Lx disc herniation
D=
A = Age, activity, smoking, obesity, sedentary
E = 25-45y/o
P = LBP + leg pain below knee, sudden onset twist/lift.
E = O/P - antalgic posture
Lx ROM - lat flex aggro
Neuro - SMR
Ortho - Lx Screen, SLR, Slump, Kemps
M = NSAIDs, opiods, diazepam, gabapentin, heat, cusion,
Lumbar Facet Syndrome
D=
E = all
P = Localised LBP w/ hip/buttock pain above knee
E = O/P = hypertonicity, flat lordosis, posture assymetry
Lx ROM - pain ext and rot
Neuro - NAD
ortho - Kemps, SLR
M = Manip/mobs, correct posture, NSAIDs
Sacroiliac Dysfunction
D = Altered positional relationship of sacrum on an ilium
E = Pts w/ Pregnant, young, degen
P = Sit to stand pain SIJ, radiate post leg, pain is sharp or dull.
E = O/P - PSIS tender/not level
Lx ROM - pain
Neuro - NAD
Ortho - 5
M = Manip/mobs, NSAIDs, cold/heat, STW
Piriformis Syndrome
D/A = hypertrophy of the piriformis muscle, which can compress the sciatic nerve.
E = Female, trauma, skier, tennis, truck driver
P = Buttock/post leg pain, pain worse on squat, hip addct/int rot mvmt
E = O/P - palpate tender/ short leg
Hip ROM - pain flex, add, int rot
neuro - NAD
ortho - SLR pain
M = STW, cold/heat, stretch, mobs/manip, NSAIDs
Lx compression Fx
D=
A = severe trauma, osteoporosis
E = Female 51-65
P = Asymptomatic, axial pain, no radiate, ache/stab/severe pain
E = O/P - Kyphosis, tender
Lx ROM - reduced
Neuro - NAD
Ortho - Tuning fork/percuss
M = Refer imaging
Cauda Equina
D = Compress cauda equina
A = disc herniation, tumour, trauma, infection, AS (late), spondylolisthesis, congenital
cause, spinal manipulation, degeneration.
E = Adults
P = sudden onset, LBP w/ leg pain, S/M abnormal legs, Bladder/Bowel dysfunction,
Saddle ana/parastesia, Sexual dysfunction
I = A&E
M = Decompress surgery,
Inflam - antinflam
Infect - antibiotics
Cancer - Chemo/radiotherapy
> lifestyle change, physio
HIPPIRONEL
• History (record card)
• Inspection (lumbs, bumps, bruises, rash)
• Palpation (warmth, sweling, tenderness, fluid)
• Percussion
• Instrumentation (ausculation)
• Range of motion (Pain, end feel, muscle, joint)
• Orthopedic tests
• Neurological tests (SMR)
• X-ray (cancer, trauma, scoliosis etc)
• Lab tests (FBC, LFT, RA factor, U&E)
Ankylosing Spondylitis (AS)
D = inflam axial skeleton start SIJ.
A = seronegative, idiopathic, hla b27
E = young male 20-30
P = Gardual onset pain/stiff SIJ + LB, a.m. stiff, Chronic, aggro rest/allev excercise,
fatigue, weight loss, fever
E = Blood test - hla b27, NY criteria, X-ray
M = NSAIDs > refer
RA
D = autoimmune arthitis
A = idiopathic
E = Old female
P = Symmetry hands, pain worse after rest, a.m. stiff >1hr, fatigue, weight loss
E = O/P - swell, tender, warm
ROM - reduce
Refer blood test
M = Increase activity, tens/wax bath, DMARDs, NSAIDs, surgery
- Upper Cx instability
Reactive Arthritis [Reiter's syndrome]
D = Spondyloarthitis, oligoarthritis KNEE, 3-12 mths, Triad
A = STI/GI infect
E = young adult HLA-B27 gene
P = weeks after infect, fever, fatigue, lower extremity arthritis, LBP
Triad - urethritis, conjuctivitis, arthritis
I = O/P - triad
Blood test - ESR/CRP high, hla-b27, rf negative
M = Rest, strengthening, physio, cold/heat, antibiotic, NSAIDs, corticosteroids,
DMARDs
spondylolisthesis
D = forward slipping of one vertebra over another
A = DIDTP
E = Male, I - children, D - old,
RF - scoliosis/spina bifida
P = Asympto, LBP aggro rot/ext + buttock pain
E = O/P - waddle gait, step deformity, tender, hypertonic
Lx ROM -pain ext/rot
Neuro - Dermo matching slip
Ortho - Stork stand test
M = grade G3-4 = Surgery
AAA
D = Bulge in aorta 3cm+
A = RF - Atherosclerosis, smoking, HTN
E = Male, 80+ - M=F
P = Asympto until rupture,
pre rupture - back,flank, abdo pain, nausea/vom?
