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Biomechanical Final

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anskorczewski12's version from 2017-05-07 18:51

Shoulder Complex

Question Answer
joints of the shoulder1.glenohumeral 2.scapulothoracic 3.sternoclavicular 4.acromioclavicular
scapulohumeral rhythm1:2 (for every 2 degrees humerus moves, scapula moves 1 degree)
referred pain to elsewhere in the bodytrigger points (scalenes commonly have them to the shoulder)
thoracic outletpathway for neural and vascular structures (mostly neural issues tho), 4 regions, brachial plexus goes through and can get impinged
presentation of impingement of brachial plexus/thoracic outlet syndromect. complains of arm and hand pain, paresthesias, weakness, doesn't follow peripheral and dermatomal patterns, intolerane of overhead activities, dropping objects, cramping of hand intrinsics while writing, walking with "dead arm", intolerance of shoulder straps
interventions for thoracic outlet syndrome(want space, motion, minimal sustained tension), breath without secondary muscles, sleep position, restrict some motion (decrease irritation), posture, scapular proprioception training (visual feedback), nerve gliding, muscle stretching (scalenes and pec)
pendulum exercises may be contraindicated if...UE is edematous
what roots supply shoulder complexC4-C7
common trigger pointsscalenes, trapezius, levator scapulae
when to introduce resistance (in open and closed chain exercises or manual resistance) post fracture8-12 weeks- start with isometric and AAROM, and then to isotonic
common m.s impinged in shoulder areasupraspinatus m., long head of biceps
calcificchronic microtears trying to heal may cause this (issue with tendonitis around rotator cuff)
ways to treat tendonitispain modalities, activity modification (decrease abnormal forces), strengthening (isotonic, resistive, chains), occupation-specific training (decrease stress)
how to know if rotator cuff issue is bursitisfeel pain during passive shoulder elevation (not active)
special tests for rotator cuff tear evaluationNeer impingement, Hawkin's, empty can, drop arm, biceps speed's
treatment of rotator cuff tears (nonsurgical)pain & inflammatory modalities, educate about activity modification, don't sleep with arm above shoulder level/in adducted IR position-pain free ROM (start with PROM to AROM), strengthen scapula at RC-
treatment of rotator cuff tears (with surgery)(24 hr.) treat pain, PROM or AAROM (pendulum), ice, teach activity adaptation, immobilize shoulder between activity (4-6 wks) AROM (6 wk) strengthening isometric (8 wk) isotonic bands and weights, above shoulder activities (12 wk) resistive occupational tasks
when can you bear weight on shoulder after fracture6 months
progression of treatment after shoulder arthroplasty(2-3days) pendulum, PROM (1-2 weeks) passive movements (4-5 weeks) AROM isometric strengthening
asischronic condition
progression of treatment after shoulder fracture(1-4 weeks) sling, (4-6 weeks) AROM, gripping exercises, stretches (6-8 weeks) isometric, non resistive (8-12 weeks) open chain
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Trunk and LE Orthopedics

Question Answer
role of OT in acute stage of orthopedicspain, decrease swelling, wound care, maintain jt and limb alignment, restore function at injury site, teach pt. safe performance for healing
role of OT in chronic jt. disease and traumapain, realign structures, decrease stress of soft tissue, work with PT, educate for lifestyle changes (alt. methods, adaptive equpiment, environmental modiciations for safe completion)
treatment options for hip fractureclosed-reduction and immobilization (pelvic fractures usually), ORIF (restricted wt. bearing), partial jt. replacement, total arthroplasty, repositioning/repairing fracture
movement restrictions for THAflexion past 90, rotation (IR or ER), no passing midline
wt. bearing restrictions for hip fracturesORIF (NWB), THA (WBAT for 4-6 wks)
purpose of orthosesSupport a painful joint, immobilize for healing, protect tissues, provide stability, restrict unwanted motion, restore mobility, substitute for weak or absent muscles, prevent contractures, modify tone
precautions of orthosesImpaired skin integrity (pressure areas, blisters), Pain, Swelling, Stiffness, Sensory disturbances, Increased stress on unsplinted joints, Functional limitations
contraindications of orthosesJoint instability, Avascular necrosis, Neurovascular deficiency (on way to necrosis), Acute inflammation, Infection, Unstable fractures
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Scar Management

