DF

subtalar pronation in closed chain (3)

-Talar ADD -Calcaneal EV -PF

subtalar joint supination in open chain

-Talar ADD -Calcaneal inversion -PF

figure of eight measurement

-Tape Measure midway between tibialis anterior tendon and lateral malleolus. -Draw tape medial just distal to navicular tuberosity -Pull tape across arch proximal to base of fifth -Pull tape across anterior tibialis tendon and around ankle just distal to medial malleolus -Return to start

drop arm test

-Testing Supraspinatus for full thickness RTC tear -Examiner passively elevates UE to 90° of abduction -Pt is instructed to maintain that position, while examiner releases arm (+) = pt is unable to maintain abducted position

Anterior shear test - what is it for, is it useful?

-UCI -useful to provoke symptoms

UCL sprain S&S

-UCL sprain thumb -Pain or tenderness ulnar aspect of MCP -swelling -+/- ecchymosis -caused by forceful radial deviation at MCP -skier falling -repeated radial stress

S&S of neurogenic TOS

-UE pain, paresthesia, numbeness, weakness in nonradicular distribution -UE heaviness and fatigue with overhead -neck and UT pain -occipital HA -numbness in 5 fingers esp ulnar side -history of previous cervical trauma

PROs for elvow

-UEFS -NPRS -DASH -PSFS -PRTEE

PROs for shoulder

-UFES -SPADI -PSFS -Penn shoulder score -UCLA shoulder rating score -ASES -DASH (quick dash)

neck pain with radiating pain

-ULTT -spurling -distraction

Talocrural A-P to improve what? and how to perform

*DF* -block post distal tib-fib -contact anterior talus w/ web space of opposite hand -apply A->P force -note pain and resistance (Maitland grades)

Star Excursion Balance Test

*Dynamic balance test* -pt. reaches in 8 different directions -test limb is stance limb -direction is named in relation to stance limb -avg. of 3 trials in each direction -can be a predictor for chronic ankle instability (post medial reach)

clinical prediction rule for cervical radiculopathy

-ULTT A -ipsilateral cervical rotation <60 -distraction -spurling test

tests for cervical radiculopathy

-ULTT A -ipsilateral cervical rotation <60 -distraction -spurling test -shoulder abd test (Bakody) -altered reflexes

Manual Therapy Contraindications (9)

-UMN lesion -SC compromise -multi-level nerve root compromise c-spine -deteriorating neuro status -intense, unremitting, non-mechanical pain -constant night pain -recent trauma to region -UCI -CAD

Hip pain can be referred from visceral structures such as: (3)

-Urethra (A) -Sciatica (B) -Psoas Abscess (C)

non-dissociative carpal instability

-a row issue -entire row of distal bones is hypermobile on proximal row -laxity issue

AROM norms side bending

-about 45 degrees

Describe Acute/Rapid Cauda Equina Progression (2)

-abrupt onset of severe symptoms, most notably urinary incontinence -poor prognosis, even after surgical decompression

What are the 3 components of promoting optimal aging?

-absence of disease & disability -high cognitive and physical functioning -active engagement w/ life

FABQ

*Fear Avoidance Behavior Questionnaire* -work subscale assoc w/ current and future disability and work loss in LBP *Cut-off scores:* >29 if working >22 if not working >14 FABQ-PA

risk factors for GTPS

*Female > 40 years* *LBP* *Morphology of female pelvis* -coxa vara -pelvic girth is larger in those w/ lateral hip pain

Ober test

*For TFL* -may assess gluteus medius, minimus and hip capsule more than ITB -pt. side lying -hip extended and ABD w/ knee flexed -*positive if leg fails to Add past neutral*

What other factors that contribute to breathing are influenced by ZOA? (3)

-accessory respiratory muscle overuse -chest wall mobility -lung hyperinflation

forearm plank

*Global test of anterior core musculature* -increased activity of anterior musculature has been shown to improve performance -rectus abdominis and EX have shown to prevent injury and improve athletic performance Norm: female: 130 sec male: 189 sec

Labral tear clinical presentation (7)

-ache at rest & at night -mechanical symptoms of locking, catching, clicking -possible relationship w/ loading -dec ROM on painful side -may have pain w/ flexion & IR @ 90 deg hip flexion -pain w/ *FADIR*, FABER -gait abnormality

scoliosis

-acquired or congenital -assoc with LLD -named for convexity -Rib hump

Wells Clinical Prediction Rule for DVT

-active CA or w/in last 6 months -paralysis, paresis or recent immobilization -bedridden for 3+ days -surgery requiring anesthesia in last 12 wks -localized tenderness along deep vein -entire leg swelling -calf swelling at least 3 cm larger than asymptomatic leg (10 cm below tib tube) -pitting edema in symptomatic leg -superficial veins -prev DVT -high prob if >3 mod if 1-2

Pronator teres syndrome - interventions (6)

-activity mod -rest -nsaids -flexibility & strength of wrist flexors & forearm pronators -soft tissue work -nerve glides

interventions for cubital tunnel syndrome (5)

-activity mod -splinting -nerve glides -limiting extremes of elbow flexion -exercise

Considerations once RTC is confirmed? (5)

-acute vs chronic -full vs partial thickness -if partial, bursal vs articular side -size -traumatic or degenerative

olecranon bursitis

-acute: direct trauma or prolonged pressure -chronic: multiple acute episodes, work, recreation, gout, RA -septic: infection or cellulitis -large amount of swelling -redness, heat -dec motion -minimal pain

wrap up

-additional questions/concerns -transition to physical exam

STAR classifications

-adhesive capsulitis -GH instability -Subacromial pain -full thickness RTC tear -AC joint injury

soreness rule for throwing program: no soreness

-advance 1 step each throwing day

posterior lateral instability

-after trauma -multiple injections for lateral epicondy. -after LCL strain -due to LCL insufficiency -proximal radius and ulna ER together on humerus causing posterior sublux of radius on capitellum -pain with varus loading and supination -difficulty pushing up from chair

Rotator cuff tear repair prognosis depends on...(6)

-age & size of tear -amount of retraction -amount of fatty infiltrate -dec pre-op ROM -concomitant labral repair -patient expectations

clinical lumbar instability illness script (4)

-age < 40 -avg SLR > 91 -aberrant lumbar movement - + prone instability test

instability illness script (usually anterior)

-age <40 -Hx of dislocation or subluxation -excessive accessory motions -apprehension test pos -relacation test pos -general laxity

Lumbar Fracture CPR (5 items)

-age > 52 -no leg pain -BMI 22 or less -does not exercise regularly -female 4 or more present suggests fracture 2 or less items suggest absence of fracture

Risk factors for post-op problems after rotator cuff repair (6)

-age > 65 -DM -osteoporosis -cardiovascular disease -smoking -size & chronicity of tear

cluster for compression fracture

-age >52 -no leg pain -BMI <=22 -does not exer regularly -female

risk factors for fracture

-age >65 -dangerous mechanism -neck rotation less than 45 degrees

Factors that influence level of diagnosis or suspicion of Inflammatory LBP / Axial Spondyloarthropathy (8)

-age at onset < 45 (younger people) -duration > 3 months -insidious onset -morning stiffness > 30 mins -improvement w/ exercise -no improvement w/ rest -waking from pain (2nd half of night) w/ improvement upon rising) -alternating buttock pain 4 or more may be diagnostic 2 or more should suspect inflammatory LBP

Cervical disc herniation epidemiology (age & sex)

-age late 30's to 50's -male 1.1-1.4 > females

Ottawa Knee Rule (5)

-age>55 -isolated patellar tenderness w/o other bone tenderness -tender fibular head -inability to flex to 90 -inability to bear weight immediately after injury and in ED (4 steps)

tests for instability in the neck

-alar ligament -sharp purser -anteiror shear test

what three red flags are associated with osteonecrosis? (3)

-alcoholism -long-term corticosteriod use -immunosuppressants

What 4 sites in the body can cause TOS symptoms? Which 2 do PT's typically deal with?

-anterior scalene triangle -posterior scalene triangle -costoclavicular space -coracoclavicular space (PT's deal mostly w/ last 2)

2 types of approaches for TSA

-anterior superior approach (preferred b/c avoids subscap if still intact) -deltopectoral approach

lateral ankle ligaments (3)

-anterior talofibular -calcaneal fibular -posterior talofibular

normal scapular position (5)

-anterior tild approximately 12 degrees -vertebral border vertical or slight upward rotation (4-10 degrees) -spine of scapular approx 3 inches from SP -superior angle of scap T2-T7 -clavicles slightly elevated laterally (inc risk for neural tension)

ACL (4)

-anteromedial bundle tight in flexion -posteromedial bundle tight in extension -*causes femoral condyles to glide anterior w/ knee flexion* -affects anterior-lateral rotary stability

Plantar Fasciopathy incidence (2)

-appears to increase w/ age & BMI -also apparent in highly athletic individuals (runners)

what kind of observations can change the torsion angle?

*Habitual sleeping and sitting postures where hip is held near end range IR or ER* -"W" sitting (excessive IR) results in: anteversion

what is superior to knee strengthening alone for decreasing pain and improving activity in person with PFPS?

*Hip and knee strengthening*

differences in IR/ER in children

*IR greater than ER by 2-16 degrees* -no diff in adults

Talar tilt test

*Lateral ankle sprain* -pt. prone w/ knee flexed to 90 -examiner inverts the talus w/in mortise *(+) laxity (>15 degree)*

Is Thessaly more specific for medial or lateral meniscus?

*Lateral meniscus (.96)* -medial (.92)

subjective complaint of deep aching throb in hip or groin w/ prolonged steroid use is most likely what?

*Legg-Calve Perthes Disease* -avascular necrosis

clonus

-applied to wrist or ankle -move wrist into ext or ankle into DF with quick overpressure -3 or more beats indicates reflex is present

2 point discrimination

-apply at all fingertips -pt. should be able to recognize at least 4/5 or 7/10 -repeat to find minimal distance pt. can distinguish -threshold is <6mm

goal of passive physiological intervertebral movement (PPIVM)

-appreciate quality & quantity of movement at each segment B -attempt to differentiate the side of pain/impaired mvmt -determine segmental levels for further investigation

where can the radial nerve become entrapped?

-arcade of Frohse PIN (motor only)

Navicular Drop test alternative

-arch height is measured at 50% the length of the foot in sitting -measure is repeated in standing -difference of >1.35 indicates foot w/ inc mobility -diff of <.64 indicates a foot w/ decreased mobility

indications for CT junction manip for shoulder pain

-arom flexion <127 -PROM IR <53 degrees -negative neer -no meds for shoulder pain -duration of symptoms < 90 days

How to assess for scapular dyskinesis?

-as patient to elevate arm 10x holding 3 lbs if <150 or 5 lbs if >150

PT Rib Assessments (3)

-assess for general motion at upper, lower cage -rib springing -rib stress test

passive accessory intervertebral movement

-assessment of movement that can occur during AROM -think: lateral glide, distraction, compression, PA, AP, rotational stress tests

what should be used on pts to reduce pain and disability in pts with *LBP w/ mobility deficits and acute low back pain*?

*Lumbopelvic manipulations* -review contraindications

Common running injuries: labral tears (1)

-associated w/ excessive hip ADD/IR (mechanical)

Dowhaggers hump

-associated with post menopausal women

cervical arthrokinematic movements: lateral flexion

-asymmetric movement of the facet joints -ipsilateral facet joint mimics extension -contralateral facet joint mimics flexion

What are you looking for during scapular observation? (2)

-asymmetry -any type of winging

breath hold test

-at end of full exhalation and inhalation hold breath and plug nose -hold until breaking point Red<35 Yellow 35-60 Green>60

Thessaly test

*Meniscus* -pt. stands flat footed on one leg -pt. *flexes knee to 20* and rotates femur on tibia medially and laterally three times -*(+) for meniscus tear if medial or lateral joint line discomfort* -* (+) locking or catching* SPECIFIC TEST

McMurray Test

*Meniscus* -pt. supine w/ knee completely flexed -IR the tibia and extend the knee *+ is snap/click accompanied by pain* -retest w/ tibia in ER

Breathing Assessment - Total Lung Capacity

-at end of full exhalation and inhalation, hold breath and plug nose -hold until breaking point -scoring: --red = < 35" --yellow = 36-60" --green = > 1 min

summary

-attend to pt. comfort and privacy -logical sequencing following an organized format -verbal communication (no jargon) -document w/o interfering -attentive listening -respect -nonverbal (eyecontact/body language)

UCL tear MOI (2)

-attenuation of valgus & external rotation forces (late cocking & acceleration phase of throwing or overhead motion) -FOOSH trauma

Special circumstances - migraine population (2)

-avoid exercises that trigger HA -if migraine is happening, avoid exercise for that day

Special circumstances - fibromyalgia or wide-spread pain (2)

-avoid reaching *fatigue* -consider low intensity (8-10 RPE) bouts

what should you not do during acute phases of GTPS?

-avoid stretching may be okay in subacute/chronic

treatment of Wartenberg Syndrome (3)

-avoid tight watches/bands -conservative treatment (PT) -surgery if PT fails

spondylolisthesis S&S (6)

-back pain w/ or w/o radicular pain -often a specific event that started symptoms -hyperextension increases pain -symptoms improved with rest -extension is limited and painful -tight hamstrings 80% of time

Optimal posture allows for...(4)

-balanced body parts -efficient muscle use -low EE -reduced joint stress

How can cauda equina signs/symptoms vary? (3 factors can effect)

-based on location of anatomy -rapidity of onset (bowel & bladder usually first) -duration of compression

What are the 17 muscles that attach to the scapula?

-biceps brachii -coracobrachialis -deltoid -infraspinatus -latissimus dorsi -levator scapulae -omohyoid -pec minor -rhomboid major & minor -serratus anterior -subscapularis -supraspinatus -teres major & minor -trapezius -long head triceps

Drawbacks of biceps surgical intervention (2)

-biceps no longer helps w/ elevation -weakness to elbow flexion

Vascular Claudication

-bilateral -*no burning* -pulses diminished or absent -skin color change -often starts in calf but may spread -*brought on by activity not position* -*relieved w/ standing still, sitting, resting* -40-60 age range

illness script for central lumbar stenosis (5)

-bilateral LE symptoms -leg pain > back pain -pain during walking and standing -pain relief w/ sitting -age >48

lumbar stenosis CPR (5)

-bilateral symptoms -leg pain more than back pain -pain during walking/standing -pain relief w/ sitting -age >48 years •1 out of 5 (Sn = .96; Sp = .20; +LR 1.2; -LR .19) •4 out of 5 (Sn = .06; Sp = .98; +LR 4.6; -LR = .95)

What types of cancer often metastasize to lumbar spine and present as LBP? (4)

-bladder -prostate -colon -lung (maybe)

Distal Tibiofibular Mobilization

-block post distal tibia -contact anterior fibula w/ hypothenar eminince -apply ant to post force -note pain and resistance (maitland grades)

3 parts of human functioning that the ICF model looks at

-body or body part -whole person -whole person in social context

key concepts of SFMA

-body works in alt. patterns of stable segments connected by mobile joints -altered motor control may lead to injury -previous injury is one of most powerful factors to determine future injury -pain alters motor control -neurodevelopmental progression -use a stop light system

management of non-dissociative carpal instability (4)

-bracing/taping (wrist restore) -activity mod -education -progressive exercise program

most common types of cancer to metastasize to UE

-breast and lung

2 most common types of cancer to metastasize to the shoulder are _____

-breast and lung (pancoast)

what to observe when observing breathing

-breath holding -mouth breathing -upper chest breathing

Breathing Assessment - Functional Residual Capacity

-breathe in & out normally, at end of exhalation hold breath and plug nose -hold until clear desire to breathe - < 25" indicates possible breathing dysfunction

Breathing Assessment - Observation items (5)

-breathing pattern -rib flaring -umbilicus movement -mouth breathing -upper chest breathing

cubital tunnel syndrome

-btwn medial epicondyle and olecranon -usually due to direct blow or repeated flexion -numbness/tingling in hand -medial palm -weak 5th finger ABD and FDP, thumb add, inteross, lumbricals -claw hand in severe cases -EMG to confirm

what motion should middle ribs have?

-bucket handle motion

type 4 SLAP tear

-bucket handle tear of labrum that extends into biceps tendon

type 3 SLAP tear

-bucket handle tear of labrum with intact biceps anchor

Manual Therapy Precautions (13)

-c-spine anatomical anomaly -collagen disorder -connective tissue disorder -current or recent CA -1st spinal pain episode < 18 or > 55 -hypermobility -inflammatory joint disease -local infection -osteoporosis -prolonged corticosteroids -recent/infrequent manipulation -systemic illness -throat infection

what motion should lower ribs have?

-caliper motion

if +SLR on opposite side what does that mean?

-called *Crossed SLR* and is more *specific for disc herniation*

red flags for shoulder

-cancer -cardiac -autosplinting -gall bladder -liver -diaphragmatic irritation -tumor -infection -fracture -neurological lesion

visceral causes of neck pain

-cancer -cardiovascular -pulmonary -GI -infection

red flags at knee

-cancer -constitutional symptoms -night pain -swelling/warmth -locking -palpable mass -inflammation -altered circulation -DVT -periph neuropathy (esp if bilat) -vascualar claudication

common conditions for > 50 (4)

-cancer -fracture -stenosis -aortic aneurysms

where is the medial meniscus attached? (3)

-capsule -MCL -semimembranosus

where is the lateral meniscus attached? (3)

-capsule -PCL -popliteus

what should you be looking for during observation of elbow?

-carrying angle -gunstock deformity -thenar atrophy -GH position -ecchymosis (pic) -erythema -popeye sign

Dupuytren contracture / palmar fascia S&S

-caucasian -men>women ->50 -alcoholic/tobacco -DM -epileptics -maily MCP/PIP -5th digit almost always invovled (70%) -palpable nodule

Anterolateral Ankle impingement

-caused by compression of osseous or soft tissue -pain at anterior ankle during DF/EV activities -may be tender to palpation

Neck pain w/ mobility deficits: common symptoms (3)

-central or unilateral pain -dec ROM that produces symptoms -may have shoulder girdle or UE pain

neck pain with HA

-cerv AROM and joint mobility -positive cervical flexion-roation test -moderate evidence

neck pain with mobility deficits

-cervical AROM and joint mobility -thoracic joint mobility -moderate evidence

regional interdependence with lateral epicondylalgia

-cervical impairments -cervical/thoracic pain -RTC weakness -dec scapular muscle performance -lower trap weakness

Neck pain w/ HA: chronic interventions

-cervical manip -cervical & thoracic manip -exercise for cervical & scapulothoracic regions (strength, end, proprio, motor control) -combined manual therapy & exercise

Neck pain w/ HA: subacute interventions (2)

-cervical manip/mob -self C1-2 SNAG

Neck pain w/ mobility deficits: subacute interventions (3)

-cervical mob/manip -thoracic manip -cervical & scapulothoracic exercise

anteversion

*Normally approx 15-16 degrees* -excessive IR and limited ER (IR > 50 and ER < 15 degrees) -inc/dec Femoral neck Angle (FMA) is associated w/ degenerative hip joint disease -generally *toeing in*

McConnel Test

*PFPS* -pt. performs isometric quad contraction at 30, 60 , 90, 120 degrees of knee flexion -if pain is produced during any of contractions the movement is repeated while examiner performs a medial patellar glide -*if pain is reduced then positive for PFPS*

Eccentric step test

*PFPS* -pt. stands on 6 inch step w/ hands on hips -pt. steps down -*pain provocation positive w/ PFPS*

muscle strain S&S

*Pain local to muscle w/ contraction and w/ stretch* *Most commonly:* -ADD -hip flexor -hamstrings *Traumatic or insidious due to:* -explosive motion -fall -muscle imbalances -limited flexibility

how to screen toe flexion muscle strength

*Paper Grip Test:* -Cardboard under toes -Examiner attempts to pull cardboard away + if patient can not maintain

Windlass Test

*Plantar Fasciitis* -pt. stands on step stool w/ toes over edge -MTP joint extended while IP is allowed to flex *(+) for pain provocation in plantar fascia* (especially medial calcaneal tubercle)

Neck pain w/ radiating pain: expected exam findings (2)

-cervical radiculopathy cluster: -- + ULTT A (median) -- + Spurling -- + Cervical distraction -- dec cervical ROM -may have UE sensory, strength, or reflex deficits associated w/ involved nerve roots

Cervical Radiculopathy clinical prediction rule

-cervical rot < 60 -symptoms dec w/ traction -symptoms inc w/ spurling -symptoms w/ ULTT (median nerve)

PT Assessment Tests of Breathing (2)

-cervical rotation lateral flexion test -thoracic AROM w/ overpressure & resistance

Medial Tibial Stress Syndrome (MTSS) (6)

*Shin splints* -periostitis of tibia, tendinopathy -dysfunction of tibialis post, tib ant, soleus -continuum of bone-stress reactions -vague diffuse pain along distal tibia w/ exertion -can progress to compartment syndrome (sensory and motor loss)

Global test for Abdominals, Gluts, QL

*Side planks* Norm: 95-99 sec men 75-78 sec women

what 7 things should we look at with regards to the shoulder (other anatomic regions)

-cervical spine -thoracic spine -ribs -AC joint -SC joint -GH joint -ST joint

ER stress test

*Syndesmotic Sprain* -pt. seated w/ hip and knee flexed to 90 -passive ER force is applied to foot *(+) is anteriolateral pain at distal tibiofibular syndesmosis-> painful palpation*

Fibular Translation test

*Syndesmotic Sprain* -pt. sidelying -stabilize tibia w/ bottom hand -apply ant/post force to fibula w/ top hand -*(+) is pain and/or laxity for syndesmotic sprain*

high ankle sprain

*Syndesmotic sprain* -less frequent -11% of all ankle sprains -*injury to anterior tibiofibular ligament* -tenderness and pain at superior medial aspect of lateral malleolus and anterior aspect of syndesmosis -pain w/ WB, DF -can be assoc w/ fracture->ext rot stress radiographs often done

90/90 test

*TESTING: hamstring flexibility* POSITION: (supine) patient flexes hip to 90 deg while knee is bent. Patient then grasps behind the knee with both hands. Therapist extends knee as much as possible. Opposite leg should be placed in full knee extension. (+) TEST: knee unable to reach -10 deg extension

In what stages of lateral epicondylosis do tendon changes begin, and then become permanent?

