NPTE Study Practice > MSK Interventions > Flashcards

MSK Interventions Flashcards

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1
Q

Define decubitus ulcers

A
  • Synonymous with pressure ulcers
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2
Q

Describe the grades/severity of tissue injuries

A
  • Grade 1: mild pain & swelling and pain with tissue tensoin
  • Grade 2: moderate pain & swelling requiring activity modification; tissue is focally tender to palpation; partial ligament tear may result in some increased joint laxity
  • Grade 3: near-complete or complete tear with severe pain; minimal or no pain with tissue tension; palpable defect; complete ligament tear will result in joint laxity
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3
Q

Describe the inflammatory stage of healing

A
  • Begins immediately and lasts 3-5 days
  • Injured cells release prostaglandins & bradykinin to initiate the inflammatory response
  • Platelets form a plug to contain bleeding
  • Vasodilation occurs to increase blood flow to area
  • Damaged tissue is removed
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4
Q

Describe the proliferation stage of healing

A
  • Lasts from 48hrs to 6-8 wks
  • Fibroblasts resorb collagen & synthesize new collagen
  • Decreased macrophages & fibroblasts with corresponding scar formation
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5
Q

Describe the remodeling stage of healing

A
  • Tissue will continue to remodal and mature for 1-2 yrs post-injury
  • Increased organization of extracellular matrix
  • Collagen begins to organize into randomly placed fibrils
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6
Q

Healing timelines for muscle

A
  • Delayed onset muscle soreness (DOMS): 0-3 days
  • Grade 1 strain: 0-4wks
  • Grade 2 strain: 3-12wks
  • Grade 3 strain: 4wks to 6 months
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7
Q

Healing timelines for tendons and ligaments

A
  • Tendon: 8wks to 6 months
  • Grade 1 ligament sprain: 0-4wks
  • Grade 2 sprain: 3wks to 6 months
  • Grade 3 sprain: 5wks to >1yr
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8
Q

Healing timeline for bone injury/fracture

A
  • Bone: 6-12 weeks
  • Cartilage (fibrocartilage): 8wks to 12 months
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9
Q

Define autonomic versus mechanical soft tissue/myofascial techniques

A
  • Autonomic: stimulation of skin & superficial fascia to facilitate a decrease in muscle tension
  • Mechanical: movement of skin, fascia, & muscle causes histological & mechanical changes to occur in soft tissues to produce improved mobility & function
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10
Q

Indications for soft tissue/myofascial techniques

A
  • Patients with soft tissue & joint restriction that results in pain & limits ADLs
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11
Q

contraindications for soft tissue/myofascial techniques

A
  • Soft tissue breakdown
  • Infection
  • Skin disease
  • Cellulitis
  • Osteomyelitis
  • Contagious illness
  • Malignant tumor
  • Aneurysms
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12
Q

Describe soft tissue without motion technique

A
  • Hands do not slide over skin instead they stay in contact with skin while hands & skin move together over the muscle
  • Direction of force is parallel to muscle fibers & total stroke time should be 5-7 seconds
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13
Q

Describe soft tissue with passive pumping technique

A
  • Place muscle in shortened position and with one hand place tension on muscle parallel to muscle fibers
  • Other hand passively lengthens muscle and simultaneously gradually releases tension of hand in contact with muscle
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14
Q

Describe soft tissue with active pumping technique

A
  • Place muscle in lengthened position and with one hand place tension on muscle perpendicular to muscle fibers
  • Other hand guides limb as patient actively shortens muscle
  • As muscle shortens gradually release tension of hand in contact with muscle
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15
Q

Describe transverse friction massage

A
  • Used to initiate an acute inflammatory response for a tissue that is in metabolic stasis, such as tendonosis
  • Performed for 5-10 minutes
  • Involved tendon is briskly massaged in a transverse fashion (perpendicular to muscle fibers)
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16
Q

What is Feldenkrais technique

A
  • Lymphatic drainage technique
  • Facilitates development of normal movement patterns
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17
Q

Describe PNF hold-relax-contract technique

A
  • Antagonist of the shortened muscle is contracted to achieve reciprocal inhibition & increased range
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18
Q

What are Maitland’s 4 grades of joint mobilization

A
  • Grade I: small amplitude before the beginning of tissue resistance
  • Grade II: large amplitude before the beginning of tissue resistance
  • Grade III: large amplitude into tissue resistance
  • Grade IV: small amplitude into tissue resistance
  • Grade V: high-velocity, low amplitude thrust at the end of joint movement
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19
Q

Absolute contraindications in mobilizations, manipulations, & traction

A
  • Ankyloses
  • Malignancy
  • Diseases that affect the integrity of ligaments
  • Arterial insufficiency
  • Active inflammatory and/or infectious process
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20
Q

