NPTE Clinical Files Cheatsheets

Sensorineural Hearing Loss

Type of hearing loss caused by a dysfunction in the inner ear, cochlea or vestibulochoclear nerve (CN VIII) Major Causes Ototoxicity (from antibiotics) Normal Aging TBI Exposure to loud noises/explosions Congenital dysfunction Acoustic neuroma Ménière's disease Complaints Soft sounds are difficult to hear and loud sounds are muffled Most commonly high-pitched frequency sounds are inaudible

Conduction Hearing Loss

Type of hearing loss that occurs when the passage of sound is blocked in East her the ear canal or the middle ear Major Causes Accumulation of ear wax Otitis (middle ear infection) Otosclerosis (abnormal bone growth in middle ear) Cholesteatoma (abnormal growth of tissue in middle ear) Complaints Soft sounds are difficult to hear regardless of the pitch Loud sounds may present muffled

Genu Recurvatum

"Back knee" or knee hyperextension Causes: Quad weakness Quad or plantarflexion spasticity Ligamentous laxity Diminished LE proprioception Secondary Complications Posterior knee pain Knee giving way into hyperextension Pinching sensation in anterior knee Treatments Quadriceps strengthening Heel Lift Hinged AFO—PF stop attachment Proprioception training Taping or breaking Tx to reduce spasticity/tightness of plantarflexors

Genu Varum/Blount's Disease

"Bow Leggedness" Characterized by knees that are angled outward, where the lower leg (tibia) is angled medially relative to the thigh Major Causes Coxa Valga (>135˚ femoral neck angulation) Femoral retroversion (<8˚) Rickets Congenital hip deformity Secondary Complications Medial knee pain Osteoarthritis Treatments Surgical correction Vitamin D & Calcium Bracing Lateral heel wedge

Genu Valgum

"Knock knees" Characterized by knees that are angles inward and often "touching" when the patient is standing erect Major Causes: Coxa Vara (< 120˚ femoral neck angulation) Excessive femoral anteversion ( >15˚) Hip ABD/ER weakness Secondary Complications Lateral knee pain Retro-patellar pain ACL & MCL tension & laxity Treatments Strengthen hip ABD/ER Medial patellar taping Knee brace w/ lateral patellar buttress Medial heel wedge

Femoral Retroversion

< 8˚ -Bring child in for out-toeing during ambulation -Excessive hip ER (> 70˚) -Restricted hip IR (< 20˚) -Genu varum with medial compartmentalism pain -Relative internal tibial rotation compensation **this is uncommon ion comparison to excessive anteversion

Femoral Anteversion

>15˚ -Bring child in for in-toeing during ambulation -Sits in W-position -Excessive hip IR (>70˚) -Restricted hip ER (< 20˚) -Genu valgum with increased Q angle -Relative external tibial rotation compensation -Greater the genu valgum, the greater the subtalar pronation **at birth, normal femoral anteversion is 30-40˚, which reduces to 10-15˚ by skeletal maturity

Muscles & Innervation of Forced Expiration

Abdominals: Intercostal Nerves (T7-L1) Intercostales Interni: Intercostal Nerves (T2-T12)

Heterotrophic Ossification

Abnormal growth of bone in the non-skeletal muscles tissues including muscle, tendons, other soft tissue New bone grows at 3x the normal rate resulting in jagged, painful joints Common after TBI who are immobilized for prolonged periods of time Presents with: Diminished joint mobility Decreased ROM Progressively painful joints

Special Test for SLAP Tear (labrum)

Active Compression Test of O'brien: in standing or sitting, patient's arm is placed into 90˚ of shoulder flexion and 10-15˚ of horizontal adduction. Patient then fully IR the shoulder and pronates the elbow. (1) a downward force s applied to the arm in this position (2) the downward force is that applied with the neutral shoulder and forearm position (+) pain reproduction, clicking in the shoulder with 1st position and reduced/absent with the 2nd

Vaulting: what is it, when does it occur, common causes?

Active plantarflexion of the stance limb in order to clear the CL limb during swing phase During midstance using the shorter LE Common causes: Leg length discrepancy CL prosthesis too long CL foot stuck into plantarflexion

Laterally Medullary Syndrome: What is it?

Aka Wallenberg Syndrome or Posterior Inferior Cerebellar Artery (PICA) Neurological condition caused by blockage of vertebral artery or PICA which leads to an infarction of he lateral medulla oblongata

What should you do if you suspect hetertrophic ossification?

Alert the physician and medical team! Pre-op PT can be performed to preserve motion around lesion PROM, AAROM, AROM and gentle stretching is ok, but should not provoke pain

Innominate Rotations & Muscle Actions

All patients with ALS need SLP You are observing an ANTERIOR INNOMINATE ROTATION if the tested leg goes from LONG to SHORT If the tested leg goes from SHORT to LONG You are observing a POSTERIOR INNOMINATE ROTATION If the innominate is anterior rotated, contract hamstrings to posteriorly rotate If innominate is posteriorly rotated, contract hip flexors to anteriorly rotate

Forefoot Valgus

Angling or everted position of the bones in the front of the foot relative to the heel. "Thumbs down" position or big toe down position Position is often ABNORMAL and is often associated with PES PLANUS Treatment RIGID: lateral wedge FLEXIBLE: medial wedge

Forefoot Varus

Angling or inverted position of the bones in the front of the foot relative to the heel. Can be described as the "thumbs up" or big toe position Average amount of forefoot varus: 0-10˚ Treatment RIGID: medial wedge FLEXIBLE: lateral wedge

Special Tests for Meniscal Tears

Apley's McMurray's Thessaly's Joint line tenderness 5

Special Test for Anterior Dislocation (anterior capsular laxity)

Apprehension Test: supine, pt's shoulder ABD to 90˚ with elbow flexed to 90˚; laterally rotated slowly to end range

Glasgow Coma Scale

Assesses person's consciousness immediately post TBI 3 components: Eye Movement Verbal Communciation Motor Response Scale 3-15 Severe: <9 Moderate: 9-12 Mild: 13-15

Myasthenia Gravis: what is it, patient profile

Autoimmune disease that takes place at the NMJ and motor endplate Commonly confused with MS with the frequent exacerbations of the condition with stress & overworking Experience excessive fatigue as the day or activity progresses; present with a characteristic improvement in strength after a period of rest Often have abnormality of the thymus PATIENT PROFILE: Female dominated, 3:2 Female:20-30 years old, Male: 50-60 years old Usually have one or more of the following: Hyperthyroidism, Thyrotoxicosis, Thymic tumor, overactive thymic gland

Myasthenia gravis: Exercise considerations

Avoid strenuous exercise and stress Avoid prolonged exposure to hot or cold environments Cautiously allow and monitor eccentric based exercises If subjected to any above, increased risk for exacerbation of their symptoms

Which view on a radiograph can you best see the pars interarticularis?

Bilateral posterior oblique views

Laterally Medullary Syndrome: Signs & Symptoms

Bradycardia Ipsilateral facial sensation loss Gag reflex diminished Horner's sign Ataxia Nystagmus Diplopia Faulty speech (dysphonia) Unable to swallow (dysphasia) Loss of CL limb sensation

Laterally Medullary Syndrome: Which CN's are affected?

CN IX: glossopharyngeal CN X: vagus CNXI: accessory CNXII: hypoglossal Also affects CN V (trigeminal nerve) causing loss of pain and temperature on the ipsilateral face

Shin Splints

Can also be referred to as medial tibial stress syndrome and is a condition characterized by exercise-induced pain along the distal third of the posteromedial tibial border MOI: overuse, repetitive loading stress (jumping, running) Pain Type: dull, non-focal and extends >5cm Pain characteristics: pain with stretching and pain that is present at the beginning of the workout, improves with exercise and returns during cool down ROM: limited mobility secondary to tightness in the posterior compartment (gastroc, soleus, post tib)

Delayed Heel Off: what is it, when does it occur, common causes?

Characterized by a lack of PF that results in an inability to transfer weight onto the forefoot in preparation for swing Terminal stance to pre-swing Common Causes: Weak plantarflexors Excessive dorsiflexion mobility Tibial nerve palsy Anterior foot pains

Trendelenburg: what is it, when does it occur, common causes?

