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OCS - random ?'s

QuestionAnswer
Pain out of proportion to injury with a long bone fracture may be indicative of what? Acute compartment syndrome (can also cause decreased sensation in nerve fields affected by the compartment)
What nerve runs in the anterior compartment of the leg? Peroneal nerve
What is the best intervention strategy for a patient with TMJ anterior disc displacement with reduction? Joint mobilization of the cervical spine. Manual therapy to the cervical spine has been shown to reduce symptoms of TMD
If a patient has aberrant jaw motion, what is the best starting intervention? Address motor control- with tongue on hard palate, have pt. open and close mouth in controlled range of motion
If a patient has R TMJ pain when biting down, what is an appropriate intervention STM with R joint mobilization - this is a case of myogenic pain
What are the examination findings of someone who has anterior disc displacement without reduction? Decreased jaw depression <30 mm.
What is normal opening of the TMJ joint? 30-35mm
When does a second click of the TMJ joint occur? As the disc reduces
Which way does the chin deviate upon opening the jaw in a TMJ disorder? To the side that is painful
When does the chin deviate to the side in a TMJ disorder? When there is limited opening
What is the best course of action for resolving acute TMJ pain after a blow to the face? Maintain the tongue on the hard palate - helps to put the jaw in resting position and inhibits tension in muscles of mastication to relieve swelling and inflammation
What are the proper arthrokinematics for the TMJ? Mandible rotates posteriorly, followed by anterior translation of the condyle
What is appropriate intervention for stage 1 (freezing stage) of frozen shoulder? Gentle, pain free mobilization and stretching, sub-maximal isometrics
Is ultrasound an effective modality for rotator cuff tears or frozen shoulder? No evidence for it
Are corticosteroid injections recommended for diabetics? Can raise blood sugar levels and may be dangerous in a diabetic
Are steroid injections recommended for phase I of frozen shoulder? Perhaps. Has small effect in the first few weeks of treatment, but should be done in conjunction with PT.
Does Thoracic Outlet Syndrome cause decrease in shoulder mobility or cause shoulder pain with all movements NO.
What percent of diabetes patients develop adhesive capsulitis 10-20%
Why do diabetics get adhesive capsulitis? glycosylation of the collagen within the shoulder joint
What is the most sensitive/specific test for isolated AC joint pathology? Cross body adduction (also Bell-Van Riet test, includes resisted elevation component)
What is the best manual treatment approach to someone with cervicogenic headache with limitation of cervical flexion/rotation to 30 degrees? C2-C3 joint mobilization
What is a normal amount of cervical flexion/rotation 45 degrees
What percentage of overall cervical rotation comes from C1-C2 50%
What are the most effective treatments for cervicogenic headaches? DNF retraining and cervical manipulation
What are potential complications of carotid artery dissection? Stroke
How do you screen for cervical arterterial dysfunction Cranial nerve testing
What are characteristics of a tension type headache? bilateral, dull, bandlike, aching, pressing, hard to differentiate from a migraine
What is central sensitization? Amplification in the CNS resulting in more intense perception of pain thereby acting in the maintenance of chronic pain CNS gets "wound up" in state of high reactivity which lowers pain threshold
What should treatment of central sensitization include? Education
What is allodynia? Person experiences pain with things that are not normally painful
What is hyperalgesia? Something that is normally painful is perceived as more painful than it should be.
What role does belief in treatment modality play in recovery? It is one of the most important factors.
What is CRPS? persistent noxious stimuli from an injured body region leads to peripheral and central sensitization, whereby primary afferent nociceptive mechanisms demonstrate abnormally heightened sensation, including spontaneous pain and hyperalgesia
What is the pathophysiogy of a diabetic neuropathy? Inc. level of intracell. glucose in nerve cells cause the saturation of the normal glycolytic pathway; accumulation of sorbitol and fructose lead to decreased membrane Na/K -ATPase activity, impaired axonal transport, and structural breakdown of nerves,
What is the pathyophysiology of fibromyalgia? biochemical, metabolic and immunoregulatory abnormalities that lead to a problem of sensory “volume control” such that patients have a lower threshold of pain and of other stimuli, such as heat, noise and strong odors
Hyperextensibility of the skin is typical of what condition? Ehlers Danlos
Ehlers Danlos presentation? a heterogeneous group of inherited connective-tissue disorders joint hypermobility, hyperextensibility,fragility of the cutaneous tissues. Includes increased fragility of arterial and intestinal tissues as well. Characterized by a defect in collagen.
