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41 Cards in this Set

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  • Back
Stinger S / Sx
Acute shooting, electrical pain down arm following tackle in football, weakness, usually c5-c6 that may last from a few secs to many months
Stinger mech of inj
shldr dep or direct comp to brachial plexus from poorly fittin pads
Stinger tx
Rest & Ice, str ex, check fitting of shldr pad, return to football when overhead Str is 5/5, str deficit may persist fo mos
Intermediate Nerve Entrapment / Inj: Dorsal Scap N. - S/Sx
Unilateral rhomboid pain, may rad into arm, ipsilateral rot and / or contralateral side bending painful
Intermediate Nerve Entrapment / Inj: Suprascap n. - S/Sx
Similar to rot cuff - atrophy in supra or infraspinatus fossa - diff dx: injection into notch for pain relief and EMG
Intermediate Nerve Entrapment / Inj: Long thoracic n. - S/Sx
Pain and weakness w/ shldr flex, Scapular winging, may be excessive, weak / absent protraction
Distal Nerve Entrapment / Inj: Median n: pronator syndrome - S/Sx
Pain reproduced on res pron and elbow flex and sometimes passive supination; + pinch sign; electrodiagnostics not helpful;
Distal Nerve Entrapment / Inj: Median n: pronator syndrome - Tx
Splinting and rest
Distal Nerve Entrapment / Inj: Median n: Carpal Tunnel syndrome - S/Sx
+ Tinels; + Phalens, thenar atrophy, Confirmed by electrodiagnostics
Distal Nerve Entrapment / Inj: Median n: Carpal Tunnel syndrome - Tx:
cock-up splint, NSAID's, correction of posture, positioning, possible surg
Distal Nerve Entrapment / Inj: Ulnar n: elbow - S/Sx
Elbow pain and paresthesia radiating into ring and little fingers; Sx should be reproduced by simultaneous contraction of elbow ext, pronation and flexor carpi ulnaris which narrows the cubital tunnel; + Sustained elbow flex, + Tinnels
Distal Nerve Entrapment / Inj: Ulnar n: wrist - S/Sx
Weakness of abductor digiti minimi and abd pollicis
Distal Nerve Entrapment / Inj: Radial n: Radial tunnel syndrome - S/Sx
Mimics tennis elbow. Main tenderness is over the radial tunnel 4 finger widths distal to the lateral epicondyle; pain on resisted supination; + middle finger sign; pain and weakness on resisted extension of the middle finger. ?ULTT (rad) +
Distal Nerve Entrapment / Inj: Radial n: Sup branch compression (Wartenberg's syndrome) - S/Sx
N. lies beneath brachioradialis near radial styloid; can occur b/c of tight bracelet or band at the wrist. Sensory changes only
4 concepts in the eval of N. injury
1. The mechanical interface
2. Nerves are elastic.
3. Tension on a nerve inc intraneural compression.
4. Tension in the nervous system by movement is not uniform.
Tx principles of nerve injury (4)
1. Tx any related jt hypomobility or hypermob that may be present 1st
2. Very careful with irritable patients
3. Start gently with stretching techniques that you used to eval.
4. Jt shoul not be stressed during the tx
Risk factors for osteoporosis
Early menopause, caucasian, thin, low Ca intake, excessive use of caffeine / alcohol, smoking, liver / thyroid / renal dz.
W/ osteoporosis, X-ray will show bone loss but only if greater than _______ %
30-50%
PT options for Osteoporosis
1. Rigid orthosis if tol. in acute stage.
2. Ext exercises as tol
3. Str paraspinals (avoid loading in flex)
4. Walking program
5. Balance ex
6. postural correction
7. Breathing ex.
8. education
Postural changes lead to a ___% dec in FVC
9%
*** When should PT's recommend that a patient be screened for osteoporosis? (5)
1. Risk factors present
2. >65 yo
3. Pt reports loss of ht, inc kyphosis or protuberant abdomen
4. Hx of chronic low back pain
5. Hx of wrist fx
Scoliosis: __% convexity to the R
90
T1 & T2 disc lesions are rare but some highlights are:
1. UE pain
2. pain reproduced by scapular retraction and cervical flex
3. placing hand behind head w/ elbow flex will be painful
4. serious dz if neuro signs are present
Herpes Zoster S/Sx
Rash and pain in dermatomal distribution; rash ceases to keep forming after 5 days and pt is nml w/i 2 weeks
Postherpetic neuralgia s/sx
Pain and hyperesthesia that persist for over a month after rash has cleared; freq inc w/ age; 30-50 yrs: 4%, >80 years: 34%
Mondors Disease: what is it?
Thrombophlebitis of the subcutaneous veins in the chest - often involves the thoracoepigastric vein; x3 more common in women
Mondors Disease: S/sx
Insidious onset of lateral chest wall pain. Pain is localized over thromb osed vein and the skin may show localized protrusion; minimal inflammatory changes and there are no associated fevers or chills; sx resolve in 1-10 wks w/o specific tx.
Intercostal Neuralgia: origin?
Development of an intercostal neuroma secondary to a prior thoracotomy, mastectomy, or fractured rib.
Intercostal Neuralgia: S/Sx
Trigger point or tenderness located at the neuroma w/ burning pain regerring into thorax or abdomen
Posterior Primary Rami innervation:
med 2/3 back: can affect rhomboids, traps, paraspinal mm. - post rami close to facet jts.
How does T4 Syndrom get its name?
Despite possible involvement from T2-T6, Hypomobility is usually reported at T4
Sympathetic trunk supply
UE; trauma to this area or irritation of the sympathetic trunk by osteophytes from the costotransverse or costovertebral ts may result in sx of vague UE pain and sensory changes
***CPR for Manip of thoracic spine to tx neck pain (6)
1. Sx <30 days
2. No sx distal to shldr
3. Looking up does not aggravate sx
4. FABQ-PA <12
5. Dec Upper thoracic spine kyphosis
6. cervical ext <30 degrees
Common features of spondyloarthropathies (7)
1. Predilection for inflammatory lesions of the axial skeleton.
2. Oligoarticular peripheral joint arthritis
3. Enthesitis or enthesopathy
4. Frequent extra-articular inflammation (uveitis, aortitis) plus skin and mucous membranes
5. affects mainly young men
6. Strong association w/ HLA-B27
7. Negative rheumatoid factor
AS Etiology
Individuals with HLA-B27 are predisposed, familial link: 20% have 1st deg rel; onset b/t 20-35; rare over 40
AS Pathology
Pathological changes in synovial and fibrous jts in the form of chronic synovitis --> cartilage destruction, erosions, sclerosis of underlying bone.

