Methods 5-Final Flashcards
(137 cards)
1
Q
Motions of the rib cage
A
-Pump handle
-Bucket Handle
-Caliper
-Torsion
2
Q
Thoracic movements
A
-Flexion/Extension (Mostly)
-Lateral Bending
-Axial Rotation
3
Q
Scheuermann’s Disease
A
-D/t growth plate trauma during adolescence
-Schmorl’s Nodes=Evidence of nuclear disc extrustions
-Wedging of >5* in three consecutive segments
-Midthoracic (75% of the time)/Thoracolumbar (25%)
4
Q
Scheurmann’s disease typically affects:
A
Young male (13-17yo) & female gymnasts
5
Q
Scheurmann’s Disease will typically structurally involve:
A
-Exaggerated cervical/lumbar lordosis
-Hyperkyphotic thoracic spine
6
Q
Scheuremann’s Disease: Management
A
-Soft tissue/gentle mobilization
-Address during adolescence/brace (>60) sometime
-Address functional overuse
-Surgery: May be considered at >70 w/ pain
-Kyphosis <60* will most likely resolve in adulthood
7
Q
Costochondritis: Observation
A
Antalgia, shallow breathing, anterior rib
pain at the costosternal articulation (usually ribs 2-5)
8
Q
Costochondritis:ROM
A
-Bucket and/or pump handle restriction
-Arm abduction limited d/t pain
9
Q
What ortho can you use for costochondritis?
A
Schepelmann’s
10
Q
Costochondritis: Active Treatment
A
-Light stretching
-Avoid exacerbating activity
-Focused breathing
11
Q
Costochondritis: Home Care
A
-Bromelain: 500mg 3x/day
-Curcumin
-Heat
12
Q
Costochondritis: Referral
A
-Massage therapy
-Anesthetic or corticosteroid
13
Q
Costochondritis: Passive Treatment
A
-Chiropractic adjustments
-Muscle work
-Moist heat
-Laser
14
Q
Causes of intercostal neuritis
A
*Herpes Zoster
-Tumors
-Ruptured discs/bone spurs
-Diabetes
-Rib motion dysfunction
15
Q
Ortho for Intercostal neuritis
A
Schepelmann’s sign produces pain on the concave
side
16
Q
During intercostal neuritis, what should you do if herpes zoster is suspected?
A
Wear gloves
17
Q
Intercostal neuritis: Supplements
A
-B1, B2, B6, B12 & pantothenic acid given together
-Zinc
18
Q
Intercostal neuritis: Active treatment
A
-Thoracic and core stability
-Posture
-Breathing exercises
19
Q
Intercostal Neuritis: Passive Treatment
A
-Adjust (be careful of shingles lesions)
-US, EMS, Laser
20
Q
Intercostal Neuritis: Co-Management
A
-Injections: Anesthetic (Xylocaine or Lidocaine)
-Analgesics, NSAIDS
-Acupuncture & Acupressure
(NO proven cures)
21
Q
Idiopathic Scoliosis is influenced by:
A
-Family History
-Female patients w/ curves >30*
22
Q
Idiopathic scoliosis can be corrected to some degree with:
A
Lateral flexion
23
Q
How does Idiopathic scoliosis affect ROM?
A
Decrease in ROM of trunk and pelvis
24
Q
Idiopathic scoliosis: Ortho
A
Adam’s Position
25
Are there any neuro findings with idiopathic scoliosis?
