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411 Cards in this Set
- Front
- Back
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NWB arthrokinematics proximal radio-ulnar joint:
___ head ______ in ____notch of the _______ |
radial head spins in radial notch of the ulna
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NWB arthrokinematics distal radial-ulnar joint
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concave radius on convex ulnar head
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in NWB, what bone rotates to cause pronation?
in WB, what bone rotated to cause pronation?....what motion at the shoulder causes this motion? |
NWB: radius around ulna
WB: ulna rotated on stable radius via ER at GH jt |
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WB proximal radioulnar joint arthrokinematics
WB distal radioulnar jt " |
concave radial notch of ulna rotates around fixed radial head
convex ulnar head on concave distal radius |
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distal to elbow, radial n. splits into superficial and deep branches. which branch is purely sensory?
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superficial
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posterior interosseous n. is a branch of what n. in the forearm?
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deep branch of radial n.
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deep branch of the median n. and innervates deep mm. of the forearm?
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anterior interosseous
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what innervates medial half of FDP?
what innervates lateral half of FDP? |
ulnar n.
anterior interosseous of the median n. |
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3 mm. innervated by musculocutaneous n.
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biceps brachii, brachialis, coracobrachialis
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what n. innervates brachioradialis?
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radial n.
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area of isolated sensory supply of radial n?
(via what branch of the radial n?) |
dorsal web space between thumb and first finger
(superficial branch) |
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3 pollicis mm innerv. by the radial n?
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abductor pollicis longus
extensor pollicis brevis extensor pollicis longus |
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what portion of the arm/forearm does musculocutaneous supply sensory inn. to?
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anterior-lateral forearm
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isolated sensory supply of the median n?
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digits 2-3 finger pads and doral surfaces
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pollicis mm innervated by the medial n.
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flexor pollicis longus
abductor pollicis longus opponens pollicis flexor pollicis brevis |
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isolated sensory supply of ulnar n?
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pinky and medial borderof hand
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medial half of lumbrical inn. by?
lateral half of lumbricals inn. by? ** note that it is the same as FDP |
ulnar n.
median n. |
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pronation occurs through mm. inn. by what n?
supination occurs mainly through mm. inn by what n. and secondarily by mm. inn by what n? |
median n.
musculocutaneous n. radial n. |
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if a mm. attaches to the ulna, does it have the ability to pronate or supinate the forearm?
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no.
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MMT forearm position for:
biceps brachioradialis brachialis |
supination
neutral pronation |
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max force output of a mm is greater when its contraction velocity approaches ____ ( a ____contraction)
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zero (isometric)
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first elbow extensor to activate and maintain low level extensor force?
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anconeus
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which triceps mm is conidered the workhorse of the elbow extension?
which is considered a "reserve" forces and fxns more to extend and adduct the shoulder? |
medial head
long head |
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what angle of the elbow produces max torque potential for both flexors and extensors?
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90
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describe the law of parsimony
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NS tends to activate the fewest mm or mm fibers possible for control of a given joint action
-- low-level force demands are often accomplised by one joint mm. (ex: anconeus before the rest of the triceps) ; as force demands increase, larger polyarticular mm are recruited, along with necessary neutralizer mm |
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someone with C6 quadriplegia might use what 2 shoulder mm to extend the elbow in WB'ing?
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clavicular portion of pec major
anterior deltoid |
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most active and consistently used pronator mm?
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pronator quadratus
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internal torque potential = ____ x ______
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force of mm parallel to plane of motion x length of internal moment arm available to the mm
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the superficial and intermediate layers of the back are considered __-trinsic and therefore inn. by ventral or dorsal rami?
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ex-trinsic
ventral rami (i.e. brachial plexus or intercostal nn) |
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what 3 mm are included in the transversospinales group? name them superficial to deep
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semispinalis, multifidus, rotatores
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B contraction of transversospinales produce what motion?
unilateral? |
extension
ltar |
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# of joints crossed by:
semispinalis multifidi rotatores |
6-8
2-4 1-2 |
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degrees of motion @ AO
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5 flexion 10 extension
5 lateral flexion negligible rotation |
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degrees of rotation @ AA (what % is this of all rotation?)
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35-40 each way ... 50%
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rotate R, which alar ligament is tight?
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L
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greatest displacement of motion occurs with what motion at what cervical levels?
BUT most common radiculopathy is at what level? then what level after that? |
flexion ; C4-C5 and C5-C6
C7 radiuculopathy (C6-C7) then C6 radiculopathy (C5-C6) |
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what blocks thoracic axial rotation?
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facet joint orientation nearly in frontal plane
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what blocks lateral flexion motion in T spine?
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rib cage
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name this phenomenon: heat is dissipated as the load is removed and causes structual changes in bonds that prevent the tissues from returning to resting length
this phenomenon can lead to what if repetition continues to occur over time with no rest to allow the tissue to return to 0 tension |
hysteresis
creep |
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name the type of herniated disk:
a. annulus intact, but failing ; nucleus is migrating b. annulus has failed ; nucleus is protruding c. segement of prolapsed nucleus is separated from the core d. segment walled off and free floating, may be more annular vs nuclear material |
a. buldging/protruding
b. prolapsed/ruptured c. extrusions d. sequestered fragment |
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3 types of herniations
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intraforaminal
postero-lateral *** most vulnerable d/t NP going around PLL central |
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healthy disc is what % H20?
aged disk is what % H20? |
80%
65% |
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name the 4 predictor values for cervical radiculopathy
3/4 = _% posttest probability 4/4=____% posttest prob. |
1. ULLT A (median n.)
2. spurling A test 3. distraction test 4. cervical rotation < 60 degrees 65% 90% |
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cervical spondylosis is a combo of (2) things
typically begins at what age? men or women more? 3 risk factors? |
DDD and osteophyte formation
40-50 men fx lifting, smoking, driving (aka truck driver?? lol) |
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causes of spondylolisthesis in C spine?
