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MSK 1 > Week 2 > Flashcards

Week 2 Flashcards

1
Q

What is patho-anatomic diagnosis?

A

The anatomical pathology

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2
Q

What is an example of a patho-anatomic diagnosis?

A
  • Herniated disc L4-5

- Polymyosis

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3
Q

What is a prognostic/treatment based?

A
  • Manipulation classification
  • Specific exercise classification
  • Elevated fall risk
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4
Q

What are the different ways a diagnostic process can be done?

A
  • Pattern recognition
  • Hypothetic deductive reasoning
  • Algorithms
  • Exhaustive
  • Logical reasoning
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5
Q

What is hypothetic deductive reasoning?

A

When we have an hypothesis/belief that the problem might be some specific disorder, and then we go about ruling in or ruling out

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6
Q

What is the algorithm diagnostic process?

A

It helps get us into the space a little better

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7
Q

Which of the diagnostic process is inefficient and used by novices?

A
  • Exhaustive
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8
Q

____ is what makes us good diagnosticians

A

Logical reasoning is what makes us good diagnosticians

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9
Q

What are the basic steps in the diagnostic process?

A
  • Generate possibilites and their relative likelihood or probabilities
  • Gather new info to clarify your initial diagnostic possibilities
  • Revise pretest and posttest probabilities
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10
Q

What is pre-test probability?

A

For any given patient, there is a baseline probability of a certain condition pretesting

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11
Q

What is a post test probability?

A

Application of a clinical diagnostic test alters the baseline probabilty

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12
Q

What does the medical model of disease say?

A
  • Pain is a reflex response to a physical stimulus
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13
Q

According to the medical model of disease, every symptom has an ____

A

According to the medical model of disease, every symptom has an underlying stimulus

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14
Q

According to the medical model of disease, alleviating the symptoms requires ___ and ___ the underlying stimulus

A

According to the medical model of disease, alleviating the symptoms requires identifying and alleviating the underlying stimulus

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15
Q

In the medical model of disease, we move from pain to ___ and from ___ to cure

A

In the medical model of disease, we move from pain to cause and from cause to cure

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16
Q

What is the summary of the medical model of disease?

A
  • Signs/symptoms analyzed
  • Pathology is determined
  • Treatment corrects pathology
  • Signs/symptoms disappear
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17
Q

There is ___ relationship between physical pathology & associated pain and disability

A

There is little relationship between physical pathology & associated pain and disability

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18
Q

According to the biopsychosocial model, what are the things that shape the pain experience?

A
  • Pain
  • Attitudes & beliefs
  • Psychological distress
  • Illness behavior
  • Social environment
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19
Q

What are the 2 major factors that widely shape how a patient’s pain?

A
  • Psychological factors

- Cultural factors

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20
Q

What are the biopsychosocial model application in clinical practice?

A
  • Psychologically informed practice
  • Understand your patient
  • Screening tools
  • Clinical decision making aides
  • CPR/CPGs
  • Treatment based classification
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21
Q

What are the diagnostic processes of choice?

A
  • Pattern recognition

- Hypothetico-deductive

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22
Q

____ is probabilistic in nature

A

Diagnosis is probabilistic in nature

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23
Q

What is the 1st step in the 1st level triage?

A

Medical management

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24
Q

What are the possible clinical findings in the medical management level of the 1st level triage?

A
  • Red flags
  • Medical comorbidities precluding rehabilitation
  • Leg pain with progressive neurologic deficits
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25
Q

What is the 2nd step in the 1st level triage?

A

Self-care management

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26
Q

What are the possible clinical findings in the self-care management level of the 1st level triage?

A
  • Low psychosocial risk status
  • Predominantly axial low back pain
  • Minor or controlled medical comorbities
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27
Q

What is the 3rd step in the 1st level triage?

A

Rehabilitation management

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28
Q

What are the possible clinical findings in the rehabilitation management level of the 1st level triage?

A
  • Medium to high psychosocial risk status
  • Low psychosocial risk status with predominantly leg pain
  • Minor or controlled medical comorbidities
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29
Q

Individuals identified in the _____ step will be referred out to a different medical provider

A

Individuals identified in the medical management step will be referred out to a different medical provider

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30
Q

What are some of the signs of a serious spinal pathology?

A
  • Signs of infection
    • Temp > 100 F
    • BP> 160/95 mmHg
    • Resting pulse > 100/ min
    • Resting respiration > 25/min
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31
Q

What are the 3 different strategies for management in the TMC model?

A
  • Symptom modulation
  • Movement control
  • Functional optimization
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32
Q

How do individuals that fall in the symptom modulation strategy for management present?

A
  • High disability
  • High to moderate pain/irritability & severity
  • Volatile symptom status
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33
Q

How do individuals that fall in the movement control strategy for management present?

