Lisfranc
: mid foot injury in which the metatarsal bone(s) displace from the tarsus; usually caused by heavy object falling on mid foot or fall from high height
Turf toe
: sprain of 1st MTP due to hyper-extension, especially from pushing off into a spring
Lisfranc
Turf toe
2:1 GH to scapulothoracic
(ex: 150� abduction = 100� glenohumeral, 50� scapulothoracic)
Shoulder elevation control ratio
1) bone tenderness at posterior edge/tip of medial OR lateral malleolus
2) inability to WB immediately and in the ER
Indications to order radiography for the ankle
shoulder
: ER > flexion > IR
hip
: flexion/IR > abduction
Capsular patterns:
shoulder
hip
Common in young, female runners; pain when sitting with knee flexion and with squatting, jumping, and stairs
pain at the lateral knee; also common in runners due to repetitive flexion and extension
Patellofemoral syndrome
IT band friction syndrome
inflammation of the patellar ligament at the tibial tuberosity (apophysitis)
common in athletic children that run, jump, and quickly change direction
causes swelling and tenderness over tibial tubercle (painful bump just below knee)
Osgood-Schlatter
elbow
: 70� flexion (35� supination for radioulnar; 10� supination for ulnohumeral)
shoulder
: 55� abduction, 30� horizontal adduction
hip
: 30� flexion, 30� abduction, slight ER
knee
: 25� flexion
Loose-packed positions:
elbow
shoulder
hip
knee
pressure within muscles decreases blood flow, starving nerve and muscle cells
acute
: medical emergency due to trauma (pain, decreased pulse, paresthesia, pallor, paralysis)
chronic
: exertional; bursting type of pressure or pain
(6 Ps: pain, palpable ten
Compartment syndrome
hip pain plus...
A) hip IR less than 15� + hip flexion limited to 115� AND 50+ years old
B) hip IR less than 15� + pain with IR + morning stiffness AND 50+ years old
Factors supporting OA
Boutonniere
: volar slippage of lateral bands due to rupture of central slip of extensor digitorum
Swan neck
: rupture of flexor digitorum superficialis
Boutonniere vs. Swan neck deformity
displace the rear axle forward for more efficient arm push
WC accommodation for obese patient with excessive tissue mass in hip area
spastic
: contracts and reflexively empties in response to certain filling pressure; can use manual stimulation such as suprapubic stroking or tapping
flaccid
: increase compression of lower abdomen with Crede maneuver (manual pressure) or Valsava; can al
Emptying techniques for spastic vs. flaccid bladder
hip flexors and plantar flexors
What muscles should be stretched in a child with Duchenne's?
patellar stabilizing brace with
lateral
buttress
(increased valgus causes increased lateral displacement forces on the patella)
Orthotic for abnormal patellar tracking due to excessive Q angle
anterior glide paired with ER of the tibia
(tibial ER occurs during open-chain extension)
Joint mobilization to increase full knee extension
sustain pain levels of at least 2/4 of claudication scale during exercise
(in order to generate collateral circulation in patients with ischemia, must have at least moderate claudication pain)
How to monitor exercise intensity for patient with claudication
supine; PT flexes knee and hip to 90�, then applies pressure to lateral femoral epicondyle with thumb, then passively extend the knee
Noble compression test
Acromioclavicular sprain/arthritis/etc
MSK injury with pain at end-ranges of shoulder elevation and horizontal adduction
Supraspinatus tendinitis
Subacromial bursitis
MSK injury with painful arc (60-120�) of elevation; no pain at end range
