MSK - Upper Body

Question 1

Whiplash Associated Disorder: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions

Answer 1

MOI: Abrupt acceleration-deceleration to the c-spine. Typically MVA or contact sports.
S/S: Decreased neck ROM, pain, increased tone in cervical spinal muscles, headaches, jaw pain, could have neuro symptoms
Diagnositc tests: No specific tests
General appraoch to treatment: Strengthening, stretching, traction, soft tissue
Education points: Importance of gentle movement. POLICE. Rest.
Precautions: 5 D’s, bilateral arm numbness, signs of concussion, C spine rules

Question 2

Cervicogenic Headaches: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions

Answer 2

MOI: From C-spine – bony, disc or soft tissue elements. Commonly associated with neck pain. Originates from AO joint and upper cervical joints, C1-C3 spinal nerves
S/S: Unilateral dominant headache, worse with neck movements and postures, tenderness of the upper c spine, increase tighness and trigger points in upper traps, LS, scalenes and suboccp extensors, splenius capitis and SCM.
Diagnositc tests: PROM and AROM. Flexion rotation test. Strength testing of DNF.
General appraoch to treatment: C spine mobilization, traction, DNF, thoracic spine mobilization, stretch suboccp
Education points: Posture education, reduce forward head posture, proper desk egronomics.
Precautions: Rule out sinister cause of headaches. Asl red flag questions.

Question 3

Cervical Disc Herniation: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions

Answer 3

MOI: Bulge from a c spine disc, increases inflammation and pressure around c spine nerve roots causing a radiculopathy.
S/S: Radiating symptoms down arm, myotomal weakness, dermatomal sensation changes, diminished deep tendon reflexes. Worse with coughing or sneezing. Referral pain around scapula.
Diagnositc tests: MRI is gold standard. ROM.
General appraoch to treatment: DNF, lower fiber of traps strengthening, postural awareness, traction, pain control.
Education points: Posture, exercises. Medical imaging education.
Precautions: Bilateral numbness, tingling and significant muscle weakness, loss of DTR and/or presence of Babinski

Question 4

Temporomandibular Myofasical Pain: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions

Answer 4

MOI: Correlated to teeth grinding, head forward posture leads to many symptoms.
S/S: TMJ would have no pain, no symptoms with mouth opening, normal mouth opening 35-40mm or 3 fingers
Diagnositc tests: Tenderness of master, temporalis, medial and lateral pterygoid, sub occipitals.
General appraoch to treatment: Intra oral soft tissue release, education on posture, dentist for mouth guard
Education points: AP jaw anatomu
Precautions:

Question 5

Jaw Anterior Disc Displacement (with and without reduction): MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions

Answer 5

MOI: With reductio - condyle can move forward, rolls over disc cause click when opening, condyle moves back also causing a click. Without reduction - lock jaw, condyle is blocked by the disc and unable to role and slide forward
S/S: Palpable reciproca click during opening and closing, lateral deviation towards the symptomatic TMJ, pain or tenderness of jaw, aching pain in or around your ear, difficulty chewing or pain with chewing, aching facial pain, locking of the joint
Diagnositc tests: Palpation, click, MRI
General appraoch to treatment: mobilizations, manual therapy, STR, HEP, postural education.
Education points: Posture, avoid biting or chewing nails, don’t rest hand under chin, place fingers on chin to while yawning to avoid anterior translation
Precautions: Superior lateral pterygoid is overworking and eccentrically not allowing disc to go fully back.

Question 6

Frozen Shoulder (Adhesive Capsulitis): MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions

Answer 6

MOI: The ligaments and capsule surrounding the shoulder joint undergo an inflammatory process resulting in swelling and stiffening. Primary = idiopathic, no known cause. Secondary = due to traumatic event, surgery.
Risk Factors: Prolonged immobilization, diabetes, Dupuytren’s disease (genetic contractors), hypothyroidism, women more than men, age 40-65.
S/S: Hallmark signs 1) pain: dull, diffuse, often occurring at the deltiod insertion. 2) muscle atrophy 3) limited ROM: abduction, ER and IR
Diagnositc tests: Hx of onset, MOI and pain, loss of ER, abduction and IR, shoulder hike with AROM. Night pain.
General appraoch to treatment: Massage, acupuncture, modalities, mobilizations (posterior-lateral glides for ER, inferior for abduction), passive stretching,
Education points: HEP, duration to heal
Precautions: Other common shoulder injuries - tendinopathy, biceps tenditis, subacromical bursitis.

