-
which grade is complete range of motion against gravity with full or normal resistance
grade 5 (normal)
-
which grade is complete range of motion against gravity with some resistance
4 (good)
-
which grade is complete range of motion against gravity
3 (fair)
-
which grade is complete range of motion with gravity eliminated
2 (poor)
-
which grade has muscle contraction but no or very limited joint motion
1 (trace)
-
which grade has no evidence of muscle function
0 (zero)
-
what is the strength of an absent reflex
zero
-
what is the strength of a reflex somewhat diminished; low normal
1+
-
what is the strength of an average reflex; normal
2+
-
what is the strength that has a reflex brisker than average
3+
-
what is the strength has a very brisk reflex, hyperactive
4+
-
the axillary nerve affects which muscle and what is its sensory location
- deltoid-shoulder abduction (C5)
- sensory is the lateral aspect of the arm
-
the musculocutaneous nerve innervates which muscle and what is its sensory location
- biceps- elbow flexion
- sensory is the lateral proximal forearm
-
the median nerve innervates which muscle and where is its sensory location
- flexor pollicis longus- thumb flexion
- sensory is the tip of the thumb, volar aspect
-
the ulnar nerve innervates which muscle and where is its sensory location
- first dorsal interosseous- abduction
- sensory is the tip of the little finger, volar aspect
-
the radial nerve innervates which muscle and where is its sensory location
- extensor pollicis longus- thumb extension
- sensory is the dorsum thumb web space
-
which dermatome is on the deltoid shield
C5
-
which dermatome is located on the dorsal forearm and web space between the thumb and index finger
C6
-
which dermatome is located at the tip of the long (middle) finger
C7
-
which dermatome is located on the hypothenar (little finger)
C8
-
which dermatome is located on the inner aspect of the forearm
T1
-
which dermatome is located on the inner aspect of the tricep
T2
-
what reflex strength test is done at C5
deltoid and biceps
-
what reflex strength test is done at C6
biceps and ECRL/ECRB
-
what reflex strength test is at C7
triceps, FCR, extensor digitorum communis
-
what reflex strength test is at C8
flexor digitorum, profundus/sublimis and interossis
-
what reflex test is at T1
interossei
-
the obturator nerve innervates which muscle(s) and where is the sensory location
- adductors- hip adductor
- sensory is the medial aspect, mid thigh
-
the femoral nerve innervates which muscle(s) and where is the sensory location
- quadriceps- knee extension
- sensory is proximal to the medial malleolus
-
the peroneal (deep branch) innervates which muscle(s) and where is the sensory location
- extensor hallucis longus- great toe extension
- sensory is the dorsum first web space
-
the peroneal (superficial branch) innervates which muscle(s) and where is the sensory location
- peroneus bervis- foot eversion
- sensory is the dorsum lateral foot
-
the tibial nerve innervates which muscle(s) and where is the sensory location
- flexor hallucis longus- great toe flexion
- sensory is the plantar aspect of foot
-
what is the principal nerve supply for the bladder, and intrinsic muscles of the feet
S2, S3 and S4 nerve roots
-
this type of reflex indicates spinal shock, they are the first reflexes to return after spinal shock and lack of motor and sensory function after the reflex has returned indicates complete SCI (spinal cord injury)
osinski reflex
-
which dermatome is tested over the patellar tendon
L4
-
which dermatome is tested of the achilles tendon
S1
-
which muscle has strength testing is at L1-L2
iliopsoas
-
which muscle has strength testing at L3
quadriceps
-
which muscle has strength testing at L4
tibialis anterior
-
which muscle has strength testing of L5
- extensor hallicis longus
- extensor digitorum longus
- gluteus medius
-
which muscle strength testing is at S1
- gastrocsoleus
- peroneus longus and brevis
- gluteus maximus
-
which muscle strength testing is at S2, S3, and S4
rectal exam
-
what are the sxs associated with compartment syndrome
acute- pain that is disproportionate to the injury and sensory hypoesthesia distal to the involved compartment. Extreme pain on stretching of the long muscles that pass through a compartment. pt complains of paresthesias and pain following trauma
