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Musculoskeletal II > 9- Lumbar II > Flashcards

9- Lumbar II Flashcards

1
Q

What pathology is typically presented as:

  • LBP and leg pain below knee
  • Hx of LBP that resolved
  • Changes in reflexes, muscle weakness, and sensation (MRS)
  • Numbness/tingling in specific dermatome
  • Special tests such as SLR, WLR, and Braggard’s +
A

Disc lesion with radiculopathy

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2
Q

What tests can be used to assess for disc lesion with radiculopathy?

A
  • SLR/Lasegue Test (Crossed, Well-Leg Raise/Fajersztajn, seated)
  • Braggard’s sign
  • Bowstring Test (Cram, Popliteal Pressure)
  • Slump Test
  • Femoral Nerve Traction Test (crossed)
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3
Q

Where is the pain located with an L3-4 disc herniation (4th lumbar nerve root)?

A

Lower back, hip, posterolateral thigh, anterior leg

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4
Q

Where is the numbness located with an L3-4 disc herniation (4th lumbar nerve root)?

A

Anteromedial thigh and knee

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5
Q

Where is the weakness with an L3-4 disc herniation (4th lumbar nerve root)?

A

quadriceps

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6
Q

Where is the atrophy with an L3-4 disc herniation (4th lumbar nerve root)?

A

quadriceps

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7
Q

Where is the reflex diminished with an L3-4 disc herniation (4th lumbar nerve root)?

A

knee jerk diminished

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8
Q

Where is the pain located with an L4-5 disc herniation (5th lumbar nerve root)?

A

over sacroiliac joint, hip, lateral thigh and leg

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9
Q

Where is the numbness located with an L4-5 disc herniation (5th lumbar nerve root)?

A

lateral leg, web of great toe

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10
Q

Where is the weakness with an L4-5 disc herniation (5th lumbar nerve root)?

A

dorsiflexion of great toe and foot, difficulty walking on heels, foot drop

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11
Q

Where is the atrophy with an L4-5 disc herniation (5th lumbar nerve root)?

A

Minor

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12
Q

Where is the reflex diminished with an L4-5 disc herniation (5th lumbar nerve root)?

A

changes uncommon (absent or diminished posterior tibial reflex)

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13
Q

Where is the pain located with an L5-S1 disc herniation (1st sacral nerve root)?

A

Over sacroiliac joint, hip, posterolateral thigh, and leg to heel

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14
Q

Where is the numbness with an L5-S1 disc herniation (1st sacral nerve root)?

A

back of calf, lateral heel, foot and toe

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15
Q

Where is the weakness with an L5-S1 disc herniation (1st sacral nerve root)?

A

plantar flexion of foot and great toe may be affected, difficulty walking on toes

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16
Q

Where is the atrophy with an L5-S1 disc herniation (1st sacral nerve root)?

A

gastrocnemius and soleus

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17
Q

Where is the reflex diminished with an L5-S1 disc herniation (1st sacral nerve root)?

A

ankle jerk diminished or absent

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18
Q

Where is the lumbar disc pain referral pattern?

A

L3/L4 and L4/5 on the front of the thigh, L4/5 and L5/S1 on the back of the thigh

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19
Q

Natural history of radiculopathy and disk herniation not quite as favorable as for simple LBP…………but still excellent with ~_____% of patients recovering in first 2 weeks and _____% recovering in 6 weeks.

A

50%

70%

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20
Q

How should lumbar disc herniations be managed?

A

McKenzie method and lumbar stabilization program with HEP

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21
Q

If centralization of pain occurs during a McKenzie exercise program, what does this mean?

A

good response to PT can be anticipated

22
Q

What is the diagnosis for a patient that presents with:

  • Patient usually presents with well-localized LBP with some hip/buttock or leg pain above knee
  • Onset after simple misjudged movement or arising from flexed position
  • Absence of neurological deficits and nerve root tension signs/tests
  • AROM provokes pain (flexion/extension)
  • Hypomobility with PPIVM and/or PPAIVM (spring testing)
A

Facet Syndrome or Z-Joint Dysfunction

23
Q

What is the typical management for patients with facet syndrome or Z-joint dysfunction?

A
  • mobilizations and/or SMT
  • postural education
  • correction of muscle imbalances
  • core stabilization exercises
  • medical approach may include injections
24
Q

What age group is spinal stenosis common?

A

elderly > 65 yo

25
Q

What is primary spinal stenosis?

A

Congenital Narrowing

26
Q

What is secondary spinal stenosis caused by?

A

degeneration, fracture/trauma, post-operative, ankylosing spondylitis, tumors

27
Q

What can degenerative secondary spinal stenosis be caused by?

A
  • hypertrophy of articular processes
  • disc degeneration
  • ligamentum flavum
  • hypertrophy
  • spondylolisthesis
28
Q

When do patients with spinal stenosis report pain occurs and relief occurs?

A

onset of leg pain with walking and relief after resting 20 min or by maintaining a flexed posture

29
Q

What tests can be positive with neurological involvement in spinal stenosis?

A

Romberg, Urine incontinence, Inability to maintain extended or erect posture

30
Q

What should happen to a spinal stenosis patient when extending?

A

Exacerbates pain

31
Q

LSS can be diagnosed if a patient scores what on the scoring system?

A

7 +

32
Q

LSS is likely not present if a patient scores what on the scoring system?

A

2 -

33
Q

What are the predictor variables/ scoring system for LSS?

A
  • age 60-70 or >70
  • symptoms > 6 mo
  • symptoms improve with flexion
  • symptoms improve with extension ( -2)
  • symptoms exacerbated while standing up
  • intermittent claudication +
  • urinary incontinence
34
Q

How many patients have resolution of symptoms without intervention that have LSS?

A

many (about 30%)

35
Q

What does PT management of LSS involve?

A
  • therapeutic exercise
  • postural education
  • stretching
  • core stabilization
  • aerobic conditioning
36
Q

What is Type I (dysplastic) spondylolisthesis caused by?

A

congenital abnormality in upper sacrum or neural arch of L5, allowing displacement

37
Q

What is Type II (isthmic) spondylolisthesis caused by?

A

a lytic or fatigue fracture of pars, elongated but intact pars, or acute fracture of pars

38
Q

What is Type III (degenerative) spondylolisthesis caused by?

A

secondary to degenerative arthrosis of z-joints or discovertebral articulation

39
Q

What is Type IV (traumatic) spondylolisthesis caused by?

A

secondary to fractures in area of neural arch other than pars

40
Q

What is Type V (pathologic) spondylolisthesis caused by?

A

in conjunction with bone disease (Paget’s disease, osteoporosis)

41
Q

What is Type VI (iatrogenic) spondylolisthesis caused by?

A

occurs above or below a spinal fusion

42
Q

What are the titles for Types I-VI for spondylolisthesis?

A 
I dysplastic
II isthmic
III degenerative
IV traumatic
V pathologic
VI iatrogenic
43
Q

What are the two most common types of spondylolisthesis?

A

isthmic (younger) and degenerative (older)

44
Q

What is the Meyerding Grading for spondyolisthesis?

A 
Grade 0 (normal)
Grade 1 (1-25%)
Grade 2 (26-50%)
Grade 3 (51-75%)
Grade 4 (76-100%)
45
Q

What are some subtle signs associated with grades 1 and 2 spondylolisthesis?

A

hamstring tightness, hyperlordosis, palpable step defect of SP

46
Q

Which test can be used to indicated active spondylitic defect or facet syndrome?

A

Stork Test

47
Q

How is the stork test done? what does it do physiologically?

A
  • stand on one leg and extend

- extension compresses SPs and ilopsosas pulls anteriorly on vertebrae creating a shear force on the pars

48
Q

What are some signs of a patient with grade 3 or greater spondylolisthesis?

A

symmetric transverse skin furrow and hyperlordosis along with anterior pelvic tilt… hamstring tightness may be significant

49
Q

When should the spine be investigated to rule out spinal cord lesions or CES?

A

if hyperreflexic or UMN signs appears (clonus, Babinski, etc.)

50
Q

Which muscles should be stretched in cases of spondylolisthesis? Why?

A

rectus femoris and iliopsoas to decrease anterior pelvic tilting

51
Q

When are patients with spondylolisthesis reffered for surgical consult?

A

grades III and IV (segment unstable or nerve compression)

Musculoskeletal II (11 decks)

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