Exam 2 Flashcards
Lumbar Spine
prognostic indicators of recurrent pain
Hx previous episodes
Excessive spine mobility
Excessive mobility in other joints
prognostic indicators of chronic LBP
Presence of symptoms below the knee
Psychosocial distress or depression**
Fear of pain, movement, and re-injury or low expectations of recovery
Pain of high intensity
A passive coping style
lumbar spine pain is classified as
Area bordered by transverse line from T12 – S1
sacral spine pain is classified as
Area bordered by vertical lines through PSISs and horizontal lines through S1 and sacrococcygeal joints
common sites of neoplasm metastasis
breast
lung
prostate
kidney
main pain complaints with neoplasms
Persistent
Not alleviated with “bed rest”
Worse at night
Neurologic symptoms
physical exam findings for neoplasms
Non-mechanical presentation
Age > 50 years
Anemia
Neurologic Signs
Lab tests for confirmation
epidural abcess– what is it and what can it be associated with
Haematogenous spread of bacteria into epidural space
Associated with DM, chronic renal failure, IV drug misuse, alcoholism, cancer
vertebral osteomyelitis
infection of the vertebrae themselves
what is the most common thing to see in pt’s history with vertebral osteomyelitis
bladder infection
who is at an increased risk for vertebral osteomyelitis
Immunocompromised patients
DM
pain complaints with vertebral osteomyelitis
Local, focal back pain
Worse with mechanical loading, improves with recumbent position
physical exam findings with vertebral osteomyelitis
Fever
Local tenderness
Aggravated with local percussion
Neurologic Signs (cord/ root)
Lab tests important for diagnosis
progression of epidural abscess
Local, focal back pain
Radicular signs/ symptoms
Paralysis
henschke cluster for vertebral fracture
Age > 70 years
Significant trauma
Prolonged corticoid steroid use
Sensory alterations from the trunk down
red flags for vertebral fracture
Older age
Significant trauma
Corticosteroid use
Contusion/ abrasion
roman cluster for vertebral COMPRESSION fracture
Age > 52 years
No presence of leg pain
Body mass index </= 22
Does not exercise regularly
Female gender
if serious health conditions are so uncommon, why do we need to still screen for them?
they are commonly misdiagnosed
better to be safe than sorry
likelihood is low but effects are significant if you find something serious
severity can prioritize unlikely conditions
spondylolysis
Fatigue fracture of pars interarticularis
MOI: Repetitive microtrauma with extension/ extension with side-bending activities
where do most spondylolysis typically occur
L5 level
spondylolysthesis
Anterior slip of the vertebra following bilateral spondylolysis
graded by amount of slippage
iatrogenic discitis
Most commonly from discography
Bacterial infection from needle during discography
Extremely painful
May lead to sepsis or epidural abscess
internal disc disruption
interrupts interior layers of the lamina
bulging (more give in areas that are weaker)
what is possible with discogenic pain and what is it
Schmorl’s nodes
Blood extruded from intraosseous veins in the marrow spaces
*Nucleus infiltrates vertebral body
