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MI2 > Spinal Assessment > Flashcards

Spinal Assessment Flashcards

1
Q

What are yellow flags?

A

Psycho-social indicators suggesting increase risk of progression to long-term distress, disability & pain - monitor & provide medical referral in near future (can affect LBP)

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2
Q

What questions should be included in the body chart for spinal assessment?

A
  • Paraesthesia/anaesthesia
  • Relationship between symptoms
  • Clear areas, especially referral sites
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3
Q

Why should you ask about coughing/sneezing in agg/easing factors?

A

Increases inter-discal pressure

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4
Q

Why should you ask about sitting & standing in agg/easing factors?

A

Standing: More likely to be loading facet joints
Sitting: More likely to be a disc

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5
Q

Why is it important to ask about past history of back pain?

A
  • Majority of patients with LBP have recurrent episodes

- Ask how many days of the year they have LBP

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6
Q

What are the cord signs (special question)?

A
  • Bladder/bowel dysfunction
  • Bilateral non-dermatonmal/myotomal weakness
  • Altered sensation
  • Difficulty walking
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7
Q

What are the VBI signs?

A

5 Ds

  • Dizziness
  • Diplopia (double vision)
  • Dysphagia
  • Dysarthria (slurred speech)
  • Drop attacks

3 Ns

  • Nausea
  • Nystagmus
  • Numb lips & tongue
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8
Q

What are the red flags associated with spinal assessment?

A
  • Patient age <20 or >55 for LBP
  • Significant trauma
  • Resting pain, night pain, non-mechanical symptoms
  • Recent unexplained weight loss
  • History of cancer
  • Constitutional symptoms (malaise, fever, chills, appetite changes)
  • High dose steroids
  • Severe, progressive or unstable neurological presentations
  • Bladder or bowel dysfunction
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9
Q

What are the yellow flags associated with spinal assessment?

A
  • High level of pain out of proportion to diagnosis
  • Unhelpful attitudes & beliefs about pain & dysfunction (avoidance, fear of re-injury, catastrophising)
  • Low mood, emotional state, anxiety, depression
  • Social withdrawal, family/relationship difficulties
  • Workplace/employment psychosocial issues affecting recovery
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10
Q

What are psychosocial factors a strong predictor of?

A

Chronicity

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11
Q

What are the patterns of movement for facet joints in the lumbar spine?

A
  • Flexion: Open
  • Extension: Closed
  • Lateral flexion: Close ipsilateral side
  • Rotation: Open ipsilateral side
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12
Q

What are the patterns of movement for the intervertebral foramen in the lumbar spine?

A
  • Flexion: Increases
  • Extension: Decreases
  • Lateral flexion: Decreases ipsilateral side
  • Rotation: Decreases ipsilateral side
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13
Q

What does back pain vs leg pain dominant indicate?

A
  • Back pain dominant: Disc, facet, spondylosis, strains

- Leg pain dominant: Nerve root irritation, claudication

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14
Q

What questions should be asked to differentiate central & peripheral patterns of LBP?

A
  • What movements make it extend peripherally
  • How far peripherally does the pain extend
  • What brings it back centrally
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15
Q

What does 5 star tissue screening consist of?

A
  • Non-contractile tissue
  • Contractile tissue
  • Neurological system
  • Vascular system
  • Integration
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16
Q

What is the recommended order of testing for spinal assessment?

A
  • Observation
  • Neuro & vascular examination (safety)
  • Screening other joints
  • Selective tissue tensioning
  • Special tests
  • Biomechanical analysis (joint play)
  • Functional tests
17
Q

When is neurological examination indicated?

A
  • Pain extending past shoulder or buttock from spinal region

- Altered sensation of power

18
Q

What are the components of a neurological examination?

A
  • Strength
  • Reflexes
  • Sensation
  • Cord signs (clonus, Babinski)
19
Q

What does the VBI screening test involve?

A
  • Sustained cervical extension & rotation looking for reproduction of symptoms
  • If patient has several of the VBI signs, don’t do the test
  • Only for patients with subtle symptoms that may be attributed to something else
20
Q

What does spinal screening include?

A
  • Joints above & below (including shoulder & hip)
  • As a minimum, AROM + OP & special test
  • Establish relationship between symptoms
21
Q

What does the 12th rib usually align with?

A

T12-L1

22
Q

What does spinal palpation include?

A
  • General temperature
  • Sweating
  • Swelling
  • Specific tenderness/tightness of tissue
23
Q

What are cervical compression & distraction used for?

A

Determining if there is a nerve root problem (compression = worse, distraction = better)

24
Q

When should neural dysfunction tests be used?

A
  • When patient isn’t positive for any initial neuro tests
  • No signs of nerve root compression
  • When patient isn’t highly irritable
  • Looking for reproduction of leg pain
25
Q

What are PPIVMs?

A
  • Passive physiological intervertebral movements
  • Movements the patient can produce themselves, but doing them passively and seeing what happens at each level of the spine
26
Q

What are PAVIMs?

A
  • Passive accessory intervertebral movements
  • Movements the patient cannot perform actively in isolation
  • Movements of joint & surrounding tissues that are necessary for full joint ROM

MI2 (10 decks)

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