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Lumbar Spine II > Lumbar Spine II > Flashcards

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
Q

Standing flexion test

A

PSIS should go post with lumbar flx. Positive for hypomobilty if there is superior/anterior ride on ipsilateral side

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26
Q

MET
- define irridation
- GTOs role
- use and dosage

A
  • 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
Q

Which ligament connects sacrum to ischial tuberosity and continues with biceps femoris

Controls

A

Sacrotuberous lig

Nutation (flx) of sacrum

28
Q

Which ligaments attaches medially to lower sacrum and coccyx and assists sacrotuberous lig?

A

Sacrospinous

29
Q

Ligament that attaches to iliac crest and SI ligaments

Stability for

A

Iliolumbar

Lumbosacral junction

30
Q

2 main causes of hypermobility of SIJ

A

Ext rot

AGMR hip

31
Q

Form and force closure work together to cause

A

Self locking mechanism to prevent shearing

32
Q

SIJ motion

A

Translation 0-8mm
Rotation 1-8 degrees

33
Q

Which lig can cause pain from ext of pelvis putting it on tension?

Prevents

A

Long dorsal

Counter nutation

34
Q

Which lig blends with thoracolumbar fascia, erector, multifidi

Makes it a good what

A

Long dorsal

Stabilizer

35
Q

SIJ tests and cluster

Research

A

Thigh thrust, Gaenslens, compression/distraction, sacral thrust

2/4 = good chance SIJ block

Find side of dysfunction and manip it

36
Q

SIJ provocation tests

A

Compression/distraction
Sacral spring
Flick

37
Q

Compression and distraction tests
Time and positive

A

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
Q

OA and SIJ
Radiograph findings
Gender
Hypo or hyper

A

Sclerosing of joint
Female > male
Causes hypo

39
Q

AS
Chronicity
Nature
Incidence
Hereditary?

A

Progressive rheumatoid disorder
Inactivity followed by exacerbation periods
1 per million, male, 25
Yes

40
Q

AS sx
Testing
Affected areas

A

+ provocation tests, - motion tests
Thoracic spine, SIJ, heels, ischial tub, SC, CS, TMJ

41
Q

Test for thoracic stiffness

A

Measure diff in rib cage circumference b/w inhalation and exhalation

Normal is 6-9cm
Less than 2.5cm suspect

42
Q

AS tx

A

NSAIDS and exercise therapy

Goal to maintain mobility in affected joints and avoid bamboo spine and thoracic kyphosis

43
Q

Strongest lig in pelvic and crucial for optimal performance

A

Interosseous lig

44
Q

Sciatic nerve entrapment sites and causes

A

Entrapped in piriformis mm in 12.5%

Usually due to sitting on wallet or direct blow

45
Q

Sciatica nerve differential diagnosis

A

Lumbar radic, gluteal muscles affected with lumbar radic not sciatic nerve

L4-S3

46
Q

Best imaging for nerves

47
Q

Ilioinguinal nerve

A

T12 - L2
Entrapped at Rectus and iliac crest
Commonly mistake for hip pain

Can be irritated with inguinal hernia, pregnancy

48
Q

Genitofemoral nerve

A

L1-L2
Anything that extends hip will hurt

49
Q

Obturator nerve

A

L2-L4
Pain with abduction, ext, IR (kick or twist)

50
Q

Femoral nerve

A

L2-L4
Absent patellar reflex

51
Q

Superior gluteal nerve

A

L4-S1
Motor only for glute med, min, TFL
Fall on butt or post hip sx approach
Pseudo sciatica

52
Q

Inferior gluteal nerve

A

Motor only glute max
L5-S2

53
Q

Post femoral cutaneous nerve

A

S1-S3
Pure sensory
Irritated from sitting activity

54
Q

Cluneal nerves

A

Inf
Mid
Superior

Sensation to butt and medial anus
Won’t refer

55
Q

Inferior cluneal n

A

Sensation to butt and medial anus
Won’t refer

56
Q

Superior cluneal nerve

A

T12-L3
Prices QL
Pseudo sciatica
Maignes syndrome: TLJ dysfunction

57
Q

Lateral femoral cutaneous nerve

A

L2-L3
TFL, inguinal ligament,
Can be from belt, more superficial
Numbness anterior lat thigh
No motor sx

58
Q

L2/L3 nerve root diff diagnoses vs inguinal nerve entrapment

A

Pain over the inguinal ligament is not with lumbar radic but common in lateral femoral cutaneous nerve

59
Q

Sciatic nerve

A

L4-S3
+ tension testing
Decreased Achilles reflex

60
Q

Lumbar vs sciatica nerve differential

A

Gluteal muscle are fine with sciatic nerve entrapment

61
Q

Common peroneal nerve

A

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
Q

Anterior tarsal tunnel syndrome

A

Caused by shoe laces tied to tight

Dorsal of foot parasthesia and 1st web space, weak EDB

63
Q

Medial plantar nerve

A

Master knot of Henry

L4-S2

FHL/FDL tendinitis

64
Q

First branch of the lateral plantar nerve

A

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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