CPR's, Grading, and Guidelines Flashcards
Response to Thrust/Nonthrust Manipulation and Exercise Post-INV Sprain
- 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
Carpal Tunnel Syndrome
- 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
Wells Criteria for DVT
- 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%)
Pulmonary Embolism
- 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
Knee OA Responds to Hip Mobilization
- 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
Altman’s Criteria for Knee OA
- Osteophytosis radiography
- Morning stiffness < 30 minutes
- Crepitus
- > 50
- Tenderness of bony margins of joint
- No palpable warmth of synovium
Ottawa Knee Rules
- 55 or older
- Fibular head tenderness
- Patella isolated tenderness
- Cannot flex to 90°
- Cannot bear weight four steps immediately and in ER
Lumbar Manipulation for PFPS
- 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
Foot Orthoses for PFPS
- Age > 25
- Height < 165
- Worst pain < 53.25 mm
- Midfoot width difference WB vs non-WB > 10.96
3 = + LR 8.8
Hip OA CPR Sutlive
-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
Altman’s Criteria for Hip OA
- Osteophytes radiography
- ESR > 20 per hour
- Hip IR < 15°
- Hip flexion < 115°
OR
- Painful, limited hip IR < 15°
- Morning stiffness < 60 minutes
Thoracic Spine Manipulation for Shoulder Pain
- 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
Adhesive Capsulitis
-Insidious pain
-Night pain
-Painful AROM/PROM:
Elevation < 100°
ER < 50% CL UE
-Normal radiography
ACJ Test Cluster
- 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
ACL Return to Running
Week 8 (Pool Running Week 6)
- Normal gait
- Quad strength 70% CL
- Min effusion and pain
Agility training at 50% if Quad 80%
Knee OA Clinical Signs
- Palpable bony prominences
- No palpable warmth
- ROM loss
- Historical signs
- Age
Knee OA Potentially Modifiable Pre-Treatment Factors
- Obesity
- Joint Mobility
- Alignment
- Knee Instability
- Psychosocial Factors
Knee OA Risk Factors
- 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)
LBP Incidence
Female
Lower education
Coronary Artery Disease
- 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%
Cancer CPR
- 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)
Ankylosing spondylitis CPR
- 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
Ankylosing spondylitis characteristics
- 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)
Osteoporosis risk factors
- Caucasian
- Smoking
- Early menopause
- Thin body build
- Sedentary
- Steroids
- Excessive caffeine or alcohol
60+ Acute pain
CA red flags
– Personal or family CA history – Recent significant weight loss – Unrelenting night pain – Smoking history/current – Age > 50
Infection red flags
– Fever – Chills – Night sweats – Recent infection like pneumonia – Current IV therapy or drug use – Recent surgery
Visceral/GI Red Flags
– Bowel or bladder dysfunction – Abdominal pain – Reflux – Excessive NSAIDs use – Alcohol abuse
Cardiopulmonary red flags
– Chest pain/SOA with exertion
– Personal/family history of CV disease
– Thoracic or chest wall pain = throbbing/pulsatile sensations
Fracture red flags
– Osteoporosis and osteoporotic fxs
– Significant trauma
– Prolonged corticosteroid use
Neuro symptoms = thoracic cord compromise from space occupying lesion/CNS disease like MS
Bilateral UE, LE and/or trunk:
– Paresthesia
– Weakness
– Sensory loss
Cervical radiculopathy
3 = + LR 6.1 4 = + LR 30.3
ULTTA = Sn .97, - LR .12
Osteoporosis/osteopenia
OP = T-score 2.5+
Op = T-score 1-2.5
Standard deviations below reference
OA Radiographic Criteria
Kellgren-Lawrence Scale
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.
