Deck 11 Flashcards
35M presents with acute L Achilles Tendon pain after playing flag football this past weekend. Has significant antalgic gait with reduced step length on R and difficulty with push off phase of gait. When asked to perform HR, pt performs at 7/10 pain. Pt has (-) Thomas test, (+) arc sign, (+) findings on Royal London Hospital test, and limited ankle DF on involved side.
Based off the above information, what intervention is recommended for this pt?
A. Heel lift
B. Rigid taping to dec strain on Achilles Tendon
C. Iontophoresis with dexamethasone
D. Anterior to posterior TC mobilizations and ankle DF stretching
C. Iontophoresis and dexamethasone
Evidence for heel lifts for Achilles tendonitis
Contradictory - NOT recommended
Achilles tendonitis: evidence for rigid taping
expert opinion only
Achilles tendonitis: level of evidence for use of iontophoresis to dec pain and improve function in pts with acute mid portion Achilles tendinopathy
B
Achilles tendonitis: level of evidence for use of manual therapy
F - expert opinion
Achilles tendonitis: level of evidence for use of stretching
C
35M presents with acute L Achilles Tendon pain after playing flag football this past weekend. Has significant antalgic gait with reduced step length on R and difficulty with push off phase of gait. When asked to perform HR, pt performs at 7/10 pain. Pt has (-) Thomas test, (+) arc sign, (+) findings on Royal London Hospital test, and limited ankle DF on involved side.
Which is NOT true regarding pathoanatomical features of Achilles tendinopathy?
A. Tenocyte degradation with tendon thinning
B. Neovascularity
C. Fat disposition
D. Overproduction of nitric acid with tissue apoptosis
A. Tenocyte degradation with tendon thinning
With Achilles tendonitis, typically get tenocyte (degradation/proliferation) and tendon (thinning/thickening)
tenocyte proliferation
tendon thickening
58F presents with acute L shoulder pain beginning abruptly 3 weeks prior. MOI of cleaning tub. L arm outstretched to stabilize while R arm was scrubbing. Pt’s L arm slipped off the tub wall moving into hyperabducted position. Reports “tearing” sensation with immediate shoulder pain. Since the injury, pain constant 1-2/10 ache at rest that refs toward deltoid tuberosity and biceps muscle. Has a difficult time reaching OH, elicits sharp 5/10 shoulder pain. UA to reach into the fridge with involved arm to lift groceries. Medical hx reveals 10 pack/year smoking hx and hypothyroidism. Not currently taking medication for shoulder pain.
Obj exam: ROM (flex/abd 180 w/ painful arc, ER/IR WNL), strength (flex/ER 4/5 painful, abd 3+/5 painful, IR 5/5), special testing (+HK, - Neer, - Jobe relocation, - Crank, - Champagne toast)
Based off the info above, what is the most likely dx?
A. Subacromial impingement syndrome
B. Full thickness RTC tear
C. GH hypermobility
D. ACJ sprain
A. Subacromial impingement syndrome
58F presents with acute L shoulder pain beginning abruptly 3 weeks prior. MOI of cleaning tub. L arm outstretched to stabilize while R arm was scrubbing. Pt’s L arm slipped off the tub wall moving into hyperabducted position. Reports “tearing” sensation with immediate shoulder pain. Since the injury, pain constant 1-2/10 ache at rest that refs toward deltoid tuberosity and biceps muscle. Has a difficult time reaching OH, elicits sharp 5/10 shoulder pain. UA to reach into the fridge with involved arm to lift groceries. Medical hx reveals 10 pack/year smoking hx and hypothyroidism. Not currently taking medication for shoulder pain.
Obj exam: ROM (flex/abd 180 w/ painful arc, ER/IR WNL), strength (flex/ER 4/5 painful, abd 3+/5 painful, IR 5/5), special testing (+HK, - Neer, - Jobe relocation, - Crank, - Champagne toast)
Which intervention is recommended at this time?
