Musculoskeletal Flashcards
(495 cards)
1
Q
What is the indication for Total Shoulder Arthroplasty surgery?
A
shoulder joint arthritis, humeral fracture or rotator cuff arthropathy
2
Q
What is an indication for reverse total shoulder arthroplasty surgery?
A
dysfunctional rotator cuff
3
Q
What is the indication for subacromial decompression surgery?
A
shoulder impingement that has not responded to conservative measures
4
Q
What is the indication for capsular shift procedure?
A
chronic shoulder instability
5
Q
What is the indication for a bankart repair?
A
Tear of the anterior shoulder labrum
6
Q
What is the indication for Slap Repair?
A
tear of the superior shoulder labrum
7
Q
What are the movement precautions for the anterior capsular shift/ bankart repair?
A
avoid ER, EXT, and horizontal ABD
8
Q
What are the movement precautions for the posterior capsular shift?
A
Avoid IR, FLEX, and Horizontal ADD
9
Q
What are the movement precautions for slap repair?
A
Avoid contracting or stretching the biceps
10
Q
What is the movement precautions for the total hip arthroplasty anterorlateral approach?
A
Avoid hip EXT, lateral rotation and ADD
11
Q
What is the movement precautions for total hip arthroplasty direct lateral approach?
A
Avoid hip flexion beyond 90 degrees, EXT, lateral rotation, and ADD.
Avoid active or resisted hip ABD if the gluteus medius was repaired.
12
Q
What is the movement precautions for total hip arthroplasty for posterolateral approach?
A
Avoid hip flexion beyond 90 degrees, medial rotation and ADD
13
Q
What is the indication for lateral ankle reconstruction?
A
Chronic ankle instability and/ or a complete tear of the anterior talofibular ligament or calcaneofibular ligament
14
Q
What is the indication for laminectomy surgery?
A
disk protrusion or spinal stenosis
15
Q
What is the indication for spinal fusion?
A
axial pain with unstable spinal segments, advanced arthritis or uncontrolled peripheral pain
16
Q
What is the graft tissue commonly utilized for an ACL reconstruction?
A
Patellar tendon, semitendinosis, gracilis
17
Q
What is the graft tissue commonly utilized for lateral ankle reconstruction?
A
peroneus brevis
18
Q
What is the graft tissue commonly utilized for the achilles repair?
A
Flexor hallucis longus
Peroneus brevis
Plantaris
19
Q
Define muscle testing grades 0/5.
A
no palpable muscle contraction
20
Q
Define muscle testing grades TRACE 1/5
A
muscle contraction can be palpated, but there is no joint movement
21
Q
Define muscle testing grades POOR MINUS 2-/5.
A
the subject does not complete ROM in a gravity eliminated position
22
Q
Define muscle testing grade POOR 2/5
A
the subject completes ROM in a gravity-eliminated position
23
Q
Define muscle testing grade POOR PLUS 2+/5
A
the subject is able to initiate movement against gravity
24
Q
Define muscle testing grades FAIR MINUS 3-/5
A
the subject does not complete the ROM against gravity but does complete more than half of the range
25
Define muscle testing for FAIR 3/5
the subject completes ROM against gravity without manual resistance
26
Define muscle testing grade for FAIR PLUS 3+/5
the subject completes ROM against gravity with only minimal resistance
27
Define muscle testing grade for GOOD MINUS 4-/5
the subject completes ROM against gravity with minimal- moderate resistance
28
Define muscle testing grade for GOOD 4/5
the subject completes ROM against gravity with moderate resistance
29
Define the muscle testing grade for GOOD PLUS 4+/5
the subject completes ROM against gravity with moderate- maximal resistance
30
Define muscle testing grade for NORMAL 5/5
the subject completes ROM against gravity with maximal resistance
31
What are the components of STANCE PHASE? (standard terminology)
Heel Strike
Foot Flat
Midstance
Heel off
Toe off
32
What are the components of the SWING PHASE? (standard terminology)
Acceleration
Midswing
Deceleration
33
What are the components of the stance phase? (Rancho Los Amigos Terminology)
Initial contact
Loading response
midstance
terminal stance
pre- swing
34
What are components of the swing phase? (Racho Los Amigos Terminology)
Initial swing
Midswing
Terminal swing
35
Define heel strike.
the instant that the heel touches the ground to begin stance phase
36
Define foot flat.
is the point in which the entire foot makes contact with the ground and should occur directly after heel strike
37
Define midstance.
the point during the stance phase when the entire body weight is directly over the stance limb
38
Define heel off.
is the point in which the heel of the stance limb leaves the ground
39
Define toe off.
is the point in which only the toe of the stance limb remains on the ground
40
Define acceleration.
begins when toe off is complete and the reference limb swings until positioned directly under the body
41
Define midswing.
is the point when the swing limb is directly under the body
42
Define Deceleration.
begins directly after midswing, as the swing limb begins to extend, and ends just prior to heel strike
43
Define initial contact.
is the beginning of the stance phase that occurs when the foot touches the ground.
44
Define loading response.
corresponds to the amount of time between initial contact and the beginning of the swing phase for the other leg.
45
Define midstance.
corresponds to the point in stance phase when the other foot is off the floor until the body is directly over the stance limb.
46
Define terminal stance.
begins when the heel of the stance limb rises and ends when the other foot touches the ground.
47
Define pre- swing.
begins when the other foot touches the ground and ends when the stance foot reaches toe off.
48
Define initial swing.
begins when the stance foot lifts from the floor and ends with maximal knee flexion during swing
49
define midswing
begins with maximal knee flexion during swing and ends when the tibia is perpendicular with the ground.
50
define terminal swing.
begins when the tibia is perpendicular to the floor and ends when the foot touches the ground.
51
define base of support.
the distance measured between the left and right foot during progression of gait.
the distance decreases as cadence increases.
the average base of support for an adult is two to four inches.
52
Define Cadence.
the number of steps an individual will walk over a period of time.
the average value for an adult is 110- 120 steps per minute.
53
Define degree of toe- out.
the angle formed by each foot's line of progression and a line intersecting the center of the heel and second toe.
the average degree of toe- out for an adult is 7 degrees.
54
Deine double support phase.
refers to the two times during a gait cycle where both feet are on the ground.
the time of double support increases as the speed of gait decreases.
this phase does not exist with running.
55
Define the gait cycle.
refers to the sequence of motions that occur from initial contact of the heel to the next consecutive initial contact of the same heel.
56
Define pelvic rotation.
rotation of the pelvis occurs opposite the thorax in order to maintain balance and regulate speed.
the average pelvic rotation during gait for an adult is a total of 8 degrees (4 degrees forward with the swing leg and 4 degrees backward with the stance leg.)
57
Define the Single Support Phase.
occurs when only one foot is on the ground and occurs twice during a single gait cycle
58
Define step length.
the distance measured between the right heel strike and the left heel strike.
the average step length for an adult is 28 inches.
59
Define stride length.
the distance measured between right heel strike and the following right heel strike.
the average stride length for an adult is 56".
60
Define an antalgic gait pattern. what are the causes of an antalgic gait?
a protective gait pattern where the stance time is decreased to avoid weight bearing on the involved side due to pain.
This is typically associated with a rapid and shorter swing phase of the uninvolved limb.
Causes of antalgic gait include disease (usually bone or joint), joint inflammation, or injuries to muscles, tendons, and/ or ligaments.
61
Define an Ataxic gait pattern.
characterized by staggering and unsteadiness.
there is usually a wide base of support and movements are exaggerated.
62
Define a cerebellar gait pattern.
a staggering gait pattern seen in cerebellar disease.
63
Define a circumduction gait pattern.
characterized by a circular motion to advance the leg during swing phase; this may be used to compensate for insufficient hip or knee flexion or dorsiflexion.
64
Define double step.
a gait pattern in which alternate steps are of a different length or at a different rate.
65
define an EQUINE gait pattern?
gait pattern characterized by high steps; usually involves excessive activity of the gastrocnemius
66
Define a festinating gait pattern.
a gait pattern where a patient walks on toes as though pushed.
it starts slowly, increases, and may continue until the patient grasps an object in order to stop.
67
Define a hemiplegic gait pattern.
a gait pattern in which patients abduct the paralyzed limb, swing it around, and bring it forward so the foot comes to the ground in front of them.
68
Define the Parkinsonian gait pattern.
a gait pattern marked by increased forward flexion of the trunk and knees; gait is shuffling with quick and small steps; festinating may occur.
69
Define the scissor gait pattern.
a gait pattern in which the legs cross midline upon advancement.
70
Define spastic gait pattern.
a gait pattern with stiff movement, toes seeming to catch and drag, legs held together, and hip and knee joints slightly flexed.
Commonly seen in spastic paraplegia.
71
Define the steppage gait pattern.
the feet and toes are lifted through the hip and knee flexion to excessive heights.
Usually secondary to dorsiflexor weakness.
The foot will slap at initial contact with the ground secondary to the decreased control.
72
Define the tabetic gait pattern.
a high-stepping ataxic gait pattern in which the feet slap the ground
73
Define the Trendelenburg gait pattern.
a gait pattern characterized by excessive lateral trunk flexion and weight shifting over the stance leg;
Typically denoting gluteus medius weakness.
74
Define Vaulting gait patterns.
a gait pattern where the swing leg advances by compensating through the combination of elevation of the pelvis and plantar flexion of the stance leg.
75
Define end feel.
the type of resistance that is felt when passively moving a joint through the end range of motion.
certain tissues and joints have a consistent end feel and are described as firm, hard or soft.
Pathology can be identified through noting the type of abnormal end- feel within a particular joint.
76
Define a normal end- feel.
occurs when the joint has full ROM and is stopped by the anatomy of the joint.
77
Define an abnormal end- feel.
consists of any end- feel that is felt at an abnormal or inconsistent point in the ROM or in a joint that normally presents with a different end- feel.
78
Examples of normal FIRM end- feel.
Ankle DF
Finger EXT
Hip medial rotation
Forearm SUP
79
Examples of normal HARD end-feel.
Elbow EXT
80
Examples of normal SOFT end- feel.
Elbow FLEX
Knee FLEX
81
Examples of EMPTY abnormal end- feel.
Joint inflammation
Fracture
Bursitis
82
Examples of FIRM abnormal end- feel.
Increased tone
Tightening of the capsule
Ligament shortening
83
Examples of HARD abnormal end- feel.
Fracture
Osteoarthritis
Osteophyte formation
84
Examples of soft ABNORMAL END-FEEL.
Edema
Synovitis
Ligament instability/ Tear
85
Closed Packed and Loose Packed position of GELNOHUMERAL:
Close Packed: ABD and Lateral Rotation.
Loose Packed: 55 deg ABD, 30 deg Horizontal ADD
86
Closed Packed and Loose Packed position of ULNOHUMERAL (elbow):
Close Packed: Elbow EXT
Loose Packed: 70 deg FLEX, 10 deg SUP
87
Closed Packed and Loose Packed position of RADIOHUMERAL.
Close Packed: Elbow Flexed 90 deg, forearm SUP 5 deg.
Loose Packed: Full EXT, Full SUP
88
Closed Packed and Loose Packed position of PROXIMAL RADIOULNAR:
Close Packed: 5 deg SUP
Loose Packed: 70 deg FLEX, 35 deg SUP
89
Closed Packed and Loose Packed position of DISTAL RADIOULNAR:
Close Packed: 5 deg SUP
Loose Packed: 10 deg SUP
90
Closed Packed and Loose Packed position of RADIOCARPAL (wrist)
Close Packed: EXT with radial deviation
Loose Packed: Neutral with slight ulnar deviation
91
Closed Packed and Loose Packed position of HIP:
Close Packed: Full EXT, Medial Rotation
Loose Packed: 30 deg Flex, 30 deg ABD, slight Lateral Rotation
92
Closed Packed and Loose Packed position of KNEE:
Close Packed: Full EXT, Lateral Rotation of Tibia
Loose Packed: 25 deg FLEX
93
Closed Packed and Loose Packed position of TALOCRURAL (ankle):
Close Packed: Maximum DF
Loose Packed: 10 deg PF, midway between maximum INV and EVER
94
Closed Packed and Loose Packed position of SUBTALAR:
Close Packed: SUP
Loose Packed: Midway between extremes of range of movement.
95
Capsular Patterns for Cervical Spine: Restriction
Lateral FLEX and Rotation equally limited, EXT
96
Capsular Patterns for Glenohumeral: Restriction
Lateral Rotation
ABD
Medial Rotation
97
Capsular Patterns for Radiocarpal (Wrist): Restriction
FLEX and EXT equally limited
98
Capsular Pattern for Thoracic Spine: Restriction
Lateral FLEX and Rotation equally limited, EXT
99
Capsular Pattern of Lumbar Spine: Restriction
Lateral FLEX and rotation equally limited, EXT
100
Capsular Patterns for HIP: Restriction
FLEX, ABD, Medial Rotation (sometimes medial rotation is most limited)
101
Capsular Patterns for KNEE: Restriction
FLEX, EXT
102
Capsular Patterns for Tibiofibular: Restriction
Pain when joint is stressed.
