MSK Flashcards
(115 cards)
1
Q
Teach a new PTA how to teach a patient wrist AROM exercises.
A
2 sets of 15 reps.
demo first, then have then demo back.
remind of their restrictions;
1
Q
Patient experiencing weakness after elbow cast removed. Name and test 4 muscles innervated by the radial nerve
A
2
Q
Speak with a nursing home patient’s spouse regarding their concerns regarding mobility. Prescribe 2 exercises for the spouse to do with them: one functional and one strengthening exercise.
A
3
Q
Patient has an osteoarthritic knee. Provide treatment, do not do accessory movements. Prescribe one exercise for home.
A
4
Q
Perform C-spine scan of male with anterior shoulder pain. – to rule out neck pathology. (10)
A
5
Q
Obtain informed consent for C-spine mobs. (explain risks/benefits) (5)
A
6
Q
Educate a whiplash patient about their injury. (MOI, cause of pain, pain management, activity modification, monitoring for VBI - vertebrobasilar insufficiency, ie. decrease in blood flow to posterior part of brain, which can lead to a stroke) (10)
A
7
Q
Whiplash injury 1/52 ago: take a focused history. (5)
(MOI – car stopped or moving? Head turned? LOC? Ask about Vertebral artery signs, headaches, pain, x-rays, previous injury, concurrent treatments, meds, occupation, 5D’s, neural, previous MVA’s etc.)
Written 🡪 what 2 treatment are contraindicated at this time; what 3 factors found during interview would you consider during the objective exam
A
8
Q
25 y.o female who has recently been experiencing headaches & neck P. Works in office and spends a lot of time at desk. Go in & complete an ergonomic Ax of workstation & educate pt on how to correct it. (pt has picture of work station – look over it & state out loud all the things wrong, then show the pt in the simulated set up a better desk layout.) (10)
A
9
Q
Office worker with LBP & Neck P (data entry worker) Teach client proper sitting posture and also how to adjust her office chair appropriately. Instruct pt on changes she can make to her workstations based on a picture she brought. (10)
A
10
Q
Pt has back/neck pain in sitting. Take Hx. (pt was secretary) (10)
A
11
Q
Pain in L shoulder after serving tennis ball. Do focused physical Ax of L shoulder movements. Describe to examiner what you’re doing and your findings. (5)
Written→
1) What is your clinical impression of this client’s shoulder pain?
2) What positive findings support this?
A
12
Q
V-ball/tennis/baseball player sustained injury 2 days ago to L shoulder. Perform AROM, PROM and MMT. (5)
Written🡪 What structure is involved? What factors support this? Outline 4 Rx approaches
A
13
Q
Shoulder: differentiate between bicipital tendonitis and supraspinatus tendonitis. (2 tests for each) (5)
A
14
Q
Pt had subdeltoid bursitis. Perform an AP mobilization. Tell the examiner what grade.
Written 🡪 what are the characteristics of a grade I mob? (5)
A
15
Q
AC joint dislocation – perform ROM & strength Ax. Give 2 exercises for ROM & strength. Sling just came off today (10)
A
16
Q
Grade II L AC jt sprain. Ax pt’s L ROM & strength (do not Ax R side) Goniometric is optional.
Give one exercise for ROM and one exercise for strength. (10)
A
17
Q
Assess AROM and PROM post anterior shoulder dislocation.
Written 🡪 chart your findings, what movements are contraindicated (5)
A
18
Q
Pt with an. dislocation of left shoulder 5 days ago. Arm is in sling. Teach home exercise program. (10)
A
19
Q
Pt with #’d head of humerus (impacted). 1 week post op. Ax ROM and teach ROM exercises. Don’t use goniometer.(10)
A
20
Q
Woman with Alzheimer’s fell & hurt elbow. Assess ROM of left elbow. ( Won’t let you touch her elbow. Won’t follow instructions - have her do functional things with the comb/toothbrush in the room).
Written 🡪 1) Document Elbow flxn.
2) Elbow extn
3) How could you determine whether her elbow pain is new or not? (5)
A
21
Q
Pt #’d head of radius on R arm 6 weeks ago. The cast is off and the # is healed & stable. Ax accessory mvmts of R elbow joint. (accessory mvmts not contraindicated at this time). Tell examiner which jts you’re Ax’ing. (5)
Written 🡪 Precautions and Complications with this #.
