M6 Midterm

Question 1

Occlusion of the ___ artery from stenosis, aneurysm, embolus, or compression from a cervical rib or anomalous first rib is the most serious cause of TOS, but accounts for less than 1% of all cases.

Answer 1

Subclavian

Question 2

___ TOS is by far the most common cause of TOS, accounting for well over 95% of cases.

Answer 2

Neurogenic

Question 3

TOS is more common in ____, with some estimates as high as 9:1

Answer 3

Women

Question 4

In TOS, pain and paresthesia predominantly involve the __/__ segmental level

Answer 4

C8/T1

Question 5

Symptoms of TOS follow a ____ nerve distribution in 90% of cases.

Answer 5

Ulnar

Question 6

A buffalo hump in the upper thoracic spine may indicate ___ syndrome

Answer 6

Cushing’s

Question 7

Scapular winging can be due to weakness of what three muscles (or their associated nerve supply)?

Answer 7

1. Serratus anterior (long thoracic n.)
2. Lower traps (spinal accessory CN XI)
3. Rhomboids (dorsal scapular n.)

Question 8

For patients with increased thoracic kyphosis, what test help differentiate between a structural or functional cause?

Answer 8

Prone extension test

Question 9

The two basic origins of intersegmental joint dysfunction (ISJD)?

Answer 9

1. Mechanical (trauma or overuse)

2. Reflexive (visceral nociceptive irritation triggering reflexive segmental muscular guarding)

Question 10

Longstanding joint dysfunction is thought to result in premature _______

Answer 10

Degenerative change

Question 11

Complaints involving the thoracic region make up approximately __% of all spinal problems

Answer 11

15%

Question 12

The one-year prevalence of thoracic spine pain is estimated at __% (much lower than cervical/lumbar)

Answer 12

17%

Question 13

The use of ____ seems to correlate with adolescent thoracic spine pain (approx. 10% of adolescents experience thoracic pain)

Answer 13

Backpacks

Question 14

Clinicians should be suspicious of ____-referred pathology when active or passive motion testing does not reproduce the chief complaint.

Answer 14

Viscerally

Question 15

MRI demonstrates the presence of thoracic disc herniation in __% of asymptomatic patients, and disc bulge in __%

Answer 15

37%, 53%

Question 16

Thoracic spine manipulation has been shown to immediately increase _____

Answer 16

Muscle strength

Question 17

___ syndrome consists of paresthesia, numbness, upper extremity pains w/or w/out headaches and upper back stiffness. It has a peculiar glove-like distribution of hand or forearm pain which often leads to misdiagnosis.

Answer 17

T4

Question 18

Studies suggest that __-__% of “chest pain” is of musculoskeletal origin

Answer 18

10-30%

Question 19

The costovertebral joints have rich, nociceptive innervation from branches of the ____ nerve

Answer 19

Intercostal

Question 20

The intercostal nerves arise from the ____ rami, which provide a plausible connection for referred pain to the chest and abdominal wall.

Answer 20

Ventral

Question 21

Movement of the upper ribs occurs primarily in a “____” elevation manner, while the lower ribs move in more of an anterior to posterior “______” fashion

Answer 21

“Pump handle”, “bucket handle”

Question 22

The __-__ segments are the most common sites of costovertebral joint dysfunction.

Answer 22

T8-T10

Question 23

Ankylosing spondylitis is suggested when chest expansion is limited to less than __” in males and __” in females.

Answer 23

1-1/2”, 1”

Question 24

Asymptomatic thoracic disc lesions may be present in up to ___ of the population

Answer 24

Half

Question 25

Over 75% of thoracic disc herniations occur below ___, with the ____ segment being affected the most.

Answer 25

T8, T11/12

Question 26

Costovertebral joint dysfunction is generally unilateral and provoked by _____

Answer 26

Deep inspiration

Question 27

Patients w/thoracic disc herniations whose symptoms centralize upon EXTENSION should be treated w/a ___ extension protocol, while patients exhibiting a flexion bias would be better served with _____ flexion exercises.

Answer 27

McKenzie, Williams

Question 28

____ is a complicated diagnosis, broadly describing dynamic, interdependent degenerative changes involving the discs, vertebral bodies, and/or facet joints that develop in response to stress, compounded by time.

