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7 Orthopedics > L7 Radicular Conditions > Flashcards

L7 Radicular Conditions Flashcards

1
Q

Key Exam Findings: Manip/Mob

A
  1. No symptoms distal to knee
  2. Recent onset <16 days
  3. Low FABQ
  4. Lumbar hypomobility
  5. Hip IR PROM >35°
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2
Q

Key Exam Findings: Stabilization

A
  1. younger age, <40
  2. 3+ prior episodes
  3. Increasing frequency of episodes
  4. Aberrant movement patterns
  5. SLR >91°
  6. pos PIT
  7. General Hypermobility
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3
Q

Key Exam Findings: Specific Direction/Centralization

A
  1. Symptoms distal to knee
  2. Symptoms centralize w/repetitive EXT or FLEX
  3. May have + nerve root signs
  4. pos SLR
  5. Presence of lateral shift
  6. Older Age
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4
Q

Key Exam Findings: Traction

A
  1. pos leg symptoms
  2. pos nerve root signs
  3. peripheralization with EXT
  4. inability to centralize
  5. peripheralization with crossed SLR
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5
Q

Interventions for Manip/Mobilization pts

A
  1. mob, manip, MET
  2. AROM
  3. stabilization
  4. address regional deficits
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6
Q

Interventions for Stabilization pts

A
  1. local activation of deep core
  2. general strengthening
  3. postural awareness
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7
Q

Interventions for Specific Direction/Centralization patients

A
  1. Directional specific exercises initially unloaded and progress to loaded
  2. temporary avoidance of aggravating direction
  3. Neurodynamics
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8
Q

Interventions for Traction patients

A
  1. mechanical or manual traction
  2. Modified WB temporarily
  3. Progress to repeated EXT
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9
Q

Radicular Pain

A

pain caused by a problem at the nerve root

ex: sciatica

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10
Q

Radiculopathy

A

weakness, numbness, loss of function caused by a problem at the nerve root

can be due to disc herniation, bone spur, trauma, stretching

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11
Q

Referred Pain

A

pain from a problem in a muscle, joint, etc that is felt in a place different to where the problem is

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12
Q

Directional Preference/Specific Exercise

A

pt reports flexion consistently makes LE pain appear and worsen, standing up and walking makes it feel better

specific exercise for this pt would be extension based until flexion isn’t aggravating

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13
Q

Loading Strategies

A

passive or active forces applied by patient or PT with the goal of effecting positive change, progressing towards end of range without flaring pt symptoms

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14
Q

Centralization at the ____

A

1st appt is a positive predictor of success with PT

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15
Q

What do nerves need to be healthy?

A

blood flow
movement
space

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16
Q

Progression of Disc Lesions

A
  1. Bulging
  2. Protrusion
  3. Extrusion
  4. Sequestration
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17
Q

Why can disc herniations get better?

A

the autoimmune system recognizes disc herniations into the spinal column as foreigners, so disc herniations cause an inflammatory response of neovascularization, matrix protease activation, increased inflammatory cells, phagocytosis, and enzymatic degradation.

most do not require surgery

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18
Q

What are signs that a disc herniation might need surgery?

A

cauda equina syndrome
progressive loss of nerve function
lack of response to conservative function

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19
Q

Progression of Sciatica

A
  1. Compression
  2. Ischemia
  3. Impaired axonal transport, demyelination, axon degeneration
  4. Loss of nerve function
  5. Chemical irritation
  6. Inflammation
  7. Gain of nerve function (pain, hyperreflexia, hyperesthetic)
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20
Q

Radiculopathy Prevalence

A

-most common in male 30-50
-3-5% of US population
-majority of cases spntaneously resolve over time

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21
Q

RF for Radiculopathy

A

driving occupations
lifting and twisting
previous history of LBP
obesity
smoking
multiple pregnancies

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22
Q

Patient Exam for Radicular Conditions

A
  1. Observation
  2. Functional Testing
  3. Movement Testing; AROM with OP and Repeated Motions
  4. Neural Exam
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23
Q

Femoral Nerve Tension

A

neurodynamic test for LE

passively flex the knee and maintain for >20s looking for reproduction of neurologic symptoms

indicative of L2-L4 lesion

24
Q

Differenetial diagnosis for radiculopathy

A

gluteal tendinopathy
focal neuropathies
hip joint issues
AVN
SIJ
piriformis irritation

25
Q

Radicular Pain…

A

leg pain > back pain
neuro descriptors
+ SLR
below knee
loss of function
well localized
shooting
dermatomal

26
Q

Referred pain…

A

back pain > leg pain
poorly localized
dull, aching pain
- SLR

27
Q

Surgery for radiculopathy

A

clear myotomal deficits
unresponsive to PT

increases speed of recovery but has same outcomes as conservative care

28
Q

Mechanical Diagnosis and Therapy (MDT)

A

classifying patients into a particular category based on a thorough patient history and careful analysis of patient response to repeated, end range movements and postures

emphasizes patient empowerment and self-treatment

high reliable, not just extension of spine

29
Q

Primary Syndrome Classifications

A

Derangement
Dysfunction
Posture
Other

30
Q

Derangement

A

-most common syndrome
-mechanical obstruction to movement within the joint
-inconsistent and changes
-symptoms can be local, referred, radicular, combo
-Onset is sudden, with no known cause, or gradual
-S/S can be influenced by postures or normal daily activities and may change throughout the day

31
Q

What is a hallmark of derangement syndrome?

