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MSK: LQ > lectre 2b: lumbar spine examination and evaluation > Flashcards

lectre 2b: lumbar spine examination and evaluation Flashcards

1
Q

• L-spine physical exam MUST include thorough assessment of NMSK and vascular structures at what 4 regions

A

• Lumbar spine
• Pelvic region
• Hip region
• Lower extremities

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2
Q

if the patient has a deep ache and boring pain what is the origin

A

bony tissues

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3
Q

if the patient has a dull , achy , sore , burning and cramping pain what is the origin

A

muscle/fascia

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4
Q

if the patient has a sharp , life liking shooting , lancinaitng , tingling, burning , numbness and weakness pain what is the origin

A

nerve

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5
Q

if the patient has a burning ,stabbing , throbbing , tingling and cold pain what is the origin

A

vascular

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6
Q

if the patient has a deep pain , cramping and stabbing pain what is the origin

A

visceral

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7
Q

if someone comes in with back pain and they are in their 10-20’s what is a common diagnoses

A

Spondylolisthesis

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8
Q

if someone comes in with back pain and they are .> 65 y/o what is a common diagnoses

A

cancer , compression fx, stenosis or AAA

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9
Q

if someone comes in with back pain and they are in their 15-40’s what is a common diagnoses

A

disc hernimation/ dysfunction

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10
Q

if someone comes in with back pain and they are > 45 y/o what is a common diagnoses

A

OA/ spondylosis

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11
Q

if a patient comes in w back pain adn they are over 50 years old , has a hx of cancer , has unexplained weight loss and has had failure of conservative therapy what condition do we suspect?n

A

back related tumor

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12
Q

if a patient comes in w back pain and has had a recent infection , is an intravenous drug user and has a concurrent immunosuppressive disorder what condition can we suspect

A

bac related infection (spinal osteomyelitis)

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13
Q

if a patient comes in w back pain and they tell us they have urine rention or incontinence , fecal incontinence , saddle anesthesia , global or progresssive weakness in the LE and sensory deficits in the feet… what condition do we suspect?n

A

cauda equina syndrome

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14
Q

if a patient comes in w back pain and has had a hx of trauma and is between 50-70 y/o what condition do we suspect?n

A

fracture

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15
Q

what are a structure based (Cyriax) evaluation and interventions

A

-selective tissue tension test
-intervention based on treating pathologic strucutre

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16
Q

what is the treatment based (McKenzie and Maitland) intervention based solely on

A

response to tissue loading and symptom response

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17
Q

what is the ultimate goal for evaluation and intervention

A

self management by the pt

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18
Q

what syndrome is typically a dx of exclusion

A

piriformis syndrome

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19
Q

if a pt presents w

• Hx of trauma to SIJ and gluteal regions
• Pain around SIJ/piriformis mm
• Symptoms worsened w/ stooping or lifting
• Palpable tension (i.e. rope-like) in piriformis mm belly
• (+) SLR test
• Gluteal atrophy (depending on length of symptoms)

what can we suspect

A

piriformis syndrome

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20
Q

if a patient has piriformis syndrome what makes the symptoms worse , and is the SLR postivie or negative and what does it feel like if u palpate it

A

symptoms worsens w stooping or lifting and SLR is positive

feels rope like

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21
Q

what is spondylolysis and is it symptomatic or asymptomatic

A

defects in the pars interarticularis , often asymptomatic

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22
Q

where does spondylolysis typically occur

A

L5 but can happen anywhere

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23
Q

what position does patients prefer if they have spondylolysis

A

flexion (walking can make it painful)

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24
Q

what is the tx for spondylolysis

A

conservative management first then sx if that has failed

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25
Q

what is spondylolisthesis

A

when there is a fx in the pars interarticularis w an anterior slippage of the body

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26
Q

what is the grading system used for in spondylolisthesis

A

measure degress of anterior slippage for lateral view

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27
Q

what is the tx for spondylolisthesis

A

surgical intervention only indicated when
• Conservative management has failed
• NeuroS&Sprogressing

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28
Q

pertaining to the spine what is the order of susceptibility to compression injury

A
  1. End-plate
  2. Vertebral body
  3. Disc
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29
Q

explain the process of disc herniation (11)

