Examination 2 Flashcards
1
Q
What is spondylolysis?
A
Pathology to the pars interarticularis
2
Q
Does unilateral or bilateral spondylolysis cause a higher risk for spondylolisthesis?
A
Bilateral (slower healing time as well)
3
Q
Why is it important to catch a spondylolysis early?
A
Because fracturing 1 side of vertebral ring leads to increased stress on the other side and higher risk for fracture
4
Q
What is a common clinical presentation of spondylolysis?
A
Activity related back pain, worse with extension, SL hop worse on side of defect
5
Q
What is a solid battery of clinical test to use during a spondylolysis exam?
A
standing 1 leg hyperextension, SL hopping, and prone hip extension
6
Q
What is the best form of imaging to use for a spondylolysis?
A
Oblique xray
7
Q
What is the best form of xray to use for a spondylolosthesis?
A
Lateral
8
Q
What is a CT scan good at visualizing?
A
Healing vs non-union
9
Q
What is more accurate at discovering spondylolysis in youth athletes: CT or MRI?
A
CT
10
Q
What is the telltale sign on an xray for a spondylolysis?
A
Scotty dog with collar
11
Q
Briefly describe an intervention plan for a spondylolysis
A
Activity modification, bracing if pain is present at rest and persistent, return to sport once pain-free
12
Q
What is the motion we are most concerned about with spondylolysis?
A
Repeated lumbar extension
13
Q
What are some areas we want to work on in rehab for a spondylolysis patient
A
Posture (worried if they have excessive anterior L-spine tilt), gait (trendelenberg), strength (glutes and abs), movement coordination (breathing pattern, prone hip extension)
14
Q
Why is it important to fix breathing pattern for a spondylolysis patient?
A
Lots of extension occurs through thoracolumbar junction with faulty breathing
15
Q
What are some factors that could contribute to an anterior pelvic tilt?
A
Tight hip flexors, weak abdominals, weak glutes
16
Q
Why is it common (25%) for spondylolysis fractures to not heal entirely?
A
Because of the direction of fracture. It’s not inline with body weight
17
Q
How is spondylolisthesis graded?
A
1 - 25% slippage 2 - 50% slippage 3 - 75% slippage 4 - 100% slippage 5 - slips entirely forward
18
Q
What are we worried about most with spondylolisthesis?
A
Neurlogic compromise. Normally irritates L5/S1 nerve root which leads to LE weakness, paresthesia with occasional dysfunction
19
Q
What does treatment for spondylolisthesis look like?
A
Bracing for acute cases (3-6mo), LE flexibility program
20
Q
Why is a little bit of hamstring tightness okay for spondylolisthesis patients?
A
Pulls pelvis posteriorly which helps with slippage
21
Q
What is not indicated for spondylolisthesis patients?
A
Extension, lumbar lordosis
22
Q
What are the indications for surgery for a spondylolisthesis patient?
A
Greater than 1 year persistant pain, lateral shift, progressive neurological deficits, slip beyond grade 2, high slip angle
23
Q
What is the surgical technique that addresses spondylolisthesis?
A
In-situ fusion
24
Q
What are some ways to distinguish the clinical presentation of spondylolysis and spondylolisthesis`
A
Potential radicular symptoms on spondylolisthesis. Tight hamstrings with lysis and palpable step off/positive dural tension sigh with lolisthesis
25
Define idiopathic scoliosis
Complex 3D deformity of the spine and trunk
26
when does idiopathic scoliosis generally occur?
During a period of rapid growth
27
What is the most common scoliosis pattern?
Right thoracic curve with a left lumbar curve
28
Is scoliosis more prevalent in males or females?
Females
29
What are some of the long term impacts of scoliosis?
>80 degrees in T-spine = SOB, some decrease in QOL b/c it affects breathing and childbirth
30
Briefly describe the Cobb angle measurement (gold standard for measuring scoliosis)
ID upper and lower end vertebrae, draw lines extending alone vertebral orders, measure Cobb angle
31
How is scoliosis named?
For the convexity
32
When are patients with scoliosis braced?
When curve is <30 degrees and progresses >5 degrees in a year
33
How long does an average scoliosis patient wear a boston brace for?
Until they're skeletally mature
34
What are some downsides of long term wearing of a boston brace?
Disuse atrophy, loss of spinal proprioception
35
What is one criticism of the Boston brace?
Fails to account for 3D control of the spine
36
What are the components of therapy for scoliosis?
Cognitive, sensory-motor, and kinesthetic
37
What are the current guidelines for treatment of scoliosis?
<25 degrees - observation
25-50 degrees - bracing
>50 degrees - surgery
38
What are some goals of rehab for scoliosis?
