NPTE MSK

Neuro/Musculo screen (muscles supplied by peripheral nerves): Accessory obturator

(Usually absent) Pectineus

Imaging uses: Myelography

(Water-soluble dye injected into vertebral canal) To assess discs and stenosis (not used much as MRI/CT generally better and have less side-effects)

Facet Entrapment

(acute locked back) caused by abnormal movement of fibroadipose meniscoid in facet during extension. flexion is more comfortable for patient and extension increases pain lumbar quadrant test PT: positional facet joint gapping and/or manipulation

Neuro/Musculo screen (muscles supplied by peripheral nerves): Obturator

(adductors) Adductors longus, brevis, magnus; gracilis, obturator externus

Special Tests (structure being tested & procedure): Grind (Scouring) test

(aka quadrant) Degenerative joint disease, AVN, osteochondral defect Hip and knee flexion, hip adduction with pressure through joint +ve = grinding, catching, crepitation

Neuro/Musculo screen (muscles supplied by peripheral nerves): Median

(anterior forearm - radial side) Pronator teres, pronator quadratus, FCR, radial 1/2 FDP, FDS, FPL, thenar eminence (FPB (superficial head), AbP, OpP), lateral 2 lumbricles

Neuro/Musculo screen (muscles supplied by peripheral nerves): Lateral plantar

(from tibial nerve - supplies lateral sole of foot) Quadratus plantae, lateral 4 lumbricles, AdH, FDM, AbDM, interossei

Bunnel-littler test vs Retinacular test

-*Bunnel-littler test*: differentiate whether joint restriction or soft tissue tightness for MP joint -*Retinacular test*: determine if there is a restriction at the PIP joint

congenital Vertical talus(infant)

-*malalignment of the talus and navicular* -forefoot is dorsiflexed, the hind foot is plantar flexed, and the foot bends at the instep.

Congenital hip dysplasia etiology

-cultural predisposition -malposition in utero -environmental and genetic influences

Gait with hip flexion contraction

-decreased hip extension during late stance on the prosthetic side-> shorter step on the uninvolved side & longer step with the prosthetic limb

RC tearing test

-drop arm test, belly press test, lift off test

Congenital Torticollis signs and symptoms

-lateral cervical flexion to same side as contracture -rotation towards opposite side -facial asymmetries

Congenital limb deficiencies etiology

-majority are idiopathic or are genetic in origin -other possible etiologies: poor blood supply, constricting amniotic bands, infection, and maternal drug exposure

metacarpophalangeal (MCP- closed packed)

1 Metacarpophalangeal (MCP) = full extension 2 - 5 MCP = full flexion

Capsular pattern: Subtalar

Increasing limitation of varus. When fixed in valgus: Inversion, eversion

Myotomes: L2

Hip flexion, abduction, external rotation

Special Tests (structure being tested & procedure): ULTT2

Median, musculocutaneous Shoulder depression and 10 degrees abduction Elbow extension Forearm supination Wrist extension Finger/thumb extension Shoulder ER Contralateral neck side flexion

End-feel at later time than opposite side

Hypermobility

Rear Foot: Sub-Talar Inversion

5-15 or do 10 (1/3 of Foot Inv. Tarsal) Fulcrum- posterior ankle midway between malleoli, Proximal- posterior midline of the lower leg, Distal- posterior midline of the calcaneus

Rear Foot: Sub-Talar Eversion

5-9 (7.5 half of Foot Ever. Trans Tarsal) Fulcrum- posterior ankle midway between malleoli, Proximal- posterior midline of the lower leg, Distal- posterior midline of the calcaneus

Secondary Internal Rotators of Shoulder

55 degrees Anterior portion of Deltoid

What is the closed packed position of the proximal radioulnar joint?

5° supination

What percentage of the gait cycle is the stance phase?

60%

Thumb: Interphalangeal Flexion

65 (MP + CMC fl) Fulcrum- over the dorsal aspect of the IP joint, Proximal- over the dorsal proximal phalanx, Distal- dorsal midline of the distal phalanx

Shoulder Complex IR

70 (can do 90) Fulcrum- olecranon process, Proximal- ⊥ or ‖ to floor, Distal- Ulna using olecranon process and ulnar styloid

What is the loose packed position of the ulnohumeral joint?

70° elbow flexion, 10° supination

What is the loose packed position of the proximal radioulnar joint?

70° elbow flexion, 35° supination

What is the average toe out for an adult?

7°

Primary Wrist Flexors

80 degrees Flexor carpi radialis (median nerve, C7) Flexor carpi ulnaris (ulnar nerve, C8 (T1))

TMJ>Trismus (dental trismus)

=lock jaw -due to spasm or to abnormally short jaw muscles -limited active & passive mouth opening -normal lateral deviation & protrusion

Head of femur coxa valga angle

>125 degrees may also result from necrosis of femoral head occurring with septic arthritis

Head of femur anterversion angle

>25 degrees

The Adductor magnus, Adductor longus, Adductor brevis, Gracilis ________ the hip joint.

Adduct

The pectoralis major, latissimus dorsi, and teres major ________ the shoulder joint.

Adduct

Palmar Interossei action

Adduct fingers at MCP joint

Adductor Pollicis action

Adducts thumb (CMC joint)

What diagnosis of the shoulder results in a loss of ROM in active and passive shoulder motion caused by adhesive fibrosis and scarring between the capsule, rotator cuff, subacromial bursa and deltoid?

Adhesive capsulitis

What system supplies ATP during low intensity, long duration activities (ie. running a marathon)?

Aerobic system

abnormal synergistic activity

I.e., stroke: excessive hip adduction combined with hip and knee extension, plantarflexion, scissoring or adducted gait pattern

Special Tests (structure being tested & procedure): Ober's

ITB/TFL tightness Side-lying, lower hip and knee flexed Passively extend test hip with knee flexed to 90 degrees Slowly lower to table (should come to rest on table)

Special Tests (structure being tested & procedure): Thoracic springing

IV joint mobility in thoracic spine Prone PA glides/springs to thoracic TPs (Positive if pain, increased/decreased movement)

Myotomes: L3

Knee extension

Capsular pattern: Thoracic spine

Lateral flexion and rotation, extension, flexion

What is the capsular pattern of the GH joint?

Lateral rotation, ABD, and medial rotation

Firm end-feel

Ligament/capsular stretching

Closed packed position of the hip

Medial (internal) rotation with extension and abduction

Nucleus pulposus thickness

Lumbar> cervical> thoracic

Radiocarpal joint articulations

Lunate and scaphoid with radius Triquetrum with ulna

TUG

Assesses fall risk, start in a chair, walk 3 m, turn and sit back down. Norm = < 10 seconds Norm for frail elderly = 11-20 sec Scores over 30 seconds = high fall risk

Close/Loose-Packed position: Distal interphalangeal (hand)

Close: Maximal extension Loose: 30 degrees flexion

Close/Loose-Packed position: Vertebral

Close: Maximal extension Loose: Midway between flexion and extension

Close/Loose-Packed position: Acromioclavicular

Close: Shoulder abducted 90 degrees Lose: Arm resting at side

Secondary Elbow Flexors

135 degrees+ Brachioradialis Supinator

What is average BOS for an adult?

2 - 4 inches

What is the purpose of the acetabular labrum?

Enhances the depth of the acetabulum

Myotomes: L5

Great toe extension (also hip abduction, flexion and medial rotation - TFL)

Flexion at the hip

Primary: iliopsoas, rectus femoris, sartorius, pectineus; Secondary: tensor fascia lata, gracilis, adductors

Lateral rotation at the hip

Primary: obturator externus, piriformis, obturator internus, gemelli, quadratus femoris, gluteus maximus; Secondary: long head of biceps femoris, sartorius

Medial rotation at the knee

Primary: semitendinosus, semimembranosus, popliteus, sartorius, gracilis; Secondary: plantaris

The serratus anterior and pectoralis minor ________ the scapula.

Protract

The massester, lateral pterygoid, and medial ptergoid muscles all cause ________ of the TMJ of the head.

Protrusion

Special Tests (structure being tested & procedure): Piriformis test (from scorebuilder's)

Pt sidelying test leg up, hip flexed to 60 degrees PT places one hand on pelvis, other on knee While stabilizing pelvis, push (adduction force) down on knee +ve = pain/tightness - may indicate piriformis tightness or sciatic nerve compression by piriformis

What is ligament limits ulnar deviation and becomes taut when the wrist is in extremes of extension and flexion?

Radial collateral ligament

Wrist radial/ulnar devision articulating motions

Radial deviation: proximal row glides ulnarly. Proximal surface of scaphoid rotates palmarly. Ulnar deviation: proximal row glides radially as a unit

The extensor carpi radialis, flexor carpi radialis, and extensor pollicis longus and brevis ________ ________ the wrist joint.

Radially deviate

Capsular pattern: Atlantoaxial joint

Restricted rotation

The temporalis, masseter, and digastric muscles all cause ________ of the TMJ of the head.

Retrusion

Iliopsoas during gait

The iliopsoas is elongated during the heel off (terminal stance) and toe off (preswing) phases of the gait cycle as the hip moves toward maximum extension. Therefore, the physical therapist should assess the heel off (terminal stance) phase of walking to determine intervention effectiveness

Manual Grading of Accessory Joint Motion: 4

Slight hypermobility

Manual Grading of Accessory Joint Motion: 2

Slight hypomobility

MC hip disorder observed in adolescents

Slipped Capital Femoral Epiphysis

Soft end-feel

Soft tissue approximation

Special Tests (structure being tested & procedure): Roos elevated arm test

Thoracic outlet Standing, shoulders abducted 90 deg, full ER, slight horizontal abduction, 90 deg elbow flexion Patient opens and closes hands slowly for 3 minutes (Looking for neurological/vascular signs)

Dermatome testing of the medial forearm tests what innervation level?

T1

Resistive testing of finger adduction tests what innervation level?

T1

Phalen's Test

TESTING: Carpal tunnel syndrome POSITION: Back of hands together and point down, hold for one minute (+) TEST: If symptoms worsen

Reverse Lachman's

TESTING: PCL POSITION: prone knee flexed to 30 deg, stabilize femur try to posteriorly glide tibia (+) TEST: ligament laxity

Lachman's

TESTING: anterior cruciate ligament POSITION: put patient's knee in 20 deg flexion, grab tibia and pull up (should be nice hard end-feel) (+) TEST: if mushy, 2 deg or 3 deg ACL tear

Clarke's Sign

TESTING: chondromalacia POSITION: Supine, MUST be in slight flexion; push patella distally, and tell patient to gently contract (+) TEST: pain

Posterior Drawer Test (ankle)

TESTING: posterior talofibular ligament POSITION: Supine: ankle in plantar flexion. Grab talus as close to the ankle joint as possible on the top of the foot. Grab the tib/fib to stabilize and push down on the foot. (+) TEST: excessive movement

Meniscus repair

NON WB 3-6 weeks Rehab will begin 7-10 days post op PT goals -Soft tissue/massage to HS/quad to reduce muscle guarding -joint oscillations -correction of muscle imbalances -mechanical faults -progression to functional training

Manual Grading of Accessory Joint Motion: 3

Normal

Special Tests (structure being tested & procedure): Reverse Lachman

PCL Prone, knee flexed to 30 Stabilize femur, glide tibia posteriorly

Capsular pattern: Talocrural

Plantarflexion, dorsiflexion

Reflexes: C7/8

Triceps

Manual Grading of Accessory Joint Motion: 6

Unstable

Special Tests (structure being tested & procedure): Elbow ligament instability

Varus/valgus forces with elbow in 20-30 deg flexion

What are three bursa within the knee joint?

a. Prepatellar bursa b. Superficial infrapatellar bursa c. Deep infrapatellar bursa

What are the attachments of the medial collateral ligament?

a. Slightly above the medial femoral epicondyle b. Medial aspect of the shaft of the tibia

Abdominal aortic aneurysm referred pain

nonspecific lumbar pain

Define cadence.

number of steps an individual will alk over a period of time

Fluroscopy

observing the actions of joints, organs or entire systems of the body.

TMJ Functional ROM; opening, rotation and translatory glide

opening: 40 mm rotation: 25 mm translatory glide: 15 mm

extensor indicis

posterior interosseous

extensor pollicus longus

posterior interosseous

Brachioradialis, triceps brachii, supinator innervation

radial nerve

What is a class 2 lever?

resistance (load) is between the axis of rotation (fulcrum) and the effort (force); effort arm is always longer than the resistance arm wheelbarrow.

What side of the body are skinfold measurements taken on?

right side

Pectoralis Minor action

scapular depression, protraction, downward rotation and tilt

Where is the Achilles tendon most often impacted?

in an avascular zone located two to six cm above the insertion of the tendon

What is the common capsular pattern for the second to fifth metatarsophalangeal joint?

variable

Spondyloptosis

vertebral body is completely off of the adjacent vertebral body (Grade 5)

supraspinatus, infraspinatus

suprascapular nerve

Heart and lung disorders can refer pain to

the chest, back, neck, jaw, UE

knee (closed packed)

tibiofemoral joint full extension and external rotation

Reverse Phalen's Test

TESTING: Carpal tunnel syndrome POSITION: Prayer position with palms together and fingers pointed upward (+) TEST: If symptoms worsen

Scour Test

TESTING: DJD at hip POSITION: (supine) flex and adduct hip so hip faces opposite shoulder and resistance is felt; hip is taken into abduction while maintaining flexion in an arc of movement; apply force thru line of femur, not straight into table; (+) TEST: look for irregularity in the movement (bumps, pain, or patient apprehension)

Finkelstein Test

TESTING: De Quervain's syndrome, tenosynovitis of the extensor pollicis brevis and abductor pollicis longus POSITION: form a fist around the thumb and then ulnar deviation (+) TEST: pain radiating up the inside of his or her arm from the thumb

Noble's Compression Test

TESTING: IT band friction syndrome POSITION: supine, hip flexed 45 deg, knee flexed 90 deg, apply pressure to lateral femoral condyle, then extend knee (+) TEST: pain at 30 deg flexion

Neers

TESTING: Impingement POSITION: Flex shoulder and apply overpressure (+) TEST: Pain with overpressure

Kennedy Hawkins Test

TESTING: Impingement POSITION: Horizontal adduction and apply overpressure to IR (+) TEST: Pain with overpressure

Sulcus Test

TESTING: Inferior instability (indicative of global instability) POSITION: Grasp humerus, pull down, look at acromion for sulcus (+) TEST: Gap at sulcus and pain

Crank Test

TESTING: Inferior labrum tear POSITION: 160˚ flexion load through the elbow and move in a IR/ER motion (+) TEST: Clicking or popping with loaded movement

Kim Test

TESTING: Inferior labrum tear POSITION: SITTING distract shoulder and elevate passively move in IR/ER motion, compress and move in IR/ER motion (+) TEST: Clicking or popping with loaded movement and absent with distracted movement

Watson Scaphoid Shift

TESTING: Instability of scaphoid (and lunate) POSITION: Patient sits w/forearm pronated. PT takes the patient's wrist into full ulnar deviation & slight extension. PT presses the thumb of other hand against scaphoid to prevent it from moving. With 1st hand, PT radially deviates & slightly flexes the patient's hand. (+) TEST: Pain, "Clunk"

Leg Length Difference

TESTING: LLD POSITION: measure ASIS to medial malleolus or lateral malleolus (supine) OR (supine) hips and knees flexed; PT palpates medial malleoli; patient lifts pelvis from table and returns to starting position; PT passively extends legsand compares the positions of the malleoli using the borders of the thumbs (+) TEST: LLD

Jerk Test

TESTING: Labral Tear POSITION: Load arm and then move into horizontal adduction in multiple positions and move in ER/IR motion (+) TEST: Clicking or popping with loaded movement

Allen Test

TESTING: Latency of ulnar and radial arteries POSITION: Pump fist then hold fisted, compress radial and ulnar arteries, release one artery and assess reflow and coloration (+) TEST: Coolness, slow fill, ischemic pain, pulse changes

Cozen's Test

TESTING: Lateral epicondylitis POSITION: the therapist stabilizes the patient's elbow 90 deg flexion with one hand while the patient is asked to pronate the forearm and extend and radially deviate the wrist against manual resistance of the clinician (+) TEST: Produces pain

Speeds

TESTING: Long head of biceps POSITION: Shoulder flexed 90˚, elbows extended and supinated; push down and resists (+) TEST: Inability to hold original position

Murphy's Sign

TESTING: Lunate dislocation POSITION: Ask patient to make fist. (+) TEST: head of of 3rd metacarpal is level with 2nd & 4th MCP

Medial/Lateral instability (knee)

TESTING: MCL, LCL and capsule POSITION: Valgus stress in 30 deg flexion - MCL (push lateral side) Varus stress in 30 deg flexion - lateral capsule (push medial side) (+) TEST: excessive movement

Bunnel - Littler Test

TESTING: MCP tightness POSITION: MCP stabilized slight extension, while PIP flexed, then MCP flexed while PIP flexed (+) TEST: if flexion limited in both cases = capsule; if flexion limited more PIP flexion with MCP flexion = intrinsic tightness

Piriformis Test

TESTING: Piriformis syndrome POSITION: stretch position, hook lying with tested leg flexed over with ankle crossed over other knee (+) TEST: LE unable to rest on other LE or pain

Posterior Apprehension Test

TESTING: Posterior instability POSITION: Supine, flex shoulder and IR, push posterior on humerus, feel behind humerus (+) TEST: Apprehension (Not pain)

Q Angle Measurement

TESTING: Q angle POSITION: measure angle between quad and patella tendon (+) TEST: more than normal (normal = 13 deg men, 18 deg women)

Yergason's

TESTING: Stability of long head of biceps, integrity of transverse ligament, may identify biceps tendonitis POSITION: Elbow flexed to 90˚ and tucked into side; forearm pronated, pt tries to supinate and flex while therapist resists (+) TEST: Inability to hold original position

Adson's Test

TESTING: TOS, Pinched between anterior and middle scalene muscles POSITION: Palpate radial pulse, patient takes deep breath and holds, extend neck fully, turn chin towards side being examined, pull patients arm back (extension) while palpating pulse (+) TEST: Pulse becomes thready or not as strong

Costoclavicular Test

TESTING: TOS, Pinched between clavicle and 1st rid POSITION: Palpate radial pulse, retract pt shoulder, ask them to take a deep breath and hold, pull patients arm down and back while palpating pulse (+) TEST: Pulse becomes thready or not as strong

Linburg Test

TESTING: Tendinitis at interconnection between FPL & Flexor indicis POSITION: Patient flexes thumb to base of the 5th digit & extends index finger as far as possible. (+) TEST: Limited index finger extension and pain

Roos Test

TESTING: Thoracic outlet signs and symptoms POSITION: Open and close both hands for 3 min (+) TEST: If one hand is numb, tingling or cold

Egawa's Sign

TESTING: Ulnar nerve dysfunction POSITION: Patient puts hand on table in prone position and spreads fingers. Patient then attempts to move 3rd digit from side to side with finger slightly flexed. (+) TEST: Inability to "wag" middle finger

Wartenburg's Sign

TESTING: Ulnar nerve dysfunction POSITION: Patient holds arm outstretched @ about 90 degrees of shoulder flexion with hand in prone position and fingers adducted. (+) TEST: Drifting of 5th digit away from 4th digit

Froment's Sign

TESTING: Ulnar nerve dysfunction POSITION: Patient holds piece of paper between thumb and index finger while therapist provides resistance. (+) TEST: Flexion @ DIP of thumb when paper is pulled

Anterior Drawer Test (ankle)

TESTING: anterior talofibular ligament, deltoid ligament, and the anterior cartilage POSITION: Supine: Stabilize on tib/fib and pull up (anteriorly) at the heel; Prone: Stabilize on tib/fib and push down (anteriorly) at the heel (+) TEST: excessive movement

Pivot Shift Test (Hughston's Jerk Test)

TESTING: anterolateral instability POSITION: IR tibia, apply valgus stress at mid-fibula, start at flexion and go into extension, then go from extension to flexion (+) TEST: tibia "clunks" at 30-40 deg flexion

Talar Tilt

TESTING: calcanofibular instability POSITION: Patient in side lying, with knee slightly flexed and ankle in neutral. Move foot into adduction testing calcenofibular ligameent and into abduction testing deltoid ligament. (+) TEST: excessive movement

Ortolani's Sign

TESTING: congenital dislocation of hip of infant POSITION: (supine) flex infant's hips and grasp legs so thumbs are against the insides of the knees and thighs and the fingers are placed along the outsides of the thighs to the buttocks; thighs are abducted and pressure is applied against the greater trochanters; resistance will begin to be felt to abduction and lateral rotation at approximately 30- 40 deg (+) TEST: feel a "click" or "jerk" ***only valid for the first few weeks after birth

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

Posterior Internal Impingement

TESTING: impingement between rotator cuff and greater tubercle POSITION: supine, UE 90 deg abduction, max external rotation, 15-20 deg horizontal adduction (+) TEST: pain

FABER

TESTING: indicates non-specific hip pathology POSITION: put leg in flexion, abduction, and ER (Stabilize at contralateral hip and push down at knee) (+) TEST: pain in hip = hip problem; pain in SI = SI problem

Ballotable Patella

TESTING: infrapatella effusion POSITION: supine knee extended, soft tap over patella (+) TEST: perception of floating patella

Fluctuation (knee)

TESTING: knee effusion POSITION: supine knee extended, one hand superior to patella other inferior, alternate pushing (+) TEST: fluctations of fluid

Anterior Drawer Test (knee)

TESTING: knee stability capsular and ligamentous POSITION: sit on patient's foot, flex their knee, palpate hamstrings for relaxation, thumbs at tibial plateaus, overlap fingers and pull; feel if one side came out more than other; check other leg to see if normal (+) TEST: if lateral side comes out more: anterolateral instability (Capsule and/or LCL); if medial side comes out more: anteromedial instability (Capsule and/or MCL); ER-anteromedial rotary instability - posterior oblique ligament; IR - no laxity if PCL is intact (Pain/Normal feel=grade 1. Pain/Wong=grade II/III)

Clunk Test

TESTING: labrum tear POSITION: supine full abduction, push GH head anterior while externally rotated (+) TEST: clunk

Ligament instability (elbow)

TESTING: ligament instability POSITION: Apply pressure from the lateral side at the elbow (varus) Apply pressure to the medial side at the elbow (valgus) (+) TEST: excessive movement

Medial epicondylitis test

TESTING: medial epicondylitis POSITION: elbow 90 deg flexion supported, passive supination and elbow and wrist extension (+) TEST: pain

Pronator Teres Syndrome

TESTING: median nerve entrapment POSITION: elbow 90 deg flexion supported, resist pronation and extension (+) TEST: pain

Apley's Test

TESTING: meniscal tear POSITION: Prone. Knee at 90deg and compress down with foot and rotate internally and externally. Distract by pulling up on foot. ER=stretching medial capsule IR=stretching lateral capsule. (+) TEST: pain with compression and no pain with distraction. If both are painful, it can be either meniscus or capsule.

McMurray's Test

TESTING: meniscal tear POSITION: supine, knee maximally flexed, IR to extension = drive down medially. ER to extension = drive down laterally. Knee should be compressed at all times during this test. (+) TEST: crunch at the medial joint line.

Tinel's Sign

TESTING: nerve entrapment POSITION: tapping over a common entrapment area, cubital tunnel, carpal tunnel, over common fibular nerve (+) TEST: tingling

Neutral Subtalar Positioning

TESTING: neutral subtalar position POSITION: prone, foot off table, palpate dorsal talus, DF foot until resistance then supinate/pronate (+) TEST: neutral is where fall off compared to forefoot and leg

Patella Apprehension

TESTING: patella instability POSITION: supine, glide patella laterally (+) TEST: apprehension

Hughston's Plica Test

TESTING: plica POSITION: supine, knee flexed IR, glide patella medially, passively flex and extend knee (+) TEST: pain or popping

Posterior Sag Test (Godfrey's Test)

TESTING: posterior cruciate ligament POSITION: 90/90 and hold foot up, (+) TEST: posterior cruciate ligament problem if tibia sags

Posterior Drawer Test (knee)

TESTING: posterior cruciate ligament, posterior capsule POSITION: supine flex hip 45 deg and patient's knee 90 deg and push tibia back (make sure tibia is in proper alignment) (+) TEST: Tibia falls back and is not in alignment. The hamstrings have dominance and will pull back on the tibia

Tight Retinacular

TESTING: retinacular tightness POSITION: PIP neutral then DIP flexion; next PIP flexion with DIP flexion (+) TEST: if flexion limited in both cases = capsule, more with both flexed = intrinsic

Drop Arm

TESTING: rotator cuff tear POSITION: shoulder flexed to 90 deg and dropped (+) TEST: Pt's arm drops

Ober's Test

TESTING: tensor fascia latae tightness POSITION: (sidelying) flex knee then extend hip and let leg drop to table (+) TEST: if leg remains up in air while patient relaxes **Modified Ober's - knee extended. Some say more functional.**

Ely's Test

TESTING: tight rectus femoris POSITION: prone with knee flexed (+) TEST: if testing LE pelvis flexes

Trendelenburg

TESTING: weak glut medius POSITION: single leg stance, observe stance LE (+) TEST: if ipsilateral pelvis drops

Deltoid origin and insertion

The deltoid tuberosity is the insertion point for the three heads of the deltoid. The anterior deltoid originates on the lateral third of the clavicle, the middle originates on the acromion process sand the posterior deltoid originates on the spine of the scap. Innervated by the axillary nerve.

Wright's Test

aka Hyperabduction TESTING: TOS, Pinched between pectoralis minor and coracoid process POSITION: Palpate radial pulse, patient SUPINE and relaxed, abduct patients arm while palpating radial pulse (+) TEST: Pulse becomes thready or not as strong

Ligamentum Flavum involvement in lumbar spondylosis

becomes hypertrophied, and may invade the intervertebral foramen, compressing the left L5 spinal nerve root.

Thoracic Outlet Syndrome

compression of neurovascular bundle (brachial plexus subclavian artery/vein, vagus and phrenic nerves and sympathetic trunk) positive sign usually indicated by diminished or disappearance of a pulse or reproduction of S/S MSK-DDX

Spondylolisthesis

forward displacement of one vertebra on another. People involved in physical activities such as weight lifting or gymnastics or football are particularly susceptible to this. Severity graded on a scale from 1-5 based on how much a given vertebral body has slipped forward.

Sustentaculum tali

horizontal eminence arising from the medial surface of the calcaneus. The bony prominence serves as the attachment for several ligaments including the plantar calcenonavicular ligament, also known as the spring ligament.

Duchenne muscle dystrophy

inherited disorder, characterized by rapidly worsening muscle weakness that starts in the proximal muscles of the LE and pelvis, and later affects all voluntary movement. Assuming normal progression, proximal muscle weakness occurs first of the LE and pelvis, then progresses to muscles of the shoulders and neck, followed by loss of UE muscles and respiratory muscles.

Increased Q angle causes

lateral patella tracking strengthen VMO

Uncinate Processes / Joint's of Lushka

located at the inferolateral aspect of the lower C spine. Found at C3-7, limits lateral flexion Side bending is lost with the degenerative changes at the joint.

Calcenofibular ligament is often associated

normal end feel of DF

Subscap origin and insertion, innervation

originates on the subscapular fossa and inserts onto the lesser tubercle. Innerved by the subscapular nerve.

Supraspinatus origin and insertion, innervation

originates on the supraspinous fossa and inserts onto the greater tubercle and is innervated by the suprascapular nerve.

Froment's Sign

paper between thumb and index. Positive is indicated by flexion of the terminal phalanx of the thumb caused by paralysis of the adductor pollicus longus. Assess integrity of the ULNAR nerve. MSK-Examination

Computerized Tomography

uses cross-sectional images based on x-ray attenuation. Allows the imaging to have significantly better contrast resolution when compared to conventional x-ray. Typically used for complex fractures, as well as facet dysfunction, disc disease, or stenosis of the spinal canal or intervertebral foramen.

Anterior joint capsule of ankle experiences increased tension

with passive PF ROM which contributes to a firm end feel.

Degenerative joint disease (DJD; degenerative osteoarthritis (OA)) - Diagnostic tests

- plain film imaging demonstrates characteristic findings of OA (diminished joint space, decreased height of articular cartilage, presence of osteophytes) -lab tests help to rule out other disorders such as RA

PCL sprain

- runs from the posterior intercondylar area of the tibia to the lateral aspect of the medial femoral condyle in the intercondylar notch

Rheumatoid arthritis (RA) - pharmacological management

- varies with disease progression -may include gold compounds and antirheumatic drugs (DMARDs) (eg, hydroxychloroquine and methotrexate) early - Nonsteroidal anti-inflammatory drugs (eg, ibuprofen), immunosuppressive agents (eg, cyclosporine, azathioprine, and mycophenolate), or corticosteroids are commonly prescribed for long term management

type of connective tissue

-*Dense regular connective tissue*: ligaments and tendons -*Dense irregular connective tissue*: joint capsules, periosteum, aponeurosis -*Loose irregular connective tissue*: superficial sheath under skin, muscle, framwork of internal organ

Scoliosis types

-*Functional scoliosis*: no rib hump, poor posture, poor muscle balance( dominant side -> cause asymmetry ex> tennis) -*Structural scoliosis*:presence of a posterior rib hump during forward bending, fixed in rotated position -*Idiopathic scoliosis*: familial tendencies -*Neuromuscular scoliosis*: neuromuscular disease processes

Fracture type

-*Greenstick fracture*: common in young people, incomplete type -*Comminuted fracture*: the bone is broken into pieces -*Avulsion fracture*: the tibial tuberosity is pulled off the tibia. -*Segmental fracture* :fractured in two places.

