Examination 2 Flashcards

1
Q

What is spondylolysis?

A

Pathology to the pars interarticularis

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2
Q

Does unilateral or bilateral spondylolysis cause a higher risk for spondylolisthesis?

A

Bilateral (slower healing time as well)

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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

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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

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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

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6
Q

What is the best form of imaging to use for a spondylolysis?

A

Oblique xray

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7
Q

What is the best form of xray to use for a spondylolosthesis?

A

Lateral

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8
Q

What is a CT scan good at visualizing?

A

Healing vs non-union

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9
Q

What is more accurate at discovering spondylolysis in youth athletes: CT or MRI?

A

CT

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10
Q

What is the telltale sign on an xray for a spondylolysis?

A

Scotty dog with collar

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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

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12
Q

What is the motion we are most concerned about with spondylolysis?

A

Repeated lumbar extension

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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)

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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

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15
Q

What are some factors that could contribute to an anterior pelvic tilt?

A

Tight hip flexors, weak abdominals, weak glutes

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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

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17
Q

How is spondylolisthesis graded?

A
1 - 25% slippage 
2 - 50% slippage 
3 - 75% slippage 
4 - 100% slippage 
5 - slips entirely forward
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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

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19
Q

What does treatment for spondylolisthesis look like?

A

Bracing for acute cases (3-6mo), LE flexibility program

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20
Q

Why is a little bit of hamstring tightness okay for spondylolisthesis patients?

A

Pulls pelvis posteriorly which helps with slippage

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21
Q

What is not indicated for spondylolisthesis patients?

A

Extension, lumbar lordosis

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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

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23
Q

What is the surgical technique that addresses spondylolisthesis?

A

In-situ fusion

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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

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25
Q

Define idiopathic scoliosis

A

Complex 3D deformity of the spine and trunk

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26
Q

when does idiopathic scoliosis generally occur?

A

During a period of rapid growth

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27
Q

What is the most common scoliosis pattern?

A

Right thoracic curve with a left lumbar curve

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28
Q

Is scoliosis more prevalent in males or females?

A

Females

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29
Q

What are some of the long term impacts of scoliosis?

A

> 80 degrees in T-spine = SOB, some decrease in QOL b/c it affects breathing and childbirth

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30
Q

Briefly describe the Cobb angle measurement (gold standard for measuring scoliosis)

A

ID upper and lower end vertebrae, draw lines extending alone vertebral orders, measure Cobb angle

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31
Q

How is scoliosis named?

A

For the convexity

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32
Q

When are patients with scoliosis braced?

A

When curve is <30 degrees and progresses >5 degrees in a year

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33
Q

How long does an average scoliosis patient wear a boston brace for?

A

Until they’re skeletally mature

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34
Q

What are some downsides of long term wearing of a boston brace?

A

Disuse atrophy, loss of spinal proprioception

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35
Q

What is one criticism of the Boston brace?

A

Fails to account for 3D control of the spine

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36
Q

What are the components of therapy for scoliosis?

A

Cognitive, sensory-motor, and kinesthetic

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37
Q

What are the current guidelines for treatment of scoliosis?

A

<25 degrees - observation
25-50 degrees - bracing
>50 degrees - surgery

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38
Q

What are some goals of rehab for scoliosis?

A

Improve curvature, improve strength and balance of muscle activation, decrease trunk asymmetry, decrease pressure on vital organs, increase lung function, arrest progression of curve

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39
Q

What is a Magnetic Expansion Control Growing Rod?

A

Used for children still going to grow a lot. Can lengthen rods with magnetic tool with no surgery

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40
Q

What is ankylosing spondylitis?

A

Inflammatory process

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41
Q

What is the classic clinical presentation of ankylosing spondylitis?

A

15-35yo, insidious onset of morning stiffness, LBP, insertional tendinitis, possible involvement of eyes, heart, lungs, pain worse with rest and better with activity

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42
Q

What are some general treatment principles for rehabing someone with ankylosing spondylitis?

A

Education, extension based exercises, NSAIDs

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43
Q

What is Scheuermann’s Disease?

A

Fixed rigid thoracic kyphotic deformity with or without pain

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44
Q

What is the clinical presentation of Scheuermann’s Disease?

A

Asymptomatic (occasional pain/fatigue), higher incidence in adolescent rowers/weightlifters, rare progression in late life

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45
Q

How is Scheuermann’s Disease diagnosed?

A

Lateral radiographs that show 3 consecutive T-spine vertebrae bodies with wedging > 5 degrees

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46
Q

How is Scheuermann’s Disease treated?