ACR Criteria Knee OA (Clinical)
Knee pain and 3/6:
- Age > 50
- AM stiffness < 30 min
- Crepitus
- Tenderness
- Bony enlargement
- No palpable warmth
Sn 95%, Sp 69%
ACR Criteria Knee OA (Clinical + Radiography)
Knee pain and 1/3:
- Age > 50
- AM stiffness < 30 min
- Crepitus and osteophytes
Sn 91%, Sp 86%
ACR Criteria Knee OA (Clinical + Laboratory)
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%
Levels of Evidence
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
Strengths of Recommendation
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
ICF Plantar Heel Pain/Plantar Fasciitis Risk Factors
- Limited DF ROM
- High BMI in nonathletic
- Running
- Work-related WB activities particularly poor shock absorption
ICF Diagnosis Plantar Fasciitis and Heel Pain
- 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
Spinal Fractures CPR (Systematic Review)
- 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)
Spinal Fractures CPR (Cohort Follow Up to Systematic Review)
- Female
- Age > 70
- Significant trauma
- Prolonged corticosteroids
Lumbar Manipulation CPR
- 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
Lumbar Manipulation CPR (Short Version)
- Symptoms < 16 days
- No symptoms distal to knee
Both = mod to large shift +LR 7.2
Back-Related Tumor CPR
- 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
Cauda Equina Syndrome CPR
- Urine retention
- Fecal incontinence
- Saddle anesthesia
- Sensory/motor deficits in feet (L4, L5, S1)
Back-Related Infection
- 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)
Spinal Compression Fracture
- 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
Abdominal Aneurysm (>/= 4cm)
- 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)
SIJ Dysfunction Levangie
- 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
SIJ Dysfunction Laslett
- 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
SIJ Dysfunction Van der Wurff
- Distraction
- Compression
- Thigh thrust
- Gaenslen’s
- Patrick’s
Fair to excellent reliability kappa .52-.88
Cervical Traction CPR
- 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%
Cervical Myelopathy Cluster
- Gait deviation
- (+) Hoffman’s
- (+) Inverted supinator sign
- (+) Babinski
- Age 45+
3-4/5 = 94-99% probability 3 = +LR 30.9 1 = -LR .18
Clinical Cervical Instability Symptoms
- 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
Clinical Cervical Instability Objective Findings
- Poor coordination/NM control
- Abnormal joint play
- Motion not smooth throughout ROM
- Aberrant movement
- Hypomobility of upper T-spine
Clinical Lumbar Instability Symptoms
- 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)
Clinical Lumbar Instability Objective Findings
- 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
Lumbar Stabilization CPR Hicks
- Age < 40
- SLR > 91 deg
- Presence of aberrant movement
- (+) Prone Instability Test
3+ = +LR 4.0
Failure of Lumbar Stabilization CPR
- FABQ-A = 8 or less
- Absence of aberrant movement
- (-) Prone instability test
- No hypermobility during lumbar spring test
2+ = -LR .18
Lumbar Stenosis CPR
- 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
Beighton Score
- 5th MCP Hyperextension
- Elbow hyperextension (10 deg)
- Knee hyperextension
- Thumb to forearm
- Lumbar flexion
4 = General hypermobility 7+ = General hypermobility
Lumbar Traction CPR
- 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%
Ankle Sprain Grading
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.
Phases of Healing
- Inflammatory (0-3 Days)
- Proliferative (4-10 Days)
- Early Remodeling (11-21 Days)
- Late Remodeling and Maturation
RCT types
A: supraspinatus, superior subscap
B: supraspinatus, entire subscap
C: supraspinatus, superior subscap, infraspinatus
D: supraspinatus and infraspinatus
E: supraspinatus, infraspinatus, teres minor
RCT size
Small: < 1 cm
Medium: 1 –3 cm
Large: 3–5 cm
Massive: > 5 cm
RC Impongement/Tendinopathy Cluster (Park)
Hawkins-Kennedy
ER MMT
Painful Arc
+LR 10.56/5.03
Probability 95.5%/91%
ER Lag Sign for SS/IS Tear
Sn .69-.98 Sp .98 \+LR 15.5-34.5 -LR .2-.32 \+Probability 88.8% -Probability 13.8%
Drop Sign 90 Abd, 45 ER for IS Tear
Sn 1
Sp 1
+LR 0
-LR 0
Hornblower’s for Teres Minor Tear
Sn 1 Sp .93 \+LR 14.29 -LR 0 \+Probability 87.7%
