MSK Flashcards

Question

What is De Quervain's Tenosynovitis? Including etiology, S + S, special tests and interventions

Answer 1

Inflammation in sheath (synovium) of ABL and EPB - compression between sheath and radial styloid process Etiology Chronic overuse - repetitive wrist (ulnar deviation) and thumb movements Direct trauma - to radial styloid process S + S Radial side wrist pain Tenderness and swelling Wrist with wrist and thumb movements - contraction and stretching of APL and EPB May have crepitus Special tests - Finklestein’s Interventions PT Activity modification Cryotherapy Splinting (thumb spica) Gradually stretching and strengthening (as tolerated) Medical NSAIDs Corticosteroid injections * Surgical release

Answer 2

Dermatomes - same procedure as cervical -L4 - patella, and to great toe -L5 - plantar and dorsal digits, lateral ankle -S1 - 5th digit Myotome - same procedure as cervical -L1/L2 - hip flexion -L3 - knee extension -L4 - Ankle DF -L5 - Great toe extension -S1 - PF, hip extension and eversion at ankle -S2 - PF, hip extension and knee flexion Reflexes - same procedure as cervical (and same rating) -L3/L4 - patella -L4/ L5 - tibialis posterior -L5/S1 - medial hamstring -S1/S2 - lateral hamstring -S1/S2 - achilles UMN - same as cervical spine as this doesn’t change

Answer 3

Grade I - stretching ligament with minimal disruption of fibers Grade II - tearing 50% of ligament fibers; small hematoma; hemarthrosis may be present Grade III - complete tear and separation of ends, hematoma and hemarthrosis -Hemarthrosis - more likely in those with hemophilia and on anticoagulants (get greater ROM limitation, increased warmth/bruising

Answer 4

-increase pain in full opening, trigger points refer pain -NO JOINT NOISE -Traumatic or insidious (dentist, FHP, grinding) -May result in deceased ROM

Answer 5

Education Mobility - early AROM, tendon gliding, nerve mobilization Encourage ADLs Compression loading Distraction Desensitization Edema control - Elevate, compression, retrograde massage Modalities - TENS, US, ice Mirror therapy Aerobic activity

Answer 6

AMBRI - born loose -Atraumatic, multidirectional, bilateral, rehab, inferior capsule shift if surgery required TUBS - torn loose -Traumatic, unidirectional, bankart, surgery

Answer 7

Thickening of fibrous tissue leading to entrpaemtn of digit nerve of foot (usually 3rd and 4th between MT) Etiology Narrow shoes High heels (MTP in extension, balls drop) Metatarsal injury - # = ossification encraoching Dropped transverse arch - all bones closer together *more common in RA * Special tests Morton’s test - press together MT heads S +S Pain between MT heads May have associated paraesthesia Worse with walking (especially push off), running and with high heeled or narrow shoes (compression of MT heads) Interventions Activity modification Changes in footwear Orthotics Cryotherapy Plantar metatarsal padding Strengthening - intrinsic foot muscles Medical - corticosteroid injections Surgical excision of nerve

Answer 8

Compression or irritation of the spinal nerves 1. Disc herniation - -Typically goes postero-lateral since weakest part of annulus fibrosus -For people in flexion with weight usually as less pressure posterior and it ruputres -*if compresses straight posterior - more likely on to SC = UMNL 2. Stenosis -Osteophyte formation -Spondylosis - degeneration plus decrease hydration = thin = compress IVF -Ligament thickening - ligamentum flavum - get central compression because of the area of that ligament 3. Swelling / inflammation (from local trauma)

Answer 9

1 - primary - idiopathic 2- secondary - other conditions *high correlation with psychosocial issues

Answer 10

Inner core stability Education - avoid aggravating movements Spinal fusion surgery *don’t manipulate

Answer 11

Median nerve 2 lumbricals - 1 and 2 Opponens pollicis Abductor pollicis brevis Flexor pollicis brevis Ulnar nerve Lumbrical 3 and 4 Hypothenar muscles -Abductor digiti minimi -Opponens digiti minimi -Flexor digiti minimi -Palmaris brevis Interossei muscles -PAD DAB -Palmar - adductor -Dorsal - abductor Adductor pollicis brevis Radial nerve Brachioradialis Extensors Supinator Triceps and anconeus

Answer 12

Education -Safe ambulation -Minimize aggravating activities Decrease pain -Grade I or II mobilizations -Assistive device for ambulation -LLD - shoe lifts -Modify chairs and commodes -Modalities Increase ROM -ROM exercises -Grade III or IV mobilizations -Stretching if chronic Strengthening -OKC first then progress to CKC -Hip strengthening as tolerated

Answer 13

Posture education Extension approach Stabilization exercises Scapular stabilization exercises Weight bearing activity and exercises Light mobilizations as needed with precautions JOINT MANIPULATIONS AND AGGRESSIVE MOBILIZATION, TRUNK FLEXION EXERCISES ARE CONTRAINDICATED*

Answer 14

5 vertebrae 5 spinal nerves coming out below 5 discs -Thicker anterior - why lumbar lordosis -Posterolateral weaker - that is why it herniations here -Also not posterior cause of the posterior longitudinal ligament Motion segment - disc + above and below vertebrae

Answer 15

Cervical radiculopathy C5, C6 Radial nerve entrapment Musculocutaneous nerve tunnel syndrome Supraspinatus referral Radial head fracture Radiohumeral synovitis

Answer 16

Max Prevent complications Ankle pumps, deep breathing and secretion clearance Reduce risk of complications education (precautions, safe bed mobility, transfers, S + S of infection) Prevent muscle atrophy Isometric quads, hip extensors and hip abductors (if not cut) Regain active mobility and control AAROM / AROM in ranges CKC weight shift, balance, heel raises, mini squats Achieve independent functional mobility Bed mobility STS Transfer training Ambulation with assistive device Stairs training Moderate Continue Minimal Continue - resume return to spots - avoid high intensity/ impact sports with slippery surfaces

Answer 17

Phalanges - Distal, Proximal and Middle MC Carpals - scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, hamate Radius Ulna Joints DIP PIP MCP CMC Midcarpal Intercarpal Radiocarpaul Distal radioulnar *there is no ulnocarpal joint because the TFCC (triangular fibrocartilage complex) articulates with ulna and triquetrum

Answer 18

Medial (C-shaped - thicker anterior / posterior) and lateral (O-shaped) meniscus -Thicker on peripheries -Vascular on lateral ⅓ - easier to heal, avascular on inner 2/3s - harder to heal, get surgery -Attach to tibia by coronary ligament and to each other by transverse ligament During flexion, the meniscus both move posterior but the lateral meniscus moves more (10mm) the medial moves less (2mm) making the lateral one less prone to injury -Lateral meniscus is less prone to injury because ot this and because it is attached to less structures Lateral meniscus - attaches to PCL and tendon of popliteus through capsular connections Medial meniscus - attached to ACL, MCL (terrible triad), PCL, semimembranosus -Because of semimem - if eccentric contraction can disrupt the meniscus Roles -Increase congruency -Shock absorber -Lubrication and nutrition of joint -Improve weight distribution -Reduce friction -Aid ligaments and capsule preventing hyperextension

Answer 19

Advantages - high mobility, used to unload limb, stairs, wide selection of gait patterns NWB, TTWB, PWB, WBAT Disadvantages - low stability, good balance and upper body/trunk strength, high energy expenditure, risks of brachial plexus or radial nerve compression injury (crutch palsy), temporary use only

Answer 20

Advantage - high stability , wide BoS, functional mobility, unloads limb NMB, TTWB, PWB, WBAT, FWB Disadvantage - high energy expenditure, no stairs, difficult to transport

Answer 21

Ottawa ankle rules - referred for radiographic imaging Bony tenderness along 6cm of posterior edge of lateral malleolus Bony tenderness along 6 cm posterior edge of medial malleolus Bony tenderness at base of 5th MT (from peroneal brevis maybe) Bony tenderness of navicular Inability to weight bear immediately after injury and for 4 steps during initial evaluation

Answer 22

See chart in book

Answer 23

Inspect device regularly Replace rubber tips when signs of excessive wear Avoid slippery surfaces Beware of ice and snow - may need ice picks on tip in winter

Answer 24

Severe headaches especially with movement Fear to movement head or neck especially in to flexion Dizziness Pupil dysfunction Nystagmus Lip or facial paraesthesia Lump in thorat Nausea/committing Severe muscle spasm Soft end feel *may have SCI S + S as well

Answer 25

NORMAL: female 10-15, male 5-10 (a little valgus) Excessive cubitus valgus: 30 Cubitus varus: -5 Gun stock deformity: -15

Answer 26

Sublux - partially out, dislocation - completely out (lateral more common) Etiology Decelerated lateral cut- eccentric quads with planted foot = hip internally rotated, foot externally rotated - quads pull patella laterally and over the lateral femoral condyle Increased likelihood of dislocation with decelerated lateral cut and external valgus force Increased likelihood -Shallow groove -Patella alta -Increased q - angle -Foot pronation Post TKR Previous subluxation S + S Audible popping noise Severe pain and immediate swelling Apprehension Knee extension relocates typically and reduces pain Knee not feeling secure and slips out of place Hypermobile patella Tenderness on medial border Special tests Fairbank’s apprehension test - lateral glide, patient shows apprehension Interventions Early: Immobilization (zimmer splints) - 3-6 weeks Decrease inflammation Crutches until full extension can be obtained Normalize gait Isometrics and ROM exercises - OKC not CKC Later: Progress to CKC - emphasis on VMO and gluteus medius Patellar bracing Surgical - medial retinaculum tightening, lateral retinaculum release, Fulkerson’s procedure

Answer 27

Pain, weakness, limited PROM Decreased strength / endurance Impaired motor control, balance Unstable structures Fear of falling Open wounds on WB surface (increase chance of infection)

Answer 28

H and I (*start with pain free direction first) -If two positive - hypomobility -If one positive - instability -as the first movement providing stability for the second movement if this is the one that is unstable -direction of instability is based on the first movement Prone segmental instability test -Upper body prone, legs on floor -PA by therapist, if pain - lift legs - not present, then need core strengthing/stability exercises

Answer 29

Special tests Valgus stress test - if full extension = capsule, so want 20-30 degrees of flexion Interventions Strengthening Decrease pain/ swelling Bracing - not in full extension due to MCL taut Proprioception Restore ROM Surgical - not usually done, because of attachment to capsule - has good blood supply and therefore can heal conservatively

Answer 30

Barlow’s maneouver Hip adduction with a posterior force - +ve if sublux or dislocation Ortolani maneouver Hip flexed to 90 then abduction with anterior force - +ve if click when hip reduces

Answer 31

Hypermobile -increase ROM, especially excessive anterior translation -May be joint noise at end range -lateral deviation contralaterally -generalized laxity -pain with opening Hypomobile -decreased ROM -potential contracture -history of trauma -secondary myofascial pain -lateral deviation ipsilaterally -localized pain at end range

