2MARKS

PT ORTHO YEAR QUESTION

1. Green stick fracture:
Green stick # is exclusively seen in children under 10 yrs. The bone is elastic and bends due
buckling or breaking of one cortex when force is applied(but doesn’t break into 2 separate pieces).
Malnutrition, specially Vitamin -D deficiency increase the risk of green stick #of long bones after
trauma.
Green stick # are stable # as a part of the bone remains intact and unbroken. So this type of #
normally cause bend at the injured site.
Symptoms (symptoms depends upon the location)
swelling, pain, tenderness
Immobilize the part/bone with cast or splint. The cast remains in place for 4-6 weeks.
2.Lateral ligament of ankle:
Lateral ligament of ankle consist of three bands:
Anterior talofibular ligament
Posterior talofibular ligament
Calcaneofibular ligament
ATL- Flat band, passes from anterior margin of lateral malleolus to neck of talus , just infront of fibular
facet.
PTL- Passes from lower part of malleolar fossa of fibula to the lateral tubercle of talus.
CFL- Long rounded cord, passes from notch on the lower border of lateral malleolus to the tubercle on
the lateral surface of calcaneum. It is crossed by tendons of the peroneus longus and brevis.
Interrosseous tibiofibular ligament, Inferior extensor retinaculum, Inferior and superior peroneal
retinacula also contribute stability of ankle joint.
3.Milwaukee brace:
Milwaukee brace- used for scoliosis. Has a rigid plastic pelvic gridle connected to neck ring over the
upper thorax by one anterior & two posterior uprights.
23%of patient are treated with this brace(for those who require surgery for scoliosis). It is used for
curve with apex above T7.
Duration : daily use- range 16-23 hrs/day.
 Treatment should be continue until pt is at riser stage IV or V. If the curve is less than 30degrees,
continue to use brace for 1-2 yrs after maturity, bcoz the curve of this magnitude is at high risk of
progression.
Complication: Jaw deformity, pain, skin breakdown, difficulty with mobility & transfer, increased
energy expenditure with ambulation.
4.Torticolis:
Torticolis is defined as the rotational deformity of cervical spine that causes turning & tilting
deformity of head and neck.
Causes: Congenital, infective Tb of cervical spine, traumatic sprains, myositis, unilateral muscle
paralysis, neuritis, ocular disturbances.
Acquired: spasmodic muscle contraction of SCM muscle.
C/F: Head of pt is tilted towards the affected side while chin points other side. SCM muscle
prominently seen. Lateral stage- Facial asymmetry & macular disturbance in eye.
Treatment : PT- ultrasound, heart, massage, acute pain-collar, neck strengthening ex’s. Surgical:
Release of SCM muscle from its clavicular attachment.
5. Lumbar pelvic rhythm:
Lumbopelvic rhythm refers to the way in which the lumbar spine, moves in combination with
pelvis. It is the kinematic relationship b/w lumbar spine and hip joint during sagittal plane mvt.
According to Cailliet , the first part of bending forward consists of lumbosacral flexion followed by
anterior tilting of pelvis at hip jts. The muscle in lower back namely erector spinae, contract
eccentrically to control the mvt against gravity while the trunk flexes and pelvis tilts anteriorly. The
muscle that flex the hip contract concentrically & this motion is balanced by eccentric contraction of
muscle that extend the hip.
When return to the erect posrure, this rhythm is reversed. It is initiated by post tilting of pelvis on
the hip, followed by extension of lumbar spine. If the muscle are weak/ fatigue , the wgt of the body is
enough to overload the muscle & this cause strain.
6. Posterior sag sign:
Posterior sag sign is used to find the injury to PCL( less than ACL). It is also known as external
rotation recurvatum test. When the leg is passively lifted by holding the toes, the knee sags posteriorly
indicating injury to PCL and posterolateral structures.
 It is highly specific & sensitive sign for diagnosing PCL injury. (PCL injury occur when knee is
flexed or during head on collision of tibia such as tibia strike the dashboard during motor vehicle
accident).
7.Splints & Deformities of Rheumatoid Arthritis:
RA is the most common inflammatory disease of jts. It is a systemic disease young and middle aged
adults characterized by proliferative and destructive changes in synovial membrane, periarticular
structure, skeletal muscle & perineural sheaths.
Male:female=1:3.
C/F: Pain, swelling, stiffness of small jt of hand and feet.
Orthopedic deformities:
Symmetrical swelling of peripheral joints.
Ulnar deviation of the fingers.
Swan neck deformity
Boutonniere deformity of fingers.
Subcutaneous nodules over the elbow.
Rheumatoid knee synovial thickening.
Rheumatoid foot: halux valgus with dorsal callosity.
Clawing of toes planar callosity.
Splints:
Role: provides rest and support, relieves pain and spasm, prevent and correct deformities.
Disadvantages: Prolonged use causes muscle atrophy.
Types:
Rest splints- provides rest and relives pain
Corrective splints- Prevent and correct the deformities.
Fixation splints-To fix the jts in good functional position of jt.
8. Wrist drop:
It is a condition in which there is injury to radial nerve resulting in flexed posture of the wrist.
Because the radial nerve innervations of the extensor muscle of the wrist and digits, those
whose radial nerve functions has been compromised cannot actively extend them.
For this, wrist drop splint is used.
9. De Quervain’s disease:
 It is a one in which the sheath of a flexor thickens, apparently spontaneously, so as to entrap the
tendon[common sheath of abductor pollicis longus and extensor pollicis brevis].
Etiology: Unknown[main], mostly seen in women and maybe due to repeated overuse of wrist.
C/F: Tenderness can be elicited by sudden ulnar deviation of flexed hand.
PT: Cryo[acute stage], TENS, US, SWD, Splinting[wrist], active and passive exercise at wrist.
10. Ober’s test:
The ober’s test evaluate and tight, contracted or inflamed tensor fasciae latae[TFL] and iliotibial
band[ITB].
Test position: Therapist: Behind the patient and stabilize the pelvis. Pt position: Side lying with
affected side up. Bottom knee and hip is flexed to flatten the lumbar curve.
Procedure: Grasp the distal end of the pt’s affected leg with one hand and flex the leg to right
angle at knee. Extend and abduct the hip jt. Slowly lower the leg towards the hip table-until mvt
restricted.
Result: TTB normal: The leg ill adduct with thigh deopping down slightly below the horizontal.
Pt has no pain.
TTB Tight: Leg will remain in abducted position, pain at lateral knee.
11.
12. Open and closed kinematic chain exercise:
OKC: Open kinematic chain ex’s are exercise that are performed where the hand or feet is free
to move. Muscle activation is usually proximal to distal. Exercise: UL: Bench press, biceps curl, chest-
fly, lat pull down, triceps extension. LL: Seated leg extension, terminal knee extension exercise,
hamstring curl, plantar / dorsiflexion [calf pumps].
CKC: These are physical exercise performed where the hand or foot is fixed in space and can’t
move. Extremity muscle activation is usually from distal to proximal. Exercise UL: push-ups, pull ups,
dips. LL: Squats, deadlifts, lunges, power clean, leg press, Both OKC and CKC are effective for
strengthening and rehabilitation objectives..
13. Lumbosacral corset:
Lumbosacral corsets encompasses the abdomen and the pelvis. The anterior borders of LS
corset are superior to symphysis pubis and inferior to the xiphoid process. Made from heavy fabrics
with laces and hooks. It is designed to limit motion, maintain three point pressure system and to reduce
pain.
14. ACL bracing and its advantage:
The ACL brace helps to control the motion of knee joint and limit the amount of ROM around
the knee. This is thought to help decrease force through the ACL graft and protect it which it heals.
Advantages:
Reduces risk of further complications, reduce risk of ACL injury recurrence, increase
ROM, reduce translation and rotation after injuries, help to maintain leg extension, protect you from
damage caused by slipping or falling, stabilizes and supports knee jt for full restoration.
15. Auto amputation:
Auto amputation is the spontaneous detachment of an appendage or organ from the body. It is
usually due to destruction of blood vessels feeding an extremity such as finger tips. Once the vessels
are destroyed the tissues starved of oxygen and dies, often followed by gangrene.
Causes: systemic disease- scleroderma, sickle cell anaemia.
16. Grading of ligamentous instability:
Ligamentous instability is a term used for loose ligament, which can lead to loose joint that
bend more than usual, can cause chronic pain and affect any jt of the body.
grade I- < 3mm gapping corresponding to jt line.
grade II- 5-10 mm laxity.
grade III- >10 mm , less painful[bcoz ligament is completely ruptured].
17. CTEV: [def and deformities]
Congenital Talipes Equino Varus- most common congenital foot disorder, Incidence is
1.2/1000 births. Male> Female. Present since birth and associated with spina bifida , bilateral bones are
normal in thickness.
Primary deformities: Equinus varus, cavus, forefoot adduction, internal tibial torsion. Late changes:
Degeneration and fusion of joints.
Secondary deformities: Foot size less to 50%, medial border- concave, lateral border-convex, forefoot
plantarflexed upon hindfoot, callosities are present over the dorsum of foot, stumbling gait,
hypertrophic anterior tibial artery. Atrophy of muscle in anterior and posterior compartment of leg.
18. Deep transverse friction:
The deep friction massage and must be applied transversely to specific tissue unlike the
superficial massage given in longitudinal direction parallel to vessels. The purpose of this is to maintain
the mobility within the soft tissue structure of ligament, tendon and muscle and prevent adherent scars
formation.
Uses: pain relief, prevent adhesion formation, traumatic hyperaia.
19. Foraminal compression test:
Foraminal compression test [maximal compression test and spurling’s test] is used during a
musculoskeletal assessment of cervical spine when looking for cervical nerve root compression causing
cervical radiculopathy. The test is done to detect spinal nerve root involvement, a herniated disc,
bulging disc or foraminal stenosis. The patient is seated with head and neck in neutral position.
Pressure is increasingly applied on the head and neck in mild lateral flexion to either side. +ve when
pain arising in the neck radiates in the direction of corresponding dermatome ipsilaterally.
20. Dupuytren’s contracture:
Dupuytren’s contracture is benign myeloproliferative progressive disease of palmar fascia
which results in shortening, thickening and fibrosis of fascia and aponeurosis of palm. It affects the
hands or fingers and results in contracture deformities. Mostly 3 rd and 4th digits affected. Begin as a
painless nodules in palm that form along the longitudinall lines of tension.
Etiology: genetic disorder[autosomal dominant], diabetes, seizures disorder, smoking, alcohol, HIV,
vascular disease.
21. Cobb’s angle:
Cobb’s angle is used to measure the severity of scoliosis. The upper and lower vertebra are
identified . The upper end vertebra is the highest one whose superior border converges is drawn
towards the concavity of the curve and the lower end vertebra is the one inferior border converges
towards the concavity. Intersecting perpendicular line from superior surface of superior end vertebra
and from the inferior surface of inferior end vertebra. The angle of deviation of these perpendiculars
from a straight line is ‘angle of curve’.
22. Complications of below knee amputation:
It is most commonly performed amputation .
Indication: Crush injuries of foot, malignant tumour of lower end of tibia,.
Minimum stump length is 14cm
Complication
Haematoma
Infection, Necrosis, Contracture, Neuromas, Phantom sensation, Causalgia.
23. MC Murray’s test:
Mc Murray’s test is used to determine the presence of a meniscal tear within the knee.
Pt position supine lying
Therapist position : Near the patient one hand hold the knee and palpates the joint line on one hand
with thumb on one side and fingers on other side.
Other hand holds the sole of foot.
Here forced flexion and internal rotation for lateral meniscus and forced flexion and external rotation
for medial meniscus.
24. Coxa Vara:
It is the abnormality of the proximal end of femur, which is characterized by decreased neck shaft
angle (normal angle - 125 -135 degree). Normal coxa vara is due to differential growth pattern of
capital femoral and greater trochanter epiphysis.
Classification : Congenital , Acquired
C/F : Small stature, waddling gait, upward shift of GT, decreased rotation and abduction of hip, pain,
Stiffness.
Treatment: Corrective Osteotomy at trochentric level.
25. Ankle Foot orthosis:
Afo is a below knee orthosis in which the ankle joint can be controlled by mechanical ankle
joints or by heel straps. It control the instabilities in the lower limb by maintaining proper alignment
and Controlling motion.
It is most often used with patient Suffering from neurological or orthopedic condition such as stroke,
multiple sclerosis, CP, Fracture, sprains and arthritis.
Two Types : Plastic AFO (Poly propylene)
Hybrid AFO (Poly propylene covered with canvas fabric)
26. Z thumb:
(Hitchhiker thumb deformity ) is a musculoskeletal manifestation of rheumatoid arthritis presenting in
thumb with MCP Joint - Fixed flexion and subluxation, IP joint - Hyperextension
Treatment: Using orthosis for rheumatoid thumb should assist with balancing soft tissue forces and
placing the joint in an appropriate or more neutral position.
27. Pes Planus :
Pes planus refers to loss of medial - longitudinal arch of the foot.
Types:
Congenital - Calcaneovalgus foot, vertical talus deformity , Talocalcaneal bar.
Acquired - Traumatic flat foot, Static flatfoot, Rigid flatfoot, Spasmodic flatfoot.
Treatment: Orthopedic shoes with Thomas Heel, Medial Heel wedges, Navicular Pads ( up to 3 Years)
Asymptomatic - parent education , symptomatic - Orthopedic shoes ( Mild case), custom prosthesis (
Severe cases) - between 3 to 9 years.
AS - No treatment, symp - molded orthoses worn in a sturdy shoe - 10 to 14 years.
28. Jumpers knee:

