Ortho III Midterm- McKenzie Flashcards
What effect does extension have on the facet? On the disc?
Facet- INCREASES the force
Disc- moves ANTERIORLY
What effect does flexion have on the facet? Disc?
Facet- force on facet DECREASES
Disc- disc moves POSTERIORLY
What is the function of annulus fibrosus? Nucleus pulposus?
Annulus fibrosus- holds IV discs together
Nucleus pulposus- resists compressive loads
Disc herniations tend to move -? Why?
Tend to move POSTERO-LATERALLY
Because they tend to herniated with flexion activities/ posterior bu the longitudinal ligament helps contain it and move it laterally
What are the 4 stages of disc herniation?
Stage 1: Disc bulge
Stage 2: Protrusion
Stage 3: Extrusion
Stage 4: Sequestration
Which stage of disc herniation is being described: annular tear with the shape of the disc still intact?
Disc Bulge (stage 1)
Disc protrusion: _ _ is still intact, and disc is bulging _ _.
LONGITUDINAL LIGAMENT is still intact, and disc is bulging POSTERIOR LATERALLY
What stage of disc herniation is being described: Posterior longitudinal ligament has failed?
Disc extrusion (stage 3)
Disc Sequestration: part of the _ _ is now _ and _ in the epidural space.
Part of the NUCLEAR MATERIAL is now DETACHED and FLOATING in the epidural space.
The protrusion progression will demonstrate an increase in _, _ or _.
Will demonstrate an increase in PAIN, PERIPHERALIZATION OR BOTH
If the LBP is postero-central it is due to a _ _ _ of _ in the _ _ _ or the _ _. Usually does not cause?
It is due to a DIRECT MECHANICAL IRRITATION of NOCICEPTORS in the POSTERIOR LONGITUDINAL LIGAMENT or the ANNULUS FIBROSUS.
Usually does not cause NEUROLOGICAL SYMPTOMS
If the LBP is postero-lateral there is _ on _ _ or it’s covering or the _ _. Causes both _ and _ _.
There is PRESSURE on ANTERIOR DURAL MATER or it’s covering or the POSTEROLATERAL ANNULUS FIBROSUS and causes both PAIN and NEUROLOGICAL SYMPTOMS
If there is buttock and thigh pain it is _ _ pain from _ irritation or _ pain from _ _ irritation.
It is EXTRASEGMENTAL REFERRED pain from DURAL irritation or REFERRED pain from NERVE ROOT irritation.
If there is sensory changes, or sciatic pain there is _ _ on the _ _, and may cause _ with possible _ of _ and/ or _.
There is a DIRECT PRESSURE on the NERVE ROOT, and may cause PARATHESIA with possible LOSS OF SENSATION and/ or CONDUCTION
The _ the _, the _ the _, the _ the _ of disc herniation.
The LONGER the duration, the WORSE the SYMPTOMS, the GREATER the SEVERITY of disc herniation
What syndrome is being described: Usually under 30 years of age, pain adjacent to midline, pain with prolonged static loading/ stretching, and seen in those with sedentary jobs or who do not exercise regualarly?
Posture syndrome
With posture syndrome pain is _ _ by movement, is _ _, and Is _ _. Patients have normal _ _ _. Most likely will not?(2)
Pain is NOT INDUCED by movement, is NOT REFERRED, and is NEVER CONSTANT. Patients will have normal RANGE OF MOTION.
Most likely will:
-not be able to reproduce symptoms during evaluation and will most likely not see in the clinic
What type of syndrome is being described: develops as a result of poor posture, trauma, degeneration. Onset is insidious and pain is usually adjacent to midline. Typically seen in patients that are over 30 years old and exhibit poor posture and are under exercised?
Dysfunction syndrome
With dysfunction syndrome: Pain is always felt _ _ _, and never felt _ the _ except for _ _ _ _ . Pain is never _. Problem usually occurs with _ of the lumbar spine.
Pain is always felt AT END ROM, and never felt DURING the MOVEMENT except for ADHERENT NERVE ROOT PAIN. Pain is never REFERRED. Problem usually occurs with EXTENSION of the lumbar spine.
With dysfunction syndrome there is loss of movement in the _ _ with _ limitations.
There is loss of movement in the SAGITTAL PLANE with SYMMETRICAL limitations.
2 types of dysfunction syndromes? Which one is most common?
Flexion and Extension dysfunction
Extension is most common
What symptoms often occur with derangement syndromes? (3) What is the age range of those commonly affected with derangement syndromes?
Pain, parathesia, and numbness (can be local or radiate)
20-55 years of age
With derangement syndromes you will commonly see _ _ posture, pain may occur _ and usually for _ _ _ .
You will commonly see POOR SITTING posture, pain may occur SUDDENLY, and usually for NO APPARENT REASON.
With derangement syndromes _ _ usually increase pain and _ _ usually decrease or centralize pain.
FLEXION ACTIVITIES usually increase pain
EXTENSION ACTIVITIES usually decrease or centralize pain.
Pain with derangement syndrome is _ in nature, _ _ is possible, pain can change _ and _, and gross loss of _ and _ may be present.
Pain is MECHANICAL in nature, REFERRED PAIN is possible, pain can change SIDES AND LOCATIONS, and gross loss of MOVEMENT AND DEFORMITIES may be present
With derangement syndrome pain may be _, _ , _, _, _ _ or _ by certain movements or postures.
Pain may be PRODUCED, ABOLISHED, INCREASED, REDUCED, MADE BETTER or WORSE by certain movements and postures .
Derangement syndromes usually occur in people _ _, can be caused by displacement of _ _ and/ or _ _. Which disturbed the _ _ _ of adjacent vertebrae.
Usually occur in people UNDER 50, can be caused by displacement of DEGENERATED ANNULUS and/ or FIBROTIC NUCLEUS. Which disturbed the NORMAL RESTING POSITION of adjacent vertebrae.
With derangement syndrome if the the disc impinges the nerve more laterally patient will shift _ Away from that side. More medially?
If it impinges the nerve more laterally the patient will shift AWAY from that side
If impingement occurs on the more medial aspect of the nerve patient will shift TOWARDS that side.
What is the goal of treatment with derangement syndromes?
Centralization
Which is the only derangement syndrome in which flexion activities decrease or centralize pain?
Derangement 7
