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Clinical Medicine II > Exam II Study Guide > Flashcards

Exam II Study Guide Flashcards

(110 cards)

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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
Erythrocyte Sedimentation Rate
Relative activity of disease process, Non-specific measure of inflammation
26
Synovial Fluid Exam
increased WBC, signs of breakdown are increased collagenase and increased debris (proteins)
27
Commonly involved joints with RA
MCP, Wrist, Knee, Ankle/foot, Upper cervical spine
28
Cervical Spine deformities with RA
occiput (C2), transverse ligament laxity, subluxation/sub-axial subluxation (2mm=suspicious, 4mm=severe), possible neurological involvement
29
Knee deformities with RA
genu valgus, bakers cyst
30
Ankle/ Foot deformities with RA
Pronation, Hallux valgus, Claw toes
31
RA stage I
Synovitis: Synovial membrane demonstrates infiltrating small lymphocytes Joint effusions X-rays: no destructive changes
32
RA stage 2
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
33
RA stage 3
Pannus of synovium Eroded articular cartilage & exposed sub-chondral bone X-rays show extensive cartilage loss, erosions @ margins of joint
34
RA stage 4
End-stage disease Inflammatory process is subsiding Fibrous or bony ankylosing of joint will end its functional life Nodules
35
Osteoarthritis pathology
Destruction of cartilage Surface irregularities Osteophyte Formation Subchondral bone thickening Secondary inflammation of periarticular structures
36
Osteoarthritis symptoms
Decreased ROM, Stiffness (Relieved by movement), Pain (Deep; aggravated by activity), Deformity, Crepitus
37
Lateral Epicondylalgia
Tennis elbow, Common extensor tendinopathy/overuse syndrome (ECRB, ECRL, ED, EDM), often associated with cervical spine pathology of C5
38
Lateral Epicondylalgia symptoms
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
39
Medial Epicondylalgia
Golfers elbow, overuse injury of the pronator teres, FCR, FD, FCU
40
Medial Epicondylalgia symptoms
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
41
Medial Valgus Stress Overload
Valgus Extension Overload (VEO)/Pitchers Elbow Repetitive stress @ ulnar collateral ligament leads to microtrauma of collagen Common in overhead athletes and pitchers
42
Medial Valgus Stress Overload symptoms
Pain over medial elbow and posterior aspect of olecranon, Increased valgus of elbow, Pronator mass hypertrophy, Loss of extension ROM
43
Supracondylar Fracture
Transverse Fracture of the Distal Humerus, Usually children, Treatment usually CR in elbow flexion, possibly PP
44
Distal humerus displaced posteriorly
Fall on extended outstretched arm
45
Distal humerus displaced anteriorly
Direct trauma to the posterior elbow
46
Volkmann Ischemic Contracture
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
Radial Head Fracture
Fall on outstretched arm 1/3 of all elbow fractures May result in change in elbow carrying angle
48
Radial Head Fracture type I
Type I: Non-displaced Immobilization 1-4 weeks Gentle pain free ROM
49
Radial Head Fracture type II
Type 2: Marginal fracture with displacement ORIF Immobilization in hinged splint ROM as allowed by surgeon Joint Mobilizations (pronation/supination)
50
Radial Head Fracture Type III
Type 3: Comminuted & Displaced Excision of fracture Change in carrying angle ROM as allowed by surgeon
51
Radial Head Fracture Type IV
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
Olecranon Fracture Non Displaced
Immobilization Gentle Active ROM after 3 weeks of immobilization No flexion greater than 90 degrees for 6-8 weeks
53
Olecrannon Fracture Displaced
ORIF No flexion greater than 90 degrees for 8 weeks Progressive weight-bearing and exercise Continued ROM, AROM, AAROM may be necessary
54
Acute Carpal Tunnel Syndrome signs and symptoms
Paresthesia with repetitive finger flexion Numbness at night Symptoms decrease with shaking of hands
55
Subacute carpal tunnel syndrome signs and symptoms
Paresthesia More consistent weakness, difficulty with fine motor activities
56
Chronic carpal tunnel syndrome signs and symptoms
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
Carpal tunnel syndrome CPR
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
DeQuervain’s Tenosynovitis
Thickening of the synovial sheaths of the APL & EPB, idiopathic, may be due to repetitive thumb movements
59
DeQuervain’s Tenosynovitis symptoms
Pain, tenderness and swelling over radial wrist
60
Dupuytren Disease
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
Mallet Finger
Interruption of the extensor tendon mechanism over the DIP joint (Zone 1), usually trauma induced
62
Mallet finger rehabilitation
Begin gentle ROM at 6 - 8 weeks, increasing flexion (20° increments/week) as long as active full extension is not compromised
63
Jammed Finger/Volar Plate Injury symptoms
pain, stiffness, catching, hyperextension deformity > 15 degrees
64
flexor tendon/repair injuries Immobilization
following repair, the wrist and hand casted or splinted for 3 - 4 weeks before beginning active and passive exercise
65
flexor tendon/repair injuries early passive Immobilization
passive flexion and active extension allowed within splint limits
66
flexor tendon/repair injuries Early active mobilization
with these programs, the tendon is moved actively within 48 hours of repair and within carefully outlined limits set by the surgeon
67
Colles Fracture
Radial fracture with dorsal displacement of the distal fragment and radial shift of the carpal bones
68
Smith’s Fracture (Reverse Colles Fracture)
Distal portion of radial fracture dislocates palmarly Surgery usually required
69
Scaphoid-Lunate Advanced Collapse (SLAC)
Disruption of the scapholunate ligament
70
SLAC Proximal Row Carpectomy
60% of normal ROM as compared to opposite wrist and over 90% of normal grip strength
71
SLAC Four corner fusion
less than 50% ROM and about 75% grip strength
72
Tibial Plateau Fracture
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
Metatarsal Stress Fractures
Rhythmic overload Females > Males Contributing factors Skeletal malalignment (cavus feet) Improper footwear
74
Stress Fractures symptoms
-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
SAD Rehabilitation overview (weeks 0-6)
Sling 2-7 days, but early mobilization encouraged, PROM and AAROM done daily to achieve full ROM, scapular stabilization
76
SAD Rehabilitation Overview (weeks 6-10)
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
Glenohumeral instability rehab weeks 1-3
-Immobilizer when not exercising -ER and extension limited to neutral -Flexion/elevation to 90° via AAROM -Scapular stabilization (isometric)
78
Glenohumeral instability rehab weeks 3-6
-ER to 45° -Immobilizer discontinued (per surgeon) -AAROM/wand exercises -Scapular stabilization progressed – No humeral movement
79
Glenohumeral instability rehab weeks 6-12
-Full AROM -Progress scapular stabilization with -UE movement and weight-bearing -PNF patterns -Functional movements avoiding previously unstable position
80
Glenohumeral instability rehab weeks 12-18
More sport or activity-specific Plyometrics added
81
Bankart Surgical Rehabilitation
Immobilization 1-8 weeks, Maintain hand, wrist, elbow ROM, CV fitness maintained
82
SLAP Repair Rehabilitation 0-2 weeks
flexion limited to 60° ER limited to 15° in neutral position IR limited to 45° in neutral position Pendulum exercises
83
SLAP Repair Rehabilitation 3-4 weeks
flexion limited to 90° ER limited to 30° and IR to 60° Wand Exercises
84
SLAP Repair Rehabilitation 6-8 weeks
Progress to full ROM
85
SLAP Repair Rehabilitation Subacute Phase (8-12 weeks post op)
Horizontal ABD/ADD PNF patterns IR and ER strengthening with arm in protected position (towel roll) Progressive UE weight bearing (hands and knees)
86
Stage 1 Disc degeneration
dysfunction, tears in the annulus, hypermobility of the facet joints
87
Stage 2 disc degeneration
instability, Disc reabsorption, Degeneration of facet joints with capsular laxity, Subluxation
88
Stage 3 disc degeneration
stabilization, Osteophyte formation, Stenosis (narrowing)
89
Herniated nucleus pulposus causes
Weight Repetition Sedentary (sitting) Smoking
90
Degenerative disc disease symptoms
Gradual onset of pain Intermittent and recurring pain over several years Pain increases with activity or static positioning Stiffness Pain into buttock/ sclerotome
91
Vertebral Osteophytes
Loss of disc height Compressive forces increase Osteophyte formation
92
Central spinal stenosis
Narrowing of the spinal canal
93
Lateral spinal stenosis
Narrowing of the intervertebral foramina
94
Lumbar Spinal Stenosis CPR
Bilat Symptoms Leg Pain > Back Pain Pain during walking or standing Pain relief upon sitting Age > 48 years
95
Spondylolysis
defect of pars interarticularis (crack)
96
Spondylolithesis
bilateral defect with displacement of the superior vertebra
97
Spondylolithesis type I
Congenital- malformation of sacrum/ L5
98
Spondylolithesis type II
Isthmic Spondylolithesis- mechanical stress leads to stress fracture at par interarticularis
99
Spondylolithesis type III
Degenerative (older)
100
Spondylolithesis type IV
Traumatic (football) Casting
101
Spondylolithesis type V
Pathologic (tumor)
102
Spondylolithesis grade I treatment
usually not symptomatic
103
Spondylolithesis grade II treatment
education to avoid extension and begin spinal stabilization. May use casting to reduce anterior shear forces and allow healing
104
Spondylolithesis grade III treatment
conservative treatment may be attempted. Surgery?
105
Spondylolithesis grade IV treatment
surgery due to neurological involvement
106
Osteoid Osteoma
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
Spondylolithesis grade I
<25% slippage
108
Spondylolithesis grade II
25-50% slippage
109
Spondylolithesis grade III
50-75% slippage
110
Spondylolithesis grade IV
>75% slippage

Clinical Medicine II (5 decks)

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