Question 7

Shoulder Instability: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions

Answer 7

MOI: Trauma or ligament laxity that decreases stability. Labral tears are commonly associated.
Types: Anterior (most common), posterior, inferior (occurs when the impact causes arm hyper-abduction, superior (very rare)
S/S: Pain, decrease ROM, swelling, shoulder may be depressed on affected side, slipping or popping when in position of apprehension. Axilla nerve may be damaged if severe dislocation.
Diagnositc tests: Apprehension test, axilla nerve symptoms (weakness in deltoids and tires minor)
General appraoch to treatment: shoulder stabilizing exercises, strengthen adductors and internal rotators, postural education, rotator cuff strengthening
Education points: Rotator cuff are common with anterior dislocations.
Precautions: Stay out of positions of apprehension

Question 8

Impingement Syndrome: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions

Answer 8

MOI: Compression of –> supraspinatus, long head of biceps or subacromial bursa. Can occur from a change in coracoacromial arch. Poor posture.
S/S: Pain during elevation on anterior and lateral aspect of shoulder. Painful arc 60-120 degrees. Weakness. No pain below elbow. Pain with rolling onto shoulder.
Diagnositc tests: Hawkins Kennedy, Neers
General appraoch to treatment: POLICE, scap stabilization, strengthen rotator cuff
Education points: do NOT immobilize
Precautions: DD: cervical Spondylosis

Question 9

Lateral Epicondylagia: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions

Answer 9

MOI: 90% involve ECRB - originates at lateral epi. 10% ECRL. Most common overuse/repetitive use injury at the elbow.
S/S: Usually symptomatic with activities involving wrist and/or finger extension.
Diagnositc tests: Maudsley’s (3rd finger), Cozens (radial deviation and wrist extension), Mills (passive pronation and flex wrist.
General appraoch to treatment: AP
Education points: Check mid C spine for nerve irritation. Lateral antebrachial distrubution, C6 myotome.
Precautions: Tendinopathy/Tendinosis

Question 10

Condition: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions

Answer 10

MOI:
S/S:
Diagnositc tests:
General appraoch to treatment:
Education points:
Precautions:

Question 11

Medial Epicondylagia: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions

Answer 11

MOI: Pronator teres and flexor carpi radialis. Repetitive motions to the wrist.
S/S: Pain at elbow using wrist flexors, pain when muscle is stretched or contracts against resistance. Decreased grip strength, limited by pain.
Diagnositc tests: Palpation tenderness on or near the medial epicondyle. Pain with resisted wrist flexion (with elbow extended). Pain with passive wrist extension while elbow is extended. Ulnar neuropathy is often an associated finding.
General appraoch to treatment: Flexion exercises. Eccentric.
Education points: Check mid C spine, C8-T1 sensory, C8-T1 myotomal.
Precautions:

Question 12

Colles Fracture: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions

Answer 12

MOI: Distal radius, linear transverse fracture of the distal radius.
Risk factors: young or elderly, more common in females.
S/S: Dinner fork demerit, FOOSH, dorsal wrist pain, swelling, inability to graps objects.
Diagnositc tests: X ray
General appraoch to treatment: Casted until ready, keep fingers and shoulder moving, strengthen, ROM and functional exercises.
Education points:
Precautions: Often assoicated with ulnar styloid #, TFCC tear and scapholunate dislocation.