____elements impose on the spinal cord pressure on the spinal cord is called: (characterized by numbness, weakness, spasticity, and proprio loss, possible bowel and bladder dysfunction) |
injury, RA, degneration
posterior myelopathy |
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spinal stenosis can be caused by (2)
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bone and ligaments narrowing the vertebral canal
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facet impingement onset is usually sudden or chronic?
___pattern: having trouble with flexion ___pattern: having trouble with extension what direction are the mobs? |
sudden
opening closing A-P |
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test for subluxation of C1 on C2
(+) test? |
sharp-purser
reduces subluxation, relieve symptoms |
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(2) other stress tests for ligaments?
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transverse ligament stress test
alar ligament stress test |
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(2) transitional areas in C-spine that can cause cervicogenic HA
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C0-C1-C2
C5-C6-C7 |
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what n. and a. are compressed @ C1-C2?
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greater occipital n. and a.
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upper normal limit of space between dens and C1?
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3 mm
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what the McKenzie technique is actually called
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mechanical dx and tx
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VAI/VBI symptoms? (5 D's and 3 N's)
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diplopia, drop attack, dysphagia, dizziness, dysarthria
nystagmus, nausea, numbness |
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if it's mechanical the pt can probably tell you...
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what activities/positions aggravate it and which ones make it better
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name the 3 classifications in the mckenzie system
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derangement
dysfunction postural |
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herniations lateral to nn root cause pain when side bending______the lesion
herniations medial to the nn root cause paint when side bending _____the lesion |
toward
away |
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for posterior derangement, perform ____-based exercises
sitting progression: 1. 2. 3. supine progression: 1. 2. 3. |
extension
sitting progression: 1. cervical retraction 2. retraction + ext 3. retraction + ext + rot supine: 1. retraction 2. repeated ext with rot 3. manual traction, retraction, extension |
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how often are exercises performed
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10x per hour or whenever pain comes back
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4 stages of treating derangement
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1. reduce
2. maintain reduction 3. recovery of fxn 4. prophylaxis |
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pt should be pain free for how many days before you start recovery of fxn?
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5-7 d
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name this McKenzie syndrome: normal mechanical load on shortened/scarred cervical tissue
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dysfunction
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name this mckenzie syndrome: no underlying pathology ; pain in present when abnormal load is placed on normal tissue
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postural
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which of the 3 syndromes is characterized by:
young, no loss of movement, insidious onset, pain is always intermittent and always local |
postural
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which of the 3 syndromes is characterized by:
20-55 y.o, varying onset and pain, loss of movement, and improves with repeated movements |
derangement
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which syndrome is characterized by:
over 30 y.o, duration at least 6-8 weeks with intermittent pain at end range and decreased ROM, no lasting affect of repeated movements |
dysfunction
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is the neck pain classification system validated?
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no
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in the Canadian C spine rule validated?
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yes (in the ER, but can be used in the clinic)
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what is the sensitivity of the Canadian c spine rules?
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100%
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regardless of high-risk event, what age warrants x-ray no matter what?
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> or= to 65 y.o.
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(3) high risk factors in C spine rules
if yes, do what? |
age 65 or older
dangerous MOI paresthesias in extremities get radiographs |
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5 low risk factors that allow ROM assessment if the person passes the first part of the test
if no, do what? |
simple rear-end MVA
normal sitting posture in ED amb at any time since injury delayed onset of neck pain absence of midline tenderness get radiographs |
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can the pt actively rotate the head _____ degrees?
if no, do what? |
45
get radiographs |
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what are the five categories of the neck pain classification system (NPCS)?
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1. mobility
2. centralization 3. control pain 4. reduce HA 5. conditioning and increase exercise tolerance |
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which category has strong, supportive evidence?
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conditioning and increase exercise tolerance
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cervical traction: in supine, what position of neck is recommended?
minimal lbs needed for separation? usual tx wt used? more flexion = more distraction in ____ c spine more extension = distraction in ______ c spine |
20-30 degrees flexion
25 lb <45lb lower upper |
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parameters for c spine traction?
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3:1 for 20-30 min after successful 10-20 min trial
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lumbar spine traction:
supine for (3) conditions ...distracts what elements? prone for what condition? ...distracts what elements? |
separation of facets, jt hypomobility, spinal stenosis
posterior disc conditions anterior |
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% BW used for lumbar traction?
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40-60%
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(2) mm that often have trigger points in the neck as a result of poor posture
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levator scapulae and semispinalis capitis
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is SCM more active with cervical or craniocervical flexion?
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cervical
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which part of the ulnar collateral ligament of the elbow is taut in extension and t/o most of ranging?
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anterior
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the medial collateral or lateral collateral of the elbow more associated with rotational stability?
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lateral (radial)
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best mobs for the humeroulnar jt?
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distraction
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humeroulnar joint:
resting close packed capsular pattern |
70 flex 10 supination
full ext + sup flexion&ext limitation |
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treatment plane for humeroradial joint?
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parallel to radial head
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resting and close packed positions of the HU and HR joints are almost opposite.
