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מסקולוסקלטל ליד > FINAL: SPINE > Flashcards

FINAL: SPINE Flashcards

1
Q

Cervical Vertebrae

spine
shape
#

A

Cervical LORDOSIS

Vertebrae CONCAVE

7 cervical vertebrae

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2
Q

Thoracic Vertebrae

spine
shape
#

A

Thoracic KYPHOSIS

Vertebrae CONVEX

12 Thoracic Vertebrae

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3
Q

Lumbar Vertebrae

spine
shape
#

A

Lumbar LORDOSIS

Vertebrae CONCAVE

5 Lumbar vertebrae

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4
Q

COCCYX vertebrae

A

3-5

FUSED

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5
Q

What are primary curves

A

convex curves that are present at birth

  • -thoracic kyphosis
  • -sacral convexity
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6
Q

What are secondary curves

A

come in as we develop (not present at birth)

Cervical Spine Lordosis : righting rxns where capital extensors get stronger

Lumbar Spine Lordosis : formed due to upright WB

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7
Q

Vertebral Body Parts

shape

size

blood supply

endplate

A

Shape: kidney, wider than height,

shape and size varies in the regions of the spine

bony outer layer and spongy medulla inside (good blood supply)

endplate on superior and inferior aspect –made of thin hylaine cartilage

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8
Q

Wolfs Law:

A

as load is placed on bone it remodels and adapts

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9
Q

Vertebral Arch

A

horseshoe shaped–foramen in the center that the SC travels through

Pedicles on lateral side face anteriorly

Facets are between the pedicles and lamina

Lamina posteriorly

PROCESSES:

  • superior/inferior: articular process
  • transverse process laterally
  • Spinous process posteriorly
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10
Q

Which vertebrae does not have an SP?

A

C1

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11
Q

Which Vertebrae does not have a body?

A

C1

C2

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12
Q

Cervical Spine

VB
SP
Articular Process

Special considerations

A

Vertebral body: small (weaker)

SP: short and bifid

Articular processes: have foramen (holes)for vertebral artery to supply blood to the brain –vulnerable to injury

*JOINT OF LUSCHKA (uncovertebral joint) [online it says they run form C3-C7!!!] C1-C2 has NO disc

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13
Q

Thoracic Spine

VB
SP
Articular Process

Special considerations

A

Vertebral Body: slender / long, course downward

SP: long and slender, course POSTERIORLY DOWNWARD *wont be in line with TP on palpation

Articular process: slender and project up

*costovertebral and costotransverse joints for ribs

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14
Q

Lumbar Spine

VB
SP
Articular Process

Special considerations

A

Vertebral Body: large/rectangular,
—–bulbous posterior tip, project posteriorly

SP: rectangular bulbous posterior tip, project HORIZONTALLY POSTERIOR

Articular Process: short and stout

** Largest Vertebral body

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15
Q

What motion most at C1/C2

A

Rotation

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16
Q

Which vertebrae no SP?

A

C1

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17
Q

What vertebrae has an extra process?

A

odontoid process on C2: axis

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18
Q

Articular Process:

where are they
where do they project from

A

paired on either side superior and inferior: project from junction of pedicle and lamina

each process has facet for articulation with corresponding facet of vertebrae above and below = ZYGAPOPHYSEAL JOINT

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19
Q

ZYGAPOPHYSEAL JOINT

A

each process has facet for articulation with corresponding facet of vertebrae above and below

capsule around facet joint has mechanoreceptor nerve endings to give proprioception to CNS–if misalign muscles told to contract to fix

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20
Q

Intervertebral Foramen

–what is its significance

A

NR exits here (it is btwn 2 vertebrae)

implication for injury:

  1. Disc bulge
  2. Degenerative disc disease
  3. Stenosis/facet hypertrophy–> spurring

boundaries of intervertebral foramen:
Superior: pedicle/arch of superior vertebrae
Inferior: pedcle/arch of inferior vertebrae

Anterior: dorsum of IV dis
***disc bulge can compress/irritate the exiting NR

Posterior: facet joint and ligamentum flavum

  • **stenosis here can affect nerve root (facet hypertrophy)
  • **DDD: if disc lose water content and foramen can collapse and issue and NR
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21
Q

What is purpose of ligaments?

A

structural stability

proprioceptive information

–can fail with repeated loading

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22
Q

ALL

purpose
attach
features

A
  • Checks hyperextension
  • High resistance to traction
  • extensive NERVE FIBERS for proprioceptive feedback

*attach to annulus, loose attach to VB

base of occiput–>Sacrum
Features: starts NARROWS in cervical spine and become more BROAD in lumbar spine

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23
Q

PLL

purpose
attach
features

A
  • Checks forward bending
  • extensive NERVE FIBERS for proprioceptive feedback

attach to annulus, NOT ATTACH TO VB**allows space for sinovertebral nerve / sinovertebral artery to feed VB with NERVE endings and BLOOD SUPPLY

base of occiput–>Sacrum
Features: thicker and stronger in CERVICAL SPINE and tapers and narrows in LUMBAR spine

**reason for POSTERIOR-LATERAL BULGE in lumbar spine instead of a central posterior bulge

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24
Q

Iliolumbar Ligament

function

attachement

special feature

A

TAUT IN CONTRALATERAL SIDEBENDING

Two bands, only in adults:

  1. superior band: transverse process L4–>Iliac crest
  2. inferior band: transverse process L5–> iliac crest

Stability: transmit force from axial skeleton through pelvic girdle

*QL/Psoas contract and cause L4/L5 motion which transmits force to SI joint

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25
Q

Ligamentum Flavum

function

attachement

special feature

A

lamina C2–>S1
(yellow=elastic)

Elastic, prestrain in neutral (15%): allow more flexion ROM and assistance returning

  • *elasticity reduce structures protrude into central canal
  • *prevent impingement: pull facet capsule so capsule doesnt pinch synovium in flexion/extension

[online: elasticity preserve the upright posture, and assist the vertebral column resuming it after flexion. elastin prevents buckling of ligament into spinal canal during extension, which would cause canal compression.]

