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BCPR Module 1 > BCPR Module 3 > Flashcards

BCPR Module 3 Flashcards

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1
Q

Synovial Joint

A

Joint space
Smooth surface
Cartilage on articular surfaces
Synovial lining
Synovial fluid
Joint capsule

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2
Q

Osteoarthritis

A

DJD
Non-inflammatory
Cartilage changes
Symptoms: pain, stiffness, swelling, loss of motion, crepitus, secondary inflammation

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3
Q

Medications for OA

A

Analgesis/topical
NSAIDs for inflammation, swelling and pain
COX-2 inhibitors for pain/inflammation
Corticosteroids
Viscosupplements

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4
Q

Rheumatoid Arthritis

A

Autoimmune
Inflammatory
Systemic
Often begins as synovitis
Symptoms: pain, fatigue, inflammation/swelling, stiffness/loss of ROM (esp in AM), deformities, crepitus, nodes, often symmetrical

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5
Q

Common types of OA

A

UE: PIP/DIP, CMC, shoulder (loss of joint space with bone spur)
LE: hips, knees
Spine

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6
Q

Common joints affected by RA

A

UE: PIP, MCP, wrist, elbow, shoulder
LE: hips, knees, ankles
C-spine

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7
Q

Acute RA

A

Active inflammation
Presents with painful, red, hot, swollen joints
Difficulty moving due to stiff joints

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8
Q

Subacute RA

A

Less inflammation but stiffness remains
No joint deformities but joint destruction continues

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9
Q

Chronic Active RA

A

Less pain
Joint deformities present

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10
Q

Chronic Inactive RA

A

Joint deformities
“Skeletal collapse”

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11
Q

RA Medical Evaluation Criteria

A

Need >6/10 for definitive diagnosis
Joint involvement (0-5 based on # and type of joints involved)
Serology (0-3 based on rheumatoid factor and anti-citrullinated protein)
Acute-phase reactants (0-1 on normal/abnormal C-reactive protein and erythrocyte sedimentation)
Duration of symptoms (0-1 <6 week or >6 weeks)

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12
Q

Joint Effusion

A

Fluid in the capsule surrounding the joint

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13
Q

Boggy Joints

A

Acute phase
Soft and spongey

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14
Q

Chronic Synovitis

A

Firm to the touch

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15
Q

OT Eval of RA

A

Swelling/inflammation
Nodes/ostephytes
Fixed deformities
Hand deformities

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16
Q

Bouchard’s Nodes

A

PIP joints

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17
Q

Heberden’s Nodes

A

DIP joints

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18
Q

Assessing stability of collateral ligaments

A

Stabilize proximal phalanx
Glide distal phalanx lateral/medical directions

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19
Q

Assessing stability of volar plate/joint capsule

A

Glide distal phalanx in anterior/posterior directions

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20
Q

PAMS for RA

A

Address pain and ROM/stiffness
Pain: hot packs, continuous ultrasound, paraffin, heating pads, ice packs
ROM: hot packs, fluidotherapy, paraffin
HEAT IS CONTRAINDICATED DURING ACUTE FLARE UP

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21
Q

TE in Acute/Subacute RA Phase

A

AROM
Pain free, gentle ROM
AAROM/PROM when too weak/fatigued
RESISTANCE EXERCISE CONTRAINDICATED

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22
Q

TE in Chronic active/inactive RA Phase

A

AROM
Pain free, gentle ROM to affected joints
**PROM with overpressure/stretching must be done with extreme caution
Can begin with isometric strengthening, progress to isotonic

