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7 Orthopedics > L2 Manual Skills > Flashcards

L2 Manual Skills Flashcards

1
Q

Causes of LBP

A

70-80% unknown medical cause

10-27% mechanical with known cause that PTs can treat

3% known medical cause that is non-MSK

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2
Q

Systemic S/S

A

disturbs sleep
deep aching/throbbing
reduced by pressure
constant or waves of pain
skin changes
weight loss
fevers
not aggravated by mechanical stress

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3
Q

Mechanical S/S

A

generally lessens at night
sharp or superficial ache

usually decreases with stopping of activity

aggravated by mechanical stress

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4
Q

Contributing conditions to insufficiency insufficiency Spinal Fractures

A

osteoporosis, hyperthyroidism, renal failure, chronic GI disorders

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5
Q

Fx of thoracolumbar spine

A

age >75
trauma
presence of osteoporosis
LBP >7/10
thoracic back pain

if greater than 3/5 S?S are present, high likelihood of fracture

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6
Q

High Risk for Cervical Spine Fracture

A

> 65, dangerous MOI, paresthesias in extremities

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7
Q

If the patient can ____, they most likely don’t have a cervical fracture

A

actively rotate neck 45°

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8
Q

Low Risk factors for Cervical Spine Fractures

A

simple rear end
sitting in the ED
ambulatory at any time
delayed onset of pain
absence of midline tenderness on C Spine

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9
Q

Red flags for cancer

A

history of cancer
age over 50
unexplained weight loss
failure of conservative therapy

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10
Q

Kidney–Visceral Back Pain

A

pain location: in back or side part of the body

pain types: severe, sharp, sudden

pain with urination. Nausea, vomiting, blood in urine, sweating

need to refer

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11
Q

Nephrolithiasis

A

most common cause of kidney visceral pain

males > females
high bmi is a rf

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12
Q

Cholecystitis

A

inflammation of gall bladder
middle aged women
upper RQ abd pain
radiation between scapulae
nausea, vomiting

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13
Q

Triple A

A

most common type of aneurysm

increasing incidence as people get older

more common in men and with people with hypertension and atherosclerosis

patient may report feeling an abdominal heart when laying down

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14
Q

Definite signs of triple a

A

definite pulsatile mass
abdominal bruit

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15
Q

Herpes Zoster Rash

A

-unilateral lesions that don’t cross midline
-painful, itchy, blisters
-fever
-headache, chills, upset stomach
-2-4 of S/S
-thoracic trunk location, in a dermatomal pattern

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16
Q

Spinal Infection

A

advanced age
open wound in spinal region
intravenous drug use
HIV
long term steroid use
diabetes
organ transplant
malnutrition
cancer

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17
Q

Cauda Equina

A

most commonly due to massive disc herniation

can also be from infections, tumors, stenosis, birth abnormalities, post-operative complications, spinal anesthesia

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18
Q

S/S of cauda equina syndrome

A

urinary retention
urinating more frequently
fecal incontinence
sexual dysfunction
saddle paresthesia
unexplained LE weakness

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19
Q

What is the most common serious spine pathology?

A

fracture

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20
Q

Lumbar Spinal Stenosis S/S

A

-worse with extension, better with flexion
-stooped posture, leaning on grocery cart
-decreased walking tolerance
-neurogenic claudication (central)
-radiculopathy (lateral)
-LE weakness
-General onset

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21
Q

Primary vs Secondary LSS

A

Primary: congenital
Secondary: Acquired

Secondary is more common

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22
Q

LSS Test Cluster

A
  1. Bilateral LE symptoms
  2. LE pain > back pain
  3. Pain during walking or standing
  4. Pain relief upon sitting
  5. Age > 48 years

high snout (0 S/S) and high spin (over 4 S/S)

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23
Q

Other tests to determine LSS

A

2 stage treadmill test (walking on incline would be less painful)

romberg test: impacted balance

30s prone hip extension test (S/S would come on w/legs raised)

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24
Q

Pain Management for LSS

A

NSAIDs
TENS
low grade CPA and STM

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25
Q

Decreased spinal ROM and jt mobility of LSS

A

central and unilateral PAs
flexion/rotation ROM

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26
Q

Decreased walking tolerance of LSS

A

modified WB program
inclined treadmill
increase cadence
decrease stride length

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27
Q

Decreased hip muscle performance of LSS

A

hip jt mob
increasing ext and rotation
hip flexor/quad lengthening

28
Q

Decreased trunk muscle performance of LSS

A

trunk stabilization with LE ex
bridging
quadruped
planks

29
Q

Decreased hip muscle performance LSS

A

hip strengthening
emphasize on extension and abduction

30
Q

LSS prognosis

A

expect at least 6 to 12 weeks for improvement

might need steroid injection, elective surgery, or radiofrequency ablation

31
Q

Spondylolisthesis

A

slip forward of the spine

can be degenerative, microtraumatic changes, traumatic, congenital, systemic

32
Q

Degenerative spondylolisthesis

A

common in older female obese adults

33
Q

Isthmic and Traumatic Spondylolisthesis

A

more common in pediatric population

usually hyperextension with impact like gymnasts, football, butterfly stroke

most happen at l5/S1 and are managed conservatively

34
Q

Degenerative Disc Disease

A

more than 50% of the population >30 /yo, and increases to 90% of pop >65

35
Q

S/S of DDD

A

loss of height
loss of motion in flex and ext
marked hypomobility
possible radicular S/S

36
Q

Manual Therapy

A

specialized, skilled hands-on techniques to produce a force on the body to restore function, increase ROm, decrease pain

joint directed
use of muscles to move jt
improve muscle extensibility
reduce muscle tone

37
Q

Mobilizations

A

passive therapeutic movement within a range of motion at variable amplitudes and speed

not always at the end of available range

38
Q

Manipulation

A

passive therapeutic movement of small amplitude and high velocity at the end of available ROM

39
Q

Passive physiologic intervertebral movements

A

flex, ext, SB, rotation

40
Q

Passive accessory intervertebral movements

A

slide, glide, roll, spin, translate

41
Q

Closed packed and manual therapy

A

typically don’t do manual therapy in closed packed position because jt surfaces are the most congruent

42
Q

Barrier Concept

A

Joint movement is limited by anatomic barrier

passive motion occurs within the physiologic to anatomic barrier

active ROM occurs between the physiologic barrier

in a dysfunctional system, the motion loss decreases how much active motion is present

43
Q

Type 1 Spinal Motion

A

neutral mechanics
SB and rotation occur to opposite sides

44
Q

Type 2 mechanics

A

when supine is flexed or extended, SB and rotation occur to the same side. Uncoupled motions

easier to feel and manipulate the cervical spine

45
Q

Type 3 Mechanics

A

motion in one plane reduces motion in remaining two planes

46
Q

Why do we need mobilize joints?

A

synovial fluid movement
extensibility of soft tissues
maintain proprioception
muscles can’t move locked jts
muscles can’t heal w/locked jts

jt that lack normal mob increase wear

47
Q

Theoretical Benefits of Manipulative Therapy

A

stretching of soft tissue
pain inhibition
positive patient expectation
provider expectation
neural plastic changes
alteration in motor neuron excite
increase in cortical drive

48
Q

Manipulative therapy does NOT

A

release joint adhesion
nitrogen gas bubbles cavitating
correcting a subluxed segment
fixing alignment

49
Q

Biomechanical benefits of manual therapy

A

vertebral segment movement
gapping of facets
increase tissue extensibility
not site specific
short term changes
doesn’t change alignment

50
Q

Neurophysiological benefits of manual therapy

A

patient expectations
stimulation of spinal afferents
enhanced motor neuron excitability
reflex post synaptic inhibition
inhibition of nociceptive transmission

51
Q

when to NOT manipulate with HVLA thrust

A

active infection
suspected or known fracture
osteoporosis
acute whiplash associated disorder
cauda equina syndrome
worsening neurologic condition
RA
cancer
cervical instability
vertebro artery insufficiency
adverse reaction
patient declines

52
Q

CPR for manipulation success for patients with LBP

A
  1. Duration of S/S less than 16 days
  2. S/S not distal to knee
  3. FABQ work subscale <19
  4. At least one hip IR PROM >35°
  5. Hypomobility at one or more lumbar levels with spring testing
53
Q

What two symptoms of childs/lynn study are the most important for manipulation and success with LBP

A

recent onset
no symptoms distal to knee

54
Q

Biggest mistakes with manual therapies

A
  1. not practicing enough
  2. not screening patients
  3. Saying all patients need manual therapy or manupulation
  4. Not adjusting your treatment plan as you go
55
Q

Transient Side Effects of Manipulation

A

local discomfort, headache, tiredness, radiating discomfort

usually resolves within 24 hours and rarely lead to impairment

56
Q

Causes of complication arising from manual therapy

A

incorrect patient selection
lack of diagnosis and complications
indadequate assessment
wrong forces
lack of consent

poor technique
excessive force, magnitude, leverage
poor positioning
lack of feedback

57
Q

Contraindications to manipulation

A

bony issues
nerve issues
vascular
lack of diagnosis
lack of patient consent

58
Q

Bony issues for manip

A

tumor
infection
metabolic
congenital
iatrogenic
inflammatory
traumatic

59
Q

Nerve Issues for manip

A

cervical myelopathy
cord compression
cauda equina syndrome
nerve root compression

60
Q

Vascular contraindications for manip

A

diagnosed vertebrobasilar insufficiency
aortic aneurysm
bleeding diastheses
severe hemophilia

61
Q

Precautions for spinal manip

A

adverse reaction to previous manual therapy
disc herniation or prolapse
pregnancy
spndylolisthesis
ligamentous laxity
psychological dependence

62
Q

Grade 1 mob

A

small amp
out of resistance

63
Q

Grade 2 Mob

A

large amplitude
out of resistance

64
Q

Grade 4 Mob

A

large amplitude
into resistance
for pain

65
Q

Grade 4 Mob

A

small amplitude
into resistance
for pain

66
Q

Grade 5 Mob

A

small amplitude
quick thrust at end range

7 Orthopedics (11 decks)

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