Ortho Test 1

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bcb2127
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67342
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Ortho Test 1
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2011-02-18 21:51:23
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Ortho Test 1
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  1. Pain that is constand and unchanging with activity & worsens at night is an example of
    Red Flags (cancer, fracture, infection, etc.)
  2. List the steps of the examination in order
    • History
    • Observation
    • Scanning Exam
    • AROM & PROM
    • Resisted Isometric Movements
    • Functional Testing
    • Special Testing
    • (Reflexes & Cutaneous Distribution)
    • Joint Play Movements
    • Palpation
  3. When do you not need to perform a Scanning Exam?
    Definite trauma that explains local symptoms
  4. When should you perform the Scanning Exam?
    • When the cause of the symptoms are unclear or when there is radiating pain.
    • specifically:
    • no trauma
    • radicular signs
    • trauma with radicular signs
    • altered sensation in limb
    • spinal cord signs
    • presents with abnormal patterns
    • suspect psychogenic pain
  5. Pain direcvtly involving a spinal nerve, a subclass of referred pain
    Radicular Pain
  6. List the steps in the scanning exam
    • AROM & PROM of spine w/ overpressure
    • Myotomes
    • Dermatomes
    • Reflexes
  7. Myotomes performed for a minimum of ____ seconds
    5
  8. List cervical myotome actions and corresponding levels
    • Neck Flexion - C1 & 2
    • Neck SB - C3
    • Shoulder Elevation - C4
    • Shoulder Abduction - C5
    • Elbow Flexion - C6
    • Elbow Extension - C7
    • Thumb Extension - C8
    • Adduction of hand intrinsics - T1
  9. List cervical dermatome areas and respective levels
    • Clavicle - C3
    • top of shoulder - C4
    • distal lateral bicep - C5
    • tip of thumb - C6
    • tip of 3rd digit - C7
    • tip of 5th digit - C8
    • distal tricep - T1
    • axilla - T2
  10. Reflexes: name and level
    • Bicep - C5
    • Brachioradialis - C6
    • Tricep - C7
  11. Pain with contraction, active stretch and passive stretch & palpation
    Contractile Lesion (yeah I'm sure muscle is fine)
  12. For resisted isometrics:
    strong and painful = _________
    weak and painful = __________
    weak and pain free = __________
    • 1. local lesion of muscle, tendinitis or 1st/2nd degree strain
    • 2. severe injury around joint, fracture, etc.
    • 3. nervous system involvement or complete rupture of muscle (though he mentioned it would still hurt, just not increase pain)
  13. spin and swing are examples of __________kinematic motion
    osteo
  14. roll and glide/slide are examples of _____kinematic motion
    arthro
  15. pull on a long axis of a bone than produces sliding
    traction
  16. separation of a joint surface at a right angle
    distraction
  17. 3 contraindication of joint mobilizations (stretch techniques is what he lists next to it, but it's under joint mobilization)