Salter Harris type fracture

-*I*: entire epiphysis -*II*: entire epiphysis and portion of the metaphysis -*III*: portion of epiphysis -*IV*: portion of epiphysis portion of the metaphysis -*V*: nothing broken off, compression injury of epiphyseal plate

after ACL reconstruction

-*Passive extension* is the *most important *motion regardless of the graft type. and then active extension

Nerve mobilization

-*Radial nerve*: shoulder extension, elbow extension, and wrist flexion -*Median nerve*: shoulder abduction, elbow extension, wrist extension -*Ulnar nerve*: shoulder flexion, elbow flexion, wrist extension

Muscle contraction

-*Speed* of contraction ->resting length of the muscle fiber -*Force* of contraction ->cross-sectional diameter. -*Creatine phosphate content*-> availability of ATP for the contraction-relaxation cycles -*Glycolytic capacity* ->endurance

Resistive test

-*Strong and painful* : minor muscle or tendinous injury -*Strong and painfree* : normal finding -*Weak and painful*: partial rupture of a muscle or tendon or potentially a fracture -*Weak and painfree*:muscle or tendon rupture/neurologic pathology

Myositis ossificans

-*abnormal bone formation* typically in response to soft tissue trauma, fracture, blunt trauma or joint replacement surgery -joint swelling, pain , limited ROM -*palpable mass* and interfere with a normal muscle contraction.

Spondylolisthesis

-*anterior slippage of a vertebral segment* in relation to the segment below it -most common at L5-S1 -dull, aching pain in the lower back & buttocks -Grade1: 25%, Grade2: 50%, Grade3: 75%, Grade4: 100% -special test: stork standing test -*increased lordosis, hamstring tightness with slight flexion*

Congenital Torticollis

-AKA wry neck -characterized by a unilateral contracture of the SCM muscle -often identified in first two months of life

Total hip arthroplasty precautions - Anterolateral approach

-Access to the hip occurs through the interval between the tensor fasciae latae and the gluteus medius muscle -Some portion of the hip abductors are released from the greater trochanter and the hip is dislocated anteriorly -PRECAUTIONS: Avoid hip flexion beyond 90°, hip extension, lateral rotation and adduction

Sever's disease

-Achilles tendon pulling away from its insertion on the calcaneus -*Sever's apophysitis*: physeal stress injury, frequently occurs with tight Achilles tendons

Osteoporosis - diagnostic tests

-CT scan to assess bone density -single and dual photon absorptiometry also used but very expensive

Osteogenesis imperfecta

-autosomal disorder of collagen synthesis - DD, hypermobility of joint, poor developed muscle-> high risk of fracture(normal healing time) -muscle strengthening, prevent fractures, proper positioning should be required, but **immobilization cause contracture and hinder normal bone growth** -type of OI is classified based on clinical findings, results of diagnostic imaging, genetic testing.

Osteopetrosis

-autosomal dominant/recessive trait with infantile -increased bone mass/excess bone formation, but notable fragility resulting from significantly decreased osteoclast activity -pathologic fractures are common. VERY RARE

Juvenile Rheumatoid arthritis signs and symptoms

-based on classification of JRA -Systemic JRA: occurs in 10-20% of cases (presents with acute onset, high fevers, rash, enlargement of the spleen and liver, and inflammation of the lungs and heart) -Polyarticular JRA: occurs in 30-40% of cases (presents with high female incidence, significant rheumatoid factor, and arthritis in more than 4 joints with symmetrical joint involvement) -Oligoarticular (pauciarticular) JRA accounts for 40-60% of cases (affects less than 5 joints with asymmetrical joint involvement)

Ligamentum flavum

-become *hypertrophied with spondylosis* ->> invade intervertebral foramen->> compressing spinal nerve root

Osteochondroma

-benign bone tumor -typically presents in long bones -patient is asymptomatic and no intervention is warranted

Type of Spondylolisthesis -Isthmic spondylolisthesis

-by *repeated hyperextended positions*, increases the risk of a *stress fracture* and subsequent instability ex>athletes

Type of Spondylolisthesis -Traumatic spondylolisthesis

-by fracture or dislocation of the facet joints or a fracture of the pars interarticularis in the absence of a pre-existing defect ex>traumatic accident

Metatarsus adductus

-congenital, muscle imbalance, neuromuscular disease (polio) -*rigid form*: medial subluxation of tarsometatarsal joint, hindfoot slightly in valgus with navicular lateral to head of talus -*flexible form*: adduction of all five metatarsals at TMT joints -Tx: stregnthening, orthoses for proper alignment

Osteogenesis imperfecta

-connective tissue disorder that affects formation of collagen during bone development -there are four classifications of osteogenesis imperfect that vary in level of severity

Recovery of Brachial plexus injury

-continued recovery can occur for up to *2 years in the upper arm* and *4 years in the lower arm*

Drop arm test

-determine RC tear -but, *axillary n. palsy* also limit the patient's ability to control their arm as it suddenly drops to the side

Scoliosis etiology

-development is typically idiopathic -idiopathic scoliosis most commonly diagnosed between 10 and 13 years of age -Girls and boys have asimilar risk of developing a mild curve (eg, 10° or less), however, girls have a significantly greater risk of acquiring a curve greater than 30°

Impingement syndrome signs and symptoms

-discomfort or mild pain deep within the shoulder -pain with overhead activities -painful arc of motion (ie, 70 - 120° ABD) -(+) impingement sign -tenderness over greater tuberosity and the bicipital groove

Female athlete triad syndrome

-disordered eating, osteoporosis, amenorrhea

*Triangular fibrocartilage complex*

-dorsal/volar radioulnar ligament, ulnar collateral ligament, ulnar articular cartilage, ulnocarpal meniscus, sheath of the extensor carpi ulnaris. -significant tear of TFCC : immobilization of the wrist joint in neutral position for 4-6 weeks

Total knee arthroplasty etiology

-elective surgical procedure -medical conditions often associated with the need for TKA include osteoarthritis and osteomyelitis, DJD

Total hip arthroplasty etiology

-elective surgical procedure -medical conditions often associated with the need for total hip hip arthroplasty include ostearthritis, rheumatoid arthritis, osteomyelitis and avascular necrosis

Exercise with Osteoarthritis

-emphasizing non-weight bearing activities -strength training with light resistance and low repetitions -*weight bearing exercise should be avoided*

Absolute contraindication for mobilization

-empty end feel, osteoporosis, acute inflammation

Medial tibial stress syndrome

-excessive pronation/ overuse injury of *post. tibialis, med. soleus*=> periosteal inflammation -Tx: correction muscle imbalance, flexibility exercise

Forefoot compensation

-if hindfoot is pronated, the forefoot can compensate for uneven terrain. -If the hindfoot is supinated, the forefoot also is likely to supinate -> cause damage to the lateral ankle ligaments

Exercise with ACL reonstruction

-immediate postoperative phase: Active knee flexion, hip strengthening, quadriceps isometrics(squat) *Open-chain knee extension should be avoided because it causes significant stress on the ligament and joint.*

Meniscal injury

-immediate swelling with blood in the joint(ant.knee) -**locking** of the joint with restricted range cf)* ACL injury -quadriceps atrophy can be followed

Hill-Sachs fracture

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

Muscle training program

-improve muscle *endurance*: 3-5 sets, 15-50 repetitions -improve *muscle strength*: 2-3 sets, 6-12 repetitions

Ely's test

-in prone -PT flexes the patient's knee and attempts to identify spontaneous hip flexion -indicative of a rectus femoris contracture

Anterior compartment syndrome (ACS)

-increased compartmental pressure(swellilng)-> local -ischemic condition, deep & cramping pain (acute ACS-> *emergency***) -*often affect deep peroneal nerve* ACUTE ACS IS A MEDICAL EMERGENCY

Adhesive capsulitis treatment

-increasing ROM with GH mobs, ROM exercises, and palliative modalities -therapist and patient should avoid overstretching and elevating pain since this can result in further loss of motion -Surgical options: suprascapular nerve block and closed manipulation under anesthesia

Nursemaid's elbow

-inferior subluxation of the radial head from the annular ligament

Iliotibial band syndrome

-inflammation caused by rubbing of the iliotibial band over the lateral femoral epicondyle -from *repetitive flexion and extension of the knee, running* -lateral knee pain is commonly reported

Pes anserine bursitis, muscles involved

-inflammation of the bursa located on the anteromedial portion of the superior tibia -typically caused by overuse or a contusion.. -*sartorius, gracilis, semitendinosus* -report pain in the immediate area of the bursa

Plantar Fasciitis

-inflammation of the plantar fascia at the proximal insertion on the medial tubercle of the calcaneus -plantar fascia is a broad structure comprised of connective tissue which spans from the calcaneus to the metatarsal heads -The structure is designed to provide support to the arch of the foot -Excessive tension over time creates chronic inflammation and microtears at the proximal insertion of the plantar fascia

De Quervain's syndrome

-inflammation of the tendons in the first dorsal compartment, results from repetitive microtrauma or as a complication of swelling from pregnancy. -involved with *abductor pollicis longus ,extensor pollicis brevis* s/s: pain at anatomical snuffbox, swelling, decreased grip strength, positive finklestieins. -special test: *Finkelstein test* Treat: biomechanical faults

Congenital Torticollis treatment

-initial tx is conservative with focus on stretching, active rom, positioning, and caregiver education -Surgical management indicated when conservative options have failed and child is over one year of age -surgical release followed by PT may be indicated for range of motion and proper alignment

Plantar Fasciitis treatment

-initially RICE, NSAIDs, and analgesics as needed -A heel up, massage using a tennis ball or rolling pin, medial longitudinal arch taping, and joint mobilization may be helpful -Prevention includes heel cord stretching exercises, use of appropriate soft-soled footwear, and avoiding sudden changes in the intensity of training programs -Orthotics may be used to minimize hyperpronation

PCL sprain treatment

-initially RICE, NSAIDs, and analgesics as needed -PT includes LE strengthening exercises and functional progression -Surgical treatment can occur, however, the procedure is not as evolved as the procedure for the ACL -If surgery is performed, isolated hamstrings exercises are often avoided for a minimum of six weeks

Turf toe

-injuries sustained while participating in sports( soccer or football) -not associated with morning pain, fever, chills *should be DD with gout*

Infraspinatus muscle

-innervated by the suprascapular nerve that extends from the *superior trunk * of brachial plexus

Adhesive capsulitis signs and symptoms

-insidious onset of localized pain often extending down the arm -subjective reports of stiffness -night pain -restricted ROM in a capsular pattern

Rotator cuff tear etiology

-intrinsic factors associated with RC tears include impaired blood supply to the tendon, resulting in degeneration -extrinsic factors include trauma, repetitive microtrauma and postural abdnormalities

pronator syndrome

-involvement with the* flexor digitorum arcade, the lacertus fibrosis, pronator teres*, supraconcylar process -lacertus fibrosis(= bicipital aponeurosis) -tested by resisted supination*

Meniscus Tear Signs and Symptoms

-joint line pain, swelling, catching, or a locking sensation -Special tests: Apley's compression test, bounce home test, and McMurray test

Degenerative joint disease (DJD; degenerative osteoarthritis (OA)) - PT goals

-joint protection strategies -Maintain/improve joint mechanics and connective tissue functions -promote dynamic stability throughout trunk and pelvis and to provide optimal stimulus for regeneration of facet cartilage and/or capsule. -implementation of aerobic capacity/ endurance conditioning or reconditioning such as aquatic programs

Rheumatoid arthritis (RA) - PT goals, outcomes, and interventions

-joint protection strategies -maintain/improve joint mechanics and connective tissue functions -implementation of aerobic capacity/endurance conditioning or reconditioning such as aquatic programs

Best position to palpate LCL

-knee in 90 degrees of flexion and the hip in external rotation

Medial Collateral Ligament Sprain signs and symptoms

-knee pain, swelling, antalgic gait, decreased ROM, and feeling of instability -valgus stress test can be used to assess integrity of the MCL

Psoriatic arthritis - Diagnostic tests

-lab tests are not useful except to rule out rheumatoid arthritis

Gout - diagnostic tests

-lab tests identify monosodium urate crystals in synovial fluid and/or connective tissue samples

Scoliosis

-lateral curvature of the spine -condition is most often quantified using the Cobb method with a standing radiograph -often classified as functional, neuromuscular or degenerative -Functional scoliosis results from abnormalities in the body that indirectly impact the spine (eg, leg length discrepancy, muscle imbalance, poor posture); this type of scoliosis is often referred to as nonstructural scoliosis since the curves are flexible and can be corrected with lateral bending -Neuromuscular scoliosis results from developmental pathology resulting in alterations within the structure of the spine; This type of scoliosis is often observed in patients with cerebral palsy or Marfan syndrome -Degenerative scoliosis occurs due to the normal aging process and is facilitated by changes such as osteophyte formation, bone demineralization, and disk herniation -Neuromuscular and degenerative scoliosis are considered to be forms of structural scoliosis since the curves are inflexible and do not reduce with lateral bending

Best position to expose *biceps long head tendon*

-lateral rotation + extension

Lateral epicondylitis etiology

-onset is gradual, caused by activities that require a lot of wrist extension or strong grip with wrist extended -can be precipitated by poor mechanics or faulty equipment such as a tennis racquet with a handle that is too small or with strings that possess too much tension -condition most common between 30-50 years of age

Rheumatoid Arthritis signs and symptoms

-onset may be gradual or immediate, symmetrical involvement, pain and tenderness of affected joints, morning stiffness, warm joints, decrease in appetite, malaise, increased fatigue, swan neck deformity (ie, DIP flexion, PIP hyperextension), boutonniere deformity (ie DIP extension, PIP flexion), low grade fever

Adhesive capsulitis etiology

-onset may be related to a direct injury to the shoulder or may begin insidiously -Peak incidence: b/t 40 and 60 years of age, females > males -Patients with diabetes have increased incidence -condition is self-limiting and typically resolves in one to two years, although some have residual loss of motion

Extension progress

-order: prone with a pillow under the waist-> prone-> prone on elbow-> prone press-up-> standing extension -*Centralized pain: positive outcome* ->continue to provide feedback regarding symptom change -*Peripheralized pain(radiating symptome): negative outcome* ->should go back to previous stage

Lateral epicondylitis signs and symptoms

-pain is present immediately anterior or distal to the lateral epicondyle of the humerus -pain typically worsens with repetition and resisted wrist extension

Legg-Calve-Perthes Disease signs and symptoms

-pain, decreased ROM, antalgic gait, (+) Trendelenburg sign

Mill's test

-palpation of the lateral epicondyle during passive forearm pronation, wrist flexion and elbow extension -positive finding is indicated by pain in the lateral epicondylepositive finding : pain in the lateral epicondyle

Tripod sign

-patient is positioned in sitting with the knees flexed to 90 degrees over the edge of a table. PT passively extends one knee. -(+): tightness in the hamstrings or extension of the trunk .

PCL sprain signs and symptoms

-patient may report feeling as if the femur is sliding off the tibia -swelling and mild pain may be present, but often the patient is asymptomatic -Special tests to identify the presence of a PCL tear: posterior drawer test and posterior sag sign

ACL signs and symptoms

-patient may report loud pop or feeling the knee "give way" or "buckle" followed by dizziness, sweating and swelling -Special tests: anterior drawer test, Lachman test, lateral pivot shift test

Bone mass aging

-peak bone mass: late twenties -begin to decrease in late thirties

Rheumatoid arthritis (RA) - Diagnostic tests

-plain film imaging demonstrating symmetrical involvement within joints as well as laboratory testing -(+) test findings include an increased white blood cell count and erythrocyte sedimentation rate -Hemoglobin and hematocrit tests will show anemia and rheumatoid factor will be elevated

Osgood-Schlatter Disease signs and symptoms

-point tenderness over the patella tendon at the insertion on the tibial tubercle, antalgic gait, pain with increasing activity

Active restraint for the *lateral side* of the knee joint

-popliteus, biceps femoris, and iliotibial band

Alar ligament stress test

-positive if it is lax in two or more planes->flex/ext (due to the variation of direction of the fibers as they connect to the alar ligament) -(+): serious medical situation (dens fracture) > *should contact referring physician*

Osteosarcoma

-primary, malignant tumor of the bone in *adolescents* -localized pain near the end of a long bone with *palpable, tender mass* ex> distal femur, proximal tibia

Total hip arthroplasty signs and symptoms

-prior to surgery, there is severe pain with WB, loss of mobility, gross instability or limitation in ROM, failure of non-operative management or a previous surgical procedure

Ankylosing spondylitis

-progressive inflammatory disorder of unknown etiology that initially affects axial skeleton -initial onset (usually mid and low back pain for 3 months or greater) before fourth decade of life -First sx include mid and low back pain, morning stiffness, and sacroiliitis -results in kyphotic deformity of the cervical and thoracic spine and decrease in lumbar lordosis -degeneration of peripheral and costovertebral joints may be observed in advanced stages -Affects men 3x more often than women

Sciatic inflammation

-radicular symptoms(post.thigh) similar to piriformis syndrome -inflammation in the area of the sciatic notch -palpable discomfort in a similar location

Throwing arm>cocking phase

-range of humeral external rotation -*greatest stress* on ant. aspect of capsule and labrum

Schmorl's nodules

-regions of lucency usually seen at the vertebral end plate where the degenerating disk is penetrating into bone material

Rotationplasty

-type of autograft where in a portion of a limb is removed (after cancer), while the remaining limb below the involved portion is rotated and reattached -typically the *ankle joint becomes the functioning knee joint* ->can run and jump

O'Brien needle test

-typically performed by a physician -inserting a needle 10 centimeters proximal to the insertion of the achilles tendon -If the tendon is intact the needle will tilt with passive dorsiflexion of the foot.

Trochanteric bursitis

-typically result in palpable pain over the greater trochanter -radicular discomfort in the lateral thigh -from direct blow, irrigation of ITB, repetitive microtrauma -common in patient with RA

How to prevent tennis elbow

-use a *light* racket has a large grip -back hand stroke시에 external rotators should be used (*do not overuse the wrist and elbow extensors*)

ACL reconstruction - post op

-use of graft: *patellar tendon, tendon of semitendinous and gracilis* post op: immediately following surgery, a CPM may be used with PROM from 0-70 degrees. Motion is increased to 0-120 by 6th week. Reconstruction is usually protected with a hinged brace set at 20-70 degrees of flexion initially. Patient is non WB for approx 1 week

Waddell testing

-used to *identify* patients suffering from *pain of a nonorganic/ psycological origin* -5 tests: Tenderness tests, Simulation tests, Distraction tests, Regional disturbances, Overreaction

Nerve and tendon gliding exercises

-utilized in early rehabilitation of both conservative and surgically managed case -facilitate smooth gliding of the structures through the surrounding tissues for *nerve mobility and preventing the formation of scar adhesions*

Straight leg raise test

-utilized to increase dural tension on the sciatic nerve cf> 90-90 straight leg test: assess hamstrings tightness

Exercise with osteoporosis

-walking, weight bearing activities, and resistive exercises to tolerance -> stimulates osteoblast formation and improves overall bone mineral density -safe community-based sport: swimming -*flexion & rotation should be avoided preventing from fracture*

Throwing arm>acceleration phase

-where maximum valgus stress is placed on the elbow and ulnar collateral ligament

Elbow extension ROM

0

What is the ROM of hip extension required for normal gait?

0 - 10°

Shoulder ABD ROM

0 - 180

Shoulder flexion ROM

0 - 180

What is the ROM of ankle plantarflexion required for normal gait?

0 - 20°

What is the ROM of hip flexion required for normal gait?

0 - 30°

Shoulder extension ROM

0 - 60

What is the ROM of knee flexion required for normal gait?

0 - 60°

Digits-2nd to 5th interphalangeal hyperextension ROM

0-10

Digits-2nd to 5th proximal interphalangeal flexion ROM

0-100

What is the ROM of ankle dorsiflexion required for normal gait?

0-10°

Hip flexion ROM

0-120

Knee flexion ROM

0-135

Ankle eversion ROM

0-15

Thumb carpometacarpal Flexion ROM

0-15

Elbow flexion ROM

0-150

Dorsiflexion ROM

0-20

Thumb carpometacarpal extension ROM

0-20

Wrist radial deviation ROM

0-20

Ankle Dorsiflexion Goni

0-20 Fulcrum- lateral malleolus, Proximal- lateral midline of fibula to fibular head, Distal- parallel to lateral aspect 5th metatarsal

Hip ADD ROM

0-30

Hip extension ROM

0-30

Wrist ulnar deviation ROM

0-30

Ankle inversion ROM

0-35

Digits-2nd to 5th Metacarpophalangeal hyperextension ROM

0-45

Hip ABD ROM

0-45

Hip Lateral rotation ROM

0-45

Hip Medial rotation ROM

0-45

Subtalar eversion ROM

0-5

Subtalar inversion ROM

0-5

Secondary Elbow Extensors

0-5 degrees Anconeus

Primary Elbow Extensors

0-5 degrees Triceps (radial nerve, C7)

Thumb metacarpophalangeal flexion ROM

0-50

plantarflexion ROM

0-50

Thumb carpometacarpal ABD ROM

0-70

Wrist extension ROM

0-70

Forearm pronation ROM

0-80

Forearm supination ROM

0-80

Thumb interphalangeal flexion ROM

0-80

Wrist flexion ROM

0-80

Digits-2nd to 5th Metacarpophalangeal flexion ROM

0-90

Digits-2nd to 5th distal interphalangeal flexion ROM

0-90

Shoulder lateral rotation ROM

0-90

What is the ROM of knee extension required for normal gait?

0°

Foot Eversion (Tarsal) Goni

10 (1/3 of Foot Inv. Tarsal) Fulcrum- distal to point midway between malleoli, Proximal- tibial tuberosity/midline, Distal- midline 2nd metatarsal

Head of femur normal anteversion angle

10-15 degrees

Glenohumeral Joint Flexion

100 Fulcrum- lateral aspect of the greater tubercle, Proximal- parallel to midaxillary line of thorax , Distal- lateral midline of humerus to lateral epicondyle

Shoulder Complex ER

100 (can do 90) Fulcrum- olecranon process, Proximal- ⊥ or ‖ to floor, Distal- Ulna using olecranon process and ulnar styloid

Finger: Proximal Interphalangeal (PIP) Flexion goni

100 (peeps pass) Fulcrum- dorsal aspect of the MCP joint, Proximal- dorsal midline of the metacarpal, Distal- dorsal midline of the proximal phalanx

Hip flexion

100-120 Fulcrum- greater trochanter, proximal- lateral midline of pelvis, distal- lateral epicondyle

What is the loose packed position of the talocrural (ankle) joint?

10° plantar flexion, midway between maximum inversion and eversion

What is the loose packed position of the distal radioulnar joint?

10° supination

What is the average cadence value for an adult?

110 - 120 steps per minute

Normal head of femur angle of inclination

115-125 degrees

What is a healthy range of body fat for males?

12 - 18%

Glenohumeral Joint abduction

120 (GH Fl + FH ext) Fulcrum- anterior aspect of acromial process, Proximal- ‖ anterior sternum, distal- Lateral midline humerus (with rotation medial epicondyle may help)

Knee Flexion Goni

135 Supine Fulcrum- lateral epicondyle of femur, Proximal- greater trochanter, Distal- lateral midline of fibula (fibular head, malleolus)

Primary Elbow Flexors

135 degrees+ Brachialis (musculocutaneous nerve, C5,C6) Biceps, when the forearm is supinated (musculocutaneous nerve, C5,C6)

Knee Flexion Prone

140 Fulcrum- lateral epicondyle of femur, Proximal- greater trochanter, Distal- lateral midline of fibula (fibular head, malleolus)

Elbow Flexion

140 Fulcrum- lateral epicondyle of humerus, Proximal- lateral midline of humerus to center of acromion process, Distal- lateral midline of the radius to radial head /radial styloid.

Thumb: Saddle (carpo-metacarpal) Flexion

15 Fulcrum- palmar aspect of the first CMC joint, Proximal- ventral midline of the radius, radial head & styloid, Distal- ventral midline of the 1st metacarpal

Foot Eversion (Transverse Tarsal)

15 (1/2 of Foot Inv. Tarsal) Fulcrum- distal to point midway between malleoli, Proximal- tibial tuberosity/midline, Distal- midline 2nd metatarsal

Shoulder Complex Flexion

160-180 Fulcrum- lateral aspect of the greater tubercle, Proximal- parallel to midaxillary line of thorax, Distal- lateral midline of humerus to lateral epicondyle

What is a healthy range of body fat for females?

18 - 23%

Shoulder Complex Abduction

180 Fulcrum- anterior aspect of acromial process, Proximal- ‖ anterior sternum, distal- Lateral midline humerus (with rotation medial epicondyle may help)

Secondary ABductors of Shoulder

180 degrees Anterior and Posterior portions of Deltoid Serratus anterior (by direct action on the scapula)

Primary ABductors of Shoulder

180 detrees Middle portion of the deltoid (axillary nerve, C5,C6) Supraspinatus (suprascapular nerve, C5,C6)

Hip adduction goni

20 Fulcrum- ASIS, Proximal-horizontal line to other ASIS, Distal- midline of patella

Wrist Radial Deviation

20 Fulcrum- dorsal aspect of wrist over capitate (proximal end of 3rd metacarpal), Proximal- dorsal midline of forearm, if shoulder & elbow at 90 then lateral epicondyle of humerus, Distal- midline of 3rd metacarpal

Hip extension

20 Fulcrum- greater trochanter, proximal- lateral midline of pelvis, distal- lateral epicondyle

Glenohumeral Joint Extension

20 Fulcrum- lateral aspect greater tubercle, Proximal- midaxillary line of thorax, Distal- Lateral midline humerus to lateral epicondyle

Thumb: Saddle (carpo-metacarpal) Extension

20 Fulcrum- palmar aspect of the first CMC joint, Proximal- ventral midline of the radius, radial head & styloid, Distal- ventral midline of the 1st metacarpal---Alternative: Fulcrum- palmer aspect of the first CMC joint, Proximal- line between palmar surface of trapezium and pisiform, Distal- ventral midline of the first metacarpal

Angles of head of humerus

20-30 degrees retroversion Longitudinal axis of head is 135 degrees from axis of neck

Cervical Lateral Flexion

25 Fulcrum- Spinous process of C7, Proximal- spinous processes of the thoracic vertebrae ⊥ to the ground, Distal- dorsal midline of the head using occipital protuberance

What is the loose packed position of the knee joint?

25° flexion

What is the loose packed position of the tibiofemoral joint?

25° flexion

What is the average step length for an adult?

28 inches

Scapula position

2nd to 7th ribs

Wrist Ulnar Deviation

30 Fulcrum- dorsal aspect of wrist over capitate (proximal end of 3rd metacarpal), Proximal- dorsal midline of forearm, if shoulder & elbow at 90 then lateral epicondyle of humerus, Distal- midline of 3rd metacarpal

Foot Inversion (Tarsal)

30 Fulcrum- midway between malleoli, Proximal- tibial tuberosity/midline, Distal- midline 2nd metatarsal

What is the loose packed position of the hip joint?

30° flexion, 30° ABD, slight lateral rotation

Foot Inversion (Transverse Tarsal) Goni

35 Fulcrum- distal to point midway between malleoli, Proximal- tibial tuberosity/midline, Distal- midline 2nd metatarsal

Thoraco-Lumbar Lateral Flexion

35 Fulcrum- spinous process of S2, Proximal- ⊥ to the ground, Distal- spinous process of C7

Jaw

35mm-50mm for mouth opening use a ruler and measure distance between teeth for whatever jaw movement is being recorded.

Thoraco-Lumbar Flexion

4" or 10 cm C7 and S2 - measure with tape measure, flexion , measure again (no ASIS activation during flexion)

Hip abduction

40 Fulcrum- ASIS, Proximal-horizontal line to other ASIS, Distal- midline of patella

What percentage of the gait cycle is the swing phase?

40%

Primary External Rotators of Shoulder

40-45 degrees Infraspinatus (subscapular nerve, C5,C6) Teres minor (branch of axillary nerve, C5)

Secondary External Rotators of Shoulder

40-45 degrees Posterior portion of the Deltoid

Ankle Plantarflexion

40-50 Fulcrum- lateral malleolus, Proximal- lateral midline of fibula to fibular head, Distal- parallel to lateral aspect 5th metatarsal

Hip ER (sitting)

45 Fulcrum- anterior patella, proximal- ⊥ to floor, distal- crest of tibia to point midway between the malleoli

Thoraco-Lumbar Rotation

45 Fulcrum- center of the cranial aspect of head, Proximal- ‖ to an imaginary line between the two prominent tubercles on the iliac crests, Distal- imaginary line between the two acromial processes

Finger: Metacarpal Phalangeal Extension goni

45 Fulcrum- dorsal aspect of the MCP joint, Proximal- dorsal midline of the metacarpal, Distal- dorsal midline of the proximal phalanx

Primary Extensors of Shoulder

45 degrees Latissimus dorsi (thoracodorsal nerve, C6,C7,C8) Teres major (lower subscapular nerve, C5,C6) Posterior portion of Deltoid (axillary nerve, C5,C6)

Primary ADductors of Shoulder

45 degrees Pectoralis major (medial and lateral anterior thoracic nerve, C5,C6,C7,C8,T1) Latissimus dorsi (thoracodorsal nerve, C6,C7,C8)

Secondary ADductors of Shoulder

45 degrees Teres major Anterior portion of the Deltoid

Secondary Extensors of Shoulder

45 degreesT eres minor Triceps (long head)

Glenohumeral Joint IR Goni

49 (position leaves arm in shape of a 4) Fulcrum- olecranon process, Proximal- ⊥ or ‖ to floor, Distal- Ulna using olecranon process and ulnar styloid

distal radioulnar joint (closed packed)

5 degrees of supination

proximal radioulnar joint (closed packed)

5 degrees of supination and full extension

Cervical Rotation

50 Fulcrum- center of cranial aspect of head, Proximal- imaginary line between two acromial processes, Distal- tip of the nose

Cervical Extension

50 Fulcrum- external auditory meatus, Proximal- ⊥ or ‖ to the ground, Distal- base of the nares

Cervical Flexion

50 Fulcrum- external auditory meatus, Proximal- ⊥ or ‖ to the ground, Distal- base of the nares

Thumb: Metacarpal Phalangeal Flexion

50 Fulcrum- over the dorsal aspect of the MCP joint, Proximal- over the dorsal midline of the metacarpal, Distal- dorsal midline of the proximal phalanx

Shoulder Complex Extension

50 (Oh sh** Shoulder is 50) Fulcrum- lateral aspect greater tubercle, Proximal- midaxillary line of thorax, Distal- Lateral midline humerus to lateral epicondyle

Primary Internal Rotators of Shoulder

55 degrees Subscapular (upper and lower subscapular nerves, C5,C6) Pectoralis major (medial and lateral anterior thoracic nerves, C5,C6,C7,C8,T1) Latissimus dorsi (thoracodorsal nerve, C6,C7,C8) Teres major (lower subscapular nerve, C5,C6)

What is the loose packed position of the GH joint?

