PTY1022 Flashcards
(210 cards)
1
Q
What is the term for injuries sustained as a result of sudden acceleration-deceleration movements.
A
Whiplash associated disorders
2
Q
What is the synovial joint in the spine?
A
zygopophyseal joint (facet)
3
Q
What is mobic?
A
NSAID (melocicam) used to relieve symptoms of arthritis
4
Q
What is the classification system for WAD?
A
The Quebec Task Force
5
Q
What are the 4 grades for severity classification of WAD
A
- NO complaint/no physical signs
- pt c/o neck pain, stiffness, or tenderness with no physical signs
- exhibits MSK signs (decreased ROM and point tenderness)
- also neurologic signs (sensory deficits, decreased deep tendon reflexes, muscle weakness)
- fracture or dislocation
6
Q
Questionnaires for whiplash?
A
Whiplash disability Questionnaire (out of 130)
Neck Disability Index (limit: not tested on pts w/ WAD)
7
Q
UL myotomes
A
C4: shoulder elevation
C5: Shoulder Abd
C6: Elbow F/ Wrist E
C7: Elbow E/Wrist F
C8: finger flexion
T1: finger abduction
8
Q
LL myotomes
A
L2: Hip F
L3: Knee E
L4: ADF
L5: Great toe E
S1: APF/ Hip E
S2: Knee F
9
Q
Intervention for Whiplash + evidence
A
Evidence: Whiplash Guidelines
Education: goals, gradual return, importance of early movement
Passive physiological movements
10
Q
Physical examination of whiplash includes:
A
-Cervical ROM, Pain on palpation or w/ movement
- Sensation
- Reflexes
- Myotomes
- Questionnaire
11
Q
What spine rule is used to determine if radiography is necessary?
A
Canadian C-spine Rule
12
Q
What is indicative of imaging for whiplash according to C-spine rule?
A
Unable to rotate 45 deg L or R
High risk: >65, dangerous mechanism (bus, high speed), paresthesias in extremities
13
Q
What Spinal level is the iliac crest at?
A
Interspinous space of L4/5
14
Q
What Spinal level is the the inferior border of scapula?
A
T7
15
Q
Which cervical SP is most prominent?
A
C7
16
Q
How are spinal nerves numbered in relation to vertebra (diff between cervical and rest of spine)
A
First 7 nerve exist above vertebra.
C8 exits above T1
Rest exist below vertebrae (T2-L5)
17
Q
What is the McKenzie method? Classifications & (treatment)
A
A mechanical diagnosis and therapy
-Derangement-directional preference (away from pain)
-Dysfunction-structural impairment (toward pain)
-Postural syndrome-static pos e.g. slouched (correcting posture)
18
Q
Explain scapulohumeral rhythm and ankles of movement
A
Coordination of mvmt b/w Clavicle, Scapula and humerus move in 1:2 ratio.
When arm ABducts to 180,
60 degrees is by scapula, 120 degrees is humerus rotation?
19
Q
3 common NSAIDS
A
Aspirin (high dose)
Ibuprofen (Advil, Motrin)
Naproxen
20
Q
What ligaments form the GH joint capsule?
A
Inferior, middle and superior GH ligaments
(located anteriorly)
coracohumeral (superior)
transverse humeral?
21
Q
What test investigates the integrity of the GH joint capsule/ instability in an anterior direction?
A
Apprehension Test
22
Q
How to conduct apprehension test?
A
Supine, PT elbow F 90 and shoulder ABd 90
Slowly applied ER
+ve: if pt apprehensive about moving into ER
23
Q
Tests for subacromial impingement
A
Hawkins-Kennedy
Neer
Yocums
24
Q
How to do Hawkins-Kennedy test? What is +ve?
A
PT bring pt’s arm to 90 Sh F and elbow 90 F
Apply IR
(compressed RC tendons in SA space)
+ve: pain on IR
25
How to do Neers test?
PT stabilises scap. IR shoulder then F shoulder
(compression in SA space)
+ve: pain upon F
26
How to do painful arc?
Instruct pt to Abd Sh to 180
+ve: painful at ~45/60-120 deg and reduces in pain after 120 ABd
(compresses supraspinatus tendon in SA space)
27
How to conduct empty can
Instruct pt to F sh to 90 in SCAPULA plane + IR
Apply downward resistance
+ve: pain or weakness compared to other side
(tension to suoraspinatus tendon via muscl contraction
28
How to do resisted shoulder ER?
Intruct pt to F elbow to 90 and keep arm close to body
PT applies IR resistance to forearm
+ve: weakness or pain
(applies tension to supra and infraspinatus tendon via muscle contraction)
29
What acromion type is at higher risk of shoulder impingement? Why?
Type II (curved) and moreso III (hooked)
Acromion process in type 3 is hooked downward more than type 2
30
What muscles does the axillary nerve innervate? What happens when this nerve is damaged?
Deltoid + teres minor
-Weakened Sh Abduction + lack of sensation on lat. shoulder
31
What does a SLAP lesion stand for?
Superior labral anterior posterior tear
32
What test is very sensitive for the detection of instability in patients with recurrent dislocation? (due to increased capsular laxity)
Load and shift test
33
How to do load and shift test? What are the grades?
Pt sitting
PT stabilise clavicle and scapula
other hands grabs humeral head and loads medially then translates ant and post.
Grades:
0- normal translation
1- excessive translation w/ no subluxation
2- subluxation to glenoid rim
3- dislocation of humeral head beyond glenoid rim
34
What shoulder test looks at joint tenderness in
patients with rheumatoid arthritis.
Ritchie articular index
35
Scoring of RAI?
0 no tenderness,
+1 patient complained of pain ,
+2 patientcomplained of pain and winced,
+3 patient complained of pain and winced and withdrew.
36
What does the inferior sulcus sign test for?
inferior GH instability
37
How to do sulcus sign?
Sitting
PT grasps arms and pulls inferiorly
+ve: dimple/sulcus beneath acromion
38
What is a classic sign of Erb's Palsy?
Waiter's tip
39
Red flags for LBP?
Red Flags
· Cauda equina - NAD
· Spinal cord compression - NAD
· No previous scans for this condition
· No unexplained LOW
· No changes to Bladder/Bowel
· No neurological symptoms
40
Which nerve roots and therefore nerves are damaged in Erb's Palsey?
C5, 6 and sometimes 7
(affecting axillary nerve, musculocutaneous, & suprascapular nerve)
41
What self-reporting screening questionnaire is helpful for chronic pain?
Central Sensitisation Inventory (CSI)
42
What score indicated central sensitisation?
A score of more than 40 indicates the presence of central sensitisation
43
What is the pedro scale?
Critical appraisal tool that looks at risk of bias of randomised controlled trials.
44
Criteria of Pedro scale? (11)
Eligibility criteria
Random allocation + similar baseline
Concealed allocation
Blinding of subjects, therapists and assessors
key outcome measured for >85% subjects
intention to treat
statistical comparisons and point measures
45
What is intention to treat?
when the data are analysed, analysis is done as if each subject received the treatment or control condition as planned (even if they did not)
46
What are some measures of variability?
standard deviations, standard errors, confidence intervals, interquartile ranges (or other quantile ranges), and ranges.
47
How to prevent performance bias?
Blinding of subjects so that therapy, participation is not influenced
48
What is reporting bias?
Include reporting certain outcomes, publishing in certain journals
49
How to prevent selection of sampling bias?
randomisation + balancing characteristics
50
Questionnaire for CTS?
Carpal Tunnel Functional Status Scale
51
Pain Catastrophising Scale
52
Postural control involves the interplay of special senses received from what parts of the body?
eyes and ears
53
The ability to maintain stability of the body and body's segments in response to forces that threaten to disturb the ____ __________
body's equilibrium
54
Examples of static posture
Standing, sitting, lying, kneeling
55
Examples of dynamic posture
walking, running, throwing
56
What is an advantage of a sustained erect standing posture for humans?
able to use upper extremities therefore able to use tools
57
3 disadvantages of erect standing posture in humans?
- reduced base of support = reduced stability
– increased work against gravity (for heart)
– increased strain on vertebral column, pelvis and lower extremities
58
What spinal level and plane is COG in standing?
S2 in midsagittal plane
59
In relaxed standing, what other structures in the body counteract gravity if muscles are activated a low levels?
passive tension in ligaments and joint capsules
60
What is another word for postural sway?
sway envelope
61
Why is postural sway needed in terms of nutrition and stress?
Opportunity for joint and intervertebral disc nutrition + reduces stress on joints and muscles
62
how many degrees is postural sway in sagittal and coronal plane?