Improve curvature, improve strength and balance of muscle activation, decrease trunk asymmetry, decrease pressure on vital organs, increase lung function, arrest progression of curve
39
What is a Magnetic Expansion Control Growing Rod?
Used for children still going to grow a lot. Can lengthen rods with magnetic tool with no surgery
40
What is ankylosing spondylitis?
Inflammatory process
41
What is the classic clinical presentation of ankylosing spondylitis?
15-35yo, insidious onset of morning stiffness, LBP, insertional tendinitis, possible involvement of eyes, heart, lungs, pain worse with rest and better with activity
42
What are some general treatment principles for rehabing someone with ankylosing spondylitis?
Education, extension based exercises, NSAIDs
43
What is Scheuermann's Disease?
Fixed rigid thoracic kyphotic deformity with or without pain
44
What is the clinical presentation of Scheuermann's Disease?
Asymptomatic (occasional pain/fatigue), higher incidence in adolescent rowers/weightlifters, rare progression in late life
45
How is Scheuermann's Disease diagnosed?
Lateral radiographs that show 3 consecutive T-spine vertebrae bodies with wedging > 5 degrees
46
How is Scheuermann's Disease treated?
Extension-based exercise, manual therapy, occasional bracing, surgery if not responsive to conservative care
47
What is the mechanism for a lumbar disc disruption?
Repetitive flexion and rotation (increases disc pressure)
48
How do you assess for diaphragm function?
Palpate rib cage and see if pt can generate IAP and breathe at same time `
49
What is a side effect showing a rectus dominant pattern?
Trouble breathing
50
What is congenital scoliosis?
Abnormal vertebrae development in the womb
51
What are some causes of neuromuscular scoliosis?
Poor muscle control, weakness or paralysis, neurological problems
52
What is the functional presentation of neuromuscular scoliosis?
Asymmetrical posture, deteriorating ability to sit
53
What are the two characteristics of a normal thorax?
Stable volume, ability to change volume
54
What structures enable a normal thorax to change volume?
Diaphragm and intercostals
55
What is thoracic insufficiency syndrome?
Limited lung growth secondary to rib cage and spinal deformities
56
How is thoracic insufficiency syndrome diagnosed?
Imaging, pulmonary function tests, physical exam, genetic testing
57
What might you focus on in PT prior to VEPTR for thoracic insufficiency syndrome?
Maximize ROM, strength, endurance, and chest wall mobility prior to surgery
58
How is VEPTR managed post-operatively
Acute - maximize independence with mobility, no lifting under shoulders, BLT, no BL UE overhead
Outpatient - help patient become as independent as possible with ADLs
59
What is the patient presentation of a R tortocollis?
R lateral flexion and L rotation
60
A baby is flexing laterally to the left and rotating to the right. What is the likely diagnosis?
L tortocollis
61
What is the cause of tortocollis?
Tight SCM
62
What are the types of tortocollis?
Postural (no SCM tightness or PROM restriction), miscular (SCM tightness and PROM restriction), SCM tumor (palpable mass in SCM)
63
What is the incidence of tortocollis?
16% of newborns
64
Why is early referral essential with tortocollis patients?
Become harder to stretch as they age and develop neck control, negate the need for later surgery
65
When should you be screening for tortocollis?
Birth - 4 mo
66
What are some potential sequalae of tortocollis if not treated early?
Hip dysplasia, brachial plexus injury, developmental delay, facial asymmetry, TMJ dysfunction
67
Why is it important to take a GI history in tortocollis patients?
History of reflux can contribute to asymmetrical postures
68
What are some things you want to be sure to document when taking a history for an infant with tortocollis?
Prenatal and birth history, head posture/preference, flatness on 1 side of head, diagnostic testing, age at onset of symptoms, developmental milestones
69
What are the key components of an exam for a child with tortocollis?
Posture, cervical ROM, cervical strength, extremity ROM, muscle tone, pain, oculomotor, objective asymmetries, SCM palpation, activity and development, craniofacial and plagiocephaly
70
What is a good way to get an objective measure of preferred head tilt in a child with tortocollis?
Digital photo, line through acromial processes, line through middle of both eyes, take angle where they intersect
71
How would one take a measurement of cervical rotation and lateral flexion?
Arthrodial protractor
72
What are the normative values for lateral flexion and rotation for an infant with tortocollis?
Flexion - 70 degrees
| Rotation - 110 degrees
73
How would one test strength/head righting in an infant > 2mo?
Hold them vertically in front of a mirror and then tip horizontally. Must hold head up for 5sec to maintain score
74
What are some potential asymmetries you would observe in children with tortocollis?