Question 13

Scaphoid Fracture: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions

Answer 13

MOI: FOOSH fal, most common # of carpal bone.
S/S: Pain with pinch or graps, visible swelling and/or bruising. Poor blood supply. Complications are common. Arthritis overtime.
Diagnositc tests: X ray
General appraoch to treatment: Initially casting or surgery.
Education points: Wrist guards.
Precautions:

Question 14

Condition: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions

Answer 14

MOI:
S/S:
Diagnositc tests:
General appraoch to treatment:
Education points:
Precautions:

Question 15

Condition: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions

Answer 15

MOI:
S/S:
Diagnositc tests:
General appraoch to treatment:
Education points:
Precautions:

Question 16

De Quervains Tenosynovitis: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions

Answer 16

MOI: Irritation of APL EPB. Over use, radial deviation. Chronic overuse.
S/S: Pain with radial deviation as well as pain with stretch.
Diagnositc tests: Finkelstein’s test.
General appraoch to treatment: Splinting, activity modification.
Education points: Change limitng mechanics, keep wrist in neutral and avoid radial deviation.
Precautions:

Question 17

Condition: MOI, S/S, diagnositc tests, general appraoch to treatment, education points, precautions

Answer 17

MOI:
S/S:
Diagnositc tests:
General appraoch to treatment:
Education points:
Precautions:

Question 18

Copy Above

Question 19

Stages of Frozen Shoulder: Freezing, Frozen & Thawing

Answer 19

Freezing: Painful, progressive. Intense pain at rest and limitation of movement. Reduced abduction < 100, ER < 5, IR < 55. Restriction normally begins before pain.
Frozen: Reduction in pain and progressive stiffness of shoulder. Pain only with movement and significant adhesions, limited GH motions. Atrophy of deltoid, triceps, and biceps.
Thawing: Mobility of shoulder returns, no pain and no synovitis but significant capsular restrictions from adhesions. Some patients never regain full ROM.

Question 20

WAD Grading

Answer 20

Grade 0: No complaints about the neck, no physical signs
Grade 1: Neck complaints of stiffness, pain or tenderness only. No physical signs.
Grade 2: Neck complaints AND MSK (objective) signs (decreased ROM, point tenderness, NO neuro signs). No fracture/dislocation.
Grade 3: Neck complaints AND peripheral neurological signs (motor or sensory) such as decreased/absent DTR, weakness, sensory deficits. No fracture or dislocation.
Grade 4: Neck complaints AND fracture or dislocation, confirmed with medical imagine.

Question 21

Canadian C Spine Rules

Answer 21

1. Any High Risk Factors: age 65 or above, dangerous mechanism, paresthesias in extremities
2. Any Low Risk Factors that allow safe assessment of range of motion: simple rear end OR sitting positions OR ambluatory at any time OR delayed onset of neck pain OR absense of midline c-spine tenderness
3. Able to assess neck: 45 right to left

Question 22

Temporomandibular Anatomy

Answer 22

• Muscle of mastication innervated by cranial nerve V (trigeminal)
• Masseter: thick and rectangular muscle in the cheek that functions to close jaw and clench teeth
• Temporalis
• Medial Pterygoid: elevation (closing) and protraction and side to side movement of the lower jaw: assists in chewing
• Lateral Pterygoid: only muscle of mastication that assists in depressing the mandible (opening the jaw) + assists in chewing and protraction

Question 23

Shoulder Anatomy

Answer 23

• 4 joints: GH, SC, scap thoracic, AC
• SC joint: saddle joint with a fibrocartilage disc between articular surfaces; get 30 deg of axial rotation
• Scap Thoracic: physiological joint between ant surface of scapula and post surface of the thorax; supported by muscle movement
• AC joint: plane (gliding) supported by acromioclavicular and coracoidclavicular ligament

Question 24

Frozen Shoulder Exercises

Answer 24

PROM: Pt performs PROM, towel IR, pendulums
AROM: finger wall walking, AROM ER
AAROM: abduction and flexion with broom stick

Question 25

Shoulder Stabilization Exercises

Answer 25

- Strengthen the proximal muscles of the thorax, neck and shoulders before starting any dynamic strengthening of the muscles that move the GH in order to avoid faulty mechanics. Phase 1: Scapular Stabilization: Middle and lower fibers of traps & SA Phase 2: Rotator Cuff Stability: Isometrics through range, thera band exercises