Question Answer
antideformity positionwrist in neutral or 30-45 ext., MPs in flexion (70-90), IPs ext. (full), thumb abduction and slight opposition
wound drainageexudate
feeling of creaking as the tendons rub against the musclescrepitus
use for antideformity positionwhen going to be immobilized and ROM at risk (not for tendon repair)
types of pain1.acute 2.chronic 3.myofascial
acute painsudden and recent onset (can last up to 6 mo.), limited course with identifiable cause, serves physiological purpose (need to protect tissue)
chronic painpersistant/unchanging, may not serve a purpose (months-years)
myofascial painmay be chronic or acute, stems from local irritation in fascia/m/t/l, has specific pain patterns and is associated with autonomic symptoms
process of tissue healinghemostasis-inflammation (0-2, 3 days) -proliferation (3 days-3 wks) -maturation/remodeling (3wks-2yrs)
when should you introduce movement during tissue healing?proliferation phase
sanguineous drainagebloody
serous drainageclear/yellow
purulent drainagepus
hematoma drainagedeep/dark red
cyanosis skin colorwithout color
erythema skin colorred
pallar skin colorwhite
gangrene skin colorblack
grayish skin colorunderperfused skin
how long should it take to refill capillaries after digital capillary refill? (when evaluating wound)2 seconds
hypertrophic scaran overgrown scar that stays local and resolves within 1 year, may become keloid (use pressure)
keloid scarproliferate out of area and don't become smaller, raised
interventions for edemaelevation, active exercise, compression, retrograde massage, modalities, manual edema mobilization
interventions used with PROM exceeds AROMtendon gliding exercises, blocking, place and hold, functional orthosis
what to consider if PROM equals AROMjoint tightness or musculotendinous issues
how to treat joint tightness(when PROM doesn't change with reposition of other joints) dynamic, static progressive, serial statis splints, then AROM (work on jt capsule or edema)
how to treat musculotendinous tightness(PROM varies with repositioning of other joints), treat with blocking exercises and dynamic/statis progressive splints
how to treat intrinsic tightness(less PIP and DIP passive flexion when MPs extended) functional splints with MPs extended and IPs free
how to treat extrinsic tightness(less PIP and DIP passive flexion when MPs flexed) MPs flexed and IPs free (promote digit flexion), blocking exercises, dynamic and static progressive splint
what is a lag and how to treat a laglimitation of active motion in jt that has passive motion; treat with facilitating motion (scar management, blocking, place and hold, static and functional splints)
what is contracture and how to treat itlimited passive motion, treat with mobilization (dynamic, static, serial static splints, then AROM)
purpose of differential digital t. gliding exercisesmax total gliding and glide of flexor tendons at wrist
purpose of blocking exercisesblock one joint to facilitate stretch in another
purpose of place and hold exercisesgood at increasing ROM and PROM exceeds AROM
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Tendinopathies

Question Answer
test for De Quervain's tenosynovitisFinkelstein's test
De Quervain's tenosynovitisswelling in abductor pollicis longus and EPB tendons and synovium, want to avoid wrist deviation and build handles up
intersection syndromepain, swelling, and crepitus of APL and EPB and extensor retinaculum(from repetitive movements), avoid forceful grip
strengthening progression of tendinopathiesP flexion - active flexion - resisted movement
tendinopathydisease of the tendon, it is important to determine dyscoordination between antagonists and agonists and retrain the movement
skiers thumbulnar collateral l. of thumb affected/sprain
Dupuytren's contracture/nodulesynovium around groupings of tendons gets thickened (after inflammation), causes tight fingers and caught tendons (usually around ulnar side)
tenolysissurgery to release a tendon from adhesions
ligaments that hold tendons in placeannular (5), cruciate (3), vinculum
difference between extrensic extensor and flexor tightnessextensor (less passive composite digital flexion when wrist in flexion than extension), flexor (less passive composite digital extension when wrist ni extension than flexion)
how to treat extrinsic flexor/extensor tightnessplace and hold, static splints at end-rand, dynamic and static progressive during day, functional splint
pyramid of progressive force application to tissues(start with protected wrist) passive extension - place and hold - active composit fist - hook and straight - isolated jt motion (wrist unprotected) discontinue splint - resistive composite fist - hook and straight - isolated jt motion
interventions in acute phase of tendinopathiesice, compression, elevation, rest (manage pain), orthosis at night, active pain-free motion to begin (next phase starts when decreased inflammation)
intervention of tendinopathy after inflammation decreases(restore normal function) gradual mobilization with rest (avoid pain), tendon gliding in pain-free range, isometric exercises (to isotonic), gradually introduce LLLD strengthening in short arcs, then increase arc, gentle stretching, educate (simulate, biofeedback, avoid reaching/gripping with extended elbow or flexed wrist, solve poor posture, pacing), proximal strengthening, kineseotape, strapping at epicondyles
lateral epicondylitis and treatment(different than radial tunnel syndrome-which has pain more distal over radial tuberosity) build up handles, splint wrist in extension
medial epicondylitis and treatment(pain worsens with resisted flexion and pronation) proximal exercises, avoid end-range activities, build up handles, splint wrist in neutral
what are factors to consider during physical examposture, guarding/gesturing, atrophy, edema
compartments of the hand(see notes)
zones of the hand(see notes)
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Burns

Question Answer
causes of burnsfire, contact with hot liquid, radiation, chemicals, electricity
TBSAtotal body surface covered; determines nutritional and fluid requirements, level of acuity, pt. protocols
levels of cellular injury1.superficial (only through epidermis, no scar, heals 7 days) 2.superficial partial thickness (epi dermis, still have hair, min scar) 3.deep partial thickness (decreased light touch, significant scar) 4.full thickness (into other tissues, need graft)
phases of rehab for burns1.emergent (0-72 hrs.) 2.acute (-wound closed) 3.rehab (post wound closed-scar maturation
potential complications of burns1. pruritis (inflammation/itch) 2.microstomia (oral commissure contracture) 3.heterotrophic ossification (bone overgrowth), heat intolerance (skin isnt tolerating temp)
occurs during emergent phase of rehabthis phase is focused on just staying alive/stabilize, treat complications (lung, kidney, heart); treat with dressing, infection control, prevent contracture with splinting and positioning, regulate body temp.
occurs during acute phase of rehabreceive skin grafts; perform detailed eval, treat ROM, splint, positioning, environmental modifications and adaptations, pain remediation (position and meds), activity (AROM is best, but can do PROM); looking at first level capacities
occurs during rehab phase of rehabtreat with ROM and strengthening, fine and gross motor coordination, increase activity tolerance (healing takes energy), sensory retraining, functional assessment and intervention for self-care, scar management (fitting pressure garments), education
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