Chronic- sxs are less acute and tend to improve with rest following exercise
-
what is the treatment of compartment syndrome
surgical fasciotomy of the compartment is essential
the wound is left open
-
which crystalline deposition disease is composed of monosodium urate crystal deposition
gout
-
which crystalline deposition disease is composed of calcium pyrophosphate deposition
pseudogout
-
what is the most frequent manifestation of gout
arthritis
-
which type of crystalline deposition disease usually begins in a single joint with symptoms appearing first at night, and the pain and swelling are intense and even the weight of a sheet is intolerable
gout
-
where is the most common location of gout and what is it known as
MTP joint of the great toe
"Podagra"
-
these are soft tissue masses resulting from urate crystal deposition that are noted several years following the onset of gout
tophi
-
which crystalline deposition disease has a negative birefringence
gout
-
which crystalline deposition disease has a positive birefringence
pseudogout
-
which diagnostic tests must be run on acute arthritis (gout)
joint aspiration and analysis of synovial fluid
-
which labs should be checked with suspicion of gout
serum uric acid levels
-
what is the treatment in chronic gout for underexcreters
anturane or probenecid
-
what is the treatment in chronic gout for overproducers
allopurinal
-
this type of crystalline deposition most commonly involves the knee, can manifest as chondrocalcinosis
pseudogout
-
calcification of the articular cartilage or meniscus, usually of the periphery of the joint is known as what
chondrocalcinosis
-
what is the most common area for DISH to affect
thoracic and thoracolumbar spine
-
DISH affects which age group
60 years or older
-
what is the difference between DISH and AS in diagnostic testing
DISH has a normal SI joint while in AS the SI joint is affected
DISH has no human leukocyte antigen while AS does
-
how is fibromyalgia diagnosed
- no radiographs or labs are diagnostic
- it should be considered in any pt with musculoskeletal pain that is unrelated to a clearly defined anatomic lesion
-
how is fibromyalgia treated
- TCA (elavil), cyclobenzaprine (flexeril), NSAIDS are helpful for pain
- Fluoxetine should be taken in the morning and is useful to reduce severe depression
- corticosteroids and narcotics are CI
- can give Ultram but watch for seizures
- Capsaicin cream may be beneficial
- aerobic exercise and stretching programs
- refer to dietician if overweight
- FMS support groups
-
what are the presenting symptoms of Lyme disease
- flu like symptoms
- erythema migrans
- subacute/intermediate stage characteristed by arthalgia and arthritis (knee)
- Bells palsy or other CN palsy
- chronic fatigue
-
what are the nonorganic signs and symptoms
- wadell signs (false pathology)
- pt responses or sxs do not fit known patterns of illnesses or injury
-
what are the radiologic clues for OA
- Fairbanks signs:
- loss of joint space
- sclerosis
- subchondral cysts
- spurs at joint margin
-
what are the treatment approaches for OA
- weight loss especially for lower extremity joints
- pain management
- PT
- glucosamine and chondroitin
- bracing- unloader
- intra-articular corticosteroid injection
- "" "" viscosupplemental injections
- surgical arthroscopy
- interpositional graft or transplant
- joint realignment
- joint replacement
- joint arthrodesis
-
a bone infection caused by pyogenic organisms, TB, syphilis, and viral or fungal elements is known as what
ostemyelitis
-
this creates an inflammatory response that progresses to an abscess that destroys bone
osteomyelitis
-
what is the most common causative organism of osteomyelitis
staph aureus
-
what are some clinical symptoms of osteomyelitis
- unrelenting pain is the first symptom
- pt may report a hx of an injury or trauma
- fever, localized tenderness, and a flushed appearance
-
this usually occurs as a result of inoculation of bacteria into a joint is known as what
septic arthritis
-
which joints does septic arthritis usually affect
- large joints of LE
- CI joint
-
