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OMM M1T3 > E1 > Flashcards

E1 Flashcards

1
Q

Where is the true hip joint located?

**board question

A

In inguinal fold, lateral to femoral artery and just lateral to femoral nerve

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2
Q

Why is the location of the true hip joint important?

A

Arthrocentesis

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3
Q

Where do you insert the needle for hip arthrocentesis?

**board question

A

Palpate the arterial pulse, cover the nerve with your finger, and insert needle just lateral to that

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4
Q

How much pressure is transmitted through the femoral head?

A

3 pounds of pressure for every pound of body weight

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5
Q

Which hand is the cane held in?

A

Contralateral hand (to the injury/dysfunction)

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6
Q

Psoas innervation

A

L1-L3

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7
Q

Actions of the psoas

A

Flexes thigh
Externally rotates femur
Balances trunk in seated position

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8
Q

How does the psoas flex the trunk?

A

Only with knees locked in extension in the recumbent position (Straight Leg Sit Up)

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9
Q

Why can the psoas muscle cause diffuse pain patterns?

A

Nerve roots L1-L4 pierce the muscle–pain can follow dermatomal, myotomal, sclerotomal patterns

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10
Q

What is in contact with the anterior surface of the psoas?

A

Ureter

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11
Q

Psoas spasm without known injury can result from…

A

Ureter problems (ureteric calculus, ureteritis)

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12
Q

What lies on the medial aspect of the psoas?

A

Sympathetic chain

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13
Q

What lies across the front of both psoas muscles?

A

Transverse colon

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14
Q 
Hip osteoarthritis
Femoral bursitis
Piriformis hypertonicity
Diverticulitis
Prostatitis
Colon cancer
Salpingitis
A

Causes of psoas spasm

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15
Q

Etiology of psoas muscle strain

A

Sudden hyperextension/external rotation of hip joint and lumbar spine
Prolonged sitting
Sudden standing after sitting for a long period of time

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16
Q

What is the Hugh Owens Thomas Test?

**board question

A

Normal:
Supine patient has increased lumbar lordosis
Flexion of one or both hips allows the lordosis to flatten out –> indicating psoas contracture

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17
Q

What would constitute an abnormal Hugh Owens Thomas Test?

A

Flexing one hip/leg causes the other to lift off the table

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18
Q

What is a frequent cause of hamstring hypertonicity?

A

Psoas shortening

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19
Q

What is often the triggering event for Psoas Syndrome?

A

Non-neutral dysfunction at L1-L3, establishing a somato-somatic reflex, triggering psoas hypertonicity.

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20
Q

What condition is commonly associated with osteoarthritis of the hip?

A

Femoral bursitis

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21
Q

What condition is often caused by tuberculosis of the spine?

A

Psoas abscess (infection in the spine at the thoracolumbar junction spreads in psoas fascia)

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22
Q

Positive (buttock pain) Straight Leg Raising Test

Positive (buttock pain) Patrick’s FABERE Test

A

Ishiogluteal bursitis

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23
Q

Ischial avulsion fracture can result from…

A

Forceful contraction of the hamstrings

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24
Q

Piriformis innervation

A

S1/S2 via superior and inferior gluteal nerves

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25
Q

What shares innervation with the piriformis?

A

SI joint

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26
Q

Actions of the piriformis

A

Externally rotates the neutral thigh
Abducts the flexed thigh
Works in conjunction with the other GOGOQ muscles

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27
Q

Common injury causing piriformis syndrome

A

Lift and internally rotate the hip on a fixed leg

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28
Q

People who drive a lot can suffer from what condition?

A

Piriformis syndrome (right hip externally rotated resulting in shortening of the piriformis)

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29
Q

Piriformis spasm causes…

A

Anterior sacral torsion on contralateral oblique axis

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30
Q

What nerves are compressed in piriformis syndrome?

A

Superior and inferior gluteal nerves, sciatic nerve

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31
Q

Fascia lata problems refer to….

A

The iliotibial tract

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32
Q

Fascia lata action

A

Lateral support for the hip joint and knee

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33
Q 
L4/L5 dysfunctions
Sacroiliac and iliosacral dysfunctions
Inominate dysfunctions
Tibial dysfunctions at the knee
Fibular dysfunctions at the knee
A

Alter the function of the IT band

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34
Q

Which dysfunctions are produced by shortening of the IT band?