A

Extension-based exercise, manual therapy, occasional bracing, surgery if not responsive to conservative care

47
Q

What is the mechanism for a lumbar disc disruption?

A

Repetitive flexion and rotation (increases disc pressure)

48
Q

How do you assess for diaphragm function?

A

Palpate rib cage and see if pt can generate IAP and breathe at same time `

49
Q

What is a side effect showing a rectus dominant pattern?

A

Trouble breathing

50
Q

What is congenital scoliosis?

A

Abnormal vertebrae development in the womb

51
Q

What are some causes of neuromuscular scoliosis?

A

Poor muscle control, weakness or paralysis, neurological problems

52
Q

What is the functional presentation of neuromuscular scoliosis?

A

Asymmetrical posture, deteriorating ability to sit

53
Q

What are the two characteristics of a normal thorax?

A

Stable volume, ability to change volume

54
Q

What structures enable a normal thorax to change volume?

A

Diaphragm and intercostals

55
Q

What is thoracic insufficiency syndrome?

A

Limited lung growth secondary to rib cage and spinal deformities

56
Q

How is thoracic insufficiency syndrome diagnosed?

A

Imaging, pulmonary function tests, physical exam, genetic testing

57
Q

What might you focus on in PT prior to VEPTR for thoracic insufficiency syndrome?

A

Maximize ROM, strength, endurance, and chest wall mobility prior to surgery

58
Q

How is VEPTR managed post-operatively

A

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
Q

What is the patient presentation of a R tortocollis?

A

R lateral flexion and L rotation

60
Q

A baby is flexing laterally to the left and rotating to the right. What is the likely diagnosis?

A

L tortocollis

61
Q

What is the cause of tortocollis?

A

Tight SCM

62
Q

What are the types of tortocollis?

A

Postural (no SCM tightness or PROM restriction), miscular (SCM tightness and PROM restriction), SCM tumor (palpable mass in SCM)

63
Q

What is the incidence of tortocollis?

A

16% of newborns

64
Q

Why is early referral essential with tortocollis patients?

A

Become harder to stretch as they age and develop neck control, negate the need for later surgery

65
Q

When should you be screening for tortocollis?

A

Birth - 4 mo

66
Q

What are some potential sequalae of tortocollis if not treated early?

A

Hip dysplasia, brachial plexus injury, developmental delay, facial asymmetry, TMJ dysfunction

67
Q

Why is it important to take a GI history in tortocollis patients?

A

History of reflux can contribute to asymmetrical postures

68
Q

What are some things you want to be sure to document when taking a history for an infant with tortocollis?

A

Prenatal and birth history, head posture/preference, flatness on 1 side of head, diagnostic testing, age at onset of symptoms, developmental milestones

69
Q

What are the key components of an exam for a child with tortocollis?

A

Posture, cervical ROM, cervical strength, extremity ROM, muscle tone, pain, oculomotor, objective asymmetries, SCM palpation, activity and development, craniofacial and plagiocephaly

70
Q

What is a good way to get an objective measure of preferred head tilt in a child with tortocollis?

A

Digital photo, line through acromial processes, line through middle of both eyes, take angle where they intersect

71
Q

How would one take a measurement of cervical rotation and lateral flexion?

A

Arthrodial protractor

72
Q

What are the normative values for lateral flexion and rotation for an infant with tortocollis?

A

Flexion - 70 degrees

Rotation - 110 degrees

73
Q

How would one test strength/head righting in an infant > 2mo?

A

Hold them vertically in front of a mirror and then tip horizontally. Must hold head up for 5sec to maintain score

74
Q

What are some potential asymmetries you would observe in children with tortocollis?

A

Tightness of upper trap, ipsilateral shoulder hiking, limb use, righting reactions, scoliosis, trendelenburg

75
Q

Define plagiocephaly

A

Flatness of 1 part of the back of skull

76
Q

Define brachycephaly

A

Head is wider than it is long

77
Q

Define scaphocephaly

A

Head is longer than it is wide

78
Q

How is plagiocephaly treated?

A

Repositioning (tummy time), supplemental devices (pillows), cranial remodeling orthosis

79
Q

What is the typical length of wear for a cranial remodeling orthosis?

A

3-6mo

80
Q

What are some findings that if present would cause you to refer to a physician?

A

Poor visual tracking, abnormal muscle tone, extra-miscular masses, side of torticollis change OR no reduction in asymmetry after 4-6 weeks

81
Q

What is the prognosis for needing surgery for torticollis based on?