103
Capsular patterns for Talocrural: Restriction
PF, DF
104
Capsular Patterns for Talocalcaneal (Subtalar): Restriction
limitation of varus range of movement
105
Arthrokinematics of Interphalangeal Joint (toes):
Convex Surface
Concave Surface
Osteo/ Arthro Motion
Convex Surface: Proximal Phalanges
Concave Surface: Distal Phalanges
Osteo/ Arthro Motion: Same direction
106
Arthrokinematics of Metatarsophalangeal Joint:
Convex Surface
Concave Surface
Osteo/ Arthro Motion
Convex Surface: Metatarsals
Concave Surface : Phalanges
Osteo/ Arthro Motion: Same direction
107
Arthrokinematics for Subtalar Joint (posterior): Convex Surface
Concave Surface
Osteo/ Arthro Motion
Convex Surface: Posterior calcaneus
Concave Surface: Posterior Talus
Osteo/ Arthro Motion: Opposite direction
108
Arthrokinematics for Subtalar joint (Anterior and Middle):
Convex Surface
Concave Surface
Osteo/ Arthro Motion
Convex Surface: anterior and middle talus
Concave Surface: anterior and middle calcaneus
Osteo/ Arthro Motion: same direction
109
Arthrokinematics for Talocrural Joint:
Convex Surface
Concave Surface
Osteo/ Arthro Motion
Convex Surface: Talus
Concave Surface: Tibia and Fibula
Osteo/ Arthro Motion: Opposite Direction
110
Arthrokinematics for Distal Tibiofibular joint:
Convex Surface
Concave Surface
Osteo/ Arthro Motion
Convex Surface: Fibula
Concave Surface: Tibia
Osteo/ Arthro Motion: Opposite Direction
111
Arthorkinematics for Proximal Tibiofibular Joint:
Convex Surface
Concave Surface
Osteo/ Arthro Motion
Convex Surface: Tibia
Concave Surface: Fibula
Osteo/ Arthro Motion: Same direction
112
Arthrokinematics for Patellofemoral Joint:
Convex Surface
Concave Surface
Osteo/ Arthro Motion
Convex Surface: Patella
Concave Surface: Femur
Osteo/ Arthro Motion: Opposite direction
113
Arthrokinematics for Tibiofemoral Joint: Convex Surface
Concave Surface
Osteo/ Arthro Motion
Convex Surface: Femur
Concave Surface: Tibia
Osteo/ Arthro Motion: Same direction
114
Arthrokinematics for the HIP joint:
Convex Surface
Concave Surface
Osteo/ Arthro Motion
Convex Surface: Femur
Concave Surface: Acetabulum
Osteo/ Arthro Motion: Opposite direction
115
Arthrokinematics for the interphalangeal (fingers 2-5):
Convex Surface
Concave Surface
Osteo/ Arthro Motion
Convex Surface: Proximal phalanges
Concave Surface: Distal phalanges
Osteo/ Arthro Motion: Same direction
116
Arthrokinematics for Metacarpophalangeal (fingers 2-5)
Convex Surface
Concave Surface
Osteo/ Arthro Motion
Convex Surface: Metacarpals
Concave Surface: Phalanges
Osteo/ Arthro Motion: Same Direction
117
Arthrokinematics for Radiocarpal Joint:
Convex Surface
Concave Surface
Osteo/ Arthro Motion
Convex Surface: Carpals
Concave Surface: Radius
Osteo/ Arthro Motion: Opposite Direction
118
Arthrokinematics for Distal Radioulnar Joint:
Convex Surface
Concave Surface
Osteo/ Arthro Motion
Convex Surface: Ulna
Concave Surface: Radius
Osteo/ Arthro Motion: Same direction
119
Arthrokinematics for Proximal Radioulnar joint:
Convex Surface
Concave Surface
Osteo/ Arthro Motion
Convex Surface: Radius
Concave Surface: Ulna
Osteo/ Arthro Motion: Opposite Direction
120
Arthrokinematics for Radiohumeral joint: Convex Surface
Concave Surface
Osteo/ Arthro Motion
Convex Surface: Humerus
Concave Surface: Radius
Osteo/ Arthro Motion: Same direction
121
Arthrokinematics for Ulnohumeral joint:
Convex Surface
Concave Surface
Osteo/ Arthro Motion
Convex Surface: Humerus
Concave Surface: Ulna
Osteo/ Arthro Motion: Same direction
122
Arthrokinematics for Glenohumeral Joint:
Convex Surface
Concave Surface
Osteo/ Arthro Motion
Convex Surface: Humerus
Concave Surface: Glenoid
Osteo/ Arthro Motion: Opposite Direction
123
Name subtypes of Synovial Joints (Diarthoses)
Uniaxial jont
Biaxial Joint
Multi- axial joint
124
Name subtypes of Cartilaginous Joints (Amphiarthroses)
Synchondrosis
Symphysis
125
Name subtypes for Fibrous Joints (Synarthroses)
Suture
Syndesmosis
Gomphosis
126
Define Synovial joints (diarthroses)
Synovial joints provide free movement between the bones they join.
They have five distinguishing characteristics:
- joint cavity
- articular cartilage
- synovial membrane
- synovial fluid
- fibrous capsule
These joints are the most complex and vulnerable to injury
127
define cartilaginous joints (Amphiarthroses)
cartilaginous joints have hyaline cartilage or fibrocartilage that connects one bone to another.
These are slightly moveable joints.
128
Define fibrous joints (synarthroses).
Fibrous joints are composed of bones that are united by fibrous tissue and are nonsynovial.
Movement is minimal to none with the amount of movement permitted at the joint dependent on the length of the fibers uniting the bones.
129
Prime movers for ADDUCTION of toe joints:
Adductor Hallucis
Plantar Interossei
130
Prime movers for ABDUCTION of toe joints:
ABD hallucis
ABD digiti minimi
Dorsal Interossei
131
Prime movers for EXTENSION of toe joints
EXT digitorum longus and brevis
EXT hallucis longus and brevis
Lumbricals
132
Prime movers for FLEXION of Toe Joints:
FLEX digitorum longus and brevis
FLEX hallucis longus and brevis
FLEX digiti minimi brevis
Quadratus Plantae
Lumbricals
133
Prime movers for EVERSION of ankle joint:
Peroneus longus
Peroneus brevis
Peroneus tertius
134
Prime movers for INVERSION of ankle joint:
Tibialis posterior
Tibialis anterior
FLEX digitorum longus
135
Prime movers for DF of ankle joint:
Tibialis anterior
EXT hallucis longus
EXT digitorum longus
Peroneus tertius
136
Prime movers for PF of ankle joint:
Tibialis posterior
Gastrocnemius
Soleus
Peroneus longus
Peroneus brevis
Plantaris
Flexor hallucis
137
Prime movers for EXT of knee joint:
Rectus femoris
Vastus lateralis
Vastus intermedius
Vastus medialis
138
Prime movers for FLEX of knee joint:
Biceps femoris
Semitendinosus
Semimembranosus
Sartorius
139
Prime movers for Lateral Rotation of hip joint:
Gluteus maximus
Obturator externus
Obturator internus
Piriformis
Gemelli
Sartorious
140
Prime movers for MEDIAL ROTATION of hip joint:
Tensor fasciae latae
Gluteus Medius
Gluteus Minimus
Pectineus
Adductor Longus
141
Prime movers for ADDUCTION of the hip joint:
Adductor magnus
Adductor longus
Adductor brevis
Gracilis
142
Prime movers for ABDUCTION of hip joint:
Gluteus medius
Gluteus minimus
Piriformis
Obturator internus
Tensor fasciae latae
143
Prime movers for EXTENSION of hip joint:
Gluteus maximus
Gluteus medius
Semitendinosus
Semimembranosus
Biceps femoris
144
Prime movers for FLEXION of hip joint:
Iliopsoas
Sartorius
Rectus femoris
Pectineus
145
Prime movers for OPPOSITION of the thumb joint:
Opponens pollicis
FLEX pollicis brevis
ABD pollicis brevis
Opponens digit minimi
146
Prime movers for ADDUCTION of thumb joint:
ADD pollicis
147
Prime movers for ABDUCTION of thumb joint:
ABD pollicis longus and brevis
148
Prime movers for EXTENSION of thumb joint:
EXT pollicis longus
EXT pollicis brevis
ABD pollicis longus
149
Prime movers for FLEXION of thumb joint:
FLEX pollicis longus
FLEX pollicis brevis
Opponens pollicis
150
Prime movers for ADDUCTION of finger joints:
Palmar Interossei
151
Prime movers for ABDUCTION of finger joints:
Dorsal interossei
Abductor digiti minimi (5th digit)
152
Prime movers for EXTENSION of finger joints:
EXT digitorum communis
EXT indicis (2nd digit)
EXT digiti minimi (5th digit)
153
Prime movers for FLEXION of the finger joints:
FLEX digitorum profundus and superficialis
FLEX digiti minimi (5th digit)
Interossei
Lumbricals
154
Prime movers for ULNAR DEVIATION of the wrist joint:
EXT carpi ulnaris
FLEX carpi ulnaris
155
Prime movers for RADIAL DEVIATION of wrist joint:
EXT carpi radialis longus
EXT carpi radialis brevis
FLEX carpi radialis
EXT pollicis longus and brevis
156
Prime movers for EXTENSION of wrist joint:
EXT carpi radialis longus
EXT carpi radialis brevis
EXT carpi ulnaris
157
Prime movers for FLEXION of the wrist joint:
FLEX carpi radialis
FLEX carpi ulnaris
Palmaris longus
158
Prime movers for PRONATION of radioulnar joint:
Pronator teres
Pronator quadratus
159
Prime movers for SUPINATION of radioulnar joint:
Biceps brachii
Supinator
160
Prime movers for EXTENSION of elbow joint:
Triceps brachii
Anconeus
161
Prime movers for FLEXION of elbow joint:
Biceps brachii
Brachialis
Brachioradialis
162
Prime movers for MEDIAL ROTATION of shoulder joint:
Subscapularis
Teres major
Pectoralis major
Latissimus dorsi
Anterior deltoid
163
Prime movers for LATERAL ROTATION of the shoulder joint:
Teres minor
Infraspinatus
Posterior deltoid
164
Prime movers for HORIZONTAL ADDUCTION of shoulder joint:
Anterior deltoid
Pectoralis major
165
Prime movers for HORIZONTAL ABDUCTION of shoulder joint:
Posterior deltoid
Infraspinatus
Teres minor
166
Prime movers for ADDUCTION of shoulder joint.
Pectoralis major
Latissimus dorsi
Teres major
167
Prime movers for ABDUCTION of shoulder joint:
Middle deltoid
Supraspinatus
168
Prime movers for EXTENSION of shoulder joint:
Latissimus dorsi
Posterior deltoid
Teres major
Triceps brachii (long head)
169
Prime movers for FLEXION of shoulder joint:
Anterior deltoid
Coracobrachialis
Pectoralis major (clavicular head)
Biceps brachii
170
Prime movers for DOWNWARD ROTATION of scapula:
Rhomboids
Levator Scapulae
Pectoralis Minor
171
Prime movers for UPWARD ROTATION of scapula:
Upper trapezius
Lower trapezius
Serratus anterior
172
Prime movers for RETRACTION of the scapula:
Middle trapezius
Rhomboids
173
Prime movers for PROTRACTION of the scapula:
Serratus Anterior
Pectoralis Minor
174
Prime movers for DEPRESSION of the scapula:
Latissimus dorsi
Pectoralis major
Pectroralis minor
Lower Trapezius
175
Prime movers for ELEVATION of the scapula:
Upper trapezius
Levator Scapulae
176
Prime movers for ROTATION and LATERAL BENDING of the thoracic and lumbar intervertebral joints:
Psoas major
Quadratus lumborum
External oblique
Internal Oblique
Multifidus
Longissimus thoracis
Iliocostals thoracis
Rotatores
177
Prime movers for EXTENSION of thoracic and lumbar intervertebral joints:
Erector spinae
Quadratus lumborum
Multifidus
178
Prime movers for FLEXION of thoracic and lumbar intervertebral joints:
Rectus abdominis
Internal Oblique
Exernal Oblique
179
Prime movers for ROTATION AND LATERAL BENDING of cervical intervertebral joints:
Sternocleidomastoid
Scalenus muscles
Splenius cervicis
Longissimus cervicis
Iliocostalis cervicis
Levator scapulae
Multifidus
180
Prime movers for EXTENSION of cervical intervertebral joints:
Splenius cervicis
Semispinalis cervicis
Iliocostalis cervicis
Longissimus cervicis
Multifidus
Trapezius
181
Prime movers for FLEXION of cervical intervertebral joints:
Sternocleidomastoid
Longus colli
Scalenus muscles
182
Prime movers for SIDE TO SIDE of temporomandibular joint:
Medial pterygoid
Lateral pterygoid
Masseter
Temporalis
183
Prime movers for RETRUSION of temporomandibular joint:
Temporalis
Masseter
Digastric
184
Prime movers for PROTRUSION of temporomandibular joint:
Masseter
Lateral pterygoid
Medial pterygoid
185
Prime movers for ELEVATION of temporomandibular joint:
Temporalis
Masseter
Medial Pterygoid
186
Prime movers for DEPRESSION of temporomandibular joint:
Lateral pterygoid
Suprahyoid
Infrahyoid
187
Define FOREQUARTER (scapulothoracic) amputation
surgical removal of the upper extremity including the shoulder girdle.
188
Define SHOULDER DISARTICULATION amputation.
surgical removal of the upper extremity through the shoulder
189
Define TRANSHUMERAL amputation.
surgical removal of the upper extremity proximal to the elbow joint.
190
Define an ELBOW DISARTICULATION amputation.
surgical removal of the lower arm and hand through the elbow joint.
191
Define TRANSRADIAL amputation.
surgical removal of the upper extremity distal to the elbow joint
192
Define WRIST DISARTICULATION amputation.
surgical removal of the hand through the wrist joint
193
Define Partial Hand amputation.
surgical removal of a portion of the hand and/ or digits at either the transcarpal, transmetacarpal or transphalangeal level
194
Define DIGITAL amputation.
surgical removal of a digit at either the metacarpophalangeal, proximal interphalangeal or distal interphalangeal level.
195
Define HEMICORPORECTOMY amputation.
surgical removal of the pelvis and both lower extremities
196
Define HEMIPELVECTOMY amputation:
surgical removal of one half of the pelvis and the lower extremity
197
Define HIP DISARTICULATION amputation
surgical removal of the lower extremity from the pelvis.
