UQS :)
LQS/SCAP&thor
Scap&thor/GH EXAM
631 FUN STUFF
Mannytime
100
What is the purpose of screening a patient who walks into your clinic? Lauren please give us at least 4 different purposes
1) Identify specific regional origin of complaint 2) Identify any medical red flags 3) inform further system and body region examination (Joint exams) 4) To facilitate appropriate & timely referral to other practitioners
100
Elizabeth, Can you please show us the dermatomes for L2, L4, & S2?
L2= anterior mid-thigh L4= medial Malleolus S2= Medial/ posterior calcaneus
100
BRIAN! True or False? -The goal regarding movement system impairment syndromes is to identify the cause of the dysfunction rather then the source. - can you explain the difference (maybe an example)
TRUE: source " tissue or pathoanatomical structure that is symptomatic" (supraspinatus tendonitis) cause: "mechanical factor/movement impairment that results in tissue irritation" (scap downward rotation syndrome)
100
Brittany! A patient comes in with an lumbar spine mobility deficits (unilateral) and possible lumbar nerve entrapment. What could be a possible manual therapy you can perform?
Lumbar Unilateral PA accessory mobilization (UPAs)
100
Kelsey! Jodie just asked me what is PICR and I have no idea what to say. HELP!
Point of Instantaneous Center of Rotation -point around which rigid body rotates at given instant of time
200
ELIZABETH! True or False? During cervical clearing exam, you are looking to reduce all symptoms patient comes in with? Perform cervical clearing exam on Lauren
False! During a cervical clearing exam, PT is looking for reproduction of familiar symptoms. If no pain then provide overpressure. Cervical: Flexion/Extension, (R) (L) Rotation & Sidebending
200
Brian...... Lets see if you can perform (or just name) each myotome test with their respective root. (if i had to bet i would say very unlikely)
Resisted Testing L2= Hip flexion L3= Knee extension L4=Ankle DF L5= Hallux Extension S1= Ankle Eversion S2= Ankle plantar flexion (or knee flexion) Functional Testing L4= HEEL WALKING S1-S2= Toe walking
200
Brittany, President elect Donald Trump comes in and you are told he has excessive downward rotation and adduction of his scapula. - what would be his postural findings -what would occur during UE elevation
Postural findings:inferior angle of scapula closer to spine (medial border not vertical) During UE elevation: inferior angle does not reach midaxillary line
200
Kelsey, can you please tell us the different types of pain?
Acute: less than 3 to 6 months Chronic: greater than 6 months duration Referred: pain is felt in the "wrong place"
200
Lauren, can you please tell us some intervention considerations for a patient with subacromial shoulder impingement? -just strategies
-Serratus anterior strengthening/ retraining -upper trap activation reduction - posterior shoulder stretching -pec minor stretching -thoracic extension posture & exercise
300
BRIAN! True or False A dermatone is an area of skin sensation supplied by multiple nerve roots from the spinal cord. Show where C4, C8, & T1 dermatome are located?
False: "supplied by a single nerve root from the spinal cord" C4= supraclavicular C8=Ulnarborder of wrist/ 5th digit T1= medial forearm
300
Brittany, can you explain to us the resting position of the scapulothoracic joint? Think about articulating surfaces, bony landmarks in respect to vertebral body, and clavicle position.
-Scapula sits on the thorax (angled 30-40 anterior to frontal plane, internally rotated, & anteriorly tilted 12degrees) -vertebral border is in slight upward rotation -superior scapular angle at T2 level -Inferior scapular angle at T7 level -clavicles should be slightly elevated laterally
300
Kelsey, David Cameron comes in and presents excessive winging and anterior tilting of his scapula. -Which muscles are long and weak? -which muscles are short and strong? Poor Dave :(
-(Short and strong): pec minor (anterior tilt), internal rotators (winging) -(long and weak): serratus anterior & lower trap
300
Lauren, can you please tell us the rules of referred pain?
-Pain radiates segmentally -does not cross midline -Pn. is usually referred distally within the dermatome -Pn. does not necessarily cover the area -Pn. may be felt anywhere in the dermatome but not in the whole dermatome
300
Elizabeth, when do symptomatic patients (shoulder impingement) present the most anterior translation (or less posterior translation)? a)30-60, 60-80, 60-90, 90-120
30-60 degrees
400
Brittany :) You have the pleasure of performing each myotome test on Brian. Please name the nerve root and action being performed!
C1-2= Cervical Flexion C3= Cervical side bending C4= Scapular elevation C5= Shoulder ABD C5-C6 Shoulder IR and ER C6= Elbow flexion & wrist extension C7= Elbow extension and wrist flexion C8= Thumb ABD and EXT T1= Finger ABD and ADD
400
Kelsey, using only PT terminology can you please tell us what is the difference between external rotation of scapula and abduction of the scapula? Oh yea can you also tell us the muscles that perform each of those actions? Thanks!
Abduction: vertebral border of scapula moves away from the spine (serratus anterior) External Rotation: later border of scapula moves posterolaterally and vertebral border moves anteromedially (serratus anterior, rhomboid, trapezius)
400
Lauren! I need your help! I forgot the shoulder ICF classifications for shoulder pain with mobility deficits. -Can you please give us 2 criteria to RULE IN and Rule OUT? THANKS!
RULE IN: age btw. 40-65, gradual onset & progressive worsening of PN., symptoms limit ADLS, GH PROM limited, GH ER and IR ROM decreases during abduction, end range motions reproduce pn. RULE OUT: PROM normal, GH ER and IR increases as humerus abducts, ULNT reproduces pt's symptoms
400
Elizabeth, please tell us how you would set up an ultrasound for a patient in a clinic? What would be the indication?
Indication: painful rotator cuff tendon related to calcium deposit - Frequency: (.89 MHz) -Intensity: (2.5 W/cm^2) -Duty cycle: 25%
400
Brian, a patient comes in with scapular elevation mobility deficits with possible excessive scapular depression movement coordination impairment. What is a therapeutic exercise you could perform?
excessive scapular depression correction
500
Kelsey! Can you please explain the steps for performing a median nerve neurodynamic test? And.. what is a positive test?
Looking for reproduction of familiar symptoms! Block scapular elevation Shoulder abduction (90-110) wrist and finger (Thumb to!) extension forearm supination shoulder lateral rotation elbow extension
500
Lauren, can you explain to us what is scapular dyskinesis? - what can it be most commonly seen as?
-describe loss of control of normal scapular physiology, mechanics, and motion - seen as - prominence of medial border or inferior border -early or excessive scapular elevation during arm elevation - rapid downward rotation during lowering of the arm
500
Elizabeth, can you please perform all the shoulder resisted tests on Lauren? -what position are the tests perfumed in?
Neutral Position: usually arm at side of body, elbow flexed 90 6 tests -aB/ADduction -IR &ER -Elbow flexion/extension
500
Bad Boys Bad Boys what are you gonna do, what are you gonna do when we come for you! Brian! Please tell us the contraindications for Therapeutic Ultrasound. We know how much Manny loves his contraindications! Don't fail us!
-In the region of a cardiac pacemaker -during pregnancy; over pelvic, abdominal, or lunar regions -eyes and testes -in a region of active bleeding or infection -in a region of tumor -in region of a deep vein thrombosis or thrombophebitis -over the heart or cervical ganglia
500
Brittany, a patient comes in with frozen shoulder. What are some early and late phase therapeutic exercises she could perform?
Early Phase: Pendulms Late phase: CANE AAROM
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