Chapter 14 Flashcards
Many mechanical causes of back pain resolve in
1-4 weeks
SI pain can mimic low back pain and discover if disease effecting pain
Below the knee to the foot
SI dysfunction is the primary cause of low back pain in
30% of cases with low back pain
RA effects the ____ early but may go unrecognized at first
C spine
Although the ____ of back pain caused by NSAIDS is low, the ________ in PT clinics is high
Incidence, prevalence
What is the most important part of the history in relation to back pain
History of cancer - long ago
_____ to ____ of increasing back ache often may be a signal of ______ especially with a history of _____
6 weeks to 6 months, lumbar metastasis, cancer
Long term use of _______ can lead to vertebral compression fractures
Corticosteroids
_________ (antibiotic) can cause neck, chest or back pain
Fluoroquinolones
Age risk factors for viscerogic or systemic causes of back pain
Under 20 or over 50
Most cases of back pain in the adult is due to
Age related degenerative process, physical loading and musculoligamentous injury
Typically systemic back pain is ___ relieved by recumbency
Not
Bone pain of metastasis or myeloma tends to be more ______ when the client is in this position
Continuous, progressive and prominent when the client is recumbent
Unable to lie still with pain indicates
Systemic origin
Visceral diseases often have a systemic backache that causes the client to go into these positions
Curl up, sleep in a chair or pace the floor at night
Review of systems questions
Fevers, excessive weight gain or loss and appetite loss should be followed up with additional questions
Red flag age:
Less than 20 or over 50
Red flag previous history of…
Cancer
Red flag signs of infection:
Constitutional symptoms
Red flag recent ____
Urinary tract infection
Red flag history of _____ drug use
Injection
Red flag _______ condition
Immune compromised
Red flag failure to improve with
Conservative care in 4-6 weeks
Red flag pain is not relieved by
Rest or recumbency
Red flag pain at this time of day
Night
Red flag neurological symptom
Saddle parasthesia
Red flag back pain Accompanied by
Abdominal, pelvic or hip pain
Red flag trauma or
History of falls
Red flag significant ____ stiffness with limitation in ___ spinal movements can indicate ____
Morning, all, ankylosing spondylitis
Red flag skin _____
Rash
Primary headaches include
Migraine, tension headache, cluster headache.
Secondary headache is
Cervicogenic headache
Cervicogenic headache is defined as
Referred pain in any part of the head caused by musculoskeletal tissues innervated by cervical nerves c1-c4
Cervical genie headaches are frequently associated with
Chronic tension or acute whiplash, intervertebral disc disease, or progressive facet joint arthritis
Sudden severe headache is a classic symptom of
Temporal vasculitis
Important measure to take when assessing vascular induced headache
BP
Headaches due to cancer are worse in the
Upon awakening due to differences in CNS drainage in the supine or prone position, and goes away after they stand up
Headache due to cancer is intensified when
There is an activity that increases intracranial pressure
Migraines may present with _____ mimicking a stroke
Paralysis or weakness on one side
Physical therapy is most effective for migraines when combined with
Thermal biofeedback and relaxation training
Radicular symptoms accompanied by weakness, coordination impairment, gait disturbance, bowel or bladder retention or Incontinence and sexual dysfunction can occur where
Cervical myelopathy occurs
Torticollis of the sternocliedomastoid may be a sign of underlying
Thyroid involvement
___ neck pain that is worse with _____ and ______ may be present with thyroiditis
Anterior, swelling and turning the head
Anterior disc bulge into the esophagus or pharynx or an osteophyte of the vertebrae may give sensations of ____ and should be followed up with screening what cranial nerves
Difficulty swelling, lump in throat, V-VIII
A sign that a patient has Vertebral artery syndrome caused by structural changes in the cervical spine is characterized by
The client turning the whole body rather than just the neck
VBI occurs when
There is decreased vertebral height, osteophyte formation, postural changes and ligamentous changes reduce the foraminal space and encroach on the vertebral artery
Systemic origins of musculoskeletal pain in the thoracic spine is usually accompanied by
Constitutional symptoms
What are the three most likely cardiac causes of thoracic pain
Thoracic aortic aneurysm, angina and acute MI
Peptic ulcer can refer pain to the mid thoracic spine between
T6 and T10
What kind of disorders can cause scapular pain
Cardiac, pulmonary, renal and GI
Sacral or sacroiliac pain in the absence of _____ and in the presence of negative____ must be evaluated more closely
Trauma, spring test
The most common cause of serious pathology in the sacral or sacroiliac region is
Spondyloarthropathies
Spondyloarthropathies are characterized by
Morning pain accompanied by prolonged stiffness that improves with activity. Limitation of movement in all directions and tenderness over the spine and sacroiliac joints
The most significant finding in ankylosing spondylitis is that the client has
Night pain in the back and morning stiffness. They may have asymmetric SI involvement radiating to the buttock and thigh
Colicky pain is associated with
Spasm of a hollow viscus
Severe tearing pain with sweating and dizziness may originate from
An expanding abdominal aortic aneurysm
Burning pain may originate from a
Duodenal ulcer
Muscle spasm and tenderness along the vertebrae may be elicited in the presence of
Visceral impairment
Spasm on the right side at the 9th and 10th costal cartilages can be a symptom of
Gallbladder problems
The spleen can cause spasm and tenderness at…..
Level of t9 through 11 on the left side
The kidneys are likely to cause tenderness, spasm and possible pain or sensitivity at the level of
The 11th and 12th ribs
Rad ocular pain results from
Irritation of axons of a spinal nerve or neurons in the dorsal root ganglion
Referred pain results from
Activation of nociceptive free nerve endings in somatic or visceral tissue
Neurological signs are produced by
Conduction block in motor and sensory nerves, but conduction block does not cause pain.
