Places one hand on the ASIS and
the other on the PSIS of the
uppermost hip
Action:
Examiner applies a gentle
posterior shear force while
assistant stabilizes the pelvis
Positive finding:
Unilateral pain at SI joint
Sacroiliac Joint Distraction Test:
Test position:
Subject prone; examiner stands at
subject’s feet
Action:
Examiner places one hand on the
sacrum and the other on the iliac
crest and applies a gentle
posterior-to-anterior shear force
Positive finding:
Unilateral pain at SI joint
Sacroiliac Joint Compression Test:
Low back pain is a common cause of disability that affects people of all cultures. It can be acute, lasting less than three months, or chronic, lasting over three months. Common causes include muscle strains, arthritis, herniated discs, and osteoporosis. Physical examination involves assessing range of motion, neurological function, and diagnostic tests like x-rays and MRIs. Physiotherapy management aims to reduce pain and inflammation, improve muscle strength and flexibility, and prevent recurrence through exercises and physical agents like ultrasound, TENS, and spinal traction.
Low back pain is very common, affecting over 80% of people at some point in their lifetime. While the exact cause is often unclear, imaging is usually not needed and most cases resolve within a few weeks with conservative treatment. Serious underlying causes that may require imaging or surgery include infection, cancer, fractures, or progressive neurological deficits. Physical therapy, medications, and avoiding prolonged bed rest can help acute low back pain, while cognitive behavioral therapy may help chronic cases influenced by psychological factors. Surgery is usually only indicated for severe or progressive neurological problems or cases resistant to other treatments.
Prolapsed lumbar intervertebral disc occurs when the soft central portion of an intervertebral disc bulges out beyond the damaged outer rings of the disc. It commonly affects the lower back and can cause lower back pain and leg pain. Diagnosis involves physical examination, imaging studies like MRI, and ruling out other potential causes of back pain. Treatment options include conservative measures like physical therapy and epidural steroid injections or surgery like discectomy if conservative options fail. Surgery aims to relieve nerve compression and associated back pain.
This document describes various orthopedic tests used to evaluate the cervical spine, including tests to assess soft tissue tenderness, range of motion, neurological function, vascular integrity, and sources of pain like strains, sprains, and nerve root compression. Grading scales are provided to classify findings. Specific tests described include Spurling's test, Jackson's compression, and distraction testing.
This document provides an overview of low back pain (LBP), including prevalence, classifications, types, and key points regarding evaluation and management. Some key points:
- 60-80% of people experience LBP at some point, though 90% resolves within 6 weeks. Recurrence is common and LBP is a major cause of disability.
- LBP can be classified as mechanical, traumatic, infectious, neoplastic, and more. 97% are considered mechanical.
- Types include discogenic, radicular, facet joint, sacroiliac joint, muscular/myofascial, and others. Herniated discs can cause radicular symptoms.
- Evaluation involves detailed history and exam to identify
Low back pain is one of the most common reasons for seeking medical attention. The majority of episodes are self-limited, but some suffer from chronic or recurrent courses. Almost any structure in the back can cause pain, most commonly the intervertebral discs and facet joints. A thorough history and physical exam are important to determine the likely cause and guide appropriate treatment. Imaging such as X-rays, CT, and MRI may help identify structural abnormalities but often are not needed for typical mechanical low back pain.
Back pain is a common problem that affects up to 90% of the population. It can be classified as acute (less than 6 weeks), subacute (6-12 weeks), or chronic (more than 12 weeks). Red flags on history and exam can indicate more serious underlying causes like cancer, infection, or fracture that require further evaluation. For nonspecific back pain without red flags, treatment focuses on analgesics, activity modification, and physical modalities. Referral is considered if red flags are present, pain persists after 4-6 weeks, or neurological deficits develop.
Low back pain is a common cause of disability that affects people of all cultures. It can be acute, lasting less than three months, or chronic, lasting over three months. Common causes include muscle strains, arthritis, herniated discs, and osteoporosis. Physical examination involves assessing range of motion, neurological function, and diagnostic tests like x-rays and MRIs. Physiotherapy management aims to reduce pain and inflammation, improve muscle strength and flexibility, and prevent recurrence through exercises and physical agents like ultrasound, TENS, and spinal traction.
Low back pain is very common, affecting over 80% of people at some point in their lifetime. While the exact cause is often unclear, imaging is usually not needed and most cases resolve within a few weeks with conservative treatment. Serious underlying causes that may require imaging or surgery include infection, cancer, fractures, or progressive neurological deficits. Physical therapy, medications, and avoiding prolonged bed rest can help acute low back pain, while cognitive behavioral therapy may help chronic cases influenced by psychological factors. Surgery is usually only indicated for severe or progressive neurological problems or cases resistant to other treatments.
Prolapsed lumbar intervertebral disc occurs when the soft central portion of an intervertebral disc bulges out beyond the damaged outer rings of the disc. It commonly affects the lower back and can cause lower back pain and leg pain. Diagnosis involves physical examination, imaging studies like MRI, and ruling out other potential causes of back pain. Treatment options include conservative measures like physical therapy and epidural steroid injections or surgery like discectomy if conservative options fail. Surgery aims to relieve nerve compression and associated back pain.
This document describes various orthopedic tests used to evaluate the cervical spine, including tests to assess soft tissue tenderness, range of motion, neurological function, vascular integrity, and sources of pain like strains, sprains, and nerve root compression. Grading scales are provided to classify findings. Specific tests described include Spurling's test, Jackson's compression, and distraction testing.
