Common Ortho Impairments

Question 1

Achilles’ tendon rupture typically in occurs in _ and within _ to _ _ above the tendinous insertion into the _. Incidence? Without?

Answer 1

Typically occurs in MEN and within 1 TO 2 INCHES above the tendinous insertion in to the CALCANEUS.

Incidence: 30-50 years of age

WITHOUT history of heel or calf pain

Question 2

Patients with Achilles rupture will typically be unable to stand? Tend to exhibit a positive _ test.

Answer 2

Will typically be unable to ON THEIR TOES

Tend to exhibit a positive THOMPSON’S TEST

Question 3

Describe the THOMPSON’S test. Positive result?

Answer 3

Patient is in prone with feet extended over the edge of the table. PT asks the patient to relax and the proceeds to squeeze the belly of the gastroc and Soleus.

Test is positive if the foot does not plantar flex in response to the pressure on the gastroc/ Soleus
- MAY indicate an Achilles’ tendon rupture

Question 4

What are some of the possible clinical presentations of a patient with Achilles’ tendon tear?

Answer 4

Swelling over the distal tendon
Palpable defect in the tendon above the calcaneal tuberosity
Pain and weakness in the plantar flexors
Limp
Complaints of snap or pop associated with severe pain
Inability to plantar flex ankle in weight bearing position

Question 5

Which diagnostic imaging would be ordered to confirm diagnosis of Achilles’ tendon rupture? What other test could be performed by an MD to confirm

Answer 5

First X-Ray to rule out avulsions fracture and/ or bony injury

MRI to locate the presence and severity of tear or rupture

The OBRIEN NEEDLE TEST can be performed by an MD to confirm diagnosis

Question 6

A patient that manages an Achilles’ tendon rupture/ tear without surgery and allows the tendon to heal on it’s own has a higher rate of? Why? What treatment option has a decreased risk for reinjury and a higher rate of return to athletic activities?

Answer 6

Patient that does not get surgery has a higher rate of rerupture (40% rerupture), and can result in an incomplete return to functional performance

Surgical repair of Achilles’ tendons has the highest success rate, decreased risk of rerupture and higher rate of return to sports.

Question 7

What is adhesive capsulitis? AKA?

Answer 7

Shoulder disorder that is characterized by inflammation and fibrotic thickening of the anterior joint capsule. Then the inflamed capsule becomes adherent to eh the humeral head and undergoes a contracture, which severely limits shoulder ROM.

AKA: frozen shoulder

Question 8

How many types of adhesive capsulitis are there? Describe cause of each.

Answer 8

2 types:
Primary adhesive capsulitis- occurs spontaneously (etiology unknown)

Secondary adhesive capsulitis- results from underlying condition (including trauma, immobilization, complex regional pain syndrome, RA, abdominal and psychogenic disorders or orthopedic intrinsic disorders such as supraspinatus or bicipital tendonitis or partial tear of rotator cuff.

Question 9

Incidence and age and gender that is most affected by adhesive capsulitis?

Answer 9

Occurs in 2% of population; 11% of those with Diaetes

10-15% develop bilateral frozen shoulder

Middle age females have the greatest incidence

Question 10

What type imaging is used to diagnose adhesive capsulitis. What is it measuring?

Answer 10

Arthro gram

Measuring the amount of fluid within the joint capsule

• normal is 16-20 mL
• adhesive capsulitis 5-10 mL of fluid

Question 11

Which two motions at the shoulder are most affected with frozen shoulder? Tightness of which areas of the joint capsule will be present?

Answer 11

Abduction and lateral/ external rotation are affected the most however there will be limitations in all planes of movement

Tightness of the anterior and inferior joint capsule will be present

Question 12

Adhesive capsulitis usually follows a - _ of recovery. What are the 2 phases, and their associated PT treatments? Spontaneous recovery is said to take - _.

Answer 12

Usually follows a NON-LINEAR PATTERN of recovery

2 phases:
ACUTE PHASE: icing/ heat, gentle joint mobs, progressive and isometric strengthening, and pendulum exercises as able.
CHRONIC PHASE: ultrasound, grade III and IV mobs, increasing joint capsule extensiblitity, and techniques such as PNF to restore painless ROM

Spontaneous recover is said to take 12-24 MONTHS

Question 13

What other impairment has similar characteristics to frozen shoulder? How do they differ?

