L/S Presentations pt 1 Flashcards
List the impairment/functional-based classifications for lumbar spine disorders
- A/SA LBP w/ Mobility Deficits
- A/SA LBP w/Related Cognitive or Affective Tendencies
- A/SA/C LBP w/Radiating Pain
- A/SA/C LBP w/Movement Coordination Impairments
- A LBP w/Related (Referred) Radiating LE Pain
- Chronic LBP w/related generalized pain
list some prognostic indicators for development of LBP
- Hx previous episodes
- excessive spine mobility
- excessive mobility in other joints
list some prognostic indicators for the developent of chronic LBP
- presence of symptoms below the knee
- pyschosocial distress or depression
- fear of pain, movement, and re-injury or low expectations of recovery
- pain of high intensity
- a passive coping style
LBP can be broken down to include what 2 areas?
- Lumbar spine pain
- area bordered by transverse line from T12-S1
- Sacral spine pain
- area bordered by vertical lines through PSISs and horizontal lines through S1 and sacrococcygeal joints
List some common clinical presentations at the L/S
- Neoplasms
- Infection
- Spondyloarthropathies
- Vertebral Body frx
- Spondylolysis and Spondylolysthesis
- Discogenic Pain
- Discitis
- internal disc disruption (IDD)
- Radicular pain/radiculopathy
- Lumbar Stenosis
- Zygapophysial Joint Pain
- Muscle Pain
- L-S surgeries
what are common sites for metastasis for lumbar neoplasms?
- 16.5% from breast
- 15.6% from lung
- 9.2% from prostate
- 6.5% from kidney
when suspecting a neoplasms what are you looking for in the patient interview?
- PMH includes cancer
- progressive in nature
- fatigue
- weight loss
- smoking
- Pain complaints:
- persistent
- not alleviated w/bed rest
- worse at night
- neurologic symptoms
for a neoplasm, the physical exam may include what?
- non-mechanical presentation
- age > 50 yrs
- anemia
- neurologic signs
- lab tests for confirmation
list 2 types of infections that may occur at the L/S
- Vertebral Osteomyelitis
- Epidural abscess
what is an epidural abscess?
haematogenous spread of bacteria into epidural space
occurs in 10% of spine infections
associated with DM, chronic renal failure, IV drug misuse, alcoholism, cancer
what are likely findings during a patient interview in someone with vertebral osteomyelitis?
- oftent traced to other source of infection (dental abscess, pneumonia, etc.)
- bladder infection most common
- Increased risk
- immunocompromised pts
- DM
- Weight loss
- Fatigue
- Fever
- Neurologic symptoms
what would pain compliants look like in someone with vertebral osteomyelitis?
- local, focal back pain
- worse w/mechanical loading
- improves w/recumbent position
physical exam findings in vertebral osteomyelitis
- Fever
- Local tenderness
- Aggravated w/local percussion
- Neurologic signs (cord/root)
- Lab tests important for dx
what may increase the risk of an epidural abscess?
- misdiagnosed vertebral osteomyelitis
- they are common concomitants
- 12-30% have a Hx of preceding trauma (fall, etc)
what is the typical progression of symptoms with epidural abscesses?
- local, focal back pain
- radicular signs/symptoms
- paralysis
abdominal referrals may cause LBP, but viseral disease accounts for ____ of cases
2%
potential organs involved:
- pelvic organs
- kidneys
- Aortic aneurysm
- Gastrointestinal
T/F: vertebral frxs are associated with increased mortality?
TRUE
predictor for subsequent vertebral frx (4-5x) and hip frx (3x)
the TLICS classification system for vertebral fractures is based off of what 3 things?
- Morphology
- Integrity of PLC
- supraspinous, interspinous ligaments, ligamentum flava, z-joint capsules
- Neurologic status
what are the 3 morphologic descriptors in the TLICS classification system?
- compression → vertebral body buckles under load to produce a compression/burst frx
- translation/rotation → vertebral column is subjected to shear/torsional forces causing the rostral part of spinal column to translate/rotate w/respect to caudal portion
- distraction → rostral spinal column becomes separated from caudal segement b/c of distraction forces
what are the 2 subtypes of compression frxs?
- Traditional
- Burst
describe traditional compression frxs
- stable injury
- invovles anterior column
- common mechanism → axial loading in flexed position
- Traumatic
- high energy
- osteoporotic
describe burst compression frxs
- anterior and middle column invovlement
- 15-20% of all major vertebral body frxs
- most common at T/L junction
- potential neural involvment
- vertebral segment subjected to high force axial (and/or flexion load)
- MVC
- falls from heights
- high-speed sport injury
describe rotation/translation frxs
- associated w/fall from a height or heavy object falling on body w/bent trunk
- torsion/shear force
- horizontal displacement of one T/L vertebral body on another
- dislocation → facet joints intact but dislocated
describe distraction frxs
- separation in the vertical axis
- anterior and posterior ligaments, anterior and posterior bony structures both
- potential frx to posterior elements
list vertebral frx red flags
- older age
- sig trauma
- corticosteroid use
- contusion/abrasion
List the Henschke cluster for vertebral frxs
- Age > 70
- sig trauma
- prolonged corticosteroid use
- sensory alterations from trunk down
list the components of the Roman cluster for osteoporotic vertebral compression frxs
- Age > 52
- no presence of leg pain
- BMI = 22
- does not exercise regularly
- female gender
4/5 = +LR 9.6
what is spondylolysis?
fatigue frx of pars interarticularis
proposed mechanism:
- acquired → repetitive microtrauma w/extension or extension w/side-bending activities
- congential
- developmental
90% of spondyloysis occur _____
at L5 level (L5/S1 > L4/L5)
what is spondylolythesis?
anterior slip of the vertebra following bilateral spondylolysis
graded 1-4 via the percentage of body slipped
describe the grades for spondylothesis
- I = 1-25%
- II = 25-50%
- III = 50-75%
- IV = >75%
greatest slippage occurs between 10-15 y/o
how would a spondylothesis show up on a radiograph?
“Scotty dog with collar”
(on PA, lateral oblique radiographs)
often, reduced ROM observed with flexion/extension radiographs (rather than instability)
prevelance of spondylolysis and spondylothesis is higher in what population?
up to 43% in athletes
- repetitive extension: gymnastics, diving, weight lifting
- high grade slippage 2x greater in girls and 4x greater in women
- greater risk among adolescents
describe the symptomology of spondylolysis and spondylothesis
- localized LBP, worsened with extension activities
what physical exam findings are expected with spondylolysis and spondylothesis?
- include neurologic testing
- visual inspection: excessive lumbar lordosis
- possible step-off deformity
- pain with lumbar extension, rotation
- “hamstring tightness” has been proposed
- instability testing and spring testing at involved segment (if administered)