Question 26

Pancoast Tumor

Answer 26

- Difficult to diagnose early on - S/S: severe pain in shoulder regions radiating towards the axilla and scapula along the ulnar aspect of the muscles of the hand, atrophy of hand and arm muscles, Horner Syndrome (dropping or falling eyelid, inability to sweat, constricted pupil), compression of the blood vessels with edema, neck pain, pain relieved when propping arm up on table or with other arm - 40 to 60 y/o

Question 27

Scapular Winging

Answer 27

- Inferior dysfunction: anteriorly tipped - Medial dysfunction: internal rotation of the scapula in the transverse plane - Superior dysfunction: excessive and early elevation of the scapula during elevation Causes: - Lesion of long thoracic nerve affecting weak SA - Trap palsy - Strain of rhomboids - Tight pec minor and/or short head of biceps - Multidirectional instability - Voluntary action - Painful shoulder causing muscle inhibition

Question 28

Shoulder Labral Tears

Answer 28

- Bankart Lesion: avulasion of the capsule and ligament complex from the ANTERIOR INFERIOR lip of the glenoid (3-7 o'clock), common with ANTERIOR shoulder dislocations, causes anterior instability and loss of stability from inferior glenoihumeral ligaments - Hill Sachs Lesions: Results from a force posteriorly, leading to anterior dislocation - SLAP: Detachment of labrum from 10-2 o'clock, when the biceps tendon is involved = further instability

Question 29

AC Joint Subluxation

Answer 29

- Formed by medial aspect of the acromion process of the scapula and the lateral end of the clavicle. - Plantar Joint - Ligaments: acromioclavicular, coracoclavicular - Support: capsule, deltoid, traps - Men 5x more (sporting - hockey) - Incomplete seperation more common than complete - Usually caused by direct hit or landing on the shoulder (arm normally adducted) - TREATMENT: deltoid and trap cross the joint so strengthen thoses muscles for support

Question 30

Bursa

Answer 30

- Inflammation of the bursa (small sacs of serous membrance that form at sites of compression or friction and produce watery fluid to lubricate surfaces and facilitate movement of tendons against bone) - Caused by overuse, direct trauma/injury, gout, infection - Most frequent location is subacromial area - S/S: pain at rest, AROM and PROM are painful

Question 31

Postures that can lead to shoulder pathology

Answer 31

- Increased thoracic kyphosis - Forward head posture - Decreased thoracic mobility - Abducted and forward tipped scapula

Question 32

Cervical Spondylosis

Answer 32

- Age 50+, acute or chronic - Minimal or no cervical spine movement. May present with torticollis. - AROM and PROM limited by pain - Resisted isometrics: normal, myotome may be affected - Special tests: Spurlings +ve, distraction test eases, ULTT +ve - Sensory function and reflexes: dermatomes and reflexes affected - Palpation: tender over appropriate vertebrae or facet - X ray: narrowing osteophytes

Question 33

Tennis Elbow Treatment: Acute Phase

Answer 33

Goals: control pain/inflammaion & maintain length/ROM - Rest, ice, modalities, patient education, tennis elbow strap - Avoid gripping and wrist extension

Question 34

Tennis Elbow Treatment: Repair Phase

Answer 34

Goals: Gently stress collagen & increase muscle length - Deep tendon friction massage, eccentric exercises, joint mobilization - Stretching exercises for elbow/wrist/hand, massage

Question 35

Tennis Elbow Treatment: Remodelling Phase

Answer 35

Goals: Increase collagen strength, increase tissue extensibility & return to activity - Progress eccentric exercises (increase reps before weight) - DTF massage, stretching - Global strength, functional and task specific drills

Question 36

How to rule of Cervical Referral Pain?

