MSPT - EXAM 2 Flashcards
(423 cards)
1
Q
Common Repetitive Stress Injuries (RSIs)
A
Tendinopathy Thoracic Outlet Arthritis Peripheral nerve entrapment Myofascial pain syndromes Neck and back postural strain
2
Q
What are workplace factors that lead to the development of MSDs?
A
Repetitive, forceful, or awkward movements over time
Prolonged bad posture
3
Q
Reported cases of work-related injuries cost how much annually?
A
$54 billion
4
Q
What is the most prevalent work-related MSD?
A
Carpal tunnel syndrome (2/3 of all work-related injuries)
5
Q
Risk factors for carpal tunnel syndrome?
A
Prolonged wrist flexion/extension Repetitive gripping Repetitive ulnar deviation Repetitive pinching Repetitive supination Exposure to cold or vibration Mechanical compression
6
Q
What is myofascial pain syndrome caused by?
A
Trigger points - bands in muscles that are tight and tender
7
Q
Risk factors for RSI or CTD (cumulative trauma disorder)?
A
Repetitiveness Forces Posture (constrained/awkward) Vibration Psychological stress Workstation design Sedentary jobs Excessive alcohol Smoking Arthritis Poor nutrition Biomechanical alignment issues
8
Q
What is Stage I RSI/CTD?
A
Some symptoms at work
Physical exam is essentially clear
9
Q
What is Stage II RSI/CTD?
A
Symptoms begin earlier in the day and start to linger after work
Some difficulty doing job at normal pace
(+) exam findings
10
Q
What is Stage III RSI/CTD?
A
Symptoms at rest or on days off
Activities outside of work are affected
Progressive disability
11
Q
What is assessed during a task assessment?
A
Forces (using dynamometer) Time (hours working, how many breaks) Repetitions Task variety Body mechanics External support (ex: vibration gloves) Evaluate tools of job (ex: weight, grip width of hammer)
12
Q
Effects of Forward Head Posture (FHP)?
A
Compression of upper CS Tension and shearing of lower CS Loss of lumbar lordosis Increase thoracic kyphosis Increased risk of disc pathology Shoulder girdle protraction (impingement) Stretch weakness in postural muscles Muscular trigger points Adaptive shortening of certain muscles (ex: subocipitals, pectoralis)
13
Q
Workstation suggestions
A
Use wrist rest Lumbar support 90 deg elbow angle Thighs parallel to floor Feet on ground or footrest Use document holder VDT screen in direct line of sight Screen center 15 deg below horizontal
14
Q
What are other important factors in prevention against RSI/CTD besides workstation design and posture?
A
Task diversity
Work pauses and rest periods
Physical fitness
15
Q
Musculoskeletal and neuromuscular tissues require what 3 things to maintain health?
A
Normal biomechanical stresses (intermittent compression and unloading)
Movement
Unimpaired circulation
16
Q
How can you be at risk for injury if you are in a correct posture?
A
If the posture is prolonged/static - no movement to maintain healthy tissue
17
Q
How long should work pauses be?
A
Recommendations vary:
between 30 sec and 15 min per hour
18
Q
What is the difference between a colles’ fracture and a smith’s fracture?
A
Colles’: extension fracture of radius (distal radius displaced dorsally)
Smith’s: flexion fracture of the radius (distal radius displaced anteriorly)
19
Q
What age/gender is commonly affected by Colles’ fracture?
A
Post-menopausal women
20
Q
What is the common mechanism of a colles’ fx?
A
FOOSH
21
Q
What are the ways to immobilize a collies fx?
A
Rigid splint
Casting (in slight flexion)
ORIF
External fixator
22
Q
Why are ADL’s limited after immobilization for colles’ fx is removed?
A
Pain
Poor grip
ROM impairments
23
Q
Why is dynamic splinting a great tool for increasing ROM?
A
Keeps patient in low load prolonged stretch for hours - much longer than a PT session (TERT)
24
Q
What are finger ladders good for?
A
Shoulder flexion ROM
Elbow and wrist extension ROM
Finger flexor and extensor activation
25
What is the Triangular Fibrocartilage Complex (TFCC) made of?
Ulnar collateral ligament
Palmar ulnocarpal ligament
Articular disc
26
WHat are the functions of the TFCC?
Primary stabilizer of distal radioulnar jt
Reinforces ulnar side of wrist
Forms part of radiocarpal joint
Transfers part of the compression forces that cross the hand to the forearm (20%)
27
What forms the carpal tunnel?
Transverse carpal ligament
28
What is in the carpal tunnel?
Flexor Digitorum Profundus tendons
Flexor Digitorum Superficialis tendons
Flexor Pollicis Longus tendon
Median n.
29
Roll and glide of distal radioulnar joint?
Same direction
Concave radius on convex ulna
30
Normal ROM and end feel of: Wrist flexion
80 (firm)
31
Normal ROM and end feel of: Wrist extension
70 (firm)
32
Normal ROM and end feel of: Ulnar deviation
30 (firm)
33
Normal ROM and end feel of: Radial deviation
20 (firm or hard)
34
Roll and glide of radiocarpal joint during flexion/extension?
Opposite
Convex lunate on concave radius
35
Roll and glide of radiocarpal joint during ulnar/radial deviation?
Opposite
Convex proximal carpal row on concave radius
Convex capitate on concave lunate
36
What are the primary wrist extensors?
ECRL, ECRB, ECU
37
What are secondary wrist extensors?
ED, EI, EDM, EPL
38
Peak grip strength occurs when wrist is in what position? Lowest grip strength?
Peak: 10-30 deg extension
Lowest: full flexion
39
What are primary wrist flexors?
FCU, FCR, PL
40
What are secondary wrist flexors?
FDP, FDS, FPL, APL, EPB
41
What is tenodesis?
Passive effect of wrist position on length and passive tension of finger flexors.
Active contraction of wrist extensors puts finger extensors on slack and pulls finger flexors into tension.
42
What patient is able to make the most out of tenodesis?
C6 tetraplegia patient - no active finger flexion but can actively extend the wrist (passive functional grip)
43
Wrist drop is caused by what kind of injury?
Radial nerve lesion or C6-7 radiculopathy
44
What is the roll and glide of MCPJ?
Same
Concave PIP on convex MC
45
What is the roll and glide of IPJ?
Same
Concave base on convex head
46
ROM/End feel of D1 CMC flexion
15 (soft/firm)
47
ROM/End feel of D1 MCP flexion
50 (firm)
48
ROM/End feel of D1 IP flexion
80 (firm)
49
ROM/End feel of D1 CMC extension
20 (firm)
50
ROM/End feel of D1 MCP extension
0 (firm)
51
ROM/End feel of D1 IP extension
20 hyper (firm)
52
ROM/End feel of D1 CMC abduction
70 (firm)
53
ROM/End feel of D1 CMC adduction
0 (soft)
54
Roll and glide of D1 CMC abduction?
Opposite
Convex MC on concave trapezium
55
Roll and glide of D1 CMC flexion/extension?
Same
Concave MC on convex trapezium
56
What is the purpose of the volar plate of the finger?
