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30 Cards in this Set

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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)

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.

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



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

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

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


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)



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*

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

Name some of the resistive supine special tests used for a lumbar screening

- Hip flexion


- Tibialis Anterior MMT


- Big toe extension


- Peroneals MMT


- Babinski

Name some of the side-lying special tests used for a lumbar screening

- SI compression test


- Femoral N. stretch

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)

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

what are the common pain characteristic or patterns for lumbar instability?

- flexion is usually pain free


- returning from flexion is painful


- neurological signs are (-)

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

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

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

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

What is the capsular pattern for the zygoaphyseal jt?

Side bend = rotation > extension

characteristics of the interverterbal discs

- nucleus pulposis becomes fibrous with age


- water holding decreases


- degeneration begins around age 14


- disc with more height and smaller = high risk of failure



mechanisms for a stress fracture in the LB

Repetitive:


- hyperextension


- flexion load


- forced rotation


- shear force


- any combination of the 4

Gold standard for LBP

SPECT scan

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

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

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

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



Complications of a Sesmoid fracture



- tibial sesmoid = weakness in the flexor hallicus brevis = hallux valgus




- fibular sesmoid = hallux varus




- both - cock-up deformity

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



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

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.