Answer 36

PMHx: CSP disc herniation, stenosis, osteophytes, neck pain, spondylosis Pain/Paresthesia: sharp, burning, numbness or pins and needles in affected dermatomes Tenderness: over affect area of posterior cervical spine Other signs: ROM decreased, myotomal weakness, reflexes depressed in nerve root Positive special tests: pain with side flexion, rotation, extension with compression increasing pain, cervical traction decreases symptoms, ULTT positive

Question 37

Elbow Anatomy

Answer 37

Elbow extension: distal movement of radius on ulna, abduction of ulna relative to humerus, pronation of ulna relative to humerus - Before age of 10, annular ligament that holds head of radius on the ulna is not fully formed -- can result in pulled elbow. - Cubital fossa: (Radical BBM) = radial nerve, biceps tendon, brachial artery, median nerve

Question 38

Fractures

Answer 38

- Defines by: site, extent, configuration, relationship of fragments, relationship to environment, complications - Precautions post fracture: radiologically healed, no stretch or resisted forces around the fracture site until bone is healed - No excessive joint compression or shear for several weeks after the period of immobilization - Use protection, weight bearing cannot begin until fracture is healed

Question 39

Wrist Anatomy

Answer 39

Proximal row (lat to med): Scaphoid, Lunate, Triquetrum, Pisiform Distal row (lat to med): Trapezium, trapezoid, capitate, hamate - ECRL to 2nd MC - ECRB to 3rd MC

Question 40

Cervical Spine Scan

Answer 40

Subjective Questions: 5D's - dizzineaa, dysphagia, dysarthria, diplopia, drop attacks + 2 N's - nausea, nystagmus Observation: front, back, side to side, sitting ROM: C spine flexion, extension, side flexion, rotation, shoulder and t spine Neurological: myotomes, dermatomes, reflexes, Babinski, clonus Neurodynamic: Slump, ULTTs Provocative: Spurlings compression, distraction Pulses: Carotid

Question 41

Reflexes

Answer 41

Biceps: C5/6 Brachioradialis: C5/6 Triceps: C7 Patella: L3 Achilles: S1

Question 42

Lumbar Spine Scan

Answer 42

Subjective Questions: saddle paresthesia/loss of bowel or bladder control/bilateral leg numbness and tingling Observation: front, back, side, squat, one leg stance ROM: Lumbar spine, hip, knee, ankle Neurological: myotomes, dermatomes, reflexes, Babinski, clonus Neurodynamic: SLR, Slump, prone knee bend (femoral nerve) Provocative: compression, distraction Pules: femoral and popliteal

Question 43

Myotomes: Upper Body

Answer 43

C4: resisted shoulder shrug C5: shoulder abduction C6: elbow flexion or wrist extension C7: elbow extension or wrist flexion C8: thumb extension or finger flexion T1: fingers abduction or adduction

Question 44

Myotomes: Lower Body

Answer 44

L1-L2: hip flexion L3: knee extension L4: dorsiflexion L5: great toe extension S1: plantar flexion or hip extension S2: knee flexion

Question 45

Dermatomes

Answer 45

C4: over AC joint C5: on lateral side of antecubital fossa, just proximal to the elbow C6: dorsal surface of thumb C7: dorsal surface of the proximal middle phalanx C8: dorsal surface of the proximal little phalanx T2: apex of axilla T4: mid clavicular line at the level of the nipples T10: level of umbilicus L1: Inguinal line L2: medial upper thigh L3: medial knee L4: medial malleolus L5: dorsum of the foot at the third MTP joint S1: lateral calcaneus S2: posterior knee S3: ischial tuberosity S4-5: perineum

Question 46

Symptoms of decreased neural mobility

Answer 46

Pain, paresthesia, spams

Question 47

ULTT: Medial

Answer 47

- Shoulder: depression and abduction to 110 - Elbow: extension - Forearm: supination - Wrist: extension - Fingers and thumb: extension

Question 48

ULTT: Radial

Answer 48

- Shoulder: depression and abducted to 10 - Elbow: extension - Forearm: pronation - Wrist: flexion and ulnar deviation - Fingers: flexion

Question 49

ULTT: Ulnar

Answer 49

- Shoulder: depression and abduction to 10-90 - Elbow: flexion - Forearm: pronation - Wrist: extension and radial deviation - Fingers: extension

Question 50

Spinal Nerve Plexus

Answer 50

- Cervial C1-C4: serves the head, neck and shoulders - Brachial plexus C5-T1: serves the chest, shoulders, arms and hands - Lumbar plexus T12-L4: serves the back, abs, groin, thighs, knees and calves - Sacral L4-S4: serves pelvis, butt, genitals, thighs, calves and feet