HU: pain with _____ and more comfortable in ____ HR: pain with _______ and more comfortable in ____ |
ext.... flex
flex... ext |
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primary stabilizer of the distal RU jt
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TFCC
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TFCC disc in contact with ulnar head in pronation or supination?
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supination
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pronation exposes the ____ surface of the ulnar head
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articular
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which mm is also a stabilizer of the wrist?
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pronator quadratus
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most active pronator?
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pronator quadratus
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work horse of elbow flexors?
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brachialis
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which flexor digitorum splits for the other?
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fdS Splits for fdp
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golfers elbow is ____ epicondylitis
tennis elbow is _____ epicondylitis |
medial
lateral |
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which muscle is most involved in tennis elbow?
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extensor carpi radialis brevis
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what is wartenberg's sign?
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cannot adduct the little finger
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what muscle does the radial n. go through?
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intramuscular tunnel of the supinator
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posterior interosseous and anterior interosseous only have _____components....
so you would expect a _____ deficit without a ______ deficit if these nn are involved exclusively |
motor
motor NOT sensory |
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the pinch grip test evaluated the integrity of what n?
what mm does the n innervate? does this n have a sensory component? |
anterior interosseous of the median n.
FPL and 1-2 FDP NO. motor only |
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normal carrying angle in the elbow
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5-15 deg
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whats the difference between wartenbergs sign and wartenbergs syndrome?
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sign: can't adduct 5th digit (ulnar n.)
syndrome: superficial radial n entrapment is SENSORY only |
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what three structures form the tunnel for the ulnar n?
what is the tunnel called? diff dx (3) |
medial epicondyle
MCL olecranon cubital tunnel c8-t1 NR, thoracic outlet, guyons canal |
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3 radial n entrapment sites
hint: 2 are posterior interosseous and 1 is superficial radial n |
posterior interosseous:
arcade of froshe near radial head superficial: under brachiradialis |
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which radial n entrapment can mimic de quervains?
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superficial radial n
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what is de quervains?
what special test will be positive? |
tenosynovitis of EPB and APL
finkelstein |
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3 median n dysfunctions
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supracondylar process syndrome
pronator syndrome anterior interosseous syndrome |
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which syndrome has motor and sensory components?
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pronator
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which syndrome has motor symptoms only and is best evaluated through pinch grip test?
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anterior interosseous of median n.
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most common elbow dx
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lateral epicondylitis
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ST and bony healing take ___
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6-8 wk
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what wks do ACLs start running
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8-10
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HR mobs:
volar/dorsal glides work on what motions? distraction works on what motions? |
flex/ext
pron/sup |
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with UCL instability (2nd most common injury in baseball) you might notice a ____contracture at the elbow which is equated with _____loss of _____
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flexion
adaptive ext |
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important cosideration for UCL return to sport
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maintain thoracic ext mobility and scap strength
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length of time to return to sport with tommy john surgery?
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6-12 mo
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is the UCL repaired or reconstructed with tommy john?
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reconstructed with palmaris longus or hamstring
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return to sport for UCL-- work on wrist ____ for dynamic stability and initiate throwing progression what mo?
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flexors
4-6 if criteria is met |
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compromise of the ulnar component of the LCL @ the elbow creates instability in what direction(s)?
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postero-lateral
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radial head makes contact with what bone?
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capitulum
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what m. needs most protected after total elbow?
how many weeks should isolated contractions of this m be avoided? |
triceps
10-12 |
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what is myositis ossificans?
most common in what 2 places? |
atypical bone formation
elbow, thigh |
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difference between tendinitis and tendinosis?
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-itis = active inflammation (will go away)
-osis = micotrauma at MTJ, fibroblasts and vascular hyperplasia |
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if posterior interosseous is affected what wrist function will be preserved? why?
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wrist drop not an issue
ECR is spared |
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should braces be used for epicondylitis?
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there is only short term improvement so wean them as fast as possible!
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most effective tx for lateral epicondylitis?
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MIXED (US, deep friction, exercise)
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what manipulation might be used at the elbow for lateral epicondylitis?
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mill's manip
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does evidence show that mobs should be used when cervical mobility issues are present?
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yes
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complication of overuse of corticosteroid injections?
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osteonecrosis
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prognosis of lateral epicondylitis?
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6 mo- 2 yr
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for lateral and medial epicondylitis what type of mm training should be used? why?
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eccentrics -- break up scar tissue
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contents of the carpal tunnel
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FDS, FDP,FPL, median n.
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which flexor has its own tunne?
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FCR
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piano key test evals integrity of what jt?
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distal RU
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does the ulna articulate with the proximal row of carpals?
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no
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greatest contact of radicarpal joint occurs with 2 motions
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extension and ulnar deviation
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tx plane for radiocarpal joint
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perpendicular to long axis of radius
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radiocarpal and midcarpal resting position?
close packed? capsular pattern? |
neutral or slight flexion with slight ulnar deviation
extension + ulnar deviation flex/ext equally limited |
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facilitate wrist flexion with ____ glide and extension with ____ glide (aka arthokin. are _____ on _____ for all carpal joints
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posterior ; anterior
convex on concave |
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stretch palmar ligaments by ______
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extension
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name 3 parts of the TFCC
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UCL, palmar ulnocarpal ligament, disc
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dorsal radiocarpal ligaments are taut in ____
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flexion
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collateral ligaments resist motion in what plane?
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frontal
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primary static stabilizer of the distal RU jt
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TFCC
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2 dynamic stabilizers of the distal RU jt
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pronator quadratus and ECU
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% of compression force through TFCC?
