Clin med test 3 Flashcards by Nolan Christopher

How many US citizens miss work daily due to LBP

10 million

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How many days of work are missed in great Britain due to LBP

15 million

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How much money does it cost us industries on account of missed days from LBP

14 billion

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Who is at the highest risk for LBP

Truck drivers

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Who is at the higher risk for LBP (Sedentary or heavy labor workers)

Same due to the poor posture of sedentary

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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

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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

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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

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What are the rates of reoccurring LBP

90% chance of getting it aging

40% chance of developing sciatica

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Why do visceral organ diseases present as low back pain

They refer pain to along the TL spine or Sacral area.

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How to differentiate between Visceral organ and a musculo problem

Visceral organs generally to not change with movement

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What comes first DJD or DDD

More likely DDD

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Where will Herniations most often occur

L4/L5
L5/S1 
L3/L4 
L2/L3 
L1/L2 
*In that order

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Describe a protrusion herniation

The least severe
There is an angular bulge
Angular fibers still intact

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Describe a prolapse herniation

Nucleus has migrated through the inner laminar layers but is still contained
The angular fibers will be disrupted

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Describe disk extrusion herniation

Angular fibers have disrupted and the nucleus has now broken past the outer most layer

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Describe a Sequestration hernia

Annular fibrosis is disrupted and the nucleus has now migrated outside the disk.

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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

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What tests or measures to use for nerve irritation

Want to do a dermatome or myotomal testing

X-rays often not helpful

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What imaging will be most useful in detecting nerve irritation

MRI
CT
Myelography
*in that order

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What may prevent D2 from responding to extension repeated movements

The Kyphosis deformity

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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

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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

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Which derangements are easily reversible

D1-4 and D7

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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)