Musc Flashcards
(158 cards)
1
Q
What are the 3 discharges after acute hospital inpatient?
A
Subacute inpatient
Home
Residential aged care
2
Q
What are indications for joint athroplasty?
A
OA, RA, trauma, tumour, hip dysplasia
3
Q
When is someone eligible for TJA?
A
Extreme pain/stiffness, limits everyday activity, exhausted all conservative treatments
Ideally not obese or younger than 60
4
Q
What are the different types of hip TJA?
A
THR- replace femoral head and acetabulum
Hemiathroplasty- femoral head only
Hip re-surfacing- articulating surface only
Revision- removal/replace prosthesis
5
Q
What are precautions for each of the hip approaches?
A
Posterolateral- through ITB, no hip F >90, adduction past midline, IR > neutral
Anterior- muscle sparing, limit active hip E above neutral, hip ER >45
Direct lateral- TFL retracted, limit hip abd.
6
Q
What are the different types of knee TJA?
A
TKR- Femoral and tibial condyles
Partial- medial or lateral femorotibial compartment
Revision
7
Q
What are the different types of shoulder TJA?
A
TSR- glenoid and humeral head, primary aim reduce pain
Partial- replace humeral head
Revision
8
Q
What are the different shoulder approaches?
A
Deltopectoral- b/n deltoid and p major
Anterior
Superior
9
Q
What is involved in pre-operative preparation?
A
Subjective
Preop requirements (e.g. fasting)
Pre-empt D/C plan
Preop education
Set goals
10
Q
What is the RAPT?
A
Gives indication D/C type and time
<6 extended inpatient
6-9 additional intervention e.g. home rehab
9+ directly home
11
Q
What are precautions for TSR?
A
Sling, limit elevation and ER >20-30
12
Q
What are some complications of TJA?
A
Loosening, fracture, dislocation, infection, DVT, pain
13
Q
What are the different classifications of fracture?
A
Transverse- horizontal
Oblique- 2D diagonal
Spiral- 3D diagonal
Segmental- 2 fractures
Comminuted- cracks no clean break
Butterfly- part horizontal fracture then triangle fragment
Compression- e.g. neck crushed inward
14
Q
What is diastasis?
A
Separation at syndesmotic joint
15
Q
What is the difference between primary and secondary healing?
A
1- Rigid fixation, no connective tissue or fibrocartilage before bone development, no hard callus formation, mostly on bone resorption and formation
2- Absence
16
Q
What are the stages of secondary bone healing?
A
Haematoma, influx of inflammatory cells, no strength/stability 0-2 weeks
Soft Callus (Fibrocartilaginous), chrondroblasts and fibroblasts, mainly fibrous tissue and cartilage 1-2 weeks
Hard Callus (Woven Bone), osteoblasts, stability, completion of this stage is union 2 to 6-24 weeks depending on fracture type and site
Remodelling (Lamellar Bone), resorption and formation, normal strength, 6-24 to 12-48 weeks depending on fracture type and site
17
Q
What are the union times?
A
Spiral UL- 6 weeks
18
Q
What are some complications of fractures?
A
Fat embolism, non/malunion, stiffness, avascular necrosis, OA
19
Q
What factors affect fracture healing time?
A
Type of bone (cancellous fast, cortical slow)
Age, time down as age increases
Mobility
Infection
Properties of bone (clavicle nonunion rare, tibia union very slow)
20
Q
What are the 3 principles of fracture management?
A
Reduction- restore fragments to anatomical position
Immobilization- casts or fixation
Preserve function
21
Q
When can you go to WBAT to FWB after LL fracture?
A
6-12 weeks
22
Q
What are subjective signs of general illness?
A
Fever, chills, unexplained weight loss, appetite loss, temperature
23
Q
What are subjective signs of GI problems?
A
Abdominal pain, nausea, vomiting, indigestion, change in bowel habits
24
Q
What are subjective signs of CV problems?
A
Dyspnoea, chest pain, palpitations
25
What are subjective signs of resp problems?
