Ortho III Midterm- McKenzie

Question 1

What effect does extension have on the facet? On the disc?

Answer 1

Facet- INCREASES the force

Disc- moves ANTERIORLY

Question 2

What effect does flexion have on the facet? Disc?

Answer 2

Facet- force on facet DECREASES

Disc- disc moves POSTERIORLY

Question 3

What is the function of annulus fibrosus? Nucleus pulposus?

Answer 3

Annulus fibrosus- holds IV discs together

Nucleus pulposus- resists compressive loads

Question 4

Disc herniations tend to move -? Why?

Answer 4

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

Question 5

What are the 4 stages of disc herniation?

Answer 5

Stage 1: Disc bulge
Stage 2: Protrusion
Stage 3: Extrusion
Stage 4: Sequestration

Question 6

Which stage of disc herniation is being described: annular tear with the shape of the disc still intact?

Answer 6

Disc Bulge (stage 1)

Question 7

Disc protrusion: _ _ is still intact, and disc is bulging _ _.

Answer 7

LONGITUDINAL LIGAMENT is still intact, and disc is bulging POSTERIOR LATERALLY

Question 8

What stage of disc herniation is being described: Posterior longitudinal ligament has failed?

Answer 8

Disc extrusion (stage 3)

Question 9

Disc Sequestration: part of the _ _ is now _ and _ in the epidural space.

Answer 9

Part of the NUCLEAR MATERIAL is now DETACHED and FLOATING in the epidural space.

Question 10

The protrusion progression will demonstrate an increase in _, _ or _.

Answer 10

Will demonstrate an increase in PAIN, PERIPHERALIZATION OR BOTH

Question 11

If the LBP is postero-central it is due to a _ _ _ of _ in the _ _ _ or the _ _. Usually does not cause?

Answer 11

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

Question 12

If the LBP is postero-lateral there is _ on _ _ or it’s covering or the _ _. Causes both _ and _ _.

Answer 12

There is PRESSURE on ANTERIOR DURAL MATER or it’s covering or the POSTEROLATERAL ANNULUS FIBROSUS and causes both PAIN and NEUROLOGICAL SYMPTOMS

Question 13

If there is buttock and thigh pain it is _ _ pain from _ irritation or _ pain from _ _ irritation.

Answer 13

It is EXTRASEGMENTAL REFERRED pain from DURAL irritation or REFERRED pain from NERVE ROOT irritation.

Question 14

If there is sensory changes, or sciatic pain there is _ _ on the _ _, and may cause _ with possible _ of _ and/ or _.

Answer 14

There is a DIRECT PRESSURE on the NERVE ROOT, and may cause PARATHESIA with possible LOSS OF SENSATION and/ or CONDUCTION

Question 15

The _ the _, the _ the _, the _ the _ of disc herniation.

Answer 15

The LONGER the duration, the WORSE the SYMPTOMS, the GREATER the SEVERITY of disc herniation

Question 16

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?

Answer 16

Posture syndrome

Question 17

With posture syndrome pain is _ _ by movement, is _ _, and Is _ _. Patients have normal _ _ _. Most likely will not?(2)

Answer 17

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

Question 18

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?

Answer 18

Dysfunction syndrome

Question 19

With dysfunction syndrome: Pain is always felt _ _ _, and never felt _ the _ except for _ _ _ _ . Pain is never _. Problem usually occurs with _ of the lumbar spine.

Answer 19

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.

Question 20

With dysfunction syndrome there is loss of movement in the _ _ with _ limitations.

Answer 20

There is loss of movement in the SAGITTAL PLANE with SYMMETRICAL limitations.

Question 21

2 types of dysfunction syndromes? Which one is most common?

Answer 21

Flexion and Extension dysfunction

Extension is most common

Question 22

What symptoms often occur with derangement syndromes? (3) What is the age range of those commonly affected with derangement syndromes?

Answer 22

Pain, parathesia, and numbness (can be local or radiate)

20-55 years of age

Question 23

With derangement syndromes you will commonly see _ _ posture, pain may occur _ and usually for _ _ _ .

Answer 23

You will commonly see POOR SITTING posture, pain may occur SUDDENLY, and usually for NO APPARENT REASON.

Question 24

With derangement syndromes _ _ usually increase pain and _ _ usually decrease or centralize pain.

Answer 24

FLEXION ACTIVITIES usually increase pain

EXTENSION ACTIVITIES usually decrease or centralize pain.

Question 25

Pain with derangement syndrome is _ in nature, _ _ is possible, pain can change _ and _, and gross loss of _ and _ may be present.

Answer 25

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

Question 26

With derangement syndrome pain may be _, _ , _, _, _ _ or _ by certain movements or postures.

Answer 26

Pain may be PRODUCED, ABOLISHED, INCREASED, REDUCED, MADE BETTER or WORSE by certain movements and postures .

Question 27

Derangement syndromes usually occur in people _ _, can be caused by displacement of _ _ and/ or _ _. Which disturbed the _ _ _ of adjacent vertebrae.

Answer 27

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.

Question 28

With derangement syndrome if the the disc impinges the nerve more laterally patient will shift _ Away from that side. More medially?

Answer 28

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.

Question 29

What is the goal of treatment with derangement syndromes?

Answer 29

Centralization

Question 30

Which is the only derangement syndrome in which flexion activities decrease or centralize pain?

Answer 30

Derangement 7