Finding the cause of back pain will also identify the neurological symptoms true or false
False
Systemic origins of musculoskeletal pain in the thoracic spine is usually accompanied by
Constitutional symptoms
What are the three most likely cardiac causes of thoracic pain
Thoracic aortic aneurysm, angina and acute MI
Peptic ulcer can refer pain to the mid thoracic spine between
T6 and T10
What kind of disorders can cause scapular pain
Cardiac, pulmonary, renal and GI
Sacral or sacroiliac pain in the absence of _____ and in the presence of negative____ must be evaluated more closely
Trauma, spring test
The most common cause of serious pathology in the sacral or sacroiliac region is
Spondyloarthropathies
Spondyloarthropathies are characterized by
Morning pain accompanied by prolonged stiffness that improves with activity. Limitation of movement in all directions and tenderness over the spine and sacroiliac joints
The most significant finding in ankylosing spondylitis is that the client has
Night pain in the back and morning stiffness. They may have asymmetric SI involvement radiating to the buttock and thigh
Colicky pain is associated with
Spasm of a hollow viscus
Severe tearing pain with sweating and dizziness may originate from
An expanding abdominal aortic aneurysm
Burning pain may originate from a
Duodenal ulcer
Muscle spasm and tenderness along the vertebrae may be elicited in the presence of
Visceral impairment
Spasm on the right side at the 9th and 10th costal cartilages can be a symptom of
Gallbladder problems
The spleen can cause spasm and tenderness at…..
Level of t9 through 11 on the left side
The kidneys are likely to cause tenderness, spasm and possible pain or sensitivity at the level of
The 11th and 12th ribs
Back pain has been linked to atherosclerotic changes in the
Posterior wall of the abdominal aorta
Continuous ______ can be a symptom of MI especially in ____ women with a positive family history
Mid thoracic, post menopausal
Spondylogenic back pain is characterized by
Bone tenderness and pain on weight bearing
Associated signs and symptoms of spondylogenic impairment
Weight loss, fever, deformity, and night pain
The most common primary malignancy involving the spine is
Multiple myeloma
Multiple myeloma often results in
Diffuse osteoporosis and pain that is not relieved in recumbent position
The two areas of the spine most effected by oncologic causes
Thoracic and lumbosacral
As a general rule thoracic Pain must be screened for
Metastatic carcinoma
Metastasises spread to the spine via
The para vertebral venous plexus
Heart is innervated by
C3-t4
Neurogenic/vascular back or leg pain is alleviated by rest within 1 to 3 minutes
Vascular
Activity will bring back or leg pan on in 3 to 5 minutes if it is vascular or neurogenic?
Vascular
Neurogenic or vascular symptoms often occur immediately with use of the affected body part or with certain positions
Neurogenic
It is not likely that positions of the spine will relive pain if it is of a ___ origin
Vascular
Auto splinting is
When the patient prefers to lie on the involved side
Pancoast’s tumor may invade the brachial plexus causing pain in this region
C8-t1
The reproductive organs are where the ___ are in the adult in utero
Kidney
Lower urinary tract infections will refer pain to the
Low back, pelvic, or sacral areas not shoulder
Upper urinary tract may refer pain to the shoulder because
It comes in contact with the diaphragm
Acute pyelonephritis refers pain to
Muscles lateral to t12-l1
Most common visceral origin of back pain
GI
What is the pain pattern for epigastic pain from esophagitis
Starts anterior, radiates around the Chest wall to the back around t5/T6
Stomach and duodenum refers pain at the level of lesion in what areas
T6-T10
Small intestines shally refers pain around the
Umbilicus
Back pain from being pregnant usually begins
In second trimester, 5-7 months
The risk of developing chronic back pain postpartum doubles with use of
Epidural anesthesia
Vertebral osteomyelitis affects most commonly the
First and second lumbar vertebrae
The most common organism responsible for vertebral osteomyelitis
MRSA
Pudendal nerve entrapment is characterized by
Pain relief when sitting on a toilet seat or standing
Three most likely muscles to refer pain to the pelvic area
Abdominals, quadratus lumborum, and iliopsoas
Muscle that acts as a sling around pelvic structures
Puborectalis
Most common gynecological cancer in women
Endometrial / uterine cancer
Endometrial cancer typically occurs in those
Between 50 and 70, obesity, endometrial hyperplasia, prolonged estrogen therapy and tamoxifen used for,breast cancer
Majority of endometrial cancers occur
Post menopausally
Most common presentation of endometrial cancer is
Abnormal vaginal bleeding or discharge
Most common complaint in PT of those with endometrial cancer is
Pelvic pain without abnormal bleeding
Second most commonly reported gynecological cancer is
Ovarian cancer
Ovarian cancer incidence peaks between th ages of
40 and 70
Factors that may influence the development of ovarian cancer besides the obvious
Nulliparity, giving birth to fewer than 2 children, giving birth for first time after age 35, bRCA1 or 2 gene, infertility, early menopause
Extra ovarian primary peritoneal carcinoma is a ___
Abdominal cancer without ovarian involvement . It Aries in the peritoneum and mimics the symptoms, appearance and pattern of spread of ovarian cancer
Third most common gynecological cancer
Cervical cancer
Most common cause of death from gynecological cancer is
Cervical cancer
A sexually active female with back or shoulder pain of unknown cause should be screened for
Ectopic pregnancy