anterior groin/hip pain reproduced by FADDIR/FABER as well as deep squats; hip IR limited to <20�; snapping and clicking present
Femoroacetabular impingement
stage 1
: hyperalgesia, allodynia, hyperpathia
stage 2
: increasing pain with edema and atrophic skin/nail changes
stage 3
: spreading pain, hardening edema, cool dry cyanotic skin, developing OA and ankylosis
Stages of CRPS
Neuropraxia
: least severe; focal injury to myelin fibers; axon and connective tissue sheath intact; short duration (days to weeks)
Axonotmesus
: injury to the axon; recovery over months and frequently incomplete nerve regeneration with residual deficit
N
Different types of peripheral nerve injuries
resistive training after cardiothoracic surgery is restricted to 5-8 pounds for first 5-8 weeks
initial loads should be 30-40% 1RM for arms, 50-60% for hips/legs
Protocol for weights/resistance training post sternotomy
silver nitrate
AND
nitrofurazone
: superficial to attack surface organisms
sulfamylon
: penetrates through eschar to provide antibacterial control
panafil
: keratolytic enzyme for selective debridement
Topicals for wound care:
Silver nitrate
Nitrofurazone
Sulfamylon
Panafil
Central vision loss
:
- cataracts
- macular degeneration
Peripheral vision loss
:
- glaucoma
Vision loss patterns in eye conditions:
Central vs. peripheral
athetosis
: slow, writhing, twisting
chorea
: rapid, irregular, jerky
dystonia
: sustained postures, slow and repetitive movements, cramping
Athetosis vs. Chorea vs. Dystonia
antero-inferior
: damaged axillary nerve (weak deltoids)
postero-medial
: damaged dorsal scapular nerve (weak rhomboids)
Injury due to different directions of shoulder dislocation
closed-chain functional strengthening of quads and hamstrings with emphasis on terminal knee extension
(terminal knee extension must be achieved during this stage for normal function)
Best intervention in sub-acute phase following meniscus and ACL/MCL tear (unhappy triad)
33-36 inches
Measurements of grab bars in bathroom
CAT scan
Imaging for very fine bone details, such as hardline fractures and cortical damage
development of HF; difficulty walking long distances and lymphedema
Side effects of Lyrica (pregabalin)
> 1.0 mm horizontal or downsloping
ECG: significant finding for myocardial ischemia
determines if disc with involved nerve root OR postural disorder
McKenzie's side glide test
10-meter shuttle walk test
Test for peak oxygen uptake (VO2 max)
Somatoagnosia
: impairment in body scheme; lack of awareness of body structure and relationship to other body part
Anosognosia
: denial of presence or severity of paralysis
Sensory impairment conditions
Somatoagnosia
Anosognosia
anterior, which produces posterior pelvic tilt
Patient on a ball:
Direction for abdominal contraction and associated movement
Bicycle test (van Gelderen's)
Test to differentiate between lumbar central stenosis and intermittent claudication
traction acting on a depressed and outwardly rotated scapula
Factor that contributes to subluxation and shoulder pain in hemiplegia
transverse ligament stress test
Test for C1-C2 articulation
pad placed proximal to the metatarsal heads
Best orthotic for metatarsalgia (due to compression of digital nerves at metatarsal heads)
medial
: eversion and/or pronation
lateral
: inversion and/or supination
-
anterior talofibular
: stretched in PF and inversion, usually sprained when ankle is rolled;
ANTERIOR DRAWER
-
calcaneofibular
: stretched in DF and inversion;
TALAR TILT
-
posteri
Movements resisted by the medial and lateral collateral ligaments of the ankle
anterior talofibular
An inversion sprain will damage what ligament?
