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Mincer - SPINE > Assessment 1/12/16 > Flashcards

Assessment 1/12/16 Flashcards

1
Q

Case 1. Lordotic Luz
Luz has central symmetrical low lumbar pain during standing and is overweight with excessive lumbar lordosis.
1. What ligament is most likely to be adaptively lengthened?

A

a. ALL (this ligament resists extremes of extension)

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2
Q

Case 1. Lordotic Luz
Luz has central symmetrical low lumbar pain during standing and is overweight with excessive lumbar lordosis.
2. Which joints are most likely to be under excessive load?

A

Facet joints 2° compressive force or load

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3
Q

Case 1. Lordotic Luz
Luz has central symmetrical low lumbar pain during standing and is overweight with excessive lumbar lordosis.
3. How is her lordosis likely to change over time if she maintains standing for a prolonged period?

A

Increase because the facet joint capsule tightens over time. Initially it’s slack but it adaptively tightens

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4
Q

Case 1. Lordotic Luz
Luz has central symmetrical low lumbar pain during standing and is overweight with excessive lumbar lordosis.
4. What is the name for the common pattern of muscle weakness and tightness that is likely to be present in Luz?

A

Lower Crossed Syndrome (Stetts & Carpenter pg 65-67), aka. Sway Back

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5
Q

Case 2. Porotic Polly
Polly has thoracic back pain and has been diagnosed with a thoracic osteoporotic compression fracture.
1. Where does the center of gravity pass relative to each of the normal spine curves? What is likely to happen to the curves over time related to gravity?

A

a. Line of gravity: Posterior to Cervical, Anterior to Thoracic, Posterior to Lumbar (Neumann pg. 314)
b. Curves will increase

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6
Q

Case 2. Porotic Polly
Polly has thoracic back pain and has been diagnosed with a thoracic osteoporotic compression fracture.

  1. Where is Polly’s fracture most likely to be located (what part of the vertebrae)?
    .
A

Cancellous/Spongy bone in the body of the vertebrae

a. Specifically the anterior body because that’s where the load is transmitted
b. Note that the joints above and below take the load now because the kyphotic curve has increased

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7
Q

Case 2. Porotic Polly
Polly has thoracic back pain and has been diagnosed with a thoracic osteoporotic compression fracture.

  1. What is the detrimental clinical significance of Wolff’s Law in osteoporosis?
A

Increase stress on bone can cause fractures

a. In other words, the load is too much for the bone to adapt

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8
Q

Case 2. Porotic Polly
Polly has thoracic back pain and has been diagnosed with a thoracic osteoporotic compression fracture.

4. What is the beneficial clinical significance of Wolff’s Law in osteoporosis?
A

When stress is applied to bone, adaptive chances occur

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9
Q

Case 3. Stenotic Stanley
Stanley has left sided low back pain and pain in her left leg and foot. She has left L5-S1 lateral stenosis.
1. What spine disorder primarily consists of degeneration of the facet joints?

A

a. Facet joint syndrome/DJD

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10
Q

Case 3. Stenotic Stanley
Stanley has left sided low back pain and pain in her left leg and foot. She has left L5-S1 lateral stenosis.
2. What is the detrimental clinical significance of Wolff’s Law in DJD?

A

Frail bones need stress but if you add too much it will fracture
a. Increased stress causes pain as well; osteophyte formation occurs 2° to load (this occurs to distribute force- adaptive change)

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11
Q

Case 4. Listhetic Larry
Larry has local symmetrical low back pain and has been diagnosed with spondylolisthesis.
1. What level of Larry’s spine is most likely to be involved? Why is this level particularly susceptible?

A

a. L5-S1 has the most motion and most susceptible to shear force
b. This level is particularly susceptible because of the increased Angle of Inclination

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12
Q

Case 4. Listhetic Larry
Larry has local symmetrical low back pain and has been diagnosed with spondylolisthesis.

  1. What movements most likely predisposed Larry to structural failure in the pars interarticularis?
A

Excessive extension causing increased lordosis of the low back

a. This structure fails under loading of repetitive flexion and extension (cyclical movement) especially at end ROM
b. Note that there is the same amount of body, but more/increased lever arm with flexion. This affects the pars the most.

