NPTE Musculoskeletal
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| Fx of pars interarticularis | Spondylolysis
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| XR sign of spondylolysis | Scotty dog on oblique view
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| Anterior or posterior slippage of one vertebra on another following bilat Fx of pars | Spondylolisthesis
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| XR view to see spondylolisthesis | lateral
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| Exercise focus for spondylolisthesis or spondylolysis | Trunk stabilization, Flexed to neutral trunk work, avoid extension / IL sidebending / CL rotation
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| Spinal manip for spondy | possibly contraindicated
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| Narrowing of spinal canal or IVF with hypertrophy of spinal lamina, lig flavum, facets | Spinal stenosis
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| Sx of spinal stenosis | bilat pain/paresthesia in back/butt/legs, extension sensitive, increases with walking, relieved with prolonged rest
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| PT Tx for spinal stenosis | joint mobilization, flexion based exercise, trunk stability, traction
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| Internal disc annulus disrupted without damage to external structures | internal disc disruption
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| Internal disc disruption most common where? | lumbar region
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| Sx of internal disc disruption | constant deep achy pain, pain increases with mvmt, no objective neuro findings but may be referred pain into LEs
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| PT Tx for internal disc disruption | joint mobs, manipulation may be contraindicated, body mechanics, trunk stability
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| Overstretching or tearing of annular rings, vertebral endplate or lig structures | disc bulge/herniation, usu occurs posterolateral
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| MOI of disc bulge or herniation | high compressive forces or repetitive microtrauma
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| Precipitating factors for herniation posteriorly | posterior disc narrower in height, posterior longitudinal lig not as strong and only central, posterior lamellae of annulus thinner
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| Sx of disc bulge | loss of strength, radicular sx, paresthesia
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| PT Tx for posterolateral disc bulge | trunk stability, positional gapping, manipulation contraindicatied, body mechanics, traction
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| Positional gapping L bulge | 10 min. R sidelying with pillow under R trunk to incr sidebend R. Flex hips/knees. Rotate trunk to left.
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| Central posterior disc bulge or herniation usually seen | in cervical spine
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| Possible serious sequelae of Cx disc bulge | SC compression with CNS sx – hyperreflexia, Babinski’s
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| DJD of facets results in | bony hypertrophy, capsular fibrosis, hyper or hypomobility of joints, synovial proliferation
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| Sx of facet DJD | decreased spinal mobility, pain, nerve root impingement signs with loss of strength & paresthesias
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| Exam to include for Facet DJD | Quadrant test
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| “Locked back” or facet entrapment | abnormal mvmt of fibroadipose meniscoid in facet when Flex to Ext. Meniscoid bunches up and becomes space occupying lesion, distends capsule, causes pain.
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| PT treatment for facet entrapment | Facet joint gapping, manipulation
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| Early Sx of WAD | HA, neck pain, decr ROM, reversal of lower Cx lordosis, decr upper Cx kyphosis, vertigo, vision/hearing changes, noise/light irritability, dysesthesias of face & UEs, nausea, dysphagia, emotional lability
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| Late Sx of WAD | chronic head/neck pain, decr ROM, TMD, limited ADL tolerance, disequilibrium, anxiety, depression
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| Clinical findings in WAD | postural changes, excessive muscle guarding, soft tissue fibrosis, segmental hypermobility with gradual devel of restricted segmental motion cranial & caudal to injury
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| Abnormal increase in ROM at a joint due to insufficient soft tissue control | hypermobile spinal segments
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| Clinical tests for SIJ conditions | Gillet’s, IL anterior rotation test, Gaenslen’s, Long-sitting test, Goldthwait’s test
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