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MSK > 3.2. Thoracolumbar Subjective > Flashcards

3.2. Thoracolumbar Subjective Flashcards

1
Q

T OR F: Diagnosing pain due to a disc is primarily diagnosis of inclusion.

A

FALSE

diagnosis of EXCLUSION

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2
Q

Most of the examination commonly revolves around differentiating symptoms of _____ (2), which refers radicular symptoms into the leg from other conditions more likely to cause localized pain

A

herniated disc or space-occupying lesion

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3
Q

If there are no radicular symptoms below the (1) ____, it often becomes difficult for the examiner to determine where in the spine the problem is, or whether the problem is truly in the lumbar spine or coming from problems in the pelvic joints, primarily the (2)_____.

A

BELOW the KNEE

pelvic joints: SI Joints or Hips

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4
Q

Only about ____% of cases can a definitive diagnosis as to the pathology of back pain be made.

A

15%

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5
Q

What are the 2 main categories of LBP?

A

Back pain dominant/ Mechanical cause
Leg pain dominant/ Nonmechanical cause

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6
Q

pattern of LBP that suggests disc involvement, sprain, strain

A

pattern 1 of back pain dominant

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7
Q

pattern of LBP that suggests facet joint involvements, strain

A

pattern 2 of back pain dominant

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8
Q

pattern of LBP that suggests nerve root irritation, primarily by a disc or some other space-occupying lesion or an injury accompanied by inflammatory swelling

A

pattern 3 of leg pain dominant

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9
Q

pattern of LBP that suggests neurogenic intermittent claudication/pressure on the cauda equina

A

pattern 4 of leg pain dominant

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10
Q

Age predisposition for Scheuermann’s disease

A

13-16 y/o

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11
Q

Age predisposition for Idiopathic scoliosis

A

adolescent females

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12
Q

Age predisposition for lumbar disc problems

A

15-40 y/o

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13
Q

Age predisposition for ankylosing spondylitis

A

18-45 y/o

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14
Q

Age predisposition for spine osteoarthritis and spondylosis

A

> 45 y/o

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15
Q

Sex predisposition for ankylosing spondylitis

A

MALES

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16
Q

Age predisposition for spine malignancy

A

> 50 y/o

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17
Q

MOI for rib injuries

A

trauma

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18
Q

MOI for thoracic spine problems

A

disease processes (e.g., scoliosis) and may have an insidious onset

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19
Q

Sex predisposition for scoliosis & LBP

A

FEMALES

Female patients should be asked about any changes that occur with menstruation, such as altered pain patterns, irregular menses, and swelling of the abdomen or breasts

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20
Q

T OR F: Pain from true thoracic trauma tends to be diffused to the area of injury.

A

FALSE

Pain from true thoracic trauma tends to be LOCALIZED to the area of injury.

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21
Q

MOI for facet syndromes

A

present as stiffness and local pain, which can be referred

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22
Q

T OR F: Lifting commonly can cause LBP

A

TRUE

forces are exerted on lumbar spine & disc

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23
Q

T OR F: The force exerted on the disc can be calculated as roughly five times the weight being lifted.

A

FALSE

roughly as TEN TIMES the weight being lifted

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24
Q

Pressure on the disc can be decreased by increasing the _____ of the backrest

A

supported inclination

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25
Q

Using the ____ for support can also decrease the pressure on the disc

A

arms

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26
Q

When one is standing, the disc pressure is approximately ____ of the pressure that occurs in the relaxed sitting position.

A

35%

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27
Q

Lower back stress tends to be ______ (%) higher in ____ (men or women)

A

15% to 20%; men>women

because men are taller and their weight is distributed higher in the body

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28
Q

T OR F: Back pain tends to be more prevalent in people with strenuous occupations

A

TRUE

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29
Q

T OR F: Familial influences have an effect on back pain

A

TRUE

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30
Q

Patients who have chronic low back pain develop what syndrome?

A

deconditioning syndrome

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31
Q

Compounds chronic low back pain problems as it leads to decreased muscle strength, impaired motor control, and decreased coordination and postural control.

A

deconditioning syndrome

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32
Q

With thoracic disc lesions, (1) ____
movements do not often show the characteristic pain pattern, and (2)_____ deficits are difficult if not impossible to detect.

A

(1) ACTIVE movements

because of the rigidity of the thoracic spine

(2) SENSORY and STRENGTH deficits are difficult to detect

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33
Q

The examiner should remember that _____ structures may refer pain to the thoracic region

A

Abdominal structures:
stomach,
liver,
pancreas

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34
Q

What diseases usually cause pain that follows the path of the ribs or a deep, “through-the-chest” pain? (2)

A

Thoracic root involvement or spondylosis

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35
Q

Acute back pain lasts for?

A

3-4 weeks

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36
Q

Subacute back pain lasts for?

A

12 weeks

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37
Q

Chronic back pain lasts for?