55° ABD, 30° horizontal ADD

What is the loose packed position of the glenohumeral joint?

55° ABD, 30° horizontal ADD

What is the average stride length for an adult?

56 inches

What is the closed pack position of the proximal radioulnar joint?

5° supination

What is the closed packed position of the distal radioulnar joint?

5° supination

Normal tibiofemoral shaft angle is

6 degrees of valgum Genu varum is an excessive medial tibial torsion, commonly referred to as "bowlegs." Results in excessive lateral patellar positioning. Genu valgum is an excessive lateral tibial torsion commonly referred to as "knock knees", Results in excessive lateral patellar positioning.

Forearm Supination

70 Fulcrum- medially and proximally to ulnar styloid process, Proximal- ‖ to anterior midline of humerus, Distal- across ventral aspect of forearm just proximal to styloid processes of radius and ulna where forearm is most level.

Finger: Distal Interphalangeal (DIP) Flexion

70 (dips fail) Fulcrum- dorsal aspect of the MCP joint, Proximal- dorsal midline of the metacarpal, Distal- dorsal midline of the proximal phalanx

Thumb: Saddle (carpo-metacarpal) Abduction

70 - but measurement done diff than book Fulcrum- lateral aspect of the radial styloid process, Proximal- later midline of the 2nd metacarpal, using the center of the 2nd MCP joint, Distal- lateral midline of the 1st metacarpal, using center of 1st MCP joint.

Primary Wrist Extensors

70 degrees Extensor carpi radialis longus (radial nerve, C6 (C7)) Extensor carpi radialis brevis (radial nerve, C6 (C7)) Extensor carpi ulnaris (radial nerve, C7)

What is the loose packed position of the ulnohumeral joint?

70° flexion, 10° supination

What is the loose packed position of the proximal radioulnar joint?

70° flexion, 35° supination

Wrist Extension

80 Fulcrum- Lateral aspect of the wrist over the triquetrum, Proximal- Lateral midline of the ulna using the using the olecranon and ulnar styloid process, Distal- lateral midline of the 5th metacarpal

Wrist Flexion Goni

80 Fulcrum- Lateral aspect of the wrist over the triquetrum, Proximal- Lateral midline of the ulna using the using the olecranon and ulnar styloid process, Distal- lateral midline of the 5th metacarpal

Forearm Pronation

80 Fulcrum- Laterally and proximally to ulnar styloid process, Proximal- ‖ to anterior midline of humerus, Distal- across dorsal aspect of forearm just proximal to styloid processes of radius and ulna

Finger: Metacarpal Phalangeal Flexion

90 Fulcrum- dorsal aspect of the MCP joint, Proximal- dorsal midline of the metacarpal, Distal- dorsal midline of the proximal phalanx

Primary Flexors of Shoulder

90 degrees Anterior Portion of the Deltoid (axillary nerve, C5) Coracobrachialis (musculocutaneous nerve, C5-C6)

Primary Supinators of Elbow

90 degrees Biceps (musculocutaneous nerve, C5,C6) Supinator (radial nerve, C6)

Secondary Supinators of Elbow

90 degrees Brachioradialis

Secondary Pronators of Elbow

90 degrees Flexor carpi radialis

Secondary Flexors of Shoulder

90 degrees Pectoralis Major (clavicular head) Biceps Anterior portion of the deltoid

Primary Pronators of Elbow

90 degrees Pronator teres (median nerve, C6) Pronator quadratus (anterior interosseous branch of median nerve, C8,T1)

Special Tests (structure being tested & procedure): Medial epicondylitis

90 degrees elbow flexion Passive supination, elbow and wrist extension

Special Tests (structure being tested & procedure): Lateral epicondylitis

90 degrees elbow flexion Resist wrist extension, pronation and radial deviation with hand in fist Cozen's test - as above with elbow in slight flexion and palpation of lateral epicondyle

humeroradial joint (closed packed)

90 degrees of flexion and 5 degrees of supination

What is the closed packed position of the radiohumeral joint?

90° flexion, 5° supination

Glenohumeral Joint ER

94 (reverse of GH IR) Fulcrum- olecranon process, Proximal- ⊥ or ‖ to floor, Distal- Ulna using olecranon process and ulnar styloid

Majority of glenohumeral dislocations/subluxations are in which direction? how do they occur?

95% anterior-inferior direction occurs mostly when abducted UE is forcefully, externally rotated, causing tearing of inferior glenohumeral ligmanet, anterior capsule and occasionally glenoid labrum.

Head of femur retroversion angle

<10 degrees

Head of femur coxa vara angle

<115 degrees coxa vara usually results fro ma defect in ossification of head of femur. may also result from necrosis of femoral head occurring with septic arthritis

Define a spiral fracture

A break in a bone shaped like an "S" due to torsion and twisting

Osteoarthritis signs and symptoms

-Cause of osteoarthritis is unknown -The condition typically appears during middle age and affects nearly all individuals to some extent by age 70 -Osteoarthritis occurs fairly equally in men and women up to age 55, however, it is more common in women later in life -Risk factors include being overweight, fractures or other joint injuries and occupational or athletic overuse

Talipes Equinovarus etiology

-Cause unknown -Theories postulate familial tendency, positioning in utero or a defect in the ovum -This condition accompanies other neuromuscular abnormalities including spina bifida and arthrogryposis and may result from the lack of movement in utero

Rheumatoid arthritis (RA)

-Chronic systemic disorder of unknown etiology that usually involves a symmetrical pattern of dysfunction in synovial tissues and articular cartilage of joints of hands, wrists, elbows, shoulders, knees, ankles, and feet -MCP and PIP joints are usually affected with characteristic pannus formation (inflammatory granulation tissue that covers joint surface), ulnar drift, and volar subluxation of MCP joints; ulnar drift observed at PIPs in severe forms. DIP joints are usually spared. Other deformities include swan neck and boutonniere deformities and Bouchard's nodes (excessive bone formation on dorsal aspect of of PIP joints) -Women have 2 - 3 xs greater incidence than men -Juvenile rheumatoid arthritis (JRA) onset prior to age 16 with complete remission in 75% of children

Cervical couple *motion*

-Co-C1: *side bending*+rotation into opposite direction -C2-C7: side bending + rotation into same direction

Glenohumeral instability etiology

-Combination of forces stress the anterior capsule, GH ligament, and RC, causing the humerus to move anteriorly out of the glenoid fossa -Anterior dislocation most common (usually associated with shoulder ABD and lateral rot

Rotator cuff tear treatment

-Conservative management includes RICE, NSAIDs, and analgesics as needed -Primary focus of therapy is to prevent adhesive capsulitis and strengthen upper extremity musculature -Surgical management to repair the tendon can be arthroscopic, mini-open with arthroscopic assist or a traditional open approach -Following surgery, patient will be immobilized in a sling -The amount of immobilization time will vary depending on surgeon preference, surgical procedure _A large tear may require four to six weeks of immobilization -PT begins with PROM and gradually moves to AAROM -Active motion and isometric exercises begin once approved by the surgeon -The patient will gradually become functional with activities of daily living and progress to more aggressive strengthening activities -Return to functional activities requiring dynamic overhead motion occurs in 9-12 months

Juvenile Rheumatoid arthritis etiology

-Exact etiology unknown -theorized that an external source such as a virus, infection or trauma may trigger an autoimmune response producing JRA in a child with a genetic predisposition

Test of infants with osteogenesis imperfecta

-Functional strength assessment(by watching infant's movement), Active range of motion assessment, Gross motor development assessment -*SHOULD NOT ASSESS passive range of motion assessment*

Limited dorsiflexion

-Gait:premature elevation of heel during midstance, slightly vault and *exhibit early toe off* -most difficult action: descending stair

Ankylosing spondylitis - diagnostic tests

-HLA-B27 antigen may be helpful, but not diagnostic by itself

Total hip arthroplasty precautions - Posterolateral approach

-PRECAUTIONS: avoid hip flexion beyond 90°, ADD, IR partial WB to tolerance is initiated on the second post surgery day; using crutches or a walker with typical surgical procedures.

Passive insufficiency vs Active insufficiency

-Passive insufficiency: two-joint muscle is passively stretched across two joints at the same time-> *inability to permit "normal elongation* simultaneously -Active insufficiency: two-joint muscle is *incapable of shortening *to the extent necessary to produce full ROM joints crossed simultaneously

Juvenile Rheumatoid arthritis treatment

-Pharmacological management to relieve inflammation and pain through NSAIDs, corticosteroids, antirheumatics and immunosuppressive agents -Physical therapy management: passive and active ROM, positioning, splinting, strengthening, endurance training, weight bearing activities, postural training, and functional mobility -Pain management: use of modalities such as paraffin, ultrasound, warm water, and cryotherapy -Surgical intervention may be indicated secondary to pain, contractures or irreversible joint destruction

Exercise with Ankylosing spondylitis

-Postural exercises emphasizing extension and postural retraining -Swimming: can avoid excessive loading of the spine -Aerobic exercise: promotes full expansion of the respiratory muscles and opens the airways of the lungs -*flexion exercise should be avoided*

Total knee arthroplasty signs and symptoms

-Prior to surgery there is severe pain with WB, loss of mobility, gross instability or limitation in ROM, marked deformity of the knee, failure of non-operative management or a previous surgical procedure

Gout - PT goals, outcomes, and interventions

-Pt education for injury prevention and reduction of involved joints -early identification of condition with fast implementation of intervention is very important

SI dysfunction test

-SI gapping, SI compression, thigh thrust, sacral thrust, Gaenslen's test

Glenohumeral instability signs and symptoms

-Subluxation: feeling the shoulder "popping" out and back into place, pain, pain, paresthesias, sensation of the arm feeling "dead", (+) apprehension test, capsular tenderness, swelling -Dislocation: severe pain, paresthesias, limited ROM, weakness, visible shoulder fullness, arm supported by contralateral limb

Total knee arthroplasty

-TKA refers to the removal of the proximal and distal joint surfaces of the knee and replacing them with an implant -The procedure is the most commonly performed surgery for advanced arthritis of the knee -TKA can be classified several different ways -First classification is based on the number of compartments replaced -Unicompartmental indicates that only the medial or lateral joint surface was replaced -Bicompartmental indicates that the entire surface of the femur and tibia were replaced, while a tricompartmental procedure includes replacement of the femur and tibia along with patella -The implant design can be classified by the degree of constraint -An unconstrained design offers no inherent stability and relies on soft tissue integrity for stability; This type of design is used primarily with unicompartmental arthroplasty -A semi constrained design offers some degree of stability without compromising mobility; This is the most common classification of TKA -A fully constrained design offers the most stability by restricting one or more planes of motion; this results in greater implant stress with a higher likelihood of implant problems (eg wear, failure, loosening) -The average lifespan for a TKA is 15-20 years and as a result, younger individuals may need one or more revision procedures in their lifetime -Minimally invasive surgical techniques are becoming more common with TKA; procedures requires only a 3-5 inch incision instead of 8-12 inches typically required with a traditional procedure; As a result, there is less soft tissue trauma and minimal damage to the quad muscle, which allows the muscle to initially produce a stronger contraction; this is extremely relevant since quad weakness is correlated with an increased risk of falling; preliminary data suggests positive outcomes including decreased hospital stays, improved ROM and improved strength -Fixation methods include cemented, uncemented (ie bone ingrowth), and hybrid -type of fixation is influenced by variety of factors including patient activity level, comorbidities, life expectancy, and tightness of fit of the femoral component achieved during surgery -cemented remains the most common method of fixation -potential complications of TKA include deep vein thrombosis, infection, pulmonary embolus, peroneal nerve palsy, restricted ROM, periprosthetic fx, and chronic joint effusion

Sringy block end-feel

-a *torn part of a meniscus* in the knee engaging between the bone ends, blocking extension

Baker's cyst

-a fluid filled cyst that develops in the *posterior* knee -often associated with *arthritis or a cartilage tear* -posterior knee discomfort -often exacerbated by extremes of flexion or extension

Achilles tendonitis signs and symptoms

-aching or burning in posterior heel -tenderness of the Achilles tendon -Pain with increased activity -swelling and thickening in the tendon area -muscle weakness due to pain -morning stiffness

Piano key sign

-acromioclavicualr joint

Legg-Calve-Perthes Disease treatment

-activities variable based on clinical presentation -primary focus: relieve pain, maintain the femoral head in the proper position, and improve ROM -PT may be required intermittently for stretching, splinting, crutch training, aquatic therapy, traction, and exercise -Orthotic devices and surgical intervention may be indicated depending on classification and severity of the condition -Goal of treatment is to keep the ball of the thigh bone inside the socket. -Possible use of abduction brace

Indication for dental splint

-aggresive bruxer, OA joint, bite changes, muscle incoordination -*contraindication*: ant. disc displacement

Alar ligament test (+)

-ample lateral flexion, no end feel -serious medical condition such as* fracture of dens* ->* immediately contact with referring physician***

Adhesive capsulitis

-an idiopathic onset of the condition -nocturnal pain is one of the initial sign -ROM often limited* by pain and/or muscle guarding -present *capsular pattern* Often associated with DM Clinical Phases: Freezing - Pain @ rest and @ night, 3-9 months Frozen - pain subsides, loss of motion in capsular pattern, 4-12 months Thawing - spontaneous, progressive improvement, 1 -1.5 years

Patellofemoral pain syndrome

-anterior knee pain with crepitus -positive *Clarke's sign* -abnormal bony contact between the laterally tracking patella and the femoral groove -*can be caused by weak VMO/tightness in ITB* -joint stiffness after sitting with the knee in a flexed position -postural alignment test : *static*-> Q-angle: ASIS-midpoint of patella, tibial tubercle *dynamic*-> Step-down test

Patellofemoral syndrome signs and symptoms

-anterior knee pain, pain with prolonged sitting, swelling, crepitus, pain when ascending and descending stairs

Rotator cuff tear signs and symptoms

-arm positioned in IR and ADD, point tenderness at the greater tubercle and acromion, marked limitation in shoulder flexion and ABD with upper trapezius recruitment evident, increased tone in anterior shoulder structures'

Forward head posture

-associated with a variety cervicogenic complaints including headache, neck pain, and temporomandibular joint (TMJ) dysfunction -passive tension in suprahyoid and infrahyoid muscle->affects resting posture of mandible ->> **posterior displacement of mandible**

Congenital hip dysplasia signs and symptoms

-asymmetrical hip ABD with tightness and apparent femoral shortening of the involved side -Testing: Ortolani's test, Barlow's test, and diagnostic ultrasound

Subtalar osteokinematics

Open Chain Inversion: Calcaneus adducts, supinates and plantarflexes on fixed talus. (opposite for eversion) Closed Chain Inversion: Talus glides laterally, abducts and dorsiflexes. Produces external rotation of tibia. (opposite for eversion).

Talonavicular osteokinematics

Open Chain Inversion: Navicular plantarflexes, adducts and externally rotates on the talus. (opposite for eversion). Closed Chain Inversion: Talus glides dorsally, abducts and internally rotates on navicular. (opposite for eversion)

Talocrural osteokinematics

Open Chain Plantarflexion: Talus glides anteriorly on mortise and medially rotates slightly. (opposite for DF) Closed Chain Plantarflexion: Tibia glides posteriorly on talus and laterally roates slightly. (opposite for DF)

ROM norms: TMJ

Opening: 35-50mm Protrusion/Retrusion: 3-6mm/3-4mm Lateral Deviation: 10-15mm

Opponens Digiti Minimi action

Opposes the fifth digit (CMC joint)

Oppons Pollicis Brevis action

Opposes the thumb (CMC joint)

When a convex suface is moving on a concave surface, the roll and slide occur in what direction?

Opposite direction

What is a chronic disease that causes degeneration of articular cartilage primarily in weight bearing joints?

Osteoarthritis

Bursae Locations: Superficial trochanteric

Over greater trochanter

Where is the subscapular bursa located?

Overlies the anterior joint capsule and lies beneath the subcapularis muscle

Which ligament may be injured when the femur is driven anteriorly on the tibia?

PCL

Which ligament may be injured when the superior portion of the tibia is struck while the knee is flexed (ie, MVA)?

PCL

Which ligament may be injured when tibia is driving posteriorly on the femur?

PCL

Which ligament may be injured with severe knee hyperflexion?

PCL

Special Tests (structure being tested & procedure): Posterior sag

PCL Supine, testing hip flexed to 45 degrees, knee flexed to 90 (look for tibia saggin posteriorly relative to femur)

Partial meniscectomy

PWAT when full knee extension is obtained PT goals -focus on edema control -AROM after post op day 1 -Isotonic and isokinetic strengthening by day 3 -Jogging on the ball of foot or ties is recommended to decrease the loading of hte knee joint

What is the capsular pattern of the AC joint?

Pain at extremes of ROM

Capsular pattern: Sacroiliac, symphysis pubis, sacrococcygeal

Pain when stressed

Capsular pattern: Tibiofibular

Pain when stressed

Anterior drawer test - ankle

Passive anterior translation of the talus is performed in 20 degrees of PF, look for excessive anterior translation of the talus, could be indicative of laxity or rupture of ATFL.

Test for interossei muscular tightness

Passively flex PIP with MP extension, then passively flex PIP with MP flexion.

Special Tests (structure being tested & procedure): Clarke's sign

Patellofemoral dysfunction Supine, knee extended, AP at patella superior pole Patient contracts quads (positive if painful)

Neuro/Musculo screen (muscles supplied by peripheral nerves): Medial pectoral

Pectoralis major and minor

Neuro/Musculo screen (muscles supplied by peripheral nerves): Lateral pectoral

Pertoralis major and minor

Digit rotation during flexion/extension

Phalanges and metacarpals rotate radially during flexion

Piriformis Syndrome

Piriformis is a hip ER, can become overworked with excessive foot pronation, causing abnormal femoral IR. Tightness or spasm of piriformis muscle can result in compression of sciatic nerve and/or SI dysfunction. S/S restriction in hip IR pain with palpation of piriformis referral of pain to posterior thigh weakness in ER, positive piriformis test uneven sacral base

The tibialis posterior, gastrocnemius, soleus, peroneus longus, peroneus brevis, plantaris, and flexor hallucis ________ ________ the ankle joint.

Plantarflex

Bursae Locations: Olecranon

Posterior aspect of elbow over olecranon process

Bursae Locations: Popliteal

Posterior knee (often connected to synovial cavity)

Neuro/Musculo screen (muscles supplied by peripheral nerves): Axillary

Deltoid, teres minor

What does the glenoid labrum consist of?

Dense fibrous connective tissue

The lateral pterygoid, suprahyoid, and infrahyoid muscles all ________ the TMJ of the head.

Depress

Trunk/Ribcage musculo/neuro testing (muscles, cord segment, nerves): Inspiration

Diaphragm (C3-C5) Phrenic nerve Levator costarum, external intercostals, anterior internal intercostals (T1-T12) Intercostal nerve

Special Tests (structure being tested & procedure): Apley

Differentiate between meniscal and ligamentous lesions Prone, test knee flexed to 90 degrees Stabilize thigh with knee Passively distract knee joint, slowly rotates tibia internally and externally (Pain or decreased motion during compression= meniscal) Pain or decreased motion during distraction = ligamentous)

Special Tests (structure being tested & procedure): Goldthwait's test

Differentiates between dysfunction in lumbar spine versus SIJ Pt supine with your fingers in between spinous processes of lumbar spine. WIht your other hand, passively perform a straight leg raise. (If pain presents prior to palpation of movement at LxSp, dysfunction is related to SIJ)

Nonnarcotic analgesics

Prescribed when NSAIDS are contraindicated Examples include acteaminophen (tylenol)

What is the purpose of the ACL?

Prevents anterior displacement of the tibia on the femur

What is the purpose of the ulnar collateral ligament?

Prevents excessive ABD of the elbow joint

What is the purpose of the MCL?

Prevents excessive valgus displacement of the tibia relative to the femur

What is the purpose of the LCL?

Prevents excessive varus displacement of the tibia relative to the femur.

What is the purpose of the PCL?

Prevents posterior displacement of the tibia on the femur.

Medial rotation at the hip

Primary: adductor longus and magnus, semitendinosus, semimembranosus; Secondary: tensor fascia lata, gluteus medius, gluteus minimus

Adduction at the hip

Primary: adductor magnus, adductor longus, adductor brevis, pectineus, gracilis

Lateral rotation at the knee

Primary: biceps femoris

Abduction at the hip

Primary: gluteus medius, gluteus minimus; Secondary: tensor fasciae latae; When the thigh is flexed: piriformis, gemelli, obturator internus

Extension at the hip

Primary: hamstrings (semitendinosus, semimembranosus, biceps femoris) and gluteus maximus; Secondary: adductor magnus

Flexion at the knee

Primary: hamstrings, gracilis, sartorius, gastrocneumius; Secondary: plantaris, popliteus

The pronator teres and the pronator quadratus ________ the radioulnar joint.

Pronate

Capsular pattern: Distal radioulnar

Pronation and supination

Special Tests (structure being tested & procedure): Bicycle (van Gelderen test)

Differentiates between intermittent claudication and spinal stenosis Rides stationary bike with trunk erect Time how long they can ride at set pace/speed After sufficient rest ride again in slumped position (If pain is related to stenosis patient should be able to ride longer while slumped)

Capsular pattern: Proximal radioulnar

Pronation and supination

Close/Loose-Packed position: Proximal/distal radioulnar

Proximal: Close: 5 degrees supination; maximal extension Loose: 70 degrees flexion; 35 degrees supination Distal: Close: 5 degrees supination Loose: 10 degrees supination

Proximal/Distal radioulnar joints

Proximal: radial head is ovoid and cone shaped, medial radius articulates with radial notch. Distal: convex ulna articulates with concave radius (opposite of proximal)

Special Tests (structure being tested & procedure): Tripod sign

Pt sitting with knees flexed to 90 degrees off edge of table PT passively extends one knee +ve = tightness in hamstring or trunk extension to limit efect of tight hamstring

Special Tests (structure being tested & procedure): Transverse ligament stress test

Tests integrity of the transverse ligament Supine C1 PA (should be firm end-feel) (Positive if end-feel is soft, dizziness, nystagmus, lump in throat, nausea etc.)

Special Tests (structure being tested & procedure): Tibial torsion test

Pt sitting with knees over table edge PT places thumb and index finger of one hand over medial and lateral malleoli PT measures acute angle formed by axes of knee and ankle Normal lateral rotation = 12-18 degrees in an adult

What reinforces the GH joint capsule?

The GH ligaments and the coracohumeral ligament

What is the weakest of the hip ligaments?

The Ischiofemoral ligament

What is the fibrocartilaginous rim attached to the margin of the acetabulum?

The acetabular labrum

What forms the midcarpal joint?

The articulations of the proximal and distal row of carpals

Internal disc disruption

internal structure of disc annulus is disrupted; however, external structures remain normal. MC in lumbar s/s: -constant deep, achy pain, and increased pain with movement. No objective neurological findings. Can be diangosed by CT discogram or an MRI. pt ed on proper body mechanics, positiong to avoid, limiting repetitive bending/twsting, limit UE overhead and sitting activities, and carrying heavy loads.

Disography

invasive imaging that involves injecting dye into the nucleus pulposus of an intervertebral disc using radiographic guidance. Used to ID disruptions of the nucleus pulposis or the annulus fibrosis.

Subtalar mobilization(convex rule)

inversion= lateral gliding eversion= medial gliding

Hoover Test

involves the therapist's evaluation of the amount of pressure the patient's heels place on the therapist's hands when the patient is asked to raise one LE while in supine

bone scan

is done by injecting a patient with a radiopharmaceutical substance and then scanning for areas of "increased uptake," which would indicate areas of increased osteoclastic and osteoblastic activity

Special Tests (structure being tested & procedure): Sitting flexion test

Pt sitting, knees flexed to 90, feet on floor PT palpates PSIS' wtih thumbs Monitor bony movements as pt bends forward to put hands on ground +ve = one PSIS moving further in cranial direction and may indicate articular restriction

Special Tests (structure being tested & procedure): Capillary refill test

Pt sitting/standing PT compresses nailbed and after releasing the pressure notes the amount of time taken for the color to return to the nail. +ve = delayed/muted response (greater than 2 seconds) May indicate arterial insufficiency

When is the peak activity of the tibialis anterior during the gait cycle?

just after heel strike (eccentric lowering of the foot into plantar flexion)

Special Tests (structure being tested & procedure): Grind test (hand)

Pt sitting/standing PT stabilize pt's hand, grasp thumb on metacarpal Apply compression and rotation through met. +ve = pain - indicates DJD at MCP joint

Special Tests (structure being tested & procedure): Standing flexion test

Pt standing with feet 12 inches apart PT places thumbs on PSIS' Monitors bony movements as pt flexes forwards with knees extended +ve = One PSIS moving further in a cranial direction and may indicate articular restriction

Special Tests (structure being tested & procedure): McMurray

Pt supine PT grasps distal leg, palpates knee joint line Medially rotate tibia and extend knee Laterally rotate tibia and extend knee +ve = click or pronounced crepitation felt over joint line May indicate posterior meniscal lesion

What may cause insufficient knee flexion with swing during gait?

knee effusion, quad extension spasticity, plantar flexor spasticity, insufficient flexion ROM

What may cause exaggerated knee flexion at terminal stance during gait?

knee flexion contracture, hip flexion contracture

Pectoralis major innervation

lateral & medial pectoral nerve

Name some common deviations with a prosthesis.

lateral bending, vaulting, forward trunk flexion, medial or lateral whip, abducted gait, circumducted gait, excessive knee flexion during stance, and rotation of the forefoot at heel strike

What is the common capsular pattern for the cervical spine?

lateral flexion and rotation equally limited, extension

What is the common capsular pattern for the lumbar spine?

lateral flexion and rotation equally limited, extension

What is the common capsular pattern for the thoracic spine?

lateral flexion and rotation equally limited, extension

What is the common capsular pattern for the glenohumeral joint?

lateral rotation, ABD, medial rotation

hip (closed packed)

ligamentous: = full extension, abduction and internal rotation bony: = 90 degrees of flexion, slight abduction and slight external rotation

What is the common capsular pattern for the TMJ?

limitation of mouth opening

What is the common capsular pattern for the talocalcaneal (subtalar) joint?

limitation of varus ROM

What may cause exaggerated hip flexion during swing of gait?

lower extremity synergy, compensation for insufficient hip flexion or dorsiflexion

Teres major innervation

lower subscapular nerve

Special Tests (structure being tested & procedure): Bounce home test

Pt supine PT grasps heel, maximally flexes knee Passively extend knee +ve = Incomplete extension or rubbery end-feel May indicate meniscal lesion

Special Tests (structure being tested & procedure): Slocum's test

Pt supine, knee flexed to 90 degrees, hip flexed to 45 PT rotates pt's foot 30 IR (to test anterolateral instability) PT rotates pt's foot 15 ER (to test anteromedial instability) PT stabilizes lower leg by sitting on forefoot Grasp prox tibia with two hands, thumbs on tibial plateau, PA to tibia on femur +ve = movement of tibia occurring primarily on lateral side = may indicate anterolateral instability

Special Tests (structure being tested & procedure): Patellar apprehension sign

Pt supine, knees extended Therapist places both thumbs on medial border of the patella and applies a laterally directed force +ve = apprehension or quads contraction May indicate patellar dislocation/subluxation

Lumbar/thoracic coupled motions neutral/extension

lumbar segments will side bend and rotate in opposite directions; e.g. side bend right results in segment rotating left

Lumbar/thoracic coupled motions flexion

lumbar segments will side bend and rotate in same direction

Flexion of the toes

lumbricals, interossei, flexor hallucis brevis, flexor digiti minimi brevis

Patella baja

malalignment in which patella tracks inferiorly in inercondylar notch results in restricted knee extension with abnormal cartilage wearing, resulting in DJD

Patella Alta

malalignment in which patella tracks superiorly in femoral intercondylar notch may result in chronic patellar subluxation positive camel back sign (2 bumps over anterior knee region instead of typical one). Two bumps, since patella rides high within femoral condyles, creating a superior bump with tibial tuberosity forming second bump inferiorly.

glenohumeral joint (closed packed)

maximal abduction and external rotation

What are characteristics of the closed packed position of a joint?

maximal stress on the joint, full joint congruency, and maximum ligament tightness

What is the closed packed position of the talocrural (ankle) joint?

maximum dorsiflexion

What is the closed packed position of the SC joint?

maximum shoulder elevation

Esophageal cancer

may include pain radiating to the back, pain with swallowing, dysphagia and weight loss

Acute pancreaitis

may manifest itself as mid-epigastric pain raditing through to the back

the most common area for osteochondritis dissecans

medial femoral condyle

What is the common capsular pattern for the tibiofibular joint?

pain when joint stressed

What is the common capsular pattern for the sacroiliac, symphysis pubis, and sacrococcygeal joint?

pain when joints are stressed

antalgic gait

painful gait: stance time is abbreviated on the painful limb that results in uneven gait pattern, the uninvolved limb has a shortened step length since it mus bear weight sooner than normal

Q-angle 30 with patellofemoral tracking problem

patella stabilizing brace with lateral buttress

What is the primary etiology of lower extremity amputations?

peripheral vascular disease

What may cause toe down instead of heel strike during gait?

plantar flexor spasticity, plantar flexor contracture, weak dorsiflexors, dorsiflexor paralysis, leg length discrepancy, hindfoot pain

What is the common capsular pattern for the talocrural joint?

plantarflexion, dorsiflexion

abductor pollicis longus innervation

posterior interosseous (PIN)

extensor pollicus brevis innervation

posterior interroseous

NSAIDS

prescribed medication for pain relief for MSK dysfunction Ex: ibuprofen (motrin), naproxen sodium (aleve), salsalate (discalced) adverse effects: GI irritation, fluid retention, prolonged bleeding

Maitland manual therapy

proposes that the subjective evaluation should be integrated with objective measurements to determine the dysfunctional area

Extension at the knee

quadriceps femoris, articularis genu

anconeus

radial

brachioradialis

radial

extensor carpi radialis brevis innervation

radial

extensor carpi radialis longus

radial

Finger: Metacarpal Phalangeal Abduction

range: no studies report it Fulcrum- dorsal aspect of the MCP joint, Proximal- dorsal midline of the metacarpal, Distal- dorsal midline of the proximal phalanx

Degenerative joint disease (DJD; degenerative osteoarthritis (OA)) - S/S

reduction in mobility of spine, pain, and possible impingement of associated nerve root, resulting in loss of strength and pareshtesia.

