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Flashcards in Other Exam Three Ortho Stuff Deck (63):
1

CPR for lumbar/SIJ manipulation: Probabilities of success

Probability of success:

  1. one positive: 46%
  2. two positive: 49%
  3. three positive: 68%
  4. four positive: 95%

Variables (basically same as manual category + 1):

  1. Duration of s/s < 16 days
  2. At least one hip with >35 degrees IR
  3. Hypomobility with lumbar spring test
  4. FABQ work subscale score
  5. no s/s distal to knee

2

Two Don'ts for Good Body Mechanics

 

Don'ts for Good Body Mechanics:

  1. Bend with our back or lift with your legs straight
  2. Twist your back when carrying a load

Six Do's for Good Body Mechanics

  1. keep your load close to your body (at arm's lenght the load on your back is 10x the load in your hands)
  2. Bend at the knees and maintain a straight back
  3. Turn with your feet not your back
  4. Keep the weight close to your body
  5. Push, don't pull objects
  6. When lifting, ensure that you keep one foot in front of the the other to maintain your balance

2

What to tell patients about posture and back pain:

 

"I want my back to stay happy, and my back is happiest when I am in good posture, so I keep two pillows on the couch, in the car, and at work. Your back wants to be in neutral position. If you do the work to keep your back happy, your back will be happy."

2

Cervical Traction, HNP angle of pull

 

15-20 degrees

2

Treatments for Lumbar Manual Classification: (4)

 

  1. CPA
  2. UPA
  3. Transverse Pressure
  4. Long Finger

3

Which evaluation tool is considered the 'gold standard' of low back functional outcome tools?

Oswestry Low Back Pain Disability Questionnaire

 

3

Five risk factors for Poor Posture

 

  1. Poor posture
  2. Tight muscles
  3. Weak muscles
  4. Poor body mechanics
  5. Poor fitness/Poor nutrition/Tobacco/Stress

4

Supine Spinal Progression (13)

 

  1. UL sh flex with ab brace
  2. Bilat sh flex with ab brace
  3. Alt knees to chest with ab brace
  4. Bilat knees to chest with ab brace
  5. Dead bug with ab brace
  6. Curl up with ab brace
  7. Rotational partical cit up  with ab brace
  8. reverse* curl-up w/ab brace (ecc sit up - full range)
  9. Bridge with march & ab brace
  10. Bridge feet on s. ball, knees bent) w/ab brace
  11. Bridge feet on s. ball, knees straight w/ab brace
  12. Supine ham curl with s. ball (w/ab brace?)
  13. S. ball pull-over with ab brace

*I had this word crossed out in my notes

5

Three Biofeedback options for ADIM

  1. Ultrasound
  2. BP cuff/stabilizer
  3. PT feeback

5

FABQ measurement characteristics

Measurement Characteristics:

  1. The FABQ hs been demostrated to be valid and reliable in chronic LBP population and
  2. appears to be useful screening tol for identifying actue LBP patients who will not return to work by 4 weeks

6

Relationship between cervical pain/ROM and thoracic manipulation

 

Research has indicated that thoracic manips can have a positive impact on cervical pain and ROM, so Dr. Worst often manipulates T-spine in patients with cervical pain, especially when cervical patients aren't improving with treatment onlh in the neck.

7

Sitting Ergonomics/Body-Mechanics Consisderations (6)

 

  1. Screen Height
  2. Desk height
  3. Chair (can you even put a lumbar support in it?)
  4. Do feet touch?
  5. Key-board distance
  6. Vision problems

8

High Kneeling Spinal Progression (6 - but 3 are in standing)

  1. Bilateral shoulder flexion
  2. Alternating shoulder flexion
  3. Body Blade (any direction)
  4. Wall Slides (standing)
  5. Forward lunge (standing)
  6. Backward lunge (standing)

8

How to do the BP cuff/stabilizer method of ADIM biofeedback

 

  1. Pump to 40 mmHg
  2. Usine to ensure absence of PPT compensation
  3. Hold for 10 seconds per rep
  4. Do 10 reps

9

Gibbus Deformity

 