Cough, dyspnoea, wheeze, night sweats
26
What are subjective signs of gynaecologic problems?
Bleeding, discharge, irregular menses
27
What are subjective signs of neurologic?
Headaches, visual disturbances, vertigo, memory, unsteadiness
28
What are subjective signs of psychologic problems?
Sleeping pattern, stress, depression
29
What are subjective signs of endocrine and metabolic problems?
Hair/nail changes, fatigue, muscle/bone pain, oedema
30
What are subjective signs of rheumatological problems?
Joint pain, stiffness, muscle pain, skin/eye/bowel disorders
31
What are cancer early warning signs CAUTION?
Change in bowel/bladder habit
A sore that does not heal
Unusual bleeding/discharge
Thickening or lump
Indigestion or difficulty swallowing
Obvious wart or mole change
Nagging cough
32
33
What are the stages of RA?
Normal
1: Early, Synovitis
2: Intermediate, Destruction
3: Late, Deformity
34
What is the presentation of RA inflammation?
Insidious onset
Prolonged stiffness
Worse at night
Improve with activity
Fever, malaise, weight loss
35
What are symptoms of RA?
Malaise
Weight loss
Pain
Swelling
Stiffness
Reduced function
36
What are signs of RA?
Joint tenderness
Heat
Effusion
Low ROM
Muscle wasting
Deformity
37
What are physio treatments for RA?
Pain relief (ice, heat, taping)
Increase movement, muscle strength
Aerobic, weights, functional
Posture
Gait advice
38
What is mallet finger?
Ruptured extensor tendon, drops DIP joint. Occurs in sports or older degenerated
39
How is mallet finger treated?
Immobilization 6-8 weeks, wean slowly
40
What is swan neck deformity?
Lateral bands have slid dorsally, if left unmanaged cannot flex
41
What is a central slip?
Extensor mechanism ruptured in centre, affects PIP, unable to straighten.
Immobilize DIP and PIP 1/52, remove splint at 5/52
42
What is trigger finger?
FDP and FDS tendons rupture don't stay close to bone. Limited ROM and strength
Finger can flex but MCP stay straight
Splint 6/52, tendon gliding exercise, taping
43
What is DeQuervain's Tendinopathy?
APL, EPB sheath, pain at base of thumb
Hurts when catheter inserted
Splint, surgery, gradual eccentric loading
44
What is Dupuytren's disease?
Contracture of fascial bands in palm
Can't get hands flat on table, hands in pocket
Can be caused by fracture
Putty, weights, glides
45
What is Skier's thumb?
MCPJ UCL
46
When does Scaphlolunate ligament injuries usually occur and what is the result?
FOOSH, Pain dorsal hand, secondary stabilizer, scaphlolunate instability
47
What is wrist injury treatment?
2-6/52 splinting
AROM
48
Describe TFCC injury?
FOOSH or torsion
Ulnar wrist pain, reduced rotation
49
Describe carpal tunnel syndrome?
Compression of median nerve, paresthesia lateral 3.5 fingers, pain and weakness
Splint
50
Describe Complex Regional Pain Syndrome and how is it treated?
- Chronic pain after injury or surgery
- Medications, education, hydrotherapy
51
What is patellofemoral pain?
Anterior or retropatellar pain in the absence of other pathology
52
What are the symptoms of PFP?
Non-traumatic, diffuse ache, exacerbated by loading, ache with sitting
53
What structures is PFP felt in typically?
Anterior fat pad and joint capsule
54
What are potential pathways of PFP?
Patella malalignment- quad weakness, weak hip m, lateral tightness
Altered joint kinematics- altered hip/foot kinematics, weak ankle m
55
What is the function of the patella?
Increases lever arm of quads, protects deeper knee structures
56
How does the patella move on the trochlea in movement?
Full extension sits laterally, F moves medially until >130 then moves laterally
57
What can cause patella tracking?
Tight lateral retinaculum and ITB
move, weak VMO laterally
58
How does gluteus medius and femoral anteversion contribute to patella tracking?
Increased hip IR -> tight ITB, increased lateral quad moment, changed femoral trochlea orientation
59
How does hamstrings and gastrocnemius affect PFP?
Decreased length, increased knee F moment, increased PFJ reaction force and PFP
60
What is the main objective assessment to rule in PFP?
Squat
61
How do you manage PFP?
Educate (contributing factors to PFP, expectations, weight loss advice)
Vasti retraining (contract VMO), quad/gluteal strengthening (quarter squat, step down, 6 week programme), movement pattern, hip abd/ER strengthen
Patellar taping
Stretching tight structures
62
How do quads and soleus work in single limb landing?
Load absorbers. Quads and soleus oppose each other, quads more breaking, calves propel midstance. Synergy to decelerate
63
How do muscles act when jumping off box?
Quads/gastroc pulls tibia forward, gastroc due to fixed tibia
Hamstring opposes, protects ACL
64
In what plane is 95% of ACL strain?
Sagittal
65
How does TFJ increase from walking to running?
3 x increase
66
How are knee injuries diagnosed?
Consider structural (ligamentous, bone, meniscal), environmental (sport, loading history) and functional factors (muscle loading, movement mechanics)
67
What can cause osteochondral defects?
OA, fracture, osteochondritis dessicans (juvenile disorder)
Common after ACL rupture
68
What are diagnostic tests for osteochondral knee injuries?
SLSq
Joint palpation
Sweep Test
Knee F/E overpressure
69
What are diagnostic tests for patellar instability?
SLSq
Ottawa Knee rules (WB, bend to 90, sore patella)
Sweep Test
Cautious glides
Tender Medial PF ligament
70
What are diagnostic tests for ACL?
Sweep Test
Lachman
Lever
Pivot
Anterior Drawer
71
What are diagnostic tests for PCL?
Sweep Test
Posterior Drawer
Reverse Lachman
Posterior sag (tibial tuberosity caved in)
Supine IR test
72
Which meniscus is more likely to injure following ACL?
Lateral. Pivoting pulls on roots
73
What causes meniscal ramp lesions?
Valgus loading, tibial IR and axial load
Prevents knee F
74
What are diagnostic tests for meniscal lesions?
McMurrays Test
Sweep Test
Joint Line Palpation
Knee F/E Overpressure
75
How do MCL injuries occur?
WB axial load + valgus force
76
What are diagnostic tests of MCL injuries?
Valgus Test (0 and 30)
Varus unknown LCL
Anterior drawer and tibial ER
77
What is the biggest factor to stability?
Active structures
78
What is the difference between CAM and pincer impingement?
CAM- bony growth on anterior/superior neck, less pronounced head/neck angle
Pincer- Extended/deepened acetabular rim/overhang
79
What are diagnostic tests for FAI?
FADIR, flex 90, IR then add
FABER
80
What signs indicate FAI?
Symptoms of hip/groin pain (e.g. C sign, pain with prolonged sitting, cross legged)
Physical impairments (e.g. SLS) including positive impingement
Positive imaging
81
What are differential diagnoses for FAI?
LBP- aggs/eases associated with spinal loading/unloading, rarely refers anteriorly
Neural- different nature of pain, P/N, distal motor loss
Sinister- WL, night pain, severe pain, history of malignancy
Hernia- pain with coughing, abdominal wall weakness
82
What physical impairments are evident in FAI?
Abductor endurance
Weakness Flexors, Extensors, Adductors, IR/ER
SLS control- greater Add, knee valgus, pelvic obliquity
83
What are treatments for FAI?
Education
Activity modification
Strengthening- hip strength, trunk strength
Motor control- dynamic balance
Manual therapy
84
What is the weight bearing status for hip arthroplasty for FAI?
Immediate WB, most PWB with aids, FWB by 10-14 days
85
What are the precautions in the first 6 weeks after FAI surgery?
Flexion 90, prolonged sitting/standing, sleeping on side, kicking, twisting, heavy lifting
86
What is involved in Phase II and III for hip arthroplasty for FAI?
II- 2-4 weeks, gait reeducation, cycling, swimming, running 4 weeks, strengthening, balance SLS
III- 6-12, return to sport
87
What does ultrasound inform about tendon characterisation?
Can tell if reactive (responds, not focal) or degenerative (focal, doesn't change)
How much normal tissue
Cannot distinguish between tendinopathy and partial tear
88
How does a tendon respond to load?
Needs load to strengthen but does not respond well to change in load
89
What is the contemporary model of the continuum of tendon pathology?
Stage Reactive Tendinopathy- non-inflammatory cell response, produce repair proteins (proteoglycans help short term thickening), seen in acute overload, swelling
Stage 2 Tendon disrepair- greater matrix breakdown, more disorganised, ingrowth of vessels and nerves, more focal hypoechogenecity
Stage 3 Degenerative Tendinopathy- greater matrix breakdown, apoptosis, large disorder, more common in older
90
What might be some signs of patellar tendinopathy?
Jumping, changing direction
Pain and tenderness at inferior pole of patella
Pain with quads contraction
Decline squats aggs
May have increased thickness
91
How does isometric exercise affect patellar tendinopathy?
Analgesic effect
92
What are some contributing factors for achilles tendinopathy?
Footwear, change in surface or training, inadequate warmup
Usually overuse
93
What are the 4 stages for achilles tendinopathy treatment?
Stage 1, pain relief, isometric exercise e.g.bw holds
Stage 2, isotonic strength and endurance (conc. ecc. heel raises)
Stage 3, faster loads
Stage 4 speed increases e.g. running, skipping
94
What is the role of the adductor magnus?
Strong hip extensor when hip flexed acts like hamstring
95
What are the two types of hamstring injury?
Type I- high speed, usually long head biceps, more acute decline in Fx recover faster
Type II- excessive stretching, usually semimembranosus, longer rehab
96
How is hamstring injury acutely managed?
RICE 10-15 min 3 hourly
Muscle contraction, isometric, prone knee bends
97
How is hamstring injury managed in subacute phase?
Stretching
Manual therapy- stiffness in lumbar, SIJ, buttock may contribute
Strengthen- conc/ecc,
98
In hamstring injury what is the criteria for return to running (subacute phase), return to full training (functional phase) and return to play?
Running- pain free walking, adequate force in resisted muscle contraction
Training- Resolution of any symptoms, full ROM, completed structural running and rehab
Play- One full week normal training, no apprehension of reinjury
99
How do you rule in/out neurological component?
Straight leg raise, DF foot
Slump, cervical flex
100
How is RCT treated?
Avoid aggs, ice, corticosteroid
Exercise, strengthen RC, ecc
101
How is ACL conservatively treated?
Muscle strength, endurance, agility, bracing
102
Why can ACL injury lead to 'old man' knees?
ACLR underloading drives OA pathogenesis
103
What happens to the vertebral and intervertebral foramen during Cx F, E and LF/R?
F- VF lenghened, IVF larger
E- VF shortened, IVF smaller
LF/R- Contralateral IVF larger
104
What are the red flag signs of Cx myelopathy?
- Neck/Sh pain, stiffness
- Loss of hand dexterity
- Wide BOS, clumsy gait
- +ve Babinski (foot reflex) +ve Hoffman (tap middle nail, index finger flexes)
105
What are muscles of interest in Cx spine impairments?
- Reduced activation of DNF with increased activation of SCM associated with neck pain
- Co-contraction of agonist and antagonist
- Delayed activation of DNF and superficial
106
How is DNF tested?
1. Quality of contraction/activation
2. Endurance
107
How is DNE tested?
4 point kneel, stabilize C2
Test for movement quality and isometric strength
108
What is the dosage for DNF treatment?
6/52, supervized 1/52 <30min, non-supervised 2x daily 20 min
109
How is neck pain with headaches treated differently?
Self SNAG exercises (natural glide)
110
How is neck pain with radiating pain treated differently?
Cx collar, mechanical traction to relieve pressure
111
What are yellow flags?
Psychosocial factors that increase risk of developing long term pain or disability e.g. moods, beliefs,
112
How is creep involved with LBP?
- Forward bending, resisted by ligaments and muscles
- Structural deformation from sustained tension, can be vulnerable to injury
113
What are common impairments in LBP?
Movement impairment, pain assoc. with F impairment
Control impairment, pain not assoc. with F impairment
114
How is LBP movement impairment treated?
- Manual therapy to restore movement
- Avoid stabilizing exercise
- Pain education
115
How is LBP control impairment treated?
- Cognitive behavioural motor learning, desensitise NS
- Manual therapy limited
116
How is pain different in movement and control impairment?
MI- Muscle guarding and co-contraction, high compressive loading, leads to tissue strain and peripheral pain sensitization
CI- Impaired control of spinal segment in direction of pain, adopt posture and movement patterns that maximally stress pain sensitive tissues. Localized pain and central pain sensitization
117
How does SIJ pain present and what are its aggs?
Usually unilateral, refer buttock, groin, posterolat thigh
Aggs- stairs, rolling in bed
118
How is SIJ pain diagnosed?
2 of 4 positive provocation tests (e.g. distraction)
119
What 4 subtypes are examined in assessment of LBP?
1. Red Flag Causes- malignancy, cauda equina etc.
2. Isolated LBP- non-specific mechanical, directional preference, discogenic or facetal
3. Limb dominance- radicular, radiculopathy, spinal canal stenosis
4. Abnormal Pain Behaviour- central sensitization, strong pain focus
120
What are the 4 P's of persistent pain management?
1. Physical- Exercise, stretching, manual therapy
2. Psychological- Pain education, fear avoidance, anxiety, CBT
3. Pharmacological- NSAIDs,
4. Procedure- Injections (local anesthetic or corticosteroids i.e. nerve blocks), surgery
121
How is red flag LBP managed?
- Refer to emergency if cauda equina or leaky abdominal aortic aneurysm
- Antibiotics, chemo
- Open repair, stenting etc.
122
How is isolated LBP managed?
Physical: heat wrap, manual therapy, exercise
Psych: patient education, self-care
Pharm: NSAIDS, muscle relxanats
Procedure: e.g. facet joint injection
123
How is limb dominant LBP managed?
Physical: physio
Psych: patient education, self-care
Pharm: NSAIDs
Procedure: spine nerve root block or decompression
124
How is abnormal LBP behaviour managed?
Physical: mind body exercise e.g. pilates
Psych: pain education, CBT
Pharm: antidepressants
Procedure: spinal root block, facet joint injection
125
What is spondyloarthritis?
Umbrella term for diseases with arthritis and inflammation, often resulting in inflammatory back pain
126
What is the criteria for inflammatory back pain?
<45 years, insidious onset
Improve with exercise, don't with rest, pain at night
4 out of 5
127
How is axial spondyloarthritis assessed?
Observe chest expansion, lateral flexion
Inflammatory markers
Imaging
128
How is axial sponyloarthritis managed?
Refer to rheumatology
Education, exercise, physical therapy, NSAIDs
129
What is the difference b/n radicular pain and radiculopathy?
RP- Referred pain to neck and UL
RPY- Compression of nerve
130
How can you elevate radicular pain?
Manual Cx distraction
Elevatory taping
Injection/Dry needling
131
Why is LBP said to be iatrogenic?
Worsened with rest and medication, relieved with exercise
132
What are the 4 aspects of LBP treatment to maximise movement and exercise?
1. Reduce hypertonicity e.g. roll downs, hands down leg, reducing extensor tone
2. Increase tone and control of agonists, activate muscles that aren't contributing
3. Endurance, repetition with minimal pain
4. Strength
133
Compare Yergason's and Speed's test?
Y resists supination arms bent, S resists forward flexion arm straight, supinated and then pronated
Both test for biceps injury, S also tests subacromial impingement
134
Distinguish b/n Empty Can, Neers, Hawkins Kennedy and OBriens Tests
All variation of IR and elevation
EC- thumbs up and then thumbs down
N- IR then flex above head
HK- therapist arm under elbow crease to shoulder, IR
OB- straight arm, IR elevate against resistance then ER elevate against resistance, for slap lesion, rest for subacromial impingement
135
What is the pain and movement model?