which pathogen may cause septic arthritis located in the knee
gonococcal infx
-
what are the offending organisms of septic arthritis in neonates
-
what are the offending organisms of septic arthritis in a child < 5 y/o
- S aureus
- group A strep
- strep pneumo
- H. flu
-
what is the offending organism of septic arthritis in a child 5 y/o to adolescents
S aureus
-
what are the offending agents of septic arthritis in adolescents to adults
-
what is the offending organism of septic arthritis in older adults
S aureus
-
how is septic arthritis treated
IV antibiotic and joint drainage
-
how is osteomyelitis treated
- IV antibiotics- empiric therapy
- is no decrease in temperature, pain and tenderness within 24-36 hrs, sx decompression is indicated
-
what is the threshold for ordering a dexa scan
- postmenopausal women under age 65 with one or more additional major risk factors for osteoporosis besides menopause
- all women ages 65 or older, regardless of risk factors
- postmenopausal women with fxs
- women considering therapy for osteoporosis if BMD testing would facilitate the decision
- women on long term hormone replacement therapy
-
explain stage I of CRP syndrome
- occurs in the first 3 months
- severe burning, throbbing pain
- swelling, sweating, red to blue skin changes
- increased hair and nail growth
-
explain stage II of CRP syndrome
- occurs after the 1st 3 months
- milder persistent pain
- pale waxy skin with loss of skin lines
- joint stiffness, muscle spasm, and brittle nails
-
explain stage III of CRP syndrome
- follows stage II
- return of severe persistent pain
- muscle and skin atrophy
- joint contractures and motion loss
-
how is CRP syndrome treated
- immediate referral to PT
- neurologist consultation
- Neurontin, Elavil, and narcotics
- pain specialist for nerve blocks
- oral steroids and NSAIDs NOT RECOMMENDED
-
what is the diagnostic criteria, cause and treatment for Reiter's syndrome
- triad:
- - urethritis
- - conjunctivitis
- - oligoarticular arthritis
- oral ulcers (painless)
- penile lesions (balanitis circinata)
- Main cause is chlamydia
- treatment is to relieve the symptoms and eradicate the infx.
- Doxy for chlamydia
- NSAIDs, Tylenol or ASA
- PT
- steroids
- surgery for late stages (arthroplasty)
-
what is the diagnostic criteria, cause and treatment for psoriatic arthritis
- skin dz usually precedes joint symptoms
- small joints are affected
- nail disorders, including pitting, ridging, and onycholysis
- iritis may occur
- sausage digits
- Treatment:
- topical agents for skin lesions
- salicylates, NSAIDs, Tylenol, ASA, splinting
- oral and intra-articular corticosteriods
- PT
- end stage arthritis requires total joint arthroplasty or arthrodesis
-
which grade of sprain has a partial tear, no instability or opening of the joint with stress
grade 1
-
which grade of sprain has a partial tear with some instability
grade II
-
which grade of sprain has a complete tear with complete joint opening
grade III
-
which diagnostic test is excellent for demonstrating bony changes and degree of calcification within the lesion and is often better for benign bony lesions
CT
-
which diagnostic test is better for malignant tumors
MRI
-
what is the best imaging study to define the extent and characteristics of a soft-tissue malignancy
MRI
-
what is necessary to make a definitive diagnosis of most lesions
fine-needle or open biopsy
-
how are DVT/PEs diagnosed and treated
- DVT:
- - pronounced unilateral calf swelling
- - a positive Homans sign is calf pain with forced ankle dorsiflexion
- *duplex U/S
- PE:
- - dyspnea, hemoptysis, tachycardia, pleural rub, tachypnea, sometimes circulatory collapse
- Tx:
- - pneumatic compression boot
- warfarin
- IV heparin as soon as dx
- lovenox
*** venography is the gold standard but it is invasive and rarely used b/c it can cause a PE
-
what are the differences between the tx of open vs closed fxs
reduction is not necessary with non-displaced or minimally displaced injuries
reduction is required for fxs with significant displacement
-
which physical therapy treatment is performed slowly and maintained for 20 to 30 seconds without bouncing
stretching
-
which physical therapy treatment is when the pt performs the stretch or movement
