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Musculoskeletal 2 > Lumbopelvic Complex Exam part 1 > Flashcards

Lumbopelvic Complex Exam part 1 Flashcards

1
Q

Lumbopelvic exam effectively assesses _______________________ of the lower quadrant

A

mobility, strength, and neurological status

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2
Q

Lumbopelvic exam helps differentially diagnose pathology arising from the _______________________

A

lumbar spine, SI joint, and hip

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3
Q

Lumbopelvic exam assists in clearing the Lumbar spine, SI joints, and hips in the presence of ___________________

A

more distal LE pathology

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4
Q

Lumbopelvic exam provides a structured, evidence-based template for examination of the _________________ which can be modified for a variety of patient scenarios

A

Lower quadrant

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5
Q

What do we want to document when observing our pt?

A

Quality of gait (use of AD, compensatory patterns, and antalgic gait), Postural preferences, and Look for redness, increased temp, rashes, skin irritation, bony/muscular abnormalities, skin creases, and hairy patches

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6
Q

When organizing our exam, we want to minimize ________________ of the pt and why?

A

transitional movements/postures; pts with LBP often have difficulty getting into multiple positions

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7
Q

When assessing location of the pt’s symptoms, we want to ______________

A

expose and palpate

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8
Q

What is the purpose of the multifidi activation test?

A

assess anticipatory recruitment of multifidi musculature in the lower L-spine with UE movement

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9
Q

Multifidi activation test procedure

A

Patient is standing, and therapist palpates multifidi bilaterally. Patient raises up his/her right UE into shoulder flexion. Patient then raises his/her left UE into shoulder flexion.

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10
Q

Multifidi activation test interpretation

A

Just prior to patient elevating his/her UE, therapist should feel contraction of contralateral multifidus muscle. If multifidi are not firing before arm raise, there is a lack of anticipatory control/stabilization.

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11
Q

Purpose of pelvic landmark palpations

A

quickly assess bony pelvic landmarks to determine symmetry right to left and screen for any obvious asymmetries in height.

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12
Q

Pelvic landmark palpations procedure

A

Patient is standing, and therapist is positioned on a stool or knees. Therapist palpates the following landmarks: Iliac Crests, ASIS, PSIS.

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13
Q

Pelvic landmark palpations interpretation: If PSIS is TTP, it may indicate __________

A

SI joint dysfunction

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14
Q

Pelvic landmark palpations interpretation: If iliac crest, ASIS, and PSIS are all elevated on the same side, it may indicate _______________

A

an upslip of that innominate

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15
Q

Pelvic landmark palpations interpretation: If ASIS is inferior, and PSIS is superior on the same side, it may indicate an ________________

A

anterior torsion of the innominate

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16
Q

Pelvic landmark palpations interpretation: If ASIS is superior, and PSIS is inferior on the same side, it may indicate a _________________

A

posterior torsion of the innominate

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17
Q

What is the purpose of the standing march test?

A

assess for Trendelenburg sign and assess SLS balance

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18
Q

Standing march test procedure

A

Patient is standing, and therapist is positioned on a stool or standing behind patient. Therapist palpates bilateral PSIS. Patient performs right hip flexion AROM to approximately 90 degrees. Patient then performs left hip flexion AROM to 90 degrees.

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19
Q

Standing march test interpretation: If see pelvic drop on stance limb = ________________

A

Gluteus Medius weakness on stance limb (Trendelenburg sign)

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20
Q

Standing march test interpretation: If see decreased balance on stance limb, it may indicate ____________________ or __________________

A

possible SI Joint dysfunction on stance side or poor motor control through ankle and LE on the stance side.

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21
Q

What is the purpose of assessing lumbar AROM?

A

assess pt’s willingness to move, identify movement limitations, objectify movement limitations, and identify painful movements

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22
Q

Lumbar Flexion AROM normal range

A

70-90 degrees

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23
Q

Lumbar Extension AROM normal range

A

20-30 degrees

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24
Q

Lumbar SB AROM normal range

A

30-35 degrees

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25
Q

If a pt has limited EXT and SB to one side, then ________________

A

facet joint can’t close on that side

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26
Q

If a pt has limited FLX and SB to one side, then _________________

A

they have an opening restriction on opposite side

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27
Q

Purpose of the standing twist test

A

assess rotational movement of entire body from upper C-spine to sub-talar joints. Helps identify where movement restrictions are present and identifies where excess motion is occurring.

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28
Q

Standing twist test Procedure

A

Patient is standing, and therapist is standing behind patient. Patient is instructed to twist to their right as far as they can and then twist to the left as far as they can. Therapist looks to identify gross movement limitations to one side versus the other and compensatory movement patterns.

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29
Q

What is the purpose of assessing a pt’s squat?

