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600 - Orthopedic Treatment > midterm op > Flashcards

midterm op Flashcards

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1
Q

Pathology specific questions:

Adhesive Capsulitis

A

Moi, onset, better or worse, location, symptoms, any other specialists, previous injuries, other health conditions, ADL’s affected,

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2
Q

Hallmark signs & symptoms:

Adhesive Capsulitis

A

Phase 1 - gradual onset of pain, severe night pain, lateral brachial region
Phase 2 - pain diminished but stiffness main complaint, capsular pattern affect adl’s, disuse atrophy (delts/SITS)
Phase 3 - local pain, motion/function gradually return

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3
Q

ROM findings:

Adhesive Capsulitis

A

AROM: Decrease
PROM: Capsular pattern of restriction ER, AB, IR
RROM: depends on if there is tear or tendonitis

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4
Q

Assessments:

Adhesive Capsulitis

A

Scapulohumeral rhythm test - (scapula moves too early)
Ddx impingement (hawkins kennedy, neer’s), tendonitis (speed’s empty can)

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5
Q

Clinical Impression & Approach to Treatment

Adhesive Capsulitis

A

General approach is to manage pain and inflammation,
maintain available ROM
Mobilize hypomobile joint
Promote normal muscle tone
Reduce fascial adhesions

Basically reduce pain and symptoms and try to maintain/improve motion and joint health. Reduce adhesions as well.
If disuse atrophy think about strengthen

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6
Q

Treatment goals and treatment plan:

Adhesive Capsulitis

A

Manage pain and inflammation

Joint health - Hypomobile joints (gr 3 or 4 subacute)

Increase ROM - passive ROM

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7
Q

Homecare:

Adhesive Capsulitis

A

1.) Stretch: Doorway stretch (high) externally rotated arms, active pendulum swing

2.) Strength: Isometric internal and external rotation (doorway)

3.) Hydro: heat if chronic

4.) ADL change: Avoid overhead reaching and sudden shoulder movements.

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8
Q

Pathology specific questions:

Bicep tendonitis

A

Moi, onset, symptoms, location, other dx, previous injuries, feel better or worse, ADL’s affected, stress, work,

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9
Q

Hallmark signs & symptoms:

Bicep tendonitis

A

Pain with contraction (MMT/RROM)
Pain with stretch (AROM opposite)
Palpation
Sleep disturbance, pain with palpation, swelling, redness

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10
Q

ROM findings:

Bicep tendonitis

A

AROM/RROM GH FLX pain
PROM possible less pain

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11
Q

Assessments:

Bicep tendonitis

A

Speed’s Test – provokes pain in the bicipital groove when resisted shoulder flexion is done in supination.

MMT of Shoulder Flexion with Supination – isolates the biceps long head for contraction pain/weakness.

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12
Q

Clinical Impression & Approach to Treatment

Bicep tendonitis

A

Decrease restrictions,
mobilize hypomobile joints,
stretch to maintain new length of functional scar,
RROM to help realign fibres and return strength
Increase circulation
Strengthen - eccentric

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13
Q

Treatment goals and treatment plan:

Bicep tendonitis

A

Decrease restrictions (MFR, frictions, stripping)

Mobilize hypomobile joints (distraction, post/ant glide)

Use RROM to help realign fibres (bicep isometrics)

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14
Q

Homecare:

Bicep tendonitis

A

1.) Stretch: Doorway stretch (Low)

2.) Strength: Eccentric bicep curls

3.) Hydro: Moist heat if chronic - ice post activity

4.) ADL change: Avoid lifting heavy objects with a palm up grip

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15
Q

Pathology specific questions:

Lateral Epicondylitis

A

When did pain start?
Specific incident or come on gradually?
Previous injuries?
Describe the pain
Where exactly do you feel it?
When do you feel pain?

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16
Q

Hallmark signs & symptoms:

Lateral Epicondylitis

A

Pain over lateral epicondyle
Referral pain down C7 dermatome (posterior forearm) into dorsum of hand. Perhaps into ring finger/middle finger

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17
Q

ROM findings:

Lateral Epicondylitis

A

ECRB
RROM: Pain wrist ext.
AROM: Pain wrist flx

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18
Q

Assessments:

Lateral Epicondylitis

A

Cozen’s Test
Mill’s Test
MMT - ECRB
Maudsleys - rule out radial nerve compression

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19
Q

Clinical Impression & Approach to Treatment

Lateral Epicondylitis

A

Decrease restrictions/adhesions
Muscle tone, TrPs
Friction therapy if needed
Mobilize hypomobile joints (check lig integrity first)
Stretch to maintain new length of functional scar
RROM to help realign fibres and return strength

