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OS Exam #2 > Psoas Syndrome > Flashcards

Psoas Syndrome Flashcards

1
Q

What were some of the bolded etiologies of Psoas syndrome?

A
  • Flexion stress of lumbar spine (prolonged sitting/bending over)
  • sit-ups
  • deadlifts/squats
  • quick elongation of psoas
  • arthritis of the hip
  • viscerosomatic reflexes (lower GI/GU)
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2
Q

What are some organic causes of psoas syndrome?

A
  • Ureteral calculi
  • appendicitis
  • salpingitis
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3
Q

If a patient doesn’t improve with OMT or has recurrent psoas issues, what diagnoses do we look for?

A
  • colon cancer
  • Diverticulitis
  • femoral bursitis
  • hip arthritis
  • prostatitis
  • salpingitis
  • ureteral calculi
  • herniated disk
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4
Q

Common patient complaints for psoas syndrome

A
  • difficulty sitting or standing upright
  • may walk flexed forward and to one side
  • difficulty lying prone
  • Pain: thoracolumbar, lumbosacral, SI, Gluteal, pain down leg stopping at knee, pain at belt line
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5
Q

Physical exam findings in psoas syndrome

A
  • cervical and lumbar lordosis changes
  • abdomen protuberant
  • tight iliopsoas and hamstrings (trying to counteract hip flexion)
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6
Q

What happens to the lumbar spine when the psoas muscles shorten?

A

-increased lumbar lordosis

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7
Q

What is a good simple test to screen for tight psoas muscles?

A

-thomas test

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8
Q

Osteopathic testing for psoas syndrome

A
  • hip flexion/extension ROM
  • screen for innominate df, sacral df, and lumbar df
  • Tenderpoints in iliacus, low ilium, and AL1-5
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9
Q

What are the key dysfunctions associated with psoas syndrome?

A
  • Tight psoas

- L1 flexed rotated and sidebent to the side of the tight psoas

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10
Q

What is stage one of the progression of psoas syndrome?

A

-bilateral spasm

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11
Q

what do we not use at stage one?

A
  • direct stretching or diret ME in acute setting (may make worse)
  • Heat (unique to this dysfunction)… DON’T USE HEAT*****
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12
Q

What is Stage 2?

A

-Unilateral spasm

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13
Q

What is the key dysfunction for Stage 2 unilateral spasm?

A
  • L1F RR SR

- there might also be L2-5 NRLSR

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14
Q

What will we find on exam on stage 2?

A
  • R psoas
  • R short leg***
  • R hip external rotation dyfunction
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15
Q

Where is the pain site for stage 2?

A
  • R belt line

- + lateral flexion test…. cannot sidebend left

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16
Q

Tx for stage 2

A
  • 1st: L1
  • 2nd: L2-5
  • Psoas stretch
  • Muscle relaxants + NSAIDs
17
Q

What is stage 3?

A

-Add sacral torsion

18
Q

Key dysfunction for stage 3?

A
  • L on R sacral torsion: axis on side of df

- L pelvic side shift: away from side of df, sidebending to the right

19
Q

What will we find on exam stage 3?

A
  • R sacral sulci deep
  • L ILA posterior/inferior
    • spring test
20
Q

Where is the pain site at stage 3?

A

-lumbosacral junction at side of sacral axis

21
Q

Tx for stage 3

A
  • treat torsion

- ME, HVLA, etc.

22
Q

What is stage 4 psoas syndrome?

A

-Add piriformis spasm on opposite

23
Q

Dysfunction for stage 4?

A
  • L piriformis spasm (opposite side from psoas df)

- L piriformis TP

24
Q

What will we find on exam for stage 4 psoas syndrome?

A

-L foot external rotation

25
Q

Where is the pain in stage 4?

A
  • L pelvic side shift

- L fluteal, SI, hip

26
Q

Tx for stage 4

A
  • treat piriformis

- counterstain, spray and stretch, trigger point injection

27
Q

What is stage 5 psoas syndrome

A

-add sciatica

28
Q

Dysfunction for stage 5

A
  • L sciatic nerve irritation

- can follow quickly after S4

29
Q

Exam for stage 5

A
  • L left paresthesias ( stop at knee)
  • no neural deficits, muscle atrophy, negative EMG, neg nerve conduction study
    • str8 leg raise (>30 degrees)
30
Q

Pain site for stage 5

A
  • L gluteal, SI hip

- radiates down L leg to knee

31
Q

Tx for stage 5?

A

-add low dose steroid

32
Q

What OMT do we do for psoas syndrome

A
  • L1 and L2 first: ME, ST/MFR, Still’s, FPR, Counterstrain, HVLA
  • Psoas muscle: ME, still’s, counterstrain
  • Piriformis: ME, FPR, Counterstrain
  • Sacrum: ME, HVLA, Still’s, FPR, Counterstrain
  • Innominate: ME, HVLA, Still’s, Counterstrain
  • Hip: ME
33
Q

What do we do for Pharmacotherapy?

A
  • treat underlying cause
  • NSAIDs: Naproxen, Ibuprofen, Meloxicam, celecoxib
  • Muscle relaxants: Metaxalone, cyclobenzaprine, baclofen, carisoprodol
34
Q

Do’s of this lecture

A
  • passive stretch with rolled towel TID
  • Active stretch
  • Supine leg lift
  • Push-ups
  • Swimming
  • Report any change in condition
35
Q

What are the do NOT’s of this lecture?

A
  • Sleep on stomach
  • Use heat to treat
  • Slump/slouch when sitting
  • Bend forward
  • Lean toward painful sidebending
  • Perform sit-ups
  • Lean backward when standing
36
Q

What was the main conclusion from this lecture?

A
  • Do not over treat
  • Presentation as high stage: avoid HVLA, Instructions and medications, Counterstrain/myofascial/ME
  • If symptoms recurrent, don’t delay: look for viscerosomatic reflex, work up for particular organ

OS Exam #2 (2 decks)

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