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CRAM REVISION Flashcards

1
Q

how is gillet test/ipsilateral kinetic test conducted

A

Start in iliac crest - L4/L5
PSIS - dimples - go below PSIS for inferior aspect of PSIS
Allow patient for lumbar flexion (ask patient to touch their toes can bend their knees )
One thumb on inferior aspect of PSIS , other thumb on sacrum
Hip flexion - normal response inferior PSIS drops inferiorly - posterior innominate rotation
Hip extension normal response. - inferior PSIS moves superiorly - anterior innominate rotation

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2
Q

how is gaenslens test conducted

A

One leg lying over the bed other leg pushes knee to their chest
Apply pressure on both legs

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3
Q

how is the compression test conducted

A

Separate front of innominate in SIJ apply compression force on SIJ
Cross my arms find medial ASIS and use palms of hands to separate them

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4
Q

how is the gapping test conducted

A

Push the front of innominates together causes a distraction force on SIJ
Place palms of hands lateral to ASIS push towards each other

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5
Q

how is the piriformis flexibility test conducted in supine

A

patient in supine
get patient to do knee and hip flexion against plinth on onel leg
external rotation with heel of foot on opposite knee
get patient to push the bottom leg to their chest

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6
Q

how is a piriformis flexibility test conducted in prone

A

Image below shows how it can be done in prone
Neutral hip flexion and neutral femur
Stretched by medial rotation

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7
Q

how is the ASLR conducted

A

Patient in supine
Ask patient to place their hands on their ASIS position it yourself
Place your hand around 20cm above their leg
Ask the patient to get the leg to touch your hand

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8
Q

what structural integrity is assessed using the ASLR

A

What structures takes load in SLR - lumbar spine vertebrae, sacroiliac joint, pelvic ring

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9
Q

how is the ASLR with form closure conducted?

A

Ask patient to place their hands on their ASIS position it yourself
Place your hand around 20cm above their leg
Ask the patient to get the leg to touch your hand
Place hand on both innominates or side of the ASIS and press towards each other
Ask patient to raise their leg

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10
Q

what is the grading interpretation of the ASLR conducted

A

0 = not difficult at all
1 = minimally difficult
2 = somewhat difficult
3 = fairly difficult
4 = very difficult
5 = unable to do

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11
Q

SIJ POSH test

A

Ask for knee flexion and 90 degree hip flexion
Stabilise contralateral ASIS - to prevent pelvic rolling
Apply downward pressure on on the patella

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12
Q

how is the dorsal ligament of SIJ palpated

A

PSIS - look for dimples
palpate inferior and medial
Patient in prone
apply transverse pressure similar to the DTF

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13
Q

When is MET rotation indicated

A

using supine to longsit test

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14
Q

when conducting a supine to longsit test what would indicate anterior innominate rotation

A

longer leg

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15
Q

what muscle energy technique if the patient was to correct anterior innominate rotation

A

patient can be in supine
ask patient to drive knee into their chest directed into their ipsilateral shoulder
place one hand on the plinth other hand on the medical aspect of their knee
ask patient to push against you using their hips extension not by straightening knee - hold 6 seconds
6 new boundaries

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16
Q

what muscle energy technique is used to correct posterior innominate rotation

A

patient in prone
palpate PSIS to promote anterior rotation - using dimples
knee flexion
passive hip extension while cupping the knee in your hand on the contralateral side of the patient
ask patient to dig knee into plinth
hold for 6 seconds 6 boundaries

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17
Q

how would you get a patient to be able to correct posterior innominate rotation independently as a HEP

A

instructions as mentioned
get towels under their knee
ask patient to dig knee into towel

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18
Q

how would you get patient to correct anterior innominate rotation METS independently as a HEP

A

supine
knee to chest in direction of ipsilateral axilla
get them to dig into their own shoulder resisting against their own hands
hold 6 seconds

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19
Q

how to conduct posterior innominate rotation sidelying

A

patient sidelying
placing hand on ASIS
forearm resting on ischial tuberosity
initiate rotation should induce passive hip flexion

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20
Q

how to conduct posterior innominate rotation sidelying in end of range

A

patient sidelying
patient in full knee extension and 90 degree hip flexion
hold leg between your iliac crest and forearm
placing hand on ASIS
forearm resting on ischial tuberosity
initiate rotation should induce passive hip flexion

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21
Q

how is thoracic rotation PPIVM conducted

A

patient side lying
ask patient to cross arms and place hands on contralateral shoulder
ensure no scapular retraction or protraction occurs
palpate the desired spinal level use forearm to stabilise the spine
using the patients elbow as a torque to gently rotate lifting the elbow upwards

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22
Q

how is thoracic side flexion occur in sitting

A

position plinth at level of hip
ask patient to cross arms and place hands on contralateral shoulder
ensure no scapular protraction or retraction occur
grasp one hand on shoulder
place other hand on vertebral space making an L shape
position yourself in a squat
work in lever lift the hand on the shoulder upwards
lower the hand on the vertebrae as you squat