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26
Q

Intertransverse Ligament

function

attachement

special feature

A

check contralateral lateral flexion + rotation

attach superior and inferior TP [like iliolumbar]

  • well developed in thoracic spine (they are round cords there)
  • conected to deep back muscles
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27
Q

Interspinous Ligaments

function

attachement

special feature

A

check forward bending

attach root of apex of adjacent SP**distinct in cervical spine

highly innervated: proprioception and pain if injury

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28
Q

Supraspinous Ligament

function

attachement

special feature

A

check forward bending + some rotation

attach apex of each SP **C7–>:4
above C7 it is ligamentum nuchae*

highly innervated: proprioception and pain if injury

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29
Q

Ligamentum Nuchae

function

attachement

special feature

A

keep erect posture in cervical spine, support cranium in upright position

sternal occipital protuberance–>spinous process of C7

homologous with interspinous and supraspinous ligaments

***some peopel have thicker that pop out when flex head and limit forward flexion

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30
Q

Orientation of facet joint
Horizontal plane and Frontal plane

Cervical Spine

Thoracic Spine

Lumbar Spine

A

Cervical Spine

  • -Horizontal: 45
  • -Frontal: 82

Thoracic Spine

  • -Horizontal: 60
  • -Frontal: 20

Lumbar Spine

  • -Horizontal: 90
  • -Frontal: 45
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31
Q

Cervical
Orientation of facet joint
Horizontal plane and Frontal plane

motion most here

A

Cervical Spine

  • -Horizontal: 45 degrees from the horizontal
  • -Frontal: 82

ROTATION

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32
Q

Thoracic
Orientation of facet joint
Horizontal plane and Frontal plane

A

Thoracic Spine

  • -Horizontal: 60
  • -Frontal: 20

so most have is: flexion/extension/sidebending

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33
Q

Lumbar
Orientation of facet joint
Horizontal plane and Frontal plane

A

Lumbar Spine

  • -Horizontal: 90
  • -Frontal: 45

**restricts rotation

L5 IS AN EXCEPTION TO THIS RULE BECAUSE IT IS A TRANSITIONAL VERTEBRAE

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34
Q

Motion in the spine is from what three joint?

A

2 facet joints

1 intervertebral joint

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35
Q

Cervical spine:

where does superior facet face?

A

BUM
backwards, upwards, and medial

most free in rotation: transverse horizontal plane

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36
Q

Thoracic spine

where does superior facet face?

A

BUL
backwards, upwards, lateral

facet surface is superior and lateral

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37
Q

Lumbar spine

where does superior facet face?

A

BM

medially

restricts rotation

so most have is: flexion/extension/sidebending

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38
Q

Disc Joint: between IV bodies

role

A

**disc doesnt have blood supply: it comes VB–>endplate–>disc

  1. dissipate forces/stress
  2. resist compression
  3. maintain size of foramina
  4. restrict motion
  5. ensure midrange position of facets during WB
  6. CERVICAL + LUMBAR: create lordosis secondary to wedge shape–anterior disc is taller than posterior disc

**allow 6 degrees of motion
disc attached to each VB through endplate

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39
Q

How many discs in the body?

A

23 (NO DISC AT C1/C2)

so 7-1 = 6 cervial
12 thoracic
5 lumbar
= 23

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40
Q

Endplate

A

superior inferior border between disc and subchondral bone

*hyaline cartilage

resembles disc:

  • center: more proteoglycans and water
  • periphery: more collagen

0.6mm thick

vascular supply from VB –> endplate –> disc

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41
Q

Annulus fibrosis

  1. what is it made of and what is its orientation
  2. what does it attach to
  3. what covers it
A

1) Made of:
- —fibrocartilage
- —12-15 concentric rings in criss-cross oblique fashion at 30 degrees from horizon–> this makes it resist ROTATION
- —outer layer it vertical

2) attachments:
- —inner 1/3 attach ENDPLATE
- —outer 1/3 attach VB: SHARPEYs FIBERS
- —ALL and PLL attach to annulous fibrosis: this helps contain bulges

3) covered by sheath:
— SINOVERTEBRAL NERVE innervation: outer 1/3
spinal NR exit through foramen (split to dorsal and ventral ramus): the sinnovertebral nerve doubles back and has pain and mechanoreceptors on outer 1/3 of annulous fibrosis
*pain can be from another level

(remember: inner disc is nucleous propulses and outer is annulus fibrosis)

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42
Q

Nucleus Prupolsus

% water
why affinity for water
nutrition source
in case of herniation, what causes the pain
how does it pressure on nucleus prupolsus decreased

A

1) 88% water
* ***Lose water with age: matrix changes and lose affinity

2) due to monopolysaccharide matrix: high affinity for water
3) nutrition from endplate: no vascularity
4) *herniation, the pain comes from outside and not from inside the disc

5) *central portion is hydrostatic cushion: distribute forces evenly: if compressed water seeps to annulus (decreases pressure on the nucleus pulposus)
- -when remove load disc should return to original position

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43
Q

Intervertebral Disc

  1. what is the pressure on it with no load?
  2. Morning
  3. Evening
  4. Aging
A

1) preloaded state: pressure is never zero
when it is decreased, flexibility is decreased

2) Morning: increased disc height: resorb water in supine and draw in nutrients [more pressure]
3) Evening: decreased disc height: pressure from WB all day –water seep out into lamellae
4) Aging: decreased disc height: decreased water content

***diseased disc wont do the norm of water seep out with pressure and water resorbed when pressure removed

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44
Q

Which ligament has 10-15% preload for flexibility/prevent impingement during motion?

A

ligamentum flavum

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45
Q

what time of day a disc herniation will hurt most?

A

morning

more pressure and bulging in the morning

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46
Q

Disc thickness to VB height?
Cervical
Thoracic
Lumbar

where is there more mobility in the spine?

A

Cervical: 2:5: most mobility in cervical: mosts disc thickness to VB height
Disc 2: VB 5

Thoracic: 1: 5: least mobility in thoracic: smallest disc thickness to VB height
Disc 1: VB 5

Lumbar: 1:3
Disc 1: VB 5

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47
Q

Which section of spine has most disc thickness to VB height?

Which section of spine has least disc thickness to VB height?

A

Most: Cervical

Least: Thoracic

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48
Q

Where is the nucleus propulses in each section of the cervical spine?

A

Cervical spine: 4-7/10 of anterior posterior depth of VB superior surface IN LINE WITH AXIS OF MOTION

Thoracic spine: 4-7/10 of anterior posterior depth of VB superior surface BEHIND AXIS OF MOTION

Lumbar spine: 4-8/10 of anterior posterior depth of VB superior surface IN LINE WITH AXIS OF MOTION

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49
Q

Is the nucleus propulses on the vertebral body in line with the axis of motion in the

Cervical Spine

Thoracic Spine

Lumbar Spine

A

Cervical Spine: IN LINE WITH AXIS OF MOTION

Thoracic Spine: posterior

Lumbar Spine: IN LINE WITH AXIS OF MOTION

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50
Q

What doesnt the disc do in osteoarthritis that is should do?

A

fail to recuperate after unloaded (the return to normal after the load taken away)

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51
Q

Where does the disc move in:

Flexion

Extension

Lateral Flexion

Rotation

A

Flexion: posteriorly
(superior vertebrae moves anterior with respect to inferior vertebrae, anterior aspect gets smaller and posterior aspect gets bigger)

Extension: anteriorly
**someone with posterior lateral disc bulge should do extension exercises to reduce the disc bulge

Lateral Flexion: side bend to the right: DISC MOVES LEFT
(superior vertebrae moves right with respect to inferior vertebrae)
**ALL and PLL push to maintain disc in flexion / extension

Rotation: compressive forces : twisting cause compression and shearing/stress torsion

**annulous fibrosis has cross fibers that resist torsion with rotation: 30 degrees alternating each layer from horizon, rotation to right : right annulous fibrosis will be taut and left will be slack

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52
Q

Motion: Flexion

Movement of upper vertebrae

change in space

Nucleus propulsus migration

IV foramen

A

Movement of upper vertebrae: anterior

change in space: more space posterior

Nucleus propulsus migration: posterior

IV foramen: opens : facet joints seperate

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53
Q

Motion: Extension

Movement of upper vertebrae

change in space

Nucleus propulsus migration

IV foramen

A

Movement of upper vertebrae: posterior

change in space: more space anterior

Nucleus propulsus migration: move anterior

IV foramen: SMALLER: facet joints close –especially with hypertrophy

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54
Q

Motion: Lateral Flexion

Movement of upper vertebrae

change in space

Nucleus propulsus migration

IV foramen

A

Movement of upper vertebrae: ipsilateral side

change in space: more space contralateral side

Nucleus propulsus migration: contralateral side

IV foramen : more open on contralateral side, more small on ipsilateral side ??

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55
Q

Motion: Rotation

Motion: Lateral Flexion

Movement of upper vertebrae

change in space

Nucleus propulsus migration

IV foramen

A

Movement of upper vertebrae ?

change in space: DECREASED JOINT SPACE DUE TO COMPRESSION

Nucleus propulsus migration ?

IV foramen
smaller on ipsilateral side, more space on contralateral side

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56
Q

Histamine Scratch Test

A

scratch and see response

no reaction or decreased: can be due to chronic injury , stagnation, lack of BF

hyper-reaction: increased inflammation due to injury

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57
Q

where in spine is nucleus propulses in line with axis of motion

A

cervical and lumbar spine

NOT THORACIC SPINE: behind axis of motion

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58
Q

if you turn R, what happens to annulus fibers?

A

R: taut
L: slack

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59
Q

What happens to load in disc in:

supine, sit, stand, lean forward, lifting

A

Disc pressure in supine less than standing

Leaning forward (sit and stand) increases pressure

Lifting with poor mechanics increases pressure

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60
Q

Nachemson et al laod in disc

*sit vs stand

A

least to most

SUPINE–> sidelie –> STAND –> unssuported SIT –> stand lean forward –>sit lean forward –> stand holding load –> unsupported sit leaning forward with load

**SITTING MORE THAN STANDING

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61
Q

Wilke et al load in disc

*sit vs stand

A

Less in sitting than in standing

less pressure when hold load with bent knees correctly

lying supine increased pressure (fluid comes in)

**STANDING MORE THAN SITTING

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62
Q

Sato et al

intradiscal pressure between positions and disc degeneration

A

SITTING MORE THAN STANDING
spinal load increased in the following order of body positions: prone –> lateral–>upright standing–> upright sitting

Intradiscal pressure significantly reduced according to the degree of disc degeneration

respiration affected disc pressure in prone (more with valsalva)

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63
Q

Sinnovertebral Nerve:

where it goes

A

recurrent meningeal nerve:

off ventral ramus and doubles back to innervate structures in the canal and annulus fibrosis then wraps around to anterior of annulus fibrosis (can go up and down and innervate different levels)

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64
Q

Medial branch of the posterior ramus

where it goes

A

to facet joint capsule and ligaments

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65
Q

Lateral branch of posterior ramus

where it goes

A

to muscles in back and skin

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66
Q

vertebral Artery

A

supplies brain with blood and O2

vulnerable to injury!!

comes up through neural foramina on either side of cervical column and takes serpintine course through C1/C2 vertebrae to enter the skull

**Check integrity to make sue with patient and not get injury

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67
Q

Spinal Movement

A

degrees of freedom
by region
coupled motions
fryette’s laws of motion

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68
Q

Spinal movement and degrees of freedom

A
  1. axial compression / distraction
  2. rotation: transveres plane
  3. forward/backward bend: saggital plane
  4. Lateral flexion: frontal/coronal plane
  5. forwar-backbend sliding/translation: rib mobilization
  6. lateral glide/translation: rib mobilization
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69
Q

