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Orthopedic II > Clinical Syndromes > Flashcards

Clinical Syndromes Flashcards

1
Q

3 categories of Lumbar Spine issues

A
  1. Serious spinal pathologies - tumor, infection, fracture, CE syndrome
  2. Sciatica - back-related LE symptoms - stenosis, arthritis, inflammation, diabetes, etc
  3. Nonspecific LBP - dysfunctions of musculoskeletal tissues
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2
Q

Spinal Stenosis

  • DEFN
  • MOI
  • SYMPTOMS
A

narrowing of central canal or lateral/iV foramina
- more commonly seen in men & >60yrs old

MOI - congenital, age related degeneration or anterior slippage
–> other causes = facet joint arthrosis, LF thickening, buldging of IVD

Symptoms - long history of LBP, leg pain, neurogenic claudication
AGG w/ extension, walking downhill, lying flat
EASING w/ flexion, sitting, walking uphill

OBJECTIVE findings - flat back
due to tight/short hip flexors & lengthened/weak hip extensors

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3
Q

Neurogenic Claudication

  • what is it
  • when should you see it
A

compression of nerve w/n canal that causes limitation of arterial supply OR claudication due to obstruction of venous return

Brought on by walking & relieved by rest

Peripheral pulses will be present & no localized leg symptoms (like vascular claudication)

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4
Q

Spinal Stenosis

- TREATMENT

A

GOALS - redue pain, improve mobility & muscle balance, improve aerobic fitness

  • Educate - ADL’s w/ neutral spine,positioning through a posterior pelvic tilt
  • Mechanical traction or rotation mobilizatino
  • Ther ex - stretch hip flexors & strengthen hip extensors & abdominals

WATCH for ANT tilt compensations

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5
Q

Acute Facet Joint

  • DEFN
  • MOI
  • SYMPTOMS
A

DEFN - mechanical block from meniscoid

MOI - return from flexion

SYMPTOMS - unilateral pain that is sharp over the facet, increased pain w/ stretch/compression of joint, limitations in side bending & extension, local tenderness, history of sudden unguarded movement

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6
Q

Meniscoid

A

synovial fold located at superior/inferior aspects of facet joints that provide & prevent excessive motion

can be dislodged and cause acute facet joint

AKA “locked back”

Usually occurs during return from flexion

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7
Q

Acute Facet Joint

-TREATMENT

A

Manual therapy - unilateral PA, traction, manipulation

Modalities

Ther ex - mobility

Excellent prognosis

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8
Q

Chronic Facet Joint

  • DEFN
  • MOI
  • SYMPTOMS
A

an acute facet joint problem that did not resolve

MOI - DJD, facet hypertrophy, osteophyte formation (arthritis), inflammation, micro-fracture

SYMPTOMS - unilateral pain (may refer to buttock area), stiffness & pain in AM, hypomobility
AGG - prolonged INACTIVITY// activity and tehn worsened again w/ activity
EASING - flexed posture

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9
Q

Chronic Facet Joint

-TREATMENT

A

MT - rotation, uniltaeral PA’s, traction, manipulation

Ther ex - stretching & muscle re-education

Address faulty movements

Facet joint injections or nerve block

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10
Q

Acute Nerve Root

  • DEFN
  • MOI
  • SYMPTOMS
A

irritation/inflammation, compression, or tension to the nerve root

MOI - disc pathologies, DDD/DJD

SYMPTOMS - DISTAL > PROXIMAL
pain severly limits activity, very limited ROM, level specific neuro symptoms, positive SLR & slump test

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11
Q

Acute Nerve Root

-TREATMENT

A

MT - manual traction in supine or sidelying

Ther ex - lumbar rotation

Epidural steroid injection

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12
Q

Chronic Nerve Root

  • DEFN
  • MOI
  • SYMPTOMS
A

chronic irritation to the nerve root/adhesion

MOI - history of disc pathology, NR injury, degenerative changes, spinal surgery/scarring

SYMPTOMS - PROXIMAL > DISTAL
- minimal limitation of activity, localized thickness in tissues, stiff at segment, pain w/ OP in ROM, movement impairments

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13
Q

Chronic Nerve Root

- TREATMENT

A

MT - unilateral PA’s, rotation, traction, soft tissue work

Mobility exercises

Segmental re-education

Treatment of neurodynamic & movement impairment findings

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14
Q

Spondylolysis

  • DEFN
  • MOI
  • SYMPTOMS
A

Structural Instability

increased IV segment motion due to defect in pars interarticularis

MOI - extreme hyperextension, sports injuries, occupation

SYMPTOMS - increased IV segment motion & pain

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15
Q

Spondylolisthesis

  • DEFN & classifications
  • MOI
A

Structural Instability

slippage of vertebra (anterior) due to complete fracture

Grades:
I - up to 25%
II - 25-50%
III - 50-75%
IV - >75%

MOI - extreme hyperextension or fracture

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16
Q

Functional Instability

  • due to
  • DEFN
A

Due to DDD, ligament injury, muscle injury or poor motor control

DEFN -abnormal movement of one vertebrae over another, inability to maintain neutral zone or segmental hypomobility