Answer 32

Impingement of infrapatellar fat pad (Hoffa’s pad) from patella - occurs at 20 degrees knee flexion Etiology Patella alta -High sitting patella - apex touching fat pad at joint line Genu recurvatum -Hyperextended, go into inferior patellar tilt, apex tilts backwards into joint to cause irritation Inferior patellar tilt -See above Anterior pelvic tilt -More likely to go into hyperextension - see above Knee hyperextension injury (sudden onset) -Irritation S + S Anterior inferior knee pain Pain with extension activities (difficult from PFPS - since hurts with flexion), prolonged standing, stairs Tenderness on Hoffa’s fat pad - joint line near outside of patella Puffy appearance below patella “Camel sign” - two humps (patella and inflamed bursa) Special tests Hoffa’s Test - palpate then go from flexion to extension - fat pad goes anterior - compressed into fingers (20 degrees knee flexion) Interventions Decrease inflammation Decrease aggravating activities Taping (tape base to tilt inferior apex of the patella off fat pad) Address muscle imbalances Surgical - partial or full removal of fat pad

Answer 33

Joint -Mandibular condyle -Glenoid fossa -Articular disc (helps with congruency and lubrication) Ligaments -Lateral ligament - strongest, thickening of capsule -Sphenomandibular and stylomandibular ligament Movement -Opening - lateral ptyergoid -Closing- medial pterygoid, temporalis and masseter -Protrusion - medial and lateral pterygoid -Retrusion - temporalis -Lateral deviation - contralateral - medial and lateral pterygoid and masseter, ipsilateral - temporalis Innervation -Trigeminal nerve (CN5), V3 branch - mandibular branch Blood supply -Secondary arteries of the external carotid arteries Differential diagnosis -trigeminal neuralgia - sensory input from the V3 trigeminal nerve

Answer 34

Erb- Duchenne’s Palsy -C5/C6 injury -Shoulder and elbow effected, not hand -Elbow extension, shoulder internal rotation, forearm pronation -Sensation - limited on deltoid area and along radial side -From traumatic birth traction of head when shoulder gets stuck Klumke’s Palsy -C8/T1 -Present with Horner’s syndrome - drooping eyelids (ptosis) and small pupils (miosis) -Effects the forearm, wrist and hand - elbow flexion, forearm supination, wrist and MCP extension, finger flexion -Sensation on ulnar side of forearm and hand -Hyperabduction injury on birth or grabbing something and hanging off of it

Answer 35

Degenerative injury to patellar tendon causing pain in infrapatellar region of knee - NOT inflammatory Etiology Jumping sports and activities Repetitive overloading - typically eccentric quads Increased risk in those with patella alta S + S Pain with quadriceps contraction Worse with jumping, squatting, resisted knee extension Decrease pain with compression over patellar tendon TOP Localized swelling, quadricep weakness Interventions Manage pain and swelling Patellar tendon strap - force going through wider surface Avoid overloading quadriceps Progressive loading → return to activity Eccentric quadricep contraction - realign collagen

Answer 36

Sagittal (runs anterior to posterior) - separates R and L - like flexion/extension (abduction/adduction for thumb) Coronal (separates anterior / posterior) - separates front and back - like abduction / adduction (flexion/extension for thumb) Transverse - separates in upper and lower - rotational movements, supination/pronation

Answer 37

Sprain of ulnar collateral ligament - occurs with valgus force of MCL joint (seen in gamekeepers, skiers, volleyball players) S +S Pain and tenderness at base of thumb on ulnar side of MCP Pain with movement - worse with abduction and extension Decreased pinch and grip Swelling and dislocation at base of thumb Special test Thumb UCL laxity or instability test- valgus stress test Interventions Acitvity modification Splint MCL in slight flexion Gentle ROM as tolerated Strengthening Medical - surgical repair - complete or displaced avulsion fracture

Answer 38

Tibiofemoral joint -Meniscus -Cruciate ligaments - support anterior/posterior direction -Collateral ligaments - supports medial/ lateral direction Patellofemoral joint Superior tibiofibular joint

Answer 39

Advantages - high mobility, WBAT or FWB, sit to rest (main reason - CRT or endurance issues) Disadvantages - low stability, no stairs, no turning if issues

Answer 40

The nucleus goes up or down, typically from a compression force, which goes through the cartilaginous end plate and vertebral body Typically in higher lumbar levels

Answer 41

Primary - congenital or degenerative Secondary - abnormal force coupling action - muscle imbalance and abnormal movement patterns (scapula or GH) -Secondary after instability (loose anterior capsule) -From tight pect minor (anterior tip), weak LFT (less post tilt), winging of scapula (internal rotation of scapula), kyphotic posture (no posterior tilt since blocked by ribs) Calcific tendinitis - typically supraspinatus

Answer 42

S + S Insidious onset (can be traumatic too) Anterior knee pain Pain with activities - prolonged knee flexion (theater/movie sign), loaded knee flexion/extension “Buckle” or “give way” - inhibited quads Crepitus PF joint pain, swelling and tenderness - common in retropatellar area Special tests Clarke’s sign (patellar grind test) - proximal patella with webspace - contract quads McConnels tests - resisted isometrics in 30,60,90 - if pain, add medial glide - if goes away = PFPS Step - up test Eccentric step test (step-down test) See if goes in to dynamic valgus Special tests for swelling Brush tests Patellar tap test Interventions Reduce activity involving high or prolonged loads Bracing or taping to prevent/limit lateral tracking Lateral retinaculum stretch VMO training Glute medius strengthening Arch support and foot intrinsic training Treat underlying cause(S) Surgical - lateral retinacular release (poor outcomes), Fulkerson’s procedure (distal realignment - changing tibial tubercle to decrease q-angle-change pull of quads)

Answer 43

A; Draws scapula anterolaterally, Suspends scapula on thoracic wall, Rotates scapula (draws inferiorly angle laterally) N: Long thoracic nerve (C5- C7) (SALT)

Answer 44

Step deformity -Distal end of clavicle raises -Grade III separation -Torn deltoid and trapezius also possible Pain with -Horizontal adduction - compressing together -Elevation - causes posterior rotation of clavicle -HBB - causes anterior rotation of clavicle Tenderness and swelling Horizontal adduction or cross body test Stress view xray - provide traction (inferior pressure) to see if there is separation

Answer 45

Axillary nerve injury - deltoid or teres minor Axillary artery Brachial plexus - posterior cord especially Bankart lesion - anterior dislocation = labrum damage Hill-Sach’s lesion - damage to posterolateral humerus (indentation) as humeral head is compressed against anterior-inferior glenoid rim

Answer 46

Advantages - high mobility, good stability, unload limb, stairs WBAT or FWB Disadvantages - minimal balance deficits, slower gait pattern

Answer 47

Lower cross syndrome Tight hip flexors, hamstrings, ES Hamstrings tight from trying to correct pelvis and compensating for glutes Weak glutes and core Anteriorly rotates the pelvis = more lumbar lordosis Intervention Strengthening weak, stretch tight

Answer 48

Posture education Stretch concavity Strengthen convexity Stabilization exercises Scapular stabilization exercises Mobilization as needed Bracing as needed - boston, milwaukee Surgery if severe

Answer 49

Replacement of the femoral head and acetabulum Indications Severe hip pain, loss of function, decrease QoL associated with OA, RA, AS, avascular necrosis with failure of conservative treatment Nonunion fracture, instability or deformity of hip Bone tumours Failure of previous joint reconstruction surgery Preoperatively Examine patient’s status Education - operative procedures, post-operative precautions and rationale Functional training for early post-op days and exercises Criteria for discharge

Answer 50

IC is similar leg pain symptoms but more to do with the use of muscles. Increase pain leads to increase activity and it is relieved by rest *see chart to differentiate between NC and IC * Use bicycle test as main measure to differentiate the two

Answer 51

Overuse injury from repetitive loading leading to microdamage Etiology Sudden and drastic change in training regime Cavus foot - increased arch, not as much shock absorption Over pronation Overall limb and foot alignment - overload it LLD - overloading one side S + S Gradual onset Focal pain - present with activity and rest, remains constant or slightly increases with activity, worse at night, worse with impact activities TOP Special tests Stress fracture test (turning fork vibration) - irritate fracture Interventions Initial period of rest Avoidance of aggravating activities Crutches if needed Gradual progressive loading - Wolfe’s law -bone adapts to demand Walk-run program *get bone scan not an XRAY*

Answer 52

Increase pressure within fascial compartments of LL - decreased BF, decreased tissue perfusion, increase ischemia, pain and permanent damance Chronic exertional compartment syndrome - increased pressure within fascial compartment due to increased activity (increased muscle pump, increased BF = increased pressure) Compartments Anterior -Muscles - EHL, EDL, tib ant, peroneous tertius -Nerves - deep peroneal nerve (foot drop = no DF) -Cutaneous - webbing between 1st and 2nd digit Lateral -Muscles - peroneous brevis and longus -Nerve - superficial peroneal nerve (stuck in inversion since no eversion) -Cutaneous - dorsum of foot, except webbing of 1st and 2nd digit Posterior superficial -Muscles - gastroc, soleus, plantaris -Nerve - Sural - purely sensory -Cutaneous -posterior lateral aspect of leg and lateral foot and 5th digit Posterior deep -Muscles - tib post, FHL, FDL, popliteus -Nerve - tibial (does motor of above too) -Cutaneous - plantar aspect of the foot Etiology - unknown S + S Gradual onset Diffuse pain - severe cramping, increased with activity, decreased or disappears with rest (significant in minutes) Severe cramping Tightness sensation May present with motor weakness, altered or absent sensation, vascular S + S Special tests Compartment pressure (gauge) test - before, after exercise Pulse palpation MMT - strength Sensory testing - peripheral nerve testing - see if alterations Interventions PT - rest, ST mobilization Surgical - interosseous membrane release (fasciotomy)

Answer 53

Special tests Anterior drawer -More in flexion -Check for muscle guarding from hamstrings that won’t let you pull it forward -Check for PCL tear as might feel like excessive motion but is because just sitting more posterior -Posterior sag sign or Godfrey’s (that is at 90-90) Lachman’s -More in flexion Pivot - shift -In flexion when supine, anterior force on the calf then in to extension - about 20-30 degrees of flexion the ITB will kick in and pull the tibia and you can see the reduction Interventions Strengthening (CKC because OKC) Decrease pain/ swelling Bracing Crutches if necessary Proprioception Restore ROM Surgical - ACL graft Autograft - you are donor -Gracilis / semitendinosus ---Don’t use semimembranosus because of the attachment to the medial meniscus ---Issues with strengthening of hamstrings - is a dynamic stabilizes so prevents the tibia from going anteriorly - prone to more tears -Patellar tendon graft ----Harder to strengthening quads - more at risks for PFPS Allograft - other donor