Tightness of upper trap, ipsilateral shoulder hiking, limb use, righting reactions, scoliosis, trendelenburg
75
Define plagiocephaly
Flatness of 1 part of the back of skull
76
Define brachycephaly
Head is wider than it is long
77
Define scaphocephaly
Head is longer than it is wide
78
How is plagiocephaly treated?
Repositioning (tummy time), supplemental devices (pillows), cranial remodeling orthosis
79
What is the typical length of wear for a cranial remodeling orthosis?
3-6mo
80
What are some findings that if present would cause you to refer to a physician?
Poor visual tracking, abnormal muscle tone, extra-miscular masses, side of torticollis change OR no reduction in asymmetry after 4-6 weeks
81
What is the prognosis for needing surgery for torticollis based on?
Limitations in C-spine ROM >15 degrees, persistent SCM mass, older age at initiation of treatment
82
What are some common interventions for children with torticollis?
Neck PROM, neck and trunk AROM, development of symmetrical movement, environmental adaptations, parent education
83
A child has R tortocollis. How do we want to stretch them?
Lateral flexion - to left, stretch R SCM
| Rotation - rotate to the right
84
If a child has R torticollis, where do we want to place toys?
Affected side (R) so they have to rotate that way to play
85
Why is the SI joint often described is regularly irregular?
2 surfaces of sacrum and innominate bone of ilium are not regular but there is a high geometric fit
86
What are the main ligaments that reinforce the SI joint?
Ventral and dorsal SI ligament
87
What does BW force acting on the sacrum cause?
Nutation (flexion of sacrum relative to innominate bone)
88
What do GRF coming up from the ground to the sacrum cause?
Moving innominate bone back relative to sacrum (nutation)
89
What ligaments prevent nutation of the sacrum?
Sacrutuberous ligament and sacrospinous ligament
90
What is form closure?
When the fit of 2 bodies hold them together
91
What is force closure?
When forces acting on bodies actively hold them together
92
What muscles cause force closure at the SI joint? What muscles oppose it?
Abdominals and pelvic musculature produce force closure, glute max opposes it
93
What action produces the least laxity at the SI joint?
Bracing
94
How does SI joint stiffness compare in males and females?
Females - 50% less stiff than males, significantly stiffened by pelvic floor muscles
95
What force does pelvic floor muscles produce?
Counternutation
96
Briefly describe motion at the SI joint?
Minimal mostly around a flexion/extension axis, moves at most 2-3 degrees
97
Describe the idea of sacroiliac torsions
1 side of pelvis goes one way while the other side goes the other way
98
What are the 3 joints that make up the ring of the pelvis?
2 SI joints and pubic symphesis
99
Though the SI joint doesn't have a classic pain pattern, pain coming from the joint still has some characteristic signs. What are those?
Primarily centered around PSIS, below L5 (can be into buttock and leg including anterolateral thigh), relieved by injection into joint
100
What are some special tests that work via symptom provocation for diagnosis of SI joint pain?
SI compression, SI gapping, sacral thrust, posterior thigh thrust, Gaenslen's, FABER, single leg drop, hip IR, active SLR
101
What are some common alignment and motion tests used for diagnosis SI joint pain? (Even though Phil thinks these are crappy)
Alignment - ASIS level, PSIS level, Iliac Cr level, supine to long sit, prone knee flexion
Motion - standing flexion standing hip flexion
102
What is Gaenslen's test?
Extreme ipsilateral hip flexion with contralateral hip extension
103
What is the thigh thrust test?
Posterior shear force through a flexed femur
104
What is SI gapping test?
Push ASIS apart
105
How many tests need to be positive for you to be fairly certain you're dealing with an SI joint problem?
3/5
106
If you have a person you think might have pain due to SI joint issues, how might you work on differential diagnosis for this?
First rule out whether or not they have a directional preference, then 3/5 positive symptom provocation tests
107
What SI joint special test is most relevant for post-partum women?
Active SLR
108
Describe the mechanics behind why the active SLR test works
Unilateral SLR causes a strong rec fem contraction which puts anterior rotation stress on the ilium
109
What is a sacral belt?
Goes around pelvis to stabilize. Shown to improve active SLR in post-partum women
110
What is the best placement for a SI stabilization belt and how should a patient wear it?
Right under SI joint (below ASIS), as tightly as they can stand
111
What is the theory behind a SI stabiization belt?
IT is an external reinforcement of the pelvic ring
112
What are the major categories of treatment used for SI joint pain?
Stabilization, mobilization/manipulation, trigger point/myofascial technique
113
What are the major predicators for which patients will do well with manipulations?
Duration of symptoms <16 days, no symptoms distal to the knee
114
What is the major treatment that has been shown to be helpful for patients with SI joint pain?
Stabilization
