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Treatments Final Rev
CanColl May 2012 Treatments Final Review Nov 2011
| Question | Answer |
|---|---|
| What is the Rh factor? | a protein antibody |
| What is the process which leads to the development of rheumatoid arthritis? | synovial membrane thickens, becomes hyperemic - pannus formation occurs. Next, capsular scarring and shrinkage impair Jt function. Tendon contractures occur, ligs fibrose, cartilage softens -is absorbed, bone atrophies, osteophyte form + ankylosing |
| What changes in the skin occur with RA? | trophic changes - red & glossy |
| What is "swan-neck" deformity? | extension at PIP and flexion at DIP |
| What is "boutonniere" deformity? | flexion at PIP and extension at DIP |
| What direction to the fingers deviate with RA? | ulnar deviation |
| Why use abdominal massage when treating RA? | to promote increased elimination |
| Why is cervical traction CI'd with advanced RA? | cartilage softens, bone atrophies - traction could cause serious injury |
| What massage is appropriate onsite for RA? | gentle, soothing - no stretch, no work on nodules |
| How can RA affect a person's feet? | arch is lost, foot widens and becomes stiff. May develop pes planus, plantar fasciitis, Achilles tendinitis, inflammation of metatarsal-phalangeal Jts. |
| Which joints are affected first with Ankylosing Spondylitis? | SI joints |
| Where does the inflammation develop with Ankylosing Spondylitis? | on the site of the ligamentous insertion into the bone (entheses) |
| What changes occur in the vertebral bodies with Ankylosing Spondylitis? | constricted in the middle and broad at the margins (bamboo-like appearance) |
| What other symptoms can occur with Ankylosing Spondylitis? | am stiffness (alleviated with exercise), mm spasm, pain low back, buttocks, hips, post. thigh, lost of spinal lordosis, flexion contractures of hips, hyperkyphosis, fusing of spine |
| What characterizes the lumbar spine in later stages of Ankylosing Spondylitis? | flattening (and fusing) of the lumbar spine |
| Why is it important to massage the muscles of respiration of a client with Ankylosing Spondylitis? | due to ossification of costo-vertebral joints - breathing becomes difficult as chest expansion becomes restricted. |
| What is the most appropriate position and pillowing for a client with Ankylosing Spondylitis whose spine has not yet fused? | If no fusion has occured - no pillow is required under the abdomen (in prone) |
| Why are deep work and frictions CI'd over areas where fusion has occured? | we cannot reduce the fusion and may cause a flare-up of inflammation |
| What types of remedial exercises are most appropriate for clients with Ankylosing Spondylitis? | regular ADL, mobility exercises for back and spine (esp extension), sleep on hard mattress, breathing/chest expansion exercises |
| What joint is most often affected with Gout? | 1st metatarsal-phalangeal joint |
| What are tophi? | deposits of crystals of uric acid -urate crystals - accumulated in synovium, subchondral bone, bursae and tendons. |
| What are the symptoms of an acute gouty attack? | sudden onset, extreme pain, joint swollen & hot, skin over Jt gets hot, shiny, red/purplish, may include fever, chills, malaise or tachycardia |
| What conditions can tophi cause? | joint deformity, dysfunction and pain, carpal tunnel syndrome,trigger finger & kidney stones |
| What massage is appropriate onsite for gout? | Acute - nothing onsite Chronic - MLD, reflex, gentle joint play if no tophi are present |
| What techniques are appropriate during an attack of gout? | elevate foot, diaphragmatic breathing,MLD (near site) treat unaffected (compensatory )areas, focus on relaxing. |
| What techniques are appropriate onsite between attacks of gout? | joint play (if no tophi), PROM (pain-free only) |
| What type of hydrotherapy is appropriate for an acute attack of gout? | cold epsom salts foot bath |
| What conditions (co-existing with gout) will CI "passive-forced range of motion?" | tophi and/or bony changes |
| What symptoms lead to a diagnosis of fibromyalgia? | widespread mm pain lasting more than 3 months, increased sensitivity to pressure over defined tenderpoints - and the absence of "other systemic conditions that would account for symptoms". |
