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OMM > Exam #2 (cont) > Flashcards

Exam #2 (cont) Flashcards

0
Q

Where does pain from the QL trigger points radiate?

A

Groin, lateral aspect of the leg

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1
Q

What is the origin, insertion, and action(s) of the quadratus lumborum?

A
  • Origin: 12th rib and TPs of L1-L4
  • Insertion: Iliolumbar ligament and posterior iliac crest
  • Actions: Stabilizes 12th rib, lateral flexion of lumbar (unilaterally) and extension
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2
Q

Give the origin, insertion, and action of the iliopsoas (psoas major) muscle

A
  • Origin: TPs and vertebral bodies of T12-L5
  • Insertion: Lesser trochanter
  • Action: Flexes thigh, some external rotation, flexes spine on pelvis.
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3
Q

What are the referred pain patterns from the iliopsoas?

A

Lumbar spine and anterior thigh

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4
Q

What visceral dysfunction(s) can be confused with iliopsoas spasm/strain?

A

Kidney stones, ovarian vessel disorder

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5
Q

What affect does a shortened iliopsoas muscle have on the lumbar spine and pelvis?

A

increased LORDOSIS and ANTERIOR pelvic shift

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6
Q

During which movement is the iliopsoas stressed?

A

Flexion

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7
Q

What postural observation can be made to identify iliopsoas syndrome?

A

Flexion at hip and sidebending of lumbar spine to side of most hypertrophied psoas

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8
Q

What three tests should be performed to diagnose iliopsoas syndrome, and rule out other pathologies (which?)

A
  1. ) Thomas test (positive)
  2. ) Straight leg raise (negative will rule out herniated disc)
  3. ) Well leg test (negative will rule out herniated disc)
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9
Q

When evaluating iliopsoas syndrome, one should pay particular attention to what vertebral levels?

A

L1 and L2

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10
Q

A full-blown LEFT iliopsoas syndrome will cause:

  1. ) A _____ pelvic shift
  2. ) Rotation of sacrum on the _____ ______ axis
  3. ) Right piriformis spasm
  4. ) Pain in the _____ hip down the back of thigh to the knee. This is due to the ________.
A
  1. ) RIGHT pelvic shift
  2. ) Rotation of sacrum on the LEFT OBLIQUE AXIS
  3. ) ______ piriformis spasm with tender point
  4. ) Pain in RIGHT hip, due to SCIATIC NERVE
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11
Q
  1. ) Where is the key lesion in acute psoas syndrome?

2. ) What type of treatment is contraindicated in acute psoas syndrome?

A
  1. ) Upper-lumbar, approx. L1-L2, sometimes T12/L3

2. ) HVLA

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12
Q

What is the origin, insertion, and action of the piriformis?

A
  • Origin: Anterolateral surface of S2-S4 at or near SI joint capsule
  • Insertion: Greater trochanter
  • External rotation of thigh at the hip, some thigh extension. If hip bent –> abduction of thigh at hip, and internal rotation of thigh.
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13
Q

Extensive sitting indicates what pathology?

A

Piriformis syndrome

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14
Q

Sciatica is a _____ rather than a _______

A

Sciatica is a SET OF SYMPTOMS rather than a DIAGNOSIS

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15
Q

Give three observations associated with piriformis syndrome

A
  1. ) Altered, painful gait
  2. ) Leg externally rotated
    3) Increased flexion of spine
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16
Q

What diagnostic technique is used to differentiate piriformis from disc herniation?

A

Electromyography (EMG)

17
Q

What technique are recommended in treatment of QL hypertonicity?

A

Treatment of QL trigger points: 12th rib technique AND passive myofascial release of the QL (both useful during acute stage)

18
Q

Which Type-II somatic dysfunction is common in psoas syndrome?

A

L5 extended

19
Q

Which OMM techniques are indicated for treatment of ACUTE psoas syndrome?

A

Passive extension, counterstrain, muscle energy, active and passive myofascial.

20
Q

Define the temporal duration of symptoms in each of the following:

  1. ) Acute
  2. ) Subacute
  3. ) Chronic
A

Symptoms lasting…

  1. ) Acute = < 6 weeks
  2. ) Subacute = 6 - 12 weeks
  3. ) Chronic = > 3 months
21
Q

What are the seven (7) possible causes of low back pain?

A
  1. ) Mechanical (disc herniation, compression fracture, DDD, etc.)
  2. ) Non-mechanical/Viscerogenic (renal disease, IBS, AAA, GI diseases)
  3. ) Neoplastic (myeloma, sarcoma, etc.)
  4. ) Infection (osteomyelitis)
  5. ) Somatic dysfunction (postural compensations)
  6. ) Psychosocial (seeking disability or drugs)
  7. ) Psychiatric (depression)
22
Q

What etiology are the following complaints typically associated with?

  1. ) Pain worse when sitting
  2. ) Pain relieved with forward flexion
  3. ) Radiation below the knee
A
  1. ) Disc herniation
  2. ) Spinal stenosis
  3. ) Sciatica
23
Q

List which structures correspond with the following sympathetic levels:

  1. ) T1-T4
  2. ) T1-T6
  3. ) T5-T9 (right and left)
  4. ) T10-T11
  5. ) T12-L2
A
  1. ) Sympathetics to head and neck
  2. ) Heart and lungs
  3. ) Upper abdominal viscera (celiac plexus) –> Right: Liver, gallbladder, duodenum, head of pancreas. Left: Stomach, spleen, tail of pancreas.
  4. ) Superior mesenteric plexus: Remainder of small intestine, kidneys (R&L), upper part of the ureters (R&L), gonads (ovaries and testes) – RIGHT: Appendix, cecum, ascending to mid-transverse colon.
  5. ) Inferior mesenteric plexus: Colon from mid-transverse to rectum and pelvic organs (bladder, uterus, prostate).
24
Q

Herniation at disc X affects nerve root ________. Why?

A

Affects nerve root X+1, because nerve root X will have already exited the foramina and will be unaffected.

25
Q

Give a description of the following:

  1. ) Sacralization
  2. ) Lumbarization
A
  1. ) 5th lumbar fused with S1

2. ) S1 independent of rest of sacrum

26
Q
  1. ) Describe spondylolisthesis
  2. ) On which diagnostic imaging tests is it best seen (2)?
  3. ) What is a typical compensatory symptom?
A
  1. ) Forward slippage of a vertebral body on the one BELOW
  2. ) Lateral X-ray, MRI
  3. ) Pelvic rotation and tight hamstrings
27
Q
  1. ) What is spinal stenosis?

2. ) What are three relieving postures for patients with spinal stenosis?

A
  1. ) Narrowing of the spinal canal, i.e. vertebral canal narrowing that compresses nerve roots, thus causing ischemia.
  2. )
    a. ) Flexion
    b. ) Sitting
    c. ) Bringing knees to chest
28
Q

What types of exercises would be useful in treating spinal stenosis?

A

Exercises that tilt the pelvis and flatten or decrease lordosis, and initiate lumbar kyphosis.

29
Q

Patients with what TWO conditions are more prone to compression fractures?

A

Hypocalcemia or osteoporosis

30
Q

Where are the weak portions of the lumbar spine?

A

“Weak” spot on the ANTERIOR PORTION.

31
Q

What are symptoms of Cauda Equina Syndrome (3)?

A
  1. ) Progressive low back pain
  2. ) Sphincter (anal/urinary) weakness
  3. ) Ascending paralysis of lower extremities
32
Q
  1. ) What is Meralgia Paresthetica?

2. ) Describe its pain pattern.

A
  1. ) A compression of lateral cutaneous nerve of the thigh.

2. ) It causes pain to the lateral anterior aspect of the thigh.

33
Q

Which nerve root is associated with the following, and how would you test:

  1. ) Great toe extension, dorsal foot sensation
  2. ) Foot inversion, patellar reflex, medial foot sensation
  3. ) Foot eversion, Achilles reflex, lateral foot sensation
A
  1. ) L5 –> Walk on heels, ABduct hip
  2. ) L4 –> Walk on heels with foot inverted
  3. ) S1 –> Walk on toes
34
Q

Osteoarthritis of the hip joint is characterized by decreases in what TWO ranges of motion?

A
  1. ) Decreased extension

2. ) Decreased internal rotation

35
Q

The innominate bone can rotate around a ______ axis, its direction of rotation is named for the direction that the _____ moves.

A
  • Transverse

- Superior iliac crest

36
Q

A posteriorly rotated innominate will make the ipsilateral leg functionally ________. Anteriorly rotated?

A

Posterior rotation = functionally SHORTER

Anterior rotation = functionally LONGER

37
Q
  1. ) If a patient has level iliac crests and significant anterior rotation of right innominate, which came first: Short right leg or rotated innominate?
  2. ) What, if any, compensation will occur in the contralateral innominate bone?
A
  1. ) Right short leg came first (likely)

2. ) Contralateral innominate will rotate POSTERIORLY to compensate

38
Q

An anterior innominate rotation on the LOW PELVIC side suggests what about a leg length discrepancy?

A

It suggests that the anteriorly rotated innominate is compensating (by functionally lengthening) for an ANATOMICALLY SHORTENED LEG. While a POSTERIOR ROTATION on the CONTRALATERAL side suggests compensation (functionally shortening) for the shortened right side

39
Q

If iliac crests are unlevel and the innominate on the lower side is POSTERIORLY rotated, what does this suggest?

A

That the innominate rotation is causing the pelvic unleveling, and thus a functionally shorter leg. While the opposite side rotated anteriorly is causing a functionally longer leg.

40
Q

The _____ is the key muscle in stabilizing the spine in a side-to-side direction

A

QL

OMM (3 decks)

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