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OCS > CPR's, Grading, and Guidelines > Flashcards

CPR's, Grading, and Guidelines Flashcards

1
Q

Response to Thrust/Nonthrust Manipulation and Exercise Post-INV Sprain

A
  • Sx worse when standing
  • Sx worse in evening
  • Navicular drop > 5.0
  • Distal Tibfib joint hypomobility

1=+LR 0.33
2=+LR 1.2
3=+LR 5.9
4=+LR 0.43

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2
Q

Carpal Tunnel Syndrome

A
  • Shaking hands relieves sxs
  • Wrist ratio index > .67
  • Symptoms severity scale > 1.9
  • Dim sensation median: thumb
  • Age > 45

3=Sn .98 Sp .54 +LR 2.1 -LR .04
4=Sn .77 Sp .83 +LR 4.6 -LR .28
5=Sn .18 Sp .99 +LR 18.3 -LR .83

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3
Q

Wells Criteria for DVT

A
  • Active CA = 1
  • Paresis, paralysis, recent LE immobilization = 1
  • Recently bed ridden 3+ days/major surgery within four weeks = 1
  • Localized tenderness over deep veins = 1
  • Entire leg swollen = 1
  • Calf swelling > 3 cm (10 cm below tib tub) = 1
  • Pitting Edema (greater in symptomatic leg) = 1
  • Collateral superficial veins (non-varicose) = 1
  • Alternative diagnosis =/> DVT = -2

0=Low Risk (3%)
1-2=Mod Risk (17%)
3+=High Risk (75%)

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4
Q

Pulmonary Embolism

A
  • Clinical symptoms of DVT = 3.0
  • No alternative diagnosis = 3.0
  • Heart rate > 100 = 1.5
  • Immobilization or surgery past four weeks = 1.5
  • Previous DVT/PE = 1.5
  • Hemoptysis = 1.0
  • Malignancy = 1.0

<2.0 = low
2– 6 = moderate
>6.0 = high

= 4.0 is unlikely, > 4.0 is likely

= 4.0 and (-) simpliRED D-Dimer = safely rule out PE

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5
Q

Knee OA Responds to Hip Mobilization

A
  • Hip or groin pain/paresthesia
  • Anterior thigh pain
  • Passive knee flexion < 122°
  • Passive IR < 17°
  • Knee pain with hip distraction
2 = + LR 12.9
3 = + LR 5.1
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6
Q

Altman’s Criteria for Knee OA

A
  • Osteophytosis radiography
  • Morning stiffness < 30 minutes
  • Crepitus
  • > 50
  • Tenderness of bony margins of joint
  • No palpable warmth of synovium
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7
Q

Ottawa Knee Rules

A
  • 55 or older
  • Fibular head tenderness
  • Patella isolated tenderness
  • Cannot flex to 90°
  • Cannot bear weight four steps immediately and in ER
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8
Q

Lumbar Manipulation for PFPS

A
  • Hip IR difference > 14°
  • Ankle DF with knee flexed > 16°
  • Navicular drop > 3 mm
  • No self-reported stiffness sitting > 20 min
  • Squatting is most painful activity

3=+LR 18.4, 94% post-test prob
4=+LR infinite
5=+LR infinite

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9
Q

Foot Orthoses for PFPS

A
  • Age > 25
  • Height < 165
  • Worst pain < 53.25 mm
  • Midfoot width difference WB vs non-WB > 10.96

3 = + LR 8.8

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10
Q

Hip OA CPR Sutlive

A

-Squatting an aggravating factor
-Hip flexion AROM = lat hip pain
–(+) Scour w/ add = lat hip/groin pain
-Hip ext AROM painful
–IR PROM < 25°

1 = + LR 1.2, -LR .27
2 = + LR 2.1, -LR .31
3 = + LR 5.2, -LR .33
4 = + LR 24.3, -LR .53
5 = + LR 7.3, -LR .87
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11
Q

Altman’s Criteria for Hip OA

A
  • Osteophytes radiography
  • ESR > 20 per hour
  • Hip IR < 15°
  • Hip flexion < 115°