Prevents hyperextension
57
Where are synovial sheaths of the wrist extensor tendons? Flexor tendons? What is synovitis?
Extensors: at wrist
Flexors: wrist and digits
Synovitis - inflammation of tendon sheaths
58
What is the extensor hood of the finger?
Central tendon, lateral bands of the ED, and fibrous extension of distal lumbricals/interossei
59
What is the intrinsic plus position?
Simultaneous contraction of interossei and lumbricals
MCP flexion and IP extension
60
What is the extrinsic plus position?
Simultaneous contraction of extrinsic muscles (FDS, FDP, ED)
MCP hyperextension and IP flexion
61
What is a boutonniere deformity?
Extension of MCP and DIP joints
Flexion of PIP joint
Rupture of tendinous slip of extensor hood
(RA or trauma)
62
What is a swan neck deformity?
Flexion of MCP and DIP joints
Extension of PIP joint
Contracture of intrinsic muscles or tearing of volar plate.
(RA or trauma)
63
What is an ulnar drift deformity?
Swelling destabilizes the MCP joints and ruptures their ligamentous support. Flexor/extensor tendons migrate medially.
Also anterior subluxation of MCP joints
(RA)
64
What is trigger finger?
Finger stuck moving into either flexion or extension at the swollen tendon/sheath tries to squeeze into fibrous tunnel.
Usually from trauma or overuse.
65
ROM/End feel of D2 MCP flexion
90 (firm)
66
ROM/End feel of D2 MCP extension
45 (firm)
67
ROM/End feel of D2 PIP flexion
100 (soft/firm)
68
ROM/End feel of D2 PIP extension
0 (firm)
69
ROM/End feel of D2 DIP flexion
90 (firm)
70
ROM/End feel of D2 DIP extension
0 (firm)
71
What is a claw finger deformity?
Loss of intrinsics and overaction of extrinsics (intrinsic minus)
Hyperextension MCP
Flexion PIP and DIP
(Combined median/ulnar n. palsy)
72
What is ape hand deformity?
Wasting of thenar eminence and thumb falls back in line with fingers due to pull of extensor muscles. Unable to oppose or flex thumb.
(Median n. palsy)
73
What is Bishop's Hand deformity?
Wasting of hypothenar eminence, interossei, and 2 medial lumbricals. Flexion of 4th and 5th fingers.
(ulnar n. palsy at wrist level - STATIC deformity)
74
What is Dupuytren's contracture?
Contracture of palmar fascia. Fixed flexion deformity of MCP and PIP joints.
75
What is mallet finger?
Result of rupture or avulsion of extensor tendon where it inserts into distal phalanx. Distal phalanx rests in flexed position.
76
What intrinsic muscles are innervated by the ulnar n.?
All interossei and medial 2 lumbricals (D4-5)
77
Low ulnar nerve lesions cause a noticeable static Bishop's Hand deformity. High unlar lesions are less noticeable. Why?
FDP is now weakened for D4-5 so it exerts less of a flexion pull on the PIPs and DIPs.
78
What issues are caused by a low (at wrist) median nerve injury?
Carpal tunnel syndrome
Partial but noticeable clawing of D2-3 (weak lumbricals
Ape Hand may be observed due to weak thenar muscles
79
Why is there less static clawing of D2-3 in a high median n. injury compared to a low median n. injury?
Less pull from FDS and FDP
80
What muscles are affected by a high median n. injury (at elbow)?
All of ventral forearm except FCU and 1/2 FDP. Lumbricals 1-2 (D2-3) and thenar eminence muscles.
81
Why is there a Papal Benediction sign in a high median n. lesion when that is a deformity of ulnar n. palsy?
"Sign of Papal Benediction" occurs when pt tries to actively flex fingers (D4-5 flex at IPJ but D2-3 won't. This is similar to the static deformity caused by ulnar n. lesions.
82
Is it possible to have compression of the median nerve and not have any motor loss?
Yes, nerve injury must be affecting motor fibers of the nerve. It is possible to not have motor loss.
83
What nerve does Radial Tunnel Syndrome affect?
Deep radial nerve (motor)
84
Where is the site of entrapment in radial tunnel syndrome?
At entrance: anterior to radial head
OR
WIthin tunnel: between ulnar side of ECRB and distal border of supinator
85
Symptoms of radial tunnel syndrome?
Weakness in wrist extension and supination
Difficulty with grasp and wrist stabilization during gripping
Pain over dorsal lateral elbow
86
Clinical signs of radial tunnel syndrome?
Wrist drop
Tenderness along radial tunnel
(+) radial n. upper limb tension test
Weak wrist/finger extension and supination
87
What are you differentiating radial tunnel syndrome from?
Lateral epicondylitis
C6 radiculopathy
DJD of radiohumeral, radioulnar, or ulnohumeral joints
Brachial plexopathy
88
What is the site of entrapment for Posterior Interosseous Nerve Entrapment?
Between 2 heads of supinator
89
Symptoms of Posterior Interosseous n. Entrapment?
Some wrist extension weakness
Thumb/finger extension weakness
Difficulty with grasp and stabilizing wrist
Pain over mid and distal dorsal forearm
90
Clinical signs of posterior interosseous n. entrapment?
Wrist drop but not as bad as radial tunnel
May have repro symptoms with resisted supination
No sensory n. impairments
Weakness in more distal dorsal forearm muscles (EPL, EPB, APL, EI, ED, EDM, ECU)
91
What are you differentiating posterior interosseous n. entrapment from?
Radial tunnel syndrome
Lateral epicondylitis
Brachial plexopathy
C7-8 radiculopathy
92
What nerve is involved in pronator teres syndrome?
Median n.
93
What is the site of entrapment for pronator teres syndrome?
Between 2 heads of pronator teres
94
Symptoms of pronator teres syndrome
Weak pronation, finger/wrist flexion
Difficulty gripping
Pain over anterior forearm or median n. distribution of hand
Sensory impairments over cutaneous median n. distribution in palm and hand
95
Clinical signs of pronator teres syndrome
May observe Sign of Papal Benediction (muscle weakness)
Repro pain with resisted pronation
Impaired sensation: palm, anterior/dorsal tips of D1,2,3 and 1/2 of D4
Weakness in FCR, PL, FDS, lateral 1/2 FDP, FPL, PQ, thenar ms, lumbricals 1-2
Pronator teres is NOT weak
96
What are you differentiating pronator teres syndrome from?
Carpal tunnel syndrome
Medial epicondylitis
Brachial plexopathy
C5-7 radiculopathies
97
What nerve is involved in anterior interosseous syndrome?
branch of median n.
98
What is the site of entrapment for anterior interosseous syndrome?
Between 2 heads of pronator teres
99
Symptoms of anterior interosseous n. syndrome?
Wrist/thumb flexion weakness
Weak pronation
Pain over mid anterior forearm
100
Clinical signs of anterior interosseous n. syndrome?
(+) Pinch Test - unable to do tip to tip pinch with D1-2
Repro symptoms with resisted pronation
Weak: FPL, lateral 1/2 FDP, PQ
No sensory impairments
101
What are you differentiating from anterior interosseous syndrome?
