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MS II > L-Spine Pathology > Flashcards

L-Spine Pathology Flashcards

1
Q

What 3 ligaments are continuous systems that wrap the lumbar spine in a “stocking”?

A
  • Supraspinous ligament
  • Interspinous ligament
  • Ligamentum Flavum
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2
Q

What is the function of the ligamentum flavum in the lumbar spine?

A
  • Forms a roof for the vertebral canal that doesn’t buckle with flexion or extension
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3
Q

What are the 4 key muscles/ muscle groups that stabilize the lumbar spine?

A
  • Multifidi
  • Transverse abdominus
  • Pelvic floor muscles
  • Diaphragm
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4
Q

What force do the multifidi resist?

A
  • Shear
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5
Q

What is a protrusion of a disc?

A
  • Posterior disc buldge without rupture of the outer annulus
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6
Q

What is a prolapse of a disc?

A
  • Nucleus contained only by the outermost fibers of the disc’s annulus fibers
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7
Q

What is an extrusion of a disc?

A
  • Disc material enters the epidural space due to a ruptured annulus
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8
Q

What is a sequestration of a disc?

A
  • Disc material within the epidural space fragments
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9
Q

What are the 3 types of spinal stenosis?

A
  • Central
  • Lateral recess
  • Foraminal
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10
Q

Where does lateral recess stenosis occur?

A
  • On the lateral aspect of the spinal canal
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11
Q

What is the major symptom of lumbar spinal stenosis? What makes it better? What makes it worse?

A
  • Neurogenic claudication (pain in the legs when walking
  • Static standing, walking, and coughing make it worse
  • Spinal flexion makes it better
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12
Q

What are 2 ways that arterial ischemic claudication can be differentiated from neurogenic claudication?

A
  • Assess pulse (a neurogenic claudication will have normal pulses)
  • Have the patient ride a stationary bike (will provoke arterial; neurogenic will be mostly unchanged)
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13
Q

What muscles should be trained to manage lumbar spinal stenosis?

A
  • Transverse abdominis
  • Pelvic floor
  • Multifidi
  • Diaphragm (?)
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14
Q

What muscles should be stretched when managing lumbar spinal stenosis? Why?

A
  • Stretch hip flexors to reduce lumbar lordosis
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15
Q

How can posture be corrected to help manage lumbar stenosis?

A
  • Encourage flexion when possible, and avoid extension postures/ movements
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16
Q

How can the patient be educated to manage lumbar stenosis?

A
  • Avoid extension of the lumbar spine, as well as quadrant like positions
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17
Q

What type of orthotic can be used to help manage lumbar stenosis?

A
  • If the symptoms are unilateral, put a heel lift in the contralateral shoe
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18
Q

What is a spondylolisthesis?

A
  • Forward subluxation of one vertebra on the vertebra below it
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19
Q

What are 4 subjective reports that are common with spondylolisthesis?

A
  • Generalized back ache
  • Gluteal pain
  • Lower back weakness
  • Lower quarter weakness
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20
Q

What specific movement can be used a clinical sign for spondylolisthesis?

A
  • A pain with return to an extended position from flexion that is made better by contracting the glutes and core before performing the motion
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21
Q

What muscles are strengthened, and which are stretched when managing spondylolisthesis?

A
  • 4 key core muscles trained

- Careful stretching of the iliopsoas to avoid an anterior shear force on the spine

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22
Q

How is the patient educated in managing a lumbar spondylolisthesis?

A
  • Avoid extension movements/ positions and movements that cause shear
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23
Q

What is one of the most common diagnoses in an outpatient setting?

A
  • A sprain-strain of the iliolumbar ligament
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24
Q

How a sprain of the iliolumbar ligament treated during the acute stage? (4 main components)

A
  • Pt education to avoid reinjury/ aggravation
  • Modalities and manual therapy for pain control
  • Gentle stretching
  • Aerobic activities as tolerated
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25
Q

What is the treatment for a ligament sprain of the lumbar region past the acute stage?

A
  • Core training and conditioning
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26
Q

What are 5 red flags that may seem present as lumbar pain?

A
  • Aortic aneurism (Pulsate pain in abdominal region)
  • Pyelonephritis (kidney infection)
  • Nephrolithiasis (kidney stones)
  • Malignant tumors of the spinal column (cords or meninges)
  • Metastatic tumors (from: thyroid, prostate, breast, colon, lung…)
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27
Q

How can a metastatic tumor easily be differentiated from a metastatic tumor?

A
  • It is outside of the dura
28
Q

Where are the 2 locations a tumor may appear as a primary cancer?

A
  • Within dura, but outside of cord

- Within the spinal cord

29
Q

What are examples of what a job task inventory may entail during an intake/ physical exam of a patient with lumbar spine impairments?

A
  • Lift-carry
  • Bend-stoop
  • Squat
  • Walk
  • Sit
  • Stand
  • Climb
  • Environmental exposures
30
Q

What are 3 scales used to measure a patient’s perception of their disability/ pain?

A
  • Oswestry disability questionnaire
  • PACT-Sort
  • FABQ
31
Q

What is assessed during a postural screen of the lumbar spine?

A
  • Start from the head and shoulders
  • Observe scoliosis
  • Observe rib symmetry
  • Check position of: Iliac crests, ASISs, PSISs
  • LE symmetry/ length
  • Lumbar lordsis
  • Pelvic rotation
32
Q

How can centralization or peripheralization be assessed during the exam?

