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7 Orthopedics > L2 Manual Skills > Flashcards

L2 Manual Skills Flashcards

(66 cards)

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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
Decreased spinal ROM and jt mobility of LSS
central and unilateral PAs flexion/rotation ROM
26
Decreased walking tolerance of LSS
modified WB program inclined treadmill increase cadence decrease stride length
27
Decreased hip muscle performance of LSS
hip jt mob increasing ext and rotation hip flexor/quad lengthening
28
Decreased trunk muscle performance of LSS
trunk stabilization with LE ex bridging quadruped planks
29
Decreased hip muscle performance LSS
hip strengthening emphasize on extension and abduction
30
LSS prognosis
expect at least 6 to 12 weeks for improvement might need steroid injection, elective surgery, or radiofrequency ablation
31
Spondylolisthesis
slip forward of the spine can be degenerative, microtraumatic changes, traumatic, congenital, systemic
32
Degenerative spondylolisthesis
common in older female obese adults
33
Isthmic and Traumatic Spondylolisthesis
more common in pediatric population usually hyperextension with impact like gymnasts, football, butterfly stroke most happen at l5/S1 and are managed conservatively
34
Degenerative Disc Disease
more than 50% of the population >30 /yo, and increases to 90% of pop >65
35
S/S of DDD
loss of height loss of motion in flex and ext marked hypomobility possible radicular S/S
36
Manual Therapy
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
Mobilizations
passive therapeutic movement within a range of motion at variable amplitudes and speed not always at the end of available range
38
Manipulation
passive therapeutic movement of small amplitude and high velocity at the end of available ROM
39
Passive physiologic intervertebral movements
flex, ext, SB, rotation
40
Passive accessory intervertebral movements
slide, glide, roll, spin, translate
41
Closed packed and manual therapy
typically don't do manual therapy in closed packed position because jt surfaces are the most congruent
42
Barrier Concept
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
Type 1 Spinal Motion
neutral mechanics SB and rotation occur to opposite sides
44
Type 2 mechanics
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
Type 3 Mechanics
motion in one plane reduces motion in remaining two planes
46
Why do we need mobilize joints?
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
Theoretical Benefits of Manipulative Therapy
stretching of soft tissue pain inhibition positive patient expectation provider expectation neural plastic changes alteration in motor neuron excite increase in cortical drive
48
Manipulative therapy does NOT
release joint adhesion nitrogen gas bubbles cavitating correcting a subluxed segment fixing alignment
49
Biomechanical benefits of manual therapy
vertebral segment movement gapping of facets increase tissue extensibility not site specific short term changes doesn't change alignment
50
Neurophysiological benefits of manual therapy
patient expectations stimulation of spinal afferents enhanced motor neuron excitability reflex post synaptic inhibition inhibition of nociceptive transmission
51
when to NOT manipulate with HVLA thrust
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
CPR for manipulation success for patients with LBP
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
What two symptoms of childs/lynn study are the most important for manipulation and success with LBP
recent onset no symptoms distal to knee
54
Biggest mistakes with manual therapies
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
Transient Side Effects of Manipulation
local discomfort, headache, tiredness, radiating discomfort usually resolves within 24 hours and rarely lead to impairment
56
Causes of complication arising from manual therapy
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
Contraindications to manipulation
bony issues nerve issues vascular lack of diagnosis lack of patient consent
58
Bony issues for manip
tumor infection metabolic congenital iatrogenic inflammatory traumatic
59
Nerve Issues for manip
cervical myelopathy cord compression cauda equina syndrome nerve root compression
60
Vascular contraindications for manip
diagnosed vertebrobasilar insufficiency aortic aneurysm bleeding diastheses severe hemophilia
61
Precautions for spinal manip
adverse reaction to previous manual therapy disc herniation or prolapse pregnancy spndylolisthesis ligamentous laxity psychological dependence
62
Grade 1 mob
small amp out of resistance
63
Grade 2 Mob
large amplitude out of resistance
64
Grade 3 Mob
large amplitude into resistance for pain
65
Grade 4 Mob
small amplitude into resistance for pain
66
Grade 5 Mob
small amplitude quick thrust at end range

7 Orthopedics (14 decks)

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