OR

  • Painful, limited hip IR < 15°
  • Morning stiffness < 60 minutes
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12
Q

Thoracic Spine Manipulation for Shoulder Pain

A
  • Pain-free shoulder flexion <127°
  • Shoulder IR PROM @ 90° < 52°
  • (-) Neer Test
  • Not taking meds for shoulder pain
  • Symptoms < 90 days
3 = + LR 5.3, 89% post-test prob
4 = + LR infinite, 100% post-test prob
5 = + LR infinite, 100% post-test prob
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13
Q

Adhesive Capsulitis

A

-Insidious pain
-Night pain
-Painful AROM/PROM:
Elevation < 100°
ER < 50% CL UE
-Normal radiography

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14
Q

ACJ Test Cluster

A
  • Active compression test
  • Cross-body adduction test
  • AC resisted extension
  • AC joint tenderness
  • Paxinos sign
1 = + LR 0
2 = + LR 7.4
3 = + LR 8.3
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15
Q

ACL Return to Running

A

Week 8 (Pool Running Week 6)

  • Normal gait
  • Quad strength 70% CL
  • Min effusion and pain

Agility training at 50% if Quad 80%

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16
Q

Knee OA Clinical Signs

A
  • Palpable bony prominences
  • No palpable warmth
  • ROM loss
  • Historical signs
  • Age
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17
Q

Knee OA Potentially Modifiable Pre-Treatment Factors

A
  • Obesity
  • Joint Mobility
  • Alignment
  • Knee Instability
  • Psychosocial Factors
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18
Q

Knee OA Risk Factors

A
  • Older
  • Female
  • Obesity (Increased incidence, progression, disability)
  • Occupation
  • Genetics
  • Higher bone mineral density (2.3x incidence, no assoc w progression)
  • Physical activity
  • Prior knee injury (ACL, meniscus)
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19
Q

LBP Incidence

A

Female

Lower education

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20
Q

Coronary Artery Disease

A
  • Female>/=65, male>/=55
  • Vascular disease (coronary aa, occlusive vascular, cerebrovascular diseases)
  • Pain worse during exercise
  • Pain not reproducible on palpation
  • Pt assumes pain of cardiac origin

2=Sn 0.98
3=Sn 0.87, Sp 0.80, +LR 4.52
Validation=Sn 89.1%

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21
Q

Cancer CPR

A
  • Age > 50 (Sn .77, Sp .71, +2.7,
    • .32)
  • CA history (Sn .31, Sp .98, +15.5)
  • Unexplained weight loss (Sn .15, Sp .94, +2.5)
  • Failure of conservative therapy (Sn .31, Sp .90, +2.6)
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22
Q

Ankylosing spondylitis CPR

A
  • Stiffness > 30 minutes
  • Exercise decreases pain, rest does not
  • Back pain wakes up second half of night only
  • Alternating buttock pain
2 = Sn .70, Sp .81
3 = Sn .33, Sp .94
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23
Q

Ankylosing spondylitis characteristics

A
  • Limited chest expansion (<2.5 cm; 5 = normal)
  • Sacroiliitis
  • Morning pain and stiffness
  • Peripheral joint involvement
  • Men 3:1
  • 15–40
  • 90% HLA–B27 positive (10-20% develop)
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24
Q

Osteoporosis risk factors

A
  • Caucasian
  • Smoking
  • Early menopause
  • Thin body build
  • Sedentary
  • Steroids
  • Excessive caffeine or alcohol

60+ Acute pain

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25
Q

CA red flags

A 
– Personal or family CA history
– Recent significant weight loss
– Unrelenting night pain
– Smoking history/current
– Age > 50
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26
Q

Infection red flags

A 
– Fever
– Chills
– Night sweats
– Recent infection like pneumonia
– Current IV therapy or drug use
– Recent surgery
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27
Q

Visceral/GI Red Flags

A 
– Bowel or bladder dysfunction
– Abdominal pain
– Reflux
– Excessive NSAIDs use
– Alcohol abuse
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28
Q

