MSK review Flashcards by Devin McDonnell

Grade this ankle sprain:

mild joint instability, moderate intra- capsular swelling and tenderness, and some loss of ROM and joint function

Grade II lateral ankle sprain

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Grade?

Complete rupture of the anterior talofibular ligament, calcaneofibular ligament, and capsule with mechanical joint instability; severe intra/extra-capsular swelling, ecchymosis, tenderness and inability to weight-bear.

a severe or Grade III lateral ak sprain

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Grade?

Stretch of the lateral ligament complex with no macroscopic tear or joint instability, little swelling or tenderness

Grade I lateral ankle sprain (mild)

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Syndesmosis sprain ankle sprain looks like?

inability to bear weight, severe ecchymosis (a discoloration of the skin resulting from bleeding underneath), mortise widening

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medical term for a dark purple spot when blood leaks into top layer of skin.

ecchymosis - from greek “to pour out”

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What test?

Lie the patient supine on the bed. Place the patient’s knee in about 20-30 degrees flexion. According to Bates’ Guide to Physical Examination, the leg should also be externally rotated slightly. The examiner should place one hand behind the tibia and the other on the patient’s thigh. It is important that the examiner’s thumb be on the tibial tuberosity.

Lachman’s test for ACL

Anterior translation of the tibia associated with a soft or a mushy end-feel indicates a positive test

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Tibialis anterior weakness and sensory loss along the anterior leg below the knee are the most common signs of x nerve root entrapment.

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a childhood condition that occurs when blood supply to the ball part (femoral head) of the hip joint is temporarily interrupted and the bone begins to die.

Legg-Calvé-Perthes’ disease

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Constant pain without any relation to position is a key indicator of

spinal cancer.

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What deformity?

digit has a hyperextended metacarpophalangeal joint, flexed proximal interphalangeal joint, and a hyperextended distal interphalangeal joint.

Boutonniere deformity

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Mallet finger involves

just flexion of the DIP joint

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The O’Brien’s test is MOST indicative of

SLAP tears.

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Extension activities will exacerbate any pain from

spondylolisthesis, stenosis of the spinal canal

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for hypomobility of the neck, thrust manipulation of the x spine can provide short-term improvements in patients with mechanical neck pain.

thoracic

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precautions to avoid dislocation with a THA that used a posterior surgical approach

flexion, medial rotation, and adduction.

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Shoulder rotation, especially x, is the MOST helpful at strengthening the rotator cuff, which will be the MOST helpful at treating subacromial bursitis.

external rotation

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Numerous studies indicate that maintaining x function after knee surgery speeds recovery.

quadricep

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Forward head posture impacted by ___ tightness and ___ weakness

pec minor tightness

Sh retractor weakness

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ligament located just inferior to the medial malleolus and is commonly injured in eversion sprains.

Deltoid

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A patient reports pain in the knee while descending stairs. The pain increases with knee flexion, especially at approximately 30 degrees of flexion.

Which disorder likely present?

pain at approximately 30 degrees of flexion with eccentric loading, the point of the greatest compression of the patella into the femur = PFPS

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Patrick’s Test (or the FABER Test) is used to test for

hip or SI joint pathology

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Straight Leg Raising Tests for what?

Herniated discs

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dark line is caused by increased melanocyte-stimulating hormone occurs in what?

Linea nigra, pregnancy

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Supine; placing pillows under the x side of the body will help offload the inferior vena cava during treatment.

good for?

right

good for pregnancy

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??, characterized by excessive collagen production and adhesions that result in restricted joint motion and pain, is the MOST common complication of surgical joint repair List examples ^

Arthrofibrosis - characterized by excessive collagen production and adhesions that result in restricted joint motion and pain. frozen shoulder, adhesive capsulitis, joint contracture stiff knee and stiff elbow.

anterior shoulder dislocation which creates a divot in the cortex of the humeral head. what is this called?

Hill-Sach’s lesion

Difference between primary vs secondary shoulder impingement

secondary causes (2)= pinching of the rotator cuff in the shoulder joint itself; OR overuse d/t rotator cuff from attempting to stabilize an unstable GHJ primary = pain in the shoulder is caused by direct (or primary) mechanical rubbing of the rotator cuff tendon by surrounding bony structures

MOST important consideration during rehab for meniscus repair? How long to limit?

