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163 Cards in this Set
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How do therapists use diff dx tests?
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to rule in or rule out a specific pathology that they hypothesize might be the source of the patients problem
Might (usually) reproduce person's symptoms, thus ruling IN diagnosis |
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What else beside diff dx test should a therapist use to determin OPP?
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correlate diff dx test w/ other findings from history and PE.
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What are the psychometric properties of Diff dx tests?
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validity
reliability sensitivity specificity positive predictive value negative predictive value |
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DEFINE sensitivity
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proportion of ppl with disease that have a positive test result
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DEFINE specificity
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proportion of ppl w/out a disease that have a neg test result
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DEFINE positive predictive value
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proportion of ppl who test positive who actually have the diagnosis
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DEFINE negative predictive value
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proportion of ppl who test neg who actually DO NOT have the diagnosis
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a test with high sensitivity is good at what?
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ruling OUT a pathology bc we can trust a neg result (few false neg)
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a test with high specificity is good at what?
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ruling IN a disorder bc there are few false positives
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Which percentage means that a diff dx test has good sensitivity/specificity?
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70% or higher
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What are common shoulder pathologies?
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*sprains
*joint capusle fibrosis * fractures *neural irritation/tension *dislocations and instability *labral tears *impingment *thoracic outlet syndrome |
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what are common elbow and hand pathologies?
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*elbow sprians/instability
* median N/pronator teres entrapment *anterior interosseous N entrapment *ulnar nerve entrapment *ulnar collateral lig sprain *tenosynobitis of ABductor pollicis longus and Ext. pollicis brevis *carpal tunnel syndrom *arterial insufficiency |
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What is a grade I AC lig sprain?
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there is tearing of the AC ligs w/out displacement of the clavicle (coracoclavicular ligs are intact)
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What is a grade II AC lig sprain?
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complete tearing of the AC ligs and partial tearing of the coracoclavicular ligs w/ slight upward displacement of the clavicle
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What is a grade III AC lig sprain?
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complete tearing of the AC and coracoclavicular ligs w/ upward displacement of the clavicle
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What mm are short in glenohumeral hypomobility?
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all scapulohumeral mm
**joint capsule is also stiff** |
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What mm are long in glenohumeral hypomobility?
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serratus anterior
lower trap **cuff is weak** |
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What are the 3 stages of Adhesive capsulitis and how long does each stage occur?
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Freezing (onset to between 10 and 36 weeks)
Frozen (4-12 mos) Thawing (12mos-several years) |
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DEFINE freezing stage of adhesive capsulitis
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characterized by the most sever pain and a gradual diminution of articular volume
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DEFINE frozen stage of adhesive capsulitis
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pain decreases gradually but w/out appreciable improvement in motion
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DEFINE thawing stage of adhesive capsulitis
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marked by gradual return of motion
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What is usually found during the AROM assessment when dealing w/ someone with adhesive capsulitis?
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limited in all directions, pt unwilling to move (arm held close to side), altered biomechanics: no scapulo-humeral disassociation
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What is usually found during the PROM assessment when dealing w/ someone w/ adhesive capsulitis?
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limited ROM in capsular pattern w/ capsular end feels
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What is usually the underlying pathology when someone comes in with adhesive capsulitis?
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impingment (look for humeral postural impairments)
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What are diff dx tests for fractures?
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usually x-rays (radiographs)
stress fractures sometimes easier to diagnosed through scintigram |
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What should therapists do if we see a pt PRIOR TO clinical union of a fracture affecting the GH joint?
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*have the pt move the shoulder as much as allowed/possible to avoid adhesions
*exercise elbow, forearm, wrist, and hand *teach pt to position arm in some degree of abduction and flexion (rest on pillow) |
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What should therapists do if we see a pt AFTER clinical union of a fracture effecting the GH joint?
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*assess for nerve involvement
*check for loss of accessory motions *be alert to postural alignment |
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What mechanisms provide passive stability of the GH joint?
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*joint geometry
*limited joint volume *adhesion/cohesion of joint surfaces *ligamentous restraints *soft tissue barrier *glenoid labrum |
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What mechanisms provide active stability of the GH joint?
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*compression of joint surfaces
*dynamic lig tension *neuromuscular control |
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What is instability often associated with?
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dislocations and/or subluxations
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DEFINE shoulder laxity
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clinical ability to passively translate the humeral head on the glenoid fossa
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DEFINE shoulder instability
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clinical condition in which unwanted humeral head translation compromises the comfort and function of the shoulder. person's inability to control the translation of the humeral head during dynamic functional activities
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What are factors limiting anterior translation of GH joint?
