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361 Cards in this Set
- Front
- Back
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who is at higher risk for RTC tears
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welders, w/c pushers
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where are the majority of clavicle fx?
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middle
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which shoulder action is for power
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adduction (pect major and lat dorsi)
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innervation of lat. dorsi
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thoracodorsal n. (post cord)
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what bone is key to powerful adduction
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clavicle
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what bone is key to glenohumeral stability?
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scapula
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which synovial joint attaches the pect girdle to the trunk
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sternoclavicular joint
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whats the strongest stabilizing factor at the ac joint
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coracoclavicular ligament
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what are four mechanical attributes of the sholder
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motion stregnth stability and smoothness
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what are the four impairments
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stiffness, weakness, instability, roughness
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whats a ddx of anterolateral shoulder pain
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subacromial bursitis, bicipital tendonitis, ac joint arthiritis, rtc tear/tendonitis
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three diseases that affect the DIP
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OA, gout, psoriatic arthritis
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red hands, red face, weak muscles
boutrons papules, erythematous nail beds |
dermatomyositis
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what are three reasons for joint pain
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mechanical inflammator and fibromyalgia
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are deep bursae attached to the synovial joints
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they can be, but abnormal if goes into subacromial bursae
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most common cause of hip pain is
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trochanteric bursitis (deep and superficial)
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where do you palpate an elbow effusion
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posterolateral elbow
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whats the location of the DRG?
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outside the cns but within the neural foramen
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nerve root dermatome to the thumb is?
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C6
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myotomes of shoulder flexors and abductors
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c5c6
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myotomes of shoulder adduction and extensors
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c7c8
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long finger flexors and extensors
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c7c8
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wrist flexion extension
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c6c7 (c8 for flexion)
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hand intrinsics
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c8t1
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which branch of spinal nerve innervate the paraspinal muscles
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dorsal primary ramis
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are there any parasympathetic fibers in the spinal nerves?
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pelvic parasympathetics (S2,3,4)
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suprascapular nerve palsey presents with?
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weakness of external rotation and shoulder abduction, normal reflexes
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what roots are involved in erb-duchene's palsy
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c56
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why does erb's duchene present with waitors tip?
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weak should flexors, abductors, elbow flexors, extensors of wrist affected more and supinator weak
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main nerve off the lateral cord
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musculocutaneous n.
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main nerve off the median cord
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ulnar nerve
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what is klumpke's palsy
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brachial plexopathy due to distraction away from body wall affecting C8T1
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Where does T1 provide sympathetics
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Face...if injured causes ptosis, anhydrosis
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what do you get with a C8T1 injury?
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Klumpke's and corresponding horner's because of the interrupted sympathetics to the face from T1
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cause of wrist drop?
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radial nerve injury, likely humeral fracture
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what does radial nerve innervate
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wrist extensors and finger flexors
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why is the triceps spared in radial nerve injury du to humeral fracture?
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Branches have already come off
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how to differentiate posterior cord injury vs radial nerve injury
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check shoulder abduction and extension, if weak, its post cord injury
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which way do most scoliotic curves go?
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right, left is less common but more problematic
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at what degree do you start thinking about treating?
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~30
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what levels do compression fx most commonl occur
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T7/8, T12/L1 because of greatest anterior forces applied at these levels
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what are the common levels of spondylolytic lesions?
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lumbar spine, L5>L4>rest of l-spine
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What leads to spondylolysis
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pars defect
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what are risk factors for spondylolysis
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genetics and repeptive high stress activities
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what part of the disc is the shock absorber
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annulus fibrosus
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where are cervical radics most common?
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C6c7 involving and most common is C7
but all levels cause pain at the base of the neck and interscapular pain |
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what is lhermitte's test/sign
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flx neck and get electrical pain down the arms/legs due to cord traction
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why are burst fractures so bad?
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retropulsion of bone into the canal
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in the three colomn model of spine stability, what makes up the middle colomn?
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post. vertebral body, annulus fibrosus, PLL
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What myotomes are for knee extension and flexion
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L3L4 extension and flexion is L5S1
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what are the three main nerves of the lumbar plexus
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femoral, obturator, and lat. fem cutaneous
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what nerve can be affected with a medial approach knee arthroscopy?
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saphenous nerve
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What are the major named nerves that branch from the roots of the lumbosacral plexus
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pudendal (S234), parasympathetics, posterior cutaneous nerve of the thigh (primarily S2)
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how do you distinguish between L5 radic and fibular nerve palsy
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motor-hip extensors and knee flexors and ankle dorsiflexors are affected in L5 radic, as well as the paraspinals
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what nerve injury gives you a trendelenberg gait
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superior gluteal nerve innervating glut medius/minimus
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what type of joint is the symphysis pubis?
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fibrocartilaginous joint
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what type of joint is the SI joint
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synovial joint
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name three anatomic variations that result in in-toeing
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excessive femoral anteversion, internal tibial torsion. metatarsus adductus,
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what position of the hip is most stable and why?