A
  • Moderate disability
  • Moderate to low pain/irritability & severity
  • Stable symptom status
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34
Q

How do individuals that fall in the functional optimization strategy for management present?

A
  • Low disability
  • Low to absent pain/irritability & severity
  • Controlled symptom status
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35
Q

If a patient centralizes with 2 or more movements in the same direction or centralize with a movement in 1 direction and peripheralize with an opposite movement, what is their proposed intervention classification according to fritz?

A

Specific exercise classification

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36
Q

If a patient has a recent onset of symptoms and no symptoms distal to the knee, what is their proposed intervention classification according to fritz?

A

Manipulation classification

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37
Q

If a patient has at least 3 of the following,
- Average SLR ROM >91 deg
- Positive prone instability test
- Positive aberrant movements
- Age < 40
what is their proposed intervention classification according to fritz?

A

Stabilization classification

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38
Q

The treatment from the TBC is an ___ approach to care

A

The treatment from the TBC is an initial approach to care

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39
Q

Which of the 3 1st level triage involves direct physical therapy interventions?

A

Rehabilitation management

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40
Q

What were the 5 most predictive variables in determining the success of spinal manipulation intervention?

A
  1. Current symptom duration < 16 days
  2. Fear-Avoidance Beliefs Questionnaire < 19
  3. Hypomobility of the lumbar spine with PA Pressure
  4. IR of at least 1 hip > 35 deg
  5. No symptoms below the knee
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41
Q

What are the factors favoring spinal manipulation to decrease LBP?

A
  • More recent onset of symptoms
  • Hypomobility with spring testing
  • Low back pain only(no symptoms below the knee)
  • Low FABQ scores (FABQw< 19)
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42
Q

What are the factors against spinal manipulation to decrease LBP?

A
  • Symptoms below the knee
  • Increasing episode frequency
  • Peripheralization with motion testing
  • No pain with spring (PA mobility) testing
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43
Q

What are some treatments that may accompany a spinal manipulation intervention?

A
  • Manual therapy
  • Soft tissue mobilization
  • Oscillations
  • Gentle manual resisted exercises
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44
Q

What are the major muscles that provide core stability and are targeted during motor control/stabilization exercises?

A
  • Transversus abdominis
  • Multifidus
  • Diaphragm
  • Pelvic floor
  • Internal and external oblique
  • Rectus abdominus
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45
Q

What are the treatments for people with a symptom modulation?

A
  • Directional preference exercises
  • Manipulation/mobilization
  • Traction
  • Active rest
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46
Q

What are the treatments for people with a movement control?

A
  • Sensorimotor exercise
  • Stabilization exercises
  • Flexibility exercise
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47
Q

What are the treatments for people with a functional optimization?

A
  • Strength and conditioning exercises
  • Work - or sport- specific tasks
  • Aerobic exercises
  • General fitness exercises
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48
Q

What is the ultimate goal of exercise progressions?

A

To mimic each patient’s functional needs or goals so that the patient develops the strength, endurance and motor control necessary to maximize recovery

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49
Q

What are the variables predicting success for a stabilization exercise intervention?

A
  • (+) prone instability test
  • (+) aberrant motions present
  • Average straight leg raise >91 deg
  • Age of below 40
50
Q

What are the variables predicting failure for a stabilization exercise intervention?

A
  • (-) Prone Instability Test
  • Aberrant Movement Absent
  • FABQPA < 9
  • No Hypermobility with Lumbar Spring Testing
51
Q

The common theme of lumbar instability is _____

A

The common theme of lumbar instability is muscle inhibition

52
Q

What is the first thing in the McKenzie classification system?

A

History and physical examination

53
Q

In the the McKenzie classification system, what follows the history and physical examination?

A

Exclude serious pathology

54
Q

In the the McKenzie classification system, what follows the exclude serious pathology?

A

Provisional MDT classification

55
Q

What are the 3 McKenzie syndromes?

A
  • Derangement
  • Dysfunction
  • Postural
56
Q

What is derangement in the Mckenzie syndrome?

A

Loading strategies centralize or make symptoms better

57
Q

What is dysfuction in the Mckenzie syndrome?

A

Pain only product at limited end range

58
Q

What is postural in the Mckenzie syndrome?

A

Pain only on static loading, no effect of repeated movements

59
Q

The annulus is weakest in the ___ aspect

A

The annulus is weakest in the posterolateral aspect

60
Q

____ pain activate nociceptors by damage causing high concentrations of chemicals

A

chemical pain activate nociceptors by damage causing high concentrations of chemicals

61
Q

Chemical pain can be reduced by movement by ____, but does not remain reduced

A

Chemical pain can be reduced by movement by mechanoreceptor modulation, but does not remain reduced

62
Q

Chemical pain can not be abolished by ___ or ____

A

Chemical pain can not be abolished by repeated motion or sustained positioning

63
Q

How does mechanical pain activate nociceptors?