What is the key to treating Ehlers Danlos? Joint protection and stabilization
What is the hallmark sign of RA? hand/feet pain. Later stages of RA can present with joint laxity because of joint destruction
What is presentation of Lupus? auto-immune disorder characterized by joint pain and extra articular organ involvement
Is piriformis syndrome a real thing? Probably not! It is a sciatica type nerve complaint down the leg
Is butt/hip pain due to SIJ common ? No , though it is somewhat common in post-traumatic or peripartum population
Is there radiographic evidence for existence of innominate rotations in the general population? No.
L5-S1 facet dysfunction would refer pain where? lateral hip, upper buttock
Where does facet joint pain radiate? ow back pain from the facet joints often radiates down into the buttocks and down the back of the upper leg. The pain is rarely present in the front of the leg, or rarely radiates below the knee or into the foot, as pain from a disc herniation often does.
What is greater trochanteric pain syndrome? Degeneration of the tendons of the hip abductors and external rotators.
Why is trochanteric bursitis a misnomer? does not appear to be a clinical entity - no inflammation actually takes place in that bursa. appears to be more relative to degenerative process
What does evidence suggest about the use of METs in correcting SIJ imbalances? No accepted evidence suggests that METs change the position of the pelvis or SIJ, but they can temporarily correct muscle imbalances
What is the best approach to treating a patient PFPS Strengthen glut max, med, and external rotators. VMO strengthen is poorly supported - cannot isolate it.
Is there evidence to support using bracing or orthotics to treat PFPS? Very little
What is Apley's test
What nerve innervtes the anterior compartment Deep fibular nerve - Big toe extensor, tib anterior, peroneous tertius, extensor digitorum longus, sensation in web of 1st and second toes
Where is the deep fibular nerve compromised and likely to get smushed? head of fibula (direct fall) - the spn can be compromised, but dpn more likely
What does the superfcial peroneal nerve innervate? peroneals, sensation to lower 2/3 of anteromedial leg and dorsum of the foot
What innervates the long head of biceps femoris? Sciatic nerve
What innervates the short head of the biceps femoris? common peroneal nerve
what muscles are in the posterior compartment of the thigh? semimembranosus, semitendinosus, biceps femoris
What visceral structures are in the lower r quadrant? ovary, kidney
Is an AAA an emergency? No - even a large aneurysm of 8 cm has only 30-50% chance of rupture within 5 years
Who is more likely to have AAA - man or woman? Man is 4-6 times more likely.
What is normal size for Abdominal aorta 2 cm.
What are uterine fibroids?
What is McBurney's point 1/3 of the way up from ASIS to the umbilicus - where you feel tenderness with appendicitis
What viscera are in lower right quadrant ovary, appendix
What viscera are in upper right quadrant Head of pancreas, Kidney,Gallbladder, Liver, colon
What viscera are in the lower left quadraant colon, ovary, small intestine
what viscera are in the upper left quadrant Pancreas, stomach, spleen, kidney
What population is most likely affected by appendicitis Under 30, usually with vomiting and fever
2 weeks out - milestones for ACL 110 degrees flex, full extension, walking with full extension, stairs step over step
4 weeks out - aCL milestones Full ROM, 50% or more of other quad
6 weeks out - ACL milestones Quad at 80%, , full ROM, normal gait
12 weeks out - ACL milestones Hop test 85%,
What benefit does CKC exercise have less patellofemoral pain, better protection of graft
For OKC exercise, what range is safe? 90-60 (45?)
What are return to sport criteria for ACL 85% quad strength (usually around 9 months, can be as early as 6)
Calcaneal fx, what else can happen Lumbar fracture often also occurs. Concomitant fx.
When will pt. be FWB after calcaneal fx? 12 weeks - probably out of cast after 6 weeks, PWB at 8 weeks
What is sail sign radiographic evidence of fat pad displacement due to effusion indicative of occult fracture
What is Galeazzi's sign DK->C with 2 month old child, if one leg sticks up, hip dysplasia is presnet
What is Boehler's angle Draw perpendicular line on top of calcaneus. normal angle is 30. Less than 20 is indicative of fx.
What percentage of people with disc bulges are asymptomatic? 50%
What is hallmark of radial tunnel syndrome? Localized pain distal to the lateral epicondyle without motor loss is a hallmark of radial tunnel syndrome.
Where is the radial nerve most likely to be entrapped? Arcade of Frohse - supinator arch (superior aspect of superficial layer of supinator
What is the presentation of saphenous nerve entrapment? medial R knee pain, burning, pain with squatting, pain with VMO palpation, decreased medial knee sensation
Where does saphenous nerve entrapment occur infratpatellar there is a branch that runs to medial side
When after TSR can a pt. resume golf? 4 months (ROM is sufficient at this point, and can begin advanced strength)
How long should a sling be worn post TSA? ~ 6 weeks
What are goals for 6 weeks after TSA? FF to 90, ER to 30, IR to 70.
Goals for 10-12 weeks TSA? FF to 140, ER to 60, IR to 70, no lifting >5 lb.s
When can light strengthening of IR begin for TSA? 6 weeks
What populations are affected by Ankylosing Spondylitis Men>women, ages 20-40
What is a Stener lesion? Stener lesion is an avulsion of a torn ulnar collateral ligament which can delay healing and can be an indication for surgery
What is Kienbock's disease AVN of lunate
What is Otosclerosis? Otosclerosis is caused by abnormal bony changes in the middle ear, and the primary symptom is hearing loss and / or tinnitus
Paralysis of which cranial nerve causes Bell's palsy 7th - facial
What is Giant Cell Arteritis? presentation is typically bilateral, but Giant Cell Arteritis should be considered in patients 50 and older with temporal and/or jaw pain. Patients with this condition often also present with constitutional signs and symptoms including fever and fatigue.
What does Jobe relocation test test for Anterior instability of the shoulder
How do you do the Jobe relocation test? Add posterior directed force after a positive apprehension test - if apprehension is reduced, test is positive for anterior instability.
What does the sulcus sign test for Multidirectional instability
What does the Yocum test for Subacromial impingement
Are the Ottawa rules sensitive or specific? sensitive
Entrapment of which nerve occurs at Guyon's canal? Ulnar nerve
What is Parsonage Turner syndrome? Upper brachial plexus injury - idiopathic abrupt shoulder pain followed by progressive neurologic deficit.
What are symptoms of radial tunnel syndrome? No motor loss - fatigue, or dull aching symptoms
What is type II scapular syndrome as described by Burkhard? Medial - border winging
What is type I scapulr syndrome as describe by Burkhard Inferior - inferomedial prominence
What is type III scapular syndrome as describe by burkhard superior- associated with impingement and RTC symptoms
What are symptoms of TMJ of myogenous origin? Recent dental procedure, history of grinding, overuse
What are symptoms of tMJ condylar subluxation? opening >40-50mm, hypermobility with opening click occuring at 40-50mm as condyle translates beyond border of anterior disc
What are symptoms of TMJ capsular fibrosis? limited jaw protrusion and lateral deviation to contralateral side with associated hypomobility of the joint
What are symptoms of TMJ disc displacement without reduction? jOint noises with opening and intermittent locking, mandible opening with deflection to ipsilateral side
Where would stomach pain refer?c Center of thorax, directly midline or slightly off to the right
Where would pancreas pain refer? lower and on the left of thorax
Where would lung pain refer? cervical
Where would LIver/gall bladder refer? R lower thorax
where would kidney pain refer? groin/thigh
What is Hangman fracture? Sponylolisthesis of C2 on C3 due to fx of posterior C2
Which ligament controls subcranial rotation and produces rotation of C2 ipsilateral to direction of mid cervical sidebend Alar
What is the function of the Transverse ligament hold the dens from c2 in place against anterior arch and prevents anterior translation of c1 on c2
What is appropriate dosage for traction? QIW, 12 minutes at 40-60% of body weight
What is the lower scapula force couple? mid trap, lower trap, serratus
What is the upper scapula force couple? rhomboids, pec minor, levator scap
What are the arthrokinematics of mandible condyle during late phase opening? Anterior translation at 50-100% in superior joint cavity.
What is the function of the masseter Bilaterally, elevation of jaw. Unilaterally slight lateral deviation.
What is the functon of the infrahyoid muscles? stabilize the hyoid bone to form firm base for suprahyoids
What is the function of the suprahyoid muscles? pharyngeal muscles help with depression of the jaw
Which test for TOS has highest sensitivity Wright test
How do you perform Wright test Elbow and shoulder at 90/90, check pulses. Then abduct arm overhead and check pulses again.
What are the 5 criteria for people who will respond to mechanical traction and exercise? Peripheralization with c4-7 mobility testing, positive shoulder abduction test, age >55, positive ulttA, positive neck distraction. 3 out of 5 .
What is the shoulder abduction test Have pt. put hand on head - if symptoms are better, then pt. may have radiculopathy
During TSA recovery what should ER be limited to in first 6 weeks 30-45 degrees
What is a Barton's fracture? Intra articular fracture (extends into the joint) of distal radius can be either dorsal or volar
What is a colles fracture? Distal radius fracture that displaces dorsally (extrarticular)
What is a smith (reverse colles fracture) Distal radius fracture that dispplaces volarly (extrarticular
Nystagmus with rapid supine to sit is indicative of what? BPPV
What does a beta blocker do? Slows heart rate, slows force of contraction (blocks adrenaline/epinephrine)
Excessive lateral trunk lean to the right instance indicates weakness of what muscle R glut med.
Who falls into EBP stabilization category Age<40, SLR>90, +aberrant movement (instability catch), +prone instability test
For whom might cervical manipulation be contraindicated when treating someone with a cervicogenic headache? RA, Marfans, Downs
What would absent Hoffman's sign indicate? Decreases concern for UMN
What do positivee Hoffman's sign/Babinski sign indicate cervical myelopathy
Is high velocity thrust manipulation indicated for hypomobile joints? yes
What are contraindications for HVLA fx, osteoporosis, down's, RA
What is type 2 shoulder impingement upward migration of humerus
What are 3 types of acromion 1. flat 2. curved. 3. hooked
What is a fat pad sign indicative of in children with elbow fracture? intra-articular fracture - trochlea fracture vs. radial head fracture.
What is the order of the structrures in the cubital fossa from lateral to medial Biceps tendon, brachial artery, median nerve
What is a Segond fracture Avulsion fracture of medial tibial plateau. Associated with varus force and internal rotation
What are effective exercise modalities for fibromyalgia Aerobic exercise. To a lesser extent strength training
What is the stork test? Test for PSIS symmetry while moving into single leg stance
What are the levels of evidence 1. meta analysis, systematic review of RCTs. CPGs based on RCT 2. RCT 3. Well designed trials w/out randomization 4.Case control or cohort. 5. systematic review of qualitiative or descriptive studies 6. Single descriptive or case s tudy.
What is positive predictive value Positive predictive value is the probability that subjects with a positive screening test truly have the disease. based on prevalence
What is calculation for positive LR sensitivity/1-specificity = true positive/false positives Likelihood you test positive if you truly have the disease
Sensitivity VS. positive predictive value Correctly identifes positives. VS. probablity that positives have the disease
What is osteochondritis dessicans Condition in joints when a small segment of bone begins to separate from surrounding region due to lack of blood supply - possibly due to repetitve trauma
What are the grades for MMT gastroc 20 = 5/5,
Are orthotics recommended for achilles rehab No
In iontophoresis what solution is indicated for inflammation Dexamethasone/hydrocortione - negative polarity
In iontophoresis what soluation is indicated for calcium deposits Acetic acid - negative polarity
in iontophoreses what solution is indicated for muscle spasm calcium chloride - negative pole, magnesium sulphate - positive
in ionto what solution used for pain lidocaine -positive pole
in ionto what soluation for adhesive capsulitis iodide - negative pole
What is mech of injury for syndesmotic sprain? direct blow to lateral knee with foot planted on ground in relative external rotation (causes talus to push mortise apart)
What is best radiographic view for syndesmosis sprain Mortise view - unilateral stance
Immediate treatment for syndesmosis sprain? PRICE, posterior splint ankle in 10 degrees PF, immediate NWB with crutches
Is stretching good for acute syndesmosis sprain Do NOT stretch gastroc soleus - will pull the syndesmosis apart.
What radiograph is good for differentiating symptomatic bipartite patella from asymptomatic bipartite patella Bone scan
Increased lumbosacral angle leads to what? Increased lumbar lordosis.
What kind of shoe recommended for someone with decrease MTP extension (such as post op bunionectomiy) shoe with stiff full length insert and morton extension inlay with rocker heel
What is a chiari malformation condition when the brain extends into the spinal canal - happens when skull is small or misshapen, pushing brain downwards
Type I chiari malformation Most common - observed in children - lower part of cerebellum extends into opening in base of skull but not the brain stem -asymptomatic often but can be neck pain, intensifies with coughing, dizziness, balance probs. sleep apnea, swallowing, hearing loss
Type II chiari malformation Spina bifiida (incomplete development of spinal cord), both cerbellum and brain stem extend into the cord. "Classic" type
Type III chiari malformation MOst serious kind - protrusion/herniation through foramen magnum - severe neurologic deficit
Type IV chiari malformation incomplete or underdeveloped cerebellum - rare type
symptoms of chiari II malofrmation? weak vocal chords, swallowing, labored breathing, throat/tongue problems. head pain with coughing/sneezing, bending over, straining with bowel movement
Most common type of chiari malformation in PT clinic? Type I
What is the time fame for acute compartment syndrome? Shortly after injury and surgical casting or surgery itself
What are the 4 P's of compartment syndrome? Pain, pallor, paresthesia, pulses
What areas of the wrist are likely to be tight after radius fixation surgery? Extrsinisc extensor muscles (due to plate fixation/screws on dorsal aspect
What is the goal of patellar taping? To reduce pain (not to help the patella track more medially - no evidence for this)
What is the best course of action to take immediately after a shoulder dislocation Immobilization for one week to prevent further dislocation
When would you need an open mouth radiograph? To diagnose injury to upper cervical spine
What position should be avoided post op ORIF of Radius? Flexion + pronation
What are the grades of glenohumeral translation 1 - less than 50% of humeral head translates over the rim 2. - more than %50 of hmeral head trannslates, but pops back in/doesn't sublux 3. Entire humeral head translates Trace - small amount of translation
What diagnostic should be used to confirm shoulder labral tear? MRA (magnetic resonance arthrogram)
What is a Hill sachs lesion? posterolateral lesion of humeral head
What are risk factors for diastasis recti? obesity, multiple births, narrow pelvis, 3rd trimester, large baby, excess uterine fluid
precautions for lumbar disc arthroplasty? extension
Who is a candidate for lumbar disc arthroplasty? Not overweight, no significatn joint disease or nerve compression in the spine, no previous spinal surgery, no scoliosis or other deformity. Disk made of metal or plastic
what is lumbopelvic rhythm flexion of lumbar spine followed by anterior rotation of pelvis in 1:1 ratio
How do you differentiate between a muscle
What is medial occlusal position? Position of the jaw where the upper and lower teeth meet with equal pressures
What is centric position? Position where the mandible is unrestrained, resting - ideally will be the same as medial occlusal position
In a forward head position, what position is the jaw in? retracted position (takes jaw out of centric position - over time hypermobility will take place to compensate for lack of proper dental alignment
What is a likely sequela at the TMJ with Forward head posture? Hypermobility of TMJ
What is a normal amount of lateral glide with TMJ
What does the masseter do elevate and protrude
What does the temporalis do Elevate and retrude
What does the suprahyoid do depress
What does the lateral pterygoid do depress, protrude, lateral movement
What does the medail pterygoid do elevation, protrude, lateral movement
what is normal protrusion of the mandible 5mm
what is normal lateral deviation of the mandible 8-10 mm
What is Yoemans test? SIJ test - pt. in prone - bend pt. knee to 90 with other hand on involved SIJ and lift pt.'s hip up by pulling up on the knee - pain under hand positioned on SIJ is positive test
When would you use STM for a TMJ problem? when TMJ muscles are tender or have trigger points.
what are signs and symptoms of CRPS hot/cold sensitivity, red, blotchy skin, burning throbbing skin, shiny skin , changes in skin temperture or textrue.
Created by: Dallin I