OMM Spring 2012 Midterm

About this deck

By: Colby Schrum
Created: 2012-03-26
Size: 102 flashcards
Views: 358

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Leading cause of work-related disability.

Low back pain

Average age of LBP onset.

20-50 due to high risk jobs and activities

DDx for intraspinous radicular pain

-neurofibroma
-ependymoma
-meningioma
-disc
-spinal stenosis
-AVM of cord
-spinal AV fistula

DDx for extraspinous radicular pain

-piriformis syndrome
-vascular disease
-nerve root irritation
-neoplasms
-plexitis
-polyneuropathy
-trauma w/ neuropraxis
-shingles

Cancer alarm symptoms

-Age>50
-prior cancer history
-fevers, night sweats, weight loss
-unrelieved pain (1 month)
-no improvement w/ conservative therapy

Characteristics of discogenic (radicular) pain

-acute
-constant, sharp, shooting
-dermatomal radiation
-increased with increased intrathecal pressure

Most common cause of discogenic LBP

nerve root irritation

Effects of nerve root irritation

-radiating pain
-motor deficits follow sensory deficits
-deep tendon reflexes are affected
-progressive motor deficit and loss of bowel control

True or False? All discogenic LBP is caused by herniated nucleus pulposus.

False, somatic dysfunctions as well as other disorders may cause nerve root irritation.

Most common segments for disk herniation (HNP)

L4/L5, L5/S1

Risk factors of herniated disk (HNP)

-repetitive lifting
-prolonged sitting
-twisting/rotational movement
-chronic cough (high intrathecal pressure)
-spinal injury or disk disease
-tobacco use
-prolonged vibratory forces

Are males or females more often affected by disk herniaiton?

Males

What is cauda equina syndrome?

Impingement of the cauda equina

True or False? Suspicion of cauda equina should be treated conservatively.

False, suspicion of cauda equina is requires emergent surgical decompression.

What are the common symptoms and most common cause of cauda equina?

Sx: bilateral extremity anasthesia, loss of rectal sphincter tone, saddle numbness, LE weakness
Cause: 50% secondary to tumor

Define Facet Trophism

asymmetry of the facet joints predisposing patients to degenerative joint disease and pain

Define Sacralization

Deformity in which L5 fuses with the sacrum and can predispose the patient to pain and early disc herniation

Define Lumbarization

Deformity in which S1 becomes similar to the lumbar spine (uncommon).

Name the 3 subtypes of spina bifida in order of relative danger.

Spina bifida Meningomyelocele > Spina bifida meningocele> spina bifida occulta

Define Spina bifida occulta

no herniation over defect, course skin or tuft of hair may be present, no neuro deficits

Define Spina bifida meningocele

A herviation of the meninges through the defect

Define Spina bifida meningomyelocele

Herniation of the meninges and nerve roots through the defect. Associated with neuro deficits.

Define Ferguson's angle and its associated pathologies.

Angle formed by L5 on the sacrum.
25-35 degrees is WNL
Increased angle is associated with lumbosacral shear and LBP

What percentage of LBP is caused by somatic dysfunction?

70%

What are the 7 muscles commonly involved in LBP?

-psoas
-piriformis
-QL
-Erector Spinae
-Gluteals
-Abdominals
-Hamstrings

Dr. Greenman's definition a postural/tonic muscle

muscle that responds by becoming hypertonic, shortened, and sometimes spastic

Dr. Greenman's definition of a dynamic or phasic muscle

Muscle that responds to dysfunction by inhibition, hypotonicity, and weakness

Describe the pain distribution of a hypertonic iliopsoas

lower-mid back and anterior thigh pain

Describe the pain distribution of piriformis hypertonicity

PSIS and greater trochanter pain

Describe the pain distribution of Gluteus hypertonicity

Pain in the butt

Common segmental and ligamentous dysfunctions involved in LBP

-L5
-SI joint (sacral torsions)
-short leg
-stretch of iliolumbar ligament
-myofascial injury

What are the main motions of the lumbar spine?

Flexion and Extension

Describe the common segmental dysfunctions associated with psoas spasm

L1 and L2 rotated to same side as spasm

What is the purpose of the straight leg raise exam?

Assess for radicular pain, indicating nerve root irritation

How are the motor nerve roots graded.

0-5, 5 being the expected response
0-no tone
1-tone w/o movement
2-movement w/o gravity
3-movement against gravity, not against resistance
4-slightly diminished strength against resistance
5-full strength

Muscle isolated for L1,2 motor nerve root

Psoas

Muscle isolated for L3 motor nerve root

Quadriceps muscle

muscle isolated for L4 motor nerve root

Tibialis Anterior

Muscle isolated for L5 motor nerve root

Extensor hallucis longus

Muscle isolated for S1 motor nerve root

Gastrocnemius

The patellar reflex test the ___ deep tendon reflex.

