CPA1 Flashcards
Rib screening/dx
screening: pt seated feel all down back for tenderness/restriction w/ breathing, then pt supine and feel laterally w/ translation and centrally w/ breathing
1-2: doc at head; thumbs on rib 1, index on rib 2 (bucket handle)
3-6: doc at side; first 2 fingers sternal end of ribs and monitor in inhalation/exhalation (pump handle), then feel costochondral ends w/ respiration (can do both at once if male)
7-10: doc at side; thumb on rib 7 (pump handle) and fingers on 8-10 at MA line (bucket handle)
pt prone
11-12: thumbs palpate posterior, fingers palpate lateral (caliper motion - down/out w/ inhalation, up/in exhalation)
TART
rib inhalation/exhalation Dx
BITE = bottom inhalation, top exhalation (key rib to treat)
if a rib stops moving before another, it has a restriction to that respiratory motion (ex: stops first in inhalation -> exhalation SD)
rib 1 inhalation SD Tx
pt supine, doc at head
thumb ipsilateral to SD on anteromedial rib, other hand flexes head, SB twoards, and rotates away from SD
resist inhalation, exaggerate exhalation (3-5x)
Ribs 2-6 inhalation SD Tx
pt supine w/ SD rib on docs knee and SB towards SD rib, doc behind w/ ispilateral knee on table
web of hand in intercostal space superior to SD rib
resist inhalation, exaggerate exhalation (3-5x)
ribs 7-10 inhalation SD Tx
pt supine w/ ispliateral shoulder adducted, doc on SD side
ipsilateral thumb and index finger on superior surface of SD rib wrapping around side
SB pt to the level of SD, resist inhalation and exaggerate exhalation
Ribs 11-12 inhalation SD Tx
pt prone w/ legs SB 15-20 degrees towards SD, doc opposite of SD
cephalad hand medial and inferior to rib, caudad hand grasps ASIS ipsilateral to SD
apply sustained lateral and cephalad traction to SD, resist inhalation and exaggerate exhalation
ribs 1-2 exhalation SD Tx
pt supine w/ head rotated 30 degrees away from SD rib w/ back of hand on forehead, doc opposite SD
cephalad hand on pts hand on head, caudad hand grasps superior angle of SD rib around back
apply caudad and lateral traction and instruct pt to flex head and neck and resist this force for 3-5 secs, repeat w/ increasing traction
ribs 3-5 exhalation SD Tx
pt supine w/ ipsilateral arm flexed, doct contralateral
cephalad hand on pts arm, caudad hand on superior angle of SD rib
apply caudad and lateral traction and instruct pt to push elbow against doc force and resist 3-5 secs, repeat w/ increasing traction
ribs 6-8 exhalation SD Tx
pt supine w/ ipsilateral shoulder flexed to 90, doc ipsilateral
cephalad hand on superior SD rib, caudad hand on elbow
apply caudad and lateral traction and instruct pt to push elbow towards the ceiling and resist 3-5 secs, repeat w/ increasing traction
ribs 9-10 exhalation SD Tx
pt supine w/ ipsilateral arm abducted, doc ipsilateral
cephalad hand abducts ipsilateral shoulder to 90 and stabilizes elbow, caudad hand on superior SD rib
apply caudad and lateral traction and instruct pt to push elbow caudally and resist 3-5 secs, repeat w/ increasing traction
ribs 11-12 exhalation SD Tx
pt probe w/ legs SB 15-20 degrees away from SD, doct contralateral
cephalad hand stabilizes rib superior to SD rib, caudad hand on iliac crest ipsilateral to SD
cephalad hand exerts pressure while pt pulls iliac crest towards ipsilateral shoulder against doc counterforce for 3-5 secs, repeat w/ increasing traction
innominate Dx
standing flexion test (+ PSIS movement) OR ASIS compression test to determine SD side (+ hard end feel)
evaluate PSIS/ASIS/iliac crest/medial malleoli
evaluate for inflares/outflares (ASIS to midline)
evaluate for pubic SD (pubic tubercle height)
anterior innominate rotation
ASIS inferior on SD side
PSIS superior on SD side
iliac crests even
malleoli long on SD side
