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Spinal Ortho DOs

NPTE Musculoskeletal

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