Answer 54

Estimate height of crutches -Height markers -ATNR method (sitting) -From folding arm to the extended arm -Axillary fold to a spot 6-8 inch lateral to heel of shoe Estimate height of handles -Measure axillary fold to greater trochanter -Measure bottom of shoe to greater trochanter Confirm fit in functional standing -Tip 2 inch lateral, 6 inch anterior to 5th digit -2 fingers between axilla and axillary pad -Hand grips at wrist crease, ulnar styloid, greater trochanter (elbows 20-30 degrees flexion)

Answer 55

-Red flags -Screening questions -Screening tests -Side effects of meds -comorbidities -visceral pain mechanism -patient doesn't get better, or initially gets better than worse, other S + S develop

Answer 56

Abnormal movement -Static - structural deformity, winging at rest -Dynamic - winging with movement Long thoracic nerve Serratus anterior weakness Other causes

Answer 57

Vertebral artery (cervical quadrant) test Bring patient in to extension and SLF holding for 10-30 sec The into ipsilateral rotation holding for 10-30 sec Dizziness or nystagmus = +ve on contralateral side artery is being compressed *keep eyes open*

Answer 58

Consider - needs (stairs, environment), abilities (physical - strength, balance, energy expenditure or psychological - cognitive), preference Help - increase support, stability, confidence (decrease fear of falling)

Answer 59

Inflammation of the periosteum- surrounds bone - chronic pulling (traction) by the muscles connected with repeated activity Anterior shin splints -Overuse of tib ant, EHL, EHL -Pain over proximal ⅔ of anterolateral aspect of tibia -Pain with resisted DF and passive PF Posterior shin splints -Overuse of tib post -Pain over the distal ⅓ of posteromedial aspect of tibia -Pain with acitve supination and with passive DF and eversion Etiology Sudden and drastic change in training regime Over -pronation - tib post on stretch Muscle dysfunction Fatigue Decreased flexibility S + S Gradual onset Diffuse pain - increases with activity, decreases or disappears with warming up and rest Diffuse TOP Interventions Avoid aggravating activities Manage inflammation and pain Taping - approximate muscles towards bone Orthotics Stretching and ST mobilization Strengthening (graduated with an eccentric focus) Walk-run program Address alignment and biomechanical issues

Answer 60

Increased pain Cast tightness Cast looseness Changes in skin colour / sensation - CRPS, nerve/blood vessel compression Increase swelling DO Maintain ROM above and below Check skin integrity above and below Check capillary refill Education - reduce swelling warning signs / precautions Remove tight jewelry DONT Stick something inside case Get cast wet

Answer 61

Test bilaterally, hold for 5-8 secs as fatigable, testing in comfortable, neutral position C1/C2 - neck flexion C3 - SLF C4 -shoulder elevation C5 - shoulder abduction C6 - elbow flexion, wrist extension C7 - elbow extension, wrist flexion C8 - thumb extension, ulnar deviation T1 - finger abduction/adduction

Answer 62

Sciatic Entrapped from piriformis Obturator Uterine pressure and damage during labour Femoral Fracture of upper femur or pelvis, reduction of congenital dislocation or pressure during a forceps labor and delivery

Answer 63

Excess fluid behind knee (between semimem and medial gastroc) which can rupture and produce pain and swelling in calf Etiology Intra-articular knee pathology, increases synovial fluid in knee which spills in to bursa May occur in children idiopathically S + S Swelling in popliteal fossa Visible lump Joint stiffness Decreased ROM Warmth Pain - worse with movement, knee extension and standing Interventions Manage pain and inflammation Avoid aggravating activities Compression sleeve Self limiting - will resolve on own Surgical - aspiration, corticosteroid injection, excision of cyst, arthroscopy and debridement of articular pathology

Answer 64

7 vertebrae - C1/C2 - upper, C3-C7 is lower 8 nerves - go out above, with extra C8 between C7 and T1 then they go out below Discs - not between C1/C2, C2/C3 is starts and continues -Thick anterior for flexion, thin to maintain mobility

Answer 65

Advantages - promotes upright posture , less energy expenditure than standard Disadvantages - no stairs

Answer 66

Diffuse pain around knee cap from abnormal patellar tracking causing increased contact pressure on posterior surface of patella against the femur Diagnosis made on history and physical exam Chondromalacia patella - progression - degeneration of patella articular cartilage Epidemiology - F>M

Answer 67

Compression medial nerve as through carpal tunnel (made by flexor retinaculum and carpal bones) Contents FDP, FDS, FPL Median nerve Etiology Typically insidious onset, F > M Repetitive hand movements Vibrations Associated conditions -RA and other inflammatory conditions -Colles’ fracture -Lunate subluxation - encroach on space -Hypothyroidism - fluid retention -Pregnancy - 2nd trimester - fluid -DM - fluid -Obesity - fluid and tissue larger

Answer 68

Advantages - max support/stability, initiate gait training, assistive gait device measurement Disadvantages - no portable, expensive

Answer 69

A: Flexion and supination of the forearm at the elbow joint, weak flexor of the arm at the glenohumeral joint N: Musculocutaneous nerve (C5- C6)

Answer 70

Bankart Anterior-inferior of labrum From anterior dislocation, common from overhead sports S + S Clicking and/or popping Diffuse shoulder pain Worse with HBB Weakness and instability SLAP Superior labrum anterior, posterior Long head of biceps attaches to superior labrum - can tear if forceful, shoulder can become unstable From -Repetitive throwing and overhead activity -Deceleration when throwing -Direct trauma -FOOSH -Traction injury (to biceps) in inferior direction S + S Clicking and/or popping GIRD - internal rotation deficit Pain with overhead activity (elevation) and lying on affected side Loss of strength and endurance in RC and scapular stabilization “Dead arm”

Answer 71

CES -Below L1 - variable nerve root damage -Flaccid paralysis -LMN injury - areflexic B + B and sacral anesthesia -Leaking but don’t notice as don’t know when it is full -Emergency Malignancy -Spinal pain common- -Age >50 -Previous history of cancer -Unexplained weight loss -Constant unrelenting pain -Pain unrelieved by rest -Pain worsens at night -Failure to improve with conservative therapy (1 month)

Answer 72

-require medical intervention -interventions do not fall in scope of practice -findings remain inconsistent with what is expected -no apparent movement dysfunction, causative factors or syndromes can be identified -client fails to improve with intervention

Answer 73

Fan shape - anterior, posterior and transverse portions Resists valgus

Answer 74

Umbrella term = pain along medial border of the tibia synonymous with medial tibial stress syndrome (MTSS) Classification -Periostitis -Stress fracture -Compartment syndrome *please ses chart for comparison* Stress - remains same pain wise Compartment - as use it, more pain - stops rapidly Periostitis - initially worse, then better, then worse once stopped

Answer 75

-Orofacial pain -Restricted jaw movement -Joint noise -Myofascial -Discal -Capsular -Ligamentous -Joint

Answer 76

Traumatic - direct, indirect -Most common abduction, ER -Stability provide - subscapularis, GH ligaments, long head biceps -Anterior dislocation injuries - subscapularis, long head of biceps, GH ligaments, anterior capsule, anterior glenoid labrum Atraumatic - general laxity lead to instability *surgery - only if recurrent - tighten subscap - no stretching or resisted activities

Answer 77

-Cluster of symptoms that typically present with a systemic disease -Diaphoresis -Dizziness/syncope -Fatigue -Fever -Nausea -Night sweats -Pallor -Unexplained weight loss -Vomiting / Diarrhea

Answer 78

Inner unit muscles - attach segmental - postural control, not that strong but have good endurance DNF, deep neck extensors and SOM Global muscles - strong but don’t have good endurance *if IUM are weak or inhibited by pain then the global muscles take over to work but they are not meant for that task* This leads to segmental instability - aberrant movements between segments and causing pain Strength DNF - coordination and timing, analgesic effect

Answer 79

Ulnohumeral joint Ulnar / Medial collateral ligament Trochlea and coronoid process Radiohumeral joint Radial / lateral collateral ligament Capitulum and radius Proximal radioulnar joint Head of radius with notch on ulna Annular ligaments holds together

Answer 80

From external auditory meatus Acromion Greater trochanter Posterior to patella Anterior to lateral malleolus

Answer 81

Sprain of 1st MTP due to hyperextension injury combined with compression loading Etiology Flexible footwear Artificial turf Decreased ankle DF - compensate with hyperextension of toe Decreased MTP ROM - taut ligaments - more strain S + S Pain, swelling, plantar tenderness at 1st MTP Decrease ROM Worse with extension Interventions Activity modification Cryotherapy Taping Stiff soled shoes Medical - NSAIDs

Answer 82

Acetabulum -Ischium -Ilium -Pubis Femur Labrum - suction, and capsule also help support Hard to dislocate unless deformity, extreme force or poor stability from passive and active structures Ligaments (*strong) -Ischiofemoral -Iliofemoral -Pubofemoral -Ligamentum teres

Answer 83

-Know what questions to ask -Know what medical conditions can cause pain superficially and in what areas -Become familiar with risk factors for various conditions and diseases

Answer 84

Inflammation of bursa (fluid filled sac between bones, ligaments or tendons) Etiology Trauma Pressure - chronic Infection *more at risk if RA/gout* S + S Swelling, TOP Redness Interventions Activity modification, ice, compression, decrease swelling Medical - NSAIDs, corticosteroid injection, aspiration (drain excess fluid), antibiotics (if infected), bursectomy (if repeated bursitis or antibiotics don’t work)

Answer 85

1. Scalenus anterior syndrome Compress = interscalene triangle - between scalene anterior and medius (SUPRACLAVICULAR) 2. Costoclavicular syndrome Compress = costoclavicular space - between clavicle and 1st rib (subclavicular) 3. Hyperabduction syndrome Compress - axillary interval - under coracoid process and behind pect minor (infraclavicular) 4. Cervical rib syndrome

Answer 86

Shoulder dislocation - separate of humerus from scapula, common (and common anterior - for MSK) Shoulder subluxation - incomplete dislocation

Answer 87

Feeling of slippage with pain or insecurity with certain activities Pain or apprehension when approaching extreme ROM Decrease ROM - acute Increase ROM - chronic Normal on clinical examination - more apparent after repeated activities with fatigue Atrophy due to disuse (chronic) Sulcus sign - multidirectional instability, loss of muscle control, groove inferior/lateral of acromion

Answer 88

Pavlik’s harness - in flexion and abduction (*avoid extension and adduction) Hip spica - if severe instability or above doesn’t work - more fixed Closed reduction - if didn’t catch it soon enough Open reduction - if tissue is stopping it

Answer 89

Compression of posterior tibial nerve through tarsal tunnel (post to medial malleolus) - created by bone and flexor retinaculum Contains -Tib post -FDL -Posterior tibial artery and vein -Tibial nerve -FHL -TOM DICK and A VERY NERVOUS HARRY S + S Pain and paresthesia -burning , electric shock nerve pain -Plantar surface of foot -Increased with weight bearing, activity -Decreased with rest May present with swelling in the feet Special tests Tinel’s sign at ankle