Spinal Movement By Region

A

CERVICAL MOST ROTATION

LUMBAR MOST FLEXION

Rotation: Cervical most
then thoracic, then ( lumbar least )

Side Bend: Cervical then Thoracic

Forward Bend: Lumbar has the most

Backbend: depend on study if cervical or lumbar (both say thoracic has the least)

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70
Q

Rotation

which spinal segment has the most rotation

A

C1/C2 has the most

diminishes as you go down the spine

hardly any in lumbar spine except L5/S1 because it is a transitional segment so more than the other of the lumbar spine

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71
Q

Flexion/extension

which spinal segment has the most

A

more cervical and lumbar

less thoracic

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72
Q

Lateral flexion

which spinal segment has the most

A

not much variation but in thoracic there is less mobility

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73
Q

Yellow flags

A

Beliefs, appraisals and judgements, Emotional Responses, Pain behavior:

Catastrophising – thinking the worst

Finding painful experiences unbearable, reporting extreme pain disproportionate to the condition

Having unhelpful beliefs about pain and work – for instance, ‘if I go back to work my pain will get worse’

Becoming preoccupied with health, over-anxious, distressed and low in mood

Fear of movement and of re-injury

Uncertainty about what the future holds

Changes in behaviour or recurring behaviours

Expecting other people or interventions to solve the
problems (being passive in the process) and serial visits to various practitioners for help with no improvement.

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74
Q

Blue flag

A

Perceptions about the relationship between work and health

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75
Q

Black flags

A

outside the immediate control of the employee and/or the team trying to facilitate the return to work.,

Legislation restricting options for return to work.
Conflict with insurance staff over injury claim.
Overly solicitous family and health care providers.
Heavy work, with little opportunity to modify duties.

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76
Q

Special questions to ask in upper quarter exam

A 
Sleeping position
Dizziness
difficulty swallowing
bilateral numb or tingling
gait disturbances 
overt weakness (dropping objects)
BECAUSE: these can all be from vsiceral or central (neuro) disorders

we want to rule out red flags (bowel, lung, cancer)

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77
Q

Yellow Flags

A

psychosocial components to their pain

fear avoidance, catastrophizing

these will complicate PT, require referral to CBT therapist

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78
Q

insidious onset

A

they dont know when it started, bothering them over time (ie an overuse injury)

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79
Q

what we want to ask in upper quarter about injury

A
  1. when did it start–mechanism, did they hear or feel something in particular
  2. did it start with pain or stiffness
3. what aggrevates the pain: 24 hour clock 
morning vs evening
sitting vs standing
ADL
sport
  1. what alleviates it / makes it better: if it never fluctuates we are concerned about a systemic or sinister source of pain

if pain is constant then it is not an indication for a musculoskeletal source of pain

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80
Q

Upper quarter:

QUICK TESTS

A

A) AROM: if painfree apply overpressure

  • shoulder
  • -apley’s scratch test and apply overpressure
  • elbow
  • wrist

Cervical spine: if full and painfree overpressure except EXTENSION (if FHP, put in neutral first)

we are looking for:

  1. quality of motion
  2. ranges
  3. willingness to move
  4. does it cause pain

B) If decreased ROM we go to PROM
supine on table, support occiput and assess endfeel as do flexion, sidebend, rotation (not extension, we have special tests for it)

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81
Q

Apley’s Scratch Test

A

+ overpressure: use combining motio and overpressure: bring hand behind the back and see where middle finger hits-see if it is the same bilaterally : do this for ER and IR

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82
Q

What do we look for in AROM test of upper quarter?

A

we are looking for:

  1. quality of motion
  2. ranges
  3. willingness to move
  4. does it cause pain
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83
Q

Upper Quarter Examination

Neuro Exam

  • -when?
  • -how?
A

if they complain of changes in sensation, radiating pain, numbness, tingling, distal weakness, or any symproms are replicated in the neck exam

MYOTOME: check integrity of the NR going into the muscle

  • -test for fatiguing weakness
  • *contractile lesion or strain will be weak or painful with every repetition in the same way**

if fatiguing weakness is due to nerve conduction it will be more weak with repetitions because they cannot recruit from other fibers when fatigued

–if there is fatiguing weakness: differentiate it
Elbow: C5/C6 so test another muscle in the myotome (ie shoulder abduction and wrist extension)

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84
Q

Can you have sensory nerve involvement and not have fatiguing weakness?

A

motor nerves are in the center of the nerve so may not be deformed immediately

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85
Q

Myotomal Exam

Neck Flexion/Rotation

A

C1

here we do one isometric test because easy to flare up the cervical spine

hand on front of forhead and back of occiput

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86
Q

Myotomal Exam

Shoulder Shrugging

A

C2, C3, C4

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87
Q

Myotomal Exam

Diaphragm

A

C4

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88
Q

Myotomal Exam

Shoulder Abduction

A

C5

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89
Q

Myotomal Exam

Elbow Flexion

A

C5, C6

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90
Q

Myotomal Exam

Wrist Extension

A

C6

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91
Q

Myotomal Exam

Wrist Flexion

A

C7

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92
Q

Myotomal Exam

Elbow extension

A

C7

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93
Q

Myotomal Exam

Thumb extension, finger flexion

A

C8

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94
Q

Myotomal Exam

Finger abduction finger adduction

A

T1

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95
Q

Myotomal Exam

C1

A

Neck Flexion/Rotation

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96
Q

Myotomal Exam

C2, C3, C4

A

Shoulder Shrugging

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97
Q

Myotomal Exam

C4

A

Diaphragm

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98
Q

Myotomal Exam

C5

A

Shoulder abduction

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99
Q

Myotomal Exam

C5, C6

A

Elbow Flexion

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100
Q

Myotomal Exam

C6

A

Wrist extension

101
Q

Myotomal Exam

C7

A

elbow extension, finger flexion

102
Q

Myotomal Exam

C8

A

thumb extension, finger flexion

103
Q

Myotomal Exam

T1

A

finger abduction, adduction

104
Q

Dermatomal Exam

Occiput

A

C2

105
Q

Dermatomal Exam

Jaw/Neckline

A

C3

106
Q

Dermatomal Exam

supraclavicular fossa

A

C4

107
Q

Dermatomal Exam

Lateral brachiam (side of arm)

