6. Selected NMS Condition Of The Lumbar Spine And Pelvis

Question 1

What are the findings of an SI strain?

Answer 1

• passive range of motion is painless except for muscle stretching
• active range of motion is painful (GIllet’s test) due to muscle contraction
• provocative tests are negative
• neurological tests are negative
• history includes a single event or cumulative trauma

Question 2

What are the findings of SI sprain?

Answer 2

• passive range of motion is painful
• active range of motion is painful (GIllet’s test) due to injured ligaments or joint capsule
• provocative tests are painful
• neurological tests are negative

Question 3

What is facet syndrome?

Answer 3

posterior joint dysfunction characterized by irritation

of the facet joints

Question 4

What are the findings of facet syndrome?

Answer 4

• area is tender to palpatory pressure
• local muscle spasms
• joint restrictions, abnormal joint
  play and/or end play
• pain patterns that may mimic SI syndrome but are bilateral
• increasing lumbar lordosis increases pain
• lumbar flexion relieves pain
• negative neurological tests

Question 5

What is Maigne’s syndrome (AKA thoracolumbar junction syndrome or posterior ramus syndrome)?

Answer 5

It is basically facet syndrome but in the thoracolumbar spine region however because the close proximity to the cluneal nerves, local inflammation caused by irritated facets can make cluneal nerves hypersensitive

Question 6

Maigne’s syndrome can affect any age group but most common after ____ years of age

Answer 6

40

Question 7

What are the possible findings of Maigne’s syndrome?

Answer 7

• painful SPs at T12, L1
• thoracolumbar extension restrictions
• painful skin rolling
• hyperesthesia to pin
• may cause sclerotogenous pain referral to posterior iliac crest region and buttock similar to lumbosacral or SI referred pain but usually unilateral

Question 8

What kind of trigger points are commonly associated with SI syndrome?

Answer 8

Gluteal myocardial trigger points

Question 9

What are the findings of gluteal myocardial trigger point associated with SI syndrome?

Answer 9

• palpable nodule
• pain referral (Myotomal)
• palpation causes local twitch response
• palpation causes reproduction of patient’s syndrome

Question 10

What is piriformis syndrome?

Answer 10

Irritation/inflammation of the sciatic nerve due to piriformis

Question 11

Entrapment syndrome is present in ______% of population

Answer 11

15-20

Question 12

What is Entrapment syndrome?

Answer 12

Impingement of sciatic nerve by hypertonic piriformis causing irritation and inflammation

Question 13

What are the two presentations of entrapment syndrome?

Answer 13

• The nerve separates into two divisions above the muscle, one branch going through the muscle belly (more common).
• The entire unsplit nerve goes
  through the muscle (less common).

Question 14

chronic inflammatory polyarthritis characterized by progressive bony ankylosis (fusion) of the sacroiliac and spinal joints

Answer 14

ankylosing spondylitis

Question 15

What usually fuses first in ankylosing spondylitis and what is the progression?

Answer 15

SI’s usually fuse first and then fusion progresses in a cephalad direction.

Question 16

What is the classic triad of symptoms for Reiter’s syndrome (reactive arthritis)?

Answer 16

• conjunctivitis (can’t see)
• urethritis (can’t pee)
• polyarthritis (can’t dance with me)

Question 17

What causes Reiter’s syndrome?

Answer 17

Reaction to an STD/STI (urogenital Reiter’s) or to an infection from handling or eating bacteria tainted substances
(gastrointestinal Reiter’s)