Triangle, altered tissue load, nociception and cognitive social and emotional state
136
What are some exercise examples for shoulder tendinopathy?
- Ecc. ER w/ theraband
- Plyometric with ball prone bouncing
- Semi closed chain rolling on ball, with ER resistance through theraband
137
What are the 3 neuropathodynamic mechanisms?
1. Mechanical interface dysfunction- closing or opening of joints (e.g. facet), pathoanatomical (e.g. tumour)
2. Neural dysfunction- hypermobile, increased tension, damage to nerve
3. Innervated tissue- dysfuntion in innervated muscles, local hyperactivity
138
How is peripheral neuropathic pain treated?
Sliding techniques, e.g. recreate provocation movement
Low dosage progress steadily
139
What is the McKenzie Approach?
Emphasizes early education and self treatment
Ax to establish mechanical diagnosis
140
What is posture syndrome?
LBP from mechanical deformation of soft tissues due to poor posture
141
What is dysfunction syndrome?
Adaptive shortening of soft tissue due to trauma, injury or posture, pain when stretched
142
What is derangement syndrome?
Pain due to derangement of IV disc, repeated movements can help reduce
143
How is posture, dysfunction and derangement syndrome distinguished?
Posture- local, gradual onset, agg sustained position
Active movement therapy doesn't reproduce pain
Dys- intermittent, gradual onset may be 2' to trauma, agg end of range
Restricted range on AMT
Der- sudden onset, related to poor posture or repeated flexion
Pain during movement
144
How is posture, dysfunction and derangement syndrome treated?
P- improve posture
Dys- stretching stiff structures
Der- extension to reduce derangement
145
Whats a consider to surgery for ACL in paeds?
Insulting growth plate, premature closure and deformity
May wrap around tibia-femur rather than through bone
146
What are the aims of paeds ACL rehab?
P1: Reduce swelling
Restore knee E, need full and 120 knee F to proceed
Normalize gait
PII: regain SLS
Strength
SLSq
Need full ROM, can jog, and symmetry on hop to proceed
PIII: Running, agility, landing
Symmetry
Full strength, balance
Then into return to sport
147
What's a red flag specific to thoracic pain?
Chest pain
Could be shingles, tracheobronchial tree or angina
Cardiac- tightness, pressure, not relieved by position change, brought on by activity
148
How is dysfunction of the thoracic spine managed?
Education
Mobs
Taping
Exercise
149
How does disc protrusion in Tx spine present?
Mostly below T9
Radicular pain
Possible spinal cord compression
150
What are common aggs and eases for Tx spine pain?
Aggs- rotation, breathing, ADLs
Eases- Tx extension
151
What is the difference between peripheral and central sensistisation?
P- altered transduction of high threshold receptors
C- increased excitability of CNS neurons
152
What is the difference between hyperalgesia and allodynia?
H- increased pain from provocative stimulus
A- pain from non-provocative stimulus
153
What is the difference between 1' and 2' hyperalgesia?
1'- present with tissue damage
2'- present without tissue damage
154
What are some explanations of pain causing reduced movement?
Spasm- increased activity => pain
Adaption- pain reduces activation of agonists, and increases antagonist
Protective- limited movement => reduce short term pain
155
What are some false beliefs of ACL surgery vs conservative?
- No evidence surgery is best treatment for RTS
- No increased risk of knee injury
- OA risk with surgery
- ACL can heal w/out surgery
156
What is tight and weak with rounded shoulders?
Tight pecs
Weak rhomboids, mid/lower traps
157
What are the stages of Tx Pain Mx?
1. Pain management, education, gentle ROM
2. Restore basic movements, strengthen, posture
3. Build functional capacity, complex movements, strength/flexibility/balance, more time in aggs position
4. RTS/RTW, prevention, ongoing maintenance
158
What are some exercise examples for Tx pain?
Bow and arrow- rotation
Extension over towel or roller
Ball underneath back