Burn's Test

requires the patient to kneels and bend over a chair to touch the floor

Meniscal injuries

results from a combo of forces to include tibiofemoral joint flexion, compression, and rotation, which places abnormal shear stresses on the meniscus. s/s -medial joint pain, effusion, joint popping, knee giving away during walking, limitation in flexibility of knee joint, and joint locking. MRI tests: mcmurray's apley

Boutonniere deformity

results of rupture of central tendinous slip of extensor hood extension of MCP and DIP with flexion of PIP Commonly occurs following trauma, or in RA with degeneration of the central extensor tendon.

The trapezius and rhomboids ________ the scapula.

retract

The psoas major, quadratus lumborum, external oblique, internal oblique, multifidus, longissimus thoracis, iliocostalis thoracis, and rotatores all cause ________ and ________ ________ of the thoracic and lumbar intervertebral joints.

rotation and lateral bending

Mallet Finger

rupture or avulsion of extensor tendon at its insertion into distal phalanx flexion of DIP joint usually occurs from trauma, forcing distal phalanx into flexed position

Lower Trapezius action

scapular depression, upward rotation

Levator Scapulae action

scapular elevation, downward rotation

Serratus Anterior action

scapular protraction, upward rotation

Middle Trapezius action

scapular retraction

Rhomboid action action

scapular retraction, elevation and downward rotation

What is the purpose of muscle spindles?

send information to the nervous system about muscle length and/or the rate of change of its length

Middle deltoid action

shoulder abduction

supraspinatus action

shoulder abduction

Posterior deltoid actions action

shoulder abduction, horizontal abduction, extension, hyperextension and lateral rotation

Anterior deltoid action

shoulder abduction, horizontal adduction, flexion and medial rotation

Pectoralis Major (clavicular and sternal) action

shoulder adduction, medial rotation and horizontal adduction

Teres Major action

shoulder extension, adduction and medial rotation

Lattisumus Dorsi actions action

shoulder extension, hyperextension, adduction, medial rotation

Pectoralis Major (sternal) action

shoulder extension- first 60 degrees

Pectoralis Major (clavicular) action

shoulder flexion- first 60 degrees

Following surgery of shoulder labrum

shoulder is kept in sling for 3-4 weeks. After 6 weeks, more sports specific training can be done although full fitness may take 3-4 months

Infraspinatus action

shoulder lateral rotation, horizontal abduction

Teres Minor action

shoulder lateral rotation, horizontal abduction

Subscapularis action

shoulder medial rotation

What is the loose packed position of the interphalangeal joint?

slight flexion

What is the loose packed position of the metacarpophalangeal joint?

slight flexion

What are the components of an upper extremity prosthesis?

socket, suspension, elbow unit, wrist unit, and terminal device

What are the components of a lower extremity prosthesis?

socket, suspension, knee, shank, and foot

Trapezius

spinal accessory

Gamekeeper's Thumb

sprain/rupture of UCL of MCP joint of first digit resulting in medial instability of thumb frequently occurs during a fall while skiing, when increasing forces are placed on thumb through ski pole. Immobilized for 6 weeks.

Coracobrachialis action

stabilizes the shoulder joint

Best type of exercise when RA is in remission

strengthening

Femoral head orientation

superiorly, anteriorly, medially

The bicheps brachii and the supinator ________ the radioulnar joint.

supinate

What is the closed packed position of the midtarsal joint?

supination

What is the closed packed position of the subtalar joint?

supination

What is the closed packed position of the tarsometatarsal joint?

supination

What is the capsular pattern of the proximal radioulnar joint?

supination, pronation

What is the common capsular pattern for the proximal radioulnar?

supination, pronation

Rotator cuff tendonitis

susceptible to tendonitis d/t relatively poor blood supply near insertion. Results from mechanical impingement of the distal attachment of the RC on the anterior acromion and/or coracoacromial ligament with repetitive OH activities. MRI may be used tests: supraspinatus test, neer's impingement test

What is an isokinetic contraction?

tension developed by the muscle, while shortening or lengthening at a constant speed, is maximal over the full range of motion

What is an isometric contraction?

tension develops, but there is no change in the length of the muscle

What is a class 3 lever?

the effort (force) is between the axis of rotation (fulcrum) and the resistance (load). Permit large movements at rapid speeds and are the MC type of lever in the body. ex: shoulder abduction w/ weight at the wrist, elbow flexion

foot slap

the foot makes floor contact with an AUDIBLE slap. the result of weak dorsiflexors or hypotonia, compensated for with steppage gait

What arises from the glenoid fossa and the glenoid labrum to blend with the muscles of the rotator cuff?

the joint capsule

What is an eccentric contraction?

the muscle lengthens while developing tension

What is an isotonic contraction?

the muscle shortens or lengthens while resisting a constant load

toes claw

the result of spastic toe flexors, possibly a hyperactive plantar grasp reflex

inadequate push off

the result of weak plantarflexors, decreased ROM or pain in forefoot

What is an example of a class 1 lever?

the tricpes brachii force on the olecranon with an external counterforce pushing on the forearm (another example is a seesaw)

Latissimus dorsi nerve

thoracodorsal nerve

Increased foot supination causes

tibial ER genu varus

Increased foot pronation causes

tibial IR genu valgus

Inversion of the foot

tibialis posterior, tibialis anterior, and extensor hallucis longus

limited hip extension

tight or spastic hip flexors

Thumb carpometacarpal opposition ROM

tip of thumb to base of fifth digit

What may cause clawing of toes during gait?

toe flexor spasticity, positive support reflex

toes first

toes contact at heel strike. the result of weak dorsiflexors, spastic or tight plantarflexor may also be caused by a shortened leg (leg length discrepancy) painful heel or positive support reflex

Kidney, bladder, ovary and uterus refer pain to the

trunk, pelvis and thighs

What is active muscle insufficiency?

two-joint muscle contracts across both joints simultaneously

What is passive muscle insufficiency?

two-joint muscle is lengthened over both joints simultaneously

What is end-feel?

type of resistance felt when passively moving a joint through the end range of motion

Lateral Retinacular Release

typically for PFPS. Purpose is to restore normal patella tracking and regain dynamic balance of all structures surrounding the knee. PT: -Intervention should emphasize CKC exercises to strengthen quad muscle and regain dynamic balance of all structures surrounding the knee. -Normalize flexibility of HS, triceps surae, and ITB -Mobilization of patella is important to maintain nutrition and decrease the likelihood of ahesions.

flexor carpi ulnaris nerve

ulnar nerve

Subscapularis innervation

upper and lower subscapular nerve

The trapezius and serratus anterior ________ ________ the scapula.

upwardly rotate

What is bioelectrical impedance analysis?

uses a small electrical current and measures the resistance or opposition to the current flow; based on principle that resistance to electrical current is inversely related to the composition of water within the body

Medial epicondylitis

usually a degenerative condition of the pronator teres and flexor carpi radialis tendons at the medial epicondyle occurs w/ overuse in sports, such as baseball pitching, driving golf swings, swimming or occupations that require a strong hand grip and excessive pronation of the forearm.

backward trunk lean

weak gluteus maximus, will also see difficulty going up stairs or ramps

lateral trunk bending

weak gluteus medius, will see bending to the SAME side as the weakness (trendelenburg gait) ,also seen with pain in the hip

excessive hip flexion

weak hip extensors or tight hip and/or knee flexors

limited hip flexion

weak hip flexors or tight extensors

What may cause insufficient hip flexion at initial contact during gait?

weak hip flexors, hip flexor paralysis, hip extensor spasticity, insufficient hip flexion ROM

forward trunk lean

weak quadriceps (decreases flexor movement at the knee), hip and knee flexion contracture

excessive knee flexion

weak quadriceps (knee wobbles or buckles) or knee flexor contracture - will also see difficulty going down stairs or ramps - forward trunk bending can compensate for weak quadriceps

hyperextension of the knee

weak quadriceps, plantar flexion contracture, or extensor spasticity (quadriceps and/or plantar flexion)

What may cause exaggerated knee flexion at contact during gait?

weak quads, quad paralysis, hamstring spasticity, insufficient extension ROM

Children with difficulty catching, reaching, or throwing

with limited anticipatory postural control (poor feedforward control)

Extensor Carpi Radialis Longus Actions action

wrist extension, radial deviation

Flexor Carpi Radialis action

wrist flexion, radial deviation

Flexor Carpi Ulnaris actions action

wrist flexion, ulnar deviation

Open Reduction Internal Fixation (ORIF) following femoral fracture - guidelines and treatment

Pt will typically be non-WB for 1-2 weeks, using crutches or a walker. Thereafter, the patient will be parital WB as tolerated. PT goals, outcomes and interventions. PT focuses onbed mobility , transitional movements, ambulation, and return to premorbid activities of ADLs.

Trunk/Ribcage musculo/neuro testing (muscles, cord segment, nerves): Spine lateral flexion

Quadratus lumborum (T12-L3) Lumbar plexus

During evaluation of a patient's gait, a physical therapist observes that the patient leans forward shortly after heel strike (initial contact). The patient's forward bending is MOST likely a compensation for weakness in the

Quads

Lab findings of decreased red blood cell count and increased erythrocyte sedimentation rate are MOST indicative of?

RA

Total Knee Replacement ROM guidelines

ROM: 0-90 degrees within 2 weeks, 0-120 degrees within 3-4 weeks.

Special Tests (structure being tested & procedure): ULTT3

Radial Shoulder depression and 10 degrees abduction Elbow extension Forearm pronation Wrist flexion and ulnar deviation Finger/thumb flexion Shoulder IR Contralateral neck side flexion

Sclerodoma is indicated by?

Raynaud phenomenon

Total Knee Arthroplasty WB status

Weight bearing status of patients with a cemented prosthesis is at the level of the patient's tolerance. Patient's with cementless prosthesis are progressed according to the time frame for fracture healing. Weight bearing is 25% at 1-7 weeks, 50% by week 8, 75% by week 10 and 100% without an AD by week 12.

Primary Scapular Protractors (Reaching)

Serratus anterior (long thoracic nerve, C5,C6,C7)

Which of the following conditions is an absolute CONTRAINDICATION to a patient's participation in aquatic physical therapy?

Severe kidney disease

Myotomes: C5

Shoulder abduction

Myotomes: C4

Shoulder elevation

The medial pterygoid, lateral pterygoid, masseter, and temporalis muscles all move the TMJ joint of the head ________ ________ ________ .

Side to side

Special Tests (structure being tested & procedure): Allen test (thoracic outlet)

Sitting/standing Test arm in 90 degrees abduction, ER, elbow flexion Pt rotates head away from test shoulder while PT monitors radial pulse +ve = diminshed/absent pulse

Firm end-feel with decreased elasticity

Soft tissue fibrosis

Special Tests (structure being tested & procedure): Valsalva maneuver

Space occupying lesion Sitting Patient takes deep breath and holds it while "baring down" (as though having a bowel movement) (Positive if LBP increases or near symptoms into LLs)

Subacromial/subdeltoid bursitis

Subacrimal and subdeltoid buristis have a close relationship with RTC making them susceptible to overuse. mc cause: repetitive, minor impact or from sudden injury. overuse/overwork mc symptom of bursitis is pain treatment: activity modification, ice, rest, NSAIDS

Neuro/Musculo screen (muscles supplied by peripheral nerves): Upper subscapular

Subscapularis

Neuro/Musculo screen (muscles supplied by peripheral nerves): Lower subscapular

Subscapularis, teres major

Glenoid labrum attachments

Superior and inferior capsule, long head of biceps attachment

Which direction does the patella move in knee extension?

Superiorly

A patient has recurrent lateral patellar subluxations. While testing the patient's patellar mobility, the physical therapist notes that the apex of the patella rotates medially during a passive medial patellar glide. Which of the following structures around the patella are tight?

Superolateral Medial glide would stress lateral structures. The apex (inferior pole) of the patella is moving, however the base of the patella (superior) is not, causing patellar rotation. Therefore, superolateral structures are tight, holding back this portion of the patella.

Capsular pattern: Midtarsal

Supination, pronation (with limited DF, PF, Add and IR)

ROM norms: Ankle

Supination: 35 Pronation: 15 PF: 50 DF: 20

Special Tests (structure being tested & procedure): Posterior apprehension sign

Supine, shoulder abducted 90 deg in scapular plane AP through elbow with IR and horizontal add

Special Tests (structure being tested & procedure): Piriformis test

Supine, test foot placed on opposite knee Testing hip adducted (positive if testing knee unable to pass over resting knee or if symptoms reproduced)

Special Tests (structure being tested & procedure): Hughston's plica test

Supine, test knee flexed, tibia internally rotated Glide patella medially while palpating medial femoral condyle Passively flex and extend knee (look for pain and/or popping)

Neuro/Musculo screen (muscles supplied by peripheral nerves): Suprascapular

Supraspinatus, infraspinatus

T/F: Motion of the wrist results in complex motion between the proximal and distal row of carpals with the exception of the pisiform.

T

T/F: Patella rotation and tilting occur during knee extension and flexion.

T

T/F: The Anaerobic glycolysis system is able to function without the presence of oxygen and only using carbohydrates (glycogen and glucose).

T

T/F: The anaerobic glycolysis system releases enough energy for the resynthesis of only small amounts of ATP.

T

T/F: The volume of the joint capsule is twice as large as the size of the humeral head.

T

Thoracic Spine "Rule of 3"

T1-T3 spinous processes even with transverse processes T4-T6 spinous processes found 1/2 level below transverse processes T7-T9 spinous processes at level of transverse process of vertebra below T10 at level of vertebra below T11 1/2 level below T12 level with it's own transverse processes

Neuro/Musculo screen (root origins of peripheral nerves): Iliohypogastric

T12-L1

Neuro/Musculo screen (root origins of peripheral nerves): Ilioinguinal

T12-L1

Thompson Test

TESTING: Achilles integrity POSITION: prone, squeeze the calf to see if the foot moves into plantarflexion (+) TEST: Foot doesn't move (Achilles tendon is ruptured)

Neuroma Squeeze Test

TESTING: Neuroma POSITION: Squeeze around the dorsum and sides of the foot with one hand while pushing down on the metatarsals with the other. (+) TEST: Pain at 3rd= neuroma

Gillet's Test

TESTING: SI POSITION: standing, place thumb under PSIS, pt flexes hip and knee, assess PSIS movement on one side compared to other (+) TEST: no identified movement of PSIS as compared to sacrum

Gaenslen's Test

TESTING: SI dysfunction POSITION: sidelying holding bottom leg in max flexion (hip and knee), passively extend top leg (+) TEST: pain in SI

Lift-off test

TESTING: Subscapularis tear POSITION: Patients hand behind their back and ask them to pull it away from their back (+) TEST: Inability to perform the movement

Empty Can

TESTING: Supraspinatus POSITION: Patient moves into empty can position and resists while therapist tries to push arm down on side Inability to hold arm in original position (+) TEST: pain and weakness = supraspinatus tendinitis

Ankle Figure 8

TESTING: ankle effusion POSITION: mark and wrap tape measure around: 1. tibialis anterior tendon 2. base of 5th metatarsal 3. navicular 4. lateral malleolus 5. medial malleolus (+) TEST: gross difference from previous measurement or other LE

Ipsilateral anterior rotation test

TESTING: anterior movement of ilium POSITION: place thumb under PSIS on test LE, other thumb over sacrum, pt extend hip, assess movement of PSIS (+) TEST: no identified movement of PSIS compared to sacrum

Goldthwait's Test

TESTING: differentiates between SI and lumbar spine POSITION: supine with your fingers between lumbar spinous process, passively perform straight leg raise (+) TEST: pain presents prior to palpation of movement in lumbar segments = SI

Spurling's Test

TESTING: dysfuction of cervical nerve root POSITION: sitting, head side bent to uninvovled side, apply pressure through head straight down, repeat with head bent toward involved (+) TEST: pain and/or paresthesia in dermatomal pattern

AC Shear Test

TESTING: dysfunction of AC joint POSITION: one had on spine of scapula, one hand on clavicle, squeeze (+) TEST: pain

Long Sitting (supine to sit) Test

TESTING: dysfunction of SI POSITION: supine, paplate medial malleoli, have pt long sit (+) TEST: reversal of limb length between supine and sitting

Slump Test

TESTING: dysfunction of neuronal structures of LEs POSITION: sitting slumped, passively flex head (no reproduction symptoms continue); passively extend one knee (no reproduction symptoms continue); passively dorsiflex ankle with knee extended. Repeat on other LE (+) TEST: reproduction of pain

Craig's Test

TESTING: femoral anteversion angle POSITION: prone knee flexed to 90 deg palpate greater trochanter, move hip in IR/ER, when trochanter feels more lateral measure angle leg to perpendicular surface (+) TEST: retroverted <8 or >15 deg anteverted; normal 8-15 deg

Thomas Test

TESTING: hip flexor tightness POSITION: supine with knees hanging off table, pull one LE toward chest, observe other LE (+) TEST: if extended LE no longer touching table.

Anterior Shear Test

TESTING: integrity of upper cervical spine, transverse ligament POSITION: supine, glide C2-7 anterior (+) TEST: nausea, soft end field

What is Achilles tendonitis?

a repetitive overuse disorder resulting in microscopic tears of collagen fibers on the surface or in the substance of the Achilles tendon

Special Tests (structure being tested & procedure): Empty can

Tear/impingement of supraspinatus or suprascapular nerve pathology Shoulder at 90 deg abduction, no rotation, resist abduction Horizontally adducted shoulder 30 deg, full IR, resist abduction

Special Tests (structure being tested & procedure): Drop arm test

Tear/rupture of rotator cuff Passive shoulder abduction 120 deg Patient slowly lowers arm to side (guard incase arm gives way) +ve if patient unable to slowly to lower to side

Special Tests (structure being tested & procedure): Barlow's test

Test for hip dysplasia Pt supine, hips flexed to 90, knees flexed PT adducts the hip and applies a light pressure on the knee in a posterior direction. Click/clunk may indicate hip dislocation being reduced

What are special tests for the ACL?

a. Anterior drawer test b. Lachmans test c. Lateral pivot shift test d. Slocum test

What are the attachments of the iliofemoral ligament?

a. Anterior inferior iliac spine of the pelvis b. Intertrochanteric line of the femur

What are the attachments of the ACL?

a. Anterior intercondylar area of the tibia b. Medial aspect of the lateral femoral condyle in the intercondylar notch

Where does the palmar radiocarpal ligament attach?

a. Anterior surface of the distal radius b. Capitate, triquetrum, and scaphoid

What does the arcuate ligament complex consist of?

a. Arcuate ligament b. Oblique popliteal ligament c. LCL d. Popliteus tendon e. Lateral head of the gastroc

What is the purpose of the arcuate ligament complex?

a. Assists the cruciate ligaments in controlling posterolateral rotatory instability of the knee b. Provides support to the posterolateral joint capsule

What is the annular ligament and what is its purpose?

a. Band of fibers that surrounds the head of the radius b. Allows the head of the radius to rotate and retain contact with the radial notch of the ulna

What is the anterior ligament of the elbow?

a. Capsular in nature and function b. Stretches from radial collateral ligament and attaches above the upper edge of the coronoid fossa, extending to just below the coronoid process

What is the function of the menisci?

a. Deepen the articular surfaces of the tibia where they articulate with the femoral condyles b. Shock absorbers c. Contribute to the lubrication and nutrition of the joint

What reinforces the articular capsule?

a. Iliofemoral ligament b. Pubofemoral ligament c. Ischiofemoral ligament

What are the attachments of the ischiofemoral ligament?

a. Ischial wall of the acetabulum b. Neck of the femur

What are the attachments of the LCL?

a. Lateral femoral epicondyle b. Fibular head

What is the purpose of the palmar radiocarpal ligament?

a. Maintain alignment of the associated joint structures b. Limits hyperextension of the wrist

What are the attachments of the ulnar collateral ligament (ie, medial collateral ligament)?

a. Medial epicondyle of the humerus b. Proximal portion of the ulna

Where is the prepatellar bursa located and what is its function?

a. Over the patella b. Allows greater freedom of movement of the skin covering the anterior aspect of the patella

What are special tests for the PCL?

a. Posterior drawer b. Posterior sag sign

What are the attachments of the PCL?

a. Posterior intercondylar area of the tibia b. Lateral aspect of the medial femoral condyle in the intercondylar notch

Where are the attachments of the dorsal radiocarpal ligament?

a. Posterior surface of the distal radius and styloid process of the radius b. Lunate and triquetrum

What is the purpose of the radial collateral ligament?

a. Prevents adduction of the elbow joint b. Provides reinforcement for the radiohumeral articulation

What is the purpose of the pubofemoral ligament?

a. Prevents excessive ABD of the femur b. Limits hip extension

What are the attachments of the pubofemoral ligament?

a. Pubic portion of the rim of the acetabulum b. Neck of the femur

What is the posterior ligament of the elbow?

a. Resembles the anterior ligament b. Blends on each side with the collateral ligaments c. Attached to the upper portion of the olecranon fossa and to just below the olecranon process

What are the attachments of the articular capsule?

a. Rim of the acetabulum b. Neck of the femur

What are the attachments of the radial collateral ligament?

a. Styloid process of the radius b. Scaphoid and trapezium

What are the attachments of the radial collateral ligament (ie, lateral collateral ligament)?

a. The lateral epicondyle of the humerus b. Lateral border and olecranon process of the ulna c. Annular ligament

What forms the wrist complex and what is its purpose?

a. The radiocarpal and midcarpal joints b. Attaches the hand to the forearm

What are the nine standard skinfold sites?

abdominal, triceps, biceps, chest/pectoral, medial calf, midaxillary, subscapular, suprailiac, thigh

The middle deltoid and supraspinatus ________ the shoulder joint.

abduct

What is a MMT of Poor Plus (2+/5)?

able to initiate movement against gravity

after tendon reattachment

active ROM of antagonist, passive ROM for Agonist

The temporalis, masseter and medial pterygoid muscles all ________ the TMJ of the head.

elevate

The upper trap and levator scap ________ the scapula.

elevate

foot flat

entire foot contacts the ground; the result of weak dorsiflexors, limited ROM; immature gait pattern (neonatal)

excessive plantarflexion

equinus gait (toe walking); heel does not touch the ground, the result of spasticity or contracture of the plantar flexors, will see poor eccentric contraction and advancement of the tibia

Metatarsalgia

etiologies: Mechanical: tight triceps surae group and/or achilles' tendon, collapse of transverse arch, short first ray. pronation of foot structural changes in transverse arch, possibly leading to vascular and/or neural compromise in tissues of forefoot s/s complaint frequently heard is pain at first and second metatarsal heads after long periods of WBing

Waddell's sign

evaluate tenderness, simulation tests, distraction tests, regional disturbances, and overreaction. Waddell's scores can be predictive of functional outcome.

What is kyphosis?

excessive curvature of the spine in a posterior direction usually identified in the thoracic spine

What is lordosis?

excessive curvature of the spine in an anterior direction usually in the cervical or lumbar spine

supination

excessive lateral contact of foot during stance with varus position of calcaneus. May occur at initial contact and correct at foot flat with weight acceptance or remain throughout stance POSSIBLE CAUSES: spastic invertors, weak evertors, pes varus, genu varum

pronation

excessive medial contact of foot during stance with valgus position of calcaneus. Possible causes: spastic invertors, weak evertors, pes varus genu varum

The Extensor carpi radialis longus, extensor carpi radialis brevis, and extensor carpi ulnaris ________ the wrist joint.

extend

The gluteus maximus and medius, semitendinosus, semimembranosus and biceps femoris ________ the hip joint.

extend

The latissimus dorsi, posterior deltoid, and teres major ________ the shoulder joint.

extend

The rectus femoris, vastus lateralis, vastus intermedius, and vastus medialis ________ the knee joint.

extend

The triceps brachii and anconeus ________ the elbow joint.

extend

Extensor Digitorum action action

extends all three joints of the fingers

The erector spinae, quadratus lumborum, and multifidus all cause ________ of the thoracic and lumbar intervertebral joints.

extension

The splenius cervicis, semispinalis cervicis, iliocostalis cervicis, longissimus cervicis, multifidus, and trapezius all cause ________ of the cervical intervertebral joints.

extension

What is the closed packed position of the facets (spine)?

extension

What is the closed packed position of the ulnohumeral (elbow)?

extension

Radiocarpal closed pack position

extension and radial devision

What is the closed packed position of the radiocarpal joint (wrist)?

extension with radial deviation

What is the common capsular pattern for the first metatarsophalangeal joint?

extension, flexion

What is the common capsular pattern for the atlanto-occipital joint?

extension, side flexion equally limited

Extension at the interphalangeal joint of the toes

extensor digitorum longus and brevis, extensor hallucis longus

Extension of the toes

extensor digitorum longus and brevis, extensor hallucis longus

Mckenzie manual therapy

feels that postural factors precipitate discal dysfunction. Treatment emphasizes the use of extension

Eversion of the foot

fibularis longus, brevis, and tertius, extensor digitorum longus

clinical presentation of ankylosing spondylitis

flattened lumbar curve with exaggerated thoracic curve

The iliopsoas, Sartorius, rectus femoris, and pectineus ________ the hip joint.

flex

Flexor Digitorum Profundus action

flexes all three joints of the fingers

Flexor Pollicis Longus action

flexes all three joints of the thumb

flexor digitorum profundus action / nerve

flexes and and both IP joints, median nerve

The rectus abdominis, internal oblique, and external oblique all cause ________ of the thoracic and lumbar intervertebral joints.

flexion

What is the capsular pattern of the radiocarpal joint?

flexion and extension equally limited

What is the common capsular pattern for the radiocarpal (wrist)?

flexion and extension equally limited

Lumbricals

flexion of MCP joint, extension of PIP, DIP -> should MCP extension, IP flexion for stretching

What is the common capsular pattern for the hip joint?

flexion, ABD, medial rotation (sometimes medial rotation is most limited)

What is the capsular pattern of the ulnohumeral joint?

flexion, extension

What is the common capsular pattern for the interphalangeal joint?

flexion, extension

What is the common capsular pattern for the knee joint?

flexion, extension

What is the common capsular pattern for the metacarpophalangeal and interphalangeal joint?

flexion, extension

What is the common capsular pattern for the ulnohumeral joint?

flexion, extension

What is the capsular pattern of the radiohumeral joint?

flexion, extension, supination, pronation

What is the common capsular pattern for the radiohumeral joint?

flexion, extension, supination, pronation

Flexion at the interphalangeal joint of the toes

flexor digitorum longus and brevis, flexor hallucis longus

What may cause excessive knee flexion with swing during gait?

flexor withdrawal reflex, lower extremity flexor synergy

Pronator Teres action

forearm pronation, assistive in elbow flexion

Supinator action

forearm supination

What may cause no toe off during gait?

forefoot/toe pain, weak plantar flexors, weak toe flexors, insufficient plantar flexion ROM

What is the common capsular pattern for the distal radioulnar?

full ROM, pain at extremes of rotation

talocrural joint (closed packed)

full dorsiflexion

What is the closed packed position of the interphalangeal joint?

full extension

What is the closed packed position of the metatarsophalangeal joint?

full extension

midcarpal joint (closed packed)

full extension

humeroulnar joint (closed packed)

full extension and supination

interphalangeal (IP in hands - closed packed)

full extension of the IP joints

interphalangeal (LE - closed packed)

full extension of toes

metatarsophalangeal (LE - closed packed)

full extension of toes

radioulno carpal joint (wrist joint - closed packed)

full extension with radial deviation

What is the loose packed position of the radiohumeral joint?

full extension, full supination

What is the closed packed position of the knee joint?

full extension, lateral rotation of the tibia

What is the closed packed position of the hip joint?

full extension, medial rotation

What is the loose packed position of the radiohumeral joint?

full extension, supination

What is the closed packed position of the metacarpophalangeal (fingers) joint?

full flexion

subtalar joint (closed packed)

full inversion

What is the closed packed position of the metacarpophalangeal (thumb)?

full opposition

carpometacarpal joint (closed packed)

full opposition

trapeziometacarpal joint (closed packed)

full opposition

midtarsal joint (closed packed)

full supination of the foot

tarsometatarsal joint (closed packed)

full supination of the foot

Plantar flexion at the ankle

gastrocnemius, soleus, plantaris, posterior tibialis, fibularis longus and brevis, flexor digitorum longus, flexor hallucis longus

PCL reconstruction guidelines

generally similar to ACL repair, except patient is often initially in hinged brace at 0 degrees during ambulation

What is a fibrocartilaginous structure that serves to deepen the glenoid fossa and increase the size of the articular surface?

glenoid labrum

What is the standard gait terminology?

heel strike, foot flat, midstance, heel off, toe off, acceleration, midswing, and deceleration

AVN of the hip (osteonecrosis)

hip ROM is decreased in flexion, IR and abduction x-ray, bone scan, CT and/or MRI pain in the groin and/or thigh, and tenderness with palpation at hte hip coxalgic gait - The gait caused by a painful hip is characterized by shifting of the upper torso toward the painful side during the single-limb stance phase on the affected hip

Lumbopelvic rhythm - extension

hips extend, pelvis rotates posteriorly, and then spine begins to extend

List five common methods to assess body composition?

hydrostatic weighing, plethysmography, skinfold measurement, body mass index, and bioelectrical impedance

Harrington Rod is used for

idiopathic scoliosis Pt can begin ambulation between 4-7 days post op pt should avoid BLT

Lumbar spine flexion is coupled with

ilial posterior rotation lumbar spine extension is coupled with anterior rotation

Femoral Anterversion

increased femoral anteversion (25+ degrees) leads to squinting patella or toeing in With an angle less than 0 degrees (retroversion) femral neck is rotated backward in relation to the femoral condyles. Craig's test is used to measure this.