| Where are the tender points located for fibromyalgia? | sub "o" insertion, ant. intertrans spaces at C5 - C7, midpoint upper border - traps, origins of supraspinatus, second costochondral jct., lat. epicondyles, upper, outer quadrants of buttocks, just post. to GT, med knee - prox to jt line. 9 pairs |
| Is fibromyalgia progressive? | No |
| Does weather affect fibromyalgia? | many patients experience flare-ups related to changes in weather. |
| What duration of treatment is appropriate for a client with fibromyalgia? | initial 30 - 40 minutes |
| Why is relaxation and sleep important for a client with fibromyalgia? | disturbed sleep patterns can cause a vicious cycle of: lack of rest - increased pain & stiffness |
| What can an RMT do to help a client with fibromyalgia to be relaxed and get proper sleep? | Perform relaxing (non-stimulating) techs - that will help the client to sleep better. |
| What differentiates trigger points from tender points? | Trigger points have referral patterns but tender points do not. |
| Are anti-inflammatory drugs often prescribed for fibromyalgia? | NO - usually, there is no inflammation with fibromyalgia |
| Why does muscular dystrophy result in progressive muscle weakness? | As the disease progresses, MM fibres are replaced by fat and fibrous tissues |
| Which muscles are most affected by Duchenne's muscular dystrophy? | Calf mm's and then glutes |
| Which muscles are most affected by Erb's muscular dystrophy? | Shoulder girdle and upper arm |
| Why is breathing a concern or clients with Erb's muscular dystrophy? | atrophy and kyphosis cause breathing to be very difficult |
| What techniques are appropriate to help to improve or maintain the respiratory function in a client with Erb's MD? | joint mobs, stretching & vibrations |
| Which symptom is most common with Lupus? | arthritis or arthalgia - is most common (95% of cases) |
| What abnormalities of skin and mucous membrane are most common with Lupus? | butterfly rash |
| What modifications to treatment are made to a client with skin lesions due to Lupus? | rash or skin lesions are local CI also, if lesions present - position client so there is no pressure on rash or lesions. |
| What conditions contraindicate abdominal massage for a client with Lupus? | kidney or spleen involvement |
| What techniques are appropriate onsite for a client with joint pain and limited ROM due to Lupus? | PROM and gentle Joint Play |
| What is the recommended duration of treatment for a client with Lupus? | brief duration to avoid fatique |
| How frequently should a client with Lupus in remission, receive massage therapy? | once per week |
| Which demographic suffers most from Lupus? | young women (30-40) (3x more common in black women) |
| When treating a breathing condition, what are your possible aims of treatment? | increase/maintain thoracic mobility, improve fx of mm's of respiration, dec stress |
| Name 5 irritants that can cause an asthma attack. | cig smoke, dust, solvent fumes, cold air, mold, dander, allergies, infections, emotional factors, exercise |
| What characterizes asthma? | attacks of wheezing and breathlessness (difficulty expelling air) |
| A patient with chronic asthma may present with what formation of the thorax? | "squared off thorax" i.e. anterior bowing of the sternum & depressed diaphragmn |
| What is your most appropriate option if you client has an asthma attack on the table? | discontinue treatment - give client access to his medication/inhaler |
| What are the primary muscles of respiration? | diaphragm |
| What are the secondary muscles of respiration? | intercostals, scalenes, serratus post, upper traps, lats, SCM's, pec minor, pec major, serratus anterior |
| What postural concerns may present with asthma? | raised shoulders, tightness in secondary mm's of respiration |
| What asthma medications may contraindicate treatment and why? | steroids, prednisone - decrease sensitivity to pain |
| What are the components of treatment to improve respiratory function? | facial steam (expectorant), heat over thorax, rib raking, thoracic mobs, scap mobs, costal margins of diaphragm, neck massage |
