MDT

Question 1

Derangement syndrome

Answer 1

Pain caused by mechanical obstruction of a joint
- Shows directional preference and centralisation
- respond to loading strategies
- group get better and worse quickly
- symptoms can be constant or intermittent
- kyphosys, lateral shift,… signs of derangement

Question 2

Dysfunction syndrome

Answer 2

Pain caused by Mechanical deformation or structured impaired tissue (hypomobility)
- always intermittent pain
- movement loss in direction of dysfunction
- End range pain
- Dysfunction named from direction that produce the symptomatic response

Question 3

Postural syndrome

Answer 3

Pain caused by mechanical deformation of soft tissue or vascular insufficiency due to prolonged static position that affects muscles
- only intermittent pain
- end range doesn’t produce pain
- pain only when sustaining end range position for long time

Question 4

Derangement dysfunction management

Answer 4

reduction and loading strategies to create centralisation

Question 5

dysfunction syndrome management

Answer 5

Repetitive movement in end of range to remodel abnormal tissue

Question 6

postural syndrome management

Answer 6

postural correction to relieve symptoms

Question 7

Others: red flags (5)

Answer 7

Cancer- unexplained weight loss and history
fracture - MVA and fall
spinal infection - fever and constant pain
cauda equinae - bladder dysfunction
vascular disease - abs aortic aneurysm

Question 8

Other: Chronic pain syndrome

Answer 8

pain influenced by psychosocial factors
- disproportionate pain with all activities

Question 9

Other: Inflammatory

Answer 9

constant pain, morning sitfness, movement exacerbate sypmtoms
- RA
- arthritis
- ankylosing

Question 10

Mechanical inconclusive

Answer 10

everything else excluded, but sx affected by position or movement.
- mechanical response on loading inconsistent
- no recognisable pattern

Question 11

mechanically unresponsive radiculopathy

Answer 11

radiculopathy that doesn’t get better with repetitive movement

Question 12

post surgery

Answer 12

recent surgery follow protocole

Question 13

SIJ and pelvic girdle pain

Answer 13

pain SIJ or pubis
exclude lumbar spine
3/5 positive test for SIJ

Question 14

spinal stenosis

Answer 14

restriction of spinal canal
- older pop
- flexion relieve
- arm or leg symptoms when foramen close

Question 15

structurally compromised

Answer 15

bony changes on joint
- affect ROM
-clunking, locking
- history of trauma
irreversible with conservative care
- RA, spond, osteoporosis

Question 16

Trauma

Answer 16

trauma associated with constant symptoms

Question 17

principle of management for DERANGEMENT

Answer 17

1- achieve reduction (centralise pain)
2- maintain reduction (avoid derangement direction)
3- recover function (go into direction that caused derangement but now no more pain)
4- train the patient in prophylaxis (work stability to prevent the same problem)