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Lumbar Spine II Flashcards

1
Q

Usual MOI for SIJ

A

Torsional leg loading
Ex. Running, skiing, golf, lift/twist

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2
Q

Patient profile SIJ age

A

25-45

(Usually not over 65 due to lack of AROM available at the joint at that age)

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3
Q

Patient profile SIJ gender

A

Female

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4
Q

PMH for SIJ

A

Pregnancy

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5
Q

SIJ hypomobility sx

A

Ipsilateral SIJ pain
Can refer to groin, post thigh, lower abs
Running agg > walking > stand > sit
No neuro sx
Ext and SB to same side hurt
Pain with carrying weight on that side

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6
Q

SIJ hypermobility sx

A

Pain with prolonged positions, relief with changing positions, carrying heavy objects

+ provacation tests
Adductor weakness
+SLR (needs SIJ belt)

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7
Q

Weakest pelvic ligament

A

Ventral sacroiliac ligament

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8
Q

SIJ innervation

A

L2 - S3

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9
Q

2 mechanisms for joint stability for pelvic and sacrum

A

Form closure and force closure

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10
Q

Force closure

A

From myofascial systems

Local and global
Local: pelvic floor, transversus, diaphragm, multifidi
Global: 4 slings

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11
Q

4 global slings of force closure

A
  1. Post oblique: glute max and lats
  2. Ant oblique: ext oblique, contra internal oblique, adductor
  3. Longitudinal: peroneii, biceps femoris, sacrotiberous lig, erector, thoracodorsal fascia
  4. Lateral: glute med, TFL, QL
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12
Q

Antegrade flow speed

A

400mm/day

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13
Q

Slow flow speed

A

1-6mm/day

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14
Q

Retrograde flow speed

A

200mm/day

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15
Q

Compression required for decreased venous flow

A

20-30mmHg

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16
Q

Compression required for decreased capillary/arterial flow and axonal transport

A

50mmHg

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17
Q

Compression required for ischemia and blocks nerve impulse

A

60-80mmHg

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18
Q

Peripheral nerve clinical sx
- where is pain most intense
- pattern
- testing

A

At entrapment site
Non Dermatomal
+tinel and NTT

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19
Q

Manipulation contraindications

A

Fracture / bone compromise osteopenia or osteoporosis

Ehlers danlos, Down syndrome

Vascular compromise

Neural compression

Lig instability

Long term corticosteroid use

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20
Q

Pregnancy and SIJ
- hormone
- term

A

Relaxin causing lig laxity

Most increase in pain 3-7mos

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21
Q

SIJ Hypermobility tx

A

Strengthening for force closure (glute max and contra lat, lower abs)

SIJ belt, wear only when vertical

Sclerosing injections

Manipulations if no ERL or contraindications

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22
Q

Normal length for piriformis

A

90 hip flx, 20 add, 20 IR

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23
Q

Normal quad length (knee flex) in Thomas test

A

80

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24
Q

SLR testing for SIJ

A

Lift leg 20, if pain then do again with stability to pelvis. + if sx reduce for hypermobility

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25
Standing flexion test
PSIS should go post with lumbar flx. Positive for hypomobilty if there is superior/anterior ride on ipsilateral side
26
MET - define irridation - GTOs role - use and dosage
- too forceful contraction of synergist - contraction of muscle in lengthened position activated GTOs which inhibits alpha and gamma motor neuron resulting in muscle lengthening - after manip, 3 sets 6-8sec holds
27
Which ligament connects sacrum to ischial tuberosity and continues with biceps femoris Controls
Sacrotuberous lig Nutation (flx) of sacrum
28
Which ligaments attaches medially to lower sacrum and coccyx and assists sacrotuberous lig?
Sacrospinous
29
Ligament that attaches to iliac crest and SI ligaments Stability for
Iliolumbar Lumbosacral junction
30
2 main causes of hypermobility of SIJ
Ext rot AGMR hip
31
Form and force closure work together to cause
Self locking mechanism to prevent shearing
32
SIJ motion
Translation 0-8mm Rotation 1-8 degrees
33
Which lig can cause pain from ext of pelvis putting it on tension? Prevents
Long dorsal Counter nutation
34
Which lig blends with thoracolumbar fascia, erector, multifidi Makes it a good what
Long dorsal Stabilizer
35
SIJ tests and cluster Research
Thigh thrust, Gaenslens, compression/distraction, sacral thrust 2/4 = good chance SIJ block Find side of dysfunction and manip it
36
SIJ provocation tests
Compression/distraction Sacral spring Flick
37
Compression and distraction tests Time and positive
Compression: Up to 30sec hold, + is unilateral pain (not midline pain) Distraction: perform side to side, + is reproduction of pain or alleviation of sx
38
OA and SIJ Radiograph findings Gender Hypo or hyper
Sclerosing of joint Female > male Causes hypo
39
AS Chronicity Nature Incidence Hereditary?
Progressive rheumatoid disorder Inactivity followed by exacerbation periods 1 per million, male, 25 Yes
40
AS sx Testing Affected areas
+ provocation tests, - motion tests Thoracic spine, SIJ, heels, ischial tub, SC, CS, TMJ
41
Test for thoracic stiffness
Measure diff in rib cage circumference b/w inhalation and exhalation Normal is 6-9cm Less than 2.5cm suspect
42
AS tx
NSAIDS and exercise therapy Goal to maintain mobility in affected joints and avoid bamboo spine and thoracic kyphosis
43
Strongest lig in pelvic and crucial for optimal performance
Interosseous lig
44
Sciatic nerve entrapment sites and causes
Entrapped in piriformis mm in 12.5% Usually due to sitting on wallet or direct blow
45
Sciatica nerve differential diagnosis
Lumbar radic, gluteal muscles affected with lumbar radic not sciatic nerve L4-S3
46
Best imaging for nerves
EMG/NCV
47
Ilioinguinal nerve
T12 - L2 Entrapped at Rectus and iliac crest Commonly mistake for hip pain Can be irritated with inguinal hernia, pregnancy
48
Genitofemoral nerve
L1-L2 Anything that extends hip will hurt
49
Obturator nerve
L2-L4 Pain with abduction, ext, IR (kick or twist)
50
Femoral nerve
L2-L4 Absent patellar reflex
51
Superior gluteal nerve
L4-S1 Motor only for glute med, min, TFL Fall on butt or post hip sx approach Pseudo sciatica
52
Inferior gluteal nerve
Motor only glute max L5-S2
53
Post femoral cutaneous nerve
S1-S3 Pure sensory Irritated from sitting activity
54
Cluneal nerves
Inf Mid Superior Sensation to butt and medial anus Won’t refer
55
Inferior cluneal n
Sensation to butt and medial anus Won’t refer
56
Superior cluneal nerve
T12-L3 Prices QL Pseudo sciatica Maignes syndrome: TLJ dysfunction
57
Lateral femoral cutaneous nerve
L2-L3 TFL, inguinal ligament, Can be from belt, more superficial Numbness anterior lat thigh No motor sx
58
L2/L3 nerve root diff diagnoses vs inguinal nerve entrapment
Pain over the inguinal ligament is not with lumbar radic but common in lateral femoral cutaneous nerve
59
Sciatic nerve
L4-S3 + tension testing Decreased Achilles reflex
60
Lumbar vs sciatica nerve differential
Gluteal muscle are fine with sciatic nerve entrapment
61
Common peroneal nerve
L4-s2 Entrapped at neck of fib Innervates short head biceps femoris (entrapment at or Prox to sciatic notch) but is spared in more distal entrapments If deep perineal nerve is affected there will be loss of sensation in first web space, the extensor hallicus and digitorum brevis will be weak
62
Anterior tarsal tunnel syndrome
Caused by shoe laces tied to tight Dorsal of foot parasthesia and 1st web space, weak EDB
63
Medial plantar nerve
Master knot of Henry L4-S2 FHL/FDL tendinitis
64
First branch of the lateral plantar nerve
Comes from post tibial nerve Sensation to 4th and 5th toes Heel pain Deferential from plantar fasciitis Ttp medial calc for tibial nerve Plantar faciiits had morning pain, that is not commo in nerves

Lumbar Spine II (1 decks)

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