Musculoskeletal Injuries 2- midterm Flashcards Preview

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Flashcards in Musculoskeletal Injuries 2- midterm Deck (182):
1

what is the lower quadrant scan?

a scanning examination is used to determine if we are dealing with a lower quadrant problem or spinal injury

2

what does soap stand for?

subjective
objective
analysis
plan

3

give an example of special question regarding safety

general health
medications

4

what are the spinal cord signs and symptoms (3)

1. blow and bladder dysfunction
2. bilateral or quadrilateral paresthesia
3. hyper-reflexia below level of lesion

5

Approx at what level does the spinal cord end?

L1-L2

6

what is considered the horses tail?

cauda equina

7

what are cauda equina signs and symptoms?

1. saddle area anesthesia (insensitive to pain)
2. bowl and bladder dysfunction
3. hypo-reflexia or a-reflexia
4. positive dural signs

8

when do you test for end feel?

if the client has gone through active ROM with no pain

9

what is an end feel?

different sensations are imparted to the hand at the extremes of range, this sensation is defined as the end feel

10

what are the 6 types of end feel?

1. bone to bone end feel
2. spasm end feel
3. capsular end feel
4. springy block end feel
5. soft tissue approximation end feel
6. empty end feel

11

what is bone to bone end feel?

an abrupt halt to the movement when tow hard surfaces hit
ex. elbow extension

12

what is spasm end feel?

a sudden stop or the sensation of vibrant twang (elastic) to passive movement
often accompanied by pain
a protective mechanism the body uses to prevent further injury

13

what is capsular end feel?

a sensation like a thick piece of leather is being stretched

14

what is springy block end feel?

a rebound sensation is felt
indicates internal articular displacement or internal derangement by me present

15

what is soft tissue approximation end feel?

joint cannot be pushed any further because one part of the body hits another.
ex. elbow flexion (biceps)

16

what is empty end feel?

movement causes considerable pain before the extreme of the range is reached
indicates a very serious pathology, acute bursitis or a symptom magnifier

17

what is the squat test used to clear?

quick clearing test for the lower extremities
if positive it may suggest it is not a spinal problem and peripheral joint assessment is the next step

18

what level does the knee jerk reflex test?

L3-L4

19

what level does the Achilles tendon reflex test?

S1-S2

20

what is a dermatome?

an area of skin supplied by a single nerve root

21

how do you test for altered nerve conduction?

by assessing pain, temperature or light touch over the area of the skin

22

what is a myotome?

a muscle group that is predominantly supplies by a single spinal nerve

23

how do you test myotomes?

test for fatigue, strength and endurance in the particular muscle group

24

myotomes- what level would you test hip flexion and what muscle

L1-L2
iliopsoas

25

myotomes- what level would you test knee extension and what muscle

L3
Quadriceps femoris

26

myotomes- what level would you test for ankle dorsiflexion and what muscle?

L4
Tibialis anterior

27

myotomes- what level would you test for extension of D1 (big toe) and what muslce

L5
extensor hallucis longus

28

myotomes- what level would you test for ankle plantar flexion & ankle eversion and what muscle?

S1 -plantar flexion
gastrocnemius
S1- Ankle eversion
Peroneii

29

myotomes- what level would you test with knee flexion and muscle?

S2
hamstrings

30

what is the clonus test?

the rthythmic and rapid alternating contraction and relaxation of a muscle brought on by a sudden passive tendon stretching
- can be tested on ankle wrist or patella
- positive test suggest an upper motor neuron lesion

31

what is the babinski test?

the skin on the sole of the foot is slowly stroked along the lateral border of the heel towards to the big to
-positive test toes spreading
-positive test indicates a disorder of motor pathways of brain and spinal cord
-exception of children 2 years and younger

32

what is dura?

a thick membrane that is the outermost of the three layers of the meninges that surround the brain and spinal cord

33

what are two dura tests?

straight leg raise
femoral nerve stretch

34

what is the straight leg rasie testing for?

integrity of the dura of the sciatic nerve and various branches

35

what is the degree range for a postive straight leg raise test?