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most stable in extension and internal rotation, the capsule is taught and spiral'd fibers
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signs of osteoarthritis of a joint on xr
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osteophytes, sclerosis, narrowed joint space
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most common carpal bone fractured?
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scaphoid
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most common carpal bone dislocated
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lunate
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injury to which structure leads to mallet finger?
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avulsion of the extensor hood of the terminal slip
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injury to which structure typically leads to the boutonniere's deformity?
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rupture of the central slip at the pip
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what structure is injured to get a swan neck deformity
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capsule and palmer plate
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what group of muscles extend the MCPs
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Long extensors of the forearm
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What group of muscles extend the PIP and DIP
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intrinsics (lumbricles and interossei)
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what is the most common cause of hip pain
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trochanteric bursitis
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what are three common causes of anterior knee pain?
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osgood schlatters, patellofemoral dz, and
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what major factors prevent the patella from dislocating laterally
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bones, patellofemoral ligaments, quad insertion especially vastus medialis (which holds the patella medially)
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what is the Qangle?
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line from ASIS to midpoint of patella and line from tibial tubercle to patella, abnormal if angle>20degrees
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why is the medial meniscus injured more than the lateral meniscus
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because the medial meniscus is less mobile due to the attachment to the medial collateral ligament
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name the four ligaments of the knee
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post/ant. crusiate ligament, med/lat collateral ligament
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what is valgus stress on a joint
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stress on a joint towards midline with the distal portion of the limb moving away from midline
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what does the ACL do?
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resists hyperextension and resist internal rotation, resist forward translation of tibia on femur
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women in jumping sports tend to injure which ligament
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ACL
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what are the six P's of acute compartment syndrome
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pain, paresthesia, paralysis, pallor, pulselessness, "phrio" cold
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after stroke, UE synergistic patterns are more commonly extensor or flexor?
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UE Flexor, LE is extensor
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what is a poor prognostic factor after stroke
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no recovery within 3 weeks, motion in one segment is not followed by another within 1 week
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after stroke, what is poor prognosis for arm recovery
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complete arm paralysis after stroke, and no grip strength at 4 weeks
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prognisis for walking after stroke
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Barthel index>50 will walk, <20 unlikely will walk, LE 3/5 strength within 1 week of stroke will walk
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vision defect, hemianopsia prognosis after stroke
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if no recovery after 3 weeks, poor prognosis
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recovery prognosis of aphasia after stroke
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depends on the size of stroke, recovery is usually slow and lasts longer (can last longer than 1 year) and recovery is variable
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what class of medication should you choose for bladder dysfunction post stroke
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alpha-blocker
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What is a more common cause of shoulder pain than subluxation
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loss of external rotation
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what can you use to help reduce pain and subluxation in the shoulder post stroke?
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NMES
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what is the gold standard to dx CRPS
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triple phase bone scan
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what are some beneficial meds in post stroke patients for recovery
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dextroamphetamine, methylphenidate, amantadine levodopa, bromocriptine
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post stroke fatigue meds
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ritalin, provigil
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how does brunnstrom therapy in post stroke work?
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incorporate synergies into adaptation and recovery
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describe trasncortical mtor aphasia
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slow rate, some fluency, GOOD REPETITION, stroke usually in area anterior/superior or deep to broca's
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what is global aphasia
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Broca's and Wernicke's affected, poor auditory comprehension and reading and writing
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what is wernicke's?
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fluent aphasia, poor comprehension but good articulation, lacks nouns and verbs
stroke usually in area of posterior portion of 1st temporal gyrus |
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What is anomia
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Very high level of function but have some word finding difficulty
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Prognosis of phasia?
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good if mild syndrome, young age at onset, higher education level, type of aphasia (comprehensive defecits improve better than motor), left handed, small lesion size, motivation
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what are some medication that can be used to help aphasia recovery?
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Dopamine (good for PD), Bromocriptine,
norepi, amphetamines, ritalin, provigil.. all have weak evidence |
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What is apraxia
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its not a language or weakness issue, just cant plan the motor muscles to produce the words (say Doffee instead of Coffee because they cant make the "K" sound))
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how to tell between apraxia vs dysarthria
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get better with practice, inconsistent errors, difficulty with initial consonants
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Prognostic factors of apraxia
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good if no previous brain damage, small lesions, no other comorbidities, rapid rate of recovery
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describe trasncortical mtor aphasia
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slow rate, some fluency, GOOD REPETITION, stroke usually in area anterior/superior or deep to broca's
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what is global aphasia
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Broca's and Wernicke's affected, poor auditory comprehension and reading and writing
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what is wernicke's?
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fluent aphasia, poor comprehension but good articulation, lacks nouns and verbs
stroke usually in area of posterior portion of 1st temporal gyrus |
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What is anomia
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Very high level of function but have some word finding difficulty
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Prognosis of phasia?
