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treatments 2 theory > final exam > Flashcards

final exam Flashcards

1
Q

list your protocols for applying friction technique:

A

area warmed with GSM
adhesions found by stripping
CFF applied
fingers dont glide
hand placement/ergonomics correct
pain scale established
check in w/ client about px
flush after frictions
stretch
ice massge CBAN

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2
Q

list protocols for applying trigger point therapy technique:

A

warm w/ GSM
TP found by stripping
pain scale
ischemic compressions
check in w/ client about px
pressure released after cx says px/referral diminished to 2/10
heat & stretch
hand placement and ergonomics

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3
Q

what homecare would be appropriate for someone experiencing acute plantar fasciitis? what about chronic plantar fascitis?

A

acute:
- forzen water bottle/marbles
- MLD
- PR ROM
- elevate
- rest
chronic:
- DMH on calf
- stretch gastroc/soleus/toe extensors
- self massage
- stretch intrinsic mm
- orthotics

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4
Q

what happens with the medial longitudinal arch when someone with functional pes planus is NOT weight bearing? what about with structural pes planus?

A

functional: will change
structural: wont change

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5
Q

transverse fracture

A

stays in place after reduction. clean break of bone across. heals more rapidly

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6
Q

oblique fracture

A

angle force to bone. hard to keep in place after injury

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7
Q

spiral fracture

A

when the bone twists/spirals during injury. hard to keep in place, small tissue damage

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8
Q

comminuted fracture

A

often unstable. consist of 2 or more fragments

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9
Q

avulsion fracture

A

ligament pulls a portion of bone away that it is attached to

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10
Q

osteochondral fracture

A

fragments of articular cartilage are sheared from joint surface

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11
Q

compression fracture

A

the bone is crushed. occurs in cancellous bone (ie. vetebral body)

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12
Q

greenstick fracture

A

“hair line fracture” bone is bent or partially broken. most common in children younger than 10

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13
Q

perforation fracture

A

result of a gunshot would to bone

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14
Q

stress fracture

A

cracks in the bone due to overuse or repetitive actions, common in runners to the tibia

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15
Q

MOI for colles fracture

A

FOOSH in extension (fork looking)

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16
Q

MOI for Galeazzi fracture

A

fall on hand w/ some rotational component. rotation causes the fracture

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17
Q

MOI for pott’s fracture

A

lateral blow causing over pronation of foot (eversion)

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18
Q

MOI for Dupuytrens fracture

A

eversion with external rotation of the ankle

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19
Q

what intake quesitons would be useful to ask your client when suspecting tendinitis?

A
  • what activities/movements cause pain?
  • where is the pain?
  • what are the present symptoms? how long have these symptoms been present?
  • what is the clients recreational/occupational posture?
  • previous injury to affected limb?
  • new activity/increase in duration.speed of activity?
  • has condition been diagnosed by physician?
  • supports/brace during activity?
  • NSAIDS? steroids?
  • does cx have a stretching/strengthening program and is is being followed?
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20
Q

does tendinitis heal quickly or slowly? why?

A

slowly, limited blood supply

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21
Q

list and describe the grades of tendinitis

A

1: px after activity
2: px before and after
3: px before, during and after. px may restrict acitivity
4: px with ADL’s, continues to get worse

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22
Q

speeds test

A

purpose: bicipital tendonitis if pain, strain if weak
action: standing. they resist shoulder flexion while supinating and then pronating
positive: tenderness in the bicipital groove and/or weakness

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23
Q

drop arm test

A

purpose: tear in rotator cuff
action: we abduct the shoulder 90 degrees, cx slowly lowers
positive: unable to return arm slowly or px

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24
Q

hawkins kennedy

A

purpose: supraspinatus tendontitis
action: client seated, flex their arm and elbow then medially rotate shoulder
positive: face shows pain

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25
Q

cozens test

A

purpose: tests for lateral epicondylitis
action: stabilize elbow (sitting), palpate lateral epicondyle with one hand. they make a fist and forearm pronated. resist radial deviation and extension
positive: pain over lateral epicondyle

