Part 3 board review (pt. 7 LB diff di and PNE)

Disc prolapse

S/S: immediate, snap, leg pain leads to LBP

Ortho: - valsalva, + SLR

confirm with MRI

tx = adjust, walk (wandering = referral)

Disc protrusion

S/S: gradual, LBP leads to leg pain

Ortho: + SLR and + valsalva

confirm with MRI

tx = adjust, walk

Posteriorlateral disc

Antalgia AWAY

+SLR, - WLR, + lindner’s

confirm with MRI

Tx = adjust and walk

Posteromedial disc

Antalgia TOWARDS

-lindner’s, + WLR and + SLR

confirm with MRI

tx = adjust and walk

Subrhizal disc aka posterior

antalgia forward

+kemps bilateral, +traction

confirm with MRI

Tx = adjust and walk

Central disc

antalgia forward

+kemps bilateral, + traction

confirm with MRI

Bilateral leg pain

tx = adjust and walk (cauda equina = referral)

Facet (bilateral)

extension painful, scleratogenous

+kemps (local)

Xray to confirm → lateral and oblique

mcnabbs

adjust, williams exercises

Spondylolisthesis (bilateral)

extension painful

+kemps

Xray and CT (lateral -classify, oblique - dx)

L5 most common, L4 degenerative

adjust only when symptomatic, supine knee chest best

IVF (unilateral)

Extension / rotation painful, dermatogenous, compression signs

+kemps, xray and orthos confirmatory

Thoracic and lumbar lateral

adjust and williams exercises

SI (unilateral)

low crest, low gluteals, sclerotogenous

+mennell’s/gillets, + gaenslen’s, + belt

xray and motion palp confirmatory

Adjust and williams brace

Central canal stenosis

extension painful

stoop and bicycle test

xray and CT scan

Neurogenic claudication

adjust and exercise, walk

Tumor

deep and boring pain, constant, nocturnal

+valsalva, MRI to confirm

refer

Prostate mets

bilateral leg pain, saddle paresthesia

+traction and + valsalva

PSA, acid phos, alk phos, Xray

Frequent

refer

Kidney pain

flank pain, costovertebral angle

+murphy’s punch, + jar

KUB and UA

stones cause colicky pain

refer

Hip

refers pain to groin, knee, sclerotogenous

+fabere, + laguerre’s

Xray

Lines, age

Adjust, trochanteric belt

AVN

variable sites, local pain and motion aggravates

unreliable orthos

Xray, MRI and bone scan to confirm

aseptic, avascular ischemic necrosis, osteochondrosis, “flattened bone”

Brace, swimming, nutrition, low force adjustments, infrared

Axillary nerve

glenohumeral dislocation

radial nerve

crutch palsy

wrist drop (supinator)

Ulnar nerve

medial elbow injury

tunnel of guyon

claw hand, cubital tunnel

Median nerve

carpal tunnel (lunate)

ape hand, cubital fossa

Sciatic nerve

wallet neuralgia

piriformis

Common peroneal nerve

lateral knee (head of fibula) injury

foot drop

tibial nerve

tarsal tunnel (medial plantar/sole)

morton neuroma (dorsum)

lateral femoral cutaneous nerve

meralgia paresthetica (L2-L3) psoas

Long thoracic nerve

winging, serratus anterior

dorsal scapular nerve

flaring, rhomboids

phrenic nerve

hiccups

brachial plexus (TOS)

scalenes and cervical rib

pectoralis major

costoclavicular

Suprspinatus and infraspinatus

suprascapular nerve

teres major and subscapularis

subscapular nerve

levator scapula and rhomboids

dorsal scapular nerve (flaring)

deltoid and teres minor

axillary

Serratus anterior

musculocutaneous

latissimus dorsi

thracodorsal

lateral forearm and hand

median

medial forearm and hand

ulnar

posterior arm, forearm and hand

radial

quadriceps

femoral

adductors

obturators

hamstrings

sciatic

peroneus longus and brevis

superficial peroneal

tibialis anterior

deep peroneal

facial muscles

CN VII

muscles of mastication

CN V

SCM

CN XI and C2 and C3

Trapezius

CN XI and C3, C4

TFL, gluteus medius and gluteus minimus

superior gluteal

gluteus maximus

inferior gluteal

Disc pressure: lying supine knees bent

25 PSI

Disc pressure: side lying

75 PSI

Disc pressure: standing

100PSI

Disc pressure: Sitting

140 PSI

Lower cross syndrome: hyperlordosis is caused by

Abdominal weakness, paraspinal spasm and psoas spasm

Anterior pelvic tilt (AS)

Hamstring weakness and quadriceps spasm

Treatment for anterior pelvic tilt

sole lifts

strengthen abdominals and hamstrings

posterior pelvic tilt and williams

Hypolordosis is caused by

abdominal spasm, paraspinal weakness (psoas weakness)

Posterior pelvic tolt (PI)

hamstring spasm and quadricep weakness

treatment or posterior pelvic tilt

heel lifts, strengthen paraspinals, psoas and quads

mckenzie

upper cross syndrome

weak suprahyoid, deep neck flexors, subscapularis, lower trapezius, diaphragm

tight pectorals, SCM, masseters, suboccipital, upper trapezius and levator scapula

Rectus femoris attaches to the

AIIS

sartorius attaches to the

ASIS

What muscle flexes the hip and knee

sartorius

what flexes the forearm and supinates

biceps

What muscle is most effected by lateral epicodylitis

ext carpi radialis brevis

deep peroneal innervates tibialis anterior and causes

dorsiflexion and inversion

superficial peroneal innervates peroneus longus and causes

eversion

does common peroneal innervate dorsiflexion / inversion and eversion?

yes, all

What innervates digiti minimi opponens

ulnar

What is in the occipital triangle

vertebral artery and ramus of C1 nerve

Suboccipital triangle

Posterior rotation of atlas = obliques inferior

anterior rotation of atlas = obliques superior

EOP

occiput (external)

IOP

occiput (internal)

Atlas TP

anterior and inferior to mastoid

Styloid

anterior to atlas TP

axis

1st palpable spinous process

Hyoid

C3

Cornu

C4

Thyroid

C4,C5

Cricoid

C6 (carotid tubercle)

C6

last moveable spinous on extension

C7

VP 70%

T1

VP 30%

T2

jugular notch

T3

spine of scapula

T5

sternal angle (2nd intercostal space)

T6

inferior angle of scapula prone

T7

inferior angle of scapula sit or stand

T10

xiphoid (7th rib, 7th dermatome)

L3 disc

umbilicus

L4

iliac crest

S2

PSIS

S4

PIIS

Vascular absolute contraindications

CVA, brain infarct, thrombus, aneurysm, advanced diabetes mellitus

Relative vascular contraindications

vertebrobasilar insufficiency, atherosclerosis, diabetes mellitus, anticoagulant therapy

Absolute Articular contraindications

disc prolapse and progressive neurological deficit

fusion, synovitis, spondylolisthesis IV, spondyloptosis, spinal instability (ADI)

relative articular contraindications

advanced osteoarthritis, inflammatory arthritis (rheumatoid, psoriatic, AS)

spondylolisthesis III

Hypermobility

Absolute Trauma contraindications

severe sprain / strain (III)

acute fracture, acute dislocation

Relative trauma contraindications

sprain and strain II

Bone weakening disorders absolute contraindications

osteomyelitis and bone infections (TB)

Bone weakening disorders relative contraindications

paget’s, mets, osteoporosis, osteomalacia