(should have at least 3/5)
1) SI gapping
2) SI compression
3) thigh thrust (P4)
4) sacral thrust
5) Gaeslen's
Cluster of tests for highest diagnostic accuracy of SIJ dysfunction
during active chin tuck, the pressure in the stabilizer cuff increases to 22 mmHg and the patient can hold this position or 10 seconds
Cranio-cervical flexion test
angina of increasing intensity that is unresponsive to nitroglycerin or rest
absolute contraindication to exercise
Unstable angina
shoulder adductors, forearm pronators, elbow/wrist/hand flexors
Muscles that are typically spastic in the UE in early recovery
combination of 65+ years old plus a history of dangerous MOI:
- fall from 3+ feet/3-5 stairs
- axial load to head
- MVA collision at high speed or with rollover/ejection
Canadian c-spine rules
internal carotid
: combined ACA and MCA symptoms
anterior spinal
: contralateral hemiplegia with deviation of tongue to affected side, dysphagia, loss of gag reflex
basilar artery
(brainstem/cerebellum): contralateral/unilateral hemiplegia and ipsilateral
CVA:
internal carotid
anterior spinal
basilar
infected
: negative electrode to attract neutrophils (POSITIVE pole with silver/anode)
non-infected: positive electrode to attract macrophages and epidermal cells (NEGATIVE pole/cathode)
Positive vs. negative electrode for wound
real loss of function for the patient; symptoms real and varied, and may be triggered by stress, psychological or physical trauma
treat the same as any other patient with SCI
Conversion disorder
supranuclear palsy; corticobulbar tract
facial palsy of the muscles on the
lower half of the left side
of the face
(muscles of lower face receive input from the contralateral motor cortex, instead of CN VII)
Deficits of stroke to the
right
internal capsule
disc displacement
Condition is jaw is locking in an open position
sensory
: high frequency, short duration
motor
: low frequency, long duration
Sensory vs. motor stimulation (e-stim)
anterior
: branch of median nerve; if damaged, unable to do tip to tip sign due to
weak flexor pollicis longus
; also lateral 1/2 of dig profundus, and pronator quadratus
posterior
: branch of radial nerve; inability to extend the wrist and the thumb
Anterior interosseous vs. posterior interosseous
55-70%
left-sided CHF
ACE inhibitors
Normal ejection fraction
What condition causes low ejection fraction?
What medication is used to increase ejection fraction?
decrease ischemia (angina) through smooth muscle relaxation and dilation of peripheral vessels
Nitrates
block the effects of ACh in the stomach to decrease gastric acid (to reduce stomach ulcers)
Anticholinergic agents
10-20% (80-90% by the venous system)
Percent of interstitial fluid that is collected by a normal lymphatic system
Acute pulmonary edema
venous stasis ulcer, intermittent claudication, lymphedema
Contraindication for intermittent compression
What CAN it be used for?
prostaglandin
: protects lining of stomach by inhibiting gastric acid secretion and increasing mucous production
gastrin
: stimulates gastric acid secretion
Prostaglandin vs. gastrin
systolic decrease >20 OR diastolic decrease >10
Orthostatic hypotension
Sever's
: AKA calcaneal apophysitis; inflammation of growth plate, causing pronation and posterior calcaneal pain
Tarsal tunnel
: compression of tibial nerve, causing pain in and around the ankle and possibly into the toes; medial ankle pain with pronated
Sever's disease
Tarsal tunnel syndrome
24/30
Minimum passing score for mini mental state exam
T3
Spine of scapula is usually lined up with...
homolateral synkinesis
: mass flexion of RLE when resistance is applied to R elbow flexion
coordination synkinesis
: voluntary contraction of muscles on involved side that cause involuntary contraction of synergistic muscles
Raimiste
: involved LE abducts
- Homolateral synkinesis
- Coordination synkinesis
- Raimiste's phenomenon
- Souque's phenomenon
Radial nerve palsy
Cause of wrist drop
increase size of cathode relative to anode
(accumulation of positive ions creates an alkaline reaction, which is more likely to cause damage)
How to minimize burn during iontophoresis
thermal
: 0.5-2.0
non-thermal
: 0.5-0.75
Intensity for thermal vs. non-thermal (US)
(HCP)
1) cholecystitis
2) pancreatitis
3) hepatitis
3 conditions that cause jaundice
60+ year olds on the medial femoral condyle
rapid onset; risk with corticosteroids
Osteonecrosis most common in...
