Neckflix and Chill
Identify the likely paraesthesia and anaesthesia along dermatomal distribution for cervical radiculopathy (which nerves go to which digits).
What are
C6 → affects D1
C7 - affects D2/3
C8 - affects D4/5
Most common cause of MSK chest pain.
What is costochondritis?
This instability is often in males 10-35 who play competitive or contact sports.
What is anterior instability?
What is false?
M=F
4th - 6th decades (35-54 years)
Most common type of Carpal Instability Dissociative.
List 3 subj factors of cervical arthrosis.
What are female, 40s-60s, stiff in am and worse throughout the day, sleep okay but may have pain w/ changing pos, describe pain as deep ache, stiff or sharp with speed dependent mvts, pain bilateral, gradual onset, previous trauma (MVA, whiplash, sport), recurrent, pain w/ ipsi ext/rot, neck pain >arm pain, periscapular pain?
Athletes who play these sports are at higher risk for rib stress fractures.
What are rowing, golf, and baseball?
Other: basketball players, weightlifters, ballet dancers
Instability due to repetitive microtruama (overhead mvt) and congenital laxity or structural lesions.
What is MDI?
This condition is not self-limiting and has progressive worsening of pain and and stiffness related to activities. It is often in throwing athletes who present with catching, clicking, locking with pronation and supination, as well has tenderness over radiocapitellar joint and lacking 15-30° of elbow ext.
What is Osteochondritis Dissecans?
Difference between CID and CIND.
What is CID = same carpal row and CIND = different carpal row?
What are Consistent w/ central mechanisms (broad pain, poorly localized and distribution of pain grows), doesn’t align w/ clear pattern of symptom modification, disproportionate responses to stimuli and long recovery, aligns w/ pattern of central patterns, females, prior hx of abuse, neglect, poverty or witness to trauma, no previous treatment (PT, chiro, etc) has been helpful?
What are:
Subj: chest wall pain, varying pain intensity described as local, sharp, aching, or pressure-like, exacerbated by ipsi upper body mvt, deep breathing, exertional activities, common onset is hx of illness w/ coughing, recent strenuous exercise or physical activities that stress U/E
Obj: pain is reproduced w/ palpation at costochondral or costosternal joints w/o swelling and is worse w/ mvt or pos (2nd to 5th rib most freq), typically at >1 location, unlat
Identify 5 subj factors for SADRC.
What are: typically insidious or gradual onset, can follow an incr in activity of shoulder, can incl use of arm for prolonged overhead activity, Incr age and decr activity, overhead activity, use of arm away from body for reaching, lifting, or carrying (supra, infra), pushing activities (subscap), ant-lat shoulder pain (localized, mechanical nociceptive mechanism), night pain (chemical nociceptive mechanism), duration and intensity of pain symptoms (impacts recovery outcomes), overhead work, throwing tasks/sports, push-pull tasks?
Degen tendon age >40
Unilat tear age >58.7
Bilat tear age >67.8
Identify 4 obj tests for tennis elbow.
Obj (at least 1 should be present)
Local pain on palpation of lateral epicondyle
Resisted testing of wrist ext (Thomsen test) reproduces pain at lat epicondyle
Resisted radially directed wrist ext from an elbow flexed, finger flexed, radially dev, and pronated pos (Cozen’s test)
Resisted testing of middle finger (Maudsley’s test) (+/- second finger ext) reproduces pain at the lat epicondyle or wrist extensor m bellies
Passive forearm pronation, wrist flex, elbow ext (Mills test) reproduces pain at lat epicondyle
Pain reproduced at lat epicondyle on gripping
Other obj testing
Shoulder, elbow, wrist, forearm ROM and strength should be compared bilat and assessed for strength deficits
More sig at wrist and shoulder than elbow
Mot control during functional tasks
C-sp and t-sp mobility and pain referral
Radial n test
Accessory mvts of humeroulnar, radiohumeral, radioulnar joints
Elbow instability (MCL, LCL, posterolateral rotary drawer test and table top relocation test)
True or false - For the scaphoid shift test, the wrist starts in RD and gets brought into UD.
What is false?
The wrist starts in UD, tuberosity of scaphoid blocked. Bring wrist into RD, painful clunk as prox pole of scaphoid is subluxed dorsally on radius
Identify the cluster of tests for degenerative cervical myelopathy.
What are 3/5 or 4/5 of gait deviation, Babinski, Hoffman's, inverted supinator, age =>45?
List 3 signs and symptoms of Tietze's Syndrome.
What are localized swelling and redness at painful area (the junction of the ribs and breastbone), commonly affects 1 joint in 70% of cases, most commonly affects 2nd or 3rd costochondral junctions, characterized by tenderness, pain and edema (70-80%) involving articulations: sternocostal and/or sternoclavicular on one side, w/ no other symptoms, agg w/ mvt of thorax or ipsi U/E?
Identify 4 obj findings of SLAP tears (not special tests).
What are: May have dislocation of arm; AROM/PROM - Normally full except in case of recent trauma, Assess for presence of GIRD, If difference b/w 2 sides exceeds 25° creates a predisposition for SLAP lesions, esp in athletes who play overhead sports; >5-10° in overall arc of shoulder rot in dominant shoulder vs other may indicate predisposition to tupe of injury; Passive GH accessory mvts - Post gliding may be decr as contracture of post capsule is freq; M testing - RC, Long head of biceps - sig weakness and symptom repro is present in type II or IV SLAP lesions as integrity of bicipital tendon insertion is compromised; scap dyskinesia during AROM and m testing - Med rot and ant tilting of scap; Stability - Signs of minor instability during load and shift, sulcus, ligament and anterosup and posterosup capsule testing?
Describe the Tinel test for cubital tunnel syndrome.
What is firmly tapping b/w the posteromedial olecranon and med humeral epicondyle (over the cubital tunnel) w/ the elbow in 45° flex, as well as 3 cm proximal and distal to this point over the ulnar n?
Identify 3 signs and symptoms for trigger finger.
What are: painless clicking w/ mvt of affected digit, progression can create catching or popping at either MCP or PIP joints, Feeling of stiffness, progressive loss of full flex and/or ext of affected digit, a painful nodule in the palmar MCP area, MCP stiffness or swelling in the morning, Waking w/ locking w/ loosening throughout the day, Recent hx of trauma to the area, Locking in flex requiring passive manip to achieve ext, Dev of secondary PIP contractures and digital stiffness?
Identify 5 obj factors associated with cervical myelopathy besides the cluster of diagnosis.
What are bilat muscle wasting in later stages incl shoulder girdle and hand intrinsics, posture: may have incr thoracic kyphosis, gait may appear with unsteadiness, wide based, spastic or ataxia, symmetrical, potential loss of c-spine ROM + paresthesia w/ mvt (esp end range flex/ext), +ve neuro conduction tests (early: LMN in U/E - hyporeflexia, sensory loss, key muscle weakness; advanced: >2 root level findings, hyperreflexia lower, marked weakness of key muscles and sensory loss in the U/E and L/E), +ve slump, balance issues (Rhomberg, tandem, narrow base)?
Special tests that may be +ve: grip dynamometer, Grip and Release Test, Foot Tapping Test, 10 sec Step Test, Triangle Step Test, Tally Counter Test
List 4 signs and symptoms of a rib stress fracture.
What are: activity-related pain in contrast to osteoid osteomas or tumours, 1st rib stress fracture when acute-onset post shoulder pain while swinging bat or club or pitching the ball or rowing, gradually incr pain directly over the area of injury, tenderness usually originates at a specific area of ribcage, pain decr during rest
Identify the 6 stages of the Watson protocol for MDI.
What are:
Scap control and arc of motion
Posterior musculature development
Flexion control from 0-45° elevation
Sagittal plane & coronal plane control form 45-90° elevation
Isolated delt drills
Sport-specific & functional stage
Describe ulnar nerve mobility testing to distinguish between ulnar n subluxations vs dislocation.
Palpation of elbow to find the proximal, posteromedial aspect of the medial humeral epicondyle and to ID the n in cubital tunnel
PT removes finger from medial humeral epicondyle and gets the pt to actively fully flex their elbow w/ forearm in supination
When pt’s elbow is in maximal flex PT replaces their finger on the proximal, posteromedial aspect of the med humeral epicondyle and had the pt actively extend their elbow
If ulnar n is trapped ant to the PT's finger then it is considered to be dislocated and if it is beneath the PT’s finger then subluxed and if it can’t be palpated it is stable and w/in groove
w/ the elbow in mid flex, PT gently grasps the n to determine if it can be moved out of its cubital groove onto the med humeral epicondyle to determine if it is able to be subluxed
Identify 4 signs and symptoms of Dupuytren’s Contracture.
What are blanching of skin when finger is extended, nodules in palm, painless cords proximal to nodules, pits and grooves, tenderness over PIP knuckle pads, flex contracture or loss of ext of affected digits, ulnar digits are more commonly affected w/ 3rd and 4th digits having highest incidence of developing a contracture?