A
22
Q
Lateral Epicondylitis/Tennis elbow: give home exercise program.
Written 🡪 what can you teach her to prevent re-injury? What is the etiology of LE? (5)
A
23
Q
Olecranon process # yesterday. Closed reduction and cast applied. Fracture clinic for follow-up visit. Instruct client in appropriate program for next 4 weeks for U/E. Indicate any warning signs to observe for (cast tightness/looseness, changes in hand colour/sensation, 🡩d swelling, remove any tight jewellery, 🡩d pain) Do not give instructions re. ADLs. (5)
Written🡪
1) List 4 problems, which may affect client while in cast
2) What exercise is contraindicated at this time and why?
3) Other than physical signs, what would indicate that it is safe to add this exercise to program?
A
24
Wrist #. Ax ROM & strength. Give exercises (5)
25
Finish taking focused Hx on pt with R palmar numbness. Info is provided re. Neck & wrist ROM as well as other Ax info. Take detailed Hx, then finish objective Ax to determine whether symptoms are coming from neck or if it’s carpal tunnel syndrome (special tests) (10)
26
Pt #’d proximal phalanx of 4th finger on L hand 6 wks ago. # is stable at this point. Cast is removed. There is restriction of MCP flex/extn & restriction of PIP flex/extn. Give 2 exercises to restore ROM. Hint: putty & tennis ball on table. (5)
Written 🡪 what will you do if he has an acute flare up of pain? What if he has trophic changes (RSD)
Reflex sympathetic dystrophy (RSD) is a condition that features a group of typical symptoms, including pain (often "burning" type), tenderness, and swelling of an extremity associated with varying degrees of sweating, warmth and/or coolness, flushing, discoloration, and shiny skin. RSD is also referred to as Complex Regional Pain Syndrome.
27
Colles fracture. Fx is stable. Teach exercises and care after cast removal. Ax ROM & strength and give exercises. Educated re warnings: swelling & RSD. (5)
Written 🡪 1) Goals of Rx 2) What condition would you suspect if you loss ROM in shoulder, elbow, wrist and skin shiny (RSD) 3) 3 ways to control edema → Ice, compression, elevation
28
Pt ruptured Flexor digitorum superficialis of index finger 4/52 ago. Splint was taken off for exercises. Teach him home exercise program for next 2 weeks. Next visit scheduled in 2 weeks. Hand is contracted in flexion. Pt keeps asking “what shouldn’t I be doing with my hand? → no extension of finger and wrist, as this puts too much tension on your tendon (10)
29
Lady post T6?T12? compression Fx, having difficulty coping at work (legal secretary). Take Hx focusing on pain and functional status. (5)
Written 🡪
1) Based on Hx, what 4 ergonomic factors would you check at her work environment.
2) What 2 tips can you give her to deal with pain at work. → 1) take a break and walk around office for a few minutes, every 30 mins, and 2) stretch every 15 mins
1) take a break and walk around office for a few minutes, every 30 mins, and 2) stretch every 15 mins
30
Pt has sudden onset of back pain 6 wks ago while lifting box. Over 3 wk period, client developed L L/E symptoms including muscle weakness. Over next 3 weeks, no change in condition. Referred to PT for Ax & Rx. Ax clients L/E Myotomes & Reflexes. Tell examiner which levels you’re testing. (10)
1) Identify level of nerve root involvement.
2) On what clinical findings do you base your answer?
3) Name one more test that you could perform to support your conclusion (dermatomes)
31
Pt has low back pain and pins and needles in leg. Do neural tension. At 8 minutes examiner asks which level it is and why. (10)
SLR (L5, S1, S2), XSLR (for disc herniation), Slump, prone knee bent (L3, L4)
32
Teach correct lifting technique for floor🡪counter (man has fused L4-5) Demonstrate first. (10)
Written🡪
1) Give 3 precautions with home exercise
2) Give 3 LE exercises in standing to help with lifting. (5)
→ bend knees, keep straight back with slight lumbar lordosis, don't twist when turning, instead take small steps to the side
→ wall squats, hip extension with theraband, hip abduction with theraband??