The Achilles reflex tests the ___ deep tendon reflex.

What is the grade of the expected DTR?

2 out of 4

What is a grade 4 DTR?

hyperactive response with clonus

Describe the setup and purpose of the Patrick's Test.

FABERE at the hip
Assesses hip arthritis with pain in SIJ and anterior groin

Describe the setup and purpose of the Thomas Test?

Patient supine, hugs knees (flattens lordosis) extends one leg.
Gapping under knee or back may signify tight hip flexors (psoas).

In the "lumbar on side" treatment, the HVLA thrust is meant to increase what direction of motion?

Sidebending

Describe the Still Technique for a Flexed Lumbar Segment.

Patient supine, physician flexes and adducts hip on same side of segmental rotation, compression vector from knee to affected segment, abduct knee w/compression, extend knee and hip to neutral.

Explain the differences in Still Treatment of and extended lumbar in comparison to flexed.

Start with hip abducted and adduct during treatment.

To what muscles do the anterior lumbar tenderpoints correlate?

AL1-internal obliques
AL2-external obliques
AL3,4-iliopsoas
AL5-rectus abdominus

What was A.T. Still's nickname?

The Lightning bone setter!

Who is Charles Hazard?

One of Still's students credited with documentation of Still's techniques

Who is Dr. Van Buskirk?

Van Buskirk found Dr. Hazard's descriptions of Still Technique

What are the major components of the Still Technique?

-moderate to low velocity
-audible release not necessary
-compression of ~5 lbs. maintained throughout treatment
-direct force over segment is unnecessary

Still Technique is applicable to every articulation of the body except _______.

cranial

What is the general starting position of Still Technique?

Exaggerated relaxation

What is the force vector in Still Technique?

direction and amount of compression toward the affected segment

True or False? Fryette's motion type does not have to be considered in FPR or Still Technique.

False, it is not considered in FPR but is of importance in Still Technique

Still Technique contraindications

-advanced bone wasting disease
-fractures
-radiculopathy
-patient objection
-facet syndrome/arthritis

Who developed FPR?

Dr. Stanley Schiowitz

True or False? FPR is an indirect technique used to normalize hypertonic muscles.

True

What is the physiological mechanism of FPR?

reset gamma loop/decrease gamma gain

decreased load via compression unloads spindle and decreases 1a fibers discharge

Is a posterior rib exhaled or inhaled?

exhaled

For Still Technique Anterior Rib, what is the starting position, articulation, final position and vector direction?

start with arm (affected side) abducted and flexed @ shoulder
articulation is adduction and extension @ shoulder
final position is slightly abducted and extended
vector is from elbow to rib head

For Still Technique Anterior innominate, what is the initial position, articulation and vector direction?

Flex hip 45-60 degrees, find soft-packing of SIJ
Flex hip completely and adduct then extend the hip
Vector is from knee to lower pole of SIJ

For Still Technique Posterior Innominate, what is the starting position, the articulation and the vector direction?

Hip flexed completely and adducted
Abduct and extend hip
Compress through the upper pole of the SIJ

For Still Technique Superior shear, what is the starting position? articulation?

Externally rotate leg from ankle, compress to SIJ
Internally rotate the leg and add traction

What are the order in which the following should be treated and why?
iliosacral, lumbar, sacral

lumbar, sacroiliac, sacral
treatment of the first two may alleviate sacral dysfunctions

Diagnose the sacroiliac joints:
+R standing flexion test
+L seated flexion test
Posterior right ILA

Diagonal left

standing flexion test not used for sacral motion on ilium

For Still Technique Diagonal SI, what is the starting position, the articulation, and the direction of the vector?

Pt. supine, both hips and knees flexed to ~90 degrees, sidebend away from diagnosis direction (toward superior pole of restricted axis)
Move legs across midline and extend
Vector is from knees toward sacrum

Diagnose the iliosacral joint for Still Technique:
+R seated flexion test
posterior right ILA

Unilateral right

For Still Technique Unilateral SI, what is the starting position, articulation, and vector direction?

Pt. supine, opposite hip flexed, abducted, internally rotated (using ankle as lever)
Adduct and externally rotate, then extend hip and knee
Vector is from knee toward sacrum

What are the key 5 Lumbar spine x-rays?

-A-P view
-Lateral View
-L-S Jctn Spot View
-Left Oblique
-Right Oblique

What x-ray view is used to examine scoliosis, unlevel sacral base, and functional short leg?

Lumbar A-P

What x-ray view is used to examine the lumbar lordosis and Degenerative Joint Diseases (DDD, Facet Syndrome)?

Lumbar Lateral

What x-ray view is best to assess spondylolysthesis grades?

L-S Jctn Spot View

What x-ray view is best to assess spondylosis and spinal stenosis (central and foraminal)?

Lumbar oblique

Why does an ankle sprain have a greater affect on the whole body's proprioceptive capacity than a proximal injury?

Due to the distal nature, the body has to correct and compensate at every joint proximal to the ankle.

What are the 4 sensory fiber types and their levels of myelination?

I - heavy
II - medium
III - light
IV - non-myelinated

Do slow twitch fibers function in postural or phasic activity?

Postural
Fast twitch participate more in phasic or dynamic activity.

Increased tension on the intrafusal muscle fiber of a flexor causes ______ _____ neurons (afferent spindle fibers) to increase AP propagation leading to an increased stimulation of ______ ______ neurons to the flexor and _______ (increased/decreased) contraction.

gamma motor
alpha motor
increased

Via reciprocal inhibition, explain the 3 effects of contraction of a left triceps.

inhibited left biceps
inhibited right triceps
enhanced right biceps

What are the key hypertonic structures?

-Hip capsule
-QL
-LE flexors (iliopsoas, rectus femoris, hamstrings, gastrocnemius, soleus)
-Tensor Fascia Lata
-Hip adductors
-Piriformis
-Upper lumbar erector spinae

What are the key inhibited/dynamic muscles?

-Abdominals (transversus abdominus, external and internal obliques, rectus abdominus)
-Lower lumbar erector spinae
-LE extensors (esp. vastus medialis)
-Gluteus
-Leg (Tibialis anterior and fibularis)

What is the goal in treating postural muscles?

stretch the hypertonic muscles

What is the goal in treating dynamic muscles?

Disinhibit and retrain weak muscles

What are the Dirty Half Dozen (name the 6 dysfunctions associated with debilitating LBP)?

-short leg/pelvic tilt
-non-neutral lumbar spine
-pubic dysfunction
-innominate shear
-restricted anterior nutation (flexion of the sacrum)
-trunk and LE muscular imbalance

What is the order of treatment for Exercise Prescription?

Assessment
Stretching (hypertonic muscles)
Strengthening (weak muscles)

What are the three systems involved in balance?

vestibular
visual
proprioceptive

What are the 4 stages of proprioceptive balance assessment?

1. one legged standing, arms down, eyes open
2. cross arms
3. arms down, eyes closed
4. cross arms
each for 30 seconds

Who advocated short foot proprioceptive training? And what is it?

Janda, short foot is elevation of the medial arch without curling of the toes.

What is lower quarter syndrome?

-Weak gluteus maximus and short hip flexors
-Weak abdominals and short lumbar erector spinae
-Weak gluteus medius/minimus and short TFL/QL
-Anterior pelvic tilt and increased lumbar lordosis
-Hypermobility of low lumbars and short piriformis
-Inability to sit up from supine and dysfunctional forward bending

What are the 4 tests for lower quarter dysfunction/syndrome?

-Trunk Rotation
-Hip Abduction firing pattern
-Hip Extension firing pattern
-Hip Scour

What does active trunk rotation assess?

-imbalance b/w multifidus and hip external rotators
-imbalance b/w abdominal obliques and lumbar erector spinae

What is the normal hip abduction firing pattern?

1. Gluteus medius
2. TFL
3. QL
4. Erector spinae

What is the common significant finding in the hip abduction firing pattern?

Late gluteus medius firing

What is the normal hip extension firing pattern?

1. hamstrings
2. gluteus maximus
3. contralateral erector spinae (low)
4. ipsalateral erector spinae (low)
5. contralateral erector spinae (high)
6. ipsalateral erector spinae (high)

What is the common significant finding in the hip extension firing pattern?

late firing of the gluteus maximus

What does the hip scour test assess?

posterior hip capsule tightness, indicated by "groin pinch"

Why do you have to touch your buttock when performing the psoas self stretch?

Gluteus maximus must fire to reprogram firing pattern

What muscles group should not be used when retraining the gluteus maximus?

hamstrings

Why is the abdominal sit back the preferred abdominal exercise?

-activates transversus abdominus subconsciously
-maintains neutral lumbar spine
-strengthens all abdominal muscles in lengthened position

About this deck

By: Colby Schrum
Created: 2012-03-26
Size: 102 flashcards
Views: 358

About StudyBlue

“Simply amazing. The flash cards are smooth, there are many different types of studying tools, and there is a great search engine. I praise you on the awesomeness.”
Dennis