[Patellar tendinitis] cause repeated trauma to the tendon bone junction at the lower part of the
patella as in athletes especially jumpers.

C/F:

Pain at inferior pole of patella ,Limp ,Tenderness is present over inferior pole.

Treatment:

Ice therapy, rest, compression bandage , limb elevation, thermotherapy-in last stages, gentle
isometric exercise.

29.Knee reflex root value:

The normal knee reflex involves no input to or from the brain. The normal knee jerk/ patellar
jerk is elicited when the knee is tapped below the knee cap (patella). Sensors that detect stretching of
tendon of this area send electrical impulses back to spinal cord. It send signal back to muscle through
nerve which causes the muscle to contract causing a kick.

Knee reflex root value(Quads, patellar): L2-L4 [predominately L4], femoral just inferior to
patella.

30.Arthoplasty:

Arthoplasty is an operation to construct a new mobile joint.

Indication:
 Advanced OA, RA of hip, knee, elbow, shoulder. Fracture neck non-union in patient above 60
years, Rarely to correct deformities . eg: Hallux valgus.

Types:

Excision arthoplasty- Ankylosing spondylitis, severe OA hip, failed THR.

Hemireplacement arthoplasty- Non union fracture of neck of femur, Avascular necrosis of head
of femur.

Total replacement arthoplasty- Both articular surface excised and replaced by prosthetic
components.

31.Meralgia prosthetica:

Meralgia prosthetica is a condition resulting from compression [pressure on or squeezing] of

lateral femoral cutaneous nerve. This nerve supplies sensation to front and side of your thigh. It results
in pain, aching, numbness, stabling, paraesthesia , sensory loss through the distribution of the LFCN.