35-70 degrees if pain is felt within this range

36

what does the patient usually complain of when we use the straight leg raise

posterior leg pain

37

how do you perform the femoral nerve stretch?

passively flex the patients knee looking for pain or onset of symptoms

38

what is the femoral nervse stretch also known as?

prone knee bend

39

what level is the lumbosacral plexus?

L2-L4

40

what do patients typically complain of when we decide to use the femoral nerve stretch

anterior thigh pain

41

what are the two components of the vertebral disc

Nucleus pulposus (dics)
Annulus Fibrosus (crisscrossing fibers)

42

what does VAN stand for?

veins
artery
nerves

43

how prevalent is LBP

4/5 people will experience it in their life time

44

what is the typical age range for people with LBP and what gender is it most common?

30-50
equal between men and women

45

is there an agreed upon LBP definition?

no

46

for LBP how long do symptoms need to be present before it is considered chronic

3 months

47

what are the 5 conditions of the lumbar spine?

1. spondylogenic
2. neurogenic
3. vascular
4. viserogenic
5. psychogenic

48

what are the six spondylogenic back pain injuries we dicussed?

1. intervertebral disc derangement
2. postural syndrome
3. mechanical
4. spinal stenosis
5. spondylolisthesis
6. fractures

49

_____ provide a pathway for the nucleus to bulge or herniate

fissures

50

what age group and sex does intervertebral disc derangement(IDD) in the thoracolumbar spine occur in?

30-40 males

51

what is a cause for IDD?

lifting, bending or twisting

52

does the pain with IDD get better or worse throughout the day? what is the pain pattern?

subsides the day of injury and worsens the following day
- pain is worse in the morning
-pain and paresthesia may be present centrally or peripherally and unilaterally or bilaterally

53

what is an aggravating factor for IDD

sitting, bending, sustained postures, coughing, sneezing and bowl movements

54

what is an easing factor for IDD

standing, supine lying and extension of the lumbar spine

55

what are some objective assessment findings with IDD

-lumbar spine appears flat or flexed
- flexion rotation increase pain
- extension decreases pain

56

what is the treatment for IDD

- education
-postural correction
-rest
-brace or corset
-surgery
-traction/spinal compression
-pain relieving modalities
-walking
-stretching
-strengthening
-mods to bio mechanics

57

what is postural syndrome?

over stretching and mechanical deformation of the normal spinal tissue results in postural pain after prolonged static loading

58

what is the age range and sex for PS

under 30 males and females

59

what would your findings be on objective testing with PS

nothing, just visual of poor posture

60

what is the most common LBP cause

mechanical

61

what is the age and sex for mechanical LBP

30+ males?

62

what are the clinical findings with mechanical LBP

-early morning stiffness
- intermitten pain
- pain greatest at the ends of range
- pain is eased with movement

63

what are the objective findings with LBP

- no deformities, poor posture may be present
-decrease active ROM in lumbar spine
-pain greatest at end of range but eased when moving in the opposite direction

64

what is the treatment for mechanical LBP

-postural correction
-stretching exercises to regain mobility
- joint mobilization
- education

65

what is spinal stenosis?

a bony narrowing of the spinal canal centrally or in the lateral recesses

66

what are the clinical presentation for spinal stenosis?

-primary complaint is vague an intense bilateral LEG PAIN
-client is comfortable at rest in a flexed position
-walking increases leg symptoms and must stop to bend over or sit
-extension increases their leg pain

67

what LBP condition do people only compain about leg symptoms about?

spinal stenosis

68

what is the treatment for spinal stenosis

-postural correction
-traction
- cycling
-flexion type exercises
- education
-surgery decompression

69

what is spondylolisthesis

forward slip one vertebra on the adjacent vertebra due to insufficiency of the facets, neutral arch or structural weakening of the bone

70

what are the clinical findings for spondyloisthesis


-low back pain that radiate to butt and legs bilaterally
-depending on grade my present with neurological symptoms
-pain increases with lumbar extension
- pain decreased with lumbar flexion

71

what are the objective assessment findings for spondyloistheis

-visible and palpable step deformity
-may see an abdominal crease anterior
- pain with resisted hip flexion
-pain with accessory glide over the painful segment

72

what is the treatment for spondylolistheis

-stabilization exercises
- posture correction
-joint mobilization
-stretching

73

what is a wedged compression fracture of the vertebral body

-fracture of the thoracolumbar spine
-severe flexion force crushes the anterior aspect of the vertebral body
posterior facets may be misaligned

74

does wedging get better with time?

no it does not go away
ex. hump back grandma

75

what is neurogenic pain?

nerve is the source of pain

76

what is the clinical presentation for neurogenic pain?