Charcot-Marie-Tooth disease

inherited disorder peroneal muscular atrophy that affects motor and sensory initially affects muscles of LE but eventually progresses to UE - slowly progressive electrodiagnostic imaging PT focuses on preventing contractures/skin breakdown and maximizing patient's functional capcity to perform activities.

What is Rancho Los Amigos gait terminology?

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

Unhappy Triad

injury to MCL, ACL, medial meniscus resulting from a combination of valgum, flexion and ER forces applied to the knee when the foot is planted

Peripheral nerve involvement: axillary (circumflex) nerve

innervates the deltoid, teres minor inability to abduct arm with neural rotation

Peripheral nerve involvement: long thoracic nerve

innervates the serratus anterior pain on flexing fully extended arm inability to flex fully extended arm scapular winging starts at 90 degrees forward flexion

What may cause heel lifting during midstance of gait?

insufficient dorsiflexion range, plantar flexor spasticity

What may cause insufficient hip extension at stance during gait?

insufficient hip extension ROM, hip flexion contracture, lower extremity flexor synergy

Special Tests (structure being tested & procedure): McKenzie side glide test

Differentiates between scoliotic curve and near dysfunction causing lateral shift (Performed if lateral shift is noted) Standing with PT on side of patient that spine is shifted towards PT places their shoulders into patient's upper trunk and wraps arms around pelvis Stabilize upper trunk, pull pelvis to bring into alignment (Positive if neuro symptoms reproduced as alignment is corrected)

Knee 'screw home' mechanism

CKC = Femoral IR OKC = Tibial ER At terminal extension the tibia externally rotates 5 degrees due to: Lateral femoral condyle has a longer articular surface than medial (20 deg femoral roll laterally; 10-15 deg medially) Medial meniscus attached to MCL which restricts medial gliding Twisted cruciate ligaments Lateral pull of quads

Shoulder labral tears symptoms

Can be SLAP, Bankart Symptoms: -non-localized shoulder pain -pain made worse w/ overhead activities or when arm is held behind the back -weakness -instability -pain on resisted flexion of the bipceps unstable injuries require surgery to reattach the labrum to the glenoid. Bankart's lesions require surgery.

Bone Tumors of the spine

Can be primary or metastatic Primary: multiple myeloma (mc primary), Ewing's sarcoma, malignant lymphoma, chondrosarcoma, osteosarcoma, and chondromas. Metatstatic bone cancer has primary sites in lung, prostate, breast, kidney and thyroid. s/s include pain that is unvarying and progressive, NOT relieved by position/rest, more pronoounced at night

Total Knee Replacement Ambulation + exercises

Ambulation: Cemented - WBAT with walker immediately post op. Ambulation with cane at week 3, transition to full WB at week 4. Non cemented - varies from WBAT to TDWB. WBAT with walker immediately postop. Ambulation with cane at week 5-6. Transition to full WB at week 6. TDWB - TDWB with walker immediately post op. WBAT within walker at week 6. Ambulation with cane at week 8-10. Transition to full WB at week 10.

THR Guidelines Cemented vs Noncemented - WB/Exercise

Cemented - partial WB for approx 3 weeks, begin ambulation with cane at 4 weeks post op, begin transition to full WB at week 4. Noncemented - varies from WBAT to TDWB, similar WB restrictions as cemented. Isometric exercise - begin immediately post op as tolerated by pt. for both cemented and noncemented. Active exercise initiation is variable between weeks 1-4 depending on surgeon

Special Tests (structure being tested & procedure): TMJ compression

Compression of retrodiscal tissues Sitting or supine Stabilize head with one hand, with other push mandible superior causing compressing to TMJ (Positive if pain reproduced)

Osteo/arthrokinematics: Acromioclavicular Shape of moving bone articular surface Opposite/Same direction

Concave Same

Osteo/arthrokinematics: Distal radio-ulnar Shape of moving bone articular surface Opposite/Same direction

Concave Same

Osteo/arthrokinematics: Facet joints Shape of moving bone articular surface Opposite/Same direction

Concave Same

Osteo/arthrokinematics: Humeroradial Shape of moving bone articular surface Opposite/Same direction

Concave Same

Osteo/arthrokinematics: Humeroulnar Shape of moving bone articular surface Opposite/Same direction

Concave Same

Osteo/arthrokinematics: Interphalangeal joints Shape of moving bone articular surface Opposite/Same direction

Concave Same

Osteo/arthrokinematics: Knee Shape of moving bone articular surface Opposite/Same direction

Concave Same

Osteo/arthrokinematics: Metacarpophalangeal joints Shape of moving bone articular surface Opposite/Same direction

Concave Same

Osteo/arthrokinematics: Proximal Tibiofibular Shape of moving bone articular surface Opposite/Same direction

Concave Same

Osgood-Schlatter Disease treatment

Conservative tx: education, icing, flexibility exercises, and eliminating activities that place strain on the patella tendon such as squatting, running or jumping

Manual Grading of Accessory Joint Motion: 5

Considerable hypermobility

Manual Grading of Accessory Joint Motion: 1

Considerable hypomobility

Dupuytren's contracture

Contracture of 4th and 5th MCP and PIP in nondiabetic individuals and third and fourth is more often in individuals with diabetes PT: PT interventions includes flexibility exercise to prevent further contracture and splint fabrication/application Once contracture is under control, promote restoration of normal hand function through functional exercises.

Osteo/arthrokinematics: Atlanto-occipital Shape of moving bone articular surface Opposite/Same direction

Convex Opposite

Osteo/arthrokinematics: Distal Tibiofibular Shape of moving bone articular surface Opposite/Same direction

Convex Opposite

Osteo/arthrokinematics: Glenohumeral Shape of moving bone articular surface Opposite/Same direction

Convex Opposite

Osteo/arthrokinematics: Hip Shape of moving bone articular surface Opposite/Same direction

Convex Opposite

Osteo/arthrokinematics: Proximal radio-ulnar Shape of moving bone articular surface Opposite/Same direction

Convex Opposite

Osteo/arthrokinematics: Radiocarpal Shape of moving bone articular surface Opposite/Same direction

Convex Opposite

Osteo/arthrokinematics: TMJ Shape of moving bone articular surface Opposite/Same direction

Convex Opposite

Osteo/arthrokinematics: Talocrural Shape of moving bone articular surface Opposite/Same direction

Convex Opposite

Special Tests (structure being tested & procedure): Hautant's test

Differentiates vascular versus vestibular causes of dizziness/vertigo 1) Patient sits with shoulders at 90 deg and palms up Close eyes, sit still for 30 seconds. (If arms loose their position there may be a vestibular condition) 2) Patient sits with shoulders at 90 deg and palms up Close eyes, extend head and neck with rotation right then left remaining in each position for 30 seconds (If arms loose their position there may be a vascular condition)

What is the function of the subacromial bursa?

Facilitates movement of the deltoid muscle over the fibrous capsule of the shoulder joint and the supraspinatus tendon

Common symptoms during beginning stages of RA

Fatigue and malaise (general feeling of discomfort)

What are the three classifications of joints?

Fibrous joints (synarthroses), cartilaginous joints (amphiarthroses), and synovial joints (diarthroses)

2nd class lever - definition and example in the body

Force and resistance on same side of the fulcrum with resistance closer to the fulcrum (wheel barrow). Two forces applied on one side of the axis. Resistance in the middle. Push-ups and toe-raises. (Few examples in body).

Pronator Quadratus action

Forearm pronation

Forefoot varus / valgus

Forefoot varus Etiology: congential abnormal deviation of head/neck of talus Deformity observed: inversion of forefoot when subtalar joint is in neutral PT: regain proper alignment, improve flexibility, orthotic fitting and patient education regarding selection of footwear Forefoot valgus Etiology: congenital abnormal development of head and neck of talus Deformity observed: eversion of forefoot when the subtalar joint is in neutral. PT: same as above

Capsular pattern: Occipitoatlantal joint

Forward bending more limited than backward bending

Boxer's Fracture

Fracture of neck of 5th MCP frequently sustained during a fight or from punching a wall casted for 2-4 weeks x-ray

Finger ligs: Accessory

From condylar head to volar plate

Finger ligs: Collateral

From lateral condyle to distal phalanx and lateral volar plate. Tighten with flexion. Volar fibers also tighten with extension.

Capsular pattern: AC joint

Full elevation, pain at extremes of movement

Capsular pattern: Sternoclavicular

Full elevation, pain at extremes of movement

What is the closed packed position of the tibiofemoral joint?

Full extension and lateral rotation of the tibia

What is the closed packed position of the iliofemoral joint?

Full extension and medial rotation

Special Tests (structure being tested & procedure): Distraction test

Indicates compression of neural structures at IV foramen or facet dysfunction Sitting, head passively distracted (Positive if symptoms decrease (facet) or there is a decrease in upper limb pain (neurological)

Special Tests (structure being tested & procedure): Shoulder abduction test

Indicates compression of neural structures within IV foramen Sitting, patient places one hand on their head, repeat with other hand (positive if upper limb symptoms decrease)

Which direction does the patella move in knee flexion?

Inferiorly

Cholecystisis

Inflammation of the gallbladder, a small, digestive organ beneath the liver. may present with abrupt, severe, abdominal pain and RUQ tenderness, nausea, vomiting and fever.

Peripheral nerve involvement: suprascapular nerve

Innervates the supra and infraspinatus increased pain on forward shoulder flexion shoulder weakness pain increases with scapular abduction pain increases with cervical rotation to the opposite side

Peripheral nerve involvement: spinal accessory nerve

Innervates the traps inability to abduct arm beyond 90 degrees pain in shoulder on abduction

Trunk/Ribcage musculo/neuro testing (muscles, cord segment, nerves): Forced expiration

Internal obliques, transverse abdominis (T7-L1) Intercostal nerve External obliques, posterior internal intercostals, rectus abdominis (T7-T12) Intercostal nerve

The tibialis posterior, tibialis anterior, and flexor digitorum longus ________ the ankle joint.

Invert

Lateral jaw movement

Ipsilateral rotation + contralateral translation

Where is the subacromial bursa located?

It extends over the supraspinatus tendon and distal muscle belly, beneath the acromion and deltoid muscle

Special Tests (structure being tested & procedure): Ortolani's test

Test for hip dysplasia Pt supine, hips flexed to 90, knees flexed PT grasps legs so thumbs are along pt's medial thighs and fingers are on lateral thighs towards buttocks. PT abducts hips and gentle pressure is applied to greater trochs until resistance is felt at ~30 degrees. +ve = click/clunk, may indicate reduction of a dislocation

Bicipital tendonitis

MC an inflammation of the long head of the biceps results from mechanical impingement of the proximal tendon, between the anterior acromion and the bicipital groove of the humerus MRI maybe used Test: Speed's

Reflexes: C5

Biceps

Extensor Indicis Muscle action

Extends all three joints of the second digit

Extensor Pollicis Longus action

Extends all three joints of the thumb

What is the closed pack position of the ulnohumeral joint?

Extension

Capsular pattern: 1st Metatarsophalangeal

Extension (++), flexion (minor)

What is the closed packed position of the radiocarpal joint?

Extension with radial deviation

Capsular pattern: Glenohumeral

External rotation, abduction, internal rotation

T/F: The menisci are thin at the periphery and thicker at their internal unattached edges.

F

T/F: The ST articulation is a true anatomical joint?

F: lack necessary synovial characteristics

Halstead maneuver

FOR TOS sitting over edge of a table. The therapist palpates the radial pulse and applies a downward traction on the involved side. The patient is then asked to extend the head and turn away from the tested side. Positive is indicated by an absent or diminished pulse. MSK-Examination

What is the loose packed position of the iliofemoral joint?

30° flexion, 30° ABD, slight lateral rotation

Neuro/Musculo screen (muscles supplied by peripheral nerves): Superor gluteal

Gluteus medius and minimus, TFL

Neuro/Musculo screen (root origins of peripheral nerves): Inferior gluteal

L5-S2

Type of Spondylolisthesis -Pathologic spondylolisthesis

-by structurally weakens one or more of the bony structures ex>systemic(osteogenesis imperfecta) or local (tumor).

Osteoporosis -meds

-calcium, vitD, estrogen, calcitonin, and biophosphates

Game's keeper injury (=skier's thumb)

-sprain/rupture of *ulnar collateral ligament of MCP joint of first digit* -immobilized for 6weeks

Shoulder medial rotation ROM

0 - 70

Hip IR (sitting)

40 Fulcrum- anterior patella, proximal- ⊥ to floor, distal- crest of tibia to point midway between the malleoli

Myotomes: T1

Digit adduction/abduction

What is the capsular pattern of the SC joint?

Pain at extreme of ROM

Reflexes: L4

Quads tendon

What are open-chain activities?

distal segment moves freely in space

Serratus anterior innervation

long thoracic nerve

What may cause foot slap during gait?

weak dorsiflexors, dorsiflexor paralysis

Upper Trapezius action

Scapular elevation, upward rotation

Muscle substitution for weak shoulder abductors

Scapular stabilizers

Reflexes: L5

Semitendinosus

Biceps Brachii action

elbow flexion, forearm supination, shoulder flexion

Functional position of the wrist and hand

(1) slight wrist extension, (2) slight ulnar deviation, (3) *fingers flexed at the MCP, PIP, and DIP joints*(4) thumb slightly abducted

Clubfoot

(=talipes equinovarus) -abnormal development of head and neck of *talus* -*plantar flexion, forefoot adduction, calcaneal varus* seen in spina bifida/myelomeningocele -Tx: casting/ splinting for postural condition, surgical intervention

Which system yields the most ATP: the anaerobic-PC system, anaerobic glycolysis, or aerobic system?

Aerobic system

Special Tests (structure being tested & procedure): Pivot Shift

(Anterolateral rotary instability of the knee - ACL) Supine, test knee extended, hip flexed and abducted 30 degrees, slight IR PT grasps leg with one hand and places other over lateral surface of proximal tibia IR, valgus force through knee with flexion positive = palpable shift of clunk occurring between 30-40 degrees of flexion (ITB relocates tibia Indicates anterolateral instability

Imaging uses: CT

(Enhanced X-rays) Complex fractures, spinal stenosis, facet dyfunction, disc disease, poor quality imaging of soft tissues

Imaging uses: Arthrography

(Inject water-soluble dye into joint) Identify joint abnormalities eg - tendon rupture

Special Tests (structure being tested & procedure): Ballotable patella

(Patellar tap) Infrapatellar effusion Soft tap over central patella (positive if patella "floats")

Imaging uses: Bone Scan

(Radioactive chemicals injected, isotope settles in area of high metabolic activity) Identify stress fractures, RA, bone cancer, bone infection

Imaging uses: Discography

(Radiopaque dye injected into disc) Specific technique to identify internal disc disruptions or the nucleus or annulus

Imaging uses: Ultrasound

(Real-time dynamic images) Soft-tissue imagin

Neuro/Musculo screen (muscles supplied by peripheral nerves): Deep peroneal

(anterior leg) Tibialis anterior, EDL, peroneus tertius, EHL, EDB

Neuro/Musculo screen (muscles supplied by peripheral nerves): Femoral

(anterior thigh) Iliacus, pectineus, sartorius, quadriceps

Neuro/Musculo screen (muscles supplied by peripheral nerves): Medial plantar

(from tibial nerve - supplies medial sole of the foot) FHB, AbH, FDB, 1st lumbricle

Neuro/Musculo screen (muscles supplied by peripheral nerves): Ulnar

(hand and anterior forearm - ulnar side) FCU, ulnar 1/2 of FDP, hypothenar eminence (AbDM, OpDM, FDM) interossei, medial 2 lumbricles, AdP, deep head of FPB

Neuro/Musculo screen (muscles supplied by peripheral nerves): Superficial peroneal

(lateral leg) Peroneus longus and brevis

Neuro/Musculo screen (muscles supplied by peripheral nerves): Radial

(posterior arm and forearm) Triceps, anconeus, brachioradialis, ECRL, ECRB, supinator, ED, EDM, EI, AbPL

Neuro/Musculo screen (muscles supplied by peripheral nerves): Tibial

(posterior leg and thigh) Temitendinosus, semitmembranosus, long head of biceps femoris, adductor magnus, gactocnemius, soleus, plantaris, popliteus, FDL, FHL, tibialis posterior

Imaging uses: MRI

(uses magnetic field rather than radiation) Two types: T1: Visualizes fat within tissues - used for bones T2: Surpresses fat - used for soft tissues (CI: Claustrophobia, metal implants)

GH joint gliding

*Ventral glide* of the humerus : increase ROM of external rotation, extension, horizontal abduction *Dorsal glide* of the humerus : increase ROM of internal rotation, flexion, horizontal adduction

Rheumatic conditions

- Ankylosing spondylitis (Marie-Strumpell, Bechterew's, rheumatoid spondylitis) -Gout -Psoriatic arthritis -RA

Psoriatic arthritis - PT goals, outcomes, and interventions

- Joint protection strategies - Maintain/improve joint mechanics and connective tissue functions -implementation of aerobic capacity/endurance conditioning or reconditioning such as aquatic programs

Psoriatic arthritis - meds

- acetaminophen for pain, NSAIDs, corticosteroids, disease-modifying antirheumatic drugs (DMARDs) can slow the progression of psoriatic arthritis, and biological response modifiers (BRMs) such as Enbrel (etanercept) are a newly developed class of meds

Osteogenesis imperfecta etiology

- cause is genetic inheritance with types I and IV considered autosomal dominant traits and types II and II considered autosomal recessive traits

Patellofemoral syndrome

- general term describing pain or discomfort in the anterior knee -often termed chondromalacia patella (which refers to softening of the articular cartilage of the patella

Osteogenesis imperfecta treatment

- management begins at birth with caregiver education on proper handling and facilitation of movement -PT will focus on AROM emphasizing symmetrical movements, positioning, functional mobility, fracture management, and the use of orthotics -In severe cases where ambulation is not realistic, wheelchair prescription and training is indicated

Osteoporosis

- metabolic disease which depletes bone mineral density/mass, predisposing individual to fx -affects women 10x more frequently than men -common sites of fx include thoracic and lumbar spine, femoral neck, proximal humerus, proximal tibia, pelvis and distal radius -Primary/postmenopausal osteoporosis: directly related to a decrease in the production of estrogen -Senile osteoporosis: occurs due to a decrease in bone cell activity secondary to genetics or acquired abnormalities

Osteogenesis imperfecta signs and symptoms

- pathological fractures, osteoporosis (i.e., brittle bones), hypermobile joints, bowing of the long bones, weakness, scoliosis, impaired respiratory function

Gait with compensation

-*circumduction gait*: compensation for weak hip flexor, weak knee&ankle dorsiflexors -*hip hiking*: compensation for abnormally long leg with lack of knee flexion& ankle dorsiflexion -*excessive hip flexion*: compensation for footdrop during swing phase -*forward trunk lean*: compensation for quadriceps weakness -*backward trunk lean*: compensation for gluteus maximus weakness (prevent excessive hip flexion & ant. pelvic tilt)

Hautant's test

-*differentiate* between a *vascular* dysfunction in *vertebrobasilar system* and a dysfunction of vestibular system

Dupuyren's contracture

-*early symptom*: several nodules can be palpated in the palmar aponeurosis immediately inferior to the ring and little finger -*pregressive painless thickening and tightening of palmar fascia* resulting in a fixed flexion deformity of MP, PIP in ring and little finger

Tarsal tunnel syndrome

-*entrapment of posterior tibialis nerve* within tarsal tunnel -from over/ excessive pronation -pain, numbness, paresthesias along med. ankle to plantar surface of foot -Tx: use of orthosis to maintain neutral alignment of foot

Common sublux in RA

-*extensor carpi ulnaris* -after rupture of the triangular fibrocartilage complex.

Hallux valgus

-*from excessive pronation, ligamentous laxity, tight footwear* -medial deviation of head of 1st metatarsal -normal MTP angle: 8-20 -Tx: early- orthotic fitting, patient education late-surgery, flexibility & strengthening exercise

Hip bursitis vs hip fracture

-*hip bursitis*: severe pain over the bursa area, with pain aggravated by active motion (walking) -*hip fracture*: pain in the groin area and tenderness occurs in the area anterior to the femoral neck

Hip quadrant test

-*hip flexion with abduction and adduction* -restrictions into these motions would be best addressed with posterior and inferior joint mobilizations

Bench press

-*incline bench press*: emphasize upper fiber(clavicular portion) of pectoralis major which innervated by lat. pectoral nerve -*traditional bench press*: sternal portion is more emphasized

Patellofemoral joint *reactive force(stress)*

-*increase as the angle of knee flexion and quadriceps muscle activity* -*Jumping (plyometrics)* can generate up to 7 times body weight at the patella -*Running* is next most stressful at 3.5 times body weight -*Squats* to 120 degree of knee flexion

Shoulder capsular pattern vs noncapsular pattern

-*most common causes of a capsular pattern* :traumatic arthritis following injury to the shoulder (gradually develop over time) -*noncapsular pattern*: painful arc from bursitis or tendinitis -*torn rotator cuff*:weakness, loss of active shoulder elevation

Posterolateral bulge herniation

-*most commonly observed disc disorder of lumbar spine -cause 1) posterior disc is narrower in height than anterior disc 2) PLL is not as strong and locate only centrally 3) post. lamella of annulus are thinner -positioning gapping (10mins) for home exercise Etiology: overstretching and/or teraing of annular rings, vetebral endplace and/or ligamentous structures, from high compressive forces or repetitive microtruama S/S -loss of strength, radicular pain, paresthesias and inability to perform ADLs MRI PT: -Pt. ed regarding proper body mechanics, positions to avoid, limit repetitive bending/twisting, limit UE overhead and sitting activities and carrying heavy load. -promote dynamic stability throughout trunk/pelvis and to provide optimal stimulus for regeneration of disc. -ex> positional gapping for 10 min, Left posterolateral herniation 1) sidelying on the right with pillow under right trunk 2) flex both hips and knees 3) rotate trunk to left -Tx: traction(O) but no manipulation!

Scaphoid

-*poor vascular supply*, aggressive therapy should be avoided until the bone is fully healed *(12 to 24 weeks)*

Sjogren's syndrome

-*rheumatoid-like* disorder -*dryness* of the mocous membrane, joint inflammation, anemia -*dryness* of eyes and mouth along with joint inflammatiion -Tx: sipping water through day, chewing sugarless gum, pain management, maintain mobility & function

SLAP - Superior labrum, anterior to posterior

-*type1*: breakdown of labrum to glenoid due to age -*type2*: entire top half of labrum is torn(ant: 12-3 o'clock, post: 9-12 o'clock) *acute tx> should avoid ext. rotation* (peel back mechanism)-> carefully perform int.rotation -*type3*: bucket handle tear may involve biceps tendon

Coronoid fractures

-1 % to 2% of all elbow fractures -seldom are isolated fractures -*usually accompanied by radial head fracture* and brachialis is the muscle usually avulsed.

Medial Collateral Ligament Sprain etiology

-A contact or noncontact, fixed foot, tibial rotational injury associated with valgus force and external tibia rotation can damage the MCL -injury often associated with activities such as football, skiing and soccer

Degenerative joint disease (DJD; degenerative osteoarthritis (OA))

-A degenerative process of varied etiology which includes mechanical changes, diseases and/or joint trauma part of normal aging process d/t weight bearing properties of facets and intervertebral joints x-ray

ACL Sprain

-ACL runs from anterior intercondylar area of tibia to medial aspect of lateral femoral condyle in the intercondylar notch -prevents anterior displacement of the tibia in relation to the femur -Grade I sprain involves microscopic tears of the ligament while Grade III indicates a completely torn ligament

Talipes Equinovarus signs and symptoms

-ADD of the forefoot, varus positioning of the hindfoot, and equinus at the ankle

Talipes Equinovarus

-AKA "clubfoot" -deformity characterized by the heel pointing downward and the forefoot turning inward

Congenital hip dysplasia

-AKA developmental dysplasia -characterized by malalignment of the femoral head within the acetabulum -develops during the last trimester in utero

Osgood-Schlatter Disease

-AKA traction apophysitis, is a self-limiting condition that results from repetitive traction on the tibial tuberosity apophysis plain x-ray

Ankylosing spondylitis - PT goals, outcomes and interventions

-Implementation of flexibility exercises for trunk to maintain/improve normal joint motion and length of muscles in all directions, especially extension -Implementation of aerobic capacity/endurance conditioning or reconditioning such as aquatic programs -Implementation of relaxation activities to maintain/improve respiratory function (breathing strategies to maintain/improve vital capacity)

Glenohumeral instability treatment

-Initial immobilization with a sling for 3-6wks -RICE and NSAIDS often utilized in early phase -Following immobilization: ROM and isometric strengthening should be initiated followed by progressive resistive exercises emphasizing the internal and external rotators, as well as the large scapular muscles

Total hip arthroplasty treatment

-Initially PT management focuses on decreasing inflammation and allowing tissues to heal, emphasizing adherence to hip precautions, minimizing muscles atrophy, and regaining full PROM -Tx may include ankle pumps, quads and gluteal sets, active hip flexion within available ROM, assistive device training and progressive ambulation -As a patient progresses, tx moves toward regaining full strength and endurance and attaining independence in a home setting

Achilles tendonitis treatment

-Initially RICE (Rest, ice, compression, elevation) -Nonsteroidal anti-inflammatory meds (NSAIDS) and analgesics as needed -Heel lift and cross training may be used to limit the amount of tensile loading through the tendon -Prevention: heel cord stretching exercises, use of appropriate soft-soled footwear, eccentric strengthening of gastroc-soleus, and avoiding sudden changes in intensity of training programs

ACL treatment

-Initially RICE, NSAIDS, and analgesics as needed -Conservative tx: LE strengthening exercises emphasizing the quads and hamstrings -Surgery often warrented in complete ACL tear (Grade III) -Surgery most often consists of intra-articular reconstruction using the patellar tendon, iliotibial band or hamstrings tendon -Derotation brace may be beneficial for a patient with an ACL deficient knee, however, it has limited benefit for a patient following surgical reconstruction

Lateral epicondylitis treatment

-Initially RICE, NSAIDs and activity modification -PT should attempt to increase strength, flexibility, and endurance of the wrist extensors -A strap placed two to three inches distal to the elbow joint can reduce muscular tension placed on the epicondyle and may diminish or eliminate pt sxs

Impingement syndrome treatment

-Initially RICE, NSAIDs and activity modification -Once tolerated, tx includes RC strengthening and scapular stability exercises -Long-term prevention includes continued strengthening of the RC and scapula stabilizers, along with improved biomechanics related to sport-specific or relevant work activities

Meniscus Tear treatment

-Initially RICE, NSAIDs and analgesics as needed -Conservative tx: palliative modalities and strengthening exercises -Surgery: ranging from a partial meniscectomy to a meniscal repair often warranted for active individuals -Meniscal repairs typically performed on tears located on the outer edges of the meniscus due to increased vascularity -recent advances in technology have increased incidence of meniscal transplantation

Medial Collateral Ligament Sprain Treatment

-Initially RICE, NSAIDs, and analgesics as needed -Conservative tx: decreasing inflammation, protecting the knee joint and ligament, ROM and strengthening exercises as tolerated -strengthening exercises gradually become more aggressive and functional activities are introduced -Surgery rarely required since MCL is well vascularized

Total knee arthroplasty treatment

-Initially, PT tx focuses on decreasing inflammation and allowing tissues to heal, emphasizing adherence to knee precautions, minimizing muscle atrophy, and regaining full passive ROM -Knee flexion requires a minimum of 90° for activities of daily living and 105° to rise comfortably from sitting -Therapeutic activities include ankle pumps, quad and gluteal sets, AROM within available range, use of a continuous passive motion machine, assistive device training, and progressive ambulation -As the patient progresses, tx moves toward regaining full strength, endurance and independence in the home setting -Advanced therapeutic activities include wall slides, controlled lunges, stationary cycling and step ups

Degenerative joint disease (DJD; degenerative osteoarthritis (OA)) - Meds

-Many different meds used to control pain: corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs) -Glucocorticoids injected into joints that are inflamed and not responsive to NSAIDs -For mild pain without inflammation, acetaminophen may be used

