OMM Spring Exam Weeks 31-35 Flashcards by vinay goyal

Describe Dr. Littlejohns background

Founder of ACO/ CCOM
president of Amity College
Graduated in 1900
Foudned British School of Osteopathy

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What is the lifetie incidence of LBP?

> 70% for adults

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What is the average ehalthcare cost for LBP?

38-50 billion dollars

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What is the main etiology of LBP?

mechanical (97%)

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What etiology would ‘hip problems’ be categorized in for LBP?

visceral-referral pain

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For waht duration of LBP is it considered a red flag?

greater than 1 month of pain,

also if treatment for a month does not help

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What are some red flags for LBP and infection?

faver
IV drug use
steroid use

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What are red flags for LBP and fracture?

> 70 years old
steroid use
bladder dysfunction
trauma

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What are characteristics of cauda equina syndrome?

saddle anesthesia
uni/bilateral  motor weakness
bowel/bladder dysfunction
reduced anal sphincter tone
radiculopathy

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A red flag for spinal stenosis?

pseudoclaudification

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What are some psychosocial factors for LBP?

low social status
low level employment
depression
work problems

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What is LeSagues test?

aka straight leg test
Positive if pain is present at 30-70 deg of leg raising
Not specific
moderately sensitive

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What are Bragard’s and Bruzinski’s tests?

Bragard: during straight leg test, if dorsiflexion causes pain
Bruzinski: during straight leg test, if flexion of head causes pain

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What is the cross over test?

When the opposite leg is raised, pain occurs in the symptomatic side
Very specific
less sensitive

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When would you use a MRI or CT for low ack pain?

neuropathy
tumor
fracture
infection
unimproved sciatica

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What type of scan would you use for a spondyloarthropathy?

ANA, ESR

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When are lumbar X-rays NOT used?

for soft tissue problems

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What are the advantages of MRI in LBP?

shows soft tissue problems

esp. disc disease and spinal cord/canal problems

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What is a myelogram?

Contrast added to subarachnoid space
usually a pre-op exam
followed up by post CT

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What is a triple phase bone scan?

added radioactive marker can be scanned to sense for increased bone turnonver and blood supply
Sensitive but not specific

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When is surgical treatment resommended for LBP?

cauda equnia syndrome
nerve root compressoin
spinal instability

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What nerve roots does the lumbar plexus contain?

T12-L4

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In what structure does the lumbar plexus actualy come together?

psoas

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If a patient cmoplains of nubness in anterior thigh and groin region, what might you expect?

tight psoas

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What is the presentation of a bilateral psoas spasm?

patient is bending forward

What s the presentation of a unilateral psoas spasm?

patient bending forward and bent towards tight side

What type of somatic dysfunction is common in a tight psoas?

Type II L1 or L2 on same side as tight psoas

What are some causes of lumbosacral radiculopathy?

disc on nerve root tumor tenosis infection

Which discs are at the greatest risk for rupture? Why?

L4 and L5 greatest motion here narrow posterior longitudinal ligament

What is piriformis syndrome?

piriformis pain can cause SI joint pain, buttock and posterior thigh pain 10% of people have n passing through primiformis m

What are some clinical presentations of piriformis syndorme?

functionally longer leg | positive pelvic sideshift on same side

What is iliolumbar ligament syndrome? What kind of pain can it mimic?

irritated with postural strain | mimics hip arthritis, trochanteric bursitis, inguinal hernia

Which clinical finding can yield false positve and false negative results?

tight hamstrings

What percent of LBP patients require surgery?

What is the stance phase in normal gait?

``` 60% of normal gait begins with heel strike/pronation foot flat mid stance push off ```

Where is the tripod weight distribution in normal gait?

1st MCP, 5th MCP, heel

What is a good test to determine lumber flexion?

Schobers test

What is the slump test?

Determines neuromeningeal tract tension | in neck extension

What motions produce L4 innervation? L5 and S1?

L4: ankle dorsiflxion L5: big toe extension S1: ankle plantarflexion

What nerve does the patella reflex activate?

What is patricks test?

Figure 4, Fabers | positive when pain on lowering

What is facet syndrome?

problem w z-jionts | lumbar nerve entrapment

What is the number one cause of sacroiliac dysfunction?

(70% idiopathic) | psoas

What do the Cochrane review tel us?

SMT is a good treatment for LBP | lots of the trials were biased tho

When was pharmacology added to the curriculum?

1929 | In 1915-material medica failed to be added

Name the axes of teh sacrum and where they are located?

respiartory- S2 postural axis - bending inferior - ilial rotation

of TART, what does the mitchell model focus on in sacrum?

asymmetry

what are the three types of dysfunctions of the sacrum?

unilateral flexion torsion respiratory restriction

Copare rotation of L5 and teh sacrum in dysfjctnios

rotation of L5 and the sacrum occurs in oopposite diresctions

What is a normla adaptation to a sacroiliac dysfunction?

neutral group curve with roation towards deeper sulcus

What is the most comon torsiton dysfucntion?

L on L

When can you see an increase in the lumabr lordosis?

unliateral flexed sacrum | forward torsion

What is the point of reference for naming the sacrum?

anterior sacrum base | promontory

When does pain from a short leg arise?

age 40

what is the fist sympto associated with an anatomic short leg?

sacroiliac discomfort anterior sacrum on the short leg side tenderness at sacral sulcus

what are some findings of an anatomic short leg?

low iliac crest | low greater trochanter

what clinical things can cpme about form a short leg

GU problems headache Temporomandibular symptoms

CCOM andgle + fergusons angle = ?

90 degrees

primary purpose of a heel lift?

level the sacral base

what is max dose of heel lift?

1/4 inch

when is the term lateral curve used?

<10 degrees

What is the Heilig lift therapy?

ultimate amount of lift for chronic problems is often about 1/2 of the total leg length discrepancy. However, if the short leg is sudden (fracture, for example), the lift should correct the entire distance.

What is the Cobb ethod?

to measure lateral curvature degrees

What is Wlfs law?

bone remodels over time to the forces applied on it

average rate of scoliosis progression?

1.3 degrees per year

average change for infant per day?

5 degreees

what is vital capacity with cobb values of 25-50 degrees?

70% of normal

What are some clincial things w scoliolis?

right ventricular pain cor pulmonale hypoxemia pulmonary hypertension