Study Guide Flashcards
OSE findings/dx/tx for piriforimis syndrome
Ext rotation of hip
+/- straight leg raise
MRI as last resort
OMT, PT
OSE findings/tx for Psoas syndrome
flexed posture
psoas TP
OMT, PT
OSE findings/dx/tx for Short Leg syndrome
Sacral base unlevel
Medial malleolus short after SDE is resolved
Postural Xray
Heel lift tx
OSE findings/dx/tx for spondylolysis/-listhesis
Step-off of sinus process in lumbar flexion
AP, Lat, Obliq Xrays
OMT/PT, bracing, lifestyle changes (lite duty)
Surgery if severe
Findings in spinal disc herniation
\+ SLR, LE weakness MRI to confirm acute = RICE post-acute = OMT Surgery if severe
OSE findings/dx/tx for Cauda Equina syndrome
Bowel/bladder dysfunction, saddle anesthesia, bilat LE pain
MRI
SURGICAL EMERGENCY **must tx within 48 hrs
Treatment recommendations for Carpal Tunnel Syndrome
Mild/Preg= usually self-limiting, wrist splints, NSAIDs, steroid inj Moderate= OMT, splints, NSAIDs, steroid inj Severe= signs of damage and muscle wasting--OMT at consult then surgical referral
S/SX of carpal tunnel
(repetitive flexion injury) nighttime numbness of lateral 3.5 digits, tingling, wrist pain, loss of grip, thenar atrophy
**common in pregnancy
DX for carpal tunnel
Gold-standard = EMG
+Phalen’s, +Tinel’s, two-point discrimination at 5mm
Findings for degenerative disc deisease
**Non-specific LBP dx with Xray
TX with OMT, PT, NSAIDs
Surgery if severe
Carpal Tunnel DX/TX
NSAIDs, OMT (MFR, ST, Lymph), Xray if concerned with fracture, MRI for ST injury (atrophy/severe/prolonged)
Surgical for severe or unresponsive
Spinal compensation in psoas strain
loss of LSpine lordosis
Spinal compensation in ageing
increased Tspine kyphosis
Spinal compensation in pregnancy
increased Lspine lordosis and Tspine kyphosis
Zink transition zones
OA cervicothoracic thoracolumbar lumbrosacral Compensated = LRLR (common) or RLRL (uncommon)
General contraindications to OMT
PT refusal, acute fracture, surgical emergency, cranial OMT for acute head bleed (dural/subdural hematomas)
OMT contraindications in LBP
Lumbar HVLA when Mets are present (avoid area)
HVLA w/ hx of osteoporosis
HVLA for acute lumbar herniation (relative contraind)
Direct tx for compression fracture (other than direct MFR)
HVLA in acute phase of RA
Contraindications of OMT in pregnant pts
undx vaginal bleeding, preterm labor, placental abruption, ruptured membranes, incompetent cervix, eclampsia, ectopic, chorioamnionitis
Contraindications for OMT in surgical PTs
Avoid direct manipulation over surgical sites for 2 weeks, abd plexus inhib if midline incision or AAA, sigmoid release if recent L hemicholectomy, mesenteric release if anterior abd incisions, rib raising if rib/spine fracture or surgery, pedal pump ABSOLUTE CI if DVT, LE fractures, or recent abd surgery, Lymph tx (relative) if osseous fx, bacterial infx w/ fever >102, abcess/local infx, TI relaease if upper rib fx/clavicle fx, liver or spleen if thoracotomy or chest tube
Common SD in 2nd trimester of pregnant patient
pelvis rotating about R/L axis with forward torsion, increased pelvic tilt (ant innom rotation), increased lumbar lordosis, compensatory increase in T kyphosis (may lead to cervical strain)
Alarm findings in pregnant patient
severe pain that interferes with function, particularly non-positional persistent pain at night, increased pain with cough, sneezing or valsalva maneuver; neuro deficits; bowel or bladder dysfunction; weakness, sensory deficits, abd reflexes
Radicular pain in pregnancy
10% herniated disc
40% bulging disc
likely d/t mechanical pressure of ligamentous structures on nerve root – presents as parasthesias in ILIOINGUINAL AND GENITOFEMORAL NN distrobution (“lightning pains”)
Reason for increase in LBP at night in pregnancy
