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ANATOMY > LSP > Flashcards

LSP Flashcards

1
Q

LSP - ROM

A
  • Flexion - 70
  • Extension - 30
  • Lateral flexion - 30
  • Rotation - 30
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2
Q

LSP - MYOTOMES

A
  • Trunk rotation - T6, T7, T8, T9, T10, T11, T12, L1, L2 - segmental nn
  • Trunk lateral flexion - T6, T7, T8, T9, T10, T11, T12, L1, L2 - segmental nn
  • Trunk flexion/extension - T6, T7, T8, T9, T10, T11, T12, L1, L2 - segmental nn
  • Hip flexion - L1, L2, L3 - femoral nerve
  • Knee extension - L3, L4 - femoral nerve
  • Knee flexion - L4, L5, S1, S2 - sciatic nerve
  • Ankle dorsiflexion - L4, L5 - deep peroneal nerve
  • Ankle inversion - L4, L5 - tibial nerve, deep peroneal nerve
  • Ankle eversion - L5, S1 - superior peroneal nerve
  • Big toe extension - L5, S1 - deep peroneal nerve
  • Big toe flexion - L5, S1 - tibial nerve
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3
Q

LSP - ORTHO TESTS - SCREENING

A
  • SCREENING - Heel walk, Toe walk, squat and rise, Kemps test
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4
Q

LSP - ORTHO TESTS - LUMBAR SPRAIN/STRAIN

A
  • LUMBAR SPRAIN/STRAIN - ROM, palpation, Kemp’s test
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5
Q

LSP - ORTHO TESTS - LUMBAR RADICULOPATHY

A
  • LUMBAR RADICULOPATHY - SLR, Bragard’s test, Femoral nerve traction test, Piriformis test
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6
Q

LSP - ORTHO TESTS - SIJ LESION

A
  • SIJ LESION - Belt test, Motion palpation
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7
Q

LSP - ORTHO TESTS - INSTABILITY

A
  • INSTABILITY - Segmental instability test, P-A glide test
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8
Q

LSP - JOINT TYPE

A
  • Gliding - zygapophyseal
  • Fibrocartilagenous - intervertebral joints
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9
Q

LSP - ARTICULAR SURFACES

A
  • Intervertebral discs oriented in horizontal plane
  • Lumbar: facet orientated in sagittal plane
  • SI: facets orientated 45
  • Facets (z-joints) take 25% of weight
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10
Q

LSP - MAIN MUSCLE ACTIONS - FLEXION

A
  • FLEXION - iliopsoas, rectus abdominis, internal/external oblique
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11
Q

LSP - MAIN MUSCLE ACTIONS - EXTENSION

A
  • EXTENSION - multifidi, erector spinae
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12
Q

LSP - MAIN MUSCLE ACTIONS - LATERAL FLEXION

A
  • LATERAL FLEXION - erector spinae, semispinalis, rectus abdominis, internal/external oblique, quadratus lumborum
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13
Q

LSP - MAIN MUSCLE ACTIONS - ROTATION

A
  • ROTATION - rotatores, multifidi, semispinalis, erector spinae, internal/external oblique
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14
Q

LSP - RESTING POSITION

A

Mid way between flexion and extension

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15
Q

LSP - CLOSED PACKED POSITION

A

Full extension

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16
Q

LSP - NORMAL END FEEL

A

FLEXION - tissue stretch

EXTENSION - tissue stretch

LATERAL FLEXION - tissue stretch

ROTATION - tissue stretch

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17
Q

LSP - ABNORMAL END FEEL

A
  • Early myospasm - muscle / ligament tear
  • Late myospasm - instability
  • Empty - ligament rupture
  • Hard - bone approximation (osteophyte)
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18
Q

LSP - COUPLED MOTIONS

A

Pure rotation and pure side bending do not occur at any region in the spine below C1-C2

