Musculoskeletal 1 & 2 Flashcards
(147 cards)
1
Q
What is the musculoskeletal system?
A
the muscles, bones, tendons, and ligaments that support and control posture and body movement
2
Q
What is soft tissue classified as?
A
muscles, tendons, ligaments, fascia, nerves, fibrous tissues, fat, blood vessels, and synovial membranes
3
Q
Tendons attach ________ to _________.
A
muscles to bones
4
Q
Ligaments attach _______ ________ to stabilize a joint structure.
A
across bones (bone to bone)
5
Q
True or False:
Muscle contractions cause, control, or prevent joint movement when initiating, decelerating, or restraining a body segment movement.
A
True
6
Q
True or False:
Muscle contractions are isotonic (static) or isometric (concentric/eccentric).
A
False;
Muscle contractions are isometric (static) or isotonic (concentric/eccentric).
7
Q
Which of the contractions (concentric, eccentric, isometric) are known as each of the following:
- control
- power
- stabilize
A
eccentric = control
concentric = power
isometric = stabilize
8
Q
What does concentric contraction (positive) mean?
A
the muscle shortens to generate tension and contract against resistance
(e.g. lifting an object/pushing an object/throwing an object)
9
Q
What does eccentric contraction (negative) mean?
A
the muscle lengthens of while controlling motion against an external force
(e.g. the lowering phase of a concentric movement)
10
Q
What does isometric contraction (static) mean?
A
the muscle develops tension, but no mechanical work occurs
(e.g. holding a weight in a fixed position/pushing against a fixed immoveable object)
11
Q
True or False:
All skeletal movements involve varying degrees of concentric, eccentric, and isometric muscle actions
A
True
12
Q
How does a therapist usually begin treatments with contractions? Which one do they use?
A
pain free isometric
13
Q
In treatments, what is the progression order following pain free isometrics?
A
- progress to AAROM
- progress to AROM
- progress to concentric/eccentric with PRE protocol
14
Q
A maximum concentric contraction produces _____ force than a maximum eccentric contraction under the same circumstances.
A
less
15
Q
A greater resistance load can be lowered ____________ than can be lifted __________.
A
eccentrically, concentrically
16
Q
True or False:
Placing a muscle on stretch prior to a concentric contraction increases the force generation potential.
A
True
17
Q
The greatest level of tension is developed when a muscle is stretched no more than ____% of its resting length
A
30%
18
Q
Which point of the ROM is the greatest muscle force output?
A
mid portion
(think of dumbbell curls, the midpoint is the strongest concentric reaction)
19
Q
What is a musculoskeletal injury?
A
damage to the muscular or skeletal structure that impairs dynamic movement or body stabilization
20
Q
What do musculoskeletal injuries include?
A
- bone fracture
- muscle/tendon and ligament injury
- nerve damage
- vertebral disc injury
21
Q
What are some theraputic exercises for musculoskeletal injuries?
A
- strength, power, and endurance training***
- flexibility and ROM***
- postural stabilization***
- balance training
- coordination exercises
- gait and locomotion training
- neuromuscular re-education (retraining)
22
Q
What is neuromuscular re-education?
A
a series of repetitive movements, posturing, and nerve stimulation designed to reinforce nerve signals to restore functional movements
23
Q
True or False:
When nerve signals are “retrained”, coordinated muscle movements can be restored through repetitive training
A
True
24
Q
When developing a patient’s therapeutic regimen, what are things that are important to take into account?
A
- current functional level
- current stage of healing
- prior activity and fitness level
- comorbidities
- setting (home, SNF, hospital, gym)
25
What should you always do to the patient before you ever begin an exercise regimen? And why should you do this?
Evaluate them to determine the level of:
- muscular strength (MMT)
- endurance
- flexibility and ROM
- functional movement status (TUG, Tinetti, Berg)
26
What can flexibility restrictions result from?
- joint structure
- muscle tightness
- neuromuscular deficits
- decreased muscular strength
- imbalanced agonist/antagonist relations across joints
27
What are some methods to restore flexibility?
