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121 terms

MDDR

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What displacement is common with RA patients?
Anterior antlanto-axial subluxation
What is Spondylosis? and where does it occur?
Degeneration of the IVD, C5, C6, C7
What are the symptoms of Spondylosis?
Neck pain, stiffness, possible headache
What are the 3 symptoms of ligament instablity?
Parasthesia (numbness) of lips, face & tongue. Signs of vertabral artery compromise & cord signs
What are the 3 clincal signs of instability?
Empty end feel, reproduction of symptoms of instability & production of lateral nystagmus
What does the tectorial membrane limit?
Flexion & rotation
2 ways to define Schuermans
Multilpe vertabral end plate irregularites & Osteochondrosis of spine
What are the symptoms of schuermans?
Pain in thoracic region
↑ kyphosis
What will X-rays show? - schuermans
Wedged vertabrae, Irregularity of end plate & narrowing of disc space
Define Ankylosing Spondylitis?
Systemic rheumatic disease with
progressive ossification of the spine
What does Ankylosing Sponylitis affect? and in what order
Starts in SIJ, affects spine & peripheral joints
What are the symptoms of Ankylosing spondylitis?
Inflammatory pain, pain in spine & pelvis, ↓ ROM in spine & fatigue
What is fibrosed & ossifced in Ankylosing spondylitis?
Insertional points of ligaments, tendons, fascia & capsule
What are the less common symptoms of Ankylosing spondylitis?
Inflammation or uveitis (middle layer of eye, heel pain, swelling/pain in Joint shoulders, knees, and ankles, fever
What are the two most commonn symptoms of whiplash?
Decreased range of motion and stiffness
Define spondylolysis?
Defect of pars interarticularis at L5, L4
What are the symptoms of sponylolysis?
Focal low back which may radiate into the buttock or proximal lower extremities
What causes radiculopathy?
Space occuping lesion such as, Disc herniation, Spondylosis ie osteophytes, trauma/ fracture & Tumour
What are the signs and symptoms of mylepoapthy
Clumsy ness, gait disturbances & upper motor neuron signs
Longus Colli Superior oblique fibers
O: Anterior tubercle of C3- C5 Transverse processes
I: Anetriorlateral surface of anterior tubercle of Atlas
Longus Colli - Inferior oblique fibers
O: Anterior aspect of T1- T3 Vertabrae
I: Anterior tubercle C5-C6 Transverse Process
Longus Colli - Vertical fibers
O: Anterior aspect of C5, C6, C7, T1, T2, T3 vertabrae
I: Anterior aspect C2,C3,C4 vertabrae
Which ligaments connect Dens to occiput
Alar
Tectorial membrane
Cruciform (comes off transverse)
Longus Capitus
O: Anterior tubercles of the transverse processes
C3, C4, C5, C6
I: Basilar part of the occipital bone
Flexion at OA joint
When to test integrity of ligaments
RA + Down sydrome & non recent trauma
Coupled movement
Lateral flexion right
Occipital condyles translate left &
Left occipital condyle posterior (flexion)
Right occipital condyle anterior(extension)
C1 rotates left
C2 rotates right
Pancoast tumour - signs and symptoms
Severe pain in the shoulder or the shoulder blade (scapula)
Pain in the arm and weakness of the hand on the affected side
Diagnosis for thoracic outlet sydrome
Adson test- reduction of radial pulse with cervical extension & rotation
Roos test - elevated arm stress test , hold for 3 mins and look for change in extremity colour
Watson et al Manual therapy 2009
Thoracic outlet syndrome pins & needles distribution
C8/T1 distribution
(Ring & little fingers, medial forearm & medial arm)
Differential diagnosis for radiating arm
thoracic outlet syndrome
Radial motor and sensory test
Motor - Wrist extension
Sensory - Dorsal webspace between thumb & index finger
Ulnar motor and sensory
Motor Abduction - little finger
Sensory - Distal ulnar aspect little finger
Median sensory and motor
Motor - Opposition of thumb
Sensory - Distal radial aspect index finger
Axillary motor and sensory
Motor - Deltoid
Sensory - Lateral arm
Musculoscutaneous motor and sensory
Motor - Biceps
Sensory - Lateral foream
Serratus anterior
Origin: External surface of the lateral aspect of ribs 1- 8
Insertion: Costal surface of the medial border of the scapula and costal surface of the inferior angle
Rectus abdominus
Origin: Pubic crest and pubic symphysis
Insertion: Costal cartilages of ribs 5 - 7
6 SIgns/symptoms of minor cervical instability
Neck pain, catching locking, weakness, altered ROM, potenial headache (from upper cervical pattern)
VBI testing sen or sp?