T6-L5 spinal segments

  • Left lateral flexion coupled with right rotation
  • Right lateral flexion coupled with left rotation

Lumbar motion is also coupled with sacral motion

  • Lumbar extension (hyperlordosis) is coupled with sacral nutation (anterior sacral tilting)
  • Lumbar flexion (hypolordosis) is coupled with sacral counter-nutation (posterior sacral tilting)
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19
Q

LSP - CONDITIONS - ANKYLOSING SPONDYLITIS

A

Hx - prior trauma - fall onto shoulder or impact over shoulder
S&S - possible step defect; tenderness to palpation over AC joint; +ve Obrien’s
DDx - supraspinatus rupture, impingement syndrome, rotator cuff tear

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20
Q

LSP - CONDITIONS - CAUDA EQUINA SYNDROME

A

Hx - Pt age 40-60, usually female, weeks of shoulder pain and restriction
S&S - restricted AROM in clear capsular pattern (external rotation > abduction > internal rotation); extermally painful & limited PROM
DDx - cervical pathology, impingement syndrome, rotator cuff tear

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21
Q

LSP - CONDITIONS - DISC HERNIATION

A

Hx - pain over anterior shoulder, history of repetitive elbow flexion (weight lifter)
S&S - pain with direct palpation of biceps long head tendon; pain with resisted horizontal adduction
DDx - cervical pathology, rotator cuff strain

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22
Q

LSP - CONDITIONS - LUMBAR (DJD) OSTEOARTHROSIS

A

Hx - pain over superior or lateral GH joint, pain at night, difficulty sleeping
S&S - tender palpation over acromion/deltoid; decreased shoulder ROM in abduction & flexion; pain may be relieved by GH inferior distraction
DDx - cervical pathology, ortator cuff strain, impingement syndrome

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23
Q

LSP - CONDITIONS - LUMBAR JOINT DYSFUNCTIONS (SUBLUXATION)

A

Hx - insidious onset of pain, morning stiffness, worse with excessive activity
S&S - crepitus and pain with ROM; +ve Ellman compression test
DDx - AC OA, GH instability, impingement syndrome

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24
Q

LSP - CONDITIONS - LUMBAR SPRAIN/STRAIN

A

Hx - history of trauma, local pain with motion
S&S - no neurologic signs; decreased AROM and PROM, PROM due to pain
DDx - lumbar joint dysfunction often coexist

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25
Q

LSP - CONDITIONS - PELVIS FRACTURE

A

Hx - significant trauma, severe pain
S&S - gait abnormalities; +ve SI compression, distraction stress test
DDx - visible on x-ray or CT scan, severe SI sprain

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26
Q

LSP - CONDITIONS - SI INSTABILITY

A

Hx - chrinic SI pain, possible repeatable “clunk” of SI joint; may occur during or shortly after pregnancy
S&S - +ve sacral glide test for increased motion
DDx - SIJ dysfunction, lumbar instability

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27
Q

LSP - CONDITIONS - SPINAL STENOSIS

A

Hx - M>F (2:1), chronic low back pain, worse with prolonged standing
S&S - decreased AROM & PROM; confirm with x-ray, decreased spinal canal diameter
DDx - vascular claudication

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28
Q

LSP - CONDITIONS - SPONDYLOLISTHESIS

A

Hx - chronic low back pain, repetitive extension motions (e.g. rowing)
S&S - possible hyperlordosis; repeatable clunk or catch with lumbar ROM
DDx - confirm on x-ray with flexion/extension studies

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29
Q

LSP - CONDITIONS - PIRIFORMIS SYNDROME

A

Hx - possible pain down back of leg, worse when sitting on a hard surface
S&S - tender to palpation, +ve SLR, sign of the buttock, +ve piriformis test
DDx - lumbar radiculopathy, disc herniation, lumbar sprain/strain, stenosis

