Musculoskeletal 2

• Extension/Flexion (60-0-180): acromial process, midaxillary line, lateral midline of humerus
• Abduction (0-180): acromial process, parallel to midline, midline of humerus
• Internal/External Rotation (70-0-90): olecranon process, parallel/perpendicular to floor, ulnar styloid process

Extension/Flexion (0-150): lateral epicondyle of humerus, lateral midline of humerus, radial styloid process

• Pronation (80): lateral to ulnar styloid process, parallel to ant. midline of humerus, dorsal aspect of forearm
• Supination (80): medial to ulnar styloid process, parallel to anterior midline of humerus, ventral aspect of forearm

• Extension/Flexion (70-0-80): triquetrum, lateral midline of ulna, fifth metacarpal
• Radial/Ulnar deviation (20-0-30): capitate, dorsal midline of forearm, third metacarpal

• Flexion (120): greater trochanter, lateral midline of pelvis, lateral midline of femur (supine)
• Extension (30): greater trochanter, lateral midline of pelvis, lateral midline of femur (prone)
• Adduction/Abduction (30-0-45): ASIS, imaginary line from ASIS to ASIS, anterior midline of femur
• Medial/Lateral Rotation (45-0-45): anterior patella, perpendicular to floor, anterior midline of lower leg

Extension/Flexion (0-135): lateral epicondyle of femur, lateral midline of fermur (greater trochanter), lateral midline of fibula (lateral malleolus)

• DF/PF (20-0-50): lateral malleolus, lateral midline of fibula, parallel to 5th metatarsal
• Eversion/Inversion (15-0-35): anterior aspect of ankle, anterior midline of lower leg, anterior midline of 2nd metatarsal

Inversion/Eversion (5-0-5): mid posterior aspect of ankle, post. midline of lower leg, post. midline of calcaneus

• Flexion/extension: external auditory meatus, perpendicular/parallel to ground, along base of the nares
• Lateral Flexion: spinous process of C7, perpendicular to ground, dorsal midline of head (occipital protuberance)
• Rotation: center of cranial aspect of head, imaginary line between acromial processes, tip of nose

• repetitive overuse, changes in training intensity
• aching/burning in posterior heel, morning stiffness
• RICE, NSAIDs, heel lift, heel cord stretching

• loss of AROM and PROM from adhesive fibrosis/scarring
• 40-60 yo female
• typically resolves in 1-2 years
• localized pain, stiffness, night pain

• noncontact twisting injury, hyperextension, varus/valgus stress to knee
• MCL, ACL, and medial meniscus- common triad
• loud pop, or bucklying
• use patellar tendon, IT band, or hamstrings

• malalignment of femoral head in acetabulum
• asymmetrical hip abduction w/ tightness
• harness, bracing, splinting, traction, hip spica cast
• ortolani's and barlows test

• "wry neck"
• unilateral contracture of SCM, usually in first 2 months of life
• ipsilateral SB and contralateral rotation
• stretch, AROM, positioning

• excessive translation of the HH on the glenoid during active rotation
• subluxation= jt laxity, dislocation= complete separation
• popping out and going back into place
• immobilization with sling for 3-6 weeks, RICE, NSAIDS

• repetitive microtrauma
• humeral head and rotator cuff attachments move proximally and impinge on undersurface of acromion & coracoacromial ligament
• painful arc of motion
• rotator cuff strengthening, scapular stabilizer exercises

• most common chronic rheumatic disease in kids
• inflammation of jts and connective tissue
• systemic, polyarticular (>4 jts, symmetrical), oligoarticular (<5 jts, asymmetrical)
• NSAIDS, corticosteroids, antirheumatics, immunosuppressive agents

• irritation/inflammation of common extensor muscles at their origin
• eccentric loading of wrist extensors- extensor carpi radialis brevis
• worsens with repition and resisted wrist extension
• RICE, NSAIDSs, strap placed below elbow jt

• degeneration of femoral head due to blood supply disturbance
• four stages: condensation, fragmentation, re-ossification, remodeling
• decreased ROM, antalgic gait, + trendelenburg
• maintain femoral head in proper position

• often involves ACL also
• contact or noncontact, fixed foot, tibial rotation
• valgus stress test

• firmly attached to proximal tibia, medial most commonly injured
• diagnosed by arthroscopy or MRI
• joint line pain, swelling, catching
• repairs generally on outer edges (red-red zone) due to vascularity
• white-white zone, innermost, avascular

• repetitive tension to patellar tendon on tibial tuberosity apophysis
• point tenderness over patella tendon
• ice, flexibility exercises, conservative treatment- decrease squatting, running, jumping,

• degeneration of articular cartilage in WBing joints
• gradual onset of pain, increased pain after exercise or weather changes
• goal is to improve lubrication of knee, reduce pain, and improve ROM

• connective tissue disorder that affects formation of collagen during bone development
• genetic inheritance- all 4 types
• brittle bones, fractures, osteoporosis, hypermobile jts
• teach proper handling and facilitation of movement

• discomfort in anterior knee, softening of articular cartilage of patella
• repetitive overuse, decreased quad strength, decreased LE flexibility, increased tibial torsion
• pain with prolonged sitting/ascending or descending steps, swelling, crepitus
• palliative modalities, LE strengthening

• inflammation of plantar fascia , over times creates microtears at proximal insertion of plantar fascia
• associated with cavus foot, excessive torsion, hyperpronation
• pain worse in morning and with prolonged standing
• RICE, NSAIDs, heel cord stretching, soft soled shoes

• landing on tibia with flexed knee or hitting a dashboard
• swelling and mild pain, but often asymptomatic
• if surgery performed often isolated HS exercises avoided for 6 weeks

• systemic autoimmune disorder with chronic inflammation in the synovial tissues
• common in small joints- symmetrical
• go through exacerbation & remission
• corticosteroids, NSAIDs, disease modifying antirheumatic meds

• partial or full thickness
• if torn arm is positioned in adduction and IR, with point tenderness over greater tubercle and acromion
• immobilized in sling (4-6 wks) -> PROM -> AAROM -> AROM/isometrics
• return to functional activities in 9-12 months

• Lateral curvature of the spine
• functional scoliosis: abnormalities in the body- muscle imbalance, poor postures- these are  nonstructural/flexible and can generally be corrected- 25-40' curve spinal orthosis, >40' surgery
• neuromuscular and degenerative scoliosis: structural scoliosis/inflexibile so can't be corrected - Marfans syndrome

• clubfoot, heel downard, forefoot inward
• forefoot adduction, varus hindfoot, equinus ankle
• splinting and serial casting

• removal of proximal and sistal joint surfaces
• anterolateral approach: avoid flexion > 90, hip extension, ER, adduction
• direct lateral : minimize probability of dislocation, avoid flexion > 90, hip extension, ER, adduction
• Posterolateral: high post-surgical dislocation rate, avoid flexion >90, adduction, IR
• cemented fixation= WBAT, cementless= WBing precautions
• complications: DVT, infection, PE, heterotopic ossification, femoral fractures, dislocation, neurovascular injury

• most commonly performed for advanced arthritis of knee
• cemented (WBAT) or non (WBing precautions)- cemented most common
• complications: DVT, infection, PE, fibular nerve palsy, restricted ROM, periprosthetic fractures, chronic joint effusion
• minimum knee flexion for ADL: 90'
• knee flexion to rise from sitting: 105'

• avulsion: traumatic & sudden stretch of tendon causes bone fragment
• closed: skin over site remains intact
• comminuted: breaks into fragments at injury site
• compound: bone protrudes through skin
• greenstick: common in kids, periosteum only damaged on one side
• nonunion: bone that has failed to unite after 9-12 months
• stress fracture: repeated forces
• spiral: shaped like and S from torsion or twisting

• tylenol, asprin, NSAID, advil
• analgesia and pain relief, lowers fevers
• for: fever, HA, muscle ache/inflammation, mod pain
• side effects: GI bleeding, ulcer formation, vomiting, vertigo

• Narcotics: oxycodone, codeine, morphine
• analgesia for acute severe pain- prevents pain impulses from reaching destination
• side effects: mood wings, sedation, confusion, vertigo, constipation, hypotension, respiratory depression
• max analgesiv benefit is 2 hrs after administration

• corticosteroids (prednisone, dexamethasone): provide hormonal, anti-inflammatory, and metabolix effects
• side effects: muscle atrophy, osteoporosis, GI distress, drug induced cushings (hyper of adrenal gland)
• PT must wear mask when working with these patients due to weakened immune system

• halt progression of rheumatic disease (RA)
• side effects: nausea, HA, jt pain/swelling, toxicity, GI distress, sore throat, liver dysfunction

• Grade I sprain: little to no tear of ligament
• Grade II sprain: min to mod tear of ligament- instability at jt, mod swelling and pain
• Grade III sprain: total tear of ligament

• Grade I strain: localized pain, swelling adn tenderness of muscle/tendon
• Grade II strain: mod swelling, tenderness and impaired motor function
• Grade III strain: palpable defect of muscle

• foot orthotics
• AFO: posterior leaf spring is plastic, floor reaction assists knee extension
• KAFO
• Craig Scoot KAFO: designed for people with paraplegia
• HKAFO: have to use wing to or swing through gait
• Reciprocating gait orthosis: generally used with paraplegics

• corset: pressure for mid-low back pathologies
• halo vest orthosis: invasive cervical thoracic orthosis restricting all cervical motion
• Milwaukee: promotes realignment-- scoliosis
• Taylor brace: limits trunk flexion/extension
• thoracolumbosacral orthosis (TLSO): prevents all motion, rigid shell

• WBing in prosthesis should be distributed over entire limb
• patellar tendon should be area of primary weight bearing
• susceptible to knee flexion contracture

• susceptible to hip flexion & abduction contracture
• adaptation required for balance, weight of prosthesis, and energy expenditure

• Contractures: jt immediately proximal to amputation most at risk
• DVT
• hypersensitivity
• neuroma: nerve endings group together and produce pain due to pressure or scar tissue
• phantom limb: painless sensation limb is still present
• phantom pain: painful stimuli relating to residual limb
• psychological impact: denial, grief, anxiety, depression, suicidal
• wound infections

• NO wrinkles
• use tape, NO clips
• don't warp in circular patterns- should be diaganol and angular
• provide pressure distally
• promote full knee extension for transtibial, full hip extension for transfemoral, and full elbow extensio for transradial
• 2-4" wrap for UE, 3-4" wrap for transtibial, 6" wrap for transfemoral