Exam II Flashcards
(190 cards)
1
Q
what is calcific tendonitis?
A
when necrosis of a tendon occurs it causes calcium to be deposited within the tendon; the consistency is like that of toothpaste
2
Q
what muscle tendon is susceptible to calcific tendonitis?
A
supraspinatus
3
Q
what is the only way calcific tendonitis can be diagnosed?
A
with a radiography
4
Q
what are the positive exam findings that would indicate calcific tendonitis?
A
(1) PFC - warmth and swelling over the tendon
(2) AROM - painful arc
(3) PROM - painful with IR and adduction
(4) MSTT - strong and painful with ER and abduction*
(5) MLT - painful test*
(6) PFT - painful over the tendon*
(7) Imaging - brightness in the tendon*
(*denotes best exam steps)
5
Q
what is the treatment for calcific tendonitis?
A
(1) NSAIDs
(2) surgery to remove deposits
6
Q
what is a good way to increase blood flow to the supraspinatus tendon?
A
keep the shoulder abducted; increased blood flow will in theory help promote healing of tendon
7
Q
what is adhesive capsulitis?
A
also known as frozen shoulder; results when the capsule becomes inflamed and adheres to the humeral head
8
Q
what population is most affected by adhesive capsulitis?
A
(1) women who are perimenopausal are the most affected (hormonal changes?)
(2) those with diabetes and thyroid disease are also at higher risk
9
Q
what is the capsular pattern for the shoulder?
A
external rotation is the most limited, abduction is the second most limited, and internal rotation is the least limited
ER>ABD>IR
10
Q
what are the 5 best exam findings observed with adhesive capsulitis?
A
(1) AROM – decreased ER>ABD>IR
(2) PROM CLASSICAL (quantity) - ROM with limitations of ER>ABD>IR
(3) PROM CLASSICAL (quality) - tight capsule end-feel in all directions
(4) PROM ACCESSORY (quantity) - decreased P/A>inferior>A/P
(5) PROM ACCESSORY (quality) - tight capsule end-feel in all directions
11
Q
what is the treatment for adhesive capsulitis?
A
(1) rest, NSAIDs, or surgical manipulation
(2) PT Treatment: increase ROM by joint mobilizations
12
Q
how do physical therapists treat fractures?
A
we can’t treat the actual fracture, but we treat muscle weakness, hypomobile joints, tight muscles, functional restrictions and secondary impairments from the surgery and immobilization
13
Q
where can humeral neck fractures occur?
A
intracapsular or extracapsular
14
Q
how do most humeral neck fractures occur?
A
secondary to a fall; FOOSHing
15
Q
what is treatment of a humeral neck fracture?
A
often immobilization, a sling, and early PT for PROM to decrease swelling and ecchymosis
16
Q
with an intracapsular humeral neck fracture, what is likely to occur?
A
hemarthrosis, or bleeding within the joint; this can lead to early adhesion formation and joint degeneration
17
Q
when an intracapsular humeral neck fracture occurs, what often happens with alignment?
A
often malaligned once healing is complete
18
Q
what is typically the cause of a humeral shaft fracture? what’s the treatment?
A
direct trauma to the arm; treatment is either a closed reduction (cast) or open reduction internal fixation (ORIF)
19
Q
when would a closed reduction be most appropriate for a fracture? when would an ORIF be most appropriate?
A
(1) a closed reduction, such as a cast, is used when the bones are still aligned
(2) an ORIF is used when the fractured bone ends have become malaligned
20
Q
what is the typical treatment for a broken clavicle?
A
usually a figure 8 brace to allow the bone to align; patient may see a therapist after the brace to improve ROM and strength
21
Q
what is Sprengel’s Deformity?
A
congential deformity; it’s considered a “high scapula”
the scapula is smaller, and inferiorly rotated, thus it limits overhead function
22
Q
what is another name for pendulum exercises?
A
Codman’s exercises
23
Q
how is the AC joint most often injured?
A
with a fall on the shoulder with the GH joint adducted
24
Q
what are ways to confirm an AC joint injury?
