Si! Si! Si!
Your patient exclaims, "I was iceskating at Rosa Parks, and fell and landed on my left buttock!"
You could assume they have ______ rotated innominate on the _____.
Posteriorly rotated innominate on the left.
I was bending forward, lifting a heavy box, and felt something give in my back. I had pain immediately in my back that has since traveled into my buttock and leg. What is the most likely anatomical cause if I am 15? If I am 45? If I am 75?
15: muscular
45: discogenic/neurogenic
75: vertebral body compression Fx
A chronic inflammatory disorder of ligament attachments, can lead to fibrosis, calcification and ossification.
Sometimes referred to as "bamboo spine"
Do any of us actually feel confident for Barb's exam?
No
If you said yes, give yourself 1000 points and teach the rest of us your ways
Numbness/tingling around where I have 1 Corinthians 9:26 tatooed on my leg (my calf, right below the knee), what nerve(s) could be involved? (5 different options)
Peripheral: posterior cutaneous nerve of thigh (central), saphenous (medial), common peroneal (lateral)
Palpation demonstrates a superior right PSIS and a superior left ASIS, what is most likely going on with the innominate?
(Feel good about yourself bonus points by listing possible MOIs)
Anteriorly rotated right innominate
Possible MOI: Dashboard injury, forceful kick of inanimate object, golf or baseball swing
What are the 4 stages of a disc bulge?
Also what is the most common age for disc lesions?
1. protrusion: no change in annulus
2. prolapse: annulus still intact
3. extrusion: annulus disrupted/perforated
4. sequestration: free material
30-40s (can be 20-55)
smoking, prolonged daily sitting/driving, heavy lifting (bending/twisting), being male (it's more common in dudes)
What is a patho-anatomic reason you would use...
Flexion exercises?
Extension exercises?
(For study bonus give an example of each)
flexion: Spondy(losis/lolysis/lolisthesis), stenosis
flexion exercise examples: seated forward bend, S/DKTC, hooklying knees side to side, "Buck-Eye" Shoe tie
extension: posterior/posterolateral disc bulge
extension exercise examples: Prone progression, standing extension, leaning on a wall & letting hips sag
What is the Cluster of Laslett for SI joint testing?
Need to rule out lumbar spine and have 3/5 positive
Pt presents with L low back and buttock pain, you decide to measure leg length in lying and supine. Indicate the possible findings with:
L Anterior Rotated Innominate:
L Posterior Rotated Innominate:
L Posterior: (PSL) left leg shorter in supine, equal or longer in sitting
What is the capsular pattern of motion loss in the lumbar spine?
Sidebending = Rotation/Extension
Define Spondylosis, Spondylolysis, Spondylolisthesis.
What osteokinematic motion aggravates all 3?
Spondylosis: osteophytes on vertebral bodies, lipping or bony overgrowth
Spondylolysis: fracture to pars interarticularis
Spondylolisthesis: anterior slippage of lumbar vertebral body
*EXTENSION*
Give 3 reasons we may use traction? (not conditions, think anatomic reasons)
Stretch spinal musculature
Tense ligaments/facet joint capsules
Offload nerves (widen intervertebral foramen)
Straighten spinal curves
Slide facet joint
"flatten" nuclear disc protrusions
What are the 5Ds and 2Ns of vascular occlusion?
Dizziness, Dysarthia, Diploplia, Dysphagia, Drop Attack
Nystagmus, Nausea
Pt with back pain has a right sacral sulcus that moves first and furthest with Forward Flexion and least and last with Gillet's test.
What information doest that give us?
It lateralizes it to the right side
List the following for NEUROGENIC claudication...
Pain type:
Location:
Aggravation:
Relief:
Time to relief:
Parasthesia (y/n):
SLR (+/-):
Distal pulses (y/n):
Pain type: heaviness, cramping
Location: diffuse or radicular
Aggravation: extension (standing, walking, biking upright)
Relief: flexion (sitting, reclining, biking bent over)
Time to relief: long time
Parasthesia (y/n): yes (possible)
SLR (+/-): + (often)
Distal pulses (y/n): yes, present pulses
This drug can prevent pain and fever, but NOT inflammation or stroke.
Some adverse affects include liver damage over time.
Acetominophen
I have recent onset of LBP (<16 days) and no symptoms below the knee. What Non Specific LBP Classification am I and how would you treat (generally)?
Mobilization/Manipulation Classification
mobilize/manipulate SI or lumbosacral region (I.e. P/A springing), AROM exercises
when no more symptoms add stabilization/core training
Name 4 special tests to test the muscles/tendons of the shoulder (and what muscles you're tensioning).
Speeds: biceps
Yergasons: biceps
Empty can: supraspinatus
Drop arm: surpaspinatus
Lift off sign: subscap
You do Gaenslen's test on a pt with them sidelying and pull back their LEFT leg (RIGHT leg knee to chest), what are the possible outcomes? (Provocation/Relief)
Provocation: posteriorly rotated RIGHT innominate, anteriorly rotated LEFT innominate
Relief: anteriorly rotated RIGHT innominate, posteriorly rotated LEFT innominate
Name 3 neural tension tests (lower extremity)
Straight leg raise
Cram (Bowstring) Test
Slump Test
Brudzinski-Kernig
Prone Knee Bending Test
Define Pharmacokinetics and list 3 things that can affect it.
How the body handles the drug
administration, absorption, distribution, storage, elimination, metabolism, age, gender
What percent weight (male/female) bearing is someone if they are in water up to...
C7 (neck)
Xiphisternal (chest)
ASIS (hips)
Xiphisternal: 28% (m) 35% (f)
ASIS: 47% (m), 54% (f)
What is Trigger Finger and what position is the finger in?
Is passive motion possible?
thickening of the A1 pulley and FDP/FDS tendons (stenosing synovitis)
Finger "stuck" in IP flexion
CAN passively extend