-changes begin stage 4 -permanent changes stage 5

medial nerve compression

-pronator syndrome -pain, tingling, numbness -worse with activity -women in 40s>men -pain and paresthesia volar aspect thumb, index, middle and radial -half of ring fingers -pain in anterior distal arm and proximal forearm -weakness of FPL/FDP -dec sensation over thenar eminance

where can the median nerve become entrapped?

-pronator teres (median and AIN) -carpal tunnel -ligament of struthers

transverse abdominus muscle function test (prone)

-prone -cuff to 70mmhg -pt. performs abdominal wall draw in for 10 seconds -should be no pelvic movement -breathing normally -dec in pressure in cuff should be observed -6-10 is considered normal - < 2 mm associated with incidence of LBP

passive lumbar extension test (PLE)

-prone with LEs straight -PROM leg elevation 30 cm (11 in) -*(+) is lumbar pain, heavy feeling in back that subsides when legs are brought down* -positive for clinical lumbar instability

FUPs for males (2)

-prostate history esp if >65 -changes in urination, bowel, gait, balance

Running interventions - localized exam components (2)

-provocation testing -appropriate follow up testing *all guided by hypotheses*

Long head of biceps pathology - MOI

-proximal biceps degeneration -subscapularis tear can lead to biceps instability -SLAP lesion

3 potential zones of compression for cubital tunnel syndrome

-proximal to epicondyle -at level of retrocondylar groove -distal to epicondyle (cubital tunnel)

hoffman sign

-pt seated with head in neutral -examiner flicks distal phalanx of middle finger -looking for adduction and opposition of thumb and slight flexion of fingers -may correlate with UMN lesion

romberg test

-pt stands w/ fee together and EO and EC -30 seconds

SIJ thigh thrust

-pt supine -flex knee -hand on sacrum and PSIS -bring leg 5-10 deg of add and compress leg down. -*positive is reproduction of pain*

Patellar Tilts

-pt supine w/ knee relaxed -lift edge of patella away from lateral femoral condyle -tilt should go beyond horizontal -named for which way a marble would roll -Approx 15 degrees is considered normal

cubital tunnel flexion test

-pt. flexes elbow fully in supination -wrist extension -hold for up to 60 seconds + for symptoms in ulnar distribution

prone instability test procedure

-pt. is prone w/ feet resting on floor -PT applies PA to painful segment -pt. lifts legs from floor (engages lumbar paraspinals) -PT maintains PA pressure

FABER

-pt. is supine -painful side leg is placed in figure 4 -examiner applies downward force through the knee of the painful side and the ASIS of non-painful side -*(+) test if pain is reproduced* -stabilized SIJ to see if symptoms are alleviated

Ballottement Test/ Patella Tap

-pt. knee extended or flexed to comfort -examiners pushes down below patella w/ one hand -examiner pushes down w/ other hand in suprapatellar region -examiner applies slight tap or pressure over patella -floating patella should be felt

cozens test

-pt. makes fist -elbow flexed -pronates forearm -radially deviates and extends wrist -applies resistance to extension

Obtain psychosocial perspective

-pt. perception of chief complaint -family, social and personal circumstances -environmental barriers/accommodations

prone knee bend test

-pt. prone -PT places one hand on PSIS of testing limb -PT passively bends knee until onset of complaints -sensitization w/ PF, DF, or neck motions

deep cervical extensor test

-pt. prone to C7 -maintain chin tuck in neutral for 20 sec -positive is neck extension and chin lengthening/neck flexion -laser on head -target on floor 60 cm away -maintain spine in neutral -neck pain time: 65.6 (41.4)

lumbar prone instability test

-pt. prone w/ feet on ground -perform P to A on lumbar spine -if pain is reproduced have the pt. straighten their legs and repeat the P to A pressure -*if pain is less the test is positive for clinical lumbar instability*

mulligan snag for flexion/ext

-pt. seated -contact thumb hooked under SP reinforced by opp thumb -glide towards eye at 45 deg -pt. moves with you while PT maintains glide -maintain constant pressure -follow up with self snag

Impingement Sign at ankle

-pt. seated -examiner brings foot into PF -place thumb over anterolateral ankle -foot is brought from PF to DF maintaining thumb pressure *(+) is pain greater in DF than PF*

shoulder abd test

-pt. seated -places hand of affected extremity on head positive is reduction in radicular symptoms

CT junction seated manipulation

-pt. seated with arms on hips -place your hands around foreams and draw hands behind head near nuchal line -fingers interlaced under nuchal line -place towel roll at T3 -just before thrust have pt. look up -take up slack -ADD arms and push sternum forward into pt. while you pull pt. towards you -quick jerk up with low amplitude high velocity

self HA snag

-pt. seated with strap or firm band around C2 with hands in front of eyes -pt. actively retracts chin posterior -repeat up to 10x

slump sit procedure

-pt. sits on edge of table -PT applies overpressure into trunk flexion w/ cervical flexion -PT applies knee extension & then dorsiflexion -PT releases cervical flexion -test can be performed w/ LE actions or cervical first

slump test

-pt. sits up with straigt arms behind back -slump spine while keeping head straight -cervical flexion -knee extension non painful side first -ankle DF

mulligan snag rotation/sidebending

-pt. sitting -contact medial border of thumb on articular pillar and reinforce with opp thumb -glide upward toward ipsilateral eye at 45 deg -pt. moves with you and can provide overpressure with their hand -maintain constant pressure -follow up with self snag

cervical rotation lateral flexion test

-pt. sitting -passively rotate head away from painful side -gently side flex head towards chest positive if bony block to lateral flexion -may indicate 1st rib involvement -not only for TOS (neck and shoulder pathology)

JPE assessment

-pt. sitting or standing 90 cm from wall -laser pointer head lamp placed on head -target centered on laser beam with pts. head in neutral -pt. asked to stabilize beam then pt. closes eyes, performs full AROM into rotation/flex/ext and attempts to return to starting position normal error 4.5 degrees

Landing Error Scoring System (LESS)

-pt. stands on 12 in box -target line drawn on floor at distance of half individuals height -jump forward and land w/ both feet ahead of line -immediately rebound and jump max vertical height -observe 2 from front and 2 from side *Cut off is 5*

10 second step test

-pt. stands unsupported -pt. marches in place with thigh coming to parallel 10 seconds normal pts. avg 19.6 12 months s/p sx 15.1

straight leg raise test procedure

-pt. supine -PT supports LE (maintain knee ext & neutral DF) -raise until symptom production -sensitization w/ DF or cervical flexion

MWM for elbow (grip strength)

-pt. supine -UE IR so head of radius is toward ceiling -belt around therapist shoulder -hold proximal forearm against table -extend knees to apply distraction -repeat 10x with elbow ext, at 45 deg flexion and at 90 -retest

FABER (patrick) test

-pt. supine -flex, abd, ER -lat ankle is across conralateral thight -satabilize ASIS -involved leg is lowered towards table to end range -positive is reproduction of symptoms

distraction test

-pt. supine -occiput and forehead grasped -lean back applying distraction force positive is reduction insymptoms indicating possible nerve root compression

Scour test

-pt. supine -passively flex hip to 90 -move knee toward opposite shoulder and apply axial load +provocation for intra-articular hip pathology

alar ligament test

-pt. supine -stabilize C2 and perform SB PROM of upper cervical spine -test left alar ligament introduce SB to right -should be very firm end feel with little to no movement -if positive perform in flexion and extension -can perform perform a confirmatory test with rot in sitting -positive for inc motion/lack of firm end feel

knee P to A glide

-pt. supine or prone in 15-20 degrees of flexion -one hand on anterior femur and the other on posterior tibia -provide anterior force on tibia -oscillate or sustained -follow up w/ knee extension activity

palpation IP

-pt. supine w/ hips flexed -midpoint btwn ASIS and umbilicus -gentle contraction of hip flexion to confirm -seeing if it reproduces symptoms -dry needling from lateral side

Thomas Test

-pt. supine w/ one hip flexed -other extended off edge of table w/ knee flexed to 90 degrees -lumbar spine stays flat to table -if leg is lowered does not reach horizontal positive can mean multiple things

supine thoracic manipulation

-pt. supine with arms crossed in parallel -pt. turns .25 turn -PT using pistol grip has tontac on the TP of lower vertebrae -PT puts sternum on arms crossed over upper abdomen -other hand supports pt. head, neck and upper t spine -flex pt. until tension is localized to target segment -perform pre-manipulative hold -get pt. consent -on exhalation apply a thrust through the patient arms towards your bottom hand and simultaneously apply traction and an upward force with the bottom hand

red flags

-pt. younger than 20 and older than 50 with 1st episode -pain following trauma (fracture/punctured lung) -constant or worsening pain -long term corticosteroid use -general malaise -night sweats -weight loss -progressive neurological symptoms -anterior neck pain and torticollis may be sign of underlying thyroid involvement

posterior shoulder tightness test

-pts. arm is passively positioned in 90 deg abduction by examiner and scapula is reatracted -PT passively lowers arm across chest into horizontal adduction while manually retracting scapula through contact with lateral border -close up picture illustrating scapular stabilization

what motion should upper ribs have?

-pump handle motion

arm cocking evaluation

-quad strength/length -timing trunk rotation & flexibility -GHJ ROM -elbow ROM -scapula dyskinesis -hand positioning

multifidus lift off test

-quadruped position and pt. extends hips and straightens their knee or arm -palpate contralateral multifidus at L4/5 or L5/S1 -should be active before movement -alternate position standing, prone

Main difference between radial tunnel & PIN

-radial tunnel primary sensory -PIN has sensory and motor deficits as well

Cervical referred or radicular pain key features (2)

-radiation of pain from c-spine, reproduced by palpation or movements of the cervical spine -focal motor, reflex, or sensory changes associated w/ affected nerve

Signs & Symptoms associated w/ Cauda Equina (6)

-radiculopathy (uni or bilat) -LE motor weakness -sensory disturbances (saddle paresthesia, hypoesthesia of L3-Coc1) -absent or diminished ankle & knee reflexes -bowel and/or bladder dysfunction -typically no abnormalities in UMN signs (bc they're NOT the SC anymore, they are now peripheral nerves!)

How does radiographic vs symptomatic OA prevalance change (male vs female)

-radiographic OA: M > F -symptomatic: M = F

FAIS - incidence

-rapidly increasing since 2000 -surgical repair common

Cauda Equina Syndrome (8)

-recent onset of bilateral radicular pain -bowel and bladder changes -urine retention -saddle paresthesia -multidirectional movement restrictions -positive bilateral SLR - +/- neuro signs IMMEDIATE MEDICAL REFERRAL

Indications for surgical treatment of shoulder instability? (5)

-recurrent dislocations (> 3x or happens in sleep) -young, active, contact sports -fracture -irreducible dislocation -non-responder to 3-6 mos of conservative treatment

Consequences of Breathing Dysfunction (3)

-reduced ability to regulate intra-abdominal pressure (implications for motor control, spinal stabilization and support) -muscle imbalances (neck, back, pelvic pain) -incontinence

Cause of LCP

-reduced blood flow to femoral head -disputed, may be influenced by repeated microtrauma

McKenzie method directional preference definition

-reduction in distal pain and/or observation of centralization w/ application of repeated or sustained end-range loading strategies to spine that remain better after assessment

Sarcopenia

-reduction in type I and type II muscle fibers -decline in cross sectional area of type II fibers -results in dec strength, power, endurance

How might SNS involvement be affected in TOS?

-reentry of visceral & somatic info into inferior cervical gangion (C5-T1) -preganglionic cells for UE are housed T2-T6/7

single leg hop

-reflects neuromuscular control, strength, confidence in limb -high test retest reliability -low to mod correlations btwn performance and LE strength and PROs

inverted suppinator reflex

-reflex of BR is absent -hyperactive response of finger flexors present

soreness rule for throwing program: sore in warm-up; resolve in 15 throws

-repeat workout -if sore during workout, take 2 days off & back off 1 step on return

Causes of bankart lesion?

-repeated anterior subluxation -GH instability

risk factors for CTS

-repetitive activity, frequent vibration exposure or sustained wrist flexion -pregnancy -hypothyroid

Internal impingement - defined

-repetitive contact of posterior greater tuberosity of humeral head & posterior-superior aspect of glenoid border at end range ABD & ER (basically, in the tendon itself)

Causes of TOS

-repetitive lifting and ABD of upper limbs -posture may contribute -excessive muscle mass/shortness -fractures to clavicle or upper ribs -bone abnormalities (cervical rub, clavicle irreg, first rib irreg, tumor)

Bursitis MOI? What do you need to rule out?

-repetitive loading or trauma -need to r/o infection

SLAP lesion MOI (4)

-repetitive throwing -articular cartilage damage due to trauma (FOOSH, dislocation) -repetitive shoulder motions -anterior instability w/ inadequate NMR

positive sharp-purser positive

-reproduction of myelopathic complaints during upper cervical flexion -dec symptoms during AP movement -application of movement during the test

Diagnostic Cluster for TOS (3)

-reproduction of patient symptoms -pain w/in same arm during any 2 tests -any symptoms during 3 tests

SIJ Special Tests

-resisted hip abduction test

Pronator teres syndrome - pain reproduction (3)

-resisted supination -resisted long finger flexor -pressure over PT 4cm distal to cubital crease against pronation, elbow flexion, wrist flexion

Refer out with sub acromial pain if (4)

-resistive tests are painfree -RTC and/or biceps have normal strength -significant loss of ROM -signs of instability

PIN syndrome interventions (5)

-rest -activity mod -*wrist cock-up splint* -nerve glides -stretch & strengthen wrist extensors *after pain alleviation*

Non-surgical treatment of rotator cuff tear (4)

-rest -activity modification -NSAID/steroid injection -PT *80% have dec pain & improved function*

Local elbow arthritis - key features (3)

-resting pain & joint stiffness -pain & dec ROM due to impingement at extremes of flex/ext -history of trauma or heavy use

TSA Key concepts (2)

-restoring soft tissue tension, specifically subscap -restore muscle balance to 66-75% ER:IR on HHD

Chronic Ankle Instability

-result of past recurrent ankle sprains -dec ankle stiffness -ankle proprioception esp inversion at 30 degrees deficient (no difference in fibularis muscle strength) -subjects who report instability during functional performance may have severe FAI

MCL Insufficiency

-result of valgus force -foosh secondary -most common in overhead athletes -medial elbow pain esp during accel -+/- pop, sharp pain, inability to throw -+/-ulnar nerve involvement -point tenderness over MCL -instability tests positive

Health History

-review constitutional symptoms -review of body systems -surgeries -allergies -meds -health habits (social, alc, smoke) -abuse history -pertinent family medical history

rib exam (5)

-rib expansion (HiLo) -breath hold time -total lung capacity -cervical rotation/lateral flexion -10 second step test?

AC joint grade 2 strain

-rupture AC ligaments and joint capsule -sprain of CC ligament -minimal detachment of deltoid and trap

AC joint grade 3 strain

-rupture of CC ligaments -clavicle elevated up to 100% -detachment of deltoid and trap

Biomechanics of SC joint

-saddle joint anatomically, but plane synovial joint functionally -has a disc

Common MSK system health conditions in older adults (7)

-sarcopenia -RA -OA -ankylosing spondylitis -cervical spinal stenosis -osteoporosis -vertebral compression fractures

Soft Tissue to consider for PT intervention (3)

-scalenes (influence on 1st rib) -input T2-9 for sympathetics -state of the tissue (tight, stretched, weak)

dissociative instability of the carpals mostly involve which ligaments (2)

-scapholunate -lunotriquitral

what should you observe during the UQS?

-scapula,spine -scars -atrophy/hypertrophy -edema -skin integrity -ataxia, coordination -willingness to move -general demeanor

SMP's for scapula (2)

-scapular assistance test -scapular reposition test (cobra grip) with supraspinatus testing

Breathing Hi-Lo Test

-seated, patient places one hand on sternum and one hand on upper abdomen for 5 cycles -normal = lower rib cage dominant

How to manage biceps/triceps tear? (2)

-sedentary: try rehab -active: surgery

Secondary effects of breathing (4)

-self regulation of mental and emotional stress -speech & vocalization -homeostatic rhythms and oscillations -spinal stability, posture, and motor control

Lumbar Instability clinical diagnosis summary - combination of research & expert opinion (7)

-self-manipulator -frequent LBP -poor muscular control -pain increases w/ static postures -hypermobility -positive prone instability test -younger age (<40)

what is joint position error?

-sense that detects bodily position, weight, movement of muscles, tendons, joints is disrupted -pts. with neck pain have greater deficits than those w/o -common in WAD

treatments for movement control TBC

-sensorimotor exercises -stabilization exercises -flexibility exercises

True Neurogenic TOS s/sx (4)

-sensory loss -motor weakness -atrophy -positive EMG or NCV testing

Cluster HA - 5 or more attacks meeting following criteria (3)

-severe orbital supra-orbital &/or temporal HA lasting 15-180 mins untreated -1 or more of following: conjunctival infection, nasal congestion, eyelid edema, forehead/facial sweating, miosis/ptosis (all on same side as HA); sense of restlessness or agitation -occuring w/ frequency of 1 every other day to 8x / day

Biceps/Triceps tendon injury complaints (4)

-sharp, sudden movement -tearing sensation -pain dissipates w/in few hrs -loss of strength

moving valgus stress test

-shoulder abd 90 -max ER -clinician maximally flexes elbow -apply valgus stress -quickly extend elbow to 30 deg -positive for medial elbow pain btwn 120-70 deg of flexion

ICF classifications for shoulder

-shoulder pain with radiating pain -shoulder pain with mobility deficits -shoulder pain with muscle power deficits -shoulder pain with mvmnt coordination deficits

wind-up evaluation

-single leg balance -hip abd strength -hip ext strength -quad strength

Manual Assessment of Respiratory Motion (MARM) what is it?

-sit behind patient w/ both hands on lower lateral ribs and thumbs parallel to spine -assess breathing & document upper & lower rib cage movement

Recommended activities after TSA w/ limitations (3)

-skiing -golf -swimming

Arthroscopic rotator cuff repair (3)

-slower initial recovery to allow fixation -preservation of deltoid -less pain & morbidity

Sizing of rotator cuff tears

-small = 0-1 cm -medium = 1-3 cm -large = 3-5 cm -massive = >5 cm

sharp purser test

-small amoutn of upper cerv flexion -stabilize C2 and apply posterior traslation of forehead -positive if laxity or feel a clunk or if symptoms are relieved

AAA Modifiable risk factors (5)

-smoking -HTN -hypercholesterolemia -atherosclerosis -obesity

treatments for TOS

-soft tissue massage (scalenes/pec minor) -neural mobs -cyriax release for up to 30 minutes -education on activity mod and sleep mod -first rib mob -stretching tight musculature -strengthening for postural muscles and scaps

cervical flexion causing electrical sensation or tingling down spine and UEs is thought to indicate what?

-spinal cord condition such as MS or tumor

where to palpate during cerv spine eval

-spinous processes -UT for trigger points (pain pressure threshold with algometer over UT) -sub-occ for HA, dec ability to perform upper cerv flexion -levator scap (trigger points/contribute to downward rot. scap) -nuchal line -scalenes

CTS management (7)

-splinting is not standardized, but helpful sometimes -NSAIDS -activity mod -night splints help reduce symptoms at night & improve sleep -tendon gliding -nerve gliding -treat the cause

cluster for cervical radiculopathy

-spurling test A -distraction -ipsilateral rotation <60 -positive ULTT

tests for cervical radiculopathy

-spurling test A -distraction -ipsilateral rotation <60 -positive ULTT -shoulder ABD test

inferior glide GH (needs picture)

-stabilize coracoid -0 and 90 degrees

1st MTP mobilization

-stabilize first ray -distract 1st MTP -apply a plantar or dorsal mobilization force

levator scapulae muscle length test

-stabilize superior angle of scapula -flex head towards opposite arm pit

What are "normal" scapular mechanics during arm elevation? (2)

-stable w/ minimal motion during initial 30-60 deg of elevation -then, smooth and continuous upward rotation during rest of elevation

transverse abdominis muscle function hook lying

-start at 40 hhHg -ADIM: abdominal draw in maneuver -should see no change in pressure -breath normally -palpate transverse abdominals *can progress to exercise w/ leg loading*

anterior to posterior glide of tibia on femur

-start in 15-20 deg of flexion -one hand on anterior femur and the other on posterior tibia -apply equal force anterior on tibia -Use Maitland grades depending on irritability -follow up w/ knee flexion motion

Scaphoid shift test/Watson's test

-start in UD and extension and place pressure on distal scaphoid to prevent it from flexing -move to radial deviation and flexion and let go of pressure -painful clunk if positive -compare to other side

wind up start and stop

-start w/ dual stance -end when in single stance hands together

stride start and stop

-start when hands separate -ends when stride foot hits ground

arm cocking start and stop

-start when stride foot hits ground -ends when shoulder in max ER

Overuse lateral elbow pathology progression (3)

-starts as inflammatory response (reactive "itis") -failed healing attempts lead to degenerative changes ("osis") -degeneration can lead to tear (usually midsubstance)

deceleration start and stop

-starts when ball leaves hand -ends when shoulder in max IR

acceleration start and stop

-starts when shoulder in max ER -ends when ball leaves hand

follow-through start and stop

-starts when shoulder in max IR -ends when weight transferred to stride leg and arm motion ceases

What tests have been deemed to have poorer clinical utility to diagnose cervicogenic dizziness? (7)

-static & dynamic balance -convergence -dynamic visual acuity -reproduction of dizziness w/ joint provocation -JPE testing -neck pain & dizziness -dizziness w/ palpation to neck muscles

soreness rule for throwing program: sore in warm-up and after 15 throws

-stop, take 2 days off -drop 1 step down on return to throwing

treatments for functional optimization TBC

-strength and conditioning exercises -work/sport specific tasks -aerobic exercises -general fitness exercise

stroke test

-stroke prox toward hip up to suprapatellar pouch two to three times -w/ opp hand, stroke down lateral side of patella -wave of fluid passes to medial side of joint and bulges just below the medial distal portion of border of patella -may take up to 2 seconds to appear 0: no wave trace: small wave on medial side 1+: large bulge on medial side 2+: effusion spontaneously returns to medial side after upstroke 3+: so much fluid that it is not possible to move the effusion of the medial aspect of knee

Common running injuries: plantar fasciitis (2)

-structurally associated w/ limited DF ROM, high or low arch -mechanics associated w/ poor force attenuation, uncontrolled pronation, stride crossing midline, "toe out"

Common running injuries: peroneal tendinopathy (2)

-structurally associated w/ pes planus -mechanics associated w/ uncontrolled pronation, rearfoot EV, "toe out"

Common running injuries: posterior tibialis tendinopathy (2)

-structurally associated w/ pes planus or uncontrolled pronation -mechanics associated w/ excessive rearfoot ev, stride crossing midline, toe out

Elevation force couple w/in the rotator cuff

-subscapularis -infraspinatus & teres minor (balance rotation during elevation)

FADIR

-supine -flexes, ADD, IR -(+) is repproduction of pain for intra-articular pathology -helps identify FAIS

capital extensors muscle length test

-supine -passive chin tuck -if less irritable can stabilize C2 and provide overpressure

passive straight leg raise

-supine -passively flex hip until feel pelvic motion -palpate ASIS -use inclinometer

pec minor muscle length test

-supine measure distance from post. acromion to mat table ->1 inch -if positive, provide overpressure (stiff vs. short)

anterior-posterior mobilization subacute/chronic

-supine to barrier of knee flexion w/ tibial IR -grade 3 or 4 to end range -perform conract relax -push further into range or pt. pull into more flexion -follow up w/ self knee flexion mobilization

What path does the long head of biceps tendon take as it travels toward muscle belly?