A

Inominate (inferior vertical shear, outflare inominate)

Anterior fibular head

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35
Q

Condition caused by increased tension in the IT band

A

Trochanteric bursitis

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36
Q

Fascia Lata Syndrome presentation

A

Tenderness along IT band
Trochanteric bursitis
Fibular nerve compression (foot drop, posterior/lateral calf pain)

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37
Q

Ely Test

A

With patient prone, flex leg at knee

If this causes the pelvis to lift up and the leg abducts at the hip, there is flexion contracture of the rectus femoris

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38
Q

Boring pain in the joint
Stiffness after periods of rest
Walking is curtailed

A

Symptoms of osteoarthritis of the hip

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39
Q

Physical finding for osteoarthritis of the hip

A 
Limp
Globally decreased ROM
Pain with Patrick's FABERE Test
Palpable joint effusion
Palpable and auscultable joint crepitance
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40
Q

Patient cannot walk

LE appears shortened and externally rotated

A

Hip fracture outside hip capsule

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41
Q

Which condition presents with pain out of proportion to physical findings?

A

Avascular necrosis of the hip

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42
Q

Etiologies of avascular necrosis of the hip

A

Increased intracapsular pressure
Intravascular coagulopathy
Fat embolism
Arteriolosclerosis

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43
Q

Corticosteroids can cause…

A

Avascular necrosis of the hip

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44
Q

Which nerve is involved in meralgia parethetica?

A

Entrapment of the lateral femoral cutaneous nerve

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45
Q

Burning, tingling paresthesia with standing, sitting, walking
Point tenderness below inguinal ligament just medial to ASIS
Numbness over lateral thigh

A

Meralgia parethetica

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46
Q

Meralgia parethetica etiologies

A 
Somatic dysfunction (anterior inominate rotation, inominate outflare, inferior inominate shear)
Tight belts
Tight jeans
Tool belts
Herniorrhaphy scar
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47
Q

What condition typically follows a trauma to the soft tissues?

A

Myositis ossificans traumatica

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48
Q

Most common locations of myositis ossificans traumatica

A

Hip and elbow

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49
Q

Where does the piriformis exit the pelvis?

A

Greater sciatic foramen

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50
Q

Psoas hypertonicity will cause sciatica on ipsilateral/contralateral side

A

Contralateral

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51
Q

There are ____ axes of sacral motion

A

Seven:

Three transverse (superior, middle, inferior)
Two oblique (left, right)
One vertical
One AP

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52
Q

Where is the sacral middle transverse axis located?

A

Anteriorly at the level of S2, near the junction of the long and short arms of the SI joint

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53
Q

What is the axis on which the sacrum flexes and extends in response to truncal motion?

A

Middle transverse

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54
Q

Once the lumbar lordosis begins to reverse with further flexion of the trunk, the sacrum moves into ______.

A

Extension

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55
Q

What is the axis the sacrum moves upon with ventilation?

A

Superior transverse: extension with inhalation, flexion with exhalation

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56
Q

Which sacral axis is located in the posterior superior sacroiliac ligaments?

A

Superior transverse

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57
Q

Which sacral axis is involved with the cranial rhythmic impulse cycle?

A

Superior transverse

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58
Q

With cranial base extension, the sacrum moves into _____

A

Flexion

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59
Q

Which sacral axis is located at the level of the ILAs?

A

Inferior transverse

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60
Q

On which axis does the inominate rotate during the gait cycle?

A

Inferior transverse

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61
Q

Which axis is not a true sacral axis?

A

Vertical –> actually an axis of pelvic rotation during the gait cycle

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62
Q

How do you know you have a unilateral sacral dysfunction?

A
  1. Motion testing (seated flexion, lumbar spring, and sphinx tests)
  2. Know the relative positions of the sacral sulci and ILAs
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63
Q

Where is the restriction in a positive seated flexion test?

A

On the side of the higher PSIS

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64
Q

Patient position for seated flexion test

A

Seated on a low stool with knees higher than hips, or seated on the edge of a low table with feet on the floor

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65
Q

Positive lumbar spring test results

A

Stiffness –> posteriorly going dysfunction (extension or posterior torsion)
Softness –> anteriorly going dysfunction (flexion or anterior torsion)

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66
Q

What is a torsion?