hemorrhagic stroke
(CAN use for ischemic stroke)
Contraindication of thrombolytic agents
lost achilles
due to tibial or sciatic nerve injury
steppage gait
due to fibular or sciatic nerve injury
Absence of Achilles reflex
Steppage gait
>40� = surgical intervention
25-45� = orthotic needed
Cobb angle indications
1) dissecting aortic aneurysm
2) decompensated CHF
3) third degree heart block
chronic atrial fibrillation is okay
Heart conditions that are absolute contraindications to PT
(inner layer of aorta tears, causing blood to flow inside; medical emergency)
pain in lower abdominals and low back; pain not relieved with eating
Dissecting aortic aneurysm
infant (birth-1 year): 30-60
toddler (1-3 years): 24-40
elementary (6-12): 18-30
Normal RR for children (infant, toddler, child)
effectiveness
: extend to which an intervention produces a desired outcome under usual clinical conditions
efficacy
: extent to which an intervention produces a desired outcome under ideal conditions
MCID
: smallest treatment effect that would resulting c
Effectiveness
Efficacy
MCID
cardiovascular pump dysfunction
will also have sudden onset dyspnea and crackles
terminate exercise as it is too strenuous
S3 is hallmark sign of...
hip ER during swing phase
(due to weak hip flexors)
L2 radiculopathy would cause what gait abnormality?
Normal: 15 seconds
>15 = arterial disease
<15 = venous insufficiency
Venous filling time: what indicates insufficiency?
increased IR during gait
A tight IT band would cause what gait deviation?
large
: 200-350 duration, 35-80 pps
small
: 150 duration, 35 pls
E-stim parameters for small vs. large muscle groups
Ibuprofen and aspirin
Most common types of NSAIDs
pronation
: shoulder IR and abduction
supination
: shoulder ER and adduction (past 0�)
Substitution for active forearm pronation
Substitution for active forearm supination
for high-level tetraplegia to improve respiratory capacity and increase vital capacity
Glossopharyngeal breathing
acute
: conventional TENS (sensory level stimulation)
chronic
: burst, acupuncture, and low frequency (releases endorphins by providing noxious stimulus; may not be tolerated by acute patient)
E-stim: chronic vs acute conditions
intracranial pressure monitor (takes very little to disrupt the valves and interfere with reading)
balloon catheter through the femoral artery (patient cannot flex the involved leg, so can't sit on side of bed)
More feasible: ventilator, tracheostomy, por
Devices that would most limit PT activity
PIP extension
: central tendon of extensor digitorum
PIP flexion
: flexor digitorum superficialis
DIP extension
: terminal tendon of extensor digitorum
DIP flexion
: flexor digitorum profundus
Actions of finger tendons
1) hypoproteinemia (<2 g/dL)
2) severe peripheral arterial disease (ABI <0.6)
Precautions: uncontrolled HTN, high fasting glucose (impaired sensation)
*can use, but monitor
Pneumatic compression of the LE is contraindicated for...