Gibbus deformity:

  1. hump back deformity with is a localized, sharp posterior angulation
  2. Has sharper angule than Dowager's hump , which is more rounded

 

11

Two important themes/principles from McKenzie progressions

  1. Find the level that makes pt feel completely better (no need to do all the levels)
  2. Start by trying to keep hands off, progress to hands on if hands off exercises don't work

11

Two types of leg length differences:

 

  1. true leg length difference
  2. Functional/apparent leg length difference

12

Contraindications for throacic manipulation:

 

  1. Osteoporosis
  2. Chronic corticosteroid use (> 1 month)
  3. Recent fracture
  4. Spinal cord compression
  5. Cauda equina compression
  6. Active degeneration (RA)
  7. positional dizziness (dizziness brought on by C-spine movments)
  8. Malignancy
  9. Active inflammatory condition: osteomyelitis/Ankylosing Spondylitis

13

Prone Spinal Progression (3)

 

  1. Alternating hip extension
  2. Alternating shoulder flexion
  3. Superman!

14

Six tps for Good Posture

 

  1. Avoid sitting on soft, squishy chairs
  2. Use lumbar rolls to support your lower back when sitting in regular chairs or driving the car
  3. Switch to ergonimic chairs in the office, or for any activity that requires you to sit for long periods of time
  4. Make sure your mattress is supportive enought to keep your spine sraight when lying on your side
  5. Use a pillow that supports your neck
  6. Keep your back straight anduse your thigh muscles when lifting heavy weights

15

CPR for lumbar/SIJ manipulation: Variables (5)

Variables (basically same as manual category + 1):

  1. Duration of s/s < 16 days
  2. At least one hip with >35 degrees IR
  3. Hypomobility with lumbar spring test
  4. < 19 FABQ work subscale score
  5. no s/s distal to knee

Probability of success:

  1. one positive: 46%
  2. two positive: 49%
  3. three positive: 68%
  4. four positive: 95%

17

4 lumbar traction equipment parts that I find difficult to remember the names of

 

  1. pelvic harness
  2. thoracic harness
  3. wieght rope
  4. thoracic straps

18

Sitting Spinal Progression (4)

 

  1. Sitting balance on swiss ball
  2. marching in place sitting on swiss ball
  3. sit to stand from swiss ball
  4. Torso twisting with plyoball on swiss ball

19

Visceral Pain

Visceral: pain originating in visera

  • Deep vauge achey (could be sharp if bad)

21

Specific Exericse Tx Category indications (2)

  1. + repeated motion tests
  2. Strong preference for sitting or walking

21

Two Common types of lifting techniques

 

  1. Golfer's LIft
  2. Power Squat

22

McKenzie Extension Program II:

Posterior central symmetrical with kyphotic shift

(5)

 

  1. Prone over pillows (enough for patient to becomfortable)
  2. decrease number of pillows as pain lessens
  3. prone lying
  4. prone on elbows
  5. progress to extension progression

23

Traction

Cervical-specific Weight guidelines (any pathology)

 

7-10% body weight

No more than 30 lbs

24

Joint Dysfuction DDD: General Traction Guidelines (3)

 

  1. ON:OFF time 30:10 sec
  2. Duration: begin with 10-12 min, progress to 20 min
  3. 1-2 steps per patient comfort/tolerance

26

Effects of traction (cervical or lumbar): (3)

 

 

  1. Reduces amount of pressure on nerve roots,
    • pain
    • paresthesia 
  2. asissts in circulation and
  3. decreases muscle guarding and spasm

27

Manual Therapy Tx Category indications (4)

 

  1. Recent onset of s/s
  2. < 19 on FABQ-W
  3. + hypomobility (use spring test to assess)
  4. LB pain only OR no distal s/s below knee

28

Sign of the Buttock

 

Seven signs that suggest a series pathology (such as osteomyelitis, fx sacrum/pelvis, infection, sacroilities, gluteal hematoma, septic bursitis, ischiorectal absess, tumor, rheumatic bursitis) posterior to the axis of flexion/extension of the hip.

Seven Signs (the more present the more likely serious pathology exists):

  1. decreased SLR (if there is unilateral restriction, flex the knee and see if ROM increased. If it doesn't then the sign is +)
  2. decreased hip flex
  3. decreased trunk flex
  4. non-capsular pattern hip restriction
  5. painful & weak hip extension
  6. gluteal swelling
  7. empty end-feel on hip flexion

29

Two Kyphotic deformities

 

  1. Dowagers's hump: Caused by postmeopausal osteoporosis. Anterior wedge fractures occur to several vertebrae, usually in the upper and middle t-spine, causing a structural kyphosis that also contributes to a decrease in hight. Found in older women. More rounded than Gibbus deformity, which is more sharp and angulated.
  2. Gibbus deformity: hump back deformity with is a localized, sharp posterior angulation

30

Other name for ADIM

Abdominal bracing

 

31

Cute kitties to the rescue!

awwwwww

32

Traction Tx Category indications (2)

(the "fake" category)

  1. Distal s/s
  2. negative repeated motions testing

(basically they can go here if they have distal s/s and don't fit into any other category)

33

ADIM: what it stands for, what it is, how to ask pt to do it, common compensations

 

Abdminal Drawing In Manuver: Contration of TA & Multifidus together

Most common to teach in hooklying:

  • "take a deep breath in and as you exhale draw belly button in and up under ribs" - instruction for pt to help avoid them just sucking in tummy at the expense of breathing

Compensations:

  • Valsalva and pass out
  • Posteiror pelvic tilt (used to be enouraged, but now we believe it is better not to). It is more functional to perform ADIM & TA is better activated without psoterior pelvic tilt)

34

Traction:

Lumbar-specific Weight guidelines (any pathology)

 

30-40% body weight

no more than 50% body weight

35

How To do Golfer's lift

 

Only for picking up light things (like a pen off the floor)

  1. Reach with one arm
  2. Kick out contralateral leg to back

Good to show pt who has back pain

Don't need to produce any power with this movment

36

Draw Three Types of poor posture & normal posture

 

  1. Forward head posture
  2. Sway back posture
  3. Flat back posture
  4. Normal posture

38

Indications for Cervical (5) & Lumbar traction (7)

 

Cervical

  1. Nerve impingement
  2. Hypomobility of joints from degeneration changes
  3. Joint pain from facet joint impingements
  4. muscle guarding/spasms
  5. HNP

Lumbar, Add the following to Cervical:

  1. DDD
  2. Sciatica

39

Five Do's for Good Body Mechanics

 

  1. keep your load close to your body (at arm's lenght the load on your back is 10x the load in your hands)
  2. Bend at the knees and maintain a straight back
  3. Turn with your feet not your back
  4. Push, don't pull objects
  5. When lifting, ensure that you keep one foot in front of the the other to maintain your balance

Don'ts for Good Body Mechanics:

  1. Bend with our back or lift with your legs straight
  2. Twist your back when carrying a load

41

Somatic Pain:

 

Somatic: structures such as bones, tendons, skeletal, muscles, etc.

  • deep, vauge (relatively)

 

42

FABQ subscales

 

FABQ consists of 2 subscales

  1. Phisial Activity subscale
  2. work subscale

Each subscale is grated separately

 

43

Two approaches to core stabilization

  • Specific apprach (trying t isolate TrA and Multifidus with little acivation of others
  • Global Approach (strenghten everything and the back pain gets better

Most clinicians are in the middle: start with foundation (specific approach) and then build house (global apporach after specific muscles have been found)

44

Dowager's hump (4)

 

 

  1. Caused by postmeopausal osteoporosis.
  2. Anterior wedge fractures occur to several vertebrae, usually in the upper and middle t-spine, causing a structural kyphosis that also contributes to a decrease in hight.
  3. Found in older women.
  4. More rounded than Gibbus deformity, which is more sharp and angulated.

 

45

Reset pelvic alignment before testing with _________ manuver

Weber-Barstow manuver

47

3 kinds of pain:

 

  • Visceral: Deep vauge achey (could be sharp if bad)
    • pain originating in viscera
  • Somatic: deep, vauge (relatively)
    • structures such as bones, tendons, skeletal, muscles, etc
  • Radicular: superficial, sharp, electric, specific
    • Nerve (root)
    • Pretty easy to have periph or centr

49

What evaluation too was developed by Waddell ot investigate fear-avoidance beliefes among LBP patients in athe clnical setting?

 

Fear Avoidance Beliefs Questionnaire (FABQ)

50

Treatments for Stability Lumbar Classification:

(one broad category)

 

  1. Core Stabilization

51

McKenzie Extension Progression I:

Posterior centrral summetrical no deformity/shift (gradual incremental increase in extension)

(6)

  1. Standing extension
  2. Prone extensions (hang feet oof to help get glute relaxation)
  3. Prone extensions with self-overpressure (belt fixation or lock an sag)
  4. Prone extensions with therapist overpressure (without blocking motion; pt doesn't need to do sag)
  5. Extension mobilizations (CPAs)
  6. Extension manipulation (hardly ever get there)

52

What is the thing that holds the head called in cervical traction?

 

Occiput halter

53

HNP: General Guidelines for Traction (4)

 

  1. ON:OFF time 60:20 sec
  2. Duration: begin with 3-5 min, progress to 15 min
  3. Steps 1st time begin with 3 steps, if tolerated 2 steps

54

Radicular Pain:

 

Radicular: Nerve (root)

  • superficial, sharp, electric, specific
  • Pretty easy to have peripheralization or centralization

55

Cervical Traction, DDD angle of pull

 

>20 degrees

56

How to clear L-Spine (4)

 

  1. Lumbar ROM (100% of the time)
  2. Repeated motion tests
  3. Lumbar Palpations for comparable sign
  4. Lower Quad Neuro Screen (esp if distal s/s) or was it Lower Quad Neurodynamic screen?

57

Stabilizaiton Exercises Tx Category indications (5)

  1. Younger age
  2. + Prone Instability Test
  3. + Hypermobility (use spring test to assess)
  4. Greater ROM in SLR
  5. Abberent Movement (need at least 1 to be +)
    • Gowers Sign (hard to get up, see pic)
    • Instability catch (pop/catch/click) in L-spine
    • Rev ersed Lumbopelvic Rhythm (hip then back is reversed for flexion)

58

Precautions for thoracic manipulation: (13)

 

  1. undiagnosed, unexplained, non-incidnet related pain (don't manip pain with cause unkown to you)
  2. history of cancer
  3. Gross psych overlay (things pt says don't make sense)
  4. osteoporosis suspected (especially elderly)
  5. spondylolistheisis
  6. instability
  7. pregnancy (3rd trimester - 2 months after birth)
  8. Spintal fusions
  9. gross foraminal encroachment
  10. acute nerve compression/irritation
  11. children/teenager
  12. acute whiplash
  13. vertebral artery issues
  14.  

59

Are SI problems second to trauma or no trauma?

 

SI issues can be atraumantic or traumantic

  • Traumatic ideology: SIJ sprain, fall on your bottom, jumping and land one-legged
  • Atruamatic ideology: the pregnant/postpartum population is more prone to atraumatic cause because the hormone relaxin is released during the 3rd trimester.

60

Treatments for Special Exercises Lumbar Classification:

(5)

 

  1. Extension progression (directional progression)
  2. Posture training/education
  3. Lumbar support
  4. Lifting mechanics
  5. Limit reptitive flexion (or extension)

61

Five Best Exercises for the Core

 

Always start 2-5 with ADIM first

  1. ADIM
  2. Crunch - hands behind head but should not be able to see elbows in peripheral vision; look at ceiling.
  3. Bridge (supine)
  4. Quadriped Alternating UE & LE (put something across low back that will fall off if pt tips)
  5. Plank (elbows) with UE & LE lift

62

Two Indications for manipulation:

 

  1. Loss of ROM
  2. hypomobility with spring test

63

normal angle of inclination

125 degrees