Back Disorders and Low Back Pain Flashcards
Kyphosis
- An increased convex angulation in the curvature of the thoracic spine
- Can be due to diseases such as TB, chronic arthritis, compression fractures or changes can be due to posture
- Postural changes occur in children during their growth spurt or due to abnormal sitting or standing position
Lordosis
- An accentuation of cervical or lumbar curvature
- Seen in people with developmental dysplasia of the hip, obesity or hip flexor contractures
Scoliosis
- Lateral curvature
- Spinal rotation with rib asymmetry
- Thoracic hypokyphosis
Diagnosis of scoliosis
- Observation for asymmetry to shoulder height, scapular or flank shape, or hip height
- Routine school screening is controversial since there have not been enough controlled studies to demonstrate improved outcomes
Management of scoliosis
Othotic Interventions
- Bracing with thoracolumbosacral orthotic brace
- Orthotic device fabricated out of plastic and custom molded to the body
- The use of a brace does not cure scoliosis but only slows the progression of the curvature during skeletal growth
Surgical Interventions scoliosis
- Re-alignment and straightening of the spinal column with metal rods and bony fusions
General post op care considerations scoliosis
- Treatment plan
- Activity restrictions
- Exercise regimen
- Emotional support
Low back pain
- Very common, affecting 80% of adults at least once during their lifetime
- Second only to headache as the most common pain complaint
- Responsible for many lost work hours and is one of the most costly health problems
- Acute low back pain generally subsides in less than 4 weeks
- Chronic low back pain generally persists longer than 3 months
Risk Factors for low back injury
- Lack of muscle tone
- Obesity
- Structural and postural abnormalities
- Lack of exercise
- Jobs that require heavy lifting, vibration and sitting
- Smokng
Subjective and Objective Assessment data for client with back pain
Subjective:
- hx of lumbosacral strain
- osteoarthritis
- degenerative disk disease
- previous back surgeries
- use of analgesics, NSAIDs and.or muscle relaxants
- Full pain assessment
- Numbness or tingling of legs, feet, toes
- Occupation and job requirements
Objective:
- Guarded movement
- Reflexes- depressed or absent
- Positive straight leg raise test
- Tense paravertebral muscles
- Decreased ROM of spine
- Obesity
Herniated Intervertebral Disk
The nucleus pulposus may rupture to cause acute injury and back pain by compressing the spinal cord. Can be the result of natural, age-related degeneration or repeated stress and trauma to the spine. Common sites of rupture are the lumboscral disks. Disk herniation may also occur in the lower cervical spine
Assessment findings herniated disk
- Neurological defects (motor and sensory) of extremities
- Reproducible sharp pain that extends from buttock down one leg when client lies down and performs straight leg raises. This pain that radiates away from the spinal column through an extremity resulting from compression or irritation of a spinal nerve root is called radicular pain. This may also be accompanied by numbness or tingling
Herniated Disk Treatment
- 4 weeks conservative therapy which includes drug therapy, limitation of spinal movement with brace or corset, local heat or ice, ultrasound and massage, transcutaneous nerve stimulation, and epidural corticosteriod injections
- Laminectomy
- Spinal Fusion
Laminectomy
Surgical excision of part of the posterior arch of the vertebra to gain access to part of all of the protructing disk to remove is (diskectomy).
Post op
- maintaining proper alignment of the spine at all times until healing has occurred
- patients encourage to walk
- avoid excessive bending, lifting, twisting for six weeks in order to avoid pulling on the suture line before it heals
- back strengthening exercises are begun twice a day and encourage for lifetime
Spinal Fusion
Done when an unstable bony mechanism is present. The spine is stablizied by creating a fusion of contiguous vertebrae with a bone graft or metal hardware. The bone graft may be from a cadaver or from the patient’s fibular or iliac crest
