Exam 4: Lumbar (9-12) Flashcards
1
Q
Lumbar spinal stenosis can be presented in the clinic in several ways. What are vast majority of ways that will be seen in the clinic
A
Facet joint
Lig. Flavum
Disc Bulge
VB flattening
2
Q
Which of the following treatment styles for spinal stenosis results in intermediate pain
A
Self help with positional change and OTC meds
3
Q
Which of the following treatment styles for spinal stenosis results in between intermediate and stenosis pain
A
Self help with PT
4
Q
Which of the following treatment styles for spinal stenosis results in stenosis pain
A
PT and injections
5
Q
What of the following treatment styles for spinal stenosis results in constant pain
A
surgery
6
Q
What are the 6 self help treatment for spinal stenosis
A
Positional changes Frequent breaks/sitting Leaning forward Shopping cart lean OTC medications Lifestyle changes/limit prolonged loading
7
Q
Describe the results of Whitman’s RCT study in which 58 patients with lumbar spinal stenosis were divided into two 6week PT programs
A
- Both groups met the threshold to recovery
- But the manual therapy, exercise, and walking group showed the highest level of recovery at 62%, while the flexion exercises and walking group showed 41% recovery rates
8
Q
What are the 7 PT treatments used for LSS
A
Education Treadmill/incline Cycling Lumbar traction Exercise/flexion based Manual therapy Neural tissue mobilization
9
Q
According to the louis gifford model, his four questions fall under which category of PT treatment for LSS
A
education
10
Q
The (young/elderly) have more spinal stenosis surgeries
A
elderly
11
Q
The fancy graph in the powerpoints are to used to provide pain neuroscience education to patients as well as to show a patient how a sensitive nervous system works. Within the graph a spot that shows there is little room for activity. How do we explain the best way to increase room for activity
A
Getting up and moving
This will increase blood flow and nerve play
12
Q
During treadmill walking for LSS, should the patient’s body weight be supported or unsupported
A
either
13
Q
During the treadmill walking for LSS, why is it important for the patient to be walking on an incline
A
It induces flexion
14
Q
Why is cycling a good intervention of LSS
A
It is recumbent and makes the patient sit upright
15
Q
A study by Fritz showed that a subgroup of LSS patients may benefit from mechanical traction. What does the subgroup must be characterized by
A
Prescence of leg symptoms
Nerve root compression
Peripheralization with extension
Crossed SLR
16
Q
What the five types of general exercises used for LSS
A
flexion based stabilization stretches aquatic aerobic
17
Q
True or False:
Clearance by a doctor is needed before performing aerobic exercises in patients with LSS
A
true
18
Q
Aquatic therapy can provide greater (short/long) term improvement in pain and function than conventional PT can in patients with LSS
A
short
19
Q
True or False:
Conventional PT can provide greater relief than aquatic therapy in patients with LSS
A
False, aquatic therapy is better. Especially in those who have limited exercise capacity on land.
20
Q
True or False:
In theory, stabilizing exercises in patients with LSS can increase space by pulling on the lig. flav.
A
true
21
Q
Manual therapy for treating LSS incudes (active/passive), (small/large) amplitude movements
A
passive; large
22
Q
How does manual therapy help treat LSS
A
increases space and blood flow
23
Q
What are the best mobs for LSS
A
PA hip mobs to facilitate natural extension
24
Q
There is a ___% increase in medicare expenditures for epidural steroid injections
A
629%
25
One interventional approach for stenosis is to reduce inflammation. This can be done by ESI's. Explain the benefits of ESI's
It will reduce inflammation which can provide relief. Disc bulges can also benefit from a decrease in swelling after ESI's. This can allow for more movements
26
True or False:
The rate of surgery for spinal stenosis alone increased 200% in the last decade
False, it increased 400%
27
There are predictors used in deciding whether a stenosis surgery will have good or poor outcomes. List the predictors for a poorer outcome
Depression
Cardio comorbidity
Disorder influencing walking ability
Scoliosis
28
There are predictors used in deciding whether a stenosis surgery will have good or poor outcomes. List the predictors for a good outcome
Better walking ability
Higher income
Less overall comorbidity
Male gender and younger age
29
Explain Cochrane's idea on surgery or not in patients with LSS
There isn't enough evidence to prove whether surgical or conventional is better for LSS. However there are no known side effects for conservative treatment.
30
Long term outcomes show that (surgical/non surgical) interventions have the highest improvement in LBP, a decrease in predominant symptoms, and are more satisfied with current status
surgical
31
The SI joint serves as the point of intersection between the ____ and the ___ ____ joints.
spine; LE
32
True or False:
The SI joint is very well understood so it has a simple treatment plan
False, it is the least understood making it controversial
33
The configuration of the SI joint is extremely _____ from person to person.
variable
34
True or False:
Differences in morphology and mobility of the SI joint from person to person are not pathological, but normal adaptation
true
35
True or False:
It is not normal for an individual to be asymmetrical in regards to the SI joint
False, it is normal
36
What is the prevalence of people seeking care for LBP as a result of SI joint pain
9%
| 1 in every 10
37
What two bones articulate at the SI joint
sacrum and ilium
38
The (anterior/posterior) side of the SI joint is synovial and has hyaline cartilage
anterior
39
The (anterior/posterior) side of the SI joint articulates with the PLL
posterior
40
What nerve innervates the SI joint and has nociceptors throughout the joint
sciatic nerve
41
The SI joint has a very (small/large) amount of movement. Approximately (4/84) %
small; 4%
42
The ligaments of the SI joint are some of the (weakest/strongest) ligaments of the body
strongest and toughest
43
What are the major ligaments on the anterior side of the SI joint
Dorsal Sacral lig.
