Lx Functional Instability CSPE Flashcards
Phrase to link Lx functional instability to a primary diagnosis
“Complicated by Lx functional instability “
3 subunits of stability
Passive
Active
Neutral
Active system
MM & their tendinous attachments
Deep segmental mm of Lx stability
Multifidi
Transverse abdominous
Neutral / motor control system
Central & peripheral nervous system Proprioception Mechanoreceptors Located in ST Coordinate stabilization mm
Motor control insufficiency (MCI)
Neuromuscular breakdown of needed spinal stiffness
Marked Skeletal deformity with excessive end range hypermobility
Poor coordination of movement, lacking proper stabilization, with episode of aberrant motion
Absence of mm & motor control
Increase GROM throughout the body
Brighton Ligamentous scale
4 prognostic factors to clinical id LBP & have better outcomes w/ stabiliztion exercises
< 40y
> 91 degrees SLR (average of both legs)
Lx flexion aberrant movement (catch, painful arc, reverse Lx pelvic rhythm)
+ prone instability test
Ancillary studies
Ultrasound (US)
FLUOROSCOPIC VIDEO
3 things the clinical clues most cited
Onset & behavior of system
Assessment of quality of regional & segmental motion
Poor motor control indicators
4 clues from history for Lx instability
Episodic nature (trivial events) Reports catching, looking, giving way Immediate Pain w/ sitting Temporary responses to manipulate Deceased manipulation response over time
3 part of Episodic nature
Multiple unpredictable episodes
Pain free intervals
Progressive course
2 parts of subject sense of instability
Report catching &mocking associate w/ giving way
Immediate pain w/ sitting relieved w/ standing
3 part of temporary response to treatment decreased over time
Medical treatment
Manual treatment
Relief w/ bracing
3 clues from the PE for Lx instability
Altered quality of movement
Specific segmental findings
Evidence of poor motor control
2 parts of painful quality of movement
Painful arc - F/E reproduce CC Aberrant motion ( minor's/Gowers' sign, instability catch, reverse lumbosacral rhythm)
6 parts of evidence of poor motor control in Lx instability
Segmental abnormal movement
Painful arc abolished w/ abdominal bracing
Poor motor control during truck forward lean
Poor motor control of pelvic clocking & abdominal hollowing
Poor motion control during hip extension test
Poor motor control during single leg stand
If these 5 things are meet, no imaging is required 6 weeks LBP
No neurological symptoms No constitutional symptoms No history of trauma No symptoms of malignancy Patient is 18-50y
Trauma, neurological compromise, disease process what to order if suspected
X-ray plain film (1st)
Stress film (Hypermobility i.e. Later film F/E, compression/ traction)
Videofluorosopy
MRI
CT
Discography (instability)
Hypermobility major criteria
> 4 Brighton score
>4 joint pain longer than 3 months
Brighton score sections for hypermobility
Hyperextension elbow Hyper extended knee Bend thumb back on forearm Bend little fingers 90degrees To back of hand Hands flat on floor with knees straight
1 point for each side, except only. Point for hands on floor
Hypermobility minor criteria
1-3 Brighton score (<50y)
P in 1-3 joints, >3 months
Joint dislocation
3 or more ST damage instances
Exceptionally tal, slim build, slender fingers (Marfanoid habitus)
This / stretchy skin, scars stretch
Drooping eyelid, short-sightedness / slanting eye
Varicose VB., hernia, prolapse of womb / rectum
Hypermobilty determined by major and minor criteria
2 major
1 major + 2 minor
4 minor
2minor + 1st degree related family member w/confirmed Hypermobility (mom, dad, sibling)
Raiographic standard for hypermobility
Total Sagittarius translation >4mm
Need F & E views then add the listhesis
Standard radiographic Hypermobility on stress views
Total Sagittal rotation >10 degrees from neutral
