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Methods > Methods 5-Midterm > Flashcards

Methods 5-Midterm Flashcards

1
Q

New Patient CPT Code: Problem focused, straightforward MDM, minimal severity, average 10 minute face-to-face visit

A

99201

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2
Q

Adjustment CPT Code: Spinal, 1-2 regions

A

98940

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3
Q

Adjustment CPT Codes: Spinal, 5 regions

A

98942

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4
Q

CPT adjustment codes: Spinal, 3-4 regions

A

98941

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5
Q

CPT Adjustment Codes: Extraspinal, 1 or more regions

A

98943

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6
Q

M99.00

A

Occiput

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7
Q

M99.01

A

Cervical

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8
Q

M99.02

A

Thoracic

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9
Q

M99.05

A

Pelvis

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10
Q

M99.06

A

Lower Extremity

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11
Q

M99.08

A

Rib

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12
Q

M99.07

A

Upper Extremity

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13
Q

M99.06

A

Lower Extremity

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14
Q

Radiculopathy involves _________ compression ; Myelopathy involves ________ compression

A

Nerve root; Spinal cord

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15
Q

Radiculopathy involves _______ stenosis; Myelopathy involves ______ stenosis

A

Foraminal (IVF) ; Spinal

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16
Q

Bone spur, osteoarthritis, growth, infection, ossification, trauma, inflammation, and degeneration are all causes of:

A

Radiculopathy

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17
Q

Cyst, hematoma, tumor, infection, autoimmune disorders, injury, inflammation and degeneration are all causes of:

A

Myelopathy

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18
Q

Symptoms of Radiculopathy

A

-Sharp Pain
-Numbness: Pins/Needles Paresthesia
-Loss of Reflexes
-Weakness in extremities
-Follow nerve root distribution

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19
Q

Symptoms of Myelopathy

A

-Pain
-Tingling, Numbness, weakness
-Difficulty with fine motor
-Increased reflexes
-Difficulty walking (hunched posture)
-Loss of bladder/bowel
-Issues w/ Balance
-Issues w/ Coordination

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20
Q

Peripheral Neuropathy

A

-Damage to the nerves located outside the brain and spinal cord
-Damage to the PNS, may overlap radiculopathy symptoms
-Ex. Carpal tunnel syndrome/Diabetics (neuropathy of feet/legs)

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21
Q

Regardless if its a lateral disc or central disc, the cervical nerve affected will be ______ the segment.

A

Above

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22
Q

Lumbar: _____ disc lesion is going to affect the segment below; (Ie. L5/S1=Affects S1). Whereas a _____ disc will affect the same segment.

A

Central; Lateral

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23
Q

Structure can cause chemical response with an extruded disc

A

Nucleus puposis

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24
Q

Stages of Disc Herniation

A

Stage 1: Disc bulging
Stage 2: Disc protrusion: Annular fibers push out but NP is contained; Can affect central spinal nerve
Stage 3: Disc extrusion: NP breaks through annulus
Stage 4: Disc sequestration: Pain can move side to side due to NP material being able to move (May be bilateral)

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25
Q

Disc Herniation Development Factors

A

-Genetic
-Changes in Hydrogen/Collagen
-Environment: Repetitive motions

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26
Q

Disc Herniation Risk Factors

A

-30-50yo
-Overweight*
-Improper lifting*
-Frequent driving
-Sedentary Lifestyle

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27
Q

Saddle anethesia is common in:

A

Cauda equina syndrome

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28
Q

Disc Injury is aggravated by _________ and relieved by _________

A

-Aggravated by sitting and bending
-Relieved with standing and recumbent positions

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29
Q

Sprain/strain injury is aggravated by __________ and relieved by _________

A

-aggravated with standing and twisting
-relieved by sitting

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30
Q

L1-2 Central Disc Radiculopathy (NR, Motor deficit, pain dist.)

