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Clin Phase 2 > Week 4-8 > Flashcards

Week 4-8 Flashcards

1
Q

What MFTP mimics C8?

A

Latissimus dorsi, serratus, pectoralis major

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2
Q

What MFTP mimics C6?

A

Infraspinatus, subclavius, supraspinous, scalenes

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3
Q

What are the x-ray indications?

A

Trauma with Ottawa rules, red flags for disease, significant deficits, nerve damage

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4
Q

What are the Ottawa rules?

A

Trauma+ over 70, limited rotation (less than 45 total), rust sign, spinal percussion

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5
Q

What are the red flags for disease?

A

Fever, fatigue, malaise, weight loss, loss of appetite

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6
Q

What are the indications for MRI?

A

Profound muscle weakness, neurological deficits, progressive muscle weakness, signs of cord involvement

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7
Q

What rules out facet syndrome?

A

Lack of tenderness on the facet and inability to recreating the pain with extension and rotation

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8
Q

What motions induce LB extension?

A

Sitting, overhead work, Superman’s, extension, prone extension, passive DSLR (prone)

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9
Q

What motions induce flexion?

A

Knees to chest, bending forward, standing with one leg on a stool, using a shopping cart to walk, squatting

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10
Q

What is the B list for spinal disorders?

A

SOL, infections, fractures, facet syndrome, sprain strain, NR adhesions, instability

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11
Q

What is the only helpful thing to rule out stenosis?

A

If flexion does not improve symptoms or ability to walk (shopping cart sign) .5 LR

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12
Q

What are the top 3 Rule in signs with stenosis?

A

Wide gait, sitting is relieving, burning sensation in buttock

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13
Q

What is the difference between radiographic stenosis and clinical stenosis?

A

Radiographic stenosis can be asymptomatic and is made by measurement
Clinical stenosis has symptoms into the extremity and may not meet the diagnostic criteria based on the radiograph

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14
Q

What are indicators of stenosis?

A

Leg symptoms made worse by walking, extension increases leg symptoms (especially arms overhead), flexion relieves symptoms, SMR deficits (50%), balance/ proprioception disturbances

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15
Q

Why do you not get a + SLR in stenosis?

A

Because the inflammation is local and less severe than in herniations

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16
Q

What is the role of age in diagnosing neuropathic leg pain?

A

It changes what is most likely.
Younger than 40: herniations
Over 60: stenosis
Between 40 and 60: 15% will have stenosis, but it could also be a herniation. There are also B list causes

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17
Q

What are the causes of peripheral neuropathic pain?

A

Diabetes, neuropathy (specific nerve), piriformis syndrome, entrapments

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18
Q

What B list causes will have red flags? What red flags?

A

Tumors: weight loss/ appetite loss, anemia, ESR/CRP, no comfortable position
Infections: fever, fatigue

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19
Q

Which A list disorder will valsalva more likely be positive?

A

Herniations

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20
Q

Which A list disorder will dejerine’s triad more likely be negative?

A

Stenosis

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21
Q

What A list disorder will sitting likely improve symptoms?

A

Stenosis

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22
Q

What A list disorder will flexion likely increase symptoms?

A

Herniations

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23
Q

What A list disorder will extension aggravate the leg symptoms?

A

Stenosis

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24
Q

What A list disorder will sustained loading centralize symptoms?

A

Herniations

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25
Q

Which A list disorder will usually have a positive SLR?

A

Herniations

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26
Q

Which A list disorder will more likely have neuro deficits?

A

Herniations (both are possible)

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27
Q

Which A list disorder will more likely have ataxia?

A

Stenosis

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28
Q

Where does Psoas refer to?

A

Anterior thigh and iliac crest

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29
Q

What is the pain pattern for Maigne’s syndrome?

A

Upper buttock, iliac crest, trochanter, and groin

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30
Q

What is the referral pattern for QL?

A

Trochanter, iliac crest, ischial tuberosity

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31
Q

What is the referral pattern for the glut med?

A

Sacrum, glut, trochanter, lateral leg

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32
Q

How do you tell if a spondy is unstable?