A
  1. End-plate fx d/t excessive compression
  2. Lesion heals OR disc DEGRADATION
  3. Exposes NP to blood supply
  4. Inflammatory response
  5. NP progressively loses H2O and disc height
  6. ↓ ability to resist loads
  7. ↑ load to AF (load on outer AF may be painful)
  8. Osteophyte formation on VB
  9. ↑ load on facet joints and more osteophyte formation
  10. Radial fissure in AF
  11. Internal disc disruption
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30
Q

what is it called if a disc bulges w/o AF rupture

A

protrusion

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31
Q

what disc pathology is it when only the outer layers of the annulus fibrosis go out and NP is contained

A

prolapse

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32
Q

what disc pathology is it when AF perforated and disc material moves into epidural space

A

extrusion

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33
Q

what disc pathology is it when disc fragments from AF and NP disconnect

A

sequestattration

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34
Q

what is the clinical presentation of a end plat fx

A
  • trauma or specific MOI
  • acute pain
  • (-) SLR
    -(+) compression test
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35
Q

• Trauma or specific MOI • Acute pain/spasm
• (-) SLR
• (+) compression test

what disc pathology is this the clinical presentation for

A

end plate fx

36
Q

what disc path is this a clinical presentation for

• Separation of inner layers
• LBP and/or referred hip/upper leg pain
• (-) SLR
• Dx made: discogram

A

internal disc disruption

37
Q

what disc path is this a clinical presentation for

• Some AF and PLL are intact
• LBP and/or referred hip/upper leg
pain
• Pain w/ cough and sneeze
• (-) SLR

A

disc protrusion and prolapse (contained)

38
Q

what disc path is this a clinical presentation for

• LBP
• Pain w/ cough and sneeze
• True sciatica (radicular pain) • (+) SLR

A

disc extrusion and sequestration (uncontained)

39
Q

what is the main clinical presentation difference for disc protrusion and prolapse (contained and uncontained)

A

for uncontained the SLR test is positive and for contained it is negative

for uncontained the patient has true sciatica bc disc is in epidural space now

40
Q

what nerve would be compressed at L3-L4 nerve toor and wha this the motor deficit and sensory deficit

A

nerve root: L4
motor: quads
sensory: anterolaterla thigh

41
Q

what nerve would be compressed at L4-L5 nerve root and wha this the motor deficit and sensory deficit

A

ROOT: L5
motor: extensor hallucis longus
snensory: lateral thigh

42
Q

what nerve would be compressed at L5-S1 nerve root and wha this the motor deficit and sensory deficit

A

root: S1
motor: ankle PF
sensory: posterior leg

43
Q

what is the difference between nerve root compression and nerve root entrapment

A

entrapment is still compression but more bc of structural reasoning

44
Q

what is spinal stenosis

A

narrowing of spinal canal causes nerve to pinch

45
Q

what are the S&S of spinal stenosis

A

persistence buttocks pain, limping , lack of sensation in LE and decrease walking/stnading ability

46
Q

what is central stenosis and what may it elicit

A

mid line sagittal spinal canal diameter decreases

elicit neuro claudication or pain in butt , thigh or leg

47
Q

what is lateral stenosis and what may it impinge

A

narroweing between superior facet and posteior vertebral margin

may impinge nerve root and causes radicular pain

48
Q

what is the main difference between central and laterla stenosis

A

lateral has more radicular pain

49
Q

• Centralcanal
• Peripheralcanal
• Degenerative spondylolisthesis

these are examples of what kind of spinal stenosis

A

acquired degenerative

50
Q

what dysfucntion has hypo mobility at 1 or both facet joints at a lumbar segment and can have pain and potential restriction w specific lumbar AROM directions

A

z-joint (facet) dysfunction

51
Q

what kind of pain is more common with z joint (facet) dysfunction

A

localized pain

52
Q

what is the tx for z joint (facet) dysfunction

A

manual therapy techniques> mobility ex’s > strengthening ex’s

bc it is hypomoble so u start w manual

53
Q

is hypo or hyper mobility most likely to cause symptoms at the facet joints

A

hypo

54
Q

what is the hallmark for any joint if they have instability

A

inconsistent symptomology

55
Q

what test is positive with clinical lumbar spine instability

A

prone instability test

56
Q
  • Loss of normal passive restraints to motion
  • Loss of active NM control
  • Reports of recurrent back pain that‘ catches’ or ‘locks’
  • Inconsistent symptomology
  • Structural instability: (+)prone instability test