A

-Nerve Root compressed: L2
-Motor deficit: Iliopsoas
-Pain distribution: Anterior medial thigh

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31
Q

L3-4 Central Disc Radiculopathy

A

-Nerve Root Compressed: L4
-Motor Deficit: Quadriceps/Tibialis anterior
-Reflex: Diminished/Absent Patellar Reflex
-Sensory Loss: Medial Ankle
-Pain Distribution: Post. Lat thigh, and anterior tibia

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32
Q

L4-5 Central Disc Radiculopathy

A

-Nerve Root Compressed: L5
-Motor Deficit: Extensor Hallucus longus
-Reflexes: Possibly medial hamstring
-Sensory loss: Greater toe
-Pain distribution: Dorsum of foot

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33
Q

L5-S1 Disc

A

-Nerve Root Compressed: S1
-Motor Deficit: Gastrocnemius and peroneus longus
-Reflex: Diminished/absent achilles
-Sensory loss: Lateral foot/heel
-Pain distribution: Lateral Foot

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34
Q

Orthopedic Tests w/ Disc Herniation

A

Straight leg raise, Femoral stretch test, slump test, Bechterew’s, Strength: Heel/Toe Walk

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35
Q

Nonorganic Physical Signs with disc herniation

A

-Malingering (“Faking”): Superficial tenderness, positive results for simulated tests, distraction tests, disturbances do not correlate, overreaction during the examination

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36
Q

Disc Herniation Treatment

A

-Active Care: Core stabilization, 30 mins/day (walking), McKenzie Exercises
-Home Care: Rest 24-48 hours from onset
Co-Management: Acupuncture, Massage, Steroid injection, PT, Surgical-Discectomy (Last resort)
-Passive Care: Mechanical traction, ultrasound, moist heat, cryotherapy

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37
Q

Categories of Acquired Spinal Stenosis

A
  1. Degenerative
  2. Combined: Congenital and degenerative stenosis
  3. Spondylolytic/spondylolisthetic
  4. Iatrogenic: After medical intervention/treatment
  5. Post traumatic
  6. Metabolic: Padget’s, Acromegaly, Pseudogout
38
Q

3 Classifications of Lumbar Facet Syndrome

A
  1. Traumatic: Facet joint inflammation to the joint capsule
  2. Pathologic: Degenerative arthrosis of the facet joint/Generally associated with DDD
  3. Postural (Chronic): Weight, occupation, increased stress on facets
39
Q

Orthopedics for spinal stenosis

A

SLR: Typically negative
-Bicycle test: Positive
-Walking Test: Positive

40
Q

Orthopedics for Lumbar Facet Syndrome

A

Absence of + valsalva, Kemps, Spring Test of the affected facets will reproduce pain

41
Q

Types of Iliosacral motion

A

1)ANTERIOR & POSTERIOR TILT
• EXTENSION (ANT, SUP, LAT)
• FLEXION (POST, INF, MED)
2) CALIPER (FLARING)
• INTERNAL OR EXTERNAL
ROTATION
• 3) SUPERIOR & INFERIOR SHEARING

42
Q

2 TYPES OF SACROILIAC MOTION:

A

• NUTATION
• COUNTERNUTATION

43
Q

Sacroiliac Dysfunction

A

-PAIN IN THE SI REGION UNRELATED TO TRAUMA,
INFLAMMATORY DISORDERS ORSYSTEMIC ILLNESS
• ABNORMAL MOTION OF THE SI
• COULD BE RESTRICTED OR HYPERMOBILE!

44
Q

SI Dysfunction: Cause/Risk

A
  1. LEG LENGTH DISCREPANCY
  2. SCOLIOSIS
    3.PREGNANCY
45
Q

SI Dysfunction: Signs/Symptoms

A

DULL TO SHARP PAIN WITHIN THE BUTTOCKS, THIGH OR LOWER BACK
• UNILATERAL OR BILATERAL
• PAIN IS WORSE UPON WAKING AND DECREASED WITH MOVEMENT OR EXERCISE
• PAIN IS EXACERBATED WITH PROLONGED SITTING OR TORSO ROTATION

46
Q

Sacroiliac Dysfunction: Diagnosis

A

• OBSERVATION: DIFFICULTY RISING FROM CHAIR, ASYMMETRICAL HEIGHT OF ILIAC CRESTS
• GILLET TEST - ASYMMETRICAL MOTION NOTED
• LEG LENGTH INEQUALITY
• ROM – NO CHANGES
• FLEXION MAY BE PAINFUL

