726 Final- Exam 1 Content Condensed

A SANE score of ≤ _____% is a risk factory for injury

92

What 3 things do PTs need to do prior to d/c to reduce re-injury risk?

-return symmetry

-achieve or exceed population norms

-identify and normalize risk factors for future injury

What is the cutoff for a fail on the PSET (horizontally abducted position) for females? Males?

46 s; 47 s

A fail on the PSET is associated with what diagnosis?

SAIS

What is the gold standard strength test that can measure strength, power, and endurance?

isokinetic testing; ICC .91-.96

Grip strength should be strongest when the shoulder is in _____ degrees of flexion

180

What tests can be used to assess closed kinetic chain stability?

CKCUEST, YBT UQ

What is the normative value for males and females on the CKCUEST?

21 touches males; 23 touches females

Which closed kinetic chain stability test requires CKC UE and core motor control near the limits of ROM?

YBT UQ

The YBT UQ tests limits of CKC stability in what 3 positions?

medial, inferolateral, superolateral

What are the common faults on the YBT UQ?

-shoving the reaching indicator

-touching down with the hand

-hand on top of stance plate

-not maintaining both feet in contact with the floor

You are planning to discharge your patient today. You have performed the FMS and are considering running them through the YBT-UQ. FMS scores are as follows:

Shoulder mobility R: 2

Shoulder mobility L: 1

Trunk stability push up: 1

Is this patient appropriate for the YBT-UQ? Why or why not?

No, shoulder mobility and TSPU are < 2

Your patient performed the YBT-UQ.

These are their results:

Medial reach: 2.5 cm

Inferolateral reach: 3.2 cm

Superolateral reach: 2.0 cm

Are these findings WNL?

Yes, all findings

Upper Body power testing includes:

seated med ball throw (ICC 0.98), unilateral shotput test, one arm hop test

For the USPT, _____% strength of the nondominant arm is considered a good standard for discharge

10

How to calculate composite reach distance on the YBT UQ?

( (medial + inferolateral + superolateral) / 3x limb length )) x100

MMT finding: strong and painless

Indication?

no lesion

MMT finding: strong and painful

Indication?

minor lesion in a part of the muscle or tendon and its attachment

MMT finding: weak and painless

Indication?

there could be a complete rupture of the muscle or tendon, but most commonly might be a malfunction of the nerves

MMT finding: weak and painful

Indication?

serious impairment. however, if a patient is reluctant to replicate the severe pain it may appear as apparent weakness

Tissue type: muscle

Range of time for healing?

2-4 weeks

Tissue type: tendon

Range of time for healing?

4-6 weeks

Tissue type: bone

Range of time for healing?

6-8 weeks

Tissue type: Ligaments

Range of time for healing?

10-12 weeks

Tissue type: cartilage

Range of time for healing?

~12 weeks

Tissue type: nerve

Range of time for healing?

3-4 mm/day

Initial rehab after a bone fracture focuses on-

normalizing movement in regions around the fracture site

Sprain refers to ______ injury while strain refers to _______ injury

ligament; muscle

Grade 1 Ligament sprain:

mild; no swelling but bruising present

Grade 2 ligament sprain:

Moderate; small tear, significant amount of swelling

Grade 3 ligament sprain:

complete tear, no stability, requires surgery to repair

Cervical protraction occurs with UPPER cervical _____ and LOWER cervical _______

extension; flexion

Cervical retraction occurs with UPPER cervical _____ and LOWER cervical ______

flexion; extension

What manual therapy should be used for an upper cervical flexion mobility dysfunction?

Bilateral OA joint mobilization

What manual therapy should be used for an upper cervical rotation mobility dysfunction?

AA joint hold relax PNF

A LEFT cervical side glide would improve which 2 motions?

RIGHT sidebending and rotation

When performing a 1st rib MET for RIGHT 1st rib hypomobility, the patient should sidebend into your _______ hand and your ______ hand should rest on the 1st rib

left; right

You are evaluating a patient with neck pain. While performing a joint mobility assessment, you find flexion hypomobility at the C5-C6 Segment. You should peform a CPA mobilization to the spinous process of _____

C5

To improve lower cervical flexion mobility, perform a CPA of the _____ segment

upper

To improve lower cervical extension mobility, perform a CPA of the _____ segment

lower

You are evaluating a patient with neck pain. While performing a joint mobility assessment, you find extension hypomobility at the C5-C6 Segment. You should peform a CPA mobilization to the spinous process of _____

C6

Your patient demonstrates LEFT sided lower cervical rotation and sidebending mobility dysfunction at C4-C5. You can perform a UPA on the RIGHT facet of _____ to open it

C4

Your patient demonstrates LEFT sided lower cervical rotation and sidebending mobility dysfunction at C4-C5. You can perform a UPA on the LEFT facet of _____ to close it

C5

_______ occurs with temporary loss of motor and sensory and motor function due to blockage of nerve conduction

neurapraxia

True or False:

In neurapraxia,

The axons, epineurium, perineurium, and endoneurium are intact with no real evidence of nerve damage

True

What are the causes of neurapraxia?

herniated or bulging disc, soft tissue entrapment of a peripheral nerve

In ______, the axons and their myelin sheath are damaged but the endoneurium, perineurium, and epineurium remain intact

axonotmesis

Which 2 classifications of peripheral nerve injury cause wallerian degeneration distal to the injury?

axonotmesis and neurotmesis

What does recovery look like for axonotmesis?