Answer 90

Costochondral Costovertebral Facet joints Transitional vertebrae Thoracic rib motion Pump handle action- ribs 1-6 - up and forward Bucket handle action - ribs 7- 10 - lateral and forward Caliper action - ribs 8-12 - lateral

Answer 91

Named based on the direction of the convexity, and level of apex -If two - minor and major names -Cobb angle - >10 is significant, <10 is not Non-structural -Based on muscle guarding or spasm, nerve irritation, inflammation, postural, leg length discrepancy -LLD - if R higher- pelvis, sacrum, Lx all shift to R then thoracic shifts to L in order to compensation. Adducted on R, abducted on L - more stress on hip joints -Easy to correct once you know the difference -Adam’s test - disappears with forward flexion Structural -Due to the bony structures - congenital or acquired -Severe (>60 degrees) - cardiopulmonary system compromised -Rotation of vertebrae is towards the convexity, creates a rib hump -This is palpable along back, might be confused with SP -If severe = razor back spine -Can’t fix bones but can manage that non-structral doesn’t exacerbate structural

Answer 92

Sublux radial head - commonly young children Longitudinal traction force with wrist in pronation S + S Child doesn’t move arm Arm is held at side in slight flexion Interventions Reduction of subluxed radial head Hyper pronation Supination / flexion maneuver Compressive manipulation on radius with arm in supination

Answer 93

Traction apophysitis of tibial tuberosity Apophysis - bony tubercle arising as a result of secondary ossification Apophysitis - inflammation /irritation of apophysis *also sinding - larsen johansson - same but the inferior pole of patella Overuse injury in growing adolescents - M>F Etiology Repeated tension on growth plate of tibia Growth spurt - bones grow fast then muscles, so muscles traction Increase incidence in sports with running and jumping (quad contraction) S + S Pain with quad contraction over tibial tuberosity Worse with quad activation Decrease with compression over patellar tendon Pai with pressure of tibial tubercle (kneeling) Increased prominence of tibial tubercle (remains in adulthood) Interventions Manage pain and swelling Decrease parameters of aggravating activity Patellar tendon strap

Answer 94

1 - <25 2 - 25-50 3- 50-75 4 - >75 5 - 100 *4 and 5 - need fixation, others core stability exercises

Answer 95

Tear to TFCC on ulnar side of wrist TFCC - transmits and distributes load, stabilizes area (therefore causes radius to bear more load) Etiology Compressive loads to wrist - while in ulnar deviation - degenerative or traumatic Distal radial - ulnar fracture S + S Ulnar side wrist pain Tenderness and swelling over dorsal ulnar aspect of wrist CLICKING with wrist movements - HALLMARK Pain with (or resisted) wrist extension and ulnar deviation Special tests TFCC load test - compressive load with ulnar deviation with flexion/extension Press test - pushing up in chair Interventions Activity modification Bracing (widget - two straps) Cryotherapy Progressive strengthening and mobility exercises when able to tolerated *after extension period of immobilization Medical management -NSAIDs, Corticosteroid injection, Surgery

Answer 96

S + S Pain in groin or hip AROM or PROM of hip Pain with LE weight bearing LLD LE assumed ER and abduction position Intervention Surgery ORIF - younger people Hemiarthroplasty - just femur and if acetabulum in good shape THA

Answer 97

Inferior tib fib -AITFL, PITFL, interosseous, inferior transverse Talocrural -Lateral - ATFL, PTFL, CFL -Medial - deltoid Subtalar -Medial / lateral talocalcaneal ligament

Answer 98

Adson’s Allen’s Costoclavicular syndrome Halstead Wright test *above are all vascular and have to do with different positioning and decreasing the pulse* Roos - opening and closing hands - see why they stop Shoulder girdle passive elevation - do to patient and see if they get decrease in symptoms

Answer 99

Max protection - Patient education -Expectations -No heavy lifting >10 pounds for up to 3 months -Signs of inflammation and infection -No getting incision wet (1 to 2 weeks) -Surgeons guidelines --Based on preference and surgery dependent - no rotation and avoid hyperflexion/extension Bed mobility Exercise - walking, gentle exercise C/I - extension exercises for laminectomy Moderate and minimum Scar tissue mobilization Progressive stretching and joint mobilization - grade I or II for pain relief Exercise - walking, strengthening - start with inner unit then progress C/I - joint manipulation at level of spinal fusion, extension exercises

Answer 100

Observable findings detected during objective exam (e.g., swelling, skin colour changes, clubbing)

Answer 101

Cracks from articular cartilage and subchondral bone due to avascular necrosis Patella or femoral trochlea Pain, swelling, crepitus May cause catching and locking if caught Worse with squatting, walking, descending stairs

Answer 102

Posterior / posterolateral Keep - Glute med and TFL Cut - Glute max and tendon, posterior capsule, small ER and piriformis, interval between glute max and medius Good for gait, bad for dislocation and subluxation in post-op Lateral Keep - NOTHING Cut - glute med, min, TFL, vastus lateralis, capsulotomy Bad recovery in gait and weakness of hip abductors, possible pelvic obliquity Anterior Keep - ALL Cut - (move sartorius and rectus femoris out of way), anterior capsulotomy WBAT immediately, good recovery, good gait

Answer 103

Anterior shear or sagittal stress test Test: anterior ligaments and capsular tissues How: stabilize at TP below, anterior force on adjacent vertebrae above through SP or posterior arch (lamina) Positive: excessive motion or S + S Lateral flexion alar ligament stress test Test: contralateral alar ligaments How: stabilize C2 at SP and lamina, side flexes C1 and head Positive: excessive side flexion Lateral (transverse) shear test Test: lateral ligaments and capsular tissues How: radial aspect of one hand on one vertebrae, other side radial aspect of one hand on another vertebrae and push together Positive: excessive motion or symptoms of instability, SC or vascular pathology Sharp purser test Test: Determine subluxation between C1 (atlas) and C2 (axis) - potentially torn transverse ligament as stops C1 moving forward on C2 in flexion How: Hand on forehead and thumb on C2, patient to flex forward and to push forehead back Positive: head slide backwards during the movement, potential clunk Cervical flexion-rotation test Test: Determines C1/C2 dysfunction or CGH How: full Cx flexion then rotate to right and left Positive: increased or decreased ROM 45 UCS rotation = C1/C2 dysfunction or headaches = CGH

Answer 104

Secondary to OP, F>M (post-menopause), 60-70 yo Most common in thoracolumbar region, typically anterior vertebral body (wedge shaping) Causes - falls, trauma, trunk flexion Increased kyphosis (multiple fractures = increase)

Answer 105

Chronic pain disorder caused by SNS malfunction and is characterized by pain out of proportion to original injury Types I - injury to tissue - also known as regional sympathetic dystrophy (RSD) II - injury to nerve - also known as causalgia Unknown etiology - association with injury to affected area, F>M S + S Severe pain (burning) Sensory abnormalities -Allodynia - pain response to non-painful stimuli -Hyperalgesia - exaggerated response to stimuli Abnormal blood flow (vasomotor changes) and sweating (sudomotor changes) Abnormal motor function - weakness and poor coordination and stiffness Trophic changes -Color changes -Temperature changes -Edema -Shiny tight skin -Abnormal hair and nail growth Late stages may develop OP

Answer 106

-indicate serious pathology needing immediate attention for further screening questions and/or tests for referral -if after screen.. PT decides physio is appropriate... continue objective, if not appropriate..referral to appropriate health care practionner *can continuously screen*

Answer 107

Stage 1 - acute / reversible - days to weeks Characteristics - pain, hyperhidrosis, warmth, erythema, rapid nail growth and edema VASODILATION PHASE Stage 2 - dystrophic or vasoconstriction (ischemic) stage - 3 months lasting 3-6 months Characteristics - burning pain, sympathetic hyperactivity, hyperesthesia exacerbated by cold weather, mottling and coldness, brittle nails and OP VASOCONSTRICTION PHASE - *careful with OP* Stage 3 - Atrophic stage - 6 months to a year and lasts for months or years Characteristics - pain decreases or becomes worse, severe OP, muscle wasting, contractures CHRONIC PHASE - *careful of OP*

Answer 108

Fracture of scaphoid - common, from FOOSH or MVA. Common in young males Complications Avascular necrosis Radial artery branch affected - no longer supplies blood, bone cause disintegrate Nonunion of fracture Arthritis S + S Radial sided pain Tenderness and swelling in anatomical snuffbox (EPL, EPB), scaphoid in floor Pain with longitudinal compression of thumb - pushing in to scaphoid Interventions Immobilization - stable (cast - thumb spica), unstable/displaced - ORIF Non - union - bone graft, avascular necrosis - vascular graft PT - mobilization and strengthening

Answer 109

Progressive ROM restriction in capsular pattern Hard with HBB, HBH, overhead Reverse scapulo-humeral rhythm (normal is 1:2, this is 2:1) Trick movements General muscle weakness and poor endurance

Answer 110

Right Liver and gallbladder - right neck and shoulder, right upper quadrant Appendix - right lower quadrant Left Lung and diaphragm - left neck and shoulder Heart - Left chest and arm and between scapula Pancreas - left upper quadrant Center Stomach - center of chest and back Small intestine - center of abdominal area Colon - center of groin area Both Kidney - left and right lower quadrants and upper legs Bladder - lower groin, inner legs

Answer 111

A: Shoulder joint: Arm external rotation, arm adduction; Stabilizes humeral head in glenoid cavity N: Axillary nerve (C5, C6) *can be injuried with axillary nerve damage from shoulder dislocation

Answer 112

Eversion sprain - tearing ligaments on the medial aspect of ankle (anterior tibiotalar, posterior tibiotalar, tibiocalcaneal, tibionavicular Due to strength of deltoid - associated with avulsion fracture Les common due to fibular blocking movement, strength of medial ligaments Etiology Traumatic Eversion Jumping and landing on uneven surface Running and cutting S + S Acute onset swelling/inflammation - warmth, bruising Medial ankle pain - worse with eversion and weight bearing Antalgic gait TOP Decreased proprioception Special tests Anterior drawer test Talar tilt External rotation stress test (Kleiger) - for high ankle sprains but if feel pain on medial side - splaying of the mortise Other - ankle lunge test (KTW), proprioception, strength Interventions Manage pain and swelling Bracing / taping Crutches Strengthening Proprioception Restore ROM - mobilizations, AROM, PROM Cross friction massage

