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MSK LQ > Lecture 2B: Lumbar Exam and Eval > Flashcards

Lecture 2B: Lumbar Exam and Eval Flashcards

1
Q

factors that influence complexity of LBP presentation

A
  • genetics
  • age
  • lack of formal ed
  • lower SES
  • race
  • physcial workload
  • presencce of radiating pains
  • smoking
  • obesity
  • psych
  • comorbidities
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2
Q

potential causes of sciatica

A
  • nerve root
  • tumor
  • abscess
  • arthritis
  • vertebral collapse
  • inflammatory nerve disease
  • toxins
  • DM
  • syphilis

need a thorough lumbar exam for neuro and vascular (hip, pelvis, LE exam)

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3
Q

low back pain algorithm chart

SUPER IMPORTNAT MEMORIZE AND UNDERSTAND

A
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4
Q

Pain discriptor and origin
- “deep, ache, boring”
- “dull, achy, sore, burning, cramping”
- “sharp knife like pain, tingling, shooting, numbness, weakness”
- “burning, stabbing, throbbing, tingling, cold”
- “deep pain, cramping, stabbing”

A
  • bony tissue
  • muscle/fascia
  • nerve
  • vascular
  • visceral

more info slide 7,8,9

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5
Q

ALWAYS do this with a patient even though LPB and a serious pathology is LOW.

A

systems review

note: examine findings for consistent patterns to indicate serious pathology (back cancer)

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6
Q

intervention based solely on response to tissue loading and sx response

A

McKenzie and Maitland (treatment-based)

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7
Q

intervention based on treating pathological structure (CT healing model)

I.D. pathologic structure and stage it

A

Cyriax (structure based)

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8
Q

ULTIMATE GOAL for LBP patient

A

self-mgmt

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9
Q

Pt presents with:

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)

A

piriformis syndrome

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10
Q

Defect in pars interarticularis, often asymptomatic
* Can be unilateral or bilateral
* Can be stress or trauma related
* Exact causes are unknown
* Typically occurs at L5, but can occur anywhere

Tx: surgical intervention only indicated when
conservative management has failed

A

Spondylolysis

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11
Q

patient with spondylolysis prefers (flex/ext)

A

flexion
- walking may be painful

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12
Q

spondylolsthesis

A

will lead to spinal instabilit. surgery indicated if PT didn’t work or neuro s&s occur

grades:
* Grade I: 1-25%
* Grade II: 26-50%
* Grade III: 51-75%
* Grade IV: 76-100%
* Grade V: >100%

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13
Q

order of susceptible structures to compression

A
  1. END PLATE
  2. vertebral body
  3. disc
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14
Q

disc herniation process

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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15
Q

stages of disc pathology

A
  • Protrusion: disc bulge w/o AF
    rupture
  • Prolapse: only outer layers of AF
    contain NP
  • **Extrusion: **AF perforated and
    disc material moves into
    epidural space
  • Sequestration: disc fragments
    from AF and NP disconnect
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16
Q

end plate fx

A
  • Trauma or specific MOI
  • Acute pain/spasm
  • (-) SLR
  • (+) compression test
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17
Q

internal disc disruption

A
  • Separation of inner layers
  • LBP and/or referred hip/upper leg
    pain
  • (-) SLR
  • Dx made: discogram
18
Q

Disc protrusion and prolapse
(contained)

A
  • Some AF and PLL are intact
  • LBP and/or referred hip/upper leg
    pain
  • Pain w/ cough and sneeze
  • (-) SLR
19
Q

Disc extrusion and sequestration
(uncontained)

A
  • LBP
  • Pain w/ cough and sneeze
  • True sciatica (radicular pain)
  • (+) SLR
20
Q

L4-5 disc pathology typically affects

A

L5 nerve roots

IMPORTANT TABLE SLIDE 20

21
Q

Large herniation of L5–S1 disc

A

Compromises not only nerve root
crossing it (1st sacral nerve root)
but
also nerve root emerging through
same foramen (5th lumbar nerve
root)

