Special Topics Flashcards
(125 cards)
0
Q
Discuss ballistic stretching.
A
Cyclically loading a muscle joint complex at or near its limits. May help with preconditioning a muscle joint complex prior to sprinting, high jump, or other events that depend on elastic energy in the MTU
1
Q
Define creep.
A
Occurs when MTU is elongated and is allowed to continue to elongate as stress relaxation occurs. Partially responsible for the immediate I bc in joint ROM with stretching
2
Q
Describe effect stretching has in performance.
A
Depends on the activity. Typical stretching may decrease performance in elite runners and sprinters bc they depend on stored elastic energy in MTU. Stretching may help performance when economy of gait is involved
3
Q
What is the optimal number I of stretch reputations and how often should they be performed?
A
1-4. Usually by the 4th stretch, 80% of MTU length is obtained. Stretches are recommended to be held 15-60 seconds. Gains last approx 24 hours so they should be repeated daily. After 6 weeks (according to Zebas), gains are retained for 2-4 weeks
4
Q
Does stretching dec injury risk?
A
Yes, usually. Flexibility imbalances may predispose someone to injury. The goal is to prevent these imbalances.
5
Q
Effect of warming up on stretches?
A
Research shows warming up makes no difference.
6
Q
When to perform joint mobilization vs stretching?
A
Joint mobilization should be first to minimize effects of abnormal joint compression and distraction on movement patterns
7
Q
How does age effect flexibility?
A
Decreases. In regards to normal ambulation, fall prevention, and balance, calf muscle stretching is beneficial
8
Q
What are physiologic and anatomic barriers?
A
Physiologic - point where voluntary range of motion in an articulation is limited by soft tissue tension.
Anatomic - final limit to motion, after which any motion would cause damage
9
Q
What is the pop in a joint manipulation?
A
Carbon dioxide gas bubbles collapsing or generating. There is no relationship between popping and effectiveness. Typically takes 15 minutes to happen again.
10
Q
Describe the grading system for joint mobilization.
A
Maitland has 5 grades:
Grade 1- slow, small amplitude at the beginning of the range
Grade 2 - Slow, large amplitude that don’t reach end range
Grade 3 - Slow, large-amplitude movements to the end range
Grade 4 - Slow, small amplitude movements at the limits of range of motion
Grade 5 - fast, small amplitude high velocity thrusts beyond pathologic limitation
11
Q
What does the evidence say about manual therapy for spinal conditions?
A
Low back: better outcomes compared to placebo, McKenzie, medical care, exercises, and soft tissue techniques. Manipulation followed by exercise is the most efficient.
Thoracic pain: limited evidence
Neck pain: effective when combined with exercise. No evidence that manipulation is better than mobilization. When directed at the thoracic region, manual therapy can cause an immediate decrease in pain and increase in neck ROM.
MT is also effective for tension HA when combined c exercise
12
Q
Is there evidence that MT is effective for extremities?
A
Hip: Research shows that it is 31% more effective than exercise alone for hip OA
Knee joint: effective when used with TherEx
Shoulder joint: effective with TherEx
Elbow: limited effectiveness
13
Q
What side effects are associated c with spinal manipulation?
A
The majority of people (61%) have some SE, with most experiencing stiffness, local discomfort, HA, fatigue, and muscle spasms
14
Q
How do loose-packed and close-packed positions influence MT Tx?
A
loose pack is used for joint play testing and to initiate Tx. Close packed is used to avoid joint motion (such as blocking lower spinal segments when attempting to mobilize a superior segment)
15
Q
What is a capsular pattern?
A
limited movement in a predictable pattern, which Cyriax suggests is a result of lesions in the joint capsule or synovial membrane (arthritis, arthrosis, immobilization, trauma)
16
Q
What are the loose-packed, close-packed and capsular patterns for head and spinal joints?
