Oce Msk Flashcards
Cervical radiculopathy
Condition described as a group pf signs and symptoms related to a compressed or irritated nerve root
What are the components for the physical examination of a cervical radiculopathy?
Neuro scan: dermatomes, miotomes, reflex
Special tests: cervical distraction and spurlings test (compression)
ULTT
What are the signs and symptoms of cervical radiculopathy?
Numbness, pain, muscle weakness, decreased nerve conduction, decreased sensation and decreased reflexes
What is VBI and what are the symptoms?
5d 3n
Compression of the vertebro artery. It can decrease blood flow and promote ischemia in areas of the brain stem.
5d
Dizziness, drop attack, dipoplia, dysphagia( dif swallowing) disartria ( dif speaking)
3n nystagmus, nausea, other neurological symptoms
Torticollis
Ipsilateral side flexion and contralateral rotation of c spine
Upper crossed syndrome
Tx
Tight pectoralis and upper trapezius
Weak cervical flexors and serratus anterior and romboides
Tx: postural correction
Cervical instability
Tests
If suspected MOBILIZATION AND OR MANIPULATIONS should not be performed
Testes: lateral flexion alarmlih stress test
Sharp purser test
Segmental instability for cervical test
Pressure biofeedback
Interventions for kyphosis
Posture education
Stabilization exercs
Stretching as needed
Compression fractures interventions and contraindications
Posture education
Weight bearing exercises
Contraindications: joint manipulation,aggressive manipulation and trunk flexion exercs
Scoliosis
Test
Tx
Named in the direction of the convexity of the curve
Test: cobb angle maior q 10
Nonstructural scoliosis and structural scoliosis
No structural:
Curve dissapers w foward flexion
Due to poor posture
Structural:
Does not dissapear w forward flexion
Structural change in bones
Vertebral bodies rotated to the side of the convexity
Lumbar radiculopathy ax
Neuro scan: dermatomes,miotomes, reflex
Reflex: patelar(l3-4), achikes (s2) babinski and clonus ( umn)
special tests: slump( detetc nerve root tension)
Slr 30-70 + nerve
Prone knee bend ( to stress the femoral nerve and the mid lumbar (L2-L4) nerve roots)
Spinal stenosis tx
Better w…
Worse w…
Better w flexion( open the intervertebral foramen)
Worse with extension ( closing intervertebral foramen)
Differential diagnosis for spinal stenosis?
Intermittent claudication
Spinal Stenosis (narrowing of the spinal canal).
Physiotherapy Goals:
-Relieve pressure on the spinal nerves
-Improve spinal flexibility and posture
-Strengthen core and lower back muscles for better spinal support
-Manage pain and improve mobility
- Intermittent Claudication (pain in the legs due to poor circulation)
Physiotherapy Goals:
-Improve blood flow to the legs
-Increase leg strength and endurance
-Enhance functional walking capacity
-Reduce pain and discomfort during activity
Differences between neurogenic claudication and intermittent claudication
Neurogenic:
1-Caused by nerve root compression
2- Onset immediate
3- Bilateral
4-Pain burning and tingling
5-Aggravating factors: spine extension,standing and walking
6- Easing factors: spinal flexion, sitting,leaning over.
Intermittent:
1- caused by perioheral artery disease
2- onset is gradual and with increased activity
3-distribution is unilateral
4-cramping
5- aggravating factors: increased muscular activity of calves
6-easing factors: rest
Test to differentiate neurogenic and intermittent claudication
Bicycle test
Postero lareral disc herniation
Worse with
Better with
Tx
Worse with flexion
Better w extension
Tx: mckenzie approach
Repeated extensions in prone
Traction
Lymbar stabilization exercs
Anterior bulge-disc herniation
Better with…
Tx
Better with flexion based exercises
repeated knees to chest in supine
Lower crossed syndrome mm
Tight: limbar erector and hip flexors
Weak: abdominal mm and gluteals
Tx for spinal stenosis
And for
Intermittent claudication
- Spinal Stenosis:
-Postural training
-Stretching exercises: Focus on hamstrings, hip flexors, and back muscles to reduce tension.
-Strengthening exercises: Core stabilization exercises to support the spine, and leg strengthening to promote proper walking mechanics.
