Clinical Syndromes Flashcards
3 categories of Lumbar Spine issues
- Serious spinal pathologies - tumor, infection, fracture, CE syndrome
- Sciatica - back-related LE symptoms - stenosis, arthritis, inflammation, diabetes, etc
- Nonspecific LBP - dysfunctions of musculoskeletal tissues
Spinal Stenosis
- DEFN
- MOI
- SYMPTOMS
narrowing of central canal or lateral/iV foramina
- more commonly seen in men & >60yrs old
MOI - congenital, age related degeneration or anterior slippage
–> other causes = facet joint arthrosis, LF thickening, buldging of IVD
Symptoms - long history of LBP, leg pain, neurogenic claudication
AGG w/ extension, walking downhill, lying flat
EASING w/ flexion, sitting, walking uphill
OBJECTIVE findings - flat back
due to tight/short hip flexors & lengthened/weak hip extensors
Neurogenic Claudication
- what is it
- when should you see it
compression of nerve w/n canal that causes limitation of arterial supply OR claudication due to obstruction of venous return
Brought on by walking & relieved by rest
Peripheral pulses will be present & no localized leg symptoms (like vascular claudication)
Spinal Stenosis
- TREATMENT
GOALS - redue pain, improve mobility & muscle balance, improve aerobic fitness
- Educate - ADL’s w/ neutral spine,positioning through a posterior pelvic tilt
- Mechanical traction or rotation mobilizatino
- Ther ex - stretch hip flexors & strengthen hip extensors & abdominals
WATCH for ANT tilt compensations
Acute Facet Joint
- DEFN
- MOI
- SYMPTOMS
DEFN - mechanical block from meniscoid
MOI - return from flexion
SYMPTOMS - unilateral pain that is sharp over the facet, increased pain w/ stretch/compression of joint, limitations in side bending & extension, local tenderness, history of sudden unguarded movement
Meniscoid
synovial fold located at superior/inferior aspects of facet joints that provide & prevent excessive motion
can be dislodged and cause acute facet joint
AKA “locked back”
Usually occurs during return from flexion
Acute Facet Joint
-TREATMENT
Manual therapy - unilateral PA, traction, manipulation
Modalities
Ther ex - mobility
Excellent prognosis
Chronic Facet Joint
- DEFN
- MOI
- SYMPTOMS
an acute facet joint problem that did not resolve
MOI - DJD, facet hypertrophy, osteophyte formation (arthritis), inflammation, micro-fracture
SYMPTOMS - unilateral pain (may refer to buttock area), stiffness & pain in AM, hypomobility
AGG - prolonged INACTIVITY// activity and tehn worsened again w/ activity
EASING - flexed posture
Chronic Facet Joint
-TREATMENT
MT - rotation, uniltaeral PA’s, traction, manipulation
Ther ex - stretching & muscle re-education
Address faulty movements
Facet joint injections or nerve block
Acute Nerve Root
- DEFN
- MOI
- SYMPTOMS
irritation/inflammation, compression, or tension to the nerve root
MOI - disc pathologies, DDD/DJD
SYMPTOMS - DISTAL > PROXIMAL
pain severly limits activity, very limited ROM, level specific neuro symptoms, positive SLR & slump test
Acute Nerve Root
-TREATMENT
MT - manual traction in supine or sidelying
Ther ex - lumbar rotation
Epidural steroid injection
Chronic Nerve Root
- DEFN
- MOI
- SYMPTOMS
chronic irritation to the nerve root/adhesion
MOI - history of disc pathology, NR injury, degenerative changes, spinal surgery/scarring
SYMPTOMS - PROXIMAL > DISTAL
- minimal limitation of activity, localized thickness in tissues, stiff at segment, pain w/ OP in ROM, movement impairments
Chronic Nerve Root
- TREATMENT
MT - unilateral PA’s, rotation, traction, soft tissue work
Mobility exercises
Segmental re-education
Treatment of neurodynamic & movement impairment findings
Spondylolysis
- DEFN
- MOI
- SYMPTOMS
Structural Instability
increased IV segment motion due to defect in pars interarticularis
MOI - extreme hyperextension, sports injuries, occupation
SYMPTOMS - increased IV segment motion & pain
Spondylolisthesis
- DEFN & classifications
- MOI
Structural Instability
slippage of vertebra (anterior) due to complete fracture
Grades: I - up to 25% II - 25-50% III - 50-75% IV - >75%
MOI - extreme hyperextension or fracture
Functional Instability
- due to
- DEFN
Due to DDD, ligament injury, muscle injury or poor motor control
DEFN -abnormal movement of one vertebrae over another, inability to maintain neutral zone or segmental hypomobility
Radiograph will appear normal
Functional instability
- SUBJECTIVE
- SYMPTOMS
Subjective info
- most common at L5/S1 (wt bearing joint)
- pain w/ extreme ext or rotation
- constantly changing their position, which will decrease pain
- history of catching or locking, giving way or feeling of instability **
- AGG by vigorous activity, static posture or returning from flexion **
History - chronic **
Functional Instability
- Objective info
Increased LL
End ROM provoke symptoms
Hesitation w/ flexion at 30-40 (global muscles shut down & local muscles kick in)
- Gower’s sign
- Extension reveals hinge
- Cetnral PA painful and altered end fel
Poor pelvic and abdominal control
Functional Instability
-TREATMENT (ther ex)
- Train local muscles FIRST
- -> tonic, low threshold exercises (10% contraction needed to stabilize the spine) - Pelvic control exercises
- train endurance!
- Muscles targeted: TA, multifidus, glutes, external obliques
- -> No global muscles (rectus abdominus)
DDD
- what is it
- due to…
Normal aging process, becomes pathologic when pain is involved
- disc integrity decreases
- decreased ability to retain water
- decreased ability to distribute load
DUE TO:
- Biochemical changes: dec rate of proteoglycan synthesis, type II collagen increases
- Nutrition deprivation due to lack of movement
- Mechanics: shear forces
- Genetics: bad collagen
DDD
- SUBJ
- SYMPTOMS
Commonly @ lumbosacral joint, males, 40-50’s
MOI - insidious, gradual onset due to aging
Symptoms:
- low grade ache, morning stiffness/pain
- rarely leg symptoms
- AGG: extending, bending, sitting, sustained posture, sudden motions
- ROM limited if acute
- pain w/ ext & rotation
- altered tissue texture
- sustained movements
- NEG SLR
History of repeated microtrauma, bone spurs, or significant trauma
DDD
- TREATMENT
GOALS: decrease compression, promote nutrition, improve mobility/flexibility, strengthen core muscles, promote function
- Education on body mechanics & unloading
- Ther ex: hip flexibility, disc rehydration in unloaded position
- 90/90 position, 15-20 minutes
Disc Herniation
- DEFN
- Clinical Presentation
displacement of nucleus pulposus
–> Most common @ L4/L5 (L5 nerve root) or L5/S1 (S1 nerve root)
Clinical Presentation:
- usually younger
- symptoms: poorly localized dull ache w/ referral, pain w/ COUGHING & SNEEZING, neurological signs
- lateral shift away from the pain
- sudden onset
Intraspongy Disc Herniation
fracture in endplate due to too much loading/compression
- nucleus migrates into vertebral body
- more common in TS
- erosion of trabecular bone = Schmorl’s nodes
