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Ortho Test 1 > L Biomechanics > Flashcards

L Biomechanics Flashcards

1
Q

what is the prevalance of lumbar radiculopathy?

A

10-25%

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2
Q

what is the capsular pattern of the lumbar spine?

A
  1. extension limited > flexion

2. SB limited equally on both sides

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3
Q

what are the moderate sxs of lumbar radiculopathy? (3)

A

radicular pain, diminished senses, and mild weakness with reflex changes

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4
Q

how do you lock the facet in lumbar flexion?

A

SB and rotation in opposite directions

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5
Q

where is L3/L4 disc pain? (71% relationship)

A

pain in ant thigh; no post thigh pain

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6
Q

how would you grade spondylolisthesis?

A

grade 1 - 0-25% slip
grade 2 - 25-50
3 - 50-75
4 - 75-100

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7
Q

what is the order of disc herniation severity?

A
  1. degeneration
  2. prolapse
  3. extrusion
  4. sequestration
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8
Q

what are the 5 types of spondylolisthesis? and which is most common

A
  1. dysplastic
  2. ISTHMIC
  3. traumatic
  4. degenerative
  5. pathological
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9
Q

what is included in the passive system that protects the neutral zone? (4)

A

vertebrae, IVD, ZAJ, ligaments

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10
Q

what is the greatest predictor of a disc pathology?

A

flexion limitation and extension provocation

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11
Q

what are the three periods of LBP?

A

dysfunction (12-40s)
instability (20s-50s)
restabilization (60s-80s)

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12
Q

what is NCS

A

nerve stimulation and recording of evoked potential to assess extent of axonal conduction loss

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13
Q

define disc prolapse

A

NP has translated all layers of the AF, but the AF remains intact

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14
Q

what are the muscles of the local ms? (4 major)

A

multifudus lumbar, psoas major, IO, TA

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15
Q

what is lumbar radiculopathy?

A

objective loss of sensory or motor function

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16
Q

what are the Aggs for ZAJ? (4)

A
  1. extension activities
  2. quick movements
  3. combined movement
  4. compressing/stretching the joint
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17
Q

when is disc pressure the highest?

A

standing with flexion

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18
Q

what are the indications for spondy surgery?

A
  1. > 4mo sxs impacting QoL
  2. progressive neuro, motor, sensory, and reflex degeneration
  3. bowel/bladder
  4. neurologic claudication
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19
Q

who gets isthmic spondy and what level is most affected

A

males 2:1 usu football linemen and gymnasts; L4/5

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20
Q

what are the four mechanical pathogenesis of lumbar radiculopathy?

A
  1. HNP
  2. spondylolysis
  3. spondylolisthesis
  4. stenosis
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21
Q

what are the common impairments found in lumbar stenosis?

A
  1. SB limited bilaterally and extension limited
  2. limited flexion which eases symptoms
  3. restricted hip mobility, particularly extension
  4. weak hip extensors and abductors
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22
Q

describe the CPR for back related tumors (4)

A
  1. hx of cancer!!!
  2. age >50
  3. cancer sxs
  4. failure of conservative interventions
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23
Q

describe the CPR for spinal compression fractures (5)

A
  1. trauma/fall/direct blow to spine
  2. age 50-70
  3. corticosteroids
  4. point tenderness
  5. increased pain with WB
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24
Q

about how long does it take for a disc to heal

A

10 mo

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25
Q

define disc protrusion

A

annular fibers intact

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26
Q

what is included in the neural system that protects the neutral zone?

A

CNS and PNS

27
Q

describe the CPR for back related infxn (4)

A
  1. recent infection
  2. IV drug user
  3. fever malaise and swelling
  4. constant deep pain and rigidity
28
Q

describe dysplastic spondylolisthesis

A

congenital defect where the ZAJ are horizontal causing slippage and perhaps radicular pain

29
Q

what is the lumbar flexion coupling

A

SB and Rot are in the same direction

30
Q

where is L4/L5 disc pain? (>63% relationship)

A

anterior thigh pain; with or without posterior thigh pain

31
Q

who gets dysplastic spondy and what level is most affected

A

females 2:1; L5/S1

32
Q

what is EMG

A

electrical recording of muscle activity during rest and during contraction

33
Q

what are the muscles of the global ms? (3 major)

A

RA, EO, iliocostalis lumborum

34
Q

who gets degenerative spondy and what level is most affected?

