ATP-214 Quiz 3

anterior pelvic tilt

"butt syndrome"; assists hip extension; tight hip flexors and back extensors, weak abs and hip extensors

Vertebral column

26 bones (7 cervical, 12 thoracic, 5 lumbar, sacrum, coccyx)

Coccyx

3+ small bones fused

Atlas

C1, flexion, "yes"

Axis

C2, rotation, "no"

To correct higher hip and tilt

Contract hamstrings, strengthen hip flexors on other side

Low back pain

E: 60-80% of Americans, congenital, posture, trauma S/S: pain, weakness, neurological if disc associated M: correct alignment and mechanics, strengthen core, stretch hip flexors

Cervical fracture/dislocation

E: Fx - axial load with cervical flexion; D - violent flexion and rotation of head S/S: c-spine tenderness, restricted motion, cervical muscle spasm, cervical pain, pain in chest and extremities, weakness/numbness in trunk/limbs, loss of bladder/bowel control M: stabilize, collar, spine board regardless of consciousness, EMS

Stress fracture

E: adolescents S/S: aching, night pain M: PWB until healed, swimming

Avulsion fracture

E: at ASIS (sartorius), AIIS (rectus femoris), ischial tuberosity (hamstrings), pubic symphysis (adductors)

Disc injury

E: caused by abnormal stresses and degeneration due to use (forward bending and twisting) S/S: pain worse in morning (compression), pain and numbness, commonly unilateral, pain worsens after standing/sitting and forward bending M: return posture to normal, surgery if severe

Cervical stenosis

E: cervical narrowing of spinal canal that impinges SC, congenital or bone spurs, osteophytes, disc bulges S/S: transient quadriplegia from axial loading, sensory/motor deficits M: x-ray, MRI, participation discouraged

Vertebrae fracture and dislocation

E: compression fracture (trunk hyperflexion, falling from height) or fracture of spinous or transverse processes (direct blow) S/S: p.t., palpable defects on processes M: x-ray, extreme caution with transport

Spondylosis

E: degeneration of vertebrae due to congenital weakness, stress fracture results, UNILATERAL S/S: aching pain, full ROM, need to change positions often M: stabilizing hypermobile segments, trunk strengthening

Trochanteric bursitis

E: direct or indirect S/S: snapping hip, p.t., predisposing condition M: stretch, avoid sleeping on side, biomechanics

Hip pointer

E: direct trauma to iliac crest S/S: p.t., spasm, flexed M: x-ray to rule out fx, protection

Muscle strain (quad & hamstring)

E: explosive or overstretch S/S: pop, p.t., ecchymosis, decreased ROM M: POLICE, depends on grade Predisposing factors: too much stress, fatigue, history, decreased flexibility

Coccygeal conditions

E: falls that cause body to land in seated position, impacting tailbone S/S: chronic pain M: x-ray, sitting ring, pain could last months (decreased blood flow)

Slipped capital femoral epiphysis

E: femoral head slips at epiphyseal plate, displaces inferiorly and posteriorly relative to femoral neck, boys 10-27, insidious M: bed rest, surgery

Scheurmann's disease

E: fracture of 3 or more consecutive vertebrae with disc abnormalities, can develop into more serious conditions S/S: kyphosis, lumbar lordosis, p.t. spinous processes, tight hamstrings M: prevent progressive kyphosis, bracing, rest, NSAIDs

Sacroiliac (SI) joint dysfunction

E: hypo or hypermobility S/S: p.t., radiating pain, increasing with unilateral stance, pelvic asymmetries, leg length discrepancies M: SI joint mobilization to correct position, strengthening

Legg-Calve-Perthes Disease

E: osteochondrosis of femoral head, boys 3-8 S/S: groin pain, limp M: bed rest, bracing

Piriformis syndrome

E: sciatic nerve location S/S: pain in back of leg M: flexibility exercises

Sciatica

E: sciatic nerve pain, tight piriformis S/S: sharp, shooting pain, burning/tingling down leg, pain in rear or leg that is worse when sitting M: rest, NSAIDs, treat cause of inflammation

Femoral fractures

E: significant trauma during hip adduction and internal rotation S/S: pain, resists movement, hip dislocation s/s, leg is flexed, adducted, and internally rotated

Spondylolisthesis

E: slipping of one vertebrae above or below another, BILATERAL S/S: aching pain, full ROM, need to change positions often M: stabilizing hypermobile segments, trunk strengthening, Surgical repair

Brachial plexus neurapraxia (burners and stingers)

E: stretching or compression of brachial plexus, disruption of normal function of peripheral nerve, unilateral S/S: pain, numbness, radiating into finger, loss of function of shoulder to hand for minutes M: rule out fx, rest, RTP when asymptomatic

Cervical sprain (whiplash)

E: sudden forward or backward acceleration, tears in supporting tissue of A or P longitudinal ligaments DDX: avulsion fracture S/S: tenderness over transverse and spinous processes, pain day after trauma (muscle spasm) M: rule out fx, dislocation, disc injury; POLICE, analgesics, NSAIDs

Cervical strain

E: sudden turn, forced flexion/extension, upper trap, sternocleidomastoid, scalenes S/S: local pain, p.t., loss of ROM M: POLICE, potential c-collar, ROM exercises

Quad contusion

E: traumatic impact, repeated hit can cause myositis ossificans or compartment syndrome S/S: p.t., ecchymosis, swelling M: ice, stretch, wrap, avoid massage, hard pad

Torticollis (wryneck)

E: unilateral pain upon wakening, synovial capsule impingement w/in facet S/S: p.t., muscles spasm, restricted ROM M: POLICE, traction, superficial heat and cold, NSAIDs

Nucleus pulposus

Gel like inner center

External Snapping hip

IT band and gluteus maximus snapping over greater trochanter during hip flexion, trochanteric bursa

Scoliosis

S or C shaped, lateral shift of spine, affect internal organs

Sacrum

S1-S5 fused

Other questions

Where is pain? Kind of pain? What were you doing when pain started? Did pain begin immediately? How long have you had pain? Positions/movements that increase or decrease pain? Past history of back pain? Sleep position and patterns? Seated positions and postures? Tingling/numbness in arms/legs? Have you ever had back pain before?

posterior pelvic tilt

assists hip flexion; tight abs and hip extensors, weak back extensors and hip flexors

4 Spinal curvatures

cervical and lumbar = lordotic thoracic and sacral = kyphotic

femoral triangle

contains femoral nerves, artery, vein; inguinal ligament (superior), sartorius (lateral), adductor longus (medial)

Lumbar spine injury prevention

correction of biomechanical abnormalities (flexibility), correct lifting (proper technique, spotters), core stabilization (neutral position, increase lumbopelvic hip stability)

Cervical vertebrae

flexibility

Kyphosis

hunch back

Internal Snapping hip

iliopsoas snapping over structures deep to musculotendinous unit, iliopsoas bursa; quick snap

Intra-articular Snapping hip

lesions of joint or labral tear, actual ball and socket; crunch

ischiofemoral ligament

limit extension

pubofemoral ligament

limits abduction and hyperextension

iliofemoral ligament

limits hyperextension

Lateral neck pain means injury to...

musculature

Thoracic vertebrae

not very flexible, stability and protection, rib attachment

Sway back

posterior tilt, flattened spine, tight abs and hip extensors

lordotic curve

posture curve from AP tilt

flat back curve

posture curve from PP tilt

Lumbar vertebrae

power and flexibility, support weight

prevention of hip and thigh injuries

protective equipment (iliac, thigh, pelvis), physical conditioning, shoes (cushion forces)

Spine pain history questions

rule out SC injury; what happened? Did you hit someone or did someone hit you? Did you lose consciousness? Pain in neck? Numbness, tingling or burning? Can you move ankle and toes? Equal strength in both hands? YES to any of these questions = EXTREME CAUTION

Spinous process pain means injury is...

serious!

Intervertebral discs

shock absorption and movement, tallest in morning, get shorter as discs compress and deteriorate

Intervertebral foramen

spaces formed by adjacent vertebrae, spinal nerves pass through

Vertebral body differences

spinous and transverse processes and bodies get bigger, foramen get smaller

Cervical spine injury prevention

strengthening, proper ROM, correct technique, stretching, avoid using head as weapon (spearing)

Anulus fibrosis

thick outer layer

Pars interarticularis fracture (scotty dog fracture)

unilateral or bilateral stress fracture of narrow bridge between upper and lower pars interarticularis