Final Review Flashcards
Cluneal nerve entrapment can occur with which of the following syndromes?
- Psoas trigger points
- Facet syndrome
- Scapulocostal syndrome
- Thoracolumbar dysfunction
Thoracolumbar dysfunction
What is the most common site for thoracic disc herniations?
T11/T12
Which of the following is true for T4 syndrome?
- The patient often complains of generalized dull headache
- It is caused exclusively by joint dysfunction of the T4/T5 motion segment
- It is very resistant to chiropractic adjusting and conservative care
- Symptoms get worse throughout the day and are relieved upon waking in the morning
The patient often complains of generalized dull headache
Patient is right side lying (right side down). Your superior hand contacts the ___ and your inferior hand contacts the ___ in order to correct for a right SI extension restriction.
superior hand contacts the left shoulder creating distraction of the torso and your inferior hand contracts the sacral apex
(this is a downside extension restriction adjustment)
In a prone hypothenar transverse process push with head assist adjustment to correct for a T1/T2 left rotation restriction, what is the correct vector of correction?
P to A to the right transverse process
Upper thoracic pain lateralized to one side that is exacerbated by shoulder motion and not provoked by thoracic or cervical spine motion is strongly suggestive of what diagnosis?
Scapulocostal syndrome
Which of the following is not associated with ankylosing spondylitis?
- Positive HLA B27 and negative rheumatoid factor lab tests
- Acute uveitis
- Progressive pain and stiffness of the thoracic spine
- Positive rheumatoid factor upon lab testing
Positive rheumatoid factor upon lab testing (not associated)
A patient presents with pain at the medial scapular border on the right. Pain can be reproduced by shoulder movement but does not change with cervical or thoracic range of motion. It does not change with coughing and sneezing or eating fried foods.
What are the top two differential diagnoses?
- Scapulocostal syndrome
- Dorsal scapular nerve entrapment
True or False:
Thoracic intervertebral disc herniations can cause myelopathic symptoms?
True
What muscles are often tight and shortened in patients with Scheuermann’s disease?
Hamstrings and pectorals
The supine index costal push adjustment for an elevated rib is performed mainly on which rib?
First rib
Which of the following conditions must be considered and ruled out before making a diagnosis of T4 syndrome?
- Thoracic outlet syndrome
- Cervical disc disease
- Diabetic neuropathy
- All of the above
All of the above
Low back pain that does not respond to usual customary localized treatment but responds to chiropractic manipulation of the motion segments between T10 and T12 strongly suggests what diagnosis?
Thoracolumbar dysfunction
What is the most prominent postural distortion associated with Scheuermann’s disease?
Thoracic hyperkyphosis
Tight and shortened scalene muscles are most closely associated with which of the following?
- Thoracolumbar syndrome
- Ankylosing spondylitis
- Depression restriction dysfunction of the first rib (ipsilaterally)
- Upper cervical joint restrictions with occipital neuralgia
Depression restriction dysfunction of the first rib (ipsilaterally)
True or False:
Constochondritis and Tietze’s syndrome can be differentiated by the facet that costochondritis involves, palpable swelling, and involvement of the sternocostal joints
False
Your patient presents with right AI sacrum. What adjustment is correct for this listing?
Patient is right side lying; hand contract is applied to left aspect of the sacral apex; a P=A, L-M, and S-I force is applied with counterclockwise torque
The pain of thoracic disc herniation can be exacerbated by which of the following?
- Neck extension
- Trunk rotation
- Coughing or sneezing
- All of the above
Coughing or sneezing
Patient is lying prone on the table. While palpating the mid thoracic spine, you find a decrease in motion upon pressing on the right TP of T7. What is correct in terms of doctor position and contact points?
Doctor stands on left side of table; left hand hypothenar will contact the right TP of T7; right hand hypothenar will contact the left TP of T8; a P-A thrust will be delivered through both contact hands
What is correct for a side lying hypothenar spinous push adjustment to correct for an L3/L4 left rotation restriction?
Left side up, contact the L3 spinous, left to right vector
With a right thoracic curve, the vertebral body will rotate to the ___, the spinous process will rotate to the ___, rib humping will be noted on the ___, and an elevated ___ shoulder will likely be noted
vertebral body will rotate to the right
spinous process will rotate to the left
rib humping in the right
elevated shoulder on the right
In a prone thumb spinous push with head assist adjustment to correct for a T1/T2 left rotation restriction, what is the correct vector of correction?
Left to right to the T1 spinous process
You perform a prone unilateral reinforced hypothenar TP push adjustment when you stand on the left of your patient and contact the left TP of T2 and thrust with a P-A vector.
Which of the following listings are you correcting?
- T2 LRM
- T2 PL
- T1/T2 RRR
- T2/T3 LRR
T2 LRM
Upon orthopedic and neurological examination of a patient, it is determined that the patient has a disc derangement at L5/S1. You also determine that there is compression of the aural nerve at the biceps femoris muscle due to the hypersensitivity of the lumbosacral pluxus.
What is this syndrome?
Double crush syndrome
Which of the following is true about Tietze’s syndrome and costochondritis?