Answer 28

Spondylosis

Question 29

Thoracic degeneration shows a predilection (common area of damage) for the most mobile segments: __-__

Answer 29

T9-T12

Question 30

Spondylosis patients often note symptoms upon arising in the morning which dissipate with _____

Answer 30

Light activity

Question 31

____ describes a painful inflammation or degeneration of the tendon of the long head of the biceps.

Answer 31

Biceps tendinopathy

Question 32

Biceps tendinopathy often results from repetitive ___

Answer 32

Overhead activity

Question 33

____ is the most common cause of shoulder complaints, in which 95% of patients with biceps tendinopathy have it as their primary diagnosis.

Answer 33

Subacromial impingement

Question 34

A popular orthopedic test for bicipital tendinitis?

Answer 34

Yergason’s

Question 35

____ syndrome is caused when the Supraspinatus tendon becomes painfully entrapped between the acromion and the greater tuberosity of the humerus during elevation and internal rotation of the arm.

Answer 35

Anterior shoulder impingement

Question 36

“Non-outlet impingement” anterior shoulder impingement syndrome arises from loss of normal numeral head depression as a result of ____ muscle weakness or denervation

Answer 36

Rotator cuff

Question 37

Scapular dyskinesia is present in up to __% of shoulder impingement cases.

Answer 37

100%

Question 38

Which of the rotator cuff muscles is the largest and strongest?

Answer 38

Subscapularis

Question 39

____ injury is the most common problem to affect the shoulder, accounting for 4.5 million physician office visits per year.

Answer 39

Rotator cuff

Question 40

____ describes an ongoing and painful limitation of active and passive glenohumeral and periscapular motion

Answer 40

Adhesive capsulitis (frozen shoulder syndrome)

Question 41

There are two types of adhesive capsulitis: primary and secondary. Which type is more common and follows a period of restricted shoulder motion (i.e. rotator cuff pathology, trauma, surgery, etc.)

Answer 41

Secondary

Question 42

Patients with ___ adhesive capsulitis are unable to identify the cause of their condition

Answer 42

Primary

Question 43

The incidence of adhesive capsulitis rises to 10-20% in patients with _____, and 36% in those with _____

Answer 43

Type 2 diabetes, Type 1 diabetes

Question 44

Loss of passive ____ with the arm positioned at the side is the most common range of motion deficit in adhesive capsulitis

Answer 44

External rotation

Question 45

The acronym “SLAP” stands for:

Answer 45

Superior Labrum Anterior Posterior

Question 46

___ is described as a tear or detachment of the shoulder’s superior glenoid labrum; generally originating at the anchor site for the long head of the biceps tendon and extending into the anterior or posterior portions of the labrum

Answer 46

SLAP Lesion

Question 47

The most common mechanism of acute SLAP lesion injury?

Answer 47

FOOSH (Fall Onto Outstretched Hand - shoulder abducted and flexed forward)

Question 48

Also called “sick scapula”

Answer 48

Scapular dyskinesis

Question 49

Scapular dyskinesis is more apparent with dynamic testing, particularly during the ____ phase of arm movement.

Answer 49

Lowering

Question 50

T/F: scapular dyskinesis can occur from core and hip abductor weakness

Answer 50

TRUE

Question 51

T/F: no single orthopedic maneuver has been shown to reliably predict a SLAP tear.

Answer 51

TRUE

Question 52

10% of patients with lateral epicondylitis have co-existent ___ syndrome

Answer 52

Radial tunnel

Question 53

In radial tunnel syndrome, the radial nerve compression occurs most commonly (70%) beneath the proximal edge of the ____ muscle at the Arcade of Froshe

Answer 53

Supinator

Question 54

__% of patients with lateral elbow pain demonstrate symptoms or positive clinical findings in the cervical or upper thoracic regions

Answer 54

70%

Question 55

Radiographs are warranted in adolescents complaining of medial epicondyle pain in order to rule out avulsion, also known as:

Answer 55

Little league elbow

Question 56

The two most common sites of ulnar nerve entrapment at the elbow are:

Answer 56

1. Within the true cubital tunnel | 2. Slightly distal to the tunnel between the two heads of the flexor carpi ulnaris

Question 57

This is the second most frequent cause of median nerve compression

Answer 57

Pronator teres syndrome

Question 58

A patient with this syndrome cannot form an “O” with the thumb and index finger

Answer 58

Anterior interosseous syndrome

Question 59

The most common nerve entrapment?

Answer 59

Carpal tunnel syndrome