Study Guide

Question 1

OSE findings/dx/tx for piriforimis syndrome

Answer 1

Ext rotation of hip
+/- straight leg raise
MRI as last resort
OMT, PT

Question 2

OSE findings/tx for Psoas syndrome

Answer 2

flexed posture
psoas TP
OMT, PT

Question 3

OSE findings/dx/tx for Short Leg syndrome

Answer 3

Sacral base unlevel
Medial malleolus short after SDE is resolved
Postural Xray
Heel lift tx

Question 4

OSE findings/dx/tx for spondylolysis/-listhesis

Answer 4

Step-off of sinus process in lumbar flexion
AP, Lat, Obliq Xrays
OMT/PT, bracing, lifestyle changes (lite duty)
Surgery if severe

Question 5

Findings in spinal disc herniation

Answer 5

\+ SLR, LE weakness
MRI to confirm
acute = RICE
post-acute = OMT
Surgery if severe

Question 6

OSE findings/dx/tx for Cauda Equina syndrome

Answer 6

Bowel/bladder dysfunction, saddle anesthesia, bilat LE pain
MRI
SURGICAL EMERGENCY **must tx within 48 hrs

Question 7

Treatment recommendations for Carpal Tunnel Syndrome

Answer 7

Mild/Preg= usually self-limiting, wrist splints, NSAIDs, steroid inj
Moderate= OMT, splints, NSAIDs, steroid inj
Severe= signs of damage and muscle wasting--OMT at consult then surgical referral

Question 8

S/SX of carpal tunnel

Answer 8

(repetitive flexion injury) nighttime numbness of lateral 3.5 digits, tingling, wrist pain, loss of grip, thenar atrophy
**common in pregnancy

Question 9

DX for carpal tunnel

Answer 9

Gold-standard = EMG

+Phalen’s, +Tinel’s, two-point discrimination at 5mm

Question 10

Findings for degenerative disc deisease

Answer 10

**Non-specific LBP dx with Xray
TX with OMT, PT, NSAIDs
Surgery if severe

Question 11

Carpal Tunnel DX/TX

Answer 11

NSAIDs, OMT (MFR, ST, Lymph), Xray if concerned with fracture, MRI for ST injury (atrophy/severe/prolonged)
Surgical for severe or unresponsive

Question 12

Spinal compensation in psoas strain

Answer 12

loss of LSpine lordosis

Question 13

Spinal compensation in ageing

Answer 13

increased Tspine kyphosis

Question 14

Spinal compensation in pregnancy

Answer 14

increased Lspine lordosis and Tspine kyphosis

Question 15

Zink transition zones

Answer 15

OA
cervicothoracic
thoracolumbar
lumbrosacral
Compensated = LRLR (common) or RLRL (uncommon)

Question 16

General contraindications to OMT

Answer 16

PT refusal, acute fracture, surgical emergency, cranial OMT for acute head bleed (dural/subdural hematomas)

Question 17

OMT contraindications in LBP

Answer 17

Lumbar HVLA when Mets are present (avoid area)
HVLA w/ hx of osteoporosis
HVLA for acute lumbar herniation (relative contraind)
Direct tx for compression fracture (other than direct MFR)
HVLA in acute phase of RA

Question 18

Contraindications of OMT in pregnant pts

Answer 18

undx vaginal bleeding, preterm labor, placental abruption, ruptured membranes, incompetent cervix, eclampsia, ectopic, chorioamnionitis

Question 19

Contraindications for OMT in surgical PTs

Answer 19

Avoid direct manipulation over surgical sites for 2 weeks, abd plexus inhib if midline incision or AAA, sigmoid release if recent L hemicholectomy, mesenteric release if anterior abd incisions, rib raising if rib/spine fracture or surgery, pedal pump ABSOLUTE CI if DVT, LE fractures, or recent abd surgery, Lymph tx (relative) if osseous fx, bacterial infx w/ fever >102, abcess/local infx, TI relaease if upper rib fx/clavicle fx, liver or spleen if thoracotomy or chest tube

Question 20

Common SD in 2nd trimester of pregnant patient

Answer 20

pelvis rotating about R/L axis with forward torsion, increased pelvic tilt (ant innom rotation), increased lumbar lordosis, compensatory increase in T kyphosis (may lead to cervical strain)

Question 21

Alarm findings in pregnant patient

Answer 21

severe pain that interferes with function, particularly non-positional persistent pain at night, increased pain with cough, sneezing or valsalva maneuver; neuro deficits; bowel or bladder dysfunction; weakness, sensory deficits, abd reflexes

Question 22

Radicular pain in pregnancy

Answer 22

10% herniated disc
40% bulging disc
likely d/t mechanical pressure of ligamentous structures on nerve root – presents as parasthesias in ILIOINGUINAL AND GENITOFEMORAL NN distrobution (“lightning pains”)

Question 23

Reason for increase in LBP at night in pregnancy

Answer 23

stagnant hypoxia of neural and vertebral tissues
dependent edema moves back into the vasculature d/t osmotic gradient plus direct pressure on IVC by the uterus leads to decreased flow in pelvis therefore stagnant hypoxia of tissues and delayed LBP

Question 24

Hormonal cause for LBP in pregnancy

Answer 24

Relaxin leads to widening of SI joints and pubic symphesis beginning at 10-12 weeks; progesterone causes changes in mechanics of thoracic cage leading to increased circumference and widening of subcostal angle from 68* to 103*

Question 25

Results of scoliosis, RA and ankylosing spondylitis during pregnancy

Answer 25

``` Scoliosis = no increase in curve, may develop increase in pain, possible preterm labor RA = improves sx from conception to 6 wks PP AS = aggrivated d/t increased mechanical stress ```

Question 26

Reason carpal tunnel is common in pregnancy

Answer 26

Common in 2nd trimester d/t fluid retention and congestion

Question 27

DX/TX of ruptured pubic symphesis in pregnancy

Answer 27

Separation >1cm (<10mm); occurs <1%; audible crack heard; acute pain radiating to back or thighs, palpable gap w/ edema, waddling gait with pain Conservative TX...bed rest (lat recumb), pelvic binder, OMM (indirect tx), pain may recur in later pregnancies

Question 28

CS for PC tenderpoints

Answer 28

PC1 inion = F StRa PC3 = FSaRa Remaining = E SaRa

Question 29

CS tx for Posterior thoracic TPs

Answer 29

``` midline = E PT1-3 = E SaRa PT4-9 = E SaRt PT10-12 = E SaRa ```

Question 30

Anterior cervical CS

Answer 30

AC1 mandible and AC1 TP = SaRa AC 7 = F StRa (clav head) Remaining = F Sara

Question 31

Heel lift therapy

Answer 31

Typically tx only if length discrepancy is > 5mm (0.19685”) o Max ¼” heel lift in shoe, ¼” may be added to outside as well; ½” total o May add full 1/2 “ outside o Final lift height should be ½-3/4 of measured discrepancy, unless recent cause apparent o Replace full discrepancy w/ acute change in leg length

Question 32

UE and LE dermatomes

Answer 32

C5: motor to deltoid & biceps; sensation to lateral arm; bicep reflex - C6: wrist extension & elbow flexion; sensation to radial forearm, thumb and index finger; brachioradialis reflex - C7: Wrist flexion, elbow extension, finger extension; sensation to middle finger; triceps reflex - C8: finger flexion; sensation to ulnar forearm and small finger - T1: finger abduction; sensation to medial arm

Question 33

Role of ANS in disease

Answer 33

o 2 neuron chain connecting preganglionic neurons through ganglia  visceral target tissues : cardiac & sm m, secretory glands, CT, immune cells o Involuntary; regulated by hypothalamus, limbic system & brainstem; limbic forebrain  hippocampus, amygdala, prefrontal & cingulate cortex  SNS or PNS

Question 34

Describe clinical signs of viscerosomatic reflex dysfunction

Answer 34

Exhibit non-neutral Type II SD, increase in moisture (skin drag), increase in temp, poorly defined end point (rubbery), affects small rotators (rotatores)

Question 35

When to refer to PT

Answer 35

Techniques Used for Injuries  US: tendon injuries, pain relief  Phonophoresis: US medication delivery, inflammatory conditions  Iontophoresis: electric current, inflammatory conditions  Laser Therapy: ↓ PGE2  Electric Stimulation: generates AP; neuropathic pain, spasm

Question 36

when to refer to OT

Answer 36

Services Provided:  An individualized evaluation, during which the client, family, and OT determine the person’s goals  Customized intervention to improve person’s ability to perform ADL and reach goals  An outcome evaluation to ensure that goals are being met and/or to modify the intervention plan based on the pt’s needs & skills

Question 37

When to refer to surgery

Answer 37

cauda equina syndrome, spondylolisthesis, severe spinal stenosis, etc; pain is not indication for surgery, nerve compression is  EMG performed

Question 38

When to refer to massage

Answer 38

Techniques: Swedish massage (hypertonicity), deep tissue (trigger points), Shiatsu (rhythmic pressure on precise points of body), lymphatic (edema), Rolfing (ten-step approach to align structure) o Great for people with lots of chronic muscle tightness, stress, etc