Deck 9 Flashcards
Based on the scientific literature, which of the following pts would benefit the most from a lumbar manipulation?
A. 63M with acute LBP and radicular sx into L posterior thigh above the knee
B. 70M with acute LBP and radicular sx to anterior thigh above the knee and prior hx of L4-5 fusion
C. 20F with acute onset of LBP and (+) SLR of <45˚
D. 18M with acute LBP and radicular sx to post thigh above knee
D. 18M with acute LBP and radicular sx to post thigh above knee
The centralization phenomenon observed during repeated motion testing occurs frequently. Which direction is the least common for a pt to centralize their referred pain into the LE?
A. lumbar extension in standing
B. lumbar extension in lying
C. side glide with OP
D. lumbar flexion
D. lumbar flexion
In a pt with absolute lumbar stenosis due to degenerative changes, what would you expect the anterior/posterior diameter of the SC on myelography to be?
A. 8 mm
B. 10 mm
C. 12 mm
D. 15 mm
A. 8 mm
Myelography has historically been used to diagnose
lumbar stenosis
A diameter < __ is considered absolute lumbar stenosis
< 10 mm
According to the lumbar CPR for manipulation developed by Flynn in 2002, what item from the CPR is the best univariate predictor of a successful outcome with manipulation?
A. Duration of sx < 16 days
B. FABQ < 19
C. At least 1 hip with > 35˚ IR
D. No sx distal to knee
A. Duration of sx < 16 days
All of the following answer choices are predictors that a subject would fail core stabilization tx for LBP except which choice below?
A. (-) prone instability test
B. absence of aberrant movement
C. a score of 9 or higher on FABQ
D. postpartum patient with pelvic girdle pain
D. postpartum patient with pelvic girdle pain
If pt have a combination of all three:
- negative prone instability test
- FABQ > 9
- absence of aberrant movement
the probability of failing core stability exercises for LBP increases to (%)
86%
You’ve decided a pt referred for LBP will benefit from strengthening exercises. What would be the best intervention?
A. TrA/multifidus strengthening
B. RA strengthening
C. strengthening of external and oblique abdominals
D. all of the above
D. all of the above
23M grad student referred for persistent LBP that started a few weeks into the semester. Pt c/o intermittent centralized LBP worse during the week. Lumbar ROM WNL. Repeated motions had no effect. According to the McKenzie method, what classification would the pt be placed in?
A. Derangement syndrome
B. Adherent nerve root syndrome
C. Flexion dysfunction syndrome
D. Postural syndrome
D. Postural syndrome
SI dysfunction can be difficult to diagnose, especially since pathology of the lumbar spine and hip can mimic SIJ dysfunction. Laslett and colleagues developed a cluster of tests to ID SIJ dysfunction including the distraction test, thigh thrust, Gaenslen’s test, compression test, and sacral thrust test. What additional testing would increase the diagnostic utility of identifying SIJ dysfunction?
A. Negative FADDIR test and 3/5 positive tests from SIJ dysfunction cluster
B. Peripheralization of sx with repeated lumbar flexion and 3/5 positive tests from SIJ dysfunction cluster
C. No effect with repeated motions examination and 3/5 positive tests from SIJ dysfunction cluster
D. Elevated R ASIS and R PSIS and 3/5 positive tests from SIJ dysfunction cluster
C. No effect with repeated motions examination and 3/5 positive tests from SIJ dysfunction cluster
An industrial worker is referred for LBP that has not resolved in 6 mos. Since the episode of LBP she has been UA to return to work d/t debilitating pain. What are the chances that the pt will return to work?
A. 20%
B. 40%
C. 60%
D. 80%
B. 40%
An industrial worker is referred for LBP that has not resolved in 6 mos. Since the episode of LBP she has been UA to return to work d/t debilitating pain. What are the chances that the pt will return to work if she is out a full year from work?
20%
50F referred with cc of leg pain and minimal LBP. Her pain increases with prolonged standing and relieves with sitting. What is the most likely dx?
A. Generalized deconditioning
B. Lumbar stenosis
C. L5 facet arthropathy
D. L4-5 disc herniation
B. Lumbar stenosis
Cook study: What are the 5 items that increase post test probability of lumbar stenosis?
- B symptoms
- pain during walking or standing
- pain relief with sitting
- leg pain > back pain
- age > 48
Cook study: If 4/5 of the following are present, it increases the post-test probability of lumbar stenosis to (%)
- B symptoms
- pain during walking or standing
- pain relief with sitting
- leg pain > back pain
- age > 48
76%
According to Dr. Cyriax, what is considered a capsular pattern for the hip?
A. IR < abd < flexion
B. abd < IR < flexion
C. flexion < abd < IR
D. IR < flexion < abduction
A. IR < abd < flexion
During your eval of a pt, you note they have a “sign of the buttock”
Which pathology would be least likely?
A. Large L4-5 disc extrusion
B. Osteomyelitis
C. Neoplasm
D. Sacral fx
A. Large L4-5 disc extrusion
What is the best test a clinician can use to r/o lumbar facet arthropathy?
A. Prone instability test
B. Slump test
C. Extension rotation test
D. Passive lumbar extension test
C. Extension rotation test
The extension rotation test is highly (sensitive/specific)
sensitive
What is the passive lumbar extension test used for?
to ID subject with some form of lumbar instability indicating they may benefit from stabilization program
What is the best test to ID radiographic instability at the lumbar spine?
A. Prone instability test
B. Slump test
C. Extension rotation test
D. Passive lumbar extension test
D. Passive lumbar extension test
23M with LBP. Before dc, you want to test his trunk endurance strength to prevent future injury. What is the ideal ratio for trunk flexion stabilizer endurance relative to trunk extension stabilizing endurance hold times?
A. 1.0
B. 0.8
C. 0.6
D. 0.4
A. 1.0
What is the ideal ratio for trunk flexion stabilizer endurance relative to trunk extension stabilizing endurance hold times for a young male?
1.0
What is the ideal ratio for trunk flexion stabilizer endurance relative to trunk extension stabilizing endurance hold times for young women?
0.79
30M referred for subacute lumbar radiculopathy down RLE. Both repeated lumbar flexion and extension increase sx and cause peripheralization from mid-thigh to mid-calf. What should the clinician consider next for both examination and tx of this pt?
A. Lumbar traction
B. Lumbar manipulation
C. Repeated side glides
D. Neurodynamics of the sciatic nerve
C. Repeated side glides
You suspect a pt has CES. In regards to dx utility, what is the most specific finding from your evaluation?
A. Urinary retention
B. Urinary incontinence
C. Saddle anesthesia
D. Decreased sphincter tone
A. Urinary retention
Urinary retention for dx of CES is (sensitive/specific)
both
Decreased sphincter tone and saddle anesthesia are (sensitive/specific) for dx CES
sensitive, NOT specific
Which nerves are most likely to be affected in a pt who has been diagnosed with CES.
A. L1-L3
B. L3-L5
C. S1-S4
D. L4 and L5
C. S1-S4
According to the CPG on LBP, what intervention has the LEAST supportive evidence in regards to tx of LBP?
A. Pt education and counseling
B. Flexion exercises
C. Traction
D. LQ nerve mobilizations
C. Traction
According to the CPG for LBP, traction was given what grade of supportive evidence?
D
According to the CPG for LBP, pt education and counseling was given what grade of supportive evidence?
B
According to the CPG for LBP, flexion exercises was given what grade of supportive evidence?
C
According to the CPG for LBP, nerve mobilizations were given what grade of supportive evidence?
C
You are mentoring a student PT on the tx of a pt with suspected disc herniation. As her CI, you want her to perform a lumbar manipulation, but she is worried she will make the herniation worse. How should the CI respond?
A. Manipulation will worsen the disc herniation
B. Try lumbar mobilizations first and attempt manipulation if tolerated well
C. Pt meets the CPR for lumbar manipulation
D. The risk of worsening a lumbar disc herniation is only 1 in 3.7 million
D. The risk of worsening a lumbar disc herniation is only 1 in 3.7 million
You are mentoring a student PT on the tx of a pt with suspected disc herniation. As her CI, you want her to perform a lumbar manipulation, but she is worried she will make the herniation worse. How should the CI respond?
A. Manipulation will worsen the disc herniation
B. Try lumbar mobilizations first and attempt manipulation if tolerated well
C. Pt meets the CPR for lumbar manipulation
D. The risk of worsening a lumbar disc herniation is only 1 in 3.7 million
Why would you not choose C?
You do not have enough information to know that the pt meets the CPR
What is the most sensitive SIJ dysfunction test?
A. Thigh thrust
B. Gaenslen’s
C. Compression
D. Distraction
A. Thigh thrust
What is the most common inflammatory condition to affect the SIJ?
A. RA
B. Ankylosing spondylitis
C. Osteomyelitis
D. Infection of the SI joint
B. Ankylosing spondylitis
Increased tension in the latissimus dorsi and/or glute max can cause slackening in which ligament?
A. Interosseous sacral iliac ligament
B. Short posterior sacroiliac ligament
C. Long posterior sacroiliac ligament
D. iliofemoral ligament
C. Long posterior sacroiliac ligament
What is it called when the sacrum rotates posterior as ilium rotates anteriorly?
counternutation
What is it called when the sacrum rotates anterior as ilium rotates posteriorly?
nutation
The nucleus pulposus of the lumbar discs is primarily composed of what type of collagen?
A. Type I
B. Type II
C. Type III
D. Type IV
B. Type II
Where is type I collagen often found?
scar tissue
Where is type III collagen typically found?
usually along with type I in structures such as muscles and other visceral structures
What are the primary stabilizers of the spine that do not cause global spine movement?
A. Lateral fibers of EO and psoas major
B. QL and IO muscle
C. TrA and multifidi
D. Medial fibers of EO
C. TrA and multifidi
Pt referred for acute low back injury after slipping at work. What score on FABQ would indicate a good prognosis of pt returning to work?
A. FABQW score > 34
B. FABQPA score > 34
C. FABQW score ≤ 29
D. FABQPA score ≤ 29
C. FABQW score ≤ 29
FABQW: If someone scores > (#), the risk or prolonged work restrictions increases from 20-58%
34
FABQW: If the pt scores less than (#), the risk of prolonged work restriction decreases from 29% to 3%
29
Pt referred for acute LBP after slipping at work site. What score would indicate a poor prognosis of pt returning to work?
A. FABQW score > 34
B. FABQPA score > 34
C. FABQW score ≤ 29
D. FABQPA score ≤ 29
A. FABQW score > 34
35M referred for localized pain in R gluteal fold. Denies MOI. First noticed last year when playing soccer and it returned again at beginning of the season. Primary complaint is inc pain after playing soccer over the weekend. During the game he only has mild discomfort, but after it is excruciating. Describes as deep that worsens with activity. Denies pain during warm ups before game, but reports inc pain into 2nd half of the game. During clinical exam, you note ttp at R ischial tuberosity, pain with deep squatting, pain with PROM knee ext stretch with hip in 90˚ of knee flex, and pain with resisted prone hip ext.
What is the most likely pathology described in this vignette
A. Proximal HS tendinopathy
B. L5-S1 disc herniation
C. Rupture of proximal HS tendon
D. Pudendal neuropathy
A. Proximal HS tendinopathy
35M referred for localized pain in R gluteal fold. Denies MOI. First noticed last year when playing soccer and it returned again at beginning of the season. Primary complaint is inc pain after playing soccer over the weekend. During the game he only has mild discomfort, but after it is excruciating. Describes as deep that worsens with activity. Denies pain during warm ups before game, but reports inc pain into 2nd half of the game. During clinical exam, you note ttp at R ischial tuberosity, pain with deep squatting, pain with PROM knee ext stretch with hip in 90˚ of knee flex, and pain with resisted prone hip ext.
Pt reported he had gone to PT last year with minimal benefit. Describes the exercise program prescribed by the therapist. Which exercise would you want to exclude?
A. Plank
B. Hip ext in prone
C. Bridge
D. Lunge
D. Lunge
35M referred for localized pain in R gluteal fold. Denies MOI. First noticed last year when playing soccer and it returned again at beginning of the season. Primary complaint is inc pain after playing soccer over the weekend. During the game he only has mild discomfort, but after it is excruciating. Describes as deep that worsens with activity. Denies pain during warm ups before game, but reports inc pain into 2nd half of the game. During clinical exam, you note ttp at R ischial tuberosity, pain with deep squatting, pain with PROM knee ext stretch with hip in 90˚ of knee flex, and pain with resisted prone hip ext.
What type of exercise would be beneficial for this pt initially?
A. Isometrics
B. Isotonics
C. Concentrics
D. Eccentrics
A. Isometrics
Pt referred for R lateral hip pain. Has a (+) derotation test and reproduction of concordant pain with SLS on R leg for 30 seconds. What activity should the pt avoid?
A. Iso contraction of hip abductors
B. Standing ITB stretch
C. Sitting in chair with hips above knees
D. Sleeping on R side with cushion under hip
B. Standing ITB stretch
