9. Bienes Singulares y Bienes Universales
9.2 Bienes Universales
QUICK REFERENCE T
ABLE
Condition Orthopedic Test How to Perform Positive Sign
Whiplash None Various tests are
performed to rule out other conditions.
NA
TMJ dysfunction None Joint can be auscul-
tated to determine sounds.
NA
Torticollis None Assess TMJ and cervi-
cal spine for involve- ment.
NA
Cervical disk injuries Cervical compression
test
Client seated. Stand behind client with head and neck in a neutral position. Interlace fi ngers and place on top of client’s head. Gently press straight down.
Any pain or increase in neurologic symp- toms
Cervical distraction Client seated. Stand to side of client. Cradle occiput using one hand; cradle the mandible with the other. Gently lift up on the head.
A decrease in pain or associated symp- toms (increase in pain indicates possible ligamentous injury)
Spurling’s test Client seated. Stand
behind client. Have client laterally fl ex and rotate the head to the side of the complaint. Interlace your fi ngers and press down on the head.
An increase in pain and symptoms
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Chapter 5 Conditions of the Head and Neck 155
Orthopedic Tests for the Head and Neck
QUICK REFERENCE T
ABLE
Condition Orthopedic Test How to Perform Positive Sign
Thoracic Outlet Syn- drome
Roos Test Client in standing posi-
tion. Have client ab- duct the shoulder to 90° and fl ex the elbows to 90°. Slightly externally rotate and horizontally abduct shoulders so that they are just be- hind the frontal plane. Have the client slowly open and close the hands for 3 minutes.
Ischemic pain, pro- found weakness in the arm, or numbness or tingling in the hand. Minor symptom repro- duction is considered a negative sign.
Adson maneuver
Note: This is the most
common test per- formed, but it has also been proved unreli- able.
Client seated. Locate the radial pulse on side you are testing. Extend and externally rotate the arm, keeping it below horizontal. Have client rotate head and look at hand being test- ed. Instruct the client to take a deep breath
Any diminishing or disappearance of the pulse indicates a posi- tive sign.
Allen test Client in seated posi-
tion. Locate the radial pulse of the client on the test side. Flex the elbow and shoulder to 90°. Horizontally ab- duct and laterally rotate the arm. Have the client rotate the head and look away from the side be- ing tested.
Any change or disap- pearance of the pulse is an indication of a positive test.
Cyriax release test
Note: This is also
known as the pas-
sive shoulder girdle elevation test and
involves the release phenomenon. That is, neurovascular symp- toms that present as a result of compres- sion will change if the structures causing the compression are moved.
Client in seated posi- tion. Stand behind the client, and hold the elbows in 90° of fl ex- ion and the forearms and wrists in a neu- tral position. Lean the client back about 15°, and passively elevate the shoulders just shy of the end range. Hold the position for 1 to 3 minutes.
A positive result can take one of two forms: If the client has active symptoms, a reduction or relief of those symptoms indicates a positive test. One interpretation of the release phenomenon is that compressed nerve trunks will initially dis- play symptoms but will return to normal; hence, a reproduction of the client’s symptoms also indicates a positive test.
jur10939_ch05_094-155.indd Sec1:155
156
chapter outline
I. IntroductionII. Anatomical Review
a. Bony Anatomy of the Lumbar Spine b. Bony Structures and Surface Anatomy of
the Lumbar Spine
c. Soft Tissue Structures of the Lumbar Spine d. Bony Anatomy of the Sacrum
e. Bony and Soft Tissue Structures and
Surface Anatomy of the Sacrum
f. Muscles of the Lumbar Spine and Sacrum
III. Movement and Manual Muscle Testing of the Region
a. Movements of the Region
IV. Dermatomes for the Lumbar Spine and Sacrum V. Trigger-Point Referral Patterns for Muscles of
the Region
a. Erector Spinae
b. Serratus Posterior Inferior c. Quadratus Lumborum d. Multifi dus and Rotatores e. Gluteus Maximus f. Gluteus Medius g. Gluteus Minimus h. Piriformis
i. Rectus Abdominus
j. Obliques and Transverse Abdominus k. Iliopsoas
VI. Specifi c Conditions
a. Lumbar Spine Conditions
b. Spondylolysis and Spondylolisthesis c. Facet Joint Syndrome
d. Sacroiliac Joint Dysfunction
VII. Summary
VIII. Review Questions
IX. Critical-Thinking Questions X. Quick Reference Tables
a. Bony Structures of the Lumbar Spine b. Soft Tissue Structures of the Lumbar
Spine
c. Bony and Soft Tissue Structures and
Surface Anatomy of the Sacrum
d. Muscles of the Lumbar Spine and Sacrum e. Trigger Points for the Lumbar Spine and
Sacrum
f. Orthopedic Tests for the Lumbar Spine
and Sacrum
chapter objectives
At the conclusion of this chapter, the reader will understand:
bony anatomy of the region
how to locate the bony landmarks and soft tissue structures of the region
where to fi nd the muscles, and the origins, insertions, and actions of the region
how to assess the movement and determine the range of motion for the region
how to perform manual muscle testing to the region
how to recognize dermatome patterns for the region
trigger-point location and referral patterns for the region
the following elements of each condition discussed:
background and characteristics specifi c questions to ask
what orthopedic tests should be performed how to treat connective tissue, trigger points, and muscles
fl exibility concerns • • • • • • • • • • • • •
key terms
congenital spondylolysis contranutation developmental spondylolysis facet joint syndromenutation
sacroiliac joint (SIJ) dysfunction spondylolisthesis spondylolysis
c h a p t e r
6
Conditions of the Lumbar
Spine and Sacrum
jur10939_ch06_156-213.indd 156
Chapter 6 Conditions of the Lumbar Spine and Sacrum 157
Introduction
The lumbar spine and the sacrum can be signifi cant sources of dys- function. Studies have estimated that up to 70% of adults have experienced low-back pain during their lifetime, with 50% reporting it every year (Jackson and Browning, 2005). Compared to pain in the cervical spine, low-back pain more often originates from chronic behavior than from acute trauma. “Back pain has been identifi ed as the leading cause of disability among persons under the age of 45 years and the third leading cause of disability among those 45 years of age or older” (McGeary et al., 2003). Back pain accounts for 200,000 offi ce visits per year—1.8% of the total medical visits in the United States (Jackson and Browning, 2005). Despite its high percentage of occurrence, only 25% of people with physical symptoms seek medical attention. Most back inju- ries are relatively minor and will resolve within a month; however, a minority of people—around 10%—develop chronic conditions that make up 80% of the cost associated with the disorder.Management of low-back pain continues to be challenging (Maluf et al., 2000), especially because there are many different variables and sources from which the pain can originate. De- spite having knowledge of the structures involved, a large percentage (up to 85%) of cases are classifi ed as “nonspecifi c” because a defi nitive diagnosis cannot be made with current methods (O’Sullivan, 2005). A nonspecifi c diagnosis is sometimes referred to as “lumbago,” but the cause of pain is usually narrowed down through a process of elimination to ensure that the correct treatment is administered.
This chapter seeks to clarify some of the major causes of lumbar spine and sacral dysfunc- tion. In addition to reviewing the structures, this chapter discusses:
Specifi c bony landmarks for palpation
Soft tissue structures, including the muscles of the region
The movements of the region, and basic biomechanics of the lumbar spine and sacrum Manual muscle tests for the lumbar spine
Dermatome and trigger-point referral patterns for the involved muscles
Some common causes of dysfunction and how to assess and treat them using soft tissue therapy • • • • • •