Answer 13

ACUTE BURSITIS

• intense pain and sometimes throbbing over lateral brachial region, may be secondary to calcific tendinitis
• AROM in all directions is limited by pain, especially abduction over 60 degrees and flexion greater than 90 degrees

DIFFERS: acute pain only lasts for FEW DAYS, unlike frozen shoulder in which the pain often resolves after a FEW WEEKS

Question 14

Lateral ankle sprain- Grade II usually are caused by? Usually involve which ligaments? Which one is the MOST commonly affected?

Answer 14

Usually caused by significant inversion

Usually involves the lateral ligament complex, which includes the anterior talo fibular (ATFL), calcaneofibular (CFL), and the posterior talo fibular ligaments (PTFL)

ATFL is the MOST likely to become sprained

Question 15

What is the ligament structure on the medial part of the ankle? Why is it less affected than the lateral structures?

Answer 15

Deltoid ligament
- strongest of the ankle ligaments and resists valgus stress

Less affected because it attaches in part to the medial malleolus and significant valgus stress would typically cause the medial malleolus to fracture before the deltoid ligament would mechanically fail

Question 16

Describe the clinical presentation of a lateral ankle sprain grade II

Answer 16

Will likely present with:

• significant pain or tenderness along the lateral aspect of the ankle, especially at the ATFL and elicited with inversion and EROM plantar flexion
• pain will typically limit strength testing, but AROM should be fine
• antalgic gait
• discernible laxity with ligament testing and joint mobs
• redness and moderate to severe edema

Question 17

An _ is not usually used with suspected lateral ligament involvement at the ankle without other extenuating circumstances. Why?

Answer 17

An MRI is not usually used. . . .

Cost prohibitive

Question 18

What PT assessment can be used to confirm diagnosis of lateral ankle sprain?

Answer 18

Anterior drawer test for ankle (specifically assesses integrity of the ATFL)

Talar tilt (assess the integrity of the CFL as the talus is moved into ABD)

Though rare, neurovascular complications may accompany injury, so you may want to screen for presence of distal pulses and/ or sensory integrity

Question 19

Medical managment of lateral ankle sprain- grade II?

Answer 19

RICE
-rest, ice, compression, elevation

Limited weight bearing/ use of crutches may be recommended until patient can tolerate/ pain subsides

Supportive taping or bracing may be recommended to prevent reinjury

Question 20

What is a similar condition that can present with like symptoms? Characteristics.

Answer 20

High ankle sprain (SYNDESMOTIC injury)

• often occur in conjunction with an ankle fracture because a great deal of force is required to injure
• if left untreated severe post-traumatic arthritis will typically occur
• significant tear will require surgery which is NOT typical for other ligamentous injuries at the ankle

Question 21

The _ _ prevents anterior translation of the tibia on the fixed femur and posterior translation of the of the femur on the fixed tibia.

Answer 21

The ACL LIGAMENT prevents anterior translation . . .

Question 22

A _ _ _ sprain refers to a complete tear of the ligament with excessive laxity. Most often occur at which location of the ligament?

Answer 22

A GRADE III ACL SPRAIN refers to a complete . . . .

Most often occurs at the middle of the ligament and really at it’s attachment to the femur or tibia

Question 23

What is the peak age range for ACL tear? Incidence?

Answer 23

14-29 years of age

Occurs more in female athletes than male athletes but currently there is no definitive evidence as to why

Question 24

Clinical presentation of a Grade III ACL sprain?

Answer 24

Clinical presentation:

• significant pain, effusion and edema that significantly limits ROM
• patient is unable to weight bear on the involved extremity, AD required for ambulation
• ligamentous testing revels visible laxity in the knee compared to uninvolved leg and may exacerbate patients pain

Question 25

What is the preferred imaging tool to identify presence of ACL tear and possible disruption of other soft tissue structures such as ligaments and Menisci? What may also be used, and why?

Answer 25

MRI is the PREFERRED IMAGING TOOL X-RAY may also be used to rule out fracture

Question 26

What additional PT assessments can be used to confirm diagnosis of grade III ACL sprain?

Answer 26

- patient report of loud pop or feeling of buckling is often associated with a complete tear - special tests such as Lachman's test, anterior drawer test, and pivot shift test can be used. Be sure to perform ALL SPECIAL TESTS BILATERALLY

Question 27

Approximately _ of the time during and ACL tear the meniscus is also involved. _ _ may also be involved although _ _ _. What is it called when all 3 structures (ACL, MCL, and medial meniscus) are involved?