A
PFC (during acute phase) and PFT
25
which ways can the SC joint be dislocated? which way is the most dangerous way to dislocate it and why?
anterior and posterior; posterior is rare, but dangerous because it could puncture the lung
26
what bursae of the shoulder can commonly present with bursitis?
subacromial, subdeltoid and subscapular
27
what is a common clinical presentation of bursitis in the shoulder?
the patient will complain of pain over the lateral brachial region of the shoulder
28
***what are the best examination steps to confirm bursitis? (2)***
(1) PFC (warmth, swelling)
| 2) PFT (pain
29
what is the most effective treatment for bursitis?
(1) avoid the activities or movements that may cause greater compression to the bursa
(2) let the bursa heal, then begin to restore functional movements
30
what is the treatment for AC joint and SC joint injuries?
immobilization followed by PT; PT interventions focus on restoring normal ROM, strength, stability and function to the shoulder complex
31
can a syndrome be considered a TSI?
no; syndromes involve multiple TSIs
32
what is typically occurring with shoulder impingement syndrome?
the greater tuberosity coming into close proximity to the underside of the coraco-acromial arch; this causes tendons to be pinched
33
what movements of the shoulder can help confirm impingement of the shoulder?
flexion and internal rotation
34
what factors can lead to an impingement syndrome of the shoulder? (5)
(1) Structure (osseous)
(2) instability / laxityu
(3) Hypomobility
(4) Muscle imbalance (tightness, weakness)
(5) Extrinsic factors: postural – functional, nerve, trauma, disease
35
what are some structural issues that could lead to impingement?
(1) osteophytes (bone spurs)
(2) curved or hooked acromion
(3) larger than average greater tuberosity
36
how can laxity lead to impingement of the shoulder?
when there is laxity, the humeral head does not align properly within the glenoid and the result is abnormal arthrokinematics; this can cause encroachment of the humeral head into the subacromial space
37
how can hypomobility lead to impingement of the shoulder?
if there is an inferior adhesion of the joint capsule, the humeral head can't glide inferiorly with elevation; this causes the humeral head to travel superiorly into subacromial space
38
what muscles are typically involved with muscle imbalances at the shoulder that lead to impingement?
the anterior musculature tends to become tight while the posterior musculature tends to become weak
(1) tight muscles: pec major, pec minor, subscap
(2) weak muscles: supraspinatus, teres minor, infraspinatus, rhomboids, traps (mid and lower), serratus anterior
39
how can kyphotic posture lead to impingement?
kyphosis tilts the scapula anteriorly and internally rotates the humerus causing decreased subacromial space
40
what are two ways a person can become hypermobile?
(1) congenital
| 2) trauma (bankart lesion, SLAP tear
41
what are TUBS and AMBRII?
```
TUBS = Traumatic Unilateral Bankart Surgery
AMBRII = Atraumatic Multidirectional Bilateral Rehab Inferior Interval
```
42
what is the most common direction people dislocate their shoulders?
anterior
43
what is the best exam step to determine hypermobility?
PROM accessory; increased mobility in direction of instability with laxity end-feel
44
how is hypermobility treated?
depends; with congenital instability the focus is on dynamic stabilization; includes strengthening of the rotator cuff and scapular stabilizers
45
what is scapular dyskinesis?
any alteration in the position or motion of the scapula
46
what are the 3 main types of scapular dyskinesis?
```
(1) Type I - SICK scapula:
Scapula malpositioned
Inferiormedial border prominence
Coracoid pain and malposition
Kinesis abnormality of scapula
(2) Type II - protruded medial border
(3) Type III - superior translation
```
47
how is scapular dyskinesis treated?
restoring normal position and motion of the scapula to allow proper scapulohumeral rhythm
48
what are potential causes of scapular dyskinesis? (5)
(1) abnormal bony posture or injury
(2) AC joint injuries / instability
(3) muscle function alterations (serratus and lower traps common source)
(4) nerve damage (rare)
(5) contractures (especially with anterior musculature)
49
what is Neer's special test for? how do you perform it? what's a positive test?
(1) shoulder impingement
(2) to perform, internally rotate the humerus (with elbow extended) and then flex the patient's arm overhead
(3) positive test: pain with internal rotation and OH flexion
50
what is Hawkins Kennedy's special test for? how do you perform it? what's a positive test?