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*coracohumeral and superior GH ligs
*subscapularis m and mid GH lig *anterior band of the inferior GH lig *infraspinatus and teres minor mm |
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What are factors limiting posterior translation of the GH joint?
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*infraspinatus and teres minor muscles
*subscapularis m *inferior GH lig *anterior superior capsule *retrotilt of the glenoid fossa |
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What are factors limiting inferior translation of the GH joint?
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*superior joint capsule and superior GH lig
*negative intra-articular pressure *inferior GH lig |
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What is the common MOI for an anterior dislocation of the shoulder?
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trauma w/ arm in ABduction, extension and lateral rotation
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What is the common MOI for a posterior dislocation of the shoulder?
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trauma w/ arm in flexed, ADducted and medially rotated postion
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What are diff dx tests for GH dislocation?
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apprehension tests for anterior/posterior dislocation
"load and shift" test for GH instability in all directions |
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DEFINE bankart lesion
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avulsion of the anterior band of the inferior GH lig along w/ a portion of the labrum
*results in anterior-inferior instability |
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DEFINE hill-sachs lesion
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part of humerus is impaled on sharp portion of glenoid and cause a fraction in humerus. humerus can get locked in position again if move and the hill-sachs lesion gets caught on other structures.
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DEFINE SLAP lesion
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SLAP= superior labrum anterior to posterior
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What are diff dx tests for glenoid labrum tears
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anterior slide test
crank test |
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What structures are impinged in subacromial impingment syndrome?
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supraspinatus tendon
subacromial bursa long head of the biceps |
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What are the 4 causative factors w/ impingement?
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*vascular deficiency
*trauma *degeneration of tendons *biomechanical and/or anatomic abnormalities (trauma and biomechanical are most common) |
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What are common impairments that can lead to altered biomechanics at the shoulder?
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*impaired control of the scapula by serratus ant. and lower trap mm
*shortness of lateral rotators *shortness of joint capsule *insufficient activity of lateral rotators *tight pect. major m *insufficient activity of subscapularis m *dominance of deltiod m *shortness of the teres major m |
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What are common "diagnoses" for impingement?
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shoulder bursitis
biceps tendonitis rotator cuff tendonitis shoulder pain |
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What are the typical ages for the 3 stages of impingement?
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Stage I: 16-20 y/o
stage II: 30-45 y/o stage III: over 45y/o |
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DEFINE stage I of impingement
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reversible inflammation and edema
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DEFINE stage II of impingement
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inflammation superimposed on slight tearing/fraying of the tendon, accompanied by fibrosis of the injured muscle/tendon
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DEFINE stage III of impingement
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more severe fraying or a complete tear of the tendon, w/ the presence of bone spurs
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What signs during interview/PE point to impingement as the cause?
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*shoulder pain that is of chronic onset
*observation reveals deviations from normal posture and abnormal biomechanics *PE reveals weakness of key synergies, tightness of specific mm, and postive diff dx tests |
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What are common diff dx tests for shoulder impingement?
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drop arm test and empty can test (implicate supraspinatus and/or subacromial bursa)
Yergason test and Speed test (implicate long head of biceps) |
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When pt comes w/ shoulder bursitis what is inflammed and what is it related to?
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subacromial bursa and almost always related to impingement unless caused by a direct blow to the bursa
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what often causes supraspinatus strains?
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impingement or fall (possibly both)
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DEFINE thoracic outlet syndrome
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a term used to describe a variety of neurovascular compression syndromes associated w/ the neurovascular bundle of the brachial plexus and the subclavian artery/vein. Syndromes typically become symptomatic due to poor posture and mm tone w/ some mm being excessively tight, and others being weak
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What are specific syndromes of thoracic outlet?
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Anterior scalene syndrome
costoclavicular syndrome pect. minor syndrome cervical rib syndrome |
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What is another name for the thoracic outlet test for pect. minor syndrom?
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hyperabduction test
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What is the normal cubital angle?
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10-25 degrees
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What side of the elbow is more prone to sprains? why?
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medial elbow due to natural valgus
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What is a common MOI of elbow sprains/instability?
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falls w/ slight bent elbow; repetitive overhead throwing
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what are diff dx test for dislocation/subluxation of radial head from annular ligament (nursemaid's elbow)?
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elbow varus and vulgus stress tests
test of annular lig |
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DEFINE lateral epicondylitis (tennis elbow)
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irritation of the common origin of the wrist extensors, primarily the extensor carpi radialis brevis and sometimes the extensor carpi ulnaris and extensor digitorum
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What is a common MOI for lateral epicondylitis
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repetitive or sustained wrist extension, with or w/out combinations of pronation/supination or heavy gripping
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What is a diff dx test for lateral epicondylitis?