33
32 y.o male has constant & severe LBP following MVA 2 days ago. Having difficulty with most movements. Objective Ax: Extension causes most LBP. Flexion relieves LBP. No neuro deficits. Client has low back soft tissue injury. Instruct client in pain management & resting positions in lying. 10
→ avoid extension mvts, put ice on low back for 15 mins every 2 hrs...?
→ when lying on side, put one pillow under head, and another between knees; when lying on stomach, put one pillow under hips
34
Pt with Grade 1 Spondylolisthesis who experiences pain on Extension & prolonged Flexion. Give instructions on how to manage symptoms with home exercise program including posture and body mechanics. Review precautions (10)
35
27 y.o marathon runner c/o pain in back of thigh (hamstrings) after yesterday’s training. He has another marathon next week. Perform an Ax and tell examiner your impression & Rx plan. Give 2 exercises to improve ROM & strength.
Do AROM, PROM & resisted isometric testing for R hip & knee. Pt asked: could she run in another 10 km race in a few days? How long it would take to heal (hamstring strain?) If she would be able to get back to “normal” running. (10)
(Answer is hamstrings strain b/c flexing knee hurt, AROM hip flex, AROM hip extn hurt, isometrics knee flex, & hip extn, palpation hurt)
36
Pt had R THA yesterday using posterolateral Sx approach. She is WBAT. Teach client appropriate Hip & Knee exercises in supine. (5)
Written🡪
1) Based on performance, outline problems in areas of: ROM, L/E strength, L/E position on entering station.
2) If same client presented with marked 🡩 in Pain in R hip, Marked ER of R hip, and unwillingness to bear wt –
a) what clinical problem would you suspect? (Dislocation; femoral shaft #)
b) What 3 actions would you take?
3) Instruct client to maintain neutral rotation, stop treatment/exercises, contact doctor, document findings in patient chart
37
Pt post THR (cemented). Is PWB w/ crutches. Has been D/C from hospital but having groin pain & L/E swelling. DVT & hip dislocation ruled out. Give strategies to manage pain at home. (10)
(Lady sitting in low chair with legs crossed at ankles. Reposition her. Watch her walk with crutches to find out if she’s putting too much wt. through bad side. She is suppose to be PWB, but she is doing Full WB. Advise re. Pain management. (teach partial WB with crutches, reinforce precautions) (10)
38
Total Hip Replacement: teach to use standard walker. (5)
Written 🡪 write a SOAP note.
39
Pt had THR 4 days ago. Teach pt sit🡪 stand transfer and ambulation with walker. (5)
Written 🡪 What was pt complaining of? Write progress notes for this pt regarding today’s visit.
40
Pt in hospital bed with L femoral neck #, 6 days after ORIF. Review ex’s & precautions (ie. Blood clot, homman’s sign, watch bedrail etc) (10)
41
Pt with L knee injury 1 day ago. Do one test for each of the major knee ligaments (ACL,PCL,MCL,LCL) and do one test for medial meniscus. Do not test opposite side. Tell examiner the name of the test & which ligament it’s testing, and your findings.(5)
Written 🡪 what are your short term goals.
42
Knee pain: take focused history excluding social and pre-med Hx.
Written 🡪 given the objective findings and you need to figure out the Dx and rationale to support it… give 4 things to help her (education, RICE, ROM, Strength). (5)
43
Pt has OA of L knee – take focused history (5)
Written → Name findings expected on an X-Ray of pt’s knee.
→ narrow joint space, osteophyte formation, destruction of cartilage??
44
Acute treatment for MCL sprain; what are the characteristics of hemarthrosis. (5)
redness, warmth, swelling, pain
45
Teach one treatment technique and one exercise to ↑ knee ROM 6 weeks post TKA. (5) →
Written 🡪 guidelines for using exercise bike
Tx technique: posterior glide of tibia on femur to increase knee flexion??; Exs.: heel slides??
(ROM > 110 degrees, able to monitor HR, sufficient balance)
46
OA of L knee. Total knee replacement tomorrow. Ax knee ROM, assess his gait and report to examiner three deviations you found. (5)
Written🡪 1) Find 2 abnormalities on X-ray
(2 signs of OA) 2)
Goals of Rx.