No
26
Congenital Scoliosis includes:
Club foot/foot deformities
27
Spina bifida includes:
Patches of hair along the spine
28
Neurofibromatosis includes:
Cafe au lait spots or patches
29
Idiopathic Scoliosis: PARTS
-Pain in areas of the rib
-Asymmetry both globally as well as joint level
30
A cobb angle of _____ is considered scoliosis
>10 degrees
31
Active treatment of Idiopathic Scoliosis: Strengthen muscles of _______/Stretch muscles of ____
Convexity; Concavity
32
With idiopathic scoliosis is contraindicated to adjust into a ________
Concavity
33
TOS: Cause/Risk
-Repetitive activity, Poor posture, pregnancy
34
Most cases of TOS are:
Neurogenic
35
TOS involves what musculature
Scalene, 1st rib, pectoralis
36
TOS: Presentation
-Pain/numbness tingling into 4th/5th digit that worsens with activity
-Neck/shoulder pain
-Thenar atrophy
-Diminished grip strength
-Hand/arm swelling
-Pallor or dislocation of the hand
37
In TOS, imaging is used to rule out:
Cervical Rib
38
TOS Treatment: Active
-Stretch Scalenes, pectoralis
-Radial and ulnar nerve flossing
39
TOS: Home Care
Bruegger’s relief*, heat, avoid sleep posture with elevated arm, postural awareness
40
TOS responds well to:
Chiropractic care
41
Adhesive Capsulitis: Phases
-Acute: Moderate to severe pain that limits ROM
-Middle: Less pain but lifting arm & internal/external rotation is severely restricted
-Final: Slowly increased ROM
42
Adhesive capsulitis often resolves in:
2-3 years
43
Adhesive Capsulitis: Stages
-Freezing
-Frozen Stage
-Thaw
44
Cause of adhesive capsulitis
-Unknown
-Slight increase if diabetic, hyperthyroid, COPD
-Inflammation leads to fibrosis
45
Adhesive Capsulitis: Risk Factors
-Age: 45 to 60 years old
-Gender: Women (70%)
-Prolonged immobility, previous injury, surgery
-Diabetes mellitus, hypothyroid
46
Adhesive capsulitis: Diagnosis
-Loss of Shoulder ROM: External and Abduction
-Orthopedic Tests: Mazion shoulder
47
Adhesive Capsulitis: Treatment (Phase 1)
Phase 1: Avoid aggressive adjustments;Focus on mobilization/pain relief & laser. Exercises: Isometric or Codman’s exercises
48
Adhesive Capsulitis: Treatment (Phases 2/3)
-Adjust and mobilize shoulder
-Codman’s and isometric exercises
49
Impingement Syndrome:Causes
-Narrowing of the space between the acromion process and head of the humerus
-Examples: Subacromial spurs, osteoarthritic spurs, variations in shape of the acromion
50
Variations in acromion process
-Type 1: Flat (normal)
-Type 2: Gently curved
-Type 3: Hooked (will lead to more issues)
51
Impingement Syndrome: Signs/Symptoms
-Pain, weakness at night sleeping on affected shoulder
-ROM limited by pain
-Painful arc during forward elevation (60-120*)
-Passive movement appears painful with downward force @ the acromion
52
Impingement Syndrome: Active Care
Isometric to Isotonic exercises, beginning with shoulder slightly abducted
53
What adjustments are best for impingement syndrome?
S-I adjustments of the glenohumeral joint
-I-S adjustments of the sternoclavicular joint
54
What disorders of the hand/wrist/elbow are most prominently seen in clinic?
Lateral Epicondylitis & Carpal Tunnel Syndrome
55
Lateral Epicondylitis: M99 Codes
M77.11(Right elbow), M77.12 (Left elbow)
56
Lateral Epicondylitis: Causes/Risk Factors
-Overuse injury
-Age: Late 30s-Early 60s
-Desk Work
57
Lateral Epicondylitis: Signs/Symptoms
-Tenderness along the lateral border of the elbow
-Pain when picking up objects while pronated
-Reduced grip strength
-Provoke pain when palpating the lateral elbow
-Hypertonicity of the forearm
-Radiating pain into the forearm
58
Lateral Epicondylitis: MSR would show
Motor strength weakness w/ wrist extension and grip
59
Lateral Epicondylitis: PARTS
-Tenderness over tendons of extensor carpi radialis brevis
-Asymmetry/diminished mobility of the radial head
-Hypertonic forearm muscles
60
Orthos for Lateral Epicondylitis
Kaplan’s, Mills, Cozens
61
Lateral Epicondylitis: Home Treatment
-Avoid excessive/repetitive twisting at the wrist
-Ice Pack: Outside of the Elbow
-Brace
62
Lateral Epicondylitis: Passive Treatment
-Soft tissue release/IASTM
-Laser
-Manipulation
63
Lateral Epicondylitis: Complications
-Recurrence of the injury with overuse
-Rupture of the tendon with repeated steroid injections
64
What kind of adjustments should be used for lateral epicondylitis?
