MSK Quiz 1 PDF

MSK QUIZ 1 (1-74) * ACROSS SESSIONS=pain reduction-achieve mobility- achieve control- achieve strength/function * WITHIN SESSIONS= soft tissue mobility- joint manip/mobility- stretch- neuromuscular training * SINSS= severity, nature, irritability, stage stability *acute LBP represents a naturally r...

MSK QUIZ 1 (1-74) * ACROSS SESSIONS=pain reduction-achieve mobility- achieve control- achieve strength/function * WITHIN SESSIONS= soft tissue mobility- joint manip/mobility- stretch- neuromuscular training * SINSS= severity, nature, irritability, stage stability *acute LBP represents a naturally recurring condition characterized by flare-ups… pts with acute symptoms should be informed that recovery is likely in a short-period of time, but recurrence is likely *Pts with lower than avg initial pain, shorter duration of symptoms, and fewer previous episodes recover quicker *Anterior longitudinal ligament= limits EXTENSION *annulus fibrosis= outside *nucleus purposes= inside *nutrition=movement *thoracolumbar fascia= very important for lumbar stability * the psoas and DES provide opposite tensions to the spine.. stabilize it - the DES attach to the transverse processes and have little movt arm for spine X. Primary function is to prevent anterior shear of each segment and to provide vertical compressive force *multifidus= spine EXTENSION. Has an excellent moment arm for spinal X, compressive element and contributes to sacral nutation WHAT CAUSES LBP CHART ON PAGE 14!!! *yelllow flags= thoughts, behaviors, emotions *blue flags= work concerns *black flags= insurance limits, finance issues, isolation during recovery *zygapophyseal (FACET) joint arthropathy= degeneration from repetive loading leading to OA -upper lumbar L1-L3= referees to flank, hip, upper lat thigh -lower lumbar L4-L5= referees to post and lat aspect of thigh, and possibly calf - hip and spine MOB, light resistance work *spinal stenosis= narrow, degenerative narrowing of spinal canal or intervertebral foramen -AGE >50, Sn 90%, Sp 70% -treat= flexion exercise, mob of hips, treadmill, manual therpay, injections, laminectiomy/fusion *ankylosing spondylitis= seronegative arthritis characterized by inflammation and eventually ankylosis. Pain begins in the SIJ and then moves up spine.. morning stiffness and repeated episodes of waking night pain!!! *sciatica= general term for pain radiating from butt to the post LE, *herniated nucleus pulposis= smoking, disc protrusion, DM, trauma, torsion, lifting.. 90% at L4-S1… sitting worse, standing better (responds well to X exercises), 90% normal in 6 months.. CORRECT SHIFT FIRST! INFLAMMATION CAUSES RADICULAR SYMPTOMS!! *spondylolysis= fracture of pars inter-articularis (vertebral arch).. most common reason for LBP in adults!! -treat= brace, rest, PT.. acute progressive chronic (Scotty dog) * spondylolisthesis= anterior displacement of spine above fracture.. treat with stability and NO X *cauda equina= urinary retention!!!! Cant fully empty bladder.. motor deficits.. medical emergency- must be decompressed within 3-4 hours… severe LBP, in both legs MECHANICAL PAIN GENERATORS CHART ON PAGE 20!! *symptom modulation -clinical findings: disability is high, symptom status is volatile, pain is high-moderate -treatments: directional preference exercises, manip/MOB, traction, active rest *movement control -clinical findings: disability is high, SS is stable, pain is moderate-low -treatments: sensorimotor exercises, stabilization exercises, flexibility exercises *functional optimization -clinical findings: disability is low, SS is controlled, pain is low-absent -treatments: strength and conditioning exercises, work or sport specific, aerobic exercises, general fit *structural inspection: glute folds, PSIS, iliac crests (post and ant), ASIS, greater trochanters SCREENING EXAM Dermatomes L1: INGUINAL REGION L2: ANTERIOR MID THIGH L3: DISTAL ANT MED THIGH L4: MEDIAL MALLEOLUS L5: LATERAL LEG/THONG SPACE/GREAT TOE S1: LATERAL FOOT S2: MEDIAL HEEL S3/S4: GENITALS Myotomes L2/L3: HIP FLEXION L3/L4: KNEE EXTENSION L4: DORSIFLEXION L5: GREAT TOE EXTENSION S1: ANKLE PF S2: HAMSTRINGS REFLEXES PATELLAR (L2-L4) ACHILLES (S1) Movement analysis STEP UP/DOWN, SQUAT, GAIT, BEND/LIFT STS, GAIT, ON/OFF SOCKS, CROSS LEGS WORK REQUIRED ACTIVITY ASSESS QUALITY, ROM, PAIN, SYMPTOM LOCATION * HIP DROP= L5-S1 *PROM= PAIVM and PIVM *post to ant non thrust of spinous process= prone, use one hand to contact spinous process, place other hand on top, take up slack and perform glide, repeat on transverse process *lumbopelvic thrust manip= supine, translate pelvis towards you and max side end patient, rotate trunk so patient is on shoulder, contact patients ASIS and grasp shoulder/scap, once ASIS elevates perform smooth thrust… no crack is fine, keep thrusting, thrust and setup is key!!!! *neutral gapping thrust manip= flex top leg while palapting motion at L4-L5, grasp patients arm and induce side mending and rotation, place thumb on L4 spinous process and position patient’s arm around yours, log roll patient towards you, perform HVLA thrust *sorenson test= hanging off edge of table prone, torso off plinth, hold position, normal data suggest 2-3 min, cut off for LBP is less than 28-29 seconds *prone iso chest raise test= prone on plinth, lift chest and head off.. cut off for LBP is 31-33 seconds *supine iso chest raise test= supine, hands over chest, hips and knees bent to 90, basically do a sit up and hold… cut off for LBP is 34 sec for males, 24 sec for females Special tests: *crossed SLR: prone, PT lifts uninvolved leg straight up.. rules IN disc herniation *SLR: supine, PT lifts involved leg straight up… rules OUT disc herniation *slump test: pt sits with legs off table, head goes down into flexion, knee extension with DF.. spinal flexion, neck flexion, knee extension, ankle DF, release neck flexion (knee flex and DF or knee X and PF to floss sciatic nerve) *femoral nerve tension test: prone, knee flexion, lift into hip extension *facet joint test (X rot): pt sitting on table with arms across chest, PT passively places pt in lumbar X (+ is pain at end range X and ROT) *prone instability test: patient torso flat on table, feet on floor to start, patient holds onto table and lifts legs.. a PA spring test is repeated SACROILIAC JOINT -L5 onto Sacrum, Ilia, Sacrum *iliolumbar: very important in prevention of anterior displacement of L5 on sacrum (prevents sheering).. can be sprained (no swelling present) *sacrotuberous: resist nutation (rocking/sway) or posterior innominate motion *nutation= sacral flexion…. Counternutation= sacral extension * motion at SI joint is now recognized to exist: however it is small ~ 3 degrees… lines of reaction force from floor up through hip joint (GRFV) tend to rotate the ilia posterior, while lines of force from body weight tend to rotate the sacrum into nutation (flexion) *CLOSED PACK POSITION IS SACRUM NUTATION *right rotation: posterior rotation: R ASIS more superior … gapping on R side forms compression on L side *PSIS AT LEVEL OF S2 *gillet test: hip hike palpate middle of sacrum at S2 *active SLR test: measure the ability for the patient to lift the leg in supine and transfer load to the pelvis *lumbopelvic dissociation: prone with one knee flexed to 90 degrees, one and on opposite PSIS and posterior iliac crest… passively IR hip PAIN PROVOCATION TESTS: 3/5 is + for SIJ dysfunction *distraction (gapping): supine, cross arm pressure over both ASIS, distraction of the aspect of the SIJ, compression of posterior part of the joint *compression= patient is sidelying with effected side up and the examiner assesses resting symptoms, hope flex 45-90 degrees, knees flexed 90 degrees, compresses anterior SIJ with distraction to posterior aspect of SI *thight thrust: patient is supine with affected hip flexed to 90 degrees, opposite leg is straight on table. Examiner places hand under sacrum just medial to PSIS to stabilize it, PT applies downward pressure through long axis of femur *gaenslens test (pelvic torsion)= supine, guides symptomatic knee to the chest with a force pushing into hip flexion, other leg is forced into hip extension, creates posterior rotation *sacral thrust= prone, vertical downforce through sacrum (S3), causes anterior shear *FABER= patient is supine, PT brings affected side into hip flexion and rests lateral side of the ankle above knee, PT stabilizes opposite ASIS and makes sure the lower back stays in neutral, PT lowers involved side to table *fortins finger test= pt points to pain region, should be 1 cm of the PSIS, palpate to confirm *sacroilitis: inflammatory process of SIJ *correction of anterior innominate- ASIS lower, PSIS higher… *correction of upslip/superior shear- ASIS higher, PSIS higher…