Answer 27

Approximately 2/3 of the time ACL tear occurs in conjunction with meniscal tear COLLATERAL LIGAMENTS may also be involved, although IT'S LESS COMMON All 3- known as the UNHAPPY TRIAD

Question 28

What is the most common graft used to repair a torn ACL? Other possibilities?

Answer 28

Most common- PATELLAR TENDON Other possibilities: IT band, quadicep tendon, hamstring

Question 29

What is the PT protocol most often used immediately after post ACL repair (Once cleared by MD)? Which type of exercise is preferred in the early stages of rehab? Why?

Answer 29

Protect integrity of the graft Control edema Improve ROM CLOSED CHAIN EXERCISES ARE PREFERRED, minimize anterior translation on the tibia

Question 30

What are the distinguishing characteristics of a similar condition to ACL grade III sprain?

Answer 30

Grade III PCL ligament sprain - most commonly due to a 'dashboard' injury or forced knee hyper flexion as the foot is plantar flexed - typically produce effusion, POSTERIOR TENDERNESS, AND POSITIVE POSTERIOR DRAWER TEST - Knee extension is often limited - Individuals with isolated PCL sprain may not exhibit any functional performance limitations, and therefore surgical intervention is less common - does alter the Arthrokinematics of the joint and therefore patient will be susceptible to degenerative changes such as arthritis

Question 31

Bicipital tendonosis is an _ _ of the tendon of the long head of the biceps. Repeated full abduction and lateral rotation of the humeral head can lead to? Most common cause?

Answer 31

Is an INFLAMMATORY PROCESS of the tendon of the . . . Repeated full abduction/ lateral rotation can lead to: -irritation, edema, microscopic tears within the tendon and tendon degeneration Most common cause: REPEATED OVERHEAD ACTIVITIES

Question 32

Clinical presentation of bicipital tendonitis? 2 special tests that can help confirm?

Answer 32

Presentation: - deep ACH directly in the front and on top of the shoulder that may spread into the bicep muscle and is usually irritated by overhead and lifting activities - resting shoulder reduces pain - positive Yegrgason's or Speed's test

Question 33

What type of imaging is used to confirm diagnosis? Which is not typically used and why?

Answer 33

X-Ray is most commonly used -don't diagnose but may show calcification in the bicipital groove or subacromial spurring MRI can view tendon but is not commonly used due to cost

Question 34

What are the most common PT recommendations during early stages of recovery? What is next step After acute phase?When is surgery recommended?

Answer 34

Early recommendations: - avoid all overhead movement, reaching, and lifting of objects until pain and inflammation subside - pendulum exercises, modalities Next step should focus on stretching and strengthening affected muscle groups Surgery is recommended if patient does not progress with conservative approach after 6 months

Question 35

What are the distinguishing characteristics of a similar condition to bicipital tendonitis?

Answer 35

GLENOID LABRAL TEAR - Labral tear is most susceptible with anterior damage or subluxation - Bankart lesion: avulsions of the Labral ligamentous complex from the anterioinferior aspect of the GLENOID - most common lesion resulting in anterior joint instability, can be differentially diagnosed via CT scan and repaired surgically

Question 36

_ _ or _ _ is characterized by inflammation or degenerative changes at the common extensor tendon that attaches to the lateral epicondyle of the elbow. What is the primary symptom of this condition?

Answer 36

LATERAL EPICONDYLITIS OR TENNIS ELBOW is characterized. . . PAIN is the primary symptom

Question 37

_ are more likely to develop lateral epicondylitis, and it's more common for individuals in their _ or _.

Answer 37

MEN are more likely to develop . . . More common for individuals in their 30'S OR 40'S

Question 38

What is the clinical presentation of lateral epicondylitis?

Answer 38

Presentation: - pain along the lateral aspect of the elbow especially over the lateral epicondyle that sometimes radiates into the dorsum of the hand - pain increases with wrist flexion and elbow extension; resisted wrist extension and radial deviation - may have difficulty gripping or holding objects and insufficient forearm functional strength - pain increases with activity and also at night - possible localized swelling

Question 39

No _ or _ _ are required to diagnose lateral epicondylitis. X-Ray or MRI may be used to? Electro diagnostic tests (nerve conduction) are?

