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MS 1 final exam USAHS with Verified
solutions2025- 2026
When a joint is referred to as , it means the motion at that joint is limited. There are many factors that can contribute to restricted motion, such as pain, musculotendinous unit dysfunction,
bony block, postural malalignment, and effusion. - ✔✔hypomobile
A refers to the adaptive shortening of the soft tissue structures that surround a joint. This causes limited passive and active range of motion. - ✔✔contracture
contracture: the adaptive shortening of the musculotendinous unit and a significant loss of ROM without a specific muscle pathology. These types of contractures can typically be resolved
by stretching exercises within a short period of time. - ✔✔Myostatic
contracture: This can be caused by hypertonicity due to a central nervous system lesion, such as a spinal cord injury or traumatic brain injury. It can also be caused by muscle guarding or
spasm. - ✔✔Pseudomyostatic
and contracture: This can result from adhesions, effusion, osteophytes, or other intra-articular pathology. - ✔✔Arthrogenic and periarticular
contracture and irreversible contracture: This can result from fibrous changes within the connective tissue of muscle that cause soft tissue structures to adhere to other structures. When normal muscle and connective tissue is replaced by large amounts of fibrotic tissue, such as scar tissue, soft tissue extensibility may not be able to be regained through even surgical interventions. If a fibrotic
contracture goes untreated for a long period of time, it may become irreversible. - ✔✔Fibrotic
- stretching of a joint well beyond its normal length of muscle and the ROM of the
joint and surrounding soft tissues - can lead to hypermobility - ✔✔Overstretching
- excessive mobility that can cause detrimental joint instability if the supporting structures of the muscle control of the joint cannot keep it in stable position during activities - this may lead to an increased risk of injuries - ✔✔Hypermobility
is the ability of the tissue or structure to permanently change its shape or lengthen in the
presence of a load. - ✔✔Plasticity
Structures are stiffer at speeds of force application, prevent adequate viscous deformation and lengthening to take place thus the structure is stiffer and will snap more readily. It can also be
thought of as the ratio of stress ( force) to strain ( elongation) within the elastic material. - ✔✔Hgih
is an important aspect of injury prevention and rehab. A certain amount of muscle length is necessary for optimal length-tension relationships during normal activities of daily living. Changes in these relationships may increase the risk of injury. - ✔✔Flexibility (reduced flexibility has been associated with a greater risk of LE musculotendinous injuries in sports. Additionally, flexibility is an important component of rehab because limited ROM may limit a patient's ability to perform functional activities like descending stairs or performing a basic sit-to-stand.)
What are the six main components of the stress strain curve? - ✔✔toe region, elastic region, elastic limit, plastic region, necking, failure
is the cumulative duration the tissue was stretched over multiple stretching
applications. - ✔✔Elongation time
stretching refers to holding a stretch just past the point of resistance, generally for a predetermined amount of time. Literature often references this duration as 30 seconds, but it can really be any amount of time. - ✔✔Static
stretching refers to lengthening a tissue until a stretch relaxation occurs. Once relaxed, further load can be applied to the tissue to further elongate. This is the concept used for
dynamic splinting devices. - ✔✔Static progressive
stretching involves lengthening a tissue for shorter periods of time than static stretching but doing more sets of the stretch. This may be used for patients who do not tolerate moderate to long durations of elongation. The total elongation time usually ends up being a similar duration than static
stretching. - ✔✔Cyclic
A application of the stretch will decrease the risk of injury and soreness after elongation. This method also decreases the chances of activating a stretch reflex. Due to the viscoelastic properties of a muscle, this type of stretch will make the tissue more compliant. - ✔✔Slower
stretching is high velocity elongation that may exceed the extensibility limit of tissue which may cause muscle soreness. The quick bouncing movements may be safe for younger individuals but is not recommended for elderly patients or those with musculoskeletal pathology. Athletes may
require this dynamic flexibility prior to plyometric or sport specific exercise. - ✔✔Ballistic
The following are to muscle stretching:
Hypomobility
Prevent structural deformities from restricted mobility
Component of total fitness or sport-specific conditioning
Prior to or after vigorous exercise to reduce post-exercise muscle soreness
Prevent Injury - ✔✔Indications
The following are to muscle stretching:
Osteoporosis
Post Immobilization
Elderly
Edematous Tissue
Monitor post-stretch soreness
Over stretching - ✔✔Precautions
The following are to muscle stretching:
Recent Fracture
Bone malformation
Acute pain with muscle lengthening
Acute Inflammation
Acute Infection
Hematoma or tissue trauma
When muscle tightness is needed for function or enhance stability - ✔✔Contraindications
reduce contractures, use of orthosis to prevent injury and improve safety and education to reduce injury.
