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ONMM Boards > Spine > Flashcards

Spine Flashcards

1
Q

How to determine flexion vs extension

A

Pt lies prone

  1. Palpate transverse process
  2. If asymmetry WORSENS in extension, the segment is FLEXED and vice versa.
  3. If asymmetry IMPROVES in extension, the segment is EXTENDED and vice versa.
  4. No change = NEUTRAL

If unclear, test in flexion.

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2
Q

Standing flexion test

A 
Pt standing w/ ft shoulder width apart
Eyes at level of PSIS
Thumbs under PSISs
Rest fingers on iliac crests or glutes
Bend forward, follow PSIS movement
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3
Q

Positive standing flexion test?

A

One PSIS moves superiorly during last 10 deg of forward bending
Pos = side of IS dysfunction

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4
Q

Cause of false positive standing flexion test

A

Contralateral tight hamstrings

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5
Q

How do you determine if the ASIS is inferior or superior?

A

Have the patient lay supine
Use your palms to locate the ASIS
Hook your thumbs under each ASIS and compare which one is superior
The side of the positive standing flexion test is the concern

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6
Q

How do you determine the height of the pubic ramus?

A

1 Explain what you’re doing to the patient
2. Patient supine, place palms on the abdomen move caudally until the superior aspect of the pubic rami is contacted. Place index fingers superior on each rami. Look straight down at your fingers to compare heights.

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7
Q

How do you determine leg length discrepancies?

A
  1. Patient lies supine.
  2. Position stands at end of table.
  3. palpate the most interior aspects of each medial malleolus with the thumbs. Determine if one leg is shorter.
    The medial malleolus follows the ASIS.
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8
Q

How do you determine the PSIS height?

A
  1. Patient lies prone.
  2. Use palms to locate the PSIS.
  3. Hook your thumbs horizontally to under each PSIS and compare which one is superior.
    floor. The side of the positive spending flexion test is the side of concern.
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9
Q

How to determine the height of the ischial tuberosity

A
  1. Patient prone.

2. A place of palms into the gluteal fold slightly medially

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10
Q

Fryette type I mechanics characteristics

A
  1. Neutral
  2. Thoracic or lumbar spine
  3. Sidebending and rotation in opposite directions
  4. Treat the apex of the group
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11
Q

Fryette type II mechanics characteristics

A
  1. Non-neutral
  2. Thoracic or lumbar spine
  3. Single vertebral unit
  4. Sidebending and rotation in the same direction
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12
Q

Muscle Energy for NSLRR L2-4

A
  1. Physician stands on the side opposite to the rotational component (on the left)
  2. Patient places L hand over R shoulder
  3. Phys weaves L arm under pt’s L arm and places L hand over pt’s L hand (to control R shoulder
  4. Phys places R thumb at apex of R convexity & applies anteromedial force vector
  5. Maintain neutral spine
  6. Side bend trunk to R, rotate upper trunk L until movement is felt under R thumb.
  7. Pt performs isometric contraction attempting to sit up 3-5 s
  8. Pt releases, phy takes up slack until restrictive barrier reached
  9. Repeat up to 3 times
  10. Goal: Improvement in motion
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13
Q

Muscle Energy for FRLSL Lumbar spine

A
  1. Pt seated, phys seated or standing behind pt.
  2. L hand monitors the inferior interspinous region and the transverse processes of vertibra.
  3. Bring upper trunk into extension, right side bending and right rotation.
  4. Pt rotates left, bends left, bends forward against resistance
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14
Q

ME for Lumbar ERSR

A
  1. Pt seated, phys stands in front
  2. Pt’s L hand placed on R shoulder
  3. Phys L axilla on pt’s L shoulder
  4. Phys R hand monitors dysfunctional Vertebra transverse processes and inferior interspinous region.
  5. Isometric contraction.
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15
Q

CS for L1 R anterior TP

A

Physician stands at same side of TP

  1. Flex hips + lumbar spine to L1
  2. Rotate pelvis toward tender side (trunk away)
  3. Sidebend toward TP (feet toward)
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16
Q

CS for L2 R anterior TP

A

Physician stands at opposite side of TP

  1. Flex hips + lumbar spine to L2
  2. Rotate pelvis away from tender side (trunk towards)
  3. Sidebend away from TP (feet away)
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17
Q

CS for L3-4 R anterior TPs

A

Phys stands at opposite side of TP

  1. Flex hips + lumbar spine to L3 or 4
  2. Rotate pelvis away from TP (trunk towards)
  3. Sidebend away from TP (feet away)
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18
Q

CS for L5 R anterior TP

A

Phys at same side of TP

  1. Flex hips + L spine to L5
  2. Rotate pelvis toward TP (Trunk away)
  3. Sidebend away from TP (move feet away)
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19
Q

CS for Posterior Lumbar TPs

A

Phys at same side of TP

1. Grasp ipsilateral IC and lift from table

20
Q

CS for Piriformis

A

Patient prone

  1. Flex + abduct ipsilateral hip
  2. Add internal/external rotation prn
21
Q

CS for iliacus

A

Pt supine

1. Bilateral hip flexion w/ ankles crossed & knees flexed

22
Q

CS for Lat trochanter TP

A

Monitor TP while abducting hip

23
Q

ME for anterior innominate rotation

A 
Pt supine
Phy stands on contralateral side
1. Flex knee & hip
2. Ext rotatte hip & abduct leg
3. Phy hand on ischial tuberosity w/ pt knee in phy axilla
4. Extend hip & knee against phys
5. 3-5 reps
6. Reassess
24
Q

ME for posterior innominate rotation

A 
Pt supine
Phy stands ipisilateral side
1. Bring pt's SI joint to edge of table
2. Phy hand on opposite ASIS
3. Phy other hand on knee hanging off table
4. Pt lift knee against phy push towards floor
5. Take up slack between contractions
6. Repeat 3-5 reps
7. Reassess
25
Q

ME for superior or inferior pubic shear

A

Pt supine

  1. Knees flexed
  2. Pt abducts both knees, 3-5 reps
  3. Phys arm between knees, Pt adducts knees, 3-5 reps
26
Q

SI joint BLT

Useful for rotation, flare or shear

A

Phy sits ipsilateral to SI dysfxn

  1. Post hand contacts post sacrum, close to SI joint
  2. Post hand proximal fingers contact medial PSIS
  3. Other hand on ASIS
  4. Post hand exerts anterior force on sacral sulcus to disengage SI joint
  5. Move innominate to balance sacroiliac ligaments
  6. Hold BLT until release felt, reassess
27
Q

What does a positive seated flexion test look like? (+SeFT)

A

PSIS on dysfxn side moves more superiorly during last 10 degrees of forward bending.
Ischial tuberosities must stay on table!

28
Q

How to test the sacral base

A

Lumbosacral spring test:

  1. patient prone
  2. Heel of hand on lumbosacral joint
  3. Apply short anterior force assessing motion or “spring”
29
Q

Pos lumbosacral spring test consists of:

A

Restricted lumbosacral motion, i.e. no spring

Cause: backward sacral torsion, bilateral sacral extension, unilateral sacral extension

30
Q

Neg lumbosacral spring test indicates:

A

forward sacral torsion, bilateral sacral flexion, unilateral sacral flexion

31
Q

Pos ILA spring test

A

Poor spring at ILA (resists anterior motion)

Cause: sacral flexions, forward torsions

32
Q

Neg ILA spring test

A

Good ILA spring

Cause: sacral extensions, backward torsions

33
Q

Sphinx test use

A

Test range of motion of the sacral base
Start prone, test depth of sacral sulci
Pt moves up on elbows, recheck sacral sulci depths and ILAs

34
Q

Pos sphinx test characteristics

A

Asymmetry between sulci (and ILAs) worsen.

Causes: Backward torsions, unilateral extensions

35
Q

Neg sphinx test characteristics

A

Asymmetry between sulci (and ILAs) improves

Causes: Forward torsions, unilateral flexion

36
Q

Sacral torsion characteristics

A

Anterior (deep) sulcus on one side

Posterior (shallow) ILA on the OPPOSITE side

37
Q

Unilateral sacral flexion/extension characteristics

A

Anterior (deep) sulcus on one side

Posterior (shallow) ILA on the SAME side

38
Q

Bilateral sacral flexion (flex-in-in) characteristics

A

Sulci b/l deep
ILAs b/l shallow
ILA spring test (+)
Lumbosacral test (-)

39
Q

Bilateral sacral flexion tx

A

Pt prone

  1. Abduct both legs 15 deg (loose packs SI joints)
  2. Internally rotate both legs (allows posterior sacral motion)
  3. Heel of hand presses anterior-superior, encourage INhalation and resists EXhalation
  4. Repeat 3-5 cycles & retest
40
Q

Bilateral sacral extension (Ex-Ex-Ex) characteristicss

A

(-) SeFT
ILAs bilaterally deep
(+) Lumbosacral test
(-) ILA spring test

tx: legs in external rotation, encourage EXhalation

41
Q

Bilateral sacral extension characteristics

A

Pt prone

  1. Abduct both legs 15 deg
  2. Externally rotate both legs
  3. Pt up to elbows (prone prop position)
  4. Heel of hand on sacral base
  5. Encourage EXhalation, resist INhalation
  6. Repeat 3-5 cycles, retest
42
Q

MFR for prone lumbosacral release

A

Assess:
rotation,
Left- thoracic hand moves right, lumbar hand moves left
Right- vice versa

side bending (clock/counterclock),
Right- thoracic hand clock, lumbar counter
Left- vice versa

flex/extend (superior/inferior)
Flex: hands move together
Extend: hands move apart

Neutral: no difference in either hand

43
Q

MFR prone lumbosacral release TX

A

Hold all tissues in plane of ease (indirect) or restriction (direct) until release is palpated
Utilize respiratory assist

44
Q

Sacral rock

A

Find area of greatest sacral restriction, gently spring against the barrier in each direction alternately. Repeat in a general rocking motion.
Add respiratory assist.

45
Q

Prone traction

A

Tx of: sacral dysfunction

46
Q

Viscerosomatic reflexes

A 
Heart: T1-5
Lungs: T2-7
Esophagus: T2-8
Stomach & duodenum: T5-9
Small intestine - ascending colon: T9-11
Transverse colon - rectum: T8-L2
Vasomotor Lower extremities: T10-L2
Kidneys + upper ureter: T10-L1
Lower ureter: L1-2
Bladder: T11-L2
Testes/Ovaries: T10-11
uterus & cervix: T10-L2
Penis/anterior vaginal wall + clitoris: T11-L2
Prostate: L1-2

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