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MS II > Exam 3: Lumbar (1-4) > Flashcards

Exam 3: Lumbar (1-4) Flashcards

1
Q

true or false:

Spinal treatment should be approached in the same way as with the extremities

A

true

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2
Q

__% of adults have LBP at some point in their life. ___ million north americans will have LBP

A

80; 10

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3
Q

____ accounts for 25% of all lost work days. Secondary to ____

A

back pain; headaches

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4
Q

LBP is the most common cause of disability in those under ___ years old

A

45

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5
Q

True or False:

There is a lot of evidence to support how PT’s can treat LBP

A

false, there is little evidence which has caused a lot of lab myths

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6
Q

True or False:

Most people with low back pain will get better no matter what you do

A

False, that is a myth

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7
Q

True or False:

Disability from LBP has decreased over the last 25 years

A

False, it has dramatically increased and even is causing disability

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8
Q

True or False:

The medical community knows how to approach the problem and has a grip on treating LBP

A

False

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9
Q

True or False:

Where an individual lives and the medical professional they see, often determines the rate of surgery

A

true

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10
Q

True or False:

The united states has the lowest rate of back surgery when compared internationally

A

False, it is at least 40% higher than any other country

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11
Q

True or False:

Surgical intervention has shown to have better effectiveness in treating pain over other non-surgical management

A

false, it has not shown to be better

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12
Q

List 5 risk factors for LBP

A
  1. Smoking - causes coughing/poor oxygen
  2. Spending more than 1 hour a day in a car
  3. Spending more than 1 hour a day enduring vibratory forces
  4. Full term pregnancy with vaginal delivery
  5. Heavy lifting (weak)
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13
Q

List 5 work requirements that can be predictors of LBP

A
  1. Unexpecting lifting (PT and patients)
  2. Lifting and rotating
  3. Static work positions
  4. Vibrations
  5. Handling materials while seated
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14
Q

True or False:

Workers that see a PT one month within the initial injury, are likely to return to work faster than those who see a PT after 1 month of the injury

A

true

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15
Q

Explain the correlation between individuals taking time off work for LBP and the rate at which they will return to work

A

A person who is away from work for 6 months has a 50% chance of returning. Any time greater than 1 year away drops down to 25%

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16
Q 
The biopsychosocial model encompasses numerous aspects besides physical dysfunction including
\_\_\_\_\_\_ distress
attitudes and \_\_\_\_
The social \_\_\_\_\_
Illness behavior
A

psychological
beliefs
environment

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17
Q

True or False:

Precise diagnosis for LBP is unknown in 80-90% of disabling cases

A

true

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18
Q

Although true pathoanatomical LBP is uncommon, the pain could also be either ___ or _____ in nature.

A

biochemical and neurophysiological

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19
Q

True or False:

The spine can be tested like the extremities

A

False

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20
Q

True or False:

The tissue in the spine react like those in the extremities and response favorably to non-destructive stress

A

true

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21
Q

Serotonin a good thing in the (CNS/PNS) system, but it is an inflammatory/pain producer in the (CNS/PNS)

A

CNS is good

PNS is pain

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22
Q

Nociceptors are generators of ____

A

pain.

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23
Q

True or False:

Nociceptors increase in activity in the presence of inflammatory response chemicals like prostaglandin or serotonin

A

True

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24
Q

(nociceptors/muscles) = free nerve endings

A

nociceptors

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25
Q

(nociceptors/muscles) = many nerve endings

A

muscles

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26
Q

Explain the results of the “Management Patterns in Acute Low Back Pain” study with Medicare beneficiaries

A

There was a strong associations between PT and a decrease in likelihood of subsequent surgery/injections. Seeing a PT sooner rather than later also decreases the likelihood of surgery/injections

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27
Q

True or False:

General physicians were the highest proportion of visits but had the lowest rate of PT referrals

A

true

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28
Q

What is the first rule of medicine

A

do no harm

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29
Q

What are four functions of the lumbar spine

A
  1. Supports the body
  2. facilitates movement
  3. Protects the spinal cord
  4. Shock absorber
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30
Q

Development of the spine includes ossification, notochord recession, blood flow to the IVD, and bone density. What are the two subparts of ossification

A

sacralization and lumbarization

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31
Q

True or False:

Lumbosacral anomalies are often the source of LBP

A

False, they are asymptomatic

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32
Q

What are the implications of tropisms and pain/function

A

Tropisms occurs as a stress response and may cause asymmetric loading later in life or as a developmental issue, but there is no clinical relevance linking tropisms to pain

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33
Q

Development of the spine includes ossification, notochord recession, blood flow to the IVD, and bone density. What is the subpart to notochord recession

A

schmorl nodules

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34
Q

The ____ is the defining structure of the spinal development, and serves as a major skeletal element of the developing embryo.

