Vignettes Flashcards
17 yo female cheerleader with bouts of LBP deep dull ache 6/10 standing stork positive
X-ray = no spondy, hyperlordosis
Clinical findings:
Increased L lordosis
Tight/hypertonic quadriceps/psoas
Inhibited abs
Hypertonic lumbar erectors
17 yo female cheerleader with bouts of LBP deep dull ache 6/10 standing stork positive
X-ray = no spondy, hyperlordosis
Best tx options:
Side posture adjusting (normalizes curve more than prone)
Continue normal activities
Anti-lordotic bracing (temperary palliative thing)
17 yo female cheerleader with bouts of LBP deep dull ache 6/10 standing stork positive
X-ray = no spondy, hyperlordosis
WOTF strengthened
Hamstrings
Gluteus maximus
Transverse abdominus
Scheurmanns adjust
Prone
17 yo female cheerleader with bouts of LBP deep dull ache 6/10 standing stork positive
X-ray = no spondy, hyperlordosis
Diagnosis
Lower crossed syndrome
CN 7 ___ the eye
Closes
42 yo female inability to close R eye after driving motorcycle cold weather inability to wrinkle forehead on R (trigeminal) and loss of taste on ant 2/3 of tongue (CN 7) pain behind right ear and top of head. Symp past 4 days. Dec levator palpebrae
Dx
Acute LMNL
Bells Palsy
CN 7 pathology
42 yo female inability to close R eye after driving motorcycle cold weather inability to wrinkle forehead on R (trigeminal) and loss of taste on ant 2/3 of tongue (CN 7) pain behind right ear and top of head. Symp past 4 days. Dec levator palpebrae
Not resolved, what happens?
Facial paresis
Dec taste discrimination
Inc tear production while chewing
42 yo female inability to close R eye after driving motorcycle cold weather inability to wrinkle forehead on R (trigeminal) and loss of taste on ant 2/3 of tongue (CN 7) pain behind right ear and top of head. Symp past 4 days. Dec levator palpebrae
Tx
Fit for eyee patch - cautious about dryness
Adjust
Co-manage with MD
Recommend artificial tears
Refer to neurologist
45 yo female back pain started when bent over to tie shoe. 2-9/10. Palliative when lying on the floor. Pain in L medial knee down into L med big toe F 40. E 10. RR 30. LR 15. Kemp pain LB and med foot. SLR pos with radiation down leg
DX
L4 nerve root lesion from disc
Cervical disc or IVF encroachment
Most common dx in vignettes
Disc
45 yo female back pain started when bent over to tie shoe. 2-9/10. Palliative when lying on the floor. Pain in L medial knee down into L med big toe F 40. E 10. RR 30. LR 15. Kemp pain LB and med foot. SLR pos with radiation down leg
3 best initial treatments
Extension exercises (McKenzie exercises)
Flexion distraction manipulation - always for disc
Lumbar traction - for disc or IVF encroachment
45 yo female back pain started when bent over to tie shoe. 2-9/10. Palliative when lying on the floor. Pain in L medial knee down into L med big toe F 40. E 10. RR 30. LR 15. Kemp pain LB and med foot. SLR pos with radiation down leg
What additional clinical findings
Dec patellar reflex - L4 LMNL
Weak leg muscles
Dec sensation over med malleolus
Hyperreflexia and clonus
UMNL
Dec hamstring =
L5