47
Q

SI Dysfunction Tests

A

Cluster of Laslette
-SI Stretch Test
-Gaenslen’s Test
-Iliac Compression Test
-Thigh Thrust
-Sacral Thrust

48
Q

SI Dysfunction: MSR/PARTS

A

MSR
• ALL SHOULD BE WITHIN NORMAL LIMITS
PARTS
• LOCAL PAIN PALPATED OVER THE PSIS
• ASYMMETRY OF THE PSIS; NUTATION/COUNTERNUTATION OF SACRUM!
• LOSS OF FLEXION OR EXTENSION
• LOCAL GUARDING OF MUSCULATURE.
• SHORTENED HIP FLEXORS, HAMSTRINGS, TFL, AND RECTUS
FEMORIS. WEAKENED GLUTS AND ABDOMINAL MUSCLES.

49
Q

SI Dysfunction: Treatment (Active/Home)

A

ACTIVE
• STRETCHES TO ELONGATE HIP FLEXORS, HAMSTRINGS, TFL, RECTUS FEMORIS.
• STRENGTHEN GLUTES AND ABDOMINAL MUSCLES.

HOME
• AVOID ACTIVITIES THAT AGGRAVATE THE CONDITION
• ICE WITH TRANSITION TO HEAT
• CUSTOMIZED ORTHOTICS TO EQUALIZE LEG LENGTH

50
Q

SI Dysfunction: Treatment (Co-Management/Passive)

A

CO-MANAGEMENT
• MEDICAL RX OF NSAIDS OR INTRA-ARTICULAR INJECTION
• MASSAGE THERAPY

• PASSIVE
• ULTRASOUND, MYOFASCIAL RELEASE, CRYOTHERAPY, MOIST HEAT
• RELEASE OF SACRAL AND PELVIC LIGAMENTS
• ADJUST PER THE PARTS FINDINGS

51
Q

Sacroiliac Sprain

A

-CLASSIC PRESENTATION: PAIN OVER ONE SI JOINT AFTER STRAIGHTENING FROM STOOPED POSITION, MAY RADIATE INTO BACK OF LEG, SHARP/STABBING, RELIEVED SLIGHTLY WITH LYING OR SITTING
-ACUTE TRAUMATIC* MODE OF ONSET (OFTEN FROM LIFTING)
-INCREASED SEVERITY OF DISCOMFORT
-EXAMINATION FINDINGS ARE OTHERWISE THE SAME AS SACROILIAC DYSFUNCTION
-TREATMENT MAY ALSO INCLUDE SI BRACING, STABILITY

52
Q

SI Sprain: Tests

A

Iliac Gapping, Gaenslen’s Test, Iliac Compression Test

53
Q

Piriformis Syndrome : Signs/Symptoms

A

-BUTTOCK AND POSTERIOR LEG PAIN UNRELATED TO TRAUMA
-PAIN THAT WORSENS WITH:WALKING, ADDUCTION AND INTERNAL ROTATION
-PAIN EXACERBATED BY PROLONGED SITTING
-SEQUELA OF TRAUMA: CHRONIC COMPLICATION OF AN ACUTE CONDITION

*DON’T LET THIS CONDITION FOOL YOU, IT MAY ACTUALLY BE A LUMBAR RADICULOPATHY!

54
Q

Piriformis Syndrome: Diagnosis

A

OBSERVATION
► PELVIC OBLIQUITY – MISALIGNMENT OF THE PELVIS

ROM
► PAIN REPRODUCED WITH FLEXION, ADDUCTION AND INTERNAL ROTATION OF THE HIP

ORTHO
► BONNETS TEST – SCIATIC NERVE PAIN FROM PIRIFORMIS
► RESISTED ABDUCTION OF THE THIGH (PACE SIGN) ELICITS PAIN
► PASSIVE, INTERNAL ROTATION OF EXTENDED THIGH (FREIBERG SIGN) ELICITS PAIN

55
Q

Piriformis Syndrome Exam (MSR/Parts/Imaging)