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good if mild syndrome, young age at onset, higher education level, type of aphasia (comprehensive defecits improve better than motor), left handed, small lesion size, motivation
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what are some medication that can be used to help aphasia recovery?
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Dopamine (good for PD), Bromocriptine,
norepi, amphetamines, ritalin, provigil.. all have weak evidence |
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What is apraxia
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its not a language or weakness issue, just cant plan the motor muscles to produce the words (say Doffee instead of Coffee because they cant make the "K" sound))
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how to tell between apraxia vs dysarthria
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get better with practice, inconsistent errors, difficulty with initial consonants
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Prognostic factors of apraxia
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good if no previous brain damage, small lesions, no other comorbidities, rapid rate of recovery
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in an mca stroke, what part of the body is affected most
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motor and sensory abnormalities in the Arm>>leg
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lacunar stroke in posterior circulation is purely...?
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sensory, in the thalamus
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When is carotid stenosis symptomatic
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in anterior circulation, stenosis >70% is may need a CEA
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Cerebral hemorrhage greater than what size should be considered for rapid surgical removal
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bleeds greater than 3cm
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In a post stroke patient with history of GI bleed, what antiplatelet med would you put them on?
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Place on plavix, avoid aspirin
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what can cause increased insertional activity on EMG?
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denervation, myopathy, normal variant
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decreased insertional activity may be due to
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fat, fibrosis, or not in muscle
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what motor units are first recruited
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small, type1 fibers, with larger type 2 fibers later recruited
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what is normal recruitment frequency in the limbs
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7-14hz normally, (10hz)
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what is recruitment interval
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time interval between 2 consecutive discharges of the the same motor unit at the time motor unit 2 starts to fire
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what is recruitment ratio
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firing rate of fastest-firing motor unit divided by # of different motor units seen (normally is about 5)
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what is te recruitment ration in myopathic an neuropathic recruitment
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myopathic is decreased ration and neuropathic ratio is increased
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what is the recruitment interval in neuropathic disorder
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decreased interval which means a decreased number of motor units firing at a rapid rate (same as decreased, delayed, late)
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describe neuropathic motor units
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polyphasic (>4phases), large amplitudes, increased duration
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myopathic motor units have what kind of recruitment
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early recruitment/increased/decreased frequency
multiple motor units fire faster than expected small amplitude |
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when is spontaneous activity normal?
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end plate activity, fascics when isolated
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what kind of firing pattern to end plate spikes have
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usually neg deflection and highly irregular
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do spontaneous potentials indicate only denervation/axonal lesions?
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no, can also be seen in myopathies, doesnt distinguish axonal versus muscle pathology
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where do most myopathies present with psw/fibs? axonal lesions?
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myopathy is predominantly proximal and axonal lesions are in a single nerve distribution
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what do CRDs indicate?
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a uniform pattern, indicates old/chronic pathology
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myotonic discharge is different from CRDs because...?
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wax and wane in amplitude and frequency (reving engine) arises from muscle fibers
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what are myotonic discharges associated with?
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waxing and waning in amplitude and frequency seen in myotonic dystrophy, etc
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what are myokymic discharges?
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repetitively firing groups of motor units burst-pause-burst-pause
(CRDs are single muscle fibers firing) |
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what findings indicate chronic/old pathology
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CRDs, small amplitude spontaneous activity, initially satellite potentials and eventually GIANT Motor Units
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When do spontaneous activity show up?
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around 7-10 days, and at 2-3% of axons lost
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what are the common features of CRPS type 1 and 2
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pain is spontaneous or evoked, allodynia/hyperalgesia, pain is disproportionate, no other cause for pain, regional, evidence of edema, skin changes, abnormal sudomotor activity (sweating)
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Differences between CRPS 1 and 2
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type 1 occurs after an initial noxious event other than nerve injury, where as type 2 occurs after nerve injury
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best way to dx CRPS?
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no gold standard, its a clinical dx, but can do bone scan
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what is stage 1 of RSD
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weeks to months, allodynia, skin is variable hot/cold, hair/nail growth is increased, swelling
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what is stage 2 of RSD
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3-6months, limb pain spreads diffusely, brawny edema, nails split and decreased growth
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what is stage 3 of RSD
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pain is persistent but maybe less intense, muscle atrophy and osteoperosis, irreversible trophic skin changes, skin is pale, cool, cyanotic
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diagnostic tests for RSD
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xray, bone scan, skin thermography, sweat test, response to sympathetic blockade
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what findings do you get on phase 3 bone scan for rsd
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diffuse increased activity with juxta-articular accentuation uptake on delayed images
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What emg/ncs findings do you get in rsd?
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no specific finding, but may find a peripheral nerve injury pointing towards a CRPS type 2 due to a definable nerve lesion
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what are the components of a motor unit
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anterior horn cells, axons, nmj, all innervated muscle fibers
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what happens in NCS, when reference electrode and recording tissue are too close together/on the same muscle
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low amplitude due to phase cancellation
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in ncs, what is latency?