(1) shoulder impingement
(2) to perform, flex the arm to 90 degrees with the elbow flexed at 90; from this position, internally rotate the forearm
(3) positive test: pain with internal rotation
51
what is the load/shift test for? how do you perform it? what's a positive test?
(1) shoulder instability
(2) to perfrom, support the arm and then shift it into the joint; then apply A/P force, followed by a P/A force, looking for abnormal movement
(3) positive test: crepitis, a shift (laxity), pain could be associated too (pain could be a result of some other pathology)
52
what is the empty can special test for? how do you perform it? what's a positive test?
(1) shoulder impingement
(2) to perform, have patient move (active) into 90 degrees of scaption, then have them IR (thumbs down); if no pain apply pressure and have them resist
(3) positive test: weakness and pain
53
what is the apprehension special test for? how do you perform it? what's a positive test?
(1) shoulder instability
(2) to perform, have patient in supine with arm abducted to 90 and elbow flexed at 90; apply a force in the anterior (from hand behind humerus); look for signs of apprehension, facial expression and pain
(3) positive test: apprehension or pain present
54
what is the lift off sign special test for? how do you perform it? what's a positive test?
(1) subscapularis tear
(2) to perfrom, passively take patient's arm behind their back (IR, extension, adduction) and ask them to hold the position
(3) positive test: if the patient can't hold hand away from body
55
what is the drop arm special test for? how do you perform it? what's a positive test?
(1) RC tear (supraspinatus / infraspinatus)
(2) to perform, passively abduct patient's arm to 90 and ask them to slowly lower it to their side
(3) positive test: patient can't control movement to their side
56
what is Yergason's special test for? how do you perform it? what's a positive test?
(1) transverse humeral ligament tear
(2) to perform, have patient sitting, support the elbow of the patient and palpate the biceps tendon; then have them flex the elbow, supinate the forearm and ER the shoulder (diagonal motion) in one motion; apply resistance with open palm while pt. performs
(3) positive test: tendon subluxes or pops out
57
what is the sulcus special test for? how do you perform it? what's a positive test?
(1) shoulder instability / superior labral tear
(2) to perform, have patient sitting; palpate area between acromion and humeral head; apply inferior traction force from the elbow and feel how much space is between the acromion and head
(3) positive test: >2 finger breaths within the space
58
What is the difference between tendonitis, tendonosis and tendonopathy?
(1) tendonitis: inflammation is occurring at tendon
(2) tendonosis: tendon degeneration (no inflammation)
(3) tendonopathy: any pathology at the tendon
59
can epicondylitis be considered a TSI?
no (unless all tendons are affected); the specific tendon involved at the epicondyle needs to be identified
60
what are some causes of epicondylitis? (3)
(1) joint restriction or hypermobility can place added stress on the tendon
(2) muscle imbalances (tight and weak muscles)
(3) faulty ergonomics related to sport, work or ADL’s
61
why should a therapist be cautious of using the word "overuse"
overuse is very specific to each individual and situation and is often used to generally
62
what is the treatment for tendon dysfunction during the ACUTE healing stage? (4)
(1) prevent condition from worsening, decrease inflammation
(2) PRICE
(3) gentle pain free PROM to preserve ROM
(4) 50% 1-RM >30 reps for pain/vascularity
63
what is the treatment for tendon dysfunction during the SUBACUTE healing stage? (4)
(1) progress AAROM to AROM as tolerated
(2) manipulations as needed
(3) gentle PRE @ 60% 1-RM 25-30 reps for coordination
(4) eccentrics (for tendon healing)
64
what is the treatment for tendon dysfunction during the CHRONIC healing stage? (4)
(1) progress to more aggressive strengthening
(2) stretch tight muscles
(3) progress manips for joint restrictions
(4) 80% 1-RM (8-12 reps) for strength
65
what specific type of exercise has research shown to be successful with degenerative tendonopathies?
eccentric exercise
66
what is the capsular pattern at the elbow?
elbow flexion is more restricted than extension
67
what is the most common population prone to elbow MCL tears?
overhead athletes (baseball, tennis)
68
what are the clinical findings of an elbow MCL sprain?
