Tuina 2, Exam 1

Front 1

Normal range of lumbar flexion

Back 1

Forward bending, ~90 degrees

Front 2

Normal range of lumbar extension

Back 2

Backward bending, ~30 degrees

Front 3

Normal bilateral flexion

Back 3

~20-30 degrees

Front 4

Normal bilateral flexion

Back 4

~30 degrees

Front 5

Describe causitive factors of lateral curviture of the spine (scoliosis)

Back 5

1) congenital deformity
2) osteoporosis of thoracic section
3) secondary injury of back (acute or chronic pain)
4) improper posture
5) uneven length of lower limbs
6) LIDP(H) Lumbar Intravertebral Disc Protrusion

Front 6

Describe causitive factors of ABNORMAL KYPHOTIC curviture of the spine

Back 6

1) congenital development deformity
2) osteoporosis of thoracic section
3) rickets
4) TB
5) RA
6) fracture of thoracic spine

Front 7

Describe causitive factors of ABNORMAL LORDOTIC curviture of the spine

Back 7

1) overweight belly
2) pregnancies
3) lumbar spondylolisthesis (pedical fracture of vertebral arch)
4) improper posture
5) poliomyelitis

* Weight lifters
* Falls

Front 8

Describe causitive factors of DISAPPEARANCE of SPINE curviture of the spine "board looking"

Back 8

appears either cervical or lumbar section due to either acute or chronic injury

Front 9

Which is the most prominent spinal process?

Back 9

Transverse process of L3 (TVP, L3)

Front 10

What is the palpation routine (5 lines or bands)?

Back 10

1) Is the spine straight (make the marks by pressing two fingers along the spine)
* Is there a deviation of the spinal processes?
2/3) Muscle (temperature, soft, tight, swelling, depression) - along erector spinae
4/5) Relationship btwn the upr and lwr spinal processes?
* even spacing?
* abnormal disconnections?
* abnormal depressions, masses or tense muscle/tissue?

Front 11

What are the primary diagnostic methods for back ds?

Back 11

1) Inspection (gait, posture, back appearance)
* scoliosis, curvature
2) Palpation
3) Inquiry

Front 12

Describe the sensitivity of the fingers and thumb?

Back 12

Thumb is the most sensitive and accounts for 50% of the sensitivity; index and ring finger account for added 25%

Front 13

What is the palpation order (i.e. top to bottom...)

Back 13

Top to bottom
Middle to sides
Unaffected to affected
Superficial to deep

Front 14

What do SUPERFICIAL tender points generally indicate?

Back 14

injury of ligament or muscles

Front 15

What do DEEP tender points generally indicate?

Back 15

1) injury of the vertebrae body,
2) PA (posterior articulation/facet joint),
3) disk or
4) ligaments

Front 16

What do REFERENT tender points generally indicate?

Back 16

irritation along the spinal nerve

Front 17

What do the tender points BTWN the spinal processes generally indicate?

Back 17

INTER or SUPRAspinal ligament injury

Front 18

What do the tender points BESIDE the spinal processes generally indicate?

Back 18

1) LIDP (lumbar intravertebral disk protrusion)
2) or PA (facet joint) pathology

Front 19

What do the tender points MUSCLE ERECTOR SPINAE generally indicate?

Back 19

Chronic or acute injury

Front 20

What do the tender points on the tip of the *3rd lumbar transverse process* generally indicate?

Back 20

Syndrome of 3rd LTVP

Front 21

What do the tender points on PSIS or SI joint generally indicate?

Back 21

SI joint pathology

Front 22

What can painful back percussion tell you?

Back 22

1) fracture of the vertebral body or spinal process, 2) LIDP, 3) KI Ds, 4) Retroversion of the uterus and nephroptosia...

Front 23

What are the 11 lower back diagnostic tests that Dr. Fan describes?

Back 23

1) Lower limb extension test (Yeoman's)
2) Heel hip test
3) Neck flexion (slump) test
4) Abdomen bridge test (Valsalva's maneuver)
5) Laseque Test (unilateral straight leg raise test)
6) Braggard's Test
7) Bilateral hip and knee flexion test
8) Bed side test (Gaenslen's test)
9) Sacroiliac joint stress test
10) Squish test
11) Patric or Faber test (4-sign)

Front 24

Describe Yeoman's Test

Back 24

Pt prone, examiner has hand on the back and raise leg (30-45 degrees)

Front 25

What does a positive Yeoman's indicate?

Back 25

1) local articulation issue
2) lumbar intervertebral disc ds
3) Other disturbance

Front 26

What is the heel hip test?

Back 26

Prone patient, passive flexion of heel to put while hand on sacrum area

Front 27

What does a positive heel hip indicate?

Back 27

1) lumbosacral joint lesion
2) sacroiliac joint lesion

Front 28

What is the neck flexion (slump) test?

Back 28

Supine position, one hand on sternum, patient actively flexes neck toward the chest and keep it for 20-30 seconds

Front 29

What does a positive neck flexion (slump) test indicate?

Back 29

Pain on the lower back or radicular pain in the lower limb may indicate LIDP
***Caution when pt has had severe neck trauma

Front 30

What is the abdomen bridge test (Valsalva's maneuver)?

Back 30

Supine position, pt instructed to hold up the abdomen supported by feet, elbows and/or head

Front 31

What does a positive abdomen bridge test indicate?

Back 31

Pt will complain with lumbar pain with lower limb(s) shooting pain and indicates LIDP
* Pt can also perform a cough, deep respiration or pretend to hold a BM instead

Front 32

What is the Laseque Test?

Back 32

AKA Unilateral straight leg raise test; supine, asked to raise affected leg straight

Front 33

What does a positive Laseque Test indicate?

Back 33

Positive if pt can't raise affected leg to the normal level (70-90 degrees hip joint flexion) due to lumbar pain and radicular pain along the leg
-> LIDP or sciatic nerve dysfunction
* Severe case only able to raise 20-30 degrees

Front 34

What is Braggard's test and indications?

Back 34

AFTER and if Laseque's test is positive; examiner lowers leg 5-10 degrees until pain releved and then passively over dorsal flexes ankle joint slowly
-> Indications same as Lasque's (LIDP or sciatic nerve dysfunction)

Front 35

What is the bilateral hip and knee flexion test?

Back 35

Supine, active flexion of hips & knees (thighs to abdomen).

Front 36

What does a positive bilateral hip and knee flexion test indicate?

Back 36

Based upon degrees where pt feels pain
<90 pain: hip joint ds
90-120 pain: sacroiliac joint ds
>120 pain: lumbar sacrum joint or intervertebral joint ds

Front 37

What is the bed side test (Gaenslen's)?

Back 37

Supine, affected lower limb hangs off bedside, pt flexes affected knee to chest while examiner stabilizes (hand on flexed knee and applies pressure to affected side that is off the bed)

Front 38

What does a positive bed side test indicate?

Back 38

Sacroiliac joint ds

Front 39

What is the sacroiliac joint stress test?

Back 39

Supine, examiner applies pressure on ASIS of each ilium downwardly and laterally with both hands.

Front 40

What does a positive sacroiliac joint stress test indicate?

Back 40

If pain on sacroiliac joint or ilium pain
->anterior sacroiliac ligament strain, sacroiliac joint pathology or ilium fracture

Front 41

What is the squish test?

Back 41

Supine (or on side), examiner applise pressure downwardly and medially on he ilium

Front 42

What does the squish test indicate?

Back 42

If pain on sacroiliac joint or ilium pain
->anterior sacroiliac ligament strain, sacroiliac joint pathology or ilium fracture

Front 43

What is the Patric or FABER Test

Back 43

4-sign
Supine, examiner takes affected leg and creates a 4-shape with the foot atop the non-affected knee, stabilizes non-affected iliac spine with one hand while pressing on the medial side of the knee joint to the table with the other hand

Front 44

What does the Patric or FABER test indicate?

Back 44

If pain on sacrum -> sacroiliac joint lesion

If pain on medial aspect of thigh -> adductor femurs lesion

Front 45

What is the normal range for external leg rotation (raised bent leg moved toward the side)?

Back 45

30-40 degrees

Front 46

What is the normal range for knee flexion (knee to chest)?

Back 46

130-140 degrees

Front 47

What is the normal range for internal rotation (raised bent leg moved medially)?

Back 47

40-50 degrees

Front 48

What is the normal range for adduction (stabilized ilium with bent leg passively raised and moved midline)?

Back 48

20-30 degrees

Front 49

What is the the normal range for a straight leg lift?

Back 49

10-30 degrees

Front 50

What is the normal range for a straight leg abduction?

Back 50

45-60 degrees

Front 51

If a pt arrives with one leg is longer and awkwardly laterally rotated while in a standing position with slight eversion what is the likely issue?

Back 51

Anterior dislocation (of the hip joint); femor is inferior to where it should be

Front 52

If a pt arrives with one leg shorter and medially rotated what is the issue?

Back 52

Posterior fracture/dislocation (which is more common than the anterior)

Front 53

Pt duck walk with hyperlordosis in the lumbar region?

Back 53

Hip joint distortion

Front 54

Where along the spine does the piriformis originate?

Back 54

From the 3rd/4th sacral foramen

Front 55

What tests would you do to identify a LIDP?

Back 55

1) tender pts along spinal process
2) back percussion methods
3) Lower limb extension (Yeoman's)
4) Neck flexion (slump)
5) Abdomen bridge (Valsalva's maneuver)
6) Laseque's test
7) Braggard's test
8) Scoliosis

Front 56

What test indicates a lumbosacral or sacroiliac joint lesion?

Back 56

Heel hip test or patric/FABER/4-sign test (for sacroiliac joint lesion when pain is from the SACRUM region)

Front 57

What test indicates a lumbosacral or inter lumbar vertebral joint ds?

Back 57

1) bilateral hip and knee flexion test
2) bedside test
3) sacroiliac joint stress test
4) squish test

Front 58

Which test indicates an adductor femurs lesion?

Back 58

Patric/FABER/4-sign test when the pain is elicited from the MEDIAL aspect of the thigh

Front 59

Which test indicates sacroiliac ligament strain?

Back 59

Sacroiliac joint stress test or Squish test

Front 60

What test indicates sciatic nerve dysfunction?

Back 60

Laseque's test or Braggard's test

Front 61

What test indicates a PA pathology?

Back 61

Deep tender points on back muscles along the spinal processes

Front 62

What tests indicate SI joint pathology?

Back 62

Tender points on PSIS or SI joint, bedside test, sacroiliac joint stress test, squish test.

Front 63

What are some causitive factors for LIDP?

Back 63

1) acute trauma
2) chronic strain
3) wind cold and dampness invasions

Front 64

What are the symptoms of LIDP?

Back 64

1) Acute/chronic injury history
2) low back pain (repeated or constant, sharp, stabbing, burning or radiating, released with bed rest, worse with exertion, cough or sneezing)
3) lower limb radiating pain
* sciatic pain (buttocks->posterior and lateral leg->foot dorsum/toes or heel, mostly unilateral)
* femoral nerve pain (anterior thigh->medial leg)
4) lumbar scoliosis (incl board back)
5) ltd waist ROM, diff walking/limp
6) Numbness, cold sensation in lwr limb, myoatrophy of hip or leg (late stage)
7) Cauda equine irritation (ab perineum, hip or anus sensation), Ds urination, BM and sex, radiating pain, numbness on legs, lwr limb paralysis (if severe compression)

Front 65

What is the physical examination for LIDP?

Back 65

1) LTD ROM of lwr back
2) Board like lower back, scoliosis, or kyphosis of lower back
3) Tender points
a) Spine
b) I.V. spaces
c) Jiaji
d) Palpate for tender pts
e) SI, PSIS joints
f) GB30
4) Laseque's/Braggard
5) Neck flexion (slump)
6) Abdomen bridge
7) Bilateral hip & knee flexion
8) Myodynamic (resist great toe dorsal flexion-> L4/L5; resist great toe plantar flexion -> L5/S1]
9) Skin sense dysfunction and myoatrophy of affected leg
10) Tendon reflex
a) Patellar L3/L4
b) Ankle L5/S1
11) Clear cut Dx w/ film, CT & MRI

Front 66

Hypo patellar reflex indicates problem is where in the nervous system?

Back 66

Peripheral

Front 67

Hyper patellar reflex indicates problem is where in the nervous system?

Back 67

CNS (spinal cord)

Front 68

Which are the indications for L4/L5 issues?

Back 68

1) Tender points (local)
2) Radial pain or skin sensation disfunction on dorsum of 1st toe (medial)
3) Weakness of 1st toe EXTENSION

Front 69

Which are the indications for L5/S1 issues?

Back 69

1) Tender points (local)
2) Radial pain or skin sensation disfunction on dorsum of 1st toe (**LATERAL**)
3) Weakness of 1st toe FLEXION

Front 70

What is the 4-step Tuina Tx for LIDP?

Back 70

1) Relax back muscles
2) Relieve pain on back (palm elbow on back, buttocks), kneeding/plucking, thumb/palm press BL23, BL25, BL26, B54 and tender
3) Relieve Sx on leg
a) UB, GB rolling
b) Grasping
c) GB30, 34, 39
d) BL36, 37, 40, 57, 60, 62, 63..[10 sec]
e) Palm pressing/pushing
4) Stretch tech (gently, slowly)
a) leg extension
b) lwr back oblique
c) hamstring stretch/sciatic on affected side

Front 71

Herbal Rx for qi/blood stag type of LIDP?

Back 71

Tao Hong Si Wu Tang modified with Yan Hu Sao, Xiang Fu, Ru Xiang, Mo Ya

Front 72

Herbal Rx for wind, cold and damp invastion/retention type of LIDP?

Back 72

Du Huo Ji Sheng Tang modified with Chuan Wu, Cao Wu, etc.