CLINICAL CARE OF THE SPINE Flashcards
Dx/Tx,
Symptoms
(1) Non-radicular, non-focal neck pain from the base of the skull to the
cervicothoracic junction
–(a) Trapezius and SCM
(2) Worse with ROM
(3) Paraspinal spasm
(4) Occipital headaches
(5) Irritability, fatigue, sleep disturbances, and difficulty concentrating
Physical Exam
(1) Visual = No visual deformity in the neck
(2) Palpation = TTP in the involved areas
(3) ROM =Limited or decreased ROM
(4) Muscle Test = Unremarkable
(5) Neurological test = Neurologic examination is normal
(6) Special test = None
Cervical Strain
Treatment
(1) Soft cervical collar for 1-2 weeks and reassurance
(2) NSAIDS and muscle relaxants
(3) Massage, manipulation, and cervical traction
(4) Return to activities as soon as possible
LBP etiologies
“Nonspecific” back pain refers to back pain in the ________ of condition that can be readily diagnosed
(a) Accounts for _____ of back pain encounters
(b) Usually due to musculoskeletal cause
(c) Usually improves in less than ___ weeks
absence
a) majority
c) four
LBP etiologies
__________ fracture
(a) Weakening of bones in the spine causes a fracture
(b) Risk factors include older age and chronic steroid use
Vertebral compression
LBP Acute vs chronic
(1) Acute: Up to __weeks
(2) Subacute: __ weeks
(3) Chronic: Over __ weeks
1) 4 w
2) 4-12 w
3) 12 w
What msk issue
(1) Most common cause of disability in people under 45
(2) 2nd most common primary care complaint
LBP
__________ : Refers to symptoms or impairment related to a spinal nerve
(a) Degenerative changes
(b) Disc protrusion
(c) Typically improves gradually with supportive care
Radiculopathy
What issue?
Refers to compression of the lumbosacral nerves regardless of etiology
Cauda Equina Syndrome
Another syndrome called ___________ presents in same way as Cauda Equina but is caused by trauma to the spinal cord
Conus Medullaris
What LBP etiology?
1) Fever
2) Pain at night
3) Recent infections such as
- -a) Pneumonia
- -b) Urinary tract infection
- -c) Cellulitis
- -d) Immunocompromised state
4) More likely to encounter in general population, not active duty
Infection
(a) Epidural abscess and vertebral osteomyelitis
Herniated Disc
(1) Over time, fissures develop on ______
(2) Nucleus pulposus contents herniate
(3) Pain from mechanical compression or chemical irritation of ________
1) annulus fibrosis
3) nerve root
Symptoms (1) Abrupt or gradual onset (2) Unilateral radicular leg pain (3) Aggravated by various factors (4) Possible neurologic involvement --(a) L4-L5, L5-S1 distribution --(b) L1-L4 refers pain to anterior thigh Physical Exam (1) Visual = Unremarkable (2) Palpation = Focal tenderness 3) ROM = Limited (4) Muscle Test --a) Weakness depends on affected myotome --(b) Dorsiflexors, plantar flexors, and extensor hallucis longus (5) Neurovascular --(a) Numbness depends on affected dermatome --(b) Knee and Achilles Reflexes --(c) Heel and Toe Walk (6) Special Tests --(a) Seated and supine SLR --(b) Crossed SLR
Herniated Disc Treatment (1) Control pain (2) Activity/lifestyle modification (3) Rehabilitation (4) Consider chiro/PT
Scoliosis
Lateral curvature of the spine that is more than ____ degrees in an adult
(1) May be from spinal degeneration or from childhood
10 degrees
True/False
Most Scoliosis cases are minor deviations from normal and asymptomatic
True
Important to monitor curve progression of scoliosis
(1) Up to __% of adults will have progression of the curvature
(2) May present with increasing pain or difficulty in performing work tasks
(3) Lumbar scoliosis greater than __ degrees or thoracic scoliosis greater than 30 degrees is disqualifying
1) 70
3) 20
True/False
Correction of the spinal deformity is a realistic goal for all cases of scoliosis
False
Is not
