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PHTH 565 - MSK > SPINE > Flashcards

SPINE Flashcards

1
Q

In the lumbar spine - can you get pure side flexion or pure rotation

A

no they will always have a component of the other one

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2
Q

why can you not get pure side flexion or rotation in the lumbar spine

A

due to the shape of the facet joints

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3
Q

What is the osteo and arthro kinematics of lumbar flexion

A

Osteo: anterior saggital rotation + anterior translation

Arthro - Anterosuperior glide

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4
Q

What is the osteo and arthro kinematics of lumbar extension

A

Osteo: Posterior saggital rotation and poserior translation
Arhro: Posteroinferior glide

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5
Q

What is the osteo and arthro kinematics of right lumbar side flexion

A

Osteo: Inferior movement right side of vertebra
Arthro: Inferior glide at the right, superior glide at the left

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6
Q

What is the osteo and arthro kinematics of right lumbar rotation

A

osteo: gapping of the right facet joint, compression of the left facet joint
arthro: depends on coupling with sideflexion, whether it is ipsilateral or contralateral

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7
Q

What are the general components of the scan

A
  • General mobility
  • General stability
  • Neural conductivity
  • Neuromeningeal (dural) tests
  • Vascular tests
  • Lower quadrant screening
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8
Q

Components of a subjective history

A
  • Age
  • Occupation
  • P/C forces involved e.g. Flexion, rotation, traumatic/insidious onset, pain location, diurnal variation
    Aggravating/Easing
    Generally improving? Generally getting worse?
    PMHx
    Fhx
    General health
    Meds
    Investigations AND results
    Sleeping affected? Position/pillows
    Sports/activities
    Previous treatment and results
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9
Q

Which questions are important for spinal cord and cauda equina involvement

A

Bladder/bowel dysfunction
Saddle paraesthesia
Anaesthesia

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10
Q

What do you ask about cough and sneeze

A

raises interdiscal pressure

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11
Q

What is neuro symptoms inclusive of

A

Numbness, tingling, pins and needles, loss of sensation, leg pain

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12
Q

What is the effect of diabetes on tissue healing

A

slows it

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13
Q

Why might you do a scan?

A
  • Rule out serious pathology
  • Determine whether appropriate for PT or referral or co-treat
  • Zero in on appropriate area, spine vs. peripheral, upper vs. lower spine
  • a necessary component of all lumbar spine examination
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14
Q

What are two commonly used outcome measures for back pain

A

Rolan Morris

Oswestry

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15
Q

How many items are on the Roland Morris? measuring what? What is the MCID ? what is the scoring?

A 
24 items 
Measuring function today 
MCID 1.5-5 points 
Score 1-24 
24 = max disability
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16
Q

How many items are on the Oswestry? What is the MCID ? what is the scoring?

A

10 questions, each score 1-5. Max 50

MCID 4-6

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17
Q

What components of a lumbar spine scan do you conduct in standing

A
  • Observation
  • active mobility tests
  • Squat
  • Kinetic tests
  • S1 Myotome
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18
Q

What components of a lumbar spine scan do you conduct in sitting

A
  • Slump test
  • L3 reflex
  • S1 reflex
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19
Q

What components of a lumbar spine scan do you conduct in supine

A
  • SLR
  • Myotomes L2, 3, 4, 5. S2
  • Dermatomes, L2, 3, 4, 5 S1, S2
  • General traction
  • General compression
  • Plantar response
  • CLonus
  • Pelvic stability tests (distraction + compression)
  • Pulses
  • Faber
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20
Q

What components of a lumbar spine scan do you conduct in prone

A
  • Femoral nerve stretch
  • myotomes S1, S2
  • Dermatomes S1, 2,
  • Farfans general torsion test
  • Facilitated segment tests
  • S1 reflex
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21
Q

What is Farfans test

A

General torsion test - testing ability of lumbar spine to tolerate rotary force

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22
Q

How do you name Farfans test

A

If you lift the right pelvis back - the upper bones are going to the left therefore it is a left test

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23
Q

What is a positive on Farfans test

A

Pain

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24
Q

What is normal range for knee flexion in the femoral nerve test

A

90-110

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25
Q

How do you treat hypermobility

A

exercise +/- external support

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26
Q

What are two spinal cord reflexes

A

plantar response

clonys

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27
Q

What is a positive plantar response called? what does it indicate?