Characterized by a marker lateral trunk lean towards the weakened LE. This lateral trunk lean shifts the COM. Towards the weak side thereby decreasing the load on the ipsilateral hip abductors During midstance on the affected side/side of the lateral trunk lean Common Causes: Glute med/min weakness Ipsilateral hip adductor tightness Superior gluteal nerve palsy

Knee Thrust: what is it, when does it occur, common causes?

Characterized by a rapid hyperextension of the knee. This deviation most often occurs in order to move the center of mass anterior to the knee thereby production a knee extensor moment Loading response to Midstance Common Causes: Weak quads Spastic quads Plantarflexion contracture

Early heel off: what is it, when does it occur, common causes?

Characterized by an inability to achieve adequate dorsiflexion during the late stance phase Midstance Common Causes: Limited posterior talocrural capsular mobility Tight or spastic plantarflexors Heel pain

Backward Trunk Lean: what is it, when does it occur, common causes?

Characterized by marked trunk extension in order to shift the COM posteriorly and reduce load on the glute max Initial contact-midstance Common Causes: glute max weakness Inferior gluteal nerve palsy

Special test for AC joint degeneration

Cross body adduction Test

Muscles & Innervation of Quiet Inspiration

Diaphragm: Phrenic Nerve (C3-5) Scalenes: Ventral Rami of spinal roots (C3-C7) Intercostales Externi: Intercostal Nerves (T2-T12)

Special Test for Rotator Cuff Full Thickness Supraspinatus Tear (Grade 3)

Drop Arm Test (+) Test: sudden dropping of the arm due to weakness and an inability to control descent without a report of pain

Myasthenia gravis: Signs and Symptoms

Dysarthria Dysphasia Dysphasia Diplopia Daily fluctuations in fatigue Proximal muscle weakness Ptosis & facial weakness NO SENSORY DEFICITS

Special Test for Rotator Cuff Partial Thickness Supraspinatus Tear (Grade 1 or 2)

Empty Can or Jobe (+) test: pain or weakness is observed when the patient is resisted in the empty can position

Canalathiasis Interventions

Epley's Brandt-Daroff

Posterior Leaf Spring AFO

Flexible co-polymer polypropylene or. Carbon fiber that typically allows for toured energy potential WHY CHOOSE THIS Assist with ankle DF and foot clearance during swing phase WHEN PRESCRIBED 1. When pt has mild spastic CP or a condition producing isolated DF weakness or paralysis 2. When pt requires little to no medial/lateral ankle support 3. When pt needs minimal restriction of sagittal plane ankle motion

Arthrokinematics of the Thumb

Flexion and Extension Concave on convex Roll and Glide in SAME direction Ex. Flexion: medial roll, medial glide (ulnar) ADD/ABD Convex on concave Roll and glide in OPPOSITE directions Ex. ABD: volar (palmar) roll, dorsal glide

Spondylolisthesis: What is it and what is the pathophysiology

Forward displacement of one vertebra over another that occurs in the caudal segments of the spine Most likely to occur at L4-L5, L5-S1 Pars interarticularis is a small segment of bone that joins the superior and inferior facets as well as the laminate and pedicle A fx or non-union of bone in this region bilaterally creates marked instability and the characteristic vertebral slippage

Goals and Activities to Avoid Post Slap Repair 6-12 Weeks

GOALS Achieve full AROM by 12 weeks Increase strength and endurance required for function activities **alternating isometrics is a common entry-level exercise to begin stability training AVOID Resisted biceps contraction 8-12 weeks ABD combined with max ER for 12+ weeks After anterior stabilization, avoid initiation of dynamic strengthening of the IR from a position of full ER After anterior stabilization, avoid strengthening of the shoulder extensors from a shoulder extension position beyond the frontal plane

Goals and Activities to Avoid Post Slap Repair 0-6 Weeks

GOALS: Reduce pain & inflammation Protect repaired structures Minimize negative consequences of immobilization Prevent reflex inhibition and disuse atrophy **Can do pendulums are gentle isometrics for "muscle setting" within the first week AVOID Active elbow flexion/supination (active biceps contraction) for 6 weeks Avoid shoulder extension combined with elbow extension for 6 weeks