A
“Loose pack, close pack, capsular pattern”
TMJ: mouth slightly open, teeth clenched, limited mouth opening
Cervical: midway between flex and ext, max ext, limitation in all motion except flexion
Thoracic: midway between flex and ext, max ext, equal limitation of SB and rotation > ext > flex
Lumbar: midway between flex and ext, max ext, equal limitation of SB/rotation/ext>flex
17
Q
What are the loose-packed, close-packed and capsular patterns for UE joints?
A
“Loose pack, close pack, capsular pattern”
Sternoclavicular: arm by side, max elevation, limited elevation with pain
ACJ: arm by side, arm at 90, limited elevation with pain
GHJ: 55 shoulder abd and 30* horizontal abd (or simply 55* scap), max abd and ER, loss of ER > abd > IR
HUJ: 70* flex and 10* supination, full ext and supination, loss of flex > ext
HRJ: ext and supination, 90* flex and full supination, loss of flex > ext
Prox RUJ: 70* flex, 35* supination, loss of pronation equal to supination
Distal RUJ: 10* supinaiton, 5* supination, loss of pronation = supination
RCJ: neutral and slight ulnar deviation, full ext and radial deviation, limited flex = ext
Hand: not reviewed
18
Q
What are the loose-packed, close-packed and capsular patterns for LE joints?
A
“loose pack, close pack, capsular pattern”
Hip: 30* flex and abd and slight ER, ful ext and abd and IR, flexion and IR > abduction > adduction > ER
Knee: 25* flex, full ext and ER, limited flex > ext
Ankle: 10* PF and neutral rotation, full DF, PF>DF
Foot: don’t worry about it.
19
Q
What are some effects of STM?
A
Improves lymphatic drainage, decreases depression, improves blood flow, improves chronic tension HA. Research does not show improvement in the immune system
20
Q
How does massage aid in sports performance?
A
increases perception of recovery, reduces soreness post injury or post workout
21
Q
How does massage relieve pain?
A
possibly pain gaiting, possibly increases stimulation of descending pain inhibitory system beginning in the periaqueductal gray matter (PAG) and continuing to the dorsal horn of the spinal cord. Activates opioid receptors in PAG
22
Q
What is the purpose of Cyriax TFM?
A
Induces traumatic hyperemia in order to stimulate healing. Tendon is put on stretch, muscles is put in a relaxed position. Chanes should be noted within the first 2 Tx sessions
23
Q
What are contraindications for spinal Txn?
A
structural disease, RA, acute strains (relative), fusion less than 1 year old
24
What is the optimal force for traction?
Cervical spine: approx 30-50 lbs.
| Lumbar spine: 40% to 50% of BW
25
Is time a factor when treating a herniated disk?
Tx time should be relatively short If it is too long, decreased pressure will cause fluid to enter the disk and worsen bulge when Txn is released. 3-5 minutes may be effective, up to 10 to 15 min
26
What are average walking times and velocities in adults?
Typically walk about 80m/min, 115 steps per min (girls slightly more than guys), with declines of up to about 10% in adults over 60. Approx 60% of gait is with contact, 40% is swing phase
27
Describe key motions and muscular activity patterns during gait:
During initial contact, the ankle moves into 5 degrees of PF, with the knee moving into 15* of flexion and hip staying in 20* of flexion Eccentric control is critical for this. Without eccentric control, the forces may get transmitted to the joint and cause pain, or joint may collapse. THe knee flexes to approx 60* of flexion during swing phase of gait
28
Describe subtalar joint movements during gait.
eversion occurs at initial contact to allow unlocking of midtarsal joints and create a flexible foot to adapt to uneven surfaces. During SLS, eversion is reduced to create a rigid lever for the BW to progress over.
29
Describe PF contracture or tightness on walking.
This disrupts normal advancement, causing compensatory mechanisms such as premature heel rise, forward trunk lean, or knee hyperextension
30
What are the energy costs associated with various assistive devices?
Crutches: 30-80% energy demand increase
Standard walker: 200% increase in oxygen consumption
RW: less demand than SW
Cane: no change
Even with the increase in demand, it may actually make walking easier and less demanding in the presence of gait pathology because it allows more normal gait patterns
31
What are the typical extra energy expenditures of amputations during level walking?
