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DPT 516 > Quiz #6 > Flashcards

Quiz #6 Flashcards

1
Q

what are common factors that lead to shoulder injury?

A

overuse, laxity, trauma, degenerative conditions, disuse, posture, and overhead use

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2
Q

what findings may overlap b/w various health conditions of the shoulder?

A

pain, paresthesia, limited ROM, weakness/atrophy, abnormal end feel

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3
Q

how do we differentiate shoulder pathologies?

A

special tests and MMT

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4
Q

what is the most mobile jt in the body and therefore the most prone to injury?

A

the GH jt (shoulder)

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5
Q

how much motion is provided by the GH jt in GH abduction?

A

120 deg abduction

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6
Q

how much motion is provided by the scapulothoracic jt in GH abduction?

A

60 deg upward rotation

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7
Q

how much motion is provided by the AC jt in GH abduction?

A

35 deg upward rotation

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8
Q

how much motion is provided by the SC jt in GH abduction?

A

25 deg elevation
25 deg upward rotation

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9
Q

how much GH jt external rotation is there with GH abduction?

A

45 deg external rotation

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10
Q

what are the motions at the SC joint?

A

elevation/depression

upward/downward rotation

protraction/retraction

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11
Q

what kind of jt is the SC jt?

A

synovial saddle jt

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12
Q

where is the synovial capsule of the SC jt the least robust?

A

inferiorly

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13
Q

SC ligaments reinforce and restrain what motions?

A

AP movements

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14
Q

the interclavicular lig of the SC jt restrains what motions?

A

superior and lateral motions

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15
Q

the costoclavicular ligs restrain what motion?

A

elevation

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16
Q

the costoclavicular ligs elevate and depress how many cm?

A

elevate: 4-6 cm
depress: 1-2 cm

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17
Q

when the SC jt elevates, what is the accessory glide?

A

downward glide

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18
Q

when the SC jt depresses, what is the accessory glide?

A

upward glide

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19
Q

what motion puts the costoclavicular ligs on slack?

A

depression

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20
Q

what motion makes the costoclavicular ligs taught?

A

elevation

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21
Q

what level of the spine is the inferior angle of the scapula?

A

T7

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22
Q

what level of the spine is the spine of the scapula?

A

T3

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23
Q

what level of the spine is the superior angle of the scapula?

A

T2

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24
Q

what planes does the scapular plane fall 45 deg between?

A

the frontal and sagittal planes

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25
Q

what part of the GH jt is convex?

A

the humeral head

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26
Q

what part of the GH jt is concave?

A

the glenoid fossa

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27
Q

what jt mimics a golf ball sitting on a tee?

A

the GH jt

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28
Q

the GH jt is retroverted about how many degrees?

A

7.4 deg

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29
Q

is the glenoid fossa angled superiorly or inferiorly?

A

superiorly

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30
Q

about how thick is the glenoid labrum?

A

2 mm

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31
Q

what is the glenoid labrum?

A

fibrocartilagenous ring that thickens the depth of the very shallow glenoid fossa to increase contact and stability

also serves as attachment for some tendons

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32
Q

what is the role of coracohumeral ligament?

A

to support the shoulder superiorly in the rotator interval

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33
Q

what is the primary restraint for posterior and inferior translation of the shoulder when the arm is at the side?

A

the coracohumeral ligament

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34
Q

when is the coracohumeral ligament tight?

A

in external rotation of the shoulder at the side

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35
Q

what are the 3 GH ligaments?

A

superior, middle, and inferior bands

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36
Q

what does the superior band of the GH ligament do?

A

resists inferior translation and external rotation when the arm is at the side

resists extension

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37
Q

what does the middle band of the GH ligament do?

A

resists external rotation

limits anterior translation from 0-45 deg of abduction

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38
Q

what does the inferior band of the GH ligament do?

A

resists anterior/posterior translation

resists internal/external rotation at 90 deg abduction

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39
Q

when is the inferior band of the GH ligament the tightest?

A

in external rotation at 90 deg of shoulder abduction

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40
Q

what is the role of the broad axillary pouch at the shoulder?

A

allows room to bring your arm over your head

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41
Q

what ligaments at the shoulder resist anterior translation in neutral?

