Shared Flashcard Set

Details

Extremities
awesome
147
Other
Graduate
08/21/2012

Additional Other Flashcards

 


 

Cards

Term
What does Allen's test check?
Definition
patency of the radial and ulnar arteries
Term
What is a positive for Allen's test?
Definition
delay in refill of the hand (> 5 second delay)
Term
What is a possible cause of a positive Allen’s?
Definition
Subluxation, Reynaud’s, old fractures, scar tissue (all can affect patency of the arteries).
Term
What are the 2 positives of Finkelsteins, and what do they indicate?
Definition
Positive – Unable to bring the thumb across, and/or muscle wasting.
Indication – Ulnar nerve palsy.
Positive – Pain along the radial side of the forearm.
Indication – Stenosing Tenosynovitis of DeQuervain
Term
What would be some differential diagnoses for a positive Finkelstein’s?
Definition
A scaphoid fracture or carpal subluxation.
Term
Treatment for a positive Finkelstein’s?
Definition
Ice and biomechanical correction.
Term
What tendons make up the Tunnel of DeQuervain?
Definition
The extensor pollicis brevis and the abductor pollicis longus. I call them “eb and al”.
Term
What some causes of ulnar nerve palsy?
Definition
Trauma to the ulnar nerve (banged it or compressed it), or elbow subluxation.
Term
What is a positive Fromon't?
Definition
Patient’s thumb flexes in order to hang onto the paper.
Term
What does a positive Fromont's indicate?
Definition
ulnar nerve palsy. By flexing the thumb the patient recruits the median in order to hang on to the paper.
Term
What ways are there to verify a positive Froment’s?
Definition
Look for thenar or hypo-­thenar muscle wasting; loss of strength in muscle tests; or utilize EMG.
Term
What is a positive English Test?
Definition
upon removing the arterial occlusion
the symptoms of CTS are reproduced.
Term
A positive English Test indicates what?
Definition
Carpal Tunnel Syndrome
Term
What are two reasons the English Test works?
Definition
Hypoxia and the pooling of blood increases the pressure at the carpal tunnel on the nerves
Term
What are some differential diagnoses for Carpal Tunnel Syndrome?
Definition
Cervical subluxation; pronator teres syndrome; elbow subluxation; shoulder subluxation; thoracic outlet syndrome; Reynaud’s syndrome; Tenosynovitis of DeQuervain; ulnar nerve palsy; radial nerve palsy; fractures; trigger points on the thumb for the stomach and liver.
Term
Carpal tunnel syndromes incude?
Definition
pain, parasthesia, numbness, and tingling of the median nerve distribution
Term
What are two tests that could verify a positive tap test?
Definition
Phalen's and English
Term
What is the direction of carpal misalignment in CTS?
Definition
Anterior lunate
Term
Is the lunate usually hypermobile or hypomobile in CTS?
Definition
Hypermobile
Term
What makes up the carpal tunnel?
Definition
The lunate at the posterior aspect and the transverse carpal ligament at the anterior aspect.
Term
What are the contents of the carpal tunnel?
Definition
The nine-­‐flexor tendons and the median nerve.
Term
The adjusting move of choice with CTS?
Definition
Wrist traction, flexion only (no extension, it would aggravate the lunate anterior, push it further anterior).
Term
Best CTS post check?
Definition
Repeat the orthopedic tests that were positive on the pre-­‐check.
Term
Which CTS test would you not do as a post check and why?
Definition
Don’t do the Reverse Phalen’s; it would drive the lunate anterior.
Term
What would you do after treating CTS?
Definition
After adjusting (for the lunate anterior) brace or support the wrist then strengthening exercises.
Term
What procedure should the Dr. perform to help differentially diagnose (DDx) with a positive Cozen’s or Mill’s test?
Definition
Palpate for point tenderness. Palpate to differentiate whether the pain is over the radial head or the lateral epicondyle.
Term
What treatment protocol would you perform for a Lateral Epicondylitis?
Definition
Correct any biomechanical dysfunction, protect, ice the swelling, wear a counter-­‐force armband, and change activities for the elbow as this alters the fulcrum for extension so it’s not directly over the lateral epicondyle.
