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PCE > Msk Spinal By Ptdi > Flashcards

Msk Spinal By Ptdi Flashcards

1
Q

The nerve roots in the c-spine exit vertebrae

A

above

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2
Q

There are cervical vertebrae and cervical nerve roots

A

7;8

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3
Q

Causes of cervical radiculopathy

A

Disc herniation, stenosis, swelling/inflammation (from local trauma)
3/100

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4
Q

Dermatome

A

An area of skin mostly supplied by a single nerve root

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5
Q

Myotome

A

A muscle or group of muscles supplied by a single nerve
root

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6
Q

When performing myotome testing the contraction should be held for at least seconds so that weakness (if any) can
be noted

A

5

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7
Q

When performing myotome testing the the joint should be placed in
position

A

Neutral

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8
Q

Myotome for C1-C2

A

Neck forward flexion

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9
Q

Myotome for C3

A

Neck side flexion

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10
Q

Myotome for C4

A

Shoulder elevation

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11
Q

Myotome for C5

A

Shoulder abduction

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12
Q

Myotome for C6

A

Elbow flexion, wrist extension

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13
Q

Myotome for C7

A

Elbow extension, wrist flexion

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14
Q

Myotome for C8

A

Thumb extension, ulnar deviation

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15
Q

Myotome for T1

A

Finger abduction/adduction

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16
Q

Myotome for L1-12

A

Hip flexion

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17
Q

Myotome for L3

A

Knee extension

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18
Q

Myotome for L4

A

Ankle dorsiflexion

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19
Q

Myotome for L5

A

Big toe extension

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20
Q

Myotome for S1

A

Ankle plantarflexion, ankle eversion, hip extension

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21
Q

Myotome for 52

A

Knee flexion, hip extension, ankle plantarflexion

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22
Q

How do you illicit a clonus reflex

A

Quickly and forcefully dorsiflex the ankle and HOLD in fully dorsiflexed position

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23
Q

What is a positive test for a clonus reflex?

A

A sustained clonus of 5 or more beats

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24
Q

How do you illicit a babinski reflex

A

Run a pointed object along the lateral aspect of the foot, from the heel and across the ball of the foot

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25
Q

What is a positive test for a babinski reflex?

A

Splaying of the toes and/or extension of the great toe

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26
Q

When do you perform a cervical distraction test?

A

When the patient is currently experiencing radicular
svmptoms

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27
Q

How do you perform Spurling’s Test?

A

Therapist applies axial load by pressing straight down on patient’s head

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28
Q

Order of limb positioning for Upper Limb Tension Test

A

Shoulder- > forearm-> wrist-> fingers-> elbow

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29
Q

ULTT1 for Median nerve

A

Shoulder depression and abduction (110°), Forearm supination, Wrist extension, Fingers and thumb extension,
Elbow extension

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30
Q

ULTT2 for Median nerve

A

Shoulder depression and abduction (10°), Forearm supination, Wrist extension, Fingers and thumb extension,
Elbow extension

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31
Q

ULTT3 for Radial nerve

A

Shoulder depression and abduction (10°), Forearm pronation, Wrist flexion and ulnar deviation, Fingers and thumb flexion, Elbow extension

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32
Q

ULTT4 for Ulnar nerve

A

Shoulder depression and abduction (10-90°, Forearm pronation (or supination depending on source), Wrist extension and radial deviation, Fingers and thumb extension, Elbow flexion

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33
Q

Shoulder dystocia

A

A complication of vaginal delivery in which the shoulder’s are caught above the mother’s pubic bone after the head has already passed through the birth canal

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34
Q

Plagiocephaly

A

A common condition in infants characterized by flattening of one side of the skull (also known as flat head syndrome)

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35
Q

What sleeping position increases the risk of sudden infant death syndrome (SIDS)?

