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Musculoskeletal Conditions II > Laslett's/Pathoanatomic LBP Classification > Flashcards

Laslett's/Pathoanatomic LBP Classification Flashcards

1
Q

What are the 3 assumptions of the Laslett’s Classificaiton System?

A
  • Most cases of LBP have non-specific diagnosis
  • Majority of LBP has pathologic basis
  • Identifying subgroups of patients with LBP will direct most appropriate treatment
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2
Q

What 4 groupings of symptoms does the Laslett Classification System sift through?

A

(1) Disc Syndrome
(2) Symptoms below gluteal fold
(3) Symptoms above gluteal fold
(4) Symptoms of secondary classifications that can occur alongside the others

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3
Q

What are the pain generators in disc syndrome?

A

annulus, nerve root, and dural sleeve are the predominant pain generators

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4
Q

What are the mechanical causes of disc syndrome? (3)

A

(1) protusion or bulging
(2) annular tear
(3) discitis

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5
Q

What is a mechanical reducible disc?

A

LBP and/or referred pain caused by displacement of nucleus that is reversible by specific loading strategies

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6
Q

What are the criteria for a mechanical reducible disc? (3)

A
  • At least one movement painfully limited
  • Either loading strategies centralize symptoms
  • Or midline pain decreases and remains better and loading strategy in other direction increases midline pain that remains worse
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7
Q

What is a mechanical irreducible disc?

A

LBP and/or referred pain caused by displacement of nucleus that is not reversible by loading strategies

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8
Q

What are the criteria for a mechanical irreducible disc? (4)

A
  • At least one movement painfully limited
  • No loading strategies that centralize symptoms
  • Either at least one loading strategy peripheralizes symptoms
  • Or distal symptoms increase and remain worse by a loading strategy
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9
Q

What is a non-mechanical disc?

A

LBP with or without referred pain, with dominant symptoms above gluteal fold, in which principal source of nociceptor activity is a chemically sensitive disc

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10
Q

What are the criteria for a non-mechanical disc? (5)

A
  • Previous criteria not satisfied
  • Loading strategies in any direction increase symptoms and remain worse
  • No loading strategies decrease or abolish symptoms
  • Range of movement unaffected by loading strategies
  • One or more other disc characteristics
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11
Q

What is an adherent nerve root syndrome?

A

Dominant symptoms below gluteal fold with limited nerve root mobility caused by fibrosis or scarring of one or more lumbosacral nerve roots

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12
Q

What are the criteria of adherent nerve root syndrome? (4)

A
  • History of acute sciatica or lumbar spine surgery at least 2 months prior
  • Flexion in standing limited and produces symptoms at end range of movement
  • Repeated flexion in standing reproduces symptoms but do not result in change
  • Extension in standing or lying, and flexion in lying, do not produce symptoms
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13
Q

What is a nerve root entrapment syndrome?

A

Dominant symptoms below gluteal fold caused by persistent compression and movement limitation of lumbar nerve root

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14
Q

What are the criteria for nerve root entrapment syndrome? (6)

A
  • Criteria for disc and adherent nerve root not satisfied
  • History of acute disc lesion causing nerve root symptoms at least 2 months prior
  • Flexion in standing limited and produces or increases distal symptoms
  • Repeated flexion in standing reproduces or increases symptoms but they do not remain worse
  • Repeated flexion in standing may temporarily increase in movement
  • No loading strategies centralize or abolish symptoms
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15
Q

What is a nerve root compression?

A

Dominant symptoms below gluteal fold caused by compression of nerve root that is not made worse or better by loading strategies (no changes in sensation)

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16
Q

What are the criteria for a nerve root compression? (1)

A

•Straight leg raise positive and one of following present (weakness or reflex deminished)

17
Q

What is spinal stenosis syndrome?

A

Dominant symptoms below gluteal fold secondary to narrowing of lumbar spinal canal or lumbar intervertebral foramen

18
Q

What are the criteria for spinal stenosis syndrome? (4)

A
  • Criteria for disc, adherent nerve root, nerve root entrapment and nerve root compression not satisfied
  • History of standing or walking intolerance (extension intolerance)
  • Symptoms improved in sitting or improved walking tolerance with flexion (shopping cart sign)
  • Worst posture with regard to symptoms is standing/walking whereas best posture is sitting
19
Q

What is vascular stenosis?

A

Pain onset not related to spinal position that is instead provoked only by aerobic demand that exceeds arterial capacity

20
Q

What are the symptoms of Central stenosis?

