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Boards OMM > Chapter 4 - Lumbar > Flashcards

Chapter 4 - Lumbar Flashcards

1
Q

Why are disc herniations common in the lumbar area?

A

Posterior longitudinal ligament begins to narrow at L1

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2
Q

Thoracic and lumbar - nerve root is (above/below)

A

BELOW

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3
Q

Lumbar nerve roots - exit through the ___ aspect of the intervertebral foramina

A

SUPERIOR (because they are extending down from the conus medullaris)

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4
Q

Erector spinae group - muscles

A

Spinalis, Iliocostalis, Longissimus

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5
Q

Psoas - origin and insertion

A 
O = T12-L5 vertebral bodies
I = lesser trochanter
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6
Q

Psoas syndrome - other findings (3)

Precipitated by ____

A

Pelvic side shift
Positive Thomas test
Upper lumbar vertebral SD

Prolonged shortening

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7
Q

Iliac crest - level?

A

L4-L5 disc

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8
Q

Umbilicus - level?

A

L3-L4 disc

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9
Q

Facet trophism - define

Cause?

Importance?

A

Asymmetry of the facet joint angles - one may point more medially or laterally than normal

Congenital anomaly (MC in lumbar spine)

VERY difficult for the vertebrae to move against each other – THUS EARLY DEGENERATIVE CHANGES

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10
Q

Sacralization - define

Cause?

Importance?

A

One or both TPs of L5 get fused with the sacrum

Congenital anomaly

Altered L-S junction –> early disc degeneration

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11
Q

Lumbarization - define

A

Failed fusion of L5 to S1

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12
Q

Spina bifida - what is the structural defect?

A

Failed closure of LAMINA (connects TP to SP)

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13
Q

Main motion of lumbar spine

A

Flexion, Extension

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14
Q

L5 SB –> sacral ____

A

OBLIQUE axis engaged on SAME side

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15
Q

L5 Rot –> sacral ____

A

Rotation to OPPOSITE side

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16
Q

Ferguson’s angle

Normal?

A

Angle between HORIZONTAL axis and axis of SACRAL BASE

25-35 degrees

17
Q

Acute back pain - options?

A 
Fracture
Strain
Herniation
Infection (osteomyelitis, meningitis)
Referred pain
18
Q

Pain in low back, buttock, posterior lateral thigh
Increased with activity or prolonged standing or sitting
Increased muscle tension

Diagnosis?
Treatments?

A

Lumbosacral SD (back strain/sprain)

Counterstrain, ME, HVLA

19
Q

L4-L5 disc herniation - which nerve root affected?

L5-S1 disc herniation - which nerve root affected?

A

L5

S1

20
Q

Numbness/tingling w/ sharp, burning, shooting pain down leg, worse with flexion of lumbar spine
Decreased reflexes and strength and sensory

Diagnosis?
Test that will be positive?
Radiology?
Treatment (for most)?

A

Herniated disc

Straight leg raise

MRI (gold standard)

Bed rest, indirect OMT, gentle direct OMT

21
Q

Organic causes of psoas syndrome (6)

Importance?

A 
Appendicitis
Sigmoid colon dysfunction
Ureteral calculi
Ureter dysfunction
Metastatic prostate carcinoma
Salpingitis

Must be ruled out before treatment for mechanical cause

22
Q

Low back pain radiating to groin, achy
Increased when standing or walking

Positive test?
**Tenderpoint?
***Lumbar SD?
Pelvic finding?
Sacral finding?
Other muscular finding?
A

Psoas syndrome

Positive Thomas test
**Tenderpoint medial to ASIS
****L1-L2 Flexed, R and SB to SAME side
Pelvic shift test to CONTRALATERAL side
Sacral dysfunction on OBLIQUE axis
CONTRALATERAL piriformis spasm
23
Q

Psoas syndrome - treatment

A

Ice (NOT heat)
**Counterstrain to tenderpoint
**ME or HVLA to high lumbar dysfunction
Stretching (ONLY if CHRONIC)

24
Q

Pain in low back, achy, shooting to leg w/ paresthesias
Worsened by extension (standing, walking, supine)

3 causes?
Radiology findings?
Treatments?

A

Spinal stenosis

  1. Hypertrophy of facet joints
  2. Calcium deposits w/in ligamentum flavum and PLL
  3. Loss of intervertebral disc height

Osteophytes, decreased disc space, foraminal narrowing

  • OMT to decrease restrictions and improve ROM
  • PT, NSAIDs, Low dose tapering steroids
  • Surgery
25
Q 
Low back, buttock, and/or posterior thigh pain, achy
Increased w/ extension
Tight hamstrings bilaterally
Stiff leg, short stride, waddling gait
NO neurologic deficits

Positive exam finding?
Radiology finding?
Treatments?

A

Spondylolisthesis

Step-off sign (forward displacement of a SP)

Forward displacement of one vertebrae on another

OMT - reduce lumbar lordosis and SD (NO HVLA)
Weight loss, no high heels, avoid flexion
Heel lifts, lumbo-sacral orthotics

26
Q

Define…

  • Spondylolisthesis
  • Spondylolysis
  • Spondylosis
A

Listhesis = forward displacement of vertebrae

Lysis = defect in pars interarticularis w/o displacement

Losis = degenerative changes w/in intervertebral disc + ankylosing of adjacent vertebral bodies

27
Q

Scotty dog

What view?

A

SpondyloLYSIS - the black “collar” on the dog is the fracture

OBLIQUE view

28
Q

**Diagnosing spondylolisthesis vs. spondylolysis on X-ray

A 
Listhesis = LATERAL view
Lysis = OBLIQUE view
29
Q 
Sharp low back pain
Saddle anesthesia
Decreased DTRs
Decreased rectal sphincter tone
Loss of bowel and bladder control

Cause?
Treatment?
Danger?

A

Cauda equina syndrome

Massive CENTRAL (directly posterior) disc herniation

Emergent surgical decompression

Irreversible paralysis

30
Q

Grading spondylolisthesis…

Grade 1
Grade 2
Grade 3
Grade 4

A 
1 = 0-25%
2 = 25-50%
3 = 50-75%
4 = 75+%

Boards OMM (18 decks)

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