Sag: up to 12
Cor: up to 16
63
If the line of gravity falls anterior to a joint, which way is the joint rotated to maintain balance?
flexion
64
If the line of gravity falls posterior to a joint, which way is the joint rotated to maintain balance?
extension
65
Where does LoG pass in erect standing at head, neck and thoracic spine in relation to joints?
Head: anteriorly to frontal axis
Neck: posterior to vertebral bodies
Throacic spine: anteriorly
66
In optimal posture, what level does the LoG pass through/slight anteriorly in lumbosacral spine?
body of L5
67
The LoG creates and extension moment of L5 in relation to S1 and tends to slide L5 anteriorly on S1. What structures prevents this ?
Passive tension in anterior longitudinal ligament & iliolimbar lig.
Facet joints lock
68
This LoG also causes the sacroiliac joint to move into nutation. What is this resisted by?
passive tension in sacrotuberous and sacropinous lig.
69
In the hip and pelvic, LoG passes slightly posteriorly to the axis of the hip joint (through the greater trochanter)
– Gravity creates an (external) extension moment
What internal structures oppose this?
Contraction of iliopsoas
passive tension in iliofemoral, pubofemoral and ischiofemoral lig.
70
Which way is sacral nutation?
anterior 'nodding'
71
What are some factors associated with excessive lumbar lordosis? (7)
Weak abdominals
tight hip flexors/lumbar extensors
frequent high heel wearing
protracted scap
forward head posture
kyphosis of thoracic spine
pes planus
72
What conditions are associated with excessive thoracic kyphosis?
Compression # of thoracic vertebrae (OP, trauma)
Scheuermann's
Habitual
Poor self-esteem
73
In terms of LoG how may scoliosis result?
LoG usually falls thru midline
Consistent lateral deviation of posture may lead to a spinal curvature (scoliosis), or may be the result of a structural scoliosis
74
4 curve types of scoliosis?
Thoracic spine
Thoracolumber curve
lumbar curve
double major curve (lumbar and thoracic)
75
4 potential cuases of Scoliosis. #1 should be most common
1. Idiopathic
2. Compensation for LL difference
3. Structure deformity (acquired or congenital)
4. Nerve root irritation (antalgia or lat. shift)
76
In Janda's muscle imbalance syndromes, what muscles are inhibited and facilitated in the Upper crossed syndrome?
Inhibited: Deep cervical flexors
Lower traps + serratus anterior
Facilitated/overractive:
upper trap, levator scap
Sternocleidomastoid + pectorals
77
In Janda's muscle imbalance syndromes, what muscles are inhibited and facilitated in the Lower crossed syndrome?
Inhibited:
Abdominals
Glutedus min/max/med
Facilitated:
Rectus femoris + iliopsoas
Thoracolumbar extensors
78
Alternative patient-friendly words for chronic, 'you are going to have to live with this', lordsis/kyphosis
-Chronic: it may persist, but you can overcome it
- You may need to make some adjustments
- The normal curve in your back
79
What are to 2 diagnostic categories of LBP and relative % (+ subtypes)
Specific low back pain
- Serious pathology (<5%)
- Neurocompression (<10%)
Non-specific low back pain (85%)
79
What are to 2 types of LBP and relative % (+ subtypes)
Specific low back pain
- Serious pathology (<5%)
- Neurocompression (<10%)
Non-specific low back pain (85%)
80
What may be serious pathology causes of LBP? (7)
Cancer
Spinal stenosis
Ankylosing spondylitis
Fracture
Infection
Cauda equina syndrome
Paget's disease & related metabolic disease
81
Red flag questions for cancer (3)
- Age > 60 years**
* Unremitting bone pain (myeloma)
* Unexplained weight loss
82
What is spinal stenosis? (what, type, clinical pattern)
-Narrowing of spinal canal
-Can be acute or degenerative
- Worse in lumbar E, better in lumbar F
83
Red flags for spinal stenosis
Pain in legs when walking is relieved by sitting
* Age>65
* No pain when seated
* ‘Pseudoclaudication’(pain pattern above)
84
Red flags for Axial spondyloarthritis
* <45yrs old
* Possible other systemic symptoms (i.e. peripheral joint involvement, psoriasis, inflamed bowel disease, uveitis).
* Family history
85
What is axial spondyloarthritis + management?
