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MS II > Exam 3: Lumbar (5-8) > Flashcards

Exam 3: Lumbar (5-8) Flashcards

1
Q

What type of pain will disc lesions have

A

somatic referred pain

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2
Q

What changes can a disc lesion have on an endplate

A

it predisposes the intervertebral disk

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3
Q

What should a patient do if their disc lesion is causing a lack of blood supply

A

get up and move around

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4
Q

True or False:

Increasing in intracranial pressure as with breathing, coughing, or sneezing can increase disc lesion pain

A

true

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5
Q

What are the two general types of disc lesions

A

tissue and directional lesions

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6
Q

What are the two subtypes of tissue disc lesions

A

hard and soft tissue disc lesions

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7
Q

In a hard lesion, the (annulus/nucleus) is more involved

A

annulus

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8
Q

Does a hard disc lesion respond well to treatment and can it be a candidate for spinal manipulation

A

yes

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9
Q

In a soft lesion, the (annulus/nucleus) is more involved

A

nucleus

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10
Q

Does a soft lesion respond well to treatment and can it be a candidate for spinal manipulation

A

no

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11
Q

Is a hard or soft tissue disc lesion more severe?

A

soft lesions since the nucleus in involved

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12
Q

Describe the onset and characteristics of a hard tissue disc lesion

A 
annulus affected
rim lesion
audible pop
immediate pain 
local pain
no distal pain
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13
Q

Describe the onset and characteristics of a soft tissue disc lesion

A 
progressive small tears to the annulus until it reaches the nucleus
activity two days ago
pain increases
AM pain severe
distal symptoms
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14
Q

(hard/soft) tissue disc lesions will have ridicular type pain

A

soft

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15
Q

What are the three subtypes of directional disc lesions

A

posterior-medial
posterior-lateral
alternating

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16
Q

Which of the directional disc lesions is the most common

A

posterior lateral

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17
Q

What percentage of the population with a directional disc lesion will have a posterior lateral lesion

A

80-90%

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18
Q

What is another name for a posterior lateral disc lesion

A

shoulder lesion

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19
Q

With a posterior lateral disc lesion, the pain will (increase/decrease) when you lean away and (increase/decrease) when you lean towards it

A

decrease when away

increase when towards

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20
Q

(opening/closing) techniques are better for posterior lateral lesions

A

opening

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21
Q

What is another name for a posterior medial disc lesion

A

armpit or trunk?

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22
Q

With a posterior medial disc lesion, the pain will (increase/decrease) when you lean away and (increase/decrease) when you lean towards it

A

increase when away

decrease when towards

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23
Q

(opening/closing) techniques are better for posterior medial lesions

A

closing

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24
Q

How do you treat an alternating disc lesion

A

its very challenging, treat it based on the direction that has pain that day

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25
Q

Describe the characteristics of a direct posterior disc lesion

A

The patients are often stuck in flexion and having severe guarding. Hard to treat but responds well to distraction

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26
Q

What should we think when we see radicular pain

A

a nerve root problem

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27
Q

What should we think of when we see referred pain

A

a somatic issue

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28
Q

Describe the general site and characteristics of directional disc lesion pain

A 
somatic
dull, constant, non specific
Can spread into thighs, groin, hip, and hamstrings 
No pain below the knees
blobs or patches of pain
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29
Q

Where would a patient with a directional disc lesion at the L4 disc have pain at

A

the hips, often think they have “hip bursitis”

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30
Q

Where would a patient with a directional L5 disc lesion have pain at

A

the coccyx

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31
Q

What are clowards points

A

referred points of pain from the cervical spine

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32
Q

Where would a patient with a lesion at the T/L junction have pain

A

L5 spinous process and to either side

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33
Q

What are two predisposing factors of developing disc lesions

A

bending and driving

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34
Q

What are the typical subjective clues of a disc lesion (aggs)

A 
increasing intraabdominal pressure
Pain that changes throughout the day
flexed positions 
sustained positions
vibrating/driving
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35
Q

What are the typical subjective clues of a disc lesion (eases)

A

Movement
supine
avoiding sustained positions
lumbosacral support

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36
Q

A disc lesion will often lead to a loss of (kyphosis/lordosis)

A

lordosis

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37
Q

A disc lesion will often have an increase in pain with (flexion/extension)

A

flexion

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38
Q

True or False:

Extension is often limited in patients with a disc lesion

A

true

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39
Q

what does aberrant mean

A

not normal

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40
Q

What are the four general ways to approach treating a disc lesion

A

education, environmental, unloading, and movement

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41
Q

True or False:

Discs heal better if the patient protects the back by not moving as much as normal

A

false, discs will heal by getting blood flow to the them by moving

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42
Q

(flexion/extension) helps diffuse nutrients/blood flow into the discs

A

extension

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43
Q

True or False:

