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30 Cards in this Set
- Front
- Back
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Describe the Zygapophyseal joint |
- It is a concave on convex facet joint of the vertebrae (usually superior to inferior) - Restricts SB and rotation - L1-L4 are broad, and L5 is pencil thin - Handles 3-25% of the vertebral load (up to 50% in degeneration) |
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What are some characteristics of Gait examined in a Lumbar screening? |
- check gait Ant. to Post. and Lat. - functional capacity or ability to move overall - cross patterns of gait - symmetry of stride - pes planus/pes cavus * if hyperprone on one side and superior on the other = indicates leg length discr. |
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What are the palpation landmarks of a lumbar screening? |
- rib angles - iliac crests - greater trochanters - ASIS (level or un-level) - Sacral Sulcus - Inf. Lateral Angle of the sacrum (ILA) - ischial tuberosities - sacrotuberous ligament - PSIS - Sacral base - long dorsal ligament - pubic tubercle
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What are some key importances in the history portion regarding age and degeneration? |
Disc begins to degenerate around age 14-20 - Anterolisthesis degeneration (ant. slip) occurs usually in patients over 60. - Retrolisthesis degeneration (post. slip) usually is seen in patients beginning around 40-45. *L3-L5 |
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What are some specific afflictions to keep in mind during the history (age), and the common ages seen? |
L3-L5 - Non-Specific LBP: 12-15 years - primary disc: 35-55 years - central protrusion/prolasped: >40 - polyradicular prolapsed: 30-45 - post. long. lig. protrusion/prolapsed: 18-35 L1-L2 - Upper lumbar primary disc lesion: >50 - secondary disc disorder: >55-60 |
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What should you note about the "who" portion of a history screening according to IAOM |
- age and the physiological process - age and specific afflictions - gender: males are more common that females
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What should you note about the "when" of a history of a screening? |
- Provocation: - pain with cough, sneeze, or small strain indicates primary disc issue - postural habits - chemical vs. mechanical - Onset: - mechanics and age: - primary: pain w/ sitting, stooping, pain with full WB (usually < 50) - secondary: pain w/ sitting while in lordosis/ pain w/ carry in ext., stooping (usually > 50)
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Name some of the standing special tests used for a lumbar screening |
- Extension - SB - Forward flexion - Rot. + SB - Unilateral toe raise (calf raise) - Heel walk - Kemp Test* |
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Name some of the supine special tests used for a lumbar screening |
- SI provocation test - SLR w/ distal initiation - Passive hip flexion - Passive hip IR/ER |
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Name some of the resistive supine special tests used for a lumbar screening |
- Hip flexion - Tibialis Anterior MMT - Big toe extension - Peroneals MMT - Babinski |
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Name some of the side-lying special tests used for a lumbar screening |
- SI compression test - Femoral N. stretch |
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Name some of the prone special tests used for a lumbar screening |
- Achilles - Glute exam - R. knee ext. - R. knee flexion - Spring test - Slump test (distal and proximal initiation) |
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Factors leading to increased LBP (especially in kids) |
Increased exercise exposure time and sport participation (kids playing multiple sports) - growth spurts - abrupt increase in training intensity/frequency - poor technique - poor trunk muscle strength |
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what are the common pain characteristic or patterns for lumbar instability? |
- flexion is usually pain free - returning from flexion is painful - neurological signs are (-) |
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What are you observing with a standing Side-Bend screening? |
- symmetry of the tissue and muscles from T1-L5 *note imbalances, hypertophy, atrophy - Symmectrical C-shaped curve bilaterally |
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What is your hand placement and observations noted during the standing forward flexion test of a lumbar screening? |
- thumbs should be placed over the PSIS - thumbs should move up and slightly forward with motion * side that moves toward the head first or furthest = side with the restriction * indicates stuck sacrum or innominate issues |
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What are you observing or noting with the Stork test in a lumbar screening? |
observing the movement of the PSIS - Normal = PSIS drops inferiorly and slightly laterally - Abnormal = no movement or movement up of the PSIS * indicates SI joint dysfunction |
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what are the indications for a seated SLR test? |
- SLR with pain with PROM beyond 70 degrees = jt pathology
- Double SLR PROM with pain less than 70 degrees = SI pathology |
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What is the capsular pattern for the zygoaphyseal jt? |
Side bend = rotation > extension |
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characteristics of the interverterbal discs
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- nucleus pulposis becomes fibrous with age - water holding decreases - degeneration begins around age 14 - disc with more height and smaller = high risk of failure |
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mechanisms for a stress fracture in the LB |
Repetitive: - hyperextension - flexion load - forced rotation - shear force - any combination of the 4 |
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Gold standard for LBP |
SPECT scan |
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characteristics of a navicular fracture |
- difficult to diagnose - can be either complete, stress, traction apophysitis (more in young hs and under) - non-union fracture is common - requires bone stim to heal - adolescents with excessive foot pronation are likely to develop stress |
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Describe Freiburgs infarction |
- painful avascular necrosis of the 2nd or 3rd metatarsal heads - seen in adolescents and young adults - seen in running and jumping sports - early x-ray will be (-); later x-ray shows flattening of the metatarsal head - if caught early it can be treated with exercise and orthotics - if not caught early requires surgery |
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Characteristics of sesmoiditis |
- can include: stress fx, contusion, osteonecrosis, chondramalacia, osteoarthritis - presents with local tenderness to med or lat sesmoid, localized swelling on WB side esp. on toes - requires bone scan confirmation - treatment is: unload sesmoid with donut pad; intrinsic foot muscle strengthening - stess fx requires 10-12 wks to up to 4 months to heal |
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characteristics of a sesmoid fx |
- usually the tibial side sesmoid; receives wt of the 1st metatarsal - usually transverse or comminuted - classified as a fatigue fx |
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Complications of a Sesmoid fracture |
- tibial sesmoid = weakness in the flexor hallicus brevis = hallux valgus - fibular sesmoid = hallux varus - both - cock-up deformity |
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List Kaltenborn's steps 1-5 for testing tarsal mobility |
1) fix 2nd & 3rd cuneiform; mob. 2nd metatarsal 2) fix 2nd & 3rd cuneiform; mob. 3rd metatarsal 3) fix 1st cuneiform; mob. 1st metatarsal 4) fix navicular; mob. 1-3rd cuneiform 5) fix talus; mob. navicular |
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List Kaltenborn's steps 6-10 for testing tarsal mobility |
6) fix cuboid; mob. 4th and 5th metatarsal 7) fix navicular & 3rd cuneiform; mob. cuboid (prone) 8) fix calcaneus; mob. cuboid 9) fix talus; mob. calcaneus (prone) 10) fix talus; mob. tib/fib |
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MOI and S&S for an injury to the Posterolateral corner of the knee |
MOI: not commonly seen with non-contact; medial posterior force (varus) S&S: - (+) with rot. posterior drawer - feeling of instability going down stairs (similar to ACL) - chronic instability - pain over med. jt line due to compensation - increased pressure on med side from force * (+) dial test; but not good spec./sens. |