A
  • Sustained or repeated endrange movements: assess effect on symptoms
33
Q

What is Gower’s sign?

A
  • Pressing through the hands to move the lumbar spine into extension
34
Q

When should the painful spinal movements be assessed during the movement assessment?

A
  • Last
35
Q

How should lumbar extension be assessed for movement?

A
  • Symmetry
  • Quality
  • Segmental recruitment
36
Q

How should lumbar flexion be assessed for movement?

A
  • Segmental motion
  • Rib humps
  • When the pelvis is recruited (lumbo-pelvic rhythm)
  • A flattening of the lumbar lordosis
37
Q

How should lumbar lateral flexion/ rotation be assessed for movement?

A
  • Segmental movement/ symmetry
38
Q

What is a rib hump indicative of?

A

Scoliosis

39
Q

How can passive movements of the lumbar spine be assessed?

A
  • Pt sidelying with hooked legs
  • Place the patient’s knees against your hip
  • Guide motion of the L-spine through while holding onto the patient’s ankles
40
Q

What is a quick test to clear the joints of the lower quarter? For whom is this test inappropriate?

A 
- Full squat with a bounce at end range
Avoid with:
- Patients who are pregnant
- Elderly patients
- Patients with know LE pathology such as arthritis
41
Q

What is the March Test?

A
  • A quick SIJ screen
  • Pt stands; PT positioned behind patient
  • Place one thumb on patient’s PSIS, and place the other on the patient’s spinous process
  • Patient lifts ipsilateral knee towards chest
  • PSIS should drop medioinferiorly
42
Q

What are the break tests for lumbar myotomes L2 - S2?

A 
L2: Hip flexion
L3 - L4: Knee extension
L4: Ankle dorsiflexion/ heel walk
L5: Great toe extension
S1: Ankle plantar flexion, eversion/ Walking on tip toes
S2: Knee flexion
43
Q

How are dermatomes measured in the lumbar spine?

A
  • Pinwheel/ light touch along the distribution of the lumbar myotomes
44
Q

What are the 2 DTRs for the L-spine, and what spinal segment do they measure?

A
  • Knee jerk (L3/4)

- Ankle jerk (S1/2)

45
Q

What is the iliac crest used to located in the L-spine?

A
  • L4-5 interspace
46
Q

What is the PSIS used to locate in the spine?

A

S2

47
Q

What 3 accessory joint motions are assessed in the L-spine?

A
  • CPA
  • UPA
  • Transverse pressure
48
Q

What spinal segments are tested by a straight leg raise?

A
  • L5

- S1

49
Q

On which side is the SLR performed first?

A

The uninvolved side.

50
Q

How can the SLR be sharpened?

A
  • With dorsiflexion of the ankle.
51
Q

What is a positive test of the SLR?

A
  • Radicular complaints distal to knee
52
Q

What is a cross-over sign during SLR? What is indicated?

A
  • A lightning bolt type pain down the contralateral leg

- Neurological or central disc problem is indicated

53
Q

What structure is tested by Ely’s test? What spinal segments?

A
  • Femoral nerve
  • L2
  • L3
  • L4
54
Q

How is Ely’s test performed when assessing Femoral nerve lesions?

A
  • Pt prone, flex knee and monitor for symptoms for 30 - 45 seconds
55
Q

What are 4 positive tests for Ely’s test

A
  • Unilateral buttock pain
  • LB pain
  • Posterior thigh pain
  • Unilateral quad tightness
56
Q

How must the Femoral nerve stretch test be modified in individuals over 40?

A
  • Move into and out of flexion slowly to avoid hamstring cramping
57
Q

Describe a Slump Sign test.

A
  • Pt sitting
  • Pt flexes at the thoraco-lumbar spine
  • Overpressure the shoulder girdle with combine C-spine flexion
  • Sharpen with ankle dorsiflexion
  • Sharpen with passive or active knee extension
  • Assess presence of radicular symptoms
  • See if neck extension reduces symptoms
58
Q

What is tested by the Slump Sign test?

A
  • Spinal cord

- Nerve roots

59
Q

What does the Thomas Test assess?

A
  • Hip flexor tightness
60
Q

Describe the quadrant position of the lumbar spine.

A
  • Extension

- Lateral flexion and rotation to the same side

61
Q

What are positive signs of a quadrant test?

A
  • Radicular signs

- Localized pain

62
Q

What is indicated by radicular signs in a quadrant test?

A
  • Disc pathology
63
Q

What is indicated by localized pain in a quadrant test?

A
  • Facet joints

- Degenerative joint disease

64
Q

What is an easy way to guide the patient through a quadrant test?

A
  • Patient stands
  • Pt places hand on contralateral posterior thigh/ buttock
  • Pt slides hand down leg rotating, sidebending, and extending
65
Q

Describe a prone instability test.

A
  • Pt prone on exam table with feet on floor
  • Examiner applies CPA
  • Assess symptoms
  • Pt lifts feet slightly off floor contracting erectors, glutes, and abdominals
  • Apply CPA
  • Assess if symptoms are better
66
Q

What may not be a successful treatment following a positive prone instability test is not positive?

A
  • Core stability training

MS II (20 decks)

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