Test one review Flashcards
Order of examination
inspection, instrumentation, static palpation, motion palpation, X-ray
can the order of examination vary?
yes, if patient is in acute pain then static palpations preferred over dynamic
Inspection categories
changes in posture/gait, changes in color, changes in symmetry, presence of scars/ lesions
what are the most important aspects of visual inspection
changes in posture and gait
every inch of anterior head translation equates to how many pounds
10lbs
what does posture reflect
the interrelationship of structural architecture
signs of scoliosis
uneven shoulders, uneven hips, curve in spine
does the shape and articulations of the bone affect posture
yes
what is important in the biomechanical function and efficiency of a joint
posture
what can affect the epiphyseal growth rates in a growing skeleton
asymmetrical loads on the bone
hyperemia (red response)
superficial vascular response of vasodilation due to digital palpation OR local autonomic system dysfunction secondary to VSC in that area
Heuter- Volkmann (HV) law
increased pressure across the growth plate inhibits vertical growth and decreased pressure accelerates growth
constant asymmetrical postural loads on the vertebral segments will lead to what
dysfunction
what can changes in color indicate
area of trauma, inflammation, lack of circulation
symmetry
hair, musculature, condition, slope, contour of the skin
Static Palpation
TEM
temperature, edema, musculature
motion palpation
evaluates 6 cardinal ranges of motion for a joint (predominantly from (L5-C2)
what does motion palpation evaluate
whether the ligament is normal through the use of joint play
joint play
the end feel spring of a joint
what does loss of joint play indicate
presence of scar tissue, swelling of the capsule, bony changes within that space
positional dyskinesia
misalignment of one vertebra on another caused by micro or macro trauma
microtrauma
degenerative processes on soft tissue that occur over time
ex: gravity, handedness
macro trauma
sudden forces acting on the body that exceed the limitations of the tissue
ex: falls, accidents, blows to the body
fixation dysfunction
implies abnormal motion characteristics are present
ligaments function
to maintain normal physiological ranges of motion, protect the spinal cord, transfer tensile forces from one bone to another, attach bone to bone
how are ligaments organized
collagen fibers are organized longitudinally in the direction the tensile forces are applied
what do fibrous adhesions do to ligaments
compromise the integrity and function
what are the types of ligaments
continuous and segmental
what is the elastic barrier
resists further movement of the joint, when the tissue has been stretched to its maximum,
what is an example of a continuous ligament
PLL, ALL
what is an example of a segmental ligament
inter-transverse ligaments
who can test joint play
only the examiner
a decrease in joint play will have what effect on the ROM
decrease ROM
active range of motion
evaluates the integrity of the muscles (STRAIN)
passive range of motion
evaluates the integrity of the ligaments, joint capsules, disc (SPRAIN)
fixation
loss of one or more ranges of motion in the joint
subluxation
fixation plus nerve interference
inspect for ?
level
palpate for ?
tone
causes for changes in the level of the gluteal folds
postural changes dye to repetitive action or scoliosis, PI/AS ilium, lumbar innervation issues due to subluxations or disc herniations, hypertrophy due to activities (cerebral dominance, work, sports)
static palpation of pelvis
T-temperature
E- edema (above and below PSIS as well as medial border)
M- musculature (tone of gluteal muscles)
ilium flexion
PSIS move posterior, inferior, medial
ilium extension
PSIS move anterior, superior, lateral
sacral extension
counter nutation
sacral base moves posterior and superior
what do we feel in lab when the sacrum is in extension
S2 and S4 move posterior and inferior
sacral flexion
nutation
sacral base moves anterior and inferior
what do we feel in lab when the sacrum is in flexion
S2 and S4 anterior and superior
when does nutation occur
sacral flexion, when sitting or forward bending
when does counternutation occur
sacral extension, standing
what influences the upper SI joint
the weight of the upper body transferred through the lumbosacral joint
what influences the lower SI joint
ground forces ascending from the lower extremities via the head of the femur
SI fixation at any degree inhibits what
compensatory torsion capacity of the spinal segments
what happens to the lumbar when the SI jt is fixated
normal lumbar torsion is restricted and axial torsion of the cord and nerve roots is produced
what is the least subjective of the objective findings
X-ray
standing pelvis movements
PSIS move anterior, super, lateral
sacral base moves into counter nutation aka sacral extension
ischial tuberosity move posterior, inferior, and medial
sitting pelvis movements
PSIS move posterior, inferior, and medial
sacral base moves into nutation aka sacral flexion, anterior and inferior
ischial tuberosity move anterior, superior, lateral
vertebral subluxation complex (VSC)
kinesiopathology, neuropathology, myopathology, histopathology, pathophysiology
kinesiopathology
deviation from normal biomechanical joint action
-hypermobility, hypomobility, joint play, and altered axis of motion
what is kinesiopathology determined through
motion palpation
if normal expected movement occurs what can be ruled out
kinesiopathology
neuropathophysiology
compression lesion, facilitated lesion, loss of neurological integration
what is compression lesion
typical pinched nerve resulting in diminished function
facilitated lesion
most common, increased function and irritation
loss of neurological integration
altered postural sense, vasomotor control and temperature regulation
what can neuropathophysiology be determined by
specialized tests
histopathology
inflammation, edema, swelling, degeneration
what test is done to determine histopathology
static palpation
myopathology
deviation from normal muscle condition
hyperactivity or hypoactivity
hyperactivity
from injury or facilitated nerve lesion resulting in spasm or contracture
hypoactivity
from a compression lesion resulting in loss of tone or atrophy
what test determines myopathology
static palpation
pathophysiology
local or peripheral
local pathophysiology
toxins damage the nerve sheath, degeneration and weakening of the disc, ligament, and joints
peripheral pathophysiology
neurotoxins are carried to the end organs and create pathology. Increased inflammatory reactions, disease, infections, and system failures
what test determines pathophysiology
special tests
which fixation is usually not the most tender
primary
thoracic fixations are usually primary or secondary
secondary
how many segments do fixations occur between
two or more
