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NYCC Homack final
NYCC TCH6706 Homack LECTURE final lower extremites
Question | Answer |
---|---|
Colle's fracture | radial head FOOSH |
Post concussion syndrome | Head trauma: balance, proprioreception, abnormal gait, memory |
Litigation neurosis | see previous notes |
DARRACH procedure | Removal of distal ulna/ulnar styloid |
Complications of Darrach procedure | AVN, Altered hand movement, Ulnar impingement syndrome, distal forearm pain |
MI CHAM (mee-cham) | Causes of NON pitting pedal edema: Milroy's, Infection, Congenital, HypOthyroid, Allergy, Malignancy |
Milroy's | SWELLING secondary to blocked lymph |
Infection causing non-pitting edema | filariasis - tropical parasite |
HypOthyroid edema | myxedema |
**Reflex Sympathetic Dystrophy aka: | Complex Regional Pain Syndrome type-I {CRPS-I} & SUDEK'S atrophy (German speaking countries) |
"burning, red hot file rasping the skin…glossy" | RSD Civil War description |
Presentation of RSD | Burning, hot swelling, red. Inc or dec sensation, Inc Temp, Pain, Stiffness, Narrowed digits, Allodynia, GLOSSY HAIRLESS SKIN |
RSD theory #1 | Failure of normal sympathetic arc to shut down |
RSD theory #2 | Reverb signal to spinal INTERNUNCIAL POOL (connected spinal neuron pool for reflexes) w/ volleys of impulses up & down spine |
RSD theory #3 | Injury to peripheral n. w/ hypersensitivity to circulating NE, pressure, movement |
RSD theory #4 | Articular synapse causing short circuit of peripheral n. |
RSD theory #5 | Nocicpetor responses assoc. w/ TRAUMA = long term SENSITIZATION of dorsal horn, inc. firing results |
RSD theory #6 | Recessive gene predispositon to NEUROPATHIC PAIN (damaged nerve fibers send distorted signals) |
RSD theory #7 | Neurochemicals released at peripheral n. endings causing vasospasm, vasoedema, pain = inflammation |
RSD theory #8 | Dysfunctional opiate system |
RSD theory #9 | Immune factor causing nerve inflammation, dormant virus (like herpes zoster causes shingles) |
3 stages of RSD | ACUTE DYSTROPHIC ATROPHIC I, II, III |
Stage of RSD at which 50% will have permanent disability | ATROPHIC III |
Stage of RSD w/ HYPERPATHIA + rubor, soft edema | ACUTE RSD - buring pain, HYPERPATHIA, rapid hair and nail growth, decreased sweating, inc temp and blood flow |
ALLODYNIA | painful (noxious) response to stimulus that is usually NON painful (innocuous) = DYSTROPHIC stage of RSD |
Stage of RSD w/ BRAWNY edema and Preoccupation of protecting injured limb | DYSTROPHIC RSD- ALLODYNIA Cyanotic, brawny edema, PROFUSE SWEATING, SLOW hair/nail growth, early Osteoporosis, Dec temp |
HYPERPATHIA | Abnormally exaggerated subjective response to PAINFUL stimulii = ACUTE RSD (opposite of allodynia, dystrophic rsd stage) |
Stage of RSD of the FROZEN, USELESS limb | ATROPHIC (stages I,II,III w/ III being permanent disability in 50%) - Chronic, persistent changes in skin/mm, Pericapsular fibrosis, osteoporosis, Atrophy |
What is a definite char. of ATROPHIC RSD | Atrophy |
Buzzword ACUTE r.s.d. | HYPERPATHIA & BURNING |
Buzzword DYSTROPHIC r.s.d. | ALLODYNA, SWEAT, PREOCCUPATION, BRAWNY EDEMA |
Buzzword ATROPHIC r.s.d. | ATROPHY, FROZEN |
Tache cerebrale | RSD: autonomic dysfunction = red lines (erythematous) persisting 15-30 sec. after blunt object stroke |
THERMOGRAPHY | RSD: shows heat distribution patterns, good for d/dx RSD |
MD tx for RSD | sympathectomy, pain block, modulate spinal cord pain area |
CHIRO tx for RSD | Mobilization, Analgesics (co-tx), Sympathetic block, passive ROM, manip, mm stim, maintain flex, strength, pain control, wet clothes |
Why is exercise important for RSD | Improves neuromuscular pattern, otherwise pt leaves extremity immoble >> neg cascade of disuse |
Physiologic tests for RSD | SSEP (to show elect potentials of nerve to brain), THERMOGRAPHY, emg, ncv, function test |
RSD test which shows glove like hypothermia | THERMOGRAPHY |
Heat distribution patterns of thermography {3} | Physiologic process, Vertebral subluxation, Autonomic nerve dysfunction |
Thermography measures (2) | 1. Pathoneurophysiology 2. Compare bilaterally 3. HYPO or HYPERthermia |
