Spine Path Review

Question 1

Whole spine disorders

Answer 1

muscle strain
capsular restriction
spondylosis
stenosis
radiculopathy

Question 2

muscle strain

Answer 2

• muscle guarding
• s/s ease with rest
• N/A stress to N/A tissue
• pain referred to several levels
• trigger point
• jump sign
• local twitch response

Question 3

capsular restriction

Answer 3

• usually chronic w/ other path
• no muscle weakness, N/T, or pain at rest
• pain only at end range
• limited flex/SB/ROT
• hypomobile passive accessory test

Question 4

spondylosis

Answer 4

• stiff in am or prolonged stillness
• pain in am/too much activity/ or at end range
• activity decreases pain and stiffness
• limited AROM/PROM/P Accessory
• pain with sit (DDD)
• pain with standing (DJD)

Question 5

lateral stenosis

Answer 5

• may have radicular symptoms
• derm/myo impairment pattern
• similar to spondylosis
• closing foramen will reproduce s/s, opening with decrease
• (+) quadrant test
• (+) positive neural tension test

Question 6

central stenosis

Answer 6

• over 60
• pain with walking and standing
• shopping cart sign
• possible N/T in LE
• limited PROM/AROM
• repeated extension will increase pain
• opening spinal cord will decrease pain
• possible UMN lesion

Question 7

radiculopathy

Answer 7

• rest doesn’t ease S/S
• sharp pain derm pattern or whole hand
• usually unilateral
• report weakness
• (+) neural tension test
• LMN lesion
• reproduced with foramen narrowing

Question 8

TOS

Answer 8

• middle aged women
• N/T, night pain, “heaviness”
• edema, skin tightness, cyanosis, pain, fatigue
• rule out cervical radiculopathy, systemic disease, and DVT
• (+) NTT esp Ulnar
• (+) cluster tests

Question 9

pathologies common to thoracic and lumbar region

Answer 9

• osteoporosis
• rib dysfunction
• scoliosis
• ankylosing spondylitis
• scheuermann’s disease
• HNP
• Spondylolysis/ spondylolisthesis
• SIJ

Question 10

osteoporosis

Answer 10

• female>male
• family history
• early menopause
• decreased activity, calcium, and vitamin D
• thin figure
• screen for falls!
• increase pain with WB, decrease pain with rest
• increase thoracic kypohosis and lordosis
• localized pain if fracture is present
• T10-L2 most common fracture

Question 11

rib dysfunction

Answer 11

• MOI typical ribs: twist/AP compression
• MOI 1st rib - overuse of accessory muscles
• sharp pain with cough/sneeze/breathing
• no neuro invovled unless 1st rib/TOS issue

Question 12

scoliosis functional

Answer 12

• reversible
• female> male
  common cause:
  idiopathic
  SIJ issue
  leg length
  poor posture
  hip contracture
  nerve root irritation

Question 13

scoliosis idiopathic (structural)

Answer 13

• high pressure increases bone growth
• musculature issue
• metabolic/chemical factors
• endocrine issues
• CNS: loss of proprioception

Question 14

ankylosis spondylitis

Answer 14

• rheumatoid disorder
• male>female, peak in 20s
• stiffness w/ or w/o pain in B SIJ area
• difficulty standing up straight
• flexed posture
• restricted chest expansion
• decreased B SB and accessory motion
• imaging: bamboo spine

Question 15

Scheuermann’s disease

Answer 15

• male>female, 20s
• “growing pain”
• stiff and or pain after rest
• increased thoracic kyphosis
• pain with axial loading, decreased pain with axial unloading

Question 16

HNP

Answer 16

• 20-45 y/o
• 90% L4/5 & L5/S1
• McKenzie theory (repeated F/Ex)
• increased pain with sitting/bending/twisting
• increased pain with cough/sneeze/laugh
• increased pain with flexion activities (standing after sitting a long time)
• DECREASED pain with standing/walking/movement
• slumped posture or very erect
• possible lateral shift
• (+) slump
• (+) SLR
• no neuro signs if minor
• TTP at involved segments

Question 17

Spondylolishthesis

Answer 17

• isthmic (fatigue) vs degenerative
• general LBP that eases with rest
• difficulty with forward bend, may use hands to walk up
• pain increase with excessive movement
• increase muscle tone in standing but gone with prone
• excessive lordosis
• hypermobile with passive accesory testing
• imaging: “scotty dog” sign

Question 18

SIJ Subjective

Answer 18

• insidious onset most common
• morning stiffness ease with WB
• unilateral pain in SIJ area may refer
• pain with walking/stairs (trendelemburg)
• pain with changing position
• pain with prolonged posture/stand on affected side

Question 19

What must you identify for SIJ pain?

Answer 19

is it mechanical or nonmechanical?

Question 20

SIJ Objective considerations

Answer 20

• posture
• clear lumbar spine and hip
• no neuro signs
• pelvic mobility
• leg length
• lasletts cluster

Question 21

What is in lasletts cluster

Answer 21

• thigh thrust
• distraction test
• gaenslen’s (thomas test)
• compression test
• sacral thrust

Question 22

Hypermobile signs of SIJ?

Answer 22

• weak glutes
• also check ham, quads, and hip rotators

Question 23

Hypomobile signs of SIJ?

Answer 23

• ant/post innominant
• upslip
• pubic symphysis disfunction
• sacral torsion

Question 24

landmarks for vertebrae

Answer 24

C1 - mastoid
C3 - hyoid
C4/5 - thyroid cartilage
C7 - most prominent
T2 - sup/medial angle of scap
T6 - inf/medial angle of scap
L2 - 12th rib
L4 - iliac crest

Question 25

rule of 3s

Answer 25

T1-3: TP level with SP
T4-6: 1/2 level below
T7-10: 1 level below
T11 : 1/2 level
T12 : level

Question 26

5 Ds

Answer 26

dizziness
diplopia
drop attacks
dysarthrea
dysphagia

Question 27

3 Ns

Answer 27

Numbness
Nystagmus
Nausea

Question 28

Cervical ROM norms

Answer 28

F: 50
E: 60
R: 80
SB: 45

Question 29

Thoracolumbar ROM norms

Answer 29

F: 4in
everything else varies, just compare to other side

Question 30

Lumbar ROM values

Answer 30

F: 6.3-6.9 cm
E: 1.6 cm