Treatment: Wearing looser clothing, losing excess weight, OTC pain relieves- ibuprofen

32. Gait cycle:

It can be defined as all activities that occur from heel contact of one foot to the next heel contact
of the same foot.
Phases:
Stance phase
Swing phase
Stance phase:60%-heel strike, footflat, midstance, heel off, toe off.
Swing phase:40%-acceleration, midswing, deceleration.
Double limb support-20% of gait cycle.
33. Osteoporosis:
This term refers to a state of decreased mass per unit volume of a normally mineralized bone due to
loss of bone proteins. Most common cause- involuntional bone loss in perimenopausal age.
Classification:
Postmenopausal (type I)- age 55-75yrs , sex(F:M) -6:1, C/F: pain , stress fracture of vertebra, distal
forearm, hip.
Age related(type II) -age 70 yrs(f) 50 yrs (m), sex 2:1, C/F: pain, stress fracture of vertebra, proximal
hip and tibia , hip.
Features of OP: brittle hair, cervical spine compression, skin wrinkles, degenerative hip, fracture of
neck femur, #of long bone.
Treatment: posture ex's , regular ex, spinal orthosis, supports-collar etc.
34. Stages of fracture healing:
Stage of impact
Stage of induction
Stage of inflammation
Stage of soft callus
Stage of hard callus
Stage of remodelling.
35. Non-union:
Non Union is said to be established when a minimum of nine months has elaped since the injury
and the #shows no radiologically visible progressive sign of healing continuously for three months.
Causes:
Compound#, infection, segmental #, distraction of #fragments, soft tissue interposition, insecure and
inadequate fixation.
Treatment: No conservative treatment, surgery is done(open reduction, rigid internal fixation).
36. Shenton's line:
Shenton's line is a imaginary curved line drawn along the inferior border of the superior pubic
ramus (superior border of obturator foreamen) and along the inferomedial border of neck of femur. It
should be continuous and smooth. It is used to determine the relationship b/w the head of femur and the
acetabulum.
Loss of contour of shenton's line is a sign of fraction of neck of femur.
37. Septic arthritis: (pyogenic infection of joint)
Septic arthritis is defined as a bacterial infection of the jt which causes an intense inflammatory
reaction with migration of polymorphonuclear leucocytes and subsequent release of proteolytic
enzymes. This could lead to destruction of articular cartilage and later the jt. Causative organisms:
Staphylococcus aureus(50%), Streptococcus (20%), Pneumococcus (10%), Gonococcus, E.coli etc. H.
Influenzae common in children below 2 years.
Blood culture is positive only in 60% of cases.
38. Speed's test:
It is used to test for superior labral tears or bicipital tendinitis. The examiner places the patient's
arm in shoulder flexion, external rotation, full Elbow extension, forearm supination. Manual resistance
is applied by examiner in downward direction.
+Ve- pain in bicipital tendon or bicipital groove.
39. Wry neck:
Congenital torticollis/ wry neck is a condition where the SCM muscle of the neck undergoes
contracture pulling it to the same side and turning the face to opposite side.
Exact cause- unknown, but may be due to fibromatosis within the SCM muscle.
C/F: Deformities in congenital torticollis
Primary- tilt the head to the same side, taut SCM.
Secondary- facial appearance distorted, macular changes in the retina.
40. Causes of foot drop:
Sciatic nerve is the thickest and largest nerve in the body. Root value: L4-L5,S1, S2,S3. Injury to
the nerve may lead to foot drop( dorsiflexion lost).
Causes:
General: mainly leprosy
Local: At spine- Spina bifida, tumour, disc prolapse.
At hip- posterior dislocation of hip, # around the hip, # of acetabulum.
At gluteal region- deep IM injections.
At thigh- # shaft femur, penetrating/ gun shot injury.
At knee- forcible inversion of knee, dislocation of knee, # lateral condyle of tibia, lateral meniscal
cysts and tumours, dislocation of superior tibiofibular joint etc.
41. Button hole deformity:
It is a Deformity of the fingers in which the PIP is flexed and DIP is hyperextended. It is an
extensor tendon injury over zone III. Also referred to as 'boutonniere deformity'.
Causes:
Often rheumatoid arthritis. Also finger dislocation, finger #, deep cut, OA.
Treatment:
Splint- stabilize the fingers, straighten and immobilize the fingers.
42. Phalen's test:
It is a clinical test for carpel tunnel syndrome. The patient is asked to actively place the wrist in
complete but unforced flexion. If tingling and numbness are produced in median nerve distribution of
hand within 60 secs, the test is + ve. It is the most sensitive provocative test. It has specificity of 80%
43. Chondromalacia patella:
It is defined as blistering, cystic changes of the patellar cartilage and it usually affects the medial
facet of patella. This condition is commonly associated with vastus medialis tendinitis. It is caused by
combination of several factors which ultimately push the patella out of its groove on femur.
Factors:
Weakness of vastus medialis muscle, high Q angle , malalignment produced by foot
pathomechanics.,
44. Hard test:
It is a passive accessory movement test of knee performed to identify the integrity of ACL. This
is an anterior drawer’s test performed at 20 and 30 degree of knee flexion with patient in supine
position. It indicates the ACL tear. This test is used in acute injuries of knee to test ACL tears where
knee cannot be flexed to 90 degree.
Technique: The therapist should place one hand in thigh and other hand behind the tibia which
the thumb at tibial tuberosity.
45. Ulnar drift:
Ulnar deviation is also known as ulnar drift. This hand condition occurs when the knuckle bones
or MCP jts become swollen and causes fingers to bend abnormally towards the little fingers.
Causes: common- RA, OA, Psoriatic arthritis, lupus over time it may lead to difficulty in doing
activities.
46. Golfer’s elbow:
It is the tendinopathy of the insertion of the epitrochlear muscle/ flexors of fingers and hand
pronators. It is also known as epitrochlitis, medial tennis elbow.
C/F: Restricted wrist and fingers flexion in pronation- leads to pain. tenderness- less , localized.
 Treatment: Rest and painkillers, elbow strap, cryo, thermo- US, SWD, ES, massage, progressive
resisted ex’s.
47. Rule of nine:
The rule of nine is a method doctor and emergency medical providers use to easily calculate the
treatment needs for a person who’s been burned. Rule of nine is meant to be used for 2nd degree burns,
also known as partial thickness burns. 3rd degree burns also known as full-thickness burns.
Adults:
Body parts percentage
arm( including the hand) 9%each
anterior trunk(front of body) 18%
Genitalis 1%
head and neck 9%
legs(including the feet) 18% each
posterior trunk(back of body) 18%
It is used in several ways . This includes the amount of fluid replacement and degree of care a
person needs.
Children:
Body parts percentage
arm( including the hand) 9%each
anterior trunk(front of body) 18%
head and neck 18%
legs(including the feet) 14% each
posterior trunk(back of body) 18%
48. Tardy ulnar nerve palsy:
Tardy ulnar nerve palsy is a chronic clinical condition characterized by a delayed onset ulnar
neuropathy after an injury to the elbow. It occurs as a consequences of non union of pediatric lateral
condyle # at the elbow, which eventually leads to cubitus valgus deformity. While the child grows, the
deformity worsens and the ulnae nerve is gradually stretched until classic symptoms of ulnar nerve
neuropathy appear.
49. Special test for supraspinatous tendinitis:
 Empty can test and full can test is commonly used orthopedic examination test for
supraspinatous muscle and tendon. Test is done at sitting/ standing. On the side to be tested one of the
examiner’s hand stabilizes shoulder gridle. The arm to be tested is moved into 90 degrees of abduction
in the plane of scapula , full internal rotation with thumb pointing down as if emptying can. The