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30
Q

LSP - ORTHO TESTS - KEMP’S TEST

A
  • Pt seated
  • Examiner stabilises lumbar spine with one hand and supports pt shoulders with the other hand and forearm
  • Pt leans away from examiner (stretch)
  • Pt then flexes forward (stretch)
  • Pt then back into lateral flexion and extension (compression)
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31
Q

LSP - ORTHO TESTS - KEMP’S TEST - POSITIVE TEST

A

Nerve root compression, radiculopathy

  • Leg pain

Local lesion (sprain/strain, facet syndrome, meniscal entrapment)

  • Local low back pain
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32
Q

LSP - ORTHO TEST - SLUMP TEST

A
  • Pt seated
  • Pt instructed to slump forward
  • Examiner extends one knee and may apply gentle overpressure
  • This increases spinal flexion
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33
Q

LSP - ORTHO TEST - SLUMP TEST - POSITIVE TEST

A

Nerve root tension (shooting or electrical pain) radiculopathy, disc herniation, SOL, osteophyte

  • Reproduction of symptoms
  • Leg pain

Lumbosacral sprain

  • Local lumbosacral pain
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34
Q

LSP - ORTHO TEST - SLUMP TEST - SN & SP

A

SN: 83

SP: 55

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35
Q

LSP - ORTHO TEST - FEMORAL NERVE TRACTION TEST

A
  • Pt side-lying
  • Pt back straight and neck slightly flexed
  • Examiner extends the pt hip 15 and flexes the knee
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36
Q

LSP - ORTHO TEST - FEMORAL NERVE TRACTION TEST - POSITIVE TEST

A

Femoral nerve or root compression (L2-L4 radiculopathy), lateral disc herniation

  • Pain radiation on anterior thigh
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37
Q

LSP - ORTHO TEST - FEMORAL NERVE TRACTION TEST - SN

A

SN: 84

38
Q

LSP - ORTHO TEST - SLR

A
  • Pt supine
  • Examiner places one hand under pt ankle and other hand over pt knee
  • Examiner then proceeds to passively elevate the straight leg
39
Q

LSP - ORTHO TEST - SLR - POSITIVE TEST

A

Nerve root compression, IVD herniation, piriformis entrapment

  • Radicular leg pain

SI/lumbar sprain/strain

  • 0 - 35 degrees = hip joint
  • 35 to 70 degrees = disc/nerve root involvement
  • > 70 degrees = SI/lumbar joint pain
40
Q

LSP - ORTHO TEST - SLR - SN & SP

A

SN: 78-98

SP: 11-64

41
Q

LSP - ORTHO TEST - BRAGGARD’S SIGN

A
  • Test should follow an SLR
  • Pt supine
  • Affected leg is lowered to an angle just below the production of pain
  • Examiner dorsiflexes the foot
42
Q

LSP - ORTHO TEST - BRAGGARD’S SIGN - POSITIVE TEST

A

Radiculopathy, IVF encroachment, SOL, nerve root tension, disc herniation

  • Leg pain
  • Reproduction of SLR test symptoms

Sprain/strain on contracture

  • Local back, hamstring or calf pain
43
Q

LSP - ORTHO TEST - SICCARD’S SIGN

A
  • Pt in position of SLR
  • Examiner elevates straight leg to angle just below reproduction of symptoms
  • Examiner extends the first toe
44
Q

LSP - ORTHO TEST - SICCARD’S SIGN - POSITIVE TEST

A

Sciatic radiculopathy, nerve root compression

  • Radicular leg pain
45
Q

LSP - ANKYLOSING SPONDYLITIS - DEFINITION

A
  • Inflammatory disease that, over time, can cause some of the bones in the spine (vertebrae) to fuse.
46
Q

