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Course 2 - Orthopedics > Back Pain and Spine > Flashcards

Back Pain and Spine Flashcards

1
Q

what are the red flags in LBP?

A

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

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2
Q

what are the associations of inflammatory LBP?

A

younger males, worse w rest, ankylosing spondylitis, seronegative spondyloarthropathy

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3
Q

do degenerative joint diseases of spine cause pain?

A

no

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4
Q

what is the only predictive factor for future back pain?

A

depression

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5
Q

what are the yellow flags in LBP healing?

A

barriers to recovery due to mindset to illness, determined via STarT back test

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6
Q

what is the goal of the second visit in LBP?

A

optimize functional level and get pt back to work

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7
Q

what is the most common cause of LBP?

A

muscles and sciatica pain

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8
Q

what are the global stabilizers of the back?

A

latissimus dorsi, bicep femoris, thoracolumbar fascia

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9
Q

what is myofascial pain?

A

local/referred pain from myofascial trigger point

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10
Q

what are the major Dx criteria for myofascial pain?

A

spot tenderness, TP present, referred pain, regional complaint, ROM restricted

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11
Q

what are the minor Dx criteria for myofascial pain?

A

reproduction of symptoms, local twitch response, pain alleviated by stretching/injecting TP

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12
Q

what are the TPs activated by Quadratus Lumborum TP?

A

glutes (3 muscles), piriformis, A/P iliopsoas

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13
Q

what are the 3 joints of the pelvis

A

Left /Right Sacroiliac joint, pubic symphysis

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14
Q

what are the factors contributing to form closure in SIJ pain?

A

vertical keystone fit-bone/joint/ligament, shape, friction

horizontal compression-fascia and muscles

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15
Q

what test is indicative of SIJ pain?

A

+ Fortin’s finger test (point to posterior superior iliac spine as most painful)

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16
Q

what functional test confirms pelvic girdle pain?

A

active straight leg raise

one leg standing balance

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17
Q

what are the indications of lumbar facet syndrome?

A 
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
18
Q

what are the indications for facet joint block (short term relief) prescription?

A

3 mo persistent axial pain, not responding to PT, functional disability

19
Q

what Tx provides long term relief for lumbar facet pain?

A

medial branch blocks or radio frequency ablation

20
Q

what are the anatomical results of poor sitting posture?

A

strained neck muscles, stiff soft tissue, increased load on discs, shorten/weaken abds and glutes, tighten iliopsoas

21
Q

what is spine surgery effective for?

A

decompressing neural elements, stabilize unstable spine, taking out tumors/infections, correcting deformities

22
Q

which part of the spine is radiculopathy likely to happen?

A

radiculopathy: pain that follows nerve

lower lumbar spine

23
Q

what are the symptoms of radiculopathy?

A

leg pain radiating over dermatome, worse w activity, numbness/weakness
many resolve spontaneously

24
Q

what is the most common cause of radiculopathy?

A

acute disk herniation/bulging from torn annulus fibrosis

leaking of nucleus propulus

25
Q

post lateral hernia affects the nerve at which level?

A

immediately below hernia

cause sciatic pain

26
Q

far lateral hernia affects the nerve at which level?

A

directly above hernia

27
Q

what are the worrisome features of lumbar radiculopathy?

A

progressive weakness, unable to cope with pain

manage with edu, analgesia, etc.

28
Q

what is spinal stenosis?

A

narrowing of spinal canal (degeneration), cause pinching on nerves–>pain

29
Q

what type of claudication is associated with spinal stenosis?

A

claudication: cramping pain induced by exercise neurogenic (heaviness in legs, better going uphills and leaning forward), sit for relief

30
Q

where does spondylolisthesis usually occur?

A

L5 (pars-connecting pedicle to IAP)

31
Q

what are the cauda equina?

A

nerves running through sacrum

32
Q

why is cauda equina syndrome dangerous?

A

sacral nerves don’t recover if they stop working, recovery is low after 24 hrs

33
Q

what are the symptoms of myelopathy (cervial stenosis)

A

loss of hand control, numbness, off balance, bladder dysfunction, Tx with surgery

34
Q

what’s the difference between lumbar and cervical stenosis?

A

lumbar: PNS, pain, minimal PE signs, reversible, wax/wane
cervical: CNS, sometimes pain, PE present, non-reversible, progressive

35
Q

what is the most common form of scoliosis?

A

idiopathic (preteen-early adulthood): more females, rib hump, FHx

36
Q

what’s the difference between low and high energy fractures?

A

low: bone density problem (compression fracture)
high: from burst fracture or fracture dislocation, needs expert assessment, red flag in back pain

37
Q

where do most spine infections start?

A

in the disc (avascular, immune privileged)

38
Q

what are the surgical goals in spine metastases?

A

relieve neural compression, achieve stability

39
Q

lower back vs. pelvic girdle

A

Lower Back:12th rib to gluteal fold

Pelvic Girdle: Iliac crest to gluteal fold (16-30% LBP)

40
Q

sacroiliac pain refer to

A

lower lumbar, some to lower limb

41
Q

Tx for pelvic girdle pain

A

compression shorts/SI belt, heel lift, weight loss

42
Q

SIJ block indications

A

Diagnostic-r/o SIJ as cause of LBP

Therapeutic-when combined w corticosteroid

Course 2 - Orthopedics (7 decks)

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