Lhermitte's Sign Assessment
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Questions and Answers

What position is the patient in during the Lhermitte test?

  • Fowler's position
  • Pike position (correct)
  • Supine position
  • Prone position

Which action does the physician perform during the Lhermitte test?

  • Stretches the patient's legs and back
  • Flexes the patient's head and shoulder
  • Simultaneously flexes the patient's head and hip (correct)
  • Tilts the patient's head to the side

What is a positive result of the Lhermitte test?

  • Dizziness experienced by the patient
  • No sensation in the legs
  • Pain localized in the hip
  • Pain radiating down the spine and both extremities (correct)

In the context of the Lhermitte test, what does the term 'pike position' refer to?

<p>Sitting with legs straight in front (A)</p> Signup and view all the answers

Which of the following sensations might be experienced during a positive Lhermitte test?

<p>Pain radiating down both legs and the spine (B)</p> Signup and view all the answers

Which of the following best describes the sagittal plane in the lumbar spine?

<p>It encompasses flexion-extension. (B)</p> Signup and view all the answers

What is considered an absolute contraindication for HVLA techniques in the lumbar spine?

<p>Joint instability. (D)</p> Signup and view all the answers

During the positioning for direct HVLA technique in the lumbar spine, the patient should lie with which side down for both Type 1 and Type 2 SDs?

<p>The side of the dysfunctional area. (C)</p> Signup and view all the answers

Which of the following conditions is not a relative contraindication for HVLA techniques?

<p>Severe discogenic spondylosis with ankylosis. (B)</p> Signup and view all the answers

What is the role of the cephalad hand during the HVLA technique in the lumbar spine?

<p>To monitor sagittal motion at the level of dysfunction. (D)</p> Signup and view all the answers

In a three-plane diagnosis of the lumbar spine, what does the horizontal/transverse plane represent?

<p>Rotation. (A)</p> Signup and view all the answers

Which step is involved in preparing a patient for HVLA technique in the lumbar spine regarding the patient's legs?

<p>Flex the knees and hips. (B)</p> Signup and view all the answers

Which term refers to conditions like Klippel-Feil syndrome or Chiari malformation in relation to HVLA techniques?

<p>Absolute contraindications. (D)</p> Signup and view all the answers

What structural change occurs in patients with increased work of breathing due to COPD or asthma?

<p>Barrel chest (D)</p> Signup and view all the answers

Which area of the body is primarily impacted by the relationship between the diaphragm and the psoas muscle in patients with respiratory conditions?

<p>Lumbar spine (C)</p> Signup and view all the answers

How does decreased diaphragm motion affect the lymphatic system in patients with COPD or asthma?

<p>Decreases lymphatic drainage effectiveness (D)</p> Signup and view all the answers

Which segment of the spine is associated with sympathetic innervation in patients with COPD?

<p>T1-T6 (D)</p> Signup and view all the answers

What treatment model addresses the need for improved diaphragm function in COPD patients?

<p>Biomechanical model (D)</p> Signup and view all the answers

Which area is vital for assisting lymphatic drainage and supports breathing in patients with asthma?

<p>Thoracic inlet (B)</p> Signup and view all the answers

What is the condition when the occiput is rotated to the RIGHT and sidebent to the LEFT?

<p>RIGHT posterior occiput (A)</p> Signup and view all the answers

What are the primary restrictions observed in a posterior occiput position?

<p>Extension on the right side (A)</p> Signup and view all the answers

What consequence does the restriction of thoracic musculature have on the autonomic nervous system in COPD patients?

<p>Facilitation of sympathetics and parasympathetics (A)</p> Signup and view all the answers

During the MET technique, how should the physician position their hands?

<p>One hand on the articular pillar and the other cradling the head (B)</p> Signup and view all the answers

What is a primary benefit of osteopathic manipulative medicine (OMM) for patients with chronic respiratory conditions?

<p>Reduction in air hunger (B)</p> Signup and view all the answers

What is a contraindication for the MET technique in the cervical region?

<p>Fractures in the cervical area (B)</p> Signup and view all the answers

What is the first action performed in the Still technique?

<p>Place dysfunctional tissues into their position of ease (A)</p> Signup and view all the answers

Which of the following represents a contraindication for the Still technique?

<p>Absence of somatic dysfunction (A)</p> Signup and view all the answers

What type of forces are added during the Still technique?

<p>Axial force vector (D)</p> Signup and view all the answers

What is an appropriate reaction by the physician when performing the MET technique?

<p>Instructing the patient to rotate to the ease (B)</p> Signup and view all the answers

What does a positive result in the lumbar spring test indicate?

<p>The sacrum is stuck in extension (D)</p> Signup and view all the answers

In a left-on-left sacral torsion, how is L5 expected to present?

<p>Neutral and rotated right (C)</p> Signup and view all the answers

What characterizes double crush syndrome?

<p>Impaired neural function due to simultaneous lesions (D)</p> Signup and view all the answers

Which muscle is used to treat rib 6 during exhaled rib somatic dysfunction with muscle energy techniques?

<p>Latissimus dorsi (B)</p> Signup and view all the answers

Which of the following is a hallmark of adhesive capsulitis?

<p>Gradual onset of stiffness and pain in the shoulder (C)</p> Signup and view all the answers

What distinguishes tennis elbow from golfer's elbow?

<p>Tennis elbow affects the lateral epicondyle (D)</p> Signup and view all the answers

What is indicated by the backward sacral torsion when referred to lumbar mechanics?

<p>Type 2 mechanics with non-neutral spine (D)</p> Signup and view all the answers

During the treatment of rib 3-5 with MET, what position should the patient's arm be?

<p>Flexed up near the head (B)</p> Signup and view all the answers

Which factors contribute to the development of carpal tunnel syndrome?

<p>Conditions such as diabetes and pregnancy (D)</p> Signup and view all the answers

What happens to the sacrum during the sphinx test if the landmarks improve with backward bending?

<p>The sacrum prefers flexion (A)</p> Signup and view all the answers

What anatomical structures define the boundaries of the carpal tunnel?

<p>Carpal bones and the flexor retinaculum (D)</p> Signup and view all the answers

Which symptoms are commonly associated with ulnar nerve impingement at the cubital tunnel?

<p>Pain and tenderness in the ring and little fingers (D)</p> Signup and view all the answers

What is the common approach to assess the ASIS compression test?

<p>Assess sacral sulcus depth (B)</p> Signup and view all the answers

What is true about the treatment for exhaled rib somatic dysfunctions?

<p>Pressure is applied to the posterior aspect of the rib (B)</p> Signup and view all the answers

How does venous and lymphatic congestion affect nerve conduction?

<p>It decreases blood flow and alters nerve conduction. (A)</p> Signup and view all the answers

What is a common misconception regarding the symptoms of adhesive capsulitis?

<p>Symptoms arise suddenly and remain constant. (A)</p> Signup and view all the answers

What is the anterior location for the bronchus?

<p>Between ribs 2-3, close to the sternum (A)</p> Signup and view all the answers

Where is the posterior location for the tonsils?

<p>Midway between the spinous process and tip of the transverse process of C1 (B)</p> Signup and view all the answers

Which structure does not have a posterior reference point described as being midway between the spinous process and transverse process?

<p>Nose (D)</p> Signup and view all the answers

What is the anterior reference point for the larynx?

<p>Upper surface of the 2nd rib, 2-3 inches lateral from the sternum (D)</p> Signup and view all the answers

Where is the anterior location for the middle ear?

<p>Upper edge of the clavicle, medial to the 1st rib (D)</p> Signup and view all the answers

The upper lungs are located posteriorly in which space?

<p>Intertransverse space, T3-T4 (A)</p> Signup and view all the answers

In which region is the posterior reference point for the lower lungs found?

<p>Intertransverse space of T4-T5 (B)</p> Signup and view all the answers

Which anterior location corresponds to the pharynx?

<p>Front of the 1st rib, medial to the clavicle (A)</p> Signup and view all the answers

Flashcards

Lhermitte's Sign

A neurological test where the physician flexes the patient's head and hip while the patient sits with legs straight, causing pain radiating down the spine and extremities.

Pike Position

The position of the patient during Lhermitte's sign, where the patient sits upright with legs extended straight in front.

Flexion

The bending or decreasing of an angle between body parts, specifically the head and hip in Lhermitte's Sign.

Positive Lhermitte's Sign

The presence of pain radiating down the spine and both extremities when the patient's head and hip are flexed during the test.

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What does Lhermitte's Sign indicate?

Lhermitte's sign is a neurological test that can indicate spinal cord lesions, specifically affecting the cervical spine, like multiple sclerosis or vitamin B12 deficiency.

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Lumbar HVLA

High-velocity, low-amplitude manipulation technique used to correct joint restrictions in the lumbar spine.

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Three-Plane Diagnosis

Assessing joint restriction in the lumbar spine by analyzing movement limitations in three planes: sagittal, transverse, and frontal/coronal.

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Sagittal Plane

The plane that describes flexion and extension movements in the lumbar spine.

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Transverse Plane

The plane that describes rotation movements in the lumbar spine.

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Frontal/Coronal Plane

The plane that describes sidebending movements in the lumbar spine.

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Absolute Contraindications for Lumbar HVLA

Conditions that make HVLA treatment in the lumbar spine completely unsafe, potentially causing further harm.

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Relative Contraindications for Lumbar HVLA

Conditions where HVLA in the lumbar spine might be risky, requiring careful consideration and potentially alternative treatments.

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Posterior Occiput

The right side of the occiput when it is rotated right and sidebent left.

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Anterior Occiput

The left side of the occiput when it is rotated right and sidebent left.

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MET for Cervical Spine

A manual therapy technique that involves applying gentle pressure to the restricted joint, followed by asking the patient to move in the direction of ease.

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Still Technique

A manual therapy technique that involves placing dysfunctional tissues into their position of ease and then exaggerating it, while applying a force vector.

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MET Indications

Somatic Dysfunction (SD) in the cervical spine.

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MET Contraindications

Fractures, neurological signs/symptoms/abnormalities during cervical rotation, eye surgery or trauma (due to oculocephalogyric reflex).

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Still Technique Indications

Somatic Dysfunction (SD) in the cervical spine.

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Still Technique Contraindications

Absence of SD, fractures or open wounds at the site of SD, IV lines that might be jostled, lack of consent.

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Anterior Location of Lungs

The front of the lungs is located between the 3rd and 5th ribs, close to the sternum.

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Posterior Location of Lungs

The back of the lungs is located in the intertransverse space, between the spinous and transverse processes of the T3-T5 vertebrae.

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Anterior Location of Tonsils

The tonsils are located between the 1st and 2nd ribs, near the sternum.

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Posterior Location of Tonsils

The tonsils are located on the posterior surface of the C1 transverse process, midway between the nuchal ligament and lateral most aspect of the C1 transverse process.

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Anterior Location of Bronchus

The bronchus is located between ribs 2-3, close to the sternum.

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Posterior Location of Bronchus

The bronchus is located midway between the tip of the transverse process and spinous process of T2 on the posterior aspect of the transverse process.

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Anterior Location of Larynx

The larynx is located on the upper surface of the 2nd rib, 2-3 inches lateral from the sternum.

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Posterior Location of Larynx

The larynx is located midway between the tip of the transverse process and spinous process of C2 on the posterior aspect of the transverse process.

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COPD Biomechanics

Focuses on improving the diaphragm's mobility and the bellows function of the rib cage. Treatment might include addressing the scalenes and first ribs.

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COPD Respiratory-Circulatory

Aims to enhance diaphragm function which improves lymphatic and immune system function.

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COPD Neurological

Utilizes viscerosomatic techniques, such as Chapman's points, to address the nervous system's role in respiratory problems.

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COPD Metabolic-Energy

Addresses common issues like protein or calorie malnutrition and altered gait patterns that increase energy expenditure.

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COPD Behavioral

Focuses on managing anxiety from air hunger and promoting smoking cessation.

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Asthma Biomechanics

Optimizes mechanical function of respiratory structures to reduce the workload on the heart and lungs.

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Asthma Neurological

Addresses the 'asthmatic reflex' at T3 on the left side, aiming to break bronchospasm through sympathetic stimulation.

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Asthma Benefits of OMM

Osteopathic Manipulative Medicine (OMM) can decrease work of breathing, reset sympathetic/parasympathetic tone, and improve overall respiratory function.

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Double Crush Syndrome

A condition where a nerve is compressed at two separate points, leading to impaired function. It's like having two separate bottlenecks on a highway, slowing down the flow of traffic.

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Adhesive Capsulitis

Inflammation of the tissue surrounding a joint, causing stiffness and pain. Imagine your shoulder joint getting stuck because of a thick, sticky substance.

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Tennis Elbow

Pain and inflammation on the outer side of the elbow, caused by overuse of the wrist extensor muscles. Like a tennis player repeatedly hitting a backhand.

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Golfer's Elbow

Pain and inflammation on the inside of the elbow, caused by overuse of the wrist flexor muscles. Like a golfer swinging a club.

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Carpal Tunnel

A narrow passage in the wrist that houses the median nerve. It's like a tunnel with too much traffic!

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Cubital Tunnel

A narrow passage at the elbow that houses the ulnar nerve, which can become compressed due to various factors. Think of a tunnel at the elbow putting pressure on the ulnar nerve.

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What are the components of the carpal tunnel?

The carpal tunnel is formed by the carpal bones (small hand bones) on the bottom and the flexor retinaculum (a tough band of tissue) on the top. It's like a bridge over the carpal bones.

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What are the common symptoms of carpal tunnel syndrome?

Carpal tunnel syndrome causes numbness, tingling, and pain, mainly affecting the thumb, index, middle, and part of the ring finger. It's like your fingers falling asleep but not waking up!

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Sacral Flexion Preference

The sacrum prefers to move into flexion when the lumbar spine is extended. This is seen when landmarks become more symmetrical during backward bending.

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Sacral Extension Preference

The sacrum prefers to stay in extension, resisting flexion. This is seen as a lack of spring or movement in the sacrum when attempting lumbar flexion.

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L5 Neutral Mechanics

A forward sacral torsion (left-on-left) occurs with neutral mechanics in the lumbar spine.

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L5 Non-Neutral Mechanics

A backward sacral torsion (left-on-right) occurs with non-neutral mechanics in the lumbar spine.

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L5 Position in Left-on-Left Sacral Torsion

In a left-on-left sacral torsion, L5 is expected to be neutral, rotated right, and sidebent left.

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L5 Position in Left-on-Right Sacral Torsion

In a left-on-right sacral torsion, L5 is expected to be flexed or extended, rotated right, and sidebent right.

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Exhaled Rib MET Treatment: Pump Handle vs. Bucket Handle

Pump handle and bucket handle motions are less important for treating exhaled ribs compared to inhaled ribs.

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Exhaled Rib MET: Patient's Respiratory Effort

Use the patient's inhalation to move the restricted rib closer to the barrier.

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Study Notes

Lhermitte's Sign

  • Patient positioned in sitting pike with legs extended.
  • Physician simultaneously flexes head and hip.
  • Positive test: Pain radiating down the spine and into both lower extremities.

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Description

This quiz covers the assessment of Lhermitte's Sign, a clinical test used to evaluate for neurological issues. The physician's procedure involves flexing the patient's head and hip to check for pain radiating down the spine and into the lower extremities. Understand the implications of this sign in diagnosing conditions affecting the nervous system.

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