Cardiopulmonary red flags

A

– Chest pain/SOA with exertion
– Personal/family history of CV disease
– Thoracic or chest wall pain = throbbing/pulsatile sensations

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29
Q

Fracture red flags

A

– Osteoporosis and osteoporotic fxs
– Significant trauma
– Prolonged corticosteroid use

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30
Q

Neuro symptoms = thoracic cord compromise from space occupying lesion/CNS disease like MS

A

Bilateral UE, LE and/or trunk:
– Paresthesia
– Weakness
– Sensory loss

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31
Q

Cervical radiculopathy

A 
3 = + LR 6.1
4 = + LR 30.3

ULTTA = Sn .97, - LR .12

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32
Q

Osteoporosis/osteopenia

A

OP = T-score 2.5+
Op = T-score 1-2.5
Standard deviations below reference

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33
Q

OA Radiographic Criteria

Kellgren-Lawrence Scale

A

Grade 0: No evidence.
Grade 1: Min osteophytes, doubtful significance.
Grade 2: Definite osteophytes, normal space.
Grade 3: Definite osteophytes, mod narrowing.
Grade 4: Definite osteophytes, severe narrowing, subchondral sclerosis.

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34
Q

ACR Criteria Knee OA (Clinical)

A

Knee pain and 3/6:

  • Age > 50
  • AM stiffness < 30 min
  • Crepitus
  • Tenderness
  • Bony enlargement
  • No palpable warmth

Sn 95%, Sp 69%

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35
Q

ACR Criteria Knee OA (Clinical + Radiography)

A

Knee pain and 1/3:

  • Age > 50
  • AM stiffness < 30 min
  • Crepitus and osteophytes

Sn 91%, Sp 86%

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36
Q

ACR Criteria Knee OA (Clinical + Laboratory)

A

Knee pain and 5/9:

  • Age > 50
  • AM stiffness < 30 min
  • Crepitus
  • Tenderness
  • Bony enlargement
  • No palpable warmth
  • ESR < 40mm/hr
  • RF < 1:40
  • SF OA

Sn 92%, Sp 75%

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37
Q

Levels of Evidence

A

Level I: High quality diagnostic studies, prospective studies, or RCT’s
Level II: Lesser quality (weaker diagnostic criteria and reference standards, improper randomization, no blinding, < 80% follow up)
Level III: Case control or retrospective studies
Level IV: Case series
Level V: Expert opinion

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38
Q

Strengths of Recommendation

A

A: Strong Evidence: Level I and/or II, at least one level I
B: Mod Evidence: One high quality RCT or many level II
C: Weak Evidence: One level II or many level III and IV + statements of consensus by content experts
D: Conflicting Evidence: Higher quality studies disagree
E: Theoretical/Foundational Evidence: Animal or cadaver studies, conceptual models/principle, basic science/bench research
F: Expert Opinion: Clinical experience of guidelines-developmental team

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39
Q

ICF Plantar Heel Pain/Plantar Fasciitis Risk Factors

A
  • Limited DF ROM
  • High BMI in nonathletic
  • Running
  • Work-related WB activities particularly poor shock absorption
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40
Q

ICF Diagnosis Plantar Fasciitis and Heel Pain

A
  • Plantar med heel pain, especially initial steps after inactivity and worse prolonged WB
  • Precipitated by recent inc in WB activity
  • Tenderness proximal plantar fascia insertion
  • (+) Windlass test
  • (-) Tarsal tunnel tests
  • Limited active and passive talocrural DF ROM
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41
Q

Spinal Fractures CPR (Systematic Review)

A
  • Age > 50 (+LR 2.2, -LR .34)
  • Female (+LR 2.3, -LR .67)
  • Major trauma (+LR 12.8, -LR .37)
  • Pain and tenderness (+LR 6.7, -LR .44)
  • Co-occurring, distracting/painful injury (+LR 1.7, -LR .78)
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42
Q

Spinal Fractures CPR (Cohort Follow Up to Systematic Review)

