Jen Exam #2

What are the s/sx of Legg Calve-Perthes disease?

-pain in groin that may be referred to abdomen, knee, or buttock - painless limping - limited ROM (abduction and IR) - positive Trendelenburg

What causes a nerve root compression?

A prolapsed or herniated disc

What is a spondylolisthesis?

Anterior slippage of vertebrae due to bilateral fracture of pars interarticularis

A 15 yo football player complains of pain in his hip off and on during the season. There is increasing hip and knee pain during movement. The athlete has a restriction of hip abduction, flexion, and medial rotation. He is beginning to walk with a limp. What should the AT be concerned about in this 15 yo, and what steps should be taken?

Bc of the athlete's age, AT should be worried about a growth problem (most likely a slipped capital femoral epiphysis). AT must refer for x-ray immediately

While assessing complaints of back pain in a warehouse stockman, the AT notes that on lateral observation the low back appears to be excessively curved and the T spine seems to have a curved, rounded appearance. When assessing posture laterally, the AT will normally see curves in various regions of the spine. What are the normal curves and their shape within the spine?

Cervical and lumbar spine have a lordotic curve meaning the they curve anteriorly while the thoracic spine and sacrococcygeal curves, are kyphotic meaning they curve posteriorly. Lordotic posture is characterized by an increased curve in the lumbar spine, with an increase in both anterior tilt of of the pelvis and hip flexion. When combined with kyphosis and a forward head posture, this condition is referred to as kypho-lordotic posture

What is cauda equina syndrome?

Compression of the spinal nerve roots innervating the bladder and bowel (L2-S4)

What is the MOI for a hip pointer?

Direct blow to the pelvis

What is the MOI for an intervertebral disc lesion?

Forward bending and twisting

An evaluation of a dancer who is complaint of low back pain shows that back pain is diminished when the patient is sitting and increased when lying down or standing; forward bending decreases the pain; the lordotic curve in the lumbar area does not reverse itself in forward bending; backward bending is painful, especially at the end range; and there is poor abdominal muscle strength. What type of exercises should the AT recommend?

It is likely that some pressure on the nerve root is causing this pain. The AT should recommend using flexion exercises to strengthen the abdominal muscles, to stretch the back extensors, and to take pressure off a nerve root by separating the lumbar facet joints and opening the intervertebral foramina

A young gymnast has a history of moderate groin pain. She is susceptible to strains in that region. The pt also appears to have an exaggerated lumbar lordotic curve. What tests should be given to evaluate the thightess of the groin region?

Kendall test. Tests if there is hip flexion when the pt leg is hanging off the edge of the table while they hold their over knee to their chest and their back is flat on the table. Also tests for rectus femoris and ITB tightness

A young patient complains to AT that her hip snaps when she stands on one leg. What is the possible cause of this snapping hip?

Like cause is a strength imbalance of the muscles that stabilize the hip joint while flexing and rotating. Pt may have a structurally narrow pelvis, greater than normal ROM of hip abduction or restricted ROM with external rotation

A football player who was not wearing hip pads receives a hard, compressive hit to his left iliac crest region. What injury has this patient sustained? What are the expected symptoms and sign?

Pt has a hip pointer. Most likely wil experience severe pain, muscle spasm, and an inability to rotate his trunk or flex his hip without pain

A football linebacker is making a tackle and makes initial contact with the ball carrier with his head forcing the neck into hyperflexion. The athlete immediately has transient quadriplegia with burning and tingling and associated motor weakness in the arms and legs. Neck pain is absent initially. Within 15 minutes, the athlete recovers completely and has full range of motion. What type of injury should the AT suspect with this athlete and how should this condition be managed?

Pt may have cervical spine stenosis, which involves a narrowing of the spinal canal in the cervical region that can impinge on the spinal cord. The presence of cervical stenosis is determined by an x-ray that measures the canal diameter and divides that by the anteroposterior width of the same vertebral body. The patient should be advised of the potential risks of continued participation in football

A triathlete stepped in a whole while running. He immediately felt pain in his left low back below his waist and hat to stop running. He comes to the AT who suspects that the mechanism of injury has caused a problem with the SI joint. What signs should the AT look for during the evaluation that would likely indication some injury to the SI joint?

Should look for symmetry of the ASIS, PSIS, and iliac crests. SI compression and distraction tests and a positive FABER test are all useful in determining a problem in the SI joint. In forward bending or flexion, the PSISs on each side should move together. If one moves farther than the other, a motion restriction is likely present int eh SI joint on the side that moves most. Usually if they move at different times, the side that moves first has a restriction

What will a pt c coxa saltans complain of?

Snapping c severe pain and disability upon each snap

What is slipped capital femoral epiphysis?

The head of the femur stays in the acetabulum while the neck slips anteriorly. Found mostly in boys ages 10-17 who are characteristically obese or during rapid growth spurt

How will a person with a dislocated hip sit?

With their hip flexed, adducted, and internally rotated **refer immediately**

How should an AT manage a quad muscle strain?

- NSAIDs - manage swelling - compression - possibly crutches - progress to isometric exercises and stretching

How should an AT treat a quad contusion?

- RICE/NSAIDs - crutches for severe cases - ice on a stretch **DO NOT USE heat, massage, or US (may lead to myositis ossificans)**

What are s/sx for erector spinae strain?

- aching LB pain - pain increases c flexion and resisted extension

What are s/sx of sciatica?

- arises abruptly or gradually - produces sharp shooting pain, tingling, and numbness in buttock and down posterior leg - sensitive to palpation - straight leg raises intensity the pain

How would a hip labral tear present?

- clicking, locking, and stiffness of the hip joint - limited ROM - pain in deep anterior hip and groin

What are the s/sx of a pincer?

- decreased internal rotation at 90 degree hip flex - positive FADIR test

What is the MOI for a spondylolisthesis?

- direct blow - sudden twist - chronic low back strain

What are predisposing factors for hamstring strains?

- fatigue - posture - leg length discrepancy - lack of flexibility - muscle imbalances

What are signs of spina bifida occulta?

- faun's beard (hairy patch) - dimpling - fatty deposits of skin

What athletes most commonly get a retrolisthesis?

- gymnasts - weight lifters - football linemen - tennis servers - volleyball spikers - butterfly stroke swimmers

What is the MOI for a hamstring strain?

- hamstring and quad contract together - change in role from hip ext. to hip flex - deccelertion

What are intra articular causes of coxa saltans?

- loose bodies - labral tears - joint subluxations - iliopsoas tendon snapping

What are s/sx of spondylolysis?

- mild to moderate aching pain across LB - beltline pain after activity - radiating back pain to buttocks or down to knee (unilateral or bilateral) - LB feels tired and fatigues easily - pain c standing, trunk ext, and trunk rotation - pain alleviated c hip and knee flexion and posterior pelvic tilt while standing - positive stork standing test

What are the s/sx of a hamstring strain?

- muscle belly or point of attachment pain - capillary hemorrhage - loss of function - possible discoloration **more proximal the injury, longer healing time**

What are the s/sx of a nerve root compression?

- neuro sx radiating down a dermatome pathway - myotome weakness - diminished refelxes - increased pain with cough, sneeze and strain (positive valsalva)

What are s/sx of a quad muscle strain?

- pain - point tenderness - loss of function (decreased knee flexion) - little discoloration **complete tear may leave patient with disability, discomfort, and some deformity**

What are s/sx of a quad contusion?

- pain - temporary loss of function - immediate effusion with palpable swollen area **rule out compartment syndrome**

What are s/sx of myositis ossificans traumatic?

- pain - weakness - swelling - decreased ROM - tissue tension - point tenderness

What are s/sx for spinal stenosis?

- pain during walking - absence of pain when seated (HS and erector spinae relaxed) - weakness - uni/bilateral buttock or leg neuro sx - decreased symptoms c forward bending

What are s/sx of slipped capital femoral epiphysis?

- pain in groin that comes over weeks or months - hip and knee pain during passive and active motion - limitation of abduction, flexion, and internal rotation - limp

What are s/sx of a sacroiliac sprain?

- palpable pain and tenderness over joint - pain after 45-70 degrees during SLR - increased pain when laterally flexing towards affected side - radiating pain posteriorly, laterally, or anteriorly down thigh - movement from sit to stand will create pain

How do lumbar vertebrae dislocations present themselves?

- point tender over affected area - palpable defects over the spinous and transverse process - localized swelling and guarding

What are s/sx of a hip pointer?

- severe pain - muscle spasm - decreased rotation of trunk and hip/thigh flexion

What is the MOI for a sacroiliac sprain?

- twisting with both feet on the ground - stumbles forward - falls backwards - steps too far down - heavy landings on one leg - bends forwards with knees locked during lifting

What are s/sx of cauda equina syndrome?

- urinary and bowel incontinence - sexual dysfunction - reduced sensation or weakness in both legs - drop foot gait - inability to walk on heels or toes - inability to arrive from sitting without using UE - balance difficulty secondary to loss of sensation

What are s/sx of intervertebral disc lesion?

- usually unilateral neuro sx and weakness along a dermatome pathway - worse in the AM (axial loading from getting out of bed) - sitting increases pain - SLR to 30 degrees increases pain - positive valsalva

What is the MOI for a lumbar vertebrae fracture?

- compression fracture: trunk hyperflexion or falling from height - fractures of processes: direct blow

Who are spinal stenosises common in?

50-60 year olds

What are extra articular causes of snapping hip phenomenon?

ITB sliding over greater trochanter of femur

What will a pt with trochanteric bursitis complain of?

Lateral hip pain that may radiate down the leg

A rodeo cowboy gets kicked in the anterior thigh after being thrown off a bull. What is the most important thing that an AT can do to allow this cowboy to continue to compete?

Make a protective thigh pad to avoid further trauma to the area. Repetitive trauma can cause myositis ossificans

What causes cauda equina syndrome?

May result from herniated disc or anything that reduces the space int he spinal foramen **MEDICAL EMERGENCY**

What is spinal stenosis?

Narrowing of the spinal canal or intervertebral foramen

What is the MOI for retrolisthesis?

Repetive hyperextension of trunk

What is the MOI for a quad muscle strain?

Sudden stretch, violent forceful contraction of hip and knee into flexion

A volleyball player comes to the AT complaining of recurring low back pain. She has been seen by a therapist in her hometown, who has told her that she has a positive straight-leg raise test, but the patient still does not understand what is causing her pain. How should the AT explain what having a positive SLR test means?

The SLR test may indicate injury to the nerve roots and discs. If neuro sx are reproduced with passive DF at 30 degrees of hip flexion then there is most likely a disc problem. If neuro sx are reproduced with passive DF at 35-70 degrees of hip flexion, there is an issue with a nerve root

How do tight hamstrings affect the pelvis?

They rotate is posteriorly

How do tight hip flexors affect the pelvis?

They rotate it anteriorly

Who is snapping hip phenomenon (coxa saltans) common in?

Young female dancers, gymnasts, and hurdlers ** habitual movement predisposes muscles around hip to become imbalanced**

What is a hip pointer?

A contusion of the iliac crest or abdominal musculature

What is a pincer?

A form of femoral acetabular impingement where the acetabulum over covers the femoral head and neck **more common in females**

What is a CAM?

A form of femoral acetabular impingement where the pt has an irregularly shaped femoral head **more common in males due to excessive sports activity during growth**

During a preparticipation exam, a high school wrestler describes a history of stingers. What is a stinger, and what are the symptoms of this injury?

An injury to the brachial plexus, resulting in transient neuropraxia. Common symptoms of a brachial plexus injury are burning, numberless and tingling, possible loss of function, and pain from the shoulder to the hand

A waitress who stands a lot in her job sustains a stress fracture to the right subtrochanter. As the stress fracture heals, what should be the neuromuscular control concerns?

As the stress fracture heals, the pt must maintain and restore neuromuscular control of the thigh and hip region. Focus should be on balance and closed kinetic chain exercises. Balance board exercises and affected leg weigh-bearing activities can also be conducted. Minisquats, leg presses, and stair cling and stepping are other possible closed kinetic chain exercises

What is Legg Calve-Perthes disease?

Avascular necrosis of the femoral head that occurs in children ages 3-12. Articular cartilage become necrotic and flattens?

What are the two types of femoral acetabular impingement?

CAM and pincer

What causes quadriceps contusions?

Constant, traumatic blow to the thigh

A sedentary office assistant has been determined to have a Q angle of 22 degrees. Her left leg is 3/4 in shorter than her right leg. She complains of pain at the point just over the left greater trochanter when she walks. Based on the info provided, what might the condition be?

Could be inflammation of the glute med or ITB, or may be trochanteric bursitis caused by the the increased Q angle and short leg

What is a spondylolysis?

Degeneration of vertebrae and defect in pars interarticularis or articular processes of the vertebrae

What is a facet joint dysfunction?

Dislocation, subluxation, or degeneration of the facet that's symptoms decrease with an increase in activity

What is the MOI for hip labral tears?

Due to repetitive movement such as running or pivoting, resulting in degeneration or breakdown of the labrum

What is myositis ossificans traumatica?

Formation of bone in abnormal places following a repeated blunt trauma **can result from improper quad contusion treatment**

During a back evaluation, the AT finds that backward bending is limited, yet the movement diminishes pain; straight leg raising is limited and painful; forward bending is extremely limited and increases pain; and back pain diminishes when the patient is lying down but increased when he is sitting. What routine rehabilitative exercises should the AT recommend to the pt?

Given the set of conditions, the AT should have the pt engage in extension exercises to strengthen the back extensors, to stretch abdominal, and to reduce the pressure on the intervertebral disks

A construction wonder jumps down off a ladder. Landing off balance, he violently twists his right hip. From the info provided, what type of injury could he have sustained?

He may have sprained his hip joint

What is the MOI for an erector spinae strain?

Heavy or repetitive lifting

What is femoral acetabular impingement?

Hip problem due to change in femoral head shape or acetabular shape that leads to lab rail tears, chondral degeneration, and osteoarthritis

What is spina bifida occulta?

Incomplete closure of the posterior lamina of the lumbar spine at birth

What is trochanteric bursitis?

Inflammation at the side where the glute med inserts or the ITB passes over the greater trochanter of the femur

What is sciatic?

Inflammatory condition of the sciatic nerve. Nerve root compression from intervertebral disc protrusion, structural irregularities within the intervertebral foramina or tightness of the piriformis muscle

A sprinter competing in a 100 yd dash experiences a supdden snap, severe pain, and weakness in the hamstring muscle. Examination reveals a grade 2 strain. In terms of exercise, how should this injury be managed?

Initially, severe reduction in activity. Once early inflammation stage has passed, isometric exercises can be done. Later stages of healing, they can perform pain free exercises like gentle stretching, jogging, and stationary cycling

A soccer player complains of a sharp, burning pain in his groin and his testicles whenever he kicks the ball. He has palpable tenderness over his pubic tubercle and indicates there is also pain on resisted adduction. The athlete is concerned that he has a hernia. What might the AT suspect is wrong with the athlete?

It is likely sports hernia, which is essentially groin pain caused by a weakness in the anterior wall of the inguinal canal. This condition is not associated with either a direct or an indirect hernia

A recreational weight lifter complains of central located back pain that radiates down her left leg. She describes a sudden onset after a workout that becomes more severe as she tries to rest it. Forward bended and sitting postures increase pain. Backward bending is restricted. Side toward the affected side increases pain. Based on the AT's assessment, what is likely causing the pain?

Pain present in forward bending and restriction in backward bending with radiating pain are usually associated with a disk proble. However, such pain may also be related to spondyloysis and spondyloisthesis

What is a retrolisthesis?

Posterior slippage of vertebrae

A gymnast constantly hyperextends her low back. She complains of stiffness and persistent, aching pain across the low back, with increased pain after, but not usually during, practice. The athlete feels that she needs to change positions frequently or selfmanipulate her low back to reduce the pain. She is beginning to develop pain in her buttock and some muscle weakness in her leg. What type of injury should the AT suspect the gymnast has, and what can be done about it?

Pt likely has a spondylolisthesis that has resulted in hypermobility of a vertebral segment. Initially, rest will help reduce pain. Rehab should consist of exercises that control or stabilize the hypermobile segment and progressive trunk-strengthening exercises, especially to the abdominal muscles through the midrange. A brace can be helpful during practice

A young patient training for a triathlon complains of pain in her groin and in the area of her symphysis pubis. She says she experienced pain when running and when doing sit up exercises. What conditions might be indicated by this patient's complaints?

Pt may has osteitis pubis, stress fracture of the inferior pubic ramus, a possible avulsion apophysis fracture, or an apophysitis

An athlete has successfully completed the rehabilitation process after a hip injury. What are the criteria for this athlete's return to activity?

Pt must demonstrate pain free movement of the thigh and hip. There must be full ROM, strength, balance, and agility, along with a preinjury level of cardiorespiratory endurance

What is the MOI for a hip dislocation?

Traumatic force directed along the long axis of the femur

During a gait evaluation an AT notices that the patient walks with a swinging hip - one side of the pelvis drops to the side during single leg stance. What could be the cause of this movement?

Weak gluteus medius. This is considered a positive Trendeleburg test