Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Adjustive Technique 3 > adj.tech.final > Flashcards

adj.tech.final Flashcards

1
Q

What are some of the features of the bony anatomy of the lumbar vertebra?

A

1) Kidney shaped 2) Wider than deep 3) Increases in size from above down 4) forms a lordotic curve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Are vertebral bodies in the lumbar wide or deeper?

A

Wider than deep.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are lumbar vertebra like at birth?

A

Concave.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When will the lordosis develop?

A

With walking.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

When is the lordosis fully developed? ***

A

By 8-10 years.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the acceptable standard for the degrees of lumbardosis?***

A

NO acceptable degree (30-35 common range).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the typical range of the sacral base angle?

A

37 - 42, 35-45 degrees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the height of an IVD?

A

about 9 mm in height

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the ratio between IVD and lumbar vertebral body?

A

Ratio is 1:3.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does the increased height of the disc to body do for lumbar flexibility?

A

It allows for increased lumbar flexibility over thoracic spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the major role of the IVD?***

A

not to direct movement, but in absorbing and dispersing compressive loads.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What shape are the articular facets of the lumbar vertebrae?

A

Slightly cupped shaped

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What plane do the lumbar articular facets sit in?

A

Sagittal, with lumbosacral becoming more coronal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which facet (inferior or superior) is convex and which facet is concave?

A

Inferior articular facets = convex, Superior articular facets = concave

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the inferior facets of the lumbar vertebrae like? ***

A

Inferior facet lies inside the superior facet.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the function of the lumbar facets? ***

A

Resists rotation (less so at L5-S1).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

In which facets are facetal tropism most commonly found?

A

In the lumbosacral facets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What percentage of the axial load do facets normally carry?

A

18%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What percentage of the axial load do facets carry in hyper extended postures?

A

Up to 33%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What provides up to 45% of the torsional strength of the lumbar spine?

A

The facets with their articular capsules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the relationship of facetal planes to palpation and adjusting vectors?

A

Avoidance of jamming or compressive adjusting forces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the physical presentation of lumbar vertebrae TP’s?

A

Small and run obliquely posterolateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are used in place of TP’s for adjustive contacts in the lumbars?

A

Mammillary bodies to avoid uncomfortable pressure on the TPs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Where are Mammilary bodies found at in relation to the SPs?

A

Located up one interspinpous and out.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How do the lumbar SPs run in relation to the vertebral body?

A

Run almost directly horizontal to the vertebral body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the shape of lumbar SPs?

A

Large and hatchet shaped

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What do the SPs do in terms of extension?

A

Provides a bony block to extension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How is the L5 SP different than the other lumbar SPs?

A

The L5 SP is shorter, more rounded and difficult to distinguish

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the lumbar SPs like for palpation?***

A

Superficial and sensitive to firm pressure. Necessitates broad and padded adjustive contacts.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the GROM for extension of the lumbar spine?

A

30 degress of extension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the GROM for flexion of the lumbar spine?

A

90 degrees of flexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

In which direction is the GROM the greatest in the lumbar spine?

A

Flexion - extension motion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How many times is flexion greater than extension?

A

2 times as much flexion as extension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What percent of trunk flexion occurs in the lumbar spine?

A

75%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the degree of SROM for flexion-extension per segment of combined movement in the lumbar spine?

A

14 degrees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the degree of movement for flexion-extension at L1-L2 and what is the degree of movement at L5-S1?

A

L1-L2 = 12 degrees, L5-S1 = 17 degrees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is the pattern of motion for flexion-extension in the lumbar spine?

A

Sagittal plane rotation coupled with some sagittal plane translation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

How much translation in the lumbar spine for flexion-extension is clinically unstable?

A

> 4.5mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

When will the IVD open and approximate?

A

Opens posteriorly during flexion and approximates during extension.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Is there a significant shift in the nucleus during flexion-extension of the lumbar spine?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Which way does the disc bulge during flexion-extension of the lumbar spine?

A

Bulges on the concave side and retracts on the convex side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

How do the articular facets glide during flexion and extension?

A

Articular facets glide apart during flexion and approximate during extension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is the GROM for rotation of the lumbar spine?

A

5-18 degrees to each side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Where does the greatest degree of trunk rotation occur?

A

Occurs in the thoracic spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is the pattern of motion for rotation of the lumbar spine?