- static stretch
- ballistic stretch
- mechanical stretch
- PNF stretch (hold relax and agonist contract)
28
What is strength training exercise?
apply the principles of progressive overload training to restore muscular strength and endurance
29
What is progressive resistive exercise (PRE)?
calculated resistance applied to muscle contraction, and progressively increase commensurate with the muscle's increased contractile force potential (by sets, reps, and time)
30
What is the difference between open kinetic chain and closed kinetic chain?
OKC: distal end is not fixed
CKC: distal end is fixed
31
True or False:
The hip joint is more stable and less vulnerable to dislocation (as compared to the shoulder joint)
True
32
What are the movements of the hip joint?
flex/ext
ab/add
ex rot/int rot
33
What type of joint is the hip?
enarthrodial ball and socket
34
True or False:
the femur is the longest bone is the body
True
35
The hip joint is ___ to the shoulder joint in regards to mobility
2nd
36
What is the iliotibial band (IT band)?
a wide sheath of fibrous connective tissue surrounding the lateral thigh
37
Where does the IT band originate and insert?
O: TFL and glute max
I: lateral epicondyle of tibia (Gerdy's tubercle)
38
What is IT band syndrome?
a painful condition caused by connective tissue abrades against the femur (rubbing)
- this is a leading cause of lateral knee pain incurred during running and cycling
39
What is trochanteric bursitis?
inflammation of the trochanteric bursa located between the greater trochanter of the femur and glute med
40
What is a bursa?
a closed, fluid-filled sac that funtions as a gliding surface to reduce friction between body tissues
41
What is the form of treatment for trochanteric bursitis?
rest and cryotherapy (cold ice), along with stretching exercises
42
What is snapping hip syndrome?
condition in which a person feels a snapping sensation or hear a popping sound in hip (dixie)
43
True or False:
snapping hip syndrome is usually painless and harmless, however, the sensation is annoying and can lead to bursitis
True
outside -- ITB (most common)
front -- rectus femoris or iliopsoas
back -- hamstring
44
What is a hip impingement (femoralacetabular impingement)?
occurs when the femoral head pinches against the acetabulum
- can results in damage to labrum
- can lead to OA
45
What is a total hip arthroplasty (THA)?
a surgical replacement of the femoral head and the acetabular surface with a prosthetic component
46
Why is a THA performed?
to correct damage from OA, RA, hip fracture, avascualr necrosis, and cerebral palsy
47
What are contraindications for a THA?
- osteoporosis (will break bone more)
- ligament laxity (more dislocation prone, continue to fall out)
- infection (even more risk of infection)
48
True or False:
THA is an end stage procedure performed when conservative measures to manage joint pain and joint function fail
True
49
What are the 5 primary THA procedures?
1. Posterior lateral approach
2. Direct lateral approach
3. Anterior lateral approach
4. Anterior approach
5. Transtrochanteric approach
50
How is the Posterior lateral approach performed?
1. glute max is split in line with the muscle fibers
2. the interval between the glute max and med is split
3. the piriformis and short external rotator tendons are transected near their insertion
4. the capsule is incised and the glute max tendon is released from its insertion in prep for insertion of the replacement components
51
What is the primary benefit of the posterior lateral approach?
Hip abductors are preserved
52
True or False: the posterior lateral approach is most commonly used
True
53
What movements should be avoided to prevent dislocation in the posterior lateral approach?
- hip flex past 90 degrees
- no adduction past midline
- no internal rotation past neutral
54
How is the direct lateral approach performed?
1. TFL is divided longitudinally
2. a portion of the proximal insertion of the glute med is released
3. vastus lateralis is split longitudinally
4. glute mini is partially detached from the trochanter
55
What can the direct lateral approach involve?
a trochanteric osteotomy
56
What is an osteotomy?
removal of a wedge of bone to change alignment or angle to alter bone stresses
57
What is an uncompensated positive Trendelenburg sign?
when the right leg moves to weight bearing (stance phase), the unsupported left hip (swing phase) drops down
58
What is deliberate compensation for a positive Trendelenburg sign (weak glute med)?
during weight bearing on the side of glute med weakness the person leans laterally to the weak side, resulting in a waddling gait
59
How is the Anterior lateral approach performed?
