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Flashcards in LECTURE MIDTERM Deck (110):
1

Lateral Epicondylitis aka

Tennis Elbow

2

What is Lateral Epicondylitis thought to begin with?

Tearing of extensor carpi radialis brevis

3

What lateral epicondylitis extend to?

Extensor digitorum communis or extensor carpi radialis longus

4

What is the mechanism of injury for Lateral Epicondylitis?

Wrist extension, radial deviation, supination

5

Types of patients you'll see for lateral epicondylitis?

Carpenters, plumbers, and maids

6

What would you do to evaluate lateral epicondylitis?

palpatory tenderness, ortho tests, radiographs may demonstrate calcification (25%)

7

Medial epicondylitis aka?

Golfer's elbow/ little leaguer's elbow

8

What is the etiology of medial epicondylitis?

Tendinopathy of wrist flexors and pronator teres at origin

9

What types of patients will you have for medial epicondylitis?

carpenters, plumbers, maids

10

Upon evaluation of medial epicondylitis, what will you notice?

Palpatory tenderness, ortho tests, radiographs may demonstrate calcification

11

What also may coexist with medial epicondylitis?

Ulnar neuropathy may co-exist

12

What is the treatment for Epicondylitis?

Initially, treatment involves reducing symptoms of pain and inflammation through rest and applying ice or cold therapy

13

What would you do after the initial phase of Epicondylitis?

Gradually increase the load through the elbow through exercises to a point where normal training and completion can be resumed

14

When should you use Ice and Compression?

In the first 72 hours post injury, you should apply the principles of P.R.I.C.E. (Protection, Rest, Ice, Compression and Elevation)

15

Apply a cold compression wrap for no more than ________ minutes as the injured tissues are very close to the skin

11 minutes

16

What type of protection is used in the treatment of epicondylitis?

Wearing a special elbow brace or support can help reduce the strain on the tendon enabling healing to take place

17

How does wearing an elbow brace work?

By applying compression around the upper arm which puts pressure on the injured tendon, changing the way forces transmitted through it allowing the injured tissues to rest

18

What is probably the most important part of treatment and is often difficult due to compliance issue?

REST

19

When should the strengthening exercises be performed?

As soon as pain allows and then continued until and after full fitness has been achieved

20

What are other conservative therapies for epicondylitis?

ultrasound, EMS, cold laser, OTC's, NSAIDs, Steroid injections

21

What is the diaphragm referred to?

Phrenic nerve to supraclavicular region

22

The stomach/pancreas is refers to ?

Interscapular region

23

What is the spine of scapula divided unevenly by?

Spine of scapula

24

What does the posterior scapula provide attachment for?

Supraspinatus and infraspinatus

25

The spine of scap expands into ______

acromion

26

THe anterior scapula has what?

Large subscapular fossa

27

T/F, the the glenuhumeral joint is larger that the head of scap?

FALSE

28

What is the clavicle attached to?

1st rib on the underside

29

What is the AC joint reinforced by?

  • capsule
  • disk
  • synovial membrane
  • AC ligament - superior AC lig/inferior AC lig
  • Coracoclavicular lig - trapezoid lig/coracoid lig

30

What is the GH joint?

true synovial line diarthrodial joint

31

What is special about the GH joint inferiorly?

joint capsule is lax inferiorly to permit full elevation of the arm

32

What are the reasons for seeking care for shoulder?

RC pathology, C-spine dysfunction, Adhesive capsulitis, OA

33

What are the 3 types of Grades in the shoulder?

  • Grade 1:  stretch of fibers
  • Grade 2:  Tear of fibers
  • Grade 3:  Avulsion from bone

34

What is the order of examination?

  1. Hx
  2. Inspection
  3. Palpation
  4. Instrumentation
  5. ROM
  6. Ortho
  7. Neuro
  8. Examine related areas

35

What % of shoulder issues are related to rotator cuff?

50-70

36

Problems of the rotator cuff occur where?

From trauma, attrition, and the anatomical structure of the subacromial space

37

What is Primary compression of the rotator cuff due to?

Reduction in size to the subacromial space

38

Primary Tensile Overload occurs when ______ ?

Rotator cuff resists adduction, internal rotation, anterior translation, and other forces during throwing

39

What occurs when your force exceed strength of tendon?

Macrotrauma

40

What are the signs of "sudden occurence" in Rotator cuff Hx?

  • intense pain
  • snapping sensation
  • immediate weakness in upper arm

41

Long term overuse of the rotator cuff results in what?

  • Pain in shoulder on abduction
  • Pain when sleep on affected side
  • Eventually, OTC's not helpful

42

Rotator cuff injury = 

Pain with use above eye level

43

Rotator cuff tendon, what are you palpating for?

"cuff tendon defect"

44

When does pain occur during rotator cuff palpation?

pduring active arc 90 to 120

45

Find rotator cuff factoids in _______ of 50 and older

25%

46

_______ of RC factoids are painless?

2/3

47

What is the main cause of pain?

inflammation

48

Whats the ortho tests for rotator cuff?

codman, apley, impingement

49

What should you do for partial tears of Rotator cuff?

  • treat inflammation
  • refrain from activity
  • adjust spine
  • adjust shoulder

50

When should you introduce isometric excercises?

During partial tears of shoulder, begin with isometric exercises progressing to strengthening exercises to ROM exercises

51

Impingement classic presentation =

Pain with overhead activities

52

What are the structures that can be impinged at the shoulder?

Biceps tendon, supraspinatus tendon, subacromial bursa

53

What is impingement of the shoulder due to?

Variant acromion, DJD of acromion, inflammation of subacromial space

54

subacromial impingement =

pain at anterior/ biceps tendon

55

supraspinatus impingement = 

pain at greater tuberosity or under AC joint

56

WHat is the way to chiropractically manage impingement syndrome?

Long term goal is to stabilize shoulder with progressive rehab, stretching posterior capsule

 

  • MANIPULATION - S to I may be helpful check cervical spine and scap. continue through subacute and symptom free stage

 

  • TAPING - discontinue during subacute and symptom free stage

 

  • EXERCISE - begin Codman exercise to stretch capsule.  Continue through subacute and symptom free stage

57

If patient doesn't respond after several months of trying to treat impingement syndrome what should be done

MRI is ordered or planning surgical managment

58

What are open chair exercises for impingment syndrome?

isometrics performed 20 - 30 degrees

 

  • during SYMPTOM FREE stage, perform plyometric exercises if patient is an athlete and uses upper body

59

CMoIS (chiro managment of impingment syndrome) closed chain exercises -

none in acute stage

60

CMoIS wall/wobble board?

push ups, press ups, during subacute stage

61

CMoIS balance ball and wobble board push ups during:

symptom free stage

62

PNF =

proprioceptive neuromuscular facilitation (PNF) training

63

Begin PNF diagonal patterns during -

subacute stage

64

Incorporate functional patterns specific to sport or occupation during ____

symptom free stage

65

what % of acute dislocation are anterior?

90%

66

Talk about inferior dislocations in the shoulder?

Inferior dislocations are rare and are often accompanied by neurovascular injury

67

How do you fall to create acute dislocation?

Fall with external rotation or abduction force is usual cause

68

when would you see "cradle arm"?

acute dislocation

69

What are the 3 main bullets in regards to acute dislocation of the shoulder?

  • Myospasm sets in quickly making reduction difficult 
  • Reduction should be performed promptly (often before radiographs are obtained)
  • Souza suggests the MILCH MANEUVER IS EASIEST

70

What is important about bicipital tendinitis?

  • Every attempt must be made to identify contributing factors, e.g. , a poorly stabilized scapula, hypomobile C-spine, hypomobile T-spine, or altered muscle recruitment

71

How would you manage bicipital tendinits?

  • mild manipulation
  • C - spine manipulation
  • exercise
  • PNF

72

Name all the types of bicipital tendinits (usually from secondary condition) ***** :

  1. Type A:  secondary to impingement syndrome or RC disease
  2. Type B:  subluxation of the biceps tendon
  3. Type C:  attrition tendinitis 

73

How would you rule out for bicipital tendinitis?

Every attempt must be made to identify contributing factors, a poorly stabilized scapula, hypomobile C-Spine, Hypomobile T-Spine, or altered muscle recruitment

74

Most common peripheral nerve entrapment is due to:

  • overuse 
  • hormonal
  • RA
  • genetic
  • diabetes
  • others

75

Dont confuse CTS with _____

pronator teres syndrome or brachial neuritis

76

What will the patient present with in CTS?

  • Pain and parasthesia at median n. distribution 
  • Pain worse in AM
  • Weakness with grip

77

What is the etiology of CTS?

  • Usually Hx of prolonged wrist use in full flexion or extension
  • Pts deficient in B vitamins are predisposed
  • Obesity increases incidence of CTS

78

What is the #2 WC injury?

CTS

79

Who is most likely to develop CTS?

Women in 40s and 50s 4 x's more likely to develop

80

After age 50, men and women's chance of CTS.....

equals eachother

 

81

SS of choice for CTS is _____

EMG/NCS

82

If CTS condition progresses to -______, surgery is likely

atrophy

83

US (for CTS) -

after 7 weeks showed significant improvement

84

What should be given to CTS patients?

B6

85

When does DeQuervain's disease occur?

As a result of trauma to synovium or sheath

86

Dequervain's disease, pt. has pain _____

gripping, ulnar deviation or repetitve use of thumb

87

Underwater ultrasound is good for what?

DeQuervain's disease (addresses inflammation)

88

What does a splint for the wrist address?

Inactivity in DeQuervain's disease management

89

When should you refer out for DeQuervain's disease?

Failure to respond in 3-4 weeks results in referral to ortho surgeon/hand specialist

90

What is a bulge?

Any abnormality of annular fibers; apparent in 30% of population; 70% have 3 or more ; asymptomatic

91

What is a protrusion?

Nucleus has slipped through and tears in annulus; there is pressure on thecal sac and/or nerve root; nucleus is contiguous

92

What is a prolapse?

Nucleus is not contiguous; mother and daughter nucleus; pressure on thecal sac and/or nerve root

93

What is a sequestation?

Nucleus held in place only by posterior longitudinal ligament; pressure on thecal sac and/or nerve root

94

When does the cervical spine nucleus dehydrate?

by age 40-45

95

Patient presents with ______ during cervical disc herniation

Pain and parasthesia in upper extremity

96

Cervical disc herniation, yu can pinpoint dermatomal pattern, and patient will present with:

Arm above head (Bakody's sign)

97

Criteria for determining disc herniation:

3 or 4 must be present

 

  1. Primary complaint is arm pain (may have neck pain)
  2. Pain follows a specific dermatomal pattern
  3. Neural stretch tests are positive
  4. 2 of 4 neuron positive

98

Order MRI for cervical if ______

no improvement after 3-4 weeks

99

Thoracic outlet syndrome affects:

  • 1st rib
  • scalenes
  • atherosclerosis
  • pancost tumor

100

What does the patient present with during TOS (thoracic outlet syndrome)

  • Pain and parasthesia at ulnar distribution of hand
  • awake at night
  • women more common

101

What is foraminal encroachment?

Degeneration in the spinal column has caused obstruction in the foramina

102

What is the etiology for foraminal encroachment?

  • Herniated discs
  • loss of disc height due to DDD
  • Loss of vertebral stability due to facet disease
  • Spondylolisthesis
  • Bone spurs caused by osteoarthritis

103

What are the AKA's for foraminal encroachment?

Foraminal stenosis; spinal foraminal stenosis

 

USUALLY UNILATERAL

104

What are the symptoms of foraminal encroachment?

  1. radiating pain
  2. tingling
  3. numbness
  4. muscle weakness
  5. local spinal pain

105

Foraminal Encroachment from Souza:

• Souza - “Manipulation of the neck is the treatment of choice. If unsuccessful,  cervical traction may be of benefit. Any myofascial contribution may be addressed with stretch-and –spray techniques, trigger point therapy or myofascial release.

 

•Because the foramina are relatively isolated within the spinal column, many of the typical conservative treatment methods used for neck and back pain — including exercise, stretching and physical therapy — might not be as effective.

 

106

What is the dural sleeve?

When the spinal nerve leaves the vertebral canal via an intervertebral foramen, 2 layers of the spinal meninges, the arachnoid and the dura invaginate the nerve to form a dural sleeve of connective tissue, which is the epineurium

107

radiating pain:

pain emitting away from the source

108

radicular pain:

pain radiating from the nerve root

109

radiculopathy:

pathology of the nerve root

110

radiculitis:

inflammation of the nerve root