A

Movement occurs predominantely in the transverse plane. Rotation is coupled with lateral flexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Is coupling stronger with primary rotation or with primary lateral flexion?

A

Primary lateral flexion provides a stronger coupled rotation than coupled lateral flexion that occurs with primary rotation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What sided lateral flexion is coupled with rotation of the upper 3 segments of the lumbar spine?

A

Rotation in the upper three segments is coupled with opposite side lateral flexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What sided lateral flexion is coupled with rotation of the lower segments of the lumbar spine?

A

Rotation in the lower is coupled with same side lateral flexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

At what point in the lumbar spine is there an increased incidence of degenerative change?

A

L4-L5 transition point

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

When will the lumbar facet joints gap with rotation?

A

On the side of rotation and approximate on the side opposite rotation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Which joints act as a barrier to rotational mobility in the lumbar spine?

A

Facet joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is the GROM for Lateral flexion of the lumbar spine?

A

approximately 25 degrees to each side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is the SROM for Lateral flexion of the lumbar spine?

A

approximately 6 dgrees per side with movement dropping to 3 degrees at L5-S1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is the pattern of motion for lateral flexion of the lumbar spine?

A

Lateral flexion is coupled with opposite side rotation (SPs rotate to the concavity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Under what spinal postions do the patterns of motion for lateral flexion occur?

A

Present with the spine in a neutral or extended position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

During lateral flexion which side does the IVF open and which side closes?

A

Opens on the contralateral side and closes on ipsilateral side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

During lateral flexion which side does the IVD bulge and retract?

A

The disc bulges on the concave side and retracts on the convex side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

During lateral flexion, does the nucleus shift?

A

No the nucleus does not significantly shift

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

During lateral flexion, which side of the articular facets glide apart and which side approximates?

A

The contralateral facets glide apart and the ipsilateral facets approximate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What is the coupled motion like in the lumbar spine?

A

rotation with lateral flexion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

When will the rotation that is coupled with lateral flexion be reduced or reversed?

A

When the spine is flexed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What will the spine do when laterally flexed or rotated?

A

Undergo slight flexion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Name the adjustive setup that is not possible in the lumbars?

A

Resisted hypothenar spinous push for rotation / lateral flexion. Only done assisted.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What are the 4 elements of lumbar adjusting?

A

1) Reduce articular slack, 2) Stabilize adjacent spinal joints 3) Establish contact points 4) Establish Adjustive vector

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

How is slack reduced as a patient positioning component?

A

It is reduced by moving a joint toward end range

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What are assisted patient positions?

A

Contact vertebra and vertebra above contact point are moved in the direction of adjustive thrust

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What are resisted patient positions?

A

Vertebra above contact point are moved in the direction opposite the adjustive thrust

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What is the intended mechanical effects seen with a flexion dysfunction adjustment?

A

Cavitation and stretching of the posterior joints, disc and posterior segmental soft tissues.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What does joint stabilization entail?

A

Counter tension and locking (induce points of resistance for adjustive thrusts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What are some ways to provide joint stabilization?

A

Tables, pillows, Doctro’s indifferent hand contacts, legs, forearms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What are contact points designed for?

A

Established to more specifically direct maximal adjustive force to a specific level or region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What is an assisted contact point?

A

Contact superior vertebr of dysfunctional joint (effect joint inferior to contact)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What is a resisted contact point?

A

Contact inferior vertebra of dysfunctional joint (effect joint superior to contact)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What would be malposition listing for a flexion restriction of L3-4?

A

Extension malposition L3.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What is adjustive vector and thrust?

A

Provides the force and direction critical to producing the desired movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What is an assisted vector and thrust?

A

Thrust on superior vertebra in direction of joint restriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What is an resisted vector and thrust?

A

Thrust on inferior vertebra in direction opposite joint restriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What is an counter thrust?

A

Thrust applied on adjacent vertebral levels to induce movement in direction of joint restriction (one assisted, one resisted)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What are the limitation of assisted and resisted language?

A

ie: supine technique, solved by classifying method by which vertebra of motion segment are contacted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Whais the intended Mechanical Effects of flexion dysfunction adjustments?

A

Cavitation and stretching of the posterior joints, disc and posterior segmental soft tissues.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What is the movement caused by a flexion dysfunction adjustment?