1. the joint is incised lateral to the TFL
2. the IT band is split
3. the anterior third of the flute med and mini are detached from their insertion and reattached at closure
4. the anterior third of the vastus lateralis may be detached
5. a capsulotomy is performed and the hip is dislocated anteriorly
60
What is a capsulotomy?
incision of a capsule
61
True or False:
The incidence os postoperative dislocation of the Anterior lateral approach is lower than with the posterior approach
True
- indicated for patients with stroke or cerebral palsy whose standing posture is characterized by hip flexion and internal rotation
62
How is the Anterior approach performed?
1. an incision is made lateral to the ASIS, slightly anterior to the greater trochanter, and medial to the TFL
2. the capsule is incised and the hip is dislocated anteriorly
(no muscles are detached by rectus femoris and sartorius are retracted medially)
63
True or False:
Concerning the anterior approach, weight bearing as tolerated is permitted immediately after surgery.
True
64
How is the transtrochanteric approach performed? (kinda sketchy)
1. used primarily in complex revision arthroplasty
2. involves an osteotomy of the greater trochanter at the insertion of the glute med and mini
3. after component placement, the trochanter is reattached and wired in place to stabilize the osteotomy site (ORIF)
4. the trochanter is often reattached in a position that improves the mechanical efficiency of the glute med
65
True or False:
In a trochanteric approach, it involves an extended period of non-weight bearing and adherence to abduction precaution
True (very slow healing for this approach)
66
What do THA postoperative exercises include?
- ankle pumps, quad set, short arc quads...
- ambulation with assistive devices, WBAT)
- progress from passive to active movement
- gradually increase to AROM
- continue to progress to ambulation with least restrictive devices
67
What is the Thomas Test used for?
labral tear (looking for click or catch)
68
What is the Trendelenburg Sign used for?
weak glute med
69
What is Ober's used for?
tight ITB or TFL
70
What is FABER's used for?
SI joint dysfunction or impingement/labral (reproduce pain)
71
What is FADIR's used for?
impingement/labral (reproduce pain)
72
What is patellofemoral pain syndrome?
anterior knee pain involving the patella and retinaculum
73
What is retinaculum?
fibrous bands of fascia that pass over or under tendons to maintain their position
74
What is overuse syndrome?
most often asociated with repetitive activities as running, jumping, ascending and descending hills
75
What is chondromalacia?
softening of the cartilage underneath the patella
76
What is Pes planus?
(flat arch) the flattening of the foot causing a compensatory internal rotation of the tibia that alters the dynamics of the patellofemoral joint
77
What is Pes cavus?
(high arch) results in uneven weight bearing distribution leads to excessive stress to the patellofemoral joint
78
What is the Q-angle?
(the quadriceps angle) the angle between the quadriceps muscles and the patella tendon
- formed by lines drawn from the ASIS trough the center of the patella and from the center of the patella to the center of the tibial tubercule
79
True or False:
A large Q-angle is associated with patellofemoral pain syndrome
True
80
Q-angles greater than ___ degrees are problematic
15
81
Do women or men have larger Q-angles?
Women
82
How can meniscal injuries occur?
trauma or degeneration (also ACL, MCL)
83
What does the unhappy triad consist of?
torn meniscus
ACL tear
MCL tear
84
Which part of the menicus is repaired and which part is cut out if needed>
outer section is repaired due to good blood supply
inner two-thirds is cut out due to bad blood supply
85
Which ligament in the knee is most commonly injured?
ACL
86
How do most ACL injuries occur?
during deceleration combined with twisting/pivoting/side stepping
- a pop noise is heard
87
True or False:
You can still function without an ACL.
True
88
What is the treatment for an ACL?
- maintain adequate ROM an balanced strength of quads and hammies
- knee brace
89
What are the causes of PCL tears?
- fall onto bent knee
- dashboard injury
- hyperflexion
- dislocation
90
What are surgical considerations for ACL tears?
