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30 Cards in this Set

  • Front
  • Back

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


- 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.


What are some specific afflictions to keep in mind during the history (age), and the common ages seen?


- 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


- 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


- 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)


- (+) 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.