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PathTreatments2 TT2
CanColl May 2012 Treatments2 TT2
| Question | Answer |
|---|---|
| What are the symptoms of a Lower Motor Neuron Lesion? | Flaccid paralysis (same side), progressive mm atrophy, paresis, loss of strength, trophic changes to skin & nails |
| At what stage of healing is it appropriate to encourage tissue health during recovery from a LMNL? | From most early stage - i.e. acute |
| What is connective tissue lengthening/contracture reduction appropriate for a client with LMNL? | When the contracture is not a functional contracture. |
| What techniques are appropriate to reduce contractures? | Fascial, frictions, Jt play, stretching |
| What types of remedial exercises are CI'd during an acute/subacute LMNL and why? | for 6 weeks, all remex is CI'd (esp traction) because of the inflammation |
| Which cranial nerve is affected by Bell's palsy? | CN VII - Facial Nerve |
| What can cause Bell's palsy? | swelling of the nerve (compression), virus, immune system, middle ear infection, injury to side of head or a TMJ problem. |
| What are the symptoms of Bell's palsy? | flaccid paralysis to one side of the face, sudden onset, drool, speech difficulties, taste dysfunction, one eye won't close. |
| Why should a patient be referred to their MD before beginning Tx for Bell's palsy? | to confirm that a stroke has not ocurred - because the symptoms are so similar to a CVA. |
| What direction should petrissage strokes be to the face of someone with Bell's palsy? | upward and outward - towards the nerve root - and where the nerve exits the foramen in the skull. |
| What remedial exercise is appropriate during Tx with Bell's palsy? | integration exercises |
| How can the eyes be affected with Bell's palsy? | eyelid may not close, dry eye - could require a patch in order to sleep. |
| What are the symptoms of the onset stage of poliomyelitis? | flu-like + neck rigidity (2 days) |
| Which mm's are most often affected by poliomyelitis? | Anterior tibialis, peronei, quadriceps, glutes, deltoids. |
| What happens to atrophied mm's which do not recover from poliomyelitis? | become fibrous bands |
| Paralysis which remains after 2 years from the onset of poliomyelitis is most likely to be ________? | permanent |
| Which demographic is more likely to acquire Post-Poliomyelitis Syndrome? | men 12:1 + those that experienced a severe early attack (of polio) with respiratory difficulties. |
| What are the symptoms of PPS? | fatique, weakness, decreased endurance, joint pain, leading to pain in normal mm's. |
| How long should the client with Polio wait before beginning massage therapy? | CI - for first 4 - 6 weeks. requires a confirmation from MD. |
| What secondary conditions can result from PPS? | Contractures, JT probs, dysarthria, dysphagia, respiratory difficulties |
| Which actions are lost or reduced as a result of median nerve paralysis? | pronation, flexion, radial deviation |
| Which pathologies can result in median nerve paralysis? | Colle's frac, CTS, lunate/schaphoid dislocation, RA, tenosynovitis, edema |
| What happens when a client with median nerve paralysis tries to make a fist? | cannot make fist - create instead "oath hand" - 1st & 2nd digits do not respond |
| Which MM's should be lengthened when treating a client with median nerve paralysis? | extensors, abductors |
| What is the characteristic clinical sign of radial nerve paralysis? | Wrist Drop - inability to extend or straighten the wrist. |
| Where does sensory loss occur occasionally with radial nerve paralysis? | Dorsum of hand & fingers and a small portion on the dorsal surface of the web between the thumb and the second finger |
| What types of remedial exercise are appropriate for radial nerve paralysis? | gripping, thumb to finger, play piano, resisted extension, supination |
| What are the CI's to treating crush and severance injuries to peripheral nerves? | 3 weeks after surgery, NO traction, Jt mobs, hydro, frics, deep pressure - until innervation & function has returned. |
| What are the guidelines for positioning a limb which has a flaccid paralysis? | gently moved out of holding position towards neutral |
| What types of techniques are appropriate distal to the lesion site for A)affected and B)unaffected mm's? | Affected - light stroking, gentle compressions Unaffected - GSM (gentle) + modified fascial, pin the edge of the lesion to prevent pull. |
| How do you re-educate a client's sensory perception once the nerve begins to heal? | passively perform action and have client mentally visualize the motion. |
| What pathologies can contribute to ulnar nerve paralysis? | compression in axilla, elbow, wrist, fracs, lacerating wound, tumor, overuse, metabolic disorder, mechanical problem. |
| What hand position presents with a complete ulnar nerve lesion? | Clawhand |
| What assessment is positive with an ulnar nerve lesion? | Froment's, loss of adduction/abduction of fingers, dec ulnar deviation, |
| Which cords of the brachial plexus are damaged with Erb's palsy? | Roots - C 5 and C 6 |
| What pathologies can precede Erb's Palsy? | birthing, separation of neck and shoulder (MVA, sports injury, etc) |
| Which mm's are innervated by the 5th and 6th cervical nerve roots? | Rhomboids, deltoids, supra/infraspinatus, teres minor, biceps, brachialis, supinator, extensors of wrist. |
| What position is indicative of Erb's palsy? | Waiter's Tip - arm adducted, shoulder internal rotation, elbow extended, wrist flexed |
| Which nerve roots are affected by Klumpke's paralysis? | C7 - T1 |
| Which symptom presents with Klumpke's paralysis if the cervical chain ganglia are affected? | Ptosis (droopy eyelid) - Horner's Syndrome |
| What is the only hand movement which remains after a full Klumpke's paralysis? | finger and thumb extension |
| Klumpke's paralysis causes atrophy and functional loss primarily where? | intrinsic hand muscles & wrist flexors |
| What non-muscular symptoms can occur in the hand of someone with Klumpke's paralysis? | edema |
| What are the nerve roots which correspond to the sciatic nerve? | L4 - S3 |
| What is the course of the Sciatic nerve? | thru greater sciatic foramen - inferior to (or thru) piriformis - inferolateral deep to glute max (midway between GT & ischial tub) - post to quad femoris & add mag - splits prox to popliteal fossa |
| The sciatic nerve provides motor function to which mm's? | hamstrings, lower leg and foot |
| The sciatic nerve provides sensory supply to which areas? | post & lat thigh + entire calf & foot |
| Which mm's will be contracted and hypertonic with a right-sided sciatic lesion? | Compensating = most mm's of left leg and both sides of lower back. Also, on right side - TFL, Quad, and IT Band |
| What areas can the sciatic nerve be entrapped in? | front of SI joint, under piriformis, over quad femoris, under glute max, between hamstrings |
| What type of gait is present with a sciatic nerve paralysis? | steppage gait |
| What position does the foot take with a sciatic nerve paralysis? | FOOT DROP = paralysis of dorsiflexors & evertors - cause foot to hang loosely in plantarflexion & inversion |
| Which mm's are innervated by the tibial division of the sciatic nerve? | Gastrocs, plantaris, popliteus, soleus, tib post, flexor digitorum longus, flex hallucis longus + intrinsic MM's of foot |
| Which actions are lost with a tibial nerve lesion? | no active plantar flexion - "toe off" |
| The loss of intrinsic foot mm's with a tibial nerve lesion cn lead to which symptom? | "CLAW TOE" DEFORMITY = hyperextension at MCP jts and flexion of IP jts. |
| Where is the peronial nerve most vulnerable to injury? | superficially wraps around neck of fib - frac of fib |
| Which areas of skin are innervated by the peroneal nerve? | lateral side of calf - onto top of foot. |
| What is foot slap? | after heel strike - dorsiflexors are not effective and foot slaps down |
| How do you differentiate between peroneal paralysis and Charcot-Marie-Tooth? | For CMT - the symptoms present in the absence of trauma |
| What is sciatica? | pain radiating along sciatic nerve - most often down buttock and the post aspect of leg to below the knee |
| How can a herniated disc cause sciatica? | causes pressure on the posterior longitudinal ligament - plus impinge on spinal canal or intervertebral foramen - irritating nerve roots. |
| Name 5 other causes of sciatica? | spondylosis, osteoarthritis of facet joints, SI sprain (heavy lifting), compression injuries, Direct trauma to nerve, tumors, |
| What type of pain is felt with sciatica? | shooting, radiating pain along narrow band - 1 1/2 inches wide |
| What type of sensory involvement can occur with sciatica? | burning, aching, tingling |
| What techniques are appropriate during the acute stage of sciatica onsite? | swelling tech to periphery of pain |
| What type of joint mobilizations are appropriate when treating sciatica and where? | lumbar back, hip and SI joints - Grade 2 only |
| What postural and positional concerns can account for piriformis syndrome? | pregnancy, wallet in back pocket, foot disorders, abnormal gait i.e. excess ext rotation, prolonged sitting, driving with foot externally rotated |
| What movement usually decreases the pain associated with piriformis syndrome? | passive external rotation of hip |
| Where is piriformis landmarked? | O - ant aspect of lat sacrum I - sup border of GT. Palpate - along a line from GT to opposite PSIS |
| Where do trigger points in piriformis refer? | SI and post thigh |
| How long is the onsite CI to massage after a cortisone injections? | 10 days |
| Which area commonly feels numbness and tingling with thoracic outlet syndrome? | fingers, hand, forearm, shoulder |
| What position places a stretch on the anterior scalene mm? | ipsilateral rotation |
| Where do trigger points in anterior scalene refer? | anterior forearm (along the median nerve) |
| What other structures should be lengthened when treating scalene anticus syndrome? | SCM - and all other neck mm's |
| What other structures should be lengthened when treating pectoralis minor syndrome? | pec major, biceps |
| What type of techniques are appropriate if edema is present with TOS? | elevate and support arms - lymph pump, lymph drainage |
| Where does numbness and tingling occur with carpal tunnel syndrome? | lateral 3 1/2 fingers |
| What other pathologies can be confused with carpal tunnel syndrome? | TOS, cervical disc compression, TP's |
| What activities can lead to carpal tunnel syndrome? | activities that compress or overuse the tendons |
| Where can adhesions develop with carpal tunnel syndrome? | flexor retinaculum |
Created by:
Hanz Onn
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