Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Spinal Disorders > Low Back Neurological Assessment > Flashcards

Low Back Neurological Assessment Flashcards

1
Q

Leg and back pain with nerve involvement

A

Cord lesions - only upper lumbar lesions
Nerve root lesions - Include cauda equina
Peripheral nerve lesions - Sciatica, femoral, neuropathy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Leg and back pain without nerve involvement

A

Deep referred pain - From Si and lumbar structures

Separat lesions - along the kinetic chain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Deep referred pain syndromes

A

irritated joints of muscles in the spine often feel pain in other areas despite no pinched or injured nerves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Sclerotomal pain

A

can come from any tissue with the same embryological origin

Pain is experienced from all of these tissues innervated by the same nerve or along sclerotomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Sclerotogenous Referred Pain Patterns

A

From deep somatic tissue

Leads to:
Deep - aching, diffuse pain
Sclerotomal segmental pattern
Often more proximal than distal

Pain often spreads out over time. Referral territory grows. Pain may skip over regions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When patients have leg or arm symptoms with spinal pain one of the top priorities are _______ or not

A

Neuropathic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

The leg rules!

A

If there are no leg symptoms, not nerve damage generally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Neuropathic Assessment: 5 key clues

A

Leg pain: territory, quality, more intense than LBP
Paresthesia: territory
Lumbar tension tests
Neurological deficits or abnormalities
Lumbar joint loading procedures that cause immediate leg sx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Neuropathic tool: Radicular syndrome - Leg Pain

A

Location - must be past the knee. may be dermatomal. feels superficial
Quality - Often sharp, stabbing, electrical, sharp, painful cold, lancinating
Severity - Worse than back pain
Affected by spinal position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Nerve root pain

A

in most cases nerve root pain should not be expected to follow a specific dermatome but it does have use in diagnosis of radicular pain.
Exception is the S1 root that often follows the dermatome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

NT Radicular Syndrome: leg paresthesia

A

Often present and more likely to follow a dermatomal distribution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

NT radicular syndrome: Sensory, motor, reflex

A

May be one or more deficits usually corresponding to the same nerve root

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Three components of Neurological components

A

Sensory
Motor
Reflex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Dermatomal Sensory Distribution explanation

A

Most often due to nerve root compression from a herniated nerve root disc

Sensory disturbance may set in before muscle weakness or atrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

L4 pure patch

A

Medial thigh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

L5 Pure Patch

A

Medial side of big toe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

S1 pure patch

A

5th toe and interdigital web

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Sciatic nerve DTR

A

S1, S2

Achilles tendon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Femoral nerve DTR

A

L3, L4

Patellar tendon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Sciatic nerve DTR

A

L5, S1

Hamstring tendon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

S1 muscle tests

A

Toe flexors - Tibial n.
Ankle evertors - Peroneal/Fibularis
Plantar flexion - Tibial n.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

L5 muscle tests

A

Big toe extensors - Peroneal nerve

Hip abductors - Superior gluteal nerve +LR 11

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

L4 muscle tests

A

Ankle dorsiflexion - Deep peroneal nerve

Ankle inversion - Deep peroneal/fibular nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Radicular syndrome nerve tension tests should _____

A

Often reproduce leg symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Straight Leg Raise

A

A passive test
Main tension is for the L4, L5, S1 nerve roots (and sciatic nerve)
Positive test: Creating or aggravating lower extremity pain. Hard positive reproduces pain past the knee.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

SLR test validity

A

Sensitivity is thought to be good for patients with
posterolateral disc herniations.