This document provides an overview of low back pain (LBP), including prevalence, classifications, types, and key points regarding evaluation and management. Some key points:
- 60-80% of people experience LBP at some point, though 90% resolves within 6 weeks. Recurrence is common and LBP is a major cause of disability.
- LBP can be classified as mechanical, traumatic, infectious, neoplastic, and more. 97% are considered mechanical.
- Types include discogenic, radicular, facet joint, sacroiliac joint, muscular/myofascial, and others. Herniated discs can cause radicular symptoms.
- Evaluation involves detailed history and exam to identify
Low back pain is one of the most common reasons for seeking medical attention. The majority of episodes are self-limited, but some suffer from chronic or recurrent courses. Almost any structure in the back can cause pain, most commonly the intervertebral discs and facet joints. A thorough history and physical exam are important to determine the likely cause and guide appropriate treatment. Imaging such as X-rays, CT, and MRI may help identify structural abnormalities but often are not needed for typical mechanical low back pain.
Back pain is a common problem that affects up to 90% of the population. It can be classified as acute (less than 6 weeks), subacute (6-12 weeks), or chronic (more than 12 weeks). Red flags on history and exam can indicate more serious underlying causes like cancer, infection, or fracture that require further evaluation. For nonspecific back pain without red flags, treatment focuses on analgesics, activity modification, and physical modalities. Referral is considered if red flags are present, pain persists after 4-6 weeks, or neurological deficits develop.
Ankylosing spondylitis is a chronic inflammatory disease that primarily affects the spine and sacroiliac joints, causing back pain and stiffness. It is strongly associated with the HLA-B27 gene and results from an autoimmune reaction. Symptoms typically begin in young adults and include inflammatory back pain and limited spinal mobility. Diagnosis is based on clinical features and x-rays showing sacroiliac joint erosion and fusion. Treatment involves physical therapy, NSAIDs, DMARDs, and anti-TNF drugs, which can significantly improve symptoms and physical function.
Case 1 involves a 40-year-old male who presented with severe lower back pain after heavy lifting with no pain radiation. Examination found reduced forward flexion, tender L5 and muscles, and no neurological symptoms.
Case 2 involves a 35-year-old male with similar presentation but pain radiating down his left leg to the ankle. Examination found weak left ankle plantar flexion and big toe flexion with altered sensation over the left foot lateral side.
The document summarizes the examination of the spine and scoliosis. It discusses inspection and palpation of the spine, range of motion tests, and special tests like compression and distraction. Neurological examination of the upper and lower limbs is described. Scoliosis is defined as a lateral curvature of the spine. Postural and structural scoliosis are distinguished. Idiopathic scoliosis is the most common type and adolescent idiopathic scoliosis is described in detail clinically. Treatment options like bracing and surgery are outlined.
Dr. Fahad Al Mulhim discusses the examination of the spine. The examination involves inspection, palpation, range of motion testing, neurological assessment including dermatomes, myotomes, and reflexes. Special tests described include Lasegue's test, Spurling's test, straight leg raise test, Bragard's test, and femoral nerve stretch test. These tests help evaluate patients for spine conditions and radiating pain. A thorough spine examination provides important information to diagnose the cause of a patient's symptoms.
Ankylosing spondylitis is a form of arthritis that primarily affects the spine and sacroiliac joints, causing fusion of the spine over time. It typically develops in young adults aged 18-30 and is more common in men. Genetics play a role, as 90% of patients have the HLA-B27 gene. Symptoms include chronic lower back pain and stiffness that worsens with inactivity. Diagnosis involves blood tests, x-rays showing spinal changes, and assessment of limited range of motion. Treatment focuses on reducing inflammation and pain through NSAIDs, DMARDs, biologics that target tumor necrosis factor-alpha, and occasionally surgery for deformities.
Back pain is common in adolescents, with incidence higher in girls than boys. Associations exist with heavy school bags, lack of lockers, and family history. Red flags include younger age, persistent or worsening pain, fever, and neurological symptoms. MRI is most valuable for imaging. Rehabilitation and back education are the mainstay of treatment.
The document discusses the challenges of diagnosing and treating acute back pain in emergency departments. It outlines key considerations for determining whether a patient's back pain could be caused by a serious underlying condition versus a simple mechanical issue. Imaging tests are recommended selectively based on risk factors present, with conservative treatment usually first for mechanical back pain. "Cannot miss" conditions like spinal infections, tumors, or abdominal aortic aneurysms require prompt diagnosis and treatment.
Low back pain is a common musculoskeletal disorder affecting 40% of people at some point in their lives. It can be acute (lasting less than 7 weeks) or chronic (more than 7 weeks). Common causes include muscle strains, poor posture, obesity, and injuries. Diagnosis involves physical examination and imaging tests like x-rays, CT scans, or MRIs. Treatment depends on whether the back pain is acute or chronic. For acute pain, conservative treatments like NSAIDs, muscle relaxants, and physical therapy are usually effective. Chronic back pain may require more intensive exercises, antidepressants if depression is present, or surgeries like laminectomy or spinal fusion if conservative treatments fail.
This document discusses the approach to a case of lumbar intervertebral disc prolapse. It outlines how to proceed with history taking, clinical examination, differential diagnosis, and management. For history taking, symptoms like pain characteristics, neurological symptoms, and bowel/bladder dysfunction are important. The clinical examination involves inspection, palpation, range of motion testing, and special tests like straight leg raise. Imaging like MRI or CT is used to confirm diagnosis. Conservative treatment includes rest, medication, and physiotherapy. Surgery is indicated for motor deficits or failure of conservative management.
