Common Health Conditions Of The Lumbo-pelvic Spine Flashcards
1
Q
What percent of LBP is from a strain/sprain?
A
60-70%
2
Q
What percent of those with neck pain is pain from a sprain/strain?
A
85%
3
Q
What are the ways in which a sprain/strain can be acquired?
A
Primary traumatic event
Secondary traumatic event
Cumulative trauma disorder (CTD)
4
Q
T/f: underlying structural or fxnal impairments can lead to sprains/strains
A
True
5
Q
Overuse associated fatigue can cause what?
A
Sprains/strains
6
Q
T/f: closing/opening dysfunction can cause sprains/strains
A
True
7
Q
Facet joints have what kind of innervation?
A
Triple innervation from at, above, and below the joint
8
Q
Why does radiofrequency ablation of just the nerve at the affected facet joint not work to reduce pain?
A
Because facet joints have triple innervation from at, above, and below the joint
9
Q
What things should we be thinking about when deciding if a pt has a sprain/strain?
A
Do they have a hx of trauma?
Do they have transient neuro s/s?
Do they ROM deficits?
10
Q
What kind of patterns do we have to differentiate with ROM deficits in sprains/strains?
A
Myofascial or capsular
11
Q
What is involved in interventions for sprains/strains?
A
Address the cause
NSAIDS
protection to gradual motion
Joint and soft tissue mobilizations
12
Q
What is the prognosis for sprains/strains?
A
90% will resolve within 8 weeks
Generally good depending on how recurrent the issue is
13
Q
T/f: sprains/strains can be chronic with an acute an overlay
A
True
14
Q
What percent of the general population has a herniated nucleus pulposus?
A
2%
15
Q
What age range is mostly affected by herniated nucleus pulposus?
A
25-50 year olds
16
Q
What percent of those with a herniated nucleus pulposus (HNP) have pain?
A
80%
17
Q
What percent of those with HNP have radiculopathy?
A
35%
18
Q
How many cases of HNP are in the cervical region?
A
.1 and 1000
19
Q
What are the most common spinal segments that get HNP?
A
C5-6, L4-5, L5-S1
20
Q
Why are spinal segments C5-6, L4-5, L5-S1 the most susceptible to HNP?
A
Bc they are the most mobile spinal segments
21
Q
Patients with HNP generally have prolonged ______ and loss of ______
A
Flexion, extension
22
Q
90% of HNP are _____ radiculopathies
A
Posterolateral
23
Q
What are the stages of HNP?
A
Pre-discal
Immediate
Settled
Chronic
24
Q
What stage of HNP is characterized by a dull ache?
A
Stage 1
25
What stage of HNP is characterized by sharp, local pain with no neuro s/s?
Stage 2
26
What stage of HNP is characterized by a lateral shift, neuro s/s, and peripheralizes with repeated movt?
Stage 3
27
What stage of HNP is characterized by variable neuro s/s?
Chronic stage
28
Forward bending results in ____ bulge and ____ nucleus shift
Anterior, posterior
29
Backward bending results in ____ bulging and ____ nucleus shift
Posterior, anterior
30
What happens when a disc encroaches on the foramina?
Neuro s/s
31
T/f: discs lose hydration with age
True
32
Hat spinal segments does the SC end and the cauda equina begin?
At L2
33
Is fluid on a T1 weighted image light or dark?
Dark
34
Is fluid on a T2 weighted image light or dark?
Light
35
Is T1 or T2 better to appreciate normal anatomy?
T1
36
Is T1 or T2 better to appreciate inflammation?
T2
37
Is T1 or T2 better to appreciate acute hemorrhage
T2
38
Does T1 or T2 show muscle, fat, cartilage?
T1
39
T/f: we can use traction or extension to help take pressure off a herniated disc
True
40
What physical exam findings would we expect for HNP?
Unilateral neuro s/s, symptomatic referral patterns, and poor tolerance for flexion
41
Does pts with HNP tend to have poor tolerance for flexion and extension?
Poor tolerance for flexion
42
Hat scans can show us a HNP?
MRI, CT, or myelogram
43
What is a myelogram and what does it show us?
When a dye is injected into the CFS and an x ray is done
It can show on a herniated disc or space occupying lesion
44
What do pts have to be cautious of following a myelogram?
Getting up too quickly bc of the increase in CSF pressures from the dye
45
What is the prognosis for HNP?
80% get better with conservative therapy
46
What is the reoccurance of HNP?
6%
47
The outcomes for HNP are more favorable when?
When the annulus is “competent” (no extruded disc materials)
48
T/f: the epidemiology of DDD follows that of HNP
True
49
When a do pts with DDD begin losing water content and GAGs from their discs?
At 30 yo
50
At _____ years old, the nucleus becomes fibrous and vascular channels in the end plate close in DDD
40
51
At ________ years old osteophytes begin to form from annular tension and they experience posterolateral radial tears in DDD
40-60
52
At ______ years old the nucleus and annulus is indistinguishable and there is reduced height in DDD
Over 60
53
What are the phases of DDD?