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tennis elbow tests (RROM or Passive stretching)
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DEFINE medial epicondylitits (golfer's elbow)
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caused by irritation of the mm originating from the medial epicondyle and is associated w/ repetitive wrist flexion, pronation, and gripping, esp. in a wrist-flexed position
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what are structures that may impinge upon the median n?
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*subscapularis
*pect. minor *lig of Struthers *pronator teres *lacertus fibrosis *proximal arch of the flexor digitorum superficialis *transverse carpal lig |
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describe the test for impingement of the median n by pronator teres
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pt sits w/ elbow flexed to 90 degrees. the therapist strongly resists pronation as the elbow is extended
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DESCRIBE test for impingement of interosseous n by pronator teres
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pt asked to pinch the tips of the index finger and thumb together. pt should be able to achieve pinch with IP joints flexed. If interosseous n affected than IP joints extended w/ "pulp to pulp pinch"
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If you have a positive test for the anterior interosseous nerve, will you always have a positive test for the median n?
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Not always; however, if you have a positive test for median n, you will have a positive test for the anterior interosseous n
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Where are common sites of impingement on the ulnar n?
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ulnar groove (student's elbow)
tunnel of guyon |
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DESCRIBE diff dx test jfor impingement of ulnar n
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"key grasp" with IP joint extended=negative test
if has to flex IP joint to grasp=positive test |
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what are diff dx tests of wrist ligs?
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stress test into ulnar and radial deviation
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What is a common MOI for wrist sprains?
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Falling on out stretched hand
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what is a common MOI for ulnar collatera lig of the thumb sprain?
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fall onto thumb
weight lifting ski pole |
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DEFINE DeQuervain's Syndrome
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tenosynovitis of the abductor pollicis longus and extensor pollicis brevis
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What is a common MOI for DeQuervain's syndrom?
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repetitive abduction and extension of the thumb (cutting w/ scissors) or repeated radio-ulnar deviation (hammering)
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DESCRIBE test for DeQuervain's Syndrome
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pt flexes the thumb toward the palmar base of 5th finger, then flexes the fingers over the thumb. the patient then actively ulnarly deviates the wrist. Sharp, sig. pain =positive
**mild degree of discomfort is normal |
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What are the most common diff dx tests for carpal tunnel?
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*square-shaped wrist (most sensitive and good specificity; BEST test)
*Abductor pollicis brevbis weakness (next best) *median n hypesthesia *phalen's test *hoffman-tinel sign |
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What is considered a positive square-shaped wrist test?
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the wrist ration (ap dimension divided by mediolateral dimension) is greater than or equal to .70
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DEFINE arterial insufficiency
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entrapment of the radial and/or ulnar arteries
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What are diff dx tests for arterial insufficiency?
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allen's test of radial and ulnar arteries
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DEFINE red flags
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findings, observations, or other pieces of info that cause therapists to suspect a serious patient problem that warrants further clarification and possible referral to a physician
**can arise from any body system** |
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what is included in the upper quarter scan?
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*C spine
*T spine *TMJ *shoulder, elbow, forearm, wrist *UE fxs -position -reach -grasp |
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what are common UE standardized outcome measures?
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*Canadian Occupation Performance Measure (COPM)
*Disability of the arm, shoulder, and hand (DASH) *quick DASH *UE functional index *short form 36 item general health survey (SF-36) *Western Ontario McMaster Osteoarthritis Index (WOMAC) |
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what is optimal scapular positioning?
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*vertyebral border is parallel to the thoracic spine and is about 3in from midline
*between T2 and T7 *flat against the thorax and rotated 30 degrees anterior to frontal plane |
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what is optimal humeral positioning?
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*less than 1/3 of the humeral head protrudes in front of acromion
*neutral rotation so antecubital fossa faces anteriorly and olecranon faces posteriorly. palms face body *proximal and distal ends of humerus are in same vertical plane |
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what is key to optimal GH joint motion?
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humerus remains centered in relationship to glenoid as motion occurs at the shoulder
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what are you checking with PROM?
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available range
end feel ligamentous stress tests accessory motions |
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what are normal end feels?
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capsular
ligamentous bony |
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what are pahological end feels?
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soft tissue approximation
muscular muscle spasm capsular (abnormal range) boggy internal derangement empty |
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what are mm that you ALWAYS want to strength test in an UE assessment?
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supraspinatus
mid deltoid infraspinatus and teres minor serratus anterior lower trap mid trap biceps brachii triceps brachii ext carpi radialis longus and brevis; ext digit flexor carpi radialis longus and brevis; flexor digit superficialis and profundus fist (palmar/dorsal interossei, lumbricales, mm of thumb) |
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what is included in the neurological assessment?
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cutaneous sensory testing (dermatomes)
strenght testing (myotomes) DTR's (reflexes) Neuroal tension tests |
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DEFINE axoplasmic flow
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vast majority of axonal nutrients (lipids, proteins, etc) are synthesized in the neuronal cell body and transported along axons through axoplasm
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DEFINE thixotrophy
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axoplasm flows better when moved
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DEFINE mechanical interfaces
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areas in whichthe nn can be compressed or entrapped and thus irritates
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What are some mechanical interfaces?
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neural branches
unyeilding interfaces (fascia, lig) areas of neural tunneling superficial areas/outside compression |
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what are some neural pathomechanics?
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mechanical interfaces
shortening of soft tissue altered vascular supply inflammatory response altered flow of axoplasm |
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what are potential areas of entrapment of the radial n?
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lateral head of triceps
subscapularis btw brachioradialis and brachialis tendinous origin of ext carpi radialis brevis tendinous origin of supinator distal edge of supinator |
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what are signs and symptoms of neural tissue involvement?
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*antalgic posture
*movement dysfunction *(+) neural tension test *palpation produces pain *PE confirms neural pain |
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what are precautions and contraindications to neural mobilizations?
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*irritable disorders or severe pain
*neurological changes are worsening *inflammatory, systemic, and ineffective disorders that affect the NS *tethered SC *marked injury or abnormality |
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what are the guiding principles of rehabilitation?
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*patient centered
*continually re-eval and question your OPP *view your intervention through the ICF model *perform onging patient/caregiver ed *choose appropriate freq of treatment |
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What are 3 possible ways therapist can treat a problem?
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*resolve
*alleviate *adapt/compenstae |
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How do you continually re-eval your OPP?
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*ongoing observation, measurement, critical thinking
*continually test your diagnosis *compare current measures to baseling *ask "am i giving this person the best care that I possibly can?" |
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What are the 6 elements of the ICF model?
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Health condition
body function and structure (impairment) activities (limitation) participation (restriction) environmental factors personal factors |
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DEFINE health condition
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the state of the individual at any given moment
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DEFINE body function and structures
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relate to an individuals anatomy, physiology and psychology and how each part performs individually or part of system
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DEFINE activity
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describes functional status and is the execution of a task or action by an individual
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DEFINE activity limitations
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difficulties an individual may have in executing activities
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DEFINE participation
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involvement in life activities. represents societal perspective of functioning
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DEFINE participation restrictions
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limitations and restrictions are assessed against a generally accepted population standard
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DEFINE environmental factors
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factors that are not w/in the person's control such as family, work, government agencies, laws, and cultural beliefs
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DEFINE personal factors
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various elements that make an individual unique
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What is included in body functions (physiology and psychology) of ICF model?
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*mental
*sensory *voice/speech *CV, immune, respiratory *digestive, metabolic, endocrine *GI and Repro *Neuromusculoskeletal *skin |
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What is included under body structures of ICF model?
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*NS
*eye, ear, etc *structures involved w/ voice and speech *structures of CV, immune, respiration *structures of digestive, metabolic, endocrine *structure of GI and repro *structures related to movement *skin |
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What is included under activites of the ICF model?
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learning and apply knowledge
general tasks and demands communication mobility habits |
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What is included under participation of ICF model?
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self care
domestic life work life recreational life interpersonal interactions/relationships major life areas community, social, civil life |
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what is included under environmental factors of ICF model?
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products/technology
natural and man made environment support and relationship attitudes services, systems, and policies |
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what is included under personal factors of ICF model?
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race
gender age ed level coping style |
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what are 2 strategies from the body function perspective?
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*addressing 4 of the 5 cardinal signs of inflammation (pain, redness, swelling, heat)
*promote optimal healing by introducing tension at appropriate times |
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What are common NSAIDs
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aspirin
ibuprofin motrin advil **NOT tylenol** **prefer motrin/advil over aspirin /ibuprofin bc easier on stomach** |
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what are some steroid drugs for treating pain/inflammation?
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medrol dose packs
local injections (Caution!) |
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what is a natural anti-inflammatory drug?
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fish oil
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What is one condition where evidence supports the use of corticosteroids?
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trigger finger
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what are some side effects of corticosteroids?
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potential for tendon weakening and subsequent rupture is incr w/ repeated injections around the tendon
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What are some recommendations for use of local steroid injections in tendonopathies?
