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MSK 2 > 2c - HVT Manip > Flashcards

2c - HVT Manip Flashcards

1
Q

what is a thrust joint manipulation (TJM)

A

high velocity, low amp therapeutic mvmt w/i or at end ROM
- w/i normal anatomical range

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2
Q

what is the significance of Freddy Kaltenborn’s nordic approach to manips in 1961

A

first to relate manip to arthrokinematics

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3
Q

what were Geoffrey Maitland’s significant contributions to PT manips

A

treats “reproducible signs”
oscillatory techniques
- grades I-V

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4
Q

what were James Cyriax significant contributions to PT manips

A

clinical reasoning and diagnostic system

he focused on transverse friction massage

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5
Q

what is the goal of TJMs in PT

A

reduce pain and restore motion as part of a comprehensive multimodal POC

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6
Q

what profession has a similar procedure to PT and what profession has a varying procedure

A

osteopath

chiropractor

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7
Q

describe when PT hit most of its legislative challenges w manips and why

A

1990s
PT profession mvmt toward direct access and doctoral ed

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8
Q

how long has manip been part of PT’s practice and why is this relevant

A

since inception of profession
vital part of scope of PT

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9
Q

what is the role that state licensing play in PT manips

A

in place to assure PTs practice w/i scope of practice and protect the public
-> thrust and non-thrust manips included in NPTE

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10
Q

what are the 3 components to a PT’s scope of practice

A

professional
jurisdictional (legal)
personal

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11
Q

what is the significance of state practice acts and TJMs in PT

A

have to check state practice rights to see if allowed to do a TJM per legal guidelines
- some states need a MD referral for a PT manip

a lot of practice acts are silent, if don’t list it as prohibited, then implied we can do it

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12
Q

what state is spinal TJM by PTs prohibited

A

arkansas

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13
Q

what is the APTA’s guidance on TJMs

A

spinal and peripheral joint mobs/manips only to be performed by PT

bc these are considered interventions which require immediate and cont exam and eval throughout intervention

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14
Q

how can adverse reactions to TJMs be avoided

A

appropriate screening

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15
Q

adverse reactions/events to TJMs vs side effects (& ex)

A

adverse reactions are sequelae that are:
- med to long term duration
- mod to severe sx
- serious, distressing, and unacceptable to pt

side effects:
- short term, mild in nature
- non serious
- transient, reversible
ex: inc neck pain, HA, fatigue

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16
Q

what is the most common type of adverse event from a cspine TJM? what are specific examples?

A

neurovascular injury
- cervical a. dissection
- vertebral a. dissection

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17
Q

positive findings for VBI

A

5D’s And 3N’s
Diplopia
Dizziness
Dysarthria
Dysphagia
Drop attack
Ataxia of gait
Numbness
Nausea
Nystagmus

concentration problems
metallic taste
tinnitus
unconsciousness
hemiparesis/hemiplegia
(+) CN signs

sudden onset of severe neck pain/HA

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18
Q

who are cervical/vertebral dissecting vs non-dissecting more common in

A

dissecting
- young pt w trauma

non-dissecting
- older pts w CV risk factors

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19
Q

what is the key point if you are trying to do a physical exam for a cervical vascular disorder

A

there isn’t a single test that can screen for them
- and they have moved away from positional testing

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20
Q

how is the decision made for implementing a manipulation on the pt

A

shared decision making
- is pt comfortable?

is there a greater benefit than the risks
- risk is often low
- higher risk from NSAID use, injections, surgeries

21
Q

what are 6 adverse events/complications from thoracic/lumbar spine manip

A

cauda equina syndrome
SCI
lumbar pedicle fx
lumbar/thoracic compression fx
rib fx
lumbar/thoracic disc herniation

22
Q

what is cauda equina syndrome

A

bilateral sciatica

severe or progressive bilateral neurological deficit of legs

23
Q

what are s/sx of cauda equina syndrome

A

major motor weakness w knee ext, ankle eversion, foot DF
saddle anesthesia/paresthesia
laxity of anal sphincter

difficulty initiation micturition, impaired sensation of urinary flow
-> untreated can lead to irreversible urinary retention w overflow urinary incontinence

loss of sensation of rectal fullness
-> untreated can lead to irreversible fecal incontinence

24
Q

what is a consideration of TJM technique and the risk of a fx

A

unlikely to cause a fx w a small amp thrust
- if too large amp then could cause a fx

25
Q

what are red flags to screen for prior to a TJM

A

significant trauma
wt loss
hx of cancer
fever
IV drug use
steroid use
pt >50yo
severe, unremitting night pain
pain worse w lying down

26
Q

what are 4 general types of absolute contraindications for TJMs (and examples)

