Final Flashcards

Question

what are the three MC ways to acquire cauda aquina?

Answer 1

- Fracture - Disc Herniation - Space Occupying Lesion

Answer 2

Patient Position: - Sidelying with target (involved) muscle up - Patient’s posterior trunk positioned close to the edge of the table. * *Upside leg (target muscle): the hip and knee are extended - leg is lowered over the edge of the table until the barrier of resistance is palpated. * *Downside leg: hip and knee flexed on the table for stability. Doctor Position: Ipsilateral to dysfunction, standing behind the patient. Procedure: - With the superior hand (cephlad) stabilize the patient’s pelvis in a sidelying position. - The inferior (caudal) hand is placed on the lateral thigh/knee of the upside leg. - Adduct (lower toward the floor) and extend the leg to the position where the “barrier of resistance” can be palpated. - Direct the patient to push their thigh/knee upward and forward against your contact hand as you apply isometric resistance to the patient’s hip abduction and flexion (20-75%). - Use “as little force as possible or as much as necessary”. Avoid Valsalva.

Answer 3

Patient Position: - Supine - Contralateral leg (target muscle): knee flexed. Hip flexed, adducted and internally rotated to the position where the “barrier of resistance” is palpated - Ipsilateral leg: extended and relaxed on the table Doctor Position: -Contralateral to dysfunction, facing the patient. Procedure: - The contralateral hip (target muscle) is placed as follows: - hip flexion < 60º - hip adduction across the midline of the body - The superior (cephalad) hand is placed on the contralateral knee (over the patella) - The inferior (caudal) hand is placed on the medial malleolus (inside) of the contralateral ankle. - Place your sternum/epigastrium/abdomen on the top of your superior hand contact on the patient’s knee. - Put compression into the hip joint by pushing and maintaining your body weight down the shaft of the femur. - With your inferior hand (ankle contact) gently push the hip into internal rotation until the “barrier of resistance” to hip external rotation can be palpated. - Direct the patient to push their foot against your contact hand (ankle) as you apply isometric resistance to the patient’s external rotation (20-75%). -Use “as little force as possible or as much as necessary”. • Avoid Valsalva. • Hold 8-10 seconds. * Slowly increase the hip internal rotation within patient’s comfort zone (the joint should move smoothly without muscle resistance). * Repeat PIR stretch 3-5 times total.

Answer 4

Patient Position: - Sitting on the edge of the foot of the table. - Ipsilateral leg: patient pulls their knee-to-chest (flexion) and reclines the upper trunk backwards onto the table, leaving the contralateral leg (target muscle) hanging off the foot of the table. - The doctor places his/her lateral hip against the sole of patient’s foot to help stabilize the leg in flexion. - Contralateral leg (target muscle): allowed to hang over the foot of the table with the thigh resting as close as possible to the table top and the knee passively flexed as much as possible over the edge of the table. Doctor Position: - At the foot of the table standing contralateral to and facing the leg with the target muscle. - The doctor places his/her lateral hip on the sole of the foot of the patient’s ipsilateral leg, stabilizing it in flexion. Procedure: • Place the superior (cephalad) hand on the patient’s ipsilateral knee to stabilize it. • With the inferior (caudal) hand push down on the contralateral (target) knee to stretch the iliopsoas muscle. • Stretch the iliopsoas until the “barrier of resistance” can be palpated. • Direct the patient to push their knee against your contact hand as you apply isometric resistance to the patient’s hip flexion (20-75%). • Use “as little force as possible or as much as necessary”. • Avoid Valsalva. • Hold 8-10 seconds. • Patient relax - wait for muscle resistance to let go (1-3 seconds) • Slowly increase hip extension within patient’s comfort zone (the joint should move smoothly without muscle resistance). • Repeat PIR stretch 3-5 times total.