A

MSR
► WNL – CLINICAL KEY IN DIFFERENTIATING BETWEEN SCIATICA AND PIRIFORMIS SYNDROME
► WEAK RESISTED HIP ABDUCTION AND EXTERNAL ROTATION

PARTS
► PAIN PALPATED OVER THE GLUTEAL REGION
► GLUTEAL ATROPHY IN CHRONIC CASES

IMAGING
► CT OR MRI FOR SOFT TISSUE: SEVERE CASES

56
Q

Piriformis Syndrome Treatment: Active/Home

A

ACTIVE
► STRETCH PRIOR TO GETTING OUT OF BED
► KNEE BENDS

HOME
► AVOID EXACERBATING ACTIVITIES
► AVOID SITTING FOR LONGER THAN 20 MINUTES
► ICE OR MOIST HEAT

57
Q

Piriformis Syndrome: Co-Management/Passive

A

CO-MANAGEMENT
► DIAGNOSTIC INJECTION OF THE PIRIFORMIS SYNDROME TRIGGER POINTS WITH LIDOCAINE
► NSAIDS
► MASSAGE THERAPY

PASSIVE
► MOIST HEAT
► ULTRASOUND
► PASSIVE STRETCHING OF THE PIRIFORMIS (FLEXION, ADDUCTION AND INTERNAL ROTATION)
► SOFT TISSUE RELEASE OF HIP ROTATORS
► ADJUST THE SI JOINTS AVOIDING DIRECT CONTACT OVER THE PIRIFORMIS MUSCLE
► CHECK HIP ROM AND ADJUST

58
Q

Reactive Arthritis (Reiter’s Syndrome)

A

YOUNG MALE WITH LBP
• ONSET AFTER URETHRITIS, CONJUNCTIVITIS, AND SKIN LESIONS ON SOLES OR PALMS
• CAUSE: D/T INFECTION OFTEN CHLAMYDIA, CAMPYLOBACTER, SALMONELLA, SHIGELLA
• SI JOINT MOST COMMON SYMPTOMATIC JOINT
• MANAGEMENT: ANTIBIOTICS
• MANIPULATION MAY AGGRAVATE!

59
Q

What are common signs and symptoms of sacroiliac dysfunction?
A) Dull to sharp pain within the buttocks, thigh, or lower back, usually bilateral
B) Pain is worse upon waking and decreases with movement or exercise
C) Exacerbated pain with prolonged sitting or torso rotation
D) All of the above

A

D) All of the above

60
Q

Migranes are more prevalent in:

A

Females (3x more)

61
Q

Migrane Symptoms

A

EPISODIC PERIODS OF SEVERE THROBBING HEADACHE PAIN
• VISUAL DISTURBANCES
• NAUSEA
• VOMITING ‘
• HYPERSENSITIVITY TO LIGHT, SOUND, SMELL, TOUCH
• FACIAL TINGLING OR NUMBNESS

62
Q

Migraine w/o Aura typically involves _____ per month and attacks can last between _____ hours

A

> 5, 4-72 hours

63
Q

Migraine w/o Aura will have at least two of the following:

A
  1. UNILATERAL LOCATION
  2. PULSATING QUALITY
  3. MODERATE-SEVERE PAIN INTENSITY
  4. AGGRAVATION BY OR AVOIDING ROUTINE ACTIVITY

“PUMA”

64
Q

During Migraine w/ Aura have one of the following:

A
  1. NAUSEA AND/OR VOMITING
  2. PHOTOPHOBIA AND PHONOPHOBIA
65
Q

Migraine w/ auro will have atleast ___ attacks

A

2

66
Q

Hemliplegic Migraine

A

MIGRAINE WITH AURA, INCLUDING FULLY REVERSIBLE MOTOR WEAKNESS
• BEGINS WITH TEMPORARY MOTOR PARALYSIS, SENSORY DISTURBANCES AND/OR SPEECH/LANGUAGE SYMPTOMS
• ONE SIDE OF THE BODY
• GENERALLY LAST < 72 HOURS

67
Q

Opthalamoplegic Headache

A

PAIN THAT SURROUNDS THE ORBIT
• LASTS FROM A FEW DAYS TO A FEW MONTHS.
• THERE MAY BE PARALYSIS IN THE MUSCLES SURROUNDING THE EYE.
• PT SHOULD SEEK IMMEDIATE MEDICAL ATTENTION BECAUSE THE SYMPTOMS CAN BE CAUSED BY PRESSURE ON THE NERVES BEHIND THE EYE.