```
Pronator teres syndrome
Brachial plexopathy
Forearm fracture
"Monteggia Fracture" - prox 1/3 ulna
Carpal tunnel syndrome
C5-6 radiculopathy
```
102
Symptoms of carpal tunnel syndrome?
Pain or sensory impairments in D1-3 and 1/2 of D4
Weak/clumsy grip
103
Clinical signs of carpal tunnel syndrome?
(+) Phalen's
(+) Tinel's over CT
May see "ape hand" and some clawing, especially at D2-3
Impaired sensation in palmar/dorsal tips D1-3 and radial 1/2 D4
Weakness: thenar eminence, lumbricals 1-2, grip
Sensation in palm is ok because palmar branch of median n. branched off above level of tunnel
104
What are you differentiating from carpal tunnel syndrome?
C5-7 radiculopathy
Brachial plexopathy
Median n. injury at elbow
Pronator teres syndrome
105
What nerve is involved with medial cubital tunnel syndrome?
Ulnar nerve (at level of elbow)
106
Symptoms of medial cubital tunnel syndrome?
Pain, paresthesias/numbness at: palmar side and dorsal tips of D5 and 1/2 of D4
Pain along ulnar side of elbow or forearm
Clumsy/weak grip or hand function
107
Clinical signs of medial cubital tunnel syndrome?
(+) Tinel's
Impaired sensation in ulnar distribution of hand
Weakness: medial FDP, FCU, hypothenar ms, interossei, lumbricals 3-4, adductor pollicis
May see some clawing at D4-5 but less than a low ulnar nerve lesion
108
What are you differentiating from medial cubital tunnel syndrome?
Medial epicondylitis
Brachial plexopathy
C8 radiculopathy
109
Where is the Tunnel of Guyon? What nerve is entrapped there?
Between pisiform and hook of hamate
Ulnar n. entrapment
110
What are the symptoms of ulnar n. entrapment at guyon?
Pain, sensory 1/2 D4 and D5
Pain along ulnar side of hand
Clumsy/weak grip and hand function
111
What are clinical signs of ulnar n. entrapment at guyon?
Inability to extend PIP and DIP of D4-5
Weak adduction/abduction fingers
Weak D5 flexion
Impaired sensation in ulnar distribution
Weakness: hypothenar ms, adductor pollicis, interossei, lumbricals 3-4
May see static deformity "incomplete claw hand" due to weakness
112
What are you differentiating from ulnar n. entrapment at guyon?
C8 radiculopathy
Brachial plexopathy
Medial cubital tunnel syndrome
113
What kind of splint would you use for immobilization of the 1st CMC joint (painful arthritis)?
Thumb spica splint
114
Does the entire thumb need to be covered by a thumb spica splint for DeQuervain's tenosynovitis?
No, the IP joint does not need to be immobilized because the 2 tendons involved (EPB and APL) do not cross the IP joint.
115
How would you differentiate between a scaphoid fracture and DeQuervain's tenosynovitis?
X-ray to rule out fracture
Scaphoid fracture is typically painful in floor of anatomical snuff box. DeQuervain's is painful directly over EPB and APL tendons (lateral border of snuff box).
116
How would you differentiate between DeQuervain's tenosynovitis and Intersection syndrome?
Both of these involve APL and EPB
DeQuervain's: pain at tendon sheaths of EPB/APL at lateral side of anatomical snuff box.
Intersection: pain from synovial sheaths of ECRL and ECRB where they cross under the muscle bellies of APL and EPB (about 4-8 cm proximal to Lister's tubercle).
117
What diagnoses can a thumb spica splint that cross the wrist be used for?
Scaphoid fracture
DeQuervain's tenosynovitis
Intersection syndrome
Arthritis of 1st CMC jt
118
What muscles are innervated by the median nerve?
APB
Opponens Pollicis
FPB
1st/2nd lumbricals
119
What is the sensory distribution of the median nerve?
Palmar surface and distal dorsal suface of D1, D2, D3, and radial side of D4
120
Why are CTS symptoms worse at night?
Body is horizontal - increased fluid pressure in UE's
Wrists drift into sustained wrist flexion or extension at night (flexion increases pressure and extension stretches/bends the nerve)
121
What is neurotmesis?
Most serious nerve injury - severance of the nerve. If partial neuotmesis, partial recovery can occur but not complete recovery.
122
Patient sustains neuotmesis injury to radial nerve in spiral groove of humerus. What kind of splint would you use?
Wrist "cock-up" splint that supports the wrist in slight extension - prevents wrist drop and optimizes functional use of hand.
123
Would you expect a patient with neuotmesis injury to recover over time?
Not unless patient has successful microsurgical repair of the nerve.
124
Would you expect a patient with axonotmesis injury to recover over time?
Yes, gradual recovery at about 1"/month.
125
What bone pathology would develop if external fixation pin sites were infected?
Osteomyelitis
126
What is the sensory distribution of the superficial radial nerve?
Radial/dorsal surface of hand and dorsal surfaces of D2-D3 as far as PIP joints.
127
What is normal period of time for recovery from impairments associated with a fracture?
Weeks immobilized x 2
128
Borders of the anatomical snuff box?
Medial: EPL
Lateral: EPB, APL
129
What muscles are part of the thenar eminence?
Abudctor Pollicis Brevis (APB)
Opponens Pollicis
Flexor Pollicis Brevis (FPB)
130
What muscles are part of the hypothenar eminence?
Abductor Digiti Minimi (ADM)
Opponens Digiti
Flexor Digit Minimi (FDM)
131
Bouchard's nodes
PIP joints; dorsal osteoarthritic enlargement
132
Heberden's nodes
DIP joints; dorsal osteoarthritic enlargement
133
How is gross grasp measured?
Measure tips of fingers to distal palmar crease
134
How do you measure finger abduction/adduction?
Measure fingertip to fingertip
135
What are the 3 types of pinch tested for pinch strength?
Tip pinch
Lateral pinch
3-jaw chuck pinch
136
What artery supplies the superficial palmar arch?
Ulnar artery
137
What artery supplies the deep palmar arch?
Radial artery
138
Purpose of static splints?
Protective
Supportive
Corrective
139
Purpose of dynamic splints?
Resolve tendon tightness
Resolve fixed joint contractures
Increase/Maintain AROM and/or PROM
140
Anatomical considerations of UE orthotics?
```
Support arches of hand
Creases
Bony prominences
Superficial nerves
Ligamentous stresses
```
141
What is the UE position of rest?
Midway btwn pronation/supination
Wrist 20 deg extension
IPs slightly flexed
Thumb partial opposition and forward
142
What is the UE position of function?
Wrist extension 20-35 deg
Normal transverse arch
Thumb in abduction and opposition, lined up with pads of 4 other phalanges
PIPs flexed 45-60 deg
143
What direction is the line of pull for flexion splints?
Toward the scaphoid
144
What is the angle of pull for extension splints?
90 deg angle of pull from outrigger to phalanx being mobilized
145
Causes of DeQuervain's?
