PT Final Exam Live July 2018 CCR # 10 With JB. Copyright 2015 PT Final Exam
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1 PT Final Exam Live July 2018 CCR # 10 With JB
2 CCR 10 Wahoo!!! Contact info: to set up a phone call, FaceTime, Skype, or Google Hangout Availability
3 What is your outlet?
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9 !QQQ! (!Quick Question Quiz!) Pulsatile lavage is an example of what type of debridement method? Full thickness skin loss involving damage of subcutaneous tissue would be what stage of an ulcer? Which type of ulcer can be more commonly seen in patient s with a history of DVT?
10 !QQQ! (!Quick Question Quiz!) Pulsatile lavage is an example of what type of debridement method? Non-selective Full thickness skin loss involving damage of subcutaneous tissue would be what stage of an ulcer? Which type of ulcer can be more commonly seen in patient s with a history of DVT?
11 !QQQ! (!Quick Question Quiz!) Pulsatile lavage is an example of what type of debridement method? Non-selective Full thickness skin loss involving damage of subcutaneous tissue would be what stage of an ulcer? Stage III Which type of ulcer can be more commonly seen in patient s with a history of DVT?
12 !QQQ! (!Quick Question Quiz!) Pulsatile lavage is an example of what type of debridement method? Non-selective Full thickness skin loss involving damage of subcutaneous tissue would be what stage of an ulcer? Stage III Which type of ulcer can be more commonly seen in patient s with a history of DVT? Venous Ulcer
13 Tonight s Plan... Informal review of musculoskeletal topics!
14 Facet Orientation C-T-L Facet orientations of C-T-L spine C deg (better for rotation) Backwards/upwards/medially T deg backwards/upwards/laterally L 90 deg (better for flex and ext) backwards/medially
15 Facet Orientations ***The orientation of the facet joints will dictate how that facet will allow motion... Helpful videos
16 Rotation at C-T-L facets Cervical Most rotation Thoracic less rotation than cervical, more than lumbar Lumbar very limited rotation
17 Torticollis Presents as ipsilateral side bending and contralateral rotation, mostly seen first in infants (pediatrics) Tight SCM muscle involved What is the action of the SCM muscle?
18 Torticollis What would a tight left SCM muscle present as??? How would you stretch it??? How do you name the side of torticollis???
19 Torticollis What would a tight left SCM muscle present as? Cervical RIGHT rotation and LEFT side bend How would you stretch it??? How do you name the side of torticollis???
20 What would a tight left SCM muscle present as??? Torticollis Cervical RIGHT rotation and LEFT side bend How would you stretch it? LEFT rotation and RIGHT side bend How do you name the side of torticollis???
21 Torticollis What would a tight left SCM muscle present as??? Cervical RIGHT rotation and LEFT side bend How would you stretch it??? LEFT rotation and RIGHT side bend How do you name the side of torticollis? To the side of which the head is tilted (side bent), or opposite the side of which it is
22 Biomechanics of Thoracic Spine and Ribcage During respiration upper ribs move upward and forward like a pump handle, while lower ribs move upward and lateral like a bucket handle pump handle refers to the upward and downward movement of the sternum with upper ribs, and bucket handle refers to lower ribs moving outward
23 Anatomy - ribs Two types: True ribs 1st to manubrium 2-7 to body of sternum False ribs 8-10: unite with cartilage above to form the costal margin 11 & 12: floating ribs; not attached anteriorly
24 Biomechanics of Thoracic Spine and Ribcage Movements of Inspiration: Increase in A-P diameter pump handle thoracic spine extension Increase in lateral diameter bucket handle Both create elevation of ribs
25 Biomechanics of Thoracic Spine and Ribcage Normally, inspiration is an active movement and expiration is a passive movement. Ex: At the end of inspiration, muscles relax, and elastic recoil of lungs pushes air out... What muscles are considered primary inspiratory muscles??? If actively exhaling, what muscles are considered primary expiratory muscles???
26 Biomechanics of Thoracic Spine and Ribcage Normally, inspiration is an active movement and expiration is a passive movement. Ex: At the end of inspiration, muscles relax, and elastic recoil of lungs pushes air out... What muscles are considered primary inspiratory muscles? External intercostals, diaphragm If actively exhaling, what muscles are considered primary expiratory muscles???
27 Biomechanics of Thoracic Spine and Ribcage Normally, inspiration is an active movement and expiration is a passive movement. Ex: At the end of inspiration, muscles relax, and elastic recoil of lungs pushes air out... What muscles are considered primary inspiratory muscles? External intercostals, diaphragm If actively exhaling, what muscles are considered primary expiratory muscles? Internal intercostals, subcostals
28 Internal Obliques vs. External Obliques Internal Oblique Back Pockets O: Starts from lateral anterior hip (iliac crest) I: Goes medially towards rectus sheath, costal margin, and pectineal line A: Laterally flexes and rotates ipsilaterally same side rotators
29 Internal Obliques vs. External Obliques External Oblique Front Pockets O: From lateral surface of ribs I: Goes to anterior iliac crest and abdominal aponeurosis A: flexes trunk, and contralateraly rotates trunk
30 Internal Obliques vs. External Obliques Functional examples: Think, what is contracting and how with these movements??? Rolling from R side lying to supine...? Swinging through with a baseball bat to the RIGHT...? Holding a resistance cable (from a workout machine) out in front of you, and controlling it towards the RIGHT back to it s machine starting point...?
31 Internal Obliques vs. External Obliques Functional examples: Think, what is contracting and how with these movements? Rolling from R side lying to supine... Left IO, Right EO concentrically Swinging through with a baseball bat to the RIGHT... Holding a resistance cable out in front of you, and controlling it towards the RIGHT back to it s machine starting point...
32 Internal Obliques vs. External Obliques Functional examples: Think, what is contracting and how with these movements? Rolling from R side lying to supine... Left IO, Right EO concentrically Swinging through with a baseball bat to the RIGHT... Right IO, Left EO concentrically Holding a resistance cable out in front of you, and controlling it towards the RIGHT back to it s machine starting point...
33 Internal Obliques vs. External Obliques Functional examples: Think, what is contracting and how with these movements? Rolling from R side lying to supine... Left IO, Right EO concentrically Swinging through with a baseball bat to the RIGHT... Right IO, Left EO concentrically Holding a resistance cable out in front of you, and controlling it towards the RIGHT back to it s machine starting point... Left IO, Right EO eccentrically
34 Trunk Rotation Functional Example If you were to rotate your trunk to the right... What is happening at the vertebral body and spinous process?? What trunk musculature is rotating trunk to the right???
35 Trunk Rotation Functional Example If you were to rotate your trunk to the right... What is happening at the vertebral body and spinous process? Vertebral body goes right, and spinous process goes left What trunk musculature is rotating trunk to the right???
36 Trunk Rotation Functional Example If you were to rotate your trunk to the right... What is happening at the vertebral body and spinous process? Vertebral body goes right, and spinous process goes left What trunk musculature is rotating trunk to the right?? L transversospinalis, L EO, and R IO
37 More Functional Movements Pull up what muscles (groups) are working and how are they contracting? Military Press what muscles (groups) are working and how are they contracting?
38 More Functional Movements Pull up what muscles (groups) are working and how are they contracting? Downward rotators concentric contraction on the way up Downward rotators eccentric contraction on the way down Military Press what muscles (groups) are working and how are they contracting?
39 More Functional Movements Pull up what muscles (groups) are working and how are they contracting? Downward rotators concentric contraction on the way up Downward rotators eccentric contraction on the way down Military Press what muscles (groups) are working and how are they contracting? Upward rotators concentric contraction on the way up Upward rotators eccentric contraction on the way down
40 Scoliosis Components Combination of side bending one direction and rotation to opposite direction Named by the convexity of the curve or curves thoracic and/or lumbar Ex: When the apex of the curve is to the right, the individual is in side bending left and rotation right
41 Scoliosis
42 Left Sided Scoliosis
43 Scoliosis What muscles would be tight in right sided scoliosis??? (Think anterior and posterior trunk musculature)
44 What trunk musculature would be tight in right sided scoliosis? Scoliosis Transversospinalis and erector spinae on the LEFT Action: Transversospinalis unilaterally rotates contralaterally Action: Erector spinae unilaterally side bends ipsilaterally Internal oblique on the RIGHT External oblique on the LEFT
45 Traction Cervical tension: 7 10 % of body weight Cervical traction angles: Upper C degrees Mid C2 C degrees Lower C5 C degrees
46 Traction Lumbar tension: Initial 25% of body weight, then progress to more than 50% of body weight Lumbar: prone and supine positions: Prone better results seen when used more with bulging disc or HNP, if patient can tolerate position. Supine better results seen used with DDD/DJD, hypomobility, and muscle spasm; maximal widening of the IF Hips flexed increasing from 0 90 degrees, causes more posterior pull, and greater posterior intervertebral space separation
47 Shoulder Special Tests TEST: RTC Tear Labrum Tear?? Biceps Tendon??????? Impingement
48 Shoulder Special Tests TEST: RTC Tear Labrum Tear Hawkins Kennedy Neer s Biceps Tendon??????? Impingement
49 Shoulder Special Tests TEST: RTC Tear Labrum Tear Hawkins Kennedy Neer s Biceps Tendon Yergesons s Speed s????? Impingement
50 Shoulder Special Tests TEST: RTC Tear Labrum Tear Hawkins Kennedy Neer s Biceps Tendon Yergesons s Speed s O brien s Clunk Sign??? Impingement
51 Shoulder Special Tests TEST: RTC Tear Labrum Tear Hawkins Kennedy Neer s Biceps Tendon Yergesons s Speed s O brien s Clunk Sign Empty Can Test Drop Arm Test Lift-Off Test Impingement
52 Great Special Tests Resource
53 Last Minute Items Practice Exams Create weakness lists Stay in a routine Availability
54 The Journey is the Reward It s the quest and the transformation within yourself that s important. Ask yourself, what can I do differently?
55 Helpful Links: Pump and bucket handle movement Facets Torticollis Subcostals image =univ&sa=&sqi=2&ved=0ahukewjn_y2zj9jlahve5cykhqg8btqqsaqigw#tbm=isch&q= subcostales&imgrc=wkoaz-esbuxm0m%3a Cadaver
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