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20
Q

Treatment goals and treatment plan:

Lateral Epicondylitis

A

Decrease soft tissue restriction/adhesions (MFR, frictions) to CET area

Reduce hypertonicity and triggerpoints

Mobilize hypomobile joints
Realign fibres and begin to return strength (RROM isomoetrics)

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21
Q

Homecare:

Lateral Epicondylitis

A

1.) Stretch: Wrist extensor stretch

2.) Strength: Eccentric wrist extension

3.) Hydro: chronic apply moist heat before stretch or exercise

4.) ADL change: Avoid gripping with palm down, lifting with your elbow extended

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22
Q

Pathology specific questions:

Medial Epicondylitis

A

When did pain start?
Specific incident or come on gradually?
Previous injuries?
Describe the pain
Where exactly do you feel it?
When do you feel pain?

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23
Q

Hallmark signs & symptoms:

Medial Epicondylitis

A

pain/weak grip
Possible ulnar nerve involvement

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24
Q

ROM findings:

Medial Epicondylitis

A

RROM: flexion pain
AROM: Pain

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25
Assessments: | Medial Epicondylitis
Medial epicondylitis test MMT flexors/pronator Pronator teres syndrome (if nerve involvement suspected)
26
Clinical Impression & Approach to Treatment | Medial Epicondylitis
Decrease restrictions/adhesions Muscle tone, TrPs Friction therapy if needed Mobilize hypomobile joints (check lig integrity first) Stretch to maintain new length of functional scar RROM to help realign fibres and return strength
27
ROM findings: RROM: flexion pain AROM: Pain Treatment goals and treatment plan: Decrease soft tissue restriction/adhesions (MFR, frictions) to CFT area Reduce hypertonicity and triggerpoints Mobilize hypomobile joints Realign fibres and begin to return strength (RROM isomoetrics) | Medial Epicondylitis
Decrease soft tissue restriction/adhesions (MFR, frictions) to CFT area Reduce hypertonicity and triggerpoints Mobilize hypomobile joints Realign fibres and begin to return strength (RROM isomoetrics)
28
Homecare: | Medial Epicondylitis
1.) Stretch: Wrist flexor stretch 2.) Strength: Eccentric wrist flexion 3.) Hydro: Apply moist heat for 10–15 minutes before stretching or exercise to increase circulation and tissue pliability. Acute or after aggravating use: Ice over the medial elbow for 10 minutes, up to 3x/day.
29
Pathology specific questions: | De Quervains Syndrome
When? Where? What movements make pain worse, swelling, clicking? Seen any other healthcare provider? Any other conditions I should be aware of? Any activities you’ve had to stop or modify, does your job involve much hand or wrist movement
30
Hallmark signs & symptoms: | De Quervains Syndrome
RSI (pain, difficulty with movements, tingling, numbness, swelling) on radial side of wrist and thumb
31
ROM findings: | De Quervains Syndrome
RROM pain thumb ABD and EXT AROM - ADD/FLX pain
32
Assessments: | De Quervains Syndrome
Finkelstein MMT ABL or EPB
33
Clinical Impression & Approach to Treatment | De Quervains Syndrome
Goals Decrease SNS Decrease pain, HT, TrP Decrease fascial restriction Decrease adhesions in tendon sheath (MFR, ice) Maintain/increase ROM Mobilise hypomobile joints Stretch shortened muscles Tissues: extensors, flexors, intrinsic hand mm, deep distal 4, carpals
34
Treatment goals and treatment plan: | De Quervains Syndrome
Reduce local irritation and tone in overused muscles. 2.)Decrease fascial restrictions and adhesions in tendon sheaths (MFR over lateral 3.) Lengthen overused and adaptively shortened structures.(finkelstein type stretch) 4.Mobilize hypomobile joints - CMC 1 jt mobilizations
35
Homecare: | De Quervains Syndrome
1.) Stretch: Thumb extensor/flexor stretch (modified Finkelstein stretch) 2.) Strength: Isometric thumb extension & abduction (early stage) 3.) Hydro: Moist heat before activity. Ice after aggrevation
36
Pathology specific questions: | Dupuytren's contracture
37
| Dupuytren's contracture
Onset? Symptoms? MOI? Trauma? Other specialist? Any other medical conditions I should be aware of? How is this affecting daily tasks? Does this interfere with work activities? Any hobbies affected?
38
Hallmark signs & symptoms: | Dupuytren's contracture