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time interval between stimulation to recording
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On NCS, what effects do you get from a cool limb
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prolonged distal latencies, decreased NCV, increased amplitudes of CMAP and SNAP
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what is orthodromic stimulation?
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conduction along the physiologic direction
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what are the filter settings for motor NCS?
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low frequency filter 2-10hz, and high freq filter is 10kHz
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What are filter settings for sensory ncs?
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Low freq: 2-10Hz
High Freq: 2-10kHz |
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what has the better prognosis in ncs neuropraxia/axonotmesis/neurotmesis
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neuropraxia with recovery in weeks to months, most within 3 months
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describe type 1 muscle fibers
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RISOR: red, type 1, slow, oxidative, resistant (to fatigue)
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what is hypertrophy of muscle fibers
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increased volume per single muscle fiber (not an increase in the number)
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describe myopathic motor units
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brief, small, abundant, polyphasic potentials (BSAPP)
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what is the chief cause of death in those with myopathies
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usually pulmonary
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what are classic emg findings in dermatomyositis/polymyositis
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increased insertional activity and fibs, myopathic motor unit potentials, CRDs
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what is muscle cell membrane conduction velocity?
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3-5 m/s
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what are some presynaptic NMJ disorders
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eaton-lambert syndrome, botulism
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what are postsynaptic NMJ disorders
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Myasthenia gravis
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at what temp are the maximum number of ach quanta released?
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20degrees
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what is the most sensative test for MG
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SFEMG
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what is MG?
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post synaptic disorder with a defect in the Ach receptors
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why do patients get stronger with repeated effort?
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keep calcium inside the terminal releasing more quanta(ach)
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what is the most common neoplasm that patients with Lambert Eaton have?
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small cell ca of lung
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on emg, if you see weakness, what test should you always try to do?
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F-wave
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what do routine NCS show on eaton lambert syndrome?
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normal sensory
very low CMAP with norm velocity amplitude improves with repeated supramax stim or muscular contraction |
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a concentric needle picks up signals from how many degrees? what about a monopolar needle?
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field of 180 degrees
monopolar is 360 degrees |
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what is the common mode rejection ratio
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Gain of non inverting (gain of non inverting - Gain of inverting)
it is usually 10000 so any difference between the two is amplified 10,000x |
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what would you expect to see in a SNAP if you raise the low frequency filter
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decrease amplitude, shorten peak latency (phase lead),
shortens negative spike duration, increases number of phases, slow rate of return to baseline |
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what would you expect to see in a SNAP if you lower the higher frequency filter
|
delayed onset delay, peak latency delay, mild amplitude reduction, longer negative spike duration
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what is the typical classic triad of a periph polyneuropathy?
|
sensory changes in glove/stocking distribution, distal weakness, hyporeflexia
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wallerian degen takes how long to complete
|
around 7-10 days.
CMAPs drop around 5 days SNAPs lag because no NMJ |
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nascent potentials are seen when?
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on emg when regenerating nerve fibers reach out to denervated muscle fibers
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what is required for myelin regeneration?
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intact axon
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what kind of polyneuropathy is uniform demyelinating
|
congenital hypomyelinating neuropathy
like HSMN/CMT type 1/3/5 (AD, with ch 17 and ch 1 duplication) |
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what do you see on edx of HSMN 1/CMT 1
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uniform slowing (typical CV is <60% of LLN) but good CMAP preservation;
fibs and psw in 1/3 - 1/2 of cases with neurogenic findings |
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What do yo need to look for with edx testing for AIDP
|
need 3 of 4:
1)dec. conduction velocity in more than 2nerves 2)partial conduction block in 1 or more nerves 3)increased distal latency in more than 2 nerves 4)abn fwaves |
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which root is most commonly affected in cervical radic?lumbar radic
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C7
L5 closely followed by S1 |
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AANEM guideline to test for single level radic require?
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at least one motor nerve and one sensory nerve
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why do you get normal sensories in radics?
|
most of the pathology is proximal to the DRG
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whay can you get normal motor nerve studies in radics
|
root compression is usually incomplete, memyelination without axonal loss, muscles are usually innervated by more than one level
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what fibers are tested in H-reflex
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type 1A afferents and efferent (alpha motor neuron)
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how can H-reflex help you?
|
differentiate L5 S1 radic, but can be normally be absent in those older than 60
used for dx of S1 radic |
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what is required for an EMG to be diagnostic in radics?
|
abnormalities found in two or more muscles innervated by the same nerve root and different peripheral nerve, with normal adjacent nerve roots
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what typical findings do you find on EMG with spinal stenosis
|
typically no specific findings, but you may see Bilateral, multilevel lumbosacral polyradic
CMAP absent or decreased, normal SNAPS, bilat absent Hreflex |
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what errors can you not avoid in emg
|
duration of lesion (sensitivity decreases over time) slowly progressive lesion (rate of denervation/reinnervation same),
type of lesion |
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Avoidable EMG errors
|
time of study, temp, number of muscles studied
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during gait, what percent of the time is spent in stance? swing?
|
stance=60%
swing=40% |
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what percent of the time is spent in single limb support? double limb?
|
single=80%
double=20 |
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in gait, toward terminal phase, what does the adductor do?
|
rotate the pelvis
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in gait, what does the abductor do in stance phase?
|
controls pelvic tilt, letting it drop just a bit
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what degree of incline/decline is compliant with the ADA for ramps
|
~4 degrees
|
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what degree of knee flexion is needed to step down a curb
|
~65degrees
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what degree of knee flexion do you need to descend/ascend stairs
|
90degrees
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what is falliing?
|
center of gravity exceeds the base of support
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what causes trendelenberg gait?
|
weak gluteus medius
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what causes a lurching gait?
|
weak glut. maximus
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what is the girdlestone procedure?
|
amputation of the femoral head, usually do to infection (not really used now)
|
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insetting the foot in prosthetic causes
|
get increased distal lateral and proximal medial pressure on distal resdiual limb
|
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what is one of the most coomon causes of AKA abduction position of the prosthesis
|
hip abduction contracture, abducted socket, prothesis too long, pain in groin from medial brim of socket
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What is the most common congenital limb deficiency
|
distal radial (usually on Left)
|
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When do you fit a prosthetic in kids
|
dependent on milestones
upper passive - sitting around 4-6mo activate terminal device - 9-18mo activate albow ~24-36mo lower nonarticulated ~6-12mo Lower articulated ~24-36mo |
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if you have a congenital fibular deficiency, what else do you look for?
|
femoral shortening (in ~50%), knee, ankle, foot deformities
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what are options to treat tibial deficiency
(from total absent of tibia to short tibia) |
knee disarticulation, fibular centralization, tib/fib fusion,
syme's, lengthen/reconstruct if ankle stable |
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if femoral deficinecy what else must you look at?
|
Absolutely need to look at knee and hip
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what options do you have prosthetic wise for femur deficiency
|
prosthetic fitting, knee fusion+ankle disartic (knee disartic), mod BKA, Consider limb lengthen if less than 50% def
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if you have a congenital radial deficiency what else must you look at
|
the shoulder and elbow mobility
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midfoot ulceration and diabetes should make you suspicious of ??
|
Charcot joint/foot
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ideal transtibial amputation length
|
proximal third of tibia cylindrical
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what residual femoral length do you need to continue doing activities like running
|
need 50% length or greater
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describe the K-levels for prosthetics
|
level 0 - nonambulatory
level 1- transfers and limited household level 2 - limited community level 3 - unlimited community ambulator level 4 - high energy activities |
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when do you use a supramalleolar orthosis
|
in kids, with mediolateral instability at ankle, midfoot, or forefoot
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what brace would you use for flaccid footdrop from peroneal nerve injury
|
plastic "PLS" afo with 3/4 footplate, maybe a 5degree DF
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what brace would you use in charcot foot with weaknes in DF/PF/inver/ever and absent sensation
|
patellar tendon bearing orthosis, calf corset or bivalve, dual channel ankle joint, custom ortho shoe and insert
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what brace would you use in a bed bound, non ambulatory patient
|
PRAFO, to prevent plantarflexion contracture
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what brace would you use in TBI
|
plastic AFO with ant. malleolar trim, full footplate, tone reducing design, 3degree DF, ankle strap
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what an advantage of the ue myoelectric design?
|
self suspending, no harness needed, less body movements, better cosmesis
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what is the primary advantage of body powered upper limb prosthesis?
|
greater sensory feedback, most durability
|
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what movements are used for cable control UE prosthetics
|
"Down, back, and out"
shoulder depression-extension-abduction |
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|
for a carpal tunnel splint, what is the ideal position
|
"cock-up splint in anywhere from neutral to 30 degrees of extension
|
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|
opioid medications are actually approved for what kind of pain mostly?
|
cancer pain
|
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what is addiction?
|
chronic disease state with 1 or more of the following: impaired Control, Continued use despite harm, Compulsive use, Craving (5 C's)
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|
what is the normal cough volume?
|
2.3liters
|
|
|
what is the normal values for Ankle-Brachial Index?
|
0.91 - 1.30 is normal
anything less indicates disease, anything more indicates calcified artery |
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what is the most common cause of amputation
|
vascular disease
|
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which way does the center of gravity move for an amputee in a wheelchair? which way should you move the rear axel of the w/c
|
center of gravity moves posteriorly so move the rear axle more posteriorly
|
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does it take more energy to walk with 1 AKA or 2BKA
|
more energy expenditure with 1 AKA
|
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|
What is the normal volume of expiration in FEV1
|
>4 liters is normal,
normal decline is 30cc/yr |
|
|
what are the 4 classes of pulmonary disease
|
obstructive, restrictive, sleep disorder breathing, psychogenic
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what is osteoperosis
|
reduced bone mass less than 2.5 standard deviations of normal
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what is the gold standard diagnostic test for osteoperosis
|
dexa scan
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what is VO2
|
the O2 consumption of the whole body
|
|
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what is VO2max
|
aerobic capacity of an individual
|
|
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what is max heart rate
|
220-age
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what does ONE MET equal
|
1.2cals per min
1 MET= VO2 at rest = #.5ml O2/kg/min |
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how many METs is walking at 3mph
|
3.0 METS
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what do you need for an RX for cardiac rehab
|
dx, duration, intensity, frequency, precautions/parameters
|
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What C-spine pathology do you not want to miss in a RA patient?
|
C1 on C2 subluxation
|
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|
What time frame do you see Methotrexate lung?
|
First 6months of therapy
|
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what is the first line tx for osteoarthritis?
|
Tylenol
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is bamboo spine an early sign or late sign of ankylosing spody?
|
late
|
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is HLA b27 a good diagnostic test for ankylosing spondy?
|
No, its more for prognostic information
better test is a SIJ xray |
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Achilles tendonitis is a hllmark finding of what disease?
|
Enthesitis
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|
|
what bacteria are associated with a reactive arthritis
|
salmonella, shigella, chlamydia, campylobacter, mycobacterium tuberculosis
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what demographic do you see most with ankylosing spondylitis
|
young males
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What disease requires a mandatory ophthamology referral?
|
Pauciarticular Rheumatoid Arthritis, with slit lamp eval 4x/year for 4 years because can lead to cataracts, glaucoma, blindness
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whats the best way to diagnose reactive arthritis from chlamydia
|
pharyngeal swab
|
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|
what drug has been shown improvement in back pain in patients
|
calcitonin
|
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|
what are two of the main drugs that can cause msk pain
|
statins and AZT
|
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|
Heliotrope and Gottrons sign indicate what
|
Dermatomyosistis unless proven otherwise
(screen for age/sex approriate neoplasms) |
|
|
What is the consensus with regards to steroids in acute SCI
|
not a standard tx, but an option with weak evidence
|
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|
in the denis three column spine theory, what is in the middle column?
|
post. vertebral body, post. longitudinal ligament, post 1/2 of the annulus fibrosis
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|
what is the goal of non-operative treatment in a SCI
|
mobile patient with/without a brace
|
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what is the first reflex that returns after SCI
|
delayed plantar reflex
|
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what is a good prognosticating factor after SCI
|
the earlier the DTR returns, the better the prognosis
|
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|
what level of SCI gives you higher risk for gallstones?
|
any injury above T7
|
|
|
what is the most common cause of autonomic dysreflexia?
|
Bladder distension
|
|
|
what pharmacologic med can you use to initially tx autonomic dysreflexia
|
nitro paste 1-2" to forehead so can easily wipe off
|
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what are the primary contributors to pulm dysfunction after SCI
|
difficulty handling secretions, atelectasis, hypoventilation
|
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|
what level of sci injury has the highest risk for respiratory problems?
|
C1-C4
|
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|
what happens to vital capacity in an SCI patient in the supine position?
|
improves in supine because provides mechanical advantage
|
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|
how do you prophylax against HO
|
its controversial, but can do Etidronate/Indomethacin
|
|
|
what should you avoid in an upper motor neuron bowel program?
|
avoid chronic use of large volume enemas
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|
|
how do you treat SMA syndrome
|
it is seen in tetraplegics and you need to treat with smll low bulk meals and left lateral side-lying
|
|
|
how do you treat hypercalcemia in SCI?
|
IVF, lasix to increase renal excretion
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|
what is the course of osteoporosis in SCI
|
initially lose trabecular bone then cortical bone in the chronic phase below the level of injury
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|
Most common area of fracture in an SCI?
|
mostly lower extremity - femur at the supracondylar region then femoral shaft then tibia
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|
|
most common cause of fractures in an SCI
|
falls during a transfer
|
|
|
what is the most common cause of progressive myelopathy after SCI
|
Syringomyelia
|
|
|
what kind of pain do you get after a SCI
|
neuropathic or nociceptive
|
|
|
what is the leading cause of death in an SCI patient over 60 or those injured for more than 30 years?
|
Cardiovascular because of decreased HDL, insulin resistance, obesity, and reduced metabolic rate
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|
where does 50% of cervical rotation occur
|
at the C1C2 level
|
|
|
Where does the majority of cervical flexion and extension occur
|
C4-C7
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|
Spinal orthosis are meant for what type of spine injuries?
