Lx Functional Instability CSPE

Question 1

Phrase to link Lx functional instability to a primary diagnosis

Answer 1

“Complicated by Lx functional instability “

Question 2

3 subunits of stability

Answer 2

Passive
Active
Neutral

Question 3

Active system

Answer 3

MM & their tendinous attachments

Question 4

Deep segmental mm of Lx stability

Answer 4

Multifidi

Transverse abdominous

Question 5

Neutral / motor control system

Answer 5

Central & peripheral nervous system 
Proprioception
Mechanoreceptors
Located in ST
Coordinate stabilization mm

Question 6

Motor control insufficiency (MCI)

Answer 6

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

Question 7

4 prognostic factors to clinical id LBP & have better outcomes w/ stabiliztion exercises

Answer 7

< 40y

> 91 degrees SLR (average of both legs)

Lx flexion aberrant movement (catch, painful arc, reverse Lx pelvic rhythm)

+ prone instability test

Question 8

Ancillary studies

Answer 8

Ultrasound (US)

FLUOROSCOPIC VIDEO

Question 9

3 things the clinical clues most cited

Answer 9

Onset & behavior of system
Assessment of quality of regional & segmental motion
Poor motor control indicators

Question 10

4 clues from history for Lx instability

Answer 10

Episodic nature (trivial events)
Reports catching, looking, giving way
Immediate Pain w/ sitting
Temporary responses to manipulate
Deceased manipulation response over time

Question 11

3 part of Episodic nature

Answer 11

Multiple unpredictable episodes
Pain free intervals
Progressive course

Question 12

2 parts of subject sense of instability

Answer 12

Report catching &mocking associate w/ giving way

Immediate pain w/ sitting relieved w/ standing

Question 13

3 part of temporary response to treatment decreased over time

Answer 13

Medical treatment
Manual treatment
Relief w/ bracing

Question 14

3 clues from the PE for Lx instability

Answer 14

Altered quality of movement
Specific segmental findings
Evidence of poor motor control

Question 15

2 parts of painful quality of movement

Answer 15

Painful arc - F/E reproduce CC
Aberrant motion ( minor's/Gowers' sign, instability catch, reverse lumbosacral rhythm)

Question 16

6 parts of evidence of poor motor control in Lx instability

Answer 16

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

Question 17

If these 5 things are meet, no imaging is required 6 weeks LBP

Answer 17

No neurological symptoms
No constitutional symptoms 
No history of trauma
No symptoms of malignancy
Patient is 18-50y

Question 18

Trauma, neurological compromise, disease process what to order if suspected

Answer 18

X-ray plain film (1st)
Stress film (Hypermobility i.e. Later film F/E, compression/ traction)
Videofluorosopy

MRI
CT

Discography (instability)

Question 19

Hypermobility major criteria

Answer 19

> 4 Brighton score

>4 joint pain longer than 3 months

Question 20

Brighton score sections for hypermobility

Answer 20

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

Question 21

Hypermobility minor criteria

Answer 21

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

Question 22

Hypermobilty determined by major and minor criteria

Answer 22

2 major
1 major + 2 minor

4 minor
2minor + 1st degree related family member w/confirmed Hypermobility (mom, dad, sibling)

Question 23

Raiographic standard for hypermobility

Answer 23

Total Sagittarius translation >4mm

Need F & E views then add the listhesis

Question 24

Standard radiographic Hypermobility on stress views

Answer 24

Total Sagittal rotation >10 degrees from neutral