Musculoskeletal Injuries 2- midterm Flashcards
what is the lower quadrant scan?
a scanning examination is used to determine if we are dealing with a lower quadrant problem or spinal injury
what does soap stand for?
subjective
objective
analysis
plan
give an example of special question regarding safety
general health
medications
what are the spinal cord signs and symptoms (3)
- blow and bladder dysfunction
- bilateral or quadrilateral paresthesia
- hyper-reflexia below level of lesion
Approx at what level does the spinal cord end?
L1-L2
what is considered the horses tail?
cauda equina
what are cauda equina signs and symptoms?
- saddle area anesthesia (insensitive to pain)
- bowl and bladder dysfunction
- hypo-reflexia or a-reflexia
- positive dural signs
when do you test for end feel?
if the client has gone through active ROM with no pain
what is an end feel?
different sensations are imparted to the hand at the extremes of range, this sensation is defined as the end feel
what are the 6 types of end feel?
- bone to bone end feel
- spasm end feel
- capsular end feel
- springy block end feel
- soft tissue approximation end feel
- empty end feel
what is bone to bone end feel?
an abrupt halt to the movement when tow hard surfaces hit
ex. elbow extension
what is spasm end feel?
a sudden stop or the sensation of vibrant twang (elastic) to passive movement
often accompanied by pain
a protective mechanism the body uses to prevent further injury
what is capsular end feel?
a sensation like a thick piece of leather is being stretched
what is springy block end feel?
a rebound sensation is felt
indicates internal articular displacement or internal derangement by me present
what is soft tissue approximation end feel?
joint cannot be pushed any further because one part of the body hits another.
ex. elbow flexion (biceps)
what is empty end feel?
movement causes considerable pain before the extreme of the range is reached
indicates a very serious pathology, acute bursitis or a symptom magnifier
what is the squat test used to clear?
quick clearing test for the lower extremities
if positive it may suggest it is not a spinal problem and peripheral joint assessment is the next step
what level does the knee jerk reflex test?
L3-L4
what level does the Achilles tendon reflex test?
S1-S2
what is a dermatome?
an area of skin supplied by a single nerve root
how do you test for altered nerve conduction?
by assessing pain, temperature or light touch over the area of the skin
what is a myotome?
a muscle group that is predominantly supplies by a single spinal nerve
how do you test myotomes?
test for fatigue, strength and endurance in the particular muscle group
myotomes- what level would you test hip flexion and what muscle
L1-L2
iliopsoas
myotomes- what level would you test knee extension and what muscle
L3
Quadriceps femoris
myotomes- what level would you test for ankle dorsiflexion and what muscle?
L4
Tibialis anterior
myotomes- what level would you test for extension of D1 (big toe) and what muslce
L5
extensor hallucis longus
myotomes- what level would you test for ankle plantar flexion & ankle eversion and what muscle?
S1 -plantar flexion
gastrocnemius
S1- Ankle eversion
Peroneii
myotomes- what level would you test with knee flexion and muscle?
S2
hamstrings
what is the clonus test?
the rthythmic and rapid alternating contraction and relaxation of a muscle brought on by a sudden passive tendon stretching
- can be tested on ankle wrist or patella
- positive test suggest an upper motor neuron lesion
what is the babinski test?
the skin on the sole of the foot is slowly stroked along the lateral border of the heel towards to the big to
- positive test toes spreading
- positive test indicates a disorder of motor pathways of brain and spinal cord
- exception of children 2 years and younger
what is dura?
a thick membrane that is the outermost of the three layers of the meninges that surround the brain and spinal cord
what are two dura tests?
straight leg raise
femoral nerve stretch
what is the straight leg rasie testing for?
integrity of the dura of the sciatic nerve and various branches
what is the degree range for a postive straight leg raise test?