Post - abdo/back pain
E = O/P - pulsitile mass
System - aorta palp 3cm+, ausculation - Bruit
M = Searing - acute rupture – REFER
Kidney stones
D = Urine supersaturated with salt/mineral. Crystal formation
A = RF - anatomical anomaly, FHx, HTN, gout, dehydration
E = Male middle age
P = Asympto/ rigor, fever, nausea/vom, haematuria/dysuria
I = O - pt agony
P - kidney ballottement, costovertebral angle tender/pain
Vital - fever, low BP
System - Abdo exam bowel sound reduced
M = Refer GP > NSAIDs, antiemetics, rehydrate
Cx facet syndrome
D = Cx facet irri - pain head, neck, shoulder
A = Cx injury, whiplash, sprain/strain, OA/RA
E = all
P = Dull/ache, localised, (acute - sharp)
E = O/P - Head carrige, hypertonic
Cx ROM - pain ext/rot
N - WNL
Ortho - Comp, distr
M = Rest, cold/heat, manip/mob, STW, NSAIDs
Whiplash
D = Soft tissue damage to ligaments, muscles, discs or other connective tissue.
A = Trauma, RTC, posture
P = Cx pain, radiate shoulder, headache
E = O/P - local tender, hypertonic
Cx ROM - reduce
N - NAD
Ortho - Distract
M = NSAIDs, PRICE, manip/mob, STW
Quebec grading
Cx spondylosis w/ radiculopathy
D = OA in Cx, LOSS
A = Injury, poor posture, Disc hernia, osteophyte
E = Female >50
P = Localised or Electric/burning/Numb/Tingling pain neck > arm, weak arm
E = O/P - Bakody sign, hypertonis/tender
Cx ROM - Reduce ext/rot/latflex, Pain latflex
N - SM depend
Orth - Cx screen, valsalva, arm squeeze, shoulder depress
M = NSAIDs, manip/mobs, STW, Sx should improve 6 weeks, if not refer,
confirmation is MRI
Torticollis
D = Rot/latflex head due to Cx muscle spasm (SCM), Aquire/Congen
A = Myo damage, Cx injury, CNS infection
E = Female 30+
P = Head tilt, ROM not equal, neck pain?
E = O/P - Asymmetry, hypertonic
ROM - reduce unilateral
N - NAD
Ortho - Cx screen
M = STW, stretch, manip/mobs, NSAIDs, excercise, heat/cold, pillow, NO Cx Collar
TMJ syndrome
D = Pain/tender due to dysfunction TMJ/muscle
A = muscle spasm, trauma, teeth grinding, dentures, psychosocial stress
E = Female 20-40
P = jaw/face pain, pain chewing, lock/catch, headache,
I = O/P - jaw asymmetry, hypertrophy, tender
ROM - reduced, click
M = Manip/mob, STW, heat, soft diet, teeth grinding stop, NSAIDs, refer dentist
Impingement RC
D = mechanical impinge RC tendon beneath acromion
A = Pri - overhead activity, trauma, subacro bursa, osteophyte
Sec - Instability, labral tear, RC imbalance
P = Hx repetative use/trauma w/ gradual increase pain shoulder
E = O/P - Myo asymmetry, tender
ROM - stiff, pain on abd 90 +
N - NAD
Otrho - Dugas, painful arc, empty can, lift off, neer, hawkin-kennedy
M = NSAIDs, rest, manip/mobs, strengthen, steroid inject, surgery
Adhesive Capsulitis (Frozen Shoulder)
D = Decreased passive and active range of motion
More stiffness than pain
A = RF diabetes, Hyper/hypothyroidism, Parkinson's, cardiac
E = Femal 40+
P = Slow onset shoulder pain/stiffness
3 phases - Fre/Fro/Thaw
I = O/P - tender
ROM - reduced/equal
Ortho - Apley scratch, painful arc, SITS
M = Years to resolve, NSAIDs, steroid inject, stretching, manip/mobs
Rotator cuff tear
D = m.c supra
A = acute - FOOSH, trauma, lift heavy
degen - repeat stress, bone spur, blood
E = Young acute tear, Old degen tear
P = Pain at rest, weakness
acute - sudden severe pain
degen - progressive weakness
I = O/P - tender/inflam
ROM - reduce, pain
ortho - SITS, Neer, Hawkins Kennedy
M = rest, activity mods, NSAIDs, strength, steroid inject, surgery
Acute calcific tendonitis
D = Calcium deposits within RC tendon, m.c supra
A = idiopathic, inflam/degen?
