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MSK III > Quiz 1 > Flashcards

Quiz 1 Flashcards

1
Q

Obriens test is for what? Explain the test

A

labral tear
fully supinate then res, fully pronate then res.
if px is worse or only with pronation it’s pos

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2
Q

Drop arm test is for

A

supraspinatus tear

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3
Q

full or empty can test is for

A

supra. tendonitis

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4
Q

cross over test is for

A

AC joint

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5
Q

Speeds test is for

A

Biceps lesion

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6
Q

Yergason’s test is for

A

tear of Transverse humeral lig

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7
Q

2 main impingement tests

A

Hawkins Kennedy

Neers

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8
Q

the TOS test for pec minor being the issue

A

Allens

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9
Q

The TOS tests for scalenes being the issue

A

Halsteads

Addsons

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10
Q

Lift off test is for

A

subscap tear

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11
Q

what does Fromonts sign test for

A

Adductor pollicis weakness

Ulnar nerve

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12
Q

Murphys sign

A

(looking for depressed 3rd MC)

lunate fx test

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13
Q

tendons that are tested by Finklestein’s test

A

abd. poll. longus

Ext. poll brevis

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14
Q

how much mobility is needed for Reaching overhead

Flexion/abduction functionally

A

148 degrees

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15
Q

what are the functional degrees needed to comb your hair

A

Abduction: 112°
Horizontal add: 104°
ER: 54°

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16
Q

2 gross assessments that are good to check for overall functional movement of UE

A

big circle with arm

arrest position

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17
Q

functional degrees needed for arrest position

A

Horiz abd: 69°;
IR: 60°
Extension: 56°

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18
Q

2 main components of GIRD

A

loss of IR 15-25 degrees compared to non dom side

AND total loss of ROM

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19
Q

pec minor actions

A

protracts, depresses, & downwardly rotates scapula (PDDR) (minor is all scap)

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20
Q

levator scap actions

A

elevates scap

DR scap

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21
Q

serratus ant does what to scap

A

UR

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22
Q

If shoulder IR are limited, what part of the capsule is tight

A

post

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23
Q

if these are tight, ER can be limited

A

IR: subscap, teres major, lats, pec major

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24
Q

If shoulder ER is limited, what part of the capsule is tight

A

ant

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25
Q

good post capsule stretch for GIRD

A

cross over rated better than sleeper stretch

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26
Q

adhesive capsulitis, what motions are really limited

A

Limited in ER, Abd, Flexion, IR

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27
Q

how to differentiate between a true capsular issue vs muscular or soft tissue issue with the shoulder

A

if motion is limited in more than 2 planes its the capsule

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28
Q

greatest ROM loss with adhesive capsulitis occurs in what stage

A

Stiffness/Frozen

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29
Q

stages of adhesive capsulitis

A

Painful/Freezing - usually reversible here
Stiffness/Frozen (loss of ROM here),
Recovery/Thawing

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30
Q

instead of the freezing stages of adhesive capsulitis, what is a better way to classify pts

A

Irritability
High =Pain > 7, consistent, ↑disability, pn limits ROM

Moderate Irritability= 4-6/10, intermittent, mod disability, pn at end of range

Low Irritability=

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31
Q

explain how to tx high irritability pts with adhesive capsulitis, what are your limits to tx

A

ROM: short duration (1-5 sec holds), pn-free range or px less than 3

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32
Q

best way to do shoulder flexion with a pulley

A

bend elbow slightly -it shortens the lever arm

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33
Q

tx for mod irritability ad. capsulitis

A

ROM: (5 – 15 sec holds at end range)
AAROM – AROM

Manual Techniques: Low-high grades (grade 3 – high amplitude motion)

Functional Activities

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34
Q

what glide is best to regain ER for adhesive capsulitis (not the norm glide for ER)

A

ER is usually most limited

This study found that a post glide was more effective in improving ER

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35
Q

treatment for low irritability of adhesive capsulitis

A

ROM: We are going to end-range, OP, longer duration
Manual technique: higher grades (grade 4)
Strengthen: Low- high resistance at end ranges
Functional activities: increase demand
MOBS: take to end range and then mob

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36
Q

If Pec Minor is tight you see what with the scapula

A

Anterior tilt of scap

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37
Q

if levator scap is tight, you might see with what with scapula

A

elevation and DR

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38
Q

if rhomboids are tight, the scap appears how

A

adducted or retracted

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39
Q

muscles prone to weakness that can alter glenoid position and scapular position

A

Lower trap
Serratus Anterior
Rotator Cuff

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40
Q

Which are typically weaker, IR or ER of shoulder

A

ER

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41
Q

what must occur in order to clear acromion in humeral elevation

A

upwardly rotate scap
posteriorly tilt scap
externally rotate scap

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42
Q

what role does serr ant play in humeral elevation (being able to clear and actually elevate shoulder)