A

Bilateral gliding separation in the sagittal plane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Which are the two adjustments that can fix a flexion dysfunction?

A

1) Assisted hypothenar spinous push 2) Resisted hypothenar spinous push

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Describe the components of a Assisted hypothenar spinous push adjustment for flexion

A

1) Superior vertebral contact 2)either side up 3) P-A & I-S vector

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Describe the components of a Resisted hypothenar spinous push for flexion

A

1) inferior vertebral contact 2) either side up 3) P-A & S-I vector

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

For flexion dysfunction adjustments, which contacts are preferred and why?

A

Assisted contacts are preferred since it is a less stressful position on the doctor’s shoulder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What is the intended mechanical effects seen with an extension dysfunction adjustment?

A

Gliding approximation of the posterior joints and disc. Stretching of the anterior segmental soft tissue.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What is the movement caused by a extension dysfunction adjustment?

A

Bilateral gliding approximation in the sagittal plane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Name a restriction listing for a flexion malposition at L3?

A

Extension restriction L3-4.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Which are the two adjustments that can fix an extension dysfunction?

A

1) Assisted hypothenar spinous push 2) Resisted hypothenar spinous push

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Describe the components of a Assisted hypothenar spinous push adjustment for extension

A

1) superior vertebral contact 2) either side down 3) P-A & S-I vector

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Describe the components of a Resisted hypothenar spinous push for extension

A

1) Inferior vertebral contact 2)either side up 3) P-A & I-S vector

92
Q

For extension dysfunction adjustments, which contacts are preferred and why?

A

Resisted contacts are preferred since it is a less stressful position on the doctor’s shoulder

93
Q

What is the intended mechanical effects of a rotation adjustment?

A

Unilateral or bilateral cavitation and stetching of the posterior joints and segmental soft tissue..

94
Q

What movements are caused by a rotational dysfunction adjustment?

A

1) Gapping on the side of posterior restriction 2) Gliding on the side of anterior restriction

95
Q

Which are the adjustments that can fix a rotational dysfunction? (7)

A

1) Assisted hypothenar mammillary push 2) Assisted digit spinous pull 3) Resisted hypothenar mammillary push 4) Resisted digit spinous pull 5) Spinous digit push-pull 6) Assisted hypothenar spinous push 7)Resisted hypothenar mammillary pull

96
Q

Describe the components of a Assisted hypothenar mammillary push for rotation

A

1) Superior vertebral contact 2)side of rotational restriction down 3) P-A & I-S vector

97
Q

Describe the components of a Assisted digit spinous pull for rotation

A

1) Superior vertebral contact 2)side of rotational restriction down 3) L-M vector

98
Q

Describe the components of a Resisted hypothenar mammillary push for rotation

A

1) inferior vertebral contact 2) side of rotational restriction up 3) M-L with slight P-A pressure

99
Q

Describe the components of a Resisted digit spinous pull for rotation

A

1) inferior vertebral contact 2) side of rotational restriction up 3) L-M vector

100
Q

Describe the components of a Spinous digit push-pull for rotation

A

1) Adjacent vertebral contacts 2) Side of rotational restriction up 3) L-M pushing vector with superior arm and L-M pulling vector with inferior arm

101
Q

Describe the components of a Assisted hypothenar spinous push for rotation

A

1)Superior vertebral contact 2) Side of rotational restriction up 3) P-A, M-L, S-I vector (typically applied to same side lateral flexion and rotational restrictions)

102
Q

Describe the components of a Resisted hypothenar mammillary pull for rotation

A

1) Inferior vertebral contact 2) rotational restriction side up 3) M-L vector (uncommon method, most effect with lumbo sacral region)

103
Q

What is the intended mechanical effects of a lateral flexion adjustment?

A

Unilateral cavitation and stetching of the posterior joints and segmental soft tissues on the side opposite lateral flexion.

104
Q

What are the motions created by a lateral flexion dysfunction adjustment?

