Case Study Pt Is The Abbreviation

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Case Study 20-1: Rotator Cuff Tear

M.L., a 56-year-old business executive and former college football player, was referred to an orthopedic surgeon for recurrent shoulder pain. M.L. was unable to abduct his right arm without pain even after 6 months of physical therapy and NSAIDs. In addition, he had taken supplements of glucosamine, chondroitin, and S-adenosylmethionine for several months in an effort to protect the flexibility of his

Case Studies, continued shoulder joint. M.L. recalled a shoulder dislocation resulting from a football injury 35 years earlier. The surgeon recommended the Bankart procedure for M.L.'s complete tear to restore his joint stability, alleviate his pain, and permit him to return to his former normal activities, including golf.

After anesthesia induction and positioning in a semisitting (beach chair) position, the surgeon made an anterosuperior deltoid incision (the standard deltopectoral approach) and divided the coracoacro-mial ligament at the acromial attachment. The rotator cuff was identified after the deltoid was retracted and the clavipectoral fascia was incised. The subscapularis tendon was incised proximal to its insertion. After incision of the capsule, inspection showed a large pouch inferiorly in the capsule, consistent with laxity (instability). The torn edges of the capsule were anchored to the rim of the glenoid fossa with heavy nonabsorbable sutures. A flap from the subscapularis tendon was transposed and sutured to the supraspinatus and infraspinatus muscles to bridge the gap. An intraoperative ROM examination showed that the external rotation could be performed past neutral and that the shoulder did not dislocate. The wound was closed, and a shoulder immobilizer sling was applied. M.L. was referred to PT to begin therapy in 3 weeks and was assured he would be able to play golf in 6 months.

Case Study 20-2: Brachial Plexus Injury

T.D., a 16-year-old high school student, had a severe football accident 3 months before his admission. He sustained a right brachial plexus injury, resulting in a flail arm. He had no recovery and was on medication for neurologic pain. He reported that he had no feeling or motion in his right shoulder or arm. He had atrophy over the supraspinatus and infraspinatus muscles and also subluxation of his shoulder and atrophy of the deltoid. He had no active motion of the right upper extremity and no sensation. The rest of his orthopedic exam showed full ROM of his hips, knees, and ankles with intact sensation and palpable distal pulses as well as normal motor function. He was diagnosed with a possible middle trunk brachial plexus injury from C7. He was scheduled for an EMG, nerve conduction studies, and somatosensory evoked potentials (SSEPs). His diaphragm was examined under fluoroscopy to R/O phrenic nerve injury.

With middle trunk brachial plexus injury, damage to the subscapular nerve will interrupt conduction to the subscapularis and teres major muscles. Damage to the long thoracic nerve prevents conduction to the serratus anterior muscles. Injury to the pectoral nerves affects the pectoralis major and minor muscles.

T.D. was scheduled for a brachial plexus exploration with possible nerve graft, nerve transfer, bilateral sural (calf) nerve harvest, or gracilis muscle graft from his right thigh.

Case Study 20-3: "Wake Up" Test During Spinal Fusion Surgery

L.N.'s somatosensory evoked potentials (SSEPs) were monitored throughout her spinal fusion surgery to provide continuous information on the functional state of her sensory pathways from the median and posterior tibial nerves through the dorsal column to the primary somatosensory cortex. Before surgery, needle electrodes were inserted into L.N.'s right and left quadriceps muscles to determine nerve conduction through L2 to L4, into the anterior tibialis muscles to measure passage through L5, and into the gastrocnemius muscles to measure S1 to S2. Electrodes were placed in her rectus abdominus to monitor S1 to S2. All electrodes were taped in place, and the wires were plugged into a transformer box with feed-

Case Studies, continued back to a computer. A neuromonitoring technologist placed the electrodes and attended the computer monitor throughout the case. During the procedure, selected muscle groups were stimulated with 15 to 40 milliamps (mA) of current to test the nerves and muscles. Feedback data into the computer confirmed the neuromuscular integrity and status of the spinal fixation of the instrumentation and implants.

After the pedicle screws, hooks, and wires were in place and the spinal rods were cinched down to straighten the spine, L.N. was permitted to emerge temporarily from anesthesia and muscle paralysis medication to a lightly sedated but pain-free state. She was given commands to move her feet, straighten her legs, and wiggle her toes to test all neuromuscular groups that could be affected by misplaced or compressed spinal fixation devices. Her feet were watched, and movement was announced to the team. Dor-siflexion cleared the tibialis anterior muscles; plantar flexion cleared the gastrocnemius muscles. Knee flexion cleared the hamstring muscle group, and knee extension determined function of the quadriceps group. L.N. had a successful "wake-up" test. She was put back into deep anesthesia, and her incision was closed. A postoperative "wake-up" test was repeated after she was moved to her bed. The surgical instruments and tables were kept sterile until after all of the monitored muscle groups were tested and showed voluntary movement. The electrodes were removed, and she was taken to PACU for recovery.


Multiple choice: Select the best answer and write the letter of your choice to the left of each number.

_ 1. The insertion of the muscle is:

a. the thick middle portion b. the point of attachment to the moving bone c. the point of attachment to the stable bone d. the fibrous sheath e. the connective tissue

_ 2. M.L. was unable to abduct his affected arm. This motion is:

a. toward the midline b. circumferential c. in the same direction as the muscle fibers d. away from the midline e. a position with the palm facing upward

_ 3. An anterosuperior deltoid incision would be made:

a. perpendicular to the muscle fibers b. below the fascia sheath c. behind the glenoid fossa d. in the best area e. at the top and to the front of the deltoid muscle

_ 4. The subscapularis tendon arises from the subscapularis:

a. fascia b. nerve c. bone d. extensor e. flexor

Case Studies, continued


The intraoperative ROM examination was performed:

a. in the OR corridor

b. during surgery

c. before surgery

d. after surgery

e. in the interventional radiology suite


M.L.'s arm and shoulder were immobilized after surgery to:

a. encourage movement beyond the point of pain

b. minimize rapid ROM

c. maintain adduction and external rotation

d. prevent movement

e. stop bleeding


T.D. had atrophy of the supraspinatus and infraspinatus muscles. The term atrophy here

refers to:

a. hypercontraction

b. intermittent contraction and relaxation

c. muscle tissue wasting

d. paralysis

e. painful discoloration


Another term for subluxation is:

a. dislocation

b. hyperextension

c. turning inside out

d. overlapping

e. stretched beyond original shape


A palpable distal pulse means that the pulse can be:

a. heard at the foot

b. felt at the top of the thigh

c. felt at the foot

d. obliterated with light

e. undetectable


The pectoralis major and pectoralis minor muscles are located:

a. below the knees

b. behind the thighs

c. in the lower back

d. in the upper chest

e. on the lateral side of the arms


The quadriceps muscle group is made up of:

a. smooth and cardiac muscle fibers

b. four muscles in the thigh

c. three muscles in the leg and one in the anterior chest

d. fascia and tendon sheaths

e. tendons and fascia around the shoulder

Case Studies, continued

_ 12. The nerve supply for the rectus abdominus muscle runs through S1-S2. This anatomic region is:

a. the first and second sural sheath b. subluxation and suppuration c. sacral disk space 1 and 2

d. sacral disk space 3

e. somatosensory electrodes 1 and 2

_ 13. The joint motion characterized by elevating the toes toward the anterior ankle is:

a. supination b. pronation c. dorsiflexion d. plantar flexion e. external rotation

_ 14. Knee extension results in:

a. a bent knee b. a ballet position with the toes turned out c. bilateral abduction d. inversion e. a straight leg

Write a term from the case studies with each of the following meanings:

15. pertaining to the arm _

16. pertaining to treatment of skeletal and muscular disorders

17. bending at a joint

18. to point the toes downward Abbreviations. Define the following abbreviations:













Chapter 2G Crossword Muscular System

Muscular System Crossword




Around: prefix


Muscle of the forearm,


Rod, such as a muscle cell: combining form



Muscle group at the back of the thigh


Muscle: combining form


Not: prefix


Referring to rheumatism


Muscle tone: combining form


Neurotransmitter active in the muscular system:


Down, without, removal: prefix



Disease caused by degeneration of motor neurons,


Wasting of tissue

with weakness, atrophy, and spasticity:


Substance that stores oxygen in muscles



Muscle that covers the shoulder


Muscle that carries out a given movement,


Sudden involuntary muscle contraction



Health profession concerned with physical rehabili


Lack of muscle tone

tation and prevention of disability: abbreviation


Referring to a joint in the foot: abbreviation


Health profession concerned with working to in


Adjective for a type of muscle contraction

crease function and independence in daily life:


Fiber: root

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  • jakob
    How is bankart procedure steps?
    8 years ago

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