Special tests for Subacromial Impingement

Hawkins-Kennedy & Neer's Test

Articulated (Hinged) Ankle Foot Orthosis

Hybrid, hinged or articulated AFOs are composed of a calf component that is separate from, but articulates with a foot plate WHY CHOOSE IT? Allow free unrestricted sagittal plane motion while still limiting medial/lateral ankle motion MODIFICATIONS 1. POSTERIOR STOP - buttress on the pension aspect of the AFO which stops excessive PF 2. DORSIFLEXION STOP - a Velcro strap on the posterior aspect of the AFO which limits excessive DF WHEN TO PRESCRIBE 1. When solid AFO provides t of much rigidity 2. Patient needs M/L stability at the ankle but is active 3. Patient has spastic CP, knee hyperextension and/or correctable ankle equinus

Isokinetic vs Isotonic Exercises

Isokinetic is SAME SPEED, VARIABLE RESISTANCE Isotonic is SAME RESISTANCE, VARIABLE SPEEDS

Special Test for Posterior-Inferior Labral Tear

Kim's Test (+) sudden onset of posterior shoulder pain and clicking present

Signs and Symptoms of Gout + Medications

Lab Values Hyperuricemia (Elevated Uric Acid): >7.0 mg/dL Male: 3.4-7.0 mg/dL Female: 2.4-6.0 mg/dL Time of Onset: sharp pain starts DURING THE NIGHT TIME Pain Locations: 1st MTP Ankle, instep, knee, wrist/hand, fingers, elbow Signs/Symptoms Great toe pain One joint in most cases Uric acid elevated Tachycardia Tophi Overly sensitive/chills Erythema & fever Medications Colchicine Alopurinol NSAIDs

Muscles that open the Jaw

Lateral Pterygoid Mylohyoid Geniohyoid Digastric

Cupulolithiasis Interventions

Liberatory Semont

Lumbar Manipulation CPR

Likely is 4 out of 5 are present Pain lasting < 16 days No symptoms distal to knee FABQ score < 19 IR of >35˚ for at least one hip Hypomobility of at least one level of the lumbar spine

Cervical Radiculopathy CPR

Likely to be present is all four characteristics are present (+) upper limb tension test (+) distraction test (+) Spurling's Involved side cervical rotation ROM < 60˚

Carpal Tunnel CPR

Likely to be present is at least 4 out of 5 are present Shaking hands to relieve symptoms Wrist ration >0.67 Symptom Severity Scale >1.9 Diminished sensation in median sensory field (thumb) Age > 45 years old

Stress Fracture (stress reaction)

MOI: overuse, repetitive loading stress (jumping, running) Pain type: deep pain that is focal with point tenderness <5cm in length Pain characteristics: pain that is present at rest (especially at night) and with activity ROM: no changes

Central Cord Syndrome: What is it? Causes?

MOST COMMON type of SCI that is typically due to traumatic hyperextension of the cervical region Other NPTE causes: Congenital or degenerative narrowing of the SC (stenosis) Pressure causes hemorrhaging and/or edema in the center most aspect of the SC

Ground Reaction AFO

Made of solid plastic material with solid ankle. Upper portion of AFO wraps around anterior part of the proximal tibia WHY CHOOSE THIS Allow for control at both the ankle and knee. AFO prevents the knee from collapsing into flexion during the stance phase by restricting DF at the ankle WHEN PRESCRIBED 1. Pts who have knee buckling during stance phase or present with a crouched gait posturing 2. When they have weak quads (SCI, CVA, MS, GBS, other neuro conditions) **Patients need 3/5 MMT of quads and good hip stability for GRAFO to be effective

Muscles that close the jaw

Medial pterygoid Masseter Temporalis

Acute Compartment Syndrome

Medical emergency where pressure in the anterior compartment of the lower leg builds up and can reduce blood flow causing death to both neural and musculoskeletal tissues MOI: severe trauma to the anterior compartment Pain Type: severe pain that presents with feelings of fullness, tightness, numbness, burning and/or tingling (paresthesias) ROM: significant changes in ankle mobility 2˚ to pain and muscular tightness

Gout: What is it? Who gets it? Major Causes?