examiner’s other hand applies downward pressure on superior aspect of distal forearm and the patient
resists.
positive- significant pain/ weakness.
50. Boxer’s fracture:
Boxer’s fracture is a break in the 5th metacarpal bone in the hand. The injury is more common in
unskilled boxers who throw round house punching, thus first point of contact being the 4 th and 5th digits
.
Signs and symptoms: swelling, pain and stiffness in the little fingers, decreased grip strength
etc.
PT Treatment: Ex’s- eccentric nd concentric, electrotherapy, deep tissue massage, hydrotherapy, joint
mobilization.
51. Putti platt operation & saha operation:
Putti- platt is one of the surgical treatment options for anterior shoulder instability. In this
procedure the flexible cord( tendon) of subscapularis muscle is cut and then reattached to the head of
the upper arm bone( humerus). This procedure makes the head of upper arm bone tighter to shoulder
blade allowing better stability to shoulder jt. This type of procedure is rarely indicated.
Saha operation - The patient in surgery was placed in lateral position. Y- shaped skin incision
was given, centered over acromion. The insertion zone was identified for the trapezius at the acromion
& the distal aspect of the clavicle. The deltoid was longitudinally sectioned to expose the proximal
humerus. The inferior part of acromion and the lateral part of proximal humerus were burced.. In
90degree of abduction and 20 degree of external rotation , the acromion was fixed to proximal
humerus with two 4.5mm cancellous/ malleolar screw but before deltoid transfer. The deltoid was
sutured over the transferred trapezius..
52. Q angle:
A line representing the resultant line of force of the quadriceps, made by connecting a point near
the ASIS to the midpoint of the patella. It can be measured in lying/ standing. Traditionally, the Q angle
has been measured with the knee/ at near full extension with subjects in supine and quadriceps
relaxed[lateral forces on the patella may be problem].
53. Spinal shock:
Spinal shock i.e., temporary electrical dysfunction.[loss of muscle tone & spinal reflex below
the level of severe spinal cord lesion].
Features: Sensory loss, flaccid paralysis, visceral paralysis, reflexes are in abeyance, anal reflex
lost.
Usually : 8 hrs later concussion regreeses, 7-10 days later complete recovery. If reflexes do not return
within 24 hrs to 10 days a diadnosis of complete cord transaction is made.
54. Trigger finger [stenosing tenosynovitis] & Trigger thumb:
Trigger finger is caused by inflammation and subsequent narrowing of A1 pulley of the affected
digit, typically the third or fourth.
C/F: Stiffness& sewlling, intermittent finger locking during active flexion, finger locking, loss of full
flexion, palpable nodules proximal A1.
PT treatment: Thermotherapy, wax bath, friction massage, hand ex’s.
Trigger thumb is one which causes pain, stiffness and sensation of locking/ catching when bend
and straighten the thumb.[ trigger finger occur in thumb- trigger thumb].
55. Trophic ulcer:
This is one of the important foot complication in leprosy. Also known as plantar ulcers due to
neurological deficit. It has a spontaneous onset, it is painless, persists and recurs. Healing process is not
defective. Recuurent ulceration causes progressive destruction of the skeleton.
Treatment: Rest, elevation, antibiotics, incision &drainage, dressing, ulcer debridment[ulcer
deeper to bones], protective footwear, reduce stress of walking.
56. Homan’s sign:
When forced ankle dorsiflexion produces calf pain,
Homans sign - positive & its pathogenic of DVT[ patient is asked to be in supine lying.
Dorsiflexion is done on ankle when it produces pain-homan’s sign +ve.
It is an indication of DVT. Treatment: prophylactic method consists of early ambulation , foot
elevation,, elastocrepe bandaging, ex’s etc.,
57. Patello femoral arthritis:
 Patello femoral arthritis refers to the presence of degenerative changes underneath the patella[
knee cap]. It usually affects the patient who have patella femoral laxity, subluxation, malalignment and
high- riding patella.
C/F: Anterior knee pain, knee crepitus, swelling, pain on PF jt, stiffness after sitting, valgus knee
deformity.
PT Treatment: Stretch & strengthen the surrounding muscle , NSAID, steroid injection.
58. Cervical rib:
Cervical rib is an accessory rib arising from 7th cervical vertebra, rarely 6th & 5th cervical
vertebra.
Incidence:0.46%- nearly 50% unilateral.
side: Mostly right.
Types: Complete, bulbous end, tapering end, fibrous band.
C/F: Lump present, tenderness, numbness.
PT Treatment: Thermotherapy, strengthening ex’s, self resisted strengthening ex’s.
59. Klapp’s exercise:
It was an non surgical method established with the aim of correcting the spinal curvature by
stretching and strengthening the back muscle. It is a unique technique which uses crawling on all fours
to correct body posture by reducing pressure on spine& optimizing use of back extensors.
Some ex’s: Walking on knees, walking with lengthened trunk, kyphotic walking on knees with
swimming motion in arms, kyphotic walking on knees with circling mvt in arms, crawling on all fours,
creeping.
60. Plantar fasciitis:
Repeated sustained stress of weight- bearing during walking, running, climbing etc., over a
number of years causes in microtrauma to the plantar fascia which results in inflammation and pain.
C/F: Pain in sole, tenderness, pain in insertion of plantar fascia.
Treatment: Stretching in calf, ice therapy, taping, rest to foot.
61. Decubitus ulcer:
Decubitus ulcer also known bedsores/ pressure ulcers are skin and soft tissue injuries that form
as a result of constant or prolonged exerted on skin. These ulcers occurs at bony areas of the body-
ischemic, greater trochanter, sacrum, heel, malleolus, occipit. Mostly occur in people with conditions
that decrease their mobility making postural change difficult.
Stages:
Stage1- Just erythema on the skin
Stage 2-erythema with the loss of partial thickness of the skin including epidermis and part of
superficial dermis.
Stage 3- Full thickness ulcer that might involve the subcutaneous fat.
Stage 4-Full thickness ulcer with the involvement of muscle or bone.
62.Stump care&exercise:
After amputation ,the part that is left beyond a healthy joint called a residual limb/ stump.
Stump cleanliness: Regular cleaning of stump with warm disinfected soap solution, thorough drying.
Stump conditioning: Regular and correct application of firm elastic bandage, regular isometric ex’s to
the stump muscle proximal to amputation, repeated massage to improve the tone of muscle, electrical
stimulation to muscle, exposing the stump to pressure by gradual weight-bearing on a soft cushioned
stool within the parallel bars and over the pylon.
Stump exercise- Stretching-hamstring, hip flexor, alternative stretch adductor, knee bending, straight
leg raise, quads sets, hip outward & inward, short arc quad, desensitization
Strengthening ex’s: hip extension- prone, side. Hip abduction- supine, side. Hip adduction-supine, side.
Alternative hip abduction ex’s. pelvic tilt, partial sit-up.
63. Foot drop gait:
Foot drop gait/ steppage gait is the gait in footdrop in which the advancing leg is lifted high in
order that the toes may clear the ground. It is due to paralysis of the anterior tibial and fibular muscle
&is seen in lesions of the LMN such multiple neuritis , lesion of anterior horn cells, lesions of cauda
equina [inability to lift the foot while walking due to weakness of muscle that cause dorsiflexion of
ankle joint].
64. Dequervains disease:
It is a stretching tenovadinitis, in which the sheath of a flexor tendon thickness, apparently
spontaneously, so as to entrap the tendon .
Etiology: women- repeated overuse of wrist.
C/F: common sheaths of abductor pollicis longus, extensor pollicis brevis tendon at wrist are involved .
Tenderness elicited by sudden ulnar deviation of the flexed hand.
PT Treatment: cryotherapy, thermotherapy, TENS, US, SWD, splinting of wrist , active &passive ex’s.