A

C5

108
Q

Dermatomal Exam

Lateral base of thumb

A

C6

109
Q

Dermatomal Exam

Distal Phalanx digit 3

A

C7

110
Q

Dermatomal Exam

Ulnar border digit #5

A

C8

111
Q

Dermatomal Exam

Medial border forearm

A

T1

112
Q

Dermatomal Exam

C2

A

occiput

113
Q

Dermatomal Exam

C3

A

neck (jawline)

114
Q

Dermatomal Exam

C4

A

supraclavicular fossa

115
Q

Dermatomal Exam

C5

A

lateral brachium

116
Q

Dermatomal Exam

C6

A

lateral base of thumb

117
Q

Dermatomal Exam

C7

A

distal phalanx digit #3

118
Q

Dermatomal Exam

C8

A

ulnar border digit #5

119
Q

Dermatomal Exam

T1

A

medial border forearm

120
Q

DTR

Biceps

A

C5, C6

121
Q

DTR

brachioradialis

A

C6

122
Q

DTR

Triceps

A

C7

123
Q

DTR

0

A

ABSENT

124
Q

DTR

1+

A

decreased/hyporeflexive

125
Q

DTR

2+

A

normal

126
Q

DTR

3+

A

brisk

127
Q

DTR

4+

A

hyperreflexive with nonsustained clonus

128
Q

Jendrassik

A

distract the patient to relax them to illicit the DTR

129
Q

Which DTR grade means normal?

A

2+

130
Q

Myotomal Test

Hip Flexion

A

T12, L1-L3

illiopsoas

131
Q

Myotomal Test

Hip Flexion

A

(L2)

T12, L1-L3

illiopsoas

132
Q

Myotomal Test

Knee Extension

A

L3

quads

133
Q

Myotomal Test

Dorsiflexion

A

L4

anterior tibialis

134
Q

Myotomal Test

Extend big toe

A

L5

EHL

135
Q

Myotomal Test

PF

A

S1

peroneus longus and brevus

136
Q

Myotomal Test

Heel Raises

A

S1-S2

Gastroc/Soleus

137
Q

Myotomal Test

Foot intrinsics

A

S2-S4

138
Q

Myotomal Test

Bladder

A

S2-S4

139
Q

Myotomal Test

T12

L1-L3

A

illiopsoas

hip flexion

140
Q

Myotomal Test

L2-L4

A

quads

knee extension

141
Q

Myotomal Test

L4

A

anterior tibialis

142
Q

Myotomal Test

L5

A

extensor hallucis longus

143
Q

Myotomal Test

S1

A

peroneus longus and brevis

144
Q

Myotomal Test

S2, S3, S4

A

bladder

foot intrinsics

145
Q

Dermatomal

Inguinal line

A

L1

146
Q

Dermatomal

anterior proximal tigh

A

L2

147
Q

Dermatomal

anterior medial knee

A

L3

148
Q

Dermatomal

medial leg

A

L4

149
Q

Dermatomal

lateral leg

A

L5

150
Q

Dermatomal

lateral foot / calcaneus

A

S1

151
Q

Dermatomal

L1

A

inguinal line

152
Q

Dermatomal

L2

A

anterior proximal thigh

153
Q

Dermatomal

L3

A

anterior medial knee

154
Q

Dermatomal

L4

A

medial leg

155
Q

Dermatomal

L5

A

lateral leg

156
Q

Dermatomal

lateral foot/calcaneus

A

S1

157
Q

DTR

achilles tendon

A

S1

158
Q

DTR

patella tendon

A

L4

159
Q

Babinski

A

start plantar calcaneus and drag it up laterally and at MTP go medially

NORMAL: toes flex = negative

POSITIVE: toes fan out (sign for UMN)

in babies 6 months - 2 years have babinski

160
Q

Clonus

A

stabilize at lower leg and give a quick stretch into DF at plantar foot

POSITIVE: patient kicks back at you: clonus (sign for UMN)

document # of beats

161
Q

Hoffman Sign

A

stabilize their hand but leave fingertips free

FLICK 3rd digit into EXTENSION

POSITIVE: clawing thumb and 1st finger

162
Q

Test Pec Minor Tightness

A

shoulder height from table

normal 1-2 inch

–if more see if pec minor causing scapula anterior tilt, palpate pec minor and see if hypertonic or tight and compare sides and see if we want to tx if fits with cheif complaint

163
Q

Soto Hall Test

A

supine: flex neck up; chin to chest

Positive: lightening pain elicited (spinal cord issue, tumor, TB, fracture)

Brudzinski sign: respond with knee flexion to get slack in the spinal cord as a result of the Soto Hall Test

164
Q

Brudzinski sign:

A

respond with knee flexion to get slack in the spinal cord as a result of the Soto Hall Test

165
Q

Vertebral Artery Tests

4

A

they are performed after clear and no signs and sx from ROM tests

  1. Quadrant test in supine
  2. Hautards
  3. Swallowing
  4. Valsalva
166
Q

Quadrant Test in supine

A

Supine: combine extension + rotation + sidebend

Wait between each layer to see if there is a change in blood flow (pick up the response)

  1. EXTEND and wait 10 seconds: make sure no changes
  2. add LATERAL FLEX: wait 10 seconds here
  3. add ROTATE wait 30 seconds

+ dizzy, nystagmus, nausea, etc.