Men over the age of 30 with a purine rich diet get URIC ACID buildup. Can form needle like crystals in a joint and cause sudden and severe episodes of pain, redness, warmth and swelling Major causes: Obesity Excessive Alcohol Use Hypothyroidism Renal Disease Immune Suppression Drugs Psoriasis Purine Rich Diet: red meat/sardines/anchovies/liver/dried beans/peas/mushrooms

How do you grade slippage for Spondylolisthesis?

Meyerding Scale Grade 1: <25% slippage Grade 2: 25-49% slippage Grade 3: 50-74% slippage Grade 4: 75-99% slippage Grade 5: 100+% slippage

CN VII

Nerve: Facial Function: taste from anterior 2/3 tongue, muscles of facial expression, tearing, salivation Common Pathologies: ALS, Bell's Palsy, GBS Important Tests: Raise eyebrows, frown, smile big, close eyes tightly and puff. Out cheeks & ability to taste sweet on anterior 2/3 of tongue

CN IX

Nerve: Glossopharyngeal Function: Taste from posterior 1/3 of tongue, sensation from posterior tongue and oropharynx, salivation Common Pathologies: ALS, Medullary Stroke, GBS Important Tests: ability to taste sweet on posterior 1/3 of tongue, swelling & phonation

CN XII

Nerve: Hypoglossal Function: Tongue movements Common Pathologies: ALS, MS Important Tests: Phonation/Articulation, tongue movements side to side, protrude tongue

CN III

Nerve: Oculomotor Function: (Motor) Elevates eyelids, constricts pupil, turns eye up, down, in Common Pathologies: MS, Horner's Syndrome Important Tests: Pupillary Reactions, H-test, saccadic/pursuits

CN II

Nerve: Optic Function: Sensory Nerve: sight/central & peripheral vision Common Pathologies: MS, Middle/Posterior CVA Important Tests: Snellen visual acuity, confrontation

CN V

Nerve: Trigeminal Function: sensation from face, cornea & anterior tongue. Muscles of mastication & dampens sound Common Pathologies: ALS, trigeminal neuralgia Important Tests: clench teeth/hold against resistance, corneal reflex, pain & light touch sensation (forehead, cheeks, jaw)

CN X

Nerve: Vagus Function: thoracic and abdominal viscera, muscles of larynx and pharynx, sensation from oropharynx Common Pathologies: ALS, medullary stroke, GBS Important Tests: swallowing & phonation, gag reflex, say 'ah'—uvula deviation

Transtibial Prosthetic Gait Deviation: Wide Based Gait During Midstance

Normal: Transtibial prosthetic should be held in relative extension as the entire body weight is supported in single limb stance. Pelvis should be level and the patient's trunk should be at relative neutral in the frontal plane Gait Deviation: during midstance, BOS is moved laterally Complains of: Pain at proximal lateral brim of socket Pain at medial distal end of residual limb Causes: Outset Foot Medially leaning pylon

Transtibial Prosthetic Gait Deviation: Knee Instability during IC to Loading Response

Normal: knee should flex to 8-10˚ during IC to loading allowing for weight acceptance and shock absorption Gait Deviation: patient buckles unit knee flexion or avoids buckling by shortening stance time Complains of: Knee buckling or feeling unstable Fear of falling Causes: Too hard cushioned heel Anteriorly displaced socket OR posteriorly set prosthetic foot

Transtibial Prosthetic Gait Deviation: Excessive Knee Extension during IC to Loading

Normal: knee should flex to 8-10˚ during IC to loading allowing for weight acceptance and shock absorption Gait Deviation: during IC to loading, patient keeps knee extended on prosthetic side making limb longer reducing shock absorption and increasing energy expenditure Complains of: Walking uphill Anterior distal stump pain CAUSES: Too soft cushioned heel Posteriorly displaced socket OR anteriorly set prosthetic foot

TMJ Normal ranges of motion

Opening: 35-55 mm Protrusion: > 7mm Recursion: 3-4 mm Lateral Deviation: 10-15 mm