65. Limp length discrepancy:
 Limp length discrepancy is when one arm or leg is longer than the other arm or leg. It is
measured by calculating the distance b/w the ASIS and medial malleolus.
Causes: Bone infection, previous injury to bone in leg, bone disease, neurological conditions, juvenile
arthritis.
66. Deep vein thrombosis:
DVT is an important complications seen after # of spine, pelvis, femur, tibia etc,. The
pathogenesis has been described by virchow’s traid of venous stasis, vascular damage &
hypercoagulability. Patient complains of mild to severe calf pain, swelling, difficulty in standing/
walking , cramps in calf muscle or foot.
Homan’s sigh is used to check for DVT.
67. Preiser’s disease:
Preiser disease / avasuolar necrosis of scaphoid is a rare condition where ischemia & necrosis of
the scaphoid bone occurs without previous #. It is thought to be caused by repetitive microtrauma or
side effects of drugs [eg: steroids or chemotherapy] in conjuction with existing defective vascular
supply to proximal pole of scaphoid.
Treatment: Immobilising the wrist with a cast[ initially].
68. Trendelunburg gait:
Trendelenburg gait is caused by unilateral weakness of hip abductors mostly gluteal muscle.
This weakness is due to superior gluteal nerve damage/ 5 th lumbar spine lesion. In this gait due to hip
abductor weakness, the pelvis tilt downward instead of upward on the non- weight bearing extremity.
The person compensates by lateral tilt of the trunk away from the affected hip, thus COG is mostly on
stance limb[ causing a reduction of pelvic drop].
69. Grading of tenderness:
Grade I- Just a suspect.
Grade II- patient winces on pressure
Grade III- patient winces & withdraws.
GradeIV-patient will not allow to touch
This grading of tenderness is superior to the conventional mild, moderate and severe grading.
70. Anterior drawer test:
 It is used for the indication of ACL tear. Patient is in supine position. Hip flexed to 45 degrees
and knee to 90 degrees. Examiner sits on the dorsum of the foot & pulls tibia forward . Anterior drawer
test is done in 3 positions.
Foot in neutral position[if +ve indicates ACL tear]
Foot in 15degree internal rotation [if +ve indicates damage to anterolateral structure]
Foot in 15degree external rotation[ if + ve indicates damage to anteromedial surface]
If tibia shits anteriorly more than 6 to 8 mm, then it indicates torn ACL & test is considered +ve. This
should always be compared with normal knee.
71. Cockup splint:
Radial nerve injury- cockup splint[ holds the wrist in 25-30 degree of extension]
It holds the wrist in extension but allows for functional use of thumb and fingers. The wrist cock-up
splint is commonly prescribed for pt with carpal tunnel syndrome, wrist sprains/ tendinitis, wrist
arthritis or following forearm and carpal tunnel surgeries/ #.
72. Patellectomy:
This is done for communited # and could be either partial [ for smaller distal or proximal pole #
] or complete[ for communited #]. The emphasis is now on preserving as much patella as possible.
Complication- early # dehiscence, post op infection, refracture, avasular necrosis.
Disadvantage-Strength of quads muscle returns slowly, atrophy of quads muscle, protection of knee by
patella is lost.
73. Feiss line:
Feiss line is a line that is drawn and extends from the 1st metatarsophalangeal jt goes over the
navicular tubercle upto the apex of the medial malleolus. Its purpose is to determine the position of the
navicular tubercle & assess the longitudinal arch of the foot. Alternative in the angulations created by
the line either before or during wgt bearing is indicative of excessive pronation of the foot.
74. Thoracic outlet syndrome:
This syndrome results from compression of neurovascular bundle comprising of subclavian
artery and vein, axillary artery& vein and brachial plexus at thoracic outlet. Thoracic outlet is a space
b/w the 1st rib, clavicle & the scalene muscle. The above structure are liable to be compressed. When
this space gets narrowed either due to hypertrophy of the existing muscle or due to any other causes
like congenital, trauma etc.,
Sites of compression: supraclavicular, subclavicular, infraclavicular.
75. Referred pain:
Referred pain is pain perceived at a location other than the site of the painful stimulus/ origin. It
is the result of a network of interconnecting sensory nerve , that supplies many different tissues.[ eg-
injury to pancreas - cause pain in back, kehr’s sign- pain in shoulder blade- ruptured / injured spleen].
76. Thoracic kyphosis:
The concave structure at the chest region[thoracic spine] is called thoracic kyphosis. This
natural curvature of the spine is important for balance & helps us to stand upright. If anyone of the
curves becomes too large/ too small , it becomes difficult to standup straight and our posture appears
abnormal. If there is an increase / decrease in thoracic kyphosis it is easily corrected by education about
proper posture, strengthening of back muscle, sometimes casting , bracing etc.
77. Brachialgia:
Brachialgia is a technical term for arm pain. It is used when the pain is thought to be due to a
problem with the nerves, most frequently a compressed/ pinched nerve in the neck .
Occurs: spinal canal and IV foreamen [bony tunnels]--spinal cord & spinal nerves[ run through]--tunnel
size reduced--loss room for spinal nerve / cord-- pressure on these structures.
Treatment: Pain relievers, analgesics, nerve sheath injections, physical therapy, activity modification.
78. Tripod sign:
A nuchal spinal sign in which the sitting position requires a rigid spine and both arms extended
towards the back for support, typically seen in children with non-paralytic poliomyelitis. It is a
characteristic feature in preparalytic and paralytic poliomyelitis. It causes muscle tenderness, weakness,
spasm in extensors of the neck and back and sometimes hamstring and other muscles.
79. Prepatellar bursitis:
`Prepatellar bursitis [housemaid knee] is seen in the lower half of patella and upper half of
ligamentum patella[ prepatellar bursa is located superficially b/w the skn and patella]
Causes: Direct fall on patella, acute trauma, repeated blows/ friction on the knee, infections, low grade
inflammatory condition-gout, syphilis, Tb& RA.
Occurs in specific jts which involves a position where they work on their knees for prolonged period of
time such as miners, garderners, carpenters & mechanics.
PT treatment: rest, ice therapy, compression & elevation.
80. Cervical traction:
 Whether it is sprain, # dislocations, infections etc in the neck, cervical traction has a role to
play in each of these troublesome neck problem.
Types: continuous traction, static traction, intermittent traction, polyaxial cervical traction.
81.Schobber’s test:
Schober test is classically used to determine if there is a decrease in lumbar spine ROM[
flexion], most commonly as a result of ankylosing spondylities.
Technique: Pt is standing, examiner marks the L5 spinous process by drawing a horizontal line across
pt back. A second line is marked 10 cm above the 1st line. Pt is instructed to flex forward as if
attempting to touch his/ her toes, examiner remeasures distance b/w 2lines with patient in flexion. The
difference b/w measurement in erect & flexion indicates outcome of lumbar flexion. +ve- less than 5cm
increase in length forward flexion with decrease in lumbar spine ROM.
82. Phantom limb pain [ phantom sensation]:
This is a pseudo feeling of the presence of the amputated limb. It could be of a painless or
painful variety. This is due to persistence of nerve impulses .
Treatment: US, TENS, cryo, reassurance, percussion, steroid injections, exploration of the neuroma etc.
It is often described as crushing, toes teisting, hot iron, burning, tingling, cramping , shocking,
shooting.
83. Side swipe injury[ traffic elbow, car window elbow]:
Mechanism: It is due to force applied to an elbow projected from a acr window by a passing
