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