68
Q

Retinal Migraine

A

TEMPORARY, PARTIAL, OR COMPLETE LOSS OF VISION IN ONE EYE
• FOLLOWED BY A DULL, ACHE BEHIND THAT EYE THAT MAY SPREAD TO THE REST OF THE HEAD

69
Q

Migraine w/ Brainstem Aura (Basilar Artery Migraine)

A

• SUDDEN ONSET DIZZINESS, CONFUSION OR LACK OF BALANCE.
• SHORT TERM VISUAL DISTURBANCES (DIPLOPIA)
• ALTERATION TO SPEECH
• RINGING IN THE EARS
• VOMITING
• ATAXIA
• STRONGLY RELATED TO HORMONAL INFLUENCES (PRIMARILY STRIKES YOUNG ADULT WOMEN/ADOLESCENT GIRLS)

70
Q

Abdominal Migraine

A

• IDIOPATHIC DISORDER SEEN MAINLY IN CHILDREN
• ATTACKS OF MODERATE TO SEVERE MIDLINE ABDOMINAL PAIN
• DULL TO SORE QUALITY
• NAUSEA, VOMITING
• LASTS 2-72 HOURS
• NO HEADACHE WITH THESE EPISODES!!

71
Q

Cluster Headaches

A

• SUDDEN ONSET OF FREQUENT, SEVERE HEADACHES THAT OCCUR IN GROUPS (CLUSTERS)
• SEVERE UNILATERAL, ORBITAL, SUPRAORBITAL OR TEMPORAL PX
• SHARP, PULSATING, PRESSURE, BURNING,
• PEAKS IN 10-15 MINUTES
• LASTS 15-180 MINUTES
• PAIN RESOLVES RAPIDLY
• TEND TO OCCUR AT NIGHT
• CYLCES CAN LAST WEEKS-YEARS WITH 1-8 ATTACKS PER DAY

72
Q

Cluster headaches are associated with:

A

TEARING, RHINORRHEA, PTOSIS, FACIAL SWEATING, EDEMA OF EYELID

73
Q

Sunct Headache

A

• SHORT LASTING, UNILATERAL, NEURALGIFORM HEADACHE WITH CONJUNCTIVAL INJECTION AND TEARING (SUNCT)
• MOD-SEVERE BURNING, PIERCING, THROBBING PAIN
• AROUND ONE SIDE OF HEAD AND EYE/TEMPLE
• PAIN PEAKS WITHIN SECONDS
• USUALLY DURING THE DAY
• LASTS 5 SECONDS TO 4 MINUTES PER EPISODES
• USUALLY 5-6 ATTACKS PER HOUR
• WATERY BLOOD SHOT EYES, EYELID SWELLING
• NASAL CONGESTION, RUNNY NOSE, SWEATY FOREHEAD
• TX: SOFT TISSUE TECHNIQUES, TRY GENTLE ADJUSTING, PT, INJECTIONS,

74
Q

Tension Headaches

A

• FREQUENT OCCURRENCE
• WORSE IN AFTERNOON/EVENING
• USUALLY BILATERAL DULL/ACHY PAIN
• TIGHTNESS ACROSS FOREHEAD
• SUBOCIPPITAL OR SUPRAORBITAL
• LAST DAYS-WEEKS
• MAY BEGIN WITH MIGRAINES GOING TO LESS SEVERE TENSION HA
• RESPOND WELL TO ST TECHNIQUES AND ADJUSTING