167
Q

Hautards

A

Part 1:
patient stand with shoulders flexion in front and supinated EYES CLOSED
-Arm loses position => this is not vascular source, it is vestibular/cerebellar source

Part 2:
OPEN EYES: rotate + extend cervical spine
to compress the vertebral artery
–Positive => this is vascular insufficiency, because compromised the bloodlfow

168
Q

Swallowing

A

observe/palpate HYOID when patient swallows

–swallow dysfunction is cranial nerve (ie tumor pressing on CN)

169
Q

Valsalva

A

space occupying lesion, cancer, disc bulge

they will say have sx when they bear down

170
Q

Thoracic Outlet Syndrome Tests

A

btwn clavicle and first rib there is decreased space and this can compromise the vascular / nerve

  1. ROOS
  2. Adson
  3. Halstead
  4. Allens
  5. Wright
171
Q

Roos Test

A

Test for TOS

Patient if in shoulder 90-elbow 90
Open and Close hands for THREE MINUTES!!!

Positieve: ellicit symptoms (numb, tingling, heaviness that is ASSYMETRICAL)

172
Q

Adson Test

A

TOS (pecs), Palpate radial pulse on snuffbox to see if it diminishes with

  1. Shoulder Extension/Abduction/ER and SUPINATION
  2. Patient holds breath (pulls up first rib)
  3. Head rotated to IPSILLATERAL side (contract scalenes to see if compromising bloodflow to radial artery)

POSITIVE: weakens radial pulse

(adson loves looking at his arm in the sun)

173
Q

Halstead Test

A

TOS, Palpate radial pulse on snuffbox to see if it diminishes with

  1. Shoulder Extension/Abduction/ER and SUPINATION
  2. Patient holds breath (pulls up first rib)
  3. Head rotated to CONTRALATERAL side (lengthen scalenes to see if compromising bloodflow to radial artery)

POSITIVE: weakens radial pulse

(halstead looks the other way instead )

174
Q

Allens Test

A

TOS, Palpate radial pulse on snuffbox to see if it diminishes with

***Shoulder 90/ Elbow 90 + Contralateral head rotation

POSITIVE: weakens radial pulse

(allen is a poser posing his muscle to you )

175
Q

Wright

A

TOS, Palpate radial pulse on snuffbox to see if it diminishes with

*** Shoulder full abduction

POSITIVE: weakens radial pulse

(jesse wants to write graffiti on the wall)

176
Q

Provocation Test

why
which (2)

A

rule in/out stenosis, disc bulge, NR impingement
**do slowly

  1. Compression / Distraction
  2. Spurlings
177
Q

Compression Test

A

provocation test to rule in/out stenosis, disc bulge, NR impingement**do slowly

  1. NEUTRAL: sitting, longitudinal force through the spinal column and see if illicit sx (bring pressure on slowly then slowly back off)
  2. FLEXION: (FB) confirm posterior bulge:
    hand on posterior cranium and thoracic back : apply compression through spine
  3. EXTENSION: (BB): if OA or facet issue it will flare with this and dx:
    hand on front of chest and head: apply compression through through spine

4: SIDEBEND: (SB): hand on top of head and on shoulder: apply compression through spine
If he has sx on contralateral side: DISC
If he has sx on ipsilateral side: NR IMPINGEMENT

178
Q

Upper Quarter: distraction relieves after traction, what is dx?

A

Stenosis or arthritis

179
Q

Compression Flexion: what it tells you

A

FLEXION: (FB) confirm posterior bulge:

hand on posterior cranium and thoracic back : apply compression through spine

180
Q

Compression test in Extension: what it tells you

A

EXTENSION: (BB): if OA or facet issue it will flare with this and dx:
hand on front of chest and head: apply compression through through spine

181
Q

Compression test in sidebend: what it tells you

A

SIDEBEND: (SB): hand on top of head and on shoulder: apply compression through spine
If he has sx on contralateral side: DISC
If he has sx on ipsilateral side: NR IMPINGEMENT

182
Q

Upper Quarter: distraction relieves after traction, what is dx?

A

Stenosis or arthritis

183
Q

Spurlings Test

A

Provocation Test: FACET PATHOLOGY / STENOSIS

extension + lateral flexion + rotation
“look up over shoulder at me”
–if painfree, no sx with this, add compression through head

(or backbend + sidebend + rotation)

184
Q

Diff Dx

C4/C5

A

Axillary (C5, C6) and Supraclavicular (C3, C4) Nerves

axillary doesnt go to biceps area but C5 goes to elbow

Check biceps

185
Q

Diff dx

C5 vs Axillary

A

check biceps

186
Q

Diff dx

C6 vs musculocutaneous nerve

A

musculocutaneous (anterior arm) - C5, C6, C7

check thumb sensation
peripheral nerves change at the wrist

187
Q

Diff dx

C6 vs radial nerve

A

check thumb sensation
peripheral nerves change at the wrist

Radial nerve: C5, C6, C7, C8 & T1.
The radial nerve and its branches provide motor innervation to the dorsal arm muscles (the triceps brachii and the anconeus) and the extrinsic extensors of the wrists and hands; it also provides cutaneous sensory innervation to most of the back of the hand. The ulnar nerve provides cutaneous sensory innervation to the back of the little finger and adjacent half of the ring finger.

188
Q

Diff dx

C6 vs ulnar nerve

A

check thumb sensation
peripheral nerves change at the wrist

Ulnar Nerve
pinky, 1.5 ring finger 
flexor carpi ulnaris
flexor digitorum profundis
lumbrical muscles
opponens digiti minimi
flexor digiti minimi
abductor digiti minimi
interossei
adductor pollicis
189
Q

Diff dx

C7 vs median nerve

A

C7: 2nd and 3rd digits -median nerve

Compare to thumb to distinguish median vs C7

190
Q

Diff Dx

C8 vs Ulnar nerve

A

C8 dermatome extends more proximally

Peripheral ulnar nerve does not extend far past the wrist

191
Q

T1 vs Medial Antebrachial nerve

A

T1 extends to cubital fossa

Medial Antebrachial nerve doesnt

192
Q

Relate Myotome, Dermatome, DTR

C1

A

dermatome: crown of head
myotome: cervical rotation

193
Q

Relate Myotome, Dermatome, DTR

C2, C3

A

dermatome: neck
myotome: shoulder elevation

194
Q

Relate Myotome, Dermatome, DTR

C5

A

Dermatome: lateral brachial

Myotome: biceps

DTR: Bicep
if have DTR here then do a test corresponding to a C5 muscle

195
Q

Relate Myotome, Dermatome, DTR

C6

A

Dermatome: Thumb

Myotome: wrist extensors

DTR: Brachioradialis

196
Q

Relate Myotome, Dermatome, DTR

C7

A

Dermatome: 3rd digit

Myotome: triceps

DTR: triceps

197
Q

Relate Myotome, Dermatome, DTR

C8

A

Dermatome: ulnar border 5th digit

Myotome: finger flexion (intrinsics ie thumb and ulnar deviation)

198
Q

Relate Myotome, Dermatome, DTR

T1

A

Dermatome: ulnar forearm

Myotome: palmar/dorsal interosseu: abduciton/adduction

199
Q

Blue Flag

A

workers compensation

if not motivated to return to job this is a barrier to recovery

200
Q

Black flag

A

barrier related to financial constraints or transportation

ie high copay / deductible that will limit their access to PT

201
Q

What do we suspect if unrelenting pain?

A

cancer

202
Q

What do we suspect if bladder in systems review? saddle numb? saddle parasthesia

A

cauda equina

203
Q

what suspect if worse in the morning?

A

arthritis
herniated disc (bulges more in the morning)
matress
sleep position

204
Q

effect of coughing, sneezing, bearing down on spine?

A

increase intraabdominal pressure so this can be a disc herniation

205
Q

effect sit to stand increase pain in spine, how this can help us with herniated disc vs arthritis/posteriro structure

A

in a dynamic task may be motor control , enough to transition position vs static flexion can be herniated disc standing extended can relieve the herniated disc

but arthritis or postrerior structure involvement can get aggravated like this

206
Q

back sx from what issue in systems review?

A

gallbladder refer to back

can be a GI dysfunction *so check if the pain fluctuates with position or body or nonmechanical movements

207
Q

3 outcome measures for the back

A

1) McGill Pain Scale:
2) FABQ: investigate fear-avoidancebeliefs among LBP patients: see if PT alone isnt going to help and need to refer to CBT
3) Owestry Low Back Disability: for pt with LBP: percent of disability (ie pain intensity, how it affects ADL)–use for insurance

208
Q

What we look at in postural exam

1) what we look at
2) what may indicate a disc bulge

A

1) head position, shoulder height, spinal alignment, iliac crest height, leg length, foot posture
2) if there is a lateral shift and may see increased arm space on one side and decreased on the other side

209
Q

How to palpate L4

A

level of Iliac crest

210
Q

How to palpate S1

A

?

211
Q

how to palpate S2

A

?

212
Q

Quick Tests for Lower Quarter

A
  1. Full Squat: make sure symmetrical bilaterally, excessive pelvic tilt, angle of torso and thighs
  2. Heel Raise: look at S1 myotome, 10 reps
  3. Stand on Heels / walk on heels: L4 myotome
  4. Gait: look for gait deviations (if more pelvic rotation this can put more motion in lumbar spine)
  5. Balance: look for pelvic drop: week gluteus medius superior gluteal nerve (L4, L5, S1 nerve roots): look for lateral trunk lean, pelvic rotation, SLS 30 seconds eyes open
213
Q

What can a squat tell you about spine?

A

Initiate with Posterior Pelvic Tilt: disc herniation issue

Anterior tilt and lumbar Lordosis and using erector spinae: not using core

214
Q

What can heel raisesies tell you about

A

Myotome S1: gastroc

215
Q

What can standing on heels tell you about

A

L4 myotome

216
Q

AROM of Lumbar Spine

what we look for

What motions

A

Look for:

  1. quality of motion
  2. ranges, excursion
  3. willingness to move, does it cause pain
  4. Muscle Power

Flexion: tuck chin and rolll to floor keep knees straight: overpressure: stabilize S5

  • -look for reversal in lumbar curve and pelvis movement (if not hamstrings need to be checked)
  • -tight erector spinae
  • -catch/jutter
  • -Gower’s Sign: hard to come back up without using hands bc lack strength or control of dynamic stabilizers

Extension: put your hands on your buttock an keep your knees straight
–reproduce sx, excursion, mobility, motor control hinge at L4/L5 because not other segments giving motion

Lateral Flexion: hand on hip and slide down leg : one hand their ribcage and one on pelvis for overpressure

Rotation: stand cross arms across chest (we stabilize pelvis, but do overpressure in sitting: block pelvis with leg and hand on ribcage for overpressure)

217
Q

Gower’s Sign:

A

-hard to come back up without using hands bc lack strength or control of dynamic stabilizers

218
Q

Lower Quarter: combo of motions

A
  1. Extension, Sidebend, Rotation:
    FACET ISSUE, NERVE IMPINGE
2. Flexion, Sidebend, Rotation 
DISC ISSUE (probably posterior lateral)
219
Q

Extension, Sidebend, Rotation:

what does pain indicate

A

FACET ISSUE, NERVE IMPINGE

220
Q

Flexion, Sidebend, Rotation

what pain indicates

A

DISC ISSUE (probably posterior lateral)

221
Q

T/F

Disc herniations rare for upper lumbar region

A

TRUE

–so on dermatome test she doesnt usually do L1/L2

222
Q

What dermatome between 1st and 2nd toe?