198
Define TRANSFEMORAL amputation.
surgical removal of the lower extremity above the knee joint
199
Define KNEE DISARTICULATION amputation.
surgical removal of the lower extremity through the knee joint
200
Define TRANSTIBIAL amputation.
surgical removal of the lower extremity below the knee joint
201
Define SYME's amputation.
surgical removal of the foot at the ankle joint with removal of the malleoli
202
Define TRANSVERSE TARSAL (CHOPART's) Amputation.
amputation through the talonavicular and calcaneocuboid joints
203
Define TARSOMETATARSAL (LISFRANC) amputation.
surgical removal of the metatarsals
204
Primary Contracture of Syme's Amputation:
Ankle PF contracture (equinus deformity)
205
Primary contracture of Transtibial Amputation
Knee and Hip FLEX contracture
206
Primary contracture of Transfemoral Amputation.
Hip FLEX and ABD contracture
207
Amputations and Gait Deviations with Prosthetic and Amputee Causes: LATERAL BENDING
Prosthetic Causes:
- prosthesis too short
- improperly shaped lateral wall
- high medial wall
- prosthesis aligned in ABD
Amputee causes:
- poor balance
- ABD contracture
- improper training
- short residual limb
- weak hip ABD on prosthetic side
- hypersensitive and painful residual limb
208
Amputations and Gait Deviations with Prosthetic and Amputee Causes: ABDUCTED GAIT
PROSTHETIC causes:
- prosthesis too long
- high medial wall
- poorly shaped lateral wall
- prosthesis positioned in ABD
- inadequate suspension
- excessive knee friction
AMPUTEE causes:
- ABD contracture
- improper training
- ADD roll
- weak hip FLEX and ADD
- pain over lateral residual limb
209
Amputations and Gait Deviations with Prosthetic and Amputee Causes: CIRCUMDUCTED GAIT
PROSTHETIC causes:
- prosthesis too long
- excessive knee friction
- socket too small
- excessive PF
AMPUTEE causes:
- ABD contracture
- improper training
- weak hip FLEX
- lacks confidence to flex the knee
- painful anterior distal residual limb
- inability to initiate prosthetic knee FLEX
210
Amputations and Gait Deviations with Prosthetic and Amputee Causes: EXCESSIVE KNEE FLEXION DURING STANCE
PROSTHETIC causes:
- socket set forward in relation to foot
- excessive DF
- stiff heel
- prosthesis too long
AMPUTEE causes:
- knee FLEX contracture
- hip FLEX contracture
- pain anteriorly in residual limb
- decrease in quadriceps strength
- poor balance
211
Amputations and Gait Deviations with Prosthetic and Amputee Causes: VAULTING
PROSTHETIC causes:
- prosthesis too long
- inadequate socket suspension
- excessive alignment stability
- excessive PF
AMPUTEE causes:
- residual limb discomfort
- improper training
- fear of stubbing toe
- short residual limb
- painful hip/ residual limb
212
Amputations and Gait Deviations with Prosthetic and Amputee Causes: ROTATION OF FOREFOOT AT HEEL STRIKE
PROSTHETIC causes:
- excessive toe- out built in
- loose fitting socket
- inadequate suspension
- rigid SACH heel cushion
AMPUTEE causes:
- poor muscle control
- improper training
- weak medial rotators
- short residual limb
213
Amputations and Gait Deviations with Prosthetic and Amputee Causes: FORWARD TRUNK FLEXION
PROSTHETIC causes:
- socket too big
- poor suspension
- knee instability
AMPUTEE causes:
- hip FLEX contracture
- weak hip EXT
- pain with ischial WB
- inability to initiate prosthetic knee FLEX
214
Amputations and Gait Deviations with Prosthetic and Amputee Causes: MEDIAL OR LATERAL WHIP
PROSTHETIC causes:
- excessive rotation of the knee
- tight socket fit
- valgus in the prosthetic knee
- improper alignment of toe break
AMPUTEE causes:
- improper training
- weak hip rotators
- knee instability
215
Define Dysvascular.
Refers to the disease of the blood vessels, including peripheral vascular disease, peripheral arterial disease, and complications related to diabetes
216
Define Endoskeletal Shank.
this type of shank consists of a rigid pylon covered with a material designed to simulate the contour and color of the contralateral limb.
217
Define EXOSKELETAL SHANK.
this type of shank consists of a rigid external frame covered with a thin layer of tinted plastic to match the skin color distally.
218
Define EXTENSION ASSIST
a mechanism that assists the knee joint into extension during the swing phase of gait
219
Define MYOELECTRIC PROSTHESIS.
a device using electromyography signals to control movements of the prosthesis with surface electrodes or implantable wires
220
Define Pistoning.
the translation of the prosthetic limb from the residual limb.
It is the result of inadequate suspension and can result in distal residual limb skin issues.
221
Define POLYCENTRIC KNEE.
refers to a knee joint that has multiple axes of rotation that allows for a more natural gait cycle when compared to a single axis knee.
222
Define PYLON
the term used to describe a pipe- like structure used to connect the socket of the prosthesis to the foot/ ankle components.
The pylon assists with weight bearing and shock absorption.
223
Define RESIDUAL LIMB:
term used to describe the remaining extremity following an amputation.
The residual limb is characterized based on its location and length.
224
Define SHRINKER.
an elastic sleeve that is placed over the end of the residual limb to control edema and encourage limb shaping.
225
Define STANCE CONTROL (SAFETY)
a weight- activated mechanism that maintains knee extension during weight bearing even if the knee joint is not fully extended.
If the knee is flexed greater than what the control mechanism is designed for, the mechanism will not engage.
226
Define SUSPENSION.
the term used to describe how the prosthetic socket is attached to the residual limb.
common types of suspension include vacuum, shuttle lock, suction, waist belt, and harness.
227
A- DELTA FIBERS: Pain Transmission
transmit sensory information rapidly from peripheral cutaneous structures.
Pain tends to be sharp and localized.
228
C FIBERS: Pain Transmission
transmit sensory information slowly from deeper tissues (joints, viscera).
Pain tends to be dull, aching, and diffuse
229
Define numerical rating scale
a tool used to assess pain intensity by rating pain on a scale of 0-10 or 0-100.
The 0 represents no discernable pain and the 10 or 100 represent the worst pain ever.
230
Define NOCICEPTORS:
are free nerve endings present in most types of tissue that are activated by thermal, mechanical, or chemical stimuli.
They are the terminal portions of two type of afferent neurons, A- delta fibers and C fibers.
231
Define GATE CONTROL THEORY.
helps to explain the regulation of pain, specifically how other stimuli can help to decrease the sensation of pain.
232
Define Viscerogenic Pain.
Pain that results from pathology of an internal organ, which can often refer to a site distant from the organ and mimic common patterns of musculoskeletal pain.
233
Pathology of Achilles Tendonitis
- Repetitive overuse disorder resulting in microscopic tears of collagen fibers on the surface or in the substance of the Achilles tendon.
- the tendon is most often impacted in an avascular zone located two to six centimeters above the insertion of the tendon.
- Patients with limited flexibility and strength in the gastrocnemius and soleus complex and patients with a pronated or cavus foot are at increased risk.
234
Pathology of Adhesive Capsulitis:
- occurs more in the middle- aged population with females having a greater incidence than males
- arthrogram can assist with diagnosis by detecting decreased volume of fluid within the joint capsule
- range of motion restriction typically in a capsular pattern (Lateral rotation, ABD, Medial Rotation)
235
Pathology of Ankle Sprain (Lateral) Grade II
- typically occurs due to significant inversion and involves the lateral ligament complex, most commonly damages the anterior talofibular ligament (ATFL).
- will likely present with significant pain or tenderness along the lateral aspect of the ankle especially at the ATFL.
- should heal fairly quickly if no other structures are involved and will return to the previous functional level within two to six weeks.
236
Pathology of Anterior Compartment Syndrome:
- characterized by increased pressure in the lower leg secondary to swelling, which can occlude blood flow and cause ischemia and necrosis of the surrounding nerves and musculature.
- chronic cases may occur secondary to athletic exertion; acute cases are often caused by a traumatic injury and are considered a medical emergency.
- symptoms include: tightness and tenderness over the muscle belly of the tibialis anterior, pain with passive stretching or active use of the muscle, and paresthesias and/ or numbness in the distribution of the deep peroneal nerve.
237
Pathology of ACL Sprain- Grade III
- injury most commonly occurs during hyperflexion, rapid deceleration, hyperextension or landing in an unbalanced position
- females involved in selected athletic activities have significantly higher ligament injury rates compared to males.
- approximately two- thirds of complete ACL tears have an associated meniscal tear.
238
Pathology of Bicipital Tendonitis.
- increased incidence of injury is associated with selected athletic activities such as baseball pitching, swimming, rowing, gymnastics, and tennis.
- characterized by subjective reports of a deep ache directly in front and on top of the shoulder made worse with overhead activities or lifting
- examination may reveal a positive Speed's test or Yergason's Test
239
Pathology of Colles' Fracture.
- frequently occurs when an individual reaches forward with their hands while attempting to break a fall.
- characterized by a transverse fracture of the distal radius
- trauma related to this maneuver is commonly termed a FOOSH ("fall on outstretched hand") injury
- X- ray of the wrist is the preferred method of confirming a Colle's fracture and identifying displaced fragments or damage to adjacent bony structures
240
Pathology of Congenital Hip Dysplasia.
- also known as developmental dysplasia, develops during the last trimester in utero
- clinical presentation includes asymmetrical hip abduction with tightness and apparent femoral shortening of the involved side
- testing for this condition may include Ortolani's test, Barlow's test, and diagnostic ultrasound.
241
Pathology of Congenital Limb Deficiences.
- malformation that occurs in utero, secondary to an altered developmental course
- patients can present with structural or acquired abnormality of a limb and/or phantom limb pain
- treatment focuses on symmetrical movements, strengthening, range of motion, weight-bearing activities, and prosthetic training when appropriate.
242
Pathology of Torticollis- Congenital
- causes the neck to involuntarily contract to one side secondary to contraction of the sternocleidomastoid muscle
- the head is laterally flexed toward the contracted muscle, the chin faces the opposite direction, and there may be facial asymmetries.
- studies indicate that the large majority of patients with congenital torticollis respond to conservative treatment and passive stretching within the first year of life.
243
Pathology of De Quervain's Tenosynovitis
- Results from an inflammatory process involving the tendons and synovium of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) at the base of the thumb.
- onset is typically due to repetitive activities involving thumb abduction and extension such as racquet sports and repeated heavy lifting.
- symptoms onset may be gradual or sudden depending on the mechanism of injury with report of localized pain and tenderness in the area of the anatomical snuffbox which may radiate.
244
Pathology of Disk Herniation.
- often the result of gradual, age- related changes that cause disk degeneration
- risk factors include being overweight and having an occupation that requires repetitive lifting, bending or twisting
- physical therapy may consist of education on activity modification and appropriate body mechanics, soft tissue manipulation, lumbar stabilization exercises, traction, and modalities for pain relief.
245
Pathology of Duchenne Muscular Dystrophy
- X- linked recessive trait manifesting in only male offspring while female offspring become carriers
- clinical presentation includes waddling gait, proximal muscle weakness, toe walking, pseudohypertrophy of the calf, and difficulty climbing stairs.
- there is usually rapid progression of this disease with the inability to ambulate by ten to twelve years of age with death occurring as a teenager or less frequently in the 20s
246
Pathology of glenohumeral dislocation anterior.
- mechanism of injury may vary but typically involves a foreful external blow or loading force when the shoulder is in a position that combines ABD, Lateral Rotation, and EXT.
- prior to relocation of the joint, visible deformity, severe pain, and significant range of motion limitations are the most significant characteristics.
- is not life- threatening though recurrent dislocations can have a substantial impact on a patient's lifestyle.
247
Patholgoy of Impingement Syndrome
- often caused by repetitive microtrauma from upper extremity activity performed above the horizontal plane
- individuals participating in throwing activities, swimming, and racquet sports are particularly susceptible
- long- term prevention includes continued strengthening of the rotator cuff and scapula stabilizers, along with improved biomechanics
248
Pathology of Juvenile Rheumatoid Arthritis.
- autoimmune disorder found in children less than 16 years of age that occurs when the immune cells mistakenly begin to attack the joints and organs causing local and systemic effects throughout the body.
- girls have a higher incidence of JRA and are most commonly diagnosed as toddlers or in early adolescence.
- clinical symptoms include persistent joint swelling, pain, and stiffness.
249
Pathology of Lateral Epicondylitis.
- characterized by inflammation or degenerative changes at the common extensor tendon that attaches to the lateral epicondyle of the elbow
- repeated overuse of the wrist extensors, particularly the extensor carpi radialis brevis, can produce tensile stress and result in microscopic tearing and damage to the extensor tendon.
- clinical symptoms include difficulty holding or gripping objects and insufficient forearm functional strength.
250
Pathology for Legg- Calve- Perthes Disease.
- degeneration of the femoral head due to a disturbance in the blood supply
- this disease is self- limiting and has four distinct stages: condensation, fragmentation, re- ossification, and remodeling
- Clinical signs typically include pain, decreased range of motion, antalgic gait, and positive Trendelenburg sign
251
Pathology of MCL sprain- Grade II.
- Grade II injury is characterized by partial tearing of the ligament's fibers resulting in joint laxity when the ligament is stretched.
- mechanism of injury is usually a blow to the outside of the knee joint causing excess force to the medial side of the joint.
- return to previous functional level should occur within four to eight weeks following the injury if no other associated structures are involved.
252
Pathology for Medial Epicondylitis.
- occurs with repetitive wrist or elbow motions or gripping, and is often seen in golfers or those who play throwing or racket sports.
- initial treatment consists of rest, ice, anti- inflammatory medications, massage, stretching, and bracing to help control acute symptoms.
- home care regimen consists of stretching and strengthening exercises, especially for the wrist flexor and forearm pronator muscle groups, as well as icing to help control symptoms.
253
Pathology of meniscal tear.
- often involve twisting of the knee when in a semi flexed position with the foot planted on the ground.