A

females 5:1 >40yrs; L4/5

35
Q

describe isthmic spondy

A

fibrous defect in the pars articularis

36
Q

define disc extrusion

A

NP breaches AF integrity

37
Q

describe the CPR for spinal stenosis (5)

A
  1. bilateral symptoms
  2. leg pain more than back pain
  3. pain during walking and standing
  4. pain relief during sitting
  5. age >48

note: 4/5 very specific! 1/5 very sensitive

38
Q

what are the mild sxs of lumbar radiculopathy? (1)

A

pure sensory radicular pattern

39
Q

what are the nonmechanical origins of LBP? (4)

A
  1. neoplasias
  2. infections
  3. inflammatory arthritis
  4. visceral
40
Q

what is the gold standard for dx spondy? (2)

A
  1. lateral lumbar x ray

2. oblique view evaluate pars articularis integrity “scotty dog”

41
Q

what structure is most stressed in locking?

A

ZAJ

42
Q

where is the most likely first time incidence of lumbar radiculopathy?

A

L5

43
Q

describe degenerative spondy

A

erosion of IVD and ZAJ

44
Q

what is the order of disc prolapse from most likely to least?

A

L4/5 > L5/S1 > L3/4 > L2/3 > L1/2

45
Q

what is the general outcome of lumbar radiculopathy?

A

60% resolve in 12 weeks
30% resolve in 3m-1yr
older patients with stenosis have poorer outcomes

46
Q

what are the sxs of lumbar radiculopathy? (5)

A

think dermatome and myotome!

numbness, motor loss, muscle wasting, weakness, areflexia

47
Q

describe the pain referral from the facet joint (3)

A
  1. predominantly thigh and buttock
  2. pain can refer below the knee but not as common
  3. distance of radiation is proportional to pain intensity
48
Q

describe the CPR for abdominal aneurysm (5)

A
  1. back/ab/groin pain
  2. cardiopulm RFs
  3. fam hx
  4. age >70
  5. bruit in central epigastric area
49
Q

what are the four nonmechanical pathogenesis of lumbar radiculopathy?

A
  1. synovial cysts
  2. infection
  3. tumors
  4. vascular abnormalities
50
Q

Where is L5/S1 disc pain? (>75% relationship)

A

pain in post thigh; no anterior pain

51
Q

what are the major physical exam findings of lumbar instability? (6)

A
  1. hyperangulation
  2. poor motor control
  3. decreased local muscle endurance
  4. gowers sign, prone instability, and shear
  5. decreased willingness to move
  6. guarding and hypertrophy at the level of instability
52
Q

what is included in the active system that protects the neutral zone? (1)

A

muscles

53
Q

what is a spondylolisthesis

A

forward slip of a vertebral body on the body below caused by a defect in the pars articularis

54
Q

how do you lock the facet in lumbar extension?

A

quadrant: extension, SB and Rot in the same direction

55
Q

define disc sequestration

A

NP fragments

56
Q

what causes secondary stenosis? (4)

A
  1. DEGENERATIVE CHANGES
  2. spondylolisthesis
  3. fractures
  4. post surgical scarring
57
Q

what is the lumbar neutral/extension coupling

A

SB and Rot are in the opposite direction

58
Q

how does spondylosis present on xray? (3)

A

narrowing disc space, osteophytes at the margin of the vertebral bodies and IVD, and facet joint erosion

59
Q

describe the 2 muscle systems theory

A
  1. global ms: torque producing muscles that provide general stability
  2. local ms: attach directly to vertebrae providing segmental stability
60
Q

what are major subjective complaints of lumbar instability? (6)

A
  1. “back giving way”
  2. self-manipulations with relief
  3. frequent bouts progressively worsening
  4. painful catching/locking
  5. pain with quick trivial movements
  6. difficulty with unsupported sitting
61
Q

what is spondylosis?

A

pars defect from age related changes

62
Q

what are the severe sxs of lumbar radiculopathy? (3)

A

radicular pain, sensory dysfunction, severe motor deficits

63
Q

what are the Ease for ZAJ? (3)

A
  1. flexion
  2. sitting
  3. lying down

Ortho Test 1 (6 decks)

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