A

1) Coronal plane gliding separation on the side opposite lateral flexion restriction 2) Coronal plane gliding approximation on the side of lateral flexion restriction

105
Q

What are the adjustments that can correct a lateral flexion dysfunction? (3)

A

1) Assisted hypothenar spinous push 2) Assisted hypothenar mamillary push (distraction) 3) Resisted digit spinous pull, Push/pull and resisted hypothenar mammillary push

106
Q

Describe the components of a Assisted hypothenar spinous push for a lateral flexion adjustment

A

1) Superior vertebral contact 2) side of lateral flexion restriction is up 3) P-A, L-M, S-I vector

107
Q

Describe the components of a Assisted hypothenar mamillary push (distraction) for a lateral flexion adjustment

A

1) Superior vertebral contact 2) Side of lateral flexion restriction is down 3) P-A, M-L, I-S vector

108
Q

Describe the components of a Resisted digit spinous pull, Push/pull and resisted hypothenar mammillary push for a lateral flexion adjustment

A

1) side of lateral flexion restriction is down 2) vectors same as those decribed for rotational restriction

109
Q

When should lateral flexion adjustments typically be used?

A

Applied in circumstances where the patient cannot tolerate coupled rotation

110
Q

When will the prone and knee chest lumbar adjustments be used?

A

Circumstances where extension is desired.

111
Q

What are the adjustments that can correct a rotation with opposite sided lateral flexion dysfunction? (4)

A

1) Assisted hypothenar mammillary push 2) Resisted hypothenar mammillary push 3) Resisted digit spinous pull 4) Spinous digit push-pull

112
Q

Describe the components of a Assisted hypothenar mammillary push for a rotation with opposite sided lateral flexion dysfunction

A

1) Superior vertebral contact 2) Side of rotational restriction is down 3) P-A, L-M, S-I vector

113
Q

Describe the components of a Resisted hypothenar mammillary push for a rotation with opposite sided lateral flexion dysfunction

A

1) Inferior vertebral contact 2) side of rotational restriction is up 3) M-L, slight P-A

114
Q

Describe the components of a Resisted digit spinous pull for a rotation with opposite sided lateral flexion dysfunction

A

1) Inferior vertebral contact 2) side of rotational restriction is up 3) L-M

115
Q

Describe the components of a Spinous digit push-pull for a rotation with opposite sided lateral flexion dysfunction

A

1) Adjacent vertebral contacts 2) Side of rotational restriction up 3) L-M pushing vector with superior arm and L-M pulling vector with inferior arm

116
Q

What are the adjustments that can correct a rotation with same sided lateral flexion dysfunction? (2)

A

1) Assisted hypothenar spinous push 2) Assisted hypothenar mammillary push

117
Q

Describe the components of an Assisted hypothenar spinous push for a rotation with same sided lateral flexion dysfunction

A

1) Superior vertebral contact 2) Side of rotation restriction is up 3) P-A, L-M, S-I

118
Q

Describe the components of an Assisted hypothenar mammillary push for a rotation with same sided lateral flexion dysfunction

A

1) Superior vertebral contact 2) side of roational restriction is down 3) P-A, M-L, I-S vector

119
Q

What are the different prone and knee chest lumbar adjustments? (5)

A

1) Bilateral thenar mammillary 2) Crossed bilateral hypothenar mammillary 3) Hypothenar spinous push 4) Hypothenar mammillary push 5) Hypothenar spinous thenar mammillary push

120
Q

For what dysfunction is there the greatest potential for application for prone & knee chest lumbar adjustments?

A

Extension dysfunctions

121
Q

Why is a flexion dysfunction an unsuitable adjustment for knee chest tables?

A

Because the lumbar lordotic curve works against the vectors required in a flexion adjustment

122
Q

Are lateral flexion and rotational adjustments possible in the prone or knee chest lumbar adjustment methods?

A

Theoretically yes, but based on the lumbar lordotic curve, patient position and P-A thrusts the potential for extension is much higher

123
Q

What is the best fit for a sitting lumbar adjustment?

A

For vectors that do not incorporate extension.

124
Q

Will sitting adjustments be assisted or resisted?

A

Assisted.

125
Q

What are the sitting lumbar adjustments that are possible?

A

1) Assisted hypothenar mammillary push 2) Assisted hypothenar spinous push

126
Q

How can pre-tension be maximized to one side of the spine when treating rotational restrictions?

A

By laterally flexing the patient away from that side.

127
Q

What are the 3 possible diagnostics with back pain (Diagnostic triage)?

