Foudations 1 Part 1

Front 1

There are 4 etiological factors of joint dysfunction:

Back 1

Trauma (macro trauma or repeated microtrauma)
• Sustained postures
• Immobilization
• Following the resolution of a more serious pathological condition

Front 2

Stanley paris joint dysfunction definition

Back 2

A state of altered mechanics, either an increase or decrease from the expected normal, or thepresence of an aberrant motion (Paris)

Front 3

Menell's amount of joint play theory

Back 3

The amount of joint play is less than 1/8 inch

Front 4

Characteristics of a single hypomobile segment:
(5)

Back 4

Loss of physiological motion
• Loss of accessory motion at the involved segment
• Increased pain at endrange
• Tissue texture abnormalities
• Presence of positional faults

Front 5

Characteristics of a single hypermobile segment:

(7)

Back 5

• Increased segmental mobility
• Full general spine mobility (may be limited if muscle guarding is present)
• Pain produced by prolonged stretch
• Muscle stiffness follows prolonged stretching
• Muscle stiffness relieved by exercise or movement
• Ligamentous tenderness in the accessible ligaments
• Joint predisposed to joint locking

Front 6

Panjabi and White (33) define clinical instability as follows:

Back 6

The loss of the ability of the spine under physiological loads to maintain its pattern ofdisplacement so that there is no initial or additional neurological deficit, no major deformity, andno incapacitating pain.

Front 7

Neutral zone

Back 7

a small range of movement near the joint’s neutral position where minimalresistance is given by the ligamentous structures.

Increased neutral zone may be a good indicator of hypermobility. Size of the neutral zone increases with injury.

Front 8

Synarththroses

Back 8

bony connections, named for the type of tissue that connects them

Front 9

Syndesmosis

Back 9

fibrous tissue (interosseous membrane between radius and ulna)

Front 10

Synostosis

Back 10

bone (sutrues in cranium)

Front 11

Symphysis

Back 11

fibrous cartilage

Front 12

shoulder cpp; rp

Back 12

Abduction and ExternalRotation

55 degrees abduction, 30degrees horizontal adduction

Front 13

ulnohumeral cpp: rp

Back 13

Extension

70 degrees flexion, slightsupination

Front 14

radiohumeral cpp; rp

Back 14

90 degrees flexion, 5 degreessupination

Full extension/supination

Front 15

wrist

Back 15

Dorsiflexion and RadialDeviation

Neutral, slight ulnar deviation

Front 16

MCP 2-5

Back 16

full flexion

semi flexion

Front 17

IP

Back 17

extension

semiflexion

Front 18

first cmc

Back 18

Full opposition

Neutral position of thumb

Front 19

hip

Back 19

Extension, Internal rotationand Abduction

30 degrees flexion, 30 degreesabduction, 20 degrees ER

Front 20

knee

Back 20

Full extension 25 degrees flexion

Front 21

ankle

Back 21

Dorsiflexion Neutral position

Front 22

tarsal joint

Back 22

Full supination

Semiflexion

Front 23

MTP 1

Back 23

Dorsiflexion

Neutral position

Front 24

MTP 2-5

Back 24

Flexion

Neutral position

Front 25

vertebral

Back 25

extension;

neutral position

Front 26

Cervical, thoracic and lumbar spine

Back 26

extension, sb, and rotation are equally limited

Front 27

OA joint cap pattern

Back 27

ext, sb are equally limited

Front 28

c1- c2 cap pattern

Back 28

equal limitation of rotation

Front 29

GHJ

Back 29

ER, Abd, IR

Front 30

ac, sc

Back 30

pain at end range or movement

Front 31

elbow

Back 31

flexion, extension

Front 32

wrist

Back 32

flexion and ext equally limited

Front 33

first cmc

Back 33

abd, ext

Front 34

mcp and IP

Back 34

flexion then extension

Front 35

mcp and ip

Back 35

flexion, extension

Front 36

hip

Back 36

flexion, abd, ir, although sometimes IR is most limited

Front 37

knee

Back 37

flexion, extension

Front 38

TC joint

Back 38

pf, df

Front 39

subtalar jt

Back 39

decreased varus

Front 40

red flags- name 5

Back 40

- Violent trauma
o Constant, progressive, non-mechanical pain
o Previous history of cancer, systemic steroids, drug abuse or HIV
o Systemically unwell
o Widespread neurology
o Structural deformity
o Presentation age <20 years or >55 years
o Signs of infection (temp>100 degrees, BP>160/95, resting pulse> 100/min,
resting respiration >25/min)