A

Limitations in C-spine ROM >15 degrees, persistent SCM mass, older age at initiation of treatment

82
Q

What are some common interventions for children with torticollis?

A

Neck PROM, neck and trunk AROM, development of symmetrical movement, environmental adaptations, parent education

83
Q

A child has R tortocollis. How do we want to stretch them?

A

Lateral flexion - to left, stretch R SCM

Rotation - rotate to the right

84
Q

If a child has R torticollis, where do we want to place toys?

A

Affected side (R) so they have to rotate that way to play

85
Q

Why is the SI joint often described is regularly irregular?

A

2 surfaces of sacrum and innominate bone of ilium are not regular but there is a high geometric fit

86
Q

What are the main ligaments that reinforce the SI joint?

A

Ventral and dorsal SI ligament

87
Q

What does BW force acting on the sacrum cause?

A

Nutation (flexion of sacrum relative to innominate bone)

88
Q

What do GRF coming up from the ground to the sacrum cause?

A

Moving innominate bone back relative to sacrum (nutation)

89
Q

What ligaments prevent nutation of the sacrum?

A

Sacrutuberous ligament and sacrospinous ligament

90
Q

What is form closure?

A

When the fit of 2 bodies hold them together

91
Q

What is force closure?

A

When forces acting on bodies actively hold them together

92
Q

What muscles cause force closure at the SI joint? What muscles oppose it?

A

Abdominals and pelvic musculature produce force closure, glute max opposes it

93
Q

What action produces the least laxity at the SI joint?

A

Bracing

94
Q

How does SI joint stiffness compare in males and females?

A

Females - 50% less stiff than males, significantly stiffened by pelvic floor muscles

95
Q

What force does pelvic floor muscles produce?

A

Counternutation

96
Q

Briefly describe motion at the SI joint?

A

Minimal mostly around a flexion/extension axis, moves at most 2-3 degrees

97
Q

Describe the idea of sacroiliac torsions

A

1 side of pelvis goes one way while the other side goes the other way

98
Q

What are the 3 joints that make up the ring of the pelvis?

A

2 SI joints and pubic symphesis

99
Q

Though the SI joint doesn’t have a classic pain pattern, pain coming from the joint still has some characteristic signs. What are those?

A

Primarily centered around PSIS, below L5 (can be into buttock and leg including anterolateral thigh), relieved by injection into joint

100
Q

What are some special tests that work via symptom provocation for diagnosis of SI joint pain?

A

SI compression, SI gapping, sacral thrust, posterior thigh thrust, Gaenslen’s, FABER, single leg drop, hip IR, active SLR

101
Q

What are some common alignment and motion tests used for diagnosis SI joint pain? (Even though Phil thinks these are crappy)

A

Alignment - ASIS level, PSIS level, Iliac Cr level, supine to long sit, prone knee flexion
Motion - standing flexion standing hip flexion

102
Q

What is Gaenslen’s test?

A

Extreme ipsilateral hip flexion with contralateral hip extension

103
Q

What is the thigh thrust test?

A

Posterior shear force through a flexed femur

104
Q

What is SI gapping test?

A

Push ASIS apart

105
Q

How many tests need to be positive for you to be fairly certain you’re dealing with an SI joint problem?

A

3/5

106
Q

If you have a person you think might have pain due to SI joint issues, how might you work on differential diagnosis for this?

A

First rule out whether or not they have a directional preference, then 3/5 positive symptom provocation tests

107
Q

What SI joint special test is most relevant for post-partum women?

A

Active SLR

108
Q

Describe the mechanics behind why the active SLR test works

A

Unilateral SLR causes a strong rec fem contraction which puts anterior rotation stress on the ilium

109
Q

What is a sacral belt?

A

Goes around pelvis to stabilize. Shown to improve active SLR in post-partum women

110
Q

What is the best placement for a SI stabilization belt and how should a patient wear it?

A

Right under SI joint (below ASIS), as tightly as they can stand

111
Q

What is the theory behind a SI stabiization belt?

A

IT is an external reinforcement of the pelvic ring

112
Q

What are the major categories of treatment used for SI joint pain?

A

Stabilization, mobilization/manipulation, trigger point/myofascial technique

113
Q

What are the major predicators for which patients will do well with manipulations?

A

Duration of symptoms <16 days, no symptoms distal to the knee

114
Q

What is the major treatment that has been shown to be helpful for patients with SI joint pain?

A

Stabilization