SI affected 100%; Cervical: 75%; Lumbar 50%; Hips / shldrs: 30%; heels: 30%

Fusion of cervical spine can put more stress on C1-C2 segment and result in sublux
AS Clinical Features
Predominant AM stiffness; insidious onset of LBP with exacerbations and remissions; may present like a rupture disc or an SI strain; earlier onset more associated w/ per. jt involvement; earlier onset more severe sx
AS Physical Findings
1. Limitation in all planes - this should make you suspicious
2. loss of chest expansion
3. + SI testing (Gaenslens & SL Compression)
4. Tenderness over bony prominences such as greater trochanters, spinous processes
5. Kyphotic thoracic spine (which result in dec pulmonary function)
AS prognosis
Severity of sx in first decade predicts long term disability; severe dz is usually marked by peripheral joint and extra-articular manifestations; osteoporotic fx, AA sublux and spinal stenosis
AS PT Eval
Respiratory - chest expansion, FVC / FEV over 1 sec, posture, trunk flexibility, extremity flexibility, blood pressure, BMI dec
AS PT intervention
1. Aerobic exercise to avoid wt gain
2. Cessation of smoking
3. Ext exercises
4. diaphragmatic breathing ex.
5. Strengthening of spine extensors
6. Correct posture / strengthen scapular retractors
7. cease exercises during exacerbations
8. Abd strengthening (for better posture)
9. Flexibility of ext as needed