Talipes Equinovarus treatment

-Medical management begins shortly after birth and includes splinting and serial casting -goal of intervention is to restore proper positioning of the foot and ankle -failed management or severe involvement may require surgical intervention and subsequent casting

Gout - meds

-NSAIDs (specifically indomethacin), COX-2 inhibitors (cardiac side effects may limit use), colchicine, corticosteroids, adrenocorticotropic hormone (ACTH), allopurinol, probenecid, and sulfinpyrazone

Ankylosing spondylitis - meds

-NSAIDs such as aspirin are used to reduce inflammation and pain associated with condition -Corticosteroid therapy or meds to suppress immune system may be used to control various symptoms -Cytotoxic drugs (drugs that block cell growth) may be used in people who do not respond well to corticosteroids or who are dependent on high doses of corticosteroids -Tumor necrosis factor (TNF) inhibitors have been shown to improve some sx of ankylosing spondylitis

Meniscal repair surgery

-Non weight bearing 3-6weeks -if partial tear: can hop after 6weeks

ACL etiology

-Noncontact twisting injury associated with hyperextension, varus or valgus stress to the knee -often involves injury to other structures such as the medial capsule, medial collateral ligament and menisci

Impingement syndrome

-One of most common injuries of the shoulder -often caused by repetitive microtrauma from UE activity performed above the horizontal plane -Individuals participating in throwing activities, swimming, and racquet sports are particularly susceptible to impingement syndrome

Typical of *OA*

-Osteophyte formation, narrow joint space, subchondral sclerosis

Rotator cuff tear

-can be torn due to an acute traumatic incident or as a result of a chronic degenerative pathology -Patients 50 years of age and older are particularly susceptible to tears due to chronic degenerative pathology -rotator cuff tears are classified as partial thickness or full-thickness -Partial thickness: extends through only a portion of the tendon -Full thickness tear: complete tear of the tendon -size of tear can range from small (1cm or less) to large (more than 5cm)

Normal end-feel of wrist flexion

-capsualr

Rheumatoid Arthritis etiology

-cause unknown -one to two percent of the American population is affected -Women are affected 3x more than men and the most common age of onset falls between 40 and 60 years of age

Congenital Torticollis etiology

-cause unknown -may be associated with malpositioning in utero (e.g., breech) and birth trauma

Osgood-Schlatter Disease etiology

-caused by repetitive tension to the patellar tendon over the tibial tuberosity in young athletes (this can result in a small avulsion of the tuberosity and subsequent swelling)

Impingement syndrome etiology

-caused by the humeral head and associated RC attachments migrating proximally and becoming impinged on the undersurface of the acromion and the coracoacromial ligament

Type of Spondylolisthesis -Degenerative spondylolisthesis

-change in the structural support that prevents anterior vertebral slippage ex>older individuals (age related degeneration)

Legg-Calve-Perthes Disease

-characterized by degeneration of the femoral head due to a disturbance in the blood supply (ie avascular necrosis) age of onset b/w 2-13, avg 6 y/o males 4x more likely characteristics: -Psoatic limp d/t weakness of psoas major, affected LE moves in ER, flexion and adduction -gradual onset of "aching" pain at hip, thigh, and knee. -AROM limited in abduction and extension x-ray / MRI -The disease is self-limiting and has four distinct stages: 1) Condensation 2) Fragmentation 3) Re-ossification 4) Remodeling

Osteoarthritis

-chronic disease -causes degeneration of articular cartilage, primarily in WB joints -Subsequent deformity and thickening of subchondral

Osteoarthritis etiology

-chronic disease that causes degeneration of articular cartilage, primarily in WB joints -subsequent deformity and thickening of subchondral bone occurs resulting in impaired functional status -Any joint may be involved, however, the most commonly affected sites include WB joints, such as the hips, knees, ankles and feet

Plantar fascitis

-chronic irrigation of plantar fascia from *excessive pronation* -limited ROM of first MTP and talocrural joint -from tight triceps surae, excessive loading -rigid cavus foot -continuous US, superficial heat => increase the viscoelasticity of the plantar fascia & quality of the stretch. -Tx: *night splint*, flexibility exercise for plantar fascia & triceps surae, strengthening of foot invertors, orthotic fitting -Iontophoresis, ice massage =>pain management

Psoriatic arthritis

-chronic, erosive inflammatory disorder of unknown etiology associated with psoriasis -erosive degeneration usually occurs in joints of digits as well as axial skeleton -Both sexes are affected equally

Periarticular osteopenia, erosion

-classic sign of *RA* due to *hyperperfusion* due to inflammation of the synovium

Swelling

-comes *soon after* injury -> blood -comes after 8 to 24hours -> synovial -boggy spongy feeling-> synovial -harder, tense feeling with warmth-> blood -thick, slow moving-> pitting edema

Stress fracture

-common cause abnormal biomechanical alignment, poor conditioning, improper training -*nagging, localized pain Lt.L/E , night pain*, increase pain during activity (microfracture of tibia/ fibula) -lower 1/3 -black line-> may need intramedullary rodding *stress fracture 10-14 X-ray !!*

Transient synovitis

-common insidious causes of hip joint pain *under 12 years old* -sudden onset of pain and limited mobility -The disease causes arthralgia and arthritis secondary to a transient inflammation of the synovium of the hip

Soft tissue ankle impingement

-common source of ant.part of ankle pain after injury

Anterior interosseous syndrome

-compression of the *anterior interosseous nerve*(a branch of the median nerve) -the flexor pollicis longus and the lateral half of the flexor digitorum profundus -*pain & difficulty to pinch or hold object with thumb and index finger*

Meralgia paresthetica

-compression of the *lateral femoral cutaneous nerve * -pain & tingling sensation but *no motor loss* -cause: obesity, postural changes, tight clothing, pregnancy

Carpal tunnel syndrome

-compression of the *median nerve* at the wrist d/t inflammation of flexor tendons on the median nerve -hand pain, paresthesia, and muscle weakness in the median nerve distribution, burning/tingling,pins and needles and numbness in median nerve distribution, long term compression causes atrophy of thenar muscles and lateral 2 lumbricals. -exacerbated by repetitive wrist motions of gripping, with pregnancy, diabetes, and RA. -special test: *Phalen's test* (ask the patient to push his wrist together into fully flexed position for *one minute* ) Treatment: biomechanical faults caused by joint restrictions should be corrected with joint mob soft tissue/massage, modalities, flexibility exercises, and functional exercises including strengthening, endurance and coordiations,

Radial tunnel syndrome

-compression of the *radial nerve* near the neck of the radius -pain exacerbated by active forearm pronation with elbow extension, resisted forearm supination, and resisted elbow extension

Cubital tunnel syndrome

-compression of the *ulnar nerve* at the elbow(posterior to med.epicondyle) -pain, paresthesia, and muscle weakness are typical in the ulnar nerve distribution -exacerbated by prolonged elbow flexion (ex> holding a phone to the ear), compression on the ulnar nerve (ex>resting elbows on a table).

Dynamometer test

-grip strength the extrinsic muscles of the hand : 3 inches the intrinsic muscles: closer positions -*maximum grip strength* occurs at the *second or third grip width*

Glenohumeral instability

-excessive translation of the humeral head on the glenoid during active rotation -involves varying degrees of injuries to dynamic and static structures that function to contain the humeral head in the glenoid -Subluxation refers to joint laxity, allowing for more than 50% of the humeral head to passively translate over the glenoid rim without dislocation -Dislocation is the complete separation of the articular surfaces of the glenoid and the humeral head -Approx 85% of dislocations detach the glenoid labrum (ie, Bankart lesion)

patient with Hammer toes

-exhibits hyperextension of DIP and MTP joints + flexion of PIP joints -callus formation in distal tips of toes, sup. surface of IP joint, metatarsal head

Best position to palpate greater tubercle

-external rotation positions in profile

Piriformis stretching

-flexion of hip to 60 + adduction -flexion of hip more than 90 + lat. rotation

Patellofemoral syndrome treatment

-focus dependent on contributing factors associated with the abnormal patellar tracking -possible tx options: palliative modalities to decrease inflammation and pain, LE flexibility exercises, medial patella glides, biofeedback, and patella taping -LE strengthening should emphasize the quads and in particular, the VMO, while minimizing patellofemoral compressive forces

Congenital hip dysplasia treatment

-focus of tx depends on age, severity and initial attempts to reposition the femoral head within the acetabulum through the constant use of a harness, bracing, splinting or traction -Pavlik harness/brace - M position, hips are flexed and abducted -Open reduction with subsequent application of a hip spica cast may be required if conservative tx fails -PT may be indicated after cast removal for stretching, strengthening, and caregiver education

Scoliosis treatment

-focus of tx: determined based on magnitude of the curve and the degree of progression -if the curve is not progressing, generally no formal action is taken -PT tx includes muscle strengthening and flexibility exercises, shoe lifts and bracing -a spinal orthosis is often warranted with a curve that ranges between 25 and 40° -Surgical intervention may be required with curves greater than 40 degrees

Congenital limb deficiencies treatment

-focus on symmetrical movements, strengthening, rom, weight bearing activities, and prosthetic training when appropriate

Total shoulder arthroplasty(TSH)

-for rotator cuff pathology, avascular necrosis, OA, shoulder pathology failed with conservative intervention -*common post-operative complication* : Joint instability >> Rotator cuff tears > Nerve injury -contraindication: *active joint infection, absent deltoid function*

Calcaneovalgus(infant)

-forefoot is lateral, the hind foot is in valgus, foot is in foil dorsiflexion

boxer's fracture

-fracture of *neck of 5th metacarpal* -can occur during fight/ punching wall -cast for 2-4weeks

Bankart fracture

-fracture of the inferior glenoid rim accompanied by *Bankart lesion* -associated with an *anterpinferior glenohumeral dislocation*

Scotty dog fracture

-fracture of the pars interarticularis

Equinus

-from congenital bone deformity, neurological disorder(CP) -plantar flexed foot -Tx: flexibility exercise, joint mobilization, orthotic management, strengthen intrinsic muscles

Delayed onset of muscle soreness

-from eccentric exercise -begins 12-24 hours after exercise, last 10-14days

Erb's palsy

-from mechanical trauma during delivery -potential cause: use of forceps, breech presentation, excessive pulling, high birth weight (poorly controlled DM) -paralysis of the arm caused by injury to the upper group of the arm's main nerves, specifically the severing of the upper trunk C5-C6 nerves -**Waiter's tip position**: shoulder in.rotation + hand pronation + wrist flexion -initial POC: partial immobilization of the limb across the abdomen and then gentle PROM -* mobilization, splint ->contraindication *

Congenital torticolllis

-from utero restrictions and perinatal trauma -*not typically observed immediately* after delivery -unilaterally involving the SCM muscle with firm non-tender mass

Gout

-genetic disorder of purine metabolism characterized by elevated serum uric acid (hyperuricemia) -Uric acid changes into crystals and deposits into peripheral joints and other tissues (eg, kidneys) -most frequently observed at knee and great toe of foot

Scoliosis screening test in a school setting

-girl: 9-11years old, boy: 11-13years old

Rheumatoid Arthritis treatment

-goal of tx: reduce inflammation and pain, promote joint function, and prevent joint destruction and deformity -Pharmacological management includes NSAIDs to reduce inflammation and pain -Corticosteroid meds may be desirable during severe flare-ups or when the patient's condition is not responding to NSAIDs -Disease-modifying antirheumatic meds are slow-acting and take weeks or months to become effective, however, they have the ability to slow the progression of joint destruction and deformity -PT interventions include passive and active ROM, heating and cooling agents, splinting, patient education, energy conservation, body mechanics, and joint protection techniques

Exercise with chondromalacia patella

-goal: promote *proper patellar tracking* -type:* isometric exercises* such as quadriceps setting and straight leg raises (SLR) ->less patellofemoral joint reaction-> less pain evoke

Osteoarthritis treatment

-gradual onset of pain present at the affected joint, increased pain after exercise, increased pain with weather changes, enlarged joints, crepitus, stiffness, limited joint ROM, Heberden's nodes, and Bouchard's nodes -Blood tests are not helpful in diagnosing osteoarthritis -Radiographs may show diminished joint space or a bone spur

Female athlete's increased risk of ACL injury.

-greater joint laxity than male -significantly less strength in Q-muscle & hamstring -narrow *intercondylar notch* -larger Q-muscle ->patella-femoral tracking dysfunction, insufficiency of VMO

Dermatome testing of the Little finger and ulnar border of the hand tests what innervation level?

C8

Total hip arthroplasty precautions - Direct lateral approach

-leaves the posterior portion of the gluteus medius attached to the greater trochanter -It requires longitudinal division of the tensor fasciae latae and vastus lateralis, along with a release of the anterior portion of the glut medius -Since the posterior soft tissues and capsule are left intact, the approach minimizes the probability of dislocation and may be ideal for noncompliant patients -PRECAUTIONS: Avoid hip flexion beyond 90°, hip extension, lateral rotation and adduction

Knee ROM

-limited AROM & PROM: tightness of the hamstrings, capsular restriction, bony obstruction -limited AROM with full PROM:**Inhibition of the quadriceps** (pain ,effusion, weakness)

TMJ>Capsular-ligament pattern

-limited opening with lateral deviation to involved side -lateral deviation *greater to the uninvolved side*

TMJ>Anterior disc displacement

-limited opening with lateral deviation to involved side -lateral deviation *lesser to the uninvolved side* -protrusion with deflection to invoved side -acute Tx: aggresive mobilization for 3-4times -Tx:exercise that avoid painful click such as hinge axis and midline opening

Congenital limb deficiencies

-malformation that occurs in utero, secondary to an altered developmental course -classified as longitudinal or transverse -longitudinal: reduction or absence of an element or elements withint he long axis of the bone -transverse: a limb that has developed to a particular level beyond which no skeletal elements exist

Multiple myeloma

-malignancy affecting the bone marrow -typically presents in patients older than 50 years of age -pain medication, bone marrow transplant

Ewing's sarcoma

-malignancy in the long and flat bones -most commonly in spine, pelvis, and long bones of extremities Patrick Ewing is long so he has long bones

Chondrosarcoma

-malignant bone tumor -most frequently in adults over 40 years of age -frequently in the pelvis, ribs, and ilium -surgical excision, chemotherapy

Meniscus Tear

-medial and lateral menisci are firmly attached to the proximal surface of the tibia -menisci are thick at the periphery and thinner at their internal unattached edges -medial meniscus is more commonly injured than the lateral meniscus because it is less mobile due to its attachment to the joint capsule -The incidence of medial meniscal tears increases significantly over time with ACL deficiency -meniscal injuries are definitively diagnosed by arthoscopy or magnetic resonance imaging

Scapula winging

-medial winging: *long thoracic nerve* -rotary winging: accessory nerve

Trimalleolar fracture

-median, lateral malleolus + post. tubercle of the distal tibia

Meniscus Tear Etiology

-meniscal injuries are usually associated with fixed foot rotation while weight bearing on a flexed knee (this action produces compression and rotational forces on the meniscus)

Osteoporosis

-metabolic bone disorder -rate of bone resorption accelerates while the rate of bone formation decreases *(osteoclast activity > osteoblast activity)* -most common fracture: *vertebrae* -annual screening test: height

High risk of Achilles tendon rupture

-more typically associated with activities that require *quick* footwork (ex>tennis, basketball) -*male between 30-50* -*inconsistent exercise*( weekend, monthly basis)

PCL sprain etiology

-most common causes are landing on the tibia with a flexed knee or hitting a dashboard in a motor vehicle accident with a flexed knee -isolated PCL tears are not common and often involve other knee structures such as the ACL, MCL, LCL, and menisci

Juvenile Rheumatoid arthritis

-most common chronic rheumatic disease in children -presents with inflammation fo the joints and connective tissue -Classification of JRA includes: systemic, polyarticular, and oligoarticular

Shin splint (anterior tibial periostitis)

-musculotendinous overuse of *TA, EHL* Three common etiologies: -Abnormal biomechanical alignment -poor conditioning -improper training methods -Tx: correction muscle imbalance, flexibility exercise

Lower limb alignment

-newborn: moderate genu varum -2 years: physiological genu valgum -4 to 6 years: leg straight in normal alignment

Patella cartilage

-no knee pain resource * Hyaline cartilage: avascular, aneural, hydrophilic (70-80%), deform under compressive loading

Anterior capsulolabral reconstruction

-no trauma to the shoulder musculature is involved -AROM can begin immediately after surgery

Arthrogryposis multiplex congenita (AMC)

-non-progressive neuromuscular disorder -*multiple congenital contractures at birth* -cylinder-like extremities, significant and multiple contractures, dislocation of joints, muscle atrophy -limitation of ROM & strength=> preclude reaching developmental milestone

Jersey finger

-occurs by forceful passive extension while the *flexor digitorum profundus* is contracting -while attempting to make a tackle

Thoracic outlet syndrome

-occurs due to compression, injury, or irritation involving *subclavian vein, subclavian artery, and lower trunks of the brachial plexus* -muscle tightness : *pectoralis major &minor muscles, subclavius muscle, ant. & middle scalene muscle* -symptoms: diffuse arm pain especially at night, paresthesias, and upper extremity weakness. -exacerbated by poor posture and activities such as overhead movement ,lifting activities, throwing activities, some sleeping positions -*special test: Adson's, hyperabduction, costoclavicular test, Roo's test* -Tx: pectoralis and scalenus stretching, Maitland grade 5 thrust of the 1st rib

Shoulder dislocation

-often *immobilized for several weeks* following a primary shoulder dislocation for damaged tissue healing and necessary functional requirements -experience recurrent dislocations, ultimately require surgical intervention.

Plantar Fasciitis etiology

-often associated with a cavus foot with excessive rosion and hyperprontation -condition most common in patients between 40 and 60 years old

Total hip arthroplasty

-removal of the proximal and distal joint surfaces of the hip with subsequent replacement by an acetabular component and a femoral implant -The acetabular component is most often press fit into place, although it is occasionally held in place by screws -bone is removed from the femur with subsequent shaping to accept the femoral stem with the attached prosthetic femoral head -the surgical procedure can utilize an anterolateral, direct lateral or posterolateral approach -the type of approach selected determines the necessary hip precautions post-op -Fixation can be cemented or cementless -Cemented fixation: allows WBAT on the involved LE, often immediately, since the cement achieves maximum fixation in approximately 15 min -Cementless and hybrid fixation rely on bone growth and may dictate PWB or NWB initially -The level of WB is determined by the surgeon, typically based on the mechanical fixation of the prosthesis -Bed positioning with a wedge to prevent adduction. -primary indication for cementless fixatino is a young, active individual (eg, less than 65 years of age) -Minimally invasive surgical techniques require one or two incisions, usually less than 10cm in length -benefit of minimally invasive procedures is less soft tissue trauma and an accelerated post-op recovery -average lifespan of total hip arthroplasty is 15 to 20 years, and as a result, younger individuals may need one or more revision procedures in their lifetime -Complications for THA include deep vein thrombosis, infection, pulmonary embolus, heterotopic ossification, femoral fx, dislocation, and neurovascular injury

Achilles tendonitis etiology

-repetitive overload of Achilles tendon often caused by changes in training intensity or faulty technique -increased risk in patients with limited flexibility and strength in the gastroc-soleus and patients with a pronated or cavus foot -Activities associated with Achilles tendonitis: running, basketball, gymnastics, and dancing -history of Achilles tendonitis increases likelihood of Achilles tendon rupture later in life

Patellofemoral syndrome etiology

-repetitive overuse disorder resulting from increased force at the patellofemoral joint -Factors associated with increased force at the patellofemoral joint include: decreased quad strength, decreased LE flexibility, patellar instability, increased tibial torsion or anteversion -Patients at increased risk for developing patellofemoral syndrome include females, individuals experiencing a growth spurt, runners who have recently increased mileage, and overweight individuals

Resistive training

-result in *hypertrophy of muscle fiber* and increase *recruitment of motor units* -> generate increased amount of force

Medial Collateral Ligament Sprain

-runs from slightly above the medial femoral epicondyle to the medial aspect of the shaft of the tibia -often involves injury to other knee structures such as the ACL or medial meniscus

Saphenous nerve impingement

-saphenous nerve distributes over distal anteromedial knee -can be compressed as it exits the *adductor canal* -flexion of the knee *past 60°* can reproduce burning pain

Possible abnormalites of patients with priformis synrome

-shortened stride length -functional shortening of affected limb -external rotation of hip in standing -decreased lumbar lordosis

Scoliosis signs and symptoms

-shoulder level asymmetry with or without the presence of a rib hump -pain is not typically associated with the spinal curvature, rather it is a result of the abnormal forces placed on other tissues of the body due to the curvature

Best position to expose *supraspinatus tendon*

-slight abduction + int.rotation (IER) -adduction + int. rotation+ extension (Saunders)

Osteochondritis dissecans

-small area of bone and cartilage loses its blood supply -*pain, stiffness, occasional locking* -average age of 10 and 20 years of age.

TMJ>Intervention for painful anterior displaced disc with reduction

-stabilization exercises within the click free range -*reciprocal clicking* during opening and closing -may need anterior stabilization splinting if painful clicking and catching persists

Relative muscle with pain in the ear

-sternocleidomastoid trigger point, deep masseter trigger point, temporomandibular joint

Congenital limb deficiencies signs and symptoms

-structural or acquired abnormality of a limb -phantom limb pain

Gluteus medius tendonitis

-symptoms similar to those of trochanteric bursitis -difficult to differentiate without diagnostic injection

Rheumatoid Arthritis

-systemic autoimmune disorder of unknown etiology -the disease presents with a chronic inflammatory reaction in the synovial tissues of a joint that results in erosion of cartilage and supporting structures within the capsule -Onset of RA may initially occur at any joint, but it is common in the small joints of the hand, foot, wrist, and ankle -This disease has periods of exacerbation and remission -RA is diagnosed based on the clinical presentation of involved joints, the presence of blood rheumatoid factor, and radiographic changes

Plantar Fasciitis signs and symptoms

-tenderness at the insertion of the plantar fascia, presence of a heel spur, pain that is worse in the morning or after periods of prolonged inactivity, difficulty with prolonged standing, and pain when walking in bare feet

Tibiofibular syndesmosis

-tests the integrity of the tibiofibular syndesmosis-> passive rotation of the lower leg

Throwing arm>most common cause

-throwing curb balls

FAIR test

-to assess for piriformis syndrome -*flexion+abduction+int.rotation of hip* -Passive internal rotation & resisted external rotation-> painful

Transverse ligament stress test

-to assess the integrity of the transverse ligament which maintains the *position of dens of C2 with ant. arch C1*

Bicycle(Van Gelderen's) test

-to differentiate spinal stenosis from intermittent vascular claudication

Legg-Calve-Perthes Disease etiology

-trauma, genetic predisposition, synovitis, vascular abnormalities, infection

Resistive testing of thumb extension tests what innervation level?

C8

The Glut med, Glut min, Piriformis, and Obturator internus ________ the hip joint.

ABD

What is the closed pack position of the GH joint?

ABD and lateral rotation

What is the closed packed position of the glenohumeral joint?

ABD and lateral rotation

What is the common capsular pattern for the trapeziometacarpal joint?

ABD, extension

Special Tests (structure being tested & procedure): AC shear test

AC joint dysfunction (arthritis, seperation etc) Sitting, arm at side PT clasps hands with heel of one hand on spine of scapula, other on clavicle Squeeze hands to compress AC

Which ligament may be injured by a noncontact twisting injury associated with hyperextension and varus or valgus stress to the knee?

ACL

Which ligament may be injured when the femur is driven posteriorly on the tibia?

ACL

Which ligament may be injured when the tibia is driven anteriorly on the femur?

ACL

Which ligament may be injured with severe knee hyperextension?

ACL

Special Tests (structure being tested & procedure): Lachman

ACL Supine, knee flexed 20-30 degrees Anterior draw

Which other structures are also injured with an MCL injury?

ACL, medial meniscus

Boston Brace commonly used for

AKA TLSO idiopathic Scoliosis, for curves between 25-40 degrees worn 18-23 hours/day

Lateral epicondylitis

AKA Tennis Elbow -irritation or inflammation of the common extensor muscles at their origin on the lateral epicondyle of the humerus, MC involves a chronic degenerative condition of the ECRB. -Individuals who take part in racquet sports or activities requiring throwing are at the greatest risk for developing lateral epicondylitis

What is the purpose of the iliofemoral ligament?

AKA Y Ligament or Ligament of Bigelow a. Prevents excessive hip extension b. Assists to maintain upright posture

What system is used to produce ATP during high intensity, short duration exercises and provides muscle contraction up to 15 s (ie. sprinting 100m)?

ATP-PC (Phosphagen) System

What are the body's three sources of ATP?

ATP-PC (Phosphagen) System, Anaerobic Glycolysis (Lactic Acid) System, and Aerobic (Oxygen) System

Capsular pattern: Trapeziometacarpal

Abduction, extension

Dorsal Interossei action

Abducts fingers at MCP joint

Abductor Digiti Minimi action

Abducts the MCP joint of the fifth digit

Abductor Pollicis Brevis action

Abducts the thumb (CMC joint)

Abductor Pollicis Longus action

Abducts thumb

Special Tests (structure being tested & procedure): Craig's test

Abnormal femoral anteversion angle Prone, knee flexed to 90 degrees Palpate greater trochanter, move hip through IR/ER When greater trochanter feels most lateral, measure angle of leg relative to perpendicular (norm= 8-15 degrees; <8 = retroverted; >15=anteverted)

Ottawa Knee Rules

According to the Ottawa knee rules, a patient who is post acute knee trauma should be referred for radiographs if any of the following five criteria are present: age 55 years or older, tenderness at the fibular head or patella, inability to flex the knee greater than 90°, or inability to weight-bear for four steps

Reflexes: S1/2

Achilles

Special Tests (structure being tested & procedure): Thompson test

Achilles tendon integrity Prone, foot off edge if plinth Squeeze calf (no movement = rupture)

What system supplies ATP during high intensity, short duration exercises and provides muscle contraction for 30 - 40s (ie. sprinting 400 or 800m)?

Anaerobic glycolysis system

Special Tests (structure being tested & procedure): Q-angle

Angle between quads muscle and patellar tendon (Norms: M=13 deg; F=18 deg)

Manual Grading of Accessory Joint Motion: 0

Ankylosed

Osteo/arthrokinematics: Subtalar Shape of moving bone articular surface Opposite/Same direction

Anterior & middle calcaneus: Concave, same Posterior calcaneus: Convex, opposite

What special tests can be used for ACL sprain?

Anterior drawer test, Lachman test, and lateral pivot shift test

Bursae Locations: Superficial Patellar

Anterior to patella ligament

Head of femur orientation

Anteriorly, medially, superiorly

What special tests can be used for meniscal pathology?

Apley's compression test, bounce home test and McMurray test

What is the closed pack position of the AC joint?

Arm abducted to 90°

What is the loose packed position of the AC joint?

Arm resting by side

What is the loose packed position of the SC joint?

Arm resting by side

What may anterior shoulder fullness indicate?

Articular effusion secondary to distention of the bursa

A posterior rotation on the involved leg (right) during sacroiliac joint involvement

As a result, the leg at the side of the posterior rotation will be shorter in supine position and longer in sitting position.

Special Tests (structure being tested & procedure): Ipsilateral anterior rotation test

Assess anterior movement of ilium relative to sacrum PT thumb under PSIS of limb to be tested, other thumb at center of sacrum at the same level and other thumb Patient extends hip of test limb Assess PSIS movement (PSIS should move superiorly) (Positive if no movement as compared to sacrum)

Special Tests (structure being tested & procedure): Ludington's test

Assess for long head of biceps rupture Sitting Hands behind head, fingers interlocked Pt alternately contracts and relaxes biceps muscles Absense of movement = rupture

Special Tests (structure being tested & procedure): Gillet's test

Assess movement of ilium relative to sacrum Standing PT thumb under PSIS of limb to be tested, other thumb on center of sacrum at same level as thumb under PSIS Patient flexes hip and knee of test limb Assess movement by comparing thumb position (PSIS should move inferiorly) (Positive if no movement of PSIS relative to sacrum)

Special Tests (structure being tested & procedure): Anterior shear test

Assesses integrity of upper CxSp ligaments/capsules Supine PA C2-C7 (should be firm end-feel) (Positive if end-feel is soft, dizziness, nystagmus, lump in throat, nausea etc.)

Special Tests (structure being tested & procedure): VBI test

Assesses integrity of vertebrobasilar vascular system Supine, head supported Progress through following procedures if no symptoms produced after each step 1) Extend head and neck for 30 seconds 2) Extend head and neck with left then right rotation for 30 seconds 3) Cradle head off the table and extend head and neck for 30 seconds 4) Cradle head off the table and extend head and neck with rotation left then right for 30 seconds (positive if dizziness, visual disturbances, disorientation, blurred speech, nausea or vomiting occur) (MOBS/MANIPS AT CxSp WITHOUT TESTING VBI FIRST IS A BREACH OF CARE)

Scapulothoracic & Glenohumeral rhythm

At 75 degrees shoulder flexion, humerus external rotates to prevent compression of greaster tuberosity on acromion. 180 degrees abduction: 2:1 movement ratio 1st 30-60 degrees at GHJ 120 degrees of total movement occurs at GHJ 60 degrees of total movement occurs at scapulothoracic joint

Glenoid fossa position and shape

At lateral angle Pear-shaped Faces anteriorly, laterally and superiorly Places true abduction at 30 degrees anterior to frontal plane

Neuro/Musculo screen (root origins of peripheral nerves): Medial cutaneous (arm and forearm)

C8-T1 (medial cord)

Neuro/Musculo screen (root origins of peripheral nerves): Medial pectoral

C8-T1 (medial cord)

Corocohumeral ligament: Attachments and function

Base of coracoid to greater and lesser tubercles of the humerus. Reinforces biceps tendon and superior capsule Prevents caudal dislocation (Taut with external rotation)

Bursae Locations: Deep trochanteric

Between gluteaus maximus and posterior lateral greater trochanter (may cause pain on hip flexion and internal rotation due to compression of gluteus maximus)

Bursae Locations: Subtendinous iliac

Between hip and os pubis

Bursae Locations: Ischiofemoral

Between ischial tuberosity and gluteus maximus

Bursae Locations: Suprapatellar

Between patella and tibiofemoral joint

Bursae Locations: Deep infrapatellar

Between patellar ligament and tibial tuberosity

Bursae Locations: Pes anserine bursa

Between pes anserinus and MCL

Bursae Locations: Semimembranosus

Between semimembranosus and femoral condyle

Bursae Locations: Prepatellar

Between skin and distal patella

Bursae Locations: Iliopectineal

Between tendon of illiopsoas and capsule (close to femoral nerve)

Where is the superificial infrapatellar bursa located?