Question 51

Erb's Palsy

Answer 51

- Injury to C5-C6 nerve roots: upper trunk of brachial plexus - Due to increased angle between head and shoulder. Often in new borns from out of the canal or sporting injuries - Loss of EF, WE, most movements of shoulder - Can affect rhomboids, LS, supinator, SA, delts, supraspinatus, intraspinatus, biceps, brachioradialis, brachalis, long extensors of wrist, fingers and thumbs - S/S: loss of sensation in the arm and paralysis and atrophy of the deltoids, biceps, and brachialis muscles. - Position: affected arm is adducted, internally rotated, elbow extended and forearm pronated. - Treatment: immobilization initially, gentle ROM, play exercises, prevent contracture

Question 52

Klumke's Palsy

Answer 52

- Claw hand - Injury to C8, T1 (lower trunk of the bracial plexus) - Often seen in falling accidents when person tries to hang on to avoid falling - Weakness of wrist flexors and finger flexors and intrinsic hand muscles

Question 53

Median Nerve Palsy

Answer 53

- Ape hand - Injury to C5-8, T1 medial nerve - Impairment of the thenar muscles, can't abduct or oppose thumb

Question 54

Carpel Tunnel Syndrome

Answer 54

- Compression of the median in palmar aspect of the wrist, can atrophy the thenar muscles - Carpal tunnel consists of flexor pollucis longus, FDS, FDP, contained by transverse carpal ligament anteriorly - Causes: anterior dislocation of lunate, tenosynovitis of the flexor tendons, direct trauma, obesity, pregnancy, #, occupation demands, overuse - S/S: sesnory changes in the median nerve (excluding the palm), night numbness, thenar atrophy, weakness, weakness of opponens pollicis muscles - Paresthesia of palmar surface of thumb, index fingers, pain distally - Special tests: positive phalen's (sustained wrist flexion), loss of two point discrimination, positive Tinel sign (tapping on medial nerve) - Treatment: tendon gliding, median nerve mobilizations, activity modification, patient education, wrist brace

Question 55

Thoracic Outlet Syndrome

Answer 55

- Entrapment syndrome cause by pressure on brachial plexus - Thoracic outlet is comprised of: subclavian artery + vein, brachial plexus, vagus/phrenic nerve and sympathetic trunk - Causes: compression at neuromuscular structures in scalene triangle, 1st rib pulled closer to clavicle by tight scalenes, poor posture, trauma, body composition, chronic compression (neuropraxia and Wallerian degeneration can occur) - S/S: pain, paresthesia, numbness, weakness, discoloured, swelling, loss of pulse. Raynaud's - Special tests: Wright Test or Allen's Maneuver (arm abducted to 90, look away, palpate radial pulse, look for it to diminsh or go away), Military Brace (palpate radial pulse then draw patients shoulder down and back. Positive if diminished or loss of a pulse) and Adson's (locate radial pulse, head rotate to the test shoulder and extends head while examiner laterally rotates and extends shoulder) - Treatment: regain normal muscle length, improve endurance, patient education - posture, nerve mobility

Question 56

Double Crush Syndrome

Answer 56

- Nerve irritability - Develop symptoms at other areas along the course of the nerve as well as at the primary site - Ex: TOS and carpal tunnel

Question 57

Posture

Answer 57

- Optimize posture to avoid energy expenditure of muscles - Postural control: anticipatory, reactive

Question 58

Plumb Line

Answer 58

Bony landmarks - slightly behind coronal suture, thru external auditory meatus, thru dens of the axis, thru cervical vertebral bodies - thru lumbar vertebral bodies, thru sacral promontory, slightly behind hip joint - slightly anterior to the knee joint - slightly anterior to the ankle joint thru the calcaneocuboid joint Surface landmarks: - thru the ear lobes, thru shoulder joint, midway of the trunk, thru greater trochanter, slightly anteruor to the knee joint, slightly anterior to the ankle joint

Question 59

Scoliosis

Answer 59

- Named relative to the convexities of the curves, with apex of the curve defining the verbral level - Rotation of the spine towards side, causes ribs to the more prominent posteriorly on convex side, especially with flexion of the spine. Shoulder may also be elevated on convex side. - 5 to 7 degrees of scoliosis is considered normal - 15 degrees or less is treatable with exercise - Usually right handed: mild right thoracic, left lumbar s-curve or mild thoracolumbar c-curve. - Structurally: irreversable, involves lateral curvature with fixed rotation of the vertebrae -- 3 kinds: idiopathic, congenital, neuromuscular - Functional: reversible - Structures compresses on concave side and stretched on convex side - Example: R scoliosis - R side convex - R side stretched - L side compressed - Treatment: education on exercise and posture, bracing, stretch tight muscles, strengthen weak muscles, postural exercises, deep breathing

Question 60

Forward Head Posture

Answer 60

- SHORT: cervical extensors, UFT, LS, SCM and scalenes - LONG: cervical flexors

Question 61

Exaggerated Lumbar Lordosis

Answer 61

- SHORT: erector spine, hip flexors - LONG; abdominals, hamstrings and glute max

Question 62

Posterior Pelvic Tilt

Answer 62

SHORT: tight abs, hip extensors (hamstrings and glute max) LONG: hip flexors and erector spinae

Question 63

Exaggerated Thoracic Kyphosis

Answer 63

SHORT: pec minor and major LONG: stretched PPL, stretched erector spine, scap retractors

Question 64

Genu Recurvatum

Answer 64

- Knee hyperextension, greater extension moment - Causes shortened gastric, spasicity of quads, weakness in quads, APT

Question 65

Important Landmarks

Answer 65

T2 - second rib - superior angle of scapula T3 - spine of scapula T7 - rib 7 - inferior angle of scapula S2 - level of PSIS S5 - inferior lateral angle

Question 66

Concussion: Overview

Answer 66

- A complex pathological process affecting the brain induced by traumatic biomechanical forces - Mild form of TBI (most common TBI)

Question 67

Concussion: Causes

Answer 67

- Direct blow - Coup contrecoup mechanism - Rapid onset of short lived impairments for neurological function that resolves spontaneously in most cases - Risks: contact sports anti-coagulants, prior brian injury

Question 68

Concussion: Signs and Symptoms

Answer 68

- Headahce, drowiness, confusion, neck pain, dizziness, low energy, emotional problems, vision problems, light/noise sensitivity - Vomitting, poor vision tracking, balance impairments, trouble with memory recall, slurred speech - Symptoms typically resolve on their own within 7-10 days but some can prolong for longerC

Question 69

Concussion: SCAT 5

Answer 69

- For 13 years or older - Symptoms, congition, balance and coordination

Question 70

Concussion: ImPACT

Answer 70

- Immediate Post-Concussion Assessment and Cognitive Test - Baseline and post injury testing

Question 71

Concussion: King Device Test

Answer 71

- Sideline concussion screening - Less than two minutes - Assess eye movement, attention and language

Question 72

Concussion: Secondary Impact Syndrome

Answer 72

- Extremely rare - Fatal uncontrolled swelling of the brain - Occurs when someone suffered a minor second blow before the symptoms of a prior brain injury are resolved - More common in young males

Question 73

Concussion: Post Concussion Syndrome

Answer 73

- Persistent concussion symptoms for > 1 month - Cumulative effects: 3+ concussions 5x greater risk of Alzheimer's, 3x memory deficits

Question 74

Concussion: Initial Treatment

Answer 74

- Physical and cognitive rest - DO NOT stay in a dark room with no stimulus - Education: restrict - TV, phone, intense PA, school, sports, driving, reading - Education: allow - increase sleep, slow walks, hydration, proper nutrition, listening to audiobooks, gentle yoga, - Graduated return to cognitive and physical activities

Question 75

Concussion: Gradual Return to Play

Answer 75

- Guided by symptoms - Physician gives final okay to play - Progression to next step if only symptoms free for 24 hours - Must go back to asymptomatic level for least 24 hours if symptoms occur