- patellar tendon graft (take middle third of patellar tendon to replace damaged ACL) GOLD STANDARD
- hamstring tendon graft (take strands of semitendinosus to reconstruct ACL)
- allograft (cadaver graft from Achillies tendon, tib ant, and patellar tendon to replace ACL
91
What is a total knee arthroplasty (TKA)?
a surgical procedure to replace components of the knee joint with artificial components
- peformed when conservative treatment fails to restore mobility or reduce chronic pain
92
What components of the knee are replaced in a TKA?
- femoral
- tibial
- patellar
93
What is a partial knee replacement?
replaces the medial or lateral component but not the patellar component
- not recommended if 2 or more compartments within the knee are damaged
- typically done for older individuals with sedentary lifestyle
94
What are the special tests for the knee?
1. Patellar grind (patellofemoral pain)
2. Lachman (ACL)
3. McMurray (meniscus)
4. Thessaly (meniscus)
5. Anterior drawer (ACL)
6. Posterior drawer (PCL)
95
What is an ankle sprain?
an injury inwhich the ligaments of the ankle tear partially or completely due to a sudden stretch force
- pain is severe and can be associated with a popping sensation
- immediate swelling
96
What is a lateral ankle sprain?
involves inversion with plantar flexion (most common type)
97
What are the grades of a sprain?
Grade 1: structural damage on microscopic level with mild pain and swelling
Grade 2: partial tear of fibers associated with moderate pain and swelling (may have instability)
Grade 3: a complete tear (rupture) of a ligament with severe pain and swelling (associated with instability
98
What are medial ankle sprains?
results from forced dorsiflexion and eversion of the ankle (less common)
- medial deltoid ligament is most common structure involved
- requires further examination to rule out fracture (fibular fractures)
99
What is plantar fasciitis?
result of collagen degeneration of the plantar fascia at the calcaneal tuberosity and surrounding structures
- presents as heel pain
100
What are the risk factors for plantar fasciitis?
- tight or weak plantar flexors
- pes cavus or pes planus
- excessive pronation
- overuse
- improper footwear
101
How does plantar fasciitis present itself?
1. heel pain with first steps in morning
2. tenderness to anterior medial heel
3. limmited DF
4. painful gait or toe walk
5. pain increases with barefoot and stairs
6. patients typically had sudden increase in activity prior to onset (grandma goes to disney)
102
What does PRICE stand for?
- Protection
- Rest/Restricted activity
- Ice
- Compression
- Elevation
103
How do you improve flexbility for the ankle?
stretch the gastroc and soleus
- avoid stretching the ankle in motions that stress the injured ligaments
104
How do you strengthen the ankle?
particular emphasis is placed on strengthening the muscles that control the foot an ankle
- plantar flexors, dorsiflexors, inverts, and everts
105
What are the special tests for the ankle?
1. Anterior drawer (talocrual laxity)
2. Squeeze test (syndesmotic injury) (fib and tib)
3. Figure 8 (swelling)
4. Talar tilt (ATFL and calcaneofibular ligament)
106
What is a joint?
an axial structure consisting of adjacent bones articulating with muscle tendons attached to each bone
107
What type of joint is the shoulder?
ball and socket
108
The ______ surrounding the glenoid socket provides increased stability of the shoulder joint.
Labrum
109
What are the 8 movements of the shoulder joint?
flex/ext
int/ext rot
ab/ad
horizontal ab/ad
110
True or False:
The shoulder is the most stable joint in the body
False, it is the most mobile
111
In which movement is the shoulder joint the most stable?
Extension
112
When does dislocation in the shoulder joint occur?
when the proximal portion of the humeral head slips out of the glenoid fossa
113
What are some exercises to strengthen the anterior deltoid?
- overhead press
- push ups
- bench press (horizontal and incline)
- front raises
- resisted scaption
114
What are some exercises to strengthen the medial deltoid?
- resisted lateral raises
- upright rows
- resisted scaption
115
What are some exercises to strengthen the posterior deltoid?
- bent over lateral raises
- bent over horizontal row
- chin ups/pull ups/lat downs
- rope climbing
116
The _____ ______ and the ___________ work in tandem during shoulder abduction.
medial deltoid and the supraspinatus
117
Which muscle pulls first in abduction? medial delt or supraspinatus?
supraspinatus
118
What are the 5 shoulder joint injuries?
1. labrum tears
2. impingements
3. tendonitis
4. tendon tears
5. OA
119
What do labrum tears result from?
- direct FOOSH
- repetitive overuse like throwing or tennis serves
120
What is a SLAP tear stand for and what does it mean?
Superior Labrum Anterior and Posterior
- most common type of labrum injury
121
What else can be injured in a SLAP tear?
biceps tendon
122
What is shoulder impingement syndrome?
compression of a tendon between the glenohumeral joint and the acromion
123
True or False:
Shoulder impingement is often secondary to rotator cuff injury.
True
124
True or False:
Impingement is a sign, not a diagnosis
True
125
What are the two planes that rotator cuffs move in?
Frontal and transverse
126
What do rotator cuff injuries result from?
- trauma to shoulder
- wear and tear
127
What is the most commonly injured rotator cuff muscle?
supraspinatus
128
When dealing with a rotator cuff injury, what is the one motion you should avoid?
the empty can
- shoulder abduction with thumb down (emphasizes internal rotation)
129
What are the special tests for the shoulder?
- full can
- empty can (supraspinatus)
- Hawkins kennedy (impingement)
- liftoff (subscap)
- speed's (biceps tendinitis)
130
What is shoulder subluxation?
(partial dislocation)
- results from joint laxity in weakness of rotator cuff muscles
131
What are 4 exercise precautions to follow following a shoulder injury?
- lat pull downs
- biceps curl
- bench press
- overhead press
132
True or False:
A torn rotator cuff cannot maintain the head of the humerus in the glenoid fossa resulting in the humerus moving upward and rubbing against the acromion
True
133
What is avascular necrosis?
AVN
- occurs when the blood supply to the humeral head has been disrupted
- death of cells
- treatment is TSA (total shoulder arthroplasty)
134
What are the two options for a TSA?
- replace humeral head only
- replace humeral head and glenoid fossa
135
In a TSA, if the ___________ is detached and reattached, to complete the procedure, resisted internal and external rotation must be avoided until healing is complete.
Subscapularis
136
What is biceps tendinitis?
occurs in the long head of the biceps tendon following the path on the anterior aspect of the humerus between the greater tuberosity and the lesser tuberosity.
137
What is epicondylitis?
inflammation or damage to the area of an epicondyle of bone
138
What is lateral epicondylitis and what else is it known as?
A.K.A Tennis elbow
- inflammation and micro-tearing of fibers in the extensor tendons of the forearm
139
How is tennis elbow produced? (what motion makes it occur?)
pain is produced with passive wrist flexion and resistive wrist extension, most specifically with the elbow in extension
140
How do you isolate the following elbow flexors?
biceps brachii
brachialis
brachioradialis
BB: supinated forearm
B: pronated forearm
BR: neutral forearm
141
What are the special tests of the elbow?
Tinel's: comrpression neuropathy
Elbow varus: integrity of LCL
Elbow valgus: integrity of UCL (MCL)
142
What does the wrist movement involve the articulation of?
- distal radius and proximal row of carpal bones
1. scaphoid
2. lunate
3. triquetrum
4. pisiform
143
What are the 6 movements of the wrist?
- flex/ext
- rad dev/uln dev
- pro/sup
144
What is the acronym for the carpal bones
Some Lovers Try Postions That They Can't Handle
- scaphoid
- lunate
- triquetrum
- pisiform
- trapezium
- trapezoid
- hamate
145
Which carpal bone is the most frequently fractured and how does it occur?
scaphoid, FOOSH injury
146
Which carpal bone is most frequently dislocated?
lunate
147
What are the 3 deformities in the finger?
Mallet finger (curved DIP when typing)
Boutonniere (extended MCP and curved PIP)
Swan neck (hyper extended PIP and flexed DIP)