Avoid lifting heavy in the AM and PM when dealing with a disc lesion

A

true

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44
Q

True or false:

LBP is not normal

A

false, it is normal bc it is the common cold of the MS system

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45
Q

True or false:

There is limited evidence for preventing LBP

A

true

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46
Q

What are the three ways to unload the spine while treating a disc lesion as discussed in the powerpoints

A

traction, aquatic therapy, and lumbosacral support (maybe)

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47
Q

True or False:

There is sufficient evidence stating that lumbosacral support will aid in unloading a disc lesion

A

false, there is very limited evidence

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48
Q

Posterior lateral disc lesions are best treated with opening techniques. List the opening techniques that are used to treat PL dis lesions

A

traction
rotation with painful side up
central PA in SB away
lateral glides

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49
Q

Posterior medial disc lesions are best treated with closing techniques. List the closing techniques that are used to treat PM dis lesions

A

Central PA
Central PA in SB towards
Unilateral on the painful side
Techniques into extension

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50
Q

Manipulation is okay to do in patients with disc lesions if the pain is (above/below) the knee

A

above

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51
Q

if a disc lesion is in the anterior portion of the vertebrae, will the patient have a flexion or extension bias

A

flexion

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52
Q

if a disc lesion is in the posterior portion of the vertebrae, will the patient have a flexion or extension bias

A

extension

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53
Q

Typically, in lumbar radiculopathy, will one or multiple nerve roots be affected

A

one

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54
Q

True or False:

Mechanical pressure to a nerve will cause pain

A

False, it doesn’t cause true pain until it becomes ischemic.

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55
Q

in lumbar radiculopathy, pro-inflammatory mediators and immune compounds are known to remove myelin from adjacent axons. What is the clinical significance of this

A

If there’s no myelin, the nerve becomes more sensitive because there’s more ion channels that are added to the nerve

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56
Q

What is the result of mechanical pressure on an exposed/unmyelinated axon

A

severe pain

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57
Q

What is the main role of neuroanatomy

A

electrochemical communication

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58
Q

When does the spinal cord end and the cauda equina begin

A

L1/2

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59
Q

What are the three layers of the meninges

A

dura mater
arachnoid
pia

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60
Q

Where does the sacral plexus provide motor and sensory innervation to

A

the posterior thigh, most of the lower leg, and the entire foot, and part of the pelvis

61
Q

Which vertebrae are included in the lumbar plexus

A

L1-1/2 of L4

62
Q

The (femoral/sciatic) nerve is in the lumbar plexus

A

femoral

63
Q

what are the special tests that test the lumbar plexus

A

Think femoral nerve so

prone knee hands and side lying slump

64
Q

Which vertebrae are included in the LS plexus

A

1/2 of L4-S2`

65
Q

The (femoral/sciatic) nerve is in the lumbar plexus

A

sciatic

66
Q

what are the special tests that test the LS plexus

A

straight leg raise

slump

67
Q

Describe the pain characteristics of radicular/nerve root pain

A

Deep, burning, throbbing “toothache”
Dermatomal patterns
Distal pain is greater than proximal pain

68
Q

True or False:

A patient experiencing radicular pain is greater than proximal pain

A

true

69
Q

True or False:

A patient with radiculopathy means they will have pain

A

False, they will have sensory issues, dermatome/myotome and reflex changes.

Patients with this can experience nerve root pain, but it isn’t guaranteed

70
Q

What are the 4 signs of threatening nerve root pain

A
  1. Area of pain: distal more than proximal
  2. Nature of pain: severe or latency
  3. Irritability to movement
  4. Protective deformities: PM towards, PM away
71
Q

What are the initial symptoms of nerve root compression

A

Numbness in dermatome
Heavy feeling in extremities
Hypersensitivity like pins and needles
Cramping

72
Q

What are the potential effects of nerve root compression

A

loss of sensation
motor weakness/atrophy
decreased reflexes

73
Q

What are eases of radiculopathy/nerve compression

A

protective deformity
movement
unloading like traction
upright postures

74
Q

What are some aggs of radiculopathy/nerve compression

A 
Neurodynamic tests to stimulate function like driving and slump tests
Loaded walking or WB
Sustain postures
Valsalva
Static stretches
75
Q

What is the behavior of symptoms of nerve compression

A

Latent pain, may need to limit objective exam

Latency that may come off as severe, sudden unprovoked pain

76
Q

When we think of latency, think of the ____

A

DRG

77
Q

What are some general signs/tests for nerve compression

A

shifting
positive neurodynamic tests like SLR, slump, side lying femoral slump test
compression/distraction
screenings

78
Q

Treating lumbar radiculopathy involves space, movement, and blood. What are the three movements that will provoke space

A

single knee to chest
double knee to chest
trunk rotation

79
Q

A study by Fritz suggests that a subgroup of lumbar radiculopathy patients may benefit from mechanical traction. What must the subgroup be characterized by to work?