Term
Cozen's test
What is the positive and what does it indicate?
Definition
Pain over the lateral epicondyle
Lateral epicondylitis
Term
Mills test
Positive and what it indicates
Definition
Pain over lateral epicondyle
Lateral epicondylitis
Term
Positive lift test in pronation indicates
Definition
lateral epicondylitis
Also look for a possible Radial P with pain over the radial head and decreased radial fluid motion
Term
Positive lift test in supination
Definition
Medial epicondylitis
Look for a possible Ulna P with pain 1-1.5" distal to medial epicondylitis, decreased fluid motion, or a PM ulna.
Term
Positive Adsons and what it indicates
Definition
decreased radial pulse amplitude.
Thoracic outlet syndrome caused by scalenus anticus syndrome
Term
Eden's test positive and what it indicates
Definition
decreased radial pulse amplitude
TOS from costoclavicular syndrome
Term
Wrights test
Positive and what it indicates
Definition
TOS: hyperabduction syndrome
Term
What subluxation would elbow traction be most effective for?
Definition
Ulna P
Term
How would you post check elbow traction?
Definition
Check the fluid motion that was lost in the pre-­‐check; look for diminished pain point; and improved elbow extension range of motion (ROM). When adjusting elbow subluxations when would you supinate and when would you pronate? You would pronate for Radius P and supinates for Ulna P and Ulna PM.
Term
What is the CP for radius P?
Definition
The tip of the thumb
Term
What ROMs are utilized during the radius P procedures?
Definition
Full extension and pronation
Term
What is the pain point for radius P?
Definition
Right over the head of the radius
Term
What are some differential diagnosis for Radius P?
Definition
Lateral epicondylitis, and cervical subluxation (especially the C5-­‐C6 area).
Term
What ROM is decreased with radius P?
Definition
Pronation
Term
What subluxation might mimic lateral epicondylitis?
Definition
Radius P
Term
What is the pain point for Ulna P?
Definition
The pain point is 1” to 1 ½“ distal to the medial epicondyle
Term
What ROMs are utilized during the Ulna PM procedure?
Definition
Supination and extension
Term
What is the pain point for Ulna PM?
Definition
The olecranon fossa
Term
What is the LOD for Ulna PM?
Definition
P-­‐A even though the DC and SCP are on the medial side of the arm.
Term
What is the most common direction for the carpals to misalign?
Definition
Posterior
Term
What are your stabilization hand fingers stabilizing during Capitate STH?
Definition
The proximal row of carpals.
Term
What ROM do you take the patient’s hand through while performing Scaphoid DTH?
Definition
Extension and radial deviation.
Term
What carpals do you test the scaphoid against for fluid motion?
Definition
The Trapezium, Trapezoid, and Lunate.
Term
What are some differential diagnoses (ddx) for a trapezium-­scaphoid subluxation?
Definition
Scaphoid fracture, degenerative joint disease (arthritides), Stenosing Tenosynovitis of DeQuervain, subluxation(s) of scaphoid-­‐lunate, trapezium-­‐1st metacarpal.
Term
How would you differentiate the diagnostic possibilities for a trapezium-scaphoid subluxation.
Definition
For the subluxations, you’d perform fluid motion check pain points, utilize information from the case history, and x-­‐ray.
For DJD (arthritides) check x-­‐ray and perform lab tests to differentiate the type of arthritis.
For Stenosing Tenosynovitis of DeQuervain perform Finkelstein’s. For a scaphoid fracture x-­‐ray, wait ten days then x-­‐ray again.
Term
Is there a difference between DJD and arthritis?
Definition
Arthritis has inflammation; therefore you’d want to deal with any swelling before adjusting to improve motion.
Term
What differential diagnoses should be ruled out before adjusting a scaphoid?
Definition
scaphoid fracture, radial styloid fracture, Stenosing Tenosynovitis of DeQuervain, other carpal subluxations, etc…
Term
Name the wrist adjusting procedures from least to most invasive.
Definition
Wrist traction, STH, DTH.
Term
The lunate usually misaligns in which direction?