A

UR, post tilt and ER scap

stabalizes medial brdr and inf angle of scap to prevent winging

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43
Q

explain the force couple of serratus and low trap

A

Serratus and low trap work together to force couple UR and returning the scap from elevation

If the pt has scap DR syndrome this cannot occur - typically bc the low trap is weak

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44
Q

how does the lower trap help with PICR

A

Maintains PICR of scapula during arm elevation by eccentric control of protraction and elevation

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45
Q

the low trap prevents ____ from occuring during lowering of the arm

A

winging

so if winging is occuring during lowering-think low trap

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46
Q

the RC stabalizes the humerus where

A

ant and superiorly

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47
Q

scapular wall clocks are good for what muscles

A

low/mid trap

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48
Q

wall washes are for what muscles

A

low trap and serratus

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49
Q

if winging is occuring with raising of arm, think what muscle

A

serratus ant

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50
Q

3 main components of pathoanatomic classification of dx

A

pts with that patho dx look similar and should be treated similar

Must fix pathologic anatomy for pain and function to improve

strong relationship btwn tissue pathology and pt complaint

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51
Q

Scap DR syndrome: if pt sx decrease if you assist their scapula in UR, what might you infer

A

that they are pos for DR syndrome

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52
Q

explain scapula DR syndrome

A

they are stuck in DR, When you abd shoulder the scap should UR. However, with scap DR syndrome it doesn’t UR
Rhomboids and levator are dominating

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53
Q

px probs assct w scap DR syndrome (pathos)

A

GH impingement
rotator cuff tear
humeral subluxation
thoracic outlet

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54
Q

explain scap depression syndrome

A

low trap is dominating
scap elevators are stretched
passive elevation decreases their sx

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55
Q

what px or pathos are assct with scap depression syndrome

A

neck px

impingement

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56
Q

scap depressors

A

lats, pecs

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57
Q

explain scap abd syndrome

A

stuck in abd and won’t return to add (excessive abd)
abd are tight, add are stretched

Dominance of serr ant., dominance of both pecs

Short: pecs

long/weak: scap adductors

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58
Q

pathos/px assosiciated with scap abd syndrome

A

TOS
subluxation
impingement

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59
Q

scap tilt syndrome

A

Dominance of pec minor, dec activity of serratus and low trap

Short: p. minor

long/weak: serratus

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60
Q

pathos/px associated with scap tilt

A

tos

impingement

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61
Q

scap winging syndrome (explain)

A

Dominance of pec minor
dec activity serratus
timing problem of low trap

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62
Q

pathos assct with winging

A

GH impingement
thoracic outlet
GH subluxation

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63
Q

scap elevation syndrome (explain)

A

stuck in elevation
dominant scap elevators
causes cervical/neck px

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64
Q

if pec minor is shortened, it can cause ____ of scap

A

ant tilt

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65
Q

stages of intervention

A

Stage I: Relieve Primary Impairment
Stage II: Relieve Movement Issues at Adjacent Body Segments
Stage III: Address Global Issues

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66
Q

why is Tspine important with humeral/shoulder motion

A

Upper segments must extend with humeral elevation
this is why we need to stretch tspine for shoulder limitation pathos

Also, you should palpate upper Tspine during shoulder elevation - if Tspine has no mvmt do PAs

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67
Q

explain prone low trap therex we did in class

A

prone
scaption
thumb up, raise arm

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68
Q

explain prone mid trap there

A

prone
arms in t out to side and raise arms
thumbs up

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69
Q

explain a simple therex used early on in order to strengthen serratus anterior

A 
wall slides
Above 90 degrees
 SCAPULAR PLANE
 Early in rehab
 Watch excessive upper trap activation
prevent winging
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70
Q

explain 3 serratus ant therexs that would be good to progress to after wall slides

A

Scaption above 120 deg. with hand weight
Important to work above 90 deg to fire serr. Ant

or upper cuts that go above 90

or dynamic hugs

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71
Q

wall washes are a good closed chain therex for what 2 muscles

A

serr ant

low trap- coming down

72
Q

scapular clocks are good closed chain therex for what 2 muscles

A

low and mid trap

73
Q

with the prone therex for mid traps vs rhomboids (arm out to side not in scaption), how would you isolate one vs the other

A

mid traps is thumb up, rhomboids is thumb down

74
Q

why might serr. punches not be the best therex choice

A

bc pec major dominates

75
Q

what might we need to consider with isometric therex

A

their force used

we need to monitor it (bladder) bc if they over do they can cause ischemia

76
Q

best supraspinatus therex for impingement pts

A

Open can is best (thumb up) bc it doesn’t cause sx with impingement pts

77
Q

how to isolate/exercise teres minor

A

prone 90/90 ER with light wt

elbow on pillow

78
Q

best way to progress (in general) therex

A

Do Scapular stability before rotator cuff!

