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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
LSP - CONDITIONS - PELVIS FRACTURE
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
26
LSP - CONDITIONS - SI INSTABILITY
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
27
LSP - CONDITIONS - SPINAL STENOSIS
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
28
LSP - CONDITIONS - SPONDYLOLISTHESIS
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
29
LSP - CONDITIONS - PIRIFORMIS SYNDROME
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
30
LSP - ORTHO TESTS - KEMP'S TEST
- 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)
31
LSP - ORTHO TESTS - KEMP'S TEST - POSITIVE TEST
**Nerve root compression, radiculopathy** - Leg pain **Local lesion (sprain/strain, facet syndrome, meniscal entrapment)** - Local low back pain
32
LSP - ORTHO TEST - SLUMP TEST
- Pt seated - Pt instructed to slump forward - Examiner extends one knee and may apply gentle overpressure - This increases spinal flexion
33
LSP - ORTHO TEST - SLUMP TEST - POSITIVE TEST
**Nerve root tension (shooting or electrical pain) radiculopathy, disc herniation, SOL, osteophyte** - Reproduction of symptoms - Leg pain **Lumbosacral sprain** - Local lumbosacral pain
34
LSP - ORTHO TEST - SLUMP TEST - SN & SP
**SN**: 83 **SP**: 55
35
LSP - ORTHO TEST - FEMORAL NERVE TRACTION TEST
- Pt side-lying - Pt back straight and neck slightly flexed - Examiner extends the pt hip 15 and flexes the knee
36
LSP - ORTHO TEST - FEMORAL NERVE TRACTION TEST - POSITIVE TEST
**Femoral nerve or root compression (L2-L4 radiculopathy), lateral disc herniation** - Pain radiation on anterior thigh
37
LSP - ORTHO TEST - FEMORAL NERVE TRACTION TEST - SN
**SN**: 84
38
LSP - ORTHO TEST - SLR
- 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
LSP - ORTHO TEST - SLR - POSITIVE TEST
**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
LSP - ORTHO TEST - SLR - SN & SP
**SN**: 78-98 **SP:** 11-64
41
LSP - ORTHO TEST - BRAGGARD'S SIGN
- 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
LSP - ORTHO TEST - BRAGGARD'S SIGN - POSITIVE TEST
**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
LSP - ORTHO TEST - SICCARD'S SIGN
- Pt in position of SLR - Examiner elevates straight leg to angle just below reproduction of symptoms - Examiner extends the first toe
44
LSP - ORTHO TEST - SICCARD'S SIGN - POSITIVE TEST
**Sciatic radiculopathy, nerve root compression** - Radicular leg pain
45
LSP - ANKYLOSING SPONDYLITIS - DEFINITION
- Inflammatory disease that, over time, can cause some of the bones in the spine (vertebrae) to fuse.
46
LSP - ANKYLOSING SPONDYLITIS - CAUSE
- No known specific cause, though genetic factors seem to be involved.
47
LSP - ANKYLOSING SPONDYLITIS - AGE GROUPS AFFECTED
- Teenagers and young adults - 2x more common in men
48
LSP - ANKYLOSING SPONDYLITIS - RISK FACTORS
- 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
LSP - ANKYLOSING SPONDYLITIS - CLINICAL PRESENTATION
- 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
LSP - ANKYLOSING SPONDYLITIS - PROGNOSIS
- No treatment can only manage symptoms
51
LSP - AROM - FLEXION - MUSCLES ACTIVATED
**Eccentric** contraction of erector spinae
52
LSP - AROM - FLEXION - TISSUES STRETCHED
Erector spinae Supraspinous & interspinous ligaments Posterior IVD Posterior facet joint capsule Intercostal muscles
53
LSP - AROM - FLEXION - TISSUES COMPRESSED
Anterior thoracic structure Anterior longitudinal ligament Anterior IVD Lungs Heart Aorta Abdominal contents
54
LSP - AROM - EXTENSION - MUSCLES ACTIVATED
**Concentric** contraction of erector spinae **Eccentric** contraction of rectus abdominis and abdominal obliques
55
LSP - AROM - EXTENSION - TISSUES STRETCHED
Rectus abdominis Anterior longitudinal ligament Aorta Lungs Anterior intercostal muscles
56
LSP - AROM - EXTENSION - TISSUES COMPRESSED