IR Lag Sign for Subscap Tear
Sn .97 Sp .96 \+LR 24.3 -LR .03 \+Probability 92.4% -Probability 1.48%
IR Resisted Strength Test (vs ER)
90 Abd, 80 ER do IR MMT -IRER=RC Pathology Sn .86 Sp .96 \+LR 22 -LR .13 \+Probability 91.7% -Probability 6.1%
Apprehension Test for Ant or Ant/Inf Instability
Sn .53-.72 Sp .96-.99 \+LR 20.2-53 -LR .29-.47 \+Probability 91-96.4% -Probability 12.7-19%
Ant Release for Ant or Ant/Inf Instability
Sn .64-.92 Sp .89-.99 \+LR 8.36-58.6 -LR .09-.37 \+Probability 80.7-96.7% -Probability 4.3-15.6%
Bankart/Ant Labral Tear Cluster
Crank, Apprehension, Jobe Relocation, Ant Load & Shift, Sulcus Sign Sn .9 Sp .85 \+LR 6 -LR .12 \+Probability 75% -Probability 7%
Jerk Test for Post or Post/Inf Labral Lesion
Sn .73 Sp .98 \+LR 36.5 -LR .28 \+Probability 94.8% -Probability 12.3%
Kim Test for Post or Post/Inf Labrador Lesion
Sn .8 Sp .94 \+LR 13.3 -LR .21 \+Probability 86.9% -Probability 9.5%
Biceps Load Test I or II for SLAP
Sn .9 Sp .97 \+LR 30 -LR .10 \+Probability 93.8% -Probability 5.3%
Post Impingement Sign for Articular-Sided Internal Impingement Syndrome
Sn .95
Sp 1
-LR .05
-Probability2.4%
Yergason’s Test for LHB Tendinopathy
Sn .43-.74 Sp .58-.79 \+LR 1.76-2.05 -LR .45-.72 \+Probability 46.8-50.6% -Probability 18.4-26.5%
Speed Test for LHB Tendinopathy
Sn .32-.9 Sp .14-.75 \+LR 1-1.28 -LR .71-.91 \+Probability 33.3-39% -Probability 26.2-31.3%
Gilcrest Palm-Up Test for LHB Tendinopathy
Sn .63-.74 Sp .35-.58 \+LR .97-1.76 -LR .45-1.06 \+Probability 32.7-46.8% -Probability 18.4-34.6%
Yellow Flags
- 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)
SLAP Tear Types
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)
Meniscus Pathology CPR
- 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
Cervical manipulation CPR for neck pain
- 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%
Thoracic manipulation CPR for neck pain
- 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%
Patellar Taping CPR for PFPS
- 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
Partial or Full Thickness RCT
- Painful arc
- (+) Drop arm sign
- ER (Infraspinatus) Weakness
3 = +LR 15.57, -LR .16
3 (+) and > 60 = +LR 28
3 (-) and > 60 = -LR .09
GIRD Kibler
< 25° IR or B IR difference > 25°
Pilates-Based Ex for LBP CPR
- 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%
Clinical Predictors of Screening Lumbar Facet Joint Blocks CPR
- 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
Pittsburgh Knee Rules
Fall or Blunt Trauma and 1/2:
- Age < 12 or > 50
- Inability to WB for 4 steps
Canadian C-Spine Rules
- High-Risk Factor? (YES=IMAGE)
- Age = 65+
- Dangerous mechanism
- Paresthesia in Extremities
- 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
- 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
Osteoporotic Vertebral Compression Fx or Wedge Deformity CPR
- Age > 52
- No leg pain
- BMI =/< 22
- No regular exercise
- Female
1-2 = Sn .95+ 4-5 = Sp .96+, +LR > 9
PT for Cervical Radiculopathy CPR
- 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
Quebec Task Force (WAD)
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
Hypermobile Pubic Joint Diagnostic Cluster
- (+) ASLR Test
- Tenderness of sup pubic lig, psoas, iliacus, and adductor (esp pectineus)
Hip OA CPR Birrell
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
Hip OA CPR Altman
- Hip Pain
- IR < 15
- Pain with passive IR
- Morning stiffness up to 60 minutes
- Age > 50
Sn .86, Sp .75
Stenosis Subjective CPR
Sensitivity: -Age > 65 = .77 -Pain below buttocks = .88 -Leg symptoms worse walking = .71 Specificity: -No pain sitting = .93 -Symptoms improve sitting = .83
Lumbar Facet CPR (Rule Out Dx)
- 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
Revel Criteria
- 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
SIJ Cluster Dreyfuss
- (+) Fortin Finger Test (point at PSIS)
- Also complains of groin pain
Sn .16, Sp .85
SIJ Dysfunction Palpation-Based Testing
- Standing flexion
- Supine long sitting
- Prone knee flexion
- PSIS position in sitting
Sn 82%, Sp 88%
Questionable due to unreliable tests used
Prognostic Factors for:
- Developing Recurrent LBP
- Developing Chronic Pain
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