A

Presence of leg symptoms
Signs of nerve root compression
Either peripheralization with extension or a crossed straight leg raise

80
Q

Treating lumbar radiculopathy involves space, movement, and blood. List ways to provoke movement

A

Active and passive Neuro mobs

Exercise

81
Q

True or False:

Results of studies have shown that slump mobilization is beneficial for improving long term disability, pain, and centralization of symptoms

A

False, only short term

82
Q

Blood flow (increases/decreases) nerve sensitivity

A

decreases

83
Q

Lumbar facet joints guides _____ and ____ plane movement

A

sagittal and coronal

84
Q

Lumbar facet joints restrain axial ____ and excessive _____.

A

rotation; translation

85
Q

True or False:

There is more flexion/extension available in the thoracic spine compared to the lumbar spine due to the facet joint position

A

False, due to the lumbar facets being parallel with the sagittal plane, we have more Flex/Ex in the lumbar than thoracic

86
Q

What type of joint are the lumbar facets joints

A

synovial

87
Q

Where does the medial branch of the dorsal ramus innervate to

A

multifidus

facet joints

88
Q

What is the clinical significance of a facet joint menisci

A

It is there for protection and cushioning, but can become a protrusion into the joint space and cause pain/stiffness.

89
Q

True or false:

Articular cartilage is vascular

A

false: it is avascular

90
Q

Explain the importance of movement for articular cartilage

A

Because articular cartilage is avascular, movement is essential to prove nutrients to the cartilage. Movement causes synovial fluid filled with nutrients to diffuse into the articular cartilage

91
Q

Muscles are (sprained/strained) and ligaments are (sprained/strained)

A

strain muscles

sprain ligaments

92
Q

Facet joints dysfunction can be caused by trauma. List ways that sprained ligaments could cause dysfunction

A

Extension damage via volleyball, basketball, or gymnastics
Flexion damage via weight lifitng
Falls
MVA

93
Q

Facet joints dysfunction can be caused by trauma. List ways that strained muscles could cause dysfunction

A

Sustained postures

Excessive lordosis caused by pregnancy/backpacks

94
Q

Facet joint dysfunction can be caused by aging. What are the two general conditions that will progress facet joint dysfunction

A

Facet joint OA

Stenosis

95
Q

Changes in lumbar facet joints can occur with age. What condition in found in young adults in response to compressive loading

A

chondromalacia

96
Q

Changes in lumbar facet joints can occur with age. What condition can be described as thickening and sclerosis in the subchondral bone leading to hypertrophy of facets with osteophytes

A

Bony hypertrophy of facets

97
Q

Changes in lumbar facet joints can occur with age. What condition occurs with natural cartilage loss

A

OA

98
Q

What condition of facet joint dysfunction will show chondrocyte swelling and splits in articular cartilage

A

Chondromalacia

99
Q

Why would there be pain with a loss of articular cartilage

A

Because the cartilage no longer protects the innervated subchondral bone

100
Q

True or False:

Facet joint positioning can change over time and with age

A

true

101
Q

True or False:

Stenosis is becoming a real problem in the aging population

A

true

102
Q

What are the characteristics of pain for facet joints

A

sharp, stabbing, localized pain with vague spreading around the area
Unilateral
Spasms
proximal pain greater than distal pain

103
Q

What are the aggs for facet joint pain

A 
Prolonged standing
Walking a long time/distance
Prone/extension
Extension with rotation
Coughing
Progressive loading during the day
OA: morning stiffness
104
Q

What are the eases for facet joint pain

A

rest/sitting
supine
flexion
movement

105
Q

What are the physical characteristics of facet joint dysfunction

A

A loss of extension more than side bending

Sustained/repeated movements

106
Q

Describe the involvement of arthritic and neurological pain along with palpation of facet joint dysfunction

A

Neurological pain typically not involved
Arthritic pain felt through the range.
Palpation causes localized and side specific pain

107
Q

In general, describe the parameters of performing mobs for painful facet joints

A

PAIVM

Large amplitudes with a smooth, slow rhythm

108
Q

What types of joint mob are best for painful facet joints

A

PA
Unilateral PA
Transverse

109
Q

In general, describe the parameters of performing mobs for stiff facet joints

A

Passive PAIVM

End ROM position

110
Q

True or False:

Pain is normal in aging

A

False it is not normal

111
Q

Why do older people think it is normal to have pain as you age

A

because as people age they tend to become more sedentary. Changes due to inactivity can lead to painful movements

