Lower Body Midterm Flashcards - Sheet1
History taken should include
age, sex, past medical hx, activity level, any dx of MC, mechanism of injury, structures involved, level of disability
MC breakdown
WHAT’s the issue? (dx/story) WHEN? (timeline) HOW? (mechanism) WHERE? (structures involved)
What things do you record about PAIN?
Location, intensity, frequency, duration (create baseline)
What is SOMATIC pain?
orthopedic, nociceptive - activation of pain receptors in the skin and musculoskeletal system including muscle, bone, ligament, tendon, etc.
What is NEUROPATHIC pain?
spinal cord or peripheral nerve pain such as tingling, burning, pins & needles, stinging, etc.
What is PSYCHOGENIC pain?
mental, emotional, social or behavioral producers of pain
What is VISCERAL pain?
nociceptive - activation of pain receptors from the internal organs
What is SYMPATHETIC pain>
non-nociceptive - pain signals sent to the brain by the sympathetic nervous system, for example Compex Regional Pain Syndrome (CRPS)
What is PHANTOM pain?
pain related to a lost limb
What is paroxysmal pain? (quality)
sudden, shooting, sharp, electric, hot, radiating
What is superficial pain? (quality)
itchy, cold, numb, sensitive, tingling
What is deep pain? (quality)
achy, heavy, crampy, throbbing
Glute Medius/Maximus IZ? (location and needling)
LOCATE by finding PSIS “peanut”/highest point, line fro here to greater trochanter, then first quarter on medial side of that line; alternately feel sit bones, go lateral to sacrum, aim for deepest part of muscle/cup of ilum; DEPTH 2-4” tx glute med/max dysfunction, pain
Piriformis IZ? (location and needling)
LOCATE midpoint between PSIS & sacral hiatus, then go from this toward greater trochanter; rotate leg to confirm on piriformis and aim toward belly of muscle; NEEDLE 1.5-3” tx piriformis dysfunction, pain
Iliacus Point IZ? (location and needling)
LOCATE ASIS and find inguinal ligament, point is in V formed here, deep to inguinal ligament, needle superior medial to lateral inferior, 1.5-2” tx iliopsoas referral
TFL IZ (side lying)? (location and needling)
LOCATE GB29 - midpoint of ASIS and greater troachanter - and go anterior, feel between muscles, NEEDLE perpendicular 1-1.5” tx TFL dysfunction, pain
Huatojiaji L4-L5/L5-S1 (location and needling)
LOCATE 0.5 cun from BSP of L4 or L5 as indicated, NEEDLE perpendicular 1-2” tx facets or nerve root referral
Straight leg raise tests for . . .
nerve root impingement
Slump test
For nerve root impingement
Gillet test
SI dysfunction
FABER
Hip joint pathology (may also be . . .)
Thomas Test
Shortened rectus femoris (if knee not fully flexed), psoas (if thigh not level) and/or IT band (if J sign, leg pulled laterally)
Low back RED FLAGS
under 20 or over 55 y.o., violent trauma, constant unremitting progressive nonmechanical pain, hx of cancer/steroids/drugs/HIV, incontinence, structural deformity, unexpected weight loss, loss of balance/strength, pain at night/resting pain, saddle anesthesia/perineal/perianal sensory loss
Nerve root L1-L2 is involved in action of?
hip flexion
Nerve root L3 involved in action of?
knee extension
Nerve root L4 involved in action of?
ankle dorsiflexion
Nerve root L5 involved in action of?
big toe extension
Nerve root S1 involved in action of?
ankle plantar flexion, eversion, hip extension, knee flexion
Nerve root S2 involved in action of?
knee flexion
Disc protrusion feels better/worse with lying down?
Better with lying down because discs are not stacked up, less force pushing stuff out of the disc
If pain feels better lying down it might be?
Disc protrusion
Sitting in extension (leaning back) reduces pain for?
Disc protrusion
Why does sitting in flexion worsen a posterior disc bulge?
Forces posterior disc to bulge MORE posteriorly, increasing symptoms.
Number one region for disc herniation to occur?
Lateral recess/paramedium zone