47
Left TKA – teach sit to stand, walking. Write a SOAP note(5
48
Pt had TKA 3 days ago. Review bed exercises with her and teach precautions. (hint: pt complained of pain in calf muscles and was not willing to exercise) (5)
→ Homan's test...
49
Laterally dislocated patella 3 hrs ago playing v-ball. Immediate self-reduction. Client recalls immediate onset of pain and hearing loud “pop” after quickly pivoting on L foot in order to return a volley. Knee still very painful.
Explain to client factors & mechanism that may have contributed to injury. Discuss how she might prevent recurrence of same injury (10) Hint: have model of knee to use
50
Pt had THR yesterday/#’d femur. You had her up walking today, but she complains of L/E pain. Perform focused assessment of their right L/E. (check for DVT, DVT is positive so explain why you would not do AROM/PROM/Strength Ax). (5)
Written 🡪 what are your immediate actions (inform doctor, advise pt not to move leg, chart your findings); what if pt asks to put heat on her calf (heat is contraindicated)
51
Post-op Achilles tendon repair: teach crutch walking; scar tissue massage. (10)
52
Ankle sprain: perform full examination (AROM, PROM, isometrics, ligament tests) (10)
53
41 y.o man with recent L foot pain comes to out-pt physio. Take focused Hx. (plantar fascitis). (10)
1) Based on Hx, what is most likely clinical Dx?
2) What leads you to suspect this clinical Dx?
54
Pt has a # ankle – take a history (5)
55
Take Hx of female soccer player 1 hr post-injury (metatarsal #?) W🡪 most probable Dx? Give 3 reasons to support Dx (MOI, can’t WB, Pain w/ mvmt) Do you think she needs medical attn? (5)
56
Teach 3 home proprioception ex’s to Pt with Hx of recurrent ankle sprains (no equipment). (5) → 1) stand on affected leg, 2) stand on affected leg with eyes closed, 3) stand on unstable surface (ie. pillow, foam, etc)
Written🡪
1) What muscles would you strengthen if he has chronic plantar flxn/inversion sprains? → tibialis anterior, peroneus longus, peroneus brevis;
2) Give 3 more advanced proprio exercises → calf raises, ...
3) What instructions can you give him to help prevent future recurrent sprains?/what can you do if the pt is a basketball player that want to prevent future sprains.
57
Pt with swollen ankle/ankle sprain – teach how to bandage with tensor. (10)
58
Take a history for a person trying to avoid a triple arthrodesis.(5)
(determine medical condition, pain characteristics, weakness, balance, medications, functional/social history). (5)
Written🡪
1) What are the indications for triple arthro? (pain with WB, ↓ stability, deformity, weakness).
2) What movement limitations would he have post arthrodesis. 3
) What is the difference b/t talotibial fusion and triple arthrodesis?
Same -Pt will undergo L ankle tibiotalar/triple/1st degree arthrodesis. Take pertinent Hx in relationship to L ankle. Do not take social Hx.
59
22 y.o F who fell 5 feet from a ladder 3 days ago & landed on both heels. Comminuted calacaneous Fx in L calcaneus & hairline Fx of R calcaneus. WB status: Left=NWB, Right=WBAT. Teach an appropriate gait pattern (room has crutches, walker and 2 canes) (10)
60
Teach 3-point crutch walking to pt with 3rd degree ankle sprain of R LE. Pt is NWB on R LE. (10)
61
Posture Ax - 1) kyphosis with forward head posture, lumbar lordosis 2)scoliosis
Written → What muscle groups were tight/shortened? Weak? (5)
62
25 y.o. worker c/o LBP. Ax posture in standing, tell examiner your findings (5).
63
Office worker with LBP & Neck P (data entry worker) Teach client proper sitting posture and also how to adjust her office chair appropriately. Instruct pt on changes she can make to her workstations based on a picture she brought. (10)
64
Sample Q: 58 y.o female has osteoporosis and had a compression # at T5, which has now healed. Ax sitting posture & describe findings to examiner. Correct sitting posture. Teach client importance of correct sitting posture (5)
Written 🡪3 goals of Rx with respect to client’s osteoporosis. →
→ decreases pain, decreases chances of compression fractures...
education, increase strength, increase ROM; 3 active spinal movements you should incorporate into an exercise program for this client.
