Evaluation of lower back

Question 1

What are redflags of lower back pain?

Answer 1

fractures, tumor, infection, cauda equina syndrome

Question 2

What is cauda equina syndrome

Answer 2

occurs when there is dysfunction of multiple lumbar and sacral nerve roots of the cauda equina. Causes numbness in your saddle area, pain in your back and legs, problems with peeing or pooping, difficulties with sex and weakness in your extremities.

Question 3

suspicions for cancer

Answer 3

weight loss, night pain, changes in bowels

Question 4

suspicions for cauda equina syndrome

Answer 4

sciatica, bilateral leg weakness, difficulty, urinary retention, unexplained constipation

Question 5

When is cauda equina a surgical emergency

Answer 5

Saddle anesthesia, Decreased anal sphincter tone associated with massive, central disc herniation

Question 6

arthritis of the spine seen as arthritic changes of the facet joint

Answer 6

spondylosis

Question 7

anterior displacement of a vertebra on the one beneath it. Slippage is on grades 1-4 (1 = 1-25%, 2= 26-50%, 3= 51 to 75%, 4 = above)

Answer 7

spondylolisthesis

Question 8

fracture in pars interarticularis where the vertebral body and the posterior elements , protecting the nerves are joined, usually at L5

Answer 8

sponndylolysis

Question 9

impairment of nerve root, usually causing radiating pain, numbness, tingling of muscles

Answer 9

radiculopathy

Question 10

If lower back pain and pt is under 20 years old

Answer 10

spondylolysis

Question 11

if there’s lower back pain and the pt is above 50 years old

Answer 11

can be systemic disease or pain unrelated to a spinal problem

Question 12

What do you look for in posterior view for lower back pain?

Answer 12

Symmetry (level of landmarks), Scoliosis, Active Regional ROM, Heel/ Toe walk, Trendelenburg Test - the provider stands behind the patient at the hip level and places their hands on the iliac crests on either side of the pelvis observing to see if it stays level during the single-leg stance.

Question 13

Lateral view of patient

Answer 13

lordosis, kyphosis
Weight bearing/ mid-gravitational line

Question 14

if patient stands very erect and dislikes forward bending..

Answer 14

think disc pathology, annular tear, bulge, acute strains/sprains

Question 15

if patient is erect and doesn’t like extension…

Answer 15

Think Spondylosis, Hypertrophy of lumbar zygoapophyseal (facet) joints,
Hypertrophy ligamentum flavum

Question 16

What is L4 nerve root a mediator for?

Answer 16

tibialis anterior (deep perinoneal), walking, patellar reflex, sensory of lower ankle, foot

Question 17

what is L5 nerve root a mediator for?

Answer 17

Motor to extensor hallucis longus, extensor digitorum longus and brevis, & gluteus medius.
ankle and great toe dorsiflexion, Stretch Reflex – Medial Hamstring Tendons
Sensory to Lateral Leg & Dorsum of Foot

Question 18

What is S1 nerve root responsible for?

Answer 18

Motor to Peroneus Longus/Brevis; Gastrocnemiu/Soleus & Gluteus Maximus
So walking on toes, plantar flexion
achilles reflex (asymmetric)
lateral & plantar plantar aspect of the foot/ankle

Question 19

Neuro genetic vs vascular claudication

Answer 19

if neuro: pain increases with increased walking up and down stairs. Vascular is relieved when seated immediately