-supraglenoid tubercle & superior labrum, travels distally and arches over humeral head. passes under coracohumeral ligament as it exits joint and through rotator interval into the groove between greater & lesser tubercle

Mulligan SNAGS

-sustained natural apophyseal glides -mobilization with movement -combo of joint gliding and physiologic movement designed to improve pain, ROM, function -should greatly reduce symptoms esp good for neck pain with HA ICF category

cervical arthrokinematic movements: flexion

-symmetric movement of bilateral facet joints -superior bone in segment glides superior -or relatively, the inferior bone in segment glides inferior

cervical arthrokinematic movements: extension

-symmetric mvmts of bilateral facet joints -superior bone in segment glides inferior -relatively, inferior bone in segments glides superior

3 classifications of rehabilitation provider under TBC

-symptom modulation -movement control -functional optimization

treatment based classification system

-symptom modulation -movement control -functional optimization

questions to ask about pain/symptoms in elbow (3)

-symptoms change with neck/shoulder mvmt -symptoms change with gripping -numbness/tingling

cardiac involvement in thoracic spine signs

-symptoms related to exertion/emotion -interscapular pain -family history, obesity, smoking, HTN, dyspnea -men>40 women>50

neurodynamic testing positive if

-symptoms reproduced -side to side difference in elbow ext >10 degrees -change in symptoms w/ different maneuver

red flags in the hip (6)

-symptoms unchaged by rest -limited PROM w/ empty end feel -hip pain in young adult worse at night and alleviated by activity and asprin (ankylosing spondy) -painless neurologic deficit -insidious onset of groin/ant thigh pain w/ recent history of inc activity -symptoms related to menstrual cycle

red flags in foot and ankle (5)

-symptoms unchanged by rest, movement or change in position -painless neurologic deficit -vascular claudication -neuro claudication -peripheral neuroapthy

IKDC subjective knee eval form

-symptoms, sports activities, ADLs -knee specific but not disease specific -MCID: 11.5

soreness rule for throwing program: sore >1 hour after throwing

-take 1 day off and repeat most recent program

tests for scaphoid fracture

-tender over anatomical snuff box -pain w/ resisted supination -pain with longitudinal compression -axial load

Ottawa Ankle Rules - radiographs are indicated if:

-tenderness to palpation of: posterior edge or tip of lat mall, posterior edge or tip of medial mall, navicular, base of 5th met OR -inability to take 4 complete steps at time of injury & at evaluation

early stage exercises

-tendon gliding -picking up objects with chop sticks -finding objects in putty, rice -putty rolling -Chinese balls -wrist maze

Biceps tenotomy vs tenodesis

-tenotomy = remove long head of biceps tendon -tenodesis = reattach tendon elsewhere on humerus

spurling test A

-test for cervical radiculopathy -perform straight compression before this test -pt. SB head and examiner places force straight down spine positive is symptom reproduction

Finkelstein's test

-test for stenosing tenosynovitis of APL and EPB -thumb tucked into fist inside hand and hand UD -pain provocation over first compartment at wrist -Tudini says its a crap test

Alar Ligament Testing - what is it for, is it useful?

-tests alar ligaments -situational usefulness

ER lag sign

-tests infra/supra -examiner passively positions arm in 20 deg of scaption and ER to 5 deg from end range -pt. is asked to maintain that position, while examiner releases arm positive is unable to maintain ER rotated position

Late stage exercises for wrist and hand

-therabar-> Con and Ecc -push/pull weight box -tug of war -hammering into foam or putty

Chief Complaint

-things other than pain (tingling, cramps, numbness) -reason for visit -functional status in various roles -pt. goals -history of chief complaint -location/behavior of symptoms -previous exams/tests

passive arthorkinematic intervertebral movement

-this is subset of accessory motion -it mimics the assumed mvmt of articular surfaces that occurs during AROM of segment being assessed

Neck pain w/ mobility deficits: acute interventions (6)

-thoracic manip -cervical manip or mob -cervical ROM & strength -encourage to stay active -impairment focused exercise -general fitness training

Neck pain w/ mobility deficits: chronic interventions (6)

-thoracic manip -cervical mob -cervical & scapulothoracic exercises w/ or w/o mob/manip -impairment based exercise -advice to stay active -dry needling, traction, TENS, E-stim

ICF classifications in tspine

-thoracic pain with mobility deficits -thoracic pain with motor control deficits -mid-back and thoracic cage pain with spinal and respiratory movement coordination impairments

parts of deltoid ligament

-tibionavicular -tibiocalcaneal -ant/post tibiotalar

medial ankle ligaments (deltoid) (3)

-tibionavicular -tibiocalcaneal -posterior tibiotalar

What 2 impairments might cause downward scapular positioning?

-tight muscles -sloping or slouched shoulders

CTS tests

-tinel -phalen -flick -hand elevation -wrist ratio?

Thermal Capsulorrhaphy (2)

-tissue heated to 150 deg to shrink capsule -not used due to high failure rates

Where does peel back mechanism occur and what is it?

-traction on biceps tendon in late cocking phase of throwing -also eccentric strain on biceps tendon in follow through

What is "traditional" vs "original" running

-traditional is heel strike when running -original is forefoot running

What is done in a Latarjet or Bristow procedure? (3)

-transfer coracoid process to anterior scapular neck to provide more anterior stability of shoulder -subscapularis pulled over the transfer anteriorly & fixed -high complication rate, reoperation rate 7%

What is the difference between true and disputed neurogenic TOS?

-true = testing confirms the presence of TOS -disputed = clinically symptom based and diagnostic testing (like doppler, EMG, or neural tension) does not confirm the presence of TOS

What is the prevalence of the 2 subtypes of neurogenic TOS?

-true neurogenic (8.5%) -disputed neurogenic (90%)

what to do if a snag doesn't reduce symptoms

-try level above/below -try opp side

press sit to stand test

-try to suspend body using only hands -pain provocation ulnar side

Meniscal tear (9)

-twisting injury -tearing sensation at time of injury -delayed effusion -*locking/catching* -*pain w/ forced hyperextension* -*pain w/ PROM max flexion* -*pain/click w/ McMurray* -*joint line tenderness* - (+) Thessaly

Elbow injuries associated w/ throwers (6)

-ulnar neuritis -cartilage damage: OCD or Panner's in kids -valgus laxity creating extension overload: degenerative changes in medial olceranon & trochlea, bone spurs, cartilage wear

Is positional testing useful for CAD?

-uncertain diagnostic validity -low sensitivity, meaning risk for high false negative rate

LCP - clinical presentation (5)

-unilateral -mild pain in knee, thigh, or hip -limp -limited hip PROM (abd & IR) (*this will probably reproduce the knee pain) -true LLD of 1-2.5 cm

S/S of Cervicogenic headache

-unilateral HA w/o side shift -symptoms triggered by neck movement or sustained awkward posture -pain episodes of varying duration/fluctuating cont. pain -mod, nonexcrutiating pain -neck pain spreads to oculo-fronto-temporal area

Predictors of positive response to PT in hip OA (5)

-unilateral hip pain -age < 58 y.o -pain >6/10 -*duration of symptoms <1 year* -40m walk test time of <25.9 2/5: 32-65% success >/= 3: 99% success

SCFE clinical presentation (5)

-unilateral or bilateral -if unilateral, most experience contralateral SCFE < 18 months -knee pain w/ limp -may have: hip pain and hold limb in ER -dec hip flexion and IR

Ankle Fracture Classifications (3)

-unimalleolar -bimalleolar -trimalleolar (both malleoli and posterior margin of tibia)

Red and Yellow flags

-unknown cause -Hx of CA -breathing difficulty -UMN signs/ataxic gait -pain in presence of normal motion -symptoms are out of proportion -symptoms persist beyond expected

Upper & Lower Rib movement patterns

-upper = pump handle -lower = bucket handle

Muscles causing upward scapular rotation (3)

-upper trap -lower trap -*lower serratus anterior* (primary mover)

What 3 muscles contribute most to scapular mobility & stability?

-upper trap -lower trap -serratus anterior

Key Notes for Passive Artho Motion Testing of SIJ (3)

-use algorithm - end feel guides testing -test both sides! -understand it is very hard to appreciate these end feels

Lateral ankle sprain

-usually PF and IN -pain -swelling -tenderness to palpation -ecchymosis anterior and inferior to lat malleolus

neurogenic claudication

-usually bilateral -*burning* and dysestheisa in back, buttock, legs -normal pulses -skin negative -*dec/absent reflexes* + SLR + shopping cart sign -symptoms inc in extension (standing) -symptoms dec in flexion (sitting)

Elbow instability ligamentous testing (4)

-valgus & varus stress -PLRI test -moving valgus stress test (milking maneuver) -sustained valgus extension testing

end stage rehab

-vapor strobe -powerball -trampoline throw

How does the dynamic systems theory relate to scapular dyskinesis?

-variability reflects the variety of coordination patterns used to complete a task -thus, variability is evidence of the flexibility & adaptability of the NM system in exploring new movement solutions

UCI patient history (4)

-variable demographics -PMH (cervicogenic HA, RA, Down's, Ankylosing Spondy) -variable pain onset & duration -trauma (concussion, MVA, fall from height)

LCL MOI (2)

-varus stress or combo of axial compression, ER, and valgus force -iatrogenic cause

What are the 2 general forms of TOS and how common are they?

-vascular (1.5%) -neurogenic (98.5%)

yellow flags in hand

-vascular signs and symptoms -previous malignancy -OA -RA

What are the effects of 20 mmHg pressure? (2)

-venous obstruction -infrafascicular edema & anoxia

Impaired venous flow with stretch of 8% or more in-vivolength can cause what? (2)

-venous pooling around nerve -takes time for nerve to reboot (paresthesia)

What are the most commonly concerning cervical arterial dissections?

-vertebral arteries -ICA

cerical artery dysfunction

-vertebral basilar artery and carotid artery -carotid more common -presentation can mimic mechanical neck pain

primary instability at the DRUJ

-very rare -RA, ehlers danlos

what does the romberg test?

-vision -proprioception -vestibular sense

palpation of femoral pulse occurs where?

-w/in femoral triangle

After TSA, recommended activities (3)

-walk/hike -jog -cycle

Compression fracture

-wedge-shaped fracture resulting from increased pressure on vertebral bodies due to forward head or excessive kyphosis

What MOI's might be involved in scalene involved TOS? (4)

-weightlifting -COPD/Asthma -Trauma -Whiplash (causing hypertrophy or hypertonia of these muscles)

disadvantage of muscle function tests (2)

-when to stop test -motivation and perceived fatigue

risk factors for cervical radiculopathy

-white race -hx smoking -prior lumbar radiculopathy

what can grip strength predict?

-winning loto numbers -slow walk speed -mobility restrictions -future disability in older men -mortality -post op morbidity and LOS

ICF classifications wrist and hand

-wrist and hand muscle power deficits (dequervains type) -wrist mobility deficits (s/p immobilization/fracture/contracture) -hand sensory deficits (CTS) -wrist and hand movement coordination deficits (UCL sprain)

international hip outcome tool (IHOT-33)

-young active individuals: 18-60 -chondral, ligament, instability -MCID: 6

where will tear of tendon occur for younger vs older population?

-younger = trauma, near the insertion point (lateral epicondyle) -older = degenerative, in midsubstance of tendon

Radiocapellar pathology key features (4)

-younger athletes following trauma or medial elbow instability -tenderness over posterior radiocapitellar joint (posterior to lateral epi) -painful click or snap w/ terminal extension & forearm supination -imaging may demonstrate inflammation or hypertrophic synovial plica or chondromalacia

How does multidirectional instability typically present? (5)

-younger females -insidious onset of shoulder pain and subluxation -laxity or repetitive microtrauma to capsule -muscle imbalance due to poor RTC control & periscapular weakness -associated w/ generalized joint laxity

what is cut off value for pain pressure threshold for GTP?

.8

community ambulator speed

.8-1.2

DIP extension

0

PIP extesion ROM

0

in closed chain there is less stress on ACL and Patella closer to:

0

reflex testing grading

0 no response 1+ minimal response 2+ normal response 3+ brisk response 4+ hyperactive, clonus grades 0 & 4 are considered pathologic grades 1 & 3 are normal unless asymmetric

loading response

0-10% -begins when limb hits ground -concludes w/ contralateral toe off

vascularity of menisci

0-3 mm is vascular 3-5 mm is gray zone >5 mm is avascular

Stage 1 Adhesive Capsulitis

0-3 months -sharp pain at end ranges -achy pain at rest -sleep disturbances -early loss of motion with intact RTC

patellar load during walking

0.3X body weight

Cause for cubital tunnel compression in zones 1,2,3

1 = medial intermuscular septum or cubitus valgus deformity 2 = subluxation or cubitus valgus deformity 3 = tight FCU or subluxation

Lateral epicondylosis grading scale (1-7)

1 = mild soreness & stiffness after activity, resolves in <24 hrs 2 = same as grade 1 but lasts > 48 hrs 3 = soreness before, reduced during & after 4 = > intensity of pain, changes performance (*tendon changes/damage*) 5 = mod-severe pain before, during, after; alters performance, complete rest controls pain (*permanent tendon damage*) 6 = same as 5 and prevents ADL's, pain persists w/ rest 7 = interrupts sleep

Primary & Secondary anatomical restraints for PCL

1 = posterior tibial translation 2 = rotation between 90-120 degrees of flexion

3 types of scapular dyskinesis (winging)

1 = prominence of inferomedial scapular border 2 = prominence of entire medial border 3 = superior medial border prominence

where to use pain pressure threshold at the knee

1 cm distal to joint line on medial knee

False positive rates in testing increase heavily after how long?

1 min

acsm guidelines to improve endurance

1-2 sets 15-25 reps no more than 50% 1RM 2-3 mins btwn sets

exercise progression phases for carpal instability

1. (up to 2 mos) iso long finger flexor activation through F/A progression 2. (up to 6 mos) gripping exer through F/A progression 3. (as early as 3 mos and up to a year) CKC exer ---all planes w/ ball and disc ---incorporate coupling and balance of flexors/ext

PCL

-least tension 25-40 degrees of knee flexion -main restriction to posterior displacement between 90-120 -causes femoral condyles to glide posterior w/ knee ext

How to measure leg length discrepancy

-legs 15-20 cm apart -ASIS to medial malleolus or lateral malleolus -1-1.5cm is normal but can still cause symptoms

Special circumstances - central pain mechanism (2)

-likely allodynia or hyperalgesia bilaterally or UE & LE -consider low intensity isometrics for major muscles

Special circumstances - peripheral pain mechanism (3)

-likely one limb w/ allodynia or hyperalgesia -may tolerate slightly higher intensity in *unaffected limb exercises* -consider mod intensity isometrics >1min in *unaffected limbs*

Simple cues for running retraining (3)

-limited force attenuation: "make your strike softer/quiet" -excessive vert displacement: mirror feedback to limit head motion -excessive dynamic valgus: "keep your knees out"

All chronic pain - special circumstances due to impairments (6)

-limited recovery & adaptability from impairments: sleep, depression/anxiety, mood, fear, physical function -*provide these patients choices*

tectorial membrane

-limits upper C ROM -less common injured than Alar or TLA -attach: arise from post body of Axis & passes post to TLA prior to attaching to basilar occiput

Alar ligament

-limits upper cervical rotation & side bend -often injured during mechanical trauma -attach: postero-lateral dens to medial aspect of occipital condyles

Ligament sprain 1st degree (4)

-local tenderness -minimal swelling -no instability -little disability

Ligament sprain 2nd degree (4)

-local tenderness -swelling -slight-mod instability -mod disability

What impairments are associated with decreased shoulder elevation? (5)

-locked 1st rib during inspiration -cervical rib presence -increased kyphosis -inc muscle tone -CSA

TMJ Disorders - Subluxation: history, exam findings, more Sn or Sp?

-locking or catching during max opening w/ a specific maneuver -when locking happens, a specific maneuver is needed to unlock -more Sn (0.98)

pt. education for GTPS

-long distance running, hill running, plyometric drills need to be suspended temporarily -recommend cycling/aquatic instead

Hallux Rigidus risk factors (5)

-long first ray -previous first ray trauma -family hx -elevated 1st metatarsal -most likely idiopathic

How does duration of symptoms relate to neck pain prognosis?

-long term symptoms = lower recovery potential; -short term symptoms = higher potential for recovery

management of ulnar nerve compression (5)

-look for bony anomalies in hook hamate or pisiform -check pisotriquetral joint -check for DM or other peripheral neuropathies -splinting and education for treatment -can try nerual mobs & local treatment

Joint, disc, and cartilage changes w/ age (5)

-loss of height (about 2 inches over lifetime) -OA & osteophyte formation -degenerative changes -*ligamentum flavum buckles & thickens* -25% bone tissue volume loss

Cervical Spinal Stenosis

-loss of joint space (spinal column) due to osteophytes, protrusion of annulus, or hypertrophy of ligamentum flavum -progresses to cause nerve root entrapment

What is an early indicator of peripheral nerve entrapment?

-loss of vibratory sense

3rd Stage (Autonomous) of Stabilization Therapy (5)

-low attention to stability -focus on task performance -mimic demands of daily activities -dynamic resisted movements -can now begin true strength training if desired

Lumbar radiculopathy s/sx (6)

-low back and/or LE pain -motor weakness in segmental pattern -diminished sensation in segmental pattern -reduced reflexes in segmental pattern -possible neural tension signs (SLR, slump, prone knee bend) -may be resultant or coinciding w/ disc herniation, lateral stenosis, or localized inflammation

TBC functional optimization

-low disability -low to absent pain -controlled pain

fuctional optimization (TBC)

-low disability and pain -controlled symptoms

Exercise induced analgesia - ascending changes (5)

-lower sensitivity: --peripheral receptors --neuronal junctions -CNS processing -increased sensitivity --opiate receptors --cannabinoid receptors

Negative effects of hyperkyphosis and compression fx's on older adults (8)

-lower walking speed -difficulty climbing stairs -impaired balance -inc risk of: falls, fx, mortality -pulm impairments (restricted lung function & SOB) -compression of internal organs -reflux -weight loss (early satiety)

follow through evaluation

-lumbar flexion -scapular dyskinesis -shoulder horizontal ADD ROM

in the carpal bones, where is there the most instability?

-lunate and capitate-> no ligament

transverse ligament

-maintains contact btwn dens & anterior arch of C1 -preventing compression on the spinal cord -attach: medial aspect of lateral mass of Atlas (C1), superior band to basilar portion of occiput, inferior band to posterior body of Axis (C2)

SCFE - incidence

-male 3:2 female -age 12-15 male, 10-13 female

MCL Sprain Risk Factors (3)

-male 44% > female -intercollegiate athletes risk ratio 2.87 M/F -wrestling, hockey, judo, rugby

ankylosing spondylitis (8)

-male > female 3:1 -SI joint pain -symptoms worse in morning (greater than >30 minutes) -improved symptoms w/ exercise -pain persisting for at least 3 months -chest expansion < 2.5 cm -insidious onset -fatigue

AAA risk factors

-males > 60 -HTN -smoking -atheroslcerosis -CAD -statin use -overweight, poorly localized -movements do not alter symptoms -pulse detection > 5 cm from midline -severe lumbar, groin, abdominal pain assoc w/ syncope, hypotension, shock, vascular claudication

scapular assistance test

-manual contact to upwardly rotate scapula during elevation -positive is reduction in pain (2 or more on NPRS) -proposed to relieve compression of RTC tendons

What are primary muscles of mastication (5)

-masseter -temporalis -medial pterygoid -lateral pterygoid -suprahyoid group

Primary muscles of TMJ Elevation (3)

-masseter -temporalis -medial pterygoid

PCL Tear presentation - subjective (3)

-may report pop or tear sensation -unsteadiness & pain in posterior > anterior knee -inc pain w/ deceleration or full speed running

VISI clinical presentation (4)

-may see limitation in extension w/ patho endfeel -pain w/ wrist flexion -symptoms same as DISI except for location of pain (more ulnar) -positive ulnar compression test

Syndesmosis ankle sprain - incidence and healing time

-may take 2x longer to recover than lateral sprains -may account for up to 25% of all ankle sprains -lateral ankle sprain = 3x syndesmosis sprain

DISI clinical presentation (5)

-maybe limitation in flexion w/ patho endfeel -pain with grasping, chronic, vague wrist pain -positive scaphoid shift or Watson's test -may see pain w/ pushing up from chair followed by dead hand -can have median nerve symptoms temporarily

Self Evaluation Breathing Questionnaire (scoring and what might higher scores indicate?)