A

By force, stress, deformity and damage

64
Q

Mechanical pain can be reduced and /or abolished by ___

A

Mechanical pain can be reduced and /or abolished by repeated motion or sustained positioning in the correct direction

65
Q

Mechanical pain can become constant with ____ causing constant ___

A

Mechanical pain can become constant with internal derangement causing constant mechanical deformation

66
Q

____ describes the phenomenom by which distal pain originating from the spine is progressively abolished in a distal to proximal direction

A

Centralization describes the phenomenom by which distal pain originating from the spine is progressively abolished in a distal to proximal direction

67
Q

Centralization is in response to ___

A

Centralization is in response to a specific repeated movement and/or sustained position and this change in location is maintained over time until all pain is abolished

68
Q

As the pain centralizes, there is often a significant increase in the ___

A

As the pain centralizes, there is often a significant increase in the central pain

69
Q

If spinal pain only is present, this moves from a ____ to a ____ then it is abolished

A

If spinal pain only is present, this moves from a widespread to a more central location then it is abolished

70
Q

What does centralizing mean?

A

During the application of loading strategies distal pain is being abolished

71
Q

Centralizing is in the process of becoming ___, but this will only be confirmed once ___

A

Centralizing is in the process of becoming centralized, but this will only be confirmed once the distal pain remains abolished

72
Q

What does centralized mean?

A

As a result of the application of the appropriate loading strategies the patient reports that all distal pain has abolished and now the patient only has back pain. The central back pain will then continue to decrease and abolish

73
Q

____ is a positive prognostic indicator

A

Centralization is a positive prognostic indicator

74
Q

____ describes the phenomenon by which

proximal symptoms originating from the spine are progressively produced in a proximal to distal direction.

A

Peripheralization describes the phenomenon by which

proximal symptoms originating from the spine are progressively produced in a proximal to distal direction.

75
Q

Peripheralization happens in response to ___

A

Peripheralization happens in response to * a specific repeated movement and/or sustained position and this change in location of symptoms is maintained over time*

76
Q

Peripheralization may also be associated with ___

A

Peripheralization may also be associated with a worsening of neurological status

77
Q

What does peripheralizing mean?

A

During the application of

loading strategies distal symptoms are being produced.

78
Q

In peripheralizing, symptoms are in the process of becoming ___, but this will only be confirmed once the ____

A

In peripheralizing, symptoms are in the process of becoming peripheralized, but this will only be confirmed once the distal symptoms remain

79
Q

____ means that as a result of the application of the inappropriate loading strategies the patient reports that the distal symptoms that have been
produced remain.

A

Peripheralized means that as a result of the application of the inappropriate loading strategies the patient reports that the distal symptoms that have been produced remain.

80
Q

Peripheralization is generally is ____ indicator

A

Peripheralization is generally is negative prognostic indicator

81
Q

What are the characteristics of postural syndrome?

A
  • End range stress on normal tissue
  • Positional pain. No loss of motion
  • No pain during management
82
Q

What are the characteristics of dysfunction syndrome?

A
  • End range stress on shortened tissue
  • Pain at end range or upon stretching on “contracted” tissues. Loss of motion
  • No pain in midrange movements
83
Q

What are the directions of movement found in a dysfunction syndrome?

A
  • Flexion
  • Extension
  • Lateral movement
84
Q

When the nerve root is adhered in a dysfunction syndrome, there may be some ___

A

When the nerve root is adhered in a dysfunction syndrome, there may be some referred pain

85
Q

How might a dysfunction be addressed?

A

Through repeated movement progression

86
Q

What is derangement syndrome?

A

A clinical presentation associated with a mechanical obstruction of an affected joint

87
Q

When does a patient with derangement syndrome experience pain?

A

During movement and loss of motion

88
Q

Patients with a derangement syndrome may have a ____

A

Patients with a derangement syndrome may have a directional preference

89
Q

Directional preference describes the clinical phenomenon where ___

A

Directional preference describes the clinical phenomenon where a specific direction of repeated movement and/or sustained position results in a clinically relevant improvement in either symptoms and/or mechanics though not always the centralization of the symptoms

90
Q

___ is an essential feature of the derangement syndrome

A

Directional preference is an essential feature of the derangement syndrome

91
Q

____ encompasses a broader range of responses than centralization

A

Directional preference encompasses a broader range of responses than centralization

92
Q

Centralization refers to the ____

A

Centralization refers to the lasting change in the location of symptoms as a result of loading strategies

93
Q

Directional preference results in ___

A

Directional preference results in a lasting improvement in symptoms and/or mechanics though not always a change in location of pain

94
Q

All centralizers have a ___

A

All centralizers have a directional preference

95
Q

If a patient presents with a lateral shift, does that mean that they won’t respond to a manual type intervention?