Recovery is spontaneous, nerve can regenerate at a site distal to the lesion at 1mm/day

In _____, both the nerve and sheath are disrupted and the entire axon is severed

neurotmesis

What are the symptoms of neurotmesis?

flaccid paralysis and muscle wasting, total loss of sensation to the area supplied by the nerve

True or False:

Neurotmesis is irreversible but there is a possibility of proximal recovery with surgery

True

If an entire dermatome is diminshed or absent, the patient likely has a _____ lesion

central

If there is diminished or absent senesation in a patchy distribution, the patient has a _______ lesion

peripheral

If you test a muscle along the same myotome but a different peripheral nerve, and it is WEAK, the patient has a ______ lesion

central

If you test a muscle along the same myotome but a different peripheral nerve, and it is STRONG, the patient has a ______ lesion

peripheral

What is a peripheral mononeuropathy?

Single nerve damage due to compression or ischemia

TOS is an example of what kind of nerve entrapment?

peripheral polyneuropathy

A peripheral polyneuropathy causes what kind of sensation loss distribution?

stocking glove

In a peripheral polyneuropathy, weakness is worse _____

distally

Entrapment of a _______ causes dermatomal deficits, weakness in a myotomal pattern, and decreased deep tendon reflexes

spinal root

Fractures of the humeral neck, inappropriate use of crutches, and anterior shoulder dislocation cause _______ nerve injury

axillary

Fracture of the CLAVICLE causes injury to which peripheral nerve?

musculocutaneous

A spiral fracture of the mid humerus causes injury to which peripheral nerve?

radial

_____ is used to evaluate the scope of a neuromuscular disorder through the assessment of muscle activity

EMG

Describe the procedure for an EMG

1. needle electrode inserted into muscle associated with the nerve being assessed

2. neurologist tells you when to contract and reset the muscle

3. needle records muscle activity during movement and at rest

Insertional irritiability should last for -

a few milliseconds

A normal relaxed muscle should exhibit _____

electrical silence

Fasciculations on EMG indicate

degeneration of anterior horn cells, nerve root compression, or muscle spasms

Describe the process of an NCV test

1. stimulating electrodes placed on skin over the course of a nerve

2. recording electrodes placed over the muscle the nerve controls

3. low level shock applied through stimulating electrodes

4. recording electrodes measure speed of impulse

5. impulses appear as waves on the monitor

How is conduction velocity calculated in NCV?

Conduction distance / (proximal - distal latency)

______ latency is the time between stimulation and muscle contraction

response

An H reflex that is too FAST indicates _____ lesion; too SLOW indicates a _______ lesion

UMN; LMN

Normal conduction velocity for both the UEs and LEs is _____ m/sec

60

A normal H reflex falls within +/- _____ msec

5

True or False:

EMG and NCV are always diagnostic in isolation

FALSE

What structures make up the interscalene triangle?

anterior scalene, middle scalene, 1st rib

TOS entrapment may occur in what 3 locations?

scalenes, 1st rib, pec minor

Vascular signs and symptoms of TOS include

swelling throughout UE

subjective report of heaviness, fatigue, weakness

throbbing in chest, neck, shoulder

cyanosis

difference in BP side to side >10 mmHg diastolic

entrapment at the ______ will likely not have vascular s/s

scalenes

There will be prominent vascular s/s with entrapment at which 2 locations?

first rib and pec minor

Neurological s/s of TOS include-

-N/t usually in ulnar nerve distribution

-stocking glove sensory presentation

-atrophy of hand intrinsics

-fine motor skill difficulty

-stabbing, burning, electric pain

Name the TOS test item cluster

Hyperabduction

Wright

Adsons

Roos

Tinels

The hyperabduction and Wright tests are positive for -

a change in the radial pulse

The wright test is the same as the hyperabduction test, with the addition of-

cervical rotation to the UNAFFECTED side

If a patient is positive on the Wright test and not the hyperabduction test, they most likely have entrapment in which location?

scalenes

The Roo's test is trying to compress the -

1st rib

The Roo's test is positive for -

symptom reproduction

Which TOS test is described below?

Patient sits with arms in 15 degrees abduction

Patient inhales deeply, holds breath, tilts head back and rotates TOWARDS the examined side

Adson's

The Adson's test is positive for -

paresthesia, radial pulse occlusion, symptom reproduction

In the Tinel's test, the examiner taps what location?

supraclavicular fossa

Cervical Flexion ROM: normal value?

40°

Cervical Extension ROM: Normal Value?

50-70°

Cervical Lateral Flexion: Normal Value?

22 degrees

Cervical Rotation: normal value?

50-90°

NDI: MDC cervical radiculopathy?

10.2-13.4

NDI: MDC Mechanical neck pain?

3.5-7.5

NDI: MCID cervical radiculopathy?

7.0-8.5

NDI: MCID mechanical neck pain?

3.5-7.5

What are the HIGH risk factors in the canadian c spine rules?

-age ≥65

-dangerous mechanism

-paresthesias in extremities