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Where would a fracture of the humorus be most likely to occur? What would be damaged and what with the outcome be?
At the surgical neck, damage to the axillary nerve, preventing shoulder abduction from 15° to 90°
Know the arm mms, nuns, and arteries
See power point
Know the Brachial Plexus
Graves Disease
Think Hyperthyroid
Metabolic Syndrome
-AKA Syndrome X: Think Pre-diabetes
-A cluster of risk factors that increases the likelihood of developing heart disease, stroke, and type two diabetes
-Criteria for diagnosis in 3 or more of the following:
1. abdominal obesity: waist size 35"+for women or 40"+ for men
2. cholesterol: elevated triglycerides 150+ mg/dL or using cholesterol medicine
3. cholesterol: low HDL-CHOLESTEROL; <40 mg/dL for men and <50 mg/dL for women or using cholesterol medicine
4. High BP: systolic 135+ mmHg or diastolic 85+ mmHg
5. blood sugar: fasting plasma glucose level 100+ mg/dL
– Etiology: no one cause, a collection of risk factors
– Incidences: up to 1 in 4 adults, more common in older adults, individuals prone to blood clots and inflammation, may run in families
– Treatment: management of risk factors
Duchenne's muscular dystrophy
-X – linked recessive, inherited by boys, carried by recessive gene of mother.
-Diagnosis confirmed my clinical examination, EMG, muscle biopsy, DNA analysis, and blood enzyme levels
-District in Jean missing results in increased permeability of sarcolemma and destruction of muscle cells
– Collagen, adipose laid down in muscle leading to pseudohypertrophic calf muscles
-Impairments:
1. Progressive weakness from proximal to distal the beginning at 3 years of age to death in adolescence or early adulthood
2. positive GOWER'S SIGN due to weak quadriceps and gluteal muscles; children must use UEs to "walk up legs" and rise from prone to standing
3. Cardiac tissue also involved.
4. Contractures and deformities developed due to muscle imbalance, especially of heel cords and TFL, as well as lumbar lordosis and kyphoscoliosis
-functional limitations:
1. Developmental milestones may be delayed
2. Ambulation ability will be lost, necessitating eventually use of WC
3. Progressive cardiopulmonary limitations
-examination for muscular dystrophy
1. Muscle strength – MMT, dynamometer
2. Active and passive ROM
3. Functional testing
4. Skeletal alignment – check for lordosis, scoliosis, kyphosis
5. respiratory function, chest excursion during reading or spirometer
6. Assess need for adaptive equipment – Interventions, goals and prognosis
1. Maintain mobility as long as possible by encouraging recreational and functional activities to maintain strength and cardio pulmonary function
2. Maintain joint ROM with active and passive ROM exercises, and positioning devices, such as from standers were standing frames. Gastrocnemius and TFL shorten first. Night splints maybe used
3. Electrical stimulation of muscles for younger children may increase contractile ability
4. educate and support parents and family manner
5. Do not exercise at maximum level – may injure muscle tissue through an overwork injury
6. supervise use of adaptive equipment as needed
7. Disease is progressive, leading to respiratory insufficiency and death and young adult hood
– Medical surgical management
1. Palliative and supportive, treating symptoms as they occur
2. Steroids increased life expectancy by decreasing pulmonary dysfunction. Antibiotics for pulmonary infections
3 orthopedic surgery for scoliosis – spinal instrumentation, muscle lengthening of gastrocnemius
Beckers muscular dystrophy is a slower variant of DMD – emerges in late childhood or adolescence; cease walking around 27 years of age and death at approximately 42 years of age
Differential Dx for Claudication
Cushing's Syndrome
Think Hypercortisolism
-metabolic disorder resulting from chronic and excessive production of cortisol by the adrenal cortex
-from drug toxicity – over administration of gluco-corticosteroids
-Etiology: most common cause is a pituitary tumor with increased secretion of ACTH
-signs and symptoms:
1. Decreased glucose tolerance
2. Round "moon" face
3. Obesity: rapidly developing fat pad on chest and abdomen; "buffalo hump"
4. Decreased testosterone levels or decreased menstrual periods
5. Muscular atrophy
6. Edema
7. Hypokalemia
8. Emotional changes
-medical interventions: goal is to decrease excess ACTH: radiation or surgical XVision a pituitary tumor or control of medication levels
and monitor weight, electrolyte, and fluid balance
Research Pyramid
SRC CCC II
http://www.slideshare.net/uqumrc/brief-introduction-to-different-types-of-studies?qid=b994563c-7243-4643-b4ad-11da63f2238e&v=qf1&b=&from_search=1
Strength of Evidence
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