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MSK3 > L spine > Flashcards

L spine Flashcards

1
Q

pain complaints with neoplasms

A

not alleviated with bed rest

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2
Q

what is epidural abscess

A

hematogenous spread of bacteria into epidural space

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3
Q

vertebral osteomyelitis hx

A

infection
weight loss
fever neuro s/s

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4
Q

vertebral osteomyelitis inc risk

A

immunocompromised pt
DM

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5
Q

vertebral osteomyelitis pain

A

worse with mechanical loading improves with recumbent position

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6
Q

PE vertebral osteomyelitis

A

fever, local tenderness, aggravated w/ percussion, neuro s/s, lab test for dx

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7
Q

common concomitant disease with vertebral osteomyelitis

A

epidural abscess

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8
Q

CPR for vertebral compression fx

A

Age > 52 years
No presence of leg pain
Body mass index </= 22
Does not exercise regularly
Female gender

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9
Q

spondylolysis what is it

A

Fatigue fracture of pars interarticularis

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10
Q

MOI of spondlolysis

A

Acquired: Repetitive microtrauma with extension/ extension with side-bending activities
Congenital
Developmental

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11
Q

what is a flail segment

A

: bilateral pars defect with attached multifidi

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12
Q

where do most spondylolysis happen

A

L5 level

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13
Q

grades of spondylolisthesis

A

I: 1-25%
II: 25-50%
III: 50-75%
IV: >75%

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14
Q

greatest slippage of spondylolysthesis occurs between what age

A

10-15 y/o

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15
Q

best radiograph and name for spndylolysthesis

A

Scotty dog with collar
oblique view

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16
Q

hx for spondy (both)

A

Prevalence 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

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17
Q

s/s for spondy both

A

Localized LBP, worsened with extension activities

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18
Q

PE for spondy both

A

Include neurologic testing
Visual Inspection: excessive lumbar lordosis
Possible step-off deformity
Pain with lumbar extension, rotation
“Hamstring tightness” has been proposed

+ instability testing & spring testing at involved segment (if administered)

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19
Q

most common disc pain

A

latrogenic discitis
extremely painful
infection from needle

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20
Q

endplate fx

A

Axial compression: Endplates weakest component of IV disc

possible smorls nodes

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21
Q

IDD - internal disc disruption
this follows what injury
what can it cause
and what cant it do anymore

A

rotary injury or endplate injury
triod effect - excessive loading on facets because of loss of disc height
nucleus less able to bind water and unable to withstand pressure

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22
Q

disc herniation broad vs focal

A

broad = 90-180
focal = <90

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23
Q

disc herniation extrusion vs sequestered

A

extrusion = protruding out
sequestered = some of the inner disc material has squirted out and disconnected

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24
Q

disc patho s/s

A

multi direction s/s
pain worsens when first getting up or improves with activity
worse through course of the day
look out for redic

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25
Q

PE for disc patho

A

pt can be asymptomatic
multi directions
spring testing
SLR
LMN redic signs
repeated motions
lateral shift or posture abnorm

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26
Q

radic pain hx

A

Acute: Trauma (twisting/ lifting injury common)
Insidious: progressively more distal as health condition progresses

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27
Q

s/s radic pain

A

Shooting/ lancing pain traveling along nerve root distribution
“band-like”
Pain with activities that close the neuroforamen

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28
Q

PE w/ radic pain

A

Visual Inspection: Lateral shift possibly
Potentially Slump test +, SLR test +, Well Leg Raise test +
Painful/ limited ROM with motions that compress foramen or place tensile load on nerve root

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29
Q

suspect foraminal stenosis with radic pain

A

Foraminal stenosis: ROM extension/ rotation/ lateral flexion

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30
Q

central canal stenosis
what is it
what happens

A

Impingement on neurologic structures in vertebral canal
Z-joint hypertrophy (related to arthropathy)
Bulging Disc
Thickening/ ossification of ligamentous structures
Spondylolysthesis
Neurogenic Claudication:
65% of patients with L-Spine stenosis

31
Q

hx of central stenosis

A

> 65
chronic LBP

32
Q

s/s central stenosis

A

Possible cauda equina symptoms
UMN or LMN symptoms in lumbosacral distributions (pending level)
Pain increases with walking/ standing (prolonged)
Pain relieved with sitting, walking with UE support (walker, shopping cart)
Pain in legs (posterior lower legs especially) > lower back
Bilateral > Unilateral

33
Q

PE central stenosis

A

Visual Inspection: diminished lumbar lordosis
Painful/ Limited Extension & lateral flexion ROM (passive & active)
Improves with flexion
Shortened hamstrings, lengthened hip flexors
Neurologic signs

34
Q

Lateral canal stenosis causes

A

Encroachment on spinal nerve in lateral foramen/ lateral recess of spinal canal
Loss of disc height with degenerative processes
Z-joint hypertrophy
Disc bulging
Spondylolysthesis