Answer 113

TA isolation Make sure deep tension, no bulge 2 inch medial to ASIS, 1 inch inferior - then draw in abdomen and hold for 10 secs May coactivate with multifidus and PF muscles and progress to sitting / standing Correct -Normal, relaxed breathing -Slow, inward movement of lower abdomen -Deep tension under palpated area Incorrect - global muscle use -No movement of lower abdomen -Rapid contraction and/or tremor -Visible contraction -Swelling or bulging -Upper abs and rib cage movement -Breathing - unable to relax abdomen, holding breath -Spinal movement - PPT or APT, flex or extension of spine Multifidus Lateral to both sides of lower lumbar SP - contract for 10 secs - swell muscle, pushing fingers away May coactivate with TA or PF muscles PF Contract PF, stop urine from flowing, NO peri-anal or glute gripping Diaphragmatic Breath through belly, not chest Progression Isolate inner unit Train inner unit Maintain control of inner unit while training outer unit Integrate into function

Answer 114

Rearfoot Talus Calcaneus Midfoot Cuneiform Cuboid Navicular Forefoot Phalanges Metatarsals

Answer 115

Pain with extension, SLF (ipsilateral) and rotation (ipsilateral) - all compression stress May refer to neck or scapula Direction of Cx is 45 degrees towards eyes - able to get more rotation Tested using coupled or combined movements Physiological coupled - SLF and rotation to same side Can use manual therapy of either because they are the same arthrokinematics Non-physiological coupled - SLF and rotation to opposite side - more provocative

Answer 116

Upper cross syndrome Weak - lev scap and upper trapezius, DNF Tight - pects and lower trapezius and lev scap Chin poking leads to tight upper extensors and lower flexors which lead to weak DNF Puts more stress on posterior structures (discs and facet) *good alignment when sitting at desk* Interventions - stretch tight muscles, strengthening of weak ones, appropriate positioning

Answer 117

Degenerative changes within spinal motion segment Increase incidence with age, typically around >50, insidious Loss of disc height, approximation of vertebrae (initially unstable because ligaments longer = more laxity, then becomes stiff), degeneration of plates, fibrotic in discs, osteophyte formation Presents with loss of lordosis - results in increased stiffness, muscle spasms and back pain (Ache) Worse with prolonged flexion, specifically load. Better unloaded, position changes and gentle movement

Answer 118

Two layers - superficial (just attaches to capsule) and deep (attaches to capsule and medial meniscus) Restrains valgus, lateral rotation of tibia and anterior/posterior tibial translation All fibers taut in extension -Anterior - more taut in flexion -Posterior - more taut mid range Etiology Valgus force (with or without compression) S + S Pain Contrast, throbbing, aching Increased with movement, especially kneeling or stairs Joint effusion Pay report knee “giving out” or feelings of instability Limited ROM

Answer 119

Median (C6-C8, T1) -Humerus supracondylar process syndrome - ENTRAPPED - under the ligament of struthers (anomaly) -Pronator syndrome - ENTRAPPED - between heads of pronator teres (does not lose innervation though) -Anterior interosseous nerve syndrome - between heads of pronator teres ---Occurs with forearm fracture ---Pinch deformity - can’t go tip to tip, pulp to pulp ---Just the motor - FPL, lat ½ of FDP and pronator quadratus ---Branch of median nerve Ulnar (C7, C8, T1) -Cubital tunnel syndrome - ENTRAPPED - cubital tunnel between two heads of FCU -More stress on nerve if more valgus or shallow tunnel -Special tests - cubital tunnel compression test, tinnel’s test at the elbow, elbow flexion test -Interventions ---Nerve mobilization ---Medial - NSAIDs, corticosteroids, ulnar nerve transposition surgery - reposition the bitch Radial (C5-C8, T1) -Posterior interosseous nerve (a branch) ENTRAPPED ---Two head of supinator in arcade of Frohse (anomaly) ---Entrance of radial tunnel anterior to radial head ---Near brachioradialis and ECRL ---Between ulnar half of ECRB tendon and fascia ---At distal border of supinator *may mimic tennis elbow* -Superficial branch of radial nerve -ENTRAPPED - under tendon of brachioradialis -*common with fractures mid-humerus - doesn’t affect triceps -Interventions ---Mobilization ---Medial - NSAIDs, corticosteroids, radial tunnel release surgery

Answer 120

Grade I - no laxity, pain and inflammation Grade II - moderate swelling, ecchymosis and pain. Increased ligament laxity but still firm end feel Grade III - severe swelling, ecchymosis and pain. Gross laxity present. No end feel noted.

Answer 121

Overuse injury of plantar fascia leading to pain at medial tubercle of the calcaneus (attachment), and it also attaches at metatarsal heads During great toe extension (heel/toe off) - plantar fascia tightens to bring bones together to lift the medial longitudinal arch - creates rigid foot ready for push off Etiology Pes planus -Increased strain trying to maintain arch- already stretched, stretching further Pes cavus -Short and thick - trying to pull against tightness Excessive walking or running -load> capacity to recover = degeneration Prolonged weight bearing -Load for long time Obesity -Load > capacity to recover Decreased ankle DF -Compensate during push off for pronation or hyperextension of 1st toe to push off = further stretching Tight calf muscles -Same as above Non-supportive footwear -Excess stress Special tests Windlass Test - standing on step and PT extends great toe - pain at insertion of calcaneus S + S Insidious onset Worse in morning and may decrease with activity Increased pain when activity is recommenced after period of inactivity tender on medial calcaneal tubercle which may extended into medial longitudinal arch Antalgic gait - less / no toe off, no heel contact

Answer 122

Degenerative changes to achilles tendon - may lead to thickening if chronic Classification Insertional - <2cm from calcaneal insertion Midsubstance - 2-6cm from calcaneal insertion Etiology Extrinsic Sudden and drastic changes in training regime - FOOT WEAR Intrinsic Age - reduced ability to recover, natural degeneration Decreased DF - excess stress on DF Foot pronation (static or dynamic) Weight gain S + S Insidious onset Morning stiffness Decreased ankle DF Decrease strength in PF Pain Increased with active/resisted PF, passive DF or weight bearing Decrease pain with walking about or applying heat TOP Antalgic gait Thickening of achilles tendon Retrocalcaneal exostosis -Excess bone - called pump bump, haglund deformity or achilles heel bone spur -Can lead to retocalcaneal bursitis May present with crepitus Interventions Avoid aggravating activities Eccentric exercises for PF (heel drops) Increasing shoe heel height and progressively decreasing heel height Stretching of PF Manage pain Taping Night splint Manage inflammation if paratenonitis or retrocalcaneal bursitis is present

Answer 123

Angina - not relieved (20 minds) with rest and/or NTG - has nausea, vomiting or profuse sweating CES-b/b incontinence, saddle anesthesia Respiratory - inadequate ventilation, respiratory acidosis Anaphylactic shock Stroke - FAST Chest - throbbing in chest, back or abdomen that increases with exertion with sensation of heart beat when lying down -pulsating palpable abdominal mass possibly indicating an aneurysm

Answer 124

Modified thomas test Iliopsoas or rectus femoris - hip stays flexed, bent knee and if continues then rectus femoris TFL and sartorius - if abducted - if in external rotation - sartorius, if internal - TFL Ely’s test Prone, flex knee - if hip flexes = rectus femoris tightness Ober’s test Tight ITB Piriformis test Sidelying, forward flex (60-90) and adduct the hip 90/90 SLR More accurate than just SLR (isolating hamstrings) In reverse table top and straight the leg

Answer 125

Flexion based exercises and positioning Avoidance of aggravating movements and positions

Answer 126

Potential lesion in brainstem, brain or spinal cord Babinski - lateral across foot - abnormal, splaying of toes or great toe extension Clonus - more than 5 times - hold DF

Answer 127

Special tests Varus stress test When doing this compress medial side - so pain there might be a meniscus injury Interventions Strengthening Decrease pain/ swelling Bracing - not in full extension due to MCL taut Proprioception Restore ROM Surgical - not usually done

Answer 128

A: Shoulder joint: Arm external rotation; Stabilizes humeral head in glenoid cavity N: suprascapular nerve (C5, C6)

Answer 129

Round, cord like - lateral epicondyle of femur to fibular head Restrains valgus, lateral rotation of tibia and anterior/posterior tibial translation All fibers taut in extension, lose in 30 degrees flexion (so when testing don’t go past this) Can feel in figure 4 position Etiology Varus force (with or without rotation) S + S Pain Contrast, throbbing, aching Increased with movement, especially kneeling or stairs Joint effusion Pay report knee “giving out” or feelings of instability Limited ROM

Answer 130

1 Pain starts, increased with movement, present at night Loss of ER <3 months 2 - Freezing More intense pain, restricted ROM in all directions 3-9 months 3 - Frozen Pain only with movement Hard capsular end feel - significant adhesions Restricted ROM in all directions with increased scapula compensation movements Atrophy of deltoid, RC, biceps, tricpes 9-15 months 4 - Thawing Minimal pain Increased ROM 15-24 months

Answer 131

Disc herniations posterolateral - due to PLL and weak annulus fibrosis, may compress nerve root Typically acute onset, 30-50 Levels -Protrusion -Prolapse -Extrusion -Sequestration Happens with flexion MOI, hurts in flexion, better in extension Worse in morning - due to larger disc = more herniation, worse with cough, sneeze, Valsalva May present with lateral shifting away from bulge (named based on the shoulders shift)

Answer 132

Advantage - high stability , wide BoS, functional mobility, unloads limb, can collapse easily TTWB, PWB, WBAT, FWB (NOT NWB LIKE STANDARD) Disadvantage - low mobility, high energy expenditure, no stairs

Answer 133

Degenerative changes to wrist extensor tendons inserting into lateral epicondyle CEO Most common ECRB Etiology (>35 years olds) Repetitive use E.g., people that do extension/pro/sup all day Poor technique Heavy racquet Heavy ball Small grip *Load> person’s capacity to recover = degeneration of tendon Load = capacity = no degeneration Decrease BS also limits someone’s ability to recover S + S Aching pain - down to proximal forearm - insidious onset TOP near lateral epicondyle Pain with resisted wrist extension and/or gripping Pain with stretching of wrist extensors Decreased wrist extension or grip strength Special test Maudsleys - resisted D3 Cozen - resisted wrist extension Mill’s - passive wrist flexion

Answer 134

Hyperlordotic Pain with hyperextension Tight hamstrings Scotty dog with collar or decapitation Step deformity maybe S + S of central and lateral stenosis

Answer 135

Wall or floor push up Scapular load test Punch out test

Answer 136

Area of skin supplied by one nerve Needs to be on bare skin, relaxed, testing bilaterally, demonstrate on non-affected area, eyes closed Start light touch, if impaired do sharp/blunt, hot/cold *see book for pictures* C5, C6,C7,C8,T1 - most important - think of the spock hand

Answer 137

Posture education Extension approach Stabilization exercises Stretching as needed Mobilization as needed * DO NOT JOINT MANIPULATE AND AGGRESSIVE MOBILIZATION IN SCHEUERMANN’S DISEASE AND DOWAGER’S HUMP*

Answer 138

Advantages - increased mobility, good stability, unload a limb PWB, WBAT, FWB Disadvantages - not for NWB, no stairs