-Manual therapy: Techniques like spinal mobilization or manipulation to improve movement.
-Decompression exercises: Positions and movements to open up the spinal canal, such as flexion-based exercises that bend the spine forward.
Intermittent claudication TX:
-Walking programs: Gradual, supervised walking exercises to increase distance and stamina. The goal is to push through the pain (to a manageable level) to improve circulation over time.
-Strengthening exercises: Focus on leg muscles (quadriceps, calves) to enhance endurance and circulation.
-Stretching exercises: To increase flexibility and reduce tightness in the lower limbs.
-Postural and gait training: Address any abnormal gait patterns that may affect walking and circulation.
-Education on vascular health: Advice on lifestyle changes, including smoking cessation, diet, and proper footwear to improve circulation
What are the lumbar radiculopathy(also known as sciatica) signs and symptoms?
1-Pain Distribution:
Radiating pain: Pain that travels from the lower back down to one or both legs, often following a specific nerve pathway. The pain can extend from the lower back or buttocks down to the thigh, calf, and sometimes the foot.
Unilateral pain: Pain is usually on one side of the body, but can occasionally affect both legs.
The pain is often described as sharp, burning, or electric shock-like.
2-Numbness or Tingling:
Sensory changes: A sensation of tingling or “pins and needles” (paresthesia) may be felt in the affected leg or foot. This may occur in a dermatomal pattern, following the specific area supplied by the irritated nerve root.
Numbness: Loss of sensation in the leg or foot is possible.
3-Muscle Weakness:
Weakness in specific muscles supplied by the affected nerve root. Common muscles affected include the hip flexors, quadriceps, hamstrings, calf muscles, and foot muscles, which may result in difficulty walking, standing, or climbing stairs.
4-Pain Aggravated by Movement:
Worsening with bending or twisting: Activities that involve bending forward, twisting, or lifting may exacerbate the pain.
Pain relief in certain positions: Some individuals may experience relief when lying on their back with knees bent (flexed position) or when in a position that reduces pressure on the nerve root.
5-Reduced Range of Motion:
Limited spinal mobility: There may be restricted movement in the lower back, particularly in bending forward (flexion) or backward (extension).
6-Positive straight leg raise test: This is a common clinical test where the leg is raised while the patient is lying flat. Pain that radiates down the leg when the leg is raised may suggest lumbar radiculopathy.
7-Loss of Reflexes:
A decrease or absence of certain reflexes in the leg, such as the ankle jerk reflex (S1 nerve root) or patellar reflex (L4 nerve root), may be present.
8-Postural Changes:
Antalgic posture: Patients may adopt a posture to avoid worsening pain, such as a slight lean away from the affected side to reduce pressure on the nerve root.
Why is intermittent claudication a differential diagnosis for spinal stenosis?
Bc pain or cramping can pccurs in the buttocks or legs as a resukt of poor circulation to the affected area.
Facet syndrome. What is it?
Degenerative condition that affects the facet joints.
Pain may refer to the lower back,glure,hops, groin or tighs but NEVER below the knee
Frozen Shoulder (Adhesive Capsulitis):
Cause
Symptoms
Stages
Pt diagnosis
• Cause: Inflammation and fibrosis of the glenohumeral joint capsule, leading to stiffness.
• Symptoms:
Progressive loss of ROM (esp. external rotation & abduction).
• Severe stiffness & night pain
• Three stages: Freezing (pain), Frozen (stiffness), Thawing (gradual recovery).
Physio Diagnosis Example:
“Achesive capsulitis at the freezing stage, causing significant shoulder stiffness and functional
impairment in daily activities.”
Shoulder Instability (Anterior, Posterior, or Multidirectional)
- Cause:
- Symptoms:
-Tests - Physio Diagnosis Example:
- Cause: Traumatic dislocation, ligamentous laxity, or repetitive microtrauma.
- Symptoms:
• Feeling of “shoulder slipping out” (subluxation).
Pain and apprehension with overhead or abduction movements.
• Positive Apprehension & Sulcus Sign.
