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NYCC Homack final
NYCC TCH6706 Homack LECTURE final lower extremites
| Question | Answer |
|---|---|
| Colle's fracture | radial head FOOSH |
| Post concussion syndrome | Head trauma: balance, proprioreception, abnormal gait, memory |
| Litigation neurosis | see previous notes |
| DARRACH procedure | Removal of distal ulna/ulnar styloid |
| Complications of Darrach procedure | AVN, Altered hand movement, Ulnar impingement syndrome, distal forearm pain |
| MI CHAM (mee-cham) | Causes of NON pitting pedal edema: Milroy's, Infection, Congenital, HypOthyroid, Allergy, Malignancy |
| Milroy's | SWELLING secondary to blocked lymph |
| Infection causing non-pitting edema | filariasis - tropical parasite |
| HypOthyroid edema | myxedema |
| **Reflex Sympathetic Dystrophy aka: | Complex Regional Pain Syndrome type-I {CRPS-I} & SUDEK'S atrophy (German speaking countries) |
| "burning, red hot file rasping the skin…glossy" | RSD Civil War description |
| Presentation of RSD | Burning, hot swelling, red. Inc or dec sensation, Inc Temp, Pain, Stiffness, Narrowed digits, Allodynia, GLOSSY HAIRLESS SKIN |
| RSD theory #1 | Failure of normal sympathetic arc to shut down |
| RSD theory #2 | Reverb signal to spinal INTERNUNCIAL POOL (connected spinal neuron pool for reflexes) w/ volleys of impulses up & down spine |
| RSD theory #3 | Injury to peripheral n. w/ hypersensitivity to circulating NE, pressure, movement |
| RSD theory #4 | Articular synapse causing short circuit of peripheral n. |
| RSD theory #5 | Nocicpetor responses assoc. w/ TRAUMA = long term SENSITIZATION of dorsal horn, inc. firing results |
| RSD theory #6 | Recessive gene predispositon to NEUROPATHIC PAIN (damaged nerve fibers send distorted signals) |
| RSD theory #7 | Neurochemicals released at peripheral n. endings causing vasospasm, vasoedema, pain = inflammation |
| RSD theory #8 | Dysfunctional opiate system |
| RSD theory #9 | Immune factor causing nerve inflammation, dormant virus (like herpes zoster causes shingles) |
| 3 stages of RSD | ACUTE DYSTROPHIC ATROPHIC I, II, III |
| Stage of RSD at which 50% will have permanent disability | ATROPHIC III |
| Stage of RSD w/ HYPERPATHIA + rubor, soft edema | ACUTE RSD - buring pain, HYPERPATHIA, rapid hair and nail growth, decreased sweating, inc temp and blood flow |
| ALLODYNIA | painful (noxious) response to stimulus that is usually NON painful (innocuous) = DYSTROPHIC stage of RSD |
| Stage of RSD w/ BRAWNY edema and Preoccupation of protecting injured limb | DYSTROPHIC RSD- ALLODYNIA Cyanotic, brawny edema, PROFUSE SWEATING, SLOW hair/nail growth, early Osteoporosis, Dec temp |
| HYPERPATHIA | Abnormally exaggerated subjective response to PAINFUL stimulii = ACUTE RSD (opposite of allodynia, dystrophic rsd stage) |
| Stage of RSD of the FROZEN, USELESS limb | ATROPHIC (stages I,II,III w/ III being permanent disability in 50%) - Chronic, persistent changes in skin/mm, Pericapsular fibrosis, osteoporosis, Atrophy |
| What is a definite char. of ATROPHIC RSD | Atrophy |
| Buzzword ACUTE r.s.d. | HYPERPATHIA & BURNING |
| Buzzword DYSTROPHIC r.s.d. | ALLODYNA, SWEAT, PREOCCUPATION, BRAWNY EDEMA |
| Buzzword ATROPHIC r.s.d. | ATROPHY, FROZEN |
| Tache cerebrale | RSD: autonomic dysfunction = red lines (erythematous) persisting 15-30 sec. after blunt object stroke |
| THERMOGRAPHY | RSD: shows heat distribution patterns, good for d/dx RSD |
| MD tx for RSD | sympathectomy, pain block, modulate spinal cord pain area |
