L-spine/LE Medical Screening Flashcards
what are red flags?
- patient who is inappropriate for independent management by MSK provider
- require medical management and present with S/Sx of serious pathology
- may have evidence of serious comorbidities including RA/central sensitization
what are broad clinical concerns?
- fever, chills, sweats
- unexplained weight loss
- fatigue/malaise
- unexplained nausea/vomiting (sometimes unremitting)
- night pain
- inability to increase or decrease pain/Sx
pathologic fractures S/Sx
- older individuals
- female
- prolonged corticosteroid use
- mild trauma/sudden pain without reason
- history of osteoporosis
- Sign of Buttock if sacral insufficiency fracture present
red flag
what 4 components are part of diagnositc rule to screen for vertebral fractures?
- female
- age >70
- significant trauma (major in young, minor in elderly)
- prolonged corticosteroid use
sacral stress fracture S/Sx
- athletic female
- increased level of vigorous/repetitive athletic activity
- pain involves buttocks
- pain reproduced with athletic activities (e.g. running)
- dietary insufficiency
- menstrual irregularities
- previous stress fractures
- non-responsiveness to previous treatment
what is Sign of Buttock?
- cluster of discomfort
- combination of findings that indicates serious pathology of gluteal/sacroiliac/low back region
what are 5 parts of Sign of Buttock?
- limited trunk flexion noted during standing exam
- supine straight leg raise limited/painful (but not radicular pain)
- hip flexion with knee flexion limited/painful (limitation > than that of SLR)
- hip rotation is painful/limited but in non-capsular pattern
- empty end feel on hip flexion
spondylolysthesis/spondylolysis S/Sx
- young individual
- repetitive hyperextension injury
- seen commonly in wrestlers/American football linemen
- sudden severe bilateral sciatica occurred during athletic activity
- pain with extension (prone with passive bilateral hip extension)
- no urinary bowel incontinence
spinal compression fracture S/Sx
- history of major trauma (such as vehicular accident, fall from height, direct blow to spine)
- history of minor trauma for osteoporotic/elderly individuals (such as falls/heavy lifts)
- age > 75
- prolonged use of corticosteroids
what factors would increase index of suspicion for spinal compression fracture?
- increased pain with WB (supine is position of comfort)
- point tenderness over site of fracture (tap over SP)
what factors would decrease index of suspicion for spinal compression fracture?
- age ≤ 50
- Sx not aggravated with weight loading or thoracolumbar flexion movements
- clinical findings are consistent with one/more of ICF-based LBP subgroups
abdominal aortic aneurysm (AAA) S/Sx
- pain at rest/night
- pulsating abdominal mass that is found with inspection/palpation of abdomen
- patient typically complains of throbbing type pain
- family history of cardiovascular disease
- risk increases with family history of AAA
- Sx cannot be provoked with mechanical examination of lower back
- back/abdominal/groin pain
- presence of peripheral vascular disease or coronary artery disease and associated risk factors (age > 50, smoker, HTN, DM)
what factors would increase index of suspicion for AAA?
- symptoms not related to movement stresses associated with somatic LBP
- abdominal girth < 100cm (40in)
vascular claudication S/Sx
- older individual
- family history of cardiovascular disease
- pain in calf with activity, relieved with rest
- one foot colder than other
- symptoms cannot be provoked with mechanical examination of lower back
- positive inclined treadmill test (pain with flat AND inclined treadmill)
key symptom → bolded
neurogenic claudication S/Sx
- compression of nerves
- Sx with walking but Sx disappear if patient is walking with shopping cart
- for treadmill test → Sx on flat treadmill, but if inclined to 25° patient will be forced to bend trunk to walk and Sx should disappear
kidney stones S/Sx
- sudden sharp pain of intermittent nature (reaches testicles or labium)
- same pain with fever
- renal infection
- Sx cannot be provoked with mechanical examination of lower back
genitourinary issues S/Sx
- lumbosacral pain
- night pain
- Sx cannot be provoked with mechanical examination of lower back
gastrointestinal issues S/Sx
- pain occurs after eating in upper lumbar area (L1-2)
- pain can be relieved by further intake of food
- Sx cannot be provoked with mechanical exam of low back
- typically Sx are chronic and progressive
- associated with abdominal pain
ankylosing spondylitis S/Sx
- middle-aged individual
- pain on/off, regardless of exertion
- progressive loss of ROM
- alternating pain in sacroiliac joints with walking
- later sign → gross bilateral limitation of side bending
- pain goes in vertical direction (not laterally or to LE)
- stiffness in morning eases with movement
- no paresthesia
- 25% of people have inflammation of eye that worsens with exposure to bright light
rheumatic disease
what are 3 differential diagnoses of LBP with potential neurologic involvement?
- radiculopathy from acute disc herniation
- spinal stenosis
- cauda equina syndrome
what are yellow flags?
MSK disorder that can be treated but there is underlying medical/psychological issue that may need co-management/outright referral
what is the summary of psychological process for pain?
what is the core philosophy of current PT practice?
address impairments based on biomedical concepts
what is the primary goal of current PT practice?
reduce symptoms
what is the core philosophy of psychologically informed practice?
incorporate patient attitudes, beliefs, and emotional responses into patient management based on biopsychosocial models
what is the primary goal of psychologically informed practice?
secondary prevention of disability (prevent the progression from acute → chronic)
what is the core philosophy of current psych practice?
identify/treat mental illness
what is the primary goal of current psych practice?
minimize impact of psych disorder on well-being/function