-mean = 11 -higher scores may indicate psychophysiological dimension

PFPS palpation (4)

-medial > lateral patella border - +/- infrapatellar - +/- ITB & lateral retinaculum - +/- effusion

Hallux valgus concomitant factors (4)

-medial arch collapse -bony overgrowth of dorsal 1st MTP -bunion -gait abnormality

SMPs for inc grip

-medial glide -lateral glide -radial head P to A -extensor grip test -cervical distraction

meniscal pathology (4)

-medial meniscus injured more in older -lateral more in younger -older > younger overall -often occur w/ ACL

SFMA pattern 1

-medial rotation extension-inferior border of scap

mobilization with movement for knee

-medial/lateral glide -foot on chair for flexion -3-5 sets of 10 per day

Carpal tunnel syndrome (3)

-median nerve compression -pressure plays large role in development -multifactorial

3 classification of TBC

-medical management (red flags) -rehab management (psychosocial risk) -self-care management

What can cause dizziness? (7)

-meds -vestibular dysfunction -cardiovascular pathology -metabolic or endocrine pathology -psychological dysfunction -visual dysfunction -neurological dysfunction or pathology

What is happening in lateral epicondylosis stage 3-4 and what is treatment?

-microdamage -rest/NSAIDs

Main primary headaches in PT practice (3)

-migraine -cluster -tension

PCL Tear physical exam findings (4)

-mild to mod joint effusion - + posterior drawer - + posterior sag sign - + quadriceps active sign

vertebral basilar artery dysfunction

-mild to moderate neck pain/HA -HA is often unilater, occipital, severe -5 Ds: dizziness, diplopia, dysarthria, dysphagia, drop attacks

progressive exercise program for carpal instability

-minimize compression -forearm positioning progression (neutral-> supination-> pronation) -finger exercise progression (FDP-> FDS)

AC joint grade 1 strain

-minor AC ligament strain

Manual Therapy - Cervical Mob Guidance (

-mobs are a good starting point -if used, follow this: --use minimal force --patient comfort --use pre-manip position testing or tolerance testing --repeat manip w/in session should be avoided --consider patient perspective & regional interdependence

Movement control (TBC)

-mod disability -mod to low pain -stable symptoms

TBC movement control

-moderate disability -mod to low pain -stable symptoms

TOS tests

-modified ULTT of elvey -elevated arm stress test -cyriax release stress test -cervical rotation/lateral flexion test (first rib)

transverse ligament testing

-modified sharp-purser -anterior shear -Patient is sitting

Describe Chronic/Prolonged Cauda Equina Progression (3)

-more gradual onset, w/ pain & progressive change in bladder function -better prognosis after surgical decompression -urinary symptoms remain most affected, w/ good recovery of motor function

ankylosing spondylitis cluster (4)

-morning stiffness >30 min -improvement of LBP w/ exercise but not rest -nocturnal back pain during second half of night only -alternating buttock pain

Dorsal Intercalated Segment Instability (DISI) (6)

-most common -tear of scapholunate ligament -verified radiologically w/ scapholunate angle >70 degrees -occurs w/ FOOSH in wrist extension -lunate no longer travels w/ scaphoid (falls palmar) -named for which way the lunate looks (dorsal)

lateral epicondylagia (tennis elbow)

-most common MSK condition at elbow -33-54 yo -dominant arm -repetitive overuse -manual occupation -pain over lateral epicondyle -aggravated with gripping -more degenerative in nature -ECRB most common tendon

What is hyperventilation?

-most common disturbance in biochemical dimension -breathing in excess of metabolic requirements -depletion of CO2 -most common cause of respiratory alkalosis (as CO2 dec, pH inc, causing alkalosis of blood (flight or fight response))

Criteria for non-neuropathic pain in central sensitization (6)

-no history of lesion or disease to nervous system -no evidence from diagnostic investigations, or damage to NS -no medical cause to pain established -pain is neuroanatomically illogical (located at sites segmentally unrelated to primary source of pain) -pain often described as vague & dull -location of sensory dysfunction is neuroanatomically illogical (numerous areas of hyperalgesia at sites outside & remote to symptomatic sites)

Premise of "Stabilization Therapy" (4)

-no single muscle can recover spinal stability or reduce size of neutral zone -only mild force needed to reduce size of neutral zone -spinal stability is a process that includes static & dynamic postures -impairment is related to MOTOR CONTROL not strength

S&S of arterial TOS

-non radicular UE pain, numbenss, coolness, pallor -worsens in cold temps -may lead to limb ischemia -may have anatomical abnormality

what is most common dynamic instability in the carpus?

-non-dissociative -may not be symptomatic and able to sublux at will -c/o clunk as distal row relocates on proximal row w/ ulnar deviation

CAD early presentation (4)

-non-ischemic s/sx -more likely to be confused w/ true MSK dysfunction -*head/neck pain, possibly lower CN dysfunction (9-12)* -recent onset moderate to severe pain of unusual nature

Clinical features of AAA (4)

-non-mechanical LBP -changes in pain w/ activity (increasing CV load) -pulsatile mass > 3 cm in abdomen (DON'T POKE IT) -+/- aortic bruit (turbulent blood flow)

SLAP tear treatment (surg vs non-surg)

-non-surg = NSAID & PT -surgical = arthroscopy for superior labral repair in younger pop, biceps tenodesis in older, less active pop

Scapular Dyskinesis Grading Scale

-normal = no evidence of abnormality -subtle abnormality = mild or questionable evidence of abnormality, not consistently present -obvious abnormality = striking, clearly apparent abnormality evident on at least 3/5 trials (1 inch or greater displacement)

sorenson back extensor test

-normal is 198 seconds -CPG: < 31 seconds likely to experience LBP

babinski

-noxious stim to pts. foot -pos if great toe ext and spraying of other toes -injury to corticospinal tract

Disputed TOS clinical diagnosis s/sx (4)

-numbness vs paresthesia -feeling of swelling -where -when

UCI Neuro Signs (5)

-nystagmus -facial or lip paresthesia -ataxia -UMN signs -sensation changes

10 steps of the UQS

-observation -review of systems -posture -cervical AROM with overpressure & resistance -UE screen -myotome testing -reflex testing -dermatome testing -neurodynamic testing -cranial nerves

shoulder exam examination flow

-observation (posture) -ROM -muscle performance -joint mobility -muscle length -sensation -palpation -special tests (clusters)

Factors that should trigger an OA hypothesis (13)

-older age (>45) -high BMI -family history of OA -previous ligament or cartilage damage -repetitive, cumulative, or heavy loading -persistent knee pain -limited function -stiffness (<30 mins) -crepitus -dec knee ROM -bony enlargement -fixed flexion deformity -moderate effusion

Possible contributing factors to lumbar fracture (4)

-older age (>65) -> osteoporotic bone changes, lifestyle, comorbidities affect people in this age range -prolonged corticosteroid use -severe trauma -contusion or abrasion

FAIS clinical presentaiton (5)

-onset of symptoms after loading -decreased and maybe painful hip flexion & abduction ROM - + FADIR, FABER -gait abnormality -pain = anterior/groin > posterior/buttock

Putti Platt Procedure (3)

-open procedure where subscap is doubled over anterior humeral head to limit ER -muscle to bone attachment w/ high compression -*initially promising but long-term follow up poor because muscle loosens up*

functional movements we should have pts. perform during exam

-opposition of thumb and finger -hook fist -standard fist -straight fist (1-2 cm from crease)

Cervical Exam - Localized Exam Purpose (3)

-origin of concordant pain & pain behavior -test for gauging progress -continue working hypothesis

Running interventions - localized exam purpose (3)

-origin of condordant pain, & pain behavior -"test" for gauging progress -continue working hypotheses

fracture in LBP risk factors (6)

-osteoporosis -long term corticosteroid use -Age > 70 -Hx of trauma -tenderness -female

what part of the fibrocartilage disc in a joint can heal?

-outer 2/3 because it has better vascularization

McKenzie Dysfunction

-over 30 years -intermittent symptoms -symptoms consistently produced at end range -symptoms do not worsen w/ repeated movement -local or referred pain w/o periph -pos dural signs -motion less in +1 plane -gradual onset -*most likely adherent nerve root* -repeated movement testing negative -treat with motion that produces symptoms -named according to restricted motion

medial epicondylalgia (golfer's elbow)

-overuse -30-59 -male>female -pain and point tenderness medial epi -inc symptoms with resisted wrist flexion and pronation -inc symptoms with passive wrist ext and elbow ext -ulnar nerve symptoms up to 50% of the time

Achilles Tendinopathy

-overuse injury -15-45 y.o -active individuals and runners -sharp, aching/burning pain w/ point tenderness 2-6 cm proximal to calcaneal insertion -reproduced w/ palpation, passive DF, active PF -+/- crepitus, tendon thickening, gastoc atrophy, AM stiffness

Posterior Tibial Tendon Dysfunction (7)

-overuse injury -caused by hypermobile midfoot and excessive pronation -feeling as if walking on inside portion of foot -pain, swelling over medial aspect of midfoot and posterior to medial malleolus -pain worse w/ WB, walking, heel raise -flat foot deformity -dec walk distance and on uneven surfaces

exam findings of CTS (4)

-pain & paresthesia in median nerve distribution -impaired motor or sensory function -pain may radiate proximally into forearm & arm -Phalen's, Tinel's, nerve compression, ULTT

Disputed compression night vs day presentation

-pain at night (release phenomenon) -wake up w/ paresthesia & full fingers in early morning -prognosis positive

RTC tear symptoms

-pain at rest if lying on shoulder -pain lifting and lowering arm -weakness -crepitus

criteria to begin throwing

-pain free ROM -satisfactory isokinetic results -negative examination -appropriate rehab progress

mobilization with movement

-pain free sustained accessory glide applied at a joint, with active or passive motion -6-10 reps, 3-5 sets

TMJ Disorders - Osteoarthrosis: history, exam findings, more Sn or Sp?

-pain hx in face, jaw, ear w/ jaw motions -*No Reproduction* of pain w/ palpation or max jaw movements AND crepitus audible 6 inches from joint OR patient reports crepitus w/ movement -More Sp (0.99)

TMJ Disorders - Osteoarthritis: history, exam findings, more Sn or Sp?

-pain hx in face, jaw, ear w/ jaw motions -*Reproduction* of pain w/ palpation or max jaw movements AND crepitus audible 6 inches from joint OR patient reports crepitus w/ movement -more Sp (0.99)

HIP OA

-pain in groin, lateral hip, medial thigh -sometimes distal to knee -less frequent in butt -later in life -gradual onset w/ progressive symptoms -aggravated w/ WB activites and end range hip motions -correlated w/ limp and ROM deficits

RA S&S

-pain in multiple joints -usually symmetric -+/- joint sweeling, stiffness, erythema -ulnar drift -boutonniere deformity -swan neck deformity

TMJ Disorders - Myalgia: history, exam findings, more Sn or Sp?

-pain in muscles of mastication that can be modified by jaw movement of function -findings: familiar pain in temporalis or masseter muscles w/ palpation, and max opening -more Sp (0.99)

TMJ Disorders - Myofascial Pain w/ Referral: history, exam findings, more Sn or Sp?

-pain in muscles of mastication that can be modified w/ jaw movement, pain is reported outside muscle location (i.e. tooth) -familiar pain reported in temporalis or masseter muscles w/ palpation & max opening -more Sp (0.98)

symptoms of TFCC

-pain inc with pronation, supination, and forceful gripping -+/- clicking -dominant radial extension- move into RD to avoid compressing ulnar side

TMJ Disorders - Arthralgia: history, exam findings, more Sn or Sp?

-pain is masticatory structure (joint pain) that can be modified by jaw movement -report familiar pain w/ palpation of TMJ, pain w/ max opening &/or lateral or protrusive movements -more Sp (0.98)

AAA S&S

-pain located in abdomen and central lumbar region -palpable pulsating abdominal mass -pain described as pulsating/throbbing -sensation of heartbeat when lying down -pain that increases w/ exertion -familial history of AAA or vascular claudication -unable to find comfortable position

True compression Night vs day presentation (3)

-pain most of time -involves most fingers -prognosis less favorable

Cubital tunnel syndrome presentation (6)

-pain or paresthesia @ night -*sensory changes* -activity related pain/paresthesia -loss of grip power/dexterity -atrophy -claw hand (late sign)

classic subjective complaints for de quervains

-pain over radial styloid process with gripping

How do pain threshold & intensity change in response to exercise in chronic pain pop?

-pain threshold can inc OR dec -pain intensity can inc OR dec

peripheral neuropathy

-pain, aching, numbness of feet (&hand) -burning, prickling, tingling -sensitivity to touch or numbness -weakness -falling and foot drop -muscle atrophy -pulses may be affected -DTRs diminished or absent -stocking glove pattern -underlying cause such as DM, alcoholism

Tegner Lysolm Knee Scoring Scale

-pain, instability, locking, swelling, limp, stair climbing, squatting, need for support -*primarily for ACL ligament surgery* but can also be for meniscus tears, chondral lesions, dislocation, PFPS, instability, OA -MDC: 8.9-10 points -< 65 poor -65-83 fair -84-90 good -> 90 excellent

capral tunnel syndrome

-pain, paresthesia, numbness on volar aspect of thumb, index and middle fingers and radial half of ring finger -possible thenar atrophy -flick sign -worse at night

what is needed before a Cervicothoracic manipulation for shoulder pain to be successful

-painfree shoulder flexion <127 -shoulder IR <53 degrees at 90 deg abd -negative neer -no med for shoulder pain -symptoms <90 days

subacromial pain impingement signs (7)

-painful arc -pain in deltoid region, not above AC joint -symptoms develop or worsen with repetitive overhead activity -strength tests of RTC reproduce pain -RTC weakness -+ Neer, hawkins-kennedy

S&S of clinical lumbar instability (7)

-painful locking or catching -pain with sudden or trivial activities -episodic -difficulty w/ sustained positions - + passive lumbar extension with abnormal sensation in lumbar spine -lack of hypomobility during PIVM w/ inc lumbar AROM -lumbar flexion ROM >53

Semmes Weinstein Monofilament Test

-palm is divided into several areas -test 1 point in each area -apply pressure until monofilament begins to bend -2.83 MN is normal for light touch

Standing Contralateral Stepping - procedure & expected motion

-palpate PSIS & lateral sacrum, active contralateral hip flex -expect Ant innominate rotation

Standing Ipsilateral Lat Flexion - procedure & expected motion

-palpate PSIS & lateral sacrum, active ipsi lateral trunk flex -expect Ant Innominate Rotation

medial epicondylalgia test

-palpate medial epicondyle -passively supinate forearm, extend wrist and elbow -pain provocation

MCL Sprain physical examination findings (5) - includes grades

-palpation = tender over MCL, usually proximal end -valgus stress test - 30 deg & full extension -GI = local tenderness, pain w/ valgus but no instability -GII = local & general tenderness, pain w/ valgus but no instability -GIII = local & general tenderness, pain w/ valgus & instability

classic subjective complaints for ulnar nerve compression at canal of guyon

-parasthesia over dorsal aspect of ulnar border of hand and fingers 4/5

joint mobility assessments in t-spine

-passive accessory intervertebral motion prone -CPA -UPA

What is the caudal shear test and what does it assess? (4)

-passive arthro motion -stabilize sacrum & provide caudal shear force w/ opposite hand to superior iliac crest -compare bilaterally -a component glide for posterior rot

What is the cranial shear test and what does it assess? (4)

-passive arthro motion -stabilize sacrum & provide cranial shear to opposite superior iliac crest w/ other hand -campare bilaterally -component glide for anterior rot

UCI Recommendations

-patient centered clinical reasoning -incorporating the accuracy info available -ligamentous testing lacks sufficient Sn to rule out UCI -subjective exam & neuro exam may ID UCI

Cervical relocation test - how to perform (6) and what is positive?

-patient seated 90cm from wall -laser pointer on top of head centered on target -eyes closed, moves head as instructed -returns to center -patient verbally states when they have returned to center & eyes remain closed -PT measures error *Positive = error > 4.5 degrees

How to perform the cervical neck torsion test (5) and what is positive finding

-patient seated in swivel chair -PT stabilize head -turns trunk 90 degrees to one side -hold 30" -return trunk to center *Positive if nystagmus >2 deg/sec is observed in any position and reproduction of any other symptoms

CAD recommendations (6)

-patient-centered clinical reasoning -incorporate accuracy info available -maintain a "high index of suspicion" -test a "vascular hypothesis" -*positional testing lacks Ns to rule out CAD* -subjective exam & neuro exam may ID early CAD

How are ground reaction forces different between "traditional" and "original" running patterns?

-peak GRF for both is ~2.5-3.0 x BW -vertical impact peak is different: --1.5xBW for traditional --absent or diminished for original

what muscles to palpate in tspine exam

-pec major -pec minor -serratus anterior -abdominal oblique

common trigger points in and around shoulder for palpation

-pec minor -deltoid -infraspinatus -pec major -scalenes

Soft Tissue Restrictions Common in breathing dysfunction (3)

-pec minor (inhalation scheme restriction, can influence dec posterior scapular tilt) -intercostal muscles (work during relaxed and forced inhalation, but only forced exhalation) -QL

UQS trunk rotation

-pelvis and shoulder should rotate approx. 50 deg -should be able to see opposite shoulder -look for excessive knee flexion or effort and lack of symmetry

For vulnerability of nerve tissue, what factors indicate better prognosis (4)

-peri & epineurium involvement -superficial nerve involvement -general compression -sensory deficits

Cervical radiculopathy compression on spinal nerve can be caused by what?

-physical compression -chemical irritation causing the symptoms

according to human movement system, what is shortness?

-physiological shortness of a muscle (post cast)

Pectus Carinatum

-pigeon chest

How to perform Shoulder abduction test to assess cervical radiculopathy

-place ipsilateral hand on top of head, symptom reduction is positive test

Criteria for Diagnosis of Plantar Fasciopathy via ICF (8)

-plantar heel pain most notable w/in initial steps after period of inactivity -worsening of heel pain after extended weight bearing or recent increase in weight bearing activity -pain w/ palpation of the proximal plantar fascia insertion -positive windlass test -negative tarsal tunnel tests -limited AROM & PROM into DF -abnormal foot posture index -high BMI in non-athletic individuals

lung involvement in thoracic spine signs

-pneumothorax -lung CA -pulmonary embolism -pancoast tumor (scap pain)

Radial tunnel syndrome presentation (4)

-poor localization pain lateral elbow -tenderness 3-4 cm distal to epi -pain w/ resisted wrist ext, forearm supination, or stretch of wrist extensors

DRUJ instability examination/pt. complaints (4)

-poor test metrics and not many tests -clicking/popping w/ forearm rotation -crepitus -weakness

subjective questions to ask during knee exam

-pop: ACL -click: meniscus/PFPS/chondral FX -varus/valgus force: Collateral Ligament -ant tib post force: PCL -non contact deceleration with rotation: ACL -forced rotation: meniscus/patellar dislocation/MCL -giving way: instability/meniscus/patellar subluxation -locking: meniscus -swelling/hemarthrosis quickly: ACL -delayed swelling: meniscus

posterolateral corner of knee includes: (3)

-popliteus -popliteofibular ligament -LCL

prone instability test results & psychometrics

-positive: reduction of pain during lifting of LEs -positive for: lumbar instability (clinical) -not very specific or sensitive •Sn = .61 •Sp = .57 • +LR = 1.41 •-LR = .69

crossed straight leg raise results & psychometrics

-positive: reproduction of concordant complaints -positive for: disc herniation -specific •Sn = .24-.43 •Sp = .88-1.0 • +LR = 1.91-14.3 •-LR = .59-.86

straight leg raise results & psychometrics

-positive: reproduction of concordant complaints -positive for: disc herniation -wide variation but pretty sensitive •Sn = .70-.97 (wide variation in reporting) •Sp = .10-.84 (wide variation in reporting) • +LR = 1-2.2 •-LR = .05-.90 (wide variation in reporting, most < .3)

slump sit results & psychometrics

-positive: reproduction of concordant pain -positive for: disc herniation -sensitive •Sn = .83-.84 •Sp = .55-.83 • +LR = 1.8-4.9 •-LR = .32-.19

prone knee bend test results & psychometrics

-positive: reproduction of concordiant sign -positive for: disc herniation -sensitive (.84)

Passive Physiological Motion of SIJ (3)

-possible, often performed in sidelying position by imparting innominate motion on superior side -appreciation of motion is difficult, complicated by abundant soft tissue -instead of PPM, kinetic motion testing is used

PCL tear (3)

-posterior force on knee -posterior knee pain w/ kneeling or deceleration - (+) posterior drawer sign

What 2 injuries are commonly seen due to posterior instability?