- characterized by joint line pain and tenderness, swelling, loss of range of motion (sometimes with a mechanical block), a complaint of "catching" or "locking" within the joint, and feelings of instability.
- PT focuses on interventions to reduce swelling, normalize range of motion, and improve muscular strength.
254
Pathology of Myositis Ossificans.
- characterized by the calcification of muscle that is usually caused by neglecting to properly treat a muscle strain or contusion.
- development of this condition occurs within a few weeks after the initial injury and may include a noticeable hard lump in the muscle belly, an increase in pain, and a decrease in range of motion.
- An x- ray is the primary imaging study used to confirm the diagnosis.
255
Pathology of Spondylolisthesis Degenerative:
- caused by the weakening of joints that allows for forward slippage of one vertebral segment on the one below due to degenerative changes.
- most common site of degenerative spondylolisthesis is the L4-L5 level.
- William's flexion exercises may be indicated to strengthen the abdominal and reduce lumbar lordosis.
256
Pathology of Osgood- Schlatter Disease.
- refers to traction apophysitis occuring at the tibial tuberosity where symptoms are typically exacerbated by running, jumping, and squatting activities.
- characterized by localized pain and edema with point tenderness over the patella tendon's insertion on the tibial tuberosity.
- limiting symptoms may last for weeks or months before abating, however, the condition typically will resolve in time without intervention.
257
Pathology of Osteoarthritis:
- degenerative process primarily involving articular cartilage resulting from excessive loading of a healthy joint or normal loading of an abnormal joint.
- typically diagnosed based on the results of a clinical examination and x- ray findings.
- prevalence is higher among women than men later in life, with the large majority of individuals older than 65 years of age demonstrating evidence of osteoarthritis.
258
Pathology of the Osteochondritis Dissecans.
- condition in which loss of blood flow to subchondral bone causes a piece of bone and its associated cartilage to crack and separate away from the end of the bone.
- symptoms may include pain with functional activities, joint popping or locking, weakness, swelling and decreased range of motion.
- X- ray imaging can be used to confirm the diagnosis.
259
Pathology for Osteogenesis Imperfecta.
- classified into 4 types with a wide range of clinical presentations ranging from normal appearance with mild symptoms to severe involvement that can be fatal during infancy.
- bone densitometry may be used to measure bone mass and estimate the risk of fracture for specific sites within the body.
- children with osteogenesis imperfecta often have delayed developmental milestones secondary to ongoing fractures with immobilization, hypermobility of joints, and poorly developed muscles.
260
Pathology of Osteomyelitis.
- an infection that occurs within the bone, most commonly secondary to the Staphylococcus aureus microbe.
- damage to the bone from a surgical procedure, compound fracture or puncture wound that penetrates the bone may directly expose the bone to
infectious microbes.
- a bone biopsy is the most conclusive procedure for diagnosing osteomyelitis and determining the specific infectious microbe present.
261
Pathology of Patellofemoral Syndrome.
- causes damage to the articular cartilage of the patella ranging from softening to complete cartilage destruction resulting in exposure of subchondral bone.
- etiology is unknown, however it is extremely common during adolescence, is more prevalent in females than males, and has a direct association with activity level.
- management includes controlling edema, stretching, strengthening, improving range of motion, and activity modification.
262
Pathology of Piriformis Syndrome.
- characterized as the result of compression or irritation to the proximal sciatic nerve due to piriformis muscle inflammation, spasm or contracture.
- location of pain is often imprecise, though typically presents first in the area of the mid- buttock then progresses to radicular complaints in the sciatic nerve distribution.
- patients typically respond well to physical therapy interventions and are able to return to regular activities without restriction.
263
Pathology of Achilles Tendon Rupture
- Typically occurs within one to two inches above the tendinous insertion on the calcaneus
- incidence is greatest between 30-50 years of age without history of calf or heel pain
- patients with an Achilles tendon rupture will typically be unable to stand on their toes and tend to exhibit a positive Thompson test.
264
Pathology of Plantar Fasciitis.
- chronic overuse condition that develops secondary to repetitive stretching of the plantar fascia through excessive foot pronation during the loading phase of gait.
- characterized by severe pain in the heel when first standing up in the morning (when the fascia is contracted, stiff, and cold).
- intervention consists of ice massage, deep friPaction massage, heel insert, orthotic prescription, activity modification, and gentle stretching program of the Achilles tendon and plantar fascia.
265
Pathology of PCL sprain.
- occurs when a posteriorly directed force is applied to the tibia in relation to the femur, such as when the knee hits the dashboard in a motor vehicle accident.
- individuals participating in contact activities requiring a high level of agility are particularly susceptible to a PCL injury.
- a large majority of patients that experience a PCL sprain are able to return to their previous level of function, including participation in athletics.
266
Pathology of Rheumatoid Arthritis.
- systemic autoimmune disorder of the connective tissue that is characterized by chronic inflammation within synovial membranes, tendon sheaths, and articular cartilage.
- incidence is greater in females than males and is diagnosed most frequent between 30-50 years of age
- blood work assists with the diagnosis of rheumatoid arthritis through evaluation of the rheumatoid factor, white blood cell count, erythrocyte sedimentation rate, hemoglobin, and hematocrit values.
267
Pathology of Rotator Cuff Tear.
- may occur as a result of an acute traumatic incident or due to a chronic degenerative pathology such as chronic supraspinatus tendonitis.
- the drop arm test and empty can test can assist in identifying supraspinatus pathology which may be indicative of a rotator cuff tear.
- failure to adequately treat a rotator cuff tear may necessitate significant activity modifications, additional surgical management, adhesive capsulitis or degenerative changes.
268
Pathology of Rotator Cuff Tendonitis.
- caused by an inability of a weak supraspinatus muscle to adequately depress the head of the humerus in the glenoid fossa during elevation of the arm
- participating in activities that require excessive overhead activity such as swimming, tennis, baseball, painting, and other manual labor activities increases the risk of rotator cuff tendonitis.
- patients may experience a feeling of weakness and identity the presence of a painful arc of motion most commonly occurring between 60 and 120 degrees of active abduction.
269
Pathology of Scoliosis.
- curvature is usually found in the thoracic or lumbar vertebrae and can be associated with kyphosis and lordosis
- a patient with scoliosis that ranges between 25 and 40 degrees requires a spinal Orthosis and physical therapy intervention for posture, flexibility, strengthening, respiratory function, and proper utilization of the spinal Orthosis.
- scoliosis does not usually progress significantly once bone growth is complete if the curvature remains below 40 degrees at the time of skeletal maturity.
270
Pathology of Spinal Stenosis- LUMBAR
- refers to a narrowing of either the lumbar vertebral or intervertebral foramen with symptoms resulting from compression on either the spinal cord or exiting nerve roots.
- symptoms include a gradual onset and worsening of chronic pain at the midline of the lumbar region, unilateral nerve root radiculopathy, paresthesia, weakness, and diminished reflexes.
- severity of symptoms reported varies widely and directly influences expectations for long- term outcomes of physical therapy interventions.
271
Pathology of Talipes Equinovarus:
- deformity known as “club foot”
- characterized by the heel pointing downward and the forefoot turning inward
- accompanies other neuromuscular abnormalities including spina bifida and arthrogryposis, and may result from the lack of movement in utero
- medical management begins shortly after birth and includes splinting and serial casting.
272
Pathology for Tarsal Tunnel Syndrome
- occurs as a result of compression of the tibial nerve as it passes through the tarsal tunnel, causing neuropathy in the distribution of the nerve.
- signs and symptoms include pain, numbness, and paresthesias in the foot, muscle atrophy, and weakness, diminished light touch and temperature sensation and an antalgic gait pattern
- Tinel’s sign can be sued to confirm the presence of the condition, though diagnostic tests (MRI, Ultrasound, EMG, NCV) may also be performed.
273
Pathology of Temporomandibular Joint Dysfunction:
- females are at greater risk than males with the most common age ranging from 20- 40 years
- clinical presentation includes pain (persistent or recurring), muscle spasm, abnormal or limited jaw motion, headache, and tinnitus.
- intervention includes patient education, posture retraining, and modalities such as moist heat, ice, biofeedback, ultrasound, electro stimulation, TENS, and massage.
274
Pathology of Total Hip Arthroplasty:
- patients are typically over 55 years of age and have experienced consistent pain that is not relieved through conservative measure which serve to limit the patient’s functional mobility.
- Posterolateral approach allows the abductor muscles to remain intact, however there may be a higher incidence of postoperative joint instability due to the interruption of the posterior capsule.
- cemented hip replacement usually allows for partial weight bearing initially, while a noncemented hip replacement requires toe touch weight bearing for up to 6 weeks.
275
Pathology of Total Knee Arthroplasty:
- primary indication for TKA is the destruction of articular cartilage secondary to osteoarthritis
- post- operative care may include a knee immobilized, elevation of the limb, cryotherapy, intermittent range of motion using a continuous passive motion (CPM) machine, and initiation of knee protocol exercises.
- patient education may include items such as avoid excessive stress to the knee, squatting, quick pivoting, using pillows under the knee while in bed and low seating.
276
Pathology of Total Shoulder Arthroplasty:
- surgical candidates typically have irreparable damage, deterioration, and destruction to the humeral head and the glenoid fossa within the shoulder complex.
- surgical complications include mechanical loosening of the prosthesis, instability, rotator cuff tear, implant failure, heterotopic ossification, and intraoperative fracture
- life expectancy is longer for the shoulder compared to the knee or hip since the shoulder is a non- weight bearing joint
277
Pathology for Transfemoral Amputation due to Osteosarcoma.
- a highly malignant cancer that begins in the medullary cavity of a bone and leads to the formation of a mass
- a patient status post transfemoral amputation may present with fatigue, loss of balance, phantom pain or sensation, hypersensitivity of the residual limb, and psychological issues regarding the loss of the limb.
- lying in a prone position is beneficial to decrease the incidence of a hip flexion contracture
278
Pathology of Transtibial Amputation due to arteriosclerosis obliterans:
- arteriosclerosis obliterans results in ischemia and subsequent ulceration of the affected tissues.
- a patient status post transtibial amputation may have a decrease in cardiovascular status depending on the frequency of intermittent claudication experienced prior to the amputation
- preprosthetic intervention should focus on strength, range of motion, functional mobility, use of assistive devices, desensitization, and patient education for care of the residual limb.
279
Pathology for Trochanteric Bursitis
- may occur as a result of acute or cumulative trauma to the lateral hip causing irritation to the trochanteric bursa
- causative factors may include a true or functional leg length discrepancy, history of lateral hip surgery, and participation in sports with significant running or contact.
- patients typically respond well to conservative interventions and should be able to return fully to their prior level of function including sport activity
280
Pathology for Ulnar Collateral Ligament Sprain- Thumb
- occurs secondary to a traumatic event in which an excessive valgus force is applied to the metacarpophalangeal joint of the thumb
- the therapist should perform ligament stability testing of the thumb by applying a valgus force to the joint; with a movement of greater than 30- 35 degrees indicating a complete tear of the ulnar collateral ligament
- X- rays should be ordered to rule out the existence of a fracture or dislocation
281
Define an Avulsion Fracture:
A portion of a bone becomes fragmented at the site of tendon attachment due to a traumatic and sudden stretch of the tendon.
282
Define a Closed Fracture.
A break in a bone where the skin over the site remains intact.
283
Define a Comminuted fracture.
A bone that breaks into fragments at the site of injury.
284
Define a Compound fracture.
A break in a bone that protrudes through the skin
285
Define a Greenstick fracture.
A break on one side of a bone that does not damage the periosteum on the opposite side. This type of fracture is often seen in children.
286
Define a Nonunion fracture.
A break in a bone that has failed to unite and heal after 9 to 12 months
287
Define a Stress fracture.
A break in a bone due to repeated forces to a particular portion of the bone.
288
Define a Spiral fracture.
A break in a bone shaped like an “S” due to torsion and twisting.
289
Define PASSIVE ROM.
Movement that is produced by an external force without muscular activation from the patient.
290
Indications for PASSIVE ROM.
- patient is unable to physically move the body segment (comatose, paralyzed)
- patient is cognitively impaired and unable to move the body segment
- active movement is contraindicated (post- operative)
- active movement is painful for the patient
- therapist is preparing the joint for stretching
- therapist is teaching an active movement to the patient
291
Define ACTIVE- ASSISTED ROM
Movement that is produced by the patient through active muscular contraction with some assistance from an external force.
292
Indication for ACTIVE- ASSISTED ROM
- patient is unable to fully contract a muscle (paresis, pain)
- full activation of a muscle is contraindicated (post- operative)
- performed prior to initiating active movement
293
Define ACTIVE ROM
Movement that is produced by the patient through active muscular contraction without any external assistance
294
Indications for ACTIVE ROM
- patient is able to contract a muscle, but demonstrates weakness
- performed prior to initiating resistance training to teach the desired movement
295
Define Elasticity.
The ability of soft tissue to return to its previous length after a stretch is no longer applied.
296
Define Viscoelasticity
A time- dependent property of soft tissue that results in resistance to stretch when it is initially applied, but allows for tissue elongation as the stretch is held for longer durations.
- as with elasticity, the tissue will return to its previous length after the stretch is no longer applied.
297
Define Plasticity.
A property of soft tissue that allows for tissue elongation even after a stretch is no longer applied.
298
Define the Stress- Strain curve.
A graphic representation that depicts the relationship between the amount of force (stress) applied to connective tissue and the amount of deformation (strain) it experiences.
299
Define Creep.
Due to the viscoelastic property, soft tissue that is stretched for a sustained duration will elongate and not return to its original length after the load has been removed
300
Define Stress- Relaxation.
The longer a stretching force is maintained, the more the tension within the tissue decreases, therefore less force is required to maintain the same tissue length.
301
Define Static Stretching.
Involves placing the muscle at its maximal length and holding the position against an external force for a prolonged period of time.
