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PCE > MSK- Lumbar > Flashcards

MSK- Lumbar Flashcards

1
Q

What is the purpose of the Slump test?

A

Detects adverse nerve root tension

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2
Q

What is the purpose of the SLR (Lasegue) test?

A

It aims to assess for lumbosacral nerve root irritation.

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3
Q

What are the ranges for a positive SLR test?

A

Less than 30• : not a positive test. Slack of sciatic.

Between 30-70• : considered a positive test with reproduction of symptoms

Above 70• : not considered a positive test ( due to other structures involved)

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4
Q

What is the “crossover sign” for SLR?

A

Indicates a large disc bulge ( protrusion)

Occurs when performing a SLR, on the unaffected side, the pt experiences pain in the affected leg.

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5
Q

What is the relief position for someone with spinal stenosis?

A

Flexion- bc it opens intervertebral foramen

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6
Q

What is a worse position for someone with spinal stenosis?

A

Extension - bc it closes the intervertebral foramen

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7
Q

What are the signs /symptoms for spinal stenosis?

A

Low back pain

Possible b/l numbness and tingling

Pain in b/l legs

Pain decreases as the morning progresses

Repetitive motion cause pain

Chronic pain w acute episodes

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8
Q

What is the Bicycle test for?

A

For neurogenic claudication. Indicative of spinal stenosis

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9
Q

What are some differences between neurogenic and intermittent claudication?

A

Neurogenic: nerves are getting compressed
Gets better w spine flexion
Onset: typically immediated
Pain characteristics: burning or tingling

Intermittent: caused due to ischemia ( decreased blood flow to the area)
Gets better w rest ( not position dependent)
Onset: gradually increases w activity
Pain characteristics: cramping

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10
Q

What are some interventions for spinal stenosis?

A

Flexion based exercises and positioning
( cycling)

Traction

Aerobic exercs

Surgical: laminectomy

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11
Q

What is laminectomy? What is a contraindication for position on the “protection phase ( 1week)?

A

Laminectomy: spinal decompression
Contraindication: pt is not supposed to rotate during transfers , on the protection phase.
Pt is encouraged to log roll.

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12
Q

What is the mechanism of injury for Postero lateral disc herniation?

A

Flexion

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13
Q

What are some interventions for Postero lateral disc herniation?

A

Typically prefer extension based exercise and mov such as repeated extensions in prone

Traction

Lumbar stabilization exercs : with core activation/ brace

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14
Q

What are some interventions for anterior bulge disc herniation?

A

Flexion based exercs

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15
Q

What is the main characteristic of pelvic crossed syndrome?

A

Imbalance patterns wich promotes increased lumbar lordosis

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16
Q

What is Spondylosis?

A

Normal age related changes
“arthitis in the spine”

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17
Q

What is Spondylolysis?

A

Stress type of fracture. It’s a repetitive stress injury

18
Q

What is spondylolisthesis?

A

Stress fracture and slinding of the vertebra (forward)

19
Q

What is retrolistheses?

A

Backward displacement of one vertebra on another

20
Q

How are the grades for spondylilisthesis?

A

Grade 1: less then 25% slippage

Grade 2: 25% -50% slippage

Grade 3: 50% -75% slippage

Grade 4: more then 75% slippage

Grade 5: 100% slippage

21
Q

What are the treatments for spondylolisthesis based on their grades?

A

Grades 1-2-3: core strengthening exercs
Grades 4-5: will need fixation

22
Q

What is a common sign on the x ray for spondylolisthesis?

A

Scotty dog with collar sign
Scotty dog with decapitation sign

23
Q

What is some
Interventions for spondylolisthesis?

A

Inner core stability exercises
Education regarding avoiding aggravating movements (extension)

24
Q

What is contraindicated on spondylilisthesis?

A

Manipulation

25
Q

What are some contraindications for laminectomy or fusion on the Maximum protection phase?

A

No heavy lifting more than 5-10 lbs for up to 3 months

Extension exercs ( pt that had a laminectomy)

Log roll for a week

Do not sit for more than 20-30min continuously for 2ws

Dont push,pull or lift

26
Q

What is Cauda equina syndrome?

What are some signs/symptoms of Cauda equina syndrome?

A

Damage to cauda equina( nerve roots below L1)

Loss of bowel and bladder control

B/l leg pain

Saddle paresthesia. (Numbness or different sensations in the backs of your legs, butt, hip and inner thighs (your saddle area, as in the parts of your body that would touch the saddle if you were on a saddled horse)

27
Q

What are some signs and symptoms for Malignancy?

A

Previous history of CA

Unexplained weight loss

Constant unrelenting pain

Pain unrelieved by rest

Pain worsens at night

Night sweats

Failure to improve w conservative therapy within one month

28
Q

To test patellar reflex…

A

L3-4

29
Q

To test achilles reflex…

A

S1-2

30
Q

Shopping cart sign

A

Relief from symptoms when leaning forward over the shopping cart, while shopping. often seen in a pt w lumbar spinal stenosis

31
Q

Which dermatome covers the great toe?

A

L4

32
Q

Laminectomy

A

Removal of lamina to make room to relieve compression on nerve roots and spinal cord

33
Q

Cause of neurogenic claudication

A

Nerve root compression due to lateral stenosis

34
Q

Slump test procedure

A

Therapist instructs the pt to place hands behind back, go into a slump posture( w rounded shoulders) and bring chin to their chest

Therapist passively extends the uninvolved knee then repeats the test on the involved le.

If symptoms have not been reproduced ankle df is added

If symptoms of low back pain/radiating pain in post leg are recreated,ask pt to ext their neck while maintaining a rounded back

35
Q

Positive slump test findings

A

Relief of symptoms when pt extends neck indicates neural tension/restriction of lumbosacral roots

36
Q

Which dermatome goes over the patella?

A

L4

37
Q

You suspect the patient may be presenting with sign of the buttock. Which of the following correctly describes underlying pathologies associated with sign of the buttock?

a. Rheumatic bursitis, osteomyelitis of the femur, neoplasm of the upper femur, ischiorectal abscess.
b. Fractured sacrum, osteomyelitis of the tibia, neoplasm of the tibia, ischiorectal abscess.
c. Septic sacroilitis, gluteal bursitis, rectal cancer.
d. Ischiorectal abscess, rheumatic bursitis, rheumatoid arthritis or osteoarthritis, neoplasm of the upper femur.

A

A

38
Q

A physiotherapist is training a patient with spasticity of lumbar extensors, notices that the patient tends to extend the trunk quite often.
The physiotherapist decides to rectify this by promoting excess anterior tilt at the pelvis.
Which of the following can be done in order to do so?

A) Pelvic positioner angled at 45° to the seat
B) Decrease the seat width by 1 inch on both sides
C) Pelvic positioner angled perpendicular to the seat
D) Provide knee blocks anteriorly to free pelvis

A

C

39
Q

A middle aged man is referred to your clinic for persistent hip and buttock pain. The patient is acute and irritable.

You perform a mobilization to increase hip flexion. Select the most appropriate treatment:

a. Rest and ice as the patient is acuterand irritable.

b. Oscillation or grade 1 posterior glide with hip in 30 degrees of flexion, 30 degrees of abduction and slight external rotation.

c. Oscillation or grade 1 anterior glide with hip 30 degrees of flexion, 30 degrees of abduction and slight external rotation.

d. Oscillation or grade 1 posterior glide with hip in 10 degrees of flexion, 10 degrees of abduction and neutral rotation.

A

B

• When the joint is acute or irritable, oscillations or grade 1 mobilizations are appropriate.

According to the convex/concave rule, to increase hip flexion, you would want to perform a posterior glide. You would perform the mobilization in the open pack position of the hip - 30 degrees of flexion, 30 degrees of abduction and slight external rotation.

40
Q

A fracture is a contraindication to all of the following except:

a. Resistance exercises in the area.
b. Grade 1 joint mobilizations.
c.Flexion exercises in spondylolisthesis.
d. Rib springing

A

C

• Spondylolisthesis is a fracture of the pars leading to anterior slippage of one vertebrae on another. Without treatment, this can lead to cord compression. Extension is contraindicated NOT flexion when a spondylolisthesis is present.

PCE (30 decks)

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