A

notochord

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35
Q

What is a schmorl’s node

A

A variety of herniation from nucleus into the vertebral body

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36
Q

True or False:

Schmorl’s node are related to LBP

A

false; 1/3 people have schmorl’s node and don’t know it

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37
Q

What parts of the spine do schmorl’s occur the most

A

lower thoracic and upper lumbar

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38
Q

Even though Schmorl’s nodes do not cause back pain, but under what circumstance can they can be correlated to pain

A

When underlying conditions like osteoporosis or degeneration occurs

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39
Q

What is scheuermann’s disease

A

Where 5 vertebrae have an anterior wedge greater than five degrees in the anterior spine

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40
Q

True or False:

Scheuermann’s disease will increase thoracic kyphosis

A

true

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41
Q

Development of the spine includes ossification, notochord recession, blood flow to the IVD, and bone density. What are the two subparts of blood flow to the IVD

A

avascular IVD and disc degeneration

42
Q

True or False:

The vertebra AND disc are both vascular in the fetus and infant

A

true

43
Q

A picture on a slide shows a transverse section of a fetal disc. We know what the picture is showing because blood vessels and nerves grow into the outer annulus in fetal life. The ____ disappear in childhood, but the ____ remain.

A

blood vessels; nerve

44
Q

True or False:

The adult disc is avascular

A

true

45
Q

___ exercises have been shown to produce some of the largest amounts of fluid transfer in the IVD and also to decrease IVD swelling/pressure

A

extension

46
Q

Development of the spine includes ossification, notochord recession, blood flow to the IVD, and bone density. What are the two subparts of bone density

A

osteoporosis and disc degeneration

47
Q

When a child begins ambulating the lumbar endplate changes from (convex/concave) to (convex/concave)

A

convex to concave

48
Q

How to identify osteoporosis in an image

A

you will see a central compression with bowing of endplates and central expansion of discs

49
Q

As one ages, how will the change in lumbar vertebrae shape change

A

they will become shorter, wider, and have increased endplate concavity

50
Q

Females have a lifetime risk of __% of developing osteoporosis compared to men who have __%

A

40; 13

51
Q

Which is more common hip fx or vertebral body fx

A

vertebral body

52
Q

The vertebral body fx prevalence of 5% at age _____, 10-15% at age _____, and 50% at age ____

A

5 at 50
10-25 at older than 50
50 at older than 80

53
Q

In the aging lumbar discs, proteoglycans and water are decreased. What is the role of the proteoglycans

A

they attract water

54
Q

When will a fissure become symptomatic

A

when it reaches the outside of the annulus

55
Q

True or false:

A loss of stature is mostly contributed for the thinning of the lumbar disc

A

False, it is more from the loss of vertebral body height rather than disc space

56
Q

A loss of stature/shortened height from shorter vertebral body height will caused (increase/decrease) (kyphosis/lordosis)

A

decreased lordosis

57
Q

True or False:

Sacralization and lumbarization are not linked to pain

A

true

58
Q

True or false:

Schmorl nodules are correlated to pain

A

false, they are not. only a poor correlation with scheuremann’s disease

59
Q

What is absolutely needed with avascular IVD

A

MOVEMENT

60
Q

Is disc degeneration linked to pain

A

poorly and only if other contributing factors may lead to the developmental pain

61
Q

True or False:

Aging is closely linked to LBP

A

False, there’s really no correlation

62
Q

What location do a lot of stress fx have within the bony structures of the spine

A

pars inticularis

63
Q

What are the three parts to an intervertebral disc

A

annulus fibrosus
cartilage endplate
nucleus pulposus

64
Q

Why are the rings angled in the annulus fibrosus

A

to handle tensile forces for rotation

65
Q

What are the two parts of the annulus fibrosus

A

ligamentous outer

cartilaginous inner

66
Q

The outer ligamentous annulus has low _____ content meaning there is low water content

A

Proteoglycan

67
Q

The (inner/outer) annulus has a high proteoglycan content so it serves as load bering

A

inner

68
Q

True or false:

