PCE Studying study guide correct

PCE Studying study guide correct PCE Studying study guide correct Neurapraxia Injury to nerve that causes a transient loss of function (conduction block ischemia); nerve dysfunction may be rapidly reversed or persist a few weeks, e.g., compression. Axonotmesis Injury to nerve interrupting the axon and causing loss of function and Wallerian degeneration distal to the lesion; with no disruption of the endoneurium, regeneration is possible, e.g., crush injury. Neurotmesis Cutting of the nerve with severance of all structures and complete loss of function; reinnervation typically fails without surgical intervention because of aberrant regeneration (failure of regenerating axon to find its terminal end). Wallerian degeneration Transection (neurotmesis) results in degeneration of the axon and myelin sheath distal to the site of axonal interruption to allow for regeneration. Clinical symptoms LMN syndrome (1) Weakness/paresis of denervated muscle, hyporeflexia and hypotonia, (rapid) atrophy, fatigue. (2) Sensory loss; proprioceptive losses may yield sensory ataxia; insensitivity may yield limb trauma. (3) Autonomic dysfunction: vasodilation and loss of vasomotor tone (dryness, warm skin, edema, orthostatic hypotension). (4) Hyperexcitability of remaining nerve fibers. (a) Sensory dysesthesias: ie. hyperalgesia. (b) Motor: fasciculations, spasms. (5) Muscle pain (myalgia) with inflammatory myopathies (e.g., post polio syndrome). Trigeminal neuralgia Degeneration/compression of trigeminal nerve (CNV), most commonly mandibular or maxillary branches. Abrupt onset, mean age of 50. Causes sharp, shooting pain, worse with stress, heat, cold, touch (brushing teeth), movement (chewing/talking), eased with relaxation. Motor fxn remains normal. Bell's Palsy Unilateral facial paralysis dt virus causing inflammatory response in facial nerve (CN VII). Can't close eyelid on affected side. Decreased taste, tears, and saliva. Recover in weeks to months. Charcot Marie Tooth Disease Hereditary Motor and Sensory Neuropathy (HMSN). Symptoms begin in adolescence or early adulthood. Extensive demyelination of m&s nerves. Begins in foot/lower leg and progresses to hand and forearm. Pes cavus or extremely flat footed, with hammer toes. Segmental Demyelination Myelin breakdown for a few segments but axons preserved. Mostly reversible because Schwann cells make new myelin, but some axons may be permanently lost. Example: GBS Axonal degeneration (distal) Degeneration of axon cylinder and myelin. Possibly d/t inability of neuronal body to keep up with metabolic demands. Distal to proximal. Example: peripheral neuropathy. Tendons consist of tenocytes (tendon-specific fibroblast cells that produce collage molecules, crave mechanical load) ECM (collagen, glycosaminoglycan) Why load tendons? increased collagen synthesis, cellular proliferation, alignment Tendonopathy/tendonosis chronic microtrauma = loss of collagen organization, no inflammation - collagen disorganisation, glycosaminoglycan, variable tenocyte density, increased vessel/nerve Tendonitis inflammation, dt overloading -- pain, swelling, from tears Achilles Tendonopathy Chronic/insidious onset of pain over Achilles tendon d/t microtrauma. No inflammation. Rx: Eccentric loading necessary, heel lifts to offload, stretching/man ther (DTF) DDx - partial tear (doesn't respond well to loading program) De Quervain's Tenosynovitis Microtrauma of APL and EPB btn radius and extensor retinaculum in anatomical snuffbox. Degeneration (+/- inflammation) of tendons. Ax: Finkelstein Test. Rx: offload, PRICE, edu, -- man ther, strengthen Sever's Disease Calcaneal apophysitis. Inflammation of calcaneal growth plate. Common in active kids (9-14, 7-15) boys girls. Spontaneous recovery with maturation. Rx: offload tissues, education, stretch calf muscles and plantar fascia Tennis Elbow Lateral epicondylalgia - 90% of cases involve ECRB. Worse with gripping, repetitive reach tasks. Tests: Mills, Resisted extension of D3, Cozen's. Rule out: nerve root (C5-7), shoulder referral, bursitis, LCL sprain, prox RU jt Rotator cuff tendinopathy Commonly long head of biceps + supraspinatus impingement. Primary: older, degen, posture, etc. Secondary: younger (35) microtrauma -- instability -- subluxation -- impingement. Ant capsule lax, post capsule tight Patellar tendinopathy Repetitive loading of extensor mechanism of knee (quad, patella, patellar tendon, tibial tuberosity). VS Osgood-Schlatter (tibial tuberosity of children/adolescents) VS Sinding Larsen Johansson Syndrome (apex of patella in adolescents) Gluteal tendinopathy AKA greater trochanteric pain syndrome. Mix of bursitis and tendinopathy of abductors. Caused by trauma, repetitive movements, increased loading, previous injury, hip instability/biomechanics. 2 Ant horns of SC contains cell bodies giving rise to efferent motor neurons: alpha motor neurons (to muscle) and gamma motor neurons (to muscle spindles) 2 Post horns of SC contains afferent sensory neurons with cell bodies located in the dorsal root ganglia (fine touch, proprio, vibration) Lateral horn of SC Only in T and upper L-spine: pre-ganglionic fibers of the autonomic nervous system Dorsal columns of SC: info it carries - fine touch/2 point discrimination - vibration - conscious proprioception Fasciculus gracilis: L/E, medial Fasciculus cuneatus: U/E, lateral Dorsal columns of SC: path + lesion Decussates at medulla, finishes in parietal lobe Lesion above medulla: contralat loss of fine touch, proprio, vibration Lesion below medulla: ipsilat loss of fine touch, proprio, vibration Lateral spinothalamic tract of SC: fxn, path pain, hot/cold decussates within 1-2 segments at anterior commissure, goes to thalamus and parietal lobe 1/2 cord lesion: ipsilat loss at level of injury, contralat loss below level of injury Anterior spinothalamic tract of SC: fxn, path crude touch and pressure (lateral spinothalamic is pain and temperature) decussates within 1-2 segments in ant commissure of SC, goes to thalamus then parietal lobe 1/2 cord lesion: ipsilat loss at level of injury, contralat loss below level of injury Lateral corticospinal tract Or pyramidal tract. Main voluntary motor pathway. 90% cross in pyramids in medulla, pyramidal decussation. Start in frontal lobe, synapse in ant horn of SC Anterior corticospinal tract 10% that crosses at level of innervation, travels in ventral white column. Innervates trunk muscles. Lesion cannot be clinically detected Myofascial pain syndrome Trigger points caused by sudden overload/stretching/repetitive strain/sustained activities. Can = referred pain, motor dysfunction, autonomic phenomena. Rx: dry needling, stretching, soft tissue massage, modalities, manual therapy if joints affected TUBS (shoulder dislocation) Traumatic onset, Unidirectional, Bankart lesion, Surgery - MOI: abd/er AMBRI (shoulder dislocation) Atraumatic, Multidirectional, Bilateral shoulder findings, Rehab appropriate, Inferior capsule shift (if surgery performed) Bankart Lesion Avulsion of ant/inf capsule and ligaments. S/S:clicking, apprehension, deep vague pain Hill-Sachs Fracture Compression fracture posterior/lateral humeral head, associated w anterior shoulder dislocation (post/lat HOH impacts c ant glenoid) Stabilization of the acromion (ligaments) Coracoclavicular ligament (conoid and trapezoid ligaments) Coracoacromial ligament - controls vertical stability Acromioclavicular ligament - controls horizontal stability SLAP lesion Superior Labrum Anterior-Posterior - elevated position with sudden (concentric or eccentric) biceps contraction - throwers Colles Fracture MOI: FOOSH into extension, distal radius + ulna subluxation. Extra-articular dorsal angulation + radial deviation/shortening Dinner fork deformity Smith's Fracture MOI: FOOSH with wrist flexed Extra-articular + palmar angulation/ulnar deviation Reverse Colles Barton's Fracture Intra-articular distal radius fracture Which areas are at a high risk of avascular necrosis with fracture? Proximal femur, 5th metatarsal, scaphoid, talus neck, proximal humerus How long does it take an adult to heal from a fracture? 10-12 weeks (Kids = 4-6, adolescents = 6-8 weeks) What is a hip hemiarthroplasty? Only femoral head is replaced (not acetabulum) Hip precautions for THA (postero-lateral approach) (75% of THA) no FL past 90 no IR no ER no ADD past midline -- cut through short external rotators, glut max and post capsule Hip precautions for THA (lateral approach) (25% of THA) no FL past 90 no IR no ADD past midline -- cut through glut med and min What do osteoclasts do? bone resorption Osteoblasts build/form bone What type of bone is most affected by osteoporosis? (same thing as trabecular bone) Cancellous -- inside bones Ranges of bone density Normal: 0-1 SD of young adult mean Low bone mass (osteopenia): 1-2.5 SD below Osteoporosis: 2.5+ Severe/established osteoporosis: presence of fragility # CN2 lesion 1. optic nerve: loss of vision ipsilat eye 2. optic chiasm: tunnel vision (loss of outer half of vision on both sides) 3. optic tract, 1arey visual cortex: hemianopsia (loss of same half of both eyes) CN1 lesion loss of smell (anosomia) CN3 lesion 1. dipoplia 2. ptosis (droopy eyelid) ipsilat 3. dilated pupil ipsiplat 4. eye down and out CN 4 lesion 1. dipoplia 2. eye up and out at rest ipsilat 3. difficulty to direct gaze down and in ipsilat Trochlear nerve (aka PATHETIC NERVE because head position) CN 5 TRIGEMINAL NERVE V1: ophthalmic V2: maxillary V3: mandibular All have sensory branches to face. V2 has sensory supply to inside of nose. V3 provides sensation to ant 2/3 of tongue V3 also has motor supply to mastication mm CN VI lesion can't abduct ipsilat eye CN VII MOTOR: - facial muscles - blink reflex (efferent limb) SENSORY: - external ear VISCERAL: - lacrimation -salivation (cry & spit) - taste ant 1/3 of tongue CN VII lesion UMN: contralateral lower part of face paralyzed (eg: MCA stroke) LMN: ipsilateral half of face paralyzed (infarct to pontine branches to basilar artery) CNVIII Vestibulocochlear Nerve Purely sensory. Receives two special sensory afferents - vestibular input - hearing CN IX SENSORY: - post 1/3 of tongue - upper pharynx - middle ear MOTOR: - swallowing (one muscle of the pharynx: the stylopharyngeus) VISCERAL: - afferent input to the carotid sinus and body - taste post 1/3 of tongue - salivation (parotid gland) CN X VALGUS Nerve MOTOR: (most of soft palate, pharynx and larynx, and one tongue muscle: the palatoglossus) - swallowing - phonation - efferent limb of gag reflex SENSORY: -sensation from the lower pharynx, larynx and external ear VISCERAL: -PNS branches to organs of thorax and abdomen -visceral afferents from the organs -taste from the epiglottis CN XI Motor to SCM and traps CN XII HYPOGLOSSAL N. MOTOR: - muscles of tongue (shape and movement) CN XII lesion HYPOGLOSSAL N. all tongue muscles innervated bilaterally except for genioglossus (protrudes tongue): when stick tongue out, will deviate to ipsilat side Pupillary light reflex afferent limb: optic nerve efferent limb: oculomotor nerve If R optic nerve lesioned and shine light in R eye, won't see constriction in either of the eyes. If shine light in L eye, will see constriction in both eyes How would you assess the 10 year absolute fracture risk of someone with osteoporosis? (tools) FRAX - Fracture Risk Assessment Tool CAROC - Canadian Association of Radiologists Types of Osteoporosis Primary Type 1: menopausal women Primary Type 2: 70+ years Secondary: d/t another med condition or treatment, any age Side effects of chemotherapy: General: nausea, constipation/diarrhea, hair loss, nail damage, sores in mouth/throat, headaches, bone marrow suppression (low WBC, RBC, platelets), pulmonary fibrosis. PT-related: weight loss/muscle loss, peripheral neuropathies, fatigue Side effects of radiation: Burns, tissue fibrosis, tightness/ROM loss, local bone density loss, cardiovascular effects, rapidly dividing cell types are affected, bone marrow (esp if pelvis, prox femur, vertebrae), swallowing difficulties, whole body symptoms, fatigue Summary of symptoms of degenerative joint disease - pain/stiffness upon getting up, which eases over the morning (4-5 hours) - pain with repetitive bending (flexion of joint) - constant awareness of discomfort when exacerbated - pain described as sore and nagging pg 22 of MSK American textbook Types of scoliosis 1) Structural or Functional -- in standing only, ie leg length discrepancy 2) Idiopathic -- most common Congenital -- vertebral deformities Neuromuscular -- secondary to other conditions, like CP, spina bifida, physical injury Swayback posture in 2018 edition, pg 16 Pelvis shifted forward in relation to thorax, increased lumbar lordosis, thoracic kyphosis and hip extension • Short and strong: hamstrings and upper fibers of internal oblique -- Lumbar erector spinae are strong but not short • Long and weak: one-joint hip flexors, external oblique, upper back extensors and neck flexors • Potential sources of dysfunction: stretched iliofemoral ligaments, hip joint dysfunction (ie. anterior femoral head, femoral-acetabular impingement), lumbar lordosis/thoracic kyphosis/HFP Flatback posture in 2018 edition, pg 16 Decreased lumbar lordosis + posterior pelvic tilt • Short and strong: hamstrings and often the abdominals • Long and weak: one-joint hip flexors • Possible causes: poor postural habit, poor ergonomics • Potential sources of dysfunction: short abdominals/hip extensors, long and weak lumbar extensors, loss of normal lumbar curve (reduced capacity for shock absorption), stretched PLL and lumbar erectors, compressed anterior disc, altered respiration Horner's syndrome Lesion to SNS commonly from neck trauma or surgical trauma resulting in loss of ipsilat sympathetic responses in the head: - ptosis (droopy eyelid) - miosis (pupil constriction) - anhydrosis (lack of sweat Think of how it is different from occulomotor n disruption