Winter Midterm Written

Question 1

Define somatic dysfunction

Answer 1

Impaired or altered function of related components of the somatic system; skeletal, arthrodial and myofascial structures, and related vascular, lymphatic and neural elements.

Question 2

What does TART stand for?

Answer 2

T- tenderness
A- asymmetry
R- restricted ROM
T- tissue texture abnormalities

Question 3

What is THE RULE OF THREES in relation to the spine

Answer 3

FOR Transvers Processes:
T1-T3: same plane as SP
T4-T6: 1/2 segment higher than corresponding SP
T7-T9: 1 full segment higher than corresponding SP
T10: 1 full segment higher
T11: 1/2 segment higher
T12: same plane

**Note: reverse is true for spinous process locations (same plane or below)

Question 4

What is Fryettes 1st Principle? What type of dysfunction is this?

Answer 4

In NEUTRAL position rotation and sidebending OPPOSITE sides. Type 1 (or neutral) DYSFUNCTION. Usually GROUP CURVE, postural causes maintained by long restrictor muscles (ILS)

Question 5

What is Fryettes 2nd Principle? What type of dysfunction is this?

Answer 5

in HYPERFLEXION or HYPEREXTENSION, rotation and sidebending on SAME side. Type 2 (non-neutral) dysfunction. Most likely single (or 2) vertebrae on one below usually caused by trauma and maintained by short restrictor muscles (rotatores, interspinalis, intertransversalis).

Question 6

What is Fryettes 3rd Principle?

Answer 6

Initiating motion of a vertebral segment in one plane of motion will modify the movement of the segment in the other two planes of motion.

Question 7

What type of dysfunction gets better in both flexion and extension or shows no change?

Answer 7

Neutral Dysfunction

Question 8

What type of dysfunction gets worse in forward bending? (or say better in extension)

Answer 8

Extension dysfunction

Question 9

What type of dysfunction gets worse in backward bending? (or say better in flexion)

Answer 9

Flexion dysfunction

Question 10

How are somatic dysfunctions named?

Answer 10

For the position where you find them living (their freedom of motion)

Question 11

Whats the action of the erector spinae (iliocostalis, logissimus, spinalis)

Answer 11

Extend and ipsilaterally sidebend the spine

Question 12

Whats the action of the quadratus lumborum?

Answer 12

Fixes the 12th rib during respiration and lateral flexes the trunk

Question 13

Whats the action of iliopsoas?

Answer 13

Strong hip flexor

Question 14

Whats the action of the diaphragm? Which 3 apertures pass through it?

Answer 14

Primary muscle of inspiration and assists in raising intra-abdominal pressure. The 1) inferior vena cava 2) esophagus 3) aorta pass through it.

Question 15

What is the motion of the internal and the external obliques? When I rotate my trunk to the right which internal and external obliques am I using?

Answer 15

Internal- Ipsilateral trunk rotator
External-Contralateral trunk rotator

Right rotation is from right internal oblique and left external oblique

Question 16

Orientation of ___________ facets determines preferred spinal motion.

Answer 16

SUPERIOR facets

Question 17

What are the facet joint orientations for: Cervical, Thoracic, and Lumbar spine?

Answer 17

Cervical: BUM (backward, upward, medial)
Thoracic: BUL (backward, upward, lateral)
Lumbar: BM (backward, medial)

Think BUM, BUL, BM

Question 18

List the primary motions for the thoracic and lumbar spine…also include facet orientations, plane of motion and axis.

Answer 18

Thoracic: Rotation (would be sidebending but ribs restrict that motion) transverse plane w/superior inferior axis
Lumbar: Flexion and Extension; sagittal plane with right left axis

Question 19

What is antalgic posture

Answer 19

Posture compensation away from side of pain

Question 20

What symptoms with low back pain could indicate a MEDICAL EMERGENCY?

Answer 20

Saddle anesthia and/or fecal or urinary incontinence

Question 21

What are a couple tests you can do to test for disc herniation?

Answer 21

Straight leg test (pt supine lift one leg at time 30-60 degrees) OR Valsalva maneuver (bear down like straining to defecate)- if pain with either they may have disc herniation impinging on spinal cord/ meninges

Question 22

Define Radiculopathy and is lumbar or thoracic spine more prone to radiculopathies?