65
Ultrasound (10) Test Machine; Settings; Contraindications; Risks, Benefits, apply.
a) Post op back laminectomy
b) MCL sprain
c) Chronic L3-4 facet syndrome
d) Lateral Epicondylitis
e) 33 y.o man presents with LBP. 3 mo ago he fx’d L2 & L3. He presents w/ spasticity of paraspinals & requires U/S to help 🡫 pain. Treat (Clear # healed, pt only comfortable in side lying, treat in 2 doses for each side – do NOT do one long dose across spine)
66
Pt with grade 3 quads weakness secondary to Grade 2 MCL sprain 3 weeks ago. Use muscle stim. (TENS is also in room, make sure you choose the muscle stim).
Question at 8 minutes: how would you proceed with the treatment today? (not sure what this meant) (10)
67
Take Hx of pt with psoriasis getting UVL Rx. (5)
Written → List 5 factors that would affect length of Rx
68
54 y.o man with PVD & IDDM for 20 yrs. He is a 25 pack year smoker. He is presently experiencing pain in both legs when he walks for greater than 20 min a day. Educate him on foot care, and give home Ex. Program. (10)
69
Lady with IDDM X 30 yrs fell 2x in last month. Take focused Hx (regarding falls?) What’s single most important reason for falls? What 5 parts of the objective examination would you do? (10)
70
Above knee amputee: TEACH 1) Stump wrapping; 2) Care & use of prosthesis; 3) Lying positions; Exercises for pre-prosthetic training. (10)
71
Below knee amputee: TEACH 1) Stump wrapping; 2) Care & use of prosthesis; 3) Lying positions; Exercises for pre-prosthetic training. (10)
72
Alzheimer’s patient fell yesterday. Teach her to walk using walker. (5)
Written 🡪 what things in her house should you assess prior to her returning home?
73
Interview (take history) for a woman with fibro (10)
74
Woman with RA in her hand. Do an objective Ax of her hand. (Ax active joint count and measure gross functional ROM in her hand. Do not Ax ROM of individual jts.) (5) (lady’s hand is very painful and hardly lets you touch her.)
Written🡪
1) How could you control her pain and swelling?
2) What Tx’s are contraindicated?
3) List 5 problems this pt has.
4) She can only see you once/month. What would you include in her Rx program (4 components of a home program)?
75
Mother with child who has juvenile chronic arthritis has an acute flare up with pain and stiffness in knees and ankles – Teach 2 modalities to his mom that she could use at home to help 🡫 pain & stiffness (instruct use of appropriate modalities, contrast baths, heat packs.) (5)
76
Pt with Anky Spon. He presents with 🡫 lumbar lordosis and hip ROM. Teach 3 exercises he can do at home. (5)
Written🡪
1) What would be the objective measures/tests you would use to monitor this client. Outline 5 items to assess progression.
2) What problems would this client have in the short and long term?
3) What are the most important goals in Rx for this pt (give 4).
77
14-month-old baby girl who had congenital femoral head softening/dislocating hips. She underwent a bilateral immobilization procedure. Mom coming for Ax as to whether PT will be helpful. Take a Hx from her mom in relation to the medical procedures that were done and developmental milestones that the child experienced. (10)
78
58 y.o. lady who has osteoporosis and had a compression # at T5, which has now healed. Ax client’s sitting posture and describe findings to examiner. Correct client’s sitting posture. Teach client importance of correct sitting posture. (5)
Written →
1) List 3 goals of Rx with respect to client’s osteoporosis
2) List 3 active spinal movements you should incorporate into an exercise program for this client.
79
Prego 6 months with 1st baby. 🡩d LBP when she lies down to rest. Teach client a resting position. Explain rationale for this resting position. (5)
Written →
1) Client is secretary who does a lot of sitting & standing at work. List 5 back care management principles that would prevent further back strain.
2) Client states she heard that shortwave diathermy or TENS would help her back. Describe how you would advise client & justify answer.
80
Teach a woman post-partum the following exercises:
1) Pelvic Floor (incontinence)
2) Abdominal ex’s.