A
  1. Serious spinal pathology. 2. Nerve root pain; radiculopathy secondary to orthopedic encroachment. 3. Mechanical back pain.
128
Q

What are some motion segment causes of mechanical back pain?

A

1) Subluxation syndrome, joint dysfunction, posterior joint or facet syndrome 2) Joint (articular) strain/sprain 3) Internal disc derangement

129
Q

What are some non segmental causes of mechanical back pain?

A

1) Muscle Strain 2) Myofascial trigger point syndrome 3) Postural syndrome

130
Q

Of the 3 possible diagnostics what % will have mechanical back pain?

A

90-95%.

131
Q

What % of patients fear they have a serious pathology?

A

40%.

132
Q

What % of patients have a serious pathology?

A

Less than 1%.

133
Q

What % of patients will have a radiculopathy?

A

Less than 5%.

134
Q

What ages bring up red flags?

A

less than 20 and over 55.

135
Q

What kind of trauma brings up a red flag?

A

Violent.

136
Q

What kind of pain would be a red flag?

A

Constant, progressive, non-mechanical.

137
Q

What type of previous history brings up red flags?

A

Carcinoma, systemic steriods, drug abuse, HIV.

138
Q

What type of systemic problems bring up red flags?

A

Systemically unwell, weight loss.

139
Q

What type of neuro symptoms are red flags?

A

Widespread neuro symptoms (like cauda equina syndrome).

140
Q

Can serious pathology be ruled out by a normal exam?

A

No.

141
Q

What are some Red Flag Findings?

A

1) Widespread neuro symptoms or signs (sensory, motor & reflex testing, palpate bladder, upper motor neuro signs) 2) persisting severe restiction of lumbar flexion (serious path, disc prolapse and infection can cause this) 3)structural deformity (does not change with position)

142
Q

Radiographs in absence of red flags catch how many problems?

A

1/12500 patients.

143
Q

When will ESR’s have a high false positive?

A

In absence of red flags.

144
Q

What do normal ESR and radiographs in presence of red flags typically mean?

A

Decrease probability of serious pathology, but does not rule out presence of serious pathology

145
Q

With Nerve root problems what will hurt more than the back pain?

A

Unilateral leg pain.

146
Q

Where will pain from nerve root problems travel to?

A

Often below the knee.

147
Q

How is the leg pain associated with nerve roots different than other leg pain?

A

It is often sharper and more localized than sclerogenic referral

148
Q

Is most leg pain radicular?

A

No

149
Q

Does numbness or paresthesia occur with nerve root problems?

A

Yes it is in the same distribution as the pain

150
Q

How can you test for nerve root irritation?

A

Nerve traction signs (SLR, Bragard’s, Bowstring)

151
Q

How can you test for nerve root compression?

A

Motor, sensory, or reflex changes.

152
Q

What is the typical age range of mechanical back pain?

A

20-50

153
Q

Where does pain refer to with mechanical back pain?

A

lumbosacral, buttocks and thigh

154
Q

How does Mechanical back pain vary?

A

With activity, position and time.

155
Q

What is a subjective and objective exam?

A

Subjective- history. Objective- Physical exam.

156
Q

What is the most common complaint with a subluxation/dysfunction syndromes?

A

Pain by far the most common complaint

157
Q

What is pain like with subluxation/ dysfunction syndromes?

A

Poorly localized, deep achy quality, midline to unilateral.

158
Q

Will absence of pain rule out dysfunction?

A

No joint pain at one level may be the product of painless dysfunction at another level.

159
Q

What causes pain joint hyper- or hypo- mobility?

A

Both.

160
Q

Subluxation/dysfunction syndrome pain is often associated with what?

A

referred pain and allodynia.

161
Q

What is the referred pain like with subluxation/ dysfunction syndromes?

A

sclerogenic, ill defined, deep and achy.

162
Q

Where might pain be worse at source or referred area for subluxation/dysfunction syndromes?

A

Sites of referred pain may be more painful to palpation and of greater intensity than the source or disorder.

163
Q

What will aggravate subluxation/ dysfunction syndrome pain?

A

Movement, position, activities of daily living.

164
Q

What are the steps used to evaluate joint and soft tissues?

A

PARTS. (pain, asymmetry, range of motion, tone, texture, temperture, special tests)

165
Q

What is the diagnosis of joint subluxation/ dysfunction syndrome based on?***

A

A collection of signs and symptoms and any one abnormality is usually insufficient to establish this clinical diagnosis.

