MS 1 hip misc 1

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shmvii
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174249
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MS 1 hip misc 1
Updated:
2012-09-29 14:20:28
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MS hip misc
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MS 1 hip misc 1
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  1. burning, sharp pain, tingling, numb ... sounds like what kind of issue?
    nerve
  2. "achey" sounds like what kind of issue?
    joint or muscle or vascular
  3. "tearing" sounds like what kind of issue?
    soft tissue or muscular
  4. soft tissue
    • tissues that connect, support, or surround other structures and organs of the body, not being bone
    • includes tendons, ligaments, fascia, skin, fibrous tissues, fat, and synovial membranes (which are connective tissue), and muscles, nerves and blood vessels (which are not connective tissue)
  5. "throbbing" sounds like what kind of issue?
    inflammation, joint, vascular
  6. "crushing" sounds like what kind of issue?
    compression of a nerve
  7. positive indicators/findings, asterisk points
    • good signs, like sleeping thru the night if pt was initially waking hourly
    • or activity level increasing
  8. referred pain - heart attack -> ? pain, kidney issue --> ?, gall stones --> ?
    • heart attack --> left arm pain
    • kidney issue --> back pain
    • gall stones --> thoracic pain
  9. beta blocker does what to the heart, BP, HR?
    • heart - slower to contract
    • HR - slow
    • BP - lower
  10. antibiotics can lead to  _?_
    steroids ...?
    • antibiotics --> tendonopathies
    • steroids --> they eat bone and soft tissue -> osteoporosis
  11. active movement testing (part 1 of selective tissue tendon testing) looks for ...?
    • pt's willingness or unwillingness to move
    • ROM
    • muscular power
    • quality of movement (smooth, jittery, stuck)
    • contractile vs noncontractile tissues
  12. how does cyriax divide things into contractile vs inert structures?
    anything that can't volitionally move is inert/noncontractile
  13. when to do overpressure, and what it indicates
    • do it when the AROM is painfree at the end of range
    • indicates the joint is clear
    • no need to do PROM at this point bc it would give no new info
  14. capsular end feel
    • firm arrest of movement w slight creep, leathery
    • ex: shoulder ER, knee ext
  15. hip capsular pattern
    order of restriction:IR >> ext>abd>flex
  16. passive movement testing inicates the state of what? (per Cyriax)
    inert or noncontractile tissues
  17. end feel of elbow extension
    hard
  18. end feel of elbow flexion
    soft tissue
  19. example of muscular endfeel
    lat head flex
  20. end feel of finger abd
    ligamentous - it feels abrupt, firm, tighter than a muscular end feel)
  21. springy rebound end feel
    bounces back  this is always pathological
  22. cartilagious/periosteus
    any joint w meniscus - TMJ, knee
  23. bony blok e feel
    • diff from hardbony end feel,this ill feel abrupt, hard, limiting the ROM
    • seen w bone chips, osteophytes
  24. abnormal end feel
    any aberration from the normal end feel for that joint
  25. pannus end feel
    • soft, squishy feel bc of synovitis
    • seen in RA
    • no healthy joint has this
  26. loose end feel
    hypermobile
  27. empty end feel
    no end feel - pt won't let you go that far bc of pain
  28. bony grate end feel
    • similarto crepitus
    • see when jnt is eroding
    • rough, unpleasant for pt and PT
  29. resisted (isometric) mvmnt provide info  about status of...?
    • contractile tissues: muscles, tendons, attachments
    • put joint in resting pos and have pt push against your hands to see if you can elicit the symptomatic pain
    • must be applied so only one muscle group is tested at a time
  30. accessory movements happen where
    in a joint - they're a component of arthrokinematics
  31. componenent movements
    • happen inside a joint - so a component of osteokinematics
    • involuntary
    • accompany and are necessary for full ROM
    • ex: depression of humeral head during flexion
  32. joint play
    • a kind of arthrokinematic
    • involuntary
    • refers to the amount of movement created under force