| CHIRO tx for RSD | Mobilization, Analgesics (co-tx), Sympathetic block, passive ROM, manip, mm stim, maintain flex, strength, pain control, wet clothes |
| Why is exercise important for RSD | Improves neuromuscular pattern, otherwise pt leaves extremity immoble >> neg cascade of disuse |
| Physiologic tests for RSD | SSEP (to show elect potentials of nerve to brain), THERMOGRAPHY, emg, ncv, function test |
| RSD test which shows glove like hypothermia | THERMOGRAPHY |
| Heat distribution patterns of thermography {3} | Physiologic process, Vertebral subluxation, Autonomic nerve dysfunction |
| Thermography measures (2) | 1. Pathoneurophysiology 2. Compare bilaterally 3. HYPO or HYPERthermia |
| ABNORMAL thermography finding | greater than 1* C of change |
| Caused by INcreased sympathetic post-gang | |
| HypERthermia is caused by | DEcreased sympathetic activity - blocked alpha receptors cannot control heat so out of control |
| Pathologic thermography findings usually | hypOthermic |
| Thermographies do NOT follow (2) | peripheral nerve patterns nor dermatomes |
| Dermal skin MICRO circulation | RSD: controlled by skin chemical mediators and sympathetic autonomics |
| How does diffuse regional hypOthermia occur? | RSD: after acute injury, SNS hyperfunctions >>> continuous VASOSPASM >> hypOthermia |
| How can entire region become hypOthermic? | RSD: 1 post gang fiber from cord can synapse w/ 100 post gangs at paravertebral chain gang to alter T* of entire region |
| 6 stages of healing | cure care quality empowerment enlightenment soul |
| D/dx RSD edema | MI CHAM for non-pitting lower limb edema |
| 1+ pitting lower edema | RSD: 2mm MILD, slight indentation, NO perceptible swelling of leg |
| 4+ pitting lower edema | RSD: 8mm DEEP pitting edema, indentation lasts long time 2-5 min, leg is VERY swollen |
| Explain heart/liver/kidney PITTING edema | PITTING edema: salt retention > water retention > water follows salt into tissues > edema |
| Fibromyalgia FM aka: | symmetric myofasciitis |
| Describe FM points | Bilateral: need 11/18 tender spots to diagnose FM |
| Which rib is tender in FM | 2nd rib |
| Sx of FM | Lower pain threshold, fatigue, paresthesias, headaches, Females w/ generalized musculoskel complaint |
| Theories of FM origin | D: O2 - I: Sub P (ischemic irritant) - D: serotonin - I: Sleep disorders – 25-50% LYME dz |
| MUSCLE PAIN greater than fatigue | Fibromyalgia |
| fatigue greater than mm pain | chronic fatigue syndrome |
| Med vs Holistic FM tx | MD: antidepressants vs. Holistic: Knox gelatin sprinkled on food |
| Raynaud's phenomenon | CT disorders (scleroderma, lupus), Vibrating machinery (pianists, typists), Cold/damp exposure |
| Raynaud's DISEASE | idiopathic (triggered by cold) |
| LEAD poisoning nerve | RADIAL |
| Radial nerve poisoning sx | WRIST DROP w/ NO loss of sensation |
| Why is RADIAL nerve susceptible to lead poisoning | Rich vascular supply |
| Compression of the radial nerve at the AXILLA | radial nerve PALSY |
| PSORIASIS etiology | LARGE intestine (elimination prob), NERVOUS, ILLNESS |
| PSORIASIS appearance | SILVERY SCALES, red patches on EXTENSOR surfaces |
| PSORIASIS tx | Pagano book, White flours, Proteolytic enzymes, Vit A & B6, Eliminate nightshades* |
| potatoes, tomatoes, eggplant, sweet &hot peppers | Nightshades to eliminate if have a psoriatic patient |
| URIC acid build up | GOUT – hot swollen painful joints, esp big toe |
| GOUT is a PREcursor to | HEART dz |
