EEO Midterm - Spine Lecture Flashcards
Foraminal stenosis
-Narrowing of intervertebral foramen, pinching the spinal nerve root.
-usually seen later in life, caused by prior injuries and repetitive motions
-SHOOTS IPSILATERAL RADICULAR PAIN DOWN THE ARM
What tests should you give to a patient who has foraminal stenosis, central stenosis, or a cervical disc lesion?
-NDI
-Grip strength dynanometer
-Cervical flexor endurance test
What is a primary difference in the symptoms of foraminal stenosis vs. central stenosis?
Foraminal stenosis will have unilateral symptoms, whereas central stenosis will have bilateral symptoms
What tests or measures can you give to someone who has foraminal stenosis?
-Cervical AROM
-Cervical MMT
-Reflex testing
What are typical causes and symptoms of central stenosis?
Anteriorly: Disc pathology
-affects motor and sensory function
Posterior: Hypertrophy of the ligamentum flavum
-affects certain types of sensory function
What are some unique tests and measures for central stenosis?
-Testing balance
-Hoffman reflex
-Shumizu reflex
These can be done because central stenosis will cause a UMNL, whereas foraminal stenosis will cause a LMNL!
What is a cervicogenic headache, and where would you expect the patient to report pain from?
-A headache that starts at the neck and migrates to the head
-Pain is usually experienced at the top of the head as well as the suboccipital region
-affects concentration, ability to read, vision, and mood
-likely due to an upper cervical spine dysfunction (C0, C1, C2)
What are some questions to include in the subjective interview for someone with cervicogenic headache?
-Which exact areas of the head or face hurt? Point to one specific area.
-Which activities bring on the headache?
-How much screen time do you have?
-What does a typical day look like for you?
What cranial nerve may contribute to cervicogenic headache?
Trigeminal (CN V)
In what age range are vertebral disc problems most common?
20’s to late 40’s
What are common causes and symptoms of cervical disc pathology?
Causes:
-prolonged flexion or whiplash
-typically dislocates posteriorly / towards the spinal canal
Symptoms:
-Bilateral presentation, motor symptoms first then can progress to sensory
-sensitivity to weightbearing
-will sometimes cause radiating pain down the arm. Not always!
True or false. Disc problems most often lead to chronic pain that does not dissipate.
False!
Disc problems tend to come in waves, with periods of relief then returning symptoms later on.
This is why it is important to ask patients if they have had previous episodes of radicular pain if you suspect disc pathology!
What are the patient presentations presentations of whiplash?
-Muscle spasm and tightness
-Disc-like symptoms in lower cervical spine
-Can sometimes present like brain stem-type injury in upper cervical spine
What are the tests and measures you would use for a patient who has whiplash?
-JPSE Laser-proprioception test
-Test UE reflexes like Shimizu for UMNL
-Eye movements for CN damage
-Screen cervical AROM and ROM as well as endfeels
-Cervical MMT
-UE myotomes + dermatomes
What is the typical cause of degenerative disc disease?
Spondylosis and/or wear and tear
Basically, the nucleus pulposis dehydrates with age which causes the discs to shrink and become more convex
What are some outcome measures you can use for lumbar DDD?
-Oswestry Disability Index (ODI)
-Modified plank
-5x Sit -> Stand
-Functional lumbar index (FLI)
When are some tests and measures to use for lumbar DDD?
-Assessing posture and gait
-Trunk and hip MMT
-Thoracolumbar AROM
-Nerve screen of the LE’s
What is the typical MOI for lumbar spine disc pathology?
Flexion and rotation, causes most of the discs to herniate POSTERIORLY
L4 and L5 are most commonly hurt!
What do the symptoms of lumbar disc pathology present?
-Unilateral presentation
-can be both motor and sensory, depends on how severe the herniation
-pain is reproduced with Valsava or weightbearing
A patient with lumbar DDD will typically have more pain at what time of day?
The morning
What are important subjective questions to ask in the differential diagnosis of DDD?
-Do you have any areas of the leg with less sensation?
-Any loss of strength to the lower leg or foot?
What motion will someone with lumbar DDD have a hard time performing?
Squatting
Before assessing a patient coming in for UE or LE pain, what should you ALWAYS DO?
Clear the spine!