25% increase for transtibial
41% for BKA
65% for AKA
32
Define Neurapraxia, axonotmesis, and neurotmesis.
Neurapraxia: conduction block, often caused by a problem with myelin but not axon damage. Usually recovers in 6 weeks.
Axonotmesis: injury results in nerve degeneration of involved fiber distal to site of injury. Nerve fibers regenerate about 1mm per day (3cm per month)
34
Discuss optimal time frame to perform EMG and NCS tests.
EMG should take place 2-3 weeks after injury because it takes 14-21 days for degenerative potentials to occur.
NCV: it requires 5-10 days for injured nerves to deteriorate distal to the suspected site of injury
35
What are common myotomes tested during screening?
```
Myotomes:
C3-4 shrugs, cervical rotation
C5: shoulder abd and ER
C6: elbow flex, wrist ext
C7 Elbow ext, wrist flex
C8: thumb and finger extensors
T1: hand intrinsic muscles
L2-L3: Hip flexors
L3-L4: knee extensors
L4-L5: Ankle DF
L5: great toe extensors, hip abd
S1: plantar flexors
S2-S3: foot intrinsic muscles
```
36
What are common dermatomes tested during screening?
```
C1: top of head
C2: side of head
C3-4: lateral neck and top of shoulder
C5: lateral shoulder and arm
C6: thumb
C7: middle finger
C8: pinky finger
T1-T2: Medial forearm and arm
L1-L2: groin
L2-L3: anterior and medial thigh
L4: medial lower leg
L5: lateral lower leg and top of foot
S1: Post lat thigh and lateral foot
S2: plantar surface of foot
S3: groin
```
37
What is the best strength test to determine weakness in the presence of known L3-L4 radiculopathy?
Single leg sit-stand test is the best, followed by knee extensors in flexed positions, then knee ext in full ext if the previous 2 tests are not tolerated
38
What are commonly tested DTRs?
```
Jaw jerk: Trigeminal nerve (CN V)
Biceps: C5
Brachioradialis: C6
Triceps: C7
Quadriceps: L4
Medial HS: L 5
Achilles Tendon: S1
```
39
How useful are the Achilles tendon reflex and the H - reflex in detecting L5/S1 root compression?
not valuable in detecting L5, but it is valuable in S1. H-reflex is the more valuable of the 2.(H reflex requires electrical stimulation)
40
How accurate is muscle strength testing, sensory testing, and reflex testing in the diagnosis of cervical radiculopathy?
muscle strength testing: weakness agrees with surgical findings 77% of the time. decreased sensation agrees 65% of the time. Reflex testing also agrees 77% of the time if there is a difference in side to side.
41
What is a "burner" or "stinger"?
A traction or compression injury to a cervical NR or brachial plexus trunk. It causes burning, numbness, tingling, or weakness in the distribution. Injury is caused to distraction of pectoral girdle through excessive shoulder depression or forced hyper lateral flexion of the neck.
42
What is Horner Syndrome?
A disease where there is an interruption of SNS innervation to the head and face region, usually caused by a brain stem lesion. Common signs and symptoms include Miosis (constricted pupil), ptosis, enophthalmos (sunken eyeball), Anhidrosis, and flushing
43
Describe some common special neurologic tests.
Babinski sign - indicates UMN lesion
Oppenheim reflex: ant border of tibia is stroked, causing babinski sign
Hoffman's sign: flick middle finger distal phalanx, indicates UMN lesion
44
How are different degrees of sprains classified?
Grade 1 - <25% ligament tearing, mild and swelling without instability
Grade 2 - 26-75% ligament tearing, moderate pain and swelling, dec ROM, slight instability
Grade 3 - total ligament tear, severe pain and swelling, severe loss of ROM, joint instability
45
How are brachial plexus lesions classified?