Excessive, repetitive combined pinch with wrist motion and forearm rotation
Trauma to radial styloid process
Ganglion within 1st dorsal compartment
Diabetes, metabolic disorders
146
Symptoms of DeQuervain's?
Localized pain
Localized swelling
Limitation in ROM
Pain aggravated by ulnar deviation of wrist or flexion of thumb
147
Conservative TX for DeQuervain's?
```
Thumb spica splint
NSAIDS
Steroid injection
Anti-inflammatory modalities
Transverse friction massage
```
148
Surgical TX for DeQuervain's?
Decompression of 1st dorsal compartment by release of extensor retinaculum
149
Post-surgical management for DeQuervain's decompression?
```
Thumb spica 10-14 days
AROM of thumb IP joint and all digits
AROM of wrist 2 weeks post op
Scar management
Strengthening 6 weeks post-op
Edema control
Massage
Ice
```
150
Post-operative complications of DeQuervaine's surgery
Neuroma of superficial radial nerve
Scar hypertrophy
Persistent symptoms if all tendons not released
151
What is Dupuytren's disease?
Disease of fascia of the palm and digits
152
Causes of Dupuytren's disease?
Northern European descent
Chronic alcoholism
Epilepsy, Diabetes, Pulmonary disease
Presents as nodule and develops into tendon-like cords
Thickening and shortening of fascia causes contractors
153
Conservative treatments for Dupuytren's?
Splints
Steroid injections
Vitamin E
(ineffective)
154
When is surgical management for Dupuytren's indicated?
When MCP joint contracts to 30 deg or PIP contracts to 15 deg
155
Post-surgical management for Dupuytren's?
```
Extension splint 1st week
Continue splint at night and periodically
Wound care
Edema management
A/AA/PROM 1st tx session
Scar management
Light ADL
Light strengthening once wound healed
Splinting to achieve full flexion/extension
Splints with scar molds for up to 6 mo
```
156
Post-operative complications for Dupuytren's?
```
Hematoma
Edema
Skin necrosis
Infection
Stiffness
Pain
RSD
Recurrence of disease
```
157
What is the goal of surgical management for extensor tendon lacerations?
Restore continuity and maintain gliding of extensor mechanism from MP joints toward wrist levels
158
Post-op management of extensor tendon lacerations (0-21 days)
Volar splint with wrist 30-45 deg ext.
| Edema control
159
Post-op management of extensor tendon lacerations (4 weeks)
Discontinue extension splinting
160
Post-op management of extensor tendon lacerations (6-10 weeks)
Strengthening
161
Post-op complications from extensor tendon repair?
Tendon rupture
Excessive scar formation
Active extensor tendon lag
Extrinsic extensor tendon tightness limiting composite flexion
162
Surgical management for flexor tendon lacerations?
```
Should be done within 1 week of injury
Ensure secure knots
Provide smooth juncture of tendon ends
Prevent gapping
Maintain tendon vascularity
```
163
Post-op flexor tendon repair - how long does it take to resume activity?
Takes approximately 12 weeks for flexor tendon to regain enough tensile strength to avoid rupture with normal strong use of the hand required to grasp, hold, or lift objects during daily activities
164
Post-op management of flexor tendon repair?
Passive flexion - all phases of rehab
Wrist tenodesis
Extension limited by positioning with dorsal blocking splint
Full IP extension while in splint
NO composite finger extension for 4 weeks
Begin active tendon gliding at 4 weeks if adhesions are present
6-12 weeks splinting discontinued and resistance initiated
165
When is an adhesion present known after flexor tendon surgery?
When active flexion is significantly less than passive flexion
166
Post-op complications of flexor tendon repair?
```
Tendon rupture
Minimal tendon gliding
Flexion contractures
Excessive scar formation
Extreme pain
Severe edema
Infection
```
167
Definition of MCP joint arthroplasty?
Surgical formation of MCP joints, typically with flexible implant
Flexible Silastic spacer replaces joint to support newly forming fibrous capsule
Used for RA of MCPJ
168
Why does ulnar drift and subluxation of MCPJ occur in RA patients?
Wrist malalignment
Posture
Gravitational forces
Dynamic flexion forces
169
Goal of surgical management after MCPJ arthroplasty?
Restore skeletal alignment and tendon repositioning for more effective and efficient finger function.
170
Post-op management of MCPJ arthroplasty (2-6 days)
Bulky dressing replaced with dynamic MP extension splint to allow full MP extension at rest and active MP flexion
171
Post-op management of MCPJ arthroplasty (2-3 weeks)
Post-op MP flexion assists initiated
172
Post-op management of MCPJ arthroplasty (6 weeks)
Dynamic extension splinting is tapered to at night only
173
Post-op management of MCPJ arthroplasty (8-10 weeks)
Mild isometric exercises (grip strengthening)
174
Post-op complications of MCPJ arthroplasty
Pronation deformity or medial rotation
Extensor contracture at D5
Dislocation or fracture of implant
Slow healing with steroid medication
175
What would you use a volar wrist control splint? Is it static or dynamic?
Median n. injury
Colles fx
Static splint
176
What is a radial gutter splint used for?
Immobilize middle and index fingers
Dupuytren's
Extensor tendon laceration
177
What is an ulnar gutter splint for?
Boxer's fx
178
What is a dorsal protective splint used for?
Flexor tendon injury
179
A dynamic splint with outrigger that pulls MPJ into extension and allows IP joints to flex. What is this used for?
Supporting wrist extensors for radial n. injury
Assists with wrist extension and overcomes wrist drop.
180
How would you treat a finger contracture?
Dynamic finger splinting (TERT)
181
What kind of injury would require the use of a lumbrical splint?
Ulnar n. injury
182
Supination of forearm - nerve supply
Radial and musculocutaneous
183
Pronation of forearm - nerve supply
Median
184
Extension of wrist - nerve supply
Radial
185
Wrist flexion - nerve supply
Median (FCR)
| Ulnar (FCU)
186
Ulnar deviation - nerve supply
Ulnar (FCU)
| Radial (ECU)
187
Radial deviation - nerve supply
Median (FCR)
| Radial (ECRL, APL, EPB)
188
Finger extension - nerve supply
Radial
189
Finger flexion - nerve supply
Median and ulnar
190
Flexor digitorum profundus - nerve supply and action
Median (D2-3)
Ulnar (D4-5)
Flexes DIP joints
191
Flexor digitorum superficialis - nerve supply and action
Median
Flexes PIP joints
192
Lumbricals - nerve supply and action
Median (D2-3)
Ulnar (D4-5)
Flex MCP, ext. PIP/DIP
193
Interossei - nerve supply and action
Ulnar
Adduct and abduct fingers
194
Abduction of fingers - nerve supply
Ulnar
195
Adduction of fingers - nerve supply
Ulnar
196
Extension of thumb - nerve supply
Radial
197
Flexion of thumb - nerve supply
Median and ulnar
198
Abduction of thumb - nerve supply
Radial and median
199
Adduction of thumb - nerve supply
Ulnar
200
Opposition of thumb and little finger
Median and ulnar
OP, FPB, APB, ODM
201
What is the oblique retinacular ligament?