Avoid full knee flexion - will shift the menisci posteriorly and disturb the repair site. Most protocols call for limited weight bearing and flexion for about 6-10 weeks.

The most dangerous point of rehabilitation is approximately x weeks when the graft is remodeling

6-8

Steps of gioniometric measurement

1) estimate 2) Locate landmarks 3) align 4) read

Joint Mob Grade X is large amplitude oscillation to the limits of available motion.

Grade X is large amplitude oscillations, but not to end of range.

Grade ?? is small amplitude oscillations at the end of range.

Grade ?? is high velocity, low amplitude thrust past the end of range.

correct landmarks for plumb line

posterior to the coronal suture anterior of the lateral malleolus. posterior to the iliofemoral joint @ Vertebral bodies of the lumbar spine

A patient with an above knee prosthetic limb is displaying lateral trunk bending toward the involved lower extremity while ambulating. What is MOST likely cause of this gait abnormality?

Medial wall too high

If prosthetic is too long, what is likely?

Circumducted gt

Poor suspension leads to what type of gt?

vaulting in order to keep residual limb inside socket (approximate gap via gastroc)

When the capsule shrinks and sticks, the end-feel becomes

very firm.

Best test for anterior talofibular ligament integrity

Anterior drawer

Talar tilt test will indicate a torn x ligament.

calcaneofibular

x is a test for Achilles tendon rupture.

Thompson

Ottowa 2-step test rules out ?

A patient is asked to flex their shoulder to 90 degrees with the forearm in full supination. The examiner places resistance downward against the flexed arm. Name? Rules out?

Speed's Test for bicep tendon pathology.

Rotator cuff pathology can be tested with resisted

external/internal rotation

Ratio of GH to scapulothoracic movement?

there is typically a 2:1 glenohumeral:scapulothoracic ratio of movement that will achieve full shoulder flexion. 120;60

Capsular pattern for T spine?

Equal lateral flexion and rotation inhibited, less so for extension

The TUG test is a timed test where less than x seconds is normal and higher than x seconds in community-dwelling elderly indicates a high fall risk.

10/30

The tibial plateau rotates laterally during the final x degrees of extension.

Having elbow flexion of approximately x degrees will allow optimal stability while ambulating on parallel bars

degrees of plantarflexion is required for gait during the preswing phase.

describe terminal stance

contralateral tibia is perpendicular to the ground w ispi knee in full extension

Terminal swing is when

reference tibia slows for initial contact with the floor

Midstance begins at what action of contralat foot

At the point of toe off of the contralateral foot.

The x joint is a flexion/extension joint of the head

Atlanto-axial joint produces what motion

"no"

Percentage of body weight offset with water levels at... neck? Chest? Hips? Knees?

90 - 75 - 50 -35

is an appropriate weight-bearing activity for patients seeking to improve bone density.

Progressive leg press training

What grades?? The patient is able to complete < ½ ROM with gravity eliminated Pt is able to complete full ROM, gravity elim Pt is able to complete full ROM in gravity elim position + slight resistance Pt is able to complete <1/2 ROM against gravity

Poor- 2- Partial ROM, gravity eliminated Poor 2 Full ROM, gravity eliminated Poor+ 2+ Gravity eliminated/slight resistance or < 1/2 range against gravity

patient is able to complete more than ½ of the available range of motion against gravity.

The patient is able to complete the range of motion against gravity, but NO resistance

The patient is able to complete less than ½ of the available range of motion with gravity eliminated

A patient with a stroke affecting the right middle cerebral artery has difficulty walking, especially over uneven surfaces. Which of the following describes the MOST appropriate initial treatment?

SPC training on even surface left LE weakness = counterbalance cane on R hand for STEP TO training

Describe Brown Sequard Syndrome

Ipsilateral Sensory/Motor loss Contralateral pain and temperature loss

Squat pivot transfer requires what?

adequate upper extremity strength

Rotator cuff strength is critical to x the humeral head during shoulder flexion.

depress aka if RTF is weak, secondary impingement occurs

is characterized by dizziness lasting about 1 minute following head position changes, such as stooping or turning The Epley Maneuver is used to treat, primarily when the disturbance is in the posterior semicircular canal.