(1) increased mobility with valgus stress test
(2) pain with PFT
(3) pain on medial elbow, warmth, swelling
69
what is the treatment for an elbow MCL sprain?
PT Management
(1) protect, rest, ice
(2) gently increase ROM and strength
(3) strengthen and stabilize above and below elbow
MD Management
(1) surgery for competitive throwing athletes
70
what are common causes of olecranon bursitis? (2)
(1) direct trauma (falling on elbow)
| 2) repetitive weight bearing (constantly leaning on elbow
71
what are the clinical findings of olecranon bursitis?
(1) warmth and swelling posterior elbow
(2) pain with AROM extension / PROM flexion of elbow
(3) pain with PFT
72
what are things that need to be ruled out to confirm olecranon bursitis? (4)
(1) infection
(2) RA
(3) gout
(4) fracture
73
what is the treatment for olecranon bursitis?
PT Management
(1) modalities to decrease inflammation
(2) patient education to decrease repetitive stress
(3) strength / strengthen as indicated by exam
MD Management
(1) cortisone, antibiotics, aspiration, sling
74
what is myositis ossficans?
bone formation in an inflamed muscle (a type of heterotopic ossification)
75
what are clinical findings for myositis ossficans?
(1) limited AROM/PROM classical
(2) decreased muscle strength and length
(3) can be observed on imaging as early as two weeks
76
what is the treatment for myositis ossficans?
(1) don't be aggressive
| (2) maintain ROM
77
how will nerve entrapments present during a clinical examination? what is the treatment?
(1) motor and sensory changes distal to site of entrapment; stress site of entrapment to confirm
(2) treatment: address what's putting pressure on the nerve; don't strengthen muscles until pressure is relieved
78
***what are the locations that the median nerve can become entrapped? (4) where can the anterior interosseous nerve become entrapped? (1)***
(1) ligament of struthers (at medial epicondyle)
(2) bicipital aponeurosis
(3) pronator teres (between 2 heads)
(4) carpal tunnel
AIN
(1) pronator teres
79
how do you differentiate between an entrapment of the median nerve and anterior interosseous nerve?
median nerve entrapment will present with both motor and sensory changes; anterior interosseous nerve (only a motor branch) will only present with motor changes
80
what are the nerve roots of the median nerve?
C6, C7 C8, T1
81
***what is the most common location for the ulnar nerve to become entrapped?***
cubital tunnel
82
***hypertrophy of what muscles could lead to compression of the ulnar nerve?***
forearm flexors
83
what are the nerve roots of the ulnar nerve?
C8, T1
84
direct trauma to what area can cause damage to the radial nerve?
radial head/neck
85
***the deep branch of the radial nerve can become entrapped by hypertrophy of what muscle?***
supinator (because it pierces through it)
86
***where is a common place the superficial branch of the radial nerve can become entrapped? what is the main complaint with this entrapment?***
fiborous edge of ECRB; pain over the dorsal aspect of the 1st CMC joint
87
what are the nerve roots of the radial nerve?
C5, C6, C7, C8, T1
88
what is a supracondylar fracture of the humerus? what population is most affected?
break right above the epicondyles of the humerus; most common in children
89
what are two common MOI that cause an avulsion fracture of the olecranon?
(1) sudden passive flexion of forearm with powerful triceps contraction
(2) a fall backwards onto the elbow
90
what are some causes of post traumatic DJD?
(1) fractures
(2) dislocations
(3) result of malunion
91
***what is a non-union?***
failure of fracture to heal with bone; fibrous non-union is when fracture is healed with fibrous tissue instead of bone
92
what is pseudoarthritis?
(1) type of non-union fracture
| 2) continual movement at fracture site (can cause formation of false joint
93
***what is a mal-union?***
fracture has healed, but incorrectly; significant deformity
94
what is a delayed union?
fracture that heals much slower than expected
95
what is a greenstick fracture?
failure on convex side of bone; bending on concave side of bone
96
what are possible end feels for classical motion following immobilization?
tight muscle, tight capsule, edema, bony block
97
what are possible end feels for accessory motion following immobilization?
tight capsule, effusion, bony block
98
what is mallet finger? what is a common MOI?