P-A glide of the radial head
65
Cubital Tunnel Syndrome: ICD Code
G56.30-Lesion of the ulnar nerve, unspecified upper limb
66
Cubital tunnel Syndrome is influenced by which movements?
Shoulder abduction, elbow flexion, and wrist extension
67
Cubital Tunnel Syndrome: Signs/Symptoms
Wartenburg Sign: Pinky finger abducts, difficulty with opposition
68
Cubital tunnel syndrome: Diagnosis
-History: Recurrent elbow flexion or pressure
-Observation: Wartenburg Sign
-ROM: Limited by elbow flexion
69
Cubital Tunnel Syndrome: Exam
Parts: Pain over the posterior and medial elbow
-MSR: Weak flexor digitorum profundus, paresthesia along the ulnar distribution of the hand
70
Cubital Tunnel Syndrome: Orthopedic Tests
Froment’s Test, Tinels sign of the elbow, elbow flexion test
71
Cubital Tunnel Syndrome: Grade I
Mild lesions with paresthesia (ulnar nerve), feeling of clumsiness in the affected hand. NO WASTING OR WEAKNESS of the intrinsic muscles
72
Cubital Tunnel Syndrome: Grade II
Intermediate lesions with WEAK INTEROSSEI and MUSCLE WASTING
73
Cubital Tunnel Syndrome: Grade III
Severe lesions with paralysis of the interossei and a MARKED WEAKNESS OF THE HAND
74
Cubital Tunnel Syndrome: Special Tests
-EMG
-NCS
-Asymptomatic: Medical subluxation of the ulnar nerve
75
Cubital Tunnel Syndrome: Treatment
-Passive: ST mobilization, adjustments
-Active: Progressively strengthen flexors
-Home: Reduce elbow flexion
-Medical comanagement: PT, surgical placement of nerve
76
Adjustments for Cubital Tunnel
-P-A glide of the ulna into extension
-A-P glide of the ulna
M-L glide of the elbow in supine position
77
Carpal Tunnel Syndrome: ICD Codes
-ICD-9354.0
-IDC-10G56.0
78
Carpal Tunnel Syndrome: Signs/Symptoms
-Pain, tingling, numbness in the hand and forearm (median nerve distribution)
-Weakness with wrist and finger flexion
• Frequently dropping things
• Prolonged or repetitive wrist flexion
79
CTS: Exam
• MSR
• PINCH AND GRIP STRENGTH WEAK OR DIMINISHED, PARESTHESIA ALONG THE MEDIAN NERVE, REFLEX – N/A
• PARTS
• PAIN NOTED OVER THE CARPAL TUNNEL REGION
• ASYMMETRY OF THE TRAPEZIUM, TRAPEZOID AND CAPITATE
• LOSS OF A-P OR P-A SEGMENTAL MOTION
• TONE – HYPOTONICITY OF OPPONENS POLLICIS BREVIS, FLEXOR POLLICUS BREVIS AND ABDUCTOR POLLICUS BREVIS
• SPECIAL TESTS
• X-RAY
• ELECTROMYOGRAM
• NERVE CONDUCTION STUDY
80
CTS: Orthopedic Tests
Tinels sign (Wrist), Phalen’s Test, Reverse Phalens Test
81
Carpal Tunnel: Adjustments
LAD of intercarpal joint
-P-A/A-P of the intercarpal joint
-A-P/P-A of distal radioulnar joint
-A-P/P-A of carpals
82
Dequervains Tenosynovitis: ROM
ROM
• LOSS OF FLEXION, EXTENSION OR RADIAL DEVIATION AT THE WRIST
• LOSS OF THUMB FLEXION/EXTENSION, ABDUCTION/ADDUCTION AND OPPOSITIO
83
Dequervains: Ortho
Finkelsteins
84
Dequervains: MSR
• WEAKNESS AND REPRODUCTION OF PAIN WITH RESISTED THUMB EXTENSION
• POSSIBLE PARESTHESIA
• DIMINISHED BRACHIORADIALIS REFLEX
85
DeQuervains: PARTS
• PALPATORY TENDERNESS NOTED OVER THE BASE OF THE THUMB
• ASYMMETRY/Loss of segmental motion OF THE SCAPHOID, TRAPEZIUM OR FIRST CARPAL
• OVERLY FIRM/HARD DORSAL COMPARTMENT
86
When would you use X-Ray with potential Dequervains Case
Rule out OA or RA
87
Dequervains: Treatment
Passive: IASTM, mobilization of the wrist
-Active: Gentle wrist stretches, ROM
-Home: Ice, Nsaids
88
Dequervains: Adjustments
LAD of the metacarpalphalangeal joints
89
Legg-Calve Perthes Disease: Causes/Risk
• Sometimes trauma?
