Spine Path Review Flashcards
Whole spine disorders
muscle strain
capsular restriction
spondylosis
stenosis
radiculopathy
muscle strain
- 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
capsular restriction
- 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
spondylosis
- 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)
lateral stenosis
- 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
central stenosis
- 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
radiculopathy
- 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
TOS
- 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
pathologies common to thoracic and lumbar region
- osteoporosis
- rib dysfunction
- scoliosis
- ankylosing spondylitis
- scheuermann’s disease
- HNP
- Spondylolysis/ spondylolisthesis
- SIJ
osteoporosis
- 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
rib dysfunction
- 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
scoliosis functional
- reversible
- female> male
common cause:
idiopathic
SIJ issue
leg length
poor posture
hip contracture
nerve root irritation
scoliosis idiopathic (structural)
- high pressure increases bone growth
- musculature issue
- metabolic/chemical factors
- endocrine issues
- CNS: loss of proprioception
ankylosis spondylitis
- 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
Scheuermann’s disease
- male>female, 20s
- “growing pain”
- stiff and or pain after rest
- increased thoracic kyphosis
- pain with axial loading, decreased pain with axial unloading
HNP
- 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
Spondylolishthesis
- 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
SIJ Subjective
- 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
What must you identify for SIJ pain?
is it mechanical or nonmechanical?
SIJ Objective considerations
- posture
- clear lumbar spine and hip
- no neuro signs
- pelvic mobility
- leg length
- lasletts cluster
What is in lasletts cluster
- thigh thrust
- distraction test
- gaenslen’s (thomas test)
- compression test
- sacral thrust
Hypermobile signs of SIJ?
- weak glutes
- also check ham, quads, and hip rotators
Hypomobile signs of SIJ?
- ant/post innominant
- upslip
- pubic symphysis disfunction
- sacral torsion
landmarks for vertebrae
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
rule of 3s
T1-3: TP level with SP
T4-6: 1/2 level below
T7-10: 1 level below
T11 : 1/2 level
T12 : level
5 Ds
dizziness
diplopia
drop attacks
dysarthrea
dysphagia
3 Ns
Numbness
Nystagmus
Nausea
Cervical ROM norms
F: 50
E: 60
R: 80
SB: 45
Thoracolumbar ROM norms
F: 4in
everything else varies, just compare to other side
Lumbar ROM values
F: 6.3-6.9 cm
E: 1.6 cm