_FIU - Thoracic and Lumbar Spine Special Tests and Pathologies (1) - نسخة.pptRadwa Talaat
This document provides information on clinical tests for the thoracic and lumbar spine. It describes positioning, procedures, and findings for special tests like the spring test, nerve root impingement tests (Valsalva, Milgram, Kernig's, straight leg raise), and tests for pathologies like facet joint dysfunction, disc lesions, and cauda equina syndrome. Clinical evaluation includes history, inspection, palpation, neurological assessment, and special tests to assess spinal mobility and nerve function. Common spinal issues addressed are muscle strains, facet joint dysfunction, disc degeneration and herniation.
Detailed history and its evaluation , examination of spine in general and local with special tests in cervical , thoracic outlet syndrome , lumbar spine and SI joint with diagrams, neurological examination both sensory and motor.
Back Pain, How do you maintain a healthy back.Sherif Watidy
Back Pain can be very painful, usually more prevailing in Adults, but did you know that you can reduce or totally relief back pain by taking only some actions into consideration. Professor Sherif ElWatidy Neurosurgeon describes them in details.
This document provides information on ankylosing spondylitis (AS), a chronic inflammatory disease primarily affecting the spine and sacroiliac joints. Key points include:
- AS causes pain and stiffness in the lower back and hips that worsens with inactivity. It is associated with the genetic marker HLA-B27 and often runs in families.
- Pathology involves inflammation at bony joints that can lead to fusion (ankylosis) over time, resulting in a fixed "bamboo spine" deformity. Diagnosis is based on clinical features and imaging showing sacroiliac joint erosion.
- Treatment focuses on general measures like exercise and posture, along with medications like NSAIDs to reduce
The document discusses prolapsed lumbar intervertebral disc (PLID), which occurs when the soft central portion of an intervertebral disc bulges out beyond the damaged outer rings. It causes severe back and leg pain. Key points include: PLID most commonly occurs at the L4/L5 level. Common symptoms are radiating pain, numbness, and weakness. MRI is the preferred imaging method to detect herniations. Treatment options include conservative measures like NSAIDs, physical therapy, and epidural injections or surgery for severe/progressive cases.
This document discusses the evaluation and diagnosis of chronic low back pain through history and physical examination. It outlines common causes of low back pain such as mechanical back pain, radicular pain, and sacroiliac joint dysfunction. The physical exam focuses on inspection, palpation, range of motion testing, and special tests to identify pain generators and neurological involvement. Differential diagnoses are discussed including mechanical back pain, radiculopathy, and conditions affecting the hip.
This document provides an overview of a presentation on managing back and joint pain in older patients. The objectives are to differentiate osteoarthritis from other causes of back/joint pain in older adults, discuss principles of medical management, and provide practice pearls. Common etiologies discussed include mechanical causes like muscle strains, degenerative conditions like spinal stenosis, and inflammatory diseases like ankylosing spondylitis. Key aspects of history and physical exam are outlined to aid in diagnosis. Treatment focuses are also mentioned.
This document provides information on evaluating the thoracic and lumbar spine through clinical examination. It discusses taking a patient history including pain location and characteristics, bowel/bladder issues, and prior injuries. The physical exam involves inspecting posture, curvature, skin, breathing and palpating bony landmarks. Specific conditions like scoliosis, kyphosis and spondylolisthesis are described in terms of causes, signs, grading severity and associated symptoms.
The document discusses various chronic pain syndromes including low back pain, sciatica, complex regional pain syndrome, trigeminal neuralgia, and cancer pain. It provides details on the definition, causes, symptoms, diagnostic tools and treatment options for low back pain and sciatica, which are the most commonly discussed chronic pain conditions. The treatment sections cover medications, physical therapy, injections including epidural steroid injections, radiofrequency ablation, and other minimally invasive procedures.
This document provides information on ankylosing spondylitis (AS), an inflammatory disease that primarily affects the axial skeleton. It causes pain, stiffness, and decreased mobility. The disease usually begins in young adults and is associated with the HLA-B27 gene in most cases. Symptoms include inflammatory back pain and stiffness. Exams can reveal limited spinal mobility and inflammation of joints. Imaging shows sacroiliitis that progresses to fusion. Treatment involves exercise, NSAIDs, DMARDs, and biologics that target tumor necrosis factor-alpha to reduce symptoms and progression.
Ankylosing spondylitis is a chronic inflammatory disease that primarily affects the spine and sacroiliac joints, causing back pain and stiffness. It is strongly associated with the HLA-B27 gene and results from an autoimmune reaction. Symptoms typically begin in young adults and include inflammatory back pain and limited spinal mobility. Diagnosis is based on clinical features and x-rays showing sacroiliac joint erosion and fusion. Treatment involves physical therapy, NSAIDs, DMARDs, and anti-TNF drugs, which can significantly improve symptoms and physical function.
Case 1 involves a 40-year-old male who presented with severe lower back pain after heavy lifting with no pain radiation. Examination found reduced forward flexion, tender L5 and muscles, and no neurological symptoms.
Case 2 involves a 35-year-old male with similar presentation but pain radiating down his left leg to the ankle. Examination found weak left ankle plantar flexion and big toe flexion with altered sensation over the left foot lateral side.
The document summarizes the examination of the spine and scoliosis. It discusses inspection and palpation of the spine, range of motion tests, and special tests like compression and distraction. Neurological examination of the upper and lower limbs is described. Scoliosis is defined as a lateral curvature of the spine. Postural and structural scoliosis are distinguished. Idiopathic scoliosis is the most common type and adolescent idiopathic scoliosis is described in detail clinically. Treatment options like bracing and surgery are outlined.
Dr. Fahad Al Mulhim discusses the examination of the spine. The examination involves inspection, palpation, range of motion testing, neurological assessment including dermatomes, myotomes, and reflexes. Special tests described include Lasegue's test, Spurling's test, straight leg raise test, Bragard's test, and femoral nerve stretch test. These tests help evaluate patients for spine conditions and radiating pain. A thorough spine examination provides important information to diagnose the cause of a patient's symptoms.
Ankylosing spondylitis is a form of arthritis that primarily affects the spine and sacroiliac joints, causing fusion of the spine over time. It typically develops in young adults aged 18-30 and is more common in men. Genetics play a role, as 90% of patients have the HLA-B27 gene. Symptoms include chronic lower back pain and stiffness that worsens with inactivity. Diagnosis involves blood tests, x-rays showing spinal changes, and assessment of limited range of motion. Treatment focuses on reducing inflammation and pain through NSAIDs, DMARDs, biologics that target tumor necrosis factor-alpha, and occasionally surgery for deformities.
Back pain is common in adolescents, with incidence higher in girls than boys. Associations exist with heavy school bags, lack of lockers, and family history. Red flags include younger age, persistent or worsening pain, fever, and neurological symptoms. MRI is most valuable for imaging. Rehabilitation and back education are the mainstay of treatment.
The document discusses the challenges of diagnosing and treating acute back pain in emergency departments. It outlines key considerations for determining whether a patient's back pain could be caused by a serious underlying condition versus a simple mechanical issue. Imaging tests are recommended selectively based on risk factors present, with conservative treatment usually first for mechanical back pain. "Cannot miss" conditions like spinal infections, tumors, or abdominal aortic aneurysms require prompt diagnosis and treatment.
Low back pain is a common musculoskeletal disorder affecting 40% of people at some point in their lives. It can be acute (lasting less than 7 weeks) or chronic (more than 7 weeks). Common causes include muscle strains, poor posture, obesity, and injuries. Diagnosis involves physical examination and imaging tests like x-rays, CT scans, or MRIs. Treatment depends on whether the back pain is acute or chronic. For acute pain, conservative treatments like NSAIDs, muscle relaxants, and physical therapy are usually effective. Chronic back pain may require more intensive exercises, antidepressants if depression is present, or surgeries like laminectomy or spinal fusion if conservative treatments fail.
This document discusses the approach to a case of lumbar intervertebral disc prolapse. It outlines how to proceed with history taking, clinical examination, differential diagnosis, and management. For history taking, symptoms like pain characteristics, neurological symptoms, and bowel/bladder dysfunction are important. The clinical examination involves inspection, palpation, range of motion testing, and special tests like straight leg raise. Imaging like MRI or CT is used to confirm diagnosis. Conservative treatment includes rest, medication, and physiotherapy. Surgery is indicated for motor deficits or failure of conservative management.
_FIU - Thoracic and Lumbar Spine Special Tests and Pathologies (1) - نسخة.pptRadwa Talaat
This document provides information on clinical tests for the thoracic and lumbar spine. It describes positioning, procedures, and findings for special tests like the spring test, nerve root impingement tests (Valsalva, Milgram, Kernig's, straight leg raise), and tests for pathologies like facet joint dysfunction, disc lesions, and cauda equina syndrome. Clinical evaluation includes history, inspection, palpation, neurological assessment, and special tests to assess spinal mobility and nerve function. Common spinal issues addressed are muscle strains, facet joint dysfunction, disc degeneration and herniation.
Detailed history and its evaluation , examination of spine in general and local with special tests in cervical , thoracic outlet syndrome , lumbar spine and SI joint with diagrams, neurological examination both sensory and motor.
Back Pain, How do you maintain a healthy back.Sherif Watidy
Back Pain can be very painful, usually more prevailing in Adults, but did you know that you can reduce or totally relief back pain by taking only some actions into consideration. Professor Sherif ElWatidy Neurosurgeon describes them in details.
This document provides information on ankylosing spondylitis (AS), a chronic inflammatory disease primarily affecting the spine and sacroiliac joints. Key points include:
- AS causes pain and stiffness in the lower back and hips that worsens with inactivity. It is associated with the genetic marker HLA-B27 and often runs in families.
- Pathology involves inflammation at bony joints that can lead to fusion (ankylosis) over time, resulting in a fixed "bamboo spine" deformity. Diagnosis is based on clinical features and imaging showing sacroiliac joint erosion.
- Treatment focuses on general measures like exercise and posture, along with medications like NSAIDs to reduce
The document discusses prolapsed lumbar intervertebral disc (PLID), which occurs when the soft central portion of an intervertebral disc bulges out beyond the damaged outer rings. It causes severe back and leg pain. Key points include: PLID most commonly occurs at the L4/L5 level. Common symptoms are radiating pain, numbness, and weakness. MRI is the preferred imaging method to detect herniations. Treatment options include conservative measures like NSAIDs, physical therapy, and epidural injections or surgery for severe/progressive cases.
This document discusses the evaluation and diagnosis of chronic low back pain through history and physical examination. It outlines common causes of low back pain such as mechanical back pain, radicular pain, and sacroiliac joint dysfunction. The physical exam focuses on inspection, palpation, range of motion testing, and special tests to identify pain generators and neurological involvement. Differential diagnoses are discussed including mechanical back pain, radiculopathy, and conditions affecting the hip.
This document provides an overview of a presentation on managing back and joint pain in older patients. The objectives are to differentiate osteoarthritis from other causes of back/joint pain in older adults, discuss principles of medical management, and provide practice pearls. Common etiologies discussed include mechanical causes like muscle strains, degenerative conditions like spinal stenosis, and inflammatory diseases like ankylosing spondylitis. Key aspects of history and physical exam are outlined to aid in diagnosis. Treatment focuses are also mentioned.
This document provides information on evaluating the thoracic and lumbar spine through clinical examination. It discusses taking a patient history including pain location and characteristics, bowel/bladder issues, and prior injuries. The physical exam involves inspecting posture, curvature, skin, breathing and palpating bony landmarks. Specific conditions like scoliosis, kyphosis and spondylolisthesis are described in terms of causes, signs, grading severity and associated symptoms.
The document discusses various chronic pain syndromes including low back pain, sciatica, complex regional pain syndrome, trigeminal neuralgia, and cancer pain. It provides details on the definition, causes, symptoms, diagnostic tools and treatment options for low back pain and sciatica, which are the most commonly discussed chronic pain conditions. The treatment sections cover medications, physical therapy, injections including epidural steroid injections, radiofrequency ablation, and other minimally invasive procedures.
This document provides information on ankylosing spondylitis (AS), an inflammatory disease that primarily affects the axial skeleton. It causes pain, stiffness, and decreased mobility. The disease usually begins in young adults and is associated with the HLA-B27 gene in most cases. Symptoms include inflammatory back pain and stiffness. Exams can reveal limited spinal mobility and inflammation of joints. Imaging shows sacroiliitis that progresses to fusion. Treatment involves exercise, NSAIDs, DMARDs, and biologics that target tumor necrosis factor-alpha to reduce symptoms and progression.
The facial nerve, also known as cranial nerve VII, is one of the 12 cranial nerves originating from the brain. It's a mixed nerve, meaning it contains both sensory and motor fibres, and it plays a crucial role in controlling various facial muscles, as well as conveying sensory information from the taste buds on the anterior two-thirds of the tongue.
The story of Dr. Ranjit Jagtap's daughters is more than a tale of inherited responsibility; it's a narrative of passion, innovation, and unwavering commitment to a cause greater than oneself. In Poulami and Aditi Jagtap, we see the beautiful continuum of a father's dream and the limitless potential of compassion-driven healthcare.
NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPTblessyjannu21
Prepared by Prof. BLESSY THOMAS, VICE PRINCIPAL, FNCON, SPN.
Emphysema is a disease condition of respiratory system.
Emphysema is an abnormal permanent enlargement of the air spaces distal to terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis.
Emphysema of lung is defined as hyper inflation of the lung ais spaces due to obstruction of non respiratory bronchioles as due to loss of elasticity of alveoli.
It is a type of chronic obstructive
pulmonary disease.
It is a progressive disease of lungs.
Enhancing Hip and Knee Arthroplasty Precision with Preoperative CT and MRI Im...Pristyn Care Reviews
Precision becomes a byword, most especially in such procedures as hip and knee arthroplasty. The success of these surgeries is not just dependent on the skill and experience of the surgeons but is extremely dependent on preoperative planning. Recognizing this important need, Pristyn Care commits itself to the integration of advanced imaging technologies like CT (Computed Tomography) and MRI (Magnetic Resonance Imaging) into the surgical planning process.
Solution manual for managerial accounting 18th edition by ray garrison eric n...rightmanforbloodline
Solution manual for managerial accounting 18th edition by ray garrison eric noreen and peter brewer_compressed
Solution manual for managerial accounting 18th edition by ray garrison eric noreen and peter brewer_compressed
Sectional dentures for microstomia patients.pptxSatvikaPrasad
Microstomia, characterized by an abnormally small oral aperture, presents significant challenges in prosthodontic treatment, including limited access for examination, difficulties in impression making, and challenges with prosthesis insertion and removal. To manage these issues, customized impression techniques using sectional trays and elastomeric materials are employed. Prostheses may be designed in segments or with flexible materials to facilitate handling. Minimally invasive procedures and the use of digital technologies can enhance patient comfort. Education and training for patients on prosthesis care and maintenance are crucial for compliance. Regular follow-up and a multidisciplinary approach, involving collaboration with other specialists, ensure comprehensive care and improved quality of life for microstomia patients.
As Mumbai's premier kidney transplant and donation center, L H Hiranandani Hospital Powai is not just a medical facility; it's a beacon of hope where cutting-edge science meets compassionate care, transforming lives and redefining the standards of kidney health in India.
2024 Media Preferences of Older Adults: Consumer Survey and Marketing Implica...Media Logic
When it comes to creating marketing strategies that target older adults, it is crucial to have insight into their media habits and preferences. Understanding how older adults consume and use media is key to creating acquisition and retention strategies. We recently conducted our seventh annual survey to gain insight into the media preferences of older adults in 2024. Here are the survey responses and marketing implications that stood out to us.
This particular slides consist of- what is Pneumothorax,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is a summary of Pneumothorax:
Pneumothorax, also known as a collapsed lung, is a condition that occurs when air leaks into the space between the lung and chest wall. This air buildup puts pressure on the lung, preventing it from expanding fully when you breathe. A pneumothorax can cause a complete or partial collapse of the lung.
This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
Hypotension, or low blood pressure, is when the pressure of blood circulating in the body is lower than normal or expected. It's only a problem if it negatively impacts the body and causes symptoms. Normal blood pressure is usually between 90/60 mmHg and 120/80 mmHg, but pressures below 90/60 are generally considered hypotensive.
Research, Monitoring and Evaluation, in Public Healthaghedogodday
This is a presentation on the overview of the role of monitoring and evaluation in public health. It describes the various components and how a robust M&E system can possitively impact the results or effectiveness of a public health intervention.
Ensure the highest quality care for your patients with Cardiac Registry Support's cancer registry services. We support accreditation efforts and quality improvement initiatives, allowing you to benchmark performance and demonstrate adherence to best practices. Confidence starts with data. Partner with Cardiac Registry Support. For more details visit https://cardiacregistrysupport.com/cancer-registry-services/
Fit to Fly PCR Covid Testing at our Clinic Near YouNX Healthcare
A Fit-to-Fly PCR Test is a crucial service for travelers needing to meet the entry requirements of various countries or airlines. This test involves a polymerase chain reaction (PCR) test for COVID-19, which is considered the gold standard for detecting active infections. At our travel clinic in Leeds, we offer fast and reliable Fit to Fly PCR testing, providing you with an official certificate verifying your negative COVID-19 status. Our process is designed for convenience and accuracy, with quick turnaround times to ensure you receive your results and certificate in time for your departure. Trust our professional and experienced medical team to help you travel safely and compliantly, giving you peace of mind for your journey.www.nxhealthcare.co.uk
4. 2nd most common cause for office visit
60-80% of population will have lower back
pain at some time in their lives
Each year, 15-20% will have back pain
Most common cause of disability for persons
< 45 years
1% of US population is disabled
Costs to society: $20-50 billion/year
Back Pain
5. Causes of Low Back Pain:
Lumbar “strain” or “sprain” – 70%
Degenerative changes – 10%
Herniated disk – 4%
Osteoporosis compression fractures – 4%
Spinal stenosis – 3%
Spondylolisthesis – 2%
6. Causes of Low Back Pain:
Spondylolysis, diskogenic low back pain or
other instability – 2%
Traumatic fracture - <1%
Congenital disease - <1%
Cancer – 0.7%
Inflammatory arthritis – 0.3%
Infections – 0.01%
7. Clinicians should conduct a focused
History and physical examination to help place patients with low
back pain into 1 of 3 broad categories:
nonspecific low back pain,
back pain potentially associated with radiculopathy or spinal
stenosis,
back pain potentially associated with another specific spinal
cause.
The history should include assessment of psychosocial risk
factors, which predict risk for chronic disabling back pain
Diagnosis and Treatment of Low Back Pain: A Joint
Clinical Practice Guideline from the American College
of Physicians and the American Pain Society
8. Assessment of LBP
• Rule out serious pathology ‘Red Flags’
• Confirm that the pain:
• Is in the lower back - always assess the hip joint
• Is mechanical — aggravated or relieved by certain movements or
postures.
• Is not inflammatory — that is:
• Not worse in the second half of the night or after waking.
• Not associated with morning stiffness lasting more than
30 minutes.
• Not relieved by activity.
• Not associated with laboratory tests for inflammation
• Exclude specific causes of low back pain
9. Classification of LBP
Conventionally low back pain is categorised
according to its duration as:
Acute (<6 weeks),
Sub-acute (6 weeks - 12 weeks)
Chronic (>12 weeks)
(Spitzer, W. O. and Leblanc, F. E., 1987).
10. Red Flags:
• Red flags for the cauda equina syndrome include:
– Saddle anaesthesia.
– Recent onset of bladder dysfunction or faecal incontinence.
– Major motor weakness.
• Red flags that suggest spinal fracture include:
– Sudden onset of severe central pain in the spine which is relieved
by lying down.
– Major trauma such as a road accident or fall from a height.
– Minor trauma, or even just strenuous lifting, in people with
osteoporosis.
– Structural deformity of the spine.
11. •Red flags that suggest cancer or infection
include:
–Onset in a person over 50 years, or under 20 years, of age.
–History of cancer.
–Constitutional symptoms, such as fever, chills, or unexplained
weight loss.
–Intravenous drug abuse.
–Immune suppression.
–Pain that remains when supine; aching night-time pain
disturbing sleep; and thoracic pain (which also suggests aortic
aneurysm).
12. Yellow Flags
Yellow flags are psychosocial barriers to recovery. They include:
• The belief that pain and activity are harmful.
• Sickness behaviours, such as extended rest.
• Social withdrawal, lack of support.
• Emotional problems such as low or negative mood, depression, anxiety, or
feeling under stress.
• Problems or dissatisfaction at work.
• Problems with claims for compensation or applications for social benefits.
• Prolonged time off work (e.g. more than 6 weeks).
• Overprotective family.
• Inappropriate expectations of treatment, such as low expectations of active
participation in treatment.
14. Investigation:
• Do not offer X-ray of the lumbar spine for the
management of non-specific low back pain.
• MRI for non-specific low back pain should only be
performed within the context of a referral for an
opinion on spinal fusion.
• Consider referral for MRI if sciatica persists > 6
weeks
• ESR/CRP if suspect cancer, infection, Ank Spond
• HLA B27 if suspect AS.
15. Disease or condition Patient age (years)
Back strain 20 to 40
disc herniation 30 to 50
Osteoarthritis or spinal
stenosis
>50
Spondylolisthesis Any age
Ankylosing spondylitis 15 to 40
Infection Any age
Malignancy >50
16. Disease or condition Location of pain
Back strain Low back, buttock, posterior thigh
Disc herniation Low back to lower leg
Osteoarthritis or spinal stenosis Low back to lower leg; often bilateral
Spondylolisthesis Back, posterior thigh
Ankylosing spondylitis Sacroiliac joints, lumbar spine
Infection Lumbar spine, sacrum
Malignancy Affected bone(s)
17. Disease or condition Quality of pain
Back strain Ache, spasm
Disc herniation Sharp, shooting or burning pain,
paresthesia in leg
Osteoarthritis or spinal stenosis Ache, shooting pain, "pins and needles"
sensation
Spondylolisthesis Ache
Ankylosing spondylitis Ache
Infection Sharp pain, ache
Malignancy Dull ache, throbbing pain; slowly
progressive
18. Disease or condition Aggravating or relieving
factors
Back strain Increased with activity or bending
Disc herniation Decreased with standing;
increased with bending or sitting
Osteoarthritis or spinal stenosis Increased with walking, especially up
an incline; decreased with sitting
Spondylolisthesis Increased with activity or bending
Ankylosing spondylitis Morning stiffness
Infection Varies
Malignancy Increased with recumbency or cough
19. Disease or condition Signs
Back strain Local tenderness, limited spinal motion
Disc herniation Positive straight leg raise test,
weakness, asymmetric reflexes
Osteoarthritis or spinal stenosis Mild decrease in extension of spine;
may have weakness or asymmetric
reflexes
Spondylolisthesis Exaggeration of the lumbar curve,
palpable "step off" (defect between
spinous processes), tight hamstrings
Ankylosing spondylitis Decreased back motion, tenderness
over sacroiliac joints
Infection Fever, percussive tenderness; may have
neurologic abnormalities or decreased
motion
Malignancy May have localized tenderness,
neurologic signs or fever
20. Clinical Evaluation
Spring Test:
Test Positioning:
Subject is prone
Examiner stands with thumbs or hypothenar eminence
over the spinous process of a lumbar vertebrae
Action:
Apply a downward “springing” force through the
spinous process of each vertebrae to assess anterior-
posterior motion
Positive Finding:
Increases or decreases in motion at one vertebrae
compared to another (hypermobility or hypomobility)
23. Nerve Root Impingement
Tests:
Valsalva Test:
Test Position:
Sitting, examiner standing next to patient
Action:
Subject takes a deep breath and holds while bearing down
as if having a bowel movement
Positive Finding:
Increased spinal or radicular pain due to ↑ intrathecal
pressure
May be secondary to a space-occupying lesion (i.e.
herniated disc, tumor, osteophyte in lumbar canal)
25. Milgram Test:
Test Position:
Patient supine, examiner at feet of the
patient
Action:
Patient performs a bilateral straight
leg raise to the height of 2 to 6 inches
and is asked to hold the position for 30
seconds
26. Milgram Test:
Positive Finding:
Patient unable to hold
position, cannot lift the
leg, or has pain with test
Implications:
Intrathecal or
extrathecal pressure
causing an
intervertebral disc to
place pressure on a
lumbar nerve root
27. Kernig’s Test:
Test Position:
Patient supine, examiner at side of patient
Action:
Patient performs a unilateral active straight leg
raise with the knee extended until pain occurs
After pain occurs, the patient flexes the knee
Positive Finding:
Pain in the spine and possibly radiating into lower
extremity
Pain relieved when patient flexes the knee
Implications:
Nerve root impingement secondary to bulging of
the intervertebral disc or bony entrapment;
irritation of dural sheath; irritation of meninges
28. Patient actively flexes
the cervical spine (lifts
the head)
Hip unilaterally flexed
(no more than 900)
Knee than flexed to no
more than 900
(+) ↑ pain with neck
and hip flexion; pain
relieved when knee is
flexed
Kernig/Brudzinski Test:
29. Test Position:
Patient supine, examiner standing at tested
side with the distal hand around the subject’s
heel and proximal hand on subject’s distal
thigh (anterior) – maintains knee extension
Action:
Examiner slowly raises the leg until
pain/tightness noted or full ROM is obtained
Slowly lower the leg until the pain or tightness
resolves, at which point dorsiflex the ankle and
have subject flex the neck.
Unilateral Straight Leg Raise Test
(Lasegue Test):
30. Positive Findings:
Leg and/or low back
pain occurring with DF
and or neck flexion is
indicative of dural
involvement and/or
sciatic nerve irritation
Lack of pain
reproduction with DF
and/or neck flexion is
indicative of hamstring
tightness or SI pathology
Straight Leg Raise Test:
31. Test Position:
Patient standing with feet shoulder width
apart
Examiner stands behind the patient, grasping
the patient’s shoulders
Action:
Patient extends the spine as far as possible,
than sidebends and rotates to affected side
Examiner provides overpressure through the
shoulders, supporting the patient as needed
Quadrant Test:
33. Positive Findings:
Reproduction of patient’s symptoms
Implications:
Radicular pain indicates compression of the
intervertebral foramina that impinges on the
lumbar nerve roots
Local pain (not radiating) indicates facet joint
pathology
Symptoms isolated to the area of the PSIS
may indicate SI joint dysfunction
Quadrant Test:
34. Test Position:
Patient sits over edge of table; examiner is at
side of patient
Action:
(1) Patient slumps forward along
thoracolumbar spine, rounding the shoulders
while keeping cervical spine neutral
(2) Patient flexes cervical spine; Clinician
holds patient in this position
(3) Knee is actively extended
(4) Ankle is actively dorsiflexed
(5) Repeat on opposite side
Slump Test:
35. Positive Findings:
Sciatic pain or
reproduction of
other neurological
symptoms
Implications:
Impingement of
the dural lining,
spinal cord, or
nerve roots
Slump Test:
36. Hoover Test:
Test Position:
Patient supine
Examiner at feet of patient with hands cupping the
calcaneous of each leg
Action:
Patient attempts to actively straight leg raise on the
involved side
Positive Findings:
Patient does not attempt to lift the leg and examiner
does NOT sense pressure from the uninvolved leg
pressing down on the hand
Patient is not attempting to perform the test
Test for Patient Malingering:
37. Hoover Test:
Test Note: Examiner should be standing at feet of patient with
their hands cupping the heels of each leg
38. Test Position: Athlete supine
Athletic Trainer Position: At the foot of the
athlete holding a blunt tool (reflex hammer)
Procedure: Rub the tool up bottom of
athlete’s foot starting at the calcaneus and
ending at the great toe.
Positive test: Great toe extends while other
toes splay.
Implications: Lesion of upper motor
neurons, may be caused by trauma to the
brain
Comments: This reflex occurs naturally in
newborns. However, this reflex should cease
quickly after birth.
Babinkski’s Test:
39. Common low back pathology
MOI:
History of heavy or repetitive
lifting
Signs/Symptoms:
Aching back
Pain ↑ with passive and active
flexion, resisted extension
Neurological Evaluation:
Negative results
Erector Spinae Muscle Strain:
40. Pathology of facet joints: 40% of all chronic low back pain
Vague signs/symptoms:
Often resemble other low back pathologies (i.e. strain/spasm
of paraspinal muscles, nerve root impingement, disc
degeneration)
Involvement:
Dislocation/sublocation of facet:
Tends to “lock” the involved spinal segment (hypomobile
vertebrae)
Facet joint syndrome: (inflammation)
Causes: repetitive stress through movement or loading
Degeneration: (arthritis)
Causes: undefined history
↓ intervertebral foramen size (nerve root impingement)
Facet Joint Dysfunction:
41. History:
Onset: Insidious
Pain characteristics: Localized
MOI: Extension, rotation, lateral bending of vertebrae
Predisposing conditions: Repeated motions of spinal
extension, rotation, lateral bending
Inspection:
Patient may assume posture that ↓ pressure on affected facets
Palpation:
Possible local muscle spasm (paravertebral muscles)
Facet Joint Dysfunction:
42. Ligamentous Tests:
Spring Test – pain, ↓ motion
Neurological Tests:
Not applicable unless secondary
nerve root impingement occurs
Special Tests:
Quadrant Test (+)ve
Intervertebral disc lesions (-)ve
Facet Joint Dysfunction:
43. History:
Onset of pain:
Insidious; pain begins as an ache, ↑ to constant pain
Characteristics:
Lumbar pain, radiating into buttocks and upper
posterolateral thigh
MOI:
Repetitive stress (extension)
Predisposing conditions:
Muscular imbalances
Repetitive hyperextension activities
Inspection:
↑ lordotic curve
Altered GAIT
Spondylolysis and Spondylolisthesis:
44. Palpation:
Step-off deformity may be felt
Spasm of paraspinal muscles
Functional Tests:
AROM:
Flexion – restricted, pain free
Extension – pain
Rotation and bending - pain
PROM:
Hip flexion – hamstring tightness
RROM:
Weakness of spinal erectors
Spondylolysis and Spondylolisthesis
45. Special Tests:
Pain with Spring test
SL stance test; straight leg
raises may produce pain
Spondylolysis and Spondylolisthesis:
47. Inspection:
Levels of iliac crests, ASIS, PSIS
Palpation:
Pain over SI joints and PSIS
Functional tests:
Trunk flexion (with knees extended) will cause movement of
the sacrum on the ilia (pain)
Neurological testing:
Lower quarter screen
Special tests:
Long sit; SI compression and distraction; straight leg
raising; fabre; gaenslen’s; quadrant
Sacroiliac Joint Dysfunction:
48. Test position:
Subject supine; examiner stands next to subject and with
arms crossed, places heel of both hands on the subject’s
ASISs
Action:
Examiner applies outward and downward pressure with
the heels of both hands
Positive finding:
Unilateral pain at SI joint or in gluteal/leg region is
indicative of anterior SI ligament sprain
Sacroiliac Joint Stress Test:
49. Test position:
Subject side-lying; examiner
stands next to patient and places
both hands (one on top of the
other) directly over the subject’s
iliac crest
Action:
Apply downward pressure
Positive finding:
Increased pain indicative of SI
pathology (possible involvement of
posterior SI ligament)
Sacroiliac Joint Stress Test:
50. Test position:
Subject lying supine; examiner places
both hands on lateral aspect of
subject’s iliac crests
Action:
Apply inward and downward
pressure
Positive finding:
Increased pain indicative of SI
pathology (possibly involving
posterior SI ligaments)
Sacroiliac Joint Stress Test:
51. Test position:
Subject lying prone; examiner places both
hands (one on top of the other) over subject’s
sacrum
Action:
Apply downward pressure on sacrum
Positive finding:
Increased pain indicative of SI pathology
Sacroiliac Joint Stress Test:
52. Test position: Subject supine
Action:
Examiner passively flexes, abducts, and
externally rotates the involved leg until
the foot rests on the top of the knee of
uninvolved lower extremity; examiner
slowly abducts the involved lower
extremity towards the table
Positive test:
Involved lower extremity does not
abduct below level of uninvolved side
SI pathology, iliopsoas tightness
Patrick or FABER Test:
53. Test position:
Subject supine, lying close to edge of
table; examiner stands at side
Action:
Slide patient to edge of table; patient
pulls far knee up to the chest; near leg
allowed to hang over edge of table
Examiner applies downward pressure on
near leg, forcing it into hyperextension
Positive finding:
Pain in SI region indicating SI joint
dysfunction
Gaenslen’s Test: