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NYCC Homack final

NYCC TCH6706 Homack LECTURE final lower extremites

QuestionAnswer
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