A

directional preference

32
Q

Treatments for derangement involve

A

specific movements that cause the pain to decrease, centralize, and/or abolish

33
Q

Dysfunction Syndrome

A

-refers to pain which is result of mechanical deformation of structurally impaired tissues
-S/S are present for 6-8 weeks
-pain is ALWAYS intermittent and arises at end range
-includes adhered nerve roots

34
Q

Treatment for Dysfunction Syndrome

A

repeated movements in direction of dysfunction or direction that causes pain

aim is to remodel the tissue that is limiting movement through exercises that become pain free over time

35
Q

Posture Syndrome

A

-refers to pain which occurs due to a mechanical deformation of normal soft tissue from prolonged end range loading of periarticular structures
-pain arises during static positioning
-pain disappears when pt moves out of static position
-no pain with active movement

36
Q

Treatment for Posture Syndrome

A

patient education
correction of posture
avoiding provocative postures
avoid prolonged tensile stress on normal

37
Q

Other Syndrome (MDT)

A

spinal stenosis
hip disorders
SI disorders
LBP in pregnancy
chronic pain syndrome
inconclusive or unresponsive
structurally compromised
post surgical problems
trauma

38
Q

Extension Direction Specific Exam Findings

A

s/s distal to knee
s/s centralize w/ext
s/s peripheralize with flex
+ nerve root compression
+ SLR

39
Q

Flexion Direction Specific Exam Findings

A

S/S peripheralize w/ext
nerve mobility deficits
older age >65
possible LSS
s/s distal to knee
+ nerve root compression
+ SLR

40
Q

Lateral Direction Specific Exam Findings

A

s/s peripheralize w/ext
s/s centralize w/flex
frontal plane deviation of shoulders
asymmetric side bending ROM
+ nerve root and SLR
limited SB ROM opposite of lateral shift

41
Q

Extension Direction Specific Interventions

A

-extension exercises
-mob to promote ext
-avoid flexion
-address neurodynamics

42
Q

Flexion Direction Specific Interventions

A

-flex exercises
-mobs to promote flex
-modified ambulation
-avoid ext
-address neurodynamics

43
Q

Lateral Direction Specific Interventions

A

-lateral shift correction in standing
-NWB shift correction
-address neurodynamics

44
Q

Derangement w/ Lateral Shift

A

-shift is named for direction shoulders are going, typically away from painful side
-perform slide glide/shift with patient

45
Q

Patient should stop action if

A

worsening ROM
pain
peripheralization

46
Q

Patient should continue action if

A

centralizing
increased ROM
reduction in pain

47
Q

Patient should exercise caution when

A

produced symptoms, not worse afterwards

48
Q

What to do once pt has centralized

A

reclassify them
stabilize
mobilize
educate

49
Q

Are manips or mobs better for lumbar dic herniation with radiculopathy?

A

MOBs with neurodynamic mb

50
Q

Overview of patients: referred pain from spine

A

-back pain with POS spine exam
-treat w/mob or stabilization, reassess LE s/s

51
Q

Overview of patients: radicular pain from spine

A

derangement classification
-centralize with one direction and peripheralize with another
-MDT repeated or sustained exercises and postures that centralize pain

52
Q

Overview of patients: adhered nerve root dysfunction

A

-scar tissue around nerve
-chronic s/s
-end range directionally specific movements produce s/s but no worse after movement
-neural mobs and spinal mob

53
Q

Overview of patients: traction

A

no specific movement that central
+ crossed LSR
responds well to manual/mech/self tract

54
Q

Traction for Lumbar Disc

A

purpose: increase lateral foraminal space for neurovascular flow

dosage: 30-40lbs or 25% BW for 5-10 min. 60s on and 20s off

prone or supine

55
Q

Traction for Lumbar Joint

A

purpose: increase space for facet jt, intervertebral jt

dosage: 50 lbs or 50% BW for 10-30 min, 15s on and 15s off

supine with pt in hook lying

56
Q

Sidelying nerve and joint mobs

A

for sciatic and femoral

30s of oscillating grade 2-3 sidebend mobs for 2-3 sets

reassess neural tension and other impairments afterwards

7 Orthopedics (14 decks)

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