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Clinical Medicine II > Exam II Study Guide > Flashcards

Exam II Study Guide Flashcards

1
Q

Subacromial Rotator Cuff Secondary Impingement

A

Loss of normal biomechanics, loss of normal inferior humeral glide w/ upward humeral rotation (flexion, abduction)

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2
Q

Neer’s 3 stages of impingement (Stage I)

A

Young (<25 y/o)
Edema and hemorrhage
Pain with > 90 degrees ABD

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3
Q

Neer’s 3 stages of impingement (Stage II)

A

Age 25-40 y/o, Fibrosis, Irreversible changes in supraspinatus, bicep tendon, Pain at night, difficulty positioning shoulder for comfort

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4
Q

Neer’s 3 stages of impingement (Stage III)

A

Age > 40 y/o, Tendon degeneration/supraspinatus tears, Hx of shoulder pain, Muscle weakness/atrophy (disuse atrophy pattern). Will most likely need surgery.

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5
Q

Anterior Subluxation/Dislocation

A

Shoulder horizontal abduction w/ ER

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6
Q

Posterior Subluxation/Dislocation

A

Shoulder adducted, IR’d, and loaded

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7
Q

Multi-directional instability of GH

A

Congenital laxity (not much can be done rehab wise, usually surgical)
Subluxation may be anterior, posterior, or inferior

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8
Q

Dislocation

A

Complete separation of humeral head from glenoid cavity, Humerus does not spontaneously reduce

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9
Q

Subluxation

A

Partial separation; results in soft tissue strain at shoulder, Humerus spontaneously reduces

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10
Q

Bankart lesion

A

Avulsion of capsule and glenoid labrum off anterior glenoid rim, result of traumatic anterior shoulder dislocation

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11
Q

Hill-Sachs lesion

A

A compression or “impaction fracture” of the posteromedial aspect of the humeral head after anterior shoulder dislocation

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12
Q

Type I Labral tear

A

degeneration of superior labrum; loss of horizontal abduction w/ ER

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13
Q

Type II labral tear

A

detachment of labrum and biceps tendon anchor with loss of stability

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14
Q

Type III labral tear

A

vertical tear of labrum, biceps intact

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15
Q

Type IV labral tear

A

tear of labrum into biceps tendon

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16
Q

SLAP (superior labral tear from anterior to posterior) lesion repair

A

Debridement of torn labrum, Reattachment of labrum and bicep tendon

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17
Q

Bankart lesion surgical rehabilitation

A

Reattachment of torn capsule and labrum to glenoid, immobilization 1-8 weeks, maintain hand, wrist, and elbow ROM

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18
Q

Anterior Bankart repair precautions

A

Avoid anterior dislocation position (i.e. ER with horizontal abduction)

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19
Q

Reverse Bankart repair precautions

A

Avoid flexion > 90, horizontal adduction, and IR

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20
Q

Adhesive Capsulitis

A

Frozen shoulder, Insidious onset between 40-60 y/o, associated w/ trigger points, guarding of subscapularis

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21
Q

Stages of development: Adhesive Capsulitis

A

Freezing (2-3 weeks)
Continuous pain (including at rest), severe limitation of movement soon after onset

Frozen (4-12 months)
Atrophy, pain (although less, and occurring primarily with movement), loss of ROM

Thawing (12-24+ months)
↓ pain, restricted ROM

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22
Q

Rheumatoid Arthritis Symptoms

A

Morning stiffness greater than one hour, joints may feel tender, warm, and stiff when not used for an hour, joint pain is symmetrical, loss of ROM, Deformity

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23
Q

Synovitis

A

synovial hyperplasia, destruction of articular cartilage, pannus formation, increased intracapsular pressure, and joint surface irregularities.