active ROM
-
which physical therapy treatment is when the therapist or outside force is used to stretch or move the joint
passive ROM
-
which physical therapy treatment is performed at a slow, controlled rate through safe parameters of the pts ROM
strengthening
-
which physical therapy treatment is used to decrease swelling, inflammation, and pain
cryotherapy
-
which physical therapy treatment is used to increase blood flow, promotes healing and muscular relaxation
thermotherapy
-
which physical therapy treatment is commonly used for chronic inflammation and increasing ROM in joints
ultrasound
-
which physical therapy treatment is commonly used to deliver topical medications
phonophoresis
-
which physical therapy treatment is commonly used for decreasing pain and edema, regaining strength, and preventing atrophy
electrical stimulation
-
which physical therapy treatment uses topical medications with electrical stimulation for chronic inflammatory conditions
iontophoresis
-
which AC injury classification is there the AC joint ligaments are partially or completely disrupted, but the strong coracoclavicular ligaments are intact, there is no superior separation of the clavicle from the acromion
type I
-
which AC injury classification is where the AC ligaments are torn and, in addition, the CC ligaments are partially disrupted, there is a partial separation of the clavicle from the acromion
type II
-
which AC injury classification id where the A-C and C-C ligaments are completely disrupted, there is complete separation of the clavicle from the acromion
type III
-
in which AC injury classification is when the clavicle is displaced posteriorly and is embedded in the trapezius muscle
type IV
-
in which AC injury classification is when the acromioclavicular and coracoclavicular ligaments disrupted, deltoid and trapezius insertions disrupted with >100% elevation of the distal clavicle
type V
-
in which AC injury classification is when the acromioclavicular and coracoclavicular ligaments disrupted with inferior dislocation of the distal clavicle inferior to the coracoid process and posterior to the biceps and coracobrachialis tendons
type VI
-
type I AC injuries are what type of injuries
sprains (xrays are normal)
-
type II AC injuries show what types of injuries
they display some AC joint widening however the distance between the clavicle and coracoid remains normal
-
type III AC injuries show what types of injuries
complete dislocation of the clavicle above the superior border of the acromion with a 30%-100% increases in the coracoclavicular interspace
-
type IV AC injuries show what types of injuries
superior displacement of the clavicle on AP radiographs, but the axillary view will show the predominant posterior displacement
-
type V AC injuries show what
complete displacement of the clavicle above the superior border of the acromion, with the coracoclavicular interspace to be increased over 100% of that seen in the opposite shoulder
-
type VI AC injuries show what
show the distal end of the clavicle to lie either in the subacromial or subcoracoid space
-
what are the treatments for types I and II AC injuries
- NSAIDs, Tylenol, ASA
- activity modification and PT
- injections
-
what is the treatment for type III AC injuries
- can be treated non-operatively
- may be considered in young manual laborer who does heavy overhead work
-
how are type IV-VI AC injuries treated
operative repair
-
what diagnostic studies are used with cervical burners
cervical spine xrays with flexion and extension views
-
when are athletes allowed to return to sports following their sports related injuries
when complete resolution of pain and neurologic symptoms, as well as a normal neurologic exam and full range of cervical spine motion are required
-
what is the most common location of injury on the clavicle
the middle 3rd of the clavicle
-
what is the treatment for a clavicular fx
arm sling or figure 8 strap for 3-4 weeks for a child under the age of 12 and 4-6 weeks for an adult
-
what are some adverse outcomes of a fx clavicle
- nonunion is rare
- mild malunion is common and a visible lump can occur and can be of cosmetic concern to some
-
