Low back notes 2

Question 1

what is used to differentiate between neurogenic and vascular claudication?

Answer 1

bicycle or walking test

Question 2

patients with neurogenic claudication find it easier to?

Answer 2

bicycle or walk farther when flexed

Question 3

what is considered relative stenosis? absolute stenosis?

Answer 3

relative: 12mm
absolute: 10mm

Question 4

what is useful for the different stenoses?

Answer 4

CT- bony

MRI- soft tissue

Question 5

what can happen if you perform spinal manipulative therapy on someone with canal stenosis?

Answer 5

increase compression, causing exacerbation or worsening of symptoms

Question 6

what happens if someone doesn’t respond to conservative care or the neurological deficits are severe?

Answer 6

warrants surgical consultation for possible decompression

Question 7

most common spondylolisthesis in young

Answer 7

isthmic

Question 8

most common spondylolisthesis in old

Answer 8

degenerative

Question 9

what are symptoms of spondylolisthesis

Answer 9

asymptomatic or have low back pain made worse with extension

Question 10

isthmic/spondylolytic spondylolisthesis is usually due to?

Answer 10

stress fracture of the pars interarticularis

repetitive hyperextension mechanisms

Question 11

most common spondylolisthesis is?

Answer 11

L5

Question 12

degenerative spondylolisthesis is associated with?

Answer 12

older age

facet arthrosis

Question 13

degenerative spondylolisthesis is most common at?

Answer 13

L4

Question 14

spondylolisthesis is primarily a?

Answer 14

radiographic diagnosis?

Question 15

some patients may experience what with spondylolisthesis?

Answer 15

increased back or leg pain with a one legged balance test

Question 16

palapation of spondylolisthesis?

Answer 16

prominent spinous process at the level with a steep sacral base angle

Question 17

how do you grade a spondylolistheiss?

Answer 17

meyerding’s method

Question 18

when might you need advanced imaging for a spondylolisthesis?

Answer 18

to evaluate ongoing stress chagnes

Question 19

name the types of neumann/wiltse classifications

Answer 19

1- dyslplastic (congenital)
2- spondylolytic (isthmic)
3- degenerative
4- traumatic
5- pathological
6- post surgical (iatragenic)

Question 20

what are the symptoms of AAA?

Answer 20

may be asymptomatic
may present with mid abdominal or low back pain
may be associated with leg complaint with exertion

Question 21

signs of AAA

Answer 21

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

Question 22

when do you send out for an AAA?

Answer 22

if you see the vessel is larger than 3.5 or shows any focal change in contour, regardless of diameter

Question 23

what is the normal measurement of AA?

Answer 23

3.0cm

Question 24

Segmental dysfunction findings

Answer 24

Nonspecific history
Local tenderness
Variable restriction with AROM
End range restriction on PROM
MoPal: restriction

Question 25

Is radiography required for segmental dysfunction?

Answer 25

No

Question 26

Lumbosacral sprain/strain findings

Answer 26

Overstretch (acute event)
Radiating pain possible
Pain on AROM that involves muscles
PROM pain on end range

Question 27

When are radiographs needed for lumbosacral sprain/strain?

Answer 27

If there was significant trauma

Question 28

How do we help with lumbosacral sprain/strain?

Answer 28

Myofascial therapy
Ergonomic advice
Limited orthotic support
Preventative exercises and stretches

Question 29

how can you diagnose neuritis or radiculitis due to disc?

Answer 29

needs hard neurological evidence of nerve dysfunction

history of similar events with resolution, major or minor trauma possible

Question 30

signs/symptoms of neuritis or radiculitis

Answer 30

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

Question 31

what types of imaging can you use to diagnose neuritis or radiculitis?

Answer 31

radiographs

MRI if not resolved after 1 month

Question 32

signs of mechanical low back pain

Answer 32

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)

Question 33

what can you do with those with mechanical LBP?

Answer 33

radiography to assess biomechanical status
myofascial therapy
limited orthotic support
ergonomic advice
preventative exercises and streteches

Question 34

signs of facet syndrome

Answer 34

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

Question 35

what should you do with those you suspect have facet syndrome?

Answer 35

radiographs
myofascial therapy
limited orthotic support
ergonomic advice
preventative exercises and stretches
avoid hyperextension initially

Question 36

what is the most common type of cancer for females? what kind of cancer is it usually?

Answer 36

breast

lytic

Question 37

what is the most common type of cancer for males? what kind of cancer is it usually?

Answer 37

prostate

blastic

Question 38

hypercalcemia can cause what symptoms?

Answer 38

nausea, confusion, constipation, polyuria, fatigue

Question 39

tetrad of multiple myeloma?

Answer 39

CRAB
calcium elevated
renal failure
anemia
bone lesions