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ECOS 1 Final Exam > Approach to Thoracolumbar Complaint > Flashcards

Approach to Thoracolumbar Complaint Flashcards

1
Q

Spina Bifida

A
  • birth defect that occurs when the spine and spinal cord don’t form properly
  • type of neural tube defect
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2
Q

Spina Bifida: Etiology/Risk Factors

A
  • Family Hx of neural tube defects
  • Folate deficiency
  • DM
  • Increased body temperature
  • Obesity
  • Medications
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3
Q

Meningo

A

refers to the lining of the vertebral canal

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4
Q

Myelo

A

refers to the spinal cord itself

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5
Q

Cele

A

means something is bulging out

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6
Q

Spina Bifida Occulta

A
  • “occulta” means hidden
  • most common type
  • small gap in one or more vertebrae
  • generally asymptomatic
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7
Q

Meningocele

A
  • sac of fluid comes through an opening in the babys back
  • small gap in the spine, but no opening or sac on the back
  • spinal cord and the nerves usually are normal
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8
Q

Myelomeningocele

A
  • most severe type
  • spinal canal is open along several vertebrae in the lower or middle back
  • membranes and spinal nerves push through this opening at birth, forming a sac on the babys back, typically exposing tissues and nerves
  • baby prone to life-threatening infections and may cause paralysis and bladder and bowel dysfunction
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9
Q

Scoliosis

A
  • lateral curve of the spine greater than 10 degrees with vertebral rotation
  • majority of cases are idiopathic
  • females are 5-10x more likely to progress to severe disease
  • if both parents have this then kids are 50xs more likely to require treatment than general population
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10
Q

What is the most common form of scoliosis?

A

Adolescent Idiopathic Scoliosis

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11
Q

Signs of Scoliosis

A
  • shoulder height difference
  • posterior scapula
  • crease/skin fold at waist
  • leg lengths typically unequal
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12
Q

Special Test for Scoliosis

A

Adams Forward Bend Test
(+ test = spinal rotation and rib hump)

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13
Q

Scoliometer

A
  • used to quantify the spinal curve and rotation
  • used to determine who needs radiography
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14
Q

Cobb Angle

A
  • necessary for dx of scoliosis
  • angle between the most tilted vertebra above the apex and the most tilted vertebra below the apex
  • angle is greater than or equal to 10 degrees
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15
Q

Scoliosis Red Flags

A
  • onset before age 8
  • severe pain
  • rapid curve progression >1 degree per month
  • unusual left thoracic curve (convex to the left)
  • neurological deficits or findings (midline hairy patch = spina bifida)
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16
Q

Short Leg Syndrome

A
  • discrepancy in leg lengths resulting in chronic leg and back pain
  • tends to tilt the pelvis down on one side placing abnormal stress on the muscles and spine
  • two types: anatomical, functional
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17
Q

Anatomical Short Leg

A

when one leg is longer and can be corrected with a heel lieft in the shoe of the short leg

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18
Q

Functional Short Leg

A

an apparent short leg although structurally both legs are the same length when measured

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19
Q

Compression Fractures

A
  • type of fracture or break in your vertebrae
  • can cause the vertebrae to collapse, making them shorter in height
  • collapse can also cause pieces of bone to press on the spinal cord and nerves, decreasing the amount of blood and oxygen that gets to spinal cord
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20
Q

What population are compression fractures most common in?

A

Elderly females

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21
Q

What is the most common cause of compression fractures?

A

Osteoporosis

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22
Q

Low Back Pain

A
  • highest prevalence in 45-64 YO age group
  • 95% recovery in 12 weeks
  • majority of pain is mechanical
  • fifth most common reason for all physician visits
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23
Q

Acute Low Back Pain

A
  • one of the most common reasons for adults to see a physician
  • pain is often self-limited and resolves with little intervention
  • defined as 6-12 weeks of pain between the costal angles and gluteal folds that may radiate down one or both legs (sciatica)
  • often nonspecific and therefore cannot be attributed to a definite cause
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24
Q

Lumbosacral Strains

A
  • injury to either a muscle or tendon
  • caused by twisting or pulling a muscle or tendon, also could be caused by a single instance of improper lifting
  • chronic strains usually result from overuse after prolonged, repetitive movement of the muscles and tendons
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25
Q

Lumbosacral Sprains

A
  • stretching or tearing of a ligament
  • typically occurs after a fall or sudden twist, or blow to the body that forces the joint out of its normal position
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26
Q

Ligament injuries lead to:

A

Degenerative Arthritis

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27
Q

How does Osteoarthritis typically begin?