Answer 139

Posterior / posterolateral No flexion past 90 degrees -Pay attention for STS No internal rotation past neutral -Pay attention for pivoting when walking - turn towards the sounds leg No adduction past neutral -Pay attention for transfer Anterior/anterolateral and direct lateral No flexion past 90 degrees No adduction past neutral No external rotation No hip extension No hip abduction (resisted or antigravity) if muscles cut 6 - 8 weeks No combined movements of FABER *less precautions that are more natural so that is why better for patient’s with dementia*

Answer 140

Postero-lateral bulge -Extension based exercises with progressions -Lumbar roll to promote extension when sitting Lateral bulge -Shift back towards the affected side Anterior bulge -Happens when bulge comes out anteriorly - less common, but there is no spinal nerves but the disc has nociception therefore can still feel pain -Flexion based exercises May be painful initially but complete entire set to evaluate the effect CENTRALIZATION is the priority Green (centralized or with an increase in pain), yellow (no change), red (no change and increase pain and peripheralized) Avoidance of aggravating movements and positions Surgical - laminectomy, discectomy

Answer 141

Tendonitis - inflammation Tendinosis - chronic degenerative changes without inflammation Tenosynovitis - inflammation of synovium Tendon rupture - tendon rupture

Answer 142

Median 1 - ULNT 1 -Shoulder depression, abduction, supination, wrist and finger extension, elbow extension Median 2 - ULNT 2 -Shoulder depression, shoulder lower abduction, forearm supination, wrist and finger extension, elbow extension Radial - ULNT 3 -Shoulder depression and abduction (10 degrees), forearm pronation, wrist flexion and ulnar deviation, finger and thumb flexion, elbow extension Ulnar - ULNT 4 -Shoulder depression and abduction, forearm pronation, wrist extension and radial deviation, and finger extension, elbow flexion

Answer 143

Fluid filled sac providing cushion, has synovial fluid reduces friction Etiology Trauma Sustained pressure Overuse and chronic friction Inflammatory conditions Infections S + S Joint stiffness Decreased ROM Warmth Pain with movement and pressure May present as visible bump *infection S + S - fever, red, warm, swollen Common Pes anserine - between sartorius, gracilis, semitendinosis Prepatellar Superficial infrapatellar Deep infrapatellar Interventions Manage pain and inflammation Avoid aggravating activities Stretching / ST mobilization putting pressure on bursa Surgical - aspiration corticosteroid injection, bursectomy

Answer 144

S + S Pain around hip, groin, glutes, thigh, back or knee Pain with weight bearing Decrease pain in loose packed position (30 flexion, 30 abduction, slight ER) Stiffness Firm capsular end feel, limited ROM Capsular pattern - flexion, abduction, IR Initially lose IR, then hip is fixed in adduction (no abduction), no IR or extension past neural and limitation in hip flexion to 90 Decrease muscle stretch Limited functional abilities (PROGRESS to this) STS Walking on uneven surfaces Difficulty with ADLs Decrease walking distance Decrease time in standing Special tests 1. Scour - in to flexion and adduction May also be iliopsoas, pectineus, TFL, sartorius pain as well if +ve 2. FABER or Patrick’s Decrease ROM, knee isn't parallel or lower = hip pathology, SIJ, iliopsoas spasm 3. Hip quadrant - flexion adduction without scouring +ve if pain

Answer 145

Syndrome cause by facet - worse with compression of facet joints May refer to low back, glutes, hips, groin, thighs (not below knees) Coupled movements -Flexion - SLF and rotation to same side -Extension - SLF and rotation to opposite sides Non-physiological coupled - the opposite of this

Answer 146

Avascular necrosis of femoral head due to interruption of blood supply (etiology unknown but risks factors - trauma, infection, family Hx, low birth weight) Children 2-15 (common 4-8) S + S Limp of insidious onset +ve trendelenberg Pain aggravated by activity and relieved by rest Pain in hip which may refer to anteromedial thigh or knee Decreased hip ROM (especially abduction, internal rotation) *XRAY - flattened femoral head, if not - MRI or bone scan Interventions Petrie’s cast - in abduction Low impact, strengthening, ROM, reduction of weight bearing if pain is severe, hemiarthroplasty *heals fairly well since young*

Answer 147

-Education -Fascial muscle relaxation -Tongue and jaw proprioception and control -Strengthening -Manual therapy - passive stretching, ST techniques, mobilization, joint manipulations -Modalities Joint manipulations - if anterior, can pull caudal and anterior to relocate disc (J-stroke), often hear click Postural - education, jaw posture, TMJ mobilization/manipulations, SOM interventions, mandibular and tongue proprioception

Answer 148

Passive, assisted (something helps), active PNF - need normal innervation and voluntary control -Hold relax - isometric contraction -Contract relax - concentric contraction Incorporating into regular basis is most effective way to gain ROM

Answer 149

Activity modification Counterforce brace Stretching Strengthening - eccentric Mobilization DTFM Pain modalities Medical - NSAIDs, corticosteroids

Answer 150

Slump - get patient to slump down and tuck chin then passively extend their unaffected leg, then their affected If no symptoms - add DF If symptoms - ask them to lift head without moving from slump Positive - symptoms become worse with DF, or better when lifting head indicated neural tension/restriction of lumbosacral roots or dura/neural tissues *If symptoms at any stages - don’t add movements SLR - testing unaffected side first, add medial rotation and adduction, then flex at hip, if pain/tightness lower slightly until disappears, then DF or flex patient’s neck to see if symptoms or reproduced ROM - 35-70 = sciatic nerve -Before 35 - slack taken up -35- under tension -60-70 sciatic roots tense over disc ->70 - pain is likely MSK (hamstring stretch) Further stress nerves -SID - sural, inversion, DF -TED - tibial, eversion, DF -PIP - peroneal, inversion, PF Crossover sign - if when doing unaffected side they feel it in affected - suggests a large disc bulge as pulling the nerves into the disc Sign of the buttock - do after SLR - go to point of restriction then back off, add knee flexion and see if can get further hip flexion Positive - hip flexion does not increase - pathology behind hip joint (bursitis, tumour, abscess) - refer to GP Bow-string test - SLR produces symptoms, slightly flex the patient’s knee (20 degrees) to reproduce symptoms, pushing then in to popliteal area Positive - reproduces radicular symptoms, pressure or tension on sciatic nerve

Answer 151

Valgus stress (chronic or acute - FOOSH with elbow stressed or forced ER) S + S -Pain, TOP -Joint effusion -Instability with valgus stress -Limited ROM -May have heard audible pop Special test Valgus stress test

Answer 152

Craniocervical flexion test Use blood pressure cuff - inflate to 20mmHg, continue to add by 2’s if patient successful. See if they can perform upper cervical flexion and hold is for 10 sec getting it up to 22mmHg Most can get it up to 26mmHg Positive: unable to get to 26mmHg, hold it, raise pressure in small increments, uses compensatory patterns (using superficial neck muscles - SCM, extends the head)

Answer 153

Subjective reports that are perceived by a person and cannot be observed (e.g., pain, numbness, tingling, burning, nausea, dizziness)

Answer 154

A; Shoulder joint: Arm internal rotation Stabilizes humeral head in glenoid cavity N: Upper and lower subscapular nerves (C5 - C6)

Answer 155

-Cervical distraction test -Spurlings (foraminal compression) test -Upper limb tension (neuro provocation tests) Cx distraction test - decrease symptoms +ve Foraminal (spurlings) compression -Compress in neutral, no symptoms - then with extension and rotation of unaffected, then of affected then side flexion to affected -+ve if increased symptoms on affected ULNT -Unaffected side first - so they know what it feels like and compare -Order → shoulder, forearm, wrist, fingers, elbow -Added sensitizing and desensitizing movements to see if makes a difference +ve if symptoms

Answer 156

add a storage attachment, glides or platform - e.g., weightbearing through forearm

Answer 157

Spondylolysis - fracture of one pars articularis - no slippage Spondylolisthesis - fracture of two and get anterior slippage -Traumatic - from trauma -Isthmic - repetitive micro trauma - common in L5/ S1 (excess movement of L5, carry weight of body, angulation is greatest) -Degenerative - degenerative changes - decrease joint space, increased laxity and risk of slippage -Dysplastic (congenital) - defect in formation of vertebrae -Pathological - secondary to another disease process or treatment Retrolisthesis - fracture of two and get posterior slippage

Answer 158

Grade 1 (SPRAIN) - no separation, capsule intact Grade 2 (SUBLUXATION) - increased AC joint spacing Grade 3 (DISLOCATION) - torn AC and coracoclavicular ligaments, joint surfaces not in contact

Answer 159

-see image in book

Answer 160

A: Shoulder joint: abduction of arm, stabilization of the humeral head in the glenoid cavity N:Suprascapular nerve (C5, C6)

Answer 161

Lateral knee pain - from irritation of structures from repeated knee flexion / extension - ITB frictions over lateral epicondyle ITB goes over lateral femoral epicondyle around 30 degrees Brought on by inflammation of ITB and underlying bursa Etiology Repetitive knee flexion / extension - e.g., sports like running/cycling Rapid increase in training volume Precipitating factors TFL/ITB tightness -Weak gluteus medius → TFL overactivity Genu varum -Increase distance of ITB Tibial IR (increase tension for ITB) -Further from gurdy’s tubercle (insertion) S + S Lateral knee pain Increase pain with repetitive knee flexion / extension Pain decreases with rest Special tests Noble compression test - compress lateral with extension, Pain at 30 degrees = +ve Obers test Thomas Test - test for ITB Interventions Decrease pain Avoid aggravating activity TFL/ITB stretches / ST

Answer 162

Degenerative changes to wrist flexors tendons inserting into medial epicondyle CFO Most common pronator teres and FCR Etiology (>35 years olds) Repetitive use S + S Aching pain - down to proximal forearm - insidious onset TOP near medial epicondyle Pain with resisted wrist flexion and/or gripping Pain with stretching of wrist flexors Decreased wrist flexion, pronation or grip strength Special test Medial epicondylitis (golfers elbow test) - reverse mills - passive wrist extension Resisted wrist flexion Resisted pronation

Answer 163

Fracture of the hip - majority in elderly women (>75 years old) Extracapsular Intracapsular -Risk of avascular necrosis -Not congruent - wears out acetabulum -Delayed healing -Non-union Etiology Falls Decreased walking speed and balance- more likely to fall sideways on the hip Decreased muscle strength and flexibility Poor vision Cognitive decline Medications Osteoporosis Sudden twisting motion of LE

Answer 164

Advantages - high mobility, used to unload limb, stairs, wide selection of gait patterns, no risks of brachial plexus injuries or radial nerve compression, allows for release of handgrips for functional activities NWB, TTWB, PWB, WBAT Disadvantages - low stability, good balance and upper body/trunk strength, high energy expenditure, good coordination *mostly for those long term use of crutches that need just a little stability* (SB, CP - grade II GMFCS)

