Quiz 1 Flashcards
Knee Raiser:
PP, DS, CH, CP, SCP, Interpretation
PP: Erect and look straight ahead
DS: Behind patient, one foot in front of other. Frnt ft point straight forward, back foot flared out 45 degrees.
CH: With hands on SCP instruct patient to raise the ipsilateral leg by flexing the hip and knee until max hip flexion. Repeat on opposite side.
CP: #9b with fingers pointing forward, resting on buttock
SCP: Inferiomedial aspect of the PSIS on side tested.
Interpretation: When ipsilateral leg is raised, the normal motion is for the PSIS on the side tested to rotate posterior, inferior and medial. If the PSIS on the side tested does not do this, the sacroiliac joint is fixed on that side. Most likely fixation listing: AS ilium.
Seated Sacroiliac Flexion:
PP, DS, CH, CP, SCP, Interpretation
PP: Erect, seated
DS: Sit behind patient
CH: Thumbs on respective PSISes, note relative positions, instruct patient to bend forward, compare relative amount of excursion of PSISes compared to starting position.
CP: #9b with fingers pointing forward and resting on iliac alae
SCP: Inferior aspects of PSISes
Interpretation: PSIS with most excursion is the side of fixation
Seated Sacroiliac Axial Rotation
PP, DS, CH, CP, SCP, Interpretation
PP: Erect sitting position
DS: Behind patient on opposite side from the shoulder that will be rotated backward. (oblique to patient) Reach across patients back and grasp shoulder on opposite side and lay forearm across the trapezius on doctor’s side.
CH: Place palpation hand on PSIS-sacrum interspace on side tested, rotate shoulder posteriorly on side opposite doctors stance. Test both joints for motion. Repeat on opposite side.
CP: Finger pads of digits 2-4.
SCP: PSIS-sacrum interspace.
Interpretation: Compare relative motion of the right sacroiliac joint during posterior rotation of the right shoulder (R. ipsilateral) to the left sacroiliac joint (L ipsilateral). Ipsilateral: Normal motion is for the PSIS to glide medially. Fixation is on side with less motion. Most likely listing: EX ilium. Contralateral: Normal motion is for the PSIS to glide laterally. Fixation is on side with less motion. Most likely listing: IN ilium.
Seated Lumbopelvic Lateral Bending
PP, DS, CH, CP, SCP, Interpretation
PP: Erect Sitting
DS: Behind patient on side patient will bend toward. (oblique to patient)
CH: Place one hand on shoulder, other on PSIS-sacrum joint (ipsilateral on doctors side) Laterally bend shoulder toward doctor’s side. Check for ipsi and contralateral motion. Repeat on opposite side.
CP: Finger pads of digits 2-4
SCP: PSIS-sacrum interspace
Interpretation: Compare motion of ipsilateral side on right test with motion of ipsilateral side on left test. Medial movement is expected. If there is fixation the listing is EX ilium for the fixed side.
Compare motion of contralateral left and right sides. Lateral motion is expected. If there is fixation, the listing is IN Ilium on fixed side.
Leg Fanning
PP, DS, CH, CP, SCP, Interpretation
PP: Seated near edge of bench, feet together
DS: Seated behind patient
CH: Slowly abduct knees completely, then slowly adduct knees back together. Repeat several times to ensure accuracy.
CP: #9b with fingers pointing forward, resting on the iliac alae.
SCP: PSIS-sacrum interspaces on each side.
Interpretation: Compare relative motion of right and left sacroiliac joints during ABDUCTION. Expected motion is medial motion of both PSISes and for the sacrum to rock forward (nutation). Fixation listing is most likely Posterior Rotation of the Sternum and EX ilium is second most common.
Compare left and right sacroiliac joints during ADDUCTION. Expected motion is lateral motion of both PSISes and backward rocking of the sacrum. Fixation listing is most likely IN ilium for fixed side.
Sacroiliac Fluid Motion
PP, DS, CH, CP, SCP, Interpretation
PP: Prone so ankles are one to two inches off the bench.
DS: Opposite the sacroiliac joint tested in a modified fencer stance witht he doctor’s inferior thigh at the level of the PSISes.
CH: Direct firm continuous pressure through the sacroiliac joint (p-a, s-i, medial to lateral) at a 45 degree angle toward the table till end of range of motion.
CP: #1b (hook of hamate) of the superior contact hand with fingers pointing toward the acetabulum on that side.
SCP: Superiomedial aspect of the PSIS.
Interpretation: Expected motion: leg on side tested lengthens while leg on opposite side remains in place. Foot flare of stationary foot is also considered normal motion. If both legs lengthen together, sacroiliac joint on tested side is fixed.
Locate Transverse Processes
T1-T3
One interspinous space above and
One inch lateral to spinous of segment palpated.
Locate Transverse Processes
T4
One inch lateral to the upper one third of the T3 spinous.
Locate Transverse Processes
T5-T9
Two interspinous spaces above and
about one inch lateral to the spinous of the segment palpated
Locate Transverse Processes
T10
About 3/4 inch lateral to the spinous process of T9.
Locate Transverse Processes
T11-T2
One interspinous space above and
about one half inch lateral to the spinous of the segment palpated.
Locate Mammillary Processes
L1-L5
One interspinous space above and 3/8 inch lateral to spinous of the segment palpated.
Osseous Landmarks - Lumbar Spine
L5
L5 spinous process is smallest of the lumbar spinous processes, therefore is feels slightly anterior. The L5 Spinous process feels more mobile on lumbar extention.
To palpate the lumbar spine with the patient seated, begin by locating the inferior aspect of the posterior superior iliac spine. The second sacral tubercle is directly medial to the inferior aspect of the PSISes. Palpate up from the second sacral tubercle to locate the S5 spinous process.
Osseous Landmarks - Lumbar Spine
L4
L4 spinous process or the L4-L5 interspinous space is directly medial to the iliac crests. (gender and itieogenic variations exist)
Osseous Landmarks - Lumbar Spine
L3-L2
Palpate up through the lumbar region using the prominent blade-like spinous process and the mammillary processes. The mammillary processes are one interspinous space above and 3.8 inch lateral to the spinous of the segment palpated.
Osseous Landmarks - Lumbar Spine
L1
L1 has the superiormost blade-like spinous process before the transistion into the thoracic spine region. Be careful to differentiate L1 from T12 however, since T12 may palpate more bladelike than the long, slender spinouses typical of the throacic spine.
Osseous Landmarks - Thoracic Spine
T12-T11
The spinous processes of thoracic vertebrae are long and slender, but T12 as a transitional vertebra, ay have a more blake-like spinous. The transverse process of T11 and T12 are one interspinous space above and 1/2 inch lateral to the spinous of the segment palpated.
Osseous Landmarks - Thoracic Spine
T10
The vertical dimension of the T10 spinous is the smallest among the thoracic vertebrae. Consequently, T10 may present a challenge tot he beginning palpator. The interval between the interapinous spaces of T9-T10 and T10-T11 is quite small, so take care to locate the T10 spinous in that interval.
Osseous Landmarks - Thoracic Spine
T9-T5
The middle throacic segments are highly imbricated with steeply sloped spinous processes. The transverse processes of the middle thoracic vertebrae are two interspinous spaces above and approx one inch lateral to the spinous of the segment palpated.
Osseous Landmarks - Thoracic Spine
T7
The spinous process of T7 is at the level of the inferior angle of the scapula with the patient seated and the arms dependent
Osseous Landmarks - Thoracic Spine
T6
The spinous process of T6 is at the level of the inferior angle of the scapula with the patient in the prone position.
Osseous Landmarks - Thoracic Spine
T4
T4 Typically demonstrates the largest spinous process of the thoracic vertebrae
Osseous Landmarks - Thoracic Spine
T3
The spinous of T3 is at the level of the root of the scapular spine, the flattened region of the scapular spine at the medial border of the scapula.
Osseous Landmarks - Thoracic Spine
T1
The vertebral prominence is usually C7 (70% rule), but it can also be T1. The definitive determination of the vertebral prominence is based on lateral x-ray view, but palpatory techniques can be used to accurately locate T1.
Use motion of C6 spinous process forward glide on extension of neck. T1 is two vertebrae below C6. :o)