posterior innominate rotation
ASIS superior on SD side
PSIS inferior on SD side
iliac crests even
malleoli short on SD side
superior innominate shear
ASIS superior on SD side PSIS superior on SD side iliac crest superior on SD side malleoli short on SD side pubic tubercle superior on SD side
inferior innominate shear
all inferior SD side
outflare vs inflare
ASIS to midline distance longer on SD side = outflare
ASIS to midline shorter on SD side = inflare
anterior innominate rotation Txs
supine: doc flexes knee to chest to RB, pt pushes against doc 3-5 secs and new RB reached
prone: doc places one hand on sacrum and uses the other to place pts foot on their thigh, doc flexes thigh to RB then MET
reassess
posterior innominate rotation Txs
supine: doc on side of SD, one hand on opposite ASIS other hand extends hip off the table to RB, MET
prone: doc opposite of SD, extends knee to RB, put pushes against doc 3-5 secs and new RB reached
reassess
superior innominate shear Tx
pt supine w/ feet off table, doc at foot
doc grasps ankle and IR/abducts then leans back, pt pulls hip back 3-5 secs against force and new RB reached
reassess
inferior innominate shear Tx
pt supine w/ feet off table, doc at foot
doc grasps ankle and IR/abducts and applies cephalad compression, pt pushes against doc force 3-5 secs and new RB reached
reassess
inflare Tx
pt supine, doc opposite of SD
pt SD hip flexed and crossed across other leg, doc cephalad hand on ASIS opposite of SD and caudad hand on flexed knee
doc abducts/ER hip to RB and pt pushes against phys force 3-5 secs, new RB reached
reassess
outflare Tx
pt supine, doc opposite side of SD
same position as inflare Tx but doc adducts/IR hip and pt force is the opposite direction
pubic SD Tx
pt supine, doc at side
doc hands on outsides of knees and pt pushes outward, then doc forearm b/w legs and pt pushes inward
innominate screening
???
sacral screening
???
sacral Dx
ss/ILA + L5 positions ->
SFB ->
LS/BB ->
Dx
(confirm w/ rocking)
bilateral sacral flexion Tx
pt prone, doc at side
doc caudad palm on ILA and cephalad hand on top
exaggerate inhalation w/ anterior force on ILA and resist exhalation (sacral flexion in exhalation), repeat 3-5x
bilateral sacral extension Tx
pt sphinx, doc behind
caudad hand first 2 fingers in sacral sulci and cephalad hand on top
resist extension of inhalation, exaggerate flexion w/ anterior and inferior force on suclci w/ exhalation, repeat 3-5x
unilateral sacral flexion Tx
pt prone, doc at SD side
cephalad hand palpates sacral base, caudad hand abducts/IR hip of effected side (if bilateral do both legs)
then place heel of caudad hand on ILA of SD side and cephalad hand on top of that hand; exaggerate inhalation w/ anterior force on ILA to encourage extension and resist flexion w/ exhalation 3-5x
unilateral sacral extension Tx
pt prone, doc on SD side
cephalad hand on sacral sulci, caudad hand abducts and ER hip of SD side (if bilateral do both legs)
then hypothenar eminence of cephald hand on sulcus of SD side and caudad hand on top
ART - spring anterior/inferior until motion improves
MET - anterior/inferior force w/ exhalation and resist inhalation
sacral forward torsion Tx (L/L or R/R)
pt modified sims w/ axis side down, doc at side knees are flexed to monitoring L5-S1 space
doc flexes hip until motion felt
ART - push down on feet
MET - have pt push up
sacral backward torsion Tx (L/R or R/L)
pt lateral recumbent w/ axis side down and doc on front side; pt top hip flexed to 90 w/ top arm extended back and bottom arm flexed forward
doc flexes top hip until motion felt, back is extended in this position so it flexes the sacrum
ART - push down on foot
MET - have pt push up
CTL screening/Dx
TART down spine for muscles ropy/boggy sections