Arises from proximal phalanx, travels volar to axis of motion at PIP joint and ends on extensor tendon dorsally.
Helps to control and coordinate flexion and extension between DIP and PIP joints.
202
What is the clinical implication of Pressure = Force/Area in splinting?
Splinting over a small area (like bony protuberance) should not be subjected much pressure to avoid skin irritation and breakdown.
203
How do you mobilize scar tissue?
Friction massage
204
How do you flatten or minimize a scar?
Silicone compression pad
205
What direction is both the acetabulum and femoral head oriented?
Both oriented anteriorly
206
What part of the acetabulum is in contact with the femoral head?
Superior horseshoe-shaped portion covered by articular cartilage.
207
What is the acetabular notch?
Inferior aspect of acetabulum that contains a fat pad covered in synovial fluid.
208
What 3 directions is the acetabulum oriented?
Laterally, anteriorly, inferiorly
209
How much of the femoral head is covered with articular cartilage?
All but the fovea
210
What is the purpose of the fovea of the femur?
Location for ligamentum teres and tenuous blood supply
211
History of steroid use often does what to the femoral head?
Avascular necrosis
212
What 3 directions is the femoral head oriented?
Medially, superiorly, anteriorly
213
What is the angle of femoral inclination?
Angle between femoral neck and shaft, typically ranging from 120-135 in adults.
214
The angle of femoral inclination decreases slightly in the elderly. Clinical implication?
Increased risk of hip fracture (greater bending moment applied to neck or falls)
215
Femoral inclination greater than 135? Less than 120?
> 135: coxa valga
| < 120: coxa vara
216
What is the angle of femoral torsion?
Angle between axis of femoral condyles and neck of femur in the frontal plane. Typically 8-15 deg anteversion in adults.
217
Anteversion > 15 deg is usually caused by what? How does it present on examination?
Causes: W sitting, heredity
Exam: Toe in gait, excessive hip IR, decreased hip ER
218
What is the typical compensation for femoral retroversion?
Toe out gait
219
Where is the hip joint capsule strongest? Clinical implication?
Anterosuperiorly
Less extension ROM than flexion
Allows you to "hang" on capsule (passive tension)
220
Where is the hip joint capsule weakest and loosest?
Posteroinferiorly
Allows for full flexion ROM
221
Where does the hip joint capsule attach?
Entire rim of acetabulum and base of femoral neck.
222
What are the anterior supportive ligaments of the hip?
Iliofemoral (Y ligament of Bigeow) - checks hyperext, IR, and ER
Pubofemoral: checks abduction and extension; checks IR at end range
223
What is the posterior supportive ligament of the hip?
Ischiofemoral - checks extension and IR; checks ADDuction if hip is flexed
224
What do all 3 supportive ligaments of the hip limit?
Extension and IR
225
Why is minimal muscle activity needed around the hips when standing?
All 3 supportive ligaments add to stability via passively counterbalancing the extension moment on the hip.
226
If D1 IP and D2 DIP collapse into extension during the pinch test, what nerve lesion does that indicate?
Interosseous nerve (FPL, FDP)
227
Patient tries to flex and goes into Sign of Papal Benediction, what nerve lesion does that indicate?
Median n. at level of elbow
228
Patient has sensory loss over palm and lateral 3 1/2 fingers, where is the median nerve lesion located?
Higher than carpal tunnel.
229
Patient has impaired sensation over palm and lateral 3 1/2 fingers, what radiculopathy levels could this indicate?
C5-6-7
230
What angles should the wrist and elbow be at while working at a computer?
Elbow 90 deg
| Wrist neutral
231
s/p FOOSH, pt has tenderness in the floor of the anatomical snuff box and painful thumb motions. Based on this, what do you suspect?
Scaphoid fracture
232
What joints need to be immobilized by a thumb spica splint for DeQuervain's?
Wirst, D1 MCPJ, D1 CMC
D1 IP does not need to be immobilized
233
Patient can perceive static 2-point discrimination with points 13 mm apart, but not if points are any closer. Patient's sensation is rated as..?
Poor
234
What deformity: DIP flexion, PIP hyper extension
Swan Neck
235
What is the cause of swan neck deformity?
Injury/overstretching of PIP volar plate
236
Rupture of central tendinous slip of extensor hood causes what deformity?
Boutonniere
237
Thickening of the flexor tendon sheath causes what deformity?
Trigger finger
238
Rupture of the extensor tendon at DIP joint causes what deformity?
Mallet finger
239
If the PIP joint flexes more with MPJ in flexion than extension, most likely explanation is?
Intrinsic muscle tightness
240
Positive Wartenberg's sign indicates what neuropathy?
Ulnar nerve
241
What radiculopathy is indicated by 1+ biceps DTR?
C5-6
242
Patient is s/p MP arthroplasty. When should patient begin mild isometric grip strengthening exercises?
8-10 weeks
243
What is the purpose of a grade III anterior glide of the hip?
Increase extension
244
Patient has tenderness over the greater trochanter and just poisterior to that. In addition to trochanteric bursa, you suspect involvement of...?
Gluteus medius tendon
245
Craig's test results in 22 deg ER. Most likely see what kind of gait?
Toe out
246
Patient is 2 weeks s/p THA posterolateral approach. Which technique is appropriate to prevent a hip flexion contracture?
Laying prone
247
Patient is s/p ORIF of hip fracture, cleared for 50% WB. Patient has balance and coordination impairments. Most appropriate AD?
Walker
248
Overweight 13 yo boy with hip pain. Risk factor for?
Slipped capital femoral epiphysis
249
Repeated hip extension is a risk factor for?
Anterior labral tear
250
Open chain roll/glide of hip?
Opposite
Convex femoral head on concave acetabulum
251
Closed chain roll/glide of hip?
Same
Concave acetabulum on convex femur
252
Why should hip joint flexion be measured with knee flexed?
ROM could be limited by hamstrings
253
Why should hip joint extension be measured with knee in extension?
ROM could be limited by rectus femoris
254
Open packed position of hip?
30 deg flexion
30 deg abduction
slight ER
255
Closed packed position of hip?
Full extension, IR, abduction
256
Capsular pattern of hip?
Limited flexion, abduction, IR
Order may vary though flexion will be easy to see since there is a lot more ROM to lose
257
When the hip is in neutral, what is the secondary function of the adductors (except magnus)? When the hip is flexed?
Neutral: hip flexors
Flexed: hip extensors
258
How does the piriformis act when the hip is in neutral? When above 60 deg flexion?
Neutral: hip abduction, ER
Flexed: hip abduction, IR
259
Minimum hip flexion needed for basic function? What is normal?
90 deg
Normal: 125
260
Minimum hip abduction needed for basic function? What is normal?
20 deg
Normal: 45
261
Minimum hip IR needed for basic function? What is normal?
0 deg
Normal: 45
262
Minimum hip ER needed for basic function? What is normal?
20 deg
Normal: 60
263
Patient has
105 deg flexion
20 deg abduction
5 deg IR/ER
Which PROM should be emphasized if goal is to facilitate basic function?
