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Med Massage 2
Hand Outs
| Question | Answer |
|---|---|
| what percent of ankle sprains are lateral | 85% |
| what are the injured ligaments in a lateral ankle sprain from weakest to strongest | ATFL, calcaneofibular and PTFL |
| what is most often injured in Grade 1 lateral ankle sprain | ATFL |
| what is most oftern injured in moderate G2 to severe G3 lateral ankle sprain | calcaneofibular and PTFL |
| etiology of lateral ankle sprain | sudden movement that caused sharp pain onthe lateral side of the ankle, previous sprains make on more suseptible to re-injury |
| characteristics of a lateral ankle sprain | swelling increased immediately after injury, bruising, walks with limp, may not want to WB, tender to the touch, tissue has a puffy feel, peroneal mm may be hypertonic to compensage for joint instability, AROM/PROM is likely painful esp inv, MRT painful |
| why is inversion painful in lateral ankle sprain | stretches ligament |
| why is MRT painful | esp in inversion if the perineal tendons are injured |
| lateral ankle test | ankle drawer test, talar tilt test |
| ankle drawer test | pull posterior calcaneous in an anterior direction to evaluate the ATFL |
| talar tilt test | moving foot into inversion to evaluate the cacaneofibular ligament |
| lateral ankle sprain treatment | acute: PRICE, subacute: local edema tx, ROM, stretching, strengthening, and proprioceptive exercise, writing alphabet with toes. chronic: cross-fiber friction to the ligament |
| which ankle sprain is less common | medial ankle sprain |
| what is more involved with medial ankle sprain and why | more tissue damage because lateral malleolus is lower than medial, possible ankle fracture or fracture at the tip of the fibula or tendon avulsion |
| aka eversion ankle sprains | medial ankle sprain |
| which ligaments involved in medial ankle sprains | deltoid ligaments |
| what does the extent of trauma needed to cause this injury cause | large amounts of scar tissue in the ankle with limited ROM |
| what is primary function of ligament | connect adjacent bones and establish stabilityin the skeletal structure, dense connective tissue composed of elastin and collagen, elastin provides a degree of pliability while collagen give tensile strength |
| ligament sprain etiology | acute overload of tensile stress, prolonged stress makes ligaments more susceptible to injury form smaller loads |
| 1st degree ligament sprain | elastic phse damage to the ligament, ligament increased in length |
| 2nd degree ligament sprain | increased in elastic phase toward plastic deformation, ligament does not return to original length |
| 3rd degree ligament sprain | from the end of plastic deformation to complete rupture |
| characteristic of ligament sprain | sudden mvment/force to jt followed by mild-severe pain, diff WB/ smb,pain subsides c rest, pain inc c motions that stretch lig, superficial ligament (MCL) direct pressure inc pain,varying swelling, HT adjacent mm, AROM pain end-feel if lig stretched. |
| ligament sprain treatment | cross-fiber friction when tolerable to stimulate collagen production in the damaged tissue in subacute or chronic phase, stretch mm in spasm c care not to irritate log, esp early stage mm protective, eval overstretched mm and strengthen |
| why lightly stretch in early stages of ligament sprain | not to irritate damaged ligament, mm tightness is protective to jt, mild stretching releases adhesions |
| what is primary function of muscle tendon | transmit the mm energy to the bone and create movement |
| muscle strain etiology | similar to sprain, most often occurs at musculotendinous junction, most often caused by eccentric action overload |
| characteristics of mm strain | similar to sprain |
| when is orthopedic assesment taken | before, during and after |
| orthopedic assesment | assess clients effectively an determine the best treatment approach, learning assessment, understanding options and effect |
| assessment vs dx | determine if massage is appropriate, ongoing process, gauge level of pain/ symptoms, I.E. provides baseline-monitors response, not exact science, no immediate assumptions-symptoms may mimic, think outside box using info about tissues, path, and conditions |
| soft tissue pathology onset | acute onset injury, chronic onset dysfunction |
| acute onset injury | occurs immediately after a traumatizing action, link btw the event and pain onset is direct, easier to identify because client remembers significant details about hte event |
| chronic onset dysfunction | repetitive or prolonged stress of structures, can happen over short or long period of time, a single movement does not produce the disorder, can be challenging to assess because it is harder to pinpoint their exact cause |
| orthopedic forms of tissue disruption | orthopedic pathologies are produced by mechanical disruption of tissue, neurological dysfunction or a combination. neurological dysfunction in CNS or PNS |
| neurological forms of dysfunction | neurological dysfunction in CNS or PNS, signals moving from CNS=efferent/mm contraction. signals moving from PNS back to CNS=afferent/pressure/temp/pain/prprioception. excessive neurological motor signals=HT mm/MFTP.deficiency of motor signal=atrophy |
| what are causative factors that produce neurological dysfunction without mechanical involvement | systemic disorders, nutritional imbalances, stimulant intake(such as caffeine) |
| soft tissue injuries result from | mechanical forces that overwhelm the strength and resilience of the tissues, postural adaptation |
| compression injuries | exert a force against each other, acute compression/contusion, meniscal damage, ulnar neuropathy, tension is a pulling force applied to tissue, shear sliding force btw tissue, torsion force applied rotary twist, bending is combo of compression and tension |
| tension compression injuries | muscle strains, tendinosis, ligament sprains, carpal tunnel, sciatica |
| shearing injuries | tenosynovitis, spondylolisthesis |
| torsion injury | applied to joints, knees, cruciate ligaments |
| bending injury | fracture |
| contractile tissue | actively engaged to create movement, mm and tendons (strains) |
| inert tissue | do not directly move bones, joint capsule, ligament, bursa, cartilage, fascia, dura mater, and nn (sprains) |
| CTS can mimic which two pathologies | TOS and pronator teres syndrome |
| where is the carpal tunnel located | volar part of wrist, bound b the carpal bones and the transverse carpal ligament |
| what does the transverse carpal ligament attach to | the pisiform and hamate on the medial side and the trapezium and scaphoid on the lateral side |
| what does the carpal tunnel contain | the median nn and nine tendons, all contained in a common synovial sheath |
| where is median nn compressed | under the transverse carpal ligament (flexor retinaculum) |
| CTS etiology | imflamm overuse, edema, woman more than men, acute injury/direct crushing trauma, chronic injury/occupational, structual changes, systemic conditions, along with UE problems, oval or square shaped wrist |
| CTS etiology chronic/occupational injury | use tools, computers, machines that req repetitive flexion and extension of the wrist |
| CTS etiology systemic conditions | gout, nn ischemia, DM, alcoholism, menopause, pregnancy, PMS, RA, Kidney failure, vitamin B6 deficiency |
| CTS characteristics | night symptoms, fibrosis proliferation tether median nn to adjacent structures, fibrosis & tendon thickening over time, sensory symptoms-digits 1-2-3, paresthesia, numb, pain, longer duration=longer recovery, gradually or suddenly=more sensory than motor |
| CTS characteristics 2 | tactile sensativity in fingertips, loss of grip strength, palp over tunnel inc sensation, HT wrist/finger flexors, fluid retention, TP's, atophy thenar mm, A/PROM pain end range flex/ext. MRT pain or weakness c resisted wrist or finger flex or thumb add |
| CST tests | phalens test, tinels sign, tethered median nn stress test |
| phalens test | + withing 60 sec |
| tinels sign | unreliable without other corroborating tests |
| tethered median nn stress test | ext and sup, index finger pulled into hyper ext |
| CTS treatment | writst splints, stretching, anti-inflammatory, Vitamin B6, reduce HT of wrist and finger flexors=deep long fx, pin and stretch, tendon glide. do not directly compress nn, MFR, TP=FCR, 1/3 below elbos crease, slightly lateral |
| flexor retinaculum | transverse carpal ligament |
| how many tendons pass through carpal tunnel | 9, all digitorum superficialis and profundus |
| which is most superficial structure in the carpal tunnel | the median nn |
| CTS is what kind of pathology | intrinsic, from internal factors rather than from force applied externally. ex: tenosynovitis, fluid retention, menopause, PMS, DM, heart disease, ganglion cyst, small tumors, gout, alcoholism, RA, vit B6 deficiency, kidney failure, work related |
| why are women more than men | type of work: data entry, food, cleaning jobs |
| characteristics of CTS | intermittent numb, paresthesia, pain in median nn distribution of hand digits 1,2,3. HT wrist and finger flex. palp fluid retention, worsen at night, dec in tactile sensitivity in the thenar mm(abd poll brev), longer duration of compression=longer recover |
| what are the several orthopedic tests for CTS | median nn compression test, phalens test, reverse phalens test, tinels sign, tethered test, o-ring test |
| median nn compression test | apply pressure to carpal tunnel and hold for 30 sec |
| AROM pain with CTS | end range of bothe flex and ext |
| phalens test | dorsum of the hand, 90 degree flex, are pressed together and exhibit sensory pain withing 60 sec |
| reverse phalens test | placing the hands in full hyperext (prayer position) with sensory pain felt withing 60 sec |
| tinels sign | lightly tap on the carpal tunnel, neurological symptoms are exhibited with each tap |
| tethered median nn stress test | wrist held in ext and sup while the index finger is pulled into full hyperext, hold 60 sec to reproduce pain |
| o-ring test | opposition of thumb/pinky-median nn feeds thenar eminence so may be weak |
| goals of tx CTS | dec swelling in carpal tunnem, dec pain, reduce HT wrist and finger flexors, reduce TP's |
| pronator teres syndrome | peripheral median nn compression btw the pronator teres mm which is HT or has fibrous bands |
| how many heads does pronator teres mm have | 2 through which the median nn travels in most people |
| what anomaly is in some people regarding the median nn | the nn travels deep to the two heads of the pronator teres mm and the nn gets compressed against the ulna |
| etiology of pronator teres syndrome | HT pron teres,tennis top spin forehand,hammer/painting, butcher, needlepoint, cont manipulation of tools, exacerbated by cont elbow flex, symptoms in forearm & hand, compress pron teres & CT same time, pain cause of fibrous bands in bicep brachii |
| characteristics of pronator teres syndrome | aching, shooting or sharp electrical tupe pain, paresthesia in median nn hand, felt in fa, no night pain, atrophy in thenar mm, TTP/HT pronator teres and forearm, AROM pain in advanced cases, PROM/MRT pain if wrist hyperext and elbow ext =nn stretched, |
| pronator teres test | elbow 90 degrees flexion, handshake, resist pronation, extend elbow |
| pronator teres syndrome tx | reduce compression on median nn at pronator teres, TPs, stretching, deep stripping or pin and stretch, contract-relax |
| what to PTS and CTS affect | median nn |
| etiology of PTS | HT of pronator teres, firbrous bands withing mm, anatomical anomalies where nn passes deep to mm and compression on ulna |
| characteristics of PTS | pain at prox attachment of mm at medial epicondyle of elbow, travel distal to the compression, mild or mod aching in fa, dull to sharp pain along sensory distribution of median nn(123 and part of 4),rep flex and ext of elbow aggravate, thenar atrophy |
| lacertus fibrosus | fibrous band from the bicep brachii mm attaching the tendon to the bicipital aponeurosis of the fa |
| 2 orthopedic tests for PTS | pronator teres test, pinch grip test |
| pinch grip test | client pinches thumb and index finger together without hyper extending the DIP jt of the index finger |
| PTS tx | reduce aggravating activities, massage HT flexors of hand and wrist and pronator teres, address other areas of compression, dont compress nn |
| what are the other areas to treat with PTS | path of median nn, btw ant and med scalenes, underneath the clavicle, pec minor, near the ant aspect of elbow and wrist at the carpal tunnel |
| difference between CTS and PTS | PTS + nn distribution & pain in forearm,+ HT pronator, etiology CTS=nn compress under carpal and fluid build up from intrinsic factors, PTS compress & HT under pronator, aggravated by CTS=hyper flex/ext or wrist, PTS=rep flex/ext elbow, rep pron of wrist |
| postural shoulder problems | elevated shoulders, slumped/rounded shoulders |
| elevated shoulders | unilateral or bilateral, chronic postural habit or psychological stress, HT neck/shoulder mm=lev and UT, tx postural re-ed, massage and stretch |
| slumped/rounded shoulders | unilat or bilat, chronic postural distortion, protracted shoulder & IR arm, freq c kyphosis & FHP, tx=-postural re-ed, massage, stretch internal rotators & protractors(pecs, lats, ant delt, teres minor, and subscap), strengthen weak rhomboids and mid trap |
| elevated shoulder target mm | levator scap and UT |
| slumped/rounded shoulder target mm | pec major/minor, lats, ant delt, teres minor and subscap |
| pec minor | stabilizes post scap mm otherwise they scap will drop everytime you contract, brachial plexus goes under pec minor |
| RTC mm | Supraspinatus, infraspinatus, teres minor, subscapularis |
| supraspinatus | adb, attaches superior greater tubercle |
| infraspinatus | ER, attaches middle greater tubercle |
| teres minor | ER, attaches inferior greater tubercle |
| subscapularis | IR, attches lesser tubercle |
| subdeltoid bursa | protects from wear and tear under glenohumeral jt |
| subacromion bursa | protects under acromion |
| TOS | entrapment of brachial plexus |
| landmarks to palpate shoulder jt | greater tubercle, bicipital groove, lesser tubercle |
| general massage for shoulder | conditions include cervical, upper thoracic, shoulder girdle and entire arm |
| suspected dislocation/subluxation | refer to MD |
| shoulder impingement syndrome | soft tissue compression btw coraco-acromial arch and head of huberu, caused by degenerative changes in compressed tissue |
| primary shuolder impingement | acromion process shape |
| secondary shoulder impingement | altered biomechanics, repetative movement |
| stages of shoulder impingement | S1=acute, S2=chronic, firbrosis and degeneration, S3=chronic possible tears and bone spurs |
| shoulder impingement HOPRS | H=rep movements, pain, weak.O=hyperkyphosis & FHP, scapulohumeral rhythm off, compensation and lack of smooth mvment.P=no pain c palp. R=A/PROM pain c abd and flex MRT pain/weak abd and flex.S=hawkins kennedy imping test, empty can test, neer impinge test |
| treatment of shoulder impingement | avoid offending activities, tx tissue, dec HT and TPs, long stip mm, deep fx tendons, strengthen subscap, abd arm in alignment c Gh jt, correct biomech imbalances |
| RTC Tendinosis and tears | collagen degeneration from repetative or excessive stress. usually starts as low level tendinosis and progresses but can be acute, freq impinge involved, usually supraspinatus, infra and teres usually by tensile stress, rarely subscap |
| RTC HOPRS | H=prev trauma rep movement, impingement, pain deep in shoulder. O=pain avoid and compensation. P=tender/pain when touched, fibrosis, thickening tissue, HT. R=A/PROM pain unlikeley except c supraspinatus-pain c abd, pain c flex=impingemet also.S=drop arm |
| treatment of RTC tendinosis and tears | stop offending activities, rest tissue, dec HT, tx TPs, deep long stretch, pin and stretch, passive or facilitated stretch to affected mm, deep fx tendon, correct biomechanical imbalances |
| the condition known as later humeral epicondylitis is commonly associated with | playing tennis |
| the proper position to work a client with tennis elbow would be | supine with arm pronated |
| in treating chronic tenosynovitis what is your primary goal | free adhesions |
| the best stroke for chronic tenosynovitis is | friction |
| a patient has injured the olecranon process as a result of excessive hammering during home renovations the mm most likely affected is | triceps |
| with shuolder bursitis the most pain is felt during | abduction |
| during active ROM, but not during PROM, your client experiences pain, what structure is involved | mm and tendon |
| what is the best stroke for working around joints | friction |
| the proper treatment for acute bursitis | apply ice |
| a client has limited horizontal shoulder abd which mm can restrict the action | pec major |
| what is the best stroke to milk the mm | petrissage |
| how would you treat HS | knees bent |
| a technique used to locate TPs | skin rolling |
| effleurage and petrissage to the lower limbs would be most effective for which of the following conditions | flaccid paralysis |
| the best treatment for acute neck strain is | wait until the acute phase subsides |
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mloft
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