BPPV Benign paroxysmal positional vertigo

x disease is a fluid imbalance in the inner ear; can cause persistent dizziness and lightheadedness.

Meniere’s

neurological disorder characterized by the inability to perform learned (familiar) movements on command, even though the command is understood Pt may try to APPROXIMATE the movement

Apraxia

A positive x sign is one when leg pain is reproduced or pain in the gluteal region passive straight leg raising. The test has a high sensitivity (0.80-0.97) for a low lumbar disc protrusion but has a low specificity

Lasègue's

The tibia rotates ____ in Open chain terminal extension In closed chain exercises, the Femur rotates _____ on the tibia

Tibia moving = Rotates Externally Femur moving = Rotates Internally

a painful condition that affects the ball of your foot, most commonly the area between your third and fourth toes; may feel as if you are standing on a pebble; may be caused by pressure or injury, such as from running or use of high heels

Mortons Neuroma

How to distinguigh valgus vs varus forces? example @ hip/knee

by PROXIMAL joint ValGUS displaces distal shaft LATERALLY to the midline Varus displaces distal shaft MEDIALLY to the midline - Lateral displacement to distal leg will produce valgus knee and varus hip/coxa - Medial displacement will produce varus knee and valgus coxa

Mechanism of injury for PLC tear/sprain

Forced knee hyperflexion on planted foot

Most common graft cite for ACL repair? Concequences?

Patellar tendon (Quads will be weakened)

Cause: repetetive overhead motion Deep ache in anterosuperior shoulder made worse with lifting objects Resisted supination tests for positivity*** what pathology?

Bicipital tendontitis

A ____ tear is most susceptible with anterior damage or subluxation (shoulder)

labral

Avulsion of labral ligament complex from the inferior aspect of glenoid = what type of lesion?

Bankarts

Primary stabilizer of medial knee against valgus force and lateral rotation of tibia

Medial Collateral Ligament

Laxity with valgus testing inability to fully extend knee loss of strength, proprioception, antalgic gait what pathology?

MCL Sprain (grade 2)

this ligament attaches proximally on lateral femoral condyle to the distal posterior insert at the fibula injury is far less common than to counterpart

Lateral Collateral Ligament of the knee

Most common joint disease

Osteoarthritis

Risk factors for secondary OA of young individuals?

``` Obesity repetitive micro trauma inflammatory arthritis neuromuscular disorders metabolic disorders ```

The Q-angle is the angle between what two cites

Patella v ASIS drop a plumb-line through the tibial tubercle and middle of the patella and another from the ASIS to intersect with the first line at the mid-patella. The angle created by the intersecting lines is the Q angle.

The XX is a region where the tibial nerve passes between the medial malleolus and the calcaneus. XX syndrome is characterized by pain in WB but not with direct palpation of patellar fascia. Numbness, burning pain, parasthesias at the heel with entrapmet and compression of posterior tibial nerve or plantar nerves; thickening of flexor retinaculum may be seen. What pathology?

Tarsal Tunnel Syndrome

Lateral shoulder pain with radiation into deltoid and upper arm mild to severe pain and lack of functionality with Sh lateral rotation and ABD Crepitus, night pain what pathology

RTC tear

Painful arc of motion at 60-120 degrees active ABD difficulty dressing, overhead motions what pathology?

Shoulder impingement, RTC tendonitis

Since RTC mm are dependent on adequate blood supply and O2, it is essential that all ROM and strengthening exercises are __ ___

PAIN FREE

Significant scoliosis can cause what type of insufficiency?

Pulmonary

Conservative tx for torticollis

Stretching, massage, positioning, bracing, HEAT and TRACTION

Over 50 yrs old back pain that increases with getting out of car/bed, standing, walking up incline or stairs pain may follow dermatomal distribution, myotomal weakness what pathology?

Spondylolysthesis (folowing DJD) follow williams flexion exercsie protocols

Posterolateral THA spares what mm group? - What containdicated movements? Anterolateral approach contraindicated movements?

Post-Lat spares Hip ABDuctors; Contraindicated is flexion past 90, adduction, Medial rotation Anterolateral = Hip flexion, Lateral rotation

Cemented hip THA WB precautions? Vs Noncemented?

Noncemented = TTWB for 6 weeks Cemented = PWB

Cemented TKA precautions vs Noncemented?

Cemented = PWB or WBAT Noncemented = TTWB for 6 weeks

TKA - what to avoid for several months after surgery?

Squatting Sleeping with pillows under knees (contractions) Quick pivoting

Most common sites for osteosarcoma? (most common primary bone tumor)

Epiphiseal plates of long bones distal femur proximal tibia proximal humerus pelvis

s/s of chemotherapy

