Lumbar (Last Clin Med lecture) Flashcards
What can happen if the hip has congenital hip dyplasia?
The ball part of the joint can come out of the socket
What are the 2 special test done as soon as the baby is born to test for congenital hip dysplasia?
Barlows & Ortolani
What does Barlow test do to the hip if it is positive?
Dislocate posteriorly
What does the Ortolani do?
If Barlow test is positive
What interventions are need for congenital hip dislocation?
Surgical Correction or Splinting/Harnessing
Gait training
ROM/Strengthening Exercise
Developmental Transitioning
What is the pain referral for SI dysfunction?
Deep in butt and refer down the leg
What are some key indicators for SI involvement?
- Mechanical low back pain
- Trauma
- Pt may or may not report LE sxm
- General hyper mobility
If a patient with SI involvement reports LE pain how will it present?
- Unilateral
- Above the knee
What are some things that will cause SI problems?
Trauma
Pregnancy
Systemic arthritis
Traumatic/ microtrauma arthritis
What would a patient present as in an exam with SIJ pathology?
- Complaints increase w/ walking
- Lumbar AROM painfree w/ no TTP in lumbar spine
- Hip extension w/ OP painful
- TTP over posterior aspect if SI joint
- ## Normal neuro exam
What are the 6 special test done to know whether or not SIJ is involved?
Distraction/Gapping
Compression
Post Shear/Thigh Thrust
Pelvic Torsion
Sacral thrust
If you can only do one test to rule out SI joint what is the best test?
Thigh thrust
If you have + test for 3 or more of the 6 special test for SIJ involvement what is the specificity & sensitivity?
Sensitivity: .94
Specificity: .78
If all 6 of of the SIJ ligamentous provocation stress exam is negative what can you rule out?
SIJ as a source of LBP
Manual therapy: If the innominate is anteriorly rotated what do you need to perform?
Posterior rotation- activation of hip extensors
Manual Therapy: if the innominate is posteriorly rotated what do you need to perform?
Anterior rotation - activation of hip flexors
Therapeutic Exercise: If the innominate is anterior rotated what do you need to perform?
Posterior rotation –> Ie pulling involved leg toward chest
Therapeutic exercise: If innominate is posterior rotated what do you need to perform?
anterior rotation –> half-kneeling lunge
What are the most common causes of piriformis syndrome?
- Inflammation (swelling) in piriformis or tissues around it
- Muscle spasms
- Scarring in muscle
What are the common patterns of symptoms for piriformis syndrome?
- Worse with sitting for long periods of time, walking or running & climbing stairs
- SXM described as pain, aching, & burning in piriformis region & N/T down the leg
What is the presentation of exam for someone with pirifromis syndrome?
- Normal lumbar ROM & no TTP
(may have pain w/ hip flexion & IR/ER - TTP in piriformis region
- Positive neruor sign may be present
- Positive FAIR test
What is the treatment for piriformis?
- Education
- Modalites PRN
- Address neural tension
- Stretch piriformis
- Eventually prescribe strengthening exercises for piriformis & lumbar spine
- General fitness activity
What is a femoral neck stress fracture caused by?
Repetitive loading of femoral neck that leads to either compression side or tension side
What is the best imagining for femoral neck stress fracture?
MRI
Why might radiographs not be the best thing for diagnosing femoral neck stress fracture?
Findings often lag behind therefore results in false negative early on
Which type of stress fracture is nonoperative treatment for?
compression fracture
Which type of stress fracture is surgery indicated?
tension sided stress fractures
What are the demographics of a femoral neck stress fracture?
Females> Males
Female athlete triad
What activity are related to femoral neck stress fracture?
Military personnel
Track & field or cross country athlete
High training volume & intensity
What medical things may make someone more susceptible to femoral stress fracture?
Lower BMI
Decreased bone mineral density
Energy deficiency
Tobacco use
What anatomical conditions may make someone more susceptible to femoral stress fracture?
Femoracetabular Impingement
Coxa Vara