A

No it doesn’t, the presence of a lateral shift should not deter the PT from doing a manual intervention. It should only be done if patient complains of pain peripheralization rather than centralization

96
Q

In the MDT physical examination, what are the things to do when testing each direction of movement?

A
  • Establish symptoms prior to start of new motion
  • Effect on patient’s symptoms
  • Repeated movements (10x)
97
Q

___ determines treatment progression

A

Symptoms determines treatment progression

98
Q

What do you do if a patient notes that pain is getting worse, increasing and peripheralizing during treatment progressions?

A

STOP treatment

99
Q

What do you do if a patient reports no changes in pain with treatment progressions?

A

Proceed with caution

100
Q

What do you do if a patient reports a decrease in pain, and centralization with treatment progression?

A

CONTINUE with treatment

101
Q

Repeated movement progression is initially ___ that may need ___

A

Repeated movement progression is initially patient induced that may need therapist augmented

102
Q

What is the general flow of repeated movement progression in extension?

A
  • Prone lying (static)
  • Prone lying in extension (static)
  • Extension in lying
  • Extension in lying with clinician overpressure
  • Extension mobilization
  • Extension in standing
103
Q

What is the general flow of repeated movement progression in flexion?

A
  • Flexion in lying
  • Flexion in sitting
  • Flexion in standing
  • Flexion in lying with clinician overpressure
104
Q

What are some therapist augmented techniques?

A
  • Extension with therapist overpressure (belts)
  • Extension mobilization/ manipulation
  • Mobilization for lateral component
105
Q

What are some things involved in the mobilization for the lateral component of therapist augmented techniques?

A
  • Hips shifted away
  • Side lying flexion rotation
  • Rotation mobilization in extension
  • Rotation manipulation in extension
  • Rotation mobilization in flexion
  • Rotation manipulation in flexion
106
Q

What is nerve root pain?

A

Unilateral leg pain below the knee, usually into the ankle or foot

107
Q

In nerve root pain, ___ pain is usually worse than __ pain

A

In nerve root pain, leg pain is usually worse than back pain

108
Q

What do people with nerve root pain present with?

A
  • Pain radiating to the foot or toes
  • Numbness or paresthesia in same dermatome distribution
  • Nerve irritation signs
  • Nerve axon loss (motor, sensory, or reflex changes) typically limmited to one nerve root (may be less than one)
109
Q

What are the synonyms of a nerve root pain called?

A
  • Radiculopathy
  • Radiculitis
  • Sciatica
110
Q

What are the patterns of a radiculopathy ?

A
  • Strength loss in a myotomal pattern
  • Sensation loss in a dermatomal pattern
  • Decrease or absence of associated DTR(deep tendon/muscle flex reflex)
111
Q

The proportion of LBP patients with concomitant LE symptoms is ___ ,while the ones that has a true sciatica or nerve root involvement is ___

A

The proportion of LBP patients with concomitant LE symptoms is 70% ,while the ones that has a true sciatica or nerve root involvement is 5%

112
Q

What is a referred pain pattern?

A

Pain down the limb that is not due to the nerve root

113
Q

Referred pain through a muscle or facet joint is often describes as ___

A

Referred pain through a muscle or facet joint is often describes as deep, achy, diffuse, dull, cramp-like and poorly localized

114
Q

What are the key things/things to test in a patient with a radiculopathy?

A
  • Positive straight leg raise
  • Positive cross leg test
  • Femoral nerve stretch test
115
Q

What is a positive straight leg raise test?

A

A test that has a score of 40 deg or less

116
Q

The ____ is highly sensitive which means it can produce a false positive, while a ___ is highly specific

A

The straight leg raise is highly sensitive which means it can produce a false positive, while a cross straight leg raise is highly specific

117
Q

What is a positive femoral nerve stretch test?

A

A burning or vague painful sensation down anterior thigh

118
Q

What are the potential causes of leg pain?

A
  • Denervation
  • Central sensitization
  • Peripheral nerve sensitization
  • Adverse neural dynamics
  • Myofascial trigger points
119
Q

What is adverse neurodynamics?

A

When the nerves aren’t gilding freely through out the system, hereby creating a degree of irritability

120
Q

Do we tell a patient with sciatica to stay active or go on bed rest?

A

Trick question

Neither reall y makes a difference in their lives

121
Q

What are the things to do for patients with a radiculopathy?

A
  • Unloading: crutches, less standing, laying flat for periods of time, then going back to the crutches
122
Q

Do injections have a long term or short term benefit for radiculopathy?

A

Short term. Provides a therapeutic window to get the patient actively involved in a progressive rehab program

MSK 1 (5 decks)

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