Closed chain before open chain

79
Q

why do closed chain ex first

A 
Promotes co-activation (R Cuff)
 Increases scapular activity
 Decreases tensile stress
 Improves proprioception
 Start with scapular stabilization
80
Q

list the progression of therex if you are working on scap stabiilty

A

static postures - set scap and hold
isolated GH motion- stabalize scap and do shoulder IR/ER
Large shoulder ROM under controlled situations (proper timing of mm) - bands or pulley through entire range
Loaded mobility upon stability - side plank with pnf

81
Q

explain how to dose RC therex

A

Rotator cuff mm are endurance-type mm
Increasing load too quickly causes compensatory movement

Do high reps low load

82
Q

explain (in general) the progression of how to increase dosing of therex

A 
Increase load
Increase speed
increase Power
Multiplane
Sport-specific
83
Q

explain the considerations for hypo/hypermobile joints with dosing therex

A

Hypomobile joints – exercise through entire range
Hypermobile joints – stay mid to shortened range
** may need to gradually introduce normal end-range motion

84
Q

with shoulder rehab, educate pts to avoid/modify what lifts during workouts

A 
bench press (limit range, grip)
 military press
 pull downs
85
Q

is pull or push better for the shoulder/scap

A

pull

86
Q

easy way to special test either epicondylitis

A

palpate the origin of the muscle and do resisted testing
lat epi = resist ext
medial epi=resist flexion

87
Q

what is the lat epicondylitis test where you resist 3rd digit ext

A

Maudsleys

88
Q

tendons effected by DeQuarvains

A

abd Polli longus

Extensor polli brevis

89
Q

explain bunnel littner test

A

you passively measure PIP without MCP flexion then flex the MCP and measure the flexion of the PIP) if they are different there is imbalance

the PIP has more flexion with the MCP flexed then with it is tight intrinsic muscles

If PIP does not move further and does not reach full ROM, consider capsular tightness.

90
Q

froment tests what nerve and what muscle is isolated

A

ulnar

adductor pollicus

91
Q

normal sternal rib angle

A

90 deg

92
Q

narrow sternal rib angle would indicate

A

tight ext obliques

93
Q

wide sternal rib angle indicates

A

tight internal obliques

94
Q

tight ext obliques can do what to pelvis/lumbar

A

: shortness or stiffness contributes to excessive posterior pelvic tilt and lumbar flexion.

95
Q

ext oblique prevents/controls ____ pelvic tilt

A

ant

96
Q

low lying AC joint might indicate lengthened __

A

upper traps (ant tight lower traps)

97
Q

Palpate under sternal notch as pt drops chin to chest then chin to ceiling (flex neck)
This describes what test, and what is it for

A

spinal activated manubrium test

if you get rotation on one side where you are palpating then there is tightness in the spine somewhere (you should feel same thing on both sides of your thumbs/fingers

98
Q

sup angle of scap is approx at T __

A

T2

99
Q

spine of scap is approx at T __

A

T3

100
Q

when you are doing the palpation technique where you push the sternum post and palpate the transverse processes, what stays stable and what moves

A

C7 stays stable with ext

T1 will move post as you push on sternum

101
Q

Jim says to teach what breathing techniques for any acute Cspine pts

A

diaphragmatic

102
Q

during diaphragmatic breathing, if there is increased px with exhalation vs inhalation what might this indicate

A

exhale -disc

inhale -rib

103
Q

in scap elevation syndrome, if the superior angle of the scapula is high, but the acromion is normal, it suggests tighness of what muscle

A

short levator scapula.