A

Passive extension, excessive motion, prone instability test, painful arc, reversed lumbopelvic rhythm

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33
Q

Who will respond well to a core stabilization program?

A

A >40 yo, with greater than 90 SLR BL, positive prone instability test, and aberrant motion with lumbar flexion

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34
Q

What are examples of aberrant motion with lumbar flexion?

A

Minors sign, reversal of lumbopelvic rhythm, or instability catch

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35
Q

What indicates poor motor control?

A

Segmental abnormal movement, painful arc abolished with bracing, trunk forward lean,
difficulty learning pelvic clocking or abdominal hollowing,
bad form in hip extension or single leg stands

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36
Q

What are history clues that suggest instability?

A

Episodic nature, progressive, popping/locking/catching/feeling of giving way, immediate pain with sitting relieved by standing, temporary response to treatment which is decreasing

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37
Q

What is the difference between structural and functional instability?

A

Structural is an issue with the bones/ tissues such that they can no longer support normal movement
Functional is a neurological issue where the muscles are not being given the signals to react in the appropriate time within the neutral zone causing other tissues to pick up the slack.

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38
Q

What is the measurement for radiographic stenosis?

A

12mm

39
Q

What is the measurement for absolute stenosis?

A

10mm

40
Q

What is the measurement for radiographic hyper mobility?

A

Greater than 3mm sagittally

41
Q

What is the gold standard imaging choice for spondys?

A

Radiographs, flexion extension and MRI

42
Q

When is spondylolethisis likely to be a candidate for DDx in a 40+ yo?

A

When there is a history of symptoms before 30 yo.

43
Q

What is phalanx Dickson sign?

A

Flexed knees and hips

44
Q

What physical exam finding suggest spondylolethisis?

A

Functional scoliosis, hamstring spasm, tenderness to deep palpation at the SP above the slip, step off defect, positive passive leg extension, and segmental hyper mobility

45
Q

Who is more likely to have a step off defect?

A

Young athletics with spondylolethisis

46
Q

What is a positive passive leg extension test?

A

Heaviness in the legs with lifting and traction that decreases when the legs are lowered

47
Q

What does a positive passive leg extension test more likely indicate?

A

Unstable spondy

48
Q

How long should an athlete with a spondy be removed from sport?

A

3 or more months

49
Q

What 3 things can you do for a stenosis patient?

A

Flexion distraction, neuromobilization and stabilization program

50
Q

What are the 5 options for neuropathic symptoms?

A

Nerve root, peripheral neuropathy, extremity lesion, referred pain, cord lesion

51
Q

What are the causes of nerve root damage?

A

Herniation, SOL, osteophytic compression, NR adhesion, instability, infection, fracture

52
Q

What are the signs and symptoms of NR osteophytic compression (lumbar)?

A

NO CES, unilateral SMR/ sensation/ pain distribution, positive kemps, pure flexion and extension loads are not sensitive or as sensitive

53
Q

What are the signs and symptoms of tumor/cyst?

A

Pt >50, SMR deficits, cord signs, spinal percussion, leg pain w/out back pain, classic red flags, increased ESR/CRP, ALP, hypercalcemia

54
Q

What are the classic red flags?

A

Prior history of cancer, unexplained weight loss, increased pain laying supine, unremitting pain unaffected by position

55
Q

What are the signs and symptoms of spinal infections?

A

Pt >50, prior history of infection (any), immunocompromised, fever, spinal percussion, high ESR, positive tension tests, neuro deficits, disc destroyed and end plates damaged

56
Q

What is the difference between infection and cancer on imaging?

A

Cancers spare the disc while infection destroy. Discs and end plates

57
Q

How to differentiate PAD from stenosis?

A

Location of pain, effect of walking on pain, what helps, what hurts, and pulses

58
Q

When will muscles be weaker after walking stenosis or PAD?

A

Stenosis

59
Q

What will help stenosis?

A

Bending over, sitting

60
Q

What will help PAD?

A

Sitting, stopping (walking or changing position)

61
Q

What will increase stenosis symptoms?