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26
Q

mills test

A

purpose: tests for lateral epicondylitis
action: arm out (flexed) a little, elbow extended, wrist flexed an resist wrist flexion
positive: pain over lateral epicondyle

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27
Q

medial epicondylitis test

A

purpose: test for medial epicondylitits
action: forearm supinated, extend wrist for them while palpating medial epicondyle
positive: pain over medial epicondyle

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28
Q

mortons test

A

purpose: test for neuromas/stress fracture
action: client supine. therapist grasps foot around metatarsal heads and squeezes the together
positive: pain between bones= neuroma’ pain on bone= stress fracture

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29
Q

thompsons test

A

purpose: achilles tendon rupture
action: prone with feet over the edge of the table and leg mm relaxed. squeeze the affected gactroc/soleus mm
positive: absence of plantar flexion when mm is squeezed

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30
Q

fabers test

A

purpose: hip joint pathology. iliopsoas spasm or SI may be affected
action: client supine, test leg ankle over knee of opposite leg, push on test leg and stabilize hip with other hand
positive: if leg remains above opposite leg or pain in hip/SI indicates SI/hip/iliopsoas

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31
Q

obers test

A

purpose: IT band/TFL contracture or trochanteris bursitis
action: side lying. lower leg is flexed for stability. upper leg abducted and extended back, knee flexed and slowly lower to the table
positive: contracture= leg will not lower. bursitis=pain over GT

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32
Q

(consider functional pes planus) how will the medial longitudinal arch be affected?

A

decreased

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33
Q

(consider functional pes planus) which mms will likely be lengthened/weak?

A

tib anterior
tib posterior
extensor hallucis longus

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34
Q

(consider functional pes planus) which mms will likely be shortened/hypertonic

A

gastroc
soleus
peroneals

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35
Q

(consider functional pes planus) what are some associated conditions with pes planus?

A

plantar fasciitis

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36
Q

(consider functional pes planus) will the joints in the medial longitudinal arch be hyper- or hypomobile?

A

hypermobile

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37
Q

(consider functional pes planus) what ranges may be limited with AF ROM?

A
  • eversion of the calcaneous is greater than 10 degrees
  • dorsiflexion of the ankle may be limited with severe pes planus
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38
Q

(consider functional pes planus) what is your primary treatment goal/aim

A
  • decrease SNS
  • treat compensatory
  • treat other conditions (tendonitis, ITB contractures)
  • reduce fascial
  • reduce HT, TP, adhesions
  • stretch shortened mms
  • increase local circulation
  • encourage circulation to weak and taut structures
  • mobilize hypomobile joints
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39
Q

(consider functional pes planus) list the causes of pes planus?

A
  • hyper mobility of foot
  • poor biomechanics
  • shortened mms (gastroc, soleus, achilles)
  • weakness in supporting structures ( tib pos)
  • habitual poor posture
  • nerve lesion to common peronal or posterior tibial nn
  • trauma to foot/ankle
  • foot weak with poor support to MLA
  • congenital abnormalities in bones of foot/legs/thigh
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40
Q

if a client has a chronic sprain to the anterior talofibular ligament, which would you want to strengthen to act as a “splint” for the injured area

A

tibialis posterior and anterior, and the peroneals

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41
Q

what ligament is most commonly sprained in the knee?

A

MCL

42
Q

which of the RC mm’s is most ocmmonly affected by tendinitis?

A

supraspinatus

43
Q

in which position should the arm be to perform frictions to the supraspinatus tendon?

A

elbow flexion
humerus internally rotated and extended

44
Q

in which position should the arm be to perform frictions to the tendon of long head biceps brachaii?

A

extension

45
Q

define a bakers cyst

A

enlargement of the extracapsular bursa b/t the gastroc & semimembranosus mm or a herniation of the synovium through the posterior joint capsule wall

46
Q

what is the most appropriate form of hydro for someone with acute bursitis? what are some CI’s with hydro and acute bursitis?

A

CI’s
- no compression of the bursa with the hydro
Hydro
- cold donut around the bursa
- frozen towel

47
Q

location of trochanteric bursitis?

