Ortho exam 2

codemans exercise
if you had a subacute stage of condition and you determ pt has supraspinat and infraspin tendonitis . both have mod tiss reactivity..pt complains of being unable to get dressed abd complete job pain while writing
a) Functional Movement - (original intent) stooping posture allows functional movement of arm
(for ADL's) w/o lifting arm above 60 degrees; doesn't stress the jt or require muscular contraction
Pendulum Exercise - used to gait pain; early form of movement (no muscular contraction...using body wt. to cause an oscillatory movt. at the joint which will gait pain & increase ROM)

palliative: condmans -gate pain-fire mechanoreceptors that block pain signal
prep: passive stretch to injured area (supr/infra
correct: correct exercise as well by increasing amp or adding weight to increase stretch
support: at home as supportve exercise to help maintain stretch
5 best findings for GH adhesive Capsulitis
At the elbow
1) Decreased Classical AROM: ER>ABD>IR
Decreased Classical PROM: ER>ABD>IR
Decreased Classical PROM: Tight Cap EF
Decreased Accesory PROM: Tight Cap EF
Decreased Acessory PROM: ant>inf>post

2) AROM: F> Ext decreases
PROM Acc Qaunt: decreased cap pattern ANT> post
PROM Access Quality: decreased tight cap end feel
PROM classical Quant: decreased cap patern f>ext
PROM Class Quality: decreased tight cap end feel
Proximal Epiphysis vs shaft fracture of humerus vs neck fracture
a) Fracture of NECK of Humerus:
- usually caused by a fall on an outstretched hand (FOOSH) with forces transmitted up arm
- most common with elderly females with Osteoporosis
- often sets asymmetrically and you get a bony block
- Other implications:
• Axillary N and Circumflex A (but recovery of nerve function is good)
• Motor and sensory loss
• Signs:
- Treatment:
• Sling for 6 weeks
• Partial shoulder replacement
• Stable fracture= active assistive ROM in 2 weeks
• Displaced fracture= hard casting, little movement
- Exam Finding:
* Limited ROM
* Relatively sore
* Can function but hurts
- PT Tx: can do NOTHING for bony block,
strengthen in available ROM
pendulum ex (Codman's) to prevent stiffness

b) Fracture of PROXIMAL EPIPHYSIS of Humerus:
- happens in children b/c their joint capsule is stronger than the epiphyseal plate
- can be damage to Axillary N (but prognosis for recovery is excellent)
- fractures of the clavicle are the most common and least serious of all childhood fractures b/c they usually all unite rapidly with NO permanent sequelae
- if fx is severe...Reduction
- if fx is NOT severe...Sling and thoracobrachial bandage used to immobilize for 3 wks
- Radial N damage?
c) Fracture of the SHAFT of the Humerus:
- common in elderly females due to direct blood flow → blood supply is very vulnerable
- can be damage to Radial N & Brachial A.
- MD tx: CRIF (cast), external fixation
- PT tx: positioning/ posture to optimize blood flow for healing
Outstretched arm and fract hum prox. fract incomplete and nondisplaced sling and may feel she has axil nerve injury two best exam findings confirm hypothesis
1) F: weak in abd due to impaired delt
Exam Step: MMT
What is Bankart Lesion
iii. Bankart lesion:
1. Avulsion of ant inf labrum from the glenoid rim to repair; from 4-6 o-clock
2. Usually occurs with anterior dislocation by forced ext rot and ext of shoulder
3. radiographic exam confirms diagnosis: hum head lost contact with glenoid cavity lying in subcoracoid position
4. Use a good sling with a pillow that keeps pt. in neutral→ helps in healing of the labrum
Define and describe difference (or anatomical location) between SLAP and Bankart and what TUBS/AMBRII/HILL-Sachs
ii. Instability:
1. TUBS: traumatic unidirectional bankart requiring surgery
2. AMBRII: a-traumatic multidirectional bilateral rehabilitation
a. Born lax in all 3 directions
3. SLAP: superior labrum, anterior to posterior
a. 2-10 o-clock
b. peeling away of the superior aspect of labrum- from pulling of the long head of bicep
4. Hill-sachs:
a. Little wedge of humeral heads gets chipped off
b. Post aspect
c. When shoulder dislocates the GH head chips off when it hit the boney glenoid
American Academy Ortho Surgeons Video what is most common lig injured in GH jt following traumatic disolocation..what is the most comm mechanism of injury position of arm leading to injury of lig
Lig inf glenohum lig
FOOSH with arm EXT Rot/abd bc it brings the waker inf gh lig anterioly
Clinically a postive special test often indicates a negative outcome. Explain a positive tinels test is a good outcome
*Tinel reveals a good outcome because a sign of tingling indicates regeneration of a nerve. (pain would result in nerve irration
MMT finding for a complete tera of a m/t is 0/5 name another tiss impairment that could give a false positive 0/5 for MMT
nerve lesion example ax n lesion becaus of the humerus fract results in 0/5 for delt/teres mn
Typical signs/symptoms of rad nerve entrapment in supinator
Describe difference in clinical presentation and nerve pathology between benediction sign and bishop deform
Benediction Sign: Median N pathology, unable to fl index and middle finger at MCP (Lumb 1& 2)- must be asked to do

Bishop deform: is observed, Uln N pathology 4th and 5th digits are in fl position at MCP
Describe diff between fiborous non-union and pseudoarthosis
Best shoulder position for supraspinatus tendon
Gh jt shoulder IR Ext ADD against side dorsum of hand to lower back
Gaunt Article guiding principle 1 what occurs surgically for the patient with an anterior instability but an intact labrum
Ident four indications for a bankart surgical repair according to video Dr. warner
specifically a bankart lesion
unidirectional Instability
traumatic event occured (minimal dislocations
Ant-inf gh lig is intact and in good condition loww fraying
Weak and painless MSTT for ext rot and abd step 11
special tests: for supraspinatus tear empty can test is positive
inability to resist scap
Best exam findings for a GH joint adhesion limiting an inferior glide and how this could diagnos of subacrom impingement
AROM is decreased F,
Describe lesion to dorsal scap nerve can result in subacrom impingement syndrome
Bunnell Littler test is positive for a tight capsule what are two other best findings from your exam that must be present to confirm this tissue impairment
Based on biomechanics explain why a FOOSH can result in volar sublux of lunate on triquetrium
the lunate is part of prox row of carpal bones . in wrist ext (common w FOOSH) the prox row glides volarly. Excessive ext may result in subl of lunate
You suspect your patient has signs of volkmans ischemic contracture whats the best sign that would indicate to you that your pt needs to see a dr immext
loss of rad/ulnar pulse
Describe appearance of Mallet finger and funct loss
mallet finger would have the appearance of a flex dip bc of an avulsion of the ext tend mechan
Benets fract 5 yrs ago. Osseous healing occured satifactory. what spec tiss impairments would be limiting cmc act and pass class movements
CMC cap laxity. a laxity in the joint capsule can cause mal alignment this results in the art surfaces of MC and trapezium to limit motion
Ape hand is ass with what specific tiss impairment and why
weakness of opponens pollicus
this occurs bc of med n pathology
a patient presents with constant pain and limitation of active motion due to a scaphoid fract. what is the most sign complication of a scaphoid fract
Adhesive Cap same diff than and adhesion of GH JT
Adhesive cap is a cond multidirection decrease in motion
Adhesion is unidirection decrease in motion
Jaime fell on jungle gym and landed on right shoulder. Best exam step to determ is she has a displaced or nondisplaced clav fracture
Hypomobile pisform pt reports no pain at restrict with accessory motion testing list 6 soft tissue attachments on to pisiform that could be contrib abnorm findings
Flex retinaculum
ulnar coll lig
ext retinaculum
pisohamate lig
fl carp uln
abd dig min
MLT is best exam findings for pt with ECRL tendonitis in chronic condition
Name position of wrist in Collis fract vs smith fracture
CF: fall on outstretched hand with wrist ext and arm pron

Smiths fract: fall on outstretched had w the wrist flex
What nerve roots cause a problem in hand mimicking carpal tunnel syn
c5-c8 t1
Perform sensory testing for suspected rad n impairment. where would you begin testing at distal point of innervation for 2 and 3? what is your rational
begin at dorsal pip jts and if you began more distal then i could poss be testing for median nerve instead of radial
MSTT of shoulder your only positive finding is : is pain and weak of gh ir
interpretation of finding : part tear of subscap
steps to defer is any and whats your rational :
MMT you dont want to cause more stress to the muscle. MLT will cause further damage
Describe theory behind abnorm "muscl force couple" result in gh joint impingement
Rotator cuss weak doesnt provide enough force to prevent superior humeral head from migrating in to the acromion during the upward force from the delt during overhead movement.
treatment for pt with radiographically confirmed myositis ossificans in brachialis muscle of 2 week onset the stage of condition is sub-acute tiss reactive is mod and sub ract is mod
No movement allow tissue to reabsorb
Three diff fractures at elb and describe the most common mech of injury for each
Rad head fract: compression force due to valgus
Surpracondylar ridge fract : forced elb ext
Olecranon fract sudden pass flex/avulsion due to triceps
2 complications with elb fract, one should be intraartic and one should be ext art
Ulnar nerve damage
Volar wrist edema resulting in med nerve impairment/ stage of condition is actue and tiss react is moderate. Ident the 4 best clin exam findings to spec diagnose this condition
Dermatomes conduct sensation from
distal to prox
Dr paris briefly described sit when its appr to treat acute pain
when pain gets in the way of normal motion and tx tech create involuntary /voluntary guarding
correct perform of a MSTT for the ECRB the patients elb should be positioned and the wrist should be position
straight in slight ext
ext and radially dev
when perform joint distract to prox carpal row on rad the direct of force should be _____ to the concave joint surgace
Bunnel-Litter test on pt and realize during 2nd step the pt ex descreased PIP joint fl Name four tiss spec impairments
Joint cap tight
Joint cap adhesion
Effusion of joint capsule
Joint capsule lax
You deter cross frict massage treatment today is warranted in part by findings from finkelstein test. Spec describe proper pt positioning during intervention
Pt would have thumb fl, fl fingers, and then finally ulnar dev their wrist all of these steps are done at the same time
Wartenbergs sign will examine the gen strength of ___Muscle
A positive test indiacted a prob with ____
palm interossei
Best 3 exam findings that indicate med n entrapment in pronator teres
Complications of anterior gh dislocation
Ax N injury
Rotator Cuff Tear
Long Head biceps tear
SC/AC jt dislocation
shoulder impingement syndrome and the five factors that contribute to this
Shape of acromion: straight, curve, hook
Rotator Cuff:
thickened tendon

increased prom of great tuberosity