Exam 1 Flashcards
(131 cards)
1
Q
Level of Irritability - Red
A
Pain before resistance
2
Q
Level of Irritability - Yellow
A
Pain and resistance happening at the same time - perform isometrics
3
Q
Level of Irritability - Green
A
Pain after resistance, good to go
4
Q
Stage of Healing
A
Acute: 7-10 days
Sub-acute: 10 days to several weeks
Chronic: several weeks
5
Q
MS problems are typically influenced by?
A
Movement or positions
6
Q
Intermittent pain is usually caused by?
A
Prolonged postures, loose intra-articular body, impingement of a MS structure
7
Q
Peripheralization
A
getting worse
8
Q
Centralization
A
getting better
9
Q
System Review
A
Determine if the patient is appropriate for PT
10
Q
Red flags for cancer
A
Night pain
Unexplained weight loss
Constant pain
11
Q
Tests and Measures are used to?
A
confirm or reject a clinical hypothesis
Support clinical judgement
12
Q
Scanning Examination Purpose
A
rule out symptom referral
rule out serious pathology
ensure correct diagnosis
assess contractile/lnert tissues
13
Q
When do you perform scanning examination?
A
no history of trauma
no history to explain signs & symptoms
redicular sign present
trauma with radicular sign
spinal cord signs
abnormal patterns or movement
suspected psychogenic pain
14
Q
When can scanning be hold off?
A
history of trauma
recent surgery
15
Q
What is included in a scanning?
A
PROM, AROM, ARM with resistance
16
Q
Altered sensation
A
dermatome
17
Q
Weakness in the nerve root
A
Myotome
18
Q
Grading of Deep Tendon Reflex
A
0 - absent
1- diminished
2 - normal
3 - exaggerated
4 - clonus
19
Q
Informal Observation
A
Body Language
Facial Expression
Fear
Attitude
Assistance
20
Q
Contraindictions - Precautions with AROM
A
Suspected fracture
Fracture Healing Process
surgical considerations
irritable joint
excessive pain
21
Q
Limitation in AROM
A
Strength
flexibility of anatagonist
arthro
neuromuscular control
nerve innervation
pain
22
Q
limitation in PROM
A
Flexibility
arthro
pain
23
Q
contractile
A
muscle belly
tendon
injury to anything that creates tension
24
Q
inert
A
joint capsule
ligaments
bursa
articular surfaces of the joint
bone
25
contractile lesion
pain with Active contraction, PROM stretching, AROM resisted
Passive movement is painful in opposite direction
Active movement is painful in one direction
26
Inert Lesion
Active and passive movements painful in the same direction
Pain at end range
Resisted movements are not painful at neutral position
27
Full ROM & No pain
no lesion of the tested inert tissue
28
Pain & Limited ROM in every direction
Entire Joint affected / Capsular pattern
29
Pain & Excessive or limited ROM in a non-capsular pattern
Lesion of inert tissue (ligament)
30
Painfree, limited ROM
Precursor OA
31
Contractile Tissue Lesion
AROM or PROM is painful in the opposite direction
Normal Joint play
Hurts with resistance
32
Inert Tissue lesion
AROM and PROM limited and painful in the same direction
Resistance at neutral can be pain free
33
Capular Patterns
Pattern of limitation or restriction in ROM
Restricted in most or ALL ROM, whole capsule
34
Purpose of MMT
Testing muscle weakness / injury
Peripheral nerve injury
35
Myotome assessment
nerve root injury- radiculopathy
Fatigable weakness
36
Isokinetic strength testing
General muscle strength
Example: Post ACL Injury
37
Resisted Isometrics
distinguish between cotractile lesion vs Inert Lesion
At Neutral/ Open Pack position (most relaxed position) - discomfort : contractile injury, because Inert structures are at rest
38
Resisted Isometric testing
- Strong & Painless: Contractile tissue not involved
- Strong & Painful: Minor lesion of contractile tissue
- Weak & Painless: complete rupture of contractile tissue
- Weak & Painful - Major lesion of contractile tissue
- Painful on Repetition: Intermittent Claudication
39
Muscle weakness
peripheral nerve damage
within muscle belly itself
40
Fatigable weakness
Nerve root Issue
Muscle with the same innervation level will experience the same issue
41
Closed Pack Position
Maximally congruent - Most stability
Twist of Joint capsule & ligaments
42
Fractures & Dislocations typically occur in?
Closed Pack Position
43
Compression
movement into CPP
44
Distraction
Movement out of CPP
45
Open Pack Position
Capsule & Ligaments on Maximum Slack
Maximal "Joint play"
46
Capsular or ligamentous sprains typically occur in?
Loose or open packed position
47
Physiological motion
Result of concentric or eccentric active muscle contractions
48
Accessory Motion
Occurs inside the joint
49
Roll
Series of points in contact with a series of points
50
Spin
rotating around an axis
51
Slide
Specific point in contact with a series of points
52
Compression
Decrease in space between two joint surfaces
53
Distraction
Two Joint surfaces pulled apart
54
Maitland's Joint Play assessment
0 - mobilization is not indicated
1- 2 Hypomobility
3 Normal
4-5 Hypermobile
6 Unstable
55
Normal End Feels
Bone to bone - at full ROM
Soft tissue - Compression of soft tissues
Tissue Stretch - Elastic or springy resistance at end range of movement
56
No stretching when
Pain before ROM where resistance is met
57
Management Plan
Goals
Progonosis
Intervention
Summary of plans
58
Joint Play Assessment: Glides
Unrestricted & Normal - Soft tissue mobs
Unrestricted & Excessive - stabilization exercises
Restricted: Joint mobilization
59
Joint Play Assessment: Distraction
Limited: connective tissue contracture
Increase Pain: Connective tissue tear
Decrease Pain: Implicates Joint surface
60
Neurophysiological effects
Stimulates Mechanoreceptors to decrease pain
Nociceptive stimulation
61
Nutritional Effects
Exchange of fluids to improve joint mobilization
62
Mechanical effects
Breakup adhesions to increase glide
63
Absolute contraindications to passive movements
Malignancy of target area
Rheumatoid collagen necrosis
Unstable upper cervical spine
Vertebral basilar insufficiency
64
Relative contraindications to passive movements
Active, acute inflammatory conditions
Acute nerve root irritation
Blood clotting disorder
Condition is worsening with treatment
65
Rules of Mobilization
Both therapist and patient are relaxed
Don't move through pain
one hand stabilizes one hand mobilize
One movement at one joint
Re-assess after each maneuver
66
Maitland Joint Mobilization grading Scale
Grade I - Small amplitude oscillating movement at beginning of range of movement (Decrease pain)
Grade II - Large Amplitude within midrange of movement (Decrease Pain)
Grade III - Large Amplitude up to point of limitation (Improve ROM)
Grade IV - Small amplitude at very end range of movement (gain motion within the joint)
grade V - Thrust technique
67
Indications for Mobilization
Grades I and II - primarily used for pain
Grades III and IV - primarily used to increase motion
68
Direction of movement during treatment is either
Parallel - compression
Perpendicular - Glides
69
Kaltenborn Traction Grading
Grade I - loosen
Grade II - take up slack
Grade III - stretch
70
Kalternborn grade I
Used initially to reduce chance of painful reaction
71
Kalternborn Grade III
used in conjunction with mobilization glides for hypomobile joints
72
Inflammation (stage I)
Avoid painful positions
AAROM or general PROM
Grade I joint mobilization
Prevent Arthrofibrosis
Sub isometrics
73
Migration and Proliferation (Stage 2)
Controlled activities
Isometrics to Isotonic
Prevent scar contracture
Grade II joint mobilization
Progress ROM
74
Remodeling (Stage 3)
Concentric & eccentric training
SAID principle - customized to the activity
Grade II - IV joint mobilization
75
Anterior to Greater Troc
Glute min
76
Lateral to Greater Troc
Glute Med
77
Posterior to Greater Troc
Bursa
78
Location of Lumbar Spine Pathology
Buttock and LBP
79
Hyaline Cartilage
Allows frictionless motion
The higher the peak pressure, the thicker the cartilage
