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OS IV > Final > Flashcards

Final Flashcards

1
Q

What changes occur in the neck as you age

A

After age 50, nucleus purposes becomes fibrocartilaginous and has characteristics similar to annulus fibrosis

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2
Q

What are the neck pain comorbidities seen in elderly

A

Autonomic failure, CV dz, concentration problems, digestive dz, dizziness, HA, low back pain, OA, orthostatic hypotension, shoulder pain, TMJ, trap m ischemia

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3
Q

What is the leading cause of LE disability in older adults

A

OA; rapid increase >50

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4
Q

What are common OA complains

A

Pain in one joint, deep ache, stiffness after inactivity, night pain

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5
Q

What is the treatment for OA

A

Weight management, walking aids, NSAIDs, duloxetine, topical capsaicin, intraarticular injections, orthopdic intervention; prevention

Multi-disciplinary approach: PCP, rheumatologist, physiatrist, orthopedist, psychologist, psychiatrist, nurse, dietician, social worker

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6
Q

What happens to the aging nervous system

A
  • decreased brain weight - drug toxicities and delirium
  • alteration in NT
  • decreased memory
  • decreased reaction time- decreased IQ
  • altered sleep
  • decreased vibratory sense
  • decreased righting reflex, increased postural instability, altered gait leading to falls
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7
Q

What reflex might be absent in older adults

A

Ankle

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8
Q

What are the treatments for Parkinson’s

A

Levodopa, amantidine, MAO-B inhibitors, anticholinergics; education, emotional support, exercise, PT/OT/speech therapy, meditation, nutrition

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9
Q

What are the pulm changes with aging

A

Decreased chest wall compliance, loss of lung parenchyma support, decreased resp m strength (less effective cough), increased alveolar dead space, increased perception of SOB -> anxiety

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10
Q

What are the CV changes with age

A

Calcification and sclerosis, increased symp tone, decreased hemodynamic response to inotropic agents leading to fatigue, increase in BP, LVH, orthostatic hypotension

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11
Q

What are the categories for HTN

A
  • pre-HTN: 120-139/80-89
  • HTN stage 1: 140-159/90-99
  • HTN stage 2: 160/100
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12
Q

What are exacerbating factors of HTN

A

Obesity, sleep apnea, polycythemia, NSAIDs, excessive alc, low potassium, smoking

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13
Q

What are the sx of HTN

A

HA, accelerated HTN - somnolence, confusion, visual disturbances, N/V

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14
Q

What effect can OMT have on HTN

A
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15
Q

Where were SD found in patients with heart failure

A

T4

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16
Q

What are the treatments for pneumonia in the elderly

A

Abx, corticosteroids, statins/ACE, O2 support

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17
Q

What is the altered febrile response in frail older adults

A
  • healthy community dwelling: >100.4 (38)

- frail: >100 single oral temp or 2 degrees above baseline (>1.1C)

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18
Q

What did preventative OMT study in nursing homes show

A

Reduced number of hospitalization and medication usage

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19
Q

What is the effect of OMT on blood cell count

A

OMT, lymphatic pump decreases platelet count

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20
Q

What OMT was used on patient with LE ulcers

A

Thoracic inlet, dome diaphragm, pelvic release, popliteal release, pedal pump

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21
Q

What are the viscerosomaticcs for symp for colon

A

T10-L2

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22
Q

What do you do for a fall risk assessment

A

Watch them stand from a sitting position without using arms for support, walk several paces, turn and return to chair, sit down without using arms

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23
Q

What are the risk factors for fall

A

Vit D def, decreased strength, SD, meds, depression

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24
Q

What is the geriatric depression scale

A

If >5/15 - probable depression

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25
Q

What is the scoring for mini mental status exam

A

Max score 30; mild impairment - 21-29, moderate 10-20, severe <9

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26
Q

How do you treat depression with OMT

A

SD related to pain, balance autonomic (OA/AA sacrum), cranial

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27
Q

What can US be used for

A

Tendon injuries, short term pain relief - warms superficial soft tissue

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28
Q

What is phonophoresis for

A

Inflammatory conditions such as tendonitits, arthritis, bursitis; U/S used to deliver med to tissue under skin

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29
Q

What is iontopheresis

A

Electric current delivers substances through skin to deeper tissues; used for inflammatory conditions

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30
Q

What is low level laser therapy

A

Absorption of photon radiation, altering cellular oxidative metabolism which decreases prostaglandin E2; used for minor MSK pain, carpal tunnel , OA RA

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31
Q

What is electric stimulation

A

Generates action potential in n tissue causing muscle contraction or altering sensory input; used for muscle spasm or contusion and neuropathic pain

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32
Q

What is a closed kinetic chain

A

Prox segment of extremity moves on fixed distal segment (ie: squats); used for shoulder and knee rehab

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33
Q

What is open kinetic chain

A

Distal segment of extremity moves about prox segment; ie: UE weight lifting; used for functional improvement in ADLs

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34
Q

What is core stability exercise

A

Targets low back, trunk and ab mm: ie back extension and Pilates; relives low back pain or pregnancy related pelvic pain

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35
Q

What is eccentric exercise

A

Muscle contracts as it lengthens; ex extension phase of biceps or hamstring curl; used to prevent injury

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36
Q

What is concentric exercise

A

Muscle contracts as it shortens ie: flex bicep; used to increase strength

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37
Q

What is isometric exercise

A

Muscle contracts but its length stays the same; ie: hold weight stationary; used for m toning and strength when joint mobility not advised (ie: patellofemoral pain syndrome)

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38
Q

What is isotonic exercise

A

Constant resistance through a joint ROM; ie free weights; used for mm toning

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39
Q

What are the different techniques acupuncturists use

A
  • guasha: deep pressure with japanese soup spoon; TTA that results in very taught thickened mm
  • cupping: TTA that results in hypertonic mm recalcitrant to OMT or massage
  • acupressure: deep pressure technique or circular masasage
  • reflexology: absorption of photon radiation; used for minor MSK pain
  • NAET: used for allergies, idiopathic illnesses; uses mm testing to identify allergies
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40
Q

Why would a DO refer to an acupuncturist

A

If feels that patient needs more frequent treatment, knows that has a physically related problem but lab findings are negative

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41
Q

When would a DO refer to chiropractor

A

If the DO lost skills or feels unskilled in OMT, feels that the patient needs more frequent treatments, specializes in another area of practice

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42
Q

What can occupational therapist do for early childhood patients

A

Play based activities, rehearsal of social behaviors, oral stimulation, infant massage, improve motor coordination

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43
Q

What are the styles of massage

A
  • Swedish: effleurage and Petrissage; hypertonicity, stress, fatigue
  • deep tissue- slow deliberate strokes; trouble spots
  • sports
  • chair
  • shiatsu: rhythmic pressure on certain precise points of body; indicated or anything acupuncture may address
  • lymph massage
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44
Q

What is Rolfing

A

Deep tissue approach; ten sessions - each one builds upon last; need high school diploma

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45
Q

What is the recommendation for yoga

A

Daily starting at 5-15 min and increase every 2 weeks by 5 min

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46
Q

What is feldenkrais

A

Uses gentle movement and directed attention to help people learn new and more effective ways of living with their bodies *use in patients who are too focused on their own pain

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47
Q

What are causes of leg length discrepancy

A

Trauma, **THA, TKA, pes planus, knock knees, blow legs, OA, childhood problems

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48
Q

What is legg-calve-perthes

A

Idiopathic avascular necrosis of femoral head; young boys; progressive painless limp; often self limiting

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49
Q

What is slipped capital femoral epiphysis

A

“Ice cream falling off a cone”; assoc with obesity, teenage boys; painful limp and decreased internal rotation; treat with surgery

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50
Q

What are the findings of long leg

A

Posterior innominate, high iliac crest, posterior sacral sulcus, concavity of lumbar spine (SB towards), convexity of thoracic spine, shoulder is low early on then goes higher, foot is pronated, ankle is dorsiflexed exerted and abducted, femur is internally rotated, knee is flexed, pelvic shift is towards (COG shit)

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51
Q

What kind of torsion is physiologic

A

Forward

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52
Q

How does L5 move during gait

A

SB towards axis, rotates opposite (towards deep sulcus)

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53
Q

What is essential in the treatment of short leg syndrome

A

Home stretching

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54
Q

How do you treat a structural LLD

A

Same as functional plus heel left therapy; rules - only when femoral head discrepancy is >5mm, max 1/2 inch heel lift then progress to whole foot, final lift height should be 1/2-3/4 of measured discrepancy

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55
Q

What is the heilig lift formula

A

Total lift needed = sacral base unleveling/duration+compensation

Duration - <10 years =1 10-30 = 2, >30=3

compensation: none=0, L spine rotation/SB =1, wedging of vertebrae =2

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56
Q

What are the functions of the psoas m

A

Flexion of femur, maintains orientation of pelvis during erect posture, medially rotates hip when laterally rotated and vice versa

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57
Q

What are the etiologies of psoas syndrome

A

Flexion stress of lumbar spine (prolonged siting or bending), sit ups, deadlifts/squats, quick elongation of psoas, arthritis of hip, pregnancy, short leg syndrome, flat lumbar lordosis, viscerosomatic reflexes (lower GI/GU)

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58
Q

What is the symp innervation to kidney

A

T12-L2

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59
Q

What are the sx of psoas syndrome

A

Can’t sit or stand upright, difficulty lying prone, pain stopping at knee, protruberant abdomen, tight hamstrings, increased lumbar lordosis

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60
Q

What should you find on OSE of someone with psoas syndrome

A

Tight psoas and L1 F R and SB to side of tight psoas

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61
Q

What is stage 1 of psoas syndrome

A

B/l spasm; lumbar flexed, increased or flat lordosis, trouble standing up straight, positive Thomas, pain on extension, pain at belt line, treat with indirect techniques and passive stretch

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62
Q

What is stage 2 of psoas syndrome

A

U/l spasm; key lesion is L1 FRrSr; right hip external rotation; pain at R belt line, positive lateral flexion test - cannot SB to opposite side; treat L1 then L2-5 then psoas stretch

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63
Q

What is stage 3 of psoas syndrome

A

Sacral torsion and side shift; dysfunction axis on side of SD; pelvic side shift away from SD causes SB toward; R post innominate leading to short leg; pain in lumbo-sacral junction at site of sacral axis; treat torsion

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64
Q

What is stage 4 of psoas syndrome

A

Piriformis spasm on opposite side of psoas; external rotation of opposite leg; treat Piriformis with counterstrain, trigger point injection

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65
Q

What is stage 5 of psoas syndrome

A

Sciatica of opposite leg; pain in butt, ,SI and hip radiates to knee; treatment - add low dose steroid

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66
Q

What are the dos and donts of stretching for psoas syndrome

A
  • do: passive stretch with rolled towel TID, active stretch 5-20x a day, supine leg lifts, push ups, swimming
  • dont: sleep on stomach, use heat to treat, slump when sitting, Bend forward, lean toward, perform sit-ups, lean backward when standing
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67
Q

What are the red flags of LBP

A

Major trauma, age <20 or >50, hx of cancer, cauda equine sx, consistutional sx (Fever, chills, weight loss, recent bacterial infection, IV drugs, immune suppression, severe nighttime pain)

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68
Q

What is the most common type of spina bifida

A

Myelomeningocele

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69
Q

What are causes of spinal canal compromise

A

Hypertrophy of posterior longitudinal ligament, thickening of ligamentum Flavum, OA, exostoses, osteophytes, tumors, disc rupture

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70
Q

What maintains the spasm in Piriformis sydrome

A

Abnormal gamma motor neuron stimulation

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71
Q

What is facilitation

A

Enhancement of response of neuron to a stimulus following stimulation

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72
Q

What aspects of the CNS lower pain threshold

A

Symp stimulation and vasoconstriction

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73
Q

What is Nervi neuvorum

A

Derived from dorsal roots forming sciatic n; unmyelinated free nerve endings

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74
Q

What are the functions of Piriformis

A

Hip ext rotator when hip extended and abductor when hip flexed

75
Q

Where does the Piriformis insert

A

Superior medial aspect of greater trochanter

76
Q

What exists superior to Piriformis vs inferior

A
  • superior: superior gluteal vessels and n
  • inferior: inferior gluteal vessels and nerves, pudendal bv and n, post femoral cutaneous n, nerves to short external rotators of femur
77
Q

Who is Piriformis more common in

A

Women (larger Q angle)

78
Q

What is the most common cause of Piriformis syndrome

A

Macrotrauma to buttocks

79
Q

What are the sx of Piriformis syndrome

A

Pain radiating down to knee, better with ambulation, worse with sitting, pain when rising from seated position, ontralateral SI pain, difficulty walking

80
Q

How is the sacrum rotated in Piriformis syndrome

A

Anteriorly rotated toward ipsilateral side on contralateral oblique axis; leads to physiologic short leg

81
Q

What are the special tests for Piriformis

A
  • straight leg
  • Freiburg sign: pain during passive internal rotation of hip
  • pace sign: patient is seated and abducts against physicians resistance reproduces pain
  • FAIR test: can perform supine or lateral recumbent with affected side up - flex, adduct and internally rotate patients affected side
  • beatty test: patient lies on unaffected side lifting and holding the superior knee 4 inches off exam table - positive if return sciatic sx
82
Q

What PT can you do for Piriformis syndrome

A

Stretching, strengthening of adductor mm, heat or cold therapy

83
Q

What are systemic causes of neuropathy

A

Pregnancy, hypothyroidism, DM

84
Q

What are the categories of nerve injuries

A
  • 1st degree: neuropraxia; involves focal damage of myelin fibers; connective tissue sheath in tact; limited course
  • 2nd degree: axonotmesis; disruption to axon itself; myelin sheath remains in tact; regeneration possible but moths without recovery
  • 3rd-5th: neurotmesis
85
Q

How do you distinguish 3rd-5th degree nerve injuries

A
  • 3rd: disruption of axons and endoneurium; recovery through axonal regeneration cannot occur
  • 4th: disruption of axon and endoneurium+perineurium (fascicles); no improvement in function; surgery used to restore
  • 5th: disruption of endoneurium+perineurium+epineurium; perineurial hemorrhage; surgery required
86
Q

What does C6 do

A

Wrist extension and elbow flexion

87
Q

What is the most common cause of cervical n root compression

A

Cervical disc dz - bulging (no damage to cartilage rings)or herniated disc

88
Q

What are the types of herniated disc

A

Protrusion - only few cartilage rings torn; no leakage of central material
Extrusion: cartilage rings have torn in small area; nucleus purposes is able to low out of disc space

89
Q

What are the cervical nerve root tests

A
  • spurling
  • adson: have patient elevate chin and rotate head toward affects side while inspiring deeply - look for obliteration of radial pulse on affected side; dx = thoracic outlet
  • Hoffmann: grasp middle finger and quickly snap or flip dorsal surface - look or quick flexion of thumb and index finger; dx = cervical myelopathy (cervical spinal stenosis)
90
Q

What is the treatment of cubital tunnel

A

Always with surgery b/c causes nerve damage

91
Q

What are the functions of radial n

A

Motor to triceps, anconus, wrist extensors; sensation to dorsum of hand

92
Q

Where can the radial n be entrapped

A
  • high on humerus secondary to fracture - sx wrist drop, weakness of elbow flexion, possible triceps involvement, pain/numbness; function usually returns in 4-5 months
  • radial tunnel: caused by repetitive rotatory movements (rowing, racket sports); sx pain and tenderness 5cm distal to lateral epicondyle wrist drop or pain with supination
  • at the wrist - sup branch binched btw brachioradialis and ECRL during pronation; sensation lost over posterolateral hand
93
Q

What is compression of superficial radial n called

A

Cheiralgia parestheticca aka wartenberg’s syndroem aka handcuff neuropathy

94
Q

What are the functions of median n

A

Forearm flexion and pronation, wrist flexion and radial deviation, thumb abduction and opposition, index and middle finger abduction and flexion

95
Q

What motions would cause pronator syndrome

A

Pianists, baseball players, dentists, weight trainers, fiddlers; sx: achy pain in mice forearm and pan with resisted forearm pronation

96
Q

What is the treatment for anterior interosseous syndrome

A

Elbow can be splinted in 90 degrees of flexion for 12 weeks

97
Q

What is the gold standard for dx of carpal tunnel

A

EMG

98
Q

What makes up the initial tunnel

A

Medial epicondyle, medial trochlea, olecranon, ulnar collateral lig

99
Q

What are the sites of compression for thoracic outlet

A

Scalene triangle, costoclavicular passage, at pectoralis minor attachment at Coracoid process

100
Q

What test should you order for suspected thoracic outlet

A

Cervical XR and chest XR if not diagnostic then EMG

101
Q

What are the nerve roots for the LE nerves at risk of compression

A

Common fib, deep fib and post fib are all L4-S2; lateral fem cutaneous is L2-L3

102
Q

What do each of the n roots of the LE do

A
  • L2,L2: hip flexion; sensation of inguinal crease (L1) and ant thigh (L2)
  • L2,L3: knee extension; L3 - ant thigh just above knee
103
Q

Where is the tinel’s sign for meralgia paresthetica

A

1 cm medial and inf to ASIS

104
Q

What is the etiology of common fibular n compression

A

Bedridden, squaring, ankle sprains or trauma, new meditators, lithotomy position

105
Q

What exacerbates common fib n sx

A

Plantarflexion and inversion

106
Q

What is the treatment for common fib n entrapment

A

Post fib he’d, ME on gastroc biceps femoris

107
Q

What is ant tarsal tunnel syndrome

A

Deep fib n compression at inf extensor retinaculum; pain over dorsomedial aspect of foot and worse at rest; weakness of extensor digitorum brevis; caused by trauma, talonavicular dysfuntion, prolonged plantar flexion, compression from shoes

108
Q

What is the treatment for anterior tarsal tunnel syndrome

A

Remove compressive forces, myofascial release of extensor retinaculum; traction tug of talonavicular joint; hiss whip for navicular cuneiform and 1st and 2nd metatarsla

109
Q

What is tarsal tunnel syndrome

A

Compression of post tibial n in tarsal tunnel behind medial malleolus and overlying flexor retinaculum; sx: pain on plantar surface of foot; no gait changes; treat with MFR, HVLA

110
Q

What is the majority of sciatica caused by

A

SI ligament weakness

111
Q

What is important when treating sciatica

A

Hamstring needs to be treated during same treatment as quads; adductors need to be released first

Tight hamstrings will increase laxity of ACL and increase tension on PCL

112
Q

What is compressing the structures in adsons when looking towards vs when looking way

A

Scalene looking away; rib one looking towards

113
Q

What mm would be hyper vs hypo tonic in lower crossed

A
  • hyper: iliopsoas, rectus femoris, hamstring, Piriformis, LE short adductors, QL, TFL
  • hypo: peroneals, abdominals, vastus medialis, ant tibialis, gluteals
114
Q

What is the stretch for iliopsoas

A

Knee, contract butt mm (rectus femoris same but pull back leg up)

115
Q

What does upward dog stretch

A

Iliopsoas

116
Q

What is the quadratus lumborum lateral recumbent stretch

A

Drop leg off like ober test and reach up over head

117
Q

When should strengthening exercises be done

A

Only if patient is pain free

118
Q

How do you retrain ab/adduction

A

Start on all fours and lean back toward right and then left

119
Q

What are the hyper vs hypo Tonic mm in upper crossed

A
  • hyper: upper trap, levator scalp, lat, pectorals, subscap, UE flexors, SCM, scalene
  • hypo: mid and lower trap, rhomboids, Supra and infra spinatus, serratus anterior, deltoids, UE extensors, deep neck flexors
120
Q

How do you stretch the diff scalene

A

No rotation: middle, rotate towards: anterior, rotate away: post

121
Q

What is the scalene self tx

A

Anchor 1st and 2nd ribs sidebnd way and rotate toward; posteriorly translate

122
Q

What is self ME for lats

A

Lay on side, raise arm above head and behind head

123
Q

What is the prayer stretch for

A

Latissimus Dorsi; use chair

124
Q

What is the subscap gravity self stretch

A

Lay on back, raise arm midway in palm up position

125
Q

How do you retrain scapular stabilization

A

Use wall; push wall away then allow body to go forward while uncurling neck

126
Q

What are the “dos and donts of scalenes”

A

Do: use elbow rest, reading light, elevate bed 3-31/2 inches , use pillow that is nor foram rubber, keep neck and shoulders warm at night
Don’t: carrying awkward packages, lift head when rolling over, using glasses that have thick lower rims, turn he’d to hear someone with better ear

127
Q

What is the firing sequence for shoulder abduction

A

Supraspinatus, deltoid, infraspinatus, mid and lower trap, contralateral quad lumborum

128
Q

What is the firing pattern for LE abduction

A

Ipsilateral gluteus medius, ipsilateral TFL, ipsilateral QL, ipsilateral e spinae

129
Q

What is counterstrain for scalene

A

FStRt

130
Q

What is counterstrain for levator scapula

A

Extend arm and add traction or compression

131
Q

What is the counterstrain for SCM

A

FSTRA

132
Q

What is the counterstrain for AC

A

AC1: RA
AC2-6:FSara
AC7:FSTRA
AC8: FSara

133
Q

Where is the TFL counterstrain point

A

Inferior to iliac crest in body of TFL; treat - knee abducted and flexed

134
Q

Where is the IT band counterstrain

A

Distal to lateral trochanter; treat - hip abducted and flexed

135
Q

Where is the lateral hamstring counterstrain

A

Distal aspect of biceps femoris; treat - knee flexed and tibia externally rotated with slight abduction; compression on calcaneus is addd to plantarflex ankle

136
Q

What is the medial hamstring counterstrain

A

Distal aspect of medial hamstring tendons; grasp lateral ankle to control lower leg; knee flexed and tibia internally rotated with slight adduction; compression on calcaneus added

137
Q

What is the lateral meniscus/LCL counterstrain

A

Lateral knee joint line; patient supine; thigh abducted so leg is off table, flex knee 35-40 degrees, tibia abducted and ext or int rotated may require dorsiflexion and eversion

138
Q

What is medial meniscus/MCL counterstrain

A

Medial knee joint line; patient supine; thigh abducted so leg is off table, flex to 35-40 degrees, tibia addicted and internally rotated may required plantarflexion and inversion

139
Q

What is the anterior cruciate counterstrain

A

Superior aspect of poplital fossa adjacent to hamstring tenons; supine; towel roll under distal femur - apply force to prox tibia to translate posteriorly

140
Q

What is the counterstrain for posterior cruciate

A

Slightly below center or pop fossa; supine; towel roll or pillow under prox tibia apply force to distal femur posteriorly

141
Q

What is the popliteus counterstrain

A

Prone; knee flexed and tibia internally rotated

142
Q

What is the gastroc counterstrain

A

Prone; patient knee flexed and dorsum of foot on doc’s thigh; add compressive force through calcaneus

143
Q

What is the tibialis anterior counterstrain (medial ankle)

A

Anterior inferior to medial malleolus along deltoid lig; lateral recumbent with pillow under affected leg; apply inversion with slight internal rotation

144
Q

What is the fibularis counterstrain (lateral ankle)

A

Anterior and inferior to lateral malleolus in sinus tarsi; lateral recumbent with pillow under affected leg; apply eversion force to foot and ankle with slight internal rotations

145
Q

What is the flexion calcaneus (quadratus plantae) counterstrain

A

Anterior aspect of plantar surface of calcaneus at attachment of plantar fascia; supine or prone; patients knee flex, dorsum of foot on doc’s thigh; marked flexion while translating calcaneus toward forefoot

146
Q

What is the navicular counterstrain

A

Patient supine or prone; patients knee flexed, dorsum of foot on doc’s thigh plantar flexion of subtalar joint supination of forefoot

147
Q

What is the supraspinatus counterstrain

A

Superior to spine of scapula; supine arm flexed abducted and externally rotated

148
Q

What is the infraspinatus counterstrain

A

Upper: inf and lat to spine of scapula (post med aspect of GH joint); supine; arm flexed 90-120 degrees and abducted Er/Ir
Lower: lower portion of m inf to spine and lat to medial border; lateral recumbent TP up; doc in front or behind patient; flexed 135-150 degrees abducted and Er

149
Q

What is the levator scapulae counterstrain

A

Prone head rotated away; IR shoulder add traction with min abduction

150
Q

What is the rhomboid counterstrain.

A

Medial border of scapula at attachment of rhomboid mm; seated or prone patients shoulder extend abducted by pulling elbow posterior and medially

151
Q

What is the subscapularis counterstrain

A

Anterolateral border of scapula; supine; ext and int rotate shoulder (maybe traction)

152
Q

What is the biceps long head counterstrain

A

In bicipital groove; elbow and shoulder flexed arm abducted and internally rotated

153
Q

What is the counterstrain or short head biceps/coracobrachilias

A

Inferolateral aspect of coracoid process of short head; supine; elbow and shoulder flexed arm adducted and internally rotated

154
Q

What is the radial head (supinator) counterstrain

A

Anterolateral aspect of radial head at supinator attachment; supine or seated; elbow full extension forearm supinated fine tune with valgus force

155
Q

What is the medial epicondyle (pronator teres) counterstrain point

A

Supine or seated; patients elbow flexed pronated and adducted

156
Q

What is the dorsal wrist (extensor carpi radialis) counterstrain

A

Dorsal surface of second metacarpal; supine or seated; wrist passively extended and abducted

157
Q

What is the dorsal wrist (extensor carpi ulnaris) counterstrain

A

Dorsal surface of 5th metacarpal; supine or seated; wrist extend and adducted

158
Q

What is palmar wrist (flexor carpi radialis) counterstrain

A

Palmar base of 2nd or 3rd metacarpal in flexor Carpi radialis m; supine or seated; wrist flexed and abducted

159
Q

What is the palmar wrist (flexor carpi ulnaris) counterstrain

A

Palmar base of 5th metacarpal in flexor carpi ulnaris m; supine or seated; wrist flexed and adducted

160
Q

What is the first CMP (abductor pollicis brevis)

A

Palmar base radial aspect of first metacarpal; supine or seated; wrist flexed thumb abducted

161
Q

What is rib 1 inhalation MET

A

Flex sidebnd towards rotate away; inhale exhale

162
Q

What is SC adducted SD MET

A

Extend and internally rotate arm

163
Q

What is SC extension MET

A

Patient grabs arm - patient pulls shoulder down toward table

164
Q

What is wrist isotonic MET

A

Cross thumbs; while patient flexes apply pressure; lighten force to allow patient to overcome force

165
Q

Where is upper vs lower pole

A

Upper is superomedial border of PSIS

Lower is inferior aspect of PSIS

166
Q

What is posterior fibular head MET

A

Pronate foot; patient supinates

167
Q

What is posterior fibular head HVLA

A

Monitor fib head with MCP of index finger; flex hip and knee to 90; evert, dorsiflexion and externally rotate ankle, rapidly flex knee while applying anterior thrust to fibular he’d

168
Q

How do you do fibular head BLT

A

Thumb of cephalon hand on superolateral aspect of fib head; caudad hand distal fibula; thumb applies pressure toward foot while caudad hand inverts foot

169
Q

What is calcaneus inv eversion HVLA

A

One hand holds calcaneus other holds dorsum of foot; apply caudad traction thrust

170
Q

What are the sx of bursitis

A

Pain with activity, none at night; tender and warm to touch; caused by trauma, prolonged pressure, overuse

171
Q

What are the sites of inflammation in dequarvains

A

Tendon sheath, abductor pollicis longus, extensor pollicis brevis

172
Q

What is the tx for fibromyalgia

A

SSRI/SNRI sleep exercise

173
Q

What is the criteria for fibromyalgia diagnosis

A

Pain and sx over past week plus fatigue, waking unrefreshd, cognitive problems; sx lasting at least 3 months, no other healt problems that wold explain

174
Q

What is meloxicam used for

A

OA, RA; not in CABG

175
Q

What is dolexitine used for

A

Depression, anxiety, diabetic neuropathy, fibromyalgia, GAD, chronic MSK pain

176
Q

What is the SC adducted (elevated) still technique

A

Patient seated; physician behind; adduct and extend elbow add compression toward SC joint; move shoulder into superior glide and abduction engaging a post circumspection motion

177
Q

What is the SC depressed still technique

A

Patient seated; physician behind; abduct and flex elbow add compression toward SC joint; move shoulder into adduction with anterior circumspection motion returning to adduction position

178
Q

What is the AC separated still technique

A

Patient seated; doc in front; affected side abducted with extension apply traction and move arm into adduction and flexion

179
Q

How do you grade an ankle sprain

A
  • 1: microscopic tear; mild tenderness and swelling
  • 2: partial tear; moderate tenderness and smelling; abnormal looseness
  • 3: complete tear; if doctor pulls or pushes ankle substantial instability
180
Q

What are the Ottawa ankle rules

A

Radiograph if point tenderness at post edge or tip of lateral malleolus, point tenderness at posterior edge or tip of medial malleolus or inability to bear weight (four steps) immediately and in ER

Foot pain - if point tenderness at base of 5th metatarsal, navicular or inability to bear weight (4 steps)

181
Q

What lower extremity problems present with issues of ascending motion

A

Pes answerine bursitis, patellofemoral pain syndrome

182
Q

What are the sx of lower crossed syndrome

A

Increased sacral flexion and lumbar lordosis, increased flexion of hips, knees

183
Q

What ligaments does Talar tilt test

A

Calcaneofibular and deltoid

OS IV (2 decks)

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