Definition
Posterior
Term
In CTS the lunate usually misaligns in which direction?
Definition
Anterior
Term
Which carpal is the most common wrist subluxation?
Definition
Lunate
Term
Which carpal is the 2nd most common wrist subluxation?
Definition
Capitate
Term
Which carpal is the 3rd most common wrist subluxation?
Definition
Scaphoid
Term
Is the posterior lunate misalignment hypermobile or hypomobile?
Definition
Hypomobile
Term
Describe the wrist traction maneuver for CTS?
Definition
Traction S-­‐I, flex, and return to neutral (no thrust and no extension).
Term
Describe the wrist traction maneuver for subluxation of a carpal.
Definition
Traction S-­‐I, flex, extend, return to neutral, then release.
Term
What would be the move of choice when fluid motion is lost between the scaphoid and the lunate?
Definition
Traction (transverse/horizontal) would be the move of choice, then STH, then DTH.
Term
Describe the Scaphoid STH procedure?
Definition
Traction, extend and radially deviate (you may add an impulse at the end if the subluxation hasn’t reduced).
Term
What is it very important to be sure of when performing the Scaphoid DTH?
Definition
That all fingers are stabilizing the carpals around the scaphoid.
Term
What stabilizes the radius during the Scaphoid DTH?
Definition
The patients own body weight
Term
How would you perform wrist traction with a hypermobile anterior lunate?
Definition
Traction S-­‐I, flex, return to neutral (DO NOT EXTEND).
Term
What direction does the 2nd C-­‐MC subluxated?
Definition
Rotationally.
Term
How can a first metacarpal subluxation be identified?
Definition
Look for loss of fluid motion (P-­‐A), point tenderness at the C-­‐MC joint, and a case history of a jammed thumb, etc…
Term
Which ROM is most prevalent at the metacarpal-­‐carpal joints?
Definition
Rotation (hand cupping), not much in extension or flexion.
Term
What are some Differential Diagnoses (DDx) for a C-­MC 1st subluxation?
Definition
Scaphoid subluxation, scaphoid fracture, trapezium fracture, Stenosing Tenosynovitis of DeQuervain, median nerve disturbance.
Term
What is the best way to post check the 2nd C-­‐MC?
Definition
Fluid motion.
Term
Which one of the C-­‐MCs 2-­‐5 would be the most mobile?
Definition
The 5th C-­‐MC.
Term
How would you determine a C-­‐MC 2-­‐5 subluxation?
Definition
Stabilize the distal row of carpals and rotate each metacarpal (relative to it’s adjacent carpal) to see if they have fluid motion. Pain over the C-­‐MC joint space. A case history with possibly a blow to the area, use of power tools, area was stepped on, a cast was recently removed, etc…
Term
What are the normal ROMs for MC-­‐P and I-­‐P joints in the hand?
Definition
They should have glide from P-­‐A and A-­‐P as well as rotation.
Term
What type of joint pathologies would you perform MC-­‐P and I-­‐P Traction (Trxn) for?
Definition
You would adjust the MC-­‐P and I-­‐P joints with traction for MC-­‐P/I-­‐P subluxation, jammed fingers, arthritic fingers, DJD, etc…
Term
What types of joint pathologies are MC-­‐P and I-­‐P traction good for?
Definition
Any joint fixation, subluxation, or dislocation, jammed finger, arthritides, DJD.
Term
How long do you palpate the radialartery when performing Adson’s?
Definition
10-20 seconds, enough to decide if the volume has changed
Term
What does a positive Adson’s indicate?
Definition
TOS-Scalenus Anticus Syndrome
Term
What usually causes scalenus anticus syndrome?
Definition
Subluxation
Term
What diagnosis is suspected with a positive Adson’s when the head is turned away from the side being palpated (Reverse Adson’s)?
Definition
It maybe Scalenus Medius Syndrome or a cervical rib.
Term
What syndrome(s) might cause a positive Allen’s Test?
Definition
TOS, Cervical subluxation, Reynaud’s syndrome.
Term
What is a positive Dawburn's and what does it indicate?
Definition
Pain over the subacromial bursa disappears on abduction of the arm.