Early dysfunction phase
Intermediate instability phase
Final stabilization phase
54
During what phase of DDD is the movt stable bc of lack of movement
The final stabilization phase
55
What are the interventions for HNP?
Conservative care
NSAIDS
epidural injections to reduce local inflammation
Microdiscectomy, laminectomy, fusion, or replacement
56
What is the risk with getting a spinal fusion?
The lack of motion can cause compensations above and below the segment
57
What segment is more affected in DDD, L4/5 or L5/S1?
L4/5
58
What symptoms may we see that make us think a pt has DDD?
Morning stiffness
Radiculopathy
Poor tolerance for extension
Narrowed disc space
59
Do pts with DDD tend to have poor tolerance for flexion or extension?
Extension
60
What are some interventions for DDD?
Flexion biased regimen NWB
Manual/mechanical traction
Pharmacology (anti-inflammatories, analgesics, muscle relaxants, epidural/facet injection)
61
If a pt with DDD has difficulties with knees to chest, what should we have them do?
Seated lumbar flexion with tactile cue to the lumbar spine to prevent hip flexion
62
The severity of the prognosis of DDD dictates the disability
False
63
What is spondylosis?
Arthritis of the spine
64
What are other names for spondylosis?
Lateral foraminal stenosis and facet DJD
65
How many of those over 40 yo have osteophyte formations (some degree of DJD)?
100% of those over 40 yo
66
Are more males or females younger than 45 affected by spondylosis.
More males than females
67
Are more males or females older than 55 more affected by spondylosis?
More females are affected
68
What factors increase risk for spondylosis?
Genetic factors
Biomechanical factors
69
T/f: spondylosis can be preceded by DDD
True
70
What are the symptoms to look out for for spondylosis?
Mixed neuro s/s
pain with prolonged positions
Pain with closing activities
Decreased disc space, IVF, and osteophytes
71
What are some interventions for spondylosis?
Facet injections
Conservative care
72
What are some conservative care interventions for spondylosis?
Traction
Flexion-biased regimen
Mobilizations to curtail progression
73
What are the signs that a pt likes flexion or extension?
Centralization of symptoms
Pain relief
Preferred position
74
What is the prognosis for spondylosis?
Gradual progression with more frequent relapses
75
20-25% of those with spinal stenosis are over _____ years old
40
76
T/f: spinal stenosis may be the sequeala of HNP, DJD, or DJD
True
77
T/f: spinal stenosis causes compression of the SC within the spinal canal
True
78
What is the difference bw neurogenic claudication and vascular claudication?
Neurogenic claudication can be relived with flexion (positive shopping cart sign) while vascular claudication will not
79
What are some UMN signs?
Hyperreflexia
Hoffmann sign
Clonus
80
Why does Hoffmann sign, hyperreflexia, and clonus occur in UMN injury?
Bc there is no inhibition from above
81
What are some LMN signs?
Myotomal weakness
Hyporeflexia
82
Why is there myotomal weakness and hyporeflexia in LMN injury?
Bc there is disrupted feedback loop leading to muscle inhibition
83
Are symptoms usually uni or bilateral in spinal stenosis?
Bilateral
84
What are some interventions for spinal stenosis?
Fluoroscopically guided epidural injections
Conservative care similar to spondylosis
Monitoring of neuro s/s
85
What is the prognosis for spinal stenosis with surgery?
63% pt satisfaction
70% improved leg and back pain
86
What is the prognosis for spinal stenosis with conservative care?
42% pt satisfaction
52% improved back and leg pain
87
Is the prognosis for spinal stenosis better with surgery or conservative care?
With surgery
88
What is the prognosis for spinal stenosis is the pt gets no care?
70% no change
15% worse
89
What age group is most affected by spondylolisthesis and spondylolysis?
Those younger than 26 yo
90
T/f: spondylolisthesis and spondylolysis are rarely the primary problem in those over 40
True
91
What is spondylolisthesis?
Anterior translation of a vertebrae
92
If a vertebrae seems very prominent, what pathology may be present?
Spondylolisthesis
93
When a vertebrae is very prominent and the next drops off when palpating in a spondylolisthesis, what is this sign called?
Drop off sign/step off sign
94
What is spondylolysis?
Fracture of the pars interarticularis
95
What is the pars interarticularis?
The part that connects the vertebrae to the lower facets
96
We may not see issues with spondylolisthesis or spondylolysis until the person does a lot of what?
Extension activities
97
What extension activities may trigger symptoms in spondylolysis and spondylolisthesis?
Gymnastics, wrestling, football linesmen, OH activities, or swimming
98
Surgery may be needed for spondylolisthesis and spondylolysis stage ____
3-4
99
Would stable or unstable spondylolisthesis and spondylolysis have symptoms of instability?
Unstable
100
Would stable or unstable spondylolisthesis and spondylolysis be asymptomatic?
