Clin med test 3 Flashcards
How many US citizens miss work daily due to LBP
10 million
How many days of work are missed in great Britain due to LBP
15 million
How much money does it cost us industries on account of missed days from LBP
14 billion
Who is at the highest risk for LBP
Truck drivers
Who is at the higher risk for LBP (Sedentary or heavy labor workers)
Same due to the poor posture of sedentary
Explain how LBP progresses as the population gets older
25 year olds will start to develop LBP
35 years old it will get moderate to severe
40-45 years old is the peak age for LBP
What is the best medical examination process for detecting LBP
Xrays have a “moderate” correlation to determining back pain. But even withexpert medical examination sometimes it is impossible to detect
What are the time periods for LBP to be self limiting
44% get better in one week
86% get better in a month
92% get better in 2 months
What are the rates of reoccurring LBP
90% chance of getting it aging
40% chance of developing sciatica
Why do visceral organ diseases present as low back pain
They refer pain to along the TL spine or Sacral area.
How to differentiate between Visceral organ and a musculo problem
Visceral organs generally to not change with movement
What comes first DJD or DDD
More likely DDD
Where will Herniations most often occur
L4/L5 L5/S1 L3/L4 L2/L3 L1/L2 *In that order
Describe a protrusion herniation
The least severe
There is an angular bulge
Angular fibers still intact
Describe a prolapse herniation
Nucleus has migrated through the inner laminar layers but is still contained
The angular fibers will be disrupted
Describe disk extrusion herniation
Angular fibers have disrupted and the nucleus has now broken past the outer most layer
Describe a Sequestration hernia
Annular fibrosis is disrupted and the nucleus has now migrated outside the disk.
What are some clinical features with herniation of IVD
Dramatic onset of symptoms Occurs day or 2 after rigorous activity Usually in early adult and middle aged people Acute sciatica Muscular spasms Pain with Motion, flexion and extension
What tests or measures to use for nerve irritation
Want to do a dermatome or myotomal testing
X-rays often not helpful
What imaging will be most useful in detecting nerve irritation
MRI
CT
Myelography
*in that order
What may prevent D2 from responding to extension repeated movements
The Kyphosis deformity
What may prevent D3 or 5 from responding to extension repeated movements
It may not respond to standing extension because it is on one side vs the other
What may prevent D4/6 from responding to extension repeated movements
They lay in the frontal plane, so they may respond better to frontal plane movements
Which derangements are easily reversible
D1-4 and D7
Which derangements are harder to fix
D5 and D6
What will degenerate first in the Disk with DDD
Nuclear pulposis
What are some physiological characteristics of the disc that occur with DDD
Disc height shortens
Angular fibrosis looses elasticity posteriorly
Angular fibrosis becomes thin and may even tear
What are schmorl’s nodes
Weakness of the cartilage endplate
How common are schmorl’s nodes
Common but not clinically significant
What can result from DDD
Compression on facet joints
DJD
Foraminal narrowing (stenosis)
Ligament laxity
What can cause DJD
Mechanical weakness or malalignment Trauma (MVA, Sports) Obesity, poor posture Smoking Infection
How much more likely are you to get DJD if you smoke
3x more likely
How does imaging help us detect stenosis
There will be decrease joint space on X-rays
What can cause narrowing of the foremen in the spine
Herniation Decreased joint space Osteophytes DJD Ligamentous flavum folding
What can compress the cauda equine
Central compression in the foremen (central stenosis)
What are the signs of lateral stenosis vs central stenosis
Radicular pain that is unilateral
What will stenosis mimic
Intermittent claudication
What is a weird feature of stenosis
Flaccid bladder
What can you rule out if there is no leg pain
Stenosis
What is the difference between hypermobility and instability
Hypermobility will be too much movement in the joint with A/PROM
Instability will create aberrant movement
Which is more severe hypermobility or instability
Instability
What does Lumbargo mean
Low Back pain
What are some clinical indications of segmental hyper extension
Better with flexion/worse ext
Local or referred to butt
Chronic or intermittent lumbargo
What are some clinical indications for hyperflexion
Herniation
DDD
Relieved with Ext
Will segment instability be worse or better with movement
Worse with movements, better at rest.
May centralize pain
What can cause segmental hyperextension
Extension checkrein compromised
Sprains subluxations
Malalignment
What role will DDD play in segmental instability
Aberrant or excessive moments in spine
What can occur with segmental instability
Osteophytes
Sprain of facet joints
What are the grades of displacements of the spine
Grade 1: 25%
Grade 2: 50%
Grade 3: 75%
Grade 4: 100%
Will spondylosthesis feel better with flexion or extension
Flexion
Provides more stability
Which lumbar are most likely to have spondylolosis
L5 85%
L4 15%
What sports are more likely to have spondylolosis
Football Linemen
Gymnastics
Butterfly swimmers
Weight lifters
What nationality Is most likely to have spondylosis
Eskimo
What is the treatment for grade 1 slipping
Strengthen core
What is the treatment for grade 2 slipping
Maybe a posterior fusion
What is the treatment for a grade 3-4 slipped disc
Posterior fusion
What is a laminectomy with decompression used for
Central Stenosis
What are the indications for a disectomy
Conventional methods have been ineffective for 6 or more weeks
Neurological deficit
Recurring sciatica
Microdisectomy
Disectomy of the disc using a scope
What are some symptoms of caudal equine syndrome
Lower Back pain
Pain in the leg
Numbness in feet
What is the treatment for cauda equina syndrome
Surgery
What are the “tell tale signs” of cauda equina syndrome
Urinary incontinence
Sciatica
Saddle anesthesia
What is saddle anesthesia
LOSS OF FEELING IN THE BUTT
What is anklosing spondylitis
Stiffening of the spine from inflammation
Have a hunched over posture
What is the ratio of male to femeale for anklosing spondylitis
4:1 males
Will anklosing spondylitis be better or worse with activity
Better with activity and worse with rest
Where can anklosing spondylitis refer and radiate to
Radiates to knee
Refers to trochanter and butt
What are some treatments for anklosing spondylitis
NSAIDS
Education
PT (heat, PRE, Extension)