Answer 39

No LAB OR IMAGING STUDIES are required . . . X-Ray or MRI may be used to rule out other conditions Electrodiagnostic tests are only beneficial if there is INVOLVEMENT OF THE RADIAL NERVE

Question 40

What is recommended in the early stages of rehab for lateral epicondylitis?

Answer 40

Treat pain and inflammation through protection and RICE. Modalities may be used On occasion resting splints may be used to relieve tension on involved muscles

Question 41

Lateral epicondylitis will commonly _, however _ _ and _ will decrease the risk. If conservative treatment does not improve symptoms in _ to _ _ surgical intervention may be indicated

Answer 41

Lateral epicondylitis will commonly RECUR, however CONTINUED STRETCHING and EXERCISE will decrease the risk If conservative treatment does not improve symptoms in 2 TO 3 MONTHS surgical intervention may . . .

Question 42

The _ _ _is the primary stabilizer of the medial side of the knee against valgus force and lateral rotation of the tibia (especially during knee flexion)

Answer 42

The MEDIAL COLLATERAL LIGAMENT is the primary. ..

Question 43

What is the common mechanism of injury for the MCL?

Answer 43

Direct blow against the lateral surface of the knee asking valgus stress and subsequent damage to the medial aspect of the knee

Question 44

A grade II injury of the MCL is characterized by? Resulting in? What other ligament is often involved in a grade II MCL sprain?

Answer 44

Characterized by PARTIAL TEARING OF THE LIGAMENTS FIBERS Resulting in LAXITY when the ligament is stretched The MEDIAL CAPSULAR LIGAMENT is often involved

Question 45

What is the clinical presentation of a MCL grade II injury

Answer 45

Presentation: - unable to fully extend and flex the knee - significant tenderness along the medial aspect of the knee - possible decrease in strength - potential loss of proprioception - antalgic gait - noticeable laxity with valgus testing and instability of the joint - moderate swelling, more severe swelling may be indicative of meniscus or cruciate ligament involvement

Question 46

What are 2 additional structures that are commonly injured during a grade II MCL sprain? What are common treatments in the early phases of rehab?

Answer 46

ACL and/ or meniscal damage is common Common treatments: - RICE - full-length knee immobilized or hinge brace and crutches to minimize weight bearing - focus on increasing ROM including heel slides or stationary cycling without resistance - begin with functional activity training (stairs, gait, etc)

Question 47

If there are no other structures that are involved a grade II MCL sprain should? Patient should be able to return to their PLOF within?

Answer 47

Should progress fairly quickly if no other structures are involved. Patient should return to PLOF within 4-8 weeks following injury

Question 48

_ collateral ligament injuries are far less common than _ collateral ligament injuries.

Answer 48

LATERAL COLLATERAL LIGAMENTS ARE FAR LESS COMMON THAN MCL

Question 49

_ _ is a rare congenital disorder of the collagen synthesis that affects all connective tissue in the body. Reduces production of collagen _-_%. Which genes mutate?

Answer 49

OSTEOGENESIS IMPERFECTA is a rare congenital disorder . . . Reduces production of collagen by 20-50% Genes for type I collagen production (COL1A1 and COL1A2) are the genes that mutate as a result of osteogenesis imperfecta

Question 50

Most children inherit OI from _ as either an _ _ or _ _ trait. 25% of the time it occurs by? Incidence in the US?

Answer 50

Inherit OI from PARENTS as either an AUTOSOMAL RECESSIVE OR AUTOSOMAL DOMINANT trait. 25% of the time it occurs spontaneously 30-50 thousand individuals are living with osteogenesis imperfecta in the US

Question 51

How many types are there? Clinical range of presentations?

Answer 51

There are 4 types: - type I: mildest form, has near normal growth and appearance with frequency of fractures usually ceasing after puberty - type II: most severe form, child dies in utero or in early childhood - type III: is severe, children present with greater skull ossification, significant growth retardation, progressive deformities, ongoing fractures, severe osteoporosis, triangular face, blue sclera and significant functional mobility limitation - type IV, milder course, involves mild to moderate fragility and osteoporosis, may or may not have shorter stature, will have bowing of long bones, Barrel shape to rib cage, possible hearing loss, brittle teeth and normal sclera (near normal life expectancy)

Question 52

What lab or imaging tests are used to confirm diagnosis?