|
for stable injuries only because do not provide immobilization (except Halo)
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whats an alternative to a HALO
|
Minerva orthosis to restrict movement below C2, not for injuroes involving C1-C2
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|
what are contraindications for a HALO
|
facet joint injury, cervical instability involving ligamentous disruption, infected skin over pin insertion sites, concomitant skull fx
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|
|
where is the most common site for HO in the burn population
|
Elbow, then hip in children, shoulder in adults
|
|
|
what is the normal response to exercise
|
vagal nerve inhibition,
increase in: sympathetic activity, HR&BP, myocardial contractility, cardiac output |
|
|
what is strength
|
maximal muscle tension or force
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|
what are the three principles of strength training
|
overload, specificity, variability
|
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what is overload in strength training
|
intensity, duration, frequency, progression, rest
|
|
|
how long does it take for muscle hypertrophy?
|
2-7weeks
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|
|
what is concentric contraction
|
muscle tenses and shortens
|
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what is eccentric contraction
|
muscle tenses while being lengthened
|
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what are the three major types of strength
|
isotonic, isometric, isokinetic
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what is isotonic
|
dynamic force against a moveable object
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what is isokinetic
|
dynamic force against an immovable object
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what is isokinetic
|
dynamic force against a preset rate limiting device
|
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what are some advantages to isotonic exercise
|
full rom, can be concentric or eccentric, easy to guage effort
|
|
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what are disadvantage of isotonic
|
requires joint motion, can be dangerous if not done correctly
|
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|
what are advantages of isometric exercise
|
no joint motion, less painfull, less joint injury
|
|
|
what are isometric exercise advantages?
|
no joint motion, joint angle specific strengthening, may shutoff muscle blood supply
|
|
|
isokinetic exercise advantages
|
strengthens at full ROM and different speeds, smooth feling
|
|
|
isokinetic exercise disadvantage
|
does not occur in nature, not proven to be bettr than isotonic, isoexoensive equipment required, usually concentric
|
|
|
according to the blix diagram, where is the muscle srongest
|
at resting length
|
|
|
describe the strength relationship diagram
|
plot of % force on y-axis and velocity on x-axis
shows most force you generate is high velocity during eccentric contraction |
|
|
how much muscle loss occurs with age and why
|
1/3rd of muscle mass is lost with age, mostly type IIb fibers, mainly because of Disuse
|
|
|
what are the physiologic effects of heating
|
analgesia, increased metabolism, sedation
|
|
|
what are the three ways to heat or cool with modalities
|
conduction, convection, conversion
|
|
|
describe Conduction, convection, conversion
|
conduction is through direct contact (hotpack)
Convection is moving air or fluid like a sauna Conversion is energy converted to heat or cold like Ultrasound |
|
|
what are contraindications for heating
|
poor circulation, poor sensation, bleeding diathesis, malignancy, pregnant, must be able to tell you if its too hot
|
|
|
what is the therapeutic temperature range?
|
40 - 45degrees C, or 104 - 113F for 3-30 minutes depending on what you are using
|
|
|
what are some common types of conductive heating
|
still water, hydrocollator packs, electric heating pads, chemical packs, paraffin/mineral oil
|
|
|
what temp rise in subcut temp does paraffin produce?
|
3-5degree celcius rise
|
|
|
infra-red heating produced how much temp rise in subcut tissue?
|
1-2degrees celcius
AT 36-INCHES for 20minutes |
|
|
how does shortwave/microwave diathermy work?
|
high frequency electricity to induce heat in soft tissues
|
|
|
What is the only deep heating modality
|
Ultrasound
however, ultrasound does not penetrate bone |
|
|
how does US work?
|
sound is converted to heat at the muscle bone interface
|
|
|
where should you not used US
|
over metal implants, impaired sensation/circulation, testes, spinal cord, post surgical site, eyes, hearts, dvt
|
|
|
describe the classical type of massage
|
Stroking (effleurage),
Compression (petrissage), percussion (tapotement) Friction |
|
|
in an injury when do you use ice and heat
|
use ice to prevent edema, when no longer have risk for ice, use heat
|
|
|
what level are most of the cervical radics
|
C7
|
|
|
what is the first sign of spinal osteoarthritis?
|
loss of neck extension
|
|
|
whats the most common cause of disc disease
|
disc degeneration
|
|
|
In CP, spastic diplegia is most often seen when
|
prematurity
|
|
|
Prognostic indicators for walking in CP patients
|
type of CP
Age of independent Sitting Age of quadruped crawling persistance of 3 or more primitive reflexes at 18 - 24 months spine to prone by 18months |
|
|
Spasticity is dependent on..?
|
velocity
|
|
|
what are the signs of baclofen withdrawl
|
Itching, Aggitation, twitching
|
|
|
why must you turn a patient every 2 hours to prevent pressure ulcers?
|
because after 2 hours of a constant pressure of >70mmhhg causes skin breakdown
|
|
|
when can you use hyperbaric O2 in would care
|
when the patient has necrotizing faciitis or osteomyelitis
|
|
|
most common level for SCI
|
C5
|
|
|
most common level of SCI for a paraplegia
|
T12
|
|
|
what are the four ways to be considered sacrally spared in SCI
|
light touch at s4/s5
pin prick sensation at s4/s5 deep anal sensation voluntary anal contraction |
|
|
when do you use zone of partial preservation?
|
only used in complete injuries
|
|
|
when is the best time to perform the ASIA exam for prognosis
|
between 72hours to 1week in the right patient
|
|
|
which is better prognostic factor in tetraplegia, pin prick or light touch?
|
preserved pin prick within 72hours of injury is a better prognostic factor for return to ambulation
|
|
|
does early surgical intervention improve recovery?
|
No early decompressive sx does not impact outcomes
|
|
|
benefit of SSEP in SCI
|
not influenced by spinal shock,
good for those not reliable patients may prognosticate hand function |
|
|
what are 3 MRI features in SCI
|
intramedullary hemorrhage(poor prognosis), Cord edema, Normal
|
|
|
what is the highest level possible for someone to transfer independently? whats the most common level to see it?
|
C6 is the highest level that its possible to transfer independently, but usually see it at the C7 level
|
|
|
to be functionally independent for almost all ADLs, what level do you need
|
C7
|
|
|
how often should you do weight shifts to prevent skin breakdown
|
every 15-30minutes for >90seconds
|
|
|
what are advanced wheelchair skills?
|
curbs, ramps, wheelies, floor to wheelchair transfers, escalators, rough terrain
|
|
|
what does standing not do in the SCI patient
|
It DOES NOT decrease bone mineral loss
|
|
|
what is community ambulation
|
able to ambulate 105' with or withut devices/braces
|
|
|
what do you need to be able to ambulate
|
bilat hip flexors >3/5, knee extensor unilaterally >3/5
or max bracing of 1 short leg brace and 1 long leg brace |
|
|
What is the most common brace used in SCI patients trying to ambulate
|
Craig-Scott Orthosis
|
|
|
is the abortion rate higher in a woman with SCI
|
it is NOT higher
|
|
|
what kind of frames can you have with wheelchairs?
|
folding frames and rigid frames
|
|
|
what kind of seats can you have with wheelchairs
|
slings and solids
|
|
|
where do you measure for seat width
|
measure at the widest parts of the hips, and with braces on if needed
|
|
|
how do you measure seat depth for a wheelchair
|
measure from rear of buttocks to poplteal fossa then subtract .5"-1" from this, and if they have a foot propellar subtract 2"
|
|
|
how do you measure seat height of a wheelchair
|
measure from bottom of heel to posterior thigh then subtract the height of the compressed seat cushion and add 3-4" for leg stance
|
|
|
when must you have a head rest with wheelchairs
|
Anytime there is a tilt to the wheelchair, you need a headrest
|
|
|
how do you measure the back rest for a wheelchair
|
measure from buttocks to just below the inferior angle of the scapula(to enhance propulsion)
|
|
|
in order to have an effective weight shift, what angle does the tilt in space chair need to achieve
|
45degrees
|
|
|
most commonly prescribed wheelchair armrest?
|
removable desk arm
|
|
|
when must you have a head rest with wheelchairs
|
Anytime there is a tilt to the wheelchair, you need a headrest
|
|
|
how do you measure the back rest for a wheelchair
|
measure from buttocks to just below the inferior angle of the scapula(to enhance propulsion)
|
|
|
in order to have an effective weight shift, what angle does the tilt in space chair need to achieve
|
45degrees
|
|
|
most commonly prescribed wheelchair armrest?
|
removable desk arm
|
|
|
how do you measure arm height for the wheelchair
|
buttocks to the bottom of the bent elbow
|
|
|
what kind of wheels can you have for the wheelchair
|
spoke and mag
|
|
|
whats the effect of moving the rear wheel more posterior
|
the chair is more stable, greater turning radius, more shoulder pain
|
|
|
what is camber and what does it do
|
it is the angle the wheel makes with the vertical axis allowing increased stability, easier to propel and turn
|
|
|
what kind of footrests do wheelchairs have
|
fixed and swing, can also have elevating foot rests but add unnecessary weight
|
|
|
what piece of equipment can be added to a wheelchair to prevent backwards roll on an incline
|
Grade Aide
|
|
|
what kind of cushions are there for a wheelchair
|
air filled, foam, gel filled, contour foam with gel, ventilated(honeycomb)
|
|
|
anterior shoulder pain with overhead activities should make you think of?
|
Labral tears, also get a clicking. popping sensation
|
|
|
pain at the thenar eminence (snuff box) indicates?
|
Scaphoid fracture. Usually after person falls on outstretched hand
|
|
|
what physical exam findings do you get with plantar fasciitis?
|
pain on palp of medial calcaneous,
pain increased with great toe dorsiflexion and palpation, tight heel cord and plantar fascia |
|
|
what is the common mode of injury that causes PCL injuries
|
Falling on a flexed knee or
dashboard injury during a MVC Tibia is jammed back against the femur |