Management guideline for recovery phase nerve injury - ✔✔The recovery phase is when there are signs that the nerve is being reinnervated. You can start a desensitization program to reduce the hypersensitivity, you can start motor retraining having a patient perform shortened position holds, as control returns progress from gravity limited AAROM, and discriminative sensory re-education, and patient education to reduce injury.
Management guideline for chronic phase nerve injury - ✔✔Chronic phase is where the reinnervation has stopped or is seeing minimal changes and it is time to teach the patient compensatory functions and preventative care to prevent skin breakdown, injury to the body
The most common mechanisms of injury include compression, friction, and stretch. -
✔✔Nerve
Describe the clinical management for adverse neural tension in the acute stage. - ✔✔If a patient is in the acute stage, we should not perform neural tension treatment because the acute stage of condition is a contraindication.
Adverse responses to and treatment can include an increase in symptoms, symptoms remaining after treatment, edema, and a decrease in ROM and function. -
✔✔neurodynamic testing
Contraindications to include acute or unstable neurological signs, Cauda equina symptoms including changes in bowel or bladder control and perineal sensation, spinal cord injury or symptoms, as well as neoplasm and infection. - ✔✔Neurodynamic testing
Describe the sensory distribution pattern as well as the testing position for the median nerve -
✔✔Testing:
- pt in supine, diagonal, no pillows; PT is positioned to facing pt's face
- depress shoulder
- shoulder abd to about 110 deg with their elbow resting on PT thigh
- SH ER
- forearm is supinated
- wrist, fingers, thumb extended with "pistol grip"
- ext elbow
- sensitization to confirm nerve related by having pt side bend neck away to inc symptoms and side bend toward to dec symptoms
- sliders: performed in symptom free range so back off a tad and have pt side bend away while flx their elbow, then pt side bend towards and ext their elbow
- tensioners: 2 jt: elbow ext and side bend away
Sensory distribution pattern will be along the anterior forearm with a pulling/burning sensation
Sensory Distribution Pattern for the ulnar nerve - ✔✔Along the ulnar side of the palm, both dorsal and volar, of the hand and digits (4 and 5).
Sensory Distribution Pattern for the radial nerve - ✔✔Radial Nerve (C 6-C8-T1): Lateral upper arm and thumb, posterior (dorsal) surface of upper arm down to thumb and 2nd, 3rd digits
is excessive movement without protective muscular control. The structures that limit joint movement are lengthened and the muscle control around the joint is insufficient to hold the joint
stable. - ✔✔Instability
is the ability of the soft tissue to return to its resting length after passive stretching. - ✔✔Elasticity
can be described as the process of when a muscle on one side of the joint contracts, the muscle on the opposite side relaxes. When a stretch is applied to the muscle- tendon unit, intrafusal muscle fibers sense the length change and signal the extrafusal muscle fibers ( via alpha neurons) to increase tension and resist lengthening. Therefore, when a stretch reflex is activated in a muscle on one side of the joint, muscles on the opposite side relax or decrease activity. - ✔✔Reciprocal inhibition
involves the GTO monitoring tension in the muscle being stretched. The GTO works to inhibit the muscle if tension is too high or stretch is prolonged. The GTO contributes to reflexive muscle relaxation during a stretch allowing the muscle to be elongated against less muscle tension. Low intensity, slow stretch is less likely to be activated as the GTO fires and inhibits tension in the muscle. - ✔✔Autogenic inhibition
- is a technique incorporated during stretching to increase the available range of motion in the stretch. The theory behind this method is to stimulate the muscle spindle located in the extrafusal fibers to react to the muscle's change in length provided by an this contraction in order to elongate further. Doing so inhibits contraction of the muscle being stretched. An example of this is while stretching the internal rotator cuff muscles (subscapularis), have the patient contract in the external rotation direction to stimulate the infraspinatus, teres minor, and supraspinatus. - ✔✔Agonist- contraction (reciprocal inhibition)
What is being described:
The limb will be moved to the point of tissue resistance, then the patient is asked to perform an isometric contraction of the range limiting muscle, followed by a voluntary relaxation of that muscle and then an immediate concentric contraction of the muscle opposite the range limiting muscle. For example, to stretch the shoulder extensors the arm will be put in shoulder flexion until tissue resistance is felt. The patient will isometrically contract the shoulder extensors by pushing gently into the therapist hand for 5 seconds, then have the patient actively move arm further into shoulder flexion for 5 seconds and relax. The therapist will then take the patient into the new range of shoulder flexion, providing a
deeper stretch. - ✔✔Hold relax with agonist contraction
Exercise for improved vascularity/mobilization/healing - ✔✔31+ reps at 50%
Exercise for coordination and endurance - ✔✔25-30 reps at 60%
Exercise for endurance and strength - ✔✔15-20 reps at 75%
Exercise for strength - ✔✔8-12 reps at 80%
Exercise for power - ✔✔4-6 reps at 90%
Repetition maximum is used to determine and progress the amount of resistance used during progressive resistance exercises. technique is progressive loading.
It is 3 sets, 10 reps and increases the load from 50% RM in the 1st set,
75% RM in the 2nd set,
and finally 100% RM in the 3rd set. - ✔✔DeLorme
What are the components of D1 flexion and extension PNF pattern at the elbow? - ✔✔Flex or extension
What are the components of D1 flexion and extension PNF pattern at the forearm? - ✔✔Flexion: Supination
Extension: Pronation
What are the components of D1 flexion and extension PNF pattern at the wrist? - ✔✔Flexion: flex, radial deviation
Extension: ext, ulnar deviation
What are the components of D1 flexion and extension PNF pattern at the fingers/thumb? - ✔✔Flexion: flex, add.
Extension: ext, abd
What are the components of D1 flexion and extension PNF pattern at the hip? - ✔✔Flexion: flex, add, er.
Extension: ext, abd, ir.
What are the components of D1 flexion and extension PNF pattern at the knee? - ✔✔Flex or ext
What are the components of D1 flexion and extension PNF pattern at the ankle? - ✔✔Flexion: DF, Inversion
Extension: PF, eversion
What are the components of D1 flexion and extension PNF pattern at the toes? - ✔✔Flexion: ext
Extension: flex
What are the components of D2 flexion and extension at the shoulder? - ✔✔Flexion: flex, abd, er
Extension: ext, add, ir
What are the components of D2 flexion and extension at the scapula? - ✔✔Flexion: elevation, abd, upward rotation
Extension: depression, adduction, downward rotation
What are the components of D2 flexion and extension at the elbow? - ✔✔Flex or ext
What are the components of D2 flexion and extension at the forearm? - ✔✔Flexion: supination
Extension: pronation
What are the components of D2 flexion and extension at the wrist? - ✔✔Flexion: extension and radial deviation
Extension: Flexion and ulnar deviation
What are the components of D2 flexion and extension at the fingers and thumb? - ✔✔Flexion: ext, abd
Extension: flex, add
What are the components of D2 flexion and extension at the hip? - ✔✔Flexion: flexion, abd, ir
Usually from mild ischemia or traction
Recovery usually complete - ✔✔Neuropraxia
Loss of axon continuity but connective tissue coverings intact
Wallerian degeneration distal to lesion
Muscle atrophy and sensory loss
Result of prolonged compression or stretch
Recovery incomplete (may require surgery) - ✔✔Axonotmesis
Complete severance of nerve fiber with disruption of connective tissue covering
Wallerian degeneration distal to lesion
Muscle atrophy and sensory loss
Result of gunshot, stab wounds, avulsion, rupture
No recovery without surgery - ✔✔Neurotmesis
Sudderland- Five levels of injury and potential for recovery
First degree injury (neuropraxia): - ✔✔Minimal structural disruption
Complete recovery
Sudderland- Five levels of injury and potential for recovery
Second degree (axonotmesis): - ✔✔Complete axonal disruption with wallerian degeneration
Usually complete recovery
Sudderland- Five levels of injury and potential for recovery.
Third degree (may be either axonotmesis or neurotmesis): - ✔✔Disruption of axon and endoneurium
Poor prognosis without surgery
Sudderland- Five levels of injury and potential for recovery.
Fourth degree (neurotmesis): - ✔✔Disruption of axon, endoneurium, and perineurium
Poor prognosis without surgery
Sudderland- Five levels of injury and potential for recovery.
Fifth degree (neurotmesis): - ✔✔Complete structural disruption
Poor prognosis without microsurgery
During the phase reinnervation has peaked. There are significant residual deficits with no signs of reinnervation and the patient will have compensatory function. The goal at this phase is to train
to allow function, providing lifelong care and patient education. - ✔✔chronic
The goal for adverse neural tension in the stage is to reduce neural symptoms and restore normal neurodynamics. Progression of neural mobilizations move from sliders/gliders to one joint
tensioners and finally to two joint tensioners. - ✔✔subacute
In the stage, neural tension treatment consists of more vigorous tensioners. Tensioners will help reduce any intraneural swelling and have beneficial effects on nerve hydration. Dosage will depend