-severe sharp electric pain
-deep burning pain
-peristsent numbness, tingling or weakness
-travels along nerve into arm or leg

77

what is a common cause for neurogenic back pain

spinal cord tumor: Nurofibroma (fibruous tissue) or Lipoma (fat tissue)

78

what is a common complaint for neurogenic back pain?

clients report they have to get out of bed and walk around at night to relieve pain

79

what is abdominal aortic aneurysm

weakening of the atrial wall causing the artery to expand and left untreated to rupture

80

what are the clinical presentation for abdominal aortic anuerysm

-boring and deep seating pain in the groin/flank
-feel a pulsating mass in abdomen
-pain is affected by activity
-minimal objective findings related to the pain
-testicular pain often proceeds rupture

81

what are the pain sites with abdominal aortic aneurysm

pain back
groin pain

82

what is intermittent claudication

insufficiency of the superior gluteal artery

83

what are the clinical presentations for intermiotten claudication

-bilateral pain
-increase pain with walking
-pain decreases standing still
-pain is unchanged in all spinal positions
-no burning or numbness
-decreased pulse is extremities
-cold, numb, dry skin
-poor hair and nail growth

84

what is the population that is most affected by intermittent claudication

40-60 years
male and female

85

what is viserogenic back pain?

diseases of the pelvic region organs

86

what are the clinical presentation for viscerogenic back pain?


-activity does not alter pain
-rest does not relieve pain
-other symptoms may include nausea, vomiting fever, bladder dysfunction, vaginal discharge, unexplained weight lose and bleeding

87

how much of a tissue needs to be consumed by a tumor before it shows up on an xray

40%

88

what is psyhcogenic pain?

pain that is due to central sensitization "all in your head"

89

what are the clinical presentation for psychogenic?

-orginal pain spreads
-mirror pain on the opposite side
-often reports sudden stabs of pain
-pain has a mind of its own
-unpredictable response to input and treatment
-all movements hurt
-associated with depression and anxiety

90

what type of patients get labeled as irritable and unstable

pyshcogenic patients

91

what is the treatment for psychogenic back pain

-multiply number of professionals (physio, psychologist..)
-counselling
-education

92

what are some other condsiderations when dealing with LBP

-diet modifications/weight lose
-positive attitude
-meditate
-dietary supplements
-maintain cardiovascular fitness
-maintain flexibility
-seek medical attention of problems occur or questions arise

93

What thoracic spine region is generally through a watershed area

T4-T9

94

severe bilateral nerve root pain in the elderly could be caused by?

neoplasm

95

what would wedging be caused by?

osteoporotic, neoplastic r traumatic fracture

96

what could the onset of offset of pain related to general activity or tress

cardiac

97

what could the onset of offset of pain unrelated to trunk movements

ankylosing spondylities and visceral

98

what could the decreased active contralateral side flexion painful with both rotations full

neoplasm

99

what could cause severe chest wall pain without articular pain

visceral

100

what could cause spinal cord signs

cord pressure or ischemia

101

what could cause pain onset related to eating or diet

visceral

102

what is scoliosis

abnormality to the lateral curvature of the spine

103

what is non structural scoliosis?