104
Q

in scap elevation syndrome, if the entire scapula AND the acromion are high it suggests tighness of

A

upper trap

105
Q

differentiate stretching upper trap vs levator scap

A

upper trap is sb away rot toward

levator scap is sb away rotate away

106
Q

differentiating btwn look of ant tilt or winged scap

A

ant tilt= about the inf angle, it comes off ribs

winged = is about the vert border, it all comes post

107
Q

in general, if the issue is impingement, what should you work on

A

work on ER of RC to bring the humeral head down

108
Q

a dominant delt would do what to the humerus

A

sup glide

109
Q

if ER is restricted, how to tell if it is tight IR or capsule issue

A

If there is decreased glenohumeral ER with the arm abducted to 45º, consider a short subscapularis; if there is decreased ER with the arm abducted to 90º, suspect a tight capsule.

110
Q

humeral head depressors, why are they significant

A

Infraspinatus
Teres minor
Subscap

During impingement (or shortened delts), working on the depressors can help to add more space and pull the humerus down

111
Q

normal resting position clavicle

A

normal is slight upward to acromion

112
Q

normal rib cage resting angle

A

Normal is 90

113
Q

normal resting position humerus

A

Normal = less than ⅓ of the humeral head should protrude in front of the acromion, antecubital crease should face forward and olecranon should face posterior

114
Q

axns of SCM

A

CRIS

contra rotation ipsi SB and neck flexion

115
Q

treatment for moderate stage of ad. capsulitis

A

● Treat with: 5-15 s AAROM, AROM, grade II-III posterior mobs AP technique, begin functional activity. Work on ER

116
Q

explain sx of moderate stage adhesive capsulitis

A

their Pain 4-6/10, it’s intermittent, moderate disability, pain at end range

117
Q

explain fibromyalgia

A

a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues.

AMPLIFIES painful sensations by affecting the way your brain processes pain signals.

● Causes: physical trauma, surgery, infection or significant psychological stress. In other cases, symptoms gradually accumulate over time with no single triggering event.

● Many people who have fibromyalgia also have tension headaches, temporomandibular joint (TMJ) disorders, irritable bowel syndrome, anxiety and depression.

● Things that can ease symptoms include:
○ exercise
○ relaxation
○ stress-reduction

118
Q

what is myofascial syndrome

A

Myofascial pain syndrome is a chronic pain disorder. Pressure on sensitive points in your muscles (trigger points) causes pain in unrelated parts of your body.

119
Q

Inf shoulder mobs help improve

A

abduction

flexion

120
Q

post shoulder mobs help improve

A

IR
flexion
hor add

121
Q

Ant shoulder mobs help improve

A

ext
ER
hor abd

122
Q

○ Form of massage using circular strokes with palm of hand

A

effluerage (stroke)

123
Q

kneading massage is aka

A

pettriassage

124
Q

contraindications to massage

A
  1. Obstructive Edema: (note that massage is indicated for non-obstructive edema.)
  2. Active malignancy: might spread the malignant cells 3: although massage during end-stage disease is most probably okay.
  3. Thrombophlebitis: might throw an embolus.
  4. Hematoma
  5. fractures
  6. In post-operative areas (e.g. around sutures, grafts, etc.)
  7. Around lacerations
  8. Active communicable diseases (via routine contact, open lesions, etc.)
  9. Mental disturbances: if you think there might be a chance that your touch could be misunderstood, don’t do it.
125
Q

Indications for massage

A
  1. Amputations: increases circulation
  2. Arthritis: decreases edema
  3. Burns: stretches skin to lessen scar formation, increases circulation
  4. Bursitis: decreases edema
  5. Myositis: increases comfort
  6. Facial paralysis (e.g. Bell’s palsy): stimulates circulation around the nerve site.
  7. Inflammation (can decrease residual edema)
  8. Insomnia: increases relaxation
  9. Pain
  10. Postural dysfunction: stretches muscle
  11. Prolonged bedrest: stimulates circulation to pressure areas.
  12. Scar tissue/contracture: softens collagen
  13. Edema (non-obstructive)
126
Q

type of effluerage For this stroking technique, both hands are used and typically sweep toward and away from each other

A

fulling

127
Q

type of effleurage that is used for deep pressure, heavy form of stroke - use fist

A

knuckling

128
Q

effleurage improves

A

circ flow (main feature)

129
Q

things we focus on in stage 1 of intervention

A

● Relieve Primary Impairment - mobs and positioning

■	Educate the patient, discuss goals, 
○	Immobility/Modified Activity
○	Mobility - how can we improve it? 
○	Fear avoidance behavior
○	Educate on positioning
○	Exercise and conditioning - how can we progress it? 
●	Start with the concordant signs/sx

and mobility needed for function

130
Q

things we focus on in stage 2 of intervention

A

Relieve movement issues at adjacent body segments
● Treat regional movement impairments;
● PROXIMAL STABILITY BEFORE DISTAL MOBILITY
● ex:
○ First Rib: if elevated could interfere w/ clavicle inf glide needed with humeral elevation
○ T-Spine: upper segments must extend with humeral elevation