Between the patellar tendon and the skin

Where is the deep infrapatellar bursa located?

Between the patellar tendon and the tibia

Neuro/Musculo screen (muscles supplied by peripheral nerves): Musculocutaneous

Biceps brachii, corocobrachialis, brachialis

Neuro/Musculo screen (muscles supplied by peripheral nerves): Common peroneal

Biceps femoris (short head)

Special Tests (structure being tested & procedure): Speed's

Bicipital tendonitis/osis 90 deg shoulder flexion, full elbow extension, supination Resist shoulder flexion

What is a skinfold measurement?

Body composition: Anthropometry: determines overall % body fat through the measurement of nine standardized sites; correlation relies on the theory that the amount of subcutaneous fat is proportional to the total fat in the body

What is plethysmography?

Body composition: Densitometry: calculates the density of the body utilizing the amount of air displaced during testing with a specialized closed chamber; change in pressure within the chamber is measured and converted to the % body fat using a standardized equation

What is hydrostatic weighing?

Body composition: Densitometry: immersing a person in water and measuring amount of water displaced; % body fat determined by calculating the measured amount of water displaced in an equation based on Archimedes' principle

Imaging uses: X-Ray

Bone dysfunction/disease

Hard end-feel

Bone/cartilage approximation

Reflexes: C6

Brachioradialis

Neuro/Musculo screen (root origins of peripheral nerves): Ulnar

C8-T1 (medial cord)

Resistive testing of cervical rotation tests what innervation level?

C1

Dermatome testing of the posterior head tests what innervation level?

C2

Resistive testing of shoulder elevation tests what innervation level?

C2-4

Dermatome testing of the posterior-lateral neck tests what innervation level?

C3

Dermatome testing of the AC joint tests what innervation level?

C4

Dermatome testing of the lateral arm tests what innervation level?

C5

Reflex testing of the biceps tests what innervation level?

C5

Resistive testing of shoulder abduction tests what innervation level?

C5

Neuro/Musculo screen (root origins of peripheral nerves): Dorsal scapular

C5 (C5 nerve root)

Resistive testing of elbow flexion tests what innervation level?

C5-6

Neuro/Musculo screen (root origins of peripheral nerves): Subclavian

C5-C6 (upper trunk)

Neuro/Musculo screen (root origins of peripheral nerves): Suprascapular

C5-C6 (upper trunk)

Neuro/Musculo screen (root origins of peripheral nerves): Long thoracic

C5-C7 (C5-C7 nerve roots)

Neuro/Musculo screen (root origins of peripheral nerves): Lateral pectoral

C5-C7 (lateral cord)

Neuro/Musculo screen (root origins of peripheral nerves): Musculocutaneous

C5-C7 (lateral cord)

Neuro/Musculo screen (root origins of peripheral nerves): Median

C5-T1 (lateral and medial cords)

Neuro/Musculo screen (root origins of peripheral nerves): Axillary

C5-T1 (posterior cord)

Neuro/Musculo screen (root origins of peripheral nerves): Radial

C5-T1 (posterior cord)

Neuro/Musculo screen (root origins of peripheral nerves): Thoracodorsal

C5-T1 (posterior cord)

Neuro/Musculo screen (root origins of peripheral nerves): Upper and lower subscapular

C5-T1 (posterior cord)

Dermatome testing of the lateral forearm and thumb tests what innervation level?

C6

Reflex testing of the brachioradialis tests what innervation level?

C6

Resistive testing of wrist extension tests what innervation level?

C6

Dermatome testing of the palmar distal phalanx - middle finger tests what innervation level?

C7

Reflex testing of the triceps tests what innervation level?

C7

Resistive testing of elbow extension tests what innervation level?

C7

Resistive testing of wrist flexion tests what innervation level?

C7

Total Hip Replacement cemented vs noncomented

Cemented hips can tolerate full WB immediately following surgery. Cement may crack with aging, causing a loosening of prosthesis. Noncemented technique is more stresful on bones during the surgical procedure. Noncemented procedures are typically used with younger and/or more active individuals. Cemented technique may be better for individuals with fragile bones, or for those who will benefit from immediate ability to weight bear; e.g. those with dementia or significant debilitation.

Vertebral canal

Cervical(triangular)>lumbar>thoracic(circular)

Special Tests (structure being tested & procedure): Neutral subtalar positioning

Check for abnormal forefoot/rearfoot positioning Prone, foot over edge of plinth Palpate dorsal talus on both sides with one hand, lateral forefoot with other hand DF until resistance is felt, move through supination/pronation Neutral=point at which foot falls off easier to one side or the other At neutral compare rearfoot to forefoot

What is the most common lever class in the body?

Class 3 lever

Where is the carpal tunnel located?

Close to the deep surface of the flexor retinaculum

Close/Loose-Packed position: Humeroradial

Close: 90 degrees flexion; 5 degrees supination Loose: Maximal extension and supination

Close/Loose-Packed position: Hip

Close: Ligamentous: Maximal extension; maximal abduction; maximal internal rotation Bony: 90 degrees flexion; slight abduction; slight external rotation Loose: 30 degrees flexion; 30 degrees abduction; slight external rotation

Close/Loose-Packed position: Glenohumeral

Close: Maximal abduction and external rotation Loose: 55-70 degrees abduction; 30 degrees horizontal adduction; neutral rotation

Close/Loose-Packed position: Talocrural

Close: Maximal dorsiflexion Loose: Midway between inversion/eversion; 10 degrees plantarflexion

Close/Loose-Packed position: Proximal interphalangeal (hand)

Close: Maximal extension Loose: 10 degrees flexion

Close/Loose-Packed position: Metatarsophalangeal

Close: Maximal extension Loose: Neutral (10 degrees extension)

Close/Loose-Packed position: Midcarpal

Close: Maximal extension Loose: Neutral; slight flexion; slight ulnar deviation

Close/Loose-Packed position: Interphalangeal (foot)

Close: Maximal extension Loose: Slight flexion

Close/Loose-Packed position: 1st Metacarpophlangeal

Close: Maximal extension Loose: Slight flexion

Close/Loose-Packed position: Humeroulnar

Close: Maximal extension and supination Loose: 70 degrees flexion; 10 degrees supination

Close/Loose-Packed position: Knee

Close: Maximal extension; maximal external rotation of the tibia Loose: 25 degrees flexion

Close/Loose-Packed position: Radiocarpal

Close: Maximal extension; radial deviation Loose: Neutral; slight ulnar deviation

Close/Loose-Packed position: Metacarpophalangeal 2-5

Close: Maximal flexion Loose: Slight flexion; ulnar deviation

Close/Loose-Packed position: Subtalar

Close: Maximal inversion Loose: Midway between extremes of ROM; 10 degrees plantar flexion

Close/Loose-Packed position: Carpometacarpal (2-5)

Close: Maximal opposition Loose: Midway between flexion/extension

Close/Loose-Packed position: Trapeziometacarpal

Close: Maximal opposition Loose: Midway between flexion/extension and adduction/abduction

Close/Loose-Packed position: TMJ

Close: Maximal retrusion (teeth clenched) or maximal anterior position (mouth maximally opened) Loose: Jaw slightly open

Close/Loose-Packed position: Sternoclavicular

Close: Maximal shoulder elevation Loose: Arm resting at side

Close/Loose-Packed position: Midtarsal

Close: Maximal supination Loose: Midway between extremes of ROM; 10 degrees plantar flexion

Close/Loose-Packed position: Tarsometatarsal

Close: Maximal supination Loose: Midway between supination/pronation

Colle's Fracture vs Smith's Fracture

Colle's Fracture - distal radius fracture, MC wrist fracture, resulting from a FOOSH. These fractures are immobilized for 5-8 weeks. Complication of median nerve compression can occur with excessive edema. Characteristic "dinner fork" deformity of wrist and hand results from a dorsal or posterior displacement of distal fragment of radius, with a radial shift of wrist and hand. Smith's Fracture - similar to Colle's except distal fragment of radius dislocates in a volar direction, causing a "garden spade" deformity x-ray

Special Tests (structure being tested & procedure): Femoral nerve traction test

Compression of femoral nerve Lie on non-painful side, trunk neutral, slight head flexion, lower-limb hip and knee flexed Passively extend hip while knee of painful limb is in extension If no symptoms, flex knee of painful leg (Positive if neuro pain in anterior thigh)

Special Tests (structure being tested & procedure): Quadrant

Compression of neural structures at IV foramen and facet dysfunction Standing: 1) IV foramen: Side bend left, rotation left, extension. Repeat to right. 2) Facet: Side bend left, rotation right, extension. Repeat to right. (Positive if pain/paresthesia (IV foramen) or localized pain (facet).

Special Tests (structure being tested & procedure): Maximum cervical compression test

Compression of neural structures at IV foramen and/or facet dysfunction Sitting Passively sidebend and rotate head towards non-painful side followed by extension Repeat towards painful side (BE CAREFUL-VERY SIMILAR TO VBI TEST) (Positive if pain/paresthesia (nerve root) or localized neck pain (facet dysfunction)

Neuro/Musculo screen (muscles supplied by peripheral nerves): Long thoracic

Serratus anterior

Special Tests (structure being tested & procedure): Noble compression test

Distal ITB friction syndrome Supine, hip flexed to 45 degrees, knee flexed to 90 Apply pressure to lateral femoral epicondyle, extend knee (positive if pain reproduced over lateral epicondyle - should be at ~ 30 deg flexion)

What forms the proximal joint surface of the radiocarpal joint?

Distal radius and radioulnar articular disc which connects medial aspect of distal radius to distal ulna

Which of the following mobilization techniques for the radiocarpal joint would be MOST appropriate for increasing limited wrist flexion range of motion?

Dorsal glide

What is the only major ligament on the dorsal surface of the wrist?

Dorsal radiocarpal ligament

The tibialis anterior, extensor hallucis longus, extensor digitorum longus, peroneus tertius ________ the ankle joint.

Dorsiflex

Myotomes: L4

Dorsiflexion

The rhomboids, levator scap, and pec minor ________ ________ the scapula.

Downwardly rotate

Special Tests (structure being tested & procedure): Foraminal compression (Spurling's test)

Dysfunction (usually compression) of CxSp nerve root Sitting with head sidebent towards uninvolved side Apply pressure straight down through the head Repeat with sidebend the other way (Positive if pain and/or paresthesia in dermatomal pattern for involved nerve root)

Special Tests (structure being tested & procedure): Slump test

Dysfunction of neurological structures supplying LL Sitting on edge of plinth, knees flexed Slump while maintaining neutral head and neck Progress through following steps if no symptoms: 1) Passive head and neck flexion 2) Passive knee extension 3) Passive DF of extended leg 4) Repeat with other leg (positive if near symptoms reproduced)

Special Tests (structure being tested & procedure): Lasegue's (SLR)

Dysfunction of neurological structures supplying LL Supine Passively flex hip with knee extended until shooting pain occurs Slowly lowers until pain subsides, DF foot (Positive if near symptoms reproduced when foot is DF)

Special Tests (structure being tested & procedure): Lhermitte's sign

Dysfunction of spinal cord and/or UMNL Long sitting Passively flex head and one hip while keeping knee extended Repeat with other hip (Positive if pain down the spine and into limbs)

Ulnar Nerve Entrapment

ECG

Special Tests (structure being tested & procedure): Rib Springing

Evaluates rib mobility Prone PA ribs beginning at upper ribs Repeat in sidelying (BE CAREFUL WITH RIBS 11 & 12 - NO ANT. ATTACHMENT = LESS STABLE) (positive if motions is increased or restricted

The peroneus longus, peroneus brevis, and peroneus tertius ________ the ankle joint.

Evert

Boggy end-feel

Edema; joint swelling

Myotomes: C7

Elbow extension, ulnar wrist flexion

Myotomes: C6

Elbow flexion, radial wrist extension

Osteo/arthrokinematics: Sternoclavicular Shape of moving bone articular surface Opposite/Same direction

Elevation/Depression: Convex, opposite Protraction/Retraction: Concave, same

What special tests can be used to used to identify contractures or tightness of the hip?

Ely's test, Ober's test, piriformis test, Thomas test, tripod sign, and 90-90 SLR test

Capsular pattern: Carpometacarpals 2-5

Equal in all directions

Capsular pattern: Midcarpal

Equal in all directions

Trunk/Ribcage musculo/neuro testing (muscles, cord segment, nerves): Spine extension

Erector spinae, transversospinalis, interspinales, rotatores, intertransversarii (T1-T12, L1-L5, S1-S3)

Spinal/Intervertebral Stenosis

Etiology: narrowing of spinal canal or intervertebral foramen, coupled with hypertrophy of the spinal lamina and ligamentum flavum or facets, as the result of age-related degenerative processes or disease. Results in vascular and/or neural compromise S/S -Bilateral pain and paresthesia in back, buttocks and LE -pain decreases with flexion, increases with extension - pain increases with extension -pain relieved with prolonged rest x-ray, MRI, CT clinical examination include: bicycle (van Gelderen's test) PT -flexion based exercises -exercises that promote dynamic stability through trunk and pelvis -avoid extension and/or positions that narrow the spinal canal or intervertebral foramen -traction - C spin positioned at 15 degrees flexion

Extensor Pollicis Brevis action

Extends CMC and MCP joints of the thumb

Extensor Digiti Minimi action

Extends all three joints of the fifth digit

Flexor Tendon repair UE

First 3-4 weeks, distal extremity is immobilized with a protective splint, with wrist and digits flexed. Rubbert band traction is applied to maintain IPJ in 30-50 degrees of passive flexion. PT goals: -Pt can perform resisted extension and passive flexion within constraints of splint. AROM to tolerance is initiated at 4 weeks. -Goals is to manage all soft tissues through wound-healing pahses by providing colllagen remodeling, which preserves free tendon gliding -early intervention consists of wound management, edema control and passive exercises. -Active extension exercises are initiated followed by flexion -resistive and functional exercises are introduced when full AROM is achieved.

The anterior deltoid, coracobrachialis, pec major, and biceps brachii ________ the shoulder joint.

Flex

The biceps brachii, brachialis, and brachioradialis ________ the elbow joint.

Flex

The biceps femoris, semitendinosus, semimembranosus, and Sartorius ________ the knee joint.

Flex

The flexor carpi radialis, flexor carpi ulnaris, and Palmaris longus ________ the wrist joint.

Flex

Lumbricals action

Flex the MCP joint while extending the PIP and DIP joints

Flexor Digiti Minimi action

Flexes CMC and MCP joints of the fifth digit

Flexor Pollicis Brevis action

Flexes CMC and MCP joints of the thumb

The sternocleidomastoid, longus colli, and scalenus muscles all cause ________ of the cervical intervertebral joints.

Flexion

Capsular pattern: Tibiofemoral

Flexion (++), extension (minor)

Capsular pattern: Wrist

Flexion and extension

Capsular pattern: Hip

Flexion and internal rotation, abduction, adduction and external rotation (add/ER limitation = little to none)

What is the capsular pattern of the iliofemoral joint?

Flexion, ABD, medial rotation (sometimes medial rotation is most limited)

Capsular pattern: Humeroradial

Flexion, extension

Capsular pattern: Humeroulnar

Flexion, extension

Capsular pattern: MCPs and IPs (hand)

Flexion, extension

What is the capsular pattern of the tibiofemoral joint?

Flexion, extension

ROM norms: 1st CMC

Flexion/Extension 45-50/0 Abd/Add: 60-70/30

ROM norms: PIP

Flexion/Extension: 100-115/0

ROM norms: Elbow

Flexion/Extension: 140-150/0-10 Supination/Pronation: 90/80-90

ROM norms: Shoulder

Flexion/Extension: 160-180/50-60 Abd/Add: 170-180/50-75 ER/IR: 80-90/60-100 Horizontal add: 130-145

ROM norms: Thoracic Spine

Flexion/Extension: 20-45/25-45 Sidebend: 20-40 Rotation: 35-50

ROM norms: Lumbar Spine

Flexion/Extension: 40-60/20-35 Sidebend: 15-20 Rotation: 3-18

ROM norms: 2nd-5th MTP

Flexion/Extension: 40/40

ROM norms: 1st MTP

Flexion/Extension: 45/70

ROM norms: 1st MCP flexion/ext

Flexion/Extension: 50-55/0

ROM norms: DIP

Flexion/Extension: 80-90/20

ROM norms: Cervical Spine

Flexion/Extension: 80-90/70 Sidebend: 20-45 Rotation: 70-90

ROM norms: Wrist

Flexion/Extension: 80-90/70-90 Radial/Ulnar deviation: 15/30-45

ROM norms: 1st IP (thumb)

Flexion/Extension: 85-90/0-5

ROM norms: MCP

Flexion/Extension: 85-90/30-45

ROM norms: 1st IP (toe)

Flexion/Extension: 90/0

ROM norms: 2nd-5th PIP

Flexion: 0-100

ROM norms: 2nd-5th DIP

Flexion: 0-90 Extension: 0-10

ROM norms: Hip

Flexion: 120 Extension: 30 IR/ER: 45 Adduction: 30 Abduction: 45

Wrist Flexion/Extension Articulating Motions

Flexion: Proximal aspect of scaphoid/lunate glide dorsally relative to radius Extension: glide ventrally relative to radius

Myotomes: S1

Foot inversion/eversion

1st class lever - definition and example in the body

Force and resistance on opposite sides of the fulcrum (see-saw). Forces are applied in either side of the axis. Triceps action at elbow.

3rd class lever - definition and example in the body

Force and resistance on same side of the fulcrum with force closer to the fulcrum. Two forces applied on one side of the axis. Force in the middle. Shoulder abduction, elbow flexion. (Most common lever-type in the body).

What are some special tests for biceps tendon pathology?

Ludington's test, Speed's test, and Yergason's test

SIJ special test

Gillet's test Ipsilatearl anterior rotation test Gaenslen's test Long-sitting (supine to sit) test Goldthwait's test

What joints comprise the shoulder joint.

Glenohumeral joint, sternoclavicular joint, acromioclavicular joint, and scapulothoracic articulation

Special Tests (structure being tested & procedure): Clunk test

Glenoid labrum tear Supine, full abduction PA humeral head with ER

Neuro/Musculo screen (muscles supplied by peripheral nerves): Inferior gluteal

Gluteus maximus

Total Knee Arthroplasty PT goals, outcomes and interventions

Goals of early rehab (1-3 weeks) include muscle reed, soft tissue mob, lymphedema reduction, initiaon of PROM, AROM and reduction of swelling. Goals of second phase of rehab include regaining endurance, coordination, and strength of muscle surrounding the knee. Functional activities include progressive ambulation stair climbing, as well as transitional training based on healing and the type of prosthesis used. Goals and outcomes of last phase of rehab include returning the patient to pre-morbid ADLs. Functional and endurance training and proprioceptive exercises are introduced during this phase.

Join mobs I - III Kaltnborn

Grade 1 - Loosening - small amplitude traction force for pain and/or decompress joint during joint glides Grade 2 - tightening - movement takes up slack in tissues surrounding joint. Used to alleviated pain, assess join play, and/or reduce muscle guarding Grade 3 - stretching - movement stretches the tissues crossing joint. Used to assess end-feel, or to increase movement.

What grades of mobilization are considered small amplitude?

Grade I and IV

What grades of mobilization are considered large amplitude?

Grade II and III

Special Tests (structure being tested & procedure): 90-90 hamstring test

Hamstring tightness Supine, hip and knee supported in 90 degrees flexion Passively extend knee as far as possible (positive if unable to reach 10 degress from full extension)

Special Tests (structure being tested & procedure): Patrick (FABER) test

Hip dysfunction (e.g. mobility restriction), iliopsoas dysfunction, SIJ dysfunction Supine Passive flexion, abduction, ER - foot resting just above opposite knee Slowly lower testing leg to surface (look for knee unable to assume relaxed position or for symptom reproduction)

Early rehabilitation after RC repair

Horizontal adduction, extension, and internal rotation should not be stretched (in the healing process)

Proximal humerus fracture

Humeral neck fractures frequently occur when a fall onto an outstretch UE among older osteoporotis women. Generally does not require immobilization or surgical repair, since it is a fairly stable fracture. Greater tuborosity fractures are MC in middle-aged and elder adults. Usually related to fall onto shoulder, and does not require immobilization for healing. plain x-rays

Joint movements during shoulder flexion

Humerus glides inferiorly and external rotates Clavical rotates at sternoclavicular joint Scapula abducts and laterally rotates

Special Tests (structure being tested & procedure): Morton's test

Identifies stress fractures and neuromas in forefoot Supine Grab around met heads and squeeze (Positive if pain in forefoot)

What diagnosis is the subacromial bursa often involved with?

Impingement beneath the acromial arch

What diagnosis of the shoulder is often caused by repetitive microtrauma from upper extremity activity performed above the horizontal plane?

Impingement syndrome

Internal (posterior) impingement

Impingment of rotator cuff on greater tuberosity or posterior labrum Often seen in athletes performing overhead activtiies. Pain commonly noted in posterior shoulder.

Special Tests (structure being tested & procedure): Posterior internal impingement

Impingment of rotator cuff on greater tuberosity or posterior labrum Supine, passive 90 deg abd, max ER, 15-20 deg horizonal add

Special Tests (structure being tested & procedure): Fluctuation test

Knee joint effusion Supine, knee extended Push down over suprapatellar pouch Push down over anterior aspect of knee joint Alternate movements looking fluid movement

Resisted hip flexion tests what innervation level?

L1-2

Neuro/Musculo screen (root origins of peripheral nerves): Genitofemoral

L1-L2

Dermatome testing of the anterior thigh tests what innervation level?

L2

Neuro/Musculo screen (root origins of peripheral nerves): Nerves to iliacus and psoas

L2

Neuro/Musculo screen (root origins of peripheral nerves): Lateral femoral cutaneous

L2-L3

Neuro/Musculo screen (root origins of peripheral nerves): Femoral

L2-L4

Neuro/Musculo screen (root origins of peripheral nerves): Obturator

L2-L4

Dermatome testing of the middle third of the anterior thigh tests what innervation level?

L3

Resisted knee extension tests what innervation level?

L3-4

Neuro/Musculo screen (root origins of peripheral nerves): Accessory obturator

L3-L4

Dermatome testing of the patella and medial malleolus tests what innervation level?

L4

The patella reflex tests what innervation level?

L4

Heel walking functionally tests what innervation levels?

L4-5

Resisted ankle dorsiflexion tests what innervation level?

L4-5

A straight leg raise functionally tests what innervation level?

L4-S1

Neuro/Musculo screen (root origins of peripheral nerves): Superior gluteal

L4-S1

Neuro/Musculo screen (root origins of peripheral nerves): Common peroneal

L4-S2 (becomes deep and superficial peroneal nerves)

Neuro/Musculo screen (root origins of peripheral nerves): Tibial

L4-S3 (becomes medial and lateral plantar nerves)

Dermatome testing of the fibular head and dorsum of the foot tests what innervation level?

L5

Resisted great toe extension tests what innervation level?

L5

Which ligament may be injured with a pure varus load at the knee without rotation?

LCL

Special Tests (structure being tested & procedure): Mill's test

Lateral epicondylitis test Pt sitting PT palpates lateral epicondyle Passive pronation, wrist flexion, elbow extension

Capsular pattern: C3-T2

Lateral flexion and rotation, extension

Capsular pattern: Lumbar spine

Lateral flexion and rotation, extension, flexion

Muscle substitution for weak hip abductors

Lateral trunk; TFL

Glut max, Obturator externus, Obturator internus, Piriformis, Gemelli, and Sartorius ________ ________ the hip joint.

Laterally rotate

The teres minor, infraspinatus and posterior deltoid ________ ________ the shoulder joint.

Laterally rotate

What is the orientation of the acetabulum?

Laterally, inferiorly, and anteriorly

Neuro/Musculo screen (muscles supplied by peripheral nerves): Thorocodorsal

Latissimus dorsi

Special Tests (structure being tested & procedure): Talar tilt

Ligament instability (especially calcaneofibular lig) Sidelying, knee slightly flexed, neutral ankle Adduct foot (CF lig) Abduct foot (deltoid lig) (positive if laxity or pain)

Special Tests (structure being tested & procedure): Anterior drawer

Ligament instability (particularly ATFL) Supine, heel off bed, 20 degrees PF Stabilize lower leg, grasp foot Pull talus anteriorly (positive if excessive movement and/or pain)

What is the purpose of the dorsal radiocarpal ligament?

Limit wrist flexion

Capsular pattern: TMJ

Limitation of mouth opening

Finger ligs: Transverse

Link MCPs Reinforce anterior capsule

Special Tests (structure being tested & procedure): Neer impingement

Long head of biceps and supraspinatus impingement Passive internal rotation followed by full passive abduction

Muscle substitution for weak pectoralis major

Long head of biceps; corocobrachialis; anterior deltoid

Empty end-feel

Loose at first then very hard: Muscle guarding to preventing entering painful ROM

Muscle substitution for weak hip extensors

Low back extensors; adductor magnus; QL

Muscle substitution for weak hip flexors

Lower abdominals; lower obliques; hip adductors; latissimus dorsi

Bursae Locations: Gastrocnemius

One under each head

Slipped Capital Femoral Epiphysis

MC hip disorder observed in adolescents the ball at the upper end of the femur (thigh bone) slips off in a backward direction. This is due to weakness of the growth plate. Most often, it develops during periods of accelerated growth, shortly after the onset of puberty onset in males: 10-17, avg 13 onset in females: 8-15, avg 11. AROM limited in abduciton, flexion and IR Patient describes pain as vauge at knee, thigh and hip. with chronic condition pt may demonstrate trendelenburg gait. x-ray treatment: goal of treatment, which req surgery, is to prevent any additional slipping of the femoral head until the growth plate closes.

Central posterior bulge/herniation

MC observed in C-spine but can be seen in L spine Etiology: overstretching and/or tearing of annular rings, vertebral endplate, and/or ligamentous structures from high compressive forces and/or long-term postural malalignment. Results in loss of strength, radicular pain, paresthesia, inability to perform ADLs, and possible compression of spinal cord. Patient exhibits CNS symptoms, e.g. hyperreflexia, and positive babinski. MRI -Pt. ed regarding proper body mechanics, positions to avoid, limit repetitive bending/twisting, limit UE overhead and sitting activities and carrying heavy load. -promote dynamic stability throughout trunk/pelvis and to provide optimal stimulus for regeneration of disc. -ex> positional gapping for 10 min, Left posterolateral herniation 1) sidelying on the right with pillow under right trunk 2) flex both hips and knees 3) rotate trunk to left -Tx: traction(O) but no manipulation!

Which ligament may be injured with a pure valgus load at the knee without rotation (ie, lateral blow to knee during football game)?

MCL

Flexor Digitorum Superficialis action

MCP and PIP flexion / assists in wrist flexion

vertebral (closed packed)

Maximal extension

What is the closed packed position of the SC joint?

Maximum shoulder elevation

What are the deep capsular fibers of the MCL attached to?

Medial meniscus

The Tensor fasciae latae, Glut med, Glut min, Pectineus, and Adductor longus ________ ________ the hip joint.

Medially rotate

The subscapularis, teres major, pec major, lat dorsi, and anterior deltoid ________ ________ the shoulder joint.

Medially rotate

Special Tests (structure being tested & procedure): ULTT1

Median Nerve, anterior interosseous nerve, C5-7 Shoulder depression and 110 degrees abduction Elbow extension Forearm supination Wrist extension Finger/thumb extension Contralateral neck side flexion

Which nerve enters the palm through the carpal tunnel?

Median nerve

Special Tests (structure being tested & procedure): Pronator teres syndrome test

Median nerve entrapment within pronator teres Sitting, elbow flexed to 90 degrees Resist pronation and elbow extension (looking for tingling/paresthesia in median nerve distribution)

MOST effective to actively stretch the lumbrical muscles?

Metacarpophalangeal extension and interphalangeal flexion

EMG testing

More than 10% of polyphasic potentials in the total output of muscle ->considered abnormal

Rubbery end-feel

Muscle spasm

Myotomes: C2

Neck flexion

Myotomes: C3

Neck side-flexin

A physical therapist places a patient on a strength training program for the lower extremities. The mode of exercise is a double-leg press unit. After 1 week, the patient shows a 10-lb (4.5-kg) increase in the amount of weight the patient is able to lift. What is the MOST likely cause of the patient's increase in strength?

Neurological adaptation Strength increase in muscle is due to a number of factors, including neurological adaptation and muscle fiber hypertrophy with an increase in actin and myosin. Long-term changes in muscle strength are due to all of the factors listed. However, short-term changes, such as changes in 1 week, are most likely to due to neurological factors such as more efficient motor unit recruitment, autogenic inhibition, and more efficient coactivation of muscle groups.

Nutation vs counternutation

Nutation: describes a movement that involves flexion of sacrum and posterior rotation of ilium. Counternutation: describes a movement that involves extension of sacrum and anterior rotation of ilium.

Cervical Spine Coupled Movement Direction (rotation/side flexion)

Occiput/C1: Opposite C2-C7: Same Lumbar/Thoracic (in Neutral or extension): Opposite Lumbar/Thoracic (in flexion): Same (differs among individuals, should be tested prior to any manual technique)

Special Tests (structure being tested & procedure): Ely test

Rectus Femoris tightness Prone Flex testing knee (look for ipsilateral hip flexion)

Trunk/Ribcage musculo/neuro testing (muscles, cord segment, nerves): Spine flexion

Rectus abdominis/external obliques (T7-T12) Intercostal nerve Internal obliques (T7-L1) Intercostal nerve Psoas Minor (L1) Lumbar plexus

What is the purpose of the ischiofemoral ligament?

Reinforces articular capsule

Scaphoid Fracture

Results from a FOOSH in younger person. MC fractured carpal. X-ray compliactions include a high incidence of AVN of the proximal fragment of the scaphoid secondary to poor vascular supply. Carpals immobilized for 4-8 weeks early intervention includes maintenance of flexibility of distal and proximal of distal and proximal joints while UE is casted.

What is a systemic autoimmune disorder caused by chronic inflammatory reaction in the synovial tissues of a joint that results in erosion of cartilage and supporting structures within the capsule?

Rheumatoid arthritis

Secondary Scapular Elevators

Rhomboid major Rhomboid minor

Primary Scapular Retractors (position of Attention)

Rhomboid major (dorsal scapular nerve, C5) Rhomboid minor (dorsal scapular nerve, C5)

Neuro/Musculo screen (muscles supplied by peripheral nerves): Dorsal scapular

Rhomboids, levator scapulae

1st CMC movement

Rotated position of trapezium places plane of flexion/extension of 1st CMC perpendicular to other digits. Flexion/Abduction 1st CMC rotates ulnarly Extension/Adduction 1st CMC rotates radially

The sternocleidomastoid, scalenus muscles, splenius cervicis, longissimus cervicis, iliocostalis cervicis, levator scapulae, and multifidus muscles all cause ________ and ________ ________ of the cervical intervertebral joints.

Rotation and lateral bending

Trunk/Ribcage musculo/neuro testing (muscles, cord segment, nerves): Spine rotation

Rotatores, internal/external obliques, intertransversarii, transversospinalis (T1-T12, L1-L5, S1-S3)

*Structural* throracic idiopathic scoliosis

Rt. : *high Rt. shoulder, prominent Rt. scapula, protruded Lt. hip* -posterior thoracic rib hump, lateral curvature of the spine -body of the vertebrae rotates to curved side (convex side) and the *spinous processes rotate toward opposite (concave side)*

TMJ dysfunction

S/S - joint noise (clicking, popping), joint locking, limited flexibility of jaw, lateral deviation of mandible during depression or elevation, decreased strength/endurnace of mastication muscles, tinnitus, headaches, forward head posture, and pain with movement of mandible Must look at C-spine too Dysfunctions fall into 3 categories: -DJD, such as OA or RA in TMJ -Myofascial pain - MC form of TMJ dysfunction, which is discomfort or pain in muscles controlling jaw function, as well as neck and shoulder muscles. -Internal derangement of joint, meaning a dislocated jaw, displaced articular disc, or injury to condyle. Loss of functional mobility may result from increased activity in muscles of mastication d/t stress and anxiety. Causes: trauma, congenital, abnormal function. x-ray, MRI if necessary PT goals: -postural re-ed -modalities -biofeedback to minimize effects of stress -joint mob -flexibility -patient ed -night splints may be prescribed by the dentist to maintain -resting jaw position -educate patient regarding resting position of tongue on hard palate -it is critical to normalize the C spin posture before the patient receives any permanent dental procedures and/or appliances.

Dermatome testing of the lateral and plantar aspect of the foot tests what innervation level?

S1

Resisted ankle plantar flexion tests what innervation level?

S1

The achilles reflex tests what innervation level?

S1

Toe walking functionally tests what innervation level?

S1

Dermatome testing of the medial aspect of the posterior thigh tests what innervation level?

S2

Neuro/Musculo screen (root origins of peripheral nerves): Perforating cutaneous

S2-S3

Neuro/Musculo screen (root origins of peripheral nerves): Pudendal

S2-S3, causes sensation to perineum and to genitals

Dermatome testing of the perianal area tests what innervation level?

S3-S5

Special Tests (structure being tested & procedure): Gaenslen's test

SIJ dysfunction Sidelying at edge of table, holding bottom leg maximal hip and knee flexion PT standing behind patient, passively extend hip of top limb (stresses ipsilateral SIJ) (Positive if pain at SIJ)

Special Tests (structure being tested & procedure): Long sitting (supine to sit) test

SIJ dysfunction which may be the cause of leg length discrepancy Supine in good alignment PT at end of plinth, palpate medial maleoli, check symmetry Patient moves to long sitting, reassess at maleoli (Positive if limb lengths reverse from supine to long-sit)

When a concave surface is moving on a convex surface, the roll and slide occur in what direction?

Same direction

What forms the distal joint surface of the radiocarpal joint?

Scaphoid, lunate, and triquetrum

Stork Standing Test

TESTING: spondylolisthesis POSITION: standing on one leg, cue into trunk extension, repeat on other LE (+) TEST: pain in low back with ipsilateral leg on ground

Morton's Test

TESTING: stress fracture, neuroma POSITION: Pinch between the metatarsals of the foot. (+) TEST: Pain between 1/2, 2/3, 3/4, 4/5 could be due to a neural irritation. Pain only between metatarsals 2/3 and 3/4 could be Morton's neuroma.

Kleiger's test

TESTING: tibial torsion POSITION: seated on the edge of the plinth with the knee supported. The low leg/foot should be hanging off in neutral. (+) TEST: foot is deviated to the inside of 0 deg, there is internal tibial torsion. foot is deviated to the outside of 15 deg, there is external tibial torsion.

Transverse Ligament Glide

TESTING: transverse ligament POSITION: supine, glide C1 anterior (+) TEST: nausea, soft end field

Romberg Test

TESTING: upper motor neuron lesion POSITION: standing, close eyes for 30 seconds (+) TEST: excessive swaying

Hautant's Test

TESTING: vascular vs Vestibular causes of dizziness/vertigo POSITION: first - sitting shoulders at 90 deg, palms up; pt closes eyes for 30 seconds; second - same position, cue pt into head and neck extension with rotation right and left each for 30 seconds (+) TEST: if arms lose position in first part = vestibular; if arms lose position in second part = vascular

Vertebral Artery Test

TESTING: vertebral artery integrity POSITION: supine head supported, extend neck for 30 seconds (if no change proceed); extend head with rotation left then right for 30 seconds (if no change proceed); extend head off table (if no change proceed); extend neck off table with rotation left then right (+) TEST: dizziness, visual disturbance, disorientation, blurred speech, nausea/vomitting

Special Tests (structure being tested & procedure): Tinel's sign

Tap nerve to identify dysfunction: - Posterior tibial nerve: posterior to medial maleolus - Deep peroneal nerve: anterior to talocrural joint - Median nerve: anterior wrist - Ulnar nerve: cubital tunnel (positive if pain/tingling/paresthesia produced in respective nerve distributions)

Special Tests (structure being tested & procedure): Stork standing test

The assessment of the Stork test involves palpation of the posterior superior iliac spine (PSIS) with placing the thumb directly on the PSIS on the side of testing the pelvis to which weight is be transferred for single-leg support. The other thumb is placed medial to the PSIS, on the sacral base. Ask the patient to raise his leg on the tested side, that hip and knee are flexed at 90°. The test should be repeated on the other side too. The direction of the bone motion is palpated as the contralateral foot is lifted off the ground. Positive: If the PSIS do not drop down into your thumb on one side, the ilium is considered to be hypo-mobile. The SI-joint is blocked. This would suggest an inability of the SI-joint to engage self-bracing mechanism and maintain alignment of the innominate bone relative to the sacrum in the closed pack position. The innominate bone will relative rotates anteriorly to the sacrum.

Convex concave rules of the spine

The convex rule applies at the atlanto-occipital joint. Below the second vertebra, the concave rule applies.

Coxalgic Gait

The gait caused by a painful hip is characterized by shifting of the upper torso toward the painful side during the single-limb stance phase on the affected hip.

What is considered the strongest ligament in the body?

The iliofemoral ligament

Ape Hand Deformity

Thenar muscle wasting, with first digit moving dorsally until it is in line with the 2nd digit. results from median nerve dysfunction electrodiagnostic testing

What is the purpose of Golgi tendon organs?

They transmit information about tension or rate of change of tension within the muscle

Volar Plate

Thickening of capsule on palmar aspect of MCP, PIP and DIP joints. More mobile at MCPs than IPs.

Special Tests (structure being tested & procedure): Costoclavicular syndrome (Military brace) test

Thoracic outlet syndrome Sitting, find radial pulse Move test shoulder back and down (Looking for neurological/vascular signs)

Special Tests (structure being tested & procedure): Adson's

Thoracic outlet syndrome Sitting, find radial pulse Neck rotation towards test side Shoulder extension and ER with neck extension (looking for neurological/vascular signs)

Special Tests (structure being tested & procedure): Wright (hyperabduction) test

Thoracic outlet syndrome Sitting, find radial pulse Passive shoulder abduction and ER Deep breath with contralateral neck rotation may increase symptoms (Looking for neurological/vascular signs)

How does the aerobic system provide energy?

Through the oxidation of food; fatty acids, amino acids and glucose with oxygen releases energy that forms ATP

Myotomes: C8

Thumb MCP extension

Special Tests (structure being tested & procedure): Tight retinacular test

Tightness around PIP joint (hand) PIP stabilized while DIP flexed PIP and DIP flexed If flexion limited in both tests, capsule is tight If flexing PIP increases DIP ROM, instrinsic muscles are tight

Special Tests (structure being tested & procedure): Bunnel-Littler

Tightness in structures around MCP joints MCP held in slight extension, PIP flexed MCP and PIP flexed If flexion limited in both tests, capsule is tight If flexing MCP increases PIP ROM, intrinsic muscles are tight

Special Tests (structure being tested & procedure): Yergason's Test

Transverse ligament and bicipital tendonitis pronation and 90 deg elbow flexion resist supination and external rotation

Secondary Scapular Retractors (position of Attention)

Trapezius

Primary Scapular Elevators

Trapezius (spinal accessory nerve, or cranial nerve XI) Levator scapulae (C3,C4 and frequently branches from dorsal sacapula nerve, C5)

When is peak activity of the quadriceps group during the gait cycle?

Two periods of peak activity: 1)periods of single support during early stance phase and 2) just before toe off to initiate swing phase

What type of muscle fiber has low fatigability, high capillary density, high myoglobin content, smaller fibers, extensive blood supply, large amount of mitochondria, and are used in activities such as a marathon or swimming?

Type I

Which muscle fibers are described as aerobic, red, tonic, slow twitch, and slow-oxidative?

Type I muscle fibers

What type of muscle fiber has high fatigability, low capillary density, low myoglobin content, large fibers, less blood supply, fewer mitochondria, and are involved in activities such as high jumping or sprinting?

Type II

Most Common Salter Harris Fracture

Type II - entire epiphysis and portion of the metaphysis - usually caused by a shear or avulsion with angular force.

Which muscle fibers are described as anaerobic, white, phasic, fast twitch, and fast-glycolytic?

Type II muscle fibers

Multilevel vertebra fusion

Typically requires 6 weeks of trunk immobility with bracing once bracing is removed and movement is allowed, important to regain as much normal/functional movement as possible, while restoring functional activation of muscles. with combined anterior/posterior surgical approach, bracing if seldom used.

Special Tests (structure being tested & procedure): Romburg's test

UMNL Standing, close eyes for 30 seconds (Positive if excessive swaying)

Special Tests (structure being tested & procedure): Babinski

UMNL Supine or sitting Glide bottom of reflex hammer along plantar surface of foot (Positive if big toe extend and others abduct or "splay")

Elbow 'Screw home' mechanism

Ulna pronates slightly with extension and supinates slightly with flexion Proximal ulna glides medially during extension and laterally during flexion

Special Tests (structure being tested & procedure): Froment's sign

Ulnar nerve dysfunction Patients grasps paper between 1st and 2nd digits Pull paper out Look for IP flexion of thumb (compensation for weak AddPL) May indicate ulnar nerve dysfunction

Special Tests (structure being tested & procedure): ULTT4

Ulnar nerve, C8-T1 Shoulder depression and 90 degrees abduction (hand to ear) Elbow flexion Forearm supination Wrist extension and radial deviation Finger/thumb extension Shoulder ER Contralateral neck side flexion

The extensor carpi ulnaris and flexor carpi ulnaris ________ ________ the wrist joint.

Ulnarly deviate

Bursae Locations: Subacromial

Under deltoid, extending under acromion and coracoacromial arch above the joint capsule

Special Tests (structure being tested & procedure): 2 point discrimintion test (hand)

Use paper clip/calipers etc to stimulate 2 points on palmar aspect of fingers Record smallest distance patient is able to distinguish Should be <6 mm

Capsular pattern: Interphalangeal (foot)

Usually extension restriction

What are special tests for the MCL?

Valgus stress test

Special Tests (structure being tested & procedure): Knee collateral ligament instability

Valgus/varus force in 20-30 degrees knee flexion

Capsular pattern: Metatarsophalangeal 2-5

Variable, usually flexion restriction

What are special tests of the LCL?

Varus stress test

Special Tests (structure being tested & procedure): Allen test

Vascular compromise Patient opens and closes their hand several times, then makes a fist Oclude ulnar artery, then have patient open their hand Observe palm, release and wait for filling Repeat with radial artery

Define an avulsion fracture

a portion of a bone becomes fragmented at the site of tendon attachment due to a traumatic and sudden stretch of the tendon

How is the glenoid labrum injured?

With recurrent shoulder instability

Extensor Carpi Radialis Brevis action

Wrist extension

Extensor Carpi Ulnaris action

Wrist extension, ulnar deviation

Muscle substitution for weak finger flexors

Wrist extensors

Define a greenstick fracture

a break on one side of a bone that does not damage the periosteum on the opposite side (fracture often seen in children)

Define a comminuted fracture

a bone that breaks into fragments at the site of injury

Define a stress fracture

a break in a bone due to repeated forces to a particular portion of the bone

Define a nonunion fracture

a break in a bone that has failed to unite and heal after nine to twelve months

Define a compound fracture

a break in a bone that protrudes through the skin aka open fracture

Define a closed fracture

a break in a bone where the skin over the site remains intact

What is a MMT of Poor (2/5)?

completes ROM in gravity-eliminated position

Osteochondrosis of humeral capitellum

affects central and/or lateral aspect of capitellum or radial head. As osteochondral bone fragment becomes detached from articular surface, forming a loose body in joint. Caused by repetitive forces b/w radial head and capitellum. Occurs in adolescents between 12-15. Panner's disease is a localized AVN of capitellum leading to loss of subchondral bone, with fissuring and osftening of articular surfaces of radiocapiteller joint. Occurs in children 10 y/o or younger. plain x-ray PT: -rest, avoid overhead/throwing motions, or UE loading activities -when pt is pain free innitiate flexibility and strengthening/endurance/coordination exercises -late in rehab, slowly increase load on joint

Patella tendonosis/tendonitis

aka "Jumper's knee" may be related to overload and/or jumping related activities

Tibia ER is coupled with

an upward glide of the talus and supination of the foot

pronator quadratus

anterior interosseous

flexor pollicis longus

anterior interosseous (AIN)

Dorsiflexion at the ankle

anterior tibialis, extensor digitorum longus, extensor hallucis longus, fibularis tertius

What is the closed packed position of the AC joint?

arm ABD to 90°

acromioclavicular joint (closed packed)

arm abudcted to 90 degrees

sternoclavicular joint (closed packed)

arm maximally elevated

What is the loose packed position of the AC joint?

arm resting by side in normal physiological position

What is the loose packed position of the SC joint?

arm resting by side in normal physiological position

Gold standard test for RTC tear

arthrogram MRI may also be done

Gold standard for identifying shoulder labral tears is?

arthroscopic surgery of the shoulder

Palmaris Longus action

assistive in wrist flexion

Things to avoid following back surgery

avoid prolonged sitting, heavy lifting, and long car trips for approx 3 months. avoid repetitive bending, twisting NO BLT!

What are hip precautions following a posterolateral surgical approach?

avoiding hip flexion beyond 90 degrees, adduction, and hip medial rotation

What are some common types of fractures?

avulsion, closed, comminuted, compound, greenstick, nonunion, stress, and spiral

Deltoid, teres minor

axillary nerve

What is a class 1 lever?

axis of rotation is between the effort (force) and resistance (load)

Kaltenborn manual therapy

believes that abnormal joint mobility and soft tissue changes acccount for dysfunction

What are closed-chain activities?

body moving over a fixed distal segment

excessive dorsiflexion with uncontrolled forward motion of tibia

calcaneous gait; the result of weak plantarflexors

What is adhesive capsulitis?

caused by adhesive fibrosis and scarring between the capsule, RC, subacromial bursa, and deltoid that results in loss of ROM in active and passive shoulder moion due to soft tissue contracture

Chondromalacia patellae

characterized by retropatellar knee pain and softening of the cartilage on the posterior aspect of the patella.

Impingement syndrome

characterized by soft tissue inflammation of the shoulder from impingement against the acromion with repetitive overhead AROM. diagnostic tests: arthrogram or MRI Clinical tests: Neer's, Hawkin's Kennedy, Supraspinatus test, drop arm test -most painful in certain positions such as *extreme overhead reaches* and with *shoulder flexion + int.roation*

What is the closed packed position of the TMJ?

clenched teeth

Muscle Relaxants

commonly used for muscle spasm Examples: cyclobenzaprine HCL (flexeril), Methocarbamol (Robaxin) carisoprodol (Soma) adversee effects: drowsiness, ataxia, lethargy, decrease alertness

What may cause hip hiking during swing of gait?

compensation for weak dorsiflexors, compensation for weak knee flexors, compensation for extensor synergy pattern

What may cause circumduction during swing of gait?

compensation for weak hip flexors, compensation for weak dorsiflexors, compensation for weak hamstrings

What may cause knee hyperextension in stance during gait?

compensation for weak quads, plantar flexion contracture

What is a MMT of Normal (5/5)?

completes ROM against gravity with max resistance

What is a MMT of Good Minus (4-/5)?

completes ROM against gravity with min-mod resistance

What is a MMT of Good (4/5)?

completes ROM against gravity with mod resistance

What is a MMT of Good Plus (4+/5)?

completes ROM against gravity with mod-max resistance

What is a MMT of Fair Plus (3+/5)?

completes ROM against gravity with only minimal resistance

What is a MMT of Fair (3/5)?

completes ROM against gravity without manual resistance

Distal humerus fracture

complications can include loss of motion, myositis osifications, malalignment, neurovascular compromise, ligamenetous injury, CRPS. Supracondylar fracture must be examined quickly for neurovascular status, d/t high number of neurological (particularly radial nerve) and vascular structures. Lateral epicondyle fracture are fairly common in young people, typically require ORIF to ensure absolute alignment. X-ray

Swan Neck Deformity

contracture of intrinsic muscles with dorsal subluxation of lateral extensor tendons observed deformity is flexion of MCP and DIP with extension of PIP commonly occurs d/t trauma, or with RA following degeneration of lateral extensor tendons

List some complications following an amputation.

contractures, DVT, hypersensitivity, neuroma, phantom limb, phantom pain, psychological impact, and wound infections

Supination of the foot is coupled with

cranial and anterior glide of the fib head

Special Tests (structure being tested & procedure): Finkelstein

deQuervain's tensynovitis (AbPL, EPB) Fist with thumb inside Passive ulnar deviation

extensor carpi ulnaris

deep branch of radial

extensor digiti minimi innervation

deep branch of radial

extensor digitorum

deep branch of radial

supinator innervation

deep branch of radial

Pancreatic cancer

deep, gnawing pain that may radiate from the chest to the back

Spondylosis vs Spondylolisthesis

defect in the pars interarticularis/ arch of the vertebra Spondylosis - fracture of pars interarticularis with positive "scotty dog" sign on oblique x-ray Spondylolisthesis is the actual anterior or posterior slippage of one vertebra on another, following bilateral fracture of pars interarticularis -graded according to amount of slippage from 1 (25%) to 4 (100%) x-ray, oblique to see fracture and lateral views to see slippage clinical examination include: stork test degeneration of the spine, most often used to describe osteoarthritis S/S of cervical spondylosis: -Limited ROM with pain -Spurlings, distraction ULTT all positive -dermatomes/reflexes affected -radiography: narrowing osteophhyte Treatment: -joint mob -dynamic trunk stabilization, with emphasis on abs -pt ed regarding the elimination of extension and postural re-ed -avoid extension and/or positions that add stress to defect -braces such as Boston brace and TLSO have traditionally been used

The latissimus dorsi, pectoralis major, pectoralis minor, and lower trap ________ the scapula.

depress

The MOST likely etiology for increased low back pain with coughing or sneezing is?

disc hernation Coughing or sneezing will increase intradiscal pressure causing pain during this activity if disc herniation is present. Increased pressure results from a space occupying lesion such as a herniation

Extensor tendon repair UE

distal repairs are immobilized such that the distal IPJ are in neutral for 6-8 weeks PT: -AROM is initaited at 6 weeks, with proximal IPJ in neutral -goal is to manage all soft tissues through wound-healing pahses by providing collagen remodeling, which preserves free tendon gliding. -Active extension exercises are initiated followed by flexion -resistive and functional exercises are introduce when full AROM is achieved. proximal repairs are immobilized, with the wrist and digital joints in extension for 4 weeks PT goals -early AROM/PROM in flexion, with MCP joint in extension. At 6 weeks, full AROM is initiated into flexion and extension.

Define step length.

distance measured between right heel strike and left heel strike

What is step length?

distance measured between right heel strike and left heel strike

What is stride length?

distance measured between right heel strike and the following right heel strike

Define stride length.

distance measured between right heel strike and the following right heel strike.

What is base of support?

distance measured between the left and right foot during progression of gait

What is a MMT of Poor Minus (2-/5)?

does not complete ROM in gravity eliminated position

What is a MMT of Fair Minus (3-/5)?

does not complete the ROM against gravity, but does complete more than 50% of the range

Levator scapula, rhomboids innervations

dorsal scapular nerve

What is the common capsular pattern for the midtarsal joint?

dorsiflexion, plantarflexion, ADD, medial rotation

What are some special tests for rotator cuff pathology/impairment?

drop arm test, Hawkins-Kennedy impingement test, Neer impingement test, and supraspinatus test

Lumbopelvic rhythm - flexion

during flexion, spine goes through 60-70 degrees of motion and then pelvis will rotate anteriorly to allow more movement, eventually followed by hip flexion.

When is peak activity of the gatroc-soleus during the gait cycle?

during late stance phase (concentric raising of heel during toe off)

When is peak activity of the hamstrings during the gait cycle?

during the late swing phase (decelerates the unsupported limb)

Triceps elbow action

elbow extension

What is the closed packed position of the radiohumeral joint?

elbow flexed 90°, forearm supinated 5°

Brachialis action

elbow flexion

Brachioradialis action

elbow flexion

What is an example of a class 3 lever?

elbow flexion

Fractures of knee joint - femoral condyle

medial femoral condyle most often involved d/t its anatomical design. Etiologies include trauma, shearing, impacting and avulsion forces. tibial plateau- common MOI is combination of valgum and compression forces to knee when the knee is in a flexed position. Often occurs with MCL injury. Epiphyseal plate - MOI is frequently a WBing torsional stress. Presents more frequently in adolescents whre an ACl injury would occur in an adult. Patella - direct blow to patella x-ray unless complex fracture which would require CT.

Pectoralis minor

medial pectoral nerve

Pronator teres, pronator quadratus innervation

median nerve

flexor carpi radialis

median nerve

flexor digitorum superficialis

median nerve

palmaris longus nerve

median nerve

pronator teres innervation

median nerve

What is the loose packed position of the carpometacarpal joint?

midway between ABD - ADD and flexion - extension

What is the loose packed position of the midtarsal joint?

midway between extremes of ROM

What is the loose packed position of the subtalar joint?

midway between extremes of ROM

What is the loose packed position of the tarsometatarsal joint?

midway between extremes of ROM

What is the loose packed position of the facets of the spine?

midway between flexion and extension

What are characteristics of the loose packed position of a joint?

minimal stress on the joint, minimal joint congruency, and maximum ligament laxity

What is a MMT of Trace (1/5)?

mm contraction can be palpated, but there is no joint movement

Elbow Dislocation

mostly posterior - defined by position of olecranon relative to humerus posteriolateral MC and occur as the result of hyperextension of elbow from a fall on outstretched UE posterior dislocations frequently cause avulsion fractures of medial epicondtyle secondary to traction pull of medial collateral ligment. with complete dislocation, UCL will rupture plain x-ray clinical signs: rapid swelling, severe pain at elbow and deformity

temporomandibular joint (closed packed)

mouth closed with teeth clenched = maximal retrusion mouth maximally open = maximal anterior position

What is the loose packed position of the TMJ?

mouth slightly open (freeway space)

Feldenkrais

movement approach that requires the patient to actively participate in treatment facilitates development of normal movement patterns PT uses skillful, supportive gentle hands to create a sense of safety, maintain supportive contact, while introducing new movement possibilities in small, easily available increments.

Anterior talofibular ligament resits

movement into PF and inversion.

What is a concentric muscular contraction?

muscle shortens while developing tension

Biceps brachii, brachialis

musculocutaneous nerve

What is the loose packed position of the metatarsophalangeal joint?

neutral

What is the loose packed position of the radiocarpal (wrist) joint?

neutral with slight ulnar deviation

What is the loose packed position of the radiocarpal joint?

neutral with slight ulnar deviation

What is a MMT of Zero (0/5)?

no palpable mm contraction

Thoraco-Lumbar Extension

no standard C7 and S2 - measure with tape measure, extension , measure again (no ASIS activation during extension)

Thumb: Saddle (carpo-metacarpal) opposition

no standard - ruler measures the shortest distance between the tip of the thumb and the center of the proximal digital crease of the little finger.

Knee locking mechanism

occurs in the last 30 degrees of flexion/extension - most evident in last 5 degrees CKC - Femur rotates internally/medially to lock when going into extension. Femur rotates externally/laterally to unlock when going into flexion OKC - Tibia externally/laterally rotates to lock when going into extension Tibial internally/medially rotates to unlock when going into flexion

Median nerve entrapment

occurs within pronator teres and superficial head of flexor digitorum superficialis w/ repetitive gripping activities s/s: weakness of forearm muscles and positive tinel's sign, aching pain in forearms, paresthesia in median nerve distribution ECG

Radial nerve entrapment

occurs within radial tunnel as result of OH activities and throwing s/s include lateral elbow pain that can be confused with lateral epicondylitis, pain over supinator msucle and paresthesias in a radial nerve distirbution. Tinel's may be positive ECG

Annular ligament

osteofibrous ring attached to medial ulna and encircles radial head. protects radial head, especially in semiflexion, where it is very unstable. Taut in extreme pronation/supination.

What is the common capsular pattern for the AC joint?

pain at extremes of ROM

What is the common capsular pattern for the SC joint?

pain at extremes of ROM

Muscle hypertrophy can be observed following how long of resistance training

(increase in size) as a result of resistance training can be observed following at least 6-8 weeks of training.

degrees of knee flexion of Lachman's test

20-30 degrees

Amount of time required to return to recreational activities following large RTC repair

24-28 weeks. Studies show that on average approx. 80% of strength in the involved shoulder is regained in the first 6 months following surgery.

Adson Manuever

FOR TOS start in sit or stand. PT monitors the radial pulse and asks the pt to rotate their head to face the test shoulder. The pt is then asked extend their neck while the therapist laterally rotates and extends the patient's shoulder. A positive test is indicated by an absent or diminished pulse. MSK-Examination

Wright test

FOR TOS test is performed in sitting or supine. The therapist moves the pt's arm overhead in the frontal plane while monitoring the radial pulse. Positive is decreased or diminished radial pulse and may b indicative of compression at the costoclavicular space. MSK-Examination

Mcmurray's

For meniscus integrity When the foot is in IR, you are providing compressive stress at the lateral meniscus and tensile stress at the medial meniscus.

Slipped capital femoral epiphysis type of gait

Glute med gait

E-stim - distance between pads

Large electrodes for larger muscles Widely spaced allows for current to travel deeper into the muscle to stimulate a greater number of deeper muscle fibers.

Rearfoot varus / valgus

Rearfoot varus = subtalar/calcaneal varus caused by: abnormal alignment of tibia, shortened rearfoot soft tissues or malunion calcaneus. Deformity observed: rigid inversion of calcaneus when subtalar joint is in neutral PT: regain proper mechanical alignment. Improving flexibility of shortened soft tissues. Orthotic fitting and pt ed regarding foot wear Rearfoot valgus Etiology: abnormal mechanical alignment of the knee (genu valgum), or tibial valgus Deformity observed: eversion of calcaneus with a netural subtalar joint PT: same as bove

Common areas of compression in TOS

Superior thoracic outlet scalene triangle between clavicle and first rib between pec minor and thoracic wall

Anterior Apprehension Test

TESTING: Anterior instability POSITION: Supine, 90˚ shoulder abduction, and take into ER (+) TEST Apprehension (Not pain)

Relocation Test (GH)

TESTING: Anterior instability (follow up to anterior apprehension) POSITION: Supine, same position at anterior apprehension but press down on head of humerus before applying ER (+) TEST: Apprehension (Not pain)