Answer 22

A disease of spinal nerve roots. Pain will follow distribution of one or more roots and is due to pressure, inflammation or other inrritations of said nerve root. Lumbar spine common site for radiculopathy.

Question 23

List the 6 causes of lumbar radiculopathy

Answer 23

1. Rupture or herniated disc
2. Bone or cord tumors
3. Bone spurs (aka: exostoses or osteophytes)
4. Spinal stenosis
5. Infection or inflammation
6. systemic diseases (like Diabetes Mellitus)

Question 24

List 4 signs and symptoms of lumbar radiculopathy

Answer 24

1. Low back pain
2. Lower extremity muscle weakness and spasm
3. Paresthesias (numbness, tingling, pins and needles)
4. Lumbar scoliosis (typically unilaterally but can be bilaterally)

Question 25

Describe typical radiculopathy pain

Answer 25

Unilat to below knee (bilat is read flag), dull/burning/lancing, radiating, located posterolaterally. If acute its aggravated by activity and improves temp at rest and if chronic hurts all the time

Question 26

At what segment(s) are lumbar herniations most common and why

Answer 26

L4-L5 b/c reduced width compared to other interspaces and post. longitudinal ligament is narrower at these segments

Question 27

List 7 differential diagnoses of radiculopathy

Answer 27

1. Acute or chronic lumbosacral sprain 2. Spondylosis and spondylolisthesis 3. Spinal arthritis 4. Bursitis 5. Referred hip pain 6. Cauda equine syndrome 7. Abdominal aortic aneurysm (mimics many low back pain symptoms)

Question 28

List symptoms of Cauda Equina Syndrome

Answer 28

bilat or unilat sciatica saddle anesthesia lower extremity weakness urinary retention or decreased sphincter tone decompressive surgery required w/in 12 hrs of initial loss of bladder control to prevent permanent neurological damage

Question 29

List 13 examination/testings for radiculopathy

Answer 29

1. postural and gait analysis 2. assessment of spinal mobility 3. assessment of hip motion and SI joint 4. Electrodiagnostic testing** 5. Radiologic procedures (xrays or MRI/CT) 6. Neurologic exam 7. Motor function testing of lower extremities 8. Straight leg test 9. Seated leg raise 10. distracted straight leg raise (Tripod test) 11. Valsalva maneuver (bear down) 12. Hoover's test 13. Babinski reflex test

Question 30

What do you test during neurologic exam for lumbar radiculopathy?

Answer 30

Deep tendon reflexes: Patellar (L4), Achilles (S1)- diminished reflexes expected Sensory Testing/dermatomal eval by pin prick and light touch

Question 31

What is being tested during motor function testing of the lower extremities with the following movements (which corresponding spinal cord segment)? Hip flexion, hip extension, knee flexion and extension, dorsiflexion and plantar flexion, great toe extension

Answer 31

``` Hip flexion L1-L2* hip extension L4-L5 knee flexion L5-S1* knee extension L3*-L4 dorsiflexion L4*-L5 plantar flexion S1-S2 great toe extension L5*-S1 ```

Question 32

What are two tests you can use to check for malingering for lower back pain

Answer 32

1. Hoovers Test | 2. Seated Knee Extension (Tripod Test)

Question 33

What would you expect to see in a L3/L4 disc herniation?

Answer 33

Affects L4 nerve root. Pain that wraps around lower back above butt to lateral anterior thigh across leg over knee to medial aspect of foot. Numbness over anterolateral thigh and knee and medial malleolus. Quadriceps weakness and atrophy, weak dorsiflexion of ankle. Diminished knee jerk reflex.

Question 34

What would you expect to see in a L4/L5 disc herniation?

Answer 34

Affects L5 nerve root. Pain that wraps from lower back above butt down the lateral thigh and leg Numbness over lateral leg and web of great toe also middle strip of dorsum of foot Weak dorsiflexion of foot and great toe, difficulty heel walking, possible foot drop Usually no change in deep tendon reflexes

Question 35

What would you expect to see in a L5/S1 disc herniation?

Answer 35

Affects S1 nerve root Pain that goes down from low back over mid buttocks and down middle of posterior thigh and leg to lateral malleolus/foot Numbness on back of calf (over gastroc) and lateral heel, foot and toe Weak plantar flexion of foot and great toe, difficulty toe walking Atrophy of gastroc and soleus Diminished or absent ankle jerk (Achilles) reflex