Pt 534 Musculoskeletal Pt Final Exam

Front 1

What is a chronic inflammatory disease characterized by pain and progressive stiffness?

Back 1

Ankylosing Spondylitis

Front 2

What is this?

Back 2

Bamboo Spine
(Ankylosing Spondylitis)

Front 3

What is a forward translation of one vertebral body on another. It is most common in the lower lumbar spine?

Back 3

Spondylolisthesis

Front 4

What are the different classifications of spondylolisthesis?

Back 4

Isthmic- basic lesion of pars interarticularis
Dysplastic- congenital
Degenerative- arthritis
Traumatic
Pathologic- metabolic bone disease, tumor, or after surgery

Front 5

What is this?

Back 5

Scotty Dog
Fracture of pars interarticularis- Spondylolysis

Front 6

What is this?

Back 6

Spondylolysthesis- slippage

Front 7

About what percent of athletes have a radiological diagnosis of spondylolysis?
In a normal population?

Back 7

14%
4-6%

Front 8

What is the ratio of men to women who present with spondylolysis?

Back 8

4.5:1

Front 9

According to O'Sullivan et al, what is proven to decrease pain and increase function in patients with spondylolysis?

Back 9

Lumbar stabilization exercise

Front 10

What are each letter?

Back 10

a- disk degeneration
b- prolapse
c- extrusion
d- sequestration

Front 11

What is each letter?

Back 11

a- L1
b- L2
c- L3
d- L4
e- L5

Front 12

What are the 3 syndromes that classify disk herniation with a mechanical diagnosis?

Back 12

Postural
Dysfunction
Derangement

Front 13

What is the treatment for postural syndrome for disk herniation?

Back 13

Patient education
Postural correction

Front 14

What is the treatment for dysfunction syndrome for disk herniation?

Back 14

Patient education
Postural correction
Stretching of contracted structures

Front 15

What is the treatment for derangement syndrome for disk herniation?

Back 15

Reduction of derangement Maintenance of reduction
Rrecovery of function and prophylaxis

Front 16

Related to centralization, which deficits represent most distal symptoms?

Back 16

Parasthesia
Neurological

Front 17

Is the centralization phenomenon as a prognostic factor for chronic low back pain and disability good for ruling in or out the condition?

Back 17

Ruling in
High specificity

Front 18

What is a big difference between how we do a physical exam today and what the McKenzie Approach did?

Back 18

The big difference is an increased emphasis on Repeated Movements & Sustained Postures

Front 19

With a lateral shift, does the patient deviate toward or away from the symptoms?

Back 19

Away

Front 20

What causes a lateral shift?

Back 20

Disc herniation
Muscle spasm
Facet-joint impingement
SI joint dysfunction

Front 21

What is the proper movement progression?

Back 21

Flexion in Standing (FIS)
Repeated FIS (RFIS)
Extension in Standing (EIS)
Repeated EIS (REIS)
Side Glide in Standing (SGIS)
Repeated SGIS (RSGIS)

Front 22

What is the proper movement progression in an unloaded state?

Back 22

Supine/Prone:
Flexion in lying (FIL)
RFIL
Extension in Lying (EIL)
REIL

Front 23

What is the proper treatment progression?

Back 23

Increase, worse - STOP

No effect/No worse -PROCEED WITH CAUTION

Decrease/Centralize, better - GO!

Front 24

Patients with disc injuries may be at increased risk of re-injury with ________ early in the morning?

Back 24

flexion

Front 25

How do you progress flexion ROM?

Back 25

Supine
Sitting
Standing

Front 26

How do you progress extension treatment?

Back 26

Prone
Prone in extension
Extension in lying
Extension in lying with patient overpressure (belts)

Front 27

What are the the general rules for clinicians regarding diagnostic imaging?

Back 27

Shouldn't routinely obtain imaging in patients with nonspecific LBP
Should obtain imaging when serious underlying conditions are suspected on the basis of history and physical examination
Should order imaging for patients with radiculopathy or stenosis only if the patient is a candidate for surgery

Front 28

What percentage of stress fractures pertaining to joggers?

Back 28

1%

Front 29

Why are femoral neck stress fractures difficult to diagnose?

Back 29

Subtle

Front 30

Which positions do you want to avoid with a THA?

Back 30

Adduction
IR
Hip Flexion > 90

Front 31

What is this position indicative of?

Back 31

Posterior Hip Dislocation

Front 32

What are physical therapy considerations for patient's who have hardware put in for femoral fractures?

Back 32

Early and aggressive mobility of the total person
High risk for complications in older adults i.e. pneumonia, DVTs, etc.
Must Avoid the “beginning of a
downward spiral”

Front 33

What are the key points when treating THA and hip fractures?

Back 33

Emerging Evidence Supportive of early and aggressive Physical Therapy intervention.
Rehab is often case/surgeon specific
Call if questions/concerns

Front 34

The highest forces in the body are required to cause a fracture where?

Back 34

Subtrochanteric Fracture

Front 35

What is best for restoring symmetrical independent walking after a THA?

Back 35

Treadmill training with partial weight bearing

Front 36

What do phase I-IV of rehabilitation represent?

Back 36

Phase I- Immediate Rehab
Phase II- Intermediate Rehab
Phase III- Advanced
Phase IV- Sport-specific training

Front 37

What are goals of phase I rehab following hip arthroscopy?

Back 37

Protect integrity of repaired tissue
Restore ROM within restrictions
Diminish pain and inflammation
Prevent muscular inhibition

Front 38

What are goals of phase II rehab following hip arthroscopy?

Back 38

Protect integrity of repaired tissue
Restore full ROM
Restore normal gait
Progressively increase muscle strength

Front 39

What are goals of phase III rehab following hip arthroscopy?

Back 39

Restoration of muscular endurance and strength
Restoration of cardiovascular endurance
Optimize neuromuscular control/balance/proprioception

Front 40

What are criteria for full return to competition following hip arthroscopy?

Back 40

Full pain-free ROM
Hip strength > 85% of uninvolved side
Ability to perform sport-specific drills at full speed without pain
Completion of functional sports test

Front 41

What are possible problems?

Back 41

L3 dermatome
Groin
Anterior or lateral thigh/ g. trochanter
Knee

Front 42

What are hypotheses for this person?

Back 42

Non-musculoskeletal tissues
Joints under area of symptoms
Joints referring to area of sx
Contractile structures under area
Other structures to be examined

Front 43

What are common hip pathologies for newborns?

Back 43

Congenital dislocated hip

Front 44

What are common hip pathologies for 2-8 years of age?

Back 44

Avascular necrosis

Front 45

What are common hip pathologies for 10-14 years of age?

Back 45

Slipped epiphysis

Front 46

What are common hip pathologies for 14-25 years of age?

Back 46

Stress fracture, synovitis

Front 47

What are common hip pathologies for 20-40 years of age?

Back 47

Avascular necrosis, synovitis, rheumatoid arthritis

Front 48

What are common hip pathologies for 45-60 years of age?

Back 48

OA, synovitis

Front 49

What are common hip pathologies for 65+ years of age?

Back 49

Stress fracture, OA

Front 50

Is hip OA higher in men or women?

Back 50

Women

Front 51

What is the prevalence of hip OA in 55-64 year olds?

Back 51

3%

Front 52

What is the prevalence of hip OA in 65+ year olds?

Back 52

5-6%

Front 53

What does hip OA usually lead to?

Back 53

THA

Front 54

What is the act or process of identifying or determining the nature and cause of a disease or injury through evaluation of patient history, examination, and review of laboratory data?

Back 54

Diagnosis

Front 55

What are traditional criteria for diagnosing hip OA?

Back 55

Hip pain for > 25 of the past 30 days
And, at least 2 of the following
criteria:
Erythrocyte sedimentation rate <20 mm/1st hr
Osteophytes on x-ray examination
Obliteration of the joint space

Front 56

What is hip OA often referred to as?

Back 56

DJD

Front 57

If AM stiffness lasts for longer than 60 minutes, is the diagnosis hip OA?

