NPTE Studycast | Physical Therapy https://www.ptpintcast.com/listen/pt-pintcast-podcast-library-recorded-over-a-beer/ Real, candid, intelligent conversations about PT... over a beer. Mon, 15 Jul 2019 10:00:18 +0000 en-US hourly 1 https://wordpress.org/?v=5.2.2 An NPTE podcast for Physical Therapy students looking to get some extra time with test prep on the go. From the brewers of the PT Pintcast. Jimmy McKay, PT, DPT clean Jimmy McKay, PT, DPT jimmy@ptpintcast.com jimmy@ptpintcast.com (Jimmy McKay, PT, DPT) PT Pintcast LLC NPTE Studycast NPTE Studycast | Physical Therapy http://ptpintcast.com/wp-content/uploads/2017/09/PTPintcastFeedLogo-compressor.jpg https://www.ptpintcast.com/listen/pt-pintcast-podcast-library-recorded-over-a-beer/ Jimmy@PTPintcast.com An NPTE podcast for Physical Therapy students looking to get some extra time with test prep on the go. From the brewers of the PT Pintcast. TV-G New York, NY Weekly E-Stim Rap – Contraindications & Precautions https://www.ptpintcast.com/2019/06/20/e-stim-contraindications-precautions/ Thu, 20 Jun 2019 15:00:31 +0000 https://www.ptpintcast.com/?p=5605 E-Stim Rap - Contraindications & Precautions E-Stim Contraindications & Precautions by DPT_Capers Jimmy McKay, PT, DPT clean 1:51 Heart Failure https://www.ptpintcast.com/2019/05/15/heart-failure/ Wed, 15 May 2019 16:00:04 +0000 https://www.ptpintcast.com/?p=5506 Heart Failure Jimmy McKay, PT, DPT clean 9:40 COPD – Chronic Obstructive Pulmonary Disorder https://www.ptpintcast.com/2019/05/09/copd-chronic-obstructive-pulmonary-disorder/ Thu, 09 May 2019 16:52:30 +0000 https://www.ptpintcast.com/?p=5504 COPD - Chronic Obstructive Pulmonary Disorder COPD with Ellen Hillegass Jimmy McKay, PT, DPT clean 8:31 Cystic Fibrosis https://www.ptpintcast.com/2019/05/07/cystic-fibrosis/ Tue, 07 May 2019 20:48:41 +0000 https://www.ptpintcast.com/?p=5486 Cystic Fibrosis Jimmy McKay, PT, DPT clean 7:56 Cardio Pulmonary – Atherosclerosis & Angina https://www.ptpintcast.com/2019/03/28/cardio-pulm-atherosclerosis-angina/ Thu, 28 Mar 2019 12:25:59 +0000 https://www.ptpintcast.com/?p=5410 Cardio Pulm - Atherosclerosis & Angina Jimmy McKay, PT, DPT clean 11:38 DVT – Deep Vein Thrombosis https://www.ptpintcast.com/2019/03/15/dvt-deep-vein-thrombosis/ Fri, 15 Mar 2019 17:31:12 +0000 https://www.ptpintcast.com/?p=5390 DVT - Deep Vein Thrombosis Jimmy McKay, PT, DPT clean 6:58 Pressure Ulcers https://www.ptpintcast.com/2019/03/15/pressure-ulcers/ Fri, 15 Mar 2019 16:41:31 +0000 https://www.ptpintcast.com/?p=5388 Pressure Ulcers Jimmy McKay, PT, DPT clean 7:41 Parkinson’s Disease https://www.ptpintcast.com/2019/03/14/parkinsons-disease/ Fri, 15 Mar 2019 03:46:13 +0000 https://www.ptpintcast.com/?p=5386 Parkinson's Disease Jimmy McKay, PT, DPT clean 8:33 THA – Total Hip Arthroplasty https://www.ptpintcast.com/2019/03/14/tha-total-hip-arthroplasty/ Fri, 15 Mar 2019 02:16:15 +0000 https://www.ptpintcast.com/?p=5384 THA - Total Hip Arthroplasty Jimmy McKay, PT, DPT clean 7:01 TKA – Total Knee Arthroplasty https://www.ptpintcast.com/2019/03/14/tka-total-knee-arthroplasty/ Thu, 14 Mar 2019 23:12:22 +0000 https://www.ptpintcast.com/?p=5379 TKA - Total Knee Arthroplasty Jimmy McKay, PT, DPT clean 5:42 Myasthenia Gravis https://www.ptpintcast.com/2019/03/14/myasthenia-gravis/ Thu, 14 Mar 2019 20:49:53 +0000 https://www.ptpintcast.com/?p=5377 Myasthenia Gravis Jimmy McKay, PT, DPT clean 4:29 Neuro – Post-Polio Syndrome https://www.ptpintcast.com/2018/09/13/27-neuro-post-polio-syndrome/ Thu, 13 Sep 2018 12:36:31 +0000 http://www.ptpintcast.com/?p=4885 Neuro - Post-Polio Syndrome Jimmy McKay, PT, DPT clean 6:31 Neuro – Bell’s Palsy https://www.ptpintcast.com/2018/09/12/26-neuro-bells-palsy/ Thu, 13 Sep 2018 03:13:44 +0000 http://www.ptpintcast.com/?p=4883 Neuro - Bell's Palsy Jimmy McKay, PT, DPT clean 5:45 Neuro – Erb’s Palsy https://www.ptpintcast.com/2018/09/12/25-neuro-erbs-palsy/ Thu, 13 Sep 2018 01:06:31 +0000 http://www.ptpintcast.com/?p=4878 Neuro - Erb's Palsy Jimmy McKay, PT, DPT clean 6:04 Neuro – ALS Amyotrophic Lateral Sclerosis https://www.ptpintcast.com/2018/08/31/24-neuro-als-amyotrophic-lateral-sclerosis/ Sat, 01 Sep 2018 02:49:22 +0000 http://www.ptpintcast.com/?p=4840 Neuro - ALS Amyotrophic Lateral Sclerosis Jimmy McKay, PT, DPT clean 6:17 Neuro – Multiple Sclerosis https://www.ptpintcast.com/2018/08/31/23-neuro-multiple-sclerosis/ Fri, 31 Aug 2018 13:30:13 +0000 http://www.ptpintcast.com/?p=4838 Neuro - Multiple Sclerosis Jimmy McKay, PT, DPT clean 9:15 Neuro – Cerebellar Disorders https://www.ptpintcast.com/2018/08/30/22-neuro-cerebellar-disorders/ Thu, 30 Aug 2018 19:43:44 +0000 http://www.ptpintcast.com/?p=4833 Neuro - Cerebellar Disorders Jimmy McKay, PT, DPT clean 7:54 Neuro – Vestibular Disorders https://www.ptpintcast.com/2018/08/30/21-neuro-vestibular-disorders/ Thu, 30 Aug 2018 19:40:56 +0000 http://www.ptpintcast.com/?p=4831 Vestibular Disorders Host: Jimmy McKay, PT, DPT Featured Guest; Alicia Flach, PT, DPT, NCS Notes by Alexis Lancaster Vestibular Disorders   What is it? Disruption that can occur from vestibular apparatus (inner ear) through the cranial nerve to the CNS where the information is processed Any disruption along this path will cause a vestibular disorder   Anatomy Peripheral vestibular system BPPV: problems within the vestibular apparatus, specifically semicircular canal Creates sensation of moving, pt feels dizzy Problem with cranial nerve 8 (before synapse in brain stem) Problem here= peripheral problem Central vestibular system After cranial nerve 8 synapses in brainstem Travels different pathways to locations within the brain Problem here= central problem   Differential diagnosis Dizziness can be due to different things Vertigo: room spinning, could be peripheral or central vestibular problem Feeling of imbalance or disequilibrium, pt doesnt feel steady on their feet. Could be peripheral or central vestibular problem Unrelated to vestibular system Polypharmacy Orthostatic hypotension (pt complains of feeling light-headed, passing out, fainting) Low blood sugar (hypoglycemia) Migraines Get to the root of how the patient describes their dizziness   Special Tests Subjective interview: try to understand when it happens, how long it has been going on, how long it lasts when it happens, does it come and go or is it constant, is it related to positional changes? Rule out/in peripheral condition, BPPV: Dix Hallpike, head thrust test, dynamic visual acuity test Look for central signs throughout exam Hypermetria with saccades Abnormal changes in the ability to perform Vestibulo-occular reflex cancellation: being able to follow a moving object with your eyes and head moving in the same direction Rule in the vestibular system overall, rule in/out peripheral vs. central   Treatment Common encounter: BPPV Managed through canalith repositioning maneuvers (otoconia getting stuck in canal): Epley and BBQ Roll Dysfunction of peripheral nerve/hypofunction Gaze stabilization Tx Movement sensitivity/central component Habituation Exercise Graded exposure   Sample Question A physical therapist evaluates a patient who reports dizziness when getting out of bed. The physical therapist suspects the pt is experiencing symptoms related to BPPV. Which of the following would be the most appropriate assessment to confirm the presence of BPPV Head thrust test Dynamic visual acuity testing Dix Hallpike maneuver Clock drawing test   Answer: C. Dix Hallpike: it is an assessment in which an individual is moved into a position and is intended to elicit a response from the presence of otoconia in the semicircular canal. Position the patient and look for the presence of nystagmus to rule in BPPV.   Why the others are wrong: A: Head thrust test looks at the ability of a patient to perform VOR (vestibulo-ocular reflex)--> specifically looks for hypofunction B: Dynamic visual acuity testing tests for peripheral hypofunction. Perform eye chart and look at visual acuity in static position and then pt will move head side to side to see visual acuity dynamically. D: Clock drawing test identifies the presence of unilateral neglect   Vestibular Disorders

Host: Jimmy McKay, PT, DPT

Featured Guest; Alicia Flach, PT, DPT, NCS

Notes by Alexis Lancaster

Vestibular Disorders

 

What is it?