-no bony deformities
-non progressive
-normal spinal flexibility
-scoliotic curve disappears with forward flexion

104

what spinal region is non structural scoliosis usually present?

thoracic

105

what are the five causes of non structural scoliosis

-postural
-hysterical
-nerve root irritation
-inflammatory
-compensatory

106

what is structural scoliosis

-scoliotic curve lacks normal flexibility
-may be progressive
-curve does not disappear with forward flexion

107

what are the causes of structural scoliosis

-idiopathic
-congenital
-neuromuscular
-neurofibromatosis
-trauma
-infection
-tumors
-inflammatory

108

what is the treatment for scoliosis

-bracing
-surgery
-exercise
-neuromuscular electrial stimulation

109

what is dowagers hump?

assoicated with post menopausal osteporosis (exaggerated kyphosis)

110

what is hump back/Gibbus

assoicated with a wedge fracture of the thoracic spine or with schenurmann's disease (exaggerated kyphosis)

111

what is a thoracic spine disc derangement

-Tears occur in the inner and outer annulus
-Fissures provide a pathway for the nucleus to bulge
-usually due to flexion and rotational injury

112

what are the clinical presentations for thoracic disc derangement

-sever arching, burning or shooting pain in posterior anterior aspect of the thorax
-may be admitted to hospital due to suspect of cardiac involvement
-all movments are limited and painful
-due to small size of the spinal cord, may present with spinal cord signs
-positive compression and sural testing
-pain eased with traction
-muscle spasms when accessory glides over the spinous prpcresses of thoracic spine

113

what are the aggravating factors for thoracic disc derangement

movement
prolonged flexion
deep breathing
coughing
sitting or lying in extension

114

what is the treatment for thoracic spinal dis derangement

-medical clearance for spinal cord compression
-treat as per lumbar spine(after ruling our cardiac issues)

115

where is it most common in the thoracic spine is get a vertebral fracture or dislocation

T12-L1

116

what is a rib fracture

-usually involve a traumatic event
-presents with crepitus and pain with breathing

117

what is teh treatment for a rib fracture

rest

118

what is costochnodritis

-local inflammation of the costochondral junctions anteriorly
-presents as hot and swollen joint on the anterior aspect of thorax

119

what is contortionists called when more ribs are involved?

tietz'e syndrome

120

what is the treatment for costochondritis

local modalties for pain relief

121

what is a barrel chest

-sternum projects forward and upward with increased anterior to posterior diameter
-associated with chronic obstructive pulmonary diseases such as emphysema

122

what is pectus excavatum

-also known as funnel chested
-sternum pushed posterior by the ribs
-resuls in altered inspiratory pattern
-associated with a increased kyphosis

123

what is herpes zoster also known as

shingles

124

what is herpes zoster

-an acute viral infection that lives in the sensory never bodies and at times of stress or illness travels to the skin and attaches to its resulting in scores on the skin and pain

125

what is scheurmanns disease

osteochondrosis of the anterior intervertebral ring epiphyses

126

what is scheurmanns disease also known as

vertebral epipyitis or adolescent kyphosis or round back

127

what population is most susceptible to scheurmanns disease

females
10-16years old

128

what is teh treatment for scheurmanns disease

postural correction
education
extension exercises
surgery

129

what is the upper quadrant scan

scanning examination to determine if a person symptoms are of a spinal origin in the cervical spine or in the periphery

130

what are the 5 d's

Dizziness
Diplopia
Drop attacks
Dysarthria
Dysphagia

131

what is dysarthria

troubles speaking

132

what is dysphagia

difficulty swallowing

133

what do the 5 D's detect for

vertebral artery signs

134

what nerve interbates the biceps

C5-6

135

what nerve intervates the brachioradialis

C6

136

what nerve inervates the triceps

C7

137

what cervical vertebra has two nerves come out of it?

C7

138

what are myotomes

a muscle group of muscles that is predominantly supplied by a single spinal nerve

139

what do myptomes test?

for fatigue and altered nerve conduction by testing strength and endurance

140

what is the only true myotome

C1

141

myotomes C1-C2

neck flexion

142

Myotome C3

NECK SIDE FLEXION

143

Myotome C4

shoudler elevation

144

Myotome C5

shoulder abduction

145

Myotome C6

elblow flexion and wrist extension

146

Myotome C7

elbow extension and wrist flexion

147

Myotome T1

Finger abduction and adduction

148

what levels of the cervical spine do we not test if the person it sitting breathing and talking

