OS3 year 2 exam 1 -Hannah

Question 1

systemic causes of compression neuropathy

Answer 1

pregnancy
hypothyroidism
diabetes

Question 2

three sites of radial nerve entrapment and associated symptoms

Answer 2

1. high on the humerus
   sx: wrist drop, weak elbow flexion, tricep weakness
2. radial tunnel
   sx: pain and tendernesss 5cm distal to lateral epicondyle , wrist drop , pain with resisted supination
3. at the wrist
   sx: sensation changes over posterolasteral hand

Question 3

what nerve causes pronator syndrome

sx: achy pain in the mid/proximal forearm, pain with resisted forearm pronation and cramping in the fingers

Answer 3

median N.

-compression by the pronator trees muscle

Question 4

anterior interosseous syndrome

Answer 4

• anterior interreouses N. from the MEDIAN N.
  sx: NO sensory symptoms, cannot make “OK” sign with thumb and index finger properly
• weak flexion of the index finger DIP and thumbs IP

Question 5

sx: parathesia to the 4th and 5th digits, medial elbow pain radiating to the hand with decreased intrinsic muscle strength (can’t turn a key in the door)
* + Tinel sign at elboww

Answer 5

ulnar nerve entrapment in cubital tunnel syndrome

*reproduction with elbow flexion, wrist extension

Question 6

what is froments sign and when do you see it

Answer 6

patient must flex thumb in order to pinch paper between 1st and 2nd digit
seen in cubital turner syndrome of ulnar n. entrapment

Question 7

what is the most common compression syndrome

Answer 7

median N entrapment at the CARPAL TUNNER SYNDROME

Question 8

sx of carpal tunnel syndrome

Answer 8

nighttime numbness of lateral 3 1/2 digits, tingling, wrist pain, dropping things, thenar atrophy

Question 9

dx gold standard for carpal tunnel syndrome

Answer 9

EMG

Question 10

sx of thoracic outlet syndrome

Answer 10

weakness, parathesia of medial arm forearms and hand worsened by overhead activity

Question 11

what causes a positive tinnels sign 1cm medial and inferior to ASIS

Answer 11

meralgia parasthetica (lat fem cutaneous n.)

Question 12

what compression is caused by “strawberry pickers palsy” (time spent in squatting position), or leg hooked over a rail, or ANKLE SPRAINS

Answer 12

common fibular nerve compression
sx: pain along proximal third of lateral leg, steps make louder sound on affected side (foot drop) , pain worsened with plantar flexion and inversion of the foot

Question 13

plantar flexion and foot inversion makes the fibular head go _____

Answer 13

posterior

*PIP

Question 14

tarsal turner syndrome (assoc with autoimmune diseases and diabetes)

Answer 14

compression of the posterior tibial n. in the tarsal tunnel behind the medial malleolus and overlying flexor retinaculum
sx: affects motor to plantar (bottom) muscles of foot and sensation to plantar aspect of the foot and toes

Question 15

anterior tarsal tunnel syndrome

Answer 15

• compression of deep fibular nerve by the inferior extensor retinaculum
• sx: pain over dorsomedial aspect of foot and worse at rest, weakness of extensor digitorum braves
• caused by prolonged plantar flexion or compression from shoes, or soccer

Question 16

cervical nerve root compression is caused by

Answer 16

2 degree to cervical disc disease
(herniated or bulging disc)
= radiculopathy

Question 17

bulging disc vs herniated disc

Answer 17

bulging
-compresses every without tearing to cartilage rings

herniated
-tearing of cartilage rings
(protrusion- few tearing, no leakage)
(extrusion- torn in a small area, nucleus pulposus is able to flow out of disc space)

Question 18

technique: extending and rotating the neck toward the symptomatic side, look for exacerbation of radicular pain
dx: cervical radiculopathy (herniated disc)

Answer 18

spurling test

Question 19

technique: elevate patient chin (extend neck) and rotate head toward affected side while inspiring deeply, look for decrease in radial pulse on affected side
dx: thoracic outlet syndrome (plexopathy)

Answer 19

adsons test

Question 20

technique: firmly grasp the middle finger and quickly snapping or flipping the dorsal surface, look for quick flexion of both the thumb and index finger
dx: cervical myelopathy (c-spine stenosis)

Answer 20

hoffmann tets

Question 21

compression of the superficial radial N., (cheiralgia parathestica, wartenbergs syndrome, “HANDCUFF NEUROPATHY”)

Answer 21

numbness, pain, tingling in the posterolateral hand and distal forearm
-compression of the radian n. at the wrist between the ECRL, and brachioradialis M.

Question 22

baseball players and dentist are likely to get what compression neuropathy

Answer 22

median n. entrapment as PRONATOR SYNDROME

Question 23

what muscle is weak in anterior interrosseous syndrome as seen with with pts with forearm casts

Answer 23

flexion pollicus longus muscle and flexor digitorum M.

Question 24

three test to dx carpal tunnel syndrome

Answer 24

tinels, phalens, 2 point discrimintion

Question 25

lumbosacral radiculopathy (sciatica) vs piriformi syndrome sx

Answer 25

sciatica travels down to foot, and low back pain, and caused by herniated disc most often at the left of L5-S1 (affects L5 nerve) piriformis syndrome - pain stops at or above kneee and radiates from the gluteal region, contralateral sacroiliac pain (SI JOINT PAIN) can have gait problems (foot drop) and weakness in ipsilateral LE

Question 26

lat fem cutaneous comes from what lumbosacral nerve roots

Answer 26

L2 -L3 | and nerve is compressed by inguinal ligament

Question 27

common fibular N. lumbosacral nerve roots

Answer 27

L4-S2

Question 28

tx for tarsal turner syndrome (posterior tibial N.)

Answer 28

gastrocnemius counterstain , calcaneal HVLA, talar tug HVLA, ankle figure 8

Question 29

if there is a thoracic and rib TP, which do you treat first?

Answer 29

thoracic

Question 30

2 cm lateral to medial end of the clavicle

Answer 30

AC 7 (clavicular head of the SCM) (F StRa)

Question 31

medial end of the clavicle

Answer 31

AC 8 (sternal head of SCM at the sternal notch ) (F SaRa)

Question 32

inferior tip of xiphoid or 1/4 of the way between the xiphoid tip and umbilicus

Answer 32

AT 7 | tx: patient sitting- knee on opposite side of TP, FSTRA

Question 33

3/4 way between xiphoid and umbilicus

Answer 33

AT 9 | tx: patient sitting- knee on opposite side of TP, FSTRA

Question 34

1/4 way between unblicius and pubic symphysis

Answer 34

AT 10 tx: F STRT - patient supine; same side as TP, pull ankles and knees toward you

Question 35

halfway between umbilicus and pubic symphysis

Answer 35

AT 11 tx: F STRT - patient supine; same side as TP, pull ankles and knees toward you

Question 36

anterior superior surface of the iliac crest at the midaxillary line

Answer 36

AT 12 tx: F STRT - patient supine; same side as TP, pull ankles and knees toward you

Question 37

medial ASIS

Answer 37

AL1 -F STRT (stand same side pull ankles and knees toward you ) 1 = STaRT

Question 38

medial, lateral and inferior AIIS

Answer 38

``` medial ( AL 2) lateral AL3 inferior AL 4 tx= F SARA (stand opposite side and pull ankles and needs to you/away from TP) ```

Question 39

superior aspect of pubic ramus just lateral to the pubic syphysis

Answer 39

AL 5 tx= F-SART stand same side and push ankles away and rotate knees towards you/TP

Question 40

lower quadrant, medial to ASIS, deep in iliac fossa | 1/3 from ASIS to midline

Answer 40

iliacus Tender point tx: "frog leg" [ F-ER ] - same side and flex hips and knees to 90 crossing ankles over doc knee and inducing marked ER "FrogER"

Question 41

superior pubic ramus where psoas muscle crosses the pelvic rim (superior surface of iliopubic/iliopectineal eminence)

Answer 41

low ilium tender point | tx= same side and flex hip and knee to 90

Question 42

lateral pubic tubercle

Answer 42

inguinal ligament tender point -tx= "cross good over bad" and pull ankles toward [internal rotation of dysfunctional hip] -associated with inguinal L. and pectineus M.

Question 43

2/3 distance from ASIS to midline, pressing deep

Answer 43

psoas major tender point tx: F STRT (same side, flex and pull ankles and feet towards you/TP)

Question 44

on the inferior nuchal line, lateral to the inion

Answer 44

PC1 inion | tx= F.STRA

Question 45

on the inferior nuchal line, 1/2 way between the inion and mastoid process (splenius Capitis M. )

Answer 45

PC1 occiput | tx: E-Sara

Question 46

on the inferior nuchal line , in the semispinalis capitis M.

Answer 46

PC2 occiput | tx: E-SARA

Question 47

on the inferior or inferolateral aspect/tip of the spinous process of C2

Answer 47

PC3 tx: F-sara (C2 has 2 tender points)

Question 48

is seated or standing flexion test for the sacrum

Answer 48

seated flexion test

Question 49

for sacral torsion, what is the relationship between the axis and the seated flexion test

Answer 49

the axis is opposite to the positive side of the seated flexion test (dysfunctional side)

Question 50

when is pedal pump ABSOLUTELY contraindicated in a surgical patient

Answer 50

if DVT, lower extremity fracture, recent abdominal surgery

Question 51

facilitated segments are often a result of ____ ___ ____ and reproduction of dysfunction occurs rapidly therefore frequency of treatment is ____

Answer 51

acute visceral processes | -very frequent, often more than once daily until the process improves and the frequency can decrease

Question 52

tx of ____ may have greater effect in segmental facilitation vs ____ because of the high concentration of nociceptors in the joint capsules vs muscle bodies

Answer 52

articular tissues treatments vs soft tissue techniques (MFR or counterstain)

Question 53

rule of W's

Answer 53

in post op fever 1. wind (Lungs) 2. water (kidneys) 3. walking (DVT, PE) 4. wound 5. wonder drug

Question 54

thoracic duct is under SNS control and therefore hyper sympathetic tone may ____ lymphatic flow

Answer 54

decrease

Question 55

what is the caution with CHF patients

Answer 55

do not overwhelm the circulatory system and exacerbate symptoms

Question 56

neurologic tx for CHF patient

Answer 56

paraspinal inhibition at T1-T6 (decrease SNS) sub occipital release (increase PNS tone) chapmans points (2 ICS anteriorly, 2-3 TP posteriorly)

Question 57

scoliosis grading

Answer 57

mild : 5-15 moderate: 20-45 severe: >50 * cobb angle measurement

Question 58

measure of the angle between a line parallel to the superior end plate of the most cephlad vertebrae in a particular curve and a line parallel to the inferior end plate of the most caused vertebra of the curve

Answer 58

Cobb angle

Question 59

in FPR the activating force is applied ___ in pelvic tx, and ____ in rib tx ; what is the one exception

Answer 59

after in pelvic, before in rib except in INH/EX seated FPR you add activation force after position indirectly

Question 60

FPR of sacral SD (restriction in cephalad motion on one side)

Answer 60

neutralize the curve, flex hip off table, knee extended abduct and add activation force by pushing cephalad on the ILA

Question 61

FPR of piriformis TP/hypertonicty (associated with sacral torsion)

Answer 61

neutralize the curve, flex hip off table, knee bent, and adduct duct, add activation axial compression through the palm at the kneee to shorten the muscle

Question 62

FPR of gluteus maximus TP/hypertonicty

Answer 62

neutralize the curve, flex hip off table, bend knee to 90 degree, extend hip with doctors knee until motion is felt at the TP, add TORSIONAL force by external rotating the hip by contact at the ankle and knee as fulcrum

Question 63

FPR of hamstring TP/hypertonicity

Answer 63

neutralize the curve, extend hip off table on top of doctors knee, flex knee until relaxation of the hamstring, induce IR/ER rotation with distally placed hand, add axial compression or traction with proximal hand as activating force

Question 64

FPR for quads (left vests lateraled hypertonicity SD)

Answer 64

neutralize the curve (with pillow under head in supine position) flex hip with knee maximally extended and calf of patient on doctors thigh. direct patella towards the monitoring hand, and induce IR/ER and AB/ADuct of hip as needed, add axial compression or traction activating force using the Dr.s thigh

Question 65

seated FPR of costochondral SD

Answer 65

neutralize curve, add compression at shoulders, rotate towards until motion felt or TP releases

Question 66

seated FPR of posterior rib SD

Answer 66

neutralize curve, add compression at shoulders, Flex, sideband towards, rotate towards (F STRT)

Question 67

where do you start and end in a stills technique

Answer 67

start at the shifted neutral position of ease, end at the ANATOMIC barrier or the direct position (not restrictive barrier)

Question 68

Stills technique for posterior rib

Answer 68

monitor costotransvere segment (posteriorly) abduct arms, add compression through elbows to the rib, and adduct the arm across the body

Question 69

tensor fascia lata TP ( at lateral trochanter)

Answer 69

F- AB (maybe IR)

Question 70

ITB TP

Answer 70

F-AB

Question 71

medial vs lateral hamstring TP

Answer 71

Lateral - F-AB-ER of tibia medial - F-AD-IR of tibia *follows same for menisci

Question 72

popliteus TP

Answer 72

F-IR (flex knee and IR tibia)

Question 73

gastrocnemius TP

Answer 73

flex knee and place dorsal of foot on doc thigh, add compression through calcaneous

Question 74

medial ankle (tibialis anterior) vs lateral ankle (fibularis m.s) TP

Answer 74

medial ankle= inversion lateral ankle = eversion (pt is lateral recumbent with pillow underneath for both)

Question 75

navicular TP

Answer 75

knee flex, dorsum of foot on doc thigh, plantarflexsion and supination (inversion) of foot

Question 76

supra spinatus, and upper and lowe infrapsinatus TP

Answer 76

all are FABER supra- 45 degree upper infra- 90-120 lower infra- >135

Question 77

levator scapula tp

Answer 77

rotate head away, | IR AB and traction on shoulder

Question 78

subscapulris TP

Answer 78

E and IR shoulder (maybe traction)

Question 79

biceps brachi TP short and long head

Answer 79

F-AB-IR (flex should and elbow, min abduct, and IR) **SHORT HEAD MIGHT BE FADDIR

Question 80

medial epicondyle (pronator teres) TP

Answer 80

Flex elbow, pronate, adduct forearm

Question 81

abductor policus brevis TP

Answer 81

flex wrist Abduct thumb | FAB

Question 82

when is an ankle series indicated according to the ottawa rules

Answer 82

if there is pain in the malleolar zone, and 1. tenderness at the posterior edge or tip of the medial or lateral malleolus or 2. can not bear weight immediately after injury or for 4 steps in ER

Question 83

when is an foot series indicated according to the ottawa rules

Answer 83

if there is pain in the mid foot zone, and 1. bone tenderness at the base of the 5th metatarsal (pinky toe) or navicular or 2. can not bear weight immediately after injury or for 4 steps in ER