Ch 11 MDT Spine Flashcards
Pathologic process affecting the nerve root
Radiculopathy
Clinical condition that involves neck, shoulder, or arm pain
Muscle weakness
Sensory changes
Diminished deep tendon reflexes
Cervical Radiculopathy
Cervical and Lumbar Radiculopathy is usually the result of:
Cervical spondylosis
Nonspecific degenerative changes of spine
Aging
Bony growth/remodeling
Osteophyte formation
Irritation of nerve root
Nucleus pulposus prolapse from intervertebral disc
Irritate nerve if compression
Disc Herniation
Increases the risk of Cervical and Lumbar Radiculopathy
Diabetes
Nerve root infarction
Nerve root avulsion
Infections
Cancer
Demyelination syndromes (Guillain barre)
Symptoms:
- Neck, shoulder, or arm pain
- Muscle Weakness
- Sensory changes
- Deep tendon reflexes
- Headaches
Cervical Lordosis reduced
Tenderness to spinous process or paraspinal muscles
Pain is reproduceable
Cervical / Lumbar Radiculopathy
Neurovascular exam for Cervical and Lumbar Radiculopathy should include:
Asses C5-T1 nerve roots for weakness
Assess upper extremity DTR’s
Special tests for Cervical and Lumbar Radiculopathy
Spurling
Treatment for Cervical and Lumbar Radiculopathy
Spontaneous resolution in weeks to a couple months
NSAIDs, Tylenol, muscle relaxers
PT or Chiropractor (rehab, traction)
Ligamentous, facet joints, muscular, disc injury
Self-limiting
Commonly from whiplash mechanism
Neck Sprain (Cervical Strain)
Non-radicular, non-focal neck pain from the base of the skull to the cervicothoracic junction (Trapezius and SCM)
Worse with ROM
Paraspinal Spasm
Occipital headaches
Irritability, fatigue, sleep disturbances, difficulty concentrating
- No deformities
- Tenderness to Palpation in involved areas
Neck Sprain (Cervical Strain)
Treatment for Neck Sprain (Cervical Strain)
Soft cervical collar for 1-2 weeks and reassurance
NSAIDs and Muscle relaxants
Massage, manipulation, and cervical traction
Return to activities as soon as possible
Most common cause of disability in people under 45
2nd most common primary care complain
Back pain
Acute back pain lasts up to ___ weeks
4 weeks
Subacute back pain lasts up to ____ weeks
4-12 weeks
Chronic back pain lasts over ___ weeks
12 weeks
Back pain in the absence of a condition that can be readily diagnosed
Accounts for majority of back pain encounters
Usually due to musculoskeletal cause
Usually improves in less than four weeks
Nonspecific Back pain
Weakening of bones in the spine causes a fracture
Risk factors include older age and chronic steroid use
Vertebral compression fracture
Back pain is rarely a systemic disease, as in:
Cauda Equina Syndrome
Metastatic Cancer
Infection
Abscess
Vertebral osteomyelitis
Compression of the lumbosacral nerves
Affects nerve roots of the spinal cord itself
- Saddle anesthesia
- Loss of bowel/bladder function
- Lower extremity weakness
Cauda Equina Syndrome
Most common cancer to metastasize to bone includes:
Breast
Prostate
Lung
Kidney
Thyroid
Risk factors of metastatic cancers
Family History
Social History
Past Medical History
Alarming symptoms of metastatic cancers
Unexplained weight loss
Night pain
Night sweats
History of cancer
Risk factors of malignancy (family hx, social hx, PMHx)
Back pain from infection can be caused from:
Epidural abscess and vertebral osteomyelitis
Treatment for back pain
Control pain, reassurance
Activity/lifestyle modification
Early mobility
Core stabilization through rehab
Over time, fissures develop on annulus fibrosis
Nucleus pulposus contents herniate
Pain from mechanical compression or chemical irritation of nerve root
Herniated disc
Abrupt or gradual onset
Unilateral radicular leg pain
Aggravated be various factors
Possible neurologic involvement
- L4-L5, L5-S1 distribution
- L1-L4 refers pain to anterior thigh
Herniated disc
Focal tenderness
Limited ROM
Muscle test: Weakness
Numbness
Herniated disc
Special tests for Herniated disc
Seated and supine straight leg raise
Cross straight leg raise
Treatment for Herniated disc
Control pain
Activity/lifestyle modification
Rehabilitation
Consider Chiropractor / Physical Therapy
Lateral curvature of the spine that is more than 10 degrees in an adult
Scoliosis
Scoliosis
Up to __% of adults will have progression of the curvature
70%
Lumbar scoliosis greater than ___ degrees
Thoracic scoliosis greater than ___ degrees
Is disqualifying
20
30
Treatment for Scoliosis
Management through physical therapy
Referral for Scoliosis if:
Radicular pain
Severe spinal deformity
Neurologic deficits
