1
Q
A loose body is often the result of…
A
OA or chip fracture
2
Q
Loose body S&S
A
Locking/catching
3
Q
Loose body Ax
A
ROM end feel as a bony block or may be springy
4
Q
Hypermobility Rx
A
- Mobilize stiff or hypomobile tissue/joint/segment
- Strengthen to stabilize the hypermobile segment/tissue
- Movement retraining - maintenance
- Supportive devices (brace/tape)
5
Q
What is spondylosis
What can it lead to
A
OA of spine -> degeneration of joints
Can lead to disc herniation &/or stenosis
6
Q
What is spondylolysis
A
Pars interarticularis (fibrous tissue) defect
- Degeneration of spine joints
- Seen in younger patients w/ hyper extension & rotation sports
7
Q
Is spondylolysis mostly symptomatic or asymmptomatic
A
asymmptomatic
8
Q
What may bilateral spondylolysis lead to
A
spondylolisthesis
9
Q
What is the most common segment for spondylolisthesis
A
L5/S1
10
Q
spondylolisthesis MOI
A
Hyper extension
11
Q
spondylolisthesis types:
A
Spondyloytic spondylolisthesis - Progressive period of rapid growth - Rarely progresses to adult life - Younger population Degenerative spondylolisthesis - 2° to DJD + Z-joint subluxation -> OA of joints in spine, foramina narrowing - Older population
12
Q
Grading of spondylolisthesis
A
1-4 25% of each grade of slippage
13
Q
spondylolisthesis S&S
A
- Central LBP +/- referred pain, associated with weak abs +/- tight hamstrings
- Aggravating factor: EXT
- Easing factor: FLEX
14
Q
Spondylolisthesis Rx
A
Stability
- Flexion exercises (open IVF to decrease pressure on nerve roots)
- Inner unit strengthening: TA/multifidus/PF
- Brace if needed
- Work into painful range with proper stability - avoid hyperextension
- Surgery?
15
Q
When is surgery needed for spondylolisthesis
A
- Increased slippage or instability even with brace
- hard neurological signs
- evidence of spinal cord involvement
- intractable pain despite treatment
16
Q
Hypomobility MOI
A
Adaptive shortening or soft tissue (tightness or contracture) or joint
- Muscle: atrophy & weakness
- Tendon: Decreased tensile strength
- Ligament: Decreased tensile strength, Increased stiffness/adhesions
- Cartilage: decreased synovial fluid, H2O content
- Bone: Increased resorption, decreased bone mass/mineral content
17
Q
Study capsular pattern, resting position, closed packed position table
A
Pg 9
18
Q
Dislocation S&S
A
Increase ROM
Soft end feel
+/- pain
19
Q
Complications of GH dislocation
A
Rotator cuff tears
Axillary nerve damage
20
Q
Dislocation types
A
TUBS: Traumatic onset, unidirectional anterior, bankart lesion, surgery
AMBRI - Atraumatic, multidirectional, bilateral shoulder findings, rehab appropriate, INF capsule shift
21
Q
TUBS dislocation MOI
A
Abduction + ER
22
Q
Bankart lesion
Definition + S&S
A
- Avulsion + of ant/inf capsule & ligaments
S&S: Clicking, apprehension, deep vague pain
23
Q
Slap Lesion
- Def
- MOI
- Major cause of pain in _)___
A
Superior labrum lesion ant-> post
Elevated position w/ sudden concentric + eccentric biceps contraction
- Major cause of pain in throwers
24
Q
Hill sachs lesion
A
- Compression Fracture post/lateral humeral head
25
Fracture dislocation usually occurs where?
| S&S ?
Usually acromion, humeral head
| S&S -> deformity, constant pain, systemic signs (nausea)
26
Which ligaments stabilize the AC joint
Trapezoid and conoid ligaments
27
S&S of an AC joint subluxation
- Step deformity
| - Osteolysis (bone resorption d/t repetitive microtrauma or post trauma
28
Is an AC joint subluxation surgical
no
29
Growth plate closure - proximal and distal femur
Prox: 18yrs
Dist: 20yrs
30
Growth plate closure - proximal and distal tibia
Prox: 16-18yrs
Dist: 15-17 yrs
31
Growth plate closure - proximal and distal Humerus
Prox: 20yrs
Dist: 16yrs
32
Growth plate closure - proximal and distal radius
Prox: 18yrs
Dist: 20 years
33
Fracture types and causes
- Spiral: twisting injury
o Transverse/oblique direct blow
- Compression/crush: longitudinal force
- Comminuted: fragments of bone
- Greenstick: young kids - malleable bones, # on only 1 side
- Avulsion: piece of bone pulled off - de-attachment of soft tissue (ligaments)
- Impact: compression force (usually more stable)
34
Colles fracture
Distal radius + subluxation of distal ulna
35
Bennetts Fracture
Fractura dislocation of CMC thumb joint
36
Scaphoid fracture MOI
FOOSH
37
Complications of fractures
- Avascular necrosis
| - Muscle weakness, contractures, re-#, infection, delayed union, malunion, CRPS
38
Where is there a high rate of avascular necrosis
- proximal femur
- 5th MT
- Scaphoid
- Proximal humerus
- talus neck
- Navicular
39
Locations of a hip fracture
Femoral neck
Intertrochanteric
Subtrochanteric
40
Hip fracture conservative vs. surgical management
Conservative: less complications, increased bed rest, decreased healing time, slower rehab
Surgical: Decreased length of stay, improved rehab, risks
41
Hemiarthroplasty vs total arthroplasty
Hemi : just femoral head
| Total: femoral head + acetabulum
42
Types of hip fracture surgery
- Cemented: Increased stability, better for sedentary elderly w/ poor bone quality
- Uncemented: components coated w/ beads - where new bone can grow, better for younger Pts, revision in 10yrs
- Hybrid - Femoral component = cemented, acetabular component = uncemented
43
Precautions following total arthroplasty - post-lateral approach
- NO hip flexion past 90
- NO IR
- NO ER
- NO hip add past midline for 1st 3months
44
Precautions following total arthroplasty - lateral approach
- No hip flex past 90
- NO IR
- No hip add past midline for 1st 3 months
45
Precautions following total arthroplasty - Anterior approach
- No hip ext
- NO hip ER
- NO Hip adduction past midline for 1st 3 months
46
Precautions following hemiarthroplasty -
No restrictions with movement & WBAT
| Check MD Orders
47
Indication for hemi, total, and reverse shoulder arthroplasty
Hemi: Arthritic conditions (w/out glenoid involvement, severe fractures of proximal humerus
Total: OA, inflammatory arthritis, osteonecrosis involving the glenoid, post-traumatic degenerative joint disease
Reverse: OA or compound fractures of the humerus w/ deficiency of the rotator cuff.
