DSA Back pain Flashcards
What are 2 protective factors low back pain?
- Regular excercise
2. education
What are 3 risk factors for low back pain?
- lifting
- smoking
- depression
What is the most common cause of back pain?
Mechanical (90%)
2 % of low back pain is due to ?
visceral etiologies (GI organs, abdominal aorta , renal , endometriosis)
1 % of low back pain is due to ?
nonmechanical etiologies ( neoplasms. infection, inflammatory)
Strain of which 3 back muscles contributes to lower back pain?
- paraspinals (multiifidus / rotatores)
- erector spinae
- quadratus lumborum
Injury to what 2 ligament contributes to low back pain?
- iliolumbar
2. sacroiliac
Aching/ burining pain in gluteal region, paresthesia down posterior thigh is ________?
Piriformis syndrome
What makes the pain worse in piriformis syndrome?
sitting
What test is used to Dx piriformis syndrome?
FAIR test. (lie lateral recumbent, flex, adduct. internal rotation)
Patient with pain at thoracolumbar junction or hip pain at the insertion tendon is ?
psoas syndrome
Psoas syndrome is made worse by?
lumbar extension
standing straight
What tests are used to dx psoas syndrome?
- Thomas test
2. Pelvic Shift
A Patient with psoas syndrome on the left will have a _____ sided pelvic shift test?
RIGHT (it is opposite the dysfunction
If patients pelvis translates easy to the left they have a ______ sided. psoas syndrome/?
RIGHT
Short leg syndrome is due to ?
sacral base unleveling
Pt with scoliosis may be at increased risk for _____?
Short leg syndrome
Short leg syndrome pain is made worse by?
activity or walking
What test for short leg syndrome?
pelvic side shift. (does not resolve with manipulation)
A left anatomic short leg will have a ______ pelvic side shift test)
RIGHT
A flexible pt with short leg syndrome you will treat by adding ______‘inches every two weeks
1/8
A fragile pt with short leg syndrome you will treat by adding ______ inches every two weeks
1/16
If pt loses height right after surgery how should you approach treatment?
replace the full length immediately , you dont need to do increments
bending forward, sneezing, coughing, can excacerbate someone who has?
Degenerative disc disease
Discogenic pain is characteristic for?
Degenerative disc disease
Defect or stress fracture of pars interarticularis?
spondylolysis
Pain pattern for spondylolysis?
pain most common at L5
Who is at increased risk for sponylolysis?
young athletes ( repetitive stress/ developing bones)
What makes the spondylolysis pain worse?
hyperextension (posterior stress)
Posterior stress makes ______ worse , Anterior stress makes _______ worse?
Spondylolysis, Degenerative disc disease
Scotty dog finding on lumbar Xray?
spondylolysis
Anterior displacement of vertebrae secondary to bilarteral pars defects?
Spondylolistheisis
What are 2 things that increase risk for Spondylolistheisis?
- Age (osteoarthritis)
2. bilateral spondylolysis
What makes the pain worse in Spondylolistheisis?
extension and activity
How do you dx Spondylolistheisis?
palpable step off on PE
What increases risk of compression fracture?
age <55
osteoporosis
menopause
malignancy (cancer)
WHat makes a compression fracture pain worse?
sitting
spine extension
valsalva maneuveur
Someone that presents with acute ATRAUMATIC PAIN, likely has ?
compression fracture
Narrowing of the neural foramen or central canal?
spinal stenosis
Unilateral numbeness of which nerve roots in spinal stenosis?
L4/L5/S1
Standing/ walking make spinal stenosis ________, (better/worse) and sitting/lying down makes it _________
Worse, better
Shopping cart sign is indicative of ?
spinal stenosis
compression of nerve roots due to herniation of nucleous pulposis through annulus fibrosis?
Herniated disc
Most common lumbar discs involved?
L4/L5 (L5 nerve roots
L5/S1 (S1 nerve roots)
What motion makes herniated disc worse?
flexion
CAuda equine is due to a ?
disc herniation
What is the pain pattern of cauda equina?
- saddle anesthesia
- fecal / urinary incontinence
- numbness /tingling
What increases risk of cauda equina?
TRAUMA
When should you order imaging for low back pain?
- progressive neurologic deficit
- saddle anesthesia
- deep bone pain (neoplasms)
- fever/ chills (osteomylitis)
What conditions make up Greenmans Dirty HalF dozen?
- Muscle imbalance- 100%
- lumbar spine type 2 -84%
- pubic symphisis dysfunction -75%
- short leg- 63%
- sacral extension- 48%
- innominate shear- 24%