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23
Q

TE for Ulnar Drift

A

Radial walks with palm on table

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24
Q

TE for Boutonniere Deformity

A

PIP held in extension with splint
Focus on active/passive DIP flexion

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25
CMC Arthroplasty
Removal of arthritic trapezium Donor tendon interposition in the space Ligaments are reconstructed Cast for 4-6 weeks Forearm-based thumb spica following cast
26
Shoulder Arthroplasty
D/t arthritis or complex proximal humeral fx Total or hemi-arthroplasty Precautions: no WB, no extension beyond neutral, no ER past 30*, no IR past 60*/small of back, no lifting more than 1-2lbs
27
Reverse Total Shoulder
D/t shoulder arthritis with deficient/irreparable RTC tears or complex proximal humerus fx with RTC tears *Must have good deltoid* Precautions: avoid IR, ADDuction, and extension for 12 weeks
28
Hip Arthroplasties
Tota: replace stem, ball, and cup Partial: only one portion of stem/ball/cup replaced Biploar: stem and ball are one component
29
Posterior Hip Precautions
No flexion beyond 90* No ADDuction past neutral No IR
30
Anterior Hip Precautions
No extension No IR
31
Global Hip Precautions
No flexion past 90* No ADduction past neutral No IR/ER No prone lying No bridging
32
Trochanteric Hip Precautions
No active hip ABduction
33
Types of Knee Replacement
Partial Unicompartmental Total
34
Rotator Cuff Musculature
Supraspinatus - ABduction/elevation Infraspinatus - ER Teres Minor - ER Subscapularis - IR Control the head of the humerus on the glenoid fossa
35
Intrinsic Rotator Cuff Injuries
Age-related changes Critical zone (supraspinatus insertion on the greater tuberosity has poor blood supply/hypovascularity)
36
Extrinsic Rotator Cuff Injuries
Repeated overhead movements with IR (cause RTC to move against acromion)
37
Most commonly injured RTC tendon
Supraspinatus (ABduction/elevation)
38
Shoulder Impingement Syndrome
At subacromial space Bursa, supraspinatus, joint capsule, LH of biceps are vulnerable to impingement
39
Neer's Classification of Shoulder Impingement
Stage 1: edema, hemorrhage from excessive overhead use (reversible) Stage 2: fibrosis, tendonitis due to multiple occurrences of inflammation (irreversible) Stage 3: bone spurs, partial/complete tears of RTC and/or LH of biceps
40
Shoulder Bursitis
In subarcomial space Differentiated from tendonitis during palpation as pain continues even with arm at rest Pain noted during PROM
41
Shoulder Tendonitis
Pain with humeral movement >90* Causes: repetitive overhead use, weakness of shoulder complex, capsule tightness
42
Types of RTC Tears
Partial Full thickness Small (1 cm) Medium (1-3 cm) Large (3-5 cm) Massive (>5 cm)
43
Medical Treatment for RTC Injuries
Rest NSAIDs Cortisone injections Surgery (arthroscopic repair, mini open, open RTC repair)
44
Hawkins-Kennedy Test
Flex shoulder and elbow to 90* Force arm into IR + if pain (indicates involvement of supraspinatus and/or LH of biceps)
45
Neer Impingement Sign
Stabilize scapula Force client's are in shoulder flexion (end range) and IR + if pain (involvement of supraspinatus and/or LH of biceps)
46
Jobe/Empty Can Test
Elevate shoulder and IR Apply resistance in elevation + pain/weakness (involvement/tear of supraspinatus) *Trouble reaching to shoulder height*
47
Biceps Speed Test
Flex shoulder to 90* with palm up Apply resistance to flexion + pain/weakness (involvement of biceps)
48
Painful Arc
60-120*
49
Adhesive Capsulitis
Frozen shoulder Cause unknown (may be linked to genetics, endocrine, immunological, inflammatory) Can be linked to shoulder trauma as secondary condition May take 2-3 years to resolve
50
Freezing Stage Adhesive Capsulitis
Major symptom is pain, usually at end range or with resistance Pain free A/PROM - focus on maintaining/increasing ROM Preserve important functional movements
51
Frozen Stage Adhesive Capsulitis
Loss of shoulder movement following capsular pattern with pain at end range Continue A/PROM Joint mobilization Gentle stretching in pain free range Modalities (hot packs, ice)
52
Thawing Stage Adhesive Capsulitis
Gradual return of ROM and function Can be more aggressive with exercises Focus to restore all functional movement without compensation
53
Lateral Epicondylitis
Tennis Elbow Degeneration of ECRP 1-2 cm distal to origin at lateral epicondyle May impact EDC and ECRL tendons D/t repetitive wrist extension under load, forceful gripping, static wrist extension (tennis, yard work, carpentry)
54
Lateral Epicondylitis S/S
Pain at lateral epocondyle w/ radiation to dorsal/distal forearm (at rest) Nighttime aching of elbow Morning stiffness of elbow Reduced grip strength when elbow in extension Tightness of extrinsic extensors Inflammation of lateral epicondyle Functional weakness of affected UE
55
Cozen's Test
Lateral Epicondylitis Stabilize forearm on table, palpate lateral epicondyle Ask client to pronate, radially deviate, make fist Ask client to actively extend wrist while therapist resists +pain in area
56
Mill's Tennis Elbow Test
Lateral Epicondylitis Palpate most tender area near lateral epicondyle Place client's shoulder into neutral w/ elbow partially flexed Pronate forearm and flex wrist Therapist moves elbow from flexion into extension +pain in lateral epicondyle
57
Radial Tunnel Syndrome Test
Client maintains elbow extension, wrist neutral, MCPs in exension Apply resistance to middle finger +pain in distal to lateral epicondyle, follow with percussion distally to proximally along superficial radial nerve +paresthesia indicates radial tunnel syndrome
58
Acute Phase Lateral Epicondylitis
Decrease pain and promote rest Ice several times/day Activity modifications Orthosis: wrist cock-up (0-30* extension for night and during gripping/wrist extension occupations) Gentle AROM fo elbow/wrist/hand Transverse friction massage PAMs (e-stim, ionto, phono, anti-inflammatory mods)
59
Chronic/Restorative Phase Lateral Epicondylitis
Activity modifications Counterforce bracing PAMs Transverse friction massage Stretching (wrist flexion, pronation, elbow extension) Hand/wrist/elbow strengthening-->shoulder, scapular
60
Functional/Prevention Stage Lateral Epicondylitis
Strengthening, endurance, flexibility of wrist extensors/flexors Modify work, sports, leisure Educate on positioning
61
DeQuervain's Tenosynovitis
Fibrous thickening of extensor retinaculum Inflammation and impaired gliding of APL and EPB in 1st dorsal compartment
62
Causes of DeQuervain's
Cumulative trauma (forceful, sustained, repetitive thumb ABduction, ulnar deviation, grasp, thumb MP flexion) Acute trauma (wrenching of wrist and thumb) Occurs in new parents, golfing/racket sports, knitting, needling, prolonged scissor/surgical retractor use
63
DeQuervain's Symptoms
Radial wrist pain (over radial styloid, radiating to thumb/distal forearm) Pan during resisted thumb extension/ABduction Weak pinch strength Increased pain with stretching/contracting APL/EPB Swelling on radial side of wrist
64
Finklestein's Test
Ask client to hold thumb in palm and ulnarly deviate wrist +sharp pain over radial styloid +DeQuervain's
65
DeQuervain's Orthotic
Forearm based thumb spica with wrist in neutral and thumb in opposition Leave thumb IP joint free Wear for 4-6 weeks as much as possible
66
Trigger Finger
Constriction of the distal flexor tendons d/t stenosis of tendon sheath or formation of nodule at flexor tendon *Most common: A1 pulley** A3 pulley/proximal portion of the A2 pulley Strong association with DM and RA
67
Symptoms of Trigger Finger
Pain over A1 pulley Gripping is painful Decreased ROM of finger flexion/extension Catching/locking in flexion, esp in AM Snapping of locked fingers into extension Inflammation
68
Nerve Compression Symptoms
Sensory impairment Motor loss Pain Impaired occupational performance
69
Causes of Nerve Compression
Narrowing of tunnel space due to swelling, inflammation, hypertrophy, anatomical abnormalities Cumulative trauma d/t repetitive movements, sustained postures, direct pressure, and/or vibration
70
Carpal Tunnel Anatomy
Floor - carpal bones Roof - flexor retinaculum (transverse carpal ligament) Structures within: tendons of FDS, FDP, FCR, FPL, median nerve (most superficial)
71
Tinels' Test
CTS Tapping over median nerve Elicits symptoms of tingling/numbness over palm and digit 1-4.5
72
Phalen's Test
Inverted prayer Hold dorsum of hands together for 60 seconds to reproduce CTS symptoms
73
Berger's Test
Hold tight fist for 30-40 seconds to reproduce sypmtoms

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