A

assess mobility and stability of the LE through a functional squat motion

30
Q

Squat procedure

A

Patient is standing with feet shoulder width apart and is asked to squat as low as they comfortably can for 5 reps. Therapist starts by standing in front of patient and then moves to side of patient. Therapist looks to identify gross movement limitations in LE mobility and stability and observe compensatory movement patterns

31
Q

Squat evaluation interpretation: If valgus collapse of knees = _____________

A

gluteus Medius strength/control deficit

32
Q

Squat evaluation interpretation: if toe out, flattening of feet, or shifting onto balls of feet = ______________________

A

potential ankle DR ROM deficit

33
Q

Squat evaluation interpretation: if lumbar flexion = _____________________

A

deficit in hip flexion, knee flexion, or ankle DR ROM

34
Q

Purpose of the Climber’s Test

A

assess mobility and stability of the LE through a functional lunge motion

35
Q

Climber’s Test procedure

A

Patient is standing with one foot on a chair and the other foot on the ground in lunge position. Patient is instructed to lunge froward onto foot that is positioned on chair. Therapist observes from the side and looks to identify gross movement limitations in LE mobility and stability and observe compensatory movement patterns.

36
Q

What should you see with the Climber’s Test?

A

Should see CKC ankle DF, hip and knee flexion on leg that is forward, and Should see CKC ankle DF, hip and knee extension on leg that is behind.

37
Q

What is the purpose of having a pt perform heel or toe walking?

A

assess strength of the L4-S1 myotomes

38
Q

Heel/Toe walking procedure

A

pt walks on heels without letting toes touch the ground for 10-20 feet, then on the balls of their feet without putting their heels down for 10-20 feet

39
Q

What must a pt have to be able to safely perform the heel and toe walking tests?

A

adequate balance

40
Q

If pt cannot perform heel walking, it may indicate ________________ weekness

A

L4/L5

41
Q

If patient cannot perform toe walking, it may indicate _________ weakness

A

S1

42
Q

What is the purpose of assessing seated rotation AROM?

A

assess rotational movement of the body above the waist.

43
Q

Seated ROT AROM procedure

A

Patient is seated, and therapist is standing to the side of the patient blocking their LE and pelvis from rotation. Patient is asked to twist to the right and left as far as they comfortably can. Therapist looks to identify gross movement limitations and asymmetries from one side versus the other.

44
Q

Seated ROT AROM interpretation

A

Limited rotation to one side may be due to hypomobility of the T-L junction, thoracic spine, cervical spine, or myofascial/muscular restrictions of the trunk

45
Q

What is the purpose of the slump test?

A

assess for neural/dural tension

46
Q

Slump test procedure

A

: Patient is seated on the edge of the table with hands behind back. Patient then slouches while performing a posterior pelvic tilt. Next, patient flexes neck and head. Then patient extends knee. Patient then DF ankle.

47
Q

Slump test interpretation

A

Each step of this test increases the tension placed on the dura. If LE radicular pain or paresthesia is reproduced during one of the components, we can add the next component to see if symptoms increase. If so, release the component to see if symptoms decrease. This is considered a positive test.
In the position where symptoms are reproduced, we can release a component from above or below to see if symptoms decrease.

48
Q

Hip IR ROM is a predictor variable in several CPRs related to _____________________ of several lumbar and hip pathologies

A

diagnosis and treatment

49
Q

L3/L4 DTR

A

Patellar

50
Q

S1 DTR

A

Achilles

51
Q

Assess UE DTRs if LE DTRs are ________________ for comparison

A

asymmetrical/abnormal

52
Q

What is considered pathologic for ankle clonus

A

4 or more beats

53
Q

Hoffman’s - perform if _______________

A

abnormal reflexes in LE or UE or if UMN signs/symptoms present

54
Q

Babinski: what is seen if present?

A

Great toe extension and fanning of other digits

55
Q

L1 dermatome

A

Inguinal area

56
Q

L2 dermatome

A

anteromedial thigh

57
Q

L3 dermatome

A

Distal anterior thigh, suprapatellar

58
Q

L4 dermatome

A

patella, proximal dorsum of foot

59
Q

L5 dermatome

A

Distomedial foot and ball of foot

60
Q

S1 dermatome

A

Lateral foot and 5th metatarsal pad

61
Q

S2 dermatome

A

Heel and inferior gluteal

62
Q

L2 Myotome

A

hip Flexion (psoas)

63
Q

L3 Myotome

A

Knee extension (quads)

64
Q

L3 Myotome alternative

A

Hip adductors

65
Q

L4 Myotome

A

Ankle DR (anterior tibilialis)

66
Q

L4 Myotome alternative

A

Posterior tibialis

67
Q

L5 Myotome

A

Great Toe Extension (extensor hallucis longus)

68
Q

L5 myotome alternative

A

gluteus Medius and medial hamstring

69
Q

S1 myotome

A

Ankle eversion (peroneals)

70
Q

S1 myotome Alternative

A

Extensor digitorum longus and lateral hamstrings

71
Q

S2 myotome

A

Glut max (hip EXT)

72
Q

When assessing myotomes, what are we looking for?

A

Fatigable weakness and atrophy

Musculoskeletal 2 (4 decks)

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