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PT OCS Exam > L/S, SIJ and Pelvis > Flashcards

L/S, SIJ and Pelvis Flashcards

1
Q

Myotome

A 
L2: hip flexion
L3: knee extension
L4: ankle dorsi-flexion
L5: great toe extension
S1: ankle plantar-flexion/ankle eversion/hip extension
S2: knee flexion
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2
Q

Dermatome

A

L1 - Inguinal area.
L2 - On the anterior medial thigh, at the midpoint of a line connecting the midpoint of the inguinal ligament and the medial epicondyle of the femur.
L3 - At the medial epicondyle of the femur.
L4 - Over the medial malleolus.
L5 - On the dorsum of the foot at the third metatarsophalangeal joint.
S1 - On the lateral aspect of the calcaneus.
S2 - At the midpoint of the popliteal fossa.
S3 - Over the tuberosity of the ischium or infragluteal fold
S4 and S5 - In the perianal area, less than one cm lateral to the mucocutaneous zone

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3
Q

Spinal Fx (CPR)

A

Female
Trauma
>70 y/o
Chronic steroid use

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4
Q

Back Related Tumor

A

H/O CA
No relief with bed rest

*greatest indicators among red flags

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5
Q

Cauda Equina Syndrome

A

Urinary retention is the best indicator to R/I and R/O
Bilat. LE symptoms
Saddles anesthesia
Bowel/Bladder changes

This is a Medical Emergency

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6
Q

Infection

A

Fever is best to R/I

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7
Q

Spinal Compression Fx

A

Major Trauma is best to R/I

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8
Q

Ab. Aortic Aneurysm (AAA)

A

Current smokers, on statin drugs are high risk factor

Sx: Reports of throbbing and can’t get comfortable, best R/O by abdominal girth

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9
Q

MD referral if?

A

Findings suggest serious medical condition
Symptoms not consistent with a classification system
No resolved by intervention

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10
Q

Outcome measures

A

Oswestry (ODI) and Roland-Morris

*Roland Morris is better when small changes in function need to be detected

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11
Q

Manual Therapy indications for LBP

A

HVLA used for acute LBP, back related buttock/thigh pain
Non-thrust mobilization useful in sub-acute and chronic cases
MTT more effective when combined with exercise

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12
Q

Fitness

A

Promote Mod. to High. intensity exercise for patients with LBP and generalized pain. Low intensity exercise for chronic LBP.

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13
Q

Education

A

Promote early activity and discourage prolonged bed rest or in depth patho-anatomical explanations

Educate on pain pathways and referral systems, favorable prognosis, understanding structural strength of the spine (especially in cases with high FABQ scores)

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14
Q

Centralization

A

cases where radicular symptoms reduced with directional bias

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15
Q

Older patients

A

Flexion bias and lower quadrant nerve mobilization can be used with MMT to dec. chronic LBP and radiating pain

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16
Q

Traction

A

(+)SLR and peripheralization of symptoms without a directional preference (performed prone with intermittent force)

EXCLUSION criteria: Pregnant, osteoporosis, H/O fx in L/S, current Fx, SCI

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17
Q

Urogenital screening

A

Blood or changes in urinary patterns (frequency or retention)?
Pain or burning?
Recent kidney stones?
Previous treatment for CA?

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18
Q

Disc degenration

A

Should not directly cause pain because only the outer 1/3 is innervated. Pain is usually Nerve Root inflammation.

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19
Q

McNab classification of HNP

A

Protrusion (localized bulge)

Prolapsed (nucleus remains contained but migrates to outer ring)

Extruded (Nucleus pushes through the outer ring)

Sequestered (Nucleus leaks into spinal/intervertebral canals

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20
Q

Rehab after disc herniation (athletes)

A

Phase 1: (Non-rotation/Non-flexion bias) week 1

Phase 2: (Counter Rotation/Flexion Phase) week 2-3

Phase 3: Rotational Phase / Power development (from 9 days until return to sport ready)

Phase 4: Return to Sport

21
Q

Tests of Nerve Root dysfunction

A

Best to R/O:
LE pain > LBP, SLR or slump, dermatomal distribution

Best to R/I:
Paresis

22
Q

DDx for patients with potential nerve involvement

A

HNP:
Age 30-55, worse with flexion, pain @ or below single LE, diminished DTR (involved side)

Stenosis:
Age >60, worse with extension (standing/walking), sensorimotor changes (neuro claudication)

Cauda Equina:
Age 40-60, Insidious or chronic with bowel/bladder changes, Bilat. symptoms worse with flexion, Absent DTR Bilat., + SLR, effects S3-S4 (anal wink and perineal sensation)

23
Q

Neural tension tests

A

Slump (false positive at 15 degrees of flexion)
SLR (+ test when 30-70 degrees flexion of the hip reproduces symptoms
X-SLR (indicates possibly large HNP, candidate for traction)

Femoral Nerve tension test (prone knee bend + if burning felt in the anterior thigh)

24
Q

Slump stretch

A

Indicated as part of HEP for patient with a + slump and negative SLR (

25
Q

Likelihood to succeed with P.T.

A

Patient to P.T. who wait 6 weeks to start P.T. more likely to develop depression (31%)

26
Q

Back pain classification based on acuity of injury

A

Acute LBP 12 weeks

27
Q

CPR for HVLA in acute LBP (4+/5)

A

pain 35 degrees hip IR
+ spring test (pain-hypomobile PA)

Cavitation is not required, most effective combined with exercise
HVLA improves nerve mobility in LBP treatment and multifidus activation

28
Q

Systems of spinal stability (3)

A

Passive - ligaments and facets offer restraint at end ranges
Active - muscles control mid-range
NM - response to unexpected afferent feedback

29
Q

Multifidus

A

Atrophy when LBP present, most important stabilizer in the sagittal plane @ L4-L5 (usually most involved L/S segment)

30
Q

4 stages of motor control

A

Local (supine, progressed to sitting and prone), drawing-in maneuver
CKC (squat, step, dynamic sitting, lunge, trunk hinge)
OKC (while moving adjacent segment such as hips)
Functional (sport or work specific)

31
Q

Lumbar Stabilization CPR (3+/4), indicates dec. recruitment of the lumbar multifidi

A

(+)Prone instability test
Aberrant motion
SLR (passive) > 90
Age

32
Q

Plank Norms, significance of ratios

A 
Low plank (2 minutes)
Side Plank (1-2 minutes)
Bridge (2 minutes, LS on non-dominant side for 1-2 additional minutes after 1st minute)

L to R ratios should be symmetrical (within .05)
Flexion to extension should be

33
Q

Flag Colors

A 
Red Flags (serious medical conditions)
Yellow Flags (patient's personal beliefs)
Blue Flags (Work, return-to-work related)
Black Flags (secondary gain)
34
Q

Stenosis CPR

A

Age > 48 with pain that is worse with standing/walking, relieved by sitting and more leg pain than back pain

35
Q

LBP that would benefit from Pilates (CPR)

A

BMI > 25
no symptoms in the LEs
Duration of current symptoms

36
Q

SIJ CPR (3+/5)

A

Thigh Thrust, compression, distraction, Gaenslen’s

sacral thrust or FABER

37
Q

Best exercises for deep abdominal strengthening

A

TrA & IO (side plank and abdominal crunch)

TrA (Drawing-in maneuver & quadruped UE/LE

38
Q

Chronic LBP treatment

A

Education + motor control exercises and graded activity

39
Q

Extension treatment Bias

A

Preference for sitting or walking
Centralization with motion
Peripheralization opposite motion

*Not effective if no distal symptoms or status quo with all movements

Prone press-up 3x10 (5 sec hold)

40
Q

Flow of classification algorithm

A

Specific exercise ->Manual based ->Stabilization

41
Q

SIJ vs. L/S HVLA

A

SIJ mobilization used if 3+ present in Dx. cluster and pain at PSIS(+ Fortin)

L/S mobilization if localized pain that is unilateral

42
Q

McKenzie classification

A

Posture Syndrome
Dysfunction Syndrome
Derangement Syndrome

43
Q

Posture Syndrome

A

Age

44
Q

Dysfunction Syndrome

A

Age > 30
Sedentary
Localized pain at end ranges
Restricted ROM from tissue shortening

45
Q

Derangement Syndrome

A

Age 20-55
Sudden onset
Radicular symptoms
Pain can be constant and predictable with movements

46
Q

Neurogenic vs. Intermittent claudication

A

Neurogenic claudication is worse with standing or walking, better with flexed trunk

Vascular claudication is worse with activity and only relieved by rest. can be treated by progressive interval walking at intensity that causes claudication after 3-5 minutes (common with PVD)
ABI should be 1:1, less than that is sign of PVD

47
Q

Spondylolysis/Spondylolisthesis

A

Spondylolisthesis is common in cause of LBP in children usually due to hyperextension (i.e. gymnast) causes fracture of the pars and anterior translation of the vertebra

Males more prone to pars defects (spondylolysis).

Usually will present as LBP with symptoms in the LE (unilaterally), dull ache. Worse with extension and TTP at segment. Step-deformity. Most common at L5/S1 followed by L4/L5. Radicular symptoms will be at the nerve root level between the fracture site

SPECT is best diagnostic image for Pars defects

Tx:In acute cases bracing 3-6 months with anterior core stabilization. surgical gold standard is a posterolateral fusion.

48
Q

Scoliosis

A

Functional may be due to spasms on discrepancy in limb length
Structural = idiopathic

Rib hump on convex side doesn’t disappear with forward flexion

Bracing is recommended after curve is >20 degrees and continues to progress by 5 degrees or more after a year. Immediate bracing is recommended if there is curve > 30 degrees.

49
Q

MCID

A

ODI 6%

NDI 5-7%

NPRS > 2

PSFS > 2

GROC >5-10

LEFS 9

DASH 12.8 (14 in quickDASH)

PT OCS Exam (8 decks)

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