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MSA > Thoracic/ Lumbar Spine > Flashcards

Thoracic/ Lumbar Spine Flashcards

1
Q

What are the atypical throacic vertebrae?

A

T1, T10-12

  • Full costal facet that accepts the entire head of the first rib and demifacet for second rib
  • T10-T12 MAY lack costotransverse joint
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2
Q

What is the most common site of problems in the vertebral column?

A

L5-S1

  • Bears more weight than any other segment
  • Center of gravity passes directly through
  • Transition from mobile to fixed segment
  • Greater angle between vertebrae
  • Greater amount of movement compared to other segments
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3
Q

What direction does the cervical spine provide the greatest ROM? Thoracic? Lumbar?

A

Cervical - rotation
Thoracic - Lateral flexion (greatest protection of spinal cord, less ROM)
Lumbar - Flexion/ Ext (equal amounts of protection and ROM)

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4
Q

What is the facet joint angle in the cervical spine? ROM in flex/ext, Rotation, and Lat flex?

A

45 degree angle (equal in all 3 planes)

  • Flex/ext = 120-130
  • Rot = 65-75
  • lat flex = 35-40
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5
Q

What is the facet joint angle in the thoracic spine? ROM in flex/ext, Rotation, and Lat flex?

A

15-25 degrees (frontal plane bias)

  • Flex/ext = 50-65
  • Rot = 30-35
  • lat flex = 25-30
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6
Q

What is the facet joint angle in the lumbar spine? ROM in flex/ext, Rotation, and Lat flex?

A

25 degrees (sagittal bias)

  • Flex/ext = 50-75
  • Rot = 5-7
  • lat flex = 20
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7
Q

compression of the lumbar nerves in the central canal causing sensory and motor deficit, saddle anesthesia, and bowel and bladder dysfunction.

A

Cauda equina symptoms?

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8
Q

What are the S and S of caudal equina syndrome?

A
  1. Low back pain
  2. Loss of sensation in the lower extremities
  3. Muscle weakness and atrophy
  4. Bowel and/or bladder changes
  5. Perineal pain
  6. Saddle and perineal hypoesthesia or anesthesia
  7. Unilateral or bilateral sciatica
  8. Change in deep tendon reflexes (reduced or absent in lower extremities)
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9
Q

Helps identify those patients who may benefit from psychosocial interventions, pain science education; Used in the clinical prediction rule for LBP

A

FABQ

  • 16 item questionnaire designed to quantify fear and avoidance beliefs for LBP patients
  • Self-reported questionnaire consisting of 16 questions scaled from 0 to 6 (maximum score of 96; higher score indicates fear avoidance behaviors).
  • FABQ-PA >14 & FABQ>34 associated with higher likelihood of disability and work
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10
Q

When a spinal segment locks or gets stuck, what does this indicate?

A

dislocation or subluxation of a facet joint

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11
Q

Pt may not be able to rotate away from side with _____ restriction.
During flexion patient may rotate [towards/ away from] the side of the restriction

A

flexion/opening; towards

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12
Q

Pt may not be able to rotate towards side with ______ restriction
During flexion pt may rotate [towards/ away from] the side of restriction

A

extension/closing; Away from

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13
Q

Neither facet joint will open and is stuck in a closed/extended position in a bilateral flexion restriction. How will the transverse processes be positioned in relation to the other segments at end range flexion?

A

More posterior

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14
Q

Neither facet joint will close and is stuck in a open/flexed position in a bilateral extension restriction. How will the transverse processes be positioned in relation to the other segments at end range extension?

A

more anterior

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15
Q

Right facet joint will not open and is stuck in a closed/extended position; Right transverse process will be more posterior in relation to left transverse process in flexion when patient is flexed

A

Unilateral R flexion restriction

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16
Q

Right facet joint will not close and is stuck in a open/flexed/anterior position; Right transverse process will be anterior in full extension

A

Unilateral R extension restriction

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17
Q

Weakness of the hip __, hip ____, and ___ are linked to patients with chronic LBP

A

ER; abductors; quads

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18
Q

What muscles should fire first when assessing pattern of core muscles?

A

TA and multifidi

- diaphragm and pelvic floor m’s are also important for core stability

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19
Q

What are the implications of a positive Stork/ Trendelenberg test?

A

(one-leg standing)

  1. Implication – pars interarticularis stress fracture (spondylolysis), if fracture is unilateral standing on ipsilateral leg will be more painful. Iliopsoas pulls the vertebrae anteriorly
  2. Pain with rotation and extension may indicate facet joint pathology to the side of rotation
  3. Pain specifically at the PSIS may indicate SI joint irritation
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20
Q

What are the implications of a positive quadrant test?

A

(standing extension with rotation)

  1. Implications – local pain facet joint pathology, radicular pain compression of intervertebral foramina
  2. Pain specifically at the PSIS may indicate SI joint irritation
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21
Q

What is the correct sequence of movements in Slump test 1?

A
  1. Thoracic and lumbar flexion
  2. Cervical flexion
  3. Dorsiflexion
  4. Knee extension (active or passive)
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22
Q

The SLR is highly sensitive. What does this mean?

A

a negative SLR can RULE OUT disc herniation (that can be misconstrued as SI pain)

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23
Q

During SLR, what range is indication disc herniation?

A 
35-70*
- above 70* indicates problem is probably joint pain
sensitizing maneuvers:
- SLR with DF – tibial
- SLR with DF/add/IR – sciatic
- SLR with inv/PF – peroneal
- SLR with inv/DF - sural
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24
Q

The crossed SLR is highly specific. what dies this mean?

A

A positive SLR can RULE in disc herniation

- contralateral S and S

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25
Q

Loss of the ability of the spine to maintain its pattern of displacement under physiologic loads; results from loss of control during movement from weakness of the “supporting” structures; occurs with disc degeneration, can indicate segment is structurally unstable (spondylolithesis)

A

Lumbar instability

- can result in an instability catch or sudden shift of movement in part of the ROM

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26
Q

Pt. flexes their body forward as far as possible and then returns to erect position; Positive test – pt. is unable to return to erect position because of sudden low back pain

A

Instability catch sign test

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27
Q

How can you interpret the prone instability test?

A
  • If a reduction or complete elimination of symptoms is noted with Step 2 PA mob as compared to Step 1, it is considered a positive test. Lifting the legs off the floor causes co-contraction of the gluteals, erector spinae, and deep segmental stabilizers which in turn stabilizes the segment where the P/A force is being applied, thus decreasing or eliminating symptoms
  • Positive test indicates dx of lumbar core instability and PT will need to address this with core strengthening in the POC
28
Q

Pt. in supine position lift both legs while in full knee extension and then return legs slowly to table. Tester has hand placed under lower back region; Positive test – Patient unable to control position of back or speed at which legs fall down

A

Double leg lowering test

29
Q

Prone position, elevate both legs simultaneously to a height of approx. 30 cm while maintaining knee extension and gently pulling the legs; Positive test – Pt. reports strong pain in lumbar region and pain disappears when legs are returned to initial position

A

Prone lumbar extension test

30
Q

What criteria are used to detect malingerers?

A

Waddell criteria

  • tenderness in areas that don’t anatomically add up
  • axial loading elicits pain
  • SLR findings are inconsistent in sitting vs standing
  • weakness and sensory regional disturbances not addingup
  • overreaction (most important)
31
Q

What common postures increase stress to the SI joint? What activities increase pain?

A 
Posture:
1. Standing on one leg
2. twisting
3. long periods of sitting
Activities:
1. Climbing/ descending stairs
2. walking
3. sit to stand
32
Q

What can cause a pelvic obliquity?

A
  1. Leg length difference
  2. M. tightness/ contractures and weakness
  3. Scoliosis
33
Q

Where do you palpate for pelvic obliquity?

A

Level of:

  1. ASISs
  2. iliac crests
  3. pubic bones
  4. PSISs
  5. Ischial tuberosities
  6. Gluteal folds
34
Q

ASIS is higher and PSIS is lower on affected side when compared to other side

A

Unilateral posterior innominate rotation

35
Q

ASIS is lower and PSIS is higher on affected side when compared to other side

A

Unilateral anterior innominate rotation

36
Q

What cluster of tests are used to identify pelvic obliquitiy?

A
  1. Standing flexion test
  2. Sitting PSIS palpation
  3. Supine long sitting test
  4. Prone knee flexion test
37
Q

Palpating PSISs while pt. bends forward in standing; Positive test – superior movement of 1 PSIS compared to the other side

A

Standing Flexion Test

38
Q

How should a positive standing flexion test be interpreted? How should it be treated?

A
  • Interpretation – hypomobility of SI joint (limited movement on the side of the superior PSIS); Lumbar segments that are “stuck” in a closed position and aren’t opening during proper Lumbopelvic rhythm cause SI to elevate superior and sooner during motion into flexion than the other side.
  • Treat LUMBAR spine to lead to better SI mobility if this test is +
39
Q

With pt. in supine compare the lengths of the inferior aspects of both medial malleoli; While examiner holds medial border of the medial malleoli with the thumbs, the pt. is asked to come to a long sitting position; Positive test –affected leg in supine that is corrected when in long sitting position (where patient is weight bearing on B ischial tuberosities and pelvis is in neutral alignment)

A

Supine Long Sitting Test

40
Q

How should a positive supine long sitting test be interpreted?

A

shorter leg in supine that equalizes in long sit suggests posterior innominate rotation when clustered with other pelvic obliquity tests
- longer leg = anterior tilt

41
Q

Compares apparent leg lengths with pt. in prone with knees fully extended and knees flexed to 90 degrees ; Visually examine the left and right heels in each position; Positive test –shortening of affected leg when knees extended that is “corrected” when knees are in flexed position

A

Prone knee flexion test
- In prone with straight legs position the pelvis is allowed to move into the position of rotation where obliquity may be observed

42
Q

How would you interpret a positive prone knee flexion test?

A

suggests posterior innominate rotation when clustered with other pelvic obliquity tests
- if there is still a leg length discrepancy in knee flexion, there is a true leg length discrepancy

43
Q

What are the clustering of special tests that would indicate SIJ disfunction as the cause of pain?

A
  1. Patrick’s Test or FABER
  2. Thigh Thrust Test (post. shear test)
  3. Iliac Compression Test
  4. Iliac Gapping Test
  5. Gaenslen’s Test
  6. Sacral Thrust Test
44
Q

Pt. in supine; Examiner places pt.’s leg so that foot in on top of opposite knee (flexion, abduction, ER); Positive test – pain in PSIS region

A

Patrick’s test or FABER

45
Q

How should a positive FABER test be interpreted?

A

SI joint dysfunction (for pain in PSIS region)

46
Q

Pt. in supine with hip at 90 degrees with slight adduction and knee flexed; Examiner’s hand cups the sacrum and other arm wraps around knee; Pressure applied posteriorly along the femur; Posterior shearing force to SI joint; Positive test – pain in PSIS region

A

Thigh thrust test

47
Q

How should a positive thigh thrust test be interpreted?

A

SI joint dysfunction

48
Q

Pt. in sidelying with hips and knees flexed ; Examiner applies a force vertically downward on the upper iliac crest; Compression force to both SI joints; Positive test – feeling of pressure in the SI joint, reproduction of symptoms (pain)

A

Iliac Compression test

  • hands should be on posterior ilium for compression
  • can do gapping with this test if hands are placed anterior near ASIS
49
Q

How should a positive iliac compression test be interpreted?

A

SI joint lesion and/or sprain of the post. SI ligaments

50
Q

Pt. in supine while examiner applies crossed-arm pressure to the ASISs; Pushing down and out; Positive – unilateral gluteal or posterior leg pain

A

Iliac gapping test

  • down and out for gapping
  • JUST out for compression
51
Q

How should a positive iliac gapping test be interpreted?

A

sprain of ant. SI ligaments

52
Q

Pt. in supine near edge of table; One leg hangs over edge of table into hip extension and other hip and knee are flexed towards the chest; Examiner applies firm pressure to knee being flexed and counter pressure to the knee hanging off edge; Post. rotation force to SI joint on flexed side and ant. rotation force to SI joint on extended side; Positive test – Pain in PSIS region on either side

A

Gaenslen’s Test

53
Q

How should a positive Gaenslen’s test be interpreted?

A

SI joint dysfunction

54
Q

Pt. in prone; Examiner applies a force vertically downward to the center of the sacrum; Anterior shearing forces of the sacrum on ilium; Positive test – pain in PSIS region

A

Sacral Thrust test

55
Q

How should a positive sacral thrust test be interpreted

A

SI joint dysfunction

56
Q

What test should you always perform with post partum women?

A

Active SLR test
- can compress SI joint area, pain, or poor motor control: due to SI joint dysfunction or inability to use core m’s to stabilize SIJ area

57
Q

What is the bridge test used for?

A

observing fun in assessment

  • pt should use gluts to extend, NOT erector spinae
  • implicates weak glut Medes or myokinematic firing
58
Q

What TBC would the following patient fall under:

  • no sx distal to the knee
  • recent onset of symptoms (< 16 days)
  • Low FABQ score (<19)
  • Hypomobility of the lumbar spine
  • Hip IR ROM (>35* for at least 1 hip)
A

Manipulation

59
Q

What TBC would the following patient fall under:
- Younger age – less than 40 y
- Greater general flexibility (postpartum, average SLR ROM >91°)
- “Instability catch” or aberrant movements during lumbar flexion/extension ROM
- Positive findings for the prone instability test
For patients who are postpartum:
- Positive posterior pelvic pain provocation (P4), and ASLR and modified Trendelenburg tests
- Pain provocation with palpation of the long dorsal sacroiliac ligament or pubic symphysis

A

Stabilization

60
Q

What TBC would the following patient fall under:

  • Symptoms distal to the buttock
  • Symptoms centralize with lumbar extension
  • Symptoms peripheralize with lumbar flexion
A

Specific exercise (activities to promote centralization)
Can fall under directional bias:
- Extension = preference for extension
- flexion = >50 yrs, preference for flexion, and imaging evidence of spinal stenosis
- Lateral shift = visible from frontal plane deviation of shoulders relative to pelvis, and directional preference for lateral translation movements of the pelvis

61
Q

What TBC would the following patient fall under:

  • Signs and symptoms of nerve root compression
  • No movements centralize symptoms
A

Traction

62
Q

Pain that is described as adaptive, transient, and has protective role

A

Acute pain

- an unpleasant experience

63
Q

Pain that is described as maladaptive, persists, and plays a role in neuroplasticity

A

Chronic pain

  • life changing
  • disease
64
Q

How do people treat pain?

A
  1. “Take foot out of the fire” - avoid movement, fear avoidance, pull back
  2. “Put fire out” - pain medications, spinal injections (pill nation; brain can produce opiates at 50x greater ability)
  3. “cut the wire” - surgery (lumbar surgeries have poor success rate)
65
Q

How should you address pain with a patient in order to promote a good relationship and best treatment for the patient?

A
  1. Direct interaction with a therapist
  2. Seek first to understand, then to be understood
  3. Individually tailored curriculum - PT should use stories, metaphors, images, and examples that fit pt’s unique circumstances
  4. Believable and beneficial content
  5. Reinforcement through the environment

MSA (13 decks)

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