...SO if disrupted, pain with any ____ activity ; and also pain with any ______ movement |
20%
WB'ing rotational |
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palmar intercarpal lig goes from ____ > ___ and ____ ; it makes a ______ on the palm
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capitate > scaphoid & triquetrum
inverted V |
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(3) ligaments involved in tension during radial and ular deviation that make the double V tension
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palmar intercarpal
palmar ulnocarpal and palmar radiocarpal |
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which one(s) pull on proximal row?
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palmer intercarpal
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which one(s) provide stability?
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palmar ulnocarpal and palmar radiocarpal
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with ulnar deviation, what is tight?
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lateral palmar intercarpal
and palmar ulnocarpal |
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double V tension leads to _____
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cross tension
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3 mm of the thenar eminence
innerv by ______ n other intrinsics innerv by median n? |
abductor pollicis brevis
opponens pollicis flexor pollicis brevis median n, 1st and 2nd lumbricals |
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ulnar n. goes through what?
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guyon's canal
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compression of the ulnar n will limit_____
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grip strength
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look@ neumann p 282 for grip definitions
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ghjghj
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which part of the scaphoid may have poor healing d/t decreased blood supply?
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proximal pole
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colles fx vs smith fx?
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dorsal displacement of wrist vs volar displacement of wrist
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what (2) tendons make up the left side of the anatomical snuff box?
which tendone makes up the right side? |
AbPL and EPB
EPL |
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what nerve is in the snuff box?
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superficial radial n.
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name 5 tendon glides starting with straight
2 others |
straight, hook, duck, straight fist, full fist
hanging limp wrist, wrist ext |
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a click or clunk with radial deviation may suggest hypo- or hyper- mobility?
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hyper
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palmar ligaments resist ; deficit causes DISI or VISI?
dorsal ligaments resist ; deficit causes DISI or VISI? |
extension ; VISI
flexion ; DISI |
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most fx dislocated carpal with rotational collapse? what direction? is this VISI or DISI? so what motion is bothersone?
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lunate ; posterior ; DISI ; flexion
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if palmar ligaments are disrupted, VISI or DISI? what action is bothersome? which way will the lunate dislocate?
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VISI ; extension ; anteriorly
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name of AVN of carpals?
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kienbock's
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special test for lunate dislocation
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murphy's sign
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(+) murphy's sign
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3rd MP jt even with 4th and 5th
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you could make a scaphoid fx worse by performing what special test? (+) test: ____
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scaphoid shift test ; pain or clunk
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push the capitate _________ for capitate apprehension test
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dorsally
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push _______ for piano key test -- tests for _____
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dorsal ; TFCC instability
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RA: _____deviation @ wrist and ______deviation @ MCP jts
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radial ; ulnar
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radial deviation caused by ______slide of proximal row
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ulnar
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ulnar deviation of MCP jt d/t ______ effect in order to compensate for wrist deviation
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bowstring
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_____ subluxation @ wrist also occurs d/t palmar radiocarpal ligament laxity
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volar
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deformity common @ thumb? describe it
" @ fingers? describe it |
boutinneire (flexed PIP with ext DIP)
swan-neck (EXT pip with flexed DIP) |
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all S/S are distal to _____ with carpal tunnel
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wrist
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4 special tests for carpal tunnel
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tinel's ; direct compression ; phalen's ; reverse phalen's (prayer)
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"abnormal" threshold for semmes-winstein monofilaments
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> 2.83
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stable carpal bone that is part of the longitudinal arch of the hand?
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capitate
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capsular pattern of the 1st CMC jt
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adduction then extension
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arthrokinematics of first CMC jt flexion
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concave metacarpal on convex trapezium
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thumb: tx abduction with a ______ glide ; tx adduction with _____ glide
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dorsal
volar |
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decribe the 2 phases of CMC opposition
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1: abduction
2: flexion & medial rotation |
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MCP jt capsular pattern
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flex then ext
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close packed of MCPs and PIPs
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fist
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are palmar plated located at all 3 finger joints?
|
yes
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skier's thumb is...
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UCL tear
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thumb MCP joint is more like a ______ (must be stable!)
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hinge with little hyperextension
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close packed of DIPs
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extension
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what may be indicated for final flexion and extension ROM for PIPs and DIPs in addition to dorsal and volar glides?
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distraction with rotation
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check rein ligaments are only present @ what joint?
what do they do? |
PIPs
reinforce palmar plates to resist hyperextension |
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what phalanx does FDS attach to?
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middle
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what phalanx does FDP attach to?
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distal
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name the 3 parts of the dorsal extensor mechanism
|
EDC terminate on prox phalanx
central slip flattens and attached to middle phalanx lateral bands split before PIP and attach on distal phalanx |
|
|
what do the transverse and oblique fibers do? (hint: they help attach the dorsal hood to palmar structures)
|
good opening transmission btw intrinsics and extrinsics via attachment to lumbricals/PAD/DAB
|
|
|
which ones attach to the palmar plates?
