Everything

Question 1

A vertebral artery dissection can result in what 3 things?

Answer 1

1. Few or minimal symptoms
2. Transient ischemic attack
3. Development of thrombi and emboli

Question 2

What is a VBI? And what causes it?

Answer 2

• vertebrobasilar insufficiency
• caused by abnormal stress on the vertebral artery, causing a reduction in blood supply to a specific part of the hindbrain

Question 3

What is mobilisation?

Answer 3

A form of non-thrust joint manipulation, typically applied within the physiological range of joint motion. May be applied at high or low velocities with a singular or repetitive movement

Question 4

Explain joint cavitation?

Answer 4

A preload force is applied to synovial joint taking viscoelastic fluid to a defined elastic barrier => stiffness
The thrust then creates a movement between two articular surfaces which is delivered to the synovial fluid=> SF cracks open like a solid ( due to the elastic recoil being above a critical velocity)

Question 5

Name the 4 hypothesis of lesions that respond to HVLA manipulation

Answer 5

• Theory 1: release of entrapped synovial folds or plica
• Theory 2: relaxation of hypertonic muscle by sudden stretching
• Theory 3: disruption of articular or peri-articular adhesions
• Theory 4: unbuckling of motion segments that have undergone disproportionate displacement

Question 6

Indications for SMT (5)

Answer 6

• posterior joint dysfunction
• muscle syndromes
• joint dysfunction co-existing with spinal stenosis
• joint dysfunction do-existing with spondylolisthesis
• S.I syndrome

Question 7

Contraindications for SMT : relative (6)

Answer 7

• acute disc herniation
• osteopenia
• spondyloathropathy
• anticoagulation
• bleeding disorders
• psychosocial overlay

Question 8

Contraindications for SMT: absolute (9)

Answer 8

• progressive neurological deficit
• destructive lesion of spine, ribs or pelvis
• healing fracture or dislocation
• avascular necrosis
• segmental instability
• cauda equina syndrome
• aortic aneurysm
• visceral pain
• malingering

Question 9

Expanding hematoma may result in what 4 things?

Answer 9

• seals off, remains small, asymptomatic
• occluded vessel => ischemia and subsequent infarction
• aneurysm => subdural hematoma
• change in normal hemodynamics

Question 10

Spinal muscle strain summary

Answer 10

• pain is main complaint
• pain can be local/ diffuse but does not radiate to extremities
• pain experienced straight after injury, increasing in intensity and distribution over time
• pain associated with increased oedema, reflex muscle contractions and limitation of motion
• overuse or stretching of a muscle

Question 11

Supraspinous ligament sprain

Answer 11

• No pain with active or passive extension

- Pain when stressed into flexion

Question 12

Lumbar spine strain/sprain summary (6)

Answer 12

1. resisted isometric contraction causes pain
2. tenderness on palpation
3. passive stretching will cause pain
4. hypertonic muscle
5. local tenderness with limited motion
6. Localised back pain also develops in people with ligamentous sprains

Question 13

3 categories of lumbar spine strain

Answer 13

• mild: subjective pain without objective findings, up to 1 week to recover
• moderate: limited range if spinal motion, paravertebral muscle spasm and pain, up to 2 weeks to recover
• severe: tilt forward or lean to one side, up to 3 weeks to recover

Question 14

Cervical spine strain summary

Answer 14

1. Pain with headache
2. Local/diffuse pain, middle to lower part of posterior neck
3. Doesn’t radiate to arm but does to shoulders
4. Dull aching pain
5. Pain worsens with activity, relieved by rest

Question 15

Posterior facet syndrome definition

Answer 15

Pain originating from any structure integral to both the function and configuration of the facet joints, including fibrous capsule, synovial membrane, hyaline cartilage surfaces and bony articulations

Question 16

Posterior facet syndrome etiology, symptoms and management:

Answer 16

Etiology: Trauma, degeneration, faulty posture
Symptoms: back pain radiating into groin, hip buttocks and often leg, in most cases above the knee
Management:
- manipulation and corrective exercises
- postural correction
- exercise to strengthen abdominal muscles
- reclining in a 90/90 position
-injection of anesthetic

Question 17

S.I syndrome symptoms

Answer 17

• pain over SI and PSIS which can refer to
• groin, hip, buttocks and posterior thigh
• aggravated by bending, sitting and riding in a car
• alleviated by standing and walking
• no true neurological symptoms of numbness or weakness

Question 18

Lasletts criteria

Answer 18

1. Distraction test
2. Thigh thrust test
3. Gaenslens test
4. Compression test
5. Sacral thrust test

Question 19

Therapeutic effects of spinal manipulation

Answer 19

Physical/ mechanical
- joint cavitation
- increased active/passive ROM
- breaking of intra-articular adhesions 
- mechanoreceptor stimulation 
Reflex/ neurophysiological
- inhibition of pain 
- relaxation of muscles by inhibition of motor neurons
- stimulation of ANS

Question 20

What are the two types of lateral stenosis

Answer 20

1. Those seen as a result of instability

2. Those seen as a result of degeneration

Question 21

Mechanism of lateral stenosis

Answer 21

• progressive degenerative changes in both facets and disc results in a loss of disc height
• approximation of the vertebrae creates a subluxation of facet joint whereby the superior facet moves upward and forward on the inferior facet, impinging on the pedicle above therefore narrowing the IVF