Erector spinae Supraspinous & interspinous ligaments Posterior IVD & IVF Z-joint capsule Posterior intercostal muscles
57
LSP - AROM - SIDE BENDING - MUSCLES ACTIVATED
**Eccentric** contraction of **contralateral** erector spinae Transversospinalis
58
LSP - AROM - SIDE BENDING - TISSUES STRETCHED
**Contralateral** erector spinae Transversospinalis Intercostal muscles Contralateral IVD & IVF Z-joints
59
LSP - AROM - SIDE BENDING - TISSUES COMPRESSED
**Ipsilateral** erector spinae Transversospinalis Intercostal muscles Contralateral IVD & IVF
60
LSP - AROM - SIDE BENDING - MUSCLES ACTIVATED
**Contralateral** external oblique and transverso-spinalis **Ipsilateral** internal oblique
61
LSP - AROM - SIDE BENDING - TISSUES STRETCHED
**Ipsilateral** external oblique and transversosoinalis **Contralateral** internal oblique
62
LSP - AROM - ROTATION - TISSUES COMPRESSED
Abdominal contents Ipsilateral intervertebral foramen
63
TRANSVERSUS ABDOMINIS - ORIGIN
Iliac crest Inguinal ligament Thoraco-lumbar fascia Lower ribs Costal cartilage
64
TRANSVERSUS ABDOMINIS - INSERTION
Abdominal aponeurosis
65
TRANSVERSUS ABDOMINIS - ACTION
Compression/stabilisation of abdomen
66
TRANSVERSUS ABDOMINIS - INNERVATION
Intercostal nerves (T7-L1)
67
TRANSVERSUS ABDOMINIS - TRIGGER POINT REFERRAL
Typically refer over the local area Referral to the abdomen is often described as cramping or colic
68
TRANSVERSUS ABDOMINIS - STRETCH
Seated with legs stabilised off end of chair rotate to side
69
TRANSVERSUS ABDOMINIS - STRENGTHEN
Compression of abdomen Stand, sit, kneel or lying; pull navel to spine and hold
70
QUADRATUS LUMBORUM - ORIGIN
12th rib (inferior border) TPs of L1-L4
71
QUADRATUS LUMBORUM - INSERTION
Posterior iliac crest Iliolumbar ligament
72
QUADRATUS LUMBORUM - ACTION
**Unilateral** - elevation of pelvis, lateral flexion of trunk, depression of 12th rib **Bilateral** - extension of lumbosacral spine
73
QUADRATUS LUMBORUM - INNERVATION
Lumbar plexus (T12-L3)
74
QUADRATUS LUMBORUM - TRIGGER POINT REFERRAL
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
QUADRATUS LUMBORUM - STRETCH
Grip table, let posterior leg hang off and laterally flex trunk
76
QUADRATUS LUMBORUM - STRENGTHEN
Side plank Side bending Resisted trunk lateral flexion
77
ERECTOR SPINAE - ILIOCOSTALIS LUMBORUM - ORIGIN
Sacrum Iliac crest
78
ERECTOR SPINAE - ILIOCOSTALIS LUMBORUM - INSERTION
Angle of ribs 8-12
79
ERECTOR SPINAE - ILIOCOSTALIS - ACTION
**Bilateral** - extension of spine and head, eccentric stabilisation during trunk flexion **Unilateral** - lateral flexion of spine
80
ERECTOR SPINAE - ILIOCOSTALIS - INNERVATION
Spinal nerve (dorsal rami)
81
ERECTOR SPINAE - LONGISSIMUS THORACIS - ORIGIN
Sacrum TPs of L1-L5
82
ERECTOR SPINAE - LONGISSIMUS THORACIS - INSERTION
TPs of T1-12 Angle of ribs 1-12
83
ERECTOR SPINAE - LONGISSIMUS - ACTION
**Bilateral** - extension spine and head, eccentric stabilisation during trunk flexion **Unilateral** - lateral flexion of spine
84
ERECTOR SPINAE - LONGISSIMUS - INNERVATION
Spinal nerve (dorsal rami)
85
ERECTOR SPINAE - SPINALIS THORACIS - ORIGIN
SPs of T10-L2
86
ERECTOR SPINAE - SPINALIS THORACIS - INSERTION
SPs of T3-T9
87
ERECTOR SPINAE - SPINALIS - ACTION
**Bilateral** - extension of spine and head, eccentric stabilisation during trunk flexion **Unilateral** - lateral flexion of the spine
88
ERECTOR SPINAE - SPINALIS - INNERVATION
Spinal nerve (dorsal rami)
89
TRANSVERSOSPINALIS - MULTIFIDI LUMBORUM - ORIGIN
Mammillary processes of L1-L5
90
TRANSVERSOSPINALIS - MULTIFIDI - INSERTION
SPs of all vertebrae extending from L5-C2
91
TRANSVERSOSPINALIS - MULTIFIDI - ACTION
**Bilateral** - extension of vertebral column **Unilateral** - rotate vertebral bodies to opposite side; control lateral flexion to side opposite contraction
92
TRANSVERSOSPINALIS - MULTIFIDI - INNERVATION
Spinal nerve (dorsal rami)

ANATOMY (10 decks)

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