localized necrosis of subchondral bone, typically in patients aged 12-20
Osteochondritis dissecans
ability to feel the 5.07 monofilament
Protective sensation
reduces pressure on the MTP joint of the toe by transferring stress to the metatarsal shaft
indicated for reduced MTP extension of great toe (need
55-90�
* passive MTP extension fo terminal stance)
Metatarsal bar
new onset vomiting, lethargy, irritability, headache, and increased seizure frequency
Signs of shunt dysfunction (myelomeningocele)
blood or fluids fills the space between the sac that encases the heart, placing extreme pressure on it
- pulsus paradoxus (large decrease in stroke volume, systolic blood pressure and pulse wave amplitude during inspiration)
- distended jugular veins
- hy
Cardiac tamponade
COPD: pulmonary function test (spirometry)
CAD: exercise testing
Progression testing of COPD vs. CAD
moving into D1 flexion (flexion, adduction, ER)
PNF pattern to roll from supine to sidelying
e-stim
: large (type 2 fast twitch) fibers first
physiological
: small (type 1 slow twitch) fibers first
Physiological vs. electrical contractions: order of fiber activation
poor
(2/5): only in prone (reduced gravity)
fair
(3/5): can do 1
good
(4/5): can do 2-24
normal
(5/5): can do 25+
Grades of heel raises
-
resonance
(low pitch, hollow; heard over lungs)
-
tympany
(high pitch, hollow; heard over the air-filled bowel loops in stomach; abnormal in chest, which could indicate pneumothorax)
-
dullness
(heard over fluid or solid organs; will be heard over lungs
Types of medical percussion sounds
HOB cannot be lower than 30� due to risk of aspiration
Rule for bed position with nasoteric tube
aquatic therapy (inability to adjust to fluid loss during immersion)
Contraindication for severe kidney disease
Normal pelvic angle: 30�
PSIS should be slightly higher than ASIS
If they are even, posterior pelvic tilt is occurring (tight hamstrings)
Normal pelvic angle and location of ASIS/PSIS
shoulder ER
(creates a values stress at the elbow)
active wrist motions and gripping activities are encouraged
Contraindication 1 week after UCL reconstruction at the elbow
- Bedridden (3+ days; or major surgery with anesthesia within last 12 weeks)
- Edema (pitting)
- Non-varicose collateral superficial veins
- Cancer (active or within 6 months)
- History of DVT
- 3+ cm of swelling on affected leg
- Paralysis, paresis (or r
Well's criteria for DVT
basal cell
: irregular/rolled borders, flaky skin, red
melanoma
: larger than 6 mm, irregular borders, dark/black
angioma
: small (<3 mm), bright red, smooth borders
squamous
: poorly defined margins; flat red area (sun exposure)
Basal cell
Melanoma
Angioma
Squamous
1) lung fibrosis
2) atelectasis
3) pneumonectomy
Conditions in which the trachea will deviate to the SAME side as the condition
(usually pushed AWAY, going into the area of less lung volume)
Spinocerebellum
: limb ataxia, such as dysmetria
Cerebrocerebellum
: distal limb function, including timing and coordination of voluntary movements to produce fluid movements
Vestibulocerebellum
: visual and vestibular; eye moves and postural control
Spinocerebellum
Cerebrocerebellum
Vestibulocerebellym
Coracoclavicular
: stressed with passive horizontal adduction
Coracohumeral
: limits flexion and extension
Inferior
: tension with abduction, extension, ER
Superior
: tension with inferior and anterior translations of humeral head
Shoulder ligaments:
Coracoclavicular
Coracohumeral
Inferior GH
Superior GH
2-3.5
too high = excessive anticoagulation/bleeding
Normal INR
C6
SCI level to do independent rolling in bed
planted DF with ER of the lower leg
1) fibular translation test
2) ER test
3) distal tibfib compression test
MOI of high ankle sprain and 3 tests
high toe box
(allows more space, less irritation)
Modification for hammer toes
high-volt pulsed current, 100 pps
(100 pps is continuous and comfortable; promotes healing)
Current used for wound healing
low occlusion/high absorption
:
- gauze
- alginate
- foam
- collagen
high occlusion/maintains moisture
:
- impregnated gauze
- hydrogels
- hydrocolloids
- transparent films
Wound dressings:
Low occlusion (more absorption)
High occlusion (maintains moisture)
check for groin pain triggered by
anterior
impingement (IR/adduction while hip is flexed to 90�)
How can you test for SCFE?
