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OPP 2.1 > LBP and HNP > Flashcards

LBP and HNP Flashcards

1
Q

localized LBP - mech w/p radiation below the knee

A
  • non-specific muscular/ligamentous injury
  • SD
  • degen disc disease
  • degen joint disease
  • spondylolithesis
  • fracture/spondlylolysis
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2
Q

localized LBP - mech with radiation below the knee

A
  • cauda equina syndrome
  • radiculopathy
  • spinal stenosis
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3
Q

localized LBP - non-mech

A
  • infection
  • neoplasm
  • inflamm
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4
Q

referred LBP

A
  • GI disease
  • renal disease
  • gynecological
  • vascular
  • pyschological
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5
Q

relief only with complete immobility suggests what ddx?

A
  • acute infection
  • compression fracture (metabolic bone disease)
  • pathologic fracture (tumor or infiltrative disease)
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6
Q

pain worsens with prolonged sitting suggests what ddx?

A

herniated disc

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7
Q

pain worsens with prolonged standing and extension suggests what ddx?

A

shopping cart sign - spinal stenosis

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8
Q

no position is comfortable suggests what ddx?

A

psychogenic pain - not well localized, follows no pattern, is constant, and patients can’t describe alleviating nor aggravating factors

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9
Q

radiating pain with extension suggests what ddx?

A

stenosis

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10
Q

radiating pain at rest suggests what ddx?

A

disc herniation

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11
Q

stiffness and pain upon waking suggests what ddx?

A

inflamm arthropathies

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12
Q

intense night time pain suggests what ddx?

A

bone tumors

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13
Q

red flags - would not treat these patients if these sx present

A
  • bowel or bladder dysfx
  • saddle anesthesia
  • b/l weakness or numbness in legs
  • acute neuro deficits in patients with cancer
  • progressive or severe neuro deficit
  • LBP along with a fever in a patient who uses IV drugs
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14
Q

yellow lights - gently treat patient during first visit if these sx present

A

pos straight leg raise test

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15
Q

latissimus dorsi

A
  • originates in the thoracolumbar fascia, iliac crest, and spinous processes of lower 6 thoracic vertebrae
  • inserts on intertubercular groove of humerus
  • connects lumbar, thoracic, and pelvic regions to UE
  • factor in cases of LBP combined with shoulder pain
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16
Q

quadratus lumborum

A
  • origin: iliolumbar ligament and iliac crest
  • inserts: L1-4 transverse processes and ant. surface of 12th rib
  • considered a posterior inferior extension of the abdominal diaphragm
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17
Q

iliopsoas

A
  • origin: vertebral bodies and anterior surfaces of transverse processes of lumbar spine
  • inserts: lesser trocanter of femur
  • often causes pain but inaccessible
18
Q

sacro-iliac joint

A
  • potential contributor to LBP
19
Q

what compromises the intervertebral foramina and disc?

A
  • arthritis
  • ligament hypertrophy
  • disc degen
  • mm imbalance
  • inherent tissue qualities
  • SD
20
Q

herniated nucleus pulposus - anatomy

A

intervertebral disc

  • mostly water
  • few pain fibers
  • compression pressure balanced by hydrostatic forces
  • annulus fibrosus and nucleus pulposus
21
Q

disc herniations commonly occur in which direction?

A

posteriorly, paracentrally or parasagitally

  • anterior longitudinal ligament much thicker and stronger than posterior
  • posterior longitudinal ligament prevents central herniation
22
Q

most common vertebral level for herniated disc?

A

L5-S1 and L4-5

  • undergo most motion and stress
  • posterior longitudinal ligament more narrow
23
Q

why does disc herniation commonly affects the nerve root below?

A
  • pedicles of the lumbar vertebra protect a nerve from being injured by the disc at its own level
24
Q

clinical features of L4-5 herniated disc

A
  • pain: over SI joint, hip, lateral thigh and leg
  • numbness: lateral leg and first 3 toes
  • weakness: dorsiflexion, walking on heel
  • atrophy: minor
  • reflex: internal hamstring reflex diminished or absent
25
Q

clinical features of L5-S1 herniated disc

A
  • pain: over SI joint, postero-lat thigh and leg to heel
  • numbess: back of calf, lat heel, foot to toe
  • weakness: plantar flexion, walking on toes
  • atrophy: gastroc and soleus
  • reflexes: ankle jerk diminished or absent
26
Q

HNP risk factors

A
  • occupational lifting
  • bending or lifting
  • prev hx of LBP
  • age
  • tobacco use
  • ethanol use
27
Q

HNP vs SD symptom distrib

A
  • HNP: dermatomal pattern

- SD: glove-like distrib

28
Q

HNP vs SD mm they affect

A
  • HNP: hypertonic paraspinal mm and hypotonic lower limb mm and possible calf atrophy
  • SD: hypertonic paraspinal and LE mm due to increased symp
29
Q

HNP vs SD LBP that radiates

A
  • HNP: down the back of the leg to the calf or foot
  • SD: down buttocks and ant/post thigh, rarely below knee, groin pain due to irritation of ilioinguinal and iliohypogastric nn, psoas tightness that cause radiation pain to ant thight (irritate lumbar plexus)
30
Q

HNP vs SD improvement of symptoms

A
  • HNP: improve with rest

- SD: improve with activity

31
Q

HNP may cause what that requires surgical emergency?

A

loss of bowel and bladder control

32
Q

HNP tx

A
  • rest
  • cont anti-inflamm tx
  • analgesics
  • mm relaxants
  • OMT
33
Q

role of acute SD on radiculopathy

A

intervertebral foramen already compromised by a chronic process, acute SD can precipiate or aggravat symptoms

34
Q

role of chronic SD on radiculopathy

A

chronic SD can alter mech forces on the disc

  • type I SD: long paraspinals
  • type II SD: short paraspinals
35
Q

role of lumbar spine on whole body as unit - MSK model

A
  • occupies 1/2 - 2/3 of post skeletal and myofascial wall of abdomen
  • directly linked to thoracic and pelvic regions
  • influences head and neck, UE and LE, and viscera
36
Q

role of lumbar spine on whole body - resp/circulatory model

A
  • located b/w 2 greater areas of stability, thus assoc with 2 junctional areas - thoracolumbar and lumbosacral junction
  • these junctional areas are key for lymphatic and venous drainage and return
37
Q

abdominal diaphragm attachment

A
  • attaches from bodies of L1-3 to lower 6 ribs and xiphoid process
38
Q

SD of L1-3 associated with?

A

flattened ineff diaphragm

39
Q

what does flattened diaphragm cause?

A
  • unable to develop eff, approp pressure gradients b/w thorax and abdomen –> decreased lymphatic flow and venous return (Batson’s Plexus) and increased abdominal and pelvic congestion
40
Q

OMT tx - acute cases

A
  • indirect tech better tolerated
41
Q

OMT tx - subacute/chronic cases

A
  • indirect tech fine but can incorp direct tech
42
Q

when to do surgery

A
  • neurologic deficit
  • cont pain combined with 2/3 of the following: paresthesia, reflex changes, mm atrophy
  • increase in intensity of symptoms despite conservative care

OPP 2.1 (6 decks)

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