| Foods to limit w gout | PURINES, seafood, ALCOHOL (beer has purines), oats, beans, peas, lentils |
| GOOD GOUT foods | water, low fat dairy, low-purine foods |
| Uric acid can be reduced by foods, but what's more important? | Gout depends on how well the KIDNEYS process uric acid |
| Intense pain of local dermatome, blisters | SHINGLES dormant herpes zoster |
| meds that PROLONG shingles attack | acetaminophen |
| SLE sx | DISCOID rash (malar) in BUTTERFLY pattern. Hair loss. Oral ulcers. |
| SLE Patient | 80% female. Auto-immune, chronic inflammatory dz |
| SLE tx | Ca+ and Mg+. Corticosteroids (side effects;-( |
| ABC'S – which is most important? | Agility Balance Coordination Skills = BALANCE most important |
| 5 biomotor skills | Speed, Strength, Endurance, Flexibility, ABCS |
| Endurance AEROBIC work capacity | Oxygen. Exercise/work forcing heart and lungs higher. Measured by O2. Running, swimming, etc. |
| Endurance Anaerobic work capacity | Absence of oxygen. Exercise/work that doesn't require inc oxygen. Wight lifting, isometrics, office work |
| Stores of potential energy | Elastic properties of ligaments and tendons |
| Stretch reflex (flexibility) includes: | MYOTOTIC reflex, ELASTIC properties of ligaments and tendons |
| BALANCE most important ABCS | helps prevent injury, is basis for all ABCS, lifelong |
| BIOMOTOR ABC's attributes – most important? | Active participation – Multi lateral development – Specialization – Individualization – Variation – Modeling – PROGRESSIVE OVERLOAD |
| Progressive Overload | imporve quality and quantity of work – work hardening (avoiding plateaus) |
| Process of restoring someone to useful life | REHABILITATION (...who has been ill, injured or otherwise handicapped.) |
| 4 goals of REHAB | 1.IMMEDIATE care 2.RESTORE 3.TEST to return to activity 4. RESUME training for occupational demands/lifestyle/performance |
| Goal #1 rehab = Immediate care | Immediate care: Reduce swelling, RICE, Limit deconditioning ***** |
| Goal #2 rehab = Restore | Restore: ROM, Strength, Balance, Endurance, Muscle contraction **** |
| Concentric | FLEXION acclerated mm contractions |
| Eccentric | LENGTHENING ligament and tendon strength |
| Isometric | STABILIZING also tendon and ligament strength |
| Goal #3 rehab = Test to return | TEST to RETURN to activity – normalize balance, proprioreception, and strength |
| Goal #4 rehab = Resume | RESUME training for life activity |
| Methods of athletic conditioning where stellar ...goal | ELITE sport science |
| Eval of the adaptive levels of the body's sys to handle greater stresses | and the goal being ever increasing athletic performance – ELITE sport science |
| How is ELITE sport science accomplished? | Athlete's BIOMOTOR skills (endurance, flexibility, speed, strength, ABC'S = agility balance coordination skill) |
| Greatest rehab challenge | lack of patient compliance |
| ANOMIE | personal feeling of a lack of norms; NORMLESSNESS |
| examples of situations that created ANOMIE | NOPD during Katrina, Stock market crash |
| Alienation examples | Abusive working conditions, Dehumanization |
| How to calculate cost per square foot | total cost of rent per year/square feet |
| ACCELERATED recovery | attention anything that creates an OPTIMAL HEALING STATE in the body naturally |
| Accelerated recovery aka | FORCED recovery – more productive weeks, months, or years of life |
| YAKOLEV's model | STRESS REST ADAPTATION |
| X axis on Yakolev | time and homeostaXis = phyXiologic balance point of body (pH, dehydration, glucose, O2, core temp) |
