Evaluation of Lower Back Pain Flashcards
90% of all low back pain will resolve in ____ weeks without intervention
6
99% of all low back pain will resolve in ____ weeks
12
What are the goals of lower back pain treatment?
Hasten recovery
Control pain
Facilitate rehabilitation
What is the first question in the initial approach to back pain?
What is the most serious thing this could be?
What are some indicators of ominous history?
Bilateral radicular pain Saddle area anesthesia Urinary incontinence Urinary retention Increased urinary frequency
What is the treatment for cauda equina syndrome?
Surgical decompression within 24-48 hours
What to rule out if pt presents with weak and rapid pulse?
Retroperitoneal hemorrhage
What to rule out if pt presents with low blood pressure?
Retroperitoneal hemorrhage
Make a mark on the skin midway between the PSIS
Make a mark 5 cm down from this point
Make a mark 10 cm up from initial point
With trunk flexed, should stretch to a minimum of 20 cm
Shober test
< 20 cm indicates significant loss of lumbar motion
Gluteus medius innervation
L5 root
What does a positive Trendelenberg test indicate?
Weakness of gluteus medius (compromise of L5 nerve root)
Straight Leg Raising Test produces no symptoms to 90 degrees of hip flexion. What does this indicate?
Normal straight leg raising test
Pt has low back pain and cannot stand on toes due to muscle weakness. Which nerve root is compressed?
S1
Pelvic rock test reproduces pt’s pain. What is the most likely diagnosis?
Sacroiliitis
Pt with low back pain presents with fever and percussive pain at L1, L2, L3, and L4. What is the most like diagnosis?
Osteomyelitis
Which of the following muscles is innervated by L2-L4?
Extensor digitorum brevis Extensor hallucis longus Gluteus medius Quadriceps Tibialis anterior
Quadriceps
Which test looks for the same pathology as the Valsalva?
Naffziger test
Shober test shows post flexion number of 16 cm. Most likely dx?
Ankylosing spondylitis
Lower extremity weaknes
Low back pain
Neck pain
Left Babinski response
Most likely dx?
Multiple sclerosis
Grade 0 muscle strength is defined as…
Flaccid paralysis
Which test will exacerbate symptoms of any space-occupying lesion in the spinal canal?
Valsalva
Which test will determine the presence of an extension lumbar spine somatic dysfunction?
Sphinx test
In which test will pain radiating down the anterior thigh imply femoral nerve entrapment or disease?
Nachalas
What is a relative contradindication for OMT for low back pain?
Herniated nucleus pulposus
Which muscle is the most overlooked cause of low back pain?
Quadratus lumborum
Rapidly alternating muscle contraction and relaxation upon dorsiflexion of ankle indicates with diagnosis?
A disconnect between upper and lower motor neurons
Weakness of both gastrocnemius and soleus muscles indicates compression of which nerve root?
S1
Positive Gaenslen test indicates which condition?
Sacroiliitis
What is the best indication for OMT for low back pain?
Somatic dysfunction
Tibialis anterior is associated with which reflex?
Patellar
Extensor hallucis longus is associated with which reflex?
There is no reflex associated
Which test will determine the presence of a lumbar somatic dysfunction?
Sphinx test
Which imaging modality would most accurately image herniated nucleus pulposus?
MRI
Herniated nucleus pulposus is most likely found at which level?
L4-L5
Loss of sensation in the web space between first and second toes would indicate compression of which nerve root?
L4-S1
With pt supine, you restrain the sternum and passively flex the neck. This reproduces pain in the lower thoracic region. Which test is this?
Soto Hall
