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Clin Phase 2 > Week 4-8 > Flashcards

Week 4-8 Flashcards

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1
Q

What MFTP mimics C8?

A

Latissimus dorsi, serratus, pectoralis major

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2
Q

What MFTP mimics C6?

A

Infraspinatus, subclavius, supraspinous, scalenes

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3
Q

What are the x-ray indications?

A

Trauma with Ottawa rules, red flags for disease, significant deficits, nerve damage

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4
Q

What are the Ottawa rules?

A

Trauma+ over 70, limited rotation (less than 45 total), rust sign, spinal percussion

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5
Q

What are the red flags for disease?

A

Fever, fatigue, malaise, weight loss, loss of appetite

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6
Q

What are the indications for MRI?

A

Profound muscle weakness, neurological deficits, progressive muscle weakness, signs of cord involvement

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7
Q

What rules out facet syndrome?

A

Lack of tenderness on the facet and inability to recreating the pain with extension and rotation

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8
Q

What motions induce LB extension?

A

Sitting, overhead work, Superman’s, extension, prone extension, passive DSLR (prone)

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9
Q

What motions induce flexion?

A

Knees to chest, bending forward, standing with one leg on a stool, using a shopping cart to walk, squatting

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10
Q

What is the B list for spinal disorders?

A

SOL, infections, fractures, facet syndrome, sprain strain, NR adhesions, instability

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11
Q

What is the only helpful thing to rule out stenosis?

A

If flexion does not improve symptoms or ability to walk (shopping cart sign) .5 LR

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12
Q

What are the top 3 Rule in signs with stenosis?

A

Wide gait, sitting is relieving, burning sensation in buttock

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13
Q

What is the difference between radiographic stenosis and clinical stenosis?

A

Radiographic stenosis can be asymptomatic and is made by measurement
Clinical stenosis has symptoms into the extremity and may not meet the diagnostic criteria based on the radiograph

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14
Q

What are indicators of stenosis?

A

Leg symptoms made worse by walking, extension increases leg symptoms (especially arms overhead), flexion relieves symptoms, SMR deficits (50%), balance/ proprioception disturbances

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15
Q

Why do you not get a + SLR in stenosis?

A

Because the inflammation is local and less severe than in herniations

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16
Q

What is the role of age in diagnosing neuropathic leg pain?

A

It changes what is most likely.
Younger than 40: herniations
Over 60: stenosis
Between 40 and 60: 15% will have stenosis, but it could also be a herniation. There are also B list causes

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17
Q

What are the causes of peripheral neuropathic pain?

A

Diabetes, neuropathy (specific nerve), piriformis syndrome, entrapments

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18
Q

What B list causes will have red flags? What red flags?

A

Tumors: weight loss/ appetite loss, anemia, ESR/CRP, no comfortable position
Infections: fever, fatigue

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19
Q

Which A list disorder will valsalva more likely be positive?

A

Herniations

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20
Q

Which A list disorder will dejerine’s triad more likely be negative?

A

Stenosis

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21
Q

What A list disorder will sitting likely improve symptoms?

A

Stenosis

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22
Q

What A list disorder will flexion likely increase symptoms?

A

Herniations

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23
Q

What A list disorder will extension aggravate the leg symptoms?

A

Stenosis

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24
Q

What A list disorder will sustained loading centralize symptoms?

A

Herniations

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25
Which A list disorder will usually have a positive SLR?
Herniations
26
Which A list disorder will more likely have neuro deficits?
Herniations (both are possible)
27
Which A list disorder will more likely have ataxia?
Stenosis
28
Where does Psoas refer to?
Anterior thigh and iliac crest
29
What is the pain pattern for Maigne’s syndrome?
Upper buttock, iliac crest, trochanter, and groin
30
What is the referral pattern for QL?
Trochanter, iliac crest, ischial tuberosity
31
What is the referral pattern for the glut med?
Sacrum, glut, trochanter, lateral leg
32
How do you tell if a spondy is unstable?
Passive extension, excessive motion, prone instability test, painful arc, reversed lumbopelvic rhythm
33
Who will respond well to a core stabilization program?
A >40 yo, with greater than 90 SLR BL, positive prone instability test, and aberrant motion with lumbar flexion
34
What are examples of aberrant motion with lumbar flexion?
Minors sign, reversal of lumbopelvic rhythm, or instability catch
35
What indicates poor motor control?
Segmental abnormal movement, painful arc abolished with bracing, trunk forward lean, difficulty learning pelvic clocking or abdominal hollowing, bad form in hip extension or single leg stands
36
What are history clues that suggest instability?
Episodic nature, progressive, popping/locking/catching/feeling of giving way, immediate pain with sitting relieved by standing, temporary response to treatment which is decreasing
37
What is the difference between structural and functional instability?
Structural is an issue with the bones/ tissues such that they can no longer support normal movement Functional is a neurological issue where the muscles are not being given the signals to react in the appropriate time within the neutral zone causing other tissues to pick up the slack.
38
What is the measurement for radiographic stenosis?
12mm
39
What is the measurement for absolute stenosis?
10mm
40
What is the measurement for radiographic hyper mobility?
Greater than 3mm sagittally
41
What is the gold standard imaging choice for spondys?
Radiographs, flexion extension and MRI
42
When is spondylolethisis likely to be a candidate for DDx in a 40+ yo?
When there is a history of symptoms before 30 yo.
43
What is phalanx Dickson sign?
Flexed knees and hips
44
What physical exam finding suggest spondylolethisis?
Functional scoliosis, hamstring spasm, tenderness to deep palpation at the SP above the slip, step off defect, positive passive leg extension, and segmental hyper mobility
45
Who is more likely to have a step off defect?
Young athletics with spondylolethisis
46
What is a positive passive leg extension test?
Heaviness in the legs with lifting and traction that decreases when the legs are lowered
47
What does a positive passive leg extension test more likely indicate?
Unstable spondy
48
How long should an athlete with a spondy be removed from sport?
3 or more months
49
What 3 things can you do for a stenosis patient?
Flexion distraction, neuromobilization and stabilization program
50
What are the 5 options for neuropathic symptoms?
Nerve root, peripheral neuropathy, extremity lesion, referred pain, cord lesion
51
What are the causes of nerve root damage?
Herniation, SOL, osteophytic compression, NR adhesion, instability, infection, fracture
52
What are the signs and symptoms of NR osteophytic compression (lumbar)?
NO CES, unilateral SMR/ sensation/ pain distribution, positive kemps, pure flexion and extension loads are not sensitive or as sensitive
53
What are the signs and symptoms of tumor/cyst?
Pt >50, SMR deficits, cord signs, spinal percussion, leg pain w/out back pain, classic red flags, increased ESR/CRP, ALP, hypercalcemia
54
What are the classic red flags?
Prior history of cancer, unexplained weight loss, increased pain laying supine, unremitting pain unaffected by position
55
What are the signs and symptoms of spinal infections?
Pt >50, prior history of infection (any), immunocompromised, fever, spinal percussion, high ESR, positive tension tests, neuro deficits, disc destroyed and end plates damaged
56
What is the difference between infection and cancer on imaging?
Cancers spare the disc while infection destroy. Discs and end plates
57
How to differentiate PAD from stenosis?
Location of pain, effect of walking on pain, what helps, what hurts, and pulses
58
When will muscles be weaker after walking stenosis or PAD?
Stenosis
59
What will help stenosis?
Bending over, sitting
60
What will help PAD?
Sitting, stopping (walking or changing position)
61
What will increase stenosis symptoms?
Walking downhill, extension
62
What will increase PAD symptoms?
Walking uphill, increased metabolic demand
63
What will have diminished lower limb pulses?
PAD
64
When will the pain come on with walking for PAD?
Commonly 30 min
65
Where is the pain for stenosis and PAD in the lower extremity?
Stenosis- thighs | PAD- calves/ lower leg
66
What is the difference between DVT and PAD?
DVT- swelling, tender nodules, increased temperature, pain at rest PAD- reduced temperature, tissue loss, muscle wasting, hair loss, bruits/ dismissed pulses
67
What are the tests you might add for stenosis?
Single leg stand (Romberg sign), sustained extension, lower extremity pulses
68
What are the ancillary studies for PAD?
MRA, ABI, and Doppler ultrasound
69
What is the conservative management for PAD?
A walking program (near the pain threshold), toe raises to pain +5
70
What 3 things together indicates the hip itself rather than the spine?
A limp, groin pain and limited internal rotation
71
What is the most common location for hip pain?
Localized to the groin
72
What muscles commonly go into spasm with hip problems?
Adductors
73
How far can hip problems radiate?
To the foot
74
What are the top ddxs for lateral hip pain?
Glut med tendinopathy, ITB tendinopathy, trochanteric bursitis, external snapping hip
75
What is snapping hip?
When a tendon is tight and snapping over the acetabulum
76
What rules in glut med tendinopathy?
Lateral hip pain with single leg stand and resisted FADER test
77
What rules out glut med tendinopathy?
Lack of tenderness with palpation of insertion
78
What are the DDxs for anterior hip pain?
Hair osteoarthritis, famoroacetablular impingement, labral tear, AVN, stress fracture, adductor tear, internal snapping hip
79
What is the DDx for posterior hip pain?
``` Femoracetabular pathology (OA, labrum, AVN) SI, Hamstring, Piriformis, lumbar referral ```
80
How much of the SI accounts for chronic low back pain?
20%
81
What 5 tests should you always do check the SI?
Thigh thrust, sacral thrust, SI compression, SI distraction, gaenslens
82
What are causes of sacroiliitis?
RA, AS, reactive arthritis, psoriatic arthritis, enteric arthritis
83
What is lower cross?
Weak abdominals, weak glut max, weak glut med, overactive psoas, overactive erectors, overactive rec fem, overactive TFL, overactive QL
84
What is SI muscle imbalance?
Ipsilateral glut max inhibited, contra glut med inhibited, ipsilateral psoas tight, ipsilateral piriformis tight
85
What is upper cross?
Overactive SCM, overactive Trap, Overactive Pec, overactive suboccipitals, overactive levator scalp, inhibited deep neck flexors, inhibited rhomboids, inhibited lower trap, inhibited serratus
86
How to progress through a stabilization program (3 stages)?
1- dead bug, quadruped, side bridge, bracing, hip hinge 2-lunge track, squat track 3- functionally mimic ADLs
87
What orthos will be positive in a sprain?
Anything passive (knees to chest, passive extension, pROM)
88
What orthos will be painful in a strain?
Anything resisted (rROM, prone extension with over pressure)
89
What is the single best clue for disc?
Centralization/ directional preference
90
What travels in the posterior column?
Proprioception, vibration, touch, 2 point discrimination
91
What travels in the lateral spinothalamic track?
Pain and temperature
92
What will effect the posterior column?
UMNL or spinal cord compression
93
What is the difference between the three piriformis diagnoses?
Piriformis syndrome-nerve involvement Piriformis MFTP- radiation Piriformis spasm- no leg pain

Clin Phase 2 (3 decks)

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