22
Q

Massive central sequestration of
disc at L4–L5 level

A

Involves all of nerve roots in cauda
equina and may result in B&B
paralysis

23
Q

T/F LBP w/ radiculopathy outcomes not as favorable as mechanical LBP, but
conservative management often possible

A

true

24
Q

foraminal encroachment

A
  • Subluxed facet
  • Facet osteophytes
  • Vertebral osteophytes
  • Laminar compression
  • Disc protrusion/HNP
  • Lateral stenosis
  • Post-surgical scar
  • Edema
  • Tumor
25
Q

all of the following could be Sx of ?

persistent buttocks pain,
limping, lack of sensation in LEs
(claudication) & ↓
walking/standing ability

vascular or neurogenic

vascular= think about the calf and walking

A

spinal stenosis

26
Q
  • Mid-line sagittal spinal canal
    diameter ↓
  • May elicit neuro claudication or
    pain in buttocks, thigh or leg
A

centra stenosis

27
Q
  • Narrowing b/t sup facet & post
    vertebral margin
  • May impinge nerve root &
    subsequently elicit radicular pain
A

lateral stenosis

more stenosis classification slide 24

28
Q

Hypomobility at 1 or both facet joints at a
lumbar segment
* AKA: segmental dysfunction
Pain and potential restriction w/ specific
lumbar AROM directions - Patterns may indicate area of dysfunction and is reprodocible
localized pain
TX: manual therapy, mobility, strengthening ex

A

z joint (facet) dysfunction

29
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
  • Tx: responds well w/ conservative
    management, recurrence is common if
    program not maintained/activities △
A

clinical lumbar instability

30
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
  • Tx: meds + conservative
    management to slow progression
A

AS

31
Q
  • Lateral curvature of spine
  • Can be congenital or acquired … many causes
  • Can be structural or functional
  • Pt lacks normal flexibility and SB becomes
    asymmetrical
  • Idiopathic scoliosis accounts for 75-85% of all
    cases of structural scoliosis
  • Tx: may require surgery if angle of curves are
    severe enough
A

scoliosis

32
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
A

fibromyalgia

33
Q

diagnosis of fibromyalgia

A

11/18 tender points w/o other reason for tenderness (unexplainable)

34
Q
  • AKA “shingles”
  • Skin rash caused by same virus as chickenpox
  • Exacerbation/recurrence w/ emotional
    stress, immune deficiency, or w/ cancer
  • Contagious w/ person who has not had
    chickenpox OR when sores are open & oozing
  • Several weeks of pain, burning (typically in
    low back) prior to development of rash
  • Tx: medical management indicated, halt PT
    until rash is no longer contagious
A

herpes zoster

35
Q

table on slide 31

A
36
Q

Acute or Sub-acute LBP w/ Mobility Deficits

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

A

back, buttock, groin, thigh

37
Q

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

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

A

end range
NM
prone

38
Q

Acute LBP w/ Related (Referred) LE Pain

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

A

repeated movements

39
Q

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

Impairments:
* Segmental or global hypomobility or
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)
* (+) ____ exam
* (+) ________ tests
* (+) ____ ____ movements tests

A

neuro exam
neurodynamic exam
repeated movements tests

40
Q

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

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

A
  • noxious
  • elaborate
  • FABQ
  • ADL
    -waddell’s test
41
Q

Chronic LBP w/ Related Generalized Pain

Impairments:
* ____ pain (present in back, other body structures or globally)
* ____ w/ MSK dysfunction
* Appropriateness of emotion
* △’s in brain and sensory structures
* High scores on ____ and Pain
Catastrophizing Scale
* Impaired ____
* ↓ activity tolerance (i.e. sitting,
standing, running)
* Impaired functional movements (i.e.
squatting, lifting)
* Inconsistent MSK exam results
* Onset of symptoms >3 months

A
  • generalized
  • inconsistent
  • FABQ
  • ADL
42
Q
A

MSK LQ (15 decks)

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