• Subcapital fx
• Posterior hip dislocation
• Boys age 4-9
• Not genetic
90
Legg-Calve Perthes: Signs/Symptoms
• Painless limp or waddling gait
• Mild pain in the affected hip
• Limited hip ROM
• Hip stiffness that restricts movement
• Ipsilateral Knee pain
• Persistent thigh or groin pain
• Wasting of muscles in the upper thigh
• Apparent shortening of the leg, or legs of unequal length
91
Stages of LCP
1) Initial- loss of blood supply
2) Fragmentation/resorptive phase
3) Re-ossification
4) Healed
92
LCP: Examination
History (rule out)
• Compression fractures
• Infection
• Endocrine disorders
• Clotting disorders
Observation
• Limping, muscle atrophy, leg length
93
LCP: ROM
Range of Motion
• Limited internal rotation and abduction
94
LCP: Orthopedic Tests
Leg Length Measurement, Trendelenburg Sign
95
LCP: PARTS
PARTS
– Palpatory tenderness over the femur head
– Asymmetry and leg length discrepancy
– Loss of segmental ROM at the hip
– Hypotonicity or atrophy of the quadriceps
• Special Tests
– X-ray or MRI
– Labs
96
LCP: MSR
MSR
– Sensory is equal and WNL
– Reflexes equal and WNL
- Weak hip muscles especially internal rotators and ABductors.
97
LCP: DDx
Unilateral: Inflammatory
• Septic arthritis, Toxic synovitis, Juvenile RA
Bilateral: Dysplasia
• Spondyloepiphyseal dysplasia, Metaphyseal dysplasia
Systems: Endocrine
• Hypothyroidism
98
LCP: Treatment (Active)
Active
– Balance training, Gait training, ROM exercises ,Strength training
Home
– Minimize weight bearing, restrict aggravating activities, Traction (PM), Ice/Heat
Co management
• Bracing to keep the femoral head abducted
and internally rotated & Pain medications
99
What kind of cast can you use with LCP
Petrie Cast
100
Subtrochanteric Bursitis: Orthos
– Ober’s
– Patrick’s
– Leg length
101
Subtrochanteric Bursitis Ddx: MSR
– Internal and external rotation weak due to pain
– Sensory - equal bilateral light touch
– Lower extremity reflexes - 2/2
102
Subtrochanteric Bursitis DDx: PARTS
– Pain over the greater trochanter and bursa
– Asymmetry R vs L femur
– Loss of internal rotation and external rotation
– Hypertonic IT band
103
Subtrochanteric Bursitis: Special Tests
– X-ray rule out bone spurs, arthritis
– MRI
104
Subtrochanteric Bursitis: Active Tx
– Stretching the IT and hip abductors
– Isometric glute strengthening
105
Subtrochanteric Bursitis: Passive Tx
– Adjust the hip, ilium, sacrum dependent on leg length.