Answer 165

Idiopathic - pain with more decrease ROM in capsular pattern from dense adhesions and capsular thickening F>M, 40-60 yo, non-dominant shoulder, increased with diabetes

Answer 166

Dupuytren’s contracture - of palmar fascia Fixed in flexion of MCP and PIP, usually D4 and D5 Skin is adherent to the fascia Splint in extension after release Trigger finger Thickening of flexor tendon sheath (Notta’s nodule) Tendon sticking, catching or locking when flexing More common D3-D4 Associated with RA Mallet finger Flexion of DIP at rest Rupture or avulsion of extensor tendon at insertion in distal phalanx Splint DIP for 6-8 weeks Bouchard nodes OA enlargement of PIP on dorsal Heberden nodes OA enlargement of DIP on dorsal Swan neck deformity (RA) Boutonniere deformity (RA) Ulnar drift (RA)

Answer 167

STS Scoot to edge, flat feet, extend restricted leg out Lean over CoM over BoS -*for posterior or posterolateral - do not - just lean back because don’t want hips to go over 90 degrees of flexion Push up stable surface -Do not push up or pull up on stable surface Once standing - grab device Stand to sit Back legs up against chair, reach back and extended weight bearing restrictions, slow descent Turning Turn towards unaffected then can progress With posterolateral turn towards unaffected Use multiple slow steps progress to pivot Stairs Good up, bad down - device moves with affected LE - guard most likely to fall Initially step to then progress to step through Use handrails (no bilateral if device) - use on affected side

Answer 168

Excessive motion between two vertebrae Can be ligament damage, fracture, dislocation,muscle weak, joint damage, poor neuromuscular control May be caused by trauma, long term corticosteroid use, congenital or secondary to other conditions Do not mobilize or manipulation Control system (CNS), active system (muscles and neural control) and passive system (bones and ligaments) Intervention = inner unit core stability training

Answer 169

Interventions Muscle strengthening Low impact exercises Decrease pain and swelling Increase ROM (continuous passive motion machine - post -op) Improve function Assistive device for ambulation if needed Bracing if needed (unloader) Weight loss Surgical Aspiration Injections - hyaluronic acid (component of synovial fluid), corticosteroids Arthroscopic debridement Proximal tibial osteotomy (closing wedge varus - take out piece, opening wedge valgus - put in piece) Partial (hemi) knee replacement - unicompartmental OA TKR - 90 degrees required by 6 weeks or manipulation under anesthetic required

Answer 170

Typically occurs in vascular region Etiology Occurs with shearing / twisting forces Compression with hyperflexion (>90 degrees) common MOI Early flexion = anterior, deep flexion = posterior Internal rotation = lateral, external rotation = medial Also think of femur - if internal rotation when cutting = external rotation of tibia so medial meniscus tear S + S Swelling, joint line tenderness “Locking” if bucket handle tear, need an external force to unlock it This and osteocondritis dyskinesis - bones get caught Clicking noise with movement Knee “gives way” - because of swelling - quads because inhibited Loss of ROM “Springy block” - bucket handle tear instead of soft tissue approximation Types of meniscal tears Posterior tear -Most common - hyperflexion and compression Transverse tear -Common in lateral meniscus, and associated with ACL injuries Longitudinal tear Bucket handle tear -Longitudinal tear but a inner edge flips up getting caught in intercondylar notch -Medial meniscus tear - associated with ACL injuries -*refer to surgery*

Answer 171

Inversion sprain - tearing ligaments on the lateral aspect of ankle (ATFL, CFL, PTFL) Etiology Traumatic - PF and inversion Landing on uneven surface, running on uneven ground Increased incidence with weak peroneal or ankle instability PF and inversion (ATFL), neutral inversion (CFL), DF and inversion (PTFL) S + S Acute onset swelling/inflammation - warmth, bruising Lateral ankle pain - worse with inversion and weightbearing Antalgic gait TOP Instability Decreased proprioception Special tests Anterior drawer test Talar tilt Other - ankle lunge test (KTW), proprioception, strength Interventions Manage pain and swelling Bracing / taping Crutches Strengthening Proprioception Restore ROM - mobilizations, AROM, PROM Cross friction massage

Answer 172

Hawkins kennedy Neers Scapular assist - help scapula move

Answer 173

Frontal plane -Normal: 120-135 -Coxa valgus - >135 ---Creates varus at the knees -Coxa vara- <120 ---Creates valgus at the knees Transverse plane -Anteverted - femoral moved anteriorly, creates internal rotation force at foot ---Associated with W sitting - already in the position, greater BoS -Retroverted - femoral head moves posteriorly, creates external force at foot -*doesn’t mean someone has pain, just different body mechanics acting on joint - might need to have variations in how they do things

Answer 174

Can be congenital or acquired -Congenital - unknown etiology - trauma during birth or positioning in utero -Positional plagiocephaly - flattened head cause of positioning - change positions or wear a helmet (cranial remodeling orthosis) Primarily tightness of SCM causing ipsilateral SLF and contralateral rotation -Cause and decrease AROM and PROM the opposite way Postural education, stretch muscles and strengthening opposite side for treatment

Answer 175

Clunk test Active compression test of O’brien - SLAP Biceps load test

Answer 176

Special tests Mcmurrys - deep flexion with external (medial) or internal (lateral) rotation into extension - can also add a varus/valgus force Apley’s - compression/ distraction in prone Thessalys - twist in SLS Bounce home test - extension and test end feel Interventions Physio - decrease swelling, increase ROM, strengthening Medical Meniscal repair -WBAT in extension ->90 flexion in 4-6 weeks -WB in flexion >90 3-4 months -No pivoting or cutting 3-4 months Partial or total meniscectomy -Recovering easier - RTW in 5-7-days, sport in 3-6 weeks -Focus on decrease swelling, improve ROM and gait -More prone to OA - redistribute load

Answer 177

Post-operative management Immobilized 7-10 days in slight extension Splint removed during surgery cannot do active flexion past neutral or use finger flexors with wrist flexion for first 10 days Pillar pain = pain in thenar and hypothenar eminences Max protection Patient education Wound management Control of edema Control of pain Active tendon/nerve gliding Upper extremity exercises Finger and thumb movements Wrist extension Active radial and ulnar deviation Pronation and supination Elbow and shoulder movements Moderate and minimum Suture removed post op 10-12 Return to full activity by 6 - 12 weeks Residual impairments -Weakness -Sensory deficits -Persistent edema -Limited ROM -Hypersensitivity -Pain Scar tissue mobilisation Progressive stretching / joint mobilisation Progressive strengthening -Isometrics - 4 weeks -Grip and pinch - 6 weeks Dexterity exercises Sensory reeducation

Answer 178

Compression of vertebral artery = decrease BF to brain Dizziness Drop attacks Dysarthria Dysphagia Diplopia Nausea Nystagmus Other neurological signs

Answer 179

Biceps -Speed -Yergasons Supra -Drop arm -Empty can Subscap -Belly press -Lift off -Internal rotation lag sign Infra -Infraspinatus test -Lateral rotation lag sign Teres minor -Hornblower’s sign

Answer 180

Stenosis - unload the nerve - SLF and rotation away, flexion based exercises, traction -Can also floss / tension Disc - graduated retraction, then add extension when ready being careful not to make things worse -The UCS in to flexion - no discs so don’t worry, LCS in to extension

Answer 181

The AC joint separation - the ligaments that hold the joint together (AC and coracoclavicular) Etiology -Downward pressure on acromion, or fall on acromion -Fall on outstretched hand or elbow

Answer 182

Quadrant Test -Patient extended Lx and side flexes and rotates to side of pain -If increase - indicate facet involvement

Answer 183

Increased pressure on structures under a narrowed sub-acromial space Subacromial bursa Supraspinatus tendon Long head biceps tendon Coracoacromial ligament Joint capsule

Answer 184

Minimize adverse effects of bed rest -Bed mobility, transfers, ambulative with assistive device (walker), deep breathing and coughing, LE edema control Exercise program - ROM, strengthening, balance

Answer 185

Degeneration of articular cartilage and subchondral bone = narrow joint space, bone on bone (no articular cartilage) and osteophyte formation Etiology Unknown Risk factors Non- Modifiable -Age -Genetics -Gender (F>M) -Congenital malformation Modifiable -Obesity -Abnormal repetitive stress -Trauma -Joint mechanics (may or may not be able to modify)

Answer 186

Flexion based exercises initially and positioning (e.g., z-posture) Avoid aggravating movements Surgical management - laminectomy

Answer 187

Neurogenic -Tingling, numbness, paraesthesia -Harder fine movements -Weak grip strength Vascular - artery -Cold and pale -Decrease pulses -Rapid fatigue of limb -Lower BP on affected side Vascular - vein -Mottled skin, blueish -Painful swelling in arm F>M, onset 20-50 - neuro most common Involves C8,T1 (ulnar nerve distribution) Athletes with abduction and external rotation

Answer 188

Observation -Cx Ax and posture -Asymmetry of face -Occlusion (over/under/cross bite or normal) -Facial profile -Teeth AROM -Cx -TMJ -Mandibular measurement -Tongue and swallowing -Cranial nerve function AROM of TMJ -Functional opening (40mm, 25mm for rotation, 15mm for translation) *can do with tongue touching, when lifts off would be around 30mm, can see where the problem is* -Max opening (50mm) -Retrusion (1-2mm), protrusion (9mm) -Lateral deviation (9mm) *look for quality, quantity, pain, clicking* Opening - 2 knuckles = functional, 3=max - with retrusion, not protrusion = anterior disc displacement with reduction PROM Isometrics Functional Ax Special tests -Auscultation - crepitus = OA or disc lesion, clicking = hypermobile, late = anterior disc displacement -Knuckle test - +ve if can't fit knuckles

Answer 189

Concave (distal) on convex - moves in SAME direction -E.g., MCP flexion = anterior, extension = posterior Convex (distal) on concave - moves in OPPOSITE direction -E.g, GH abduction - inferior, adduction - superior, flexion = posterior, extension = anterior, external rotation = anterior, internal rotation = posterior Rule of same different same as you name joints going down

Answer 190

*see picture in book*

Answer 191

C5 - deltoid C6 - biceps/ brachioradialis C7 - triceps C8 - pronator quadratus T1 - abductor digiti minimi *Use jendrassik - pull legs apart for upper, hands apart for lower Put tendons on slight stretch Rating 0-4 with increasing response - 0, no, 1, decreased, 2, normal 3, exaggerated 4, is clonus/very brisk

Answer 192

Physiological movements that occur between segments (bones) End feel Normal -Bone to bone -Soft tissue approximation -Tissue stretch Abnormal -Abnormal capsular - frozen shoulder -Springy block - meniscus tear -Muscle spasm -Empty - can’t get to the end range -Abnormal bone to bone