Indicates subacromial bursitis.
Term
If the pain in Dawburns does not diminish when the arm is raised, what could be the cause?
Definition
an inferior humerus
Term
What is part 1 of the arm drop test? What does it indicate?
Definition
Patient attempts to raise their arm, if they can’t the doctor will raise it for them.The patient will then lower their arm to their side against gravity. If the arm drops fast it’s often a severe tear (Grade 3) of the rotator cuff. Most likely involving the supraspinatus muscle.
Term
What is part 2 of the arm drop test and what does it indicate?
Definition
Starting with the patient’s arm at 90° of abduction the Dr. will apply a little pressure to the arm while the patient lowers it to their side (some resistance). If the arm fails here it is a moderate tear (Grade 2) of the rotator cuff.
Term
What is part 3 of the arm drop test and what does it indicate?
Definition
With the patient’s arm at 90° of abduction, the Dr. will apply an impulse (S-­‐I) to the arm. If this is positive it is a mild tear (Grade 1) strain of the rotator cuff.
Term
What does a positive Eden’s Test indicate?
Definition
TOS -­‐ Costoclavicular syndrome.
Term
How to treat for a positive Eden’s Test?
Definition
Determine if it is due to muscle guarding, often a hypertonic pectoralis major, which needs to be stretched out.
It may also be a cervical, thoracic or rib that is subluxated and can be helped by adjusting.
Term
What questions would be useful to ask a patient with a positive Eden's test?
Definition
i. Do they carry: a backpack or heavy objects in front of them at work?
ii. Have they ever: had an accident with the seatbelt on; fractured or dislocoted their clavicle; or had a shoulder problem.
iii. Have they ever fallen on their shoulder or with an outstretched arm/hand (FOOSH)?
Term
What constitutes a positive Wright’s Test?
Definition
A 10°-­15° difference in left vs. right arm abduction.
You’re comparing where you lose the palpable radial pulse from one arm to the other arm.
Term
What does a positive Wright’s Test indicate?
Definition
TOS -Hyperabduction syndrome.
Term
What is the most common muscle involved with a positive Wright’s?
Definition
The pectoralis minor.
Term
What causes the pectoralis minor to be shortened or go into contracture?
Definition
Cervical subluxation, subacromial bursitis, rolled shoulder posture, other types of TOS.
Term
What constitutes a positive Yergason’s?
Definition
The bicepital tendon pops out of the groove.
Term
What could cause the instability noted in a positive Yergason's?
Definition
The instability may be due to a shallow groove or a lax/tear/sprain of the transverse humeral ligament.
Term
What could be causing the pain with a negative yergason's?
Definition
Inferior Humerous
Term
What would the visual indicators of a A-­CPS be?
Definition
Distal end of the clavicle sits higher (posterior superior) causing a visual prominence.
Compare the trapezius muscles on each side to see if there is a smooth transition over the distal clavicle.
Term
What is the visualization for G-­H I
Definition
Will see a (dimpling or indent of the soft tissue along the G-­‐H joint space (sulcus sign).
Term
Visualization for S-­T L
Definition
The medial (vertebral)border of the scapula has flared lateral in relation to the spine.
Term
What is the visualization for St-­Cl S?
Definition
The proximal end of the clavicle sits higher than the opposite side.
Term
What is the fluid motion for A-­C PS?
Definition
Stabilize the humeral head into the glenoid fossa, then apply S to I pressure over the distal end of the clavicle.
Term
What is the fluid motion for G-­H?
Definition
Stabilize the A-­C joint and the scapular spine with the hand closest to the patient. The other hand will hold the elbow and draw the humerus I-­‐S.
Term
What is the fluid motion for S-­T?
Definition
To check for a medial scapula – the Dr. will place their thumb at the medial inferior angle of the scapula and press from M-­L. To check for a lateral scapula – the Dr. will place their thumb at the lateral inferior angle of the scapula and press from L-­M.
Term
What is the fluid motion for St-­Cl?
Definition
Dr. stands behind the patient and places their 2nd & 3rd digits at the St-­‐Cl joints and asks the patient to shrug their shoulders up and roll them backward/forward.