if a patient has this what condition is it

A

clinical lumbar spine instability

57
Q

what does Ankylosing Spondylitis affect first

A

the spine and progresses to fusion of invovled joints

58
Q
  • Chronic inflammatory disease of unknown origin
  • 1st affects spine & progresses to fusion of involved joints
  • Males, <30 y/o
  • Typically follows a 20-yr course
  • 90-95% of pts w/ AS have human leukocyte antigen B27
  • “Bamboo-spine” in radiography

what condition does this patient have

A

Ankylosing Spondylitis

59
Q

what condition has a “bamboo spine” in radiography

A

Ankylosing Spondylitis

60
Q

• Chronic condition
• Causes pain, stiffness & tenderness of muscles, tendons & joints
• Characterized by:
• Pain (100%)
• Restless sleep
• Wake up feeling tired
• Fatigue (90%)
• Emotional disturbances (>50%)
• Disturbances in bowel function
• 1o women (80%) ages 35-55 y/o

what condtion is this

A

fibromyalgia

61
Q

is a patient is >60 has bilateral leg pina that is insidious and is increased q stnading and decreased with sitting and bending and has a positive SLR what condition is it

A

spinal stenosis

62
Q

what positions make the pain worse and better for spondylolisthesis

A

standing anf bending make it better
sitting makes it worse

63
Q

what positions make the pain worse and better for scoliosis

A

stnading and bending make it better
sitting makes it worse

64
Q

what positions make the pain worse and better for herniated nucleus pulposus

A

standing makes it worse
sitting and bending make it better

positive SLR

65
Q

• Impairments:
• Segmental or global hypomobility
• Pain in back, buttock, groin or thigh
• Impaired functional movements (i.e. squatting, lifting)
• (-) neuro tests
• Onset of symptoms <3 months

what ICF categories from low back pain does this fit into

A

Acute or Sub-acute LBP w/ Mobility Deficits

66
Q
  • Impairments:
  • Segmental or global instabilities
  • Pain in back, buttock, groin or thigh
  • Worsens w/ end range movements
  • ↓ NM control of voluntary
    movements
  • Muscle weakness * Fatigueable
  • Non-fatigueable
  • ↓ activity tolerance (i.e. sitting,
    standing, running)
  • Impaired functional movements (i.e. squatting, lifting)
  • (+) prone segmental instability test

what ICF category does this fit into for LBP

A

Acute, Sub-acute or Chronic LBP w/ Movement Coordination Impairments

67
Q

• Impairments:
• Segmental or global hypomobility
• Significant pain in back, buttock, groin or thigh
or instabilities
• Postural deficits
• ↓ activity tolerance (i.e. sitting,
standing, running)
• Impaired functional movements (i.e. squatting, lifting)
• Onset of symptoms <3 days
• (+) repeated movements tests

what ICF category does this fit into for LBP

A

Acute LBP w/ Related (Referred) LE Pain

68
Q

• Impairments:
• Segmentalorglobalhypomobilityor
instabilities
• Radiating pain(often times below the knee) in a dermatomal pattern
• Muscle weakness • Fatigueable
• Non-fatigueable
• ↓activity tolerance(i.e.sitting,
standing, driving, running)
• Impaired functional movements(i.e. squatting, lifting)
• (+)neuro exam
• (+)neuro dynamictests
• (+)repeated movements tests

what ICF caterogy does this fit into for LBP

A

Acute, Sub-acute or Chronic LBP w/ Radiating Pain

69
Q

• Impairments:
• Sensitivity to noxious stimuli
• Displays range of emotions
• Pain in back,buttock,groin or thigh,lower leg
• Tendency to elaborate physical symptoms for emotional/affective reasons
• High scores on FABQ and Pain Catastrophizing Scale
• Impaired ADLs
• ↓activity tolerance(i.e.sitting,standing,
• Impaired functional movements(i.e. squatting, lifting)
• Inconsistent MSK exam results
• Onset of symptoms <3months
• (+)Waddell’s test

