Musculoskeletal 2

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Musculoskeletal 2
2013-01-09 11:06:24
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Musculoskeletal 2
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  1. Shoulder goni measurements (norm range): axis, stationary arm, moveable arm
    • 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
  2. Elbow goni measurements (norm range): axis, stationary arm, moveable arm
    Extension/Flexion (0-150): lateral epicondyle of humerus, lateral midline of humerus, radial styloid process
  3. Forearm goni measurements (norm range): axis, stationary arm, moveable arm
    • 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
  4. Wrist goni measurements (norm range): axis, stationary arm, moveable arm
    • 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
  5. Hip goni measurements (norm range): axis, stationary arm, moveable arm
    • 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
  6. Knee goni measurements (norm range): axis, stationary arm, moveable arm
    Extension/Flexion (0-135): lateral epicondyle of femur, lateral midline of fermur (greater trochanter), lateral midline of fibula (lateral malleolus)
  7. Ankle goni measurements (norm range): axis, stationary arm, moveable arm
    • 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
  8. Subtalar goni measurements (norm range): axis, stationary arm, moveable arm
    Inversion/Eversion (5-0-5): mid posterior aspect of ankle, post. midline of lower leg, post. midline of calcaneus
  9. C-spine goni measurements: axis, stationary arm, moveable arm
    • 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
  10. Achilles Tendonitis
    • repetitive overuse, changes in training intensity
    • aching/burning in posterior heel, morning stiffness
    • RICE, NSAIDs, heel lift, heel cord stretching
  11. Adhesive Capsulitis
    • loss of AROM and PROM from adhesive fibrosis/scarring
    • 40-60 yo female
    • typically resolves in 1-2 years
    • localized pain, stiffness, night pain
  12. ACL sprain
    • 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
  13. Congenital Hip Dysplasia
    • malalignment of femoral head in acetabulum
    • asymmetrical hip abduction w/ tightness
    • harness, bracing, splinting, traction, hip spica cast
    • ortolani's and barlows test
  14. Congenital Torticollis
    • "wry neck"
    • unilateral contracture of SCM, usually in first 2 months of life
    • ipsilateral SB and contralateral rotation
    • stretch, AROM, positioning
  15. Glenohumeral instability
    • 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
  16. Impingement Syndrome
    • 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
  17. Juvenile Rheumatoid Arthritis
    • 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
  18. Lateral epicondylitis
    • 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
  19. Legg-Calve Perthes Disease
    • 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
  20. MCL Sprain
    • often involves ACL also
    • contact or noncontact, fixed foot, tibial rotation
    • valgus stress test
  21. Meniscal tear
    • 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
  22. Osgood Schlatter Disease
    • repetitive tension to patellar tendon on tibial tuberosity apophysis
    • point tenderness over patella tendon
    • ice, flexibility exercises, conservative treatment- decrease squatting, running, jumping,
  23. Osteoarthritis
    • 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
  24. Osteogenesis Imperfecta
    • 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
  25. Patellofemoral Syndrome
    • 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
  26. Plantar Fasciitis
    • 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
  27. PCL Sprain
    • 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
  28. Rheumatoid Arthritis
    • 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
  29. Rotator Cuff Tear
    • 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
  30. Scoliosis
    • Lateral curvature of the spine
    • functional scoliosis: abnormalities in the body- muscle imbalance, poor postures- these areĀ  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
  31. Talipes Equinovarus
    • clubfoot, heel downard, forefoot inward
    • forefoot adduction, varus hindfoot, equinus ankle
    • splinting and serial casting
  32. Total Hip Arthroplasty
    • 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
  33. Total Knee Arthroplasty
    • 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'
  34. Fracture types
    • 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
  35. Pharmacological Management of Musculoskeletal System- nonopiod
    • 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
  36. Pharmacological Management of Musculoskeletal System- opioid
    • 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
  37. Pharmacological Management of Musculoskeletal System- glucocorticoid
    • 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
  38. Pharmacological Management of Musculoskeletal System- disease modifying antirheummatic
    • halt progression of rheumatic disease (RA)
    • side effects: nausea, HA, jt pain/swelling, toxicity, GI distress, sore throat, liver dysfunction
  39. Sprain vs. Strain
    • 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
  40. List of LE orthotics
    • 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
  41. List of spine orthotics
    • 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
  42. Transtibial amputation
    • WBing in prosthesis should be distributed over entire limb
    • patellar tendon should be area of primary weight bearing
    • susceptible to knee flexion contracture
  43. Transfemoral amputation
    • susceptible to hip flexion & abduction contracture
    • adaptation required for balance, weight of prosthesis, and energy expenditure
  44. Complications from amputation
    • 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
  45. Residual Limp Wrapping Guidelines
    • 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