3) Pelvic tilts ex’s. (10) (check diastasis recti – lift head & shoulders up)
81
Pt 4 months pregnant with 2nd child. Pt developed LBP with previous pregnancy that resolved after giving birth. Provide client with 3 different exercises:
1 must be strengthening
2 must be for posture
At 8 min, examiner asks you what 4 things would you also like to discuss with client? (10)
82
Client fell at home – brought to ER by family. D/C from hospital. Needs Ax for walking aid. No serious injuries besides minor scalp laceration, sutured. PMHx unremarkable. Take focused Hx to help determine if client needs walking aid. (10)
83
Perform pre-op physical Ax for pt who will have exploratory laparotomy. (IPPA) (5)
Written → Write up chest Ax (impression, goals, objective examination)
84
One day post gastrectomy: is semi-concious sleeping d/t strong anesthesia. Do Resp Ax in L side-lying. Explain findings to examiner. (10)
8min questions: If pt had find insp crackles, what may be the cause?
What other things would you like to be able to do if pt was conscious?
85
Pt underwent gastrectomy 2 days ago. Chest Ax reveals poor resp effort, shallow resp, RR of 20 breath/min; 🡫 lat costal expansion & diaphragmatic expansion with 🡫d breath sounds to bases bilaterally. No adventitious sounds and cough is weak & ineffective. Demonstrate appropriate Rx program for this client. (10)
8 minute mark:
1) Outline 4 goals of Rx?
2) What additions would you make to Rx based on client’s response to Rx?
86
Spontaneous R pneumothorax. Yesterday, chest tube inserted into lateral aspect of chest to evacuate air. Client is non-smoker and otherwise healthy. Auscultate the client’s chest in sitting. (10)
87
Russian with rib fractures (4/5/6): teach deep breathing and coughing. (10)
88
Pt had lobectomy done 3 days ago & has been in bed since then. Perform DB & coughing with pt sitting side of bed. (pt had Chest tube in situ) (5)
Written🡪
1) What important part of the Rx would you add to her current Rx?
(2) What is the tube for?
3) What is the distal end of the tube attached to?
4) What are contraindications for a chest tube?
89
Pt in respiratory distress (medically stable): Ax situation & act accordingly. Pt was received supine with nasal prongs out. When NP’s put back on, pt got better, but still SOB. Placing pt in respiratory distress position (hunched over with arms over bed?) relieved SOB. After, auscultate 🡫’d BS bilat, pneumonia, R pneumothorax? (5)
Written 🡪
1) Describe resp distress recovery position & rationale
2) 4 strategies to deal with a reoccurrence/manage SOB
90
Pt with COPD c/o SOB. Give 1 breathing technique to help SOB. Give 2 suggestions (1 in sitting and 1 standing) to help with SOB.(5)
Written 🡪 what phase of breathing would a person with emphysema have most difficulty (5)
*USE THE FOLLOWING TO ENHANCE RESPIRATION (*PNE list)
Positions to relieve dyspnea
Positions to improve ventilation/oxygenation
Breathing exercises
Respiratory Muscle training with or without equipment
Incentive Spirometry
91
Gait Assessment
1) Prior to standing, assess strength of hip flexors, knee flexors/extensors, PFs/DFs should be at least grade
3 for standing/walking
2) Put transfer belt on client
3) Place chair at other end of room for rest break
4) Instruct client on proper way of standing up from chair (come to edge of chair, bring feet backwards, lean
forward, push up with both hands on armrests, then reach for gait aid once standing) and in proper way of
sitting down (turn towards stronger side, take a could steps back towards the chair until you feel the chair at
the back of your legs, reach back with one hand for the armrest, then reach back with the other hand and
slowly lower yourself to the chair)
5) When standing, ensure gait aid is properly measured for client.
6) Walk first with client and ensure he/she is safe to walk on own.
7) Observe gait anteriorly, laterally and posteriorly.
8) Comment on gait deviations
92
Transfers- when to use a sliding board?