  • Disruption that can occur from vestibular apparatus (inner ear) through the cranial nerve to the CNS where the information is processed
  • Any disruption along this path will cause a vestibular disorder

 

Anatomy

  • Peripheral vestibular system
    • BPPV: problems within the vestibular apparatus, specifically semicircular canal
      • Creates sensation of moving, pt feels dizzy
    • Problem with cranial nerve 8 (before synapse in brain stem)
    • Problem here= peripheral problem
  • Central vestibular system
    • After cranial nerve 8 synapses in brainstem
    • Travels different pathways to locations within the brain
    • Problem here= central problem

 

Differential diagnosis

  • Dizziness can be due to different things
    • Vertigo: room spinning, could be peripheral or central vestibular problem
    • Feeling of imbalance or disequilibrium, pt doesnt feel steady on their feet. Could be peripheral or central vestibular problem
  • Unrelated to vestibular system
    • Polypharmacy
    • Orthostatic hypotension (pt complains of feeling light-headed, passing out, fainting)
    • Low blood sugar (hypoglycemia)
    • Migraines
  • Get to the root of how the patient describes their dizziness

 

Special Tests

  • Subjective interview: try to understand when it happens, how long it has been going on, how long it lasts when it happens, does it come and go or is it constant, is it related to positional changes?
  • Rule out/in peripheral condition, BPPV: Dix Hallpike, head thrust test, dynamic visual acuity test
  • Look for central signs throughout exam
    • Hypermetria with saccades
    • Abnormal changes in the ability to perform
  • Vestibulo-occular reflex cancellation: being able to follow a moving object with your eyes and head moving in the same direction
  • Rule in the vestibular system overall, rule in/out peripheral vs. central

 

Treatment

  • Common encounter: BPPV
    • Managed through canalith repositioning maneuvers (otoconia getting stuck in canal): Epley and BBQ Roll
  • Dysfunction of peripheral nerve/hypofunction
    • Gaze stabilization Tx
  • Movement sensitivity/central component
    • Habituation
    • Exercise
    • Graded exposure

 

Sample Question

A physical therapist evaluates a patient who reports dizziness when getting out of bed. The physical therapist suspects the pt is experiencing symptoms related to BPPV. Which of the following would be the most appropriate assessment to confirm the presence of BPPV

  1. Head thrust test
  2. Dynamic visual acuity testing
  3. Dix Hallpike maneuver
  4. Clock drawing test

 

Answer: C. Dix Hallpike: it is an assessment in which an individual is moved into a position and is intended to elicit a response from the presence of otoconia in the semicircular canal. Position the patient and look for the presence of nystagmus to rule in BPPV.

 

Why the others are wrong:

A: Head thrust test looks at the ability of a patient to perform VOR (vestibulo-ocular reflex)–> specifically looks for hypofunction

B: Dynamic visual acuity testing tests for peripheral hypofunction. Perform eye chart and look at visual acuity in static position and then pt will move head side to side to see visual acuity dynamically.

D: Clock drawing test identifies the presence of unilateral neglect

 

]]>
Neuro - Vestibular Disorders Host: Jimmy McKay, PT, DPT
Featured Guest; Alicia Flach, PT, DPT, NCS
Notes by Alexis Lancaster
Vestibular Disorders
 
What is it?

Disruption that can occur from vestibular apparatus (inner ear) through the cranial nerve to the CNS where the information is processed
Any disruption along this path will cause a vestibular disorder

 
Anatomy

Peripheral vestibular system

BPPV: problems within the vestibular apparatus, specifically semicircular canal

Creates sensation of moving, pt feels dizzy


Problem with cranial nerve 8 (before synapse in brain stem)
Problem here= peripheral problem


Central vestibular system

After cranial nerve 8 synapses in brainstem
Travels different pathways to locations within the brain
Problem here= central problem



 
Differential diagnosis

Dizziness can be due to different things

Vertigo: room spinning, could be peripheral or central vestibular problem
Feeling of imbalance or disequilibrium, pt doesnt feel steady on their feet. Could be peripheral or central vestibular problem


Unrelated to vestibular system

Polypharmacy
Orthostatic hypotension (pt complains of feeling light-headed, passing out, fainting)
Low blood sugar (hypoglycemia)
Migraines


Get to the root of how the patient describes their dizziness

 
Special Tests

Subjective interview: try to understand when it happens, how long it has been going on, how long it lasts when it happens, does it come and go or is it constant, is it related to positional changes?
Rule out/in peripheral condition, BPPV: Dix Hallpike, head thrust test, dynamic visual acuity test
Look for central signs throughout exam

Hypermetria with saccades
Abnormal changes in the ability to perform


Vestibulo-occular reflex cancellation: being able to follow a moving object with your eyes and head moving in the same direction
Rule in the vestibular system overall, rule in/out peripheral vs. central

 
Treatment

Common encounter: BPPV

Managed through canalith repositioning maneuvers (otoconia getting stuck in canal): Epley and BBQ Roll


Dysfunction of peripheral nerve/hypofunction

Gaze stabilization Tx


Movement sensitivity/central component

Habituation
Exercise
Graded exposure



 
Sample Question
A physical therapist evaluates a patient who reports dizziness when getting out of bed. The physical therapist suspects the pt is experiencing symptoms related to BPPV. Which of the following would be the most appropriate assessment to confirm the presence of BPPV

Head thrust test
Dynamic visual acuity testing
Dix Hallpike maneuver
Clock drawing test

 

Answer: C. Dix Hallpike: it is an assessment in which an individual is moved into a position and is intended to elicit a response from the presence of otoconia in the semicircular canal. Position the patient and look for the presence of nystagmus to rule in BPPV.

 
Why the others are wrong:
A: Head thrust test looks at the ability of a patient to perform VOR (vestibulo-ocular reflex)--> specifically looks for hypofunction

B: Dynamic visual acuity testing tests for peripheral hypofunction. Perform eye chart and look at visual acuity in static position and then pt will move head side to side to see visual acuity dynamically.

]]>
Jimmy McKay, PT, DPT clean 6:43
Neuro – Cauda Equina https://www.ptpintcast.com/2018/08/24/20-neuro-cauda-equina/ Fri, 24 Aug 2018 23:30:39 +0000 http://www.ptpintcast.com/?p=4782 Episode 20: Cauda Equina Syndrome Host Jimmy McKay Featured guest Bridget Ripa Notes Alexis Lancaster Cauda equina: “horse’s tail”   What is it? Injury to lumbar and sacral spinal nerve roots within the canal   Presentation Variable lower extremity paralysis Sensory loss Bowel and bladder dysfunction   Causes Trauma, pelvic crush (MVA), child birth could precede it   Differential diagnosis Other spinal cord syndromes Transverse myelitis MS Spinal infarct Spinal tumor   Special tests CT, MRI Clinical presentation & mechanism of injury   Treatment Make sure they are managed medically first Bowel/bladder program Motor learning Task-specific training ICF model Weight-bearing Neuromuscular re-education Tone management FES Aerobic training Positioning Bracing/splinting Locomotion if applicable Keeping an eye on shoulder pain Allow compensation in this population when they need to How will it look on the test? Mechanism of injury and clinical presentation Bowel and bladder dysfunction will be present with cauda equina! Episode 20: Cauda Equina Syndrome

Host Jimmy McKay

Featured guest Bridget Ripa

Notes Alexis Lancaster

Cauda equina: “horse’s tail”

 

What is it?

  • Injury to lumbar and sacral spinal nerve roots within the canal

 

Presentation

  • Variable lower extremity paralysis
  • Sensory loss
  • Bowel and bladder dysfunction

 

Causes

  • Trauma, pelvic crush (MVA), child birth could precede it

 

Differential diagnosis

  • Other spinal cord syndromes
  • Transverse myelitis
  • MS
  • Spinal infarct
  • Spinal tumor

 

Special tests

  • CT, MRI
  • Clinical presentation & mechanism of injury

 

Treatment

  • Make sure they are managed medically first
  • Bowel/bladder program
  • Motor learning
  • Task-specific training
  • ICF model
  • Weight-bearing
  • Neuromuscular re-education
  • Tone management
  • FES
  • Aerobic training
  • Positioning
  • Bracing/splinting
  • Locomotion if applicable
  • Keeping an eye on shoulder pain
  • Allow compensation in this population when they need to

How will it look on the test?

  • Mechanism of injury and clinical presentation
  • Bowel and bladder dysfunction will be present with cauda equina!
]]>
Neuro - Cauda Equina Host Jimmy McKay

Featured guest Bridget Ripa

Notes Alexis Lancaster
Cauda equina: “horse’s tail”
 
What is it?

Injury to lumbar and sacral spinal nerve roots within the canal

 
Presentation

Variable lower extremity paralysis
Sensory loss
Bowel and bladder dysfunction

 
Causes

Trauma, pelvic crush (MVA), child birth could precede it

 
Differential diagnosis

Other spinal cord syndromes
Transverse myelitis
MS
Spinal infarct
Spinal tumor

 
Special tests

CT, MRI
Clinical presentation & mechanism of injury

 
Treatment

Make sure they are managed medically first
Bowel/bladder program
Motor learning
Task-specific training
ICF model
Weight-bearing
Neuromuscular re-education
Tone management
FES
Aerobic training
Positioning
Bracing/splinting
Locomotion if applicable
Keeping an eye on shoulder pain
Allow compensation in this population when they need to

How will it look on the test?

Mechanism of injury and clinical presentation
Bowel and bladder dysfunction will be present with cauda equina!
]]>
Jimmy McKay, PT, DPT clean 3:07
Neuro – Central Cord Syndrome https://www.ptpintcast.com/2018/08/24/19-neuro-central-cord-syndrome/ Fri, 24 Aug 2018 23:03:55 +0000 http://www.ptpintcast.com/?p=4780 Episode 19: Central Cord Syndrome Host Jimmy McKay Featured guest Bridget Ripa Notes Alexis Lancaster What is it? Damage to the central portion of the spinal cord   How does it happen? Hyperextension of the cervical spine is the typical cause Inflammation or pressure on the cord centrally   Anatomy/Presentation Tricky Damages spinothalamic, corticospinal, and dorsal columns Upper extremities weaker than lower extremities Greater motor deficits than sensory deficits The sensation of the sacral region is present   Differential diagnosis The other spinal cord syndromes Rely on clinical presentation Imaging (CT/MRI)   Special tests CT/MRI Clinical presentations (UE deficits>LE)   Treatment Medically stable first Bowel/bladder program Motor learning Task-specific training Weight-bearing Neuromuscular re-education Strengthening Tone management FES Aerobic training Positioning Bracing/splinting Locomotion if applicable LE stronger than UE! So you will probably be walking Keeping an eye on shoulder pain Allow compensation in this population   How it will look on the NPTE Upper involved more than lower (hallmark sign) Mechanism of injury→ hyperextension injury Episode 19: Central Cord Syndrome

Host Jimmy McKay

Featured guest Bridget Ripa

Notes Alexis Lancaster

What is it?

  • Damage to the central portion of the spinal cord

 

How does it happen?

  • Hyperextension of the cervical spine is the typical cause
  • Inflammation or pressure on the cord centrally

 

Anatomy/Presentation

  • Tricky
  • Damages spinothalamic, corticospinal, and dorsal columns
  • Upper extremities weaker than lower extremities
  • Greater motor deficits than sensory deficits
  • The sensation of the sacral region is present

 

Differential diagnosis

  • The other spinal cord syndromes
    • Rely on clinical presentation
  • Imaging (CT/MRI)

 

Special tests

  • CT/MRI
  • Clinical presentations (UE deficits>LE)

 

Treatment

  • Medically stable first
  • Bowel/bladder program
  • Motor learning
  • Task-specific training
  • Weight-bearing
  • Neuromuscular re-education
  • Strengthening
  • Tone management
  • FES
  • Aerobic training
  • Positioning
  • Bracing/splinting
  • Locomotion if applicable
    • LE stronger than UE! So you will probably be walking
  • Keeping an eye on shoulder pain
  • Allow compensation in this population

 

How it will look on the NPTE

  • Upper involved more than lower (hallmark sign)
  • Mechanism of injury→ hyperextension injury
]]>
Neuro - Central Cord Syndrome Host Jimmy McKay

Featured guest Bridget Ripa

Notes Alexis Lancaster
What is it?