Stable
101
What would a radiograph show in spondylolisthesis and spondylolysis?
Scotty dog
102
Do pts with spondylolisthesis and spondylolysis respond better to flexion or extension?
Flexion
103
What are some interventions for spondylolysis and spondylolisthesis?
Flexion based regimen
DLS
Bracing
Mobilization of adjacent segments
Fusion
104
What spinal segments would be tight in spondylolysis or spondylolisthesis?
The adjacent segments
105
What is the prognosis for spondylolysis and spondylolisthesis?
>50% progression
106
T/f: surgical and non-surgical interventions for spondylolysis and spondylolisthesis have similar outcomes
True
107
What are the red flags that would make us suspect cauda equina syndrome?
Saddle parenthesia
Sensory and motor deficits in L4/5/S1
Urinary and fecal incontinence
108
What motions may lack in cauda equina syndrome bc of the deficits in L4/5/S1?
Lack ankle DF, PF, and toe extension
109
What red flags would we look for that make us suspect a spinal tumor?
The pt is older than 50
Unremitting pain
Failure of conservative management
Hx to has a hx of cancer
Unexplained weight loss
110
What is unremitting pain?
Pain that cannot be relieved with position changes
111
What s/s would make us suspicious of spinal fracture?
Chronic use of steroids
Hx of traumatic events
Pt is over 70 years old
112
What is included in the PMHx for the spine?
Hx of LBP
Hx of interventions
Related PMH (urogenital, OBGYN, visceral)
113
What is the HPI for the spine?
Age related dysnfxn
Occupation related dysfunction
Gender related dysfunction
MOI
pain behavior
Hx of meds
114
What info should we get using the VAS or NPRS
The current, best and worst pain on a scale of 0-10
115
A rating of 0-2 on the VAS indicates what level of pain?
Low
116
A rating of 3-5 on the VAS indicates what level of pain?
Moderate
117
A rating of 6-10 on the VAS indicates what level of pain?
High
118
What is the most common VAS score for magnifiers?
7
119
What is the Global Rating of Change (GROC) used for?
To quantify the self-perceived extent to which a pt has improve or gotten worse over time
120
What test/measure is a single question used to compare the status of change in symptoms at two different time intervals?
GROC
121
T/f: the GROC is used to objectively measure how much the pt feels they have improved
True
122
What is the STarT Back Screening Tool used for?
It is a primary care tool for pts with LBP used to ID high risk groups for poor outcomes
123
A score of 0-3 on the STarT Back Screening Tool indicates what?
Low risk
124
A score of 4-9 on the STarT Back Screening Tool indicates what?
Medium risk
125
What is the Oswestry Disability Questionnaire used for?
Identifying the effects of chronic LBP on ADLs
126
What does 0-20% on the Oswestry indicate?
Minimal disability
127
What does 20-40% on the a Oswestry indicate?
Moderate disability
128
What does 40-60% on the Oswestry indicate?
Severe disability
129
What does 60-80% on the Oswestry indicate?
Crippled
130
What does 80-100% on the Oswestry indicate?
Bed bound or exaggeration of symptoms
131
What is the fear avoidance questionnaire used for?
To determine the fear avoidance levels of patients with a higher score indicating higher fear avoidance
132
What are the two subscales of the Fear Avoidance Questionnaire?
Work sub scale and physical activity sub scale
133
What is the Roland-Morris Disability Questionnaire used for?
To describe the acute LBP that pts have
Mostly for mild to moderate disability
134
What is the McGill Pain Questionnaire used for?
To classify the pain rating of pts
135
What are the three major classes of word descriptors used in the McGill Pain Questionnaire?
Sensory, affective, and evaluative
136
What are the three measures of the McGill Pain Questionnaire?
1) pain rating index
2) # of words chosen from the 20 groups
3) present pain intensity (1-5 scale)
137
What is the Ransford Pain Drawing?
An image of the body the pt is asked to draw on to ID the location and description of pain
138
A total score of >___ on the Ransford Pain Drawing indicates the need for a psych eval
3
139
T/f: the Ransford Pain Drawing is effective at identifying 93% w/psych overlay
True
140
What are the three groups of pts that can be determined from the Ransford Pain Drawing?
Organic
Amplified organic
Non organic
141
What is the PSFS used for?
Determining how problematic pt’s daily activities are for them
142
What outcome form helps predict work absenteeism?
The Orebro MSK Pain Questionnaire
143
What is the Orebro MSK Pain Questionnaire used for?
To ID barriers to recovery including the pt’s context and psychosocial factors that influence their pain and disability
144
What does a score of >50 on the Orebro MSK Pain Questionnaire indicate?
Risk for future work disability
145
What is a lesser used outcome form for depressive symptoms, anxiety, fear avoidance, kinesiophobia, catastrophizing, self-efficacy, and pain acceptance?
The OSPRO-YF
146
T/f: the OSPRO-YF identifies yellow flags to care
True
