pattern recognition - spine Flashcards
subjective exam/symptoms
what are symptoms seen in capsular pattern of facet joint capsule?
- acute onset (inflammation)
- gradual onset (osteophyte formation)
- unilateral
- localized to one facet level (ipsilateral)
- no radicular symptoms
objective exam/signs
what are signs seen in capsular pattern of facet joint capsule?
- equally limited ipsilateral LF and rotation ROM (%)
- limited extension ROM
subjective exam/symtpoms
joint dysfunction: hypomobility
what are symptoms seen?
something won’t be able to move normally both osteo and arthero kinematically
- acute facet joint restriction
- or gradual onset (spondylosis)
- non traumatic
- “it feels stuck”
- “I can’t move my neck during _______ activity”
- localized to one level
- no radicular symtpoms
objective exam/signs
joint dysfunction: hypomobility
signs to look for?
- decreased AROM (osteokinematics) due to muscle guarding
- onset of pain early to mid rang AROM
- decreased joint glide (arthrokin)
- often seen at CTJ and TLJ
what is closing restriction
facet joint has limited posterior/inferior glide (ipsilateral side)
if one segment doesn’t move, another segment will take over
what is opening restriction
facet joint has limited anterior/superior glide (ipsilateral side)
if one segment doesn’t move, another segment will take over
subjective exam/symptoms
joint dysfunction: hypermobility
symtpoms seen?
remember hypermobility = instability
- chronic or gradual onset
- repeated episodes w progressive worsening symptoms
- younger (<40)
- history of muscle spasms
-radicular symptoms –maybe
localted to one or two levels
decreased pain with cahnge in position or movement (walking)
history of muscle spasms = trying to provide stability and they are not meant to
radicular symptoms maybe = if segment moves to much, could hit nerve
decrease pain w/ change or movement = puts pressure somewhere else
objective exam/signs
joint dysfunction: hypermobility
signs to look for?
- ↓or↑ rom (skin fold observed)
- pain at end AROM
- orr upone returing to neutral from full ROM
- aberrant motion during AROM
- positive (+) gowers sign
- ↑ joint glide (segmental mobility)
- temp relief with self manipulation
what is a positive gowers sign?
help returing from flexion to standing by using hands on legs to “walk” up (aberrent motion)
subjective exam/symptoms
pattern: nerve compression from disc inury.
what are symptoms of this?
- often traumatic onset (specific event)
- radicular pain (pressure on nerve)
- ↓ pain with decompression (gravity minimized positions)
- pain with valsalva (going poo could increase symtpoms)
possibly could have pain first thing — gets better – then worse again
What is peripheralization?
increased radicular pain with spine flexion movements
what is centralization?
decreased radicular pain with spine extension movements
objective exam/signs
nerve compression from disc injury
signs of this?
- peripheralization/centralization
- increased pain with compression (weight bearing in the morning)
- positive neuro screen (dermatomes/myotomes/reflexes)
objective exam/signs
compression fracture
signs of this?
- increased spine or radicular pain with spine extension movements
- increased spine or radicular spain with spine flexion movements
- T11 is most fracture level
- may or may not have positive neuro screen
- extension and flexion = pain/symptoms
what level is most often fractured during a compression fracutre?
T-11 (kyphosis)
subjective exam/symptoms
compression fracture
symptoms of this?
- often traumatic onset
- radicular pain (maybe)
- younger patients = traumatic
- older patients = less traumatic more osteoporotic
a wedge compression fracture will bias what plane of movement?
flexion
subjective exam/symptoms
nerve compression at foramen (foraminal stenosis)
symptoms of this?
- acute onset or gradual onset
- radicular pain
- increased pain with extension biased functional activities (standing, walking)
foraminal stenosis = narrowing of foramen and pressure on nerve root
objective exam/signs
nerve compression at foramen
signs?
foraminal stenosis= FS
- ↑ spine or radicular pain with extension
- ↓ spine or radicular pain with flexion movements
- in younger patients = facet joint hypermobility
- older patients = radiographic signs of FS
- maybe + neuro screen
extension bad= peripharalization
flexion good = centralization
subjective exam/symptoms
symptoms of muscle strain
- unilateral pain
- localized to one muscle
- acute
- no radicular symptoms
objective exam/signs
signs of muscle strain
- pain with contraction (MMT)
- pain with muscle stretch during AROM
- tenderness to palpation over muscle belly
*if chronic/non-traumatic injury, diffuse symptoms, or multiple muscles involved often a symptom of another injury (generally jont or ligament)
When is a muscle strain often considered part of another injury (like joint or ligament)?
- if chronic/non traumatic injury
- diffuse symptoms
- multiple muscles involved
in nerve compression from disc injury, what is typically observed during examination?
increased radicular pain with spine flexion movements (peripheralization)
what is a chracteristic of nerve compression from disc injury regarding pain patterns?
decreased pain with decompression positions
