Review of year 1 material Flashcards
1
Q
Manipulation is a _______ velocity technique.
A
High
2
Q
Mobilization is a _______ velocity technique
A
Low
3
Q
Distraction is a form of ?
A
traction
4
Q
Mobilization principles
A
- hands close to the joint line
- patient comfortable?
- therapist comfortable? (table height, joints in neutral)
- position joint (open packed, end range)
- keep arms in line with the direction of force
- stabilize (proximal bone usually)
- continually assess patient’s tolerance/response
- if the patient isn’t relaxing, ask yourself what you can do to make them relax more
5
Q
Lumbar tests
A
- passive supine SLR
- crossed supine SLR
- slump (seated SLR)
- femoral nerve tension test
- spring test
- prone instability test
6
Q
SIJ tests (4)
A
- SI distraction
- SI compression
- thigh thrust (posterior shear test)
- sacral thrust (spring test)
7
Q
Screening: tests of function (4)
A
- chair stand
- squat
- single leg stance
- back bending
8
Q
Screening: active motion testing (5)
A
- flexion/extension
- lateral flexion
- rotation
- repeated movements
9
Q
Things to watch for when testing active motion
A
- symptoms
- deviations
- limitations of movement
- curve reversal
- rhythm
- compensatory movement
10
Q
Contraction of what muscle facilitates pelvic floor contraction?
A
TR
11
Q
What two muscles might atrophy post lumbar surgery?
A
Multifidi
TRA
12
Q
When would you perform dynamic lumbar stabilization with a patient?
A
- hypermobile people who are symptomatic
- people with a fracture to promote stabilization
13
Q
What is lumbar spinal stenosis?
A
Narrowing of the skeletal canal
14
Q
Symptoms of lumbar spinal stenosis
A
- loss of sensation
- weakness
- reflex changes
- balance deficit from decreased nerve function
- pain with extension like reaching overhead
- relief with flexion, sitting, recumbence*
15
Q
Clinical picture of spinal stenosis patient
A
- 30’s 40’s: long history of low back pain
- 50’s: generally asymptomatic
- 60’s: slow onset, feels like leg pain but is actually compression. can’t walk or stand long due to upright posture. numbness, paresthesia, weakness. LE symptoms predominate back pain, if any.
16
Q
Symptoms of neurogenic claudication
A
- absent peripheral pulse (nerve compression affects blood circulation)
- ischemic signs in calves (pain, paresthesia, cramping)
- cauda equina symptoms (incontinence, saddle paresthesia, gait imbalance due to inability to coordinate muscle activity)
17
Q
Spine diameter
A
C: 17-18mm
T: 12-14mm
L: 15-17mm
18
Q
Interventions for stenosis
A
- flexion: knees to chest, drape over a swiss ball
- Neurontin: decreases nerve excitability
- laminectomy: cutting away bone and cleaning out
19
Q
Spondylosis is…
A
spinal arthritis
20
Q
Spondilolysis…
A
defect or fracture of vertebrae (typically pars, located between facets)
21
Q
Spondylolysthesis…
A
vertebrae shifted out of normal position
Grades: fraction of body slipped I: up to 1/4 II: 1/4 to 1/2 III: 1/2 to 3/4 IV: 3/4 to full V: complete
22
Q
Symptoms of spondylolisthesis
A
pain with palpation
flexion (midrange) feels good
23
Q
Symptoms of clinical lumbar instability
A
- “catch in the back”
- Gower’s sign
- reversal of LP rhythm
- pain moving into flexion
- pain returning from flexion
- clunking feeling or giving way
24
Q
Treatment for clinical lumbar instability
A
core exercise in neutral spine
- NSAIDS
- lumbar fusion
25
Lateral shift is named for...
the direction the shoulders move
26
The upper body shifts _______ from pain in lateral shift.
away from the pain
27
Correction of lateral shift _______ intensity and causes _________.
increases intensity
| centralization of symptoms
28
After correction of lateral shift, one should avoid...
flexion
29
Classifications of instability (5)
```
stabilization
manipulation
specific exercise (flexion or extension biased)
traction
lateral shift
```
30
Factors for stabilization
```
younger
+ prone instability test
aberrant motions
greater SLR ROM
Spring test hypermobility
increasing episode frequency
3+ episodes
```
31
Factors against stabilization
discrepancy in SLR ROM of >10 degrees
| low FABQ scores
32
Factors for manipulation
onset of pain
33
Factors against manipulation
leg symptoms
no pain with spring test
increasing episode frequency
peripheralization with motion testing
34
Factors for specific exercise
strong preference for sitting/walking
centralization with motion testing
peripheralization in direction opposite to centralization
35
Factors against specific exercise
LBP only
| no change with all movements
36
Red flags for referral
```
saddle anesthesia
urinary incontinence
history of cancer
abdominal pain that is non-musculoskeletal in nature
night pain
no response to treatment
```
37
What motion is C2 built for?
rotation
38
What are characteristics of the atlas?
no body
no spinous process
lateral masses
39
What are implications of DDD for movement?
loss of rom
| fear of moving
40
What are functions of the disc?
shock absorption
structural stability
full mobility
protection of spinal cord and axial neural tissue
41
What disc is most likely to degenerate?
C5-6
| followed by C6-7
42
Radicular
pertains to nerve root
43
Radiculitis
inflammation of spinal nerve
| pain, paresthesia but no signs of reflex, sensory or motor change
44
Radiculopathy
disease of the nerve root
| reflex, sensory and or motor changes!
45
What are classifications of disc disorders?
Bulge
Contained (protrusion- annulus disrupted, nucleus confined)
Extrusion (prolapse- nucleus attached to disc but outside annulus)
Sequestered (nuclear material in intervertebral canal)
46
Pain in the thoracic spine is...
poorly localized
A or P
may follow a rib
47
What ribs are true? false? floating?
true 1-7
false 8-12
floating 11-12
48
Describe the pump handle motion
upper ribs
up and forward motion of sternum
axis is the frontal plane
49
Describe the bucket handle motion
upper ribs
up and lateral motion
axis is frontal plane
50
How is scoliosis named?
apex of the convexity
51
What are tests to determine scoliosis?
Adam's sign (scoliosis persists with flexion and indicates structural curvature)
xray
Cobb angle
52
What are components of a T spine exam?
```
AROM
AROM with overpressure
neuroscreen
joint mobility assessment
PROM
special tests
palpation
```
53
What is thoracic outlet syndrome?
compression of neurovascular bundle between c spine and axilla
54
Typical symptoms of thoracic outlet syndrome?
swelling or arm/hand, fatigue in UE, pain, vein distention, weakness, problems with fine motor tasks, cramps, numbness, tingling
55
Potential causes of TOS?
congenital anomaly, postural, exostosis (cartilaginous tissue on bone), trauma, pregnancy
56
What could mimic thoracic outlet syndrome?
anterior scalene tightness
costoclavicular approximation
pec minor tightness
cervical rib
57
What is T4 syndrome?
like TOS plus a headache caused by thoracic hypomobility
vague complaints of back and arm pain
58
Why classify with McKenzie?
assess intensity and location of symptoms prior, during and after
59
What are the possible McKenzie classifications?
posture
dysfunction
derangement
60
McKenzie classifications: posture
intermittent pain
no pathology
not referred
soft tissue stress
61
McKenzie classifications: dysfunction
```
creeping onset
pain before end range
intermittent
only referred to adherent nerve root (ANR)
adaptive shortening
```
62
McKenzie classifications: derangement
```
affects joint surfaces ability to move
sudden onset
pain during movement
constant pain
may refer
```
63
Describe a McKenzie spine assessment
```
flexion
extension
lateral bending
loading and unloading
mobility
```
64
Peripheralization means symptoms move
midline to distal
65
Centralization means symptoms move
distal to prozimal
66
How does the facet orientation of the thoracic spine change from T1-T12?
angle of inclination increases
| middle limits flexion, facilitates rotation
67
What is a potential negative consequence of the natural spinal curvatures?
shear forces at transitions between curves
68
Amount of spinal motion depends on what?
```
soft tissue extensibility
flexibility of ligaments
force of muscles
disc displacement
fear
pain
```
69
What region produces the most axial rotation?
C1-C2
70
What segments produce the most sagittal plane movement?
C4-5
C5-6
L5-S1
71
What 2 major motions are the facet joints capable of?
gliding up and down
72
What movements open the right facet?
Flexion
left side bend
left rotation
73
What movements open the left facet?
Flexion, right side bend, right rotation
74
What movements close the right facet?
extension, right side bend, right rotation
75
What movements close the left facet?
extension, left sidebend, left rotation
76
How do you know if it's fixed or static posture?
Does the posture changes with movement during mobility testing?
- if yes, it's static
- if no, it's fixed
77
What are possible impairments leading to poor posture?
proprioception
mobility
muscle impairment
body mechanics
78
What are some common faulty postures?
```
lordosis
flat back
kyphosis
forward head
scoliosis
```
79
Where should the line of gravity fall?
posterior to the hip
| anterior S2, knee and ankle