``` anemia abnormal bleeding infection kidney impairment fatigue diarrea confusion ```

_____ _____, also known as PAD, produces thickening and narrowing with eventual occlusion of the arteries; results in ____ of affected tissues; areas may become ____, ____, and require amputation

Arteriosclerosis Obliterans Ischemia --> necrotic/necrosis, gangrenous

Individual over 45 that smokes, presents with intermittent claudication in gastroc/soleus, decreased pulse and skin temperature. Likely eventual candidate for what surgery?

Transtibial amputation

The Neer shoulder protocol advocates initiating isometric shoulder exercises approximately ? weeks after TSA, and active shoulder exercises ? weeks after surgery. What types of ROM are okay in first phase of rehab?

Isometric @ 3 wks, ACTIVE Sh exercise @ 6 wks PROM,AAROM okay in first phase (pendulum, rod)

Transverse fx of distal radius secondary to FOOSH associated deformity?

Colle's fx dinner fork/bayonet deformity - hand/wrist shaped in zig-zag

Infection of bone with staph = Osteo??? Calcification of mm post mm strain or contusion = ???

Infection = Osteomyelitis Calcification = Myocitis Ossificans

Compound vs communicated fx

compund - breaks skin communicated = shattered

What is a nonunion fx?

A fx that has failed to heal after 9-12 months

RTC tear repair precautions after surgery

AROM, lifting, WB through arm for several weeks

Precautions for shoulder stabilization surgeries (SLAP repair, capsular tightening, etc.) remember lab!

External Rotation Extension Horizontal ABDuction Resisted internal Rotation if subscap was detached during surgery

After a SLAP repair, avoid contracting ?

biceps

Common precautions for TSA

Avoid extension and external rotation to protect healing subscap and anterior capsule avoid resisted internal rotation

Signs of failure for hip ORIF following fx? (3) What is more common with these fractures?

Leg length discrepency taht was not present initially Trendelenburg sign that does not improve with strengthening persistent thigh/groin pain More common = nonunion and osteonecrosis d/t lack of blood @ femoral neck

For external hip ORIF, early ___ is allowed but ____ _____ is postponed until mm have healed what mm likely affected from surgery?

Early WB, isotonic strenghtening postmponed TFL, Glute Med, Vasus Lateralis

Graft tissue is most vulnerable when?

6-8 weeks post op

ACL rehab = avoid what?

open chain ex @ o-45 deg (stresses graft site)

Ulnohumeral resting position vs Radiohumeral resting position

Ulonhumeral = 70 deg ext + 10 supination Raiohumeral - FULL ext, FULL sup

Radioulnar jts connect the ends of the radius and ulna. Proximal radioulnar resting position vs Distal

Proximal = 70 deg flexion, 35 sup Distal = 10 deg sup

Most common carpal fractured?

Scaphoid @ base of Radius

Name carpals in clockwise from SCaphoid S T T C H T P L

Scaphoid Trapezius Trapezoid Capitate Hamate Triquetrum Pisiform Lunate

Actions Origin Insertion Lat Dorsi

Scapular depression GH EXT + ADD + MR Originates @ spinous process T7-L5 Inserts at intertubuercular groove

Mm of scap upward rotation

Trap | Serratus

MSK review Flashcards

(118 cards)