-
red flags for disease of the spine
- Hx of cancer
- unexplained wt loss
- fever/chills
- malaise
- loss of appetite
- sharp/severe pain
- unvarying sx
- cape-like distrobution
- horner's syndrome
-
follow up tests for suspected disease
-
follow up tests for suspected cancer
-
follow up tests for suspected arthritis
-
Facet syndrome s/sx
- tenderness over facet
- local spasm
- joint restriction
- extension causes pain
-
trigger point s/sx
- tender nodule
- familiar pain
- stretch causes pain
- familiar pain referral
- jump sign
- twitch
- muscle weakness
-
muscle home treatment
- AROM 3 cycles
- moist heat
- avoid strenuous exercise
- gentle home stretching
-
5 high pay off areas of the lumbar spine
- t/l junction
- l/s junction
- SI joints
- pubic symphysis
- hip
-
signs of myelopathy
- clumsy hands
- clumsy gait
- gait disturbances
- paresthesia
- proximal leg pain
- proximal muscle weakness
- bladder problems
-
cauda equina sx
- urinary retention
- alterned saddle sensation/paresthesia
- decreased sexual function
- decreased sphincter tone
- + SLR
-
cauda equina causes
- midline herniation
- tumor
- spinal stenosis
- trauma
- spinal manipulation
- pneumococcal meningitis
- paget's
- A/S
-
lumbar radiculopathy causes
- disc herniation
- stenosis
- tumor
- instability
- spondylolisthesis
- NR adhesion
- fx
- infection
- osteophytes
-
pain aggravated by lumbar flexion suspect:
- sprain
- disc derangement
- subluxation
-
pain relieved by lumbar flexion suspect:
- muscle spasm
- facet syndrome
- anterior disc derangement
-
leg sx aggravated by lumbar flexion suspect:
- disc derangement
- disc herniation
-
leg symptoms centralized by lumbar flexion suspect:
- spinal canal stenosis
- anterior disc derangement
-
flexion sensitivity, pain with:
- bending
- lifting
- squating
- sitting
-
flexion sensitivity activity modification
- avoid sustained flexion
- shift posture often
- microbreaks
- hip hinge
- proper lifting techniques
-
pain aggravated by active lumbar extension suspect:
extensor sprain
-
pain aggravated by passive overpressure of lumbar extension suspect:
- facet syndrome
- disc derangement
- subluxation
- sprain
- spondylolisthesis
-
local pain with hypermobility into lumbar extension suspect:
segmental instability
-
leg sx aggraveted with lumbar extension and older than 55 suspect:
stenosis
-
leg sx centralized with repetitive lumbar extension suspect:
disc derangement
-
extension sensitivity, pain with:
- walking
- prolonged standing
- working with arms above head
- lift objects off a counter
-
extension sensitivity activity modification
- walk faster
- stand with foot on a step
- lean over the counter
- posterior pelvic tilt
- step stools/ladder for reaching
-
positive orthopedic tests with L4 radiculopathy
- femoral nerve stretch test
- possible negative SLR
-
Maigne's syndrome
- TL restriction
- crest pain
- groin pain
- hip pain
-
recommended SI tests
- ASLR
- thigh thrust
- Gaenslen's test
- Fabere
- SI compression
- SI distraction
- palpation of long dorsal lig
-
lumbar instability palpation
- tenderness
- hypermobility
- clunk
-
stork stand for:
- spondylosis
- spondylolisthesis
-
follow up test after positive stork stand
-
cervical radiculopathy causes
- DJD
- disc
- trauma
- tumor
- NR adhesions
- fx
- infection
-
tests for cervical radiculopathy
- cervical compression
- cervical distraction
- ULTT
- shoulder abduction
- valsalva
- door bell/tinels
-
causes of visceral somatic pain
- GI (esophagus, gallbladder, pancreas)
- heart
- lung
-
T4 syndrome
- T4 joint dysfunction
- glove paresthesia
- HA on top of head
-
high pay off locations of the thorax
- vertebra/intrinsic muscles
- ribs
- paraspinal muscles
- scapula/scapular muscles
-
causes of chest pain
GI>heart>chest wall
-
heart referral
- retrosternal/preordial
- radiate ulnar aspect of left arm
- jaw
- interscapular
- epigastric
-
associated symptoms of a heart attack
- dyspnea
- diaphoresis
- enausea
- weak/fatigue
- syncope
-
predisposing factors for coronary syndrome
- hypertension
- smoking
- diabetes
- hyperlipidemia
-
cardiac red flags
- pain stops patient from activity
- pain plus vomitting
- pain in the right arm
-
typical angina
- substernal chest discomfort
- provoked by exertion
- relieved by rest and nitroglycerin
-
atypical angina
- two of the following
- substernal chest discomfort
- provoked by exertion
- relieved by rest and nitroglycerin
-
non-cardiac chest pain
- one or none of the following
- substernal chest discomfort
- provoked by exertion
- relieved by rest and nitroglycerin
-
stable angina
- occurs during activity
- lasts 10-20 minutes
- provoked by exertion, stress, cold
- relieved by rest and nitroglycerin
-
unstable angina/acute MI
- no previous sx
- sudden/rapid progression
- have at rest and during exercise
- niroglycerin relieves unstable angina but not MI
- unstable angina lasts 30-40 minutes, MI lasts > 1 hr
-
angina ancillary studies
- 12 lead EKG
- stress test
- lipid and glucose pannel
- chest radiograph
-
MI ancillary studies
- 12 lead EKG
- cardiac enzymes
- troponin, myoglobin, ESR
-
mitral valve prolapse
- mid systolic click/murmur
- do echocardiogram
-
pericarditis
- non-pleuritic friction rub
- forward bending aggravates
-
pleuritis
- pleuritic pain, respiration friction rub
- fever/malaise
- chest x-ray, CBC, chem, ESR
-
pubic symphysis palpation
- palpate rectus abdominus
- tender bony palpation
- compare height of ramus
- motion palpation
-
tests for a cervical disc herniation
- cervical compression
- cervical distraction
- shoulder abduction
- ULTT
- valsalva
- palpation
-
specificity/sensitivity cervical compression
90/50
-
specificity/sensitivity cervical distraction
90/50
-
specificity/sensitivity shoulder abduction
90/50
-
specificity/sensitivity ULTT
22/97
-
specificity/sensitivity valsalva
94/22
-
tests for lumbar disc herniation
- anchilles reflex
- L5 sensations
- S1 sensations
- S1 plantar flexors
- L5 hallux extension
- ankle dorsiflexion
- calf wasting
- SLR
- XSLR
- ankle reflex
-
specificity/sensitivity achilles reflex
89/45
-
specificity/sensitivity L5 sensory
95/25
-
specificity/sensitivity S1 sensory
90/45
-
specificity/sensitivity S1 plantar flexors
99/26
-
specificity/sensitivity L5 hallux extension
75/12-51
-
specificity/sensitivity ankle dorsiflexion
89/54
-
specificity/sensitivity calf wasting
94/29
-
specificity/sensitivity SLR
40/80
-
specificity/sensitivity XSLR
95/25
-
specificity/sensitivity ankle reflex
60/50
-
red flags for cancer
- age >50
- hx of cancer
- weight loss
- no response for 1 month
- no pain relief with bed rest
- pain duration > 1 mo
-
serious disease associated symptoms
- fever/chills
- malaise
- loss of appetite/anorexia
- significant fatigue
- bilateral sciatica
- sciatica with non-dermatomal symptoms
- sciatica thats non-responsive
- urinary changes
- multiple joint involvement
- sexual dysfunction
- abnormal menstrual bleeding
- GI/GU symptoms
-
increased risk of serious disease
- bacterial infections
- increased susceptibility to infection
- taking anti-coagulants
- history of corticosteroids
- history of diabetes
-
timing of pain pattern for serious disease
- spontaneous onset of LBP
- progressive pain over wks/mo
-
signs of serious disease from physical
- neurological deficits in older patients
- pt points to location of specific pain during SLR
- pain with spinal percussion
- hip pain with contracture
- pronounced hip flexor loss
- palpable mass
- bony tenderness
- vascular deficits
- deformity
- abdominal mass/bruit
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