Signs and symptoms of the “opioid overdose triad”

A
  • Pinpoint pupils
  • Respiratory depression
  • Unconsciousness
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21
Q

Describe an autologous chondrocyte implantation

A
  • Chondrocytes harvested from lesser weight bearing area of a joint
  • Chondrocyte volume expanded in monolayer culture
  • Re-implanted in the damaged region under a natural or synthetic membrane via an open joint procedure
  • Indication: full thickness cartilage defects
  • Contraindication: severe osteoarthritis
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22
Q

Describe platelet rich plasma therapy

A
  • Blood collected from pt & separated into components
  • Preparation of autologous plasma enriched with platelets is injected into target site
  • Supplies supra physiologic amounts of essential growth factors & cytokines to provide a stimulus for tissues with low healing potential
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23
Q

Indications for platelet rich plasma therapy

A
  • Tendiopathies
  • Osteoarthritis
  • Ulnar collateral ligament injury
  • Meniscus
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24
Q

Contraindications to platelet rich plasma therapy

Study These Flashcards
A
  • Severe osteoarthritis
  • Prosthetic joints
25
Describe stem cell therapy
- Mesenchymal stem cells harvested from bone marrow & concentrated in a centrifuge - Preparation is injected into the site of injury to attempt to stimulate healing
26
Indications for stem cell therapy
- Osteoarthritis - Muscle injuries
27
Contraindications for stem cell therapy
- Severe osteoarthritis - Prosthetic joints
28
Define malingering (symptom magnification syndrome)
- Behavioral response where displays of symptoms control the life of the patient leading to functional disability
29
Tests to evaluate malingering back pain may include
- Hoover test: assesses the amount of pressure placed on hands from patient's heels when asked to raise on LE while in a supine position - Burn's test: requires patient to kneel & bend over a chair to touch the floor - Waddell's signs evaluate tenderness, simulation tests, distraction tests, regional disturbances, & overreaction
30
Level I evidence for hamstring strain injury prevention interventions
- Nordic hamstring exercise - Warm-up, stretching, stability, strengthening, & functional movements
31
Evidence for management of TKA interventions
- Level I: motor function training
32
Prognostic factors to consider for management of a TKA
- Higher BMI associated with more post-op complications/worse outcomes - Depression associated with worse outcomes - Pre-op ROM associated with post-op ROM - Pre-op strength/function associated with post-op function - More comorbidity associated with worse outcomes
33
Pros and cons of a hamstring graft for ACL reconstruction
- Pros: few symptoms post-op; greater return to pre injury level of activity; allows earlier rehab - Cons: more expensive; believed to be more technically difficult procedure; rehab can be more difficult (slower)
34
Pros and cons of a patella tendon graft for ACL reconstruction
- Pros: better at maintaining graft tension post-op; less expensive; faster healing time - Cons: increased potential for anterior knee pain/later patellar femoral osteoarthrosis; increased potential for knee extension deficit; potential delay in rehab 2ndy to more atrophy of quads
35
Level I evidence for LBP interventions
- Thrust/non-thrust joint mobs to reduce pain/disability in pts with acute LBP and/or chronic LBP - Trunk muscle strengthening/endurance, specific trunk muscle activation exercise, aerobic exercise, aquatic exercise, or general exercise
36
Level II evidence for neck pain with mobility deficits interventions
- Acute: thoracic manipulation, neck ROM, scapulothoracic & UE stretching and strengthening - Subacute: neck and shoulder girdle endurance - Chronic: thoracic manip, cervical mob/manip, neuromuscular exercises, stretching, strengthening, endurance, aerobic conditioning, cognitive, dry needling, intermittent traction
37
Level II evidence for acute neck pain with movement coordination impairments (including WAD) interventions
- Advice to remain active - Education to return to pre accident activities ASAP - Minimize use of cervical collar - Perform postural/mobility exercises to decrease pain & increase ROM - Reassurances that recovery will occur within first 2-3 months - Multimodal interventions including mobilization, strengthening, endurance, flexibility, postural, aerobic for those pts predicted to have a moderate to slow recovery
38
Level II evidence for neck pain with headache interventions
- Acute: supervised active mobility exercises - Subacute: cervical mobilization/manipulation - Chronic: cervical/thoracic mobilization/manipulation, shoulder girdle & neck stretching, endurance and strengthening
39
Level II evidence for chronic neck pain with radiating pain interventions
- Stretching - Strengthening - Cervical/thoracic mobilization/manipulation - Education & counseling to participate in activities & movement - Mechanical intermittent cervical traction
40
Level I interventions for heel pain-plantar fasciitis
- Should use joint & soft tissue mobilization - Should use dry needling in the gastroc, soleus, & plantar muscles of the foot - Should include motor function training - Should use either rigid or elastic taping in conjunction with other PT treatments - Should prescribe night splints for 1-2 months - Should NOT use ultrasound