Damage to the central portion of the spinal cord

 
How does it happen?

Hyperextension of the cervical spine is the typical cause
Inflammation or pressure on the cord centrally

 
Anatomy/Presentation

Tricky
Damages spinothalamic, corticospinal, and dorsal columns
Upper extremities weaker than lower extremities
Greater motor deficits than sensory deficits
The sensation of the sacral region is present

 
Differential diagnosis

The other spinal cord syndromes

Rely on clinical presentation


Imaging (CT/MRI)

 
Special tests

CT/MRI
Clinical presentations (UE deficits>LE)

 
Treatment

Medically stable first
Bowel/bladder program
Motor learning
Task-specific training
Weight-bearing
Neuromuscular re-education
Strengthening
Tone management
FES
Aerobic training
Positioning
Bracing/splinting
Locomotion if applicable

LE stronger than UE! So you will probably be walking


Keeping an eye on shoulder pain
Allow compensation in this population

 
How it will look on the NPTE

Upper involved more than lower (hallmark sign)
Mechanism of injury→ hyperextension injury
]]>
Jimmy McKay, PT, DPT clean 2:52
Neuro – Brown Sequard Syndrome https://www.ptpintcast.com/2018/08/24/18-neuro-brown-sequard-syndrome/ Fri, 24 Aug 2018 19:31:19 +0000 http://www.ptpintcast.com/?p=4772 Episode 18: Brown Sequard Syndrome Notes by Alexis Lancaster, SPT What is it? Damage to one side of the spinal cord   Mechanism of injury: MVA, gunshot wound, stab wound   Impairments/presentation: Ipsilateral losses: proprioception, vibration, deep touch, discriminative touch, and voluntary motor control Contralateral losses: pain, temperature, crude touch   Differential diagnosis: Other spinal cord injuries (see above impairments list and differentiate this way) MS Spinal infarct Spinal tumor Transverse myelitis   Special tests: CT, MRI Clinical presentation   Treatment: Medically stable/managed Bowel/bladder program Task-specific training Motor learning Neuromuscular re-education Weight-bearing Tone management FES Aerobic training Positioning, splinting, bracing Keep an eye on shoulder pain   Allow for compensation!! (This is different, usually with the neurological population you want to use less compensation and aim for recovery of function, but these patients will need to compensate some)     How it will appear on the test: Know how it presents clinically Know the type of injury that may result in Brown-Sequard Episode 18: Brown Sequard Syndrome

Notes by Alexis Lancaster, SPT

What is it?

  • Damage to one side of the spinal cord

 

Mechanism of injury:

  • MVA, gunshot wound, stab wound

 

Impairments/presentation:

  • Ipsilateral losses: proprioception, vibration, deep touch, discriminative touch, and voluntary motor control
  • Contralateral losses: pain, temperature, crude touch

 

Differential diagnosis:

  • Other spinal cord injuries (see above impairments list and differentiate this way)
  • MS
  • Spinal infarct
  • Spinal tumor
  • Transverse myelitis

 

Special tests:

  • CT, MRI
  • Clinical presentation

 

Treatment:

    • Medically stable/managed
    • Bowel/bladder program
    • Task-specific training
    • Motor learning
    • Neuromuscular re-education
    • Weight-bearing
    • Tone management
    • FES
    • Aerobic training
    • Positioning, splinting, bracing
    • Keep an eye on shoulder pain

 

  • Allow for compensation!! (This is different, usually with the neurological population you want to use less compensation and aim for recovery of function, but these patients will need to compensate some)

 

 

How it will appear on the test:

  • Know how it presents clinically
  • Know the type of injury that may result in Brown-Sequard
]]>
Neuro - Brown Sequard Syndrome Notes by Alexis Lancaster, SPT
What is it?

Damage to one side of the spinal cord

 
Mechanism of injury:

MVA, gunshot wound, stab wound

 
Impairments/presentation:

Ipsilateral losses: proprioception, vibration, deep touch, discriminative touch, and voluntary motor control
Contralateral losses: pain, temperature, crude touch

 
Differential diagnosis:

Other spinal cord injuries (see above impairments list and differentiate this way)
MS
Spinal infarct
Spinal tumor
Transverse myelitis

 
Special tests:

CT, MRI
Clinical presentation

 
Treatment:



Medically stable/managed
Bowel/bladder program
Task-specific training
Motor learning
Neuromuscular re-education
Weight-bearing
Tone management
FES
Aerobic training
Positioning, splinting, bracing
Keep an eye on shoulder pain



 

* Allow for compensation!! (This is different, usually with the neurological population you want to use less compensation and aim for recovery of function, but these patients will need to compensate some)

 

 
How it will appear on the test:

Know how it presents clinically
Know the type of injury that may result in Brown-Sequard
]]>
Jimmy McKay, PT, DPT clean 3:38
Neuro – Posterior Cord Syndrome https://www.ptpintcast.com/2018/08/24/17-neuro-posterior-cord-syndrome/ Fri, 24 Aug 2018 19:28:40 +0000 http://www.ptpintcast.com/?p=4770 Episode17: Posterior Cord Syndrome Notes by Alexis Lancaster, SPT What is it? Damage to the posterior cord itself Occlusion of posterior spinal artery Very rare   Differential diagnosis Any of the other spinal cord syndromes (anterior/brown sequard/central cord)   Clinical presentation Isolated loss of proprioception, vibration, & discriminative touch   Special tests Clinical presentation stated above CT/MRI for confirmation   Treatment ICF model Medical management Bowel/bladder program Motor learning Task-specific training Weight-bearing Neuromuscular re-education Tone management FES Aerobic training Positioning Bracing/splinting Locomotion Keeping an eye on shoulder pain Allow compensation in this population   Sample question Identification of the mechanism of injury related to this condition Identification of clinical presentation   Episode17: Posterior Cord Syndrome

Notes by Alexis Lancaster, SPT

What is it?

  • Damage to the posterior cord itself
  • Occlusion of posterior spinal artery
  • Very rare

 

Differential diagnosis

  • Any of the other spinal cord syndromes (anterior/brown sequard/central cord)

 

Clinical presentation

  • Isolated loss of proprioception, vibration, & discriminative touch

 

Special tests

  • Clinical presentation stated above
  • CT/MRI for confirmation

 

Treatment

  • ICF model
  • Medical management
  • Bowel/bladder program
  • Motor learning
  • Task-specific training
  • Weight-bearing
  • Neuromuscular re-education
  • Tone management
  • FES
  • Aerobic training
  • Positioning
  • Bracing/splinting
  • Locomotion
  • Keeping an eye on shoulder pain
  • Allow compensation in this population

 

Sample question

  • Identification of the mechanism of injury related to this condition
  • Identification of clinical presentation

 

]]>
Neuro - Posterior Cord Syndrome Notes by Alexis Lancaster, SPT
What is it?

Damage to the posterior cord itself
Occlusion of posterior spinal artery
Very rare

 
Differential diagnosis

Any of the other spinal cord syndromes (anterior/brown sequard/central cord)

 
Clinical presentation

Isolated loss of proprioception, vibration, & discriminative touch

 
Special tests

Clinical presentation stated above
CT/MRI for confirmation

 
Treatment

ICF model
Medical management
Bowel/bladder program
Motor learning
Task-specific training
Weight-bearing
Neuromuscular re-education
Tone management
FES
Aerobic training
Positioning
Bracing/splinting
Locomotion
Keeping an eye on shoulder pain
Allow compensation in this population

 
Sample question

Identification of the mechanism of injury related to this condition
Identification of clinical presentation

 ]]>
Jimmy McKay, PT, DPT clean 2:52
Neuro – Anterior Cord Syndrome https://www.ptpintcast.com/2018/08/21/16-neuro-anterior-cord-syndrome/ Tue, 21 Aug 2018 13:00:54 +0000 http://www.ptpintcast.com/?p=4749 Neuro - Anterior Cord Syndrome Jimmy McKay, PT, DPT clean 3:07 Neuro – Autonomic Dysreflexia https://www.ptpintcast.com/2018/08/20/15-neuro-autonomic-dysreflexia/ Tue, 21 Aug 2018 02:09:46 +0000 http://www.ptpintcast.com/?p=4747 Episode 15- Autonomic Dysreflexia   What is it? Excessive autonomic nervous system activity triggered by afferent stimuli below the level of the spinal cord injury (usually level T6 and above) The stimulus can be noxious or non-noxious Usually it is a noxious stimulus Example: kinked catheter, tight clothing, overheating, UTI, bowel impaction, skin irritation Need to realize that the patient does not have sensation at this level, so their body is telling them that something is wrong via AD/excessive ANS activity and you as the PT need to figure out what is causing this response   Anatomy Know what level it can occur at (T6 level of injury and above) Noxious/non-noxious stimuli   Differential Diagnosis Orthostatic hypotension: presents similarly, check BP! OH: BP drops, AD: BP stays the same or is rising Migraine: a lot of reports from patients involve a pounding headache Essential hypertension: a person is becoming hypertensive with a certain activity Anxiety Withdrawal from pharmacologic drugs   Special tests BP Clinical diagnosis: look at the signs & symptoms Signs: very rapid increase in BP (doesn’t always increase, but if it does, it will be rapid), decreased heart rate, goosebumps, diaphoresis, flushed skin above the level of the injury Symptoms: pounding headache, chills, anxiety, nausea   How it will look on the test: Incorporating a patient with a SCI and identifying AD and knowing how to manage it, what level injuries it may occur with How to manage: sit the patient up! (the direct opposite of orthostatic hypotension), quickly identify what the irritant is Fun way to remember how to treat immediately: AD: BP up, sit the patient up OH: BP down, lay patient down Episode 15- Autonomic Dysreflexia

 

What is it?

  • Excessive autonomic nervous system activity triggered by afferent stimuli below the level of the spinal cord injury (usually level T6 and above)
    • The stimulus can be noxious or non-noxious
    • Usually it is a noxious stimulus
    • Example: kinked catheter, tight clothing, overheating, UTI, bowel impaction, skin irritation
  • Need to realize that the patient does not have sensation at this level, so their body is telling them that something is wrong via AD/excessive ANS activity and you as the PT need to figure out what is causing this response

 

Anatomy

  • Know what level it can occur at (T6 level of injury and above)
  • Noxious/non-noxious stimuli

 

Differential Diagnosis

  • Orthostatic hypotension: presents similarly, check BP! OH: BP drops, AD: BP stays the same or is rising
  • Migraine: a lot of reports from patients involve a pounding headache
  • Essential hypertension: a person is becoming hypertensive with a certain activity
  • Anxiety
  • Withdrawal from pharmacologic drugs

 

Special tests

  • BP
  • Clinical diagnosis: look at the signs & symptoms
    • Signs: very rapid increase in BP (doesn’t always increase, but if it does, it will be rapid), decreased heart rate, goosebumps, diaphoresis, flushed skin above the level of the injury
    • Symptoms: pounding headache, chills, anxiety, nausea

 

How it will look on the test:

  • Incorporating a patient with a SCI and identifying AD and knowing how to manage it, what level injuries it may occur with
  • How to manage: sit the patient up! (the direct opposite of orthostatic hypotension), quickly identify what the irritant is

Fun way to remember how to treat immediately:

  • AD: BP up, sit the patient up
  • OH: BP down, lay patient down
]]>
Neuro Autonomic Dysreflexia  
What is it?

Excessive autonomic nervous system activity triggered by afferent stimuli below the level of the spinal cord injury (usually level T6 and above)

The stimulus can be noxious or non-noxious
Usually it is a noxious stimulus
Example: kinked catheter, tight clothing, overheating, UTI, bowel impaction, skin irritation


Need to realize that the patient does not have sensation at this level, so their body is telling them that something is wrong via AD/excessive ANS activity and you as the PT need to figure out what is causing this response

 
Anatomy

Know what level it can occur at (T6 level of injury and above)
Noxious/non-noxious stimuli

 
Differential Diagnosis

Orthostatic hypotension: presents similarly, check BP! OH: BP drops, AD: BP stays the same or is rising
Migraine: a lot of reports from patients involve a pounding headache
Essential hypertension: a person is becoming hypertensive with a certain activity
Anxiety
Withdrawal from pharmacologic drugs

 
Special tests

BP
Clinical diagnosis: look at the signs & symptoms

Signs: very rapid increase in BP (doesn’t always increase, but if it does, it will be rapid), decreased heart rate, goosebumps, diaphoresis, flushed skin above the level of the injury
Symptoms: pounding headache, chills, anxiety, nausea



 
How it will look on the test:

Incorporating a patient with a SCI and identifying AD and knowing how to manage it, what level injuries it may occur with
How to manage: sit the patient up! (the direct opposite of orthostatic hypotension), quickly identify what the irritant is

Fun way to remember how to treat immediately:

AD: BP up, sit the patient up
OH: BP down, lay patient down
]]>
Jimmy McKay, PT, DPT clean 4:06
Neuro – Huntington’s Disease https://www.ptpintcast.com/2018/08/20/14-neuro-huntingtons-disease/ Mon, 20 Aug 2018 17:59:30 +0000 http://www.ptpintcast.com/?p=4744 Episode 14: Huntington’s Disease Host Jimmy McKay Featured guest Bridget Ripa Notes by Alexis Lancaster What is it? Inherited, an autosomal dominant trait Causes degeneration to specific brain regions Huntington’s disease gene is on chromosome 4 and it produces the Huntington protein that’s found throughout the body   Signs/Symptoms Symptoms can present at any age Symptoms can include physical, cognitive, and psychiatric signs & symptoms   The disease is divided into 5 stages Preclinical, early, middle, late, end of life   Anatomy/Presentation Mechanism unclear Hallmark sign: atrophy of striatum that later involves cerebral cortex and subcortical structures Leads to severe loss of neurons in caudate and putamen Also affects basal ganglia pathways, the indirect pathway is affected before direct pathway (important)   Differential diagnosis Lupus, chorea, ataxia, generalized neurodegenerative disorder R/O with genetic testing   Treatment PT will see patients in middle/later stages (95% of pts) Check medications→ should have meds for abnormal movements and psychiatric disorders Specific to individual Family training Management of falls and decreased mobility   On the NPTE Medications will be important (drastically changes function) Know meds they may be on Antipsychotics Antidepressants disorder. Side effects may include nausea, diarrhea, drowsiness and low blood pressure. Mood stabilizing drugs Know the PT management of disease progression (family education, etc.) Episode 14: Huntington’s Disease

Host Jimmy McKay

Featured guest Bridget Ripa

Notes by Alexis Lancaster

What is it?

  • Inherited, an autosomal dominant trait
  • Causes degeneration to specific brain regions
  • Huntington’s disease gene is on chromosome 4 and it produces the Huntington protein that’s found throughout the body

 

Signs/Symptoms

  • Symptoms can present at any age
  • Symptoms can include physical, cognitive, and psychiatric signs & symptoms  
  • The disease is divided into 5 stages
    • Preclinical, early, middle, late, end of life

 

Anatomy/Presentation

  • Mechanism unclear
  • Hallmark sign: atrophy of striatum that later involves cerebral cortex and subcortical structures
    • Leads to severe loss of neurons in caudate and putamen
    • Also affects basal ganglia pathways, the indirect pathway is affected before direct pathway (important)

 

Differential diagnosis

  • Lupus, chorea, ataxia, generalized neurodegenerative disorder
  • R/O with genetic testing

 

Treatment

  • PT will see patients in middle/later stages (95% of pts)
  • Check medications→ should have meds for abnormal movements and psychiatric disorders
  • Specific to individual
    • Family training
    • Management of falls and decreased mobility

 

On the NPTE

  • Medications will be important (drastically changes function)
    • Know meds they may be on
      • Antipsychotics
      • Antidepressants disorder. Side effects may include nausea, diarrhea, drowsiness and low blood pressure.
      • Mood stabilizing drugs
  • Know the PT management of disease progression (family education, etc.)
]]>
Neuro - Huntington's Disease Host Jimmy McKay

Featured guest Bridget Ripa

Notes by Alexis Lancaster
What is it?

Inherited, an autosomal dominant trait
Causes degeneration to specific brain regions
Huntington’s disease gene is on chromosome 4 and it produces the Huntington protein that’s found throughout the body

 
Signs/Symptoms

Symptoms can present at any age
Symptoms can include physical, cognitive, and psychiatric signs & symptoms  
The disease is divided into 5 stages

Preclinical, early, middle, late, end of life



 
Anatomy/Presentation

Mechanism unclear
Hallmark sign: atrophy of striatum that later involves cerebral cortex and subcortical structures

Leads to severe loss of neurons in caudate and putamen
Also affects basal ganglia pathways, the indirect pathway is affected before direct pathway (important)



 
Differential diagnosis

Lupus, chorea, ataxia, generalized neurodegenerative disorder
R/O with genetic testing

 
Treatment

PT will see patients in middle/later stages (95% of pts)


Check medications→ should have meds for abnormal movements and psychiatric disorders
Specific to individual

Family training
Management of falls and decreased mobility



 
On the NPTE

Medications will be important (drastically changes function)

Know meds they may be on

Antipsychotics
Antidepressants disorder. Side effects may include nausea, diarrhea, drowsiness and low blood pressure.
Mood stabilizing drugs




Know the PT management of disease progression (family education, etc.)
]]>
Jimmy McKay, PT, DPT clean 3:38
Neuro – Guillain Barre https://www.ptpintcast.com/2018/08/18/13-neuro-guillain-barre/ Sat, 18 Aug 2018 13:40:47 +0000 http://www.ptpintcast.com/?p=4718 Neuro - Guillain Barre Get Jimmy McKay, PT, DPT clean 6:10 Neuro – Orthostatic Hypotension https://www.ptpintcast.com/2018/08/18/12-neuro-orthostatic-hypotension/ Sat, 18 Aug 2018 13:17:07 +0000 http://www.ptpintcast.com/?p=4715 Get free NPTE Study Flashcards here: https://www.aureusmedical.com/nptestudycast.aspx Orthostatic Hypotension NPTE Studycast Featured Expert Bridget Ripa, PT, DPT, NCS, CBIS, CSRS Notes by Alexis Lancaster, SPT What is it A decrease in blood pressure by ≥20mmHg systolic and ≥10mmHg diastolic when moving from a supine to upright position Causes Cardiovascular system, BP, blood supply to the brain Signs & Symptoms: Physical signs: pallor, diaphoresis, loss of consciousness (potentially) Symptoms pt will report: dizziness, light-headedness, faintness, nausea Differential Diagnosis: Autonomic dysreflexia Look at the blood pressure: AD will have ↑ in BP, OH will have ↓ in BP Vertigo, BPPV: b/c of dizziness and light-headedness symptoms Generalized nausea from infection, etc. Special tests Orthostatic testing: monitor BP with position changes Treatment examples: Immediately: lay the person down, elevate legs to prevent loss of consciousness After: talk to the team about BP treatment medications Encourage fluids with pt Progress upright tolerance with a hospital bed, tilt table to decrease the number of OH episodes/frequency & duration of OH episodes Abdominal binders, ace wraps on legs to keep BP up How can it look on the test? The important part: recognizing OH and manage it Emergent scenario: decide that it’s OH and what you would do about it May need to differentiate between OH and more emergent conditions, such as AD Get free NPTE Study Flashcards here: https://www.aureusmedical.com/nptestudycast.aspx

Orthostatic Hypotension NPTE Studycast

Featured Expert Bridget Ripa, PT, DPT, NCS, CBIS, CSRS

Notes by Alexis Lancaster, SPT

What is it

  • A decrease in blood pressure by ≥20mmHg systolic and ≥10mmHg diastolic when moving from a supine to upright position

Causes

  • Cardiovascular system, BP, blood supply to the brain

Signs & Symptoms:

  • Physical signs: pallor, diaphoresis, loss of consciousness (potentially)
  • Symptoms pt will report: dizziness, light-headedness, faintness, nausea

Differential Diagnosis:

  • Autonomic dysreflexia
  • Look at the blood pressure: AD will have ↑ in BP, OH will have ↓ in BP
  • Vertigo, BPPV: b/c of dizziness and light-headedness symptoms
  • Generalized nausea from infection, etc.

Special tests

  • Orthostatic testing: monitor BP with position changes

Treatment examples:

  • Immediately: lay the person down, elevate legs to prevent loss of consciousness
  • After: talk to the team about BP treatment medications
  • Encourage fluids with pt
  • Progress upright tolerance with a hospital bed, tilt table to decrease the number of OH episodes/frequency & duration of OH episodes
  • Abdominal binders, ace wraps on legs to keep BP up

How can it look on the test?

  • The important part: recognizing OH and manage it
  • Emergent scenario: decide that it’s OH and what you would do about it
  • May need to differentiate between OH and more emergent conditions, such as AD
]]>
Neuro - Orthostatic Hypotension Get free NPTE Study Flashcards here: https://www.aureusmedical.com/nptestudycast.aspx Jimmy McKay, PT, DPT clean 4:06
Neuro – TIA https://www.ptpintcast.com/2018/08/17/11-neuro-tia/ Fri, 17 Aug 2018 23:53:23 +0000 http://www.ptpintcast.com/?p=4711 TIA – Transient Ischemic Attack Notes by Nick O'Hanlon, SPT What is it? The same underlying mechanism as an ischemic stroke; with the main difference being the duration of symptoms is significantly less In other words, a brief episode of neurological dysfunction caused by ischemia (lack of blood supply) to the brain No tissue death occurs Signs and Symptoms Clinically presents like a stroke, but can also look like: a seizure disorder, tumor, migraines, or hypoglycemia Stroke symptoms – slurred speech, paralysis, overactive reflexes, balance and coordination issues, reduced sensation A complete resolution of symptoms occurs within 24 hours   Anatomy Dependent on an area of the brain the ischemic attack occurs, but any part of the brain Crescendo TIAs – having more than one TIA within a specified time period 2 within 24 hours 3 within 3 days 4 within 2 weeks   Special Tests Imaging – CT/MRI Clinical Exam – ABCDD2 prediction rule, which can predict risk of stroke after a TIA Age, >60 years BP, >140/90 Clinical presentation: unilateral weakness with or without speech impairment Duration of symptoms Diabetes Above a certain point threshold for the rule, patient is at increased risk for a stroke Differential Diagnosis Can present similarly to stroke, but the duration of symptoms for a stroke is much longer Causes Risk factors for TIA include: smoking, high blood pressure, high cholesterol, diabetes, and family history Treatment examples Treating the person as they present with their impairments There is a good possibility the duration of symptoms is too short for us to see them during the dysfunctional window before resolution of symptoms Education about risk factors and crescendo TIAs How does it look on the test? ABCDD prediction rule is important to know Be able to differentiate between TIA and stroke TIA – Transient Ischemic Attack

Notes by Nick O’Hanlon, SPT

What is it?

The same underlying mechanism as an ischemic stroke; with the main difference being the duration of symptoms is significantly less

In other words, a brief episode of neurological dysfunction caused by ischemia (lack of blood supply) to the brain

No tissue death occurs

Signs and Symptoms

Clinically presents like a stroke, but can also look like: a seizure disorder, tumor, migraines, or hypoglycemia

Stroke symptoms – slurred speech, paralysis, overactive reflexes, balance and coordination issues, reduced sensation

A complete resolution of symptoms occurs within 24 hours

 

Anatomy

Dependent on an area of the brain the ischemic attack occurs, but any part of the brain

Crescendo TIAs – having more than one TIA within a specified time period

2 within 24 hours

3 within 3 days

4 within 2 weeks

 

Special Tests

Imaging – CT/MRI
Clinical Exam – ABCDD2 prediction rule, which can predict risk of stroke after a TIA
Age, >60 years
BP, >140/90
Clinical presentation: unilateral weakness with or without speech impairment
Duration of symptoms
Diabetes

Above a certain point threshold for the rule, patient is at increased risk for a stroke

Differential Diagnosis

Can present similarly to stroke, but the duration of symptoms for a stroke is much longer

Causes

Risk factors for TIA include: smoking, high blood pressure, high cholesterol, diabetes, and family history

Treatment examples

Treating the person as they present with their impairments

There is a good possibility the duration of symptoms is too short for us to see them during the dysfunctional window before resolution of symptoms

Education about risk factors and crescendo TIAs

How does it look on the test?

ABCDD prediction rule is important to know

Be able to differentiate between TIA and stroke

]]>
Neuro - Ischemic Stroke Notes by Nick O'Hanlon, SPT
What is it?
The same underlying mechanism as an ischemic stroke; with the main difference being the duration of symptoms is significantly less

In other words, a brief episode of neurological dysfunction caused by ischemia (lack of blood supply) to the brain

No tissue death occurs
Signs and Symptoms
Clinically presents like a stroke, but can also look like: a seizure disorder, tumor, migraines, or hypoglycemia

Stroke symptoms – slurred speech, paralysis, overactive reflexes, balance and coordination issues, reduced sensation

A complete resolution of symptoms occurs within 24 hours

 
Anatomy
Dependent on an area of the brain the ischemic attack occurs, but any part of the brain

Crescendo TIAs – having more than one TIA within a specified time period

2 within 24 hours

3 within 3 days

4 within 2 weeks

 
Special Tests
Imaging – CT/MRI
Clinical Exam – ABCDD2 prediction rule, which can predict risk of stroke after a TIA
Age, >60 years
BP, >140/90
Clinical presentation: unilateral weakness with or without speech impairment
Duration of symptoms
Diabetes

Above a certain point threshold for the rule, patient is at increased risk for a stroke
Differential Diagnosis
Can present similarly to stroke, but the duration of symptoms for a stroke is much longer
Causes
Risk factors for TIA include: smoking, high blood pressure, high cholesterol, diabetes, and family history
Treatment examples
Treating the person as they present with their impairments

There is a good possibility the duration of symptoms is too short for us to see them during the dysfunctional window before resolution of symptoms

Education about risk factors and crescendo TIAs

How does it look on the test?

ABCDD prediction rule is important to know

Be able to differentiate between TIA and stroke]]>
Jimmy McKay, PT, DPT clean 3:42
Neuro – Ischemic Stroke https://www.ptpintcast.com/2018/08/13/6-neuro-ischemic-stroke/ Mon, 13 Aug 2018 11:53:01 +0000 http://www.ptpintcast.com/?p=4687 Neuro - Ischemic Stroke Jimmy McKay, PT, DPT clean 3:50 Neuro – Heterotrophic Ossificans https://www.ptpintcast.com/2018/08/13/9-neuro-heterotrophic-ossificans/ Mon, 13 Aug 2018 11:52:50 +0000 http://www.ptpintcast.com/?p=4693 Episode 9: Heterotopic ossification (HO) featured guest Bridget Ripa Notes by Alexis Lancaster What is it? The formation of bone inside soft tissue structures, where it’s not supposed to be It is extra-articular, so it occurs outside of the joint capsule   What is involved? How does it happen? Exact pathophysiology is unknown Usually comes from a period of immobilization or traumatic injury to that bone or to the affected area of the body   Presentation Swelling, redness, warm to the touch Similar to a DVT presentation Presents similarly to an infection within that area, such as thrombophlebitis, osteomyelitis, cellulitis, sepsis, septic arthritis Can present as a fracture, trauma, bruise, hematoma   Special tests XRay (gold standard) Bone scan   Treatment examples As the PT you can’t change the bone formation once it occurs Maintain ROM of the joint/area Maintain strength Prophylaxis is important: before HO occurs, you want to make sure you are paying attention to maintaining ROM with positioning, splinting/bracing early on to avoid HO development   On the NPTE Might be integrated into a question “During an initial evaluation of a patient s/p MVA with a complete lesion at C7, the PT notes redness, swelling, and warmth at the posterior knee joint. Which of the following conditions would most likely be present? Dependent on answers if HO is an answer, you can go with that Could be DVT, as well Consider answers that are available on the test! Episode 9: Heterotopic ossification (HO)

featured guest Bridget Ripa

Notes by Alexis Lancaster

What is it?

  • The formation of bone inside soft tissue structures, where it’s not supposed to be
  • It is extra-articular, so it occurs outside of the joint capsule

 

What is involved? How does it happen?

  • Exact pathophysiology is unknown
  • Usually comes from a period of immobilization or traumatic injury to that bone or to the affected area of the body

 

Presentation

  • Swelling, redness, warm to the touch
  • Similar to a DVT presentation
  • Presents similarly to an infection within that area, such as thrombophlebitis, osteomyelitis, cellulitis, sepsis, septic arthritis
  • Can present as a fracture, trauma, bruise, hematoma

 

Special tests

  • XRay (gold standard)
  • Bone scan

 

Treatment examples

  • As the PT you can’t change the bone formation once it occurs
  • Maintain ROM of the joint/area
  • Maintain strength
  • Prophylaxis is important: before HO occurs, you want to make sure you are paying attention to maintaining ROM with positioning, splinting/bracing early on to avoid HO development

 

On the NPTE

  • Might be integrated into a question
  • “During an initial evaluation of a patient s/p MVA with a complete lesion at C7, the PT notes redness, swelling, and warmth at the posterior knee joint. Which of the following conditions would most likely be present?
    • Dependent on answers if HO is an answer, you can go with that
    • Could be DVT, as well
    • Consider answers that are available on the test!
]]>
Neuro - Heterotrophic Ossificans featured guest Bridget Ripa

Notes by Alexis Lancaster
What is it?

The formation of bone inside soft tissue structures, where it’s not supposed to be
It is extra-articular, so it occurs outside of the joint capsule

 
What is involved? How does it happen?

Exact pathophysiology is unknown
Usually comes from a period of immobilization or traumatic injury to that bone or to the affected area of the body

 
Presentation

Swelling, redness, warm to the touch
Similar to a DVT presentation
Presents similarly to an infection within that area, such as thrombophlebitis, osteomyelitis, cellulitis, sepsis, septic arthritis
Can present as a fracture, trauma, bruise, hematoma

 
Special tests

XRay (gold standard)
Bone scan

 
Treatment examples

As the PT you can’t change the bone formation once it occurs
Maintain ROM of the joint/area
Maintain strength
Prophylaxis is important: before HO occurs, you want to make sure you are paying attention to maintaining ROM with positioning, splinting/bracing early on to avoid HO development

 
On the NPTE

Might be integrated into a question
“During an initial evaluation of a patient s/p MVA with a complete lesion at C7, the PT notes redness, swelling, and warmth at the posterior knee joint. Which of the following conditions would most likely be present?

Dependent on answers if HO is an answer, you can go with that
Could be DVT, as well
Consider answers that are available on the test!


]]>
Jimmy McKay, PT, DPT clean 3:33
Neuro – Spasticity https://www.ptpintcast.com/2018/08/13/8-neuro-spasticity/ Mon, 13 Aug 2018 11:49:29 +0000 http://www.ptpintcast.com/?p=4691 Episode 8: Spasticity Featured expert Bridget Ripa, PT, DPT, NCS, CBIS, CSRS Notes by Alexis Lancaster, SPT What is it   A type of tone Two types of tone exist: hypotonic and hypertonic Spasticity is a velocity-dependent resistance to stretch: this is the biggest difference between “tone” in general and “spasticity” Can lead to synergistic movement patterns   Anatomy   You won’t see spasticity unless there has been an injury to the CNS or the motor neuron Typical presentation of synergies when you see spasticity: Flexor synergies in the upper extremities Proximal extensors of the lower extremities Distal flexors of the lower extremities   Differential Diagnosis   Differentiate “tone” from “spasticity” What may present like spasticity: Decreased muscle flexibility Multi-trauma/anxious patients & muscle guarding Red flag to know it is spasticity: velocity dependent!   Special tests   Modified Ashworth (gold standard for measuring spasticity): grades spasticity, scale= 0-4   Treatment examples:   Early intervention is very important As soon as you notice spasticity, focus should shift to positioning, splinting if necessary, bracing, PROM, serial casting could be an option for more serious cases Medications: Botox, baclofen pump Surgery can be an option if ROM is significantly impaired   How can it look on the test?   Questions will be about identifying spasticity or the best way to treat it Example: Patient incurred a right CVA, he is a month out and demonstrating moderate spasticity in the left upper extremity, showing increased flexor tone. The major problem at this point is the lack of voluntary movement control. There is active movement but it is minimal and the patient has a ¼ inch separation of the shoulder. The initial treatment activity of greatest benefit would be with the patient sitting, weight-bearing on the extended affected upper extremity. Need to think about what the best option would be, go with the evidence and gold standard     Episode 8: Spasticity

Featured expert Bridget Ripa, PT, DPT, NCS, CBIS, CSRS

Notes by Alexis Lancaster, SPT

What is it

 

  • A type of tone
  • Two types of tone exist: hypotonic and hypertonic
  • Spasticity is a velocity-dependent resistance to stretch: this is the biggest difference between “tone” in general and “spasticity”
  • Can lead to synergistic movement patterns

 

Anatomy

 

  • You won’t see spasticity unless there has been an injury to the CNS or the motor neuron
  • Typical presentation of synergies when you see spasticity:
  • Flexor synergies in the upper extremities
  • Proximal extensors of the lower extremities
  • Distal flexors of the lower extremities

 

Differential Diagnosis

 

  • Differentiate “tone” from “spasticity”
  • What may present like spasticity:
  • Decreased muscle flexibility
  • Multi-trauma/anxious patients & muscle guarding
  • Red flag to know it is spasticity: velocity dependent!

 

Special tests

 

  • Modified Ashworth (gold standard for measuring spasticity): grades spasticity, scale= 0-4

 

Treatment examples:

 

  • Early intervention is very important
  • As soon as you notice spasticity, focus should shift to positioning, splinting if necessary, bracing, PROM, serial casting could be an option for more serious cases
  • Medications: Botox, baclofen pump
  • Surgery can be an option if ROM is significantly impaired

 

How can it look on the test?

 

  • Questions will be about identifying spasticity or the best way to treat it
  • Example: Patient incurred a right CVA, he is a month out and demonstrating moderate spasticity in the left upper extremity, showing increased flexor tone. The major problem at this point is the lack of voluntary movement control. There is active movement but it is minimal and the patient has a ¼ inch separation of the shoulder. The initial treatment activity of greatest benefit would be with the patient sitting, weight-bearing on the extended affected upper extremity.
  • Need to think about what the best option would be, go with the evidence and gold standard

 

 

]]>
Neuro - Spasticity Featured expert Bridget Ripa, PT, DPT, NCS, CBIS, CSRS
Notes by Alexis Lancaster, SPT
What is it
 

* A type of tone


* Two types of tone exist: hypotonic and hypertonic


* Spasticity is a velocity-dependent resistance to stretch: this is the biggest difference between “tone” in general and “spasticity”


* Can lead to synergistic movement patterns

 
Anatomy
 

* You won’t see spasticity unless there has been an injury to the CNS or the motor neuron


* Typical presentation of synergies when you see spasticity:


* Flexor synergies in the upper extremities


* Proximal extensors of the lower extremities


* Distal flexors of the lower extremities

 
Differential Diagnosis
 

* Differentiate “tone” from “spasticity”


* What may present like spasticity:


* Decreased muscle flexibility


* Multi-trauma/anxious patients & muscle guarding


* Red flag to know it is spasticity: velocity dependent!

 
Special tests
 

* Modified Ashworth (gold standard for measuring spasticity): grades spasticity, scale= 0-4

 
Treatment examples:
 

* Early intervention is very important


* As soon as you notice spasticity, focus should shift to positioning, splinting if necessary, bracing, PROM, serial casting could be an option for more serious cases


* Medications: Botox, baclofen pump


* Surgery can be an option if ROM is significantly impaired

 
How can it look on the test?
 

* Questions will be about identifying spasticity or the best way to treat it


* Example: Patient incurred a right CVA, he is a month out and demonstrating moderate spasticity in the left upper extremity, showing increased flexor tone. The major problem at this point is the lack of voluntary movement control. There is active movement but it is minimal and the patient has a ¼ inch separation of the shoulder. The initial treatment activity of greatest benefit would be with the patient sitting, weight-bearing on the extended affected upper extremity.


* Need to think about what the best option would be, go with the evidence and gold standard


*

 

 ]]>
Jimmy McKay, PT, DPT clean 4:53
Neuro – Traumatic Brain Injury https://www.ptpintcast.com/2018/08/13/7-neuro-traumatic-brain-injury/ Mon, 13 Aug 2018 11:47:41 +0000 http://www.ptpintcast.com/?p=4689 Neuro - Traumatic Brain Injury Jimmy McKay, PT, DPT clean 4:03 Neuro – Hemorrhagic Stroke https://www.ptpintcast.com/2018/08/13/6-neuro-hemorrhagic-stroke/ Mon, 13 Aug 2018 11:43:21 +0000 http://www.ptpintcast.com/?p=4685 Featured instructor Bridget Ripa, PT, DPT, NCS, CBIS, CSRS Featured instructor Bridget Ripa, PT, DPT, NCS, CBIS, CSRS ]]> Neuro - Hemorrhagic Stroke Featured instructor Bridget Ripa, PT, DPT, NCS, CBIS, CSRS]]> Jimmy McKay, PT, DPT clean 4:20 Orthopedics – UE Nerve Entrapment https://www.ptpintcast.com/2018/08/13/5-orthopedics-ue-nerve-entrapment/ Mon, 13 Aug 2018 11:41:04 +0000 http://www.ptpintcast.com/?p=4683 Orthopedics - UE Nerve Entrapment Jimmy McKay, PT, DPT clean 11:59 Orthopedics – Thoracic Outlet Syndrome https://www.ptpintcast.com/2018/08/13/4-orthopedics-thoracic-outlet-syndrome/ Mon, 13 Aug 2018 11:38:56 +0000 http://www.ptpintcast.com/?p=4681 Thoracic Outlet Syndrome Host Jimmy McKay, PT, DPT Featured professor:  Skye Donovan | PT, PhD, OCS Notes by Lauren Knasel What is it? Entrapment disorder of the nerves or the vascular that occurs inside the “thoracic outlet” → space between the collarbone and the first rib Three types Neurogenic Vascular Nonspecific Signs and Symptoms Shoulder pain: over the AC joint or biceps area→ could be a continuous burning, lame feeling in the shoulder and down the arm Tingling down the arm into the hand→ could lead to loss of control of the hand with the dropping objects Heaviness in the extremity Pain present at rest (when driving or watching tv) Pain radiating into the neck, trapezius musculature, shoulder blade, jaw, head, and chest Traction downwards on the arm when carrying shopping bags Pain often present during activities such as swimming, throwing, overhead activities→ could cause a feeling of fatigue and burning and having to bring the arm down due to not being able to maintain that position Anatomy Many bones, muscles, nerves, and blood vessels that course through the thoracic outlet Structures most commonly affected include: Clavicle 1st rib Scalene muscles (anterior and middle) →  more neurological s/s Pectoralis minor→ vascular s/s Subclavian artery and vein Upper and lower brachial plexus Special Tests The different tests are used to elicit symptoms of TOS with positions that would compress the nerves within the anterior scalene muscle Common Tests: Roos “Chicken Dance Test” (or commonly called Elevated Arm Stress Test or “EAST”) → nonspecific; doesn’t specify a location A positive test would result in usual TOS symptoms such as a gradual increase in pain in the neck and shoulder, aching progressing down the arm, and paresthesias Normally, a person can perform this test for 3 minutes with only minimal distress Adson’s → test for the scalenes “Reverse Dab” A positive test would result in peripheral radial pulse disappearing once the patient was put into the test position Allen’s A positive test would result in peripheral radial pulse disappearing once the patient was put into the test position Military Test → compression of costoclavicular space Hyperabduction Test or Wright’s Test→ for pec minor Recommended to use a combination of tests in order to come to clear diagnosis Differential Diagnosis Disc herniation in the cervical spine Peripheral nerve entrapment CRPS Inflammatory condition Causes Posture Forward head Tight pectoralis musculature Tight scalenes Repetitive overuse with poor posture Heavy backpacks Acute trauma Anatomic predispositions Treatment Examples Therapeutic Exercise Relaxing the shoulder girdle and upper trapezius musculature Stretching the scalenes and pectoralis muscles Strengthening the cervical extensors, scapular adductors, and shoulder retractors Manual Therapy Nerve Glides Posture Re-education Ergonomics NSAIDs Surgery (Rare) Modalities How can it look on the test? Just remember your anatomy! Postural Re-education is going to be your best answer   Thoracic Outlet Syndrome

Host Jimmy McKay, PT, DPT

Featured professor:  Skye Donovan | PT, PhD, OCS

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Orthopedics - Thoracic Outlet Syndrome Host Jimmy McKay, PT, DPT
Featured professor:  Skye Donovan | PT, PhD, OCS


Notes by Lauren Knasel

What is it?

Entrapment disorder of the nerves or the vascular that occurs inside the “thoracic outlet” → space between the collarbone and the first rib
Three types

Neurogenic
Vascular
Nonspecific



Signs and Symptoms

Shoulder pain: over the AC joint or biceps area→ could be a continuous burning, lame feeling in the shoulder and down the arm
Tingling down the arm into the hand→ could lead to loss of control of the hand with the dropping objects
Heaviness in the extremity
Pain present at rest (when driving or watching tv)
Pain radiating into the neck, trapezius musculature, shoulder blade, jaw, head, and chest
Traction downwards on the arm when carrying shopping bags
Pain often present during activities such as swimming, throwing, overhead activities→ could cause a feeling of fatigue and burning and having to bring the arm down due to not being able to maintain that position

Anatomy

Many bones, muscles, nerves, and blood vessels that course through the thoracic outlet
Structures most commonly affected include:

Clavicle
1st rib
Scalene muscles (anterior and middle) →  more neurological s/s
Pectoralis minor→ vascular s/s
Subclavian artery and vein
Upper and lower brachial plexus



Special Tests

The different tests are used to elicit symptoms of TOS with positions that would compress the nerves within the anterior scalene muscle
Common Tests:

Roos “Chicken Dance Test” (or commonly called Elevated Arm Stress Test or “EAST”) → nonspecific; doesn’t specify a location

A positive test would result in usual TOS symptoms such as a gradual increase in pain in the neck and shoulder, aching progressing down the arm, and paresthesias
Normally, a person can perform this test for 3 minutes with only minimal distress


Adson’s → test for the scalenes “Reverse Dab”

A positive test would result in peripheral radial pulse disappearing once the patient was put into the test position


Allen’s

A positive test would result in peripheral radial pulse disappearing once the patient was put into the test position


Military Test → compression of costoclavicular space
Hyperabduction Test or Wright’s Test→ for pec minor


Recommended to use a combination of tests in order to come to clear diagnosis

Differential Diagnosis

Disc herniation in the cervical spine
Peripheral nerve entrapment
CRPS
Inflammatory condition

Causes

Posture

Forward head
Tight pectoralis musculature
Tight scalenes


Repetitive overuse with poor posture
Heavy backpacks
Acute trauma
Anatomic predispositions

Treatment Examples

Therapeutic Exercise

Relaxing the shoulder girdle and upper trapezius musculature
Stretching the scalenes and pectoralis muscles
Strengthening the cervical extensors, scapular adductors, and shoulder retractors


Manual Therapy
Nerve Glides
Posture Re-education

Ergonomics


NSAIDs
Surgery (Rare)
Modalities

How can it look on the test?

Just remember your anatomy!
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Jimmy McKay, PT, DPT clean 8:29
Orthopedics – Frozen Shoulder https://www.ptpintcast.com/2018/08/13/3-orthopedics-frozen-shoulder/ Mon, 13 Aug 2018 11:36:15 +0000 http://www.ptpintcast.com/?p=4679 Orthopedics - Frozen Shoulder Jimmy McKay, PT, DPT clean 8:21 Orthopedics – Elbow Differential Diagnosis https://www.ptpintcast.com/2018/08/12/2-orthopedics-elbow-differential-diagnosis/ Mon, 13 Aug 2018 02:42:34 +0000 http://www.ptpintcast.com/?p=4677 Featured professor:  Skye Donovan | PT, PhD, OCS Episode 2: Elbow Differential Diagnosis Notes by Alexis Lancaster, SPT General information Tennis elbow: lateral epicondylitis “Thumb side” Golfers elbow: medial epicondylitis “Pinky side” Country club elbow: both medial & lateral epicondylitis Symptoms Pain on medial or lateral side Causes Does not need to be tennis or golf Grip usually causes these conditions Driving & gripping steering wheel too tight Weight lifting with too much gripping Swimmers can be affected (pointing their fingers) Differential diagnosis Bursitis: bursa sits under olecranon Pronator teres syndrome: painful/achy on lateral side Osteoarthritis of elbow joint Rheumatoid arthritis C-spine radiculopathy (especially C6-C7) Ulnar nerve pathology What does the pain feel like? Nerve pain? Think nerve injury/problem Tendinopathy Overuse Lateral epicondylitis: usually due to excessive grip, excessive wrist extension→ seen in racquet sports, occupation and work-related tasks that have a lot of vibration (jack-hammering) Medial epocondylitis: usually due to excessive grip while in pronation, or excessive wrist flexion Anatomy Lateral: wrist extensors (common extensor origin) Usually associated with extensor carpi radialis brevis (ECRB) involvement. ECRB attaches to 3rd digit Extensor carpi radialis longus inserts on 2nd digit It could be any muscle that shares the common extensor origin that is involved (ex. brachioradialis and extensor digitorum) The radial nerve supplies extensor carpi ulnaris, radialis brevis & longus Medial: wrist flexors (common flexor origin) “Pass/fail/pass/fail”: pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris Not everyone has a palmaris longus Median nerve: pronator teres, flexor carpi radialis, palmaris longus Ulnar nerve: flexor carpi ulnaris Deep to these= flexor digitorum profundus and superficialis “Medial side of forearm” Special tests Lateral epicondylitis “Tennis elbow test”: MMT for wrist extensors Can add some radial deviation Can lift the third finger to see if it is ECRB Look for provocation of pain at the lateral epicondyle   Medial epicondylitis “Golfer’s elbow test: MMT for wrist flexion Look for provocation of pain at the medial epicondyle Cervical spine testing to rule out the spine Grip testing (will be weak) Treatment examples Modalities Corticosteroid injections TherEx: Loosen grip Eccentrics Take pressure off the origin, start with forearm supported to shorten lever arm Don’t have pt exercise into pain Bracing More common with lateral epicondylitis compared to medial Education/prevention: pts don’t understand their grip may be the problem Sample question: If your patient comes to you with lateral epicondylitis, where is the best position that you would put their brace? Superior to the elbow Inferior to the elbow Superior to the wrist At the wrist Answer: Inferior to the elbow Why: You can have a brace that is giving compression, so you put it at the joint. However, in this case, if you are bracing to decrease the force that is coming through something, you need to cheat the body into thinking that the muscle’s origin is coming from a different place so it is not getting pull where it is getting damaged. You can place a brace here because the part of the muscle that is inflamed is a tendon, not contractile tissue. If you put the brace superior to the elbow, it would likely increase pain. You’re putting compression on the damaged part, so you aren’t changing the lever arm. If you had an answer of “at the elbow”, the compression will be great, but it won’t be the best answer if “inferior to the elbow” is also a choice, Superior to the wrist/at the wrist: missing the point of the brace for the condition   Featured professor:  Skye Donovan | PT, PhD, OCS

Episode 2: Elbow Differential Diagnosis

Notes by Alexis Lancaster, SPT

General information

  • Tennis elbow: lateral epicondylitis
    • “Thumb side”
  • Golfers elbow: medial epicondylitis
    • “Pinky side”
  • Country club elbow: both medial & lateral epicondylitis

Symptoms

  • Pain on medial or lateral side

Causes

  • Does not need to be tennis or golf
  • Grip usually causes these conditions
  • Driving & gripping steering wheel too tight
  • Weight lifting with too much gripping
  • Swimmers can be affected (pointing their fingers)

Differential diagnosis

  • Bursitis: bursa sits under olecranon
  • Pronator teres syndrome: painful/achy on lateral side
  • Osteoarthritis of elbow joint
  • Rheumatoid arthritis
  • C-spine radiculopathy (especially C6-C7)
  • Ulnar nerve pathology
    • What does the pain feel like? Nerve pain? Think nerve injury/problem
  • Tendinopathy
    • Overuse
    • Lateral epicondylitis: usually due to excessive grip, excessive wrist extension→ seen in racquet sports, occupation and work-related tasks that have a lot of vibration (jack-hammering)
    • Medial epocondylitis: usually due to excessive grip while in pronation, or excessive wrist flexion

Anatomy

  • Lateral: wrist extensors (common extensor origin)
    • Usually associated with extensor carpi radialis brevis (ECRB) involvement. ECRB attaches to 3rd digit
    • Extensor carpi radialis longus inserts on 2nd digit
    • It could be any muscle that shares the common extensor origin that is involved (ex. brachioradialis and extensor digitorum)
    • The radial nerve supplies extensor carpi ulnaris, radialis brevis & longus
  • Medial: wrist flexors (common flexor origin)
    • “Pass/fail/pass/fail”: pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris
      • Not everyone has a palmaris longus
      • Median nerve: pronator teres, flexor carpi radialis, palmaris longus
      • Ulnar nerve: flexor carpi ulnaris
      • Deep to these= flexor digitorum profundus and superficialis
      • “Medial side of forearm”

Special tests

  • Lateral epicondylitis
    • “Tennis elbow test”: MMT for wrist extensors
      • Can add some radial deviation
      • Can lift the third finger to see if it is ECRB
      • Look for provocation of pain at the lateral epicondyle  
  • Medial epicondylitis
    • “Golfer’s elbow test: MMT for wrist flexion
      • Look for provocation of pain at the medial epicondyle
  • Cervical spine testing to rule out the spine
  • Grip testing (will be weak)

Treatment examples

  • Modalities
  • Corticosteroid injections
  • TherEx:
    • Loosen grip
    • Eccentrics
    • Take pressure off the origin, start with forearm supported to shorten lever arm
  • Don’t have pt exercise into pain
  • Bracing
    • More common with lateral epicondylitis compared to medial
  • Education/prevention: pts don’t understand their grip may be the problem

Sample question:

If your patient comes to you with lateral epicondylitis, where is the best position that you would put their brace?

  1. Superior to the elbow
  2. Inferior to the elbow
  3. Superior to the wrist
  4. At the wrist

Answer: Inferior to the elbow

Why:

  • You can have a brace that is giving compression, so you put it at the joint. However, in this case, if you are bracing to decrease the force that is coming through something, you need to cheat the body into thinking that the muscle’s origin is coming from a different place so it is not getting pull where it is getting damaged. You can place a brace here because the part of the muscle that is inflamed is a tendon, not contractile tissue.
  • If you put the brace superior to the elbow, it would likely increase pain. You’re putting compression on the damaged part, so you aren’t changing the lever arm.
  • If you had an answer of “at the elbow”, the compression will be great, but it won’t be the best answer if “inferior to the elbow” is also a choice,
  • Superior to the wrist/at the wrist: missing the point of the brace for the condition

 

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Orthopedics - Elbow Differential Diagnosis Featured professor:  Skye Donovan | PT, PhD, OCS
Episode 2: Elbow Differential Diagnosis
Notes by Alexis Lancaster, SPT
General information

Tennis elbow: lateral epicondylitis

“Thumb side”


Golfers elbow: medial epicondylitis

“Pinky side”


Country club elbow: both medial & lateral epicondylitis


Symptoms

Pain on medial or lateral side


Causes

Does not need to be tennis or golf
Grip usually causes these conditions
Driving & gripping steering wheel too tight
Weight lifting with too much gripping
Swimmers can be affected (pointing their fingers)


Differential diagnosis

Bursitis: bursa sits under olecranon
Pronator teres syndrome: painful/achy on lateral side
Osteoarthritis of elbow joint
Rheumatoid arthritis
C-spine radiculopathy (especially C6-C7)
Ulnar nerve pathology

What does the pain feel like? Nerve pain? Think nerve injury/problem


Tendinopathy

Overuse
Lateral epicondylitis: usually due to excessive grip, excessive wrist extension→ seen in racquet sports, occupation and work-related tasks that have a lot of vibration (jack-hammering)
Medial epocondylitis: usually due to excessive grip while in pronation, or excessive wrist flexion




Anatomy

Lateral: wrist extensors (common extensor origin)

Usually associated with extensor carpi radialis brevis (ECRB) involvement. ECRB attaches to 3rd digit
Extensor carpi radialis longus inserts on 2nd digit
It could be any muscle that shares the common extensor origin that is involved (ex. brachioradialis and extensor digitorum)
The radial nerve supplies extensor carpi ulnaris, radialis brevis & longus


Medial: wrist flexors (common flexor origin)

“Pass/fail/pass/fail”: pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris

Not everyone has a palmaris longus
Median nerve: pronator teres, flexor carpi radialis, palmaris longus
Ulnar nerve: flexor carpi ulnaris
Deep to these= flexor digitorum profundus and superficialis
“Medial side of forearm”






Special tests

Lateral epicondylitis

“Tennis elbow test”: MMT for wrist extensors

Can add some radial deviation
Can lift the third finger to see if it is ECRB
Look for provocation of pain at the lateral epicondyle  




Medial epicondylitis

“Golfer’s elbow test: MMT for wrist flexion

Look for provocation of pain at the medial epicondyle




Cervical spine testing to rule out the spine
Grip testing (will be weak)


Treatment examples

Modalities
Corticosteroid injections
TherEx:

Loosen grip
Eccentrics
Take pressure off the origin, start with forearm supported to shorten lever arm


Don’t have pt exercise into pain
Bracing

More common with lateral epicondylitis compared to medial


Education/prevention: pts don’t understand their grip may be the problem

Sample question:
If your patient comes to you with lateral epicondylitis, where is the best position that you would put their brace?

Superior to the elbow
Inferior to the elbow
Superior to the wrist
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Jimmy McKay, PT, DPT clean 9:34
Orthopedics – Biceps Tendonitis https://www.ptpintcast.com/2018/08/12/1-orthopedics-biceps-tendonitis/ Mon, 13 Aug 2018 02:41:05 +0000 http://www.ptpintcast.com/?p=4675 Episode 1: Biceps Tendonopathy Featured professor:  Skye Donovan | PT, PhD, OCS Notes by Alexis Lancaster, SPT What is it A strain of the muscle can be damage to the muscle belly but is usually damage to the tendon Tendon can be ruptured, varying in severity from only a few fibers being interrupted all the way to a complete tendon rupture Signs and symptoms Pt may come in with pain, can also be weak Pain could limit strength depending on the amount of muscle damage With a lot of muscle damage/tendon damage they will be unable to fire the biceps muscle Point tenderness in the bicipital groove could be the pt’s only symptom More people have proximal pain rather than distal pain (this will be pain at the origin of the muscle Complete rupture: the “Popeye’s Sign”—the muscle will have detached from the bicipital groove and will be balled up in the middle of the upper arm. Pt will say they heard a “ripping” noise, and that they now have a ball in their arm that didn’t used to be there Anatomy 2 heads The short head of the biceps Origin: coracoid process, Insertion: short head and long head tendons come together and insert into the bicipital aponeurosis on the radius Long head of the biceps Origin: superior glenoid, superior portion of the labrum*, Insertion: short head and long head tendons come together and insert into the bicipital aponeurosis on the radius *Key for differential diagnosis, labrum may be the problem Can be thought of as the 5th muscle of the rotator cuff due to origin anatomy Biceps’ main action is supination, as well as elbow flexion The “wine bottle” muscle: powerful supination (wine opening), elbow flexion (pull the cork out) Innervation: musculocutaneous nerve (C5, C6, C7) Reflex testing: C5 Special tests Speed’s Test (gold standard) Patient in shoulder flexion, some external rotation, elbow extended, full supination PT applies resistance into shoulder extension, patient will resist by flexing shoulder Positive test: pt complains of pain (at the groove or at origin), pt may be weak Supination requires pt to use biceps instead of brachialis or brachioradialis Yergason’s sign Put patient into 90 degrees elbow flexion, in supination PT will try to pull pt into elbow flexion and pronation while patient resists by flexing elbow and supinating forearm Positive: pain Obrien’s test (to differentiate biceps tendinopathy from a SLAP tear) Patient in 90 degrees shoulder flexion, slight horizontal adduction, pronation, internal rotation PT applies resistance downward Positive: pain, possibly a click After: Place patient in supination and apply resistance downward, patient should feel better Pt will have less pain when in neutral forearm position compared to when they are fully pronated, as well Differential Diagnosis Pain is usually at the origin, so you have to rule out rotator cuff tendons Palpate for bicipital groove between greater and lesser tubercles Biceps sits here Could also be palpating some of supraspinatus at this location Impingement Biomechanics Supraspinatus impingement Subacromial bursa impingement Remember: many pts don’t have a great sense of pain within centimeters, so they may be having subacromial pain (hard to localize) Labral tear Long head of biceps inserts into the superior labrum Gallbladder Referred pain to right shoulder (opposite of heart attack, which is left) Coracoid process will always hurt when palpated 3 muscles attach here: short head of the biceps, coracobrachialis, pec minor MMT’s, ROM for these muscles to determine if it is one of these three muscles   Causes: Overhead sports Eccentric phase for pitchers Lifting too-heavy of weights Multiple corticosteroid injections in shoulder Treatment examples: Treat like any other tendinopathy Strengthening Restoration of ROM Episode 1: Biceps Tendonopathy

Featured professor:  Skye Donovan | PT, PhD, OCS

Notes by Alexis Lancaster, SPT

What is it

  • A strain of the muscle can be damage to the muscle belly but is usually damage to the tendon
    • Tendon can be ruptured, varying in severity from only a few fibers being interrupted all the way to a complete tendon rupture

Signs and symptoms

  • Pt may come in with pain, can also be weak
    • Pain could limit strength depending on the amount of muscle damage
    • With a lot of muscle damage/tendon damage they will be unable to fire the biceps muscle
  • Point tenderness in the bicipital groove could be the pt’s only symptom
    • More people have proximal pain rather than distal pain (this will be pain at the origin of the muscle
  • Complete rupture: the “Popeye’s Sign”—the muscle will have detached from the bicipital groove and will be balled up in the middle of the upper arm.
    • Pt will say they heard a “ripping” noise, and that they now have a ball in their arm that didn’t used to be there

Anatomy

  • 2 heads
  • The short head of the biceps
    • Origin: coracoid process, Insertion: short head and long head tendons come together and insert into the bicipital aponeurosis on the radius
  • Long head of the biceps
    • Origin: superior glenoid, superior portion of the labrum*, Insertion: short head and long head tendons come together and insert into the bicipital aponeurosis on the radius
      • *Key for differential diagnosis, labrum may be the problem
      • Can be thought of as the 5th muscle of the rotator cuff due to origin anatomy
  • Biceps’ main action is supination, as well as elbow flexion
    • The “wine bottle” muscle: powerful supination (wine opening), elbow flexion (pull the cork out)
  • Innervation: musculocutaneous nerve (C5, C6, C7)
  • Reflex testing: C5

Special tests

  • Speed’s Test (gold standard)
    • Patient in shoulder flexion, some external rotation, elbow extended, full supination
    • PT applies resistance into shoulder extension, patient will resist by flexing shoulder
    • Positive test: pt complains of pain (at the groove or at origin), pt may be weak
    • Supination requires pt to use biceps instead of brachialis or brachioradialis
  • Yergason’s sign
    • Put patient into 90 degrees elbow flexion, in supination
    • PT will try to pull pt into elbow flexion and pronation while patient resists by flexing elbow and supinating forearm
    • Positive: pain
  • Obrien’s test (to differentiate biceps tendinopathy from a SLAP tear)
    • Patient in 90 degrees shoulder flexion, slight horizontal adduction, pronation, internal rotation
    • PT applies resistance downward
    • Positive: pain, possibly a click
      • After: Place patient in supination and apply resistance downward, patient should feel better
      • Pt will have less pain when in neutral forearm position compared to when they are fully pronated, as well

Differential Diagnosis

  • Pain is usually at the origin, so you have to rule out rotator cuff tendons
    • Palpate for bicipital groove between greater and lesser tubercles
      • Biceps sits here
      • Could also be palpating some of supraspinatus at this location
  • Impingement
    • Biomechanics
    • Supraspinatus impingement
    • Subacromial bursa impingement
    • Remember: many pts don’t have a great sense of pain within centimeters, so they may be having subacromial pain (hard to localize)
  • Labral tear
    • Long head of biceps inserts into the superior labrum
  • Gallbladder
    • Referred pain to right shoulder (opposite of heart attack, which is left)
  • Coracoid process will always hurt when palpated
    • 3 muscles attach here: short head of the biceps, coracobrachialis, pec minor
      • MMT’s, ROM for these muscles to determine if it is one of these three muscles  

Causes:

  • Overhead sports
    • Eccentric phase for pitchers
  • Lifting too-heavy of weights
  • Multiple corticosteroid injections in shoulder

Treatment examples:

  • Treat like any other tendinopathy
  • Strengthening
  • Restoration of ROM
  • Pt may be on NSAIDS (decrease inflammation)
  • Postural retraining
    • Biceps may be at a bad angle, pt will overuse it while doing overhead activities
  • Surgery
    • Precautions: no contractions of biceps, stay out of external rotation
      • Relatively the same precautions as rotator cuff surgery

How can it look on the test?

After a SLAP lesion you are seeing a patient S/P @ 1 week, what treatment would you implement

  1. Active ROM into external rotation
  2. Strengthen scapular stabilizers
  3. Joint mobilizations to increase glenohumeral extension
  4. Isometric biceps exercises
]]>
Orthopedics - Biceps Tendonitis Featured professor:  Skye Donovan | PT, PhD, OCS
Notes by Alexis Lancaster, SPT
What is it

A strain of the muscle can be damage to the muscle belly but is usually damage to the tendon

Tendon can be ruptured, varying in severity from only a few fibers being interrupted all the way to a complete tendon rupture



Signs and symptoms

Pt may come in with pain, can also be weak

Pain could limit strength depending on the amount of muscle damage
With a lot of muscle damage/tendon damage they will be unable to fire the biceps muscle


Point tenderness in the bicipital groove could be the pt’s only symptom

More people have proximal pain rather than distal pain (this will be pain at the origin of the muscle


Complete rupture: the “Popeye’s Sign”—the muscle will have detached from the bicipital groove and will be balled up in the middle of the upper arm.

Pt will say they heard a “ripping” noise, and that they now have a ball in their arm that didn’t used to be there



Anatomy

2 heads


The short head of the biceps

Origin: coracoid process, Insertion: short head and long head tendons come together and insert into the bicipital aponeurosis on the radius


Long head of the biceps

Origin: superior glenoid, superior portion of the labrum*, Insertion: short head and long head tendons come together and insert into the bicipital aponeurosis on the radius

*Key for differential diagnosis, labrum may be the problem
Can be thought of as the 5th muscle of the rotator cuff due to origin anatomy




Biceps’ main action is supination, as well as elbow flexion

The “wine bottle” muscle: powerful supination (wine opening), elbow flexion (pull the cork out)


Innervation: musculocutaneous nerve (C5, C6, C7)
Reflex testing: C5

Special tests

Speed’s Test (gold standard)

Patient in shoulder flexion, some external rotation, elbow extended, full supination
PT applies resistance into shoulder extension, patient will resist by flexing shoulder
Positive test: pt complains of pain (at the groove or at origin), pt may be weak
Supination requires pt to use biceps instead of brachialis or brachioradialis


Yergason’s sign

Put patient into 90 degrees elbow flexion, in supination
PT will try to pull pt into elbow flexion and pronation while patient resists by flexing elbow and supinating forearm
Positive: pain


Obrien’s test (to differentiate biceps tendinopathy from a SLAP tear)

Patient in 90 degrees shoulder flexion, slight horizontal adduction, pronation, internal rotation
PT applies resistance downward
Positive: pain, possibly a click

After: Place patient in supination and apply resistance downward, patient should feel better
Pt will have less pain when in neutral forearm position compared to when they are fully pronated, as well





Differential Diagnosis

Pain is usually at the origin, so you have to rule out rotator cuff tendons

Palpate for bicipital groove between greater and lesser tubercles

Biceps sits here
Could also be palpating some of supraspinatus at this location




Impingement

Biomechanics
Supraspinatus impingement
Subacromial bursa impingement
Remember: many pts don’t have a great sense of pain within centime...]]>
Jimmy McKay, PT, DPT clean 10:21