Static stretching is characterized by low intensity and long duration.
302
Define Ballistic Stretching.
Is characterized by quick, jerky movements that result in a rapid change in muscle length.
- the muscle is placed near its end of range of motion and then the patient bounces back and forth to place repetitive stretch on the muscle (ie: high intensity, short duration).
303
Define PNF Stretching.
Incorporates active muscle contractions into stretching techniques.
- muscular contraction is thought to lead to muscle relaxation through the principles of autogenic or reciprocal inhibition and results in greater gains in muscle flexibility.
304
Define Dynamic Stretching.
Involves the patient actively moving a body segment to the end of range (but not beyond this limit) while the antagonist muscle relaxes and stretches.
- unlike static stretching, the end- range movement is held only briefly and is performed repeatedly.
305
Define Endomysium.
The innermost connective tissue layer that covers individual muscle fibers
306
Define Perimysium.
The connective tissue layer that groups bundles of muscle fibers (i.e., a fasciculus) together
307
Define Epimysium:
The outermost connective tissue layer that surrounds the entire muscle
308
Define Myofibril
Are the subunits that make up each muscle fiber.
- are in turn made up of sarcomeres.
309
Define Sarcomere.
The smallest unit of a muscle that gives it the ability to contract.
- composed of the myofilaments actin and myosin.
310
Define Isometric Contraction:
Muscular force is generated without a change in muscle length.
311
define Isotonic contraction.
Muscular contraction is generated with the muscle exerting a constant tension.
- this can also be thought of as muscle movement with a constant load.
312
Define Concentric Contraction.
Is an isotonic contraction where the muscle is shortening.
313
Define Eccentric Contraction
Is an isotonic contraction where the muscle is lengthening.
314
Define Isokinetic contraction.
Muscular contraction is generated with a constant maximal speed and variable load.
315
Define open- chain activity:
Involve the distal segment, usually the hand or foot, moving freely in space.
316
Define Closed- chain activity.
Involve the body moving over a fixed distal segment.
317
Define the Overload Principle
States that in order for a muscle to adapt and become stronger, the load that is placed on it must be greater than what it is normally accustomed to.
318
Define the SAID Principle
Specific Adaptation to Impose Demands
- states that the body will adapt according to the specific type of training that is utilized
- to bring about an improvement in a patient’s function, the type of training should specifically mirror the desired goal.
319
Define the Transfer of Training Principle.
States that there can be a carryover effect from one exercise or task to another.
- for example: a patient who performs exercises to improve muscular strength may also see improvements in muscular endurance. HOWEVER, these carryover effects are far less beneficial than the adaptations that result from more specific training.
320
Define the Reversibility Principle.
States that the adaptations seen with resistance training are reversible if the body is not regularly challenged with the same level of resistance or greater.
321
Define Length- Tension Relationship.
Is a principle that states that the ability of a muscle to produce force depends on the length of the muscle.
- a muscle can usually produce a maximal force near its normal resting length.
- if the muscle is lengthened or shortened, it will likely produce less force.
322
Define Force- Velocity Relationship
A principle that states that the speed of a muscle contraction affects the force that the muscle can produce.
- during a concentric contraction, as the speed of contraction increases, the force of contraction decreases.
- during an eccentric contraction, as the speed of contraction increases, the force of contraction also increases.
323
define Endurance
The ability of a muscle to contract repeatedly against a light external load and resist fatigue over a prolonged period of time.
324
Define Moment Arm.
The linear distance from the axis of rotation to the site of the external load.
325
Define Power.
The rate at which work is performed (i.e. work divided by time)
326
Define Strength.
The greatest amount of force that can be produced within a muscle during a single contraction, which may be assessed clinically by determining a patient’s 1 RM (i.e., maximum amount of weight that can be lifted once)
327
Define Torque
The ability of an external load to produce rotation around an axis, calculated by multiplying the magnitude of the load by the moment arm.
328
define work
The magnitude of a load (e.g., weight) multiplied by the distance the load is moved (e.g., range of motion used)
329
Define Bursitis.
A condition caused by acute or chronic inflammation of the bursae.
- symptoms may include:
Limitation in AROM secondary to pain and swelling.
330
define Contusion.
Sudden blow to a part of the body that can result in mild to severe damage to superficial and deep structures.
- treatment includes: ACTIVE ROM, ice and compression.
331
Define EDEMA.
An increased volume of fluid in the soft tissue outside of a joint capsule.
332
Define Effusion.
An increased volume of fluid within a joint capsule.
333
Define Genu Valgum.
A condition where the knees touch while standing with the feet separated.
- will increase compression of the lateral tibial condyle and increase stress to the medial structures
- also termed knock- kneed.
334
Define Genu Varum.
A condition where there is bowing of the legs with added space between the knees while standing with the feet together.
- will increase compression of the medial tibial condyle and increase stress to the lateral structures.
- also termed bowleg.
335
Define Kyphosis
An excessive curvature of the spine in a posterior direction, usually identified in the thoracic spine.
- common causes include:
Osteoporosis
Compression fractures
Poor posture secondary to paralysis
336
define Lordosis.
An excessive curvature of the spine in an anterior direction, usually identified in the cervical or lumbar spine.
- common causes:
Weak abdominal muscles
Pregnancy
Excessive weight in the abdominal area
Hip flexion contractures
337
Define Q Angle
The degree of angulation present when measuring from the midpatella to the anterior superior iliac spine and to the tibial tubercule
- a normal Q angle measured in supine with the knee straight is 13 degrees for a male and 18 degrees for a female
- an excessive Q angle can lead to pathology and abnormal tracking.
338
Define Sprain.
An acute injury involving a ligament.
339
Define Sprain- Grade I
Mid pain and swelling, little to no tear of the ligament.
340
Define Sprain- Grade II
Moderate pain and swelling
Minimal instability of the joint
Minimal to moderate tearing of the ligament
Decreased ROM
341
Define Sprain- Grade III
Severe pain and swelling
Substantial joint instability
Total tear of the ligament
Substantial decrease in ROM
342
Define Strain.
An injury involving the musculotendinous unit that involves a muscle, tendon or their attachments to bone.
343
Define Strain- Grade I
Localized Pain
Nominal Swelling
Tenderness
344
Define Strain- Grade II
Localized pain
Moderate swelling
Tenderness
Impaired motor function
345
Define Strain- Grade III
A palpable defect of the muscle
Severe Pain
Poor motor function
346
define Tendonitis
A condition caused by acute or chronic inflammation of a tendon.
Symptoms may include:
- gradual onset
- tenderness
- swelling
- pain
347
Special Tests for Apprehension Test for Anterior Shoulder Dislocation: Test Position, Procedure, & Positive Test.
Test Position:
- patient is supine with the shoulder abducted to 90 degrees and elbow flexed to 90 degrees
Procedure:
- therapist laterally rotates the shoulder
Positive Test:
- a look of apprehension from the patient before an end- feel is reached, which may indicate anterior shoulder instability.
348
Apprehension test for Posterior Shoulder Dislocation: Test Position, Procedure, & Positive Test.
Test Position:
- patient is supine with the shoulder flexed to 90 degrees and medially rotated
Procedure:
- therapist applies a posterior force through the long axis of the humerus.
Positive Test:
- a look of apprehension from the patient before an end- feel is reached, which may indicate posterior shoulder instability.
349
Speed’s Test: Test Position, Procedure, & Positive Test.
Test Position:
- patient is positioned in sitting or standing with the elbow extended and the forearm supinated.
Procedure:
- therapist resists active shoulder flexion while palpating the bicipital groove
Positive Test:
- pain or tenderness in the bicipital groove, which may indicate bicipital tendonitis
350
Yergason’s Test: Test Position, Procedure, & Positive Test.
Test Position
- patient is sitting with the elbow flexed to 90 degrees and forearm pronated.
Procedure
- therapist resists active forearm supination and shoulder lateral rotation while palpating the bicipital groove.
Positive Test
- pain or tenderness in the bicipital groove, which may indicate bicipital tendonitis.
351
Drop Arm Test: Test Position, Procedure, & Positive Test.
Test Position:
- patient is sitting or standing with the shoulder abducted to 90 degrees
Procedure
- patient is asked to slowly lower their arm to their side
Positive Test
- presence of pain or inability to slowly lower the arm, which may indicate a rotator cuff tear.
352
Hawkins- Kennedy Impingement Test: Test Position, Procedure, & Positive Test.
Test Position
- patient is sitting or standing
Procedure
- therapist moves the shoulder into 90 degrees of flexion with the elbow flexed to 90 degrees and then medially rotates the shoulder
Positive Test
- presence of pain, which may indicate shoulder impingement involving the supraspinatus tendon
353
Infraspinatus Test: Test Position, Procedure, & Positive Test.
Test Position
- patient is standing with the elbow flexed to 90 degrees and the shoulder medially rotated to 45 degrees.
Procedure
- patient resists as the therapist applies a medially directed force to the forearm
Positive Test
- presence of pain or weakness, which may indicate an infraspinatus strain or tear.
354
Neer Impingement Test: Test Position, Procedure, & Positive Test.
Test Position
- patient is sitting or standing
Procedure
- while stabilizing the posterior aspect of the scapula, the therapist moves the shoulder through full elevation in the plane of the scapula with the arm medially rotated
Positive Test
- presence of pain or a facial grimace, which may indicate shoulder impingement involving the supraspinatus tendon.
355
Supraspinatus Test: Test Position, Procedure, & Positive Test.
Test Position:
- patient is standing with the shoulder abducted to 90 degrees, then horizontally adducted to 30 degrees, with the thumb pointing downward
Procedure
- therapist resists active shoulder abduction
Positive Test
- presence of weakness or pain, which may indicate a supraspinatus tear, impingement or suprascapular nerve involvement.
356
Adson Maneuver: Test Position, Procedure, & Positive Test.
Test Position
- patient is sitting or standing while the therapist monitors the radial pulse.
Procedure
- the patient rotates their head toward the test side, then extends their neck while the therapist extends and laterally rotates the shoulder
Positive Test
- an absent or diminished pulse, which may indicate thoracic outlet syndrome
357
Allen Test (Thoracic Outlet Test): Test Position, Procedure, & Positive Test.
Test Position:
- patient is sitting or standing with the test shoulder in 90 degrees of abduction and lateral rotation and the elbow in 90 degrees of flexion.
Procedure
- patient is asked to rotate their head away from the test shoulder while the therapist monitors the radial pulse.
Positive Test.
- an absent or diminished pulse, which may indicate thoracic outlet syndrome.
358
Roos Test : Test Position, Procedure, & Positive Test.
Test Position :
- patient is sitting or standing with both shoulders abducted and laterally rotated to 90 degrees and elbows flexed to 90 degrees
Procedure
- patient is asked to open and close their hands for 3 minutes
Positive Test
- weakness, sensory loss, ischemic pain or an inability to hold the test position, which may indicate thoracic outlet syndrome.
359
Elbow- Valgus Stress Test: Test Position, Procedure, & Positive Test.
Test Position:
- patient is sitting with the elbow flexed to 20 to 30 degrees
Procedure:
- therapist applies a valgus force to test the medial collateral ligament while palpating the medial joint line.
Positive Test:
- apprehension, pain or increased laxity compared to the contralateral side, which may indicate a medial collateral ligament sprain.
360
Elbow Varus Stress Test: Test Position, Procedure, & Positive Test.
Test Position:
- patient is sitting with the elbow flexed to 20-30 degrees
Procedure:
- therapist applies a varus force on the medial side of the elbow while palpating the lateral joint line.
Positive Test.
- apprehension, pain or increased laxity compared to the contralateral side, which may indicate a lateral collateral ligament sprain.
361
Cozen’s Test: Test Position, Procedure, & Positive Test.
Test Position
- patient is sitting with the elbow in slight flexion while the therapist places their thumb on the lateral epicondyle and stabilizes the elbow joint.
Procedure
- patient is asked to make a fist, pronate the forearm, radially deviate, and extend the wrist against resistance.
Positive Test
- weakness or pain near the lateral epicondyle, which may indicate lateral epicondylitis.
362
Elbow- Lateral Epicondylitis Test (Maudsley’s Test): Test Position, Procedure, & Positive Test.
Test Position:
- patient is sitting with the forearm pronated
Procedure
- therapist stabilizes the elbow with one hand and resists active extension of the third digit with the other hand just distal to the proximal interphalangeal joint
Positive Test:
- weakness or pain near the lateral epicondyle, which may indicate lateral epicondylitis
363
Elbow- Medial Epicondylitis Test: Test Position, Procedure, & Positive Test.
Test Position
- patient is sitting
Procedure
- therapist supinates the patient’s forearm, extends the wrist, and extends the elbow while palpating the medial epicondyle.
Positive Test.
- pain near the medial epicondyle, which may indicate medial epicondylitis
364
Tinel’s Sign: Test Position, Procedure, & Positive Test.
Test Position:
- patient is sitting with the elbow slightly flexed
Procedure
- therapist taps between the olecranon process and medial epicondyle with their finger
Positive Test.
- tingling sensation in the ulnar nerve distribution of the forearm and hand, which may indicate ulnar nerve compression or compromise.
365
Ulnar Collateral Ligament Instability Test: Test Position, Procedure, & Positive Test.
Test Position:
- Patient is sitting
Procedure
- therapist holds the patient’s thumb in extension and applies a valgus force to the metacarpophalngeal joint of the thumb.
Positive Test.
- excessive valgus movement, which may indicate a tear of the ulnar collateral and accessory collateral ligaments.
366
Allen Test (Circulation): Test Position, Procedure, & Positive Test.
Test Position:
- patient is sitting or standing
Procedure:
- patient opens and closes the hand several times and then maintains the hand in a closed position; therapist compresses the radial and ulnar arteries; patient is asked to relax the hand while the therapist releases the pressure on one of the arteries and observes the color of the hand and fingers.
