Christina Fall 25 :) > MSK: 4B > Flashcards

MSK: 4B Flashcards

(55 cards)

Study These Flashcards
1
Q

fortins sign

A

unilateral pain just medial to PSIS

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2
Q

+ sign of buttock test

A

vertebral/pelvic/hip fx

note: sometimes ppl have trauma
-special test: used as screening tool if + tumor,abscess, fx –> refer

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3
Q

lumbar disc pathology

A

+ pain with cough and sneeze
sx decrease w/ walking (extension)

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4
Q

lumbar spine joint pathology

A
  • pain with cough/sneeze (nothing invading space)

+ pain with extension or flexion (opening or closing)

+ pain with PA joint glides

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5
Q

hip joint

A

+ trendelenberg sign

+ pain or decrease ability to squat

+ sign of buttock test

note: dont like flexion generally

note: illiopsoas has lots of blood infections prone

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6
Q

SI vs hip

A

SI: PSIS
hip: anterior femoral head

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7
Q

any of the following tests + proceed to full SI joint exam

A

fortins sign

primary SI joint stress tests: gapping or compression

TTP at post SI ligaments

pain/weakness with SLS

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8
Q

what exam do you do first before SI?

A

lumbar or hip

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9
Q

special test: fortins sign

A

pt can localize pain w/ one finger

area 1cm of PSIS inferomedial)

pt consistently points to same area 2 or more trial

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10
Q

special test: primary SI joint stress test

A

gapping (distraction): anterior SI joint stress
+ pain in back

compression test: posterior SI joint stress
(painful side up)
+pain on bottom

pressure 5 secs

only have to do one side

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11
Q

what if patient tightens up their muscles during primary joint stress test

A

they contract mms but dont want them to

-pelvic girdle instability

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12
Q

what if primary SI joint stress test is negative?

A

stop! not SIJ

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13
Q

sacral thrust

A

Special Tests: 2º SI Joint Stress Tests

SIJ PA glide

push in the middle –> S3

Pt positioned in prone
PT palpates inferior aspect of sacrum in midline
PT then applies significant anterior force at S3 multiple times (up to 6 thrusts)

(+) test = reproduction of concordant symptoms over SI joint and/or posterior SI ligaments

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14
Q

Gaenslen’s test

A

Special Tests: 2º SI Joint Stress Tests

Pt positioned in supine w/ 1 leg near the edge of the side of a table or mat

PT assesses pt’s resting symptoms in this position

PT flexes hip furthest from edge of mat to 90° and maintains that position

PT then passively positions testing leg off the side of the table, resulting in hip hyperextension

PT then applies forces to both legs, resulting in ↑ hip extension of testing leg and ↑ hip flexion of non-testing leg

(+) test = reproduction of concordant pain at SI joint or pubic symphysis at back

TEST BOTH SIDES

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15
Q

how do you label gaenslens

A

Special Tests: 2º SI Joint Stress Tests

label testing leg (leg thats down)

note: test both sides even if one side hurts
can have + R and L
only need one for CPR

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16
Q

FABER/Patrick’s test

A

Special Tests: 2º SI Joint Stress Tests

AKA: ‘Flexion ABduction External Rotation’ test

Screening test for lumbar, SI joint and hip pathology

Pt positioned in supine

PT places pt’s heel of 1 leg over opposite knee

PT passively ER and abducts testing leg while stabilizing opposite ASIS

If no symptoms, can add overpressure to further assess

(+) test for SI joint dysfunction = reproduction of concordant pain over posterior pelvis/buttoc

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17
Q

what if in gaenslens is pain anterior?

A

not + b/c that hip flexor tightness

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18
Q

during FABER pt has pain actively

A

dont do OP but need to know where it hurts over PSIS if over femoral head –> hip

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19
Q

FABER pain with OP

A

pain in back and their pain –> +

test both sides!
only need one + for CPG

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20
Q

how do you label FABER

A

leg bent

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21
Q

thigh thrust test

A

Special Tests: 2º SI Joint Stress Tests

Pt positioned in supine w/ PT standing on painful side

PT flexes hip (on painful side) to 90° w/ neutral adduction

PT then slightly rolls pt to 1 side to place hand under pt’s sacrum to form a stable base

Once sacrum stabilized, PT slightly adducts pt’s hip and then applies downward force through the femur causing a posterior translation of the innominate on the sacrum