    • hypermobility
    • joint effusion
    • inflammation
  18. In the acute phase of injury, you would use grade ____ and ____ mobilizations
    1 & 2
  19. In the subacute stage you would use which joint mobilizations?
    1 & 2 for pain relief, 3 & 4 without causing lingering symptoms
  20. In the remodeling (chronic) phase, what joint mobes would be appropriate?
    3 & 4 for stretch
  21. In what direction is a transverse/cross friction massage performed?
    Across the fibers desired direction (derp)
  22. A cross friction massage assist in organizing and maturation of collagen by:
    • maintaining mobility with respect to adjacent tissues
    • promoting increased interfiber mobility without longitudinal stress
  23. pain and muscle guarding prior to tissue resistance
    acute
  24. pain with tissue resistance
    subacute
  25. pain after tissue stretch
    chronic/remodeling
  26. a wound in muscle or skin closes in about
    5-8 days
  27. a wound in a tendon or ligament closes in
    3-5 weeks
  28. muscles active on opening of jaw
    lateral pterygoid and if assistance necessary mylohyoid, geniohyoid, digastric
  29. muscles active with jaw closing
    masseter, temporalis, medial pterygoid
  30. Range of active movements at shoulder:
    1abduction
    2 flexion
    3 lateral rotation
    4 medial rotation
    5 extension
    • 1) 170-180
    • 2) 160-180
    • 3) 80-90
    • 4) 60-100
    • 5) 50-60
  31. loose pack position of TMJ
    mouth slightly open
  32. loose pack position of shoulder
    • 30d horizontal adduction & 55d abduction
    • (aka 55d scaption)
  33. loose pack position of elbow
    90d flexion
  34. loose pack position of wrist
    neutral
  35. capsular pattern in order of greatest limitation (shoulder)
    lateral rotation > abduction > medial rotation
  36. special test: Neer
    forced flexion pain = SS impingement
  37. special test: Hawkins-Kennedy
    • flex to at least 90, internally rotate & move around
    • pain = SS impingement
  38. special test: Yocum
    • reach across to opposite shoulder and raise elbow to 90d
    • pain = SS impingement
  39. special test: apprehension
    • supine, abduct to 90, then externally rotate, can add fulcrum
    • Anterior Instability
  40. special test: relocation
    • same as apprehension but add post pressure on anterior GH
    • Anterior Instability
  41. special test: posterior apprehension
    • 90d scaption elbow at 90d, horizontal adduction & medial rotation, push through elbow
    • Posterior Instability
  42. special test: sulcus
    • pt. seated/standing, pull on arm below elbow and look for sulcus
    • Inferior Instability
  43. special test: full can
    • SS tear
    • 90d scaption
    • have pt hold, can add pressure
  44. special test: Drop Arm
    • SS tears
    • uable to sustain 90d abduction, don't just drop them, ease off of support
  45. special test: lift-off
    • arm medially rotated, hand on back or butt, have them lift hand off
    • if can't lift off hand, subscap tear likely
  46. special test: dropping for infraspinatus
    • elbow at side & bent to 90d, hold actively in as much external rotation as possible
    • positive test unable to hold
  47. special test: crank
    • labral tears
    • 160d scaption, elbow bent, pressure through elbow, then rotate external and internally
    • look for pain & click
  48. special test: SLAP pronated load test
    • 90d shoulder abduction, full forearm pronation, maximally externally rotate shoulder
    • after max external rotation achieved, resist elbow flexion but maintain pronation
    • positive test is deep pain in shoulder
  49. What causes thoracic outlet syndrome?
    compression of brachial plexus by scalenes and/or pec minor
  50. swelling that comes on sono after injury
    blood
  51. swelling comes on after 8-24 hours
    synovial
  52. swelling has boggy, spongy feeling
    synovial
  53. swelling has harder, tense feeling with warmth
    blood
  54. sweilling is tough & dry
    callus
  55. swelling characterized by leathery thickening (think stage)
    chronic
  56. swelling is soft and fluctuating (think stage)
    acute
  57. swelling is hard
    bone
  58. swelling is thick and slow moving
    pitting edema
  59. concave/convex rule for shoulder
    • head of humerus = convex
    • glenoid fossa = concave
  60. concave/convex rule humeral ulnar joint
    • humerus = convex
    • ulna = concave
  61. concave/convex rule radiohumeral joint
    • radius = convex
    • ulna = concave
  62. concave/convex rule radiocarpal joint
    • carpals = convex
    • radius = concave
  63. Carpal bones
    • Scaphoid, Lunate, Triquetrum, Pisiform
    • Trapezium, Trapezoid, Capitate, Hamate
  64. The ______ tunnel, formed by flexor retinaculum spanning the carpal gutter, contains ____ tendons & ____ nerve