Grade 1: neupraxia, transient loss of motor and sensory conduction with repair in <2 weeks
Grade 2: significant deficits ranging from 2 weeks to 1 year (avg 3 months)
Grade 3: complete loss for at least one year with no improvement over time
46
Why do females sustain so many non-contact ACL injuries?
Intrinsic factors: inc valgus at knee, physiologic rotation laxity, smaller ACL size, narrower notch, increased ligament laxity during parts of menstrual cycle
Extrinsic factors: shoes, training, dec strength, females fire quads before HS, females land from jump with straighter knees
47
How are contusions Tx?
ice, compression, AROM. Avoid heat, massage, US, and PROM because of inc risk of myositis ossificans
48
How are femoral neck stress fractures ID'd?
One key differentiating factor is limited IR, whereas ER is usually limited in trochanteric bursitis
49
What are three functional tests that can help determine readiness for return to sport following ACL reconstruction?
Single-leg hop for distance, single-leg vertical jump, cross-over hop test. An LSI (limb symmetry index) can be calculated for the three tests by dividing the involved side by the uninvolved side and multiplying by 100. An LSI 85% or better is ideal.
50
Discuss athletic tape vs bracing for joints.
Tape may inc proprioception and inc stability but loosens approx 20 min after start of athletic event. Bracing may be easier and reduce long term costs, as well as last longer.
51
Describe the female athlete triad?
Amenorrhea, eating disorders, osteoporosis
52
What is glucosamine?
A nutritional supplement that is a building block for the synthesis of glucosaminoglycans. Studies show it promotes the production of chondrocytes, dec pain, and improves joint function. Shown to reduce OA. The AAOS position statement indicates that there is good evidence that glucosamine and chondroitin sulfate may help without side effects.
53
What is turf toe?
An acute sprain of the 1st metatarsalphalangeal joint, usually caused hyperextension of the joint as the foot gets jammed on artificial turf while pushing off. Ice, strapping the toe, and using NSAIDs are used in Tx.
54
What are signs and symptoms associated with cardiac pathology?
chronic, unexpected fatigue in women; shortness of breath in women. Remember that angina pectoralis may appear similar to an MI but is relieved by cessation of activity
55
What are the key characteristics of cellulitis?
poorly defined and widespread distribution that is red, edematous, warm-hot, and often accompanies an infection
56
What is the costovertebral angle and what is the significance?
The angle formed between the last rib and lumbar vertebrae. Tenderness in this region is indicative of renal disease.
57
What are symptoms involved with prostate pathology?
low back pain c concurrent symptoms of malaise, urinary infrequency, urinary urgency, pain with urination, and interrupted urine streams
58
What are some causes of orthostatic hypotension?
Medication, dehydration
59
What is iterative hypothesis testing?
a process described by Kasper and Harrison that is used to increase efficiency of the interview process. questions are used to confirm or refute evolving diagnostic hypothesis.
60
When do children develop an adult gait pattern?
established at 3 years, becoming stable about 7 years of age.
61
What is Gower's Sign or maneuver?
Children with weakness, especially in quads, that stand up by rolling prone, getting onto hands and knees, extending the knees, and using their hands to walk up the legs. Suspect muscular dystrophy.
62
Describe the Ortolani Sign, Barlow's Test, and Galeazzi sign.
Ortolani: grasp the flexed thigh of a supine child with thumbs on the inner thigh and fingers on the greater trochanter. As hips are abducted, a clunk is felt indicating the hip is reduced. "Out to in"
Barlow's Test: same position as Ortolani, but adduct thigh and push gently posteriorly, testing for dislocation
The above tests aren't very sensitive after 2 months of age.
Galeazzi sign: supine, knees flexed to 90, checking to see if one knee is higher
63
What tests are useful for diagnosing Osteochondritis dissecans?
Wilson Test: knee flexed at 90, gently rotate tibia medially and extend knee passively while holding rotation. Pain at 30* of knee flexion that is relieved by IR is indicative of possible pathology
64
What is Osgood-Schlatter disease?