stagnant hypoxia of neural and vertebral tissues
dependent edema moves back into the vasculature d/t osmotic gradient plus direct pressure on IVC by the uterus leads to decreased flow in pelvis therefore stagnant hypoxia of tissues and delayed LBP
Hormonal cause for LBP in pregnancy
Relaxin leads to widening of SI joints and pubic symphesis beginning at 10-12 weeks; progesterone causes changes in mechanics of thoracic cage leading to increased circumference and widening of subcostal angle from 68* to 103*
Results of scoliosis, RA and ankylosing spondylitis during pregnancy
Scoliosis = no increase in curve, may develop increase in pain, possible preterm labor RA = improves sx from conception to 6 wks PP AS = aggrivated d/t increased mechanical stress
Reason carpal tunnel is common in pregnancy
Common in 2nd trimester d/t fluid retention and congestion
DX/TX of ruptured pubic symphesis in pregnancy
Separation >1cm (<10mm); occurs <1%; audible crack heard; acute pain radiating to back or thighs, palpable gap w/ edema, waddling gait with pain
Conservative TX…bed rest (lat recumb), pelvic binder, OMM (indirect tx), pain may recur in later pregnancies
CS for PC tenderpoints
PC1 inion = F StRa
PC3 = FSaRa
Remaining = E SaRa
CS tx for Posterior thoracic TPs
midline = E PT1-3 = E SaRa PT4-9 = E SaRt PT10-12 = E SaRa
Anterior cervical CS
AC1 mandible and AC1 TP = SaRa
AC 7 = F StRa (clav head)
Remaining = F Sara
Heel lift therapy
Typically tx only if length discrepancy is > 5mm (0.19685”)
o Max ¼” heel lift in shoe, ¼” may be added to outside as well; ½” total
o May add full 1/2 “ outside
o Final lift height should be ½-3/4 of measured discrepancy, unless recent cause apparent
o Replace full discrepancy w/ acute change in leg length
UE and LE dermatomes
C5: motor to deltoid & biceps; sensation to lateral arm; bicep reflex
- C6: wrist extension & elbow flexion; sensation to radial forearm, thumb and index finger; brachioradialis reflex
- C7: Wrist flexion, elbow extension, finger extension; sensation to middle finger; triceps reflex
- C8: finger flexion; sensation to ulnar forearm and small finger
- T1: finger abduction; sensation to medial arm
Role of ANS in disease
o 2 neuron chain connecting preganglionic neurons through ganglia visceral target tissues : cardiac & sm m, secretory glands, CT,
immune cells
o Involuntary; regulated by hypothalamus, limbic system & brainstem; limbic forebrain hippocampus, amygdala, prefrontal &
cingulate cortex SNS or PNS
Describe clinical signs of viscerosomatic reflex dysfunction
Exhibit non-neutral Type II SD, increase in moisture (skin drag), increase in temp, poorly defined end point (rubbery), affects small rotators (rotatores)
When to refer to PT
Techniques Used for Injuries
US: tendon injuries, pain relief
Phonophoresis: US medication delivery, inflammatory conditions
Iontophoresis: electric current, inflammatory conditions
Laser Therapy: ↓ PGE2
Electric Stimulation: generates AP; neuropathic pain, spasm
when to refer to OT
Services Provided:
An individualized evaluation, during which the client, family, and OT determine the person’s goals
Customized intervention to improve person’s ability to perform ADL and reach goals
An outcome evaluation to ensure that goals are being met and/or to modify the intervention plan based on the pt’s needs
& skills
When to refer to surgery
cauda equina syndrome, spondylolisthesis, severe spinal stenosis, etc; pain is not indication for surgery, nerve compression is
EMG performed
When to refer to massage
Techniques: Swedish massage (hypertonicity), deep tissue (trigger points), Shiatsu (rhythmic pressure on precise points of body),
lymphatic (edema), Rolfing (ten-step approach to align structure)
o Great for people with lots of chronic muscle tightness, stress, etc
