9- Lumbar II Flashcards
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 +
Disc lesion with radiculopathy
What tests can be used to assess for disc lesion with radiculopathy?
- SLR/Lasegue Test (Crossed, Well-Leg Raise/Fajersztajn, seated)
- Braggard’s sign
- Bowstring Test (Cram, Popliteal Pressure)
- Slump Test
- Femoral Nerve Traction Test (crossed)
Where is the pain located with an L3-4 disc herniation (4th lumbar nerve root)?
Lower back, hip, posterolateral thigh, anterior leg
Where is the numbness located with an L3-4 disc herniation (4th lumbar nerve root)?
Anteromedial thigh and knee
Where is the weakness with an L3-4 disc herniation (4th lumbar nerve root)?
quadriceps
Where is the atrophy with an L3-4 disc herniation (4th lumbar nerve root)?
quadriceps
Where is the reflex diminished with an L3-4 disc herniation (4th lumbar nerve root)?
knee jerk diminished
Where is the pain located with an L4-5 disc herniation (5th lumbar nerve root)?
over sacroiliac joint, hip, lateral thigh and leg
Where is the numbness located with an L4-5 disc herniation (5th lumbar nerve root)?
lateral leg, web of great toe
Where is the weakness with an L4-5 disc herniation (5th lumbar nerve root)?
dorsiflexion of great toe and foot, difficulty walking on heels, foot drop
Where is the atrophy with an L4-5 disc herniation (5th lumbar nerve root)?
Minor
Where is the reflex diminished with an L4-5 disc herniation (5th lumbar nerve root)?
changes uncommon (absent or diminished posterior tibial reflex)
Where is the pain located with an L5-S1 disc herniation (1st sacral nerve root)?
Over sacroiliac joint, hip, posterolateral thigh, and leg to heel
Where is the numbness with an L5-S1 disc herniation (1st sacral nerve root)?
back of calf, lateral heel, foot and toe
Where is the weakness with an L5-S1 disc herniation (1st sacral nerve root)?
plantar flexion of foot and great toe may be affected, difficulty walking on toes
Where is the atrophy with an L5-S1 disc herniation (1st sacral nerve root)?
gastrocnemius and soleus
Where is the reflex diminished with an L5-S1 disc herniation (1st sacral nerve root)?
ankle jerk diminished or absent
Where is the lumbar disc pain referral pattern?
L3/L4 and L4/5 on the front of the thigh, L4/5 and L5/S1 on the back of the thigh
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.
50%
70%
How should lumbar disc herniations be managed?
McKenzie method and lumbar stabilization program with HEP
If centralization of pain occurs during a McKenzie exercise program, what does this mean?
good response to PT can be anticipated
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)
Facet Syndrome or Z-Joint Dysfunction
What is the typical management for patients with facet syndrome or Z-joint dysfunction?
- mobilizations and/or SMT
- postural education
- correction of muscle imbalances
- core stabilization exercises
- medical approach may include injections
What age group is spinal stenosis common?
elderly > 65 yo