The outer annulus of the intervertebral disc are innervated by nociceptive nerve fibers

A

true

69
Q

Describe the relationship between the blood vessels and nerves with the outer annulus

A

blood vessels and nerves grow into the outer annulus, but during childhood, the blood vessels disappear and the nerves are left

70
Q

The ____ ____ is a pathway for diffusion for nutrients to disc and is a barrier between avascular nucleus and vascular

A

cartilage endplate

71
Q

Describe the blood flow to the vertebra and disc as aging continues

A

In fetus and infant life the vertebra and disc have blood supply. During childhood the disc loses its blood supply but the vertebra continues to be highly vascular

72
Q

If the adult disc is avascular, how do the disc cells receive and supply the nutrients essential for cellular activity to remove wastes

A

The discs rely on diffusion from blood vessels at the discs margin

73
Q

What is the best way to improve disc nutrition

A

get up and move

74
Q

In erect posture, ___% of axial loads pass through the vertebral bodies and IV discs

A

85

75
Q

What does prolonged axial loading do

A

It reduces stature by squeezing water out of the discs

76
Q

In the (morning/evening) there is increased loading on the nucleus and inner annulus

A

morning

77
Q

In the (morning/evening) a person is more likely to damage the nucleus and inner annulus)

A

morning

78
Q

In the (morning/evening) the disc is more loaded

A

morning

79
Q

In the (morning/evening) there is increased loading on the outer annulus

A

evening

80
Q

In the (morning/evening) a person is more likely to damage the outer annulus fibers

A

evening

81
Q

In the (morning/evening) the facet joints are loaded more

A

evening

82
Q

On average, an adult loses ___cm in stature over the course of the day. Mainly in the (morning/evening)

A

1.5; morning

83
Q

Intradiscal disc pressure studies have correlated disc pressure to _____ _____

A

breathing rhythms

84
Q

During inspiration, pressure (increases/decreases) in the IVD

A

increases

85
Q

during expiration, pressure (increases/decreases) in the IVD

A

decreases

86
Q

True or False:

Disc pressure is decreased in degenerative discs compared to young, healthy adults

A

true

87
Q

What happens when you “throw your back out”

A

Tears occur in the annulus and rim lesions, if the tear gets to the outer 1/3 then it becomes painful

88
Q

Describe the classic “story” that presents with throwing your back out

A

injury occurs and causes local pain after loading. Pain goes away after a couple day but then each time the injury is tweaked, the paid lingers longer.

89
Q

Describe the pathological stuff behind the classic story of throwing your back out

A

Progressive radial tears occur with scar formation. The tears get larger and eventually reach the outer rim. The tweaking of original injury weakens the annulus over time

90
Q

What are three things that can accelerate lumbar disc degeneration

A
  1. genetics
  2. heavy lifting
  3. frequent loading positions
91
Q

Functional changes in the disc as you get older include (increased/decreased) creep and hysteresis

A

increased

92
Q

(creep/hysteresis) is the progressive deformation/strain of a structure, or of tissues under prolonged loading/stress.

A

creep

93
Q

(creep/hysteresis) is the recovery from distortion or the lag of recovery from deformation after the load has been removed

A

hysteresis

94
Q

True or False:

discs are designed to bulge out

A

true

95
Q

True or False:

Mechanical pressure to a nerve causes pain

A

false, it causes tingling not pain. Pain only comes if the pressure is prolonged and becomes ischemic

96
Q

Several studies have show that disc bulges reabsorb over time. This can happen in a matter of ____

A

days or weeks

97
Q

Bulging disc _____ has the highest probability of spontaneous disc regression out of the various types of disc lesions

A

sequestration

98
Q

True or False:

At least 40% of normal people have a bulging disc proven by an MRI, and have no LBP

A

true

99
Q

True or False:

Time of day can impact MRI results

A

true

100
Q

Explain why the time of day can impact MRI results

A

Discs are swollen 20% more in the morning compared to evening

101
Q

At what level do lumbar disc lesions occur the most at

A

L4/L5 or L5/S1

102
Q

An endplate fracture causes blood to go into the nucleus. Explain why this is bad and what happens next

A

This is a problem because cytokines (inflammatory enzymes) will be activated which will lead to more pain and swelling. The inflammation can irritate the DRG (super sensitive bc no myelin). Endplate fx wont become apparent right away because the DRG has a latency period of about two weeks

MS II (14 decks)

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