Podcast
Questions and Answers
Which area of the spine is most commonly affected by fragility fractures due to osteoporosis?
Which area of the spine is most commonly affected by fragility fractures due to osteoporosis?
What is a characteristic symptom associated with an acute fracture in the neck?
What is a characteristic symptom associated with an acute fracture in the neck?
Which of the following stages of Ankylosing Spondylitis represents the phase characterized by progressive inflammatory disease?
Which of the following stages of Ankylosing Spondylitis represents the phase characterized by progressive inflammatory disease?
In the assessment of potential cervical spine injury, what observation might indicate a protective response?
In the assessment of potential cervical spine injury, what observation might indicate a protective response?
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Which of the following conditions is classified as a non-inflammatory spondylopathy?
Which of the following conditions is classified as a non-inflammatory spondylopathy?
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Which of the following mechanisms of injury is associated with spinal issues?
Which of the following mechanisms of injury is associated with spinal issues?
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What demographic factors increase the risk of Schmorl's nodes?
What demographic factors increase the risk of Schmorl's nodes?
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Which statement accurately defines Schmorl's nodes?
Which statement accurately defines Schmorl's nodes?
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What is centralization in the context of pain assessment?
What is centralization in the context of pain assessment?
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Which risk factor is linked to increased vascular health issues in the context of spinal problems?
Which risk factor is linked to increased vascular health issues in the context of spinal problems?
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Which mechanism of injury involves excessive stress produced in areas of adhesion in the dura?
Which mechanism of injury involves excessive stress produced in areas of adhesion in the dura?
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What is the primary focus of neurodynamics in the context of nerve function?
What is the primary focus of neurodynamics in the context of nerve function?
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Which special test is NOT typically associated with assessing cervical conditions?
Which special test is NOT typically associated with assessing cervical conditions?
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During nerve movement, the nerve does which of the following?
During nerve movement, the nerve does which of the following?
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In the context of adverse neurodynamics, which of the following is NOT a physiological component?
In the context of adverse neurodynamics, which of the following is NOT a physiological component?
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What does structural differentiation help assess in nerve function?
What does structural differentiation help assess in nerve function?
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Which structure adjacent to a nerve is considered an interface?
Which structure adjacent to a nerve is considered an interface?
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What symptom is likely to aggravate pain during the assessment?
What symptom is likely to aggravate pain during the assessment?
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Which of the following is a common observation of nerve dysfunction?
Which of the following is a common observation of nerve dysfunction?
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Which condition is indicated by the presence of bilateral or quadrilateral paresthesia?
Which condition is indicated by the presence of bilateral or quadrilateral paresthesia?
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What position is least likely to alleviate pain?
What position is least likely to alleviate pain?
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What quality of pain is characterized as dull, aching, and stiff?
What quality of pain is characterized as dull, aching, and stiff?
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What factor can lead to an increase in pain during the morning?
What factor can lead to an increase in pain during the morning?
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Which of the following is a sign of muscle wasting?
Which of the following is a sign of muscle wasting?
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Which symptom is not typical of radiating pain due to disc impingement?
Which symptom is not typical of radiating pain due to disc impingement?
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What method is often used to assess the change in symptoms during movement?
What method is often used to assess the change in symptoms during movement?
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What is a common characteristic of spondylolisthesis?
What is a common characteristic of spondylolisthesis?
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Which sign is NOT typically associated with stenosis?
Which sign is NOT typically associated with stenosis?
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In an adolescent athlete, which condition is often associated with repetitive spinal extension?
In an adolescent athlete, which condition is often associated with repetitive spinal extension?
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What type of movement typically aggravates pain in facet joint dysfunction?
What type of movement typically aggravates pain in facet joint dysfunction?
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Which group of individuals is at a greater risk for developing osteoporosis?
Which group of individuals is at a greater risk for developing osteoporosis?
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What is a possible consequence of central stenosis?
What is a possible consequence of central stenosis?
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In assessing a patient for spondylolysis, which motion is likely to be restricted?
In assessing a patient for spondylolysis, which motion is likely to be restricted?
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Which symptom is most commonly associated with spondylolisthesis?
Which symptom is most commonly associated with spondylolisthesis?
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Which factor is NOT a common cause of sprains and strains?
Which factor is NOT a common cause of sprains and strains?
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What finding is consistent with rib joint dysfunction?
What finding is consistent with rib joint dysfunction?
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What is the most common position that alleviates symptoms in individuals with foraminal stenosis?
What is the most common position that alleviates symptoms in individuals with foraminal stenosis?
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Which of the following is a classic observation in patients with osteoporosis?
Which of the following is a classic observation in patients with osteoporosis?
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What type of tests are contraindicated in patients with osteoporosis?
What type of tests are contraindicated in patients with osteoporosis?
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Which of the following muscle groups is typically affected by muscle spasms in spondylolysis/spondylolisthesis?
Which of the following muscle groups is typically affected by muscle spasms in spondylolysis/spondylolisthesis?
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Which age group is typically more affected by vascular issues related to sustained overhead positions?
Which age group is typically more affected by vascular issues related to sustained overhead positions?
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What is a common quality of pain associated with vascular symptoms?
What is a common quality of pain associated with vascular symptoms?
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Which of the following is NOT a factor that could aggravate pain in individuals with neck and shoulder issues?
Which of the following is NOT a factor that could aggravate pain in individuals with neck and shoulder issues?
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Which special test might be considered for assessing first rib mobility?
Which special test might be considered for assessing first rib mobility?
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What characteristic is associated with a neurological issue involving the arm?
What characteristic is associated with a neurological issue involving the arm?
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Which symptom is indicative of vascular complications in the arm?
Which symptom is indicative of vascular complications in the arm?
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What mechanism of injury is commonly related to poor posture?
What mechanism of injury is commonly related to poor posture?
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Which sleeping position could potentially exacerbate symptoms related to neck and shoulder pain?
Which sleeping position could potentially exacerbate symptoms related to neck and shoulder pain?
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What is a common observation in patients experiencing vascular symptoms?
What is a common observation in patients experiencing vascular symptoms?
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Which of these demographic factors is more prevalent in patients with neck and shoulder issues?
Which of these demographic factors is more prevalent in patients with neck and shoulder issues?
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Study Notes
Critical Rule Outs
- Upper cervical instability
- Fractures
- Vertebral artery injury
Scanning
-
Upper Quadrant:
- Tspine PAVCP's (Upper: T1-6)
- Peripheral Joint Scan:
- TMJ (open, close, side to side)
- Shoulder (AROM/OP)
- Elbow (AROM/OP)
- Wrist (AROM/OP)
- Myotomes: C3-T1
- Dermatomes: C1-T2
- Reflexes:
- Biceps tendon
- Brachioradialis
- Triceps tendon
-
Lower Quadrant:
- Tspine PACVPs (Lower: T7-12)
- Quick Test - Squat
- Peripheral Joint Scan:
- SI Joint (Gillet's)
- Hip (AROM/OP)
- Knee (AROM/OP)
- Ankle (AROM/OP)
- Myotomes: L1-S2
- Dermatomes: L1-S2
- Reflexes
Clearing
-
Upper Quadrant:
- Clear joint above & below
-
Cervical:
- TMJ (open, close, side to side)
- T spine (PACVPs (T1-6))
- Shoulder (AROM/OP)
-
Thoracic:
- C spine PAVCPs
- L spine PACVPS
- Shoulder AROM/OP
-
Lower Quadrant:
- Tspine PACVPS (T7-12)
- SI Joint (Gillet's)
- Hip (AROM/OP)
Bony Conditions of the Spine
- Bone Pain Characteristics: Deep, nagging, aching, sharp, localized
-
Fractures:
- Acute: More common in cervical spine, compression (osteoporosis), and avulsion. Can involve Spinous process, Transverse process, Vertebral arch, Vertebral body
- Insidious: Fewer but more common than traumatic, often stress fractures. Most common in lumbar spine (spondylolysis and spondylolisthesis) or thoracic spine (osteoporosis). May involve Pars interarticularis or Vertebral end plate
Acute Fracture Rule-Out
- Mechanism of Injury: Axial compression, MVA & other traumatic forces
- Associated symptomatology: Central, local pain, Bilateral paresthesia, Headaches, Tinnitus, Nausea, Cranial nerve symptoms
- Patient profile - Osteoporosis
Spondylopathies
- Inflammatory: Ankylosing Spondylitis
- Non-Inflammatory: Spondylosis, Spinal stenosis, Spondylolysis, Spondylolisthesis
Spondylolysis
- Defect of pars interarticularis, often unilateral or bilateral
- Predominantly in lumbar spine, especially at L5
- Sometimes associated with trauma and occurs in adolescents related to spondylolysis / growth spurts
- May also be seen in older populations, athletes who frequently engage in repetitive spinal extension
Spondylolisthesis
- Bilateral defect of pars interarticularis
- Predominately seen in lumbar spine, most common at L5
- Forward slippage (traumatic or chronic) of superior vetebrae over the inferior vertebrae
- Similar symptoms to spondylolysis, but different on physical examination
Spondylosis
- Development of osteophytes around vertebral margins, decreasing disc space
- Possible ligamentum flavum hypertrophy/ossification
- Seen predominantly in individuals >40 but degeneration may start in 20s
Stenosis
- Narrowing of spinal canal, often caused by facet joints, arthritis, disc degeneration, etc.
- Usually appears in people over 50 years old
- Can be congenital (present at birth)
Whiplash
- Caused by high velocity/traumatic forces, often associated with MVA or WCB (Workplace Compensation Board)
Facet Joint Dysfunction
- Mechanism of Injury
- Sustained or repeated spinal extension/rotation
- Sudden or unusual movements
- Habitual posture
- Poor sleeping positions
- Degenerative/cumulative trauma
- Often insidious onset and can have positional faults and misalignments
Rib Joint Dysfunction
- Mechanism of Injury
- Sustained/repeated thoracic movements
- Traumatic twisting/torsional movement
- Direct blow/trauma
- Exertional
- Habitual postures/muscular imbalances
- Insidious onset
Disc Pathologies
- Disc Pathology: Localized, graded herniation of the nucleus pulposus against or through the wall of the intervertebral disc
Vertebrobasilar Artery Insufficiency (VBI)
- Localized or diffuse disruption of circulation to the brain and brainstem.
- Most frequently injured site C1-C2
Thoracic Outlet Syndrome
- Obstruction of structures emerging from the superior thoracic aperture
- Types: Neural, Vascular, Non-specific/mixed
Sprains/Strains
- Location: Dependent on involved tissue structure (usually posterior or lateral muscle groups)
- Quality: Dull, aching, stiff, tight
- Severity: Variable
- Aggravates: AROM contraction, PROM stretch, sustained posture
- Alleviates: Supine or neutral/unloaded position, ice or heat, medications for pain, stiffness in AM
- Radiating: Variable
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Description
This quiz covers critical rule outs, scanning techniques, and clearance protocols in physical assessment of the musculoskeletal system. Focused on upper and lower quadrant evaluations, it addresses myotomes, dermatomes, and joint mobilizations to ensure a comprehensive understanding of the assessment process.