Enlargement and microfracture in apohysis of tibia tubercle. Commonly seen in young, highly active males going through a growth spurt. Boys are most affected at ages 13 to 14, while girls are 11 or 12. Pain is worsened by squatting, jumping, or kneeling. Tx with ice, activity modification, NSAIDS, flexibility exercises, and isometric strengthening.
65
What is Sinding-Larsen-Johansson syndrome?
traction apophysitis at distal patellar pole
66
What is Legg-Calve-Perthes disease?
AVN of femoral head, usually in boys near 4-12. Usually heals within 18-24 months. Usually Tx with ROM (especially abduction), to keep femoral head in place.
67
Who is most likely to suffer from SCFE?
Obese males, 10-16 yo. Presents with limping and pain in distal thigh/knee. More common in African Americans and those with endocrine abnormalities. Gait may be waddling in nature with ER leg. Tx with surgical pinning with PT focussing on strengthening (esp hip abd), and ROM. PWB is suggested because it places less compression on hip than NWB
68
What are growing pains?
nonspecific intermittent pains, often occurring at night, that may be due to rapid bone growth and muscular fatigue while accommodating to new length. Usually slow stretching, warmth, and massage may help
69
What are the Salter-Harris classifications for growth plate fractures?
Type 1 - fracture through the growth plate
Type 2 - fracture through growth plate and metaphysis (most common, 75%; heals in 2-3 weeks)
Type 3 - fracture through growth plate and epiphysis
Type 4 - Fracture through growth plate, metaphysis, and epiphysis
Type 5 - compression fracture of growth plate
```
Salter Mnemonic:
1- S (straight through)
2- A (above)
3: L (low)
4: TE (through everything)
5: R (ram)
```
70
What cardiovascular and respiratory changes occur during pregnancy?
CV: Blood volume increases 50%. Initially dilutional anemia occurs because plasma volume increases quicker than RBCs. HR increases
Resp: changes that occur are amplified in the fetus, so any persistent hypoxia or acidosis with exercises in experienced to a greater degree in the fetus. So avoid prolonged anaerobic exercise or aerobic exercise causing dyspnea.
71
How soon after normal delivery can women begin exercise?
Pelvic floor/Kegel: ASAP. Aerobic exercise: when pt feels able. Hormone-induced joint laxity can be present 4-6 weeks after delivery, longer if the mother is nursing, so precaution should be taken not to stretch too far, and to avoid unilateral WB exercises and excessive jumping
72
Discuss delayed menarche in relation to PT.
Lack of menstruation by 16 yo. Associated c inc risk of scoliosis and stress fractures during high impact sports
73
Why does heart attack and stroke risk increase after menopause?
lower estrogen decreases levels of HDL and increases level of LDL. Low estrogen also allows more plaque to form on the inside of arteries
74
What is the primary difference in the presentation of venous vs arterial ulcers?
Venous ulcers are typically brownish skin, are irregular in shape and tend to be over the medial malleolus. Pain is decreased with leg elevation, worsened with standing.
Arterial ulcers are usually regular in shape ("punch out") and have more pain when elevated
75
What metabolic condition can cause achilles shortening?
Diabetes because of changes in the structure of collagen
76
How does the CNS contribute to the genesis of chronic pain?
High intensity noxious stimulation may alter the central processing of afferent neural information. Changes include enhancement of dorsal horn neuronal activity after repetitive c-fiber barrage (wind-up), receptive field expansion, dec dorsal horn threshold (inc temporal and spatial summation).
77
Why do muscles ache?
primary nociceptors from muscle tissue transmit afferent information slowly that give rise to dull, aching pain.
78
What causes trigger points and how can they be treated?
Not well understood. May be caused by transient overload of a muscle that causes damage to the sarcoplasmic reticulum. This focal disruption may cause localized zones that remain in a contracted position becasue of impaired calcium reuptake. ATP may cause contraction locally without AP in the presence of calcium, increasing metabolic activity locally. Accumulation of these byproducts may result in local acidosis, which sensitizes adjacent nociceptors. Stretching may help symptoms (avoid inducing reflexive contraction due to pain) by mechanically separating actin-myosin complex.
79
When does inflammation cease to be useful after musculoskeletal injury?
Inflammation beyond first 2-3 days is not helpful.
First stage (inflammatory response) lasts the first 2 days and induces cell mobilization and infiltration.
Second stage is days 3-5 and has ground substance proliferation to prepare for collagen deposition.
Third stage: collagen formation occurs and last through the second week.
Final stage is 2 weeks plus.
80
Can corticosteroids interfere with healing?
It can interfere with the initial proliferative phases of healing b/c it inhibits prostaglandin synthesis and may also inc fluid retention. Use caution in acute strains and with blunt trauma when compartment syndrome is a concern.
81
Who is at risk for headache?
women are 3 times more likely than men to have cervical headaches, especially those in either clerical or blue-collar occupations
82
Discuss the neuroanatomic basis for cervicogenic headache.
Afferent fibers from the trigeminal nerve that carries pain and temperature information for the head region descend through the medulla oblongata and into the gray matter of the spinal cord as far as C3/C4. Afferent fibers from C1-C3 enter the spinal cord and send collateral branches superior and inferior. Within the gray matter is the trigeminocervical nucleus that receives both trigeminal and cervical afferents. The convergence of afferents constitues the basis for referred pain.
83
Describe the anatomy of the posterior neck musculature, C2 sensory nerve root, and occipital notch.
The dorsal root of C2-C3 courses under the obliquus capitis and through the splenius capitis and trapezius muscles before transversing the occipital notch and onto the scalp. The occipital nerve and deep cervical artery course approx 2-3 cm lateral to midline at the level of the free edge of the posterior skull.
84
What do cervical radiographs show in patients with headache?
no significant differences in conventional positions compared to normal, but when flexed, one study found significant semgemental hypomobility of the craniocervical joints from C0-C2.
85
What are some treatment strategies for patients with cervicogenic headache?
Specific TherEx and manipulation/mobilization is effective, concurrent with HEP and postural awareness
86
What is trigeminal neuralgia?
AKA "tic douloureux" is an episodic, recurrent, unilateral pain syndrome in adults (females more than males, pain most often on right). Affects branches of CN V: face and jaw, sometimes forehead. Slight stimulation near nose can trigger an attack. Surgery is rarely successful. Tegretol has been found to be the most successful oral medication.
87
What is the most effective manual therapy technique for cervicogenic headache?
Manipulation is more effective than massage
88
When should functional capacity examinations be performed?
Early on you can test job functions not involving the injured part. Basically, the sooner the better.
89
What are components of a functional capacity examination?
Usually follow US Dept of Labor guidelines and include lifting, carrying, pushing, pulling, gripping, pinching, hand coordination, reaching, bending, climbing, walking, standing, sitting, balance, and for chronic cases - level of effor ot cooperation
90
How long does a FCE take?
Usually 4-6 hours
91
Mn: What is the military saying for shoulder muscles?
Lady between the majors (Latissimus dorsi is between the pec major and teres major
92
Mn: What is SALSAP?
The axillary artery is a continuation of the subclavian artery as it passes the lateral edge of the first rib. It passes behind the pec minor which divides it into 3 parts (before, behind, after the muscle). Of the 6 branches, the 1 comes from part one, 2, from part 2, and three from part three:
S- supreme thoracic
A- acromiothroacic trunk (thoracoacromial trunk)
L- lateral thoracic
S - Subscapular
A- Anterior circumflex humeral
P - posterior circumflex humeral
93
Mn: How do elephants serve as a memory tool?
Elephants have a trunk and the thoracoacromial is a trunk with 4 branches. An elephant is a pachyderm (PACD):
Pectoral, acromial, clavicular, deltoid
94
Mn: What is the order of structures in the cubital fossa?
```
TAN (from lat to medial):
T- biceps tendon
A: biceps artery
N: median nerve.