166
Q

What are some NMS outcome measures?

A

1) Pain (pain drawings, palpation, joint challenge, end play) 2) Function (Regional mobility measures, physical capacity questionanaires, physical capacity tests: muscle strength and endurance)

167
Q

When should we not take X-rays?

A

Patients under 50 with no red flags during the first 4 weeks of acute back pain.

168
Q

What is the chiropractic rational for taking x-rays?

A

1) Aid in establishing biomechanical diagnosis 2) Identify anomalies that would contraindicate manipulation 3) Screen for contraindications: check for safety of manipulation 4) Monitor degenerative process

169
Q

What are the limitations to a static x-ray evaluation for segmental alignment ?

A

1) Anatomic asymmetry 2) Radiographic magnification/distortion 3) Radiographic malpositioning 4) Static analysis of dynamic motion segments 5) Marking errors

170
Q

How is the reliability of static x-ray evaluation for segmental alignment ?

A

incomplete and inconclusive where marking procedures are reliable but have not been tested through all steps

171
Q

How is the validity of static x-ray evaluation for segmental alignment ?

A

Untested

172
Q

What can be seen in a static AP lumbar x-ray film?

A

1) Horizontal plane lines (lateral flexion malpositions) 2) spinous body margin: rotational malpositions 3) laterallisthesis

173
Q

What can be seen in a lateral lumbar x-ray film?

A

1) A-P plane lines (flex-ext malpositions) 2) George’s line (antero & retrolisthesis) 3) Gravitational line (determination of ant or post weight bearing 4) Lumbar curve angle (lumbar lordosis: 50-60 degrees = average) 5) Sacral base angle: (average = 41 degrees range of 26 -56 degrees (+/-7))

174
Q

What are some conclusions to the use of static x-ray evalutions?

A

1) static xrays not indicated for uncomplicated acute back pain 2)not needed as screening tools for safety 3) biomechanical findings must correlate with clinical findings

175
Q

Are X-rays needed as a screening tool for safety?

A

Only in airports, and not in DC offices.

176
Q

What are the 3 different dynamic x-ray evaluations?

A

1) Lateral bending 2) Flexion/Extension 3) Compression/distraction

177
Q

Are lateral bending x-rays commonly applied in practice?

A

No

178
Q

What is measured in a lateral bending x-ray?

A

Meaure rotation, lateral flexion and observe for translation in neutral and right and left lateral flexion views

179
Q

How many types of mechanical categories and abnormal movements are there?

A

4

180
Q

What does a type I mechanical category mean?

A

normal bending and coupling

181
Q

What does a type II mechanical category mean?

A

normal bending with reversed coupled rotation

182
Q

What does a type III mechanical category mean?

A

limited or absent bending with normal coupled rotation

183
Q

What does a type IV mechanical category mean?

A

limited, aberrant or absent bending and coupled rotation

184
Q

What are flexion/extension studies a standard for assessing?

A

Setandard for lumbar instability assessment

185
Q

What does an anterior element of a flexion/extension study consist of?

A

Lateral translation

186
Q

What does an posterior element of a flexion/extension study consist of?

A

Abnormal coupled rotation

187
Q

How is the reliability for dynamic x-ray evaluations?

A

L1-L4 good segmental assessment and categorization but L5 is not so good

188
Q

How is the validity of dynamic x-ray evaluation?

A

Mixed, preponderance (with quanitity) shows poor correlation to back pain

189
Q

What is the compression/distraction method?

A

Standing loaded (20kg) lateral lumbosacral spot, measure sagittal plane translation (> 5 mm abnormal)

190
Q

What is the Clinical application of the compression/distraction method?

A

Strictly for instability assessment

191
Q

What is the flexion extension method?

A

Comparing neutral, flexed and extension views in a standing or side lying lateral lumbar to measure for segmental translation and degree of angulation

192
Q

What is a normal translation for the flexion extension method?

A

4 mm

193
Q

What is the Clinical application of the flexion extension method?

A

1) Primarily for stability assessment 2) standard of care for instability assessment 3) consider compression/ distraction if movement is significantly limited 4) UWS protocol: do both with strong suspicion of instability to see which performs better

194
Q

What is the absolute contraindication to Lumbar adjusting?