A

Babinski

UMN lesion

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28
Q

What is the normal response for clonus in adults over 40

A

1-2 beats

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29
Q

What does an impairment of spinal cord reflexes indicate

A

serious pathology: central disc pressing on cord, infection, space occupying lesion, neurological condition

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30
Q

What is a hard neurological sign? what does it imply?

A

Loss of myotome and/or reflex and/or sensatoin

Impairement of nerve conduction

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31
Q

What may cause an impairment of nerve conduction leading to a hard neurological sign

A

disc
local inflammation
stenosis

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32
Q

What does the healing time of impaired nerve conduction depend on

A

Whether it is a neuropraxia, axonotmesis, neurotmesis

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33
Q

Differentiate neuropraxia, axonotmesis, and neurotmesis

A

Neuropraxia: transient conduction block or motor or sensory without nerve degeneration (motor more common)
Axonotmesis: moderate, axon damage but intake endoneurium, perineurium, epineurium
Neurotmesis: Most serious, both nerve and nerve sheath, nerve completely divided

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34
Q

How would you know if impairement of nerve mobility is a serious concern

A

if there are hard neurological signs

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35
Q

What are symptoms of mechanical pain

A

MOI
Specific aggravating + easing factors
Predictable patterning

36
Q

What are the symptoms of inflammatory pain

A
  • First 24hours post injury or may not be as a result of injury
  • Worse in morning of after immobilisation
  • Better with a little rest but worst with prolonged rest
  • better with a little mobility but worse with too much movement
37
Q

What are the signs of mechanical pain

A
  • pain with selective tissue tension tests
38
Q

What are the signs of inflammatory pain

A
  • Red/hot/swollen

- Acute inflammation can also cause decreased mobility

39
Q

What is pain on the eccentric component of a test indicative of

A

tendon involvement

40
Q

Generally - what are mobility tests for the lumbar spine

A

PIVM and PAVM

41
Q

Generally - what are the stability tests for the lumbar spine

A 
Compression 
Traction 
Torsion 
Anterior shear 
Posterior shear
42
Q

Where do you typically start when doing PIVMs of the lumbar spine

A

Thoracolumbar junction and move caudally

43
Q

What are some contraindications to lumbar PAs

A
  • Spondylolisthesis
  • Fracture
  • Infection (osteomyelitis)
  • Neoplasm
    …. (at specific segment)
44
Q

What are some precautions to lumbar PAs

A
  • Osteopenia
  • Osteoporosis
  • Inflammation
  • Active cancer
  • Acute trauma
  • Hypermobility
45
Q

What are you assessing with lumbar PAs

A 
Mobility (hypo- or hyper-) 
Provocative tests (seeing if pain or spasm is evoked)
46
Q

How long should you do PAs for when using as treatment

A

90 seconds

47
Q

What are some things that would make you cautious upon noticing on observation

A
  • Step deformity (instability)
  • Facilitated segment
  • Crease
  • Changes in skin colouration (port wine stain, cafe au lait - these tell you there may be something going on with the architecture beneath)
  • Tuft of hair (same as colouration)
  • Scoliosis (change in underlying angles and architecture)
48
Q

How should PAs be angle to assist with flexion and extension

A
  • Cranially 45 deg for flexion

- Caudally for extension

49
Q

What are you assessing for in a PA

A

Presence of pain
Quality of segmental motion
Range of segmental motion
End Feel

50
Q

What is the purpose of a PA Unilateral pressure

A

Test joint mobility for sideflexion/rotation

To determine if one Z-joint is stiffer or more painful than other side

51
Q

PA Unilateral pressure can be angled which ways for which motions

A

Caudally for ipsilateral side flexion

Cranially for contralateral side flexion

52
Q

What are the primary structures being tested in traction

A 
Disc 
Anterior&posterior longitudinal lig 
Supraspinous lig 
Intraspinous lig 
Ligamentum flavum
53
Q

What is a positive compression test

A

pain in the back or leg
Spasm
Empty end feel
Limited ROM

54
Q

What are the primary structures being tested by Compression

A

Vertebrae
Facet Joint
Disc?

55
Q

Torsion is the name applied to a ____

A

rotation stress

unphysiological amount of rotation

56
Q

What is a positive torsion test

A

Pain
Laxity
Soft end feel
Spasm end feel

57
Q

Picking on the right ASIS is a ____ torsion test

A

Lef

58
Q

If you rotate R which facets are compressed and which are gaped

A

Gap on R facet

Compression on L facet

59
Q

What are the primary structures being tested in a rotation test

A

Disc
Facet
Capsule

60
Q

Can lumbar facet joints do pure rotation

A

no - always combined with side flexion

61
Q

How many degrees of pure rotation does the lumbar spine have

A

3

62
Q

Capsular pattern in the spine =

A

Painful, limited ipsilateral side flexion, rotation, and extension. Full but painful flexion at the end of range

63
Q

Disc lesion symptoms:

A

LBP +/- leg pain
LBP +/- root pain
Aggravated by sitting, flexion, cough/sneeze

64
Q

Disc lesion signs

A

Non-capsular pattern
+/- root signs
+/- dural signs (SLR slump)
+ve torsion/compression

65
Q

Spinal stenosis symptoms

A

LBP +/- leg pain

Aggravated by standing & walking, relieved by sitting down (flexion)

66
Q

Spinal stenosis signs

A

Capsular/non-capsular pattern
+/- root & dural signs
May involve more than one segment

67
Q

Spondylolithesis symptoms

A

LBP +/- leg pain
Aggravated by prolonged standing, walking, extension
Eased by flexion

68
Q

Spondylolithesis signs

A

Step deformity
+/- muscles changes
+ve stability test (i.e instability)

69
Q

Sacroiliac dysfunction symptoms

A

Buttock +/- leg pain

Aggravated by turning, twisting, swing phase, in& out of car, weight bearing

70
Q

Sacroiliac dysfuntion signs

A

Local tenderness +/- kinetic testing

+ve stress tests (SI joint)

71
Q

Zygapophyseal joint dysfunction symptoms

A

LBP +/- leg pain

Aggravated by extension, maybe by stretch

72
Q

Zygopophyseal joint dysfunction signs

A

Non-capsular pattern

+ve flexion or extension quadrant

73
Q

Spondylosis Degenerative disc D, Degenerative Joint D Symptoms

A

LBP +/- leg pain
LBP +/- root pain
Stiff, worse when still, better with movement

74
Q

Spondylosis Degenerative disc D, Degenerative Joint D signs

A

Often a capsular pattern

X-ray evidence of widespread degenerative changes

75
Q

What three general categories decide the choice of technique to be used (i.e manual, mechanical, or active)

A
  • Presenting signs & symptoms
  • Impairment
  • Stage of healing
76
Q

What is the purpose of biomechanical counselling

A

to give the patient skills for self-management, education about preventing reinjury and to provide optimum conditions for healing

77
Q

4 main principles of treatment applied to the spine

A
  • Treat according to findings on subjective and objective exams
  • Treat according to the end-feel (grade 1-2 for pain…etc)
  • Treatment time will be dictated by joint irritability and stages of healing
  • Reassess frequently
78
Q

When is a soft tissue lateral flexion technique used

A

for general soft tissue stretching
For multisegmental tightness
To decrease a long SF curve (non-structural scoliosis)

79
Q

When is traction used

A
  • Relieve compressive forces
  • Provides gentle movement to painful segments
  • assess suitability for mechanical traction
80
Q

What might you use for someone who is too sore to tolerate PAs

A

General rotation

81
Q

What is your line of force for general rotation

A

line of femur

82
Q

General rotation is for which grades

A

1 and 2

83
Q

What type of rotation do you do for grades 3 and 4

A

rotation combined with flexion

84
Q

Which muscles atrophies very quickly following LBP

A

Multifidus

85
Q

What may someone standing up using their legs or nearby furniture be indicative of

A

An instability - trying to use legs/furniture to self-stabilize

86
Q

Prescription for mobilizations?

A

3 sets of 10 - check in with how they are doing often.

repeat 3x for total of 90

PHTH 565 - MSK (8 decks)

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