Week 9: RAT Flashcards
Your patient has a traumatic cervical hyperflexion injury, posterior neck pain and no arm sx. Active and passive cervical flexion hurt throughout the range. Cervical distraction is painful. Cervical compression, valsalva, neck muscle test, and extremity SMR tests are all normal. Probably working dx for this patient?
A) cervical disc herniation B) cervical disc derangement C) cervical facet syndrome D) cervical sprain E) cervical strain
D) cervical sprain
Which of the following is a positive prone lumbar instab test?
A) increased pain when pressing down on SP with feet lifted
B) decreased pain when pressing down on SP with feet lifted
C) increased sense of hypermobility when pressing down on a SP with feet lifted
D) decreased sense of hypermobility when pressing down on a SP with feet lifted
B) decreased pain when pressing down on SP with feet lifted
Which of the following is an accurate description of an instability catch?
A) bending the knees and initiating the motion in the lumbar spine instead of at the pelvis when returning from touching the toes
B) deviating into rotation while the patient is attempting to perform active flexion
C) placing hands on legs and “walking up one’s thighs” when returning from a flexed position
D) pain which may be accompanied by a painful catch while bending through just certain degrees of motion going down or coming back from toe touching
B) deviating into rotation while the patient is attempting to perform active flexion
What is “bending the knees and initiating the motion in the lumbar spine instead of at the pelvis when returning from touching the toes” called?
Reversal of lumbopelvic rhythm
When returning from forward flexion, the patient bends the knees and initiates the motion in the lumbar spine instead of at the pelvis, extending the lumbars first and then extending at the hips.
What is “placing hands on legs and ‘walking up one’s thighs’ when returning from a flexed position” called?
Minor’s/Gower’s sign
The patient supports hands on lower extremity, “walking up one’s thighs,” when returning from a flexed position.
What is “pain which may be accompanied by a painful catch while bending through just certain degrees of motion going down or coming back from toe touching” called?
Painful arc
During flexion and extension a patient may display a range of movement which reproduces his/her complaint and may be accompanied by a painful catch. This arc of motion is not at the end range and may be experienced on return from flexion.
Which of the following is least likely a signal of functional instability?
A) painful catch disappears when performing abdominal bracing
B) there is immediate increased pain when sitting that is relieved by standing
C) loss of Achilles reflex
D) spine deviates from vertical position gowns performing the single leg stand
C) loss of Achilles reflex
Which of the following is most likely a signal of functional instability?
A) painful arc during active flexion and extension
B) positive Romberg test
C) pain centralization with repetitive lumbar extension
D) 5mm lipase on a lumbar flexion-extension study
A) painful arc during active flexion and extension
Your patient has severe LBP aggravated by reaching above his head. Active and passive lumbar extension, the 4 quadrants test, having a bowel movement, and bilateral active SLR are all painful. His LBP disappears if he lies on his back and hugs both legs to his chest for about 1 minute. He has no SMR deficits and SLR is negative. Most probable working diagnosis?
A) lumbar disc herniation B) lumbar disc derangement C) lumbar facet syndrome D) lumbar sprain E) lumbar joint dysfunction
B) lumbar disc derangement
List the positive clues plus the BEST clue that best fit disc derangement from this case.
Your patient has severe LBP aggravated by reaching above his head. Active and passive lumbar extension, the 4 quadrants test, having a bowel movement, and bilateral active SLR are all painful. His LBP disappears if he lies on his back and hugs both legs to his chest for about 1 minute. He has no SMR deficits and SLR is negative.
1–Having a bowel movement is painful
2–Bilateral active SLR
3–LBP disappears if he lies on his back and hugs both legs to his chest for a minute (pain centralization for anterior disc herniation) ⬅️ this is the strongest clue
4-four quadrants test
Cite the positive findings that are least likely to be present in facet syndrome.
Your patient has severe LBP aggravated by reaching above his head. Active and passive lumbar extension, the 4 quadrants test, having a bowel movement, and bilateral active SLR are all painful. His LBP disappears if he lies on his back and hugs both legs to his chest for about 1 minute. He has no SMR deficits and SLR is negative.
1–Having a bowel movement causes P
2–Bilateral active SLR causes P
3-four quadrants test unlikely in flexion
4-P centralization in sustained endrange (knees-to-chest 1 minute)
Besides aberrant movement, what are 3 components of the clinical prediction rule for lumbar stabilization exercises?
(+) prone lumbar instability
SLR >91˚ average for both legs
Age <40
So, the whole thing:
- age under 40
- SLR mobility above 91 degrees (average of both legs)
- aberrant movement with lumbar flexion (i.e., painful arc, instability catch, or reverse lumbopelvic rhythm)
- (+) prone instability test
List 3 other + physical findings that are not part of the clinical prediction rule for lumbar stabilization exercises.
Altered quality of movement (e.g. painful arc)
Specific segmental findings (e.g. decreased resistance with prone joint play)
Evidence of poor motor control (e.g. poor motor control during trunk forward lean)
For patients with isthmic spondylolisthesis.
Positive straight leg raise: common or uncommon?
Uncommon
If significant listhesis? Radicular syndromes uncommon, CES more rare. SLR rarely positive even if pt has sciatica (unlike disc herniation). NR deficits not common. L5 nerve root is the MC followed by L4 NR in more severe cases (w/ weakness in the tibialis anterior muscle).
For patients with isthmic spondylolisthesis.
Made worse by extension: common or uncommon?
Common