RA
: bilateral symptomatic joints, often first in wrists and hands; hallmark sign is ulnar drift
OA
: often in hands, but not bilateral at onset nor present in multiple joints
RA vs. OA: joint involvement
lower
: prone, FOB up 18"
right middle
: supine, FOB up 12"
anterior
: supine, FOB up 18
Lower lobes
Right middle lobe
Anterior lobes
systematic review
: secondary analysis of individual studies with similar characteristics to create a combined conclusion
meta-analysis
: aggravation of raw data from multiple studies to increase sample size and generate conclusion based on larger populat
Systematic review vs. Meta-analysis
- night pain
- urinary incontinence
- severe abdominal pain
(medical emergency!)
Signs of cauda equina
CHF
Manual lymphatic drainage is CONTRAINDICATED for what condition?
increased: consolidation
decreased: deflated lung tissue, such as atelectasis, pleural effusion, pneumothorax
When does a patient have positive egophony?
What will cause decrease in voice sounds?
attachment of semitendinosus and sartorius; anteromedial, just distal to the joint line
stretched with extension and valgus; pain with active knee flexion
Pes anserine
Radial
What nerve is involved in de Quervain?
ramp
: 12 inches for each inch of rise
threshold
: no higher than 0.5 inch
width
: 32 inches
opening space
: 5x5 feet (with door that swings towards patient)
WC accommodations:
- ramp length
- thresholds
- doorway width
- doorway opening space
commonly post-surgical (commonly THA)
includes dyspnea, chest pain, cough, apprehension, and tachycardia
Signs of pulmonary embolism
Provides posteriorly directed force to resist knee flexion during stance
Function of a GRAFO
PaO2
: 80-100
- if low, chest percussion will help ventilation
Pulmonary artery
: 5-15 mmHg
- NO if too low
Intracranial pressure
: 0-10 mmHg for adults; 0-5 mmHg for children under 6
- NO if too high
Platelets
: NO if below 20,000
Normal (and whether percussion is contraindicated):
- PaO2
- Diastolic pulmonary artery pressure
- Intracranial pressure
- Platelets
osteopenia: -1 to -2.5
osteoporosis: > (-2.5)
T-scores: osteopenia vs. osteoporosis
1) pubococcygeus
2) iliococcygeus
3) puborectalis
Levator ani muscles
(which can compress the urethra, vagina, and rectum to maintain continence)
DIP joints
Psoriasis will typically affect what joints?
CS
: irregular respiration pattern characterized by period of apnea followed by gradually increasing depth of respirations
(coma, BG disease, sometimes CHF)
Biot
: irregular respiration pattern characterized by highly variable respiratory depth and interm
Cheyne-Strokes respiratory pattern
Biot respiratory pattern
Transient synovitis
: younger children; antalgic gait that is worse with IR and abduction; occurs after a viral infection, which travels to the hip joint
Trochanteric bursitis
: 40-60 years; lateral hip/thigh pain aggravated by lying on involved side; pai
Transient synovitis
Trochanteric bursitis
Femoral stress fracture
- patient with recent head trauma
- spinal fusions
CONTRAINDICATED drainage of posterior lower lobes (FOB lifted)
acute monoarticular arthritis with redness and swelling, most commonly affecting the knee and 40-50 year-old men
Gout
fever, tachycardia, tachypnea, confusion
Symptoms of sepsis
1.2-2 inches (3-5 cm)
Normal diaphragmatic excursion
patient's pain is relieved with hand is on top of their head; indicates disc lesion at C4-C5
Bakody sign
lateral shoulder pain, pain with overhead activities, painful arc
Signs of shoulder impingement
continuous, monophonic high-pitched crowing noises during inspiration only due to upper airway obstruction
Stridor
direct current, 3-4 milliamperes
(will NOT used pulsed current for iontophoresis)
Iontophoresis parameters for tendonitis
vital capacity of 1 liter or less
Aquatics is CONTRAINDICATED for what respiratory issue?
CHRONIC hypoxemia, such as pulmonary fibrosis
Indication of clubbing digits
liver flap disease, usually due to ammonia imbalance
jaundice, dark urine, ascites
Asterixis
UMN disorder
Pronator drift is a sign of what?