pattern recognition - spine

Question 1

subjective exam/symptoms

what are symptoms seen in capsular pattern of facet joint capsule?

Answer 1

• acute onset (inflammation)
• gradual onset (osteophyte formation)
• unilateral
• localized to one facet level (ipsilateral)
• no radicular symptoms

Question 2

objective exam/signs

what are signs seen in capsular pattern of facet joint capsule?

Answer 2

• equally limited ipsilateral LF and rotation ROM (%)
• limited extension ROM

Question 3

subjective exam/symtpoms

joint dysfunction: hypomobility
what are symptoms seen?

something won’t be able to move normally both osteo and arthero kinematically

Answer 3

• acute facet joint restriction
• or gradual onset (spondylosis)
• non traumatic
• “it feels stuck”
• “I can’t move my neck during _______ activity”
• localized to one level
• no radicular symtpoms

Question 4

objective exam/signs

joint dysfunction: hypomobility
signs to look for?

Answer 4

• decreased AROM (osteokinematics) due to muscle guarding
• onset of pain early to mid rang AROM
• decreased joint glide (arthrokin)
• often seen at CTJ and TLJ

Question 5

what is closing restriction

Answer 5

facet joint has limited posterior/inferior glide (ipsilateral side)

if one segment doesn’t move, another segment will take over

Question 6

what is opening restriction

Answer 6

facet joint has limited anterior/superior glide (ipsilateral side)

if one segment doesn’t move, another segment will take over

Question 7

subjective exam/symptoms

joint dysfunction: hypermobility
symtpoms seen?

remember hypermobility = instability

Answer 7

• chronic or gradual onset
• repeated episodes w progressive worsening symptoms
• younger (<40)
• history of muscle spasms
  -radicular symptoms –maybe
  localted to one or two levels
  decreased pain with cahnge in position or movement (walking)

history of muscle spasms = trying to provide stability and they are not meant to
radicular symptoms maybe = if segment moves to much, could hit nerve
decrease pain w/ change or movement = puts pressure somewhere else

Question 8

objective exam/signs

joint dysfunction: hypermobility
signs to look for?

Answer 8

• ↓or↑ rom (skin fold observed)
• pain at end AROM
• orr upone returing to neutral from full ROM
• aberrant motion during AROM
• positive (+) gowers sign
• ↑ joint glide (segmental mobility)
• temp relief with self manipulation

Question 9

what is a positive gowers sign?

Answer 9

help returing from flexion to standing by using hands on legs to “walk” up (aberrent motion)

Question 10

subjective exam/symptoms

pattern: nerve compression from disc inury.
what are symptoms of this?

Answer 10

• often traumatic onset (specific event)
• radicular pain (pressure on nerve)
• ↓ pain with decompression (gravity minimized positions)
• pain with valsalva (going poo could increase symtpoms)

possibly could have pain first thing — gets better – then worse again

Question 11

What is peripheralization?

Answer 11

increased radicular pain with spine flexion movements

Question 12

what is centralization?

Answer 12

decreased radicular pain with spine extension movements

Question 13

objective exam/signs

nerve compression from disc injury
signs of this?

Answer 13

• peripheralization/centralization
• increased pain with compression (weight bearing in the morning)
• positive neuro screen (dermatomes/myotomes/reflexes)

Question 14

objective exam/signs

compression fracture
signs of this?

Answer 14

• increased spine or radicular pain with spine extension movements
• increased spine or radicular spain with spine flexion movements
• T11 is most fracture level
• may or may not have positive neuro screen

• extension and flexion = pain/symptoms

Question 15

what level is most often fractured during a compression fracutre?

Answer 15

T-11 (kyphosis)

Question 16

subjective exam/symptoms

compression fracture
symptoms of this?

Answer 16

• often traumatic onset
• radicular pain (maybe)
• younger patients = traumatic
• older patients = less traumatic more osteoporotic

Question 17

a wedge compression fracture will bias what plane of movement?

Answer 17

flexion

Question 18

subjective exam/symptoms

nerve compression at foramen (foraminal stenosis)
symptoms of this?

Answer 18

• acute onset or gradual onset
• radicular pain
• increased pain with extension biased functional activities (standing, walking)

foraminal stenosis = narrowing of foramen and pressure on nerve root

Question 19

objective exam/signs

nerve compression at foramen
signs?

foraminal stenosis= FS

Answer 19

• ↑ spine or radicular pain with extension
• ↓ spine or radicular pain with flexion movements
• in younger patients = facet joint hypermobility
• older patients = radiographic signs of FS
• maybe + neuro screen

extension bad= peripharalization
flexion good = centralization

Question 20

subjective exam/symptoms

symptoms of muscle strain

Answer 20

• unilateral pain
• localized to one muscle
• acute
• no radicular symptoms

Question 21

objective exam/signs

signs of muscle strain

Answer 21

• pain with contraction (MMT)
• pain with muscle stretch during AROM
• tenderness to palpation over muscle belly

*if chronic/non-traumatic injury, diffuse symptoms, or multiple muscles involved often a symptom of another injury (generally jont or ligament)

Question 22

When is a muscle strain often considered part of another injury (like joint or ligament)?

Answer 22

• if chronic/non traumatic injury
• diffuse symptoms
• multiple muscles involved

Question 23

in nerve compression from disc injury, what is typically observed during examination?

Answer 23

increased radicular pain with spine flexion movements (peripheralization)

Question 24

what is a chracteristic of nerve compression from disc injury regarding pain patterns?

Answer 24

decreased pain with decompression positions