A

one is between the glute max tendon and trochanter
one is between glute med and trochanter

48
Q

location of iliopectineal bursitis

A

between the iliopsoas mm and iliofemoral ligament

49
Q

location of ischial bursitis

A

bewteen glute max and ischial tuberosity

50
Q

location of infrapatella bursitis

A

between the patellar ligament and tibia

51
Q

location of retrocalcaneal bursitis

A

between achilles and calcaneus

52
Q

location of subacromial bursitis

A

between the acromion and the supraspinatus tendon

53
Q

location of subcoracoid bursitis

A

through the anterior deltoid mm near acromion

54
Q

location of subscapular burisitis

A

between scapula and subscap mm

55
Q

list some complications associated with fractures:

A

compartment syndrome
nerve compression
vascular damage
bone and soft tissue infections
DVT
pressure/plaster sore
cast dermatitis
loose cast syndrome

56
Q

list and describe the grades of sprains:

A

grade 1:
- minor stretch & tear to ligament
- no instability on PR testing
- can continue with some discomfort
grade 2:
- tearing of ligaments & fibers (several to majority)
- snapping sounds @ injury & joint gives way
- joint hypermobile yet stable on PR testing
- difficulty continuing activity due to px
grade 3:
- complete rupture or avulsion fracture
- snapping sound @ injury & joint gives way
- instability w/ no end point on PR testing
- person cannot continue due to px & instability
- px present in actue phase & hypermobile in the direction

57
Q

what complications can result from prolonged ischemia to a tendon, usually due to compression of a nearby bony structure?

A

tendinosis

58
Q

what is tendonosis and how is it different from chronic tendinitis?

A

tendonosis: tendon changed permanently
chronic tendonitis: hasn’t changed permanently

59
Q

what is myositis ossificans?

A

when mm tissue eventually will ossify

60
Q

how would you approach the treatment of an acute grade 3 sprain injury that has not yet been assessed by a MD?

A

refer them to MD

61
Q

what type of force will injure the MCL? LCL?

A

MCL: knee is struck by a medially directed force/valgus force
LCL: knee is struck by a lateral directed force/varus force

62
Q

what is loose cast syndrome?

A

end up with blisters between cast & skin from being loose

63
Q

how long does it take for union of the bone to occur with a fracture?

A

4 weeks - stage 3

64
Q

with AR ROM for a client experiencing plantar fasciitis, what ranges would you expect to show weakness?

A

sime weakness in metatarsophalangeal extension & plantar flexion
length of gastroc & soleus will likely reveal shortness

65
Q

describe each stage of bone healing:

A

1: hematoma forms around ends of fractured bone within 72 hrs. a mash of fibrin forms around injury
2:inflammation & proliferation of osteoblasts at the periosteum. these cells create pfibrocartilginour bridge between the fragment ends
3: soft callus/splind is formed from the mass of proliferating osteoblasts.
4: consolidation occurs as the immature bone is changed into mature lamellar bone
5: remodeling of irregular outer surface and reshaping of the marrow space inside the bone takes place through alterating osteoblastic & osteoclastic activity

66
Q

what is wolff’s law?

A

where a bone responds to mechanical stress by becoming stronger and thicker the more strenuous its function

67
Q

what are some CI’s for hydro for a client who has had a fracture repaired by metal implants?

A

no heat directly over the implants

68
Q

review which structures support the medial longitudinal arch - some of these support passively and some dynamically

A
  • long & short plantar ligmanets, plantar calcaneonavicular ligment & aponerosis
  • tib pos, tib an, peroneals provide a muscular sling to support the arch
  • flexor hallucis longus, flexor digitorum longus & the intrinsic mm of the foot
69
Q

compare the different types of fractures and how their healing times differ. why to upper body fractures heal faster than lower body? why does a spiral fracture heal more quickly than a transverse fracture? what is the healing time for each? (rattray for further explanation)

A

a transverse fracture is a clean break, there is noting left intact. a sprial fracture still has some bone left intact, therefore there is less surface area to heal

70
Q

what CI’s should you consider for frictions?