A

Two parts of the spine rotating in opposite directions about a single axis

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67
Q

When L5 is dysfunctional and rotates with the sacrum rather than the ilia, it is called ______

A

Non-compensated L5

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68
Q

What determines direction of rotation of the sacrum?

A

Motion of the anterior most point on the sacral promontory

69
Q

What causes anterior sacral torsion?

A
  1. Truncal sidebending and rotational forces in extension coming down from the lumbar spine
  2. Gait cycle
70
Q

Symptoms of anterior sacral torsion

A

Back pain, buttock pain

71
Q

What causes posterior sacral torsion?

A

Truncal sidebending and rotational forces in flexion coming down from the lumbar spine

72
Q

T/F: Gait cycle causes posterior sacral torsion

A

False. Only anterior.

73
Q

Symptoms of posterior sacral torsion

A

Intense low back and hip pain, piriformis pain, walking with a limp

74
Q

Unilateral flexed sacral dysfunction is also called….

A

Sacral shear

75
Q

Positive sacral rock test indicates….

A

Bilateral dysfunction

76
Q

Really, really shallow sacral sulci
ILAs so far anterior that you feel like you will be going internal before you find them
Flattening of the lumbar lordosis

A

Bilaterally extended sacrum

77
Q

Where are the SI joints?

A

Where the LE ends and the spine begins

78
Q

During the gait cycle, as the leg comes forward, the inominate rotates _______

A

Posteriorly

79
Q

What serves as a universal joint in the gait cycle?

A

Pubic symphysis

80
Q

How much motion is available in the SI joint?

A

About 5 degrees each for sacral flexion and extension.

81
Q

Dysfunction introduced from the LE and causing restriction of motion between the ilium and sacrum

A

Iliosacral / inominate dysfunction

82
Q

Dysfunction introduced from the spine and causing restriction of motion between the sacrum and the ilium

A

Sacroiliac / sacral dysfunction

83
Q

A pubic symphysis dysfunction is an iliosacral or sacroiliac dysfunction?

A

Iliosacral

84
Q

How are pelvic dysfunctions named?

A

For the site of greatest motion restriction and apparent assymetry

85
Q

SI joint innervation

A

S1-S5

86
Q

Where is the site of greatest ligamentous stress in the pelvis?

A

The site from which somato-somatic and somato-visceral reflexes will emanate

87
Q

False positives for standing flexion test

A

Asymmetric hamstring or gluteal tension
Sacral dysfunction
Severe L4 or L5 dysfunction

88
Q

What do you do after a negative standing flexion test?

A

This means inominates are normal, so screen the sacrum next

89
Q

Posterior inominate landmarks

A

PSIS
Sacral sulci
Ischial tuberosities
Sacrotuberous ligament tension

90
Q

Anterior inominate landmarks

A

ASIS
Pubic tubercles
Pubic symphysis

91
Q

What are the inominate axis dysfunctions?

A

Anterior/posterior rotation

Superior/inferior pubic shear

92
Q

What is the most common pelvic dysfunction?

A

Posterior inominate rotation

93
Q

Symptoms of posterior inominate rotation

A

Pain located at the ipsilateral PSIS

94
Q

Which muscle is targeted in treatment for posteriorly rotated inominate?

A

Rectus femoris

95
Q

Symptoms of anterior inominate rotation

A

Diffuse low back pain radiating around the abdominal wall attachments to the iliac crest and following the inguinal ligament into the groin

96
Q

Asymmetries in anterior vs. posterior inominate rotation

A

Anterior: PSIS cephalad, sacral sulcus shallow
Posterior: PSIS caudad, sacral sulcus deep

97
Q

Which muscle is targeted in treatment for anteriorly rotated inominate?

A

Gluteus maximus

98
Q

What are the symptoms of superior inominate shear?

A

Pain overlying the posterior sacroiliac ligaments

99
Q

PSIS cephalad
Ischial tuberosity cephalad
Sacrotuberous ligament lax

A

Superior inominate shear

100
Q

Respiratory assistance (muscle energy) is used to treat what condition?

A

Superior / inferior inominate shear

101
Q

What are the symptoms of inferior inominate shear?

A

Often very painful. Pain overlying posterior sacroiliac ligaments. More intense pain in the buttock overlying the sacrotuberous and sacrospinous ligaments.

