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IMC > RBA > Flashcards

RBA Flashcards

1
Q

how common is myotomal deficit in spine Drg?

difference in lumbar vs cervical?

A

common

more so in cervical

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2
Q

can stenosis symptoms be radicular and referred? What areas of the spine?

A

only see radicular in cervical

lumbar both

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3
Q

can stenosis have an acute onset? how common?

A

yes, trauma can reveal stenosis

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4
Q

can NRE have an acute onset? how common?

A

No

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5
Q

what provokes stenosis symptoms? How quickly?

A

extension activities of course

  • can be immediate or require sustained to expose in lumbar
  • typically immediate in C/S
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6
Q

how to confirm or rule out stenosis diagnosis in lumbar spine

A 
IF patient denies obstruction...
- go RFISit or RFIL to provoke
if no...
- go REIS over fulcrum, look for NE or P, NW
- then test over 48-72 hours to R/O Drg
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7
Q

how long does a NRE take to develop

A

12 weeks, longer than other fixed lesions

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8
Q

Do you see obstruction with nerve root entrapment?

A

No, maybe minimal. but, will see some temporary “stiffness” after sitting due to creep loading.
Never will fully obstruct after prolonged sitting

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9
Q

are nerve root entrapment symptoms constant or intermittant

A

constant.

-sometimes only proximal pain is constant, and limb symptoms are intermittent

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10
Q

what is the minimum time for onset of ANR or dysfunction?

A

at least 8 weeks, shorter than NRE

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11
Q

uni- or multi-directional for dysfunction?

A

can be multi-directional, but one will dominate

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12
Q

with dysfunction, does patient have PDM or ERP? Describe

A

ERP, but at a premature end range

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13
Q

mechanically inconclusive- radicular, referred, or local pain?

A

referred and local primarily

radicular is rare

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14
Q

mechanically inconclusive- chronic, acute, subacute

A

primarily chronic

-occasionally see acute or subacute

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15
Q

mechanically inconclusive- intermittent or constant?

A

both

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16
Q

mechanically inconclusive- what makes them worse?

A

usually all movements and positions make them worse over time
- rarely a clear pattern

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17
Q

mechanically inconclusive- can they be obstructed?

A

NO, they will not have any functional deficit when their pain is worse

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18
Q

mechanically inconclusive- typical ROM loss?

A

none, nonspecific

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19
Q

mechanically inconclusive- PDM or ERP?

A

usually multidirectional ERP, less PDM

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20
Q

mechanically inconclusive- nerve tension?

A

No

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21
Q

mechanically inconclusive- space occupation producing limb symptoms?

A

no

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22
Q

RBA approach for suspected mechanically inconclusive

A

1 focus on RFISit/RFIL to eliminate Drg

  • if they can’t tolerate, or yellow flags dominate
  • –> give SOC for 48 hours
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23
Q

Must have general baselines in an IMC RBA

- spine and extremity

A 
ERP or PDM with ROM (or space occupation)
functional complaint
nerve tension (esp. L/S)
myotomes (esp. C/S)!!
postural correction!!
extremity baselines b4 spinal screen
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24
Q

must have baselines for an RBA of the shoulder

- besides the obvious (ROM of course, but what specifically is often missed)

A

resisted movements

- OP to ROM, esp. flexion, abduction

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25
Q

must have baselines for an RBA of the elbo- besides the obvious (ROM of course, but what specifically is often missed)

A
  • resisted movements of elbow, wrist, grip

- OP extension, compare sides

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26
Q

must have baselines for an RBA of the wrist

- besides the obvious (ROM of course, but what specifically is often missed)

A

OP to active ROM

27
Q

must have baselines for an RBA of the hip

- besides the obvious (ROM of course, but what specifically is often missed)

A
  • resisted, passive, and OP at end range
  • at least 1 weight bearing functional test
  • FABERs supine or seated
28
Q

must have baselines for an RBA of the knee

- besides the obvious (ROM of course, but what specifically is often missed)

A
  • terminal extension, supine, with OP

- 1 weight bearing funct. test (squat, climb stairs, etc)

29
Q

must have baselines for an RBA of the ankle

- besides the obvious (ROM of course, but what specifically is often missed)

A

accessory movements of the mid- and hindfoot

30
Q

General order to the RBA, after funnel Hx

A
  1. set baselines
  2. perform necessary test to confirm/rule out Hx based theory
  3. test hunch if desired
  4. if hunch is wrong, immediately focus exam on Hx-based Ddx
31
Q

which has more scientific support: symptomatic or mechanical improvement?

A

symptoms!

32
Q

does symptomatic improvement confirm Dx of Drg?

If not, what is needed?

A

No.

mechanical improvement must confirm Dx

33
Q

If mechanics improve first, is this enough to confirm Dx of Drg?
If not, what else is needed?

A

suggests Drg only

- symptoms must respond within 3 days, or reassess

34
Q

In what populations/conditions do mechanics often improve initially without symptom change?

A

geriatrics
mechanical C/S headaches
thoracic region

35
Q

Pt case- symptoms improved, but mechanics are worse

  • what do you do?
  • what are you thinking?
A

Stop and reassess, likely will need GR tutor

  • person may have 2 simultaneous conditions, or weird structural thing
  • somethings off, fortunately this is uncommon
36
Q

Pt case- symptoms worsened, but mechanics are better

  • what do you do?
  • what are you thinking?
A
  • decrease force first. may have direction right, but need to back off
37
Q

What is massively important to assess in the spine, but often forgotten! (esp. by me…)

A

Postural correction!

  • can confirm Drg Dx just with this!
  • they’ve been slouched sitting during history, it’s the perfect oppportunity
38
Q

4 general rules of RBA

think C-, T-, and L-Spine

A
  1. If Drg and Pt knows the Better
    - go with relieving direction
  2. If Drg and Pt doesn’t know the Better
    - goes with worse, provoke
  3. No Drg Evidence
    - C and L-Spine: flexion, provoke
    - T-Spine: blast extension
    • repeated with OP, mob, sustained in lying
  4. Must have ? to Answer before Movement test`
39
Q

If a patient has thoracic pain, and there’s no evidence suggesting Drg from the funnel Hx, where do you start?

A

with Extension!
repeated with OP
mobilization
SUSTAINED in lying

40
Q

How many baselines should you retest during the RBA?

A

or a few key indicators after the initial baseline setting.

retesting everything is inefficient and confusing

41
Q

The 2 purposes of baselines

A
  1. prove the existence of “Must Haves” for a condition
    e. g. nerve tension for ANR
  2. reference point of course
    B, S, or W
42
Q

How important is nerve tension as a baseline in the spine?

A

L-spine: “gift from the gods”
- commonly rapidly reversible, great for patient buy-in

C-spine: good, but not as commonly rapidly reversible
- only retest once for change, could scare patient

T-spine: irrelevant?

43
Q

3 primary conditions that cause nerve tension

A
  1. Drg
  2. ANR (uncommon)
  3. Inflammatory (very uncommon)
44
Q

In a patient with a derangement and ANR, when do you start remodeling?

A

only after Drg fully reduced, AND maintained

45
Q

What are the characteristics of nerve tension in a inflammatory mechanism patient?

A

not classic

- Pt can move through it to some degree

46
Q

what is starting treatment often for inflammatory patient with positive nerve tension? (besides anti-inflamm chemicals)

A

SOC

  • if they respond to this, gentle end range nerve stretches may help, proceed cautiously
  • only to tolerance, remember 15-20 min
47
Q

How to test for nerve tension with C-spine

A
  1. modified Elvey’s seated
    - if weakly positive, confirm supine
  2. full Elvey’s supine - ensure shoulder depression! and pivotal response
48
Q

how to educate patient around (+) nerve tension?

A

immediate after confirming it with test!

  • draw on whiteboard the 3 possibilities
    1. Hung Up (rapidly reversible)
    2. Tight (longer, but can fix at home)
    3. inflamm

explain possibilities, and what we’ll do to confirm one or the other

49
Q

PDM in the spine equals…

A

Derangement!

until proven otherwise

50
Q

PDM in the lumbar spine can very rarely be this condition, rather than a Drg

A

lumbar spondylolisthesis

- will fool you for a few visits

51
Q

What are the 2 most basic, but often the most important, or only present, baselines to have before the movement exam?

A

PDM

ERP

52
Q

ERP as a baseline is seen most commonly in what classification?

A

Drg!

53
Q

Why is unilateral ERP (like with side glide or rotation) a great Pt education opportunity?

A

There’s proof on the unaffected side that this shouldn’t hurt!!
Point that out to them.

54
Q

What simple baseline is often most revealing (for me and patient) in the cervical spine?

A

rotation!

  • premature ERP is gold
  • cue Pt awareness of where in ROM and intensity
55
Q

What if there’s no baselines?! Pt has no symptoms, ROM is fine, functional test negative

A

Try OP or mobilization (accessory movements) to ROM

56
Q

accessory movement (OP or Mob) baselines for the L/S

A
  1. shift over-correct B/L with EIS
  2. exten. mob, prone or sphinx
  3. EIS over fulcrum
57
Q

accessory movement baselines (OP or Mob) for the C/S

A

retraction, rotation, and side flexion with OP

- if I need to save time, do it myself

58
Q

accessory movement baselines (OP or Mob) for the T/S

A

perform seated

- ext. and rotation OP/mob

59
Q

accessory movement baselines (OP or Mob) for the hip

A

flexion, extension, FABERs with OP

60
Q

accessory movement baselines (OP or Mob) for the knee

A

terminal ext of course, flex

61
Q

accessory movement baselines (OP or Mob) for the ankle/foot

A

calcaneal and midfoot/forefoot

- inversion and eversion

62
Q

accessory movement baselines (OP or Mob) for the elbow

A

terminal extension

- Specifically, bounce and clunk the joint

63
Q

How does Mark Miller test terminal extension of the elbow?

A
  • Pin Pt hand between my trunk and arm

- grab elbow and snap up into extension

IMC (3 decks)

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