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13
Q

Case 5. Discal Diane
Diane, who is middle-aged, has central low back pain, right buttock pain and right leg paresthesia and weakness. She has been diagnosed with an L4-L5 disc extrusion.
1. Do you think Diane’s disc degeneration began when she started having pain a few weeks ago?

A

No, because this is usually a degenerative disorder. The outer fibers of the annulus are innervated; the inner fibers are not innervated. Thus, she didn’t feel the pain until the outer fibers were affected.

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14
Q

Case 5. Discal Diane
Diane, who is middle-aged, has central low back pain, right buttock pain and right leg paresthesia and weakness. She has been diagnosed with an L4-L5 disc extrusion.
2. What is the pain generator for her local back pain?

A

The outer fibers of the annulus (they are innervated and vascularized)

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15
Q

Case 5. Discal Diane
Diane, who is middle-aged, has central low back pain, right buttock pain and right leg paresthesia and weakness. She has been diagnosed with an L4-L5 disc extrusion.
3. How does Diane’s age affect her nucleus?

A

Decreased capability of the nucleus to absorb water, and as she ages, there is less water to lose.

Also less ability to absorb shock

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16
Q

Case 5. Discal Diane
Diane, who is middle-aged, has central low back pain, right buttock pain and right leg paresthesia and weakness. She has been diagnosed with an L4-L5 disc extrusion.
4. How does Diane’s age affect her annulus?

A

Fibers become less elastic and strength is reduced

17
Q

Case 5. Discal Diane
Diane, who is middle-aged, has central low back pain, right buttock pain and right leg paresthesia and weakness. She has been diagnosed with an L4-L5 disc extrusion.
5. Why are most people with disc problems middle-aged?

A

Loss of water occurs during this time, but the disc is still high enough to become extruded with increased load

18
Q

Case 5. Discal Diane
Diane, who is middle-aged, has central low back pain, right buttock pain and right leg paresthesia and weakness. She has been diagnosed with an L4-L5 disc extrusion.
6. Why are Diane’s daughter and mother less likely to have problems with disc herniation than Diane?

A

Younger individuals have a thick annulus to contain gooey nucleus so there is less chance of herniation

Older individuals have thick nucleus but weak annulus so there is less chance of herniation

19
Q

Case 5. Discal Diane
Diane, who is middle-aged, has central low back pain, right buttock pain and right leg paresthesia and weakness. She has been diagnosed with an L4-L5 disc extrusion.

  1. If Diane flexes in the morning, she has more pain than when she flexes in the evening. Connect this pattern of symptoms to what is happening in her nucleus and resulting intradiscal pressure.
A

The nucleus absorbs water and as a result it increases pressure in the disc overnight. In the morning the intradiscal pressure is increased so as Diane flexes it hurts because there is more pressure to herniate the disc/extrude through the annulus as opposed to the evening when intradiscal pressure is decreased. The intradiscal pressure is decreased at night because of the load that is placed through the spine (reason why we are shorter in the evening).

a. Note that as you go to bed, you unload the spine, this in turn causes a vacuum in the disc to allow water and nutrients to be absorbed.
b. Movement/exercise is important for good disc health
c. Intradiscal pressure is at its highest during sitting; and lower in standing; and lowest in lying

20
Q

Case 5. Discal Diane
Diane, who is middle-aged, has central low back pain, right buttock pain and right leg paresthesia and weakness. She has been diagnosed with an L4-L5 disc extrusion.

  1. Can Diane’s annulus heal?
A

Yes but it will take a very long time. We know that the outer fibers of the annulus is vascularized but it is decreased because she is middle-aged.

21
Q

Case 5. Discal Diane
Diane, who is middle-aged, has central low back pain, right buttock pain and right leg paresthesia and weakness. She has been diagnosed with an L4-L5 disc extrusion.

  1. Diane thinks her pain started when she lifted a suitcase after a long airplane flight. Relate this to what was probably happening to her annulus while she was sitting during the flight.
A

Connective tissue lengthening over minutes or hours is known as creep- secondary to weakening

a. Posterior part of the annuus creeps, so when she stands the annulus is not set
b. As she stands and flexes to lift her suitcase and rotates, the intradiscal pressure is increased, thus the nucleus herniates posteriorly

22
Q

Case 5. Discal Diane
Diane, who is middle-aged, has central low back pain, right buttock pain and right leg paresthesia and weakness. She has been diagnosed with an L4-L5 disc extrusion.