A. Thoracic manipulation and GH joint mobilizations
B. RTC and scapular mm strengthening
C. high energy extracorporeal shockwave therapy
D. Myofascial TrP release and NSAIDs
B. RTC and scapular mm strengthening
Cervicothoracic manipulation for shoulder impingement: evidence?
unable to be validated, not recommended in clinical practice
24F presents with c/o posterior hip/sacral/buttock pain that intermittently refers into HS when provoked. Sx began 2 weeks ago when participating in a Barre fitness class, which she was not accustomed to doing, followed by couch to 5k running program. Walking, jumping, and other spinal loading activities reproduce sx.
(+) ASLR, less provocative with pelvic compression (+) distraction (-) compression (+) thigh thrust (+) sacral thrust
In order to apply the Laslett SIJ dx cluster to this pt, what first must be completed?
A. McKenzie evaluation of repeated lumbar movements/sustained positions
B. Completion of sacral provocation tests in the correct order
C. Neurological testing
D. Hip ROM testing with OP
A. McKenzie evaluation of repeated lumbar movements/sustained positions
24F presents with c/o posterior hip/sacral/buttock pain that intermittently refers into HS when provoked. Sx began 2 weeks ago when participating in a Barre fitness class, which she was not accustomed to doing, followed by couch to 5k running program. Walking, jumping, and other spinal loading activities reproduce sx.
(+) ASLR, less provocative with pelvic compression (+) distraction (-) compression (+) thigh thrust (+) sacral thrust
What treatment strategy has the most potential for success in managing pts with intra-articular SIJ pain?
A. Supine lumbopelvic manipulation and MET
B. Exercises aimed at stabilizing lumbopelvic mechanism and fluoroscopically guided intra-articular corticosteroid injections
C. Prolotherapy and correction of pelvic alignment
D. Use of SI belt and progressive walking program
B. Exercises aimed at stabilizing lumbopelvic mechanism and fluoroscopically guided intra-articular corticosteroid injections
31M caught his 3 yo son from falling when the child jumped out of his crib. Resulted in rapid flex/rot movement of the spine. Reports immediate “pop” sensation that was accompanied by sharp pain. Attempted to self-treat with rest as he was worried about making the condition worse. Upon waking, the pt noted sx continued to worsen and is now UA to don pants without assistance and struggles to put his shoes on without immense pain.
He presents to you 3 days s/p injury with 8/10 R lower back pain and R buttock pain. He is concerned that he needs spine imaging before he can resume activity. Given only this info, the best course would be
A. Agree with the pt and request lumbar MRI as sx are c/w disc problem
B. Agree with the pt and request lumbar radiographs or CT bc he has had trauma
C. Tell the pt that the likelihood of spine films detecting any abnormalities is low and that he should not get one
D. Tell the pt that typically spine films are not informative for mgmt of his condition and there is nothing in his presentation that indicates the need for radiography
D. Tell the pt that typically spine films are not informative for mgmt of his condition and there is nothing in his presentation that indicates the need for radiography
31M caught his 3 yo son from falling when the child jumped out of his crip. Resulted in rapid flex/rot movement of the spin. Reports immediate “pop” sensation that was accompanied by sharp pain. Attempted to self-treat with rest as he was worried about making the condition worse. Upon waking, the pt noted sx continued to worsen and is now UA to don pants without assistance and struggles to put his shoes on without immense pain.
He presents to you 3 days s/p injury with 8/10 R lower back pain and R buttock pain. He is concerned that he needs spine imaging before he can resume activity.
Physical exam: 8/10 pain with fwd flex with deviation to the R during flex. Ext WNL, but with PAER. Lumbar SB limited to 50% to L and 75% to R. SLR does not reproduce LBP. Slump produces stretch in HS equal B. Given only the above info, what may be concluded about the pt’s concern of a lumbar disc herniation?
A. Disc herniation is not likely d/t pain free neurodynamic testing in SLR position
B. Disc herniation is a probable dx d/t directional preference for ext
C. Disc herniation is not likely d/t negative slump test
D. Disc herniation is probable d/t aberrant mvt and high severity during fwd bending
C. Disc herniation is not likely d/t negative slump test
