Clinical Lumbar

Question 1

Innervation of latissimus dorsi

Answer 1

Thoracodorsal n. (C6-8)

Question 2

Innervation of gluteus maximus

Answer 2

Inferior gluteal n. (L5-S2)

Question 3

Innervation of quadratus lumborum

Answer 3

T12 and L1-4 ventral rami

Question 4

Origin of quadratus lumborum

Answer 4

12th rib

Lumbar transverse processes

Question 5

Insertion of quadratus lumborum

Answer 5

Iliolumbar ligament

Iliac crest

Question 6

Innervation of piriformis

Answer 6

L4-S3

Question 7

What is special about the piriformis?

Answer 7

Only m. to bridge the anterior SI joint

Question 8

What is the first ligament to become tender with lumbar posture changes?

Answer 8

Iliiolumbar ligament

Question 9

What happens to the PLL as it descends?

Answer 9

Narrows

Question 10

Which discs most commonly herniate?

Answer 10

L4-L5

L5-S1

Question 11

What direction does a disc normally herniate?

Answer 11

Posterolaterally

Question 12

Symptoms of a herniated disc

Answer 12

Sharp low back pain
LE radiculopathy
Worsened with valsalva
Positive straight leg raise

Question 13

Which nerve root is affected in a disc herniation?

Answer 13

Never root below

Question 14

How are discs named?

Answer 14

Named for the vertebrae above

Question 15

If L4 disc herniates, which nerve root is affected?

Answer 15

L5

Question 16

L4 motor, reflex, and sensation

Answer 16

Tibialis anterior - foot inversion and dorsiflexion
Patellar reflex
Sensation on medial aspect of foot, medial leg to tibial crest

Question 17

L5 motor, reflex, and sensation

Answer 17

Extensior hallicus longus - great toe extension
Gluteus medius - abduct the leg
No reflex
Sensation on lateral leg and dorsum of foot

Question 18

S1 motor, reflex, and sensation

Answer 18

Peroneus longus and brevis - foot eversion
Gastrocnemius/Soleus
Gluteus maximus - hip extention
Achilles tendon reflex
Sensation on lateral foot

Question 19

Which n. root is most commonly injured?

Answer 19

S1

Question 20

3 concentric rings around the anus

Answer 20

S2 - outer
S3 - middle
S4 - innermost

Question 21

Symptoms of spinal stenosis

Answer 21

Aching low back pain to lower legs
Worsened by lumbar extension (standing, walking, lying supine)
Relieved by sitting

Question 22

Spondylosis

Answer 22

Degenerative changes within intervertebral disk with ankylosing of adjacent vertebral bodies

Question 23

Spondylolysis

Answer 23

Defect/fracture of pars interarticularis without anterior displacement of vertebral body

Question 24

Dx of spondylolysis

Answer 24

Oblique x-rays showing collar on Scottie Dog

Question 25

Spondylolisthesis

Answer 25

Anterior displacement of one vertebral body in relationship to one below

Most often L5 on S1

Question 26

Dx of spondylolisthesis

Answer 26

Lateral x-rays showing forwards displacement

Question 27

To which side does the pelvis shift in psoas syndrome?

Answer 27

Contralateral side of affected psoas

Question 28

Somatic dysfunction in which lumbar levels are associated with psoas syndrome?

Answer 28

L1 or L2

Question 29

Which piriformis spasms in psoas syndrome?

Answer 29

The piriformis contralateral to the affected psoas

Question 30

What is the best thing to do for a pt with a complaint of low back pain?

Answer 30

Take a good history, bitch!

Question 31

Severe low back pain with sudden onset and without hx of trauma

Answer 31

Dissecting AA

Question 32

Claudication symptoms with back pain

Answer 32

Spinal stenosis

Question 33

Pain that wakes pt from sleep

Answer 33

Malignancy until proven otherwise

Question 34

Rapidly progressing neurological deficits

Answer 34

Epidural abscess/infection