A

On stomach (prone) or on side

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36
Q

Name 5 Kyphosis deformities seen in the thoracic spine

A

Round back, Scheuermann’s Disease, Hump back, Flat back,
Dowager’s hump

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37
Q

Herpes Zoster is also known as

A

Shingles

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38
Q

In non-structural scoliosis the curve flexion
with forward

A

disappears

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39
Q

Klumpke’s Paralysis

A

Injury to the lower nerve roots C8, T1 (lower brachial plexus) causing weakness and paralysis in the muscles of the forearm, hand, and triceps

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40
Q

The nerve roots in the L-spine exit vertebrae
the corresponding

A

below

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41
Q

Compression fractures are typically secondary to

A

Osteoporosis

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42
Q

Which dermatome covers the dorsal surface of the foot?

A

L5

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43
Q

Tight muscles in upper crossed syndrome

A

Upper trapezius, levator scapula, pectoralis (major and minor

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44
Q

What position would you put the ankle to stress the sural nerve?

A

“SID” Inversion + Dorsiflexion]

45
Q

Erb-Duchenne Paralysis

A

Injury to the upper nerve roots C5-C6 (upper brachial plexus) causing paralysis of the arm (shoulder and elbow)

46
Q

“Shopping cart sign”

A

Relief from symptoms when leaning forward over the shopping cart while shopping at a grocery store often seen in client’s with lumbar spinal stenosis.

47
Q

The joint that connects the ribs to the vertebrae

A

Costovertebral joints

48
Q

Spondylolisthesis

A

Anterior displacement of a vertebra over the vertebra inferior to it

An easying factor will be extension***

49
Q

Which dermatome covers the great toe?

A

L4

50
Q

Vertebral Artery Test procedure

A

Patient supine. Therapist passively takes patients head and neck into extension and side flexion and holds for 10-30 seconds. If no symptoms are produced, ipsilateral neck rotation is added and position is held for 10-30 seconds.

3n :nystagmus,nausea, other neurological symptoms

5d: dipoplia,disartria, disphagia, dizziness, drop atacks

51
Q

Laminectomy

A

Removal of lamina to make room to relieve compression on nerve roots and spinal cord

52
Q

Scoliotic curves are labeled in the direction of the of the curve

A

Convexity

53
Q

Cause of neurogenic claudication

A

Nerve root compression due to lateral stenosis

54
Q

Most common cause of Klumpke’s Paralysis

A

Traction on an abducted arm as the child is being pulled out during birthing

C8-t1

55
Q

Pump handle action of ribs

A

With inspiration the ribs are pulled up and forwards (like a pump handle)

56
Q

Bucket handle action of ribs

A

With inspiration the ribs move upwards laterally (like a bucket handle)

57
Q

Caliper action of ribs

A

With inspiration the ribs move laterally (like a caliper)

58
Q

“Waiter’s tip” position

A

Position seen in patient’s with Erb-Duchenne Paralysis: arm I hanging by the side, shoulder internal rotation, elbow extension, and forearm pronation

59
Q

SLUMP test procedure

A

1) Therapist instructs the patient to place hands behind back, go into a slump posture (with rounded shoulders) bringing their chin to their chest.

2) Therapist passively extends the uninvolved knee, then repeats the test on the involved LE.

3) If symptoms have not been reproduced ankle dorsiflexion is added.

4) If symptoms of low back pain/radiating pain in posterior leg are recreated, ask patient to extend their neck while maintaining a rounded back

60
Q

Positive SLUMP test finding

A

Relief of symptoms when patient extends neck indicates neural tension/restriction of lumbosacral roots

61
Q

Straight Leg Raise (SLR) procedure

A

1) Therapist slightly adducts and medially rotates patient’s hip, keeping the knee in full extension.

2) Therapist flexes patient’s hip (with knee in full extension) until the patient indicates pain or tightness in posterior thigh.

3) Therapist slowly lowers leg slightly until pain or tightness disappears.

4) Therapist dorsiflexes the foot or alternatively asks the patient to flex their neck to verify if symptoms are reproduced.

62
Q

At what range are the sciatic nerve roots under most tension in a SLR test?

A

35°-70°

63
Q

Which dermatome goes over the patella?