C1-C4

149

what are dermaomes

an area of skin supplied by a sngle nerve root

150

what is the test for sesnstaion such as temperature

deramtomes

151

what is similar test to the straight leg rasie

slump test

152

what is the accessory movements of the cervical spine

joint mobilization techniques used to identify the level of involvement in the cervical spine

153

what is teh vertabral artery test

patients head taken into extension and rotation held for 30 seconds
looking for 5 D's

154

what is whiplash assicated disorder

-the head and neck moves into extension in relation to the shoulders
-followed by flexion
-the brain is forced against the skull

155

can whiplash cause jaw problems?

yes, when the head goes back the jaw opens stretching the musculature of the temporomandiulbur joint and the disc

156

during the extension phase of whiplash what happens the the facet joints

compression resulting in damage ti the joint surface, capsule and ligaments

157

what happens the to the anterior structurs of teh throat during whiplash

a strecth to all the structures such as esophagus can hemmorhage

158

during the flexion stage of whiplash what happens to the vertebral bodies?

compression, may cause disc damages or a compressive fracture

159

what are the clinical presnetations for whiplash

-pain in neck,shoulders and inter scapular regions
-headache
-blurred vision
-tinnitus(ringing in ear)
-dizziness
-numbness in upper extremities
-dysphagia
-facial anteriolateral throat and retro orbital pain
-compulsive clearing of throat
-depression and feels of fatigue
-irrtability and insommia

160

what is horner syndorme

a sinking in the eyeball, drooping of the upper eyelid, constriction of the pupil, lack of sweat production and facial flushing of the skin

161

how many grades of whiplash are there

4

162

what is grade 1 whiplash

complains of pain, stiffness and tenderness only. no physical signs of upper quad scan all came back negative

163

what is grade 2 whiplash

complains of pain and musculoskeletal signs present including decreased ROM and point tenderness (nerves not involved)

164

what is grade 3 whiplash

Complains of pain and neurological signs present including decreased or absent deep tendon reflexes,weakness and sensory deficits

165

what is grade 4 whiplash

complains of pain and fracture or dislocation presnet

166

what is the treatment for whiplash

-RICE
-NSAIDS
-soft cervical collar
-non weight bearing exercises initially and pressing to weight bearing exercises working in mid range
-gentle isometric strengthening exercise
-electrical modailities such as TENS
-joint mobilization and manipulation
-progress into stabilization exercises and end of range stretching exercises cautiously
-ergonomic modifications

167

what is acute torticollis

-sudden onset of neck pain and stiffness upon awakening
-may also be caused by a sudden rotation of the cervical spine
-subluxation of the facet or uncinated process

168

what level does acute torticollis usually occur at

C2-C3

169

what is teh treatment for Acute toticollis

-manual traction of the cervical spine
-joint mobilization
-soft collar

170

what is acute torticollis called in children (ages 5-7)

Grisels syndrome

171

what is teh treatment for Grisels

NO TRACTION
antibiotics

172

what is the most common level for cervical disc derangement

C5-C7

173

what is cervical spine and spinal stenosiss

stenosis due to disc prolapse is very uncommon but is more commonly caused by degeneration of the uncovertebral joint and due to the small size of the lateral foramen

174

what is the symptom for cervical spinal spinal stenosis

-NO NECK PAIN
- ARM PAIN

175

what are the clinical presentaions for cervical spinal stenosis

-segmental paraesthesia pain
-age greater than 45
-compression in extension aggravates symptoms
-traction relieves symptoms
-x-rays confirm clinical findings

176

where is spondylothesis most common

-common at L5-S1

177

what age group is most common for spondylothesis

-under 30

178

what may be the cause for viscerogenic back pain

-tumors

179

what is neoplasm

a new and abnormal growth of tissue in some part of the body, especially as a characteristic of cancer

180

what region is disc derangement most rare? and why

-extremely rare in the thoracic spine due to the thick posterior longitudinal ligament and ribs

181

What age group is mostly affected by thoracic spinal disc derangement

-most common in 40s
-more common in males

182

what level on the thoracic spine is disc derangment most common?

-most common levels affect are between T6-T10