35
Q

lateral canal stenosis s/s

A

LMN symptoms in lumbosacral distributions
Pain increases with walking/ standing (prolonged)
Pain relieved with sitting, walking with UE support (walker, shopping cart)
LBP & LE pain
Unilateral (bilateral if present bilaterally)

36
Q

PE lateral canal stenosis

A

Visual Inspection: diminished lumbar lordosis
Painful/ Limited Extension & lateral flexion ROM (passive & active)
Commonly improves with flexion
Neurologic signs
Other findings consistent with degenerative z-joint arthropathy

37
Q

z-joint pain

A

Referred pain in buttock & thigh, though pattern not reliable
- May occur below the knee or as far as foot (primary arthrogenic pain)
Often secondary with DDD/ disc spondylosis

38
Q

potential etiology of z-joint pain

A

Osteoarthrosis
Spondyloarthropathy

39
Q

s/s of zjoint pain

A

Local/ referred, unilateral LBP/ buttock pain
Aggravating factors consistent with MSK pattern of facet closing (refer to AROM below)
Relief with facet gapping positions/ activities

40
Q

zjoint pain PE

A

PROM & AROM: Pain/ limited lumbar extension/ ipsilateral lateral flexion ROM, contralateral rotation, end-range flexion
Muscle guarding lumbar erector spinae
Possibly difficulty activating multifidi
Painful spring testing/ UPA
Hypomobility with joint mobility testing

41
Q

z-pain acute trauma hx

A

Sudden onset, potentially Hx of trauma
Possible “acute locked back”

42
Q

z pain acute trauma s/s

A

Diminished pain in slight flexion position and positions that gap the z-joint
Pain with extension activities greatest (closing of z-joint)

43
Q

PE z pain acute trauma

A

“slouched” posture, potentially lateral shift
Painful limited ROM greatest with extension
Painful spring testing/ UPA
Tender, guarded paraspinals

44
Q

possible acute trauma z joint pain

A

Meniscoid Extrapment: Following trauma, may serve as attached loose body
During lumbar flexion, drawn out of joint
During extension, buckles and occupies space

45
Q

NMS instability proposed pain

A

Proposed pain generators
Involved musculature (DOMS with excessive guarding)
Joint structures (aberrant loading patterns)

46
Q

NMS instability hx

A

Recurrent exacerbations
Feelings of instability

47
Q

NMS instability s/s

A

LBP is constant
Catching & locking with trunk motion
Clicking/ clunking/ popping noises
Aggravated with prolonged positions (sitting, standing), flexion motion, sudden trunk movements, returning to upright position from flexed position

48
Q

PE NMS instability

A

Aberrant motions (trunk AROM)
Painful/ limited: AROM (commonly flexion), returning from full motion (looks like Gower sign)
Excessive motion
Paraspinal guarding/ tenderness
Hypermobility (joint mobility testing)
+ Prone Instability Test
+Passive Lumbar Extension Test

49
Q

thoraculumbar fascia fat herniation what is it

A

AKA “back mice”
Herniation of fat through posterior layer of thoracolumbar fascia
Innervated fat tissue compressed as exit site during motions that place tensile loading on fascia
Palpable subcutaneous nodule with provocation of concordant pain

50
Q

morphologic changes of back mm with fatty infiltrate

A

multifidi & atrophy (reduced CSA) of multifidi
psuedohypertrophy
Recurrent unilateral LBP

51
Q

trigger point dx requires

A

Palpable band
Local and referred tenderness
Local twitch response

52
Q

sx Medial Branch Neurotomy

A

Radiofrequency ablation of medial branch of dorsal rami
Indicated for pain relief to address z-joint pain

53
Q

Laminoforaminotomy

A

Tissues in neuroforamen compressing nerve tissue removed

54
Q

Laminoplasty

A

Reconstruction of posterior ring at lamina
Increases space for cord

55
Q

Percutaneous Discectomy

A

Aspiration of nucleus via probe
Indications: HNP/ disc origin of symptoms

56
Q

Microdiscectomy

A

Removal of disc that is compressing/ irritating the nerve root

57
Q

tripod effect

A

zygapophysial joints now become weight-bearing (excessive duration of low-level excessive loading)
Possible consistent with Spondylolysthesis (lead to palpate for “step-off deformity”)
May accompany anterior pelvic tilt

58
Q

pelvic cross syndrome

A

Shortened erector spinae and iliopsoas, lengthened abdominals & glut max

59
Q

dermatomes myotomes DTRs for L spine

A
60
Q

spondy interventions

A

Activity modification: address repetitive activities
Address muscle guarding
Stretching of shortened hip musculature
Progress lumbar stabilization exercises

61
Q

disc interventions

A

AROM exercises
Address muscle guarding
Low-intensity/ high frequency & duration exercises
Progress lumbar stabilization exercises
ext exercises

62
Q

z joint arthropathy intervention

A

Address muscle guarding
Paraspinal coordination training as indicated
Low-intensity/ high frequency & duration exercises
Manual therapy interventions
- manips

63
Q

acute LBP with cog

A

Clinical presentation suggesting the presence of fear-avoidance, pain catastrophizing, or depression

rule out if
Scores on the psychosocial subscale of the STarT Back Screening tool total to be 0

64
Q

chronic LBP with gen pain

A

Low back and/or low back-related lower extremity pain with symptom duration for longer than 3 months
Generalized pain not consistent with other impairment-based classification criteria
Cognitive processes or affective behaviors exhibited that suggest the presence of fear-avoidance beliefs, pain catastrophizing, and/or depression

same as LBP with cog but chronic

65
Q

ACUTE LBP WITH MOVEMENT COORDINATION IMPAIRMENTS

A

Acute exacerbation of recurring LBP that is commonly associated with referred lower extremity pain
Symptoms often include numerous episodes of low back and/or low back-related lower extremity pain in recent years

rule in:
(1) mid-range motions that worsen with end-range movements or positions, and (2) provocation of the involved lumbar segment(s)
Observable movement coordination impairments
mobility deficits
diminished strength and endurance
lumbar segmental or sacroiliac hypermobility
rule out if:
of adequate left and right passive straight leg raise (80∘) and thorax rotation (80∘) mobility
normal mm performance

66
Q

CHRONIC LBP WITH MOVEMENT COORDINATION IMPAIRMENTS

A

Chronic, recurring LBP that is commonly associated with referred lower extremity pain
same as acute but chronic

67
Q

acute LBP with related referred/radiating LE

A

LBP commonly associated with referred buttock, thigh, or leg pain, that worsens with flexion activities and sitting
Reports numerous low back-related lower extremity pain episodes

rule in: Low back and lower extremity pain that can be centralized and diminished with positioning, manual procedures, and/ or repeated movements
rule out: pain location and pain levels are not altered with prolonged positioning, manual
or repeated movements

68
Q

acute LBP with radiating pain

A

Acute LBP with associated radiating (narrow band of lancinating) pain in the involved lower extremity
Lower extremity paresthesias, numbness, and weakness may be reported

rule in
reproduced or aggravated with mid-range and worsen with end-range spinal mobility, lower limb tension/ straight leg raising, and/or slump tests
nerve root involvement

rule out if:
Lower limb tension tests (eg, straight leg raising) or slump testing do not reproduce reported low back or leg pain

69
Q

chronic LBP with radiating pain

A

Chronic, recurring, mid-back and/or LBP with associated radiating pain and potential sensory, strength, or reflex deficits in the involved LE
LE paresthesias, numbness, and weakness may be reported

70
Q

which LBP CPG do you do manips with

A

ACUTE LBP WITH MOVEMENT COORDINATION IMPAIRMENTS
CHRONIC LBP WITH MOVEMENT COORDINATION IMPAIRMENTS
ACUTE LBP WITH RADIATING PAIN
CHRONIC LBP WITH RADIATING PAIN
ACUTE LBP WITH MOBILITY DEFICITS (includes acute LBP with radiating LE in later stages)

71
Q

ACUTE LBP WITH MOBILITY DEFICITS

A

Acute low back, buttock, or thigh pain (≤6 weeks)
Onset of symptoms is often linked to a recent unguarded/awkward movement or position
rule in if
lower Tspine or lumbar ROM limitations
Low back and low back-related lower extremity reproduced with (1) end-range spinal motions, and (2) provocation of the involved lower thoracic or lumbar segments

rule out
Combined end-range spinal motions (eg, end-range lumbar extension combined with end-range lumbar sidebending) with clinician-provided overpressure into the combined motion is pain free
Unable to produce reported low back or low back-related lower extremity pain with provocation

72
Q

which LBP patients are the best for spinal manip

A

Duration of symptoms <16 days

No symptoms distal to the knee

FABQ (work subscale) score <19

At least one hip with >35° of IR ROM
Pt in prone with ~30 deg hip abduction

Hypomobility in the lumbar spine
Prone PA

73
Q

ODI

A

10-item self-report questionnaire that is designed to measure disability related to LBP
Minimally important change: 30% from baseline score
Lower scores are associated with less LBP-related disability and limitations

74
Q

Roland-Morris Disability Questionnaire (RMDQ): Design, Burdon, & Scoring

A

24-item questionnaire that measures physical disability secondary to LBP
Commonly takes ~5 minutes
Scores range from 24 (maximal disability) to 0 (no disability)
Easier to detect change for individuals who start with scores in the middle of the range than those who start with high or low scores
Clinically meaningful improvement: change in baseline by 30% (5 points improvement)

MSK3 (6 decks)

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