________ is most common in runners and cyclists with gene varum
Iliotibial band syndrome
what is the characteristics for Iliotibial band syndrome
dull pain and clicking at the lateral femoral condyle
what are the orthopedic tests for Iliotibial Band syndrome
Ober’s
Noble
whats the most efficient treatment for iliotibial band syndrome
stretch the tensor fascia lata
strengthen the vastus medals obliquis
Facet Syndrome is known to have a ____ pain pattern
Sclerotomal (referred)
what is the sensory distribution of facet syndrome
diffuse deep poorly localized
- local over the gluteals and anteriorly into the groin
- rarely below the knee
T/F
facet syndrome will have motor changes in the patient
False
T/F
facet syndrome will have decrease reflex response in the patient
false
no changes
what is the x- ray view of choice to rule in or out facet syndrome
lateral lumbar
which 2 x ray measurements are used for facet syndrome
mcnabbs
Hadley’s
what is the best management for facet syndrome
- reduce lumbar lordosis
- Pelvic tilt
- wiliam exercises
IVF Encroachment AKA
lateral recess stenosis
T/F
Lateral recess stenosis is know for a sclertomal pain pattern
false dermatomal (radicular)
what is the sensory distribution of pain for lateral recess stenosis
- sharp radicular, well define
- distinct dermatomal pattern (peripheralization)
what type of motor changes are seen with IVF encroachment
atrophy
weakness
What are types of reflex changes with lateral reflex stenosis
Hypo-reflexia to absent
What is the view to take for lateral recess stenosis
- lateral=lumbar
- Oblique=Cervicals
What is IVF encroachment usually due from
DJD (chronic and progressive)
what are the orthopedic tests called when testing for lateral epicondylitis
- Cozens
- Mills
which muscle is commonly involved with lateral epicondylitis
Extensor carpi radialis
what are the treatments for lateral epicondylitis
- transverse friction massage
- Ultrasound
- Brace the wrist NOT the elbow
An Avulsion fracture at the ASIS is due to which muscle
sartorius
Avulsion fracture to the AIIS is due to which muscle
rectus femoris
Biceps femurs can cause an avulsion fracture to what area
Ischial Tuberosity
the hip adductors can cause an avulsion fracture to what area
Pubis
which muscle is most common to atrophy first with a knee injury
vastus medialis
Vastus medials is _______
- most important muscle in the knee
Heel strike uses what muscle
rectus femoris
foot flat uses what muscle
foot dorsiflexors
quads
gluteus medius and maximus
Kush off/toe off uses what muscle
gastrocnemius
soleus
Autoimmune diseases is most common in _____
females 20-40 yrs
a fibrotic, degenerative inflammation affecting the skin, muscles, cardio-vascular system and viscera is called what
Scleroderma
what are the signs and symptoms of scleroderma
poly-arthralgia G-I, renal and cardiopulmonary disturbances calcinosis Raynaud's (acro-osteolysis) esophageal dysfunction sclerodactyl Telaniectsia -spider veins (CREST syndrome)
A syndrome characterized by joint and myofascial pain , morning fatigue, headaches, anxiety and disturbed sleep.
Fibromyalgia
what is the treatment for fibromyalgia
rest heat (no cryotherapy) massage ROM exercises psychotherapy
a diffuse inflammatory disorder of striated muscle resulting in symmetrical muscle weakness of PROXIMAL limbs and trunk … affects females 40-60 yrs
Polymyotisis
Polymyositis affects females ____> males
2x
what are the sings and symptoms for polymyositis
- motor disability
- muscle tenderness
- pain
- dysphagia
- heliotropic rash of eyelids
G-I and skin manifestations
what are the lab findings for Polymyositis
- increase aldoase
- CPK
- SGOT
- creatinuria
an auto-immune disorder characterized by xerophthalmia( keratoconjunctivitis sicca) xerostomia and rheumatoid arthritis. Primarily affects females 9:1 ages 40-60
Sjorens
what are the lab findings with sjorens
rheumatoid factor (zero-positive)
leukopenia
eosinophilia
anti-RNA
Sjoren disease may be associated with what other disorders
- RA
- SLE
- -Polymyositis
- Felty’s syndrome
- Hashimoto’s syndrome
a seronegative arthritis with inset before age 17.