(1) an injury to the extensor tendon of the DIP joint of any of the fingers
(2) MOI: DIP joint being forced into excessive flexion when the extensor musculature is contracting
99
what is Bennett's Fracture? what is a common MOI?
(1) fracture of the base of the first metacarpal (often with dislocation of CMC)
(2) MOI: direct axial force applied to thumb
100
what is a boxer's fracture? what is a common MOI?
(1) fracture of 5th metacarpal
| 2) MOI: unskilled blow with a clinched fist (or slamming fist down
101
what is the most commonly fractured carpal bone?
the scaphoid
102
what are two primary complications associated with a scaphoid fracture?
(1) avascular necrosis
| (2) delayed healing & non-unions
103
what are 3 reasons the scaphoid doesn't heal well?
(1) poor blood supply (no proximal blood supply, only distal)
(2) no muscle attachments (Wolf's Law doesn't work)
(3) covered in articular cartilage (very little periosteum, which is vascular)
104
what is the most common MOI for a fracture of the scaphoid?
FOOSH, with wrist extended and radially deviated
105
what is a Colles fracture? what is a common MOI?
(1) transverse fracture of distal radius with dorsal displacement of radius
(2) FOOSH with wrist extended
106
what is a Smith's fracture? what is a common MOI?
(1) transverse fracture of distal radius with volar displacement of radius
(2) FOOSH with arm pronated
107
what is a Galeazzi fracture?
fracture of the distal radius with a dislocation of the distal radio-ulnar joint; ulna is not fractured
108
what is a Monteggia fracture?
fracture of proximal ulna with dislocation of the radial head from humerus
109
what is Dupuytren's contracture?
a contracture of the palmar fascia of the hand; leads to shortening of the palmar fascia resulting in the MCP and PIP being pulled into flexion
110
what is Kienbock's disease?
osteochondrosis (avascular necrosis) of the lunate bone
111
what are Heberden's and Bouchard's nodes?
(1) Heberden's nodes: swelling or thickened bone (nodes) at the DIP
(2) Bouchard's nodes: swelling or thickened bone (nodes) at the PIP
112
what is swan neck deformity? how does it present clinically?
(1) the lateral bands of the PIP become displaced dorsally
| (2) flexion of MCP and DIP joints with extension of the PIP joint
113
what is boutonniere deformity? how does it present clinically?
(1) the lateral bands of the PIP become displaced volarly
| (2) extension of the MCP and DIP joints with flexion of the PIP joint
114
what is trigger finger? what are 3 possible causes?
finger being stuck in flexion and unable to extend
(1) swelling around flexor tendons
(2) nodule within flexor tendon
(3) thickening of flexor tendon or sheath
115
what is Z deformity? what is this commonly associated with?
(1) MCP joint of thumb being positioned in flexion while IP is hyperextended
(2) RA
116
what is opera glove anesthesia? does it correlate with any neurological pathology?
loss of sensation/numbness from the wrist down to the fingers; no correlation with neurological causes
117
what is Benediction sign?
when a patient is asked to make a fist and can only flex the 4th and 5th digits
118
what is Bishop’s deformity?
patient holds their 4th and 5th digits flexed due to ulanr nerve damage (can't use medial 2 lumbricals to extend)
119
what is CRPS?
complex regional pain syndrome; an impaired response to injury through the sympathetic system that results in a painful and intolerable hypersensitivity
120
what are 5 theories as to the cause of CRPS?
(1) Direct trauma to sympathetic nerves
(2) Direct trauma to a peripheral nerve
(3) Immobilization
(4) Immobilization in the presence of edema
(5) Psychological predisposition
121
what is the difference between CRPS Type I and Type II?
(1) Type I: CRPS without any nerve abnormalities
| 2) Type II: CRPS with objective nerve abnormalities (crush injury, laceration, etc.
122
what is the physical therapy treatment for CRPS?
the main goal of treatment is to treat all tissue impairments as permitted by the tissues reactivity
(1) patient education on pain science
(2) desensitization (massage, estim)
(3) maintain ROM & muscular function
(4) mirror training
123
within 18 months, what percentage of patients have complete spontaneous relief of symptoms from CRPS?
