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76 Cards in this Set
- Front
- Back
Carpal Tunnel Syndrome Sxs
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numbness and tingling in radial 3
Night pain worse iwth prego, thyroid dz, DM, Thenar muscle wasting, slowing of condution |
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Carpal Test
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Tinels
Phalens Median Nerve compression test |
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Carpal Tx
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splinting, change movement,s NSAIDs, steroid injections
Surgical release of the transverse carpal ligament |
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Cubital Tunnel Syndrome description
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compression of the ulnar nerve at the medial epicondyle
parasthesia of the ring and small fingers. worse with elbow flesion, nigh pain Second most common UE nerve may sublex anterioly sensory loss Positive tinels sing ULNAR claw deformity |
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Cubital Dx
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Ulnar nerce compression test
finger abdutiction strength fromens test |
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Cubital tx
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extension splinting of the elbow
elbow pat at night Unlar nerve decompression or trasnposition |
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Ulnar Tunnel Syndome
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ulnar nerve compressed between the transverse carpal ligament and the volar carpal ligament in Guyon's conal
Unlar numbness Reproducivble Tx same as carpal |
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Long thoracic Nerve Palsy
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serratus anterior muscle dysfunciton
get EMG NCV, and shoulder x-ray for eval |
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Spondylolitheses description
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forward slippage of one vertebra on antoerh
presents as lower back pain |
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Spondylithises Classifications
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1-0-25
2-25-50 3-50-75 4-75-100 5-over 100 |
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Spondylolitheses treatment
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1/2- PT,avoid football, lumbar bracing in lordosis, serial xray until mutirity, fusion in situ if not going away.
3,4,5 - bilateral posterolateral fusion w/ o w/o decompression |
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HNP description
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displacemnt of the central area of the disc resulting in impingment on a nerve root
MC L4 L5 and L5 S1 -Mosty middle aged, radicular and lower back pain |
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HNP findings
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Motor weakness
L4 - tibilais ant L5-extensor hallicis longus S1- achillis Asymmetic reflexes Knee jerk -L4 Tibialis post or Medial Hamstring tendong - L5 Ankle Jerk S1 Positive tension sings |
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HNP Dx and Tx
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Dx - MRI, mylography, Nerve studies
Tx: most resolve with time, pt Nsaids, aerobic, lumbar epidural steroids if no improvement in 6-12 moths - surgery |
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Prereqs for HNP surgery
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Failrue of nonop
Predominately lege sxs enuro positive tension sings pos imagin studies no psychosocial 95% are better right after, but afer 5 years there is no difference between surg and non-surg |
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Cauda Equina Syndrome
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massive central nerniation of lumbar DISC that causes
progressive motor weakness, numbness Saddle anesthesia Retention of pee SURGICAL emergency |
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Chronic Lumbar Disx Dz
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Over 40 yo treat sx, thearpy Nsaids, injections, may require fusion
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Spinal Stensosis
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narrowing of spinal canal - either central or later
Most are acquired Sxs: pain and parasthes cause NEUROGENIC claudication (takes longer for relief of sxs upon sitting |
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Neurogenic Claudication
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pain and wakness in the muscle of the thighs and calvs
proximal, flexed is better, No bike, longer with upill |
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Vascular Claudication
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cramping without parasthesisa, sxs more distal, sooner, relieved with standing or lying flat.
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Spinal Stenosis Tx
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Non - rest, exercise, NSAIDS, lumbar epidurla steroids,
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Scolisis Treatment
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lateral spinal curvature over 10 dagrees
10-13 years old ido under 10 needs referall. 0,1 - more risk of it progresses 2,3,4 - less likely to progress |
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Scolosis Dx and Tx
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Stadning posteranterior and latera radio on 36 casstte - limit number due to radiation exposrue
Tx: young - brace surg Old - preserve funtion and control pain, PT |
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Kyphosis
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Forward bending, scheuermans dz - fixed kyphsois
Tx: therapy, treat underlying condition, bracing |
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Ankylosing Spondylitis
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involves the sacroiliac joints and the spine
onset 15-30, male LBP, morning stiffness, SI joint, loss of chest expansion Bamboo - spine Positive HLA - B27 Tx - sxs NSAIDS and PT |
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Reiter Dz
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Urethritis, Conjuncitviites, and arthritis
younger pt with reactive sxs within 3-4 weks of infection knee, sacrolititis, heel pain, plantar fascitis chlamydia, camp Posit B27 |
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Psoritic Arthtis
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30-55, DIP, DJD
skin dz usu preceeds joint sxs nail disorders, pitting, riding, and onycolylsis |
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Arthritis with Inflame bowel dz
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inflame of tendon, fascia, or joint capsule insertions
paucuticuarl arthris, in LE extra-articualr inflame involving the eye, skin, mucous membranes, heart, and bowle assdon attoc with B27 |
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Diffuse Idiopathic Skeletal Hyperostosis
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idiopathic, in men over 60
clacificsaiton of ligament and tendon attachments thoraci spine is most commonyl affected - stiffness Fusing of at least four vertebrae, anterior bridging, disck space, and SI joint sparing Tx: presenting sxs |
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C-Spine Traumat - Criteria for clearing
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table 264-2
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Unlikely C-spine
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nl mental status, no nekc pain, no tenderness on palp, no neuro signs, no other distracting, no hx of loss of consceousness.
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View for C-spine
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PA view, a lateral view, an odontoid hx
-DONT just do lateral radio - most c-spines are missed technically inadquiate. |
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Birth Palsy
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uncommon - fractures are more common - get x-ray - after 2 years old its not going to change
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Erb Duchene
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MC - C5 Dn C6 injury and watiers test - this has a good outcome
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Whole - arm
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Flaccid and uncommon
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Klumpkes
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Likley clawhand deformity and horners syndrome
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SHoulder Impingement Syndrome Description
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Inflame of the subacromial bursa and underlying rotator cuff tendoms, common cause of shoulder pain in middle aged patients
rotator cuff - edema, hemorrhage, chronic inflame, fibrosis to mircorscopic tendon fiber fialure, full thickness teart |
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Impingement syndrome symptoms
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Anterior and lateral shoulder pain exacerbated by overhead activity, nigh pain,
Palpation over the greater tuberosity and subacromial bursa commonly elicits tenderness and crepitus with serveral months Posistive neers and haowkins sign |
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How do you tell if it impingment syndrome
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subacromial injection - it will cause relief, record as %, use posterior approach, 3 injections/yr
Radiograpghs will look nl |
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Impingement Adverse outcomes and Red flags
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pain can be persistent
rotator cuff tear wekaness of rotator cuff or failure of 2-3 months of rehabd, Surgerg - Subacromial decompression SAD, Consider getting and MRI if you think that there is a tear |
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Impingement treatment
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Rest from the offending activity, PT, SNAIDs,
3-4x a day for 6 weeks PT Subacromial corticosterodd injection with stretching Injections DO not give injection if there is a rotator cuff tear. |
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Another name for Frozen Shoulder
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Adhesive Capsulitis
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Frozen shoulder description
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Inflmmation and thickening of the shoulder capsule
loss of both active and passive motion distinct from posttraumatic shoulder stiffness Affects 40-60, with no clear predispostion But bwith with DM are a RF - and are refactory to tx, freezing - thawoing, Takes 1-2 years to resove |
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Frozen Shoulder PE
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reduction in both active and passive motion
motion is painfule - especially at the extremes pain and tenderness at the deltoid insertion |
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Frozen shoulder Diagnositic Tests
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Radiographs are use dto rule other things out
CT and MRI are NOT indicated becase they will look normla. |
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Frozen shoulder Tx
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NSAIDS, non-narcoitic, moist heat, streching, intra-articulare injeciton, home stretching,
refer if no improvement with rehab after 3 months |
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Rotator Cuff tear descirption
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-result of age, chronic use, or altered blood supply
MC - suprapinates - then extends to infraspinatous, teres minor, subscapularis Full thick are uncommon |
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Rotator Cuff Tear Sxs
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recurrent shoulder pain for several months after a specific injury
Night pain weakness cathcing, grating - esp with overhead activty Supra - unable to hold hand in forward flexsion and abduction Infa/teres - external rotation Sub - internal rotation |
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Rotator Cuff Exam
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back of shoulder is sunken in from atrophy
Passive ROM is nl but activ is limited large tears - they can only shrug their shoulders Drop arm test Supra Test - JOBE Test for external rotation strength Internal rotation strength test Subscapuslaris Liftoff test |
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Rotator Dx test
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AP - you will see a high-riding humerus relative to the glenoid
May need an MRI - if operative. |
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Rotator Cuff massive tear
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positive arm drop
external rotation 3+/5 |
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Rotator adverse outcomes
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loss of shoulder motion, especiall the ability to lift arm overhead, chornic pain, wekaness,
long standing - joint dengeration |
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Rotoator Tx
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NSAIDs, PT, stretching, strengthening, steoir injection, (to many though will increase tear)
3 subacromial injections failed rehabd - surg younger then 60 with an acute tear shouwld have surgery within 6 weeks of injury |
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Shoulder Instability desciption
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Episodes of sublextion
Ant - most common - TUBS (traumatic, uni, bankart lesion - tear in anterior lenoid labrum - surg) Mulit - AMBRI - atrautamic, mulit, bilat, rehab, indefinately Post - result of post directed force when the arm is in adduction and internal rotation - seizures and electric shock REhav is ptest |
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Shoulder instability Sxs
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AN - shoulder slipping out of joint when the arm is abducted and externally rotated
Ant - initial with traum like throwing, but then it just becomes unstable. |
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Labrum - AP lesions description
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An injury to the superior glenoid and the biceps anchor complex TUBS
Super Labrum - SLPA |
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labrum Tear sxs
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SLAP
painful popping or catching sensations Pain deep inside the shoulder Overhead sports hx - like volleyball |
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Labrum PE and Diag tests
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O'brien test - pt internally rotates shoulder from a forwad elevarted position
An increase in pain witht pts tumbs are pointd down - labral tear Plan film will look Nl MR anrthrography - GOLD |
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PE for volunary dislocations
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Anterior disloc - pt supports arm in neutral psostion
pt with Posterior disoclation hold the arm in adductiona dn internal rotation Neurovasc function - watch expecially the axillary nerve See how far the fingerst can extend past neutral (pt with ligamentous laxity are more likely ot have a mutlidirectional instability |
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Diag test - AP and labrum
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AP and axillary raido
Hill sachs - posteriro humeral head against the anterior edge of gleinoid you know there is a tear older then 40 with trauma - likley to ahve torn the rotator cufff as well- so do an MRI post dislciation - missed on AP radio If no Axillary view attanable do a transscapular lateral view |
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Adverse outcomes of an labrum tear
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Axillary nerve injury - deltoid dysfunction, and numbness over lateral arm
- risk is greater in younger patientw ith multiple episodes Osteoarthittis, DO NOT miss bony bankart |
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Tx for a labrum tear and dislocaitons
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Reduce in ER
pt first time dislocation put them in PT if it keeps reoccurring they will need surgery if AMBRI - then treat non-op AVOID voluntarilty dislocating |
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Red flags for dislocations
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failure ot reduce ny closed mainpulation
recurrent dislocation failure of 3 mo of rehab |
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Biceps Tendon Description
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proximlal injureis are more common, often caused with impingement
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Biceps Tendon signs
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Speed test,
Yergason's Test |
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Biceps tendonitis Tx
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Limit flexion and supination
NSAIDS, PT, iNjeciton - but try to avoid thi Surg - decompression, biceps tenodesis or rlease (consider SLAP lesion in bicep tenonitis pt - with positive speed) |
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Biceps tunon rupture description
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proximal lon head, older adults secondary to hx of shoulder pain and impingment
young- wt lifting or throwing Sudden pain in upper arm, audible snap bulge in lower arm ecchymosis - tracking downt he middle and lower arm |
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Biceps ruputre Dx tes
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AP and axilarry
MRI to ro rototor cuff tears |
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Biceps rupture adverse outcomes
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pt can loss 10% of flesion and foraearm supiatnion strenth,
cosmetically ugly |
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Biceps Rupture Tx
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non-op - is effective for most pt,
If youn and need extra help with lifting do surgery Distal bicep rupture is worse and needs surgery in less then 7 days. |
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Thoracic Outlet Syndrome Description
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compression of the brachial plexus and or subclavian vessels as they exi the spave betweent eh superiro shoudler girdle and the first rib
Types: cervical rib, costoclaviclualr, hyperabduction syndrome |
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Thoracic outlet sx and PE
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vague, can mimic distal nerve entrapment exp ulnar nerve, aching and paresthesis can extend from shoulder, arm, medial foramr and fingers,
aching fatigue If lower complex= HORNERS - ptosis, miosis, enopthalmos, anhidrosis Inspect of swelling of discoloration compare distal pulses see sensory and motron funtion check ulnar nerve, vervical spine, neuro and bascuarl test (a sense of fatiuge is a negative an inconclusive. |
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Thoracic Outlest tests
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Adson test - pull arm back, neck in extension, check for radial pulse
Roo's test - both arms up for 60 seconds, pump hands for 3 minutes, any sx? Wrights test - arm over head - check the radial pulse |
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Thoracic Outlet Dx
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AP and lwateral of cerpcial spine
PA and lateral - to check apical lung tumor MRI of cervical spine EMG and NCV |
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Adverse outcomes of Thoracic Outlet Syndrome
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wakness or loss of cordination of upper estreme, AH, cant use arms over head,
can cause venous thrombosis, and aneurysnm of the subclavian arterym |
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Tx of Thoracic Outlet
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Most - 3 mo PT
Avoid strenous acitivy - no straps on arms nsaids, muscle relasant, Transcutaneous electrical nerve stimulation TENS wt reduction PT, OT, physiatrist, NON-oper (surg does not help this people. |