    • carpal
    • flexor
    • median
  65. ________'s _______ is formed by the pisiform, hamate & pisohamate ligament & contains the __________ nerve
    • Guyon's Canal
    • ulnar
  66. Scapulohumeral Rhythm: ______d humeral to ______d scapular motion
    120 humeral to 60 scapular
  67. Reverse scapulohumeral rhythm means _______ moves more than ________ & suggests ____________
    • scapula moves more than the humerus
    • suggests frozen shoulder
  68. The first ______ mm of opening of the TMJ is _________ motion, then from there to full opening ______ motion
    • 10mm
    • hinge/rotation
    • gliding/sliding
  69. flexion of MCP and distal IP
    Extension of proximal IP
    potential cause: contracture of intrinsic muscles, often seen in RA or after trauma
    Swan Neck
  70. extension of MCP and Distal IP
    Flexion of PIP
    potential cause: rupture of the central tendinous slip of the extensor hood: RA or trauma
    Boutonniere
  71. ulnar deviation of the digits
    potential cause: weakening of the capsuloligamentous structures of the MCP and accompanying bowstring effect of the extensor communis tendons
    ulnar drift
  72. MCP hyperextended
    proximal and distal IP are flexed
    potential cause: loss of intrinsic musculature of the hand; medial and ulnar nerve palsy
    intrinsic minus hand
  73. sticking of the tendon in the sheath when trying to flex the finger
    potential cause: thickening of the flexor tendon sheath
    trigger finger (digital tenovaginitis stenosans)
  74. contracture of the palmar fascia, especially of the ring or little finger
    dupuytren's contracture
  75. distal phalanx rests in a flexed position
    rupture or avulsion of extensor tendon where it inserts on the distal phalanx
    mallet finger
  76. special test: valgus/varus at elbow
    elbow at 90d, apply counterpressure to humerus, pressure at distal forearm
  77. capsular patter for elbow
    flexion more than extension
  78. special test: lateral epicondylitis (two methods)
    • method one: contraction
    • method two: stretch
  79. special test: medial epicondylitis
    wrist flexor stretch
  80. special test: tinel's sign (elbow)
    • tap ulnar nerve between olecranon and medial epicondyle
    • positive intense tingling > unaffected side
  81. special test: elbow flexion test
    • stretch ulnar nerve by flexing elbow & extending wrists & holding for 3-5 minutes
    • positive is tingling and paresthesia
  82. special test: pronator teres syndrome
    • elbow at 90d with examiner resisting pronation while patient extends fully
    • positive tingling or paresthesia
    • medial nerve
  83. special test: pinch grip test
    • have patient pick up piece of paper tip-to-tip, if they go pulp to pulp positive test
    • anterior interosseous nerve
  84. special test: froment's sign
    • start pulp-to-pulp and if they go tip-to-tip positive sign
    • ulnar nerve
  85. median nervecompressed by pronator teres
    pronator teres has normal strength, but distal innervated musculature can be affected
    weakness and paresthesia in the median nerve distribution
    pronator syndrome
  86. weakness of flexor carpi ulnaris and ulnar half of the flexor digitorum profundus in the forearm, the hypothenar eminence in the hand, the interossei and the third and fourth lumbricals
    most obvious & earliest symptom is sensory: pain and paresthesia in the medial elbow & forearm, paresthesia in the ulnar sensory distribution of the hand
    cubital tunnel
  87. branch of the radial nerve gets compressed as it passes between the 2 heads of the supinator muscle in the canal of Frohse
    weakness in wrist extensor muscles, wrist drop
    beacause no sensory changes, often get misdiagnosed with tennis elbow
    radial tunnel syndrome (post int nerve)
  88. special test: thumb ulnar collateral ligament laxity
    • extend thumb with valgus stress to MCP joint
    • positive is >35d movement
  89. special test: grind test (thumb)
    • compression and rotation of CMC joint
    • positive is pain, indicative of osteoarthritis
  90. special test: finkelstein test
    • make fist with thumb inside, ulnarly deviate fist
    • positive is excruciating pain, as it fucking hurts no matter what
  91. special tests: tinel sign at wrist
    • tap carpal tunnel
    • positive is excess tingling
  92. special test: phalen's
    • full flexion of wrists
    • positive is intense tingling
  93. special test: allen test
    • open & close hand 5 times, hold closed, then block off both radial and ulnar arteries
    • open fist and release arteries one at a time
    • test both arteries separately
    • check for flushness

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