MSK II final exam

thoracic outlet syndrome

thoracic outlet syndrome

Group of disorders that results in pain and other symptoms in the shoulder, arm, and neck due to compression of nerves or blood vessels below the clavicle

neurogenic TOS

most common type of thoracic outlet syndrome

Roo’s Test

test for TOS

aka EAST

venous TOS

• Asymetrical upper extremity edema

• Pain in the chest

• Cyanosis

• Cyanosis

• Fatigue, feeling of heaviness

• Venous engorgement

• Visible veins compared to non involved side

neurogenic TOS

• Pain, paresthesia

• Headaches

• Decreased dexterity

• Cold intolerance

• Color changes/sympathetic over activity

arterial TOS

• pain in hand

• Pallor

• Coldness

• Dead arm

• Can be fatal

treating TOS

symptom control, specific postural control exercises, general maintenance exercises

primary bone healing

occurs with a reduction without a callus formation where there is <2% strain on fx

secondary bone healing

occurs with fixation devices and a fracture healing where there is 2-10% strain

includes a callus

endochondral ossification

the most common type of fracture healing

hematoma stage

• 1st 24 hours: 

  • fibrin blood clot

  • stability/immobilization is crucial during callus formation during hematoma

  • cast/splint, internal and external fixators

inflammatory stage

• 1st 24 hours to 1 wk

  • Hematoma forms, fibroblast migrate to the fracture site and osteoblasts.

  • Fibroblasts proliferate

  • Fractures are immobilized during phase I

Repair stage

•  1-6 weeks

  • Callus forms (2-3 wks)

  • Soft callus converts to hard callus (4-6 wks)

  • The stiffer the mobilization a lesser amount of callus will form

  • Flexible immobilization allows for an abundant callus creating endochondral ossification

Remodeling

 extra-articular matrix undergoes calcification

Wolf’s Law

bone remodels in response to mechanical stress

4-6 weeks

how long the pt should be immobilized after a fracture

displaced

a bone breaks into two or more pieces and moves out of alignment

non-displaced

the bone breaks but does not move out of alignment

closed

the skin is not broken

open

the bone has broken through the skin

transverse

broken piece of bone is at a right angle to the bone’s axis

linear

the break is parallel to the bone’s long axis

oblique

the break has a curved or sloped pattern

spiral

one part of the bone has been twisted at the break point

greenstick

an incomplete fracture in which the bone is bent; occurs most often in children

comminuted

the bone break into several pieces

avulsion

when fragment of bone is separated from the main mass

pathologic

caused by a disease that weakens the bones

stress

a hairline crack

bone healing factors

• Lack of vitamin D and calcium

• Diabetes: decreases cellularity of fracture callus

• Nicotine: inhibits growth of new blood vessels during remodeling

• HIV: higher rate of fragile bones, delayed healing

• Medications: bisphosphonates, systemic corticosteroids, NSAIDs

Fracture complications

• Joint stiffness

• Tendon adhesion

• Chronic regional pain syndrome

• Open fractures: infection/including osteomyelitis

4-6 weeks

about how long it takes for a fracture to fuse

non displaced and stable

managed by protection alone

non displaced but unstable

requires positioning and immobilization in cast or fracture brace

functional capacity exam

• assesses the client with standardizes and validated tools to determine job needs and/or accommodations

  • Subjective

  • ADL review

  • Other medical problems

work conditioning

rehab to restore functional work tasks (2-4 days/wkly)

work hardening

multidisciplinary approach to progress client to return to work activities (5 days/wkly)

malingering tests

abductor and hoover’s test

ergonomics

posture and the position of equipment in the work environment are the largest contributing factors to injuries 