ABNORMAL thermography finding | greater than 1* C of change |
Caused by INcreased sympathetic post-gang | |
HypERthermia is caused by | DEcreased sympathetic activity - blocked alpha receptors cannot control heat so out of control |
Pathologic thermography findings usually | hypOthermic |
Thermographies do NOT follow (2) | peripheral nerve patterns nor dermatomes |
Dermal skin MICRO circulation | RSD: controlled by skin chemical mediators and sympathetic autonomics |
How does diffuse regional hypOthermia occur? | RSD: after acute injury, SNS hyperfunctions >>> continuous VASOSPASM >> hypOthermia |
How can entire region become hypOthermic? | RSD: 1 post gang fiber from cord can synapse w/ 100 post gangs at paravertebral chain gang to alter T* of entire region |
6 stages of healing | cure care quality empowerment enlightenment soul |
D/dx RSD edema | MI CHAM for non-pitting lower limb edema |
1+ pitting lower edema | RSD: 2mm MILD, slight indentation, NO perceptible swelling of leg |
4+ pitting lower edema | RSD: 8mm DEEP pitting edema, indentation lasts long time 2-5 min, leg is VERY swollen |
Explain heart/liver/kidney PITTING edema | PITTING edema: salt retention > water retention > water follows salt into tissues > edema |
Fibromyalgia FM aka: | symmetric myofasciitis |
Describe FM points | Bilateral: need 11/18 tender spots to diagnose FM |
Which rib is tender in FM | 2nd rib |
Sx of FM | Lower pain threshold, fatigue, paresthesias, headaches, Females w/ generalized musculoskel complaint |
Theories of FM origin | D: O2 - I: Sub P (ischemic irritant) - D: serotonin - I: Sleep disorders – 25-50% LYME dz |
MUSCLE PAIN greater than fatigue | Fibromyalgia |
fatigue greater than mm pain | chronic fatigue syndrome |
Med vs Holistic FM tx | MD: antidepressants vs. Holistic: Knox gelatin sprinkled on food |
Raynaud's phenomenon | CT disorders (scleroderma, lupus), Vibrating machinery (pianists, typists), Cold/damp exposure |
Raynaud's DISEASE | idiopathic (triggered by cold) |
LEAD poisoning nerve | RADIAL |
Radial nerve poisoning sx | WRIST DROP w/ NO loss of sensation |
Why is RADIAL nerve susceptible to lead poisoning | Rich vascular supply |
Compression of the radial nerve at the AXILLA | radial nerve PALSY |
PSORIASIS etiology | LARGE intestine (elimination prob), NERVOUS, ILLNESS |
PSORIASIS appearance | SILVERY SCALES, red patches on EXTENSOR surfaces |
PSORIASIS tx | Pagano book, White flours, Proteolytic enzymes, Vit A & B6, Eliminate nightshades* |
potatoes, tomatoes, eggplant, sweet &hot peppers | Nightshades to eliminate if have a psoriatic patient |
URIC acid build up | GOUT – hot swollen painful joints, esp big toe |
GOUT is a PREcursor to | HEART dz |
Foods to limit w gout | PURINES, seafood, ALCOHOL (beer has purines), oats, beans, peas, lentils |
GOOD GOUT foods | water, low fat dairy, low-purine foods |
Uric acid can be reduced by foods, but what's more important? | Gout depends on how well the KIDNEYS process uric acid |
Intense pain of local dermatome, blisters | SHINGLES dormant herpes zoster |
meds that PROLONG shingles attack | acetaminophen |
SLE sx | DISCOID rash (malar) in BUTTERFLY pattern. Hair loss. Oral ulcers. |
SLE Patient | 80% female. Auto-immune, chronic inflammatory dz |
SLE tx | Ca+ and Mg+. Corticosteroids (side effects;-( |
ABC'S – which is most important? | Agility Balance Coordination Skills = BALANCE most important |
5 biomotor skills | Speed, Strength, Endurance, Flexibility, ABCS |
Endurance AEROBIC work capacity | Oxygen. Exercise/work forcing heart and lungs higher. Measured by O2. Running, swimming, etc. |
Endurance Anaerobic work capacity | Absence of oxygen. Exercise/work that doesn't require inc oxygen. Wight lifting, isometrics, office work |
Stores of potential energy | Elastic properties of ligaments and tendons |
Stretch reflex (flexibility) includes: | MYOTOTIC reflex, ELASTIC properties of ligaments and tendons |
BALANCE most important ABCS | helps prevent injury, is basis for all ABCS, lifelong |