A
  • Bilateral sciatica
  • Neurogenic claudication walking or standing
  • Relief with sitting or lumbar flexion
  • Extension worsens
  • Confirmation with CT or MRI

Spondylolisthesis a possible cause

21
Q

What are the symptoms of Lateral Stenosis?

A
  • Unilateral sciatica
  • Neurogenic claudication walking or standing
  • Ipsilateral flexion and extension provoke leg symptoms
  • Relieved by flexion and contralateral flexion
  • Confirmation with CT or MRI
22
Q

What is zygapophyseal joint syndrome?

A

LBP with or without referred pain with dominant symptoms above gluteal fold in which principal source of nociceptive activity is a zygapophyseal joint syndrome (two subcategories = mechanical and inflammatory)

23
Q

What are the criteria for zygapophyseal joint syndrome?

A

3 or more of following positive:

  • Age > 50
  • Symptoms best when walking
  • Symptoms best when sitting
  • Onset pain is paraspinal (one side)
  • Positive extension/rotation test (Kemp’s test)
24
Q

What is postural syndrome?

A

LBP with or without referred pain with dominant symptoms above gluteal fold resulting form mechanical deformation of innervated normal soft tissues by prolonged static end range loading

25
Q

What are the criteria for postural syndrome? (4)

A
  • Full ROM in all directions
  • No pain with any movement
  • Repeated dynamic end range loading does not produce symptoms
  • Sustained end range loading in at least one direction produces familiar symptoms
26
Q

What is sacroiliac joint syndrome?

A

LBP with or without referred pain with dominant syndrome above gluteal fold in which principal nociceptor activity is in a sacroiliac joint

Subcategories:

  • Mechanical: lumbopelvic instability or dysfunction following trauma
  • Inflammatory: chronic (secondary to instability), rheumatic disease, infection
27
Q

What are the criteria for sacroiliac joint syndrome?

A
  • Disc syndrome, z-joint syndrome, postural syndrome criteria not satisfied
  • 3 or more of 5 SI pain provocation tests are positive: Distraction, Compression, Thigh thrust, Pelvic torsion, Sacral thrust
28
Q

During posterior innominate rotation, will the leg become longer or shorter with sitting?

A

longer

29
Q

During anterior innominate rotation, will the leg become longer or shorter with sitting?

A

shorter

30
Q

What is dysfunction syndrome?

A

LBP with or without referred pain with dominant symptoms above gluteal fold resulting from mechanical deformation by end range loading of innervated shortened soft tissues

31
Q

What are the criteria for dysfunction syndrome?

A
  • Criteria for disc, z-joint, postural and SI joint syndromes not satisfied
  • At least 1 movement limited in range and not rapidly altered by loading strategies
  • Limited movement produces familiar symptoms at end of available range
  • End range loading does not peripheralize symptoms
  • End range loading does not rapidly produce limitation of movement in any other direction
32
Q

What are potential causes of mechanical instability? (4)

A

(1) incompetent disc
(2) segmental degeneration
(3) spondylolysis/spondylolisthesis
(4) incompetent active stabilization (i.e. transverse abdominis, lumbar multifidi, internal oblique)

33
Q

What is myofascial pain syndrome?

A
  • LBP and/or referred pain with dominant symptoms above or below gluteal fold
  • Hyperirritable point in a skeletal muscle or fascia that is painful on compression and can give rise to referred pain in a characteristic area
34
Q

What is the criteria for myofascial pain syndrome?

A

•Firm palpation of a painful point within a taut band in a specific muscle reproduces familiar symptoms

35
Q

What is adverse neural tension?

A

•LBP and/or referred pain resulting from abnormal physiological and mechanical responses produced from nervous system structures when their range of movement and stretch capabilities are challenged

36
Q

What are the criteria for adverse neural tension?

A

Familiar symptoms reproduced by at least 2 stages of neural testing:

  • SLR with cervical flexion or slump test
  • Sidelying knee bending test (femoral nerve stretch test)
37
Q

What is abnormal pain syndrome?

A

•Maladaptive or illness-related behavior disproportionate to the underlying physical disease and more readily attributable to associated cognitive and affective disturbances

38
Q

What are the criteria for abnormal pain syndrome?

A

At least 3 of 5 non-organic signs are positive:

  • Widespread superficial or non-anatomic tenderness
  • Pain provocation on axial loading or simulated rotation of the spine
  • SLR improved at least 30o with distraction
  • Muscle weakness or sensory disturbance in non-anatomic distribution
  • Over-reaction during examination
39
Q

What are other diagnoses not included in the Laslett Classification that you should consider? (5)

A
  • hip joint & buttock
  • fractures
  • metastases
  • visceral disease
  • vascular claudication

Musculoskeletal Conditions II (20 decks)

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