Back 57

No

Front 58

What does Hoeksma (2004) say is the best prescription for PT for hip OA?

Back 58

Long axis manipulation + stretching

Front 59

What should be the first treatment choice when dealing with a patient who suffers from hip OA?

Back 59

Manual Therapy

Front 60

What often accompanies hip OA?

Back 60

Bursitis
Tendonitis
Tendinopathy

Front 61

What gait pattern is evident with patients who have greater trochanteric bursitis?

Back 61

Trendelenberg

Front 62

What is defined as pain in the tenon?

Back 62

Tendinopathy

Front 63

What are some causes of gluteus medius tendinosis?

Back 63

Friction
Alteration in gait
Repetitive microtrauma: steps and hyperadduction

Front 64

What is the triad of iliopsoas bursitis?

Back 64

Mass
Pressure effects
Advanced arthritis

Front 65

Which motions would reproduce pain caused by iliospoas bursitis?

Back 65

Passive hip flexion
Passive hip IR
Pain with resisted IR and ER

Front 66

What can cause iliopsoas bursitis?

Back 66

Friction
Elevated intracapsular pressure
Extensions of hip synovia

Front 67

How do you treat iliospoas bursitis?

Back 67

NSAIDs, ice, physical agents
Activity modification
Stretch hip flexors as tolerable
Steroid injections, Aspiration

Front 68

What are the different grades of ankle sprains?

Back 68

Grade I
Mild symptoms, no functional loss, local tenderness, mild swelling, no instability
Grade II
Moderate functional loss, diffuse swelling, mild echymosis, more diffuse tenderness, mild instability
Grade III
Significant functional loss, gross swelling, echymosis, multiple ligament tenderness, gross instability, possible fracture

Front 69

What percent of all ankle sprains are syndesmotic?

Back 69

10-18%

Front 70

How does a syndesmotic ankle sprain occur?

Back 70

Forced external rotation of foot &
internal rotation of the leg
Hyperdorsiflexion
Hyperplantarflexion

Front 71

What is the impairment?

Back 71

Osteochondritis Dissecans of the Talus

Front 72

What are the criteria for return to activity for ankle sprains?

Back 72

Restoration of normal accessory & physiological ROM.
Restoration of muscle function, including strength and proprioception.
Functional use of the injured part in full speed activities.

Front 73

What is a good intervention for subtalar joint dysfunction?

Back 73

Supine subtalar (rearfoot) distraction manipulation

Front 74

What is the best treatment for acute ankle sprain?

Back 74

PRICES (protection, rest, ice, compression. elevation and
support)
Minimize swelling with compression wrap, elevation, cryokinetic program and protected WB'ing if indicated.

Functional treatment better than immobilization

Front 75

What is the best treatment for sub-acute ankle sprain?

Back 75

Protection/Immobilization
–As symptoms subside, protect ligament with Aircast or splint.
–Frict Massage and gentle joint mobilization to prevent adherence and restore normal mobility.
–Flexibility, strength and proprioception program as early as tolerated.

Front 76

What is the best treatment for chronic ankle sprain?

Back 76

Adhesions develop during healing phase and lack of reflex muscle protection due to proprioceptive deficit and faulty mechanoreceptor function.
–ntervention emphasis: Functional (proprioceptive) exercise activities and comprehensive biomechanical evaluation.

Front 77

What is pain and paraesthesia in the interdigital space (3-4) with a fibrous entrapment of the interdigital nerve.
May be referred to in any of the interdigital spaces.

Back 77

Morton's Neuroma

Front 78

What is the best intervention for Morton's Neuroma?

Back 78

Decompression of the space through modification of shoe wear, (wide toe box), correcting biomechanical stress (metatarsal pad or tube) to splay metatarsals, mobilization of the MT, instrumented soft tissue techniques.

Front 79

What is the most common cause of Charcot Joint?

Back 79

Diabetes

Front 80

What are common causes of pain with running?

Back 80

Knee valgus
Foot pronation (excessive and rapid)
Hip IR and Adduction
Glut Med weakness