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23
Q

how is rib 1 longitudinal caudad conducted

A

patient in supine
therapist seated in direct of head
palpate clavicle - palpate
push in direction on feet

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24
Q

how is cervical PPIVM side flexion conducted

A

patient - supine, head of table,
physio - supporting weight of patients with abdomen, palpate articular pillar between C2/C3, other hand support head, compare findings
movement - lateral flexion, feel for the opening and closing of the joint

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25
how is cervical PPIVM rotation conducted
Physio - Palpate contralateral articular pillar, reinforced index finger, as joint opens during rotation, other hand support weight of occiput, patient - supine, head lying off edge of bed movement - on same hand while index finger on lamina produce produce cervical rotation away from palpating hand
26
positive findings of cervical PPIVM side flexion
increased resistance through motion, muscle spasm, decreased opening or closing of the joint, pain provocation
27
how is the craniocervical flexion test conducted
place towel on occiput place pressure biofeedback in 3rds aim patient to nod target - 22, 24, 26, 28, 30 mmHg observe any compensatory behaviours - retraction, SCM, scalene activity determine the pressure the patient can hold steady with no palpable superficial muscle activity measure enurace - 10secs hold, 10 reps
28
what is the normal reps and pressure that can be maintained by patient during craniocervical flexion test
26-30 mmHg 10 secs x 10reps
29
how is the cervical flexion/extension test conducted
Patient - side lying with head cradled in physios forearm, head on bed therapist - facing patient, back elbow contacts front of facem forearm contacts side of head, palmar surface of hand contacts back of head one hand supporting head, other hand palpate C2 spinous process, forearm stabilise vertebral column, palpate interspinous space C2-C3 Movement - guide head into flexion not as clinically useful
30
how is ULNT 1 conducted
ULNT 1 = median nerve lie patient in supine stand facing patient grasp pt hand, extend wrist and fingers fully straighten out thumb and fingers abduct shoulder supinate forearm LR of shoulder lateral cervical flexion extend elbow
31
how is ULNT 2 conducted
ULNT 2 = radial nervePatient positioning - supine physio - depress scapula with thigh, extend elbow Glenohumeral IR, elbow pronation flex wrist - w/ patients thumb grasp in hand
32
how is ULNT 2 conducted
ULNT 2 = radial nervePatient positioning - supine physio - depress scapula with thigh, extend elbow Glenohumeral IR, elbow pronation flex wrist - w/ patients thumb grasp in hand
33
normal response for ULNT 1
Deep stretch or ache in cubital fossa (99%) extending down anterior & radial aspect of forearm into radial side of hand Tingling in thumb and first 3 fingers Anterior shoulder stretch. Ipsilateral cervical sideflexion decreases responses
34
list sensitising manoeuvres that add further longitudinal stress on neural tissue for median nerve ULNT
Cervical side flexion Scapula depression
35
What is the normal response for ULNT 2
stretch pain in – Lateral aspect of upper arm. Biceps Dorsal aspect of hand
36
What are the desensitising manoeuvre for ULNT 2
ULNT 2 = radial nerve Cervical spine ipsilateral sideflexion Shoulder abduction
37
how is ULNT 3 conducted
ULNT 3 =ulnar nerve Patient in supine cusp scapula with one hand, other hand on elbow flex elbow abduct shoulder lateral rotate shoulder pronate forearm extend wrist and fingers - to face side of face
38
what is a normal response for ULNT 3
ULNT 3 = ulnar nerve stretching discomfort in hypothenar eminence & medial 2 fingers tingling in same region.
39
describe the Roos test
90 degree shoulder abduction external rotation repeated grasping and releasing of hand
40
what nerve roots make up the median nerve
C5-T1
41
what nerve roots make up the radial nerve
C5-T1
42
what nerve roots make up the ulnar nerve
C7-T1
43
How is the spurling test conducted?
Passively laterally flex neck towards the symptomatic side and apply downward overpressure (approx. 7kg).
44
what is the purpose of the spurling test
assess radicular pain
45
how can the spurling test be further sensitised
If no symptoms are reproduced at this stage, cervical extension and rotation can be added to lateral flexion
46
what is the diagnostic criteria needed for cervical radiculopathy
Positive ULNT1 Positive Spurling’s test Limited cervical rotation to affected side (<60deg) Positive distraction test
47
differential diagnosis of upper arm pain
C5/6 referred pain Shoulder (GH jt) referred pain C5 Radiculopathy
48
how is the distraction test performed in supine
Patient supine. Therapist securely grasps the patient's either by placing each hand around the patient’s mastoid processes/ one hand under chin and other on occiput, while standing at their head. Slightly flex the patient’s neck and pull the head towards your torso, applying a distraction force
49
how is the distraction test performed in supine
Patient supine. Therapist securely grasps the patient's either by placing each hand around the patient’s mastoid processes/ one hand under chin and other on occiput, while standing at their head. Slightly flex the patient’s neck and pull the head towards your torso, applying a distraction force
50
what is a positive response to the distraction test
reduction of symptoms
51
how is passive neck flexion conducted
Hypothesized to provoke neurological tissue that may be responsible for clinical symptoms such as headaches, or pain in the arms and legs are of spinal origin and
52
why else may pain be provoked in patients with neck pain when performing passive neck flexion
Possible neuromeningeal mechanosensitivity in patients with neck pain.
53
list possible core rehab exercises
deep transverse abdominis activiation - dead bug (supine 90 degree hip flexion and 90 degree knee flexion) shoulder flexion 90 degree plank position - intensify with hip extension, contralateral shoulder flexion and elbow extension side plank -intensify with hip abduction bird dog -
54
what core exercises test functional muscle control
SLS, bridge, reverse lunge, front plank, side plank
55
what core exercises work as manual muscle test
supine curl up, supine curl up with bilateral rotation
56
how to conduct lumbar side flecion PPIVM
Patient in side flexion/sidelying PT in front facing patient using left hand to rest on back and stabilise vertebrae from formarm to elbow moving hand grasp patients uppermost innominate under ischial tuberosity bring patient into hip flexion compare opposite side
57
Describe lumbar rotation PPIVM
Side lying with his and knees flexed physio - forearm resting on back, other hand holds hip fingers spread over ilium/greater trochanter movement - stabilise thorax and pelvis rotated away from therapist. palpate relative movement of distal spinous process in relation to proximal one.
58
Describe lumbar rotation PPIVM
Side lying with his and knees flexed physio - forearm resting on back, other hand holds hip fingers spread over ilium/greater trochanter movement - stabilise thorax and pelvis rotated away from therapist. palpate relative movement of distal spinous process in relation to proximal one.
59
Describe lumbar flexion extension PPIVM
Patient position - side lying, hips and knees flexed physio position - in front facing patient moving hand grasps back of flexed knees posteriroly and hips will grasp knees anteriorly palpating hand - feel space gap in flexio and narrow in extension movement - flex hips by rocking the patients knees towards patients chest to flex and extend lumbar spine
60
Normal response to SLR NDT
ROM 50-120 degree hip flexion posterior thigh, knee calf pulling relieved by neck extension
61
What sensitising manoeuvres for SLR NDT
Hip Add Hip MR Passive neck flexion Opposite SLR (B/L) Ankle DF PF/Inv
62
What type of stress is applied on SLR NDT
longitudinal stress on neural tissue - sciatic nerve
63
When would an SLR NDT be indicated
if patient presents with spinal or leg pain used to highlight disc pathology in isolation tests sciatic nerve - L4-S1
64
purpose of passive neck flexion
loads connective and conductive tissue of spinal cord stresses cervical, thoracic and lumbosacral nerve root and cervical meningeal structures
65
red flags that can identified in passive neck flexion
foot P&N numbness
66
what desensitising manoeuvres for passive neck flexion
Hip and knee flexion
67
what desensitising manoeuvres for passive neck flexion
SLR Cervical sideflexion Upper limb BPPT
68
purpose of prone knee bend
test femoral nerve L2-L4
69
purpose of adding sensitising manoeuvres in prone knee bend
delineate neuropathodynamics from quads, psoas muscle tightness
70
when would PKB be indicated
lumbar pain anterior hip pain thigh and knee symptoms
71
sensitising manoeuvres for prone knee bend
Hip Extension Hip Adduction Slump (cervical and trunk flexion) in side lying Hip rotation Ankle DF / Ever Bilateral PKB
72
indications for slump test
Spinal symptoms Lumbar or thoracic radiculopathy Sciatic tract symptoms Provocative activities that indicate that slump may be aggravating e.g. pain aggravated by kicking, dance (leg kick) or driving (bucket seat).
73
contra indication for slump test
Irritable disorder Unstable disc pathology Recent progressing neuro changes Cord or Cauda equine symptoms.
74
normal response to slump test
Trunk flexion – nil Add cervical flexion – 50% normals report pain in T8/9 region – why? Add knee extension – discomfort & pulling in posterior knee / thigh / hams and symmetrical restriction – most people can’t fully extend knee. Add DF – intensifies above Release neck – decreases all symptoms and increases knee extension possible.
75
how is grade III lumbar rotation PPIVM conducted
patient - Lying on side, with uppermost (left) leg flexed with foot hooked behind lower knee. Lower leg extended. therapist - To apply rotation, therapist stands behind patient again and stabilises thorax at anterior aspect of left shoulder, while producing rotation via pelvis.
76
how is grade IV lumbar rotation PPIVM conducted
patient -Same as for Grade III except left leg is now allowed to drop over edge of bed. Stabilising pressure can alternately be provided through patient’s left hand on abdomen – this reduces strain on thoracic spine during technique therapist -Same as for Grade III except different amplitude.

Advanced MSK (18 decks)

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