More specific Kerry 2003
Thoracic spine - common causes of pain
Facet, Costotransverse, costvertrabral, Paraspinal muscle strain, schuermanns
Facet joint sprain movements
Injury during rotating, bending, lifting, arching and twisting
Facet symptoms -2
Hypomobility & local tenderness
Costvertabral/costotransverse joint symptoms 4
Hypomobility & local tenderness, +/- pain on inspiration, local or referred pain to chest wall
If IVD protusion happens (alhtough it is rare) which thoracic disc will it affect and why
T11-12 beause the discs are larger
Role of physio in the osteoporosis in older patients, Bennell 2000
Conserve bone mass, reduce the risk of falls, promote extended posture, reduce pain, and improve mobility and function.`
Signs and symtpoms of OA
Increase thoracic kyphosis and dowagers hump
Is pain present with OA
No unless fractured
Where is the primary site for neoplasm in the thoracic spine
Bronchial tumour and pancoasts (lung apex)
Symtpoms of bone cancer in thoracic spine
Severe pain in central thoracic region, Limited ROM, swelling, tenderness, fatigue, weighloss & un-remitting night pain
What is T4 syndrome
Sponylitic/osteochodritic lesions from T4, 5, 6
What does Sponylitic/osteochodritic lesions mean ( T4 syndrome)
Inflammation of bone and joint surfaces
What does it result from ( T4 syndrome)
Trauma, RA or infection
What are the T4 clinical features
Diffuse arm pain in helmut glove distribution, distal pain worse at night, increase thoracic kyphosis, tight pectorals, foward head posture, local thoracic tenderness wit marked stiffness in PAIVM
Where does some one with MI have pain
retrosternal/paraspinal, jaw, neck and inside arm
What is the pain like with MI
vice like
What aggravateds MI symptoms
exercise and stress
MI confirmed with ?
ECG
Is degeneration of the cervical discs common
Yes
When does coupled movement of OA AA happen
with side flexion
AO movements
flexion/extension and some rotation and side flexion`
AA joint movements
Rotation as well as some flexion and extension
Degrees of movement up and down slope in cervical spine
8
Signs on instablity of cervical spine 3
Parasthesia of lips, face and tongue. VBI signs and cord signs
Signs of instability on testing cervical spine 3
empty end feel on testing, reproduction of lateral nystagmus, reproduction of signs of instability
When to test ligaments in cervical spine
Upper cervical pain post trauma, congenital abnormalities ie downs, degenerative such as RA
Clinical features of artery dissection
Pain like no other, acute, neck stiffness but no decrease in ROM, pain in head and neck
PART means
Pain provocation, asymetry, range of motion and tissue texture changes
Red flags for lumbar spine
tumour, spinal osteomyletis, fracture and cauda equina
Tumour signs
pain at rest, might pain, upper lumbar radiculopathy in the young, UEWL,age above 50 below 17, family or previous history of cancer
Spinal osteomyletis 7
fever, chills, night sweats, IV drug user, immunosuprresent disorder history of surgery or recent infection
Fracture
Trauma, long term sterioid, age above 70 menopause or amenmhorhea
What can be narrowed in lumbar spine stenosis
vertabral canal, nerve root canal or intervertabral foramin
SIgns of vascular intermittent claudication (which is secondary to peripheral arterial disease)
Pain ache in calf, associated with cramps, cyanosis, atrophic changes, decreased pulse, regular pattern and worse up hill
SIgns of neurogenic intermittent claudication
Deterioating pattern and better up hill
What releives neurogenic intermittent claudication
flexing and lying down
SIgns of derangement
Repeated movements centralises or peripheralises, decreased ROM or movement obstruction and shift possible
What produces Postural sydnrome symptoms
Sustained EROM
Who said that directional preference was highly prognostic of disc pain and associated with good outcome
Aina 2004
Effect of manipulation
Local tissue effect, neuromodulation of pain and short term ROM changes
Name the SIJ tests
Distraction, thight thrust, compression, sacral thrust and gaenslens
Laslett 2005 said what
2/4 or 3/6
How many tests have to be negative to rule out SIJ
All
What attaches to the TCF
...
Where does biceps femoris attach
...
Who said that instability tests correspond moderately well with MRI in patients with WAD
Kaale 2008
Who said that McKenize assesment for centralisation has 74% accuracy
Donelson 1997 ( I think!)
Management for derangement (after treatment)
Avoid flexion in morning. Gym programme for core stabilisers
Nuation is what
sacrum anterior, ilium posterior
Nuation causes tension in what ligaments
Interosseus, short dorsal and sacrotuberous
Which muscles cause relative nuation
biceps femoris and gluteals
Pain pattern of SIJ - young and april
Unilateral, dull ache in buttock, subjective heavyness of limb
Mechanism of injury for SIJ
Jarring through one leg, fall onto buttocks and preganancy
Two other tests for SIJ
SLR and SKE
with 100% sensitivity the test will be always negative or positive if some has the condition
positive
with 100% specificity the test will have no
there will be no false positives
Global muscles of the spine 4
Iliocostalis, longissimus, quadratus lumborum, rectus abdominus
Local muscles
Multifidus, TA, IO (posterior), QL (medial), intertransversarri, spinales
Quadratus lumborum O and I
Origin iliac crest and iliolumbar ligament
Insertion Last rib and transverse processes of lumbar vertebrae
Lat D
Origin: spinous processes of thoracic T7-L5, thoracolumbar fascia, iliac crest and inferior 3 or 4 ribs, inferior angle of scapula
Insertion: floor of intertubercular groove of the humerus
Validity of PAIVMs and PIVMs in lumbar spine for instabilit
Specific but not sensitive Abbot 2005
Dysfunction location
LBP w+/- referred pain with dominat symptoms above the gluteal fold
Treat dysfunction with
TERT, low load prolonged stretching
With radiculopathy is the numbness & weakness dermatonal.myotomal
Yes (Bogduk) 2009
Active straight leg raise tests what
Form and force closure of the pelvis
Which sling should you activate when doing the SLR
Anterior
What makes up the anterior sling
TA, IO & EO (Vleeming 1995)
If a patient had right sided pain turning left and you thought they had an upslope problem on the left at the CT junction, would you place the blocking hand on the same or opposite side as you
Opposite (and you try and grip the spinous process above with your pinkie
When assesing physiological movement at the CT junction where should you fingers be
between the spinous process or on the articular pillar
To test OA joint physiological movements which directions do you test
Flexion, extension, side flexion and flexion in side flexionq
How do you test the tectorial membrane
Fix C2 and grip occiput, distract
When testing alar ligaments how much movement are you expecting
10 degree
Test Alar ligaments in what position
neutral, if positive, flexion and extension
WHen testing the alar ligs with left lateral flexion which bands are tight
right uppper and left lower
When testing left flexion alar what happens to C1/C2`
Altlas (C1) moves to the right and C2 rotates right
What do you need to determine about pain before proceeding with repeated movements
site, intensity, nature & any other symptoms
When performing test determine what about pain
Symptoms better, worse or the same, are they only at end rom
What must happen with each movement
PRogressively further into rom
Do you apply over pressure with repeated movements
If it is required, if there is a poor response
How long do you hold sustained movements for
1-2 minutes an document change
What do patients with disc bulges need to be educated about
Gettting up of bed, how to sit and stand with lumbar spine extended, (tense abdominals before movement) to avoid flexion in the morning, then progress to strengthening programme
For a left sided disc bulge which side against the wall
RIght