cycle

how much time to do one cycle

repetitive

less than 2 minute cycle time

highly repetitive

cycle time less than 30 seconds

fundamental cycle

what the cycle involves

1-1.5 hours

breaks should be taken after this amount of continuous compute use

sternal precautions

no pushing, pulling, or lifting arms x 12 weeks

use pillow when coughing

keep your move in the tube

rate of perceived exertion scale

contraindications for therapy

• Abnormal vital

• Abnormal labs

• Up-trending troponins

• Femoral access continuous renal replacement therapy

• Femoral intra-aortic balloon pump

• Chest pain

• Active bed rest orders

• Inability to actively participate in therapy session

normal blood pressure

systolic: less than 120

diastolic: less than 80

endurance

the ability to sustain an activity over time

a physiological factor

MET

energy expanded during an activity

equals 3.5 mL of oxygen per kg of body weight per minute

1 MET

approximately equivalent to oxygen uptake a person requires at rest

light intensity

1.0 to 2.5 METs

moderate intensity

3.0 to 5.9 METs

vigorous intensity

6.0 METs or more

HR max

220-age

Heart rate reserve

HR max- HR rest

HR target

(HRR x desired % intensity) + HR rest

fatigue

• the enduring subjective experience of generalized tiredness or exhaustion

  • Not a physiological factor

  • Multidimensional

    • Includes cardiovascular, emotional, behavioral, and cognitive components

beta blockers and calcium channel blockers

regulate heart rate and blood pressure

client’s heart rate and blood pressure may not change significantly during exertions

radiation therapy

• Uses beams of high energy particles to kill cancer cells or slow growth

• Can be external or internal

chemotherapy

• Systemic drug treatment that travels through the bloodstream to kill cancer cells

• Given through IV, shot, oral pill, topical, etc

surgery

Removing the cancer mass or debulking

immunotherapy

• Treatment that helps your immune system fight cancer using biological substances

• Immune checkpoint inhibitors, T-cell transfer therapy, vaccines

neoadjuvant

treatment given as a first step to shrink a tumor before the primary treatment (i.e. surgery)

adjuvant

additional cancer treatment given after the primary treatment to lower the risk that the cancer will come back

radiation fibrosis

scar tissue due to damage from radiation therapy

• Causes stiffness, skin changes, ROM deficits, pain, weakness

• Most common in the first 2 years post treatment

• Can occur up to 10 years after therapy

Chemo induced peripheral neuropathy

Damage to peripheral sensory, motor, and autonomic neurons caused by neurotoxic antineoplastic agents

lymphedema

tissue swelling caused by accumulation of protein rich fluid

head and neck cancer

highest cancer location for lymphedema

complex regional pain syndrome

• Mechanism is not completely understood

• 90% of cases are triggered by injury involving nerve damage

• Most common precipitating conditions

  • Fractures

  • Surgery

  • sprains/strains

  • Burns or cuts

  • Penetration

Type 1 CRPS

injury that does not have apparent damage to nerves

previously known as reflex sympathetic disorder

Type II CRPS

damage to peripheral nerve apparent or identified

previously known as causalgia

stage 1 of CRPS

• acute 

  • Burning pain, sweating, tenderness, possible patchy bone thinning on x-ray

stage II of CRPS

• dystrophic (3 to 6 months)

  • Skin changes (shine and/or thickened), contractures and pain

stage III of CRPS

• atrophic

  • Loss of motion and function, contractures and thinning of skin

grade I and II

joint mobilization levels for treating CRPS

joint mobilizations

moving joints in specific directions and at different speeds to regain movement (recommended to follow with stretching)

soft tissue indications

>improve tissue extensibility

>promote relaxation

>decrease edema

>modulate pain

>reduce soft tissue movement restrictions

joint mobilization indications

>increase ROM of joint complex

>mobilize joints

>modulate pain

>reduce capsular movement restrictions

>decrease muscle spasms, decrease guarding

grade I

oscillates for pain

grade II

distract combined with a glide taking up slack in the joint

grade III

distract combined with a glide, passive stretch at the end range

rigid tape

tape used to correct a position

elastic tape

tape used for pain management

type 1 diabetes

when the pancreas is unable to create insulin

type 2 diabetes

when cells become insuline resistant

COPD

chronic progressive lung syndrome characterized by airflow blockage and breathing related problems

>includes emphysema and chronic bronchitis

reverse TSA

surgery that is chosen when the pt has a torn rotator cuff injury

anatomical TSA

surgery chosen when the rotator cuff is intact

anatomical TSA precautions

limit resisted shoulder internal rotation and passive external rotation

reverse TSA precautions

limit combine shoulder extension, adduction, and internal rotation

ORIF

gold standard surgery for a clavicle fracture

Colle’s fracture

dorsal displacement of distal radius

Smith’s fracture

volar displacement of distal radius

TWA

remove joint and cut away damage

insert prosthesis

(of the wrist)

TWF

 tendons and ligaments are moved to the side

-articular cartilage removed from each joint being fused

-bone graft is placed between each spaces in wrist bone

hip fracture

number one cause of this is a fall

anterolateral hip precautions

do not roll surgical leg outward

osteoarthritis

main cause of TKA

total elbow arthroplasty

damaged part of the humerus and ulna are replaced with artificial components