  1. She says she lifted the suitcase from the luggage carousel and was also twisting her back when she hurt it. Give two reasons the added rotation increased her risk of injury.
A

Rotation cuts the annular strength in half (think about the orientation of the annular fibers- diagonal-)

The facets are moving in a manner that causes shear and compression on the disc

23
Q

Case 5. Discal Diane
Diane, who is middle-aged, has central low back pain, right buttock pain and right leg paresthesia and weakness. She has been diagnosed with an L4-L5 disc extrusion.

  1. What is the effect of flexion on the nucleus?
A

Increased intradiscal pressure

24
Q

Case 5. Discal Diane
Diane, who is middle-aged, has central low back pain, right buttock pain and right leg paresthesia and weakness. She has been diagnosed with an L4-L5 disc extrusion.

  1. Diane’s herniation occurred posterolaterally. What structure prevented it from herniating posteriorly in midline?
A

. PLL (it’s skinny)

25
Q

Case 5. Discal Diane
Diane, who is middle-aged, has central low back pain, right buttock pain and right leg paresthesia and weakness. She has been diagnosed with an L4-L5 disc extrusion.
13. What nerve root is most likely being impinged by Diane’s nucleus?

A

L5

26
Q

Case 5. Discal Diane
Diane, who is middle-aged, has central low back pain, right buttock pain and right leg paresthesia and weakness. She has been diagnosed with an L4-L5 disc extrusion.

  1. Did Diane’s L4-5 disc herniation occur at a typical vertebral level for this type of problem?
A

Yes

27
Q

Case 6. Spondylitic Steve
Steve has local symmetrical low back and leg pain and paresthesia. He has been diagnosed with multi-level lumbar spondylosis with central stenosis at L5.
Steven is most likely to be in what age group (young, middle, elderly)? Why?

A

Elderly: age-dependent change, thus more osteophyte formation

28
Q

Case 6. Spondylitic Steve
Steve has local symmetrical low back and leg pain and paresthesia. He has been diagnosed with multi-level lumbar spondylosis with central stenosis at L5.

Steve’s MRI says he has “decreased disc height L3, L4, L5.” How would this affect the facet joints?

A

The loss in height of the disc 2° loss of water increased the load on the facet joints

29
Q

Case 6. Spondylitic Steve
Steve has local symmetrical low back and leg pain and paresthesia. He has been diagnosed with multi-level lumbar spondylosis with central stenosis at L5.

What do you predict about the IVF’s at these levels?

A

Narrowed

30
Q

Case 6. Spondylitic Steve
Steve has local symmetrical low back and leg pain and paresthesia. He has been diagnosed with multi-level lumbar spondylosis with central stenosis at L5.

How does the disc height loss affect the movement occurring at each intradiscal joint (direct or inverse relationship)?

A

Direct- discs acts as a ball-bearing and allow movement

31
Q

Case 6. Spondylitic Steve
Steve has local symmetrical low back and leg pain and paresthesia. He has been diagnosed with multi-level lumbar spondylosis with central stenosis at L5.

Is Steven at risk for spinal cord compression from his central stenosis?

A

No, because we are referring to the Cauda Equina now (spinal cord ends/tapers at L1/L2)

32
Q

Case 6. Spondylitic Steve
Steve has local symmetrical low back and leg pain and paresthesia. He has been diagnosed with multi-level lumbar spondylosis with central stenosis at L5.

Reaching overhead with both hands increases Steve’s neuro symptoms. Why?

A

Extension narrows the central canal as well as the IVF

33
Q

Case 6. Spondylitic Steve
Steve has local symmetrical low back and leg pain and paresthesia. He has been diagnosed with multi-level lumbar spondylosis with central stenosis at L5.

If his central stenosis worsen, he may exhibit neurologic symptoms. What are the symptoms of a space-occupying lesion in the lumbar spinal canal?

A

Cauda Equina Syndrome: bowel & bladder changes, saddle paresthesia, bilateral N/T in LE

Mincer - SPINE (16 decks)

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