    • ex: in dorsiflexion the head of the talus rotates post and tib/fib spread
    • ex: PT pulling on a joint to creat movement inside a capsule
  33. mobility testing grades and therapy for 0 and 6
    • 0-ankylosed-none
    • 6-unstable (prob due to torn lig)- surgery
  34. what to do if you have pain w resistance and a capsular end feel? hard end feel?
    • cap - progress to next level of care
    • hard - treat as if acute
  35. ligamentous adhesions
    • a non-capsular pattern
    • restricts movement in one direction
  36. internal derangement
    • non-capsular pattern
    • a loose fragment of cartilage or bone causes a localized block --> springy rebound or bony block
  37. two types of extra-articular limitation (which is a subcategory of non-capsular patterns)
    • disproportionate limitaton, ie muscle shortening, spasm -- shortening, loss of ROM in 1 dir
    • constant-length phenomenon - limitation at one joint related to the position in which another joint is held (blockage in 1 joint limits ROM in another) - only in 2 joint muscles
  38. that thing about active passive movements same opp direction
    • if painful/limited in opp dir - contractile structure at fault (muscle, tendon, attachment)
    • if restricted in same dir - noncontractile or arthrogenic lesion
  39. indications of painful&strong, painful&weak, painless&strong, painless&weak, painful on repetition
    • pain and strong: small lesion/tear
    • pain and weak: big lesion/tear
    • painless and strong: get some ice cream
    • painless and weak: neuropathy
    • painful on repetition: vascular supply troubles
  40. painful arc
    • pain appears near mid range, but there are painless areas on either side of it
    • pain elicited by internal squeezing
    • may be due to pinch and release of bursa, tendon, etc, or arthritis in one region
  41. pain at one extreme of range
    • diff from pain caused by squeezing
    • impingement (prob of a tendon)
  42. mobilization/manipulation def
    a passive movemen to a joint requiring tx
  43. 4 ways to apply accessory movements
    • sustained stretch (~7 sec)
    • oscillatory (1-2/sec)
    • grades of movement (increasing the ROM)
    • progressive ossilations (I-IV)
  44. grade V mob
    • aka thrust
    • small amplitude, high velocity (classic chiro move)
  45. contraindications to mobilization
    • recent fracture
    • osteoporosis, metastatic bone disease (grades I and II are ok)
    • pregnancy (bc ladies get hypermobile. but can do Grades I and II)
    • RA (leads to laxity, edema, sinovitis in joints)
    • prolonged steroid use
    • hypermobility
    • bleeding disorders or cumadine
    • hemophilia
    • blood thinners
  46. type 1 articular receptor fibers
    • in fibrous capsule of joint - mainly in superficial layers btwen collagen fibers
    • small myelinated fibers
    • static and dynamic mechanoreceptors w low threshold, slowly adapting

    so, like type II, they're good for pain inhibition, and can be activated at beginning and middle of range (grades I and II)
  47. type II articular receptor fibers
    • found in fibrous capsule of joint, mainly in deep layers,
    • medium myelinated
    • dynamic mechanoreceptors, low threshold, rapidly adapting

    so, like type II, they're good for pain inhibition, and can be activated at beginning and middle of range (grades I and II)
  48. type III articular receptor fibers
    • found in joint ligaments and facet joints in spin
    • large myelinated fibers
    • dynamec mechanoreceptors, high threshold, very slow adapting

    • we know them as GTOs
    • responsive at end of range - grade III and IV, so they're good for stretching
  49. type IV articular receptor fibers
    • found in fibrous capsule, articular fat pads, ligaments, walls of blood vessels, posterior longitudinal ligament, ant long lig
    • very small and unmyelinated
    • pain receptors, high threshold, non-adapting, nociereceptors-C-fibers, slow conducting, respond to temp and pressure, give a burning feeling when they react
  50. 3 causes of loss of articular receptors
    • direct tauma
    • long term immob
    • inflam condition

    (in ankle leads to repeated sprains bc ankle is no longer telling were it is)

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