A

bony issues - any path that may lead to a bony compromise
- tumor, infection
- inflammatory, trauma

neuro issues - any path impacting the neuro system
- myelopathy, SC compression
- nerve root compression w inc neuro deficits
- sudden n/v & vertigo

vascular issues - any path may lead to vascular compromise (more for cspine)
- VBI, aortic aneurysm, angina
- acute ab pain w guarding (AAA)
- bleeding diatheses (hemophilia, anticoags)

clinical issues - any matter that inc risk of harm to pt
- lack of subj/obj exam info
- lack of dx
- lack of PT skill
- lack of pt consent

27
Q

what are ex of relative precautions for TJMs to thoracic spine

A

HTN
serious degen joint dz
growing children
serious kyphosis/scoliosis
herpes zoster on spine
vertigo
systemic infection
psych dependence on manip
pain w psych
no change/worse sx after multiple manips

28
Q

what is the general consensus for safety w thoracic and lumbar TJM and what does the literature say for safety

A

impossible to determine precise risk
- no accepted standard reporting
- not all events published

clinical decision making based on exam and evidence-based approach

29
Q

what does the research/CPGs say for TJM use

A

recommended in CPGs for acute and chronic LBP

30
Q

what pts w LBP is the evidence not as strong for TJMs and what is the assumption

A

those w back pain and leg pain
- consider neuro involvement anyway

31
Q

what does the evidence say about manip vs mob in chronic LBP

A

manip appears to produce larger effect than mob

32
Q

what are considerations for sidelying lumbar manip

A

rotate upper body all the way down to level you want to manip and flex leg up to that level

short lever arm w arm on pelvis

33
Q

what is a consideration of supine lumbar regional manip

A

very non-specific
- can have manip anywhere from lumbar to SIJ

34
Q

what is the lumbar spine clinical prediction rule and what are the

A

classifies pts w LBP who demonstrate respond favorably to HVT (4 of 5 signs)

  1. duration of sx <16days
  2. no sx distal to knee
  3. LB hypomobility
  4. at least 1 hip >35deg IR
  5. FABQ work subscale <19pts
35
Q

what are inclusion/exclusion criteria for lumbar HVT

A

18-60yo

red flags for manip
- OP, fx, CA, prolonged steroid use, RA, infection
- LMN involvement
- pregnancy
- prior lumbar surgery

36
Q

what are the 2 most important factors of the lumbar spine clinical prediction rule

A

duration <16 days
not having sx distal to knee

37
Q

CPGs recommend thoracic manip in:

A

pts w neck pain with:
- mobility deficits
- chronic HA
- chronic radiation pain

38
Q

what do the CPGs say about thoracic manual therapy benefits depending on phase of recovery of neck pain

A

tends to be better in acute phase
- in subacute to chronic stage, benefit tends to dec

39
Q

what do CPGs say about thoracic manip vs mobilization in neck pain

A

thoracic manip may not offer any benefit over mobilization
(and may be associated w temporary discomfort)

40
Q

what is an important consideration for your set up with a supine segmental AP thoracic thrust technique

A

position their elbows under your xiphoid so you can get force from legs and be more effective
- bc you are going to be smaller than most pts

41
Q

what is the overall consensus of what evidence is available for spinal HVTs

A

greater evidence available for it than other PT interventions

evidence for thrust manip for LBP
- clinical prediction rule may be of limited help to guide decision making in use of TJM for pts w LBP

evidence for mob/manip combined w exercise in neck pain

benefit to treating the thoracic spine

42
Q

what is the proposed mechanical MOA for thoracic and lumbar spinal thrust techniques

A

realignment
breakdown of adhesions
dec acute joint locking
- meniscoid entrapment
joint cavitation
- audible click

43
Q

what is the proposed neurophysiological MOA for thoracic and lumbar spinal thrust techniques

A

inc firing of mechanoreceptors
- inhibition of ms reflex contraction
- dec pain perception

stim of pain inhibition pathways
- PAG

44
Q

how does manual therapy work per the mechanical and neurophysiological model

A
  1. mechanical force
  2. cascade of neurophys response (peripheral and central nervous system)
  3. clinical outcomes
45
Q

how does the patient-provider interaction impact the outcome

A

a lack of confidence when PT does the technique can create less optimal outcomes

46
Q

what are 5 indications for a HVT manip

A
  1. hypomobile segment
  2. acute facet joint locking
  3. mob technique showed benefit but didn’t achieve full effects
  4. criteria for clinical prediction rule -> L spine
  5. neck/shoulder dysfunction -> tspine TJM
47
Q

what are important components of informed consent

A

explain nature, purpose, implications, risks, and alternatives for technique

document consent every time

48
Q

what are the steps to the thrust manip technique

A
  1. isolate joint
  2. preposition, hold, reposition
  3. speed not force**
  4. re-assess
49
Q

what are components to document about the HVT manip

A

pt position
direction of force
target/location of force
grade of manip

MSK 2 (20 decks)

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