Answer 52

Skin biopsy performed to examine the collagen ad determine which type of OI X-rays and bone scans may be used for evidence of deformities or past fractures Bone densitometry may also be used to measure bone mass and estimate risk of fracture for specific sites

Question 53

General goals for treatment of OI?

Answer 53

Maximizing independence with mobility, improving optimal bone mass and muscle strength, prevention of fractures and deformities. Incorporation of developmental activities, positioning, weight bearing and activities that facilitate safe movement

Question 54

What are distinguishing characteristics of a similar condition?

Answer 54

Arthrogyrposis multiplex congenita (AMC) is a non-progressive neuromuscular disorder that results from multiple conditions that ultimately limit fetal movement and cause multiple congenital contractures at birth. - children are also born with muscle atrophy and weakness and articular rigidity - some will be able to ambulate and some will require wheelchairs for mobility

Question 55

_ _ is caused by abnormal tracking of the patellar tendon between the femoral condyle. Commonly occurs when the patella is pulled too far?

Answer 55

PATELLOFEMORAL SYNDROME Commonly occurs when the patella is pulled too far LATERALLY DURING KNEE EXTENSION

Question 56

PFS causes damage to the _ _, and the damage can range from _ of the _ to _ _ _ resulting in exposure of subchondral bone.

Answer 56

Causes damage to the ARTICULAR CARTILAGE, and the damage can range from SOFTENING of the CARTILAGE to COMPLETE CARTILAGE LOSS resulting in . . .

Question 57

PFS is extremely common during _, and is more prevalent in _ than in _. In the older population PFS is commonly associated with?

Answer 57

Is extremely common during ADOLESCENCE and is more prevelant in FEMALES than in MALES. In the older population PFS is commonly associated with OSTEOARTHRITIS

Question 58

Clinical presentation of patellofemoral syndrome

Answer 58

Presentation: - gradual onset of anterior knee pain following physical activity - retro patellar burning pain that may be exacerbated with activities such as upping and stair climbing, or prolonged sitting with knee at 90 degrees - point tenderness over lateral border of the patella - crepitus with manual compression - visible atrophy of the quadriceps particularly along vastus medialis

Question 59

Laboratory or imaging studies are _ _ used to diagnose PFS. X-rays can? Arthrogram and arthroscopy can be used to?

Answer 59

. . . Are NOT COMMONLY used to diagnose PFS X-rays can rule out fracture, examine configuration of patellofemoral joint, and identify potential osteophytes Arthro gram/ arthroscopy can be used to examine articular cartilage

Question 60

What special test can be useful to confirm diagnosis of PFS? How is it performed? Test should be performed?

Answer 60

Clarke's sign can be useful Performed by applying pressure immediately proximal to the upper pole of the patella and ask the patient to isometrically contract the quadriceps. Positive test is failure to to fully contract the quadriceps or retro patellar pain complaints from patient Test should be performed at various angles of flexion and extension

Question 61

Patients with PFS often have an _ _ _. What is normal in males and females?

Answer 61

Often have an INCREASED Q ANGLE Normal: Females- 18 degrees Males- 13 degrees

Question 62

With PFS, differential diagnostic tests should be performed to rule out other problems such as?