Positive Test:
- delayed or absent flushing of the radial or ulnar half of the hand, which may indicate occlusion in the radial or ulnar artery.
367
Froment’s Sign: Test Position, Procedure, & Positive Test.
Test Position:
- patient is sitting or standing
Procedure:
- patient holds a piece of paper between the thumb and index finger while the therapist attempts to pull the paper away from the patient.
Positive Test:
- patient flexes the distal phalanx of the thumb to hold hold onto the paper, which may indicate adductor pollicis muscle paralysis probably secondary to ulnar nerve compromise;
- if the patient also hyperextends the metacarpophalangeal joint of the thumb, it is termed Jeanne’s sign
368
Phalen’s Test: Test Position, Procedure, & Positive Test.
Test Position: patient is sitting or standing
Procedure:
- patient presses the dorsal aspect of both hands against one another so that the wrists are maximally flexed and holds the position for 60 seconds.
Positive Test:
- tingling in the thumb, index finger, middle finger, and lateral half of the ring finger, which may indicate carpal tunnel syndrome due to median nerve compression.
369
Wrist/ Hand- Tinel’s Sign: Test Position, Procedure, & Positive Test.
Test Position: Patient is sitting or standing
Procedure:
- therapist taps the volar aspect of the wrist with their fingers
Positive Test:
- tingling in the thumb, index finger, middle finger, and lateral half of the ring finger which may indicate carpal tunnel syndrome due to median nerve compression.
370
Finkelstein Test: Test Position, Procedure, & Positive Test.
Test Position: patient is sitting or standing
Procedure:
- patient is asked to make a fist with the thumb tucked inside the fingers; therapist stabilizes the forearm and ulnarly deviates the wrist.
Positive Test:
- pain over the abductor pollicis longus and extensor pollicis breves tendons at the wrist, which may indicate Tenosynovitis in the thumb (de Quervain’s disease)
371
Ely’s Test: Test Position, Procedure, & Positive Test.
Test Position: patient is prone
Procedure
- therapist flexes the knee
Positive Test
- hip flexion that occurs as the knee is flexed, which may indicate a rectus femoris contracture.
372
Ober’s Test: Test Position, Procedure, & Positive Test.
Test Position:
- patient is sidelying with the lower leg flexed at the hip and knee
Procedure:
- therapist moves the hip of the test leg into extension and abduction, then slowly lowers it toward the table
Positive Test:
- inability of the leg to adduct and touch the table, which may indicate an iliotibial band or tensor fasciae latae contracture.
373
Piriformis Test: Test Position, Procedure, & Positive Test.
Test Position:
Patient is sidelying with the test leg positioned toward the ceiling and the hip flexed to 60 degrees
Procedure
- therapist places one hand on the pelvis and the other hand on the knee and applies a downward (adduction) force on the knee.
Positive Test.
- pain or tightness, which may indicate Piriformis tightness or compression on the sciatic nerve caused by the Piriformis.
374
Thomas Test: Test Position, Procedure, & Positive Test.
Test Position: patient is supine
Procedure:
- patient brings one knee to their chest as the therapist observes the position of the contralateral hip.
Positive Test:
- contralateral hip moves into flexion so that the leg rises off the table, which may indicate a hip flexion contracture.
375
Tripod Sign: Test Position, Procedure, & Positive Test.
Test Position: patient is sitting with the knees flexed to 90 degrees over the edge of a table.
Procedure:
- therapist passively extends one knee
Positive Test.
- tightness in the hamstrings or extension of the trunk in order to limit the effect of the tight hamstrings.
376
90-90 Straight Leg Raise Test: Test Position, Procedure, & Positive Test.
Test Position: Patient is supine and is asked to stabilize the hips in 90 degrees of flexion with the knees relaxed
Procedure:
- Therapist has the patient alternately extend each knee as mulch as possible while maintaining the hip position.
Positive Test:
- knee remains in 20 degrees or more of flexion, which indicates hamstrings tightness
377
Craig’s Test: Test Position, Procedure, & Positive Test.
Test Position: patient is prone with the knee flexed to 90 degrees
Procedure:
- therapist rotates the hip until the greater trochanter is parallel with the table, then the therapist measures the angle between the lower leg and the perpendicular axis of the table.
Positive Test:
- an angle less than 8 degrees indicates femoral retroversion, while an angle greater than 15 degrees indicates excessive femoral anteversion.
378
Patricks’ Test (FABER Test): Test Position, Procedure, & Positive Test.
Test Position: patient is supine with their hip flexed, abducted, and laterally rotated so that their foot rests on the contralateral leg.
Procedure:
- therapist lowers the leg toward the table into more abduction
Positive Test:
- failure of the leg to abduct below the level of the contralateral leg, which may indicate iliopsoas, sacroiliac or hip joint.
379
Trendelenburg Test: Test Position, Procedure, & Positive Test.
Test position:
- Patient is standing
Procedure:
- Patient is asked to stand on one leg for ten seconds
Positive test:
- a drop of the pelvis on the contralateral side, which may indicate gluteus medius weakness on the Ipsilateral side.
380
Anterior Drawer Test: Test Position, Procedure, & Positive Test.
Test Position: patient is positioned in supine with the knee flexed to 90 degrees and the hip flexed to 45 degrees.
Procedure
- therapist stabilizes the lower leg by sitting on the forefoot.
- therapist grasps the patient’s proximal tibia with two hands, places their thumbs on the tibial plateau, and administers an anterior directed force to the tibia on the femur.
Positive Test.
- excessive anterior translation of the tibia on the femur with a diminished or absent end- point and may be indicative of an anterior cruciate ligament injury.
381
Lachman Test: Test Position, Procedure, & Positive Test.
Test Position: patient is positioned in supine with the knee flexed to 20- 30 degrees
Procedure:
- therapist stabilizes the distal femur with one hand and places the other hand on the proximal tibia.
- therapist applies an anterior directed force to the tibia on the femur.
Positive Test:
- excessive anterior translation of the tibia on the femur with a diminished or absent end- point; maybe indicative of an anterior cruciate ligament injury.
382
Lateral Pivot Shift Test: Position, Procedure, & Positive Test
Position:
- patient is supine with the hip flexed and abducted to 30 degrees and medially rotated slightly Procedure:
- therapist medially rotates the tibia and applies a valgus force to the knee while the knee is slowly flexed.
Positive Test
- a palpable shift or clunk between 20 and 40 degrees of flexion, which may indicate anterolateral rotatory instability.
383
Posterior Drawer Test: Position, Procedure, & Positive Test
Position: patient is supine with the hip flexed to 45 degrees and knee flexed to 90 degrees while the therapist sits on the patient’s forefoot.
Procedure:
- therapist pushes posteriorly on the proximal tibia with both hands while palpating the tibial plateau with the thumbs
Positive Test:
- excessive posterior translation of the tibia with a diminished or absent end- feel, which may indicate a posterior cruciate ligament injury.
384
Posterior Sag Sign: Position, Procedure, & Positive Test
Position: Patient is supine with the hip flexed to 45 degrees and the knee flexed to 90 degrees
Procedure:
- therapist observes the position of the tibia in relation to the femur.
Positive Test:
- tibia sags back from the femur, which may indicate a posterior cruciate ligament injury
385
Knee- Valgus Stress Test: Position, Procedure, & Positive Test
Position: patient is supine with the knee flexed to 20- 30 degrees
Procedure:
- therapist applies a valgus force to the knee while stabilizing at the ankle with the other hand
Positive Test:
- excessive valgus movement, which may indicate a medial collateral ligament sprain.
386
Knee- Varus Stress Test: Position, Procedure, & Positive Test
Position: patient is supine with the knee flexed to 20- 30 degrees.
Procedure:
- therapist applies a varus force to the knee while stabilizing at the ankle with the other hand
Positive Test:
- excessive varus movement, which may indicate a lateral collateral ligaments sprain.
387
Apley’s Compression Test: Position, Procedure, & Positive Test
Position: patient is prone with the knee flexed to 90 degrees
Procedure:
- therapist medially and laterally rotates the tibia at the heel while applying a compressive force through the tibia.
Positive Test:
- pain or clicking, which may indicate a Meniscal lesion
388
McMurray Test: Position, Procedure, & Positive Test
Position: patient is supine with the knee in full flexion
Procedure:
- therapist medially rotates the tibia at the distal leg, then brings the knee into full extension while palpating the joint line (the test is repeated while laterally rotating the tibia)
Positive Test:
- a click or pronounced crepitation felt at the joint line, which may indicate a posterior Meniscal lesion.
389
Brush Test: Position, Procedure, & Positive Test
Position: patient is supine
Procedure:
- therapist strokes proximally on the medial surface of the patella (from below the joint line to the suprapatellar pouch), then strokes distally on the lateral surface of the patella
Positive Test:
- a wave of fluid just below medial distal border of the patella, which may indicate effusion of the knee.
390
Patellar Tap Test: Position, Procedure, & Positive Test
Position: patient is supine with the knee flexed or extended to a point of discomfort.
Procedure:
- therapist applies a slight tap over the patella
Positive Test:
- patella appears to be floating, which may indicate effusion of the knee.
391
Ankle- Anterior Drawer Test: Position, Procedure, & Positive Test
Position: patient is positioned in supine.
Procedure:
- therapist stabilizes the distal tibia and fibula with one hand, while the other hand holds the foot in 20 degrees of plantar flexion and draws the talus forward in the ankle mortise.
Positive Test:
- excessive anterior translation of the talus away from from the ankle mortise and may be indicative of an anterior talofibular ligament sprain.
392
Tamar Tilt Test: Position, Procedure, & Positive Test
Position: Patient is sidelying with the knee flexed to 90 degrees
Procedure:
- therapist stabilizes the distal tibia while tilting the talus into inversion and eversion
Positive Test:
- excessive inversion, which may indicate a calcaneofibular ligament sprain.
393
Thompson Test: Position, Procedure, & Positive Test
Position: Patient is prone with the feet over the edge of a table
Procedure:
- therapist squeezes the muscle belly of the gastrocnemius/ soleus muscles
Positive Test:
- absence of plantar flexion, which may indicate a ruptured Achilles tendon
394
True Leg Length Discrepancy Test: Position, Procedure, & Positive Test
Test Position: Patient is supine with the feet 15- 20 cm apart.
Procedure: therapist measures with a tape measure from the distal point of the anterior superior iliac spine to the distal point of the medial malleoli
Positive Test:
- a variation of greater than 1 cm between legs, which may indicate a true leg discrepancy.
395
Goniometric Technique- Shoulder Flexion: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: supine
Stabilization: thorax to prevent extension of the spine
End- Feel: firm
Axis: Acromial process
Stationary Arm: midaxillary line of the thorax
Moveable Arm: lateral midline of the humerus using the lateral epicondyle of the humerus for reference.
396
Goniometric Technique- Shoulder Extension: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: Prone
Stabilization: thorax to prevent flexion of the spine
End- Feel: firm
Axis: Acromial process
Stationary Arm: midaxillary line of the thorax
Moveable Arm: lateral midline of the humerus using the lateral epicondyle of the humerus for reference.
397
Goniometric Technique- Shoulder Abduction: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: supine
Stabilization: thorax to prevent lateral flexion of the spine
End- Feel: firm
Axis: anterior aspect of the Acromial process
Stationary Arm: parallel to the midline of the anterior aspect of the sternum
Moveable Arm: medial midline of the humerus
398
Goniometric Technique- Shoulder Adduction: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: supine
Stabilization: thorax to prevent lateral flexion of the spine
End- Feel: firm
Axis: anterior aspect of the Acromial process
Stationary Arm: parallel to the midline of the anterior aspect of the sternum
Moveable Arm: medial midline of the humerus.
399
Goniometric Technique- Shoulder Medial Rotation: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: supine with shoulder abducted to 90 degrees and elbow flexed to 90 degrees
Stabilization: distal end of the humerus to maintain the shoulder in 90 degrees of abduction
End- Feel: firm
Axis: olecranon process
Stationary Arm: parallel or perpendicular to the floor
Moveable Arm: ulna using the olecranon process and ulnar styloid process for reference.
400
Goniometric Technique- Shoulder Lateral Rotation: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: supine with shoulder abducted to 90 degrees and elbow flexed to 90 degrees
Stabilization: distal end of the humerus to maintain the shoulder in 90 degrees of abduction
End- Feel: firm
Axis: olecranon process
Stationary Arm: parallel or perpendicular to the floor
Moveable Arm: ulna using the olecranon process and ulnar styloid process for reference
401
Goniometric Technique- Elbow Flexion: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: supine
Stabilization: humerus to prevent flexion of the shoulder
End- Feel: soft
Axis: lateral epicondyle of the humerus
Stationary Arm: lateral midline of the humerus using the center of the Acromial process for reference
Moveable Arm: lateral midline of the radius using the radial head and radial styloid process for reference.
402
Goniometric Technique- Elbow Extension: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: Supine
Stabilization: humerus to prevent flexion of the shoulder
End- Feel: hard
Axis: lateral epicondyle of the humerus
Stationary Arm: lateral midline of the humerus using the center of the Acromial process for reference
Moveable Arm: lateral midline of the radius using the radial head and radial styloid process for reference
403
Goniometric Technique- Forearm Pronation: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: sitting with the elbow flexed to 90 degrees
Stabilization: distal end of the humerus to prevent medial rotation and abduction of the humerus.
End- Feel: firm or hard
Axis: lateral to the ulnar styloid process
Stationary Arm: parallel to the anterior midline of the humerus.
Moveable Arm: dorsal aspect of the forearm, just proximal to the styloid process of the radius and ulna.
404
Goniometric Technique- Forearm Supination: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: sitting with the elbow flexed to 90 degrees
Stabilization: distal end of the humerus to prevent lateral rotation and adduction of the humerus
End- Feel: firm
Axis: medial to the ulnar styloid process
Stationary Arm: parallel to the anterior midline of the humerus
Moveable Arm: ventral aspect of the forearm, just proximal to the styloid process of the radius and ulna.