A
  • Female
  • Age > 70
  • Significant trauma
  • Prolonged corticosteroids
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43
Q

Lumbar Manipulation CPR

A
  • Symptoms < 16 days
  • No symptoms distal to knee
  • Lumbar hypomobility
  • At least 1 hip IR > 35 deg
  • FABQ-W < 19

4+ = post-test probability from 45% to 95%

Validated: 4/5 = +LR 13.2

44
Q

Lumbar Manipulation CPR (Short Version)

A
  • Symptoms < 16 days
  • No symptoms distal to knee

Both = mod to large shift +LR 7.2

45
Q

Back-Related Tumor CPR

A
  • Constant pain not affected by position or activity; worse with WB, worse at night
  • Age > 50
  • Hx of CA
  • Failure of conservative intervention (30 days)
  • Unexplained weight loss
  • No relief with bed rest
46
Q

Cauda Equina Syndrome CPR

A
  • Urine retention
  • Fecal incontinence
  • Saddle anesthesia
  • Sensory/motor deficits in feet (L4, L5, S1)
47
Q

Back-Related Infection

A
  • Recent infection (UTI, skin), IV drug use/abuse (Sn .40)
  • Concurrent immunosuppressive disorder
  • Deep constant pain, increases with WB
  • Fever, malaise, and swelling
  • Spine rigidity; accessory mobility may be limited
  • Fever: TB osteomyelitis (Sn .27, Sp .98, +LR 13.5, -LR .75)
  • Fever: pyogenic osteomyelitis (Sn .5, Sp .98, +LR 25, -LR .51)
  • Fever: spinal epidural abscess (Sn .83, Sp .98, +LR 41.5, -LR .17)
48
Q

Spinal Compression Fracture

A
  • Major trauma (MVA, fall from ht, blow to spine) (Sn .30, Sp .85, +LR 12.8, -LR .37)
  • Age > 50 (Sn .79, Sp .64, +LR 2.2, -LR .34)
  • Age > 75 (Sn .59, Sp .84, +LR 3.7, -LR .49)
  • Prolonged corticosteroids
  • Point tenderness over fx site
  • Increased pain with WB
49
Q

Abdominal Aneurysm (>/= 4cm)

A
  • Back, abdominal, or a groin pain
  • Presence of PVD or a CAD and associated risk factors (age > 50, smoker, HTN, DM)
  • Smoking history
  • Family history
  • Age > 70
  • Non-Caucasian
  • Female
  • Symptoms not related to movement stresses associated with somatic LBP
  • Abdominal girth < 100 cm (Sn .91, Sp .64, +LR 2.5, -LR .14)
  • Presence of a bruit in central epigastric area on auscultation
  • Palpation of abdominal aortic pulse (Sn .88, Sp .56, +LR 2.0, -LR .22)
  • Aortic pulse 4+ cm (Sn .72)
  • Aortic pulse 5+ cm (Sn .82)
50
Q

SIJ Dysfunction Levangie

A
  • Standing flexion
  • Sitting PSIS palpating
  • Supine long sitting test
  • Prone knee flexion test

Sn .82, Sp .88, +LR 6.83, -LR .20

*Reliability of individual tests are poor

51
Q

SIJ Dysfunction Laslett

A
  • Distraction (Sn .60, Sp .81, +LR 3.2, -LR .49)
  • Thigh thrust (Sn .88, Sp .69, +LR 2.8, .18)
  • Gaenslen (Sn .53, Sp .71, +LR 1.84, -LR .66)
  • Compression (Sn .69, Sp .69, +LR 2.2, -LR .46)
  • Sacral thrust (Sn .63, Sp .75, +LR 2.5, -LR .5)

2/4 = Sn .88, Sp .78, +LR 4, -LR .16 = Distraction, thigh thrust, compression, sacral thrust

3/5 = Sn .91, Sp .78, +LR 4.16, -LR .12

52
Q

SIJ Dysfunction Van der Wurff

A
  • Distraction
  • Compression
  • Thigh thrust
  • Gaenslen’s
  • Patrick’s

Fair to excellent reliability kappa .52-.88

53
Q

Cervical Traction CPR

A
  • Peripheralizarion with C4-7 mobility testing
  • (+) Shoulder abduction test
  • Age >/= 55
  • (+) ULTT A
  • (+) Distraction test
1 = Sn .07, Sp .97, +LR 1.15, -LR .21, 47.6%
2 = Sn .30, Sp .97, +LR 1.44, -LR .40, 53.2%
3 = Sn .63, Sp .87, +LR 4.81, -LR .42, 79.2%
4 = Sn .30, Sp 1.0, +LR 23.1, -LR .71, 94.8%
54
Q

Cervical Myelopathy Cluster

A
  • Gait deviation
  • (+) Hoffman’s
  • (+) Inverted supinator sign
  • (+) Babinski
  • Age 45+
3-4/5 = 94-99% probability
3 = +LR 30.9
1 = -LR .18
55
Q

Clinical Cervical Instability Symptoms

A
  • Intolerance to prolonged static postures
  • Fatigue, inability to hold head up
  • Symptom decrease with external support
  • Frequent need of self-manipulation
  • Feeling of instability, shaking, lack of control
56
Q

Clinical Cervical Instability Objective Findings

A
  • Poor coordination/NM control
  • Abnormal joint play
  • Motion not smooth throughout ROM
  • Aberrant movement
  • Hypomobility of upper T-spine
57
Q

Clinical Lumbar Instability Symptoms

A
  • Feeling of giving way or giving out
  • Frequent self manipulation
  • Frequent bouts of symptomatic episodes
  • History of painful catching or locking during twisting or bending of the spine
  • Pain during transitional activities (sit to stand)
58
Q

Clinical Lumbar Instability Objective Findings

A
  • Poor lumbopelvic control including segmental hinging or pivoting with movement + poor proprioceptive function
  • Poor coordination/NM control including juddering or shaking
  • Decreased strength/endurance of local muscles at level of segmental instability
  • Aberrant movement including changing lateral shift during AROM
  • Pain with sustained positions and postures
59
Q

Lumbar Stabilization CPR Hicks

A
  • Age < 40
  • SLR > 91 deg
  • Presence of aberrant movement
  • (+) Prone Instability Test

3+ = +LR 4.0

60
Q

Failure of Lumbar Stabilization CPR

A
  • FABQ-A = 8 or less
  • Absence of aberrant movement
  • (-) Prone instability test
  • No hypermobility during lumbar spring test

2+ = -LR .18

61
Q

Lumbar Stenosis CPR

A
  • B neurological symptoms
  • Leg pain more than back pain
  • Pain during walking/standing
  • Pain relief upon sitting
  • Age > 48
0 = Sn 96%, -LR 0.19
4+ = Sp 98%, +LR 4.6
62
Q

Beighton Score

A
  • 5th MCP Hyperextension
  • Elbow hyperextension (10 deg)
  • Knee hyperextension
  • Thumb to forearm
  • Lumbar flexion
4 = General hypermobility
7+ = General hypermobility
63
Q

Lumbar Traction CPR

A
  • FABQ-W < 21
  • No neurological deficits
  • Age > 30
  • Non-manual work
3 = Sn .76, Sp .75, +LR 3.04, -LR  42.2%
4 = Sn .36, Sp .96, +LR 9.36, -LR  69.2%
64
Q

Ankle Sprain Grading

A

Grade I Mild: Little swelling and tenderness with little impact on function.
Grade I Moderate: Moderate swelling, pain and the impact on function. Reduced proprioception, ROM, and instability.
Grade III Severe: complete rupture, large swelling, high tenderness, loss of function, and marked instability.