(+) test = reproduction of concordant pain at SI joint

note: stand on ipsi side testing so leg that down

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22
Q

what is false negative for thigh thrust test

A

if hand over ilium

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23
Q

+ SIJ dysfunction CPR

Study These Flashcards
A
  1. compression
    2.distraction
  2. sacral thrust*
  3. Gaeslen Test
  4. thigh thrust

if 3 or more out of 5 test + = SIJ dysfunction

24
Q
  • SIJ dysfunction CPR
Study These Flashcards
A
  1. compression
  2. distraction
  3. gaeslen test
  4. FABER test
  5. thigh thrust

if 3 or less out of 5 test + its not SIJ dysfunction

25
Pubic stress (superior-inferior) test for anterior pain
Special Tests: 2º SI Joint Stress Tests Pt positioned in supine Using heel of 1 hand, PT palpates superior aspect of 1 pubic rami while simultaneously using heel of opposite hand to palpate inferior aspect of other pubic rami Stabilizing 1 pubic rami w/ heel of hand, PT applies slow, steady infero-superior force to opposite pubic rami Then switch sides w/ hand placement and repeat above steps on opposite pubic rami (both sides should be assessed during test) (+) test = reproduction of concordant symptoms over pubic symphysis/anterior pelvis
26
special tests: sign of buttock test
Indicates serious pathology: Neoplasm Fracture Infection Osteomyelitis Abscess in muscle Septic arthritis Procedure: Passive SLR = (+) pain Return LE to neutral Passively flex hip w/ knee flex = (+) test when ↑ pain w/ no Δ ROM
27
passive SLR hurt what next
bend knee sciatic is on slack pain --> something blocking (tumor,fx,etc) no pain --> nerve (non capsular ROM should increase with knee flexed) REFER most of time
28
Palpation/Alignment
supine: ASIS, pubic tubercle Prone: PSIS, sacral base depth, inferior lateral angle, ischial tuberosity *reset with glute bridge
29
Special Tests: Mobility/Functional Tests Seated flexion test
Seated flexion test Pt positioned in sitting w/ legs over edge of table and feet supported PT uses both thumbs to palpate just inferior to both PSIS PT instructs pt to flex trunk forward keeping 🡪 PSIS should move equal distance in superior direction Can use to rule out LE dysfunction such as LLD or hamstring tightness when compared to standing test (+) test = PSIS do not move equal distances w/ affected side moving more than unaffected side
30
what are you looking for with seated and standing* flexion test
hypomobility *aberrant mvmts note: + affected side moving more than unaffected side
31
Special Tests: Mobility/Functional Tests Long sitting (supine to sit) test
Used to determine direction of innominate rotation Pt positioned in supine PT then instructs pt to perform double limb bridge to standardize position prior to testing PT then palpates superior surfaces of both medial malleoli and assesses positions of malleoli relative to each other PT instructs pt to sit up (into long sitting position) while maintaining thumbs on malleoli PT then re-assesses positions of malleoli in long sitting position Both medial malleoli should move equal distance in inferior direction (+) test = malleoli do not move equal distances Longer limb = posterior innominate on respective side Shorter limb – anterior innominate on respective side
32
what is long sitting test (supine to sit) looking for
innominate rotation
33
Special Tests: Mobility/Functional Tests Standing flexion test
Pt positioned in standing PT places thumbs just inferior to each PSIS PT instructs pt to flex trunk forward keeping knees extended 🡪 PSIS should move equal distance in superior direction (+) test = PSIS do not move equal distances w/ affected side moving more than unaffected side
34
Special Tests: Mobility/Functional Tests Gillet’s (Stork) test
Pt positioned in standing PT uses thumb to palpate just inferior to 1 PSIS and other thumb to palpate base of sacrum on opposite side (just medial to PSIS) PT instructs pt to stand on 1 leg and then flex the opposite hip to >90° PSIS should move inferiorly to sacrum during test Test should be repeated on opposite leg (+) test = PSIS does not move inferiorly when compared to sacrum OR causes concordant SI joint pain
35
Special Tests: Active SLR
Insufficient form closure Part 1: Pt positioned in supine w/ both legs extended PT instructs pt to lift 1 leg off table w/o flexing knee PT observes pt’s movement strategy during test (+) test = reproduces concordant pelvic/SI joint pain OR compensatory pattern(s) observed Part 2: If (+) test present in part 1, test is repeated w/ PT applying compression force through pelvis (+) test = if pt able to perform ASLR test w/ less pain OR fewer compensatory patterns when compressive force was applied
36
Special Tests: Active SLR Insufficient force closure
Part 3: If (+) test present in part 1, test is repeated w/ PT instructing pt to contract core mm. prior to lifting leg Can add resistance at opposite shoulder for ↑ mm contraction (+) test = if pt able to perform ASLR test w/ less pain OR fewer compensatory patterns when core mm. activated **Part 1 has to be (+) before continuing to Part 2 or Part 3 of this test **
37