BIOMOTOR ABC's attributes – most important? | Active participation – Multi lateral development – Specialization – Individualization – Variation – Modeling – PROGRESSIVE OVERLOAD |
Progressive Overload | imporve quality and quantity of work – work hardening (avoiding plateaus) |
Process of restoring someone to useful life | REHABILITATION (...who has been ill, injured or otherwise handicapped.) |
4 goals of REHAB | 1.IMMEDIATE care 2.RESTORE 3.TEST to return to activity 4. RESUME training for occupational demands/lifestyle/performance |
Goal #1 rehab = Immediate care | Immediate care: Reduce swelling, RICE, Limit deconditioning ***** |
Goal #2 rehab = Restore | Restore: ROM, Strength, Balance, Endurance, Muscle contraction **** |
Concentric | FLEXION acclerated mm contractions |
Eccentric | LENGTHENING ligament and tendon strength |
Isometric | STABILIZING also tendon and ligament strength |
Goal #3 rehab = Test to return | TEST to RETURN to activity – normalize balance, proprioreception, and strength |
Goal #4 rehab = Resume | RESUME training for life activity |
Methods of athletic conditioning where stellar ...goal | ELITE sport science |
Eval of the adaptive levels of the body's sys to handle greater stresses | and the goal being ever increasing athletic performance – ELITE sport science |
How is ELITE sport science accomplished? | Athlete's BIOMOTOR skills (endurance, flexibility, speed, strength, ABC'S = agility balance coordination skill) |
Greatest rehab challenge | lack of patient compliance |
ANOMIE | personal feeling of a lack of norms; NORMLESSNESS |
examples of situations that created ANOMIE | NOPD during Katrina, Stock market crash |
Alienation examples | Abusive working conditions, Dehumanization |
How to calculate cost per square foot | total cost of rent per year/square feet |
ACCELERATED recovery | attention anything that creates an OPTIMAL HEALING STATE in the body naturally |
Accelerated recovery aka | FORCED recovery – more productive weeks, months, or years of life |
YAKOLEV's model | STRESS REST ADAPTATION |
X axis on Yakolev | time and homeostaXis = phyXiologic balance point of body (pH, dehydration, glucose, O2, core temp) |
(+) y axis | IMPROVED physical state = healing, adaptation, performance |
[-] y axis | fatigue, decreased performance, illness, injury |
Multifactorial, protective mechanism of body | FATIGUE - affects body systems differently |
Yakolev model “S” curve to LEFT on X axis? | IMPROVED physical state SOONER w/ accelerated recovery |
Uses the body's natural rhythms to return body to BMR asap | ACCELERATED recovery (using sleep, hydration, diet, circulation, respiration) |
Overreaching | Programmed increase in volume, intensity or frequency (10% rule) = GOOD |
Overtraining | BAD. NON-functional = fatigue that won't go away; can lead to overtraining syndrome. |
FUNCTIONAL overREACHing | GOOD! Training load paired w/ APPROPRIATE recovery. Ready to go again! |
Describe overTRAINING syndrome | |
Overtraining pushes the Yakolev curve | DOWN (solid red line) |
DOWN curve on Yakolev means | non functional overreaching that results in overtraining syndrome – NO RECOVERY time. Diminishing returns. |
BOMPA's sx of overtraining (OT) | mimics MVA concussion, depression (physio, psycho, immuno, biochem/hormonal crashes) |
Canadian OT scale | good: normal and reversible in short term. Bad: Chronic fatigue/overtrain. Not reversible in short or mid term. Too late! |
How long is CFS | 6+ months |
Norm time HEART recovery | 20-60 min |
Norm time STRENGTH recovery | 2-3 days |
Norm time CNS recovery | 7x muscular system (mm is 1-2 days) |
Morning pulse CFS indication | AM pulse 10% over baseline |
Difference in heart rate CFS indication | Supine to Standing differs 8-16 BPM |
pH urine test CFS indication | ALKALINE morning pH of urine |
1% dehydration means | 2% decrease in optimal performance |
#1 indicator of proper HYDRATION | CLEAR urine |
Outlier effect of dehydration | FASTER reaction time |
F=Ma | More mass, more force |
What is absorbed by the vehicle versus transferred to occupants | force TRANSFER |
When the vehicle collapses into the occupants | Intrusion PROTECTION |
Speed threshold for MVC injury is | 5 mph |
Most dangerous drivers | |
leading cause of unintentional death in 14 and under | MVC (2/5 of teen deaths are MCV related) |
Men are 2x as likely to die in MVC. Why? | Because they drive more often and farther from home |
Female drivers have a greater # of | minor crashes because they drive shorter distances and stay closer to home |
Men are ___% more likely to be in a serious crash. | 70.00% |
Highest speed related fatalities state | SOUTH Carolina |
Safest day of week to drive | Tuesday |
Percent of speed crashes on a CURVE | 40.00% |
Percent of fatal speed crashes w/ ALCOHOL | 41.00% |
What's a more prevalent cause of crashes than alcohol? | SLEEPINESS |
5 basic TYPES of crashes | Frontal/offset, Side Impact/T-bone, Rear end, Rollover, Sideswipe |
Most common MCV of 5 basic types | FRONTAL & SIDE IMPACT |
Which of the 5 MCV's causes greatest injury and why | REAR END (due to SHEAR forces) |
Why retake films if MCV pt suffering sore throat | RETROPHARYNGEAL BLEED |
Human error causes 93% of MCV. MAIN causes? | CELL PHONE and TIRED DRIVERS (more than DWI in both cases) |
Reflex, Simple, Complex, Discrimination | REACTION TIMES (discrimination between unfamiliar 2 options takes +1.0 sec) |
Avg reaction time in MVC | 1.5-3.2 sec |
Avg stoppage time between cars | 40-100 yds (football field) at 60mph/88 ft/sec |
BRACING for impact ________ head/neck injury | DECREASES |
drivers or passengers have fewer injuries? | DRIVERS |
Most frequently injured upper extremity peripheral n. | RADIAL |
Most frequently injured lower extremity peripheral n. | PERONEAL |
Energy absorption limit of SEAT | speeds greater than 25mph |
Females are more likely to suffer a _____ | CAD |
Males are more aggressive; more likely to die in MCV. | |
Car seat backs were designed for ___ % of pop. | 90.00% |
Head travels at a rate of | 100,000*/second: 1400 mph |
Sx of MCV often not immediate due to | SHOCK |
Safest cars | full frame 4 door full size station wagon (no longer made) |
Kind of collision that transfers force to occupants | LOWER speed |
Leading cause of Head and Brain injuries | CAR accidents |
Coup-contre coup injury | brain slamming against inside of skull in acceleration/deceleration (whiplash) |
preferred imaging for MCV | CT acute, MRI later (for chronic hemorrhage) |
contusion or concussion | brain bruised by striking cranium |
anoxic brain injury | injury disrupts blood flow to brain |
skull fx | break in surrounding bone – will heal but if tissue damage, need surgery |
Coup-contrecoup | brain propelled against both sides of skull – REBOUND (mc is front to back) |
Diffuse axonal injury (DAI) | rotation and disruption of brain SEVERS or shears NERVE FIBERS or axons. |
Most difficult d/dx brain injury MCV | DAI – microscopic. Mild brain injury or could be severe and permanent disability. No tx. |
Damage to axons in DAI | First 12-24 hours after injury |
Epidural hematoma | blood between skull and above (top lining) of dura = pressure |
Subdural hematoma | blood accumulates between brain and dura (below dura) |
ORDER of WHIPLASH sx *** | NECK pain > stiffness. TRAP pain. HEADACHE. INTRA-SCAPULAR pain. BACK pain. PARESTHESIA. EXTREMITY pain and weakness. |
Order of secondary whiplash sx *** | DIZZINESS – injury to SCM. FACIAL pain. AUDITORY sx. VERTIGO. OCULAR dysfunction. DYSPHAGIA/HOARSEness |
Post Concussion Syndrome is a | SOFT head injury (blunt, non-penetrating trauma to brain) – DAI (shaken brain.) SPORTS, MCV, CHILD abuse. |
20% of returning Iraq vets have | Post Concussion syndrome (a DAI) called the 'invisible injury' |
Characteristics of PCS | Depression, phono and photophobia, outbursts, mood swings, neck pain, impaired comprehension |
recent imaging very sensitive to damage to WHITE matter | DIFFUSION TENSOR IMAGING (DTI) for post concussion syndrome because MRI scans are normal |
PCS victims have a higher incidence of | STROKE |
PCS signs are similar to | LITIGATION NEUROSIS |
Odd sign of TMJ | FULLNESS or RINGING in the ears |
MCV Clay Shoveler's fx of C-spine | REAR END or HEAD ON hyperflexion – spinous process fx |
MSTM | My Stupid Teaspoon is Missing |
UNCINATE process fx MCV | rare: hyper LATERAL flexion – side impact crash. FOOSH happens w/. |
What does DJD from MCV look like over time on film | Long uncinates, reduced IVF's, bilateral numbness |
SEATBELT hyperflexion spine fx from MCV | WEDGE or COMPRESSION fx – hyperflexion during rear-end or head-on collision |
Hyperextension of wrist inc pressure by | 3x |
First mm affected w/ carpal tunnel syn after FOOSH | Abductor pollicis brevis (innervated by MEDIAN n. ) |
How seatbelt causes TOS from MCV | pressure of shoulder strap across TOS in MCV |
Is treatment outcome any different for people w/ LITIGATION NEUROSIS | No. Sue or don't sue, but the chronic pain stays put. |
Prognosis of MCV injury | 54-61% never fully recover. 6-9% become chronic pain patients. |
CHIRO tx for MCV | Soft tissue (ART, NIMMO), Modalities, Rehabilitation, Postural assessment |
Key to good testimony in litigation case | Good record keeping; “I am not qualified to make that judgement” if you aren't. DON'T guess. |
Body Dysmorphic Disorder | Psychiatric disorder: IMAGINED DEFECTS in appearance |
Fear of gaining weight | ANOREXIA – factually knowlegeable about food. Pica (non-food ingestion) |
Lanugo | fine, white down growing on anorexics, babies and cancer patients – no body fat left to keep them warm |
'failed anorexics' | Bulimia – binge and purge eaters. Dental issues from stomach acid |
FEMALE TRIAD *** | ANOREXIA – AMENORRHEA – OSTEOPOROSIS |
DISORDERED eating | NARROW food selection – inadequate nutrition base, upsets body chemistry |
Where is DISORDERED eating found? | GYMNASTS -runners -figure skaters – ballet (wherever looks matter) |
Disordered eating in athletes is ___x more than general public | 15x |
Potential life threatening problem of eating disorders | ESOPHAGEAL VARICES (rupture of vein, bleed out). |
Percentage of anorexics that die from anorexia | 10% anorexics die from anorexia. |
Repetitive purposeful behavior accd'ing to rules | Compulsion (no satisfaction – done to avoid perceived bad outcome) |
OCD physiologic manifestations | Decreased body pH – Amenorrhea – Calcium loss & early osteoporosis |
Thought is __________ | biochemistry |
Long term effects of OCD | Stress fractures, potentially death |
Why is pH affected by OCD | Long term ACIDIC body pH leeches Ca+ from bones to balance pH |
TRIUNE brain | subjectivity sense of time & space memory (OCD is a triune issue) |
Important muscle groups that are strong | CORE strength |
ERGONOMICS definition | the scientific study of human work – matching the job to the worker and product to user |
The work environment affects __ | profit. Ergonomics is an economic process! |
Cost of CTS per case | 3-30k per case |
PRESENTEEISM | The practice of workers reporting to work when ILL and NOT operating to their usual level of productivity |
costs for presenteeism | |
ACCIDENT | unplanned outcomes |
Example of ASSAULT on the SENSES ergonomic | VISUAL Fatigue – truck drivers, computer work |
Example of QUALITIES of the JOB ergonomics | Monotony & Nightshifts Stress & Aerobic demands Work stations |
Chimney sweeps life expectancy *** | 12 years |
White collar upper crossed syndrome | GATHERING actions (computer work) |
CHIRO shoulder concern ergonomic | ROTATOR CUFF |
CHIRO wrist and hand concerns ergonomic | Strains and Sprains TRIANGULAR fibrocartilage |
CHIRO low back concerns ergonomic | Strains and Sprains DISC injury |
Cognitive ergonomics that cause accidents | Mental taxonomy of thought – did not follow rules |
3 types of mistakes that cause accidents | SKILL based (poor training) – RULE based (altered equipment) – KNOWLEGDE based (poor training) |
50% of ATHLETIC INJURIES involve _______ motion. | REPETITIVE |
Most common violaton of ergonomics | repetitive motion injuries (the 'industrial athlete') |
FORCE | CUMULATIVE microtrauma over days, weeks, or years |
FREQUENCY | too much REPETITION or movement with too little rest inbetween |
POSTURE | extremes of ROM – unguarded reaching – POOR BODY MECHANICS |