Lumbosacral Examination and Intervention Flashcards Preview

PT 515 Musculo > Lumbosacral Examination and Intervention > Flashcards

Flashcards in Lumbosacral Examination and Intervention Deck (42):
1

Herniated Disk pattern

-Insidious onset
-Unilateral to symmetrical
-Worse with flexion activities
-Variable symptoms
-Periods of no pain
-Mornings and evenings worse
-Low back and buttock symptoms

2

Lumbar Radiculopathy pattern

-Back pain initially before leg pain
-Pain/parasthesia presents suddenly
-Symptoms intermmittent or constant
-Varies dependent on activity and position
-Pt reports weakness or difficulty with gait
-Pain in low back and radicular pattern down LE

3

Adherent Nerve Root pattern

-Episode of back pain months ago or surgury
-Leg symptoms never completely went away
-Sitting not and issue and walking makes it feel better
-Reports episodes of burning and aching or parasthesias
-Unable to bend forward due to sharp pain in LE
-Pain in low back and leg

4

Stenosis pattern

-Chronic back pain
-Intermittent sx in back "Stiffness"
-complains of one or both legs cramping with walking
-Sitting always relieves symptoms
-Standing tall or extending spine aggravates leg pain
-low back and bilateral leg pain

5

Spondylosis Pattern

Symmetrical or asymmetrical back pain
Localized pain
Episodic; usually time b/w episodes decreases
May not c/o functional limitations until tissue is engaged

6

Spondylolysis Pattern

Localized back pain; usually asymmetrical
May have been due to trauma or excessive repetitive force
Most cases insidious
OK with stationary tasks like sitting and standing
Extending or side-bending towards painful side an issue
Pain localized in low back

7

Spondylolesthesis Pattern

General back ache to intense stabbing pain or catching
Flexion activities ok compared to extension
Transitioning in and out of positions painful
May c/o feeling weak, difficult to stand up

8

SI subjective exam

More likely to be traumatic
Fortin sign = pt points toward PSIS
Pt may report difference in fit of pants or that they feel uneven when they sit

9

Red Flags

Failure to improve with conservative care >30 days
Cancer
Cauda Equina syndrome
Infection
Spinal Compression fx
Abdominal Aortic Aneurysm

10

Shift named for...

Position of the shoulders relative to the pelvis

11

Stenotic posture

Flexed at the hip and reduced lordosis

12

Derangements will deviate...

Away from the painful side

13

Adherent nerve roots will deviate...

Towards the painful side

14

Stenosis marked limitation in...

Extension

15

Spondylolysthesis will always be better....

Towards endrange

16

Flexion ROM

80°

17

Extension ROM

25°

18

Side-bending ROM

35°

19

Rotation (Thoracolumbar)

45°

20

Acute Kyphotic deformity

Testing starts prone over pillows to accomodate deformity

21

Flexion PROM End feel

Firm

22

Extension PROM End feel

Firm or hard

23

Side-bending/rotation PROM end feel

Firm or hard

24

Grading of PROM

Hypo/Hyper/Normal

25

Hicks CPR on stabilization

3 of 4 variable present:
-Younger than 40 y/o
-Greater general flexibility (SLR >91°)
-Instability catch or aberrant movement during flex/ext
-Positive findings on the prone instability test

26

Symptoms below the buttock?

Do a neuro screen

27

Neuro Exam

LLNT (SLR, slump)
Myotomes
Dermatomes
MSRs/DTRs

28

SLR/Slump 3 criteria for being positive

Reproduce comparable sign
Asymmetrical findings
Sensitizing movements change symptoms

29

Tests for intermmittent claudication of nerve

Bicycle test (Patients with PVD will get ischemic pain)
Stoop test

30

Test cluster for SIJ provocation

Iliac compression
Iliac Gapping
Thigh Thrust
Pelvic Torsion Left
Pelvic Torsion Right

31

Clinical Reasoning in patients with Lumbopelvic pain

Use repeated movements in conjunction with the 5 pain provocation tests

32

Diagnosis vs classification

Try to classify, diagnosis isnt necessarily possible

33

Low back pain classifications

1) Manipulation
2) Specific Exercises
3) Stabilization
4) Traction

34

CPR for success with manipulation

4 or more present:
-Recent onset
-Low FABQ (35)

35

Stabilization training

Specific exercise approach more effective in patients with chronic spondylolysis or spondylolysthesis

36

Directional Preference return to function phase

Once pt centralized, after 72 hours w/o symptoms you start repeated FIL
After FIL, flip over and do prone ext w/ a sag
Continue if no pain

37

Anterior rotated SI

Needs posterior rotation

38

Posterior rotated SI

Needs anterior rotation

39

Sliders used

In acute conditions
5-6 active repetitions
or 1-2 sets 30-60 seconds passively

40

Tensions used

Sub-acute to chronic

41

Femoral nerve testing

Prone or side-lying

42

Sciatic nerve testing

Supine
Bias nerve for sural, tibial, and fibular