MSC practical

buttock or LE pain with or without back pain

spinal stenosis

history of LE pain, wide BOS gait, abnormal Romberg, thigh pain w/ back extension, UMN lesion symptoms

physical findings of spinal stenosis

postural education (flexion bias), orthoses, manual therapy, exercise, and aerobic conditioning

interventions for stenosis

broad-based disc extension outward with intact but weak PLL and AF

disc protrusion

focal protrusion of disc material, tear of AF contained by PLL

disc extrusion

complete separation of disc material rupture through PLL into epidural space

disc sequestration

displacement of nucleus into vertebral body through end plate, AF fibers intact

intra-spongy nuclear herniation

intra-spongy nuclear herniation into vertebral body through

schmorls nodes

axial load compression fracture usually in lower t or upper L spine common mechanism of

intra-spongy nuclear herniation

pain rest, avoidance of disc compression, modalities to decrease guarding, hyperextension, bracing, exercise intervention for

intra-spongy herniation

free nerve endings in disc (c-fibers), irritation of nerve root, chemical irritation from nuclear material in epidural space cause pain in

disc herniations

foraminal encroachment of disc

radiculopathy

spinal cord encroachment of disc

myelopathy

more LE than back pain, rare in isolated injury, decreased mobility (extension), postural impairments presentation of

disc protrusion

pain only at end ranges

dysfunctional ANR

loading strategies decrease, abolish, or centralize symptoms

derangement reducible

no loading strategies decrease, abolish, or centralize symptoms

derangement irreducible

pain only on static loading, physical examination normal

postural

fix lateral shift, maintenance of correct position, attempt to correct in standing then try prone, avoid rotation , treat pain, restore function/mobility, and decrease muscle guarding

intervention for herniated disc

pain for less than 16 days, no symptoms below knee, FABQ under 19, at least one hypo mobile LS segment, at least one hip w/ 35 degrees or more of IR indications for

manipulation

peripheralization/centralization during exam, postural preference indications for

specific exercise

+ PIT, aberrant motions, hypermobile segments, under 40 y/o, 3 or more prior episodes, increasing episode frequency, more than 91 degrees SLR B indications for

stabilization exercise

difficulty flexing in standing, + neural tension signs indications for

nerve flossing

near signs, leg symptoms, no centralization during exam indications for

traction

addresses how people respond to the fear of pain

FABQ (fear avoidance behavior questionnaire

superficial or non anatomic tenderness to palpation, simulation sign, distraction sign, regional sensory or motor disturbance, overreaction signs

waddells nonorganic signs

self report tool that gives a numerical index of perceived disability

Oswestry disability index

higher percentage of Oswestry index means

higher level of perceived disability

minimal disability oswestry

0-20%

moderate disability oswestry

21-40%

severe disability oswestry

41-60%

crippled oswestry

61-80%

bed bound or exaggerating

81-100%

not a limiter of motion in thoracic spine

facet orientation

% of spinal problems in thoracic spine

less than 15%

location in spine where most metastasis happen

t spine

pain and itching followed by a rash along dermatome

shingles

facilitated muscles in upper crossed syndrome

SCM and Pecs, upper traps and levator

inhibited muscles in upper crossed syndrome

deep cervical flexors, lower trap and serratus

facilitated muscles in lower crossed syndrome

trunk extensors and hip flexors

inhibited muscles in lower crossed syndrome

abdominals and glutes

structural hyperkyphosis caused by anterior wedging of vertebral bodies, irregular end plates with schmorls nodes, narrowing of IV space, thickening of ALL characteristic of

scheuermanns disease

scheuermanns disease increases risk of

lumbar spndylolisthesis and scoliosis

age of onset scheuermanns disease

13-16

compensatory increase in lumbar lordosis may occur with

scheuermanns

back pain in scheurmanns located over

apex of kyphosis

pain in scheuermanns worsens with

extension and rotation

associated neurological deficits common/uncommon

uncommon

degree of kyphosis for only exercise scheuermanns

below 60

degree of kyphosis for exercise and bracing scheuermanns

over 60

degree of kyphosis where surgery is indicated scheurmanns

over 80

patients with ankylosing spondylitis usually carry

human leukocyte antigen b-27

age of onset ankylosing spondylitis

20-30

more affected sex ankylosing spondylitis

men (2-3x more)

back pain, stiffness, fever, loss of appetite, uveitis, IBD, peripheral joint involvement symptoms of

ankylosing spondylitis

morning stiffness, improvement in discomfort with exercise, onset before 40, gradual onset, pain for more than 3 months questions to ask for

ankylosing spondylitis

cervical rotation, tragus to wall, lumbar side flexion, modified schober, intermalleolar index tests for

severity of ankylosing spondylitis

mild ankylosing spondylitis cervical rotation

more than 70 degrees

moderate ankylosing spondylitis cervical rotation

20-70 degrees

severe ankylosing spondylitis cervical rotation

less than 20 degrees

mild tragus to wall ankylosing spondylitis

less than 15 cm

moderate tragus to wall ankylosing spondylitis

15-30 cm

severe tragus to wall ankylosing spondylitis

more than 30 cm

mild lumbar side flexion ankylosing spondylitis

more than 10 cm

moderate lumbar side flexion ankylosing spondylitis

5-10 cm

severe lumbar side flexion ankylosing spondylitis

less than 5 cm

mild lumbar flexion ankylosing spondylitis

more than 4 cm

moderate lumbar flexion ankylosing spondylitis

2-4 cm

severe lumbar flexion ankylosing spondylitis

less than 2 cm

mild intermalleolar distance ankylosing spondylitis

over 100 cm

moderate intermalleolar distance ankylosing spondylitis

70-100 cm

severe intermalleolar distance ankylosing spondylitis

below 70 cm

education for ankylosing spondylitis should focus on

exercise, posture, joint protection

treatment goals for ankylosing spondylitis

symptom relief, maintain function, delay structure changes

spinal mobility, spinal stabilization, posture, breathing, no flexion based exercise used for

ankylosing spondylitis

areas most affected by osteoporosis

highest cancellous bone content

cement injected into fractured vertebral body, no change in shape

vertebroplasty

balloon inserted into vertebral body, inflated and filled with cement, restores shape

kyphoplasty

scoliosis defined as frontal plane curve of

10 or more degrees

percent of scoliosis with no apparent cause

80-90%

scoliosis named by

side of convexity and location

ribs on side of concavity

pulled together

ribs on side of convexity

pulled apart

angle used to diagnose scoliosis on xray

Cobb angle

feature on x ray showing iliac apophysis designating skeletal maturity

risser sign

open epiphyses at distal radius, proximal phalanges, and metacarpals indicates how many more years of growth

2 years

accepted definition of progression of scoliosis

over 5 degree change in 6 months or less

relative progression 20 or more degrees of scoliosis

more than 5 degrees in 6 months

relative progression less than 20 degrees of scoliosis

10 degrees or more in 6 months

scoliometer positive screen in sitting and/or sitting

more than 5 degrees

SRS recommendation for scoliometer

7 degrees

scoliometer measures

angle of trunk rotation (ATR)

score on brighten score indicating hypermobility

4 or more

stop progression at puberty, prevent/treat respiratory dysfunction, prevent/treat spinal pain syndromes, improve aesthetics

goals of conservative management

curves less than 30 degrees if 5 degrees in one year or curves over 30 degrees

indications for bracing

annual incidence of C-spine dysfunction

10-20%

more affected six with c spine dysfunction

women

c spine typical age

45-59

lung cancer in upper lobe that impacts lower brachial plexus (c5-T1)

pancoasts tumor

higher score on NDI means

more disability