A

Walking downhill, extension

62
Q

What will increase PAD symptoms?

A

Walking uphill, increased metabolic demand

63
Q

What will have diminished lower limb pulses?

A

PAD

64
Q

When will the pain come on with walking for PAD?

A

Commonly 30 min

65
Q

Where is the pain for stenosis and PAD in the lower extremity?

A

Stenosis- thighs

PAD- calves/ lower leg

66
Q

What is the difference between DVT and PAD?

A

DVT- swelling, tender nodules, increased temperature, pain at rest

PAD- reduced temperature, tissue loss, muscle wasting, hair loss, bruits/ dismissed pulses

67
Q

What are the tests you might add for stenosis?

A

Single leg stand (Romberg sign), sustained extension, lower extremity pulses

68
Q

What are the ancillary studies for PAD?

A

MRA, ABI, and Doppler ultrasound

69
Q

What is the conservative management for PAD?

A

A walking program (near the pain threshold), toe raises to pain +5

70
Q

What 3 things together indicates the hip itself rather than the spine?

A

A limp, groin pain and limited internal rotation

71
Q

What is the most common location for hip pain?

A

Localized to the groin

72
Q

What muscles commonly go into spasm with hip problems?

A

Adductors

73
Q

How far can hip problems radiate?

A

To the foot

74
Q

What are the top ddxs for lateral hip pain?

A

Glut med tendinopathy, ITB tendinopathy, trochanteric bursitis, external snapping hip

75
Q

What is snapping hip?

A

When a tendon is tight and snapping over the acetabulum

76
Q

What rules in glut med tendinopathy?

A

Lateral hip pain with single leg stand and resisted FADER test

77
Q

What rules out glut med tendinopathy?

A

Lack of tenderness with palpation of insertion

78
Q

What are the DDxs for anterior hip pain?

A

Hair osteoarthritis, famoroacetablular impingement, labral tear, AVN, stress fracture, adductor tear, internal snapping hip

79
Q

What is the DDx for posterior hip pain?

A 
Femoracetabular pathology (OA, labrum, AVN)
SI, Hamstring, Piriformis, lumbar referral
80
Q

How much of the SI accounts for chronic low back pain?

A

20%

81
Q

What 5 tests should you always do check the SI?

A

Thigh thrust, sacral thrust, SI compression, SI distraction, gaenslens

82
Q

What are causes of sacroiliitis?

A

RA, AS, reactive arthritis, psoriatic arthritis, enteric arthritis

83
Q

What is lower cross?

A

Weak abdominals, weak glut max, weak glut med, overactive psoas, overactive erectors, overactive rec fem, overactive TFL, overactive QL

84
Q

What is SI muscle imbalance?

A

Ipsilateral glut max inhibited, contra glut med inhibited, ipsilateral psoas tight, ipsilateral piriformis tight

85
Q

What is upper cross?

A

Overactive SCM, overactive Trap, Overactive Pec, overactive suboccipitals, overactive levator scalp, inhibited deep neck flexors, inhibited rhomboids, inhibited lower trap, inhibited serratus

86
Q

How to progress through a stabilization program (3 stages)?

A

1- dead bug, quadruped, side bridge, bracing, hip hinge

2-lunge track, squat track

3- functionally mimic ADLs

87
Q

What orthos will be positive in a sprain?

A

Anything passive (knees to chest, passive extension, pROM)

88
Q

What orthos will be painful in a strain?

A

Anything resisted (rROM, prone extension with over pressure)

89
Q

What is the single best clue for disc?

A

Centralization/ directional preference

90
Q

What travels in the posterior column?

A

Proprioception, vibration, touch, 2 point discrimination

91
Q

What travels in the lateral spinothalamic track?

A

Pain and temperature

92
Q

What will effect the posterior column?

A

UMNL or spinal cord compression

93
Q

What is the difference between the three piriformis diagnoses?

A

Piriformis syndrome-nerve involvement
Piriformis MFTP- radiation
Piriformis spasm- no leg pain

Clin Phase 2 (3 decks)

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