-posterior labral tear -posteriorinferior capsular stretch

Internal impingement complaints (3)

-posterior shoulder pain, esp in late cocking -stiffness -dec performance

4 components of valgus extension overload syndrome

-posteromedial impingement -chondropathy -osteophyte formation -loose bodies

MCL Sprain incidence (2)

-potentially highest injured knee ligament -tears account for 8% of all knee injuries

what factors can contribute the CTS? (6)

-pregnancy -DM -instability -degenerative changes -reduced nerve mobility -overuse

SIJ dysfunction risk factors

-pregnant females -infants -pts. suffereing from systemic disease or infection -major trauma

myelopathy CPR

-presence of gait deviation -positive Hoffman's sign -inverted supinator sign -positive babinksi -patient age >45 years

Why are cervical disc herniations less common than lumbar herniations? (2)

-presence of uncinate process -lower loading forces in cervical region

tests for TFCC pathology

-press sit to stand test -ulna fovea -supination lift test

Articular Cartilage pathology

-prevalence: 60-70% -most common sites: medial femoral condyle & retropatellar surface *ICF knee pain with mobility deficits*

*Posterior Talofibular ligament* -Prevents: -Limits:

-prevents *ER* -limits *IR and ADD* if other ligaments injured

Lateral ankle sprain risk factors (5)

-previous ankle sprain -do not use external support (bracing) -fail to warm up -lack ankle DF ROM -do not participate in proprioception or balance activities

*Anterior Talofibular ligament* -primarily restricts: -secondarily limits:

-primarily restricts *IR* -secondarily limits *anterior translation*

McKenzie method centralization definition

-progressive change in pain from a more distal location to a more proximal location that remains better after applying repeated or sustained end-range movements to the spine -symptoms may increase but they have moved more proximal

Centralization

-progressive retreat of referred pain toward midline of the lumbar region from a more peripheral location -can be from any direction of motion (flex, ext, SB, rot)

Algorithm for determining central sensitization

1. MSK pain = yes 2. disproportionate pain experience? = yes 3. diffuse pain distribution? = yes if no, go to central sensitization inv -> 4. central sensitization inventory 40 or >? = yes

ICF Neck Pain Categories

1. Neck pain w/ mobility deficits 2. neck pain w/ movement coordination impairments 3. neck pain w/ HA 4. neck pain w/ radiating pain

3 parts of spinal stability model

1. Neural Control - CNS, peripheral nerves, force transducers 2. Passive Subsystem - ligaments, bones, IVD's, capsule 3. Active Subsystem - muscles & tendons

General steps to diagnosing cervicogenic dizziness (5)

1. Patient history 2. triage 3. vestibular assessment 4. detailed cervical spine exam 5. clincal tests for CGD

Physical Stress Theory (amount of stress, % 1RM, and impact on tissue)

1. Too much stress - > 100% 1RM - Injury or tissue death 2. *Appropriate Overload* - 60-100% 1RM - strengthening 3. *Usual Stress* - 40-60% 1RM - no change in tissue 4. Too little stress - < 40% 1RM - *Atrophy* 5. No stress - 0% 1RM - loss of ability to adapt (death)

Pragmatic Approach to TMJ (4)

1. address posture & ergonomics (fwd head, shoulders, work posture) 2. provide exercises to address cervico-cranial impairments (extensibility of pecs, suboccipitals, deep neck flexor endurance, normal scapulo-thoracic rhythm) 3. Provide MT to address cervico-cranial impairments (AA, OA, cervical, thoracic joints, STM to orofacial muscles in myogenic dysfunction) 4. use of TMJ directed manual therapy w/ caution

For compartment syndrome, what compartments are most common

1. anterior 2. lateral 3. deep post 4. superficial post

Neck pain CPG - medical screening 3 options to proceed with

1. appropriate for PT *(treat)* 2. appropriate for PT along with consult from another health care provider *(treat & refer)* 3. not appropriate for PT *(refer)*

Canadian C-Spine Rules Algorithm

1. high risk factor? -age > 65, dangerous MOI, or UE paresthesia? Yes = radiograph, No = continue 2. Low risk factor that allows safe ROM assessment? -simple rear end MVA, sitting position in ED, ambulatory, delayed onset, absence of midline c-spine tenderness? Yes = continue, No = radiograph 3. able to rotate neck at least 45 degrees actively? -Yes = no radiograph, No = radiograph

Non-traumatic progressive stages of elbow dislocation

1. subluxed LUCL injury 2. dislocated ("perching") - anterior/posterior capsule & complete lateral ligament complex 3. complete dislocation - medial elbow complex failure

Good Primary observations to start with for a running evaluation (4)

1. what does cadence sound like? 2. what is overall stride pattern 3. how much vertical displacement is present 4. do the hips & knees & ankles attenuate force

70-79 gait speed

1.27 w 1.33 m

60-69 gait speed

1.28 w 1.36 m

50-59 gait speed

1.4 m/s

TUG

10 meters - >14 sec = fall risk

Tension HA - episodic, infrequent

10 or more attacks / year lasing 30 min to 7 days (total 12 or fewer days / year)

Tension HA - episodic, frequent

10 or more attacks / year, lasting 30 min - 7 days (total 12-180 days / year)

when does first contact for patella occur?

10-20 degrees of flexion

midstance

10-30% -begins w/ contralateral toe-off -concludes when LOG passes through MTP of stance foot -single limb support

PIP flexion ROM

100

how many pounds should men be able to grip?

100 lbs

Amount of normal lateral TMJ excursion

11 mm from neutral

Bent knee fall out

1. Assess passively 2. Then have pt move actively -contralateral ASIS should not move before 50% of range

3 Tiered / Staged Approach to Spinal Instability

1. Cognitive: isolation of local vs global muscle in neutral position 2. Associative: instruction of controlled movement in neutral spine & dynamic spinal patterns 3. Autonomous: normal activity participation through complex movements w/ low attention to stabilitzation

Causes of Lumbar Stenosis (2)

1. Congenital: abnormalities of spinal canal narrowing resulting from postnatal development -------------------------------- 2. Acquired: changes in the spine resulting from or coinciding w/ aging: (4) -loss of IVD height -facet joint hypertrophy -osteophyte formation -hypertrohpy of ligamentum flavum

Continuum of PA - Fit, Independent, Frail

1. Fit: highly active, remain mobile late into life (5% pop) 2. Independent: fully functional w/ low activity levels, future decline to frailty (70% pop) 3. Frail: assistance w/ basic ADL's or IADL's (25% pop)

sitting requires how much hip flexion?

112

squatting requires how much hip flexion?

115

knee flexion needed to lift object from floor

117 degrees

Hip flexion ROM Norm and end-feel

120 -Tissue Approximation or Tissue Stretch

shoe tying requires how much hip flexion

120 degrees

prehypertension

120-139/80-90

normal blood pressure

120/80

initial swing

60-73% -begins w/ initial lift of foot from floor -concludes when swing foot is opposite stance foot

knee flexion needed for walking?

63

DIP flexion

70

thumb CMC ABD ROM

70

AROM wrist extension

70-90

what should AROM and endfeel be for wrist extension?

70-90 -tissue stretch

Do many athletes return to sport after labrum tear?

71% total athletes return 66% to overhead

mid swing

73-87% -begins when swing foot is opposite stance foot -concludes when swinging shank is vertical

AROM pronation

75

patella load during squatting

7X body weight

normal RR

8-14 -faster in children

CAD is the cause of CVA in patients < 45 y/o how often?

8-25%

Types of Labrum Tears

I = frayed/degenerative labrum II = detachment of superior labrum & biceps from glenoid III = bucket-handle tear of labrum w/ intact biceps IV = bucket-handle tear of labrum extending into biceps

Thomas test is testing for:

IP ITB RF

capsular pattern in the hip

IR>flexion>ABD -not really a thing

exercise after manipulation

Important to re-enforce mobility gained 6-10 reps 3-5 sets

gastroc/soleus complex MMT

Includes Fibularis muscles WB: 1 Heel Raise: 3/5 MMT 2-9 Reps: 4/5 MMT 10 Reps: 5/5 MMT

Gluteus Maximus

Inf. Gluteal N. L5-S2

Sup & Inf Gemelli

L5, S1 L5, S1

What is #1 global cause of disability?

LBP

varus stress test

LCL -supine w/ knee flexed to 30 -palpate joint line -apply varus force *+ excessive gapping and soft end feel*

thumb IP flexion ROM

80

best nonsurgical treatments for RTC

80% have dec pain and improved function with -rest -activity mod -NSAID/steroid -PT

AROM wrist flexion

80-90

what should AROM and endfeel be for wrist flexion?

80-90 -tissue stretch

AROM supination

85

knee flexion needed for descending stairs

86.9

terminal swing

87-100% -begins when swinging shank is vertical -concludes when foot strikes floor

Lower Extremity Functional Scale MCID:

9

What runs through the carpal tunnel? (10)

9 tendons and median nerve 4 Flexor digitorum profundus, 4 flexor digitorum superficialis, and flexor pollicis longus

Stage 3 adhesive capsulitis

9-15 months (frozen stage) -pain and loss of motion -loss of axillary fold

how to asses gastroc/soleus length

Ankle DF w/ knee ext compared w/ DF w/ knee flexion WB or NWB -*SHORT GASTROC if less range w/ knee extension* -*SHORT SOLEUS and JOINT CAPSULE if DF is limited equally w/ knee flexion and extension*

Flexor Pollicis Longus

Anterior Interosseous N. C8, T1

Pronator Quadratus

Anterior Interosseous N. C8, T1

Piriformis

Anterior Rami of S1-S2 S1, S2

What structure is present in the TMJ to control movement?

Articular disc -controls movement and cushion between bones so the condyle doesn't jam into the joint cavity

AMBRI

Atraumatic Multidirectional Bilateral Rehabilitation Inferior capsular shift

Deltoid

Axillary N. C5, C6

Teres Minor

Axillary N. C5, C6

Levator Ani

Branches of S3-S4 S3, S4

hallux valgus deformity

Bunion -changes tendon insertion in relation to axis of motion

Pec minor muscle length test

Distance from table to posterior aspect of acromion Patient supine with arms at side and elbows flexed Positive is > 1 inch Deliver pasive stretch to determine stiffness

Obliquus Capitis Inferior

Dorsal Rami C1, C2

Rectus Capitis Posterior Major

Dorsal Rami C1, C2

Rectus Capitis Posterior Minor

Dorsal Rami C1, C2

Obliquus Capitis Superior

Dorsal Ramus C1

Levator Scapulae

Dorsal Scapular N. C4, C5

Rhomboid Major

Dorsal Scapular N. C4, C5

Rhomboid Minor

Dorsal Scapular N. C4, C5

Hawkins-Kennedy Test

Examiner flexes arm to 90 degrees IR shoulder Pain provocation test

If someone has excessive hip IR that is going to lead you *away from* which pathologies? (2)

FAIS and Hip OA

what is strongest wrist flexor?

FCU

what are the SFMA abbreviations for motion screening?

FN -functional non-painful FP -functional painful DP -dysfunctional painful DN -dysfunctional non-painful

Pectineus

Femoral & Obturator N. L2, L3

Sartorius

Femoral N. L2, L3

Rectus Femoris

Femoral N. L2, L3, L4

Vastus Intermedius

Femoral N. L2, L3, L4

Vastus Lateralis

Femoral N. L2, L3, L4

Vastus Medialis

Femoral N. L2, L3, L4

Capsular pattern in Knee

Flexion > Extension

Y-balance cutoffs for injury risk (TEST Question)

Football: 89% High school basketball: 94%

painful arc test

For subacromial pain syndrome Pain in mid-range 6—120 degrees Usually performed with ABD ROM

Main indication for total shoulder arthroplasty

GH arthritis *and pain management*

What test was omitted from the SIJ cluster since it did not add to prognostic accuracy?

Gaenslen's Test

soft tissue approximation end feel

Giving, squeezing quality, typically painless ex: elbow flexion

Spondylolisthesis grades

Grade 1: 0-25% displacement Grade 2: 25-50% displacement Grade 3: 50-75% displacement Grade 4: 75-100% displacement

ulnar nerve compression typically occurs where?

Guyon's canal

what is the first question you need to ask that older pt before you go poking at their spine?

Have you had imaging yet?

hand muscles innervated by median nerve

LOAF lumbricals 1/2 Opponens pollicis Abductor pollicis brevis FPB

hand muscles innervated by ulnar nerve

LOAF PAD Lumbricals 3/4 Opponens Digiti Minimi Abductor Digiti Minimi Flexor Digiti Minimi Palmar interossea Adductor Pollicis Dorsal Interossei

good clinimetric values

LR+ of 5.0 or higher LR- of .2 or lower Sn of .9 or higher QUADAS of 10 or higher

With the arm elevated above 90 degrees, what is the lower trap & serratus anterior function?

LT = maintain scap upward rotation SA = stabilize medial border of scapula against thorax

Prior to implicating SIJ dysfunction, what must be cleared first? (3)

LUMBAR!!!!! -manual therapy assessment of SIJ requires proper lumbar motion screen -lumbar dysfunction can create altered SIJ motion -muscle tone changes from lumbar dysfunction can alter SIJ motion

Pectoralis Major - clavicular

Lateral Pectoral N. C5, C6

what SMP can you do to increase wrist extension?

Lateral glide

sharp sensation travels on what tract in spinal cord?

Lateral spinothalamic tract

precautions of manual therapy

Local infection Inflammatory Disease Active Cancer Long Term Steroid use Osteoporosis Systemically unwell CT disease and hypermobility Adverse reaction to previous manual therapy Pregnancy Ligamentous laxity First episode < 18 years or > 55 Cervical anomalies Throat infection in children Recent manipulation by another health professional Anatomic abnormalities

Serratus Anterior

Long Thoracic N. C5, C6, C7

LEFS

Lower Extremity Functional Scale MCID 9 MCID individual item: 2.5

Teres Major

Lower Subscapular N. C5, C6

valgus stress test

MCL -pt. supine -knee flexed to 30 -palpate medial joint line and apply valgus force *+ for excessive gaping and soft end feel*

how much finger flexion do you need for writing

MCP flexion of 30-40

What type of impairments are associated w/ clinical instability? (big picture)

MOTOR CONTROL

What is the preferred imaging modality for TMJ?

MRI -able to visualize both bony & soft tissue structures

What is the typical whiplash cause?

MVA

what is useful to treat PFPS

Manual therapy directed at the local knee structures help decrease pain in the short term

Pectoralis Major - sternocostal

Medial Pectoral N. C7, C8, T1

Pectoralis Minor

Medial Pectoral N. C8, T1

Flexor Carpi Radialis

Median N. C6, C7

Pronator Teres

Median N. C6, C7

Palmaris Longus

Median N. C7, C8

Flexor Digitorum Superficialis

Median N. C7, C8, T1

Brachialis

Musculocutaneous N. C5, C6

Biceps Brachii

Musculocutaneous N. C5, C6, C7

Coracobrachialis

Musculocutaneous N. C5, C6, C7

Quadratus Femoris

N. to Quadratus Femoris L5, S1

Do patient's have pain over peroneal tendons or have peroneal subluxation with Anterolateral Ankle Impingement

NO

Is impaired stability correlated with reduced strength?

NO

did pts who received a PT program consisting of exercise and manual therapy get additional benefit from the use of kinesio tape?

NO

is there a physical test for diagnosing Spondys?

NO

is there a significant difference between spinal fusion and PT?

NO

did treatment for PFPS and patellar tendinopathy work 1 X per week? (TEST Question)

NO -1 X per week had no effect *2-3 days a week for 8-12 weeks is best*

If you get 2 positive tests in the SIJ cluster, should you continue with the rest of the cluster?

NO - you will only make things worse and it will not give you any more valuable information

Clinical Instability is NOT what? (4)

NOT *Gross Structural Deformation* -not ligament rupture -not vertebral fracture -not spondylolysis or lysthesis -not radiographically significant

NDI

Neck Disability Index -most widely used outcome measure for cervical spine disorders -MCID 8.5 on scale of 50

What if the pt is stiff vs short. Are you going to worry about stretching that stiff muscle?

No -you're going to strengthen the antagonist

Does a disc herniation cause radicular signs?

No - the herniation causing radiculopathy causes the radicular signs

Do the R & L TMJ's always function together?

No - they often do but can function independently due to wide range of motion available at the TMJ

Does a spondylolysis always progress to a spondylolisthesis & corresponding spinal instability?

Not always

Is SIJ distraction sensitive?

Not great, Sn 0.6, Sp 0.81

How much stock should be put into deviations in mouth opening/closing?

Not too much - since there is so much motion available at these joints, deviations are normal *limitation at one joint can cause excessive movement OR limited movement at the other

OIAN Serratus anterior

O = Ribs 1-9 I = medial border of scapula A = draw scapula laterally forward, elevate ribs, upward rotation of scapula N = long thoracic nerve (C5-7)

OIAN External oblique

O = ribs 5-12 I = xyphoid process, iliac crest, pubic tubercle, inguinal ligament, ASIS A = trunk flexion, contralateral rotation N = thoracodorsal nerve (T7-11) & subcostal nerve (T12)

Medial Pterygoid Muscle OIAN

O: deep = medial surface of lateral pterygoid plate of sphenoid, superficial = posterior maxilla I: internal surface of mandible, near angle A: Bilat = mandible elevation & protrusion; Uni = mandible contralateral excursion N: branch of mandibular nerve, CN V

Suprahyoid OIAN

O: mandible & temporal bone I: hyoid or intermediate tendon to hyoid A: open mouth/depress mandible when hyoid is stabilized by infrahyoid group N: ???

Lateral Pterygoid Muscle OIAN

O: superior = greater wing of sphenoid; inferior = lateral surface of pterygoid plate & maxilla I: neck of mandible, pterygoid fossa, articular disc, TMJ capsule A: Uni = contralateral excursion; Bilat = mandible protrusion N: branch of mandibular nerve, CN V

Temporalis Muscle OIAN

O: temporal fossa (passes through zygomatic arch) I: coronoid process, anterior edge & medial surface of mandibular ramus A: mandible elevation, oblique fibers mild retrusion N: branch of mandibular nerve, CN V

Masseter Muscle - OIAN

O: zygomatic arch/bone I: external mandibular ramus A: mandible elevation, biting N: branch of mandibular nerve, CN V

subjective complaint of age over 60 with pain and stiffness is most likely what?

OA

subjective complaint of constant LBP and buttock pain is most likely what?

OA

Ober test

Ober test may assess tightness of gluteus Medius and minimus muscles and hip joint capsule rather than ITB

Gracilis

Obturator N. L2, L3

Adductor Brevis

Obturator N. L2, L3, L4

Adductor Longus

Obturator N. L2, L3, L4

Adductor Magnus

Obturator N. L2, L3, L4 Tibial N. (via Sciatic N.) L4

What is the most common form of arthritis?

Osteoarthritis

Pre participation screening for exercise intervention in patients w/ chronic pain (5)

PAR-Q+ in addition to... -any recent accident, trauma, falls -changes in pain (intensity, location, type) -onset of numbness or tingling -has the person completed medical testing & therapies as directed for their condition

posterior drawer

PCL -pt. supine w/ hip flexed to 45 degrees -knee flexed to 90 deg -sit on foot -apply post force to tibia *+ for excessive translation and soft end feel*

actions of posterior tibialis

PF and IN

Cross Arm Adduction Test

PROM flexion and ADD +pain provocation over AC joint

relocation test

PROM posterior GH force positive is dec pain and apprehension

What 2 structures are palpated to assess Kinetic Motion Testing?

PSIS & Sacrum

MWM for shoulder indications

Painful ROM and Anterior Humeral Glide that is decreased with correction of humeral head alignment

PSFS

Patient Specific Functional Scale pt. ranks list of difficult tasks and ranks how difficult on scale of 1 to 10 -neck dysfunction and whiplash -MCID2.5 single item 1.5 average

Slump Test

Patient sits up straight with arms behind back Slump Spine while keeping head straight Cervical Flexion Knee Extension non-painful side first +/- Ankle DF Cervical Differentiation

proximal tibiofibular anterior/posterior joint mob

Perform: -*esp in pts. w/ lateral knee pain* -*after IN ankle injury* -pt. supine w/ knee flexed -PT grasps proximal fibular be careful for fibular nerve -*posterior medial to anterior lateral*

how much force do the menisci absorb in the knee?

about 45%

If there are multiple contributing factors present for lumbar fx, what is best course of action?

absolutely need x-ray imaging

Clinical intervention scope for runner injuries

address MSK issues as you would in non-runner but place in context of running demand

*Calcaneal fibular ligament* restricts:

adduction

hard capsular end feel

adhesive capsulitis

shoulder pain with mobility deficits pathoanatomic equivalents

adhesive capsulitis

Amount of normal TMJ depression motion

adult = 50mm (quick = about 3 knuckles width in mouth)

rinne test results

air conduction > bone conduction (normal, sensorineural hearing loss) BC > AC (conductive hearing loss)

Nursemaid's elbow

aka acute radial head subluxation -axial traction to extended elbow -children -female>male -acute onset of pain with tenderness -unwillingness to move elbow -pain with forearm rotation

Elevated Arm Stress Test (EAST)

also called *Roos' Test* & *Hands-up Test* ___Patient's arms are at *90 abduction, laterally rotated & elbows flexed to 90* ___Patient is instructed to *open & close fists for 3 minutes *(unless symptoms start first) ___Positive findings: ischemic pain, profound weakness, paresthesias ___Indications: *thoracic outlet syndrome*

Humeral head superior migration leads to what in reverse TSA population? (pre-surgery)

altered biomechanics cause migration that erodes the coracoacromial ligament & AC joint

Ely test

Positive Test: Ipsilateral hip flexes when knee is passively flexed. Indication: Rectus femoris muscle tightness.

Abductor Pollicis Longus

Posterior Interosseous N. (via Radial N.) C7, C8

Extensor Pollicis Brevis

Posterior Interosseous N. (via Radial N.) C7, C8

Extensor Pollicis Longus

Posterior Interosseous N. (via Radial N.) C7, C8

latissiumus dorsi muscle length test

Posterior Pelvic Tilt with UE's ER Flex both arms in ER IR UE"s or allow lumbar extension Look for increased ROM (10 deg?)

TMJ Elevation Arthrokinematics

Posterior slide of mandibular condyle & disc on mandibular fossa

Dial test

Posterolateral Corner w/ or w/o PCL injury -pt. prone -perform ER w/ knee at 30 and 90 degrees PCL injured >10 degrees of ER in involved LE at 30 but not 90 PLC and PCL: >10 degrees of ER in involved LE at bot 30 and 90

belly press test

Pt's arm is at side of body with elbow flexed to 90 degrees Pt is instructed to press palm into belly by internally rotating shoulder (+) = uses elbow ext or shoulder ext to press into belly, or weakness compared to opp side

if you have a UD loss which direction are you going to mobilize?