Radiograph will appear normal

17
Q

Functional instability

  • SUBJECTIVE
  • SYMPTOMS
A

Subjective info

  • most common at L5/S1 (wt bearing joint)
  • pain w/ extreme ext or rotation
  • constantly changing their position, which will decrease pain
  • history of catching or locking, giving way or feeling of instability **
  • AGG by vigorous activity, static posture or returning from flexion **

History - chronic **

18
Q

Functional Instability

- Objective info

A

Increased LL
End ROM provoke symptoms
Hesitation w/ flexion at 30-40 (global muscles shut down & local muscles kick in)

      • Gower’s sign
    • Extension reveals hinge
    • Cetnral PA painful and altered end fel

Poor pelvic and abdominal control

19
Q

Functional Instability

-TREATMENT (ther ex)

A
  1. Train local muscles FIRST
    - -> tonic, low threshold exercises (10% contraction needed to stabilize the spine)
  2. Pelvic control exercises
  3. train endurance!
  4. Muscles targeted: TA, multifidus, glutes, external obliques
    - -> No global muscles (rectus abdominus)
20
Q

DDD

  • what is it
  • due to…
A

Normal aging process, becomes pathologic when pain is involved

  • disc integrity decreases
  • decreased ability to retain water
  • decreased ability to distribute load

DUE TO:

  1. Biochemical changes: dec rate of proteoglycan synthesis, type II collagen increases
  2. Nutrition deprivation due to lack of movement
  3. Mechanics: shear forces
  4. Genetics: bad collagen
21
Q

DDD

  • SUBJ
  • SYMPTOMS
A

Commonly @ lumbosacral joint, males, 40-50’s

MOI - insidious, gradual onset due to aging

Symptoms:

  1. low grade ache, morning stiffness/pain
  2. rarely leg symptoms
  3. AGG: extending, bending, sitting, sustained posture, sudden motions
  4. ROM limited if acute
  5. pain w/ ext & rotation
  6. altered tissue texture
  7. sustained movements
  8. NEG SLR

History of repeated microtrauma, bone spurs, or significant trauma

22
Q

DDD

- TREATMENT

A

GOALS: decrease compression, promote nutrition, improve mobility/flexibility, strengthen core muscles, promote function

  1. Education on body mechanics & unloading
  2. Ther ex: hip flexibility, disc rehydration in unloaded position
    - 90/90 position, 15-20 minutes
23
Q

Disc Herniation

  • DEFN
  • Clinical Presentation
A

displacement of nucleus pulposus
–> Most common @ L4/L5 (L5 nerve root) or L5/S1 (S1 nerve root)

Clinical Presentation:

  • usually younger
  • symptoms: poorly localized dull ache w/ referral, pain w/ COUGHING & SNEEZING, neurological signs
  • lateral shift away from the pain
  • sudden onset
24
Q

Intraspongy Disc Herniation

A

fracture in endplate due to too much loading/compression

  • nucleus migrates into vertebral body
  • more common in TS
  • erosion of trabecular bone = Schmorl’s nodes
25
Q

Protrusion

A

nucleus migrates outward through tear in annulus but does NOT escape from intact outer AF or the PLL

  • contained herniation
  • more extent protrustion may have neurological symptoms
26
Q

Prolapse/extrustion

A

nucleus material escapes the AF and the PLL but remains attached to the disc

  • intense pain due to chemical reactions
27
Q

Sequestration

A

free fragment of the NP that is free to migrate

28
Q

Posterolateral vs. Posteromedial disc herniations

A

Posterolateral - most common

  • bulge/protrusion LATERAL to the nerve root
  • protective scoliosis: shift to OPPOSITE side

Posteromedial

  • protrusion MEDIAL to nerve root
  • protective scoliosis: shift to the SAME side
29
Q

Disc Herniation

- TREATMENT

A

McKenzie Protocal - repeated extension

MT - intermittent traction (best during SUBACUTE stage)

Educate on body mechanics, sit in slightly extended posture to unload

Ther Ex - abdominal bracing, walking, focus on hip motion & limit spine motion

Epidurals, steroids or surgery

30
Q

Sacroiliac Dysfunctions

A

Torsions or Rotations

Torsions are named after the direction of rotation & direction of axis
- i.e. Right rotation on a Left axis (R on L) = R sacral base is posterior and there is backward (counternutation) torsion

31
Q

Iliosacral Dysfunctions

- rotations

A

anterior & posterior rotated ilium

- ANT = ASIS anterior and inferior, functionally LONG leg, decreased posterior rotation and decreased hip flexion

32
Q

Iliosacral Dysfunctions

- Upslip/downslip

A

Upslip = ASIS & PSIS superior
- decreased strength in hip abductors

Downslip = inferior

33
Q

Iliosacral Dysfunctions

- inflare/outflare

A

Inflare - ASIS medial and PSIS more lateral

vice versa for outflare

34
Q

Symptoms of a Hypermobile SI joint

A 
pain w/ change in position
deep shift or clunk
difficulty with WB activities
positive stability tests
positive SLR

NO centralization w/ repeated motions

Orthopedic II (9 decks)

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