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DPT Spring 2024 > Thoracolumbar Spine VI- Hypermobility/Instability/ ARJC > Flashcards

Thoracolumbar Spine VI- Hypermobility/Instability/ ARJC Flashcards

1
Q

The four variables of stabilization?

1.
2.
3.
4.

A

joint integrity (cartilage)
passive stiffness (ligament)
neural input
muscle function

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2
Q

What are the two types of instability?

A

function and mechanical

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3
Q

Abnormal movement of spinal segments under loaded conditions, results in P!/disability that changes the ______ ______

A

instantaneous AOM

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4
Q

_______ instability- instability that CAN be stabilized with m. activity and/or positioning

A

Functional

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5
Q

Hypermobility is more prevalent in biological _______

A

females

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6
Q

What are some causes of hypermobility/instability?

A

Traumatic or recurrent sprains i.e., IDD

Age-related disc changes

Repetitive ext activities like gymnastics, dance, power lifting

Creep due to persistent poor posturing

Adjacent joint hypomobility

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7
Q

Generalized hypermobility is a ______ ______ order

A

connective tissue

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8
Q

Hypermobility is MOST common at the ___-____ level and more common in the ____ and _____ planes

A

L4; S1

frontal

sagittal

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9
Q

With hypermobility, the _____ is less controlled

A

AOM

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10
Q

Benign Joint Hypermobility Syndrome if:

____ major criteria present

___ major and ____ minor criteria present

_____ minor criteria present

A

2; 1; 2; 4

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11
Q

Which type of instability has:

Predictable P!

Spine and referred P!

Possible paresthesia’s from nociplastic pain due to sensitization

NO clear directional preference

A

Functional

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12
Q

_______ Instability:

↓ed P! with positional changes and support

↑ed P! with:
Prolonged positions

Prolonged and repetitive
- Forward bending
- Arching
- Strenuous activities
- Possibly, sudden motions
- Catching
- Easy self manipulation

A

Functional

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13
Q

With functional instability:

Hx- often < ____ years of age

ROM- if acute, there will be limited and P!ful _______ motion

A

40
abberant

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14
Q

With functional instability, the ROM is primarily limited and painful with _____ because of increased _______ _______ shearing followed by ______

A

EXT

anterior vertebral

SB

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15
Q

With functional instability and FLX may be limited with UE assistance returning from FB… what is this called?

A

Gower’s sign

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16
Q

With hypermobility, ______ ROM is more notable than _______ ROM particularly in ___-______ vs WBing

A

Passive
Active
Non- WBing

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17
Q

With hypermobility, combined motion will have an _________ block

A

inconsistent

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18
Q

If it’s NOT acute, it’s often WNL or excessive except for _______ that may still be limited with creasing

A

EXT

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19
Q

Signs of aberrant (deviating) AROM with functional instability:

P!ful ____ of motion, primarily in sagittal plane

Uncoordinated _______ primarily in sagittal plane

________ sign

_____/_____ compensations

Positive if ≥ ___ present

A

arc

motion

Gower’s

LE/Pelvis

1

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20
Q

With functional instability:

Resisted/MMT- if ____ may be P!ful

Most often _____ and ______ bc the global muscles are not affected

A

acute

strong; painless

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21
Q

With functional instability, neuro tests will be __ except possibly a ______ with pinwheel sensation and brisk DTRs

A

-
hyperesthesia

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22
Q

With functional instability, there will be P! with ____ _____ and there are mixed findings with _______ depending on severity

A

PA pressures

distx

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23
Q

With functional instability and accesory motion, there is possible ________ if the ________ joint is stuck

Possible adjacent hypomobility with
- ___ rotation
- ____ jt. motion
- _____ hyperextension

A

hypomobility; hypermobile

T10
SI
Hip

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24
Q

Special Tests for hypermobility:

Possible + prone LE _____ test

+ segmental _______
( _______ shear)

+ ______

A

extension

stability; anterior

ASLR

25
Q

LBP can lead to an excessively recruited ______

This muscle maintains_____ in standing

A

Psoas

lordosis

26
Q

An excessively recruited Psoas can further add to the __________ and anterior shearing MOST often occuring with ______ hypermobility/instability

A

hyperextension; lumbar

27
Q

With functional instability, there will be _____ local muscles and you should focus on _______ by activation or positioning

A

inhibited

stabilization

28
Q

With mechanical instability:

It has _________ pattern of provoking activities

_______ symptoms with MORE frequent _____

______ pain with even _____ and _____ ADLs

A

unpredictable

Worsening

episodes

increased; trivial; lesser

29
Q

With mechanical stability, the + stability tests won’t stabilize fully with ________ and/or _____ _______

A

repositioning; muscle activity

30
Q

With functional and mechanical instability PT Rx:

Rx like ______ laxity
POLICED
______ education to activate local mm. (chair support)