A

L4

64
Q

Spinal Stenosis

A

Narrowing of the central canal (central stenosis) and or intervertebral foramen (lateral stenosis)

Worse w flexion and better w extension. Rarely symptoms are bilateral

65
Q

Non-structural scoliosis is also known as

A

functional or postural scoliosis

66
Q

Valsalva maneuver

A

Forceful attempted exhalation against a closed airway.

67
Q

Time of day disc herniations are worse

A

Morning

68
Q

Cervical instability

A

Excessive motion between two adiacent cervical vertebrae

69
Q

Laminectomy is also known as

A

Spinal decompression

70
Q

Tight muscles in lower crossed syndrome

A

Iliopsoas (iliacus + psoas major), erector spinae, hamstrings

71
Q

What position would you put the ankle in to stress the peroneal nerve?

A

“PIP” Inversion + Plantar flexion

72
Q

Rib hump

A

The posterior rib prominence seen in patient’s with scoliosis .

Vista do lado convexo da escoliose qdo feito o test de adams(post view)

73
Q

Where does lumbar facet pain refer to?

A

Pain may refer to low back, glutes, hips, groin, or thighs (never below the knees)

74
Q

Pain characteristics of neurogenic claudication

A

Burning, tingling

75
Q

Crossover sign

A

When performing a SLR, on the unaffected side, the patient experiences pain in the affected leg

76
Q

Inner Unit muscles of lumbar spine

A

Transverse abdominis, multifidus, pelvic floor muscles, diaphragm

77
Q

Quadrant Test procedure

A

Patient extends lumbar spine, and side flexes and rotates to the side of pain. Overpressure is applied into extension by the therapist.

78
Q

Positive Quadrant Test finding

A

Reproduction of symptoms (low back pain) may indicate facet joint involvement

79
Q

Upper extremity position observed with Klumpke’s paralysis

A

Elbow flexion, forearm supination, wrist and MCP extension, PIP and DIP flexion

80
Q

Weak muscles in upper crossed syndrome

A

Deep neck flexors, lower trapezius, rhomboids, serratus anterior

81
Q

Spondylolysis

A

A defect in the pars interarticularis (no slippage)
Stress type of fracture due to repetitive dtress injury

82
Q

Pattern of distribution for neurogenic claudication

A

Proximal to distal, usually bilateral

83
Q

Which dermatome cover the index and middle finger?

A

C7

84
Q

Spondylosis

A

Degenerative changes in spinal motion segment (vertebral body and disc)

Artrite na spine

85
Q

In structural scoliosis the vertebral bodies are rotated to the side of the

A

convexity

86
Q

Discectomy

A

Removal of discal material that is pressing on a nerve root or spinal cord

87
Q

Sign of the buttock procedure

A

1) The therapist performs a SLR until the point of restriction. 2) The therapist proceeds to flex the knee to see whether an increase in hip flexion may be achieved.

88
Q

Signs and symptoms of cauda equina

A

Areflexive bowel and bladder (urinary retention, urinary and/or fecal incontinence),

sacral/saddle anesthesia,

LMN signs and symptoms (e.g., weakness/sensation impairments in lower extremities depending on nerve roots affected)

89
Q

Weak muscles in lower crossed syndrome

A

Abdominals, gluteals, multifidus, rotatores.

90
Q

Herpes Zoster

A

A viral infection of a nerve causing a painful skin rash (essentially re-activation of chicken pox)

91
Q

What is the pattern of the skin rash seen in shingles

A

Typical dermatomal pattern

92
Q

Observational signs of spondylolisthesis

A

Hyperlordotic posture, may present with step deformity

93
Q

Characteristics of spinal metastasis

A

Age >50,
Previous history of cancer,
Unexplained weight loss,
Constant unrelenting pain,
Pain unrelieved by rest,
Pain worsens at night
, Failure to improve with conservative therapy (within 1 month)

94
Q

Which intervention is contraindicated in a client with spinal instability

A

Mobilizations and manipulations

95
Q

Which positions or movements typically aggravate symptoms of client’s with postero-lateral disc hernation?

A

Flexion based positions (e.g., sitting, fetal position) and movements (e.g., bending forward, lifting from floor)

96
Q

Aggravating factor for neurogenic claudication

A

Spine extension, standing, walking, walking downhill

97
Q

Where does cervical facet pain refer to?

A

Neck and/or scapula region

98
Q

Signs and symptoms of VBI

A

5D’s: Dizziness, Diplopia, Drop attacks, Dysphagia, Dysarthria;

3N’s: Nystagmus, Nausea or vomiting, other
Neurological symptoms

99
Q

Which dermatome cover the thumb?

A

C6

100
Q

What position would you place the ankle to stress the tibial nerve?

A

“TED” Eversion + Dorsiflexion

101
Q

What are the muscles involved on the pelvic crossed syndrome?

A

Weak: abs and gluteals max and med

Tight: lumbar erector spinae and hip flexors( rectus femoris and iliopsoas)

102
Q

Pelvic crossed syndrome will lead to anterior or posterior pelvic tilt?

A

Anterior
Also increase of lumbar lordosis

103
Q

What are the inner muscles for lumbar control?

A

Transverse abd,lumbar multifidus,pelvic floor muscles and diafragma

104
Q

What are the muscles of the outer unit “primer movers”?

A

Rectus abs,internal/external oblique and erector spinal

105
Q

What is the test for lumbar instability?

A

Prone segmental inst test or
Prone inst test

106
Q

Which of the following is false regarding a Dowager’s Hump?

a) It is typically seen in older women
b) It is associated with trunk flexion
c) It occurs primarily in the lower back
d) It is due to anterior wedge fractures

A

C

107
Q

You perform a series of neurodynamic tests on a patient. Which is the correct position to bias the peroneal nerve?

a) Hip flexion, knee flexion, ankle plantarflexion, ankle eversion

b) Hip flexion, knee extension, ankle dorsiflexion, ankle inversion

c) Hip flexion, knee extension, ankle plantarflexion, ankle inversion

d) Hip extension, knee flexion

A

C

Peroneal nerve: PIP
PLANTAR FLEX AND ANKLE INVERSION

108
Q

Your 50 year old patient presents with low back pain that started 6 weeks ago after spending a weekend gardening at their cabin. On assessment, pain is increased with extension, side flexion, rotation, standing, walking and exercise in general. He also reports pain in his right thigh.
Myotomes, dermatomes and reflexes are all normal.

Which of the following back conditions is most likely leading to this patient’s current presentation?

a. Mechanical low back pain
b. Lumbar disc herniation
c. Spinal stenosis
d. Spondylolisthesis

A

Mechanical low back pain can refer to the buttocks and thighs. Note: This referred pain will never go below the knee.

• Pain is produced with forward flexion and often also on returning to the erect position.
Pain is often produced or aggravated with extension, side flexion, rotation, standing, walking, sitting and exercise in general.

• Pain is usually increased through the course of the day.

• Pain is relieved by lying down, especially in the fetal position.

109
Q

Your 50 year old patient presents with low back pain that started 6 weeks ago after spending a weekend gardening at their cabin. On assessment, pain is increased with extension, side flexion, rotation, standing, walking and exercise in general. He also reports pain in his right thigh.
Myotomes, dermatomes and reflexes are all normal.

Your patient states that he thinks the pain is getting worse with working at his job and feels that he would benefit from time off work. He is under a lot of stress at home and describes the pain to be unreliable and cyclical in nature. Which of the following statements is not a predictor of chronic pain?

a. Pain is getting worse with working.
b. Feels he would benefit from time off work.
c. Under a lot of stress at home.
d. Describes the pain as cyclical

A

D

Describes the pain as cyclical
• Common finding in mechanical low back pain

Predictors of Chronicity within the first 6-8 weeks (Yellow Flags):
• The longer some is off work with back pain, the lower the probability that they will return to work
• Time off work
• Compensation
• Psychosocial aspect of work
• Psychological distress
Beliefs about pain being work related
• Reported severity of pain at the acute stage Nerve root pain or specific spinal pathology

PCE (40 decks)

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