112
Q

Describe the correlation between age and activity

A

we become really active in mid years and it gradually declines

113
Q

True or False:

Age is poorly correlated to LBP

A

true

114
Q

What age group seeks the most care for LBP

A

40’s seeks greater care and a good decrease in seeking care around age 55+

(Slide 7 on Session 8)

115
Q

True or False:

Disc problems become less of an issue as we age

A

True

116
Q

True or False:

Facet pain tends to increase as we age

A

true

117
Q

What percentage of the population seeking care for LBP is due to lumbar spinal stenosis

A

10-15%

118
Q

What are the two things we need to understand in order to understand spinal stenosis

A

facet joints

lumbar ligaments

119
Q

What are the two spinal ligaments that can become a problem as we age related to spinal stenosis

A

Ligamentum flavum and posterior longitudinal ligament. They can harden and buckle

120
Q

What are the degenerative changes of a vertebral body

A

loses trabeculae

osteophytes

121
Q

What are the degenerative changes of intervertebral discs

A

Fluid content

Fissuring

122
Q

What are the degenerative changes of facet joints

A

Sclerosis leading to ankylosis

Spinal stenosis

123
Q

True or False:

Disc bulges can be significant in stenosis

A

true

124
Q

What are the three types of stenosis discussed in the power point

A

degenerative, vascular, and postural/positional stenosis

125
Q

Vascular _____, which is a symptom of peripheral artery disease, can cause vascular stenosis

A

claudication

126
Q

True or False:

Vascular stenosis can be related to postural and/or degenerative stenosis

A

true

127
Q

What are the symptoms of vascular stenosis

A

Bilateral, distal typically feet
Temp changes
“My feet are cold all the time”
“My legs and calves hurt so much I have to stop”

128
Q

True or False:

People with vascular stenosis have difficulty walking

A

True

129
Q

True or False:

People with vascular stenosis will be the most comfortable in sitting

A

False, they have the most discomfort, standing is better

130
Q

What are the comorbidities that vascular stenosis is associated with

A

diabetes, peripheral neuropathies, PVD, and smoking

131
Q

True or False:

Vascular stenosis causes pain

A

False

132
Q

Wearing high heels can attribute to postural stenosis. Heels will (increase/decrease) lumbar (kyphosis/lordosis)

A

increase lordosis

133
Q

What are four postural changes that will increase lumbar extension/stenosis

A

obesity
pregnancy
high heels
ligamentous laxity

134
Q

Describe the characteristics of the symptoms of postural stenosis

A

In younger patients
Increased symptoms with time/loading
Static posture increases pain
Walking eases pain

135
Q

Degenerative stenosis will cause a (increase/decrease) or lumbar (kyphosis/lordosis)

A

decreased lordosis

136
Q

What is referred to as the “blue collar disease”

A

Degenerative spinal stenosis

137
Q

Describe the characteristics of symptoms of degenerative stenosis

A 
AM stiffness
Progressive throughout the day
Bilateral symptoms unless its foraminal then unilateral
Leg pain greater than back pain
Numbness, pins and needles, weakness
138
Q

If the central canal is effected during degenerative stenosis, will there be bilateral or unilateral symptoms

A

bilateral

139
Q

If the lateral canal is effected during degenerative stenosis, will there be bilateral or unilateral symptoms

A

unilateral

140
Q

Symptoms will be felt through the (feet/legs/gluteal) regions during the early stage of degenerative spinal stenosis

A

feet

141
Q

Symptoms will be felt through the (feet/legs/gluteal) regions during the middle stage of degenerative spinal stenosis

A

legs

142
Q

Symptoms will be felt through the (feet/legs/gluteal) regions during the late stage of degenerative spinal stenosis

A

gluteal

143
Q

What are the aggs of degenerative stenosis

A 
extension
standing 
progressive throughout day
prolonged walking
increased body weight
144
Q

What are the eases of degenerative stenosis

A

Flexion/walking in flexion
sitting
supine/hook-lying

145
Q

What is the physical presentation of degenerative stenosis

A 
Loss of extension
hypomobility
Progressive stages: 
Cord compression
Babinski/clonus
Hyperreflexia
146
Q

When performing a treadmill test for LSS, what should the walking speed start at

A

1.2 mph

147
Q

True or False:

Exercise treadmill testing has poor test-retest reproducibility

A

false, it has good reliability

148
Q

Explain the procedure of a treadmill test for LSS

A

Patient walks at 1.2mph or at a comfortable pace until symptoms start.
Let patient rest until symptoms go away
Increase the incline and have the patient walk again until their symptoms come back
If the symptoms take longer to come back, the spinal stenosis is a positive

149
Q

What is the best treatment for LSS and why

A

PA hip mobs because it aids them in standing up more erect which naturally induces more extension

MS II (14 decks)

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