Clinical Application Template Level 1 (Scorebuilders 2024 edition) Exam

-eccentric -plantar-flexors -Answer-Achilles tendon rupture occurs most frequently when ______________ off of a ______________-______________ extremity with an extended ______________, through unexpected ______________ while weight- bearing or with a forceful ______________ contraction of the ______________-flexors. -Swelling -defect -pain -weakness -Answer-The clinical presentation of an Achilles tendon rupture will present with ______________ over the distal tendon, a palpable ______________ in the achilles above the calcaneal tuberosity, and ______________ and/or ______________ with plantar flexion. Pt. reports "popping" sound upon injury. -Xray (to rule out avulsion) -MRI (locate presence/severity of tear) -Answer-What lab/imaging test would confirm an Achilles tendon rupture Dx? -Men -exercise -Answer-Additional findings likely with an achilles tendon rupture are: -More common in ______________ and individuals that do not consistently ______________ i.e. weekend warriors. -casting -surgical -Pharmacological -Pain killers -serial -weeks -heel -stress -cast -surgical/non-surgical -Range of motion -stretching -icing -assistive device training -endurance programming -gait training -plyometrics -Answer-The Most effective management of a ruptured Achilles tendon: -Immobilization through ______________ or a ______________ approach for repair or reconstruction. -______________ intervention is not necessary for this condition except to relieve pain through ______________ ______________ (NSAIDS, acetaminophen, narcotics, etc). -Non-surgical tx includes ______________ casting for approx 10 ______________ followed by the use of a ______________ lift to ensure max healing without ______________ on the tendon for 3-6 months. PT begins after ______________ is removed. -PT intervention is the same for both ______________ and non-______________ pts. and includes ______________ of ______________, s______________, i______________, ______________ ______________ training, ______________ programming, gait ______________, strengthening, plyo______________. -cast/Brace -weeks -surgical/non-surgical -stretching -icing -assistive device training -endurance programming -gait training -plyometrics -Answer-The Most effective surgical management of a ruptured Achilles tendon: -Surgical intervention requires a ______________ or ______________ for 6-8 ______________. -PT intervention is the same for both ______________ and non-______________ pts. and includes ______________ of ______________, s______________, i______________, ______________ ______________ training, ______________ programming, gait ______________, strengthening, plyo______________. Return to PLOF in 6-7 months. -Answer-What is the likely outcome for a ruptured Achilles Tendon if recovery is unremarkable (normal). -higher -lower -infection -PLOF -Answer-Long term effects of pt. condition? -Management w/o surgery has a ______________ recurrence of re-rupture (40% chance). -Management w/ surgery has a significantly ______________ chance of re-rupture. (0- 5%) -The advantage to non-surgical management is the lack of ______________ risk although may result in an incomplete return to ______________. Achilles Tendon Rupture -Answer-Clinical Scenario A 32 y.o. fem playing soccer in a *recreational* league. Therapist observes her kick the ball and fall to the ground. Therapist examines the pt. and finds that she has some planter flexion in non-wb but is *unable to plantarflex while wb.* Pt. states that something *"popped"* while running and palpation indicates a *separation in the Achilles Tendon.* Achilles Tendon Rupture -Answer-Clinical Scenario 46 y.o male s/p *surgical reconstruction of L Achilles Tendon.* Pt. has been *casted* for one week and using axillary crutches for household mobility. *No significant past medical Hx.* Pt. is a *truck driver* (not much exercise) and sustained injury while playing tennis. Adhesive Capsulitis -Answer-Summary of what pathology? -Occurs commonly in *female middle-aged* population -Arthrogram can assist Dx by detecting decreased fluid volume within joint capsule -ROM restricted in a capsular pattern. (ER/ABD/IR) -frozen shoulder -enigmatic -inflammation -fibrotic -anterior -glenohumeral -Answer-Dx Adhesive capsulitis aka "______________ ______________" is an ______________ (mysterious/unknown) shoulder disorder characterized by ______________ and ______________ thickening of the ______________ joint capsule of shoulder. Condition is characterized by Sx of limitation in ______________ motion and pain. -primary/secondary -Primary/secondary -Inflammation -fibrous -capsule -decrease -synovial -glenohumeral -Answer-Dx Adhesive Capsulitis is classified as ______________ or ______________. ______________ Adhesive Capsulitis occurs spontaneously and ______________ Ad. Cap results from an Underlying condition. ______________ within the joint capsule causes ______________ adhesions to form and the ______________ to thicken. A ______________ in space within the capsule leads to a decrease of ______________ fluid and further irritation to the ______________ Jt. -enigmatic -diabetes mellitus -thyroid -cardiopulmonary -trauma -immobilization -middle-aged -females -higher -males -Answer-Most likely contributing factor in the development of Adhesive Capsulitis: -Primary Ad. Cap has an ______________ etiology but is associated w/ conditions such as ______________ ______________ (DM), ______________ abnormalities, and ____________________________ conditions. -Secondary Ad. Cap. results from ______________, ______________, reflex sympathetic dystrophy, RA, abdominal disorders and psychogenic disorders. -Ad Cap occurs more in the ______________-aged population w/ (males/females) having a ______________ incidence than (males/females). -AROM/PROM -Acute (painful) -Chronic (not painful) -Answer-Most likely clinical presentation of Adhesive Capsulitis: -Restricted ______________/______________ at the GH jt. -______________ phase characteristics include radiating elbow pain inferiorly that awakens pt. at night. As well as limited PROM during this phase due to pain and guarding. -______________ phase characteristics include localized pain around the lateral brachial region, dissipation of night pain (no night pain), and PROM is limited due to capsular stiffness (vs. guarding due to pain.) -Arthrogram (detects decreased volume of fluid within jt. capsule) -Answer-What lab or imaging studies would confirm Adhesive Capsulitis Dx? -muscle spasms -arm swing -atrophy -Answer-Additional findings likely with adhesive capsulitis: -______________ ______________ around shoulder 2nd (secondary) to muscle guarding. -loss of reciprocal ______________ ______________ -GH *disuse* muscle ______________ over time. -self-stretching -Abduction -self-stretching -exercises -postural -PNF -ROM -Answer-Home Care for Adhesive Capsulitis: -Acute phase of Ad. Cap at home should include only *some* self-______________ *while avoiding ______________.* -Chronic phase of Ad. Cap at home should emphasize self-______________, progressive ______________, ______________ management, ___ ___ ___, and therex specific to improve ___ ___ ___. (i.e. pendulum, wall climbing) Return to PLOF 12-24 months -Answer-What is the likely outcome of Adhesive Capsulitis WITH PT? -Full Recovery (for most) -Small (7-14%) possibility of permanent loss of GH ROM. (ROM loss usually asymptomatic) -Answer-What are the Long term effects of Adhesive Capsulitis? -Acute Bursitis (A.B. resolves in days to weeks, Ad. Cap. resolves in months to years) -Answer-What other condition is commonly confused with Adhesive Capsulitis? What is the main difference? Adhesive Capsulitis -Answer-Clinical Scenario Pt. is a self-employed artist and enjoys outdoor activity. Past Med Hx. includes *DM* since 6 y.o. and a femur Fx 11 months ago. Pt. noticed *reduced ROM and pain increase in the shoulder over the last few wee