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Part III Vignettes > Vignettes > Flashcards

Flashcards in Vignettes Deck (23)
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1

17 yo female cheerleader with bouts of LBP deep dull ache 6/10 standing stork positive
X-ray = no spondy, hyperlordosis

Clinical findings:

Increased L lordosis

Tight/hypertonic quadriceps/psoas

Inhibited abs

Hypertonic lumbar erectors

2

17 yo female cheerleader with bouts of LBP deep dull ache 6/10 standing stork positive
X-ray = no spondy, hyperlordosis

Best tx options:

Side posture adjusting (normalizes curve more than prone)
Continue normal activities
Anti-lordotic bracing (temperary palliative thing)

3

17 yo female cheerleader with bouts of LBP deep dull ache 6/10 standing stork positive
X-ray = no spondy, hyperlordosis

WOTF strengthened

Hamstrings
Gluteus maximus
Transverse abdominus

4

Scheurmanns adjust

Prone

5

17 yo female cheerleader with bouts of LBP deep dull ache 6/10 standing stork positive
X-ray = no spondy, hyperlordosis

Diagnosis

Lower crossed syndrome

6

CN 7 ___ the eye

Closes

7

42 yo female inability to close R eye after driving motorcycle cold weather inability to wrinkle forehead on R (trigeminal) and loss of taste on ant 2/3 of tongue (CN 7) pain behind right ear and top of head. Symp past 4 days. Dec levator palpebrae

Dx

Acute LMNL
Bells Palsy
CN 7 pathology

8

42 yo female inability to close R eye after driving motorcycle cold weather inability to wrinkle forehead on R (trigeminal) and loss of taste on ant 2/3 of tongue (CN 7) pain behind right ear and top of head. Symp past 4 days. Dec levator palpebrae

Not resolved, what happens?

Facial paresis
Dec taste discrimination
Inc tear production while chewing

9

42 yo female inability to close R eye after driving motorcycle cold weather inability to wrinkle forehead on R (trigeminal) and loss of taste on ant 2/3 of tongue (CN 7) pain behind right ear and top of head. Symp past 4 days. Dec levator palpebrae

Tx

Fit for eyee patch - cautious about dryness
Adjust
Co-manage with MD

Recommend artificial tears
Refer to neurologist

10

45 yo female back pain started when bent over to tie shoe. 2-9/10. Palliative when lying on the floor. Pain in L medial knee down into L med big toe F 40. E 10. RR 30. LR 15. Kemp pain LB and med foot. SLR pos with radiation down leg

DX

L4 nerve root lesion from disc

Cervical disc or IVF encroachment

11

Most common dx in vignettes

Disc

12

45 yo female back pain started when bent over to tie shoe. 2-9/10. Palliative when lying on the floor. Pain in L medial knee down into L med big toe F 40. E 10. RR 30. LR 15. Kemp pain LB and med foot. SLR pos with radiation down leg

3 best initial treatments

Extension exercises (McKenzie exercises)
Flexion distraction manipulation - always for disc
Lumbar traction - for disc or IVF encroachment

13

45 yo female back pain started when bent over to tie shoe. 2-9/10. Palliative when lying on the floor. Pain in L medial knee down into L med big toe F 40. E 10. RR 30. LR 15. Kemp pain LB and med foot. SLR pos with radiation down leg

What additional clinical findings

Dec patellar reflex - L4 LMNL
Weak leg muscles
Dec sensation over med malleolus

14

Hyperreflexia and clonus

UMNL

15

Dec hamstring =

L5

16

Dec achilles

S1

17

45 yo female back pain started when bent over to tie shoe. 2-9/10. Palliative when lying on the floor. Pain in L medial knee down into L med big toe F 40. E 10. RR 30. LR 15. Kemp pain LB and med foot. SLR pos with radiation down leg

What likely to occur if left untreated

Cauda equina syndrome - disc - change in bowel/bladder
Permanent sensation loss
Atrophy of muscles

18

Gastroc weak

S1

19

Med ham

L5

20

Lat foot

S1

21

Vibration loss

Dorsal columns

22

Loss pain and temp

Acute ant cord syndrome

23

Change in bowel and bladder/ cauda equina =

No chiropractic care