Term
With any shoulder complaint the Dr. should routinely examine these 6 things.
Definition
spine for subluxation
A-­C
G-H
S-T
St-Cl
St-Co
Term
Which part of the A-C PS adjustment takes care of superiority?
Definition
Pushing down on the distal end of the clavicle.
Term
Which part of the A-C PS adjustment takes care of posteriority?
Definition
Pushing slightly forward and externally rotating the arm.
Term
What is a “shoulder separation”?
Definition
It is a dislocation (vs. subluxation) of the A-C joint.
Term
Treatment for AC dislocation
Definition
immobilize with a brace or “reminder” tether.
Term
What is the move of choice for the G-­H joint?
Definition
G-­H traction supine because you can palpate the joint during this procedure.
Term
Give at least 3 diagnoses that G-H Traction would work for?
Definition
Frozen shoulder, G-­H I, G-H P, G-H dislocation, osteoarthritis with fixation.
Term
What tests will help to differentially diagnose (ddx) a G-­H I and G-­H P?
Definition
Yergason’s,
Dawburn’s,
Supraspinatus.
For extra information use: Appley’s Scratch, Teres Major, Anterior Deltoid, internal and external rotation.
Term
What is the most common shoulder misalignment?
Definition
G-­H I (due to gravity).
Term
Indications of a G-­H I
Definition
Shoulder visualizes with a sulcus sign (soft tissue dimpling along the G-­‐H); point tenderness at the anterior aspect of the G-­‐H joint capsule; loss of fluid motion; decrease in Appley’s on external rotation; anterior deltoid weakness.
Term
Indications of a G-­H P
Definition
Visualizes as normal (no apparent visual change); loss of fluid motion; point tenderness at the posterior aspect of the G-­‐H joint; decrease in Appley’s on internal rotation; teres major muscle weakness.
Term
What part of the scapulo-­‐humeral ration would be decreased with a G-­‐H P?
Definition
The glenohumeral part.
Term
What is the LOC for G-­H P?
Definition
P-­A, being careful to not get any S-­I.
Term
How to differentially diagnose a G-­H P from a G-­H I?
Definition
a. Pain point is posterior; visualizes as normal, not inferior (no sulcus sign).
b. G-­‐H P has decreased ROM on internal rotation, not external. Appley’s Scratch ROM loss internal rotation.
c. X-­‐ray shows humeral head is posterior and superior, not inferior.
d. Teres major muscle test is weak on G-­‐H P, not the anterior deltoid as G-­‐H I.
Term
Is G-­H Traction Supine the move of choice for a G-­‐H fixation?
Definition
Yes, because you can palpate the joint space opening instead of trying to visualize it.
Term
What are at least 3 other diagnoses that G-­‐H I should be differentiated from?
Definition
G-­H P, Subacromial bursitis, bicepital tendonitis, bicepital instability, sprain or tear of the rotator cuff, dislocation, heart attack, gall bladder, spleen.
Term
What is preffered, G-H P prone or G-H P seated?
Definition
G-H P prone, the table stabilizes the shoulder joint.
Term
What ROMs do you use to bring G-H P seated to tension?
Definition
Abduction and extension
Term
What is the most common shoulder dislocation and why?
Definition
Anterior-­‐inferior due to: gravity pulling down and forward; carrying things pulls it down and forward; the anterior glenoid labrum is shallow; and the anterior inferior aspect of the joint capsule is weaker
Term
What motions do you take the patient’s arm through for Kocher's?
Definition
Traction
S-­‐I, external rotation, adduction, internal rotation, finally support in the Dugas position.
Term
What 3 systems do you want to post check after performing kocher's?
Definition
i. Vascular – Arterial – check pulse, color or nail beds, warmth (or lack) of hand.
ii. Neurological – Reflexes – pinwheel, sharp/dull, feel hot/cold, muscle test the hand, check muscle tone, ↓ pain.
iii. Musculoskeletal – biomechanical – Dugas is now negative, x-­‐ray, and visually the shoulder appear
Term
How to differentiate a S-­T L from a S-­T M?
Definition
a. Fluid motion decreased (↓) from lateral to medial for a S-­T L, and ↓ from medial to lateral for a S-­T M.
b. Visualization of distance of the medial border of the scapula from the spine. Greater (>) 3 finger widths for a S-­T L, and < 3 finger widths for a S-­T M.
c. S-­T L – Appley’s scratch is ↓ on internal rotation.
d. S-­T M – Appley’s scratch is ↓ on external rotation.
Term
Should ROM be checked after performing Kochers?
Definition
No, it will be hypermobile and could easily redislocate.
Term
Describe the 1st part to Frozen Shoulder.
Definition
Part 1: Patient’s arm is over the padded back of a sturdy chair, traction S-­‐I to patient tolerance, hold for 60-­‐90 seconds, then check ROM. If no improvement stick with Part 1. If improved go on to part 2.
Term
Describe the 2nd part of frozen shoulder.
Definition
Part 2: Same position, traction S-­‐I while taking through the newly gained ROM (to tolerance). Do 1x per day until progress stops from 1 visit to the next then go on to Part 3
Term
Describe the 3rd part of frozen shoulder.
Definition
Determine the more restricted ROMs. At the end of a couple of those apply an impulse, then go back to
Part 2 until no progress is noted again between visits. Before performing Part 3: make sure patient is performing at home exercises. Post check with ROM comparing L to R side.
Term
What can the Dr have the patient do for home treatment of Frozen Shoulder?
Definition
Part 2 with a family member; arm over the padded back of a chair while swinging a weight or plastic jug filled with sand or H2O. Finger walking up the wall (abduction), broom handle assistance for ROM, towels to perform Appley’s scratch exercises, pulley over door or basement beam, et…
Term
What is the most important component to the Frozen Shoulder Treatment?
Definition
Find out what caused the patient to stop using their shoulder thus allowing it to “freeze”, then address that problem. It could be due to scar tissue buildup, or DJD/Arthritis.
Term
Why is a 3-­‐part traction procedure preferred over surgery for Frozen Shoulder?
Definition
There is less risk of fracturing the humerus, dislocating the G-­‐H joint, neurovascular damage.
Term
Pain point for both S-­T L & S-­T M?
Definition
Deep to the (anterior to the scapula) in the subscapularis muscle.
Term
How to differentiate a S-­T L from a S-­T M?
Definition
A. Fluid motion decreased (↓) from lateral to medial for a S-­T L, and ↓ from medial to lateral for a S-­T M.
B. Visualization of distance of the medial border of the scapula from the spine. Greater (>) 3 finger widths for a S-­T L, and < 3 finger widths for a S-­T M.
C. S-­T L – Appley’s scratch is ↓ on internal rotation.
D. S-­T M– Appley’s scratch is ↓ on external rotation.
Term
What position is the patient’s arm placed in for S-­T L?
Definition
Behind the patient’s back while side-­‐lying. This is to help pre-­stress the scapula from lateral to medial.
The Dr will each their arm through the axillary/arm opening.
Term
Where is #11 of the stabilization hand for an S-T L?
Definition
Over the A-­‐C joint.
Term
Where are the fingers of the SH for a S-T L?
Definition
Over the G-H joint.
Term
In what direction does the Dr push with the SH to help bring the S-T articulation to tension?
Definition
S-I
Term
What position is the patient’s arm placed in S-T M?
Definition
In front of the patient’s body while side-­lying. This is to help pre-­stress the scapula from medial to lateral.
Term
Where is #11 of the SH for S-T M?
Definition
Over the G-­H joint.
Term
Where are the fingers of the SH for S-T M?
Definition
Over the A-­C joint.
Term
In what direction does the Dr push with the SH to help bring the S-­T articulation to tension in ST-M?
Definition
I-­S
Term
What are the 3 most common mistakes for S-T M prone?
Definition
A. The patient’s shoulder should be off of the table.
B. Dr should stand opposite the side of contact (reach across to medial aspect of scapula).
C. Dr should use an inferior CH.
Term
In what direction does the Dr push with the SH to help bring the S-­T articulation to tension in S-T M prone?
Definition
S-­I
Supporting users have an ad free experience!