RD

Gerber Lift-Off Test

RTC pathology/sub acromial pain -pt. places hand behind back at midlumbar level -dorsum of hand is moved off back -pt. asked to lift hand off lower ack positive is unable to lift hand or unable to hold it there if preplaced there

shoulder pain with muscle power deficits pathoanatomic equivalents

RTC tendinopathy or tear

Brachioradialis

Radial N. C5, C6, C7

Extensor Carpi Radialis Longus

Radial N. C6, C7

Triceps Brachii

Radial N. C6, C7, C8

Extensor Carpi Radialis Brevis

Radial N. C7, C8

Extensor Carpi Ulnaris

Radial N. C7, C8

Extensor Digiti Minimi

Radial N. C7, C8

Extensor Digitorum

Radial N. C7, C8

Extensor Indicis

Radial N. C7, C8

Supinator

Radial N. C7, C8

What are secondary physiological motions of the SIJ? (2)

Rarely Used, but: -Ilial Lateral Rotation = Innominate Outflare -Ilial Medial Rotation = Innominate Inflare

shoulder pain with stability and mvmt coordination deficits patoanatomic equivalents

SAP labral tear instability AC joint dysfunction

how to test CN11

SCM and UT

Ten Test

Subject reports light touch perception on skin being tested as compared to the reference normal area when giving a simultaneous stimulus by stroking a normal area on the contralateral limb 10 is normal

Subscapularis

Subscapular N. C5, C6, C7

Gluteus Medius

Sup. Gluteal N. L4-S1

Gluteus Minimus

Sup. Gluteal N. L4-S1

Tensor Fascia Latae

Sup. Gluteal N. L5, S1

Fibularis Brevis

Superficial Fibular N. L5, S1, S2

Fibularis Longus

Superficial Fibular N. L5, S1, S2

Supraspinatus

Suprascapular N. C4, C5, C6

Infraspinatus

Suprascapular N. C5, C6

SFMA classifications

TED (tissue extensibility deficits) JMD (joint mobility deficits) SMCD (stability and motor control deficits)

shoulder pain with radiating pain pathoanatomic equivalents

TOS

SIJ pathology should be suspected as primary hypothesis in what situations?

TRAUMA! infection

C5 myotome

abd and ER

A one-time traumatic injury of what 2 combined motions causes anterior instability

abduction & ER

What is imperative for whiplash patients?

early intervention!!!

Pincer deformity - defined

either a deep acetabulum (anteriorly) or excessive acetabular retroversion

how to test C7 myotome

elbow ext and wrist flexion

C7 myotome

elbow extension and wrist flexion

type 3 scapular dyskinesis

elevation

Bouchard Nodes

enlargement of PIP joints -RA

capsular pattern of wrist ROM

equal loss of flexion/ext -little loss of RD/UD

How to manage biceps/triceps/ tendinosis?

exercise

radiohumeral posterior glide (and what is it for)

extension

when are you going to do a radiocarpal palmar glide?

extension

how to test CN7

facial expressions

When is surgery indicated for cubital tunnel syndrome?

failed conservative tx or hard neuro signs

Resistance exercise (isometric) changes & dosing in chronic pain pop (3)

fairly consistent -mod to very large improvement in pain threshold & intensity -*optimal intensity 10-20% MVIC @ distal sites only*

Plantar Fasciitis is a misnomer. It is more likely:

fasciosis with chronic degeneration of fascia

Are symptoms more reliable if they come on faster or slower?

faster

why do you get excessive ER and limited IR when measuring ROM in a pt with retroversion?

femoral head is preposition in IR, so you have less room to go in IR and a lot more room to go for ER

how to measure swelling at wrist and hand

figure 8 -ulna to radius volar then across dorsum of hand to 5th MCP and then to 2nd MCP joint and then back to start

When is it most desirable to treat these patients?

first thing in the morning because they have not been compressed all day. Will likely be asymptomatic at end of day, more symptoms in morning

radiohumeral anterior glide (and what is it for)

flexion

when are you going to do a radiocarpal dorsal glide?

flexion

function of flexor digitorum profundus

flexion of DIP

Boutonniere deformity

flexion of PIP joint and hyperextension of DIP joint -*ruptured central slip* -common in RA

function of flexor digitorum superficialis

flexion of PIP joints

ulnohumeral capsular pattern

flexion>extension

FAAM

foot and ankle ability measure -general MSK foot and ankle disorders -21 items ADL 8 items for sport

Male sports w/ highest risk for ACL tear (3)

football > lacrosse > soccer

flexion-rotation test

for AA dysfunction, diff cervicogenic vs. migraine, TMD Supine -maximal active cerv flex followed by PROM into rotation positive if symptoms, HA, >10 degree differnece btwn sides/normal range of 44 deg

CMC grind test

for OA -axially load thumb metacarpal into trapezium -add rotation of metacarpal -pain provocation for joint dysfunction such as arthrosis ro synovitis

Supination Lift Test

for TFCC pathology -pt. seated w/ elbows at 90 and forearms supinated -palms flat on underside of table -pt. asked to push up against table + is pain on ulnar side of wrist

yergarson's test

for biceps pathology, SAP, SLAP, transverse humeral ligament -pt. seated or standing with humerus in neutral -elbow flexed to 90 -pt. is asked to ER and supinate arm against manual resistance positive if pain provocation in biciptal groove

After compression for how long can neural restoration occur?

for compression of < 6 hrs, restoration happens in < 6 hrs

closed fist percussion sign

for fracture -PT stands behind pt. with pt. facing a mirror so they can see pt. reaction -entire length of spin is examined using firm, closed-fist percussion positive is complaints of sharp, sudden pain

jerk test

for posterioinferior labral tear (SAP) -Patient sits with arm IR and flexed to 90 degrees -Examiner grasps elbow and loads the humerus proximal -While maintaining load the examiner moves the arm horizontally into adduction -Positive test is sudden clunk

How does the subacromial space change during elevation?

from 10 mm to 5 mm

Pectus Excabatum

funnel chest

scapular dyskinesis

general term that is used to describe loss of control of normal scapular physiology, mechanics, and motion -commonly seen as winging medial border

GIRD

glenohumeral internal rotation deficit -loss of IR of throwing shoulder of 20 degrees or more as compared with non-throwing shoulder

hip posterior glide

good for ER loss

hip anterior glide

good for ER loss -Good for Glut max training after mob

hip lateral distraction

good for all motions

Tibiofemoral knee distraction

good for any motion loss -3 sets of 30 seconds -then get pt moving to gain ROM

hip inferior glide

good for: -Flexion -ABD

Pain serves a function in what 3 ways (2 good, 1 bad)

good: -early warning system -adaptive & protective mechanism bad: -can be maladaptive

Is cervical meylopathy typically traumatic or gradual?

gradual onset, but can be traumatic

SLR: glide test

grasp greater trochanter and take SLR to end range -pt. holds position -PT feels for excessive movement of GT

subjective complaint of lat thigh pain exacerbated when transferring is most likely what?

greater trochanteric pain syndrome

bony end feel

hard and abrupt stop

Characteristics of running that make it different from walking (2)

has periods of double support and periods of FLIGHT

CAM Impingement (FAIS)

head of femur is too large/neck is too thick or too short

Pincer Impingement (FAIS)

head of femur is too small for acetabulum

What is the goal you are seeking to achieve with nerve sensitization for persistent pain?

help the nervous system return to a normally functioning state

Scapular dyskinesis is more likely to cause pain in what type of population?

high level overhead athletes

y-balance cut off of 94% is for?

high school basketball

Aerobic exercise changes & dosing in chronic pain pop (4)

highly inconsistent -small improvement in pain intensity & threshold -time: 10-30' -intensity: *self-selected*

Physical examination findings indicate _______ are common in pts presenting with LBP

hip dysfunction

GT gliding anteriorly during SLR: glide test means what?

hip flexors not being offset by glutes and hip rotators

Medial epicondylosis involves what muscular structures? (2)

humeral portion of pronator teres & flexor carpi radialis

OA - what is lost?

hyaline cartilage in joints

Swan neck deformity

hyperextension of PIP joint and flexion of DIP joint -intrinsic contracture -volar plate laxity -FDS rupture causes PIP extension -may be RA

Beighton scale

hypermobility scale (+) is > 4/9

How to muscles tend to present in hyperventilation?

hypertonic and fatigue

Compression of the SC in cervical myelopathy leads to what?

hypoxia in the cord & dynamic mechanism leading to local neural tissue damage

when should you have pt do a prone press up?

if disc derangement is suspected and standing extension fails to centralize symptoms

What 2 muscles are closely linked to the diaphragm?

iliopsoas and quadratus lumborum

cross friction massage for MCL and LCL is used for___

improve tissue mobility

tuning fork test

improves specificity in Ottawa (+) population -128 Hz

Is a cranial nerve exam useful for CAD testing?

in situations where indicated, this is useful testing to perform and ID neurological impairments but non-specific to CAD

How do pain threshold & intensity change in response to exercise in normal healthy pop?

inc pain threshold, dec pain intensity

how can other regions of the LE affect PFPS?

increase PFPS: -femoral internal rotation (inc lat patellar displacement/tilt) -tibial internal rotation (dynamic knee valgus) -hip ADD (dynamic knee valgus) -excessive pronation -limited DF

excessive femoral IR causes what?

increases lateral patellar displacement and tilt

Meniscal Tear incidence

increases w/ age & concomitant ligament tears

type 1 scapular dyskinesis

inferior angle prominence

What stability does the superior GH ligament provide?

inferior stabilizer

What is costochondritis?

inflamation of cartilage that connects ribs -anterior chest wall pain and tenderness -+/- swelling -aggravated w/ deep breathing, sneezing, coughing -must differentiate cardiac/pulmonary causes -look for history of trauma -diagnosis of exclusion

muscle spasm

inflammation (early) or joint instability (late)->reflexive

What is lateral epicondylosis pain stage 1-3 due to?

inflammatory responses

when performing SLR, if you get more than 91 degrees =

instability

Cervical Exam "flow"

intake & big picture -> regional exam -> localized exam

What position is the scapula generally in (resting)

internally rotated

What is the long head of biceps tendon considered to be?

intra-articular but extra-synovial

What "path" does T1/C8 root take?

inverted U

Vertebral artery dissection pain pattern distribution

ipsilateral lateral / posterior neck

ICA dissection pain pattern distribution

ipsilateral lateral / posterior neck and temporal region

there is atrophy of ____ in pts w/ LBP

ipsilateral multifidus

irritability

is dependent on severity and how quickly onset and dec of symptoms with irritating factors

What is the most important factor related to compression?

ischemia

SC joint function

it is the only structural attachment of the shoulder complex & UE to the axial skeleton

SFMA JMD

joint mobility dysfunction -OA, fusion

anterior to posterior Tibial glide is used for (4)

knee OA -decreased knee extension -hypomobility -pain

lumbopelvic manipulation reduces what?

knee extensor muscle inhibition

KOOS

knee injury and osteoarthritis outcome score -pain, other symptoms, function ADL, function sports and recreation, QOL -extension of WOMAC -MDIC 8-10 -knee OA, ACL, meniscus, chondral injury

subjective complaint of clicking or catching in hip joint is most likely what?

labrum

what condition should you consider first with 35 and older?

lateral epicondylagia

What is the most common soft tissue complaint of elbow?

lateral epicondylosis

TMJ Contralateral excursion arthrokinematics

lateral slide of contralateral condyle, medial/anterior slide of ipsilateral condyle

TMJ Ipsilateral Excursion Arthrokinematics

lateral slide of ipsilateral condyle, medial/anterior slide of contralateral condyle

PFPS joint mobility

lateral tilt and position, may be limited in glides (any direction)

Extraforaminal disc herniation

lateral to the pedicles

Capsular Stretch End Feel

leathery, stiff but a little elastic

MSK changes as we age - joints

less resilient cartilage, ligament stiffness

how to test CN5

light touch clench teeth

likelihood ratio

likelihood that a given test result would be expected in a pt. with the target disorder compared to the likelihood that the same result would be expected in a pt. w/o the disorder

PFPS - strength (4)

limited power/endurance control of hip ABD/ER/Ext, trunk, quads, hamstrings

torsion angle

line bisecting the femoral head and neck on the proximal femur and another line connecting the medal and lateral femoral condyles

osteochondritis dissecans

little leaguer's elbow -progression of panners -13-16 -assoc with loose body formation -insidious onset -lateral elbow pain -restriction motion +/- locking/catching -swelling, tenderness -plain films to dx

PFPS - aggravating factors (6)

loading across PFJ -stairs -prolonged sitting -squatting -lunging -running -jumping

Running terminology - strike

location of initial impact between foot & ground -forefoot strike = sprinters -rearfoot or heel strike = aerobic system runners -midfoot strike more variable

Treatment of Dupuytren's Contracture

low load, long duration stretch or surgery -stretching -splinting -steroid injections (early in process) -surgery

TBC was developed for what body region

lumbar spine

The TMJ is a loose articulation between what?

mandibular condyle of mandible and mandibular fossa of temporal bone

What is the "mobile" articulation of the TMJ?

mandibular condyles

does manual therapy improve pain and function in pts with plantar fasciitis

manual therapy + exercise improves results then just exercise alone

tectorial membrane testing

manual traction (non-specific) -Patient is supine and supported occiput -PT applies gradual traction (MILD) -PT should appreciate the quality and quantity of motion

What bone is heavily involved in TMJ function but not directly involved in TMJ motion?

maxilla

Hallux Valgus risk factors

may be higher in females w/ history of "fashionable shoe" wear

when long toss can be performed at 120 feet pain free _____

may begin windup on flat ground and progress to the mound

PFPS - observation

may see increased femoral IR/ADD/valgus/pronation

CAD patient demographic info

mean age mid 40's, 50/50 male-female split

Thomas test: if leg that is lowered does not reach horizontal then____ (4)

measure w/ inclinometer on thigh -*extend knee*: short rectus -*thigh abduction*: short TFL -*hip ER*: short IP or if other two motions have no effect

Primary muscles of TMJ protrusion (2)

medial & lateral pterygoids

What is scapular winging?

medial and/or inferior angle of scapula are posteiorly displaced away from posterior thorax

Type 2 scapular dyskinesis

medial border prominence

what SMP can you do to increase wrist flexion?

medial glid

what part of the patella is in contact at 135 degrees?

medial margin/odd facet

ULTT 1

median nerve -block scap -abd shoulder to 90-100 -ext wrist and fingers (first 3) -supinate forearm -ER rotate -extend elbow -lat flex of spine away and towards

weber test results

midline: normal Conductive hearing loss: sound louder in affected ear Sensorineural hearing loss: sound louder in good ear.

how to test posterior band of UCL?

milking maneuver

what does it mean if myotome is strong and painful

minor lesion 1st degree strain

how are you going to increase ROM in the CMC joints?

mobilize in direction of loss -distract MC and glide A/P

what intensity of exercise should be prescribed for pts with *chronic LBP without generalized pain*?

mod-high intensity

What is different about tenotomy rehab vs tenodesis?

more aggressive and faster return to activity with still very good outcomes

Meniscus tear prevalence

most people undergoing ACL repair

Femoro-acetabular impingement - defined

motion related clinical disorder of the hip w/ premature contact between the proximal femur & acetabulum

sensation on lateral forearm tests what peripheral nerve and what nerve root?

musculocutaneous nerve C6

3Ns

nausea numbness nystagmus

how to measure neck flexor muscle endurance

neck flexor muscle endurance test -tuck chin and lift head 1 in off table -mean is 38.9 for men and 29.4 for women -avg. 21.9 for those with neck pain place mark on fold to see when you need to stop test

Whiplash - defined

neck injury associated disorders that result from a quick acceleration & deceleration of the head & neck

what does it mean if myotome is weak and painless

neurologic lesion grade 3 strain

Does the presence of a re-tear correlate with outcome?

no

Is the coracoacromial ligament a true ligament?

no - goes from one point to another on the same bone

Is it important to specifically identify an isolated disc herniation in clinical practice?

no - regardless of the cause, you are still treating impairments to reduce symptoms and improve function

how to test CN9

no commonly assessed

which is better, ODI or Roland Morris

no different

Is cervicogenic dizziness most often the cause of dizziness?

no it is not, usually it is one of the other causes listed

Is scapular dyskinesis a diagnosis/injury?

no it is not. since this is conflicting evidence on if we can change/affect it, we cannot diagnose it

AROM norms cervical extension

no overpressure -10 degrees from horizontal

For nerve compression of > 8 hrs, what are consequences?

no reflow = miniature compartment syndrome

PFPS - flexibility restrictions

no specific pattern

Is TOS common during puberty?

no, not commonly seen before end of puberty

PCL tear injury - is it often PCL in isolation?

no, rarely independent of other knee injury -79% of multi-ligament injuries include PCL

What is allodynia

non-noxious stimulus causes sensation of pain

what does it mean if myotome is strong and painless?

normal

carrying angle

normal 10-17 deg -females 13-16 -males 11-14 -greater than 15 assoc with cubital tunnel -greater angle on dominant arm

What is hyperalgesia

normally sub-threshold noxious stimulus causes sensation of pain

NPQ

northwick park neck pain questionaire -higher the percentage greater the disability 9 5 part sections for nonspecific neck pain

Is SIJ compression test sensitive?

not great, Sn & Sp both 0.69

Is the sacral thrust test sensitive?

not great, Sn 0.63, Sp 0.75

Does the SIJ cluster implicate SIJ movement dysfunction?

not necessarily - all the cluster says is "there is pain coming from the area" - that's it

Reverse TSA indicated for what population?

not-intact or very poorly functioning rotator cuff

Disc herniation - prolapse

nuclear material bulges *through* the annulus fibrosis

Disc herniation - sequestration

nuclear material has *crossed through annular fibers and is no longer continuous with the central nuclear material*

Disc herniation - extrusion

nuclear material has crossed *through annular fibers although remains in contact w/ central nuclear material* and has either passed through PLL or migrated cranially or caudally from disc space

Stride rate

number of complete cycles in one minute (1/2 of cadence)

Cadence

number of steps per min

Presentation of Neurogenic Claudication (stenosis)

numbness, tingling in lumbar region, buttocks, thighs, and/or legs that are POSTURE DEPENDENT

what condition should you consider first with young children?

nursemaid's elbow

examination flow (observation to ROM to ....)

observation ROM joint mobility muscle length muscle strength outcomes palpation special tests

how to test CN3,4,6

observe ptosis (3) letter H tracking convergence

Why can AAA be problematic for PT's in practice? (think how it presents)

often presents as LBP

what condition should you consider first with 15-20 yo

osteochondritis dissecans

Legg-Calve-Perthes Disease - defined

osteonecrosis of the femoral head in children < 15 years

ODI

oswestry disability index MDC = 10 pts (Miekisiak 2013), MCID: 12.8 0-20% Minimal Disability 21-40%: Moderate Disability 41-60%: Severe Disability 61-80%: Crippled 81-100%: Bed Bound or exaggerating symptoms

where do you administer pain pressure threshold?

over gluteus medius approx 1/2 way bw GT and top of iliac crest

where to test pain pressure threshold with algometer?

over lateral epicondyle or extensor mass

cervical spine yellow flags

pain in the presence of normal ROM

What does regional pain mean regarding elbow pathology?

pain is a good indicator as to the location of the pain source (compared to shoulder where pain can be much more diffuse and non-specific)

cervical radiculopathy

pain is shooting, stabbing, electric in nature and is commonly associated with paresthesia -usually unilateral -incidence is highest in 4th/5th

What is the purpose of SIJ cluster testing?

pain provocation, can localize offending side

concordant sign

pain/symptoms identified on pain drawing -verified by pt. as being chief complaint

cluster for infraspinatus

painful arc infraspinatus resisted test age >60

discordant sign

painful movement that is not the concordant sign

What is a common description of the headache associated w/ CAD?

patient usually describes a "headache unlike any other"

specificity

percentage of people who test negative for a specific disease among a group of people who do not have the disease -true negatives

sensitivity

percentage of people who test positive for specific disease among a group of people who have the disease -true positives

Homeostasis involves managing what 2 things when considering the physical stress theory?

physiological stressors and lifestyle adaptations

How is cervicogenic dizziness diagnosed?

poorly understood - diagnosis of exclusion (rule out more sinister pathologies)

biceps squeeze test

positive is lack of supination as biceps squeezed

What do you need to know before starting TSA rehab?

post-op motion under anesthesia

TMJ Retrusion arthrokinematics

posterior slide of mandibular condyle & disc on mandibular fossa

Injury to LCL complex retuls in what?

posterolateral rotary instability

Plantar Fasciopathy - definition

potential thickening of the plantar fascia & pain related to compression w/in the plantar foot

pre -> post test probability factors for malignancy

pre-test probability 1% or less -history of cancer = posttest probability 7-33%! -1 of these factors: no improvement after 1 month, unexplained weight loss, older age = posttest probability ~3%

How does pre -> post test probability change with how many contributing factors are present for lumbar Fx ? (2)

pre-test probability for lumbar fx is 1% or lower -if 1 factor present, post-test probability = 10-33% -if multiple factors present, post-test probability = 42-90%

Y-balance is used to:

predict injury

Cam deformity - defined

presence of additional bony tissue at the *anterior, and/or superior aspect of the femoral head/neck junction*

What is dizziness?

presence of an abnormal imbalance, unsteadiness, disorientation, or disequilibrium

ulnar fovea test

press thumb deep into soft spot btwn ulnar styloid and FCU -pain provocation

What is the function of ligaments in the ankle?

prevent EXCESSIVE movement of the joint, there should not be tension in ligaments during normal ROM

Appropriate management of acute pain is:

preventing the progression to persistent pain

Charcot Foot - defined

progression of bone destruction, dislocation, and deformity that occurs as a result of uncontrolled inflammation & peripheral neuropathy

Hallux Valgus - defined

progressive deformity of 1st MTP where hallux shifts laterally and the metatarsal shifts medially

what intensity of exercise should be prescribed for pts with *chronic LBP with generalized pain*?

progressive, low intensity

QUADAS

quality assessment of diagnositic accuracy studies

ULTT 2

radial nerve -pt. on diagonol with your thigh depressing shoulder -ext elbow -whole UE IR -wrist flexion -shoulder ABD up to 40 degrees -cerv lat flexion

if SLR is (+) before 20-30 degrees then it could be:

radiculopathy

empty end feel

range limited by pain -no real end feel -pt. could be resisting with musculature

Cervical Arterial Dysfunction (defined)

range of pathologies to a vascular structure w/in the cervical region that may mimic MSK complaints

hip long axis distraction

really just for decompression

spring block

rebound -common in cartilage tears/meniscus/labrum

MSK changes as we age - muscles

reduced strength, increased fat stores

what is repeated movement testing used for in the cervical spine? and what are the types

reduction of symptoms, esp. if radiculopathy is suspected types -retraction -retraction w/ extension -protraction start with 10 reps

optimal management of PFPS

remains unclear -exercise targeting the proximal hip musculature and quadriceps -taping/bracing may improve propioception -inc step rate by 10% reduced PFJ stress -increase forward trunk lean

why do unweighted ROM?

removes effects of gravity -Significant differences in ROM may indicate clinical instability or LBP with movement coordination deficits

vital sign precautions/contraindications to therapy

resting HR 120-130 resting SBP 180-200 resting DBP 105-110 marked dyspnea

Dancers are associated with having Anterversion of Retroversion? (TEST QUESTION)

retroversion

What position is the humeral head in to create better joint congruence w/ glenoid?

retroversion

Why might MARM be superior to Hi-Lo?

assessing rib cage, not the abdomen

when performing cervical AROM testing, you should be looking for what?

asterisk or concordant sign and loss of ROM

acsm guidelines to improve neuromuscular

at least 2-3 days per week -up to 20-30 minutes -need to be able to do motion correctly

AAA is typically asymptomatic until when?

at or near rupture

MCL sprain MOI

athletic movement or trauma resulting in valgus & rotation force

Role of AC joint

attach scapula to clavicle

IFOMPT Framework: risk, benefit > action: moderate/moderate

avoid or delay treatment / monitor & reassess

IFOMPT Framework: risk, benefit > action: high/low

avoid treatment

What is a reverse bankart lesion?

avulsion of posterior labrum (6-11 on clock) due to posterior instability/dislocation

sensation on the lateral arm tests what peripheral nerve and what nerve root?

axillary nerve C5

why do yo have excessive IR and limited ER with anteversion?

bc they are starting in so much ER in the first place, and you have a lot more room to go posterior when measuring IR

Why is LCP often missed?

because the child will have knee pain and you FORGOT TO CHECK THE HIP!!!