41
Level I evidence for Achilles' tendinopathy interventions
- Mechanical loading (eccentric or heavy load, slow velocity) exercise to decrease pain and increase function
42
Level I evidence for ankle ligament sprain interventions
- Primary prevention should prescribe prophylactic bracing - 2ndy prevention should prescribe prophylactic bracing & proprioception/balance training - For severe injuries, may immobilize for up to 10 days post-injury - Should implement structured therapeutic exercise program - Should use manual therapy in conjunction with exercise to reduce swelling, improve mobility, and normalize gait - Should NOT use ultrasound
43
Level I evidence for patella femoral pain interventions
- Should consider foot orthoses, patellar taping, patellar mobs, & LE stretching - Should include both hip & knee exercises - Hip exercises should target posterolateral hip muscles - Knee exercises may include weight bearing or non-weight bearing exercises - Should NOT dry needle - Should NOT use manual therapy as a stand alone treatment
44
Level II evidence for meniscal/articular cartilage lesions interventions
- Early progressive knee motion - Supervised rehab program - Progressive ROM exercises, strength training for knee/hip, & neuromuscular training - NMES to increase quad strength. functional performance, & knee function - Stepwise progression of weight bearing following surgery to reach full weight bearing at 6-8wks
45
Level I evidence for knee ligament sprain interventions
- Concentric/eccentric exercises in non-weight bearing & weight bearing status starting with 4-6wks & continuing up to 10mo - NMES following reconstruction surgery (up to 6-8wks) - Neuromuscular reeducation along with strengthening in patients with knee instability & movement coordination impairments
46
Level I evidence for older adults with hip fracture interventions
- Across the entire episode of care you MUST provide structured exercise, to include progressive high-intensity resistance exercise (weight bearing & non-weight bearing), balance training, & functional mobility training - Patient education to maximize safe physical activity - Should prescribe a multidisciplinary orthogeriatric program
47
Level II evidence for non-arthritic hip pain interventions
- Movement pattern training - Therapeutic exercises/activties to address identified joint mobility, muscle flexibility, & strength deficits - Patient education and counseling
48
Level II evidence for carpal tunnel syndrome interventions
- Should recommend neutral positioned wrist orthoses worn at night for short-term symptom relief & functional improvement - Should NOT use low-level laser therapy or iontophoresis or use/recommend magnets
49
CPG for diagnosing carpal tunnel syndrome
- Need 3 of the following to diagnose - Age >45 - Shaking hands relieves symptoms - Sensory loss in the thumb - Wrist ratio index >0.67 - CTQ-SSS score >1.9
50
Level II evidence for lateral elbow pain interventions
- Therapeutic exercises with isometric, concentric, and/or eccentric wrist extension exercise for subacute or chronic lateral elbow tendinopathy - Should use local elbow manual therapy to reduce short-term pain & increase grip strength - Should use resisted wrist extension exercises in combination with other interventions, including manual therapy - Should use rigid taping for short-term pain relief in patients with irritable pain - Should use either tendon or trigger point dry needling for treating pain
51
Level I evidence for adhesive capsulitis (Frozen shoulder) interventions
- Intra-articular corticosteroid injections combined with shoulder mobility & stretching provide short-term (4-6wks) pain relief & improved function as compared to exercises alone
52
Special tests to confirm a full thickness supraspinatus tear
- Jobe (empty can) - Full can - ER lag sign
53
Special tests to confirm a full thickness infraspinatus tear
- ER lag sing
54
Special tests to confirm a full thickness subscapularis tear
- Lift off and belly press OR belly press and bear hug
55
Special tests to confirm a RTC tendinopathy/partial tear
- Painful arc test
56
Sort A level evidence for RTC interventions
- Consider corticosteroid injection to reduce pain & short-term disability in patients with severe/persistent pain associated with rotator cuff tendinopathy - Use an active rehab program as the initial treatment to reduce pain/disability - Subacromial decompression is NOT recommended even if initial non-surgical management failed
57
Level I evidence for post-op management interventions of glenohumeral joint arthritis
- Should use a sling & progressive ROM & strengthening exercises to improve reported outcomes & ROM
58
Examination CPG to diagnose hip OA
- Hip IR <24º or IR/flexion 15º less than non painful side - Passive IR increases pain - Morning hip stiffness after awakening - Moderate anterior or lateral hip pain when weight bearing
59
Level I evidence for hip OA interventions
- Flexibility, strengthening, & endurance (dosage 1-5x per wk for 6-12wks with mild to moderate hip OA) - Manual therapy for mild to moderate hip OA that may include soft tissue mobilization, thrust, & non thrust (dosage 1-3x per wk over 6-12wks)
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