80%
124
what is Volkman's contracture? what are the common causes? (3)
a form of a compartment syndrome within the forearm
| 1) direct trauma (which results in edema
(2) edema
(3) cast being too tight
125
what is no-man's-land in the hand? where is it located?
(1) area within the hand that has great difficulty healing
| (2) located from distal palmar crease to the mid portion of the middle phalanx; FDP & FDS tendons run through here
126
what is DeQuervain’s tenovaginitis?
inflammation within the tendons and tendon sheath of the first extensor tunnel (this is considered an overuse injury)
127
what is carpal tunnel syndrome (CTS)? what are primary signs and symptoms?
(1) compression of the median nerve within the carpal tunnel
(2) paresthesias within the median nerve distribution and motor weakness within the muscles innervated by the median nerve (KNOW YOUR ANATOMY); night pain is also a common symptom
128
what are 8 possible causes of CTS?
(1) trauma
(2) ergonomics (associated with overuse; ex: keyboard for typing)
(3) edema / effusion
(4) flexor tightness
(5) displaced lunate (volar displacement)
(6) tight flexor retinaculum
* Last 2 aren't technically CTS*
(7) pronator teres syndrome
(8) C5-T1 nerve root problems
129
what are the three best examination findings to confirm CTS?
(1) night pain
(2) MMT - weakness of hand muscles innervated by median nerve
(3) neurovascular - decreased sensation where median nerve innervates sensory of hand
130
what are the 3 types of nerve injuries?
(1) Neuropraxia
(2) Axonotmesis
(3) Neurotmesis
131
what is associated with neuropraxia? (3)
(1) slight damage to nerve with transient loss of conductivity
(2) corresponds to 1st degree nerve injury
(3) complete recovery expected within 12 weeks
132
what is associated with axonotmesis? (3)
(1) injury damages axons but not the body of the nerve
(2) corresponds with 2nd, 3rd, 4th degree nerve injury
(3) nerve regeneration occurs at 1mm/day
133
what is associated with neurotmesis? (3)
(1) internal framework and axon are destroyed
(2) corresponds to 5th degree injury
(3) loss of neural tubes negates potential for normal regeneration
134
what are two reasons side bending could be restricted in the cervical spine?
(1) tight muscles
| (2) tight facet joint capsules
135
how do you determine if there is muscle tightness or it's facet joint capsule tightness?
(1) have the patient side bend with their arms at their side
(2) put the muscle you think could be tight on slack and have them side bend again
(3) if pain decreased with muscle on slack then it was muscle tightness, if not it was likely facet joint tightness
136
why does poor posture typically cause neck pain?
the mid-upper t/s flexes more causing the mid-upper cervical spine to extend more (compressing cervical facet joints)
137
how would you test a facet joint?
(1) by gapping the joint and stretching the capsule
| (2) flex and side bend to the contralateral side
138
what muscles tend to get weak with poor posture? (2)
(1) deep neck flexors
| (2) middle and lower traps
139
what muscles tend to get tight with poor posture? (4)
(1) upper traps
(2) levator scap
(3) pec major & minor
(4) suboccipital muscles
140
what should the order of treatment always be for any pathologies?
(1) treat pain and muscle guarding FIRST
| (2) then treat any TSIs
141
what causes a sprain in the cervical spine?
overstretch of the facet capsule; typically unilaterally
142
what are two main signs that there's a capsule strain in the cervical spine?
(1) no neurological signs
| (2) pain doesn't radiate into UE
143
which side of the body will muscles typically be tight with a capsule strain?
same said as the strain
144
what are the 3 main structures that prevent the facet joint capsule from getting pinched?
(1) ligamentum flavum
(2) multifidus muscles
(3) menisci of facet joint
145
what causes painful entrapment of the spine?
when the capsule gets entrapped between the articular surfaces of the facets
146
what motion usually causes pain with painful entrapment of a facet? how does pain usually present?
```
pain is worse with compression
(1) ipsilateral rotation or side bending
(2) extension
Pain Presentation
(1) unilateral; no neurological signs; often worse after waking up
```
147
what is the main intervention to improve an entrapped capsule? how does this intervention work?