Haglund deformity

bony enlargement on the back of the heel seen in chronic cases Achilies Tendinopathy

elbow extension test

bony or joint injury -pt. seated, arms supinated -shoulders flexed to 90 -extend both elbows -positive for dec extension

Lateral recess disc herniation

bordered by the lateral margin of dural sac and the medial aspect of pedicle & neural foramen

sensation on medial arm tests what peripheral nerve and what nerve roots?

brachial cutaneous T1

treatment for posterior lateral instability

bracing that limits valgus and supination -surgery to reconstruct LCL

Disc herniation - protrusion

bulge through an *intact* annulus fibrosis

mobilization with movement: lateral glide

can incorporate IR and ER -decreased pain -increased ROM

Panner disease

capitellum osteochondrosis -due to repetitive microtrauma to lateral elbow from valgus stress or inc axial load -throwers/gymnists -boys>girls 7-12 yo -swelling and stiffness -loss of extension ROM up to 20 deg -diagnosed with X-ray

how to rest C3 myotome

cervical side flexion

Most cervical radiculopathy cases involve what structure abnormalities?

cervical spondylolysis consistent w/ disc height loss and foraminal narrowing

Secondary headaches in PT practice (1)

cervicogenic

Reverse TSA procedure

changes the orientation of joint by placing the "ball" in the glenoid and "socket" in the humerus

AROM norms rotation

chin to mid-clavicle

AROM norms cervical flexion

chin to sternum

VISA-A

chronic achilles tendinopathy

Compared to healthy population, how does exercise intensity affect pain in chronic pain individuals

chronic pain population gets into painful effects of exercise at lower intensities than healthy population (slide 3)

Cervical radiculopathy - defined

clinical manifestation of irritation or compression of a cervical nerve root

Cauda Equina Syndrome - defined

clinical syndrome resulting from acute or chronic compression of the cauda equina

in the early stages of PFPS or ACL rehab you are going to do which type of exercise?

closed chain exercises

In what phase do elbow injuries occur during throwing?

cocking & acceleration

What is a primary headache?

complaints are a result of the underlying headache pathology

What is a secondary headache?

complaints are resultant from & dependent upon another pathology that can create symptoms including HA

what is cervical myelopathy?

compression of spinal cord -spondylotic changes are most common cause (esp >55 yo) -MRI is gold standard of diagnosis

gunstock deformity

condylar fracture -usually lateral -caution with growth plate

What is purpose of Passive Arthro Motion Testing for SIJ?

confirms direction & quality while providing end feel

How might a bankart lesion immobilization differ from other cases?

consideration for immobilization in ER for better approximation of lesion

Aerobic exercise changes & dosing in healthy pain free pop (4)

consistent -mod improvement in pain intensity & threshold -time: 10-30' -intensity: 70-75% VO2 max

Resistance exercise (isometric) changes & dosing in health pain free pop (3)

consistent -mod to very large improvement in pain intensity & threshold -optimal intensity 40-50% MVIC

Spondylolysis - defined

defect in the pars interarticularis -stress fx, traumatic fx, developmental anomaly

What is the purpose of SIJ Kinetic Motion Testing?

defines direction & quality of impairment

Hip OA - defined

degeneration of the articular cartilage & normal shape of hip joint

Lumbar Stenosis - defined

degenerative narrowing of spinal canal, nerve root canal, or intervertebral foramina

What is cervical myelopathy

degradation of some structures causing central canal stenosis & compression of the SC

What muscle spasms in response to hill sachs lesion?

deltiod - causing greater force put into the joint

Reverse TSA alters the center of shoulder rotation by affecting what muscle?

deltoid, allows it to produce more force

Who should be consulted if the PT thinks imaging is warranted for TMJ dysfunction?

dentist or oral surgeon

how to test T1-2 myotome?

digit ADD

hip ADD can increase what at the knee?

dynamic knee valgus and patellofemoral stress

tibial IR can increase what at the knee?

dynamic knee valgus and patellofemoral stress

cadence

steps/min -avg= 110-115

according to human movement system, what is stiffness?

still have motion but muscle seems stiff as result of agonist/antagonist imbalance

McBurney's point

right side -1/3 btwn ASIS and umbilicus -*Appendicitis*

y-balance score of less than 89% means what?

risk of injury in foot ball players

What is the most common cause of shoulder pain & disability in SAP?

rotator cuff

a high +LR does what?

rules in diagnosis

a low -LR does what?

rules out diagnosis

What is scapular dysrhythmia? (3)

scapula demonstrates: -premature or excessive elevation or protraction -non smooth or stuttering motion during elevation or lowering -rapid downward rotation during lowering

C4 myotome

scapular elevation

Neck pain w/ HA: acute interventions (1)

self C1-2 SNAG

Medial epicondylosis is typically _________ in nature?

self limiting - 80% of cases will resolve on their own w/in 1-3 years

What does the concept of a force couple mean?

several muscle working in unison by applying different forces to create a common motion

What "sign" is commonly associated w/ neurogenic claudication?

shopping cart sign

up sloping collar bone means what?

shorter, stronger upper trap

how to test C4 myotome

shrug

SIJ compression

side lying -reproduction of pain is pos

what does it mean if myotome is weak and painful

significant pathology fracture or 2nd degree tear

how to test CN8

simple hearing test rinne test weber test

Why is the cervical neck torsion test useful?

since head is not moving the inner ear canals are taken out of the equation. it stresses the c-spine as the body moves around the stable head

According to the human movement system what is the cause of pain?

site of excess movement

Is Horner's syndrome assessment useful in CAD testing?

situationally, yes. may ID ICA pathology in early stages prior to ischemic s/sx

How does the mandibular condyle move during mouth opening?

slides anteriorly from w/in dome of mandibular fossa onto the sloped edges of the articular eminence

neurodynamic testing

slump and ULTT

Female sports w/ highest risk for ACL tear (3)

soccer > basketball > lacrosse

what is cervical radiculopathy? and what does it result from?

some combo of sensory loss, motor loss, impaired reflexes in segmental distribution results from: -space occupying lesion -disc herniation -sypondylosis -osteophytes

Foraminal disc herniation

space between the ipsilateral adjacent pedicles

In cervical radiculopathy, what structure is generally impaired?

spinal nerve

common condition of 10-20 y.o

spondylolisthesis

what is the jendrassik maneuver

squeeze knees together to distract pt.

boggy end feel

squishy produced by fluid/edema

What stability does the inferior GH ligament provide?

stability against anterior translation w/ arm in *90 degrees of ABD & ER*

What stability does the middle GH ligament provide?

stability against anterior translation w/ arm in ER & ABD *less than 90 degrees*

SFMA SMCD

stability and/or motor control dysfunction -breathing, local or global muscle asymmetry, static vs. dynamic

upper trapezius muscle length test

stabilize acromion flex, SB away, rotate towards

MWM for shoulder

stabilize scapula, thenar eminence of other hand over the medial head of the humerus (avoid coracoid process) Direction: Posterior lateral and possibly inferior Repetitions with weight or overpressure

stride evaluation

stance leg -single leg balance -hip IR ROM stride leg -hip ER ROM -foot positioning shoulder -GHJ ROM -scapula dyskinesis

Fulcrum test

stress fracture -pt. sitting w/ knees bent over edge of bed -firm towel roll placed under thigh and moved proximal and distal and pressure is applied post to knee (+) is sharp pain and/or apprehension when the fulcrum is placed under the fracture site

Patellar-pubic percussion test

stress fracture -supine -percuss one patella while auscultating pubic symphysis w/ stethoscope + diminution of percussion on affected side

horizontal collar bone means what?

stretched upper trap

declined collar bone means what?

stretched, weak upper trap

Does stretching/tension or compression tend to have better prognostic factors?

stretching or tension better prognosis than compression

Primary External Impingement

structural changes that narrow the subacromial space

Neer test

subacromial pain -stabilizes scapula with one hand -PROM flexion while in IR -pain provocation test

Cervical radiculopathy, most cases can be diagnosed by what information?

subjective history!!

What are important considerations w/ biceps tenodesis?

subscapularis & RTC interval important

CAD - is pain onset sudden or gradual?

sudden pain

SLAP tear and common causes

superior labrum anterior to posterior (to biceps insertion) -trauma or repetitive shoulder motion -MVA -FOOSH -forceful pulling of arm -rapid movement when arm is above 90 -shoulder dislocation

What part of the patella is in contact at 90 degrees?

superior pole

C6 myotome

supination and wrist extension

how to test C6 myotome

supination and wrist extension

SIJ distraction

supine anterior -reproduction of pain is pos

Order of RC muscle tear prevalence

supraspinatus > infraspinatus > upper subscapularis

What is next option if ulnar neuritis conservative treatment fails?

surgery

When assessing myotomes for cervical radiculopathy, what should you look for besides weakness?

sustain the hold because the impaired muscle will fatigue differently, which is almost exclusive to cervical radiculopathy

what is the single strongest predictor of success of treatment of hip OA?

symptom duration < 1 year

Multidirectional instability - defined

symptomatic GH translation, subluxation, or dislocation in more than one direction that leads to functional impairment (AMBRI)

Instability is...

symptomatic laxity

peripheralization McKenzie definition

symptoms moving distally

SMPs

system modification procedures -Changing kinematic behaviors with a primary objective of altering symptoms

What forms the superior articulation of the TMJ?

temporal bone in the mandibular fossa

Primary muscles of TMJ Retrusion (1)

temporalis (oblique fibers)

How does LCP differ from other pediatric hip conditions in how pain & symptoms present?

tends to be an earlier onset of pain & symptoms compared to other conditions

how to differentiate radial tunnel syndrome from lateral epicondylagia

tennis elbow brace -takes pressure off insertion but can make radial tunnel syndrome worse

Patellar Tendon Graft for ACL reconstruction tensile strength

tensile strength: -3 months: 57% -6 months: 56% -9 months: 86% 9 month return to sport minimum if clinical criteria met

biceps load 2 test

test for SAP -pt. supine -Shoulder ABD to 120 degrees and ER with elbow fleed to 90 and forearm supinated -Examiner takes arm into full ER and holds -Patient asked to flex elbow against rsistance If pain is produced or increases, test is +

lateral pivot shift test of the elbow

tests for posterior lateral instability -pt. supine with arm overhead, supinated, extended -examiner applies axial compression and valgus while flexing elbow -if unstable this will produce a sublux of radial head and a dimple posteriorly -as PT flexes elbow btwn 40-70 degrees a reduction occurs +/- clunk

Why does cauda equina typically present as LMN and not UMN?

the cauda equina is NOT the spinal cord. -the nerves are peripheral spinal nerves that are located in the central spinal canal

Contained herniation

the herniation has not progressed beyond the outer fibers of the annulus and not through the PLL

Uncontained herniation

the herniation has progressed through the annular fibers and the PLL

What is the "Neutral Position" of the spine?

the posture of the spine in which the overall internal stresses in the spinal column are minimal (including muscular effort to hold the posture)

What is a good working definition of clinical instability?

the presence of excessive uncontrolled intervertebral motion that triggers nociceptor stimulation w/in abnormally stressed tissue

What is relationship between forearm extensors and LCL/annular ligament?

the tendon combines w/ ligament as they attach to bone and the tendon "dynamizes" the ligament, thus they share the load on the lateral aspect of the elbow

manual therapy should always be followed by ___

therapeutic exercise

What does recent literature suggest regarding contact between the femur & acetabulum for FAIS?

there may not be any contact between the bones at all, the definition is evolving

Why are females more likely to get TOS?

they have a more horizontally oriented first rib, so the C8-T1 nerve roots have more distance to travel up & over the rib to get to the UE

C8 myotome

thumb extension and UD

SFMA TED

tissue extensibility dysfunciton (similar to McKenzie dysfunction) -muscle insufficiency, neural tension, scarring

normal end feel in abnormal place

tissue stretch for elbow extension

Cervical Exam - Regional Exam Purpose (4)

to ID: -dysfunction, impairment, and pain behavior -test for gauging progress -body regions for localized exam -continue working hypothesis

how to test CN12

tongue protrusion- towards affected side

total rotation motion

total IR and ER at 90 degrees of ABD -if TRM is >5 degrees, it may contribute to shoulder injuries

On initial portion of stance phase in running, what is the big difference between traditional and original running?

traditional style increases initial GRF at a much faster rate than original -big deal is rate of force rather than amount of force

Subluxation - defined

translation of humeral head beyond normal physiologic limits while still maintaining contact w/ glenoid

Dislocation - defined

translation of humeral head far enough to completely disassociate the articular surfaces of humerus & glenoid

What covers the long head of biceps?

transverse humeral ligament

Labrum tear risk factors (1)

trauma (fall, twist, pivot)

ankle sprain cause

trauma, mechanical force stressing the ligament(s) beyond their physiological capacity for tension

Most common cause of elbow dislocation

traumatic - axial force combined w/ valgus & supination stress (most often lateral & posterior dislocation)

IFOMPT Framework: risk, benefit > action: low/low

treat w/ care / continual monitoring for change or new symptoms

what should be used to reduce LBP and disability in pts with *subacute and chronic LBP with movement coordination impairments* and in those post op microdisectomy

trunk coordination, strengthening, and endurance exercise

What is intervention for stage 5-7 lateral epicondylosis?

try exercise & pain reduction, surgery for failed cases

how to test C8 myotome

tumb extension and UD

What does the coracohumeral ligament help provide? (2)

tunnel for biceps brachii -part of rotator interval that resists: --inferior translation of humeral head --anterior translation w/ arm in ADD

SLAP debridement has a high rate of failure in athletes except for what type of lesion?

type I

Most common type of labral tear

type II

SLAP repairs are for what type of labral tears?

type II & IV (the two types that involve the biceps tendon)

ULTT 3

ulnar Shoulder Girdle Depression Shoulder ABD 90 - 110 Shoulder ER Elbow flexion Wrist and Finger Extension Forearm Pronation Cervical Side Flexion

ULTT 3

ulnar nerve -shoulder girdle depression -shoulder abd to 90-110 -shoulder ER -elbow flexion -wrist and finger extension -forearm pronation -cervical side flexion

Cause of FAIS?

uncertain

In what situation is surgical intervention extremely necessary for cauda equina?

unexplained loss of bladder function should be considered an EMERGENT need or referral for surgical evaluation

Is LCP typically unilateral or bilateral?

unilateral

Cause of SCFE (1)

unknown, some deficiency in growth plate integrity

C1-3 myotome

upper cervical rotation

how to test C1-3 myotomes

upper cervical rotation

How can scapular ROM be assessed/measured?

upward rot & posterior tilt via inclinometer

What 2 scapular motions are necessary for full UE flexion? Whar are the ROM norms for these?

upward rotation (50-60 deg) & posterior tilt (10 deg)

extensor grip test

use hands to squeeze forearm near insertion for extensors to see if it alleviates pain while gripping -may be sign a brace may be helpful

PFPS knee ROM

usually normal

how do you test the UCL?

valgus stress test

how to test RCL

varus stress test

if a pt. loses their balance when you ask them to turn their head could signify what?

vestibular basilar artery problems and need for referral

how to test CN2

visual field: snellen chart 20 ft -confrontation test (visual field)

if you have a pronation loss, what direction are you going to mobilize at the distal radioulnar joint?

volar

if you have a supination loss what direction are you going to mobilize at the proximal radioulnar joint?

volar

When do majority of complications & re-tears occur w/ rotator cuff repair?

w/in first 6 months post op

Shod

wearing a shoe w/ cushion (heel strike cushion running)

Minimalist shoe

wearing a shoe w/ little to no cushion

Barefoot "shoe"

wearing no shoe or sometimes refers to forefoot strike pattern

Cervical myelopathy - clinical presentation

widely variable! - based on patient specific factors -no specific clinical sign or symptom, but: general presentation: -possible neck stiffness, shoulder pain paresthesia, LE abnormalities in early stages, UE LMN impairments in later stages

How does LT work during arm descent?

works eccentrically to control anterior tilt

Copenhagen Hip and Groin Outcome Score (HAGOS)

young to middle aged physical active individuals w/ hip and groin pain MDC: 5.2

Reverse TSA patient typically achieve how much elevation?

~105 *do NOT expect improvments in rotation*

thumb CMC extension ROM

20

Hip extension ROM Norm and end-feel

20 -Tissue stretch

Hip ADD ROM Norm and end-feel

20 -Tissue Approximation or Tissue Stretch

DF ROM and endfeel

20 w/ tissue stretch *WB approx 25-30*

when does the anterior band of the UCL become tight?

20-120 degs -lax in full extension

AROM radial devation

20-25

how common are meniscal injuries?

25% of all knee injuries

nerve roots of radial nerve

C5-T1

triceps reflex tests what nerve roots?

C6,7

Cervical disc herniation pathoanatomy - levels most commonly affected

C6-7 > C5-6 > C7-8

What spinal levels are commonly affected in cervical radiculpathy?

C7 > C6 > C8 (correspond to sensation changes in the HAND)

nerve roots of PIN

C7-8

what nerve roots are affected with TOS?

C8 T1 85-90% of the time

nerve roots of ulnar nerve

C8-T1

how to test C5 myotome

CH abd and ER

C2 myotome

CV flexion

how to test C2 myotome

CV flexion

Risk Factors for FAIS?

Cam or Pincer Deformity

Tissue Stretch End Feel

Capsule and ligs provide resistance Springy with a slight give Most Common endfeel

Cause & Presentation of Vascular claudication

Cause: ischemic response from peripheral vascular disease -------------------------------- Presentation: pain in legs during or as a result of walking, based on the demand to the CV system (POSTURE INDEPENDENT)

C3 myotome

Cervical side flexion

In general, large improvements are seen in what time frame for cervical radiculopathy patients?

3-4 mos

Normal TMJ retrusion ROM

3-5 mm

Stage 2 adhesive capsulitis

3-9 months (freezing) -gradual loss of motion in all directions

patella load during descending stairs

3.5X body weight

how much MCP finger flexion do you need to type

30

thumb IP extension ROM

30

thumb MCP ext ROM

30

inversion ROM and endfeel

30 w/ tissue stretch

AROM ulnar deviation

30-39

what should AROM and endfeel be for ulnar deviation?

30-39 -bone on bone

how much PIP finger flexion do you need to type

30-40

How much of labrum anchor tear is indicated for surgery?

30-40% or more, repair the labrum

MTP flexion ROM and end feel

30-45 w/ tissue stretch

Terminal stance

30-50% -begins when LOG passes through MTP of stance foot -concludes when contralateral foot strikes ground -single limb support

Biceps Femoris - SH

Common Fibular N. L5, S1, S2

How is Kinetic motion testing assessed (what is it compared to?

Compared vs expectation & contralateral side

Types of Spondylolisthesis (5)

Congenital: developmental anomaly of facets & posterior arch Isthmic: pars interarticularis defect (traumatic or not) Degenerative: results from changes in disc height & articular surface integrity (COMMON) - no pars fx! Traumatic: fracture or dislocation or facet joint (RARE) Pathologic: abnormal process resulting in structural decay of the boney or ligamentous structures (not a primary process)

What is Horner's syndrome?

a disruption to the oculosympathetic pathway that runs in parallel with the ICA. OSP supplies sweat glands to face/head, dilator muscle of pupil, and retractor muscles of the eyelids

a Baker's cyst that has burst can mimic S&S of what?