Poorer sensitivity (but can be present) for patients with: Spinal stenosis, spondylolisthesis, midline and medial disc herniations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Tension tests can be used to confirm a positive SLR

A

Braggard, Bowstring, Bonnet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Maximum SLR

A

SLR, Flex neck, push led medially, invert foot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Femoral stretch test

A

reverse SLR

stretches femoral nerve and the L2, 3, 4 nerve roots

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Radicular Syndrome Tool - Spinal loading procedures

A

Rapid reproduction of leg symptoms possible

31
Q

Leg pain can result from Radicular Syndrome with ____, ____, _____

A

Forward flexion, extension + rotation, valsava maneuver

32
Q

Radiculitis

A 
Inflamed nerve root
Neuropathic pain (dermatomal)
Paresthesia (dermatomal)
Positive tension tests
Reproduce the pain by loading the spine
Increased sensitivity
33
Q

Radiculopathy

A

Compressed/torn nerve roots
Motor deficits (muscle weakness, atrophy)
Hyporeflexia
Dermatomal sensory loss

think deficits

34
Q

Cauda Equina Syndrome: Referral

A

Very uncommon

But it requires urgent referral (same day)

35
Q

Cauda Equina Syndrome: Causes

A

Large midline disc herniation (top cause)
Severe spinal stenosis (top cause)
Tumor
Infection hematoma

Affected nerve roots: S2-4
Damage can occur in damage

36
Q

Saddle Anesthesia

A

With CES
80% sensitivity
Bilateral (maybe unilateral)
test with light touch and sharp

Strong indicator with unrinary dysfunction

37
Q

Altered perineal sensation may be most important predictor of ___________

A

Impending bowel or bladder dysfunction

Associated with Saddle Anesthesia

38
Q

CES effect on bladder

A

Painless urinary retention (LR+ = 18; LR- = 0.1) and overflow incontinence

Incomplete: Urinary difficulty, altered sensation, loss of desire to void, poor urinary stream, need to strain to urinate

Strong indicator with saddle hypesthesia

39
Q

CES effect on bowel

A

Inability to control defecation
Sense rectal fullness
Decreased anal sphincter tone

absent anal wink

40
Q

CES sexual dysfunction

A

Decrease in genitalia sensation
Inability to get or maintain an erection
Reduced sensation during sexual stimulation

41
Q

Symptoms occur ____ after neurological compromise in __% of the cases.
Unfortunately ___, ___, and _______ abnormities may not be recognized in the short time frame

A

Less than 24 hours, 90%

Urologic, bowel, sexual dysfunction

42
Q

Incomplete CES

A

better prognosis with immediate intervention

Patient has altered urinary sensation, loss of desire to urinate, weak stream, or may have to push to void

43
Q

Complete CES

A

Urinary retention, overflow incontinence

Complete saddle anesthesia

44
Q

Pudendal (neuropathy) Nerve Lesion

A

Unilateral or bilateral perineal pain

May be a burning or a sensation of a foreign body in the rectum or vagina

45
Q

Pudendal Nerve Lesion

A

Alcock’s syndrome
Urinary incontinence or sexual dysfunction
Often related to a fall on the butt or traction injuries, or biking
Aggravated by sitting

DDX with CES

46
Q

Peripheral nerve damage DDX for CES

A

Femoral nerve
Lateral cutaneous femoral nerve
Sciatic nerve
Common peroneal

47
Q

PNS Lesions (entrapments and compression)

A

Piriformis syndrome
Peroneal nerve compression
Femoral neuropathy (secondary to pelvic tumor)

48
Q

PNS lesions (diseases)

A

Polyneuropathy

Diabetes
Alcoholic neuropathy
Vitamin B12 deficiency

49
Q

Femoral compression most often occur in _____ _____

A

Iliac Fossa

50
Q

Causes of femoral neuropathy

A 
Diabetic mononeuropathy
Tumor
Psoas or ilicus hematoma
Injury (surgery)
Inflammatory conditions (such as rheumatoid bursitis)
51
Q

Femoral nerve damage may result in:

A

Unilateral lower extremity pain that may involve:
The groin, anterior thigh and sometime the lower leg
Patient may flex the hip for pain relief