LSP - ANKYLOSING SPONDYLITIS - CAUSE

A
  • No known specific cause, though genetic factors seem to be involved.
47
Q

LSP - ANKYLOSING SPONDYLITIS - AGE GROUPS AFFECTED

A
  • Teenagers and young adults
  • 2x more common in men
48
Q

LSP - ANKYLOSING SPONDYLITIS - RISK FACTORS

A
  • Gut inflammation, suggesting a potential origin in the gut. It’s thought disruption to the microbiome in your gut may play a role in its development.
  • Smoking.
49
Q

LSP - ANKYLOSING SPONDYLITIS - CLINICAL PRESENTATION

A
  • Neck pain and stiffness, some years after onset of backache
  • Neck gradually becomes rigid and kyphotic, some movement preserved at atlantooccipital and atlantoaxial joints
  • Pain that’s worse in the morning or after sitting for a long time
  • A rigid spine that curves forward
  • Tiredness
  • Swelling in your joints
  • Trouble taking deep breaths
50
Q

LSP - ANKYLOSING SPONDYLITIS - PROGNOSIS

A
  • No treatment can only manage symptoms
51
Q

LSP - AROM - FLEXION - MUSCLES ACTIVATED

A

Eccentric contraction of erector spinae

52
Q

LSP - AROM - FLEXION - TISSUES STRETCHED

A

Erector spinae
Supraspinous & interspinous ligaments
Posterior IVD
Posterior facet joint capsule
Intercostal muscles

53
Q

LSP - AROM - FLEXION - TISSUES COMPRESSED

A

Anterior thoracic structure
Anterior longitudinal ligament
Anterior IVD
Lungs
Heart
Aorta
Abdominal contents

54
Q

LSP - AROM - EXTENSION - MUSCLES ACTIVATED

A

Concentric contraction of erector spinae
Eccentric contraction of rectus abdominis and abdominal obliques

55
Q

LSP - AROM - EXTENSION - TISSUES STRETCHED

A

Rectus abdominis
Anterior longitudinal ligament
Aorta
Lungs
Anterior intercostal muscles

56
Q

LSP - AROM - EXTENSION - TISSUES COMPRESSED

A

Erector spinae
Supraspinous & interspinous ligaments
Posterior IVD & IVF
Z-joint capsule
Posterior intercostal muscles

57
Q

LSP - AROM - SIDE BENDING - MUSCLES ACTIVATED

A

Eccentric contraction of contralateral erector spinae
Transversospinalis

58
Q

LSP - AROM - SIDE BENDING - TISSUES STRETCHED

A

Contralateral erector spinae
Transversospinalis
Intercostal muscles
Contralateral IVD & IVF
Z-joints

59
Q

LSP - AROM - SIDE BENDING - TISSUES COMPRESSED

A

Ipsilateral erector spinae
Transversospinalis
Intercostal muscles
Contralateral IVD & IVF

60
Q

LSP - AROM - SIDE BENDING - MUSCLES ACTIVATED

A

Contralateral external oblique and transverso-spinalis
Ipsilateral internal oblique

61
Q

LSP - AROM - SIDE BENDING - TISSUES STRETCHED

A

Ipsilateral external oblique and transversosoinalis
Contralateral internal oblique

62
Q

LSP - AROM - ROTATION - TISSUES COMPRESSED

A

Abdominal contents
Ipsilateral intervertebral foramen

63
Q

TRANSVERSUS ABDOMINIS - ORIGIN

A

Iliac crest
Inguinal ligament
Thoraco-lumbar fascia
Lower ribs
Costal cartilage

64
Q

TRANSVERSUS ABDOMINIS - INSERTION

A

Abdominal aponeurosis

65
Q

TRANSVERSUS ABDOMINIS - ACTION

A

Compression/stabilisation of abdomen

66
Q

TRANSVERSUS ABDOMINIS - INNERVATION

A

Intercostal nerves (T7-L1)

67
Q

TRANSVERSUS ABDOMINIS - TRIGGER POINT REFERRAL

A

Typically refer over the local area
Referral to the abdomen is often described as cramping or colic