Answer 5

Rectus Femoris Patient Position: Same as the iliopsoas position Doctor Position: Same as the iliopsoas position Procedure: • Place the superior (cephalad) hand on the patient’s ipsilateral knee to stabilize it. • With the inferior (caudal) hand push on the contralateral tibia to induce knee flexion. • Stretch the rectus femoris (quadriceps) until the “barrier of resistance” can be palpated. • Direct the patient to push their lower leg against your contact hand as you apply isometric resistance to the patient’s knee extension (20-75%). • Use “as little force as possible or as much as necessary”. • Avoid Valsalva. • Hold 8-10 seconds. * Patient relax - wait for muscle resistance to let go (1-3 seconds) * Slowly increase the knee flexion within patient’s comfort zone (the joint should move smoothly without muscle resistance). * Repeat PIR stretch 3-5 times total.

Answer 6

Note: For stretching purposes the Quadratus Lumborum can be divided into an anterior and a posterior division and each division can be stretched separately. The procedure is similar for both divisions except for the following: • when stretching the posterior division the patient’s trunk is positioned toward the back edge of the table and the hip is placed in extension. • when stretching the anterior division the patient’s trunk is positioned toward the front edge of the table and the hip is placed in flexion. Patient Position: Sidelying with target (involved) muscle up Patient’s trunk is positioned close to the edge of the table. ♣ Upside leg (target muscle): the knee is straight (extended) and the hip is either flexed or extended (anterior vs. posterior divisions) with the leg lowered over the edge of the table. ♣ Downside leg: hip and knee are flexed on the table for stability. ♣ The patient’s upside arm reaches overhead and grasps the top of the table. ♣ A roll may be placed on the table under the patient’s waist. Doctor Position: Ipsilateral to dysfunction; standing behind the patient to stretch the posterior division or in front of the patient to stretch the anterior division. Procedure: • The fingers of both hands are interlaced and placed over the upside iliac crest. • The doctor straddles and lightly squeezes the patient’s leg between his/her knees. • Pull on the iliac crest with both hands to the position where the “barrier of resistance” can be palpated. • Ask the patient to breathe in and look up with both eyes. • Direct the patient to pull their iliac crest superiorly (cephalad) against your contact hands as you apply isometric resistance to the patient’s iliac elevation (20-75%). • Use “as little force as possible or as much as necessary”. • Avoid Valsalva. • Hold 8-10 seconds. • Instruct the patient to breathe out and release their eyes. • Patient relax - wait for muscle resistance to let go (1-3 seconds) • Slowly pull downward on the iliac crest, lowering it within the patient’s comfort zone (the iliac crest should move smoothly without muscle resistance). • Repeat PIR stretch 3-5 times total.

Answer 7

Patient Position: -Sidelying with a pillow or roll under their waist. The patient’s upper trunk is placed in a pronated position (hugging the table) and their downside hip and knee is flexed. Doctor Position: Standing behind the patient near the patient’s pelvis. Procedure: Doctor’s hand position: • Reach over to the patient’s posterior trunk and contact the iliac crest/ASIS with the superior hand. With the inferior hand contact the lower thoracic or upper lumbar erector spinae muscles. Alternative hand placement: • The doctor’s arms do not have to be crossed as illustrated here. * The doctor uses the superior hand to pull the patient’s pelvis posteriorly while using the inferior hand to push superiorly and anteriorly on the erector spinae until the “barrier of resistance” is reached * Ask the patient to breathe in and look up with both eyes. * Direct the patient to push their trunk backward against your contact hand as you apply isometric resistance to the patient’s trunk extension (20-75%). * Use “as little force as possible or as much as necessary”. * Avoid Valsalva. * Hold 8-10 seconds. * Instruct the patient to breathe out and release their eyes. * Patient relax - wait for muscle resistance to let go (1-3 seconds) * Slowly increase the trunk flexion within patient’s comfort zone (the trunk should move smoothly without muscle resistance). * Repeat PIR stretch 3-5 times total.

Final Flashcards

(31 cards)