405
Goniometric Technique- Wrist Felxion: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: sitting next to a supporting surface with the shoulder abducted to 90 degrees and the elbow flexed to 990 degrees.
Stabilization: radius and ulna to prevent supination or pronation
End- Feel: firm
Axis: lateral aspect of the wrist over the triquetrum
Stationary Arm: lateral midline of the ulna using the olecranon and ulnar styloid process for reference
Moveable Arm: lateral midline of the 5th metacarpal
406
Goniometric Technique- Wrist Extension: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: sitting next to a supporting surface with the shoulder abducted to 90 degrees and the elbow flexed to 90 degrees
Stabilization: radius and ulna to prevent supination or pronation
End- Feel: firm
Axis: lateral aspect of the wrist over the triquetrum
Stationary Arm: lateral midline of the ulna using the olecranon and ulnar styloid process for reference
Moveable Arm: lateral midline of the fifth metacarpal
407
Goniometric Technique- Wrist Radial Deviation: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: sitting next to a supporting surface with the shoulder abducted to 90 degrees and the elbow flexed to 90 degrees.
Stabilization: radius and ulna to prevent supination or pronation
End- Feel: firm or hard
Axis: over the middle of the dorsal aspect of the wrist over the capitate.
Stationary Arm: dorsal midline of the forearm using the lateral epicondyle of the humerus for reference.
Moveable Arm: dorsal midline of the third metacarpal
408
Goniometric Technique- Wrist Ulnar Deviation: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: sitting next to a supporting surface with the shoulder abducted to 90 degrees and the elbow flexed to 90 degrees
Stabilization: radius and ulna to prevent supination or pronation
End- Feel: firm
Axis: over the middle of the dorsal aspect of the wrist over the capitate
Stationary Arm: dorsal midline of the forearm using the lateral epicondyle of the humerus for reference.
Moveable Arm: dorsal midline of the third metacarpal
409
Goniometric Technique- Thumb CMC Flexion: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: sitting with the forearm and hand on a supporting surface.
Stabilization: carpals, radius, and ulna to prevent wrist motion
End- Feel: firm
Axis: over the palmar aspect of the first carpometacarpal joint
Stationary Arm: ventral midline of the radius using the ventral surface of the radial head and radial styloid process for reference
Moveable Arm: ventral midline of the first metacarpal
410
Goniometric Technique- Thumb CMC Extension: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position:
Sitting with the forearm and hand on a supporting surface
Stabilization:
- Carpals, radius, and ulna to prevent wrist motion
End- Feel
- firm
Axis: over the palmar aspect of the first carpometacarpal joint
Stationary Arm:
- ventral midline of the radius using the ventral surface of the radial head and radial styloid process for reference
Moveable Arm:
- ventral midline of the first metacarpal.
411
Goniometric Technique- Thumb CMC Abduction: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: sitting with the forearm and hand on a supporting surface
Stabilization: carpals and second metacarpal to prevent wrist motion
End- Feel: firm
Axis: over the lateral aspect of the radial styloid process
Stationary Arm: lateral midline of the second metacarpal using the center of the second metacarpophalangeal joint for reference
Moveable Arm: lateral midline of the first metacarpal using the center of the first metacarpophalangeal joint for reference.
412
Goniometric Technique- Thumb CMC Adduction: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: sitting with the forearm and hand on a supporting surface
Stabilization: carpals and second metacarpal to prevent wrist motion
End- Feel: Firm
Axis: over the lateral aspect of the radial styloid process
Stationary Arm: lateral midline of the second metacarpal using the center of the second metacarpophalangeal joint for reference.
Moveable Arm: lateral midline of the first metacarpal using the center of the first metacarpophalangeal joint for reference.
413
Goniometric Technique-Fingers MCP Flexion: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: sitting with the forearm and hand on a supporting surface
Stabilization: metacarpal to prevent wrist motion
End- Feel: firm or hard
Axis: over the dorsal aspect of the metacarpophalangeal joint
Stationary Arm: over the dorsal midline of the metacarpal
Moveable Arm: over the dorsal midline of the proximal phalanx
414
Goniometric Technique- Fingers MCP Extension: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: sitting with the forearm and hand on a supporting surface
Stabilization: metacarpal to prevent wrist motion
End- Feel: firm
Axis: over the dorsal aspect of the metacarpophalangeal joint
Stationary Arm: over the dorsal midline of the metacarpal
Moveable Arm: over the dorsal midline of the proximal phalanx
415
Goniometric Technique- Fingers- MCP Abduction: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: sitting with the forearm and hand on a supporting surface
Stabilization: metacarpal to prevent wrist motion
End- Feel: firm
Axis: over the dorsal aspect of the metacarpophalangeal joint
Stationary Arm: over the dorsal midline of the metacarpal
Moveable Arm: dorsal midline of the proximal phalanx
416
Goniometric Technique- Fingers MCP Adduction: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: sitting with the forearm and hand on a supporting surface
Stabilization: metacarpal to prevent wrist motion
End- Feel: firm
Axis: over the dorsal aspect of the metacarpophalangeal joint
Stationary Arm: over the dorsal midline of the metacarpal
Moveable Arm: dorsal midline of the proximal phalanx
417
Goniometric Technique- Fingers PIP Flexion: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: sitting with the forearm and hand on a supporting surface
Stabilization: proximal phalanx to prevent motion at the metacarpophalangeal joint
End- Feel: soft, firm or hard
Axis: over the dorsal aspect of the proximal interphalangeal joint
Stationary Arm: over the dorsal midline of the proximal phalanx
Moveable Arm: over the dorsal midline of the middle phalanx
418
Goniometric Technique- Fingers PIP Extension: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: sitting with the forearm and hand on a supporting surface
Stabilization: proximal phalanx to prevent motion at the metacarpophalangeal joint
End- Feel: Firm
Axis: over the dorsal aspect of the proximal interphalangeal joint
Stationary Arm: over the dorsal midline of the proximal phalanx
Moveable Arm: over the dorsal midline of the middle phalanx
419
Goniometric Technique- Fingers- DIP Flexion: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: sitting with the forearm and hand on a supporting surface
Stabilization: middle and proximal phalanx to prevent motion at the proximal interphalangeal joint
End- Feel: firm
Axis: over the dorsal aspect of the distal interphalangeal joint
Stationary Arm: over the dorsal midline of the middle phalanx
Moveable Arm: over the dorsal midline of the distal phalanx
420
Goniometric Technique- Fingers DIP Extension: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: sitting with the forearm and hand on a supporting surface
Stabilization: middle and proximal phalanx to prevent motion at the proximal interphalangeal joint
End- Feel: firm
Axis: over the dorsal aspect of the distal interphalangeal joint
Stationary Arm: over the dorsal midline of the middle phalanx
Moveable Arm: over the dorsal midline of the distal phalanx. .
421
Goniometric Technique- Hip FLEXION: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: supine
Stabilization: pelvis to prevent posterior tilting
End- Feel: soft or firm
Axis: over the lateral aspect of the hip joint using the greater trochanter of the femur for reference
Stationary Arm: lateral midline of the pelvis
Moveable Arm: lateral midline of the femur using the lateral epicondyle for reference
422
Goniometric Technique- HIP Extension: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: Prone
Stabilization: Pelvis to prevent anterior tilting
End- Feel: Firm
Axis: over the lateral aspect of the hip joint using the greater trochanter of the femur for reference
Stationary Arm: lateral midline of the pelvis
Moveable Arm: lateral midline of the femur using the lateral epicondyle for reference
423
Goniometric Technique- HIP Abduction: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: supine
Stabilization: pelvis to prevent lateral tilting and rotation; trunk to prevent lateral flexion
End- Feel: firm
Axis: over the anterior superior iliac spine (ASIS) of the extremity being measured
Stationary Arm: align with imaginary horizontal line extending from one ASIS to the other ASIS
Moveable Arm: anterior midline of the femur using the midline of the patella for reference
424
Goniometric Technique- HIP Adduction: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: supine
Stabilization: pelvis to prevent lateral tilting
End- Feel: firm
Axis: over the anterior superior iliac spine (ASIS) of the extremity being measured.
Stationary Arm: align with imaginary horizontal line extending from one ASIS to the other ASIS
Moveable Arm: anterior midline of the femur using the midline of the patella for reference
425
Goniometric Technique- HIP Medial Rotation: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: sitting
Stabilization: distal end of the femur
End- Feel: firm
Axis: anterior aspect of the patella
Stationary Arm: perpendicular to the floor or parallel to the supporting surface
Moveable Arm: anterior midline of the lower leg using the crest of the tibia and a point midway between the two malleoli for reference
426
Goniometric Technique- HIP Lateral Rotation: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: sitting
Stabilization: distal end of the femur
End- Feel: firm
Axis: anterior aspect of the patella
Stationary Arm: perpendicular to the floor or parallel to the supporting surface
Moveable Arm: anterior midline of the lower leg using the crest of the tibia and a point midway between the two malleoli for reference.
427
Goniometric Technique- KNEE Flexion: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: Supine
Stabilization: femur to prevent rotation, abduction, and adduction of the hip
End- Feel: soft or firm
Axis: lateral epicondyle of the femur
Stationary Arm: lateral midline of the femur using the greater trochanter for reference
Moveable Arm: lateral midline of the fibula using the lateral malleolus and fibular head for reference.
428
Goniometric Technique- KNEE Extension: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: supine
Stabilization: femur to prevent rotation, abduction, and adduction of the hip
End- Feel: firm
Axis: lateral epicondyle of the femur
Stationary Arm: lateral midline of the femur using the greater trochanter for reference
Moveable Arm: lateral midline of the fibula using the lateral malleolus and fibular head for reference.
429
Goniometric Technique- ANKLE Dorsiflexion: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: sitting with the knee flexed to 90 degrees
Stabilization: tibia and fibula to prevent knee and hip motion
End- Feel: firm
Axis: lateral aspect of the lateral malleolus
Stationary Arm: lateral midline of the fibula using the head of the fibula for reference
Moveable Arm: parallel to the lateral aspect of the fifth metatarsal
430
Goniometric Technique- ANKLE Plantar Flexion: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: sitting with the knee flexed to 90 degrees
Stabilization: tibia and fibula to prevent knee and hip motion
End- Feel: firm or hard
Axis: lateral aspect of the lateral malleolus
Stationary Arm: lateral midline of the fibula using the head of the fibula for reference
Moveable Arm: parallel to the lateral aspect of the fifth metatarsal
431
Goniometric Technique- MIDTARSAL Inversion: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: sitting with the knee flexed to 90 degrees
Stabilization: tibia and fibula to prevent knee and hip motion
End- Feel: firm
Axis: anterior aspect of the ankle midway between the malleoli
Stationary Arm: anterior midline of the lower leg using the tibial tuberosity for reference
Moveable Arm: anterior midline of the second metatarsal
432
Goniometric Technique- MIDTARSAL Eversion: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: sitting with the knee flexed to 90 degrees
Stabilization: tibia and fibula to prevent knee and hip motion
End- Feel: firm or hard
Axis: anterior aspect of the ankle midway between the malleoli
Stationary Arm: anterior midline of the lower leg using the tibial tuberosity for reference
Moveable Arm: anterior midline of the second metatarsal
433
Goniometric Technique- SUBTALAR Inversion: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: prone with the foot extended over a supporting surface
Stabilization: tibia and fibula to prevent knee and hip motion
End- Feel: firm
Axis: posterior aspect of the ankle midway between the malleoli
Stationary Arm: posterior midline of the lower leg
Moveable Arm: posterior midline of the calcaneus
434
Goniometric Technique- SUBTALAR Eversion: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: prone with the foot extended over a supporting surface
Stabilization: tibia and fibula to prevent knee and hip motion
End- Feel: firm or hard
Axis: posterior aspect of the ankle midway between the malleoli
Stationary Arm: posterior midline of the lower leg
Moveable Arm: posterior midline of the calcaneus
435
Goniometric Technique- CERVICAL SPINE Flexion: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: sitting with the thoracic and lumbar spine supported
Stabilization: shoulder girdle and chest; the patient’s hands should be placed on their knees
End- Feel: firm
Axis: over the external auditory meatus
Stationary Arm: perpendicular or parallel to the ground
Moveable Arm: along the base of the nares, or if using a tongue depressor, align the goniometer parallel with the tongue depressor.
436
Goniometric Technique- CERVICAL Spine Extension: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: sitting with the thoracic and lumbar spine supported
Stabilization: shoulder girdle and chest to prevent extension of the thoracic and lumbar spine
End- Feel: firm
Axis: over the external auditory meatus
Stationary Arm: perpendicular or parallel to the ground
Moveable Arm: along the base of the nares, or if using a tongue depressor, align the goniometer parallel with the tongue depressor
437
Goniometric Technique- CERVICAL Spine Lateral Flexion: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: sitting
Stabilization: shoulder girdle and chest to prevent lateral flexion of the thoracic and lumbar spines
End- Feel: firm
Axis: over the spinous process of the C7 vertebrae
Stationary Arm: with the spinous processes of the thoracic vertebrae so that the arm is perpendicular to the ground
Moveable Arm: along the dorsal midline of the head using the occipital protuberance for reference.
438
Goniometric Technique- CERVICAL Spine Rotation: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: sitting with the thoracic and lumbar spine supported
Stabilization: shoulder girdle and chest to prevent rotation of the thoracic and lumbar spine
End- Feel: firm
Axis: over the center of the cranial aspect of the head
Stationary Arm: parallel to an imaginary line between the two acromial processes
Moveable Arm: with the tip of the nose, or if using a tongue depressor, align the goniometer parallel with the tongue depressor
439
Describe the Goniometric Technique- THORACOLUMBAR Spine Flexion and Extension
- most commonly measured with a tape measure
- the therapist aligns a tape measure between the spinous processes of T1 and S2
- the distance is recorded.