Answer 193

Posterior Most common, ulna and radius (distal segment) moves posterior MOI: FOOSH *often involves disruption of UCL and RCL *often involves fracture of coronoid process or radial head Major complications from impairment of vascular supply (CHECK DISTAL PULSES) Anterior Distal segment moves anterior MOI: High energy trauma (MVA) Lateral Distal segment moves lateral MOI: humerus moves medial Medial Distal segment moves medial MOI: humerus moves lateral Divergent Ulna and radius move apart MOI: driving force inferiorly

Answer 194

Anterior instability Crank, apprehension test with relocation Apprehension release (surprise) Load and shift test Posterior instability Posterior apprehension test Load and shift test Jerk test Inferior and multidirectional instability Sulcus sign Feagin test - push inferior with their hand on your shoulder

Answer 195

General instability resulting in increased risk of hip fractures, common in infants (F>M) Etiology Genetics F>M - gender First born Breech birth Narrow uterus Tight swaddling Signs and symptoms Asymmetry (if unilateral) -LLD or gluteal folds Hip abduction limitations Hip clicks *diagnosis through US, not XRAY

Answer 196

Gait belt -Secure when seated, usually at midsection or high if physical condition or patient’s size (breasts, incision) -Hold with supinated grip Stand posterior and to the side (which they are most likely to fall - weaker or side they lean to) Maintain broad BoS in staggered stance

Answer 197

Accessory nerve (CNXI) Branches of cervical plexus C2,C3

Answer 198

Direction - anterior, posterior, inferior, multidirectional Degree - subluxation, dislocation Etiology - traumatic, atraumatic Timing - acute, recurrent Epidemiology - M, <30

Answer 199

Congenital anatomical anomaly Inflammation or scar tissue Hypertrophy of scalenes, pect minor, subclavius Pressure Posture Overhead movements Trauma Thrombus (vascular TOS) Pancoast tumor

Answer 200

Weight bearing capacity of device (standard - <300 pounds, bariatric >300 pounds) Handgrip placement - *wearing shoes Elbows in 20-30 degrees of flexion Estimate using -Greater trochanter to heel -Wrist crease in standing -Ulnar styloid process -Height markings on device Confirm in functional standing -Tips of cane or crutches slight forward (4-6 inches) and to the side (2 inches) -Feet within box of walker

Answer 201

Pain arc (60-120) Pain - with overhead, anterior lateral shoulder, not below elbow, no pain at rest TOP - SSp, LHB, bursa Revered scapula-humeral rhythm Decreased HBB or HBH Pain and weakness on resisted abduction and ER Anterior-superior placed HH at rest Decreased posterior-inferior glide

Answer 202

Indications Pain, muscle guarding, spasm Reversible joint hypomobility Positional faults, subluxations Progressive limitation -frozen shoulder - need to maintain ROM Functional immobility - isn’t moving (cast) - regain ROM Contraindications Hypermobility Joint effusion Inflammation Precautions Malignancy Bone disease Unhealed fracture Excessive pain Hypermobility in associated joints Total joint replacements Weakened connective tissue Systemic connective tissue diseases Elderly individuals with weakened connective tissues

Answer 203

Activity modification Stretching Strengthening - eccentric Mobilization DTFM Pain modalities Medical - NSAIDs, corticosteroids

Answer 204

Formation of bone instead muscle-tendon unit, capsule, ligamentous structure Calcification may occur following injury (i.e.,. Bruising forms to bone) Commonly quads (also brachialis) MASSAGE, PASSIVE STRETCHING AND RESISTED EXERCISE IS C/I*

Answer 205

Activity modification Correcting faulty technique Decrease pain Decrease swelling Bracing (medial strapping of elbow) Strengthening (focus on forearm flexors and pronators) Restore ROM Surgical - ligament reconstruction (take from other tendon typically hamstring) Immobilize to 90 degrees elbow flexion, neutral pro/sup = stiff especially in to elbow extension

Answer 206

Severe pain increasing with weight bearing or hip movement Shortening that was not immediately present Positive trendelenburg on involved side that doesn’t resolve Damage to superior gluteal nerve Lurching gait - getting CoG over stance leg Persistent external rotation

Answer 207

-Signs of degeneration -Crepitus -Reduced ROM - especially in the morning, then increases as time goes on -Diffuse pain - especially when biting firm foods -Muscle weakness and atrophy

Answer 208

Inner unit muscles - stabilizers - timing and endurance is important Transverse abdominis, PF muscles, diaphragm, lumbar multifidus Neurophysiological connected - meaning that they all fire at once, anticipatory before movement Often weak, trouble with timing - leads to aberrant movement and increased recruitment of global muscles to maintain stability Active muscle systems -Local and global - see chart in book

Answer 209

Tearing of syndesmotic ligaments connecting tib-fib (inferior transverse, AITFL, PITFL, interosseous membrane / ligament) Associated with deltoid ligament injuries or fracture of the fibula/ medial malleolus Etiology Traumatic External rotation Hyper-DF S + S Acute onset swelling/inflammation - warmth, bruising Anterior ankle pain - worse with external rotation and weight bearing Antalgic gait TOP over syndesmosis and interosseous membrane Decreased proprioception May present with widening of mortis on imaging Special tests External rotation stress test (Kleiger) - for high ankle sprains - splaying of the mortise since wider anterior Squeeze test - pain, in weightbearing and do this adds stability and may get increased DF Other - ankle lunge test (KTW), proprioception, strength Interventions Manage pain and swelling Bracing / taping Crutches Strengthening Proprioception Restore ROM - mobilizations, AROM, PROM Cross friction massage

Answer 210

Indications ROM limitations -Adaptive muscle shortening -Adhesions -Contractures -Scar tissue formation Preventable structural deformity due to restricted movements Component of sport to increase performance or reduce risk of injury Potentially reduce post-exercise soreness Contraindications Bony block limiting ROM Recent fracture or incomplete bone union Evidence of acute inflammation or infection Sharp acute pain with muscle elongation Hematoma Hypermobility Functional muscle shortening

Answer 211

Median Ape hand - thumb in same plane, stuck in adduction - no other thumb movements Lower level lesion Hand of benediction - cannot flexion digits 1-3, so when make a fist those digits remain (ONLY SEE WITH FIST) High level lesion Ulnar Claw hand - hyperextension of MCP, flexion of digits 4 and 5 Radial Wrist drop - cannot extend wrist or MCP

Answer 212

Diagnosis of exclusion - results from compression of nerve or vascular structures in outlet Types Neurogenic (True TOS) -From anatomical anomaly - compression of nerve Non specific (symptomatic) neurogenic -Most common, diagnosis of exclusion - nothing shows up on scan, muscle atrophy or anatomical anomaly -Maladaptive postures - tight scalenes or pect minor Vascular - arterial -Compression of subclavian artery from anatomical anomaly -Worse with upper arm movements Vascular - vein -Does not typically result in TOS complaints - result of another cause (thrombus)

Answer 213

Excessive motion between two adjacent vertebrae Due to joint damage, muscle weakness, fracture, dislocation, ligament damage Caused by trauma, long term corticosteroid use, congenital or secondary to other conditions (RA,OA, downs syndrome) *DO NOT MOBILIZE OR MANIPULATE

Answer 214

Pain with muscle contraction TOP

Answer 215

Physiological Movements Done actively by the patient Accessory Movement Cannot be actively performed by the individual Component movements - motions that accompany physiological movements (but not voluntary) -Scapular movements, clavicular movements Joint play - motions that occur between joint surfaces - describe distensibility of capsule (hypo/hypermobility, normal, doing traction, compression, distraction, glide spine)

Answer 216

Special tests Posterior drawer Posterior sag sign Godfrey test Interventions Strengthening Decrease pain/ swelling Bracing Proprioception Restore ROM Surgical - ACL graft Autograft - you are donor Gracilis / semitendinosus Patellar tendon graft Allograft - Achilles tendon

Answer 217

A: Clavicular part: flexion and internal rotation of the arm, Acromial part: abduction of the arm beyond the initial 15° Spinal part: extension and external rotation of the arm. N: Axillary nerve (C5, C6)

Answer 218

Advantages - good stability, use when stability is needed but only one UE can be used, unload limb PWB, WBAT or FWB Disadvantages - low mobility, high energy expenditure, cannot be used on most stairs

Answer 219

Intra-operatively Malpositioning Femoral fracture Nerve injury Peroneal division of sciatic - most common = drop foot Also superior gluteal or obturator or femoral nerve LLD - either prosthesis not in place or dislocated Early post- op DVT Infection Wound healing problems Pneumonia - HAP, immunity decreased Dislocation of prosthetic joint Late post - op Prosthesis doesn’t fit - mechanical loosening, atraumatic wearing out

Answer 220

Interventions Activity modification ST mobilization or stretching- plantar fascia / calf Strengthening - intrinsic foot muscles Taping Orthotics, insoles, heel pad Night splints / Strassberg sock (DF over night - on stretch) Cryotherapy - decrease inflammation and analgesic Iontophoresis - medication given through electrodes Extracorpeal shock wave therapy Medical - NSAIDs, corticosteroids (inflammation and to wear down connective tissue so it eventually just breaks), plantar fasciotomy Ddx Fat pad contusion -High impact on heel - increase heel strike - common with fat pad atrophy (posterior-lateral of heel) Calcaneal stress fractures -Common with pes cavus - heel strike hurts Lateral plantar nerve entrapment - most common -Extension of posterior tibial nerve -Presents with pain - do S + S, SLR with tibial nerve stress, with head movements -Similar Rx

Answer 221

Freddy Kaltenborn - sustained glides grades I (loosen - small distraction, pain), II (tighten - small amplitude - distraction/glide - tighten tissue around joint, joint sensitivity, helps with pain, maintain joint play), III (large amplitude - distraction or glide to stretch joint capsule and periarticular structures - helps increase joint play) Geoffrey Maitland - oscillatory glides - grades I (small - pain and spasm), II (large - pain and spasm), III (large - regain ROM), IV (small - regain ROM), V (small - high velocity thrust) Brain mulligan - MWM (sustained glides with movements) Sustained accessory glide during active or passive physical movement by patient Comparable sign - determine effectiveness Accessory - pain free OP - pain free Improve comparable sign Failure to improve - something fucked up Parameters Type Direction Grade Speed (Hz) - how many pushes per sec (2Hz = 2 pushes per sec) Time (reps / sets)

Answer 222

-Club foot -Pes Cavus -Pes Planus -Hallux rigidus -Hallux valgus -Claw toe -Hammer toe -Mallet toe

Answer 223

CMC OA - common Etiology Repetitive movement Joint injury F>M, advanced age S + S Pain at base of thumb Worse at night, changes in weather and with overuse Tenderness at CMC Decreased pinch and grip strength Muscle wasting at thenar eminence (disuse) Possible instability (sublux or dislocation) Lead to hyperextension deformity of MCP Special tests Grind test - compression with rotation Interventions Activity modification Splinting Larger grip handles AROM within limits Strengthening Medical - NSAIDs, corticosteroids, 1st CMC arthroplasty (replaced trapezium with something else / arthrodesis (fuse bones)

MSK Flashcards

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