– Adjust above and below: pelvis, knees, ankles, feet – Avoid side posture (Bergmann figure 6-155)
– Ultrasound (Pulsed ultrasound if chronic)
– EMS
106
Osteitis Pubis: ICD
ICD-10 M85.30 UNSPECIFIED
107
Osteitis Pubis is common in:
• Athletes- runners or kicking activities
• Exercise intensity
• Direct compressive or distractive injury
• Often from a sudden forced adduction injury
• Repetitive side-foot kicking
108
Osteitis Pubis: Signs/Symptoms
• Adductor pain
• Lower abdominal pain
• Clicking sensation
• Pain walking, running, kicking, etc
109
Osteitis Pubis: Observation
– Limping gait, difficulty rising from a chair/car
– ROM: Weak hip aDDuctors and flexors
– Local pain with resisted adduction
110
Osteitis Pubis: Orthopedics
– Compression ASIS joints toward one another
– Spring test: apply direct pressure over the pubic rami approximately 3cm from midline
111
Osteitis Pubis: PARTS
– Pain with palpation over the pubic symphysis
– Asymmetry of pubic rami
– Loss of PA motion
– Spasm of the piriformis, adductors
112
Osteitis Pubis: MSR
– Motor weakness due to pain
– Sensory & Reflexes WNL
113
Osteitis Pubis: Special Tests
– Gait evaluation
– X-ray, MRI, CT
114
Osteitis Pubis: Active Tx
-Strengthening of the hip flexors, adductors, abdominal muscles, hamstring and quadriceps
-Dynamic muscular stabilization technique
115
Osteitis Pubis: Home
– Avoidance of side-foot kicking and bilateral adduction maneuvers until pain and inflammation is reduced. A slow return to activity is recommended
– Heat or ice
116
Osteitis Pubis: Passive Tx
– Adjust the pelvis and pubic symphysis.
117
Osgood Schlatter: Presentation
• Young athlete (Runners, jumpers, etc)
• More common in male athletes
• Worse with activity
• Pain/swelling and tenderness at tibial tuberosity
• Due to repetitive stress on the tibial apophysis by the patellar tendon
• RARE to have avulsion of the apophysis
118
Sinding-Larsen-Johansson Syndrome
• Involving the patellar tendon and the lower margin of the patella
• Also called Juvenile Osteochondrosis of the patella
119
Osgood-Schlatter Disease Diagnosis
• OBSERVATION – PAINFUL, RED LUMP INFERIOR TO THE PATELLA
• ROM – PAIN INFERIOR TO THE PATELLA WITH RESISTED EXTENSION
• MSR: WEAKNESS DURING RESISTED KNEE EXTENSION D/T PAIN
• PATELLAR REFLEX INTACT BUT SITE MAY BE PAINFUL
120
Osgood-Schlatter Disease: PARTS
• PALPATORY PAIN AT THE POINT OF INSERTION
• ASYMMETRY OF PATELLA, FIBULA AND TIBIA ASSESSED. PALPATORY BUMP OVER THE TIBIAL TUBEROSITY
• PATELLAR TRACKING, FIBULA AND TIBIA
• HYPERTONICITY OF THE QUADRICEPS, SCAR TISSUE OF THE TENDON
121
X-Ray would be used with suspected Osgood-Schlatter if a ______ is suspected
Avulsion Fracture
122
Osgood-Schlatter Disease: Active Tx
• STRETCH THE QUADRICEPS AND HAMSTRING
123
Osgood-Schlatter Disease: Passive Tx
• PER THE PARTS EXAM FINDINGS
• AVOID ADJUSTING OVER THE ACUTE AREA AS IT IS CONSIDERED A POTENTIAL AVULSION FRACTURE (SCOPE OF PRACTICE)
• LASER
124
Prepatellar Bursitis: Causes/Risk Factors
Housemaid’s Knee
125
Pre-patellar Bursitis DDx
HISTORY
• ACTIVITIES/OCCUPATION
• SIGNIFICANT PAIN WHEN KNEELING
• STIFFNESS AND PAIN WITH WALKING
OBSERVATION: RUBOR, CALOR, EDEMA
ROM – GENERALLY PRESERVED
• ORTHOPEDIC TEST: PATELLAR GRINDING TEST – PAIN ON TOP
126
Prepatellar Bursitis Diagnosis: MSR
• MOTOR – PAINFUL 5/5
• SENSORY – NAF
• REFLEXES – WNL (2/4) MAY BE PAINFUL
127
Prepatellar Bursitis Ddx: PARTS
• PALPATORY DOLOR (PAIN) NOTED
• ASYMMETRY BETWEEN RIGHT AND LEFT PATELLA
• PATELLAR TRACKING PROBLEM D/T TUMOR (SWELLING)
• EDEMA AND BOGGINESS OVER THE SWOLLEN AREA
128
Prepatellar Bursitis: Tx
• THE TREATMENT OF ANY BURSITIS DEPENDS ON WHETHER OR NOT IT INVOLVES INFECTION
ASEPTIC PREPATELLAR BURSITIS
• ICE COMPRESSES, REST, AND ANTI-INFLAMMATORY AND PAIN MEDICATIONS.