Front 41

8 signs indicative of serious pathology

Back 41

1. A patient who presents with a back ache, having a history of malignancy during the
previous 2 years, must be assumed to have secondary malignant deposits in the
spine until this is proven otherwise, even though the onset is mild and the signs and
X-rays are negative.
21
2. When the onset of back pain is late in life, without any previous history of back
symptoms, the patient is more likely to have osteoporosis or secondary deposits
than some simple mechanical fault.
3. When there is serious loss of spinal function, or shock, or vomiting after trivial
spinal injury or strain, the patient is likely to have a pathological fracture of the
spine.
4. Severe pain, deformity and muscle spasm in areas of the spine other than the lower
cervical and lower lumbar regions should arouse suspicion of disease. For example,
a lateral shift in the thoracic spine is never a result of a simple movement
dysfunction.
5. Constitutional signs, which accompany back pain, suggest disease (fever,
unexplained weight loss >10 lbs, malaise and excessive weakness).
6. Loss of power that is too widespread to be accountable by a single nerve root lesion
suggests neurological disease.
7. Loss of sphincter control is never due to simple mechanical causes.
8. Continuous pain unrelated to posture is unlikely to be mechanical in origin.

Front 42

Mobilization/manipulation CPR

Back 42

Mobilization/manipulation
More recent onset of symptoms (<16 days)
Hypomobility at any level
Not having symptoms distal to the knee
FABQ work subscale score <19
Hip IR with 1 or both hips > 35 degrees
Diagnostic accuracy: reference standard for success with spinal manipulation
When at least 4 of the 5 criteria were met: +LR =13.2
When only 1 or 2 of the criteria were met: -LR = .10

Front 43

s/s of traction

Back 43

Symptoms
Radiating pain below the knee
Weight bearing worsens pain
Better with non-weight bearing
Signs
Both flexion and extension peripheralize pain
Positive neurological signs, with a + crossed SLR present
Postural deviations that can’t be corrected conventionally

Front 44

Stabilization prediction signs

Back 44

Age less than 40 years
Average SLR >91 degrees
Positive prone instability test
Aberrant motion present
Reference standard for success with a program of lumbar stabilization exercises:
When at least 3of the 4 criteria were met: +LR = 4.0
When only 1 of the 4 criteria was met: -LR =.20
When only 2 of the 4 criteria were met: -LR = .30

Front 45

4 building blocks of collagen

Back 45

water- ground substance- collagen fibers- fibroblasts

Front 46

ground substance made up of 2 macro-molecular complexes

Back 46

glycoproteins

proteogylcans

Front 47

metabolic turnover rate of ground substance

Back 47

2-10

Front 48

metabolic turnover rate of collagen fibers

Back 48

approx 300 days

Front 49

inflammatory phase

Back 49

With connective tissue injuries, bleeding in the tissue usually takes place. After the bleeding isstopped, the inflammation process gets started. Depending on the severity of the injury, this canlast from 1 to several days. The inflammation activates the fibroblasts in the injured area. Therewill be increased permeability of the capillaries, which leads to edema in the tissue. White bloodcells infiltrate the area. The goal of this inflammatory phase is to clean up the injured tissue andactivate the cells necessary for repair.

Front 50

proliferation phase

Back 50

With the activation of the fibroblasts, the healing process gets started. This usually happens 4-5days after the injury. There is a strong proliferation of capillaries, which together with thefibroblasts invade the wound. Together they form granulation tissue. There is a fast accumulationof new collagen fibers. The newly formed scar tissue is still weak. Wound contraction is takingplace.

Front 51

maturation phase

Back 51

This phase can last from several months to more than a year. There is continued synthesis ofcollagen fibers, albeit slowly. The strength of the scar tissue is being adapted to the demandsbeing put on the tissue. The collagen fibers are being oriented according to the lines of stress.This is a lengthy process.

Front 52

rate of healing in first 2 weeks

Back 52

50% in the first 2 weeks

Front 53

rate of healing in first 6 weeks

Back 53

80% in the first 6 weeks

Front 54

rate of healing in first 12 weeks

Back 54

100%

Front 55

high reactivity

Back 55

pain is felt before restriction; oscillations

Front 56

moderate reactivity

Back 56

pain is felt with restriction; oscillate-stretch-oscillate

Front 57

low reactivity

Back 57

stretch

Front 58

remodeling is influenced by:

Back 58

MotionBlood supply and oxygen supply to the injured tissueVitamin CAdequate protein intakeAnti inflammatory drugs

Front 59

scar formation chart:

scar tissue remains stretchable for how long?

Back 59

8-10 weeks

Front 60

scar tissue shrinkage completed when ?

Back 60

6-12 month

Front 61

wound closure for tendons and ligaments completed when?

Back 61

3-5 weeks

Front 62

wound closure for skin and muscle completed by?

Back 62

5-8 days