Thickened palmar fascia, MCP,IP FLX (digits 4-5 usually), wrist flexor hypermobility, Decreased IP ROM, gradual onset
39
ROM findings: | Dupuytren's contracture
Decreased AROM of IP’s
40
Assessments: | Dupuytren's contracture
Cozen’s, Mill’s, Maudsley’s if lateral EPI pain Scapulohumeral rhythm if adhesive capsulitis MMT
41
| Dupuytren's contracture
42
Clinical Impression & Approach to Treatment | Dupuytren's contracture
Goals Decrease SNS Decrease pain, HT, TrP Decrease fascial restriction Decrease adhesions in palmar fascia (frictions, ice) Maintain/increase ROM Increase circulation/improve tissue health Tissues Forearm flexors Palmar Fascia Palmaris Longus, FCU Carpals, metacarpals, PIPs, DIPs Contrast hydro
43
Treatment goals and treatment plan: | Dupuytren's contracture
Reduce fascial restrictions in the palm and forearm (MFR) Maintain joint health Strengthen wrist flexors Stretch passively wrist and finger extension
44
Homecare: | Dupuytren's contracture
1.) Stretch: Finger extension stretch: fingers on table 2.) Strength: Isometric finger extension holds (press fingers against resistance like putty or towel without movement). 3.) Hydro: Contrast baths (3 min warm : 1 min cool, repeat x3) to improve circulation and tissue pliability. 4.) ADL change: Avoid prolonged gripping, tight fists, or tool use that encourages flexed hand postures.
45
Pathology specific questions: | Elbow sprain
When? What happened? Where is the pain? Describe pain? Feel instability? Doctor? Any other conditions affecting this? Previous joint hypermobility? Is injury affecting daily work tasks? Does it interfere with general activities such as cooking, etc… Have you had to stop or change your daily tasks?
46
Hallmark signs & symptoms: | Elbow sprain
Pain, swelling @ joint, instability, tenderness, decreased ROM (guarding) esp extension, stiffness
47
Assessments: | Elbow sprain
Valgus or varus stress test DDX lateral or medial epicondylitis
48
Treatment goals and treatment plan: | Elbow sprain
Prevent/reduce adhesions (frictions, MFR) Strengthen mm (isometric contractions) Decrease pain Maintain tissue health.
49
Pathology specific questions: | Post-fracture forearm
When, how? Any pins? Symptoms? ROM? Did you see doctor? Any other conditions? Medications? Able to perform usual activities? Hobbies affected? Difficult with strength or lifting?
50
Hallmark signs & symptoms: | Post-fracture forearm
Possible edema, dry, scaly skin (post cast), disuse atrophy, bruising, scars?
51
Assessments: | Post-fracture forearm
Capillary Refill test Forearm extensor or flexor mmt Valgus or varus stress test
52
Clinical Impression & Approach to Treatment | Post-fracture forearm
Reduce HT and TrP Gentle stimulating techniques Pain free PROM and AAROM interspersed to improve tone Joint play on joints proximal and distal to area
53
Treatment goals and treatment plan: | Post-fracture forearm
Reduce hyper tonicity Facilitate joint nutrition and health (jt mobs grade 1-2) Facilitate muscular strength/ function - isometrics Facilitate ROM - passive stretch
54
| Post-fracture forearm
55
Homecare | Post-fracture forearm
1.) Stretch: 2.) Strength: Isometric contractions for wrist and forearm muscles: (against wall or table) 3.) Hydro: Contrast to improve circulation. Heat before stretch or exercise (if no swelling)
56
Pathology specific questions: | Shoulder instability
When? How, symptoms, pain weakness? Seen anyone else, any medications or other specialists, is work affected, hobbies, how have ADL’s been affected
57
Hallmark signs & symptoms: | Shoulder instability
Acute: SHARP, bruising Subacute: Unstable, reduced ROM, adhesions Chronic: Restricted ROM, matured adhesions, hypertoned, trp, weakness, sulcus sign, protective posturing
58
ROM findings: | Shoulder instability
Apprehension in direction of injury” Anterior: ABD/EXT ROT Posterior: FLX,ADD,INT ROT Inferior: Force ABD with fixed hand
59
Assessments: | Shoulder instability
Anterior: Rockwood Test (primary) MMT of rotator cuff or Push-Pull Test (to rule out combined instability) (MMT subscap,delts, pec minor) Posterior: Push-Pull Test, MMT of external rotators (to differentiate muscle weakness vs true instability) (MMT, infra, teres minor, post delt) Inferior: Feagin Test,Scapulohumeral Rhythm Test (to assess poor motor control contributing to instability) For MMTs: Patient will be apprehensive/stops and guards
60
Clinical Impression & Approach to Treatment | Shoulder instability
Maintain available ROM (PROM) Prevent disuse atrophy (Isometric contractions) Prevent excess adhesion formation: begin cross-fibre Frictions Reduce hypertonicity Restore ROM and strength
61
Treatment goals and treatment plan: | Shoulder instability
Decrease Pain ( Improve Joint Stability - isometric strengthening Restore and Maintain normal ROM (prom)
62
Pathology specific questions: | Wrist sprain
When? What happened? Where is the pain? Describe pain? Feel instability? Doctor? Any other conditions affecting this? Previous joint hypermobility? Is injury affecting daily work tasks? Does it interfere with general activities such as cooking, etc… Have you had to stop or change your daily tasks?
63
Hallmark signs & symptoms: | Wrist sprain
Pain, swelling @ joint, instability, tenderness, decreased ROM (guarding) esp extension, stiffness
64
Assessments: | Wrist sprain
Valgus or varus stress test Ulnocarpal stress test (dx tfcc)
65
Treatment goals and treatment plan: | Wrist sprain
Prevent/reduce adhesions (frictions, MFR) Strengthen mm (isometric contractions) Decrease pain Maintain tissue health.
66
Homecare: | Wrist sprain
1.) Stretch: Wrist and forearm stretches (as tolerated): 2.) Strength: Isometric wrist strengthening 3.) Hydro: Contrast to boost circulation and tissue healing. Heat before stretching or exercise. 4.) ADL change: Avoid activities that involve pushing, pulling, lifting.
67
Assessments: | Supraspinatus tendonitis
Empty Can Test – resists abduction with IR; local pain or weakness suggests supraspinatus injury. MMT of Shoulder Abduction (in scaption plane) – contraction pain points specifically to supraspinatus involvement.
68
Clinical Impression & Approach to Treatment | Supraspinatus tendonitis
Decrease restrictions, mobilize hypomobile joints, stretch to maintain new length of functional scar, RROM to help realign fibres and return strength Increase circulation Strengthen - eccentric
69
Treatment goals and treatment plan: | Supraspinatus tendonitis
Decrease restrictions (MFR, frictions, stripping) Mobilize hypomobile joints (distraction, post/ant glide) Use RROM to help realign fibres (bicep isometrics)
70
Homecare: | Supraspinatus tendonitis
1.) Stretch: Pendulum exercises: Let the arm hang and gently swing in small circles to maintain mobility. 2.) Strength: Isometric shoulder abduction: Press the arm gently against a wall or surface without moving the shoulder; hold 5–10 seconds, repeat 10 times. 3.) Hydro: Apply moist heat before stretching and strengthening to relax muscles and increase blood flow (10–15 minutes). 4.) ADL change: Avoid overhead activities or lifting heavy objects with the affected arm.
71
Pathology specific questions: | Subacromial bursitis
Moi, onset, symptoms, location, other dx, previous injuries, feel better or worse, ADL’s affected, stress, work,
72
Hallmark signs & symptoms: | Subacromial bursitis
Acute: SHARP, burning at rest/activity, sudden onset, severe debilitation Chronic: Pain localized and felt with activity/compression, protected with guarded movement, with chronic inflammation - fibrosis and adhesions
73
ROM findings: | Subacromial bursitis
RROM ABD may be less painful - unless compressed at end range AROM ABD may be painful in arc 60-120* PROM ABD may be more painful - passive can compress the structure
74
Assessments: | Subacromial bursitis
Neer Impingement Test — pain with passive shoulder flexion (impinges subacromial space) Hawkins-Kennedy Test — pain with forced internal rotation at 90° flexion (narrows subacromial space)
75
Clinical Impression & Approach to Treatment | Subacromial bursitis
Decrease restrictions, mobilize hypomobile joints, stretch to maintain new length of functional scar, RROM to help realign fibres and return strength Increase circulation Strengthen - eccentric
76
Treatment goals and treatment plan: | Subacromial bursitis
Decrease restrictions (MFR, frictions, stripping) Mobilize hypomobile joints (distraction, post/ant glide) Use RROM to help realign fibres (bicep isometrics)
77
Homecare: | Subacromial bursitis
1.) Stretch: Pendulum (Codman) exercises: Let the arm hang and gently swing in circles to maintain gentle joint mobility. 2.) Strength: Isometric rotator cuff exercises: (wall or door frame) 3.) Hydro: heat for 10-15 min before stretch or exercise 4.) ADL change: avoid heavy lifting

600 - Orthopedic Treatment (19 decks)

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