A

Ligament weakness

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28
Q

Wolfs Law

A

bones respond to stress by making new bone

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29
Q

Osteoarthritis

A
  • age-related degeneration of the spine due to encroachment on the spinal canal with potential for radiculopathy and myelopathy
  • often related to formation of OA growths on the bone (osteophytes)
  • Presentation: pain, stiffness, occasional numbness
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30
Q

Spondylolysis

A
  • defect in par interarticularis (often unilateral) w/o anterior displacement of the vertebral body
  • can lead to small stress fxs in the vertebrae that can weaken the bones so much that one slips out of place – spondylolisthesis
  • very common cause of low back pain in children and people under 26 years of age
  • pain typically spreads across lower back and might feel like muscle strain, worse with vigorous activity and with spine extension
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31
Q

How is Spondylolysis diagnosed?

A

“Collar of Scotty Dog”
- dx made with oblique view of lumbar spine
- fx of par interarticularis is described as “Collar of Scotty Dog” usually at L5/S1

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32
Q

Spondylolisthesis

A
  • vertebral body slips in relation to the one below at pars interarticularis (usually between L5/S1)
  • bone may press on nerve and cause pain
  • most common cause of back pain in teens
  • sxs often begin during the teen-age growth spurt
  • if slipped vertebrae is pressing on nerve, will have pain/numbness spreading down leg to the foot which is often worse when standing
  • usually the leg pain is worse than the back pain
  • pain improves with rest or when spine is flexed
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33
Q

How is Spondylolisthesis diagnosed?

A

On palpation of lumbar spinous process there is a “Step Off” sign

34
Q

Ankylosing Spondylitis

A

ossification of the annulus fibrosus in the lumbar spine resulting in the formation of marginal syndesmophytes in a gradually ascending pattern (“bamboo spine”)

35
Q

Spinal Stenosis

A
  • narrowing of the spaces within your spine
  • can put pressure on nerves
  • most often in lower back and neck
36
Q

Degenerative Lumbar Stenosis is common in:

A

Elderly adults (esp adults over 50 years old)

37
Q

Neurogenic Claudication

A
  • combination of low back pain, numbness, and motor weakness that starts or intensifies on standing or walking and is eased by sitting or lying down
  • common in patients with lumbar spinal stenosis
38
Q

Spinal Stenosis: Clinical Presentation

A
  • low back pain
  • difficult walking
  • changes in urinary functions
  • root sxs such as numbness, burning and feeling of heaviness in legs
39
Q

Progression of Disc Degeneration and Herniated Disc

A

(1) Primary ligament weakness
(2) Deteriorating disc
(3) Outside edges of disc become cracked and torn
(4) High pressure scenarios can cause disc center to leak out
(5) Leads to decreased disc height
(6) Causes ligaments to become weakened
(7) Joint becomes more unstable and more likely to herniate

40
Q

Spinal Disc Disease

A
  • progressive degeneration of the spinal discs in conjunction with osteophyte formation; disc changes result in disc space narrowing and bulging or herniation of the degenerative nuclear contents
  • most common in individuals ages 70+
  • has similar sxs as an acute herniation but a chronic onset
41
Q

Herniated Disc (Nucleus Pulposus)

A
  • fragment of the disc nucleus is pushed out of the annulus into the spinal canal through a tear or rupture in the annulus
  • discs that this happens to are typically in an early stage of degeneration
42
Q

Herniated Disc: Clinical Presentation

A
  • arm or leg pain, numbness or tingling, weakness
  • pain originating from lumbar spine that radiates down the leg into the foot
  • sharp burning pain - electric quality
  • weakness in affected myotome (decreased reflexes)
43
Q

Referred Pain: Spine Structures (muscles, ligaments, facets, discs)

A

refer pain to the thigh region, but rarely below the knee

44
Q

Referred Pain: Sacroiliac Joint

A

refers pain to the thigh but can also radiate below the knee

45
Q

Referred Pain: Lumbar Root (irritation, impingement, compression)

A
  • pain results in more leg pain than back pain
  • L1-L3 nerve roots
  • L4-S1 nerve roots
46
Q

L1-L3 Nerve Root Impingement/Compression

A

Pain radiates to the hip and/or thigh

47
Q

L4-S1 Nerve Root Impingement/Compression

A

Pain radiates below the knee

48
Q

Herniation at L4/L5:

A

L5 nerve root impinged

49
Q

Herniation at L5/S1:

A

S1 nerve root impingement

50
Q

L4

A

Patellar Reflex

51
Q

L5

A

great toe sensation, heel walk

52
Q

S1

A

Achilles reflex, toe walk

53
Q

Sciatica

A
  • symptom
  • pain emerging from the lower back that is felt along the distribution of the sciatic nerve in the LE
  • frequently attributed to disc herniation
  • # 1 reason of this is ligamentous laxity in SI joint
54
Q

Sacroiliitis

A
  • inflammation of one or both of your SI joints
  • Sxs: pain in butt or low back that can radiate down both legs, prolonged standing or stair climbing worsens the pain
55
Q

What test is used to dx Sacroiliitis?

A

FABER test – (+) = buttock pain

56
Q

Piriformis Syndrome

A

injury to piriformis causes inflammation leading to swelling and pressure on sciatic nerve causing pain and referred pain

57
Q

Hoover Test

A
  • used to differentiate between leg paresis that has no definitive neurological pathology to that which has a definite, identifiable cause
  • identifies functional weakness in LEs
58
Q

Red Flag Sxs in Back Pain

A

TUNA FISH
- Trauma
- Unexplained weight loss
- Neurologic sxs
- Age >50
- Fever
- IVDU
- Steroid use
- Hx of cancer (prostate, renal, breast, lung)

59
Q

Cauda Equina Syndrome

A
  • large central disc herniation compressing the tail of the lumbar spine, causing compression of sacral nerve roots
  • signs and sxs: pain similar to herniated disc (low back pain) that radiates down leg, numbness around the anus, loss of bowel or bladder control
  • impingement of S2-4
    **emergency surgery is imperative to avoid paralysis
60
Q

Impingement of S2-4 causes:

A
  • bowel dysfunction (decreased rectal tone)
  • bladder dysfunction
  • sexual dysfunction
  • saddle anesthesia
61
Q

When to Image for Low Back Pain:

A

Don’t do imaging within the first 6 weeks UNLESS red flags are present

62
Q

FAIR Test

A
  • Flexion, ADduction, Internal Rotation
  • Indication: Piriformis Syndrome
  • (+) Test = pain produced in sciatic/gluteal region
63
Q

Thomas Test

A
  • Indication: Hip flexor (iliopsoas) contraction
  • (+) Test = inability to fully extend leg OR the other leg raises off the table
64
Q

FABER Test

A
  • Flexion, ABduction, External Rotation
  • Indication: intra articular disorders, labral tear, sacroiliitis, bursitis, OA
  • (+) Test = groin/anterior hip pain: iliopsoas bursitis, labral tear, OA; posterior hip pain: sacroiliitis
65
Q

Positive Straight Leg Test

A
  • Pain over lateral leg at 15-30 degrees: IT band contracture
  • Neurologic pain between 30-60 degrees: lumbar disc herniation at L4-S1 nerve roots, lumbosacral radiculopathy, sciatic neuropathy
  • Pain at >70 degrees: mechanical low back pain due to muscle strain or joint disease, pathology of hip or SI joints, tightness of hamstrings or gluteus maximus
66
Q

Adam’s Forward Bend Test

A
  • Indication: scoliosis
  • (+) Test = functional: resolution of rib hump with sidebending; structural: persistence of rib hump with sidebending
  • REMEMBER angle of trunk rotation (ATR) >7 degrees and Cobb Angle >10 degrees
67
Q

Malingering (Factitious Disorder)

A
  • patient misrepresents, stimulates or causes sxs of an illness even in absence of clear external reward
  • can occur in Hoovers Test when patient isnt trying to lift the weak leg so feel absence of pressure in heel of good leg
68
Q

3 Types of Posterior Lumbar Tender Points:

A

(1) PL 1-5 Spinous Process
(2) PL 1-5 Transverse Process
(3) Unique

69
Q

Pelvic rotates ___ of spine

A

Opposite

70
Q

OMT: PL 1-5 SP

A
  • Torso: e-E Adduction RA (rotate away)
  • Pelvis: e-E Adduction RT (rotate towards)
71
Q

OMT: PL 1-5 TP

A
  • Torso: E Sa RA
  • Pelvis: E Sa RT
72
Q

Muscle that shortens during treatment of PL 1-5 SP

A

Multifidus

73
Q

Muscle that shortens during treatment of PL 1-5 TP

A

Intertransversarii

74
Q

Upper Pole L5

A
  • Location: superior medial surface of PSIS
  • Treatment: E Add IR/ER
  • Muscle shortened: iliolumbar ligament
75
Q

Lower Pole L5

A
  • Location: ilium just inferior to PSOS pressing superiorly
  • Treatment: F Add IR
  • Muscle shortened: posterior sacroiliac ligament
76
Q

High Ilium Sacroiliac (HISI)

A
  • Location: 2-3cm lateral to PSIS pressing medially towards PSIS
  • Treatment: e-E Abd ER
  • Muscle shortened: glut max
77
Q

PL3 GLUT

A
  • Location: 2/3 lateral from PSIS to tensor fascia latae
  • Treatment: E Abd ER
78
Q

PL4 GLUT

A
  • Location: posterior margin of tensor fascia latae
  • Treatment: E Abd ER
79
Q

OMT: Psoas Major

A

F ST

80
Q

OMT: Piriformis

A

F Abd ER

ECOS 1 Final Exam (11 decks)

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