DVT

ACL-RSI

(return to sport after injury) -psychological readiness for return to sport after ACLR -emotions, confidence -cut off 56 for return to play

Whiplash Quebec Task Force Grades (0-IV)

*0* = no complaints of neck pain AND no physical signs *I* = complaints of neck pain, stiffness, or tenderness, AND no physical signs *II* = complaints of neck pain, stiffness, or tenderness, AND MSK signs (dec ROM) *III* = complaints of neck pain, stiffness, or tenderness, AND neuro signs (dec DTR, strength, sensation) *IV* = complaints of neck pain, stiffness, or tenderness, AND fracture or dislocation

Thompson Test

*Achilles tendon rupture* -pt. prone -examiner gently squeezes pt. calf muscles -if achilles is torn-> ankle will remain still or only minimally PF

Adductor strain risk factors

*Adductor weakness* -should be 95% of ABD strength -if ADD strength is < 80% of ABD strength 17X more likely to suffer groin strain

FAIR test

*piriformis syndrome* + reproduction of symptoms -pt. side lying -flex hip under 90 deg w/ IR and ADD

active straight leg raise (ASLR)

*positive w/ a score of 2/5* 0=not difficult 1=minimal difficult 2=somewhat difficult 3=fairly difficult 4=very difficult 5=unable

Hip outcome score (HOS)

*primarily used after arthroscopic hip surgery* -MCD: 3 -MCID: 9 ADLs, 6 sport

Sacroiliac joint pain

*radiates towards calf and foot mimicking radicular pain* -affects up to 30% of pts. with chronic LBP

STarT Back Screening Tool

*risk stratification tool for people w/ LBP* -higher scores predict higher disability -based on presence of physical or psychosocial prognostic factors

Spoldylolisthesis

*slippage of one vertebra over another* -bony defect usually occurs over pars interarticularis allowing ant displacement of vertebral body -usually anterior -often in sports with hyperextension -often starts as spondylolysis

spondylolysis

*stress fracture of the pars interarticularis* -can lead to spondylolisthesis

two stage treadmill test

*test for Spinal Stenosis* -pain and weakness while walking -can walker longer w/ incline versus flat walking

Ely test

*testing: RF* -pt prone -passive knee flexion -palpate PSIS for movement -compare to opposite side *(+): hip flexion before 90* *SMP: Abdominal contraction*

Neck pain w/ HA: expected exam findings (4)

- *+ cervical flexion-rotation test* -HA reproduced w/ segment provocation in upper C spine -decreased upper C spine segmental mobility -dec strength, endurance, motor control of neck muscles

Baker's cyst

- +35 y.o -accum of fluid in 1 of 6 bursa behind knee -traumatic or insidious -assoc w/ RA or OA -common w/ meniscus tear -swelling and pain w/ knee flexion behind knee -usually respond to conservative care and resolve in 10-20 months

Common running injuries: hamstring tendinopathy / strain (2)

- < 25% of running related injuries -associated w/ overstriding and poor control of running

Ankle Sprain radiograph - what would cause suspected ligamentous injury (3)

- >15 degrees w/ inversion stress - >10 degrees w/ eversion stress - >5 degree difference between sides

palpation of abdominal aortic pulse

- >2.5 cm requires additional diagnostics -palpate parallel to vessel

lumbar stenosis (9)

- >50 -m>f -insidious onset -hx of chronic LBP -limited lumbar movement -intolerance to extension -preference to flexion -pain below buttock -pseudo claudication (lateral stenosis will only affect 1 side)

Knee OA illness script

- >50 y.o -morning stiffness <30 -crepitus -bony tendernes -bony enlargement -no palpable warmth

*Knee OA risk factors* -Tibiofemoral (medial or lateral) -Patellofemoral

- >50 y.o -obestiy -trauma -genetics -peripheral neuropathy -joint hypermobility/instability

Prevalence of labral tears

- >90% of individuals w/ mechanical hip pain -20% of athletes w/ groin pain

grade 2 mobilization

2/3 sets 30-60 secs larger oscillations 1-2/sec -pain management

Common running injuries: PFPS (2)

-most common injury in runners (F 2x > M) -associated w/ limited force attenuation, excessive hip ADD/IR, uncontrolled pronation/tibial IR

Shoulder instability - arthroscopic capsular plication (3)

-most common procedure used currently -pleating & sutures to tighten capsule -recurrence rates similar to open, especially if no bony deficit

Common running injuries: tibial stress syndromes/fractures (2)

-most common site of stress fx (F > M) -associated w/ limited force attenuation, hip add, rearfoot ev

Scaphoid fracture

-most commonly fractured carpal bone -FOOSH -distal wrist pain -tender over anatomical snuff box -painful weakness -initial x-rays are neg, cast and re-xray in 2 weeks to look for new bone growth

greater trochanteric pain syndrome (GTPS)

-most commonly inflamed bursa -aggravated w/ lying on affected side, transfers, walking, climbing stairs -hip motion after prolonged static position -gradual onset or traumatic from fall -correlated w/ weak hip abductors and LLD -trendelenburg sign

Iliotibial Band Syndrome

-most frequent in miliatry, cyclist, runners (5-14% of runners) -cause is repetitive flexion and ext creating friction btwn lat epicondyle and IT band -usually occurs at 30 deg of flexion -pain/burning lat femoral condyle that can radiate into lat thigh or calf

Disc Herniation Classification systems (3)

-movement of nuclear material -ligamentous disruption -anatomic location

contraindications of manual therapy

-multi-level nerve root pathology -worsening neuro function -unremitting, severe, non-mechanical pain -unremitting night pain -relevatn recent trauma -UMN -spinal cord damage -pt. fear -bone weakening -lack of diagnosis -lack of pt. consent

TSA Risks (5)

-musculocutaneous nerve injury -axillary nerve injury -cephalic vein injury -anterior circumflex humeral artery injury -loosening & revision of glenoid component is a concern

Suprahyoid Muscles - group of what 4 muscles?

-mylohyoid -digastrics -stylohyoid -geniohyoid

Cervical Radiculopathy generally presents with what unilateral signs and symptoms? (4)

-neck pain -motor function impairments (myotomal weakness) -sensory impairments -diminished deep tendon reflexes -pain

signs of upper cervical instability

-neck pain +/- instability -limitation of neck movements -torticollis -neurological symptoms such as 5Ds -neurological signs

Neck pain w/ radiating pain: common symptoms (2)

-neck pain w/ radiating pain into involved UE -UE dermatomal paresthesia or numbness, & myotomal weakness

ICF classifications of neck pain

-neck pain with mobility deficits -neck pain with HA -neck pain with movement coordination impairments -neck pain with radiating pain

Cervical disc herniation clinical presentation (3)

-neck pain, usually unilaterally -radiating pain from neck to posterior back, shoulder, upper arm -difficult to isolate w/ clinical testing

cervical myelopathy S&S

-neck/shoulder pain/stiffness -sensory disturbance of hands -muscle waisting of thernar and intrinsic muscles -unsteady gait with wide base -hoffman's reflex and babinski -hyperreflexia -urinary retention followed by overflow incontinence -10 second step test

stages of ligamentization (ACL)

-necrosis for 3 weeks -revascularization during 6-8 to 16 weeks -cellular proliferation -collagen formation, remodeling and maturation -Return to sport: 9 months minimum if clinical criteria met

Posterior interosseous nerve entrapment key features (3)

-neuro deficit: weakness of finger and thumb extensors & APL -abnormal radial nerve conduction shown via testing -pain usually in distal forearm & wrist, may refer proximally

what are the 3 types of TOS?

-neurogenic -venous -arterial

Quebec Task force recommendations for imaging (5)

-neurologic deficits -age >50 or < 20 -fever -trauma -signs of neoplasm

Thumb CMC flexion ROM

15

Tension HA - chronic

15 or more days per month on average, lasting days/hours/unremitting (180 days or more / year)

eversion ROM and endfeel

15 w/ tissue stretch

Stage 4 adhesive capsulitis

15-24 months (thawing stage) -pain begins to resolve -stiffness persists for 15-24 months after onset

at what position do you measure pec major ROM for sternal portion muscle length?

150 sternal portion

stage 1 hypertension

159/90-99

FABQ

16 items on 7 point Likert scale -higher score indicates fear avoidance beliefs >34 work; >15 physical activity

grade 4 mobilization

2/3 sets 30-60 secs small oscillations 1/sec -inc ROM -more subacute/chronic

grade 1 mobilization

2/3 sets 30-60 secs small oscillations 1/sec -pain management

MCP extension ROM

20

how much thumb IP flexion do you need to type

18 degrees

Numeric Pain Scale rating MCID:

2

how much thumb MCP flexion do you need to type

2 degrees

maitland scale

2-3 sets of 30-60 secs Grade 1: small oscillations at rate of 1/sec Grade 2: larger oscillations at rate of 1-2/sec Grade 3: larger oscillations at rate of 1-2/sec Grade 4: small oscillations at rate of 1/sec Manipulation 1-2 times

acsm guidlines for improving strength

2-4 sets 8-12 reps at 60-80% 1RM 2-3 mins btwn sets

is it OK to have pain or an increase in pain when exercising?

2-5/10 pain then you dont need to worry -may need to educate pt on normal soreness with exercise vs pain

patella load during climbing stairs

2.5X body weight

grade 3 mobilization

2/3 sets 30-60 secs large oscillations 1-2/sec -inc ROM -more subacute/chronic

Cervical radiculopathy impairment of how many spinal nerves is considered a red flag?

3 or more

Wells CPR for DVT (possible test question)

3 points = high risk 1-2 points = mod risk <1 point = low risk - active cancer (treated in last 6 months or currently receiving palliative care) (+1 point) - paralysis, paresis, or recent plaster immobilization of LE (+1 point) - major surgery within previous 12 weeks requiring general or local anesthesia or recently - bedridden for 3 or more days (+1 point) - localized tenderness along deep venous system distribution (+1 point) - swelling of entire leg (+1 point) - calf swelling at least 3 cm larger than asymptomatic side (+1 point) - pitting edema confined to symptomatic leg (+1 point) - collateral superficial nonvaricose veins (+1 point) - previously documented DVT (+1 point) - alternative diagnosis at least as likely as DVT (-2 points)

Pain Catastrophizing Scale (PCS)

3 sub scales: -rumination -helplessness -pessimism higher scores indicate higher pain catastrophizing

T1-2 myotome

4 & 5 digit ADD

functional wrist flexion/extension

40

Hip ABD ROM Norm and end-feel

40 -Tissue stretch

normal sitting craniovertebral angle

42.8

Hip ER ROM NORM and end-feel

45 -Tissue stretch

Hip IR ROM Norm and end-feel

45 -Tissue stretch

Tinel's sign

a way to detect irritated nerves. It is performed by lightly tapping (percussing) over the nerve to elicit a sensation of tingling or "pins and needles" in the distribution of the nerve.

subtalar inversion and eversion ROM and end feel

5 w/ tissue stretch

Amount of normal TMJ protrusion

5-10 mm

What age range has the highest incidence for LCP?

5-8 years old (boys 4x > girls)

Secondary running observations to progress to if needed (3)

5. are there gross deviations present in the joints? 6. what is the cadence? (at least 140 expected) 7. is there an anterior lean from ankles or hips?

CPR for Anterior ankle impingement

5/6 symptoms present considered positive for anterior ankle impingement -anterolateral ankle joint tenderness -anterolateral ankle joint swelling -pain w/ forced dorsiflexion -pain w/ single-leg squat -pain w/ activities -*absence* of ankle instability

functional ROM for pronation/supination

50

how many pounds should women be able to grip?

50

PF ROM and endfeel

50 w/ tissue stretch

how much of elbow stability comes from ligament and capusle?

50%

Risk factors for SCFE (1)

50% or more patients are >95% in body weight (bigger, obese child)

Self-paced Walk Test Norms

50-59: 1.4 m/sec 60-69: 1.28 W; 1.36 M 70-79: 1.27 W; 1.33 M

thumb MCP flexion ROM

50-60

preswing

50-60% -begins w/ initial contact of opposite limb -concludes w/ ipsilateral toe-off

MTP extension ROM and end feel

50-70 w/ tissue stretch

What are the chances of recovery w/ whiplash?

50/50

what kind of MVA accident can cause PCL tear?

Dashboard injury

MCP flexion ROM

90

in open chain thers is less stress on the ACL and Patella closer to:

90

apprehension and relocation test test

90 deg of abd and PROM of ER -pain and/or apprehension

knee flexion needed to rise from chair

90 degrees

at what position do you measure pec major ROM for clavicular portion muscle length?

90 degrees for clavicular

knee flexion needed for ascending stairs

92.9

Time of compression and how it affects accumulation (2)

< 2 hrs = no accumulation > 8 hrs = accumulation

Self-paced Walk Test time associate with 1.5X fall risk

<0.7 m/sec

what is the normal resting position of the humeral head

<1/3 of humeral head anterior to acromion

Central sensitization - defined & effects of it (4)

= amplification of neural signaling w/in the CNS that elicits pain hypersensitivity -inc pain facilitation (ascending) -dec pain inhibition (central & descending) -neuropathic pain: pain arising from direct consequence or lesion to somatosensory system

Lateral epicondylosis in younger (<18) population

= apophysitis rest is treatment to allow healing

Patellofemoral pain definition and diagnosis

= pain arising from structures w/in the PFJ articulation - a diagnosis of exclusion, r/o meniscus and patella tendinopathy

how much of an iliac crest height asymmetry is significant?

> 1/2 inch

at what carrying angle should you be worried about cubital tunnel problems?

>15 degrees

stage 2 hypertension

>160/>100

how many degrees of JPE is considered abnormal?

>3 degrees -test with goni/inclinometer -wrist flexion/extension

Kyphosis

>40 degrees is hyperkyphosis -measured with dual inclinometer

when is the posterior band of the UCL taut?

>55 degrees of flexion

dart throwers motion

A pattern of wrist extension/radial deviation to wrist flexion/ulnar deviation -40% occurs at scaphoid and lunate -60% at mid carpal joint -good for comparison from side to side

Extensor Digitorum Longus

Deep Fibular N. L4, L5

Extensor Hallucis Longus

Deep Fibular N. L4, L5

Fibularis Tertius

Deep Fibular N. L4, L5

Tibialis Anterior

Deep Fibular N. L4, L5

Aggravating & Relieving factors for neurogenic claudication

Aggravating: walking, lumbar extension -------------------------------- Relieving: sitting, forward flexion of the trunk

GH joint closed pack position

ABD & ER

MOI for high ankle sprain (Syndesmotic sprain)

ABD or ABD and ER to the foot or forced IR of the body over a planted foot

anterior drawer

ACL -pt. supine -hips flexed to 45 -knee flexed to 90 w/ feet flat -sit on feet -draw tibia forward w/ both hands + w/ excessive translation, soft end feel

Lachman test

ACL -pt. supine w/ knee 20-30 degrees of flexion -one hand is post to lat thigh -other hand is on medial post tibia w/ thumb on tib tubersoity -*more than 2mm ant glide compared to other knee w/ soft end feel is positive* -do it quickly

subjective complaint of loss of top running speed is most likely what?

ADD pathology

Trapezius

Accessory N. (CN XI) N/A

How much stock should we put into kinetic motion testing?

Be skeptical - they likely do not do what we think they do

biceps reflex tests what nerve roots?

C5,6

brachioradialis reflex tests what?

C5,6 look for inverted supinator as well

Nerve roots of musculocutaneous nerve

C5-C7

nerve roots of median nerve

C5-T1

light touch travels on what tract in the spinal cord?

DC/ML

actions of anterior tibialis

DF and IN

the talocrural joint is responsible for what motions?

DF and PF

which has better clinimetrics: Tuning Fork Lateral Malleolus (TLM) or Tuning Fork Fibular Shaft (DFS)?

DFS: Tuning Fork Fibular Shaft -1.0/.95 TLM: 1.9/.61

Heberden's nodes

DIP enlargement -OA

Achilles Tendinopathy treatment

ECC exercise AND -joint mobilization/manipulation

what is the strongest wrist extensor?

ECU

capsular pattern in shoulder

ER>ABD>IR

action of fibularis

EV

trunk flexion and LBP

Early lumbar motion in the first 50% is moderately associated with the person's LBP related functional limitations

5Ds

drop attacks dizziness dysphasia dysarthria diplopia

capsular pattern of restriction

a limitation of pain and movement in a joint specific ratio, which is usually present with arthritis, or following prolonged immobilization

tibiofemoral posterior joint mob

pt. supine w/ knee in open pack -stabilize distal femur -provide post force to prox tibia *can be treatment for: flexion*

if you have a RD loss which direction are you going to mobilize?

UD

Flexor Carpi Ulnaris

Ulnar N. C7, C8

Flexor Digitorum Profundus

Ulnar N. to 4th & 5th digits; Anterior Interosseous N. (from Median N.) to digits 2nd & 3rd digits C8, T1; C8, T1

tibiofemoral anterior joint mob

pt. supine w/ knee in open pack/end range (depending on irritability) -prox tibia is stabilized -posterior force directed to distal femur *can be treatment for: extension*

Ottawa Ankle rule

X-ray is indicated if there is bony pain in malleolar zone AND any one of the following: -tenderness at distal 6cm of *posterior edge of tibia* or *tip of medial malleolus* -tenderness at distal 6cm of *posterior edge of fibula* or *tip of lateral malleolus* -inability to bear weight both immediately after injury and in the ED for 4 steps

Ottawa Foot rule

X-ray is indicated if there is bony pain in the midfoot zone AND any one of the following: -tenderness at *base of 5th met* -tenderness at *navicular* -inability to bear weight both immediately after injury and in the ED for 4 steps

Big picture, does exercise help pain?

YES

Is thigh thrust test sensitive?

Yes, Sn 0.88

Is BP testing useful for CAD?

Yes, strong CV disease risk factor identifier and easy to perform

gibbus

a sharp, angular deformity associated with a collapsed vertebra due to osteoporosis -wedging from fracture, tumor or bone disease

UQS should be performed on which pts.?

pts. with symptoms in -upper extremity -cervical spine -thoracic spine

Latissiumus Dorsi

Thoracodorsal N. C6, C7, C8

Biceps Femoris - LH

Tibial N. (via Sciatic N.) L5, S1, S2

Semimembranosus

Tibial N. (via Sciatic N.) L5, S1, S2

Semitendinosus

Tibial N. (via Sciatic N.) L5, S1, S2

Tibialis Posterior

Tibial N. L4, L5

Popliteus

Tibial N. L4, L5, S1

Gastrocnemius

Tibial N. S1, S2

Plantaris

Tibial N. S1, S2

Soleus

Tibial N. S1, S2

Flexor Digitorum Longus

Tibial N. S2, S3

Flexor Hallucis Longus

Tibial N. S2, S3

TUBS

Traumatic Unidirectional Bankart Surgery

Cluster headache also known as:

Trigeminal Autonomic Cephalalgia

A migraine may or may not present with what?

an aura

reduced anterior reach is linked to what?

ankle sprains

what is the most common cause of Sacroiliac Joint Pain (SIJ)

ankylosing spondylitis

sensation on medial forearm tests what peripheral nerve and what nerve roots?

antebracial cutaneous nerve C8

What is the most common manifestation of unidirectional instability of shoulder dislocations?

anterior instability

TMJ Protrusion Arthrokinematics

anterior slide of mandibular condyle & disc on mandibular fossa

TMJ depression arthrokinematics

anterior slide of mandibular condyle & disc on mandibular fossa

PFPS - area of pain

anterior, medial > lateral > infrapatellar; may not be clearly palpable

where is bankart lesion seen on the glenoid?

anterior-inferior (2-6 on clock)

When should double crush be considered?

any longstanding peripheral neuropathy (proximal involvement "heightens" the symptoms that are experienced distally)

how to test CN1

ask for change in smell

Central disc herniation

contained w/in borders of dural sac

What does chronic compression lead to?

continued cycle of: fibroblast invasion (scarring) > impaired gliding > continual edema cycle

What bony landmark on the temporalis serves as an insertion point for temporalis muscle?

coronoid process

how to test for lateral epicondylagia

cozens test mill's test maudsley test extensor grip test

how to assess deep cervical flexors?

cranial cervical flexion test (CCFT) -pt. supine -inflate cuff to 20mmHg -pt. nods into bladder to inc to 22 and hold for 10 secs -10 sec rest -inc to 24 -cycle repeats until they cant complete the task or they reach 30 norm is 26-30

What are the 2 most common nerve conditions of the elbow?

cubital tunnel and radial tunnel syndrome

How to test for cubital tunnel syndrome?

cubital tunnel flexion test

acsm guidelines to improve flexibility

daily if possible -static stretch 10-30 seconds -2-4 reps

What is the most common surgical procedure to address symptomatic SLAP lesions?

debridement

MSK changes as we age - bones

dec strength

Neuromuscular Re-education can:

decrease pain; lumbar excursion more like people without back pain after 1 session of training

women w/ posterior tibial tendon dysfunction have ____

diminished ankle and hip muscle performance

ICF disability definition

disability involves dysfunction at one or more of these levels: -impairments -activity limitations -participation restrictions -environmental factors

centralization of symptoms considered a positive finding for ___

discogenic symptoms

Spondylolisthesis - defined (what is common location)

displacement of a vertebral segment over another -common @ L5-S1, less often L4-5

SCFE - defined

displacement of the femoral epiphysis (usually posterior and inferior)

Meniscus tear - definition

disruption of meniscal tissue possibly resulting from trauma

Labral tear - defined

disruption of the labral tissue w/in the acetabulum *(anterior > posterior)*

Upper Cervical Instability (defined)

disruption of the osteoligamentous structures resulting in compression of neural &/or vascular structures in the cervical region

syndesmosis ankle sprain definition

disruption to the ligaments that provide stability to the mortise of the distal tibia & fibula to accommodate the talus

In what order should neural mobs be emphasized?

distal first, then proximal, then total segment

wrist ratio index

distal wrist crease: AP/ML diameter ->.67 is + for CTS predisposing factor

What is a Hill Sachs lesion?

divot in posterior-superior humeral head due to force driving the humeral head into the glenoid rim (glenoid is harder than humeral head)

What specific question related to physical activity should be asked in subjective section when considering possible CAD?

does the neck pain get worse with physical activity? (looking to see if the neck pain increases with a greater load on the CVP system)

if you have a pronation loss, what direction are you going to mobilize at the proximal radioulnar joint?

dorsal

if you have a supination loss what direction are you going to mobilize at the distal radioulnar joint?

dorsal

With a negative PNE exam, you must consider what?

double crush at the -thoracic outlet -shoulder -elbow

the subtalar joint is responsible for what motions?

pronation & supination

SIJ sacral thrust

prone with anterior force directed to sacrum -*positive is reproduction of pain*

which row of carpals is more mobile?

proximal row

patellar superior mob

pt supine in 30 deg of knee flexion w/ quads relaxed -test for loss of knee extension *can be treatment for: knee extension loss*

patellar inferior mob

pt supine in 30 degrees of knee flexion w/ quads relaxed -test for loss of knee flexion *can be treatment for: knee flexion loss*

supine sign

pt. is asked to lie supine on table with only 1 pillow positive is unable to do so due to severe pain in spine

infraspinatus resisted test

pt. resists IR (by doing ER) with UEs at side of body positive if pt. igve way b/c of weakness/pain

mulligan HA snag

pt. sitting -PT stands behind pt. with head cradled -little finger lies over C2 SP -with other hand apply straight P to A pressure through little finger