Still’s disease ( juvenile arthritis)
signs and symptoms for Still’s disease
- intermittent fever
- salmon colored macular rash
- polyarthritis
- arthralgia - affecting the apophyseal joints of the upper cervicals
tenosynovitis
pericarditis
a chronic inflammatory disorder of connective tissue.
Systemic Lupus Erythematosus
Signs and symptoms for SLE
- exacerbations and remissions
- migratory joint pain of the hands and feet
- non- pruritic scaling erythema of the face
- photosensitivity
- vasculitis
visceral (cardiopulmonary and renal manifestations
what are the lab findings of SLE
ANA
anti- DNA
LE cell
Cubitus Varus (elbow)
gunstock deformity
Cubitus Valgus (elbow)
increased carrying angle
ulnar deviation
Carpus varus/ RA
Radial deviation
carpus valgus/ Madelung’s deformity
coxa varus
knock knee ( femoral angle < 120 affects gluteus medium and minimus
coxa valgus
femoral angle >130
bow legs
Gene varus
bow legs
gene valgus
knock knee
weak gluteus medius, minimus
talipes varus
inverted ankle
talipes equinus
plantar- flexion deformity
talipes valgus
everted ankle
talipes calcaneus
dorsiflexion deformity
pes planus
flat foot
pes Cavus
high arch
___% of structural scoliosis is idiopathic
70
infantile scoliosis is between what age
0-3 yrs
Juvenile Scoliosis
3-10 yr
adolescent scoliosis
10-16 yrs
which age group of scoliosis is considered the most important, most progressive, associated with menses, has Risser;s sign
adolescent
what is the management for < 20 scoliosis
conservative tx - manipulation - heat - massage - exercise Bracing is not indicated - re-examine 4x a year - re-xray 2x year for 2-3 years after skeletal maturity
what is the management for scoliosis that is > 20 + 1 a month
- refer for bracing
- milwakkee , visser bracing ( 23hr/day)
- Blount’s exercises for flexibility
what is the management for a scoliosis that is > 50
surgery
a scoliosis that is > ___ may cause cardio-pulmonary problems
60
what is the measurement for lumbar canal stenosis
,15mm (eisenstiens method)
what is the measurement for interpedicular distance that will be considered stenosis
<26mm
what is the best view for the GH joint and labrum
baby arm view
what is the default view for the greater tuberosity , rotator cuff calcification
external rotation
a condition of the thoracic spine typically seen in adolescents (13-17) and characterized by schmorls nodes, anteriorly wedged vertebrae, decreased disc spaces, increased dorsal kyphosis
scheurermenn’s disease
what is the common age for scheuermenns
13-17
what is th sign and symptoms of scheuermenn’s
- back pain
- fatigue
- painless DJD
- Hyper-kyphosis
- postural stress
the aka of scheuermenns
Juveniles Kyphosis Dorsalis
what is the best exercises for all shoulder problems
- Codman’s exercise
what are the 3 different codman exercise
- pendulum
- broomstick
- wall climbing
Passive ROM exercises for most shoulder problems : sub-acromial bursitis, rotator cuff tendinitis, frozen shoulder and impingement syndrome
Codmans
External Rotation is good what views of the shoulder
greater Tuberostiy
rotator cuff calcification
subacromial bursitis
The baby arm view of the shoulder is good for which landmarks
GH
Labrum
CBC count is good to order for ____
anemia
Erythrocyte count
4.0-6.0 mm
Hemoglobin count
15 grams
Hematocrit count
35%-55%
Sedimentation Rate:
<15-20 mm/hr
Platelet count
150,000-350,000 mm (aka thrombocytes)
Normocytic/ Normochromic
acute hemolysis/ hemorrhage, aplastic/ hypoplastic
Microcytic/ Normochromic
lead poisoning, infection, liver disease, malignancy
microcytic/ Hypochromic
iron deficiency
Macrocytic/ Normochromic
vitamin B12/ folic acid deficiencey, pernicious anemia
megaloblastic anemia.
Normal White blood cell count
5,000 to 10,000mm
Neutrophils is _ % of the white blood cells and their main function is to _____
- 60
- acute bacterial infections , inflammatory disorders
Lymphocytes is ___ % of the white blood cells and the main function is ____
- 30 %
- viral infections
- chronic inflammation
Monocytes is ___ % of white blood cells and the main function is ____
8%
- phagocyte for large particles (dust,fungi)
Basophils is _% of white blood cells and the function is ____
- 0%
- produce histamine and herapin
Eosinophils is __% of white blood cells and the function is ___
- 2%
- allergies
- asthma
- parasitic infections
C- Reactive Protein (CRP) is what
an abnormal protein seen in tissue inflammation or destruction
Erin tests are most appropriate for what
- diabetes or kidney disease
Normal values for urine test ( volume, specific gravity and pH)
- volume - 800-2000ml/24hours
- Specific gravity - 1.010-1.030
- pH- 4.6-8 (avg 6)
Squamous epithelial cells in a urine test is considered a disease of some kind
false
normal
hyaline cast are shown in urine when there is renal disease
false
- non-specific
seen in concentrated urine and in one that exercised a lot
WBC casts in urine determines what
- glomerulonephritis
- pyelonephritis ( form of infection)
RBC casts in urine determines what
- glomerulonephritis
epithelial casts in urine determines what
- glomerulonephritis
with glomerulonephritis what type of casts are usually seen in the urine
- WBC casts - RBC casts - epithelial casts
waxy casts in urine determines what
- chronic renal disease
Organ panels are good to determine ___
which organ is bad
with a patient that has had an heart attack , what will show up in the organ panel
- AST (SGOT)
- LDH
- CPK
- HBDH
- potassium
patient with prostate cancer , what panels will show up
- acid phosphaatase
- alkaline phosphatase
- PSA
What is shown with someone that has had muscle damage
- AST
- CPK
- creatine
- Creatinine
- LDH
what are the 3 types of CPK and which ones are they related to
- CPK1- Brain
- CPK2 - heart
- CPK3- Muscle
CPK3 is seen in what conditions
- Polymyositis
- MS
muscle tension with no change in muscle length . the strength is specific to the angle at which the exercise is performed
Isometric
____ exercises is good to perform after passive exercise when someone has had an muscle injury
- isometric
resistance to muscle contraction remains constant through range of motion
isotonic
____ is a full range of movement against a rate limiting device
isokinetic
what is the 0 rule referring to when it comes to bone cancers
any bone cancer starting with an O is males 2:1 and ages 10-25
A condition of the thoracic spine seem in adolescents that have multiple schmorls nodes, anteriorly wedged vertebrae, decreased disc space and increased dorsal kyphosis
Scheuermann’s disease
what are the signs and symptoms of scheurmann’s
back pain
fatigue
muscle imbalance due to postural stress
scheurmann’s can lead to _____ and ___
painless DJD and hyper-kyphosis
aka for scheurmann’s
juveniles kyphosis dorsalis
Anterior displacement of a vertebral body relative to its base vertebra
spondylolistheisis
spondylolistheis on a AP lumber shows a ____ or ___ of ____ signs
- inverted napoleon hat
- bow line
- brailsford
spondylolisthesis is determined by ____ and _____
- Ulmann’s line
- Meyerding’s classification
what is the most common type of spondylolisthesis that occurs at L5
Isthmic
what is the most common spondylolisthesis that occurs at L4
Degenerative
what is the only bone tumor that grows off the bone
osteochondroma
pedunculate or sessile
cartilage capped
coat hanger or cauliflower exotosis
osteochondroma
osteochondroma grows away the ___ and favors the ____ and ___
- epiphysis
- knee
- humerus
name the least common type of bone tumors
- chondrosarcoma
- fibrosarcoma
- osteoblastoma
- ABC
age >40 what is the type of bone tumors that will most commonly occur
- metastatic carcinoma
- multiple myeloma
- Paget’s
20-40 age group with bone tumors will be most likely which type
- giant cell tumor
- fibrous dysplasia
<20 bone tumors are most likely what kind
- benign tumors
- tumor stimulating conditions
- osteosarcoma
- Ewing’s
Bine infarct most commonly occurs with _________
post surgical fracture alcoholism steroid therapy caisson disease
AVN is commonly found in the ____
meta- epiphyseal region of long bone
“well defined white chewing gum”
AVN
Radiating periosteal reactions AKA
speculated
sunburst
malignancy (osteosarcoma)
Laminated periosteal reaction
onion skin
wings sarcoma
parallel periosteal reaction
bone infection
Lumber canal stenosis is when the measurements are below ____
15mm
interpedicular stenosis is when measurements is below _____ mm
26mm
Deep boring pain , unrelenting constant . may be worse at night nut related to activity, position or rest
bone
Dull, achey , difficult to localize and aggravated with movement/position
muscle/somatic
Sharp , severe, shooting pain, tingling, radiating or dermatomal pain
nerve root
referred, diffuse, ill-defined ashiness , throbbing, cramming, heaviness, color and temp changes
vasulcar
vague unpleasant quality , burning, gnawing contralateral to the lesion . symptoms aggravated by stress
thalamic
visceral
diffuse, poorly localized and referred
pain increases with motion or position , decrease with rest
arthritis
dull, achy , poor;y localized pain, arising from deep somatic tissue, facet syndrome or spondylolisthesis
Sclerotogenous
mc mechanism of ankle injury
inversion stress with foot planter flexion
mc ankle ligament damaged on inversion
- anterior talo fibular lig.
- calcanei-fibular
- posterior tala-fibular
mc damaged ligament in the ankle with eversion
- deltoid ligament
Patient coes in will pain in the shoulder of unknown cause, there is decrease ROM in all directions especially in external rotation , muscle atrophy is also noted … X-ray findings were a negative study
Frozen shoulder ( adhesive capsulitis)
what is the best Tx for adhesive capsulitis
ROM and Codman’s exercises
avoid bracing
patient has knee pain and is worse by sitting in a cramped position or walking downstairs.. Clinical findings were crepitus at the knee joint, normal ROM and joint effusions
Chondromalacia Patella
AKA of chondromalacia patella
PFA- patellar femoral arthralgia
Jumper’s knee is worse going up or down stairs
upstairs
patient has anterior heel pain radiating from the calcaneus to the ball of the foot. The pain is worse in the morning. exacerbation of pain upon dorsiflexion of the big toe was noted.
plantar Fascitis
what is the Tx of plantar fasciitis
heel pad
ice
massage
achilles tendon stretching
what is usually the cause of plantar fasciitis
standing, walking pronated
shoulder impingement syndrome is the entrapment of the _____, ____ and ______ by the acromion, coracoid ligament.
- biceps tendon
- supraspinatus
- sub-acromail bursa
patient has pain in the shoulder, she describes it as dull achy and points to the anteroom-lateral portion of the shoulder, clinical findings were palpable tenderness at the greater tuberosity and the bicipital grooves.
shoulder impingement syndrome
what is the tx for shoulder impingement syndrome
-codman’s exercise
adjust caviled (I-S)
- humerus axial distraction
name the 3 stages of shoulder impingement syndrome
stage 1-Acute phase
stage 2- Recurrent Phase
Stage 3- Chronic phase
what typeof exercise is recommended for spondylolithesis
william exercise
Central canal stenosis is sclertomal referred pain
false radicular ( dermatomal)
what is the sensory distribution for central canal stenosis
inconsistant , maybe unilateral, bilateral or single dermatomal
are there motor changes with central canal stenosis
yes
atrophy and weakness
what are the reflex changes with central canal stenosis
hypo-reflexia to absent
what is the best diagnostic imaging required for central canal stenosis
CT scan
what is the AKA for central canal stenosis
Spondylotic Myelopathy
Piriformis syndrome is ______ dermatomal
multi
sensory distribution for piriformis syndrome is _______
sciatic -like pain, mainly to buttocks
is there motor and reflex changes with piriformis syndrome
nope
what is the best test for piriformis syndrome
NCV
EMG
with piriform pain is most upon _____ rotation of the hip
external
Patient comes in with the complaint of dysphagia, post prandial gastroesoophageal reflux … it is worse when reclining back of belching… x rays show displacement of the stomach above the diapraghm
hilt hernia
what are the signs and symptoms of leukemia
- elevated lymphoblasts with pancytopenia
- acute illness with bleeding
- secondary infections , septicemia, bone and joint pain
which leukemia is most common with ages 3-7 years
ALL
which leukemia is 80% of childhood leukemias
acute lymphoblastic leukemia
which leukemia is high WBC count and philadelphia chromosome is present
Chronic myelogenous leukemia
which leukemia is most common in the median age of 65 and among the immunosuppressed
Chronic Lymphocytic leukemia
what are the signs and symptoms of Rheumatic fever
pericarditis valvular insufficiency - apical systolic rumbling murmur migratory polyarthritis fever polyarthralgia pharyngitis glomerulonephritis ASO- titre(strep test)
what is the triangle of rheumatic fever
-glomerulonephritis
- strep
- pharyngitis
beta hemolytic
what plane is flexion/ extension in and with what axis
- sagital
- x- axis
what plane is axial rotation, pronation/supination in and with what axis is it in
- horizontal/transverese
- y- axis
what plane is inversion/eversion in and what axis is it in
- frontal/coronal
retropharyngeal interspace is in what level
C2
hyoid is in what spinal level
C3
superior thyroid cartilage is at what spinal level
C4
inferior thyroid cartilage is at what spinal level
C5
cricoid cartilage/ retrotracheal interspace is at what spinal level
C6
spine of the scapula is at what level
T3
angle of the scapula is at what levels
T6
angle of scapula seated is at what level
T7
PSIS and ASIS is at what level
S2
____ poisoning results with a cherry red skin and mucosa, clonus and headache
CO
what type of drug is tar dive (orofacial) dyskinesia
antipsychotic drugs
pt with appendicitis will have pain upon_____
flexion
what type of lung disease will be hyper-resonant with radiolucent films
- Emphysema
- Pneumothorax
pt has muffled lung sounds, chest pain, dyspnea, orthopnea and a dry non productive cough
pleural effusion
exam findings for pleural effusion
decrease fremitus
dullness on percussion of lungs
decrease breath sounds near lung bases
pneumonia will have decrease voice sounds and decrease tactile fremitus
false
opposite
what is the result of hypertension in the upper extremities, head and neck dizziness, epistaxis, headache) decrease blood pressure in the lower extremities
coarctation of the aorta
which is considered the worst prognosis for diabetes
diabetes insipidus
____ may be due to diabetes, pt will havee puffy face, peripheral neuropathy, increased urinary proteins with ascites, hypokalemia and hypercholesterolemia
nephrotic syndrome
which test is used to confirm mononucleosis
heterophil (paul- bunnerl)
which stage of lyme disease is affected more with the musculoskeletal system
stage 3
3 phases of Degeneration is described by who
Kirkcaldy- Willis
what are the 3 phases of degeneration
- segmental dysfunction
- Instability - repetitive trauma/ postural stress - scarring of articular tissue/disc
- Stabilization - Chronic overstress of spinal joints along with trauma may produce pro inflammatory changes - osteophytic changes occur
Segmental Dysfunction Hypothesis
- aka fixation theory
- inflammatory or non - inflammatory mechanisms may trigger segmental fixation
3 components of SDF
- locked joint or entrapped/ pathologic meniscus
- abnormal muscle function - fixation causes facilitation resulting in muscle spasm
- abnormal biochemical processes in the joint (inflammation decreases mobility)
the findings of SDF include a triad of: ____
- point of tenderness or altered pain threshold
- decreased of altered motion
- abnormal tension of para- vertebral muscles
who came up with the nerve compression hypothesis
DD Palmer
_________ Hypothesis - nerve pressure due to subluxation or IVF encroachment may cause : loss of nerve transmission, decrease action potential, altered axoplasmic flow (trophic changes to nerve and wallerian degeneration, micro-circulation ischemia to the nerve root.
Nerve compression hypothesis
Acute nerve compression causes_____ and chronic causes _____
- increase signal, irritation , spasm , hyperesthesia, increase sympathetic activity
- chronic - decrease signal hyoesthia, decrease reflexes, paresis, flaccidity, increase parasympathetics
Axoopasmic Aberration Hypothesis
compression or segmental dysfunction may affect growth and function of nerve roots/ nerves by altering normal flow of neural proteins, glycoproteins, neurotransmitters and Nerve Growth Factors
_____ Hypothesis explains that inflammation may predispose to spinal lesions and arthritis by cellular response which releases histamine by mast and plasma cells and tissue response
Inflammation