102
Q

PSIS caudad
Ischial tuberosity caudad
Exquisitely tender over sacrotuberous ligament
Taut sacrotuberous ligament

A

Inferior inominate shear

103
Q

Symptoms of inflare inominate

A

Pain medial to PSIS

104
Q

Principal asymmetry in inflare inominate

A

ASIS closer to midline

105
Q

Which musculature is targeted in treatment of inflare inominate?

A

Hip adductors

106
Q

Symptoms of outflare inominate

A

Pain along the ipsilateral inguinal ligament

107
Q

Principal asymmetry in outflare inominate

A

ASIS farther from midline

108
Q

Which muscles are targeted in treatment of outflare inominate?

A

Tensor fascia lata, gluteus minimus, piriformis

109
Q

Most common in women, especially ages 25-35, and during third trimester of pregnancy, as well as in immediate post-partum period

A

Pubic symphysis dysfunctions

110
Q

Tenderness at pubic symphysis
Pain in anterior and medial thigh inferior to the inguinal ligament
Pain may radiate into labium or testicle

A

Superior symphyseal shear

111
Q

Primary asymmetry in superior symphyseal shear

A

Pubic tubercle cephalad

112
Q

HVLA is ill advised for which pelvic dysfunction?

A

Symphyseal shear, pubic symphysis gapping

113
Q

Which musculature is targeted in muscle energy tx of superior symphyseal shear?

A

Hip adductors

114
Q

Which is more common, superior or inferior symphyseal shear?

A

Inferior

115
Q

Lower abdominal pain, just superior to inguinal ligament

May be mistaken for intra-abdominal pathology

A

Inferior symphyseal shear

116
Q

Primary asymmetry in inferior symphyseal shear

A

Pubic tubercle caudad

117
Q

Pain at pubic symphysis

Urinary urgency, frequency, dysuria (with sterile urine)

A

Pubic symphysis gapping

118
Q

Symptoms of pubic symphysis compression

A

Pain at pubic symphysis (no urinary symptoms)

119
Q

Because degenerative disease of the spine may be asymptomatic, how do you determine the appropriate course of action?

A

Imaging, combined with history and physical

120
Q

Symptoms of spinal osteoarthritis

A 
Local and/or radicular pain of insidious onset
Mild to moderate intensity (1-6)
Pain worse with use, better with rest
Weather sensitivity
Stiffness after periods of rest
Crepitance with motion
Joint enlargement
Weakness
121
Q

Most cases of spinal osteoarthritis appear after what age?

A

40

122
Q

Radiographic findings of spinal osteoarthritis

A 
Osteophyte formation (bone spurs)
Asymmetric joint space narrowing
Subchondral sclerosis
Subchondral cyst formation
Chondrocalcinosis
123
Q

MRI findings of spinal osteoarthritis

A

Neural entrapment

Intervertebral disc dessication, internal disruption, or protrusion

124
Q

What is The Challenge in treating spinal osteoarthritis?

A

Discover the pain generator

125
Q

What is the innervation of facet joints?

A

Posterior primary ramus of nerve root of both that segment and the segment below

126
Q

What is the innervation of discs?

A
  1. Recurrent meningeal nerve innervates the posterior longitudinal ligament and outer 1/3 of the annulus fibrosus posteriorly
  2. Visceral afferents from the SNS make up the sensory supply for the anterior longitudinal ligament and the outer 1/3 of the annulus fibrosus anterolaterally
127
Q

What type of joints are the spinal facet joints?

A

Synovial

128
Q

What is first in the sequence of events leading to osteoarthritis of a synovial joint?

A

Articular somatic dysfunction (compression and adherence of the joint surfaces impairs the flow of synovial fluid across the joint surface, a major contributor to cartilage nutrition)

129
Q

What leads to thinning of the hyaline cartilage surface of the joint?

A

Immobility. This is believed to be due to reduced nutritional support from decreased blood flow.

130
Q

What does “luxation” mean?

A

Full joint dislocation

131
Q

What is Wolff’s Law?

A

Bone will remodel in accordance with the stresses placed on it

132
Q

What forms as a result of degenerative disease in the joint?

A

Bone spurs (osteophytes)

133
Q

What is the difference between radicular pain, radiculitis, radiculopathy?

A

Pain: pain that follows a nerve distribution
Itis: nerve root distribution pain without identifiable neurologic deficits
Opathy: nerve not functioning properly (compressed)

134
Q

First step in sequence of events of disc degeneratiion

A

Disc is weakened by circumferential microtears in the annulus fibrosus

135
Q

Sequence of events of disc degeneration

A
  1. Disc weakened by microtears
  2. Radial tear formation
  3. Focal disc bulging
    4a. Disc herniation
    or
    4b. Circumferential bulging
  4. Disc narrowing
  5. Osteophyte formation
  6. Vertebral body enlargement
136
Q

Where does the pain originate from in a radial tear of the disc?

A

Believed to be related to the leakage of nucleus pulposus into this pain sensitive area of the disc

137
Q

T/F: the nucleus itself and the inner 2/3 of the annulus fibrosus contain no free nerve endings

A

True

138
Q

What does the psoas test provoke?

A

Discogenic pain in the spine

139
Q

Disc herniation is usually accompanied by….

A

Radiculopathy

140
Q

What are the three stages of spinal degeneration?

A
  1. Dysfunction
  2. Instability
  3. Restabilization and Stenosis
141
Q

Therapy for stage I of spinal osteoarthritis

A

Exercise and OMT

142
Q

Therapy for stage II of spinal osteoarthritis

A 
Exercise
OMT
Bracing
Prolotherapy
Pain mangement
Rhizotomy
Fusion surgery
143
Q

Therapy for stage III of spinal osteoarthritis

A

Exercise
OMT
Pain management
Surgical decompression

144
Q

Disc narrowing leads to what nerve root symptomatology?

A

Narrowing of the neural foramen

145
Q

What two conditions yield posterior joint syndrome?

A

Facet synovitis and circumferential annular tears

146
Q

How do you differentiate between facet syndrome and facet subluxation?

A

Imaging. Subluxation imaging reveals misalignment of facet joint surfaces

147
Q

Facet subluxation therapy

A

OMT
Exercise
Bracing
Prolotherapy

148
Q

Neurologic evaluation of the extremities if typically normal
Pain increases in seated position
Pain in L spine increases with voluntary contraction of the psoas
Pain in L spine increases with truncal rotation
Pain in C spine increases with attempts at rotation or sidebending

A

Disc bulging

149
Q

When is imaging performed for potential disc bulging?

A

After six weeks

150
Q

What are McKenzie exercises used for?

A

Disc bulging

151
Q

Entrapment of the nerve root in the area of the lateral recess caused by facet subluxation and disc narrowing

A

Dynamic lateral stenosis

152
Q

Excruciating nerve pain relieved by position
Worst positions are extension and rotation
Much easier to walk uphill or push a shopping cart
Increased pain walking downhill and reaching overhead
Neurogenic claudication

A

Dynamic lateral stenosis

153
Q

Use flexion exercise series

Avoid McKenzie exercises

A

Dynamic lateral stenosis

154
Q

Gold standard imaging for fixed lateral stenosis

A

CT scan with myelogram

155
Q

Patchy neurologic exam calling card of which condition?

A

Central canal stenosis

156
Q

CT scan is better than MRI at showing what feature in the spine?

A

Bone detail

157
Q

Williams ____ Exercises

McKenzie _____ Exercises

A

Flexion –> Dynamic lateral stenosis

Extension –> Disc bulging

158
Q

Which condition can cause neurogenic claudication?

A

Fixed lateral stenosis

159
Q

How many degrees of motion in the SI joint?

A

5 each in flexion and extension –> 10 total

160
Q

PSIS caudad

Sacral sulcus deep

A

Posterior inominatre rotation

161
Q

PSIS caudad
Ischial tuberosity caudad
Salcral sulci even

A

Inferior inominate shear

162
Q

PSIS cephalad

Sacral sulci shallow

A

Anterior rotation

163
Q

PSIS cephalad
Ischial tuberosity cephalad
Sacral sulci even
Lax sacrotuberous ligament

A

Superior inominate shear

164
Q

ASIS lateral

A

Outflare

165
Q

ASIS medial

A

Inflare

166
Q

Pubic tubercle cephalad

A

Superior pubic shear

167
Q

Pubic tubercle caudad

A

Inferior pubic shear

168
Q

What happens to the sacral sulcus when the pelvis rotates posteriorly?

A

Becomes deeper

OMM M1T3 (2 decks)

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