Answer 62

``` Referred pain from the hip Osgood-Schlatter syndrome Neuroma Patellar tendonitis Plica syndrome Knee joint infection ```

Question 63

Rotator cuff tears occur as a result of? Tears may be classified as? Most commonly involve? With more severe or traumatic etiologies which other muscles may be involved?

Answer 63

Occur as a result of acute trauma or du to chronic degenerative pathology such as chronic supraspinatus tendonitis Tears are classified as: partial thickness, full thickness, acute, chronic or degenerative Most commonly involve the supraspinatus With more severe injury/ trauma: infraspinatus and subscapularis can also be involved

Question 64

Clinical presentation for rotator cuff tear

Answer 64

Presentation: - pain and weakness - generalized pain exacerbated by specific movements or functional tasks, typically in the lateral aspect of the shoulder with radiating symptoms into the upper arm and deltoid region - complaints of shoulder instability or stiffness, sense of GH grinding, crepitus and discomfort when lying on side

Question 65

Which 2 special tests are used to help confirm diagnosis of rotator cuff tear? What type of imaging is typically used?

Answer 65

Special tests: - drop arm and empty can test - pain with resisted muscle testing is likely to be greatest with a partial thickness tear Imaging: MRI is typically used to detect the size, location ,and general characteristics as well as possible damage to adjacent structures. -X-rays may be used to assess possible bones spurs within the joint capsule

Question 66

Conservative management with PT is typically? Acute phase of PT should include?

Answer 66

Conservative management with PT is typically tried prior to surgical intervention, unless severe trauma was mechanism of injury Acute phase includes: -cryotherapy, activity modification, ROM, rest, and gentle isometrics

Question 67

_ is the forward slippage of one vertebrae on another. Several types that are classified by? Name them. What is the most common type?

Answer 67

SPONDYLOLISTHESIS is forward slippage of . . . Types are classified by ACUTAL CAUSE OF SLIPPAGE, and include: -congenital, isthmic, degenerative, post-traumatic, and pathological. Most common type is DEGENERATIVE

Question 68

What level of the spinal cord is usually affected by degenerative spondylolisthesis? Can cause? Caused by?

Answer 68

L4-L5 level most commonly affected Can cause cauda EQUINA symptoms secondary to stenosis of the canal Caused by arthritis and degenerative changes in the spine.

Question 69

Degenerative spondylolisthesis affects individuals? Is more common with _ _ and _. Primary symptoms include?

Answer 69

Affects individuals OVER 50 YEARS OF AGE Is more common with AFRICAN AMERICANS AND WOMEN Primary symptoms include: - back pain that increases with exercise, lifting overhead, prolonged standing, getting in/ out of a car, walking up stairs or incline, and extension position - pain may be severe and may radiate depending on stenosis and slippage - sensory and motor loss may be significant and follow a myotomal and/ or dermatomal pattern

Question 70

What type of PT should be initiated after the acute phase?

Answer 70

Williams flexion exercises to strengthen the abdominals and reduce lumbar lordosis Back school Modalities Postural education External support such as bracing or wearing of corset may reduce intradiscal pressure

Question 71

When is surgical intervention recommended? What type?

Answer 71

Surgical intervention is recommended if conservative treatment does not work Usually involves decompression with or without spinal fusion

Question 72

_ _ is a condition that causes the neck to involuntarily unilaterally contract to one side secondary to contraction of the SCM. Patient presentation?

Answer 72

CONGENITAL TORTICOLLIS is a condition . . . Patient presentation: - head is laterally flexed toward the contracted muscle, the chin faces that opposite direction and there may be facial asymmetries - first sign may be a firm non tender enlargement of the STM visible at birth or within the first few weeks of life and then gradually decreases in size and usually disappears by 6 mos. of age

Question 73

Congenital Torticollis is usually seen at? Causes?

Answer 73

Usually seen at birth Causes: - local trauma to the soft tissue of the neck before or during delivery - breech or forceps delivery

Question 74

Medical managment of congenital Torticollis? PT intervention?

Answer 74

usually treated with non-operative intervention for 12-24 months before considering surgical intervention PT intervention: - passive stretching - parent/ caregiver education and training regarding proper positioning during feeding and sleeping - heat, analgesics, TENS - AROM exercises with subsequent strengthening

Question 75

_ _ also known as _ _ _ (_) is a form of peripheral as ulnar disease that produces thickening, hardening and eventual narrowing and occlusion of the arteries. Results in?

Answer 75

ARTERIOSCLEROSIS OBLITERANS, also known as PERIPHERAL ARTERIAL DISEASE (PAD) . . . Results in: - ischemia and subsequent ulceration of the affected tissues - may become necrotic, gangrenous, and require amputation

Question 76

Risk factors associated with PAD/ arteriosclerosis obliterans

Answer 76