what are the diagnostic signs associated with adhesive capsulitis and what are the most common risk factors
the pt typically progress from an early freezing phase of pain and progressive loss of motion to a thawing phase of decreasing discomfort associated with a slow but steady improvement in ROM
most common risk factor is Type I DM
-
what is the diagnostic criteria for impingement syndrome
- gradual onset of anterior and lateral shoulder pain exacerbated by overhead activity is characteristic
- night pain and difficulty sleeping on affected side
- TTP over greater tuberosity and subacromial bursa
- crepitus with shoulder motion
- muscle atrophy
- impingement sign/test
- modified Neer's
- Hawkins
- supraspinatus
- speeds
- cross arm adduction and drop arm
-
what are the rotator cuff muscles
- Supraspinatus
- Infraspinatus
- teres minor
- subscapularis
-
what are the prime movers of the rotator cuff muscles
- deltoid
- pectoralis major
- serratus anterior
- latissimus dorsi
-
which special tests would indicate a rupture of the rotator cuff muscles
- drop arm test
- suprasinatus isolation (Jobe) test
- subscapularis liftoff test
- internal/external rotation strength test
-
what is the treatment for bicipital tendonitis vs long head biceps ruptures and what is the functional loss
- non-operative tx is effective for most pts
- ruptures, sx for distal end but not proximal end
there is no functional loss for tendonitis but there is a 10% loss of elbow flexion and forearm supination strength
-
what is the imaging required for scapula fxs, what are the findings associated with this injury, and what nerves are associated with it
- Scapular fx- CT: dorsal scapular nerve
- Rotator Cuff- MRI: supra/infra-supraspinatus nerve, teres minor- axillary nerve, subscapularis- subscapularis nerve
- Labral tears-MRA: suprascapularis (MC)
- Humeral fx- CT: depends on location for nerve
-
what are the clinical sxs associated with shoulder arthritis
- diffuse deep seated pain in the posterior aspect of shoulder for glenohumeral arthritis and the top of the shoulder for acromioclavicular arthritis
- the pain is initially aggravated by any strenuous activity esp overhead
-
what is the usual presentation for shoulder dislocations and associated tx's
- anterior: more common in younger pts, associated with hill-sachs defect and bony bankhart lesions.
- the pt will present with armn abducted and externally rotated.
- -TX: reduction, traction with countertraction, SUBLUX PT
- Posterior: can be caused by shock/seizure, pt presents with the arm adducted and internally rotated and have limited external rotation and forward flexion
- Inferior: traumatic (dislocation) or chronic/stretching (sublux)
- Multidirectional: pts often displace hyperelasticity of several joints
-
which impingement test has internal rotation and passive forward flexion that increases pain
modified Neers
-
which impingement test has forward flexion with passive internal rotation what leads to impingement pain
Hawkins test
-
which impingement test is where the pt has pain with flexion during passive full ROM
Neers
-
which impingement test is when the pt is unable to oppose even gentle downward force on the arm held in 90 degrees of abduction
drop arm
-
which impingement test is with resistance applied with the pts arms abducted 90 degrees, forward flexed 30 degress, and pronated
Jobe (supraspinatus test)
-
which test for bicipital tendonitis is when the pts elbows are extended and the forearm is placed in the supinated position, resisted forward flexion of the humerus past 60 degrees causes bicipital groove tenderness
speeds test
-
in AC joint pathology, which special test is passive adduction of the arm across the midline causes acromioclavicular joint pain
cross-chest adduction
-
a positive Neer and Hawkins test tells you what
impingement syndrome
-
a positive supraspinatus test tells you what
supraspinatus tendonitis
-
a positive speeds test tells you what
bicipital tendonitis
-
a positive cross-arm adduction test tells you what
AC pathology or arthritis
-
which special test indicates a subluxed biceps tendon long head
yergason test
-
which test can be done to see if there is a labral tear
O'Brien test
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