Pc1 inion Tx
inferior nuchal line, lateral to inion
F StRa
Pc1 occiput Tx
inferior nuchal line, midway b/w inion and mastoid
E SaRa
Pc2 occiput Tx
inferior nuchal line
E SaRa
Pc2 Tx
superior/lateral tip of spinous process of C2
e-E SaRa
Pc3 Tx
on inferolateral aspect of spinous process of C2
f-F SaRa
Pc4-8 Tx
on inferiolateral tip of spinous processes
e-E SaRa
Pt1-3 spinous process Tx
pt prone w/ arms draped, doc cups chin w/ one hand and monitors tender point w/ other hand
e-E
Pt4-6 spinous process Tx
pt prone w/ arms draped, doc cups chin w/ one hand and monitors w/ other
e-E
Pt7-12 spinous process Tx
pt prone w/ arms over top of table, doc w/ knee under pt chest and uses one hand to cup chin and other to monitor
e-E
Pt1-3 transverse process Tx
pt supine w/ head off table, doc supports head
E SaRa
Pt4-9 transverse process Tx
pt prone w/ head rotated towards tender point, doc at side opposite SD
pt sidebends away from SD side, doc pulls on shoulder of SD side w/ posterior and cephalad force to simulate extension, rotation towards, and SB away
E SaRt
Pt10-12 transverse process Tx
pt prone, doc at either side; legs positioned to the side that produces the least tenderness
doc grasps ASIS on side of tender point and leans back to induce extension and rotation
e-E SaRa (pelvis), SaRt (torso)
PL1-5 spinous process Tx
pt prone, doc opposite tender point
doc extends leg of SD side
e-E adduct Rt (pelivs) Ra (torso)
PL1-3 transverse process Tx
pt prone, doc opposite tender point
doc extends ASIS of SD side
E SaRt (pelvis) SaRa (torso)
upper pole L5 tx
superior medial surface of PSIS
pt prone, doc opposite tender point
doc extends leg of tender point side
E adduct IR/ER
lower pole L5 Tx
on the ilium, just inferior to PSIS pressing superiorly
pt prone w/ ipsilateral leg off table, doc ipsilateral
doc moves flexed leg
F IR adduct
high ilium sacroilliac Tx
2-3 cm lateral to PSIS pressing medially
pt prone, doc ipsilateral
doc extends ipsilateral leg
e-E abduct ER
PL3 gluteus Tx / Pl4 gluteus Tx
2/3 lateral from PSIS to TFL / posterior margin of TFL
pt prone, doc ipsilateral
doc extends ipsilateral knee under his knee
E abduct ER
bilateral sacral extension BLT
pt supine, doc at side
doc lifts sacral apex anterior to point of BLT, pt holds deep breath as long as possible, repeat until best motion is obtained
bilateral sacral flexion BLT
pt supine, doc at side
lift sacral base anterior to point of BLT, respiratory phases are tested and one his held, repeated until best motion obtained
forward sacral torsion (supine) BLT Tx
pt supine, doc ipsilateral to rotation
both hands apply anterior pressure to base to the point of BLT, respiratory phases tested and BLT held and repeated
forward sacral torsion (seated) BLT Tx
pt seated, doc behind
monitor sacral sulci, induce extension from above in the seated pt until posterior sacral base motion is palpated as moving anterior, rotate pt in the direction of the sacral rotation
have pt hold exhalation until air hunger
backward sacral torsion (supine) BLT Tx
pt supine, doc at side
both hands apply anterior pressure to side of the deep ILA, test respiratory phases and do BLT
backward sacral torsion (seated) BLT Tx
pt seated, doc behind
monitor sacral sulci, induce flexion until sacral base moves posterior to BLT, rotate pt in direction of sacral rotation, have pt hold inhalation until air hunger
posterior innominate rotation BLT Tx
pt seated, doc at feet
doc holds both ankles, pushes up on effected leg and pt rotates the same direction into BLT, pt inhales and holds
anterior innominate rotation BLT Tx
pt seated, doc at feet
doc holds both ankles, pulls down on effected leg and pushes up on opposite leg while pt rotates trunk towards the contralateral leg and inhales w/ BLT