- the patient then performs spinal flexion and the second distance is recorded.
- the amount of thoracic and lumbar flexion is determined by calculating the difference between the first and the second measurements.
- extension is measured in a similar manner
440
Goniometric Technique- THORACOLUMBAR Spine Lateral Flexion: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: standing with the feet shoulder width apart
Stabilization: pelvis to prevent lateral tilting
End- Feel: firm
Axis: over the posterior aspect of the spinous process of S2
Stationary Arm: perpendicular to the ground
Moveable Arm: along the posterior aspect of the spinous process of T1
441
Goniometric Technique- THORACOLUMBAR SPINE Rotation: Patient Position, Stabilization, End- Feel, Axis, Stationary Arm, and Moveable Arm.
Patient Position: sitting on a chair without a back with the feet positioned on the floor for pelvic stabilization.
Stabilization: pelvis to prevent rotation
End- Feel: firm
Axis: over the center of the cranial aspect of the head
Stationary Arm: parallel to an imaginary line between the two prominent tubercules on the iliac crests
Moveable Arm: along an imaginary line between the two acromial processes
442
Normal Range of Motion for Shoulder:
Flexion
Extension
Abduction
Medial Rotation
Lateral Rotation
Flexion= 0- 180
Extension= 0- 60
Abduction= 0- 180
Medial Rotation= 0- 70
Lateral Rotation= 0- 90
443
Normal Range of Motion for ELBOW:
Flexion
Extension
Flexion= 0
Extension= 0- 150
444
Normal Range of Motion for FOREARM:
Pronation
Supination
Pronation= 0- 80
Supination= 0- 80
445
Normal Range of Motion for WRIST:
Flexion
Extension
Radial Deviation
Ulnar Deviation
Flexion= 0- 80
Extension= 0- 70
Radial Deviation= 0- 20
Ulnar Deviation= 0- 30
446
Normal Range of Motion for THUMB- CMC:
Abduction
Flexion
Extension
Opposition
Abduction= 0- 70
Flexion= 0- 15
Extension= 0- 20
Opposition= tip of thumb to base of fifth digit
447
Normal Range of Motion for Thumb MCP: Flexion
Flexion= 0- 50
448
Normal Range of Motion for THUMB IP- Flexion
Flexion= 0- 80
449
Normal Range of Motion for DIGITS- second to fifth MCP:
Flexion
Hyperextension
Flexion= 0- 90
Hyperextension= 0- 45
450
Normal Range of Motion for Digits- Second to Fifth PIP: Flexion
Flexion= 0- 100
451
Normal Range of Motion for DIGITS- Second to Fifth DIP:
Flexion
Hyperextension
Flexion= 0- 90
Hyperextension= 0- 10
452
Normal Range of Motion for HIP:
Flexion, Extension, Abduction, Adduction, Medial Rotation, Lateral Rotation
Flexion= 0- 120
Extension= 0- 30
Abduction= 0- 45
Adduction= 0- 30
Medial Rotation= 0- 45
Lateral Rotation= 0- 45
453
Normal Range of Motion for KNEE: Flexion
Flexion= 0- 135
454
Normal Range of Motion for ANKLE (TALOCRURAL): Dorsiflexion
Plantar Flexion
Dorsiflexion= 0- 20
Plantar Flexion= 0- 50
455
Normal Range of Motion for MIDTARSAL (Transverse Tarsal): Inversion and Eversion
Inversion= 0- 35
Eversion= 0- 15
456
Normal Range of Motion for SUBTALAR: Inversion and Eversion
Inversion= 0- 5
Eversion= 0- 5
457
Normal Range of Motion for CERVICAL SPINE: Flexion, Extension, Lateral Flexion, Rotation
Flexion= 0- 45
Extension= 0- 45
Lateral Flexion= 0- 45
Rotation= 0- 60
458
Normal Range of Motion for Thoracic and Lumbar Spine: Flexion, Extension, Lateral Flexion, and Rotation
Flexion= 0- 80
Extension= 0- 25
Lateral Flexion= 0- 35
Rotation= 0- 45
459
Ideal Plumb Line Alignment for EXTERNAL AUDITORY MEATUS:
Through the external auditory meatus
460
Ideal Plumb Line Alignment for the SHOULDER:
Midway through the tip of the shoulder
461
Ideal Plumb Line Alignment for LUMBAR VERTEBRAE
Through the bodies of the lumbar vertebrae
462
Ideal Plumb Line Alignment for the HIP JOINT:
Slightly posterior to the hip joint
463
Ideal Plumb Line Alignment for KNEE JOINT:
Slightly anterior to the axis of the knee joint
464
Ideal Plumb Line Alignment for Lateral Malleolus
Slightly anterior to the lateral malleolus
465
Define Anatomical Position
Is an erect posture of the body with the face forward, feet pointing forward and slightly apart, arms at the side, and palms forward with fingers and thumbs in extension
- the position serves as a point of reference for definitions and descriptions of movement including the cardinal planes and associated axes.
466
Define the Planes of the Body.
Motions are described as occurring in three cardinal planes of the body (frontal, sagittal, transverse).
- movement in the cardinal planes occurs around three corresponding axes (anterior- posterior, medial- lateral, vertical).
467
Define Frontal Plane (Coronal) .
The frontal (or coronal) plane divides the body into anterior and posterior secretions.
- motions in the frontal plane include abduction and adduction.
468
Define Sagittal Plane.
Divides the body into right and left sections.
- motions include FLEXION and EXTENSION.
469
Define Transverse Plane.
Divides the body into upper and lower secretions.
- motions include Medial and Lateral Rotation.
470
define the axes of the body.
Imaginary lines at right angles to planes, about which the body rotates or spins
471
Anterior- Posterior Axis
Motions in the frontal plane such as ABDUCTION and ADDUCTION
472
Medial- Lateral Axis
Motions in the sagittal plane such as FLEXION and EXTENSION
473
Vertical Axis
Motions in the transverse plane such as Medial and Lateral Rotation.
474
Describe the ATP- PC System.
This energy system is used for ATP production during high intensity, short duration exercise such as sprinting 100 meters.
- the system provides energy for muscle contraction for up to 15 seconds.
- the phosphagen system represents the most rapidly available source of ATP for use by the muscle.
475
Describe the Anaerobic Glycolysis.
This energy system is a major supplier of ATP during high intensity, short duration activities such as sprinting.
- anaerobic glycolysis results in the formation of lactic acid, which causes muscular fatigue.
- this system is nearly 50% slower than the phosphocreatine system and can provide a person with 30 to 40 seconds of muscle contraction.
476
Describe the Aerobic Metabolism.
The aerobic system is used predominantly during low intensity, long duration exercise such as running a marathon.
- the oxygen system yields by far the most ATP, but requires several series of complex chemical reactions.
- this system provides energy through the oxidation of food.
- the combination of fatty acids, amino acids, and glucose with oxygen releases energy that forms ATP.
- this system will provide energy as long as there are nutrients to utilize.
477
Joint Receptors- FREE NERVE ENDINGS: Location, Sensitivity, and Primary Distribution
LOCATION:
- joint capsule
- ligaments
- synovium
- fat pads
SENSITIVITY:
- one type is sensitive to non-noxious mechanical stress
- other type is sensitive to noxious mechanical or biochemical stimuli
PRIMARY DISTRIBUTION:
- all joints
478
Joint Receptors- GOLGI LIGAMENT ENDINGS: Location, Sensitivity, Primary Distribution
LOCATION:
- ligaments
- adjacent to ligaments’ bony attachment
SENSITIVITY:
- tension or stretch on ligaments
PRIMARY DISTRIBUTION:
- majority of joints
479
Joint Receptors- GOLGI- MAZZONI CORPUSCLES: Location, Sensitivity, & Primary Distribution
LOCATION:
- joint capsule
SENSITIVITY:
- compression of joint capsules
PRIMARY DISTRIBUTION:
- knee joint
- joint capsule
480
Joint Receptors- PACINIAN CORPUSCLES: Location, Sensitivity, & Primary Distribution
LOCATION:
- fibrous layer of joint capsule
SENSITIVITY:
- high frequency vibration
- acceleration
- high velocity changes in joint position
PRIMARY DISTRIBUTION:
- all joints
481
Joint Receptors- RUFFINI ENDINGS: Location, Sensitivity, & Primary Distribution
LOCATION:
- fibrous layer of joint capsule
SENSITIVITY:
- stretching of joint capsule;
- amplitude and velocity of joint position
PRIMARY DISTRIBUTION:
- greater density in proximal joints, particularly in capsular regions
482
Describe TYPE I Muscle Fibers:
Aerobic
Red
Tonic
Slow- Twitch
Slow- Oxidative
483
Describe TYPE II Muscle Fibers:
Anaerobic
Red/ White
Phasic
Fast Twitch
Fast- glycolytic
484
Characteristics of TYPE I Muscle Fiber:
Low fatigability
high capillary density
High myoglobin content
Smaller fibers
Extensive blood supply
Large amount of mitochondria
485
Characteristics of TYPE II Muscle Fiber
High fatigability
Low capillary density
Low myoglobin content
Larger fibers
Less blood supply
Fewer mitochondria
486
Define Muscle Spindle.
Are distributed throughout the belly of the muscle.
- they function to send information to the nervous system about muscle length and/ or the rate of change of its length.
- the muscle spindle is important in the control of posture, and with the help of the gamma system, involuntary movements.
487
Define Golgi Tendon Organ.
Are encapsulated sensory receptors through which the muscle tendons pass immediately beyond their attachment to the muscle fibers.
- they are very sensitive to tension, especially when produced from an active muscle contraction.
- they function to transmit information about tension or the rate of change of tension within the muscle.
488
Pharmacology: Disease- Modifying ANTIRHEUMATIC AGENTS: Action & Indications
ACTION: slow or halt the progression of rheumatic disease
- they are used early during the disease process to slow the progression prior to widespread damage of the affected joints
- they act to induce remission by modifying the pathology and inhibiting the immune response responsible for rheumatic disease.
INDICATIONS:
- rheumatic disease
- preferably during early treatment
489
Pharmacology- Disease- Modifying ANTIRHEUMATIC AGENST: Side Effects & Implications for PT
SIDE EFFECTS: vary considerably based on the classification of disease- modifying Antirheumatic drugs;
- nausea
- headache
- joint pain and swelling
- toxicity
- gastrointestinal distress
- sore throat
- fever
- liver dysfunction
- hair loss
- potential for sepsis
- retinal damage
IMPLICATIONS FOR PT:
- therapists should recognize that many of the agents have a high incidence of toxicity
490
Pharmacology- GLUCOCORTICOID AGENTS (Corticosteroids): Action & Indications
ACTION: glucocorticoids provide hormonal, anti- inflammatory, and metabolic effects including suppression of articular and systemic diseases.
- these agents reduce inflammation in chronic conditions that can damage healthy tissue through a series of reactions.
- vasoconstriction results from stabilizing lysosomal membranes and enhancing the effects of catecholamines
INDICATIONS:
- replacement therapy for endocrine dysfunction, anti- inflammatory and immunosuppressive effects
- treatment of rheumatic, respiratory, and various other disorders.
491
Pharmacology- GLUCOCORTICOID AGENTS (Corticosteroids): Side Effects and Implications for PT
SIDE EFFECTS:
- muscle atrophy
- gastrointestinal distress
- glaucoma
- adrenocortical suppression
- drug induced Cushing’s syndrome
- weakening with breakdown of supporting tissues (bone, ligament, tendon, skin)
- mood changes
- hypertension
IMPLICATIONS FOR PT:
- a therapist must wear a mask when working with patients on glucocorticoid therapy since their immune system is weakened.
- a therapist must be aware of signs of toxicity including moon face, buffalo hump, and personality changes.
- patients are at risk for osteoporosis and muscle wasting
- treatment of an injected joint will require special care due to ligament and tendon laxity or weakening.
492
Pharmacology- Nonopioid Agents: Action & Indications
ACTION: provide analgesia and pain relief, produce anti- inflammatory effects, and initiate anti- pyretic (reduces fever) properties.
- these drugs promote a reduction of prostaglandin formation that decreases the inflammatory process, decreases uterine contractions, lowers fever, and minimizes impulse formation of pain fibers
INDICATION:
- mild to moderate pain of various origins, fever, headache, muscle ache, inflammation (except acetaminophen), primary dysmenorrhea, reduction of risk of myocardial infarction (aspirin only)
493
Pharmacology- NONOPIOID AGENTS: Side Effects & Implications for PT
SIDE EFFECTS:
- nausea
- vomiting
- vertigo
- abdominal pain
- gastrointestinal distress or bleeding
- ulcer formation
- ulcer formation
- potential for Reye syndrome in children (aspirin only)
IMPLICATIONS FOR PT: patients are at increased risk for masked pain that would allow for movement beyond limitation or false understanding of their level of mobility.
- complaints of stomach pain should be taken seriously with a subsequent referral to a physician.
494
Pharmacology- OPIOID AGENTS (Narcotics): Action & Indications
ACTION: provide analgesia for acute severe pain management.
- the medication stimulates opioid receptors within the central nervous system to prevent pain impulses from reaching their destination.
- certain drugs are also used to assist with dependency and withdrawal symptoms.
INDICATIONS: moderate to severe pain of various origins, induction of conscious sedation prior to a diagnostic procedure, management of opioid dependence, relief of severe and persistent cough (codeine).
495
Pharmacology- OPIOID AGENTS (Narcotics): Side Effects & Implications for PT
SIDE EFFECTS:
- mood swings
- sedation
- confusion
- vertigo
- dulled cognitive function
- orthostatic hypotension
- constipation
- incoordination
- physical dependence
- tolerance
IMPLICATIONS FOR PT: A therapist must monitor the patient for potential side effects, especially signs of respiratory depression.
- treatment that is otherwise painful should be scheduled approximately 2 hours after administration to maximize the analgesic benefit.
- a patient may not accurately report if a particular technique is painful