A

CAUDA EQUINA

195
Q

Name 3 other contraindication to lumbar adjusting?

A

AAA, Ankylosing spondylitis (inflammatory/ autoimmune expression in lumbar), Disc herniation.

196
Q

What will cauda equina cause?

A

Bowel or bladder dsyfunction, saddle anesthesia.

197
Q

What are the neurological symptoms of cauda equina?

A

Widespread neuro symptoms. (> than one level, progressive motor weakness, gait disturbances, multiple sensory levels effected, paraparesis)

198
Q

What should you do with cauda equina patients?

A

Immediate referral with bladder retention or rapidly deteriorating neuro deficits same day if recent onset.

199
Q

Should referals be made for those experiencing cauda equina syndrome?

A

YES, immediate referral with bladder retention or rapidly deteriorating neuro deficits

200
Q

At what diameter indicates an abdominal aneurysm?

A

Above 3 cm

201
Q

When will an AAA be an absolute contraindiction for lumbar adjusting?

A

Until determined otherwise.

202
Q

What is the mortality rate with a ruptured AAA?

A

90%.

203
Q

How are AAA identified on X-ray?

A

50-75% calcified.

204
Q

At around what age is the incidence of AAA most cmmon?

A

over 60

205
Q

Which signs that accompany a suspicion of AAA acute back pain would need an emergent referral?

A

1) sudden change or increase in symptoms 2) pulsating mass 3) dropping blood pressure 3) dizziness, disorientation, 4) nausea/vomiting 5) AAA 7 or > cm

206
Q

Which signs that accompany a suspicion of AAA acute back pain would need an urgent (same day) referral?

A

AAA >6cm, actue back pain but no additional signs

207
Q

Which signs that accompany a suspicion of AAA acute back pain would need an immediate (within 48 hours) referral?

A

AAA>3.5 cm but < 6cm with acute back pain with no additional symptoms

208
Q

What is the gold standard for identifying an AAA?

A

Ultra sound.

209
Q

What is a symptom of inflammatory arthritis (Ankylosing spondilitis, Reiter’s)?

A

Marked morning stiffness, persistent decrease in ROM in all direction, family history.

210
Q

At what age does inflammatory arthritis typcially occur?

A

Gradual onset, before 40

211
Q

What is more critical with disc herniations?

A

Motor weakness more critical than sensory deficits.

212
Q

Is conservative treatment indicated for disc herniations with progressive motor weakness?

A

Conservative treatment and watchful waiting are appropriate but advised to consult with conservative neurosurgeon or orthopedist

213
Q

When would a disc herniation be indicated for chiropractic care?

A

Disc herniation without marked neuro deficit.

214
Q

When should HVLA thrust not be delivered to a patient with disc herniation without marked neuro deficits?

A

With increased leg symptoms.

215
Q

What % of patients have serious complications from lumbar adjustments?

A

Very low.

216
Q

How often will a serious complication from lumbar adjusting happen in a year?

A

On average less than one serious case per year. 1 per 100 million manipulations.

217
Q

What are some reported complications associated with lumbar adjustments?

A

1) Disc related complications 2) diagnostic error, vascular complications from thrombosis, 3) fracture (osteoporosis), 4) manipulation in patient on anti-coagulant therapy, 5) rib fracture, 6) inguinal and abdominal hernia

218
Q

What will account for the greatest % of malpractice claims filed?

A

Disc problems.

219
Q

IVD is protected from rotational injury by what?

A

Facets.

220
Q

What type of force must be applied with rotation to injure the disc?

A

Marked, and movement must be beyond normal range of motion.

221
Q

How would a healthy disc be injured by manipulation?

A

An unskilled and very forceful manipulation is what would need to be applied

222
Q

What motion will the disc be most vulnerable in?

A

Flexion and rotation positions.

223
Q

What motion should be avoided with rotational adjustments?

A

Excessive flexion

224
Q

When should rotational manipulation be contraindicated upon lumbar motion evaluation?

A

If lumbar movements increase the patient’s leg pain

225
Q

Has a compression fracture even been confirmed to be a result of spinal manipulation?

A

No independently confirmed & documented case because SP manipulation is unlikely to produce the compression forces necessary to cause compression fractures.

Adjustive Technique 3 (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions