Provimi i Shtetit - Fizioterapeut cheat sheet

The brachial plexus derives from ventral rami C5–T1; roots→trunks→divisions→cords→terminal branches.

Rotator cuff muscles (SITS): supraspinatus (abduction initiation), infraspinatus and teres minor (external rotation), subscapularis (internal rotation).

The femoral triangle borders: inguinal ligament superiorly, sartorius laterally, adductor longus medially; contents NAVEL (nerve, artery, vein, empty space, lymphatics).

Lumbar plexus (L1–L4) gives femoral and obturator nerves; sacral plexus (L4–S4) gives sciatic and pudendal nerves.

The ACL prevents anterior tibial translation; the PCL prevents posterior translation; the MCL resists valgus and the LCL resists varus stress.

The median nerve passes through the carpal tunnel with the flexor tendons; the ulnar nerve passes through Guyon's canal.

Diaphragm innervation is the phrenic nerve (C3–C5); accessory muscles of inspiration include scalenes and sternocleidomastoid.

Muscle force depends on cross-sectional area and length-tension relationship; active tension peaks near resting sarcomere length (~2.0–2.2 µm).

Type I fibers are slow, oxidative, fatigue-resistant; Type IIb are fast, glycolytic, fatigue rapidly.

The length-tension curve of collagen: toe region (crimp straightening) precedes the linear elastic region and yield/failure point.

Newton's third law and lever mechanics: first-class lever (neck extension), second-class (calf raise), third-class (biceps curl, most common in the body).

Joint arthrokinematics: convex surface moves opposite to the bone's swing; concave surface moves in the same direction (roll-glide rule).

Cardiac output = heart rate × stroke volume; mean arterial pressure ≈ DBP + 1/3 (SBP − DBP).

The Frank-Starling law: increased end-diastolic volume increases stroke volume within physiological limits.

Gait cycle: stance ~60%, swing ~40%; double support occurs twice per cycle and increases with slower walking speed.

Red flags for low back pain: age >50 with new onset, night pain, weight loss, fever, neurological deficit, history of cancer, trauma.

Osteoarthritis: cartilage loss, subchondral sclerosis, osteophytes, joint space narrowing; management emphasizes exercise and load management.

Rheumatoid arthritis is symmetric, involves MCP/PIP joints, morning stiffness >1 hour, and systemic features; OA typically affects weight-bearing joints.

Deep vein thrombosis signs: unilateral swelling, calf pain, warmth, erythema; immobilization and anticoagulation are priorities before mobilization.

Osteoporosis is defined by T-score ≤ −2.5 on DXA; fragility fracture risk increases with low bone mineral density.

Peripheral neuropathy: distal, symmetric, stocking-glove sensory loss; diabetes is the most common cause.

Stroke: sudden focal deficit; thrombolysis window typically ≤4.5 hours from symptom onset.

SOAP format: Subjective, Objective, Assessment, Plan - a structured documentation framework.

Range of motion is measured in degrees with a goniometer; reliability is highest when the same examiner repeats the measurement.

Manual muscle testing uses the 0–5 Oxford scale: 0 no contraction, 3 antigravity, 5 normal against resistance.

Special tests: Lachman for ACL, McMurray for meniscus, Phalen for carpal tunnel, Spurling for cervical radiculopathy.

The International Classification of Functioning (ICF) distinguishes body function/structure, activity, participation, and environmental/personal factors.

Differential diagnosis reasoning uses hypothesis generation, confirmation, and refutation; the most likely diagnosis is not always the safest.

Outcome measures: VAS/NPRS for pain, DASH for upper limb, WOMAC for knee/hip OA, Berg Balance Scale for balance.

Progressive overload: load must exceed habitual levels to produce adaptation; frequency, intensity, time, and type (FITT) guide prescription.

Isometric exercise is used early when joint movement is contraindicated; isotonic exercise includes concentric and eccentric phases.

Eccentric exercise is effective for tendinopathy (e.g., Alfredson protocol for Achilles).

Manual therapy techniques include Maitland mobilizations (grades I–V), Mulligan mobilizations with movement, and Maitland's irritability classification.

Mobilization grades: I–II for pain, III–IV for stiffness; grade V is a manipulation (high-velocity thrust).

Plyometric exercise uses the stretch-shortening cycle; it requires adequate strength and joint stability before progression.

Motor control training emphasizes low-load, precise activation and is used in chronic low back and neck pain.

TENS: high-frequency (80–120 Hz) for pain gating; low-frequency (2–4 Hz) for endorphin release; contraindicated over pacemakers and the pregnant uterus.

Ultrasound: 1 MHz penetrates deeper (~5 cm), 3 MHz is superficial (~1–2 cm); continuous for thermal effects, pulsed for non-thermal.

Cryotherapy reduces tissue temperature, blood flow, and edema; contraindicated in cold hypersensitivity and Raynaud's.

Thermotherapy increases blood flow and tissue extensibility; avoid over acute inflammation and impaired sensation.

Interferential current uses two medium-frequency currents producing a low-frequency beat; contraindicated over the heart and pacemakers.

Laser therapy (LLLT) uses red/infrared wavelengths; eye protection is required for patient and therapist.

Electrical stimulation contraindications: pacemaker, over the carotid sinus, transcerebrally, over malignancy, and pregnancy.

Osteoarthritis knee exercise reduces pain and improves function; quadriceps strengthening is a core intervention.

Rotator cuff tendinopathy: progressive loading plus scapular control; avoid aggressive overhead loading in acute irritability.

Low back pain: stay active, avoid bed rest; the biopsychosocial model guides chronic pain management.

Frozen shoulder (adhesive capsulitis) progresses through freezing, frozen, and thawing phases; early aggressive stretching is avoided.

Lateral epicondylalgia: eccentric wrist extensor loading and load modification are first-line.

Fracture healing phases: inflammation (0–2 weeks), repair/soft callus (2–6 weeks), remodeling (months).

Post-operative ACL rehabilitation progresses through protection, strengthening, and return-to-sport criteria including limb symmetry index.

Upper motor neuron lesion signs: hyperreflexia, spasticity, positive Babinski, and loss of fine motor control.

Lower motor neuron signs: flaccidity, atrophy, fasciculations, and areflexia.

The Brunnstrom stages describe motor recovery after stroke from flaccidity to near-normal movement.

Berg Balance Scale: score ≤45 indicates increased fall risk; 41–56 suggests independent balance.

Neuroplasticity principles: use it or lose it, specificity, repetition, salience, and intensity.

Spasticity is velocity-dependent increased muscle tone; the Modified Ashworth Scale grades it 0–4.

Gait training after stroke should emphasize task-specific practice and appropriate assistive device selection.

Breathing exercises: pursed-lip breathing prolongs expiration; diaphragmatic breathing improves ventilation efficiency.

Airway clearance techniques: ACBT, PEP, autogenic drainage, and postural drainage with positioning.

Spirometry: FEV1/FVC <0.70 indicates obstructive pattern; restrictive pattern shows reduced FVC with preserved ratio.

COPD management includes pulmonary rehabilitation, smoking cessation, and energy conservation.

Chest auscultation: crackles suggest fluid or secretions; wheeze suggests bronchospasm.

Exercise prescription in cardiac rehabilitation uses the FITT principle and Borg RPE (target 11–13 for moderate intensity).

Post-operative respiratory physiotherapy reduces atelectasis and pneumonia risk after thoracic/abdominal surgery.

Informed consent requires capacity, disclosure, understanding, and voluntariness; it must be documented.

Confidentiality: patient information may be disclosed only with consent or when legally required.

Scope of practice: physiotherapists must work within their competence and refer when outside it.

Documentation must be contemporaneous, objective, and retained per local legal requirements.

Professional boundaries: dual relationships and conflicts of interest should be avoided or disclosed.

Mandatory reporting obligations apply to suspected abuse or certain communicable diseases per law.

Ethical principles: autonomy, beneficence, non-maleficence, justice, and fidelity.

Hand hygiene is the single most effective measure to prevent healthcare-associated infection; use the WHO 5 moments.

Standard precautions apply to all patients; transmission-based precautions (contact, droplet, airborne) are added for specific infections.

Personal protective equipment sequence: gown, mask, goggles, gloves; removal reverses the order.

Fall prevention: assess fall risk, use appropriate assistive devices, and ensure environmental safety.

Evidence hierarchy: systematic reviews/meta-analyses > RCTs > cohort > case-control > case series > expert opinion.

Critical appraisal of RCTs considers randomization, allocation concealment, blinding, and intention-to-treat analysis.

Evidence-based practice integrates best evidence, clinical expertise, and patient values and preferences.