Therex Exam 2

What is plantar fasciitis?

Pain in the bottom of the foot near the heel or along the arch

What is achilles tendinopathy?

pain and stiffness along achilles tendon- symptoms improve with activity and then worsen

Which soft tissue injury at the ankle would commonly occur with starting and stopping quickly (strong contraction of gastroc-soleus?

achilles rupture

Which soft tissue injury to the ankle/foot results in pain along the anterior tibial region?

anterior shin splints

Which soft tissue injury to the ankle/foot results in pain along the instep or posterior medial tibial region?

posterior shin splints

which sprain is the most common ligament injury in the ankle?

inversion sprain

what is the most common ligament injured within the ankle?

ATFL

a grade three ankle sprain means..

complete rupture of ligament

a grade one ankle sprain means..

stretching or light tearing of ligament

What is the acronym for the most recommended method to be used in the acute phase of healing of an ankle sprain?

PRICE

What is a lisfranc injury?

injury that involves the bones and ligaments of the midfoot

are OKC or CKC exercises recommended for arthritis of the ankle of the foot and why?

closed chain because it reduces shearing forces

What is gout?

inflammatory arthritis caused by deposition of uric acid crystals in joint synovial fluid

what is the most common cause of a gout flare?

alcohol consumption

What is another word for arthrodesis?

fusion

what is the main drawback to an ankle/foot arthrodesis?

higher risk of developing arthritis at adjacent joints after a fusion because the mobile joints compensate for lack of movement at fused joints

What is a high ankle sprain?

injury to the tibiofibular ligaments, interosseous membrane

What is the windlass effect?

extension of the great toe that occurs at push-off, stretches the plantar fascia

what is the ROM of great toe needed for normal gait

60-70

describe a pronated foot

flexible, absorbs shock during weight bearing

describe a supinated foot

more rigid, provides rigid lever for push-off

what do the intrinsic foot muscles do?

support the arch and assist with balance

What is the screw home mechanism?

lateral tibial rotation that occurs the last 20 degrees of knee extension to lock the knee

Describe patellar malalignment?

resting position of patella- can be laterally tilted, rotated, laterally displaces

what are common symptoms of patellofemoral pain syndrome?

pain behind the patella or adjacent area, crepitus, increased pain with stairs/squatting, movie-goers knee

what exercises should you avoid in patients with PFPS?

OKC exercises in 0-45 flexion and CKC exercises in 45-90

what is chondromalacia?

softening of patellar cartilage

what is patellar tendonitis (jumpers knee)?

inflammation of patellar or quadriceps tendon, typically occurs from overuse

What is IT band friction syndrome?

irritation of ITB as it crosses femoral condyle

What is osteochondritis dissecans?

bone/cartilage separates from patella or femoral condyle, d/t poor blood supply/ repetitive stress

What is osgood schlatter disease?

occurs during adolescence due to overuse or rapid growth, commonly in athletes

what is someone with osgood schlatters at risk of developing?

tibial tubercle avulsion fx

T/F someone with genu valgum is at risk of developing OA of the knee

False- genu varum

What is rheumatoid arthritis?

inflammatory, systemic autoimmune disease that effects the connective tissue, symmetrical&bilateral

What are the exercise parameters for RA?

lower reps/sets/resistance but perform more often during the day

What is the difference between cemented vs cementless arthroplasties?

WBAT w cemented & PWB/TTWB w cementless

What is the ROM goal s/p TKA day one?

0-90

what is the ROM goal s/p TKA weeks 3-8?

0-110

what is the most commonly injured ligament in the knee?

ACL

What is the mechanism of injury for an ACL tear?

blow to lateral side of the knee, tibia is ER on planted foot, forceful hyperextension

What is the difference between an allograft and autograft?

allograft (cadaver) & autograft (own body)

how long must you protect an ACL graft for post surgery?

up to 12 weeks

What are the exercise precautions s/p ACL reconstruction?

avoid CKC >60 flexion & OKC between 0-40 extension for up to 6 weeks

What is the mechanism for injury for PCL tears?

blow to the tibia in a flexed position (dashboard injury), fall on flexed knee with foot PF, forceful hyperflexion

T/F the MCL resists varus forces

false- valgus

T/F the LCL resists varus forces

True

What is the terrible triad?

partial or full tear of ACL, MCL, and medial meniscus

T/F the MCL is often left on its own to heal in a terrible triad injury

True

T/F the meniscus has good vascular supply so that means it'll heal better

False- means it will have poor healing

Is a the lateral meniscus torn more or the medial?

medial

What is extensor lag?

lack of active knee extension at end range d/t weak quads

Which arthroplasty technique is most commonly used with the elderly or less active patients?

cemented

Will someone with coxa valga have a leg that appears longer or shorter?

longer

what is the normal Q angle at the hip?