| (+) y axis | IMPROVED physical state = healing, adaptation, performance |
| [-] y axis | fatigue, decreased performance, illness, injury |
| Multifactorial, protective mechanism of body | FATIGUE - affects body systems differently |
| Yakolev model “S” curve to LEFT on X axis? | IMPROVED physical state SOONER w/ accelerated recovery |
| Uses the body's natural rhythms to return body to BMR asap | ACCELERATED recovery (using sleep, hydration, diet, circulation, respiration) |
| Overreaching | Programmed increase in volume, intensity or frequency (10% rule) = GOOD |
| Overtraining | BAD. NON-functional = fatigue that won't go away; can lead to overtraining syndrome. |
| FUNCTIONAL overREACHing | GOOD! Training load paired w/ APPROPRIATE recovery. Ready to go again! |
| Describe overTRAINING syndrome | |
| Overtraining pushes the Yakolev curve | DOWN (solid red line) |
| DOWN curve on Yakolev means | non functional overreaching that results in overtraining syndrome – NO RECOVERY time. Diminishing returns. |
| BOMPA's sx of overtraining (OT) | mimics MVA concussion, depression (physio, psycho, immuno, biochem/hormonal crashes) |
| Canadian OT scale | good: normal and reversible in short term. Bad: Chronic fatigue/overtrain. Not reversible in short or mid term. Too late! |
| How long is CFS | 6+ months |
| Norm time HEART recovery | 20-60 min |
| Norm time STRENGTH recovery | 2-3 days |
| Norm time CNS recovery | 7x muscular system (mm is 1-2 days) |
| Morning pulse CFS indication | AM pulse 10% over baseline |
| Difference in heart rate CFS indication | Supine to Standing differs 8-16 BPM |
| pH urine test CFS indication | ALKALINE morning pH of urine |
| 1% dehydration means | 2% decrease in optimal performance |
| #1 indicator of proper HYDRATION | CLEAR urine |
| Outlier effect of dehydration | FASTER reaction time |
| F=Ma | More mass, more force |
| What is absorbed by the vehicle versus transferred to occupants | force TRANSFER |
| When the vehicle collapses into the occupants | Intrusion PROTECTION |
| Speed threshold for MVC injury is | 5 mph |
| Most dangerous drivers | |
| leading cause of unintentional death in 14 and under | MVC (2/5 of teen deaths are MCV related) |
| Men are 2x as likely to die in MVC. Why? | Because they drive more often and farther from home |
| Female drivers have a greater # of | minor crashes because they drive shorter distances and stay closer to home |
| Men are ___% more likely to be in a serious crash. | 70.00% |
| Highest speed related fatalities state | SOUTH Carolina |
| Safest day of week to drive | Tuesday |
| Percent of speed crashes on a CURVE | 40.00% |
| Percent of fatal speed crashes w/ ALCOHOL | 41.00% |
| What's a more prevalent cause of crashes than alcohol? | SLEEPINESS |
| 5 basic TYPES of crashes | Frontal/offset, Side Impact/T-bone, Rear end, Rollover, Sideswipe |
| Most common MCV of 5 basic types | FRONTAL & SIDE IMPACT |
| Which of the 5 MCV's causes greatest injury and why | REAR END (due to SHEAR forces) |
| Why retake films if MCV pt suffering sore throat | RETROPHARYNGEAL BLEED |
| Human error causes 93% of MCV. MAIN causes? | CELL PHONE and TIRED DRIVERS (more than DWI in both cases) |
| Reflex, Simple, Complex, Discrimination | REACTION TIMES (discrimination between unfamiliar 2 options takes +1.0 sec) |
| Avg reaction time in MVC | 1.5-3.2 sec |
| Avg stoppage time between cars | 40-100 yds (football field) at 60mph/88 ft/sec |