48
Patients must have _____ in order to receive a total shoulder arthroplasty
rotator cuff
49
Post op precautions for a total shoulder arthroplasty
Immobilization daily for 1 week nightly for 1 month, sling 4 weeks
50
Post op precautions for a reverse shoulder arthroplasty
flexion/elevation in scapular plane passively up to 0- degrees, pure abduction
51
Post op contraindication for a reverse shoulder arthroplasty
Avoid IR for 6weeks
52
Types of bone
- Cortical - outside long bones
| - Cancellous - inside, more affected by OP
53
OP Categories
- Normal: 0-1.0 SD of young adult mean
- Low bone mass: 1-2.5 SD below young adult mean (Osteopenia)
- Osteoporosis - 2.5+ SD below young adult mean
54
OP Types
Primary type 1 - Post menopausal women
Primary type 2 - 70+ years risk women=men
Secondary OP - Due to another med condition or treatment, any age
55
OP risk factors
```
Family history, lifestyle
Gender
Age
Lifetime exposure to estrogen, breast cancer
Fragility fracture under 40yrs
```
56
OP Dx
Bone scan
| Fracture assessment tools - FRAX, CAROC 2010
57
OP Ax
Vertebroplasty -> fusing of 3+ segments- Risk of subsequent fracture
58
OP Rx
- Pharmacological - anti-absorption agents, anabolic bone formation (hormone treatment). Side effects = vertigo, nausea, dizziness, muscle/back/ue/le pain
- Nutrition: Ca+, Vit D
- PT: posture, aerobic (WB), resistance exercises, core, balance, extension exercises, no spinal flex or flex + rot
59
S&S of tumor fractures
Asymptomatic but can show cancer signs
60
Primary malignant tumors of soft tissues/bone are common or rare?
Most likely population?
RARE
| May occur in youth
61
Types of soft tissue/bone tumors
Osteosarcoma
Synovial sarcoma
Malignant tumors
Osteoid osteoma
62
Where do Osteosarcomas occur? S&S? Rx?
At ends of long bones
Pain - at joint, worse with activity
Imaging- xray moth eaten appearance
Rx: surgery
63
Where do Synovial sarcomas occur? S&S? Rx?
In larger joints - knee/ankle
Pain - at night, w/ activity
Swelling/instability
Rx: Surgery, chemo/radiation
64
Rx for malignant bone tumors
Metastasize from elsewhere
| Rx: Thorough PMx & FHx
65
Are osteoid osteoma malignant or benign? S&S? Key sign? Rx?
```
Benign
Pain in bone, At night, w/ exercise
Key sign: no pain w/ aspirin
Imaging: CT scan shows a central focus point
Rx: ablation, ethanol, laser
```
66
Degenerative joint disease:
- Cause
- Population
- Result
Due to mechanical change, joint disease, joint trauma
Seen in Pts >40 yrs
Result: ++ Loading on surfaces that are weight bearing
67
Types of vertebral degenerative joint disease
- Spinal (lateral) stenosis
- Central stenosis (canal)
- Spondylosis - spine OA
- Spondylolysis - Pars interarticularis defect, may start as stress #
- Spondylolisthesis
68
Degenerative joint disease Rx
- Joint protection
- Increase joint mechanics
- aquatics = Decrease WB
PCE - Neuromusculoskeletal
flashcards
Decks in class (8)
# Cards
-
Muscle Contusions/strains/tears/weakness22
-
Pelvic Floor Dysfunction16
-
Ligament sprains/tears & Tendinopathies49
-
Joint Derangements/Dysfunction68
-
Spinal Abnormalities32
-
INFLAMMATORY/INFECTIOUS CONDITIONS OF NEUROMSK SYSTEM29
-
Congenital Malformations19
-
Nerve compression/entrapment, peripheral nerve injuries59
