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summer 2025 > msk 3 - Lumbar > Flashcards

msk 3 - Lumbar Flashcards

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1
Q

what are the three diagnosis classifications?

A

patho-anatomical
mvmt system
treatment response

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2
Q

why are neural impairments above orthopedic on the line of logic?

A

sensation
“muscles are dumb” need nerves to tell them what to do

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3
Q

what are the red flags associated with cauda equina syndrome?

A

saddle paresthesia
sensory and motor deficits in L4-S1
urinary and fecal incontinence

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4
Q

what are the red flags associated with spinal tumor?

A

over 50 yo
unremitting pain
failure of conservative treatment
history of cancer
unexplained weight loss

top concerns:
lumps
unexplained hard nodules

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5
Q

what are the red flags associated with spinal fracture?

A

chronic use of steroids
history of traumatic event
over 70 yo

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6
Q

what are the red flags to diagnose malignancy?

A

over 50 yo
prior history of cancer
unexplained weight loss
night pain not relieved by positional changes
failure of conservative care

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7
Q

what is the SFMA flexion ROM analysis?

A

touch toes
posterior weight shift
sacral angle at 70 deg or better
uniform spinal curve

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8
Q

what are the steps to SFMA extension?

A

shoulders reach and maintain 170 flexion
asis clears toes
spine of scapula clears behind heels
uniform spinal curve

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9
Q

what are the steps to spinal rotation ROM?

A

does the pelvis rotate 50 deg?
can you see the far shoulder from behind?
no pelvic deviation or knee bending
symmetry between sides

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10
Q

what are the steps to side bending ROM?

A

measure fingertips to floor
uniformity in spinal curve
use a spot in mid thoracic to measure against midline of sacrum

skin folds indicate hinging

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11
Q

when is overpressure needed?

A

not when motion is already painful
may use when trying to locate problem area

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12
Q

which motions are more provocative?

A

combined motions

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13
Q

what does sagittal motion pain indicate?

A

dysfunction of discogenic origin

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14
Q

what does rotation motion pain indicate?

A

facet joint pathology

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15
Q

what are the steps to an arms down deep squat?

A

shoes off
full knee flexion
full hip flexion
full ankle dorsiflexion
stay in sagittal plane

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16
Q

what dysfunction happens during overhead squat dysfunction?

A

feet flatten
feet turnout
knees bow in or out
asym weight shifts
excessive lordosis (ant pelvic tilt)
post pelvic tilt/trunk flexion
excessive forward lean
arms fall forward, adduct or elbows bend
shoulder girdle elevation

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17
Q

myotomes

A

L1: hip flex
L2: hip flex, hip add
L3: knee ext
L4: ankle DF
L5: foot/toes DF
S1: foot/toes PF, ankle eversion, hip ext
S2: knee flex
S3: foot intrinsics

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18
Q

reflexes

A

patellar: L3/3
achilles: S1/2

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19
Q

describe a functional myopathy eval?

A

have pt try to walk on toes then heels
S1 is for toes
L4/5 for heels

asym is bad

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20
Q

what nerve root does each disc affect respectively?

A

disc will affect nerve root below it

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21
Q

dermatomes

A

L1: high ant thigh
L2: mid ant thigh
L3: low ant thigh
L4: medial lower leg and calf, medial foot
L5: lateral lower leg and calf, middle foot
S1: lateral foot
S2: middle calf, post thigh
S3-S5: bullseye on ass

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22
Q

babinski

A

UMN if bilateral
norm: toe flex
abnorm: toes extend and fan

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23
Q

study on relationship between core and endurance

A

the more robust/strong your back is, the better.

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24
Q

flexion strength MMT

A

supine

5/5: hands behind head, scap off table
4/5: hands crossed on chest
3/5: hands slide down thighs
2/5: hands slide down thigh, partial scap off
1/5: palpable contraction, head lifts, no scap off
0/5: no abdominal contraction

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25
extension strength MMT
prone 5/5: hands behind head, full xiphoid off 4/5: hands on low back 3/5: lift towards ceiling 2/5: hands/arms at side, partial off 1/5: palpable paraspinal contraction, head lifts, no sternum off 0/5: no head/shoulder mvmt, no palpable contraction
26
what compensations indicate long/underactive core?
ant pelvic tilt asym weight shift excessive forward lean abdominal distention flexion of spine during quadruped exercise
27
PPIVM vs PAIVM
physiological - the normal motion accessory - joint play in neutral
28
PPIVM for rotation
pt on side press pelvis ant force on segment towards table
29
what plane are thoracic and lumbar facets oriented in?
thor: coronal lum: 90 deg in sagittal, 45 deg in frontal
30
describe the thoracolumbar fascia.
a superficial structure that influences deeper structures may be a pain generator may be able to stretch and shorten
31
describe the concept of a myofascial chain.
muscles are neurologically ties together
32
describe the PLL.
thicker center and thinner outside more disc bulges posterior lateral in lum when buckles, can lead to stenosis
33
flexion and ext ROM
sag plane 60 deg flex 25 deg ext
34
axial rotation ROM
horizontal plane 5 deg (30 deg for t and l spine combined)
35
lateral flexion ROM
frontal plane 25 deg (20-40 deg)
36
thoracolumbar kinematics
flexion: slide up ext: slide down rot: slide to same side lat flex: ipsi slide down, contra slide up
37
what vertebra has the most axial rotation?
C1
38
lumbar coupled motion patterns in neutral: lateral flexion
if side bend to left, spine rotates to right, SP rotates to left ipsi SP rotation L5 can go either way
39
lumbar coupled motion patterns: flexion or extension
when spine in non-neutral and side bends to left, spine will rotate to left, SP will rotate to right contra SP rotation similar to cervical spine
40
T12-L1 facet orientation
facets of T12-L2 oriented closer to midsag plane superior articulating process vertical in coronal L1 SAP vertical in sag plane
41
which areas of the spine seem to be the most dysfunctional?
transition areas
42
what is the purpose of the SI joint?
shock absorber for spine provide flex when under force
43
which is shorter L5 SP or L4 SP?
L5
44
how does sleep affect lumbar discs?
min of 5 hours helps discs regain original shape blood supply limited to out 1/3
45
describe ligamentum flavum.
highly elastic helps control flexion and facet capsule
46
describe anterior longitudinal lig.
biomechanical stability and proprio
47
describe the sacral ligs.
superio and inferior iliolumbar - restricts lateral sidebending post sacroiliac - restricts sacral ext sacrospinous - resists sacral flex sacrotuberous - restricts sacral flex
48
where does the aortic artery lie?
anterior to vertebral bodies
49
what are the two overlapping presentations of disc herniation at the L5/S1 level?
L5: lateral herniation compresses L5 nerve. weakness of hip abd and ankle DF S1: central herniation compresses S1 nerve. weakness of ankle PF
50
what is the nervous supply to the facet joints?
articular rami from the medial branch of the posterior rami of two adjacent spinal nerves
51
describe the dorsal rami innervations.
deep back muscles and skin med: multifidus lat: erector spinae
52
describe the ventral rami of lumbar spine.
lumbar plexus: ant rami of T12, L1-4 femoral and obturator nerve ant and medial thigh
53
describe the ventral rami of lumbar spine and sacrum.
sacral plexus: ant rami of L4-S2 sci, tib and common fib nerves post thigh, post and ant lower leg
54
describe pudendal and parasympathetic fibers.
S2-4 supply colon, rectum, urinary bladder, genitals
55
what are the pinch points of lumbosacral nerves?
psoas - obturator, lat cute femoral triangle - sar, add long sci notch/piri fibular head - common fib nerve
56
what is the sinuvertebral nerve?
sensory recurrent nerve ventral ramus - somatic grey communicating ramus - autonomic disc pain autonomic dysfunction/sensitization
57
where does the lumbar sympathetic chain lie?
anterolateral to bodies of lumbar vertebrae deep to medial psoas
58
PPIVM's for side-bending, flexion and extension.
arm around abdomen instruct pt to move with you hand on SP's checking for consistency in mvmt
59
lumbar spine lateral flexion and rotation analysis
pt side-lying dr moves pts legs up and down like a lever
60
extension-rotation/kemps test
FACET DYSFUNCTION/FACET SYNDROME client sitting passively moves client into full extension and rotates trunk in both directions (one at a time) POSITIVE: reproduction of concordant pain
61
quadrant test
LUMBAR FORAMINAL STENOSIS sitting in neutral extension, ipsilateral side-bending, contralateral rotation overpressure at end range POSITIVE: reproduction of radicular symptoms or local pain
62
bike test and shopping cart sign
CLAUDICATION "when pushing a cart, does leaning over it allow you to walk farther?" BIKE: have them start extended then flex after some time. "does leaning over relieve your pain" POSTIVE: NEUROGENIC/STENOSIS: reproduction of leg pain that reduces when pt slumps POSITIVE: INTERMITTENT VASCULAR CLAUDICATION: no change when pt slumps
63
slump test
LUMBAR RADICULOPATHY pt sitting moves into trunk flexion, cervical flexion, knee extension and ankle DF once symptoms are found, cervical spine is extended POSITIVE: reproduction of neuro symptoms that diminish when cervical spine is released will light up external disc bulge
64
4 straight leg raise biases
HNP SCIACTIC: hip flexion, adduction, internal rotation, knee extension, ankle dorsiflexion TIBIAL: hip flexion, adduction, internal rotation, knee extension, ankle dorsiflexion, eversion, toe extension PERONEAL: hip flexion, adduction, internal rotation, knee extension, ankle plantarflexion, inversion SURAL: hip flexion, adduction, internal rotation, knee extension, ankle dorsiflexion, inversion POSITIVE: reproduction of neuro symptoms under 40 deg: HNP 0-35 deg of hip flexion: slack taken by sci 35-70 deg hip flexion: limited neural mobility greater than 70: SI joint involvement
65
crossed straight leg raise OR well-leg raise
EXTERNAL DISC BULGE raise unaffected leg POSITIVE: affected leg is still bothered not great for prog
66
active SLR
HYPERMOBILITY, INSTABILITY, SIJD, PELVIC FLOOR DYSFUNCTION pt supine with legs straight and feet 20 cm apart try to raise one leg at a time 20 cm off table without bending knee 5 point scale from not difficult at all to unable to perform, scores added together for range of 0-10 NEG: 0 POS: 1-10
67
active straight leg raise test with and without pelvic compression
SI JOINT PAIN, HYPERMOBILE does compression make this easier? does compression make this harder? points of compression: greater troch helps pelvic floor transverse abdominus multifidus
68
hip abduction test
PAIN WITH STANDING, HYPERMOBILE, PELVIC PAIN, SI JOINT PAIN indications: LBP & SI joint pain glut med dysfuction QL trigger points LE pain - IT band syndrome, PFPS, gait dysfunction too much flexion - psoas too much IR - TFL too much ER - piriformis POSTIVE: leg is not in line with body
69
take home messages about leg raises
tell about discogenic/nerve root issues if lifting leg causes pain in other leg - BAD tell about relative flexibility vs hypertonicity if active, guide towards weak muscles that need treatment
70
multifidus lift test/arm raise
MULTIFIDUS WEAKNESS pt prone raise arm to 120 deg GH flexion palpate multifdus activation on opposite side
71
femoral nerve bias for burning or painful sensation down the anterior thigh
ANTERIOR HIP/PELVIC/LEG PAIN PRONE KNEE BEND - FEMORAL: pt prone hip neutral, passively flex knee PRONE KNEE BEND - LATERAL FEMORAL CUTANEOUS: paresthetica meralgia passively extend and adduct hip passively flex the knee POS: reproduction of pain
72
prone instability test
LUMBAR INSTABILITY - SPONDYLOLISTHESIS pt bent over table with feet on florr perform central glides with and without pts feet on ground POS: incr mobility and reproduction of symptoms with feet on floor and subsides when feet are lifted
73
one legged stork standing test
SPONDYLOLISTHESIS AND FACET SYNDROME pt standing client lifts one leg and holds it against WB leg client hyperextends lumbar spine to EROM POS: repro of concordant pain
74
spinal torsion test
LUMABR INSTABILITY, HYPERMOBILITY side-lying stabilize pelvis, overpressure on test segment POS: tissue laxity with overpressure into rotation and reproduction of cc
75
tests to detect motor control deficits
dyskinetic mvmts signs of instability/hypermobility visually identify faulty patterns chronic pain and fear
76
what does aberrant motion include?
painful arc in flexion painful arc on return from flexion instability catch reversal lumbopelvic rhythm gower's sign
77
what is gower's sign?
walking hands back up thighs because the back has been flexed for too long
78
rolling as an assessement
use leg to flop yourself over if have multifidus dysfunction

summer 2025 (5 decks)

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