MSK: Lab 2

Question 1

Length of acute symptoms:

Length of subacute:

Length of chronic:

Answer 1

3-4 weeks

<3 months

> 3 months

Question 2

Pain w/ increased intrathecal pressure (coughing/sneezing/laughing) could indicate what?

Answer 2

A compression somewhere in the spinal cord

Question 3

When is disc herniation most common?

What about ankylosing spondylitis?

Answer 3

15-40

18-45

Question 4

When is OA/degenerative spondylosis most common?

What about Spinal tumor?

Answer 4

45+

50+

Question 5

What gender is LBP more common in?

Answer 5

Women

Question 6

What are the 3 kinds of pain?

Answer 6

Localized: pain stays put (mechanical LBP)

Referred: pain refers but does not go below knee (joints, muscles, viscera)

Radiating: pain radiates below knee (NERVE)

Question 7

If someone has leg dominant pain what is the likely pathogenesis?

Answer 7

Disc herniation

Question 8

Is someone has back dominant pathogenesis ?

Answer 8

Mechanical LBP

Question 9

If your screening for the LBP what are some factors that would point to cancer ?

Answer 9

above 50 or below 17
unexplained weight loss / night pain
failure to improve

Question 10

If your screening for the LBP what are some factors that would point to infection ?

Answer 10

Hx of immunosuppression
Prolonged fever or recent illness
Hsx of drug use

Question 11

If your screening for the LBP what are some factors that would point to vertebral Fx?

Answer 11

Corticosteroids
Hx of osteoporosis
age over 70

Question 12

What is a potential diagnosis for someone with back pain who is 70+ with bruising over the spine and a recent trauma

Answer 12

Vertebral fracture

Question 13

In which direction do people typically lean with a disc problem?

Answer 13

Away from the bulge

Question 14

What are we thinking if a patient has a tuft of hair at the level that they have back pain?

Answer 14

potential Spina-bifida

Question 15

Sway back posture has ___________ pelvic tilt, with the hips hyperextended and thoracic kyphosis

Answer 15

posterior

Question 16

A LQ scanning exam is to rule _____

a lumbar exam is to rule ______

Answer 16

out

in

Question 17

If a patient can preform a full double limb squat with no pain or compensatory patterns, what does this likely indicate

Answer 17

that there is no issue with the hip knee foot or ankle joints

Question 18

Abnormal findings in SLS and SL squat

Answer 18

Trendelenburg sign

poor balance (< 30 seconds)

Question 19

In the case of doing a lumbar ROM exam, from what position should you preform resisted isometrics for a patient?

Answer 19

From the end range if there is no pain

Test from neutral position if the patient had pain with AROM

Question 20

What part of the vertebrae does quadrant testing focus on?

Answer 20

The facets

do only when there is no reproduction of symptoms with AROM/overpressure

Question 21

When is it indicated to utilize the inclinometer?

Answer 21

if the patient has a ROM deficit

if normal → “WNL”, no need to measure ROM

Question 22

If there is NO pain with AROM/overpressure, perform resisted testing in the _________ position

If there IS pain with AROM/overpressure, perform resisted testing in the _________ position

Answer 22

lengthened

neutral

Question 23

If pain is not provoked with neither flexion or extension, what category do they get put into?

Answer 23

traction

Question 24

When attempting to centralize a patients symptoms, what needs to be examined and possibly corrected first

Answer 24

A lateral shift

Question 25

How many reps of repeated extension/flexion should a patient do?

Answer 25

10 reps and then reassess

Question 26

If the patient has radiating pain and it centralize but the pain gets worse is that a good sign or bad sign ?

Answer 26

It is a good sign The pain level/intensity is not important as long as it centralizes

Question 27

If a patient's referred pain peripheralizes when performing extension-based movements. What do you need to do?

Answer 27

Check FLEXION-based motion to see if the symptoms CENTRALIZE

Question 28

What is the easiest position to do repeated extensions from?

Answer 28

Prone (easiest) standing (most difficult)

Question 29

What is the easiest position to do repeated flexion testing from?

Answer 29

Supine is easiest sitting is more difficult standing is the most difficult

Question 30

Repeated motion testing only helps with what kind of pain?

Answer 30

Radiating pain

Question 31

Most patients who need repeated motions testing respond to which direction best?

Answer 31

extension

Question 32

If we are having a patient do their repeated motions testing to centralize symptoms, and they say it has made the pain worse in their back, what should we do?

Answer 32

They still complete all 10 reps, goal is to stop the symptoms from radiating, it may be worse temporarily

Question 33

Always check the ______________ when assessing a joint for a problem

Answer 33

ROM/MMT of joints above and below (AKA T-Spine and Hips for lumbar)

Question 34

What position and how long does a patient need to hold the sorenson test? Normal 5 Good 4 Fair 3 Poor 2

Answer 34

5 20 -30 seconds hands crossed over chest or behind head 4 15-20s hands at side 3 fair 10 -15s hands at side 2 poor 1-10s hands at side

Question 35

What position and how long does a patient need to hold the dynamic abdominal endurance test? Normal 5 Good 4 Fair 3 Poor 2 Trace 1

Answer 35

5 20 -30 seconds hands behind head 4 15s hands over chest 3 fair 10 -15s arms elevated 2 poor 1-15s hands at side 1 trace only raise the head 2-5 Scaps must come off

Question 36

How should you test a myotome for fatiguability?

Answer 36

hold each 5 seconds, if the patient got weaker overtime, do 3-5 repetitions to see if they fatigue

Question 37

What are the DTR associated with the LQ and spinal level.

Answer 37

L4 Patellar L5 Medial S1 Achilles

Question 38

what myotome does toe walking test? Where should the PT be?

Answer 38

S1-S2 Behind the patient

Question 39

What myotome does heel walking test? What position should the PT be in relation to the patient?

Answer 39

L4 Viewing the patient from the front

Question 40

What indicates a positive SLR

Answer 40

Reproduction of THEIR symptoms in the ROM of 30-70 hip Flexion

Question 41

How do you test Piriformis flexibility?

Answer 41

Below 90 degree hip flexion + IR Above 90 degree hip flexion + ER

Question 42

Well/crossed SLR sign is an indication of what?

Answer 42

Large space ocuppying lesion in the spinal cord, contralateral to the raised leg

Question 43

If someone has a positive wells/crossed SLR what intervention might they benefit from?

Answer 43

TRACTION due to Irritability

Question 44

If the patient has radiating pain to both legs at all times what is likely? If the patient has radiating pain to each leg sometimes, what is likely?

Answer 44

CNS problems Vertebral instability (sometimes it irritates one side and sometimes it irritates the other)

Question 45

How do you bias the tibial nerve in the SLR test?

Answer 45

Add DF and EV

Question 46

How do you bias the sural nerve (medial) in the SLR test?

Answer 46

DF + INV

Question 47

How do you bias the fibular nerve/peroneal in the SLR test

Answer 47

PF + INV

Question 48

A positive prone knee bend test is between what ROM of knee flexion? What nerve does it test? How do you eliminate gravity in this test?

Answer 48

80-100 Tests femoral nerve Sidelying

Question 49

How do you preform the Prone Instability test?

Answer 49

Apply lumbar mob to area with suspected instability with patient in prone and feet supported (patient should have their pain increase if they have spinal instability, but that’s not the end of the test) Then try the same mob while the patient turns on their extensors to lift their legs A (+) test is decreased pain with muscles working, because the muscles increase the stability

Question 50

What does the bicycle or stoop test measure?

Answer 50

Intermittent claudication Pt bicycles on recumbent bike upright, record time until pain patient then bicycles with a stooped posture, record time until pain + test is indicated if there's less pain w/ stooped posture

Question 51

If someone has bicycle or a Stroop test what might their pathogenesis be

Answer 51

Spinal Stenosis

Question 52

What are the 5 components of Waddell's test How many out of 5 need to be true, what does it test for?

Answer 52

1. Stimulation- light axial compression and hip rotation irritate lumbar symptoms 2. Regional - sensory and weakness deficit s 3. tenderness- superficial 4. distraction improves symptoms 5. overreaction (less reliable than other signs) 3+/5 need to be true Tests for non-organic symptoms