This is importatn for stimulating the median nerve in nerve conduction studies for CTS
```
95
Mn: What is the area code for carpal country?
921.
9 tendons (8 from fl digitorum profundus and superficialis, 1 from flexor pollicis longus)
2 bursae - one ulnar surrounding 8 digitorum tendons (aka common synovial sheath), 1 around FPL
1 nerve: median nerve
96
Mn: If I go cruising in my VAN, where would I be?
The arteries, veins, and nerves of the thoracic wall share the name intercostal. Within the groove, the structures are from superior to inferior: vein, artery, and nerve.
97
Mn: How many birds reside in the thoracic cage?
4. The Esophagus, Azygous (veins), thoracic duct, and vagus nerve. The duck lies between the gooses (esophagus, azygous).
98
Mn: What are the branches of the facial nerve?
To Zanzibar By Motor Car
Temporal (muscles of eye and forehead)
Zygomatic (muscles of the eye and upper lip)
Buccal (muscles fo the cheek and upper lip
Marginal mandibular (muscles of the lower lip)
Cervical (neck muscles/platysma)
99
Mn: What are the cranial nerves?
```
I: Olfactory
2. Optic
3. Occulomotor
4: Trochlear
5: Trigeminal
6: Abducens
7. Facial
8: Auditory
9: glossopharyngeal
10: Vagus
11: Spinal Accessory
12: Hypoglossal
"On Old Olympus' Towering Top, A Finn And German Viewed Some Hops"
"Some Say Marry Money, But My Brother Says: Big Brains Matter Most"
```
100
Mn: What is the formula for remembering the nerve supply to the seven muscles of the orbit?
LR6(SO4)3
| Lateral Rectus is CN 6, Superior Oblique is by the trochlear nerve), remaining 5 are by the occulomotor nerve
101
Mn: What are the muscles of the pes anserine?
"Say Grace Before Tea"
Sartorius
Gracilis
Semitendinosus
102
Mn: What is the innervation of the pectoral muscles?
"Lateral is less, meidal is more"
Lateral pectoral nerve is pec major only
Medial pectoral nerve is pec major and pec minor
103
Mn: What are the structures in the Tarsal Tunnel?
```
Tom, Dick, ANd Harry:
From anterior to posterior:
Tibialis posterior
flexor Digitorum
posterior tibial Artery
tibial Nerve
flexor Hallucis Longus
```
104
Mn: What is the relationship between the structures at the suprascapular notch?
Army (artery) goes over the bridge, and the Navy (nerve) travels under.
105
What are the advantages of isokinetic devices and contraindications?
Advantages: challenge muscle to maximal capacitiy throughout entire range, resistance that accomodates to pain and fatigue provides inherent safety factor, and real time feedback is available to the patient for motivation during exercise. It may detect subtle differences in strength that MMT cannot.
Contraindications: acute strain/sprain, severe pain, severe effusion, joint instability
106
Is isokinetic testing functional?
Most, but not all, research indicates a correlation exists.
107
What are the three most comon fractures in older adults, in order of prevalence?
Vertebral (compression) fractures
Proximal femur fractures
Distal radius fractures
most are caused by osteoporosis or cancer
108
What medications are associated with an increased risk of falling?
antidepressants, sedatives, and antihypertensive medications
109
Define orthostatic hypotension.
>20 mmHg decrease in systolic pressure and >10 mmHg increase in diastolic pressure and increased heart rate >10% when rising from supine to standing.
OR systolic BP <90 mmHg
110
What is the PT intervention for orthostatic hypotension?
No supine exercises are effective. Progressive elevation of the head of the bed, dangling one extremity over the edge of the bed, sitting at EOB, active LE exercises in sitting, deep breathing are effective exercises. Elastic stockings may be worn and head of bed should be elevated 5-20* during sleep
111
Summarize the recommended protocol for resistance training in older adults.
ACSM recommends strength training 2-3 times per week with intensity that fatigues between 8-12 reps. Older adults that are deconditioned may benefit from 10-15 reps. 2-3 reps are used. Significant strength gains are made by 12 weeks of age in older adults, whereas younger people take 6-8 weeks.
112
What changes in strength training should be made in adults with hypertension?
Resting systolic BP >/= 160 mm Hg and diastolic BP >/= 100 mmHg are relative contraindications
Aerobic exercise should be the first priority
113
How should a person taking a beta blocker or having a pacemaker be monitored during exercise?
RPE is appropriate, age predicted HR is not appropriate. Extend warm-up and cool down periods.
114
What is metabolic syndrome?
A combination of s/s that identifies individuals at an increased risk of cardiovascular events and/or diabetes. 3 of the following must be met:
1. increased abdominal circumference (35in women, 40in men)
2. Elevated triglycerides, low HDL levels, elevated fasting glucose, HBP
115
How does MRI obtain images?
Based on tissue responses to magnetic fieleds. The field knocks the tissue off its aligned position and the tissue responds based on its water content (hydrogen ion content). IThe time it takes to return to the upright position generates the T1 signal (spin-lattice relaxation time), and the time it takes to return to moving at its natural frequency generates the T2 signal (spin-spin relaxation time).
116
What are the characteristics of T1 and T2 images, and what are the normal appearances of ligaments and tendons on MRI?
T1-weighted images show fat and blood as white, muscle as gray, edema, tumors, and CSF as black T2-weighted images show CSF, edema, and tumors as white, muscle as gray, and fat/cartilage, and tendons as black.
Normally ligaments and tendons are dark on all images. A tear is usually visible with disruption in the black.
A T2 weighted image is usually the most useful sequence to assess abnormalites because fluid is bright in this image. Most pathologies (trauma, tumor, infection) lead to inc fluid contact and are bright on T2 images.
117
Who should be excluded from an MRI?
people with metal implants because metal severely degrades an image. The farther away, the less the effect (LE implants do not effect brain MRIs). Peopl with ferrous metal implants are considered a contraindication. Electronic implants are contraindicated.
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When will a stress fracture become visible on a radiograph?
Approx 7-14 days after injury (may see evidence of healing more than the Fx itself), while bone scans can detect the fracture very early on (MRIs are considered safer).
119
What is a sulcus angle?
Used to quantify the angle of the femoral sulcus where the patella sits. Obtained from a Merchant's view (knee is flexed 30 degrees) and determined by the highest point of the medial and lateral edges to the lowest point of the sulcus. An angle >140* indicates a shallow sulcus that can cause patellofemoral problems.
120
Is osteoporosis detectable on x-ray?
Yes, but only after 30-50% loss of bone. It usually looks like "picture framing", where the cortex is sharp but trabeculae are decrease.
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What are delayed union and nonunion fractures?
Delayed union is when healing is slower than expected (16-18 weeks) while non-union is when a fracture is delayed longer than 6 months.
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How is scoliosis measured radiographically?
On a PA film of the entire spine with pt standing. Usually measured using the Cobb method:
Lines are drawn on the superior endplate and inferior endplate of the highest and lowest vertebrae involved in the curvature and a line is drawn perpendicular to the endplates. The angle formed by the lines is the Cobb angle.
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How is alignment of the cervical spine evaluated?
Three imaginary smooth curved lines are drawn on a lateral view of the cervical spine to assess alignment (anterior aspect of vertebral bodies, posterior aspects, and spinolaminar line). In the setting of trauma, any malalignment of the first 3 lines should be considered evidence of fracture or ligamentous injury.
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What is ulnar variance?
The position of the distal articular surface of the ulna relative to the radius. Ulna neutral exists when the radius and ulna are equal (80% of axial load is transmitted through the radius, 20% through the ulna). Ulna negative is if the ulna is proximal to radius, and ulna positive is if the ulna is distal than radius.
125
What is the femoral neck-shaft angle?
Measures approx 150* at birth and decreases with age to about 125* in adults. A decreased angle is termed coxa vara while an increased angle is termed coxa valga.