Associative Stage of Motor Learning

Relies on: Proprioception & introspection "feeling the movement" Needs: Less augmented feedback and more practice Type of Feedback: KR & KP, but limit feedback. Only for improving performance or correcting faulty movement Type of Environment: Closed with progression to Open Practice Time: Distributed practice as needed Type of Practice: Random Practice Order: Variable, serial, random Part or Whole Training: Part as needed, focus on whole training if possible

Cognitive Stage of Motor Learning

Relies on: Vision & Demonstration Needs: Guidance, direction to pay attention to critical details of task Type of Feedback: KP and KR Type of Environment: Closed Practice Time: Distributed Type of Practice: Blocked Practice Order: Blocked followed by serial & random Part or Whole Training: Part if possible

Autonomous Stage of Motor Learning

Relies on: self evaluation, conscious awareness of performance Needs: Higher level practice with distraction Type of Feedback: Only occasionally, KP and KR, when errors are consistent Type of Environment: Open Practice Time: Massed Type of Practice: Random Practice Order: Random Part or Whole Training: Whole training only

TMJ: resting position, closed packed, open packed positions

Resting: mouth slightly open, lips touching, teeth not in contact Closed: teeth tightly clenched Open: limited mouth opening

How do you name spondylolisthesis if you feel L4 anteriorly displaced relative to L5?

This is called L5-S1 spondylolisthesis

5 NPTE Key Principles for Decision Making for Mechanical Traction

1. Greater than 25% of patient's BW is required to overcome friction 2. > 50% of patient's BW is required to achieve separation of joint spaces in the lumbar spine 3. When attempting lumbar mechanical traction for the first time, a max of 30lbs should be trialed to determine patient response 4. In acute phase, intermittent lumbar mechanical traction should be < 15 min and < 10 for sustained 5. Max duration of lumbar mechanical traction should be 30 min

Which bones make up the 1st CMC?

1st metacarpal and trapezium

Normal Femoral Torsion

8-15˚

Bilateral Vestibular Hypofunction: What is it, how do you treat it?

Pathology affecting both sides of the vestibular system that causes loss of signaling or diminished signaling to the brain. Condition characterized as having disequilibrium and gait ataxia. NO NYSTAGMUS OR VERTIGO. Treatment Gaze Stability Training (VOR x1, VOR x2) Postural Stability Training

Unilateral Vestibular Hypofunction: what is it, how do you treat it?

Pathology affecting one side of the vestibular system hat causes a loss of signaling or diminished signaling to the brain. Characterized as having nausea/vomiting nystagmus, vertigo, disequilibrium and postural instability Treatment Habituation Gaze Stability Training (VOR x1, VOR x2)

Pusher Syndrome

Patient actively pushes with their stronger extremities towards a weaker hemiparetic side DO NOT: Don't attempt to passively push patient into correct alignment Don't allow patient's sound extremity to drift into ABD and/or EXT and push Don't provide continuous solutions to orientation problems. Allow the patient to problem-solve for themselves

Intracranial Pressure: what is it, what's normal, what needs to be avoided with increased ICP?

Pressure that is exerted on the brain tissues inside the cranium Normal ICP: 5-15 mmHg Abnormal: >20 mmHg PT Activities that should be avoided: 1. Cervical flexion 2. Percussion/vibration 3. Coughing 4. Trendelenburg position (head below feet)

Bite Down/Cotton Roll TMJ Special Test

Purpose: determine origin of patient's jaw pain (muscle vs joint) Procedure: tongue depressor or cotton roll is placed on one side of the patient's mouth in between the teeth. Patient is asked to bite down on the object Pain reproduced on SAME SIDE of the cotton roll = muscle on same side is causing pain Pain reproduced on OPPOSITE SIDE of cotton roll = joint on the opposite side is causing the pain

Spina Bifida: L1

Quick motor description: Complete trunk function Hip flexion 2/5 or less Loss of muscle function below L1 Community Mobility: Wheelchair use Household Mobility: Walker Orthotic Prescription: Parapodium, RGO (coordination required), HKAFO

