Back pain

Question 1

spondylosis

Answer 1

umbrella term for different forms of age-related degeneration of the spine

Question 2

spinal stenosis

Answer 2

narrowing of the spaces in your spine, can compress your spinal cord and nerve roots exiting each vertebrae

Question 3

spondylolysis

Answer 3

stress fracture through the pars interarticularis of the lumbar vertebrae

Question 4

spondylolisthesis

Answer 4

a bone (vertebrae) in the spine moves forward out of the proper position onto the bone below it

Question 5

causes of acute LBP

Answer 5

lifting, twisting
avoid BLT- bend lift twist 
mva 
slip and fall injuries 
weekend warrior

Question 6

what not to miss for LBP

Answer 6

cauda equina 
fx
cancer
progressive neurological symptoms 
AAA (abdominal aortic aneurysm) 
spinal abscess (fever + back pain)

Question 7

SIJ vs facet pain

Answer 7

SIJ= 1 
Facet= 2

Question 8

Sacroiliac joint formed by

Answer 8

formed by the connection of the right and left iliac bones to the sacrum

reinforced by strong ligaments

not much motion

Question 9

What can SIJ mimic and why?

Answer 9

sciatic pain- piriformis syndrome

sits on top of sciatic nerve

Question 10

SIJ dysfunction results from and involves what

Answer 10

injury

hypomobility of joint

Question 11

SIJ dysfunction physical exam tests

Answer 11

patricks/fabers - stresses the sij
leg length measurement- looking for hypomobility- gold= xray and measure
forward bend and march test- looking for hypomobility

Question 12

What would you find on physical exam for sij dysfunction?

Answer 12

leaning to one side while sitting
tenderness over affected sij and piriformis m
limited rom in no or all planes in L/S
hypomobility of joint

Question 13

forward test is looking for

Answer 13

affected SIJ to raise

Question 14

match test is looking for

Answer 14

affected SIJ to drop

Question 15

Facet joint

Answer 15

small, stabilizing joint that prevents the spine from translating anteriorly

slide upon each joint surface and have tiny nerve innervations- Rhizotomy kills the nerve

Question 16

Facet syndrome usually includes

Answer 16

paraspinous muscular involvement (spasm)

Question 17

Facet syndrome presentation

Answer 17

flexion= open= better 
extension= worst 

vague, dull back pain 
tenderness over facet joints 
tight hamstrings 
excessive lordotic curve 
truncal obesity 
lordosis of pregnancy

Question 18

what contributes to facet pain and why?

Answer 18

arthritis

due to joints that are small and constantly in motion

Question 19

facet pain test

Answer 19

quadrant/kemps test “facet loading”

Question 20

discogenic pain

Answer 20

bulging disk

Herniated disc

Question 21

who is predisposed to disc injury?

Answer 21

repetitive lifting, pulling, pushing, bending sideways and twisting 
smokers 
exposure to vibration 
prolonged sitting 
static posture 
weak core strength

Question 22

common complaints with discogenic pain

Answer 22

hurts when I sneeze, cough, bear down, laugh 
pain w l/s flexion, relief laying down 
radicular pain/paresthesia
back pain 
muscle spasm 
pain with prolonged sitting

Question 23

physical exam findings with discogenic pain

Answer 23

still ambulation 
pain with positional changes 
paresthesias in dermatomal pattern 
weakness in myotomal pattern 
\+ SLR 
decreased DTR 
paraspinous muscle spasm

Question 24

acute lbp non surgical management

Answer 24

NSAIDS
opioids
topamax

Question 25

imaging for back pain is not recommended in the first ___ unless

Answer 25

6 weeks

red flags are present

Question 26

Right sided low back pain and possibleinjections. She reports achy, burning right sided low back pain that radiates to the right posterior leg, knee, calf with numbing in the 4th and 5th toes.She denies weakness or loss of sensation in the lower extremities. The pain lasts all day and is worst in the evening. Ice, diclofenac and gabapentin, stretching all help the pain. Standing, sitting or bending worsen the pain. She has difficulty sleeping due to pain. She is only able to sit, stand or drive for 15 minutes due to pain.She did fall skiing 5 months ago tearing her left ACL. She believes the change in her gait and caring for her mother with Parkinson’s has aggravated her back pain.Symptoms interfere with: daily activity, sleep and any bending. Prior episodes of this problem: Similar pain 2015 treated with TF ESI with good result. she does report some chronic right sided low back pain but the pain radiating to her leg is recent.

Answer 26

bulge

Question 27

2-3 years of achy and stabbing low back pain that intermittently worsens after nonspecific activity. He has constant low-grade pain that is worst in the morning and last 8-12 hours a day. He also has episodes of severe low back pain approximately once a month. He feels he cannot straighten due to something “stuck” in his back. When he is able to straighten, he has severe low back pain for 2-3 days. He denies weakness, loss of sensation or radiating pain to his lower extremities. Advil and rest help his pain. Bending, twisting, and walking all worsen his pain. He is unable to load to the dishwasher because the twisting and straightening of his spine aggravatehis pain. He is able to sit and most comfortable driving his work truck.

Answer 27

facet

Question 28

Severe tight low back pain that radiates to his posterior legs and ankles whenever he stands or walks. He denies weakness or loss of sensation in the lower extremities. He has no pain sitting down and is only able to walk or stand for 3-4 minutes before he must sit back down due to severe pain. The pain started gradually 2 years ago and has been consistent.Symptoms interfere with: daily activity, cooking, and all mobility. MedicationGabapentin with some mild relief.

Answer 28

discogenic

Question 29

Left side low back pain that feels like a “hot needle” in his back. The pain does not radiate to the buttock or lower extremities. He denies weakness or loss of sensation in the lower extremities. The pain is constant and worst in the am upon arising from bed. Lying down helps the pain. Any movement or activity worsens the pain, he also wakes in the night due to pain. His activity is severely limited due to pain. The pain started 2 months ago after a trip to Texas which included lots of walking, fishing, lifting suitcases and dragging suitcases through the airport.

Answer 29

facet