Low back notes 2 Flashcards
what is used to differentiate between neurogenic and vascular claudication?
bicycle or walking test
patients with neurogenic claudication find it easier to?
bicycle or walk farther when flexed
what is considered relative stenosis? absolute stenosis?
relative: 12mm
absolute: 10mm
what is useful for the different stenoses?
CT- bony
MRI- soft tissue
what can happen if you perform spinal manipulative therapy on someone with canal stenosis?
increase compression, causing exacerbation or worsening of symptoms
what happens if someone doesn’t respond to conservative care or the neurological deficits are severe?
warrants surgical consultation for possible decompression
most common spondylolisthesis in young
isthmic
most common spondylolisthesis in old
degenerative
what are symptoms of spondylolisthesis
asymptomatic or have low back pain made worse with extension
isthmic/spondylolytic spondylolisthesis is usually due to?
stress fracture of the pars interarticularis
repetitive hyperextension mechanisms
most common spondylolisthesis is?
L5
degenerative spondylolisthesis is associated with?
older age
facet arthrosis
degenerative spondylolisthesis is most common at?
L4
spondylolisthesis is primarily a?
radiographic diagnosis?
some patients may experience what with spondylolisthesis?
increased back or leg pain with a one legged balance test
palapation of spondylolisthesis?
prominent spinous process at the level with a steep sacral base angle
how do you grade a spondylolistheiss?
meyerding’s method
when might you need advanced imaging for a spondylolisthesis?
to evaluate ongoing stress chagnes
name the types of neumann/wiltse classifications
1- dyslplastic (congenital) 2- spondylolytic (isthmic) 3- degenerative 4- traumatic 5- pathological 6- post surgical (iatragenic)
what are the symptoms of AAA?
may be asymptomatic
may present with mid abdominal or low back pain
may be associated with leg complaint with exertion
signs of AAA
may have a bulsatile abdominal mass &/or bruit
vascular calcification may be with or without dilitation
erosion of anteiror vertebral bodies
diagnostic ultrasound or CT exam
when do you send out for an AAA?
if you see the vessel is larger than 3.5 or shows any focal change in contour, regardless of diameter
what is the normal measurement of AA?
3.0cm
Segmental dysfunction findings
Nonspecific history Local tenderness Variable restriction with AROM End range restriction on PROM MoPal: restriction
Is radiography required for segmental dysfunction?
No
Lumbosacral sprain/strain findings
Overstretch (acute event)
Radiating pain possible
Pain on AROM that involves muscles
PROM pain on end range
When are radiographs needed for lumbosacral sprain/strain?
If there was significant trauma
How do we help with lumbosacral sprain/strain?
Myofascial therapy
Ergonomic advice
Limited orthotic support
Preventative exercises and stretches
how can you diagnose neuritis or radiculitis due to disc?
needs hard neurological evidence of nerve dysfunction
history of similar events with resolution, major or minor trauma possible
signs/symptoms of neuritis or radiculitis
radiation of pain into leg and foot pain
valsalva radiation possible
pain worse with specific ROM
SLR, WLR, slump positive
deficit in corresponding dermatome, myotome and DTR
AROM: variable, weakness more in lower limb muscles
what types of imaging can you use to diagnose neuritis or radiculitis?
radiographs
MRI if not resolved after 1 month
signs of mechanical low back pain
no recent trauma
radiation of pain into buttocks or leg, not below knee
no orthos positive, may reproduce symptoms
no neuros positive, patient may have neurological complaints (numbness)
what can you do with those with mechanical LBP?
radiography to assess biomechanical status myofascial therapy limited orthotic support ergonomic advice preventative exercises and streteches
signs of facet syndrome
LBP with hyperextension or movement with local pain or referred pain into leg
pain could radiate down to leg, knee or foot
valsalva may be painful
kemp or hyperextension maneuvers positive
mopal: end range restriction to side of involved facet
what should you do with those you suspect have facet syndrome?
radiographs myofascial therapy limited orthotic support ergonomic advice preventative exercises and stretches avoid hyperextension initially
what is the most common type of cancer for females? what kind of cancer is it usually?
breast
lytic
what is the most common type of cancer for males? what kind of cancer is it usually?
prostate
blastic
hypercalcemia can cause what symptoms?
nausea, confusion, constipation, polyuria, fatigue
tetrad of multiple myeloma?
CRAB calcium elevated renal failure anemia bone lesions