What is the lumbopelvic rhythm, and what are some common errors associated with it?
Rhythm for bending forward (opposite when going back up)
1. Lumbosacral flexion
2. Anterior pelvic tilt
3. Hip flexion
Errors:
-only pelvic motion
-only lumbar motion
- a + Gowers sign
- a + “S” or “C” upon standing upright
What is the typical MOI and presentation of spondylolisthesis?
MOI:
-repetitive or macrotraumatic hyperextension
-typically affects L5
Presentation:
-if minor injury, localized pain
-if major injury, bilateral radicular symptoms
What motion will cause problems with someone who has spondylolisthesis of the lumbar spine?
Extension!
What are some tests and measures to aid in the differential diagnosis of spondylolisthesis?
-POSTURE. Can feel where the vertebra dislocates
-Lumbar AROM (be careful or avoid extension!)
-Reflexes
-Derma + Myotomes
-Trunk MMT
What are some subjective factors to keep in mind when assessing chronic low back pain?
-Motivation interviewing
-Activity level of the patient
-Pain psychology
-Patient education
What are some aggravating and relieving factors of lumbar spinal stenosis?
Aggravating - walking or standing for a short period of time
Relieving - Sitting in a flexed or slouched position
What functional outcome measure is best for someone with lumbar spinal stenosis?
6 minute walk test to assess for pain that starts after walking for a little bit
Basically any measure that assess walking endurance will be good!
SIJ Hypermobility
MOI
-More common in young or pregnant females
-Aggravated with macrotrauma
Patient Presentation
-Pain at SI joint, can unilaterally radiate down posterior limb to the knee
-often seen in a hypermobile patient
What is functional instability?
MOI
-repetitive motion
-macrotrauma
Patient Presentation
-can’t sit or stand in unsupported position for prolonged time
-altered or abnormal movement patterns
-can happen in any part of the spine
-weakness in deep stabilizing muscles
What are some clinical practice guidelines for functional instability?
Subjective
-ask about tolerances for sitting and standing
Performance measures
-look at endurance posture tests such as the Sorensens, side plank, or prone plank
-Lumbar AROM
-Hip and trunk MMT
Cervical AROM Values
Flexion = 40 degrees
Extension = 50-70 degrees
Sidebending = 22 degrees
Rotation = 70-90 degrees
Thoracolumbar AROM Values
Flexion = 60 degrees
Extension = 25 degrees
Sidebending = 35 degrees
Rotation = 45 degrees
Lumbar AROM Values
Flexion = 40-50 degrees
Extension = 15-20 degrees
Side bending = 25 degrees
What are the two most common self-report measures for the spine?
Neck Disability Index (NDI)
Oswestry Disability Index (ODI)
What performance test can be done for older patients experiencing low back pain?
5x Sit to stand
What should be performed when the patients primary complaint is NOT the spine?
Clear the spine!
Helps to to rule out the spine as a contributing factor.
What all is tested when clearing the spine?
-AROM of spine (all 6 directions)
-RROM of spine (all 6 directions)
-Overpressure of all 6 directions
-Compression and distraction (cervical spine only)
Look to see if moving the spine either alleviates or recreates the pain and the patient’s quality of motion!
In kyphosis, the convexity of the spine faces ______, but in lordosis the convexity of the spine faces _____.
Posteriorly; anteriorly
What areas of the spine are most likely to experience disc issues?
Transition zones
-the discs take extra pressure here and the joints can get stuck
What are hinge points?
Basically the same thing as transition zones. The vertebrae can get stuck and add extra pressure, and the nearby muscles become shortened or overstretched
Common areas are lower cervical and lower lumbar area
What is postural dysfunction normally caused by?
Changes in normal kyphosis and lordosis
What part of the spine is prone to exhibit reverse lordosis?
The cervical spine
This happens when the cervical spine loses its normal curve and becomes straight
Aggravating and relieving factors for foraminal stenosis
Pain relieved by bending AWAY from the affected side, opens up the foramen
Pain is made worse by bending TOWARDS the affected side. Closes the foramen even more!
Which spinal levels affect grip strength?
C6-C8
Which outcome measure is useful for assessing the severity of central or foraminal stenosis in the cervical spine?
Cervical flexor endurance test