what ICF caterogy does this fit into for LBP

A

Acute or Sub-acute LBP w/ Related Cognitive or Affective Tendencies

70
Q

• Impairments:
• Generalizedpain(presentinback,other
body structures or globally)
• Inconsistentw/MSKdysfunction
• Appropriatenessofemotion
• △’sinbrainandsensorystructures
• HighscoresonFABQandPain Catastrophizing Scale
• ImpairedADLs
• ↓activitytolerance(i.e.sitting,
standing, running)
• Impairedfunctionalmovements(i.e. squatting, lifting)
• InconsistentMSKexamresults
• Onsetofsymptoms>3months

what ICF category does this go into for LBP

A

Chronic LBP w/ Related Generalized Pain

71
Q

what are the treatment based categories for LBP

A

-manipulation/ manual therapy
- stabilization exercises
-direction specific exercises
- traction

72
Q

TBC: manual therapy classification criteria

Anatomic location of sx:

Duration of current episode of pain:

Score on FABQ – work subscale:

Results of segmental mobility testing in PA direction:

Hip internal rotation ROM:

A

No sx distal to knee

Less than 16 days

Score of less than 19

At least 1 hypomobile segment in L- spine

At least 1 hip w/ >35° of internal rotation

73
Q

TBC for LBP: stabilization classification criteria

Younger age:

Greater general flexibility:

Aberrant movements in lumbar spine:

Lumbar instability:

Patients who are post-partum:

A

Less than 40 years

Post-partum, average SLR >91°

Visible ‘instability catch’ or aberrant movements during lumbar flexion/extension ROM

(+) prone instability test

(+) posterior pelvic pain provocation, ASLR, modified Trendelenburg tests
OR
Pain w/ palpation of long dorsal SI ligament or pubic symphysis

74
Q

Direction-Specific Exercise Classification for extension

A

• Sx centralize w/ lumbar extension
• Sx peripheralize w/ lumbar flexion

75
Q

Direction-Specific Exercise Classification from flexion

A

• Sx centralize w/ lumbar flexion
• Sx peripheralize w/ lumbar extension

76
Q

TBC for LBP: Direction-Specific (Extension): Classification Criteria

Anatomic location of sx

Sx response to lumbar ROM

Sx response to lumbar ROM

Subjective response to movement

A

Sx distal to buttock

Symptoms centralize w/ lumbar ext

Symptoms peripheralize w/ lumbar flex

Directional preference for extension

77
Q

TBC for LBP: Direction-Specific (Flexion): Classification Criteria

Older age

Subjective response to movement

Imaging evidence

A

Greater than 50 years

Directional preference for flexion

Lumbar spinal stenosis

78
Q

TBC for LBP: Direction-Specific (Lateral Shift): Classification Criteria

Observation

Subjective response to movement

A

Visible frontal plane shift of shoulders relative to pelvis

Directional preference for lateral translation movements of pelvis

79
Q

TBC for LBP: Traction: Classification Criteria

Sx response to lumbar traction

A

Symptoms decrease w/ manual or autotraction

80
Q

if your patient demonstrates (+) CPR for manual therapy what is the recommended interventions

A

• Lumbopelvic HVLAT
• Lumbar and LE ROM exercises

81
Q

If your patient demo (+) CPR (clinical practice rule) for stabilization what is the recommended interventions

A

• Promote isolated contraction and co-contraction of deep stabilizers (multifidi, TA)
• Strengthen large spinal stabilizers (ES, internal/external obliques

82
Q

if a pateitns fits >1 classification group u prioritize order of treatment based on what 3 things

A

• Level of risk
• Psychosocial factors
• Co-morbidities

83
Q

Presence of psychosocial factors and co-morbidities ____ a treatment effect

A

weaken

84
Q

what TBC category would u use if the ICF caterogry was acute or sub acute LBP w/ mobility deficits

A

Manipulation/Manual Therapy:

85
Q

what TBC category would u use if the ICF caterogry was Acute, sub-acute or chronic LBP w/ movement coordination impairments

A

stabilization exercises

86
Q

what TBC category would u use if the ICF caterogry was • Acute, sub-acute or chronic LBP w RADIATING pain and Acute LBP w/ related (referred) LE pain

A

direction specifici exercises

87
Q

what 2 ICF categories for LBP do NOT fit not TBC category

A

• Acute or sub-acute LBP w/ related cognitive or affective tendencies
• Chronic LBP w/ related generalized pain

MSK: LQ (22 decks)

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