E = adults 30-50
P = Severe acute pain with any shoulder mvmt, stiff/snap/weak
I = O/P - hold arm/subacromial bursa
ROM - restricted/pain
M = NSAIDs, steroid inject, physio, strength, shockwave/ultrasound
TOS
D = Compression of neurovascular structures at the thoracic outlet.
A = trauma, cx rib, hypertonic muscle, pancoast tumour
E = Female poor posture
P = Unilateral Neuro Sx into arm (med)
I = O/P - Ant head carrige, hypertonic, tender
Neuro - SM abnormal
Ortho - ROOS, adsons, halstead, wrights, costoclavicular, phalen, allen.
M = manip/mobs, stretch/strengthen, STW, refer
SLAP lesion
D = Labral tear shoulder
A = RTC, FOOSH, heavy catch, trauma
E = overhead athlete, young adult/adult
P = Lock/pop/grind, pain on mvmt, weak
I = O/P - tender
ROM - reduce, pain int rot, abd, ext rot
M = NSAIDs, stretch/strength, surgery
carpal tunnel syndrome (CTS)
D = compression of the median nerve as it passes between the ligament and the
bones and tendons of the wrist.
A = RA, ganglion, neuroma, sublux, diabetes, preg, overuse, trauma, vit b deficient
E = Female, middle age
P = Neuro Sx into 1,2,3 finger, gripping clumbsy, flick pain
I = O/P - muscle waste (late)
Neuro = above + loss of 2 point discrim
Ortho - tinel, phalen/reverse, allen
M = rest, avoid repetative mvmt, manip/mobs, STW, cold/heat, NSAIDs, surgery
Lateral epicondylitis
D = tennis elbow, tendinosis of extensor carpi radialis brevis
A = overuse injury
E = 40+
P = Pain lat elbow + radite forearm, worse with activity, improve rest,
I = O/P - tenderness
ROM - pain
Ortho - Resist middle finger extend
M = PRICE, manip/mobs, STW, strength/stretch
Trochanteric Bursitis
D = Inflam of bursa superficial to GT
A = running, falls, surgery, trauma, repeat activity
E = Female
P = lat hip pain, limp, pain radiate LB, late thigh, knee, aggro int/ext rot + activity
I = O/P swell, tender
ROM - pain
Ortho - Ober, Faber
M = rest, physio, antiinflam, steroid inject, ESWT
Snapping Hip Syndrome
D = audible snap hip on mvmt
A = tendon snap over bony prominence/bursa
E = female 15-40
P = Lat - IT band tendon, GT
Ant - Iliopsoas tendon, ant joint capsule
Post - Bicep femoris tendon, ischial tuberosity
I = O/P =gait change, tenderness, snap
Ortho - Ober, Faber, USG
M = Stretch/strength, NSAIDs, correct biomech
Osteoarthritis of the hip
D = Inflam joints + breakdown of cartilage
A = wear and tear weight bearing joints
E = 50+ females RF - obesity, injury, joint misaligned/stress
P = Hip/Groin/Buttok pain, ant thigh/knee pain. a.m. stiff <30min aggro by movmt,
relief rest
Limp, ROM reduced, may DDH as a child.
I = O/P - antalgic, crepitus, inflam
ROM - reduced
Ortho - Log roll (int), Scouring
M = Weight loss/activity, cold/heat, manip/mobs, stretching, tens, arthroscopy,
NSAIDs, steroid inject, surgery
Anterior Cruciate Ligament (ACL) injury
A = low velocity, noncontact, deceleration injury, rotation injury
P = Feel/hear pop in knee, halt activity, swelling/unstable, knee buckle
I = O/P - antalgic, muscle spasm
ROM - reduce ext, pain
Ortho - Lachman, Sag, ant/post drawer, slocum, valgus/varus
M = Depend on severity.
mild - PRICE, NSAIDs > excercises, manip/mob
Osteochondritis Dissecans (OCD)
D = joint condition in which bone underneath the cartilage of a joint dies due to lack
of blood flow.
This bone and cartilage can then break loose, causing pain and possibly hindering
joint motion.
A = m.c knee(femoral condyle) idiopathic link avascular necrosis
E = Male children/teens, RF - trauma, overuse, genu
P = Vague ache joint/swelling, worse with mvmt, loose bodies
I = O/P - swelling, tender med fem condyle
Ortho - Wilson's
M = Analgesia, antiinflam, physio, crutch, surgery
Baker's cyst (popliteal cyst)
D = Fluid filled cyst politeal fossa, as a result of stretched joint capsule
A = idiopathic, underlying pathology
E = Children/older adults m.c
P = Asympto, ache/tight behind knee
I = O/P - Lump
ROM - reduce flex
M = lasts mnths, NSAIDs, ice, aspiration, steroid inject, surgery
Developmental displasia of hip
D = Abnormal hip growth, ligament laxity, shallow acetabulum
A = unclear - race, breech, female, swaddling
E = 1/1000
P = identify neonate exam
E = Clunk with hip abd, thigh thrust dislocate hip.
- Limited Abd of hip = best
M = resolve 2-6 wks old, 6mnth+ > bracing, surgery
- Chiro can help with chronic LB/leg pain due to DDH
Patellofemoral pain syndrome
D = A degenerative condition friction between the patella and the groove in the femur
A = Compress patellofemoral joint, prolong compress/shear of patellafemoral joint,
patella tracking issues
E = young adults active
RF - overuse, knee alignment, pes planus, repeat minor injury
P = Retro-patellar pain, aggro by knee flexion activity
I = O/P - gait, tibial torsion, pes planus, genu, increase Q angle, IT/TFL tight,.
Ortho - Clarkes, slocum, drawer, lachman, mcmurray
M = Correct patella tracking, manip/mobs, activity mods, ice, stretch/strength,
orthotics
Tarsal Tunnel Syndrome
D = Entrap post tibial nerve as it passes under med malleolus
A = ankle sprain, swell, trauma, overuse, tendinopathy
P = O/P - may plantar flex issue
ROM - reduce toe strength
Neuro - S/M parasthesia
Ortho - Tinels
M = Activity mods, PRICE, manip/mods
Ankle sprain
D/A = m.c inversion injury which damages the anterior talofibular, calcaneofibular,
and posterior talofibular ligaments
E = Sporty m.c
P = Grades - S,B,L,L,R
G1 - S minimal, B none, L 2days, L none, R 1-2mnth
G2 - S yes, B unilat, L 2wks, L slight, R 6-12mnth
G3 - S yes, B bilateral, L cant weight bear, L yes, R >1yr
I = O/P - bruise/swelling
ROM - reduced depend grade
Ortho - drawer, TF (rule out fx)
M = PRICE, refer fx, > manip/mobs
Plantar fascitis
D = Heel or arch pain resulting from microtears of collagen fibers in the plantar fascia
A = strain, inflam, degen, footwear, prolong tension
P = Pain days/months in heel, medial arch, insidious onset, aggro mvmt, relief rest
Hallmark - pain getting out of bed
I = O/P - tender med tubercle calcaneus
Neuro - pain heel/toe walking
M = PRICE, NSAIDs, manip/mobs, KT tape, stretch/strength GCM/Tib A
Benign vs Malignant Tumours
Benign
• Grow slowly & do not invade other tissues.
• Often do no harm if left alone - however local structures can be affected.
Malignant
• Grow quickly & invade local structures causing damage.
• Spread to other parts of the body (metastases), which also grow & spread.
Cancer types
Benign
• Bone - osteoid osteoma
• Cartilage - chondroma, osteochondroma
• Fibrous tissue - fibroma • Bone marrow - eosinophilic granuloma
• Vascular - haemangioma
• Uncertain - giant cell tumour
Malignant
• Bone - osteosarcoma • Cartilage - chondrosarcoma
• Fibrous tissue - fibrosarcoma
• Bone marrow - Ewing sarcoma, myeloma
• Vascular - angiosarcoma
• Uncertain - malignant giant cell tumour