Interosseus lig.
Anterior sacroiliac lig.
44
What are the major ligaments on the posterior side of the SI joint
Dorsal sacral lig.
Sacrospinous lig.
Sacrotuberous lig.
45
How many muscles attach directly to the sacrum and/or innominate
35
46
Are the 35 muscles that attach to the sacrum and/or innominate for mobility or stabilization purposes. Why?
stability
| It would be bad for the sacrum to move that much bc we would then compensate for a lot of unnecessary movement
47
What muscles are involved in the outer unit of the SI joint
| Think about ant. post. lateral. and deep longitudinal systems
lats, glute max, glute med, thoracodorsal fascia, ext/int obliques, contralateral hip adductors, and intervening abdominal fascia, ES, sacrotuberous lig. and Bicep femoris
48
What is another name for the term "pelvic floor muscles" and what are the three muscle groups involved
levator ani is the other term
Muscle groups: pubococcygeus, puborectalis and iliococcygeus
49
The levator ani musles joint the _____ muscles to complete the pelvic floor
coccygeus
50
What are the 5 functions of pelvic floor muscles
```
Increase intra-abdominal pressure
Provide rectal support during defecation
Inhibit bladder activity
Support the pelvic organs
Assists in lumbopelvic stability
```
51
The inner SI unit is like a ____. The bottom is the pelvic floor and the top is the diaphragm
cylinder
52
What are the muscles of the inner unit of the SI joint
multifidus, transverse abdominis, diaphragm, and pelvic floor
53
True or False:
It is unclear how the anterior and posterior aspects of the SI joint are innervated
True
54
Even though it is unclear how the anterior and posterior aspects of the SI joint are innervated, it is most likely to receive innervation from the (anterior/posterior) rami of the ____ roots.
posterior; L2-S2
55
Explain why there is a very diffuse pattern of pain referral from the SI joint
The joint is highly variable and differs among individuals, making it complex to pin point the exact nerve roots involved
56
Studies show that __% of sacra are found to have a sacralized L5 and __% are found to have a lumbarized S1
33; 24
57
is it more common to have a lumbarized S1 or L5
L5
58
What are the sagittal plane motions of the SI joint
Nutation/flexion
| Counter-Nutation/extension
59
The small amount of Sagittal plane movement occurs when both feet are (in the air/on the ground)
on the ground
60
Is there more nutation or counter nutation
nutation
61
What are the terms used in Snijders and Vleeming's research of SI joint kinetics
Form closure and force closer to describe the passive and active forces that help stabilize the pelvis and the sacroiliac
62
The more weight bearing, the (looser/tighter) the fit between the pelvis and sacrum creating a strong stabilization of the SI joint
tighter
63
What term is used when describing the appropriate amount of force between the sacrum and pelvis creating strong stabilization
key stone
64
SI joint stabilizing works in (parallel/cross) patterns
cross
65
The SI joint is basically a friction device. A "____" effect must be slightly unlocked to move functional. This effect is made possible because the SI joint (smoot/rough)
clutching; rough
66
SI joint dysfunction is generally caused by moving too little or moving to much. Match the patient population with whether the SI joint tends to move too little or too much
Men moves too little
| Women moves too much
67
The SI joint moving too little can also be caused by aging. List the 5 conditions that aging impacts the SI joint moving too little
```
OA
Shortened SIJ ligaments
RA
Decreased function
Ankylosing spondylitis
```
68
List some conditions that can cause the SI joint to move too much
```
Hormones/pregnancy
Ligamentous laxity
Excessive lumbar lordosis
Leg length
Ankylosing spondylitis
```
69
What type of pain will occur in patients in regards to ligaments moving too little at the SI joint
vague, posterior local ache
70
What type of pain will occur in patients in regards to intraarticular structures causing too little movement at the SI joint
Deep, posterior pain
| and possible groin pain
71
Is sacroiliitis a form of the SI joint moving too little or too much
too much
72
Sacroiliitis can occur with hormonal changes and pregnancy. List the physical characteristic that would be seen in sacroiliitis in pregnant women
Increased ptosin levels
Increased laxity of the SIJ lig.
Increased lumbar lordosis
Shifts weight posterior towards SIJ
73
Sacroiliitis can be caused by an increased stiffness from adjacent joints. What are the conditions that would cause increased stiffness
```
Lumbar surgery
Hip OA
Scoliosis
Lumbar spine degeneration
Ankylosing spondylitis
```
74
What is the gold standard of managing SI joint pain after lumbar fusion
anesthetic block under fluoroscopic
75
The SI joint is a synovial joint with (very little/abundance) of innervations which can contributed to LBP and referred pain in the ____
abundance; LE
76
What are the symptoms of sacroiliitis
Localized sharp stabbing pain. Can even be dull or throbbing
77
Is sacroiliitis bilateral or unilateral
unilateral
78
True or False:
There are neurological symptoms in patients with sacroiliitis
False, there is not
79
List the sacroiliitis provocation studies referral patterns in order from most referred to least referred
```
Buttock
Lumbar
LE
Below Knee
Groin (more proximal than distal)
```
80
True or False:
Sacroiliitis does not usually present with radiculopathy pain
true
81
Which dermatome will be responsible for pain that goes down the posterior entire leg but doesn't reach the top of the foot or the front of the leg
S2
82
What is referral pattern for an S2 dermatome
Pain the posterior leg that stops before it reaches the top of the foot
83
What are the aggs of a SI joint that moves too little
Prolonged walking/loading that puts strain on the ligs. and joints.
Rotational tasks
Morning pain due to OA
84
What are the eases of a SI joint that moves too little
Little bit of movement
Stop training task
Unloading
85
What are the aggs of a SI joint that moves too much
```
Loading with standing or walking
Transistional movements like stairs
Later in the day
Prolonged WB like running
Extension
Cough/Sneeze
```
86
What are the eases of a SI joint that moves too much
```
Rest
Unloading
Stabilization belt
Flexion
Muscle energy
```
87
Evidence available over the SIJ is (some/worth considering/still searching) regarding pain pattern generation and MOI
some
88
Evidence available over the SIJ is (some/worth considering/still searching) regarding provocation stresses
worth considering
89
Evidence available over the SIJ is (some/worth considering/still searching) regarding where to palpate for bone position or palpation for joint mobs
Still searching
90
Based on a review by Simopoulos, the evidence for dx accuracy of SIJ injection is (good/fair/limited)
Good
91
Based on a review by Simopoulos, the evidence for provocation maneuvers is (good/fair/limited)
fair
92
Based on a review by Simopoulos, the evidence for imaging is (good/fair/limited)
limited
93
True or False:
Even though there are many provocation tests for SI joint pain, the research shows that none of them are valid and/or do not have significant specificity or sensitivity
true
94
Explain the results of Dreyfuss study regarding SIJ provocation tests
None of the 12 tests demonstrated worthwhile diagnostic value
95
Explain the results of Slipman's study regarding SIJ provocation tests
Positive predictive values were shown as long as at least 3 tests were positive. Two of the three positive tests had to be Patrick's test and Ipsilateral sacral sulcus
96
Explain the results of Laslett's provocation test regarding SIJ pain
This study showed high sensitivity and specificity and 2 of the 4 tests showed the best predictive value:
-Distraction, compression, thigh thrust, Gaenslen's test, sacral thrust
97
Laslett's study in regards to SIJ provocation tests had a sensitivity of 91%, Explain the significance of this
If all tests are negative, we can be 91% sure it is not an SIJ problem
98
What mobs should be performed on a patient whose SIJ moves too little
Unilateral PA
Central PA
Rotation
99
What manipulations should be performed on a patient whose SIJ moves too little
```
Anterior innominate (CPR)
Rotational manipulation
```
100
The SIJ can either move too little or too much. What are the three general subcategories under the SIJ moving too much
mechanics, treat above and below, and stabilization
101
What are the mechanical interventions for treating SIJ that moves too much
Leg length
Orthotics
Taping
Bracing
102
What are the interventions used to treat above and below an SIJ that moves too much
Mobs and Manips to the lumbar spine and hip joint
103
What are the stabilization interventions for an SIJ that moves too much
exercises for the inner and outer units
104
What are the symptoms of piriformis syndrome
```
Sciatic nerve pathology
Numbness from mechanical pressure
Local pain
Deep buttox pain
Trigger points
Altered neurodynamics
```
105
What are the interventions used to treat piriformis syndrome
```
stretches
soft tissue treatment
trigger point therapy
neurodynamics
mobs/manips for S1,S2
```
106
Which neurotag structure is responsible for organizing and preparing movements
premotor/motor cortex
107
Which neurotag structure is responsible for concentration and focus
Cingulate cortex
108
Which neurotag structure is responsible for problem solving and memory
prefrontal cortex
109
Which neurotag structure is responsible for fear, fear conditioning, and addiction
amygdala
110
Which neurotag structure is responsible for Which neurotag structure is responsible for sensory discrimination
Sensory cortex
111
Which neurotag structure is responsible for stress responses, autonomic regulation, and motivation
Hypothalamus/thalamus
112
Which neurotag structure is responsible for movement and cognition
cerebellum
113
Which neurotag structure is responsible for memory, spatial recognition, and motivation
hippocampus
114
Which neurotag structure is responsible for gating from the periphery
spinal cord