" lateral bands? |
transverse
oblique |
|
|
which band extends PIP?
which bands extend DIPs? which jt do transverse fibers extend? which joints to oblique retinacular ligaments extend? |
central
lateral MCP PIP and DIP |
|
|
are interossei and lumbricals needed to extend IPs?
|
yes
|
|
|
lumbricals actively flex ____ and extend ______ via ____
|
MCP jts ; PIP and DIP via attachment to lateral bands
|
|
|
duck position is:
|
intrinsic plus
|
|
|
hook position is:
|
extrinsic plus
|
|
|
circulatory test @ wrist
|
allen test
|
|
|
ape hand is assoc with _____mm wasting and ______n injury
|
thenar ; median
|
|
|
bishops deformity is assoc with wasting of _____
|
hypothenar eminence
|
|
|
sweater finger is cause by ______
|
ruptured FDP
|
|
|
boutonniere deformity:
flexed _jt ; hyperextended ___ caused by: |
PIP
DIP subluxed MCP or torn central tendon of EDC |
|
|
Swan neck deformity--
__ and __ jt flexion hypermobile____ jt d/t _______-- the joint position puts tension on the lateral bands to cause DIP flexion and scars down |
MCP and DIP
PIP d/t laxity or rupture of volar plate |
|
|
ulnar drift: extrinsic tendon pull on _____ side when the wrist is _____ deviated
|
ulnar ; radially
|
|
|
what does Boye's test eval?
what is a positive test? |
central extensor tendon
inability to flex DIP |
|
|
gamekeeper's thumb (skier's) thumb is from _____ and ______ injury and can be eval'ed via _____ stress test of the _____
|
abduction and extension
valgus UCL |
|
|
use jean's sign and fromet's sign to eval ____n.
|
ulnar n.
|
|
|
fromet's sign:
jean's sign: |
flex IP = adductor pollicis paralyzed
IP + MCP extension = ulnar n. palsy |
|
|
egawa's sign
|
flex middle finger then abduct/adduct
unable = ulnar n. injury |
|
|
guyon's canal vs. cubital tunnel
|
dorsal sensation preservation vs all preservation lost
|
|
|
which zone has poor blood supply?
|
zone 2
|
|
|
when is repair no longer possible?
|
> 3 wks s/p injury
|
|
|
is early mobilization advocated for flexor tendon repairs?
|
yes-- 3 d
|
|
|
whichever direction is impaired, position wrist in slight similat direction?
|
yes
|
|
|
type of wrist splint for flexor repair?
extensor repair? |
dorsal block
outrigger |
|
|
RA mobility pattern--
acute: chronic: end-stage |
hypo-
hyper- hypo- |
|
|
lowest to highest pressure:
1. squat 2. stand 3. stoop 4. sit up |
2, 4, 1, 3
|
|
|
spondy in lumbar spine is most frequently @____
|
L4 (L4-S1 in notes elsewhere)
|
|
|
scotty dog can be seen in the ____ plane
|
oblique
|
|
|
extension of the low back causes _______ @ sacrum
|
nutation
|
|
|
type of loading handled best by disc?
worst? |
compression
shear with rotation |
|
|
according to MB, most flexion in the spine is at what segment?
|
L5-S1
|
|
|
inferior facets of superior vertebrae are ____ to superior facets of inferior vertebrae in the L-spine
|
medial
|
|
|
this means that R rotation causes gapping on the ______ and approximation on the____
|
R
L |
|
|
L3-L5 spinal coupling of rotation and SB?
L5-S1 ? |
neutral or extension= opposite
flexion = same same |
|
|
inferior facets of L5 face _____ and hook onto S1 facets that face _____
|
anteriorly ; posterior
|
|
|
normal lumbosacral angle?
|
30-40 deg
|
|
|
ultimate end point of stability training in lumbar spine?
|
hoop + brace
|
|
|
2 approaches to lumbar stabilization
|
dynamic lumbar stabilization (co-contraction abd/back ext in neutral spine)
spinal segmental stabilization training (focuses on TrA and multifidi specific, co-cointraction) |
|
|
2 times to avoid lifting
|
after prolonged flexion ; shortly after rising from bed
|
|
|
how to stretch the lumbar facet capsule?
|
rotation with flexion
|
|
|
scotty dog can be seen in the _____ plane
"eye" "ears" "collar" |
oblique
pedicle ascending processes spondylolysis |
|
|
spondylolysis is---
|
pars interarticularis fx
|
|
|
spondylolisthesis occues when fx of ___ causes _____slippage of the _____ vertebrae on the ____ vertebrae
4x more common @ what segment compared to another? |
B pars interarticularis (scotty dog-spondylolysis)
anterior ; superior ; inferior l4-l5 vs l5-s1 |
|
|
tx of spondy's is _____-based
|
flexion
|
|
|
spinal stenosis:
feels better in _____, worse in _____ feels better walking _____ vs. _____ hill |
sitting , standing
up vs down |
|
|
how to distinguise between stenosis and vascular claudication?
|
positional vs onset with activity
|
|
|
most common pt complaint with cauda equina?
|
urinary retention
|
|
|
cauda equina can be caused by (2)
|
spinal stenosis and spondylolisthesis
|
|
|
juvenile kyphosis = _______ disease
caused by _____ of vertebral _______ ; segments usually affected? age group? |
scheuermann's
AVN of vertebral endplates T6-T12 ; young teenagers |
|
|
chronic inflammatory disease primarily affecting the axial skeleton ; ages ______; men or women? ; areas of pain? may be accompanied by wt loss and chest pain or fever?
|
ankylosing spondylitis
15-35 ; men LBP, SI pain yes |
|
|
most common scoliosis
|
single apex @ t7-t9
|
|
|
rotation coupling for scoliosis: involved SP rotated toward _______
|
concavity (rib hump)
|
|
|
stretch _____ side and strengthen _____ side of scoliosis
|
concave ; convex
|
|
|
SI mob if 3/4 of the following are +:
|
1. PSIS asymmetry
2. standing flex test 3. supine to long sit 4. prone flex test |
|
|
3 or more present you can use stabilization:
|
1.< 40 y.o.
2. avg SLR > 90 3. aberrant lumbar AROM 4. positive prone instability test |
|
|
what is gower's sign?
|
walking hands up legs: trying to unload the spine
|
|
|
(+) prone instability test
|
no pain with legs up because mm are stabilizing
|
|
|
CPR for failure of stabilization:
3 or more |
1. FABQ > or = to 9
2. no aberrant motion 3. (-)prone instability 4. no hypermobility with spring testing |
|
|
spinal manip has best outcomes within ____d of injury
(within 6 wk, better short term success but just okay overall) |
16
|
|
|
are multifidi and facet jts innerv by the same nn?
|
yes-- medial branch of dorsal ramus
|
|
|
if you ask a pt to lift an arm or leg, which side multifidi should fire first?
|
opposite!
|
|
|
______N = minimal risk of spine injury
________N =high risk |
< 3400
>6400 |
|
|
most compression to spine (what exercise?)
|
supermans
|
|
|
planks have high activation of what mm?
|
QL, obliques
|
|
|
directional preference: flexion syndrome means _____and extension syndrome means_____
|
flexion preferred
extension preferred |
|
|
SI ligament taut with counternutation
|
posterior SI ligament
|
|
|
counternutation is sacral ____
the base moves: the apex moves: |
extension
posterior-inferior anterior-superior |
|
|
nutation is sacral ______
|
flexion
|
|
|
nutation occurs with what lumbar, pelvis, and hip motions?
|
extension, anterior tilt, flexion
|
|
|
counternutation occurs with what pelvis, lumbar, and hip motions
|
posterior tilt, flexion, ext
|
|
|
the sacrum ____ @ end range with trunk flexion
|
extends (counternutates)
|
|
|
the sacrum_____ @ end range of trunk extension
|
flexes (nutates)
|
|
|
the ____ translates the opposite direction of the trunk during flexion and extension
|
pelvis
|
|
|
describe R on R sacral torsion
|
sacrum rotated anteriorly on R oblique axis, so the left sulcus is deep and the R ILA is more prominent
|
|
|
describe L on R sacral torsion
|
sacrum rotated posteriorly on R oblique axis so the L sulcus is shallow the the R ILA is less prominent
|
|
|
2 pubic structures that afford 40% of the pelvic rigidity
|
pubic symphysis and pubic rami
|
|
|
Pelvis fx-- describe each type and give an example
Type A: Type B: Type C: |
A: stable pelvic ring - iliac wing fx
B: unstable pelvic ring- open book fx with concommitant acetabular fx C: posterior SI articulation dislocation - requires fixation! |
|
|
mm to fix the following alignment issues:
anterior rotation: posteior rotation: inflare: outflare: R on R: |
hams, glutes @ 90 deg
hip flexors @ hip hyperextension adductors in FABER abductors in FADIR R piriformis |
|
|
excessive anteversion blocks ____ @the hip
|
ER
|
|
|
decreased anteversion decreases ____ @ the hip
|
IR
|
|
|
functional adaptation for excess anteversion?
|
in-toeing to increase congruency of the surfaces
|
|
|
what test positions the pt in prone, palapates greater tuberosity, and looks @ degrees of IR?
|
craig's test
>15 deg = excess anteversion < 8 deg = decreased antevesion kids: 15 deg |
|
|
name the 2 anterior hip ligaments
|
iliofemoral and pubofemoral
|
|
|
name the posteior hip ligaments
|
ischifemoral
|
|
|
which hip ligaments are taut in extension
|
ALL
|
|
|
which are taut in IR
|
ischiofemoral
|
|
|
which are taut in abduction
|
inferior Y of iliofemoral and pubofemoral
|
|
|
which are taut in adduction
|
superior Y of iliofemoral
|
|
|
how much flexion ROM @ hip needed for stairs?
|
70
|
|
|
flexion needed @ hip for gait?
|
10
|
|
|
arthrokinematics of the femur on the hip
flex/ext: IR/ER/AB/AD: |
spin
convex on concave |
|
|
arhthrokinematics of pelvis on femur
ant/post tilt AB/AD/IR/ER |
SPIN
concave on convex |
|
|
ipsilateral lumbo-pelvic rhythm
|
lumbar and pelvis in same direction (forward bend)
|
|
|
what n inner the short head of the biceps femoris?
|
common fibular n.
|
|
|
what n inner. adductor magnus hamstring portion?
|
tibial n
|
|
|
primary WB'ing zone in the acetabulum?
|
anterior-superior
|
|
|
JRF's in the body
walking stairs running stumbling |
2.4x
2.5x 5.5x 8.7x |
|
|
intertrochanteric line vs crest
|
line- anterior
crest- posterior |
|
|
clinical findings of hip OA
|
morning stiffness and pain gradual onset
deep pain in hip, groin, anterior thigh antalgic gait with lean toward painful side decreased ROM: IR > E > AB |
|
|
when is snapping hip "heard" or felt
|
45 deg flexion --> extension
|
|
|
when will pain be felt with iliopsoas bursitis?
|
ext PROM
|
|
|
test for snapping hip
|
FABER to EADIR
|
|
|
contents of femoral triangle from medial to lateral?
|
VAN
|
|
|
FAI: symptoms come on with what 2 hip motions during activity?
|
flexion and IR
|
|
|
describe CAM deformity vs Pincer deformity
|
CAM: neck bump
pincer: acetabular retroversion |
|
|
CAM causes injury to:
Pincer causes injury to: |
acetabular articular cartilage
labrum damage |
|
|
3 clinical tests for FAI
|
quadrant test, scour test, FADIR with axial compression
|
|
|
what 3 joint mobs @ hip increase flexion and IR
|
posterior, lateral, distraction
|
|
|
SS of labrum tear
|
anterior hip/groin pain, clicking, more acute, usually occurs with trauma
|
|
|
(+) tests for anterior labrum
|
click with thomas test, sharp catching pain with click on FABER to EADIR
|
|
|
lateral bursitis will have pain during what phase of gait
|
stance
|
|
|
etiology of external snapping hip
|
ITB over greater trochanter @ close to full extension
|
|
|
what special test will be positive for the ITB with external snapping hip?
|
Ober's
|
|
|
2 possible etiologies of posterior hip pain
|
labrum tear or piriformis syndrome
|
|
|
special test for posterior labrum pain
|
flexion.IR with axial load
|
|
|
prone test for rectus tightness
|
ely's
|
|
|
SC arthrokinematics
|
elevation and depression: convex clavical on concave strernum
retraction: concave clavicle on convex sternum |
|
|
orientation of humeral head vs orientation of femoral head?
|
humeral: medial, superior, posterior (retroversion)
femoral: medial, superior, anterior (anteversion) |
|
|
most mobile joint of all?
|
shoulder
|
|
|
GH ligaments--
restricts downward translation of the humerus with the arm at the side retstricts anterior translation below 90 restricts anterior translation above 90 restricts posterior translation above 90 restricted inferior translation above 90 |
superior GH lig
middle GH ligament anterior band of inferior GH ligament posterior band of inferior GH ligament axillary pouch of inferior GH ligament |
|
|
elevation = _____ jt + _____ jt regardless of plane
|
GH and ST
|
|
|
ST motion is _____ +_____
|
SC + AC
|
|
|
DOF of the ST joint?
|
5 (3 angular and 2 translational)
|
|
|
upward rotation of the scapula is accomplished by ____ @ SC jt and _____ @ AC jt
|
elevation
upward rotation |
|
|
primary elevator of the GH jt
|
deltoid
|
|
|
role of infre, subscap, and tere minor during elevation to 120 deg?
|
humeral head depression for surface congruency
|
|
|
describe force couple for elevation @ GH jt
|
supra + deltoid = superior translation force
ITS = inferior stabilizing |
|
|
at what angles does the low trap become an upward rotator?
|
above 60
|
|
|
3 roles of SA on elevation
|
upward rotation
external rotation of scapula posterior tilt of scapula |
|
|
upper trap role in elevation
|
clavical elevation and retraction
|
|
|
force couple for upward rotation during elevation?
|
trapezius + SA
|
|
|
what mm are opposites (neutralize each other) and create a medial force to prevent unnecessary protraction during elevation
|
rhomboids and middle/low traps
|
|
|
shoulder depressors
|
latissimus dorsi
pec major pec minor low trap |
|
|
greatest shear forces at what angles
|
30-60
|
|
|
open pack position of GH jt
|
55 AB 30 flex neutral otherwise
|
|
|
scapular dyskinesis:
type 1 vs type 2 vs type 3 |
abnormal motion @
horizontal (lower angle sticking out) vs vertical (medial border) vs saggital (superior angle sticking out) |
|
|
gold standard imaging for the shoulder
|
MRI
|
|
|
common area of referred pain from the RTC
|
deltoid insertion
|
|
|
type 1 vs type 2 vs type 3 acromion
|
straight, curved, hooked
|
|
|
few word to describe each type of impingement:
intrinsic primary extrinsic secondary extrinsic internal extrinsic |
aged collagen
biomechanics hypermobility pitchers cocking phase |
|
|
if these three things are positive, suspect tear
|
drop arm
ER weakness painful arc |
|
|
does cuff activation with exercise lead to increased blood flow?
|
yes
|
|
|
3 places where thoracic outlet might occur
|
interscalene triangle, costoclavicular space, subpectoral tunnel
|
|
|
extra rib sometimes comes from what part of what C spine segment?
|
C7 transverse process
|
|
|
good indication of TOS?
|
good reflexes with sensory disturbance
|
|
|
is loss of pulse with special testing thegold standard for TOS special tests?
|
no
|
|
|
Adson (looking toward affected side) test targets which of 3 areas for TOS?
|
interscalene
|
|
|
Wright/Allen test evals what area that may cause TOS?
|
costoclavicular
|
|
|
Roos special test evals what area that may cause TOS?
how to perform the Roos test? |
costoclavicular, functional
open, close fists @ 90-90 for 3 min |
|
|
when might a reverse total shoulder be indicated?
|
massive, irrepairable RTC
|
|
|
TSA or RTSA less probable for loosening?
which uses cement or screw? which is cementless and screw? |
RTSA
TSA RTSA |
|
|
which dx leading to TSA would you expect to be allowed to perform ROM early?
|
OA
|
|
|
RTSA: no lifting for ____ wk and ROM limited to __ ER and ____elevation for 3 mo
|
6 ; 0
90 |
|
|
phase 1:
2: 3: 4: |
inflammatory
repair remodel maturation |
|
|
ANKLE
stress the anterior tibiofibular ligament? |
DF + EV
|
|
|
stress anterior talofibular?
|
inverstion and PF
|
|
|
nwb ankle arthrokinematics @ talocrural kt
|
DF: talus glides posteriorly
PF: talus glides anteriorly |
|
|
talocrural close packed?