65
Q

Phases of Healing

A
  • Inflammatory (0-3 Days)
  • Proliferative (4-10 Days)
  • Early Remodeling (11-21 Days)
  • Late Remodeling and Maturation
66
Q

RCT types

A

A: supraspinatus, superior subscap
B: supraspinatus, entire subscap
C: supraspinatus, superior subscap, infraspinatus
D: supraspinatus and infraspinatus
E: supraspinatus, infraspinatus, teres minor

67
Q

RCT size

A

Small: < 1 cm
Medium: 1 –3 cm
Large: 3–5 cm
Massive: > 5 cm

68
Q

RC Impongement/Tendinopathy Cluster (Park)

A

Hawkins-Kennedy
ER MMT
Painful Arc

+LR 10.56/5.03
Probability 95.5%/91%

69
Q

ER Lag Sign for SS/IS Tear

A 
Sn .69-.98
Sp .98
\+LR 15.5-34.5
-LR .2-.32
\+Probability 88.8%
-Probability 13.8%
70
Q

Drop Sign 90 Abd, 45 ER for IS Tear

A

Sn 1
Sp 1
+LR 0
-LR 0

71
Q

Hornblower’s for Teres Minor Tear

A 
Sn 1
Sp .93
\+LR 14.29
-LR 0
\+Probability 87.7%
72
Q

IR Lag Sign for Subscap Tear

A 
Sn .97
Sp .96
\+LR 24.3
-LR .03
\+Probability 92.4%
-Probability 1.48%
73
Q

IR Resisted Strength Test (vs ER)

A 
90 Abd, 80 ER do IR MMT
-IRER=RC Pathology
Sn .86
Sp .96
\+LR 22
-LR .13
\+Probability 91.7%
-Probability 6.1%
74
Q

Apprehension Test for Ant or Ant/Inf Instability

A 
Sn .53-.72
Sp .96-.99
\+LR 20.2-53
-LR .29-.47
\+Probability 91-96.4%
-Probability 12.7-19%
75
Q

Ant Release for Ant or Ant/Inf Instability

A 
Sn .64-.92
Sp .89-.99
\+LR 8.36-58.6
-LR .09-.37
\+Probability 80.7-96.7%
-Probability 4.3-15.6%
76
Q

Bankart/Ant Labral Tear Cluster

A 
Crank, Apprehension, Jobe Relocation, Ant Load &amp; Shift, Sulcus Sign
Sn .9
Sp .85
\+LR 6
-LR .12
\+Probability 75%
-Probability 7%
77
Q

Jerk Test for Post or Post/Inf Labral Lesion

A 
Sn .73
Sp .98
\+LR 36.5
-LR .28
\+Probability 94.8%
-Probability 12.3%
78
Q

Kim Test for Post or Post/Inf Labrador Lesion

A 
Sn .8
Sp .94
\+LR 13.3
-LR .21
\+Probability 86.9%
-Probability 9.5%
79
Q

Biceps Load Test I or II for SLAP

A 
Sn .9
Sp .97
\+LR 30
-LR .10
\+Probability 93.8%
-Probability 5.3%
80
Q

Post Impingement Sign for Articular-Sided Internal Impingement Syndrome

A

Sn .95
Sp 1
-LR .05
-Probability2.4%

81
Q

Yergason’s Test for LHB Tendinopathy

A 
Sn .43-.74
Sp .58-.79
\+LR 1.76-2.05
-LR .45-.72
\+Probability 46.8-50.6%
-Probability 18.4-26.5%
82
Q

Speed Test for LHB Tendinopathy

A 
Sn .32-.9
Sp .14-.75
\+LR 1-1.28
-LR .71-.91
\+Probability 33.3-39%
-Probability 26.2-31.3%
83
Q

Gilcrest Palm-Up Test for LHB Tendinopathy

A 
Sn .63-.74
Sp .35-.58
\+LR .97-1.76
-LR .45-1.06
\+Probability 32.7-46.8%
-Probability 18.4-34.6%
84
Q

Yellow Flags

A
  • Emotional distress (anxiety acute, depression chronic)
  • Hypervigilance (focus on pain)
  • Pain catastrophizing
  • High fear avoidance beliefs
  • Low self-efficacy
  • Misunderstanding nature/impact of pain
  • Misunderstanding best long term strategies (i.e. Passive tx)
85
Q