(1) isometric contraction of the multifidus
(2) multifidi attach to the joint capsule, so an isometric contraction can pull the capsule out from the two articular surfaces
148
how are isometric multifidus contractions dosed?
contraction is held for 5-6 seconds and 2-3 reps are performed for 2-3 sets by PT providing submaximal resistance
149
what is the most likely cause of cervical radiculopathy?
spondylitic changes (disc herniations are much less likely)
150
what level of the spinal cord is most commonly affected by cervical radiculopathy?
C6/C7
151
how will pain present with cervical radiculopathy?
(1) gradual onset of pain in the neck / upper trap area that spreads to the arm
(2) paresthesias of the UE
(3) Neurological signs in dermatome/myotome
152
what symptoms coupled together indicate cervical radiculopathy as the injury? (4)
(1) (+) neural tension test for the median nerve
(2) cervical rotation less than 60 degrees
(3) distraction decreases symptoms
(4) spurling’s test increases symptoms
153
what is spinal stenosis? what is myelopathy?
(1) narrowing of the spinal canal
| (2) damage or degeneration of the spinal cord
154
what typically causes myelopathy of the cervical spine?
a combination of DJD and DDD; osteophytes forming on the posterior aspect of the vertebral canal that cause spinal stenosis
155
what conditions may myelopathy of the cervical spine mimic?
ALS, MS, Parkinson's
156
what are signs of cervical myelopathy? (6)
(1) permanent or transient neuological signs
(2) positive Babinski and clonus
(3) LE weakness
(4) balance problems
(5) paresthesias in hands / feet
(6) pain in neck / shoulders that radiates into arms
157
what is normal translation of the odontoid in children and adults?
(1) children: 3mm
| (2) adults: 4mm
158
excessive translation of the odontoid can cause compression of what structures?
(1) medulla Spinal cord
(2) vertebral arteries
(3) superior sympathetic ganglion
(4) nasopharynx
159
what are symptoms of subcranial instability? (3)
(1) pain in upper neck radiating to occipital and sometimes temporal and frontal regions
(2) difficulty returning head to neutral after looking down
(3) feeling head is falling forward and weak
160
what are signs that the lower brain stem is compressed? (4)
(1) dysarthria
(2) dyphagia
(3) lingual deviation
(4) cardiac or respiratory distress
161
what are signs that the vertebral artery is compressed? (7)
(1) dysarthria
(2) dyphagia
(3) staggered gait
(4) vertigo
(5) hypotonia
(6) incoordination of movement
(7) nystagmus
162
what are signs that the spinal cord is compressed? (2)
(1) bilateral or quadrilateral parathesia
| (2) hypoesthesia
163
what are signs for sympathetic paresis (Horner's syndrome)?
(1) ptosis (drooping eyelid)
(2) miosis (contraction of the pupil)
(3) anhydrosis (absence of sweating)
(4) enopthalmos (recession of the eyeball within the socket)
164
what is muscular torticolis?
a tightness/restriction in the sterno-cleido-occipital-mastoid muscle
165
what is scheurmann's disease?
osteochondrosis of the spine which is also called juvenile kyphosis
166
what does NDI stand for? what is it?
Neck Disability Index; a functional index that we can use for cervical spine dysfunction
167
what motion usually causes pain with a ligament capsule strain? how does pain usually present?
```
by stretching ligaments
(1) contralateral side bending
(2) flexion
(both cause gaping of facet)
(3) pain presents unilaterally
```
168
what motion usually causes pain with facet cartilage damage? how does pain usually present?
compression movements
(1) ipsilateral side bending and rotation
(2) extension
pain presents unilaterally
169
what motion usually causes pain with posterior annular tear of disc? how does pain usually present?
pain with stretch of annulus
(1) pain with flexion
(2) possible pain with extension
(3) pain could present with bilateral rotation
Pain presents unilaterally or bilaterally
170
what motion tends to decrease cervical radiculopathy pain?
distraction
171
what motion tends to increase cervical radiculopathy pain?
compression
(1) extension
(2) ipsilateral side bending
172
what has been shown to be very effective at picking up on dermatome issues?
vibration
173
how are reflexes graded? what does each grade mean?
0 no response
1+ somewhat dimished; low normal
2+ average; normal
3+ brisker than average; possible, but not indicative of disease
4+ very brisk, hyperactive; clonus (rhythmic oscillations between flex/ext)
174
what does a hyper reflex indicate?
nerve irritation
175
what does a hypo reflex indicate?
nerve compression
176
what are Babinski and Hoffman’s Sign indications of?
upper motor neuron lesion
177
what is the moving valgus stress test for? how do you perform it? what's a positive test?
(1) dynamic test for tear / instability of MCL
(2) to perform, patient can be standing or sitting; abduct arm to 90 and flex elbow to 120; apply valgus force as you quickly extend elbow
(3) positive test: pain at medial elbow
178
what is Cozen's test for? how do you perform it? what's a positive test?
(1) lateral epicondylitis
(2) to perform, patient will be seated; have forearm pronated, elbow at 90; patient will make a fist and extend the wrist while force is applied by PT
(3) pain at lateral epicondyle
179
what is Mill's test for? how do you perform it? what's a positive test?
(1) lateral epicondylitis
(2) to perform, patient will be seated; full pronation, elbow extension and full wrist flexion; passively stretch extensors by pushing down on hand
(3) pain at lateral epicondyle
180
what is Tinel's Sign for? how do you perform it for the ULNAR NERVE? what's a positive test?
(1) nerve irritation (ulnar)
(2) to perform, tap on the ulnar nerve with your index finger at the cubital tunnel; can also be tapped before and after hook of the hamate
(3) tingling sensation distal to area being tested
181
what is the supination lift test for? how do you perform it? what's a positive test?
(1) TFCC tear
(2) to perform, patient will be sitting with elbows flexed to 90 and supinated; patient will place palms on underside of heavy table and push up against the underside
(3) pain on ulnar side of wrist with difficulty applying force
182
what is the Bunnell Littler test for? how do you perform it? what's a positive test?
(1) determine if the PIP flexion limitation is due to tight intrinsic muscles or capsule
(2) to perform, hold MCP in extension and flex PIP
next, flex MCP to 90 then flex the PIP
(3) if PIP is tight in both positions, it's capsular
if however, you see improved ROM with the MCP flexed, it's intrinsic muscle tightness
183
what is Finkelstein's test for? how do you perform it? what's a positive test?
(1) tenosynovitis of 1st extensor tunnel (APL and EPB)
(2) to perform, with wrist in neutral have patient make a fist with thumb inside of fist; passively ulnarly deviate the wrist
(3) pain near radius at wrist (possible de Quervain’s)
184
what is Froment's (paper) Sign for? how do you perform it? what's a positive test?
(1) ulnar nerve entrapment
(2) to perform, have patient with wrist in neutral; have patient adduct their thumb and squeeze a sheet of paper; then try to pull the paper
(3) if paper can be pulled from thumb, indicates adductor policis weakness (ulnar nerve problem)
185
what is Phalen's test for? how do you perform it? what's a positive test?
(1) carpal tunnel syndrome
(2) to perform, have patient flex wrists and elbows (reverse prayer); hold for 30-60 seconds
(3) numbness and tingling along median nerve
186
what is Reverse Phalen's test for? how do you perform it? what's a positive test?
(1) carpal tunnel syndrome
(2) to perform, have patient extend wrists and finger and put hands together (prayer); hold for 30-60 seconds
(3) numbness and tingling along median nerve
187
what is Tinel's Sign for? how do you perform it for the MEDIAN NERVE? what's a positive test?
(1) nerve irritation (median)
(2) to perform, tap on the median nerve with your index finger at the carpal tunnel
(3) tingling sensation distal to area being tested
188
what is Allen's test for? how do you perform it? what's a positive test?
(1) check vascularity of the hand
(2) to perform, occulde radial and ulnar nerves; have patient clinch fist 3-4 times and release one side; do the test again and compare
(3) if releasing one said takes longer for hand to regain pink color (>5 seconds)
189
what is pinch grip (thumb / index finger) test for? how do you perform it? what's a positive test?
(1) anterior interosseous nerve entrapment
(2) to perform, have patient bring tips of thumb and index finger together by flexing IPs of both
(3) inability to flex IPs (APL and FDP)
190
***what is the best step exam step for the MCL and LCL of the elbow?***
special tests
