Podcast
Questions and Answers
What should be assessed in patients with non-specific thoracic spine pain?
What should be assessed in patients with non-specific thoracic spine pain?
- Neither active nor combined movements
- Active movements and combined movements (correct)
- Only active movements
- Only combined movements
Tensioners aim to decrease nerve strain by elongating the nerve bed at multiple joints.
Tensioners aim to decrease nerve strain by elongating the nerve bed at multiple joints.
False (B)
What type of exercise involves flexion, extension, and rotation movements around the thoracic spine?
What type of exercise involves flexion, extension, and rotation movements around the thoracic spine?
PAVIMs
The spinous processes of T1 and T2 require a finger-width distance of ____ for assessment.
The spinous processes of T1 and T2 require a finger-width distance of ____ for assessment.
Match the following assessments with their descriptions:
Match the following assessments with their descriptions:
Which of the following treatments aims to stretch and mobilize the thoracic spine?
Which of the following treatments aims to stretch and mobilize the thoracic spine?
Flexion and extension combined movements are not relevant for assessing thoracic spine pain.
Flexion and extension combined movements are not relevant for assessing thoracic spine pain.
What does a positive result in the shoulder abduction test indicate?
What does a positive result in the shoulder abduction test indicate?
What is the purpose of measuring the range of motion using a tape measure?
What is the purpose of measuring the range of motion using a tape measure?
In a neurodynamic test, reproduction of the patient's symptoms is not a must for a test to be considered abnormal.
In a neurodynamic test, reproduction of the patient's symptoms is not a must for a test to be considered abnormal.
What is the main goal of a neurodynamic test?
What is the main goal of a neurodynamic test?
The __________ test is painful in the mid-section of the upper arm and has high sensitivity and specificity.
The __________ test is painful in the mid-section of the upper arm and has high sensitivity and specificity.
Match the following nerves to their palpation location:
Match the following nerves to their palpation location:
What percentage indicates a high rule for cervical spine radiating symptoms if all top tests are positive?
What percentage indicates a high rule for cervical spine radiating symptoms if all top tests are positive?
Structural differentiation in a neurodynamic test necessarily produces a neural result.
Structural differentiation in a neurodynamic test necessarily produces a neural result.
What is a function of 'sliders' in treatment techniques?
What is a function of 'sliders' in treatment techniques?
Which of the following is NOT a symptom of vestibular basilar insufficiency?
Which of the following is NOT a symptom of vestibular basilar insufficiency?
The chance of death in patients with vestibular basilar insufficiency is 90%.
The chance of death in patients with vestibular basilar insufficiency is 90%.
What is the recommended period for conservative treatment before considering surgical evaluation?
What is the recommended period for conservative treatment before considering surgical evaluation?
Patients with vestibular basilar insufficiency may experience ________ attacks.
Patients with vestibular basilar insufficiency may experience ________ attacks.
Match the symptoms with their possible descriptions:
Match the symptoms with their possible descriptions:
Which of the following exercises is recommended for patients with vestibular basilar insufficiency?
Which of the following exercises is recommended for patients with vestibular basilar insufficiency?
All exercises for patients with vestibular basilar insufficiency should be performed with pain.
All exercises for patients with vestibular basilar insufficiency should be performed with pain.
What kind of manual therapy techniques are mentioned in the context of vestibular basilar insufficiency?
What kind of manual therapy techniques are mentioned in the context of vestibular basilar insufficiency?
What does unilateral PA refer to?
What does unilateral PA refer to?
Cranio-cervical movement includes flexion, extension, and rotation.
Cranio-cervical movement includes flexion, extension, and rotation.
What is the assessment tool used to identify neuro examination reflexes?
What is the assessment tool used to identify neuro examination reflexes?
Non-specific lower back pain is often associated with ______.
Non-specific lower back pain is often associated with ______.
Match each type of pain to its description:
Match each type of pain to its description:
Which of the following combined movements aims to increase extension range of motion?
Which of the following combined movements aims to increase extension range of motion?
Name one assessment used to determine pain in the thoracic region.
Name one assessment used to determine pain in the thoracic region.
Central PA is primarily aimed at increasing flexion range of motion.
Central PA is primarily aimed at increasing flexion range of motion.
What is the main focus of the Kemps test?
What is the main focus of the Kemps test?
The Slump test is primarily used for assessing lumbar or cervical paraspinal tone.
The Slump test is primarily used for assessing lumbar or cervical paraspinal tone.
What are two types of exercises included in McKenzie exercises?
What are two types of exercises included in McKenzie exercises?
The pressure applied between the spinous processes L4-5, L5-S1 during the Bell test is supposed to detect __________.
The pressure applied between the spinous processes L4-5, L5-S1 during the Bell test is supposed to detect __________.
Match the following tests with their respective focuses:
Match the following tests with their respective focuses:
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Study Notes
Vestibular Basilar Insufficiency
- Characterized by insufficient blood supply to the brain, affecting carotid or vertebral arteries.
- Common symptoms include vertigo, dizziness, unsteadiness, and giddiness.
- Additional symptoms may be headache or neck pain that differs from previous experiences.
- Possible visual disturbances, facial numbness or paresthesias, dysphagia, dysarthria, hoarseness, drop attacks, and hemiparesis may occur.
- Prognosis indicates a 90% chance of conservative treatment leading to improvement in 6-8 weeks.
- If there’s no improvement within 6 weeks, surgical evaluation is advised.
Treatment Approaches
- Manual therapy including traction and PAIVMs (posteroanterior mobilizations).
- Use sliders and tensioners for median and ulnar nerve mobilization to reduce pain.
- Exercise prescription tailored to the patient's lifestyle and capability, avoiding pain but allowing for post-exercise soreness.
- Recommended exercises include isometric upper cuts, four-point kneeling push-ups, and chin tucks.
Neurodynamic Testing
- Neurodynamic tests aim to determine peripheral nerve response to mechanical stress.
- An abnormal (positive) test reproduces patient symptoms and shows structural differentiation.
- Range of motion reduction is not mandatory for a positive result.
- Non-abnormal tests could be due to irrelevant testing or equal responses on both sides.
Assessment Techniques
- Palpation of nerves at key anatomical sites (e.g., median nerve at cubital fossa).
- Combination of active movements (flexion, extension, rotation, lateral flexion) with overpressure.
- Special tests include Spurling's test and median nerve neurodynamic testing for diagnosing cervical radiculopathy.
Non-specific Thoracic and Lower Back Pain
- Non-specific thoracic pain may involve movements such as flexibility tests and mobilization assessments focusing on spinous processes.
- Specific lower back pain might present patterns of movement, neuro examination including reflex and sensory assessments.
- Red flags to rule out serious pathology include indicators like bilat/unilateral leg pain and specific movement-related pain.
Treatment Strategies for Back Pain
- Education on pain neuroscience and advice to remain active are crucial.
- Manual therapy, including mobilizations and specialized exercises, may alleviate symptoms.
- Short-term pain relief techniques include massage, heat packs, and manual traction.
- Specific exercises for rehabilitation involve motor control exercises and McKenzie protocols to enhance functional recovery.
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