52
Q

Femoral damage sensory changes

A

Numbness and paresthesia on the anterior or medial thigh

53
Q

Motor symptoms of femoral nerve damage

A

Hip flexors and knee extensors are affected first
Sudden knee buckling may be initial symptom (seen in uneven road or step ups and down)

None of the affected muscles are below the knee

54
Q

Femoral nerve physical exam findings

A

Weakness with iliopsoas
Weak quadriceps
Decreased or absent patellar reflex

55
Q

Lumbosacral plexus damage

A

Mimics damage to femoral nerve but with the addition of adductor weakness
Affects adductor longus and magnus

56
Q

Femoral stretch test

A

Stretches femoral nerve
Stretches L2, 3, 4
Creates sharp anterior thigh pain

57
Q

Diabetic amyotrophy

A

Multiple lumbosacral nerve roots are affected but sometimes only the femoral nerve

Sudden severe lower extremity, Muscles weakness precedes the onset of pain, muscle testing the femoral nerve is painful
Patients usually have well controlled type 2 DM and are middle aged or older. Weight loss is a frequent accompanying symptom

58
Q

Painful femoral nerve involvement should trigger an appropriate ______ _____

A

Diabetes evaluation

59
Q

Diabetic polyneuropathy

A

The majority of patients with diabetes have LS plexus involvement rather than just femoral nerve involvement
Symptoms are bilateral and more distal

60
Q

Classic diabetic peripheral neuropathy

A

Symmetric/polyneuropathy
Results in sensory loss in extremities - usually in feet and hands in a stocking and glove distribution (sensory changes occur first)
Causes burning
Exaggeratedly intense or distorted experience of touch

Late findings are autonomic and motor deficits. Can lead to gait abnormalities

61
Q

Classic diabetic peripheral neuropathy ancillary studies

A

CT should always be done to rule out mass

EMG and nerve conduction may be necessary to determine where the lesion is

62
Q

Femoral nerve treatments

A

Hematoma or tumor is removed
Diabetes is treated
If secondary to surgery then it recovers spontaneously in weeks or months

63
Q

Meralgia Paresthetica pathophysiology/etiology

A

Entrapment of nerve as it passes the inguinal ligament near the ASIS
Tight pants, obese, pregnancy, diabetes, local trauma, or extended sitting/cycling/walking
40-60 yo

64
Q

Meralgia Paresthetica presentation

A

Lateral femoral cutaneous (anterolateral thigh) distribution of numbness, tingling or dull pain (bilateral in 20%)
No motor involvement

65
Q

Meralgia Paresthetica Treatment

A

Change to looser pants, losing weight
OTC pain meds
Conservative care

66
Q

Peroneal Nerve Entrapment

A

Most are due to external compression or stretching of the nerve near the fibular head

Some or all of these:
Pain is not common, foot drop may be partial or complete
Ankle dorsiflexion, great toe extension or eversion
Numbness over the lateral aspect of lower leg
Ankle inversion may increase pain
Normal achilles reflex

67
Q

Peroneal Nerve Entrapment Causes

A 
Postural factors (sitting with legs crossed, etd.)
Repetitive motion (sports, running)
Weight loss
Trauma
Iatrogenic
68
Q

Tibial nerve affects ____

A

Flexors

69
Q

Common peroneal nerve controls _____

A

Extensors

70
Q

Myelopathy

A

Spinal cord lesions (uncommon) compression?
Common at L2
Cord problems are not commonly associated with LBP

71
Q

Causes of cord compression

A

INJURY
TLJ compression fracture
Upper lumbar disc lesion
Spinal canal stenosis

DISEASE
Tumor

72
Q

Stenosis

A

The narrowing of the spinal canal due to degenrative changes:
disc thinning, facet enlargment, thickening of ligamentum flavum

73
Q

Cord compression

A

Presents with common leg symptoms
Urinary incontinence
Constipation
Impotence

Spinal Disorders (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions