05.patrickm

  Epley Maneuver for right-sided posterior canal BPPV Anterior BPPV Evaluation and Treatment Evaluation: Supine Head-Hanging Test for the Diagnosis of Anterior Canal BPPV. Clinically, ac-BPPV is characterized by a vertical downbeat nystagmus with a torsional component toward the affected side when the individual is looking straight ahead as evoked by the supine head-hanging test. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8497794/#:~:text=Supine%20Head%2DHanging%20Test%20for%20the%20Diagnosis%20of%20Anterior%20Canal,the%20supine%20head%2Dhanging%20test.  Treatment with Yacovino maneuver: Doesn't matter which ear you are treating, the maneuver is the same. (1) supine with head extended 30 deg, (2) supine head flexed 45 deg, (3) seated with head flexed 45 deg. (step two for too long, you risk the otoconia staying in the posterior canal.  Habituation Exercises: -Gaze stabilization Gaze stabilization protocol: -3x/day, at least 12 min daily.  -VORx1 (head movement...

The pain is greater than the degree of tissue injury and occurs long after the injury has healed.  Type 1: with or without nerve damage. Can be from minor soft tissue injuries bone fracture or surgery, frostbite or burn, stroke, MI, immobilization, etc. Changes to the sensory nerves causing paresthesia. Can cause autonomic changes: swelling and edema, abnormal blood flow, temperature changes. Can cause trophic changes: thick and brittle nails, increased hair growth, fibrosis, osteoporosis. Can cause motor dysfunction: weakness of all muscles, stiffness, tremor, reduced ROM, atrophy. Can cause increased pain.  Type 2: following nerve damage and can cause similar characteristics. Symptoms can spread beyond the lesion nerve in type 2 which can cause central sensitization.  The majority of people with CRPS have bilateral differences in skin temperature.  PT can consist of any of the following: -TENS -Aquatic therapy -Mirror therapy -Desensitization -Gradual weight bearin...

Posture: including scapulae position Rule out cervical involvement: ROM, compression Special Tests: Phalen's, median nerve compression, Tinel's test ROM MMT : hand held dynamometer Joint mobility Palpation Carpal Tunnel Hand numbness and pain in the median nerve distribution, which may present in the entire hand. Pain can occasionally go up to the shoulder. Symptoms usually worse at night. When the wrist is out of neutral, the carpal tunnel pressure increases. They may have difficulty picking up small objects or c/o dropping items. Increased risk if you have diabetes, obesity, female gender, previous diagnosis of carpal tunnel syndrome, RA, thyroid disease, previous MSK problems. Occupational factors that increase risk: vibration exposure, forceful exertion of hand and wrist, repetitive use of hand/wrist, jobs with non-neutral wrist position. Interventions : night splint, day and night splint if night splint alone is ineffective, transverse carpal ligament mobilization (refer t...

Posture, general appearance, ambulation Special Tests ROM (DF/PF, inversion/eversion, knee extension) Strength (DF/PF, inversion/eversion, knee flexion/extension, hip ABD, hip extension) Joint mobility  Palpation Muscle length testing (gastrocnemius/soleus) Outcome Measures:  FFI, FAAM, PSFS, pVAS Talar/Talocrural glides Subtalar tilt Plantar Fasciitis https://www.orthopt.org/uploads/content_files/files/Heel%20Pain%20Revision%20Decision%20Tree.pdf  Ankle Sprain Interventions -Acute phase: If in protective motion phase, they will have acute swelling. Manual lymph drainage can reduce swelling.  -If limitations in ROM, soft tissue mobilization to triceps surae.  -Graded mobilization to talocrural joint with posterior glide. Posterior glide of fibular malleolus for improvements in DF. To improve PF, anterior glide at talocrural joint. Joint mobilization with movement using a stool and a mobilization belt while patient goes into DF. Can also glide the fibula wit...

 

Posture Triage screen: -End Range Rotation Test for VBI -Modified Sharp Purser -Alar Ligament Stability Rule out shoulder and thoracic spine Active repeated motions and overpressure for pain adaptive vs. pain non-adaptive Passive repeated motions  Passive accessory -CPA (C2 à upper aspect of T-spine) -UPA (C2/C3 à upper aspect of T-spine) Palpation  (trigger points, tinder areas) Isolating movements Muscle endurance  -Jull Test (BP cuff, 10 bouts of 10 seconds) -Scapular endurance test -Neck flexor endurance test.  Normative values: men=38.9 sec, women: 29.4 sec. -Posterior neck endurance test -Lateral lift test (sidelying) -CkCues test Confirmation Tests -Cervical Flexion-Rotation Test for HA -C1-C2 PA mobilization for HA -UPA for cervical facet dysfunction -Cluster for cervical radiculopathy: Spurling, ROM < 60 degrees, distraction test, and ULTT. When all 4 are positive, extremely high probability for cervical radiculopathy. Passive Physiologic Cervical passive...

Posture: including scapulae position Rule out cervical involvement: ROM, compression Special Tests ROM: including scapulae mobility during arm elevation MMT Joint mobility Palpation Passive scapular mobility Labral Lesions Labrum lesions often occur as a result of a traumatic incident, including a fall on outstretched hand (FOOSH), direct blow to or fall on the shoulder, a sudden pull or other overhead motion (trying to lift an object or trying to grab/hang from something to prevent a fall). Participation in certain activities may increase the risk of a labrum lesion, including weight lifting, throwing sports, sports with overhead activities (e.g., swimming), contact sports, rock climbing/bouldering. Many patients have experienced direct shoulder trauma, but onset may be insidious secondary to repetitive overuse of the shoulder. Surgical management: If patient fails to improve with conservative therapy (usually a trial of 6–12 weeks), labral repairs (including Bankart/SLAP rep...