A

> 3 months

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38
Q

Unilateral pain with no referral below the knee caused by injury to muscles (strain) or ligaments (sprain), the facet joint, or, in some cases, the sacroiliac joints

A

mechanical LBP

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39
Q

pain is moving toward or is centered in the lumbar spine

A

Centralization

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40
Q

implies the pain is being referred or is moving into the limb

A

Peripheralization

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41
Q

T OR F: Injuries in the lumbar spine ted to be peripheralized in the limbs.

A

FALSE

There is seldom if ever
peripheralization of the symptoms.
The symptoms tend to stay CENTRALIZED in the back.

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42
Q

T OR F: If the muscles and ligaments are affected, movement will decrease and pain will increase with repeated movements.

A

TRUE

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43
Q

Pain on standing that improves with ____ and pain on forward flexion with no substantial muscle tenderness suggests ____.

A

walking

disc involvement

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44
Q

T OR F: A minor disc injury (protrusion) will show pain when pain-provoking (stress) tests are used. The sacroiliac joints may show the same symptoms, but the pain is more likely to be bilateral if it is a central protrusion.

A

FALSE

The SI JOINTS will show pain when pain-provoking (stress) tests are used.

A MINOR DISC INJURY (PROTRUSION) may show the same symptoms, but the pain is more likely to be bilateral if it is a central protrusion.

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45
Q

Disc problems account for only about ___% of low back pain cases.

A

5%

The examiner must be careful when looking at the lumbar spine that he or she does not consider every back problem a disc problem

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46
Q

Anterolateral leg pain is suggestive of?

A

L4 disc problems

46
Q

Definitive diagnosis of a disc problem often requires _____

A

neurological pain extending below the knee

This means that although there may be pain in the back and in the leg, the leg pain is dominant

47
Q

Pain radiating to the posterior aspect of the foot suggests?

A

L5 disc problems

48
Q

Pain radiating into the leg below the knee is highly suggestive of?

A

disc lesion

Pain below the knee strongly suggests a disc lesion but ISOLATED BACK & BUTTOCK does not exclude disc involvement.

49
Q

Lumbar and sacroiliac pain referral sites

A

buttock and posterior leg,
lateral aspect of the leg

49
Q

Minor injuries like disc protrusions may only cause _____ pain.

A

BACK OR BUTTOCK pain

Minor injuries can complicate diagnosis, as they may also stem from muscle, ligament, or facet joint injuries or degeneration.

50
Q

Hip pain usual sites & referral sites

A

typical site of pain: groin, anterior thigh

referral site: medial side of the knee

51
Q

Pain referred around the chest wall tends to be ____ in origin.

A

costovertebral

51
Q

T OR F: The hip can be ruled out by assessing for the presence of a hip capsular pattern and a positive sign of the buttock.

A

FALSE

The hip can be ruled out by assessing for the ABSENCE of a hip capsular pattern and a NEGATIVE sign of the buttock.

52
Q

Pain related to breathing may signal _____ problems or may be related to movement of the ____.

A

PULMONARY problems

movement of RIBS

53
Q

_____ nerve root pain is typically severe and referred in a sloping band along an intercostal space.

A

THORACIC nerve root pain

54
Q

Pain between the scapulae may indicate a _____ lesion

A

CERVICAL lesion

55
Q

T OR F: Dural pain would not be accentuated by coughing, sneezing, or straining.

A

FALSE

Dural pain is often accentuated by these maneuvers

55
Q

T OR F: Symptoms above a line connecting the inferior angles of the scapulae should be considered of thoracic origin until proven otherwise, especially if there is no hx of trauma.

A

FALSE

should be considered CERVICAL origin until proven otherwise

56
Q

T OR F: Increase in intrathecal pressure would indicate the problem is in the lumbar spine and affecting the neurological tissue.

A

TRUE

56
Q

actions such as coughing & sneezing increase the _____ (the pressure inside the covering of the spinal cord)

A

intrathecal pressure

57
Q

T OR F: Pulling and pushing activities are particularly bothersome for patients with lumbar issues.

A

FALSE

Pulling and pushing activities are particularly bothersome for patients with THORACIC issues.

57
Q

T OR F: Passive use of the arms can irritate a thoracic lesion

A

FALSE

ACTIVE use of the arms can irritate a thoracic lesion

58
Q

Costal pain may be triggered by ____ 2)

A

breathing and/or overhand arm motions

58
Q

often makes breathing easier because this facilitates the action of the accessory muscles of respiration

A

bracing the arms

59
Q

T OR F: Pain may be referred to the thoracic spine or ribs from thorax or abdominal conditions

A

TRUE

60
Q

What kind of pain is often vague, dull, and indiscrete, potentially accompanied by nausea and sweating.

A

Visceral pain

61
Q

Where is cardiac pain referred?

A

shoulder (C4) and posteriorly to T2

62
Q

Where is stomach pain referred?

A

T6–T8 posteriorly

63
Q

most common space-occupying lesion in the lumbar spine and most common cause of radiating pain below the knee

A

disc pathology

64
Q

Where is ulcer pain referred?

A

T4–T6 posteriorly

64
Q

Sitting may increase pain, suggesting ____ is causing mechanical deformation or increased intradiscal. pressure.

A

sustained flexion

65
Q

commonly results in increased pain during sitting, lifting, twisting, and bending

A

disc pathology

66
Q

If standing, walking, and lying increases pain, ____ may be causing the issues.

A

EXTENSION is the mechanical deformation

especially in relaxed standing or in prone lying

67
Q

T OR F: Persistent or worsening pain in the supine position may suggest neurogenic or space-occupying lesions

A

TRUE

space-occupying lesions such as infection, swelling, or tumor

68
Q

T OR F: Pancreatic tumors may radiate pain to the thoracic spine

A

FALSE

radiates pain to LUMBAR spine

69
Q

Stiffness or pain after rest may indicate conditions like ____ (2)

A

Ankylosing spondylitis or Scheuermann disease

70
Q

T OR F: Pain from mechanical breakdown generally increases with activity and decreases with rest.

A

TRUE

71
Q

_____ pain often worsens with prolonged maintenance of a single posture (especially flexion).

A

Discogenic pain

72
Q

T OR F: Pain from spinal issues is almost always influenced by posture and movement.

A

TRUE

73
Q

What is the key to proper back posture?

A

pelvis

74
Q

Pelvis in neutral position

A

ASIS 1-2 finger widths below PSIS

75
Q

What are the muscles balancing the pelvis?

A

abdominals,
hip flexors (iliopsoas, rectus fem, sartorius),
hip extensors (glutes max, hamstrings),
back extensors (erector spinae)

76
Q

morning stiffness relieved by activity

A

OA of facet joints

77
Q

respond to pathology with tightness, spasm, or adaptive shortening

A

Postural (static) muscles (e.g., iliopsoas)

78
Q

tend to response to pathology with atrophy

A

Dynamic (phasic) muscles (e.g., abdominals)

79
Q

Can occur when pathology affects both postural and dynamic muscles

A

Pelvic Crossed Syndrome

80
Q

Painful arc of movement

Pain on _____ (2) may indicate a disc protrusion or instability in part of the range of motion (ROM)

A

forward or side flexion

81
Q

Difficulty moving to the seated position

A

Lumbar Instability/Muscle Spasm

82
Q

Pain in flexion (e.g., sitting), which may increase the longer the patient is seated

A

Discogenic Pain

83
Q

Occurs if pressure is relieved from a nerve trunk

A

paresthesia

84
Q

Occurs if the pressure is on the nerve trunk

A

numb sensation

85
Q

T OR F: The nerve root is always compressed by the disc at the same level, except when the protrusion is more lateral.

A

FALSE

SELDOM is the nerve root compressed by the disc at the same
level

nerve roots extend in such a way that it is rare for the disc to pinch on the nerve root of the same level

85
Q

Abnormal sensations in the perineal area often have associated _____ problems

A

micturition (urination) problems

notes: may indicate a MYELOPATHY - warrant immediate surgical intervention d/t potential long term bowel or bladder problems if pressure on SC is not relieved ASAP

86
Q

How many degrees are the difference in straight leg raise in lying and sitting

A

10-20 degrees

because of the change in lordosis and position of the pelvis

86
Q

What level of IV disc would compress the L5 nerve root?

A

L4 IV Disc

87
Q

T OR F: If the patient lies supine, the lumbar spine often falls into extension increasing the stress on the posterior elements of the vertebrae

A

FALSE

if the patient lies in PRONE

87
Q

What is the best sleeping position?

A

side-lying with the legs bent in a semifetal position

88
Q

T OR F: In prone lying, the spine tends to flatten out, decreasing the stress on the posterior elements.

A

FALSE

in SUPINE lying

89
Q

T OR F: having problems with micturition (urinating) may involve conditions more than the lumbar spine

A

TRUE

90
Q

2 common fear-avoidance questionnaire used in lumbar examination

A

Fear- Avoidance Beliefs Questionnaire (FABQ),
Linton and Hallden’s Acute Low Back Pain Screening Questionnaire

91
Q

Disc derangement can cause? (4)

A

Total urinary retention (can’t empty bladder),
Chronic, long-standing partial retention,
Vesicular irritability,
Loss of desire or awareness of the necessity to void

92
Q

Long-term use of steroids can lead to?

A

osteoporosis

93
Q

T OR F: Psychosocial issues often play a role in low back pain, especially if it is chronic

A

TRUE

94
Q

outlines yellow flags indicating psychosocial barriers for recovery with questions related to attitudes and beliefs about back pain, behavior, compensation issues, diagnosis and treatment, emotions, family and work

A

New Zealand Acute Low
Back Pain Guide

95
Q

T OR F: The yellow flags in New Zealand Acute Low Back Pain Guide should be seen as factors that can be influenced negatively to facilitate diagnosis and increase work loss and long-term disability

A

FALSE

The yellow flags in New Zealand Acute Low Back Pain Guide should be seen as factors that can be influenced POSITIVELY to facilitate RECOVERY and DECREASE work loss and long-term disability

96
Q
A
97
Q
A
98
Q
A
99
Q
A
99
Q
A
100
Q
A
100
Q
A
101
Q
A

MSK (7 decks)

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