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TreatmentsTT2 Review
CanColl May 2012 Treatments TT2 Review
| Question | Answer |
|---|---|
| What location is tendinitis most likely to occur at? | avascular part of the tendon |
| What are the causes of tendinitis? | Trauma, strain, and Fatigue - excessive or unaccustomed exercise. Note:Degeneration and reduced vascularity of tendons tend to occur after the 3rd decade. |
| What assessments are used to determine the presence of tendinitis? | Pain on palpation, Pain on resisted action and Pain on stretch |
| What causes can lead to Supraspinatus tendinitis? | Overuse of arm (esp abduction), carrying heavy objects, overhead use - sports or occupation,calcium deposits, direct irritation (sling,strap,etc) |
| What especially can lead to supraspinatus tendinitis in the elderly? | A degenerative lesion due to hypovascularity. |
| Where can the pain radiate to with Supraspinatus tendinitis? | Pain may radiate into the Deltoid and/or the neck. |
| Which pathologies can occur following Supraspinatus tendinitis? | If left untreated, it can result in Subacromial or Subdeltoid bursitis or Immobility (aka adhesive capsulitis) |
| Why is Painful Arc test painful in the presence of Supraspinatus tendinitis ? | The test creates pressure on the structures between the GT and the Coracoacromial Arch. This where the Supraspinatus tendon is located. |
| What is the position for frictions to the Supraspinatus tendon and why? | Humerus is internally rotated & adducted - allows access - in neutral position - no sheath. |
| Which orthopedic test can be prescribed as a remedial exercise for Supraspinatus tendinitis? | Lower Apley's - to stretch the tendon |
| Name 3 causes of Long Head of Biceps tendinitis. | Overuse of shoulder in flexion, injury or stretching of transverse humeral lig or direct trauma. |
| Which tests identify Long Head of Biceps tendinitis? | Speed's and Yergason's - also A,P,R testing |
| What is the arm position for frictions to the Long Head of Biceps? | Shoulder and elbow are extended with forearm in pronation. Stretch - there is a sheath. |
| Which conditions leading to Long Head of Biceps tendinitis may require surgery ? | Deformation of the bicipital groove or injury to the transverse humeral ligament. |
| Tendinitis of the short head of Biceps can be due to overuse in which position? | Shoulder and elbow flexion and forearm supination. |
| Which synergists should be treated when treating short head of Biceps tendinitis? | Brachioradialis and all MM's involved in flexion and supination. |
| Which antagonists should be treated when treating short head of Biceps tendinitis ? | Triceps brachii and posterior deltoid |
| What are the first remedial exercises used to maintain ROM in tendinitis of biceps Brachii? | Pendulums to maintain and increase ROM and wall walking |
| Origin of Abductor Pollicis Longus | middle 1/3 post radius, interosseus membrance and ulna |
| Insertion for abductor pollicis longus | Base of 1st metacarpal |
| Action of abductor pollicis longus | Abduct and extend thumb at CMC joint + radially deviates hand at wrist |
| Origin for Extensor pollicis longus | Post aspect of middle 1/3 of ulna and interosseous membrane. |
| Insertion for Extensor pollicis longus | Base of distal phalanx of thumb. |
| Action for externsor pollicis longus | Extend thumb at CMC, MCP and IP joints + radially deviates hand at wrist |
| Origin of extensor pollicis brevis | distal 1/3 post. radius and interosseous membrane. |
| Insertion for extensor pollicis brevis | base of proximal phalanx of thumb |
| Action for extensor pollicis brevis | abduct and extend thumb at the CMC joint |
| What is the intersection syndrome? | It occurs where abductor pollicis longus and extensor pollicis brevis cross over extensor radialis brevis and longus - about 4cm prox to wrist |
| Where is pain most usually felt with DeQuervain's tenosynovitis? | one cm prox to the radial styloid process |
| What actions cause pain with DeQuervain's? | Repetitive thumb use, repetitive ulnar or radial deviation, resisted use in gripping. |
| What assessments are used to detect the presence of DeQuervain's? | A.P.R. testing, Finklestein's Test. |
| What hydro is appropriate for chronic DeQuervain's? | Ice or vascular flush (mostly cold) |
| What is the recommended position for frictioning abductor pollicis longus and extensor pollicis brevis tendons? | Slightly flexed. |
| What other tendons in the hand can be affected by tensynovitis? | Any of the tendons in the wrist and fingers. |
| What muscles originate in the lateral epicondyle of the humerus? | Extensor Carpi Radialis Longus and Brevis ECRL and ECRB |
| Name 5 causes of lateral epicondylitis. | Overuse of wrist in extension, any grasping activities, racquet sports (backhand), hammering, writing, massage. |
| Where does pain most frequently occur with tennis elbow? | Lateral epicondyle |
| Which remedial exercises are appropriate for tennis elbow? | Stretch extensors, grip and flip - progress to resisted extension. |
| What does a tendon strap do? | Pins the tendons in place - MM's exert pull on different location - reduces tendon strain. |
| Which forearm MM's should be massaged when treating tennis elbow? | ECRL, ECRB and supinator |
| Which MM's originate at the medial epicondyle of the humerus? | Flexor carpi radialis (FCR), flexor carpi ulnaris (FCU), palmaris longus |
| Name 5 activities that can cause golfer's elbow. | Racquet sports (forehand), golf, driving a vehicle w/o power steering, massage, hammer/screwdriver. |
| Where is the pain usually located with medial epiconylitis? | at the medial epicondyle (who'd a thunk it!) |
| What neuropathy can occur following golfer's elbow? | ulnar neuropathy |
| What are the symptoms of Ulnar Neuropathy? | Weak grip and weak ulnar deviation |
| Which two tendons are most likely to suffer micro tearing with golfer's elbow? | The common flexor tendon and the pronator teres tendon. |
| What steps are necessary to locate a tendon adhesion? | 1. locate using bony landmarks 2.isometrically contract the effected MM 3.palpate for the tender lesion site in the tendon. |
| What does the client need to commit to in order to maximize their chances of a successful course of treatment for tendinitis? | rest from function and regular treatment |
| Why stretch after performing frictions? | to maintain flexibility - normalize tissue length and realign fibers. |
| When can ice massage be used on tendinitis | in chronic stage - if there is no visible swelling. |
| Tension headaches can be due to TPs and hypertonicity in which MM's? | SCM, Upper Traps, Splenius Capitus, Sub Occipitals, Temporalis |
| Name 3 causes of cervical muscle hypertonicity. | Stress, injury, subluxations, TPs, poor posture, TMJ dysfunction |
| What is the referral pattern for SCM? | Above the eye, into the cheek and mastoid |
| What is the referral pattern for splenius capitus? | centre of the top of the head |
| What is the referral pattern for the sub-occipital group? | band along the side of the head |
| What is the referral pattern for temporalis? | superiorly from the TP - up the side of the head. |
| What are the characteristics of headache due to muscular tension? | aching throbbing pain, usually bilateral, related to TPs, usually worse late in day. |
| What painful tech should be avoided during a tension headache? | trigger point release |
| describe the components of massage for Tension headache. | rhythm - soothing, rate - slow, duration - 30 minutes, pressure - light, direction - centripetal |
| How does a treatment between headaches differ from one during a headache? | During - dec pain & relax only Between - inc circ, release TPs, dec adhesions, stretch affected MM's |
| How does a classic migraine differ from a common migraine? | Classic = preceded by aura, usually unilateral. Common = no aura, usually bilateral |
| Describd the vascular changes leading to a migraine | AURA - inc seratonin then vasoconstriction = dec blood flow to brain. HEADACHE - dec seratonin then vasodilation = inc circ = severe pain |
| Name 6 migraine triggers. | food related allergies, environmental allergies, hormone changes, barometric changes, external stimulii (paint, light, perfume...) changes in blood sugar. |
| Name 3 symptom of a migraine aura. | alteration in senses, sensory hallucinations, equilibrium disturbances, craving for carbs. |
| What symptoms are apparent post-migraine? | skull, face & neck sore (from guarding), fatigue, edema in extremities. |
| Which assessments should be performed on a client who has just finished having a migraine headache? | ROM, vertebral artery, compression & distraction. |
| What hydro is appropriate after a migraine? | Stim - contrast bath, heat to HT areas to dec tension. |
| What type of massage is appropriate during a migraine, if your client managed to drag themselves to their appointment? | Usually a CI. If possible - only slow, rhythmical work - very superficial. No prone. |
| Name the sinuses. | Ethmoid, frontal, maxillary, sphenoid. |
| Which sinuses drain upward? | Maxillary |
| Name 4 causes of sinusitis. | Viral infection, bacterial infection, change in barometric pressure, inc in pressure (airplane), allergies. |
| What techniques are appropriate onsite for sinusitis headache? | pressure points, vibrations, drainage, neck mobs, light tapotement (tapping) GTO to sub-o's |
| What assesments are used for a suspected sinus headached? | forward flexion test and palpation of sinuses. |
| What contraindicates treatment for sinusitis? | Fever |
| What types of hydro are appropriate for sinusitis? | During headache - cold compress. Between headaches - heat on cervical region, steam inhalation. |
| Why is PROM to the neck important when treating sinusitis? | Neck will often be stiff due to guarding - also PROM will encourage drainage |
| Name 3 symptoms of TMJ dysfunction. | muscular tenderness, decreased ROM, dull ache in jaw, crepitus |
| Name 5 causes of TMJ dysfunction. | trauma, bruxism, stress, uneven dentition, mm imbalance, infection, sinus blockage |
| What should you ask your client before performing intra-oral massage? | specific consent must be obtained |
| Why should you face your client during intra-oral massage? | So you can constantly monitor their progress and remove your hand immediately if necessary |
| Describe how you would perform inferior traction to the mandible. | thumbs on each side on top of lower teeth and press jaw down towards feet |
| What is the origin of temporalis? | temporal fossa |
| What is the insertion of temporalis? | coronoid process of the mandible |
| What is the action of termporalis? | elevate and retract mandible |
| What is the origin of Masseter? | zygomatic arch |
| What is the insertion of Masseter? | angle and ramus of mandible |
| What is the action of masseter? | elevate mandible |
| What is the origin of Medial pterygoid? | sphenoid and maxillary bones |
| What is the insertion of medial pterygoid? | internal surface of mandible at the angle and inferior surface of ramus |
| What is the action of medial pterygoid? | elevate mandible, protracts and contra lateral deviation |
| what is the origin of lateral pterygoid? | sphenoid bone |
| What is the insertion of lateral pterygoid? | neck of mandible and capsule & articular disc of TMJ |
| What is the action of lateral pterygoid? | protracts and contr lateral deviates mandible. |
| What is the origin of digastric? | mastoid process |
| What is the insertion of digastric? | inferior border of mandible |
| What is the action of digastric? | depress mandible (with hyoid fixed) or elevates hyoid (with mandible fixed) |
| How to you palpate the TMJ itself? | palpate outer portion of auditory canal while client opens and closes mouth |
| How do you differentiate a strain from a sprain? | Strain = overstretch of muscle/tendon Sprain = tearing of lig or joint capsule |
| What type of fracture can occur with a 3rd degree sprain? | Avulsion fracture |
| Why is an x-ray necessary within the 1st 24 hours of a severe strain or sprain? | To ensure that there is no fracture or damage to the joint. |
| What percentage of muscle fibers are torn with a 1st degree strain? | None |
| What are the individual actions of the 5 adductor MM's? | Adductor brevis, longus and pectineus - adduct plus flex hip. Gracilis = only adduction. Adductor magnus adducts and extends hip. |
| What techniques are appropriate for an adductor if the muscle bellies are too sore to be worked on directly? | GTO, O & I, reflex |
| What overstretch can cause an adductor strain? | forced extension & abduction |
| What type of fall will most commonly cause a wrist strain or sprain? | fall on outstretched hand = hyperextension |
| What type of assessment can indicate the degree of a sprain? | amount of pain, ROM, amount of swelling/bruising |
| What is the progression of remideal exercise for a wrist strain? | passive exercise during Tx, then Active ROM, progress to gentle stretch, isometric strengthening, wrist curls/ball squeezes |
| What type of hydro is appropriate for an acute wrist sprain? | RICE |
| What are the symptoms of a 2nd degree strain? | Pain/swelling, short term loss of Fx, point tenderness. |
| Why are joint mobs to prox and distal joints more appropriate than stretches when treating a wrist strain? | Because the wrist joint itself will be hypermobile because of the overstretch |
| Where are the supraspinous, interspinous, intertransverse, lumbosacral and illiolumbar ligaments located? | Lumbar region |
| What type of pain typically accompanies a lumbar strain or sprain? | straight across the back, may radiate to gluteals |
| What symptoms (other than pain) are present at a lumbar strain or sprain? | spasm, client walks slightly flexed at waist |
| What type of movement can relieve the pain of lumbar strain or sprain? | rest and slightly flexed at waist |
| What types of assistance can a client with lumbar strain or sprain require? | assistance to get on table and assistance to turn from prone to supine. |
| What types of remedial exercise are appropriate for a lumbar strain or sprain? | gentle pelvic tilts, knee to chest stretch, seated back stretch, deep breathing |
| What types of movement can cause SI sprain? | extension esp with rotation, coming out of flexion or going into extension, lifting and turning at the waist, during pregnancy (lax ligs) |
| Where are the Sacrotuberous ligaments located? | Between the ischial tuberosity and the sacrum |
| What positional clues can indicate an SI sprain? | bent position - can't straighten up |
| How can the therapist differentiate SI ligament injuries from disc injuries? | When the ligs are torn, there is no weakness or paresthesia in lower extremities as there is in disc lesion. |
| What orthepedic tests are used to differentiate disc injuries from SI ligament injuries? | Kernig Test, Valsalva's, FABER, Kemp's, Gaeslen's, Thomas, leg length measurement tests. |
| Where is the referred pain located for SI ligament upper fibers? | lat post thigh, ant thigh to patella, lat leg towards malleolus |
| Where is the referred pain located for SI ligament lower fibers? | post thigh. post lat lef, laterally below malleolus to 5th digit |
| Where is the referred pain located for the iliolumbar ligament? | to groin, anteromedial upper 2/3 thigh, lower abdomen, testes/vagina, upper buttocks, sup lat thigh. |
| Where is the referred pain located for the sacrospinous ligament? | central post thigh, central post calf, beneath heel |
| Where is the referred pain located for the sacrotuberous ligament? | same as sacrospinous ligament |
| What TPs can be associated with SI pain? | Glute max and med - into sacrum glute min - into butt and lower leg |
| What TP's mimic sciatic pain? | Quadratus lumborum - into butt, soleus to SI joint, multifidus to sacrum |
| What is the origin for iliopsoas? | T12 - L5 and internal surface of ilium |
| What is the insertion for iliopsoas? | lesser trochanter of femur |
| What is the action of iliopsoas? | flex hip |
| What can cause contracted ilipsoas? | cycling, prolonged sitting, forced extension, scoliosis, too many situps, tight erector spinae, hyperlordosis |
| What positional clues can indicate a shortened iliopsoas? | client holding thigh in flexed, abducted position |
| What pillowing is suggested when treating shortened or strained iliopsoas? | pillow under hip to accomodate flexion |
| Where is iliopsoas palpated? | between the ASIS and umbilicus |
| What type of stretch is a remedial exercise for a strained iliopsoas? | Fencer's lunge or kneeling lunge |
| Why should both sides be treated when only one psoas muscle is contracted? | To reset compensating mm |
| What is the origin of the IT band? | Glute max and TFL |
| What is the insertion of the IT band? | lateral condyle of tibia |
| What can cause a contracted IT band? | prolonged bed rest, wheel chair, pregnancy, pelvic misalignment, horseback riding, activies that flex knee and hip (most sports) |
| What is IT band friction syndrome? | inflammation with Px where IT band crosses lateral femoral condyle |
| Where is the pain located with a contracted IT band? | Lateral thigh into lat aspect of knee upon palpation. |
| Where is the pain located with IT band friction syndrome? | directly over the lateral femoral condyle |
| Why is it important to carefully assess SI function when treating a contracted IT band? | possible SI joint dysfunction |
| What postural changes are noted with a contracted IT band? | valgus knee, hyperlordosis |
| Which techs are indicated for a contracted IT band? | GSM, fascial, bowing, stripping, frictions, drainage. |
Created by:
Hanz Onn
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