35-70 degrees if pain is felt within this range
what does the patient usually complain of when we use the straight leg raise
posterior leg pain
how do you perform the femoral nerve stretch?
passively flex the patients knee looking for pain or onset of symptoms
what is the femoral nervse stretch also known as?
prone knee bend
what level is the lumbosacral plexus?
L2-L4
what do patients typically complain of when we decide to use the femoral nerve stretch
anterior thigh pain
what are the two components of the vertebral disc
Nucleus pulposus (dics) Annulus Fibrosus (crisscrossing fibers)
what does VAN stand for?
veins
artery
nerves
how prevalent is LBP
4/5 people will experience it in their life time
what is the typical age range for people with LBP and what gender is it most common?
30-50
equal between men and women
is there an agreed upon LBP definition?
no
for LBP how long do symptoms need to be present before it is considered chronic
3 months
what are the 5 conditions of the lumbar spine?
- spondylogenic
- neurogenic
- vascular
- viserogenic
- psychogenic
what are the six spondylogenic back pain injuries we dicussed?
- intervertebral disc derangement
- postural syndrome
- mechanical
- spinal stenosis
- spondylolisthesis
- fractures
_____ provide a pathway for the nucleus to bulge or herniate
fissures
what age group and sex does intervertebral disc derangement(IDD) in the thoracolumbar spine occur in?
30-40 males
what is a cause for IDD?
lifting, bending or twisting
does the pain with IDD get better or worse throughout the day? what is the pain pattern?
subsides the day of injury and worsens the following day
- pain is worse in the morning
- pain and paresthesia may be present centrally or peripherally and unilaterally or bilaterally
what is an aggravating factor for IDD
sitting, bending, sustained postures, coughing, sneezing and bowl movements
what is an easing factor for IDD
standing, supine lying and extension of the lumbar spine
what are some objective assessment findings with IDD
- lumbar spine appears flat or flexed
- flexion rotation increase pain
- extension decreases pain
what is the treatment for IDD
- education
- postural correction
- rest
- brace or corset
- surgery
- traction/spinal compression
- pain relieving modalities
- walking
- stretching
- strengthening
- mods to bio mechanics
what is postural syndrome?
over stretching and mechanical deformation of the normal spinal tissue results in postural pain after prolonged static loading
what is the age range and sex for PS
under 30 males and females
what would your findings be on objective testing with PS
nothing, just visual of poor posture
what is the most common LBP cause
mechanical
what is the age and sex for mechanical LBP
30+ males?
what are the clinical findings with mechanical LBP
- early morning stiffness
- intermitten pain
- pain greatest at the ends of range
- pain is eased with movement
what are the objective findings with LBP
- no deformities, poor posture may be present
- decrease active ROM in lumbar spine
- pain greatest at end of range but eased when moving in the opposite direction
what is the treatment for mechanical LBP
- postural correction
- stretching exercises to regain mobility
- joint mobilization
- education
what is spinal stenosis?
a bony narrowing of the spinal canal centrally or in the lateral recesses
what are the clinical presentation for spinal stenosis?
- primary complaint is vague an intense bilateral LEG PAIN
- client is comfortable at rest in a flexed position
- walking increases leg symptoms and must stop to bend over or sit
- extension increases their leg pain
what LBP condition do people only compain about leg symptoms about?
spinal stenosis
what is the treatment for spinal stenosis
- postural correction
- traction
- cycling
- flexion type exercises
- education
- surgery decompression
what is spondylolisthesis
forward slip one vertebra on the adjacent vertebra due to insufficiency of the facets, neutral arch or structural weakening of the bone
what are the clinical findings for spondyloisthesis
- low back pain that radiate to butt and legs bilaterally
- depending on grade my present with neurological symptoms
- pain increases with lumbar extension
- pain decreased with lumbar flexion
what are the objective assessment findings for spondyloistheis
- visible and palpable step deformity
- may see an abdominal crease anterior
- pain with resisted hip flexion
- pain with accessory glide over the painful segment
what is the treatment for spondylolistheis
- stabilization exercises
- posture correction
- joint mobilization
- stretching
what is a wedged compression fracture of the vertebral body
-fracture of the thoracolumbar spine
-severe flexion force crushes the anterior aspect of the vertebral body
posterior facets may be misaligned
does wedging get better with time?
no it does not go away
ex. hump back grandma
what is neurogenic pain?
nerve is the source of pain
what is the clinical presentation for neurogenic pain?
