B6.032 - Preworks 1-3 Lower Back Paim Flashcards
number of cervical spine vertebrae
7
number of thoracic spine vertebrae
12
number of lumbar spine vertebrae
5
number of sacral vertebrae
5
parts of vertebrae
body and arch
what is the body of the vertebrae
has cortical and trabecular bone health of trabeculae is important
factors that can compromise trabeculae health
smoking obesity osteoporosis age lack of physical activity
compression fracture
spondylolysis
partial or complete fracture of pars interarticularis
spondylolithesis
pars interarticularis complete fracture where the vertebrae moves forward
describe the pain associated with compression fracture, spondylolysis or spondylolithesis
central back pain
point tenderness
requires plain radiograph
what are facet joints
synovial joints beteween the superior and inferior articular processes on each side of spine
hyaline cartilage, joint capsule, meniscoid
allow gliding motion
nerve innervation; medial branch
describe facet joint issues/pain
arthritis (DJD); meniscoid displacement causing facet lock
sharp unilateral paraspinal pain
no imaging is indicated
describe intervertebral joints
pseudo joints: discs and vertebral bodies
describe the disc of the spine
nucleus puplosis: deforms under pressure
annulus fibrosis: resists tensile forces
allow weight bearing and stability
nerve innervation: outer 1/3 annulus by sinuvertebral nerve
describe DDD pain
arthritis, disc herniation
back or back and leg pain
MRI indicated
describe ligaments of spine role
collectively stabilize vertebral colum and resist sagittal motion
subject to injuriy and arthritic changes
describe ligament pain dx
central
no imaging necessary
describe superficial and deep muscles
superficia/interm - prime movers, increase activity in response to pain/injury
deep - stabilize each vertebral segment
decreases activity in response to pain/injury
describe the role of transverse abdomini
deepes of all abdominal muslce
attaches to thoracolumbar fascia, stabilizes spain
creates natural corset to stabilize spine
can be compromised
what can a spinal tumor cause
leg sx
what can a spinal infection cause
severe back pain
what houses CSF
subarachnoid space, ends at L2 so an LP lower than L2 can get the fluid
what level is epidural given to
subdural space
all 3 meninges surround nerver roots, why is this important
you can place tension on nerve root or dura matter to assess pain
what do the dorsal/ventral horns have extending from them
dorsal - sensory neurons
ventral - motor neurons
describe where nerves exit in each part of the spine
cervical - nerves exit above vertebral level till T1 (C8 exits below C7)
thoracic - nerves exit below
lumbar - nerves exit below
sacrum - nerves exit below
radicular sx
leg pain > back pain
pain (sharp pain distal to injury)
parasthesia
weakness
clinical exam for back pain
neuro
electrophysiology
imaging
neuro exam
myotomes - muscle motor roots (key muscle testing)
dermatomes - sensory, cutatenous light touch
reflexes - L3, L4, L5, S1, babinski
nerve root injury will result in what
sensory and motor changes in specific dermatome and myotomeand hypo reflexes
spinal cord injury will result in what
symptons of non dermatome and non myotome pattern of multiple segments and hyper reflexes
nerve root L1, L2
groin
anterior proximal thigh (hip flexion psoas)
nerve root L3, L4
L3 - medial aspect of distal thigh and knee, Knee extensions (quads)
L4 - lateral aspect of knee or medial distal leg, DF/Inv (ant tibialis)
reflex = patellar tendion
nerve root L5
dorsum of foot
toe extension (EHL and EDL)
proximal hamstring tendon reflex
S1
lateral foot
gastoroc/soleus
eversion (peroneals)
achilles tendon reflex
S2
medial aspect of heel
toe flexion (FDL)
lumbar plexus
L2-L4
terminates into femoral n, obturator n, lateral femoral cutaneous
lumbar plexus provides motor and sensory contributions to what
anterior and medial compartments of the leg
lumbar plexus peripheral nerves for neuro exam
femoral (L1-L4)
obturator (L2-L4)
femoral sensory comp
medial side fo thigh and leg
motor and reflexes for femoral nerve
motor - hip flexion: iliacus, psoas, sartorius, pectineus, quadriceps
patellar reflex
sensory obturator comp
middle thigh on anterior aspect
obturator motor and reflex areas
hip add and ER: adductor brevis, adductor magnus, adductor longus, obturtor externus
no reflex
sacral plexus components
sciatic (L4-S3)
superficial peroneal (L4-S2)
Deep peroneal (L4-S2)
Tibial (L4-S3)
sciatic sensory
post thigh and leg, whole foot exept instep and medial malleolus
sciatic motor
knee flexion: semitendinous, semimembraneosus, bicepts femoris and adductor magnus
sciatic reflex
medial hamstrings, achilles
superficial peroneal sensory
lateral calf and dorsum of foot
motor superficial peroneal
eversion of foot: peroneus longus, peroneus brevis
deep peroneal sensory
cleft between 1st and 2nd toe
motor of deep peroneal
dorsiflexion of foot: tibialis anterior, EDL, EDB, EHL, peroneus tertius
tibial sensory
heel
tibial motor
plantarflex, adduction of foot: gastroc, soleus, plantaris, tibialsi posterior, FDL, FHL, abductor digiti minimi, flexor digiti minimi , lumbricales, interosseiu, adductor hallucis, abductor hallucis, flexor digitorum brevis. flexor hallucis brevis
reflex tibial
achilles
sacral plexus overall provides what
L4-S4
sacral plexus provides motor and sensory contributions to gluteal and parts of pelvic region, posterior thigh, most of lower leg, entire foot
what can a tight piriformis do
cause compression of sciatic nerve and give posterior leg sx of pian and parasthesia
inn all 3 knee muscles
then branches into tibial and common peroneal nerve
what can be caused by prolonged crossing leg
common peroneal nerve neuropathy - foot drop
what can be caused by hip arthroplasty
sup gluteal nerve leadin gto pelvic drop opposite (trendelenburg gait)
injury to lateral femoral cutaneous neuropathy
inguinal area from wearing heavy belt or overweight
sensory loss to lateral thigh
discuss saphenous nerve entrapment
from medial knee injury/surgery leads to pain medial distal knee
sural nerve entrapment
from recurrent ankle problesm leading to pain post lateral lower 1/3 leg or lateral foot