- Physio Diagnosis Example:
“Anterior shoulder instability due to ligamentous laxity, leading to recurrent subluxations and
functional limitations.*
Ac joint sprain or separation
Cause
Symptoms
Tests
Pt diagnosis ex
- Cause: Direct trauma (fall on the shoulder) or repetitive stress.
- Symptoms:
- Localized pain over AC joint.
• Pain with cross-body adduction
(Positive Cross-Body Adduction Test).
• Step deformity in severe cases.
Physio Diagnosis Example:
“Grade Il AC joint sprain causing pain and functional limitations in horizontal adduction and
overhead lifting.”
Cervical radiculopathy ( referred sh pain)
Cause
Symptoms
Positive test
• Cause: Compression of cervical nerve roots (C5-C7).
• Symptoms:
• Pain radiating from neck to shoulder.
•Weakness in deltoid, biceps, or wrist extensors.
• Positive Spurling’s Test.
Physio Diagnosis Example:
“Co radiculopathy leading to referred shoulder pain and upper limb weakness, affecting grip
strength and arm function.”
Brachial plexus injury (tos)
Cause
Symptoms
Test
• Cause: Compression of nerves or blood vessels in the thoracic outlet (scalene, clavicle, or pec minor entrapment)
• Symptoms:
• Pain, numbness, or tingling down the arm.
• Weak grip strength.
• Positive Adson’s & Roos Test.
Physio Diagnosis Example:
‘Thoracic outlet syndrome with neurovascular compromise, leading to arm pain and sensory disturbances.”
Red flags for sh pain
Systemic/Non-Musculoskeletal Causes (Red Flags)
• Myocardial Infarction (Heart Attack) → Left shoulder pain, chest tightness, nausea.
• Gallbladder Disease - Right shoulder pain, digestive issues.
- Pancoast Tumor (Lung Cancer) → Shoulder pain with unexplained weight loss, Horner’s syndrome.
• Red Flag Action: Immediate referral to a physician.
Lumbar strain/sprain
Mechanical & Musculoskeletal Causes
(a) Lumbar Strain/Sprain
•Cause: Overstretching or microtrauma to lumbar muscles, ligaments, or fascia.
Symptoms:
• Localized pain in the lower back, often unilateral.
•Worse with movement, prolonged standing, or lifting.
• No neurological signs (no radicular pain, normal reflexes).
•Tenderness over paraspinal muscles.
Physio Diagnosis Example:
“Mechanical low back pain due to lumbar strain with soft tissue involvement, leading to movement
restriction and muscle guarding.”
Lumbar disc herniation
Cause
Symptoms
Tests
Pt diagnosis
Lumbar Disc Herniation (Discogenic Pain)
• Cause: Herniation of the nucleus pulposus compressing nerve roots.
• Symptoms:
• Unilateral radicular pain (shooting down leg, sciatica).
• Worse with sitting, bending forward, coughing, sneezing.
• Better with standing or walking.
• Positive Straight Leg Raise (SLR) Test.
• Physio Diagnosis Example:
“L5-S1 discogenic lumbar radiculopathy with associated nerve root compression, resulting in functional mobility limitations and pain with forward flexion.”
Facet joint dysfunction
Cause
Symptoms
Pt diagnosis
Facet Joint Dysfunction
•Cause: Irritation or degeneration of facet joints due to repetitive extension or twisting.
• Symptoms:
• Localized pain in lower back and glutes.
• Worse with extension, prolonged standing.
• Better with flexion, sitting.
• No nerve root involvement.
• Physio Diagnosis Example:
“Facet joint dysfunction at L4-L5 leading to reduced spinal mobility, pain with extension, and
postural compensations.”
Lumbar spondylosis Degenerative disc disease
(d)
Lumbar Spondylosis (Degenerative Disc Disease - DDD)
• Cause: Degeneration of intervertebral discs, leading to stiffness and pain.
- Symptoms:
• Chronic, dull lower back pain with stiffness.
• Worse with prolonged standing or activity.
• Morning stiffness improves with movement.
• May have reduced lumbar ROM. - Physio Diagnosis Example:
“Degenerative lumbar spondylosis with associated stiffness, functional mobility limitations, and
postural adaptations.”
Lumbar spinal stenosis
Cause
Symptoms
Test
Pt diagnosis
Cause: Narrowing of spinal canal, compressing nerve roots (often age-related).
• Symptoms:
• Bilateral leg pain, weakness, or numbness (neurogenic claudication).
• Worse with standing, walking.
• Better with sitting or bending forward (“Shopping Cart Sign”).
• Positive Two-stage Treadmill Test.
• Physio Diagnosis Example:
*Lumbar spinal stenosis with neurogenic claudication, presenting as bilateral lower limb weakness and gait disturbance.”
Sacroiliac joibt dysfunction
Cause: Malalignment, inflammation, or hypomobility of the SI joint.
- Symptoms:
• Pain localized to SI joint, buttocks, or posterior thigh (not below knee).
• Worse with single-leg stance, prolonged standing, or stairs.
• Positive FABER and SI Joint Provocation Tests.
• Physio Diagnosis Example:
“Sacroiliac joint dysfunction with impaired load transfer, leading to pain during weight-bearing
activities.*
Lumbar radiculopathy (sciatica)
Cause
symptoms
Test
Diagnosis
Cause: Compression or irritation of lumbar nerve roots (commonly L5 or S1).
• Symptoms:
• Sharp, burning pain radiating down leg (dermatomal pattern).
• Weakness in ankle dorsiflexion (L5) or plantarflexion (51).
• Positive SL and Slump Test.
• Physio Diagnosis Example:
*L5 radiculopathy secondary to disc herniation, causing weakness in dorsiflexion and gait impairment.”
Cauda equina syndrome
Causes
Symptoms
- Cause: Compression of cauda equina nerves.
- Symptoms:
• Saddle anesthesia (numbness in perineal region).
• Urinary retention or incontinence.
•Severe bilateral leg weakness.
Physio Action: IMMEDIATE REFERRAL to emergency services!
Ankylosing Spondylitis (AS)
Características
Ankylosing Spondylitis (AS) → Chronic back pain, morning stiffness, improves with activity, HLA-B27+-
RA
• Rheumatoid Arthritis (RA) → Symmetrical joint pain, systemic symptoms.
Infections (Discitis, Osteomyelitis, Abscess
• Persistent back pain with fever, night sweats, weight loss.
• RED FLAG: REFER IMMEDIATELY.
Tumors or Metastases
Unrelenting night pain, unexplained weight loss, history of cancer.
• RED FLAG: REFER IMMEDIATELY.
Patellofemoral Pain Syndrome (PFPS)
Cause
Symptoms
Tests
Pt diagnosis
• Cause: Overuse, muscle imbalances, or malalignment of the patella in the femoral groove.
• Symptoms:
• Anterior knee pain, worse with stairs, squatting, or prolonged sitting (“movie sign”).
• Painful resisted knee extension.
• Positive Clarke’s Test (Patellar Grind Test).
• Physio Diagnosis Example:
* “Patelloemoral pain syndrome due to patellar maltracking, leading to anterior knee pain ano
functional limitations in stair climbing and prolonged sitting.”
Patellar tendinopathy -Jumpers knee
Cause: Overuse of the patellar tendon from repetitive jumping or running.
- Symptoms:
• Pain at the inferior pole of the patella.
• Worse with jumping, landing, or resisted knee extension.
• Tenderness at the patellar tendon. - Physio Diagnosis Example:
“Patellar tendinopathy affecting the inferior patellar pole, causing pain during high-impact
activities.”
Meniscus tear
Cause
Symptoms
Tests
Cause: Twisting injury with knee flexion or degeneration over time.
• Symptoms:
• Joint line tenderness.
• Locking, catching, or giving way.
• Positive McMurray’s & Thessaly Test.
• Physio Diagnosis Example:
Medial meniscus tear leading to mechanical symptoms and reduced knee stability in weight-bearing activities.”
- Anterior Cruciate Ligament (ACL) Tear
Cause
Symptoms
Tests
Pt diagnosis
Cause: Sudden deceleration, pivoting, or direct trauma.
• Symptoms:
• Immediate swelling (hemarthrosis).
Feeling of instability or “giving way”.
• Positive Lachman’s & Anterior Drawer Test.
• Physio Diagnosis Example:
• “Complete ACL tear causing knee instability, requiring structured rehabilitation and possible surgical intervention.”