125 degrees

What will occur due to femoral neck anteversion?

toe in posture (greater troch is ant)

what will occur due to femoral neck retroversion?

toe out (greater troch is post)

What occurs d/t OA?

hypomobility

what changes are associated with hip/knee OA?

articular cartilage breakdown, capsular fibrosis, and osteophyte formation

What are common symptoms associated with hip/knee OA?

pain and difficulty with WB, gait deviations, stiffness after prolonged sitting, ROM restrictions

T/F you ALWAYS work on ROM even if it doesn't prevent FUNCTION

False

T/F you NEVER introduce an AD to a pt who has an antalgic gait pattern

False- can prevent long term gait deviations and further injury

What is an osteotomy?

reshapes bone to improve alignment/stress on joint

What does an hip arthroplasty surgery entail?

remove damaged bone and insert metal cap and socket

What is a hip hemiarthroplasty?

only the femoral head is replaced

what are the contraindications for a THA/THR?

active infection, inadequate bone stock after resection, paralysis of muscles around hip joint

What are the indications for THA/THR?

severe OA with pain interfering with ADLs, hip dysplasia, bone tumors, failure of previous

What are the three THA precautions?

no hip flexion past 90, no crossing midline, no rotation

what are PT interventions s/p THA day one?

ankle pumps, bed mobility, transfers, gait training with SW, patient/family education (no pillows under knee), AAROM

What are common signs and symptoms of hip fractures?

pain in groin or hip region, pain with movement, pain w WB, involved LE can be shorter with ER posture

Which patient population is hip traction commonly used for?

non-ambulatory or medically unstable

What is ORIF?

Open reduction and internal fixation- used to realign broken bones and stabilize with metal hardware

T/F the labrum in the hip will have poor healing d/t place in the body

False- d/t poor vascular supply

Which pathology in the hip is characterized by pain in hip or groin, locking/clicking/catching sensation, and stiffness or decreased ROM

labral tear

Which painful hip syndrome is characterized by pain localized to lateral hip and thigh associated with prolonged asymmetrical standing

trochanteric bursitis

Which painful hip syndrome is characterized by pain localized to anterior thigh or groin

psoas bursitis

What is FAI?

Femoral Acetabular Impingement- change in shape in the surface of the hip joint

T/f research shows that increasing IAP will unload compressive forces on the spine and stabilize it

True

How can you verbalize to your pt how to contract pelvic floor?

draw it up as if youre trying to stop the flow of urine

T/F Patients should hold their breath while bracing their core

False- this can cause an increase in BP

Define static posture

body is maintained in fixed position and not moving

define dynamic posture

position of the body when moving

What are the three natural curves of the spine?

cervical, thoracic, lumbar

describe an anterior pelvic tilt

increased lumbar extension (lordosis)

describe a posterior pelvic tilt

reduced lumbar lordosis (flat back)

T/F the lumbar curve increases with slouching and further increases disk pressure

False- lumbar curve decreases

T/F prone best aligns the spine and unloads

False- supine

define kyphosis

excessive flexion of thoracic spine

what would a right lateral pelvic tilt result in

left side bending of lumbar spine

what would left lateral pelvic tilt result in

right side bending of lumbar spine

what is the difference between structural and functional scoliosis?

structural- deformity that is irreversible, nonstructural- not structural and can be changed and corrected based on cause

a forward head posture can lead to..

tighter upper trap, levator, sub occipitals, and pecs

Thoracic kyphosis or hunch back posture can lead to..

protracted/winged scapulae, posterior pelvic tilt, lengthened and weak scap stabilizers

a flat back posture can lead to..

flat lumbar spine, hip and knees extended, lengthened hip flexors, shortened glute max/hamstrings

a sway back posture can lead to..

pelvis sways forward, hip extended, knees hyperextended, COG is shifted backwards, weak glute max

What is the best way to sit based on ergonomics?

line of vision perpendicular to monitor, feet flat on floor, 90 degree bend at knees, relax shoulders, arms at 90 degrees, keep often used items close, keep lower back supported

What are three methods to posture treatment?

postural alignment, ROM, joint mobility, educate in ergonomics/body mechanics, strengthening to hold and sustain correct posture

What exercise could you do for a patient with lateral knee pain and a trendelenberg gait d/t weak abductors

lateral step ups

which exercise puts the most strain on an ACL?

LAQs

What is a way you can regress treatment for a pt that comes in and complains of acute inflammation?

isometrics, review HEP, educate on PRICE

T/F You would do PROM for inflammation reduction, comatose pt, medical restrictions/surgical protocols and NOT for limited ROM

True- it would be considered a stretch