vehicle or when it hits a fixed object or when it overturns.
Shorbe’s classification:
Group I- Only soft tissue injury.
Group II- Only tip of the elbow is injured & olecranon #
Group III- # of both radius and ulna
Group IV- Variations of communited intercondylar # of humerus.
Group V- Severly injured, # of all bones around elbow with tissue injury.
84. Manual muscle grading:
MRC grading[Medical Research council]
0- No palpable contraction
1- flickering of contraction
2- full ROM, active mvt, elimination of gravity
 3- Full ROM, active mvt, against gravity
4- full ROM, active mvt, against gravity, minimal resistance
5- full ROM, active mvt, against gravity, maximal resistance.
Daniels & worthigham:5- normal, 4+- good +, 4- good, 4-=good -, 3+-fair +, 3- fair, 3-= fair-,
2+-poor+, 2- poor, 1-=poor -, 1- trace, 0-0.
85. Joint mobilization grades:
Maitland:
I- small amplitude mvt performed at beginning of available ROM
II- large amplitude mvt performed through middle of ROM
III- large amplitude mvt performed from middle to limit of ROM
IV- small amplitude mvt performed at end of the ROM
V- small amplitude , manipulative mvt performed beyond the end ROM.
Kalterborn:
I- slow, small amplitude perpendicular mvt performed within the1st tissue stop
II- slow, large amplitude perpendicular mvt performed upto 1 st tissue stop
III- slow, large amplitude perpendicular mvt performed upto the level crossing the 1 st tissue
stop, but without crossing 2nd tissue stop.
86. Chauffeur fracture:
Chanffeur’s #[ Hutchinson#] is a type of oblique # of the radial styloid process in forearm. This
injury is typically caused by compression of scaphoid bone of the hand against the styloid process of
the distal radius. It is caused by falling onto an outstretched hand.
Treatment: open reduction& internal fixation- realignment of bone fragments.
87. Myositis ossificans:
It is a reactive lesion occurring in the soft tissue and at times in the bone periosteum. It is
characterized by fibrous, osseous & cartilage proliferation of the subperiosteal hematoma. This is later
followed by metaplastic changes[ condition where bone tissue forms inside muscle or other soft tissue
after an injury]. Occurs in large muscleof arms/ legs.
Causes: trauma, simple blow/ repeated necrosis trauma , dislocation & avulsion injuries.
PT Treatment:1st 2 weeks- hand elevation, unaffected- active ex’s, isometric ex’s.
After 2 weeks - thermotherapy, hydrotherapy, isometric ex’s , mobilization, self assisted ex’s, gentle
passive stretching.
88. Antiflexion brace:
Rigid braces may be used to treat low back pain. They are also commonly prescribed to
stabilize your lumbar spine after surgery. They usually have metal/ plastic upright in back as the shape
of low back & pelvis. It also have bands that lay across the thoracic spine. To help transfer wgt off the
spine, these braces features fabric straps that place pressure on abdomen.
Chairback brace, Raney flexion jacket, Williams brace.
89.Tinel’s sign:
[way to detect irritated nerve compression neuropathy-carpal tunnel syndrome]
This is an important sign which helps in recording the rate of regeneration of nerve clinically.
Procedure: Gentle percussion is done along the course of injured nerve. Tingling sensation is
experienced by pt in distribution of injured nerve rather than area percussed & the sensation should
persist for several seconds after stimulation.
+ ve - Indicates regenerating axonal sprouts haven’t obtained complete myelination[ even few
regenerating fibers can also results in positive sign]. Thus its presence cant be taken as an absolute
evidence of recovery.
90. Hill sach lesion:
Hill sach lesion is a posterolateral defect in the head of humerus. [injury occur secondary to
anterior shoulder dislocation]. Hill sach lesion is a compression # or ‘dent’ of the posterosuperolateral
humeral head that occurs in association with anterior instability or dislocation of glenohumeral jt.
Etiology: Anterior shoulder instability, bankart lesion, anterior glenoid bone loss.
91. Frozen shoulder [ periarthritis, adhesive capsulities]:
It is defined as a clinical syndrome characterized by painful restriction of both active & passive
shoulder mvt due to causes within the shoulder jt or remote [ other parts of body].
Causes: Primary- rotator cuff tendinitis, bicipital tendinitis, # & dislocation around the shoulder.
Secondary- diabetes, hyperthyroidism, CVD with referred pain keeps jt immobile, reflex sympathetic
dystrophy etc.,
Stage: stage of pain[I], stage of stiffness[II], stage of recovery[III].
92. End feel:
The end feel is a type of sensation or feeling which the examiner experienced when the joint is
at the end of its available passive ROM. The end of each motion at each jt is limited from further mvt
by particular anatomical structures.
Types: Normal end feel [physiological]
End feel Structures example
Soft - soft tissue approximation - knee flexion
Firm - muscular stretch - hip flexion with knee straight
- capsular stretch - extension of MCP jts of fingers
- ligamentous stretch - forearm supination
Hard - bone contacting bone - elbow extension
93. Klumpke’s paralysis:
This is due to either birth trauma or bike trauma. The C8, T nerve roots are involved & there
will be paralysis of wrist flexors, finger flexors & intrinsic muscle of hand. This results in claw hand
deformity . Pt complains of paraesthesia along the medial aspect of the arm, hand, little finger & ring
finger, weakness in hand.
94. Fracture disease:
It is a complication of # treatment due to prolonged immobilization . # disease includes-
musculoskeletal, cardiovascular.
Musculoskeletal: muscle weakness, atrophy, soft tissue contracture, osteoporosis, jt stiffness, skin
atrophy.
Cardiovascular: increase HR, circulatory dysfunction, orthostatic hypotension, venous
thromboembolism & pulmonary problem.
Prevention: proper fixation, early mobilization, daily muscle stretching, leg elevation, change pt
position frequently.
95. Ely’s test:
Ely’s test/ Duncan ely test is used to assess rectus femoris spasticity or tightness.
Technique: The pt lie in prone in relaxed state. The therapist is standing next to the pt, at the side of the
leg. One hand should be on the lower back, other hand holding the leg at the heel. Passively flex the
knee in a rapid fashion. Test both sides for comparison.
+ve- heel cannot touch the buttocks, the hip of tested side rises up from the table, pt feels pain/ tingling
in back or legs.
96. Osteoma:
 Osteoma is a benign bone tumour, occurs in membranous bones of skull and face. Usually there
are very few complaints, the history is long & finding is a diffuse bony hard tumour. It rarely requires
treatment.
Osteoid osteoma: This is a benign osteoblastic tumour with a well demarcated nidus of less than 1cm
surrounded by a distinct reactive bone.
97. Skin graft:
A skin graft is where healthy skin is removed from an unaffected area of the body & used to
cover loss or damaged skin. They can be used for bone # that break the skin[open #], large wounds or
where an area of skin is surgically removed . eg: cancer/ burns.
Types: split thickness graft, full thickness graft.
Procedure: Skin graft will usually be held in place using stitches, staples, clips or special glue.
98. Unstable hip gait[trendelenburg gait]
99. Types of sequstrum:
Sequestrum is a fragment of dead bone or other tissue that has separated from healthy tissue as a
result of injury/ disease.
Types:
Tubular- long bone, Annular- amputation stump, Ring- around pin tracts, Tubercular- flake, coke, rice,
grain. Button- histiocytosis, Feathery- syphilis, Match stick- sickle cell, Coloured- fungal, Black-
gunshot, Bombay- exposed bone after #.
100. Erb’s palsy:
This is due to injury to the C5 nerve root and rarely the C6 nerve root is also injured. It occurs
either very early in life due to birth trauma [ obstetric palsy, due to faulty application of forceps] or in
young adults due to bike trauma.
Effects: At shoulder: loss of abduction & external rotation.
At elbow: loss of flexion
At forearm: Loss of supination[arm hanging loosely by side of trunk]
Shoulder internally rotated, elbow in extension , forearm pronated , wrist flexion. It is called as
policeman or waiter tip.
Treatment: splinting, full range of passive mvt, ex’s.
101. Arthodesis:
 Arthodesis refers to the fusion of two or more bones in a joint. In this process, the diseased
cartilage is removed , the bone ends are cut off and the two bone end are fused into one solid bone with
metal internal fixation. This is done to relieve intractable pain in a jt which cant be managed by pain
medication, splints or normally indicated treatment.
102. Painful arc syndrome:
Impingement occurs beneath the coraco acromial arch. The most vulnerable structures for
impingement b/w the undersurface of the acromion and the head of the humerus are the greater
trochanter , the overlying suprapinatous tendon & the long head of biceps. The major site of
compression is slightly anterior to the angle of the acromion. Hence it is called as anterior impingement
syndrome or painful arc syndrome. At grade I pain appears.
103. Complications of colle’s #:
This is also known as poutteau’s #. It is not just a # of lower end of radius but a # dislocation of
the inferior radioulnar jt. The # occurs about 2.5 cm above the carpal extremity of the radius .
Complications: OA changes in wrist, residual deformity, loss of ulnar deviation , loss of supination,
persisting swelling.
104. Sudeck’s atrophy:
It is a condition of intense burning pain, stiffness, swelling, dislocation that most often affects
the hand. Arms, legs & feet can also be affected by sudeck’s atrophy.
Treatment: Injection[ anesthesia], biofeedback, active ex’s.
Surgical: Spinal cord stimulator, pain pump implantation etc.,
Risk factors: Idiopathic , prolonged immobilization, diabetes, stroke, heart attack, thyroid disease,
cancer.
105. Degrees of burns:
Burns are one of the most common household injuries.
Causes/ types: Friction burns, cold burns, thermal burns, radiation burns, chemical burns, electrical
burns.
Degrees: 1st degree burns- red, nonblistered skin[ only outer layer of the skin]
2nd degree burns- blisters, some thickening of the skin[ outer layer of skin & dermis]
3rd degree burns- widespread thickness with white leathery appearance[ full thickness destroys 2 layers
of the skin]
4th degree burns- all symptoms of third degree burns and also extend beyond the skin into tendon &
bones.
106. Pott’s #:
A pott’s # is a # affecting one or both of malleoli. During activities such as landing from jump[
volleyball, basketball] or when rolling an ankle, a certain amount of stress is placed on the tibia and
fibula & the ankle jt.
C/F: Sudden sharp & intense pain at ankle or lower leg immediately at the time of injury, ‘crack’
sound, swelling, bruising, pain increase during certain mvts.
107. Flat back:
In flat back the normal curve in lumbar spine is reduced/ eliminated. Primary symptom-
difficulty in standing for long period of time.
In this type of posture, there is forward head, extension of cervical spine, extension of the thoracic
spine, loss of lumbar lordosis & posterior pelvic tilt.
PT Treatment: Ex’s to strengthen the core, gluteal, back, neck, planking, sidelying leg raise, chest
stretch, back extension, hamstring & abdominal stretches-main.
108. Normal & abnormal end feel:
Normal end feel:94
Abnormal end feel:
End feel Eg
Soft - soft tissue edema, synovitis
Firm - Increased muscular tone, capsular , muscular, ligamentous
shortening
Hard - OA, myositis ossificans, #, condromalacia
Empty - Bursitis, #, acute jt inflammation, abscess .
109. How will you correct the posture in patient with scoliosis:
Scoliosis is an abnormal lateral curvature of the spine.
Conservative treatment: Braces[ for children]. Most braces are worn day and night. Milaukee brace is
used. braces are discontinued after the bones stop growing.
Surgical treatment : Spinal fusion.
PT Treatment: Milder scoliosis- physical ex’s , bracing , manipulation, ES, insoles[ braces are also used
to prevent worsening].
110. Boutonniere deformity:
This is a middle phalanx injury with either rupture of central slip dorsally or avulsion # from
base of the middle phalanx. This causes flexion of the PIP joint with compensatory hyperextension of
the dip joint.
Treatment requires the PIP jt to be splinted in hyperextension for a period of 4-6 weeks.
111. Special test to diagnose pes cavus and pes planus deformity:
Pes Cavus- The coleman block test that determines if subtalar jt is flexible. The test is
performed by having a pt stand with 1 inch wood block under the heel and the lateral foot. This allows
the first ray to be plantar flexed off the block. If the hindfoot corrects to neutral position the deformity
is flexible. If the hindfoot doesn’t correct the deformity is rigid.
Pes planus- The hubscher maneuver[ or jack’s test] is a method of evaluating the flexibility of pes
planus. The test is performed with pt weight bearing with flat foot on ground , which the clinician
dorsiflex the hallux and watches for an increases concavity of arches of foot.
+ve- arch formation- flatfoot flexible.
-ve- lack of arch formation- rigid flatfoot.
112. Compartmental syndrome:
Mubarak defined compartmental syndrome as an elevation of interstitial pressure in a closed
osseofascial compartment that results in microvascular compromise and may cause irreversible damage
to the contents of the space.
Sites: Anterior & deep posterior compartment of legs.
Volar components of forearm- ischemic necrosis of structure contained within the volar comopartment
of the forearm.
Buttocks, shoulder , hand, foot, arm & limbar paraspinous muscle are rare sites.
113. Club foot boot- uses:
The boots and bar hold the feet in the position to prevent the muscle and ligaments from
becoming tight again. After the foot’s position is corrected in casting phase, it must be maintained in
bracing phase for upto 5 yrs.
[ How to put: 1. Dress the child in light cotton socks that are long enough to cover their foot and leg. 2.
Loosen the strap & laces of the boots. 3. Bend your child’s knee as myou push the heel down into the
boot.4. Lace the shoe tightly . 5. Tighten the strap one more hole if possible and tighten the lace again.
6. Repeat on other boot. 7. Apply bar to correct angles as marked on the bottom of boots]
114.Wind swept deformity:
Wind swept deformity describe the appearance of abnormal valgus deformity in one knee in
association with varus deformity in the other knee. It is commonly seen in young children in certain
parts of Africa.
Causes: No etiology exists as specific, seen in inflammatory arthritis like RA, skeletal dysplasia,
sequelae of childhood rickets, lateral femoral condyle dysplasia in one knee etc.,
115 .Valsalva maneuver:
It is a breathing technique that can be used to help diagnose a problem with ANS. It can help to
restore a normal heart rate if your heart starts beating too fast.
1. Pinch your nose closed
2. close your mouth
3. try to exhale, as if inflating a balloon
4. Bear down os if having a bowel mvt
5. Do this for about 10 to 15 secs.
116. Mill’s test:
The test aids in diagnosing lateral epicondylitis in the elbow. The pt is seated & the clinician
palpates the pt’s lateral epicondyle with one hand while pronating the pt’s forearm fully flexing the
wrist the elbow extended. A production of pain in the area of insertion at the lateral epicondyle
indicates a positive test.
117. Empty can test:
It is used to assess the supraspinatus muscle and supraspinatus tendon. The PT can be seated or
standing for this test. The PT's arm should be elevated to 90° in scapular plane with elbow extended,
full internal rotation pronation of forearm. This results in thumbs down position, as if the pt emptying
the can. The therapist should stabilize the shoulder while applying downward force to arm, the pt tried
to resist this motion.
+Ve - pain or weakness with resistance

118. Stretching of gluteal maximus.:

Self: seated figure four stretch, pigeon stretch, seated glute stretch, knee to opposite shoulder,
downward facing dog, seated twist.
119. Bamboo spine:
 Bamboo spine is a pathogenic radiographic feature seen in ankylosing spondylosis that occur as a
result of vertebral body fusion by marginal syndesmophytes. It is often accompanied by fusion of
posterior vertebral element as well.( It is less flexible and more fragile).
120. Spasticity and rigidity:
Rigidity: Rigidity is a hypertonic state characterized by constant resistance throughout ROM that is
independent of the velocity of mvt. Rigidity is the tightness of the muscle in both agonist and
antagonist.
Types: cogwheel, leadpipe
Spasticity: spasticity is a motor disorder characterized by a velocity dependent increase in tonic stretch
reflex ( muscle tone) , with exaggerated tendon jerks, resulting from hyperexcitability of stretch reflex,
as a component of UMN syndrome. Ashworth and modified ashworth scale is used.
121. Skin traction:
In this , the traction is applied over a large area of skin. Max wgt that can be applied through skin
traction is 15lbs or 6.7 kg. If the wgt is used more than this, it will slide down peeling the skin.
Types: adhesive ST, non adhesive ST.
Contraindications: abrasions, lacerations, impaired circulations, dermatitis, allergy to plaster etc.
Important ST: Bucks extension ST, Dunlop's traction, gallow's traction.
122. Boston brace:
Boston brace is used for scoliosis. It is a type of thoraco lumbosacral orthosis , is a back brace used
primarily for the treatment of idiopathic scoliosis in children. This brace when used 18 or more hours
per day is effective in preventing progression of large curves.
Working: applying corrective pressure on the convex side of curve and cutting out corresponding area
of relief on concave side of the curve so the spine can migrate in that direction.
123. Features of rickets :
It is a metabolic disease of childhood in which the osteoid , organic matrix of bone, fails to
mineralize due to interference with calcification mechanism. It is usually common b/w 6 months and 2
yrs.
Features: Wizened look, delayed dentition, prominent abdomen, separation of recti, pale and flabby
skin, incomplete#, frontal bossing, chovstek's sign, aminoaciduria, expanded wrist, genu valgum,
myopathy, skin changes.
124. Genu valgum:
 It is outward deviation of the longitudinal axes of both tibia and femur. Apex of the curve or
angulation of the knee is medial.
Incidence: 75% upto 4 yrs- physiological valgus that disappears by 7 yrs.
Causes: unilateral- trauma, osteomyelitis, trauma.
Bilateral- physiological, pathological, congenital disorder, idiopathic (common), developmental
disorder, endocrine disorder, paralytic, traumatic, infective disorders etc.
125. Ankle sprain:
These are common injury in sports. If improperly treated, it may result in chronic laxity, pain or
delayed recovery.
Lateral ligament sprain: most common musculoskeletal injury. Incidence:1/10,000 per day. 85% cases-
inversion of supinated plantar flexed foot.
C/ F: Pain, swelling, tenderness over affected ligament.
Grading:
Grade I- no laxity, minimal pain and swelling.
Grade II- mild to moderate laxity, soft tissue swelling, anterior drawer and talar tilt is slightly +ve.
Grade III- severe swelling and pain, anterior drawer and talar test - highly + ve.
126. Guillotine amputation:
In this type of amputation, the skin is not closed primarily, later it is followed by anyone of the
closure method like secondary closure, re amputation, revision amputation or plastic repair.
Indications: sever infection, severe crush injuries.
Types: open amputation with inverted skin flaps, circular open amputation.
After treatment: 2 concepts- rigid dressing concept, soft dressing concept.
127. March #:
March# is a subtype of fatigue/ stress #. They occur due to repeated concentrated trauma to a
normal bone, mostly 2nd metatarsal bone of foot.( In some cases due to genetic factor, weakness of
core muscle, limb length discrepancy, poor bone density).
Treatment: rest, NSAID, rest for 6 to 8 weeks.
128. Causalgia:
It is a neurological disorder that can produce long lasting, intense pain. It arises after an injury or
trauma to a peripheral nerve. Most common site- brachial plexus.
Symptoms: pain is localized to the area around the injured nerve. Pins and needles sensation,
hypersensitivity around the area of injury, burning, aching , swelling/ stiffness , abnormal sweating at
injured site, colour changes of skin.
Treatment: steroids, antidepressants, opioids
PT : TENS, thermotherapy.
129. Sciatica:
It is defined as radiating pain along the course of sciatic nerve and is felt in the back, buttocks,
posterior of thighs , legs and foot. It is commonly due to disk prolapse.
Other causes: spondylolisthesis, sacroiliac jt arthritis, tuberculoma causing cord compression,
lymphomas and pelvic malignancy, invited thickened ligamentum flavum, cysts of sacral nerve root,
intraspinal neurofibroma and other tumours, diabetic neuropathy.
130. Straight leg raise test:
SLR test is neurodynamic test. SLR is a neural tension test that can be used to rule in or out
neural tissue involvement as a result of a space occupying lesion, often lumbar disc herniation.
Technique: SLR is passive test. Each leg is tested individually with normal leg being test 1 st. When
performing SLR, the pt is in supine without any pillows under head, the hip medially rotated and
abducted and knee extended. The therapist stands at the tested side with distal hand around the pt's heel
and proximal hand on pt's distal thigh to maintain knee extension. The therapist lifts the pt's leg by
posterior ankle while knee is fully extended. The therapist continues to lift the pt's leg by flexing the
hip until the pt complains of pain or tightness in back or back of the leg. Then the therapist slowly
lower the leg until the pain / tightness resolvesz at which point he puts the ankle in dorsiflexion and
will have the PT to flex the neck.
Pain primarily at back- mostly disc herniation.
Pain at leg- mostly pressure on neurological tissue.
131. IT band stretching:
Standing IT band stretch, standing forward bend variation, wide legged standing forward bend, low
lunge variation, glute stretch.
132. Types of fracture:
Types of # based on # patterns: transverse , spinal, oblique, communities, segmental , bone loss.
Simple or compound #.
Based on extent of # line: incomplete# , complete#.
 Atypical #- greenstick#, impacted#, stress/ fatigue#, pathological#, hairline#, tonus#.
133. Splints of scoliosis:
Full time brace: Boston brace, Wilmington brace, Milwaukee brace.
Night time brace: Charleston bending brace, Providence brace.
134. Dennis brown splint:
Dennis brown bar/ splint is a device used in treatment of club foot. The bar may be used as a part of
the ponseti method, a series of non surgical technique to address club foot. It consists of 2 straight
border, high top, open toe shoes that are commonly attached to an aluminum bar. The distance b/ w the
heels of shoes is equal to the width of baby's shoulder.
135. Stress fracture:
Stress # are tiny cracks on bone. They're caused by repetitive force, often overuse such as
repeatedly jumping up and down or running long distance. Stress # can also develop from normal use
of bone that's weakened by a condition such as osteoporosis. Stress # are common in wgt bearing bones
of the lower leg and foot.
136. Femoral triangle:
It is a triangular depression on the front of the upper one third of the thigh immediately below the
inguinal ligament.
Boundaries: lateral- medial border of sartorius.
Medial- medial border of adductor longus.
Base- inguinal ligament.
Apex- directed downward, forward by lateral and medial boundaries cross..
Contents: femoral artery and it's branches, femoral vein and it's branches, femoral sheath, femoral
femoral nerve, nerve to pectineus, femoral branch of genifemoral nerve nerve, lateral cutaneous nerve
of thigh.
137. Deformities of knee jt:
Genu Varum, genu valgum, genu recurvatum
138. Schober's test:
Schober's test is classically used to determine if there is a decrease in lumbar spine ROM( flexion)
most commonly as a result of ankylosing spondylitis.
139. Measurements of limb length:
 Involves measuring with tape b/w 2 defined pts in stand. Two common points are anterior iliac
spine and lateral malleolus.
Apparent length: from umblicus to medial malleolus.
True length: from ASIS to medial malleolus.
140. Perthe's disease:
It is a disorder affecting the capital femoral epiphysis. It is most common form of osteochondroses,
characterized by avascular necrosis( AVN) and disordered enchondral ossification of the primary and
secondary centres of ossification. It is associated with potential long term morbidity.
C/ F(symptoms) : painless limp, mild pain in the hip, history of trauma may be present/ absent , onset
of pain may be acute or insidious.
Sign: antalgic gait, muscle spasm, proximal thigh atrophy (2-3cm) , short stature, mild fixed flexion
deformity of hip < 15°
PT treatment: cryotherapy, thermotherapy, muscle strengthening, passive ROM ex' s.