75
Q

Treatment of Tension Headaches

A

Passive: Adjust!, Manual or instrument assistant muscle work Modalities

Active: Post isometric stretching, Deep neck flexors

Home care: Postural awareness, Heat, Stress management

Co-Management: Acupuncture, Massage

76
Q

Sinus Headaches

A

ASSOCIATED WITH INFLAMMATION OF THE SINUS CAVITIES
• FACIAL PAIN WORSE FIRST THING IN THE MORNING, IMPROVES AS THE DAY PROGRESSES
• WORSE WITH SUDDEN HEAD MOVEMENT AND BENDING FORWARD
• FEVER, CORYZA, YELLOW OR GREEN MUCUS, FOCAL FACIAL PAIN
• RISK FACTORS INCLUDE ALLERGIES, HIGH ALTITUDES, NASAL POLYPS, SWIMMING OR DIVING

77
Q

Types of Headache Characteristics: Sinus, Cluster, Tension, Migraine

A

-Sinus: Behind browbone and/or cheekbones
-Cluster: Pain is in and around the eye
-Tension: Pain is like a band squeezing the head
-Migraine: Pain, nausea, and visual changes

78
Q

Cervical Facet Syndrome: Presentation

A

Point tenderness over facet, stiff achy neck, limited ROM
• May radiate into skull, neck, shoulders, upper back
• Pain with extension, Possible HA
• Possible trauma, sometimes insidious

79
Q

People with cervical facet syndrome often report:

A

They “Just woke up with it”

80
Q

Cervical Facet Syndrome: Cause/Risk

A

• Trauma due to an injury to the facet joint
• Degenerative disc disease
• Stress or strain in a prolonged posture.

81
Q

Cervical Facet Syndrome Examination

A

Observation: Antalgia, Anterior Head Carriage
MSR: Rarely Weakness and Sensory Changes (UE)
ROM: Limited ROM

82
Q

Cervical Facet Syndrome: Orthopedic Tests

A

Foraminal Compression, Jacksons, Shoulder Depression Test,

83
Q

C5 Radiculopathy

A

• Weakness: deltoid and biceps
weak – shoulder abduction
• Sensory: Anterior lateral arm along
the deltoid
• Reflex: Diminished biceps

84
Q

C6 Radiculopathy

A

• Weakness: biceps and wrist
extensors
• Sensory: radial aspect of
antebrachium, thumb and index
• Reflex: diminished brachioradiali

85
Q

C7 Radiculopathy

A

• Weakness: triceps and wrist
flexion
• Sensory: anterior
antebrachium, middle finger
• Reflex: diminished triceps

86
Q

C8 Radiculopathy

A

• Weakness: finger flexors
• Sensory: Ulnar aspect of
antebrachium, ring and little finger
• Reflex: Finger flexors

87
Q

T1 Radiculopathy

A

• Weakness: Finger
abduction/adduction
• Sensory: medial biceps
• Reflex: N/A

88
Q

Lower Cervical Disc w/ Radiculopathy: Signs/Symptoms

A

In the older patient, cervical radiculopathy is often
a result of foraminal narrowing from:
• osteophyte formation
• decreased disc height
• degenerative changes of the uncovertebral joints anteriorly/facet joints posteriorly.

89
Q

Lower Cervical Disc w/ Radiculopathy Examination

A

-Observation: Antalgia, Cervical Flexion
-MSR: Changes in Motor, Reflex and Sensation
-ROM: Limited ROM

90
Q

LOWER CERVICAL DISC W/
RADICULOPATHY: ORTHOPEDIC TEST

A

• Foraminal compression test – neg do Spurling’s
• Jackson’s and Spurling’s test is considered the best
• Shoulder depression test reproduces neck and arm symptoms on the side of head deviation
-Valsalva and Soto Hall
• Manual cervical distraction can be used as a physical examination test which will greatly reduce the neck and limb symptoms in patients with radiculopathy.
• Bakody’s sign will decrease discomfort – C5-C6

91
Q

Cervical Sprain/Strain: Examination

A

Observation: Antalgia, Outward injuries, Confusion
MSR: Changes in Motor, Reflex and Sensation
ROM: Limited

92
Q

Cervical Sprain/Strain Orthopedic Tests

A

O’ Donoghues, Shoulder Depression, Rusts, Soto Hall, Naffzinger’s, Jackson’s, Foraminal Compression, Valsalva, Maximum Cerivcal compression

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