Hip ER
264
What functional abilities would be difficult if patient's hip flexion is limited to 105?
Tying shoes
Picking something up off floor
Getting into car
265
What ADs can unload up to 100% BW?
Walker
| 2 axillary crutches
266
One crutch can unload up to how much BW?
50%
267
Cane can upload up to how much BW?
40%
268
Why is there such a big range of how much force walking places on the hip?
Gait patterns determine amount of force (heel vs. midfoot striker)
269
Patient is not at FWB status yet. What exercises should you avoid?
SLR or bridging
270
What is Legg-Calve-Perthes disease? What population does it affect?
Osteochondrosis of the femoral head (progressive deformity during revascularization)
Occurs in boys 5x more than girls
271
What is Slipped Capital Femoral Epiphysis? Who does it affect?
"Adolescent Coxa Vara" - weakened epiphyseal plate at proximal femur results in "slips" secondary to shearing forces.
Affects boys > girls, age 9-17
272
What age group is most affected by femoral acetabular impingement?
Young and middle aged adults
273
What age does DJD start?
Can start as early as 50's
274
Patient has trouble crossing legs and putting shoes on/off. Pain increases with long walks. Suggestive of?
Hip OA/DJD
275
What non-hip problems can be represented by hip pain?
```
Aortic aneurysm
Iliac aneurysm
Abdominal pathology
Hernia
Ilioinguinal bursitis
DVT
Spinal stenosis
Sacroiliac disease
Trochanteric bursitis
Coccydynia
Ischial bursitis
```
276
Hip problems can refer to what other areas?
Low back
Groin
Lateral thigh/anterior thigh
Knee
277
DJD of the hip is commonly presenting as pain in what region?
Groin
278
What motions do you need to fully cross the legs? To cross the legs at the knee?
Fully: Add/IR
Knee: Abd/ER
279
What are the 3 causes of snapping hip syndrome?
Iliopsoas tendon over the lesser trochanter
IT band over the greater trochanter
Intra articular loose bodies
280
What is the saying for going up the stairs with a bad leg?
Up with the good, down with the bad
281
Decreased step length with uninvolved leg can be due to...
Pain on stance by involved leg
282
Decreased step length with the involved leg can be due to...?
decreased ROM
283
What are the compensations for weak hip abductors?
Trendelenberg or Abductor lurch
284
What side does the patient lean to in an abductor lurch?
Involved side while standing on involved leg because it reduces joint reaction forces across hip and requires less strength from abductors
285
What hand should a cane be in? Why?
Contralateral hand
Facilitates reciprocal arm swing
Increased BOS
Helps hip abduction (decrease add moment)
286
How do you check for muscle wasting of the quads? Of the glutes?
Quads: sitting, extend knees
Glutes: gluteal skyline
287
Possible causes of true LLD?
Bowing of bone / bone deformity
| Coxa vara/valga
288
Possible causes of functional LLD?
Spasm in LS or pelvis
Asymmetrical pelvic torsion
Lateral pelvic tilt
289
If you get reproduction or increase in sciatica symptoms at 30 deg hip flexion, can you differentiate between sciatica and piriformis?
No, hip must be > 60 deg
290
What does Ortolani's check for?
Congenital Hip Dysplasia in infants
291
What does Barlow's Test check for
Developmental Dysplasia of the Hip in infants; first part of the test checks for Ortolani's, 2nd half indicates hip instability
292
What are 3 self-report outcomes tools that are good for the hip?
LE Functional Scale
Harris Hip Function Scale - good pre/post op comparison
WOMAC - outcomes research
293
What motions should be performed in squatting? Why turn feet in or out?
Flexion/Abduction/ER
ER so hip doesn't impinge
294
What is Scarpa's Triangle? Where would you find the iliopsoas tendon?
Also called the femoral triangle. Iliopsoas tendon is lateral to the femoral pulse
295
Which leg works harder during standing abduction exercise?
Stance leg
296
Typical exam findings of OA of hip?
```
Crepitus
Hip pain worse in morning
Difficulty with stairs, chairs, crossing legs
Groin pain, back pain
Abductor lurch
Weak abductors and extensors
Limited ROM in all directions
(+) scouring, quadrant, adduction, FABER, FADDIR
Distraction feels better
```
297
Conservative intervention for DJD of hip?
Movement
Strengthening
Stretching
Joint mobilization
Bike, hip abd/add/rot, marching, lunging, squatting
298
Prosthetic components of THA?
Acetabular component (metal substrate with plastic insert)
Femoral head - metal alloy or ceramic
299
What population is cemented THA typically used for? Advantages/Disadvantages?
For elderly or frail patients
Adv: stable and ready to walk on
Disadv: doesn't last as long
300
What population is uncemented THA typically used for? Adv/Disadv?
For younger, more active pt
Adv: bone grows into pores & locks
Disadv: nonWB status for weeks
301
What is a hybrid THA?
Acetabular cemented with uncemented femoral component
302
What is the most common THA approach?
Posterolateral
303
Adv/Disadv of posterolateral THA?
Adv: good exposure of joint, rehab more predictable, surgeons more trained
Disadv: must detach posterior capsule which destabilizes joint & greater chance of dislocation
304
Precautions for posterolateral THA?
No flexion > 90
No IR > neutral
No adduction > midline
305
ADL precautions for posterolateral THA?
```
Transfer: lead with uninvolved side
No crossing legs
Knees lower than hips when sitting
Raised toilet seat, bed, chair
Don't bend forward to stand up/sit down
Use shower chair
Up stairs with good, down with bad
Pivot on good side
Don't rotate to involved when standing
Sleep supine with abduction pillow
```
306
When you had a posterolateral THA, but are able to bend forward, what side of the leg should you go down? Why?
Go down inside of leg - limits chance of dislocating hip.
307
Adv/Disadv to anterolateral/lateral THA?
Adv: can go between TFL and glut med and preserve those muscles; less chance of dislocation
Disadv: Might split TFL and glut med which leads to difficulty regaining function abductors
308
ROM precautions for anterolateral THA?
No extension > neutral
No adduction > neutral
No ER > neutral
Avoid combined Flexion/Abd/ER (tailor sitting)
309
What precaution would you have for a anterolateral THA that disrupts the glut med or with a trochanteric osteotomy?
No anti-gravity hip abduction for 6-8 weeks or until approved by surgeon
310
ADL precautions for anterolateral THA?
No excessive flexion, adduction, and hyperextension
Ambulation - step to rather than step past operated side
Avoid rotating away from operated side when standing
311
Upper limit of acceptable RESTING HR?
100 beats/min
312
Upper limit of acceptable RESTING BP?
165/90
313
What BP is a relative contraindication for exercise?
165-180 / 90-100
314
What is absolute BP contraindication for exercise?
> 180/100
315
What is the limit of an increase in HR during intervention session?
Up to 30 beats/min increase is ok
316
What is the limit of an increase in BP during intervention session?
Systolic up by 10-20 during LE; 30-40 with more demanding exercise
Diastolic +/- 10 points
317
Indications for hip hemiarthroplasty?
Acute displaced intracapsular proximal femoral fracture (frail elderly)
Failed internal fixation of intracapsular fractures --> osteonecrosis of femoral head
Severe DJD of femoral head with healthy acetabulum
318
Why would you do a hip hemiarthroplasty for a proximal femoral fracture in an elderly patient instead of immobilization?
Immobilizing a frail elderly patient would be more stressful for them due to NWB status - need to get them mobile as much as possible.
319
What is a unipolar hemiarthroplasty?
Simple femur replacement
320
What is a bipolar hemiarthroplasty?
Stem and ball for femur with cap of metal alloy for acetabulum; movement is mostly in the cap and protects articular cartilage of acetabulum
321
What is the surgical approach and precautions for a hip hemiarthroplasty?
Same as THA with same precautions
322
Are hip hemiarthroplasties cemented or uncemented?
Typically cemented.
323
Indications for ORIF of proximal hip fracture?
Displaced or nondisplaced intracapsular femoral neck fracture
Dislocation of femoral head
Intertrochanteric fractures
Subtrochanteric fractures
324
What is the traction procedure for ORIF?
Pin through distal femur and traction system in hospital bed to reduce fracture; typically followed by surgery.
325
What is the in situ fixation procedure for ORIF?
Percutaneous nail through the skin from greater trochanter to femoral head; holds neck in place
326
What is the dynamic procedure for ORIF?
Dynamic extramedullary fixation with a sliding hip screw and lateral compression plate.
Matches contour of bone and allows for sliding between plate and screw - creates compression across fracture with WB
327
Why use dynamic extramedullary fixation?
Plate and screws often allow for quicker healing and earlier WB
Mainly for stable intertrochanteric fractures and may be combined with osteotomy for comminuted fractures.
328
What is the static procedure for ORIF?
Static interlocking intramedullary nail fixation or sliding hip screw coupled with intramediullary nail for subtrochanteric fractures
329
Why do stable fracture components often have early WB status?
Aids in healing process
330
Why should a patient be fully upright when doing a standing abduction exercise?
So they don't compensate with TFL
331
What are s/s of possible failure of internal fixation following hip surgery?
Severe, persistent groin, thigh, or knee pain that increases with limb movement or WB
Progressive LLD
Persistent ER
(+) Trendelenberg that does not resolve with strengthening exercises
332
What is trochanteric bursitis? How does it present?
Aggravation of trochanteric bursa by ITB rubbing over trochanter.
Pain over lateral hip with referral to lateral thigh and knee; symptoms increase by laying on it, standing with hip in adduction, and running on crested road
333
A pt with trochanteric bursitis is an athlete that runs on banked roads. Which leg is affected?
"Downhill" leg
334
Interventions for trochanteric bursitis?
Stretching tight structures around hip (ITB, glutes, TFL, hamstrings)
Therapeutic modalities (US, heat, e-stim)
Rolling pin over ITB
335
How does a single leg stance test differentiate between trochanteric bursitis and gluteus medius tendon?
Bursitis will not worsen
Tendon pain will worsen as it is increasingly stressed in standing
336
Where is the iliopectineal bursa?
Deep to iliopsoas tendon as it crosses the hip joint.
337
How does iliopectineal bursitis present?
Pain in inguinal region referring to anterior thigh and knee
Associated with hip joint pathology
Symptoms increase with repeated hip flexion, sit to stand (burst of pain), prolonged walking, crossing legs, adduction
338
Interventions for iliopectineal bursitis?
Stretching iliopsoas
Hip mobilization
Soft tissue mobilization
Therapeutic modalities
339
How would you isolate the iliopsoas to test it for pathology?
SLR test with 45 deg hip ER
340
Where is the ischiogluteal bursitis? What population does it affect?
Deep to gluteus maximus over ischial tuberosity.
Seen in people with sedentary occupations or from direct trauma to region (sitting on hard surface too long, especially)
341
How does ischiogluteal bursitis present?
Pain over ischial tuberosities, especially when sitting; may spread to sciatic distribution due to swelling
Area painful to palpation or with resisted hip extension and hamstrings
342
Treatment for ischiogluteal bursitis?
```
Doughnut pad to relieve pressure
Soft tissue work
Therapeutic modalities
Stretching, movement
IASTM
```
343
What do you need to differentiate ischiogluteal bursitis from?
Referral from LS or from hip
344
How many people are affected by sciatic nerve passing through the piriformis?
10% of population
345
How does piriformis syndrome present?
Mimics sciatica
Buttock pain with sciatic symptoms
Repeated movements of LS will have no effect
Elicited by pressure over piriformis and/or stretching piriformis
346
Interventions for piriformis syndrome?
Gentle stretching
Soft tissue work
Gentle neural mobilization stretches
347
What causes a muscle strain?
Forceful movement - quick change of direction or acceleration
348
What is the concern with bruising and muscle healing?
Blood becomes scar tissue and can potentially scar around a nerve - need to keep nerve mobilized in addition to muscle
349
When is scarring unable to be mobilized?
Around 3 months post injury
350
What are the 2 conditions that predispose a person to FAI?
1) misshapen neck of femur (CAM)
| 2) deep acetabulum (pincer)
351
If a patient had a subclinical SCFE growing up, what kind of deformity are they likely to have when older?
CAM deformity
352
Typical exam findings of a labral tear?
Dull, nonspecific pain
Athletes with IR/adduction movements
(+) FADDIR, FABER
Pain and clicking with hip flexion, IR, add
353
Interventions for labral tear?
Strengthen muscles around hip
Keep out of impingement
Balance
Stability
354
Typical cause for posterior hip dislocations?
High velocity trauma (MVA) or untreated dysplasia
355
Interventions for posterior hip dislocations?
Reduced under fluoroscopy with traction at ER
Check for nerve involvement (ankle/foot strength, sensory disturbances
Strengthen and gain motion safely (muscles around the hip especially)
356
Primary function of hip joint?
Carry weight of HAT
357
What is developmental dysplasia of the hip (DDH)?
Acetabulum that is not deep enough causing chronic subluxation of hip joint.
Caused by W sitting or malpositioning in utero
358
What are labral tears caused by?
Repetitive microtrauma from repeated twisting or pivoting, especially IR/adduction
359
In what position is femoral head most in contact with the acetabulum?
Midstance
360
What side of the femoral neck is subjected to tensile force and compressive force
Superior: tensile
Inferior: compression
361
What is a SCFE?
Gradual or sudden inferior and posterior displacement of epiphysis or growth plate due to shearing forces
362
How does SCFE present?
Limping for no reason
| Dull, aching pain
363
Why do surgeons add a varus angle during THR?
Lengthens the moment arm of abductors and therefore decreases joint reaction forces for the patient
364
Femoral anteversion - what are femoral and tibial compensations?
Femoral - Hip IR (toe in)
| Tibial - lateral torsion to keep toes neutral
365
Hips are more likely to dislocate in what directions?
Posteriorly and inferiorly
366
Bilateral hip flexion contractures will cause what kind of pelvic tilt? How will patient present?
Anterior pelvic tilt
Good flexibility = lumbar lordosis
Poor flexibility = flattened lordosis and forward lean
367
What are some compensations for unilateral hip flexion contracture?