___- to increase adjacent joint hypomobility

_______/taping prn

A

ligamentous

postural

JM

Bracing

31
Q

With MET for functional and mechanical instability, there should be emphasis on ________ with local muscles

Addition of _____ exercises provided greater pain and disability improvements

________ is CONTRAINDICATED

A

stabilization

hip

Hyperextension

32
Q

With mechanical instability, MD Rx in rare cases of severe shearing/slippage:

Prolotherapy for stabilization into _______ ligaments along with PT

______ fusion

A

iliolumbar; spinal

32
Q

Age-related joint changes is aka…

  1. 2.
    3.
A
  1. DJD
  2. OA
  3. Spondylosis- if multiple spinal levels
33
Q

Age-related joint changes is MOST common at __-____ level, it progresses along with ______

A

L4; S1
ARDC

34
Q

Age-related joint changes is _______ and MORE common in _______ individuals

A

degenerative; older

35
Q

With age-related joint changes, there are rarely _____ tears

Typically, in younger active individuals

Involves high _____ forces

A

acute

shear

36
Q

What are the causes for age-related joint changes?

A

Prior trauma
Age
Genetics
Other diseases (Ex. RA)
Sedentary lifestyle with underloading

37
Q

What are the 5 components of a synovial joint?

A

articular cartilage
fibrous capsule
synovial membrane
synovial fluid
joint space

38
Q

With age-related joint changes:

The _____ cartilage thins and that causes the joint space to ____

A

articular; narrow

39
Q

With age-related joint changes: _______ bone is overloaded and injured including marrow with greater load

A

subchondral

40
Q

With age-related joint changes:

_______ or _____ can form due to excessive bony stress

A

osteophytes; spurs

41
Q

With age-related joint changes:

The ______ capsule slackens then thickens and stiffens

A

fibrous

42
Q

With age-related joint changes:

_______ membrane produces less ______ fluid and nutrients

A

synovial; synovial

43
Q

With age-related joint changes:

There can be _______ tissue inflammation (i.e., ligaments, capsule, mm, etc.)

A

periarticular

44
Q

With age-related joint changes: Persistent P! and inflammatory response partly due to…

_____ on other tissues like bone

Increased local _______ sensitivity for greater P! transmission fostering inflammation

Local production of nitrous oxide leads to MORE interstitial _______ and excess collagen (_____ ______)

Blood being released from bone ______

A

Stress; nociceptor;inflammation; joint fibrosis; marrow

45
Q

Age-related joint changes lumbar symptoms:

______ onset

P! with with ______ extended positions, particularly ______, and possibly sleeping, why?

A

Gradual

prolonged; standing

squeezes out synovial fluid w/o allowing refill

46
Q

With age-related joint changes involving lumbar region, there will be _____ stiffness or after ______ positions < _____ mins

A

morning

prolonged

30

47
Q

With age-related joint changes involving lumbar region, there will be P! and limitation typically while ____ or _____ or lying on stomach

A

Standing; Walking

48
Q

With age-related joint changes involving lumbar region, there could be possible paresthesia’s due to?

A

stenosis and a narrow vertebral foramen

49
Q

With age-related joint changes involving lumbar region, what might you observe about the patient?

A

possible fwd bent in standing/walking

50
Q

ROM for age-related joint changes signs:

P!ful and _____
P! with ____/______SB/ and _____ROT
It is typically ____ side
_____ pattern of restriction

A

limited
EXT; ipsi; contra
one
capsular

51
Q

With age-related joint changes involving lumbar region combined motion will have a _______ block often into the _______ quadrant OR opposing quadrants

A

consistent; extension

52
Q

With age-related joint changes involving lumbar region, resisted/MMT depends on _____

A

acuity

53
Q

With age-related joint changes involving lumbar region and stress tests:

Likely P! with ______ (if added while in EXT, Ipsi. SB, and contralat ROT)

PA _____ and unilateral ______ likely P!ful

_______ relieving if acute

A

compression

glides; torsion

distx

54
Q

With age-related joint changes involving lumbar region, neuro tests are often ______ but could be _____ for radiculpathy if spurring creates _______

A

negative

positive

stenosis

55
Q

With age-related joint changes involving lumbar region, the accesory motion will indicate ________

A

hypomobility

56
Q

Know this

A
57
Q

With age-related joint changes and PT Rx:

there is greater focus on improving ______ of cartilage and ______

POLICED

Patient _____ on weight management and avoiding _______

Assistive _____/orthotics to unload involved ______ (Ex. cane/ waist wrap)

______ for P!

A

integrity; mobility

education; provocation

devices; cartilage

JM

58
Q

With age-related joint changes PT Rx:

MET for: ultimate focus on improving _____, ________ integrity, and _________ benefits

A

motion; cartilage; neuromuscular

DPT Spring 2024 (30 decks)

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