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24
Q

Pannus

A

Destructive vascular granulation tissue, Disrupts synovial function, Destroys collagen, cartilage and subchondral bone

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25
Q

Erythrocyte Sedimentation Rate

A

Relative activity of disease process, Non-specific measure of inflammation

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26
Q

Synovial Fluid Exam

A

increased WBC, signs of breakdown are increased collagenase and increased debris (proteins)

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27
Q

Commonly involved joints with RA

A

MCP, Wrist, Knee, Ankle/foot, Upper cervical spine

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28
Q

Cervical Spine deformities with RA

A

occiput (C2), transverse ligament laxity, subluxation/sub-axial subluxation (2mm=suspicious, 4mm=severe), possible neurological involvement

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29
Q

Knee deformities with RA

A

genu valgus, bakers cyst

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30
Q

Ankle/ Foot deformities with RA

A

Pronation, Hallux valgus, Claw toes

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31
Q

RA stage I

A

Synovitis:

Synovial membranedemonstrates infiltrating small lymphocytes
Joint effusions
X-rays: no destructive changes

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32
Q

RA stage 2

A

Inflamed synovial tissue now proliferates & begins to grow into joint cavity across articular cartilage (which it gradually destroys)

Narrowing of joint due to loss of articular cartilage

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33
Q

RA stage 3

A

Pannus of synovium

Eroded articular cartilage & exposed sub-chondral bone

X-rays show extensive cartilage loss, erosions @ margins of joint

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34
Q

RA stage 4

A

End-stage disease

Inflammatory process is subsiding

Fibrous or bony ankylosing of joint will end its functional life

Nodules

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35
Q

Osteoarthritis pathology

A

Destruction of cartilage
Surface irregularities
Osteophyte Formation
Subchondral bone thickening
Secondary inflammation of periarticular structures

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36
Q

Osteoarthritis symptoms

A

Decreased ROM, Stiffness (Relieved by movement), Pain (Deep; aggravated by activity), Deformity, Crepitus

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37
Q

Lateral Epicondylalgia

A

Tennis elbow, Common extensor tendinopathy/overuse syndrome (ECRB, ECRL, ED, EDM), often associated with cervical spine pathology of C5

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38
Q

Lateral Epicondylalgia symptoms

A

Pain on palpation of the common extensor tendon especially over ECRB, Pain with resisted wrist extension, Pain on stretch of the wrist extensors, Grip strength with dynamometer painful and limited

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39
Q

Medial Epicondylalgia

A

Golfers elbow, overuse injury of the pronator teres, FCR, FD, FCU

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40
Q

Medial Epicondylalgia symptoms

A

Pain with screwdriver/hammer use, golfing, baseball

Palpation tenderness along medial epicondyle and common flexor tendon/muscles

Discomfort with combined wrist/elbow extension

Pain with resisted wrist flexion and forearm pronation

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41
Q

Medial Valgus Stress Overload

A

Valgus Extension Overload (VEO)/Pitchers Elbow

Repetitive stress @ ulnar collateral ligament leads to microtrauma of collagen

Common in overhead athletes and pitchers

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42
Q

Medial Valgus Stress Overload symptoms

A

Pain over medial elbow and posterior aspect of olecranon, Increased valgus of elbow, Pronator mass hypertrophy, Loss of extension ROM

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43
Q

Supracondylar Fracture

A

Transverse Fracture of the Distal Humerus, Usually children, Treatment usually CR in elbow flexion, possibly PP

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44
Q

Distal humerus displaced posteriorly

A

Fall on extended outstretched arm

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45
Q

Distal humerus displaced anteriorly

A

Direct trauma to the posterior elbow

46
Q

Volkmann Ischemic Contracture

A

Severe pain in forearm muscles
Limited and painful finger movement
Paresthesia
Median nerve with loss of sensation
Loss of radial pulse
Pallor and paralysis

47
Q

Radial Head Fracture

A

Fall on outstretched arm

1/3 of all elbow fractures

May result in change in elbow carrying angle

48
Q

Radial Head Fracture type I

A

Type I: Non-displaced

Immobilization 1-4 weeks
Gentle pain free ROM

49
Q

Radial Head Fracture type II

A

Type 2: Marginal fracture with displacement

ORIF
Immobilization in hinged splint
ROM as allowed by surgeon
Joint Mobilizations (pronation/supination)

50
Q

Radial Head Fracture Type III

A

Type 3: Comminuted & Displaced

Excision of fracture
Change in carrying angle
ROM as allowed by surgeon

51
Q

Radial Head Fracture Type IV

A

Type IV: Radial Head Fracture + Elbow Dislocation

Excision of fracture
Change in carrying angle
ROM as allowed by surgeon
Type 3 and 4 typically demonstrate extension lag

52
Q

Olecranon Fracture Non Displaced

A

Immobilization
Gentle Active ROM after 3 weeks of immobilization
No flexion greater than 90 degrees for 6-8 weeks