Forward lean
Dropping pelvis ipsilaterally
Plantar flexing foot ipsilaterally
Flexing knee on contralateral side
368
Why do patients with herniated lumbar discs have hip pain?
Contraction of psoas major pulls on lumbar intervertebral discs which increases pain
369
What presentations develop for a shortened quadratus lumborum?
```
Decreased contralateral lateral flexion
Elevated ipsilateral iliac crest
Shortened ipsilateral LE
Tenderness on palpation of iliac crest
Mimics herniated disc
```
370
BW passes slightly posteriorly to the axis of the hip joint producing a very small extension moment which is counterbalanced by?
Passive tension in anterior hip capsule and ligaments
371
ROM/end feel of hip flexion
0-120 (soft)
372
ROM/end feel of hip extension
0-10 (firm)
373
ROM/end feel of hip IR
0-45 (firm)
374
ROM/end feel of hip ER
0-45 (firm)
375
ROM/end feel of hip abduction
0-45 (firm)
376
ROM/end feel of hip adduction
0-25 (soft/firm)
377
Patient has gross weakness of their glutes, what may be a compensatory gait deviation?
Posterior lurch - keeps glutes in extension
378
Functional tests of the hip?
```
Squatting
Going up and down stairs 1 at time
Crossing ankle to opposite knee
Going up and down stairs 2 at time
Running straight ahead
Running and decelerating
Running and twisting
One-legged hop
Jumping
```
379
Sciatic nerve injury - muscle weakness
Hip extension
Knee flexion
Plantar flexion
Toe flexion/extension
380
Sciatic nerve injury - sensory alteration?
Posterior thigh
Posterior leg
Whole foot except instep and medial malleolus
381
Superior gluteal nerve injury - muscle weakness
Hip abduction
382
Femoral nerve injury - muscle weakness
Hip flexion
| Knee extension
383
Femoral nerve injury - sensory alteration
Medial side of thigh and leg
384
Obturator nerve injury - muscle weakness
Hip adduction
385
Obturator nerve injury - sensory alteration
Middle thigh on anterior aspect
386
Flexor tendon laceration - primary and delayed primary repair of complete rupture or laceration of digital flexor tendons in which zones?
I through V
387
Extensor tendon repairs - primary repair of complete rupture or laceration of any tendons in what zones?
Digital extensors: V, VI, VII
Thumb extensors: TIII, TIV, TV
Wrist extensors: VII
388
Nerve roots for musculocutaneous n.?
C5-C7
389
Nerve roots for median nerve?
C5-T1
390
Nerve roots for ulnar nerve?
C8-T1
391
Cutaneous innervation of musculocutaneous nerve?
Lateral forearm
392
Nerve roots for radial nerve?
C5-T1
393
Nerve roots for axillary nerve?
C5-C6
394
Cutaneous innervation for radial nerve?
Lateral arm
Posterior arm
Posterior forearm
Dorsum of D1-D3
395
Cutaneous innervation of axillary nerve?
Over deltoid
396
What muscles are innervated by axillary nerve?
Teres minor
| Deltoid
397
Clinical tests to rule in pronator teres syndrome?
Resisted pronation with neutral forearm while extending the elbow
Pronator compression test
(+) Tinel's over pronator teres
398
What is the difference between pronator teres syndrome and anterior interosseous syndrome?
AINS does not cause paresthesia
399
Clinical tests to rule in AINS?
EMG
(+) Pinch test
Resisted pronation
400
PT interventions for pronator teres syndrome or AINS?
Rest/immobilization
E-stim
Soft tissue mobilization & nerve gliding
401
Optimal position of wrist for splinting for CTS?
Neutral
402
PT interventions for CTS
```
Splinting
Low-level heat wraps
Pulsed current e-stim
Reduce aggravating movements
Frequent gliding exercises
Pain-free isometrics
Rice gripping
Stretching
```
403
If have CTS decompression, what wrist motion should be avoided until 4-5 weeks post-op
Wrist flexion
404
Typical mechanism of injury for groin strain?
Overloading during eccentric phase of forced adduction, overextension, twisting, running, or jumping with ER
405
Typical complaints of groin strain?
Sudden, sharp pain along ischiopubic ramus, lesser trochanter, or musculotendinous junction of adductor muscles
Pain with passive abduction and resisted adduction
Radiation into abdominal area
406
Purpose of hip spica wrap for groin strain?
IR hip in order to relax adductors and reduce pain
407
What is a hip pointer? Typical s/s?
Contusion to iliac crest, local soft tissue, or greater trochanter
Local pain and tenderness, sudden onset
Pain exacerbated by activity with possible limited hip/trunk ROM
408
Typical mechanism of injury of hip pointer?
Direct blow or fall to hip region, usually contact sports
409
Interventions for hip pointers?
Anti-inflammatory treatment
| ROM exercises when tolerated progressing into strength and conditioning
410
How to prevent hip pointers?
Padding over area
| Falling strategies
411
What is CAM-type impingement?
Osseous prominence at femoral head-neck junction
Prominent femoral neck abuts acetabulum resulting in damage to anterosuperior labrum and articular cartilage
412
What is pincer-type impingement?
Increased acetabular coverage of femoral head secondary to deepened socket or altered rim
Labral tears followed by ossification of acetabular rim and degenerative changes increase the deepending of the acetabulum
413
PT interventions for small anterior labral tear?
Core strengthening
Proprioceptive training
NSAIDS
LE PREs
414
Activities that should be avoided for labral tear?
Passive ROM, stretch, or activities that exacerbate symptoms
415
Hamstring strains typically occur during terminal swing phase of high speed running. Why?
They are lengthened and contracting in order to absorb the impact of the foot contacting the ground. At high speeds, the soft tissue doesn't have as much time to deform its viscoelastic properties to sufficiently cushion the blow.
416
Hamstring injuries occur during dancing and kicking?
Simultaneous hip flexion and knee extension place hamstrings in extreme stretch position which can cause damage or make it more susceptible to damage.
417
Modifiable factors for hamstring strain?
Hamstring weakness, fatigue, stiffness
Strength imbalance btwn hams & quads
Limited quads flexibility
Strength/coord deficits of pelvic/trunk ms
418
Pt sustains grade II hamstring strain. Tenderness is felt in proximal tendon at ischial tuberosity. What does location suggest about recovery time?
Longer - tendon injuries take longer to heal.
419
Phase I hamstring strain exercise
Grapevine
420
Criteria to progress from phase I to phase II of hamstring strain rehab?
Normal walking stride without pain
Painfree low speed jogging
Pain free isometric against submax
421
Phase II hamstring strain exercises
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Boxer shuffle
Rotating body bridge
Single limb balance windmill touches
Lunge walk with trunk rotation
Single limb balance with forward trunk lean and opposite hip extension
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422
Criteria to progress from phase II to phase III of hamstring strain rehab?
Full 5/5 strength without pain during 1RM isometric MMT
| Forward and backward jogging at 50% max speed without pain
423
Phase III hamstring strain exercises
A skip
B skip
Forward-backward accelerations