A
  • not used over peripheral nerves
  • acute injury
  • RA
  • infective arthritis
  • structures that are to deep to reach
  • anti-inflammatoris, anticoagulants, high dose long term steroid medications
  • peripheral vascular disease
  • fragility of the skin or soft tissue
71
Q

what CI’s should you consider for TP’s?

A
  • actue conditions
  • hypotonis/atonic mms
  • painful conditions
    tissue “lumps” such as lipomas, cycts, and ganglions
72
Q

tendinosis

A

degeneration changes with chronic overuse tendon injuries, such as tennis elbow

73
Q

main cause of tendinitis

A

chronic overuse

74
Q

what activities can cause rotator cuff injuries

A

swimming, golf, any throwing sports, overhead arm positions

75
Q

MOI for biceps tendonitis

A

swimming, throwing sports where the arm is in adduction

76
Q

where will adhesions form with long head of biceps of tendonitis

A

bicipital/intertubicular groove

77
Q

laymans for lateral epicondylitis

A

tennis elbow

78
Q

what acitivies may cause lateral epicondylitis

A

tennis/racket sports, poor technique, wheelchair athletes, plumbing, electrical

79
Q

laymans for medial epicondylitis

A

golfers elbow

80
Q

what is a common complaint for someone with medial epicondylitis

A

weak grip

81
Q

anatomical teminology for mommy thumbs

A

dyquervians tendosynovitis

82
Q

what tendons are afftered with dyquervians tenosynovitis

A

abductor pollicis longus and extensor pollicis brevis

83
Q

MOI for dyquervians

A

anything with repetitive thumb use

84
Q

where will pain be felt with patellar tenonitis

A

local to tendon it self

85
Q

what can popliteus tendonitis be confused with

A

IT band syndrome

86
Q

impingement syndrome

A

inflammation, pain and edema of tissues between AC & GH joints (supraspinatus, biceps, subacromial bursa)

87
Q

3 stages of impingement syndrome

A

1: edema & hemorrhage of subacromial bursa
2: tendinits & fibrosis. both stages 1 & 2 are reversible with rest, stretching & strengthening
3: incomplete tears or complete tendinosus rupture. my be bony changes in acromion & AC joint. surgery indicated

88
Q

at what point is surgery indicated with impingement syndrome

A

in stage 3

89
Q

what is calcific tendonitis

A

late occurring stage of RC tendinitis, usually in supraspinatus tendon

90
Q

trigger finger

A

overuse of flexor tendons that may develop a thickened, nodular swelling. swelling is unable to move through the tendon sheath and gets stuck

91
Q

how will ROM be affected with tendonitis

A

AF: usually painless
PR: pain on actions that fully stretch the tendon
AR: px on contraction of the mm of affected tendon which increases with force of contraction, as well as possible weakness

92
Q

tendonitis differentiation test

A

apply resistance. pain at the beginning=bursitis
pain as your increasing resistance= tendonitis

93
Q

length test

A

put mm in stretched position, compare bilaterally

94
Q

ROM tendonitis

A

PR PF mid range

95
Q

exercise for chronic tendonitis

A

isotonic eccentrics

96
Q

between which structures will you find bursa

A

usually between tendon and bones

97
Q

causes of bursitis

A

overuse of surrounding structures which leads to excessive friction and inflammation of bursal walls

98
Q

common associated condition with burisits

A

tendonitis

99
Q

contributing factors to bursitis

A

poor biomechanics
mm imbalance
postural dysfunctions
lack of flexibility
(less common: acute trauma, infection & pathologies (ie. RA, OA, gout))

100
Q

acute burisits- what most likely casues it

A

direct blow

101
Q

what do px feel like with bursitis

A

burn

102
Q

fiesse line test

A

purpose: test for plat feet
action: mark apex of mallelous & plantar aspect of 1st metatarsal MTP joint. which client is not weight bearing as well as the navicular tubercle. client stands with feet 3-6 inches apart. observce where the mark is made on the navicular tubercle
positive: navicular tubercle moves closer to floor

treatments 2 theory (3 decks)

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