lumbar 3 Flashcards
what is treatment for congenital hip dislocation due to dysplasia?
Surgical Correction or Splinting/Harnessing
Gait Training
ROM/Strengthening Exercises
Developmental Transitioning
what are both the barlow and ortolani test for?
to dislocate or reduce the hip used in babies to screen for congenital hip dislocation due to dysplsia
how does SI dysfunction present in the subjective exam?
*May present like mechanical lower back pain
*Most cases will have some sort of trauma
* Slip and fall onto the buttock region
*MVA - jamming femur into pelvis
*Pregnancy (with in the last trimester or a few months post partum)
*May be due to:
* Systemic arthritis (i.e., RA, AS)
*traumatic/microtraumatic arthritis
*Pt may or may not report LE symptoms (usually, unilateral and almost always above the knee)
*pain in the PSIS region
*General hypermobility – more challenging to treat
how does SI dysfunction present in the physical exam?
- c/o inc. pain w/ walking – especially at heel strike just prior to heel off- Getting in and out of a car may be painful
- Lumbar AROM may be painfree with no TTP in lumbar spine
*Hip extension with OP – most painful - TTP over post. aspect of SI jt
*Normal neuro exam
*Be sure to evaluate SIJ ligamentous provocation stress exam
how is distraction (gapping) perfromed?
Pt is lying supine on the table. Establish a baseline.
Locate the ASIS either side and place your palms directly over the bony ASIS.
Apply a lateral-posterior force slowly taking up the “slack.”
Apply 3 to 6 thrusts in an attempt to reproduce the concordant sign. May also hold for 30 sec.
+ if reproduction of patient’s
concordant sign
how is the compression test performed?
Pt lies in side-lying, painful side up. Resting symptoms are established
Cup the iliac crest and apply a downward force through the ilium. Slowly take up all the “slack”
Apply 3 to 6 thrusts in an attempt to reproduce the concordant sign. May also hold for 30 sec.
+ test is reproduction of patient’s concordant sign
how is the thigh thrust (femoral shear) performed?
Patient is lying supine near the edge of the table
Examiner stands opposite the painful side
Flex the hip on the painful side to 900
Examiner places his/her hand under the sacrum
Apply a downward pressure and 3 to 6 thrusts in an attempt to reproduce the concordant sign
+ test is reproduction of patient’s concordant sign
how is the sacral thrust performed?
The pt lies in a prone position
Palpate the sacrum for the second spinous process and a place the pisiform of one hand directly over the sacrum
Apply a PA force and assess pt response. If no symptoms apply a thrust (up to 6 times) in an attempt to reproduce symptoms
+ test is reproduction of concordant sign
how is the pelvic torsion (Gaenslen’s) performed?
Pt lying supine on the table with the painful leg resting off the table (or near edge of
table). Assess baseline symptoms.
Examiner raises the non-painful leg to 900 of hip flexion.
A downward force is applied to the lower leg while a counter force is applied to the flexed
leg.
Repeat procedure on opposite leg.
+ test is reproduction of concordant sign
how is the standing flexion test performed?
Pt assumes a standing posture
Examiner kneels behind the pt and palpates the pt’s PSIS bilaterally
The examiner instructs the patient to bend forward. Avoid side-bending or rotation
The examiner attempts to evaluate movement b/w PSIS. Symmetrical movement is normal.
+ test if asymmetrical movement is noted
how is gillet test perfomred?
Examiner stands behind the patient and palpates the pt’s PSIS
The patient is instructed to lift his/her hip to 900
Examiner attempts to evaluate whether the same side PSIS drops during hip flexion (normal) or rotates anteriorly (or superiorly) with respect to the stance leg
Positive test: If PSIS does not drop or slides superiorly the test is considered positive for that side
what is the supine to sit test?
The patient is instructed to lie supine in a hooklying position. Ask the patient to perform a bridge and return to the resting hooklying position (Weber Barstow maneuver)
At the completion of the bridge the examiner passively extends the patient’s lower extremities and evaluates the leg length differences (compare the levels of the medial malleoli)
The patient is instructed to sit up (maintain grip on medial malleoli) and the examiner again evaluates the leg length
If one leg moves further then the other, the test is positive
Note: if one malleolus moves from short to long it is indicative of a posterior rotation of the innominate. If the malleolus goes from long to short it is indicative of an anterior rotation of the innominate
what are the muscle energy techniques for the SI joint?
- Anteriorly rotated innominate = needs posterior rotation (i.e. activation of hip extensors)
- Posteriorly Rotated innominate = needs anterior rotation (i.e. activation of hip flexors)
what is the AROM in a directional preference for SI dysfunction?
- Anteriorly rotated innominate = needs posterior rotation (i.e. pulling involved leg toward chest)
- Posteriorly Rotated innominate = needs anterior rotation (i.e. half-kneeling lunge)
what are the most common causes of piriformis syndrome?
- Inflammation (swelling) in the piriformis or the tissues around it (due to trauma, overuse or prolonged sitting)
- Muscle spasms (due to overuse)
- Scarring in the muscle (due to trauma)