Spina Bifida: L3

Quick motor description: Complete trunk function Hip flexors & adductors >3/5 Quads 3/5 Community Mobility: Wheelchair use Household Mobility: Walker, Crutches, Wheelchair Orthotic Prescription: HKAFO & KAFO (if knee extensor MMT <3/5)

Spina Bifida: L2

Quick motor description: Complete trunk function Hip flexion & adductors: 3/5 Quads 2/5 or less Community Mobility: Wheelchair use Household Mobility: Walker, wheelchair Orthotic Prescription: parapodium, RGO (coordination required), HKAFO, KAFO

Spina Bifida: L4

Quick motor description: Complete trunk/hip/knee function Ankle DF 3/5 Medial knee flexors 3/5 Community Mobility: Walker, cane, crutches Household Mobility: May need no support Orthotic Prescription: AFO

Spina Bifida: L5

Quick motor description: Complete trunk/hip/knee function Ankle DF good Hip ABD 2/5 Ankle Inversion 3/5 Community Mobility: Walker, cane, crutches Household Mobility: May need no support Orthotic Prescription: AFO

Motion that occurs at costovertebral joint during inspiration

Roll: Anterior and superior roll Glide: Inferior Inferior glides Improve Inhalation

Motion that occurs at costovertebral joint during expiration

Roll: Posterior and inferior Glide: Superior Superior glides Improve Exhalation

Important Post-Op Notes for SLAP repair

SLAP tear repairs where the biceps tendon is detached should be progressed more cautiously than when biceps is intact Shoulder elevation PROM is limited to 30˚ per week (90˚ by week 3-4) IR/ER shoulder only be performed passively or assisted Week 1-2: 0-15˚ of ER and 0-45˚ IR Week 3-4: 15-30˚ ER and 0-60˚ IR

What is a SLAP tear? What is the most common type? What is the most common direction of instability?

SLAP tear: tear of the superior labrum that extends anterior to posterior. Type 2 is most common, which is characterized as a detachment of the superior labrum from the glenoid along with the long head of the biceps tendon Instability is likely to be anterior but can also be posterior

Weber's Test

Screening test used to evaluate presence of sensorineural and/or bone conductive hearing loss by comparing the difference in sound intensity between both ears Tuning fork is struck and place on top of head equidistant from patient's ears. Patient is asked to report in which ear the should is heard louder (+) test: If sound is heard louder on affected side = CONDUCTIVE HEARING LOSS If sound is heard louder on unaffected side = SENSORINEURAL HEARING LOSS IN AFFECTED EAR

Where should a cane be measured to on a patient?

Should be placed at the level of the patient's greater trochanter, ulnar styloid process or wrist crease

Special Test for bicep's tendonitis

Speed's Test

Rinne's Test

Used to evaluate loss of hearing in one ear by comparing sounds transmitted by air conduction to those transmitted by bone conduction through the mastoid Primarily assesses for unilateral bone conductive hearing loss and therefore should be accompanied by the Weber's Test Procedure: tuning fork struck and placed on mastoid of suspected side while asking patient to report when sound is no longer heard. When sound is no longer heard, vibrating tuning fork is placed 1-2 cm away from auditory canal and asked to report when sound has stopped (+) test: Patient unable to hear the tuning fork after is is moved from the mastoid to the outside of the ear = CONDUCTIVE HEARING LOSS Patient is able to hear the tuning fork outside of the ear longer than when held against mastoid BUT reports that the sound has stopped before the tuning fork quits vibrating = SENSORINEURAL HEARING LOSS

When should a cane or unilateral assistive device be avoided?

When there are weight bearing precautions

Ottawa Ankle Rules

X-ray is required if there is pain in malleolar zone and ANY ONE of the rolling are present: Bone tenderness along the distal 6cm of the posterior edge of the tibia or tip of the medial malleolus OR Bone tenderness along the distal 6cm of the posterior edge of the fibula or tip of the lateral malleolus OR Inability to bear weight both immediately and in the emergency department for four steps

Ottawa Foot Rules

X-ray is required if there is pain in the mid foot and ANY ONE of the rolling are present: Bone tenderness at the base of the 5th metatarsal OR Bone tenderness at the navicular bone OR Inability to bear weight both immediately and in the emergency department for four steps