- Chronic inflammatory LBP (affects spin and SIJ)
* Management = medical + exercise
86
Red flags for spinal fractures
Major trauma (e.g. fall from height, motor vehicle accident)
* Age >70
* Prolonged use of corticosteroids
* Female
87
Red flags for other serious pathology in LBP and what are they asked for? (3)
Unexplained weight loss, unremitting pain – greater risk of malignancy or infection
* Saddle anaesthesia, urinary retention or faecal incontinence – possible cauda equina syndrome
* Severe or progressive neurological loss - possible cauda equina syndrome or severe nerve root compression
88
Management of serious pathology
Medical referral
Co-management
Condition-specific management
89
6 LBP yellow flags
Depressions & anxiety
Catatrophising
Work dissatisfaction
High fear avoidance beliefs
Low recovery expectations
90
Sensory Signs/symptoms of neurocompression LBP (5)
Pins & needles and/numbness
* Shooting leg pain
* Leg pain worse than back pain
* High irritability
* Shooting pain with cough / sneeze
91
Muscular/postural signs/symptoms of neurocompression LBP (3)
* Muscle weakness
* Positive straight leg raise and/or slump test
* Antalgia or spinal list or lateral shift
92
Management of neurocompressive LBP (5)
Education (acitvity within limits) + reassurance ++
Manual therapy (massage,mobs, manipulations)
Mckenzies (other exercises)
NSAIDS
Surgery (LAST resort)
93
Management of low back pain (3PT, 3 Pharma)
Education, manual therapy, exercise
Analgesia, NSAIDs, Epidural injections, surgical (discectomy, laminectomy)
94
3 typs of approaches for manual therapy for LBP
McKenzie
Maitland (mobs)
Mulligan
95
Spondylosis
Spondylolysis
Spondylolysthesis
Spondylosis: degeneration of the spine
Spondylolysis:
- congenital defect or stress #at pars interarticularis (L5)
Spondylolisthesis:
- superior articular processes (plus body and pedicles) of L5 slip forwards with rest of spine
96
How may a nerve be injured? (7)
Stretch
lacerations
compression (external or internal
ischaemic
crush
cold
iatrogenic (caused by medical treatment or examination)
97
What are the 3 Seddon classifications of nerve injury in relation to structural damage?
Neuropraxia
Axonotmesis
Neurotmesis
98
Neuropraxia (severity, what, recovery time)
-Least severe
– Some myelin damage; rest of neural tissues intact
– Conduction block (motor and sensory deficits)
supplies
– Complete recovery (hours to months)
99
Axonotmesis (severity, what, common injuries, recovery)
- More severe (interruption of axons and endoneurium); Perineurium and epineurium remain intact
– Traction and severe crush injuries
– Loss of motor and sensory function along distribution of
nerve
– Recovery often good – over several months
100
Neurotmesis
Most severe injury (Axon and surrounding connective tissue lose continuity
– Extreme = complete disruption of all neural components
– Requires surgical repair
101
When is surgical repair not possible in neurotmesis?
– If pre-ganglionic injury (avulsion), surgical repair not possible
102
How many sunderland classifications are there?
5
103
What is Sunderland classification I? + Seddon
Local myelin damage. Axons preserved. No degeneration.
(neuropraxia)
104
Sunderland Classification II? + Seddon
Axonotmesis
Endoneural tube preserved. Axon degeneration
105
Sunderland Classification III? + Seddon
Axonotmesis
Loss of endoneural tube continuity. Perineurium intact. Axon degeneration.
106
Sunderland Classification IV? + Seddon
Axonotmesis
Endoneural tube and perineurium disrupted. Epineurium intact. Axon degeneration.
107
Sunderland Classification V? + Seddon
Neurotmesis
Complete loss of neural continuity
108
Types of nerve surgery (5)
Neurolysis
Neuroma Excision
Nerve repair (end to end graft)
Nerve Grafting
Tendon Transfer (extreme)
109
Sections of brachial plexus
Roots
Trunks
Divisions
Cords
Branches
110
Nerve roots of brachial plxues
C5,6,7,8, T1
111
5 branches of brachial plexus
- Musculocutaneous
▪ Median
▪ Ulnar
▪ Axillary
▪ Radial
112
What is the most common upper trunk injury at birth?
traction at neck- shoulder dystocia
damage to C5 & C6 nerve root
'Erb's palsy'
113
Causes of brachial plexus (upper trunk) injury in adults
MVA (Trauma)
Inflammation (brachial neuritis)
Tumor
Radiation
114
Peripheral nerves affected in upper trunk injury of brachial plexus + movements affects
1. Axillary nerve (shoulder Ab and ER)
2. Musculocutaneous nerve (shoulder and elbow flexion)
3. Suprascapular nerve (shoulder ER)
4. Dorsal scapular nerve (scapular retraction)
115
Summary of movement loss w/ upper trunk injury of brachial plexus?
Loss of abduction and ER of shoulder, loss of scapular retraction, often loss of elbow flexion
116
Infant treatment for UTI of brachial plexus
Priority to maintain PROM abduction and ER If no change over 3 months – may consider surgery
117
How much does nerve heal in upper trunk injury of brachial plexus in mm (infants)
1-2mm/day
118
Whats nerve roots are involved in lower trunk injury of brachial plexus?
C8-T1
119
Common cause of lower trunk injury of brachial plexus?
Fall, arm forced into extreme abduction
– Obstetric (Klumpke’s palsy)
120
What delivery may cause Klumpke's palsy?
Breech delivery (feet/buttocks positioned to come out of vag first)
121
Sensory and motor deficits with Lower trunk injury
Sensory: ulnar border of arm, forearm and hand
Motor: thumb E, finger control
122
WHat is Horner's syndrome?
disruption of T1 sympathetic fibres on ventral ramus
123
3 Classic signs of Horner's Syndrome
1. constricted pupil (miosis)
2. drooping of the upper eyelid (ptosis),
3. absence of sweating /dryness of the affected side of face and eye (anhidrosis),
124
What term refers to a group of distinct disorders that affect various nerves (including the brachial plexus) and blood vessels between the base of the neck and axilla (thoracic outlet)
Thoracic outlet syndrome
125
Thoracic outlet syndrome is a group of disorders that affects _____ and _____ between the _____ and ______ (thoracic outlet)
nerves and various blood vessels
base of the neck and axilla
126
Thoracic outlet syndrome can result from what causes? (3)
injury
disease
congenital abnormality
127
Injuries that can result in TOS(1)
Fractured clavicle
128
What gender is TOS more common in?
WOMEN
129
Diseases that can result in TOS (2)
Obesity
Chronic lung disease
130
Congenital/vasular/muscular factors that can result in TOS (5)
Poor posture
cervical rib
anomaly of T2
Vascular compromise
Spasms of scalenes or pec minor
131
How to diagnose nerve injury? (symptoms, tests, imaging) PNS vs CNS
PNS:
- Pain: burning or crushing
- hyperaesthesia or anaesthesia
- Nerve conduction studies (determine extent of damage)
- EMG
CNS:
- MRI
- CT myelogram
132
What is a CT myelogram?
It uses a contrast dye and computed tomography (CT) to look for problems in the spinal canal.
133
What is an EMG?
Electromyography
measures muscle response or electrical activity in response to a nerve’s stimulation of the muscle
134
TOS symptoms (4)
-ache lateral neck, shoulder, axilla, medial forearm and hand +/- radiation to chest wall unilateral or bilateral
-aggs: by driving, carrying heavy objects, writing or overhead activities,
- hands feel ‘clumsy’
- paraesthesia
135
TOS symptoms w/ arterial involvement (3)
- coolness and cold sensitivity
- numbness in the affected limb
- venous symptoms (cyanotic discoloration, feeling of heaviness and stiffness, swelling)
136
What may be used to diagnose TOS
- Signs and symptoms
- X-rays may be recommended (may show
extra rib)
– MRI
– Nerve conduction tests
– Electromyography (EMG)
– Ultrasound
137
Treatment for TOS (PT) (4)
- Pain management
– Postural re-education
– Strengthening neck, shoulder and scapular muscles
- Stretching tight anterolateral cervical spine muscles
138
Treatment for TOS that may involve MDT? (3)
– Diet changes (dietitian involvement)
– Change occupational/work site set up if
aggravating or contributing factor (+/- OccupationalTherapist)
– Surgery required on occasion to release
compressed nerves of brachial plexus
139
What nerve roots are involved in Axillary nerve injury?
(C5,C6)
140
Causes of Axillar nerve injury? 3
– Badly adjusted crutch
– Downward displacement of
humeral head (GH dislocation
– #SNOH
141
Motor changes in Axillary nerve injury
Paralysis of the deltoid +
teres minor muscles (Sh AB is impaired)
142
Sensory changes
Loss of skin sensation over the lower half of deltoid muscle
143
Erbs palsy affect spinal root C5 & 6 and an axillary nerve injury (PNS) involves C5,6. How do you differentiate?
Peripheral n. cutaneous supply: Loss of skin sensation over the lower half of deltoid muscle
Dermatome (n. roots): C5,6 -lat. upper arm and lat. hand (thumb + 1/2 index)
144
What does the radial nerve supply?
triceps, extensor mm of the wrist, skin over posterior aspect arm and forearm
145
What cervical segment does radial nerve originate from?
C5-T1 (post. divisions)
146
Where does radial nerve pass through?
Passes posteriorly, along the spiral groove of humerus
147
What nerve is injured in Crutch palsy and saturday night palsy?
Radial nerve
148
What is the mechanism of crutch palsy? What does it result in?
– Compression in axilla
– All motor and sensory branches lost
(triceps, wrist extensors)
149
Mechanism of Sat night palsy? How much of triceps affected? Sensation? (3)
Compression in the spiral (radial) groove
Not all triceps lost (as supply given to 2 heads before entering this groove)
Sensation lost over posterior arm
Usually transient (neuropraxia)
150
What is the most common peripheral nerve injury associated with # in the UL?
Radial nerve
151
What nerve is commonly injured with fractures SHAFT of humerus?
radial nerve
152
What are common signs in radial nerve injury? 3
How long does muscular function take to return?
▪ Lose motor control of wrist extensors +/- sensation dorsum hand 1st web space
▪Varying loss of triceps
▪“Wrist Drop”
▪4-8 months depending on degree of damage
153
What cervical segments does median nerve arise?
C6-T1 (anterior divisions)
154
Where is the median nerve's motor suppy?
Most muscles in anterior forearm (wrist and finger flexors)
155
Where does median nerve pass?
under flexor retinaculum at wrist to supply most muscles of the thumb and some intrinsics of hand
156
3 common causes of median nerve injury?
Supracondylar humeral #
Pronator syndrome
Carpal Tunnel Syndrome
157
Where is sensation lost in CTS?
Lat 3.5 digits (sensation over thumb often preserved)
158
Cause of CTS?
repetitive occupational strain, pregnancy, RA
159
Ulnar nerve comes from which cervical segments?
C8-T1 (ant. divisions and medial cord)
160
Where does ulnar nerve pass in arm?
Wraps directly behind medial epicondyle of humerus
161
What is the cutaneous and motor supply for ulnar nerve?
1.5 medial digits
intrinsic muscles of hand
162
What may cause ulnar nerve injury?
medial epicondyle / # ulna
– Cubital tunnel syndrome (b/w 2
heads FCU)
– Guyon’s/ulnar canal syndrome
(wrist)
163
What may be some post surgical complications for nerve injury?
failure of nerve repair, neuroma, infection, scarring, joint contractures
164
What 4 muscle groups comprise the intrinsic hand?
thenar, hypothenar, interossei and the lumbrical muscles
165
Injury to thumb with MCP hyperextension?
Skier's thumb
166
Mx for skier's thumb G1 or 2
Immobilise in thermoplastic splint in slight MCP flexion for 6/52
then increase ROM + strength
167
Mx for skier's thumb G3
surgery + Immobilisation for 1/12
168
Ways to immobilise skiers thumb? (2)
short opponens splint
taping
169
Mallet finger ?
Rupture / avulsion fracture of extensor tendon at the DIP joint (Avulsion of tendon at Distal Phalanx)
170
Mallet finger Mx
Splinted in DIP extension for 6- 8/52 – cont splinting 6-8/52 RTS
171
Boutonnière Deformity Mx
Splint PIP in ext 6/52 but allow DIP flex
172
Position of safe immobilisation for wrist
Wrist 20-30 degrees ext and slight ulnar deviation
173
Position of safe immobilisation for thumb
45 degrees abduction
174
POSI for MCP joints
45-70 degrees flexion (collateral ligs are taut
175
POSI IP joints
extension (or up to 15 degrees flexion) volar plate taut.
