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