| How to you perform postural drainage? | tapotement - prone with several pillows under abdomen |
| What type of remedial exercise is appropriate for asthma? | gentle aerobic exercise, diaphragmatic breathing, yoga, shoulder rolls (relax raised shoulders) stretch scalenes |
| What can cause acute bronchitis? | virus, bacteria, irritants (dust, fumes, smoke, acids) |
| When pus occurs in sputum with acute bronchitis, what does it indicate? | pus is suggestive of bacterial infection |
| What co-existing condition can contraindicate treatment for bronchitis? | fever & infection |
| What position does a client with bronchitis' cough worsen in? | when lying down |
| How do you teach your client to "huff" and cough? Why? | seated - leaning forward - forced expiration - contract glottis (cough) or not (huff) - saying Ha Ha Ha |
| What positioning/pillowing is appropriate to perform postural drainage? | prone with 2-3 ( or more) pillows under abdomen |
| What hygenic precautions should you take before performing postural drainage on a client with bronchitis? | provide a bucket and tissues |
| What type of hydrotherapy is appropriate for a client with bronchitis? | heat to thorax to relax mm's of respiration |
| What type of remedial exercise is appropriate for a client with bronchitis? | gentle aerobic exercise, diaphragmatic breathing, shoulder rolls, stretch SCM, scalenes, intercostals |
| How is pulmonary emphysema defined? | enlargement of the airspaces distal to terminal non respiratory bronchioles accompanied by destructive changes of the alveolar walls |
| How much sputum is produced by someone with emphysema? | severity of cough out of proportion to the amount of sputum produced |
| What shape can the thorax of a client with emphysema take? | barrel chest - anteroposterior diameter of chest increased: dorsal kyphosis increased. |
| How to you determine the length of treatment for a client with emphysema? | more severe case = shorter treatment time |
| What is your most appropriate treatment for hypertrophied neck muscles? | light repetitive work - strokings, vibrations, slow rocking - perhaps TP's |
| How do you explain deep diaphragmatic breathing to your client? | Three steps - client supine - abdomen, lateral rib cage and manubrium - raise each in turn |
| How does massage therapy help clients with cancer? | supports by providing relaxation and stress relief - also - addresses consequences and sequelae |
| What is the most appropriate positioning for a client with severe hypertension? | if uncontrolled = CI. If controlled = reduce time spent prone - use seated, supine or right sidelying. Avoid AB pillows, avoid raising limbs over head, use 2 or more pillows under head. |
| What techniques are appropriate onsite to reduce a cramp? | light passive stretching, reciprocal inhibition, mm squeezing & shaking, hydro, low grade joint mobs |
| What assessment differentiates a subacromial bursitis from supraspinatus tendinitis? | for bursitis - there is not usually pain on resisted abduction |
| What techniques are appropriate to reduce local edema caused by fascial restrictions? | PROM, pain-free joint play, fascial techs, Buerger's Exercises, |
| What tendons compose the anatomical snuffbox? | Extensor pollicis brevis & longus, abductor pollicis longus - EPL, EPB & APL |
| Define grade 3 tendinitis. | Px at beginning, middle and end of activity - |
| Trigger points in which muscles can cause tension headache? | SCM - traps, splenius capitus, sub-0's, temporalis |
| Which muscles should be included in a TMJ dysfunction treatment? | Masseter, lat pterygoid, med pterygoid, temporalis, digastric & hyoid mm's |
| What are the most appropriate techniques for treating an acute adductor sprain? | GTO, O&I, reflex, reciprocal inhibition: with very gentle passive stretch, lots of drainage |
| Which muscles are most often affected with a hyperflexion wrist sprain? | extensor MM's |
| Where does pain from a sprained upper SI ligament refer? | lat posterior thigh, ant thigh to patella, lat leg toward malleolus |
| What type of remedial exercise is most appropriate for a contracted iliopsoas? | Fencer's lunge or kneeling lunge, supine floor stretch |
| What muscles should be treated in conjunction with a contracted IT band? | TFL and Glute Max |
| Differentiate between the QTF grades of whiplash. | 0 - no complaint about neck, 1 - neck pain, stiff, but no signs, 2 - neck pain, stiff - with MS signs, 3 - neck pain with neuro signs, 4 - neck probs with frac or dislocation |
| What techniques are appropriate onsite for a suspected whiplash in the first 48 hours? | None |
| Why is the swallowing test important for a client with suspected whiplash? | could indicate serious injury to hyoids, esophagus or trachea - if prob refer to MD |
| What other areas can be injured in conjunction with whiplash? | cervical ganglia, vertebrae, IVDs, blood vessels (VBAI), nervous system, brain damage |
| What muscles are commonly injured with whiplash? | SCM, scalenes, longus colli, supraspinous, interspinous and posterior neck mm's |
| Why is it important to progress slowly with a client with whiplash? | condition can be extremely painful and client will be fearful of injudicious movement |
| What types of remedial exercise are appropriate for a client with subacute whiplash? | isometrics to maintain mm strength - in all ranges |
| Where are the longus colli muscles located? | between c3 and t3 from TVP to anterior vertebral body |
| Which cervical discs are most likely to herniate/prolapse? | discs between C5 - C6 and between C6 - C7 |
| How does a herniated disc cause pain? | pressure on the surrounding structures by the bulged material - two types - local and radicular |
| What assessments are useful to determine whether a prolapsed disc has caused nerve impingement? | AROM, PROM, Cervical Compression/Distraction Test |
| What techniques are appropriate onsite in the acute stage of a disc herniation with nerve involvement? | massage is CI until x-rays taken and approved by MD. Ice can be used if due to injury |
| What techniques are appropriate in the chronic stage of a herniated disc? Why? | full range of techs on compensatory strucs. We cannot reverse the prolapse - but can only manage compensatory events. |
| Why is it important for the client to have an x-ray before undergoing treatment for a herniated disc? | To determine the extend of the injury or damage - there could be a fracture or dislocation as well |
| Define torticollis? | unilateral shortening of the mm's parallel to spine. Head & neck positioned abnormal relative to body. Contracted state of cervical MM's with torsion of the head. Flexed ipsi and rotate contra. More common on left side |
| What can cause torticollis? | congenital or acquired |
| What other symptoms can be present with torticollis? | limited ROM, pain, headache, guarded arm position, anxiety, earache, TP's, lacrimation, tinnitis, dizziness, nausea, syncope, ptosis |
| What symptoms indicate a sternal SCM trigger point? | lacrimation, droopy eye, tinnitis |
| What treatment is appropriate onsite for acute torticollis? | CI for first 2 days - after - only pain free techs - O&I, GTO release, Reciprocal Inhibition, MM approximation |
| What co-existing condition can contraindicate massage for torticollis? | glandular inflammation, subluxation, |
| What is the action(s) of the SCM? | bilateral: flexes the neck unilateral: lateral flex of neck (ipsilaterally) and rotation (contralaterally) |
| What techniques are appropriate to treat an SCM in spasm? | O&I, GTO release, mm approximation, reciprocal inhibition (agonist contraction) |
| What joint mobilizations are appropriate onsite for torticollis in the chronic stage? | long axis traction and cervical mobilizations (in a pain free manner) |
| What type of hydrotherapy is appropriate for acute torticollis? | If inflammation is present - cold compress. If no inflammation - warm compress to relax mm's |
| Which muscles are synergist with sternocleidomastoid? | scalenes, upper traps, lev scap, pecs. rotatores |
| What is the trigger point referral for the scalene group? | inferiorly into the chest and the back + all down the lateral arm to the thumb and index finger |
Created by:
Hanz Onn
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