A

the subscap and middle and inferior bands of the GH ligament

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42
Q

where is the transverse humeral ligament?

A

b/w the greater and lesser trochanters

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43
Q

what is the big dynamic support of the shoulder?

A

the rotator cuff

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44
Q

what motion(s) does the subscap resist?

A

external rotation

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45
Q

the supraspinatus and teres minor can produce and resist what motion?

A

posterior translation

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46
Q

the supraspinatus and teres minor protect from ____ instability by resisting ____ translation

A

anterior, anterior

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47
Q

what is the role of the rotator cuff?

A

stabilize the humeral head in the glenoid fossa

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48
Q

what does the rotator cuff do in arm elevation?

A

depresses the head of the humerus and keeps it centered in the fossa

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49
Q

what forces does the rotator cuff creates with the arm in elevation?

A

compression and depression

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50
Q

the rotator cuff creates a force couple with what muscle at the shoulder?

A

the deltoid

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51
Q

external rotation of the shoulder creates what accessory glide?

A

posterior glide

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52
Q

the follow are all causes of what shoulder problem?

space issue
anatomic variations
shoulder girdle kinematics
rotator cuff pathology
degenerative changes
overuse

A

subacromial impingement syndrome

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53
Q

what are intrinsic causes of subacromial impingement syndrome?

A

vascular changes in RC tendons

tissue tension overload

collagen disorientation

collagen degeneration

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54
Q

what are primary extrinsic causes of subacromial impingement syndrome?

A

structural posterior capsular tightness, anterior capsular tightness, or rotator cuff pathology

increased superior migration of the humeral head

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55
Q

why would the humeral head ride superiorly?

A

weak rotator cuff/rotator cuff pathology

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56
Q

what are secondary extrinsic causes of subacromial impingement syndrome?

A

instability, impaired muscle coordination, or weakness of the scapular stabilizers

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57
Q

what are tertiary extrinsic causes of subacromial impingement syndrome?

A

contact of the greater tuberosity with the posterosuperior aspect of the glenoid when the arm is abducted and externally rotated

58
Q

what is the definition of aging?

A

accumulated results of reduced cellular fxn, cell injury, and cell death

the inability to deal with physiological (emotional and corporal) stressors that heretofore had minimal functional, physiological, and societal impact

59
Q

what is the primary theory of aging?

A

aging is pre-programmed (finite lifespan)

60
Q

what is the secondary theory of aging?

A

aging is the result of environmental insults that eventually overwhelm the body (free radicals, environmental toxins, bacterial viruses, trauma)

61
Q

what is the inflammaging theory of aging?

A

chronic inflammation is thought to be a risk factor for a board range of age-related diseases such as HTN, DM, atherosclerosis, and cancer

62
Q

how is inflammation defined?

A

elevation of serum and local pro-inflammatory cytokines

63
Q

what is a complex process that results from a combo of environmental, genetic, and epigenetic factors?

A

aging

64
Q

what is a pervasive feature of aging?

A

chronic pro-inflammatory status

65
Q

what is inflammaging?

A

chronic low grade inflammation in the absence of an overt infection that represents a significant risk factor for morbidity/mortality in the elderly

66
Q

what are some examples of pro-inflammatory factors in the body?

A

LDL cholesterol and the renin-angiotensin system (RAS)

67
Q

what protein can measure inflammation in the body?

A

c-reactive protein

68
Q

increased in pro-inflammatory stimuli= __ aging

A

faster

69
Q

t/f: there is a decrease in muscle strength with age even if activity remains consistent

A

true

70
Q

with consistent activity, when does muscle decline begin? when does it continue until?

A

teens/early 20s, 60

71
Q

after what age does muscle decline accelerate?

A

60

72
Q

at 25 y/o, muscle mass contributes up to ___% of body weight

A

50

73
Q

what 80 y/o, muscle mass contributes up to __% of body weight

A

25

74
Q

what is the primary cause of muscle decline with age?

A

decreased cross sectional area of the muscles due to loss of motor fibers and decreased size of motor fibers

75
Q

there is a preferential loss of what type of fibers with aging?

A

type 2

76
Q

loss of strength__loss of endurance

A

>

77
Q

what is sarcopenia?

A

low muscle mass and function

78
Q

t/f: even with exercise, aging brings about increased deposits of fat b/w and w/in skeletal muscles and intra-muscular adipose tissue (IMAT)

A

true

79
Q

what happens with IMAT in aging?

A

it replaces lean muscle mass

80
Q

what does replacement of lean muscle mass with IMAT do to muscle strength and performance?

A

it decreases muscle strength and performance

81
Q

why does IMAT lead to systemic inflammation?

A

IMAT releases pro-inflammatory cytokines

82
Q

what happens to muscle capillary diameter with age?

A

it decreases

83
Q

t/f: IMAT is shown to blunt the effects of resistance training

A

true:(

84
Q

what scan is used to quantify IMAT and lean muscle tissue?

A

MRI

85
Q

systemic inflammation associated with aging is exacerbated by what 3 things?

A
  1. disuse
  2. hormonal changes
  3. disease
86
Q

IMAT results in microvascular changes in what corporal systems?

A

muscle, bone, brain, heart, and kidney

87
Q

lack of perfusion leads to what

A

cerebrovascular ischemia

IMAT

chronic renal insufficiency

88
Q

exercise __ times a week for ___ weeks has been shown to lower the IMAT to lean muscle ratio in skeletal muscle

A

3, 12

89
Q

what are the proposed causes of loss of muscle fibers?

A

microvascular changes, decreased testosterone and estrogen, increased insulin resistance, vit D deficiency, decreased human growth hormone, increased parathyroid hormone (breaks down bone), disuse atrophy, diminished protein intake, and decreased ability to extract O2 from blood due to microvascular changes

90
Q

what factors can accelerate loss of muscle mass?

A

diabetes, metabolic syndrome, COPD, CHF/cardiomyopathy, osteoarthritis, Parkinson’s disease cancer, inflammatory diseases, stroke, and disuse

91
Q

how does diabetes contribute to loss of muscle mass?

A

insulin resistance

micro/macrovascular changes

narrowed vessels and stenosis from prolonged hyperglycemia

92
Q

how does metabolic syndrome contribute to loss of muscle mass?

A

large waistline

increased triglyceride levels

decreased HDL levels

increased BP

93
Q

how does COPD contribute to loss of muscle mass?

A

decreased vital capacity

hypoxic and hypercapnic respiratory failure

increased resting and exercise HR due to hypoxia

steroid meds leading to proximal muscle weakness, weight gain, and insomnia

94
Q

how does CHF/cardiomyopathy contribute to loss of muscle mass?

A

decreased EF=decreased CO=decreased exercise tolerance

beta-blockers+decreased resting and exercise HR

diuretics=hypokalemia and low blood volume

95
Q

how does Parkinson’s disease contribute to loss of muscle mass?

A

rigidity, bradykinesia, festinating gait, and difficulty intimating movement makes exercise difficult

96
Q

how does cancer contribute to loss of muscle mass?

A

pro-inflammatory effects of the tumor, pain, chemo, radiation, and surgery

97
Q

how do inflammatory diseases contribute to loss of muscle mass?

A

systemic effects of pro-inflammatory cytokines

steroids

proximal muscle weakness, increased insulin resistance, fluid gain, and osteoporosis

98
Q

how can a stroke contribute to loss of muscle mass?

A

functional limitations

99
Q

what is an ideal muscle strength training regime to produce strength gains in all ages?

A

6-25 weeks using at least 1 rep of 70-80% max torque

100
Q

is reaction time affected with increased strength?

A

no

101
Q

is improved balance likely more due to muscle strength or increased rxn time?

A

muscle strength

102
Q

do men or women experience more bone loss with age?

A

women

103
Q

when does bone density peak?

A

in late 20s/early 30s

104
Q

by age 65, __ women will have a vertebral fx

A

1/3

105
Q

by age 80, __ women will have a hip fx

A

1/3

106
Q

by age 90 men lose about __% of bone and women lose about __% of bone

A

20, 30

107
Q

what factors cause skeletal changes in aging?

A

microvascular changes, decreased calcium and vit D intake, decreased weightbearing exercises, and decreased estrogen in women

108
Q

what are some risk factors for osteoporosis?

A

gender

thin/small frame

age

Asians>Caucasians>African American descent

early menopause

decreased calcium intake

excessive alcohol

family hx

hypocalemia and decreased serum vit D levels

malnutrition, eating disorders, gastric bypass

hx of long term steroids

nicotine

sedentary lifestyle (Wolff’s Law)

109
Q

what is the most common femoral fx?

A

intertrochanteric (greater to lesser troch)

110
Q

what is the most problematic femoral fx?

A

transcervical/subcapital (need partial hip arthroplasty)

111
Q

what are 3 different proximal femoral fxs?

A

intertrochanteric

transcervical/subcapital

subtrochanteric

112
Q

what is a DEXA scan?

A

dual x-ray absorptiometry that shows bone mineral density

113
Q

what DEXA score is being described?:
- “young normal”

  • indicates how much bone mineral density (BMD) compares to that of a healthy 30 y/o
A

the T score

114
Q

what DEXA score is being described?:

  • “age-matched”
  • compares BMD to expected for comparable age and body size
A

Z score

115
Q

what is normal BMD T score?

A

+1 to -1

116
Q

what T scores would indicate osteopenia?

A

-1 to -2.5

117
Q

what T scores would indicate osteoporosis?

A

<-2.5

118
Q

what T scores would indicate severe osteoporosis?

A

<-3.0

119
Q

t/f: lower BMD in adults is common, so age-matched comparison may be misleading

A

true

120
Q

what are common meds for osteoporosis?

A

calcium and vit D, biphosphanates, and others

121
Q

t/f: all exercise will lessen bone loss

A

true

122
Q

order the following exercises from most to least protective against bone loss:

  • walking
  • swimming
  • intense weight bearing (running)
  • bicycling
  • weight lifting
A

intense weight bearing>walking>weight lifting>bicycling>swimming

123
Q

t/f: people with Alzheimers disease tend to develop osteoporosis

A

true

124
Q

why do ppl with Alzheimers tend to develop osteoporosis?

A

leakage of beta amyloid into the blood stream resulting in increased osteoclastic activity

125
Q

why do ppl with osteoporosis tend to develop AD?

A

decreased serum vit D which may be neural protective against development of amyloid deposits

126
Q

t/f: most prostate cancers are hormone dependent

A

true

127
Q

what does it mean when cancers are hormone dependent?

A

the higher the hormones in the body, the faster the tumor will grow

128
Q

t/f: lowering testosterone can slow tumor growth

A

true

129
Q

what are the effects of low testosterone on the body?

A

mimic multisystem aging

130
Q

what is the role of hyaline cartilage?

A

line articular surfaces to provide shock absorption, lubrication, and protect jts from damaging transarticular forces

131
Q

what is the purpose of the elastic component of cartilage?

A

shock absorption

132
Q

what provides the strength of the scaffolding of the fibrils of cartilage?

A

negative charge b/wfibrils and proteoglycans=repellent each other

133
Q

what molecules reinforce scaffolding?

A

water molecules

134
Q

what happens to water molecules during weightbearing that allows WB cartilage to deform?

A

they are squeezed to NWB areas

135
Q

what is the effect of dehydration of cartilage with aging?

A

decreased deformation with WB, so fibrils break down with constant WB forces

136
Q

why is bone on bone contact painful?

A

there are a lot of nociceptive receptors on the bones that the cartilage doesn’t have

137
Q

what does more white bone on an x-ray mean?

A

increased bone density from increased forces

138
Q

t/f: the rate of hip fx doubles each decade after 50 y/o

A

true

139
Q

what % of women and men will have a fx hip by age 90?

A

32% of women and 17% of men

140
Q

what % of pts who have had an hip fx never resume ambulation?

A

50%

141
Q

what are arthrokinesiological implications of aging?

A

obesity

age related PNS changes (proprioception, kinesthesia, light touch, pain, temp, vision, hearing)

preferential loss of slow fibers>fast twitch

stiffness in periarticular CT

decreased in extremes of ROM

natural neural adaptive mechanism to improve safety

loss of gluten med strength secondary to aging hip

COM moving anteriorly to the BOS secondary to senile kyphosis

142
Q

what are the impacts of aging on movement systems?

A

decreased dynamic and standing balance

difficulty with motor planning when performing secondary fxns (singing, talking, reading, listening)

loss of ROM

weakness

decreased voice amplitude

DPT 516 (14 decks)

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