- HVLA adjustments to the affected costosternal joints will speed recovery
- Usually resolves on its own in 7-10 days
- The two disorders have different presentations which assist in differential diagnosis
- Diagnosis requires diagnostic imaging for confirmation
The two disorders have different presentations which assist in differential diagnosis
Which of the following sites is not one of the three major locations for neurovascular entrapment in the etiology of thoracic outlet syndrome?
- Scalene muscles
- Behind pectoralis minor muscle
- Between the acromion process and humeral head
- Between the clavicle and first rib
Between the acromion process and humeral head (not a major site)
Thoracolumbar dysfunction can refer pain to which of the following areas?
- Ovaries
- Low back
- Inguinal region
- All of the above
All of the above
Which adjustive setup would correct for an AI body listing of T5?
Patient prone using a bilateral crossed hypothenar contact of the TPs with a P-A thrust
A 34-year-old male presents with pain along the superior border of the right gluteal area and right sided testicular pain. The neurological exam is unremarkable and there are no changes with a repetitive end range loading (MTD/Mackenzie) exam. There are no changes in bowel or bladder function and an examination of the kidneys is unremarkable. The pain is not reproduced by coughing or sneezing, but can be reproduced by lumbar spine range of motion. The pain is not reproduced with any motion of the sacroiliac joints (compression, distraction, and shearing).
Which condition would you suspect at this point?
Mainge’s syndrome
In a prone T2/T3 thumb spinous push with head assist for right rotation, which way are you pushing the spinous process?
Right to left
A patient presents with chest pain near the sternum. When asking them to point, they use one finger to point near the right costosternal junction on the fourth rib. You ask about shortness of breath, sweating, indigestion and nausea, to which the patient responds they have not experienced any of those.
What is on the top of your differential diagnosis list?
Costosternal joint dysfunction
The pathological changes associated with AS may eventually involve the entire spine and pelvis, but most notably begins in which region?
SI joints and pelvis
Which of the following should be included in your differential diagnosis of thoracic outlet syndrome?
- Cervical radiculopathy
- Cervical rib
- Shoulder arthropathy
- All of the above
All of the above
Upon palpating, you determine your patient has an elevation restriction of the right sixth rib.
Which set up would correctly address this finding?
Standing on the left side of the patient with a left hand reinforced hypothenar contact, applying an I-S and P-A impulse
Neurovascular entrapment involving the thoracic outlet may occur at all of the following anatomical sites except which of the following?
- Between anterior and middle scalene
- Between middle and posterior scalene
- Between the clavicle and first rib
- Deep to pectoralis minor
Between the middle and posterior scalene (does not occur at this site)
Upon palpation, you determine your patient as a depression restriction of the left fifth rib.
Which setup would correctly address this finding?
Standing on the left side of the patient facing caudally with a left hand reinforced hypothenar contact, applying a S-I and P-A impulse
You are standing behind a patient and you observe rib humping on the right. You ask the patient to bend forward and the humping straightens out.
What is the convexity of the curve, the orthopedic test performed, and the type of scoliosis this patient presents with?
Right convexity; Adams test; functional scoliosis
Which of the following is not a feature of scapulocostal syndrome?
- Difficulty distracting the scapula from the posterior chest wall
- Upper extremity dermatomal pattern parasthesias
- Symptoms seem to worsen as the day progresses
- Main cause thought to be postural, most likely due to upper crossed syndrome
Upper extremity dermatomal pattern parasthesias
Upon palpation, you determine there is a posterior articular pillar on the right at C3.
What listing and adjustive set up would be correct for this presentation?
C3 right rotation malposition; supine articular pillar push
Patient is left side lying (left side down). Your superior hand contacts the ___ and your inferior hand contacts the ___ in order to correct for a PRS of L3.
superior hand contacts the right shoulder lifting the torso into right lateral flexion and your inferior hand contacts the right side of L3 spinous process
T1 PR is the same as which listing?
Right rotation restriction
During an examination of a patient with scoliosis, you observe that the right convexity straightens out upon forward bending.
How would you categorize this scoliosis?
Functional scoliosis
Scheuremann’s disease mostly affects what population (age)?
10-20 years of age
A patient is positioned lateral recumbent on the table with their left side up. The doctor’s superior hand is contacting the upside of T12 spinous process. The doctor’s inferior hand is contacting the downside of L1 spinous process.
What is this adjustive procedure called and which listing is it correcting?
Side lying bilateral digital/ adjacent spinous process block/ pull; correcting a T12/L1 left rotation restriction
In order to define the direction of curvature in scoliosis, this is based on the ___ of the curve
convexity
True or False:
Thoracolumbar dysfunction often involves trigger points in the quadratus lumborum muscles requiring soft tissue manipulation of these areas
True
What is the most common direction of scoliosis?
Right
True or False:
Ankylosing spondylitis presents with the distinguishing radiographic feature known as “bamboo spine”
True
What is considered the gold standard for evaluation of scoliosis measurement?
Cobb’s angle
Sensory evaluation reveals decreased sensation along the medial forearm. You want to differentiate between cervical radiculopathy and TOS. Cervical distraction and compression tests are negative. Repetitive end range loading exam of the cervical spine is negative. There are no changes to the muscle strength or reflexes. Orthopedic testing was performed with the following findings: negative Adson’s test, positive Wright’s test, negative traction test, and a positive hostage position.
Based on the above findings, what is your diagnosis?
TOS entrapment at pectoralis minor