Manual Therapy: Joint Manipulations Million dollar (Chicago) roll:
Pt lays supine w/ hands interlaced behind head and feet together PT sidebends pt’s head and feet away (like a banana facing away from PT) W/o losing L sidebend, PT rotates pt’s upper trunk to the R (pt should rest on their R shoulder facing the PT) PT places caudal hand on L ASIS then ‘takes up the slack’ by further rotating the pt until L ASIS starts to move W/ cranial hand maintaining upper trunk rotation either on the pt’s back OR on the mat Quick AP thrust through caudal hand (on ASIS) **Can tx all SI joint dysfunction on affected side, sometimes used specifically for anteriorly rotated innominate**
38
Manual Therapy: Joint Manipulations Sidelying SI gapping:
Pt lays in sidelying (affected side up) w/ hips flex to 90° PT stands behind pt, table elevated to chest level (if possible) PT grasps ‘table side’ UE (just above the wrist) & pulls across pt’s body PT then stabilizes ‘top side’ PSIS w/ other hand PT ‘takes up the slack’ by concurrently pulling ‘table side’ arm towards PT while pushing ‘top side’ PSIS away from PT Quick thrust through ‘top side’ hand in sup-med direction (PSIS)
39
Manual Therapy: Joint Manipulations Long axis traction (prone): 2-person technique
Pt lays prone w/ LEs extended and feet off end of table PT grasps affected LE (just above the ankle) w/ both hands and lifts LE up and out -Affected hip in position of ext, slight abd and IR Additional person needed to stabilize sacrum standing on opposite side of PT PT ‘takes up the slack’ by distracting LE until just before pt’s body slides down on table Quick pull of LE towards PT (long axis traction force)
40
Manual Therapy: Joint Mobilizations Prone sacral PA (grades I-IV):
Same technique learned in thoracic and lumbar spines Use hypothenar eminence to assess PA glides and mobilize in same direction Can perform bilateral and unilateral mobs -Base (for counternutated sacrum) -Apex (for nutated sacrum)
41
Manual Therapy: Joint Mobilizations
Pt lays in prone w/ unaffected LE relaxed or off the table Can stand on same side or opposite side depending on comfort and skill PT extends affected side LE while stabilizing same PSIS PT uses hypothenar eminence to mobilize affected joint into ant rotation (PA glides) Maintain hip extension
42
Manual Therapy: Muscle Energy Techniques (METs) Supine w/ hip flex and ext iso holds:
Pt lays on back w/ hips and knees flexed to 90° PT places 1 hand on pt’s ipsilateral knee and the other hand on pt’s contralateral posterior thigh (near knee joint) PT instructs pt to ‘push against my resistance’ PT simultaneously resists both hip flexion on 1 leg and hip extension on the other
43
Manual Therapy: Muscle Energy Techniques (METs) Adduction isometric for anterior pelvic / SI joint pain:
Adduction isometric for anterior pelvic / SI joint pain: Pt lays in hooklying position PT braces against medial surface of both knees using hands (or arm) PT instructs pt to ‘squeeze knees together’ for about 3 seconds Same sequence is then repeated w/ pt cued to ‘push knees apart’ Repeat process 3x
44
Mobility exercises
Foam roll/lacrosse ball Low load/long duration stretches AROM
45
Stability exercises*
AROM Spinal stabilization NM re-ed Scapular strength Pelvic floor strength
46
Functional activity tolerance
↑ muscular endurance Low intensity for prolonged period vs high intensity for short period Goal: mimic daily life
47
Maintenance & D/C planning
Identify 2-3 exercises to continue progress Provide criteria for exercise/activity progression Educate pt about tx options if/when symptoms recur
48
Stabilization Exercises
Spinal stabilization -Hooklying -Hooklying w/ LE movements -Quadruped -Quadruped w/ LE vs UE -Prone on elbows -Side plank -Prone on elbows w/ LE vs UE movements -Side plank w/ LE vs UE movements AROM Lumbar extensor strength NM re-ed: core musculature Pelvic floor strength!!! GLUTE STRENGTH!!!
49
Stabilization Technique: SI Belt Application
PT provides the following instructions to the pt to ensure proper application and use: ‘Flex hip while standing to find the hip crease as the bottom edge of the belt will go there’ ’Find the middle seam of the belt and place it in the center of your back/pelvis’ ‘Pull the non-label side of the belt close to your body’ ‘Then pull the label side of the best away from your body while maintaining tension and pull the belt around the front of your body’ ‘Fix the label side of the belt to the non-label side … the belt should be snug to prevent excess unwanted motion at the joint’ ‘Finally, pull the elastic straps on each side forward to comfort (not too tight)’ Pt then instructed to perform ADLs, HEP and general physical activity w/ belt in place for symptom reduction
50
what's so special about the Gillet's (Stork) test?
one hand inferior to PSIS other hand base of sacrum on opposite side (just medial to PSIS)
51
how to label Gillet's
leg flexed ex: R PSIS palpation R hip flexed
52
ASLR tests
instability form vs force closure 3 parts
53
ASLR when do you move to part 2?
when pt 1 is positive move to 2 and 3
54
ASLR insufficent form closure symptoms decrease with
pelvic compression
55
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