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7 Orthopedics > L8 Special Considerations > Flashcards

L8 Special Considerations Flashcards

1
Q

Key Exam Findings for SI joint dysfunction

A
  • does not centralize with repeated lumbar movements
  • need 2/4 positive tests of the SI joint tests
  • positive active SLR test
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2
Q

Interventions for SI Joint Dysfunction

A
  • lumbosacral regional manip
  • MET
  • stabilization, belt, tapping
  • stabilization exercise
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3
Q

Sacrum Joint Overview

A
  • sacrum and two innominates
  • large stable joint due to convoluted surface and very strong anterior and posterior ligamentous structures
  • 35 muscles attaching on the sacrum and innominates
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4
Q

Incidence and Prevalence of SI Joint Disorders

A

very wide range

.4% to 98% depending on diagnostic criteria

more widely accepted to be 10-22% of idiopathic back and butt pain

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5
Q

RF for SI Joint Dysfunction

A
  • post operative lumbar fusions (depends on # of fused vertebrae)
  • pregnancy due to increased laxity and altered COM
  • hypermobility
  • high energy trauma such as fall or MVA
  • previous hx of BP

maybe related to leg length discrepancy, scoliosis, hip OA

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6
Q

Possible causes of dysfunction

A
  • rotation of innominate
  • torsion
  • nutation/counternutation
  • upslip/downslip
  • inflare/outflare
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7
Q

Posterior Rotation might present as

A
  • decreased hip extension during long stride gait
  • apparent leg length shorter on that side
  • LBP during squat
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8
Q

Anterior Rotation might present as

A
  • decreased gluteal activation on that side
  • tight spasmed parapspinals
  • limited hup flexion during squat
  • adaptively shortened hip flexors and rectus femoris if chronic
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9
Q

SIJ Dysfunction Common things seen in exam

A
  • pain is reported inferomedial to PSIS
  • alterations in gait
  • should observe squatting, lateral step down, SLS, hopping
  • loss of sagittal and frontal plane motion with pain
  • overpressure may be provocative
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10
Q

SIJ Provocation Tests

A
  1. Thigh Thrust = 3-4 downward thrusts
  2. Distraction = forces on ASIS
  3. Compression = greater trochanter for 10s
  4. Sacral Thrust = 3-4 thrust on post sacrum
  5. Gaenslen’s = maxxing hip flex and hip ext
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11
Q

SIJ Management

A
  • manual therapy - joint mob, manip, MET, manual stretching, STM
  • gait training
  • postural re-ed
  • strengthening
  • taping to support correction
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12
Q

Anteriorly Rotated on the Right SIJ MET

A

right glues push and L hip flexors pull 3-5 seconds for 3-5 sets

need extensors to pull pelvis back

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13
Q

Posteriorly Rotated on the Right SIJ MET

A

right hip flexors pull and R glutes push 3-5s for 3-5 sets

need flexors to pull pelvis forward

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14
Q

Shotgun Technique

A
  • using the abd/add to reset SIJ and pubic symphysis
  • pt is supine hooklying
  • abduct into PT’s hands 5 seconds at multiple progressive angles
  • PT forearm placed between knees and pt adducts into 5s
  • reassess for symptoms and impairments
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15
Q

Lumbar fusions

A

rates continue to go up, especially post-traumatic and elderly populations

good for spondylolisthesis and scoliosis, not great for DDD or DJD

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16
Q

Indications for Lumbar Fusions

A

progressive, neurologic symptoms and/or severe instability

failed conserative care

17
Q

Types of surgical approaches for lumbar fusions

A

PLIF = decompression of lateral foramen

TLIF = complete removal of facet joint

ALIF = anterior approach for revision after failure

18
Q

Post-Operative Complications for Lumbar Fusions

A

LOTS of complications

Myocardial infarcation
pulmonary embolus
CSF leaking
vertebral fractures

19
Q

Post Fusion Rehab

A
  • preferably pt had PT before surgery
  • watching for numerous complications
  • protect incision and surgical site until anatomic fusion occurs
  • focus on ADLs initially
  • most likely won’t be totally pain-free
20
Q

Stabilization Clinical Findings

A
  • younger age <40
  • 3+ prior episodes
  • increasing frequency of episodes
  • aberrant movement patterns
  • SLR > 91°
  • pos prone instability test
  • general hypermobility
21
Q

Interventions for Stabilization

A

local activation of deep core
general strengthening
postural awareness

22
Q

Aberrant movement patterns

A

gower’s sign
altered lumbopelvic rhythm
deviation from sagittal plane
painful arc of motion
instability catch or judder

23
Q

Indictors of Failure with stabilization program

A

neg prone instability
hypomobility to spring test
aberrant motion absent
FABQ score <9

24
Q

Sorenson’s test predictive values

A

LBP <176s
no LBP >198s

3x more likely to have LBP <58s

25
Q

Grade 5 prone plank

A

120s or more

26
Q

Grade 4 prone plank

A

<90 seconds

27
Q

Grade 3 Prone Plank

A

can assume but can’t hold it

28
Q

Grade 2 Prone Plank

A

on knees instead of toes

29
Q

Normal timing for side plank test

A

94s males
72s females

30
Q

Motor Control Exercises for Sagittal

A

promoting flexion
activities like bridges, bird/dog

watching for anterior/poterior pelvic tilt error

31
Q

Motor Control Exercise for Frontal Plane

A

Abduction/Adduction motion

fire hydrant, walking with kettle bells in each hand

watching for lateral ean error

32
Q

deadlift clinical progression

A
  1. Assessment for adequate mobility and stability
  2. Hip hinge with dowel
  3. Hip hinge with dowel press
  4. Wall touch
  5. Banded pull through
  6. Banded pull up
  7. Banded extension
  8. Elevated deadlift
33
Q

Squat Teaching Progression

A
  1. Watch in all three planes with body weight
  2. Assess for adequate mobility and stability
  3. Squat sit to stand with dowel
  4. Wall sit to assisted squat to chair/box squat
  5. goblet squat to back squat to front squat to overhead squat

7 Orthopedics (14 decks)

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