53
Q

Olecrannon Fracture Displaced

A

ORIF

No flexion greater than 90 degrees for 8 weeks
Progressive weight-bearing and exercise
Continued ROM, AROM, AAROM may be necessary

54
Q

Acute Carpal Tunnel Syndrome signs and symptoms

A

Paresthesia with repetitive finger flexion
Numbness at night
Symptoms decrease with shaking of hands

55
Q

Subacute carpal tunnel syndrome signs and symptoms

A

Paresthesia
More consistent weakness, difficulty with fine motor activities

56
Q

Chronic carpal tunnel syndrome signs and symptoms

A

Paresthesia constant
Muscle wasting thenar eminence (FPB, APB, OP)
Loss of opposition of the thumb
Fine motor function impairments (writing, prehension, dexterity)
loss of grip strength

57
Q

Carpal tunnel syndrome CPR

A

Age > 45
Shaking hands relieves symptoms
Wrist ratio > .67
divide AP by ML wrist width
Reduced sensation median nerve (@ thumb)
Symptom Severity Scale Score > 1.9

58
Q

DeQuervain’s Tenosynovitis

A

Thickening of the synovial sheaths of the APL & EPB, idiopathic, may be due to repetitive thumb movements

59
Q

DeQuervain’s Tenosynovitis symptoms

A

Pain, tenderness and swelling over radial wrist

60
Q

Dupuytren Disease

A

Formation of pits and firm nodules that lie just below the skin of the palm, Flexion contractures of the MCP and PIP joints (usually fingers 4 and 5), often bilateral

61
Q

Mallet Finger

A

Interruption of the extensor tendon mechanism over the DIP joint (Zone 1), usually trauma induced

62
Q

Mallet finger rehabilitation

A

Begin gentle ROM at 6 - 8 weeks, increasing flexion (20° increments/week) as long as active full extension is not compromised

63
Q

Jammed Finger/Volar Plate Injury symptoms

A

pain, stiffness, catching, hyperextension deformity > 15 degrees

64
Q

flexor tendon/repair injuries Immobilization

A

following repair, the wrist and hand casted or splinted for 3 - 4 weeks before beginning active and passive exercise

65
Q

flexor tendon/repair injuries early passive Immobilization

A

passive flexion and active extension allowed within splint limits

66
Q

flexor tendon/repair injuries Early active mobilization

A

with these programs, the tendon is moved actively within 48 hours of repair and within carefully outlined limits set by the surgeon

67
Q

Colles Fracture

A

Radial fracture with dorsal displacement of the distal fragment and radial shift of the carpal bones

68
Q

Smith’s Fracture (Reverse Colles Fracture)

A

Distal portion of radial fracture dislocates palmarly

Surgery usually required

69
Q

Scaphoid-Lunate Advanced Collapse (SLAC)

A

Disruption of the scapholunate ligament

70
Q

SLAC Proximal Row Carpectomy

A

60% of normal ROM as compared to opposite wrist and over 90% of normal grip strength

71
Q

SLAC Four corner fusion

A

less than 50% ROM and about 75% grip strength

72
Q

Tibial Plateau Fracture

A

High energy trauma (e.g. falls, MVA)

Ensure no SX of compartment syndrome

Beware: 50% of closed tibial plateau fractures have menisci and collateral ligament tears

73
Q

Metatarsal Stress Fractures

A

Rhythmic overload
Females > Males
Contributing factors
Skeletal malalignment (cavus feet)
Improper footwear

74
Q

Stress Fractures symptoms

A

-Stiffness/soreness after activity
-Mild soreness/pain during activity that persists afterward
-Pain during activity that alters performance
-Pain during and after, does not subside with complete rest

75
Q

SAD Rehabilitation overview (weeks 0-6)

A

Sling 2-7 days, but early mobilization encouraged, PROM and AAROM done daily to achieve full ROM, scapular stabilization

76
Q

SAD Rehabilitation Overview (weeks 6-10)

A

Once ROM achieved, ensure physiologic movement in available range, scapular balance, Once scapular stability achieved, progress to overhead movement, Pain free ROM with adequate strength

77
Q

Glenohumeral instability rehab weeks 1-3

A

-Immobilizer when not exercising
-ER and extension limited to neutral
-Flexion/elevation to 90° via AAROM
-Scapular stabilization (isometric)

78
Q

Glenohumeral instability rehab weeks 3-6

A

-ER to 45°
-Immobilizer discontinued (per surgeon)
-AAROM/wand exercises
-Scapular stabilization progressed – No humeral movement

79
Q

Glenohumeral instability rehab weeks 6-12

A

-Full AROM
-Progress scapular stabilization with -UE movement and weight-bearing
-PNF patterns
-Functional movements avoiding previously unstable position

80
Q

Glenohumeral instability rehab weeks 12-18

A

More sport or activity-specific
Plyometrics added

81
Q

Bankart Surgical Rehabilitation

A

Immobilization 1-8 weeks, Maintain hand, wrist, elbow ROM, CV fitness maintained

82
Q

SLAP Repair Rehabilitation 0-2 weeks

A

flexion limited to 60°
ER limited to 15° in neutral position
IR limited to 45° in neutral position
Pendulum exercises

83
Q

SLAP Repair Rehabilitation 3-4 weeks

A

flexion limited to 90°
ER limited to 30° and IR to 60°
Wand Exercises

84
Q

SLAP Repair Rehabilitation 6-8 weeks

A

Progress to full ROM

85
Q

SLAP Repair Rehabilitation Subacute Phase (8-12 weeks post op)

A

Horizontal ABD/ADD

PNF patterns

IR and ER strengthening with arm in protected position (towel roll)

Progressive UE weight bearing (hands and knees)

86
Q

Stage 1 Disc degeneration

A

dysfunction, tears in the annulus, hypermobility of the facet joints

87
Q

Stage 2 disc degeneration

A

instability, Disc reabsorption, Degeneration of facet joints with capsular laxity, Subluxation

88
Q

Stage 3 disc degeneration

A

stabilization, Osteophyte formation, Stenosis (narrowing)

89
Q

Herniated nucleus pulposus causes

A

Weight
Repetition
Sedentary (sitting)
Smoking

90
Q

Degenerative disc disease symptoms

A

Gradual onset of pain
Intermittent and recurring pain over several years
Pain increases with activity or static positioning
Stiffness
Pain into buttock/ sclerotome

91
Q

Vertebral Osteophytes

A

Loss of disc height
Compressive forces increase
Osteophyte formation

92
Q

Central spinal stenosis

A

Narrowing of the spinal canal

93
Q

Lateral spinal stenosis

A

Narrowing of the intervertebral foramina

94
Q

Lumbar Spinal Stenosis CPR

A

Bilat Symptoms
Leg Pain > Back Pain
Pain during walking or standing
Pain relief upon sitting
Age > 48 years

95
Q

Spondylolysis

A

defect of pars interarticularis (crack)

96
Q

Spondylolithesis

A

bilateral defect with displacement of the superior vertebra

97
Q

Spondylolithesis type I

A

Congenital- malformation of sacrum/ L5

98
Q

Spondylolithesis type II

A

Isthmic Spondylolithesis- mechanical stress leads to stress fracture at par interarticularis

99
Q

Spondylolithesis type III

A

Degenerative (older)

100
Q

Spondylolithesis type IV

A

Traumatic (football) Casting

101
Q

Spondylolithesis type V

A

Pathologic (tumor)

102
Q

Spondylolithesis grade I treatment

A

usually not symptomatic

103
Q

Spondylolithesis grade II treatment

A

education to avoid extension and begin spinal stabilization. May use casting to reduce anterior shear forces and allow healing

104
Q

Spondylolithesis grade III treatment

A

conservative treatment may be attempted. Surgery?

105
Q

Spondylolithesis grade IV treatment

A

surgery due to neurological involvement

106
Q

Osteoid Osteoma

A

Benign (noncancerous) bone tumor that usually develops in the long bones of the body, such as the femur (thighbone) and tibia (shinbone), does not spread, Most likely in children and young adults age 4-25
Males 3x > females, great responses to aspirin

107
Q

Spondylolithesis grade I

A

<25% slippage

108
Q

Spondylolithesis grade II

A

25-50% slippage

109
Q

Spondylolithesis grade III

A

50-75% slippage

110
Q

Spondylolithesis grade IV

A

> 75% slippage

Clinical Medicine II (5 decks)

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