Approach to Thoracolumbar Complaint Flashcards
What are the emergent conditions of concern in regards to a thoracolumbar complaint?
cauda equina syndrome or malignancy
spina bifida is what type of defect?
neural tube defect
What is one main cause of spina bifida?
folate deficiency
mildest form of spina bifida?
spina bifida occulta
a sac of fluid comes through an opening in the baby’s back. No opening of sac on the back. Spinal cord and nerves usually normal
meningocele
most severe type of spina bifida. Spinal canal is open along several vertebrae
myelomeningocele
What is the most common form of scoliosis?
adolescent idiopathic scoliosis (AIS)
Are males or females more likely to have their scoliosis progress to severe disease?
females
What is the physical examination for scoliosis?
adam’s forward bent test
If a patient is diagnosed with AIS, when would they be evaluated?
if the angle of trunk rotation was greater than 7 degrees and if the Cobb angle was greater than or equal to 10 degrees
What are the red flags for patients presenting with scoliosis?
onset before age 8, severe pain, rapid curve progression (>1 degree per month), unusual left thoracic curve, neurological deficits
what could a compression fracture lead to?
could cause the vertebra to collapse or pieces of bone to press the spinal cord and nerves
what signs would lead you to think compression fracture?
point tenderness and pain that worsens with flexion
what is the most common cause of compression fractures?
osteoporosis
What is the clinical presentation of a herniated nucleus pulposus?
pain will originate from the lumbar spine and radiate down the leg into the foot “sciatica”, weakness in affected myotome (decreased reflexes) and decreased sensation to affected dermatome
What is the gold standard for diagnosing a herniated disc?
MRI
if the L1-L3 nerve roots are impinged, how will pain present?
pain will radiate to the hip and/or thigh
if the L4-S1 nerve roots are impinged, how will pain present?
pain will radiate below the knees
How do you test the L4 nerve root?
Patellar reflex
How do you test the L5 nerve root?
great toe sensation and heel walk
how do you test the S1 nerve root?
achilles reflex and toe walk
What is the mnemonic for red flags of back pain?
TUNAFISH
large central disc herniation compressing the tail of the lumbar spine, causing compression of sacral nerve roots
cauda equina syndrome
What does impingement of S2-S4 cause?
bowel dysfunction, bladder dysfunction, sexual dysfunction, and saddle anesthesia
Who most commonly gets psoas syndrome?
athletes, runners, and those engaged in plyometric jumping exercises
What is psoas syndrome initiated by?
positions that shorten that psoas, sitting, bending, getting up quickly from squatting position, and desk jobs
What is the exam for psoas syndrome?
tender point at iliacus (medial to ASIS), positive Thomas test, positive FABER
What is the most common symptoms of psoas syndrome?
lower back pain
What is the most common presentation of sacroilitis?
pain in the buttocks or low back, extending down one or both legs
What is the sign of sacroiliitis?
positive faber test with buttock pain not groin pain
What is the clinical presentation of spinal stenosis?
leg pain is greater than back pain, pain worsens with standing and walking and improves with rest or when spine is flexed
Osteoarthritis is often times related to the formation of what?
osteoarthritic growths on the bone (osteophytes)
what is osteoarthritis of the spine referred to as?
spondylosis
most common cause of low back pain in people younger than 26
spondylolysis
defect in par interarticularis without anterior displacement of the vertebral body
spondylolysis
how is the diagnosis of spondylolysis made?
by an oblique view of the lumbar spine
condition where the vertebral body slips in relation to the one below
spondylolisthesis
how is spondylolisthesis diagnosed?
on palpation of lumbar spinous process, step off sign and as seen on the lateral view of the x-ray
forms of arthritis that usually affect the bones in your spine and nearby joints
spondyloarthropathies
what is the most common spondyloarthropathy?
ankylosing spondylitis
ankylosing spondylitis is related to the prevalence of what?
HLA-B27
Ankylosing spondylitis most often affects who?
white males between 15-40 years of age
ossification of the annulus fibrosus in the lumbar spine
ankylosing spondylitis
what is the pattern used to diagnose ankylosing spondylitis?
bamboo spine
what often develops after an infection in the urinary tract or digestive system?
reactive arthritis
what does reactive arthritis tend to attack?
asymmetrical LE joints
eye, urethra, and joint inflammation
reiter’s syndrome
What cancers commonly metastasize to bone?
breast, colon, testicular, lung, and prostate
what is the presentation of malignancy?
pain worsens in prone position, recent weight loss, and fatigue
inflammation that develops between the intervertebral discs of the spine
discitis
who is at risk for discitis
IV drug users