A

L5

223
Q

Which vertebrae common spondylolisthesis

A

L5

224
Q

Lower Quarter Special Tests

A
  1. Slump Test
  2. passive SLR
  3. Soto Hall Test
  4. Femoral Nerve Stretch
  5. Compression of the Trunk
  6. Distraction
  7. INTRATHECAL PRESSURE TESETS
    - –Milgram Test
    - –Nafzieger Test
    - –Valsalva Test
  8. SI Joint Special Tests
    - –Anterior Gapping Test
    - –Posterior Gapping Test
    - –Gaenslens Test
    - –Thrust Test
    - –Spring Test
    - –Faber
225
Q

Lower Quarter: Intrathecal Pressure Tests

3

A

1—Milgram Test
2—Nafzieger Test
3—Valsalva Test

226
Q

Lower Quarter: SI Joint Special Tests

6

A 
1---Anterior Gapping Test
2---Posterior Gapping Test
3---Gaenslens Test
4---Thrust Test
5---Spring Test
6---Faber
227
Q

Slump Test

Lower Quarter:

A

NEUROTENSION TEST:

  1. herniated disc pressing on NR
  2. NR adhesions along the nerve path

1) Sit, hands rest on table, patient SLUMP down (this may cause sx)
2) KNEE EXTENSION
3) DF
4) HIP FLEXION

5) If there is sx with any of them ask what he feels then to LIFT HIS HEAD UP

negative: lifting head doesnt change sx
POSITIVE: symptoms change when he lifts his head up–positive for nerve tension

228
Q

pSLR/Lasegue Test

Lower Quarter:

A

disc bulge
sciatic nerve neurotension/limited mobility
(not so good at discriminate other causes with this test)

1) PT lifts pt leg into SLR:
2) Note if there are sx before 70 degrees of hip flexion
3) lift head up and see if this changes the symptoms

POSITIVE: symptoms increase with cervical flexion

Negative: symptoms dont change, may just be tight hamstrings

229
Q

Soto Hall Test

Lower Quarter:

A

Central Cord Issue
Space occupying lesion

supine: flex neck up; chin to chest

Positive: lightening pain elicited (spinal cord issue, tumor, TB, fracture)

Brudzinski sign: respond with knee flexion to get slack in the spinal cord as a result of the Soto Hall Test

230
Q

Femoral Nerve Stretch

Lower Quarter:

A
  • upper lumbar herniated disc
  • nerve tension restriction due to adhesion of NR as exit spine/ adhesions as travel through soft tissue

1) Patient prone, PT flexes knee

Positive: patient indicate pain is in upper lumbar spine (femoral nerve on stretch)

2) if not provocative enough do in sidelie
–head flexed
–hip extended
–flex knee
see if changes when lift head back up (if no change it is just tightness, if changes it is NR restriction)

231
Q

Compression of Trunk Test

Lower Quarter:

A

1) Supine, hug knees to chest
2) compress spine through ischial tuberosities superiorly to load spine

Positive if this increases symptoms

232
Q

Distraction

Lower Quarter

A

Hookline
pull distal thigh away and see if it ALLEVIATES symptoms

Positive: symptoms alleviated with trunk distraction

233
Q

Tests for Intrathecal pressure

A
  1. milgram
  2. nafziger
  3. valsalva
234
Q

Milgram Test

A

–central cord lesion

bilateral passive SLR

positive: sx

235
Q

Nafziger Test

A

palpate jugular vein until face flushes

we dont do this one

236
Q

Valsalva

A

space occupying lesion
cancer
disc bulge

they will say have sx when they bear down

237
Q

SI Joint Special Tests

A

3 out of 5 tests in the clinical prediction rule test positive indicate SI joint dysfunction

  1. Anterior Gapping Test
  2. Posterior Gapping Test
  3. Gaenslens Test
  4. Thrust Test
  5. Spring Test
Faber Test (Flexion, Abduction, ER)
Patrick Test
238
Q

Anterior Gapping test

A

SI joint dysfunction

pt supine
heel of palms on bilateral ASIS
distract laterally

Positive: sx reproduced

239
Q

Posterior Gapping Test

A

Si joint dysfunction

pt supine
heel of palms on bilateral ASIS
compress medially

Positive: sx reproduced

240
Q

Gaenslens Test

A

SI joint dysfunction

1) Supine, (R) Knee to Chest, Contralateral (L) leg off table
2) PT press (L) leg into extension to stress L inotimate

241
Q

Thrust Test

A

1) Supine with hip flexed
2) PT has one hand under scrum with thumb on PSIS
3) PT does posterior force to stress the ilium to stress the SI joint

Positive: pain or excursion compared to the other side

242
Q

Spring Test

A

1) Prone
2) hand on sacrum for pure posterior to anterior force

Positive: excursion and pain

243
Q

Faber Test/Patric Test

A

1) pt supine
2) PT passively flexes, abducts, and externally rotates the involved leg until the foot rests on the top of the knee of uninvolved lower extremity
3) examiner slowly abducts the involved lower extremity towards the table

Positive test: Involved LE does not abduct below level of uninvolved side

SI pathology, iliopsoas tightness

244
Q

Diff dx

Lateral Thigh

A

Lateral cutanous nerve of the thigh

–numb with tight jeans, tight belt compressing the nerve

peripheral vs dermatome:
-dermatomal nerve spirals

245
Q

Diff Dx

Medial Thigh

A

Obterator nerve

Dermatome: different levels that innevrate the medial thigh

246
Q

Diff Dx Lateral Calf

A

Peripheral:

proximal: common peroneal nerve

Distal: superficial peroneal nerve

Between the toes: Deep peroneal nerve

L5: down between toes but use other distribution parts to help

247
Q

Diff Dx

Posterior Calf

A

Sural nerve

S1/S2 lateral foot border and go up calf

248
Q

LE diff dx

Peripheral nerve vs. dermatome

A
  • Lateral thigh = lateral cutaneous nerve of thigh/ multiple dermatomes
  • Prox- medial thigh = obturator vs. multiple dermatomes
  • lateral calf
  • proximal = common peroneal nerve
  • distal = superficial peroneal nerve
  • deep peroneal nerve btwn toes (L5)
  • Sural nerve – posterior-lateral calf- more distinct boundaries vs. S1-S2

מסקולוסקלטל ליד (14 decks)

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