SPINE Flashcards
1
Q
In the lumbar spine - can you get pure side flexion or pure rotation
A
no they will always have a component of the other one
2
Q
why can you not get pure side flexion or rotation in the lumbar spine
A
due to the shape of the facet joints
3
Q
What is the osteo and arthro kinematics of lumbar flexion
A
Osteo: anterior saggital rotation + anterior translation
Arthro - Anterosuperior glide
4
Q
What is the osteo and arthro kinematics of lumbar extension
A
Osteo: Posterior saggital rotation and poserior translation
Arhro: Posteroinferior glide
5
Q
What is the osteo and arthro kinematics of right lumbar side flexion
A
Osteo: Inferior movement right side of vertebra
Arthro: Inferior glide at the right, superior glide at the left
6
Q
What is the osteo and arthro kinematics of right lumbar rotation
A
osteo: gapping of the right facet joint, compression of the left facet joint
arthro: depends on coupling with sideflexion, whether it is ipsilateral or contralateral
7
Q
What are the general components of the scan
A
- General mobility
- General stability
- Neural conductivity
- Neuromeningeal (dural) tests
- Vascular tests
- Lower quadrant screening
8
Q
Components of a subjective history
A
- Age
- Occupation
- P/C forces involved e.g. Flexion, rotation, traumatic/insidious onset, pain location, diurnal variation
Aggravating/Easing
Generally improving? Generally getting worse?
PMHx
Fhx
General health
Meds
Investigations AND results
Sleeping affected? Position/pillows
Sports/activities
Previous treatment and results
9
Q
Which questions are important for spinal cord and cauda equina involvement
A
Bladder/bowel dysfunction
Saddle paraesthesia
Anaesthesia
10
Q
What do you ask about cough and sneeze
A
raises interdiscal pressure
11
Q
What is neuro symptoms inclusive of
A
Numbness, tingling, pins and needles, loss of sensation, leg pain
12
Q
What is the effect of diabetes on tissue healing
A
slows it
13
Q
Why might you do a scan?
A
- Rule out serious pathology
- Determine whether appropriate for PT or referral or co-treat
- Zero in on appropriate area, spine vs. peripheral, upper vs. lower spine
- a necessary component of all lumbar spine examination
14
Q
What are two commonly used outcome measures for back pain
A
Rolan Morris
Oswestry
15
Q
How many items are on the Roland Morris? measuring what? What is the MCID ? what is the scoring?
A
24 items Measuring function today MCID 1.5-5 points Score 1-24 24 = max disability
16
Q
How many items are on the Oswestry? What is the MCID ? what is the scoring?
A
10 questions, each score 1-5. Max 50
MCID 4-6
17
Q
What components of a lumbar spine scan do you conduct in standing
A
- Observation
- active mobility tests
- Squat
- Kinetic tests
- S1 Myotome
18
Q
What components of a lumbar spine scan do you conduct in sitting
A
- Slump test
- L3 reflex
- S1 reflex
19
Q
What components of a lumbar spine scan do you conduct in supine
A
- SLR
- Myotomes L2, 3, 4, 5. S2
- Dermatomes, L2, 3, 4, 5 S1, S2
- General traction
- General compression
- Plantar response
- CLonus
- Pelvic stability tests (distraction + compression)
- Pulses
- Faber
20
Q
What components of a lumbar spine scan do you conduct in prone
A
- Femoral nerve stretch
- myotomes S1, S2
- Dermatomes S1, 2,
- Farfans general torsion test
- Facilitated segment tests
- S1 reflex
21
Q
What is Farfans test
A
General torsion test - testing ability of lumbar spine to tolerate rotary force
22
Q
How do you name Farfans test
A
If you lift the right pelvis back - the upper bones are going to the left therefore it is a left test
23
Q
What is a positive on Farfans test
A
Pain
24
Q
What is normal range for knee flexion in the femoral nerve test
A
90-110
25
How do you treat hypermobility
exercise +/- external support
26
What are two spinal cord reflexes
plantar response
| clonys
27
What is a positive plantar response called? what does it indicate?
Babinski
| UMN lesion
28
What is the normal response for clonus in adults over 40
1-2 beats
29
What does an impairment of spinal cord reflexes indicate
serious pathology: central disc pressing on cord, infection, space occupying lesion, neurological condition
30
What is a hard neurological sign? what does it imply?
Loss of myotome and/or reflex and/or sensatoin
| Impairement of nerve conduction
31
What may cause an impairment of nerve conduction leading to a hard neurological sign
disc
local inflammation
stenosis
32
What does the healing time of impaired nerve conduction depend on
Whether it is a neuropraxia, axonotmesis, neurotmesis
33
Differentiate neuropraxia, axonotmesis, and neurotmesis
Neuropraxia: transient conduction block or motor or sensory without nerve degeneration (motor more common)
Axonotmesis: moderate, axon damage but intake endoneurium, perineurium, epineurium
Neurotmesis: Most serious, both nerve and nerve sheath, nerve completely divided
34
How would you know if impairement of nerve mobility is a serious concern
if there are hard neurological signs
35
What are symptoms of mechanical pain
MOI
Specific aggravating + easing factors
Predictable patterning
36
What are the symptoms of inflammatory pain
- First 24hours post injury or may not be as a result of injury
- Worse in morning of after immobilisation
- Better with a little rest but worst with prolonged rest
- better with a little mobility but worse with too much movement
37
What are the signs of mechanical pain
- pain with selective tissue tension tests
38
What are the signs of inflammatory pain
- Red/hot/swollen
| - Acute inflammation can also cause decreased mobility
39
What is pain on the eccentric component of a test indicative of
tendon involvement
40
Generally - what are mobility tests for the lumbar spine
PIVM and PAVM
41
Generally - what are the stability tests for the lumbar spine
```
Compression
Traction
Torsion
Anterior shear
Posterior shear
```
42
Where do you typically start when doing PIVMs of the lumbar spine
Thoracolumbar junction and move caudally
43
What are some contraindications to lumbar PAs
- Spondylolisthesis
- Fracture
- Infection (osteomyelitis)
- Neoplasm
.... (at specific segment)
44
What are some precautions to lumbar PAs
- Osteopenia
- Osteoporosis
- Inflammation
- Active cancer
- Acute trauma
- Hypermobility
45
What are you assessing with lumbar PAs
```
Mobility (hypo- or hyper-)
Provocative tests (seeing if pain or spasm is evoked)
```
46
How long should you do PAs for when using as treatment
90 seconds
47
What are some things that would make you cautious upon noticing on observation
- Step deformity (instability)
- Facilitated segment
- Crease
- Changes in skin colouration (port wine stain, cafe au lait - these tell you there may be something going on with the architecture beneath)
- Tuft of hair (same as colouration)
- Scoliosis (change in underlying angles and architecture)
48
How should PAs be angle to assist with flexion and extension
- Cranially 45 deg for flexion
| - Caudally for extension
49
What are you assessing for in a PA
Presence of pain
Quality of segmental motion
Range of segmental motion
End Feel
50
What is the purpose of a PA Unilateral pressure
Test joint mobility for sideflexion/rotation
| To determine if one Z-joint is stiffer or more painful than other side
51
PA Unilateral pressure can be angled which ways for which motions
Caudally for ipsilateral side flexion
| Cranially for contralateral side flexion
52
What are the primary structures being tested in traction
```
Disc
Anterior&posterior longitudinal lig
Supraspinous lig
Intraspinous lig
Ligamentum flavum
```
53
What is a positive compression test
pain in the back or leg
Spasm
Empty end feel
Limited ROM
54
What are the primary structures being tested by Compression
Vertebrae
Facet Joint
Disc?
55
Torsion is the name applied to a ____
rotation stress
| unphysiological amount of rotation
56
What is a positive torsion test
Pain
Laxity
Soft end feel
Spasm end feel
57
Picking on the right ASIS is a ____ torsion test
Lef
58
If you rotate R which facets are compressed and which are gaped
Gap on R facet
| Compression on L facet
59
What are the primary structures being tested in a rotation test
Disc
Facet
Capsule
60
Can lumbar facet joints do pure rotation
no - always combined with side flexion
61
How many degrees of pure rotation does the lumbar spine have
3
62
Capsular pattern in the spine =
Painful, limited ipsilateral side flexion, rotation, and extension. Full but painful flexion at the end of range
63
Disc lesion symptoms:
LBP +/- leg pain
LBP +/- root pain
Aggravated by sitting, flexion, cough/sneeze
64
Disc lesion signs
Non-capsular pattern
+/- root signs
+/- dural signs (SLR slump)
+ve torsion/compression
65
Spinal stenosis symptoms
LBP +/- leg pain
| Aggravated by standing & walking, relieved by sitting down (flexion)
66
Spinal stenosis signs
Capsular/non-capsular pattern
+/- root & dural signs
May involve more than one segment
67
Spondylolithesis symptoms
LBP +/- leg pain
Aggravated by prolonged standing, walking, extension
Eased by flexion
68
Spondylolithesis signs
Step deformity
+/- muscles changes
+ve stability test (i.e instability)
69
Sacroiliac dysfunction symptoms
Buttock +/- leg pain
| Aggravated by turning, twisting, swing phase, in& out of car, weight bearing
70
Sacroiliac dysfuntion signs
Local tenderness +/- kinetic testing
| +ve stress tests (SI joint)
71
Zygapophyseal joint dysfunction symptoms
LBP +/- leg pain
| Aggravated by extension, maybe by stretch
72
Zygopophyseal joint dysfunction signs
Non-capsular pattern
| +ve flexion or extension quadrant
73
Spondylosis Degenerative disc D, Degenerative Joint D Symptoms
LBP +/- leg pain
LBP +/- root pain
Stiff, worse when still, better with movement
74
Spondylosis Degenerative disc D, Degenerative Joint D signs
Often a capsular pattern
| X-ray evidence of widespread degenerative changes
75
What three general categories decide the choice of technique to be used (i.e manual, mechanical, or active)
- Presenting signs & symptoms
- Impairment
- Stage of healing
76
What is the purpose of biomechanical counselling
to give the patient skills for self-management, education about preventing reinjury and to provide optimum conditions for healing
77
4 main principles of treatment applied to the spine
- Treat according to findings on subjective and objective exams
- Treat according to the end-feel (grade 1-2 for pain...etc)
- Treatment time will be dictated by joint irritability and stages of healing
- Reassess frequently
78
When is a soft tissue lateral flexion technique used
for general soft tissue stretching
For multisegmental tightness
To decrease a long SF curve (non-structural scoliosis)
79
When is traction used
- Relieve compressive forces
- Provides gentle movement to painful segments
- assess suitability for mechanical traction
80
What might you use for someone who is too sore to tolerate PAs
General rotation
81
What is your line of force for general rotation
line of femur
82
General rotation is for which grades
1 and 2
83
What type of rotation do you do for grades 3 and 4
rotation combined with flexion
84
Which muscles atrophies very quickly following LBP
Multifidus
85
What may someone standing up using their legs or nearby furniture be indicative of
An instability - trying to use legs/furniture to self-stabilize
86
Prescription for mobilizations?
3 sets of 10 - check in with how they are doing often.
| repeat 3x for total of 90