- severe sharp electric pain
- deep burning pain
- peristsent numbness, tingling or weakness
- travels along nerve into arm or leg
what is a common cause for neurogenic back pain
spinal cord tumor: Nurofibroma (fibruous tissue) or Lipoma (fat tissue)
what is a common complaint for neurogenic back pain?
clients report they have to get out of bed and walk around at night to relieve pain
what is abdominal aortic aneurysm
weakening of the atrial wall causing the artery to expand and left untreated to rupture
what are the clinical presentation for abdominal aortic anuerysm
- boring and deep seating pain in the groin/flank
- feel a pulsating mass in abdomen
- pain is affected by activity
- minimal objective findings related to the pain
- testicular pain often proceeds rupture
what are the pain sites with abdominal aortic aneurysm
pain back
groin pain
what is intermittent claudication
insufficiency of the superior gluteal artery
what are the clinical presentations for intermiotten claudication
- bilateral pain
- increase pain with walking
- pain decreases standing still
- pain is unchanged in all spinal positions
- no burning or numbness
- decreased pulse is extremities
- cold, numb, dry skin
- poor hair and nail growth
what is the population that is most affected by intermittent claudication
40-60 years
male and female
what is viserogenic back pain?
diseases of the pelvic region organs
what are the clinical presentation for viscerogenic back pain?
- activity does not alter pain
- rest does not relieve pain
- other symptoms may include nausea, vomiting fever, bladder dysfunction, vaginal discharge, unexplained weight lose and bleeding
how much of a tissue needs to be consumed by a tumor before it shows up on an xray
40%
what is psyhcogenic pain?
pain that is due to central sensitization “all in your head”
what are the clinical presentation for psychogenic?
- orginal pain spreads
- mirror pain on the opposite side
- often reports sudden stabs of pain
- pain has a mind of its own
- unpredictable response to input and treatment
- all movements hurt
- associated with depression and anxiety
what type of patients get labeled as irritable and unstable
pyshcogenic patients
what is the treatment for psychogenic back pain
- multiply number of professionals (physio, psychologist..)
- counselling
- education
what are some other condsiderations when dealing with LBP
- diet modifications/weight lose
- positive attitude
- meditate
- dietary supplements
- maintain cardiovascular fitness
- maintain flexibility
- seek medical attention of problems occur or questions arise
What thoracic spine region is generally through a watershed area
T4-T9
severe bilateral nerve root pain in the elderly could be caused by?
neoplasm
what would wedging be caused by?
osteoporotic, neoplastic r traumatic fracture
what could the onset of offset of pain related to general activity or tress
cardiac
what could the onset of offset of pain unrelated to trunk movements
ankylosing spondylities and visceral
what could the decreased active contralateral side flexion painful with both rotations full
neoplasm
what could cause severe chest wall pain without articular pain
visceral
what could cause spinal cord signs
cord pressure or ischemia
what could cause pain onset related to eating or diet
visceral
what is scoliosis
abnormality to the lateral curvature of the spine
what is non structural scoliosis?
- no bony deformities
- non progressive
- normal spinal flexibility
- scoliotic curve disappears with forward flexion
what spinal region is non structural scoliosis usually present?
thoracic
what are the five causes of non structural scoliosis
- postural
- hysterical
- nerve root irritation
- inflammatory
- compensatory
what is structural scoliosis
- scoliotic curve lacks normal flexibility
- may be progressive
- curve does not disappear with forward flexion
what are the causes of structural scoliosis
- idiopathic
- congenital
- neuromuscular
- neurofibromatosis
- trauma
- infection
- tumors
- inflammatory
what is the treatment for scoliosis
- bracing
- surgery
- exercise
- neuromuscular electrial stimulation
what is dowagers hump?
assoicated with post menopausal osteporosis (exaggerated kyphosis)
what is hump back/Gibbus
assoicated with a wedge fracture of the thoracic spine or with schenurmann’s disease (exaggerated kyphosis)
what is a thoracic spine disc derangement
- Tears occur in the inner and outer annulus
- Fissures provide a pathway for the nucleus to bulge
- usually due to flexion and rotational injury
what are the clinical presentations for thoracic disc derangement
- sever arching, burning or shooting pain in posterior anterior aspect of the thorax
- may be admitted to hospital due to suspect of cardiac involvement
- all movments are limited and painful
- due to small size of the spinal cord, may present with spinal cord signs
- positive compression and sural testing
- pain eased with traction
- muscle spasms when accessory glides over the spinous prpcresses of thoracic spine
what are the aggravating factors for thoracic disc derangement
movement prolonged flexion deep breathing coughing sitting or lying in extension
what is the treatment for thoracic spinal dis derangement
- medical clearance for spinal cord compression
- treat as per lumbar spine(after ruling our cardiac issues)
where is it most common in the thoracic spine is get a vertebral fracture or dislocation
T12-L1
what is a rib fracture
- usually involve a traumatic event
- presents with crepitus and pain with breathing
what is teh treatment for a rib fracture
rest
what is costochnodritis
- local inflammation of the costochondral junctions anteriorly
- presents as hot and swollen joint on the anterior aspect of thorax
what is contortionists called when more ribs are involved?
tietz’e syndrome
what is the treatment for costochondritis
local modalties for pain relief
what is a barrel chest
- sternum projects forward and upward with increased anterior to posterior diameter
- associated with chronic obstructive pulmonary diseases such as emphysema
what is pectus excavatum
- also known as funnel chested
- sternum pushed posterior by the ribs
- resuls in altered inspiratory pattern
- associated with a increased kyphosis
what is herpes zoster also known as
shingles
what is herpes zoster
-an acute viral infection that lives in the sensory never bodies and at times of stress or illness travels to the skin and attaches to its resulting in scores on the skin and pain
what is scheurmanns disease
osteochondrosis of the anterior intervertebral ring epiphyses
what is scheurmanns disease also known as
vertebral epipyitis or adolescent kyphosis or round back
what population is most susceptible to scheurmanns disease
females
10-16years old
what is teh treatment for scheurmanns disease
postural correction
education
extension exercises
surgery
what is the upper quadrant scan
scanning examination to determine if a person symptoms are of a spinal origin in the cervical spine or in the periphery
what are the 5 d’s
Dizziness Diplopia Drop attacks Dysarthria Dysphagia
what is dysarthria
troubles speaking
what is dysphagia
difficulty swallowing
what do the 5 D’s detect for
vertebral artery signs
what nerve interbates the biceps
C5-6
what nerve intervates the brachioradialis
C6
what nerve inervates the triceps
C7
what cervical vertebra has two nerves come out of it?
C7
what are myotomes
a muscle group of muscles that is predominantly supplied by a single spinal nerve
what do myptomes test?
for fatigue and altered nerve conduction by testing strength and endurance
what is the only true myotome
C1
myotomes C1-C2
neck flexion
Myotome C3
NECK SIDE FLEXION
Myotome C4
shoudler elevation
Myotome C5
shoulder abduction
Myotome C6
elblow flexion and wrist extension
Myotome C7
elbow extension and wrist flexion
Myotome T1
Finger abduction and adduction
what levels of the cervical spine do we not test if the person it sitting breathing and talking
C1-C4
what are dermaomes
an area of skin supplied by a sngle nerve root
what is the test for sesnstaion such as temperature
deramtomes
what is similar test to the straight leg rasie
slump test
what is the accessory movements of the cervical spine
joint mobilization techniques used to identify the level of involvement in the cervical spine
what is teh vertabral artery test
patients head taken into extension and rotation held for 30 seconds
looking for 5 D’s
what is whiplash assicated disorder
- the head and neck moves into extension in relation to the shoulders
- followed by flexion
- the brain is forced against the skull
can whiplash cause jaw problems?
yes, when the head goes back the jaw opens stretching the musculature of the temporomandiulbur joint and the disc
during the extension phase of whiplash what happens the the facet joints
compression resulting in damage ti the joint surface, capsule and ligaments
what happens the to the anterior structurs of teh throat during whiplash
a strecth to all the structures such as esophagus can hemmorhage
during the flexion stage of whiplash what happens to the vertebral bodies?
compression, may cause disc damages or a compressive fracture
what are the clinical presnetations for whiplash
- pain in neck,shoulders and inter scapular regions
- headache
- blurred vision
- tinnitus(ringing in ear)
- dizziness
- numbness in upper extremities
- dysphagia
- facial anteriolateral throat and retro orbital pain
- compulsive clearing of throat
- depression and feels of fatigue
- irrtability and insommia
what is horner syndorme
a sinking in the eyeball, drooping of the upper eyelid, constriction of the pupil, lack of sweat production and facial flushing of the skin
how many grades of whiplash are there
4
what is grade 1 whiplash
complains of pain, stiffness and tenderness only. no physical signs of upper quad scan all came back negative
what is grade 2 whiplash
complains of pain and musculoskeletal signs present including decreased ROM and point tenderness (nerves not involved)
what is grade 3 whiplash
Complains of pain and neurological signs present including decreased or absent deep tendon reflexes,weakness and sensory deficits
what is grade 4 whiplash
complains of pain and fracture or dislocation presnet
what is the treatment for whiplash
- RICE
- NSAIDS
- soft cervical collar
- non weight bearing exercises initially and pressing to weight bearing exercises working in mid range
- gentle isometric strengthening exercise
- electrical modailities such as TENS
- joint mobilization and manipulation
- progress into stabilization exercises and end of range stretching exercises cautiously
- ergonomic modifications
what is acute torticollis
- sudden onset of neck pain and stiffness upon awakening
- may also be caused by a sudden rotation of the cervical spine
- subluxation of the facet or uncinated process
what level does acute torticollis usually occur at
C2-C3
what is teh treatment for Acute toticollis
- manual traction of the cervical spine
- joint mobilization
- soft collar
what is acute torticollis called in children (ages 5-7)
Grisels syndrome
what is teh treatment for Grisels
NO TRACTION
antibiotics
what is the most common level for cervical disc derangement
C5-C7
what is cervical spine and spinal stenosiss
stenosis due to disc prolapse is very uncommon but is more commonly caused by degeneration of the uncovertebral joint and due to the small size of the lateral foramen
what is the symptom for cervical spinal spinal stenosis
- NO NECK PAIN
- ARM PAIN
what are the clinical presentaions for cervical spinal stenosis
- segmental paraesthesia pain
- age greater than 45
- compression in extension aggravates symptoms
- traction relieves symptoms
- x-rays confirm clinical findings
where is spondylothesis most common
-common at L5-S1
what age group is most common for spondylothesis
-under 30
what may be the cause for viscerogenic back pain
-tumors
what is neoplasm
a new and abnormal growth of tissue in some part of the body, especially as a characteristic of cancer
what region is disc derangement most rare? and why
-extremely rare in the thoracic spine due to the thick posterior longitudinal ligament and ribs
What age group is mostly affected by thoracic spinal disc derangement
- most common in 40s
- more common in males
what level on the thoracic spine is disc derangment most common?
-most common levels affect are between T6-T10