• OCCASIONALLY, IT REQUIRES ASPIRATION OF THE BURSA FLUID.
• CBC - ASPIRATED TO IDENTIFY THE MICROBES
• ANTIBIOTIC THERAPY
129
Prepatellar Bursitis: Passive Care (Acute)
• ASSESS & ADJUST ABOVE/BELOW
• ADJUST THE KNEE: IF there is Patellar tracking disorder
• TAPE THE KNEE FOR COMPRESSION AND/OR LYMPHATIC DRAINAGE
130
Prepatellar Bursitis: Chronic (Active Care)
ACTIVE CARE (ONCE PAIN AND SWELLING HAS REDUCED)
• ISOMETRIC CONTRACT OF HAMSTRINGS/ QUADS
• LEG EXTENSION AND LEG CURLS
• FUNCTIONAL EXERCISES– SQUATS, ETC.
• HOME – ANTI INFLAMMATORY DIET, HEAT/ICE PUMP
131
Prepatellar Bursitis: Passive Care (Chronic)
• PULSED ULTRASOUND
• GENTLE MANIPULATION OF THE PATELLA
132
Meniscus Tear: History
HISTORY OF TRAUMA (YOUNGER) OR DEGENERATION(AGE RELATED)
• PAIN
• STIFFNESS
• SWELLING OFTEN MAIN COMPLAINT
• CATCHING OR LOCKING OF THE KNEE
• SENSATION OF KNEE INSTABILITY
• ROTATIONAL INJURY OF KNEE (PLANT AND TWIST)
• LIMITED ROM
133
Meniscus Tear: Observation
• NOT A LOT OF BRUISING FROM PURE MENISCUS TEARS DUE TO LACK OF BLOOD SUPPLY (ALSO SPEAKS TO HEALING). HOWEVER, CAN HAVE SWELLING DUE TO SYNOVIAL FLUID REACTION
• LIMPING GAIT
134
Meniscus Tear: Examination
• ROM: LIMITED FLEXION AND EXTENSION
• PARTS: PAIN ALONG THE JOINT LINE, IF LOCKED - LIMITED ROM AND CLICKING NOTED, SWELLING
• MSR: NO ABNORMAL FINDINGS
• MRI: CORRELATE WITH CLINICAL FINDINGS; FALSE POSITIVES – ASYMPTOMATIC TEAR WITH OTHER PATHOLOGY CAUSING SYMPTOMS
135
Meniscus Tear: Orthopedic Tests
McMurrays, Apley’s Compression Test, Bounce Home
136
Meniscus Tear Treatment
• ACTIVE: FOCUS ON ROM, GAIT, PROPRIOCEPTION, MUSCLE STRENGTH
• HOME CARE: AVOID AGGRAVATING ACTIVITY, HYALURONIC ACID
• CO-MANAGEMENT: PT, NSAIDS, SURGERY
137
Meniscus Tear Treatment: Passive
• STABLE TEARS WITH LESS THAN 1CM DAMAGE
• ADJUST TO PATIENT’S TOLERANCE: INDUCE LAD OR GAPPING
