MSC II Exam 2

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

postural

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?

derangement

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?

0-20%

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?

endurance

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?

females

Acute, subacute, or chronic: symptoms produced with mid-range motions that worsen with end range movements

subacute

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?

T-spine

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

T5-6

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?

lower

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

true

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?

Scheuermann's

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

pre

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

80-90

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

before

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

true