131
Q

HU medial glide is for

A

flexion and add

132
Q

HU lateral glide is for

A

ext and abd

133
Q

medial and lateral gap glides are for

A

flex, ext, pronation

134
Q

HR dorsal/post glide is for

A

ext

135
Q

HR volar/ant glide is for

A

flexion

136
Q

prox RU post

A

pro

137
Q

prox UR ant glide is for

A

sup

138
Q

dist RU post glide is for

A

sup

139
Q

dist RU ant glide is for

A

pro

140
Q

post/dorsal wrist glide improves

A

flexion

141
Q

ant/ventral wrist glide improves

A

wrist ext

142
Q

radial wrist glide improves

A

ulnar deviation

143
Q

ulnar wrist glide improves

A

radial deviation

144
Q

joint mob grade progression for stages of adh. capsulitis

A

irritable -grade 1
moderate-grade 3
low irritable-grade4

145
Q

what muscles are dominating in scapular DR syndrome

A

rhomboids

levator

146
Q

RC tear is assct with what syndrome

A

DR syndrome

147
Q

proximal ____ before distal _____

A

stability before mobility

148
Q

diff btwn a neural slider and tensionor

A

tensioner you are lengthening at both ends

slider you lengthen 1 end only

149
Q 
maitland = \_\_\_\_
standard ULNT (1) test = \_\_\_\_
ULNT 2 and 3 = \_\_\_\_
A

maitland = slump
standard = elvey
2 and 3 = butler

150
Q

2 main tension points in body

A

ant elbow

post knee

151
Q

pulling like a tight string, catches of pain and tightness is ____ neural

A

extraneural px

152
Q

symptoms such as bizarre clumps of pain, crawling, antlike, dry, woody, and dragging and report sensations of swelling, burning or electricity are ___ neural

A

intraneural

153
Q

ULNT 1 stresses what

A

brachial plexus and the median nerve.

154
Q

ULNT 2a (Mb) stresses what

A

brachial plexus and the median nerve.

155
Q

steps to ULNT 2a

A 
Shoulder girdle depression
Elbow extension
GH lateral rotation
Wrist and finger extension
GH abduction
156
Q

steps to ULNT 2b

A 
Shoulder girdle depression
Elbow extension
Forearm pronation and shoulder medial rotation
Wrist flexion
Thumb flexion and ulnar deviation
157
Q

ULNT 2 b stresses

A

brachial plexus and radial N

158
Q

ULNT 3 stresses

A

ulnar nerve

159
Q

steps to ULNT3

A 
Shoulder girdle stabilization
Full elbow flexion
Wrist extension
Forearm pronation
Shoulder lateral rotation
160
Q

great way to stretch Tspine

A

lay on vertical bolster or towel

ball overhead and hold stretch at end range

161
Q

what is a key component to strengthening serr ant (position wise)

A

do above 90 deg

162
Q

which elbow glides are “backwards” from your thought process

A

HR
proximal RU

distal RU make sense

163
Q

tx for high irritability adhesive capsulitis

A

ROM: short duration (1-5 sec holds), pn-free range or px less than 3, PROM, AAROM

164
Q

explain how traps can be weak in scap DR sydrome

A

it’s lower traps

Serratus and trap force couple for UR, so if these are weak then UR is an issue and the scap is stuck in DR

165
Q

what muscle is weak in scap DR syndrome

A

lower traps

166
Q

steps to ULNT1

A 
○	GH abduction
○	GH external rotation 
○	Forearm supination 
○	Wrist and finger extension
○	Elbow Extension
167
Q

adhesive capsulitis is restricted in both ___ and ___ movements

A

active and passive

168
Q

the 2 shoulder pathologies with clicking/popping

A

labral tears/instability

impingement

169
Q

with a RC tear, is PROM usually an issue

A

no

170
Q

which flexor is most common for medial epicondylitis

A

FCR

171
Q

what N is cubital tunnel involved

A

ulnar

172
Q

diff btwn radial tunnel syndrome and post int syndrome

A

radial tunnel is sensory loss and px at lat elbow

post int is motor loss of finger/thumb ext

173
Q

loose bodies
ant LAT elbow px
necrosis

A

osteochonritis dissecans

174
Q

panners disease

A

lateral elbow px
young pts
necrosis of bone

175
Q

Little leagers elbow

A

young

medial elbow sx/px

MSK III (8 decks)

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