MSC II Exam 2

0.0(0) Reviews
Report Flashcard set

Spaced Repetition

spaced repetition





Practice Test



190 Terms
😃 Not studied yet (190)
If herniation is lateral to the nerve root, will bending towards the affected side or away from the affected side relieve the pain?
leaning away will relieve (contralateral)
If herniation is medial to the nerve root, will leaning away or leaning towards the affected side cause more pain?
leaning away will cause more pain
What kind of herniation syndrome if loading strategies decrease, abolish, or centralize symptoms? (DH)
derangement - reducible
What kind of herniation syndrome if no loading strategies decrease, abolish, or centralize the symptoms? (DH)
derangement - irreducible
What kind of herniation syndrome if pain only at end ranges?
dysfunction (adherent nerve root)
What kind of herniation syndrome if pain only on static loading with physical examination showing normal
What kind of mckenzie herniation classifications are symptomatic? What kind are symptomatic and mechanical? What does this mean?
symptomatic - postural symptomatic and mechanical - derangement and dysfunction symptomatic if pain, mechanical if difference in movement
Which herniation syndrome will patient pursue centralization of symptoms and avoid peripheralization of symptoms?
What syndrome if LIMITED ROM and pain at end range?
dysfunction (ANR)
Postural syndrome only has pain at when? What is an example?
static loading, example = slouched posture lengthening posterior tissues
What is McKenzie's prone progression for herniation?
prone, prone on elbow, prone on hand
Methods for maintenance of positions for healing annular fibers in treating HNPs?
use lumbar roll to maintain correction and proper posture
What kind of movements to avoid in treating HNPs?
rotation, flexion
What is the process for intervening with herniation?
1) establish diagnosis 2) determine irritability 3) determine outcome to measure to re-assess
What are the three components of movement?
mobility/flexibility, power/endurance, motor control
What kind of things should the patient demonstrate prior to doing LBP stabilization exercises in terms of positive tests, mobility and motions at segments, age, prior episodes, and SLR?
positive prone instability, aberrant motions, hypermobile segments, younger than 40, 3 or more prior episodes with increasing frequency, and over 91 SLR bilaterally
Clinical guideline summary for LBP says what required to do mechanical nerve root tension (flossing)?
difficulty flexing in standing, positive neural tension signs
If neuro signs, leg symptoms, and no centralization during objective exam, what kind of intervention? (AKA nonreducible derangement)
traction (mechanical or manual)
Name this wadells sign: disproportionate pain to light touch, not correlating with anatomic structures
superficial or nonanatomic tenderness to palpation
Name this waddells sign: Axial compression of the head or rotational simulation maneuver elicits "pain" despite no actual provocation
simulation sign
name this waddels sign: when a test that was painful originally when performed is not painful anymore when they are in a distracted state
distraction sign
What score on Wadell's means no organic reason for pain? What are the five signs?
3/5 or higher 1. superficial/non anatomic tenderness to palpation 2. simulation sign 3. distraction sign 4. regional sensory/motor disturbance 5. overreaction
Score on Oswestry index that is normal?
In lower crossed syndrome, match hip and trunk muscles? Which are facilitated/inhibited?
hip flexors with back extensors (facilitated) hip extensors with trunk flexors (inhibited)
Pain in the thoracic spine is often ____ related
posture (excessive kyphosis)
Is trunk extensor weakness or trunk extensor endurance a bigger issue in thoracic back pain?
Subacute low back pain with mobility deficits seen at what part of range in spinal motions?
mid to end range
Spinal instabilities with acute low back pain with movement coordination impairments seen at what part of range?
initial to mid range
Thoracic pain is higher in females or males?
Acute, subacute, or chronic: symptoms produced with mid-range motions that worsen with end range movements
Trunk coordination, strengthening, and endurance exercises used in acute, subacute, or chronic?
subacute and chronic
Most common part of spine affected by metastases from other cancers?
What are the facilitated muscles in upper crossed syndrome?
SCM/pectorals + upper trap/levator scapula
What are the inhibited muscles in upper crossed syndrome?
deep cervical flexors + lower trap/serratus anterior
according to clinical guidelines Activities/exercise to promote centralization is recommended as intervention if pt meets what 2 criteria?
Peripheralization/Centralization during objective exam preference for one posture
What kind of interventions for reducing pain and disability in older patients with chronic low back pain with radiating pain? (4)
flexion combined with manual therapy, strengthening, nerve mobs, walking
most common area for abdominal aortic aneurysm?
below renal artery
Symptoms of herpes zoster?
pain and itching in cranial or spinal dermatome before a unilateral maculopapular rash
Most common vertebral dermatome for shingles
What are the "typical" ribs
ribs 3-9
What are the "atypical" ribs and where do they attach?
1,2,10,11,12 all attach to their respective vertebrae
What are the true, false, and floating ribs?
true - 1-7 false - 8-10 floating - 11-12
Most flexion allowed in what part of the t-spine?
Dowager's hump associated with
osteoporosis or long term corticosteroid use
What is the Gibbus deformity? What is it associated with as for a cause?
sharp posterior angulation of spine, associated with infection, fracture, or bony anamoly
T/F: there is reduced motion at the thoracic spine compared to the L-spine/C-spine due to the facet orientation
false - less motion but NOT due to the facet orientation
____ disorders such as _____ can refer to the thoracic spine
renal; pyelonephritis (kidney infection), nephrolithiasis (kidney stones)
Typical and atypical thoracic vertebrae?
typical T2-10 atypical T1,T11,12
T/F: during forward flexion, nonstructural scoliosis does not appear whereas structural scoliosis appears
Ribs on side of convexity and concavity in scoliosis would do what?
convexity - spread apart concavity - come together
What is T4 syndrome? What does it manifest as?
hypomobility of a segment (normally T4) leading to sympathetic reaction; can manifest as glove like numbness/paresthesias in arms/hands
What techniques can resolve T4 symptoms?
manual therapy
local tenderness of bony points, positive slump test, positive upper limb tension tests, depression or prominence of one or more spinous processes, and local thickening and stiffness of one segment
T4 syndrome
5 criteria for spinal manipulation according to CPR
1. Duration of current LBP under 16 days 2. no symptoms distal to knee 3. FABQ under 19 points 4. at least one hypomobile segment in LS 5. 1 or both hips at least 35 IR
What is Scheuermann's disease?
hyperkyphosis in adolescents (13-16), an osteochondrosis of the spine
In Scheuermann's disease, what happens at the vertebral bodies, end plates, IV space, and ALL?
vertebral bodies wedge anteriorly end plates have Schmorl's nodes, IV space narrowed ALL thickened
Compensatory increase in lumbar lordosis in adolescents associated with what disease?
In Scheuermann's, if kyphosis under ____ then exercise intervention only. What kind of interventions?
under 60 degrees intervene with muscle stretching hip flexors, pecs, and hamstrings extension exercise
What degree for bracing + exercise or surgery in Scheuermann's?
bracing + exercise if over 60 degrees surgery only over 80 degrees
Genetic marker for ankylosing spondylitis
carry HLA-B27
Age and sex of ankylosing spondylitis typically? What ethnicity?
adult 20-30 years old, males 2-3 times more likely northern european most common
Back pain worsens with what motions in Scheuermann's? Where is this pain usually located?
extension and rotation - apex of the kyphosis
Radiographic changes in ankylosing spondylitis (2)
intervertebral ossification like bamboo spine, sacroiliitis which leads to SI ankylosis
Symptoms of ankylosing spondylitis (5)
back pain and stiffness, fever, IBD, uveitis, peripheral joint involvement
History questions about ankylosing spondylitis? What would 4 or more positive answers tell you?
morning stiffness, reduction in discomfort with exercise, onset of back pain before 40, gradual onset, pain over 3 months 4 or more tells you high probability of AS
BASDAI, BASFI, and BASMI all for what (bath forms)
ankylosing spondylitis
Tragus to wall measurement used to detect what? What score of 15 or 30 tell you?
change in AS posture under 15 is mild, over 30 severe
Components of the BASMI (5)
cervical rotation, tragus to wall, lumbar side flexion, modified schobers, intermalleolar index
treatment goals for AS (3)
symptom relief, posture correction, delaying the inevitable
Education pieces for AS? (3)
daily exercise crucial, joint protection, posture
Best approach for exercise in AS (3)
multimodal approach with aerobics, strengthening, pulmonary
things to avoid with AS movements
high impact, abrupt movements, FLEXION
sex, ethnicity, body type, nutritional risk factors for osteoporosis?
female, northern european or asian, ectomorph skinnier builds, and lack of calcium and Vit D in diet
Diagnosis of osteoporosis done with
bone densitometry (dexa scan)
What makes up bone strength
bone mineral density and bone quality
Regions of the body with high cancellous bone (most affected by osteoporosis)
spine, hip, distal forearm, proximal humerus, pelvis
T-scores for osteopenia, osteoporosis, and severe osteoporosis
ostopenia: T score between -1.0 and -2.5 SD osteoporosis: over -2.5 T score severe osteoporosis: over -2.5 T score with one or more fraactures
Exercise focused on what components in osteoporosis
increasing bone and muscle strength and balance
What exercises indicated for osteoporosis with no fractures
resistance, aerobics, tai chi
What kind of strengthening exercise may indirectly reduce fall risk and fracture in osteoporosis
spinal extensors strengthening
impact exercise does a better job increasing BMD in pre or post menopausal women
85-90% of adult bone mass acquired by what age in males and females
18 females, 20 males
Vertebroplasty versus kyphoplasty? (thoracic vertebral fracture)
vertebroplasty - cement injection in v-body that doesn't restore shape kyphoplasty - balloon injection to help restore shape/height of fx. bone
Due to the compensatory lumbar lordosis that is present in Schuermann's disease, there is an increased risk of what other pathology?
spondylolisthesis due to increased shear (from increased lordosis/sacrohorizontal angle)
Short muscles requiring lengthening in hyperkyphosis? (4)
upper cervical extensors, levator, pecs, upper trap
Lengthened muscles requiring shortening in hyperkyphosis? (3)
cervical flexors, scap retractors, upper thoracic extensors
Functional versus structural scoliosis
functional can be corrected by posture shift, structural cannot
____ to ___% of scoliosis is idiopathic
Radiologic criteria for scoliosis
over 10 degrees cobb angle, VB rotation, vertebral deformity
How do we name a scoliosis curvature?
Segment of the spine + side of the convexity
If someone has R thoracic scoliosis, how might they be rotated?
Rotated to right (toward the convexity)
Which side would we see a posterior rib hump in scoliosis? Why? Will anterior ribs be pushed out on the same side
Side of the convexity because the posterior ribs are pushed posteriorly No anterior ribs will be pushed out on contralateral side
Peak height growth velocity occurs before or after Risser sign emerges
Four things to monitor for scoliosis curve progression
cobb angle, age of curve onset, current age, risser grade
Definition of progression of scoliosis in terms of degrees and time?
-Greater than 5 degrees of progression in 6 months or less
relative progression is defined as: ↑≥_____° Cobb/______ months (reference value ≥ 20°) ↑≥______° Cobb/______ months (reference value ˂ 20°) •Two consecutive ↑≥_____° in two periods of _____ months
•↑≥5° Cobb/6 months (reference value ≥ 20°) •↑≥10° Cobb/6 months (reference value ˂ 20°) •Two consecutive ↑≥3° in two periods of 3 months
Screening test for scoliosis? What is positive screen?
Adams forward bend test, 5 degrees is positive
What is scoliometer used for? What is a drawback of using it?
measures angle of trunk rotation, only tells you rotation component and not what is happening at vertebra
Scoliometer positive screen in sitting/standing, SRS recommendation?
5 deg, 7 degrees
T/F: A scoliosis pt typically sidebends opposite the side of the convexity and rotates toward the side of the convexity
What is the Beighton score test out of? What does it measure? What score indicates that a pt is likely to have hypermobility?
out of 9 points measures HYPERmobility in scoliosis >4 = likely to have hypermobility
Stop progression at puberty, prevent/treat respiratory dysfunction, prevent/treat spinal pain syndromes, improve aesthetics
goals of conservative management of scoliosis
Risser of 0 and over 50 deg most likely needs what?
When bracing for scoliosis, want to see at least ___% correction in a x-ray
What features of PSSE can we use as PTs to help reduce a mild scoliosis curve?
pelvic corrections auto-elongation (breathing) de-angulation (side shift of torso/move into concavity) derotation/dekyphosing stabilization/muscle activation
What is the risser sign? 0=?, 5=?
radiographic depiction of the iliac apophysis appearance that can designate skeletal maturity, 0 = immaturity, 5 = complete maturity
Pain in what position in facet syndrome? What positions relieve? radicular or no radicular features? How can you differentiate from stenosis?
pain in extension/ I/L side bend + rotation, relieved by flexion, no radicular features. Differentiate with unilateral PA provoking pain, pain localized in back
Characteristics of DDD (4)
NP dehydrated, annular rings weakened, facet joints approximate, IVF narrow
Unilateral or bilateral pain in DDD/DJD? What would you see with central and unilateral PA?
unilateral; central PA provokes pain, unilateral limited motion
Pain in what movements with DDD/DJD?
extension, rotation, I/L sidebending
thoracic herniations more common in what part of T spine
lower T-spine
Mechanism of injury in thoracic fracture? Most common fracture types?
from hyperflexion or loading - most common are anterior wedge fractures or burst fractures
Pain in what positions with stenosis? What positions relieve pain?
pain in standing, prone, extension relieved by sitting, supine, flexion
Stenosis typically unilateral or bilateral
What muscles might you want to stretch in stenosis and why?
hip flexors and paraspinals because putting into more APT will cause extension which will cause more pain
Stability exercise targeting what muscles in stenosis?
abs and glutes
What three categories do rib conditions fall under?
structural, rotational, respiratory
Treat rib conditions with what techniques?
Beevor's sign positive could tell you what if the umbilicus deviates cranially? What about if it moves laterally?
T10 segment involvement laterally, could be contralateral motor deviation
Inspirations restrictions for a depressed or elevated rib?
Distraction extension technique indicated for what?
hypomobility w extension
What rib pathology has less prominent rib angle and has more prominent thoracic findings?
anterior subluxation
What rib pathology has more prominent rib angle and less prominent thoracic findings?
posterior subluxation
In external rib torsion, prominence/tenderness at the superior or inferior part of the rib angle? What happens at the intercostal space above and below?
prominent and tender on the superior border of the rib angle, at intercostal space above, is WIDENED, below is narrow
In internal rib torsion, prominence/tenderness at the superior or inferior part of the rib angle? What happens at the intercostal space above and below?
prominent and tender on inferior border of rib angle, intercostal space above is NARROW, and wide below
Surgical intervention for scoliosis is indicated when there is over ____ degree curve in T spine and ____ in thoracolumbar spine
50; 40
What is the range of degrees that indicates bracing for scoliosis? How much progression in one year would indicate bracing under 30 deg?
30-45 5 deg
What risser grades allow for bracing?
What are the contraindications to a brace for scoliosis?
lordotic spine, skeletal maturity, hypokyphosis
T/F: bracing is rare in the older adult
true (non-opeartive tx. is more common - PT, meds, nerve blocks, epidural steroids)
Scoliosis changes occur in what planes?
coronal, sagittal, and axial plane
Scoliosis presents similarly to a ___ patholgoy in PFTs
What distinguishes early onset vs late onset for scoliosis?
early: 0-9 y.o late: >10 y.0
What are some pulmonary medical causes of thoracic pain? (3)
PE pleurisy tracheobronchial pain
What are some cardiac medical causes of thoracic pain? (4)
angina, abdominal aortic aneurysm, MI
What are three GI medical causes of thoracic pain?
esophageal disorders *c-spine referral too*, peptic ulcer disease, cholecystitis
Biggest red flag symptoms (5)
insidious onset with no mechanical association, symptoms unchanged by movement/position, bowel and bladder changes, night pain, weight loss
What is thoracic pain persisting after herpes zoster
postherpetic neuralgia
How would you differentiate referred thoracic pain from an ulcer vs cholecystitis?
eating makes ulcer pain better/stool consistency altered, pain for cholecystitis is 1-3 after eating (especially from fatty foods)
Scheurman's disease has an associated increase in risk in what other two conditions?
lumbar spondylolisthesis and scoliosis
What two muscle groups are typically adaptively short in Scheuermanns?'
hamstrings and hip flexors
T/F: neuro symptoms don't normally appear in scheuermann's?
Chronic seronegative spondyloarthritis aka Marie Strumpell disease affecting SI, facet joints, C-V joints, and IVD articulations
ankylosing spondylitis
What are the three main joints that 1/3 of AS patients will have involvement at?
shoulders, knees, hips
Why should we tell AS patients to think tall/maintain upright position
Their spine is constantly autofusing
What is a spinal weighted kypho-orthosis? (WKO) What condition is it mainly used for?
Weighted backpack with the majority of the weight in the lower back region to pull upper thorax posteriorly thoracic vertebral fracture
T/F: The lower the risser/cobb angle, the bigger the impact PT will have on the scoliosis pt
convexity side is usually associated with (protracted/retracted) shoulders concavity side is usually associated with (protracted/retracted) shoulders
convexity= protracted concavity= retracted
We need to treat the asymmetry that is present in scoliosis with ____ exercise
asymmetrical exercise
What is the recommended hrs/day a scoliosis pt should wear their brace?
16-18 hrs
Flat back can be defined as ____ of kyphosis. What is excessive kyphosis?
less than 20 deg, >45 deg
Lateral shift/sciatic scoliosis is considered a ___ scoliosis and is typically ____
functional, correctable
Describe the owestry index percentages along with each category?
0-20%: minimal disability 21-40%: moderate disability 41-60%: severe disability 61-80%: crippled 81-100%: bed bound/exaggerating
scoliosis is defined as a frontal plane curve of ___ or more deg
What are the four etiologies of scoliosis?
congenital, neuromuscular, idiopathic, degenerative
What are the five mechanisms of HNP?
1. spine compression loads -- *endplate failure* 2. repeated full flexion 3. Long periods of sitting 4. repetitive loading (fatigue is a factor) 5. shear + twisting loads
What are the three classifications of disc herniation according to mckenzie philosophy?
derangement, dysfunction, postural
Concept of mckenzie: HNP leads to a disturbance of ____ ___ of articular surfaces of adjacent vertebrae secondary to changes in the ___. This ultimately leads to a disturbance of normal ___ ___.
resting position nucleus movement mechanics
mckenzie classification: frequency of compaints (responses) postural= (intermittent/constant) dysfunction= (intermittent/constant) derangement= (intermittent/constant)
p= intermittent dys= intermittent derange= intermittent OR constant
Which mckenzie classification has pain response during the motion?
what are perferred loading strategies for each mckenzie classification? postural= dysfunction= derangement=
p= avoid symptoms dys= pursue symptoms derange= pursue centralization, avoid peripheralization
Why should you avoid rotation in exercise or mobilizations when patient has HNP?
rotation narrows disc space and increases intradiscal pressure
3 goals of treating HNP
1) treat pain 2) decrease muscle guarding 3) restore function/mobility
which waddells nonorganic sign is this? A nonanatomic distribution of abnormal sensation is reported rather than an anatomic, dermatomal distribution of pain or numbness
regional sensory or motor disturbance
which waddells nonorganic sign is this? Verbally or physically reacts in an inappropriate, theatrical manner to light touch or gentle examination.
Nerve flossing has what two effects
slackening on one end and tensioning on the other end
Two characteristics that were negatively associated with seeking PT for neck pain
age (older pts) and male
osteomyelitis, symptoms?
bone inflammation secondary to infection neck pain, stiffness, fever
Alantoaxial instability (upper cervical) pain location, symptom presentation
pain localized to the suboccipital area, UMN symptoms, headaches, blurred vision, BILATERAL UE/LE paresthesias, nystagmus
Congenital conditions associated with atlantoaxial instability
down's syndrome or bony malformation
Neck Disability index score of 5= __, 0=___? What was the MCID?
5=most disabled, 0=least disabled MCID was 7
Special tests (such as modified sharp purser) typically go where in the tests/measures process
later or at the end
What did specificity and sensitivity for the vertebral artery test find positive and negative tests results meant
positive could indicate, but negative not clinically meaningful
cluster for radiculopathy (4)
spurling's, cervical distraction, rotation under 60, ULNT median passive
If ___ out of 4 cluster tests positive, high confidence of radiculopathy
ligament stability tests
sharp-purser alar ligament stress transverse ligament test tectorial membrane shear AO membrane shear
5 D's of vertebrobasilar insufficiency
dizziness, diplopia, dysarthria, dysphagia, drop attacks
Most cervical tests tend to be highly specific or sensitive
specific (bad because neg results are not clinically meaningful)
how can RA cause AA instability?
destruction of dens/transverse ligament or both
what are 4 inflammatory conditions that can cause AA instability? what medication
RA psoriatic arthritis ankylosing spondylitis osteomyelitis chronic corticosteroid use
Summarize diagnostic accuracy, more useful clinically than other statistics
likelihood ratios
The further likelihood ratios are from 1 the (weaker/stronger) the evidence for the presence or absence of disease
Pancoast's tumor
lung upper lobe tumor that invades the brachial plexus
Cardiovascular conditions referring to the neck (4)
acute MI, coronary insufficiency, abdominal aorta, carotodynia (painful carotid artery)
Likelihood ratios for positive tests above _____ and for negative tests below _____ provide strong evidence to rule in or rule out diagnoses
10, 0.1
What is an activity that increases the risk of cervical neck pain?
The greatest risk factor for an injury is _____
previous injury to that area
Someone who is in subacute osteomyelitis is at risk for developing _____
What are the age classifications for infantile, juvenile, and adolescent scoliosis?
infantile: birth - 3 juvenile: 4-10 adolescent: 11-? (depends)
We want clearing tests to be highly ___ to rule out the condition. What is a good example
sensitive, UNLT (median)