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*reserve for chronic injuries
*when rehab is inhibited by symptoms *use short or medium acting corticosteroid preps in most cases *injection should be peritendinous; avoid injection into tendon substance *minimum interval btw injections in 6 weeks *max of 3 injections at one site |
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What does PRICE stand for as a treatment from the body function perspective? (inflammation)
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Protect
Rest Ice Compression Elevation |
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DEFINE Protect as a treatment from the body function (inflammation)
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to reduce the chance of further injury to the tissue
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DEFINE rest as a treatment fromt he body fx perspective (inflammation)
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to promote proper healing
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DEFINE ice as a treatment from the body fx perspective (inflammation)
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to reduce blood flow, decrease perception of pain
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DEFINE compression as a treatment from the body function perspective (inflammation)
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to prevent and reduce swelling
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DEFINE elevation as a treatment from the body fx perspective (inflammation)
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to prevent and reduce swelling and hyperemia
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What are aspects that you need to remember when using a treatment from the body function perspective?
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identify the source of ongoing irritation
apply knowledge of tissue healing apply tension to the healing tissues |
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what can occur if you immobilize healing tissue to long? too early?
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Long: excessive development of scar tissue and loss of mobility
early: tear/stretch the healing wound such that the structure becomes non-functional |
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what does a therapist need to consider when applying Wolf's and Davies' laws to healing tissues?
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*when to intro tension to tissues
*magnitude and type of tension *how to progress the tension such that the tissue can tolerate the demands of the pts various activities |
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What imaging techniques are best for determing soft tissue healing status? hard tissue?
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soft: MRI
hard: xray, CT |
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What are different application techniques of tension?
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manual
Active and resistive exercises mechanical methods (splint) weight bearing |
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What does recurrence of inflammation during/after tension is introduced mean?
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indicates that the tension applied exceeded the tolerance level
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What are common body structure impairments?
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joint capsule tightness
shortened muscles lengthened muscles muscle atrophy postural deviations sensory deficits |
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DEFINE joint capsule tightness
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typically due to immobility and incr collagen formation leading to fibrosis
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DEFINE shortened muscles
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are typically overly strong.
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DEFINE lengthened muscles
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typically week
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DEFINE muscle atrophy
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due to disuse or immobility
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DEFINE postural deviations
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due to a combination of muscular problems as well as potential joint capsule problems
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what are some interventions for impairements of body function?
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manual therapy
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What are some treatments from the perspective of activities and participation?
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*learn/apply knowledge
*general tasks and demands *communication *mobility *habits *self care *domestic/work/rec life *interpersonal interactions/relationships |
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What are some treatment areas from the personal perspective?
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life skills
counseling |
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when dealing with activities/participation, what must a therapist do to understand a person's limitations in performing activities that are important to them?
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observe the person attempting to perform the activities (preferable in environment)
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what is the extent of protection of an injury dependant on?
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degree of the tissue injury
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What is the range of resting injured tissues?
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not allowing the pt to perform any activity to performance of the activity w/ certain modifications
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What mush therapists be very clear about w/ protection and rest?
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what constitutes protection and rest for each patient (differs)
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what are some interventions that protect/rest musculoskelatal tissues?
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immobilization
protected mobilization reduce loading alteration of activities (incl enviornment) |
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What are some immobilizing interventions used?
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casting, splinting, internal fixation
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what are some examples of protected mobilization techniques?
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braces, splints, strapping, taping
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what are some examples of reduced loading techniques?
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assistive devices, adaptive equipment
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what are some examples of alteration of activities?
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maintaining optimal levels of function while preventing unnecessary loading of the tissues
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what does patient education include?
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educating patient about problem
teaching home programs providing strategies for resuming activities |
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what can therapists use to augment pt edu?
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handouts, videotapes, pictures
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what are key elements of exercise prescription?
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ex. counteract sustained posture
achieve proper alignment before, during, and at the end of exercise assess pt performance of exercises provide feedback |
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what are factors that determine frequency of treatment?
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extent of injury
degree of "skilled" service needed |
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when should you see a patient?
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when you change the intervention
follow-up session soon after you've changed intervention **avoid "habitual scheduling" |
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what should the frequence of visits be during the initial stage (generally)?
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more frequent w/ rapid improvement of pt
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what should the frequency of visits be during the intermediate visits?
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reflect tapering
pt becomes more responsible for treatment (home exercise), pt resumes activities |
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what should the frequency of visits be for the final visits?
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gaps of a week or more
*final "tweaking" and transition to independence |