SLAP Tear Types

A

Type I: Degenerative fraying
Type II: Detachment of superior labrum and biceps from glenoid rim. Subgroups: Ant, Post, Both.
Type III: Bucket handle tear of labrum, intact biceps insertion
Type IV: Bucket handle tear with intra-substance biceps tear
Type V: Bankart with Type II
Type VI: Unstable labral flap tear with biceps detachment
Type VII: Sup labrum and biceps ant, inf to MGHL
Type VIII: SLAP, post glenoid rim to 6 o’clock
Type IX: Pan-labral SLAP along entire glenoid
Type X: SLAP with Post-inf labral tear (reverse bankart)

86
Q

Meniscus Pathology CPR

A
  • History if catching or locking
  • Joint line tenderness
  • Pain with forced hyperexrension (Mod bounce home)
  • Pain with max passive knee flexion
  • Pain or audible click with McMurray’s
87
Q

Cervical manipulation CPR for neck pain

A
  • Symptoms < 38 days
  • Positive expectation manipulation will help
  • 10°+ Difference side to side cervical rotation
  • Pain with PA spring testing of mid C-spine

Symptoms and ROM best indicators

1-4=Sn 1 to Sp 1
3-4/4 = 90-100%

88
Q

Thoracic manipulation CPR for neck pain

A
  • Symptoms < 30 days
  • No symptoms distal to shoulder
  • Looking up does not aggravate symptoms
  • FABQ-PA < 12
  • Diminished upper thoracic kyphosis (T3-5)
  • Cervical extension < 30°

Symptom duration and looking down best indicators

5-6/6=+LR infinite, Sp 1.0
4/6=+LR 12, probability 93%
3/6=+LR 5.5, probability 86%
2/6=+LR 2.1, probability 71%

89
Q

Patellar Taping CPR for PFPS

A
  • Tibial angulation > 5° varus (Sn .81, Sp .62, +LR 2.1, -LR .3)
  • (+) Patellar tilt test = tilt above horizontal plane (Sn .88, Sp .51, +LR 1.8, -LR .24)

Additional variables:

  • Ankle DF with knee flexed, 15° (.53, .75, 2.1, .63)
  • Relaxed calcaneal stance > 4° varus (.7, .6, 1.8, .5)

Sn .53, Sp .88, +LR 4.4, -LR .53

90
Q

Partial or Full Thickness RCT

A
  • Painful arc
  • (+) Drop arm sign
  • ER (Infraspinatus) Weakness

3 = +LR 15.57, -LR .16
3 (+) and > 60 = +LR 28
3 (-) and > 60 = -LR .09

91
Q

GIRD Kibler

A

< 25° IR or B IR difference > 25°

92
Q

Pilates-Based Ex for LBP CPR

A
  • Total trunk flexion ROM < 70°
  • Symptoms =/< 6 months
  • No LE symptoms past week
  • BMI = 25+
  • L or R average hip rotation > 25°

3/5 = +LR 10.64, probability 93%

93
Q

Clinical Predictors of Screening Lumbar Facet Joint Blocks CPR

A
  • Age > 50
  • Pain best walking
  • Pain best sitting
  • Onset of pain was paraspinal
  • MSPQ exceeding 13
  • (+) Extension-Rotation Test
  • Absence of centralization during repeated movements

3 (of all but MSPQ and centralization) = +LR 9.7
4 of 7 = +LR 7.6

94
Q

Pittsburgh Knee Rules

A

Fall or Blunt Trauma and 1/2:

  • Age < 12 or > 50
  • Inability to WB for 4 steps
95
Q

Canadian C-Spine Rules

A
  1. High-Risk Factor? (YES=IMAGE)
    • Age = 65+
    • Dangerous mechanism
    • Paresthesia in Extremities
  2. Low-Risk Factor Allows Safe ROM? (NO=IMAGE)
    • Simple rear-ended MVA
    • Sitting position in ER
    • Ambulatory at any time
    • Delayed onset of neck pain
    • Absence of midline c-spine tenderness
  3. Able to Actively Rotate Neck? (NO=IMAGE)
    • 45° bilaterally
  • Dangerous Mechanism
    • Fall 3 feet/5 stairs
    • Axial Load to head
    • High speed MVA (>100km/hr, roll, ejection)
    • Motorized recreational vehicle
    • Bicycle struck/collision
  • Simple Rear-Ended MVA Excludes
    • Pushed into oncoming traffic
    • Hit by bus or large truck
    • Rollover
    • Hit by high speed vehicle
  • Rule Not Applicable if
    • Non-traumatic
    • GCS < 15
    • Unstable vital signs
    • Age < 16
    • Acute paralysis
    • Known vertebral disease
    • Prior c-spine surgery
    • Pregnant
96
Q

Osteoporotic Vertebral Compression Fx or Wedge Deformity CPR

A
  • Age > 52
  • No leg pain
  • BMI =/< 22
  • No regular exercise
  • Female
1-2 = Sn .95+
4-5 = Sp .96+, +LR > 9
97
Q

PT for Cervical Radiculopathy CPR

A
  • Age < 54
  • Dominant arm not affected
  • Looking down does not aggravate symptoms
  • Multi-modal > 50% visits (OMPT, Traction, DNF strengthening)
3 = +LR 5.2
4 = +LR 8.3
98
Q

Quebec Task Force (WAD)

A 
0 = No neck pain, No mechanical signs
1 = Neck pain, stiffness, or tenderness only, No mechanical signs
2 = Neck pain and Mechanical signs
3 = Neck pain, Mechanical signs, Neurological signs
4 = Neck pain and Fracture or Dislocation
99
Q

Hypermobile Pubic Joint Diagnostic Cluster

A
  • (+) ASLR Test

- Tenderness of sup pubic lig, psoas, iliacus, and adductor (esp pectineus)

100
Q

Hip OA CPR Birrell

A

3+ restricted planes:

  • Hip flexion
  • Hip IR @ 90° flexion
  • Hip ER @ 90° flexion
  • Hip extension
  • Hip add at 0 degrees flexion

Sn .54, Sp .88

101
Q

Hip OA CPR Altman

A
  • Hip Pain
  • IR < 15
  • Pain with passive IR
  • Morning stiffness up to 60 minutes
  • Age > 50

Sn .86, Sp .75

102
Q

Stenosis Subjective CPR

A 
Sensitivity:
-Age > 65 = .77
-Pain below buttocks = .88
-Leg symptoms worse walking = .71
Specificity:
-No pain sitting = .93
-Symptoms improve sitting = .83
103
Q

Lumbar Facet CPR (Rule Out Dx)

A
  • Pain not relieved in supine
  • History of surgery
  • Occupationa onset
  • Abnormal gait
  • (+) Neuro exam
  • No evidence of osteoporosis

4/6 Present = Not likely to respond to Facet block, unlikely a facet issue

Very Sp, Low Sn

104
Q

Revel Criteria

A
  • Age > 65 and Pain not exacerbated by coughing
  • Not worsened by hyperextension
  • Not worsened by forward flexion
  • Not worsened rising from flexion
  • Not worsened by active rotation-extension in standing
  • Well relieved by recumbency

5/7 = (+) Facet injection response
Apparently Findings controversial

105
Q

SIJ Cluster Dreyfuss

A
  • (+) Fortin Finger Test (point at PSIS)
  • Also complains of groin pain

Sn .16, Sp .85

106
Q

SIJ Dysfunction Palpation-Based Testing

A
  • Standing flexion
  • Supine long sitting
  • Prone knee flexion
  • PSIS position in sitting

Sn 82%, Sp 88%
Questionable due to unreliable tests used

107
Q

Prognostic Factors for:

  1. Developing Recurrent LBP
  2. Developing Chronic Pain
A 
1.
-Prior episodes of LBP
-Excessive spine mobility
-Excessive mobility in other joints
2.
-Symptoms below the knee
-Psychological distress or depression
-Fear of pain, movement, and reinjury or low expectations of recovery 
-High pain intensity
-Passive coping style

OCS (4 decks)

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