| BRACING for impact ________ head/neck injury | DECREASES |
| drivers or passengers have fewer injuries? | DRIVERS |
| Most frequently injured upper extremity peripheral n. | RADIAL |
| Most frequently injured lower extremity peripheral n. | PERONEAL |
| Energy absorption limit of SEAT | speeds greater than 25mph |
| Females are more likely to suffer a _____ | CAD |
| Males are more aggressive; more likely to die in MCV. | |
| Car seat backs were designed for ___ % of pop. | 90.00% |
| Head travels at a rate of | 100,000*/second: 1400 mph |
| Sx of MCV often not immediate due to | SHOCK |
| Safest cars | full frame 4 door full size station wagon (no longer made) |
| Kind of collision that transfers force to occupants | LOWER speed |
| Leading cause of Head and Brain injuries | CAR accidents |
| Coup-contre coup injury | brain slamming against inside of skull in acceleration/deceleration (whiplash) |
| preferred imaging for MCV | CT acute, MRI later (for chronic hemorrhage) |
| contusion or concussion | brain bruised by striking cranium |
| anoxic brain injury | injury disrupts blood flow to brain |
| skull fx | break in surrounding bone – will heal but if tissue damage, need surgery |
| Coup-contrecoup | brain propelled against both sides of skull – REBOUND (mc is front to back) |
| Diffuse axonal injury (DAI) | rotation and disruption of brain SEVERS or shears NERVE FIBERS or axons. |
| Most difficult d/dx brain injury MCV | DAI – microscopic. Mild brain injury or could be severe and permanent disability. No tx. |
| Damage to axons in DAI | First 12-24 hours after injury |
| Epidural hematoma | blood between skull and above (top lining) of dura = pressure |
| Subdural hematoma | blood accumulates between brain and dura (below dura) |
| ORDER of WHIPLASH sx *** | NECK pain > stiffness. TRAP pain. HEADACHE. INTRA-SCAPULAR pain. BACK pain. PARESTHESIA. EXTREMITY pain and weakness. |
| Order of secondary whiplash sx *** | DIZZINESS – injury to SCM. FACIAL pain. AUDITORY sx. VERTIGO. OCULAR dysfunction. DYSPHAGIA/HOARSEness |
| Post Concussion Syndrome is a | SOFT head injury (blunt, non-penetrating trauma to brain) – DAI (shaken brain.) SPORTS, MCV, CHILD abuse. |
| 20% of returning Iraq vets have | Post Concussion syndrome (a DAI) called the 'invisible injury' |
| Characteristics of PCS | Depression, phono and photophobia, outbursts, mood swings, neck pain, impaired comprehension |
| recent imaging very sensitive to damage to WHITE matter | DIFFUSION TENSOR IMAGING (DTI) for post concussion syndrome because MRI scans are normal |
| PCS victims have a higher incidence of | STROKE |
| PCS signs are similar to | LITIGATION NEUROSIS |
| Odd sign of TMJ | FULLNESS or RINGING in the ears |
| MCV Clay Shoveler's fx of C-spine | REAR END or HEAD ON hyperflexion – spinous process fx |
| MSTM | My Stupid Teaspoon is Missing |
| UNCINATE process fx MCV | rare: hyper LATERAL flexion – side impact crash. FOOSH happens w/. |
| What does DJD from MCV look like over time on film | Long uncinates, reduced IVF's, bilateral numbness |
| SEATBELT hyperflexion spine fx from MCV | WEDGE or COMPRESSION fx – hyperflexion during rear-end or head-on collision |
| Hyperextension of wrist inc pressure by | 3x |
| First mm affected w/ carpal tunnel syn after FOOSH | Abductor pollicis brevis (innervated by MEDIAN n. ) |
| How seatbelt causes TOS from MCV | pressure of shoulder strap across TOS in MCV |
| Is treatment outcome any different for people w/ LITIGATION NEUROSIS | No. Sue or don't sue, but the chronic pain stays put. |
| Prognosis of MCV injury | 54-61% never fully recover. 6-9% become chronic pain patients. |
| CHIRO tx for MCV | Soft tissue (ART, NIMMO), Modalities, Rehabilitation, Postural assessment |
| Key to good testimony in litigation case | Good record keeping; “I am not qualified to make that judgement” if you aren't. DON'T guess. |
| Body Dysmorphic Disorder | Psychiatric disorder: IMAGINED DEFECTS in appearance |
| Fear of gaining weight | ANOREXIA – factually knowlegeable about food. Pica (non-food ingestion) |
| Lanugo | fine, white down growing on anorexics, babies and cancer patients – no body fat left to keep them warm |
| 'failed anorexics' | Bulimia – binge and purge eaters. Dental issues from stomach acid |
| FEMALE TRIAD *** | ANOREXIA – AMENORRHEA – OSTEOPOROSIS |
| DISORDERED eating | NARROW food selection – inadequate nutrition base, upsets body chemistry |
| Where is DISORDERED eating found? | GYMNASTS -runners -figure skaters – ballet (wherever looks matter) |
| Disordered eating in athletes is ___x more than general public | 15x |
| Potential life threatening problem of eating disorders | ESOPHAGEAL VARICES (rupture of vein, bleed out). |
| Percentage of anorexics that die from anorexia | 10% anorexics die from anorexia. |
| Repetitive purposeful behavior accd'ing to rules | Compulsion (no satisfaction – done to avoid perceived bad outcome) |
| OCD physiologic manifestations | Decreased body pH – Amenorrhea – Calcium loss & early osteoporosis |
| Thought is __________ | biochemistry |
| Long term effects of OCD | Stress fractures, potentially death |
| Why is pH affected by OCD | Long term ACIDIC body pH leeches Ca+ from bones to balance pH |
| TRIUNE brain | subjectivity sense of time & space memory (OCD is a triune issue) |
| Important muscle groups that are strong | CORE strength |
| ERGONOMICS definition | the scientific study of human work – matching the job to the worker and product to user |
| The work environment affects __ | profit. Ergonomics is an economic process! |
| Cost of CTS per case | 3-30k per case |
| PRESENTEEISM | The practice of workers reporting to work when ILL and NOT operating to their usual level of productivity |
| costs for presenteeism | |
| ACCIDENT | unplanned outcomes |
| Example of ASSAULT on the SENSES ergonomic | VISUAL Fatigue – truck drivers, computer work |
| Example of QUALITIES of the JOB ergonomics | Monotony & Nightshifts Stress & Aerobic demands Work stations |
| Chimney sweeps life expectancy *** | 12 years |
| White collar upper crossed syndrome | GATHERING actions (computer work) |
| CHIRO shoulder concern ergonomic | ROTATOR CUFF |
| CHIRO wrist and hand concerns ergonomic | Strains and Sprains TRIANGULAR fibrocartilage |
| CHIRO low back concerns ergonomic | Strains and Sprains DISC injury |
| Cognitive ergonomics that cause accidents | Mental taxonomy of thought – did not follow rules |
| 3 types of mistakes that cause accidents | SKILL based (poor training) – RULE based (altered equipment) – KNOWLEGDE based (poor training) |
| 50% of ATHLETIC INJURIES involve _______ motion. | REPETITIVE |
| Most common violaton of ergonomics | repetitive motion injuries (the 'industrial athlete') |
| FORCE | CUMULATIVE microtrauma over days, weeks, or years |
| FREQUENCY | too much REPETITION or movement with too little rest inbetween |
| POSTURE | extremes of ROM – unguarded reaching – POOR BODY MECHANICS |
Created by:
hecutler
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