Back and Pelvic Disorders Flashcards
1
Q
Common back complaint hx? How common of a visit is this?
A
- 2nd MC sx reason for provider visit
- hx of back, buttock, leg pain assoc w/ movement or positional changes
- may or may not recall a specific injury or mechanism
- acute, chronic or acute on chronic
2
Q
Lordosis?
Kyphosis?
Scoliosis?
A
- lordosis: increased anterior convexity in the curvature of the spine
- kyphosis: exaggeration of posterior convexity of the thoracic vertebral column found commonly w/ OA and osteoporosis
- scoliosis: lateral curve of the spine usually right convex thoracic, most of, which are idiopathic
3
Q
What is spondylolisthesis?
Stenosis?
Spondyloysis?
A
- spondylolithesis: anterior slip, bilateral pars defect, congenital usually L5 on S1, degenerative L4 on L5 - palpable step off w/ or w/o neurological sxs
- stenosis: narrowing of the spinal canal or neural foramen producing root ischemia or neurogenic claudication
- spondylolysis: stress fracture of pars interarticularis
4
Q
What should be included on your PE of LB?
A
- note curves of spine, posture, uneven ht of iliac crests
- ROM: flexion, extension, sidebend, rotation
- palpation of spinous processes: prominence especially of L4-L5 in relation to another indicates potential spondy
- paravertebral palpation
- LE ROM: decreased IR/ER or reproduction of pain may indicate hip jt pathology
5
Q
L4 testing?
A
reflex: patellar
- muscle test: ankle
- dorsiflexion = anterior tibialis
- sensory - medial foot and leg
6
Q
L1, L2, L3 testing?
A
- L1, L2, L3 no individual reflex, muscle and sensory testing only
- muscle test - hip flexion = iliopsoas
- sensory: area b/t inguinal ligament and above patellae
7
Q
L5 testing?
A
- reflex - none
- muscle test - great toe extension = extensor hallucus longus
- sensory-lateral leg and dorsum of foot
8
Q
S1 testing?
A
- reflex: achilles
- muscle test: ankle eversion = preens longus and brevis
- sensory: lateral foot
9
Q
Composition of discs?
A
- lumbar vertebrae are largest, and strongest
- interverteral disc lies b/t 2 adjacent vertebrae
- composed of nucleus pulposus (central gelitanous portion) enclosed in several layers of fibrocartilaginous laminae (annulus)
- fxn of disc is to provide cushion and facilitate movement in the spine
10
Q
Ligaments of the vertebrae?
A
- ALL: broad sheath of CT along w/ the anterior surface of vertebral bodies
- PLL: lies along posterior surface of vertebral bodies inside vertebral canal
- interspinous and suprapinous: connect spinous processes
11
Q
Musculature of the spine is innervated by?
A
- dorsal rami of spinal nerves and are enclosed by fascia
12
Q
Attachment of muscles and location of nerves in spine?
A
- muscles of spine attach to spinous and transverse processes
- superior and inferior articulating processes articulate w/ vertebrae above and below to create facet jt on either side of spine
- openings b/t 2 adjacent vertebrae is the intervertebral foramen which forms the spinal canal, the passage of spinal nerves occurs here
13
Q
Dx tests for spine disorders?
A
- plain radiographs: AP and lateral along w/ A/P pelvis and lateral hip on affected side. Visualize compression fractures, DDD, scoliosis, spondy, hip OA ex bondy deformities
- bone scan: r/o infection, occult met tumor
- Diskography: surgical purposes only: determines level of pain source
- CT myelogram: accurate assessment of stenosis
- MRI: most useful for disc injury, road map for surgery (only get contrast for: tumor, infection, recurrent disc herniation)
- labs: high risk pts (nursing home pts, poorly controlled diabetes, cancer pts) or unimproved after 8-12 wks of conservative tx. CBC and sed rate to r/o infection, tumor
- other dx tools for neurogenic pain: abdominal x-ray, CT
14
Q
What is a herniated disc? What can this cause?
A
- herniated disc fragment comes from nucleus pulposus of the disc
- in normal condition: nucleus is in disc center securely contained by annulus fibrosus
- when fragement of nucleus herniates, it irritates and/or compresses the adjacent nerve root
- this can cause pain syndrome known as sciatica and in severe cases, dysfxn of the nerve
- almost 5% of males and 2.5% of females experience sciatica at some time in their lifetime
15
Q
Sxs of a herniated disc?
A
- can or can’t be assoc w/ some degree of back pain
- pain usually radiates into leg
- may be characterized as less achy, burning or similar to an electrical shock and is often described as a shooting or stabbing pain
- level of leg pain/radiculitis usually depends on level of disc involvement
- L5-S1 which occurs MC, causes lateral and posterior thigh and leg pain
- the pain usually improves when the pt is in supine position w/ the knee bent
- numbness or tingling occurs with a distribution similar to the pain
16
Q
How will herniated disc present on exam?
A
- pts may be neurologically normal, or may have a profound radiculopathy
- a + straight leg raising sign is almost always present for lower levels. However a crossed straight-leg raising sign may be even more predictive of a lumbar disc herniation
- gait is often abnormal, muscle weakness may be revealed particularly when testing walking on heels and toes (may have foot drop: won’t be able to dorsiflex)
17
Q
Imaging for herniated discs?
A
- MRI is most useful, however far lateral recess disc herniation can be missed w/ MRI
18
Q
Tx for herniated discs? What pts are candidates for surgery?
A
- tx: consists of conservative care vs surgical management
- conservative care: consists ofPT in conjunction w/ NSAIDs or oral steroids, w/ muscle relaxants
- most cases will resolve w/ conservative tx, try to avoid prolonged narcotic, muscle relaxant or steroid use
- can use epidural steroid injections (helpful for herniated discs not general back pain)
surgical: need to have the right situations
- pt presenting w/ cauda equina syndrome or profound motor deficits
- a pt demonstrating progressive neurologic deficit during a period of observation
- a pt w/ persistent bothersome sciatic pain, despite conservative management, for a period of 6-12 wks
19
Q
What is spinal stenosis?
A
- spinal canal narrowing w/ possible subsequent neural compression
- facet hypertrophy of vertebra, vertebral body osteophytes, ligamentous flavum hypertrophy and disc degeneration
- narrowing is at disc space
- can be caused from secondary etiologies as well: neoplasm, acromegaly, pages disease, ankylosing spondylitis
20
Q
How will spinal stenosis manifest?
A
- bilateral neural claudication (NC)
- NC pain is exacerbated by standing erect and downhill ambulation and is alleviated w/ lying supine and forward flexion
- NC, unlike vascular claudication, isn’t exacerbated w/ biking, uphill ambulation, and lumbar flexion and isn’t alleviated w/ standing
21
Q
Exam findings of spinal stenosis?
A
- pain w/ extension that is relieved w/ flexion
- radiculopathy may be noted w/ motor, sensory, and/or reflex abnormalities
- other + findings would include loss of lumbar lordosis and forward flexed gait
22
Q
Studies and tx for spinal stenosis?
A
- imaging: basic radiographs
- MRI: imaging of choice
- vascular studies: if unsure or if confounding findings
- tx: PT stressing good spinal flexion, maintain fitness level
- surgery usually some form of laminectomy