176
Is x-ray required after gh disolcation? Why?
yes- to elimnate bony damage to glenoid, humeral head and eliminated avulsion # of greater tuberosity
177
What is a Bankart lesion?
Displaced fracture of the glenoid rim after anterior glenohumeral dislocation (arrow)
178
Refer to orthoepedic specialist post GH dislocation if (4)
– Insufficient expertise***
– 2 failed reduction attempts
– 2or more traumatic dislocations
– Multidirectional instability
179
Mx post GH dislocation
immobilise in sling for comfort after traction
Isometric rotator cuff strengthening
Reconditioning and strengthening of rotator cuff and
scapular muscles (trapezius and serratus anterior)
improve neuromuscular control (proprioception)
180
what movement is to be avoided post GH dislocation and for how long?
Avoid abduction and external rotation (in first 6 weeks)
181
Risk factors of shoulder instability
– Age:
– Severity of initial trauma
– Limited or no immobilization of the shoulder
after first dislocation
– Presence of either :
* Bankart lesion
* Hill-Sachs lesion
182
Special tests for anterior shoulder instability
Apprehension test
inferior instability
183
In superior labrum anterior to posterior tear, what point is torn?
point where the long head of biceps tendon attaches to the superior labrum
184
Special test for SLAP lesions
Anterior slide test
* O’Brien Test or Active compression test
* Crank Test
(poor accuracy)
185
PT management of unstable shoulders
Scap stability
Rotator cuff strengthening
Proprioceptive training
186
Mx of SNOH#
4-6/52 sling, pendular Xs, isometric strengthening, ROM, Cuff and global mm strengthening
conservative: minimally displaced
comminuted: surgical
187
Rotator cuff muscles
Supraspinatus
* Infraspinatus
* Teres minor
* Subscapularis (under scap)
188
Role of rotator cuff muscles
maintaining position of humeral head in glenoid cavity
189
What would result without RC MUSCLES?
unopposed action of deltoid would cause
upward translation of HH = impingement
190
Most common source of shoulder pain?
Rotator cuff tear
191
Physical exam for RC tear?
Painful arc
+ve empty can
Pain + weakness on resisted ER + ABd
192
Mx for rotator cuff tear? G1/2
Restore ROM
* RC strengthening with theraband/ weights etc
* 0°abdto90°abd(progresstofunctionallyspecific exercises)
193
Mx for G3 rotator cuff tear?
Surgery(cuffrepair+/-decompression)
194
Mx subacromical impingemnt
1) Load management
2) Scapular stabilisation (often present with protracted and downwardly rotated scapula)
Examples: Prone, prone with arm elevation, wall push ups, push ups, ‘setting’ with RC strengthening
3) RC muscle isolated strengthening (theraband and weights)
4) Posterior Capsule stretching
5) Proprioceptive Retraining (ball, wall, controlled rotations)
195
Mx of adhesive capsulitis
Analgesic (but seldom control night pain adequately)
– Hydrodilatation (guided)
– Intra-articular corticosteroid injection (early management)
Gentle exercise when acute pain settles (e.g. active assisted
Flex/Abd with walking stick, pulleys)
196
Classification for AC joint injury
Rockwood
197
Mx for AC joint
Ice and analgesics
– Immobilization in a sling for pain relief
– (2-3 days for type I or up to six weeks in severe type III).
– Cervical spine ROM
– Progressive exercise program and gentle mobilization once
pain permits
– Protective taping
198
what type of AC joint injury requires surgical intervetnion?
Type IV, V, and VI and those type III that failed conservative management may require surgical management
199
What is Colles #?
Distal radius #
200
Mx for Colles #?
POP for 6/52 till union.
201
Scaphoid # may not should for ___ day on xray
10-14days
202
Complication w/ scaphoid #
on-union, avascular necrosis due to poor blood supply. Consequent wrist instability (scaphoid acts as an important stabiliser)
203
Normal carrying angle of elbow?
10-15 deg
204
Greatest MA of brachialis at what angle?
100
205
What bicep muscle is not affected with forearm or sh pos.
brachialis
206
Radial head # mechniasm
FOOSH
207
What is a sail sign that can be seen on xray?
indicated effusion
208
Supracondylar # what movement not to do as it can occlude brachial artery?
Flexion
209
Supracondylar # Mx
ften ORIF: sling and cast * Pins removed 4-6 weeks