Transfer towards stronger side
If muscle strength is less than 2/5 use sliding board transfer
93
Treatment for gait:
Wide BOS and/or unsteady gait –
Absence of heel-toe gait pattern –
Foot drop/ no heel contact –
Absence of toe-off –
Swaying of trunk –
Bucking knee –
Hyper-extending knee –
Circumduction –
Trendelenberg –
Wide BOS and/or unsteady gait – trial gait aid to increase BOS and stability
Absence of heel-toe gait pattern –
Foot drop/ no heel contact – strengthen DF’s, stretch PF’s
Absence of toe-off –
Swaying of trunk –
Bucking knee – increase quads control, esp eccentric (Quads over roll, eccentric quads, mini squats)
Hyper-extending knee – a/a; can try to place tape on back of knee for feedback
Circumduction – lack of hip/knee flexion
Trendelenberg – increase hip abductor strength, clamshells, standing hip ABD, hip drops/lifts
94
Discuss with RN about nursing staff wanting to change a patient from step around transfer to mechanical lift as they are struggling with transfers in the afternoon… (weird question)
Patient perspective- advocate for independence.
RN perspective: time requirements, ask to understand their situation & concerns.
What I can do: timing PT in the afternoon
Safety always: for staff & client
95
Set up a patient for Right quad strain with NRMES, F/U why might you change the parameters of the machine?
Explain modality: neuromuscular electrical stim
Purpose and Rationale: produce muscle contraction (strength, prevent atrophy, reduce spasticity, restore function).
Expected sensation: starts tinglingly
Contra: pregnancy, pacemaker, clots, CA (damaged skin, chest, abdomen)
Adverse effects: burns, skin irritation, pain
Comparable sign (ROM, MMT, pain, swelling)
Application:
- Placement: one over motor point, one parallel to muscle fibers
- Inspect skin – inspect electrode – place smoothly against skin
o Far apart- deeper, closer is more superficial
- Select settings – start slow- monitor client
- Turn off – take off - inspect skin – document placement and settings used
- Leave call bell
Settings:
Frequency: 50Hz
Amplitude: 200 us pulse duration (large m)
Strength: 10% MVC, 10 reps at 1:5 on:off 10s on:50 s off (10minutes). Ramp 2sec up and 1 down
1x/day
96
Patient has Tennis elbow give 2 exercises a stretch and a strengthening exercise. Educate patient on ways to modify her activity while playing tennis. Follow up – what other treatments could physiotherapist do for this disorder?
Tennis elbow – lateral epicondylagia.
Special tests: modesley’s, cozens, mills
2 exercises: grip strength squeezes on ball, eccentric wrist extensors
1 stretch: forearm extensors stretch
Other Tx: cryotherapy
Modifications: brace
97
Mr. X had a total knee replacement 5 weeks ago.
RA is seeing your patient for the first time. Teach RA to perform 30 sec sit to stand test
Questions- what RA can’t do in charting
Can RA perform assessments on the patient? Why or why not?
98
Patient has Dequervain’s syndrome and recently had a baby.
1) Take subjective history of the patient.
2) 2 recommendations to control pain.
3) techniques to confirm the diagnosis
1) Typical MSK Hx – directed about baby care
Pain onset – gradual vs mechanism (trauma/chronic)
2) Splinting
Lifting mechanics to avoid ulnar/radial deviation (try long way of the baby)
Strength: grip, finger sprinting
Stretch: ulnar/radial dev, wrist flex
3) Finkle steins (active or passive)
Pain on palpation over snuff box
Resisted thumb APL and EPB
Passive ulnar deviation
99
Do a SLR test and myotomes of LE. Verbalize findings to examiner. F/U what would a cross sign indicate during this test (having pain on contralateral side when SLR) and based on your diagnosis, which exercises would you tell the pt to avoid. (Patient had a lumbar disc herniation.
SLR: Supine – unaffected side first. But do both. Instruct “don’t help me (raise the table up) keeping the knee In full extension and moving slow – asking the patient what they are feeling as they go.
- Cross Sign: raising the unaffected side produces symptoms in the involved side. Indicative of a central disc herniation (major nerve root impingement).
LE Myotomes in supine: L1/2: Hip flexion. 3: knee extension 4: DF 5: Great toe Ext S1: plantar flexion S2 Hamstring (knee flex)
Based on findings – avoiding flexed forward positions to avoid symptom aggravation. Exercise Rx: Repeated prone, prone on elbows to hands – eventually in standing. (Mckenzie method)
Differential Dx: muscle spasm, cauda equina, peripheral nerve entrapment (sciatic)
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Low back pain hx and specifically clear the red flags. Ended up being Cauda equiana.
What do you think it is? Justify it? And why? Bowel leakage, pain down both sides leg, sensory changes in the seated area. What would you do next?
It is CEq because this is an issue with the long nerves of L1 (LMN injury)
This results in the following symptoms:
- Bilateral progressive weakness
- saddle numbness
- issues using the toilet
Immediate referral to emergency. Document findings in a note/ letter for the patient to take to the hospital. Also document in your own findings.
Follow-up via email or phone.
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Focused hx on neck pain. Hx of neck pain for 3 months. Difficulty moving in all directions. No family hx of anything. Answered for Cancer questions.
Observation
Palpation
AROM, PROM, RAROM
Special tests (anterior sheer, lateral sheer, lateral flexion sheer, sharp purser, flexion rotation)
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Dequarvains Tenosynovitis – provide 1 stretch, 1 strengthening exercise and a progression for the strengthening. They were wearing splint.
Stretch: ulnar deviation stretch (pain free ROM)
Strength: finger opening against band, radial deviation (isometric progress to eccentric)
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Delegating a task to a PTA. They learned about lateral costal breathing and pursed lipped breathing in school but haven’t done it since school They are a new hire. Task is to check their competence.
Costal is holding on the bottom of the rib cage
Pursed lips, relax the shoulders
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Spondylolisthesis Grade 2.
He gets pain with prolonged flexion.
Provide 3 exercises and educate on 3 things they shouldn’t be doing (movement and activities).
Teach them how to lift.
Exercises:
1) triA activation
2) Curl ups
3) Gluteal stretch (figure 4)
Avoid
1) extensions (push-ups, cobra)
2) twisting activities (Golfing)
3) high impact activities (running)
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Achilles post op. 6 weeks post-op. 3 tasks.
1) teach exercises for all uninvolved muscles.
2) Talk to the examiner about how you would apply deep transverse friction.
3) Teach weight bearing precautions for this patient moving forward
PEP: When will I be able to walk without restrictions (or asked normally)?
1) quads, hamstrings, glutes
2) DTF: two finger stack with massage local to the area for 5minutes perpendicular to the tendon over the insertion to promote collagen alignment / pain management and decrease scar tissue adhesions in the area
3) Prioritize good walking form and pain free – gradual decrease in the wedge within the foot. Weeks 6-8 discontinue gee lift in walking boot (crutches to maintain normal gait pattern), 8-12 wean off boot
Likely on track for 12weeks + post op as long as the other phases progress as expected
106
Humeral fracture 8 weeks. Give 4 exercises for muscles innervated by the radial nerve. You could use soup can. E.g. Triceps, brachioradialis, supination pronation, wrist extension. You have to list the muscles and then do the exercise.
PEP: Will the nerve pain I have in my hand ever go away?
BEST: Brachioradialis, extensors, supinator, triceps
Wrist extension, supination, hammer curl, elbow extensions
Yes likely, your nerve pain will diminish. Nerves recover slower than muscles and bones, generally ~1mm/day.
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Intermittent claudication focused Hx
Treatment
Differentiate between stress #, shin splints and neurological claudication
Tx: progressive increase activity/ aerobic exercise (may be painful but creating more blood vessels). Educate on skin care and warning signs of DVT
108
Hemophilia knee ROM. Kept saying things are painful. Was laying on the bed. Do all the exercises in lying was the task. Knee flexion/extension in lying. Do a quad strengthening exercise is lying
hemophilia is when the blood doesn't clot effectively. Slowing healing.
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6-weeks CTS release. Do 3 mobility exercises
Wrist extensions
medial nerve glides
Prayer stretch
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They have inflammatory arthritis and is in a bad flare up these last 2 months.
1) Discuss their discharge plan
2) Educate the patient on two community resources
3) Follow Up: How would you document the discussion
1) D/C plan: Planning, Prioritizing, Pacing, Joint Protection, Posture.
Discuss ADLs, Occupation – availability of adaptive equipment to help cope at home. (assistive devices).
2) Arthritis society of Canada. Youtube – Arthritis home tips and tricks.
3) I would document the conversation under the treatment section of my documentation note regarding education and then a brief description of the conversation and whether or not the patient understood.
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Patient presents post soccer with an injury to their ankle Perform an assessment of the contractile or non-contractile structures Discuss the findings with the invigilator
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Patient presents one day post-op Achilles repair Teach them how to use crutches
Teach 2 exercises
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