68
Q

TRANSVERSUS ABDOMINIS - STRETCH

A

Seated with legs stabilised off end of chair rotate to side

69
Q

TRANSVERSUS ABDOMINIS - STRENGTHEN

A

Compression of abdomen
Stand, sit, kneel or lying; pull navel to spine and hold

70
Q

QUADRATUS LUMBORUM - ORIGIN

A

12th rib (inferior border)
TPs of L1-L4

71
Q

QUADRATUS LUMBORUM - INSERTION

A

Posterior iliac crest
Iliolumbar ligament

72
Q

QUADRATUS LUMBORUM - ACTION

A

Unilateral - elevation of pelvis, lateral flexion of trunk, depression of 12th rib
Bilateral - extension of lumbosacral spine

73
Q

QUADRATUS LUMBORUM - INNERVATION

A

Lumbar plexus (T12-L3)

74
Q

QUADRATUS LUMBORUM - TRIGGER POINT REFERRAL

A

Deep in the angle where the crest of ilium and paraspinal muscle mass meet
Inner crest of ilium where iliocostalis lumborum fibres attach
Angle where paraspinal muscles and 12th rub meet

75
Q

QUADRATUS LUMBORUM - STRETCH

A

Grip table, let posterior leg hang off and laterally flex trunk

76
Q

QUADRATUS LUMBORUM - STRENGTHEN

A

Side plank
Side bending
Resisted trunk lateral flexion

77
Q

ERECTOR SPINAE - ILIOCOSTALIS LUMBORUM - ORIGIN

A

Sacrum
Iliac crest

78
Q

ERECTOR SPINAE - ILIOCOSTALIS LUMBORUM - INSERTION

A

Angle of ribs 8-12

79
Q

ERECTOR SPINAE - ILIOCOSTALIS - ACTION

A

Bilateral - extension of spine and head, eccentric stabilisation during trunk flexion
Unilateral - lateral flexion of spine

80
Q

ERECTOR SPINAE - ILIOCOSTALIS - INNERVATION

A

Spinal nerve (dorsal rami)

81
Q

ERECTOR SPINAE - LONGISSIMUS THORACIS - ORIGIN

A

Sacrum
TPs of L1-L5

82
Q

ERECTOR SPINAE - LONGISSIMUS THORACIS - INSERTION

A

TPs of T1-12
Angle of ribs 1-12

83
Q

ERECTOR SPINAE - LONGISSIMUS - ACTION

A

Bilateral - extension spine and head, eccentric stabilisation during trunk flexion
Unilateral - lateral flexion of spine

84
Q

ERECTOR SPINAE - LONGISSIMUS - INNERVATION

A

Spinal nerve (dorsal rami)

85
Q

ERECTOR SPINAE - SPINALIS THORACIS - ORIGIN

A

SPs of T10-L2

86
Q

ERECTOR SPINAE - SPINALIS THORACIS - INSERTION

A

SPs of T3-T9

87
Q

ERECTOR SPINAE - SPINALIS - ACTION

A

Bilateral - extension of spine and head, eccentric stabilisation during trunk flexion
Unilateral - lateral flexion of the spine

88
Q

ERECTOR SPINAE - SPINALIS - INNERVATION

A

Spinal nerve (dorsal rami)

89
Q

TRANSVERSOSPINALIS - MULTIFIDI LUMBORUM - ORIGIN

A

Mammillary processes of L1-L5

90
Q

TRANSVERSOSPINALIS - MULTIFIDI - INSERTION

A

SPs of all vertebrae extending from L5-C2

91
Q

TRANSVERSOSPINALIS - MULTIFIDI - ACTION

A

Bilateral - extension of vertebral column
Unilateral - rotate vertebral bodies to opposite side; control lateral flexion to side opposite contraction

92
Q

TRANSVERSOSPINALIS - MULTIFIDI - INNERVATION

A

Spinal nerve (dorsal rami)

ANATOMY (10 decks)

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