Back Pain and Spine Flashcards
what are the red flags in LBP?
cauda equina syndrome, saddle region neuropathy, difficulty w gait and urinary continence, unremitting pain worsening, trauma, age over 65, B symptoms (cancer/HIV Hx), IVDU/steorids, neuro signs
what are the associations of inflammatory LBP?
younger males, worse w rest, ankylosing spondylitis, seronegative spondyloarthropathy
do degenerative joint diseases of spine cause pain?
no
what is the only predictive factor for future back pain?
depression
what are the yellow flags in LBP healing?
barriers to recovery due to mindset to illness, determined via STarT back test
what is the goal of the second visit in LBP?
optimize functional level and get pt back to work
what is the most common cause of LBP?
muscles and sciatica pain
what are the global stabilizers of the back?
latissimus dorsi, bicep femoris, thoracolumbar fascia
what is myofascial pain?
local/referred pain from myofascial trigger point
what are the major Dx criteria for myofascial pain?
spot tenderness, TP present, referred pain, regional complaint, ROM restricted
what are the minor Dx criteria for myofascial pain?
reproduction of symptoms, local twitch response, pain alleviated by stretching/injecting TP
what are the TPs activated by Quadratus Lumborum TP?
glutes (3 muscles), piriformis, A/P iliopsoas
what are the 3 joints of the pelvis
Left /Right Sacroiliac joint, pubic symphysis
what are the factors contributing to form closure in SIJ pain?
vertical keystone fit-bone/joint/ligament, shape, friction
horizontal compression-fascia and muscles
what test is indicative of SIJ pain?
+ Fortin’s finger test (point to posterior superior iliac spine as most painful)
what functional test confirms pelvic girdle pain?
active straight leg raise
one leg standing balance
what are the indications of lumbar facet syndrome?
Facet joints: set of synovial, plane joints between the articular processes of two adjacent vertebrae axial pain (lumbar to thigh), extension w rotation exacerbates pain, worse w immobilization, direct pressure over facet joints relieve pain
what are the indications for facet joint block (short term relief) prescription?
3 mo persistent axial pain, not responding to PT, functional disability
what Tx provides long term relief for lumbar facet pain?
medial branch blocks or radio frequency ablation
what are the anatomical results of poor sitting posture?
strained neck muscles, stiff soft tissue, increased load on discs, shorten/weaken abds and glutes, tighten iliopsoas
what is spine surgery effective for?
decompressing neural elements, stabilize unstable spine, taking out tumors/infections, correcting deformities
which part of the spine is radiculopathy likely to happen?
radiculopathy: pain that follows nerve
lower lumbar spine
what are the symptoms of radiculopathy?
leg pain radiating over dermatome, worse w activity, numbness/weakness
many resolve spontaneously
what is the most common cause of radiculopathy?
acute disk herniation/bulging from torn annulus fibrosis
leaking of nucleus propulus
post lateral hernia affects the nerve at which level?
immediately below hernia
cause sciatic pain
far lateral hernia affects the nerve at which level?
directly above hernia
what are the worrisome features of lumbar radiculopathy?
progressive weakness, unable to cope with pain
manage with edu, analgesia, etc.
what is spinal stenosis?
narrowing of spinal canal (degeneration), cause pinching on nerves–>pain
what type of claudication is associated with spinal stenosis?
claudication: cramping pain induced by exercise neurogenic (heaviness in legs, better going uphills and leaning forward), sit for relief
where does spondylolisthesis usually occur?
L5 (pars-connecting pedicle to IAP)
what are the cauda equina?
nerves running through sacrum
why is cauda equina syndrome dangerous?
sacral nerves don’t recover if they stop working, recovery is low after 24 hrs
what are the symptoms of myelopathy (cervial stenosis)
loss of hand control, numbness, off balance, bladder dysfunction, Tx with surgery
what’s the difference between lumbar and cervical stenosis?
lumbar: PNS, pain, minimal PE signs, reversible, wax/wane
cervical: CNS, sometimes pain, PE present, non-reversible, progressive
what is the most common form of scoliosis?
idiopathic (preteen-early adulthood): more females, rib hump, FHx
what’s the difference between low and high energy fractures?
low: bone density problem (compression fracture)
high: from burst fracture or fracture dislocation, needs expert assessment, red flag in back pain
where do most spine infections start?
in the disc (avascular, immune privileged)
what are the surgical goals in spine metastases?
relieve neural compression, achieve stability
lower back vs. pelvic girdle
Lower Back:12th rib to gluteal fold
Pelvic Girdle: Iliac crest to gluteal fold (16-30% LBP)
sacroiliac pain refer to
lower lumbar, some to lower limb
Tx for pelvic girdle pain
compression shorts/SI belt, heel lift, weight loss
SIJ block indications
Diagnostic-r/o SIJ as cause of LBP
Therapeutic-when combined w corticosteroid