Avascular - no blood pressure
Aneural - no nerves
Alymphatic
80
Elastic cartilage
Highly specialized
81
Articular Cartilage Injury
Lesions generally do not heal
Believed to progress to severe forms of OA
82
Importance of Articular Cartilage Injury
Constant repair but a slow process
Gradual thinning of the articular layer occurs
83
Outerbridge Classification of Cartilage Damage
Grade 0 -Normal
Grade 1- cartilage softening and swelling, blisters
Grade 2 - Partial- thickness loss, less than 1.5 cm in diameter
Grade 3 - Fissuring to the level of subchondral bone more than 1.5 cm
Grade 4 - exposed subchondral bone
84
Cartilage healing
Limited ability to repair itself
Closer to blood supply - better healing
No inflammatory stage, no blood supply
Defects less than 3mm wide tend to heal completely
Defects greater than 9 mm wide do not heal completely
Motion enhances the healing of chondral defects (Active motion vs. Passive motion)
85
Osteochondritis Dissecans
Most common - Medial portion of the medial femoral condyle
86
Fractures of the proximal and distal segments are either
Extra-articular or articular
87
Extra-articular fractures
do NOT involved the articular surface
88
Partial articular fractures
involve only one part of the articular surface, while the rest remains attached to the diaphysis
89
Complete articular fractures
the articular surface is disrupted and completely separated from the diaphysis
90
Types of Forces that Commonly Produce Fractures
Tension - Avulsion, transverse fractures
Compression - Impaction fractures
Bending - short oblique fractures
Torsion - Spiral fractures
Comminuted - High energy forces
91
Cartilage healing doesn't have which phase?
Inflammatory phase
92
Bone healing
1. Inflammatory phase
2. Reparative Phase - Soft callus Formation
3. Remodeling Phase - Hard callus Formation, up to 1 year, Wolf's Law
93
items that affect the rate of fracture healing
Blood Supply - better blood supply, better healing
Location - closer to the blood supply - better healing
Age
94
Displacement of fracture fragments
Small space between the fracture structure - Better Healing
95
Slow Healers
Patients with Diabetes
Smokers
long-term steroid use
Poor Nutritional state
96
Phases of fracture Management
1. Diagnosed - confirmed exp: X-ray
2. Reduced if needed: put it back in place
3. Stabilize / Immobilize
4. Rehab
97
Delayed Union
Non-union
Mal-union
Delayed union: Taking longer to heal, still healing
Non-union: Healing is finished, fracture still there
Mal union: Healed, but not in good alignment
98
Pathologic Fracture
Tumor in the femur - femur fractures
Structure affecting the fracture
99
Osteoporosis
Osteopenia
Osteomalacia
Osteomyelitis
Osteoporosis - softning of the bone
Osteopenia - Precursor of Osteoporosis
Osteomalacia - Softning of the bone, but different than osteoporosis
Osteomyelitis - inflammation around the Bone
100
Non-Operative treatment of Fractures
Casting - closed reduction
Splints/ Fracture Braces
101
Surgical Treatment of Fractures
Precutaneous Pinning - small fracture, pins outside
External Fixation - pins on the outside, increase pressure
Intramedullay Nailing - femoral fracture
102
Immobilization
small bones - 3 weeks
long bones - 8 weeks
103
While in a cast
submax isometrics
104
Cast removed
Controlled stresses - gaining strength in the new motion
105
Salter Harris Classification
type I: separation between metaphysis & epiphysis
type II: separation and fracture on metaphysis
type III: separation and fracture on epiphysis
type IV: on both metaphysis and epiphysis
compression: on growth plate itself
106
Treatment for Salter Harris Classification
Type I: Non displaced - immobilization
Displaced: closed reduction & immobilization
Type II: Closed reduction & immobilization - cast
Type III: Open Reduction & immobilization
Type IV: need surgery
Type V: stop growth plate
107
Tendon Injuries (Strain)
Tendonitis: Inflammation, Microscopic Tearing
Tendinosis: Degenerative process, increased risk for Rupture, lack of inflammatory cells
108
Tendon Rupture
Pain free
Tendon Degeneration - decreased elasticity + Acceleration/deceleration force
109
Tendinopathy
absent or minimal inflammation
failed healing response
110
Causes of Tendinopathy
Mechanical Theory - Overload (overuse)
Vascular Theory - Poor Blood Supply
Neural Theory - Neurotransmitters / Mediators
111
Tendons that are vulnerable to Overuse injuries
-Wrap around a convex surface or the apex of a concavity
-Cross two joints
- low vascular supply
- repeptitive tension
112
Phases of pain
Phase I: pain less than 24 hours after exercise
Phase II: pain after exercise 48 hours
phase III: Tolerable pain with exercise activity
Phase IV: pain with exercise that alters activity
Phase V: pain caused by heavy activities of daily living
Phase VI: Intermittent pain at rest does not disturb sleep
Phase VII: Pain disturb sleep
113
Ligaments
Connect bones across joints
Guides/ checkreins to normal motion
114
Ligamentous injury
Point Tenderness
Joint Effusion
History of Trauma
115
Ligament Injuries (Sprains)
First degree - hurt to touch, no increased excursion
Second Degree - stretch increase excursion
Third Degree - gone, no end feel
116
Muscle injuries
Strains
Contusions (Bruise Injury)
Exercise-induced muscle injury
117
Muscle Strains
All degrees hurt with palpation
-First degree: strong & painful (a few fibers torn)
-Second degree - Bruises
-Third degree - torn, muscle tear
118
3 Phases of Healing
-Phase I Inflammatory: 48-72 hours to 14 days
-Phase II Reparative & Proliferation: 2-6 weeks
-Phase III Remodeling & Maturation: 6 weeks - 1 year
119
Subluxation
Partial or incomplete dislocation
120
Dislocation
bone is forced out of the joint as a result of tearing of the ligaments & joint capsule
121
Bursae
Fluid-filled sac
Reduce friction between surfaces
Primary: Degenerative changes, RA, Gout, Infection
Secondary: inflammatory, Repeated microtrauma
122
Classification of Nerve injuries
- Neuropraxia: Transient paralysis, temporary compression
-Axonotmesis: Complete paralysis, recovery can be complete
-Neurotmesis: Complete loss of axon & Schwanna Sheath, Recovery is rarely complete
123
Clinical Signs of Nerve Compression
-Pain on stretch
- Provocation of pins & needles
- Tenderness & swelling of sheath
- Postural deformity (Lateral trunk shift)
- Decreased conduction (weakness)
- Relief following steroid infiltration
124
Somatic Referred Pain
Ligaments, Joint Capsule, Annulus
125
Improvement in pain in a sitting position
ruling out the hip
Lumbar stenosis
126
Hips Symptoms get worse with
-Activities
- Twisting, turning, or changing directions
- Seated positions with hip flexed
- Rising from the seated position
127
Trochanteric Bursitis
inability to lie on their side
128
Intra-articular hip pathology
Clicking, snapping, or pain with movement of the hip
129
Patients with pain caused by hip pathology
- 7x more likely to have a limp and groin pain
- 14x more likely to have limited IR
130
Strongest predictors of Cancers in patients with complaints of hip and LBP
- previous history of cancer
- age over 50
- failure to improve with conservative care
- unexplained weight loss
131
Red Flags for the Hip
- Hip pain in men with testicular cancer
- Pain at MC Burney's point
- Blumberg's Sign - rebound tenderness for visceral pathology