capsular pattern? |
DF
PF > DF |
|
|
calcaneofibular stressed with
|
eversion
|
|
|
subtalar inversion occurs by _______ glide of calcaneus
|
lateral
|
|
|
TTJ moves ______ subtalar in NWB
TTJ moves _______subtalar in WB |
with
opposite |
|
|
tibia ______ with supination and _____with pronation
|
ER ; IR
|
|
|
first ray DF during _____ to help _______
|
early MS to help put the foot on the ground
|
|
|
in normal mechanics, do the midfoot and forefoot follow each other or go opposite?
|
follow
|
|
|
when will they do opposite?
|
is TTJ is hypomobile
ex: excessive pronation @ TTJ = supination twist @ forefoot to keep the lateral border on the ground |
|
|
need at least _____ deg @ 1st MTP joint for walking
|
65
|
|
|
how does the COP move across the foot thru stance phase?
|
heel to toe, lateral to medial
|
|
|
relationships of 3 things lead to estimations of joint movement
|
gravity, GRF, COP
|
|
|
% time in stance and % time in swing
|
60, 40
|
|
|
describe loading response
|
HS --> FF
|
|
|
describe weight acceptance
|
IC + LR
|
|
|
periods of DL support?
|
LR and PreSw
|
|
|
% stance and % swing in running
|
40-60
|
|
|
increase speed by increasing :
|
step length and cadence
|
|
|
cervical enlargement @ what segments?
lumbosacral enlargement @ what segments? |
C5-T1
L2-L3 |
|
|
where is the cell body of sensory information?
|
dorsal root ganglion (PNS)
|
|
|
where is the cell body of the motor information?
|
anterior/ventral horn of the SC
|
|
|
areas of the brain damaged in PD vs Alz.
|
BG vs hippocampus
|
|
|
hippocampus function?
|
facts (declarative memory)
|
|
|
where at the cerebral peduncles located?
|
midbrain
|
|
|
where are the cerebellar peduncles locared?
|
pons
|
|
|
which tract definitely goes through the cerebral peduncles?
|
corticospinal
|
|
|
what responsbility does the olive of the medulla have?
|
motor learning
|
|
|
where are the pyramids located?
|
medulla
|
|
|
only cranial nerve that exits dorsally vs ventrally?
|
trochlear n.
|
|
|
origin of all descending motor pathways except the corticospinal?
|
brainstem
|
|
|
resting membrane potential in a healthy cell
|
-65 mV
|
|
|
in a resting membrane
K+ is ____ Na+ is _____ Cl- is ______ |
inside
outside outside |
|
|
what kind of pump regulates Na+/K+
|
active transport
3K+ in and 2 Na+ out |
|
|
due to concentration gradients, what moves into the cell?
|
Na+
|
|
|
due to electrical gradients, what moves out of the cell?
|
Na+ and K+
|
|
|
most common type of synapse
|
axodendritic
|
|
|
briefly describe events at a synapse
|
AP reaches presynaptic terminal, Ca released, vesicles move toward presynaptic terminal, neurotransmitter released in cleft, cross cleft and bind to ligand-gated channels, channels open and ions enter post-synaptic cleft
|
|
|
does EPSP or IPSPs make depolarization more likely?
|
EPSP
|
|
|
if it is an EPSP, permeability to what ion increases?
|
Na+
|
|
|
if it's an IPSP, permeability to what increases?
|
Cl- or K+
|
|
|
why doesn't increased permeability to K+ cause depolarization?
|
increased K+ permeability means that K+ will flow out d/t concentration gradients
|
|
|
2 kinds of summation?
|
temporal, spatial
|
|
|
where does the AP actually occur?
|
axon hillock
|
|
|
why is the axon hillock where an AP occurs?
|
high Na+ concentration causes passive potentials
|
|
|
what # is threshold?
|
+15 mV OR -50 mV typical
|
|
|
what happens when threshold is reached?
|
Na+ voltage gates channels open
|
|
|
when do K+ channels open when an AP is happening?
|
+ 50mV
|
|
|
which way does the K+ flow?
what kind of polarization is happening? |
OUT
repolarization |
|
|
during the absolute refractory period, which channels are closed and which channels are open?
|
Na+ CLOSED
K+ open |
|
|
a neurotransmitter can behave differently from one instance to the next depending on what?
|
receptor that it binds to
|
|
|
are each of the following excitatory or inhibitory?
ACh GABA glutamate |
excitatory
inhibitory excitatory |
|
|
name that glial cell:
form myelin in the CNS form myelin in the PNS buffer synaptic environment, form scar tissue after trauma neuroimmune cells of CNS, phagocytic, inflammation |
oligodendrocytes
schwann cells astrocytes microglia |
|
|
sensory system--
first order cell body is where? 2nd order afferents do what? 3rd order usually where and project to _____ |
dorsal root ganglion
decussate thalamus brain |
|
|
3 types of nociceptors
|
chemo- thermal- mechano-
|
|
|
what structure is each sensory action associated with?
A-alpha1a a-alpha 1b a-beta II a-delta and c |
spindle
GTO discriminative touch pain and temp |
|
|
if you have a larger generator potential, APs will fire ______
|
more frequently
|
|
|
how is the generator potential formed?
|
receptor potentials summate and exceed threshold
|
|
|
slow adapting receptors are on ____
fast adapting receptors are on ______ |
as long as a stimulus is present
when a change in state occurs |
|
|
somatosensory receptors detects (3) changes
|
thermo- mechano- chemical
|