Age over 45, diabetic, smoker, Hyptension, high cholesterol, impaired glucose tolerance, and sedentary lifestyle

Question 77

Clinical presentation for PAD?

Answer 77

Presentation: - intermittent claudication that causes cramps and pain in the affected areas (typically gastroc-Soleus complex) - resting pain - decreased pulses and skin temperature - ischemia, pallor skin

Question 78

What four diagnostic imaging tests are used to confirm PAD? What do they examine?

Answer 78

Doppler ultrasound, ultrasonography, MRI, or arteriography Examine the degree of blood flow throughout the extremities

Question 79

_ _, aka _ _ is tendonitis at the flexor tendon of the elbow. Commonly occurs due to ?

Answer 79

MEDIAL EPICONDYLITIS, aka GOLFERS ELBOW is tendonitis. . . Commonly occurs due to: - repetitive wrist or elbow motions or gripping - often seen in golvfers or those who play throwing or racquet sports

Question 80

Clinical presentation of medial epicondylitis?

Answer 80

Presentation: - pain and/ or tenderness over the medial epicondyle - pain with resisted wrist flexion and pronation and with gripping - may also have weakness associated with above motions - possible pain and/ or parathesia into the forearm and 4th and 5th digits

Question 81

What other structure should you rule out that can have similar symptoms to medial epicondylitis?

Answer 81

Ulnar collateral ligament damage (differentiate through palpation and/ or imaging

Question 82

_-_ _ refers to traction apophysitis occurring at the tibial tuberosity. Which activities often exacerbate?

Answer 82

OSGOOD-SCHLATTER'S DISEASE refers to traction . . . Often exacerbated by: -running, jumping and squatting activities

Question 83

When does Osgood schlatters onset most commonly occur? Incidence?

Answer 83

Most commonly occurs in adolescents following a period of rapid long bone growth Affects 20% of adolescents involved in running, jumping, and cutting sports (soccer, ballet) Historically more prevalent in boys, although gender gap is lessening with increased participation in sports for girls

Question 84

What is the conservative PT management for Osgood Schlatters?

Answer 84

- patient education (avoid or modify pain producing activities) - ice, rest, otc medication - knee immobilized may be beneficial to facilitate rest during acute faces - infrapatellar strap may assist in distributing forces - pain relieving modalities, activity modification, and gentle stretching and strengthening

Question 85

_ _ _ is a result of an inflammatory process involving the tendons and synovium of the abductor pollicis longus and extensor pollicis brevis muscles. Typically due to?

Answer 85

DE QUERVAIN'S TENOSYNOVITIS is a result of . . . Typically due to repetitive activities involving thumb abduction and extension such as racquet sports and repeated heavy lifting

Question 86

Clinical presentation of De QUERVAIN'S Tenosynovitis. More prevalent in?

Answer 86

Presentation: - localized tenderness and pain in the anatomical snuff box which may radiate into the forearm on occasion - onset may be gradual or sudden - pain typically improves with rest, worsens with activity - edema at base of thumb More prevalent in women with higher risk among new mothers due to repeated lifting and carrying of infants

Question 87

What special test is used to confirm diagnosis of de QUERVAIN'S Tenosynovitis? How is it performed?

Answer 87

Finklesteins test Patient is in sitting or standing and is asked to make a fist with the thumb tucked inside. The therapist then stabilizes the forearm and ulnarly deviates the wrist -positive test is pain over the APL and EPB tendons at the wrist

Question 88

_ _ is a condition characterized by calcification of muscle. Typically caused by failing to treat? Characterized by _ _ in the muscle belly and often occurs in muscles prone to traumatic injury such as muscles of _ and _. Bone will begin to grow in _-_ _ after injury and will mature within _-_ _

Answer 88

MYOSITIS OSSIFICANS is a condition . . . Typically caused by failing to treat a muscle strain or contusion Characterized by BONE GROWTH in the muscle belly . . .muscles of the ARM AND LEG Bone will begin to grow in 2-4 WEEKS after injury and will mature within 3-6 MONTHS

Question 89

Clinical presentation of myosotis OSSIFICANS?

Answer 89

Presentation: - in initial stages will present with typical symptoms of contusion - pain with functional activities - stiffness and pain after prolonged rest - swelling, tenderness, and bruising - later stages, hard lump in the muscle belly - increase in pain and a decrease in ROM

Question 90

_ _ is a condition where subchondral bone and it's associated cartilage crack and seperate from the end of the bone. What special test can be performed to detect _ _ of the knee?

Answer 90

OSTEOCHONDRITIS DESSECANS is a condition where . . . Special test to detect OSTEOCHONDRITIS DESSECANS of the knee: -Wilson's test

Question 91

_ refers to an infection that occurs within the bone. Most commonly secondary to _ _ infection.

Answer 91

OSTEOMYELITIS Most commonly secondary to STAPHYLOCOCCUS AUREUS infection

Question 92

Clinical presentation of osteomyelitis. Confirmed by?

Answer 92

Presentation: - similar to infection: fever and chills - pain, edema, erythema Confirmed by bone biopsy